Dermatology2 Flashcards
(311 cards)
1
Q
What is the prophylaxis for influenza?
A
Oseltamivir (Tamifulu), Zanamivir (Relenza) and Peramivir (neuromindase inhibitor)
2
Q
When should antivirals be given for influenza?
A
within 48hrs
3
Q
What is the recommendation for vaccine for influenza?
A
everyone > 6mo
4
Q
When is the influenza season?
A
Nov- March
5
Q
C/I for influenza vaccine?
A
egg allergy, previous rxn to vaccine, developed Guillain Barre syndrome, have had GBS in past 6ks, <6mo
6
Q
What are the symptoms of flu?
A
abrupt fever, chills, malaise, muscle aches, sore throat, headache, coryza
7
Q
What defines AIDS?
A
CD4 count of <200 cells
8
Q
What screening test is used for HIV?
A
ELISA
9
Q
What test confirms HIV?
A
Western blot
10
Q
What is the txt for HIV?
A
HAART
11
Q
When should PEP be started for HIV?
A
within 72hrs of exposure
12
Q
How is HIV transmitted?
A
semen, blood, vaginal secretions breast milk
13
Q
Erythema migrans is seen in what disease?
A
Lyme disease
14
Q
What is the treatment for lyme disease?
A
Doxycycline
15
Q
What is the prophylactic for lyme disease?
A
Doxycycline
16
Q
What are the 3 stages of lyme disease?
A
early localized, early disseminated, late disease
17
Q
Diagnosis lyme disease?
A
ELISA followed by Western blot to confirm
18
Q
What is the txt of lyme disease in children and preggo?
A
Amoxicillin or cefuroxime
19
Q
What is the classic triad of meningitis?
A
fever greater than 38
nuchal rigidity
headache
20
Q
Knee extension causes pain neck?
A
Kernig’s sign
21
Q
Leg raise when bend neck?
A
Brudzinski’s sign
22
Q
What is seen in babies with suspected meningitis?
A
bulging fontanelle
23
Q
What are the two types of meningitis?
A
aseptic and bacterial
24
Q
What is the most common cause of aseptic meningitis?
A
Enterovirus
25
What is the most common cause of bacterial meningitis?
S. pneumoniae
26
Evidence of meningitis but negative blood cultures indicates?
Aseptic meningitis
27
Gram negative diplococci?
N. meningitidis
28
MC cause of neonate meningitis?
E. coli and S. agalactiae
29
MC cause of >60 or immunocomprised meningitides?
Listeria or cryptococcus neoformans
30
Dx of meningitis?
lumbar puncture
31
CSF finding for bacterial meningitis?
Increase protein
decreased glucose
markedly increased opening pressure
32
CSF finding for viral meningitis?
```
normal pressure
increased WBC (lymphocytes)
```
33
CSF finding for Guillain Barre Syndrome?
increased protein
| normal glucose
34
Household contacts of pts with bacterial meningitis are treated with?
Ciprofloxacin, Rifampin, Levaquin, Zithromax, Rocephin
35
What is the treatment for bacterial meningitis?
Dexamethasone + empiric IV abx (cephalosporin, vancomycin, pencillins)
36
What is the treatment for viral meningitis?
symptomatic or IV acyclovir for HSV
37
What is seen in dx of mono?
atypical lymphocytosis
38
A Pencillin given in mono can cause what?
maculopapular rash
39
Classic triad of mono?
fever
lymphadenopathy
pharyngitis
40
How is mono transmitted?
oropharyngeal secretions and salvia
41
The kissing disease
Epstein Barr virus
42
Pts with mono are at risk of what?
splenic rupture
43
How is Epstein Barr virus diagnosed?
"monospot"
44
What is a monospot?
mononucleosis rapid slide agglutination test for heterophile antibodies
45
What antibodies are seen in mono?
heterophile antibodies
46
Treatment for Mono?
Supportive
47
Can a patient contract mono again after exposure?
nope!
48
Rose spots is seen in?
Enteric fever (salmonella typhi)
49
Pea soup diarrhea is seen in?
Enteric fever (typhoid)
50
infected egg yolks?
Gastroenteritis (salmonella typhimurium, Enteritidis)
51
How is salmonella treated?
