skin conditions Flashcards
(85 cards)
1
Q
risk factors for melanoma
A
> 65 yo
fair-skinned
many atypical moles
50 moles
2
Q
if diagnosed with BCC
A
40% will be diagnosed with 2nd BCC in 3 years
3
Q
history taking for skin condition
A
look at skin, feel (infectious: scabies, HSV, syphillis), distribution and then ask questions
4
Q
scaly rash
precancerous lesion of seborrheic keratosis
A
actinic keratosis
5
Q
scattered lesions (bloodborne) vs along sensory dermatome
A
chickenpox vs HSV
6
Q
nail pitting
A
psoriasis
7
Q
hand eruption: autosensitzation to
A
fungal infection on feet
8
Q
white patches on buccal mucosa
A
lichen planus
9
Q
hereditary skin conditions
A
psoriasis acne atopic dermatitis skin cancer dysplastic nevi neurofibromatosis tuberous sclerosis
10
Q
fungal infection lab preparation
A
KOH slide: see hyphae of dermatophytes or psuedohyphae of yeast of candida or pityrosporum
11
Q
diagnosis of tinea capitis
A
wood’s light: green fluourescence
-caused by microsporum
12
Q
diagnosis of erythrasma
A
wood’s light: red fluorescence
13
Q
medical treatment of skin conditions
A
topical steroids: antiinflammatory, anti-mitotic effect, SE: skin atrophy (reversible) - capillaries dilate, hypopigmentation, striae (irreversible), systemic SE: if young, thinner skin
PO steroids
antibiotics
antifungal/antiviral
14
Q
diagnostic + surgical treatment of skin conditions
A
shave: raised
punch, ellipitcal: flat
scissor
15
Q
choosing topical steroid
A
chronic disease: higher potency
thicker: higher potency (psoriatic plaque)
thin: face, GU, skin folds - low potency
infant/children: higher SA, increased absorption - low potency
16
Q
type of vehicle of topical steroid affects
A
potency - determines rate at which steroid is absorbed
17
Q
bacterial skin infections
A
s. aureus - most common MSSA abx: cephalexin, dicloxacillin, clindamycin MRSA abx: trimethorpim-sulfamethoaxazole (bactrim) rifampin clindamycin tetracycline
18
Q
honey crusts around nose + mouth
A
impetigo
19
Q
impetigo tx
A
s. aureus, MRSA (bullous impetigo) and s. pyogenes:
7-10 days Abx:
cephalexin
dicloxacillin
20
Q
severe variation of bullous impetigo
bullae caused by exfoliating toxin
systemically ill
A
SSSS:
IV Abx, fluids
21
Q
infection of dermis + subq tissues
- break in skin from trauma, bite, dermatosis (tinea pedis)
- usually extremities
A
cellulitis
22
Q
cellulitis tx
A
B hemolytic strep or s. aureus
need MRSA coverage (IV or PO)
23
Q
infection of dermis with lymphatic involvement - usually extremities (lesions raised above skin, clear demarcation)
A
erysipelas
24
Q
erysipelas
A
B hemolytic strep
need MRSA coverage(IV or PO)
25
infection of superficial portion of hair follicle
| perifollicular erythema, papules, pustules
S. aureus, yeast, other bacteria
26
hot tub folliculitis
psuedomonas
27
folliculitis with tight fitting clothing
pityrosporum yeast
28
abscess that starts in hair follicle or sweat gland
furuncle or boil
29
furuncle extends into subq tissue
carbuncle
30
cause of skin abscess
s. aureas, MRSA
| I&D, po antibiotics if surrounding cellulitis
31
```
infection of subq tissue + fascia
diffuse swelling → bullae
skin necrosis/echymosis (bruising)
edema beyond area of erythema
pain out of proportion
systemic: fever, tachycardia, delerium, renal failure, rapid spread during antibiotic therapy
```
necrotizing fasciitis
32
treatment of NF
s. pyogenes: after VZV, scratch, insect bite
bowel flora
need surgical debridement + IV abx
33
cause of warts
HPV
hands: verruca vulgaris
feet: plantar warts
face/legs: flat warts
34
cauliflower appearance
| transmitted sexually
genital warts - HPV 6 (condyloma acuminata)
35
causes cervical intraepithelial neoplasia and cervical cancer and throat cancer
HPV 16, 18
36
virus in dorsal root ganglia - recurrence
| vesicular, surrounding erythema, crusts over weeks
HSV and VZV
37
primary herpes gingivostomatitis (cold sore) and labialis (lips)
primary: whole mouth, fever, chills, maliase
| recurrent episodes are labialis (lips): viral shedding, asymptomatic
38
herpetic lesion on but, genital, anus
HSV
39
HSV can be spread when asymptomatic (between active episodes)
can shed virus asymptomatically
40
if active ulcer + HIV +
more likely to acquire HIV
41
vesicles on red base
trunk → extremities
fever + respiratory symptoms
initial infection of VZV (chickenpox)
42
complications of HSV or VZV
encephalitis
disseminated infection
esp if infant or IC
postherpatic neuralgia: chronic pain in dermatome previously infected with herpes zoster (shingles)
43
HSV tx: acyclovir, famiciclovir, valacyclovir
prophylactic oral antiviral to prevent or reduce recurrences
44
VZV tx: acyclovir (only one approved for chickenpox), famiciclovir, valacyclovir
early antiviral to prevent postherpatic nueralgia
45
causes of fungal skin infections
dermatophytes: tinea infections (ringworm)
candida
pityrosporum
46
annular appearance with central clearing, redness, scale on perimeter
tinea corporis
47
inflammatory reaction to pityrosporum (malassezia furfur)
tinea versicolor
48
thrush
balanitis
vaginitis
rashes in groin, breast
candida
