Pance pearls Flashcards
1
Q
Triggers of Dishydrosis
A
Sweating, emotional stress, warm weather, metals
2
Q
Pruritus “tapioca pudding” tense vesicles on palms, soles and fingers
A
Dishydrosis
3
Q
Management of Dishydrosis
A
Topical steroids (high strength)- ointments preferred
4
Q
What is atopic dermatitis linked with?
A
Hay fever, allergy, allergic rhinitis, asthma, & other atopic dx
5
Q
Altered immune reaction in genetically susceptible population when exposed to triggers –> T-cell mediated immune activation with increase in IgE production
A
Atopic dermatitis
6
Q
Triggers of atopic dermatitis?
A
heat, perspiration, allergens, and contact irritants
7
Q
What is the hallmark clinical manifestation of atopic dermatitis?
A
Pruritus- “itch-scratch cycle”
8
Q
Tiny, erythematous, edematous ill-defined blisters –> dries/crusts over and scales. MC in flexor creases (anticubital & popliteal folds)
A
atopic dermatitis
9
Q
Sharply defined coin-shaped lesions on dorsal hand, feet extensor surface
A
Nummular eczema
10
Q
Management of atopic dermatitis
A
High strength topical steroids & antihistamines for itching
11
Q
Skin thickening in patients with eczema secondary to repetitive rubbing/scratching
A
Lichen simplex chronicus
12
Q
Scaly, well-demarcated rough plaques with exaggerated skin lines
A
Lichen simplex chronicus
13
Q
Management of LSC?
A
Topical steroids (high strength) and avoid scratching
14
Q
Where does lichen planus develop?
A
Flexor surfaces of extremities, mucous membranes on skin mouth, scalp, genitals, or nails
15
Q
In which disease do you see lichen planus more often?
A
HCV infection
16
Q
What are the 5 P’s for lichen planus?
A
Purple, polygonal, planar, pruritic papules with fine scales
17
Q
What type of lesions can be seen in the oral mucosa with lichen planus?
A
Lacy lesions (Wickham striae)
18
Q
Management of lichen planus?
A
Topical steroid ointment and antihistamines
19
Q
Herald patch (solitary salmon-colored macule) on trunk –> general exanthem 1-2 weeks later with smaller, round/oval salmon-colored papules with white circular (collarette) scaling along cleavage lines. VERY PRURITIC
A
Pityriasis rosea
20
Q
What rash pattern is seen with Pityriasis rosea?
A
Christmas tree
21
Q
Management for Pityriasis rosea
A
None needed
22
Q
What is the pathophysiology of psoriasis?
A
Keratin hyperplasia (proliferating cells in the stratum basale and stratum spinosum due to T-cell activation & cytokine release). Leads to epidermal thickening and continuous turnover of the dermis
23
Q
Plaques seen in Psoriasis?
A
- MC type
- raised dark red plaques/papules with thick silver/white scales
- found on extensor surfaces and scalp
- Nail pitting in 25%
24
Q
What signs/phenomenon are seen with Psoriasis?
A
Auspitz sigmn and Koebner’s phenomenon
25
Clinical manifestations of Pustular psoriasis?
Deep, yellow non-infected pustules --\> red macules on palms/soles
26
Clinical manifestations of Guttate psoriasis?
* small, erythematous papules with fine scales, discrete lesions, and confluent plaques
27
What inflammatory condition is seen with psoriasis?
Psoriatic arthritis
28
Sx of psoriatic arthritis?
* Stiffness \>30mins relived with activity
* Sausage digits
* X-ray: pencil in cup deformity
29
Management of psoriasis?
* Topical steroids, tar-based anthralin, Vit. D analnogs & retinoid
* UBV light therapy , immune agents
30
Occurs in areas of high sebaceous glands over secretion (scalp, face, eyebrows, body folds)
Seborrheic dermatitis
31
What do you have a hypersensitivity too in seborrheic dermatitis?
Pityrosporum ovale
32
What does seborrheic dermatitis present as in infants?
Cradle cap
33
Erythematous plaques with fine white scales common on the scalp (dandruff)
Seborrheic dermatitis
34
Management of seborrheic dermatitis?
Selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream), steroids, zinc pyrithione
35
Type I HSN (IgE) reaction of dermis or SQ tissues
Urticaria (Hives)
36
Triggers of Urticaria (Hives)?
* foods
* meds
* infections
* insect bites
* drugs
* environmental
37
What is the pathophys of Urticaria (Hives)?
Mast cells release histamine causing vasodilation of venules --\> edema of dermis and SQ tissues
38
Blanchable, edematous pink papules, wheals, or plaques that are oval, linear, or irregular
Urticaria (Hives)
39
What is Darier's sign?
