Derm Block 1 Flashcards
(170 cards)
1
Q
Urticaria angioedema most concerning things to eval for?
A
Airway management
2
Q
Definition of urticaria
A
W healing of the skin pruritic pink pale swelling of the superior dermis w Erythematous flare.
3
Q
Mast Cell Degranulation induces what
And is associated with what disease
A
A histamine response;
-URTICARIA = firm edematous plaque.
Transient fade and recurrent.
Lesions come and go rapidly; generally 24 hours.
4
Q
Acute urticaria rxn is defined as how long
A
6 weeks
Reproducible
Anaphylaxis reaction to allergen
5
Q
Chronic urticarial rxn is defined as how long with what features
A
Greater than 6 weeks
Dx of exc. / no trigger small lesions recur over 6 weeks
6
Q
Distro for urticarial
A
Skin localized and organized
7
Q
Physical appearance of a urticaria rxn
A
Within 30-60 mins
Jewelry rxn
Aquagenic
Cholinergic
8
Q
TXM of urticaria
Acute
A
IM/IV Benadryl
IM/IV CC
Epi
Avoid H1 antihistamine
9
Q
TXM of uticaria chronic
A
2nd Gen Antihistamine
H2 Blockers
PO Steroids
Elimination diet
10
Q
Circular uticaria is defined as what
A
Polycystic
11
Q
Angioedema presentation
A
Deeper in the dermis and in the subcu or submucosal tissue.
Localized Burning Painful swelling (of one body part) FACE —> due to the amount of subcu tissue
+GI / Resp. Tract = dysphagia; dyspnea
12
Q
Angioedema txm
A
ID allergen
IM/PO antihistamine
H1
PO steriods [EPI READY}
Air way precautions
13
Q
Viral Exanthems
A
Measles
: Koplik : white spots on buccaneers mucosa
Erythematous
+ BLANCHING
+/- Fever
14
Q
Where do viral exanthems show up
A
Face
With central spreading leaves a BROWN discoloration
15
Q
TXM for viral exanthems
A
Supportive
REFER to HEALTH department
16
Q
Hand Foot and Mouth presentation
A
ORAL -1st
Papules to vesicles
2-10 lesion can be painful
Mac Pap Lesions —> vesicles
[DORSAL aspect of fingers and toes]
17
Q
HAND FOOT and Mouth TXM
A
Magic mouthwash
Oragel
Sxs relief
Dietary adjustments
+/- antipyretics
18
Q
Erythema infectiosum 5th disease presentation
A
Slapped cheek rash = macular Erythematous Lacey appearance purpuric and vesicular lesions
19
Q
5th dz txm
A
Supportive
Infection during prodrome period (w/o rash)
20
Q
Kawasaki dz
A
7 weeks to 12 years old
Myco cutaneous
Lymph node syndrome
HIGH PAIN
no response to antipyretics
+Strawberry tongue
+Desquamation of fingers and toes
21
Q
Kawasaki acute phase
A
Less than 7 days resolves
Conjunctival injection
Strawberry tongue
Tender edema of palms soles
Diffuse rash
22
Q
About how long should Kawasaki disease resolve
A
6-8 weeks
23
Q
Describe a cutaneous drug rxn
A
Looks like a viral exanthem
Macupapular morbilliform
ONSET 7-10 days
Fever variable
24
Q
Common cutaneous eruption body manifestation
A
Glans penis
Lips
Hands
Face
25
Mgmt for a cutaneous drug reaction
Stop med!
