Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

clin med 1 > Dermatology-Peckham 2 > Flashcards

Dermatology-Peckham 2 Flashcards

1
Q

What is a common pruritic inflammatory disease of skin, mucous membranes and hair follicles?

A

Lichen Planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 Ps involving Lichen Planus?

A

Purple, Polygonal, Pruritic, Papule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where are the lesions grouped to in lichen planus?

A

Flexor aspect of wrists, lumbar area, eyelids, shins, scalp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Si/sx of Lichen Planus

A

Pruritic, lesions appear for <1yr, can cause hair loss and damage nails. Variations can be ulcerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Potent topical steroids w/occlusion is the proper tx for what?

A

Lichen Planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can also be known as a benign “warty” growth

A

Seborrheic Keratosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Seborrheic keratosis has what presentation?

A

“Stuck on” flat or raised papule or plaque. White, flesh colored to tan, brown, warty or smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is tx required for seborrheic keratosis?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a vascular neoplasm brought on by genetic factors, hormonal factors, immunodeficiency or infection with HHV-8?

A

Kaposi Sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 4 types of Kaposi Sarcoma?

A
  1. Classic
  2. HIV associated
  3. Endemic/African
  4. Iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Kaposi Sarcoma presentation

A

Purplish macules that evolve to infiltrative plaques and nodules or tumors, often on lower extremities with lymphedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where can Kaposi Sarcoma also involve?

A

GI tract and lungs (very rarely)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the best Dx for Kaposi Sarcoma?

A

Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What progresses slowly with rare lymph node or visceral involvement?

A

Kaposi sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Some treatment options for Kaposi sarcoma include?

A

Radiation therapy, cryotherapy, surgical excision of individual nodules, topical Alitretinoin, dye laser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are in situ dysplasias resulting from UV radiation that may progress to SCC?

A

Actinic Keratosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common epithelial precancerous lesion?

A

Actinic keratosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Who is at greater risk for actinic keratosis?

A

White men older then 50 with an outdoor lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The etiology of actinic keratosis

A

UVR leads to mutations in TP53 and deletion of the gene coding for p16 tumor suppressor protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the pathophys behind actinic keratosis?

A

Epidermal lesion with atypical keratinocytes at basal layer that can extend upwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where is actinic keratosis most commonly found on the body?

A

Chronically sun exposed surfaces like the face, ears, scalp, dorsal hands, forearms, anterior legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

On palpation, what does actinic keratosis feel like?

A

Sandpaper texture, most times more easily felt than seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Actinic keratosis clinical manifestations

A

Multiple discrete, flat or elevated verrucous or keratotic, red, pigmented or skin colored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would be some differential diagnoses for actinic keratosis?

A

BCC, SCC, seborrheic keratosis, lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is is appropriate to biopsy for actinic keratosis?

A

Yes, clinical/history Dx is also very important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for actinic keratosis is

A

Surgical: cryotherapy
Medical: Imiquimod or 5-FU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Is cryotherapy effective with actinic keratosis?

A

Yes with limited lesions. Goal is to produce cell death at -320F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What structures in the skin are more resistant to cryotherapy?

A

Collagen, blood vessels and nerves are more resistant that keratinocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the risk for cryotherapy?

A

Blistering, melanocytes are more sensitive so if often leaves hypopigmented spots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Imiquimod

A

For extensive broad and numerous AK lesions. its an interferon inducer that produces an immune rxn against lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does imiquimod cause?

A

Erythema and crusting, but is less irritating than 5-FU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

5-FU

A

Interferes with DNA synthesis, apply bid for 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Ingenol mebutate

A

Used for AK, induces cell death. Apply daily x 3 days to face or 2 days to body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How should you follow up on a pt with AK?

A

Areas should smooth over, stubborn lesions should be biopsied for concern for squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How is the prognosis for pts with AK?

A

Good with continued monitoring every 2-6 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How can a pt prevent AK?

A

Avoid sun exposure, use broad spectrum sunscreen, apply often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the most common form of all cancers?

A

Nonmelanoma skin cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What type of cancer is an epithelial tumor of the basal keratinocytes?

A

Basal Cell Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Who has a greater risk for BCC?

