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Clinical Medicine 1 > Lecture 6- Derm (Exam 3) > Flashcards

Lecture 6- Derm (Exam 3) Flashcards

1
Q

What are the different lice (3)?

A
  • Pediculus humanus capitis (head louse)
  • Pediculus humanus corporis (body louse, clothes louse)
  • Pthirus pubis (“crab” louse, pubic louse)
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2
Q

Lice:
* What population is affected more?
* What can vary
* Can occur where? What can the lice not do?
* What labs can be order?

A

Children affected more
* Pruritis (occurs as an allergic reaction to lice saliva injected during feeding) of variable severity in the presents of nits on the hair shaft, or rarely a visible lice.
* Can occur on scalp, body and pubic area. They do not jump,fly, or use pets as vectors.
* Laboratory: Can visualize under microscope, if any doubt-> only way to dx is visualize

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3
Q

What is this?

A

Pruritus occurs as an allergic reaction to lice saliva injected during feeding

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4
Q

Txt of lice:
* What is the first line?
* When do you reapply?
* What do you need to comb?
* Wash and replace what?
* What do you do if eyelash involvement?
* What is preventative measures?

A

Do not give lindane or ivermectin to kids under two dt neuro SE

Multiple topical pediculicides are accepted first-line treatments for pediculosis capitis. Wet combing is an alternative intervention that is primarily used for very young infants and patients who prefer to avoid pediculicides

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5
Q

Bedbugs:
* When do they feed?
* What type of rash is it? Can be delayed for how long?
* What do the bugs not do?
* Bugs can survive how long without a host?

A
  • Bugs feed at night on blood
  • See macular popular rash with central scab and moderate pruritis
    * 2-5 mm erythematous papule or wheal with central hemorrhagic punctum
    * Can be delayed 10 days
  • Bites do not transmit disease
  • Bugs can survive up to a year without a host
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6
Q
  • What is this?
A
  • Bed bugs
  • Tx is symptomatic, may need to cover for co-infections
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7
Q

Notes under PP

  • Where are bedbugs found in the world? What are the two subtypes?
  • Common in what area?
  • How do you the bugs spread?
A
  • Bedbugs are present throughout the world.C. lectulariusis found in temperate climates, andC. hemipterusis most prevalent in tropical climates,
  • Common in economically disadvantaged areas, refugee camps
  • Within multifamily and institutional buildings, bedbugs will move among rooms or may spread when items harboring bedbugs are moved within the building. Bedbugs are increasingly being identified in office environments, but spread within that environment is often limited
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8
Q

What is this? What is it caused by?

A
  • Human scabies is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis).
  • The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs.
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9
Q

What does scabies look like in terms of rash?

A

Pruritic burrows, vesicles, and/or nodules with excoriations and crusting

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10
Q

What is this?

A

Scabies

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11
Q

What is the lifecycle of scabies? Where are they most commonly located on body and what time is the itching worst?

A
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12
Q

Scabies
* Spread by what? (frequently _ acquired, common where, and exposure to what?
* What are the clinical features? (When will ss appear, itching, rash type, what areas?)

A
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13
Q

What is this?

A

Scabies

Under notes:
* Typical cutaneous findings are multiple small, erythematous papules, often excoriated
* Burrows may be visible as 2 to 15 mm, thin, gray, red, or brown, serpiginous lines
* Burrows are a characteristic finding but often are not visible due to excoriation or secondary infection.
* Miniature wheals, vesicles, pustules, and, rarely, bullae also may be present.

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14
Q

Scabies:
* How do you diagnosis?
* What is the txt? (pharm)

A
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15
Q

Txt of scabies:
* What about household?
* Wash what?
* What do you do for unwashable items?
* What do you do for furniture?
* What is post scabetic prurtis and what do you tx that with?

A
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16
Q
  • What is this?
  • When does this occur?
  • What are the characterisitcs?
A
  • Crusted scabies (also known as scabies crustosa, Norwegian scabies, Boeck scabies, or keratotic scabies) can occur in the presence of conditions that compromise cellular immunity, such as AIDS, human T cell lymphotropic virus type 1 (HTLV-1) infection, leprosy, and lymphoma
  • Crusted scabies (also called Norwegian scabies) is a highly contagious variant of scabies in which there are thousands or even millions of mites, associated with psoriasiform scaling patches.
  • The patient may complain of severe itching just as is seen in classical scabies, but more commonly, there is minimal to no pruritus.
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17
Q

Spider Bites
* How many spiders are there and how many can actually penetrate human skin?
* What does the venom cause?
* What are the two types we care about?

A
  • There are over 30,000 spider species and only approx 100 defend themselves and have fangs long enough to penetrate human skin.
  • Venom from the bite causes necrosis of the skin and systemic toxicity
  • 2 main culprits: Brown recluse and Black widow spiders
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18
Q

What type of spider is this? What do they cause?