Cefriaxone, fluoroquinolones, azithromycin
52
Fever increases with "pea soup" diarrhea followed by pink papules on the trunk, which fades when pressure is applied
Salmonella typhi
53
The most common form of salmonella infection?
gastroenteritis
54
What is the treatment for gastroenteritis?
self-limited, symptomatic
55
What symptoms are seen in gastroenteritis?
```
mucus+ bloody diarrhea
vomiting
abdominal pain
fever
cramping
```
56
Diarrhea from poultry products- dairy, meat, eggs, exotic pets (reptiles, turtles)
salmonell
57
What are symptoms of typhoid?
headache, pea soup stools (brown-green), intractable fever, bradycardia, rose spots
58
Diarrhea from undercooked ground beef, unpasteurized milk/ apple cider, day care centers, contaminated water
enterohemorrhagic ecoli 0157:H7
59
Treatment for enterohemorrhagic ecoli?
fluid replacement and supportive
60
Abx use in enterohemorrhagic e.coli can cause what?
hemolytic uremic syndrome
61
What are symptoms of enterohemorrhagic e.coli?
water diarrhea -> bloody, crampy abdominal pain, vomiting. Fever low grade
62
Rice water stools?
Vibrio cholerea
63
What is the MC cause of traveler's diarrhea?
Enterotoxigenic e.coli
64
What are the symptoms of enterotoxigenic e.coli?
abrupt onset of watery diarrhea, abdominal cramping, vomiting
65
Lower abdominal pain, explosive watery diarrhea, mucus blood
Shigella
66
MC strain of shigella in US?
S. sonnei
67
What diarrhea can cause reactive arthritis and febrile seizure in children?
Shigella
68
Whom does Shigella predominately affect?
children (daycares)
69
treatment for Shigella?
ciprofloxacin
70
What is the diagnosis of Shigella?
leukocytes and red blood cell on stool culture
71
Transmitted by drinking unsanitary water/ice
enterotoxigenic e.coli (traveller diarrhea)
72
What can cause osteomyelitis in the sickle cell patient?
Salmonella
73
Salad bar diarrhea?
Shigella
74
How is cryptococcus neoformans meningitis diagnosed?
india ink stain
75
A rash present with meningitis indicates?
Neisseria meningitidis
76
multiple well demarcated red/purple infiltrative firm nodules and plaques in pt with a history of HIV
Kaposi sarcoma
77
What virus causes Kaposi sarcoma?
Human Herpes Virus 8 (HHV8)
78
AIDS defining cancer?
Kaposi sarcoma
79
Dx of Kaposi sarcoma?
biopsy- spindle cells mixed w/ vascular tissue
80
What is the txt for Kaposi sarcoma?
Chemotherapy or radiation
81
Prognosis of melanoma is most strongly associated with what dimension?
depth of lesion
82
The most common histologic type of melanoma?
Superficial spreading malignant melanoma
83
What type of melanoma is seen on the palms, soles, and nail beds?
acral lentiginous melanomas
84
Txt for Melanoma?
wide excision I-III, IV- chemo
85
Asymmetric, elevated, blue-tinged lesion with irregular scalloped borders
melanoma
86
large pruritic, subepidermal bullae in a 75y/o
Bullous pemphigoid
87
chronic acquired autoimmune subepidermal blistering skin disorder
Bullous pemphigoid
88
What is the mechanism of bullous pemphigoid?
IgG produced against the basement membrane
89
Whom does bullous pemphigoid usually affect?
60-80yr old, increases with age
90
Dx of bullous pemphigoid?
biopsy w/ immunofluorescence - IgG and C3 basement membrane
91
Txt for bullous pemphigoid?
Topical Corticosteriods, Prednisone, Azathioprine
92
Nikolsky sign negative in what disease?
Bullous pemphigoid
93
What are the 3 main pathogens seen in cellulitis?
H. influenzae, Streptococcus, Staphylococcus
94
Red hot, swollen, tender, fever, and chills
cellulitis
95
What is the txt for mild cellulitis (MSSA)?
Cephalexin or Dicloxacilln
96
What is the txt for MRSA?
TMP-SMZ, clindamycin, doxycyline
97
What is the treatment for a cat bite?
Augmentin or Doxy
98
Txt for a puncture wound through the shoe?
