Derm exam 1

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Derm exam 1
2014-03-01 14:38:12
Derm exam

derm exam 1
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  1. What is this
    acne vulgaris

  2. what is this
    scarring cystic acne

  3. what is this
    pomade acne

  4. what is this
    acne rosacea

  5. what is this

  6. what is this
    hidradenitis suppurative

  7. what is this
    acne keloidalis nuchae

  8. what is this
    epidurmal inclusion cyst

  9. what is this
    pilar cyst

  10. what is this
    seborrheic dermatitis

  11. what is this
    nummular eczema

  12. what is this
    atopic derm

  13. what is this
    chronic plaque psoriasis

  14. what is this
    guttate psoariasis

  15. what is this
    pustular psoariasis

  16. what is this
    pityriasis rosea

  17. what is this
    seborrheic keratosis

  18. what is this
    cushings syndrome

  19. what is this
    acanthosis nigricans

  20. what is this

  21. what is this

  22. what is this
    atrophy from overuse of topical steroids

  23. what is this

  24. what is this
    Kaposi sarcoma

  25. what is this
    asteatotic eczema
  26. what can cause adrenal suppression in an infant
    hydrocortisone under the diaper
  27. what are 2 examples of natural occlusion
    groin and axilla
  28. what are 3 effects of topical steroids
    anti-inflammatory, vasoconstriction and anti-mitotic
  29. A circumscribed, flat discoloration…generally less than 1 cm
  30. a macule that is greater than 1 cm
  31. An elevated solid lesion up to .5 cm in diameter; color varies; may become confluent and form plaques
  32. A circumscribed, elevated, superficial, solid lesion more than .5 cm in diameter, often formed by the confluence of papules
  33. A circumscribed, elevated, solid lesion more than .5 cm in diameter; a large nodule is referred to as a tumor
  34. A circumscribed collection of leukocytes and free fluid that varies in size
  35. A circumscribed collection of free fluid up to .5 cm in diameter
  36. A circumscribed collection of free fluid more than .5 cm in diameter
  37. A firm edematous plaque resulting from infiltration of the dermis with fluid; these are transient and may last only a few hours
    Wheal (hive)
  38. Excess dead epidermal cells that are produced by abnormal keratinization and shedding
  39. A collection of dried serum and cellular debris; a scab
  40. this is a localized, dramatic, and rapid swelling of the lips, eyes, genitalia, hands, or tongue and may lead to anaphylaxis
  41. how do you treat angioedema
    • IM or PO benadryl
    • PO steroids
    • epi 1:1000 for anaphylaxis

    *if angioedema, need to monitor at least 24 hrs
  42. this is an inflammation of blood vessel wall that causes leakage of RBCs, may have palpable purpura, vesicles and points of necrosis, and is associated with fever, malaise, myalgia, or arthralgias
    leukoclastic vasculitis
  43. what are the dependent areas of leukoclastic vasculitis
    • lower legs
    • arms
    • back and sacrum in the bed bound pts
  44. how is leukoplastic vasculitis tx
    • stop suspected meds
    • treat underlying condition
    • prednisone 60-80mg and taper over 3-6 weeks
  45. this vasculitis affects children and teens, is more common in the spring, is a vasculitis of venules with palpable purpura and hives.
  46. what is the distribution of HSP
    • legs
    • buttocks
    • occasionally arms and abd
  47. this vasculitis is due to a hypersensitivity reaction, may be preceded by an illness by 1-3 weeks (RUI, strep with IgA deposits)
  48. this affects young adults, they complain of fever, malaise, and burning of lesions. On PE you see target lesions that are a red macule with central color change, the mucus membrane lesions are vesiculo-bulious, and coalesce to involve large areas
    Erythema multiforme
  49. this is an immune complex dz that damages vasculature causing tissue necrosis
    erythema multiforme
  50. this is a direct toxic effect for pts on medications for seizures (MC) and/or gout, it is preceded by a URI with prodrome and malaise. The pt will present with blistering and erosion of mucous membranes
  51. this has a fever as the MC prodromal symptom, also assoc with HA, URI, ST, with a sudden onset of red tender skin, conjunctivitis/stomatitis. The pt will present with a generalized red macular "sunburn" look, and may have Nikolsky's sign
    toxic epidermal necrolysis
  52. what are the common causes of toxic epidermal necrolysis
    • sulfa
    • dilantin
  53. what is the tx for TEN and what is the #1 reason for death
    tx in burn unit

