DERMATOLOGY PANRE Flashcards
(213 cards)
1
Q
Acne vulgaris (Level 2) what is it?
A
Obstruction of pilosebaceous units (i.e. hair follicles & sebaceous glands), with/without
inflammation → formation of:
○ Comedones (whiteheads or blackheads) → non-inflammatory acne( blackheads incomplete blockage and complete bloakage-white heads )
○ Papules, pustules, nodules and/or cysts → inflammatory acne
2
Q
Acne vulgaris (Level 2) presentation?
A
Lesions typically develop on face & upper trunk, most often in adolescents
Comedones can become inflamed from Propionibacterium
○ Comedonal (mild)
○ Papulopustular (moderate)
○ Nodulocystic (severe)
3
Q
Acne vulgaris (Level 2) Dx?
A
Clinical
4
Q
Acne vulgaris (Level 2) tx?
A
Comedones: Topical retinoid (e.g. tretinoin)
○ Mild inflammatory acne: Topical retinoid alone, or with topical antibiotics (e.g.
erythromycin, clindamycin), benzoyl peroxide, or both
○ Moderate acne: Oral antibiotics (e.g. tetracycline ) + topical tx as for mild acne
○ Severe acne: Oral isotretinoin (teratogenic)
■ When taking isotretinoin, patients, providers & pharmacists must be
registered with iPledge (pregnancy testing, oral contraceptive pills for
women, etc)
○ Cystic acne: Intralesional triamcinolone
○ Mild/moderate acne usually heals without scarring by mid-20s
○ Patients should avoid triggers (e.g. cosmetics)
○ Severe acne can result in physical & psychological scarring → appropriate
referral is indicated
5
Q
Actinic keratosis (Level 2) -what is it?
A
Precancerous changes in skin cells due to many years of sun exposure; most often seen in
fair-skinned individuals
6
Q
Actinic keratosis (Level 2) CM?
A
White, pink or red, poorly marginated, scaly or crusty macules,
papules or plaques of varying thickness
7
Q
Actinic keratosis (Level 2) Dx?
A
Clinical; biopsy for definitive dx
8
Q
Actinic keratosis (Level 2) Tx?
A
Minimizing UV light exposure (e.g. protective clothing, sunscreen)
○ Dermatologic consultation/referral (cryotherapy or curettage with
electrocautery, topical 5-fluorouracil [5-FU])
9
Q
AKA: Hives, wheals → migratory, well-circumscribed, red, itchy or burning plaques on the
skin that occur due to mast cell & basophil release of histamine & other vasoactive
substances; acute lesions have a duration <6 wks
A
What is Acute urticaria
10
Q
Acute urticaria (Level 2) two types?
A
Immune-mediated: IgE activated mast cell degranulation
○ Allergic reaction: Food (e.g. shellfish, peanuts), drugs (e.g. penicillin)
● Non-immune-mediated: non-allergic activation of mast cells
○ Non-allergic drug effect, emotional or physical stimuli (stress; heat or cold
exposure)
11
Q
Acute urticaria (Level 2) Dx ? TX?
A
Dx: Clinical
● Tx:
○ Try to identify the offending agent
○ Antihistamines (e.g. cetirizine, diphenhydramine) → First-line tx
○ Epinephrine for angioedema of airway structures
12
Q
What is Drug eruptions (Level 2)
A
Drug eruptions typically occur in any patient who is taking medication & suddenly
develops a symmetric, cutaneous eruption
● Can mimic a wide range of dermatoses including morbilliform, urticarial, papulosquamous,
pustular & bullous lesions
13
Q
What typically cause Drug eruptions (Level 2)?
A
Common culprits: Antibiotics, anti-epileptics, NSAIDs
14
Q
Drug eruptions (Level 2) dx? Treatment?
A
Dx: Clinical; biopsy, immunoserology, skin patch testing
● Tx: Stop offending agent, symptomatic treatment; most are self-limited
15
Q
Do drug eruptions occur in the sam or different spot?
A
Fixed drug eruptions typically occur in the same location each time
16
Q
What is Atopic dermatitis (Level 2)? What is it associated with ?
A
Atopic dermatitis (AKA: eczema) is a chronic inflammatory disorder of the skin characterized by intense itching & various skin lesions ○ Associated with IgE (i.e. asthma & allergies
17
Q
At what age does Atopic dermatitis (Level 2) presents?
A
Usually starts early in life & is a chronic, relapsing condition
18
Q
Common triggers of Atopic dermatitis (Level 2)
A
ollen, dust, sweat, harsh soaps, rough fabrics, fragrances
19
Q
Atopic dermatitis (Level 2) CM? (Acute and chronic)
A
Acute: Red, edematous, scaly patches or plaques that may be weepy; ± vesicles
○ Chronic: Dry, lichenified lesions due to chronic scratching
○ Usually occurs over flexor creases in older children & adults
20
Q
Atopic dermatitis (Level 2) dx? Tx?
