Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
571 Cards in this Set
- Front
- Back
|
Streptococci structural virulence factors
|
Capsule-hyaluronic acid
Fibrils-consist of M-protein (80 serotypes) lipoteichoic acid Peptidoglycan layer T and R proteins |
|
|
S. pyogenes lab test
|
Bacitracin S
|
|
|
S. agalactiae lab test
|
Hippurate hydrolysis pos
|
|
|
S. faecalis lab test
|
Bile esculin pos
|
|
|
S. pneumoniae lab test
|
Optochin S, Bile solubility pos, Quelling test pos
|
|
|
Preliminary Beta hemolysis
|
S. pyogenes, S. agalactiae
|
|
|
Preliminary alpha hemolysis
|
S. faecalis (Gamma (alpha), S. pneumoniae
|
|
|
Gram positive cocci chains, catalase negative
|
general properties of Streptococci
|
|
|
Soluble virulence factors of Streptococci
|
Streptokinase, streptodornase, hyaluronidase, erythrogenic toxin, nicotinamide adenine dinucleotidase, streptolysins
|
|
|
Streptolysins (hemolysins)
|
Streptolysin O - oxygen labile, antigenic
Streptolysin S - oxygen stabile, nonantigenic |
|
|
Pathogenesis of Streptococci
|
resist phagocytosis, chemotaxins, complement alt.,
|
|
|
Localized infections (diseases of S.pyogenes)
|
Pharyngitis, Scarlet fever, impetigo
|
|
|
Invasive infections (diseases of S.pyogenes)
|
Wounds, erysipelas (upper dermis), cellulitis, puerperal fever (bacteria during pregnancy), endocarditis
|
|
|
Postinfection diseases (diseases of S. pyogenes)
|
Rheumatic fever, glumerulonephritis
|
|
|
Lab diagnosis of Strep
|
pharyngitis (throat cultures, direct antigen test)
|
|
|
Invasive infections
|
Gram stain/culture, blood culture if bacteremia is suspected
|
|
|
Antibodies to S. pyogenes
|
streptozyme test- screens for ASO, anti-DNAase B, AHase, and anti-NAD
antistreptolysin O titer |
|
|
Scarlet fever
|
erythrogenic toxin produced by lysogenic Grp A streptococci causes rash, treat with penicillin
|
|
|
Grp B strep
|
infect neonates, stepticemia, meningitis, and pneumonia
|
|
|
Grp D strep or enterococcus faecalis
|
urinary tract infection, wounds, sepsis
|
|
|
Viridans strep or alpha strep
|
subactue endocarditis, dental caries
|
|
|
Streptococcus pneumoniae
|
pneumonia, otitis media, sinusitis
|
|
|
Pseudomonas aeruginosa
|
motile with polar flagella, oxidase positive that are obligate aerobes, grow at 42 degrees Celsius, colonies produce a fruity odor
|
|
|
Pseudomonas aeruginosa, virulence factors
|
Pili, polysaccharide capsule-slime layer(antibiotic resistant), endotoxin(lipopolysaccachride, ECE, exotoxin A
|
|
|
Polysaccharide capsule
|
Biofilm resists killing by antibiotics
|
|
|
Exotoxin A
|
Causes ADP-ribosylation of elongation factor 2-inhibits protein synthesis, eschar formation with tissue necrosis
|
|
|
Oxidase negative (aerobic), nonfermentative, nonmotile, pleomorphic organisms, gram neg rods
|
Acinetobacter
|
|
|
A. anitratus
|
cause a variety of nosocomial infections similar to Pseudomonas, naturally resistant
|
|
|
A. baumanii and A. calcoaceticus
|
Opportunistic infections, american soldiers wounded in Iraq, multiple drug resistant (MDRAB)
|
|
|
Acne vulgaris
|
proprionibacterium acnes
|
|
|
Impetigo
|
streptococcus pyogenes
|
|
|
Bullous Impetigo
|
Staphylococcus aureus
|
|
|
Erythrasma
|
Corynebacterium minutissimum
|
|
|
Erysipelas
|
Streptococcus pyogenes
|
|
|
Folliculitis
|
Staphylococcus aureus
|
|
|
Sycosis Barbae
|
S. aureus
|
|
|
Folliculitis
|
Pseudomonas aeruginosa
|
|
|
Furunculosis/boils
|
S. aureus
|
|
|
Carbuncle
|
S. aureus
|
|
|
Hidradenitis Suppurativa
|
S. aureus
|
|
|
Lymphangitis
|
S. pyogenes
|
|
|
Hemorrhagic Cellulitis
|
Vibrio vulnificus
|
|
|
Streptococcal Cellulitis
|
Streptococcus pyogenes
|
|
|
Cellulitis due to flesh eating bacterium
|
Streptococcus pyogenes
|
|
|
Necrotizing fasciitis
|
S. pyogenes
|
|
|
Ecthyma gangranosum
|
Pseudomonas aeruginosa
|
|
|
Ecthyma
|
S. pyogenes, or enterics
|
|
|
Cat or Dog bite
|
Pasteurellla multocida
|
|
|
small, gram-negative aerobic bacilli, hard to grow, angiomatosis in immunocompromised patients
|
Bartenella henselae (cat scratch fever
|
|
|
Scarlet fever
|
S. pyogenes
|
|
|
Scalded Skin syndrome
|
S. aureus
|
|
|
Toxic shock syndrome
|
S. aureus
|
|
|
Gonococcal septicemia
|
Neisseria gonorrhoeae
|
|
|
Rocky Mountain Spotted Fever
|
Rickettsia rickettsii
|
|
|
Secondary Syphilis
|
Treponema pallidum
|
|
|
Meningococcemia
meningococcal gangrene from septicemia |
Neisseria meningitidis
|
|
|
Leprosy
|
Mycobacterium leprae
|
|
|
Primary Syphilis
|
Treponema pallidum
|
|
|
Diabetic Foot
|
mixed infections
|
|
|
Conjunctivitis and cellulitis
|
haemophilus influenzae
|
|
|
Decubitus ulcer
|
S. aureus, S. pyogenes, enteric organisms
|
|
|
Exogenous infections
|
through abrasions, trauma, hospital procedures, bed sores, compromised blood supply
|
|
|
ds DNA, icosahedral, enveloped, intranuclear inclusion bodies, multinucleated giant cells (syncytia)
|
herpesviruses
|
|
|
Neurotropic (skin, mucous membranes, nervous system)
|
HSV-1,2
VZV |
|
|
Lymphotropic
|
EBV, CMV, HHV 6,7, HHV8, KSHV
|
|
|
Mucoepithelia, neuron, close contact
|
HSV-1
|
|
|
Hallmarks of Herpes
|
Lifelong, latent, recurrent, tethered, latency-associated RNA transcript
|
|
|
Mucoepithelia, neuron, close (sexual) contact
|
HSV-2
|
|
|
Mucoepithelia, neuron, contact or respiratory route
|
VSV
|
|
|
B lymphocyte, epithelia, B lymphocytes, saliva
|
EBV
|
|
|
Epithelia, monocytes, lymphocytes, monocytes, lymphocytes, contact, blood, transplantation, congenital
|
CMV
|
|
|
T lymphocytes and others, contact, respiratory route
|
HHV-6
|
|
|
T lymphocytes and others, transmission unknown
|
HHV-7
|
|
|
Endothelial cells, latency unknown, exchange of body fluids?
