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PANCE Practice > Quick Derm Review > Flashcards

Quick Derm Review Flashcards

1
Q

vesicles form large bullae (rapidly)–> rupture–> thin “varnish-like crusts”
-fever diarrhea

A

Bullous impetigo
*S. auersus MC

TX:

  1. Mupirocin (Bactroban) topically drug of choice TID x10 days
  2. Extensive disease or systemic symptoms (ex. fever) systemic abx – cephalexin
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2
Q

Describe the different types of hypersensitivity reactions (cutaneous drug reactions)

A

1- IgE mediated, ex. urticarea and angio edema
2- Cytotoxic, Ab-mediated
3- immune antibody-antigen complex ex. drug-mediated vasculitis and serum sickness
4- delayed (cell mediated) morbiliform reaction ex. erythema Multiforme
5- nonimmunologic- due to genetic incapability to detoxify certain meds

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3
Q

mild fever, URI sx, decreased appetite starting 3-5 days after exposure
-Oral enanthem: vesicular lesion w/ erythematous halos in oral cavity (esp. buccal mucosa and tonge)–> exanthem 1-2 days afterwards- vesicular, macular or maculopapular lesion on the distal extremities on palms and soles

A

Hand foot and mouth (Coxsackie A)

Tx: supportive, encourage hydration

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4
Q

Cafe au lait macules are commonly associated with what other disease?

A

neurofibromastosis type 1

*if child has 6 or more cafe au lait macule (esp. w/ axillary or inguinal freckling) they should be evaluated for neurofibromastosis type 1

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5
Q

What type of burn?

  • Extends through entire skin
  • Waxy, white, leathery, dry
  • PAINLESS
  • Absent cap. refill
A

Full thickness (3rd degree)

*months to heal

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6
Q

Red, elevated thickened nodule with adherent white scaly or crusted, bloody margins
-hyperkeratosis and ulceration

A

Squamous cell carcinoma of the skin

dx: biopsy: atypical keratinocyte and malignat cells with large, pleomorphic, hypercchrommatic nuclei in epidermis
tx: wide local surgical excision*

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7
Q

Describe the rule of nine for burns

A

Head and neck- 9% (4.5 front and 4.5 back)
Upper limbs- 9% each (4.5 front and 4.5 back)
Trunk- 36% (9 chest, 9 upper back, 9 abdomen, 9 lower back)
Genitalia- 1%
Palms- 1%
Legs 18% each (9 front, 9 back)

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8
Q

Single or multiple dome-shaped, flesh-colored to pearly white WAXY papules with central umbilication.
-curd like material may be expressed from the center if lesion is squeezed

A

Molluscum Contagiosum

  • benign viral condition (poxviridae family/ pox virus)
  • highly contagious

TX: self-limited- resolves in 3-6 months
-Curettage

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9
Q

1-2 mm pearly white-yellow* papules esp. seen on cheecks, forehead, chin and nose in a newborn

A

Milia

TX: none- usually disappears by 1st month of line but may be seen up to 3 months

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10
Q

Diffusely red rash on the groin or on the scrotum.

A

Tinea cruris (jock itch)

TX: Topical antifungal*, PO Griseofulvin if ineffective

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11
Q

How do you dx Rubella (German measles)

A

Clinical

Rubella-specific IgM Ab via enzyme immunoassy

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12
Q

pink lesions that develop into Irregular discrete macule and papules of total depigmentation

  • milky white patches
  • commonly involves DORSUM OF HANDS, axilla, FACE, fingers, body folds and genitalia
A

Vitiligo
*autoimmune destruction of melanocytes–> skin depigmentation

DX workup: TSH (associated w/ autoimmune disorders like Hashimotots or Grave’s)

TX:
Localized: topical corticosteroids. Calcineurin inhibitors great for facial involvement
-Disseminated: systemic phototherapy (narrow band UVB)
PUVB****

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13
Q
  • Comedones: small, noninflammatory bumps from clogged pores (open comedones=black heads= incomplete blockage, closed comedone= whitehead= complete blockage
  • papules or pustules surrounded by erythema
  • nodular or cysic
A

Acne vulargis
mild= comedones
moderate= comedones, larger amounts of papules and/or pustules
severe= nodular

TX:
Mild- topical retinoids***, benzoyl peroxide, topical Abx (clindamycin), OCPs (decrease androgen)
Moderate- as above + oral Abx (doxy or minocyline) +/- anti androgen agent (spironolactone)
Severe- Isotretinoins (severely teratogenic)

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14
Q

streaking from the infected area of cellulitis following the lymph vessels

A

Lymphangitis

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15
Q

Complications/clinical manifestations of high voltage electric injuries

A
  1. cardiac arrest: low voltage- Vfib, high voltage- asystole
  2. Rhabdomyolysis (urinalysis is performed to look for myoglobinuria)
  3. neurological
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16
Q

numerous, small, discrete, flesh-colored papules measuring 1-5mm in diameter and 1-2mm in height

  • MC on hands
  • often form linear patterns bc scratchin or shaving spreads the virus
A 
verruca plana (aka flat warts)
***Human papilloma virus