A

The Brown Recluse
* The lesion is a sinking macule, pale dead gray in color, slightly eroded in the center, with a halo of very tender inflammation and hemorrhage

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19
Q

What spider is this?

A

Black widow spider

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20
Q

Brown Recluse Spider
* Where are they located in US?
* What do the bites cause?
* Only bite when?
* Hides where?
* Most bites occur where?

A
  • Southern and Midwestern US
  • Most bites are minor-> Erythema and edema-> Envenomation can cause tissue necrosis and hemolysis
  • Usually not aggressive, only bite when threatened
  • Hide in dark places->Rocks, logs, caves, closets, garages, attics
  • Most bites occur on arms, neck, and lower abdomen
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21
Q

Brown recluse spider bite:
* What happens initally?
* What happens within a few hours?
* What does it look like?
* What happens in most cases?

A
  • Painless or stinging sensation initially
  • Within a few hours site is painful and pruritic
  • Central induration with a zone of ischemia and zone of erythema
  • In most cases resolves in a few days without tx
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22
Q

Brown Recluse Spider Bite (SEVERE)
* What happens with the bite
* Can result in what?
* What needs to happen after fully evolved?

A
  • Spreading erythema with center of lesion becoming hemorrhagic and necrotic with overlying bulla
  • Black eschar forms and sloughs weeks later leaving an ulcer and eventually a depressed scar (not that common)
  • Can result in nerve injury and secondary infection
  • DEBRIDEMENT AFTER FULLY EVOLVED
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23
Q

What does this show?

A

Brown Recluse Spider Bite-> sereve

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24
Q

Brown Recluse Spider Bite
* What are the systemic complications?
* What is the txt?

A
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25
Q

Black Widow Spider
* Where is it located in the US?
* Potent what?
* Spin their web where?
* When does a problem occur? Bites are more common when?

A
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26
Q

Black widow spider bite:
* What happens initally with bite?
* What does the active component of the venom do?
* What happens within 60 mins?
* What happens to the muscles?
* What are other symptoms?
* What are the complications?

A
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27
Q

What is the txt of black widow spider bite?

A
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28
Q

Spider bites:
* Patients feel pain at bite site when?
* What does the black widow cause?

A
  • Patients feel pain at bite site within 3 hour and systemic symptoms begin 4-6 hours after the bite
  • The Black Widow cause neurologic overstimulation (muscle aches, spasms, and rigidity)
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29
Q

What is this?

A

Alopecia Areata

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30
Q

Alopecia areata
* What is it?
* What is the severity range?
* What are the characterisitcs?
* What can it be seen with?

A
  • Alopecia areata is a chronic, relapsing, immune-mediated, inflammatory disorder that affects hair follicles and results in nonscarring hair loss.
  • The severity of the disorder ranges from small patches of alopecia on any hair-bearing area to the complete loss of scalp, eyebrow, eyelash, and body hair
  • Circular/patchy (areata) shape-> Sharply outlined portion of the scalp with complete hair loss, without erythema, scale, atrophy, or scarring
  • Can be seen with SLE
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31
Q

Alopecia areata
* What areas can be affected?
* What is the percentage locaalized and extensice?
* What is alopecia areata, totalis and univeralis?
* Can affect who?

A
  • Recurrent non scarring alopecia that can affect any hair bearing area->Scalp, beard, eyebrows
  • Localized<50%, Extensive>50% involvement
  • Alopecia Areata-Discrete patches of loss
  • Alopecia Totalis-Entire scalp is bald
  • Alopecia Universalis-All hair bearing areas of body are bald
  • Can affect children and adults
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32
Q

Alopecia areata:
* Cause is what?
* What are Xthe clinical features?

A
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33
Q

What is this?

A

well defined alopecia areata

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34
Q

What is this?

A

Alopecia areata

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35
Q

What is exclamation point?

A
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36
Q

Alopecia areata
* What is the dx evaluation?
* What is the txt?

A
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37
Q

Alopecia areata
* What are the other txts?
* Diseaseis what?
* What is the chance of regrowth?
* When hair regrows, what will it look like?
* No _ tx
* What type of support?

A
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38
Q

What is scarring alopecia, trichtillomania, traction alopecia?

A
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39
Q

Androgenetic alopecia
* _ determined patterned alopecia
* Affects who?
* How does it occur?
* What is the role in men and women?
* _ pattern hair lose for women

A
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40
Q

Androgenetic alopecia
* How do men present?
* How do women present?
* Patient may report what?
* What do women notice?
* What symtoms are NOT present?

A
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41
Q

What is the hamilton norwood scale?

A

Progressive balding occurring from bitemporal recession, to frontal and/or vertex thinning to loss of all hair except for occipital and temporal margins.
* Used for hair transplant

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42
Q

What is the ludwig scale?

A

used for hair transplant

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43
Q

Androgenetic Alopecia
* What are the diagnostic evalutions?
* What is the txt?

A
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44
Q

Topical Minoxidil
* Best used when?
* MOA?
* What are side effects?