Localized urticaria appearing where skin is rubbed (histamine induced)
40
What is the tx of choice for Urticaria (Hives)?
oral antihistamines
41
Acute, self-limiting type IV HSN rxn most common in adults 20-40 y/o
Erythema multiforme
42
What infections are assoicated with erythema multiforme?
* HSV most common
* mycoplasma
* s. pneumo
43
What meds are associated with erythema multiforme?
* sulfa drugs
* beta-lactams
* phenytoin
* phenobarbital
44
What type of lesion is pathognomonic of erythema multiforme?
TARGET (iris) lesions
45
Dull, "dusty-violet" red, purpuric macule/vesicle or bullae in center surrounded by pale edematous rim & peropheral halo. Patient often FEBRILE
Erythema multiforme
46
What are the guidelines for erythema multiforme minor?
* target lesions distributed acrally
* no mucosal membrane lesions
47
What are the guidelines for erythema multiforme major?
* target lesions with involvement of \>1 mucous membranes (oral, genital, ocular mucosa)
* \<10% BSA acrally --\> centrally
* no epidermal detachment
48
Management of erythema multiforme?
* Symptomatic: discontinue drug causing rash
* can also use steroid mouthwashes for oral lesions
49
What most commonly causes SJS and TEN?
Drug eruptions esp. Sulfa and antioconvulsant meds and infections like Mycoplasma, HSV, HIV, malignancy
50
What % of sloughing of BSA is seen in SJS and TEN?
* SJS: \<10%
* TEN: \>30%
51
What sign is positive in SJS and TEN?
Nikolsky sign: pushing a blister causes further separation of the dermis
52
What are the clinical manifestations of SJS and TEN?
* Fever & URI sx
* Widespread blisters begin on trunk/face
* erythematous/pruritic macules \>1 mucous membrane with epidermal detachment
53
Management of SJS and TEN?
treat like severe burns
54
4 main pathophysiologic factors of acne vulgarus
* Increased sebum production: MC due to puberty (increased androgens)
* Clogged sebaceous glands
* Propionibacterium acne overgrowth in blocked pores
* Inflammatory response
55
Clinical manifestations of acne vulgaris?
* Comedones
* Inflammatory papules or pustules
* Nodular or cystic acne --\> often heals with scarring
56
What is an open comedone?
Blackhead --\> due to incomplete blockage
57
What is a closed comedone?
Whitehead --\> complete blockage
58
What is seen in mild acne?
Comedones w or w/o small amounts of papules or pustules
59
What is seen in moderate acne?
Comedones with larger amounts of papules and/or pustules
60
What is seen in severe acne?
Nodular or cystic acne
61
What is the management for mild acne?
* topical retinoids
* benzyl peroxide
* topical abx
* OCPs
62
What is the management for moderate acne?
Same as mild acne but can add oral abx like doxy or minocycline and spironolactone (anti-androgen agent)
63
What is the management for severe acne?
Isotretinoins
64
What are the side effects of Isotretinoins?
* Highly teratogenic
* psych side effects
* hepatits
* increased triglycerides/cholesterol
* MUST obtain 2 pregnancy tests prior to starting & monthly while on it
65
What is considered "adult acne"?
Rosacea
66
Triggers of Rosacea?
* EtOH
* increased temperature
* hot drinks
* hot/cold weather
* hot baths
* spicy foods
67
Acne-like rash with erythema, facial flushing, telangiectasia, skin coarsening, papulopustules with burning/stinging
Rosacea
68
What distinguishes rosacea from acne?
Absence of comedones
69
What is first line treatment for rosacea?
Topical metronidazole and clonidine may be used for flushing
70
Lifestyle modifications for rosacea?
* sunscreen
* avoid toners
* astringent menthols
* camphor
71
What population is actinic keratosis most commonly seen in?
fair-skinned elderly with prolonged sun exposure
72
What is actinic keratosis a premalignant condition to?
squamous cell carcinoma
73
Dry, rough, scaly "sandpaper" skin lesions or edematous, hyperkeratotic plaques
Actinic keratosis
74
How do you diagnose actinic keratosis?
epidermal/dermal cells with large hyper chromatic nuclei
75
Management of actinic keratosis?
* Observation
* Surgical: cryotherapy or dermabrasion
* medical: 5FU or imiquimod
76
What is the pathophysiology of vitiligo?
Autoimmune destruction of melanocytes that leads to skin depigmentation
77
Irregular macules & patches of total depigmentation
vitiligo
78
Management of vitiligo?
* Systemic phototherapy (may aid in repigmentation)
* laser therapy (effective on limited areas)
79
What is the most common benign skin tumor that is seen in fair-skinned elderly with prolonged sun exposure?
