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Family Medicine > skin conditions > Flashcards

skin conditions Flashcards

1
Q

risk factors for melanoma

A

> 65 yo
fair-skinned
many atypical moles
50 moles

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2
Q

if diagnosed with BCC

A

40% will be diagnosed with 2nd BCC in 3 years

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3
Q

history taking for skin condition

A

look at skin, feel (infectious: scabies, HSV, syphillis), distribution and then ask questions

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4
Q

scaly rash

precancerous lesion of seborrheic keratosis

A

actinic keratosis

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5
Q

scattered lesions (bloodborne) vs along sensory dermatome

A

chickenpox vs HSV

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6
Q

nail pitting

A

psoriasis

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7
Q

hand eruption: autosensitzation to

A

fungal infection on feet

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8
Q

white patches on buccal mucosa

A

lichen planus

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9
Q

hereditary skin conditions

A 
psoriasis
acne
atopic dermatitis
skin cancer
dysplastic nevi
neurofibromatosis
tuberous sclerosis
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10
Q

fungal infection lab preparation

A

KOH slide: see hyphae of dermatophytes or psuedohyphae of yeast of candida or pityrosporum

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11
Q

diagnosis of tinea capitis

A

wood’s light: green fluourescence

-caused by microsporum

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12
Q

diagnosis of erythrasma

A

wood’s light: red fluorescence

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13
Q

medical treatment of skin conditions

A

topical steroids: antiinflammatory, anti-mitotic effect, SE: skin atrophy (reversible) - capillaries dilate, hypopigmentation, striae (irreversible), systemic SE: if young, thinner skin
PO steroids
antibiotics
antifungal/antiviral

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14
Q

diagnostic + surgical treatment of skin conditions

A

shave: raised
punch, ellipitcal: flat
scissor

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15
Q

choosing topical steroid

A

chronic disease: higher potency
thicker: higher potency (psoriatic plaque)
thin: face, GU, skin folds - low potency
infant/children: higher SA, increased absorption - low potency

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16
Q

type of vehicle of topical steroid affects

A

potency - determines rate at which steroid is absorbed

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17
Q

bacterial skin infections

A 
s. aureus - most common
MSSA abx:
cephalexin, dicloxacillin, clindamycin
MRSA abx:
trimethorpim-sulfamethoaxazole (bactrim)
rifampin
clindamycin
tetracycline
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18
Q

honey crusts around nose + mouth

A

impetigo

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19
Q

impetigo tx

A

s. aureus, MRSA (bullous impetigo) and s. pyogenes:
7-10 days Abx:
cephalexin
dicloxacillin

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20
Q

severe variation of bullous impetigo
bullae caused by exfoliating toxin
systemically ill

A

SSSS:

IV Abx, fluids

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21
Q

infection of dermis + subq tissues

  • break in skin from trauma, bite, dermatosis (tinea pedis)
  • usually extremities
A

cellulitis

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22
Q

cellulitis tx

A

B hemolytic strep or s. aureus

need MRSA coverage (IV or PO)

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23
Q

infection of dermis with lymphatic involvement - usually extremities (lesions raised above skin, clear demarcation)

A

erysipelas

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24
Q

erysipelas

A

B hemolytic strep

need MRSA coverage(IV or PO)

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25
Q

infection of superficial portion of hair follicle

perifollicular erythema, papules, pustules

A

S. aureus, yeast, other bacteria

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26
Q

hot tub folliculitis

A

psuedomonas

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27
Q

folliculitis with tight fitting clothing

A

pityrosporum yeast

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28
Q

abscess that starts in hair follicle or sweat gland

A

furuncle or boil

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29
Q

furuncle extends into subq tissue

A

carbuncle

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30
Q

cause of skin abscess

A

s. aureas, MRSA

I&D, po antibiotics if surrounding cellulitis

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31
Q 
infection of subq tissue + fascia
diffuse swelling → bullae
skin necrosis/echymosis (bruising) 
edema beyond area of erythema
pain out of proportion
systemic: fever, tachycardia, delerium, renal failure, rapid spread during antibiotic therapy
A

necrotizing fasciitis

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32
Q

treatment of NF

A

s. pyogenes: after VZV, scratch, insect bite
bowel flora
need surgical debridement + IV abx

