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109 Cards in this Set

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DERMATOLOGY: AM
DERMATOLOGY: AM
Discuss Hx, PE, and Tx for urticaria
Hx: most common cause-foods PE: itchy red swellng few ml's to cm's Tx: remove cause, antihistamines H1, H2, prednisone
Discuss Hx, PE and Tx for Warts
Hx: HPV PE: verrucous papules anywhere <1cm Tx: Liquid nitrogen, keratolytic/occlusion salicylic acid, operative, laser, etc.
Discuss Hx, PE and Tx for Furuncle
Hx: predisposing condition, DM, HIV,etc. PE: px, tender, red, Tx: I&D maybe ABX
Define Furuncle
Boil, deep-seated infection (abscess) red, hot, tender nodule evolving from staph folliculitits, involving the entire hair follicle and adjacent subq tissue
Discuss Hx, PE and Tx for herpes zoster
Hx: Px along dermatone, trunk and face PE: grouped vesicular lesions, unilateral Tx: antivirals, px mgt, NO oral steroids!
Discuss Hx, PE and Tx for Acne Vulgaris
Hx: puberty-comodones, adult-papulare sesion on chin around mouth PE: Open/closed hallmark Tx: Benzoyl peroxide, retinoids, abx
What is the most common of all skin conditions
acne vulgaris
Discuss Hx, PE and Tx for Impetigo
Hx: Contagious caused by staph/strep PE: vesiculopustular: gold honey crusted, itchy Tx: systemic abx more effective than topical abx
Discuss Hx, PE and Tx for eczema
Hx: allergies PE: pruritic, exudative or lichenified eruptions Tx: corticosteroids sparingly, anything drying or irritating skin makes worse
Discuss Hx, PE and Tx for allergic contact dermatitis
Hx: skin contact with chemicals or allergens PE: erythema, edema, puritus, vesicles and bullae Tx: systemic corticosteroids
Discuss Hx, PE and Tx for scabies
Hx: sleeping with infested bedding or person PE: itching, excoriated, sm pruritic vesicles, pustules and runs or burrows in web spaces, heels, palms, wrists, elbows, axillae Tx: permethrin
Discuss Pediculosis and Tx
Pruritus with excoriation. Nits on hair shafts; lice on skin or clothes. Tx-disposing infested clothing. pubic lice-permethrin rinse 1% 10 min and permethrin cream 5% applied 8 hours is effective
Discuss Psoriasis and Tx
Silvery scales on bright red, well-demarcated plaques, usually on knees, elbows, and scalp. Nails may be pitting/onycholysis. Mild itching. Tx-high-potency to ultra-high-potency topical corticosteroid cream or ointment. If involves >30% body surface, difficult to tx with topical agents. UVB light exposure three times weekly. maintenance may be required.
What drugs may worsen psoriasis
b-blockers, antimalarials, statins, lithium
Discuss seborrheic dermatits and Tx
Dry scales & underlying erythema. Scalp, central face, presternal, interscapular areas, umbilicus, body folds. Acute or chronic papulosquamous dermatitis. Tx: mild corticosteroid. scalp-shampoo containing zinc pyrithione or selenium. On eyelids-gentle cleaning with diluted Johnson & Johnson Baby shampoo using cotton swab
Discuss pityriasis rosea and Tx
Oval, fawn-colored, scaly eruption following cleavage lines of trunk. Herald patch precedes eruption 1-2 wks. Occasional pruritus. common mild, acute inflammatory disease 50% more common in females. Tx: can be none. lesions in darker skin may remain hyperpigmented. aggressive mgt may be indicated-daily UVB or prednisone. Topical corticosteroids if pruritus is bothersome
Discuss herpes simplex and Tx
Recurrent small grouped vesicles on erythematous base, especially in orolabial & genital area. May follow minor infections, trauma, stress, or sun exposure; regional lymph nodes may be swollen & tender. Tx-topical not effective. acyclovir, valacyclovir & famciclovir
Discuss Pityriasis versicolor and Tx
Velvety, tan, or pink macules or white macules that don't tan. Fine scales not visible but seen by scraping lesion. Central upper trunk most frequent site. Yeast observed on microscopic. Tx-sulfide lotion, Ketoconazole shampoo. Ketoconazole 200mg daily orally for 1 wk or 400 single dose, results in short-term cure of 90% cases
Discuss Tinea Pedis
asymptomic scaling. Common cofactor in lower leg cellulitis. Itching, burning, stinging of interdigital web; scaling palms, & soles; vesicles of soles in inflammatory cases.
