Dermatology Flashcards
(301 cards)
1
Q
Long term use of immunomodulator meds increases the risk of developing?
A
Lymphoma
2
Q
Atopic dermatitis (eczema)
A
chronic inflammatory skin condition that starts in infancy and persists into adulthood. characterized by puritis leading to lichenification.
3
Q
Atopic triad
A
asthma, eczema, allergic rhinitis
4
Q
Patients with eczema are at increased risk for?
A
2ndary infections with staph aureus and viral HSV or molluscum due to itch/scratch cycles
5
Q
Triggers for eczema?
A
climate, food, stress, skin irritants, allergens
6
Q
Manifestation of eczema in
Infants: Children: Adults:
A
Infants: red, edematous, weeping, puritic papules and plaques on face, scalp, extensor surfaces (diaper usually spared)
Children: dry, scaly, pruritic, excoriated papules/plaques in flexural areas and neck
Adults: lichenification and dry, fissured skin in flexural areas. hand or eyelids too
7
Q
How to diagnose eczema?
A
Clinical.
KOH prep can help distinguish eczema from tinea
Eosinophilia and IgE may be seen in some patients with eczema but not used to diagnose
8
Q
Treatment for Eczema
A
Topical corticosteroids- 1st line (use intermittently to avoid skin atrophy)
9
Q
Other pharm therapy to treat eczema and avoid steroids?
A
Immunomodulators- Tacrolimus
10
Q
Erythema toxicum neonatorum
A
begins 1-3 days after delivery and resembles eczema, presenting with red papules, pustules, vesicles with surrounding erythematous halos. Eosinophils present in the pustules or vesicles.
11
Q
Treatment for erythema toxicum neonatorum?
A
Bening. usually resolves in 1-2 weeks without treatment.
12
Q
Contact dermatitis
A
Type IV hypersensitivity reaction. results from contact with an allergen that patient has previously been exposed to (nickel, poison ivy, perfume/deodorant, neomycin)
13
Q
Contact dermatitis description
A
“linear” “angular”
can spread over body if hands spread it or via transfer via circulating T lymphocytes.
14
Q
Is latex a contact dermatitis reaction?
A
NO- type 1!
15
Q
Type I hypersensitivity reaction
Mechanism
A
Antigen cross-links IgE on presented mast cell and basophils triggering release of vasoactive amines (histamine). develops rapidly due to preformed antibody.
16
Q
What types of hypersensitivy reactions are antibody mediated
A
I, II, III
17
Q
Asthma is what type of hypersensitivity reaction?
A
Type I
18
Q
Type II hypersensitivity reaction
A
IgM and IgG bind to antigen on enemy cell- lead to lysis by complement or phagocytosis -> leading to MAC
19
Q
goodpasture syndrome is a ___ hypersensitivity reaction?
A
Type II
20
Q
Rheumatic fever is ___ hypersensitivity rxn?
A
type II
21
Q
Autoimmune hemolytic anemia, erythroblastosis fetalis are type ____ hypersensitivity rxn?
A
II
22
Q
Type III hypersens rxn
A
antigen/antibody complexes activate complement. complement attracts PMNs which release lysosomal enzymes.
23
Q
What is an immune complex?
A
Antigen-antibody-complement
24
Q
Glomerulonephritides and vasculitides are often type ____ hypersens rxn?
A
Type III
25
Arthus reaction
Type III: local reaction to antigen by preformed antibodies (vascular necrosis and thrombosis)
26
when might an arthus reaction occur?
rarely 4-12 hours post vaccination
27
hypersensitivity pnemonitis is what type of hypersensitivity reaction?
Type III (Arthus reaction)
28
Serum sickness
antibodies to foreign proteins are produced in 5 days. Immune complexes form and deposit in membranes- lead to tissue damage by fixing to complement.
Ex: drug reaction
29
type IV hypersensitivity
Delayed cell mediated. sensitized T lymphocytes encounter antigen, release lymphokines and lead to macrophage activation
30
TB skin test is what type hypersens rxn?
