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Clin Med Exam 1 (Lauren) > Rosacea, Acne, Insects, Etc > Flashcards

Rosacea, Acne, Insects, Etc Flashcards

1
Q

Acne vulgaris is a disease of the :

A

Pilosebaceous unit

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2
Q

What type of lesion is considered the precursor for the clinical lesions of acne vulgaris

A

Microcomedone

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3
Q

What converts a microcomedone into a closed comedone?

A

Accumulation of sebum and kertainous material

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4
Q

What areas of the body are affected by acne vulgaris

A

Areas with the largest, hormonally responsive sebaceous glands
(Face, neck chest, back, upper arms)

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5
Q

If a female pt has acne and addition signs of androgen excess, you should?

A

Work up for hyperandrogenism

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6
Q

Rapid appearance of acne in conjunction with virilization suggests..?

A

An underlying adrenal or ovary tumor

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7
Q

How do you treat comedonal (noninflammatory)acne?

A

Topical retinoid (Tretinoin)

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8
Q

How do you treat mild papulopustular and mixed acne?

A

Benzoyl peroxide
+/- TOPICAL antibiotic
topical retinoid

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9
Q

How do you treat moderate papulopustular and mixed acne?

A

Benzoyl peroxide
ORAL antibiotic
Topical retinoid

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10
Q

How do you treat severe acne?

A

Retinoid
ORAL antibiotic
Benzoyl Peroxide

OR

Oral isotretinoin (accutane)

+birth control for women

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11
Q

What is a safe regimen for pregnancy?

A

Oral erythromycin
Topical clindamycin
Topical azelaic acid

NO BP
NO RETINOIDS

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12
Q

Who most commonly gets rosacea

A

White ladies in 30’s

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13
Q

What are some things we think might cause rosacea?

A

bacteria on demodex mite
UV damage
Vascular dysfunction
Immunity abnormalities

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14
Q

What are the 4 types of rosacea

A

Erythematotelangiectatic

Papulopustular

Phymatous

Ocular

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15
Q 
What type of rosacea:
Chronic redness of central face
Flushing
Dry skin
Telangiectasias
A

Erythematotelangiectatic

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16
Q

What type of rosacea:
Papules and pustules on central face
No comedones
Papules/pustules may coalesce

A

Papulopustular rosacea

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17
Q 
What type of rosacea:
Tissue hypertrophy causing irregular contours 
Mostly nose
Cheeks, forehead, chin maybe
Mostly men
A

Phymatous

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18
Q

What should you keep in mind if someone with a history of rosacea presents with bilateral eye problems?

A

Ocular rosacea

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19
Q

How is rosacea diagnosed

A

Clinical presentation

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20
Q

Treatment for erythematotelangiectatic rosacea

A 
FIRST LINE
-avoid triggers
-sun protection
-gentle skin care
SECOND LINE
-Laser/light therapy
-topical brimonidine
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21
Q

Treatment of mild-moderate papulopustular rosacea

A

Metronidazole topical
Azelaic acid

(Ivermectin and sulfacetamide-sulfur as well)

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22
Q

Treatment of moderate-severe papulopustular rosacea

A

Oral antibiotics

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23
Q

Treatment of phymatous rosacea

A

Early: isotretinoin (accutane)

Advanced: surgical/laser debulking

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24
Q

Treatment of ocular rosacea

A

Refer to ophthalmologist

Topical/oral abx

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25
Q

When is scorpion venom depleted

A

After 1st sting

Subsequent stings don’t matter

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26
Q

What are the 2 worst types of scorpions

A

Bark and Mexican

Exilicauda and suffusus

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27
Q

What is a grade I envenomation?

A

Pain and paresthesias at site of sting

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28
Q

What is a grade II envenomation?

A

Pain and paresthesia beyond site of sting

-often radiating up affected extremity but sometimes even on other limb

29
Q

What is a grade III envenomation

A

Produce EITHER:
Cranial nerve dysfunction
OR
neuromuscular dysfunction

30
Q

What is a grade IV envenomation?

A

Produces BOTH:
cranial nerve dysfunction
AND
Neuromuscular dysfunction

31
Q

How long does it take for scorpion sting symptoms to progress to maximum severity?

A

Within 5 hours

32
Q

How long does it take for scorpjon sting symptoms to improve

A

9-30 hours for severe (III or IV) envenomation

33
Q

How long does the pain and paresthesias from scorpion stings to go away

A

May persist for up to 2 weeks

34
Q

How quickly can an infant progress to grade IV envenomation symptoms after being stung by scorpion

A

15-30 min

35
Q

What is the tap sign

A

Tapping near site of scorpion sting and exacerbating pain

36
Q

What are signs of cranial nerve dysfunction due to scorpion sting?

