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447 Cards in this Set
- Front
- Back
What are the 3 types of acquired nevi? Please describe
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Junctional: Begin at the dermal-epdermal junction -flat
Compound: found at dermal-epidermal junction- elevated or dome like Dermal: Found in the dermis - More pedunculated |
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describe a small congenital nevus (size and malignancy potential)
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<1.5cm and low malignant potential
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describe a medium congenital nevus (size and malignancy potential)
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1.5-19.9 cm and malignant potential is questionable and are often prophylactically removed to be sure.
can depend on the location of the nevi, if easily observed then can just monitor. If in a difficult to monitor place, just get that bad boy out |
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describe a large/giant congenital nevus (size and malignancy potential)
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5% or greater of body of greater than 20cm, definite increased risk with melanoma. Treatment is to remove if possible.
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this nevi is normally not going to be malignant and gets its color from the Tyndall effect. What is this? What is the Tyndall effect?
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Blue Nevus
TE=Scattering of light that depends on the depth of the pigment |
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what is a dysplastic nevi? what does it look like?
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sign of increased cancer risk, has irregular borders (not round) and dark pigmentation. Often biopsied to determine whether they are a melanoma. Classic FRIED EGG APPEARANCE.
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A patient has a hamartomatous growth of smooth muscle fibers leaving a large brown macule with a patch of hair. What is this? what can it be associated with?
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Becker's Nevus
Can be associated with hypoplasia of ipsilateral limb or breast |
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What is the most common type of melanoma, and where is it located?
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Superficial Spreading Type Melanoma
Found most often on the back of males and the legs of females. |
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2nd most common melanoma and is commonly very aggressive, often resemble other skin lesions.
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Nodular Type Melanomas
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Lentigo Maligna is what? cause?
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an often non aggressive melanoma.
known as 'liver spots' by old people due to sun |
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melanoma occuring around the nails, palms, and soles (normally on the foot). VERY aggressive, and the only type of melanoma seen in pigmented races. What is this?
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Acral Lentiginous Melanoma (ALM)
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What is a Hutchinson's Sign? What does ti show?
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Dark band in the nail and proximal nail fold , indicates an ACRAL LENTIGINOUS MELANOMA
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What is the Breslow depth? used for what?
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Granular layer (stratum granulosum) to the deepest portion of the malignant cells
This is the determinant of the prognosis of the melanoma: >1mm in depth is recommendation for sentinel lymph node biopsy. |
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when do you get a sentinel lymph node biopsy? What is this?
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when Breslow depth is greater than 1mm
this is getting rid of the lymph node that the melanoma is most likely to spread to |
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What are the ABCDE's of melanoma?
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Asymmetry -
Border Color – multiple colors Diameter (>6mm) Evolving – changing over time (especially if the patient notices) |
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what happens to the epidermal cell cycle time in psoriasis?
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decreased by a factor of 8 (turns over faster)
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what is Auspitz sign? what do you see this with?
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bleeding upon removal of a scale
psoriasis |
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what % of population is affected with psoriasis?
**TEST |
2-3%
|
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what moderates Psoriasis? (cause)
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T cells
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what is Kebnerization (sp)
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trauma leads to psoriasis formation in a person who is predisposed
Examples: Pt gets a tattoo, breaks out in psoriasis when a skin graft develops psoriasis person scratches one place of psoriasis and it leads to more |
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Reiter’s Triad?
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Urethritis, Conjunctivitis, Arthritis
and PSORIASIS OF THE PENIS (ballinitis) ouch! ouch! ouch! |
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Reiter's Disease is associated with what genotype?
*MUST KNOW |
HLA B27
|
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HLA B27 is the genotype for what disease?
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Reiter's Disease
|
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What drugs trigger psoriasis? 2
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Lithium
Beta Blockers |
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discuss how guttate psoriasis will respond to treatment
***TEST what caused this again? |
1.3 will clear and never have psoriasis again
1/3 will clear and get psoriasis again 1/3 will progress cause: upper respiratory strep pharengitis |
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what causes guttate psoriasis?
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upper respiratory strep
pharengitis |
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Patient has Urethritis, arthritis, ocular, oral, and skin lesions (psoriasis).
what does this person have? |
Reiter’s Disease
associated with psoriasis |
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on a gram stain, how will staph a look?