Type IV
31
transplant rejection is what type hypersens?
type IV
32
How do you diagnose contact dermatitis
Patch testing (after acute phase eruption is treated)
33
Treatment
topical corticosteroid and allergen avoidance (systemic corticosteroid in severe cases)
34
Seborrheic dermatitis
common. chronic inflammatory skin disease caused by hypersensitivity to (Malassezia furfur, a generally harmless yeast found in sebum and hair follicles)
35
Malassezia furfur
yeast found in sebum, hair follicles, around sebaceous glands- can lead to seborrheic dermatitis reaction
36
Presentation of seborrheic dermatitis
Infants:
Children/Adults:
Infants: severe, red diaper rash with yellow scale, erosions, blisters. scaling and crusting (cradle cap) on scalp
children/adult: red, scaly, patches seen around ears, eyebrows, nasolabial fold, midchest, scalp.
37
Who is at higher risk for severe seborrheic dermatitis?
HIV/AIDS and Parkinson disease patients
38
Diagnosis of seborrheic dermatitis?
clinical
39
Treatment of seborrheic dermatitis?
Selenium sulfide or Zinc Pyrithione shampoo
Topical antifungal (ketoconazole cream) or topical corticosteroid for other areas.
40
Stasis dermatitis
Lower extremitity dermatitis due to venous hypertension (forcing blood from deep to superficial venous system)
41
Venous htn is often a result of?
Venous valve incompetence or flow obstruction
42
Where does stasis dermatitis usually occur?
medial ankle. stasis ulcers may develop
43
treatment for stasis dermatitis?
leg elevation, compression stockings, emollients, topical steroid
44
Eczema herpeticum
medical emergency. grouped vesicles. emergency due to propensity for systemic spread- potentially to brain.
45
treatment for eczema herpeticum?
IV acyclovir
46
A rash involving extensor surfaces think?
psoriasis
47
Flexor surface rash think?
atopic dermatitis (unless infant- located on extensor)
48
Psoriasis
T-cell mediated inflammatory dermatosis characterized by erythematous plaques with silver scale (dermal inflammation and epidermal hyperplasia)
49
Koebner phenomenon
lesions of psoriasis can be provoked by local irritation or trauma
50
What medications may worsen psoriatic lesons?
B-blockers, lithium, Ace-Inh
51
finding is psoriatic arthritis
small joints in hands and feet affected. "sausage digits" and pencil in cup on xray
52
Diagnosis of psoriasis
Clinical. Biopsy if diagnosis uncertain.
53
Auspitz sign?
Pinpoint bleeding when scale of psoriasis is scraped
54
histology for psoriasis shows?
thickened epidermis, elongated rete ridges, absent granular cell layer, preservation of nuclei in stratum corneum (parakeratosis), neutrophil infiltrate in stratum corneum (munro microabscess)
55
parakeratosis
nuclei in stratum corneum in psoriasis
56
munro microabscess
neutrophil infiltrate in stratum corneum in psoriasis (sterile)
57
Treatment for psoriasis
Topical steroids
Calcipotriene (Vit D)
Tazarotene (Vit A)
58
If you have severe psoriasis or psoriatic arthritis treat with?
Methotrexate or anti-TNF biologics
| UV light therapy can also be used for patients with lots of skin involvement
59
Urticaria (hives)
Result from release of histamine and prostaglandins from mast cells in type I hypersensitivity response
60
Dermal edema
urticaria/ wheals
61
Most common cause of chronic urticaria
idiopathic
62
Treatment for urticaria?
Systemic antihistamines
63
treatment for anaphylaxis?
epinephrine, antihistamine, IV fluid, airway maintenance
64
morbilliform rash should make you think of
drug reaction
65
Patients with drug reactions often have what on histology?
eosinophilia
66
When do drug reactions usually take place?
7-14 days after starting a new drug
67
IF a patient reacts within 1-2 days of starting a new drug is it likely the causative agent?
NO
68
Extreme complications of drug eruptions include?
Erythroderma, SJS, TEN
69
erythroderma
intense, wide spread reddening of the skin with exfoliation
70
treatment for drug reaction
stop drug. antihistamines for symptoms. topical steroids for itching if needed
71
Erythema multiforme
Cutaneous reaction with targetoid lesions that have many triggers (often recurrent)
72
Presentation of erythema multiforme
Lesions start as erythematous macules that become centrally clear and develop a blister. may have systemic symptoms (fever, myalgias, arthralgias, HA)
73
What characteristic part of body is often affected with erythema multiforme?
PALMS AND SOLES
74
Erythema multiforme major involves?
mucous membranes
75
Nikolsky sign
Push on rash and it exfoliates
76
Nikolsky (+) or (-) in EM, SJS, TEN?
