Week 6 Dermatology Flashcards
What is a wheal?
An elevated, irregularly shaped area of cutaneous edema; wheals are solid, transient, and changeable, with a variable diameter, can be red, pale, pink or white
describe papule
elevated, palpable, firm circumscribed area generally less than 5 mm in diameter
describe plaque
: elevated, flat-topped, firm, rough, superficial papulae greater than 2 cm in diameter
Atrophy
: diminution of epidermal surface; skin looks thinner and more translucent than normal
Keloid
: augmentation of scar tissue, creating a significant elevation on the skin surface after healing
Lichenification
: rough, thickened epidermis; accentuated skin markings caused by rubbing or scratching (EX chronic eczema or lichen simplex)
Excoriation
: linear scratches that may or may not be denuded
Erosion
: loss of epidermis that does not extend into the dermis
A 9-month-old infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S-shaped burrow lesions on the parent’s hands and wrists. What is the treatment for this rash for this infant?
A Ivermectin 200 mcg/kg for 7–14 days, along with symptomatic treatment for itching
B Permethrin 5% cream applied to face, neck, and body, and rinsed off in 8–14 hours
C Treatment of all family members except the infant with permethrin 5% cream and ivermectin t
D Treatment with permethrin 5% cream for 7 days, in conjunction with ivermectin 200 mcg/kg
Permethrin 5% cream is the drug of choice for treating scabies and is intended for use in infants as young as 2 months of age. Infants will get lesions on the face and neck, and permethrin may be applied to the face, avoiding the eyes. Ivermectin is not recommended for children under 5 years old. Treatment must include the infant as well as all family members whether symptomatic or not.
A provider is considering an oral contraceptive medication to treat acne in an adolescent female. What is an important consideration when prescribing this drug? A A progesterone-only contraceptive is most beneficial for treating acneA progesterone-only contraceptive is most beneficial for treating acne B Combined oral contraceptives are effective for non-inflammatory acne onlyCombined oral contraceptives are effective for non-inflammatory acne only C Oral contraceptives are effective because of their androgen-enhancing effectsOral contraceptives are effective because of their androgen-enhancing effects D Yaz, Ortho Tri-Cyclen, and Estrostep are approved for acne treatment
Yaz, Ortho Tri-Cyclen, and Estrostep are approved for acne treatment
A patient comes to the clinic after being splashed with boiling water while cooking. The patient has partial thickness burns on both forearms, the neck, and the chin. What will the provider do? A Clean and dress the burn wounds clean and dress the burn wounds B Order a CBC, glucose, and electrolytes Order a CBC, glucose, and electrolytes C Perform a chest radiograph Perform a chest radiograph D Refer the patient to the emergency department (ED)
D Refer the patient to the emergency department (ED)
A child has small, firm, flesh-colored papules in both axillae, which are mildly pruritic. What is an acceptable initial approach to managing this condition?
A Application of trichloroacetic acid 25–50% using a dropper
B Applying liquid nitrogen for 2–3 seconds to each lesionA
C Reassuring the parents that these are benign and may disappear spontaneously
D Referral to a dermatologist for manual removal of lesions with curettage
Reassuring the parents that these are benign and may disappear spontaneously Molluscum contagiosum is a benign viral skin infection; most lesions disappear within 6 months to 2 years. An initial “wait and see” approach is acceptable. If itching is severe, the risk is autoinoculation and spread of lesions, along with increased discomfort and then other treatment measures may be attempted, depending on the severity. Topical medications, such as trichloroacetic acid or liquid nitrogen may be used if the lesions become uncomfortable or persist and should be used with caution. More severe outbreaks may require removal with curettage.
Which is the primary symptom causing discomfort in patients with atopic dermatitis (AD)? A Dryness B Erythema C Lichenification D Pruritis
Pruritus Itching is incessant, and patients usually develop other signs at the site of itching. None of the other options are associated with AD.
