Derm Flashcards
1
Q
Characterized by acute onset of flushing, hives, angioedema, dyspnea, wheezing, tachycardia/bradycardia, hypotension hypoxia or cardiac arrest is
A
Anaphylaxis
2
Q
What its the immediate treatment for anaphylaxis
A
epinephrine 1mg/mL 0.3-0.5mg IM
repeats q5-15 minutes if response is poor
3
Q
Abrupt onset of fever, chills, severe headache, nausea, vomiting, photophobia, myalgia, arthraliga, and a rash that erupts 2-5 days after the onset of fever
Rash is petechial that erupts on wrists, forearms, ankles and sometimes palms and soles then to the trunk
A
RMSF
4
Q
What is 1st line treatments of RMSF
A
Doxycycline
5
Q
Honey-colored crusts, fragile bullae and pruritic
A
Impetigo
6
Q
Small white round spots on the head of a red base on the buccal mucosa by the rear molars and appear 2-3 days before symptoms.
A
Koplik spots
7
Q
Very pruritic, serpiginous rash on interdigital webs, waist, axilla and penis
A
Scabies
8
Q
Sandpare rash with sore throat
A
Scarlet fever or scarletina
9
Q
Hypopigmented round to oval macular rashes
A
Tinea versicolor
10
Q
Herald patch followed by a christmas tree patterned rash
A
Pityriasis rosacea
11
Q
Smooth papules 2-5mm in size that are dome shaped with central umbilication with a white plug
A
Molluscum contagiosum
12
Q
Red target like lesion that grows in size, some central clearing
A
Early lyme or Erythema migrans
13
Q
Purple to dark red painful skin lesions all over the body, acute onset of high fever, headache, changes in LOC
A
Meningococcemia
14
Q
Swollen tender and red then blisters center of the lesion may form a purple to black eschar which becomes an ulcer when sloughed off
A
Brown recluse spinder
15
Q
What are the sx of brown recluse spider bite
A
- fever
- chills
- nausea
- vomiting
- bitten area becomes swollen, red, tender, and blisters appear within 24-48 hours
- Central area becomes necrotic when this area sloughs off it leaves an ulcer
16
Q
Dark colored moles with uneven texture, variegated colors, irregular borders with a diameter of 6mm of larger
A
Melanoma
17
Q
Pearly or waxy skin lesaions with an atropic or ulcerated center that does not heal. May be white, light pink, brown or flesh colored, may easily bleed with trauma
A
BCC
18
Q
Dry round, red colored lesions with a rough texture that doe not heal, in sun exposed areas are
A
Actinic Keratosis
19
Q
What are triggers for Steven-Johnson-Syndrome
A
-meds: Allopurinol, anticonvulsants, sulfonamides, NSAISs
20
Q
What are risk factors for Steven-Johnson-Syndrome
A
- HIV
- Genetics
- Lupus
- Malignancy
21
Q
Acral means
A
Distal portion of the limbs
22
Q
Annular means
A
ring shaped
23
Q
Exanthem means
A
Cutaneous ras
24
Q
Extensor means
A
Skin area outside of the joint
25
Flexor means
Area of skin on top of the joint with skin folds
26
Flexural means
Skin flexures are body folds
27
Intertriginous means
Area where 2 skin areas touch or rub together
28
Maculopapular rash means
Rash with color and small raised bumps
29
Morbiliform rash means
Rash that resembles measles (pink rash with texture)
30
Xerosis means
dry skin
31
Verrucous means
Wart like
32
Nummular means
Coin shaped, round
33
Serpiginous means
snake like
34
ABCDEs of melanoma
```
Asymmetry
Borders irregular
Colors multiple
Diameter >6mm
Enlargement or change in size
```
35
Macule
-flat non palpable lesion <1cm
36
Papule
-elevated solid lesion = 0.5cm in diameter
37
Plaque
Flattened, elevated lesion >1cm in siz
38
Bulla
Elevated superficial blister filled with serous fluid >1cm in size
39
Vesicle
Elevated superficial skin lesion <1cm in diameter
40
Pustule
Elevated superficial skin lesion <1cm in size filled with purulent flud
41
Erythematous and raised skin lesions with discrete borders that are irregular, oval or round. They enlarge over minutes to hours then disappear
Urticaria
42
Soft wartlike fleshy growths that look pasted on the skin that range from light tan to black
Seborrheic Keratosis
43
Raised and yellow colored soft plaques that are usually located under the brow or upper and lower lids of the eyes on the nasal side
Xanthelasma
44
Bilateral brown to tan colored stains on the upper cheek, malar area, forehead and chin in pregnancy or pts on OCP
Melasma
45
A loss of epidermal melanocytes resulting in white patches of hyperpigmentation with irregular shapes that gradually develop and coalesce over time. Chronic and progressive
Vitiligo
46
What are risk factors for vitiligo
- graves, hashimotos
- RA
- Psoriasis
- Pernicious anemia
47
Benign small smooth round papules that are bright red. These lesions are due to a nest of malformed arterioles
Cherry angioma
48
Soft fatty cystic tumors that are painless and located in the subcutaneous layer of skin
Lipoma
49
Round macules to papules that range in color from tan to dark brown
nevi
50