EM: (-) SJS: (+) TEN: (+)
77
Treatment of erythema multiforme
symptomatic treatment (systemic corticosteroids have no benefit)
78
SJS and TEN
2 diff points on spectrum of life-threatening exfoliative mucocutaneous diseases often caused by drug induced immune reaction
79
Epidermal separation of SJS involve < ___ % of body surface area whereas TEN involves > _____ % of BSA.
SJS < 10%
TEN > 30%
80
Common drugs that may cause SJS/TEN
Sulfa, penicillins, seizure meds, quinolones, cephalosporins, steroid, NSAIDs
81
Diagnosis of SJS
Biopsy: degeneration of basal layer of epidermis
82
Diagnosis of TEN
Full-thickness eosinophilic epidermal necrosis
83
With (+) Nikolsky sign, what should be on differential?
SJS, TEN, SSSS, graft vs. host (after bone marrow transplant), radiation therapy, burns)
84
SSSS is usually seen in? etiology?
kids < 6 (infectious etiology)
85
SJS/TEN usually seen in? etiology?
adults, drugs
86
Treatment of SJS/TEN
early diagnosis. discontinue drug
| cover skin, manage fluids and electrolytes like you would for burn victim
87
Erythema nodosum
panniculitis process of subcu adipose tissue caused by infection wth strep, coccidiodes, yersinia, TB, drug rxns (sulfa, abx, OCPs) and chronic inflammatory diseases (sarcoid, crohn, ulcerative colitis, behcet)
88
panniculitis
process of subcu adipose tissue
89
erythema nodosum presents as?
painful, red nodules on anterior shins. slowly spread- turning brown or gray. Present with fever and joint pain
90
Patients with erythema nodosum may have what false (+) test
VDRL
91
Work up for erythema nodosum?
ASO, PPD in high risk patients, CXR (sarcoid), IBD work up?
92
Treatment for erythema nodosum?
underlying disease. cool compress, NSAID, potassium iodide
93
```
BULLOUS PEMPHIGOID
location of blisters:
autoantibodies:
blister appearance:
nikolsky sign:
mucosal involvement:
patient age:
med triggers:
mortality:
diagnosis:
treatment:
```
location: basement membrane zone
autoantibodies: hemidesmosomes
appearance: firm, stable blisters, can be preceded by urticaria
Nikolsky: (-)
Mucosal involve: no rarely
Patient age: > 60
Trigger: idiopathic
Mortality: rare, and milder course
Diagnosis: clinical. skin biopsy with direct immunoflorecense is best test or ELISA
Treatment: prednisone
94
```
PEMPHIGOUS VULGARIS
location of blisters:
autoantibodies:
blister appearance:
nikolsky sign:
mucosal involvement:
patient age:
med triggers:
mortality:
diagnosis:
treatment:
```
location of blisters: intraepidermal
autoantibodies: desmoglein (keratinocye adhesion)
blister appearance: erosion more common bcz no keratinocyte adherence
nikolsky sign: +
mucosal involvement: common
patient age: 40-60
med triggers: ACE-in, penicillamine, phenobarb, penicillin
mortality: possible
diagnosis: clinical. skin biopsy with direct immunoflorecense is best test or ELISA
treatment: high dose therapy or immunomodulators
95
HSV1 vs HSV2
HSV1- oral-labial
| HSV2- genital
96
Recurrent HSV-1 often triggered by?
sun and fever
97
Diagnosis
Clinical. Viral culture of lesion is most accurate test.
98
Positive Tzanck smear will show?
Multinucleated giant cells
99
If no multinucleated giant cells on Tzanck smear is it herpes?
NO
100
Treatment of herpes in immunocompromised patient
need to start antiviral (acyclovir, famciclovir, valacyclovir) within 72 hours of start of outbreak
101
Treatment for herpes if severe frequent recurrences- more than 6 outbreaks/year?
Daily prophylaxis with acyclovir, famciclovir, valacyclovir
102
Symptomatic HSV lasting > 1 month can be a sign of
AIDS defining illness
103
In adults, varicella zoster infections can be more severe and have associated systemic complications like
pneumonia and encephalitis
104
Treatment for varicella in kids?
self-limited
105
Treatment for varicella in adults?
acyclovir
106
pain control for adults with varicella?
neuropathic agents: gabapentin. TCAs
107
If immunocompromised, pregnant or newborn is exposed to varicella zoster how do you treat?