Ciprofloxacin (Pseudomonas)
99
raised cauliflower like lesions in clusters on shaft of penis
condyloma acuminatum
100
What HSV strains cause genital warts?
6 and 11
101
what vaccine is approved for HPV?
Gardasil 9
102
How is condyloma acuminatum dx?
NAAT, colposcopy, anoscopy
103
What is the txt for condyloma acuminatum?
Imiquimod (Aldara), Podofilow, Cryotherapy, surgery or TCA (trichloroacetic acid)
104
T/F HPV vaccine treats a existing infection
False
105
When should the HPV vaccine be given?
before the start of sexual activity (age 11-12)
106
Breakout from nickel, poison ivy?
Allergic dermatitis
107
Breakout from diaper, cleaners, solvents, detergents, urine, feces
irritant
108
pruritic lesions, lichenification mostly on the flexor creases
atopic dermatitis
109
What type of reaction is atopic dermatitis?
IgE, Type I
110
Coin shaped disc shaped skin lesion?
nummular eczema
111
Erythematous, yellowish greasy scales, crusted lesions
seborrheic dermatitis
112
What is the txt for seborrheic dermatitis?
Antifungal shampoo
topical corticosteriod
olive oil compresses
113
Young woman. Papulopustular, plaques, and scales around the mouth
Perioral dermatitis
114
What type of reaction is allergic dermatitis
Type IV
115
What is the dx for dermatitis?
patch test
116
Pts with atopic dermatitis usually have?
asthma or allergic rhinitis
117
The "itch that rashes"
atopic dermatitis
118
Txt for atopic dermatitis?
topical cortiocosteriods
119
Txt for perioral dermatitis?
topical metronidazole, erythromycin
120
What is C/I txt in perioral dermatitis?
topical steroids- cause flare of lesions
121
What is the most common adverse drug reaction?
Skin reactions
122
What dosage of epinephrine is used for acute txt of anaphylaxis?
02-0.5 mg
123
What is the txt for drug eruption?
withdrawal offending drug
epi, prednisone-prevent recurrence
urticaria- 2nd gen anthistamine
124
acute onset of vesicles without erythema on the lateral aspects of fingers, palm, and feet
dyshidrosis
125
What is another name for dyshidrosis?
pompholyx
126
What causes dyshidrosis?
unknown
127
Resembles tapioca pudding?
dyshidrosis
128
Txt of dyshidrosis?
1st line- Topical steroids, 2nd- oral steroids
129
What do pt with dyshidrosis usually have in their pmhx?
atopic background
130
Painful rash, that is red, hot, shiny, raised, indurated, and tender, well demarcated and hot to the touch
erysipelas
131
What organism causes erysipelas?
Streptococcus pyogenes (group A strep)
132
What is erysipelas?
superficial cellulitis w/ dermal lymphatic involvement
133
What looks like cellulitis but is well demarcated and painful?
erysipelas
134
What must be ruled out in erysipelas?
MRSA
135
Dx erysipelas?
culture and senstivity
136
Txt for mild erysipelas?
Penicillin G (allergy- erythromycin or clindamycin)
137
What type of reaction is erythema multiforme?
Type IV
138
What common infection is associated with erythema multiforme?
herpes simplex
139
What drugs can cause erythema multiforme?
```
sulfa drugs
phenytoin
barbiturates
penicillin
allopurinol
```
140
Target or iris lesions, localized to hands, feet or mouth
erythema multiforme
141
Dx of erythema multiforme?
absent of prodromal symptoms preceding HSV infection
| Neg Nikolsky
142
Txt for erythema multiforme?
Avoid substances
control herpes- acyclovir
topical corticosteriods
143
Slapped cheek
Erythema infectiosum
144
What causes Erythema infectiosum?
Parvovirus B19
145
What symptoms are seen in erythema infectiosum?
slapped cheek rash on face and lacy rash on extremities
146
What are sickle cell pts at risk with erythema infectiosum?
aplastic crisis
147
How is fifth disease diagnosed?
clinical, enlarged nuclei
148
Txt for fifth disease?
NONE, symptomatic
149
Older adults who get fifth disease what syndrome can occur?
polyarthropathy syndrome (swelling/ pain in joints)
150
Sores in the mouth, rash on hands, feet, mouth, and buttocks?
