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Clinical Medicine > Test 3 - Derm > Flashcards

Test 3 - Derm Flashcards

1
Q

Describe the stratum corneum

A

Top layer of skin

Contains keratin & fillagrin surrounded by lipid matrix that provides a water barrier

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2
Q

What is fillagrin?

A

A protein in the granular cell layer
Holds water
Found in stratum corneum

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3
Q

What are the types of skin cells?

A
  1. Keratinocytes
  2. Melanocytes
  3. Langerhans
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4
Q

Describe keratinocytes

A

90% of skin cells
Migrate from basal layer
Desquamation 40-56 days
Spiny layer, held together by desmosomes -stripes/spines

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5
Q

Defects in fillagrin causes?

A

atopic dermatitis

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6
Q

Defects in keratinocytes causes?

A

psoriasis

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7
Q

Describe melanocytesres

A

basal layer of skin

produce melanin which is transferred to the keratinocytes

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8
Q

Describe langerhans

A

mid-epidermis cells

Responsible for delayed hypersensitivity immune response reactions

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9
Q

What are the types of flat lesions?

A
  1. Macule
  2. Petechiae
  3. Ecchymosis
  4. Telangiectasia
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10
Q

What are the types of elevated lesions?

A
  1. Papule
  2. Plaque
  3. Nodule
  4. Wheal
  5. Papilloma
  6. Vesicle
  7. Bulla
  8. Abscess
  9. Cyst
  10. Scales
  11. Lichenification
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11
Q

Papule

A

raised, solid lesions <.5cm in daimeter

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12
Q

Nodule

A

raised, solid lesions >0.5 cm in diameter

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13
Q

Plaque

A

plateau-like elevation

confluence of papules

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14
Q

Lichnification

A

chronic, thickening of the epidermis leading to exaggerated, deep skin lines, usually due to chronic rubbing/scratching

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15
Q

Wheal

A

round of flat topped evanescent lesion,

changes rapidly in size & shape

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16
Q

urticaria

A

multiple wheals

“hives”

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17
Q

Vesicle

A

fluid filled lesion <0.5 cm

often thin walled

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18
Q

Bullae

A

fluid filled lesion >0.5 cm

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19
Q

Furuncle

A

abscess where hair follicle is involved

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20
Q

Carbuncle

A

multiple furuncles

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21
Q

What is cryotherapy?

A

liquid nitrogen

Warts, seborrheic keratoses, actinic keratoses

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22
Q

When do you perform an excisional biopsy?

A

Pigmented lesions >4mm
All lesions >6mm
Deep dermis/subQ involvement

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23
Q

Indications for Mohs surgery

A
  1. Incompletely excised BCC or SCC
  2. Primary BCC or SCC w/ indistinct borders
  3. Cosmetic areas
  4. Aggressive, rapidly growing lesions
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24
Q

Types of pigmented lesions

A
  1. Nevi
    - melanocytic
    - atypical
    - blue
  2. Lentigines
  3. Seborrheic keratoses
  4. Malignant melanoma
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25
Q

Evaluation of a pigmented lesion

A 
A - Symmetry
B - Borders; irregularly, poorly defined
C - Color - inconsistent
D - Diameter/size >6mm
E - Evolving/changing (shape, size, color)
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26
Q

Risk Factors of melanoma

A
  1. Hx of melanoma
  2. Family Hx
  3. > 100 acquired nevi
  4. Any new lesion >50 y/o
  5. Fair skin, blue eyes, freckles (Fitzpatrick skin II)
  6. Big sunburn
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27
Q

Classification of atypical nevi

A

Meet 3/5

  1. Poorly defined borders
  2. Irregular borders
  3. Irregular pigment
  4. Background erythema
  5. > 5mm diameter
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28
Q

Seborrheic keratoses

A 
Benign, may appear in 4th decade
Not on palms & soles
Pink, tan, dark brown
Texture - velvety to warty
Stuck on appearance

Tx - cryotherapy, curetted

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29
Q

Lentigo

A

Melanoma in elderly pts
Sun exposed areas
Slow growing
Horizontal growth

Clyde spots!

