Derm Flashcards
1
Q
Onset of rash with RMSF
A
2-5 days after fever
2
Q
RMSF rash
A
- petechiae erupting on both wrists, forearms, and ankles
- rapidly progress towards trunk and becomes generalized
- 10% do not develop rash
3
Q
First line treatment for RMSF
A
Doxycycline
4
Q
Erythema migrans
A
-bulls eye rash
5
Q
When does erythema migrans rash occur
A
-7-14 days after deer tick bite
6
Q
Measles rash description
A
-Koplick spots: small, white, round spots on red base of buccal mucosa
7
Q
Scabies rash description
A
- pruritic especially at night
- serpiginous rash on interdigital webs, waist, axilla, penis
8
Q
Scarlet fever rash description
A
-sandpaper rash with sore throat
9
Q
Meningococcemia rash
A
purple-colored to dark-red painful skin lesions all over body
10
Q
Meningococcemia (meningitis) presentation
A
- sore throat
- cough
- fever
- Headache
- stiff neck
- photophobia
- change in LOC
11
Q
People at highest risk for meningitis
A
- first year college students in dorms
- asplenia
- defective spleen (sickle cell)
- HIV
- complement immune system deficiencies
12
Q
What level of precaution is needed for meningitis
A
droplet
13
Q
What CN does herpes zoster ophthalmicus affect
A
-CNV
14
Q
Most common type of melanoma in AA and Asians
A
- Acral Lentiginous melanoma
- palms, under nails, soles of feet
15
Q
Acral lentiginous melanoma presentation
A
- dark brown to black lesions on nail beds, palmar, and plantar surfaces
- subungal melanoma: longitudinal brown to black bands on nail bed
16
Q
BCC presentation
A
- pearly or waxy skin lesion with atrophic or ulcerated center that does not heal
- bleeds easily with trauma
17
Q
Actinic keratosis
A
- precursor to SCC
- dry, round, red colored lesions with rough texture
- does not heal
18
Q
> ___% hematoma of nail matrix has high risk of permanent ischemic damage to nail bed if not drained.
A
25
19
Q
SJS and TENs
A
- multiple lesions ranging from hives to necrosis
- TEN more severe than SJS
20
Q
HIV patients taking which medication is at higher risk for SJS
A
Bactrim
21
Q
3 layers of skin
A
epidermis
dermis
subcutaneous
22
Q
Common skin conditions of AA
A
- keloids
- hyperpigmentation
- traction alopecia
23
Q
T/F People with darker skin need more sun exposure to synthesize vitamin D
A
true
24
Q
Vitamin D deficiency in pregnancy
A
infantile rickets
25
Which cancer is most common
BCC
26
Macule
flat
| -<1 cm
27
papule
palpable solid
| <0.5 cm
28
Plaque
flattened elevated with variable shape
| >1 cm
29
Bullae
fluid filled
| >1 cm
30
Vesicle
filled with serous fluid
| <1 cm
31
Pustule
elevated lesion <1 cm filled with purulent fluid
32
Lichenification
-thickening of epidermis due to chronic itching
33
Acral
-distal portions of the limbs like hands and feet
34
Annular
ring shaped
35
exanthem
cutaneous rash
36
Flexural
skin flexure are body folds
37
Morbilliform
rash that resembles measles
38
Nummular
coin-shaped
| round
39
Serpiginous
shaped like a snake
40
Verrucous
wart-like
41
Xanthelasma
raised and yellow-colored soft plaques
| -if <40, r/o HLD
42
Melasma
- mask of pregnancy
- upper cheeks, malar area, forehead, chin
- can be permanent, may lighten over time
43
Vitiligo is more common in patients with
autoimmune disease
44
Vitiligo treatment
refer to derm
45
Cherry angioma treatment
none needed
46
Xerosis
-inherited skin disorder that is extremely dry skin
47
Acanthosis nigricans can indicate what
-diabetes
-metabolic syndrome
-obesity
Cancer of GI tract
48
Acrochordon
skin tags
| -more common in diabetics and obese
49
Steroid class range
1 (superpotent) to 7 (least potent)
50
Topical steroids on children and face
- use class 7: 0.5%-1% hydrocortisone
| - Class 6: fluocinolone
51
How long do topical steroids need to be used for HPA axis suppression to occur
>2 weeks
52
Psoriasis patho
- inherited
| - squamous epithelial undergo rapid mitotic division and abnormal maturation
53
Koebner phenomenon
new psoriatic plaques form over areas of skin trauma