A
Dx: Clinical
● Tx:
○ Mainstay: Topical corticosteroids
○ Antihistamines for pruritus
○ Supportive skin care: non-soap cleansers, moisturizers
○ Avoidance of precipitating factors, if identified
21
Q
What is Basal cell carcinoma (Level 1)
A
Superficial, slow-growing carcinoma derived from basal keratinocytes
● Commonly occurring in fair-skinned people with a history of sun exposure
22
Q
What is the most common skin CA?
A
Basal cell carcinoma
23
Q
Basal cell carcinoma (Level 1) CM
A
Most common clinical manifestations: Small, shiny, firm, pink nodule with a pearly border; telangiectasias that usually occur on the face; recurrent ulceration; crusting of the
lesion are also common.
Slow growing
● “Classic” description → Central crater with rolled border (“Rodent ulcer”)
24
Q
Basal cell carcinoma (Level 1) dx ? Treatment
A
Dx: Clinical & biopsy
● Tx: Surgery, topical chemotherapy (e.g. imiquimod, 5-FU)
25
Burns (Level 2)
Injury to skin or other tissues caused by thermal exposure (e.g. heat or cold), electricity,
chemicals, or radiation
26
First degree burn
painful red skin (e.g. sunburn)
27
First degree burn
Epidermis only painful red skin (e.g. sunburn)
28
3rd degree burn
Epidermis & dermis (full thickness burn) →often ↓ or no pain, dry, waxy or
leathery appearance, loss of hair follicles & glands
29
4th degree
Burn extending to deep tissues (fat, muscles, tendons, bone)
30
Burns dx?
Dx: Clinical; appropriate tests for associated conditions (e.g. endoscopy for inhalation
injury)
31
Burns Tx?
ABCs
○ IV fluids (e.g. lactated Ringers) for burns >10% BSA (guided by Parkland formula)
○ Wound cleaning, dressing & serial assessment
○ Surgery for deep partial thickness & full thickness burns
○ Supportive measures, pain control
○ Management at burn center for select patients, PT, OT
32
Burns Tx?
ABCs (airway breathing circulation)
○ IV fluids (e.g. lactated Ringers) for burns >10% BSA (guided by Parkland formula)
○ Wound cleaning, dressing & serial assessment
○ Surgery for deep partial thickness & full thickness burns
○ Supportive measures, pain control
○ Management at burn center for select patients, PT, OT
33
Electrical burns tx?
Skin findings may not correlate with underlying tissue damage;
measure creatine kinase & check for myoglobinuria for evidence of muscle damage (Skin appears normal but underneath skin is a big mess)
34
What are the complications for burns?
Hypovolemia & infection
35
Most common organisms of Cellulitis (Level 3)?
Group A beta, Staphylococcus aureus (methicillin-resistant S. aureus [MRSA] → common
36
What are organisms are typical of Cellulitis (Level 3)
Pasteurella, Pseudomonas aeruginosa, Vibrio vulnificus, Group B streptococci
37
What organism for Cellulitis (Level 3) is common in neonates?
Group B streptococci (e.g. S. agalactiae
38
Cellulitis (Level 3)-Haemophilus influenzae is found in what type pts ?
Children
39
Cellulitis (Level 3)-Pseudomonas aeruginosa is found in what type pts ?
with DM or neutropenia, hot tub/spa users,
| hospitalized patients
40
Cellulitis (Level 3)-Vibrio vulnificus is found in what type pts ?
Marine environments
41
Cellulitis (Level 3)-Pasteurella multocida is found in what type pts ?
Cat/dog bites
42
Cellulitis (Level 3)-Eikenella corrodens
Human bites
43
Cellulitis (Level 3) CM of skin? Other CM?
Involved skin is red & hot with indistinct borders, tender, edematous & induratedn (NOT FLUCTUANT): Fever, chills, tachycardia, headache; May have lymphangitis, lymphadenopathy, petechiae, vesicles & bullae
44
Cellulitis (Level 3) dx? imaging?
Clinical; lab tests → Leukocytosis; cobblestoning on ultrasound
45
Cellulitis (Level 3) Tx?
Tx: Antibiotics targeted at suspected organism
○ Strep/staph → dicloxacillin, cephalexin
○ Penicillin allergic pts → clindamycin; azithromycin
○ MRSA → trimethoprim/sulfamethoxazole, clindamycin, doxycycline
46
Cellulitis (Level 3) Complications?
Abscess formation, necrotizing subcutaneous infection, bacteremia with
sepsis
47
Erysipelas (Level 3)-What is it?
Superficial bacterial skin infection that involves dermal lymphatics
48
Erysipelas (Level 3) Risk factors?
Risk factors: Infants, children, elderly, lymphatic obstruction, lymphedema, immune
deficiency states
49
Erysipelas (Level 3) cm?
Clinical manifestations: Fever, chills, malaise; involved skin has red, shiny, raised,
indurated, tender plaques with sharp, demarcated borders; classically on face or legs
50
Erysipelas (Level 3) dx? MC organism?
