Derm Stepup Flashcards
1
Q
what causes cellulitis
A
staph aureus
GAS
MRSA
2
Q
risk facotrs cellulitis
A
IV drug use and DM
immunicompromised
srugery
venous or lymphatic dysfunction
3
Q
H and P for cellulitis
A
erythema, swollen and painful skin, myalgias, chillas, warmth
fever, lymphadenopathy
4
Q
labs in cellulitis
A
inc WBC ESR and cRP
5
Q
Tx cellulitis
A
oral cephalosporings, penicillinase-R beta lactams
IB antibioics for severe cases
linezolid or vanco for MRSA
6
Q
complications cellulitis
A
necrotizing fasciitis
7
Q
abscesses in lower back and perineal area are caused by what bacteria
A
anaerobes
8
Q
hidradenitis suppurativa
A
chronic follicular occlusion and apocrine gland inflammation
causes recurrent abscesses in axilla groin and perineum
9
Q
Tx for hidradenitis suppurativa
A
incision and drainage
10
Q
complications of hidradenitis suppurativa
A
large eroding facial abscess can cause cavernous sinu thormbosis
11
Q
what causes necrotizing fasciitis
A
GAS or multipathogen
12
Q
signs necrotozing fasciitsi
A
erythema, warm swollen skin loss of sensation fever crepitus from gas purple discoloration bullae
13
Q
labs in necrotizing fasciitis
A
inc WBC ESR and CRP
14
Q
imaging for necrotizing fasciits
A
XR or CT
15
Q
Tx for necrotizing fasciitis
A
surgical debridement, drainage, IB antibitics
16
Q
what causes gangrene
A
poor vascular supply or severe infection (perfringens)
17
Q
rotten smelling skin
A
gangrene
18
Q
dry gangrene
A
gradual necrosis of skin from vascular insufficiency
19
Q
wet gangrene
A
necrosis from acute vascular obstruction or infection
have blistering
20
Q
imaging of gangrene
A
subcutaneous air on XR or CT for wet gangrene
angiography or MRA for vascular insufficnecy
21
Q
what causes impetigo
A
GAS or staph
22
Q
Tx impetigo
A
washing
erythromycin
cephalosporins
topical antibiotics
23
Q
what causes acne vulgaris
A
propionibacterium acnes
24
Q
Tx for acne vulgaris
A
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