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30
Q

Acral lentiginous melanoma

A

Melanoma common in Asians/blacks
hands, feet, nails
Hutchinson sign - very aggressive w/ mets - line on nail

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31
Q

Amelanotic melanoma

A

Subtle w/o pigmentation

DDx:
diff. types of skin cancer
psoriasis
dermatitis

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32
Q

Atopic dermatitis

A

aka eczema
“itch that rashes”
Erythematous papules that coalesce into plaques
xerosis

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33
Q

What is the atopic triad?

A

50-80% of children will have another atopic disease

  1. Asthma
  2. Atopic dermatitis
  3. Allergic rhinitis
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34
Q

Risk factors of atopic dermatitis

A
  1. Hx/FH
  2. Hx asthma/allergic rhinitis
  3. Xerosis
  4. Repeated skin infections
    - S. aureus
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35
Q

Tx atopic dermatitis

A
  1. Topical steroids
  2. Calcineurin inhibitors (Elidel, Protopic)
  3. Antihistamines
  4. Tx secondary bacterial infections
    milds soaps, bath 1x/day, moisturizers, avoid wool & acrylics, sweat, heat & ointments
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36
Q

Lichen Simplex Chronicus & Tx

A
  1. Localized area of lichenification
  2. May be secondary to atopic dermatitis or other itchy conditions
  3. Hyperexcitability/abnormal itching
  4. Intense, may be unconscious habit

Tx - break the itch! Steroids, antihistamines, occlusive/hydrocolloidal dressing

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37
Q

Psoriasis & Risk Factors

A 
Chronic inflammatory condition
Bimodal peak 20-30 or 50-60 
Familial, waxes & wanes 
Risk factors:
1. BMI
2. Smoking
3. EtOH
4. Medications
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38
Q

Types of psoriasis

A
  1. Plaque
  2. Guttate
  3. Inverse/flexural
  4. Erythrodermic
  5. Pustular
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39
Q

Plaque psoriasis

A

Most common type of psoriasis
Salmon colored plaques w/ silvery scales**
May itch
Hyperproliferative disease - immune response causes excess cytokine release

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40
Q

What is auspitz sign?

A

Psoriasis bleeds when plaques removed

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41
Q

Psoriatic arthritis

A

Considered seronegative spondyloarthropathies

OFten affects hands, feet & spine

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42
Q

Guttate psoriasis

A

Drop like lesions 1-10mm
Acute onset*
Often preceded by strep pharyngitis*

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43
Q

Erythrodermic & pustular psoriasis

A

Both rare but can be serious life threatening conditions

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44
Q

Inverse/flexural psoriasis

A

Found in body folds
Axilla common
Lacks scales due to moisture
May mimic candidiasis

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45
Q

Tx psoriasis

A 
Mild:
1. Topical steroids
2. Vit D analogs
3. Keratolytic agents (salicylic/lactic acid)
4. Topical retinoids
5. Coal tar
Moderate to sever:
1. PUVA (UV therapy)
2. Retinoids
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46
Q

Pityriasis rosea

A 
Fawn/salmon colored plaques 
May be caused by herpes 
Peak age 10-35
more common in females
Herald Patch** - 2-10cm patch w/ peripheral scaling, central clearing often located on the back 
1-2 wks later, full blown rash on trunk & proximal extremities 
Xmas tree distribution* 
Spares the face, palms & soles of feet
Neg KOH scraping 
no Tx
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47
Q

What causes a Herald patch?

A

Pityriasis rosea

2-10 cm patch w/ peripheral scaling, central clearing often located on the back

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48
Q

Which rash has a Christmas tree distribution?

A

Pityriasis rosea

spares the face, palms & soles of feet

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49
Q

Seborrheic dermatitis

A

Scaly, greasy looking rash
Beard, eyebrows, nasolabial fold, eyelids, under boobs, dandruff/cradle cap
Most likely caused by inflammatory rxn to fungus (Malassezia) or yeast

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50
Q

Tx Seborrheic dermatitis

A
  1. Antifungals & topical steroids
  2. Selenium sulfide shampoo or zinc pyrithione
  3. Salicylic acid
  4. Tx blepharitis by gently cleaning w/ soap
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51
Q

Chronic cutaneous lupus erythematosus

A

Discoid lupus - DLE chronic scarring lesions
Subacute cutaneous - SCLE nonscarring
Malar/butterfly rash -often pptd by sun exposure
Sharply marginated w/ irregular borders
Expansion peripherally w/ central regression leading to atrophy

