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Where do you find acanthosis nigricans?
Cutaneous manifestation of hyperinsulinemia. Moist, velvety found neck, axilla, also may have skin tags in same area.
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Recluse spider bite lesion?
Red, white, blue. Core is blue necrotic
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Tinea Unguium?
Onychomycosis, tinea of nail
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Tinea capitis?
Scalp. See alopecia patches
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Tinea Manuum?
Tinea of hands
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Tinea Pedis?
Athletes foot. Moist and stinky or dry and scaly.
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Tinea versicolor?
Pityriasis Versicolor.
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Pityriasis alba?
Hypopigmentation
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What does KOH slide provide?
Diagnosis for tinea and other dermatophytes. Will see hyphae and spores.
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What is noted in Pityriasis rosea?
"Herald Patch" may need antihistamines
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What does pityriasis mean?
Pityriasis commonly refers to flaking (or scaling)of the skin.
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Acne Rosacea what is it and what can it lead to?
Chronic facial acne, may lead to rhinophyma of nose with irregular bulbous thickening
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What exacerbates Acne Rosacea flares?
Flushing in response to ETOH, sun, cold, skin products, wind, etc
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Tinea Barbae?
Tinea of Beard
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Acne Vulgaris?
Plain old acne
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Acne Conglobata?
highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tract
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Tinea Corporis/ Tinea circinate?
Ringworm. Ring-like pruritic rash
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Tinea Cruris?
Jock itch. Red, pruritic rash with fine scales
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Characteristics of candidal groin infection?
Bright red rash with satellite lesions
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Intertrigo?
Bright red diffuse rash, indicative of bacterial infection
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Anthrax lesion?
Starts as inflammatory papule, becomes necrotic
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How does Silvadene (Silver sulfadiazine) work?
It is bactericidal. Acts on cell membrane and cell wall.
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How does silver nitrate work?
Bacteriostatic.
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How does one get an Orf skin ulcer?
Contact with sheep or goats, parapoxvirus transmits across species
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How do you diagnose candidiasis?
KOH stain
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What is a Kopick's spot?
A buccal mucosal lesion that appears before skin rash of measles
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How do you identify clubbing?
See thickening and broadening of ends of fingers. Bulbous appearance with swelling of terminal phalanges.
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What degree of change is noted in nailbed/digit angle in clubbing?
Increase from 160 to 180 degrees
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Where do you find a Podagra lesion?
It is gout of the great toe, from hyperuricemia causing uric acid crystal deposit
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What food causes gout exacerbation?
High purine foods, such as organ meats.
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What drugs are contraindicated in gout?
Salicylates. They block renal excretion of uric acid
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What happens if itch continues to occur during the week after lice treatment?
Most likely due to inflammatory reaction to lice bites causing itch
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What is an annular lesion?
Ring shape lesion
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What is acral location?
Located on an extremity
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Rash of scarlet fever?
Diffuse erythema sandpaper rash texture
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Toxic shock syndrome rash?
Diffuse, sunburn like erythroderma
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Meningococcemia rash?
Nonn confluent, discrete papules, erythematous
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What lesions can be pustular?
Acnes, folliculitis, candidiasis,
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What are the characteristics of Lichen Planus?
"5 P's": well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle
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What does long term use of topical corticosteroids cause?
Cutaneous atrophy, telangiectasis, easy bruise-ability
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Name for infection of hair follicle that causes abscess and what microorganism causes it?
Furuncles (boils), Carbuncles. Staph aureus.
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How does topical corticosteroids work?
Decrease inflammation and allergic reaction and cause vasoconstriction.
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Potency classes number range of Corticosteroids?
Class 1 is highest potency. Class 7 is lowest.
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Where is Hydrocortisone in the class range for corticosteroid?
Low potency
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Where is triamcinolone in the class range for corticosteroid?
Low potency
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Where is Betamethasone in the class range for corticosteroid?
High Potency
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What drugs can induce acne?
Lithium, phenytoin
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Topical Vitamin A concerns?
Need to use sunscreen
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What drug treats acne Rosacea?
Metronidazole topically
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Oral Accutane side effects?
Elevated triglycerides, elevated LFTs, depression, suicide, teratogenic
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What should Accutane be taken with?
Highly lipophilic, eat with fatty foods
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Restrictions on Accutane RX for women?
Only one month supply, no refills, be on BCP
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What is another name for an open comedone?
Black head
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Closed comedone alternate name?
Papule
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Treatment for minor acne?
Benzoyl peroxide
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Treatment for moderate acne?
Oral tetracycline
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Treatment for severe cystic acne?
Accutane
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How do you treat a cat bite?
Can cause Pasteurella multocida infection, give Augmentin x 10 days, culture wound, and don't suture shut
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What is the rule of 9s for burns? And what is a good 'ruler'
To tell percent of BSA of burn. The palm of the hand is 1% BSA
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What are BSA burn calculations that are 4.5%
4.5% is face, or posterior head, or front of arms, or back of arms
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What are BSA burn calculations that are 9%
9% is front of leg or back of leg
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What are BSA burn calculations that are 18%
18% would be entire chest or entire back
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What is another name for atopic dermatitis?