49
hair loss with broken hairs + scaling
tinea capitis: hair shaft + follicle involved
50
red, scaling
no central clearing
in groin
tinea cruris (vs candida infection: redder, satellite lesion vs erythasma: pink/brown, red flouresnce)
51
scaly, itchy, symmetric
hx or family hx of asthma, allergic rhinitis
infant: face → FLEXURAL: antecubital fossa, popliteal
atopic dermatitis
52
linear, vesicular
| response to poision ivy, nickel, deodarants
allergic contact dermatitis
53
treatment of dermatitis/eczema
avoid skin irritants/hot water: dry skin
emollients: add moisture
topical steroid: inflammation
54
```
occurs in areas with most pilosebaceous units producing sebum
inflammatory hypersensitivty to yeast: pityrosporum
worsens with stress, cold
erythema, scaling of scalp + face
over sternum
axillae
umbilicus
groin
gluteal creaes
```
seborrhea
55
treatment of seborrhea: not curative
antifungal
| topical steroid
56
epidermal proliferation and inflammation
well-demarcated red, scaling plaques
white thickened scales
EXTENSOR surface, sacral region, genitalia, scalp
nail changes: pitting, subungual keratosis
psoriasis
57
treatment of psoriasis
emollients
topical steroids - high potency (most common)
topical tar
58
types of BCC
nodular: pearly papules, telangiectasias, central ulcer - lesion bleeds or itchy, grows
superficial: red, pink,flat, scaling (like SCC)
sclerosing: scarlike
59
SCC
hyperkeratotic
scaly, ulcerate, bleed easily
irregular shaped plaques or nodules with raised borders
higher risk of metastasis vs BCC
60
actinic keratosis
bowen disease (SCC in situ)
HPV
are precursors to
SCC
61
ABCDs of malignant skin cancer
```
Assymetric
Border
Color
Diameter: >6 mm
Evolution (bleeding, enlarged), elevated (raised)
```
62
biopsy skin lesion if
think premalignant or malignant only
2-3 mm margin around lesion for complete excision
if pathology says malignant - need 5 mm margins
if lesion to large - ensure excision is full-thickness of most suspicious part
risk factors: UV radiation for all skin cancers (#1), family history or personal hx of skin cancer, fair skin, burn easily, chemical exposure, suppressed immune system
63
bulla
blister >0.5 cm
64
macule
not raised or depressed
65
nodule
elevated lesion
| > 1 cm in diameter
66
papule
elevated lesion
67
vesicle
blister
68
plaque
plateu like, raised
69
most common type of melanoma in both sexes
raised, brown with pink, white, gray, blue
spreads along top before penetrating into deep layers (dermis and beyond)
radial growth slower than vertical phase
men: upper torso
women: legs
superficial spreading melanoma
70
most common in 60-70 yo
brown/tan with irregular borders
chronic sun-damaged skin: face, ear, arm, upper trunk
lentigo maligna
71
most common type in AA and asians
under nails, sole of foot, palm of hand
flat, irregular, brown/black
acral lentiginous melanoma
72
unique feature: invasive at time of diagnosis
most aggressive
brown/black
nodular melanoma
73
shave biopsy
raised lesion
74
punch biopsy/elliptical excision
flat lesions
75
prognostic feature of melanoma
thickness
76
treatment of localized reaction to bug bite (venom releases histamine-like substance):
red, warm, swollen
tender, itches
occur immediately, last few hours
no antibiotics
pain: NSAID or acetaminophen
antihistamine, ice: itching
Td booster if not up-to-date
77
immediately remove stinger by scraping or brushing stinger off (credit card preferred) because
causes continued injection of venom
78
```
treatment of LARGE local reaction (IgE mediated to venom)
>10 cm diameter
red, warm
occurs over 24-48 hrs
50% risk of similar reaction in future
NO increased risk of anaphylaxis
```
oral steroids initiated early after sting
| Td booster if not-up-to-date
79
treatment of systemic anaphylaxis reaction to sting:
gradient: nausea, urticaria, angioedema to hypotension, shock, airway edema, death
occurs within minutes
50% risk of anaphylaxis with future stings
ABC
IV access
fluid resuscitation to 10-20 mg/kg asap
suq or IM epinephrine asap (repeat q 10-15 min PRN)
+/- antihistamines, steroids, bronchodilators
Td booster if not-up-to-date
hospitalized for 12-24 hrs since symptoms may reoccur
densensitization tx: can reduce risk by 50%
80
animal and human bite management
ABC
clean with soap + water, irrigate with saline, debride devitazlied tissue asap
vaccination status of animal: rabies (bat, skunk, dog, fox -NOT rodents/rabbits)
antibiotic prophylaxis
Td vaccine up-to-date
81
bite wounds with increased risk of infection
large, deep
hand
host chronic illness, immune suppression
cat or human bite
82
dog and cat bite organisms
staph
strep
anaerobes
pasteurella
83
human bite organisms
```
staph
strep
haemophilus
eikenella: most common in closed fist injury
anaerobes
```
84
closure of bite wounds
85
treatment of bite wounds
| especially if on hand, late presentation, dog/cat/human bite
antibiotic prophylaxis for 5-7 days if mod-severe wound
amoxicillin-clavulanate (augmentin PO)
if cellulitis (erythema around site) also present: 7-14 days PO
hospitalization/surgery: osteomyleitis, joint infection
