Dermatology/ ID Flashcards
(135 cards)
1
Q
<6mm, macule/papule, well-defined border, homogenous color [brown or pink]
A
benign mole
2
Q
> 6mm, ill-defined border, irregular color
A
Atypical Nevi
3
Q
Asians; ‘old & unchanged’ = benign; ‘new or changed’ = EVALUTE IMMEDIATELY
A
Blue nevi
4
Q
hereditary; ↑sun exposure; fade without sun
A
freckles
5
Q
sun exposed area; tx w/topic agents/laser/cryotherapy
A
Lentigines [sunspots]
6
Q
benign; beige/brown. VELVETY or thick/scaly papules/plaques; stuck-on appearance. If unbothersome leave alone, may use cryotherapy otherwise
A
Seborrheic Keratosis
7
Q
flat/raised; red, white, blue, black; RECENT CHANGE IN APPEARANCE – SUSPECT; tumor thickness = prognostic factor
A
Malignant Melanoma
8
Q
MOST COMMON FORM OF SKIN Cx, sun-exposed areas – light-skinned pt; papule/nodule + central scab or erosion, slow-growing, waxy pearly appearance + vessels easily visible; BACK / CHEST; dx: punch/shave biopsy; MOHs = HIGHEST CURE RATE; High recurrent follow-up annually
A
Basal Cell Carcinoma
9
Q
red, conical hard nodule ulcerate + bleed; NO HEAL; Mohs excision; follow-up 2x/yr
A
Squamous Cell Carcinoma
10
Q
narrow linear crack into the epidermis, exposing dermis (athletes’ foot)
A
fissure
11
Q
flat, discoloration <1cm, (freckle)
A
macule
12
Q
flat discoloration >1cm, (vitiligo)
A
patch
13
Q
skin thickening usually found over pruritic or friction areas atopic dermatitis, areas of recurrent scratching
A
Lichenification
14
Q
raised, flaking lesion (dandruff, psoriasis)
A
scale
15
Q
loss of dermis/epidermis (pressure sore)
A
ulcer
16
Q
a vesicle-like lesion with purulent content (acne, impetigo)
A
pustule
17
Q
raised lesion >1cm same or different color than surrounding skin (psoriasis)
A
plaque
18
Q
in streaks (poison ivy)
A
linear
19
Q
in a ring (erythema migrans)
A
annular
20
Q
along neurocutaneous dermatome (herpes zoster)
A
dermatomal
21
Q
circumscribed area of skin edema (hives, urticaria)
A
wheal
22
Q
fluid fluid <1cm (varicella)
A
vesicle
23
Q
fluid-filled, >1cm blister (2nd-degree burn0
A
bulla
24
Q
raised lesion, <1cm, same or diff color than surrounding skin (raised nevus)
A
papule
25
raised lesion >1cm, usually mobile (epidermal cyst)
nodule
26
dry skin (atopic dermatitis)
xerosis
27
net like cluster
reticular
28
multiple lesions blend together
confluent
29
Small flesh-colored, pink macule/papule, feels rough like sandpaper, TENDER when brushing a finger over, affects sun-exposed area. Consider pre-malignant and may progress to SCC
Actinic Keratosis
30
Treatment for AK
cryotherapy
31
Treatment for BCC
Mohs
32
Treatment for Lentigines
topic agents/laser/cryotherapy
33
Treatment for Seborrheic keratosis
cryotherapy if bothersome
34
Treatment for SCC
Mohs
35
ORANGE-RED or GRAY WHITE with GREASY or white dry scaling macules/papules of varying size. Redness/scaling occurring in regions where sebaceous glands. Are most active – FACE & SCALP
Seborrheic dermatitis
36
Treatment for seborrheic dermatitis
topical ketoconazole and selenium sulfide – shampoo [zinc pyrithione or selenium – use daily WASH HEAD TO TOES]; ketoconazole 1-2% 2x/week; Tar shampoo – scalp; low potency steroid cream 1-2.5% flares
37