WIthin 10 days they should be given varicella immunoglobulin
108
Immunocompetent adults should receive a varicella vaccine within ____ days of exposure?
5
109
If you see giant molluscum contagiosum think:
HIV and decreased cellular immunity
110
Molloscum is spread by?
direct skin to skin contact
111
Diagnosis of molluscum
clinical. best test is large inclusions (molluscum bodies) seen under microscope
112
What subtypes of HPV lead to squamous malignancies?
16 and 18
113
Spread of HPV is by?
direct contact
114
Condyloma accuminatum - genital warts are caused by HPV subtypes
6,11
115
How do you visualize mucosal HPV lesions?
acetic acid
116
most accurate test to diagnose HPV?
PCR
117
Bullous impetigo is almost always caused by?
staph aureus
118
Impetigo affects what skin layers?
Epidermis
119
Cellulitis affects what skin layers?
Dermis and subcu fat
120
Erysipelas affects what skin layers
dermis
121
Nec fasc affeccts what skin layers
subcu and fascia and muscle
122
Rash of salmonella typhi
small pink papules on trunk "rose spots" in groups of 10-20
123
For chronic carrier state of salmonella typhi what operation should be considered?
cholecystectomy
124
Treatment for impetigo
mild:
severe non-MRSA
severe MRSA likely
mild: mupirocin topical
severe non MRSA: cephalexin, dicloxacillin, erythromycin
severe MRSA: TMP-SMX, clinda, doxy
125
Erysipelas
typically raised, indurated, well demarcated area confined to dermis and typically caused by strep
126
Treatment for cellulitis
5-10 days of oral antibiotics. IV antibiotics if evidence of systemic tox, comorbid conditions, DM, extremes of age, hand or orbital involvement
127
Nec Fasc
Mixed infection of anaerobic and aerobic bacteria that includes S. aureus, E.coli, C.perfringens
128
Presentation of nec fasc
erythema quickly spreads over course of hours to days and skin becomes dusky or purple leading to necrosis
129
physical exam signs suggesting nec fasc
gas production, crepitus, putrid discharge, bullae, severe pain
130
Treatment
immediate surgery and debridement and broad spectrum antibiotics (penicillin G is drug of choice for strep)
131
Why is clindamycin helpful in nec fasc
used to decrease toxin production by bacteria
132
for anaerobic coverage for nec fasc use?
metronidazole or 3rd gen cephalosporin
133
Ludwig angina
bilateral cellulitis of submental, submaxillary, sublingual spaces that results from an infected tooth.
134
How does ludwig angina present?
dysphagia, drooling, fever, red, warm mouth and can lead to death from asphyxiation
135
Does erythromycin cause photosensitivity?
No! Its doxy and tetra
136
Treatment for superficial folliculitis?
mupirocin
137
Treatment for more severe folliculitis?
cephalexin, cloxacillin and clinda if MRSA is suspected
138
Most effective treatment for comedonal (black head) acne
Topical retinoid cream
139
What kills p.acnes?
Topical benzoyl peroxide
140
If retinoids and benzoyl peroxide are inadequate, what can you use for comedonal black head acne?
topical clindamycin or erythromycin
141
General progression of pharmacotherapy for acne treatment?
topical benzoyl peroxide/retinoid/antibiotic/oral antibiotic/oral isoretinoin
142
isoretinoin (oral) contraindications
teratogen
elevates LFTs
patients require periodic blood tests to check LFTs, cholesterol, triglycerides
143
Pilonidal cysts
abscesses in the sacrococcygeal region. starts as folliculitis then becomes infected with perineal microbes like bacteroides (most common in 20-40 year old men)
144
Pilonidal cysts can develop into?
perianal fistulas
145
Risk factors for pilonidal cyst?
deep and hairy natal clefts, obesity, sedentary lifestyle
146
Treatment for pilonidal cyst?