TX: most warts resolve spontaneously w/in 2 yrs

  • topical OTC salicylic acid and plasters
  • cryotherapy, electrocautery
  • Gardasil vx
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17
Q

How do you dx Pityriasis (Tinea) veriscolor

A
  1. KOH prep from skin scraping: hyphae and spores “spaghetti and meatball” appearance
  2. Wood’s lamp: yellow-green fluorescence
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18
Q

-Blanched circular patch with surrounding red perimeter and central punctum (target lesion) associated w/ piloerection* and sweating
Latrodectism: local sx: asymptomatic or pain at site of inoculation with the onset of generalized sx w/in 30 min -2hrs–> systemic sx: muscle pain*, spasms, and rigidity

A

Black Widow Spider Bites

TX: Mild: wound care, pain control
mod-severe: opioids +/- muscle relaxants (benzo and methocarbamol)

*antivenom reserved for patients not responsive to above meds

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19
Q

Congenital disorder associated with class triad:

  1. Facial port wine stain (esp. along trigeminal distribution and around eyelids)
  2. leptomeningeal angiomatosis
  3. Ocular involvment (ex. glaucoma)
A

Sturge-Weber syndrome
*may develop hemiparesis contralateral to the facial lesion, seizures or intracranial calcifications and learning disabiliites

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20
Q

Target (iris) lesion classic: dull, dusty-violet red purpuric macules/vesicles or bullae in the center surrounded by pale edematous rim and a peripheral red halo
-often afebrile
+/0 mucosal membrane lesions

A

Erythema multiforme (type 4 HSN rxn)

EM minor: no mucosal membrane lesions
EM major: 1 or more mucosal membrane lesions, *no epiderlam detachment

Tx: self-limiting, supportive, dc med
PROPHYLAXTIC tx: Acyclovir (MC due to HSV)

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21
Q
  • Central blue color of impending necrosis w/ surrounding white area of vasospasm/vasoconstriction and peripheral RED HALO of inflammation
  • 24-72 hr after hemorrhagic bullae that undergoes eschar formation
A

Brown Recluse Spider Bite (MC in SW and Mid-West)

TX: Local wound care: clean w/ soap and water, apply cold packs, keep area elevated or neutral position

  • Pain control: NSAIDS
  • Tetanus prophylaxis
  • Debridement if necrosis develops
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22
Q

When is Rubella most teratogenic in pregnancy and what are the possible consequences?

A

1st trimester (TORCH infection)

  • Sensorineural deafness*
  • Cataracts
  • TTP (“blueberry muffin rash”)
  • mental retardation
  • heart defects
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23
Q 
What type of burn?
-Epidermis
-Erythemaous and dry
-Painful , tender to touch
\+ refill intact, blanches w/ pressure
A

Superficial 1st degree

  • heals w/in 7 days
  • no scarring
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24
Q

Inflammatory, erythematous blue-red papules or pustules–> PAINFUL,HEMORRHAGIC, necrotic ulcer with irregular purple/violet undermined borders and a purulent base

**Associated w/ inflammatory diseases: IBD, Crohn, UC, RA, spondyloarthropathies

A

Pyoderma gangrenosum

TX: Topical corticosteroids (HD) or tacrolimus. local wound care

  • 2nd line- systemic corticosteroids
  • 3rd line- IVIG
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25
Q
  • **Wickham Striae- fine white lines on the skin lesions or on oral mucosa. Nail dystrophy
  • Purple, planar, polygonal, pruritic papules w/ fine scales and irregular borders
  • MC on flexor surface of extremities, skin, mouth, scalp, genital, nailes
  • May develop Koebner’s phenomenon: new lesions at sites of trauma
A

Lichen planus

TX: topical corticosteroids
antihistamines

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26
Q

What type of burn?

  • Entire skin into underlying fat, muscle, bone
  • Black, charred, eschar, dry
  • PAINLESS
  • Absent cap refill.
A

4th degree

*Does not heal well

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27
Q

Small erythematous macules or papules–> pustules on erythematous base 3-5 days after birth.

  • does not involve palms or soles
  • individual lesions may disappear spontaneously
A

Erythema toxicum

Tx: self-limited (resolves 1-2 weeks)

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28
Q

MC type of skin CA in US

2nd MC type of skin CA

MC type of CA-related death

A

basal cell carcinoma
*slow growing- locally invasive but very low incidence of metastasis

Squamous cell carcinoma of the skin- often preceded by actinic keratosis or HPV infection

Malignant Melanoma
*aggressive, high METS potential, UV radiation associated w/ 80% of cases

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29
Q

painful, erythematous inflammatory nodules seen on anterior shins (range in color from pink, red to purple)
-usually bilateral

A

Erythema nodosum

TX: self-limiting- resolve w.in weeks

  • tx underlying condition
  • NSAIDS pain
  • peristent: corticosteroids
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30
Q

How do you dx Melasma

A

Wood’s lamp: appearance is unchanged under black light in dermal melasma

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31
Q
  • Erythematous plaques w/ white white scales on scalp of infants
  • yellowish-erythematous plaques w/ fine white scales common on scalp (dandruff), eyelids, beard, nasolabial folds, trunk, and intertriginous regions of the groin
  • worse in winter months
A

