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Dermatology > Skin Manifestations of Systemic Disorders > Flashcards

Skin Manifestations of Systemic Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

Characteristics of Pyoderma Gangrenosum

A

Rapidly evolving
Idiopathic
Chronic & severely debilitating ulcerative skin disease

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2
Q

Associated Underlying Inflammatory or Malignant Disease Presenting with Pyoderma Gangrenosum

A 
Chronic UC
Crohn's disease
Chronic active hepatitis
Hematologic malignancies
Rheumatoid arthritis
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3
Q

Hx of Pyoderma Gangrenosum

A

Acute onset
Painful hemorrhagic pustule
Painful nodule surrounding by erythematous halo

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4
Q

PE Findings of Pyoderma Gangrenosum

A

Breakdown with ulcer formation with dusky red or purple borders
Irregular & raised
Boggy with perforations that drain pus

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5
Q

Most Common Sites for Pyoderma Gangrenosum

A

Lower extremities
Buttocks
Abdomen

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6
Q

Treatment of Pyoderma Gangrenosum

A

Treat underlying disease
Avoid trauma
High dose systemic corticosteroids
Systemic immunosuppression

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7
Q

Types of Systemic Immunosuppression

A

Sulfasalazine
Cyclosporine
Infiximab

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8
Q

Diabetic Associations with Skin Issues

A 
Acanthosis nigricans
Necrobosis lipoidica diabeticorum (NLD)
Granuloma annulare
Thrush
Intertrigo
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9
Q

Characteristics of Acanthuses Nigricans

A

Velvety thickening & hyper pigmentation of the skin

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10
Q

Acanthosis Nigricans is Associated with what Issues

A

Diabetes
Insulin resistant syndromes
Obesity
Internal malignancy (GI most common)

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11
Q

History with Acanthuses Nigricans

A

Insidious onset

Darkening of pigmentation

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12
Q

PE Findings of Acanthosis Nigricans

A

Hyperpigmentation
Velvety looking
Skin line accentuated
Surface become wrinkled or creased

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13
Q

Most Common Sites for Acanthosis Nigricans

A

Axilla
Neck (back & sides)
Groin
AC fossae

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14
Q

Treatment of Acanthosis Nigricans

A

R/O DM
Treat associated disorder
Usually none required

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15
Q

PE Findings of Necrobiosis Lipoidica Diabeticorum (NLD)

A 
Oval, violaceous patch
Advancing border is red
Central area turns yellow-brown
Telangiectasias
Ulceration possible esp. after trauma
Usually anterior surface of the legs
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16
Q

Treatment of Necrobiosis Lipoidica Diabeticorum (NLD)

A

Difficult
Refer to derm
DM control doesn’t determine presence of NLD

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17
Q

Type 1 DM Trifecta

A

PVD
Neuropathy
Sugar everywhere

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18
Q

Characteristics of Granuloma Annular

A

Self limiting
Asymptomatic
Chronic dermatosis
Slight association with DM

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19
Q

History of Granuloma Annular

A

Slowly increases over months

Duration variable

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20
Q

PE Findings of Granuloma Annular

A

Smooth, shiny firm ring of flesh colored papule & plaques
Annular with central depression

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21
Q

Most Common Sites of Granuloma Annular

A

Dorm of hands & feet
Extremities
Trunk

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22
Q

Treatment of Granuloma Annular

A

Not necessary

If needed: potent topical steroids, or intralesional injections of steroids

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23
Q

Characteristics of Intertrigo

A

Irritation in the skin folds

Worse with heat & moisture

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24
Q

Intertrigo Associated With

A

DM
HIV
Obesity

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25
Q

Intertrigo Related to

A

Candida
Fungus irritation
Secondary bacterial infection

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26
Q

Most Common Sites of Intertrigo

A

Axilla
Groins
Gluteal folds
Overlapping abdominal panniculus

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27
Q

PE Findings of Intertrigo

A

Erythema
+/- pruritis
Tenderness
Erythematous plaques

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28
Q

Treatment of Intertrigo

A

Keep cool & dry

Treatment based on cause

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29
Q

What should be avoided in the treatment of intertrigo?