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they are gram positive cocci
they will be little purple balls in CLUSTERS |
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on a gram stain, how will strep pyogenes look?
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they are gram positive cocci
they will be little purple balls in CHAINS learning tool: strep-strip-chain |
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What is erythema multiform associated with (not what directly causes its activation, but what is the underlying cause)
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herpes simplex
mycoplasma |
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what normally causes Steven Johnson's and Toxic Epidermal Necrolysis? #1?
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drug reaction
anti-convulsants |
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what determines if you have SJS vs TEN?
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< 10% BSA = SJS
10% - 30% = SJS-TEN > 30% = TEN |
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what is a positive Nikolsky's Sign?
seen in? |
Epidermal detachment reproduced by mechanical pressure on an area of erythematous skin
SJS & TEN |
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what must be involved for the diagnosis of SJS?
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oral mucosa + 2 or more sites
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Erythema Nodosum
caused by most often? what is it? where does it affect? what type of biopsy would you use for this? |
Commonly caused by birth control pills,
tender ill-formed bruise-like spots. (inflammation of the fat) punch mutha ucka |
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what is the characteristic lesion of small vessel vasculitis?
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PALPABLE PURPURA
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you see PALPABLE PURPURA, what does the person have?
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small vessel vasculitis
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you have a young child, who recently had an upper respiratory infection and severe abdominal pain. they also have palpable purpura. What does this patient have?
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Henoch-Schonlein Purpura
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how long does uticaria last for (hives)
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<24hours, no scale, no scar remains!!!
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Angioedema?
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swelling and no itching
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what is Seborrheic Dermatitis? caused by?
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Chronic, inflammatory disease
due to yeast (malassea furfur) |
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if you see salmon colored plaques, what should you be thinking
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Pityriasis Rosea
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if you see plaques with islands of sparing, what should you think?
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Pityriasis Rubra Pilaris
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you have a patient with Benign, usually asymptomatic, distinctive, self-limiting patches. The etiology is unknown but possibly viral. You see a Collarette scale
what is this? |
Pityriasis Rosea
|
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What is a Herald Patch? What is it seen in?
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first lesion, usually the largest (pts think it was ringworm)
Seen In: Pityriasis Rosea |
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a patient comes in with Lesions are oriented along skin lines giving the appearance of a Christmas tree. What do they have?
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Pityriasis Rosea
|
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a patient has many of the signs of Pityriasis Rosea. You should do a history though to see if the pt has?
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secondary syphilis
|
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what are the 5 P's
what are they for? |
papules, purple, polyangular, planar. puritic
Lichen Planus |
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what is Lichen Planus associated with?
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Association with viral hepatitis
|
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if you see Wickham's striae, what does the patient have?
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Lichen Planus
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If a patient has a painless chancre what do they have? what is this?
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1º Syphilis
its a painless erosion |
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patient comes in with Copper Penny oval papules and plaques on the palms. whats this ucka have?
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2º Syphilis
|
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what is the most infectious lesion with secondary syphilis? describe
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Condyloma Lata
Ooze fluid filled with spirochetes Flesh colored smooth, papillated, cauliflower like vegetations Occur on genital and perianal areas |
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what is the most infectious stage of syphilis?
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2º Syphilis
|
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what is the treatment for Syphilis ?
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PENICILLIN G or DOXYCYCLINE (100mg)
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11 criteria of SLE
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MD SOAP BRAIN
M – Malar Rash D – Discoid Lesions S – Serositis O – Oral Ulcers A – ANA P – Photosensitivity B – Blood (Hematologic abnormalities) R – Renal abnormalities A – Arthritis I – Immunologic (other autoantibodies) N – Neurologic (Seizures, Psychosis) |
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which type of lupus do you expect a negative ANA in?
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Discoid Lupus
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you see a scale that penetrates down into the follicular orifices creating a “carpet tack” appearance. what does this person have?
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Discoid Lupus
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lupus with atrophy, hypopigmentation and scarring is what kind of lupus?
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discoid lupus
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SS-A (Ro) is usually positive
SS-B (La) may be positive what disease are we talking about? |
Subacute Lupus Erythematosus
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does Subacute Lupus Erythematosus spare the knuckles?
