PANCE PREP PEARLS Flashcards
ALOPECIA AREATA
ETIOLOGY IMMUNE-MEDIATED HAIR LOSS (ASSOCIATED WITH THRYOID, ADDISONS DISEASE)
PRESENTATIONS “SMOOTH CIRCULATE PATCHES OF COMPLETE HAIR LOSS
EXCLAMATION POINT HAIRS”
TREATMENT TOPICAL AND INTRALESIONAL CORTICOSTEROIDS.
ANDROGENETIC ALOPECIA
ETIOLOGY PROGRESSIVE HAIR LOSS- DIHYDROTESOSTERONE IS KEY ANDROGEN LOSS.
PRESENTATIONS MC AFFECTING TEMPORAL SCALP
TREATMENT “MINOXIDIL
ORAL FINASTERIDE: 5-a REDUCTASE INHIBITOR”
ATOPIC DERMATITIS (ECZEMA) ATOPIC TRIAD
“ECZEMA
ALLERGIC RHINITIS
ASTHMA”
ATOPIC DERMATITIS (ECZEMA)
ETIOLOGY ^ IgE PRODUCTION
PRESENTATIONS “ACUTE LESIONS = MC IN FLEXOR CREASES
NUMMULAR ECZEMA= COIN SHAPED”
TREATMENT "TOPICAL CORICOSTEROIDS ANTIHISTAMINES FOR ITCHING WET DRESSING ANTIBIOTICS FOR SECONSARY INFECTIONS. PREVENTIONS: AVOID IRRITANTS. "
CONTACT DERMATITIS
ETIOLOGY IRRITANT CAUSED
PRESENTATIONS “DIAPER RASH
BURNING, ITCHING, ERYTHEMA”
TREATMENT FREQUENT DIAPER CHANGES, TOPICAL PETROLEUM OR ZINC OXOIDE
DYSHIDROSIS (DYSHIDROTIC ECZEMA)
ETIOLOGY “TRIGGERED BY SWEATING/WARM HUMID WEATHER.
^ WITH TIMES OF STRESS”
PRESENTATIONS TAPIOCA-LIKE TENSE VESICLES ON THE SOLES, PALMS AND FINGERS-LATERAL DIGITS.
TREATMENT TOPICAL STEROIDS
LICHEN SIMPLEX CHRONICUS (NEURODERMATITIS)
ETIOLOGY SKIN THICKENING IN PATIENTS WITH ECZEMA- REPETATIVE RUBBING/SCRATCHING
PRESENTATIONS SCALY, ROUGH SKIN WITH EXAGGERATED SKIN LINES
TREATMENT “AVOID SCRATCHING LESIONS
TOPICAL STEROIDS”
PERIORAL DERMATITIS
ETIOLOGY “MC YOUNG WOMEN
HISTORY OF TOPICAL CORTICOSTEROID USE”
PRESENTATIONS
TREATMENT “TOPICAL: METRONIDAZOLE OR ERYTHROMYCIN
ORAL: TETRACYCLINES
AVOID TOPICAL STEROIDS”
LICHEN PLANUS
ETIOLOGY ^ WITH HEPATITIS C PRESENTATIONS "5 P's: PURPLE POLYGONAL PLANAR (Flat-topped) PRURITIC PAPULES w/ FINE SCALES
SKIN, MOUTH, SCALP, GENITALS AND NAILS
KEOBNER’S PNENOMENON: NEW LESIONS AT SITE OF TRAUMA
WICKHAM STRIAE: FINE WHITE LINES ON THE SKIN LESIONS OR ON THE ORAL MUCOSA”
TREATMENT “TOPICAL CORTICOSTEROIDS #1
PO STEROIDS UVB THERAPY #2”
LICHEN PLANUS
5 PS
5 P's: PURPLE POLYGONAL PLANAR (Flat-topped) PRURITIC PAPULES w/ FINE SCALES
PITYRIASIS ROSEA
ETIOLOGY “IDIOPATHIC
CHILDREN/YOUNG ADULTS”
PRESENTATIONS “HERALD PATCH: SOLITARY SALMON-COLORED MACULE —–>
CHRISTMAS TREE PATTERN”
TREATMENT NONE NEEDED
PSORIASIS
ETIOLOGY STRATUM BASALE + STRATUM SPINOSUM —-> T CELL ACTIVATION
PRESENTATIONS “PLAQUE : MC TYPE—RAISED, DARK RED PLAQUES/PAPULES WITH THICK SILVER/WHITE SCALES
PUSTULAR: YELLOW NON-INFECTED PUSTULES
