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Untitled Deck Flashcards

1
Q

When would you refer someone to the ER for a derm emergency?

A

Acute, rapid desquamation (SJS/TEN),
severe bleeding
severe infection
abnormal vitals.

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2
Q

What is the definition of Impetigo?

A

Contagious superficial skin infection.

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3
Q

What is the etiology of Impetigo for non-hospitalized people?

A

Group A strep and S. aureus.

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4
Q

What is the etiology of Impetigo for hospitalized patients?

A

MRSA due to hospitalization.

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5
Q

What is the epidemiology of Impetigo?

A

10% of complaints in pediatric population.

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6
Q

What are the risk factors for Impetigo?

A

Skin trauma (bites, dermatitis, eczema, scabies, herpes) 2-6 years old, poor hygiene, poverty, crowding (hospital).

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7
Q

What are the key clinical presentations of Impetigo?

A

Honey colored golden crusts, erythematous papules and pustules.

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8
Q

What are the differential diagnoses for Impetigo?

A

Cold sores (herpes type 1), fungal infection (tinea corporis), perioral dermatitis.

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9
Q

What is the management for mild Impetigo?

A

Consider observation, wash area gently with soap and water.

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10
Q

What are the drugs used for Impetigo management?

A

Topical mupirocin for 5-7 days.

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11
Q

What is the definition of Folliculitis?

A

Inflammation of hair follicle.

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12
Q

What is the etiology of Folliculitis?

A

S. aureus (lives on skin), Pseudomonas (hot tub), fungal and viral also common.

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13
Q

What is the inflammation etiology for Folliculitis?

A

Pseudofolliculitis barbae, drug-induced, chemicals, sun.

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14
Q

What is Pseudofolliculitis barbae?

A

Shaving.

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15
Q

What are the risk factors for Folliculitis?

A

Prolonged antibiotic use
Prolonged steroid use
shaving against the grain
Acne, rosacea, perioral dermatitis, eczema, herpes infection, psoriasis, immune suppression, pregnancy, contaminated water exposure.

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16
Q

What are the clinical presentations of Folliculitis?

A

Perifollicular papules and/or pustules on an erythematous base surrounding hair follicles, often pruritic.

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17
Q

What tests are used for recurrent episodes of Folliculitis?

A

Culture, KOH scraping, fungal culture.

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18
Q

What are the differential diagnoses for Folliculitis?

A

Acne, rosacea, cellulitis, abscess.

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19
Q

What is a Furuncle?

A

Deep infection of the hair follicle.

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20
Q

What is a Carbuncle?

A

Multiple furuncles.

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21
Q

What is the management for Folliculitis?

A

Mupirocin for bacterial, other hair removal methods, I&D.

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22
Q

What are the medications for Folliculitis caused by S. aureus?

A

Doxycycline, Bactrim.

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23
Q

What are the medications for Folliculitis caused by Pseudomonas?

A

Ciprofloxacin.

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24
Q

What is the definition of Erysipelas?

A

Infection of the skin in the upper dermis and cutaneous layer.