Seborrheic dermatits (hypersensitivity to Malassezia furfur)* occurs in areas of high sabaceous gland oversecretion

TX:

  • Topical:Selenium sulfide, sodium sulfacetamide, Ketoconazole or steroids, Zinc pyrithione
  • Systemic: oral antifungals (itraconazole, fluconazole)
  • Cradle cap: baby shampoo, ketoconazole shampoo or cream
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32
Q

3 C’s of Rubeola (measles)

A

3 C’s: Cough, Coryza (aka rhinitis-Irritation and swelling of the mucous membrane in the nose), Conjunctivitis–> Koplik spots (small red spots in uccal mucosa with pale blue/white center)

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33
Q

How do you dx dermatophytosis fungal skin infections

A
  1. KOH smear

2. Wood’s lamp: green fluorescence if due to Microsporum

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34
Q

URI prodrome: high fever
3 C’s: Cough, Coryza, Conjunctivitis–> Koplik spots (small red spots in uccal mucosa with pale blue/white center) precedes rash by 24-48hrs, last 2-3 days
–> morbiliform (maculopapular) BRICK-RED* rash on face beginning at hairline–> extremities
-Rash lasts 5-7 days fading from top to bottom

A

Rubeola (measles- paramyxovirus)

Tx: supportive, vitamin A reduces mortality in all children w/ measles

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35
Q

Mumps is caused by what virus

A

paramyxovirus

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36
Q 
Intense itching (esp in occipital area), papular urticaria near bites
-white oval-shaped egg capsules at the base of the hair shafts (nits)
A

Pediculosis (Lice)

TX:

  1. Permethrin topical (1st choice)
  2. Lindane (2nd choice)- neurotoxic: seizure risk if used after showering
  3. bedding/clothing are laundered in hot water w/ detergent and dried in hot drier for 20 min
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37
Q

What are the 5 P’s of Lichen Planus

A
  1. Purple
  2. Planar
  3. Polygonal
  4. Pruritic
  5. Papules
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38
Q

Chronic abscess of APOCRINE sweat gland or sebaceous cyst w/ tract formation
-Red tender inflammatory nodules/abscesses

A

Hidradenitis suppurativa
*MC in obese women and MC in axilla, groin, under breasts

TX: mild: topical clindamycin, intralesional injections of trimcinolone

  1. deep, recurrent infections: punch debridement if small, unroofing of larger ones w/ washout
    - painful abscess: I&D
  2. systemic Abx
  3. Surgical excision of apocrine gland
  4. Life style changes: avoid high glycemic foods, smoking cessation, local skin care
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39
Q

Tx of pressure ulcers

A
  1. wet to dry dressings, hydrogels

2. local wound care, pain management +/- surgical debridement (III and IV)

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40
Q

vesicles, pustules–> honey-colored crust

-associated with regional lymphadenopathy

A

nonbullous impetigo
*highly contagious superficial skin infection

**Staph aureus MC and GABHS 2nd MC

TX:

  1. Mupirocin (Bactroban) topically drug of choice TID x10 days
  2. Extensive disease or systemic symptoms (ex. fever) systemic abx – cephalexin
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41
Q

Scaly, well-demarcated, rough hyperkeratotic plaques w/ *exaggerated skin lines

A

Lichen Simplex Chronicus (Neurodermatitis)
*skin thickening in pts w/ eczema secondary to repetitve rubbing/scratching- itch-scratch cyle

TX: avoid scratching lesion, topical steroids (high), antihistamine, occlusive skin dressing

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42
Q

Describe fluid resuscitation for burn

A

Parkland Formula:
Lactated Ringers 4ml/kg/%TSA IV x fist 24 hours
1/2 in 1st 8 hours and other 1/2 over remaining 6 hours

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43
Q

Pink-red sharply demarcated, blanchable macules or papules in infancy. Over time they grow and darken to a purple color and may develop a thickened surface.
-MC on head and neck and usually unilateral or segmental

A

Port-wine stains (capillary malformation, nevus flammeus)
*vascular malformation of the skin

TX: pulse dye laser treatment (best if used in infancy for best outcomes)

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44
Q

“3-day rash” that spread rapidly

  • low grade fever, cough, anorexia, lymphadenopathy (posterior cervical, posterior auricular)*–> pink, light-red spotted maculopapular rash on face–> extremities
  • Forchheimer spots: small red macules or petechiae on soft palate
  • Transient photosensitivity* and joint pain (esp. in young women)
A

Rubella (German measles)

TX: support, anti-inflammatories

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45
Q

HA, nausea, malaise, altered mental status, seizures, brain hypoxia, coma
-cardiac dysrhythmias, dyspnea, angina

A

CO toxicity
*nonirritating gas that has over 200x the affinity for hemoglobin than oxygen

TX: O2 100% nonrebreather 10-12L/min until carboxyhemoglobin <10%
*may need hyperbaric O2 in sever cases

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46
Q

Complications of Rubeola (measles)

A
  1. Diarrhea*
  2. Otitis media*
  3. pneumonia
  4. Conjunctivitis and encephalitis
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47
Q

deeper infection of the hair follicle. Tender nodule

-Fluctuant abscess w/ central plug +/- surrounding cellulits

A

Furuncle (boil)

