Lecture 6 (derm)-Exam 3 Flashcards
1
Q
Lice
* What mc patients?
* What are the sx?
* How do you dx?
A
- MC pediatric patients
- Asymptomatic – itchy scalp
- DX: visual inspection
2
Q
lice:
* How long do they live for (one and off scalp)
* At what stage can they transfer?
* They do not do what?
* What is generally required for lice to tranfer?
* What is rare?
A
- Live for 3 weeks on the scalp/ 24 hours off
- Only live lice can transfer / not nits
- THEY DO NOT JUMP OR FLY
- Head-to-head contact is generally required
- Transmission via combs or brushes rare
3
Q
Lice: non-pharm
* Wash what?
* Bag items for how long?
* Vacuum what?
* Do not use what?
A
- Wash combs and brushes in hot water
- Wash and dry linens and clothing used within 48 hours of diagnosis (130˚F H20 / high heat dry)
- Bag items that cannot be laundered for minimum of 48 hours
- Vacuum flooring and furniture
- Do not use fumigant sprays
4
Q
Lice-pharm
* What are the diff types?
* What is not recommended?
A
- Topical (first line)
- Oral
- Not recommended: lindane due to neurotoxicity and seizures
5
Q
When can people return to school and work with lice?
A
Return to school / work / daycare after first treatment and nit removal complete (comb out
6
Q
What are the top three topical lice txts?
* What stages do they txt?
* Contact time?
* Retreatment needed?
* What is the cure rate?
* What are the comments?
A
7
Q
What is first line for topical lice?
A
Permethrin 1% cream
* Even though only 25% cure rate, still first line because cheap+OTC
8
Q
Alternative treatment of lice: Oral agents
* What are the two?
A
Ivermectin and trimethoprim/sulfamethozazole
9
Q
Ivermectin:
* What is the cure rate?
* What is the dosing?
* What is CI? ⭐️
A
- 93% cure rate
- 200 to 400 mcg/kg x 1 dose; may require repeat dose in 8 days
- CI: pregnancy and patients ≤ 15 kg
10
Q
Tri/sulf:
* What is the dosing?
* Recommend concomitant use with what?
* What is the MOA?
* What is the combine efficacy?
A
- 5 mg/kg/dose PO BID x 10 days
- Recommend concomitant use with permethrin
- Kills vitamin-B producing bacteria in louse gut
- Combined efficacy 93%
11
Q
What are the alternative txts of lice?
A
12
Q
Scabies:
* What is it?
* What are the MC sites?
* How do you diagnosis?
A
- Mite infestation with intense itching
- MC sides and web spaces of fingers, flexor aspects of wrist, waistline (to be warm)
- Diagnosis: inspection ± skin scraping
13
Q
Scabies txt:
* What is the non-pharm?
* What is the first line pharm (how do you apply)?
A
Nonpharmacologic – environmental control
Permethrin 5% cream TOC
* Apply chin down including fingers, toes overnight (8 to 14 hours)
* Repeat in 1-2 weeks
14
Q
Scabies:
* What is the alternative txt?
* What may persist?
A
- Ivermectin 200 mcg/kg/dose x 1 dose; repeat 1 week later
- Itching may persist for weeks following treatment
For if you cannot get rid of the scabies
15
Q
When can people return to work/school with scabies?
A
May return to work 24 hours after treatment complete
16
Q
A
17
Q
Black widow envenomation
* mild sx?
* What is the txt?
A
18
Q
What is the MOA of benzodiazepines?
A
- Bind to gaba a receptors
- increases cl- influz
- hyperpolarization and decrease exitation
19
Q
Black widow envenomation
* moderate to severe sx?
* What is the txt?
A
20
Q
BROWN RECLUSE ENVENOMATION
* What are the symptoms?
* What is the txt plan?
A
- Clean with soap and water
- Local ice packs – inhibits toxin activity
- Elevate affected body part if possible
- Pain medications: acetaminophen/NAIDS
- Tetanus prophylaxis
- No antivenom in US
- Local wound care once stable
- Antibiotics only if infection suspected
21
Q
A
22
Q
A
23
Q
What is DTaP?
* What type of vaccine series?
* What population gets this?
A
24
Q
What is Tdap?
* What is this form used for and for who?
A
25
ROCKY MOUNTAIN SPOTTED FEVER (RMSF)
* What bacteria causes this?
* What vector?
* Where is the highest incidences?
* Rickettsia rickettsii (gram negative rod)
* American dog tick / Rocky Mountain wood tick southeast
* Highest incidence Southeastern and Southcentral US
26
RMSF:
* What are the sx?
* Increased risk of what? What are the risk factors?
* How do you diagnosis?
