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547 > Week 11 derm > Flashcards

Week 11 derm Flashcards

1
Q

ABCDE for melanoma screening

A 
Asymmetry
Border (irregular)
Colour (variation)
Diameter (>6 mm)
Evolving
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2
Q

what are the four steps in 4-point derm description?

A
  • anatomic distribution
  • lesion configuration
  • primary lesion and colour
  • secondary change
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3
Q

SCALDA for derm

A 
size
colour
arrangement
lesion morphology
distribution
always check hair, nails, mouth, toes
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4
Q

what lesion is….

waxy, stuck on, wart-like

A

seborrheic keratosis

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5
Q

what is lesar trelat sign?

A

sudden multiple eruptions of SK

-?associated with internal malignancy

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6
Q

what lesion is:

solitary pink-brown dome-shaped firm papule and has dimple sign when squeezed?

location: common to legs

A

dermatofibroma

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7
Q

what lesion is….

initially poorly defined redness
then becomes pink-brown papule/patch with yellow scale or gritty texture

location: sun-exposed areas

A

actinic keratosis

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8
Q

actinic keratosis is precursor to…..

A

SCC or BCC

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9
Q

IDRBEU is a mnemonic that helps to determine if lesionis more likely to be SCC vs AK

A 
Inflammation/induration
Diameter > 1 cm
Rapidly enlarging
Bleeding
Erythema
Ulceration
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10
Q

common locations affected by squamous cell carcinoma?

A

face, head, neck, hands

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11
Q

what lesion is….

indurated, pink-red, scaly plaque/nodule
OR
non-healing ulcer

A

squamous cell carcinoma

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12
Q

what are risk factors for squamous cell carcinoma?

A 
sun exposure
radiation exposure
chronic infections (osteomyelitis)
burns
immunosuppression
fair skin
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13
Q

what is bowen’s disease?

A

SCC in situ

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14
Q

what is keratoacanthoma?

A

firm nodule with central necrosis

*low grade variant of invasive SCC

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15
Q

what lesion is….

shiny/pearly papule or nodule with smooth surface, central depression, rolled edges and telangiectasia?

location: sun-exposed skin: face, scalp, ears, neck

A

nodular BCC

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16
Q

what lesion is….

scaly, irregular plaque, thin and translucent with rolled border?

location: trunk and extremities (shoulders)

A

superficial BCC

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17
Q

what are the four subtypes of melanoma?

A
  • superficial spreading melanoma
  • nodular melanoma
  • lentigo maligna melanoma (growing brown patch with irregular edges and pigmentation)
  • acral lentiginous melanoma (palms, soles, nail)
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18
Q

secondary causes of pruritis without a rash in older adults?

A
  • CKD
  • med side effect
  • metabolic (anemia, cholestasis, hypercalcemia, thyroid)
  • neuropathy
  • paraneoplastic (lymphoma, leukemia, myeloma)
  • psychogenic (dx of exclusion)
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19
Q

what are some medications that can cause pruritis?

A 
statins
CCB
HCTZ
ACE-I
opioids
  • discontinue
  • allow 1-2 month drug holiday before assessing
  • chronically prescribed anti-HTN can be cause of pruritis with eczematous changes
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20
Q

what derm condition is….

dry, scaly, lichenified plaques with fissures?

A

chronic eczema

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21
Q

what derm condition is….

itchy red/blistered/crusted plaques or dry fissured and scaly plaques to one/both lower legs?

A

venous stasis dersmtaitis

*often mis-diagnosed as bilateral leg cellulitis

WORSENED by amlodipine

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22
Q

what derm condition is….

solitary or multiple coin-shaped plaques
-can be crusted, weeping or blistered

location: lower legs, back of hands, trunk

A

nummular eczema

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23
Q

treatment for nummular eczema?

A

one of most difficult forms of ezema to treat
*chronic and relapsing

medium to high potency steroid BID for 3-4 weeks (treat for one extra week)

  • occlusion with plastic wrap
  • non-fragranced emollients
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24
Q

what is autoeczematization aka id reaction?

A

eruption of eczema DISTANT to primary site of chronic skin inflammation

(eg eczema to upper torso with chronic tinea pedis)

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25
Q

differential diagnoses for eczema?

A
  • cutaneous T-cell lymphoma
  • scabies
  • SCC or BCC
  • Paget’s disease
  • dermatophytosis
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26
Q

what is Grover’s disease?

A

aka transient acantholytic dermatosis

  • intensely pruritic pink papules and vesicles with scale to torso
  • most common in middle aged white men
  • worse with cold weather, sweating, heat, friction
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27
Q

what organism is linked to seborrheic dermatitis?

A

malassezia furfur

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28
Q

what chronic conditions are associated with seborrheic dermatitis?