TX: I&D. Heat compresses, oral abx if associated w/ cellulitis

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48
Q

What is the treatment of cellulitis caused by:

  1. Cat bite
  2. Dog bite
  3. Human bite:
  4. Puncture wound through shoe
A
  1. Cat bite (pasteurella multocida**)- amox/clavulante
  2. Dog bite: amox/clavulante
  3. Human bite: amox/clavulante
  4. Puncture wound through shoe (Pseudomonas)- Ciprofloxacin
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49
Q

How do you dx Mumps

A

serologies, increased amylase, often clinical dx

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50
Q

Low grade fever, myalgias, headach–> parotid gland pain and swelling*

A

Mumps (paramyxovirus)

TX: supportive
Preventative: MMR vx

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51
Q

How do you dx malignant melanoma

A

Full-thickness wide excisional biopsy + lymph node biopsy

**shave biopsy discouraged

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52
Q

Raised, itchy dark-red plaques/papules w/ thick silver/white scales

  • MC on extensor surfaces
  • Nail pitting- yellow-brown discoloration under the nails (oil spot*)
  • Positive Auspitz sign: punctate bleeding w/ removal of plaque/scales
  • Koebner’s phenomenon: new skin lesions at sites of trauma
A

Plaque psoriasis
(due to T cell activation)

TX:
mild-mod: topical steroids (high)
mod-severe: phototherapy, UVB
Systemic tx: methotrexate

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53
Q

Pruritic, “tapioca-like” tense vesicles on the soles, palms, and fingers (lateral digits)

A

Dyshidrosis (dyshidrotic eczema)

Tx: topical steroids (med-high)

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54
Q

Hyper/hypopigmented, well-demarcated round/oval macules with fine scaling. Often coalesce into patches on trunk, face and extremities.
-involved skin fails to take

A

Tinea (pityriasis) veriscolor
*caused by overgrowth of yeast Malassezia furfur

TX: topical antifungals: Selenium sulfide, sodium sulfacetamide, zinc pyrithione, “azoles”
Systemic tx: itraconazole or fluconazole

**topical glucocorticoids could exacerbate it!

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55
Q

PVB19 may cause ___ in patients with sickle cell disease or G6PD deficient

A

aplastic crisis

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56
Q

Oral mucosal membrane erosions and ulcerations 1st–> painful flaccid skin bullae (ruptures easily) leaving painful denuded skin erosions that bleed easily
+ Nikolsky sign: superficial detachment of skin under pressure/trauma

A

Pemphigus Vulgaris
*autoimmune disorder secondary to desmosome disruption

DX: skin biopsy-
Direct immunofluorescence: IgG throughout epidermis
ELISA

TX: HD corticosteroids*
methotrexate

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57
Q

larger, painful, interlocking furuncles/abscesses w/ multiple openings* + cellulitis

A

Carbuncle

TX: TX: I&D. Heat compresses, oral abx if associated w/ cellulitis

58
Q

High fever 3-5 days (well and alert appearing usually)–> fever resolves before onset of a rose, pink maculopapular, blanchable rash that starts on the trunk/back and then later spreads to face

A 
Roseola infantum (6th disease)
*only childhood viral exanthem that starts on trunk and spreads to face

TX: supportive, antipyretics

59
Q

Pruritic scaly eruption rash btwn toes

A

Tinea pedius (athletes foot)

TX: Topical antifungal*, PO Griseofulvin if ineffective
-clean shoes with antifungal spray

60
Q

Soft, symmetric, painless easily mobile palpable mass in the subcutaneous tissue
-MC on trunk and extremities

A

Lipoma

TX: none- surgical removal for cosmetic reasons

61
Q

Fever and URI sx–> wide spread blisters begin on trunk/face, erythematous, pruritic macules, 1 or more mucous membrane involvement with epidermal detachment
-Most often after drug eruptions (esp. sulfa and anticonvulsant meds)

A

SJS= sloughing <10% of body surface area

Toxic epidermal necrolysis (TEN): sloughing >30% of body surface area

TX: tx like severe burns, admit to burn unit, pain control, fluids and electrolytes

62
Q 
What type of burn?
-Epidermis into portion of dermis (reticular)
-red, yellow, pale white, dry
\+ BLISTERING
-NOT USUALLY PAINFUL
-Absent capillary reflex
A

Deep partial thickness (2nd degree)

  • 3 weeks-2 months
  • Scarring common
63
Q

Acne-like rash + erythema, facial flushing, telangiectasia, skin coarsening, papulopustules with burning, stinging, red eyes
-absence of comedones
Triggers: ETOH, high temp, hot drinks, hot/cold weather, hot baths, spicy foods

A

Rosacea

TX:

  1. Topical: metronidazole 1st line
  2. mod-severe: oral abx, laser
  3. life-style modifications: sunscreen, avoid toners, and triggers
64
Q

Painful, red swollen area around the nail at the cuticle site

A

Paronychia (MC cause S. Aureus)
*may progress to felon

TX: warm soaks (reduce pain and swelling)

