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Clinical Med I > Derm - Acne, Roscae, Insects - Exam 1 > Flashcards

Derm - Acne, Roscae, Insects - Exam 1 Flashcards

1
Q

What are the four factors that drive Acne vulgaris?

A
  • Follicular hyperkeratinization
  • Increased sebum production
  • Cutibacterium acnes within the follicle
  • Inflammation
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2
Q

What is considered the precursor for the clinical lesions of acne vulgaris?

A

Microcomedone

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3
Q

What converts a microcomedone into a closed comedone or whitehead?

A

Accumulation of sebum and keratinous material.

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4
Q

What contributes to the development of inflammatory lesions in acne vulgaris?

A

Follicular rupture and presence of bacteria.

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5
Q

What areas of the body does acne affect?

A

Areas that have the largest, hormonally-responsive sebaceous glands such as the face, neck, chest, upper back, and upper arms.

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6
Q

When would you prescribe oral antibiotics for acne?

A

Severe inflammatory acne

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7
Q

What is the role of benzoyl peroxide with acne?

A

Decreases the emergence of antibiotic resistant bacteria.

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8
Q

What is the most effective treatment method for comedonal (noninflammatory) acne?

A

Topical retinoid (tretinoin)

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9
Q

What is the most effective treatment method for mild papulopustular and mixed acne?

A

Benzoyl peroxide +/- topical antibiotic (erythromycin, clindamycin) and topical retinoid.

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10
Q

What is the most effective treatment method for moderate papulopustular and mixed acne?

A

Benzoyl peroxide + topical retinoid + oral antibiotic (tetracycline class)

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11
Q

What is the most effective treatment method for severe acne?

A
  • Retinoid + oral antibiotic (tetracycline class) + benzoyl peroxide

OR

  • Oral isotretinoin monotherapy (Accutane)
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12
Q

Which acne medications are teratogenic and contraindicated in pregnancy?

A

Retinoids

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13
Q

What is a safe acne regimen for pregnancy?

A

Oral erythromycin, topical clindamycin, topical azelaic acid

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14
Q

What population is Acne Rosacea most prevalent in?

A

Fair-skinned females

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15
Q

At what age does Acne Rosacea typically emerge?

A

In the 30’s

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16
Q

What areas of the body are commonly affected in acne rosacea?

A

Nose, cheeks, chin, and forehead

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17
Q

What are the four subtypes of acne rosacea?

A
  • Erythematotelangiectatic
  • Papulopustular
  • Phymatous
  • Ocular
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18
Q

What are clinical signs typically associated with Erythematotelangiectatic rosacea?

A
  • Chronic redness of central face
  • Flushing (wet or dry)
  • Skin sensitivity
  • Dry appearance
  • Telangiectasias (vascular markings)
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19
Q

What are clinical signs typically associated with Papulopustular rosacea?

A
  • Papules and pustules of central face
  • Inflammation can be confluent
  • No comedones
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20
Q

What are clinical signs typically associated with Phymatous rosacea?

A
  • Tissue hypertrophy causing irregular contours
  • Mostly nose, but can involve cheeks, forehead, and chin
  • Most affects men (exception to the general rule)
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21
Q

What are clinical signs typically associated with Occular rosacea?

A
  • Greater than 50% of those have other types of rosacea
  • Seen in children and adults
  • May precede, coincide, or follow other acne rosacea types
  • Dry eyes, pain, itching, blurred vision
  • Photosensitivity
  • Blepharitis
  • Keratitis
  • Conjunctivitis
  • Stye
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22
Q

What is the first line of treatment for erythematotelangiectatic rosacea?

A

Behavior modification

  • Avoid triggers
  • Sun protection
  • Gentle skin care
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23
Q

What is the second line of treatment for erythematotelangiectatic rosacea?

A
  • Laser and pulsed light therapies

- Topical Brimonodine (vasoconstrictor)

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24
Q

What is the first line of treatment for mild to moderate papulopustular rosacea?

A
  • Metronidazole

- Azelaic acid

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25
Q

What are the second line topicals used in mild to moderate papulopustular rosacea?

