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160 Cards in this Set
- Front
- Back
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locations of impetigo
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face, hands, genitalia, scalp
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superficial bullae, vesicles w/ turbid fluid, golden-crusted erosions
possible pruritus |
impetigo
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ecthyma, location and healing process
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deep impetigo
legs heals with scars |
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complications of impetigo
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post-streptococcal glomerulonephritis
- RARE not caused by staphylococcus impetigo |
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RX for impetigo
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remove crusts
wash lesions topical antibiotics (mupirocin) systemic antibiotics |
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small, dome-shaped, yellow pustules on a red base, hair shaft in center lesion
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Bockhart's impetigo
-aka superficial folliculitis |
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Bockhart's impetigo location, etiology, treatment
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children- scalp, face, buttocks, extremities
S. aureus RX: gentle cleansing, topical antibiotics, occasionally systemic antibiotics |
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florid appearance
superinfection in acne patients on long term systemic antibiotics |
Gram-negative folliculitis
-Klebsiella, Enterobacter, Proteus Rx: oral antibiotics, Retinoids |
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Folliculitis barbae (sycosis barbae)
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deep-seated folliculitis of bearded area
Staph origin Rx: topical or oral antibiotics |
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central necrosis and suppuration- deep, red, tender nodules
Painful, circumscribed, perifollicular |
Staph abscess --> Furuncles
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extreme pain, constitutional symptoms
deep-seated staph abscesses |
interconnected furuncles = carbuncle
men back of neck, shoulders, buttocks, hip joint and thighs |
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deeper subcutaneous tissue, acute suppurative inflamation
diffuse redness, swelling, tenderness |
Cellulitis
- complication of wound or trauma - Staph aureus> Group A strep |
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non-sharply defined/elevated borders
VS well demarcated border |
Cellulitis
VS Erysipelas (more superficial) - Group A strep, face |
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Corynebacterium minitussimum
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Erythrasma
superficial bacterial infection |
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reddish brown, slightly scaly to smooth, shiny patches
groin and axillae toe webs- maceration and scaling |
Erythrasma
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obese, diabetic, debilitated pt
Wood's lamp exam: coral red fluorescence |
Erythrasma
rx: topical or oral antibiotics (erythromycin) |
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papillomavirus causing intraepidermal tumor
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warts
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sessile lesions, on fingers
raised, rough gray surface |
verruca vulgaris
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face and neck
looks like a skin tag |
filiform, digitate warts
fingerlike projections |
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slightly elevated papules
may have just a few, or several hundred smooth, flesh-colored to tan/brown |
flat warts
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fleshy warts, around mucocutaneous junctions and intertriginous areas
pedunculated or polypoid nodules |
condylomata acuminata aka genital warts
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associated with cervical or penile carcinomas
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condylomata acuminata
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grouped vesicles on erythematous base
primary and recurrent infection (pain and burning- triggers: fv, trauma, sunlight, stress) |
HSV
Dx: Tzanck smear- multi-nucleated giant cells, viral culture! |
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erythematous macules, clear vesicles, then pustules and rupturing with crust formation
mutliple lesions stages present at one time |
Varicella-Zoster virus
- spread: respiratory route |
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mostly epidermal changes
may be: macules, patches, papules, plaques scales are present sharp marginatinos |
papulosquamos disorders
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large oval patch, then multiple lesions in symmetrica long asix distribution along lines of cleavage on trunk and proximal extremities
(pruritis w/ onset) |
pityriasis rosea
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possible pregnancy complications
especially first trimester infection |
pityriasis rosea
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important to exclude syphilis
(see rash on palms, soles, mucous membranes and shotty adenopathy) |
pityriasis rosea
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treatment for pityriasis rosea
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none necessary
- topical creams, steroids, anti-itch, immunomodulators PO erythromycin 2-3 weeks UVB/sunshine |
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post streptococcal upper respiratory infection, kids/adolescents
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guttate psoriasis
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post steroid withdrawal + fever + arthalgias
mucous membrane involvement- erythema with sheets of small pustules |
generalized pustular psoriasis
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Psoriasis:
genetic aspect? T cell driven? related cytokine and chemokine pathways? ICAM-1 and E-selectin on vascular endothelial cells? |