Anti histamine
Topical PO steroid Class 3-5
26
What are two cutaneous drug reaction serious complications
Urticarial
Exanthematous rash
27
What is an example of a hypersentivity reaction
Erythema
Multiforme
28
EM Major presentation
Sever mucosal rash with airway restriction
29
EM minor reaction
Minor mucosal reaction
30
2 characteristics of EM
Bulla crust ring
Edematous outer ring
31
Distribution of EM
Dorsal hands and genitalia mucosa
32
What two things should be ruled out with EM
LUPUS and secondary Syphillis
33
Mgmt of EM
NONE
Sxs relief
Mild CC (prednisone 1-3 weeks)
Antihistamine
Local orajel
+/- antivirals after resolve of lesions
34
If there is ocular involvement with EM what needs to happen
STAT Opthalmology
35
Steven Johnson syndrome presentation
1st - URI
Malaise myalgia arthralgia
Fever 102 degree
Odynophagia
Papules-TRUNK first
Lesions - mucosal
Meds = Seizure ABX Gout
36
What meds are known to induce SJS
Allopurinol and Lamatrogine
37
Where does an SJS patient need to be admitted
Burn unit
38
Complications of SJS
Slough of upper and lower resp tract with blindness and ulcers
*Mx the airway!!*
39
What is an SJS like syndrome that is progressive diffeuse and generalized detachment of epidermis
Toxic epidermal necrolysis
40
Skin presentation in toxic epidermal necrolysis
Localized
Painful
SUNBURNED LOOK
(Infectious sepsis)
Slight thump pressure will pull skin off - NIKOLSKY sign
41
Where does toxic epidermal necrolysis commonly effect
Mucous membranes
Eyes
Respiratory Tract
42
What is the defintion of SJS + TEN
Severe Erythema Multiforme
43
Epidermal involvement of SJS and TEN
Less than 10% = SJS
10-30% = SJS + TEN
Greater than 30% = TEN
44
Presentation of erythema nodosum
Arhtalgia
Arthritis
Malaise
Red nodes thata re first tense hard and painful and then
FLUCTUANT
45
Pyoderma gangrenosum is assoicated with what other disease process
IBD
46
Presentation of pyoderma gangrenosum
Lesions tender red macula’s that last months to years
Dusky red induration leading to GANGRENE
47
Acne vulgaris presentation
Puberty onset
Can have FAM HX
Pilosebacuos unit multifactorial disease excess sebaceous gland secretion
Non inflammatory = open and closed comdomes
Inflammatory = papules pustules nodules and cyst
48
Diagnosis of acne vulgaris is
Clinical
49
Explain mgmt of acne vulgaris
No quick fix.
Most benign first
4-8 weeks then reevaluate
Mild = soap and water frequent exfoliation
(Dont over dry)
(Avoid oil containing; caffeine; and stress)
50
What are the therapeutic targets in acne vulgaris
With what treatment first
Then what
COMDONES with retinoid treatment 1st!
Them benzoyl peroxide
With Clindamycin combo
51
Mild inflammatory acne can be treated with what
Topical ABX
Doxy / Tetracycline / minocycline
Min = 3 months trial
52
Mod to severe inflammatory txm of acne vulgaris
Topical retinoid
Topical benzoyl peroxide
ORal ABX
ALL 3 then;
Doxy/ TETRACYCLINE/ MINO
Singular nodules = intralesional steroid injections
53
What can women take that can help treat their acne
OCPs spirinolactone
54
Describe acne congloblata
Communicating cysts ; ulcerations tracks WITH formed under the skin
55
What is the combo of pyoderma faciale
Acne + rosacea fulminans
56
What is a good mgmt for acne congloblata
Isotratinoin
Intralesional steroids
57
What labs are required for isoretinion txm
CBC
UA
LFTS
Lipids
HCG !!!!!!!!!!
58
What should you d/c if you start accutane
Retinoids
59
What is the mgmt for women on accutane
HCG monthly during txm and 1 month after d/c
WITH two methods of birth control
60
Accutane patients should watch for what
Mood swings
61
Can accutane patients donate blood during txm
NO!
62
What are sings of possible ICH with accutane txm
HA with visual changes
not relived by OTC
Retinol checks might show papilledema (pseudo cerebri)
63
What is the common location of female adult acne
Chin and jawline
64
Mgmt for femal adult acne
OCP’s spirinolactone
Tretinoin
Erythromycin if refractory
65
Perioral dermatitis is most common with who
Young women
66
Perioral dermatitis common presentation
Female pustules on cheek adjacent to nasolabial folds with VERMILLION BORDER CLEAR ZONE
67
Mgmt for Perioral dermatitis
D/c. Facial mositurizers and cosmetics
Doxy 2-4 weeks
Hydrocortisone
68
Acne rosacea has an assocation with what?
