Derm Flashcards
(168 cards)
1
Q
tx acne vulgaris
A
mild: benzoyl peroxide topical/wash first line, benzoyl peroxide + abx (topical clinda/erythro) 2nd line
moderate: systemic abx (PO doxy/mino) 1st line, topical retinoids (adapalene, trentinoin) 2nd line
severe: systemic retinoids (PO isotrentinoin/accutane)
hormonal: OCP or spironolactone
2
Q
Isotrentinoin monitor
A
need pregnancy test done
3
Q
acne rosacea tx
A
topical metronidazole
brimonidine: for itchy dry eyes
resistant/ocular: PO tetracycline, retinoids
4
Q
folliculitis MCC
A
S. aureus
5
Q
Folliculitis from hot tub MCC
A
pseudomonas
6
Q
tx folliculitis
A
topical mupirocin 1st line
benzoyl peroxide
2nd line: PO clindamycin, bactrim, keflex
7
Q
erythema multiforme hypersensitivity reaction
A
type IV
8
Q
erythema multiforme MCC
A
herpes simplex virus (HSV1)
9
Q
erythema multiforme rx causes
A
beta lactams, sulfonamides, phenytoin, phenobarbital
10
Q
erythema multiforme tx
A
minor: supportive
PO acyclovir for HSV
major: PO prednisone, mucous membranes involved
11
Q
SJS/TEN med causes
A
allopurinol
abx (sulfa, bactrim), tetracyclines, penicillin
anticonvulsants (carbamazepine, lamotrigine, phenytoin)
NSAIDS
sulfasalazine
12
Q
SJS vs TEN
A
SJS <10%
SJS/TEN: 10-30%
TEN: >30%
13
Q
SJS/TEN tx
A
dermatologic emergency
initial: D/C Rx. admit to ICU/burn unit
supportive care
14
Q
alopecia sx
A
localized, round, no inflammation or scarring
exclamation mark hairs
15
Q
alopecia tx
A
resolves in 6mo
refer to derm if large area
potent topical CS
16
Q
androgenic alopecia tx
A
minoxidil (smaller area and recent onset)
oral finasteride
17
Q
finasteride AE
A
decreased libido
sexual or ejaculatory dysfunction
18
Q
onychomycosis MC type
A
distal sublingual (DSO) due to T. rubrum
19
Q
onychomycosis tx
A
terbinafine
2nd line: itraconazole
20
Q
terbinafine AE
A
hepatotoxic, monitor LFT
21
Q
itraconazole monitor
A
check LFT
22
Q
paronychia tx
A
w/ abscess: culture and I&D, PO bactrim or clindamycin
w/o abscess: topical abx
severe: empiric PO abs
nail biter: augmentin, tx for eikenella
23
Q
brown recluse bite sx
A
red, white, and blue sign
24
Q
brown recluse bite tx
A
rest, ice, elevation
tetanus
supportive
25
black widow bite sx
local papule w/ halo
| neuro/msk sx (diaphoresis, abd pain, muscle fasciculations)
26
black widow bite tx
initial: wound care, tetanus
opioids and benzos
antivenin in severe cases
27
scorpion sting can cause
pancreatitis
28
scorpion sting sx
increased oral secretions
blurred vision, tongue fasciculations
nystagmus, chorea, hyperthermia
29
scorpion sting tx
antivenom needed
analgesics, IV benzos, tetanus
intubate if respiratory compromise
30
snake bite sx
bleeding (coagulopathy)
local edema, neuromuscular blockage
cardiac failure due to hypotension and acidosis
31
rattlesnake identification
triangular head with elliptical pupils and nostril pits
32
coral stake identification
ren on yellow stripes w/ black in between
33
rattlesnake bite sx
local pain, swelling, paresthesia
| oozing blood, coagulopathy
34
coral snake bite sx
muscle paralysis
35
rattlesnake bite tx
antivenom
observe for 8hrs
dopamine for shock
36
coral snake bite tx
antivenin needed
observe 8h
dopamine for shock
37
erythema infectiosum etiology
5th disease
| Parvovirus B19
38
erythema infectiosum sx
children 4-10yo
low fever, coryza
slapped cheek
lace like reticular eruption on trunk and extremities
39
erythema infectiosum test
clinical
| specific IgM ab to confirm
40
erythema infectiosum tx
supportive
| resolves 5-10d
41
erythema infectiosum complications
aplastic crisis (sickle cell)
42
hand foot and mouth dz etiology
coxsackie virus type A
43
hand foot and mouth dz sx
children
mild F, sore throat, joint pain
painful oral lesions, palms and soles, grey yellow vesicles palms and soles
vesicular lesions w/ erythematous halos
44
herpangina sx
sudden fever
| stomatitisL small vesicles on soft palate, uvula, and tonsils
