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Derm Geriatrics Flashcards

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1
Q

MC benign epidermal skin tumor

A

seborrheic keratosis

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2
Q

sx seborrheic keratosis

A

well-demarcated round or val velvety warty lesions with a greasy “stuck on” appearance

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3
Q

dx seborrheic keratosis

A

clinical
biopsy if uncertain - well demarcated proliteration of keratinocytes with characteristic small keratin-filled cysts

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4
Q

tx seborrheic keratosis

A

no tx

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5
Q

MC premalignant skin condition

A

actinic keratosis

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6
Q

what skin CA can actinic keratosis progress to

A

squamous cell carcinoma

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7
Q

sx actinic keratosis

A

dry, rough macules or papules that feel like sandpaper with transparent or yellow scaling

can be erythematous or hyper pigmented (hyperketatotic) plaques

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8
Q

dx actinic keratosis

A

clinical
punch or shave bx - atypical epidermal keratinocytes

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9
Q

tx actinic keratosis

A

avoid sun
use sunscreen
a few - surgical - liquid nitrogen cryotherapy MC used

multiple - topical 5-fluorouracil, imiquimod, tribanibulin, photodynamic therapy. thick lesions may need cryotherapy after 5-FU

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10
Q

what is Bowen’s dz

A

squamous cell carcinoma in situ (has not invaded the dermis)

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11
Q

2nd MC skin CA

A

squamous cell

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12
Q

RF squamous cell carcinoma

A

sun - actinic keratosis
HPV

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13
Q

sx squamous cell carcinoma

A

erythematous, elevated thickened nodules with white scary or crusted, bloody margins

non healing ulceration/erosion

most lower lip cancer are squamous cell type and involve vermillion border

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14
Q

dx squamous cell carcinoma

A

biopsy - atypical keratinocytes

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15
Q

tx squamous cell carcinoma

A

surgical excision with clear margins (4-6 mm)

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16
Q

MCC skin cancer related death

A

melanoma

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17
Q

MC type melanoma and characteristics

A

superficial spreading - involves de novo or preexisting nevus; trunk in men and legs in women

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18
Q

other subtypes and characteristics of melanoma

A

nodular - 2nd MC, rapid vertical growth phase

lentigo maligna - older individuals; areas that are highly sun exposed (face)

aural lentiginous - MC in darker pigmented individuals; palms and soles and nail beds

desmoplastic - most aggressive

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19
Q

tx melanoma

A

local wide surgical excision

1 mm thick or less - 1 cm margin of normal tissue
>1-2 mm - 2 cm
2-4 - 2 cm

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20
Q

MC skin CA in US

A

basal cell carcinoma

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21
Q

sx basal cell carcinoma

A

small, raised dome-shaped papules that are pink, white, or flesh colored; pearly quality with raised “rolled” borders