Treatment for blepharitis
J&J baby shampoo daily
38
Silvery scales on bright red well-demarcated plaque; knees, elbows, scalp; onycholysis associated joint pain; <10% BSA
Psoriasis
39
injury or irritation of normal skin may cause a flare of psoriasis
Koebner phenomenon
40
the appearance of small bleeding pt after layers of scale are removed [pinpoint bleeding]
Auspitz sign
41
These drugs may cause Flare / Exacerbate existing plaque
BB, antimalarial, statins, lithium
42
A drug that may cause a severe rebound of psoriasis
systemic corticosteroids
43
1st line of treatment for psoriasis
high-ultra potent topical steroids 2-3x/wk MAX
44
Treatment for plaque psoriasis
calcipotriene ointment 0.005% or calcitriol ointment 0.003% vit D analogs BID [start with both steroid + vitD 2x/day until plaques improve à continue vitD daily x2 more weeks; Tar shampoo [scalp daily]; 6% salicylic acid gel [Keralyt] @ night with shower cap – wash out in AM
45
VELVETY TAN or pink macules DON’T TAN; fine scales not visible / seen with scraping lesion; CENTRAL UPPER TRUNK; HIGH RECURRENCE RATE – YEAST. Dx: KOH prep; re-pigmentation may take wk-months
tinea versicolor
46
Treatment for tinea versicolor
SELENIUM SULFIDE LOTION: neck-waist daily 5-15m wash off [once x7d, once per week x4wk, monthly]; ketoconazole shampoo [leave on 5m BEFORE rinsing]; ketoconazole PO daily [SWEAT! No shower 8-12hr]
47
Ring-shaped lesion; scaly border; central clearing; ANYWHERE ON BODY
Tinea Corposis (ringworm)
48
Treatment for tinea corposis
topical antifungals [OTC 7-14d after clearing]; NO CORTISONE [lotrisone]; griseofulvin 350-500mg BID 4-6wk
49
SIGNIFICANT ITCHING intertriginous areas + peripherally spreading sharply demarcated centrally clearing erythematous lesion; CANDIDIASIS bright red + satellite
tinea crusis (jock itch)
50
Treatment for tinea crusis
drying powder MICONAZOLE
51
Asymptomatic scaling; fissures or maceration between toes; moccasin distribution; CELLULITIS COMPLICATION; itching/burning/stinging
tinea pedis (Athlete's foot)
52
Treatment for tinea pedis
PREVENTION! Drying powders
| [miconazole]; griseofulvin, itraconazole, terbinafine = SEVERE cases
53
Localized violaceous red plaques; scaling follicular plugging; atrophy dyspigmentation & telangiectasia; PHOTOSENSITIVITY; malar rash = BUTTERFLY
Lupus
54
Lupus medication triggers
hctz, CCB, H2 blockers, PPI, ACE-I, terbinafine;
55
type of lupus that occurs on face/scalp – thumbtack like
DLE
56
lupus that occurs on the trunk
SCLE
57
Lupus treatment
PROTECT SKIN FROM SUNLIGHT, SPF>50 uva/uva coverage; NO RAD TX; high potency corticosteroid cream EVERY PM with an occlusive dressing
58
Scaling, red plaque on breast [uni or bil]; intraductal mammary carcinoma
Paget's Disease
59
Squamous cell carcinoma in situ – abnormal growth of cells in epidermis [outer layer]; 0.5-3cm slightly raised pink-red plaque, excision; develop into SCC 3-5% RARE
Bowen's Disease
60
Unpigmented white macules 0.5-5cm; MEN/WOMEN
Vitiligo
61
Treatment for vitiligo
wear protective clothing/sunscreen; topical corticosteroids, phototherapy, >40% BSA = sx graft or perm depigmentation
62
HSV 1 occurs where?
Mouth
63
HSV 2 occurs where?