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52
Q

Tx of lupus rash

A

Prevention - avoid sun

  1. Topical steroids
  2. Antimalarials
  3. Retinoids
  4. Thalidomide
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53
Q

Mycosis fungoides & Tx

A 
aka cutaneous Tcell lymphoma
Indolent
Patches & plaques that may resemble psoriasis
Sezary cells 
Tx - PUVA, retinoids
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54
Q

Actinic keratoses

A 
Small lesions 0.2-0.6 cm 
Macular or papules
Pinkish/flesh colored rough patches
Often in sun-exposed areas 
Premalignant deformation of keratinocyte may develop into SCC
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55
Q

Tx actinic keratoses

A
  1. Liquid nitrogen
  2. Topical agents
    - Fluorouracil cream
    - Imiguimod 5%
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56
Q

Squamous Cell Carcinoma

A 
Usually in sun exposed areas 
White fair skin
Inc. mortality rate compared to BCC 
1. Papule, plaque or nodule
2. Pink, red or flesh colored
3. Scaly
4. Grows outward
5. Firm
6. May have cutaneous form
7. Friable (bleed easily)
8. May be pruritic
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57
Q

Types of SCC

A
  1. In situ- Bowen: localized to intraepidermal layer

2. Invasive - involvement of dermis

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58
Q

Tx of SCC

A
  1. In situ - curette & desiccation, topical

2. Invasive - wide & local incision, MOHS

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59
Q

Mammary Paget disease

A

Unilateral red scaling plaque
Dx w/ Bx
Tx - mastectomy, chemo

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60
Q

Dishidrotic eczema & Tx

A 
aka vesiculobullous hand eczema
Tapioca vesicles affecting hands & feet
Blisters, pruritic, may become scaly & fissured 
Tx - topical/oral corticosteroids
keep dry - white cotton socks
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61
Q

Porphyria cutanea tarda & causes

A 
Blisters on dorsal surface of hands 
Skin fragility 
Hypertrichosis (facial hair)
Causes:
1. Sun exposure
2. Liver disease/alcoholism
3. Hep C
4. Hemosiderosis
Dx - urinary uroporphyrins
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62
Q

Tx of porphyria cutanea tarda

A
  1. Avoid sun (suncreen doesn’t help)
  2. Avoid/remove other triggers
  3. Phlebotomy
  4. Antimalarials
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63
Q

Contact dermatitis causes

A

Exposure to chemicals or allergens
Irritant - additive, soaps, detergents
Allergic - plants, antimicrobials, adhesive tape, jewelry, rubber
Hypersensitivity rxn taking 10-14 days 1st time or 12-48 hrs repeated

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64
Q

Contact dermatitis presentation

A

Irritant - erythematous, flat, scaly
Allergic - vesicular, weepy, crusting
Itching & burning
Linear distribution

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65
Q

Rhus dermatitis causes

A

Uroshiol

  1. Poison ivy
  2. Poison oak
  3. Poison sumac

Type of contact dermatitis

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66
Q

Who gets Acne vulgaris?

A

May appear 8-12 y/o
Peaks 15-18 y/o
Often resolves by 25 y/o
Men>women

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67
Q

Pathophysiology acne vulgaris

A
  1. Production of sebum (androgen mediated)
  2. Keratinous obstruction of sebaceous outlet
  3. Baterial colonization - Propionionbacterium acnes
  4. Inflammatory rxn
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68
Q

What is an open comedone?

A

black head

seen w/ acne vulgaris

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69
Q

What is a closed comedone?

A

white head

seen w/ acne vulgaris

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70
Q

Tx acne vulgaris

A
  1. Topical antibiotics
  2. Benzoyl peroxide - helps open pores
  3. Topical retinoid
    w/ severe - accutane - contraindicated in pregnancy
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71
Q

What worsens acne vulgaris?