|
HHV-8, KSHV
|
|
|
encephalitis, conjunctivitis, gingivostomatitis tonsilitis labialis, pharyngitis esophagitis, herpes gladiatorum, tracheobronchitis, genital herpes, herpes whitlow
|
HSV-1
|
|
|
Meningitis, gingivo somatitis tonsilitis labialis, pharyngitis, perianal herpes, genital herpes, herpes whitlow
|
HSV-2
|
|
|
Gingivostomatitis
|
mouth, HSV-1
|
|
|
Herpes labialis
|
cold sores, lips, reactivate recurrent latent virus, HSV-1
|
|
|
Keratoconjunctivitis
|
conjunctiva, cornea, recurrent, HSV-1
|
|
|
Eczema herpeticum
|
primary infection around pre-existing eczema or dermatitis
|
|
|
Meningoencephalitis
|
meningitis, encephalitis, can be recurrent, follow skin, oral, genital, ocular infection, HSV
|
|
|
Meningoencephalitis
|
meningitis, encephalitis, can be recurrent, can follow skin, oral, genital, ocular infection
|
|
|
Herpes gladiatorum
|
wrestlers
|
|
|
Herpetic Whitlow
|
health care professionals
|
|
|
Erythema Multiforme
|
drug eruption, follows allergic reactions (bulls-eye, target lesions
|
|
|
14 days
|
time to manifest VZV
|
|
|
reactivation of latent virus adults. Thoracic or trigeminal. Post-herpetic neuralgia
|
Zoster (shingles)
|
|
|
vesicles, pustules, ulcers, crusts
|
Zoster stages
|
|
|
droplet (respiratory) transmission contact with lesions
|
VZV
|
|
|
Roseola, Febrile seizures, encephalitis, hemophagocytic syndrome, MS?
|
HHV-6, T/B-cells
|
|
|
Roseola, no other association
|
HHV-7
|
|
|
Kaposi's sarcoma, oral, sexually transmitted, vascular endothelial, spindle cells, lymph nodes, B-cell lymphomas, immunosuppressed
|
HHV-8
|
|
|
Inhibiting herpesviruses
|
all inhibit viral DNA polymerase
|
|
|
Reduces morbidity/mortality in HSV encephalitis, neonatal and immunocompromised HSV/chickenpox
|
Acyclovir
|
|
|
for resistant HSV, VZV
|
Foscarnet
|
|
|
For HSV ocular use
|
TFT-trifluorothymidine
|
|
|
vaccine for VZV
|
Varivax
|
|
|
ds DNA, complex, unique structure, size, surrounded by membrane, nucleoid, lateral bodies, largest physically and genetically
|
poxviruses
|
|
|
only infectious agent eradicated from world
|
variola virus
|
|
|
small pox vaccine
|
vaccinia virus
|
|
|
Common poxvirus skin infections
|
molluscum contagiosum, orf, milker's nodules
|
|
|
B19 parvovirus diseases
|
erythema infectiosum, fetal hydrops fetalis, miscarriage, transient aplastic crisis (TAC), persistent anemia, arthritis
|
|
|
parvovirus spread
|
respiratory droplets, blood. Very common infection
|
|
|
fever, hydrops fetali; transient aplastic crisis anemia. transient depletion
|
parvovirus pathogenesis
|
|
|
fever and pruritic rash, arthralgia
|
erythema infectiosum
|
|
|
Non-immune hydrops fetalis
|
kills babies
|
|
|
infection of patients with sickle cell disease, hemolytic anemia, RBC deficiencies
|
Transient Aplastic Crisis
|
|
|
Basophilic normoblasts
|
Parvo
|
|
|
responsible for 95% of malignant cervical carcinoma
|
HPV
|
|
|
Circular ds DNA genome, host histones, overlapping genes, disruption of p53/Rb
|
Papilloma
|
|
|
Koilocytes
|
cervical dysplasia from HPV
|
|
|
Podophyllin, Podophyllotoxin, Trichloracetic acid, 5-fluorouracil
|
chemical treatment for HPV
|
|
|
Cryotherapy, Electrosurgery, Laser vaporization, Excision
|
Surgical treatment
|
|
|
Interferon, Imiquimod
|
Immunotherapy for HPV
|
|
|
changes which occur due to normal maturity and occuring in all individuals
|
intrinsic aging
|
|
|
changes induced by UV light exposure, smoking and other environmental pollutants
|
extrinsic aging
|
|
|
infectious dandruff
|
Malassezia
|
|
|
pigmented fungus, found in dirt or showers
|
tinea nigra
|
|
|
Benzoic acid, Salicylic acid
|
Exophiala
|
|
|
Itraconazole, oral cream, shampoo
|
treatment for Malassezia
|
|
|
Grows on outside of hairshaft
|
Black piedra, white piedra
|
|
|
starts as a pinpoint and spreads out
|
tineas
|
|
|
fungus that induces an inflammatory response
|
cutaneous
|
|
|
Trichophyton, microsporum, epidermophyton
|
cutaneous fungi
|
|
|
Trichophyton rubrum
|
tinea pedis or tinea cruris
|
|
|
Epidermophyton floccosum
|
tinea pedis or tinea cruris
|
|
|
ectothrix
|
conidia outside of the hair shaft, tinea capitis
|
|
|
endothrix
|
conidia inside
|
|
|
kerion
|
big circular bald spot associated with tinea capitis
|
|
|
infection of hair and skin around the bearded areas of the neck and face
|
tinea barbae, trichopyton
|
|
|
fungal infection of the nail
|
tinea unguium, trichophyton rubrum, candida sp.
|
|
|
azoles, terbinafine
|
oral treatment to handle tinea unguium
|
|
|
traumatic barefoot wart lesions
|
chromoblastomycosis, fonsecaea, cladosporium, phialophora
|
|
|
rose disease that spreads by sinus tracts
|
sporotrichosis, sporothrix
|
|
|
oral potassium iodide
|
treatment for sporotrichosis
|
|
|
astroid body
|
central yeast cell that radiates , shows sporotrichosis
|
|
|
older treatment of sporotrichosis
|
oral potassium iodide
|
|
|
amphotericin B
|
potent treatment of sporotrichosis
|
|
|
foot thorn/spinter infection
|
mycetoma, pseudoallescheria, madurella
|
|
|
Very thin and short body hair, 20-22 weeks gestation
|
Lanugo
|
|
|
Cyanosis of the hands, feet and sometimes lips, no concern~, in response to chilling
|
Acrocyanosis
|
|
|
netlike, reddish-blue mottling of the skin, occurs symmetric, transient
|
Cutis marmorata
|
|
|
if cutis marmorata persists in older children....
|
could be trisomy 18,21, hypothyroidism or CMTC
|
|
|
sweat gland obstruction and sweat retention from overbundling
|
Miliaria
|
|
|
clear vesicles on head/neck/upper trunk from overbundling
|
Miliaria Crystallina
|
|
|
prickly heat, erthematous erupt on sweaty areas
|
Miliaria Rubra
|
|
|
cool em, dont use creams
|
treatment for miliaria crystallina
|
|
|
in the sweat areas prickly heat, erythematous papules
|
miliaria rubra
|
|
|
nose! tiny white papules containing keratin, resolves without treatment!