A
  • Ivermectin

- Sulfacetamide-sulfur

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26
Q

What is the treatment method for moderate to severe disease or failed topical treatment for papulopustular rosacea?

A
  • Oral Tetracyclines

- Oral Macrolides

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27
Q

What is the treatment method for early phymatous rosacea?

A

Isotretinoin (topical retinoid)

28
Q

What is the treatment method for advanced phymatous rosacea?

A
  • Surgical debulking

- Laser ablation

29
Q

What is the treatment method for ocular rosacea?

A
  • Refer to ophthalmologist

- Topical/oral antibiotics and cyclosporin

30
Q

What can the venom in scorpion stings cause?

A

Hyperexcitability and excessive neuro/muscular activity

31
Q

What are clinical findings associated with a grade 1 envenomation from a scorpion?

A

Local pain and paresthesias at the sting

32
Q

What are clinical findings associated with a grade 2 envenomation from a scorpion?

A

Local symptoms as well as remote pain and paresthesias

33
Q

What are clinical findings associated with a grade 3 envenomation from a scorpion?

A

Either cranial nerve or somatic skeletal neuromuscular dysfunction.

34
Q

What are clinical findings associated with a grade 4 envenomation from a scorpion?

A

Both cranial nerve and somatic skeletal neuromuscular dysfunction.

35
Q

What are some clinical signs of cranial nerve dysfunction associated with a scorpion sting?

A
  • Hypersalivation
  • Abnormal eye movements
  • Blurred vision
  • Slurred speech
  • Tongue fasciculations
36
Q

What are some clinical signs of somatic skeletal neuromuscular dysfunction associated with a scorpion sting?

A
  • Fasciculations
  • Shaking and jerking of extremities
  • Opisthotonos (arching of back)
  • Emprosthotonos (tetanic forward flexion of the body)
  • Fever up to 104 F from excess motor activity
37
Q

What is the typical treatment for mild envenomations by a scorpion?

A
  • Pain management with oral medications
  • Cleansing of the sting site
  • Tetanus prophylaxis
  • Observe for four hours
38
Q

What should you monitor for in cases of severe envenomation by a scorpion?

A
  • Respiratory compromise
  • Myocardial infarction
  • Hyperthermia
  • Rhabdomyolysis
  • Multiple organ failure
39
Q

What does the treatment for severe envenomations by a scorpion include?

A
  • IV fentanyl for pain

- IV benzodiazepines UNLESS you give Antivenom as the combination could cause respiratory depression

40
Q

What is the most common reaction from a bee sting?

What is it treated with?

A

Localized swelling and erythema that lasts for a few hours to 1-2 days

Treat with cold compress

41
Q

What does a bee sting cause about 10% of the time?

What are the symptoms associated with it?

What is it treated with?

A

Large Local Reaction (LLR)

  • Exaggerated erythema and swelling
  • Gradually enlarges over 1-2 days
  • Resolves in 5-10 days

Treated with cold compress, prednisone, antihisatmines, NSAIDS

42
Q

How do you treat an anaphylactic reaction to a bee sting?

A

IM epinephrine

43
Q

What is the leading cause of fatal anaphylaxis?

A

Insect stings

44
Q

What does the release of catecholamine from a Black Widow’s venom cause?

A
  • Intermittent radiating pain
  • Abdominal/chest/back pain and muscle spasm
  • Local/regional diaphoresis
  • Headache
  • Nausea/vomiting
45
Q

Do Black Widow bites typically cause many symptoms? Why or why not?

A

Often cause few symptoms because no venom is typically injected

46
Q

What are clinical signs of a Black Widow bite?

A

Blanched circular patch, surrounding red perimeter and central punctum

47
Q

What is the treatment management for Black Widow bites?

A
  • Local wound care
  • Antiemetics
  • Narcotic analgesics
  • Tetanus immunization
  • Muscle relaxers
  • Antivenom (caution)
48
Q

Brown Recluse bites are often painless initially, but what are some possible effects after the initial bite?

When do the symptoms typically resolve?

A
  • Progress to severe pain in 2-8 hours
  • Usually a red plaque or papule with central pallor
  • May see two small puncture marks within the erythema
  • Vesiculation can occur

Typically resolves in a week.