    #1 cause of death is infection
  54. this can be caused in post-partum women, post C-section, nasal packing and nasal staph carriage, diaphragm use, and post-op (Most cases). the pt will have a diffuse scarlet fever-like rash, will have desquamation of palms/soles, conjunctival injection and a strawberry tongue. Pt will have a fever >102, rash and HoTN
  55. what are the dx criteria for TSS
    • fever >102
    • rash
    • mucous membranes (vag, oral, conj) involvement
    • HoTN
    • multisystem involvement
  56. how is TSS tx
    • Beta-lactamase resistant anbx
    • oxacillin
    • nafcillin
    • cefoxitin
    • vanc/clinda IV 3-5 days then PO x 2 wks
  57. what is the management for drug eruptions
    • stop meds
    • antihistamines
    • PO or topical steroids class III-V
    • be on alert for SOB (anaphylaxis)
  58. this psoriasis is worse in the winter, develop lesions related to trauma "koebnerize", and may have psoriatic arthritis
    chronic plaque psoariasis
  59. a pt presents to your clinical c/o red discrete flat topped, persistent plaques and papules, with a thick silvery scale on his extensor surfaces (knee/elbow, presacral and groin area). To dx this you scrape the scales and cause pinpoint bleeding known as the Auspitz sign. What is your dx
    chronic plaque psoariasis
  60. this is common in young adults, it is a rapid onset post strep/viral illness and may be pruritic. On PE of a pt with this, you will notice a tear-drop, diffuse scattered psoriasis with multiple tiny discrete red papules with a thick white scale on their trunk and proximal extremities (maybe knees/elbows also). what is your dx
    guttate psoriasis
  61. what is the tx for guttate psoriasis
    • throat cx to r/o strep
    • UVB 6-8 weeks
    • PCN or erythromycin for 10 days
    • keep moist with creams
  62. this type of psoriasis has deep seated pustules in the middle of the palm or sole of foot, they do not rupture, they dry up and harden and then fall off.
    pustular psoriasis
  63. a baby is brought into the clinic with the mom c/o fine white/yellow greasy flakes on the childs head. There is no erythema, but she states the baby seems to itch at it. On PE you notice an annular rash with raised edges and red papules. What is the dx
    seborrheic derm
  64. this is common in pts with allergies, atopy, asthma, or sinusitis, it flares with seasonal pollen, stress or illness. On PE you will notice erythema progressing to papules and plaques with flaking, xerosis, cracks, fissures, and excoriations. what is the dx
    atopic derm
  65. this has multiple tiny deep seated vesicles, tapioca lesions on the palms and lateral aspects of fingers and hands or feet with surrounding erythema. The vesicles are very itchy and sometimes painful. The vesicles dry and are replaced with scales that crack and then fissure. what is the dx
    dyshidrotic eczema (pompholyx)
  66. what is the management of dyshidrotic eczema (pompholyx)
    • avoid water, irritants, trauma
    • use bland emollients
    • use a potent steroid (make sure to wean)
    • if infx use anbx (dicloxacillin, erythro or cephalexin)
    • hydroxyzine (atarax)
    • cold wet compresses
    • PUVA
  67. this is known as the winter itch, it more common in the elderly and c/o an itch more than a rash. on PE you will see dryness or xerosis, cracking and flaking with minimal erythema. Usually is located anterolateral lower legs
    asteatotic eczema
  68. this occurs in the same spot every winter, has intense itching, is a coin-shaped or "discoid" eczema, are a 1-2cm discrete and round intensely erythematous plaques that flake and scale.
    nummular eczema
  69. what is the management/tx of nummular eczema
    • correct dryness of skin and environment
    • potent steroids for 4-6 weeks
    • antipruritic PRN
  70. this has plaque-like nodules and discrete papules, can lead to cracks and fissures and excoriations. It is a defense mechanism against recurrent trauma to skin and can lead to hyperpigmentation
    lichen simplex chronicus
  71. what are the convenient areas of lichen simplex chronicus for pts to scratch
    • arms, legs
    • anogenital area
    • upper back
