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ER EOR > Derm Geriatrics > Flashcards

Derm Geriatrics Flashcards

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
Q

stages of pressure ulcers

A

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

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26
Q

tx pressure ulcers

A

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

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27
Q

what is rosacea

A

chronic acneiform skin condition

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28
Q

what is most commonly involved in rosacea

A

face

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29
Q

triggers for rosacea

A

alcohol
hot/cold weather
hot drinks
hot baths
spicy foods
sun exposure

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30
Q

sx rosacea

A

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

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31
Q

PE rosacea

A

telangiectasia
absence of comedones (black heads)
red enlarged nose (rhinophyma)

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32
Q

dx rosacea

A

clinical
bx definitive - rarely needed

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33
Q

tx rosacea

A

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

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34
Q

onychomycosis MC affects the ____

A

great toe

35
Q

causes of onychomycosis

A

dermatophytes - trichophyton and epidermophyton (T. rubrum MC)

36
Q

RF onychomycosis

A

age
tinea pedis
psoriasis
occlusive shoes
immunodeficiency

37
Q

sx onychomycosis

A

nail that is plaque, thick, discolored and/or cracked

subungual hyperkeratinization

38
Q

dx onychomycosis

A

KOH wet mount prep or fungal culture

periodic acid-schiff test - most sensitive - performed on nail plate clippings

fungal culture confirms

39
Q

tx onychomycosis

A

systemic antifungals - oral terbinafine

40
Q

what is cellulitis

A

infection of deeper dermis and subq tissues

41
Q

MCC cellulitis

A

group A strep (S pyogenes)

then staph

42
Q

sx cellulitis

A

localized macular erythema (flat margins that are not sharply demarcated)

swelling, warmth, tenderness

43
Q

dx cellulitis

A

clinical

44
Q

tx cellulitis

A

oral abx - cephalexin and dicloxacillin - if allergy - clinda or erythromycin

cat/dog/human bite - augmentin

MRSA - tmp-smx + cephalexin; IV - vancomycin

45
Q

what is erysipelas

A

variant of cellulitis involving upper dermis and cutaneous lymphatics

46
Q

MCC erysipelas

A

Group A strep (S pyogenes)

then staph aureus

47
Q

sx erysipelas

A

intensely erythematous, raised area with sharply demarcated borders

MC in LE or face

associated with systemic sx (fever, chills, malaise)

48
Q

dx erysipelas

A

clinical

49
Q

tx erysipelas

A

PCN, amoxicillin, cephalexin

IV - cefazolin, ceftriaxone

MRSA - IV vancomycin

50
Q

cause of scabies

A

sarcoptes scabiei

51
Q

sx scabies

A

intense pruritus esp at night

small red papules with excoriations; linear burrows!!!! esp in web spaces.

52
Q

tx scabies

A

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
Q

what is another name for lice

A

pediculosis

54
Q

tx for any type of lice

A

permethrin

55
Q

warts are caused by

A

HPV

56
Q

sx common/plantar warts

A

hyperkeratotic papules
thromboses capillaries are pathognomonic

57
Q

tx common, flat,plantar warts

A

most resolve within 2 years if immunocompetent

topical - salicylic acid

cryotherapy with liquid nitrogen or electrocautery or imiquimod

58
Q

what is another name for genital warts

A

condyloma acuminata

59
Q

sx genital warts

A

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
Q

MC type of HPV for genital warts

A

6 and 11

61
Q

tx genital warts

A

patient applied - imiquimod or podophyllotoxin

clinician administered - cryotherapy, trichloroacetic acid, surgical removal

62
Q

Lyme dz is usually caused by

A

borrelial burgdorferi - a spirochete
usually transmitted by exodus scapularies (deer tick)

63
Q

where is Lyme dz MC

A

northeast states - CT, NY, NJ, MA

64
Q

stages/sx of Lyme dz

A

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
Q

dx Lyme dz

A

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
Q

tx Lyme dz

A

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
Q

prophylaxis for Lyme dz

A

doxycycline 200 mg x 1 does within 72 hours of tick removal

if doxy can’t be given, don’t give prophylaxis

68
Q

chicken pox is caused by

A

varicella zoster virus - HHV3

69
Q

primary vs secondary varicella

A

primary - varicella (chickenpox)
secondary - herpes zoster (shingles) - after 6th decade of life MC

70
Q

how is varicella zoster transmitted

A

aerosolized droplets or direct contact with skin lesions

71
Q

sx varicella zoster

A

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
Q

dx varicella zoster

A

clinical

PCR is highest yield

tzanck smear - multinucleate giant cells

73
Q

tx varicella zoster

A

if healthy - supportive ; acyclovir within 72 hours of onset

74
Q

sx herpes zoster

A

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
Q

dx herpes zoster

A

clinical
PCR has highest yield

tzanck - multinucleate giant cells

76
Q

tx herpes zoster

A

acyclovir, valacyclovir, famciclovir within 72 hours

77
Q

herpes zoster ophthalmicus involves what cranial nerve

A

trigeminal nerve (CN5)

78
Q

sx herpes zoster ophthalmicus

A

same prodrome as herpes zoster

grouped vesicles on erythematous base on the face; ocular involvement

79
Q

PE herpes zoster ophthalmicus

A

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
Q

herpes zoster oticus is also called

A

Ramsay hunt syndrome

81
Q

herpes zoster oticus involves what cranial nerve

A

geniculate ganglion o the sensory branch of cranial nerve 7 (facial nerve)

can spread to CN8

82
Q

sx herpes zoster oticus

A

ipsilateral ear pain, vesicles in the external auditory canal and/or auricle, and ipsilateral facial paralysis

83
Q

tx herpes zoster oticus

A

valacyclovir and prednisone

84
Q
A

ER EOR (28 decks)

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