Muscle And Integument: Skin Infections

Front 1

Name some gram positive normal skin flora.

Back 1

- staph epidermidis
- propionibacterium
- coreynebacterium
- brevibacterium
- microcci

Front 2

Name a gram negative normal skin flora.

Back 2

- acinetobacter

Front 3

Name a normal yeast flora of skin.

Back 3

pityrosporum

Front 4

Staph aureus can be found in ___.

Back 4

nose, umbilicus

Front 5

Strep pyogenes can be found in ___.

Back 5

nose, umbilicus

Front 6

Group B strep can be found in ___.

Back 6

vulva

Front 7

E. coli can be found in ___.

Back 7

external auditory meatus
perineum

Front 8

Protus species can be found in ___.

Back 8

external auditory meatus

Front 9

What are the skin's defense mechanism aginst bacteria?

Back 9

- stratum corneum
- low moisture content
- acid pH
- inorganic salts -> hypertonic -> inhibit bacterial growth
- normal flora
- suboptimal surface temperature and rich oxygen
- humoral and cellular immunity

Front 10

Etiology of impertigo contagiosa.

Back 10

- staph aureus
- group A strep (strep pyogenes) less common

Front 11

What is this?

- honey colored crusts

Back 11

impertigo

Front 12

What is this?

- begins with vesicles and bulla
- results in shallow erosions

Back 12

bullous impertigo caused by S. aureus phage II

Front 13

What skin lesions does staph aureus phage II caues?

Back 13

- bollous impertigo
- staph scalded skin syndrome

Front 14

What is the cause?

- impertigo
- glomerulonephritis

Back 14

strep pyogenes

Front 15

Treatment for impertigo contagiosa.

Back 15

- oral antibiotics which cover penicillinase prooducing staph:
erythromycin
dicloxacillin
cefalexin

Front 16

How to treat MRSA?

Back 16

- trimethoprim-sulfamethoxazole
- clindamycin
- doxycyclin

Front 17

What is the etiology of ulcerative impertigo (ecthyma)?

Back 17

- group A strep
- staph aureus

Front 18

What is an ecthyma?

Back 18

- ulcerative impertigo: edematous, erythematous plaque forms a bulla containing blood which collapses, center becomes necrotic and ulcerative

Front 19

How to treat ecthyma?

Back 19

- dicloxacillin
- cefalexin
- erythromycin

debridement

Front 20

Which organism cause scalded syndrome?

Back 20

staph aureus phage II:
- exfoliative toxin acting on fesmoglen in granular layer of epidermis.
- toxin is renally excreted

Front 21

Why do people with chronic renal disease more likely to get scalded syndrome?

Back 21

Exfoliative toxin from staph aureus phage II is excreted through kidney. When kindey fails, toxins stays in the system destroying the desmosones in granular layer of skin causing scalded syndrome.

Front 22

How to treat staph scalded skin syndrome?

Back 22

beta-lactamase resistance antibiotics:
- dicloxacillin
- cefalexin

Front 23

What is this skin lesion?

- prodrome: painful skin, redness
- then: falccid bulla and suferficial exfoliation

Back 23

scalded skin syndrome

Front 24

Etiology of scarlet fever.

Back 24

Group A strep: erythrogenic toxins A,B,C

Front 25

Wich toxins from group A strep cause scarlet fever?

Back 25

erythrogenic toxins A,B,C

Front 26

What is this?

- abrupt history of fever,pharyngitis, headache, nausea, vomiting, malaise, abdominal pain, chills.
- white strawberry tongue followed by red srawberry tongue
- punctate papular elevations (skinpaper quality)
- Pastia's lines
- desquamation as rash fades

Back 26

scarlet fever

Front 27

Enanthem or exanthem?

- strawberry tongue

Back 27

enanthem

Front 28

Enanthem or exanthem?

- petechiae on soft palate

Back 28

enathem

Front 29

Enanthem or exanthem?

- sandpaper skin (punctate papular elevations)
- Pastia lines: linear petechiae in skin folds

Back 29

exanthem

Front 30

What is this called? in what condition do you see this?

- linear petechiae in skin folds

Back 30

pastia's lines (scarlet fever)

Front 31

What are some complications of scarlet fever?

Back 31

- otitis
- mastoiditis
- sinusitis
- pneumonia
- myocarditis
- acute glomerulonephritis
- rheumatic fever

Front 32

How to treat scarlet fever?

Back 32

penicillin for 10-14 days.

Front 33

Etiology of folliculitis.

Back 33

s. aureus
gram - bacilli: psudomonas

Front 34

predisposing factors of folliculitis.

Back 34

- occlusion, maceration, hyperhydration of skin
- shaving/waxing/plucking of hair
- use of topical steroids
- hot/humid weather
- diabetes mellitus

Front 35

How to treat folliculitis?

Back 35

- antibacterial soap
- topical antiobiotic mupirocin
- dicloxacillin, erythromycin, cefalexin for severe systemic antibiotics

Front 36

What kind of people are more likely to get recurrent furuncles?

Back 36

- S. aureus carriers
- diabetes mellitus
- immune deficiency

Front 37

What is this called?

