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Derm Flashcards

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1
Q

What are the components of the atopic triad?

A

asthma
Eczema
Allergic rhinitis

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2
Q

True or false: the diaper area is usually spared in atopic dermatitis in infants

A

True

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3
Q

Where does the rash show up on children with atopic dermatitis?

A

Flexural surfaces

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4
Q

Long term use of immunomodulator medications increases the risk of what malignancy?

A

Lymphoma

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5
Q

What are zonula occludens?

A

Tight junctions in the skin

Presents paracellular movement of solutes

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6
Q

What are the adherens junctions?

A

Junction below tight junctions in the skin

Forms belt connecting actin cytoskeletons of adjacent cells with CADherins

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7
Q

What are desmosomes?

A

Macula adherens

Structural support via keratin interactions

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8
Q

What do the antibodies in pemphigus vulgaris attack?

A

Desmosomes

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9
Q

What are gap junctions?

A

Channel proteins composed of connexons that allow electrical and chemical communication between cells

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10
Q

How do you diagnose atopic dermatitis?

A

Clinically–some may have increased IgE and eosinophilia, but not all

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11
Q

What is the pharmacotherapy for atopic dermatitis?

A

Topical corticosteroids

tacrolimus for more severe

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12
Q

What is the general care for atopic dermatitis?

A

Goal is to break the itching and scratching cycle. Use gentle soaps and moisturize after bathing, avoid irritants, and use antihistamines to control pruritus.

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13
Q

What type of hypersensitivity reaction is contact dermatitis?

A

4

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14
Q

What are the common things that can cause contact dermatitis?

A

Ni
Poison ivy
Perfumes
Neomycin

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15
Q

What is the metal that can cause contact dermatitis?

A

Ni

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16
Q

What is the abx that can cause contact dermatitis?

A

Neomycin

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17
Q

What type of hypersensitivity reaction is latex allergy?

A

Type 1

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18
Q

What is erythema toxicum neonatorum, and what is the prognosis?

A

Eczema like rash that begins 1-3 days after delivery. Presents with red papules, pustules, and/or vesicles with surroundings halos

Benign

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19
Q

What is the size of a macule?

A

Less than 1 cm

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20
Q

What is the size of a patch?

A

Macule that is more than 1 cm

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21
Q

What is the size of a papule?

A

Less than 1 cm

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22
Q

What is a plaque?

A

Papule more than 1 cm

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23
Q

What is the larger form of a vesicle?

A

bulla

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24
Q

What is a wheal?

