Lecture 6- Derm (Exam 3) Flashcards

Question

Black Widow Spider * Where is it located in the US? * Potent what? * Spin their web where? * When does a problem occur? Bites are more common when?

Answer 1

* Patients feel pain at bite site within 3 hour and systemic symptoms begin 4-6 hours after the bite * The Black Widow cause neurologic overstimulation (muscle aches, spasms, and rigidity)

Answer 2

Alopecia Areata

Answer 3

* Alopecia areata is a chronic, relapsing, immune-mediated, inflammatory disorder that affects hair follicles and results in nonscarring hair loss. * The severity of the disorder ranges from small patches of alopecia on any hair-bearing area to the complete loss of scalp, eyebrow, eyelash, and body hair * Circular/patchy (areata) shape-> Sharply outlined portion of the scalp with complete hair loss, without erythema, scale, atrophy, or scarring * Can be seen with SLE

Answer 4

* Recurrent non scarring alopecia that can affect any hair bearing area->Scalp, beard, eyebrows * Localized<50%, Extensive>50% involvement * Alopecia Areata-Discrete patches of loss * Alopecia Totalis-Entire scalp is bald * Alopecia Universalis-All hair bearing areas of body are bald * Can affect children and adults

Answer 5

well defined alopecia areata

Answer 6

Alopecia areata

Answer 7

Progressive balding occurring from bitemporal recession, to frontal and/or vertex thinning to loss of all hair except for occipital and temporal margins. * Used for hair transplant

Answer 8

used for hair transplant

Answer 9

* Best when used early * MOA – widens blood vessels allowing more O2 from blood, nutrients to support growth * Side effects – pruritis, irritation, flaking

Answer 10

* Androgen inhibitor * Inhibits the conversion of testosterone to dihydrotestosterone * **Side effects** – decreased libido, erectile, ejaculation dysfunction * **Increased risk of prostate cancer**

Answer 11

* Surgical Treatment: Hair transplant * Wigs

Answer 12

* Will resolve on its own but may take 6-12 mos for resolution and regrowth to occur * No tx will speed up the process of resolution and regrowth * Emotional Support

Answer 13

* Thickened, discolored nail and debris on nail bed * DDX: psoriasis, rauma, aging * Etiology – T. rubrum most common, Candida effects fingernails more than toenails * Laboratory: KOH, PAS Stain-> This is more applicable if you suspect another nail dz

Answer 14

Onycomycosis Clincial features: * Asymptomatic at first->Pt usually presents for cosmetic reasons * As disease progresses pt may c/o pain, numbness * May interfere with walking, exercise, standing * Subungual hyperkeratosis

Answer 15

Topical Antifungal; combo topical/oral (risk benefits) * Terbinafine (Lamisil), avoid with liver disease (need LFTs, needs grow out to see improvement) * Itraconazole (Sporanox) Risk vs benefit with tx * Cost, labs, side effects, med interactions * Topical-Generally ineffective, unable to penetrate nail plate * Daily application for almost a year * Ciclopirox, efinaconazole

Answer 16

Fungal hyphae from KOH

Answer 17

Soft tissue infection that occurs around the fingernail (lateral and proximal nail folds) * Acute-Painful/purulent-Caused by staph infection * Chronic (6Weeks+)-Swelling, non purulent-Candida often isolated but not causative Breakdown of the nail fold caused by cracks, fissures, trauma.->Allows entryway for organisms

Answer 18

Paronychia

Answer 19

* Avoid nail biting * Trim hang nails * Trim nails flush to tip * Avoid excessive moisture exposure

Answer 20

Splinter Hemorrhages

Answer 21

## Footnote Grooved – depressed in chemotherapy.

Answer 22

Beau’s Lines - Transverse grooves on the nail

Answer 23

Koilonychia – “spoon nail” * SEEN: IRON DEFICIENCY ANEMIA

Answer 24

Terry’s Nails – “white nails” ## Footnote Cirrhosis. Terrys nails. 2/3 of proximal nail bed is white.