54
Auspitz sign
pinpoint areas of bleeding in skin when scales from a psoriatic plaque are removed
55
Fingernail presentation with psoriasis
pitting
56
Psoriasis medications
- topical steroids
- topical retinoids
- tar preparations
- severe disease: MTX, cyclosporine, biologics
57
Topical tacrolimus BBW
- rare malignancy
| - use sunblock
58
Goeckerman regimen
-UVB light and tar-derived topical may induce remission in severe psoriasis
59
Guttate sporiasis
- drop-shaped lesions
| - severe psoriasis from GABHS
60
Actinic keratoses treatment
-refer to derm for biopsy
61
Tinea versicolor treatment
- selenium sulfide and topical azole antifungals (ketoconazole, terbinafine)
- will take several months for pigment to fill in
62
Mild eczema treatment
- hydrocortisone 2.5%
| - low-potency, group 5
63
Moderate eczema treatment
- Triamcinolone acetonide
| - medium potency, group 4
64
Halcinonide (Halog)
high potency topical steroid
| group 2
65
Contact dermatitis treatment
- stop exposure
- topical steroids once to twice a week 1-2 weeks
- calamine lotion
- oatmeal baths
- consider referral to allergist
66
superficial candidiasis presentation
- bright red shiny lesions
- itch or burn
- intertriginous areas
67
thrush presentation
- severe sore throat
- white adherent patches
- hard to dislodge
68
Superficial candidiasis treatment
- Nystatin powder and/or cream in skin folds
- OTC antifungals: miconazole, clotrimazole
- Prescription: terconazole, ciclopirox
- keep dry and aerated
69
Thrush treatment
- Nystatin oral suspension (swish and swallow)
| - Magic mouthwash: lidocaine, diphydramine, Maalox for severe sore throat
70
HIV positive patients with thrush treatment
-oral fluconazole
71
Leading cause of shellfish associated death in US
V. vulnificus
72
People with liver disease or IC or pregnant should avoid eating raw or undercooked oysters or clams due to
- Vibrio vulnificus infection
| - 50% mortality
73
Clenched fist injuries treatment
-ED
74
Necrotizing Fasciitis infected area may appear like what
-woody induration
75
Folliculitis treatment
Muporicin
| usually self limiting
76
Furuncle treatment
- warm compress
- if >2 cm, I&D
- if over joint, refer to ED for xray to rule out osteomyelitis
77
What is a furuncle
infected hair follicle
78
What is a carbuncle
-several boils that coalesce to form a large boil or abscess
79
Carbuncle treamtent
- mild cases
- nonpurulent: dicloxacillin PO, cephalexin, clindamycin
- PCN allergy: azithromycin
- suspected MRSA: Bactrim DS or doxycycline
- severe cases: ED referral
80
Erysipelas is what
- subtype of cellulitis involving upper dermis and superficial lymphatics
- usually Strep
81
Erysipelas can present where
- lower legs
| - cheeks
82
Human and dog bite treatment
- Augmentin 875mg/125mg PO BID x 10 days
- PCN allergy: Doxycyline BID, Bactrim + metronidazole or clindamycin
- irrigate
- no suture
- if cartilage involvement refer to plastics
- tetanus booster
- f/u 24-48 hours
83
Hidradenitis Suppurativa patho
- chronic and recurrent inflammatory disorder of apocrine glands
- painful nodules, abscess, pustules in axilla, mammary area, perianal, groin
- risk: smoking and obesity
- no cure
84
Hidradenitis suppurativa treatment
- mild: CHX (Hibiclens) wipes
- topical clindamycin
- warm compress
- avoid high glycemic foods, dairy
- smoking cessation, weight loss
- oral abx: tetracycline, doxycycline, minocycline
- refer to derm
85
Two types of impetigo
- bullous
| - nonbullous; more common
86
Treatment for severe impetigo
-Keflex, dicloxacillin x10 days
87
Mild impetigo treatment
-Clean lesions and apply muporicin
88
Impetigo and school
-no school until 48-72 hours of treatment
89
Prophylaxis for close contacts with meningitis
-Rifampin PO every 12 hours x 2 days
90
close contact description
-<3 feet of persons infected for >8 hours or directly exposed to patients oral secretions, going back to 7 days before onset of patients symptoms and until 24 hours after initiating abx