A

Transient smooth papule or plaque

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25
What is the MOA of a type I hypersensitivity rxn?
Antigen crosslinks IgE on mast cells, causing release of histamine and other vasoactive amines
26
What is the MOA of a type II hypersensitivity rxn?
Cytotoxic--IgM and IgG bind to antigen on an enemy cell, leading to lysis by complement activation or phagocytosis
27
What is the MOA of a type III hypersensitivity rxn?
Immune complex deposition leading to PMN activation
28
What is the MOA of serum sickness?
Antibodies to the foreign proteins are produced in ∼ 5 days. Immune complexes form and are deposited in membranes, where they lead to tissue damage by fixing complement.
29
What is an arthus reaction?
A local reaction to antigen by preformed antibodies characterized by vascular necrosis and thrombosis.
30
What is the MOA of a type IV hypersensitivity rxn?
Sensitized T lymphocytes kill
31
How do you definitively diagnose contact dermatitis?
Patch testing
32
What is the treatment for contact dermatitis?
Topical corticosteroids and allergen avoidance
33
What is seborrheic dermatitis?
Chronic inflammatory skin disease that may be caused by a rxn to malassezia furfur Presents in seborrheic regions
34
What is "Cradle cap"?
Seborrheic dermatitis of the neonate
35
What are the two major ways that seborrheic dermatitis presents in the neonate?
Red diaper rash with yellow scales, erosions, and blisters
36
What are the two major diseases associated with seborrheic dermatitis?
PD | AIDS
37
How do you diagnose seborrheic dermatitis?
Clinically
38
What is the treatment for seborrheic dermatitis?
Selenium sulfide or zinc pyrithione shampoos
39
What is stasis dermatitis?
Lower extremity dermatitis due to venous HTN forcing blood from the deep to the superficial venous system
40
What is the treatment for stasis dermatitis to prevent stasis ulcers?
Leg elevation | Compression stockings
41
What is the effect of sunlight on seborrheic dermatitis?
Exacerbates it
42
What is psoriasis?
T cell mediated inflammatory dermatosis characterized by erythematous plaques with silvery scales
43
What areas of the body are affected by psoriasis?
Extensor surfaces
44
Rash that affects the flexural surfaces? Extensor surfaces?
``` Flexural = atopic dermatitis Extensor = psoriasis ```
45
What are the labs that should be obtained prior to starting methotrexate, or anti-TNF biologics?
CBC CMP Hepatitis PPD
46
What is the a Auspitz sign?
Pinpoint bleeding when a scale is scraped
47
Sausage digits = ?
Psoriatic arthritis
48
How do you definitively diagnose psoriasis?
bx
49
Munro microabscesses on histology =?
Psoriasis
50
erythematous plaques with silvery scales = ?
Psoriasis
51
What is the treatment for psoriasis? (3)
Topical steroids | Methotrexate or anti-TNF biologics
52
Why is UV light contraindicated as a treatment for psoriasis in immunosuppressed patients?
Cancer
53
What is the pathophysiology of urticaria?
the release of histamine and prostaglandins from mast cells in a type I hypersensitivity response.
54
What is the duration of urticaria?
Up to 6 weeks in some cases
55
What are the lesions of urticaria?
Wheals of reddish or white transient papules or plaques representing dermal edema
56
What are the extracutaneous manifestations of urticaria?
Angioedema Asthma GI s/sx Joint swelling
57
How do you diagnose urticaria?
H&P
58
What is the treatment for urticaria?
Systemic antihistamines
59
What is the most common skin reaction to a drug?
Mild morbilliform rash that is widespread, symmetric, and pruritic
60
Which type of hypersensitivity reaction can drugs cause?
All types
61
How long does it take for a patient to react to a drug?
7-14 days
62
True or false: If a patient reacts within 1–2 days of starting a new drug, it is probably not the causative agent.
True
63
What usually triggers erythema multiforme?
HSV or mycoplasma
64
What is the treatment for a cutaneous drug reaction?
antihistamines and topical steroids
65
What are the characteristics of the lesions with erythema multiforme?
Targetoid lesions
66
True or false: the palms and soles are usually spared with erythema multiforme?
False--often affected
67
What is the difference between erythema multiforme major and minor?
Major involves mucosal surfaces
68
