SDNP dcnp infections Flashcards

Question

Condylomata acuminata tx pregnancy

Answer 1

* Cryosurgery: LN2 is effective in treating smaller lesions, and safe during pregnancy. * Laser therapy, YAG or CO2: good for primary and recurrent lesions, safe for pregnant patient who have failed LN2 and trichloracetic therapies..

Answer 2

* Podoflox 0.5% (condylox): not in pregnancy * Interferon alfa-2b: Not for use during pregnancy * 5-fluorouacil 5%:. Not to be used during pregnancy. * Imiquimod: Lowest recurrence rate; not first-line therapy * Sinecatechins 15% (Veregen): MoA unknown Pregnancy can cause warts to grow d/t hormone changes and immune suppression; should be treated after the first trimester.

Answer 3

* The CDC Advisory Committee on Immunization Practices recommends the HPV vaccine Gardasil for M/F between ages of 11-16 years. Effective in prevention of HPV types 6,11,16, and 18.

Answer 4

* Transmission is through sexual contact * Educate patients about risk factors including infection and cancer * Condoms should be used when warts are visible or during treatment, or abstinence is advised * Patients should notify all sexual contacts to be evaluated * Patients should be followed every 2-4 weeks during treatments until no lesions are noted, then every 3-6 months * Appropriate PAP smears and STD tests should be performed

Answer 5

* Frustrating disease characterized by frequent recurrences * Patients should be treated respectfully and non- judgmentally * Application of a gauze- soaked pad over suspicious lesions for 5-10 minutes reveals sharply demarcated lesions with white opacity

Answer 6

Self-limiting dermatitis triggered by viral infections: * most often Epstein-Barr * Hepatitis B * CMV * RSV * Parvovirus 19 Spring, early summer, children 6 months to 14 years * Often prodrome low-grade fever, URI * Resolves in 3-8 weeks

Answer 7

* Symmetric, pink/brown flat- topped papules or vesicles on buttocks and spread to face and extensors. Trunk typically spared * May be pruritic * Koebner phenomenon reported

Answer 8

* Palms and soles not involved * Genital only lesions in children: high suspicion of child abuse * Red halo: BOTE sign (beginning of the end)

Answer 9

* Tx takes multiple visits over 1 month or + * Do not share bath or towels. * Children may attend school and daycare * Cover lesions likely to come in contact w others * Avoid sexual activity until lesions resolved. * Maintain skin integrity, prevent auto-inoculation * NCAA return to play: lesions curetted or removed; site covered * NFHS return to play: 24 hours post curettage; site covered

Answer 10

* Individualize tx * Tx mult lesions in children conservatively to prevent scarring * Genital lesions in adults should be treated to prevent transmission through sexual contact. * Cantharidin: generally tolerated. Gently drop cantharidin on lesion, cover with tape, wash with soap and water in 2-24 hours. * Liquid Nitrogen: Usually not tolerated in cases with multiple lesions, especially in children. * Curettage: In the presence of few lesions, gently curette papules. This may result in scars and should not be utilized in cosmetic areas. Topical anesthesia may be needed in children. * Salicylic acid 2% applied daily without occlusion * Trichloracetic acid 35-50% * Off-label: Tretinoin, imiquimod

Answer 11

Pearls * Usually self-limited. * Goal of treatment is to avoid scarring * Often a tincture of time is the only treatment needed * Refer to ophthalmology for lesions in the periocular area

Answer 12

* Prodrome: fever, malaise, cough, conjunctivitis. Ill-appearing * Koplik’s spots: bluish-white elevations on buccal mucosa * Exanthem: erythematous maculopapular eruption, from scalp to forehead, posterior ears, face, neck, to trunk and extremities. Fades in same progression * Incubation: 10-12 days

Answer 13

* Other morbilliform eruptions: Rubella, erythema infectiosum, pityriasis rosea, infectious mono * DRUG * Papulosquamous disorders: psoriasis, guttate psoriasis

Answer 14

* Variola Major: mortality 30% * Variola Minor: mild illness, mortality <1% * Prodrome: fever, malaise, abd pain, chills, HA, vomiting * 2-4 days: macules and papules in mouth, face, extremities, spread to trunk, including palms and soles * Lesions all same stage of development

Answer 15

* Contact local public health officials for handling and evaluation * Supportive therapy * TPOXX (tecovirmat) app by FDA in 2018: Emergency Use authorization *Strict standard, contact, and Airborne precautions * Category A bioterrorism agent