  • Abx: Cephalexin
  • I&D
65
Q
  • Blanchable, edematous pink papules, wheals or plaques that may coalesce
  • Rash occurs within minutes-hours after drug administration
  • MC triggers: abx, NSAIDS, opiates, radiocontrast media
A

Urticarial (type 1 IgE hypersensitiivty rxn- mast cells release histamine causing vasodilation)
*2nd MC skin eruption

TX: anthistamine*, systemic corticosteroids, dc med

66
Q

Describe different types of malignant melanoma

A
  1. Superficial spreading- MC type, Lesion may raise de novo or from pre-existing nevus
  2. Nodular- 2nd MC, may be associated w/ rapid vertical growth phase
  3. Lentigo maligna
  4. Acral lentiginous: MC found in dark-skinned indivuals
  5. Desmoplastic: most aggressive type

**thickness most important prognostic factor for METS

67
Q

Fever, chills, diffuse skin eruption that occurs in the setting of pharyngitis

  • Rash is diffuse erythema that blanches w/ pressure plus many small (1-2 mm) papular elevation that feels like “SANDPAPER” when palpated, “sunburn goosebumps”
  • MC starts in groin and axillae the rapidly spreads to trunk and extremities
  • Rash often dequamates over time
  • Associated with flushed faces w/ circumoral pallor and strawberry tongue
  • *Pastia’s lines= linear petechial lesion seen at pressure points, axillary, antecubital abdominal or inguinal areas
A

Scarlet Fever (Scarlatina)

  • occurs in setting of GABHS (streptococcus pyognes) infection
  • due to Type 4 hypersensitivity rxn

TX: same as strep pharyngitis

  1. Abx: Penicilin G or VK 1st line. amoxicillin or augmentin
  2. Macrolides if PCN allergy
  3. May return to school 24 hours after abx initiation
68
Q

How do you dx basal cell carcinoma

A

Punch or shave biopsy: basophilic palisading cell on histology

69
Q

hyperpigmentation (brown-pigment) symmetrical macules esp. on face and neck
Risk factors: estrogen exposure (OCP, pregnancy), sun exposure

A

Melasma (Chloasma)

TX: Sunscreen
Topical bleachers: hydroquinone, azelacic acidd

70
Q

Erythema multiforme is commonly associated with what?

A
  1. HSV (MC)
  2. sulfa drugs
  3. beta-lactams
  4. phenyotin
  5. phenobarbital
71
Q

Intensely pruritic lesion: papules, vesicles and linear burrows found in intertriginous zones including WEB spaces btwn fingers/toes, scalp

  • Increased pruritic intensity at night*
  • Red itchy pruritic papules or nodules on the scrotum, glans or penile shaft, body folds
A

Scabies (mites)

DX: mineral oil scraping

TX: Permethrin topical (Elimite, Nix) drug of choice* 8-14 hrs before showering and then repeat application in 1 week
2. Lindane: (cheaper)- DO NOT USE after bath/shower (causes seizures due to increased absorption)

72
Q

Dry, rough, scaly, sandpaper skin lesion or erythematous, hyperkeratotic (hyperpigmented) plaques
-MC seen in fair-skinned elderly w/ prolonged sun exposure

A

actinic keratosis
premalignant condition to squamous cell carcinoma**

TX: observation, surgical cryosurgery*

73
Q

Small, erythematous teardrops papules with fine scales, discrete lesion and confluent papules

A

Guttate psorasis

TX:
mild-mod: topical steroids (high)
mod-severe: phototherapy, UVB
Systemic tx: methotrexate

74
Q

Describe general burn management

A
  1. Cleansing: soap and water. DO NOT Apply ice directly. Chemical burns: irrigate for at least 20 min
  2. Debridement
  3. Ruptured blisters should be removed
  4. Pain management w/ acetaminophen, NAIDS
  5. ABX Topical
    - Silver sulfadiazine (SSD) on 2-3rd degree (CI in sulfa alergies, pregnancy and kids <2 and NONE ON FACE)
  6. Dressing: superficial burns do NOT require dressings
    - fingers and toes should be individually wrapped
  7. Fluid resuscitation
75
Q

Tx of voltage electric injuries

A
  1. Thermal burn management as needed
  2. Tele
  3. managed as outpatient if normal EKG and PE
  4. Admit if >600V even if asymptomatic
76
Q

Flat, firm area w/ small, raised, TRANSLUCENT/Pearly/WAXY papule and central ulceration* and raised, rolled borders

  • MC on face, nose or turunk
  • bleeds easily
  • May have overlying telangiectatic vessels
A

Basal cell carcinoma

TX:

  1. Electrodesiccation/curettage
  2. +/- Mohs micrographic surgery for facial involvment
  3. Surgical excision used for high or low grade tumor recurrence
77
Q

Uniformly hyperpigmented macules or patches with sharp demarcation. Either present at birth (or developing early in childhood). Varing in colors from light brown to chocolate brown

A

Cafe au lait macules

due to increased number of melanocytes and melanin in the epidermis

78
Q 
erythematous plaques (circular rash with clear center and defined borders), scaling, cracking and vesicle
-scales
A

Tinea corporis (presence of scale in tinea corporis distinguishes it from erythema migrans)

