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X Clin Med Exam 1 > L7 Cellulitis and Other Derm Disorders > Flashcards

L7 Cellulitis and Other Derm Disorders Flashcards

1
Q

Lymphangitis

A

Seen as red streak in areas of cellulitis, mark borders to notice this

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2
Q

Folliculitis

A

Inflammation of hair follicle leading to pustules and papules, itching and painful

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3
Q

Cause of folliculitis

A

S. aureus

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4
Q

Cause of hot tub folliculitis

A

Pseudomonas

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5
Q

Progression of folliculitis

A

Furuncle (well-circumscribed, painful, inflammatory nodule) and can become carbuncle/abscess

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6
Q

Treatment of staph. folliculitis

A

Usually self-limited, for moderate/ severe use topical abx (mupirocin) or oral abx (cephalexin), if MRSA then sulfa, clindamycin or doxycycline

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7
Q

Impetigo

A

Contagious superficial bacterial infection seen more in kids due to autoinoculation causing satellite lesions

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8
Q

3 variants of impetigo

A

Nonbullous, bullous or ecthyma

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9
Q

Nonbullous impetigo

A

Most common, see papules, vesicles, pustules and “honey colored crusting”- s aureus

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10
Q

Bullous impetigo

A

Vesicles enlarge and form a flaccid bulla- s aureus

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11
Q

Ecthyma

A

“Punched out” ulcers with overlying crust (like a cigarette burn)- strep bacteria

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12
Q

Treatment of variants of impetigo

A

Non-bullous and bullous is topical abx like mupirocin with oral abx for more severe, ecythma is always treated orally

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13
Q

Cellulitis

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Inflammation of skin with a diffuse, spreading superficial infection

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14
Q

Pathogen of cellulitis

A

Beta-hemolytic strep, can be staph

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15
Q

2 types of cellulitis

A

Nonpurulent (cellulitis or erysipelas)-strep and purulent (abscess and purulent cellulitis)-staph aureus

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16
Q

Symptoms of cellulitis and erysipelas

A

Erythema, edema, warmth and can be fever

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17
Q

Symptoms of an abscess

A

Painful, fluctuant (squishy), erythematous nodule

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18
Q

Erysipelas

A

Superficial skin infection from b-hemolytic strep., seen mostly on cheeks and LE, sharply demarcated border with tender, warm and erythematous

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19
Q

Treatment of abscess

A

Most important is incision and drain, sometimes abx (because purulent)

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20
Q

Treatment for cellulitis

A

Empiric coverage for beta-hemolytic strep and staph (cephalexin or cefazolin)

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21
Q

Treatment of erysipelas

A

Empirical treatment for beta-hemolytic strep

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22
Q

Reasons to do I&D and abx for abscess

A

Abscess greater than 2 cm (or multiple), toxicity, extensive cellulitis, immunosuppression, indwelling medical device, high risk for transmission

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23
Q

Decolonization of MRSA

A

Chlorohexidine wash, mupirocin ointment intranasally

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24
Q

When IV abx necessary for MRSA

A

Extensive involvement, toxicity, rapid progression, failure PO tx, immunocompromised pt, infection near indwelling device

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25
Q

Cutaneous manifestations of SLE

A

Discoid lupus or malar/butterfly rash

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26
Q

Discoid lupus

A

Annular, erythematous, scaly plaques on sun-exposed areas (15-30% of SLE pts)

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27
Q

Malar/butterfly rash

A

Erythema on cheeks and bridge of nose, nasolabial folds spared

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28
Q

Tx for SLE

A

Topical or intralesional steroids (not face), hydroxychloroquine or other systemic med, must confirm it is not drug induced cutaenous lupus (1-5 mos after new med)

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29
Q

Erythema multiforme

A

Acute, immune mediated condition causing distinct target-like lesions

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30
Q

Erythema multiforma major

A

Will also affect the mucosa

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31
Q

Cause of erythema multiforme

A

Herpes simplex is most common, but be some drugs (NSAIDs or abx)

32
Q

Tx for erythema multiforme

A

Usually self-limited within 2 wks, can use topical steroids or oral antihistamines, mouthwash for symptoms, no anti-virals for acute EM

33
Q

Dermatitis herpetiformis

A

Uncommon autoimmune skin condition associated with gluten sensitivity (Celiac)

34
Q

Sxs dermatitis herpetiformis

A

Intensely pruritic papules and vesicles seen on forearms, knees, scalp and buttocks

35
Q

Tx for dermatitis herpetiformis

A

Dapsone and gluten elimination

36
Q

Pemphigus

A

Group of rare, autoimmune, life-threatening, blistering disorders

37
Q

Forms of pemphigus

A

Vulgaris, foliaceus, IgA and paraneoplastic

38
Q

Acantholysis

A

Separation of epidermal cells from each other (caused by antibodies in pemphigus), lead to blister

39
Q

Presentation of pemphigus

A

Mucosal involvement in oral cavity where see flaccid bullae that may spread to skin (scalp, face, axilla, groin), Nikolsky sign, S=superficial