Eczema, at type I hypersensitive RXN
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What are examples of immunomodulators?
Pimecrolimus (Elidel) and Tacrolimus (Protopic)
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What is immunomodulators mechanism of action?
Block T cell stimulation by antigen presenting cells and inhibits mast cell activation.
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Side effect of immunomodulators drugs?
Cancer
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What does a positive Tzanck smear show and what is it positive for?
Giant Multinucleated cells. Herpetic lesions.
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Infection of Herpes in what Cranial Nerve can cause blindness?
Cranial Nerve #5, the ophthalmic branch of trigeminal nerve can cause result in corneal blindness.
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What can clue you in to the fact that you have herpes on CN 5?
Herpetic lesion will be noted on tip of nose
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What location of lesions carry highest incidence of post herpetic neuralgia?
Trigeminal and brachial plexus. Followed by thoracic and then LS areas with lower risks.
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Other than location of lesion, what other things cause higher chance of post herpetic neuralgia?
Severity of lesions, intense prodrome, and age >80
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What drugs are indicated on post herpetic neuralgia treatment?
Pregabalin (Lyrica) TCAs, (amitriptyline), Gabapentin
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What is the Zoster Vaccine? And what population is it indicated for?
Live attenuated varicella zoster virus to protect elderly against Shingles. Indicated in adults >60
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What happens at a cellular level with Psoriasis Vulgaris?
Accelerated mitosis and rapid cell turnover causes decreased skin maturation and keratinization
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What is the Goeckerman regimen used for and what does it entail?
Psoriasis. UV light therapy with coal tar 2 times a day
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Where is seborrheic Dermatitis noted?
Skin areas with high sebaceous glands. Ears, scalp, eyelid margins, nasolabial fold, upper trunk
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Treatment for seborrheic dermatitis?
Low dose topical steroid during flare. Ketoconazole.
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Surgical procedure for skin cancer removal?
Mohs micrographic surgery
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How much compression should be on venous stasis ulcer?
30-40 mmHg
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What is urticaria?
Hive eruptions. Typically in response to allergen. Itchy, and raised.
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What combination of symptoms is seen in anaphylaxis?
Wide spread urticaria, vasodilation, angioedema and bronchospasm
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What virus causes verruca vulgaris warts?
HPV 1, 2, 4
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What would you prescribe if you weren't sure if a skin infection was gram positive or gram negative or wanted to cover for both?
Bactrim plus add a beta lactam, such as a cephalosporin
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What can mimic CA MRSA wound?
The spider bite of the brown recluse spider. It has more of a red, white, and blue. Red being halo. Blue being internal necrotic spot.
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What is contained in the Dermis?
Blood vessels, sebaceous glands, and hair follicles
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What is contained in the subcutaneous layer?
Fat, sweat glands, hair follicles
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What happens on the epidermal layer?
Melanocytes are there, vitamin D synthesis occurs, top layer has keratinized cells
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What is a xanthelasma and who might you see this in?
Deposit of cholesterol under skin of eyelid. Seen in those with hyperlipidemia.
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Melasma?
Mask of pregnancy. Tan cheeks and forehead
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Xerosis?
Inherited skin disorder causing extremely dry skin
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Xerostomia?
Extremely dry mouth
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Xerophthalmia?
Extremely dry conjunctiva
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Where would you note the Koebner Phenomenon?
Skin lesions occurring along traumatic areas, sometimes noted in psoriasis
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What is an Auspitz sign?
If remove psoriatic plaque, will see punctate bleeding
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What is Rhus Dermatitis?
Rash due to position ivy, oak, etc
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What is noted in hidradenitis Suppurativa?
Staph aureus bacterial infection of sebaceous glands of axillae and groin with sinus tracts and scarring
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Treatment for Hidradenitis Suppurativa?
Augmentin or dicloxacillin x 10 days
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Another name for Stevens-Johnson's syndrome?
Erythema Multiform Major
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What causes Stevens-Johnson's syndrome?
Sever hypersensitivity reaction to medications, viral or fungal infection or malignancies
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What medications can cause Stevens-Johnson's syndrome?
Dilantin, PCNs, and Sulfas
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What is characteristic lesions of Stevens-Johnson's syndrome?
Multiple lesions abruptly erupt, hives, blisters, bullae, petechiae, hemorrhagic lesions, with extensive mucosal surface involvement including airway.
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What area of skin does dermatophytosis affect?
Superficial keratinized tissues of skin, nails, and hair
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Rule of thumb about pruritic rashes that are worse at night?
Scabies until proven otherwise
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What is a lesion covered in fine silvery scales called?
Psoriasis
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What is a herald patch and what is it associated with?
Christmas tree rash noted in Pityriasis Rosacea that then progresses to a diffuse exanthem rash.
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What is an Exanthem?
A wide-spread rash
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Another name for seborrheic dermatitis?
Dandruff
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Cautions with oral antifungals?
Assess for hepatotoxicity with LFT checks. Careful of other CYP 450 3A4 enzymes.
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What areas of body absorb the highest amount of topical medication?
Genitalia
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Crust, Primary or secondary lesion?
Secondary. Crust forms after a primary lesion has opened and dried
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