Incision and drainage and sterile packing of wound
147
Tinea versicolor
Caused by malassezia furfur- yeast that is part of normal skin flora (humid conditions and oily skin can make organism pathogenic
148
risk factors for tinea versicolor
cushing syndrome. immunosuppression
149
presentation of tinea versicolor
small scaly patches of varying color on chest or back. patches can be hypopigmented or hyperpigmented
150
Diagnosis
clinical. best test is KOH prep of scale revealing "spaghetti and meatball" (hyphea and spores)
151
Treatment for tinea versicolor
ketoconazole cream or selenium sulfide cream
152
Candidiasis presents in what areas?
moist areas like groin, skin folds, vagina, below breast
153
Oral thrush is common in infancy?
| What is it a sign of in adults?
Yes common in infants!
| Sign of immunocompromise in adults
154
Oral candidiasis presents as
painless white plaques that can be easily scraped off
155
Candidiasis of the skin
erythematous patches with occasional erosions and satellite lesions often seen in skin folds and diapers of infants
156
Diagnosis of candida?
clinical. KOH- candidal spores and psuedohyphea. Best test is fungal culture
157
Treatment for oral candidiasis
oral fluconazole tablets
nystatin swish and swallow
clotrimazole
158
treatment for superficial skin candidiasis
topical antifungal
159
treatment for candidiasis diaper rash
topical nystatin
160
Dermatophyte infections occur only in
cells with keratin (skin, hair, nails)
161
Causative dermatophyte organisms
trichophyton, microsporum, epidermophyton
162
Risk factors for dermatophyte infection
DM, decrease peripheral circulation, immune compromise, chronic maceration of skin (athletic activity)
163
Types of dermatophyte infections
tinea corporus, tinea pedis/manuum, tinea cruris, tinea capitis
164
tinea corporis
scaly, pruritic eruption with sharp irregular border and with central clearing (ringworm like rash)
165
tinea pedis/manuum
chronic interdigital scaling with erosions between toes or as thickened scaly skin on soles of feet and involvement of 1 hand is typical in 1 hand/2 feet syndrome
166
tinea cruris
jock itch. typically spares scrotum.
167
tinea capitis
fungal scalp infection causing scaling and hair loss.
168
keroin
large inflammatory, boggy mass caused by tinea capitis
169
Diagnosis of tinea
clinical. Best initial test: KOH showing hyphea. Most accurate. fungal culture
170
Treatment of tinea?
| Exception?
topical antifungal. escalate to oral if infection is widespread.
Tinea capitis must be treated with oral medications to penetrate into hair follicles.
171
Pubic lice bites often turn what color? why?
blue. contain anticoagulant in their saliva.
172
Treatment of head lice:
topical permethrin. pyrethin. benzoyl alcohol. mechanical removal
173
body lice treatment
wash body, clothes, bedding. rarely may need topical permethrin
174
pubic lice
permethrin, pyrethin, benzoyl alcohol, mechanical removal
175
can scabies be seen with naked eye?
no
176
diagnosis of scabies.?
history of itching in several family members is suggestive
177
treatment of scabies
5% permethrin from neck down. (head to toe in infants) and contacts should be treated as well.
Ivermectin can also be used
clothing and bedding should be thoroughly washed
178
3 types of gangrene
Dry, wet, gas
179
dry gangrene
due to insufficient blood flow to tissue- typically from atherosclerosis. early signs are dull ache, cold, pallor. necrosis sets in and tissue becomes blue/black
(DM, vasculopathy, smoking are risk factors)
180
wet gangrene
bacterial infection with skin flora. tissue appears bruised, swollen, blistered with pus
181
gas gangrene
c.perfringes infection (med emergency!)
| associated with dirty wounds contaminated with dirt or fecal matter
182
subcu injection of black tar heroin is a risk factor for?
gas gangrene
183
Skin finding for paraneoplastic sign of GI adenocarcinoma
Acanthosis nigricans
184
lichen planus 6 P's
planar, purple, polygonal, pruritic, papules, plaques
185
What drugs can induce lichen planus?
thiazide, quinolone, b-blocker
186
lichen planus is associated with what infection?
HCV
187
Wickham striae
lacy white lines present on lichen planus lesions
188
Koebner phenom
lesions that appear at site of trauma (can occur in lichen planus)
189
Treatment of mild lichen planus
topical corticosteroids
190
Rosacea
chronic disorder of pilosebaceous units without a clear etiology
191
Central facial erythema with telangiectasias is an early sign of?
rosacea
192
rhinophyma
longstanding facial rosacea can lead to severe overgrowth of nasal connective tissue
193
Treatment for rosacea
topical metronidazole
| for severe or ocular disease- oral doxycycline
194
How can you differentiate pityriasis rosea from 2ndary syphillus?
pityriasis spares palms and soles
195
Pityriasis roseA
acute dermatitis reaction best hypothesized to result from viral infection with human herpesvirus
196
herald patch
initial lesion of pityriasis rosea. erythematous with peripheral scale.
