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CSI > skin > Flashcards

skin Flashcards

1
Q

common causes of rash

A

allergens, infections, collagen vascular disease, toxic, drugs, metabolic

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2
Q

life threatening rashes

A

anaphylaxis, angioedema, bacterial endocarditis, meningococcal meningitis, severe thrombocytopenia, Kawasaki syndrome, TSS, toxic epidermal necrolysis (TEN)

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3
Q

flat, non-palpable skin lesion

A

macule–>patch(>1cm)

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4
Q

elevated, firm circumscribed skin lesion

A

papule–>nodule(1-2cm)

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5
Q

elevated firm rough skin lesion (>1cm) flat top

A

plaque

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6
Q

elevated, irreg. shaped cutaneous edema

A

wheal

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7
Q

elevated, circumscribed, superficial, not into dermis, filled with serous fluid

A

vesicle–>bulla (>1cm)

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8
Q

like vesicle but pus

A

pustule

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9
Q

superficial dilated blood vessels

A

telangiectasia

1 cause: chronic etOH

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10
Q

allergic skin reaction

A

urticaria, hives

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11
Q

suspect bacterial endocarditis

A

Oslar nodes and Janeway lesions

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12
Q

if wet purpura in mouth worry about

A 
severe thrombocytopenia (as low as 2000)
infectious etiology
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13
Q

peds

A

Kawasaki

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14
Q

skin sloughs off, typ. medication related, tachy

A

toxic epidermal necrolysis (TEN)

also SJS w/ sulfa drugs

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15
Q

present w. purpura, fever, altered, neck stiffness

A

meningitis

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16
Q

K-OH prep

A

highlights fungal infection

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17
Q

basal cell carcinoma

A
  • caucasians
  • pearly white lesion, pt may scratch–>bleed
  • slow growing tumor
  • 30% lifetime risk M>F
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18
Q

BCC risk factors

A

-UV sunlight, tanning, chronic arsenic exposure, radiation, long term immunosuppr. tx (transplants)

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19
Q

BCC dx

A
  • pearly/waxy translucent in light papule
  • best obs. w/ stretched skin
  • erythematous patch >6mm or non-healing ulcer in sun exposed areas
  • shave or punch biopsy: bests of basaloid cells in dermis, sep. from adj stroma by thin clefts
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20
Q

BCC tx

A
  • electrodessication and curettage: not able to histologically confirm complete removal
  • surgical excision
  • Mohs surgery: take out one slide at a time til histologically confirm no more BCC (imp. on face, lips, nose, etc)
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21
Q

BCC topical/non-surg tx

A
  • 5-fluorouracil: pyrimidine antimetabolite, interferes w. DNA synthesis
  • Imiquimod (Aldara): unknown mechanism, TLR7 agonist, induces cytokines (INF-a)
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22
Q

radiation therapy for BCC

A

typically avoided
used in pt. who are nonsurgical candidates
-admin. in 4+ fractions, limits side effects, gives normal skin time to heal while cancerous cells cannot repair themselves as quickly

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23
Q

benefits of radiation tx

A

-cosmetically sparing, noninvasive, painless, nonsurg. candidates

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24
Q

BCC follow up

A

monitor pt annually

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25
Q

metastatic basal cell

A

deeply invasive/large lesions >10cm2

  • missed w. poor examination, altered elderly pts
  • reg. lymph nodes, lungs, bones, skin, liver
  • Vismodegib (Erivedge): Hedgehog pathway inhibitor
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26
Q

squamous cell carcinoma

A

non-healing ulcer/wart nodule
recurring, bleeding lesion, dry, scaly
dorsum of hand, arm, nose
-sun damage, fair skinned ind., transplant recipients

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27
Q

SCC risks

A

2nd most common
UV radiation, tanning, arsenic exposure, smoking, high fat/meat diet, immunesuppr (transplant >5 yrs, HIV, long term glucocorticoid use)

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28
Q

genetic risk factors for SCC

A

xeroderma pigmentosum, v. rare
epidermolysis bullosa
albinism
Fanconi’s anemia

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29
Q

other SCC risk factors

A

Chronic lymphocytic leukemia (CLL)
meds:
Voriconazole(longterm anti fungal)
BRAF inhibitors (Vemurafenib and Dabrafenib) used to tx metastatic melanoma, but do not stop, cut out SCC