Diffuse velvety thickening of the skin that is usually located behind the neck and the axilla it is associated with
Acanthosis nigricans
| -associated with DM, Metabolic syndrome, Obesity, GI cancer
51
What are acrochordon
Skin tags
| -painless and peduncultated outgrowths of skin
52
Class I Topical Steroids are ____ potency and an example is ____
Super high potency Halobetasol propionate 0.5%
53
Class II Topical Steroids are ____ potency and an example is ____
High Potency
| Halcinoide 0.1%
54
Class III Topical Steroids are ____ potency and an example is ____
Medium High Potency
| Triamcinolon acetonide
55
Class IV Topical Steroids are ____ potency and an example is ____
Medium
| Mometasone Furate
56
Class V Topical Steroids are ____ potency and an example is ____
Low Medium
| Desonide 0.05%
57
Class VI Topical Steroids are ____ potency and an example is ____
Low
| Fluocinolone acetonide
58
Class VII Topical Steroids are ____ potency and an example is ____
Hydrocortisone 1%
59
Super high potency topical steroids are recommended for
severe dermatoses on non facial and nonintertriginous areas for 2 weeks
60
Medium high potency topical steroids are recommended for
Use on mild to moderate non facial and nonintertriginous areas
61
Low potency topical steroids are recommended for
use on eyes, genital area for limited duration
62
Low-medium potency topical steroids can be used on
Larger areas that need treatment
63
An inherited skin disorder in which squamous epithelial cells undergo rapid mitotic division and abnormal maturation
Psoriasis
64
New psoriatic plaque forms over areas of skin trauma
Koebner phenomenon
65
Pinpoint areas of bleeding in the skin when psoriatic plaques are removed
Auspitzs sign
66
What is the classic presentation of Psoriasis
-pruritic, erythematous plaques covered with fine silvery white scales along with pitted fingernails and toenails
67
What is the medications indicated in psoriasis
- topical steroids
- Topical retinoids
- Tar
- Methotrexate
- Cyclosporine
- Biologics
68
Guttate psoriasis is
severe form of psoriasis r/t beta hemolytic strep infection
69
What is a black box warning for topical tacrolimus
-malignancy
70
What is the treatment plan for actinic keratosis
- Biopsy
| - Tx options: cryo, 5-FU crea,
71
What is the medications indicated in tinea versicolor
-topical selenium sulfid and topical azole antifungals
72
Chronic inherited skin disorder marked by extermely pruritic rashes that are located on the hands, flexural folds and neck. Exacerbated by stress and environmental factors
Atopic dermatitis
73
What is considered 1st line in the treatment of atopic dermatitis
- topical steroids and emolliants
- mild disease: Class V (Hydrocortisone 2.5%)
- Moderate Class IV Triamcinolone
74
Acute onset of 1 to multiple bright red pruritic lesions that evolve into bullous or vesicular lesions, easily rupture, leave bright red moist areas that are painful. May experience burning or stinging. When dried it becomes crusted, pruritic and lichenified , may follow a patter or shape
Contact dermatitis
75
What is the management of contact dermatitis
- stop exposure to the substance
- topical steroids for 1-2 weeks
- consider high potency if: skin is lichenified or does not involve face/flexural areas
76
What are environmental factors that promote overgrowth of yeast
- warmth
- humidity
- friction
- obesity
- diabetes
- decreased immunity
77
Bright red shiny lesions that itch or burn located in the intertriginous areas, may have satellite lesion
Candidiasis
78
Severe sore throat with white adherent plaques with a red base that are hard to dislodge on the pharynx
Thrush
79
What is the treatment plan for thrush
- Clotrimazole troches or miconazole buccal tablets
| - Nystatin oral suspension
80
For moderate to severe cases of candidiasis, first line is
-oral fluconazole
81
What is the treatment for external candidiasis
- OTC miconazole/clotrimazole
| - Terconzole or ciclopirox as prescription
82
What are point of entry for cellulitis
- skin breaks
- insect bites
- abrasions
- pre-exisitng skin infections
83
Vibro vulnificus is usually related to
Exposure of a wound to brackish water or saltwater or eating raw oysters/clams
84
Puncture wounds of the foot may be at risk for what bacteria
Pseudomonas aeruginosa
85
Dog bites: most common bacteria
P. multocida, p canis, capnocytophag
86
Cat bites: most common bacteria
Pasteurella Multocida (gram negative)
87
Purulent forms of cellulitis are often caused by
MRSA
88
These people should avoid eating raw or undercooked oysters or clams due to the possibility of vibri vulnificus
- Pregnant
- liver disease
- immunocompromised
89
Acute onset of diffused pink to red skin that is poorly demarcated with advancing margins, the lesion feels warm to touch, may become abscessed or fluctuant.