45
hand foot and mouth tx
supportive
| resolves in 10d
46
hand foot and mouth complications
myocarditis
| CNS dz
47
rubeola sx
measles, unvaccinated children
F, conjunctivitis, cough, coryza
begin on face, spread down
koplik spots (grains of salt on wet background)
48
rubeola test
clinical, confirm w/ serology and report to local/state departments
anti measles IgM and IgG
49
rubeola tx
self limited
supportive
vitamin A
50
necrotizing fasciitis etiology
GABHS
51
fournier's gangrene
necrotizing fasciitis of the penis/scrotum
| pts w/ DM, impaired immunity, or trauma
52
fournier's gangrene sx
pain out of proportion, erythema
| blue, hemorrhagic bullae --> gangrene --> septic shock
53
fournier's gangrene tx
surgical debridement
| broad spectrum abx (zosyn, imipenim)
54
cellulitis etiology
GABHS (s. pyogenes)
55
cellulitis tx
```
non purulent outpt: PO cephalexin
MRSA (IVDU): PO clindamycin
purulent/systemic infx: IV clindamycin, culture
fluctuant: I&D, tx both MRSA and GAS
Bites: augmentin
```
56
erysipelas etiology
GAS (S. pyogenes)
57
erysipelas vs cellulitis
Cellulitis: not sharply demarcated
erysipelas: well defined margins
58
erysipelas tx
limb elevation
mild: PCN/amoxicillin or cephalosporin
IV: cefazolin or ceftriaxone
59
erysipeloid
puncture wound from raw fish, shellfish, raw meat, poultry
edema, purplish erythema w/ sharp irregular margins extending peripherally but clearing centrally
tx w/ pen G or V, cephalosporin, or clindamycin
60
impetigo etiology
S. aureus or GAS
61
impetigo tx
topical mupirocin
| PO cephalexin/dicloxacillin
62
another name for staphylococcal scalded syndrome
Ritter disease
63
staphlococcal scalded skin syndrome
```
S. aureus
neonate/children
flaccid blisters in areas of mechanical stress
MSSA: IV nafcillin
MRSA: IV vanco
```
64
candida intertrigo sx
candida diaper dermatitis in children
beefy red plaques
peripheral scaling
satellite lesions
65
candida intertrigo test
clinical
KOH prep initial
fungal culture definitive
66
candidal intertrigo tx
nystatin, clotrimazole, or ketoconazole 1st line
severe: PO fluconazole, itraconazole
diaper dermatitis: zinc oxide, nystatin cream
67
tinea capitis sx
school kids, pruritic scalp w/ patchy hair loss
| kerion: inflammatory plaque w/ drainage and crusting. raised boggy lesion w/ purulent nodules
68
tinea capitis test
clinical
KOH/ woods lamp
culture definitive
69
tinia capitis tx
conservative, ketoconazole or selenium sulfide shampoo
| PO antifungals 1st line= griseofulvin PO (child), terbinafine
70
tinea corporis MCC
trichophyton rubrum
71
tinea corporis sx
scaly patch in oval/annual shape w/ central clearing
72
tinea corporis test
KOH
| microscopy and culture definitive
73
tinea corporis tx
topical antifungals 1st line: clotrimazole or miconazole
allylamines 2nd line: terbinafine
failure of topicals: PO itraconazole or PO terbinafine
74
tinea pedis tx
topical clotrimazole and miconazole 1st line
topical terbinafine if <12yo
PO terbinafine or itraconazole 2nd line
75
tinea versiolor association
seborrheic dermatitis
76
tinia versicolor etiology
malassezia
77
tinta versicolor sx
hypo/hyperpigmented macules/patches of trunk, neck, and face
| lesions w/ fine scaling
78
tinea versicolor test
KOH: spaghetti and meatballs
| woods lamp: yellow/green scales
79
tinea versicolor tx
1st line: shampoo (selenium sulfide, ketoconazole)
| 2nd line: PO antifungals (fluconazole, itraconazole)
80
amphotericin B AE
```
nephrotoxic
cardiotoxic (QT prolongation, arrhythmia, electrolyte imbalance)
```
81
ketoconazole AE
avoid in pregnancy and breastfeeding
CI in arrhythmias
D/C PPI (for absorption)
82
ciclopirox AE
facial edema
V tach in shampoo form
skin irritation/pruritus
83
terbinafine AE
hepatotoxic
CI in SLE, children <4yo, and breastfeeding
check and monitor LFT
84
griseofulvin AE
hepatotoxic
CI in pregnancy and breastfeeding
SJS
85
lice caused by
pediculosis capitis
86
lice tx
was everything in hot water
topical pediculicide: permethrin cream
PO ivermectin if topical fails
87
scabies cause
sarcoptes sabiei (mite)
88
scabies sx
burrows, linear markings on wrist, elbow, and webs of fingers
89
scabies tx
topical permethrin
| ivermectin if immunocomp
90
lindane AE
neurotoxic
seizures
teratogenic
91
condyloma acuminatum caused by
HPV 6 and 11
92
condyloma acuminatum transmission
sexual contact (adults)
if in children, investigate abuse
immunocomp
93
condyloma acuminatum tx
1st: TCA, todophyllin, imiquimod
| operative
94
HSV sx
vesicles on erythematous base
| bright red rim
95
HSV test
tzank smear
| confirm w/ PCR
96
HSV tx
acyclovir
| 1st time/conservative: cool compress, lubricants, topical/PO analgesics
97
herpes zoster tx
famciclovir
| postherpetic neuralgia: gabapentin
98
shingle vaccine
one time dose >50yo regardless of chickenpox hx
99
molluscum contagiosa etiology
poxvirus
100
molluscum contagiosa sx
flesh colored pearly white dome shaped papules w/ central umbilication
BOTE: tenderness, crusting, erythema, inflammatory halo
101
molluscum contagiosum tx
self limited, resolve in 6-9mo
102
chickenpox caused by
HHV3
103
chickenpox sx
teardrop vesicles
104
chickenpox tx
supportive
| immunocomp: acyclovir
105
chickenpox complications
secondary infx
reyes syndrome (ASA=CI)
encephalitis
106
verrucae etiology
HPV 1, 3, 10
107
verrucae tx
salicylic acid or cryotherapy 1st line
108
actinic keratosis has potential of turning into
SCC
109
actinic keratosis sx
sun exposure
rough gritty scale
sandpaper
easier to feel than see
110
actinic keratosis tests
clinical
| skin bx: doesn't bleed w/ excoriation
111
actinic keratosis tx
annual f/u w/ derm
liquid nitrogen/cryo if single lesion
topical 5FU, imiquimod if multiple
112
seborrheic keratosis sx
wart like, velvet or verrucous
waxy greasy
stuck on appearance
113
seborrheic keratosis tx
N/A
| curettage or cryotherapy for cosmetic
114
BCC of skin sx
translucent pearly white or shiny pink papule/nodule
telangiectasia
raised/rolled boarder
115
BCC of skin dx
dermoscopy initial
| definitive: skin bx
116
BCC skin tx
nonfacial, small, superficial: electrodesiccation and curettage
danger sites: mohs
nonsurgical: imiquimod, 5FU cream
f/u Q 6-12mo for 2yrs
117
kaposki sarcoma etiology
HHV8
HIV/AIDS
CD4 <100
118
kaposki sarcoma sx
red/purple painless lesion
oral lesions start on feet, leg, hands
slowly spread centripetally
119
kaposki sarcoma tx
antiviral
| HAART therapy
120
melanoma criteria
```
Asymmetric
Border irregularity
Color change
Diameter >6mm
Evolution over time
```
121
most important prognosis factor for mets of melanoma
thickness
122
SCC skin sx
sun exposed, HPV, actinic keratosis hx
| friable, raised elevated thickened nodule
123
SCC skin tests
1st line and definitive: skin bx
124
SCC skin tx
surgical excision TOC
| mohs
125
perioral dermatitis tx
topical metronidazole or erythromycin
oral tetracyclines
avoid topical CS
126
contact dermatitis tx
topical steroids
127
poison ivy tx
PO prednisone
128
drug eruption causes
bactrim, tetracyclines, PCN, NSAIDS, allopurinol
129
drug eruption tx
D/c med
diphenhydramine
topical steroids
reassurance
130
DRESS (drug reaction w/ eosinophilia and systemic systems) causes
anticonvulsants: phenytoin, carbamazepine
allopurinol
sulfonamides (sulfasalazine)
abx: minocycline, vancomycin
131
DRESS sx
systemic sx and internal organ involvement w/ drug eruption
2-8wks after drug exposure
morbilliform rash, F, LAD, eosinophilia >700
liver, kidney, lung
132
atopic triad
eczema
allergic rhinitis
asthma
133
nummular eczema sx
coin shaped
| dorsum of hands, feet, and extensor surfaces
134
lichen Planus sx
6Ps: papule, purple, polygonal, planar, pruritic, plateau
| whickham striae
135
lichen Planus tx
first line: high dose topical steroids w/ occlusion (betamethasone)
2nd line: PO prednisone, phototherapy, PO retinoids
136
lichen simplex chronicus
neurodermatitis
| skin thickening in patients w/ eczema secondary to scratching
137
pityriasis rosea etiology
HHV7
138
pityriasis rosea sx
stage 1: URI sx
stage 2: herald patch, salmon colored
eruption: Christmas tree distribution, longer lines
stage 3: resolution 4-12w w/o scarring
139
pityriasis rosea test
clinical
| skin bx w/ KOH -
140
pityriasis rosea tx
self limited
mild: topical emollients and PO antihistamines
severe: topical steroid creams, UVB phototherapy
141
koebners sign
lesions appear at site of mechanical or thermal trauma
142
auspitz sign
small pinpoint bleeding when scraped off
| psoriasis
143
psoriasis tx
moisturizers + topical steroids, first line (triamcinolone or clabetasol)
moderate: topical RX and systemic (MTX)
severe: topical + systemic TX, phototherapy, biologics
144
seborrheic dermatitis tx
initial: emollients/shampoos/topical steroids
anti dandruff shampoo: topical keoconazole, selenium sulfide
flares: topical CS (desonide)
severe: PO ketoconazole or steroids
145
melasma tx
daily sunscreen
triple topical therapy: hydroquinone, trentinoin, CS
laser, chemical peels
146
vitiligo associated w/
vitamin D deficiency
thyroid
alopecia
147
vitiligo tx
potent topical CS
| topical tacrolimus/pimecrolimus ointment
148
cyanide poisoning tx
amyl nitrate
| IV sodium nitrate or thiosulfate
149
MC complication pressure ulcers
osteomyelitis
150
stasis dermatitis sx
itchy pruritic red scaly plaques, yellow brown pigmentation
venous ulcers (medial malleolus)
inverted champagne bottle legs
151
stasis dermatitis test
doppler US
152
stasis dermatitis tx
elevation, compression stockings
high potency topical CS
avoid topical Abx
153
bullous pemphigoid tx
prednisone
| mild/stable/local: topical CS or tacrolimus
154
pemphigus vulgaris tx
PO steroids 1st line
155
pemphigus vulgaris associated with
Rx: PCN, captopril, cephalosporin
thymoma
myasthenia gravis
lupus
156
acanthosis nigricans malignancy
MC gastric CA
| lung/GU/lymphoma
157
acanthosis nigricans malignant sx
palms, oral mucosa, periocular, vermillion border
mamillary
stripe hands
158
hidradenitis suppurativa tx
mild: topical abs (clindamycin) + intralesional tramcinolone
mod/maintenance: PO abx (minocycline, doxy, augmentin, clindamycin)
severe: immunosuppressants (adalimumab, cyclosporine)
surgery
159
photosensitivity reaction caused by
abx: tetracyclines (doxy), sulfonamides, FQ
antipsychotics: chlorpromazine
diuretics: furosemide, HCTZ
amiodarone, promethazine
160
pyogenic granuloma
aka lobular capillary hemangioma
children/young adult after trauma
solitary glistening friable red (raspberry like) nodule or papule
excision, topical imiquimod, injectable sclerosis agents
161
pyoderma gangrenosum
associated w/ IBD
ulcerative skin lesion 2ndry to immune dysregulation
painful necrosis ulcer w/ irregular purple undermined borders and purulent base
tx w/ topical CS high potency or tacrolimus
162
miliaria
blocked eccrine sweat glands
163
milia tx
N/A
| resolves 1st month of life
164
child with >6 cafe au lait macules
possible neurofibromatosis type I
165
port wine stains
pink red sharply demarcated macules or papules
darken to purple and may develop thickened surface
pulse dye laser treatment
166
surge weber syndrome
triad: facial port wine stain, leptomeningeal angiomatosis, ocular involvement (glaucoma)
can develop hemiparesis contralateral to facial lesion
seizures
intracranial calcification and learning disabilities
167
Mongolian spots
blue or slate gray pigmented macular lesions
common in presacral/sacral-gluteal area, indefinite borders
usually fade over first few years (before 10yo)
168
nevus simplex
stork bite
surface capillary dilation on nape of neck , eyelid, forehead
observation: resolve by 2yo and dont darken over time
laser therapy to reduce appearance