A
  1. Androgenic steroids
  2. Corticosteroids
  3. Phenytoin (Dilantin)
  4. Isoniazid
  5. Oral contraceptives
72
Q

Rosacea

A

Papules & pustules
Neurovascular component - flushing & telangiectasia
Glandular component - hyperplasia of the soft tissue of the nose (rhinophyma)

73
Q

Tx of rosacea

A
  1. Metronidazole gel or clindamycin gel
  2. Oral antibiotics
  3. Benzoyl peroxide, topical retinoin
74
Q

Milaria

A

aka heat rash
Keep cool w/ non-restrictive clothing
Clean skin w/ chlorhexadine
Topical steroids

75
Q

Urticaria

A 
Swelling of the upper dermis
Angioedema - swelling of the deep dermis & subQ tissue
Often involves face, tongue & larynx 
May be manifestations of anaphylaxis
acute 6 wks
76
Q

Types of urticaria

A
  1. Cholinergic - heat & emotion
  2. Solar
  3. Water - aquagenic
  4. Dermatographism - when skin is rubbed or scratched, leaves sharply localized edema or wheals
77
Q

Causes of urticaria

A

Immunologic - IgE mediated activation of mast cells
Non-immunologic - Release of histamine through other pathways
1. Idiopathic
2. Food allergies
3. Infections
4. Drugs
5. IV contrast dye

78
Q

What type of reaction do detergents cause?

A

contact dermatitis

79
Q

Which drugs can cause urticaria?

A
  1. ACE
  2. PCN
  3. ASA
  4. NSAIDS
    NSAIDS may not be cause but exacerbate it
80
Q

Erythema multiforme Minor

A

Usually caused by Herpes or mycoplasma
Papules evolve into vesicles over ~10 days
Target lesions
Tx - acyclovir

81
Q

What drugs can cause erythema multiforme major?

A
  1. Sulfa
  2. Allopurinol
  3. PCN
  4. Anticonvulsants
  5. NSAIDS
82
Q

Tx erythema multiforme major

A
  1. Withdraw insulating agent
  2. Burn unit
  3. IV fluids
  4. IV immunoglobulins
  5. Corticosteroids maybe
    - prone to infections
83
Q

Pemphigus & causes

A 
Rare
Bullae - tender, painful & rupture
Susceptible to secondary S aureus infection 
Nicholsky sign
Causes:
1. Autoimmune
2. Drug induced
3. Paraneoplastic
84
Q

What is the Nicholsky sign & when is it seen?

A

separation of epidermis w/ contact

Seen w/ pemphigus

85
Q

What are the forms of pemphigus?

A
  1. Vulgaris
  2. Vegetans
  3. Foliaceus
  4. Erythematosus
86
Q

Dx & Tx of pemphigus

A

Immunofluorescence - IgG deposits on keratinocytes & other inflammatory processes
Tx:
1. Corticosteroids, immunosuppressants, IVIG
2. Tx of secondary infection
3. Chronic, some remission

87
Q

Bullous pemphigoid & Dx & Tx

A 
Deep, tense bullae
Common in flexural areas
Age >60, men
Autoimmune 
Course: exacerbations/remissions, remits 5-6 yrs 
Dx: Immunofluorescence
Tx: Derm referral
88
Q

Corns & Callosities

A

Hardened hyperkeratotic overgrowths
Protection from friction; pressure areas
Calluses are larger on the bottom/plantar surface

89
Q

Types of corns

A
  1. Hard - thickened area w/ packed center
  2. Soft - thinner surface, nonweight bearing surfaces, more painful
  3. Seed - smaller, bottom foot, very tender, may be clogged sweat duct
90
Q

Tx callus & corns

A
  1. Better fitting shoes
  2. Trimming
  3. Salicylic acid
  4. Soaking/pumice
  5. Urea/lactic acid
    Refer if diabetic
91
Q

Basal Cell Carcinoma

A 
MCC of skin cancer 
Can occur in pale or dark skins 
Pink pearly papules*** 
rarely mets
Locally invasive
At risk for other types of skin cancer 
Follow up q 6mo-1yr
92
Q

What is pathognomonic for pink pearly papules?