A preschool-age child has honey-crusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on the arms and legs. The child’s parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated? A Amoxicillin 40-50 mg/kg/day for 7-10 days B Amoxicillin-clavulanate 90 mg/kg/day for 10 days C Bacitracin cream applied to lesions for 10–14 days D Mupirocin ointment applied to lesions until clear
Amoxicillin-clavulanate 90 mg/kg/day for 10 days When children have multiple impetigo lesions or non-bullous impetigo with infection in multiple family members or child care groups, oral antibiotics are indicated. Amoxicillin-clavulanate is a first-line drug for this indication. Amoxicillin is not used for skin infections. Bacitracin is bacteriostatic and may be used when only a few lesions are present and if bacterial resistance is not an issue. Mupirocin is used for mild impetigo when the case is isolated.
Question A school-age child has several annular lesions on the abdomen, characterized by central clearing with scaly, red borders. What is the first step in managing this condition? A Fluoresce the lesions with a Wood’s lamp B Obtain fungal cultures of the lesions C Perform KOH-treated scrapings of the lesion borders D Treat empirically with antifungal cream
D Treat empirically with antifungal cream Unless the diagnosis is questionable, or if treatment failure occurs, tinea corporis is treated empirically with topical antifungal creams; therefore, it is not necessary to fluoresce the lesions, culture the lesions, or complete KOH testing of scrapings as an initial management step.
During a total body skin examination for skin cancer, the provider notes a raised, shiny, slightly pigmented lesion on the patient’s nose. What will the provider do? A Consult with a dermatologist about possible melanoma B Reassure the patient that this is a benign lesion C Refer the patient for possible basal cell carcinoma D Tell the patient this is likely a squamous cell carcinoma
C Refer the patient for possible basal cell carcinoma This lesion is characteristic of basal cell carcinoma, which is treated with electrodessication and curettage. Melanoma lesions are usually asymmetric lesions with irregular borders, variable coloration, >6 mm diameter, which are elevated; these should be referred immediately. All suspicious lesions should be biopsied; until the results are known, the provider should not reassure the patient that the lesion is benign. Squamous cell carcinoma is roughened, scaling, and bleeds easily.
Which type of bite is generally closed by delayed primary closure? Select all that apply. A Bites to the face B Bites to the hand, C Deep puncture wounds, D Dog bites on an arm E Wounds 6 hours old or older
Bites to hand and wounds 6 hours old or older and deep puncture wounds Cat and human bites, deep puncture wounds, clinically infected wounds, wounds more than 6 to 12 hours old, and bites to the hand should be left open and closed by delayed primary closure. A bite to the face is closed by primary closure. Dog bites do not require delayed or secondary closure.
What is the most common cause of acute maculopapular rash in adults?
drug eruptions
What is the most common cause of acute maculopapular rash in children?
viral infection
When does maximum destruction occur in cryotherapy?
What is cryotherapy indicated for?
liquid nitrogen is used…..max destroy with repeated freeze-thaw cycles
Indication
- acrochorda (skin tags)
- warts
- seborrheic keratosis
- actinic keratosis
Caution
- Can cause hyperpigmentation in blacks
- postinflammatory hyperpigmentation
Antiviral suppressive therapy is needed for people who have more than _____ outbreaks a year
6
What are TNF antagonists presribed for in dermatology?
Black box warning
Contraindications
Indication: severe psoriasis or psoriatic arthritis.
BBW
- Increase susceptibility for infection
- Blood dyscrasias
- lymphoma
Contraindications
- Live Vax
- HF
- MS
- Tb & Hep B can be reactivated
**patients on these are considered to be immunocompromised**
What does basal cell carcinoma typically look like?
flesh-colored to slightly pigmented
raised, shiny, often with pearly borders
What doe squamous cell carcinoma characteristically look like?
Rough, scaling that does not heal and readily bleeds
how is BCC treated?
electrodessication and curettage
how is SCC treated?
total excision
What is adnexal?
What are the adnexal diseases?