  72. this is seen in young adults usually in the spring and fall. It has a sudden onset and resolves in 6-8 weeks, it is self-limiting and may be recurrent. A pt will present with a herald patch with round to oval salmon colored lesions. It usually is located on the trunk and follows a Christmas tree pattern. what is the dx
    pityriasis rosea
  73. what is the management for pityriasis rosea
    • topical steroids
    • antihistamines
    • oral steroids
    • UVB up to 2 weeks
    • erythro 250mg QID for 2 weeks
  74. what are the 6 p's of lichen planus
    • pruritic
    • planar (flat)
    • polygonal
    • purple
    • papules/plaques
    • persistent
  75. this usually has intense itching, with lesions that flare without any cause. They persist but then fade. The primary lesion is 2-10mm and is assoc with Wickhams striae (white lacey pattern on lesion). Usually on the acral- hands and feet, ankles and wrists. They are also erosive and painful
    lichen planus
  76. what are the most common types of irritant dermatitis
    • diaper derm
    • occupational-hand
  77. what is the most common cause of allergic contact dermatitis
  78. a pt presents to the clinic c/o a very red inflamed and swollen vesicle/bullous. Upon exam you notice it is very exudative and crusty and the pt cant stop itching it. You ask if the pt recently had anything new touch the skin in that area and she says she was wearing a ring made of nickel at the time of eruption. what is your dx
    allergic contact derm
  79. this type of acne is assoc with the onset of puberty, may have papules, pustules, nodules/cysts if inflammatory or open/closed comedones if non-inflammatory.
    acne vulgaris
  80. what are the 3 components of acne vulgaris pathogenesis
    • plugging-retention at top of hair follicle
    • increased sebum production and increased "sticky" nature
    • occluded oil-proliferation of propionibacterium acne which breaks down sebum to free fatty acids which are irritating
  81. how is comedone acne vulgaris tx
    • retinoids
    • benzoyl peroxide
    • isotretinoin
    • sulfur
    • salicyclic acid
    • azelaic acid
    • alpha hydroxyl acid
  82. how is sebum producing acne vulgaris tx
    • retinoids
    • antiandrogens
    • low dose OCP
  83. how is P acne of acne vulgaris tx
    • antibiotics
    • retinoids
    • benzoyl peroxide
  84. how is inflammation assoc acne vulgaris tx
    • oral anbx
    • retinoids
  85. how long should you wait to re-evaluate acne once tx has started
    4-8 weeks
  86. if you notice a pt is having scarring acne vulgaris how is it treated
  87. this causes small non-inflamed papules and comedones on the forehead, temples, and sides of face. it is common is adult females that use hair products
    pomade acne
  88. this affects older people (30-40s thru old age), pt will come in c/o redness, enlarged nose, and swelling of the cheeks and forehead. It only affects the mid-face malar area. it is usually seen in fair skinned ppl that have more oily skin and are easily flushed.
    acne rosacea
  89. what is the causative agent of acne rosacea
    mite (demodex folliculorum)
  90. what is the tx for acne rosacea
    metrogel BID (active against mite)
  91. this is due to hypothyroidism, you will see pretibial area thickness with raised, rough, waxy palques. May see an orange peel appearance.
  92. a pt presents with central obesity, a buffalo hump, and moon facies to you clinic. You also notice that there is muscle wasting at the distal extremities and bright purple striae on their skin. What is the dx
    cushing syndrome
  93. what is the cause of cushing syndrome
    • dysfxn of the adrenal axis
    • Iatrogenic administration of PO corticosteroids or overuse of topical steroids (MC)
  94. what labs are used to test for cushing syndrome
    overnight dexamethasone suppression test
  95. a pt presents to the clinic c/o a weird dirty looking like rash on his armpit. On PE you notice it has a velvety texture to it. What is your dx
    acanthosis nigricans
  96. if you notice acanthosis nigricans on a child what must you screen for
  97. what can cause acanthosis nigricans in an adults
    • obesity
    • hereditary
    • process of puberty
  98. what is the number one worry if an adult has acanthosis nigricans
    malignancy (#1 site is the stomach)
  99. this are a superficial, flat yellow, plaques around the eyes. What is it associated with

