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Flashcards in MTB Dermatology/emergency Deck (37):
0

Kaposi sarcoma treatment

Antiretrovirals

1

Imiquimod

Actinic keratoses
Molluscum Contagiosum
Chondylo Acuminatum

2

Seborrhoeic keratoses, premalignant?

No

3

Atopic dermatitis is a common skin disorder associated with...

overactivity of mast cells and the immune system. Look for a history of:
• Asthma
• Allergic rhinitis
• Family history of atopic disorders
• Onset before age 5, very rare to start after age 30

4

Psoriasis treatment

1. Topical high-potency steroids: fluocinonide, triamcinolone, betametha-sone, clobetasol
2. Vitamin A and vitamin D ointment help get the patient off steroids. The vitamin D agent is calcipotriene. Steroids cause skin atrophy.
3. Coal tar preparation
4. Pimecrolimus and tacrolimus are used on more delicate areas such as the face and penis. They are an alternative to steroids and are less potentially deforming.

Extensive Disease

1. Ultraviolet light
2. Antitumor necrosis factor (TNF) inhibitors (etanercept, adalimumab, inflixirnab). These agents can be miraculous in efficacy for severe disease.
3. Methotrexate: used last because of adverse effects on the liver and lung. It is a drug oflast resort except for psoriatic arthritis.

5

Eczema skin treatment

Moisturize
Avoid bath, soap, and washcloths
Cotton instead

Topical corticosteroids
Tacrolimus and pimecrolimus
Antihistamines:
Antibiotics if impetigo

6

Pityriasis rosea is...

an idiopathic, transient dermatitis that starts out with a single lesion (herald patch) and then disseminates. It can look like secondary syphilis but it spares the palms and soles. It is transient, but if symptomatic it is treated with steroids or ultraviolet light.

7

Bullous Pemphigoid

This is a much milder disease than pemphigus because:
• Bullae stay intact and there is less loss of fluid and infection. • Mouth involvement is uncommon.
Nikolsky sign absent
Prednisone

8

Pemphigus vulgaris (Blistering Diseases)

Autoimmune
Associated with ACEi
Autoantibodies split the epidermis, resulting in:
• Bullae that easily rupture because they are thin walled • Involvement of the mouth • Fluid loss and infection if widespread; they act like a burn
Nikolsky sign
Biopsy to Dx
Prednisone
Azathioprine
Rituximab

9

Impetigo causes

weeping, crusting, oozing, and draining of the skin.

10

Erysipelas is...

a much more severe disease than impetigo because it occurs at a deeper level in the skin. Erysipelas is much more often from Streptococcus than Staphylococcus.

11

Treatments for erysipelas, cellulitis, folliculitis, furuncles, and carbuncles.

Mild disease: Use oral medications:
• Penicillin, dicloxacillin, cephalexin, cefadroxyl
• Penicillin allergic: erythromycin, clarithromycin, or clindamycin
• MRSA: doxycycline, trimethoprim/sulfamethoxazole

Severe disease (fever present): Use intravenous medications:
• Oxacillin, nafcillin, cefazolin
• Penicillin allergic: clindamycin, vancomycin
• MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline

12

Penicillin Allergy

If the reaction to penicillin is a rash, use cephalosporins.
If the reaction is anaphylaxis:
• Mild infection: macrolides, clindamycin, doxycycline, or TMP/SMZ
• Severe infection: vancomycin, or ceftaroline

13

Skin drug reactions

Morbilliform rash: mildest reaction. Skin stays intact without mucous mem-1 brane involvement. No specific therapy.

Erythema multiforme: widespread, small "target" lesions; most are on the trunk. No mucous membrane involvement. May also be from herpes or myco-plasma. Prednisone may benefit some patients.

Stevens-Johnson syndrome: very severe. Involves the mucous membranes. Sloughs off respiratory epithelium and may lead to respiratory failure. Steroids not clearly beneficial. Use intravenous immunoglobulins (IVIG).

Toxic epidermal necrolysis (TEN): rash with mucous membrane involvement and adds Nikolsky sign. Steroids definitely do not help. Treat with IVIG.

14

SSSS and TSS

Staphylococcal scalded skin syndrome (SSSS) and toxic shock syndrome (TSS) are different severities of the same event: a reaction to a toxin in the surface of Staphylococcus.

