skin conditions 5 and 6 Flashcards

(120 cards)

1
Q

what are the viral exanthams

A
  • measles
  • rubella
  • fifth disease
  • varicella
  • zoster
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2
Q

what is another name for measles

A

rubeola

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3
Q

how is measles spread

A
  • respiratory droplets
  • incubation of 9-12 days
  • clears in 4-7 days
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4
Q

si/sx of measles

A
  • prodrome of cough, coryza, conjunctivitis
  • fever
  • descending rash of papules that coalesce
  • rash includes palms and soles
  • koplick spots*
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5
Q

what are koplick spots

A
  • white papules 1 mm on buccal mucosa and pharyn

- occurs during measles

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6
Q

treatment for measles

A
  • prevention- vaccine

- supportive

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7
Q

what another name for rubella

A

german measles

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8
Q

how is rubella spread

A
  • respiratory droplets
  • incubation- 12-23 days
  • caused by toga virus
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9
Q

si/sx of rubella

A
  • no prodrome
  • 1-5 days fever, malaise, sore throat, h/a
  • pain with lateral upward eye movement
  • lymphadenopathy*
  • pale pink morbilliform macule (smaller ran rubeola)
  • starts of face, spreads to whole body in 23 h
  • forscheimers sign*
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10
Q

what is forscheimers sign

A
  • pitechiae on soft palate of uvula

- occurs in rubella

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11
Q

treatment of rubella

A
  • prevention- vaccine

- supportive

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12
Q

how is fifth disease spread

A
  • respiratory droplets
  • viral shedding stopped by the time rash appears
  • incubation of 4-14 days
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13
Q

whats another name for fifth disease

A

erythema infectiosum

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14
Q

si/sx of fifth disease

A
  • 3 stages
  • 1: aburpt asymptomatic erythema on cheeks (slapped cheek)
  • 2: day four discrete erytematous macules and papules on proximal extermitities and trunk, lacey reticulate pattern
    3: recurring stage d/t heat or light
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15
Q

treatment for fifths disease

A

supportive

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16
Q

how is pityriasis caused

A
  • unknown

- thought to be previous viral exposure

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17
Q

si/sx of pityriasis rosea

A
  • herald patch**
  • oval erythematous patches with fine scaes
  • macular or papular lesions on trunk, neck, extremities following skin folds
  • christmas tree pattern
  • can be pruritic
  • lasts 3-8 weeks
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18
Q

what is a herald patch?

A
  • 2-5 mm scaly lesion that may mimic tinea corporis

- happens in pityriasis rosea

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19
Q

treatment for pityriasis rosea

A
  • not needed

- can give antihistamine for pruritis

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20
Q

morbilliform reactions

A
  • most common adverse drug eruption
  • type IV allergic reaction mediated by t helper cells
  • commonly from ampicillin or amoxicillin
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21
Q

si/sx of morbilliform rash

A
  • erythema with macules and papules initially on trunk then generalized within 2 days
  • can present within first 2 weeks of exposure up to 10 days after d/c
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22
Q

treatment for morbilliform rash

A
  • clears w/ in 2 weeks d/c

- symptomatic relief: antihistamines, low potency topical steroids

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23
Q

when do fixed drug reactions occur

A
  • usually with meds that need to be taken itermittently
  • NSAIDs
  • sulfonamides
  • barbituates
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24
Q

