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Flashcards in DERM Deck (46)
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1
Q

What causes rhinophyma if left untreated?

A

Rosacea

Patho- chronic inflam, acneiform, of pilosebacceosu units. w/ increased reactivity of caps to heat resulting in flushing and telangectasia. Who?- 30-50yr olds, > F, light skin.

CP- Worse w/ alcohol, stress, hot foods Sym-pattern on cheeks, nose, forehead, paulopustules on cheeks, nose, forehead. comps: rhinophyma- large, thicken nose-M untreated

TX- metronidazole topical 0.75% AVOID EtOH, hot bevs

2
Q

What is T-cell activated and has rapid cell turnover of 3-4d?

A

PSORAISIS WHO-2% by 20. M=F, PATH- immune mediated hereditary

CP-graudal mild itch, ‘SALMON PINK” lesions, wax and wan, chronic red scaling papules circular plaques. silvery white Red border thick d/t neutrophils well defined borders sym BiL scalp, pitting nails, Extensor surface of limbs SACRUM-MC oil slicks and pits on nails. Plaque psoriasis MC MC-scalp, elbows, knee, groin, ears Comps- CV, DM, HTN, metabolic, IBD, flu-like sx

TX- Pt education no scrath ITch -topical steroids/antihist Topical corticosteroids- RISK-skin atrophy, abosrbs Saran wrap w/ steroid then emollient Wks-months Sun 15min

3
Q

What has a “christmas tree” pattern that is viral?

A

PITYRIASIS ROSEA

Who? 10-35Y, 2%

PATH? viral w or w/o pruritis.

CP-maculopapular, red scaling eruption TRUNK. HERALD patch=larger first lesion. Lesions w/ fine scaling oval shapes macules and papules on erythematous base. ***Christmas Tree.

TX- viral, so self-limiting. pruritis- doxepin 5% cream, or Calamine lotion. 2 MONTHS

4
Q

If a patient never had chicken pox or vaccinatin, what MAY they get in older age?

A

VARICELLA

WHO- KIDS, vaccin 12-18mo, 4-5

PATH- varicela zoster virus, !!contagious

CP- dew drop on a rose petal crusty

TX- RARE treatment oatmeal baths antihistamine 24 hr after crusty return to school

DANGER Elderly PT NO HX OF VARICELLA/VAC- HIGH RISK >AGE. MUST HAVE 1ST B4 SHINGLES ALL IF VAC- RISK OF SHINGLES

5
Q

What do you scrape off with little bit of bleeding/Pt discomfort then treat with cryotherapy?

A

VERRUCA VULGARIS (warts)

WHO: F. kids, rare > 25 adults have immunity PATH: HPV. Contagious!!!No itchy. No Pain.

CP- raised firm papules/plaques, lesions: 1-10mm, hyperkeratonic, skin colored. **Cauliflower appearance. Reddish brown dots.

TX-topical: 3-6 TX Q3WKS 1. scrape off dead tissue 2. salicylic acid, or liquid nitrogen, 4-duct tape 3. Laser treatment for resistant warts.

6
Q

What grows on bottom of feet?

A

Verruca plantaris

WHO- 5-25, F

PATH-soles of feet ONLY

CP- skin flushed

TX-resolve spontaneously. Shave and salicylic acid. Cryotherapy

7
Q

What is umbilicated not itching firm papules related to poxvirus?

A

MOLLUSCUM CONTAGIOSUM TANA FAV

WHO: M, KIDS /ADULTS-SEX/

PATHO: Poxvirus, sex

CP: discrete FIRM umbilicated(BELLY BUTTON, pit/depression in middle) pearly-white papules. isolated or generalized. Neck, anogenital region, eyelids. TRUNK and extremities NO itching

TX: Self Limiting. AVOID KIDS BC LESS SCAR liquid nitrogen, electrocautery, curettage SCAR lesions last 2-3 mos

8
Q

Pt has very painful finger. What is the sign and TX?