A

Same as AK, white men 40 yrs or older with an outdoor lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are some causes for BCC?

A

UVR, immunosuppression for organ transplant increases risk as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What does BCC arise from?

A

Immature pluripotential cells associated with the hair follicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

BCC lesions

A

Flat, firm, pale area that is small, raised, pink or red, translucent, pearly and waxy, and the area may bleed following minor injury. May have “rolled edge”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A lesion that bleeds without significant pain or symptoms can be from what?

A

BCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is nodular BCC?

A

Most common, waxy, pearly, semitranslucent nodules or papules with a “rolled edge” forming around a central depression that may or may not be ulcerated, crusted and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Superficial BCC

A

Dry. scaly lesions, superficial flat growths may be misdiagnosed as eczema or psoriasis. Edge shows a “threadlike” raised b border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Morpheaform (sclerosing) BCC

A

Appear as a white sclerotic plaque w/ telangiectasia, scar-like in appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pigmented BCC

A

Similar to nodular but brown or black pigmentation is present. Mostly found in dark skinned people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How can we diagnose BCC?

A

Biopsy; consists of large, round or oval tumor island within the dermis w/ and epidermal attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tx for BCC

A

Permanently cure with best cosmetic result, surgical topical and radiation options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the topical txs for BCC?

A

5% imiquimod for non-facial superficial BCCs less than 2cm in diameter
5-FU for superficial BCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is a surgical option for a BCC?

A

E&C Electrodessication and Currettage, cryotherapy, excision with margins, and Mohs micrographic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How can E&C be discribed?

A

For superficial lesions, use sharp curette to scape away friable tumor until normal dermis is felt. Then area is electrodessicated to cause necrosis of cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When would cryotherapy be a good option for BCC?

A

For pts who are debilitated with medical conditions that preclude other types of surgery, generally not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Excision with margins for BCC

A

Has a high cure rate 95%, less effective in treating recurrent BCC, better for primary lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the gold standard treatment for BCC?

A

Mohs Micrographic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Mohs micrographic surgery

A

If tumor is >2cm and on facial area. Take small layer at a time and examined under microscope, gives smallest defect ensuring the best cosmetic potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When would radiation be used for pts with BCC?

A

Older pts who are not candidates for surgery or where surgical excision will be disfiguring. Takes 5-25 visits, cure rate can be 80-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the prognosis for a pt with BCC?

A

Good is appropriate method of tx is used. Recurrent cancers are harder to cure. 100% survival if it hasn’t metastasized.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What type of cancer can arise from the malignant proliferation of epidermal keratinocytes?

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What can put you at risk for SCC?

A

> 50yrs, light skinned males, tobacco/alcohol use, nonmelanoma skin cancer, HPV, immunosuppression, chemical carcinogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is characterized by the irregular nest of epidermal cells invading the dermis to varying degrees?

A

SCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the two types of SCC?

A

SCC in situ (Bowen’s Disease) or invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Which layers does Bowen’s disease of SCC effect

A

Full thickness of epidermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which layers does invasive SCC effect

A

Penetrates into the dermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Clinical manifestations of SCC

A

Begins at AK site, can be superficial papules, plaques, or nodules discrete and hard arising from indurated, round elevated base

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Lower lip SCC

A

Starts as actinic chelitis, local thickening then a firm nodule, then can grow out as a sizeable tumor. Usually with hx of smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Periungual SCC

A

Presents with swelling, erythema and localized pain. Commonly in nail folds of hands resembling a wart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the histologic hallmark of SCC?

A

Presence of keratin of “keratin pearls” (well formed desmosome attachments and intracytoplasmic bundles of keratin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Dx of SCC

A

Biopsy to find keratin pearls, lymphadenopathy on palpation in adjacent lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the 3 treatment options for SCC?

A

Excision, Mohs, radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the prognosis of SCC?

A

Mohs 94-99%, metastasis associated with poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Which pts have a better prognosis for SCC?

A

Pts w/ in-transit or regional metastasis as 1st site have better chance than those whose initial diagnosis included a distant nodal site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How often must pts with SCC come for follow ups?

A

Annual skin check every year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is skin cancer of the melanocyte?

A

Melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What does MMRISK stand for?

