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Professional Development > Part 18 > Flashcards

Part 18 Flashcards

1
Q

Leser trelat sign

A

A sudden increase in seborrheic keratosis #’s suggestive of internal malignancy in the body

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2
Q

Pyogenic granuloma

A

A benign acquired vascular lesion of the skin 2ndary to skin trauma, lobular and extremely friable

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3
Q

Dermatofibroma

A

Benign cell proliferation that appears like a wad of scar tissue that dimples down upon pinching, more common in females due to shaving trauma

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4
Q

Keloid treatment

A

Only intralesional steroids will help

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5
Q

Epidermal inclusion cyst

A

Mobile subcutaneous nodule often with overlying punctum that does NOT arise from sebaceous glands, have a foul smelling white discharge, sterile and do not require antibiotics

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6
Q

Milia

A

Tiny epidermoid cyst often on the face and tends to resolve in infancy but may persist if occur in adulthood

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7
Q

Skip areas

A

Spots of superficial basal cell carcinomas that remain low in the dermis and continue to replicate even after excision of all the visible lesion - can be avoided by performing mohs procedure to ensure excising what is missed

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8
Q

Important pre-existing factors when considering dermatologic procedure (4)

A
  • anticoagulant/bleeding
  • immunosuppression
  • diabetes
  • cardiovascular disease (the epi injection can be a big deal)
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9
Q

Shave vs punch vs excisional biopsy

A
  • A shave takes a superficial layer and says nothing about the depth of the lesion, but can allow for wide excision, does not scar
  • A punch biopsy is a deep incision all the way to the fatty layer of tissue to see how deep a lesion is
  • excisional is removal of the entire lesion (diff from incisional which is partial), done in the case of suspect of melanoma within a few cm margins of extra spacing
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10
Q

PUVA

A

Combination of psoralen and UVA therapy used to treat skin conditions, with the psoralen making it more sensitive to the UV allowing for deep penetrating work on the skin

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11
Q

Actinic keratosis, if left untreated, can degranulate and turn into…

A

….squamous cell carcinoma

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12
Q

The key to painless lidocaine injections is….

A

….slow speed of injection with a small diameter needle

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13
Q

Cellulitis differs from erysipelas in that it…

A

…affects deeper dermis and sub Q opposed to the superficial dermis and has poorly demarcated borders

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14
Q

Necrotizing fascitis

A

Flesh eating, rapidly spreading infection of deep fascia with inflammation leading to necrosis, can be idiopathic or due to trauma or surgical wounds and has a mortality rate of 30% requiring surgical treatment and antibiotics quickly

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15
Q

Fournier’s gangrene

A

Necrotizing fasciitis of the perineum region

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16
Q

Predominant infection obtained from dog/cat bites

A

Pasteurella multocida

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17
Q

___% of cat bites become infected, ___% of dog bites do

A

80, 5

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18
Q

2 booster vaccines for animal bites

A

-tetanus -rabies

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19
Q

Pseudofoliculitis barbae

A

Refers to razor bumps of the beard

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20
Q

Nikolsky’s sign

A

Slight rubbing of skin resulting in exfoliation and wet appearance of skin indicating staph scalded skin syndrome

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21
Q

Community acquired MRSA vs Hospital acquired differentiaion

A

Considered community acquired if not undergone any medical procedure or hospitalized within the past year

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22
Q

CA (3) and HA (2) MRSA treatment

A

Community: -Sulfamethoxazole (bactrim) -tetracyclines -clindamycin Hospital: -vancomycin -linezolid

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23
Q

Ways to test for fungal infections (3) and which is the gold standard

A

-KOH prep -culture (gold standard but takes time) -woods lamp

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24
Q

Cornyebacterium minitussiumm

A

Causes erythasma, and is NOT a fungus but fluoresces with a woods lamp with a bright coral red color

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25
Q

All types of tinea respond to the same oral and topical agents except…

A

…tinea versicolor

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26
Q

“one hand, 2 feet syndrome”

A

Refers to moccasin type presentation of tinea pedis where an affected hand shows unilateral scalingin creases and indicates to look at feet for tinea pedis

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27
Q

Pitted keratolysis and what is the recommended treatment

A

A bacterial in origin condition often mistaken for tinea pedis or plantar warts that has much lowered severity of itchiness and pain and appears as little pitted spots on soles of feet, treated with drysol (aluminum chloride)

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28
Q

Tine corporis treatments (2)

A

-Topical antifungals for at least 2 weeks (sue even if goes away visually) -oral antifungals if resistant but watch liver function

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29
Q

If dermatitis is treated with topical steroids, it will initially appear ___ and this is called ____