* Fever, rash (95%)-distal extremities to trunk, petechiae (40 to 50%)
* Increased risk of mortality if not treated early (within 5 days of symptom onset
* Risk factors: > 60 years, delayed therapy, failure to use doxycycline
* Diagnosis: mostly clinical; fever in endemic area, known or possible tick bite, +/- rash; immunofluorescent antibody (IFA)
27
RMSF:
* What is the DOC? Who do we use it in?
28
Lyme disease:
* What bacteria causes this?
* What is the vector?
* Where is it most common?
* Tick-borne; Borrelia burgdorferi (gram negative spirochete)
* Black legged ticks
* Northeast, North Central, Middle Atlantic US
29
* What are the sx of early lyme disease?
* What txt is appropriate?
* Erythema migrans, arthralgias, first-degree heart block, facial palsy
* Oral therapy appropriate
30
What is the DOC for early diease lyme disease? What if preg?
Primary Regimens (duration dependent on exact
syndrome)
* Doxycycline
* Amoxicillin (DOC in pregnancy)
* Cefuroxime axetil
31
What are the sx of advance lyme disease? What is the DOC?
32
* What is ehrilichiosis?
* Spread sprimarily through what?
* Ehrlichiosis is the general name used to describe diseases caused by the bacteria Ehrlichia spp
* Spread primarily through the bite of infected ticks including the lone star tick (Amblyomma americanum) and the blacklegged tick (Ixodes scapularis).
33
What are the symptoms of ehrilichiosis?
* Fever, chills, headache, muscle aches, abdominal pain, nausea
* Rash is uncommon
* Elevated liver enzymes
* Thrombocytopenia
34
What is the txt of ehrichiosis?
Doxycycline is the treatment of choice
35
What is the moa and dosage forms of imidazole?
36
What is the moa of allyl amines?
What is the moa of ciclopirox?
What is the moa of nystatin?
MOA (most allyl amines-> terbinafine and naftifine):
* Inhibition of squalene epoxidase, an enzyme needed for sterol biosynthesis
MOA (ciclopirox):
* Inhibition of essential elements in the fungal cell disrupting synthesis of DNA, RNA, and proteins
MOA (nystatin):
* Increases cell permeability causing cell death
37
38
Fluconazole, itraconazole:
* What is the MOA?
* What are the SE?
* Why is oral ketoconazole no longer recommended?
39
Terbinafine:
* What is the MOA?
* What is the SE?
* What is reported?
40
Griseofulvin:
* What is the MOA?
* What are the SE?
* Indicated for only what?
41
Candidiasis:
* Tends to occur where?
* MC in who?
* What are the sx?
42
What is the txt of candiasis?
Topical antifungals
* Terbinafine, naftifine
* Ciclopirox
* Nystatin
43
What is the prevention for candidiasis?
44
What are the common causes of diaper dermatitis?
45
What are the mc of areas of diaper dermatitis-irritant?
* What is mild, mod, severe?
* What does it spare?
46
Candida diaper dermatitis:
* What are the s/s?
47
What is the txt for irrirant/chaffing and candida?
48
What is the DOC for candida dermatitis?
* DOC: nystatin
* Alternative: azole antifungals
49
50
NOT TOPICAL
51
52
* What is this?
* Which drug and which route is more effective?
Tinea unguium - onychomycosis
* Terbinafine more effective than azole therapy
* Systemic therapy more effective than topical
53
54
What is this?
* How would you explain this rash?
* What are the MC areas?
* What is the dx?
Pityriasis vericolor
* Fine, scaley rash with patches of discolored skin with sharp boarders
* MC back, underarms, chest, neck
* MC hypopigmentation
* Dx: KOH prep or Wood’s lamp (fluoresce yellow)
55
56
What are these?
* First two to the left: Cellulitis
* Other two: erysipelas
57
What is this?
Impetigo
58
What is this?
LYMPHANGITIS
59
What organisms?
60
What is the most common organisms for animal bite wounds and human bit wounds?
61
Erysipelas:
* What is first and 2nd line?
1. Penicillin or amoxicillin
2. Cephalexin (not IgE)
| PEA for erysipelas, pen, amox
62
Impetigo:
* What is first and 2nd line?
1. Penicillin or TMP-SMX or mupirocin topical
2. Cephalexin
| BIMP
63
cellulitis:
* What is first and 2nd line?
1. Cephalexin or dicloxacillin
2. TMP-SMX or clindamycin
64
Cat bite:
* What is the mc organism?
* What is the first line and second line?
* MC org: Pasteurella multocida
* First: Amoxicillin / clavulanate
* Second: cefuroxime or doxy (if pen allergic)
65
Dog bite:
* What is the MC organism?
* What is first and second line?
* MC: Pasteurella canis
* First:Amoxicillin / clavulanate
* Second: Clindamycin plus TMP/SMX or a fluoroquinolone
66
Human bite
* MC org?