A 
Moles: atypical
Moles >50 common molves
Red hair and freckles
Inability to tan
Sunburn
Kindred/family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Etiology of melanoma

A

Damage to DNA of melanocyte, non-inherited BRAF oncogene mutation, CDKN2A and CDK4 mutated tumor suppressor genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Where does melanoma originate?

A

From melanocytes via the dermoepidermal junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the greatest risk factor for metastasis?

A

Depth of the invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Clinical manifestations of melanoma

A

Macular, nodular, color varies from white non-pigmented to dark black blue or red. Lesions borders tend to be irregular, growth is quick or slow, distribution can be non sun exposed areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

ABCD of melanoma

A

Asymmetry, border (irregular), color (varied), diameter (>6mm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Which type of melanoma does not have a preference for sun damaged skin?

A

Superficial spreading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Superficial spreading melanoma

A

Tendency to multicoloration including black, red, brown, blue, and white. Borders more sharply defined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Which type of melanoma starts as macular and flat then becomes nodular?

A

Lentigo Maligna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Which type of melanoma has an insidious slow growth?

A

Lentigo Maligna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Nodular Melanoma

A

Arise w/out radial growth phase, head neck and trunk, smooth and dome shaped, friable or ulcerated and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Which type of melanoma is common in darker skin types?

A

Acral-Lentiginous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Acral-Lentiginous melanoma

A

Light brown uniform pigmentation initially, on palms, soles, or nail beds. Lesion becomes darker, nodular and may ulcerate

88
Q

Which type of melanoma typically has a delay in diagnosis?

A

Acral-Lentiginous

89
Q

What can be the first sign of metastasis in melanoma?

A

Early mets occurring in lymphatics and regional lymphadenopathy

90
Q

Melanoma metastasis

A

Lymphatics first, then satellite metastases appear as pigmented nodules, then spreads via blood stream to any site including skin, brain, lung, and bone

91
Q

How is melanoma staged?

A

T (tumor) N (lymph node) M (metastasis)

92
Q

What is the T stage for?

A

How far the tumor has grown in the skin. Assigned 0-4 based on the depth

93
Q

What is the N stage for?

A

Assigned 0-3 based on whether it has spread to lymph nodes or lymph channels

94
Q

What is the M stage for?

A

Based on which organs and blood levels of LDH

95
Q

T1

A

Tumor 1.0mm or less

96
Q

T2

A

1.01mm-2.0mm

97
Q

T3

A

2.01mm04.0mm

98
Q

T4

A

> 4.0mm

99
Q

N1

A

One lymph node involved

100
Q

N2

A

Two or three lymph nodes involved

101
Q

N3

A

Four or more lymph nodes involved

102
Q

M0

A

No detectable evidence of distant metastases

103
Q

M1a

A

Metastases to skin, subQ, or distant lymph node, NORMAL SERUM LDH

104
Q

M1b

A

Lung metastases, NORMAL LDH

105
Q

M1c

A

Elevated LDH

106
Q

What is Breslow thickness?

A

The total vertical height of melanoma, from very top granular layer to area of deepest penetration.

107
Q

Less than 1mm Breslow thickness

A

5-yr survival is 95-100%

108
Q

1-2mm Breslow thickness?

A

5-yr survival is 80-96%

109
Q

2.1-4mm Breslow thickness?

A

5-yr survival is 60-75%

110
Q

> 4mm Breslow thickness?

A

5-yr survival 37-50%

111
Q

Melanoma Dx

A

Excisional biopsy preferred, take entire lesion out to see how deep it goes. Palpate lymph glands as well!

112
Q

Melanoma workup

A

LDH can be prognostic, 3A: CXR, 3B/C: fine needle aspiration of lymphs, 4: Abdominal or pelvic imaging or PET scan

113
Q

What is the surgical tx for melanoma?

A

Simple excision for early stage. For primary: wide local excision with sentinel lymph node biopsy or dissection

114
Q

When can radiation be given for melanoma pts?

A

As an adjuvant to surgery in area where lymph nodes were removed, used to relieve symptoms caused by metastases to brain or bone

115
Q

When is chemotherapy used for melanoma?

A

Advanced cases, to relieve symptoms and extend survival. Given in cycles lasting a few weeks

116
Q

What are some adjunct therapies for melanoma?