may have overlying telangiectatic surface vessels

bleeds easily

80% on face/head

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22
Q

dx basal cell carcinoma

A

punch or shave bx

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23
Q

tx basal cell carcinoma

A

if face - mohs
excision vs curettage

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24
Q

what are decubitus ulcers

A

ulcers from vertical pressure
MC on bony prominences

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25
stages of pressure ulcers
stage 1 - superficial, nonblanchable redness that does not dissipate after pressure is relieved stage 2 - epidermal damage extending into the dermis. resembles a blister or abrasion stage 3 - full thickness of skin and may extend to subq layer stage 4 - depends; extends beyond fascia into muscle, tendon, bone
26
tx pressure ulcers
wound care with a moist wound environment pain control debride if necrotic repositioning stage 1 - wound protection w protective dressings stage 2 - hydrocolloids to maintain moist environment if no infection stage 3 and 4 - wound cleaning; maintain moist environment; debride necrotic tissue
27
what is rosacea
chronic acneiform skin condition
28
what is most commonly involved in rosacea
face
29
triggers for rosacea
alcohol hot/cold weather hot drinks hot baths spicy foods sun exposure
30
sx rosacea
transient centrofacial erythema (nose and cheeks) or flushing often accompanied by feeling of warmth non-comedogenic inflammatory papules and pustules telangiectasis on face and cheeks ocular sx - ocular erythema or tearing
31
PE rosacea
telangiectasia absence of comedones (black heads) red enlarged nose (rhinophyma)
32
dx rosacea
clinical bx definitive - rarely needed
33
tx rosacea
lifestyle - mild cleansing agents and moisturization topical metronidazole first line medical moderate or severe - tetracycline, doxycycline, minocycline for facial erythema - topical brimonidine telangiectasia - vascular laser therapy
34
onychomycosis MC affects the ____
great toe
35
causes of onychomycosis
dermatophytes - trichophyton and epidermophyton (T. rubrum MC)
36
RF onychomycosis
age tinea pedis psoriasis occlusive shoes immunodeficiency
37
sx onychomycosis
nail that is plaque, thick, discolored and/or cracked subungual hyperkeratinization
38
dx onychomycosis
KOH wet mount prep or fungal culture periodic acid-schiff test - most sensitive - performed on nail plate clippings fungal culture confirms
39
tx onychomycosis
systemic antifungals - oral terbinafine
40
what is cellulitis
infection of deeper dermis and subq tissues
41
MCC cellulitis
group A strep (S pyogenes) then staph
42
sx cellulitis
localized macular erythema (flat margins that are not sharply demarcated) swelling, warmth, tenderness
43
dx cellulitis
clinical
44
tx cellulitis
oral abx - cephalexin and dicloxacillin - if allergy - clinda or erythromycin cat/dog/human bite - augmentin MRSA - tmp-smx + cephalexin; IV - vancomycin
45
what is erysipelas
variant of cellulitis involving upper dermis and cutaneous lymphatics
46
MCC erysipelas
Group A strep (S pyogenes) then staph aureus
47
sx erysipelas
intensely erythematous, raised area with sharply demarcated borders MC in LE or face associated with systemic sx (fever, chills, malaise)
48
dx erysipelas
clinical
49
tx erysipelas
PCN, amoxicillin, cephalexin IV - cefazolin, ceftriaxone MRSA - IV vancomycin
50
cause of scabies
sarcoptes scabiei
51
sx scabies
intense pruritus esp at night small red papules with excoriations; linear burrows!!!! esp in web spaces.
52
tx scabies
permethrin topical on entire body - leave on for several hours before showering. repeat after 1 week. oral ivermectin is alternative all clothing and bedding should be placed in bag for at least 72 hours --> washed and dried using heat all close contacts need tx
53
what is another name for lice
pediculosis
54
tx for any type of lice
permethrin
55
warts are caused by
HPV
56
sx common/plantar warts
hyperkeratotic papules thromboses capillaries are pathognomonic
57
tx common, flat,plantar warts
most resolve within 2 years if immunocompetent topical - salicylic acid cryotherapy with liquid nitrogen or electrocautery or imiquimod
58
what is another name for genital warts
condyloma acuminata
59
sx genital warts
can be small, flat-topped painless raised papules and evolve into large, soft, cauliflower-like lesions in clusters on anogenital mucosa skin colored, pink, or red
60
MC type of HPV for genital warts
6 and 11
61
tx genital warts
patient applied - imiquimod or podophyllotoxin clinician administered - cryotherapy, trichloroacetic acid, surgical removal
62
Lyme dz is usually caused by
borrelial burgdorferi - a spirochete usually transmitted by exodus scapularies (deer tick)
63
where is Lyme dz MC
northeast states - CT, NY, NJ, MA
64
stages/sx of Lyme dz
early localized - erythema migrans (bulls eye/target appearance); may have constitutional sx like viral syndrome early disseminated - multiple erythema migrans; facial nerve palsy late dz - intermittent or persistent arthritis (knee MC joint)
65
dx Lyme dz
clinical - if residing in or recently traveled to endemic area; esp if rash ELISA followed by western blot if ELISA is positive don't wait for testing to be positive if characteristic rash
66
tx Lyme dz
doxycycline amoxicillin or cefuroxime if pregnant or kid < 8 if second/third AV block, syncope, dyspnea, chest pain, CNS dz other than CN7 palsy (meningitis) -- IV ceftriaxone
67
prophylaxis for Lyme dz
doxycycline 200 mg x 1 does within 72 hours of tick removal if doxy can't be given, don't give prophylaxis
68
chicken pox is caused by
varicella zoster virus - HHV3
69
primary vs secondary varicella
primary - varicella (chickenpox) secondary - herpes zoster (shingles) - after 6th decade of life MC
70
how is varicella zoster transmitted
aerosolized droplets or direct contact with skin lesions
71
sx varicella zoster
fever, malaise, myalgia, oral enanthem --> generalized exanthema vesicular rash - pruritic erythematous macules that become papules then vesicles and pustules then crust over. --- they are at different stages dew drops on a rose petal
72
dx varicella zoster
clinical PCR is highest yield tzanck smear - multinucleate giant cells
73
tx varicella zoster
if healthy - supportive ; acyclovir within 72 hours of onset
74
sx herpes zoster
fever, malaise, sensory changes (pain, burning, paresthesias) dermatomal vesicular rash - unilateral vesicular dermatomal eruption -painful eruption of grouped vesicles or bull on an erythematous base unilaterally within a single dermatome MC (T3 - L3) -- does not cross midline
75
dx herpes zoster
clinical PCR has highest yield tzanck - multinucleate giant cells
76
tx herpes zoster
acyclovir, valacyclovir, famciclovir within 72 hours
77
herpes zoster ophthalmicus involves what cranial nerve
trigeminal nerve (CN5)
78
sx herpes zoster ophthalmicus
same prodrome as herpes zoster grouped vesicles on erythematous base on the face; ocular involvement
79
PE herpes zoster ophthalmicus
Hutchinson sign - vesicular lesions on the tip of the nose, inner corner of the eye, and root/side of the nose --> involvement of trigeminal nerve and eye
80
herpes zoster oticus is also called
Ramsay hunt syndrome
81
herpes zoster oticus involves what cranial nerve
geniculate ganglion o the sensory branch of cranial nerve 7 (facial nerve) can spread to CN8
82
sx herpes zoster oticus
ipsilateral ear pain, vesicles in the external auditory canal and/or auricle, and ipsilateral facial paralysis
83
tx herpes zoster oticus
valacyclovir and prednisone
84

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