Clinical; Group A beta-hemolytic streptococci
51
Erysipelas (Level 3) cm?
Clinical manifestations: Fever, chills, malaise; involved skin has red, shiny, raised,
indurated, tender plaques with sharp, demarcated borders; classically on face or legs; Pruritic, edematous, painful, DEMARCATED BORDERS
52
Contact dermatitis (Level 2)? TYPES?
Acute inflammation of the skin caused by irritant or allergens
● Irritants (immune system not activated): Chemicals, soaps, plants
● Allergic response: Type IV cell-mediated hypersensitivity reaction (e.g. poison ivy)
○ Id reaction: Activated T cells migrate to different location & cause dermatitis at site
remote from initial trigger
53
Contact dermatitis (Level 2)-most common in pts with ?
atopic disorders
54
Contact dermatitis (Level 2) cm?
Pain (irritants), pruritus (allergens), involved skin can range from
erythema to blistering & ulceration
○ Rash may take the shape of the object (e.g. watch)
55
Contact dermatitis (Level 2) -(dx)
Clinical; possibly patch testing
56
Most comedones (acne) become inflamed from?
Propionibacterium
57
Contact dermatitis tx?
Mainstay: Topical or oral corticosteroids
○ Avoid offending agents
○ Supportive care (e.g. Burow solution compresses, antihistamines)
58
Erythema multiforme (Level 1)
Inflammatory reaction to an infectious agent or drug
Etiology:
○ Herpes simplex virus → most common
○ Drugs, vaccines
59
Erythema multiforme (Level 1) CM ?
Sudden onset of asymptomatic, symmetric erythematous
macules, papules, wheals, vesicles, bullae, or a combination of lesions
○ Usually starts on distal extremities (including palms & soles), then moves centrally
60
Erythema multiforme (Level 1) Classic findings?
Target lesions, oral lesions (intraoral vesicles, erosions)
61
What is the most common etiology Erythema multiforme (Level 1) ?
Herpes simplex virus → most common
62
Erythema multiforme (Level 1) dx and tx?
Dx: Clinical
| ● Tx: treat underlying cause; supportive tx
63
What is Herpes simplex virus (Level 2)?
Herpes simplex virus infections commonly cause recurrent infections affecting the skin,
mouth, lips, eyes & genitals
64
Etiology of Herpes simplex virus (Level 2)?
```
Etiology:
○ Herpes simplex virus type 1: Usually causes gingivostomatitis, herpes labialis &
herpes keratitis (saliva transmission)
○ Herpes simplex virus type 2: Usually causes genital lesions (sexual contact
```
65
How is Herpes simplex virus (Level 2) reactivation stimulated by?
Sunlight, fever, physical/emotional stress,
| immunosuppression
66
CM of Herpes simplex virus (Level 2)
Mucocutaneous lesions are usually clusters of small, painful
| vesicles on an erythematous base
67
How is Herpes simplex virus (Level 2) dx?
Clinical; confirmation testing – Tzanck smear, culture, PCR, direct
immunofluorescence or serology
68
Treatment care of Herpes simplex virus (Level 2)
If treatment is begun early for primary or recurrent lesions, mainstay: antivirals
(e.g. acyclovir)
69
What is Dermatophyte infections (Level 2)
Fungal infections of keratin in the skin, hair and nails
○ Tinea ____ → pedis (foot), cruris (groin), corporis (trunk, limbs), unguium (nails) &
versicolor (AKA: pityriasis versicolor)
70
Transmission of Dermatophyte infections (Level 2)
Usually person-to-person or animal-to-person
71
Most common organisms of Dermatophyte infections (Level 2)
Trichophyton
○ Microsporum
○ Epidermophyton
○ MALASSEZIA FURFUR (tinea versicolor
72
Clinical of characteristics Dermatophyte infections (Level 2)
Varies by location, host susceptibility & hypersensitivity
○ Usually very little inflammation; ASYMPTOMATIC → MILD ITCHING
○ Lesions are usually erythematous, SCALY ANNULAR PATCHES with a distinct border &
CENTRAL CLEARING
73
How is Dermatophyte infections (Level 2) diagnose?
Dx: Clinical, KOH wet mount, culture of plucked hairs
74
Tx of Dermatophyte infections (Level 2)
```
Topical antifungals (e.g. terbinafine, clotrimazole)
■ Topical steroids should be avoided because they promote fungal growth
○ Oral antifungals for nail & scalp infections
```
75
Hidradenitis suppurativa (Level 2)
CHRONIC inflammatory condition of hair follicles & associated structures → rupture of
follicles, development of abscesses, sinus tracts & scarring
76
Hidradenitis suppurativa (Level 2) CM:
Swollen, tender nodules usually develop in axillae or groin
○ 2° bacterial infection can occur
○ Inflamed nodules can coalesce into PALPABLE CORDLIKE FIBROTIC bands
77
Hidradenitis suppurativa (Level 2) Dx: TX?