A

Cytokines (interferon-alpha and IL-2) which can help shrink advanced melanomas, can also be used with chemo drugs

117
Q

What is Vemurafenib used for?

A

Inhibits growth of melanoma w/ some mutated forms of BRAF for late stage melanoma

118
Q

What is Dabrafenib used for?

A

BRAF inhibitor for an unresectable or metastatic melanoma

119
Q

What is Trametinib used for?

A

MEK inhibitor for an unresectable or metastatic melanoma

120
Q

Follow up for pts w/ melanoma

A

Every 6 mos full skin check, self skin checks 1/mo and sun protection

121
Q

Which virus spreads via respiratory droplets and has an incubation period of 9-12 days?

A

Measles (Rubeola)

122
Q

How long does it take for measles to clear?

A

4-7 days

123
Q

Si/Sx of measles

A

Prodrome of cough, coryza, conjunctivitis, fever, then rash develops

124
Q

What do the measles lesions look like?

A

Start as macular or morbilliform rash on anterior scalp and behind ears then by day 2 or 3 down the trunk to the extremities

125
Q

What are Koplick spots?

A

Pathognomonic white papules 1mm on buccal mucosa and pharynx (measles)

126
Q

Do the lesions for measles spread to the palms and soles?

A

Yes

127
Q

What is the treatment of measles?

A

Vaccination w/live virus at 15 mo and 5 yrs, and supportive therapy (rest, fluids, etc.)

128
Q

What is caused by the Toga virus?

A

Rubella, German Measles

129
Q

How are the german measles spread?

A

Respiratory secretions, 12-23 incubation period

130
Q

Si/Sx of German Measles

A

Pain with LATERAL UPWARD EYE MOVEMENT, lymphadenopathy, begins on face and spreads inferior covering body in 24h

131
Q

What is Forsceimer’s sign?

A

Pitechiae on soft palate and uvula (German Measles)

132
Q

What do the lesions look like in Rubella?

A

Pale pink morbilliform macules smaller than rubeola

133
Q

What is the treatment for German Measles?

A

Vaccination with MMR, supportive therapy

134
Q

A benign infectious exanthem caused by Parovirus

A

Fifth Disease (Erythema Infectiosum)

135
Q

How is 5th disease spread?

A

Respiratory droplets

136
Q

Erythema Infectiosum

A

Viral shedding stops by the time symptoms appear (when no longer infectious), incubation of 4-14 days

137
Q

What are the 3 phases of Erythema Infectiosum?

A
  1. Abrupt erythema of cheeks (slapped cheek)
  2. Day 4-erythematous macules on proximal extremities and trunk evolving into lacy pattern by day 9
  3. Recurring stage with heat or sunlight
138
Q

Treatment for 5th disease?

A

Supportive therapy

139
Q

What is Pityriasis Rosea?

A

An acute benign self-limiting eruption common in spring/fall w/unknown cause

140
Q

Herald Patch

A

2-5cm scaly lesion that may mimic tinea corporis (Pityriasis Rosea)

141
Q

Si/Sx for Pityriasis Rosea

A

Over 2 weeks oval or elliptic erythematous patches w/fine scale. “Christmas tree” like pattern on trunk. Viral symptoms may occur

142
Q

What do the lesions look like in Pityriasis Rosea?

A

Macular or papular lesions develop on trunk, neck, extremities. May be pruritic

143
Q

How long does Pityriasis Rosea last?

A

3-8 weeks, resolves spontaneously

144
Q

How can you treat Pityriasis Rosea?

A

Not needed, antihistamines for pruritis

145
Q

The most common form of adverse drug eruptions

A

Morbilliform reactions

146
Q

What is the patho behind morbilliform rxns?

A

Type 4 allergic rxn mediated by T-helper cells

147
Q

Morbilliform rxns commonly caused by which drugs?

A

Ampicillin, amoxicillin, bactrim

148
Q

Si/Sx of a morbilliform rxn

A

Erythema w/macules and papules intitally on trunk then generalizing w/in 2 days.

149
Q

How long can the si/sx last for a morbilliform reaction?

A

Can present within first 2 weeks of exposure up to 10 days after

150
Q

Treatment for morbilliform reaction?