A
  • Best when used early
  • MOA – widens blood vessels allowing more O2 from blood, nutrients to support growth
  • Side effects – pruritis, irritation, flaking
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45
Q

Oral Finasteride
* _ inhibitor
* Inhibits what?
* What are the side effects
* Increased risk of what?

A
  • Androgen inhibitor
  • Inhibits the conversion of testosterone to dihydrotestosterone
  • Side effects – decreased libido, erectile, ejaculation dysfunction
  • Increased risk of prostate cancer
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46
Q

Androgenetic alopecia
* What is the surgical txt?
* What is non surgical?

A
  • Surgical Treatment: Hair transplant
  • Wigs
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47
Q

Telogen Effluvium
* What is it?
* Considered what?
* Patient will complain of what?
* There is no associated what?
* What is normal hair loss?

A
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48
Q
A
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49
Q

Telogen Effluvium
* What are the inciting factors (6)
* What is the workup?

A
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50
Q

Telogen Effluvium
* Will resolve when?
* Txt?

A
  • Will resolve on its own but may take 6-12 mos for resolution and regrowth to occur
  • No tx will speed up the process of resolution and regrowth
  • Emotional Support
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51
Q

Hirsutism
* What is shown in female?
* Definition based on what?
* May have what type of connection? What should the differential include?
* What is the management?

A
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52
Q

Onycomycosis
* What is it?
* What are the DDX?
* What is the etiology?
* What labs need to be done?

A
  • Thickened, discolored nail and debris on nail bed
  • DDX: psoriasis, rauma, aging
  • Etiology – T. rubrum most common, Candida effects fingernails more than toenails
  • Laboratory: KOH, PAS Stain-> This is more applicable if you suspect another nail dz
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53
Q

What is this? What are the clinical features?

A

Onycomycosis
Clincial features:
* Asymptomatic at first->Pt usually presents for cosmetic reasons
* As disease progresses pt may c/o pain, numbness
* May interfere with walking, exercise, standing
* Subungual hyperkeratosis

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54
Q

What is the txt of onycomyosis? What is the risk vs benefit with tx?

A

Topical Antifungal; combo topical/oral (risk benefits)
* Terbinafine (Lamisil), avoid with liver disease (need LFTs, needs grow out to see improvement)
* Itraconazole (Sporanox)

Risk vs benefit with tx
* Cost, labs, side effects, med interactions
* Topical-Generally ineffective, unable to penetrate nail plate
* Daily application for almost a year
* Ciclopirox, efinaconazole

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55
Q

What does this show?

A

Fungal hyphae from KOH

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56
Q

Onycholysis
* What is it?
* May be from what?

A
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57
Q

Paronychia
* What is it?
* What are the clincial features (acute and chronic)

A

Soft tissue infection that occurs around the fingernail (lateral and proximal nail folds)
* Acute-Painful/purulent-Caused by staph infection
* Chronic (6Weeks+)-Swelling, non purulent-Candida often isolated but not causative

Breakdown of the nail fold caused by cracks, fissures, trauma.->Allows entryway for organisms

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58
Q

What is this?

A

Paronychia

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59
Q

Paronychia
* What is the diagnostic evaluation?
* What is the txt?

A
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60
Q

What do you need to educate your patients on with paronychia?

A
  • Avoid nail biting
  • Trim hang nails
  • Trim nails flush to tip
  • Avoid excessive moisture exposure
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61
Q

Splinter Hemorrhages:
* May be seen in?

A
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62
Q

What is this?

A

Splinter Hemorrhages

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63
Q

What are beau’s line? May be seen in who?

A

Grooved – depressed in chemotherapy.

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64
Q

What is this?

A

Beau’s Lines - Transverse grooves on the nail

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65
Q

What is this? Who may be seen in?

A

Koilonychia – “spoon nail”
* SEEN: IRON DEFICIENCY ANEMIA

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66
Q

Terry nails:
* What is it?
* May be seen in who?

A
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67
Q

What is this?

A

Terry’s Nails – “white nails”

Cirrhosis. Terrys nails. 2/3 of proximal nail bed is white.

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68
Q

What are mee bands? May be seen in who?

A
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69
Q

What is this?

A

Mee’s bands – white transverse lines

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70
Q

Who do you see with clubbing of fingers? What technique?

A
  • Shamroth technique – see diamond not
  • Emphysema, cystic fibrosis, cancer. Chronic hypoxic state.
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71
Q

What is this?

A
  • Clubbing
  • Schamroth technique
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72
Q

Verrucae:
* What is verruca vulgaris
* What is condyloma acuminata
* What is plantar wart
* What colors?

A
  • Verruca Vulgaris -Common Wart
  • Condyloma Acuminata -Genital Wart
  • Plantar Wart -Wart @ bottom of foot
  • Tan, brown, or pink cauliflower-like papules ->Can occur anywhere
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73
Q

Verrucae (Warts)
* What is it caused by?