Coxsackievirus
151
T/F Coxsackievirus is contagious in the 1st week of illness?
True
152
Txt for Hand, Foot, and Mouth disease?
supportive
153
What virus causes measles?
paramyxovirus
154
What the three phases of measles?
prodrome
enanthem
exanthem
155
3 C's in the prodrome measles phase?
cough
coryza
conjunctivitis
156
Koplik spots?
Rubeola (Measles)
157
When does Koplik spot appear?
Enanthem phase
158
When does the rash appear in measles and how does it spread?
Exanthem
| face downward
159
What serology dx measles?
Igm antibodies
160
txt of measles?
supportive (during rash must be isolated)
161
What vaccine protects against measles?
MMR
162
Describe measles rash?
brick red maculopapular blanching rash on face progressing to palms and soles lasts 7 days
163
3-day rash that appears on face spreads downward
Rubella (German Measles)
164
Symptoms of rubella?
rash, fever, lymphadenopathy
165
Which rash is teratogenic in the 1st trimester?
Rubella
166
What is seen in congenital rubella syndrome?
hearing loss
developmental delay
growth retardation
cardiac and ophthalmic defects
167
What is the difference between rubeola and rubella rash?
rubella is less red (pink maculopapular rash)
168
txt for rubella?
supportive and vaccine
169
Whom is Roseola usually seen in ?
children 6mo- 2yrs old
170
How does Roseola usually present?
high fever, followed by a pink maculopapular rash
171
How does Roseola rash spread?
starting at trunk and neck spreading elsewhere
172
Just as the child appears to be recovering from fever, a red rash appears?
Roseola
173
What causes Roseola
HHV 6
174
Txt for Roseola?
supportive
175
Besides rash and fever what can Roseola cause?
afebrile seizures
176
What is associated with Nagayama spots?
Roseola
177
Papules and pustules in hair follicules
Folliculitis
178
Hot tub users folliculitis is caused by what organism?
Pseudominas
179
Folliculitis is MC caused by?
S. aureus
180
What causes razor bumps?
Pseudofolliculitis barbae
181
Txt of hot tub folliculitis?
none
182
1st line txt for folliculitis?
Mupirocin ointment and topical benzoyl peroxide
183
Mechanism behind Hidradenitis suppurativa?
disorder of apocrine gland
184
txt of hidradenitis suppurativa?
Topical clindamycin +/- oral abx
| Intralesional triamcinolone
185
Non painful, pruritic lesion in a <6y/o child that has "honey colored crust?
Impetigo
186
MC cause of impetigo in temperate regions and tropical?
S. aureus and Strep pyoderma
187
Txt for impetigo?
topical mupirocin
188
Complications of impetigo?
poststreptococcal glomerulonephritis
| strep throat
189
Most common form of impetigo?
nonbullous impetigo
190
several ovid, grey white eggs in hair
lice
191
Pediculosis?
lice
192
Txt for lice?
Permethrin topical
193
flat topped, shiny, violaceous papules with fine white lines (wickham striae), pruritic
Lichen planus
194
What are the 5 P's of Lichen planus?
pruritic, purplish, polygonal, planar, papules
195
Txt for lichen planus?
resolves spontaneous
| Topical steroid ointments- antihistamines-Hydroxyzine, 2nd line- systemic steriods
196
What disease is Lichen planus associated with?
Hep C
197
All pts with Lichen planus should be checked for?
Hep C
198
Hyperpigmented large plaque that is very itchy that is spreading across the front left ankle
Lichen simplex chronicus
199
What causes Lichen simplex chronicus?
chronic repeated rubbing or scratching of the skin causing lichenifications
200
Condition that causes thick leathery brownish skin?
Lichen simplex chronicus
201
Txt of lichen simplex chronicus?
STOP SCRATCHING
| High potency steroids
202
Non-painful mass on upper back that is slow growing, firm, but highly mobile
Lipoma
203
Treatment of lipoma?
surigical excision or liposuction
204
Hyperpigmentation, light to dark brown macules to bilateral cheeks
Melasma
205
What causes melasma?
increase in estrogen
206
Chloasma, or the mask of pregnancy
Melasma
207
What can cause melasma?
OCP
pregancy
HRT
208
What can be used to dx melasma?
wood's lamp
209
Txt for melasma?