May have lymphadenopathy, may have systemic sx.
Cellulitis
90
Where is the most common location for cellulitis
lower limb
91
Clenched-fist injuries have a high risk of
infection
92
Reddish to purple colored lesions that increase rapidly in size, may have bullae, appear induated with complains of severe pain on affected site
Necrotizing fasciitis
93
Folliculitis
infection of the hair follicile
94
What is the tx for folliculitis
-Mupirocin
95
For small boils (furuncles) the management is
use warm compresses BID
96
If a furuncle is >2cm you should consider
-draining +/- empiric antibiotic treatment
97
If a furuncle is located over a joint what should you do
-refer to ED for x-ray to rule out osteomyelitis
98
The treatment for nonpurulent cellulitis is
```
Dicloxacillin QID x 10 days
or
Cephalexin QID
or
Clindamycin TID
```
99
If a patient has a penicllin allergy and non purulent cellulitis consider
Azithromycin x 5 days
100
If you have MRSA the treatment is
Bactrim
Clinda
Doxycycline
101
Patients with cellulitis being treated with antibiotics should show improvement in ____ hours
48-72
102
A subtype of cellulitis involving the upper dermis and superficial lymphatics caused by group A strep
Erysipelas
103
What are the sx of erysipelas
- sudden onset of 1 large hot and indurated red skin lesion with clear demarcated margins
- usually located on the lower legs or cheeks
- accompanied by fever or chills
104
What is the treatment plan for bites
- Augmentin (Doxy or Bactrim flagyl or clinda if pen allergic)
- irrigate with saline
- wound C&S
- tetanus prophylaxis
105
You should consider a rabies shot if
patient has a bite from a:
| -bat, racoon, skunk, fox, coyote, dogs (if not recently immunized )
106
Chronic and recurrent inflammatory disorder of the apocrine glands that result in painful nodules, abscesses and pustules in locations like the axillae, mammary glands, perianal areas, groin
Hidradenitis suppurativa
107
What are risk factors for hidradenitis suppurativa
- Women
- smoking
- obesity
108
What is the treatment plan for hidradenitis suppurativa
- avoid high glycemic foods and dairy
- smoking cessation
- weight loss if obese
- Topical antibiotics or oral antibiotics
109
Acute onset of itchy pink to red lesions which evolve into vesiculopustules that rupture when serous fluid dries up it looks like lesions covered with honey colored crusts
-impetigo
110
What are the treatment options for impetigo
- bactroban
| - severe cases: Keflex or dicloxacillin; azithro or clinda if pen allergic
111
Close contacts in regards to meningitis is defined as
- close proximity to a patient (<3 feet) who has had prolonged contact (>8 hours)
- Or direct exposure to oral secretions going back 7 days before the onset of a patients sx
112
The CDC recommends MCV4 vaccination for
- college students living in dorms
- military
- persons with asplenia
- sickle cell
- routinely for preteens and teens (first dose at 11 and booster at 16)
113
Erythema migrans is
a skin lesion caused by the bite of a tick infected with borrelia burgdorferi, results in a bulleye appearing lesion
114
What is the test for lyme disease
- 2 step testing
- 1st step is EIA (enzyme immunoassay) if the 1st step is positive or indeterminate the second step is the IFA or western blot if both are positive the patient has lyme
115
What is the treatment for early lyme
Doxycycline BID x 10 days
116
What are complications of lyme
Neuropathy
Lyme arthritis
Chronic fatigue
Impaired memory
117
Rocky mountain spotted fever is caused by
-caused by the bite of a dog tick (wood tick) that is infected with the parasite Rickettsia rickettsii
118
Treatment for RMSF is most effective if started in the 1st ____ days of symptoms
5 days
119
What is the diagnostic test for RMSF
-Antibody titres to R. rickettsii
120
What is first-line treatment for RMSF
-Doxycycline 100mg x 7 days
121
When is chickenpox and shingles contagious
Chicken pox: 1-2 days before onset of rash and until all lesions have crusted over
Shingles: Contagious with onset of rash until all lesions have crusted
122
Prodrome of fever, pharyngitis and malaise that is followed by eruption of pruritic vesicular lesions in different stages of development over a 4 day period
-Chickenpox
123
Acute onset of groups of papules and vesicles on a red base that ruptures and become crusted following a dermatomal patter on one side of the body.