A

HSV 1

WHO young adults

PATH-HSV type 1 or 2 genital. Virus in CV trigenimal nerve ganglia. V1-3Ophthalmic, maxillary, mandibular.

CP: **grouped vesicles on an erythematous base**, malaise, lymphadenopathy, fever.

KIDS: gingivostomatitis MC primary sx.

Lesions do not cross midline.

COMPS: herpetic whitlow: painful infection of finger w/ herpes.

TX- acyclovir topical or oral, supportive treatment. Anelgelsic. Key-treat early before tingling and rash

primary lesions are self-limiting,

9
Q

What is tingling and itching before onset of lesions?

A

PRODROME of HSV

CP-prodrome of tingling, itching or burning

24 hr later vesicles in groups

Maybe umbilicated, papules, bleed and crust.

TX- cold sores are self-limiting.

topical acyclovir

oral outbreaks-suppress oral antivirals.

10
Q

What is difference btwn HSV and HZV?

A

Herpes zoster virus

WHO? >50.

PATH? Immunosuppression, compromise, stress. Contageous!

VZV CP-VERY PAINFUL!!! prodrome 3-5 days, burning, numb, tingling. Pain w/ eruption, wanes over time. malaise, fever, lymphadenopathy acute, bullous eruption dermatome.

Herpeteform lesions- beefy red base, crusts, w w/out pustules and bleeding. 50% on thorax, 10-20% trigenimal (eye)

TX-Narcotics

Oral acyclovir: high dose asap.

antiviral IV. lesions: 2-3 weeks.

COMPS-50% postherpetic neuralgia,

GABA meds

Urgent referral to opth if eye/ tip of nose HUTCHINGSON SIGN

11
Q

What has no distinct margins, mergining to macular erythema. Warm, tender. 2nd to impetigo, follulitis? What is treatment?

A

Cellulitis

PATH-Disruption of cutaneous barrier, venous/lymphatic compromise, h/o, S. aureus/B-hemolytic strep.

Continuum of skin infxns: impetigo, folliculitis, carbuncles, and abscesses.

CP-

  • NO distinct margins.
  • Confluent macular erythema,
  • swelling, warmth, tenderness,
  • LAD, systemically–fever, chills, myalgias (more in sick and elderly)
  • abscess
  • LABS-blood and skin culture Deeper

TX- slow.

  1. Oral: Cephalexin x10-14d.
  2. Alt’s: Clindamycin or levofloxacin.
  3. IV: vanco, OR cefazolin or nafcillin**
12
Q

What is treated with Vanco in the hospital?

A

WHO: sports teams, jails, day cares

PATHO- NOT spider bites, know local resist. Poor hygiene. Recurrent

CP: compromised skin integrity

TX=

  1. Culture a wound DOC=Vacomycin IV, *not oral -c.diff
  2. Bactrim (+rifampin to dec resistanc)
  3. clindamycin (+/- rifampin or linezolid)
  4. tetracyclin (mino, doxy) + rifampin,
  5. Never use rifampin or linezolid alone-d/t inc. resistance
13
Q

What leads to crusty vesiculpapular skin infx of face the crust?

A

WHO: varies PATH: S. aureus, B-hemolytic strep. poststrep glomerulonephritis or rhematic fever

CP-Superficial **vesiculopapular skin infxn on face and extremities–> rupture and “honey crust”.

TX:Topical Mupirocin for small, non-bullous lesions. Oral: Erythro, Dicloxacillin, cephalexin, or clindamycin x 7d

14
Q

Folliculitis

A

PATH:Nasal carriage of S. aureus, exposure to whirlpools, hot tubs, abx use-flora, use of steroids, P. aeruginosa hot tub

CP- multiple, red, pruritic, <5mm, cluster NO systemic. Purulent

TX-WARM COMPRESS topical antibiotics no shaving

15
Q

Furuncles

A

PATH-Inflam nodule of hair follicle. Follows episode of folliculitis. Caused by Staph

TX- w/ warm compresses; surgical I/D;

systemic sx’s req abx’s: dicloxacillin or cephalexin

16
Q

How to prevent Recurrent Furunculosis?

