Dermatology Flashcards
(165 cards)
1
Q
blistering diseases
A
pemphigus vulgaris
bullous pemphigoid
dermatitis herpetiformis
porphyria cutanea tarda
2
Q
pemphigus vulgaris path
A
anti-desmoglein antibodies = desmosomes
intra-epithelial lesions
3
Q
pemphigus vulgaris pt
A
thin, easily torn blisters (+ Nikolsky)
INVOLVES mucosa
age 30-50
4
Q
pemphigus vulgaris dx
A
biopsy showing tombstoning
immunofluorescence shows intra-epithelial pattern, surround cells
5
Q
pemphigus vulgaris tx
A
acute, life-threatening = IVIG
acute, not life-threatening = steroids
chronic = mycophenolate or rituximab
6
Q
bullous pemphigoid path
A
anti-hemidesmosome antibody
sub-epidermal lesion
7
Q
bullous pemphigoid pt
A
tense, rigid bull (- Nikolsky)
no mucosa
age 70-80
8
Q
bullous pemphigoid dx
A
biopsy intact epithelium detached from basement membrane
immunofluorescence shows antibodies at dermal-epidermal junction
9
Q
bullous pemphigoid tx
A
steroids
- topical for limited
- systemic for severe
mild: dapsone + nicotinamide
10
Q
dermatitis herpetiformis path
A
deposition disease, papillae
IgA anti-transglutaminase
cutaneous manifestation of celiac sprue
11
Q
dermatitis herpetiformis pt
A
palpable pruritus rash on extensor surfaces and buttocks
12
Q
dermatitis herpetiformis dx
A
anti-transglutainase, anti-endomysial
EGD = smooth vili
biopsy not needed = neutrophilic abscess
13
Q
dermatitis herpetiformis tx
A
remove gluten from diet
temporize with dapsone
14
Q
porphyria cutanea tarda path
A
most common porphyria
uroporphyrin decarboxylase deficiency
accumulation of uroporphyrins
15
Q
porphyria cutanea tarda pt
A
bull on sun-exposed lesions
16
Q
porphyria cutanea tarda dx
A
coral red urine under WOod’s lamp
24hr urine collection for uroporphyrins
17
Q
porphyria cutanea tarda tx
A
avoid the sun
18
Q
porphyria cutanea tarda f/u
A
look for hemochromatosis, HepC, EtOH, and OCPs
19
Q
papulosquamous dermatoses
A
seborrheic dermatitis
psoriasis
pityriasis rosea
lichen planus
20
Q
seborrheic dermatitis path
A
fungal infection
‘dandruff plus’
21
Q
seborrheic dermatitis pt
A
rash and flakes seen on scalp and eyebrows, hair-bearing regions only
22
Q
seborrheic dermatitis dx
A
clinical
23
Q
seborrheic dermatitis tx
A
selenium shampoo
24
Q
seborrheic dermatitis f/u
A
HIV, cradle cap, Parkinson’s
25
psoriasis path
autoimmune disease, helper T cells
| excess stratum corneum
26
psoriasis pt
symmetric, well-demarcated patches with silvery scales that bleed when picked
nail pitting, onycholysis (nail detachment)
27
psoriasis dx
clinical (may biopsy to r/o lymphoma)
28
psoriasis tx
1st: UV light
alternative: topical steroids (use sparingly)
flare: oral steroids
recalcitrant: immune modulators such as tacrolimus
29
psoriasis f/u
joint pain, seronegative spondyloarthropathy
30
pityriasis rosea path
benign, self-limiting, idiopathic
31
pityriasis rosea pt
flat oval-shaped salmon-colored macule (hyperpigmentation in dark skin)
scaling lesion that does not reach the border (trailing scale)
32
pityriasis rosea dx
RPR to r/o syphilis, pityriasis is clinical
33
pityriasis rosea tx
non, self-limiting
34
pityriasis rosea f/u
if on palms and soles, syphilis likely, should normally spare palms and soles
35
lichen planus path
inflammatory, idiopathic
36
lichen planus pt
intensely pruritic pink/purple flat-topped papules with a reticulated network of fine white lines
wrists and ankles common, can be in mouth or vagina
37
lichen planus dx
clinical
38
lichen planus tx
```
topical steroids (first line)
UV light (adjunct)
oral steroids (severe)
immune modulators (recalcitrant)
```
39
lichen planus f/u
drug induced from ACE-i, thiazides, loops
40
eczematous dermatoses
atopic dermatitis
contact dermatitis
stasis dermatitis
hand dermatitis
41
atopic dermatitis path
immune reaction to allergens or foods
42
atopic dermatitis pt
adult: symmetric lichenification wherever the patient can reach to scratch
child: dry, red, itchy rash on cheeks and extensor surfaces, look for asthma and allergies along with atopy
43
atopic dermatitis dx
clinical
44
atopic dermatitis tx
