Flashcards in Dermatology 2 Deck (23):
0
Pemphigus vulgaris – causes?
#drug induced (ACE inhibitors, penicillamine, phebobarbitol, penicillin)
#autoimmune
1
Pemphigus vulgaris – clinical features? Clinical sign?
#Easily ruptured bullae
#Mouth involvement
#Fluid loss infection widespread (like a burn)
Nikolsky sign
2
Pemphigus vulgaris - diagnosis and management?
Biopsy showing antibodies on a immunofluroescent studies
#Systemic steroids
#Azathioprine or mycophenolate to wean patient off steroids
#Rituximab
#IVIg in refractory cases
3
Bullous Pemphgoid vs Pemphigus vulgaris - bullae? Mouth involvement? Infection rates?
Intact versus rupture easily
Uncommon versus common
Less lots of fluid and infection vs more
4
Patient presents with intact bullae and negative Nikolaky sign – suspected diagnosis? Most accurate test? Best initial therapy? (Subsequent therapy?)
If mild, can treat with?
Bulbous pemphigoid
Biopsy with immunofluorescence stains
Prednisone (later steroid alternatives)
#Dapsone
#Nicotinamide
5
Patient presents with blistering skin disease on the backs of hands and face – suspected diagnosis? Specific history to get?
Porphyria cutanea tarda (rash on sun exposed areas)
#Hepatitis C, or liver disease from alcohol
#Estrogen use
#Hemachromatosis
6
Patient presents with blisters on sun exposed areas – diagnosis? Deficiency? most accurate diagnostic test? Treatment?
Porphyria cutanea tarda
Uroporphyrin decarboxylase
24-urine for uroporphyrins
#stop EtOH and estrogens
#phlebotomy
7
Oral vs IV medications for cellulitis, folliculitis, furuncles, carbuncles?
If penicillin allergic?
If MRSA?
Mild disease (oral meds)
#dicloxacillin, cephalexin, cefadroxyl
#Penicillin allergic – erythromycin, clarithromycin, clindamycin
#MRSA – doxycycline, clindamycin, Bactrim
Severe disease (IV)
#Oxacillin, nafcillin, cefazolin
#Penicillin allergy – clindamycin, vancomycin
#MRSA – vancomycin, daptomycin, tigecycline, ceftaroline
8
Anti-staph penicillins?
OX-CLOX-DICLOX-NAF
9
Staph infection - Switch to these if patient develops penicillin induced rash? Anaphylactic reaction?
Switch to cephalosporins
If mild infection: macrolides, clindamycin, doxycycline, Bactrim
If severe infection: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
10
Location of body:
1. Tinea corporis
2. Tinea manus
3. Tinea pedis
4. Tinea cruris
5. Tinea unguium
1. Body
2. Hand
3. Foot
4. Groin
5. Nail
11
Fungal skin infection – best initial test? Most accurate test? Best initial therapy if hair/nails not involved?
Best initial therapy if hair and nails involved?
KOH prep
Fungal culture
Topical Antifungal
Terbinafine Or itraconazole
12
Topical antifungals?
#Clotrimazole
#Ketoconazole
#Econazole
#Miconazole
#Nystatin
#Ciclopirox
13
Side effect of oral ketoconazole?
Gynecomastia (anti-androgenic)
14
Patient with oral/vaginal candidiasis best initial test? Most accurate test? Best initial treatment?
KOH prep
Fungal culture
Topical antifungal
15
Drugs that cause hypersensitivity skin reactions?
#Penicillins
#Sulfa drugs (including thiazides, furosemide, sulfonylureas)
#Allopurinol
#Phenytoin
#Lamotrigene
#NSAIDs
16
Drugs that cause hypersensitivity skin reactions also cause?
#Hemolysis
#Interstitial nephritis
#Drug induced thrombocytopenia
17
Hypersensitivity skin reactions in order of the severity? Therapies?
#Morbilliform rash (skin intact without mucous membrane involvement – no therapy)
#Erythema multiforme (small target lesions without mucous membrane involvement – prednisone)
#Stevens-Johnson syndrome (rash involves mucous membranes and sloughing off of respiratory epithelium leading to respiratory failure – IVIg)
#Toxic epidermal necrolysis (rash with mucous membrane involvement and Nikolsky sign – IVIg)
18
In addition to drug reactions, erythema multiforme also seen with?
Herpes or Mycoplasma
19
Staphylococcal scalded skin syndrome findings vs Toxic shock syndrome?
#Like TEN, including Nikolsky sign
Versus
#Same skin findings AND:
#Hypotension
#Renal dysfunction (elevated BUN and creatinine)
#Liver dysfunction
#Delirium (CNS involvement)
20
Treatment of staphylococcal scalded skin syndrome him and toxic shock syndrome?
Oxacillin or Nafcillin or cefazolin
21
Side effect of isotretinoin?
Hyperlipidemia
22