YES
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relation to crohn's, ulcerative colitis, sacroiliitis, forms of arthritis (variety of manifestations), cardiovascular diseases, HLA-B27
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Psoriasis
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Bowen's disease
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squamos cell carcinoma in situ
-ulcerated surface |
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localized chronic eczema
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lichenified, excoriated skin
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urethritis, arthritis, conjunctivitis (mucocutaneous lesions)
psoriasiform skin lesions |
Reiter's disease
most often seen in men |
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rx for cutaneous lesions of psoriasis
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emolliation
topical steroids (strength variation depending on skin area and plaque resistances) sunlight, UVB NEVER use systemic steroids (disease may worsen when dose lowered, may precipitate pustular psoriasis) |
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possible development of squamos cell carcinoma
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oral ulcerated lichen planus
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lichenified skin, excoriations
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localized neurodermatitis
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uniform, pinhead-sized flesh colored papules
asymptomatic or mildly prurits |
lichen nitidus
upper extremities, chest/abdomen, glans penis self limited |
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linear eruptions of scaly patches
arms and upper trunk appear 2-3 weeks |
lichen striatus
possible infections trigger self limited |
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fine white lacy lines on papules
papules - flat topped, purple, polygonal lacy reticulated pattern on mucous membranes VERY ITCHY |
whickham's striae
Lichen planus mucous membranes: mouth, penis, vagina |
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thinning, longitudinal ridging of nails, subungal hyperkeratosis - lifting distal nail plate, pterygium formation
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Lichen planus
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Psoriasis, Lichen Planus, Lichen nitidus
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Koebner phenomenon
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30 year old, with + family history
verrucous surface, hyperpigmented |
Seborrheic Keratosis
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Dermatosis Papulosa Nigra
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small seborrheic keratosis
malar area, darker individuals |
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rapid, widespread seborrheic keratosis
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associated internal malignancy
Sign of Lesar-Trelat |
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middle aged person
fleshy, papillomatous skin lesion on areas of skin that rub together |
Acrochordon- Skin tag
(neck, axilla, inguinal folds, under breasts, waist/bra-line) multiple- may have systemic associations possible link to Seborrheic keratosis |
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middle aged woman, with lesion on extremities
possible relation to trauma reddish-brown, firm papule, dimple sign on compression |
dermatofibroma
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if painful or compressing vital organs- require surgery
small, firm, flesh-colored papules |
Neurofibroma
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Von Recklinghausen's disease
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multiple neurofibromas + internal neurofibromas + cafe-au-lait spots
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male with acne history, who picked at his lesions leading to infection/inflammation
develops dermal nodule w/ central puncta, that may express cheesy material |
Epidermal Inclusion Cyst/Sebaceous Cyst
rx: surgical excision, intralesional kenalog |
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Gardner's syndrome
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multiple epidermal inclusion cysts, colon polyps, osteomas, fibromas
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looks just like epidermal cyst but involves a hair follicle, on scalp or face
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pilar cyst
benign, remove everything, all epidermal lining |
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white or yellow, small papule (<3mm), often multiple
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Milium
no required therapy (incise, express) |
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childhood lentigines
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congenital syndromes- multiple organ system defects
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associated with vitiligo and malignant melanoma (especially when present in adults)
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halo nevus
hypopigmented area around junctional nevus requires good skin checks |
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most melanomas arise from melanocytic nevi
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false,
most melanomas arise de novo |
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familial dysplastic nevus syndrome
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multiple unusual looking moles, develops melanoma
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60-70 year old fair skinned lady who use to love to tan
pearly papules/nodules w/ telangiectasias rolled pearly borders |
Basal cell carcinoma
slow growing, locally invasive rx: curettage/electrodesiccation, surgical excision, or Mohs re-check q3-6 months |
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Nodulo-ulcerative basal cell carcinoma
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pearly, telangiectatic papule/nodule
frequently ulcerates |
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superficial basal cell carcinoma