A

Clears within 2 weeks of stopping medication, can use antihistamines and low potency topical steroids

151
Q

A fixed drug reaction happens when?

A

Usually with meds taken intermittently, NSAIDs, Sulfonamides, Barbiturates

152
Q

What do the lesions look like in a fixed drug reaction?

A

Round/oval erythematous plaques may be pruritic/burning or asymptomatic. Usually 6 or few lesions, usually 1

153
Q

Where do the lesions appear in a fixed drug reaction?

A

Genitals or oral mucosa

154
Q

What is the treatment for a fixed drug reaction?

A

Stop drug, if symptomatic can use antihistamines or topical steroid

155
Q

What is a self-limited eruption brought on by drug exposure viral infections or can be idiopathic?

A

Erythema Multiforme

156
Q

What drugs can cause erythema multiforme?

A

Sulfa, Barbs, PCN, Phenytoin

157
Q

What do the lesions look like in erythema multiforme?

A

Begin as macules and become papular then vesicles and bullae form in the center of papules. Localized to hands and feet

158
Q

Si/sx of erythema multiforme

A

Mucosal lesions are painful and erode, fever, malaise

159
Q

Treatment of erythema multiforme?

A

Avoid target substances, sever reaction may require systemic steroids

160
Q

SJS and TEN

A

Mucocutaneous blistering rxn from drug rxn

161
Q

SJS is thought to be a severe variant of what?

A

Erythema Multiforme

162
Q

TEN is thought so be a severe variant of what?

A

SJS

163
Q

Si/Sx of SJS and TEN

A

Fever, mucosal inflammation. Lesions begin on trunk and may be painful, TEN exhibits higher fever and more epidermal separation then SJS

164
Q

Tx of SJS and TEN

A

Withdrawal of offending agent, treatment at burn center for fluid and electrolyte imbalance, wound care

165
Q

What is Bullous pemphigoid?

A

Autoimmune presents in 6th decade of life caused by autoantibodies, complement fixation, neutrophil and eosinophils

166
Q

What type of antibodies bind to basement membrane in bullous pemphigoid?

A

IgG antibodies

167
Q

What do the IgG antibodies activate?

A

Activates complement and inflammatory mediators, attracting cells to basement membrane and releasing proteases

168
Q

Proteases lead to what?

A

Blister formation (Bullous Pemphigoid)

169
Q

The blister is formed how?

A

By cleavage of the basal cells away from the basal lamina

170
Q

What are the lesions like in bullous pemphigoid?

A

Bullae are large and may contain serous or hemorrhagic fluid. Targets the axillae, thighs, groin and abdomen

171
Q

What is the course and prognosis of bullous pemphigoid?

A

Usually self-limiting over a 5-6 year period

172
Q

How can you diagnose bullous pemphigoid?

A

Biopsy and immunofluorescence. C3 deposition is nearly always present in BP

173
Q

Tx for localized or limited bullous pemphigoid

A

Potent topical steroid, Clobetasol with occlusion

174
Q

Tx for moderate and severe bullous pemphigoid

A

Prednisone, once in remission can taper cautiously

175
Q

What can be considered for pts that cant handle steroids? (bullous pemphigoid)

A

Immunosuppressive meds

176
Q

What other meds have been helpful with bullous pemphigoid?

A

Azathioprine, Mycophenolate mofetil, the combo of Tetracycline and Niacinamide, TCN, Doxy or Minocycline (instead of TCN), Dapsone, Recalcitrant

177
Q

What is pediculosis?

A

Lice

178
Q

How long does it take the eggs to hatch on hair shafts?

A

One week

179
Q

Pediculus humanus capitis

A

Scalp

180
Q

Pediculus humanus corporis

A

Body

181
Q

Phthirus pubis

A

Pubic area (crabs)

182
Q

The female louse cannot survive for more than _ days off the human head

A

3

183
Q

Where does the body louse live?

A

Not on the human body, lives in human clothing crawling onto the body only to feed at night

184
Q

The adult female body louse can survive how long away from human body?

A

10 days

185
Q

P.pubis are different from head and body louse how?

A

Shorter, broader body with large front claws, making it able to grasp the coarser pubic hairs

186
Q

Heavy infestation of crabs can also involve where?