Dx: Clinical; Topical antibiotics (clindamycin), intralesional corticosteroids & oral antibiotics
(e.g. tetracycline)
○ Surgery
78
What is What is Impetigo (Level 2)? What are the RF? What are the organisms?
Superficial skin infection commonly occurring in infants & children
● Risk factors: Moist environment, poor hygiene
● Organisms: Staph aureus (most common); also Strep pyogenes, or both
79
Impetigo (Level 2) CM, what are the 2 types of presentations?
Nonbullous: Erythematous macule becomes clusters of vesicles or pustules that
rupture & develop a HONEY-COLORED CRUSTY EXUDATE over the lesions
○ Bullous: Similar, but VESICLES ENLARGE RAPIDLY to form bullae which then rupture &
expose a larger base covered by a similar crusty exudate
○ PRURITUS IS COMMON → scratching which can spread the infection to other sites
80
Impetigo (Level 2) Dx and TX?
Dx: Clinical
● Tx:
○ Mainstay: Topical mupirocin; ORAL ANTIBIOTICS for more SEVERE cases
○ Wash crusty areas with mild soap & water
81
Wha tis Lipomas (Level 2)
Common benign tumor made of ADIPOSE TISSUE
82
Cm of Lipomas
SOLITARY, SOFT, MOVABLE SUBCUTANEOUS (right below surface) nodules, commonly
occurring on proximal limbs, trunk, or neck
○ Multiple lipomas = familial, or associated with various syndromes
83
Lipomas Dx and TX?
Dx: Clinical
| ● Tx: surgical excision only if painful
84
What are Epidermal inclusion cysts
Most common benign cutaneous cyst
85
What are the MC benign cutaneous cyst?
Epidermal inclusion cysts
86
CM of cutaneous cysts?
Firm, globular(globe-shape), movable, NONTENDER mass that contains a WHITE,
CHEESY & MALODOROUS SUBSTANCE; if rupture or infected=painful
Often times, a punctum or pore can be visualized on the overlying skin
87
TX and DX of cutaneous cysts?
Surgical excision or I & D if infected → cyst wall must also be removed to prevent
recurrence; Clinical
88
What is Melanoma (Level 1)
Malignancy of melanocytes; that occurs most commonly on skin
89
MC cause of skin cancer deaths ?
Melanoma
90
Melanoma occurs where else beside the skin?
oral cavity, genito-rectal areas, choroid of eye & nail beds
91
RF of Melanoma?
```
Repeated sun/UV exposure, family or personal hx, fair skin, atypical moles, ↑
# of melanocytic nevi, immunosuppression
```
92
CM of melanoma? Does melanoma metastasis?
Lesions vary in size, shape & color (usually pigmented), and their
propensity to invade & metastasize (metastasis occurs via lymphatics & blood vessels);
local metastasis results in formation of satellite lesions - think ABCDE
93
Key findings in melanoma? ABCDE?
Change in size, consistency, shape (e.g. irregular borders), color (e.g. red,
white, blue pigmentation of surrounding skin), or signs of local inflammation; A-asymmetry, B borders, C color, d -diameter, E evolving/elevation
94
Melanoma dx and tx?
excisional biopsy; Dermatology consult/referral; possibly oncology depending upon extent of disease
95
What virus causes Molluscum contagiosum (Level 2)
poxvirus, chronic skin infection
96
Molluscum contagiosum is MC seen in ?
Children
97
Molluscum contagiosum form of transmission?
Direct contact, autoinoculation, bath water & fomites (e.g. towels
98
CM of Molluscum contagiosum?
Clusters of flesh-colored, dome-shaped, smooth, waxy or pearly
UMBILICATED PAPULES, usually 2-5 mm in diameter; Lesions do not occur on palm & soles
○ Immunosuppressed patients may develop more widespread infection
99
Molluscum contagiosum lesions occurs in what body part in children? Adults?
Children: Face, trunk, extremities
| ○ Adults: Pubis, penis or vulva
100
Molluscum contagiosum dx? Do lesions regress? If you how long? TX
Clinical; Most lesions regress in 1-2 yrs; tx is mostly for cosmetic reasons
○ Mechanical → Curettage, cryosurgery, laser tx, electrocautery
○ Topical irritants → Trichloroacetic acid, tretinoin
○ Prevent spread
101
What is Onychomycosis (Level 2)
Fungal infection of the nail plate, nail bed, or both (TOENAILS 10X > fingernails)
102
RF of Onychomycosis
Tinea pedis, older age, exposure to someone else with this condition,
immunocompromised (ex dm, hiv etc)
103
What are the organisms in Onychomycosis?
Dermatophytes (e.g. Trichophyton rubrum ) → Most common; Non-dermatophyte molds (e.g. Aspergillus )
104
Onychomycosis CM?
Deformed & white → yellow discolored nail plate
105
How is Onychomycosis Dx?