49
Q

What signs/symptoms are associated with rare, severe ulcerative necrosis from a Brown Recluse bite?

A
  • Dark, depressed center develops at wound site after 1-2 days
  • Nausea/vomiting
  • Headache
  • Fever/chills
  • Rarely have renal failure, hemolytic anemia, hypotension, DIC, rhabdomyolysis
50
Q

How do necrotic lesions from Brown Recluse bites typically heal?

A

By secondary intention without scarring

51
Q

What is the treatment management for necrotic lesions from Brown Recluse bites?

A
  • Cleansing
  • Cold compresses
  • Analgesics
  • Antibiotics
  • Surgical excision and reconstruction may be necessary, but is avoided until wound has stabilized
52
Q

What is Vitiligo?

A

An acquired skin depigmentation via an autoimmume process directed against melanocytes.

53
Q

What are clinical indications of Vitiligo?

A
  • Milk-white macules with homogenous depigmentation and well-defined borders
  • Slow progression
54
Q

Where does Hidradenitis Suppurativa “acne inversa” occur?

A

Occurs in the axillary, inguinal, and anogenital regions

55
Q

What does Hidradenitis Suppurativa result from?

What are some other factors that may contribute to Hidradenitis Suppurativa?

A
  • Results from the cycle of follicular occlusion, rupture, and the associated immune response
  • Other factors include genetics, mechanical stress, obesity, smoking, and diet
56
Q

How does Hidradenitis Suppurativa begin?

How does it progress?

A
  • Begins with a single, deep-seated inflammatory nodule.
  • More nodules form as disease progresses
  • May form an abscess that opens to the skin
  • Purulent drainage occurs if ruptured
57
Q

What are some other skin changes that occur as Hidradenitis Suppurativa progresses?

A
  • Sinus tract
  • Comedones
  • Scarring
58
Q

What are medical treatment options for Hidradenitis Suppurativa that are used in combination with lifestyle strategies?

A
  • Local treatment with topical clindamycin or intralesional corticosteroids
  • Systemic antibiotics such as doxycycline or minocycline
  • Anti-androgenic agents
  • Surgery such as punch debridement of nodules or wide excision
  • TNF inhibitors and oral retinoids for severe cases
59
Q

What are complications associated with Hidradenitis Suppurativa?

A
  • Fistulaes
  • Strictures and contractures
  • Lymphatic obstruction
  • Infectious complications
  • Squamous cell cancer
  • Malaise
  • Depression
  • Suicide
60
Q

What should you consider doing when patient is diagnosed with Vitiligo or you are considering Vitiligo as a diagnosis?

A
  • Consider screening for other autoimmune diseases

- Skin biopsy will show epidermis devoid of melanocytes

61
Q

What contributes to the first stage of acne, microcomedone?

A

Increased serum production and follicular hyperkeratinization

62
Q

How is an open comedone or blackhead formed?

A

Follicular orifice is opened with continued distention

63
Q

What factors contribute to the process of developing inflammatory lesions in acne vulgaris?

A
  • Androgens stimulate the growth and secretory function of sebaceous glands
  • Mechanical trauma can rupture comedones, causing inflammatory lesions
  • Stress has effect on severity
64
Q

What are important considerations when diagnosing acne vulgaris?

A
  • Work up for hyperandrogenism is indicated for females patients with acne and additional signs of androgen excess
  • Rapid appearance of acne in conjunction with virilization suggests an underlying adrenal or ovarian tumor
  • A medication history should also be reviewed for acne-inducing drugs
65
Q

What are clinical signs of a secondary bacterial infection caused by a hymenoptera sting?

How is it treated?

A
  • Worsening of symptoms 3-5 days after sting
  • Fever
  • Sting is from fire ants or yellow jacket

Treated with antibiotics

66
Q

What are treatment methods for vitiligo?

A
  • Topical and systemic corticosteroids (first line)
  • Calcineurin inhibitors
  • Narrowband ultraviolet B phototherapy (for extensive disease)
  • Skin grafts
67
Q

What helps you distinguish between acne vulgaris and papulopustular rosacea?

A

Papulopustular rosacea does not have comedones

Clinical Med I (24 decks)

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