Answer 25

Mee’s bands – white transverse lines

Answer 26

* Shamroth technique – see diamond not * Emphysema, cystic fibrosis, cancer. Chronic hypoxic state.

Answer 27

* Clubbing * Schamroth technique

Answer 28

* Verruca Vulgaris -Common Wart * Condyloma Acuminata -Genital Wart * Plantar Wart -Wart @ bottom of foot * Tan, brown, or pink cauliflower-like papules ->Can occur anywhere

Answer 29

Caused by Human Papilloma Virus (HPV) * There are different types of HPV * Typing is most important for genital warts as it determines low risk vs high risk lesions and development of cancer * High risk subtypes include 6,11,16,18

Answer 30

Condyloma Acuminatum

Answer 31

Measles Virus Disease (1st Disease) or Rubeola

Answer 32

Scarlet Fever (2nd Disease)

Answer 33

German Measles (3rd Disease) or Rubella Virus

Answer 34

Erythema Infectiosum (5th Disease)

Answer 35

* **Patients with chronic hemolytic anemias or sickle cell** who develop transient aplastic crisis (pallor, weakness and lethargy) need to be treated for symptoms of anemia i.e. require blood transfusion. * **Pregnant women (with signs or symptoms suggestive of B19 infection or known recent exposure to infected contacts)** should have serum B19 IgM and IgG titers drawn. If maternal infection is supported, by positive IgM and IgG levels then serial fetal ultrasounds should be performed to evaluate for changes of hydrops fetalis

Answer 36

Papular Purpuric Glove and Sock Syndrome

Answer 37

Exanthem Subitum (6th Disease) or Roseola

Answer 38

* The viruses that cause HFMD and herpangina usually are transmitted from person to person by the fecal-oral route. * The incubation period for HFMD typically is three to five days, but has been reported to be as short as two days and as long as seven days * Examination of the throat reveals hyperemia and yellow/greyish-white papulovesicular lesions. The areas most frequently involved are the anterior pillars of the fauces, soft palate, tonsils, and uvula. Very occasionally, a lesion may be seen on the hard palate, tongue, or buccal mucosa. The number of lesions varies but is usually less than 10

Answer 39

Herpes simplex * Grouped vesicles on an erythematous base

Answer 40

## Footnote **Multinucleated giant cells seen under microscope**

Answer 41

* Associated with less severe symptoms & shorter duration * Patients get prodromal of pain, tingling, & burning prior to onset of vesicles * Decision to treat is individualized based on severity of symptoms, frequency of recurrence, patient preference, & cost

Answer 42

Herpetic Whitlow

Answer 43

Molluscum Contagiosum

Answer 44

Molluscum Contagiosum

Answer 45

Molluscum Contagiosum

Answer 46

Systemic symptoms highly variable and include low grade fever, malaise, headache etc. Severe, progressive infections manifest with deeper lesions in lung, liver, pancreas, or brain; mortality approaches 10%

Answer 47

Shingles (reactivated latent phase of VZV or HZV) - Dermatomal, grouped and confluent vesicles and pustules limited to a dermatome(s) innervated by a corresponding sensory ganglion. Pain and burning are common symptom

Answer 48

* Trigeminal (ocular n) eruptions that include the tip of the nose risk corneal involvement-> **Hutchinson’s Sign** * There is no conclusive evidence regarding the benefits of oral corticosteroids * Pain management with narcotics is often necessary * URGENT OPHTHALMOLOGIST REFERAL in all cases involving the ophthalmic branch of the trigeminal nerve **(heralded by vesicles on the nose)**

Answer 49

Cellulitis-> red and warm

Answer 50

Cellulitis

Answer 51

* Palpable purpura (left). Multiple red papules on leg of a patient with Henoch–Schönlein purpura. * Retiform purpura (right). Purpura on toes with retiform pattern on foot in a patient with cholesterol emboli.

