Dermatology from PANCE Pearls

Question 1

What is a Cutaneous Drug Reaction

Answer 1

Medication-induced changes in skin and mucous membranes
Most are hypersensitivity reactions
Most are self-limiting if offending drug is discontinued

Question 2

What are triggers for Cutaneous Drug Reactions

Answer 2

Antigen from foods, insect bites, drugs, environmental, exercise, infectious

Question 3

What is a Type I Hypersensitivity Reaction

Answer 3

Ig-E mediated
Urticaria and Angioedema
Immediate

Question 4

What is a Type II Hypersensitivity Reaction

Answer 4

Cytotoxic, Ab-mediated

Question 5

What is a Type III Hypersensitivity Reaction

Answer 5

Immune Antibody-Antigen Complex

Such as drug-mediated vasculitis and serum sickness

Question 6

What is a Type IV Hypersensitivity Reaction

Answer 6

Delayed (Cell Mediated)

Such as Erythema Multiforme

Question 7

What is an Exanthematous/Mobiliform Rash
When does the rash begin
What types of drugs cause it

Answer 7

Generalized, bright red macule and papules that coalesce to form plaques
Rash starts 2-3 days after initiation of meds
Antibiotics, NSAIDS, Allopurinol and Thiazide Diuretics

Question 8

What is an Urticarial Rash
When does the rash begin
What types of drugs cause it

Answer 8

Blanchable, edematous pink papule, wheals or plaques
Occurs within minutes to hours of drug administration
Antibiotics, NSAIDS, Opiates and radio contrast

Question 9

What is Erythema Multiforme

What types of drugs cause it

Answer 9

Target Lesions

Sulfonamides, Penicillins, Phenobarbital, Dilantin

Question 10

What general sx are seen with drug reactions

Answer 10

Fever, abdominal pain, joint pain

Question 11

Tx of drug reactions
Exanthematous
Urticaria
Erythema Minor
Anaphylaxis

Answer 11

Discontinue medication is #1
Exanthematous: Histamines
Urticaria: Corticosteroids, Antihistamines
Erythema Minor: Sx
Anaphylaxis: IM Epinephrine

Question 12

What is Urticaria/Angioedema

Answer 12

Hives

A type I HSN IgE

Question 13

Sx or Urticaria

Answer 13

Blanchable, edematous pink papules, wheals or plaques
Darier’s Sign: Localized urticaria appearing where the skin is rubbed (histamine induced)
Angioedema: Painless, deeper form of urticaria affecting lips, tongue, eyelids, hands feet and genitals

Question 14

Tx of Urticaria

Answer 14

Antihistamines
Eliminate triggers
H2 blockers
Corticosteroids

Question 15

What is Erythema Multiforme

Answer 15

Acute self-limited type IV HSN reaction

Question 16

What are common drugs that result in Erythema Multiforme

Answer 16

Sulfa Drugs
Beta-Lactams
Phenytoin
Phenobarbital

Question 17

Sx of Erythema Multiforme

Answer 17

Traget lesions
Dusty-violet red purpuric macule/veicle or bullae in center surrounded by pale edematous rim and peripheral red halo
Fever

Question 18

Tx of Erythema Multiforme

Answer 18

Discontinue drugs
Treat sx
Antihistamines, Analgesics, Skin care, Steroids

Question 19

What is Steven Johnson Syndrome and TEN

What are drugs that cause it

Answer 19

Drug Eruption
SJS 30% surface affcted
Usually with Sulfa and Anticonvulsants
If infectious: Mycoplasma, HIV, HSV

Question 20

Sx of Steven Johnson Syndrome and TEN

Answer 20

Fever, URI sx, widespread blisters that begin on trunk/face, erythematous/pruritic macules with epidermal detachment (positive Nikolsky sign)

Question 21

TX of Steven Johnson Syndrome and TEn

Answer 21

Treat like severe burns

Hydrate!

Question 22

What is Basal Cell Carcinoma

Answer 22

Most common type of skin cancer in US
Found in fair-skinned people with prolonged sun exposure, xeroderma
Slow growing, locally invasive but low incidence of mets

Question 23

Sx of Basal Cell Carcinoma

Answer 23

Flat firm area with small raised, translucent/pearly/waxy papule with central ulceration and raised rolled borders
Usually seen on face/nose/trunk
Friable (bleeds easily)
May have Telengiectasis

Question 24

Dx of Basal Cell Carcinoma

Answer 24

Punch or Shave Biopsy, see basophilic cells

Question 25

Tx of Basal Cell Carcinoma

Answer 25

Electric Desiccation/curettage | Excision, cryosurgery

Question 26

What is a Squamous Cell Carcinoma

Answer 26

Second most common skin cancer Often preceded by actinic keratosis, HPV infection, sun exposure Usually found on lips, hands, neck, and head