How can you differentiate erythema multiforme vs SJS or TEN?
Nikolsky sign negative for EM
69
What is the treatment for erythema multiforme?
Supportive
70
What is the role of steroids in the treatment for erythema multiforme?
Of no benefit
71
What is the difference between SJS and TEN?
SJS is less than 10% of body surface | TEN is more than 30%
72
What is the nikolsky sign?
Finger pressure on the skin results in sloughing off of the skin
73
What is the histological difference between SJS and TEN?
SJS shows degeneration of the basal layer of the epidermis, whereas TEN reveals a full thickness eosinophilic epidermal necrosis
74
What is the treatment for SJS/TEN?
Thermoregulatory and electrolyte disturbance correction
75
What are the causes of erythema nodosum?
``` NO cause Drugs OCPs Sarcoidosis Ulcerative colitis Microbiology ``` (NODOSUM)
76
What is panniculitis?
Inflammatory process of the SQ adipose tissue
77
What is the presentation of erythema nodosum?
Painful, erythematous nodules that appear on the patient's anterior shins that eventually turn brown or gray
78
Patient with erythema nodosum will often test positive for what infectious agent?
VDRL (like SLE)
79
How do you workup erythema nodosum? (3)
ASO titer PPD CXR to r/o sarcoidosis
80
What is the treatment for erythema nodosum?
NSAIDs and cool compresses | KI for persistent cases
81
Which is an intraepidermal lesion, and which along the BM: bullous pemphigoid vs pemphigus vulgaris?
``` Intraepidermal = pemphigus vulgaris BM = bullous pemphigoid ```
82
What are the antibodies directed against in bullous pemphigoid vs pemphigus vulgaris?
``` BP = hemidesmosomes PV = desmoglein ```
83
Compare the appearance of the blisters in bullous pemphigoid vs pemphigus vulgaris.
``` BM = firm, stable blisters preceded by urticaria PV = Erosions more common than intact blisters ```
84
Which is nikolsky sign positive: bullous pemphigoid vs pemphigus vulgaris?
PV = positive
85
Which has mucosal involvement: bullous pemphigoid vs pemphigus vulgaris
PV
86
What is the age of onset for bullous pemphigoid vs pemphigus vulgaris?
BP = over 60 | PV 40-60
87
What is the treatment for bullous pemphigoid vs pemphigus vulgaris?
Steroids for BP | Steroids and immunosuppressants for PV
88
Which has a higher chance of mortality: bullous pemphigoid vs pemphigus vulgaris
PV (super rare to die from BP)
89
What is the best way to diagnose HSV infection?
viral culture of the lesions
90
Where are the lesions of dermatitis herpetiformis usually found?
elbows, knees, buttocks, and neck
91
When should patient with a primary outbreak of HSV be given acyclovir?
Within 72 hours of onset
92
When is daily prophylaxis indicated for HSV?
More than 6 outbreaks per year
93
HSV infection lasting longer than how long is considered an AIDS defining illness?
1 month
94
What are the lesions like with VZV?
evolving from red macules to vesicles that then crust over.
95
What is the difference in lesions between smallpox and varicella?
Smallpox has lesions that are all at the same stage, whereas VZV has lesions all at different stages
96
What are the meds that are used for pain control for VZV?
Gabapentin | TCAs
97
What is the post exposure prophylaxis with VZV?
Rarely needed as most patients in the United States have been vaccinated or had childhood varicella. If needed, immunocompromised individuals, pregnant women, and newborns should receive varicella-zoster immune globulin within 10 days of exposure. Immunocompetent adults should receive a varicella vaccine within 5 days of exposure.
98
What type of virus is molluscum contagiosum?
Poxvirus
99
How is molluscum contagiosum spread?
Skin-skin contact, or towel sharing
100
True or false: mollusscum contagiosum usually spares the palms and soles
True
101
What are the histological findings of molluscum contagiosum?
Inclusion bodies
102
What is the treatment for molluscum contagiosum?
Local destruction | Resolve spontaneously
103
True or false: impetigo can lead to acute glomerulonephritis
True
104
What is the treatment for mild impetigo?
Topical abx
105
What is the treatment for severe impetigo caused by MRSA? If not caused?
``` MRSA = TMp-SMX Not = cephalexin, dicloxacillin ```
106
What is the treatment for cellulitis?