Discuss Tinea Cruris
Marked itching in intertriginous areas, usually sparing scrotum. Peripherally spreading sharply demarcated, centrally clearing erythematous lesions.
Drying powder should be used on pts with excessive perspiration
Discuss Tinea Corporis (ringworm) and Tx
Ring-shaped lesions with advancing scaly border & central clearing or scaly patches with distinct border Systemic tx-Griseofulvin, Itraconazole or terbinafine can be given orally
What is the Tx for all the "Tineas" except Tinea Capitis?
topically-miconazole 2% cream, clortrimazole 1% solution, cream or lotion, econazole 1% cream, solution or lotion
Discuss Tinea Capitis and Tx
dermatophytic tricomycosis of the scalp predominant in preadolescent & children. mild scaling, broken-off hairs, px, boggy nodules that drain pus and result in scarring alopecia
Discuss Tx for Tinea Capitis
Topical agents are ineffective. Griseofulvin is considered drug of choice. Short-term terbinafine, itraconazole, and fluconazole have comparable efficacy and safety
Discuss Onychomycosis
trichophyton infection of 1+ nail. Most commonly caused by dermatophytes. PE: lusterless, brittle, hypertrophic, and friable
Discuss Tx for Onychomycosis (Tinea Unguium)
In general, systemic therapy required. difficult to tx because long duration needed. fingernails, ultramicronized griseofulvin, terbinafine, or itraconazole all given orally. toenails, don't respond to griseofulvin therapy or topical ts, best tx is oral terbinafine
Describe seborrheic keratosis
Benign plaques, beige-brown or black 3-20mm diameter, with velvety or warty surface. appear stuck or pasted on skin. common, especially in elderly & mistaken for melanomas or other neoplasms
Discuss Tx for seborrheic heratosis
They may be frozen with liquid nitrogen or curetted if they itch or are inflamed, no treatment is needed
Discuss Folliculitis
Itching, burning in hairy areas. Pustules in hair follicles. multiple causes, but frequently caused by staphylococcal & may be more common in diabetic pt
Discuss Tx for folliculitis
Anhydrous ethyl alcohol containing 6.25% aluminum chloride applied to the lesions may be helpful. Systemic abx may be tried if skin infection is resistant to local tx
Discuss "Hot tub folliculitis"
caused by pseudomonas aeruginosa. pruritic or tender follicle, pustular lesions occurring 1-4d after bathing in hot tub, or swimming pool.
Discuss Lipoma and Tx
Single or multiple, benign subq tumors: soft, rounded, or lobulated & movable against overlying skin. Many small but may enlarge to >6cm. Commonly neck, trunk, & extremities but can be anywhere. Tx-excised usually when disfiguring
Discuss Cellulitis
Edematous, expanding, erythematous, warm plaque with/without vesicles or bullae. Lower leg frequently involved. Px, chills, fever commonly present. Septicemia may develop. Most commonly gram+ cocci, especially group a beta-hemolytic strep & S. aureus
Discuss Tx for cellulitis
IV or parenteral antibiotics may be required for first 24-72 hours. Dicloxacillin or cephalexin
Discuss alopecia in regards to scarring
may occur following chemical or physical trauma, lichen planapilaris, bacterial or fungal infections, severe herpes zoster, chronic DLE, scleroderma, & excessive ionizing radiation. Irreversible, important to find cause & tx scarring process early as possible
Discuss alopecia in regards to not scarring
may occur with various systemic diseases like SLE, 2nd syphilis, hyper/hypo-thyroidism, iron deficiency anemia, & pituitary insufficiency. Tx of prompt & adequate control of the underlying disorder
Discuss androgenetic (pattern) alopecia
most common form is genetic predetermination. Rogaine Extra Strength is available OTC and is best used for recent onset
Discuss telogen effluvium
transitory increase in # of hairs in telogen (resting) phase of hair growth cycle. May occur spontaneously, may appear at termination of pregnancy, may be precipitated by “crash dieting,” high fever, stress from surgery or shock, or malnutrition, or may be provoked by hormonal contraceptives
Discuss alopecia areata and Tx
idiopathic: believed immunologic process. patches with smooth & without scarring. Tiny hairs 2-3 mm called “exclamation hairs” may be seen. beard, brows, & lashes may be involved. Hashimoto’s thyroiditis, pernicious anemia, Addison’s disease, & vitiligo. Intralesional corticosteroids are frequently effective
Discuss necrotizing faciitis
rapidly spreading infection involving fascia of deep muscle. PE: severe cellulitis, systemic toxicity, severe px, which followed by anesthesia of involved area due to destruction of nerves as advances thru fascial planes. Surgical exploration mandatory. Early, extensive debridement essential for survival
What are the 3 main types of skin cancers
1. basal cell 2. squamous cell 3. malignant melanoma
Describe presentation of basal cell cancer
Pearly papule, erythematous patch >6 mm, or non-healing ulcer, in sun exposed areas (face, trunk, lower legs), with hx of bleeding. Fair-skinned persons with hx of sun exposure (often intense, intermittent)
Describe Tx for basal cell cnacer
Therapy is aimed at eradication with minimal cosmetic deformity
What is the most common form of cancer
Basal cell
Describe presentation of squamous cell cancer
Non-healing ulcer or warty nodule, sun damage due to long-term sun exposure. Common in fair-skinned organ transplant pts. may arise from actinic keratosis. small red, conical, hard nodules that occasionally ulcerate.