Answer 52

* May occur as an idiopathic, predominantly cutaneous vasculitis * Palpable purpura (nonblanching, elevated lesions) is the cutaneous hallmark of vasculitis * Other lesions include petechiae (esp. early lesions), necrosis with ulceration, bullae, and urticarial lesions * Lesions most prominent on lower extremities

Answer 53

Vasculitis * Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis.

Answer 54

* Cutaneous Acute Vasculitis (Leukocytoclastic Vasculitis) * Characterized clinically by palpable purpura, especially of the legs * May be limited to the skin or involve other tissues as in Henoch- Schönlein purpura

Answer 55

* Reticulated (lace-like or Net-like) blanching erythema symmetrically distributed over lower extremities. * Frequently seen in autoimmune vasculitis * Do not confuse with Cutis Marmorata

Answer 56

Livedo Reticularis

Answer 57

Polyarteritis Nodosa

Answer 58

Polyarteritis Nodosa

Answer 59

* Sharply demarcated, painful, indurated, erythematous “fiery red”, edematous plaques

Answer 60

Erysipelas

Answer 61

Erysipelothrix

Answer 62

Impetigo * Thick, “honey” crusted lesions

Answer 63

Ecthyma Gangrenosum

Answer 64

* If on culture report see bacteria resistant to erythromycin but susceptible to clindamycin, DO NOT give Clindamycin. Not as good of a coverage. * A flattening of the zone of inhibition around the Clindamycin disk proximal to the Erythromycin disk (producing a zone of inhibition shaped like the letter D) is considered a positive result and indicates that the Erythromycin has induced Clindamycin resistance (a positive “D-zone test”).

Answer 65

* Pyoderma gangrenosum. Look for purple border. * Due to UC. * Tx with steroids and treat UC. DO NOT want to debride, makes it worse. So do wet to dry. No topical corticosteroids for any open wound.

Answer 66

Hanson's disease (leprosy) * Dapsone+Rifampin+Clofazimine for 6-12 months

Answer 67

* Type 1: polymicrobial/ salt-water contamination with Vibrio species, MRSA and others * Type 2: Group A streptococcal * Type 3: Clostridium infection, Clostridium myonecrosis (gas gangrene) ## Footnote History of trauma, surgery, predisposing condition (like DM)

Answer 68

Candidiasis

Answer 69

Candidiasis * Small erosions in the interdigital web space of the hand-> looks moist * Don’t confuse with dyshidrosis

Answer 70

* Necrotic lesions of palate and mucosa due to fungi * Clinically patients have depressed sensorium and CN palsies * Seen in immunocompromised state * Is a surgical emergency * Dx: PCR * DDx: Aspergillosis * Tx: Amphotericin B, surgical consult

Answer 71

Rhinocerebral Mucormycosis (Zygomycosis)

Answer 72

* Hypopigmented or hyperpigmented round or oval macules with fine scaling that do not tan and can be pruritic * Variation of presentation based on skin tone.

Answer 73

Tinea Versicolor

Answer 74

Erythematous, annular patch with distinct borders and central clearing usually with scaling

Answer 75

Tinea Corporis/Pedis

Answer 76

Tinea Corporis/Ped

Answer 77

Scalp(Tinea Capitis)-broken hair shafts are seen as black dots

Answer 78

Erythrasma

Answer 79

Serpiginous Lesion

Answer 80

* **Hyperpigmentation with thick, velvety accentuation of the dermal lines** * Most commonly on the axillae, neck but can also be groin, anogenitalia, antecubital fossae, knuckles, submammary, and umbilicus.

Answer 81

Acanthosis Nigricans

Answer 82

* Laboratory: R/O Diabetes Mellitus, Carcinoma (gastric) if clinically suspected * Treatment: No proven treatment other that for underlying disorder if present

Answer 83

* 1st and 2nd degree burns: cool compresses * Silver sulfadiazine is no longer recommended * Blisters should not be broken according to AAPA; however, rupturing the blister and using the top as a partial thickness skin grafts allows the wound to heal quicker and gives pain relief

Answer 84

* Total fluid = 4mL x wt(kg) x TBSA(%)

Answer 85

* Topical antibiotics (not neomycin) – allergic reaction * If debridement is needed: wet to dry normal saline dressings * Consider hydrogels or hydrocolloid dressings if the ulcer does not heal by 30% in 2 weeks.