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33
Q

cause of warts

A

HPV
hands: verruca vulgaris
feet: plantar warts
face/legs: flat warts

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34
Q

cauliflower appearance

transmitted sexually

A

genital warts - HPV 6 (condyloma acuminata)

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35
Q

causes cervical intraepithelial neoplasia and cervical cancer and throat cancer

A

HPV 16, 18

36
Q

virus in dorsal root ganglia - recurrence

vesicular, surrounding erythema, crusts over weeks

A

HSV and VZV

37
Q

primary herpes gingivostomatitis (cold sore) and labialis (lips)

A

primary: whole mouth, fever, chills, maliase

recurrent episodes are labialis (lips): viral shedding, asymptomatic

38
Q

herpetic lesion on but, genital, anus

A

HSV

39
Q

HSV can be spread when asymptomatic (between active episodes)

A

can shed virus asymptomatically

40
Q

if active ulcer + HIV +

A

more likely to acquire HIV

41
Q

vesicles on red base
trunk → extremities
fever + respiratory symptoms

A

initial infection of VZV (chickenpox)

42
Q

complications of HSV or VZV

A

encephalitis
disseminated infection
esp if infant or IC
postherpatic neuralgia: chronic pain in dermatome previously infected with herpes zoster (shingles)

43
Q

HSV tx: acyclovir, famiciclovir, valacyclovir

A

prophylactic oral antiviral to prevent or reduce recurrences

44
Q

VZV tx: acyclovir (only one approved for chickenpox), famiciclovir, valacyclovir

A

early antiviral to prevent postherpatic nueralgia

45
Q

causes of fungal skin infections

A

dermatophytes: tinea infections (ringworm)
candida
pityrosporum

46
Q

annular appearance with central clearing, redness, scale on perimeter

A

tinea corporis

47
Q

inflammatory reaction to pityrosporum (malassezia furfur)

A

tinea versicolor

48
Q

thrush
balanitis
vaginitis
rashes in groin, breast

A

candida

49
Q

hair loss with broken hairs + scaling

A

tinea capitis: hair shaft + follicle involved

50
Q

red, scaling
no central clearing
in groin

A

tinea cruris (vs candida infection: redder, satellite lesion vs erythasma: pink/brown, red flouresnce)

51
Q

scaly, itchy, symmetric
hx or family hx of asthma, allergic rhinitis
infant: face → FLEXURAL: antecubital fossa, popliteal

A

atopic dermatitis

52
Q

linear, vesicular

response to poision ivy, nickel, deodarants

A

allergic contact dermatitis

53
Q

treatment of dermatitis/eczema

A

avoid skin irritants/hot water: dry skin
emollients: add moisture
topical steroid: inflammation

54
Q 
occurs in areas with most pilosebaceous units producing sebum
inflammatory hypersensitivty to yeast: pityrosporum 
worsens with stress, cold
erythema, scaling of scalp + face
over sternum
axillae
umbilicus
groin
gluteal creaes
A

seborrhea

55
Q

treatment of seborrhea: not curative

A

antifungal

topical steroid

56
Q

epidermal proliferation and inflammation
well-demarcated red, scaling plaques
white thickened scales
EXTENSOR surface, sacral region, genitalia, scalp
nail changes: pitting, subungual keratosis

A

psoriasis

57
Q

treatment of psoriasis

A

emollients
topical steroids - high potency (most common)
topical tar

58
Q

types of BCC

A

nodular: pearly papules, telangiectasias, central ulcer - lesion bleeds or itchy, grows
superficial: red, pink,flat, scaling (like SCC)
sclerosing: scarlike

59
Q

SCC

A

hyperkeratotic
scaly, ulcerate, bleed easily
irregular shaped plaques or nodules with raised borders
higher risk of metastasis vs BCC