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30
Q

Actinic Keratosis

A

-develops into SCC
-chronic sunlight exposure–>excess keratin buildup
-

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31
Q

SCC dx

A

complete skin and regional exam
-lymph node exam
biopsy

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32
Q

SCC tx

A

surgical excision
Mohs
electrodesiccation and curettage
radiation therapy: for non surg candidates, if extensive perineural or large nerve involvement, LN involvement

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33
Q

SCC follow up

A

every 3 mos w/ LN exam for 1 year, then every 6 mos thereafter

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34
Q

malignant melanoma

A 
UV radiation exposure
cutaneous
acral: palms, soles
mucosal
ocular/uveal
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35
Q

inc. risk for malignant melanoma

A
  • Irish/European, fair
  • more freckles
  • Fam Hx
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36
Q

ABCDE of malig mel

A 
Asymmetric
Borders-irregular
Color-variations
Diameter->pencil eraser
Evolution-take pic to monitor changes
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37
Q

staging of malig mel

A

> 4 mm deep: systemic chemo (T4, metastatic)

  • thickness, ulcerated or not
  • regional LN
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38
Q

stage 1A-1B

A

wide excision

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39
Q

stage 1B (0.76-1mm)

A

wide excision +/- INF

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40
Q

stage III

A

LN dissection and INF

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41
Q

stage IV

A

systemic therapy (chemo)

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42
Q

wider margins do not have added benefit with tumor thickness

A

> 4mm (grow deeper)

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43
Q

sentinel LN biopsy if..

A

> 1mm depth

-less if high risk features: ulceration, elevated MR, regression signs, BT>=0.75 mm

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44
Q

complete LN dissection

A

radiation after

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45
Q

stereotactic radiosurgery

A

for brain metastases: hottest around lesions to spare rest of brain tissue

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46
Q

chemotherapy meds

A

Ipilimumab
Dabrafenib + trametinib
Pembrolizumab
Nivolumab

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47
Q

other chemo meds

A 
Vemurafenib
Dabrafenib
Trametinib
Imatinib 
Dacarbazine
Temozolomide
Alb-bound palitaxel
IL-2
Dacarbazine or temozolomide-based combo
Pacliltaxel
Pacliltaxel/carboplatin
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48
Q

BRAF inhibitors

A

Vemurafenib, dabrafenib
-MAP kinase pathway inhib. (inhib. BRAF V600E)
SE: edema, HA, rash **SCC of skin! arthralgia

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49
Q

MEK inhibitors

A

Trametinib
-rev. and sel. inhib. mitogen-act EC kinase (MEK) downstream from BRAF (combine with BRAF inhibs.)
SE: *cardiomyopathy, rash, anemia, hemorrahge, liver inflamm.

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50
Q

CTLA-4 inhibitors

A

Ipilimumab
blocks CTLA-4, allows for enhanced T-cell activation and prolif
SE: (hyperactivates Imm. sys) colitis, dermatitis, hepatitis, hypophysitis, thyroiditis

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51
Q

Anti-PD-1 Monoclonal Ab

A

Nivolumab
Pembrolizumab
inhib. PD-1 activity by binding PD-1 rec. to block ligands PD-L1/2, releases PD-1 pathway med inhib of IR (anti tumor response)
SE: e-lyte abnormalities, cytopenia, rash

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52
Q

Ipilimumab

A

enables prolif of T cells thru CD28 or CTLA-4–>inc. signalling–>T-cell activation

  • works in 10-15% pts
  • takes 1-4 mos (diff. to monitor)
  • may look worse on CAT scan after tx before gets better
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53
Q

50% BRAF mutations in

A

skin lesions, not as common in others

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54
Q

BRAF inhibitors (vemurafenib)

A

shuts down cascade of DNA replication

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55
Q

combine BRAF and MEK

A

to inc. survival

56
Q

largest challenge w/ BRAF/MEK combo w/ PD1 inhibitors

A

poor side effects w/ PD1 inhibs.