197
differential for pityriasis
secondary syphilis. tinea corporis.
198
Treatment of pityriasis rosea
heals in 6-8 weeks without treatment. skin lube, antipruritics, antihistamine for symptoms
199
Vitiligo often presents on?
hands, face, genitals
200
treat vitiligo with?
topical steroids, tacrolimus ointment, UV and laser therapy
201
eyelid lesions types
xanthelasma, hordeolum, chalazion
202
xanthelasma
soft, yellow plaques on medial aspects of eyelids associated with hyperlipidemia and primary biliary cirrhosis
203
hordeolum
painful acute eyelid gland infection (stye) (usually staph aureus located on edge of lid)
204
Chalazion
painless cyst due to blocked eyelid gland
205
Seborrheic keratosis
very common skin tumor that appears in almost all people after age 40. no malignant potential.
206
presentation of seborrheic keratosis
exophytic, waxy brown papule and plaque with superficial keratin cysts. "stuck on appearance"
207
Treatment
cryotherapy, shave excision, currettage. Some may appear similar to melanoma so biopsy may be needed
208
Actinic keratosis
flat areas of erythema and scale caused by exposure to sun. need to be treated to prevent transformation into squamous cell carcinoma
209
Treatment actinic keratosis
cryosurgery, topical 5-FU, topical imiquimod
210
Cutaneous squamous cell carcinoma
2nd most common skin cancer. sun exposure most common cause. chemical carcinogens, radiation therapy, burns or trauma (draining infection sinuses in osteomyolitis), chronic immunosuppression (transplant recipient) all dispose patients to SCC
211
Presentation of SCC
erythematous, ulcerated, papule or nodule
212
Marjolins ulcer
type of rare SCC that arises in sites of scars, burns, ulcers
213
Arsenic exposure
rare cause of multiple SCC in palmoplantar distribution
214
SCCs that rise from actinic keratosis are more or less likely to metastasize than those on lips and those that form ulcers?
less likely if from actinic keratosis
215
Diagnosis
confirm with shave biopsy
216
Treatment of SCC
surgical excision. Mohs surgery (very thin slices excised and examined). lesions with high metastatic potential may need radiation or chemo.
217
basal cell carcinoma
most common malignant skin cancer. slow growing and locally destructive but has VIRTUALLY NO METASTATIC POTENTIAL.
218
inherited basal cell nevus syndrome
multiple BCCs appearing early in life and on non-sun exposed areas
219
Melanoma
most common life threatening derm disease.
220
Risk factors for melanoma
fair skin, tendency to burn, intense burst of sun exposure (especially in childhood and with intermittent exposure), presence of large congenital melanocytic nevi, increased number of nevi or dysplastic nevi. Immunosuppression increases risk.
221
FAM-M syndrome
familial atypical mole and melanoma syndrome (inherited predisposition to melanoma)
222
ABCDEs of melanoma
asymmetric, irregular border, color variation, diameter >6, evolution (change)
223
Diagnosis
excisional biopsy on any suspiciuos lesionq
224
itching in a changing skin lesion is suspicious for?
malignancy
225
Staging of malignant melanomas?
Breslow thickness (depth of invasion in millimeters) and by tumor-node-metastasis (TNM)
226
poor prognostic sign for melanoma?
ulceration
227
Name the 5 types of melanoma
1. superficial spreading
2. nodular
3. acral lentiginous
4. lentigo maligna
5. amelonotic
228
superficial spreading melanoma
60% of all. Can occur at any age. most common in young adults. presents on trunk in men. legs in women. Prolonged horizontal growth allows for early diagnosis when still confined to epidermis
229
Nodular
Lesions have rapid vertical growth phase and appear as fast growing red-brown nodules with ulcerations
230
acral lentiginous
begins on palms, soles, nail beds as slowly spreading pigmented patch. most common in asian and black
231
lentigo meligna
arises in a solar lentigo. common on sun damaged areas of face
232
amelanotic
lesion without clinical pigmentation. difficult to identify. can be further classified into any above type
233
Patients with early melanoma are at high or low risk of recurrence? high or low risk of subsequent melanomas?
low risk of recurrence.
| high risk of subsequent melanomas.