60
Q

actinic keratosis
bowen disease (SCC in situ)
HPV
are precursors to

A

SCC

61
Q

ABCDs of malignant skin cancer

A 
Assymetric
Border
Color
Diameter: >6 mm
Evolution (bleeding, enlarged), elevated (raised)
62
Q

biopsy skin lesion if

A

think premalignant or malignant only
2-3 mm margin around lesion for complete excision
if pathology says malignant - need 5 mm margins
if lesion to large - ensure excision is full-thickness of most suspicious part
risk factors: UV radiation for all skin cancers (#1), family history or personal hx of skin cancer, fair skin, burn easily, chemical exposure, suppressed immune system

63
Q

bulla

A

blister >0.5 cm

64
Q

macule

A

not raised or depressed

65
Q

nodule

A

elevated lesion

> 1 cm in diameter

66
Q

papule

A

elevated lesion

67
Q

vesicle

A

blister

68
Q

plaque

A

plateu like, raised

69
Q

most common type of melanoma in both sexes
raised, brown with pink, white, gray, blue
spreads along top before penetrating into deep layers (dermis and beyond)
radial growth slower than vertical phase
men: upper torso
women: legs

A

superficial spreading melanoma

70
Q

most common in 60-70 yo
brown/tan with irregular borders
chronic sun-damaged skin: face, ear, arm, upper trunk

A

lentigo maligna

71
Q

most common type in AA and asians
under nails, sole of foot, palm of hand
flat, irregular, brown/black

A

acral lentiginous melanoma

72
Q

unique feature: invasive at time of diagnosis
most aggressive
brown/black

A

nodular melanoma

73
Q

shave biopsy

A

raised lesion

74
Q

punch biopsy/elliptical excision

A

flat lesions

75
Q

prognostic feature of melanoma

A

thickness

76
Q

treatment of localized reaction to bug bite (venom releases histamine-like substance):
red, warm, swollen
tender, itches
occur immediately, last few hours

A

no antibiotics
pain: NSAID or acetaminophen
antihistamine, ice: itching
Td booster if not up-to-date

77
Q

immediately remove stinger by scraping or brushing stinger off (credit card preferred) because

A

causes continued injection of venom

78
Q 
treatment of LARGE local reaction (IgE mediated to venom)
>10 cm diameter
red, warm
occurs over 24-48 hrs
50% risk of similar reaction in future
NO increased risk of anaphylaxis
A

oral steroids initiated early after sting

Td booster if not-up-to-date

79
Q

treatment of systemic anaphylaxis reaction to sting:
gradient: nausea, urticaria, angioedema to hypotension, shock, airway edema, death
occurs within minutes
50% risk of anaphylaxis with future stings

A

ABC
IV access
fluid resuscitation to 10-20 mg/kg asap
suq or IM epinephrine asap (repeat q 10-15 min PRN)
+/- antihistamines, steroids, bronchodilators
Td booster if not-up-to-date
hospitalized for 12-24 hrs since symptoms may reoccur
densensitization tx: can reduce risk by 50%

80
Q

animal and human bite management

A

ABC
clean with soap + water, irrigate with saline, debride devitazlied tissue asap
vaccination status of animal: rabies (bat, skunk, dog, fox -NOT rodents/rabbits)
antibiotic prophylaxis
Td vaccine up-to-date

81
Q

bite wounds with increased risk of infection

A

large, deep
hand
host chronic illness, immune suppression
cat or human bite

82
Q

dog and cat bite organisms

A

staph
strep
anaerobes
pasteurella

83
Q

human bite organisms

A 
staph
strep
haemophilus
eikenella: most common in closed fist injury
anaerobes
84
Q

closure of bite wounds

A
85
Q

treatment of bite wounds

especially if on hand, late presentation, dog/cat/human bite

A

antibiotic prophylaxis for 5-7 days if mod-severe wound
amoxicillin-clavulanate (augmentin PO)
if cellulitis (erythema around site) also present: 7-14 days PO
hospitalization/surgery: osteomyleitis, joint infection

Family Medicine (21 decks)

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