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Test 2 Flashcards

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1
Q

clinical presentation and tx for Mycobacterium marinum?

A

Mycobacterium marinum
Severe fish-tank granuloma w/sporotrichoid distribution pattern
Tx: Clarithromycin/Rifampin + ethambutol

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2
Q

Clinical presentation of Microsporum canis, and the txs?

A

Microsporum canis:
Tinea corporis, use topical terbinafine
Tinea capitis, use oral terbinafine

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3
Q

What are 2 cutaneous MRSA presentations, and their txs?

A

MRSA
Impetigo, use topical mucipiron
Curbuncle, use TMP/SMX or (a Lincosamide)

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4
Q

What are the scalp layers?

A 
S = skin
C = dense Connective tissue
A = Aponeurotic (occipitofrontalis m)
L = Loose connective tissue
P = Pericranium
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5
Q

What’s innervation for scalp?

A

CN V1-3 anteriorly

C2-3 posteriorly

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6
Q

What’s vascular for scalp?

A

Supratrochlear and Supraorbital arteries from Ophthalmic artery from Internal Carotid
External carotid’s superficial temporal, posterior auricular, and occipital

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7
Q

Describe major hair cycle phases

A 
Hair cycle:
Anagen growth
Catagen = regression
Telogen = rest
Exogen = ejection from follicle
Kenogen = no hair in follicle
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8
Q

Differentiate vellus and terminal hair?

A

· Most follicles produce vellus hair: fine (<0.03 mm,) short, non-pigmented, rapidly-cycling.
· Eyebrow, scalp, and eyelash follicles produce terminal hair: course (>0.06 mm,) long, pigmented, slowly-cycling.
· Lanugohairs are fine and long, and are formed in the fetus at 20 weeks’ gestation. They are normally shed before birth, but may be seen in premature babies.
· During puberty, vellus hairs in the genital areas and axilla are stimulated to become terminal hairs

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9
Q

Compare Exogen during Anagen w/exogen in Telogen

A

Exogen during Anagen = normal

Exogen during Telogen = longer period of Kenogen

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10
Q

What are 6 stages of Anagen?

A

Anagen:
1-5 Proanagen: proliferation of hair generating in dermal pipilla
6 Metanagen: full hair unit produced w/epithelial hair bulb around dermal papilla

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11
Q

What occurs during Catagen? how long does it last?

A

Catagen:
Hair follicle involutes, goes through apoptosis-driven regression, shrinks to 1/6 of its diameter in Anagen, and moves up towards surface
Club hair forms w/brush-like base to anchor hair fiber in Telogen follicle
Lasts few weeks

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12
Q

What occurs during Telogen

A

Telogen:

no melanocytes, layer of epithelial cells forms over dormant dermal papilla

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13
Q

What occurs during Exogen?

A

Exogen:
proteolytic cleaving of hair fiber shaft
Technically this is occurring in early Anagen

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14
Q

What protein occurs just before Anagen? and where?

A

WNT proteins appear just before Anagen in hair follicle bulb

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15
Q

Differentiate Psoriasis and Seborrheic dermatitis

A

Psoriasis = beyond hairline, silver scale on erythematous base, asymptomatic, Auspitz sign

Seborrheic dermatitis = chronic inflammation where sebaceous glands dense (scalp, forehead, eyebrows, lash line, nasolabial folds, beard postauricular), yellow greasy crust, Malassezia furfur

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16
Q

Differentiate Nevus sebaceous, Pilar cyst

A

Nevus sebaceous = hamartomatous lesion of sebaceous gland, usually found in newborns, velvety yellow/orange/tan plaque, hairless, benign but 10% transform to BCC

Pilar cyst = keratin arising from hair follicle, multiple/firm/mobile/slow growing SubQ nodules up to 5cm

Both on scalp

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17
Q

Differentiate Epidermoid cyst and Lipoma

A

Epidermoid cyst = usually trunk, can be scrotal/face/neck proliferation of EPIdermal cells within DERMIS, a keratin plug, looks like pore, ruptured smelly cottage cheese-like

Lipoma = trunk and extremities, can be scalp, painless/rubbery/mobile

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18
Q

Differentiate Epidermoid from Pilar cyst?

A

Epidermal cysts are usually trunk, epidermal cells in dermis, causing keratin plug that looks like pore, and smelly cottage cheese inside

Pilar cysts are on scalp, multiple/firm/mobile/slow growing, keratin arising from follicle

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19
Q

Describe inheritance pattern of androgenetic alopecia, and what’s the 1 gene that contributes the most to it?
How to tx? MOA?