Genital
64
Triggers for HSV 1 flare
surgery, stress, sun exposure, fever
65
A cluster of vesicles on erythematous base; mouth; STINGING/BURNING before; crust & heal in 1 week
Herpes Simplex
66
Bleeding/ulceration are the most ominous sign of:
malignant melanoma
67
single most important prognostic factor in malignant melanoma
tumor thickness
68
Key clinical feature of atopic dermatitis
itching
69
a cardinal sign of secondary infection in atopic dermatitis
infra-auricular fissure
70
the most common form of erythema multiforme minor
herpes simplex
71
initial treatment for herpes simplex
valtrex 1g TID 7-10 days
72
treatment of recurrent HSV
initiate @ 1st signs 12-24hr Valtrex 500mg PO BID x3d
73
suppressive treatment therapy for HSV
Valtrex 500mg once a day x1yr [up to 5-7yr] WEAR CONDOMS
74
Clusters of lesions [unilateral] on FACE/TRUNK – dermatome w/pain along that nerve [pain occurs 48hr+ BEFORE rash
herpes zoster
75
pain/burning that persists after herpetic infection
post-herpetic neuralgia
76
vaccine for zoster
Shingrix Vaccine: 2 doses [1 now; repeat 2-6mo] born before 1980 should have antibodies – if you test and it's NEG = need varicella vaccine [1 today, another 4wk later = 2 doses]
77
referral needed to __________ if zoster on face
ophthalmology
78
treatment for post-herpetic neuralgia
TCAs or gabapentin
79
Pruritic ‘tapioca’ vesicles PALMS/SOLES/SIDES OF FINGERS. May have scaling/fissures after vesicles dry. Associated with ATOPIC DERMATITIS. Increased occurrence with stress or may be driven by nickel allergy. Must check for tinea pedis
POMPHOLYX VESICULOBULLOUS – Hand Eczema [Dyshidrosis]
80
Treatment for dyshidrosis
TOPICAL CORTICOSTEROIDS; RECURRENT; AVOID IRRITANTS – EMOLLIENT AFTER WASHING
81
Erythema, scaling perineal area; URINE/FECES; beefy red sharply demarcated w/satellite lesions
Primary Irritant Contact Dermatitis
82
Treatment for primary CD
ZINC OXIDE; if >3d diaper rash = CANDIDA ALBICANS = Nystatin
83
Hx of venous insufficiency/immobility; irregular shaped ulceration on LE above malleolus [edema, hyperpig brawny edema, scaling, erythema à breakdown]; 1st check ABI <0.7 = Vas Sx
leg ulcer r/t venous insuff
84
treatment for leg ulcer
Compression TED hose + wound care (unna boot if ABI WNL); Pentoxifylline 400mg TID accel healing
85
Asians/NA/AA 90%, blue-black lumbosacral area; fade as skin darkens; NOT ABUSE
Mongolian Spot
86
Light brown oval macule; ANYWHERE ON BODY; develops as pt ages
CAFÉ AU LAIT
87
If 6 or more Cafe Au Lait > 1.5cm present increased risk for?
neurofibromatosis (NF-1)
88
Red rubbery vascular plaque/nodule; regresses by 9yo
hemangioma
89
Treatment for hemangiomas
PO propanolol
90
caused by HPV
warts
91
Treatment for warts
vaccine Gardasil 9yr [27 max G, 22 B]; fever, pain, fainting, site rx; monitor 15m post inj; liquid nitro, keratolytic agents 40% salicylic acid
92
Treatment for genital warts
podophyllum resin
93
STAPH; itching/burning hair follicle; hot tub 1-4d after [pseudomonas]; TENDER, pruritic pustular lesion + fatigue, low-grade fever, malaise
folliculitis
94
Treatment for folliculitis
SILVADENE BID or cipro if recurrent
95
Deep-seated abscess entire hair follicle + adj tissue; STAPH AUREUS
furuncle/ boil
96
several furuncles
Carbuncle
97
Treatment for furuncle/boils
I&D + PO abx
98
Firm, benign growth of upper portion of hair follicle; black comedone or punctum; foul-smelling cheesy material on I&D
epidermal inclusion cyst
99
SEVERE ITCHING AT NIGHT + burrows interdigits
scabies
100
treatment for scabies
15-20m close physical contact or bedding; plastic bag x14d or high heat 60C; permethrin 5% 1 app neck down 8-12hr rinse repeat 1wk; triamcinolone cream for persistent itching
101
hands, palms, soles, MM; herpes simplex. TARGETOID LESIONS clear centers concentric; erythematous rings “iris” lesions
erythema multi-forme minor
102
trunk; <10% epidermal detachment; caused by medication
erythema multi-forme major
103
Medications that may cause erythema multi-forme major
sulfa, NSAID, allopurinol, anticonvulsants STOP DRUG; >30% ADMIT
104
itching + nits in hair
pediculosis (lice)
105
treatment for pediculosis
permethrin 5% cream on scalp
106
Located on Upper trunk body [no palms, soles], erythematous, blanching except in skin folds (Pastia sign) fine macules, sandpaper-like rash. Fever occurs 1-2 days prior. Not pruritic
scarlet fever
107