A

Nasal Mupirocin ointment.

Vitamin C.

Low dose clindamycin supressive therapy for patients who really continue to get infections (usually immunocomp pts)

17
Q

Carbuncles

A

PATH-Series of abscesses in the subcutaneous tissue that drain via hair follicles.

CP-Swollen lump under skin: White/yellow center, weep, ooze, or crust. May have systemic sx’s

Tx w/ warm compresses to promote drainage; surgical Incision; Drainage;

systemic sx’s req abx’s: dicloxacillin or cephalexin

18
Q

What is polymicriobial and my have complications?

A

Abscess

WHO: DM or immunosuppressed, VDU, nasal colony of staph,

PATH: Minor local skin trauma (insect bite, abrasion); IDeeper than carbuncles. May be polymicrobial. MC S. aurues. Localized accumulation of PMN leukocytes with tissue necrosis involving the dermis and subcutaneous tissue. NOT associated with hair follicles. Infxn tracks in from skin to deep skin layers. Localized accumulation of PMN leukocytes w/ tissue necrosis

CP

  • Local pain, swelling, erythema, fluctuance, warmth;
  • cellultis around the abscess;
  • regional adenopathy;
  • spont drainage of purulent material;
  • UNUSUAL to have systemic sx’s (fever, chills) indicates necrotizing fasciatis.
    • LABS-Large numbers of microorg’s present. Celluitis surrouding the abcess is normal.

TX:

  1. I/D: fluctuance or “pointed”,
  2. send purulence for C/S testing. I/D at the Point. ID to open even more.
  3. If theres no point, do NOT I/D, tell patient to put warm compress erryday till point forms.
  4. Pack after Oral abx: Dixcloxacillin
  5. -secondary, cephalexin, clindamycin,
  6. NOT AN INGROWN HAIR.
19
Q

Why do we draw a line around cellulitis?

A

Necrotizing Fascitis

CP-Very Painful. Systemic symptoms (fever, chills) Don’t confuse with an Abscess. DRAW outline If growing w/ 1-2h

TX-Surgical emergency. Vanco. Send to ED. All tissue must be removed.

20
Q

WHat are complication of absesses?

A

Fournier’s Gangrene

WHO:Bed ridden patients.

Gonads TX- Surgical emergency. All tissue must be removed. Vanco.

21
Q

What is MC in armpit, or groin, genitofolds, but is inflammed follicule?

A

Hidradenitis Suppurative

WHO- women

PATH- follicular occulsive dz interignous skin, terminal follicular obstruction, rupture of follicle, inflammation

CP - not purulent, not inflammed ishlymph node, small pain. ITchy, erthema, burning. May ruptudre

TX; cant I/D.send to OR. NO cure.

  1. Exp surgeon for cysts
  2. Antiperspiratns not deordorants
  3. no shaving
  4. wt dec, stop smoking
  5. Oral ABX for persistent
22
Q

What is the MC malignancy of Caucasians?

A

BASAL CELL CARCINOMA

PATH:basal layer of epidermis, LOW METASTIC. UV as child

Grow deep and moundlike- 7mm above skin, 7mm bel

CP: surrounding ulceration w/ pearly rolled border. small translucent nodule w/ telangiectatic vessels. Leads to central necrosis

Hyperpigmentation dots w/in

DX- biopsy

TX- electrodesssciation/curettage ED/C. Scars

Monitor Q6m for 1 yr, than annually

23
Q

What is dangerous and metastasis quickly?

A

Squamous Cell Carcinoma

Oral

PATH: Malignant tumor from keratinocytes.