A

better, tinea incognito

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30
Q

___ agents do not work for tinea capitis

A

TOPICAL

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31
Q

Inflammatory tinea capitis is a dermotologic emergency because…

A

…it can lead to permanent balding and scarring

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32
Q

Tinea versicolor (pityriasis versicoor)

A

A yeast infection not a dermatophyte, can cause some itching and can appear very variantly but does not have visible scale until rubbed with finger or scalpal blade (differentiates from tinea corporis)

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33
Q

Tinea versicolor (pityriasis versicolor) treatments (3)

A

-Topical shampoos (selenium sulfide) -imidazole creams -oral medications such as fluconazole but monitor liver

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34
Q

Seborrheic dermatitis

A

Also known as dandruff, common inflammatory rxn to eyast that thrives on seborrheic skin and causes inflammation to normal flora, chronic condition that can be controlled but not cured

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35
Q

Seborrheic dermatitis treatments (2)

A

-Topical shampoos (selenium sulfide) -imidazole creams

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36
Q

Diaper candidiasis treatments (1) and what treatment should be avoided

A

-nystatin cream Combination therapieswith high potency steroids

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37
Q

Keratolytic agents

A

Drugs that promote the shedding of the stratum corneum layer of skin causing peeling to extensive desquamation

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38
Q

Salicylic acid drug class and function

A

Keratolytic agent, promotes desquamation by disllolving intracellular cement that binds scales to stratum corneum used in low conc. to treat dandruff, seborrheic dermatitis, acne, psoriasis, warts, and corn

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39
Q

Salicylic acid ADR

A

-salicylism (same as in aspirin thru absopriton of skin) casuing tinnitus and hyperpnea

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40
Q

Benzoyl peroxide function

A

First line drug employed topically to treat mild to moderate acne, penetrates stratum corneum or follicular openings unchanged converted metabolically within epidermis promoting keratoysis and suppressing growth of P. acnes (does not cause resistance)

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41
Q

Dapsone function

A

Topical agent that provides modest decrease in inflammation often as an alternative to benzoyl peroxide

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42
Q

Tretinoin drug class and function

A

Retinoids, derivatives of vit A, approved for treatment of mild to moderate acne thru decreasing cohesion between epidermal cells remove existing comedones aand preventing formation of new plugs

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43
Q

Isotretinoin (accutane) ADR’s (7)

A
  • nosebleeds
  • inflamation of lips
  • dryness and itching of skin, nose and mouth
  • loss of night vision
  • UV sensitivity
  • psychological effects
  • teratogenic during pregnancy
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44
Q

iPledge program

A

FDA mandated program to manage accutane related teratogenicity requires 2 active forms of birth control

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45
Q

Methotrexate drug class and function

A

Immunosuppressent, cytotoxic agent that targets tissues with high growth rate, only should be used when severe psoriasis has not responded to safer therapy

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46
Q

Methotrexate ADR’s

A
  • systemic administration can result in toxic effects
  • GI effects
  • bone marrow suppression
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47
Q

Cyclosporine drug class and function

A

Immunosuppressant that can treat moderate to severe psoriasis

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48
Q

Tumor necrosis factor antagonsists function

A

Inhibition of TNF suppresses immune function reducing inflammation in psoriais, very effective but can increase risk of opportunistic infections

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49
Q

Interleukin 12/23 antagonists function

A

Human monoclonal antibody directed againast interleukins 12 and 23 that promte inflammatory response, to decrease psoriasis

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50
Q

Ketoconazole function

A

Antifungal cream and shampoo for seborrheic dermatitis

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51
Q

Finasteride (propecia) drug class and function

A

5-a reductase inhibitor, Indicated for treatment of hair loss of males, inhibits conversion of testosterrone to DHT causing decrease in DHT conc. in scalp

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52
Q

Flurouracil function

A

PO antineoplastic agent used for topical treatment of multiple actinic keratoses and superficial basal cell carcinoma thru interupting DNA and RNA synthesis

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53
Q

Tacrolimus (protopic) oitnment drug class and function

A

Calcineurin inhibitor (immunosuppressent) used to treat severe atopic dermatitis by reducing local immune response

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54
Q

UVA vs UVB

A

UVA is 95% of terrestrial UV radiation and penetrates skin much more deeply causing most skin aging, UVB is 5% and main cause of tanning and sunburn

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55
Q

SPF to sunburn protection relationship

A

As SPF increases, protection increment becomes smaller, with values greater than 30 providing minimal benefit and products not being allowed to be labeled above 50 (just called 50+)