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25
What is the etiology of Erysipelas?
Break in skin -> strep A or S. aureus, prominent lymphatic involvement.
26
What are the risk factors for Erysipelas?
Lower extremity involvement, skin trauma, preceding streptococcal sore throat.
27
What are the clinical presentations of Erysipelas?
Demarcated/well defined borders, intensely erythematous, tender, warm, swelling, systemic symptoms of fever, chills, lymphadenopathy.
28
What tests are used for Erysipelas?
CBC-WBC elevation, ESR/CRP, blood cultures.
29
What are the differential diagnoses for Erysipelas?
Folliculitis, abscess, lymphangitis, cellulitis.
30
What is the management for mild Erysipelas (no systemic infections)?
Strep coverage: penicillin, cephalosporin (cephalexin), dicloxacillin, clindamycin.
31
What is the management for moderate Erysipelas (systemic symptoms)?
IV strep coverage: penicillin, cephalosporin (ceftriaxone), clindamycin.
32
What is the management for severe Erysipelas (sepsis)?
Treat broadly against strep and staph: IV vancomycin, piperacillin-tazobactam.
33
What is the definition of Lymphangitis?
Inflammation of lymph vessels.
34
What is the etiology of Lymphangitis?
Break in skin -> pathogen enters, strep A and S. aureus.
35
What are the clinical presentations of Lymphangitis?
Erythematous streaking along lymph drainage, tender, swollen regional lymph nodes, warmth, peripheral edema, systemic symptoms.
36
What tests are used for Lymphangitis?
WBC elevation, culture the drainage.
37
What are the differential diagnoses for Lymphangitis?
Folliculitis, abscess, erysipelas, cellulitis, thrombophlebitis, herpes zoster.
38
What is the management for mild Lymphangitis?
Penicillin, cephalexin, dicloxacillin, clindamycin.
39
What is the management for MRSA Lymphangitis?
Doxycycline, Bactrim, clindamycin (not really).
40
What is the management for moderate Lymphangitis?
IV penicillin, ceftriaxone, clindamycin.
41
What is the management for severe Lymphangitis (sepsis)?
IV vancomycin, piperacillin-tazobactam.
42
What is the definition of Cellulitis?
Infection of the skin in the dermis and subcutaneous tissue.
43
What is the etiology of Cellulitis?
Break in skin -> strep A or staph A get in.
44
What are the risk factors for Cellulitis?
Trauma, IVDU, pressure ulcers, surgical wounds, venous insufficiency, diabetes mellitus.
45
What are the clinical presentations of Cellulitis?
Poorly defined borders, localized macular erythema, tender, warm, swelling, can have systemic symptoms.
46
What tests are used for Cellulitis?
WBC elevation, blood culture (only for systemic illness).
47
What is the ultrasound appearance of Cellulitis?
Cobblestoning.
48
What are the differential diagnoses for Cellulitis?
Abscess, lymphangitis, erysipelas, stasis dermatitis, gout, septic arthritis, DVT.
49
What is the management for mild Cellulitis?
Streptococcus coverage: penicillin, cephalosporin (cephalexin), dicloxacillin, clindamycin.
50
What is the management for MRSA Cellulitis?
Doxycycline, TMP/SMX (Bactrim), clindamycin.
51
What is the management for moderate Cellulitis (systemic symptoms)?
IV Streptococcus coverage: penicillin, cephalosporin (ceftriaxone), clindamycin.
52
What is the management for Cellulitis in sepsis?
Treat broadly against Streptococcus and Staphylococcus aureus: IV vancomycin, piperacillin-tazobactam. Hospitalization criteria: SIRS, AMS, hemodynamic instability, deep infection, failed outpatient therapy, severe immunocompromise.
53
What is the definition of Abscess?
A collection of pus within the dermis and deeper skin tissues.
54
What is the etiology of Abscess?
Infection from local skin flora, Staph A most common.
55
What are the risk factors for Abscess?
Preceding folliculitis, underlying skin trauma.
56
What are the clinical presentations of Abscess?
Painful tender indurated erythematous subcutaneous nodule, induration, fluctuance, may spontaneously drain, can have systemic symptoms.
57
What tests are used for Abscess?
Gram stain from I&D, ultrasound: hypoechoic area, CT for deep space infection.
58
What is the management for Abscess?
I&D, packing, warm/moist compress.
59
When are antibiotics used for Abscess management?
Save for multiple lesions, signs of systemic illness, lack of response to incision and drainage alone, patients with comorbidities, immunosuppression, or at extremes of age.
60
What is the definition of Pilonidal cyst?
Acute or chronic abscess of the tail bone region.
61
What is the epidemiology of Pilonidal cyst?
15-30 year old men.
62
What are the risk factors for Pilonidal cyst?
History of hidradenitis suppurativa.
63
What are the clinical presentations of Pilonidal cyst?
Abscess in the superior gluteal cleft region.
64
What is the management for Pilonidal cyst?
I&D, unfrooding and curettage (derm), surgical excision.
65
What is Hidradenitis suppurativa?
Multiple deep abscesses that are connected.
66
What are the clinical presentations of Hidradenitis suppurativa?
Deep inflammatory nodules and abscesses, sinus tracts connections, fibrotic, hypertrophic scar tissue overlying, commonly located in the axillae, groin, and inframammary regions.
67
What are the prevention strategies for Hidradenitis suppurativa?
Reduce blood sugar and weight, smoking cessation, improve local skin hygiene, eliminate irritants, reduce skin friction.
68
What is the management for clear acute Hidradenitis suppurativa?
Topical clindamycin, oral doxy, I&D if indicated.
69
What is the management for inflammation in Hidradenitis suppurativa?
Intralesional steroid injection, oral steroids, oral isotretinoin, adalimumab.
70
What are the strategies to prevent future occurrences of Hidradenitis suppurativa?
Surgical debridement and reconstruction.
71
What is the definition of Paronychia?
Infection of the skin surrounding the nail.
72
What is the etiology of Paronychia?
Staph A infection.
73
What are the risk factors for Paronychia?
Nail biting, manicures, ingrown nails, immunosuppression.
74
What are the clinical presentations of Paronychia?
Painful, erythematous swollen area around the proximal or lateral nail folds, purulent discharge beneath nail fold.
75
What tests are used for Paronychia?
Gram stain and culture if recurrent.
76
What is the difference between how Paronychia presents and Herpetic whitlow?
Paronychia presents more on the nail.
77
What is the management for Paronychia?
Warm soak, I&D, promote draining.
78
What are the antibiotics used for severe Paronychia?
Amoxicillin/clavulanate, MRSA: Bactrim, clindamycin, doxycycline.
79
What is the definition of Necrotizing fasciitis?
Infection of the deep fascial planes destroying muscle fascia and overlying subcutaneous fat.
80
What is the etiology of Necrotizing fasciitis?
Gas forming organisms, most commonly Group A strep.
81
What are the clinical presentations of Necrotizing fasciitis?
Painful, rapidly worsening, blue/black, crepitus, induration.
82
What is the diagnosis for Necrotizing fasciitis?
Surgery, labs, radiology.
83
What is the management for Necrotizing fasciitis?
Surgery as soon as possible, don't waste time with imaging if possible.
84
What is the common pathogen associated with purulent infections?
Staphylococcus.
85
What are the risk factors for MRSA?
Previous MRSA infection, penetrating trauma (surgery included), recent hospitalization, poor hygiene.

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