A

Caused by Human Papilloma Virus (HPV)
* There are different types of HPV
* Typing is most important for genital warts as it determines low risk vs high risk lesions and development of cancer
* High risk subtypes include 6,11,16,18

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74
Q

What is this?

A

Verrucae

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75
Q

Condyloma Acuminatum
* What is this?
* What labs?
* What is the txt?

A
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76
Q

What is the clinican administered txt of condyloma acuminatum?

A
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77
Q

What is this?

A

Condyloma Acuminatum

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78
Q

What is this? Who is is seen in?

A
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79
Q

Exanthems
* What is it? Enanthem is referred to what?
* Itchy or not?
* Txt?

A
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80
Q

What is this?

A

Exanthems

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81
Q

Measles Virus Disease (1st Disease) or Rubeola
* Contagious? Developed when?
* Rash starts where and goes where?
* What are the symptoms?
* What spots are there?
* What can be drawn to diagnose?
* What is the tx?
* May lead to what?

A
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82
Q

What is this?

A

Measles Virus Disease (1st Disease) or Rubeola

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83
Q

Scarlet Fever (2nd Disease)
* What is it?
* Post what infection?
* Causes what?
* May have what type of tongue?
* Untreated infection develops into what?

A
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84
Q

What is this?

A

Scarlet Fever (2nd Disease)

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85
Q

German Measles (3rd Disease) or Rubella Virus
* What is it milder than?
* what is the rash?
* Can result in what?
* Can have what?
* What is advised?

A
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86
Q

What is this?

A

German Measles (3rd Disease) or Rubella Virus

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87
Q

Erythema Infectiosum (5th Disease)
* What is the rash?
* Caused by what?
* Rash appears after what?
* Can cause what?

A
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88
Q

What is this?

A

Erythema Infectiosum (5th Disease)

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89
Q

Erythema Infectiosum (5th Disease)
* Disease is self-limiting, be concerned with who?

A
  • Patients with chronic hemolytic anemias or sickle cell who develop transient aplastic crisis (pallor, weakness and lethargy) need to be treated for symptoms of anemia i.e. require blood transfusion.
  • Pregnant women (with signs or symptoms suggestive of B19 infection or known recent exposure to infected contacts) should have serum B19 IgM and IgG titers drawn. If maternal infection is supported, by positive IgM and IgG levels then serial fetal ultrasounds should be performed to evaluate for changes of hydrops fetalis
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90
Q

Papular Purpuric Glove and Sock Syndrome
* Can stem from what?
* Can mimic what?
* What is common?
* How do you diagnosis?
* txt?

A
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91
Q

What is this?

A

Papular Purpuric Glove and Sock Syndrome

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92
Q

Exanthem Subitum (6th Disease) or Roseola
* Stem from what?
* Most common in who?
* Rash?
* What is txt?
* itchy or no?

A
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93
Q

What is this?

A

Exanthem Subitum (6th Disease) or Roseola

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94
Q

Exanthems
* Hand foor mouth
* What is the outbreak?
* What sx may occur?

A
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95
Q

Notes:

HFMD:
* How is the transmission?
* What is the incubation period?
* What does the examination show?

A
  • The viruses that cause HFMD and herpangina usually are transmitted from person to person by the fecal-oral route.
  • The incubation period for HFMD typically is three to five days, but has been reported to be as short as two days and as long as seven days
  • Examination of the throat reveals hyperemia and yellow/greyish-white papulovesicular lesions. The areas most frequently involved are the anterior pillars of the fauces, soft palate, tonsils, and uvula. Very occasionally, a lesion may be seen on the hard palate, tongue, or buccal mucosa. The number of lesions varies but is usually less than 10
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96
Q

Wha is this?

A

Herpes simplex
* Grouped vesicles on an erythematous base

97
Q

Herpes Simplex Virus (HSV)
* What are the types?
* What are the labs?
* What is the txt?

A

Multinucleated giant cells seen under microscope

98
Q

HSV
* Associated with waht?
* Patients get what?
* Decision to treat is individualized based on what?

A
  • Associated with less severe symptoms & shorter duration
  • Patients get prodromal of pain, tingling, & burning prior to onset of vesicles
  • Decision to treat is individualized based on severity of symptoms, frequency of recurrence, patient preference, & cost
99
Q

HSV:
* What has been shown to reduce the number of clinical HSV episodes
* What are the indications?
* Avoid what?

100
Q

Herpetic Whitlow
* What is it?
* Common in who?
* Can be seen in who?
* What is dx?
* What is tx? What will make it worse?

101
Q

What is this?

A

Herpetic Whitlow

102
Q

Molluscum Contagiosum
* Common in who?
* May also be seen in who?
* Auto _

103
Q

What is this?

A

Molluscum Contagiosum

104
Q

What is this?

A

Molluscum Contagiosum

105
Q

Molluscum Contagiosum-> clinical features
* What is the rash
* What is the size?
* Most are what?
* Can occur where?
* Lesions may become what?

