Fitzgerald - Dermatology Flashcards

Question

Confluent/coalescent lesions

Answer 1

Multiple lesions bleding together

Answer 2

Occurring ina group with pattern e.g. Acne-form drug induced rash seen with lithium, phenytoin, and iodine use = anticipated adverse effect

Answer 3

In streaks e.g. Contact dermatitis poison ivy

Answer 4

Appearing in a net-like cluster e.g. Erythema infectiosum (Fifth Disease/slapped cheek)

Answer 5

Limited to boundaries of a single or multiple dermatomes e.g. Shingles NOTE: If suspected, start on high-dose acyclovir and come back in 24 hours to confirm dx Pain occurs 1-2 days before lesions erupt Suspect in acute shoulder/back pain, skin is "sore" Skin could also itch severely

Answer 6

Infants vulnerable - vaccine is given at year 2-3 mm vesicles that start on trunk, appear on limbs 2-3 days later Nonclustered lesions at a variety of stages Mild to moderately ill Miserably itchy, risk for bacterial suprainfection of lesions **Tx:** Acyclovir within 24-48 hours of eruption **Prevention:** Varicella vaccine = 80% lifetime immunity first dose, 99% lifetime immunity second dose

Answer 7

Typically 50 years or older Possible in anyone with history of varicella Vesicles in a unilateral dermatomal pattern, slowly resolving with crusting Usually not systemically ill but quite miserable with pain and itch. Complications include postherpetic neuralgia, ophthalmologic involvement, and superimposed bacterial infection. **Tx:** High-dose acyclovir within 72 hours of eruption helps minimize duration and severity of illness **Prevention:** Zoster vaccine

Answer 8

Predominantly on sun-exposed skin Size ranges On skin surface - red, brown, scaly, often tender but usually minimally symptomatic Occassional flesh-colored - more easily felt than seen **Most common precancerous lesion though possibly represent early-stage SCC** **1 in 100 will progress to SCC** Tx: Topical 5-FU, 5% imiquimod cream, topical diclofenac gel or photodynamic therapy with topical delta-aminolevulinic acid Cryosurgery w/ liquid nitrogen, laser resurfacing, chemical peel

Answer 9

More common than SCC Sun-exposed area Arises de novo (of new) Papule, nodule w/ or w/o central erosion Pearly or waxy appearance, usually relatively distinct borders w/ or w/o telengiectasia Metastatic risk low

Answer 10

Less common than BCC Sun-exposed areas Can arise from AK or de novo Red, conical hard lesions w/ or w/o ulceration Less distinct borders Metastatic risk greater (3-7%) Greatest metastatic risk = lesion on lip, oral cavity, genitalia

Answer 11

A - Asymmetric B - Irregular borders C - Color not uniform D - Diameter usually 6mm or \> E - Evolving (new) lesion or change in a longstanding lesion, particularly in a nevus or other pigmented lesion E - Elevated (not consistently present) \* Majority of melanoma are de novo

Answer 12

medium-potency topical corticosteroid

Answer 13

Topical metronidazole

Answer 14

Acute, self-limited, erythematous skin disease Most likely viral Herald patch X-mas tree pattern Prodrome might occur but typically asymptomatic aside from itching Most cases do not require tx, may use medium-potency topical corticosteroid for itching Acyclovir may be useful in severe disease in shortening length of disease

Answer 15

cutaneous manifestation of hyperinsulinemia puberty = worsenign insulin resistance can regress w/ control of disease e.g. after gastric bypass

Answer 16

Infection of upper dermis, superficial lymphatics Streptococcus pyogenes (aka GABHS)

Answer 17

Infection of dermis and subcutaneous fat Streptococcus pyogenes, less commonly MSSA beta-lactamase producing, MRSA (resistance via altered protein-binding sites)

Answer 18

Skin infection involving hair follicle and surrounding tissue Carbuncles = cluster of furuncles connected subcutaneously, causing deeper suppuration and scarring Staph aureus (MSSA, MRSA)

Answer 19

**Necrotizing infection/Cellulitis/Erysipelas** Moderate = inpatient for IV PCN or Ceftriaxone, Cefazolin, or Clindamycin Mild = Oral Rx of PCN VK or Cephalosporin or Dicloxacillin or Clindamycin Dicloxacillin = PCN stable in beta-lactamase Clindamycin = most common abx assoc. w/ c-diff; take with probiotic

