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Flashcards in Derm Stepup Deck (110):
1

what causes cellulitis

staph aureus
GAS
MRSA

2

risk facotrs cellulitis

IV drug use and DM
immunicompromised
srugery
venous or lymphatic dysfunction

3

H and P for cellulitis

erythema, swollen and painful skin, myalgias, chillas, warmth
fever, lymphadenopathy

4

labs in cellulitis

inc WBC ESR and cRP

5

Tx cellulitis

oral cephalosporings, penicillinase-R beta lactams
IB antibioics for severe cases
linezolid or vanco for MRSA

6

complications cellulitis

necrotizing fasciitis

7

abscesses in lower back and perineal area are caused by what bacteria

anaerobes

8

hidradenitis suppurativa

chronic follicular occlusion and apocrine gland inflammation
causes recurrent abscesses in axilla groin and perineum

9

Tx for hidradenitis suppurativa

incision and drainage

10

complications of hidradenitis suppurativa

large eroding facial abscess can cause cavernous sinu thormbosis

11

what causes necrotizing fasciitis

GAS or multipathogen

12

signs necrotozing fasciitsi

erythema, warm swollen skin
loss of sensation
fever
crepitus from gas
purple discoloration
bullae

13

labs in necrotizing fasciitis

inc WBC ESR and CRP

14

imaging for necrotizing fasciits

XR or CT

15

Tx for necrotizing fasciitis

surgical debridement, drainage, IB antibitics

16

what causes gangrene

poor vascular supply or severe infection (perfringens)

17

rotten smelling skin

gangrene

18

dry gangrene

gradual necrosis of skin from vascular insufficiency

19

wet gangrene

necrosis from acute vascular obstruction or infection
have blistering

20

imaging of gangrene

subcutaneous air on XR or CT for wet gangrene
angiography or MRA for vascular insufficnecy

21

what causes impetigo

GAS or staph

22

Tx impetigo

washing
erythromycin
cephalosporins
topical antibiotics

23

what causes acne vulgaris

propionibacterium acnes

24

Tx for acne vulgaris

topical retinoids

25

causes of acne outbreaks in adults

corticosteroids and androgens

26

complications acne vulgaris

permanent scarring
oral vitamin A analogues cause birth defects and hepatotoxicity

27

before prescribing oral isotretinoin

2 negative pregnancy tests

28

tzanck smear of HSV

multinucleated giant cells
viral culture confirms

29

varicella

varicella zoster virus
chicken pox then shingles

30

pregnant woman with chicken pox, next step

give varicella Ig

31

immunocompromised patients are at risk from what complications of varicella virus

encephalopathy and retinitis

32

what strains HPV assoc with genital warts

6 and 11
aslos assoc with cervical CA

33

molluscum contagiousm

usually in patients with HIV
painless shiny papules with central umbilication

34

labs for molluscum contagiousm

giemsa and wright stain will show large inclusion bodies

35

Tx for molluscum contagiousm

chemical, laser, cryotherapy

36

severe pruritis worse after hot baths in webs of fingers

scabies

37

Tx scabies

permethrin cream r oral ivermectin
benadryl to help with pruritis

38

complicaitons scabies

infection of close contacts

39

type I HS reaction skin

mast cell degranulation
diffuse urticarial rash
only lasts hours

40

type IV Hs reaction

lymphcyte activity
morbilliform rash
several days after second exposure
(allergic contact dermatitis)

41

most common causes allergic contact dermatitis

poison ivy poison oak
nickel
soaps
latex

42

Tx for allergic contact dermitiis

topical corticosteroids and antihistamines

43

erythema multiforme

serious cuteaneous HS reaction
drugs infection or vaccines cause it

44

signs of erythema multiforme

malaise, myalgias, pruritis, macules, plaques, vesicles
target lesions

45

labs in erythema multiforme

increased eosinophiles
skin Bx will show increased lymphocytes and necrotic keratinocytes

46

Tx for erythema multiforme

stop offending agent, corticosteroids, analgesics

47

what drugs commonly cause erythema multiforme

penicillins, sulfonamides, NSAIDs, oral contraceptives and anticonvulsants

48

stevens johnson syndrome

severe form erythema multiforme
mucous membranes and skin sloughing
high risk dehydration

49

Common infectious causes erythema multiforme

HSV and mycoplasma pneumonia

50

Topic epidermal necrolysis

HS reaction of skin sloughing and full thickness epidermal necrosis

51

labs in toxic epidermal necrolysis

dec WBC
dec Hb and Hct
inc ALT AST

52

Tx for topic epidermal necrolysis

stop offening agent, Tx in burn center with IV hydraiton, corticosteroids and IV Ig

53

Seborrheic dermatitis

chronic hyperporliferation
plaques with yellow greasy scales

54

Tx for seborrheic dermatitis

shampoo with selenium, tar or ketoconazole for scalp
topical corticosteroids and antigundals

