Dermatology Lecture – Flashcards
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Which antibiotics could be used to treat cellulitis in the previous picture? 1.Cephalexin (Keflex) 2.Cefadroxil (Duricef) 3.Amoxicillin (Amoxil) 4.Cefdinir (Omnicef)
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1. Cephalexin (Keflex) (methicillin sensitive staff infection). (MSSA). see them back in 48 hours. mark it with pen and if the redness is increased then change abx.
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Which antibiotics could be used to treat purulent cellulitis in the previous picture? Select all that apply. 1.Cephalexin (Keflex) 2.TMPS (Bactrim) 3.Doxycycline 4.Ceftriaxone (Rocephin)
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Staph infection: use Bactrim, Doxycycline do not use Rocephine-ceftrioxone or cephlexine to treat MRSA. MRSA is usually is purulent when it pus about then let it out, always purulent present, I&D is the first action. Doxycycline, Bactrim, clindamycin.
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When should you see a person in the office after cellulitis txmt or starting of abx?
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48 hours.
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A 20 year old plays in the college marching band. She has beenbitten on the practice field several different times by "mosquitoes". Today she presents with pruritic bites on her legs and arms consistent with mosquito bites. There is crusting around most of the bites. What condition does this describe? 1.Cellulitis 2.Pyoderma (impetigo) 3.Contact dermatitis 4.Bullous impetigo
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2.Pyoderma (impetigo). Example of staph infection. Gram +.
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What could be the cause of this? Select all that apply. 1.Poor hygiene 2.Elevated glucose levels 3.HIV infection 4.Inhaled steroid for asthma
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1.Poor hygiene 2.Elevated glucose levels 3.HIV infection What's the most likely pathogen?Staph
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Bites: Cat, Dog, Human
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Pasturella Gram negative, Staph, Strept
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A patient was bitten b y a dog about 2 hours ago. There are puncture marks and a small laceration on the right anterior thigh. What should be done at this time? Select all that apply 1.Clean and flush bite thoroughly 2.Prescribe amoxicillin-clavulanate for 7-10 days 3.Order tetanus,rabies prophylaxis if needed 4.Suture the lacerated area
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1. Clean and flush bite thoroughly not number 2 as we should only treat the patient propholaxis for only 3-5 days, not longer than that. 3.Order tetanus,rabies prophylaxis if needed 4.Suture the lacerated area-never do this one as bugs need to clear off
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Fungal Infections: Dermatophytosis
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Tinea capitis (head) •Tinea corporis (bodysurfaces) Tinea cruris ("jock itch") •Tinea pedis (foot) •Tinea unguium (nail
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What is commonly used to confirm diagnosis of fungal infections? 1. Clinical presentation 2.Response to treatment 3. KOH slide preparation 4.Fungal culture
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1. Clinical presentation, 3. KOH slide preparation
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Onychomycosis
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Fungal nail infection •Terbinafine 73-79%cure rate (treat for 6 -12 weeks) •Others are less effective •Watch for hepatotoxicity, drug-drug interactions •Topical are poorly effective
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A patient presents with a vesicular rash on the lateral neck with acute neuritis. This is: 1.bullous impetigo. 2.post-herpetic neuralgia. 3.motor neuropathy. 4.Varicella zoster virus
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4. Varicella zoster virus. known as shingles. it is darn common. we got exposed to the chicken pox virus, if something awakens it, what ever dermatome it harbors in then exacerbation happens only in that dermatome. Unilateral. Your trunk, thoracic region is loaded with nerve endings, therefore lot of pain is involved.
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HERPES ZOSTER (Shingles)
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A reactivation of the varicella-zoster (chickenpox) virus that has lain dormant in nerve cells. This involves the skin of a single dermatome or less commonly, several dermatomes
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Pharmacologic Management
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NSAIDs or narcotic analgesics for pain •Antiviral agents if patient presents within 72 hours of symptoms (acyclovir, famciclovir, valacyclovir) •Antiviral agents to all immunocompromised patients •Treatment Post Herpetic Neuralgia (PHN): TCAs, gabapentin, pregabalin (Lyrica), Capsaicin® cream, others
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What is the most common complication of herpes zoster infection? 1.Bacterial skin infection 2.Post-herpetic neuralgia 3. Motor neuropathy 4.Meningitis
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2.Post-herpetic neuralgia (PHN), it creates month or years of pain. Occures in 10-15% of the people and these patients are absolutely miserable for months and years.