A

Steroids: fungus will spread rapidly

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30
Q

Describe Thrush

A

White plaques or red erosive areas in the oral mucosa

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31
Q

Associations with Thrush

A

DM
HIV
Immunosuppresion

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32
Q

Treatment of Thrush

A

Antifungal troches
Fluconazole
Itraconazole

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33
Q

Other Systemic Disorders that Manifest Dermatologic Symptoms

A

Lupus
Dermatomyositis
Scleroderma
Xanthoma

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34
Q

3 Types of Lupus

A

Chronic cutaneous (discoid)
Subacute cutaneous
Systemic lupus erythematosus (SLE)

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35
Q

Describe Chronic Cutaneous Lupus (Discoid)

A

Scarring, dispigmented, scaly plaques on primarily the face

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36
Q

Epidemiology of Chronic Cutaneous Lupus

A

Women > Men

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37
Q

Treatment of Chronic Cutaneous Lupus

A

Potent topical steroids

+/- anti-malarials

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38
Q

Describe Subacute Cutaneous Lupus

A

Polycyclic scaly plaques in sun exposed areas

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39
Q

Epidemiology of Subacute Cutaneous Lupus

A

White women 15-40

50% meet criteria for SLE

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40
Q

Treatment of Subacute Cutaneous Lupus

A

Anti-malarials

Immunosuppressants

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41
Q

Symptoms of Systemic Lupus

A

Severe fatigue
Low grade fever that won’t go away
Glomerulonephritis
Joint pain

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42
Q

Describe Systemic Lupus Erythematosus (SLE)

A

“Butterfly” facial erythema
Photosensitivity
Oral ulcers
Discoid lupus

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43
Q

Treatment for Systemic Lupus Erythematosus (SLE)

A

Anti-malarials

Immunosuppression

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44
Q

Describe Dermatomyositis

A

Erythema, photosensitivity, heliotrope eyelid rash

Weakness of proximal muscles

45
Q

Define Gottron’s Papules

A

Knuckles
Periungual
Telangiectasia
Poikiloderma (red, white, brown)

46
Q

Synonym of Scleroderma

A

CREST Syndrome

47
Q

What does CREST stand for?

A 
C: calcinosis
R: reynaud's phenomenon
E: esophageal dysmotility
S: sclerodactyly
T: telangiectasia
48
Q

What internal organs involved in scleroderma?

A

Heart
Lungs
GI
Kidney

49
Q

Treatment with Scleroderma

A

Systemic immunosuppression

50
Q

Define Xanthomas

A

Lipid deposits in skin & tendons

51
Q

Describe Xanthomas

A

Yellow-brown, pinkish or orange merciless, papule, plaques, nodules

52
Q

Xanthomas Associated With

A 
Hyperlipidemia
Biliary cirrhosis
DM
CRF
Hyperthyroid
53
Q

Common Sites of Xanthomas

A

Upper & lower eyelids

Inner canthus

54
Q

Xanthelasma

A

Most common of all xanthomas
Unrelated to hyperlipidemia
Individuals >50 y/o

55
Q

Treatment of Xanthomas

A

Laser
Excision
Electrodesiccation or topical application of trichloroacetic acid

56
Q

Types of Desquamation Disorders

A

Erythema Multiforme
Stevens-Johnson Syndrome (SJS)
Toxic Epidermal Syndrome

57
Q

Erythema Multiforme Presentation

A 
Erythematous "targetoid" macules/patches
Papules/plaques
Vesicles/bullae
Wheals (urticaria)
Erosions
58
Q

En Minor Erythema Multiforme

A 
Little/no mucous membrane involvement
Few systemic systems
Often due to HSV
Can be due to medications
Extensor surfaces
59
Q

En Major Erythema Multiforme

A 
Always mucous membrane involvement
Skin involvement more widespread
Systemic symptoms
Hepatitis, nephritis
Often due to medications
Nikolasky Sign
60
Q