A
  • neurological (Parkinson’s, CVA, head trauma)

- HIV

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29
Q

triggers for rosacea

A
  • UV/sunlight
  • exercise
  • heat (including hot food and drinks)
  • embarrassment
  • spicy foods
  • chocolate
  • alcohol
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30
Q

what derm condition is…..

papulopustular eruptions to nose, cheeks, around eyes

A

rosacea

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31
Q

what are ocular symptoms of rosacea?

A

-mild conjunctivitis: sore eyes, gritty, teary

  • photophobia, itching, burning
  • conjunctival hyperemia, telangiectasia of eyelid, blepharitis, chalazion, crusting along lash line
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32
Q

DDX for rosacea

A

acne
perioral dermatitis
lupus
sarcoidosis

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33
Q

rosacea first line treatment

  • systemic
  • topical
A

doxycycline 100 mg BID for 2-4 weeks
*systemic abx needed if ocular involvement

metrogel (no difference between 0.75 and 1%) BID

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34
Q

patient teaching rosacea

A
  • avoid triggers
  • avoid irritating cleansers and anti-aging creams
  • may worsen for 1-2 weeks before noticing improvement with treatment
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35
Q

what is Hutchinson’s sign?

A

vesicle to nasal tip, redness to eye –> signals ocular involvement of herpes zoster

36
Q

what is Ramsay Hunt Syndrome?

A

facial nerve palsy with herpes zoster vesicles to ear (canal or on pinna) or mouth

may involve hearing loss/tinnitus/otalgia, lacrimation, vertigo

37
Q

optimal vehicle of topical rx for hair-bearing skin?

A

gel, lotion, shampoo, oil, foam

easier than ointment and cream

38
Q

pityriasis rosea is caused by….

A

herpesvirus 6 and 7

39
Q

pityriasis rosea timeline:

A

herald patch 1-20 days before generalized rash

duration: 6-12 weeks

self-limiting

40
Q

what derm condition is this?

oval pink plaque 2-5 cm, collarette scale

A

pityriasis rosea

41
Q

what does the secondary rash of pityriasis look like?

location?
itch?

A

scaly patch or plaques to chest and back, Christmas tree pattern

25% itchy

42
Q

what derm condition is this?

primary lesion: purple, planar (flat topped), papule/plaque, polygonal, pruritic

  • surface: lacy reticulated white lines: Wickham’s striae
    location: wrists, ankles, vulva, mucous membranes
A

lichen planus

43
Q

cause of lichen planus?

A

?T-cell driven autoimmune

can be associated with hep C
can be drug induced (esp antihypertensives: ACE-I, BB, thiazides)

44
Q

what is potential sequelae of lichen sclerosus?

A

increased risk VIN and vulvar SCC

45
Q

vulvar pruritis, dyspareunia, dysuria

DDx:

A

lichen sclerosus

lichen planus

46
Q

first line treatment of lichen sclerosus

A 
• 1st line- super potent topical corticosteroid (group 1)
	• Clobetasol propionate 0.05% 
	• Initially: 0.5 FTU
		○ Weeks 1-4:  once nightly
		○ Weeks 5-8: every other night
		○ Weeks 9-12: twice weekly
	• Maintenance:
		○ Mometasone 0.1% twice weekly
Long term maintenance needed to maintain skin colour and reduce risk of VIN, vulvar cancer
47
Q

symptoms of notalgia paresthetica?

A

unilateral infrascapular itching T2-T6

unilateral hyperpigmented patch to infrascapular region (3-10 cm)

may have pain, paresthesia, hyperalgesia, hyperesth

48
Q

what derm condition is this?

dome shaped cherry red/purple papule, 0.1-0.5 cm

location: trunk
may have many

A

cherry angiomas

49
Q

onychomycosis

most common organism

A

trichophyton rubrum

50
Q

onychomycosis

what to do before treatment?

A

confirm fungal infection (scraping)

check CBC and LFT at baseline

51
Q

onychomycosis

pulse treatment with terbinafine?

A

terbinafine 250 mg BID for 1 week, repeat every 3 months for 4 cycles

52
Q

first line treatment for bullous pemphigoid?

A
  • high potency topical steroid (clobetasol)
  • prednisone
  • doxycycline
53
Q

Risk factors for intertrigo

A 
obesity
immunodeficiency
DM
meds: prednisone
hot weather
poor hygiene
incontinence
54
Q

what derm condition is this?

Red moist, glistening plaques w/satellite pustules and papules w/fringe of white scale

A

intertrigo

55
Q

DDx of intertrigo?

A

inverse psoriasis
seborrheic dermatitis
erythasma
irritant contact dermatitis

56
Q

Treatment of intertrigo?

A
  • wet dressings for 20 min, then dry
  • nystatin for anti-yeast or econazole (antifungal) BID
  • light moisturizer (lubriderm) to decrease friction, create barrier
  • weight loss
  • avoid tight clothing
57
Q

what are consequences of ocular rosacea?