TX: Topical antifungal*, PO Griseofulvin if ineffective

79
Q

Nail infection Mc on great toe

-Opaque, thickened, discolored and cracked nails with subungual hyperkeratinization

A

Onychomycosis

TX: Itraconazole, Terbinafine

80
Q

Flesh colored papules (due to sweating in the papillary dermis)

A

Miliaria profunda

81
Q

There is an increased incidence of ___ with Lichen Planus

A

Hep C

82
Q

Grossly exaggerated scar that often grows pedunculated (esp. on the earlobes, face and upper extremities)
-MC in African-Americans

A

Keloids

TX: Corticosteroid injections (1st line)- intralesional Triamcinolone

83
Q

Mobile masses of fibrous tissue and keratinous (cottage cheese like) substance

A

Sebaceous Cyst

TX: none- cosmetic removal

84
Q

Describe the different stages of pressure ulcers

A

Stage I: superficial, NONBLANCHABLE REDNESS that does not dissipate after pressure is relieved

Stage II: epidermal damage extending into the dermis, resembles blister or abrasion

Stage III: FULL THICKNESS of skin that may extend into subcutaneous layer

Stage IV: deepest, extends beyond fascia INTO MUSCLE, tendon or bone

85
Q

MC viral cause of pericarditis and myocarditis

MC cause of pancreatitis in kids

A

Coxsackie B

Mumps

86
Q

Superficial hair follicle infection w/ singular or clusters of small papules or pustules with surrounding erythema

A

Folliculitis
*S. aureus MC

TX:
1. Topical Mupirocin, Clindamycin, Erythromycin
severe/refractory: oral cephalexin

87
Q

What is Bowen’s disease

A

squamous cell carcinoma insitu, slow growing

TX: topical imiquimod (Aldara) or surgical excision

88
Q

How do you dx CO toxicity

A

Measure SaO2, carboxyhemoglobin, methemoglobin

  • Increased carboxyhemoglobin levels on ABG or VBG* (levels do NOT correspond with severity)
  • most pulse ox can’t differentiate btwn HbO2 and carboxyhemoglobin
89
Q

Malaise, fever, irritability, extreme skin tenderness–> cutaneous, blanching erythema- often starting centrally and around the mouth before spreading diffusely

  • Erythema is worse over flexor areas and around orficies
  • develop sterile, flaccid BLISTERS esp. in area of mechanical stress (hands, feet, flexural areas and butt)
  • Positive Nikolsy sign- separation of the dermis and rupture of the fragile blisters when gentle pressure is applied to skin
  • Dequamative phase-skin that easily ruptures, leaving moist, denuded skin before healing
A

Staphylococcal Scalded Skin Syndrome (Ritter Disease)

TX:

  1. Abx: Penicillinase-resistance penicillin 1st line- Nafcillin or oxacilin +/- clindamycin
  2. Supportive skin care- keep clean and moist
  3. Fluid and electrolyte replacement
90
Q
  • Solitary salmon-colored macule on the trunk 2-6cm in diameter–> general exanthem 1-2 weeks lateral: smaller very pruritic 1 cm round/oval salmon-colored papules with white circular (collarette) scaling along cleavage lines* in a Christmas tree pattern
  • Confined to trunk and prox. extremities (face usually spared)
A

Pityriasis Rosea

TX: None- antihistamines

91
Q

Annular, scaling lesions and broken hair shafts.

-inflamed plaques with multiple spustules (kerion) with scarring and alopecia

A

Tinea captius (ring worm)

TX:
PO Griseofulvin 1st line
PO terbinafine, itraconazole

92
Q

Well demarcated margins of cellulitis, intensely erythematous (St. Anthonys fire) (MC on face)

A

Erysipelas
*GABHS MC cause

TX: IV penicillin

93
Q

Sudden onset of high fever, stomatitis*, small vesicles on the soft palate, uvula and tonsillar pillars that ulcerate before healing, sore throat, 3-5 days.

A

Herpangia (Coxsackie A)

Tx: supportive, encourage hydration

94
Q

Small papule/plaque velvety warty lesion with “greasy/stuck on appearance”

  • varied possible colors ex. flesh-colored, grey, brown and black
  • MC in fair-skinned elderly
A

Seborrheic keratosis
*MC benign skin tumor

TX:- non needed
-cosmetic management- cryotherapy

95
Q

Coryza, fever–> “slapped cheeks” rash on face w/ circumoral pallor 2-4 days–> lacy reticular* rash on extremities (esp. upper)

  • Spares palms and soles
  • Arthropathy/arthralgias: older children and adults
  • Associated w. increased fetal loss in pregnancy )fetal hydrops, CHF, spontaneous abortion)
A

Erythema infectiosum (fifth disease)–> parvovirus B19

DX: serologies
Tx: support

96
Q

macular erythema (flat margins, not sharply demarcated), swelling, warmth, and tenderness

A

Local cellulitis

TX:
Cephalexin; dicloxacillin 7-10 days
MRSA: IV vanco or oral trimethoprim-sulfamethoxazole

97
Q

macular, papular nodules, plaque like brown/pink/red or violaceous lesions
-MC in immunosuppressed or HIV (CD count <100)

A

Kaposi sarcoma (CT CA caused by Human herpesvirus 8-HHV-8)

TX: HAART therapy, radiation for local disease

98
Q

Complications of mumps

A
  1. Orchitis in males (usually unilateral)

2. pancreatitis

99
Q

How do you dx Condyloma acuminata

A

Whitening of lesion with acetic acid application
-clinical, seroliges
Histology: koiocystic squamous cells with hyperplastic hyperkeratosis
-Gardasil vx

100
Q

How do you dx actinic keratosis

A
  1. punch or shave biopsy- atypical epidermal keratinocytes and cells w/ large hyperchromatic pleomorphic nuclei from the basal layer upwards
101
Q

area of surface capillary dilation.

