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Flashcards in Adult - Derm Deck (70):
1

What is the most common of all skin disorders?

acne

2

Which acne symptoms are red flags that indicate the need for referral?

  • scarring
  • cyst formation

3

First line (non-pharmocologic) treatment for acne

wash several times daily with mild soap

use oil-free products

 

4

What is the order of pharmacologic treatment in acne?

  1. comedolytics
  2. topical combination agents: comedolytic + ABT 
  3. topical antibiotics
  4. oral antibiotics
  5. oral contraceptives

5

First line pharmacologic treatment for acne

comedolytics:

benzoyl peroxide - bacteriocidal

trentoin (Retin-A) 

6

What is a potential side effect of retin-a (tretinoin)?

Increased sensitivity to sunlight

7

What is the second pharmacologic step in acne treatment?

combination agents:

benzoyl peroxide + erythromycin = Benzamycin

benzoyl peroxide + clindamycin = Benzaclin

8

What is the third pharmacologic step of acne management?

topical antibiotics:

clindamycin

9

What is the fourth pharmacologic step of acne management?

Oral antibiotics:

tetracycline

why is tetracycline contraindicated in pregnancy and children under 9 years?

due to staining of teeth

10

What is the fifth pharmacologic step of acne management?

oral contraceptives:

combination products are most effective 

ortho tri-cyclen or estrostep

11

What is a derm-related side effect of oral contraceptive therapy?

melasma - brown splotches on the skin

as opposed to the "mask of pregnancy" which is known as: 

chloasma

12

What are two additional therapies that could be used for acne treatment, though not in primary care?

dermabrasion

intralesional injections of the steroid triamcinolone

13

Which two pathogens are the "major players" in skin infections in the community?

staph aureus

strep (usually Group A)

14

Inflammation of the hair follicle - 

term and pathogen

folliculitis

staph

15

Localized infection originating from the hair follicle but now more involved - 

term and pathogen

furuncle

"boil"

staph

16

What does a CA-MRSA furuncle look like?

A spider bite

17

A red, swollen, and painful cluster of boils that are connected to each other under the skin -

term and pathogen

carbuncle

staph

18

What are the common causes of cellulitis in the community?

  1. Strep pyogenes (Group A) - usual cause 
  2. Staph aureus - less common

19

What are the common causes of cellulits in the inpatient population?

Gram NEGATIVE organisms -

 E. coli

Klebsiella

Psuedomonas

Enterobacter

less frequently - Gram POSITIVE organisms

MRSA? CA-MRSA?

20

In the outpatient, what 3 drugs can be used to treat CA-MRSA cellulitis?

  • Bactrim (TMP/SMZ)
  • Doxyclycline / minocyline
  • Clindamycin

Which of these also covers Group A strep?

Clindamycin

 

 

21

What additional drug class must be aded to Bactrim or  Doxycyline / Minocycline in order to provide Group A strep coverage? 

a beta lactam

22

What are some examples of the beta lactams?

penicillin

amoxicillin

1st generation cephalosporin (Keflex)

23

What cellulitis-treating antibiotic provides coverage for both staph and strep?

Clindamycin

24

An acute infection of the upper dermis and superficial lymphatics; more superficial than cellulitis, typically more raised and demarcated

"look's like big sunburn"

- condition and pathogen

Erysipelas

Strep

Known for insidious or rapid progression?

rapid

25

Infection and abcess formation,

typically in the axilla or groin - 

condition and pathogen

Hidradenitis suppurativa

staph

26

Characterized by honey colored crusts on an erythematous base -

condition and pathogen

Impetigo

staph

27

Infection of the skin around the finger or toe nail -

term and pathogen

paronychia

staph

28

Collection of blood between the fingernail and nail bed - 

term and management

subungual hematoma

trephination - drilling a hole through the nail

to relieve the pressure

29

candida balanitis - 

location?