57
Q

PD1 inhibitors

A

releases shut down of CTL, allows immune response

58
Q

scaly

A

psoriasis, xerosis, pityriasis

59
Q

vesicular

A

shingles, herpes simplex

60
Q

weepy/crusted

A

impetigo

61
Q

pustular

A

acne, folliculitis

62
Q

figurate

A

erythema mulitform

63
Q

bullous

A

bullous pemphigoid, pemphigus vulgaris

64
Q

nodular

A

erythema nodosum

65
Q

morbilliform

A

drug rash, viral exanthema

66
Q

erosive (umbilicated)

A

vesicular dermatitis

67
Q

ulcerative

A

decubiti, herpes simplex, cancers

68
Q

biliform rash

A

chest and neck (drug reaction)

69
Q

honeycombing rash

A

face and chin-impetigo rash

70
Q

impetigo

A

chin, crusty, weepy lesion

71
Q

melanocytic nevi (normal moles)

A
72
Q

atypical/dysplastic nevi

A

> 6mm, irreg borders, irreg. pigment

-5-10% adults

73
Q

separated keratosis

A

“stuck on” lesion, waxy
not worrisome
could transition into something worse

74
Q

malig mel

A

flat or raised, suspected in any lesion w/ appear. change, varying colors
ABCDE

75
Q

most common malig mel etiology

A

“superficial spreading” comes from dysplastic nevi

-acral lentinginous in all skin types (palms/soles)

76
Q

malig. mel tx

A

excision and re-excision (Mohs)
margins depend on size/thickness
LN biopsy for high risk/thick lesions (sys. chemo)

77
Q

atopic dermatitis

A

pruritis, exudative eruptions on face, neck, wrists, hands, skin folds

  • hx of allergies, rhinitis
  • tendency to recur
  • typ. childhood (
78
Q

atopic dermatitis

A

wet: dry it
dry: moisten
acute weeping: oatmeal astringent soaks, high pot. corticosteroids

79
Q

tx for subacute or scaly lesions

A

(dry, red and pruritic)

mid-high pot. steroids, wean to emollients

80
Q

tx for chronic dry lichenified lesions

A

nightly occlusion to hold in moisture (silvadene, vaseline)
high pot corticosteroids
aquaphor

81
Q

atopic dermatitis maintenance tx

A

constant appl. of moisturizers, sparing used of corticosteroids

82
Q

lichen simplex chronicus

A

itching, scratching, dry, leathery lesions
-trauma, exposure
*exaggerated skin creases
-well circum. scaly plaque
neck, wrists, forearms, lower legs, scrotum, vulva (vulva: biopsy)
-often appear psoriatic
-risk of invasive superinfection

83
Q

lichen simplex chronicus tx

A

high dose topical corticosteroid +/- occlusion
antihistamins to prevent itching
(dis. may remit to other sites)

84
Q

psoriasis

A

-AI, may have no sympts or itching
-scalp, elbows, knees, palms, soles, nails
-“silver scales” on erythematous plaque, occurs in creases
limited (10% BSA)–>moderate–>generalized (>30%) disease
continuum w/ rheumatoid arthritis

85
Q

psoriasis tx

A

numerous sm. plaques (mild-mod disease): phototherapy, home UV lights
lg plaques: v. high pot steroids 2-3 wks BID then pulse
-vit. D analogs
-scalp: tar shampoo, salicylic acid gel
*never use SYSTEMIC (ORAL) corticosteroids (lead to severe rebound)

86
Q

severe psoriasis tx

A 
UVB tx 3x week
psoralen plus UVA (PUVA)
methotrexate
acitretin (pustular)
cyclosporin
anti-TNF agents, DMARDs
87
Q

pityriasis rosea

A 
oval scaly eruption on trunk
Herald path-->then eruptions
"christmas tree" distribution
occasional pruritus
resolves in 6 wks
88
Q

seborrheic dermatitis and dandruff

A

dry scales w/ underly. erythema
-face, scalp, eyelids, ears, presternal inter scapular areas
acute or chronic
-pruritis is inconsistent mild–>severe

89
Q

tx for seborrhea

A

scalp: shampoos w. zinc pyrithione, selenium, ketoconazole
tar shampoo
facial: mild c.steroids, ketoconazole cream 2x daily
intertrig. : low pot. c.steroids 5-7 days
eyelids: baby shampoo

90
Q

fungal inf. of skin

A 
tinea corporis (body)
tinea circinata (body)
tinea cruris (groin)
tinea manuum (foot)
tinea pedis (foot)
tinea versicolor (pityriasis versicolor) (cent. up. trunk)
-dx with 10% KOH prep, Cx, skin biopsy
91
Q

tinea corporis/circinata

A

ring-shaped, exposed areas, +/- itching (often) can be severe in HIV pts
tx: topical antifungals (PO griseofulvin if severe)

92
Q

tinea cruris (“jock itch”)

A
  • groin, sparing scrotum
    peri. spread, sharply demarcated, central clearing
  • assoc. pedis, onychomycosis
  • reoccurs after tx
    tx: antifungal powder, top. antifung. cream, oral griseofulvin/itraconazole if severe
93
Q

lyme disease should not..