si/sx of fixed drug reactiosn

A
  • oval/round erthematous plaque
  • pruritic, burning, or asymptomatic
  • reoccur at same site with each exposure
  • usually 6 or fewer lesions
  • 50% of lesions appear on genitals or oral mucosa
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25
treatment for fixed drug reactions
- symptomatic: antihistamines and topical steroids
26
erythema multiforme
- self limited eruption - d/t drug exposure, viral infection, or ideopathic - usually sulfa, barbs, phenytoin
27
si/sx of erythema multiform
- begins as macules -> papular -> vesicles -> bullae - localized to hands and feet, can become more generalized - targetoid appearance - mucosal lesions are painful and erode
28
treatment for erythema multiforme
- avoid target substances | - severe reaction can require systemic steroids
29
SJS and TENS
- mucocutaneous blistering reaction from drugs | - thought to be an immune response
30
si/sx of SJS and TENS
- fever - mucosal inflammation - lesions begin on trunk and may be painful - TEN- higher fever, more epidermal sepearation
31
treatment for SJS or TEN
- treatment at burn center for fluid and electrolyte imbalance - wound care - ? steroid treatment
32
bullous pemphigoid
- autoimmune process - usually in 60s - IgG antibodies bind to basement membrane -> inflammation -> protease release -> blister - Ab separate epidermis from dermis
33
si/sx of bullous pemphigoid
- prodrome of urticarial lesions - bullae are large and can have serous or hemorrhagic fluild - axillae, thigh, groin, abdomen
34
course of bullous pemphigoid
- usually self limited | - can last 5-6 years
35
differential dx for bullous pemphigoid
- epidermolysis bullosa acquisita | - bullous scabies erruptions
36
dx of bullous pemphigoid
- biopsy and immunofluroescence | - C3 deposition is almost always present
37
treatment for bullous pemphigoid
- potent steroids - clobetasol ointment - PO prednisone - if very severe can give immunosuppressants - tetracycline + niacinamide
38
what are the 3 types of lice
- pediculus humanis capitis- scapl - p. humanis corporis- body - phthirus pubis- pubic area, crabs
39
p. humanis capitis
- cant live more than 3 days off human head - easily dislodged - lay eggs on most fabric
40
p. humanis corporis
- lives in human clothes - prefers cooler temps - can live 10 days off the human body
41
p. pubis
- looks like a crab - large claws -> grasp to coarser hair in groin, perianal, axillary areas - heavy infestations can involve eyebrows, facial hair, eye lashes - less mobile - can only survive for 1 day off human
42
si/sx of p. capitus
- intense pruritus of scalp - posterior cervical lymphadenopathy - may see lice, nits, or dung
43
p. corporis si/sx
- small pruritic papules - progress d/t scratching to rusted and infected papules - spares hands and feet - usually d/t poor hygiene
44
p. pubis si/sx
- intense pruritus in affected areas - small blue macules - spread by close physical contact
45
differential diagnosis of pediuclosis
- scabies - eczema - delusions of parasitosis
46
treatment of pediculosis
- OTC Nix cream rinse, RID acticin - ovid lotion - elimite cream - bactrim - vasaline - wash clothes/sheets etc. and expose to high heat - seal objects in plastic bag for 2 weeks - ppx treat family members
47
scabies
- infestation of sarcoptes scabiei - burrow into epidermis and deposit feces and lay eggs -> irritation - type IV hypersensitivity reaction 30 days after infestation - should be considered on any pt with pruritus not responding to topical steroids
48
si/sx of scabes
- vesicles, papules, or nodules - found between fingers and toes, flexor aspect of wrists, axilla, antecubital area, abdomen, umbilicus, genitals, gluteals, feet - spares the face - burrows**
49
crusted/ norwegian scabies
- immunocompromised pts - crusts and scales teem with mites - psoriasis like scaling around nails with crusting
50
differential dx for scabies
- bite reaction - atopic dermatitis - delusions of parasitosis
51
treatment of scabies
- permethrin cream- apply for 8-12 hours, repeat in one week - lindane lotion- more toxic - precipitated sulfur ointment - PO ivermectin - after treatment was all clothes, bedding etc.. - treat family members
52
loxoscelism
- bite from a brown recluse spider
53
where are brown recluse spiders found?
- commonly in midwest and southwest - woodpiles, grass, rocky bluffs, barns - stings in sell defense - has violin shaped markings on body
54
what is in the brown recluse spider venom
- phospholipase enzyme called sphingomyelinase D | - breaks down proteins
55
si/sx of brown recluse spider bite
- localized sx - pain after 3 hours - extensive necrosis and edema within 8 hours - bulla surrounding erythema and ischemia can extend into muscle - 1 week- gangrenous and dark
56
treatment for brown recluse spider bite
- rest, ice, elevate bite - analgesics - tetanus prophylaxis - surgical debridement