A

Androgen receptors are X-linked, esp PAX1 (paired box 1) gene is implicated
Tx: Minoxidil, direct vasodilator

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20
Q

Describe Telogen Effluvium hx, PE findings, tx?

A

Telogen effluvium =
stress response triggers up to 50% of hair to pass into Telogen phase
PE: diffuse shedding/thinning 2-4mo after stress event, when new hairs begin to gow
Tx: reassurance

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21
Q

Describe Alopecia Areata, what are the associated conditions and subtypes?

A

Alopecia areata:
Spontaneous tart/end to smooth round areas completely devoid of hair
Assoc w/autoimmune diseases
PE finding = exclamation point hairs

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22
Q

Differentiate Traction alopecia from Trichotillomania?

A

Traction alopecia = hair loss d/t styling aka white people tryna dread
Trichotillomania = hair loss d/t nervous compulsions of pulling out hair, and loss can become permanent

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23
Q

Compare mechanism and causative agents for Anagen vs Telogen effluvium

A

Anagen effluvium: reversible impaired mitotic ability causing hair loss when they’re in Anagen… XRT, chemo, ANTIMITOTICS (etoposide, teniposide), or ANTITUMOR ABX (doxorubicin, daunorubicin)
Telogen effluvium: meds that start hair loss 2-4mo after, by inducing Telogen… OCPs, lithium, anticoagulants, valproic acid, heavy metals, colchicine, cimetidine

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24
Q

How does Lupus manifest on scalp?

Dx?

A

SLE can manifest as scarring alopecia in well-circumscribed erythematous patches w/follicular hyperkeratosis/plugging
Once starts, is permanent
Bx is diagnostic