Stopping exposure
topical hydroquinone (bleaching)
chemical peels
sunblock
210
flesh-colored, waxy dome shaped, umbilicated pearly papules over the face, trunk, and extremities
molluscum contagiosum
211
Molluscum contagiosum is usually seen in whom?
Children, but can affect adults
212
What causes molluscum contagiosum?
Pox virus
213
Extensive molluscum contagiosum in adults suggest?
immunosuppresion
214
What screening is indicated in a adult with molluscum contagiosum?
HIV
215
Txt of molluscum contagiosum?
NONE! self limited
216
Yellowish-green nail pigmentation
onychomycosis
217
Dx of onychomycosis?
KOH prep
218
Txt for oral antifungal?
terbinafine
219
What are sde of terbinafine?
liver failure, monitor LFT and liver failure
220
What should be monitored with terbinafine therapy?
LFT
221
What causes most toenail and fingernail oncyhomycoses?
Dermatophytes
222
Fingernail onychomycosis is more often caused by?
Candida
223
Red, warm pain along nail margin after manicure
paronychia
224
MC cause of Acute of paronychia?
staph aureus
225
MC cause of chronic paronychia?
candida albicans
226
Txt for acute paroncyhia?
I&D, warm compresses, abx cream
227
Txt for chronic paronychia?
topical antifungal clotrimazole or nystatin
228
Abscess or sinus tract in the upper part of the gluteal cleft
Pilonidal disease
229
Txt for pilonidal disease?
I&D, if infection Cefazolin + metronidazole or bactrim
230
A HEARLD patch following a URI that line up along skin folds and resembles CHRISTMAS Tree distribution
Pityriasis rosea
231
HEARLD PATCH and CHRISTMAS TREE distribution
Pityriasis rosea
232
What organism causes pityriasis rosea?
Herpes virus 7
233
What is the txt for pityriasis rosea?
NO treatment! self limiting
234
What appears first in pityriasis rosea?
herald patch
235
Who is at the greatest risk for developing pressure ulcers?
spinal cord injuries
236
What is the best txt for pressure ulcer?
prevention by frequent positioning
237
Well demarcated, erythematous, silvery scaly plaques involving the scalp and extensor
Psoriasis
238
Auspitz sign and Koebner's phenomenon?
bleeds when scale is picked
| minor trauma causes new lesion
239
MC type of psoriasis?
Psoriasis Vulgaris
240
Txt of psoriasis?
emollients, Vit D, topical retinoids, tar, anthralin, corticosteroids
241
Whom is more likely to have rosacea?
women aged 30-50
242
Facial erythema, telangiectasia, papules, and rhinophyma
Rosacea
243
What are 3 triggers of rosacea?
heat, alcohol, and spicy foods
244
Where is rosacea most common?
forehead, cheeks, and nose
245
Txt for rosacea?
topical metronidazole
246
Intensely itchy, painful, red streaks between the fingers, that is worse at night
Scabies
247
Vesicles and burrows in the webbed spaces of the fingers and toes
Scabies
248
What causes scabies?
Sarcoptes scabiei hominis
249
Dx for scabies?
skin scrape (microscope)
250
Txt for scabies?
Topical 5% permethrin cream
| Oral ivermectin
251
Flesh colored, grey brown and black papules/plaques with a velvty warty texture, "Stuck on" apperance, barnacles of old age
seborrheic keratosis
252
T/F seborrheic keratosis is benign and usually asymptomatic?
True
253
Txt for seborrheic keratosis?
NO txt (not premalignant)
254
Necrotic wound with central necrosis around a red halo would be seen in what insect bite?
Brown recluse spider
255
N/V, HA, fever, syncope and convulsions, muscle spasm would be seen in what insect bite?
Black widow spider
256
Txt for brown recluse spider bite?
wound care, delayed excision
257
Txt for black widow spider bite?
wound care, benzo's, antivenom- elderly and kids
258
What classifies as Stevens Johnson syndrome (SJS)?
milder form <10% of body surface
259
What classifies as Toxic Epidermal Necrolysis (TEN)?
severe form >30% of body surface
260
What two classes of drugs cause SJS?
Anticonvulsants
| sulfa drugs
261
What symptoms are seen in SJS and TENS?