GUTTATE: SMALL, ERYTHEMATOUS PAPULES WITH FINE SCALES
PSORIATIC ARTHRITIS”
TREATMENT “MILD-MODERATE: TOPICAL STEROIDS
MODERATE/SEVERE: POTOTHERAPY, UVB
SYSTEMIC: METHOTREXATE”
PIRYRIASIS (TINEA) VERSICOLOR
ETIOLOGY MALASSIZEA FURFUR - OVERGROWTH OF THIS YEAST
PRESENTATIONS HYPER/HYPOpigmentation w/ WELL DEMARCATED MACULES WITH FINE SCALING
DIAGNOSIS “KOH PREP: HYPHAE AND SPORES (SPEGHETTI AND MEATBALLS)
“
TREATMENT TOPICAL ANTIFUNGALS: SELENIUM SULFIDE, SODIUM SULFACETAMIDE, ZINC PYRITHIONE, “ AZOLES”
SEBORRHEIC DERMATITIS
ETIOLOGY HYPERSENSITIVITY TO MALASSEZIA FURFUR YEAST PRESENTATIONS "CRADLE CAP: INFANTS ADULTS: DANDRUFF" DIAGNOSIS TREATMENT "TOPICAL: SELENIUM SULFIDE- SELSON BLUE SODIUM SOLFACETAMIDE KETOCONAZOLE SYSTEMIC: ORAL ANTIFUNGALS"
CUTANEOUS DRUG REACTIONS
ETIOLOGY “TYPE 1- IgE Mediated- Urticaria/angioedema- Immediate
TYPE 2 - Cytotoxic
TYPE 3- Immune antibody-antigen complex
TYPE 4- Delayed (Cell mediated)”
PRESENTATIONS “Exanthematous/Morbiliform Rash
- Bright Red macules & papules that form plaques
Uticarial
- 2nd MC”
TREATMENT Antihistamens and Systemic Coricosteroids
UTICARIA (HIVES) & ANGIOEDEMA
ETIOLOGY “Type 1 HSN IgE
MAST CELLS RELEASE HISTAMINE”
PRESENTATIONS UTICARIA- BLANCHABLE, EDEMATOUS PAPULES, WHEALS AND PLAQUES
TREATMENT ORAL ANTIHISTAMINES
ERYTHEMA MULTIFORME
ETIOLOGY “ACUTE SELF-LIMITED TYPE IV HYPERSENTISIVITY REACTION
HERPES SIMPLEC VIRUS MC”
PRESENTATIONS TARGET (IRIS) LESIONS
TREATMENT SYMTOMATIC- STEROIDS/BENADRYL
STEVENS-JOHNSON SYNDROME (SJS) & TOXIC EPIDERMAL NECROLYSIS (TEN)
ETIOLOGY DRUG ERUPTIONS —-> SULFA/ANTICONVULSANT MEDS
PRESENTATIONS “WIDESPREAD BLISTERS
>1 MUCOUS MEMBRANE w/ EPIDERMAL DETACHMENT”
DIAGNOSIS “>1 MUCOUS MEMBRANE w/ EPIDERMAL DETACHMENT
NIKOLSKY SIGN- Able to make a new blister with pencil eraser. “
TREATMENT TREAT LIKE SEVERE BURNS
ACENE VULGARIS
ETIOLOGY “4 MAIN PAHTO FACTORS:
INCREASED SEBUM PRODUCTIONS:
- ^ ANDROGENS
CLOGGED SEBACEOUS GLANDS
PROPIONIBACTERIUM ACNE OVERGROWTH
INFLAMMATORY REPSONSE"
PRESENTATIONS "COMEDONES:
- OPEN ==== BLACKHEADS
- CLOSED ==== WHITEHEADS
INFLAMATORY
NODULAR OR CYSTIC ACNE"
DIAGNOSIS "MILD: Comedones w/ small papules
MODERATE:Comedones w/ large papules
SEVERE: Nodular >5mm or cystic "
TREATMENT "MILD: TOPICAL RETINOIDS + BENZOYL PEROXIDE
MODERATE: TOPICAL/SYSTEMIC ANTIBIOTICS (DOXY) +/- KERATOLYTIC +/- TOPICAL RETINOID
SEVERE: ISOTRETINOINS
- HIGHLY TERATOGENIC"
ACENE VULGARIS
TREATMENT
“MILD: TOPICAL RETINOIDS + BENZOYL PEROXIDE