A

BCC

93
Q

Tx BCC

A
  1. Curettage & dessication
  2. Cryotherapy
  3. Excision
  4. Mohs
  5. Imiquimod
  6. 5% Fluorouracil
  7. Radiation?
94
Q

Violaceous purple plaques & nodules

A
  1. Lichen planus
  2. Kaposi sarcoma
  3. Purpura & vasculitis
    - petechiae
    - ecchymosis
    - vasculitis
95
Q

Lichen planus

A 
Inflammatory pruritic condition
1. Purple
2. Papules
3. Pruritic
4. Polygonal (cells)
Wickham's striae - fine white lacy lines
Distribution - flexor surfaces, genitals
96
Q

Causes & Tx of lichen planus

A
  1. Idiopathic
  2. Drugs
  3. Metals
  4. Infection (HCV)

if erosive/ulcerative - inc risk of SCC

Tx - PUVA & immunosuppression

97
Q

Kaposi’s sarcoma

A

Vascular neoplastic condition caused by HHV8
Seen on face, trunk extremities & hard palate, GI tract & lungs
Refer!

98
Q

Types of purpura

A

palpable - vasculitis (inflammatory)

non-palpable - petechiae 5mm

99
Q

Does it blanch?

A

Blanch - secondary to vasodilation

non-blanch - extravasation of blood
hemorrhagic

100
Q

Causes of petechiae

A
  1. Abnormal platelet function
  2. DIC & infection (meningitis)
    3 Thrombocytopenia
    -idiopathic
    -drug induced
    -thrombotic
101
Q

Causes of ecchymosis

A
  1. Coagulation defects
  2. DIC & infection
  3. Trauma
102
Q

Causes of vasculitis

A
  1. Henoch-Schonlein purpura
  2. Idiopathic
  3. Malignancy
  4. Infections
  5. Drug induced
  6. Polyarteritis nodosa
  7. Takayasu arteritis
  8. Giant cell arteritis
103
Q

Anogenital pruritis & causes

A
  1. Hemorrhoids, fissures
  2. Infections
    - Candidiasis
    - Erythrasma
    - Oxyuriasis (pinworms)
  3. Contact dermatitis
  4. Irritating secretions
    - diarrhea
    - trichomoniasis
  5. Psoriasis, seborrheic, dermatoses
104
Q

Causes of vulvar pruritis

A
  1. Candidiasis
  2. Trichomoniasis
  3. Lichen conditions
105
Q

Tx anogenital pruritis

A
  1. Hydrocortisone-pramoxine (pramasone)
  2. Topical doxepin
  3. Topical capsaicin
106
Q

Erythema nodosum

A 
Painful erythematous nodules**
Bright red, brown-yellow & resemble contusions*
Inflammation panniculus w/o ulcerations 
Anterior tibial surface
Usually symmetric 
\+/- fever, fatigue & arthralgias 
2-4th decade
women>men
107
Q

Causes of erythema nodosum

A
  1. Streptococcus
  2. Fungal (histoplasmosis, coccidiomycosis), TB, syphilis
  3. Drugs - oral contraceptives, sulfa
  4. Sarcoidosis
  5. IBD
  6. Diverticulitis
  7. Neoplasms
  8. Idiopathic
108
Q

Tx erythema nodosum

A 
Address underlying condition
Usually resolves in 3-6 wks 
1. NSAIDS
2. Oral KI
3. Steroids maybe
109
Q

Epidermoid cysts

A

Epidermal inclusion cyst
Benign growths in the upper hair
Can become inflamed
Typically have a pore, punctate center

110
Q

Epidermal inclusion cyst

A

Filled w/ cheesy, foul smelling material

May need I&D 1st then removal if infected/inflamed

111
Q

Milia

A

Keratin filled cysts

benign, nonpainful, no Tx needed

112
Q

Pilonidal cyst

A 
Pit forms at gluteal cleft
Blocked w/ hair & keratin 
Abscess may form
High recurrence rate after Tx
May need I&D, surgical referral
113
Q

Causes of photodermatitis

A
  1. Solar urticaria
  2. Lupus
  3. Porphyria
  4. Photosensitization due to drugs
  5. Polymorphous Light Eruption (PMLE)
114
Q

Drugs that cause photodermatitis

A
  1. Antibiotics
    - sulfa, fluoroquinolones, tetracycline
  2. NSAIDS
  3. Diuretics
    - furosemide, HCTZ
  4. Retinoids
115
Q

Polymorphous Light Eruption

A

PMLE
~23 y/o
Occurs w/ sun exposure, spring/early summer
Probably a photoallergy type response
Appears w/in 18-24 hrs of exposure & resolves over 10 days