|
Milia
|
|
|
stimulation of sebaceous glands by maternal or endogenous androgens, hypertrophic sebaceous glands involute
|
neonatal acne
|
|
|
smear of pustular contents reveals numerous eosinophils, fades in hours or up to 2 weeks
|
Erythema Toxicum Neonatorum
|
|
|
stain of pustules reveals neutrophils, hyperpigmentaled macules
|
Transient Neonatal Pustular Melanosis
|
|
|
Red, greasy, scaling eruption mainly on hairbearing, responds to shampoos with sulfur and salicyclic acid, persistent lesions may require topical antifungal
|
Seborrheic Dermatitis
|
|
|
Flat, gray to bluish-black macules from the accumulation of melanocytes, no risk of malignancy. black/asian infants
|
Mongolian spots
|
|
|
Most common vascular lesion of infancy, pale pink macules or poorly circumscribed patch
|
Salmon Patch
|
|
|
most common benign tumor of infancy, vascular endothelium.
proliferative phase until 9-12 months. involution by 6-10 years |
Hemangiomas of infancy
|
|
|
strawberry, grow rapidly protrude from the surface of the skin, looks like a flat macule
|
Superficial HI
|
|
|
deep seated capillary hemangiomas, bluish-red masses
|
Deep HI
|
|
|
Airway compromise, amblyopia, strabismus, astigmatism, growth of septum
|
Complications of hemangiomas
|
|
|
Lumbosacral, tethered cord, spinal dysraphism, imperforate anus, renal/sacral anomalies
|
obtain an MRI to rule out associated abnormalities
|
|
|
problems with blood clotting due to hemangiomas
|
Kasabach-merritt syndrome
|
|
|
Macular sharply circumscribed, pink to purple, usually unilateral
|
Port-Wine Stain
|
|
|
overgrowth to one side
|
visual at Port Wine Stain
|
|
|
Port-wine stain over the opthalmic branch of the trigeminal nerve
|
Sturge-Weber Syndrome
|
|
|
local overgrowth of soft tissue and bone, Port wine stain on an extremity
|
local overgrowth of soft tissue and bone
|
|
|
Toxoplasmosis, Other(syphilis), Rubella, Cytomegalovirus, Herpes
|
Torch Infections, congenital infections of the fetus
|
|
|
Hydrocephalus, Chorioretinitis, Intracerebral calcifications
|
Congenital Toxoplasmosis
|
|
|
transplacental transmission, treponemal IgM, CSF VDRL, 2 years clinical
|
Congenital Syphilis
|
|
|
papulosquamous lesions anywhere, including palms and soles, rhitis, anemia, jaundice, osteochondritis
|
Early congenital syphilis
|
|
|
Hutchinson teetch, mulberry molars, 8th nerve deafness, sabre shin, saddle nose, treat with penicillin
|
Late Congenital Syphilis
|
|
|
Cataracts, Deafness, Heart Malformations, patent duct arteriosis, blueberry muffin rash, dermal ethropoiesis
|
Congenital Rubella
|
|
|
Periventricular calcifications, swelling eye optic nerve atrophy, sensorineural hearing loss
|
Congenital CMV
|
|
|
No mom lesions, cutaneous disease, disseminated, encephalic, erythematous halo vesicles
|
Neonatal herpes
|
|
|
Hepatic lesions, intravascular coagulations (DIC), shock, CNS problems and FOCAL SEIZURES
|
Neonatal Herpes-Disseminated
|
|
|
Mucocutaneous lesions (tongue), focal seizures, bloody lumbar puncture, cold sore kissin babies
|
Neonatal Herpes
|
|
|
single stranded RNA virus, nasoendothelial spread, multiplies by reticuloendothelial system, 3 C cough, coryza, and conjuctivitis, 10-12 incubation, koplik spots, high fever at 3-5, then maculopapules
|
Rubeola (measles)
|
|
|
Gray-white papules of the buccal mucosa in a patient with measles
|
Koplik Spots
|
|
|
Neurologic complications are more common than in any other exanthematous illness
|
Rubeola (Measles) Complications
|
|
|
RNA Togaviridae, prodrome of low grade fever, headache, rhinorrhea, malaise, myalgias, sore throat, rose pink macules and papules
|
Rubella
|
|
|
The goal of Rubella immunization
|
prevent spread to pregnant women
|
|
|
Parvovirus B19, late winter and spring in school, prodrome of low grade fever, URI, headache, 3 stage rash, facial flush (slapped cheaks, macular erythema, wax wayne fro three weeks.
|
Erythema Infectiosum
|
|
|
HHV-6 or 7, herpesviridae, DNA virus preferentially infects activated T cells enhancing natural killer cell, activate in altered immunity peak incidence between 6-12 months, high fever then rash, which is gone in 1-3 days
|
Roseola Infantum
|
|
|
respiratory droplet or contact with lesion spread, prodrome of fever, chills, malaise, headache, myalgias and arthralgias 24 to 48 hours before the rash develops, dew drop rose petal
|
VZV chicken pox
|
|
|
Summer fall, enteroviral spread, fever malaise exanthem, grey-white vesicular lesions hand feet macules on the butt, vesicles in mouth
|
Hand-Foot-Mouth
|
|
|
target lesions as reactions to viral illness(e.g. herpesviridae), lesions of cell necrosis, no prodrome, low grade fever, malaise, myalgia
|
Erythema Multiforme
|
|
|
2 or more mucous membranes involved, epidermal detachment, EM major, prodromal period 1-14 days of fever, Niolsky sign
|
Stevens-Johnson Syndrome
|
|
|
Nikolsky sign
|
exert liht pressure on an area of erythema, and the epidermis peels right off
|
|
|
Toxic epidermal Necrolysis
|
>30 involved skin, always systemic, less dermatitis
|
|
|
Mucousal membrane involvement, swelling, hemorrhagic crusting, cutaneous sloughing below level of epidermal cells+ melanocytes
|
Stevens-Johnson syndrome and TEN
|
|
|
Causes and Treatment of SJ/TEN
|
mycoplasma in kids, drugs, take to burn unit discontinue drugs
|
|
|
Does NOT have a prodrome including fever
|
Erythema multiforme
|
|
|
palpabale non-blanching, purpuric lesions, 2-11 years, normal platelets, hematuria->glomerulonephritis, GI Tract Intussusception in 2% or more boys, Butt lesions
|
Henoch-Schnonlein Purpura
|
|
|
cutaneous erutpion with immune-ab complexes, lymphadenopathy, splenomegaly, proteinuria, arthralgies
|
Serum Sickness
|
|
|
urticarial fever, periarticular swelling, cefaclor, penicillins, minocycline, cefprozil, griseofulvin, and bupropion. vasculitis renal dz, and hypocomplementemia absent
|
SSLR (serum sickness-Like reaction)
|
|
|
antihistamines, self limiting 2-3 week treatment
|
SSLR
|
|
|
Big deal cause of the heart?