“connected structures” EXhair follicle, sebaceous glands, eccrine gland, apocrine sweat gland, and arrector pili muscle. Direct extensions of epidermis
- Acne vulgaris
- acne rosacea
- perioral dermatitis
- folliculitis
- hidradenitis
- hyperhidrosis
Acne Vulgaris
What
What:
- pilosebaceous follicle disorder
- increased sebum
- altered keratinization
- inflammation
- bacterial colonization P. acnes
*
how long for oral antibiotics to work for acne vulgaris?
Treatment
- 6 to 8 weeks for improvement
- Reevaluation at 12 to 18 weeks
**benzoyl peroxide helps reduce antibiotic resistance
What should you monitor for someone on Isotretinoin?
triglycerides
LFTs
Rosacea
Who:
Difference between acne
Hallmark characteristics #7
WHO: 30 to 50yrs; usually women
DIFFERENCE: no comedones
Characteristics:
- flushing, erythema
- inflammatory papules & pustules
- Telangiectasia
- Edema
- Watery/Irritated eyes
Rosacea
Treatment
Complications
Treatment
- Flagyl; max 2 years(for erythema)
- Azelaic acid; max 4 weeks (for erythema)
- Oral abx; Tetracycline
Complications
- Ocular Rosacea IMMEDIATE REFERRAL
Signs of Ocular Rosacea
- watery eyes
- telangiectasia of conjunctiva & lid
- periocular erythema
- light sensitivity
- blurred vision
- foreign body sensation
Perioral dermatitis
Who:
Presentation
Who: Women 20 to 45
Presentation
- Resembles acne; papules/pustules w/ diffuse erythema
- Confined to chin and nasolabial folds
- symmetric
- Itch & burning sensation
Treatment
- Avoid steroids on face
- Flagyl
- Tetracycline
Folliculitis
Presentation
Treatment
Presentation
- Itch
- Can turn into carbuncle
Treatment
- Benzoyl peroxide 1st line
- Abx
Hidradenitis Suppurative (Acne Inversa)
Pathophysiology
presentation
diagnostic
Patho: keratin plugged apocrine glands
Presentation
- Usually females, genital & axillary regions
- swelling/pain/erythema
- Abscess
- Leaves scars w/basket weaving configuration
Diagnostics
- culture lesions
Treatment
- depends on “Hurley stage”
- In collaboration with dermatologist
- Abx
- NSAIDs
- Retinoids
Hyperhydrosis
Diagnostics
Diagnostics
- TSH
- Fasting glucose
- Quantiferon (r/o tb if nightsweats)
- if with HTN, r/o pheochromocytoma
The hair pull test notes 5+ hairs that include anagen hairs (with follicle sheath)
Telogen Effluvium would show….
Hair Breakage =
telogen Effluvium = no obvious cause = underlying illness
Causes: fever, anemia, childbirth, malnutrition.
Hair Breakage =
- Anagen Effluvium = chemo = diffuse pattern
- Tinea capitis = scale/crust/patchy
What animal bite bacteria causes devastating sepsis?
Animal bite Aerobic flora
Anaerobic
Capnocytophaga canimorsus
Aerobic
- Pasteurella multocida
- Staph
- Strep
- Coryne
Anaerobic
- Bacteroides
- Actinomyces
- Porphyromonas
- Fusobacterium
What is the bacteria that causes cat scratch disease?
Bartonella henselae
What bacteria causes plague and is endemic among rodents in western US?
Yersinia pestis
What bacteria causes rat bite fever in the US?
Step moniliformis
What bacteria is often present in clenched-fist injuries?
fun fact #2
complication
E. corrodens; ALSO: MRSA; s. pyogenes
E. Corrodens Facts:
- Resistant to empiric abx
- Produces beta-lactamases
Complications
- endocarditis
What are risk factors for wound bite infection? #8
- >50 years
- Advanced liver disease/ETOH/Asplenia, DM
- Crush injury/penetrating injury
- Hand or foot location
- Failure to irrigate & debride during initial management
- Treatment delay >12 hours
- Edema at site
- Peripheral vascular disease
How long for most bite wounds to develop signs of infection?
Which bite wounds should be left open?
24 to 72 hours after
- cat & human bites
- deep wounds
- infected wounds
- wounds >6 hours old
- Bites to hand
What bite wound patients should receive prophylactic antibiotics?