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red, microulcerative macule
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white-yellow, poorly defined skin color
telangiectatic macule/plaque |
morphea/infiltrative basal cell carcinoma
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imiquimod
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topical immune modulator
actinic keratoses superficial basal cell carcinoma |
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pre-cancerous lesion of keratinocytes
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actinic keratosis
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rough, sandpaper feel
on sun-damaged skin |
actinic keratosis
-hyperkeratotic papules on erythematous base |
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potential devo to squamos cell carcinoma if untreated
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actinic keratois
-hyperkeratotic papules on erythematous base |
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in situ SCC
pt exposed to arsenic erythematous, slightly scaly plaque, occasional ulceration |
Bowen's Disease
-possible increased internal malignancy |
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elderly person with previous large amount of sunlight exposure
hyperkeratotic or ulcerative |
Squamous Cell Carcinoma
rx: curettage/electrodesiccation, excision w/ permanent/frozen section control, Mohs surgery, RT |
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spreading of Squamos Cell carcinoma
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local lymph nodes, liver, lung, bone, brain
perineurally |
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Well differentiated SCC, sudden onset/rapid growth
rarely malignant |
Keratoacanthoma
possible spontaneous regression |
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tumor with central crater or keratinous plug
often telagiectasias |
Keratoacanthoma
rx: isotretinoin |
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fibroblast tumor that may accelerate during pregnancy
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red-brown infiltrative nodules
Dermatofibroma Sarcoma Protuberans |
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ABCDE, U
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Melanoma
clinical signs: Asymmetry, Border (irregular/notched), Color, Diameter (>1 cm), Evolution/Change, Ulceration also check for diffusion of pigment in surrounding normal skin |
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65yo+, sun-exposed skin damage
slowing growing melanoma in situ, should be removed |
Lentigo Maligna
- irregular brown macule - Hutchinson's Freckle |
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invasive melanoma component, similar to hutchinson's freckle
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lentigo maligna melanoma
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30-50 yo
male- flat lesion w/ nodules, pigmented on back female- same but on posterior thigh most common clinical variant of melanoma |
Superficial spreading melanoma
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most common melanoma in dark skinned people
found late, poor prognosis |
Acral-lentiginous melanoma
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most important indicator of prognosis for melanoma
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Breslow's thickness
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what to do with a suspicious melanoma lesion
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BIOPSY w/in a week- time is life w/ melanoma
- local- depth, aggressiveness, clear margins - sentinal node biopsy chemo/removal if mets immunotherapy |
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effects of blocking COX-1
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gastric ulcers, perforations, GI bleeds
And anti-thrombolytic effect - impairs platelet function - why aspirin is given to pts at CVD risk |
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effects of blocking COX-2
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COX-2 is inducible and inflammatory (as opposed to COX-1 which is constituitive and protective)
antipyretic, analgesic, anti-inflammatory |
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benefits of NSAIDs when treating Rheumatoid Arthritis
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reduce pain/inflammation, improve motility, slow/arrest tissue damage
possible inhibition of PMN adhesion also use NSAIDs: OA, acute gouty arthritis, SLE, spondyloarthropathies |
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Coxibs
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signs and symptoms of RA and OA
preferential inhibition of COX-2 with newer generations, increasing COX-2 selectivity, but drastic GI (perforation, ulceration, bleeds) and heart (MI, stroke) side effects |
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adverse effects of coxibs
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GI: perforation, bleeding, ulceration
(PUBs) CV: MI, stroke |
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special property of aspirin
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covalently acetylates COX-1,2
- works for the life of the platelet - no functioning enzyme present until the cell makes a new one - COX-1 - stops platelet aggregation--> anti-thrombolytic effect |
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what drug levels are increased by either aspirin or celecoxib
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warfarin!
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Salicylic acid
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NSAID
reversible inhibition of COX |
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peripheral COX inhibition
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acetominophen
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uses of acetominophen
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infection related fever, pain, aches
- analgesic, antipyretic NO anti-inflammatory effects |
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what effect that aspirin has is acetominophen lacking?