-MC seen on nape of neck, eyelids and forehead

A

Nevus Simplex (Stork bite)

TX: observation- most resolve spontaneously by age 2
OR laser therapy will reduce appearance of lesion

102
Q
  • asymmetry, irregular borders, color variation (dark blue, black), diameter usually 6mm or greater
  • Varying thickness
A

Superficial Spreading Malignant Melanoma
*MC type 70%

TX: complete wide surgical excision with lymph node biopsy or dissection
+/- adjuvant therapy in high risk

103
Q
  • Blue or slate gray pigmented macular lesion most commonly seen in presacral/sacral-gluteal area (may be seen on shoulders, legs, back and posterior thighs) w/ indefinite borders
  • Congenital dermal melanocytosis due to mid-dermal melanocytes that fail to migrate to the epidermis from neural crest
A

Mongolian Spots

*spots usually fad over the first few years of life (before 10 yrs of age)

104
Q

Tiny, painless* papules evolve into soft, fleshy cauliflower-like lesion ranging from skin-colored to pink or red, occurring in clusters in the genital regions and oropharynx

A 
Genital wars (Condyloma acuminata)
**mucosal Human papilloma virus

Tx: -lesions persist for months and may spontaneously resolve, remain unchanged or grow it not treated

  • Chemical, salicylic acid, cryotherapy
  • Gardasil vx
105
Q

Generalized distribution of “bright-red” macules and papules that coalesce to form plaques.
-rash typically begins 2-14 days after medication initiation (ex. NSAIDS, abx, allopurinol, thiazide diuretics)

A

Exanthematous/Morbiliform Rash (type 4 hypersensitivity)
*MC skin eruption

TX: oral histamine and d/c med

106
Q

Firm, hyperkeratotic papules between 1-10mm w/ red-brown punctations (thrombosed capillaries*)
-borders +/- be rounded or irregular

A

vulgaris and plantis (common and planter warts)
**Human papilloma virus

TX: most warts resolve spontaneously w/in 2 yrs

  • topical OTC salicylic acid and plasters
  • cryotherapy, electrocautery
107
Q

What type of burn?
-Epidermis + portion of dermis (papillary)
-Erythematous, pink, moist weeping
+ BLISTERING
-Most painful of ALL BURNS (VERY TENDER TO TOUCH)
+ refill intact, blanches w/ pressure

A

Superifical partial thickness (2nd degree)

  • heals 14-21 days
  • No scarring (but +/- leave pigment changes)
108
Q

Tiny, friable clear vesicles (due to sweat in the superficial stratum corneum)
-MC in neonates

A

Miliaria crystallina

*blockage of eccrine sweat glands

109
Q

Positive Auspitz sign is seen with what conditions

Koebner’s phenomenon is seen w/ what conditions

A

Plaque psoriasis and actinic keratosis
*punctate bleeding w/ removal of plaque/scales

Plaque psoriasis, eczema, lichen planus
*new skin lesions at site of trauma

110
Q

Pruritic, ill-defined blister/papules/plaques MC on flexor creases

A

Atopic dermatitis (eczema)

Tx: topical corticorsteroids, antihistamine for itching

111
Q

Etiologies of Erythema nodosum

A
  1. Estrogen exposure: OCPs, pregnancy
  2. Inflammatory dz: sarcoidosis, IBD, leukemia
  3. Infections: streptococcal, TB, sarcoidosis, fungal (**Coccidiomycosis)
112
Q

MC drugs that cause erythema multiforme

A

sulfonamides
penicillins
phenobarbital
Dilantin

113
Q

Smooth discrete circular patches of complete hair loss and exclamation point hairs

A

Alopecia areata

Tx:
Local: intra-lesional corticosteroids
Extensive: topical corticosteroids

114
Q

Pruritic, papulovesicular rash on the extensor surfaces (including the forearms) and scalp
-Strongly associated w/ celiac disease

A

Dermatits herpetiformis

DX: immunofluorescence of skin biopsy- *IgA immune complex deposition in the dermal papillae

TX: gluten free diet. Dapsone.