Clinical; potassium hydroxide (KOH) wet prep, culture
106
Onychomycosis is treated ? prevention
Asymptomatic-tx not necessary as oral tx =long term +hepatotoxicity & drug
interactions (if on meds); Mainstay: Oral terbinafine or itraconazole
○ Topical tx may help (e.g. efinaconazole, ciclopirox); Keep nails trimmed short, keep feet dry, use absorbent socks &
antifungal foot powder
107
What is Paronychia (Level 2)?
Inflammation of PROXIMAL &/OR LATERAL NAIL fold adjacent to nail plate
108
Why does Paronychia occur in the fingers? Toes?
Fingers: Usually due to HANGNAIL OR NAIL BITING
| ● Toes: Usually due to INGROWN TOENAIL
109
Paronychia is mc cause by what organism?
Staph aureus
110
Paronychia cm?
Pain, warmth, redness, swelling & throbbing
111
Paronychia dx ? TX
Clinical; Warm compresses or soaks & anti-staph antibiotics
○ If pus present → I & D
112
What is Pilonidal disease (Level 2? Whom do they most occurred?
abscess or chronic draining sinus in the SACROCOCCYGEAL AREA ; occurring
in young, hirsute men or women
113
How does Pilonidal disease presents ?
One or several, midline or adjacent to midline, pits or sinuses that
often contain hair in the skin of the sacrococcygeal cleft
○ Lesions are usually asymptomatic until they become infected
114
Pilonidal dx? Tx?
DX? Abscess → I & D
| ○ Surgery follow-up for definitive tx
115
What is Pityriasis rosea (Level 2)? It occurs Most often in ? Possible etiology?
Self-limited inflammatory disease of the skin; women between
| ages 10-35 yrs; viral (herpes virus) vs drugs?
116
CM of Pityriasis rosea
-Single, primary, 2-10 cm HERALD PATCH on the trunk or proximal limbs,
followed by a CENTRIPETAL ERUPTION of smaller ROSE-, SALMON- OR FAWN-COLORED papules &
plaques over the next 7-14 DAYS- Christmas tree distribution [orients along skin lines]);
lesions are usually ITCHY, SCALY & SLIGHTLY RAISED; May present with viral prodome prior (malaise, headache)
117
Pityriasis rosea dx and tx ?
Dx: Clinical
| ● Tx: topical corticosteroids, oral antihistamines as needed for itching
118
Does Pityriasis rosea presents with viral produce?
It may but not necessary
119
What are Pressure ulcers (Level 2)?
Areas of skin necrosis and ulceration where tissues are compressed between bony
prominences & hard surfaces; other causes also include friction, shearing forces & moisture (areas of dying tissue with ulcers due to tissues are being squished in-between hard surfaces)
120
What are the RF of Pressure ulcers?
>65 yrs, impaired circulation & tissue perfusion, immobilization,
undernutrition, decreased sensation & incontinence
121
What are the Clinical manifestations (commonly used staging system of Stage 1-IV) of pressure ulcers?
Stage I: Non- blanching erythema
○ Stage II: Loss of epidermis (superficial) or partial thickness skin loss
○ Stage III: Crater ulcer with full thickness skin loss (∅ bone/muscle exposure)
○ Stage IV:(all the way) Full thickness ulceration with exposure of underlying bone, tendon or
muscle
122
Pressure ulcers dx and tx?
Clinical; 1. Pressure reduction 2. avoidance of friction & shearing forces 3. Good nutrition
4. Wound care (cleaning, debridement, dressings)
5. Infection & pain control
6. Surgery referral for skin grafts or other treatments
123
Psoriasis (Level 2)
Hyperproliferation of epidermal keratinocytes along with inflammation of the epidermis
& dermis thought to be triggered by environmental factors (e.g. trauma, infection, drugs)
in susceptible individuals (overgrowth of keratins in skin +inflammation of top /middle )
124
What are subtypes of psoriasis?
Plaque psoriasis → MOST COMMON (90%); psoriatic arthritis (5-30%)
involves inflammatory arthritis
125
CM of Psoriasis (Level 2)
Asymptomatic or pruritic, well-circumscribed, erythematous
| papules & plaques covered with SILVERY SCALES
126
What are the common locations of Psoriasis
scalp, EXTENSOR
| SURFACES of elbows & knees, nails, sacrum, gluteal cleft & genitals;
127
How is Psoriasis dx and treated?
Dx: Clinical; Tx: 1. Topical: Corticosteroids, vit D3 analogs (e.g. calcitriol), emollients, coal tar preps
2. UV light tx
3. Systemic tx: Methotrexate, immunomodulatory agents (e.g. etanercept)
4. Appropriate dermatology referral
128
What is Rosacea (Level 2)
Chronic inflammatory disorder of the skin that most commonly affects the FACE & SCALP OF
individuals with fair skin(aka adult acne)
129
What ages does Rosacea (Level 2)
30-50 yrs
130
Possible triggers of Rosacea (Level 2)
Sun exposure, emotional stress, cold/hot weather, Et-OH, spicy foods,
hot baths, hot drink
131
cM Rosacea (Level 2)
Facial FLUSHING/STINGING, TELANGIECTASIAS, erythema, papules,
pustules, and in severe cases, RHINOPHYMA (large red, bulbous nose
132
How is Rosacea (Level 2 dx and tx?
