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109 Cards in this Set
- Front
- Back
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DERMATOLOGY: AM
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DERMATOLOGY: AM
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Discuss Hx, PE, and Tx for urticaria
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Hx: most common cause-foods PE: itchy red swellng few ml's to cm's Tx: remove cause, antihistamines H1, H2, prednisone
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Discuss Hx, PE and Tx for Warts
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Hx: HPV PE: verrucous papules anywhere <1cm Tx: Liquid nitrogen, keratolytic/occlusion salicylic acid, operative, laser, etc.
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Discuss Hx, PE and Tx for Furuncle
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Hx: predisposing condition, DM, HIV,etc. PE: px, tender, red, Tx: I&D maybe ABX
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Define Furuncle
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Boil, deep-seated infection (abscess) red, hot, tender nodule evolving from staph folliculitits, involving the entire hair follicle and adjacent subq tissue
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Discuss Hx, PE and Tx for herpes zoster
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Hx: Px along dermatone, trunk and face PE: grouped vesicular lesions, unilateral Tx: antivirals, px mgt, NO oral steroids!
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Discuss Hx, PE and Tx for Acne Vulgaris
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Hx: puberty-comodones, adult-papulare sesion on chin around mouth PE: Open/closed hallmark Tx: Benzoyl peroxide, retinoids, abx
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What is the most common of all skin conditions
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acne vulgaris
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Discuss Hx, PE and Tx for Impetigo
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Hx: Contagious caused by staph/strep PE: vesiculopustular: gold honey crusted, itchy Tx: systemic abx more effective than topical abx
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Discuss Hx, PE and Tx for eczema
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Hx: allergies PE: pruritic, exudative or lichenified eruptions Tx: corticosteroids sparingly, anything drying or irritating skin makes worse
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Discuss Hx, PE and Tx for allergic contact dermatitis
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Hx: skin contact with chemicals or allergens PE: erythema, edema, puritus, vesicles and bullae Tx: systemic corticosteroids
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Discuss Hx, PE and Tx for scabies
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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
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Discuss Pediculosis and Tx
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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
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Discuss Psoriasis and Tx
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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.
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What drugs may worsen psoriasis
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b-blockers, antimalarials, statins, lithium
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Discuss seborrheic dermatits and Tx
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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
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Discuss pityriasis rosea and Tx
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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
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Discuss herpes simplex and Tx
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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
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Discuss Pityriasis versicolor and Tx
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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
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Discuss Tinea Pedis
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asymptomic scaling. Common cofactor in lower leg cellulitis. Itching, burning, stinging of interdigital web; scaling palms, & soles; vesicles of soles in inflammatory cases.
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Discuss Tinea Cruris
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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 |
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Discuss Tinea Corporis (ringworm) and Tx
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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
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What is the Tx for all the "Tineas" except Tinea Capitis?
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topically-miconazole 2% cream, clortrimazole 1% solution, cream or lotion, econazole 1% cream, solution or lotion
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Discuss Tinea Capitis and Tx
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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
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Discuss Tx for Tinea Capitis
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Topical agents are ineffective. Griseofulvin is considered drug of choice. Short-term terbinafine, itraconazole, and fluconazole have comparable efficacy and safety
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Discuss Onychomycosis
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trichophyton infection of 1+ nail. Most commonly caused by dermatophytes. PE: lusterless, brittle, hypertrophic, and friable
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Discuss Tx for Onychomycosis (Tinea Unguium)
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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
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Describe seborrheic keratosis
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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
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Discuss Tx for seborrheic heratosis
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They may be frozen with liquid nitrogen or curetted if they itch or are inflamed, no treatment is needed
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Discuss Folliculitis
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Itching, burning in hairy areas. Pustules in hair follicles. multiple causes, but frequently caused by staphylococcal & may be more common in diabetic pt
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Discuss Tx for folliculitis
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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
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Discuss "Hot tub folliculitis"
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caused by pseudomonas aeruginosa. pruritic or tender follicle, pustular lesions occurring 1-4d after bathing in hot tub, or swimming pool.