Demodex folliculorum
69
Acne reosacea presentation
Telagiactasia
Erythematous papules and pustules
Chin and forehead
Flush vasodilation
May burn or sting
70
Mgmt for acne rosacea
Avoid triggers
Metronidazole
Azelazlic acid
71
What is an enlarged nose known as
Assoc with what dz?
Rhinophyma ; association with rosacea
72
Mgmt for pomade acne cosmetics
Lifestyle changes benzoyl peroxide
+ Tretinoin @ bedtime
Inflamed lesions = Top ABX
73
Common locations for steroid acne
Face and neck
Back and chest
74
Milia clinical presentation
Small epidermal cyst without openings
Tiny white pea chaped papules 1-2 mm diameter
Asx
Response to sun damage and physical trauma
At any age
75
Mgmt for Milia solitary few lesions
Incise over lesion and extract content = cannot be expressed
76
Forehead cheek and trunk heat rash presentation
Prickly sweat retention
1 mm papule or vesicle
Skin colored —> red
Stings that are pruritic
77
TXM of heat rash
Self limited
Remove clothing
78
Hidradenitis Suppurative presentation
Between skin and subcutaneous tissue
Apocrine gland wiht secondary bacterial infection
+/- strictures
Mild severe erythema pain
Double comedomes
Sinus tract development
Scarring
79
HS locations
Axial
Robin
Under breasts
80
Mgmt of HS
Stop smoking
Long term (I and D) with large cysts or abscess
Hot compress
Communicating cysts and scarring active disease = surgical excision and Grafts
+/- Isoretinion
81
Who commonly is affected by staph follicilitis
Health care workers and family members
82
Mgmt for staph folliculitis
Local = topical muprocoin or Clindamycin
Eruptions = PO dicloxicilin or cephalexin
Recurrent = Clindamycin
83
What is the name of the foreign body hair reaction associated with black males that shave
Psuedofollicilitis barbae
“Razor Bumps”
84
Pseudo folliculitis barbae primary locations
Beard
Axilla
Groin
85
Pseudo barbae mgmt
Modify shaving
Hydrate
Wash wiht benzoly peroxide
Glycolic acid or aveeno
Shave with the grain
Top steroid Group 6-7
Large lesions = group 2-3
LASER HAIR REMOVAL (ingrown hairs)
86
Acne keloidalis nuchae (AKN) is a ______ formation where?
Keloid
Back of the neck
87
3 step plan for control of AKN
Topical Clindamycin BID
Fluocinide
Tretinoin
Oral steroids and intralaser
88
Epidermal inclusion cyst presentation
@ PUBERTY / OILY SKIN
Excess sebum and large swelling
Occluded and dysfucntional
Round smooth mass soft MOBILE dysfunction pore
89
Mgmt of epidermal inclusion cyst
No TXM req’d
Removal of non inflamed lesion along skin lines
90
Pilar cyst called a _____. Presentation
WEN
Firm smooth MOBILE
Asx
Solitary tough lining keratinized different from
90% on the scalp
91
How does a Pilar cyst differ from a EIC
Solitary tough lining that is KERATINIZED
92
Psoriasis presentation
Immune mediated skin or joint inflamm disease
Hyperkaratosis
EXTENSOR SURFACES
Red discrete flat topped scales with papules that CAOALESCE to form round to oval plaques
+Koebner phenomenons induce
93
Chronic psoriasis presentation
Disable emotional and physical
Childhood to adult presentation
94
What sign is common for psoriasis
AUSPITZ SIGN = small pinpoint bleeding after scales have been removed
95
RF for psoriasis (3)
Genetics
Meds : Lithium and Beta blockers Tetracyclines and NSAIDS
Past Hx
96
Mgmt of psoriasis
Centered on patient
Worse with stress / meds
Psychosocial adjustment
97
Less than 5% of body surface with psoriasis txm