Frequent Offenders for Erythema Multiforme

A

Sulfa containing drugs
Anti-epileptic drugs
Antibiotics
Allopurinol

61
Q

Sulfa Containing Drugs that Cause Erythema Multiforme

A

Bactrim

Dapsone

62
Q

Anti-epileptic Drugs that Cause Erythema Multiforme

A

Phenytoin
Cabemazepine
Pehnobarbital

63
Q

Antibiotics that Cause Erythema Multiforme

A

Penicillin

Cephalosporins

64
Q

Treatment of Erythema Multiforme

A

Systemic steroids

65
Q

Define Stevens-Johnson Syndrome

A

Mucocutaneous drug-induced or idiopathic reaction patterns characterized by skin tenderness & erythema of skin & mucosa, followed by extensive cutaneous & mucosal epidermal necrosis & sloughing

66
Q

Characteristics of Stevens-Johnson Syndrome

A 
Onset at any age
Associated with drugs
Systemic lupus
HIV
HLS-B12
67
Q

Prodromes of Stevens-Johnson Syndrome

A

Rash: morbilliform, diffuse erythema
Fever
Mouth lesions
Flu-like symptoms prior to mucocutaneous lesions
Mucocutaneous lesion, skin pain, burning & itching

68
Q

Progression of Stevens-Johnson Syndrome

A

Necrotic epidermis, macular areas
Sheet-like loss of epidermis
Flaccid blisters that spread with lateral pressure on erythematous areas
With trauma: full thickness epidermal detachment yielding expose, red, oozing dermis resembling a 2nd degree burn

69
Q

Define Nickolsky Sign

A

Flaccid blisters that spread with lateral pressure on erythematous areas

70
Q

Other Organs that may be Involved in Stevens-Johnson Syndrome

A

Hepatitis
Nephrititis
Pneumonitis

71
Q

Drugs Associated with SJS & TEN

A 
Sulfa drugs
Barbituates
Allopurinal
Diclofenac
Sulindac
Ketoprofen
Ibuprofen
Naproxen
Cephalosporins
Fluroquinolones
Vancomycin
Aminopenicillins
Rifampin
Ethambutol
72
Q

Treatment of EM Minor/Major

A

Antiviral prophylaxis to control HSV

Early diagnosis & cessation of suspected causative drug

73
Q

Treatment of SJS/TEN

A

Early diagnosis & cessation of suspected causative drug
Supportive care: ICU, fluids
Systemic steroids controversial
Growing evidence for the use of IVIG
Treat eye lesions with erythromycin ointment
Transfer to burn unit if widespread sloughing

74
Q

Treatment of Drug Reactions

A

Benadryl
IV/IM steroids
Steroid dose pack
Don’t use covers

75
Q

Characteristics of Bacterial Endocarditis

A

Staph aureas, strep viridans
Proliferation of microorganisms on the endocardium
Incidence increasing in the elderly, IVDU, & prosthetic valves

76
Q

History of Bacterial Endocarditis

A 
Fever
Chills
Sweats
Anorexia
Weight loss
Malaise
77
Q

PE Findings of Bacterial Endocarditis

A

Heart murmur
Arterial emboli
Splenomegaly

78
Q

Skin Lesions Associated with Bacterial Endocarditis

A

January lesions
Osler’s nodes
Subungual splinter hemorrhage
Petechial lesion

79
Q

Define Janeway Lesions

A

Nontender, hemorrhagic maculopapular lesions on palms & soles

80
Q

Define Osler’s Nodes

A

Painful, red nodules on fingertips

81
Q

Define Petechial Lesions

A

Small, non-blanching, reddish-brown merciless on extremities, upper chest, mucus membranes
Occur in crops

82
Q

Work Up for Bacterial Endocarditis

A 
Identify patients at risk & prophylaxis
Blood cultures
CBC
Chem panel
Coags
Echo
83
Q

Treatment of Bacterial Endocarditis

A 
PCN-G
Nafcillin
Gentamycin
Vanco in MRSA
Zyvox in MRSA
84
Q

What is the most common cause of bacterial endocarditis in IVDU?