116
Q

Tx of PMLE

A
  1. Sunscreen
  2. +/- antimalarials
  3. +/- PUVA (to inc. tolerance)
117
Q

Venous ulcers

A 
Signs of venous insufficiency 
Varicosities
Dusky pigmentation (hemosiderin deposits)
Discomfort relieved by elevation 
Medial ankle most common
118
Q

Tx of venous ulcers

A
  1. Compression Tx (Unna boot)/compression stockings
  2. Carefully measure/document
  3. Keep moist (semipermeable dressings)
  4. Clean w/ saline
  5. Weekly dressing changes
  6. Systemic abx w/ infection
  7. If not healed w/in 6 wks - wound care referral
119
Q

Arterial ulcer

A 
Dependent rubor
Diminished pulses
Hx claudication 
Punched out appearance
Well demarcated w/ pale base, minimal exudate
120
Q

Diabetic ulcers

A

Neuropathy
Callus is considered pre-ulcerative condition in DM/neuropathy
Consider Xray to r/o osteomyelitis
Culture, abx

121
Q

Pyoderma granulosum

A

Unknown cause
Minor trauma leads to development of pustule that quickly expands, inflammatory process
Multiple satellite lesions may form & coalesce
Violaceous border
Tx - steroids, immunosuppression

122
Q

Vitiligo

A

Absence of melanocytes
Familial
Linked to autoimmune thyroid disease
White macules, can affect hair

123
Q

Tx of vitiligo

A
  1. PUVA
  2. Steroids maybe
  3. Makeup
124
Q

Albinism

A

Defect in tyrosinase - synthesis of melanin
1. Ocular - X linked
2. Oculocutaneous - autosomal recessive
Inc. risk of SCC & BCC but not melanoma

125
Q

Melasma

A

Abnormal, irregular facial hyperpigmentation w/ sun exposure
Often assoc. w/ pregnancy, BC pills w/ estrogen & progesterone
Usually goes away after birth/stopping pills

126
Q

Acanthosis nigricans & Tx

A

“Brown velvety thickening” in neck & axilla
assoc. w/ diabetes, insulin resistance
Tx underlying condition/wt loss

127
Q

Addisons

A

Adrenal insufficiency & excess ACTH stimulates melanocytes

128
Q

Types of aloe pecia

A
  1. Androgenetic
  2. Telogen effluvium
  3. Alepecia areata
  4. Trichotillomania
129
Q

Androgenetic aloe pecia

A

Dec. anagen phase (growing phase)
Influenced by:
1. Inc. androgen levels
2. Inc. DHT levels (metabolite of testosterone)
3. Women w. inc. 5a reductase androgen receptors

Patterns in men - widows peak & crown
women - crown

130
Q

Tx of androgenetic aloe pecia

A
  1. Minoxidil (Rogaine)
  2. Finasteride (Propecia) - males only
  3. Spironolactone (women)
131
Q

Telogen effluvium aloe pecia & causes

A 
Inc. # of hairs in telogen phase (resting)
Inc. hair on pillows/shower 
Causes:
1. Pregnancy
2. Fever
3. Stress (inciting 2-4 mo prior)
4. Malnutrition
5. BC pills
6. Hyper/hypothyroidism
7. Anemia
132
Q

Dx telogen effluvium aloe pecia

A
  1. Hair pluck test - 50 hairs & check for bulbs
  2. CBC (anemia)
  3. Iron studies
  4. Total testosterone, free testosterone, DHEA-5, prolactin
  5. Syphilis
    Treat underlying cause
133
Q

Aloe pecia areata

A

May be autoimmune disorder
Patchy hair loss but may become universal
Eyebrows & body hair affected
Tx - intralesional steroids
May resolve spontaneously, often recurs
Poor prognosis if: atopic dermatitis, FH, early onset

134
Q

Exanthemeous eruptions & Tx

A 
Caused by drugs, occuring 7-10 days later 
Only affects skin
Symmetric macules & papules 
Resolves after ~1 wk
Tx:
1. +/- Topical steroids 
2. +/- Antihistamines
135
Q

Fixed Drug Eruptions & causes

A 
Solitary erythematous patch w/ bulla
May involve mouth, face, genitalia, extremities 
Occurs in 30min-8hrs
Lesion may erode, ulcerate
Resolves over few weeks 
Causes:
1. Abx Sulfa, Tetracycline, Metronidazole 
2. NSAIDS
136
Q

Common causes of SJS/TEN

A 
Sulfa
Allopurinol
Tetracyclines
Anticonvulsants
NSAIDs

& PCN

137
Q

Dermatofibroma

A

More common in women & extremities
Reactive process usually at site of mild trauma/insect bite
~1 cm, pink-brown
Lesion tethered to dermis - pinch sign

138
Q

What lesion has a pinch sign?