Question 27

What is Bowen's Disease

Answer 27

Squamous Cell Carcinoma in situ | Slow growing, rarely mets

Question 28

Sx of Squamous Cell Carcinoma

Answer 28

Red, Elevated nodule with adherent white scaly or crusted bloody margins

Question 29

Dx of Squamous Cell Carcinoma

Answer 29

Biopsy | Epidermal and Dermal cells with large pleumorphic hyperchromatic nuclei

Question 30

Tx of Squamous Cell Carcinoma

Answer 30

Excision

Question 31

What is Melanoma

Answer 31

Skin Cancer UV radiation is most common cause Aggressive, high Mets potential Light-skinned, light hair, light eye color most at risk

Question 32

Sx of Melanoma

Answer 32

ABCDE | Asymmetry, Irregular borders, Dark Color, >6mm Diameter, Evolution

Question 33

What is the most important factor for prognosis of a Melanoma

Answer 33

Thickness

Question 34

Dx of Melanoma

Answer 34

Full thickness wide excisional biopsy with lymph node biopsy | NO Shave Biopsy

Question 35

Tx of Melanoma

Answer 35

Excision with lymph node dissection

Question 36

What is Cellulitis

Answer 36

Acute, spreading superficial infection of dermal, subcutaneous tissues caused by S. Aureus, Group A Strep Usually occurs after a break in the skin (trauma, surgical wounds)

Question 37

Sx of Cellulitis

Answer 37

``` Macular erythema (margins flat, not sharply demarcated), swelling, warmth, and tenderness Fevers, Chills, Lymphangitis, Myalgias ```

Question 38

Tx of Cellulitis

Answer 38

Cephalexin, Dicloxacillin Erythromycin or Clindamycin if PCN allergy Vancomycin or Linezolid if MRSA Cat Bite (Pasteurella Multocida): Augmentin, Doxy if PCN allergy Puncture Wound: Ciprofloxacin

Question 39

``` What is a 1st degree burn Depth Appearance Sensatin Capillary Refill Prognosis ```

Answer 39

``` Superficial Epidermis Erythematous and Dry, Painful, tender to touch Refill Intact, Blanches with pressure Heals within 7 days, No scarring ```

Question 40

``` What is a 2nd degree burn (Superficial Partial Thickness) Depth Appearance Sensatin Capillary Refill Prognosis ```

Answer 40

Epidermis + Superficial portion of dermis Erythematous, Pink, Moist, Weeping, Blisters MOST painful of all burns, Very tender to touch Refill Intact, blanches with pressure Heals within 14-21 days, No scarring but leaves pigment changes

Question 41

``` What is a 2nd degree burn (Deep Partial Thickness) Depth Appearance Sensatin Capillary Refill Prognosis ```

Answer 41

Epidermis into deep portion of dermis Red, yellow, pale white, dry, Blisters Not usually painful, Possible pain with pressure No Refill Heals in 3 weeks - 2 months, Scarring is common

Question 42

``` What is a 3rd degree burn Depth Appearance Sensatin Capillary Refill Prognosis ```

Answer 42

``` Extends through entire skin Waxy, White, Leathery, Dry Painless No Refill Heals in months, Does not spontaneously heal well ```

Question 43

``` What is a 4th degree burn Depth Appearance Sensatin Capillary Refill Prognosis ```

Answer 43

``` Entire skin into underlying fat, muscle, bone Black, Charred, Eschar, Dry Painless No Refill Does not Heal ```

Question 44

What is a minor burn

Question 45

What is a major burn

Answer 45

``` >25% total body surface area in adults >20% total boy surface area in young/old >10% full thickness burns Involves the face, hands, perineum, feet Cross major joints Circumferential ```

Question 46

Tx of Burns

Answer 46

``` Clean with mild soap and water NO ice or ointments Debridement Tx pain: Acetaminophen, NSAIDS, Opioids Abx Silver Sulfadiazine (none on face) Aloe Vera Dressings for partial and full-thickness, fingers and toes individually wrapped IV Fluid Resuscitation: Parkland Formula (Lactated Ringers 4mL/kg/%total surface area for 24 hours. Give half in the first 8 hours, the other half in the remaining 18 hours ```

Question 47

Tx of Chemical Burns

Answer 47

Irrigate profusely with running water for 20 minutes

Question 48

What is a Pressure Ulcer | Stage I - IV

Answer 48

Stage I: Superficial, nonblanchable redness that does not dissipate after pressure is relieved Stage II: Epidermal damage into dermis. Looks like a blister or abrasion Stage III: Full thickness of skin and may extend into subcutaneous layer Stage IV: Deepest, Extending into muscle, tendon or bone