What is the exception?
- high risk bites with high risk conditions
- cat bite
- hand bite (whether human or animal)
EXCEPT FOR patients seen 72 hours of injury with no signs of infection
Sebaceous Hyperplasia
Describe
Management
Describe
- enlargement of sebaceous gland beneath skin assoc w/pore/follicle
- Yellow with raised outer area
- “crown vessels”
- Usually on Face
- Assoc w/aging and pregnancy
Management
- R/o BCC
- electrodessication
- phototherapy
- laser therapy
Seborrheic Keratosis
Describe
Describe
- common benign NM lesion
- Waxy/verrucous papules/plaques
- “stuck on”
Bullous Phemigoid
Patho
Clinical Presentation
Patho
- autoimmune disorder
- circulating IgG >>> tissue damage and blisters
- Usually >60 years
Clinical Presentation
- Prodromal phase: pruritus, red/eczema papules that last for weeks to months
- Bullous phase: intense pruritus & widespread blisters
- Usually flexors, lower legs
- Negative Nikolsky sign
Acute Generalized Exanthematous Pustules
Describe
Diagnostics
Management
Describe
- hundreds pinhead pustules on swollen red skin
- usually flexural sites
- Facial edema
- 90% drug causes: antibiotics, CCB, antimalarials
Diagnostics
- Fever, Leukocytosis, eosinophilia
Manage
- Remove drug
- Monitor liver toxicity
Exanthematous Drug Eruptions
Cause
Presentation
Management
Cause
- Delayed Type IV, T-cell reaction
- abx, anticonvulsants, NSAID
- immunosuppressed & concomitant viral infection more affected
Presentation
- Pruritus, low grade fever, eosinophilia
- Morbilliform
- May progress
Management
- Recovery w/in 2 weeks drug stopping
- topical steroids and antihistamines
Fixed Drug Eruption
Describe
Management
Describe
- Single or multi red/brown/black macules
- Reappear at same site w/reexposure
- w/in weeks of exposure
- may burn or itch
- Locations: lips, perianal, hands, feet
Management
- Distinguish from SJS, cellulitis or plaque
- Resolve within 10 days after stopping drug
Drug Reaction w/ Eosinophilia and Systemic Systems (DRESS)
What? assoc with?
Presentation 4
Complications
Management
RARE; sometimes fatal develops 2-8 weeks after exposure;
associated with reactivation Herpes
Presentation
- Morbilliform on face and upper body >>>
- Edematous & vesicular
- Facial Edema*****hallmark
- Systemic s/s: fever, lymphadenopathy, arthralgia
Complications
- Hepatitis**
- myocarditis
- pneumonitis
- nephritis
- thyroiditis
Management = HOSPITAL
Erysipela
What (makes it diff from cellulitis)
Cause
Presentation
WHAT: nonpurulent SSTI upper dermis and includes lympthatics
“superficial cellulitis” - restricted to superficial dermis and lympthatics
CAUSE: Children & elderly at risk
- Group A strep***
- S. pyogenes
- S. aureus
Presentation
- Sudden onset of erythema, edema, pain
- itching
- Hallmark
- well-demarcated borders of inflammation
- bright red w/orange skin surface
- Unilateral, lower extremity
Erythrasma
What
Who
Cause
Presentation
WHAT: chronic, mild infection of skin folds
WHO: diabetic, elderly, immunocompromised
CAUSE: Cornybacterum minutissum
Presentation: Well-demarcated, brown-red macular patches
Diagnostic:
- Wood’s Lamp = coral-red lesion **essential diagnostic
- R/o concurrent infection with KOH
- Gram satin
Intertrigo
patho
diagnosis
management
PATHO: superficial inflammatory skin disorder from areas of friction that disrupt skin barrier to allow for opportunistic infections
*possible initial presentation of HIV
Diagnosis:
- KOH r/o candida
- culture
- woods lamp
Management
- Burrow solution compress to soothe
- Culture before oral abx
- keep skin folds cool and dry