57
latrodectism
- black widow spider bite
58
where are black widow spiders found?
- continental US - caribbean - wood piles and outhouses - red hourglass shaped markings on abdomen
59
si/sx of black widow spider bite
- central reddened fang puncture site with area of blanching and outer halo of redness- target appearance - systemic pain/ cramping in one hour - tachycardia - HTN - pulmonary edema - fever, chills, delirium - vomitting - partial paralysis - abdominal pain is severe*
60
treatment for black widow spider bite
- ACLS - anti-venom - analgesics - antihistamines - tetanus
61
what is lichen planus
- pruritic inflammatory disease of skin, mucous membranes, and hair follicles - mostly affects adults - T cell reaction -> keratinocytes undergo apoptosis
62
si/sx lichen planus
- four P's - purple - polygonal - pruritic - papules - on flexor aspects of wrists, lumbar area eyelids, shins, scalp - reticulate white lesions on buccal mucosa - lesions for < 1 year - can cause hair loss and nail damage
63
treatment for lichen planus
- potent topical steroid | - intralesional steroid injection
64
seborrheic keratosis
- senile wart - basal cell papilloma - over 90% of adults over 60 have these - occurs in all races
65
presentation of seborrheic keratosis
- "Stuck on" appearance - white, flesh colored, tan, brown - can be warty or smooth
66
kaposi sarcoma
- vascular neoplasm - usually in HIV pts - infection with HHV8 - 4 types but HIV associated is most common
67
si/sx of kaposi sarcoma
- red/purple macules -> infiltrative plaques and nodules or tumors on mucous membranes - often on lower extremities - presents later on arms and hands - lymphedema - becomes painful and ulcerated - internal involvement possible
68
histology of kaposi sarcoma
- capillaries are large and protrude into lumen - proliferation of vessels around existing vessels - spindle cells found in nodular lesions
69
clinical course of kaposi sarcoma
- variale - progresses slowly with rare lymph node or visceral involvement - almost never fatal - death usually d/t unrelated cause
70
treatment of kaposi sarcoma
- antiretroviral HIV tx - radiation - cryotherapy - surgical excision of individual nodules - topical alitretioin - pulsed dye laser
71
actinic keratosis
- in situ dysplasia d/t UV radiation - can progress to SCC - thick scaly growths - most common epithelial precancerous lesion
72
epidemiology of actinic keratosis
- white > darker skin - men > women - > risk with outdoor occupation or lifestyle - most common >50 y/o
73
pathophysiology of actinic keratosis
- atypical keratinocytes at basal layer that can extend upward - epidermis shows atypia, hyperkeratosis with inflammatory infiltrate
74
clinical manifestations of actinic keratosis
- found on chronically sun exposed surfaces - drivers sides - multiple discrete, flat, or elevated verrucous - keratotic, red, pigmented, or skin colored - may be scaley, smooth, shiny - rough sandpaper texture - usually felt more easily than seen
75
differential dx for actinic keratosis
- BCC - seborrheic keratosis - SCC - lupus erythematosus
76
dx of actinic keratosis
- clinical/ hx | - biopsy if palpable dermal component, "pearly" appearance or failed tx
77
tx of actinic keratosis
- based on number of lesions, persistence of lesions, and pt tolerability - cryotherapy - imiquimod - 5-FU - picato - be sure to follow up with pt
78
prognosis of actinic keratosis
- good | - continue to monitor for 2-6 mo depending on number of lesions and maintenance tx
79
basal cell carcinoma
- epithelial tumor of basal keratinocytes - invades dermis - rarely metastasizes - slow growing
80
epidemiology of BCC
- white > dark skinned - geography - closer to equator - age > 40 - outdoor lifestyle/ occupation - immunosuppression increases risk by 10X
81
pathophysiology of BCC
- immature pluripotent cells associated with hair follicle - mutations activate pathway that controls cell growth - activates oncogenes and tumor suppressor genes
82
clinical manifestations of BCC
- slowly enlarging lesion that does not heal, bleeds easily - mostly on face, head, neck, hands - appears as flat, firm, pale area - small, raised - pink or red, translucent or pearly** - rolled edge - can become ulcerative- "rodent ulcer" - bleeds without significant pain or sx - ulceration may burrow deep into subcutaneous tissue
83
types of BCC
- nodular - superficial - morpheaform (sclerosing) - pigmented
84
nodular BCC
- most common type - waxy, pearly, semitranslucent nodules or papules - rolled edge - central depression that may become ulcerated, crusted, or bleed
85
superficial BCC
- dry scaly lesion - superficial flat growths - can be misdx as eczema or psoriasis - threadlike raised boarder
86
morpheaform (sclerosing) BCC
- white sclerotic plaque - tenagiectasia - scar like appearance
87
pigmented BCC
