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Flashcards in Derm Deck (127):
1

Dx any dermal malignancy

Bx
Never shave

2

Dx any dermal malignancy

Bx
Never shave

3

Who gets skin CA

More sun
Pale skin

4

Features of melanoma

Assymetry
Borders irregular
Colours not uniform
Diameter >6mm
Evolving

5

Worst prognostic sign of melanoma

Growing

6

Dx melanoma

Full thickness Bx

7

Rx melanoma

Surgical removal including a significant amount of normal skin
IFN injection for widespread

8

Where does melanoma metastasize to

Brain

9

Who gets squamous cell skin CA

Sun
Organ transplant
- Long term immunosuppresive meds

10

What does SCC look like

Ulcer that doesn't heal and continues to grow

11

Management of SCC

Bx and remove

12

MCC skin CA

Basal cell carcinoma

13

What does BCC look like

Waxy lesion that is shiny like a pearl

14

Dx BCC

Shave and bx

15

Rx BCC

Mohs micrographic surgery

16

What is Mohs micrographic surgery

Removal of skin CA under dissecting microscope with immediate frozen section
Lose very small amount of NL tissue

17

What is Mohs micrographic surgery best for

Delicate areas like eyelid or ear

18

Who gets Kaposi (HHV8)

AIDS (via sexual contact, NOT IVDU)

19

Where does Kaposi manifest

Skin
GI
Lung

20

What doesn Kaposi look like

Reddish/Purple lesions
More vascular
Cuboidal epithelium

21

CD4 in Kaposi

22

Rx Kaposi

Rx AIDS w/ antiretrovirals (goes away when CD4 ↑)
Vincristine or IFN intralesional injection
Chemo w/ liposomal doxorubicin if all else fails

23

What is actinic keratosis

Premalignant
High intensity sun exposure

24

What can actinic keratosis convert to

SCC

25

What is Imiquimod used for

Actinic keratosis
Molluscum contagiosum
Condyloma acuminatum

26

What is Imiquimod used for

Actinic keratosis
Molluscum contagiosum
Condyloma acuminatum

27

Who gets skin CA

More sun
Pale skin

28

Features of melanoma

Assymetry
Borders irregular
Colours not uniform
Diameter >6mm
Evolving

29

Worst prognostic sign of melanoma

Growing

30

Dx melanoma

Full thickness Bx

31

Rx melanoma

Surgical removal including a significant amount of normal skin
IFN injection for widespread

32

Where does melanoma metastasize to

Brain

33

Who gets squamous cell skin CA

Sun
Organ transplant
- Long term immunosuppresive meds

34

What does SCC look like

Ulcer that doesn't heal and continues to grow

35

Management of SCC

Bx and remove

36

MCC skin CA

Basal cell carcinoma

37

Rare AE of Tacrolimus and pimecrolimus

Develop lymphoma

38

Dx BCC

Shave and bx

39

Rx BCC

Mohs micrographic surgery

40

What is Mohs micrographic surgery

Removal of skin CA under dissecting microscope with immediate frozen section
Lose very small amount of NL tissue

41

What is Mohs micrographic surgery best for

Delicate areas like eyelid or ear

42

Who gets Kaposi (HHV8)

AIDS (via sexual contact, NOT IVDU)

43

Where does Kaposi manifest

Skin
GI
Lung

44

What doesn Kaposi look like

Reddish/Purple lesions
More vascular
Cuboidal epithelium

45

CD4 in Kaposi

46

Rx Kaposi

Rx AIDS w/ antiretrovirals (goes away when CD4 ↑)
Vincristine or IFN intralesional injection
Chemo w/ liposomal doxorubicin if all else fails

47

What is actinic keratosis

Premalignant
High intensity sun exposure

48

What can actinic keratosis convert to

SCC

49

How to remove actinic keratosis

Curettage
Cryotherapy
Laser
Topical 5-fluorouracil
Imiquimod

50

What is Imiquimod used for

Actinic keratosis
Molluscum contagiosum
Condyloma acuminatum

51

What is seborrheic keratoses

Liver spots on elderly, benign
"stuck on" appearance
Removed w/ cryotherapy, surgery, laser for cosmetic reasons