106
Q

What is this?

A

Molluscum Contagiosum

107
Q

Molluscum Contagiosum
* Caused by what?
* What is the lab?
* What is the txt?

108
Q

Verrucae
* What is the shape?
* What is it?
* What is the lab?

109
Q

Verrucae
* What is the txt?

110
Q

Varicella-Zoster
* Primary what?
* What is the rash?
* Same thing as what?

111
Q

What is the varicella (latent disease)

A

Systemic symptoms highly variable and include low grade fever, malaise, headache etc. Severe, progressive infections manifest with deeper lesions in lung, liver, pancreas, or brain; mortality approaches 10%

112
Q

What is the txt for varicella zoster? What is the prevention

113
Q

What is shingles?

A

Shingles (reactivated latent phase of VZV or HZV) - Dermatomal, grouped and confluent vesicles and pustules limited to a dermatome(s) innervated by a corresponding sensory ganglion. Pain and burning are common symptom

114
Q

Varicella-Zoster
* What is trigeminal eruptions? What is the sign?
* There is no convlusice evidence of what?
* Pain management with what?
* How do you need to refer to?

A
  • Trigeminal (ocular n) eruptions that include the tip of the nose risk corneal involvement-> Hutchinson’s Sign
  • There is no conclusive evidence regarding the benefits of oral corticosteroids
  • Pain management with narcotics is often necessary
  • URGENT OPHTHALMOLOGIST REFERAL in all cases involving the ophthalmic branch of the trigeminal nerve (heralded by vesicles on the nose)
115
Q

Zoster (Shingles)
* What do you dx with?
* What is the txt?
* When must you start antivirals?
* Caustion exposure to who?

116
Q

PHN – Post Herpetic Neuralgia
* What is the txt?
* What is the prevention?

117
Q

Echovirus 9
* Genetically identical to what?
* May minic what?
* What is Dx?
* What is Tx?

118
Q

Cellulits:
* What is it?
* What is often assoicated with?
* Non-necrotizing tx with what?
* necrotizing requires what?

119
Q

Cellulitis
* Diffeuse spreading infection of what?
* usually where?
* What are the causative agents?
* What are the predisposing factors?

120
Q

What are the clinical features and work up of cellulitis?

121
Q

What is this?

A

Cellulitis-> red and warm

122
Q

What is this?

A

Cellulitis

123
Q

Txt of cellulitis:
* Mild/early?
* why does the choice of anx varies?
* What do you use for dog, cat, and human bite?
* If immunocompromised?
* What is mandatory if poor txt response?

124
Q

Cellulitis
* What are the differential DX?
* When is hospitalization required?

125
Q

Purpura:
* What is the definition?
* Blanch or non?
* What are the four types?

126
Q

What are these?

A
  • Palpable purpura (left). Multiple red papules on leg of a patient with Henoch–Schönlein purpura.
  • Retiform purpura (right). Purpura on toes with retiform pattern on foot in a patient with cholesterol emboli.
127
Q

Vasculitis
* May occur as an what?
* What is palpable purpura?
* What are other lesions?
* Lesions most prominent on what?

A
  • May occur as an idiopathic, predominantly cutaneous vasculitis
  • Palpable purpura (nonblanching, elevated lesions) is the cutaneous hallmark of vasculitis
  • Other lesions include petechiae (esp. early lesions), necrosis with ulceration, bullae, and urticarial lesions
  • Lesions most prominent on lower extremities
128
Q

What is vasculitis associated with?

129
Q

What is this?

A

Vasculitis
* Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis.

130
Q
  • What is this?
  • Characterized by?
  • May be limited to what?
A
  • Cutaneous Acute Vasculitis (Leukocytoclastic Vasculitis)
  • Characterized clinically by palpable purpura, especially of the legs
  • May be limited to the skin or involve other tissues as in Henoch- Schönlein purpura
131
Q

Henoch-Schönlein Purpura
* What is this?
* Petechiae and purpura of necrotizing vasculitis are usually localized to where?
* What should lead the examiner to consider necrotizing vasculitis?
* What is the txt?

132
Q

Livedo Reticularis
* What is the rash like?
* Frequently seen in what?
* Do not confuse with what?

A
  • Reticulated (lace-like or Net-like) blanching erythema symmetrically distributed over lower extremities.
  • Frequently seen in autoimmune vasculitis
  • Do not confuse with Cutis Marmorata
133
Q

What is this?

A

Livedo Reticularis

134
Q

Vasculitis
* What is the txt?

135
Q

Polyarteritis Nodosa
* Systemic vasculitis characterized by what?
* Can lead to what?
* What is usually spared?

136
Q

What is this?

A

Polyarteritis Nodosa

137
Q

Polyarteritis Nodosa
* Can be seen with what?
* What are the sxs?
* How do you dx?
* how do you txt it?

138
Q

What is this?

A

Polyarteritis Nodosa

139
Q

Erysipelas
* What is this?