A

mild to severe corneal involvement in up to 1/3 of patients (keratitis)

58
Q

which cranial nerve is involved in herpes zoster ophthalmicus or keratitis?

A

ophthalmic branch of trigeminal nerve (CN V)

59
Q

what is the difference between acute neuritis and postherpetic neuralgia?

A

acute neuritis: acute pain lasting for 30 days

PNH: 3/10 pain persisting for 90 days after rash onset

60
Q

what is consequence of herpes ophthalmicus?

A
  • threat to vision loss
  • acute keratitis involves all layers of cornea
  • acute retinal necrosis: iritis, viritis, retinal vasculitis, retinal detachment
  • blurred vision and pain
61
Q

which cranial nerve is involved in Ramsay Hunt syndrome?

A

CN VIII

62
Q

when should antivirals be started for max benefit with herpes zoster?

A

<72 hours

Valtrex 1 g TID x 7 days

63
Q

what is Auspitz sign?

A

psoriasis - removal of scale causes bleeding

64
Q

risk factors for psoriasis?

A
  • Age
  • Family history (genetic)
  • Medications
  • Stress
  • Localized trauma
  • Streptococcal infection
  • HIV
  • ETOH, Tobacco
65
Q

patho of psoriasis?

A

abnormal T-lymphocyte function

inflammatory cascade causing hyperproliferation, decreased turnover time for epidermal shedding (from normal 14-20 days to 3-4 days)

66
Q

what is the cause of guttate psoriasis?

A

beta-hemolytic strep stimulates T-cell proliferation

67
Q

timeline of guttate psoriasis?

  • time after strep infection
  • duration of rash?
A

1-2 weeks post-strep

resolves in 6-12 months

25% develop chronic plaque psoriasis

68
Q

what derm condition is this?

  • red sharply defined papules and plaques with scale
    location: extensor surfaces
A

psoriasis

69
Q

lesions for guttate psoriasis appear commonly in what location?

A

torso, extremities

70
Q

changes to nails seen in psoriasis?

A
  • pitting onycholysis
  • subungual hyperkeratosis
  • nail plate dystrophy
71
Q

allergic contact dermatitis is what type of hypersensitivity?

A

type IV (delayed cell-mediated)

72
Q

what category of topical corticosteroid should be used for lichenified plaque psoriasis?

A

group I

*eg clobetasol propionate 0.05%

73
Q

what category of topical corticosteroid should be used for seborrheic dermatitis?

  • mild to moderate?
  • mild
A

if moderate: group V
*betamethasone 0.1%

if mild: VI or VII

  • tiamcinolonce acetonide 0.025%
  • hydrocortisone 0.5-2.5%
74
Q

what category of topical corticosteroid should be used for

nummular eczema?

A

group I or II

  • group I: clobetasol propionate 0.05%
  • group II: betamethasone diproprionate 0.05%
75
Q

what category of topical corticosteroid should be used for

moderate or severe chronic eczema?

A

group IV

*mometasone furoate 0.1%

76
Q

what vehicle is best for corticosteroids to soles or palms?

A

ointment

77
Q

what vehicle is best for corticosteroids to scalp?

A

lotions or foams

78
Q

what vehicle is best for corticosteroids to face?

A

cream, lotion, gel

79
Q

what vehicle is best for corticosteroids to eyelids and genitalia? (42x absorption)

A

creams, lotions, paste

80
Q

rank in order of potency:

cream
lotion
ointment

A

ointment&raquo_space; cream&raquo_space; lotion

81
Q

dosing schedule of topical corticosteroids?

  • group I
  • group II to VII
A

group I:

  • avoid > 2 weeks
  • once daily
  • cyclic dosing: 2 weeks on, 1 week off

group II

  • BID
  • response in 2-6 weeks
  • limit use for 1-2 weeks if face, genital or intertriginous areas
82
Q

describe the four stages of a pressure ulcer

A

stage 1: red, no open areas

stage 2: open ulcer/blister

stage 3: ulcer extends –> fat

stage 4: extends to muscle/bone

83
Q

IDIPAMOP

mnemonic about management of pressure ulcer

A
  • Infection (eliminate)
    • Debride necrotic tissue
    • Insulate the wound
    • Protect the periwound tissue
    • Absorb excess exudate
    • Maintain a constant moisture level
    • Obliterate dead space
    • Prevent future injury
84
Q

what medications can trigger psoriasis?

A 
Lithium
beta-blockers
NSAIDs
antimalarials 
sudden withdrawal of systemic/topical corticosteroids
85
Q

psoriasis is linked to an increased risk of……

A 
anxiety, depression
obesity
DM
HTN
lymphoma, non-melanoma skin cancer, cutaneous T-cell lymphoma, and solid organ cancer
MI, stroke

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