```
Dx: Clinical
● Tx:
1. Avoidance of triggers
2. Topical: Metronidazole, ivermectin
3. Oral: Antibiotics (e.g. doxycycline) 4. For severe cases (e.g. rhinophyma): Isotretinoin, surgery
```
133
What is Scabies (Level 2)? How is transmitted?
Infestation of skin with the mite SARCOPTES SCABIEI; Typically person-to-person; HIGHLY CONTAGIOUS
134
Rf of scabies ?
Crowded conditions (e.g. schools, shelters, barracks), immunosuppression
135
Scabies (Level 2)
INTENSELY PRURITIC lesions (classically, worse at night) with
erythematous papules & burrows in FINGER WEB SPACES, FLEXOR surfaces of wrists, elbows &
axillary folds (INTERTRIGINOUS AREAS), waistline, umbilicus & genitals;
○ In adults, the face is not involved
136
Scabies (Level 2)
Clinical; microscopic examination of skin scrapings for mites, ova, fecal pellets;
Tx: 1. Mainstay: Topical permethrin or lindane (can be neurotoxic; not for use in
children <2 yo)
2. Pruritus: Topical corticosteroids, oral antihistamines
3. Treat close contacts, launder clothing & bedding
137
What is Lice (Level 2)? 3 main types?
Infestation of scalp, body, pubic area or eyelashes by lice (pediculosis); 1. Head lice, 2. body lice 2. Pubic lice.
138
How is head lice transmitted?
Person to person
139
Head lice signs/symptoms?
Severe pruritus; excoriations & posterior cervical adenopathy
140
head lice dx?
Finding of lice (combing thru wet hair) or nits [eggs] (near base of hair
shaft), usually at back of head or behind ears → live nits fluoresce with
Woods lamp
141
Head lice tx?
Tx: Mainstay: Topical permethrin (may need retreatment in 7 days); nit
removal with fine-toothed comb; laundering of personal items; oral
antihistamines for pruritus
142
what is Body lice? How is it transmitted?
live on bedding or clothing; NOT ON PEOPLE ; transmission: Sharing of clothing/bedding in cramped, crowded settings
143
Body lice s/s?
Pruritus; small red puncta on skin caused by bites, linear scratch marks &
urticaria; most commonly seen on SHOULDERS, BUTTOCKS & ABDOMEN
144
Body lice dx and tx?
Finding lice & nits in clothing (esp. seams); nits may be present on body hairs;Mainstay: thorough cleaning or replacement of clothing/bedding; oral
antihistamines for pruritus
145
Pubic lice? transmission? where do they live?
crabs; Sexually transmitted in adolescents & adults; also fomites; (live on people
146
Pubic lice cm?
Pruritus; usually infest pubic & perianal hairs, but may spread to thighs, trunk
& facial hair (beard, mustache, eyelids); ± pale, bluish-gray skin macules (from
anticoagulant activity of louse saliva), excoriations & regional lymphadenopathy
147
Pubic lice dx and tx?
Dx: Finding of nits (Woods lamp) &/or lice
Tx: 1. Mainstay: topical permethrin (may need retreatment in 7 days); treat sexual
partners; laundering of personal items; oral antihistamines for pruritus; petrolatum
for eyelash infestations
148
Seborrheic dermatitis (Level 2)
Inflammation of skin areas that have a high density of sebaceous glands (e.g. face, scalp,
upper trunk) [cradle cap in infants (inflammation of skin thats has lots of secreting glands)
149
What organism may play in seborrheic dermatitis?
Malassezia (fungus) may play a role
150
Seborrheic dermatitis cm?
Develops gradually with occasional pruritus & dandruff → GREASY
SCALING OR YELLOW-RED SCALING PAPULES along hairline & face (nose, eyebrows, eyelids, ears
151
Seborrheic dermatitis dx and tx?
Dx: Clinical
● Tx:
○ Mainstay: Tar preparations & topical corticosteroids
○ Topical antifungals
152
Spider bites (Level 2) types?
Black widow:Brown recluse:
153
where do spider bites typically occur near what places?
woodpiles, outhouses, or in hidden spaces
154
How are black widow described?
Large, shiny black spider with a red-orange hourglass marking on abdomen
○ Only female envenomates humans
155
Are black widow's bite fatal?
no
156
sx/s of Black widow:
PAINFUL ‘pin prick’ bite with sx developing within 30 mins → ‘BULL’S EYE’ WITH
ERYTHEMA & CENTRAL BLANCHING at bite site, diaphoresis, muscle cramping, spasm
or rigidity & abdominal pain (may mimic acute abdomen
157
Black widow dx and tx?
Dx: Clinical (hx of seeing spider)
○ Tx: Wound care, opioids for pain relief, benzodiazepines for muscle spasms;
antivenom for severe cases
158
brown recluse are described as ?
