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EOR- PEDS > Peds - Derm > Flashcards

Peds - Derm Flashcards

1
Q

Atopic derm pathophys

A

Rash due to defective skin barrier susceptible to drying, leading to pruritus & inflammation

Disruption of the skin barrier (filaggrin gene mutation) and disordered immune response which manifests mostly in infancy or almost always by age 5

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2
Q

MC bug causing 2ndary infection in atopic derm

A

S. Aureus

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3
Q

Contact derm pathophys

A

Inflammation of the dermis & epidermis from direct contact between a substance & the skin surface

Allergic: type IV hypersensitivity reaction (T cell lymphocyte-mediated), delayed by days

Irritant: non-immunologic reaction (immediate)

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4
Q

Parkland formula to manage LR in burns

A

Parkland Formula to determine how much LR: 4mL x %BSA x weight (kg)

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5
Q

MCC of perioral derm

A

MC in young woman w/ hx of prior topical steroid use in area

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6
Q

Tx of perioral derm

A

Topical metronidazole; can also use erythromycin or Pimecrolimus

If no clearance: systemic tx w/ minocycline, doxycycline or tetracycline

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7
Q

Morbilliform or maculopapular drug eruption characterized by macules/small papules after the initiation of drug treatment

A

Drug eruption

Type IV delayed hypersensitivity reaction that most commonly occurs 5-14 days after initiation of offending medication or within 1-2 days in previously sensitized individuals

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8
Q

Self-limited localized subcutaneous (or submucosal) swelling resulting from extravasation of fluid into interstitium

A

Angioedema

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9
Q

2 types of angioedema

A

Mast-cell (histamine) mediated – allergic reactions • Angioedema that may be accompanied w/ other allergic reaction symptoms (urticaria, flushing, generalized pruritus, bronchospasm, stridor, throat tightness, & hypotension)

Bradykinin-mediated: ACE inhibitor-induced or hereditary (d/t C1 esterase inhibitor deficiency) Angioedema without allergic reaction symptoms

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10
Q

Tx of angioedema for mast cell mediated & bradykinin mediated

A

Mast-cell (histamine) mediated – epinephrine (if severe), glucocorticoids, and antihistamines

Bradykinin-mediated: • C1 inhibitor concentrate, Ecallantide (kallikrein inhibitor), Icatibant (bradykinin-beta2 receptor antagonist), FFP if other therapies aren’t available

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11
Q

What type of reaction is erythema multiforme

A

Type IV hypersensitivity reaction assoc. w/ certain infections, medications (sulfa drugs), & other various triggers

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12
Q

MC RF of erythema multiforme

A

MC: HSV, Mycoplasma in children, S. pneumoniae

Meds: sulfa drugs, beta-lactams, Phenytoin, Phenobarbital, Allopurinol

Malignancy, autoimmune, idiopathic

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13
Q

Target lesions w/ 3 components on trunk & extremities: (1) dusky, central area or blister + (2) dark red inflammatory zone surrounded by pale ring of edema + (3) erythematous halo on extreme periphery of lesion

A

Erythema multiforme

Also (-) Niklosky skin

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14
Q

Tx of erythema mutliforme

A
  • Symptomatic: d/c offending drug, give antihistamines, analgesics, skin case
  • Oral lesions: Corticosteroid + Lidocaine + Diphenhydramine mouthwash
  • Severe: systemic corticosteroids
  • Mycoplasma related: antibiotics • HSV related: Acyclovir
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15
Q

S/S of dermatitis medicamentosa

A

Abrupt onset of eruption of widespread, symmetric, pruritic erythematous lesions w/ many types

  • MC skin reaction to drugs: erythema
  • Fever &/ other syx may be present – HA, malaise, arthralgias, &/or myalgias
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16
Q

Difference in SJS vs TEN

A

SJS: sloughing involving <10% of body surface

TEN: >30% body surface area

17
Q

widespread flaccid bullae beginning on trunk & face before spreading to other areas (palms and soles rarely involved)

Pruritic targetoid lesions (erythematous macules w/ purpuric centers) or diffuse erythema w/ involvement of at least 1 mucous membrane + involvement with epidermal detachment (+ Nikolsky sign), skin often tender to touch

