- Distinct papules or plaques - Scaling - Primarily epidermal features

- Irregular plaques - Oozing and crusting - Lots of dermal activity

Intro to Dermatology Flashcards by Doug Peters

What is the correct order of history and physical in dermatology?

Physical first, then history

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Elements of a derm history

Onset
Pattern of spread
Sx
Tx
Contacts
Meds
Family Hx
Work and hobby contactants
Travel/exposures
Sexual Hx

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Steps to physical exam

type/morphology of lesion
color, consistency, texture, surface changes
individual lesion configuration
distribution

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Things to examine together:

Scalp, hair, nails and teeth

- Hands and feet

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What differentiates dermal vs epidermal lesions?

Epidermal:
- Sharply defined border
- Surface change
- Scaling
Dermal:
- Smooth appearance

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What does “Koebner phenomenon” refer to?

Appearance of lesions along an area of trauma

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Papulosquamous = ?

Distinct papules or plaques
Scaling
Primarily epidermal features

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Eczematous = ?

Irregular plaques
Oozing and crusting
Lots of dermal activity

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What is “honey colored crust” suggestive of?

Impetigo

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Auspitz sign

Pinpoint bleeding when scales are removed from psoriatic plaques/warts

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Gottron sign

Pink or violaceous macular or papular erythema of hand, knee, elbow or ankle joints with dermatomyositis

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Hair collar

Ring of hair around a congenital lesion such as a meningocele

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Nikolsky sign

Lateral pressure results in sloughing of skin in blistering disorders (e.g., SJS)

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Oil drop sign

Distal yellowing of nail beds due to psoriatic disease

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Ugly duckling sign

Pigmented lesion that stands out from surrounding lesion, indicative of melanoma

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What do you look for in a Tzanck smear that’s indicative of herpes?

Giant multi-nucleated cells

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Impetigo vs. cellulitis

Epidermal vs. Dermal

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Bullous impetigo

Localized staph scalded skin reaction

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Most common cause of bullous impetigo

S. aureus phage group II

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What causes cleavage of desmoglein in bullous impetigo?

Exfoliative Toxin- A

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Important clinical signs of necrotizing fasciitis

Gas in tissue
Cutaneous anesthesia
Bullae
Ecchymosis that may precede necrosis

What are the hallmarks of a tinea infection?

Round
Accentuated border
Scale

What does “spaghetti and meatballs” suggest

Tinea versicolor infection

What does grouped vesicles on an erythematous base indicate?

Herpes simplex

What should you look for in the absence of vesicles with herpes infections?

Stellate, cribriform appearance

What is Hutchinson's sign?

Zoster involvement on the tip of the nose. Usually indicates that the eye is involved as well.

Difference in presentation: smallpox vs. chicken pox

- Smallpox vesicles all appear at the same time and progress together - Chicken pox lesions appear at different times, so some will be new and some will be advanced

"Hot tub folliculitis" bug

Pseudomonas

Majocchi's granuloma treatment

Oral terbinafine 250 mg QD for 6 - 12 weeks

The default assumption with any SSTI should be that it is?

Staph or strep.

What often happens with OTC topical antibiotics?

- resistance (s. aureus w/in 48 hrs) | - contact dermatitis

Silvadene should be avoided in patients with?

- sulfa allergies (silvadene = silver sulfadiazine cream) - pregnant patients - newborns

1st line tx for MSSA and strep impetigo?

- cephalexin 250 mg qid x 7d, OR - dicloxicillin 250 mg quid x 7d - usually used with mupirocin as well

1st line management for outpatient MrSA

- TMP-SMX DS (1 po bid x 7d?) | - Doxycycline

1st line Tx for pseudomonas folliculitis (hot tub folliculitis):

- Cipro 500 mg bid x 7-14d | - will resolve on its own without Tx

True or false: OTC fungal drugs are effective for hair and nail fungal infections

False: good for skin and SSTI's but not hair or nails.

Triazoles have (2 things):

- longer half life that ketoconazole | - less hormonal inhibition

1st line Tx for tinea capitis

Griseofulvin (Grifulvin, Gris-peg)

When should you NOT do arthrocentesis?

- cellulitis (high risk of inoculating the sterile joint with bacteria infecting the dermis) - pts on anticoagulants - prosthetic joint

Facts about synovial fluid

- similar to plasma - hyaluronic acid - no clotting factors - acellular - a semi-liquid connective tissue

Most common organism in a septic joint

S. aureus

True or false: a negative gram stain can be used to rule out infection of a joint.

False

True or false: a positive gram stain is not necessarily diagnostic of infection

False

What are rapidly progressive monoarticular Sx most indicative of?

Septic joint

Collection of pus with surrounding granulation

Abscess

Superficial form of cellulitis

Erysipelas

Presents with bright red spots that form smooth, hot plaques

Erysipelas

Red, hot, edematous, shiny plaque at port of entry

Cellulitis

Presents with sharply marginated tan or pink patches. Bacteria will glow red under Woods lamp.

Erythrasma

Cornybacterium minutissimum

Erythrasma

An abscess in the eccrine sweat glands or fat globules on fingertips

Felon