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Flashcards in skin conditions Deck (85):
1

risk factors for melanoma

>65 yo
fair-skinned
many atypical moles
>50 moles

2

if diagnosed with BCC

40% will be diagnosed with 2nd BCC in 3 years

3

history taking for skin condition

look at skin, feel (infectious: scabies, HSV, syphillis), distribution and then ask questions

4

scaly rash
precancerous lesion of seborrheic keratosis

actinic keratosis

5

scattered lesions (bloodborne) vs along sensory dermatome

chickenpox vs HSV

6

nail pitting

psoriasis

7

hand eruption: autosensitzation to

fungal infection on feet

8

white patches on buccal mucosa

lichen planus

9

hereditary skin conditions

psoriasis
acne
atopic dermatitis
skin cancer
dysplastic nevi
neurofibromatosis
tuberous sclerosis

10

fungal infection lab preparation

KOH slide: see hyphae of dermatophytes or psuedohyphae of yeast of candida or pityrosporum

11

diagnosis of tinea capitis

wood's light: green fluourescence
-caused by microsporum

12

diagnosis of erythrasma

wood's light: red fluorescence

13

medical treatment of skin conditions

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

diagnostic + surgical treatment of skin conditions

shave: raised
punch, ellipitcal: flat
scissor

15

choosing topical steroid

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

type of vehicle of topical steroid affects

potency - determines rate at which steroid is absorbed

17

bacterial skin infections

s. aureus - most common
MSSA abx:
cephalexin, dicloxacillin, clindamycin
MRSA abx:
trimethorpim-sulfamethoaxazole (bactrim)
rifampin
clindamycin
tetracycline

18

honey crusts around nose + mouth

impetigo

19

impetigo tx

s. aureus, MRSA (bullous impetigo) and s. pyogenes:
7-10 days Abx:
cephalexin
dicloxacillin

20

severe variation of bullous impetigo
bullae caused by exfoliating toxin
systemically ill

SSSS:
IV Abx, fluids

21

infection of dermis + subq tissues
-break in skin from trauma, bite, dermatosis (tinea pedis)
-usually extremities

cellulitis

22

cellulitis tx

B hemolytic strep or s. aureus
need MRSA coverage (IV or PO)

23

infection of dermis with lymphatic involvement - usually extremities (lesions raised above skin, clear demarcation)

erysipelas

24

erysipelas

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