A 
Hypersalivation
Abnormal eye movements
Blurred vision
Slurred speech
Tongue weird contractions
37
Q

What are signs of somatic skeletal neuromuscular dysfunction due to Scorpion sting

A 
Hot yoga:
Fasciculations
Shaking and jerking of extremities
Opisthotonos
Emprosthotonos
Fever
38
Q

What labs should you draw if a patient has a severe scorpion envenomation

A

every single one to be safe in case they crash

39
Q

Treatment for mild scorpion envenomations

A

Pain management
Cleansing site
Tetanus shot
Observe for 4 hrs

40
Q

What is the treatment for severe scorpion envenomations?

A

Monitor for major issues (ABC’s)
IV Fentanyl
IV benzos

Anti venom (BUT NOT if you gave benzos)

41
Q

What percentage of bee stings cause anaphylaxis?

A

0.3-3%

42
Q

What is the treatment for a large local reaction to a bee sting?

A

Cold compress
Prednisone
Antihistamine
NSAIDs

43
Q

What two species of Hymenoptera usually cause secondary bacterial infections to their stings

A

Fire ants (super itchy get infected from scratching)

Yellow jackets (hang out near dumpsters and toilets)

44
Q

What is the leading cause fo anaphylaxis

A

Insect stings

45
Q

How do you treat anaphylactic rxn to bee sting

A

IM epinephrine

Refer to specialist

46
Q

Where are widow spiders usually found

A

Outdoors near human habitats

47
Q

What tupe of spider bite causes a blanched circular patch, surrounding red perimeter and a central punctum?

A

Widow

48
Q

What does widow venom cause?

A

Catecholamine release

  • radiating pain
  • muscle spasm
  • local diaphoresis** if pt is sweating in just one area, think widow spider
49
Q

If a spider bite victim has local/regional diaphoresis, headache and N/V, what type of spider bit them?

A

Widow

50
Q

How do you treat widow bite?

A 
Local wound care
Antiemetic
Narcotic pain meds
Tetanus shot
Muscle relaxers
Anti venom (with caution)
51
Q

What type of bite is the recluse spider known for

A

Necrotic bite

52
Q

Where do recluse bites usually happen

A

Indoors when spider is crushed in clothing or bedding

53
Q

What type of spider bite: red plaque with central pallor +/- vesiculation

A

Recluse

54
Q

Do recluse bites hurt at first?

A

No, progress to severe pain in 2-8 hrs

55
Q

How long until recluse bites develop necrosis?

A

1-2 days (if they even do, it’s very rare)

56
Q

How do you treat necrotic recluse bites?

A 
Cleaning
Cold compress
Pain relief
Antibiotics
Surgical excision and reconstruction (maybe, after wound has stabilized)
57
Q

Where is the hobo/ aggressive house spider usually found?

A

Fields and meadows

58
Q

What causes vitiligo?

A

Autoimmune process that attacks melanocytes

59
Q

Is there a family history to vitiligo?

A

Yes in 20-30% of pts

60
Q

Is vitiligo associated with other autoimmune disorders?

A

Yes 20-30% of the time

61
Q

How often does vitiligo spontanously repigment?

A

10-20% of the time

62
Q

Does vitiligo get worse over time?

A

Yes, it is slowly progressive

63
Q

What is the first line treatment for vitiligo

A

Topical and systemic corticosteroids

64
Q

Average age of onset for hidradenitis suppurativa

A

23

65
Q

How does hidradenitis suppurativa begin?

A

A single, deep-seated nodule

66
Q

What types of lifestyle modification should a pt with hidradenitis suppurativa make

A 
Avoiding skin trauma
Hygiene (keep it clean and dry)
Stop smoking
Lose weight
Change diet (high glycemic seems to make it worse)
67
Q

Where do hidradenitis suppurativa lesions occur?

A

Armpits
Inguinal region
Anogenital region

68
Q

What are the medical treatments for hidradenitis suppurativa?

A 
Topical clindamycin
Intralesional corticosteroids
Oral antibiotics
Anti-androgenic agents
Surgery (cut top off or wide excision)
Severe cases: TNF inhibitors and oral retinoids

Clin Med Exam 1 (Lauren) (5 decks)

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