A

ITCH
-think fungal- tinea
ringworm

94
Q

tinea manuum/pedis

A 
scaling, itching btw toes along foot
-can prog. to moist macerated areas
-common in LE cellulitis pts
tx: macerated: aluminum subacetate soaks, br.spec antifungal creams
dry/scaly: OTC topical anti fungal
95
Q

tinea versicolor (pityriasis versicolor)

A

velvety pink, tan macules (also white, tanning resist.)
fine scales
upp trunk/chest
yeast on microscopic exam (Malassezia-“spaghetti and meatballs”)
tx: selenium sulfide lotion, Ketoconazole PO if severe

96
Q

cutaneous lupus

A

chronic cut. lupus and discoid lupus

  • scaling, atrophy, dyspigmentation, telangiectasia, photosensitive
  • head, scalp, face, ears
    tx: avoid sun, photosens. drugs, radiation therapy
  • high pot. steroid creams
97
Q

cutaneous T-cell lymphoma (Mycosis fungoides)

A

loc/gen erythematous patches/plaques >5 cm
-trunk
severe pruritis
tx: diff. PUVA, retinoids, other skin. dir tx

98
Q

vesicular dermatoses

A

HSV 1 & 2
herpes zoster (shingles)
vesiculobullous eczema
porphyria cutanea tarda

99
Q

HSV

A

recurrent sm. vesicles on an erythematous base (orolabial/genital distribution)
-post-stress, trauma, sun
-viral cx, abx test +
-1st episodes may present as gingivostomatitis or sev. genital outbreak w/ flu sumps and lymphadenopathy
(ppl test + for HSV)
-shingles should not typ. recur

100
Q

herpes zoster

A

pain along dermatome distribution–>grouped vesicular lesions
(occ. fall outside if >20 lesions), typ. not dissem unless pt. is IC
-face, trunk
varicella zoster virus
tx: zostavax >50yo

101
Q

Hutchinson’s sign

A

shingles on nose

must consider optic nerve is involved

102
Q

Ramsay-Hunt syndrome

A

shingles in ear, must consider ear drum is involved, Bell’s palsy
can lead to systemic infection

103
Q

Herpetic whitlow

A

lesion on finger/thumb (HC workers, sexual activity(autoinoculatoin) finger/thumb suckers)
HSV 1* or 2

104
Q

herpes/shingles tx

A

oral antiviral: acyclovier, valacyclovir w/in 72 hours
-abx if secondary cellulitis
tx only shortens duration by 1-2 days BUT **dec. risk of post-herpetic neuralgia!!* (esp. elderly)

105
Q

vesiculobullous eczema

A

“tapioca” vesicles on palms, soles, sides of fingers
multiloculated large blisters
recurs over lifetime
tx: topical & systemic steroids, chronic prob–> steroids abort the flares

106
Q

porphyria cutanea tarda

A

non-inf./inflamm. blisters on sun-exp. sites

  • assoc. liver disease
    dx: PE, abn. LFTs, elev. ur porphyrins
    tx: phlebotomy, eliminate etOH,
107
Q

impetigo

A

superficial blisters w. some opaque/purulent material

  • rupture easily, weep–>crusted superfic. erosions
    dx: Gs often + for GPC in clusters/pairs (staph or strep, MRSA)
    tx: top. bacitracin or mupirocin(bactroban) chlorhexidine/bleach baths, occasional oral coverage
108
Q

contact dermatitis poison ivy

A

erythema, intense pruritus–>dev. of blisters: weeping, crusting
autoinoculation, spread by scratching, look for exposure hx
tx: was oil w/ dish soap
severe: mid-pot steroid creams
m. severe: tapering prednisone