52

What is atopic dermatitis (Eczema) associated with

Overactivity of mast cells and immune system

53

What is in the Hx of a pt w/ eczema

Asthma
Allergic rhinitis
FHx of atopic disorders
Onset

54

MC presentation of eczema

Pruritis and scratching
Often on face

55

Pathogenesis of eczema

Pruritis and scratching
Scaly, rough areas of thickened skin
Superficial staph infections

56

Where does eczema usually manifest

Face, neck, behind knee

57

Skin care in eczema

Moisturize
Avoid bathing, soap, washcloths
Cotton instead of wool

58

What is elevated in atopic dermatitis

IgE

59

Medical therapy of eczema

Topical steroids
Tacrolimus and pimecrolimus (less AE than steroids)
Antihistamines
ABX when impetigo occurs
UV light (severe recalcitrant disease)

60

Antihistamines for mild eczema

Cetirizine
Fexofenadine
Loratidine

61

Antihistamines for severe eczema

Doxepine
Hydroxyzine
Diphenhydramine

62

Rare AE of Tacrolimus and pimecrolimus

Develop lymphoma

63

What causes psoriasis

Abs attacking epidermis

64

Presentation of psoriasis

Silver scaly plaques
NOT itchy
Extensor surfaces
Extensive disease associated with depression

65

Rx local psoriasis

Topical high potency steroids
Vitamin A and D ointment
- Calcipotriene
Coal tar
Pimecrolimus and tacrolimus on delicate areas

66

Steroids used in local psoriasis

Fluocinonide
Triamcinolone
Betamethasone
Clobetasol

67

Rx extensive psoriasis

UV light
Anti-TNF
MTX

68

Pityriasis rosea features

Idiopathic transient dermatitis
Herald patch that disseminates
Spares palms and soles

69

Rx symptomatic Pityriasis rosea

Steroids or UV

70

Differentiate Pityriasis rosea from secondary syphilis

Syphilis is VDRL or RPR positive in all cases

71

MCC contact dermatitis

Poison ivy
Rx w/ steroids

72

Features of seborrheic dermatitis

Hypersensitivity to dermal infection w/ noninvasive dermatophytes
Increased in AIDS and parkinson

73

Rx seborrheic dermatitis

Topical steroids AND antifungals

74

What drugs are pemphigus vilgaris associated with

ACEIs
Penicillamine
Phenobarbitol
PCN

75

Most accurate test for cellulitis

Inject sterile sale and aspirate for Cx
Staph > strep

76

Most accurate test for pemphigus vulgaris

Bx w/ auto-Abs

77

Rx pemphigus vulgaris

Systemic steroids
Azathioprine or mycophenolate
Rituximab or IVIG if refractory

78

Why is bullous pemphigoid less severe than pemphigus vulgaris

Bullae stay intact (less loss of fluid and infection)
Mouth not involved

79

Most accurate test for bullous pemphigoid

Bx w/ immunofluorescent stain

80

Best initial therapy for bullous pemphigoid

Prednisone
Wean off w/ azathioprine, cyclophosphamide, mycophenolate

81

Mild bullous pemphigoid responds to

Erythromycin
Dapsone
Nicotinamide

82

What does PCT usually affect

Backs of hands and face

83

What is in the Hx of a pt w/ PCT

Chronic liver disease (hep C, alcoholism)
Estrogen use
Fe overload (hemochromatosis)

84

Most accurate test for PCT

Increased uroporphyrins in 24hr urine collection

85

What is the defect in PCT

Deficiency of uroporphyrin decarboxylase

86

Rx PCT

Rx underlying cause (stop estrogen, stop alcohol)
Remove Fe w/ phlebotomy

87

Features of impetigo

"Honey coloured"
Weeping, crusting, oozing, draining skin

88

Causes of impetigo

Staph
Strep (group A beta hemolytic)