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Herpes Zoster Vaccine
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-ACIP recommends for all immunocompetent (because its a live vaccine persons >60 years -32% of adults will have this once in lifetime -Reduces risk of shingles and post-herpetic neuralgia
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Systemic Lupus Erythematosus (SLE)
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more women then men in childbearing age. Chronic inflammatory disease that affects the skin, joints, kidneys, lungs, nervous system, serous membranes •Course is variable: characterized by remissions and relapses •More common in women in 20's, 30's
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Symptoms of Lupus: lupus on the inside such as joint aches, myalgias
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-Fatigue most common complaint (80-100% of patients) •joint aches(hands) and myalgias(90%) •Eye: keratoconjunctivitis sicca •Butterfly rash, malar rash (very prominent in the sun, its a photosensitive rash) -Discoid lupus: lupus on the outside, very distinct rash •Oral and nasal ulcers(12-45%): painless ulcers •Renal involvement: 50% •Hematologic: Leukopenia, anemia, thrombocytopenia •Gastritis, peptic ulcer
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A 25 year old female is suspected of having lupus. Lupus is characterized by: 1.thrombocytopenia. 2.anemia. 3.presence of Howell Jolly bodies. 4.production of antinuclear antibodies
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4.production of antinuclear antibodies (clue to order a test ANA, don't order without a good reason, because there are lot of false positive. if the titer is 1 to 160 that means something is going on, refer them to reheumotologist.
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Lupus: what diagnostic workup is required for the diagnosis of Lupus
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ANA positive with titer (1:160 or higher) Lots of false lupus positives and other diseases at lower titers (Sjogren's syndrome is dry mouth and dry eyes, scleroderma, RA, Mixed connective tissue disease, undifferentiated connective tissue disease, others Refer to rheumotologise
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Acne Rosacea? Chronic what is the treatment for it? topical metronidazole
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orally: tetracycline, it is a chronic condition.
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SKIN CANCER:Squamous Cell Carcinoma (SCC) Locations: Sun exposed areas oHead and neck 55% oDorsum of the hands/forearms: 18% oLegs: 13% oShoulder, back: 4% oLower lip is common location in smokers, scrape it gently with a tongue blade, and common characteristic of squamous cell is that it bleeds very easily.
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Head and Neck anything exposed to sun Presents as papules, plaques, nodules, smooth, hyperkeratotic or ulcerative lesions •May bleed easily •Definitive diagnosis always with biopsy or excision of specimen
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Basal Cell Carcinoma: 40X more common than squamous cell
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Common in fifty and sixty year olds •Most common sites are head and neck •Usual appearance is pearly domed nodule with overlying telangiectatic vessels, later, central ulceration and crusting •Occurs 40x more common than squamous cell •Particularly common in Caucasians •Uncommon in dark skinned populations •Most important risk factor is sun exposure •Definitive diagnosis always with biopsy or excision of specimen •Presentations: nodular, superficial, other presentations •70% occur on the face •Nodular: Typically present on face as a pink or flesh colored papule
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Malignant Melanoma ABCDE pneumonic(AAD, ACS) ABCDE pneumonic (AAD, ACS)
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A=asymmetry •B=border is irregular •C=different colors within the same region •D=diameter>6mm (pencil eraser) •(in whites primarily on lower legs and back; in African Americans, on hands, feet and nails) •E =Enlargement (evolution)
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Glasgow 7-point Checklist
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Major Features: Change in size, color, shape (Refer for any major feature) -Minor Features: Presence of inflammation oBleeding or crusting oSensory change oLesion diameter > 6mm
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ITCHY THINGS A 66 year old male has Parkinson's disease. What is a common skin manifestation of this? 1.Atopic dermatitis 2.Seborrheic dermatitis 3.Contact dermatitis 4.Dyshidrotic eczema
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Seborrheic dermatitis
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Seborrheic dermatitis:Dermatological Disorders How might this manifestation be described? 1.Maculopapular 2.Extremely pruritic 3.Scaly, greasy 4.Burning
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Scaly, greasy
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What is seborrheic dermatitis of the scalp termed?