Children less than 5yo? prolonged fever..... |
Kawasaki Disease
|
|
|
5+ day fever without goop and a polymorphous rash, oral mucous membrane changes, lymphoadenopathy
|
Kawasaki Disease
|
|
|
Extensive peeling of the hands and digits associated with common febrile illness
|
Scarlet Fever and Kawasaki Disease
|
|
|
Greatest concern for Kawasaki Disease
|
Cardiac sequelae
|
|
|
Treatment for Kawaski Disease
|
IVIG and Aspirin; within the first 10 days of illness
|
|
|
infection of the upper portion of hair follicle, staph aureus implicated
|
folliculitis
|
|
|
predisposing factors of folliculitis
|
shavin, occulsion, high temp/humiditiy, diabetes, immunosuppression
|
|
|
hot tub folliculitis is due to
|
pseudomonas
|
|
|
acne vulgaris is as disease of
|
pilosebaceous unit
|
|
|
picking acne too much
|
acne mechanica
|
|
|
open and closed comedones
|
noninflammatory acne lesion
|
|
|
papules, pustules, nodules(cysts)
|
inflammatory acne lesions
|
|
|
Pathogenesis of acne
|
multifactoral, genetics, puberty= increased sex hormones sebaceous glands enlarge; more sebum
|
|
|
cornified cells linging the follicle begin to adhere to the follicular wall and form a plug
|
the microcomedone
|
|
|
normal skin resident promotes inflammation in follicules
|
Proprionbacterium acnes
|
|
|
dirt causes acne, overwashing is good, more picking, diet, scrub away
|
acne myths
|
|
|
hallmark of acne is
|
microcomedone (clog)
|
|
|
4 kinds of topicals
|
antibiotics, retinoids, benzyl peroxides, combos
|
|
|
Topical retinoids are
|
always appropriate
they target the microcomodone |
|
|
reverse the abnormal pattern of keratinization, reduce follicular plugging
|
topical retinoids
|
|
|
effects of retinoids
|
produce erythema & irritation, 2-3 months before you get results
|
|
|
Antibacterial wash/gel which is somewhat comedolytic
|
Benzoyl Peroxide
|
|
|
Oral Antibiotics are used for...
|
their anti-inflammatory activity
|
|
|
if treatment failure acne in women might be time to look at....
|
antiandrogens
|
|
|
3 options of antiandrogen therapy
|
Estrogens, glucocorticoids, antiandrogens at the peripheral level
|
|
|
antibiotics reduce effectiveness of oral contraceptives?
|
only rifampin and metronidazole
|
|
|
Steroid use for acne?
|
only special circumstances, intralesional injection
|
|
|
Spironolactone
|
androgen receptor blocker (dont use during pregnancy)
|
|
|
Rosacea
|
adult acne, no comedones
|
|
|
Rhinophyma
|
enlarged glands due to Rosacea
|
|
|
treat rosacea with...
|
the same as you'd treat acne
|
|
|
What causes warts...
|
HPV causes hyperplasia and hyperkeratosis
|
|
|
treat warts?
|
different techniques to try to get the immune system to respond
|
|
|
check thrombosed vessels...
|
to see if the virus is gone
|
|
|
Molluscum Contagiosum is caused by.....
|
Poxvirus
|
|
|
Poxvirus in little kids shows up as...
|
Molluscum Contagiosum, discrete 2-5mm umbillicated papules
|
|
|
one of the itchiest diseases, spread by contact
|
scabies
|
|
|
scabies itches most....
|
at night, in fingerswebs and wrist, buttocks penis groin
|
|
|
diagnose scabies by....
|
scrape, exam in mineral oil, see mites eggs feces
|
|
|
treat scabies with....
|
permethrin neck down overnight, repeat in one week
|
|
|
scabies itches after treatment?
|
yep, feces makes it itch for up to one month after Rx
|
|
|
Pediculosis Capitis is transmitted by...
|
(Head Lice)....contact, lice and eggs in hair
|
|
|
treat Pediculosis Capitis
|
Permethrin in dry hair, wash repeat in one week
|
|
|
Pediculosis Pubis...
|
Crabs, sexually transmitted, itching in the groin, blue gray macules may be present
|
|
|
itchy recurrent commonly confused with tinea infections, presents when the humidity levels are low (winter) in the elderly
|
Nummular Eczema
|
|
|
wet, red, symmetric vessicular hand and foot dermatitis, itching precedes vesicles, chronic eczematous inflammation
|
Dyshidrotic Eczema
|
|
|
dry lose moisture, like a river
|
Asteatotic/ Xerotic Eczema
|
|
|
localized plaque of chronic eczematous inflammation, more skin lines due to lichenification, chronic scratch, stop the itch
|
Lichen simplex chronicus
|
|
|
acute, subacute, chronic, begins in infancy, familial, atopic triad, AD, allergies, asthma, IgE?
the itch that rashes.... |
Atopic Dermatitis
|
|
|
seen most often in patients with atopic dermatitis....
|
Keratosis Pilaris
|
|
|
Asymptomatic, hypopigmented, and slightly scaly plaques, with atopic dermatitis, face and arms
|
Pityriasis Alba (self limiting)
|
|
|
lesions that appear first before the patient messes with them...
|
primary lesions
|
|
|
lesions that result from trauma, scratch, regression.....
|
secondary lesions
|
|
|
flat, discolored, different colors, <1cm
|
macule
|
|
|
flat discolored different colored >1cm
|
patch
|
|
|
<1cm elevated solid lesion
|
papule
|
|
|
superficial elevated circumscribed lesions greater than 1 cm
|
Plaque (hives can be plaques)
|
|
|
>1cm, circumscribed solid lesion
|
nodule
|
|
|
<1cm fluid filled, may arise from macule or papule
|
vesicle
|
|
|
>1cm, fluid filled
|
bulla
|
|
|
evanescent, edematous, flared, quick, transient
|
wheals (hives can be wheels)
|
|
|
collection of necrotic inflammatory cells and free fluid, size varies
|
vesicles
|
|
|
dry or greasy laminated masses of keratin \///flaky
|
scales
|
|
|
scabs, dried blood, pus, bacterial debris
|
crusts
|
|
|
focal loss of adjunct, heal without scarring, don't penetrate below the dermoepidermal junction
|
erosion
|
|
|
focal loss of epidermis and dermis, heals with scarring
|
ulcers
|
|
|
cracks, linear cleft through epidermis or dermis, inelastic hurts to move
|
fissures
|
|
|
normal with aging, depression in the skin resulting from thinning of the epidermis or dermis, can be a side effect of topical steroids
|
atrophy
|
|
|
new connective tissue, replacing old lost tissue in the dermis or deeper
|
scars
|
|
|
scar that grows too much
|
keloid
|
|
|
erosions caused by scratching
|
excoriations
|
|
|
plug of sebaceous and keratinous material in the opening of a hair follicle
|
comedones
|
|
|
small, superficial keratin cyst with no visible opening
|
milia
|
|
|
small circumscribed lesions with a wall and a lumen containing either solid or fluid matter
|
cysts
|
|
|
narrow, elevated, toruous channel, probably parasites.....
|
burrow
|
|
|
area of thickened epidermis induced by scratching, skin lines are accentuated
|
lichenification (psoriasis)
|
|
|
dilated superficial blood vessels, single or multiple
|
telangectasia
|
|
|
circumscribed deposit of blood <1cm
|
petechiae
|
|
|
cirumscribed deposit of blood >1cm
|
Purpura
|
|
|
inflamed, red
|
erythematous
|
|
|
violet
|
violaceous
|
|
|
angiomas are
|
red
|
|
|
eruptive greasy vanthomas are
|
yellow
|
|
|
PRP with islands of scarring are
|
Salmon (orange-red)
|
|
|
tinea versicolor shows
|
hypopigmentation
|
|
|
darker skin color
|
hyperpigmenation
|
|
|
glow skin color
|
depigmentation
|
|
|
bruise, blood skin color
|
blue
|
|
|
lesion forming a ring or circle
|
annular
|
|
|
lesion forming part of a circle (seen in lime disease)
|
arcuate
|
|
|
several intersecting portions of a circle
|
polycyclic
|
|
|
snake like parasite, curving line, like in hookwarm
|
serpiginous
|
|
|
small round lesions "drop like"
|
Guttate
|
|
|
coin-like (associated with psoriasis)
|
Nummular
|
|
|
layers of skin
|
stratum.....corneum, lucidum, granulosum, spinosum, basale
|
|
|
connective tissue...
|
makes you look good. collagen elastic tissue, reticular fibers
|
|
|
papillary dermis
|
thin upper layer containing thin collagen fibers
|
|
|
reticular dermis
|
thicker lower layer containing thick collagen fibers arranged parallel to the skin surface
|
|
|
skin functions
|
physical barrier, thermoregulation, sensation, interpersonal, maintains physical and emotional healthy
|
|
|
don't maintain your skin you could get...
|
warts
|
|
|
3 basic skin care produc
|
cleaseners, astringers, moisurizers
|
|
|
cleansers
|
soaps, combars, syndets
|
|
|
soaps
|
for dirt, hurt stratum corneum
|
|
|
syndets
|
light dry skin
|
|
|
combars
|
oily, milder than true soaps
|
|
|
transepidermal water loss is noted in direct proportion to
|
cleanser
|
|
|
incorporate both hydrophilic and lipophilic ingredients emulsify together and moisturize
|
body washes (cleanses)
|
|
|
retard transepidermal water loss, saran wrap for skin
|
moisturizers
|
|
|
most occlusive moisturizer
|
vasoline (99%)
|
|
|
substances that attract moisture
|
humectants
|
|
|
improve skin texture by inducing keratinocyte. honey, sodium lactate, glycerin,
|
humectants
|
|
|
products that correct deficiencies of cleanser (here!) or supplement moisturizer, for soap scum
|
astringents and toners
|
|
|
SPF measures
|
UVB protection by ratio of the duration of UV radiation exposure necessary to produce erythema protected/unprotected
|
|
|
sunscreen reduces
|
actinic keratoses, squamous cell carcinomas, melanocytic nevi, decrease photoaging, melanoma
|
|
|
scatter sunscreen protects from...
|
UVA and UVB
|
|
|
titanium oxide and zinc oxide are examples of....
|
scatter sunscreen
|
|
|
absorption sunscreen protects against....
|
UVB
|
|
|
chemical sunscreens are examples of......
|
absorption sunscreens
|
|
|
recommended dosage for sunscreen.....
|
2mg/cm^2
|
|
|
UVA (320-400nm)-less substantially blocked by the atmosphere
|
(NOT blocked by glass)
|
|
|
UVB (290-320nm)
|
substantially blocked by ozone and glass
|
|
|
UVB radiation is more ----- than UVA
|
erythemogenic
|
|
|
----- is reflected by snow ice and sand
|
UVA
|
|
|
Dry lesions treat with
|
emollients to wet them
|
|
|
Wet lesions treat with
|
wet compress to decrease inflammation and remove crusts. it dries them
|
|
|
Restore water lipids to the epidermis
|
emollients
|
|
|
wound debridement, suppresses inflammation, drying is accomplished by....
|
wet dressings/compresses
|
|
|
most potent topical group...
|
Group 1
|
|
|
least potent topical group...
|
group 7
|
|
|
the decrease in the responsiveness to a drug as a result of enzyme induction....
|
tachyphylaxis
|
|
|
increases the potency of topical steroids....
|
occlusion
|
|
|
some adverse reactions to topicals include.....
|
Rosacea, rebound phenomenon, telangectasis, atrophy, weakened immune system causes scabies or tineas
|
|
|
class of anti-fungal that kill the fungal elements....
|
cidal
|
|
|
class of anti-fungal that suppress the fungal elements....
|
static
|
|
|
common low malignant melanocyte
|
nevi (mole)
|
|
|
nevus cells at DE junction
|
juntional nevi
|
|
|
nevus cells at DE junction and dermis
|
compound
|
|
|
nevus cells found in the dermis
|
dermal
|
|
|
tend to be flat or slightly elevated, light brown-black, DE junction
|
junctional MN
|
|
|
slightly elevated, dome shaped, papules, flesh colored or brown, hair present, nevus cells at DE junction and upper dermis
|
compound MN
|
|
|
Dome shaped verrucous, pedunculated papules, brown black, cells in the dermis
|
dermal MN
|
|
|
Malignant potential of congenital Nevi depends on
|
histologic pattern and clinical size
|
|
|
>1.5cm a medium sized congenital nevus needs..
|
lifelong observation versus biopsy versus prophylactic excision
|
|
|
large >20cm nevi
|
remove if possible
|
|
|
blue nevus
|
tyndall effect, the brown pigment picks it up, removal is cosmetic
|
|
|
dysplastic nevi
|
increased risk for melanoma, may not be cancerous
|
|
|
speckled hairless oval brown lesion
|
letiginous nevus
|
|
|
hamartomatous growth of smooth muscle fibers. never been malignent
|
Becker's nevous
|
|
|
compound or dermal nevus with white border
|
Halo nevus
|
|
|
Lumbosacral steel-blue patch @ birth or early childhood. not malignant
|
Mongolian spots
|
|
|
benign juvenile melanoma hairless red papules/nodules. complete excesion. appear suddenly in children
|
Spitz Nevus
|
|
|
consistancy clear in the center.....ABCDE
|
malignent melanoma....more gone the worse....
|
|
|
superficial spreading type
|
malignant melanoma
|
|
|
melanoma that resembles blood blisters
|
nodular type, resembles dermal nevi, hemangiomas, seborrheic keratoses, dermatofibroma
|
|
|
malignant melanoma usually found on face looks like sun spot, found in sun damaged skin
|
Lentigo maligna type melanoma
|
|
|
malignant melanoma that appears on palms, soles, phalanges, and mucous membranes, common in African American and Asians
|
Acral lentiginous type
|
|
|
appearance of a pigmented band with extension suggesting lentiginous melanoma. nail matrix biopsy
|
Hutchinson's sign
|
|
|
risk factors for MM
|
familyhistory/UVR/sunburnsduringchildhood/intermittentburningexposureinfairskin/greaterthan50nevi/greaterthan5atypicalnevi/personalhistory/etc
|
|
|
ABCDE'S of MM
|
Asymmetry, border, color, diameter, evolving
|
|
|
malignant blue, ocular,desmotropicmucosal, from congnital nevus, amelanotic
|
rare melanomas
|
|
|
measure malignant melanoma from.....
|
granular layer to the deepest portion of malignant cells
|
|
|
criteria for a sentinel lymph node biopsy
|
breslow thickness is >=1 mm or has ulceration regression angio-lymphatic invasion, in transit recurrence mitotic rate 1, patient is 60 y/o
|
|
|
waxy brown stuck on placks with no malignant transformation
|
seborrheic keratosis
|
|
|
treatment for seborrheic keratosis
|
not necassary, laser if you want or freaze
|
|
|
benign pedunculated papules in the axilla, neck, and inguinal area, more common in obese
|
skin tags
|
|
|
found on the lower legs, a firm bump, reaction to trauma insect bit or infection, dimple sign compress to elevate
|
dermafibroma
|
|
|
compress to elevate dermatofibroma
|
dimple sign
|
|
|
Multiple itching nodules, multifactorial, break the cycle, intermittent pruritus
|
prurigo nodularis
|
|
|
most common aquired vascular lesion. appears with age
|
cherry angiomas
|
|
|
dark blue aquired vascular lesion on lip tip face or ears, color goes away with compression
|
Venous lake
|
|
|
hyperpigmentation usually on the face usually in women, and hormone changes and sun exposure brings em out
|
Melasma
|
|
|
incidental benign finding but 6 or more might mean neurofibromatosis(VRD)
|
cafe au lait
|
|
|
true cysts central punctum most common on the trunk but can form anywehre, get inflammed/infected become red and painful white chee sub, inflame
|
epidermal inclusion cyst
|
|
|
due to p. orbiculare and p. ovale, Mal furr. never on face, appears after puberity. KOH spagetmball, use antifungals
|
tinea versicolor
|
|
|
immune mediated loss of melanocytes
mouth hands feet around eyes, genetically linked, thyroid disease |
vitiligo
|
|
|
the three C's cough coryza conjuctivitis, fever photophobia prodrome then rash 3-4 days later spreads head down
|
Rubeola (Measles)
|
|
|
facial erythema, "slapped cheek" spread by respiratory droplets or lood transfusion Parvovirus B19. age 5-14 y/o, spares nasolabial folds
|
Erythema infectiosum
|
|
|
Net-like pattern of erythema, trunk and buttocks 6-14d
|
erythema infectiosum
|
|
|
6th disease/herpesvirus6/80% of kids by age1, saliva, similar to mono in adults
|
Roseola infantum
|
|
|
103-106 fever for several days, few symptoms, seizures, rash appears as fever fades
|
Roseola infantum
|
|
|
Red with white little center, erosive stomatitis, palmplanterupt kids shed for up to 6 weeks, by Coxsackie A16
|
Hand foot and mouth disease
|
|
|
lateral nail fold red swelling bright usually s. aureus infection, treat with oral Abiotics and soak if draining
|
acute paronychia
|
|
|
proximal nail fold, asymptomatic, usually candidiasis, cuticle maybe missing, oral/topical antifungal
|
chronic paronychia
|
|
|
green discoloration in nail, due to water trapping, use acetic acid soaks, antibiotic therapy
|
pseudomonas
|
|
|
auto-immune hair loss quick outbreaks not permanent sometimes has a trigger
|
alopecia areata
|
|
|
IL steroid injections topical steroids melanin is the target
|
first line of treatment for alopecia areata
|
|
|
male pattern baldness men AND women, gradual
|
androgenic hairloss
|
|
|
you can cure psoriasis!
|
false, just treat it
|
|
|
chronic recurrent disease stress medications infections envirmonment precipitate, 1/3 with family history....
|
psoriasis
|
|
|
lithium, beta-blockers, interferons, ACE inhibitors.......URI, strep, HIV, 30-40% exacerbate during a stressful time
|
psoriasis triggers
|
|
|
Psoriasis is an inflammatory disease in which.--------play a major role
|
T-lymphocytes
|
|
|
suppressing-------improves psoriasis
|
T cells
|
|
|
epidermal cell cycle is -------in psoriasis. (basal to corneal)
|
decreased, they proliferate too fast
|
|
|
bleeding upon removal of the scale
|
auspitz sign
|
|
|
lineation of lesions
|
koebnerization
|
|
|
Reiter's disease
|
Urethritis, conjunctivitis, arthritis
|
|
|
destructive changes in arthritis
|
catch em' on an X-ray
|
|
|
"sausage digits"
|
dactylitis
|
|
|
looks like big old plaques on the joints and what not
|
chronic plaque psoriasis
|
|
|
little scaly plaques, i woke up and hey, there it was, HAD STREP PHARYNGITIS 3 WEEKS AGO
young. |
guttate psoriasis
|
|
|
more red plaques, T cells goin crazy
|
erythrodermic psoriasis
|
|
|
dactylitis, palms and toes plaques
|
psoriasis of palms and toes
|
|
|
putules coaless from plaques, they group together, hypocalcemia, hypoalbuminia, leukocytosis
|
pustular psoriasis
|
|
|
occuriing in the body folds, not visible scale, red glistening skin
|
inverse psoriasis
|
|
|
removes excessive scale, lubricates, moistens
|
keratolytics
|
|
|
first line of therapy for psoriasis
|
topical steroids
|
|
|
more effective than topicals but has risks for psoriasis
|
systemics
|
|
|
acute reccurent has preceding herpes simplex or mycoplasma infection
|
erythema multiforme
|
|
|
classic cold sore hand sore lesions, no prodrome, 1-4 weeks, self-limited & recurrent
|
erythema multiforme
|
|
|
targetoid lesions, major cause is HSV
|
erythema multiforme
|
|
|
bad erythema multiforme, looks similar under a microscope, common cause is DRUGS
|
SJS/TEN
|
|
|
<10% BSA
|
SJS
|
|
|
10-30% BSA
|
SJS/TEN
|
|
|
>30%
|
TEN
|
|
|
fever/flu symptoms prodrome, 1-14 days later abrupt onset of symmetric red macules, always 2 or more mucosal sites
|
SJS
|
|
|
worst morbidity from SJS
|
ocular scaring
|
|
|
mortality from TEN
|
usually infection
|
|
|
small push lateral epidermal detachment
|
Nikolsky's sign
|
|
|
pushin a bulla enlarges the blister
|
Asboe-Hansen sign
|
|
|
#1 cause of TEN
|
Drugs! antibiotics/anticonvulsants, analgesics, higher frequency in patients with HIV
|
|
|
SJ look alike in kids....
|
Staph Scalded Skin Syndrome from staph a.
|
|
|
SSSS has loss of
|
granular layer of epidermis
|
|
|
TEN has loss of full thickness skin involvement
|
dermal epidermal junction
|
|
|
In USA most commonly caused by Oral Birth Control Pills, and coccidiodomycosis in Arizona
|
Erythema Nodosum
|
|
|
see/feel blood palpable purpura
|
vasculitis!
|
|
|
following an upper respiratory tract infection, acute vasculitis of SMALL TO MEDIUM sized vessels in young patients
|
Henoch-schonlein purpura
|
|
|
the purpura associated with young child abdominal pain....
|
Henoch-schonlein purpura, try and prevent blood in the stool or kidneys huh?
|
|
|
wheals.itchy.acute.chronic.noscale.goesawayfast.treatwithantihistamine.
|
urticaria....(rash)
|
|
|
scratching skin results in urticarial wheals/lines
|
dermatographism
|
|
|
urticaria lasting less than 6 weeks
|
acute
|
|
|
urticaria lasting more than 6 weeks
|
chronic
|
|
|
Antihistamines-newer non-sedating antihistamines
|
First Line therapy for urticaria
|
|
|
second line therapy for urticaria
|
systemic corticosteroids, epinephrine
|
|
|
pityrosporum ovale, oily complexion "seborrheic diathesis"
|
Seborrheic Dermatitis
|
|
|
Cradle Cap!