55

atopic dermatitis

chronic skin rahs, dry skin patches with papules

56

risk factors atopic dermatiits

asthma, allergic rhinitis, FMH

57

Tx for atopic dermatitis

moisturizing cream, topical corticosteroids or tacrolimus

58

rash in atopic dermatitis

pruritis
erythematous patches of dry skin, maybe vesicles on flexor surfaces and dorsum hands and feet, chest, back or face

59

cradle cap

seborrheic dermatitis in infants

60

psoriasis

epidermal hyperproliferation
red plaques with silvery scales on extensor surfaces
auspitz sign- bleed easily when scales removed

61

labs of psoriasis

- RF
skin Bx will show thickened epidermis
absend granular cell layer
nucleated cells in stratum corneum and increased uric acid and ESR

62

tx psoriasis

topical corticosteroids, tar, retinoids, tacrolimus, antifungals, phototherapy, MTX, cyclosporine, anti-TNFa

63

pityriasis rosea

viral association
papular lesion on trunk and extremities in tree pattern
herald patch is the singe round lesion that appears before the eruption

64

Tx of pityriasis rosea

topical steroids, phototherapy, erythromycin

65

erythema nodosum

inflammation subcut fat septa causeing painful erythematous nodules on anterior tibias or trunk

66

cause of erythema nodosum

delayed immunologic reaction, collagen vascular diseases, IBD, drugs

67

labs in erythema nodosum

possible + ASO titer
increased ESR
skin Bx shows fatty infiltration

68

Tx erythema nodosum

NSAIDs, K iodide, corticosteroids

69

pemphigus pemphigoid

autoimmune with auto Ab to epidermal BM

70

signs pemphigus pemphigoid

painful fragile blisters in oropharynx, on chest, face and perineal region
rupture easily

71

skin Bx pemphigus pemphigoid

separating epidermal cells (acantholysis) with intact BM
antiepidermal Ab on immunofluorescence

72

Tx pemphigus pemphigoid

corticosteroids, azathioprine or cyclophosphamide

73

complications pemphigus pmephigoid

sepsis, osteoporosis
high mortality if not treated

74

bullous pemphigoid

autoimmune with autoAb against BM

75

signs of bullous pemphigoid

above 60 years old
widespread blistering especiialy flexor surfaces and perineal area
erosions
pruritis

76

Tx bullous pemphigoid

oral or topical corticosteroids or azathioprine

77

porphyria cutanea tarda

deficiency of hepatic uroporphyrinogen decarboxylase
used for heme metabolism

78

risk factors for porphyria cutanea tarda

alcoholisms
hep C
iron overload
estrogen use
smoking

79

signs Sx porphyria cutanea tarda

chronic blistering lesions on sun exposed areas like dorsum of hands
hyperpigmented skin, facial hypertrichosis
ruptured blisters heal poorly

80

labs in porphyria cutanea tarda

elevated LFTs
increased total plasma porphyrin
increased urine porphyrins
decreased uroporphyrinogen decarboxylase

81

Tx of porphyria cutanea tarda

periodic phlebotomy, low dose chloroquine, hydroxychloroquine
sunscreen use, avoidance triggers

82

actinic keratosis

precancerous skin lesion

83

what can actinic keratosis change into

squamous cell CA

84

risk factors actinic keratosis

sun exposure

85

rash in actinic keratosis

erythematous papule with rough yellow-brown scales that are

86

Bx of actinic keratosis

dysplasia epithelium

87

Tx actinic keratosis

topical 5 -fluorouracil or imiquimod or cryotherapy

88

complications

only 0.1% progress to squamous cell CA

89

what skin lesion is hyeprpigements, warty and looks "stuck on"

seborrheic keratosis

90

when suspect actinic keratosis next step

Bx to rule out squamous cell

91

what sunlight radiation causes cancer

UVB

92

what does squamous cell carcinoma of skin look like

painless, erythematous papule with scaling or keratinized growths
can bleed or uclerate

93

Mohs excision

serial shallow exicions with histo analysis to minimzed cosmetic damage

94

complications squamous cell carcinoma

5-10% mets

95

basal cell carcinoma comes from

basal epidermal cells

96

pearly papule iwht telangiectasias

basal cell

97

Bx of basal cell

basophilic staining epidermal cells in palisades

98

Tx basal cell carcinoma

surgical excision, mohs, radiaiton or crytotherapy

99

most common skin cancer

basal cell

100

complications basal cell

mets in less than 0.1%

101

risk factors melanoma

sun exposure, fair complexion, FMH, numerous nevi

102

types of melanoma

superficial spreading
nodular
acral lentiginous
lentigo maligna

103

what do you not do for suspected melanoma

shave Bx

104

most common type melanoma

superficial spreading
laterally before vertically

105

describe nodular melanoma

grows only vertically and invasive rapidly
difficult to detect

106

where is acral lentiginous melanoma

palms, soles and nail beds

107

slow melanoma

lentigo

108

Tx malnoma

surgical excision with 0.5 cm margin in situ
1 cm margin if 2mm thick
possible lymph node dissection
chemo and radiation if mets

109

complications melanoma

aggressive,
mets to lung, brain and GI tract

110

most important prognostic factor for melanoma

thickness of lesion