Small, brown spider with VIOLIN-SHAPED mark on dorsal thorax
159
Are brown recluse bites fatal?
yes, they can be
160
Brown recluse dx and tx?
Dx: Clinical
| ● Tx: wound care, supportive care; possibly surgery for necrotic tissue
161
Squamous cell carcinoma (Level 1)
Malignant tumor of epidermal keratinocytes
162
2nd most common skin CA?
Squamous cell carcinoma; Metastasis can occur & is more common with CA involving lingual or mucosal
surfaces
163
Squamous cell carcinoma (Level 1) risk factors?
Precancerous lesions (e.g. actinic keratosis, leukoplakia); sun exposure
164
sx/s Squamous cell carcinoma (Level 1)?
red papule or plaque with scaly, crusted or HYPERKERATOTIC SURFACE; any
NON-HEALING LESION found on sun-exposed surface
165
Squamous cell carcinoma (Level 1) dx and tx?
Dx: Clinical & biopsy; Tx: Surgery, topical chemotherapy, radiation
166
what is Stevens-Johnson syndrome (SJS) (Level 1)
Severe CUTANEOUS hypersensitivity reaction involving <10% BSA
167
Stevens-Johnson syndrome (SJS) (Level 1) etiology?
Most commonly due to drug reaction (sulfa drugs, antibiotics, antiepileptics)
168
Stevens-Johnson syndrome (SJS) (Level 1) sx/s?
1-3 wks after drug exposure → patients develop malaise, fever, headache, cough &
KERATOCONJUNCTIVITIS; macules then appear, rapidly spread & coalesce → LARGE, FLACCID
BULLAE THAT SLOUGH OVER 1-3 DAYS; skin, mucosal & eye pain are common; lesions may
involve PALMS & SOLES
169
Stevens-Johnson syndrome (SJS) (Level 1) dx and tx?
Dx: Clinical, biopsy
| ● Tx: remove offending agent, treat similar to burns
170
Toxic epidermal necrolysis (Level 1)
Severe form of SJS involving >30% BSA
171
sx/s of Toxic epidermal necrolysis (Level 1)
Large sheets of epithelium may slough (+ NIKOLSKY SIGN) exposing weepy, painful &
erythematous skin; painful oral lesions, keratoconjunctivitis; may involve GU &
RESPIRATORY EPITHELIUM
172
Toxic epidermal necrolysis (Level 1) dx and tx?
Dx: Clinical, biopsy
● Tx: Remove offending agent, burn ICU, supportive care, appropriate consults (e.g.
ophthalmology)
173
Brown recluse sx/s ?
Painless bite with pain then developing over 30-60 mins; bite area
becomes erythematous & ecchymotic, ± pruritus; central bleb then forms → fills
with blood, ruptures & leaves a BLACK COLORED ESCHAR OVER AN ULCER; severe
systemic effects can occur
174
What differentiates acne from rosacea? corticosteroid-induced acne
rosacea does not have comedones;; which lacks comedones and in which pustules are usually in the same stage of development)
175
Neonatal acne? length? located? tx?
newborn to 8 weeks, lesions limited to the face, responds to topical ketoconazole 2% cream
176
what oral birth control has been approve for acne ?
Ethinyl estradiol– norgestimate (Ortho Tri-Cyclen) is approved by the FDA for treatment of acne vulgaris in women and adolescent girls.
177
What is Cherry Angioma?
Benign growth of small blood vessels; Usually seen in pts >30 yo
178
What is the mc benign vascular tumor?
Cherry Angioma;
179
Cherry Angioma CM?
bright red, circular or oval in shape, flat or raised
180
Cherry Angioma TX?
usually no treatment needed unless bleeding or bothersome; possibly
electrodesiccation, liquid nitrogen, laser; Any change in size, shape or color should have dermatology follow-up
181
What is Folliculitis
Infection & inflammation of hair follicle
182
What is the organisms of folliculitis?
Organisms: Staphylococcus aureus (most common); also Pseudomonas aeruginosa (‘hot tub
folliculitis
183
Folliculitis presentations?
pruritus, follicular pustules with penetrating hair
o Deeper infection → furuncle (abscess of hair follicle)
o Furuncle spread to adjacent follicles → carbuncle
184
Folliculitis dx and tx?
Tx: mild superficial dz - topical antibiotics (eg. mupirocin); more extensive dz – oral
antibiotics (eg. cephalexin, clindamycin
185
What is Hand Foot and Mouth? What virus is responsible? how long does it last
Oral enanthem & a macular, maculopapular or vesicular exanthem usually on the hands &
feetmost often due to Coxsackievirus A serotypes & usually lasts 7-10 days
186
Hand foot and mouth is transmitted how?
is fecal-oral, but can also occur by contact with oral & respiratory secretions
or vesicular fluid
187
Hand foot and mouth presents?
usually <7 yo; mouth or throat pain or refusal to eat, vesicles with
erythematous halos on buccal mucosa & tongue followed 1-2 days later with extremity
exanthem (may occurred in adults)
188
Dx and Tx for Hand foot and mouth
clinical
| ● Tx: supportive
189
Lacerations: wound assessment?