89

Erysipelas and impetigo can cause

Glomerulonephritis but not rheumatic fever

90

Rx mild impetigo

Topical
- Mupirocin
- Retapamulin
- Bacitracin

91

Rx severe impetigo

Oral
- Dicloxacillin
- Cephalexin

92

Rx impetigo due to community acquired MRSA

Doxy
Clinda
TMP/SMX

93

Why is erysipelas more severe than impetigo

Deeper in the skin

94

What causes erysipelas

Strep > staph

95

Presentation of erysipelas

Bright red hot swollen lesion on face
Leukocytosis

96

Treatment rule for erysipelas

Treat for staph and strep unless there is a definitive diagnosis

97

Rx mild erysipelas (same as for cellulitis, folliculitis, furuncles, carbuncles)

Diclox, cephalexin, cefadroxyl
PCN allergic: erythro, clarithro, clinda
MRSA: Doxy, clinda, TMP/SMX

98

Rx severe erysipelas (same as for cellulitis, folliculitis, furuncles, carbuncles)

Ox, clox, cefazolin
PCN allergic: Clinda, vanco
MRSA: vanco, linezolid, dapto, tige, ceftaroline

99

What does cellulitis look like

Warm, red, swollen, tender
Legs > arms

100

Most accurate test for cellulitis

Inject sterile sale and aspirate for Cx
Staph > strep

101

Features of folliculitis, furuncles, carbuncles

Folliculitis is small and mild hair follicle infection
Furuncle is small abscess
Carbuncle is collection of furuncles

102

Get around PCN rash in skin infections

Use cephalosporins

103

Get around PCN anaphylaxis in mild skin infections

Macrolides, clinda, doxy, TMP/SMX

104

Get around PCN anaphylaxis in severe skin infections

Vanco, linezolid, dapto, tige, ceftaroline

105

What is a severe skin infection

Fever
Chills
Bacteremia

106

Best initial test for fungal infection

KOH prep

107

Most accurate test for fungal infection

Fungal Cx

108

Best initial therapy for fungal infection (no hair or nail)

Topical antifungal agent

109

Best initial therapy for fungal infection with hair or nail involvement

Terbinafine
Itraconazole

110

What are topical antifungal agents

Clotirimazole
Ketoconazole
Miconazole
Nystatin (candida only)
Ciclopirox

111

AE ketoconazole

Antiandrogenic
Oral can cause gynecomastia

112

Best initial test/most accurate test for vaginal fungal disease

Same as oral
If presentation is clear then next best step is topical antifungal

113

Drug hypersensitivity presentation

Morbilliform rash
Erythema multiforme
SJS
TEN

114

Drugs that can cause any HS presentation

PCNs
Sulfas
Allopurinol
Phenytoin
Lamotrigine
NSAIDs
Rifampin
Quinidine

115

Drugs that cause skin HS can also cause

Hemolysis
Interstitial nephritis
Drug induced thrombocytopenia

116

Causes of chronic urticaria

Pressure, cold, vibration

117

Rx urticaria

Antihistamines (non-sedating)
Sedating antihistamines are for anaphylaxis

118

Appearance of erythema multiforme

5cm is lyme

119

Appearance of SJS

Mucous membrane involvement
May lead to resp failure
Rx w/ IVIG

120

Appearance of TEN

Rash, mucous membrane involvement
Positive nikolsky sign
Rx w/ IVIG

121

What is "fixed" reaction

Drug HS only happens on one part of body

122

Aside from drugs, what is erythema multiforme associated with

Mycoplasma
HSV

123

What is staph scalded skin syndrome and toxic shock syndrome

Different severeties of a reaction to a staph surface toxin

124

Features of SSSS and TSS

Hypotension
Renal dysfunction
Liver dysfunction
CNS involvement

125

Rx SSSS and TSS

Supportive care
Antistaph ABX (Ox, Naf, cefazolin)
ABX do not reverse disease

126

Progression of acne rx

Benzoyl peroxide (topical ABX if ineffective)
ADD topical vit A
Oral ABX if fail
ADD oral vit A to oral ABX

127

Important to consider when administering vit A derivative in acne

Teratogenic so do a pregnancy test