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25
What's mechanism for Acne Keloidalis nuchae? tx?
Acne Keloidalis nuchae... is not Acne or Keloids! AA 15-24yo M athletes w/irritated follicles when hairs cute short, causing papules, pustules, hair loss, and granuloma formation Tx: stop close shaving, friction, and styling products Use Abx + topical steroid + retinoids if necessary
26
What's typical presentation of dissecting cellulitis?
Dissecting Cellulitis: | Painful pustules, nodules connected by infected sinus tracts draining blood or pus, leading to allopecia
27
what's pathophysiology of allopecia areata?
``` Loss of immune privilege leads to: – Peribulbar inflammation – Oligoclonal T lymphocytes – Aberrant expression of HLA class I antigens – Activation of CD8+ T lymphocytes – Secretion of IFN-γ ○ Maybe introduced from an infection – Up-regulation of HLA class II antigens, Activation of CD4+ T lymphocytes, and CD4+ Th1 lymphocytes provide help to CD8+ lymphocytes which cause damage **CD8 mediated response though ```
28
Differentiate immunopathogenic mechanisms responsible for allopecia areata and primary cicatrical alopecia
Allopecia areata = Th1 mediated d/t loss of immune privilege, so autoimmune diesease Primary cicatrical alopecia = Th17 and inflammation mediated Both end up having CD8 Tcells activate
29
differentiate the 3 types of tinia capitis?
Tinia capitis: (progressively worse) Black dots are broken off hairs kerion are painful, inflamed nodules that drain pus favus are extensive alopecia, atrophy, scarring, YELLOW adherent crusts
30
what are the asexual conidia of the 3 dermatophytes?
Epidermophyton: thin walled, 2-4cell macroconidia Microsporum: spindle-shaped, thick walled, 8-15celled Trichophyton: broad hyphae w/microconidia growing at 90 degree angles
31
What are 2 most common bacterial agents of scalp folliculitis
Usually Staph aureus or P acnes cause scalp folliculitis | unless it's fungal, then t's Deramtophytes
32
What are 3 types of cells in nail matrix?
Nail matrix = Langerhans, melanocytes, and keratinocytes
33
What usually causes the follow nail colors? Blue Brown/Black yellow
``` Blue = usually hypoxia or vasoconstriction, but can be d/t drugs like Minocycline, if only Lunula think Wilson's disease Black/brown = melanoychia, caused by nevus in nail bed, can be melanoma Yellow = usually elderly, can be lymphedema or pulmonary disease ```
34
How do the following present? significance? Splinter hemorrhage? Subungual hematoma?
Splinter hemorrhages = sign of Infective Endocarditis! +Roth spots in macula, Osler nodes on fingers, Janeway lesions on palms/soles Subungual hematoma = super painful traumatic hematoma under nail, needs acute puncture for relief, bc old wounds already coagulated
35
How do the following present? significance? half and half nails? Mee's lines? Beau's lines?
Half and half nails = prox white, dist brown/red nails, indicated liver disease if line is straight (Terry's nails) or renal disease if wavy Mee's lines = multiple transverse white lines d/t arsenic poisoning or severe illness Beau's lines = transverse depressions in nails d/t severe illness or disease that causes nails to stop growing, then as they regrow the groove forms
36
How do the following present? significance? Onycholysis? Onychoschizia? Onychogryphosis?
``` Onycholysis = nail plate separating from nail bed Onychoschizia = thing/brittle nails that split distally, foten d/t repeated wetting and drying, can be seen in thyroid dz Onychogryphosis = hypertrophy and excessive curving of nails, elderly claw nails or d/t hypoperfusion, DM, or neglect ```
37
How do the following present? significance? Clubbing? Koilonychias? Paronychia?
``` Clubbing = pulmonary, cardiac, GI, or malignancies Koilonychias = spoon nails d/t iron deficiency Paronychia = acute/chronic infection of tissue surrounding nail ```
38
What are 2 types of Leukonychia, and differentiate
Leukonychia = white spots Leukonychia striata = usually d/t trauma like vigorous manicuring, can be spontaneous Leukoncyhia totalis = can be hereditary or acquired in hypoalbuminemia and other severe systemic diseases
39
define Uritcaria
Urticaria = hives, well circumscribed, raised, erythematous w/central pallor, may coalesce, typically disappears over a few hrs
40
define xerosis?
Xerosis = dry skin
41
Cause of atopic dermatitis? | differentiate atopic dermatitis in infants vs kids vs adults
Atopic dermatitis = eczema, d/t mutations in Fillagrin infants: face, scalp, extensors kids: flexors, eyelids, neckline, Dennie-Morgan lines pronounced infraorbital fold d/t edema adults: flexors, eyelids, neckline
42
what are tx options for atopic dermatitis, and why?
atopic dermatitis tx options - avoid irritants, sweating, use antihistamines and - corticosteroids - immunomodulators (Tacrolimus, Pecrolimus) - PUVA - Methotrexate, Cyclosporine, or Azathioprine if severe disease
43
what are systemic causes of pruritus?
Systemic causes of pruritis: ○ Hodgkin’s lymphoma (legs especially pruritic),Non-Hodgkin’s lymphoma, Cutaneous T Cell Lymphoma ○ Polycythemia Vera (aquagenic) ○ ESRD ○ hyper/hypothyroidism ○ diabetes ○ dz causing bile stasis (primary biliary cirrhosis, viral hep, cholestasis of pregnancy, sclerosing cholangitis, drug induced cholestasis) ○ infections like HIV, *eosinophilic folliculitis
44
what are common neurogenic causes of pruritis?
``` Neurogenic causes of pruritis: Brachioradial pruritis Notalgia paresthetica = chronic sensory neuropathy, usually upper back just inf to scapula Peripheral neuropathy Post-herpetic neuralgia ```
45
what are common psychiatric causes of pruritis?
Psychogenic causes of pruritis: | Psychogenic excoriation = skin picking disorder
46
What is hyperkeratosis pilaris?
Hyperkeratosis pilaris = thickened/keratinized skin around follicles on posterior-lateral UEs usually, puberty problem usually disappears in adulthood tx: exfoliation and lotion