MODERATE: TOPICAL/SYSTEMIC ANTIBIOTICS (DOXY) +/- KERATOLYTIC +/- TOPICAL RETINOID
SEVERE: ISOTRETINOINS
- HIGHLY TERATOGENIC”
ROSACEA
ETIOLOGY “IDIOPATHIC
TRIGGERS: ETOH, ^ TEMPERATURE
“
PRESENTATIONS ACNE-LIKE RASH + ERYTHEMA, FACIAL FLUSHING, TELANGIECTASIA, SKIN COARSEING, PAPULOPUSTULES
TREATMENT METRONIDAZOLE
ACTINIC KERATOSIS
ETIOLOGY "MC- fiar skinned Parmers PREMALIGNANT CONDITION TO SQUAMOUS CELL CARCINOMA MC- PREMALIGNANT SKIN CONDITION" PRESENTATIONS "DRY, ROUGH, SCALY -SANDPAPER- SKIN LESIONS HYPERKERATOTOC-HYPERPIGMENTED" DIAGNOSIS BIOPSY TREATMENT "DERM-REFERAL CRYOSURGERY"
SEBORRHEIC KERATOSIS
ETIOLOGY MC BENIGN SKIN TUMOR
PRESENTATIONS SMALL PAPULE/PLAQUE VELVETY WARTY LESIONS—— GREASY/STUCK ON APPEARANCE
TREATMENT NO TREATMENT NEEDED
VITILIGO
ETIOLOGY AUTOIMMUNE DESTRUCITON OF MALANOCYTES —-> DEPIGMENTATION
PRESENTATIONS
TREATMENT “LOCALIZED ====> TOPICAL STEROIDS
DISSEMINATED: SYSTEMIC PHOTOTHERAPY”
BASAL CELL CARCINOMA
ETIOLOGY “MC TYPE OF SKIN CANCER IN US
SLOW GROWING w/ LOW INCIDENTS OF METASTISIS”
PRESENTATIONS TRANSLUCENT/PEARLY/WAXY PAPULE AND CENTRAL ULCERATION
DIAGNOSIS PUNCH OR SHAVE BIOPSY
TREATMENT “ELECTRODESICCATION/CURETTAGE
MOHS MICROGRAPHIC SURGERY FOR FACIAL INVOVLMENT”
MALIGNANT MELANOMA
ETIOLOGY “UV RADIATION
AGGRESIVE HIGH METS POTENTIAL——> MC SKIN CANCER RELATED TO DEATH
4 MAJOR SUBTYPES
- SUPERFICIAL SPREADING- MC TYPE
- NODULAR
- LENTIGO MALIGNA
- ACRAL LENTIGINOUS”
PRESENTATIONS “ABCDE’S
ASYMMETRY
BORDERS: IRREGULAR
COLOR: DARK/BLACK
DIAMETER: >6MM
EVOLUTION: RAPID CHANGE”
DIAGNOSIS FULL-THICKNESS WIDE EXCISIONAL BIOPSY + LYMPH NODE BIOPSY
TREATMENT COMPLETE WIDE SURGICAL EXCISION
MALIGNANT MELANOMA
ETIOLOGY
“UV RADIATION
AGGRESIVE HIGH METS POTENTIAL——> MC SKIN CANCER RELATED TO DEATH
4 MAJOR SUBTYPES
- SUPERFICIAL SPREADING- MC TYPE
- NODULAR
- LENTIGO MALIGNA
- ACRAL LENTIGINOUS”
MALIGNANT MELANOMA
ABCDES
“ABCDE’S
ASYMMETRY BORDERS: IRREGULAR COLOR: DARK/BLACK DIAMETER: >6MM EVOLUTION: RAPID CHANGE"
SQUAMOUS CELL CARCINOMA OF THE SKIN
ETIOLOGY “OFTEN PRECEDED BY ACTINIC KERATOSIS
HPV INFECTION
BOWMENS DISEASE = SQUAMOUS CELL CARCINOMA IN SITU
“
PRESENTATIONS RED- ELEVATED, THICKEND NODULE W/ WHITE SCALY OR CRUSTED BLOODY MARGINS
DIAGNOSIS BIOPSY
TREATMENT WIDE LOCAL SURGICAL EXCISION TREATMENT OF CHOICE
IMPETIGO: NON- BULLOUS
ETIOLOGY “STAPH AUREUA
VERY CONTAGIOUS”
PRESENTATIONS “SMAL MACULE BECOMES PAPULE, THEN VESICLE THAT RUPTURES AND DEVELOPS HONEY-COLORED CRUST
-All Ages”
TREATMENT MUPIROCIN
IMPETIGO: BOLLOUS