40
Q

Nikolsky sign

A

Gentle application of lateral pressure in an uninvolved area that causes superficial layer of skin to slough off

41
Q

How to diagnosis pemphigus/pemphigoid

A

Lesional (routine histological exam) or perilesional (direct immunofluorescence) skin biopsies, DIF is gold standard

42
Q

Tx of pemphigus

A

Refer to derm, main choice is systemic corticosteroids or immunosuppressive agents, can then treat oral lesions with lidocaine or acetonide or abx for secondary infection, death possible if not treated

43
Q

Pemphigoid

A

Chronic autoimmune subepithelial blistering disorder, D=deep

44
Q

Types of pemphigoid

A

Bullous and mucuous membrane (MMP)

45
Q

Presentation of pemphigoid

A

Urticarial, erythematous plaques and tense bullae that do not slough off on the trunk and extremities (can see mucosal involvement)

46
Q

Tx for pemphigoid

A

Skin care and topical or systemic corticosteroids, refer to derm, some immunosuppressive agents

47
Q

Melasma/chloasma

A

Acquired hyperpigmentation of the skin, hormonal effect, “mask of pregnancy”

48
Q

Acanthosis nigricans

A

Hormonal effect, common disorder associated with insulin-resistance (DM, obesity), presents with hyperpigmented velvety plaques

49
Q

Hirsutism

A

Male pattern hair growth in women

50
Q

Causes of hirsutism

A

Polycystic ovarian syndrome, idiopathic, cushing’s disease, insulin resistance, drugs etc

51
Q

Cushing Syndrome

A

Excess androgens/steroid hormone, this affects pilosebeaceous unit so increased sebum/acne/ atrophy, striae

52
Q

Addison’s disease

A

Adrenal insufficiency, hyperpigmentation of gums, buccal mucosa, elbows, knees, palms and genitalia

53
Q

Pretibial myxedema

A

Thyroid dermopathy seen in hyperthyroidism, nonpitting, scaly thickened skin, orange peel appearance, warm, moist skin

54
Q

Presentation of hypothyroidism

A

Dry, cool skin

55
Q

Porphyrias

A

Metabolic disorders due to altered activity of enzymes in heme synthesis

56
Q

Cause of porphyria cutanea tarda

A

Deficiency of uroporphyrinogen decarboxylase (UROD) in liver, leads to excess porphyrins

57
Q

Sxs of porphyria cutaneous tarda

A

Painless sub-epidermal blistering of skin on sun exposed areas, photosensitivity, seen on dorsum of hands, forearm, face, neck and feet

58
Q

Tx of porphyria cutanea tarda

A

Phlebotomy in order to deplete iron and prevent formation of UROB inhibitor and then low dose hydroxychloroquine

59
Q

Ulcer

A

Pressure induced injury over bony prominences, usually related to immobility- prevention!

60
Q

Stage 1 of ulcer

A

Intact skin with localized erythema

61
Q

Stage 2 of ulcer

A

Partial thickness skin loss with exposed dermis, adipose not visible, no eschar (thick, dark, black scab)

62
Q

Stage 3 of ulcer

A

Full thickness skin loss, see adipose, rolled wound edges, may see eschar

63
Q

Stage 4 of ulcer

A

Full thickness skin and tissue loss with exposed muscle, tendon, bone or fascia, common eschar and rolled edges, fistulas

64
Q

Tx of stage 1 ulcer

A

Transparent film for protection

65
Q

Tx of stage 2 ulcer

A

Dressing that maintains moist wound environment (if no infection)

66
Q

Tx of stage 3/4 ulcer

A

Debridement of necrotic tissue, appropriate dressing, maybe abx

67
Q

Findings associated with tick borne illness

A

Erythema migrans or rocky mountain spotted fever

68
Q

Why remove tick within 2-3 days

A

Prevent lyme disease (if so single 200mg dose of doxycycline)

69
Q

Erythema migrans

A

Seen in early stage of lyme disease, bull’s eye appearance of rash (slightly raised, warm red with central clearing), 7-14 days after tick bite

70
Q

Pathogenesis of erythema migrans

A

Borrelia Burgdorferi

71
Q

Late stages of erythema migrans

A

Cardiac, arthritis and neurologic sxs, bell’s palsy

72
Q

Tx of erythema migrans

A

Abx like doxycycline or amoxicillin

73
Q

Pathogenesis of rocky mountain spotted fever

A

Rickettsia rickettsia

74
Q

Sxs of rocky mountain spotted fever

A

Nonspecific sxs (fever, HA, malaise) within 2 wks, rash within 3-5 days that is macular with petechial lesions seen on ankles, wrists and trunk

75
Q

Why must treat rocky mountain spotted fever early

A

It is lethal within 5 days!

76
Q

Tx of rocky mountain spotted fever

A

Empiric tx based on suspicion (doxycycline)

X Clin Med Exam 1 (7 decks)

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