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anti-inflammatory
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what's the big concern with tylenol use
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overdose~ at 20X the therapeutic level (lower in alcoholics whose damaged livers can't handle the same load)
- no signs for first 24 hrs - then N/V, anorexia, ab pain, detectable LFTs - 2-5 days- devo jaundice and bleeding - at day 5- either spontaneously heal, or require liver transplant! |
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what's the antidote to tylenol overdose?
and what does it do |
mucomyst
- replaces glutothione given oral or IV |
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what happens if you give aspirin to kids, especially post febrile viral illness
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Reye's syndrome:
brain and liver effected - possibly fatal |
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aspirin overdose
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CNS stimulant and depressant
- increase respiration: respiratory alkalosis - decrease respiration: respiratory acidosis requires cardiovascular and respiratory support, and sodium bicarbonate |
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what can you give when salicylates (ie aspirin) are no longer tolerated/effective?
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indomethacin, ibuprofen (advil)
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indomethacin stronger or weaker than tylenol?
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stronger
but toxicity (GI and CNS) sufficient to NOT use for simple analgesia/antipyretic action- use tylenol instead |
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if pt can't take aspirin, and have an acute attack of gouty arthritis or ankylosing spondylitis, what do you give?
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indomethacin (primarily anti-inflammatory)
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which has worse side effect profile?
- indomethacin - advil/ibuprofen |
indomethacin: GI and CNS
advil: nausea, heartburn, epigastric pain - RA, DJD (has anti-pyretic,analgesic and anti-inflammatory properties) |
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when would you want to use aleve/naproxen
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longer half life than advil and indomethacin
use with PPI |
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name the one drug that can be given parenterally, and is a potent non-narcotic analgesic?
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Ketorolac
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two major NSAID AE that should be watched out for?
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SKIN: Stevens-Johnson
RENAL: AIN, acute papillary necrosis |
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which rheumatic disease due you prescribe an NSAID for?
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Gouty arthritis, RA, OA, SLE, spondyloarthropathies
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what is conservative treatment of rheumatoid arthritis?
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rest, proper diet, physical therapy, NSAIDs
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list the NSAIDS
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Salicylates/Aspirin
Para-Aminophenol: Acetaminophen (tylenol) Indomethacin and Ibuprofen (advil) Ketorolac Coxibs- selective NSAIDs |
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young female
palpable purpuric lesions after taking penicillin biopsy: dermal blood vessel shows PMNs in walls, fibrin in/around the vessel, nuclear fragments from dead PMNs. Extravasated RBCs in dermis and epidermis |
leukocytoclastic vasculitis
- hypersensitivity vasculitis |
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which is the more locally invasive form of basal cell carcinoma?
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sclerosing > multifocal superficial or nodular
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57 yo, male construction worker
mass developed 2 years ago PMHx: roughened scaly lesions on arms/face were frozen off what were the lesions? what does he have now? |
actinic keratosis (parakeratosis, cytologic atypica/dysplasia, basophilic degeneration)
current tumor: Squamous cell carcinoma |
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which has higher metastatic potential:
SCC de novo or one that developed from previous actinic keratosis? |
de novo
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70 year old seaman
head lesion: dark, variable pigmentation and irregular borders what does he have? |
melanoma!!!
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what neoplasm most commonly occurs in sun exposed skin?
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basal cell carcinoma
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clinically, how to id junctional nevi from compound and intradermal
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junctional nevi: macular
compound and intradermal nevi: papular intradermal- flesh colored junctional and compound: pigmented |
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pts with family history of melanoma who have dysplastic nevi have increased risk of developing melanoma even in clinically unaffected skin. T/F
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T
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how do you measure breslow's thickness?
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from granular layer to deepest aspect of melanoma
<.85 mm- low malignant potential > 4 mm |
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in which disease does serum antibody level correlate with disease activity?