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Discuss Lipoma and Tx
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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
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Discuss Cellulitis
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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
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Discuss Tx for cellulitis
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IV or parenteral antibiotics may be required for first 24-72 hours. Dicloxacillin or cephalexin
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Discuss alopecia in regards to scarring
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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
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Discuss alopecia in regards to not scarring
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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
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Discuss androgenetic (pattern) alopecia
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most common form is genetic predetermination. Rogaine Extra Strength is available OTC and is best used for recent onset
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Discuss telogen effluvium
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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
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Discuss alopecia areata and Tx
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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
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Discuss necrotizing faciitis
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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
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What are the 3 main types of skin cancers
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1. basal cell 2. squamous cell 3. malignant melanoma
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Describe presentation of basal cell cancer
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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)
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Describe Tx for basal cell cnacer
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Therapy is aimed at eradication with minimal cosmetic deformity
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What is the most common form of cancer
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Basal cell
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Describe presentation of squamous cell cancer
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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.
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What areas of the body with squamous cell cancer are more prone to metaastasis
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lip, oral cavity, tongue, and genitalia have much higher rates of metastasis.
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How do you Tx squamous cell cancer
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excision. Electrodesiccation and curettage and x-ray radiation may be used for some lesions
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What is the leading cause of skin cancer death
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malignant melanoma
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Describe presentation of malignant melanoma
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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
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Describe Tx for malignant melanoma
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excision. After histologic dx, area is reexcised with margins dictated by thickness of tumor
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Name 4 precursor lesions
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1. Actinic keratoses 2. leukoplakia 3. nevi 4. Kaposi's sarcoma
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Discuss actinic keratosis
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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
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Discuss leukoplakia
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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
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Define benign mole nevi
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small (<6mm) well-circumscribed lesion with a well defined border and a single shade of pigment
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Define junctional nevi
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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
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Define compound nevi
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2 decades past junctional nevi, moles grow in size often become raised, reflecting appearance of a dermal component
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Define atypical nevi
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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
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Define congenital nevi
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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
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Define blue nevi
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small slightly elevated, blue-black lesions. If present without change for many years, may be considered benign, since malignant blue nevi are rare
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Discuss Hx of Kaposi's sarcoma
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occurs largely in homosexual men with HIV. May complicate immunosuppressive therapy and stopping immunosupression may result in improvement
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Discuss PE for Kaposi's sarcoma
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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.
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Discuss Tx for Kaposi's sarcoma
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Elderly: palliative local intralesional chemo/radiation. Immuno: reduction of doses of immunosuppressive meds. Other txs: cryotherapy, laser surgery
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What am I? Hives, wheels, itching, allergy caused, dermagraphism
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Urticaria
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What am I? Honey crusted small fluid filled vescicles
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Impetigo
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What am I? itching especially at night, small pruritic vesicles, pustules nad runs or burrowns in web spaces, heels, palms, wrists, elbows, etc.
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Scabies
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What am I? dry scaly, red, yellow scurf, on scalp, central face, body folds,
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seborrheic dermatitis
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What am I? silver scale, red base well demarcated plaques in extensor areas
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Psoriasis
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What am I? fluid filled vescicle on erythematous base, follow dermatone
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Herpes Zoster
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What am I? I have a prodromal stage, caused by HPV, verrucous papules
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Wart
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What am I? deep seated, red, hot tender nodule or abscess evolving from staphylococcal folliculitis
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Furuncle - AKA Boil
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What am I? present at different ages, comodomes both closed and open,
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Acne vulgaris
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What am I? I come from direct skin contact with chemicals or allergens, erythema, edema, puritus, vesicles and bullae in area of contact, pattern
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Allergic contact dermatitis
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What am I? Pruritic, exudative or lichenified eruptions, hx allergic manifestations (asthma, allergic rhinitis, atopic dermatitis)
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eczema
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What other name does atopic dermatitis have?