47
Differentiate acute vs chronic Urticaria
acute urticaria <6w | chronic urticraia >6w
48
What's pathophysiology behind Urticaria?
Urticaria: mediated by mast and basophils that release Histamine causes pruritis, vasodilation, and edema in epidermis
49
What are most common tx for Urticaria?
- 2/3 of acute urticaria resolves spontaneously - H1 antihistamines, use 2nd gen (cetrizine, loratadine, fexofenadine) over 1st gen (phenylnephrine) - H2 antihistamines (ranitidine, nizatidine, famotidine, cimetidine) usually used for GERD but maybe more effective for acute urticaria than H1 - glucocorticoids
50
What is Pediculosis? | What is Sarcoptes?
``` Pediculosis = lice Sarcoptes = scabies, most common infestation worldwide ```
51
What 3 bacteria can Pediculosis transmit?
Pediculosis carries 1) Rickettsia prowazekii 2) Bartonella 3) Borrelia
52
What is the super bad form of Sarcoptes called?
Crusted = Hyperkeratotic = Norwegian scabies
53
What are 2 drug tx for Sarcoptes?
Sarcoptes (Scabies) Tx: Permethrin cream for immunocompetent Ivermectin for immunocompromised w/Norweigan/crusted scabies
54
Why isn't Lindane usually used for Sarcoptes or Pediculosis tx?
Lindane has serious CNS ADEs that easily occur w/percutaneous absorption
55
why does fluid resuscitation need to be aggressive but monitored carefully?
Bc excess can cause infection, Acute Respiratory Distress Syndrome (ARDS), abdominal compartment syndrome, or death Edema: capillaries increase permeability -> systemic capillary leaks -> severe protein loss -> localized and generalized edema w/o HTN Shock: zones of Coagulation, Stasis, and Hyperemia will occur -> Ischemia + Hyperemia (excess blood) + inflammation cascade
56
What can happen during burn shock? (hypovolemia, distribution, and cardiogenic shock)
Burn shock: Hypovolemia d/t fluid loss to outside AND into cells AND into interstitium Distributive d/t vasodilation, moving fluid away from organs that need it Cardiogenic d/t decreases in preload and contractility, and increase in afterload
57
What kind of AKI can occur w/burns?
burn AKI: early phase = hypovolemia w/low cardiac output and systemic vasoconstriction (less common w/fluid resuscitation) late phase = sepsis, multiorgan failure, fluid shifts, myocardial depression... Abdominal compartment syndrome pressure compresses renal vein and decreases GFR... stress hormones, inflammatory mediators, and nephrotoxins damage
58
What type of hypermetabolic state is assoc w/burns?
Hypermetabolic burn state Ebb: first 48hrs hypometabolic state, decreased cardiac output, metabolism, O2 consumption Flow: can last up to 1yr after burn, hypermetabolic state, increased cardiac output up 2x, insulin resistance, increased lipid/protein consumption leading to higher resting energy expenditure, reduced bone mineralization, linear growth, muscle, and immune response
59
What are 2 types of ionizing radiation? how do they damage DNA?
Particulate (alpha, beta, neutrons) directly ionize -alpha and neutrons cause tissue damage -Beta cause Burns Electromagnetic (gamma, xrays, photos) indirectly ionize -gamma causes local injury and acute radiation syndrome
60
Define acute radiation syndrome
Acute radiation syndrome: prodrome 0-2d = GI sxs latent 2-20d = asymptomatic manifestation 21-60d = anemia, infection, bleeding, diarrhea, hypovolemia, electrolyte disturbances, cerebral edema, mental deterioration, CV collapse
61
what's usual time course of sxs and tx involved in acute radiation syndrome?
Prodrome 0-2d Latent 2-20d Manifestation 21-60d
62
which layer of skin do you find sebaceous glands?
Sebaceous glands are in Connective Tissue sheath surrounding hair follicle
63
What are the 3 parts of skin called around the nail? 1-overlying nail root 2-keratinized free edge 3-under free end
1 Nail fold overlies nail root 2 Eponychium is keratinized free edge 3 Hyponychium is under nail's free end
64
what classifies a burn as 3rd degree?
3rd degree burns have transmural necrosis and fibrin exudation
65
What are hallmark characteristics of CO poisoning?
CO poisoning = bright cherry-red blood fingernail beds also bright red soot in airways if CO source was fire
66
What happens w/direct lightening strikes? w/indirect?
Direct lightening strike causes Cardiopulmonary arrest | Side-flash hit causes clothing tearing and electrical burns
67
Describe histology of psoriasis (Epidermis, Dermis)
Psoriasis Epidermis = hyperkeratosis, parakeratosis (retains nuclei in stratum corneum), acanthosis (stratum spinosum thickening), elongation of rete ridges, dermal papillae Neutrophils migrate into Epidermis, forming Munro Abscesses Dermis super vascularized -> Auspitz sign
68
Which mutation's seen in all benign nevi (melanoma)? Which mutations are most often seen in cutaneous melanoma? Which mutation's seen in all invasive melanomas?
Benign nevi = BRAF-V600E Cutaneous melanoma = BRAF and NRAS invasive melanoma = CDKN2A
69
How do you classify Melanomas subtypes?
Melanoma: Junctional = dermal epidermal junction Compound = at dermal-epidermal junction AND in dermis Intradermal = dermis only
70
What do you see histologically for Squamous Cell Carcinoma?
SCC = well differentiated, atypical keratinocytes that're slightly enlarged w/abundant amounts of cytoplasm, "pearls"
71
Describe Basal Cell Carcinoma's appearance?
BCC = pearly nodules w/telangectasia, made of uniform basaloid nests in dermis
72
What are common complications of SLE?
``` SLE: butterfly/malar rash Discoid lupus Pleuritis Pericarditis (seizures/psychosis, endo/myocarditis, hemolytic anemia, leukopenia, thrombocytopenia, glomerulonephritis, nonerosive arthritis, LAD) ```
73
Which 2 drugs are ovicidal and which 3 are not for Sarcoptes?
Ovicidal 1 Ivermectin 2 Spinosad non-Ovicidal 1 Permethrin/myrethrin 2 Malation = organophosphate 3 benzyl alcohol

Derm (2 decks)

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