Use 5–10 days of oral antibiotics. IV antibiotics are used if there is evidence of systemic toxicity, comorbid conditions, diabetes mellitus (DM), extremes of age, or hand or orbital involvement. Antibiotic choices similar to impetigo.
107
What is the classic rash associated with scarlet fever?
Rose spots on the abdomen
108
What is the treatment for salmonella typhi?
Fluoroquinolones
109
What is the presentation of scarlet fever?
sandpaper rash + strawberry tongue
110
What is the treatment for scarlet fever?
PCN
111
What is/are the infectious agent(s) that cause necrotizing fasciitis?
S aureus E.coli Clostridium perfringens
112
What is the presentation of nec fas?
Quickly moving erythema that becomes dusky or purplish as it progresses. initially painful, followed by anesthesia in necrotic areas
113
What is Ludwig's angina?
bilateral cellulitis of the submental, submaxillary, and sublingual spaces that usually stems from an infected tooth
114
How does Ludwig's angina usually present?
Dysphagia Drooling Fever
115
What is the treatment for nec fas?
Broad spectrum abx + surgical debridement
116
What bacteria usually cause folliculitis?
Staph Strep Gram - bacteria
117
What is a furuncle?
hair follicle abscess
118
What is a carbuncle?
Collection of furuncles
119
If eosinophilic folliculitis is suspected, what can be used to confirm the diagnosis?
Bx with KOH prep
120
What are the abx that cause sun sensitivity?
Tetracycline and doxycycline
121
What is the treatment for mild acne?
Topical retinoids
122
What is the treatment for moderate-severe acne?
doxycycline or minocycline. Oral retinoids
123
What are the labs that need to be followed with retinoids?
LFTs Cholesterol Triglycerides
124
What diseases are risk factors for the development of tinea versicolor?
Cushing's | Immunosuppression
125
What is the test for tinea versicolor?
KOH prep showing spaghetti and meatball appearance
126
When are abx needed in the treatment of a pilonidal cyst?
If cellulitis is present
127
What are the two treatments for tinea versicolor?
Ketoconazole or selenium sulfide
128
Where anatomically does candida usually present?
Skin folds and moist areas
129
How does skin candidiasis present?
markedly erythematous patches with occasional erosions and smaller satellite lesions
130
What is the treatment for oral candida?
Oral fluconazole | Nystatin swish and swallow
131
What is the treatment for a diaper rash 2/2 candida?
Topical nystatin
132
What is the treatment for superficial candidiasis?
Topical antifungals
133
Dermatophytes only live in what type of tissue?
keratinized tissues
134
What are the top three dermatophytes?
Trichophyton Microsporum Epidermophyton
135
loss. A large inflammatory boggy mass caused by tinea capitis is called what?
A kerion
136
Which tinea needs to be treated systemically? Why?
Tinea capitis to penetrate into hair follicles
137
What is the treatment for head lice?
Permethrin Pyrethrin Benzyl alcohol
138
What is the treatment for body lice?
Wash clothes and sheets thoroughly
139
What is the treatment for pubic lice?
Same as head lice (permethrin)
140
What are the characteristics of the lesions with scabies?
linear tracks, which represent the burrows of the mite
141
What is the most commonly affected site for scabies lesions?
interdigital finger webs
142
When is the itching worse with scabies?
After hot showers and at night.
143
What is the treatment for scabies?
Permethrin from the neck down oral ivermectin
144
What is the pathophysiology of decubitus ulcers?
Chronic pressure restricts microcirculation
145
What is the low grade and high grade decubitus ulcers?
Low grade = wound care | High grade = surgical debridement
146
What are the three types of gangrene?
Dry Wet Gas
147
What is the cause of dry gangrene?
Due to insufficient blood flow, typically from atherosclerosis
148
What is the causative agent of gas gangrene?
C perfringens infection
149
What are the s/sx of dry gangrene?
Dull ache, and pallor that progresses to bluish-black
150
What is the appearance of wet gangrene?
Tissue appears bruised, swollen or blistered with pus
151
What is the treatment for gangrene?
Surgical debridement (gas gangrene is an emergency)
152
Why are abx not sufficient to treat gangrene?
Poor blood flow to the wound
153
What, in addition to emergency surgical debridement, can be done for gas gangrene?
Hyperbaric oxygen
154
What is acanthosis nigricans? What is the treatment?