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Eczema
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What am I? common, mild itch, oval, fawn color, christmas tree pattern, harold patch, occuring mostly in spring or fall
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Pityriasis rosea
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What am I? burning, itching, small grouped vesicles occuring anywhere but especially vermilion border of lips, penile shaft, labia, perianal skin
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Herpes simplex
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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
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Pityriasis versicolor AKA Tinea versicolor
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What am I? pruritus, deep excoriations, nits on hair shafts, occasionally sky-blue macules on inner thighs or lower abd
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Pediculosis: Lice
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What is layman term for Pediculosis Pubis
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crabs
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What is layman term for Pediculosis corporis
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body lice
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What is layman term for Pediculosis capitis
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head lice
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What am I? common, acute or chronic, asymptomatic or itching, burning, stinging, scaling, fissuring, grouped vesicles, maceration in toe web spaces,
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Tinea Pedis AKA athletes foot: If you get this that doesn't mean your feet perform as well as an athlete...
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What am I? ring-shaped lesions with advancing scaly border and central clearing or scaly patches with distinct border
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Tinea corporis AKA ringworm - gives a new meaning to "ring around the colar"
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What am I? itching in intertriginous areas, sharly demarcated, centrally clearing erythematous lesions
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Tinea Cruris AKA Jock itch: No comment
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What am I? thichened broken-off hairs with erythema and scaling, px, boggy nodules that drain pus, results scarring alopecia
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Tinea Capitis
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Name the 3 variants of Tinea Capitis:
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1. Black dot: resembles seborrheic dermatitis
2. Kerion: boggy inflammatory plaques 3. Favus: arthroconidia (?) and airspaces in hair shaft |
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What am I? lusterless, brittle, hypertrophic friable nails
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Onychomycosis AKA Tinea Unguium
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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
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Seborrheic keratosis
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What am I? itching, burning in hairy areas, pustules in hair follicle
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Folliculitis
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What am I? single or multiple benign subq tumor, soft, round or lobulated and movable against overlaying skin.
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Lipoma
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What am I? diffuse and spreads quickly, edematous, erythematous, warm plaque w/without vesicles or bullae, septicemia may develop
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Cellulitis
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What am I? hair loss or baldness
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Alopecia
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What Alopecia am I? most common form, genetic predetermination
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androgenetic (pattern) baldness
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What alopecia am I? transitory (thining) increase in # of hairs in telogen (resting) phase, pregnancy, crash dieting, etc. may cause it
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Telogen effluvium
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What alopecia am I? patches smooth, tiny hairs called exclamation hairs
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Alopecia areata
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What am I? rapidly spreading infection involving fascia of deep muscle, severe cellulitis, pain
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necrotizing faciitis
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What am I? pearly, waxy, translucent papule, maybe ulcerated center, always raised, erythematous patch >6mm or non-healing ulcer, hx sun,
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Basal cell cancer
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What am I? non-healing ulcer or warty nodule, hx sun, flat
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squamous cell carcinoma
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What am I? flat or raised, pigmented, varying colors or dark or black, irregular borders, thick tumor
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Malignant melanoma
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What am I? small flesh colored, pink, or hyperpigmented, feels like sandpaper, tender
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Actinic keratosis
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What am I? white lesion, which doesn't rub off mucosal surface
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Leukoplakia
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What am I? small well-circumscribed lesion with well defined border and single shade of pigment
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Nevi: Benign mole
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What kind of nevi am I? 1st decade of life, flat, small, brown lesions
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junctional nevi
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What kind of nevi am I? 2nd 2 decades of life, raised growing moles reflecting appearance of dermal component
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Compound nevi
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What kind of nevi am I? large with an ill-defined irregular border and irregularly distribued pigment
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Atypical nevi
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What kind of nevi am I? small, slightly elevated and blue-black lesions
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Blue nevi
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What am I? Often associated with AIDS, red or purple plaques or nodules on cutaneous or mucosal surfaces
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Kaposi's sarcoma
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What am I? tired, fatigued, cranky, unable to concentrate
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MEDEX student Spring quarter and very glad we are almost done! :)
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