avoidance of triggers (remove foods)
| topical steroids for adult (brief use)
45
contact dermatitis path
hypersensitivity type IV reaction
| latex, nickel, poison ivy
46
contact dermatitis pt
well-demarcated red rash in the shape of an object or clothing
pruritic, raised, and red
47
contact dermatitis dx
clinical
48
contact dermatitis tx
avoid contact with triggers
| topical steroids
49
stasis dermatitis path
skin changes associated with edema
50
stasis dermatitis pt
edema in an extremity, chronic
| brownish discoloration, erythema, scaling at site of edema
51
stasis dermatitis dx
clinical
52
stasis dermatitis tx
get the fluid out of the extremity with either diuretics if overloaded or compression stockings/leg elevation
53
hand dermatitis path
dermatitis isolated to the hands in someone who washes their hands a lot or deals with chemicals
54
hand dermatitis pt
food-service worker, healthcare worker
55
hand dermatitis dx
clinical
56
hand dermatitis tx
moisturizers and avoidance of harsh soaps
57
hypersensitivity reactions
```
urticaria
drug reaction
erythema multiform
stevens-johnson syndrome
toxic epidermal necrosis
staphylococcal scalded skin syndrome
```
58
urticaria path
type I hypersensitivity
| IgE induced mast cell degranulation -> histamine release = leaky capillaries
59
urticaria pt
annular, blanching red papule following any antigen exposure (bee stings, heat, pressure, medication)
60
urticaria dx
clinical
61
urticaria tx
antihistamine
62
urticaria f/u
send for RAST to identify culprit antigen
63
urticaria f/u
if anaphylaxis, give subQ epi, f/b steroids, H1-blocker and H2-blocker
- epi is crucial and is first
64
drug reaction path
autoimmune
65
drug reaction pt
pink morbilliform rash occurring 7-14d after drug exposure, usually in hospitalized patients
if day 2-3 after drug, that ISN'T the cause
wide-spread, symmetric, and pruritic
66
drug reaction dx
clinical
67
drug reaction tx
remove offending agent
diphenhydramine for mild symptoms
corticosteroids for severe symptoms
68
erythema multiforme path
drug-reaction, HSV reaction
69
erythema multiforme pt
targetoid lesions that appear on palms and soles
70
erythema multiforme dx
clinical
71
erythema multiforme tx
Acyclovir if HSV related
| self-limited otherwise
72
erythema multiforme f/u
if involving the oral mucosa, it is considered erythema multiforme major, and is SJS spectrum
73
erythema multiforme f/u
syphilis can also present with targetoid lesions on palms and soles
74
stevens-johnson syndrome/toxic epidermal necrosis path
drug reaction
75
stevens-johnson syndrome/toxic epidermal necrosis pt
+ nikolsky and oral involvement
| BSA: <10% SJS z> 30% TENS
76
stevens-johnson syndrome/toxic epidermal necrosis dx
biopsy
- SJS = basal cell degeneration
- TENS = total epidermal thickness necrosis
77
stevens-johnson syndrome/toxic epidermal necrosis tx
admit to burn unit, supportive care
NO steroids
withdraw all medications
78
staph scalded skin syndrome path
intraepidermal lesions from staph toxin targeting desmoblein (desmosomes)
79
staph scalded skin syndrome pt
NO mucosal involvement
| febrile, sloughing of skin, skin folds first off the axillae and inguinal creases
80
staph scalded skin syndrome dx
biopsy
81
staph scalded skin syndrome tx
clindamycin (stop toxin production)
82
hyperpigmentation
```
nevus
seborrheic keratosis
actinic keratosis
squamous cell carcinoma
keratoacanthomas
kaposi's sarcoma
```
83
nevus path
benign hyperplasia of melanocytes
84
nevus pt
raised, painless, pigmented lesion that has none of the ABCDE
if hair-bearing, it is benign
85
nevus dsx
```
ABCDE... any one means malignancy
Asymmetric
Border irregularity
Color mixed
Diamter large (>5mm)
Evolving over time
```
86
nevus tx
wide excisional biopsy if you think melanoma
| leave it alone if all ABCDE are negative
87
seborrheic keratosis path
looks like cancer, but isn't
88
seborrheic keratosis pt
large, brown, greasy, 'stuck on' lesions
89
seborrheic keratosis dx
clinical
90
seborrheic keratosis tx
leave it alone
91
seborrheic keratosis f/u
biopsy if changing, if not changing, leave it alone.