A

Dermatofibroma

139
Q

Cherry Angioma

A

Benign, dilated capillaries, trunk

Appears in 30s

140
Q

Pyogenic Granuloma

A 
Rapidly developing hemangioma 
Smooth nodule, w/o crusting
Age <30 y/o
Often occurs at sites of minor trauma
Benign but must Bx
141
Q

Achrochordon

A 
Skin tags
Pedunculated polyp
Frequently on neck, axilla, groin & chest
Inc. w/ age
Tx - snip w/ scissors
142
Q

Pseudomonas folliculitis & Tx

A

Aka hot tun folliculitis
Papulopustular lesions, Pruritic
Tx - may resolve in few weeks
Quinolone if needed

143
Q

Cellulitis

A

Acute spreading infection & inflammation of the dermis & hypodermis
Usually Staph/Strep
Erythema, warm, tender, swollen, possible lymphangitis w/ cellulitis streaking, adenopathy
Tx - demarcate, Abx, surgery if bad/necrotizing

144
Q

Abscess & Tx

A 
Localized pocket of infectious material - may have surrounding cellulitis 
Causes - IVs, IVDU
MCC - Staph
TX:
1. Warm soaks
2. I&D w/ wick 
3. Culture 
4. Oral/IV abx if >5cm in diameter
145
Q

Impetigo

A

Strep pyoderma/staph
Crusted, golden & honey crusted yellow lesions
Tx - Bacitracin
If caused by GABHS - poststrep glomerulonephritis can occur

146
Q

What usually causes bullous impetigo?

A

Staph

147
Q

Erysipelas & Tx

A

Painful, macular, erythematous & well demarcated rash usually on the face
Desquamates in 10 days
Tx - admit, IV abx

148
Q

Scarlet fever

A

Strep throat w/ rash
Fine red papular, sandpaper like rash on the cheeks, blansh, pastia lines
Assoc. w/ circumoral pallor & strawberry tongue
Fades in 2-5 fays w/ desquamation
Caused by GABHS

149
Q

Necrotizing fasciitis & risk factors

A 
Flesh eating bacteria 
severe swelling, warmth, pain, erythema, crepitus spreading rapidly along fascia lines, pain out of proportion to exam 
Risk Factors:
1. Age
2. DM
3. Immune issues
4. Renal failure
5. Chronic skin infections
150
Q

Types of necrotizing fasciitis

A
  1. Polymicrobial - most common
  2. Monomicrobial - Group A Strep
  3. CA - MRSA
  4. Caused by Vibrio Vulnificus from seawater exposure
151
Q

What should you suspect when someone has pain out of proportion to the exam?

A

necrotizing fasciitis

152
Q

Fornier’s gangrene

A

Form of necrotizing fasciitis common in DM

Affects perianal area

153
Q

Toxic Shock Syndrome

A

Bacteremia caused by Staph & Strep
Due to toxin mediated inflammatory response
Causes - tampons, nasal packing, wounds, rectal
Abrupt onset of fever, vomiting & diarrhea
Diffuse maculopapular rash & conjunctivitis
Multisystem organ failure
Cultures usually negative

154
Q

Staphylococcal scalded skin syndrome

A

Exfoliative endotoxin - S. aureus
Children under 5 - URI Sx then tender red skin followed by exfoliation
+ Niklosky sign

155
Q

Vibrio Vulnificus & Tx

A

Infection from contaminated seafood
Vomiting, diarrhea, abdominal pain & sepsis
Leads to necrotizing fasciitis, hemorrhagic bullae, HOTN/shock, purpura
CDC reportable
Tx - Abx, Debridement

