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MTB - Dermatology Flashcards

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1
Q

ab’s to intercellular space of epidermal cells

A

pemphigus vulgaris

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2
Q

causes of pemphigus vulgaris:

A

idiopathic
ACE inhibitors
Penicillamine

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3
Q

3 diseases that have positive Nikolsky’s sign

A

pemphigus vulgaris
TEN
SSSS

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4
Q

are the lesions in pemphigus painful or pruritic?

A

painful

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5
Q

most accurate dx test - pemphigus vulgaris

A

biopsy of the skin

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6
Q

DOC: pemphigus vulgaris

A

glucocorticoids - prednisone

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7
Q

what drugs can be used in pemphigus if steroids are ineffective?

A

azathioprine
mycophenolate
cyclophosphamide

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8
Q

dz characterized by tense bullae formation, usually in an elderly person

A

bullous pemphigoid

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9
Q

Dx. test - bullous pemphigoid

A

biopsy w/ immunofluorescent abs

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10
Q

Tx. bullous pemphigoid

A

systemic steroids (prednisone)
alternatives:
- tetracycline
-erythromycin w/ nicotinamide

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11
Q

Pemphigus Foliaceus

A

blistering dz assoc with other autoimmune diseases or drugs (ACE inhibitors or NSAIDs); much more superficial than pemphigus

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12
Q

a patient presents with nonhealing blisters on sun-exposed parts of the body, hyperpigmentation of the skin and hypertrichosis of the face - dx?

A

porphyria cutanea tarda

- abnormal photosensitivity reaction

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13
Q

porphyria cutanea tarda is associated with…

A 
alcoholism
liver disease
hep C
OCP use
liver dz - chronic hepatitis, hemochromatosis
diabetes
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14
Q

Dx test - porphyria cutanea tarda

A

urinary uroporphyrins

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15
Q

Tx. porphyria cutanea tarda

A
  • stop drinking alcohol
  • stop estrogen use
  • use barrier sun protection
  • use phlebotomy or deferoxamine
  • chloroquine (increases excretion of porphyrins)
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16
Q

uriticaria

A

hypersensitivity reaction mediated by IgE and mast cell activation resulting in wheals and hives and pruritus.

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17
Q

Medications causing uriticaria

A 
aspirin
NSAIDs
morphine/codeine
penicillins
phenytoin
quinolones
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18
Q

MCC of uriticaria

A 
medications
insect bites
foods
emotions
contact w/ latex
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19
Q

Management - uriticaria

A

severe and acute? first generation anti-histamines

chronic? newer gen, nonsedating anti-histamines

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20
Q

morbilliform rash

A

typical type of drug reaction - generalized maculopapular eruption that blanches with pressure; mediated by lymphocytes

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21
Q

tx. morbilliform rash

A

antihistamines

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22
Q

causes of erythema multiforme

A 
penicillins
phenytoin
NSAIDs
sulfa drugs
infection w/ herpes simplex or mycoplasma
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23
Q