56
Q

Mupirocin (bactroban) function

A

Inhibitor of protein synthesis and thus bactericidal topical agent against MRSA often used to treat impetigo or intranasal use for elimination of nasal carriage of S aureus

57
Q

2 DOCs for scabies and pediculosis (lice)

A

permethrin and malathion

58
Q

Permethrin function

A

Agent of choice for mites and lice, toxic to them and their ova killing them by causing paralysis with minimal side effects

59
Q

Malathion function

A

Agent of choice for mites and lice, has enzyme that kills lice and ova as an insecticide, devoid of significant ADR’s

60
Q

The lowest risk for skin cancer development is fitzpatrick skin type ___, the highest risk is fitzpatrick skin type ___

A

VI,I

61
Q

3 common types of skin cancer and info about them

A

80% - Basal cell carcinoma (arises stratum basale), typically does not metastasize and is locally destructive
20% - squamous cell carcinoma (arises epidermis), substantial risk of metastasis and AK is precursor
1% - melanoma (melanocytes in stratum basale), most aggressive and most likely to metastasize

62
Q

Pathologic staging of melanoma (2 ways)

A
  • breslow thickness (preferred)
    • clark level
63
Q

Golden rule of diagnosis of skin cancer

A

Always obtain full thickness specimen, not shave biopsy

64
Q

Koplik’s spots

A

Red spots with bluish white centers that appear in the mouth as an enanthem before exanthem spreading systemically indicative of measles infection

65
Q

Measles symptoms

A

Severe cough, nasal congestion, photophobia, koplik’s spots 24-48 hrs before exanthem outbreak

66
Q

Exanthem definition

A

A skin eruption that comes quickly and affects several areas at a time, a rash essentially

67
Q

Enanthem definition

A

A mucus membrane eruption that comes quickly and effects several areas at a time

68
Q

Hand foot and mouth disease

A

Caused by coxsackievirus A16 spread via fecal oral route often in kids resulting in low grade fever, sore throat, and lymphadenopathy, with 90% developing enanthem oral lesions followed by red macules that become pale, white, oval vesicles on palms, soles, face, and buttocks

69
Q

Scarlet fever

A

Contagious disease produced by strep toxin, see strawberry tongue, N/V/D, and fever greater than 101 derees, really fine rash begins on neck and face and spreads over 48 hrs sparing the palms and soles and has sandpaper quality with pastia’s sign

70
Q

Rubella

A

Contagious viral infection with nonspecific signs and symptoms but can have conc. to unborn causing fetal anomalies (blueberry muffin lesions), see a rash on neck or face that fades in 24-48 hrs, ask patient if they or anyone they are in contact with is pregnant

71
Q

Congenital Rubella Syndrome triad of clinical effects

A

-Cardiac malformation -hearing deficits -ocular anomalies

72
Q

Fifth disease

A

Parovirus B19/erythema infecetiosum, common in children 4-10. primary cause of aplastic crisis in sickle cell children, results in congenital anemia if in utero infection or hydrops fetalis, has 3 stages of facial erythema (slapped cheeks), net pattern erythema (fishnet on extremities) and recurrent phase (eruption fades and reappears next 2-3 weeks)

73
Q

Kawasaki disease

A

Children disease with febrile phase for greater than 5 days, swelling and redness on hands and feet, and cervicallymphadenopathy, if left untreated can see arteritis

74
Q

Kawasaki disease treatment (2)

A

-high dose aspirin -IVIg

75
Q

Reye’s syndrome

A

Rare condition that affects liver and brain and has been shown to be caused by aspirin in children

76
Q

Psoriasis primarily targets the ___ surfaces and eczema on the ___ surfaces

A

Extensor, flexor

77
Q

Koebner’s phenomena

A

Tendency for psoriasis to occur at sites and in shapes of where trauma to the body has occurred

78
Q

Lichen planus vs psoriasis

A

Lichen planus is very smooth and often found on flexor surfaces and only lasts for a period of time, psoriasis is very rough and lasts an entire lifetime

79
Q

Psoriatic arthritis

A

Condition occuring in 5-10% of patients with psoriasis, results in distal phylangial “pencil in cup” appearance

80
Q

Calcipotriene (dovonex) for psoriasis treatment

A

Vit D3 analogue that inhibits cell proliferation and is safe to apply topically on skin without affeecting Ca2+ body conc. for treatment of psoriasis

81
Q

Bed bugs

A

Red blood sucking insects that hide during day and emerge at night to feed, saliva causes itches and welts in most patients, capable of living one year without food, cannot transmit disease

82
Q

Bed bugs treatments (3)