+ Nikolyskys sign
| red papules and dusky blisted eroded areas, mucous membrane involvement
262
Txt for SJS?
Stop all offending meds
Burn unit admin
Intravenous immunoglobulin (IVIG)
263
Steroids use to be the TOC for SJS, but now it has a increase risk for what?
Sepsis
264
More severe form on SJS?
TEN
265
DX for TEN and SJS?
biopsy
266
Txt for TEN?
burn unit
| Cyclosporine
267
Tinea corporis?
infection of body surfaces other than feet, groin, face, scalp hair or bread
268
Tinea pedis?
infection of feet
269
Tinea cruris?
infection of the groin
270
Tinea capitis?
infection of scalp hair
271
Tinea unguium?
infection of nail
272
What medicine is not effective for dermatophyte infections?
Nystatin
273
What is the most common fungal infection in pediatrics?
Tinea capitis
274
Drug of choice for Tinea capitis?
Oral griseofulvin
275
Txt for Tinea barbae?
oral griseofulvin
276
What is the most common dermatophyte causing athlete's foot?
Trichophyton rubrum
277
Txt for Tinea pedis?
Topical antifungals- azoles
278
Txt for jock itch?
Topical antifungals- azoles
279
What is the most comon cause of Tinea corporis?
T. rubrum
280
Txt for tinea corporis?
Topical antifungals- azole or terbinafine
281
What organism causes Tinea versicolor?
Malassezia furfur
282
Hypo or hyperpigmented macules that do not tan
Tinea versicolor
283
Txt for Tinea versicolor?
selenium sulfide shampoo 2.5%
284
Dx of Tinea infections?
KOH prep
285
Whom should be monitored closely when using oral antifungals?
Pt with hepatic disorders
286
When taking griseofulvin pts should avoid ?
alcohol- can cause a disulfiram rxn- flushing, HA, N/V, sweating, weakness, vertigo
287
Blanchable, edematous pink papules, wheals or plaques often disappears within 24hrs
Urticaria
288
Another name for Hives?
Urticaria
289
What is Darier's sign?
localized urticaria appearing where the skin is rubbed
290
What mechanism causes urticaria?
release of histamines due to Ig E
291
Dx of urticaria?
lab testing not indicated
| skin or IgE testing
292
1st line txt for urticaria?
2nd gen antihistamine H1 (Fexofenadine, Loratadine, Desloratadine, Cetirizine)
293
If 1st line txt for urticaria doesn't work whats next?
double H1 or add H2 antihistimine (Cimetidine, ranitidine, nizatidine, famotidine)
Corticosteriods
294
Txt of urticaria that might progress to anaphylaxis?
EpipEN
295
4-5mm flesh colored, sharply demarcated, rough, round and firm nodules with no skin lines, pinpoint black dots
warts (verrucae)
296
T/F Freezing and other destructive modalities do not kill the virus but just destroy the cells that harbor HPV?
True
297
Txt for verrucae?
most resolve in 2yrs
cryotherapy w/ liquid nitrogen
salicylic acid
298
What is vitiligo?
patterned loss of melanin pigment that occurs when immune cells destroy the melanocytes
299
Where does Vitiligo normally occur?
around orifices- mouth, eyes, nose, and anus
300
What 3 autoimmune diseases is Vitiligo associated with?
Addison's disease
Hyperthyroidism
Pernicious anemia
DM
301
Dx of vitiligo?
wood's light
302
"Milk white" fluorescence under Wood's light?
Vitiligo
303
Whom is at a 50% risk of having Vitiligo?
someone w/ a family hx
304
hypo pigmentation macules
Vitiligo
305
Txt for Vitiligo?
sunscreen, cosmetic cover up, repigmentation therapy
306
Which dermatitis is assoicated with celiac disease (gluten-intolerance)?
dermatitis herpetiformis
307
What is acanthosis nigricans commonly associated with?
hyperinsulinemia, insulin resistance, obesity, endocrine disorders
308
velvety, Hyperpigmented, papillomatous lesions of the neck and axillae
acanthosis nigricans
309
Pts with acanthosis nigricans are at risk for what?
metabolic syndrome
310
Txt for acanthosis nigricans?
weight loss and metformin
311
What is malignant acanthosis nigricans associated with?
gastric carcinoma