109
Q

acne vulgaris

A 
onset of puberty
op/closed comedones (white/black heads)
most common
severe: papular, pustular, cysts, nodules, scarring
-face, upper trunk
110
Q

tx of acne vulgarism: comedones

A

face wash, topical retinoids, benzoly peroxide, top. abx

111
Q

tx of acne: mild papular/cystic

A

top. clindamycin/eryth w/ benz peroxide, poss. tretinoin cream

112
Q

tx of acne: mod pap/cystic

A

oral tetra, doxy, minocycline, OCTs, topical

113
Q

tx of sev. acne

A

isotrentinoin, intralesional injection, laser dermabrasion, oral and topical agents

114
Q

rosacea

A

chronic, neurovasc. component, telangiectasias, flush
glandular as well
exacerb. by hot foods, etOH, emotions, sun
tx: avoid triggers, also tetra/doxy/mino

115
Q

folliculitis

A

hairy areas typ.
itching, burning, pustular formation
staph, strep, MRSA
“hot tub”: diffuse pruitis, rash in exposed areas, pseudomonas, clears spontaneous (no abx)

116
Q

candida tx

A

topical: miconazol, nystatin powders
clotrimazole, ketoconazole creams/lotions
oral: flucanazole, voriconazole
nystatin swish and swallow

117
Q

MRSA

A

v. indurated w/ min. purulence
may req. drainage, some spont. drain
tx: trimethoprim/sulfa, doxy, clindamycin
–>rarely causes sys. inf.

118
Q

steven johnson syndrome

A

dry, cracked bleeding lips,
red rash, stinging sensation, skin peeling
stop offending medication!!

119
Q

erythema multiforme

A

sudden onset of syst. erythematous skin rxn
target lesions having clear centers
mild, self-lim post-viral inf. or med rxn OR
major, life threatening: SJS, TEN

120
Q

erythema multiform tx:

A

stop offending agent!
TEN: burn unit for massive skin exfoliation
steroids, IVIG

121
Q

erythema migrans

A

bullseye, with Lyme disease

122
Q

bullous pemphigoid

A

tense blisters in flexural areas, subepiderm. blisters, gen >60 yo

123
Q

pemphigus vulgaris

A

flaccid blisters, crusts, erosions, acantholysis

any age

124
Q

BCC

A

pearly papule >6mm, non healing, sunexp. area, “rat bite” lesion, bleeding
tx: Mohs, removal

125
Q

SCC

A

nonhealing ulcer, long term sun exposure, often begins as actinic keratosis
tx: Mohs, excisional, top. retinoid acid

126
Q

Kaposi’s sarcoma

A

brown/black flecks, classically on chest
HIV+, males (anal sex)
can be in bowels–>bleed to death

127
Q

Pediculosis

A

(lice!)
pruritus w/ excoriations, nits(eggs) on hair shafts, lice on skin, clothing
direct contact needed (can’t jump)
tx: permethrin cream rinse (Nix), high temp laundering

128
Q

erythema nodosum

A

painful, erythematous nodules on ant. aspects of shins, below knees
mostly women (10:1)
-recent viral proc., drug rxn, underly. IBD
-lasts about 6 wks, can reflare

129
Q

erythema nodosum tx

A

NSAIDS, time

130
Q

cellulitis

A 
may come in w. flu-like symptoms: fever, chills, body aches, nausea
typically GAS (redness, blisters) (staph causes pus, boils, abscesses)
131
Q

cellulitis tx

A

cephalosporins: cefalexin, (4x day, low compliance), cephadroxil, cefuroxine
clindamycin
not her favs: bactim, amoxicillin
vs IV: ancef (ceph) or vancomycin

132
Q

cellulitis vs decubitis ulcer

A

the latter needs wound care, typ. IV abx, doppler to ensure perfusion

133
Q

scabies

A 
*extremely itchy*
ask about bugs
extremely contagious
chest, classically on fingers
topical permetherin
oral ivermectin
134
Q

what can cause low grade fever/fatigue for weeks

A 
CMV
Coxsackie
Parvovirus
Mono
(*viruses*!)
or smoldering diverticulitis, abscess
135
Q

non infectious causes of low grade fever/fatigh for weeks

A

malignance (>50)
joint pains: rheumatoid arthritis
AI diseases
LPE

CSI (75 decks)

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