UV, chron inflam changes, chem carcinogens, immunosupp and viral infxn, transplant. Destructive growth and metastasizes via lymph

CP: small, erythematous papules, plaques, nodules, dome shaped, slightly raised, warty, pink dull red. Yellow-white scale. Progress to extensive non healing ulcerative necrosis

TTP

DX- biopsy

TX-Excision MC w/ histology of margins

MOHS tech 98%cure rate

24
Q

What proliferation of atypical epidermal keratinocytes,SCALY, and overtime forms a cutaneous horn?

A

Actinic keratosis

WHO; M, Fair skin, elderly, solid organ transplant Pts.

PATH; proliferation of atypical epidermal keratinocytes.

Sun damaged areas. ***Progress to SCC.

CP-Scaly, hyperkeratotic, sandpaper-like, dry, rough, (seborrheic more greasy looking). Face or scalp

DX- biopsy

TX: Prevention, Cryotherapy. Topical 5-fluorauracil, IMIQUIMOD- FIELD TX

25
Q

Tinea corporis (Ring worm)

A

PATH: Long-term wetness of skin, poor hygiene/ Fungis=ringworm (dermatophyte)

CP: Contagious!!! Itchy, no pain.

  • Itching; small area of red, raised spots/pimples, ring-shaped w/ raised border and a clearer center
  • LAB/DX-KOH test to see if it’s a fungus.
  • TX;
  1. Keep skin dry and clean.
  2. BID x4wksTopical antifungal creams: miconazole, clotrimazole, ketoconazole work but it just takes a while. . Avoid steroids (hydrocortisol)
26
Q

What is itchy, stinging around groin?

A

Tinea cruris (jock itch)

WHO; children, youngs

CP; erythematous border. Peripheral scalling.

Kerion = inflammatory reaction causing induration body papule, with pustules. Most seen in children

TX- orals, topicals don’t work.

TX;ORAL up to 3 months:Chronic resistant infections, nail infections, scalp infections (kerion) require oral meds for . Monitor LFTs

27
Q

What is the athletes’s foot?

A

Tinea pedis

PATH- Hyphae molds (tinea fungus)

Cracked, flaking, peeling skin btwn toes; red, itchy burning

LAB- KOH prep

TX- AVOID steroids- grow cholesterol membrane growth

28
Q

What is significant difference btwn ersipideas and 5th dz?

A

Erythema infectiosum

  • caused by parvovirus B19. A person usually gets sick with fifth disease within four to 14 days after getting infected with parvovirus B19.

5thMC skin rash

Erythema nodsum

causes painful red bumps under the skin shins

29
Q

What is term for tinea that is subungal and req long term oral meds?

A

Onychomycosis

Itraconazole

30
Q

Pt “christmas tree” pattern with upper trunk only that is hypopigmented in summer only?

A

Tinea (Pityriasis) Versicolor

WHO; Adolescence /young adults summer months.

PATH; Superficial fungal Infection caused by Malassezia Yeast.

CP-Hypopigmented or hyperpigmented or erythematous macules, usually upper trunk

DX- KOH prep will confirm the diagnosis. NOT woods lamp**.

TX:

  1. Antifungal Shampoo or creams x2w selenium sulfide or ketoconazole. itraconazole -
  2. ORAL 400 mg if resistant.
31
Q

What is rash under breast with SATILITE LESIONS treated with antifungal cream?

A

Candida

WHO; obesity, occlusive clothing, incontinence, hyperhidrosis, DM, steroid/ABX use

PATH; in between toes, in between fingers. skin folds. Superficial yeast (balls) infection of intertriginous areas (skin folds)

CP; erythematous macerated plaques and erosions with delicate peripheral scaling. ***satellite lesions.

TX

  1. Antifungal creams/powders BID for 1-2 weeks or until resolved.
  2. Remove exacerbating factors.
  3. Probiotics.
  4. Keep area clean and dry. Severe or recalcitrant infections give oral fluconazole daily or 150 mg weekly x 2-6 weeks.
32
Q

What is the most common tumor arising in HIV infected persons?