describe erythema multiforme

A

targetlike lesions esp. on palms and soles; does not involve mucosal membranes

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24
Q

Tx. erythema multiforme

A

antihistamines

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25
Stevens-Johnson syndrome
Hypersensitivity reaction involving < 10-15% of BSA and mucous membrane involvement (oral cavity and conjunctivae)
26
What meds can cause SJS?
``` penicillins sulfa drugs NSAIDs phenytoin phenobarbital ```
27
Management of SJS
pts should be managed in burn unit (high risk for infection, dehydration and malnutrition) meds to try: IVIG, cyclophosphamide, cyclosporine, thalidomide
28
Toxic Epidermal Necrolysis
most serious version of cutaneous hypersensitivity | - involves from 30-100% of BSA w/ mortality of 40-50% (MCC of death is due to sepsis)
29
Dx. TEN
skin biopsy
30
fixed drug reaction
localized allergic drug reaction that recurs at precisely the same anatomic site on skin w/ repeated drug exposure leaving a hyperpigmented, sharply demarcated spot
31
tx. fixed drug reaction
topical steroids
32
causes of erythema nodosum
``` pregnancy recent streptococcal infection coccidioidomycosis histoplasmosis sarcoidosis IBD syphillis hepatitis enteric infections - Yersinia ```
33
tx. erythema nodosum
analgesics, NSAIDs
34
best initial test for fungal infection of the skin
KOH prep
35
most accurate test for fungal skin infection
culture of fungus (take up to 6 weeks)
36
Tx. onychomycosis or tinea capitis
oral terbinafine or itraconazole 6 weeks - fingernails 12 weeks - toenails
37
s/e: terbenafine
hepatotoxic --> monitor LFTs periodically
38
s/e: systemic ketoconazole
hepatotoxicity | gynecomastia
39
which anti-fungal does NOT come in a topical form
fluconazole
40
Tx. mild bacterial skin infections
dicloxacillin, cephalexin (Keflex) or Cefadroxil (Duricef)
41
Tx. moderate-severe bacterial skin infections
IV oxacillin/nafcillin or IV cefazolin
42
pt with bacterial skin infection, gets a rash with penicillin - what drug can you use?
cephalosporins are OK (Cefadroxil or cefazolin)
43
pt with bacterial skin infection, anaphylaxis allergy to penicillin - what can you use to treat his infection?
macrolides - erythromycin, azithromycin, clarithromycin | newer FQs
44
MC organisms causing necrotizing fasciitis
Streptococcus | Clostridia
45
CF: necrotizing fasciitis
``` very high fever portal of entry to skin pain out of proportion to superficial appearance bullae palpable crepitus ```
46
Dx. necrotizing fasciitis
elevated CPK Imaging showing air in the tissue/necrosis best initial step: SURGERY (debridement)
47
Tx. necrotizing fasciitis
Ampicillin/Sulbactam Ticarcillin/Clavulanate Piperacillin/Tazobactam if strep infection: Clindamycin + Penicillin
48
what has the best efficacy for decreasing the risk of postherpetic neuralgia from herpes zoster
rapid admin of acyclovir
49
most effective analgesic for postherpetic neuralagia
gabapentin
50
Criteria for Toxic Shock Syndrome
``` fever > 102 systolic BP < 90 desquamative rash vomiting involvement of mucous mbs of eye, mouth and genitals ```
51
Lab findings in TSS
elevated Cr, CPK, LFTs | lowers platelets
52
Tx. TSS
1. IVF 2. pressors ie DA 3. antistaph meds: oxacillin, nafcillin or cefazolin (if MRSA - vancomycin, linezolid)
53
Staphylococcal Scalded Skin Syndrome
Skin infection mediated by toxin released by staphylococcus causing sloughing off of superficial layers of epidermis (granular layer) in sheets (positive Nikolsky); no other organ involvement like as in TEN
54
Tx. SSSS
manage in a burn unit | Oxacillin/Nafcillin
55
Tx. Anthrax
Ciprofloxacin | Doxycycline
56
Tx. seborrheic dermatitis
liquid nitrogen or curretage | - removal only for cosmetic purposes
57
Tx. actinic keratosis
cryotherapy, topical 5FU, imiquimod, topical retinoic acid, curettage
58
chemotherapy for Kaposi's sarcoma
liposomal Adriamycin and vinblastine
59
Tx. psoriasis
1. emollients 2. salicylic acid - removes crust 3. topical steroids (if localized) 4. topical vitamin D (calcipotriene) and vitamin A (tazarotene) (chronic psoriasis)
60
if psoriasis covers > 30% of BSA, treatment?
PUVA therapy
61
severe, widespread and progressive psoriasis - tx?
methotrexate
62
seborrheic dermatitis
oversecretion of sebaceous material; HS rxn to a superficial fungal organism (pityrosporum ovale)
63
Tx. seborrheic dermatitis
low potency topical steroids - hydrocortisone topical antifungals zinc pyrithione shampoo
64
stasis dermatitis
hyperpigmentation that is built up hemosiderin in tissue from long periods of venous incompetence of LE (no way to reverse this)
65
Tx. keloid scars
intralesional corticosteroids | - recurrence after treatment is common
66
Tx. psoriasis localized to the skin
topical high potency steroids (betamethasone 0.05%)
67
Tx. psoriasis that involves > 30% of the body surface area
phototherapy with UVB radiation
68
when is MTX used in psoriasis?
severe psoriasis psoriatic arthritis psoriasis involving the nails
69
drugs that may exacerbate psoriasis lesions
1. beta blockers 2. antimalarial drugs 3. NSAIDs 4. ACE inhibitors 5. lithium
70
stage 1 pressure ulcers
nonblanchable erythema of intact skin
71
stage 2 pressure ulcers
superficial ulcers causing a partial thickness of epidermis, dermis or both
72
stage 3 pressure ulcers
full thickness loss with damage to subcutaneous tissue that may extend to but not through any underlying fascia
73
stage 4 pressure ulcers
very deep ulcers causing full thickness loss with extensive destruction that may damage adjacent muscle, bone or supporting structures
74
tx. stage 3 or 4 pressure ulcers
pack with saline moistened gauze or cover with occlusive dressing
75
most accurate test for dx of psoriasis
skin biopsy - epidermal hyperplasia or hyperproliferation with neutrophillic infiltrate into stratum corneum and thinned to absent granular layer of epidermis
76
initial drug of choice for psoriatic arthritis
Methotrexate | - once weekly low dose regimen
77
topical treatments for psoriasis
low potency steroids (hydrocort) - face, intertriginous areas, thin plaques high potency steroids (thick plaques) anthralin - mild psoriasis calcipotriene - moderate plaque psoriasis
78
clinical associations with alopecia areata
1. exclamation point hairs, esp at periphery 2. nail pitting 3. other autoimmune conditions: thyroid dz, vitiligo, pernicious anemia
79
drugs implicated in telogen efflivum
``` beta blockers anticoagulants systemic retinoids anticonvulsants antithyroid medications ```

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