A

SJS or TEN

18
Q

Tx of SJS or TEN

A

Discontinue causative agent • Supportive: treat like severe burns – burn unit admission, pain control, prompt withdrawal of offending meds, fluid & electrolyte replacement, wound care w/ gauze and petroleum

19
Q

MC Bug in impetigo

A

MCC: S. auereus

2nd MCC: Group A Streptococcus

20
Q

Tx of i mpetigo

A

Mild: Mupirocin topically TID X10d, may use Bacitracin or Retapamulin; good skin hygiene, wash area with soap & water to prevent recurrence @ distant sites

Extensive disease or systemic syx: systemic antibiotics – Cephalexin or Dicloxacillin, Macrolides

Community acquired MRSA?: Doxycycline, Clindamycin, Bactrim or Linezolid PO x7days

21
Q

Head lice tx

A

Pediculus humanus capitis

Drug of choice: Permethrin topical, shampoo left x10min & use of a fine tooth cone to remove nits, reapply 7-10d

Alternative: Malathion – 8-12h tx period

*Oral Ivermectin in refractory cases

22
Q

Pediculus humanus corporis

A

Body lice

Sexually transmitted, strongly related to poor body hygiene; can be a vector for diseases to humans like relapsing fever, epidemic typhus, & trench fever

23
Q

Difference in body lice vs head/pubic lice

A

Body lice do not live on skin; they live & lay eggs in seams of clothing/bedding & move to skin only to feed

24
Q

Phthiriasis pubis tx

A

pubic lice

1st line: topical Permethrin or Pyrethrins x8-10 hours • Repeat tx if lice remains after 9-10 days • Treat sexual partners & launder clothing & bedding

25
Q

Multiple, small erythematous papules, excoriations

Linear burrows (pathognomonic) – commonly found in intertriginous zones, including the scalp & web spaces between fingers & toes, spares neck and face

A

Scabies

26
Q

Tx of scabies

A

Permethrin topical from neck down 8-14 hours before showering, repeat once after 1w ** Safe in pregnancy & lactation

May use Lindane – cheaper, can cause seizures d/t incr. absorption through open pores, DON’T USE IN PREGNANT PATIENTS

Infants/pregnant woman: 6-10% sulfur in petroleum jelly

Extensive: Ivermectin

27
Q

Dx of scabies

A

Clinical • Skin scrapings will show mites, eggs, & feces

28
Q

6 P’s: Purple. Polygonal, planar, pruritic, papules or plaques w/ irregular borders

A

Lichen planus

29
Q

Koebners phenomenon

A

Koebner’s phenomenon: new lesions at site of trauma [may see in psoriasis also]

30
Q

What is wickham striae in lichen planus

A

Wickham Striae: lacy striation [fine white lines] on lichen planus lesion or on oral mucosa

31
Q

Tx of lichen planus

A

1st line: Topical steroid ointment • Antihistamines for pruritus

2nd line: PO/intralesional CS, topical Tretinoin or photosensitizing Psoralen + UV light therapy General Measures: will resolve spontaneously in 8-12 months

32
Q

Etiology of tinea capitis

A

90% caused by Trichophyton tonsurans, 10% Microsporum

33
Q

Sx of tinea capitis

A

Patches of alopecia w/ black dots: multiple black dots are d/t broken hair shafts d/t endothrix infection

Scaly patches w/ alopecia: single or multiple patches w/ hair loss, erythema & pruritus may be present

Kerion: severe manifestation characterized by inflammatory plaque w/ pustules & thick crusting, often painful

Favus: less common form – cup-like shaped yellow crusts composed of dried scalp secretions, fungi, skin cells & dead inflammatory cells

34
Q

Definitive dx of tinea capitis

A

KOH Prep – most common initial test, fungal element inside or surrounding the hair

Wood’s lamp: no fluorescence w/ Trichophyton spp., (+) fluorescence with Microsporum

Definitive Diagnosis: Culture

35
Q

Tx of tinea capitis

A

Oral Griseofulvin: first line treatment x6-12 weeks, can cause hepatitis, GI, headache, & Disulfiram rxn; better absorption w/ fatty food; may add topical 2.5% selenium sulfide/ketoconazole shampoo 2x/week to suppress spores

2nd line: Oral Terbinafine, less common: Itraconazole or Fluconazole

36
Q

most common dermatophyte infection

A

Tinea pedis - athlete’s foot

EOR- PEDS (9 decks)

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