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Dermatology Flashcards

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1
Q

DDx of atopic dermatitis

A

seborrheic dermatitis, scabies, psoriasis, nutritional deficiencies (zinc), immunodeficiency, cutaneous lymphoma

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2
Q

Which bacteria/viruses can cause superinfection of eczema?

A

Staph aureus, group A strep, candida, viral (HSV, coxsackie, molluscum)

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3
Q

First-line treatment of atopic dermatitis?

A
  • Bathing 1X per day 5-10 min with lukewarm water (frequency unclear). No oils
  • Pat dry, apply steroids then vaseline. Atarax 2-3 times per day for itch
    Hydrocortisone 1% ointment
    Betamethasone valerate 0.05% ointment for the body
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4
Q

Treatment of scabies?

A

5% permethrin overnight + repeat 1 week later, treat household contacts, sheets
Apply to entire body in kids < 2 (neck down in kids and adults)
< 8 weeks old: precipitated sulfur in petroleum

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5
Q

Which organism causes “hot tub folliculitis”?

A

Pseudomonas

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6
Q

Which organism causes furunculosis? Treatment?

A

MRSA
Tx with I&D, (antibiotics are controversial). Recurrence is common, may need decolonization for MRSA with chlorhexidine washes or intranasal mupirocin

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7
Q

Which organism causes bullous impetigo?

A

Staph aureus

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8
Q

What is Nikolsky sign? What conditions is it seen in?

A

skin peeling when rubbed

Seen in SSSS, SJS/TEN

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9
Q

Treatment of SSSS?

A

Tx with oxacillin or beta lactamase-resistant abx (can use cefazolin), add clindamycin for toxin (+vanco if very unwell for MRSA)

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10
Q

List 5 bacteria that cause soft tissue infection in exposure to water? Which organism causes a bullous infection?

A 
Aeromonas species
Edwardsiella tarda
Erysipelothrix rhusiopathiae
Vibrio vulnificus *BULLOUS
Mycobacterium marinum
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11
Q

Which organisms cause tinea capitis?

A

microsporum canis and trichophyton tonsurans

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12
Q

Treatment of kerion?

A

terbinafine/griseofulvin and steroids

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13
Q

DDx of hair loss

A

Tinea capitis/ kerion
Alopecia arreata (no inflammation or scale, hair loss)
Trichotillomania (hairs of different lengths, irregular pattern)

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14
Q

DDx of vesiculobullous rash

A
  • Acquired: Bullous arthropod bites, scabies, drug reaction, friction blisters, burns, dyshidrotic eczema, vasculitis (KD, HSP), frost bite, acropustulosis of infancy
  • Congenital: epidermolysis bulla, incontinetia pigmenti, mastocytosis
  • Autoimmune: linear IgA disease (chronic bullous disease of childhood), bullous pemphoigoid, SLE, dermatitis herpetiform
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15
Q

DDx of blistering rash

A
  • SJS, TEN, SSSS, VZV, disseminated herpes zoster infection (can also see pneumonia, encephalitis, hepatitis), disseminated HSV infection, sweet syndrome, bullous SLE
  • Other generalized blistering disorders: bullous impetigo, bullous pemphigoid, epidermolysis bullosa
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16
Q

List 5 types of drug eruptions

A
  1. Urticaria
  2. “Simple drug reaction” - morbilliform
  3. Drug hypersensitivity reaction/ DRESS
  4. Pustular: AGEP (acute generalized exanthematous pustulosis)
  5. Vesiculobullous - fixed drug eruption, erythema multiforme,. SJS/TEN
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17
Q

Work-up for suspected DRESS

A

Check echo, eosinophilia, renal/ liver function, thyroid function

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18
Q

Causes of erythema multiforme

A
  • infectious triggers – HSV1/2, mycoplasma

- medications – sulfonamides, abx, antiepileptics

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19
Q

Clinical characteristics and treatment of erythema multiforme?