 

candida of the penile head

30

candida intertrigo -

location?

candida in warm, moist folds of skin

31

For most candida, what is management?

topical antifungals first

oral antifungals only if topicals unsuccessful

32

Four examples of antifungals?

miconazole

clotrimazole

fluconazole 

griseofulvin

33

What are two fungal infections which are treated with selenium shampoo?

tinea capitus

tinea versicolor

34

Another name for herpes zoster is:

shingles

 

35

Pharm options for herpes zoster have what suffix?

-cyclovir

36

What is a red flag in herpes zoster?

eye or face involvement -

 refer right away

37

What medications can be used for post-herpetic neuralgia?

gabapentin (Neurontin)

pregabalin (Lyrica)

38

What are two significant side effects of gabapentin and pregabalin?

excessive sleep

significant weight gain

39

What vaccine can be used to prevent or mitigate herpes zoster?

approved starting at what age?

zostavax

age 50

40

What are pre-malignant, small, rough patches on sun-exposed parts of the body?

actinic keratosis

41

What type of skin cancer arises from actinic keratosis?

squamous cell carcinoma

42

How is actinic keratoses treated?

liquid nitrogen

43

What lesions are the precursors to squamous cell carcinoma?

actinic keratosis

44

How long does it take for squamous cell carcinoma to develop from an AK?

over a few months

45

Description of squamous cell carcinoma

firm, irregular papule or nodule

with keratictic, scaly bleeding

(yum)

46

Treatment for squamous cell carcinoma

refer for:

biopsy 

Mohs excision

47

Benign, beige to black plaque, with a "stuck-on" appearance.

seborrheic keratosis

48

Treatment in seborrheic keratoses

liquid nitrogen

or 

none

49

What is the most common type of skin cancer?

basal cell carcinoma

50

Waxy, pearly, shiny lesion with central depression or rolled edge, and possibly with telangiectatic vessels.

basal cell carcinoma

51

What is the treatment for basal cell carcinoma?

shave or punch biopsy and surgical excision

52

Which skin cancer has the highest mortality rate?

melanoma

53

What are the ABCs to remember with melanoma?

A - asymmetry

B - border irrecularity

C - color variation

D - diameter > 6 mm

E - elevation

E - enlargement

54

What is an important detail to teach patients about applying steriods to their atopic dermatitis?

it is most effective when rubbed in very well

55

What might be the underlying cause of an explosive onset derm disorder that an adult has never previously had?

HIV infection

56

What is the only derm disorder for which tar shampoo is recommended?

psoriasis

57

Yellow plaques as a result of fat build up under skin; often near inner canthus.

Xanthelasma

what is underlying cause?

hyperlipidemia

58

What is the hallmark rash of Lyme disease?

erythema migrans

59

What is the initial test for Lyme disease? 

confirmatory?

ELISA

Western blot

 

(same as HIV)

60

What antibiotics are used for Lyme disease?

Doxycyline

Amoxicillin

61

What is the typical rash in Rocky Mountain Spotted fever?

maculo-papular

petechial 

62

What is the testing for Rocky Mountain Spotted fever?

PCR (like infant HIV test)

 

63

What is the treatment for Rocky Mountain Spotted Fever?

Doxycycline

 

64

Hallmark distribution of smallpox lesions - 

first lesions on face, palate, oral mucosa

spread from there

on any one part of the body, all lesions are at the same stage

65

What is the causative agent of anthrax?

bacteria, though often referred to as "spores"

66

Is there a vaccine for anthrax?

yes

67

What are the two types of anthrax infections?

cutaneous

inhalation

68

What is the progression of the cutaneous form of anthrax?

pruritic papule

ulcer surrounded by vesicles

black necrotic eschar with edema

eschar falls off leaving scar

69

What is used to treat anthrax?

PCN

ciprofloxacin (Cipro)

doxycyline

70

Treatment options for genital warts:

  • podophyllin resin
  • podofilox (Condylox)
  • cryosurgery
  • TCA - trichloroacetic acid
  • BCA - bichloracetic acid