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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
When is scorpion venom depleted
After 1st sting | Subsequent stings don’t matter
26
What are the 2 worst types of scorpions
Bark and Mexican | Exilicauda and suffusus
27
What is a grade I envenomation?
Pain and paresthesias at site of sting
28
What is a grade II envenomation?
Pain and paresthesia beyond site of sting | -often radiating up affected extremity but sometimes even on other limb
29
What is a grade III envenomation
Produce EITHER: Cranial nerve dysfunction OR neuromuscular dysfunction
30
What is a grade IV envenomation?
Produces BOTH: cranial nerve dysfunction AND Neuromuscular dysfunction
31
How long does it take for scorpion sting symptoms to progress to maximum severity?
Within 5 hours
32
How long does it take for scorpjon sting symptoms to improve
9-30 hours for severe (III or IV) envenomation
33
How long does the pain and paresthesias from scorpion stings to go away
May persist for up to 2 weeks
34
How quickly can an infant progress to grade IV envenomation symptoms after being stung by scorpion
15-30 min
35
What is the tap sign
Tapping near site of scorpion sting and exacerbating pain
36
What are signs of cranial nerve dysfunction due to scorpion sting?
``` Hypersalivation Abnormal eye movements Blurred vision Slurred speech Tongue weird contractions ```
37
What are signs of somatic skeletal neuromuscular dysfunction due to Scorpion sting
``` Hot yoga: Fasciculations Shaking and jerking of extremities Opisthotonos Emprosthotonos Fever ```
38
What labs should you draw if a patient has a severe scorpion envenomation
every single one to be safe in case they crash
39
Treatment for mild scorpion envenomations
Pain management Cleansing site Tetanus shot Observe for 4 hrs
40
What is the treatment for severe scorpion envenomations?
Monitor for major issues (ABC’s) IV Fentanyl IV benzos Anti venom (BUT NOT if you gave benzos)
41
What percentage of bee stings cause anaphylaxis?
0.3-3%
42
What is the treatment for a large local reaction to a bee sting?
Cold compress Prednisone Antihistamine NSAIDs
43
What two species of Hymenoptera usually cause secondary bacterial infections to their stings
Fire ants (super itchy get infected from scratching) Yellow jackets (hang out near dumpsters and toilets)
44
What is the leading cause fo anaphylaxis
Insect stings
45
How do you treat anaphylactic rxn to bee sting
IM epinephrine | Refer to specialist
46
Where are widow spiders usually found
Outdoors near human habitats
47
What tupe of spider bite causes a blanched circular patch, surrounding red perimeter and a central punctum?
Widow
48
What does widow venom cause?
Catecholamine release - radiating pain - muscle spasm - local diaphoresis** if pt is sweating in just one area, think widow spider
49
If a spider bite victim has local/regional diaphoresis, headache and N/V, what type of spider bit them?
Widow
50
How do you treat widow bite?
``` Local wound care Antiemetic Narcotic pain meds Tetanus shot Muscle relaxers Anti venom (with caution) ```
51
What type of bite is the recluse spider known for
Necrotic bite
52
Where do recluse bites usually happen
Indoors when spider is crushed in clothing or bedding
53
What type of spider bite: red plaque with central pallor +/- vesiculation
Recluse
54
Do recluse bites hurt at first?
No, progress to severe pain in 2-8 hrs
55
How long until recluse bites develop necrosis?
1-2 days (if they even do, it’s very rare)
56
How do you treat necrotic recluse bites?
``` Cleaning Cold compress Pain relief Antibiotics Surgical excision and reconstruction (maybe, after wound has stabilized) ```
57
Where is the hobo/ aggressive house spider usually found?
Fields and meadows
58
What causes vitiligo?
Autoimmune process that attacks melanocytes
59
Is there a family history to vitiligo?
Yes in 20-30% of pts
60
Is vitiligo associated with other autoimmune disorders?
Yes 20-30% of the time
61
How often does vitiligo spontanously repigment?
10-20% of the time
62
Does vitiligo get worse over time?
Yes, it is slowly progressive
63
What is the first line treatment for vitiligo
Topical and systemic corticosteroids
64
Average age of onset for hidradenitis suppurativa
23
65
How does hidradenitis suppurativa begin?
A single, deep-seated nodule
66
What types of lifestyle modification should a pt with hidradenitis suppurativa make
``` Avoiding skin trauma Hygiene (keep it clean and dry) Stop smoking Lose weight Change diet (high glycemic seems to make it worse) ```
67
Where do hidradenitis suppurativa lesions occur?
Armpits Inguinal region Anogenital region
68
What are the medical treatments for hidradenitis suppurativa?
``` 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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