A
  • Sharply demarcated, painful, indurated, erythematous “fiery red”, edematous plaques
140
Q

What is this?

A

Erysipelas

141
Q

Erysipelas
* What is it?
* Bacterial skin infection involving what?
* Caused by what bacteria?
* What is frequently affected?

142
Q

What are the clinical features of erysipelas?

143
Q

Erysipelas
* What bacteria causes this? What bacteria is causing it in newborn?
* What is the lab?
* What is the txt?

144
Q

Erysipelothrix
* What is the bacteria?
* Passed from what?
* manifests as what?
* How do you dx?
* How do you txt?

145
Q

What is this?

A

Erysipelothrix

146
Q

What is this?

A

Impetigo
* Thick, “honey” crusted lesions

147
Q

What is this?

148
Q

Ecthyma:
* What is this caused by?
* What is it?

149
Q

What is this?

150
Q

Impetigo/Ecthyma
* Caused by what?
* What is the lab?
* What is the txt?

151
Q

Ecthyma Gangrenosum
* Vesicular rash progressing to what? Note what?
* What is the bacteria?
* Freq seen in who?
* How do you dx?
* What is the tx?

152
Q

What is this?

A

Ecthyma Gangrenosum

153
Q

What is the d test for?

A
  • If on culture report see bacteria resistant to erythromycin but susceptible to clindamycin, DO NOT give Clindamycin. Not as good of a coverage.
  • A flattening of the zone of inhibition around theClindamycindisk proximal to the Erythromycindisk (producing a zone of inhibition shaped like the letter D) is considered a positive result and indicates that the Erythromycinhas induced Clindamycinresistance (a positive “D-zone test”).
154
Q
A
  • Pyoderma gangrenosum. Look for purple border.
  • Due to UC.
  • Tx with steroids and treat UC. DO NOT want to debride, makes it worse. So do wet to dry. No topical corticosteroids for any open wound.
155
Q

Hanson’s Disease (Leprosy)
* Caused by what?
* What is the skin issue?
* What is the vector?
* How do you dx?
* What is the tx?

156
Q

What is this? What is the txt?

A

Hanson’s disease (leprosy)
* Dapsone+Rifampin+Clofazimine for 6-12 months

157
Q

Typhoid Fever
* _ species
* Seen where?
* What is the rash and GI effects?
* How do you dx?
* What is the txt?

158
Q

Ehrlichiosis
* What type of infection?
* What is uncommon? What is it accompanied by?
* How do you dx?
* What is the tx?

159
Q

What is the 3 types of necrotizing fasciitis?

A
  • Type 1: polymicrobial/ salt-water contamination with Vibrio species, MRSA and others
  • Type 2: Group A streptococcal
  • Type 3: Clostridium infection, Clostridium myonecrosis (gas gangrene)

History of trauma, surgery, predisposing condition (like DM)

160
Q

Necrotizing Fasciitis
* Widespread what?
* What is clostridial myonecrosis?
* usually direct inoculation from what?
* What are the ss?

161
Q

Necrotizing Fasciitis
* Update what?
* What do you give?
* What is surgery?

162
Q
  • What is this?
  • What is the rash?
A

Candidiasis

163
Q
  • What is this?
  • Do not confuse with what?
A

Candidiasis
* Small erosions in the interdigital web space of the hand-> looks moist
* Don’t confuse with dyshidrosis

164
Q

Candidiasis
* What is the labs?
* What is the txt?

165
Q

Rhinocerebral Mucormycosis (Zygomycosis)
* What is this?
* Clinically present as what?
* Seen in who?
* What is this?
* How do you dx?
* What is DDX
* What is the txt?

A
  • Necrotic lesions of palate and mucosa due to fungi
  • Clinically patients have depressed sensorium and CN palsies
  • Seen in immunocompromised state
  • Is a surgical emergency
  • Dx: PCR
  • DDx: Aspergillosis
  • Tx: Amphotericin B, surgical consult
166
Q

What is this?

A

Rhinocerebral Mucormycosis (Zygomycosis)

167
Q

Tinea Versicolor
* What is the rash?
* Variation of what?

A
  • Hypopigmented or hyperpigmented round or oval macules with fine scaling that do not tan and can be pruritic
  • Variation of presentation based on skin tone.
168
Q

What is this?

A

Tinea Versicolor

169
Q

Tinea Versicolor
* What are the labs?
* What is the topical txt?

170
Q

Tinea Corporis/Pedis
* What is this?

A

Erythematous, annular patch with distinct borders and central clearing usually with scaling

171
Q

What is this?

A

Tinea Corporis/Pedis

172
Q

What is this?

A

Tinea Corporis/Ped

173
Q
  • What is tinea capitis? What are the sx?
  • What can be present in any location of tinea, but most commonly seen on the scalp?
174
Q

What is this?

A

Scalp(Tinea Capitis)-broken hair shafts are seen as black dots

175
Q

Tinea Corporis/Pedis
* What are the labs tests?
* What is the txt? WHAT SHOULD BE AVOIDED?
* What is key?