156
Q

Tinea infections

A

Red annular patch w/ central clearing & scale
Dx w/ KOH prep/clinical
Tx - antifungals
1. Dermatophytosis
2. Trichophyton
3. Microsporum
4. Tinea capitus, cruris, corporis, mnuum, unguium, barbae, pedis, cruris

157
Q

Onycomycosis

A

Nails become white/brown/yellow & thicken
Caused by fungus - trichophyton rubrum
KOH prep
Tx w/ oral antifungals

158
Q

Scabies

A

Sarcoptes scabiei - arthropod
Most common on hands, genitals, axillary
Secondary infection due to staph/strep
Lesions are pruritic burrows, pustules & nodules
Dx - clinical or explore for egg/mite
Tx - Lindane, Permethrin

159
Q

Pediculosis

A

Pediculus capitis - Headlice, Rx - Permethrin
Pubic lice - crabs, STI
Body lice - can cause trench fever - Bartonella quintana

160
Q

Molluscum Contagiosum

A

Cause - Poxvirus
STD, skin to skin
Common in AIDS w/ CD4 < 100
Single or multiple dome-shaped, waxy papules 2-5 mm in diameter that are umbilicated
Common on face, lower abdomen & genitals
Last 2 mo then remit
Tx - Curettage/liquid nitrogen, electrosurgery

161
Q

Warts

A

Verrucous papules on skin/mucous membrane
Cause - HPV
Condyloma acuminata - genital warts types 6&11

162
Q

Lyme Disease & Dx

A

Spirochete Borrelia burgorferi from ixodes scapularis tick that lives on deer mouse
Dx - serum Ab w/ ELISA, confirm w/ western blot, PCR
Leukocytosis, elevated ESR, hematuria, moderately elevated LFTs, LP, arthrocentesis PRN
Tx w/ abx - Doxycycline

163
Q

Stages of Lyme Disease

A

Stage 1 - (7-10 days) early localized infection, erythema migrans on groin, thich of axilla, lesion w/ bulls eye, myalgias, fatigue, fever
Stage 2 - (wks-mo) early disseminated infection, bacteremia, secondary skin lesions, myocarditis, meningitis, keratitis, cranial neuropathies, ongoing flu-like Sx
Stage 3 - (mo-yrs) late persistent infection, large joint chronic arthritis, encephalopathy - memory loss, behavoiral changes, paresthesias, acrodermatitis chronicum atrophicans

164
Q

Dew drops on a rose pedal?

A

Chicken pox! aka varicella

Lesions turn pustular then crust

165
Q

Rubeola

A

aka measles

High fever, malaise, anorexia, conjuncitivis, cough, Koplik spots, exanthem rash spreading cephalocaudally

166
Q

Rubella

A

TORCH infection
Aerosolized infection
Systematic maculopapular rash - malaise, ocular pain, low fever, HA

167
Q

5th disease

A

Erythema infectiousum
Cause - Prvovirus B19
red slapped cheek fac & lacy pink macular rash on torso
Spread - droplet or bloodborne
Causes a polyarthropathy syndrome in adult females

168
Q

Roseola infantum

A

Cause - HHV6
High fever, then goes away, then pink macular morbilliform rash
Tx - supportive

169
Q

What is Darier’s sign?

A

Rubbing a lesion causes urticarial flare

170
Q

What is Koebner’s phenomenon?

A

Minor trauma leads to new lesions at site of trauma

171
Q

What is Shagreen skin?

A

An oval-shaped nevoid plauw

Skin is colored or pigmented on the trunk or back & is assoc. w/ tuberous sclerosis

172
Q

When is cryotherapy typically used?

A
  1. Warts
  2. Seborrheic keratoses
  3. Actinic keratoses
173
Q

1-6th diseases

A
  1. Measles
  2. Scarlet Fever
  3. Rubella
  4. -No 4th..
  5. Fifth’s disease - Erythema Infectiosum
  6. Roseola Infantum HHV-6
174
Q

What is a big complication of measles?

A

Pansclerosing encephalitis

175
Q

Scarlet Fever

A

Strep throat w/ sandpaper rash

Strawberry tongue

176
Q

Erythema Multiforme Major

A 
Usually from drug exposure 
1-3 wks after exposure, erythematous coalescence 
sheet-like loss of epidermis, blisters
resembles 2nd/3rd degree burns 
may cause renal dysfunction

Clinical Medicine (11 decks)

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