May have a prodrome with severe pain/burning at site before the breakout
-Shingles
124
Although history and physical alone are usually enough to make a diagnosis, The gold standard test for chicken pox or shingles is
Polymerase chain reaction
125
What is the treatment of shingles
Acyclovir 5x/day or valacyclovir BID x 10 days
126
Post herpatic neuralgia is best reated with
TCAs or Gabapentin
127
Triad of ipsilateral facial paralysis, ear pain and vesicles in the ear canal
Ramsay Hunt Syndrome
128
Herpes Zoster Ophtalmicus can result in
Corneal blindness so refer to opthalmology
129
Woman should wait ___ to get pregnant after a varicella immunization
1 month
130
Shingles vaccine is recommended as a 1 dose shot for people age
60+
131
CI to the shingles vaccine include
AIDS
Chronic high dose steroids
Chemo/Radiation
Immunocompromised state
132
Acute onset of extremely painful red bumps and small blisters on the sides of the finger, the cuticle area or the terminal phalanx of 1 or more fingers
Herpetic whitlow
133
Patient education regarding herpetic whitlow
-Cover skin lesions until they heal
134
An acute local bacterial skin injection of the proximal or lateral nail folds that resolves after the abscess drains. Associated with picking a hangnail, trimming cuticle
Paronychia
135
What are causative agents for paronychia
- Staph
- Strep
- Pseudomonas
136
What is the treatment plan for paronychia
- warm water soaks
| - topical antibiotic
137
What is the management of pityriasis rosacea
-self limiting usually takes 6-8 weeks to resolve
138
A pruritic rash located in the interdigital webs of hands axillae, breast, buttocks, waist, scrotum and penis. Rash appears like serpiginous or linear burrows
-Scabies
139
What is the treatment plan for scabies
- Permethrin cream
- Treat close contacts
- Pruritus can last up to 2-4 weeks treat itch with benadryl/topical steroids
- Wash clothes and bedding in hot water and dry on hot setting
140
KOH slid microscopy tests for
Tinea infections
141
Black dot tinea capitis gold standard treatmemtn is
Griseoulvin
142
What is kerion
Inflammatory and indurated lesions that permanently damage hair follicles causing patchy alopecia
143
What is the first line treatment for mild acne
Topical retinoids
144
If no improvement with topical retinoids add
Oral antibiotics Tetracyclines
145
When can tetracyclines be given
13 years and up
146
These OCP are indicated in acne
Desogen and Yaz
147
First line management of rosacea is aimed at
symptom control and avoidance of triggers (spicy foods, alcohol, sunlight, toners, AHA, strong soaps)
148
Small acne like papules. and pustules around nose, mouth and chin, telangiectasis may be present on the nasal area and cheeks, flushing, chronic blepharitis
-Rosacea
149
What mediations are indicated in the management of rosacea
- Metrogel
- Azelaic acid
- Low dose Tetracyclines orally
150
Dome shaped papules iwth central umbilication
Molluscum contagiosum
151
Minor burn criteria includes
- Partial thickness burns <10% of TBSA in patients 10-50 and <5% of TBSA in patients <10 and >50
- Full thickness burns <2% of TBSA
Above plus:
- may not involve face, hands, perineum, feet,
- may not cross major joints
- may not be circumferential
- no suspicion of inhalation injury
- no suspicion of high voltage injury
152
First degree burns and management
- erythema only (no blisters)
- Cleanse with soap and water or saline
- Ice packs x 24-48 hours
- OTC benzocaine or aloe vera PRN
153
Partial thickness or second degree burns and management
- red colored with superficial blisters
- cleanse with mild soap/water or saline
- treat with silvadene or triple anitbiotic ointments
154
Full thickness burns (3rd degree burns) and management
- pain less
| - involve entire skin layer, subcutaneous area and soft tissue fascia
155
Rule of 9's adult
arm/head: 9% each
| legs/trunk: 18% each
156
Rule of 9's in child
arms: 9%
legs: 14%
Trunk: 18% each anterior and posteriror
157
Anthrax prophylaxis is
Doxycyline 100mg BID x 60 days
158
Use of lidocaine with epi is contraindicated on areas with high risk of ischemia
-tip of nose, ears, fingertips, toes and penis
159
Suture removal is indicated
Face: 5-7 days
Scalp: 7-10 days
Upper extremities: 7 to 10 days
Lower extremities: 10-14 days