CC Topical BEsT (Clobetasol/Fluiconinide)
Class 1 or 2 to taper
Traimcinolone for plaques
98
What can be used prior to steroids to remove scales of psoriasis
Salicylic acid to decrease to help the steroid work better
99
What are topical treatments for psoriasis
Vit D3 analogs
Top Vit D
Calciopotrien / Hydrate
Top Tazoprotene (rentinoid agent gel or cream)
100
Diffuse thick psoriasis txm
Calcipotrien and betamethasone lotion
101
More than 5% of the body psoriasis txm
Biologics 1st = Entanercept / Infliximab
Methotrexate
Cyclosporine
Amit Retinoin
Isoretinon
UVA
102
What dz can cause psoriatic arthritis to persist
RA
103
Mainstay txm for guttate psoriasis
UVA
With Vit D3
Spont resolve
104
With guttate psoriasis what test should you get to manage
Strep - viral URI get culture
105
Guttate psoriasis presentation
Sudden scales with papules
*not on palms or soles*
106
Classic locations for guttate psoriasis
Elbow and knee plaques
107
Distro for psoriasis
Truncal extremities
Nail pitting
108
Pustular psoriasis presentation
Deep seated
Creamy yellow
Mid PALM
Evolves to a dusky red crust
109
Mgmt for psoriasis
Class 1 top steroid
ABX if 2ndary infxn
Emollient
Seep skin supple
Acitretinoin
Cyclopsorine
Methotrexate
Biologics
110
Common locations for pustual psoriasis
Hands
Palms
Soles of feet
111
Common timeline for pustular psoriasis
Hardens then falls off
112
What is a generalized variant of pustular psoriasis
Von Zumba (with known psoriasis)
Toxic febrile LEUKOCYTOSIS
Numerous tiny pustules evolve and then coalesce
113
What happens if you push on the LAKES of PUS for Von Zumbusch
Pools opposite
114
Psoriasis inversion locations
Flexor areas
Red plaques with increased pain
Nail changes : Onychosis and subcungal debris
Oil spots
115
What are oil spots
Locales sedation on the nail plate in psoriasis inversus
116
Seborrheic DERM presentation
Chronic!
Confined to skin with high sebum
Pattern of different age groups
Hygiene dependent
117
MC cutaneous manifestation in AIDS pts
Seborrheic derm
118
Etiology of Seborrheic derm
M. Furfur
119
Morphology of Seborrheic derm
Fine white yellow greasy flakes
Cradle cap with scalp vertex
Inflamed pruritic red papules
120
Mgmt for Seborrheic derm
Freq wash
With wash anti Seborrheic shampoo
Top anti fungal
Top steroid
(Hydrocortisone or desonomide on the FACE)
121
Seborrheic derm on the eye txm
Baby shampoo
122
Putyriasis rosea presentation
Young adults
COLD MONTHS
Viral origin - HHV 6/7
Suddne
Herald Patch (LARgE)
Hyperpigmentation
Macula’s and papules
“Christmas branches”
123
Distro for pityriasis rosea
Proximal extremities
Hands palms soles
124
Best mgmt for pityroasis rosea
NONE
125
Severe pityriasis rosea txm
Group 5 steroids
R/O syphilis
126
Intense pruritc lesion
Planar
Polygonal
Purple
Papules
Lichen Planus
127
What do you have to do to visualize best lichen plain
Emerson oil shows :
Wickhams straie
W/ Lacey pattern
128
What are concerning locations for lichen planus (4)
Oral lesions
Nail involvement
Scalp
Genital
129
What dz is associated with lichen planus
Hep C
130
Dx of lichen planus
1st clinical / biopsy
131
Mgmt of local lichen planus
Top 1/2 steroid
+/- occlusion
Intralesional steroid every 3-4 weeks
132
Mucous membrane mgmt for lichen planus
Steroid adhesive base
[azathiporine]
133
Generalized Lichen planus txm
Prednisone with taper
Hydroxyzone
134
If lichen planus is refractive consider what?