A

Kaposi Sarcoma

WHO- HIV, Iatrogenic- IMC drug therapy, renal transplant

PATH- HHV-8 angioproliferative d/o slow growth, but then rapid

CP- purple reddins, blue, dark brown lowe extremities. Oral and skin, LE

DX- biopsy

TX-HIV ART

systemic chemo

33
Q

What is BACTERIA in upper dermis, extends to superFIC cutaneous lymph?

A

Erysipelas

WHO

PATH- more serious, STREP CP- FACE, TENDER, RED, DEFINED MARGIN STEAKING COMPS- abscess, nephrotic syndrome, IMC, DM, IVIV, surgery breast, Edema

TX- PCN 5d strep, NSAIDs, hydrate, cold Saline dressing

34
Q

What in situ tumor is a progression from Actninc Kerotosis?

A

Bowmen Disease

PATH- has not invaded other tissue

involve epidermis ONLY

CP- if not sure provide steroids, wil not repsond

TX-topical chemo w/ 5-FU IMIQUIMOD

35
Q

What is very itcy btwn fingers?

A

Scabies

PATH- sarcoptes scabeii. GAS

WHO- <3MO. Daycare, SNFs, schools

CP- VERY ITCHY! Very contagious via direct contact. wrists and fingers!!!! Interdigital, writst flexors.

DX- KOH prep. Scrape the scabes off the skin and put on a slide

TX-Topical Permethrin 5% cream - apply to entire body below neck, wait 8-12 hours then wash off, repeat in 1 week. All toys need to be washed in hot water or in air tight bag to kill the mites.

36
Q

Pediculosis (pediculosis capitis nits, Pediculosis pubis lice & nits))

A

PATH- direct contact

  • AKA-crabs, body lice, head lice, pubic lice,
  • Pediculosis corporis -clothing.
  • Pediculosis capitis and pubis- skin/hair.

TX- preventions**

  1. Topical insecticides: DOC Permethrin Pyrethrins, Malathion
  2. Special combs help remove nits;
  3. occlusive dressing with petroleum to suffocate lice.
  4. Retreat in 7-10 days to kill any newly hatched lice.
37
Q

A 56 year-old, right hand dominant, Physical examination reveals a nontender left thumb with a 6 mm macular lesion located under the distal nail bed. It is mixed dark brown and black in color, with irregular borders. The most likely diagnosis is

A

MELANOMA

WHO- 20-30y, fair skin, FH., UV child

PATH- MC fatal maligant skin tumor. rapid prolif,

CP- dark, irregular border, thickness MC prognosis, >6mm. Recent changes in moles. 3+ colors, nail changes, itching/bleed

Acral Lentiginous- palms, soles, nails

Amelanotic

Lentigo-sun damage skin, gradually enlarges

DX- biopsy w/ 1-3mm

TX- ASAP specialist

wide surgical excesion

38
Q

What is Auspits phenomenon?

A

Psorasis rxn when scraped, blood droplets

39
Q

How to differentiate btwn Tinea corporis?

A

scales on periphery

psorasis- scales entire lesion

40
Q

How to differentiate btwn ezema/AD?

A

AD very itchy

AD flexor areas psorasis extensor

41
Q

How do you distinguish lesion on nose crease?

A

Seborrheic dermatitis ONLY in nose crease greasy, NO auspitz psorasis - flaky

42
Q

How to distinguish psorasis btwn lichen simplex chronicus?

A

Lower legs for LSP

43
Q

psorasis vs. chronic contact derm?

A

History- FH psorais

Intense itch- contact derm

44
Q

What is Koebner phenom?

A

Trauma- l/t irratated skin/psorasis around Hair scalp waits.

diffuse psoarsis

45
Q

What are alternatives if topical don’t work?

A
  1. Calipotriene-
  2. Vit D
  3. Coal tar- shampoo
  4. Tazaroten-
  5. Retinoid- skin irritation Anthralin
46
Q

When should psoaris be refer to rheumatologist

A

Psoratic Arthriis TX- systmic Destroys jt fast