115
Q

pruritic, sharply defined discoid/coin-shaped lesion on the dorsum of the hands, feet and extensor surfaces

A

nummular eczema

Tx: topical corticorsteroids, antihistamine for itching

116
Q

How do you dx Staphylococcal Scalded Skin Syndrome (Ritter Disease)

A
  • clinical dx- intact blisters are sterile
  • cultures from urine, blood and nasopharynx
  • Skin biopsy: lower stratum granulosum layer splitting

Complications: sepsis, PNA, cellulitis, fluid loss, electrolyte imbalance

117
Q

Solitary glistening, SESSILE, FRIABLE red (raspberry-like) nodule or papule (may bleed or ulcerate if bumped)

  • usually evolve over a period of weeks. MC on arms, hands, fingers, and legs
  • *increased incidence in pregnancy (higher incidence of gingival involvement)
A

Pyogenic Granuloma
*aka lobal capillary hemangioma

TX: Pedunculated: shave excision or curettage followed by cautery of the base
2. non-pedunculated (sessile): surgical excision

118
Q

Rashes that affects the palms and soles

A
  1. Coxsackie (hand, foot, and mouth)
  2. Rocky mountain spotted fever (esp. wrist/ankles)
  3. Syphilis (secondary)
  4. Janeway lesions
  5. Kawasaki
  6. Measles (Rubeola)
  7. Toxic Shock syndrome
  8. Reactive arthritis (Keratoderma Blenorrhagica)
  9. Meningococcemia

“STC-R(R-M)M-JK”

119
Q

severely pruritic papules (may develop pustules). deeper in the epidermis

A

Miliaria rubra

120
Q

Linear vesicles w/ underlying erythema on hands, arms and legs after being outside/hiking

A

toxicodendrons dermititis (allergic phytocontact dermatitis from plans of poison ivy, poison sumac, or poison oak

121
Q

velvety, hyperpigmented, papillomatous lesions of the neck and axillae on an obese patient

A

Acanthosis nigricans

DX: fasting blood sugar

122
Q

an *older adult w/ dark red pruritic urticarial plaques on flexor surfaces, which begin to develop tense bullae overlying the surface of the plaques

A

Bullous pemphigoid
*autoimmune blistering disease of older adults

DX: Direct immunofluorescence IgG and C3 deposition at the dermal-epidermal junction

123
Q

Painful flaccid bulla and erosions on skin or mucous membrane

A

Pemphigus vulgaris

*rare autoimmune disorder

124
Q

Immunosuppressive agents required following organ transplant greatly increase the risk (65-fold) for developing ____

*hx of organ transplant presents w/ 6mm, red irregularly shaped, sharply demarcated, eroded lesion on forehead

A

squamous cell carcinoma

125
Q

small soft skin-colored to brown papules that occur on the lower eyelids, face, neck and trunk

A

Syringomas

126
Q

African american presents w/ indurated, translucent reddish orange lesion on face and neck and indurated painful nodules on the shins bilaterally

A

Sarcoidosis
*MC non-specific associated skin lesion is erythema nodosum

DX: Antinuclear antibody

127
Q

___ causes folliculitis under areas of occlusion of bathing suit and improper cleaned hot tubs

__ causes folliculitis in areas of trauma such as shaving

__ causes folliculitis seen in febrile bedridden patients generally on the back due to occlusion

A

Pseudomonas aeruginosa

S. aureus

Candida albicans

128
Q

hypopigmentation secondary to an inflammatory rash of eczema

A

pityriasis alba

129
Q

f*ish-like scale most prominent on lower extremities that get progressively worse
*Associated w/ HIV, lymphoma, sarcoidosis and thyroid diseases

A

acquired ichthyosis

130
Q

winter itch that occurs in high temp/low humidity environments (heated homes and desert climates)
-more common in older patients and presents as dry, cracked skin w pruritis

A

Eczema craquele

131
Q

**Associated w/ inflammatory diseases: IBD, Crohn, UC, RA, spondyloarthropathies

A

Pyoderma gangrenosum

132
Q

__ often manifests in the presence of iron overload, ethanol abuse, hep C and estrogen use

A

Porphyria cutanea tarda (PCT)

133
Q

alopecia due to sensitivity to dihydrotestosterone (DHT)

A

androgenetic alopecia

TX: 5-alpha reductase inhibitor (finesteride)

134
Q

redness, pruritus ad white discharge to the head of the penis w/o hx of STDs
*often in diabetic

A

Candida balanitits

TX: topical azoles (topical clotrimazole (Mycelex) or oral fluconazole)

135
Q

young child w/ fussiness, decreased appetite, multiple lesions to kids face and mouth and ulcers to the hard palate and gingiva and redness lesions to right vermilion border

  • vesicular lesions that quickly ulcerate*
  • submandibular lymphadenopahty
A

Gingivostomatitis Herpes simplex

136
Q

who is most likely to get MRSA

A

immunocompromised, those w/ chronic illness (ESRD, diabetes), inmates and athletes

137
Q

Hib vaccination may help to prevent what skin disorder in children

A

cellulitis

138
Q

Toxic shock syndrome is associated w/ many ___ species

A

staphylococcal and streptococcal species

139
Q

yeast infection commonly in skin folds and is provoked by warm, moist environments
-pruritic red macerated patches

A

Intertrigo

*caused by C. albicans

140
Q

Common signs of child abuse

A
  1. bruising to soft padded areas of body in multiple stages of healing
  2. burns that are uniform and bilateral in appearance
  3. in areas that can be covered

*facial lacerations and black eyes in kids are not considered suspicious for abuse

141
Q

What skin lesion, if left untreated may progress to squamous cell carcinoma

A

Actinic keratosis

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