  100. these are yellow/red papules or nodules on the extensor surfaces of the elbows/knees or palms. What is it assoc with

  101. what is the tc for xanthoma/xanthalasmas
    • low fat/low calorie diet
    • stop smoking
    • exercise
    • rx for dyslipidemia
  102. this can be seen in young adults c/o fatigue, malaise, SOB, cough, and weight loss. It is non-fatal but waxes and wanes. On PE you see asymptomatic hyper/hypopigmented macules, papules, or plaques with an annular configuration. what is the dx and what is the work-up for it

    brochoscopic bx confirms dx
  103. this is usually seen in older men (legs, GI bleed and leukemia). The pt will have purple-blue to red papules that decrease in size with firm pressure and increases back to normal size on release. They tend to scale then ulcerate and bleed. What is it and how is it dx
    Kaposi's sarcoma

    bx- proliferation of blood vessels with neoplastic endothelial cells

    * do not have to have AIDS/HIV to have this
  104. which herpes virus is Kaposi sarcoma
  105. this is a discrete raised rough or hyperkeratotic papules to plaques. They are often verrucous and the skin is colored brown to black. It has a stuck on appearance and is greasy. what is it
    seborrheic keratosis
  106. this is usually seen in the middle age-eldery pt that have sun damage to their skin or a family hx of it. Its origin is due to proliferation of immature keratinocytes and are usually pigmented bc of the transfer of melanin into the keratinocytes
    seborrheic keratosis
  107. if a pt has seborrheic keratosis, what must be be careful about
    dark lesions.. need to r/o malignancy such as melanoma if there are darker colored lesions
  108. this vehicle is most lipophilic, moisturizing, and occlusive. It has a translucent, greasy feeling on skin, provides more lubrication, has greater penetration/increased potency, but too occlusive for acute eczematous inflammatory for the groin, rectal, axillary areas
  109. this vehicle has a white color, greasy texture, it may cause irritation and allergy, has a high versatility (used almost anywhere), is cosmetically acceptable, may cause possible drying with long term use. Is useful for groin, rectal and axillary areas
  110. this vehicle has a greaseless, clear, jelly-like consistency, it is useful for acute exudative inflammation, and good for use on the scalp
  111. these vehicle are useful for scalp dermatoses and in other areas of acute eczematous inflammation such as poison ivy and plaque psoriasis

    • Do not use if <12 yoa
    • do not use longer than 2 weeks
  112. the are the least lipophilic topical steroids and can be very drying
    • solutions
    • sprays
  113. these vehicles can be clear or milky, are useful on the scalp, drying in the groin, rectal and axillary areas and may cause stinging
    • solution (alcohol)
    • lotions (water)
  114. these vehicles are good for the scalp, moist lesions, convenient with decreased mobility
  115. what may increase barriers for absorption of topical steroids
    • thick scales
    • lichenifications
    • thicker skin areas
  116. what may decrease the barriers for absorption of topical steroids
    • abrasions
    • cracking
    • fissuring
    • atrophy
    • keratolytic agents
    • propylene glycol
  117. what are some local SE of topical steroids
    • burning and itching
    • hypopigmentation
    • purpura
    • atrophy
    • striae
  118. what are the 5 most common mistakes when Rx topical steroids
    • #1 is the steroid is too weak for the process and area
    • not enough med is given
    • failure to f/u on tx
    • too strong on kids
    • too strong on face