91
Lyme disease organism
-Borrelia burgdorferi
92
Early lyme labs
- enzyme immunoassay (EIA): if negative, no further
- if positive, IFA or western blot
- if both EIA and IFA are (+)= Lymes
- antibody testing may have false negative in first 4-6 weeks
93
Early Lyme treatment
-Doxycycline BID x 10 days
94
RMSF labs
- Antibody titers to R.rickettssi by indirect fluorescent abs
- biopsy of skin lesion
- CBC, LFTs, CSF, etc
95
how to remove tick
- tweezers grasp part closest to tick
- pull upward
- do not twist or jerk
96
How long is chickenpox contagious
-1-2 days before onset of rash and until all lesions have crusted over
97
How long is shingles contagious
-onset of rash until lesions have crusted over
98
Gold standard diagnosis for varicella zoster virus
-viral culture, PCR
99
When are antivirals most effective for varicella zoster
-within 48-72 hours after appearance of rash
100
Postherpetic neuralgia treatment
- tricyclic antidepressants (low-dose amitriptyline)
- anticonvulsants
- gabapentin
- lidocaine 5% patch
101
Ramsay Hunt syndrome
- ipsilateral facial paralysis
- ear pain
- vesicles in ear canal and auricle
- refer to neurologist
102
Herpetic whitlow cause by
herpes simplex 1 or 2
103
Herpetic whitlow presentation
- acute onset extremely painful red bumps
- small blisters on sides of skin
- ask about oral or genital herpes
104
Herpetic whitlow treatment
- mild: analgesics
| - severe: acyclovir
105
Herpetic whitlow patient education
-cover with bandage until lesions healed
106
Paronychia treatment
- soak in warm water for 20 minutes three times a day
- apply triple abx or muporicin after soaking
- Abscess: I&D, gently separate the cuticle margin from nail bed to drain
107
Herald patch
- first lesion to appear
- largest
- appears 2 weeks before full breakout
108
How long does pityriasis rosea last
6-8 weeks
| self-limiting
109
Scabies presentation
-serpiginous or linear burrow rash
110
Scabies labs
- skin scraping wet mount
| - observe for mites or eggs
111
Scabies treatment
- Pemethrin 5%
- apply from neck to feet
- wash off after 8-14 hours
- repeat in 7 days
- treat everyone in household
- wash all things
- pruritus improves in 48 hours but can last up to 2-4 weeks
- treat with Benadryl and topical steroids
112
Tinea capitis treatment
- Baseline LFT and repeat 2 weeks after starting systemic antifungal treatment --> not needed unless treatment extends beyond 8 weeks
- Gold standard: griseofulvin daily to BID x 6-12 weeks
113
Kerion
complication of tinea capitis
- inflammatory and indurated lesions that permanently damage hair follicles causing patchy alopecia
- permanent
114
Tinea corporis treatment
- Topical treatment 1-2x per week for 3 weeks (ketoconazole, clotrimazole)
- oral antifungals (terbinafine, itraconazole, fluconazole)
115
Tinea manuum is usually caused by
-scratching foot that is infected with tinea
116
What medication should be avoided with suspected dermatophyte infection
topical steroids
117
Treatment of mild onychomycosis
Penlac "nail polish" (cyclopirox)
118
Onychomycosis treatment
- oral terbinafine or itraconazole 1 week per month for 3 months (pulse therapy)
- not all need treatment
119
Mild acne treatment
- Rx: Tretinoin topical (Retin-A)
- benzoyl peroxide gel with erythromycin (Benzamycin) or with clindamycin (Cleocin)
- start with lowest dose: Retin-A 0.25%
- alt: azelaic acid or salicylic acid (OTC)
120
Patient education with retinoids
- skin can become red and irritated
- may worsen at first, will improve in 4-6 weeks
- if no improvement in 8-12 weeks, consider increasing dose or adding BP with erythromycin
121
Mild acne criteria
- open and closed comedones
| - with or without small papules
122
Moderate acne criteria
-papules and pustules with comedones
123
Moderate acne treatment
- Retin-A, Benzamycin, or Cleocin
- Oral abx: Tetracycline, minocycline, doxycycline, erythromycin, or clindamycin
- Tetracyclines not for <13 years old!