A

target lesions (3 zones), often distal extremities. Bullous lesions can rupture. Mucous membrane involvement (1/2 cases), lesions themselves are fixed. Systemic symptoms of fever, malaise, arthralgias are present. Self-limited, lasts 2-3 weeks, stop any offending meds, can treat HSV with acyclovir, antihistamines

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20
Q

Clinical features of SJS/TEN?

A

SJS < 10%, TEN > 30%
Fever + systemic symptoms – then bullous rash, rupture and desquamation + necrosis.
Nikolsky sign = areas of skin sheer off with gentle pressure.
Involvement of 2+ mucous membranes (oral, ocular, urethral, genital), ocular involvement, scarring. Usually 1-3 weeks after medication.

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21
Q

Treatment of SJS/TEN?

A

Stop offending meds, wound care – petroleum gauze, analgesia, nutrition, watch for infection. Can use IVIG

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22
Q

How to differentiate EM vs. SJS/TEN vs. SSSS

A
  • Classic targets in EM
  • SJS/TEN usually starts on face and trunk, EM on extremities
  • EM can involve mucous membranes, but 2+ involved in SJS/TEN
  • SSSS affects superficial skin (not full thickness), and no oral mucosal involvement
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23
Q

Manifestations of neonatal lupus

A

Annular, red, scaly patches. anti-Ro, anti-La. Skin and cardiac (third degree AV block), hematologic (thrombocytopenia, anemia, neutropenia)