Answer 20

**Furuncle/Carbuncle/Abscess** Mild = I & D Moderate = I & D and C & S Empiric therapy with Bactrim, Doxy Defined Rx MRSA = Bactrim MSSA = Dicloxacillin or Cephalexin \*Keflex = First gen $4

Answer 21

"Red, white, and blue" Central blistering with surrounding gray to purple discoloration at bite site Surrounded by ring of blanched skin surrounded by large area of redness

Answer 22

Narrow spectrum Beta-lactamase resistant PCN Use of not risk factors for MRSA

Answer 23

Tick-borne Most cases occur in spring or early summer Early in disease: fever, malaise, arthralgias, headache, nausea w/ or w/o vomiting; children might present w/ abd pain Rash between day 3 and 5 of illness Early disease = empiric tx based on clinical judgment and epidemiological likelihood Later disease = dx via skin bx or serological testing

Answer 24

Start within 5 days of symptom onset Doxycycline 200 mg/day in two divided doses Tx should continue until 3 days of patient being afebrile Doxy: risk of _dental staining_ in children Doxy typically tolerated well except for _N&V_, give antiemetics/antimotility agents as needed Doxy assoc. w/ _photosensitivity_ = counsel about skin protection Pregnancy: use chloramphenicol if available

Answer 25

Erythema migrans (central erythema, ring remains flat, blanches, does not desquamate) **Tx:** Doxy 100 mg BID x 10-21 days Amox 500 mg every 6-8 hours for 21 to 30 days Cefuroxime 500 mg BID x 20 days Use Amox/Ceftin for children **Prophylaxis:** Within 72 hours of tick removal: Doxy 200 mg x 1 dose

Answer 26

Bactrim DS = 2 tablets x 5-10 days Rifampin can be added - use w/ caution CYP450 inducer If can't have sulfa (bactrim), use: Doxy Minocycline To cover staph and strep use Bactrim with a beta-lactam (cephalosporin)

Answer 27

Avoid sun exposure Lightweight long pants, long-sleeved shirts, brimmed hats May apply sunscreen 15 spf or \> minimal amt If sunburned - apply cold compresses to affected area

Answer 28

Hat w/ 3 inch brim or bill facing forward Sunglasses that block 99 to 100% of UV, cotton clothing w/ tight weave Stay in shade limit sun exposure during peak intensity hours 10 and 4 Use SPF 15 or \> on both sunny and cloudy days Protect against UVB and UVA rays Apply enough sunscreen 1 oz (30 mL) per sitting for older child and adult Reapply every 2 hours or after swimming/sweating Extra caution near water, sand, snow (reflects UV rays)

Answer 29

2 g 3 g 6 g 30-60 g

Answer 30

face, axillae, genitals palms and hands and soles of the feet cutaneous absorption is inversely proportion to the thickness of the stratum corneum Thicker/more viscous = greater absorption

Answer 31

inflammatory and allergy derm disorders potency is based on vasoconstrictive effects techniques to enhance delivery/potency? cover with an occlusive dressing. low potency (class 5-7): * hydrocortizone (all strengths and types) * triamcinolone * fluocinolone 0.01%; 0.025% midrange potency (3-4) * betamethasone * mometasone high potency (2) * fluocinolone 0.2% * fluocinonide 0.05% * betamethasone 0.05% super-high potency (1) * Clobetasol * halobetasol

Answer 32

**MOA:** Blocking histamine-1 receptor site (antagonist) in the respiratory tract, blood vessels & GI smooth muscle **Symptoms controlled:** itching and allergy (runny nose) also antiemetic. **SE:** anticholinergic and sedation (mainly 1st gen) **Compare 1st & 2nd gen antihistamines:** 1st gen crosses the blood-brain barrier - more sedation and cognitive effects. **Examples of 1st gen** * diphenhydramine -- Benedryl * chlorpheniramine -- Chlortrimetron (cranky cousin) **Examples of 2nd gen** * loratadine -- Claritin * desloratadine -- Clarinex * cetirizine -- Zyrtec * fexofenadine. -- Allegra * levocetirizine -- Xyzal

Fitzgerald - Dermatology Flashcards

(57 cards)