- can consider OCP
124
Severe cystic acne criteria
-mild and mod acne with painful indurated nodules, cysts, abscesses, and pustules over face, shoulders and chest
125
Severe cystic acne treatment
- Isotretinoin (Accutane) category X
- prescribed by prescribers in iPLEDGE program
- 2 forms of contraception
- monthly pregnancy test shown to pharmacist
126
Rosacea patho
-chronic relapse inflammatory skin disorder
127
Rosacea presentation
- Celtic background
- chronic and small acne-like papules and pustules around nose, mouth, chin
- telangiectasias present on nasal area and cheeks
- blushes easily
- blonde or red-haired with light eyes
- may have red eyes, dry eyes, or chronic blepharitis
128
Rosacea treatment
- Metronidazole (Metrogel) topical gel
| - Azelaic acid (Azelex) topical gel
129
Complications of rosacea
- rhinophyma
| - ocular rosacea
130
How long does molluscum take to resolve
6-12 months
131
When is molluscum considered an STD
-if lesions are located on genitals in sexually active adolescents and adults
132
First degree burn
- superficial
- erythema only, painful
- clean with soap and water
- cold packs for 24-48 hours
- benzocaine or aloe vera
133
Second degree burn
- partial thickness
- red colored with superficial blisters
- painful
- water and mild soap
- do not rupture blisters
- treat with silver sulfadiazine (Silvadene) or triple antibiotic (Polysporin)
- honey or aloe vera
134
Third degree burn
- full thickness burn
- rule out airway and breathing compromise
- smoke inhalation injury --> emergency
- painless
- REFER
135
Body surface for child each arm
9%
136
Body surface for child each leg
14%
137
Body surface child front trunk and back
18% each
138
Body surface adult each arm and head
9%
139
Body surface adult each leg, anterior trunk, posterior trunk
18%
140
Criteria for burn referral
- burns involving face, hands, feet, genitals, major joints
- electrical burns, lightening burns
- partial thickness >10% TBSA
- Third-degree burn in any age group
141
Anthrax is caused by
Bacillus anthracis
| G-
142
Cutaneous anthrax presentation
- papule that enlarges in 24-48 hours
| - eschar and ulceration
143
Pulmonary anthrax presentation
- recent work with animals, wools, hair
- bioterrorism
- flu-like
- cough, hemoptysis, dyspnea, hypoxia, shock
144
Cutaneous anthrax treatment
-doxycycline, cipro, levo
145
Smallpox treatment
- symptomatic
| - 20-50% mortality rate
146
Smallpox vaccine is given when
3-4 days postexposure
147
With suspected MRSA infection, which antibiotic to give if patient has PCN allergy
- doxycycline
- minocycline
- clindamycin
148
Treatment duration for suspected bioterrorism with anthrax
60 days
149
Trephination
straighten one end of a large paper clip or 18 gauge needle and heat it with a flame
gently drill down nail until blood seeps out
150
Primary healing
- primary closure
- wound closed within 24 hours by suturing, glue, strips
- least amount of scarring
151
Secondary intention wound healing
- left open with formation of granulation tissue and scarring
- heals from bottom of wound up
- wound edges not well approximated
- more scarring
152
Tertiary intention
- delayed primary closure
- wounds with heavy contamination left open to heal by secondary intention (granulation) and contarction
- wound edges approximated in 3-4 days
- produces most scarring
153
Phases of wound healing
- hemostasis
- inflammation
- Proliferation
- Remodeling
HIPR (HYPER)
154
Hemostasis
constriction of blood vessels, platelet aggregation, fibrin formation
155
Inflammation
- macrophages and lymphocytes proliferate
| - inflammatory mediators
156
Proliferation
basal and epithelial cells proliferate
| -angiogenesis
157
Remodeling
-remodeling of collagen and scar formation
158
Areas with high risk of ischemia
-tip of nose
-ears
fingertips
toes
penis
159
Local anesthesia medication used
lidocaine 1%
160
What wounds are not to be sutured
-puncture wounds or human or animal bites
-heavily contaminated wounds
lacerations >12 hours old
wounds open for more than 24 hours
161
When are sutures to be removed
within 7-10 days
162
Why is ecthyma treated with an oral medication
because of dermis involvement
163
Which tinea infections require oral treatment
- captitis
- unguium (onychomycosis)
- barbae
164
Lupus presentation
- butterfly rash
- child-bearing aged female
- arthritis
- arthralgias
165
Lupus labs
- presence of ANA antibodies
| - refer to rheumatology
166
Weakest vehicle strength for topical steroids
lotions
167
Most potent vehicle strength for topical steroids
ointments
168
Pinworm diagnosis
- visual inspection of anus, may have mobile worms
- looks like cotton threads
- tape on asshole early in the morning
169
Pinworm treatment
-Albendazole
| PO
170
Alt medication for child presenting with Lyme-like symptoms
- Amoxicillin
| - doxycycline should not be used in children <13
171
First line treatment for genital warts
cyrotherapy
172
Erythema multiforme description
target rash
173
Days to quarantine suspected rabies positive animal
10 days
174
Candida intertrigo
- candida in body areas where skin rubs together
| - breasts, groin