- similar to nodular - brown or black pigmentation - usually in darker skin
88
differential dx of BCC
- SCC - sebaceous hyperplasia - actinic keratosis - eczema - psoriasis
89
dx of BCC
- biopsy - large, oval, or round tumor islands within dermis - often epidermal attachment
90
treatment of BCC
- goal= cure with best cosmetic results - reoccurrence usually from inadequate tx - usually seen in first 4-12 mo after tx - surgical, topical, or radiation tx
91
topical tx for BCC
- imiquimod - 5-FU - best for superficial BCC, less invasive
92
surgical options for BCC
- electrodisseication and Currettage for superfical lesions - cryosurgery (not common) - excision with margins- high cure rate - mohs micrographic surgery- gold standard (takes small layer at a time and checked under microscope until all cancer cells removed)
93
radiation for BCC
- not often used unless lesions are large - usually old pts who aren't candidates for surgery - can take 5-25 visits
94
prognosis of BCC
- good if appropriate tx used early - recurrent cancers are much harder to cure - 100% survival if it has not metastasized - can impinge on vital structures
95
squamous cell carcinoma
- many arise from actinic keratoses - can metastasize - arise from malignant proliferation of epidermal keratinocytes
96
epidemiology of SCC
- > 50 y/o - male > female - light skin > dark skin - tobacco and/or alcohol use - geography - hx of previous non-melanoma skin cancer - immunosuppression - HPV - chemical carcinogens
97
pathophysiology of SCC
- UVR, PUVA - smoking (oral ca) - HPV 16, 18, 31, 35 - irregular nests of epidermal cells invading into dermis - TP53 mutation
98
types of SCC
- in situ (bowen's disease)- full thickness of epidermis | - invasive
99
clinical manifestations of SCC
- begings at site of acitinic keratosis on sun exposed areas - superficial papules, plaques, or nodules - hard - become larger, ulcerated, covered by crust - lesions are moveable at first but then become fixed
100
lower lip SCC
- starts as actinic chelitis - local thickening on keratosis then firm nodule - usually hx of smoking
101
periungual SCC
- signs of swelling, erythema, local pain - commonly in nail folds of hands - resembles warts
102
differential dx for SCC
- actinic keratosis - eczematous rash - atopic dermatitis
103
dx of SCC
- biopsy- reveals "keratin pearls" | - lymphadenopathy*
104
treatment of SCC
- excision - mohs - radiation
105
prognosis of SCC
- Mohs surgery provides best cure rates - if metastasized, associated with poor prognosis - regular f/u required
106
melanoma
- skin cancer of melanocytes - least common skin cancer - most deadly
107
melanoma risk factors
- M- mole atypia - M moles > 50 - R red hair and freckling - I inability to tan - S sunburn, severe/ blistering - K kindred/ family history
108
etiology of melanoma
- damage to DNA of melanocytes -> oncogene and tumor suppressor gene mutations - UVR - genetics
109
pathophysiology of melanomas
- originate from melanocytes via dermoepidermal junction - half will dev in preexisting nevi - usually prolonged, noninvasive radial growth - tumor nodule dev- vertical growth
110
what is the greatest factor risk for metastasis in melanoma
- depth of invasion of melanoma lesion
111
clinical manifestation of melanoma
- macular or nodular - color varies - lesions boarders are irregular - growth is quick or slow - distribution can be o non sunexposed spots
112
superficial spreading of melanoma
- does not have a preference for sun damaged skin - tends to be multicolored - boarders are more sharply defined
113
lentigo maligna
- macular and flat then nodular - most common on sun damaged skin - insidious slow growth - type of melanoma
114
nodular melanoma
- arise without apparent radial growth phase - primarily sun exposed areas of head, neck, trunk - smooth and dome shaped - friable or ulcerated and bleeding
115
acral- lentiginous
- most common in darker skin types - light brown uniform pigmentation initially - on palms, soles, or nail beds - lesion becomes darker and nodular - can ulcerate - usually delay in dx - type of melanoma
116
melanoma metastasis
- early mets via lymphatics and regional lymphadenopathy mya be first sign - satellite mets appear as pigmented nodules around site of excision - spread via blood mainly to brain and lung
117
what are the markers for melanoma metastasis
- cancer at other organs- usually brain and lungs | - elevated LDH
118
breslow thickness
- total vertical height of melanoma - ocular micrometer is used to measure thickness - smaller the thickness the better the survival
119
dx of melanoma
- excisional biopsy | - palpate lymph nodes
120
melanoma treatment
- surgery- simply excision for early stage - wide local excision with sentinel LN biopsy or elective lymph node dissection = mainstay - radiation- usually at metastatic sites as palliative care - chemo- not often used - frequent follow ups