A
  • prevention looking for smears on bed linen
  • topical steroid creams
  • laundering, pesticides, heating, freezing, vacuuming
83
Q

Crusted/Norwegian scabies

A

Rare form of severe scabies only present in immunocompromised patients

84
Q

Malar rash

A

Lesion that occurs when systemic lupus is active, a classic rash in sun exposed areas that spares nasolabial folds and knuckles and is nonpruritic

85
Q

Sicca syndrome/sjogrens

A

Associated autoimmune disease occurs with lupus, indicated by dry eyes, sandy feeling in eye, dry mouth

86
Q

Positive ANA

A

A cardinal feature of lupus erythmatosus, indicates 90% likely positive, chances of false positive increases in older patients

87
Q

Dermatomyositis

A

Rare inflammatory muscle and skin disease that typically presents with a violet colored red rash that does not spare the knuckles followed by proximal skeletal muscle weakness and inflammation, gottron’s papules are pathognomonic finding, often autoimmune and co-occurs with malignant tumor (and resolves with their clearance)

88
Q

Gottron’s papules

A

Round 1cm red flat topped papules that occur ofer the knuckles and alongside the sides of fingers pathognomonic for dermatomyositis

89
Q

Signs of Crest syndrome (5)

A
  • telangiectasia
  • raynauds
  • esophageal dysfunction
  • sclerodactyly (claw hand)
  • Ca2+ deposit buildup
90
Q

Wegner’s granulomatosis and how does it relate to pharyngitis

A

Inflammatory dz of the blood vessels that if left untreated can be fatal, has subtle onset and is caused by autoantibodies against proteinase 3, often have sore eye, ear, and stuffy nose and SORE THROAT (keep it on differential for pharyngitis)** as well as microscopic hematuria

91
Q

How long to avoid contact sports after mono infection?

A

1 month resolution of symptoms

92
Q

“bull neck” is a common finding of what condition?

A

Diptheria

93
Q

Diptheria signs and symptoms (3)

A
  • sore throat, malaise
  • spots of gray and white exudate pseudomembrane
  • bull neck
94
Q

Scarlet fever as a result of strep pharyngitis infection signs and symptoms (3)

A
  • sandpapery red reash
  • strawberry tongue
  • pastia lines in the antecubital fossa
95
Q

Centor score

A

Addition of 4 variables to determine likelihood of follow up for culture to confirm suspected positive, with higher scores increasing probability of positive culture and 1-2 variables only requiring rapid strep initially

96
Q

Trismus

A

Inability to fully open jaw (limited motion, lockjaw)

97
Q

2 most common benign nonhereditary sources of pediatric neck masses and 2 most common benign hereditary ones

A

1) cervical adenitis
2) cat scratch disease
1) branchial cleft anomalies
2) thyroglossal duct cyst** (usually inferior to the hyoid and soft cystic)

98
Q

90% rule for pediatric neck masses

A

90% are inflammatory or congenital, higher likelihood of malignancy in adults

99
Q

Recall the anterior and posterior triangles of the neck

A

anterior: mandible, SCM, midline
Posterior: clavicle, SCM, trapezius

100
Q

Standard of diagnosis for neck mass

A

Fine needle aspiration biopsy

101
Q

Removal of parotid tumors raises this complication during the procedure…

A

…facial nerve palsy

102
Q

Carotid body tumor (paraganglioma) and diagnosis (3)

A

A highly vascular usually benign neck mass affecting chemoreceptors of the carotid body, pulsatile and if functional can cause flushing or HTN from catecholamine release, requires clinical diagnosis and plasma 24 hr urine for catecholamines followed by confirmatory angiogram or CT

103
Q

Bartonella henselae and treatment (1)

A

Cat scratch disease transmitted by flea or kitten over period of few weeks see regional lymphadenopathy, erythema, and tenderness, treated with macrolide antibiotics

104
Q

Most common causative agent of acute otitis externa

A

P aeruginosa

105
Q

2% acetic acid solution

A

Very cheap, safe, and effective bactericidal OTC agent for otitis externa often completely treating it on its own

106
Q

Fluorquinolones for otitis externa (Cipro + hydrocortisone), (cipro + dexamethasone), (ofloxacin)

A

Preferred prescribed today as no ototoxicity or local rxns, used topically

107
Q

Cough mech of action

A

Important defense reflex of respiratory tract starting with deep inspiration followed by closure of glottis and forceful contraction of chest and abdominal wall against closed glottis, that then opens and with high velocity propels mucus, debris, and foreign material from lower respiratory system

108
Q

Opioid antitussives names and mech of action

A

(codeine and hydrocodone) Suppress cough decreasing intensity and frequency acting on CNS respiratory centers in medulla raising cough threshold