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Dandruff
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Atopic Dermatitis(eczema)
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Clinical diagnosis,pruritis is predominant symptom •Clues: chronic and recurring •Family history of allergic disease (Asthma, allergic rhinitis runs together with Atopic dermatitis.
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Contact Dermatitis:
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Trigger induces an immune response (T cell media ted response) •May be allergic or irritant-induced •Example: Poison ivy It means we need to give a systemic agent: oral steroid, or oral antihistamine.
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Dyshidrotic Eczema (pompholyx or dyshidrosis)
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Vesicular dermatitis •Intensely pruritic •Chronic •Involves palms, soles what else should be in differentials: Scabies.
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Itchy Things: Systemic
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Renal, liverdisease •Connective tissue disorders •Post-herpetic neuralgia •Multiple sclerosis •Psychogenic itch •Burns/Scar
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PSORIASIS: its always bilateral, silvery scalses
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Plaque psoriasis , always itching most common variant
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Pharmacologic Management for Psoriasis
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Emollients to hydrate skin luberaderm, Eucerin. •Topical steroids(lowest strength that eradicates symptoms) for small places. •Methotrexate •Systemic agents prescribed by derm **always use low potency steroids, use it <5 days, never use longer than 5 days especially on the face.
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A topical steroid may be most appropriately delivered to the thin skin of an older adult via a(n) 1. gel (3) 2.cream.(2) 3.ointment.(4) 4. lotion (1)
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4.lotion vehicle: is what you place the drug in, Gel would be way too much potent, lotion would way less potent. Older adults should be used the weakest vehicle. treating something on scrotum use lotion 1. lotion 2. cream 3. gel 4. ointements.
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Which organism listed below may be diagnosed using the "scotch tape test ape" test? 1.Pinworms 2.Bed bugs 3.Pubic louse 4.Scabies
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1.Pinworms
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A patient has scabies. Which contacts listed below should be treated? Select all that apply 1.Household contacts 2.Sexual contacts 3.Office mates 4.Close personal contacts
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1.Household contacts 2.Sexual contacts 4.Close personal contacts
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What Dermatologic conditions are these associated with? Honey colored crusts
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Impetigo
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Herald patch
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Pityriasis rosea (PR)
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Christmas tree pattern rash
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Pityriasis rosea (PR)
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Burrows
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scabies
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Well circumscribed lesion found on the trunk
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Tinea corpus, or PR or Hives
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Sandpaper textured rash
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Strep infection
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Pearly domed nodule
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basal cell carcinoma
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Bright, beefy red rash
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Candida Albicanas
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Silvery scales
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Psoriasis
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Bull's eye lesion
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lyme disease
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Nits
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head lice
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Plaques
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psoriasis
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Dermatomal rash
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Shingles (varicella Zoster)
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Butterfly rash
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Lupus
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Tinea Versicolor:
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Tinea versicolor is typically visualized during the spring and summer months when a patient has become tanned. The areas that are infected do not tan and so become very noticeable. The chest and back are common areas to observe tinea versicolor. There can be 100 or more in some infections. This can be treated with ***topical selenium sulfide or an oral antifungal agent****.
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Dyshidrotic dermatitis
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small vesicles on the lateral edges of his fingers and intense itching. On close inspection, there are small vesicles on the palmar surface of the hand.
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Basal Cell Carcinoma: P: Pearly papule U: ulcerating T: telangiectasia O: on the face, scalp, pinnae N: Nodules slow growing
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Slow growing perlie or waxy apperence nodules wth relatively distict border.
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Squamous cell carcinoma: N: nodular O: opaque S: sun exposed areas U: ulcerating N: non distinct borders
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can arise from actenic keratosis, red conical hard lesion with or without ulceration, less distict border.