- one firm, tender nodule around one hair follicle that becomes fluctant and ruptures discharging a necrotic plug.

Back 37

furuncle

Front 38

What is this called?

- multiple superficial pustules around hair follicles, draining pus.

Back 38

carbuncles

Front 39

Treatment for furuncle and carbuncle.

Back 39

- dicloxacillin
- erythromycin
- cefalexin

warm compress
drainage

Front 40

Which drug can be used to eliminate S. aureus carriage in the nose?

Back 40

Rifampin

Front 41

Etiology of erysipilas and cellutitis.

Back 41

group A strep
S. aureus
Hemophilus

Front 42

How do bacterias like GAS, S.aureus,hemophilus cause erysipelas/cellulitis?

Back 42

they can access to dermis via external or hematogenous route.

Front 43

Who are more likely to get erysipelas?

Back 43

- young age
- debilitated
- those with lymphedema(eg swollen legs) or chronic cutaneous ulcers.

Front 44

Complication of erysipelas/cellulitis.

Back 44

- releated infection: local edema amd lymphatic obstruction

Front 45

Treatment for erysipelas/cellulitis.

Back 45

- penicillin for strep
- cephalosporin for Haemophilus

Front 46

Etiology of erythrasma.

Back 46

corynebacterium minitissimum

Front 47

Pathogenesis of erythrasma.

Back 47

organisms grow in moist, intertriginous areas (between toes, groin, axilla)

Front 48

What is hyperhidrosis?

Back 48

excess sweating

Front 49

Where do you usually see erythrasma?

Back 49

intertriginous areas (between toes, groin, axilla)

Front 50

What is this?

- pruritic
- reddish brown patches with sharp border
- intertriginous areas
- fluoresces bright red under wood's light

Back 50

erythrasma

Front 51

Treatment for erythrasma.

Back 51

- antibacterial soaps
- topical or oral erythromycin
- topical clindamycin

Front 52

What genetic material is in HPV?

Back 52

DNA

Front 53

Where do HPV live on a host?

Back 53

only in differentiated squamous epithelium

Front 54

Pathogenesis of HPV.

Back 54

- abrasion or trauma to epithelium
- cycle only in differentiated sqamous wpithelium

Front 55

What is verruca vulgaris? what is the etiology?

Back 55

common wart
etiology: HPV

Front 56

What is this?

- firm hyperkeratogenic papules with vegetations
- often reddish brown dots visible

Back 56

verruca vulgaris (common wart)
- redish brown dots are thrombose capillaries.

Front 57

How to treat veruca vulgaris (common wart)?

Back 57

- salicylic acid
- imiquimod (interferon)
- liquid nitrogen
- cantharidin

Front 58

What is this and what is the etiology?

- wart on sole of the foot

Back 58

verruca plantaris caused by HPV (hard to treat)

Front 59

What is this and what is the etiology?

- flat papules on face, dorsa of hands or shins.

Back 59

verruca plana caused by HPV

Front 60

How to treat verruca plana?

Back 60

tretinoin
imiquimod
cryosurgery

Front 61

What is this and what is the etiology?

- cauliflower masses on genital, perineal, or perianal areas

Back 61

genital warts (condyloma acuminata) by HPV

Front 62

Treatment for condyloma acuminata.

Back 62

Genital warts:
- liquid nitrogen
- podophyllin
- imiquimod
- surgical excision

Front 63

What skin lesions does S aureus cause?

Back 63

- impertigo
- ulcerative impertigo
- folluculitis, furuncle, carbuncle
- erysipelas/cellulitis

Front 64

What skin lesions does GAS cause?

Back 64

- impertigo
- ulcerative impertigo
- scarlet fever
- erysipelas/cellulitis

others:
glomerulonephritis

Front 65

Etiology of molluscum contagiosum.

Back 65

Poxvirus (brick shaped ds-DNA)

Front 66

What kind of skin lesions do you see in HIV patients infected with poxvirus?

Back 66

molluscum contagiosum: large numbers of giant lesions

Front 67

What is this called and what is the etiology?

- skin-colored, or pearly white papules or nodules with central umbilication

Back 67

molluscum contagiosum caused by poxvirus

Front 68

How to treat molluscum contagiosum?

Back 68

- liquid nitrogen
- cantharidin
- imiquimod
- tretinoin
- curettement

Front 69

When does HSV transmit?

Back 69

during both asymptomatic and symptomatic periods

Front 70

Which virus is this?

- spread skin to skin
- travels to DRG

Back 70

HSV1

Front 71

Which virus is this?

- spread through sexual contact
- travels to DRG

Back 71

HSV2

Front 72

What types skin lesions are caused by nongenital HSV?

Back 72

- cold sore
- fever blister
- whitlow
- gladitorium

Front 73

What is this diagnosis?

Positive Tzanck smear: multinucleated giant cells

Back 73

HSV

Front 74

How to treat HSV?

Back 74

penciclovir
acyclovir

Front 75

How to diagnose HSV?

Back 75

- Tzanck smear: positive id see multinucleated giant cell
- DFA
- serology

Front 76

What is this and what is the etiology?