A

Eyelashes, eyebrows, facial hair, and the periphery of the scalp

187
Q

How long can the pubic louse survive away from human body?

A

1 day

188
Q

Si/sx of pediculosis capitus (head lice)

A

Present w/intense pruritus of scalp with posterior cervical lymphadenopathy, excoriations and small specks of louse dung on scalp

189
Q

Si/sx of pediculosis corporis (body lice)

A

Initially small pruritic papules that progress to scratching, crusted and infected papules, Spares the hands and feet

190
Q

Si/sx of pediculosis pubis (crabs)

A

Intense pruritis in affected areas, small blue macules can present

191
Q

Dx of pediculosis

A

History, microscopic examination, biopsy

192
Q

What are some topical treatment options for pediculosis?

A

OTC Nix cream Rinse, RID Acticin

193
Q

What is the active ingredient in Nix cream rinse and RID Acticin

A

Permethrin. Acts as neurotoxin and paralysis of nerves in parasite leading to death

194
Q

When should you repeat treatment?

A

One week later. Permethrin only kills active louse, not the nits.

195
Q

Ovid lotion

A

Topical treatment for pediculosis. Most effective for head louse. NOT FOR CHILDREN <6mos. Apply to dry hair let sit for 8-12 hours

196
Q

Elimite cream

A

Has 5% permetherin, leave on overnight and repeat in one week

197
Q

What else can be used to treat pediculosis?

A

Bactrim and vasaline. *Treat entire family**

198
Q

What is environment eradication?

A

Fomites should be washed in hot water and dried. Should be exposed to temps >50-55C for atleast 5 mins to kill any bugs left. Can also seal in a plastic bag for 2 days

199
Q

What is an infestation w. the Sarcoptes scabiei

A

Scabies

200
Q

Mites burrow into epidermis and deposit feces and lay eggs in what?

A

Scabies

201
Q

What type of reaction happens with scabies?

A

Type 4 hypersensitivity reaction about 30 days after infestation

202
Q

Scabies should be considered when?

A

Any patient with persistent pruritis not responding to topical steroids

203
Q

Si/sx of scabies

A

Pruritic lesion vary from vesicles or papule, nodules located b/w web space of finers, flexor aspects of wrists, axilla, antecubital area, abdomen, umbilicus, genital gluteal areas, and feet

204
Q

Where does scabies spare on the body?

A

Face

205
Q

Burrow

A

Pathognomonic of scabies infestation, appearing as a thin short gray brown, wavy channel on the skin

206
Q

Crusted/Norwegian scabies

A

Immunocompromised or debilitated pts. Crusts and scales teem with mites. Psoriasis like scaling around nails with crusting

207
Q

Topical treatment for scabies

A

Permethrin, apply to skin for 8 hrs
Lindane not for pregnant or kids
Percipitated Sulfar best for pregnant pts, all for 8-10 hrs

208
Q

Oral treatment for scabies

A

Ivermectin

After treatment: bedding, clothing, towels washed in hot water or removed for 72 hrs

209
Q

Loxoscelism is what?

A

Brown recluse spider bite

210
Q

How is the brown recluse spider identified?

A

Dark, violin-shaped markings over cephalothorax and 3 sets of eyes rather than usual 4

211
Q

What does the brown recluse spiders venom contain?

A

Phospholipase enzyme, sphingomyelinase D which is a major toxin

212
Q

Si/sx of brown recluse spider bite

A

Bite site painful after 3 hrs, necrotic cutaneous loxoscelism, extensive necrosis develops with edema w/in 8hrs with bulla and surrounding erythema and ischemia that can extend to muscles

213
Q

Treatment for brown recluse spider bite

A

Rest, ice and elevation of site, analgesics, tetanus prophylaxis and surgical debridement

214
Q

Si/sx of black widow spider (lactrodectism) bite

A

Locally limited to small circle of redness. Systemically: pain/cramping within an hour, tachycardia, HTN, PE, fevers, chills, vomiting, violent cramps, delirium or partial paralysis

215
Q

Treatment of black widow spider bite

A

ACLS, antivenom administer in ER, analgesics (Morphine), antihistamine (Benadryl), tetanus

clin med 1 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions