Derm 2 Flashcards Preview

Old DOOS > Derm 2 > Flashcards

Flashcards in Derm 2 Deck (121):
1

Greasy, “stuck-on” appearance
Average diameter is 1 cm
Flesh-colored, tan, brown, or black
Appear on the face, neck, scalp, back, upper chest and less frequently on the arms, legs and lower trunk

Seborrheic Keratosis (SK)

2

tx for seborrheic keratosis

Scissor biopsy, electrosurgery, liquid nitrogen, surgical excision
Often reoccur

3

Typically multiple pre-malignant lesions on sun-exposed areas.
Itching, burning or dry skin
looks rough and feels rough

actinic keratosis

4

first line tx for actinic keratosis

surgical- liquid nitrogen

5

other topical tx for actinic keratosis

fluorouracil (FU)
imiquimod
diclofenac

6

how do you dx actinic keartosis

touch it- will feel rough

7

does actinic keratosis occur on non-sun exposed skin?

No

8

how long can lice be asymptomatic for?

30 day (inducbation)

9

Tx for lice

Permethrin, malathion, lindane, benzyl alcohol
wash all bedding and clothing in hot water
remove nit s

10

should close contacts with lice be treated

Yes

11

inflammatory, erythematous pruritc papules. Most common in finger webs, flexor surfaces of wrists, elbows, axillae, buttocks. Burrows, worse at night.

Scabies

12

tx for scabies

Permethrin is most effective topical treatment
Treat all close contacts

13

if someone comes in with a "spider bite" but didn't witness the bit bite what should you consider?

MRSA

14

Local- : pain that is sharp or burning, onset within minutes of the bite, typically resolving within minutes to hours. onset within 20 – 30 minutes, painful cramps or spasms, arm bite may lead to chest tightness or dyspnea. : tetanic contractions of the limbs, spasms, rigidity

Black widow spider bite

15

tx for black widow spider bite

Pre-hospital – immobilize the wound site
Supportive care, tetanus immunization prn
Venom extracting apparatus – must be used within 10 minutes of the bite

16

Local: often asymptomatic, pain that is stinging or burning, onset 1 – 24 hours after the bite
Systemic: fever, chills, malaise, nausea, vomiting

brown recluse spider

17

tx for brown recluse spider

Pre-hospital – immobilize the wound site, cool compresses
Supportive care, tetanus immunization prn
Venom extracting apparatus – must be used within 10 minutes of the bite

18

tests for brown recluse

venom can be detected in wound (not widely used)
UA for systemic hemolysis

19

what can happen with a brown recluse spider

tissue necrosis around bite

20

Pink papule/plaque, crusting, Rolled periphery, telangectasias, head/face/neck, atrophic center

basal cell carcinoma

21

tests for BCC

shave bx or punch bx to assess depth

22

most common skin cancer

BCC

23

tx for BCC

topical- 5-flurouracil, imiquimod
radiation, phototherapy
surgical excision is preferred

24

what is a melanoma that occurs on a nail?

ACRAL

25

does melanoma have to do with sun exposure?

No, there is some genetic predisposition

26

Tx for melanoma

surgical management

27

margins you need to get if melanoma is >1 mm thick

1 cm

28

margins needed if lesion is 1-2 mm thick

1-2 cm

29

Sun-exposed sites of elderly, fair-skinned individuals.
Majority of lesions arise from actinic keratoses but some arise de novo, also from old burn scar or from sites previously exposed to ionizing radiation, or preexisting human papilloma virus infection

Squamous cell carcinoma

30

where does SCC commonly metastasize to?

Lung

31

when is a SCC most apt to metastasize

when on the lip

32

tx for SCC

Total excision, electrocautery, or Mohs

33

loss of hair on the entire scalp

alopecia totalis

34

hair loss of all body hair

alopecia universalis

35

tests for alopecia

TSH
CBC (anemia)
CMp (electrolytes)
testosterone
iron
ferritin
zinc
RPR (syphillis)
prolactin (pituitary)
ANA (autoimmune disorders)
KOH (tinea vs. alopecia)

36

test where you pull on the hair and depending on the number of hair that pall out can determine alopecia vs. androgen problem

light hair pull test

37

tx for alopecia areata

intralesional steroids (painful)
oral corticosteroids

38

Patchy, non-scarring hair loss

Alopecia Areata

39

Hair loss along with miniaturization of hair follicles
Men: frontal recession, then vertex affected; over time, only has lateral and occipital hair
Women: Thinning across the crown with frontal hair initially in place but later may be lost

Androgenetic alopecia

40

tx for androgenetic alopecia

Topical minoxidil or finasteride

41

Chronic fungal infection of the finger- or toenails. Subungual hyperkeratosis, subungual paronychia, onycholysis, nail dystrophy, discoloration (yellow-brown)

Onycomycosis

42

test for onycomycosis

KOH prep or culture

43

tx for Onycomycosis

Oral antifungals are first line, but some severe systemic side effects and drug reactions
Cicloporox 8% nail lacquer
Nail debridement

44

Swelling and erythema of the nail bed or surrounding tissues. Acute or chronic infection or eczematous inflammation of the skin folds surrounding the finger- or toenails

Paronychia

45

if there is a Green changes in nail it is typically what?

Pseudomonas

46

tx for paronychia

tetanus is indicated
abx, antifungals
I and D

47

Soft, skin-colored, fleshy warts that are caused by human papillomavirus (HPV)
Warts appear singly or in groups, on the vagina, cervix, around the external genitalia and rectum, and in the urethra and anus

Condyloma acuminatum

48

tests where Subclinical lesions can be visualized by wrapping the penis with gauze soaked with 5% acetic acid for 5 minutes. Using a 10× hand lens or colposcope, warts appear as tiny white papules.

acetowhitening test

49

tx for condyloma acuminatum

cryosurgery
imiquimod, podophyllin TCA acid

50

usually painful vesicles that often occur in clusters on skin, cornea, or mucous membranes
May occur as encephalitis, pneumonia, or disseminated infection, and/or skin lesions including but not limited to oral and genital sites

herpes simplex

51

tests for herpes simplex

STI screening
Tzanck smear
HSV culture

52

tx for herpes simplex

antiviral (acyclovir)

53

Dome-shaped papules with central umbilication
Common, benign, viral skin infection
Highly contagious with autoinoculation, skin-to-skin contact, sexual contact, shared clothing, towels, bathing water

Molluscum contagiosum

54

Tx for molluscum contagiosum

Topical (harsh meds like cantharidin), podophyllin, cryosurgery

55

how long can it take for molluscum contagiosum to go away

3 months

56

who have hve molluscum contagiosum occur all over their body w/ hundres of lesions

those with HIV/ AIDS

57

Raised, flesh-colored lesions, no central umbilication

verrucae

58

what are common warts

verruca vulgaris

59

what are plantar warts

verruca plantaris

60

what are veneral warts

condyloma acuminatum

61

Rough-surfaced, hyperkeratotic, papillomatous, raised, skin-colored to tan papules 5–10 mm in diameter; most frequently seen on hands, knees, and elbows; usually asymptomatic

verrucae

62

tx for verrucae

Most warts regress spontaneously
OTC topicals, Rx topicals, cryotherapy

63

what should you do before freezing warts off

take off the top layers of the wart off first

64

Generally a unilateral, painful, vesicular eruption within a dermatome

varicella zoster

65

tx for varicella zoster

Oral antivirals within 72 hours of onset of symptoms
Analgesics (NSAIDs, acetaminophen, opioids)
Gabapentin is commonly prescribed for pain (adverse reactions)

66

pain associated along same area are varicella zoster

poster herpatic neurlagia

67

Diffuse non-purulent infection of the skin and sub-Q tissues
Initially epidermis and dermis, but can spread to deeper fascia. Localized pain and tenderness, erythema
Fever, chills, malaise, regional lymphadenopathy
Itching, burning, irritability

cellulitis

68

tests for cellulitis

Culture aspirates from point of maximum inflammation
Blood cultures
Plain radiographs show bubbles in soft tissues

69

tx for cellulitis

Empiric therapy or mild cellulitis: oral dicloxacillin, cephalexin, clindamycin or IV cefazolin, oxacillin, or nafcillin
may want to culture area

70

Presentation results from the destruction of blood vessel walls, with subsequent aneurysm, bleeding, thrombosis, or ischemia in the various vascular beds
Constitutional: malaise, fatigue, anorexia, sweats, and weight loss
Skin: palpable purpura, livedo reticularis, nodules, ulcers, gangrene, nail bed capillary changes

Vasculitis

71

tests for vasculitis

Necessary to rule out multiple etiologies, so lots and lots of tests

72

most common cause of vasculitis

adverse drug rxns

73

tx for vasculitis

glucocorticoids then stronger immunosuppressive meds
remove offending agent if drug related

74

Sharply demarcated, erythema, swelling, shiny

Erysipelas

75

what bacteria causes erysipelas most commonly

S. pyogenes

76

hx associated w/ erysipelas

Prodromal symptoms may occur in the first 48 hours that include chills, malaise, headache, fever, vomiting, and anorexia

77

tx for mild erysipelas

penicillin V

78

tx for moderate to severe erysipelas

cefazolin

79

if MRSA is suspected how do you tx erysipelas

vanco

80

Small, flaccid bullae, honey-colored crusts

impetigo

81

most common cause of impetigo

staph aureus

82

tx for impetigo

topical abx

83

what should you not rx for impetigo due to huge resistance

penicillin and macrolide therapy

84

Painful erythematous papules/nodules (1–5 cm) with central pustulation
Located in hirsute sites of body, especially areas prone to friction or minor trauma (e.g., underneath belt, anterior thighs, back of neck, buttocks)
Tender red perifollicular swelling, terminating in discharge of pus and necrotic plug; pus usually drains spontaneously

Furnucle/ carbuncle/ abscess

85

tx for furnucle/ carbuncle/ abscess

drain
oral abx
use swab to get out inoculations
used those aimed at MRSA if suspected

86

Dark, thick, velvety skin in body folds and creases
often hx of Obesity, endocrine disorders, namely diabetes

Acanthosis Nigricans

87

Burn- Erythema of involved tissue, skin blanches with pressure, skin may be tender

first degree burn

88

Burn- Skin is red and blistered, skin is very tender

second degree burn

89

Burned skin is tough and leathery, skin is not tender

3rd degree burn

90

how much is each upper extremity percentage

9% adult and child

91

how much is each lower extremity rule of 9s

adult 18% child 14%

92

anterior trunk percentage

18% adult and child

93

posterior trunk percetnage

18% adult and child

94

head and neck percentage

9% adult 18% child

95

genitals percentage

1%

96

stage of pressure ulcer with Nonblanching erythema, warmth, induration

Stage 1 pressure ulcer

97

stage of pressure ulcer with that may include dermis; appears as abrasion, blister, or superficial ulcer

Stage II pressure ulcer

98

stage of pressure ulcer that Extends through subcutaneous tissues but not fascia; may appear necrotic with changes in pigmentation

stage III pressure ulcer

99

Ulcers extend beyond deep fascia into muscle or bone, decayed area may be larger than visibly apparent wound, osteomyelitis or sepsis may be present, and granulation tissue and epithelialization may be present at wound margins.

stage IV pressure ulcer

100

will pressure ulcers heal without proper nutrition

No, need higher protein diet

101

tx for pressure ulcers

antibiotics for cellulitis or osteomyelitis, silver dressings, triple antibiotic ointment can be tried for 2 weeks to treat bacterial overgrowth
Second Line – zinc and vitamin C if dietary deficiency

102

Cyst-like abscesses in gland-bearing skin, boils. often happens in obese, smoking, females. Tender nodules (dome-shaped) 0.5–3 cm in size are present:
Large lesions often are fluctuant

Hidrandenitis suppurativa

103

is there a staging system with hidradenitis suppurativa?

Yes- used to guide tx

104

first line tx for hidradenitis suppurativa

I & D
oral antibiotics

105

mobile mass
Most common soft tissue tumors
Mostly are subcutaneous and composed of normal adipose tissue
Slow growing, often asymptomatic, and usually diagnosed by palpation

Lipoma

106

tx for lipoma

observatin
sx removal if questionable

107

Common skin condition in which brown patches appear on the skin often affects the face
Typically young women who are pregnant or taking any form of hormone-based birth control

Melasma

108

fast growing lipoma with a large diameter may indicate what?

liposarcoma

109

Raised, red lesions with central clearing and swelling. blanching; associated with itching or burning. often will have generalized edema/ swelling of skin

Urticaria

110

From sunlight exposure, usually UV; onset in minutes; subsides within 2 hours

solar urticaria

111

Linear, itchy, red wheal and flare from scratching or rubbing the skin

Dermatographism

112

hives from : From exposure to cold; usually idiopathic

cold urticaria

113

hives from From strong vibrating mechanical forces, very rare

vibratory urticaria/ angioedema

114

Owing to brief increase of core body temperature; small pin-sized (5- to 10-mm) wheals surrounded by an erythema but also can have larger wheals; from physical exercise, stress, and hot showers

Cholinergic urticaria

115

Caused by stress; extremely rare; has pinpoint-sized red wheals with a white halo

Adrenergic urticaria:

116

Wheals at sites where chemical substances contact the skin

contact urticaria

117

Small wheals after contact with water at any temperature; rare

Aquagenic urticaria

118

A leukocytoclastic vasculitis looking like urticaria and tending to last > 24 h; more painful than pruritic; may be palpable and purpuric; usually caused by a collagen-vascular disease

Urticarial vasculitis

119

Acquired, slowly progressive, depigmenting condition of the skin due to the disappearance of previously active melanocytes

vitiligo

120

what is repigmentation tx for vitiligo

corticosteroids, calcineurin inhibitors, phototherapy (narrow-band ultraviolet B (NB-UVB) or broadband ultraviolet B (BB-UVB), and surgery

121

what is depigmentation tx

For vitiligo affecting more than 50% of the face or body and recalcitrant to therapy. Topical agents include monobenzyl ether of hydroquinone 20% and methoxy-phenol