- prodrome: pain tenderness, burning of skin
- vesicles on erythematous base often crusting
- mouth and lips(vermillion border)

Back 76

cold sore caused by HSV1

Front 77

What is the most common STD worldwide?

Back 77

HSV2

Front 78

What is this and what is the etiology?

- painful erosive balanitis, vulvitis or vaginitis
- regional lymphadenopathy and fever
- clusters of vesicles on glans penis in males, cervix buttocks and perineum in women
- redness

Back 78

genital HSV

Front 79

Reactivation of varicella zoster causes ___.

Back 79

shingles

Front 80

What is this and what is the etiology?

- prodrome: severe pain with pruritis
- paindul eruption of grouped papules, vesicles, bullae, pustules or crusts
- dermatomal distribution

Back 80

shingles caused by herpes zoster

Front 81

What is this?

- shingles
- involvement of facial and auditory nerves

Back 81

Ramsay-Hunt syndrome

Front 82

What is this?

- vesicles on tip of the nose

Back 82

Hutchison's sign. need to have ophthalmologist evaluate the patient.

Front 83

What is the vaccine for herpes zoster called?

Back 83

Zosterzax

Front 84

What is the time frame form herpes zoster treatment?

Back 84

within 72 hrs
- acyclovir
- famciclovir
- valacyclovir

Front 85

What is a complication of herpes zoster?

Back 85

post-hepetic neuralgia

Front 86

Species that cause human dermatophyte infections.

Back 86

- trichophyton
- microsporum
- epidermophyton

Front 87

Pathogenesis of dermatophyte infection.

Back 87

- produce keratinase to invade skin
- mannans in cell walls have immunoinhibitory effects

Front 88

What is the most common fungal infection in general population?

Back 88

tinea pedis (athletes foot)

Front 89

What is this?

- pruritis, burining
- scaling ("moccasin" pattern)
- maceration of toe webs
- vesicular

Back 89

tinea pedis

Front 90

What is this?

- diffuse hyperkeratosis of palms and digits
- vesicles and papules

Back 90

tinea manuum

Front 91

If you see tinea pedis on both feet, where else would you see skin lesions?

Back 91

one hand. ("two-foot-one hand disease")

Front 92

Etiology of tinea unguium.

Back 92

dermatoohyte (most commonly)
candida

Front 93

What is this?

- thickening of big toe nail
- subungal debris
- may see paronychia

Back 93

tinea unguium

Front 94

What is this?

- bilateral, erythematous, symmetric plaques with scaly border and central clearing
- medial thigh and buttocks

Back 94

Tinea cruritis

Front 95

What is this?

- annular plaques with red scaly border and central clearing
- on the trunk or extremeties

Back 95

tinea coporis

Front 96

What is this?

- well circumscribed macule to plaque of variable size
- on area of face
- secondary impertigo

Back 96

tinea faciei

Front 97

What age group do you often see tinea capitus?

Back 97

4-14

Front 98

What is this?

- circumscribed patches of alopecia, scale, and pustule

Back 98

tinea capitus

Front 99

What pattern of tinea capitus is this?

- hairs broken off at skin surface

Back 99

black dot pattern

Front 100

What pattern of tinea capitus is this?

- hairs break off several millimeters above scalp surface

Back 100

gray patch pattern

Front 101

What pattern of tinea capitus is this?

- delayed, inflammatory hypersensitivity reaction
- boggy, elevated, oozing plaque

Back 101

Kerion pattern

Front 102

On top of skin finding, what else would you see for patients with tinea capitus?

Back 102

posterior cervical and post auricular adenopathy

Front 103

Name the tinea that is not dermatophyte.

Back 103

tinea versicolor

Front 104

What are some predisposing conditions of candidiasis?

Back 104

- antibiotic therapy
- ill-fitting dentures
- pregnancy
- old age
- immune defects
- diabetes
- hypoparathyroidism
- hypothyroidism
- iron, zinc deficiency

Front 105

What is this?

- bright red plaques with satellite papules or pustules

Back 105

candidiasis

Front 106

Name a lipophilic yeast.

Back 106

tinea versicolor (pityrosporum ovale)

Front 107

What is this?

- hypo or hyperpigmented macules
- on trunk or proximal extremities
- often seen in spring and summer

Back 107

Tinea versicolor

Front 108

What is this diagnosis?

KOH preparation:
- true branching spetate hypae

Back 108

dermatophytes

Front 109

What is this diagnosis?

KOH preparation:
- pseudohyphae

Back 109

candida

Front 110

What is this diagnosis?

KOH preparation:
- spaghetti and meatballs

Back 110

tinea versicolor

Front 111

Treatment for fungal infecions.

Back 111

- imidazole creams (ketoconazole)
- oral Griseofulvin for tinea capitus: affect microtubule function. Also use antifungal shampoo (ketoconazole)

Front 112

How to treat tinea capitus?

Back 112

oral Griseofulvin for tinea capitus: affect microtubule function. Also use antifungal shampoo (ketoconazole)

Front 113

How to treat onychomycosis?

Back 113

- terbinafine/itraconazole
- 2 month for finger nail, 3 month for toenail
- monitor liver function