|
Seborrhea in new born
|
|
|
red orange plaques, follicular papules and the islands of sparing....
|
pityriasis rubra pilaris
|
|
|
benign, usually asymptomatic, distinctive, and self limiting
23 year olds get this in the colder months..... |
Pityriasis Rosea
|
|
|
the herald patch
|
2-10cm round to oval lesion found on trunk, (Pityriasis Rosea)
|
|
|
Salmon pink lesions in whites and hyperpigmented in blacks.....use the collarette scale....
|
Pityriasis Rosea
|
|
|
Pityriasis Rosea orients lesions along skin like a.....
|
christmas tree
|
|
|
DDx's for Pityriasis Rosea
|
Secondary Syphilis, Tinea Versicolor, guttate psoriasis, nummular eczema
|
|
|
the five P's for Lichen Planus
|
pruritic, planar, polyangular, purple, papules
|
|
|
Wickham's striae, could be linear, muco-cutaneous, on wrists buccal mucosa. viral hepatitis!
|
Lichen Planus
|
|
|
Uncommon, Females:males 10:1 vulva, perianal, groin, trunk & extremities, dull wrinkled skin, ivory papules plugs
|
Lichen Sclerosis et Atrophicus
|
|
|
Chancre, painless erosion, on genitalia, cervix, mouth
|
1 syphilis
|
|
|
nonpruritic macular erythematous eruption. predilection for palms and soles, sharp demarcation and copper color
|
2 syphilis
|
|
|
Mucous patches occur on the mouth, lips, pharynx, genitalia, anus infectious, moth eaten alopecia, condyloma lata
|
2 syphilis
|
|
|
gumma! mucocutaenous, osseous, neural visceral
|
3 syphilis
|
|
|
gumma
|
painless pink ulcers
|
|
|
treat syphilis with
|
penicillin
|
|
|
common pruitic eruption, the itch that rashes, 2-3 months, child to adult
|
atopic dermatitis
|
|
|
facial dermatitis moves from cheek/chin to periorbital/perioral
|
childhood phase of atopic dermatitis
|
|
|
hyperlinear palms, dennie-morgan folds, keratosis pilaris
|
atopic dermatitis associated findings
|
|
|
atopic dermatitis asthma, allergic rhinitis
|
Atopic triad
|
|
|
flexor surfaces widespread atopic dermatitis on adults
|
eczema
|
|
|
face uper arms hypopigmented slightly scaly plaques, in children, returns to normal without treatment
|
pityriasis alba
|
|
|
group of multisystem illnesses of unknown etiology
|
connective tissue diseases
|
|
|
strongest risk factor for lupus erythematosus
|
gender! 6:1 female ratio
|
|
|
systemic lupus aka
|
acute cutaneous LE
|
|
|
discoid lupus aka
|
chronic cutaneous LE
|
|
|
amount needed for criteria of diagnosis of SLE
|
4/11
|
|
|
SLE criteria
|
Malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, pleuritis/carditis, renal disorder, neruo, anemia, anti-DNA, positive ANA
|
|
|
MDSOAPBRAIN
|
malar,discoid,serositis,oral,ANA, photosensitivity, blood, renal, arthritis, imunologic, neuro
|
|
|
LE treatment
|
Sunscreen & sun avoidance
|
|
|
discoid lupus characteristic
|
ANA negative
|
|
|
carpet tack scaling
|
discoid lesions
|
|
|
Mucous patches occur on the mouth, lips, pharynx, genitalia, anus infectious, moth eaten alopecia, condyloma lata
|
2 syphilis
|
|
|
gumma! mucocutaenous, osseous, neural visceral
|
3 syphilis
|
|
|
gumma
|
painless pink ulcers
|
|
|
treat syphilis with
|
penicillin
|
|
|
common pruitic eruption, the itch that rashes, 2-3 months, child to adult
|
atopic dermatitis
|
|
|
facial dermatitis moves from cheek/chin to periorbital/perioral
|
childhood phase of atopic dermatitis
|
|
|
hyperlinear palms, dennie-morgan folds, keratosis pilaris
|
atopic dermatitis associated findings
|
|
|
atopic dermatitis asthma, allergic rhinitis
|
Atopic triad
|
|
|
flexor surfaces widespread atopic dermatitis on adults
|
eczema
|
|
|
face uper arms hypopigmented slightly scaly plaques, in children, returns to normal without treatment
|
pityriasis alba
|
|
|
group of multisystem illnesses of unknown etiology
|
connective tissue diseases
|
|
|
strongest risk factor for lupus erythematosus
|
gender! 6:1 female ratio
|
|
|
systemic lupus aka
|
acute cutaneous LE
|
|
|
discoid lupus aka
|
chronic cutaneous LE
|
|
|
amount needed for criteria of diagnosis of SLE
|
4/11
|
|
|
SLE criteria
|
Malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, pleuritis/carditis, renal disorder, neruo, anemia, anti-DNA, positive ANA
|
|
|
MDSOAPBRAIN
|
malar,discoid,serositis,oral,ANA, photosensitivity, blood, renal, arthritis, imunologic, neuro
|
|
|
LE treatment
|
Sunscreen & sun avoidance
|
|
|
discoid lupus characteristic
|
ANA negative
|
|
|
carpet tack scaling
|
discoid lesions
|
|
|
carpet tack followed by atrophy hypopigmentation and scarring
|
discoid lesions
|
|
|
SS-A (Ro) is usually positive in
|
subacute lupus erythematosus
|
|
|
papulosquamous/annular patterns sparing the knuckles, no atrophy scars usually, photodistributed
|
SCLE
|
|
|
anti-histone antibodies associated with....
|
Drug induced lupus erythematosus
|
|
|
rare condidtion caused by transplacental autoantibodies from the mother to fetus
CONGENITAL HEART BLOCK |
Neonatal Lupus
|
|
|
rare inflammatory muscle disease with cutaneous findings
|
Dermatomyositis
|
|
|
believed to be a vasculopathy mediated by complement deposition with lysis of endomysial capillaries. muscle ischemia
|
dermatomyositis
|
|
|
problems drying hair or rising out of seat, muscles tire
heliotrope eyelids, round papules on hands, spares between knuckles, nail redness, shawscales |
dermatomyocitis
|
|
|
most prominent diagnostic feature of dermatomyocitis.