109
Q

Dextromethorphan definition

A

OTC derivative of morphine with no analgesic or addictive properties at recommended doses, used in most OTC cough preps, has not been shown to be safe or effective in young children and at high doses can be abused

110
Q

Reye’s syndrome

A

Rare disorder following viral illness most commonly, occurs in children and can result in brain and liver damage as a result of giving ASA to children

111
Q

Decongestants used to relieve the symptoms of common cold (2)

A

-phenylephrine (OTC and not very effective) and pseudoephedrine

112
Q

Choanal atresia

A

Absence or impaired development of nasal passage

113
Q

The nasolacrimal duct empties into this part of the nose resulting in rhinorhea when crying

A

Inferior meatus

114
Q

Translumination of the sinus

A

If seeing light shines thru the hard palate that implies air and that it is clear, however if it does not emit then that implies a fluid filled cavity

115
Q

Pott’s puffy tumor

A

Superiosteal Abscess and osteomyelitis of the frontal bone that is tender, pitting, requires I and D and IV antibiotics

116
Q

Most common pediatric illness causing stridor (6-36 months)

A

Croup/acute laryngotracheobronchitis

117
Q

Croup/acute laryngotracheobronchitis presentation

A

Starts with URI symptoms, low grade fever, within 1-2 days develop hoarseness, barking cough, respiratory distress, symptoms resolve within 3-7 days but most can last 2 weeks

118
Q

Westley croup score

A

A survey to score symptoms between 0-12 ranging severity with 12 being impending respiratory failure in a patient with croup

119
Q

Croup diagnosis (3)

A
  • primarily clinical
  • AP neck radiograph presenting with steeple sign
  • CBC and other basic shit
120
Q

Croup treatment (mild and significant (3))

A
  • Mild can be done at home with management
  • significant respiratory distress will require oxygenation with ventilatory support (bag ventilation mask but potentially intubation (rare less than 2%)), single dose dexamethasone .6mg/kg oral, IM, or IV, or nebulized racemic epi
121
Q

Epiglottitis

A

Acute inflammation caused by bacterial infection typically of epiglottis and surrounding tissues, uncommon in US more common in populations lacking against Haemophilus influenza type B immunization, viruses do not typically cause but can predispose to bacterial infection, sees RAPID* symptom progression, often present with sore throat, dysphagia, hot potato voice, tripoding

122
Q

Classic clinical triad of epiglottitis

A

Drooling
Dysphagia
Distress

123
Q

Epiglottitis diagnostic studies (3)

A
  • secure the airway first**
  • nasopharyngoscopy/laryngoscopy
  • thumb sign on x ray
124
Q

Ludwig angina

A

Rapidly progressive gangrenous “woody” or brawny cellulitis of the sublingual and submaxillary spaces of the neck typically odontogenic in source from 2nd and 3rd molars most commonly, presents as bilateral submandibular swelling with elevated protruding tongue and airway compromise is a potential complication

125
Q

Procedures employed to remove foreign body (2)

A

Chest x ray followed by Rigid bronchoscopy

126
Q

Dentition through the life cycle

A
  • 2 sets of teeth
  • 20 deciduous teeth 6 month to 2 years
  • shed between ages 6-12
  • replaced with 32 permanent teeth
127
Q

Crown of tooth

A

Portion of tooth exposed to oral cavity, covered in enamel which is the hard white substance covering it acting as the hardest material in the body

128
Q

Root of tooth

A

Portion of tooth under gums extending into the bone

129
Q

Vincent’s angina (trench mouth)

A

Polymicrobial opportunistic infection from poor oral care, painful bleeding gingiva, fever, etc

130
Q

How to differentiate between oral thrush and leukoplakia

A

Oral thrush can be removed manually and has red spot underneath, leukoplakia cannot

131
Q

Familial Adenomatous polyposis (FAP) manifestation oral exam (what study is required immediately upon diagnosis)

A

Growth of multiple torus (slow growing bone on palate or mandible) that require immediate colonoscopy as cancer will develop

132
Q

Most common causative pathogen of croup

A

parainfluenza virus

133
Q

Chronic hoarseness associated with otalgia is often concerning for

A

Laryngeal carcinoma

134
Q

Mild, moderate, and severe croup treatments

A

Mild - dexamethosone
Moderate - nebulized epi + dexamethasone
Severe - nebulized epi + dexamethasone + admission

135
Q

Polypoid corditis (reinke’s edema)

A

Edema results in vocal fold mass with progressive deepening of the voice (low pitch and husky) in smokers or those with laryngopharyngeal reflux

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