Intertriginous zones become hyperkeratotic and hyperpigmented Not treated--encourage weight loss
155
What will an x-ray show with gas gangrene?
Bubbles of air in soft tissue
156
What is lichen planus?
A self-limited, recurrent, or chronic inflammatory disease affecting the skin, oral mucosa, and genitalia.
157
What are the 6's of lichen planus?
``` Planar Purple Polygonal Pruritic Papules Plaques ```
158
What infectious agent is associated with lichen planus?
HCV
159
What is the natural history of lichen planus?
Purplish, pruritic plaques that demonstrate the koebner phenomenon
160
What is the treatment for lichen planus?
Topical corticosteroids
161
What is rosacea?
Chronic disease of pilosebaceous units, characterized by central facial erythema with telangiectasias
162
What does longstanding rosacea progress to?
Rhinophyma
163
Who usually gets rosacea?
Middle aged women with fair skin Usually have an abnormal flushing response to hot drinks
164
What is the treatment for rosacea?
metronidazole
165
What is pityriasis rosea?
Idiopathic dermatitis (possible 2/2 HHV 7 infx)
166
What is the natural history of pityriasis rosea?
Herald patch days to weeks before outbreak of multiple papules and plaques with a fine ("cigarette paper") feeling in a tree like pattern
167
What is the feeling of pityriasis rosea commonly likened to?
Cigarette paper
168
What is the treatment for pityriasis rosea?
Supportive (antipruritics, lubrication, antihistamines)
169
What is vitiligo?
Acquired loss of function or absence of melanocytes
170
What is the treatment for vitiligo?
Topical steroids
171
How can you confirm vitiligo?
Serological markers of autoimmune disease
172
What are xanthelasmas?
Soft, yellow plaques seen on the medial aspects of the eyelids bilaterally, associated with hyperlipidemia
173
What is a hordeolum?
Painful acute eyelid gland infection (stye) usually caused by staph aureus
174
What is a chalazion?
A self-limited, recurrent, or chronic inflammatory disease affecting the skin, oral mucosa, and genitalia.
175
What are the characteristics of seborrheic keratoses? What is their malignant potential?
Stuck on appearance with a sandpaper like texture | Totally benign
176
What is the appearance of actinic keratoses?
flat areas of erythema and scale
177
Why should actinic keratoses be treated? How are they treated?
Risk of progression to SCC | Cryosurgery or 5FU
178
What are marjolin's ulcers?
SCC that arises from site of drainage or burns
179
Ar exposure can cause SCC in what anatomic distribution?
palmoplantar distribution
180
True or false: BCC has virtually no metastatic potential
True
181
What is the inherited disease that predisposes people to melanoma?
Familial atypical mole and melanoma syndrome
182
Pruritus in a changing skin lesion is a suspicious feature for what?
Malignant change to melanoma
183
What is amelanotic melanomas?
Melanomas that present without pigment--hard to identify
184
What is acral lentiginous melanoma?
Melanoma that begins on the palms, soles, and nail bed as a slowly spreading, pigmented patch
185
What is lentigo maligna?
Melanoma that arises in a solar lentigo. Usually found on sun-damaged skin of the face
186
Diameter greater than what is suspicious for melanoma?
6 mm
187
What is the treatment for metastatic melanoma?
chemo
188
What infectious disease can mimic the cutaneous lesions of kaposi's sarcoma?
Bartonella henselae
189
What is the causative agent of kaposi's sarcoma?
HHV8
190
What is the treatment for kaposi's sarcoma 2/2 AIDs?
HAART
191
What is the treatment for Kaposi's sarcoma not 2/2 AIDS?
Excise and/or IFN-alpha
192
What is mycosis fungoides?
Cutaneous T cell lymphoma--progressive neoplastic proliferation of T cells
193
What are the lesions like with mycosis fungoides?
Psoriatic appearing plaques or patches that are often pruritic with a predilection for the trunk an buttocks
194
What is Sezary syndrome?
Leukemic phase of cutaneous T cell lymphoma, manifesting as Sezary cells in the peripheral blood
195
How do you diagnose mycosis fungoides?
bx showing
196
Dermatitis that is chronic and resistant to treatment should be biopsied for what condition?
Mycosis fungoides
197
What is the treatment for mycosis fungoides?
Phototherapy
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