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24
Q

What electrolyte to test in subcutaneous fat necrosis

Study These Flashcards
A

Calcium - hypercalcemia

25
DDx of diaper dermatitis?
- Irritant contact dermatitis (skin folds are spared) - Atopic or seborrheic dermatitis - Moniliasis (candida) - skin folds involved, beefy red plaques, satellite papules - Acrodermatitis enteropathica (zinc deficiency), Langerhans, psoriasis
26
Treatment of diaper dermatitis?
- Frequent diaper changing, air exposure, gentle cleansing. - Barrier diaper creams: zinc oxide, petrolatum, silicone. - Topical steroids (1% hydrocortisone) if atopic or seborrheic dermatitis component. - Topical nystatin or clotrimazole BID if candida (PO nystatin if also have oral thrush)
27
Guttate psoriasis is frequent preceeded by which infection?
often preceeded by strep infection
28
List 6 secondary skin lesions
crust, scale, fissuring, erosions, ulceration, umbilication, excoriation, atrophy, lichenification, scar
29
Molluscum more common with which physical activities?
swimmers and wrestlers
30
Treatment of molluscum?
Spontaneously resolve; if treating – apply local EMLA, prick the skin over the core with 26G needle and squeeze core out, or use liquid nitrogen. Can apply 0.1% tretinoin cream or cantharidin if affecting large areas (avoid in face or genital areas as can cause blistering)
31
Treatment of warts?
Often recur, disappear with time. | Treatment: airtight occlusion with duct tape for 1 month, salicylic acid, liquid nitrogen.
32
Treatment of brown recluse spider bite?
tetanus prophylaxis, dapsone for necrosis (not in G6PD), surgical debridement, antivenom if systemic signs
33
Treatment of scabies?
Tx with 5% permethrin cream, x 12 hours (keep overnight), re-treat 1 week later. Asymptomatic and symptomatic household members should all be treated at the same time. For infants < 3 months can tx with Sulphur (8%–10%) precipitated in petroleum jelly
34
Treatment of lice?
Tx with 1% permethrin or pyrethrin cream x 10 min (repeat 7-10 days later), can also apply Vaseline to hair x 1 week, isopropyl miristate (Resultz) or dimeticone
35
How does pyogenic granuloma present?
papule/nodule develops at the site of trauma or burn, bleed easily. Remove
36
What is Darier's sign?
scratch a papule and develop a hive --> contains Mast cells (mastocytoma or urticaria pigmentosa).
37
Triggers for erythema nodosum?
Infectious (strep, TB, histoplasmosis), IBD, sarcoidosis, meds (OCP)
38
DDx of morbilliform rash and severe illness?
measles (rubeola), KD, RMSF, DRESS, Dengue fever
39
Clinical features of measles?
10-14 days incubation period, cough, coryza and conjunctivitis, fever --> Koplik spots --> morbilliform rash (head --> toe).
40
How does scarlet fever present?
Group A strep makes erythrogenic toxin. Fine, raised, generalized, morbilliform rash (sandpaper feel), strawberry tongue. Pastia’s lines = bright red lines in axilla, folds.
41
How does pityriasis rosea present?
Christmas tree pattern of papules and plaques with “collarette of scale”, herald patch. HHV 6 or 7
42
Triggers of Gianotti-Crosti (papular acrodermatitis)
Hep B, EBV (CMV, enterovirus, influenza + many more).
43
Clinical features of rubella?
Rash head --> toes over 2-3 days, gone by 4th day. Rash doesn’t coalesce. Fever is uncommon, joint pain and adenopathy.
44
Causes/ DDx of urticaria?
Urticaria – acute (< 6 weeks) vs. chronic (> 6 weeks), individual wheels last < 24 hours. • Idiopathic • Insect bites • Allergy to drugs or food • Infection: Viral (EBV, hepatitis), Bacterial (strep), parasitic • Cold urticaria • Dermatographism
45
What is eponychia/ paronychia?
Eponychia is superficial cellulitis of cuticle --> forms a pocket of pus and is this called a paronychia
46
Treatment of herpetic whitlow?
- Oral acyclovir given in first few days to shorten course, but does not have to be given (self-limited condition) - If immunocompromised IV acyclovir
47
What is a felon? What is the treatment?
- Deep infection into distal pulp space of finger can be caused by punctures or splinters - Usually very tender swollen finger tip that is tense, warm and red – “minicompartment syndrome” - Can lead to osteomyelitis, tenosynovitis, septic arthritis - Treatment is incision, dissections and drainage; digital block for analgesia; extend incision past DIP joint to prevent flexor contracture then oral antibiotics (Keflex x 10 days) and close follow up
48
What is the treatment for a subungual hematoma?
Tx = nail trephination if intact nail margins (regardless of size of hematoma). - If nail or margins are disrupted +/- displaced phalanx fracture --> remove nail and perform nail bed repair - Abx prophylaxis if underlying fracture/ significant soft tissue injury
49
Removal techniques for a hair tourniquet? (list 3)
1. Forceps and thin probe inserted below hair, then cut with scissors 2. Nair 3. Remaining hair or very deep --> digital block and perpendicular incision (over the hair) at 3 or 9 o’clock (to avoid neurovascular bundle)
50
How does Sturge Weber present?
Port wine stain, ipsilateral vascular angiomatosis of leptomeningies and ocular vessels; seizures/MR/hemiplegia and glaucoma.
51
What are the 3 types of hemangiomas?
- Superficial (red, raised) - Deep hemangiomas (bluish hue) - Mixed
52
What is Kasabach-Merritt phenomenon?
Very large hemangioma can develop Kasabach-Merritt phenomenon (consumptive coagulopathy with hemolytic anemia, CHF, thrombocytopenia)
53
Red flags for hemangiomas?
``` large face hemangioma (PHACES syndrome) Midline prevertebral airway, eye and nose involvement beard distribution and laryngeal hemangioma --> stridor large liver hemangioma at risk CHF ```
54
Treatment of umbilical granuloma?
cauterization with silver nitrate (cover the surrounding skin with gauze to prevent burn)
55
DDx of umbilical granuloma?
omphalomesenteric duct or patent urachus
56
Risk factors for pilonidal sinuses/ cysts?
Obesity, hirsutism and sedentary lifestyle
57
Tx of urethral prolapse
treatment of predisposing condition, pain control, topical antibiotic cream and twice daily estrogen cream
58
Rectal prolapse risk factors
severe constipation or severe diarrhea; also think spina bifida, CF, pinwords, sigmoid intussuception
59
Blistering rash on hand of teen after canoe trip. List 6 possible etiologies
- poison ivy, poison oak, poison sumak - bullous impetigo - polymorphous light eruption - swimmer's itch - bug bites with local reaction - vibrio vulnificus

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