ETIOLOGY STAPH AUREUA toxin causes flaccid bullae that rupture, minimal redness
PRESENTATIONS Less contagiousInfants- Preschool
TREATMENT MUPIROCIN
CELLULITIS
ETIOLOGY “STAPH AUREUS & GROUP A BETA HEMOLYTIC STREPTOCOCUS
“
PRESENTATIONS “LOCAL: MACULAR ERYTHMEA —-> NOT SHARPLY DEMARCATED
SYSTEMIC: NOT COMMON”
DIAGNOSIS
TREATMENT “CEPHALEXIN, DICLOXACILLIN
MRSA: IV VANCOMYCIN”
SCABIES
ETIOLOGY “SARCOPTES SCABIEI
BURROW INTO THE SKIN AN LAY EGGS/FEED/DEFECATE”
PRESENTATIONS “INTENSELY PRURITIC LESIONS- LINEAR BURROWS
WEB SPACES BETWEEN FINGERS/TOES SCALP
RED ITCHY PRURUITC PAPULES OR NODULES ON THE SCROTUM/GLANS/PENIL SHAFT/BODY FOLDS”
DIAGNOSIS
TREATMENT “PERMETHRIN TOPICAL
LINDANE- DO NOT USE AFTER BATH/SHOWER——-> SEIZURES
CI: TERATOGENIC- NO BREASTFEEDING”
PEDICULOSIS (LICE)
ETIOLOGY "PEDICULUS HUMANUS CAPITUS
PERSON TO PERSON"
PRESENTATIONS "INTENSE ITCHING, PAPULAR URTICARIA NEAR THE LICE BITES
NITS- WHITE OVAL EGGS CAPSULES
LYMPHADENOPATHY"
DIAGNOSIS
TREATMENT "PERMETHRIN TOPICAL
LINDANE- DO NOT USE AFTER BATH/SHOWER-------> SEIZURES
CI: TERATOGENIC- NO BREASTFEEDING"PEMPHIGUS VULGARIS
ETIOLOGY Autoimmune —-> desmosome distruption
PRESENTATIONS Painful flaccid skin bullae- rupture easily
DIAGNOSIS IgE throughout the epidermis
TREATMENT HIGH DOSE CORTICOSTEROIDS
BROWN RECLUSE SPIDER BITES
ETIOLOGY MC IN SOUTHWEST & MIDWEST
PRESENTATIONS “LOCAL EFFECTS: BURNING/ERYTHMEA
RED HALO
HEMORRHAGIC BULLAE THAT UNDERGOES ESCHAR FORMATION”
DIAGNOSIS
TREATMENT “LOCAL WOUND CARE- CLEAN WITH SOAP AND WATER- COLD PACK
PAIN CONTROL - NSAIDS”
BLACK WIDOW SPIDER BITES
ETIOLOGY CLINICAL PROBLEM- NOT A SURGICAL PROBLEM (HOBO-SURGICAL PROBLEM)
PRESENTATIONS “< 8 HOURS AFTER BITE
LOCAL SYMPTOMS: ASYMPTOMATIC OR PAINFUL
SYSTEMIC: MUSCLE PAIN, SPASMS AND RIGITIDY- ABD CRAMPS”
DIAGNOSIS
TREATMENT “MILD: WOUND CARE/ PAIN CONTROL
MODERATE/SEVERE: OPOIODS AND MUSCLE RELAXANTS”
MILIARIA
ETIOLOGY "PRURITIC RASH CAUSED BY TRAPPED SWEAT OCCURS IN WARM MOIST AREAS OF BODY" PRESENTATIONS DIAGNOSIS TREATMENT "CONTROL HEAT REDUCED SWEAT ANTIHISTAMIES STEROIDS"
DERMATITIS HERPETIFORMIS aka “DUHRING”
ETIOLOGY "NOT RELATED TO HERPES VIRUS AUTO IMMUNE LINKED WITH CELIAC DZ" PRESENTATIONS PRURIGO PAPULES AND VESICLES WHICH ARISE ON NORMAL OR REDDNED SKIN. DIAGNOSIS BX TREATMENT "TOPICAL STEROIDS ANTIBIOTICS TO PREVENT SECONDARY BACTERIAL INFECTION. GLUTEN FREE DIET"
EPIDERMOLYSIS BULLOSA
ETIOLOGY RARE GENETIC PRESENTATIONS NORMAL DAILY ABBRASION CAUSES BLISTER FORMATION DIAGNOSIS TREATMENT "NO CURE BEST TREATMENT IS PREVENTION"