petechiae on the palate, strawberry tongue, Group A beta-hemolytic strep culprit, circumoral pallor, enlarged tonsils
scarlet fever
108
Treatment for scarlet fever
PCN or erythromycin/ clinda with PCN allergy
109
Starts with FEVER caused by parvovirus spread through respiratory secretions. Affects face and thighs, Erythematous “slapped cheek” pink papules and macules in lacy reticular pattern, low grade fever, pruritic. Contagious 1 week prior to rash
erythema infectiosum (5ths Dz)
110
pregnant women may develop this complication with 5ths disease which increases risk for fetal demise
Hydrops fetalis
111
Prominent feature is abrupt onset of fever 102-105 degrees for 3-8 days which resolves abruptly then faint maculopapular pink spots that blanch upon pressure that develop on FACE FIRST, then spreads down body. Transmitted through respiratory secretions. Incubation period 9 days. Caused by human herpesvirus 6 or 7
Roseola
112
Incubation period 9-14 days. Prodrome of fever, cough, conjunctivitis, and coryza. Koplik spots appear 1-2 days prior to and after onset of rash. Maculopapular rash cephalocaudally [face/hairline down body over 3 days] then becomes confluent. Supportive treatment only
Rubeola (Measles)
113
lasts 3 days, incubation period 4-14 days. Prodrome of respiratory symptoms, low-grade fever, conjunctivitis. Characteristic post-auricular and sub-occipital adenopathy. Most infectious 1-5 days after rash appears. Starts on face then spread to extremities and trunk while fading from face.
Rubella "3 day German Measles"
114
Unilateral parotid swelling progressing to bilateral and salivary gland swelling. Prodromal features last 3-5 days low-grade fever, headaches, malaise/myalgias, loss of appetite. May have an earache. Transmitted through respiratory droplets. May cause aseptic meningitis, pancreatitis, orchitis, and miscarriage in 1st trimester. Symptomatic treatment: NSAIDs, warm/cold packs, Tylenol, rest/fluids
Mumps (rubulavirus)
115
Widely scattered red macules and papules followed rapidly by vesicles, pustules then crusting in 5-7 days. New crops stop after 5-7 days. Contagious usually 1-2 days before rash appears and until lesions crust over. Spread primarily through droplets and direct contact with lesions. Pruritus usually intense.
Varicella
116
Prevention and treatment of Varicella
Varivax, 12mo & 5yr booster. May give 72hr from exposure.
117
Incubation 1-2 months after exposure. 2-3 day prodrome of malaise leads to febrile illness. Major complaint is pharyngitis and generalized adenopathy, splenomegaly and hepatomegaly common. Heterophile antibodies may not be detectable until 2nd week of illness. Symptomatic treatment. Avoid contact sports for 6-8w. Followup LFTs/ultrasound if indicated.
Infectious Mononucleosis
118
Caused by Cocksakie Type A rash found on tongue, oral mucosa, hands, and feet. Associated with fever (1st symptom), malaise, and sore throat.
Hand-Foot-Mouth
119
Oval, fawn-colored, scaly eruption that follows the cleavage lines of the trunk “Christmas Tree Pattern” Herald Patch occurs 1-2 weeks prior to lesions. Oval plaques up to 2 cm in diameter- crinkled or cigarette paper appearance- tiny scale on the edges but clear in the center. Appears mostly in Spring/Fall. If plantar, palmar, or mucous membrane lesions are present- screen for secondary syphilis. Consider UV treatment
Pityriasis Rosea
120
Macules, vesicles, bullae, pustules, and honey-colored crusts Contagious – staphylococci or streptococci
Face and other ‘exposed’ body parts. Soaks and scrubbing can be helpful- clears the pus.
Topical agents such as bacitracin and mupirocin (Bactroban) are indicated the first line
Impetigo
121
Single or multiple dome-shaped, waxy papules, 2-5 mm in diameter with umbilication. Initial appearance are firm, solid, flesh-colored lesions but change to soft, white, pearly gray in color that may have suppuration.
Spread by wet skin-to-skin contact. Estimated time to remission is approximately 13 months. Can be treated with liquid nitrogen, curettage, or light electrocautery.
These lesions should spontaneously resolve without treatment.
Molloscum Contagiosum
122
Scaly red plaques (no thickening as with psoriasis) – can be long term with weeping- consider staph infections. Face, neck, upper trunk, wrists, hands, and antecubital and popliteal folds. Family hx of asthma, allergic rhinitis, or atopic dermatitis (Triangle of A).