| it could be cancer if it is changing
92
actinic keratosis path
premalignant lesion
| squamous cell carcinoma in the making
93
actinic keratosis pt
sun-exposed area (hands, face, back)
sun-exposed person (sailor, farmer)
erythematous with sandpaper-like yellow to brown scale
94
actinic keratosis dx
biopsy
95
actinic keratosis tx
primary prevention is key
cryosurgery if small lesion
5-FU if diffuse
96
squamous cell carcinoma path
actinic keratosis -> carcinoma in situ -> invasive carcinoma (DOES metastasize)
97
squamous cell carcinoma pt
```
sun-exposed areas
sun-exposed person
lesion on the lower lip
dark lesion on the face, hands, back
ulcers taht fail to heal (Marjolin's ulcer)
```
98
squamous cell carcinoma dx
biopsy
99
squamous cell carcinoma tx
surgical resection
100
keratoacanthomas path
benign lesions that look like SCC
101
keratoacanthomas pt
they have SCC except it grew rapidly and then resolved spontaneously
102
keratoacanthomas dx
surgical resection
103
keratoacanthomas tx
surgical resection
104
kaposi's sarcoma path
malignancy of vascular endothelial cells
| AIDS (CD4 <200) and HHV-8 coinfection
105
kaposi's sarcoma pt
purple lesions that can be literally anywhere, mouth, arms, intestines
106
kaposi's sarcoma tx
HAART, treat AIDS, this gets better
107
kaposi's sarcoma f/u
local or systemic chemo may be needed in refractory cases (do not learn chemo)
108
hypopigmentation
tinea versicolor
vitiligo
albinism
ash leaf
109
tinea versicolor path
infection with the fungus Malassezia furfur
110
tinea versicolor pt
small scaly patches of hyper and hypopigmentation
111
tinea versicolor dx
KOH prep = spaghetti and meatballs, actually hyphae and spores
112
tinea versicolor tx
selenium sulfide
113
vitiligo path
autoimmune disease
114
vitiligo pt
sharply demarcated, small patches of depigmented skin, often on face, hands, and genitalia
115
vitiligo dx
Wood's lamp shows NO pigment
| biopsy = absence of melanocytes
116
vitiligo tx
none
cosmetics
- bleaching to lighten uniformity
- dyes/makeup to darken uniformity
117
albinism path
tyrosinase deficiency
118
albinism pt
pale skin, pale eyes, pale hair
119
albinism dx
clinical
120
albinism tx
supportive, avoid UV light
121
albinism f/u
PKU has funny smell, intellectual disability, seizures in addition to pale skin and fair hair
screened for at birth
122
ash leaf path
hypo pigmented (NOT depigmented)
123
ash leaf pt
child, hypopigmented
124
ash leaf dx
Wood's lamp = ash leaf
| CT scan head = tubers
125
ash leaf tx
nothing can be done about tuberous sclerosis
| supportive care
126
skin infections
impetigo
erysipelas
acne vulgaris
127
impetigo path
infection with Strep pyogenes
| infection with Staph aureus (bullous)
128
impetigo pt
child
| honey-crusted lesions on face
129
impetigo dx
clinical
130
impetigo tx
local disease = muprocin
lots of disease = amoxicillin (strep)
refractory = clindamycin (staph)
131
impetigo f/u
can cause post-strep glomerulonephritis
| canNOT cause rheumatic fever
132
erysipelas path
infection of strep in lymphatics
133
erysipelas pt
dark red, clearly defined lesion in the shape of lymphatics (tracks or lines)
134
erysipelas dx
clinical
135
erysipelas tx
ß-lactams, amoxicillin (strep)
136
acne vulgaris path
propionibacterium acnes
137
acne vulgaris pt
zits, acne
138
acne vulgaris dx
clinical
139
acne vulgaris tx
comedones = topical retinoids
inflamed comedone = topical retinoids and benzoyl peroxide
severe pustular = oral abx (doxy)
resistant disease = isotretinoin
140
acne vulgaris f/u
UPT before isotretinoin (teratogen)
141
alopecia
```
alopecia areata
trichotillomania
tinea capitis
traction alopecia
chemo
male-pattern baldness
```
142
alopecia areata path
autoimmune disease
| well-defined circular bald spot
143
alopecia areata pt
may include entire body
| exclamation point sign
144
alopecia areata dx
clinical, r/o tinea capitis if in question
145
alopecia areata tx
steroids
146
trichotillomania path
compulsive disorder (OCD, PTSD, MDD)
147
trichotillomania pt
patchy alopecia
hair in different lengths of growth
women
148
trichotillomania dx
clinical, can use a 'window'
149
trichotillomania tx
treat the psychiatric disease
150
tinea capitis path
fungal infection, trichophyton tonsurans
151
tinea capitis pt
well-defined circular bald spot
| all hairs at equal length
152
tinea capitis dx
KOH prep
153
tinea capitis tx
```
oral antifungals (griseofulvin)
hair loss permanent if not treated
```
154
traction alopecia path
scarring from pulling hair tightly
155
traction alopecia pt
tight braiding, ponytails
| hair loss is preventable, but irreversible
156
traction alopecia dx
clinical
157
traction alopecia tx
none
158
chemo path
chemo targets rapidly dividing cells
159
chemo pt
patients can lose their hair during chemo
| clinical
160
chemo dx
none
161
chemo tx
none
162
male pattern baldness path
5DHT (androgen) driven loss of hair
163
male pattern baldness pt
crown thins, then loses hair
| rest of hair on top of head then follows
164
male pattern baldness dx
clinical
165
male pattern baldness tx
1st minoxidil topical
best minoxidil topical and finasteride oral
woman = OCPs and spironolactone