SCC
135
Lichen sclerosis presentation
Early and Late
Vulvovaginal perianal groin
Pruritic painful
Dyspareunia
Dry
Early = smooth small pink ivory flat top
Late = papules and plaques
136
TXM for lichen sclerosis
Top steroid
PUVA
137
What presents with a woody induration red border that advances to a tough yellow violaceous patch
That burns and stings
Necrobioiss lipodica
138
Necro lipodica is assoc with what dz
DM
139
Distro for necro lipiodica
Tib fib region
140
Rare chronic ulcerated lesion of necro lipodica can result in what
SCC
141
Mgmt for necro lipodica
Topical Steriod
Intralesional steroid
Oral steroid - systemic sxs
Pentoxifylline (with results in 1 month)
142
Granuloma annular presentation
Lesions persis and reels with time
Dorsal surface
Increasing diameter rings
Red papules
143
Mgmt for granuloma annulare
Spont resolve ! Common!
Top steroid
Intralesional steroid
Disseminated = multi granuloma = PUVA
144
Acanthodii’s Nigeria can rxn pattern
Velvety texture that becomes leathery
Symmetrical brown thickened skin
Warty papillomatous
145
Associations that can caues acnthosis nigricans (5)
Hypothyroid
Drugs : NICOTINE ESTROGEN CC
Insulin resistance
Malignancy
Pradar willi syndrome
146
Distro for Acanthosis nigricans
Axilla = MC
Flexor
Neck
Areola
147
Mgmt for acanthosis nigracans
ASX = no txm
Soft wart lesions = ammonium lactate
Retinoin cream for thick skin
TXT cause
148
Xanthoma is a what
Lipid abnormality
Superficial flat yellow and inner and outer canthens
*arond the eyes = no lipid assoc*
149
Eruptive xanthoma =
Yellow in sudden crops
Extensor arm surfaces
Legs
Butt
Clear rapidly!
150
Tuberous xanthoma presentation
R/O what?
Asx but very large!
Slowly evolves
R/O Biliary cirrhosis
Does not clear with txm of triglycerides
151
Tendinous xanthoma presentation
Smooth deeply situated Achilles attachment
Back of ankle; top of knee
152
Tendinous xanthoma txm
Dyslipidemia txm
Trichlorectic acid
TCA
153
Kaposi sarcoma presentation
AIDS pts
Rapid onset trunk multiple lesions
Slightly raised RUST colored poor demarcation
Red and purple nodules with plaques
+/- mucocutaneous lesions
Ulcerate and Bleed
154
Screen for what in kaposi sarcoma
HIV
155
TXM for kaposi
Liquid nitrogen cryotherapy
Excisional surgery
Intralesional chemo = vinblastine
Large/Sever = Radiotherapy
156
Hyperthyroid skin manifestation
Moist warm skin
Thyroid acropachy
Digital clubbing / Plummer nails : concave onycholysis
Periosteal changes
Pretibial mxedema
157
Early hyperthyroid skin
Bilateral asymmetric firm non putting nodules
Pink SKIN Color PURPLE
158
Late hyperthyroid presentation
Confluent symmetric peritibila exageered hair follicles
ORANGE PEEL
159
Hypothyroid skin manifestations
Yellow cool waxy skin
Carotinuria
Wrinkle
Dry skin
Pale coarse hair
Pretibial mxedema
160
Pemphigus presentation
Assoc with what dz
IgA Ab
Blister or bubble
AI blister dz of skin and mucous
Cell to cell adhesion molecules in desomosomes
Myasthenia Gravis
161
Universal involvement of mucosa with painful erosions intact oral blisters friable! Precedes blisters by weeks or months
Pemphigus vulgaris
162
Does Pemphigus vulgaris itch
NO!
163
End result of Pemphigus vulgaris
Ooze non healing
164
Mgmt for Pemphigus vulgaris
Derm consult!
165
How will Pemphigus vulgaris be managed
Immune modulators and immune supresents
Syst GC
Rituximab
166
Bulbous pemphigoid presentation and age group
Subendothelial blister dz
Local pruritic Multiforme
Yellow / Red serous plaques that crust
After 60 years old
167
Mgmt bullous pemphigoid
Mid local = Groupd 1 top steroid
Severe = systemic txm
168
Dermatitis herpetiformis
Chronic intents burn pruritic BURN papules or vessels
Grouped together on extensor surfaces
Symmetric unROOFED excoriations
169
What is the reason for punch biopsy in dermatitis herpetiformis
Check for celiac disease
170
TXM for dermatitis herpetiformis
Dapsone
Gluten free diet