176
Q

Erythrasma
* What is this caused by?
* What does it affect?
* What does wood lamp exam show? What does KOH?
* What is the txt?

177
Q

What does this show?

A

Erythrasma

178
Q

Serpiginous Lesion
* What is this?
* What is the cause?
* Presents as what?
* How do you dx?
* What is the txt?

179
Q

What is this?

A

Serpiginous Lesion

180
Q

Acanthosis Nigricans:
What is this?
Where is it more common?

A
  • Hyperpigmentation with thick, velvety accentuation of the dermal lines
  • Most commonly on the axillae, neck but can also be groin, anogenitalia, antecubital fossae, knuckles, submammary, and umbilicus.
181
Q

What is this?

A

Acanthosis Nigricans

182
Q

Acanthosis Nigricans
* What are the labs?
* What is the txt?

A
  • Laboratory: R/O Diabetes Mellitus, Carcinoma (gastric) if clinically suspected
  • Treatment: No proven treatment other that for underlying disorder if present
183
Q

What is first, second and third degree burn?

184
Q

What are the rules of 9s?

185
Q

Burn txt:
* What do you use for 1st and 2nd? What is no longer recomended?
* Blisters should not be what? But what is the exception?

A
  • 1st and 2nd degree burns: cool compresses
    * Silver sulfadiazine is no longer recommended
  • Blisters should not be broken according to AAPA; however, rupturing the blister and using the top as a partial thickness skin grafts allows the wound to heal quicker and gives pain relief
186
Q

Burn txt:
* Larger 2nd degree and any 3rd degree burns?
* When do you do fluid replacement?
* What is the most common formula?
* What do you do for inhalation injury?
* Assess what?

187
Q

What is the equation to know how much fluid to give?

A
  • Total fluid = 4mL x wt(kg) x TBSA(%)
188
Q

What are the stages for decubitus ulcers? (1-4)

189
Q

Decubitus due to what?
What is the txt for ulcers?

190
Q

What is the management for stage one and two?

A
  • Topical antibiotics (not neomycin) – allergic reaction
  • If debridement is needed: wet to dry normal saline dressings
  • Consider hydrogels or hydrocolloid dressings if the ulcer does not heal by 30% in 2 weeks.
191
Q

What is the management of 3 and 4?

A

Surgical management
* Debridement of necrotic tissue —
* Bony prominence removal
* Skin grafts

Prolonged systemic antibiotics depending on sensitivities for any secondary bacterial infections

192
Q

Leg Ulcers
* Diabetic-tend to be what?
* Arterial?

A
  • Diabetic-tend to be deep, punched out lesions over the malleoli, the plantar surface of the feet or toes and are usually painless
  • Arterial-Not preceded by dermatitis and are smaller than stasis ulcers. These are painful, pulses are diminished or absent, and the distal areas are cold
193
Q

Stasis preceded by what?

A

Stasis- preceded by dermatitis, then wide but not deep ulcers develop, with irregular, undulating edges and clean base. Elevation relieves pain

194
Q
  • What is the txt of diabetic and arterial?
  • What is the txt of stasis?
195
Q

Hidradenitis Suppurtiva:
* What is it?

A

Multiple comedones, some paired (which is characteristic), associated with several deep exquisitely painful abscesses and old scars

196
Q

What is this?

A

Hidradenitis Suppurtiva

197
Q

Hidradenitis Suppurtiva
* Where does it occur?
* What is often present from abscesses or open sinus tracts?
* What is common?

A
  • Occurs in axillae, groin, anogenital, and/or breasts
  • Purulent/seropurulent drainage often present from abscesses and/or open sinus tracts
  • Fibrosis, “bridge” scars, keloids and contractures are common
198
Q

Hidradenitis Suppurtiva
* What is the lab?
* What is the txt?

199
Q

Lipomas
* What are they?
* What is the txt?

200
Q

What is this?

201
Q

Epithelial Inclusion Cysts:
What are these?

A

Epithelial Inclusion Cysts-Freely movable subcutaneous masses

202
Q

What is this?

A

Epithelial Inclusion Cysts

203
Q

Epithelial Inclusion Cysts
* Demeral nodule due to what?
* What is the txt?
* They get inflamed typically from what?

204
Q

Melasma
* What is this?

A

Hyperpigmented macules occurring on sun-exposed areas of the face (forehead, cheeks, upper lip)

205
Q

What is this?

206
Q

Melasma
* Usually in who?
* What are the labs?
* What is the txt?
* When may this disappear without txt?

207
Q

Malar or “Butterfly rash”of SLE
* What is the malar distribution?
* Showing what?
* Involvement of what?

A
  • Malar distribution = Cheeks and Nose
  • Showing prominent, scaly, malar erythema
  • Involvement of other sun- exposed sites is also common
208
Q

What is this?

A

Malar or “Butterfly rash”of SLE

209
Q

What is this?