Dx criteria: Must have pruritus, typical morphology and distribution (flexural lichenification, hand eczema, nipple eczema, eyelid eczema in adults), onset in childhood with chronicity.
Atopic Dermatitis (Eczema)
123
Erythematous macules, papules, and vesicles- look for patches, such as where something may have rubbed or brushed against the skin. Results from contact with an allergen or chemical. Soaps, detergents, solvents, metals, antimicrobials such as bacitracin or polysporin, artificial nails, adhesive tape, etc. Consider latex as well. Treatment: prompt and thorough washing of affected area with liquid dishwashing soap to remove the oils must be done within 30 minutes to decrease the effects of the irritant. McPhee suggests Dial Ultra. Barrier creams – applied prior to exposure- include Stokogard, Hollister Moisture Barrier, and Hydropel. treat the itching with caladryl, calamine, Benadryl cream OR Benadryl tablets, Vistaril, etc. New treatment option- Zanfel- may prove beneficial- according to the package instructions- it may be used anytime after exposure. Reports 10 year half life (15 treatments per box)
Contact Dermatitis
124
Comedomes are hallmark although papular, pustular, cysts or nodules may be present. Treatment begins with educating the patient- treatment can take 6-8 weeks to make a difference- avoiding topical oils found in cosmetics and hair products is helpful. Comedones respond well to topical retinoids such as Retin A (tretinoin). Benzoyl peroxide 2.5% will do well (and cause less irritation than the 10%)- may be combined with an antibiotic for topical application (Benzaclin, Bezamycin). Papular or Cystic Acne- same initial treatment as comedones- if no response- then consider oral antibiotics such as doxycycline, minocycline, etc. Severe Acne: Accutane: NOT RESPONDING TO TX; supply 1mo at a time; 2 forms of effective of birth control (abstinence can be 1 form) must be utilized INFORMED CONSENT; enroll in a monitoring program (iPledge); MUST HAVE two serum preg tests before starting tx
Acne Vulgaris
125
Erythema and telangiectasia with a tendency to flush easily. May have associated flares with acne- papules and pustules. Hyperplasia of the soft tissue of the nose- rhinophyma. May be triggered by heat, hot/spicy food/drink, sunlight, exercise, alcohol, emotions, or hormones (menopause). Burning and stinging may accompany the flushing. avoid triggers- use broad spectrum sunscreen (although this might take some experimenting to find one that is well tolerated). Metronidazole gel, 0.75% can be applied bid or 1% applied qd. Another alternative is clindamycin gel. Oral medications can be used when topical are not effective.
Rosacea
126
36-58hr to transmit; borrelia burgdorferi spirochete, gram- bacteria; REFER TO ID; stage 1 erythema migrans 3-30 day incub; viral illness “summer cold” that resolves 3-4wk without tx; stage 2: FATIGUE, cardiac, neuro; stage 3: musc mo-years after infection; ELISA, western blot; all ages + preg. Erythema migrans "bullseye" Treatment: doxy 200mg PO x1 proph; active tx: 14-21 days in early stage doxy >8yr or amox
Lyme Disease
127
Treatment for cat bites
prophyl PCN + ceph or augmentin
128
Treatment for all bites
AUGMENTIN if allergic to PCN--- clinda+doxy or Bactrim or a fluoroquinolone 5-7 days
129
Monkey bites add?
Valtrex
130
38.3C or 101F needs >3wk of fever to diagnose. Infections account for most cases in children and adults cancer.
FEVER OF UNKNOWN ORIGIN
131
fluoroquinolone single dose [>10d watery stool C&S + O&P]
TRAVELERS DIARRHEA
132
Highest attack rate in children <6y with a peak from 6m-2y. Stools are watery but may have mucous and blood which may indicate shigellosis. Fever, abdominal pain and diarrhea associated with bacteremia especially in newborns/infants.
Salmonella Gastroenteritits
133
shorter incubation 2-4 hours; vomiting is main symptom, no fever
Staph food poisoning
134
resembles salmonellosis clinically, must culture to differentiate
campylobacter
135
Treatment for salmonella
antibiotics in infants <3m, SSD, immunocompromised, severely ill children. 3rd generation cephalosporin and fluoroquinolones for adults. Plus PROBIOTICS