- pemphigus vulgaris - bullous pemphigoid |
pemphigus vulgaris
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17 yo male, increasing pain in left knee
- no limitation of movement or soft tissue mass Labs: increased alkaline phosphatase Bone scan: increased uptake in left knee region radiograph: dense lesion in distal femural metaphyseal region, extending into anterior and posterior cortices and epiphysis |
osteosarcoma (mostly present in metaphyse=is)
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what bone lesions can yield increase uptake on a bone scan?
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osteomyelitis (infection)
fracture with callus formatin (possible trauma?) Osteosarcoma |
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most common primary malignant tumor of the bone
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osteosarcoma
- characteristically osteoblastic/osteosclerotic |
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where are ewing's tumors located?
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diaphyseal region of bone
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what is codman's triangle?
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frequently noted in osteosarcomas
triangle center contains reactive bone - borders are: - cortical bone, periosteum, tumor |
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most common soft tissue tumor of adulthood
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lipoma
- round, regular borders, no ulceration of skin, soft, not painful palpatation, freely moveable located in: subcutaneous/adipose tissue |
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68 yo male, increasing mass in right thigh
no pain or limitation of motion resected lesion: large, adipose tissue, myxoid/mucoid appearance, intralesional hemorrhage, invades skeletal muscle micro: lipoblasts near arborizing vascular network |
myxoid liposarcoma
- chicken-wire pattern of vasculature - must be adequately excised to avoid recurrence as cellularity increases, so does level of aggression (mets and recurrence) |
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young pt with nodule on forearm/chest/back
biopsy: myofibroblast like, w/ extracellular mucinous production sharply demarcated, pushing but not invading or destroying surrounding tissue |
nodular fasciitis
- reactive fibroblast tumor |
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fibroblast tumor that can be superficial (palmar, plantar) or deep (abdominal), hard to id margins
no mets, but can be fatal due to invasion and obstruction |
fibromatosis
- fibroblastic proliferation- hypercellular scar like |
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most common soft tissue tumor in adults (40-60 yo)
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malignant fibrous histiocytoma (extremities and retroperitoneum)
liposarcoma (deep tissues of thigh and retroperitoneum) |
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adult female with lots of pain, discomfort in lower abdomen area
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leiomyoma
- smooth muscle tumor or uterine wall very common |
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fibroblasts in storiform pattern: hurricane like, spins out from the center
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benign vs maligant fibrous histiocytoma
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benign vs maligant fibrous histiocytoma
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benign: dermis or subcutaneous, pushing stellate border, excise wide border to avoid recurrence
malignant: cellular pleomorphism, multinucleate cells, atypical mitosis - Mets and local recurrence- very likely! |
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30-60 yo
presents with sudden shoulder pain xray shows: periarticular deposits |
Basic Calcium Phosphate deposits
-hydroxyapatite - NOT birefringent |
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degeneration of joints and tendons
- large joint destruction calcific bursitis and tendonitis = painful! - proliferative synovitis - tendon erosion |
BCP- hydroxyapatite
NSAIDs/corticosteroids- acute surgery- large deposits impinging on joint |
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majority of pts with gout have hyperuricemia b/c?
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decreased urate excretion
decreased renal clearance - thiazides, alcohol intake/lactic acidosis (metabolic acidosis), respiratory acidosis -thyroid disorders |
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excess urate synthesis causes?
how is this identified? |
PRPP synthetase - increases de novo pathway
HGPRT - decreased re-utilization via salvage pathway increased breakdown of nuclei acids (myeloproliferative disorders) excess meat consumption alcohol intake (increases ATP breakdown) Urine urate levels: >800-1000mg/24hrs |
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arthritis incredibly prevalent in individuals above 85 years old
F> M can mimic a variety of other forms of arthritis (gout, RA, OA), or asymptomatic |
Pseudogout (calcium pyrophosphate dihydrate)
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Diagnosis of Pseudogout
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+Birefringent crystals, rhomboid/rectangular
Xray- calcification of cartilage = chondrocalcinosis most prevalent in knee joint |
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Negative birefringent crystals, needle shaped
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Monosodium urate, gout
- monoarticular: first metatarsophalangeal joint tarsus knee, ankle - inflammation develops w/in 24hrs - erythema over joint - Xray- asymmetric swelling of joint, soft tissue swelling |
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Factors associated with hyperuricemia
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HTN, increased body weight, atherosclerosis, DM, hyperlipidemia
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Treatment for chronic tophaceous gout?