What areas of the body with squamous cell cancer are more prone to metaastasis
lip, oral cavity, tongue, and genitalia have much higher rates of metastasis.
How do you Tx squamous cell cancer
excision. Electrodesiccation and curettage and x-ray radiation may be used for some lesions
What is the leading cause of skin cancer death
malignant melanoma
Describe presentation of malignant melanoma
flat or raised. suspect any pigmented skin lesion with recent change in appearance. Exam with good light may show varying colors, red, white, black, & bluish. Borders irregular. Tumor thickness most single important prognostic factor
Describe Tx for malignant melanoma
excision. After histologic dx, area is reexcised with margins dictated by thickness of tumor
Name 4 precursor lesions
1. Actinic keratoses 2. leukoplakia 3. nevi 4. Kaposi's sarcoma
Discuss actinic keratosis
Small patches-flesh-colored, pink, or slightly hyperpigmented-that feel like sandpaper & tender when finger drawn over them. occur on sun-exposed body parts. considered premalignant, but 1:100 anually progress to squamous cell carcinoma
Discuss leukoplakia
white lesion unlike oral candidiasis can't be removed by rubbing mucosal surface. areas usually small but may be several cm's in diameter. often hyperkeratosis occurring in response to chronic irritation; 2-6% represent dysplasia or early squamous cell carcinoma
Define benign mole nevi
small (<6mm) well-circumscribed lesion with a well defined border and a single shade of pigment
Define junctional nevi
In pts 1st decade of life moles often appear flat, small, brown lesions, because the nevus cells are at the junction of the epidermis and dermis
Define compound nevi
2 decades past junctional nevi, moles grow in size often become raised, reflecting appearance of a dermal component
Define atypical nevi
dx made clinically not histology. moles should be removed only if suspected to be melanomas. these moles are large (>5mm in diameter) with ill-defined, irregular border & irregularly distributed pigment
Define congenital nevi
less than a few centimeters in diameter. majority will never become malignant but some experts believe risk of melanoma in these lesions may be somewhat increased
Define blue nevi
small slightly elevated, blue-black lesions. If present without change for many years, may be considered benign, since malignant blue nevi are rare
Discuss Hx of Kaposi's sarcoma
occurs largely in homosexual men with HIV. May complicate immunosuppressive therapy and stopping immunosupression may result in improvement
Discuss PE for Kaposi's sarcoma
red purple plaques or nodules on cutaneous or mucosal surfaces. Commonly involves GI tract, by in asymptomatic pt's lesions are not sought or treated. Pulmonary kaposi life-threatening.
Discuss Tx for Kaposi's sarcoma
Elderly: palliative local intralesional chemo/radiation. Immuno: reduction of doses of immunosuppressive meds. Other txs: cryotherapy, laser surgery
What am I? Hives, wheels, itching, allergy caused, dermagraphism
Urticaria
What am I? Honey crusted small fluid filled vescicles
Impetigo
What am I? itching especially at night, small pruritic vesicles, pustules nad runs or burrowns in web spaces, heels, palms, wrists, elbows, etc.
Scabies
What am I? dry scaly, red, yellow scurf, on scalp, central face, body folds,
seborrheic dermatitis
What am I? silver scale, red base well demarcated plaques in extensor areas
Psoriasis
What am I? fluid filled vescicle on erythematous base, follow dermatone
Herpes Zoster
What am I? I have a prodromal stage, caused by HPV, verrucous papules
Wart
What am I? deep seated, red, hot tender nodule or abscess evolving from staphylococcal folliculitis
Furuncle - AKA Boil
What am I? present at different ages, comodomes both closed and open,
Acne vulgaris
What am I? I come from direct skin contact with chemicals or allergens, erythema, edema, puritus, vesicles and bullae in area of contact, pattern
Allergic contact dermatitis
What am I? Pruritic, exudative or lichenified eruptions, hx allergic manifestations (asthma, allergic rhinitis, atopic dermatitis)
eczema
What other name does atopic dermatitis have?