234
What bacterial infection can mimic kaposi sarcoma?
bacillary angiomatosis caused by bartonella henselae.
235
how do you treat bacillary angiomatosis?
erythromycin
236
Treatment for Kaposi's?
HAART therapy if HIV. small local lesions can be treated with radiation or cryotherapy. Systemic spread to GI tract or lung requires systemic chemo.
237
Mycosis fungoides
slow progressive neoplastic proliferation of T cells. More common in men.
238
Presentation of mycosis fungoides?
non-specific psoriatic appearing plaques or patches that are itchy and on trunk and butt. later lesions are skin tumors with palpable lymph nodes.
239
Sezary syndrome
Leukemic phase of cutaneous T-cell lymphoma characterized by circulating sezary cells in peripheral blood- erythroderma and lymphadenopathy
240
Diagnosis of mucosis fungoides
clinical features, histology, sezary cells on microscopy (ceribriform lymphocytes)
241
treatment for mycosis fungoides
phototherapy. electron beam radiation.
242
cherry angiomas (hemangiomas)
small, vascular, red papule that appear anywhere on body. most common benign vascular tumor. no treatment needed.
243
Immediately after a burn injury, what organisms predominate?
Gram positive
| S.aureus
244
After more than 5 days, which organisms predominate in wound infections?
gram negative or Fungi
| Pseudomonas, Candida
245
Who is at highest risk of a wound infection after a burn?
patients with >20% surface area burns
246
What is the first sign of burn wound infection?
change in appearance- partial thickness burns turn into full thickness injury or wound loses loss of viable skin graft
247
Burn wound sepsis findings for vital signs
temp <36.5 (97.7), >39 (102.2)
Progressive tachy >90
Progressive tachypnea >30
Refractory hypotension <90 systolic
248
In burn patients oliguria, unexplained hyperglycemia, thrombocytopenia, mental status changes are concern for?
wound infection
249
how do you diagnose wound infection in burn patients
quantitative wound culture and biopsy for histopathology
250
Treatment for burn infections?
empiric broad spectrum antibiotics IV (Pip/tazo, carbapenem) with possible Vanc for MRSA coverage or an aminoglycoside for multidrug resistant pseudomonas
251
delayed neuropsychiatric syndrome
carbon monoxide poisoning due to fire exposure can lead to mental status change
252
why does metabolic rate increase after large surface area burns?
release of inflammatory mediators
253
signs of increased metabolic rate with surface area burns?
increased temp to 38.5 (101.3), tachycardia, tachypnea, hyperglycemia
254
Signs of deliberate burn injury and child abuse?
Linear demarcation with no splash marks, extensive burns to back and butt with sparing of flexural creases (due to dipping in boiling water)
255
Compare erysipelas vs cellulitis
erysipelas: superficial dermis, raised and sharply demarcated edges, rapid spread, fever early in course
cellulitis: deep dermis and subcu fat, flat edges poor demarcation, slow spreading, fever later in course
256
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Tinea corporis (ringworm)
risk factors, presentation, treatment
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Risk factors: athletes who have skin-to-skin contact, humid environment, contact with infected animals (rodents)
Presentation: scaly, red, itchy patch with centrifugal spread and later central clearing with a raised annular border
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treatment: topical antifungal (clotrimazole, terbinafine)
oral antifungals (terbinafine, griseofulvin)
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257
nummular eczema
presentation
treatment
red, itchy patch with some scale. can be confused with tinea corporis
treatment- topical corticosteroid and moisture
258
Porphyria cutanea tarda presentation
blisters, bullae, scarring, hypo/hyperpigmentation on sun-exposed skin (back of hands, forearms, face)
scarring and calcifications like with scleroderma
259
Conditions associated with porphyria cutanea tarda
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Hep C
HIV
Excessive alcohol
Estrogen use
Smoking
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260
Testing for porphyria cutanea tarda diagnosis
elevated liver enzymes and iron overload
| elevated plasma or urine porphyrin
261
porphyria cutanea tarda leads to photosensitivity due to accumulation of?
porphyrinogens that react with oxygen by UV light
262
porphyria cutanea tarda is due to deficiency of
uroporphyrinogen decarboxylase
263
Treatment for porphyria cutanea tarda
Phlebotomy or hydroxychloroquine
264
Allergen induced delayed type hypersensitivity
contact dermatitis
265
bacterial invasion of superficial skin infection
impetigo
266
subepidermal anti-transglutaminase IgA autoantibody?