Seborrheic keratosis
80
Small papule/plaque velvety warty lesion with "greasy/stuck on appearance"
varied colors: flesh-colored, brown, black, grey
Seborrheic keratosis
81
Management of seborrheic keratosis?
Benign= NO TREATMENT NEEDED! :)
Can use cryotherapy for cosmetic reasons
82
Most common type of skin cancer in the US
Basal cell carcinoma
83
Where is basal cell carcinoma most commonly seen?
Fair-skinned with prolonged sun expsoure and xeroderma
84
Slow growing
Locally invasive but _very low incidence of metastasis_
Basal cell carcinoma
85
Flat, firm area with small, raised, _translucent/pearly/waxy papule with central ulceration & raised, rolled borders_
MC on face/nose/trunk
Often friable (bleeds easily)
Basal cell carcinoma
86
How do you dx basal cell carcinoma?
Punch or shave biopsy
87
What is the tx of choice for basal cell carcinoma?
Electric desiccation/curettage
88
2nd MC skin cancer
Squamous cell carcinoma
89
What often preceeds squamous cell carcinoma?
* **Actinic keratosis**
* **HPV infection**
* Sun/envrio exposure
* Xeroderma pigmentosum
90
Where on the body is SCC most commonly found?
Lips, hands, neck & head
91
Pathophysiology of SCC?
Malignancy pf keratinocytes of skin/mucous membranes: hyperkeratosis & ulceration
92
What is Bowen's disease?
SCC in situ --\> slow growing
93
Red, elevated nodule with white scaly or crusted bloody margins
Squamous cell carcinoma
94
How do you dx SCC?
Biopsy: epidermal & dermal cells with large, pleomorphic, hyperchromatic nuclei
95
Tx of choice for SCC?
Excision!!
96
What % of cases of malignant melanoma are associated with UV radiation?
80%
97
Agressive with high METS potential
Malignant melanoma
98
In which population is malignant melanoma most commonly seen?
Caucasian patient with light hair/eye color
Also pt's with Xeroderma pigmentosum
99
"ABCDE" of malignant melanoma
* Asymmetry
* Borders: irregular
* Color: variation (dark blue, black)
* Diameter: \>6mm
* Evolution (suspect in a lesion with recent/rapid change in appearance)
100
What is the most important prognostic factor for METS in malignant melanoma?
Thickness
101
What is the MC skin cancer death?
Malignant melanoma
102
How do you dx malignant melanoma?
Full-thickness wide excisional bx with LN biopsy
103
Management of malignant melanoma?
Excision (lymph node bx or dissection)
104
What is the MC neoplasm seen in HIV/immunocompromised?
Kaposi sarcoma
105
Connective tissue cancer caused by HHV-8
Kaposi sarcoma
106
Macular, popular, nodule, plaque-like brown/pink/red or violaceous lesions
Kaposi sarcoma
107
Management for Kaposi sarcoma?
HAART therapy
108
Highly contagious superficial vesiculopustular skin infection primarily on exposed surface of face and extremities
Usually multiple lesions
Impetigo
109
Risk factors of impetigo?
* warm, humid conditions
* poor personal hygeine
110
Where does impetigo most often occur?
@ sites of superficial skin trauma (eg insect bites)
111
What is nonbullous impetigo?
* Impetigo contagiosa: vesicles, pustules
* characteristic "honey-colored crusts"
* MC type!
112
What is the MC and 2nd MC cause of nonbullous impetigo?
1st: S. aureus
2nd: GABHS
113
What is bullous impetigo?
Vesicles form large bullae (rapidly) --\> rupture --\> thin "varnish like crusts"
114
What is the MC cause of bullous impetigo?
S. aureus
115
Is bullous impetigo common?
NO, but usually seen in newborn/young children
116
What is ecthyma impetigo?
Ulcerative pyoderma caused by GABHS (heals with scarring)
Not common
117
What is the DOC for impetigo?
Mupirocin (Bactroban)
118
What tx is used for extensive impetigo dx?
Systemic abx (Cephalexin, Dicloxacillin)
119
What is cellulitis?
Acute, spreading superficial infection of dermal, subcutaneous tissues
120
What bacterias cause cellulitis?
S. aureus and group A strep
H. influenza/S. pneumonia in children
121
How does cellulitis usually occur?
Break in the skin
122
Local manifestations of cellulitis?
macular erythema (margins flat, not sharply dermarcated), swelling, warmth, and tenderness
123
Tx for cellulitis?
Abx for 7-10 days: Cephalexin or Dicloxacillin
124
Systemic manifestations of cellulitis?
Fever, chills, +/- tender lymphadenopathy, **+/- lymphangitis (erythematous streaking),** myalgias
vesicles, bullae, hemorrhage, and necrosis may form
125
What abx should you use for cellulitis caused by a cat bite? :)
Augmentin for Pasteurella multocida
126