SSSS looks similar to TEN, including Nikolsky sign. TSS has the same skin involvement as well as life-threatening multiorgan involvement such as:

• Hypotension • Renal dysfunction (elevated BUN and creatinine) • Liver dysfunction • CNS involvement (delirium)

15

The best initial management of altered mental status of unclear etiology is

an opiate antagonist and glucose.
Naloxone and dextrose

16

Aspirin overdose causes...

• Tinnitus and hyperventilation
• Respiratory alkalosis progressing to metabolic acidosis

17

Drug induced seizures

Although flumazenil can cause seizures from reversing chronic benzodi-azepine dependence, this case quite specifically states the benzodiazepine ingestion was today only. Benzodiazepines, however, can prevent seizures from tricyclic toxicity. When you reverse the benzodiazepines, you remove the suppression of the tricyclic toxicity. Opiate withdrawal does not cause seizures. Cocaine toxicity causes seizures, not withdrawal. Coingestion of tricyclics and benzodiazepines is very common.

18

Tricyclic antidepressant toxicity is rapidly detectable on

EKG. The EKG will show widening of the QRS complex. Torsade de point

19

Tricyclic antidepressant (TCA) toxicity can cause

seizures and arrhythmia leading to death. A wide QRS will tell who is about to have an arrhythmia. TCAs cause signs of anticholinergic effects such as:

• Drymouth • Constipation • Urinary retention

None of these effects causes death.

Treatment of TCA overdose is with sodium bicarbonate. Bicarbonate will protect the heart against arrhythmia. The bicarbonate does not increase uri-nary excretion of TCAs as it does for aspirin.

20

Carbon monoxide poisoning

CO binds oxygen to hemoglobin so tightly that carboxyhemoglobin will not release oxygen to tissues. Carboxyhemoglobin acts functionally like anemia. There is no functional difference between the absence of blood and carboxyhemoglobin; 60% carboxyhemoglobin acts like the loss of 60% of blood. CO poisoning presents with dyspnea, lightheadedness, confusion, sei-zures, and ultimately death from a myocardial infarction.

pH 7.35 pC02 26 HC03 18
Carbon monoxide poisoning prevents oxygen release to tissues, so lactic acidosis develops.

21

Methemoglobinemia

Brown oxidized hemoglobin that cannot carry oxygen.
Caused by anesthetics, nitrates
Carbon is abnormally red
Methemoglobinemia is brown

22

Digoxin toxicity

Predisposed by hypokalemia
Causes:
Hyperkalemia
GI nausea vomiting
Confusion
Visual yellow halo
Arrhythmia

23

PPI is given to prevent stress ulcer when...

Head trauma
• Burns
• Endotracheal intubation
• Coagulopathy (platelets below 50,000 or INR over 1.5) with respiratory failure

24

Unsynchronized cardioversion when...

VF and pulseless FT

25

AF presentation

Palpitations, dizziness, or lightheadedness
Exercise intolerance or dyspnea
Embolic stroke

26

Synchronization cardioversion helps...

prevent deterioration into VT or VF.

28

SVT The best initial step is:

1. Vagal maneuvers (e.g., carotid massage, Valsalva, dive reflex, ice immersion) 2. Adenosine if vagal maneuvers don't work 3. Beta blockers (metoprolol), calcium channel blockers (diltiazem), or digoxin if adenosine is not effective

29

CHADS Score

C: CHF or cardiomyopathy
H: hypertension
A: age >75
D: diabetes
S: stroke or TIA = 2 points
When CHADS score is 1 or less, use aspirin. When CHADS score is 2 or more, use warfarin, dabigatran, or rivaroxaban.

30

Skin Cancer

• More sun, more cancer
• Biopsy
• Remove

31

Skin cancer ABCDE

A: asymmetry
B: border irregularity
C: color irregularities
D: diameter greater than 6 millimeters
E: evolution (changing in appearance over time)

32

Actinic/Solar keratosis

must be removed with curettage, cryotherapy, laser, or topical 5-fluorouracil before they transform. The local immunostimulant imiquimod is also effective.

33

Dermatophyte =

superficial fungal infection = tinea

KOH(potassiumhydroxide)preparation
terbinafine
Topicals:
• Clotrimazole
• Ketoconazole
• Nystatin

34

When the answer is not clear and the cause of overdose is asked, say:

• Acetaminophen • Aspirin

35

• Opiate overdose is fatal:
• Benzodlazeplne overdose by itself is

Give naloxone immediately.
not fatal and acute withdrawal causes seizures. Do not give flumazenll.

36

xxx is benign and should be given to anyone with a pill overdose.

Charcoal

37

Cyanosis + normal p02 =

methemoglobinemia