Dermatitis herpetiformis (autoimmune reaction triggered by dietary gluten)
267
vasculitis due to cryoglobulin immune complexes
mixed cryoglobulinemia
(associated with hep C)
palpable purpura, arthralgias, glomerulonephritis
268
cherry angiomas (hemangiomas) are also known as
senile hemangiomas
269
cavernous hemangiomas
dilated vascular spaces with thin-walled endothelial cells. present as soft, blue, compressible masses growing up to a few cm. appear on skin, mucosa, deep tissues, viscera
270
cavernous hemangiomas of brain and viscera are associated with?
Von Hippel-Lindau disease
271
spider angiomas
bright red arterioles surrounding by outwardly radiating vessels. they blanch with pressure. blanch with pressure. estrogen dependent and seen in preg, OCP use, and cirrhosis related hyperestrogenemia
272
strawberry (infantile) hemangiomas
appear during first weeks of life. grow rapidy and then regress spontaneously by 5-8
273
SCC typically present as
enlarging nodule in sun exposed areas with thick rough skin surface or ulceration
274
Is it typical for SCC to cause numbness and paresthesias
Yes- can invade perineural area early
275
Seborrheic dermatitis
common inflammatory disease that affects the scalp (dandruff), face (eyebrow, nasolabial folds, external ear, chest and intertriginous areas.
276
What disorders can seborrheic dermatitis be associated with?
Parkinson disease
| HIV
277
itchy red plaques with fine, loose, yellow greasy looking scale?
seborrheic dermatitis!
278
Treatment for seborrheic dermatitis?
topical antifungals
279
dermatofibroma
fibroblast proliferation causes isolated or multiple lesions- most commonly on lower extremities.
lesions are non-tender and can be triggered by trauma in area or insect bite.
280
"dimple or buttonhole" sign
dermatofibroma with a firm fibrous component that may cause dimpling in the center when its pinched
281
Treatment of dermatofibroma
cryosurgery or shave excision
282
pyogenic granuloma
benign vascular skin tumor that presents as small red papule and grows rapidly over weeks-months to a pedunculated or sessile shiny mass. most commonly occur on lip or oral mucosa and can bleed with minor trauma
283
skin infection caused by poxvirus?
molluscum contagiosum
284
treatment for molluscum
its self limited and lesions usually resolve in 6-12 months
285
SSSS
caused by exfoliative toxin-producing strains of S.aureus
286
why are cultures from bullae in SSSS usually sterile?
because its a toxin mediated process
287
HSV is the most common infectious agent associated with what acute-self limited skin eruption?
erythema multiforme
288
what adults can be affected by SSSS?
kidney disease or immunocompromised
289
if you biopsy erythema toxicum neonatorum- you will find
eosinophils and sterile pustule
290
initial management of comedonal acne ?
topical retinoid with organic acid preparations (salicylic, azelaic, glycolic acid)
291
when should you use benzoyl peroxide for acne?
inflammatory pustular acne
292
histopathology "tombstone cells"
pemphigous vulgaris
293
netlike itercellular IgG and C3 on immunoflourescence?
pemphigous vulgaris
294
autoantibodies against desmogleins 1+3
pemphigous vulgaris
295
acantholysis
detached keratinocytes
296
linear IgG deposits at basement membrane and tense bullae?
bullous pemphigoid
297
Flaccid bullae and mucocutaneous blisters with biopsy showing intraepidermal cleavage
pemphigous vulgaris
298
Two types of contact dermatitis
allergic (type IV hypersensitivity)
| irritant (physical or chemical contact)
299
A rash typically beginning as small papules that become confluent and evolve into vesicles or bullae and eventually crust in 7-10 days. Rash is limited to single dermatome but may involve adjacent dermatomes
Herpes Zoster
300
Widely scattered, red, scaly papules and plaques that often follow strep infection or can occur in patients with RA (on TNF-a)
Guttate Psoriasis
301
Treatment for guttate psoriasis
UV phototherapy
Topical glucocorticoids
Vitamin D