Answer 86

Surgical management * Debridement of necrotic tissue * Bony prominence removal * Skin grafts Prolonged systemic antibiotics depending on sensitivities for any secondary bacterial infections

Answer 87

* Diabetic-tend to be deep, punched out lesions over the malleoli, the plantar surface of the feet or toes and are usually painless * Arterial-Not preceded by dermatitis and are smaller than stasis ulcers. These are painful, pulses are diminished or absent, and the distal areas are cold

Answer 88

Stasis- preceded by dermatitis, then wide but not deep ulcers develop, with irregular, undulating edges and clean base. Elevation relieves pain

Answer 89

Multiple comedones, some paired (which is characteristic), associated with several deep exquisitely painful abscesses and old scars

Answer 90

Hidradenitis Suppurtiva

Answer 91

* Occurs in axillae, groin, anogenital, and/or breasts * Purulent/seropurulent drainage often present from abscesses and/or open sinus tracts * Fibrosis, “bridge” scars, keloids and contractures are common

Answer 92

Epithelial Inclusion Cysts-Freely movable subcutaneous masses

Answer 93

Epithelial Inclusion Cysts

Answer 94

Hyperpigmented macules occurring on sun-exposed areas of the face (forehead, cheeks, upper lip)

Answer 95

* Malar distribution = Cheeks and Nose * Showing prominent, scaly, malar erythema * Involvement of other sun- exposed sites is also common

Answer 96

Malar or “Butterfly rash”of SLE

Answer 97

Pilonidal Cyst/Sinus

Answer 98

* Pore, sinus and/or fistulas may be visualized alone or in the presence of nodule on the midline sacral region at the upper end of the cleft of the buttocks * Lesions become inflamed due to rupture, or less commonly, infection * Often occur with nodulocystic acne, dissecting cellulitis, and hidradenitis suppurativa

Answer 99

* Present as generalized pruritic wheals (blanch with pressure) * A sign of more systemic/generalized involvement of allergic reaction * Showing characteristic discrete and confluent, edematous, erythematous papules and plaque

Answer 100

* Dermatographism: urticaria formation in skin after being stroked/scratched * Laboratory: CBC with Diff, CMP, Hepatitis antigens, ESR (necrotizing vasculitis), Stool for ova and Parasites * Allergy work up

Answer 101

* Known as Strawberry Nevus, is a most common benign vascular skin tumor in children * Found in up to 12% of children <1yo * Placental GLUT1 protein expression * Consider biopsy to r/o vascular malformations or Kaposi or angiosarcoma

Answer 102

Infantile Hemangioma

Answer 103

Sweet Syndrome

Answer 104

Still’s Disease

Answer 105

TTP (Thrombotic Thrombocytopenic Purpura)

Answer 106

* Three most common causes are drug reaction (particularly penicillin's and sulfonamides) **or concurrent HSV or Mycoplasma infection** * Other drugs: phenytoin, barbiturates, phenylbutazone, or allopurinol * Tx with removal of offending substance

Answer 107

Erythema Multiforme

Answer 108

Erythema Marginatum

Answer 109

Erythema (Chronicum) Migrans

Answer 110

* Toasted Skin Syndrome * Secondary to long-term exposure to infrared radiation/heat. * Develop reticulated erythema, hyperpigmentation, teleangiectasia, burning and pruritis. * Discontinue heat exposure

Answer 111

Erythema Ab Igne

Answer 112

* Previously known as Bazin Disease, now just Panniculitis * Commonly associated with cutaneous TB * Small superficial and painful nodules are felt * Work-up for TB * Differentiate from early Erythema Nodosum

Answer 113

Erythema Induratum

Answer 114

Erythema Nodosum

Lecture 6- Derm (Exam 3) Flashcards

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