Eczema
What am I? common, mild itch, oval, fawn color, christmas tree pattern, harold patch, occuring mostly in spring or fall
Pityriasis rosea
What am I? burning, itching, small grouped vesicles occuring anywhere but especially vermilion border of lips, penile shaft, labia, perianal skin
Herpes simplex
What am I? superficial fungal infection, can be asymptomatic or itching, sharply marginated, velvety, tan, pink, or white macules 4-5mm, fine scales seen only by scraping lesion
Pityriasis versicolor AKA Tinea versicolor
What am I? pruritus, deep excoriations, nits on hair shafts, occasionally sky-blue macules on inner thighs or lower abd
Pediculosis: Lice
What is layman term for Pediculosis Pubis
crabs
What is layman term for Pediculosis corporis
body lice
What is layman term for Pediculosis capitis
head lice
What am I? common, acute or chronic, asymptomatic or itching, burning, stinging, scaling, fissuring, grouped vesicles, maceration in toe web spaces,
Tinea Pedis AKA athletes foot: If you get this that doesn't mean your feet perform as well as an athlete...
What am I? ring-shaped lesions with advancing scaly border and central clearing or scaly patches with distinct border
Tinea corporis AKA ringworm - gives a new meaning to "ring around the colar"
What am I? itching in intertriginous areas, sharly demarcated, centrally clearing erythematous lesions
Tinea Cruris AKA Jock itch: No comment
What am I? thichened broken-off hairs with erythema and scaling, px, boggy nodules that drain pus, results scarring alopecia
Tinea Capitis
Name the 3 variants of Tinea Capitis:
1. Black dot: resembles seborrheic dermatitis
2. Kerion: boggy inflammatory plaques
3. Favus: arthroconidia (?) and airspaces in hair shaft
What am I? lusterless, brittle, hypertrophic friable nails
Onychomycosis AKA Tinea Unguium
What am I? common, benign plaques, beige, brown, black, 3-10mm, velvety or warty surface, appear stuck or pasted on skin, may be mistaken for melanomas or neoplasms
Seborrheic keratosis
What am I? itching, burning in hairy areas, pustules in hair follicle
Folliculitis
What am I? single or multiple benign subq tumor, soft, round or lobulated and movable against overlaying skin.
Lipoma
What am I? diffuse and spreads quickly, edematous, erythematous, warm plaque w/without vesicles or bullae, septicemia may develop
Cellulitis
What am I? hair loss or baldness
Alopecia
What Alopecia am I? most common form, genetic predetermination
androgenetic (pattern) baldness
What alopecia am I? transitory (thining) increase in # of hairs in telogen (resting) phase, pregnancy, crash dieting, etc. may cause it
Telogen effluvium
What alopecia am I? patches smooth, tiny hairs called exclamation hairs
Alopecia areata
What am I? rapidly spreading infection involving fascia of deep muscle, severe cellulitis, pain
necrotizing faciitis
What am I? pearly, waxy, translucent papule, maybe ulcerated center, always raised, erythematous patch >6mm or non-healing ulcer, hx sun,
Basal cell cancer
What am I? non-healing ulcer or warty nodule, hx sun, flat
squamous cell carcinoma
What am I? flat or raised, pigmented, varying colors or dark or black, irregular borders, thick tumor
Malignant melanoma
What am I? small flesh colored, pink, or hyperpigmented, feels like sandpaper, tender
Actinic keratosis
What am I? white lesion, which doesn't rub off mucosal surface
Leukoplakia
What am I? small well-circumscribed lesion with well defined border and single shade of pigment
Nevi: Benign mole
What kind of nevi am I? 1st decade of life, flat, small, brown lesions
junctional nevi
What kind of nevi am I? 2nd 2 decades of life, raised growing moles reflecting appearance of dermal component
Compound nevi
What kind of nevi am I? large with an ill-defined irregular border and irregularly distribued pigment
Atypical nevi
What kind of nevi am I? small, slightly elevated and blue-black lesions
Blue nevi
What am I? Often associated with AIDS, red or purple plaques or nodules on cutaneous or mucosal surfaces
Kaposi's sarcoma
What am I? tired, fatigued, cranky, unable to concentrate
MEDEX student Spring quarter and very glad we are almost done! :)