* What is first line early and infect? What if the patient is pen allergic?
* Org: Eikenella corrodens
* First-line early: Amoxicillin / clavulanate
* First-line infected: ampicillin / sulbactam or cefoxitin or piperacillin / tazobactam
* Penicillin allergic: clindamycin plus a fluoroquinolone
67
Paronychia/felon:
* What are the MC organisms for bacterial, fungal and viral?
68
Bacterial paronychia/felon
* What is the first line txt with and w/o abcess?
* What is second line?
muprocin
69
paronychia/felon-fungal
* What is the first line txt?
Topical antifungals
70
paronychia/felon-viral
* What is the first line txt?
Acyclovir/valacyclovir
71
What is Condylomata acuminata?
Condylomata acuminata (CA), also known as anogenital warts, are manifestations of anogenital human papillomavirus (HPV) infection. CA manifest as variably sized and shaped soft papules or plaques on anogenital skin
72
CONDYLOMA ACUMINATA
* What is key?
* What are the HPV strains for genital warts?
* What are the strains associated with cervical and anal cancer?
73
CONDYLOMA ACUMINATA-HPV
* What is the prevention?
* Who is it recommended for?
* Prevention: Gardasil-9 vaccine
* Recommended for all teens and young adults up to age 26; conditional recommendations up to age 45
74
When are the doses of condyloma acuminata?
First dose: 11 to 12 years
* 2 dose series if first dose before age 15
* 3 dose series if first dose after 15 years
* Doses 6 to 12 months part
75
What are the patient applied HPV txts?
## Footnote
HIP
76
Imiquimod 5% and podofilox 0.5% solution:
* Pregnancy?
* What are the adverse effects?
* Preg: category C (not good)
* Adverse effects: itching, burning, irritation, inflammation; ulceration / erosion less common
77
What are the provider applied HPV txt?
78
What is the DOC during pregnancy for HPV?
Trichloroacetic acid (TCA) = DOC for pregnancy
79
What are the 3 types of common warts?
* Verruca vulgaris
* Verruca plantaris (feet)
* Verruca plana (face)
80
What is the primary txts of common warts? (3)
* Watch and wait
* Salicylic acid
* Cryotherapy
81
Common warts: salicylic acid
* What is the MOA?
* What are their multiple ofs?
* what is the cure rate?
82
Common warts-cryotherapy
* Similar effcacy to what?
* What is the difference between OTC and RX?
* What is the application process?
* What is efficacy?
83
MOLLUSCUM CONTAGIOSUM
* What is the cause?
* What type is most common?
* What is the presentation?
* Molluscum contagiosum virus (MCV) is a poxvirus
* MCV1 MC in US (90%)
* Chronic, localized infection, consisting of flesh-colored, dome-shaped papules
84
What are the first line therapies of molluscum contagiosum?
IF ON GENITALS THEN TXT
85
86
87
Oral herpes lesions:
* What is the txt?
* What is the prophylaxis?
* Txt: Oral Famciclovir and acyclovir 5% cream (not topical unless HIV +)
* prophylaxis: not recommended
88
Herpes gential lesions:
* What is the txt?
* What is the prophylaxis?
* Txt: Valacyclovir, acyclovir, famciclovir
* prop:> 6 recurrences/year Reduces recurrences by 70-80%
89
Varicella Zoster
* What is the txt?
* What is the prophylaxis?
* txt: Valacyclovir, Acyclovir, Famciclovir
* Prop: Vaccination recommended for patients > 50 year
| treatment must be started within 72 hour
90
Varicella zoster:
* What is ramsay hunt?
* What is the txt?
* What is the hutchinson's sign?
91
POST HERPETIC NEURALGIA
* What is given to reduce?
* What is the drug?
92
What are the other txts of post herpetic neuralgia?
93
94
BASIC BURN TREATMENT
* What do you remove?
* What do you txt the pain with?
* Leave what intact?
* Dressing with what?
* Give what if indicated?
95
What is the american burn assoication criteria for burn center referreral?
96
What is the rule of nines?
97
What is the parkland formula?
98
Fluid replacements:
* What are the type of burns that get the replacement?
99
What is HIDRADENITIS SUPPURTIVA?
Multiple comedones, some paired (which is characteristic), associated with several deep exquisitely painful abscesses and old scars
100
What are the non pharm txt of HS?
101
What is the pharm txt for hs (antibiotics, hormone, others)
102
103
Seborrheic keratosis (SK)
* What is the patho?
* What does it look like?
* MC age?
* What is txt?
* Benign proliferation of immature keratinocytes
* Well-demarcated, round or oval lesions with a dull, verrucous surface and a typical stuck-on appearance
* MC > 50 years
* MC asymptomatic Treatment not necessary
* **MC treatment: cryotherapy**