A

Fungus

85
Q

What is the most common cause of bacterial endocarditis in tooth extractions?

A

Strep viridans

86
Q

Characteristics of Rocky Mountain Spotted Fever

A

Rickettsia rickettsii spirochete
Common May-September
Fatal if not treated

87
Q

History of Rocky Mountain Spotted Fever

A

Hx of tick bite
Ask about outdoor activity
Prodrome: anorexia, irritability, malaise

88
Q

PE Findings of Rocky Mountain Spotted Fever

A 
Fever >102
Chills
Weakness
Headache
Photophobia
Pronounced joint pain
89
Q

Skin Lesions of Rocky Mountain Spotted Fever

A

2-6 mm, pink blanching merciless begin on extremities & spread centrally
Evolve to papules & petechiae
Begins on wrists, forearms, ankles

90
Q

Treatment of Rocky Mountain Spotted Fever

A

Doxycycline (except for PG)

Chloramphenical (for PG)

91
Q

Lyme Disease can Cause What Kind of Problems

A

Skin
Joint
Heart
Nervous system

92
Q

How is Lyme disease transmitted?

A

Bite of an infected tick or flea

93
Q

Ticks that cause Lyme Disease

A

Deer tick
Lone star tick
Rocky Mountain tick

94
Q

Signs/Symptoms of Stage 1 Lyme Disease

A 
Flu-like symptoms
Fatigue
Headache
Fever/chills
Muscle/join pain
N/V
Dizziness
Non-productive cough
Small, red circular rash skin lesions
95
Q

Signs/Symptoms of Stage 2 Lyme Disease

A 
Severe headache
Neck pain or stiffness
Arthritis
Neurological symptoms
Psychiatric problems
96
Q

Preventing Lyme Disease

A

Take protective measures when outdoors

Keep pets free of ticks

97
Q

Protective Measures when Preventing Lyme Disease

A 
Wear light-colored clothing
Tuck pants into boots or socks
Use repellant containing DEET
Walk in the center of trails
Avoid contact with high grass & brush at trail edges
98
Q

Characteristics of Meningococcemia

A

Mid-winter to early spring

Most rapidly lethal form of septic shock

99
Q

PE Findings in Meningococcemia

A 
High fever
Tachycardia
Mild hypotension
Signs of meningeal irritation
Patient appears acutely ill
100
Q

Early Exanthema in Meningococcemia

A

Soon after onset
Pink 2-10 mm macules/papules
Sparsely distributed on trunk/lower extremities, face, palate, conjunctivae

101
Q

Later Lesions in Meningococcemia

A

Petechiae in center of merciless
Lesions become hemorrhagic
Purpura fulminans
Hemorrhagic bullae

102
Q

Work Up of Meningococcemia

A

Blood cultures
Pus from nodular lesions
D-dimers
LP

103
Q

What will LP show?

A 
Increased pressure
Cloudy
Decreased sugar
Increased protein
Gram negative diplo-cocci
104
Q

Treatment of Meningococcemia

A

Cefotaxine (Claforin)
Ceftriaxone (Rocephin)
PCN-G
Hemodynamic stabilization

105
Q

Characteristics of Gonococcemia

A

Bacteremic phase: tenosynovitis, arthralgias, & dermatitis
Males age 20-24
Females aged 15-19
Acral hemorrhagic pustules lesions

106
Q

Most Common Joints Affected in Gonococcemia

A 
Wrists
Fingers
Elbows
Knees
Ankles
Migratory polyarthralgia
107
Q

Labs to Determine Gonococcemia

A

CBC
ESR
Culture

108
Q

Treatment of Gonococcemia

A

Hospitalization with IV antibiotics

109
Q

IV Antibiotics Use to Treat Gonococcemia

A

Empiric with Rocephin
PCN-G
Augmentin
Doxycycline & Azithromycin

Dermatology (13 decks)

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