Answer 16

* Benign epidermal neoplasms caused by HPV * Affects 10% of children. Peak incidence 12-16 * Most are transient but recurrence common, especially in immunocompromised patients * Lesions may koebnerize * Risks: close personal contact: lesions spread by skin-to-skin contact or skin-to-mucosa contact; indirectly by contact with contaminated surfaces: wrestling mats, swimming pools, showers

Answer 17

* Common warts: Hands most commonly involved, but may appear anywhere * Filiform warts: Single or multiple projections, most common around the mouth and face * Flat warts: Flesh colored to pink flat or slightly elevated; few to multiple; usually on the face and areas that are shaved: beard area in males and legs in females * Plantar warts: on the plantar surface (palms and soles); usually on pressure points: head of the metatarsal bones or heels * Mosaic warts: Cluster of many warts, usually flat with black dots; usually on the heels * Periungual and subungual warts: around and under the nail

Answer 18

* Salicylic acid: OTC, available in liquid form and patches, removes surface keratin; preg cat C, therefore avoid during pregnancy * Cryotherapy: LN2 most common office procedure; poorly tolerated in young children; requires mult tx spaced 2-3 wks apart; TOC during pregnancy * 35-50% trichloroacetic acid: causes immediate superficial tissue necrosis * Cantharidin: extract of the blister beetle causes epidermal necrosis and blistering; painless application, but can form painful blister; often referred to as “Blister Juice” * Retinoids: useful for flat warts; tx may take months * IL immunotherapy: Bleomycin: high risk for infection and scar; do not use during pregnancy * Surgical excision ablative laser * Curettage and desiccation * Snip or shave excision for filiform warts * Off-label Therapies: Imiquimod cream, 5-fluorouracil, intralesional squaric acid and Candida, duct tape, cimetidine 30 mg/kg/day

Answer 19

* Often spontaneous resolution in 1-2 years: do not necessarily need to be treated * Treat if lesions are painful, interfere with daily activities, or are multiplying * In-office therapies most effective when combined with home treatment * NCAA (National Collegiate Athletic Association) and NFHS (National Federation of State High School Associations) return to play rules for athletes: face: cover with mask; Nonface: cover or curette

Answer 20

* Don't make the tx worse than the condition: don't leave a scar * Tx take consistent tx for wks or mons * Home tx are most effective after soaking lesion in warm water to soften skin and allow better penetration of medications; paring with pumice weekly removed keratotic skin

Answer 21

* Increased risk with TH17 biologic use, immunocompromised * Dx based on clinical presentation * Microscopy w KOH: budding hyphae, pseudo yeast cells; quickest and least expensive * Fungal culture: gold standard to diagnose fungal infections can take 2-6 weeks for results *Biopsy with Periodic acid- Schiff (PAS): helpful to rule out tinea if clinical presentation and microscopy are not conclusive

Answer 22

* Maintaining dryness necessary for intertriginous candidiasis * Burrow's compresses * Absorbent powders (Zeasorb AF 1%) * Loose-fitting clothes, frequent diaper changes * Antifungal topical medications: Polyenes, and azoles. * Nystatin, miconazole, clotrimazole, ketoconazole, Econazole * Oral medications: fluconazole (Diflucan), itraconazole (Sporonox)

Answer 23

* Refer to ID specialist for wide-spread infections * Examine every pt w candidiasis for oral thrush Education * Teach pts the risks of recurrence. * Keep skin dry w powders & frequent clothing changes * Pts should be re- evaluated if there is no response to tx in 10-14 days

Answer 24

* Dermatophyte infection most commonly caused by Trichophyton, Microsporum, and Epidermophyton * Advancing erythematous border with scale and central clearing

Answer 25

dermatophyte invasion of hair follicles

Answer 26

Terbinafine 250mg/day x 2-4 weeks Griseofulvin 500 mg/day x 2-4 weeks or 150 mg weekly x3- 4 weeks Fluconazole 200 mg daily x 1-2 weeks

Answer 27

Griseofulvin: 15 mg/kg/day ultramicrosized x3-6 wks Terbinafine 3-6 mg/kg/day x 6 weeks Itraconazole 25-200 mg/kg x 23 days

Answer 28

Appropriate abx w + culture Off-label oral prednisone 0.05-1 mg/kg/day x 10-14 days

Answer 29

Topical antifungals

Answer 30

Topical antifungals Terbinafine 250 mg/day x 6 weeks Itraconazole 400 mg/day x 4 weeks Fluconazole 150 mg /week x 3-4 weeks

Answer 31

Systemic antifungals treatment of choice Topical meds high noncompliance rate

Answer 32

Terbinafine125-250 mg/day x 2-4 weeks Itraconazole 25-200 mg/kg x 2-4 weeks

SDNP dcnp infections Flashcards

(56 cards)