1. Mechanism & time of injury
2. Possible foreign body: get x-ray (metal & glass are radiopaque)
3. Assess condition & viability of tissues
4. Functional assessment
a. Neurologic: motor, sensory (light touch, 2-point discrimination)
b. Vascular: pulses, capillary refill
c. Muscles/tendons: flexion, extension, ab-/adduction
5. Wound exploration
190
Why close wounds?
Achieve hemostasis, repair loss of structure &/or function,
↓ healing time, ↓ likelihood of infection, ↓ scar tissue formation & improve
cosmetic appearance
191
When to close wounds
Golden period’ is variably defined; in general, clean uninfected wounds on most
areas of the body in healthy pts can be closed primarily up to 18 hrs after injury –
for the face, up to 24 hrs after injury
192
Wound stages ?
1. Hemostasis
(Clot formation) 2. Inflammation
(Demolition 3. Proliferation 4. Remodeling
(Maturation)
193
Hemostasis?
| Clot formation
(Clot formation) 1. Vascular constriction
| 2. Thrombus formation
194
Inflammation
(Demolition); 1. PMN infiltration
2. Monocyte infiltration ® macrophage
3. Lymphocyte infiltration
195
Proliferation
1. Re-epithelialization
2. Angiogenesis
3. Collagen synthesis
4. Extracellular matrix formation
196
Remodeling
(Maturation)
1. Collagen remodeling
2. Vascular maturation & regression
197
Wound healing categorie
Primary closure (intention
198
What is Primary closure of wound healing?
closing lacerations or surgical wounds with apposed
| edges using sutures, staples, skin adhesive; results in minimal scarring
199
What is 2nd closure of wound healing?
process used for wounds with large separated
wound edges (eg. gouges, infected or chronic wounds); needs frequent wound
care, wounds granulate from inside out, typically produces larger scar
200
What is Delayed primary closure (tertiary intention)
wounds are left open for 4-5 days,
| then re-evaluated – if no signs of infection, wounds are surgically closed
201
Tetanus prophylaxis?
Clean/minor wounds: last tetanus shot within 10 yrs
| o Contaminated/large wounds: last tetanus shot within 5 yrs
202
Possible indications for surgical consult/referral for lacerations?
Deep or penetrating wounds of unknown depth
o Full-thickness lacerations of eyelid, nose, lip or ear
o Lacerations involving nerves, arteries, bones or joints
o Severe crush and/or contaminated wounds
o Wounds with strong concern about cosmetic outcome
203
What are Photosensitivity Reactions?
Abnormal skin reactions to UV or visible light (AKA: photodermatoses
204
Polymorphous light eruption? Presentation? tx?
(AKA: ‘sun poisoning or sun allergy’)
o Idiopathic photodermatosis
o Presentation: pruritic papules & plaques that appear hrs to days after
sun exposure; can last several days
o Tx: topical steroids, oral antihistamines; prevention (avoiding sun exposure,
protective clothing, sunscreen
205
Drug-induced phototoxicity? Common agents? Presentation? tx?
Most common drug-induced photo eruption
o Common agents: tetracyclines, thiazides, sulfonamides, fluoroquinolones, NSAIDs,
phenothiazines
o Presentation: erythema, edema, occasionally with vesicles or bullae, that occurs in
sun exposed areas of the skin within mins to hrs of sun exposure
o Tx: treat similar to sunburn (cool compresses, oral analgesics), stop offending
agent, sun protective measures
206
What is Phytophotodermatitis? Presentation? TX?
Topical skin exposure to a plant substance → phototoxic reaction (eg. carrot,
citrus, mulberry, legume family)
o Presentation: erythema, edema, vesicles, bullae on sun exposed skin surface of
plant exposure; Tx: cool wet compresses, topical steroids, NSAIDs, avoiding contact with
offending plant(s)
207
What is Stasis Dermatitis
Inflammatory dermatosis of the lower extremity due to chronic venous insufficiency with
venous hypertension
208
Stasis Dermatitis presentation?
edema, pruritus, reddish-brown skin discoloration (usually over
medial ankle), eczematous skin changes; late – lichenification, hyperpigmentation,
induration, lipodermatosclerosis
209
Stasis Dermatitis TX?
Chronic venous insufficiency: compression stockings, elevation, ambulation,
weight reduction
o Symptomatic: wet dressings, topical steroids, emollients
210
What is Telangiectasia?
Small superficial dilated capillaries or veins (AKA: spider veins) located near surface of
skin or mucous membranes
o Usually benign
211
Telangiectasia is associated?
Can be associated with pregnancy, aging, rosacea, alcoholism
212
Telangiectasia presentation?
discrete pink & red, punctate, linear or lacework-like blood vessels that
blanch with pressure
213
Telangiectasia tx?
Tx: usually not required; may be treated for cosmetic purposes (sclerotherapy, laser)