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Febuxostate> allopurinol
- handled by liver, not kidney, therefore easier to dose - xanthine oxidase inhibitor NSAIDs, corticosteriods, colchicine |
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X-ray shows rat bite, over-hanging edge
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erosions from tophi- Gout
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ILD, arthritis, Raynauld's
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overlap syndrome of Polyomyositis
auto-antibody: Jo-1 |
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treatment for PM/DM
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corticosteroids- muscle strength recovers in 2-3 months
IVIG- for severe rash severe- chemo drugs or cyclosporin avoid sunlight prevent osteoporosis |
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Lung findings in scleroderma
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ILD
Pulmonary hypertension- extra P2 Fibrosing alveolitis, encases entire lung dx: xray shows bilateral basilar fibrosis rx: early!! w/ steroids/cyclophosphamide |
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CREST syndrome
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limited type of scleroderma
anti-centromere antibody Calcinosis Raynauld's Esophagial dysmotility/dysphagia Sclerodactyly Telangiactasia (face, lips, down GI tract) |
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anti-Scl 70
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antibody against topoisomerase I
diffuse form of scleroderma |
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skin findings of Dermatomyositis
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Periorbital edema
Gottron's papules (reddish-white shiny lesions over joints) telangiectasias of nailbed sunsensitive rash - face, chest, extensors (shawl distribution) |
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EMG findings in PM/DM
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spontaneous, bizarre, polyphasic
fibrillation and sharp positive waves |
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highest contributing factor to mortality in Scleroderma pt
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Renal involvement- intimal fibrosis in small renal arteries --> cortical hemorrhages, malignant HTN
- strokes and renal failure - ACEI- MUST control BP |
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disease with increased osteoblast and osteoclast activity
increased vascularity |
Paget's
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pumice bone- susceptible to fracture
mosaic bone pattern from haphazard osteoclast resorption and then laying down of new bone by osteoblasts |
Paget's
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increased blood supply to affected bone --> leading to high output cardiac failure
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Paget's
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bone disease with increased risk of osteosarcoma development
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Paget's
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diseases with increased osteoclastic activity
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osteoporosis
paget's disease hyperparathyroidism- osteitis fibrosis cystica |
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thin, poorly formed bone
multiple fractures blue sclerae loose jointedness |
osteogenesis imperfecta
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osteoblast failure- inability to make type I collagen --> can't form trabeculae, therefore no woven bone
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osteogenesis imperfecta
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Bone disease where bone marrow transplant is curative
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Osteopetrosis
- defect due to osteoclast failure - sclerosis (thickened cortex) --> marrow cavity filing, visual disturbances, deafness, CN palsy, hydrocephalus - bones brittle and subject to fracture |
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treatment for atopic dermatitis
|
enhance water content of skin and control pruritus
- avoid soaps and water - topical steroids - anti-histamines - Moisturize - UV light |
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uveitis, aortitis (aortic insufficiency), upper lobe fibrosis (and rigidity of chest wall)
|
additional signs of Ankylosing Spondylitis
- sacroiliac joints- narrow/obliterated joint space- fused joints - longitudinal ligaments of spine calcified, fusion of vertebrae |
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urethritis- dysuria
conjunctivitis/mucocutaneous lesions arthritis (periarticular structures)- achille's tendon, heal spur, sacroilitis |
Reiter's
- US: chlamydia - developing countries: diarrhea (C. jejuni) |
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insidious low back/gluteal pain
lasting longer than 3 months |
Ankylosing spondylitis
|
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in which rheum diseases is kidney involvement the major cause of mortality?
|
scleroderma, SLE
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myocardial fibrosis, cardiomyopathy
EKG: RBBB, LAH |
PM/DM
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