mottled white areas with brown pigment, telangiectasia, and atrophy |
poikiloderma
|
|
|
positive antibody during dermatomyositis
|
anti-Jo-1 antibody
|
|
|
systemic form of sclerosis
|
scleroderma
|
|
|
localized from of systemic sclerosis
|
morphea
|
|
|
changes in skin and internal organs. 15;1 women. sclerodactyly. Pulmonary dz most common cause of death
|
scleroderma
|
|
|
white blue red discolor in fingers
|
raynaud's phenomenon, tied to scleroderma
|
|
|
CREST
|
milder form of scleroderma, calcification of cutis involved
|
|
|
highly specific antibody for CREST syndrome
|
anticentromere antibodies
|
|
|
telangiectasia
|
scleroderma
|
|
|
purple discolored areas progressing to firm hairless ivory patches. en coupe de sabre
|
morphea
|
|
|
IgA deposits in upper dermis, associated with subclinical gluten-sensitive enteropathy
|
dermatitis herpetiformis
|
|
|
pruritic vesiclular disease with itch papules on elbows knees scalp, nuchl area, shoulders, buttocks
|
dermatitis herpetiformis
|
|
|
associated with dermatitis herpetiformis
|
thyroid disorders, increased incidence of malignancy, jejunal mucosa abnormalities
|
|
|
subepidermal seperation by IgA
|
Dermatitis herpetiformis
|
|
|
neutrophilic microabscesses in dermal papillae, IgA deposits in dermal papillae
|
dermatitis herpetiformis
|
|
|
intraepidermal blisters, skin mucous membranes, IgG against keratinocytes, 61% neoplasm in immune system
|
pemphigus
|
|
|
mucal erosions healing with hyperpigmentation and NO SCARRING
|
pemphigus vulgaris
|
|
|
Nikolsky sign and asboe hansen sign positive. ELISA testing for anti-desmoglein 1 and anti-desmoglein 3 autoantibodies
|
pemphigus vulgaris
|
|
|
flaccid bullae, corn flake scale crust, nikosky sign positive
|
pemphigus foliaceus
|
|
|
IgG in blisters, 65-75 y/o, oral blister itch, lower abdomen, flexors, IF pattern IgG and C3
|
Bullous pemphigoid
|
|
|
sub-epidermal split
|
dermatitis herpetiformis
bullous pemphigoid |
|
|
intra-epidermal split
|
pemphigus vulgaris & pemphigus foliaceus
|
|
|
anti-endomesial
|
Dermatitis herpetiformis
|
|
|
anti-desmoglein 3 = mucosal disease
anti-desmoglein 1 & 3 mucocutaneous disease |
pemphigus vulgaris
|
|
|
anti-desmoglein 1 = skin involvement only
|
pemphigus follicularis
|
|
|
anti-BP180/230
|
bullous pemphigus
|
|
|
thin walled flaccid bullae that appear on normal skin Nicolsky + 50-60's
|
pemphigus
|
|
|
tense bullae appearing on erythematous skin, Nickolsky -, 70's-80's
|
pemphigoid
|
|
|
actinic keratoses AKs(precancer)
basal cell carcinoma, squamous cell carcinoma |
non-melanoma skin caner
|
|
|
most common of all human malignancies
|
NMSC
|
|
|
small scaly skin patches flat patch pink/red/brown face/scalp, forearms, dorsum of hands
|
AK
|
|
|
cutaneous horn
|
hyperkeratotic outgrowth, from AK, BCC, SCC Wart,
|
|
|
topical therapy cryotherapy diclofenac gel...
|
ways to deal with AK's (actinic keratoses)
|
|
|
early stage SCC
|
ak
|
|
|
the trick for 5-fluorouacil treatment
|
is to illicit an immune response
|
|
|
use of ALA and blue light....
|
99% removal of acitinic keratoses
|
|
|
Pearly papule!
|
Nodular BCC
|
|
|
superficial BCC
|
pink well-defined slightly elevated papules or plaques, red, scaly, resembles dermatitis
|
|
|
nodular/micronodular BCC
|
dome-shaped maybe a central depressed ulcer
|
|
|
morpheaform
|
scar-like, indurated margins beyond the lesion. Mohs!~
|
|
|
ulcer center scaly poorly defined NMSC
|
SCC
|
|
|
pleomorphic keratinocytes confined to epidermis
|
SCC in situ
|
|
|
pleomorphic keratinocytes extending into dermis
|
invasive SCC
|
|
|
pleomorphic keratinocytes that rapidly grow spontaneously
|
keratoaconthoma
|
|
|
rapid enlarging nodule with crater-like center
|
keratoaconthoma
|
|
|
goals of NMSC treatment
|
complete cure, minimize scarring and reduce need for restorative procedures
|
|
|
whats the point of epinephrine use with lidocaine?
|
Epinephrine produces vasoconstriction reduces bleeding, makes anesthesia last longer
|
|
|
where should you avoid use of epi with lidocaine?
|
distal parts (fingers toes nose hose & ears)
|
|
|
max dose of lidocaine with epi?
|
7mg/kg
|
|
|
max dose of lidocaine without epi?
|
5mg/kg
|
|
|
get full thickness skin biopsy including lil subcutaneous fat
avoid in malignant melanoma |
punch biopsy
|
|
|
good for elevated lesions, use only if full thickness of tissue is not important, superficial piece of tissue for biopsy, seborrheic keratoses, benign nevi, wart
|
shave biopsy
|
|
|
things to use for a shave biopsy
|
lidocaine elevating lesion above surrounding skin, #15 surgical blade, smooth single stroke through
|
|
|
for an excisional biopsy you
|
biopsy entire lesion down to and including some subcutaneous fat
|
|
|
for malignant melanoma use
|
excisional biopsy
|
|
|
elliptical excision length to width ratio to avoid dog ears
|
3:1
|
|
|
liquid nitrogen boiling point
|
-196 degrees C
|
|
|
cryosurgery
|
treat superficial nonmalignent lesions, 5-13 sec to get 1-3 mm rim
|
|
|
complications of cryosurgery
|
hyperpigmentation, hypopigmentation (permanent), damage nerves, doughnut wart
|
|
|
removal of superficial lesions like BCC, SK, Pyogenic granulomas, warts
|
Electrodesiccation & Curettage
|
|
|
electrode contacts the skin, eee scarring
|
electrodesiccation
|
|
|
electrode held 1-2 mm from skin, less scarring
|
electrofulguration
|
|
|
scraping technique to remove soft tumors, smooth firm strokes pull the curette through the tissue
|
curettage
|
|
|
ED&C
|
for superficial skin lesions, small nodular BCC and superficial BCC
|
|
|
tissue sparing technique
|
Moh's micrographic surgery
|
|
|
Large lesions near nerves and morpheaform BCC, tissue preservation
|
MMS
|
|
|
sergical complications
|
infections, dehiscence(breaking open), scar formation, injury to nerves/blood vessels, lidocaine toxicity
|
|
|
superficial area of hyperkeratosis
|
callus
|
|
|
plantar warts are caused by
|
HPV
|
|
|
acute paronychia
|
lateral nail fold, bacterial
|
|
|
onychomycosis
|
itraconazole, caused by T. rubrum
|
|
|
on or between toes, kernal of keratin
|
corns
|
|
|
pit viper venom causes
|
angioedema, anaphylaxis, locl tissue dammage, coagulopathy, 2nd degree heart failure risk, toxicologist
|
|
|
equipment needed in office to deal with anaphylaxis
|
IV equipment, needles, tourniquet, oral airway, epi, antihistamine, steroids, O2, vasopressors, nebulizer
|
|
|
FIRST LINE treatment for anaphylaxis
|
epinephrine
|
|
|
adult epi treatment
|
.3mL-.5mL of 1:1000 epi in thigh every 5-10 min to control symptoms and increase BP
|
|
|
children epi treatment
|
.01 mg/kg maximum .3 mg dose of 1:1000
|
|
|
true or false, anaphylaxis always presents with cutaneous manifestations
|
False
|
|
|
true or false, idiopathic anaphylaxis is common
|
True
|
|
|
anaphylaxis pathogenesis
|
type 1 hypersensitivity, IgE mediated, anaphylactoid reaction is not IgE mediated
|
|
|
true or false, anaphylaxis is rare
|
false, its just under reported
|
|
|
potentially fatal allergic reaction that can happen anytime anywhere
|
anaphylaxis
|