A

Pilonidal Cyst/Sinus

210
Q

Pilonidal Cyst/Sinus
* What may be visualized?
* Lesions become what?
* Often occur with what?

A
  • Pore, sinus and/or fistulas may be visualized alone or in the presence of nodule on the midline sacral region at the upper end of the cleft of the buttocks
  • Lesions become inflamed due to rupture, or less commonly, infection
  • Often occur with nodulocystic acne, dissecting cellulitis, and hidradenitis suppurativa
211
Q

Pilonidal Cyst/Sinus
* What are the labs?
* What is the txt?

212
Q

Urticaria
* Present as what?
* A sign of more what?
* Showing characteristics of what?

A
  • Present as generalized pruritic wheals (blanch with pressure)
  • A sign of more systemic/generalized involvement of allergic reaction
  • Showing characteristic discrete and confluent, edematous, erythematous papules and plaque
213
Q

Urticaria
* What is Dermatographism
* What are the labs?
* What is the work up?

A
  • Dermatographism: urticaria formation in skin after being stroked/scratched
  • Laboratory: CBC with Diff, CMP, Hepatitis antigens, ESR (necrotizing vasculitis), Stool for ova and Parasites
  • Allergy work up
214
Q

Urticaria
* What is the txt?

215
Q

Vitiligo
* What is the pattern?
* Early lesions are what?
* Frequently are what?

216
Q

What is this?

217
Q

Vitiligo
* Macules with what?
* What are the labs?
* What is the txt? (pharm and nonpharm)

218
Q

Milia
* What are they?
* Most common in who?
* May occur in who? Around where?
* Tied tow hat?
* May form what?
* What is the pathophysiology?
* How do you dx?
* What is the tx?

219
Q

Infantile Hemangioma
* Known as what?
* Found in up to what?
* What is the protein expression?
* Consider what?

A
  • Known as Strawberry Nevus, is a most common benign vascular skin tumor in children
  • Found in up to 12% of children <1yo
  • Placental GLUT1 protein expression
  • Consider biopsy to r/o vascular malformations or Kaposi or angiosarcoma
220
Q

What is this?

A

Infantile Hemangioma

221
Q

Sweet Syndrome
* What is this? What is it linked to?
* What plays a role in activation?
* What is on the skin?
* Expect what?
* How do you dx?
* What is the tx?

222
Q

What is this?

A

Sweet Syndrome

223
Q

Still’s Disease
* What are the sxs?
* What is the rash?
* Appears similar to what?
* How do you dx?
* What is the tx?

224
Q

What is this?

A

Still’s Disease

225
Q

TTP (Thrombotic Thrombocytopenic Purpura)
* noninfectious cause of waht?
* Triggered by what?
* Genetically linked to what?
* How is it dx?
* What is the tx?
* Purpura fulminans see in _

226
Q

What is this?

A

TTP (Thrombotic Thrombocytopenic Purpura)

227
Q

Erythema Multiforme:
* What are the most common causes?
* What is the tx?

A
  • Three most common causes are drug reaction (particularly penicillin’s and sulfonamides) or concurrent HSV or Mycoplasma infection
  • Other drugs: phenytoin, barbiturates, phenylbutazone, or allopurinol
  • Tx with removal of offending substance
228
Q

What is this?

A

Erythema Multiforme

229
Q

Erythema Marginatum
* What is it?
* Occurs with what?
* Presents with what?
* May have what?
* Look for what?
* Tx with what?
* Timely treat what?

230
Q

What is this?

A

Erythema Marginatum

231
Q

Erythema (Chronicum) Migrans
* Seen in what?
* Not what?
* Txt with what?

232
Q

What is this?

A

Erythema (Chronicum) Migrans

233
Q

Erythema Ab Igne
* What is also called?
* Secondary to what?
* develop what?
* Discontinue what?

A
  • Toasted Skin Syndrome
  • Secondary to long-term exposure to infrared radiation/heat.
  • Develop reticulated erythema, hyperpigmentation, teleangiectasia, burning and pruritis.
  • Discontinue heat exposure
234
Q

What is this?

A

Erythema Ab Igne

235
Q

Erythema Induratum
* Previous know as what? Now just what?
* Commonly associated with what?
* What is felt?
* Work up for what?
* differentiate from what?

A
  • Previously known as Bazin Disease, now just Panniculitis
  • Commonly associated with cutaneous TB
  • Small superficial and painful nodules are felt
  • Work-up for TB
  • Differentiate from early Erythema Nodosum
236
Q

What is this?

A

Erythema Induratum

237
Q

Erythema Nodosum
* Just like what?
* Due to what? Some can have what appearance?
* can be seen with what?
* If idopathic?
* What can be used in severe disease?

238
Q

What is this?

A

Erythema Nodosum

239
Q

Erythema Infectiosum (5th Disease)
* Does not involve only what?
* Caused by what?
* Rash occurs when
* Can cause what?

Clinical Medicine 1 (8 decks)

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