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yeah
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Dermatomyositis vs. SCLE
which affect knuckles? |
Dermatomyositis
|
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patient has ANA positive with anti-histone antibodies
what do they have |
Drug Induced Lupus Erythematosus
|
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child has Annular and polycyclic lesions. what is this?
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neonatal lupus
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what is associated with neonatal lupus?
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3rd degree congenital heart block
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if you have a woman with Dermatomyositis what MUST you look for?
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ovarian cancer
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you have a patient who has lost strength in the proximal muscles and has a heliotrope rash. What do they have?
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dermatomyositis
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if you see heliotrope erythema of eyelids, what do you have
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dermatomyositis
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if you see Gottron's papules, what does your patient have? what are they
|
Dermatomyositis
Round, smooth, violaceous/red, flat-topped papules that occur over the knuckles and lateral aspects of the digits Spares the area between the knuckles (Lupus spares the knuckles) |
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if you see the autoantibody anti-Jo-1 antibody what does the patient have?
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dermatomyositis
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what is the most common cause of death in scleroderma?
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Pulmonary Dz
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What is Raynaud's phenomenon, what is it seen in?
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Vasospastic disorder precipitated by temperature changes
(blue fingers) seen in sclerosis |
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what is CREST syndrome?
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syndrome-variant of systemic scleroderma with the most favorable prognosis (limited systemic involvement)
Calcinosis cutis Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia |
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what are Anticentromere antibodies is associated with?
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CREST
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if you have ANA to Type II collagen what do you have?
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Relapsing Polychondritis
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Relapsing Polychondritis
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Primarily effects cartilage
Autoantibody to Type II collagen Redness, swelling and pain of cartilaginous portion of the ear – spares the lobe |
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Morphea
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Localized scleroderma
One or more circumscribed areas of purple discoloration--> progresses to a thickened, firm, hairless, ivory patch |
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Sjogren’s Syndrome
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Autoimmune disorder that primarily affects secretory glands
DRY |
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do discoid lesions scar
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roger roger
what's your vector Victor |
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if you see IgA deposits in the upper dermis what does the person have?
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dermatitis Herpetiformis
|
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if you see gluten-sensitive enteropathy what might your patient also have
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Dermatitis Herpetiformis
|
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if you see Anti-endomesial antibodies
what does the pt have |
Dermatitis Herpetiformis
|
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which disease has an intraepidermal split?
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PEMPHIGUS
|
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IgG autoantibodies directed against the cell surface of keratinocytes destroy the adhesion between epidermal cells
What does this person have |
PEMPHIGUS
we were told about IgG with BP..which is what you may have been thinking. but note that it said between epidermal cells. remember that pemphigus is intraepidermal while BP is subepidermal |
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dude comes in with oral lesions, he says his predominant symptom is he "hurts". He has underyling lymphoma. What does this guy have?
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PEMPHIGUS
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Autoantibodies to Desmoglein 1 and 3 correlate to what
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Pemphigus Vulgaris
|
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if you see only desmolein 1 what do you have?
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pemphigus foliaceus (lesser form of pemiphigus)
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dude comes in in a wheelchair with an EMT behind him from the nursing home. He is frail and covered in blisters all over the place. What symptom bothers you the most? This shit itches me like a motha ucka he says.
Whats this guy got? |
Bullous Pemphigoid
|
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if you see BP230 and BP180 autoantibodies, what does this person have?
|
Bullous Pemphigoid
|
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Bullous Pemphigoid effects where?
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SUBEPIDERMAL
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what happens during the migratory phase in wound healing? 2
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angiogenesis and Epithelialization
|
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what cells flatten out to cover a wound?
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basal cells
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what contributes to contraction to pull the wound edges together to reduce defect? how long does this process last?
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myofibroblasts
12-15 days |
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Please summarize the 4 phases of wound healing
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Inflammatory
Migratory Proliferative Scar Remodeling |
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what happens in the inflammatory phase of wound healing (3)
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Hemostasis/vasoconstriction
Vasodilation Phagocytosis |
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what happens in the proliferative phase? 2
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Fibroplasia
Contraction |
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vitamin C is necessary for what process? deficiency leads to?
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wound healing
scurvy |
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Zinc toxicity inhibits ...?
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macrophage migration and phagocytosis—so be careful not to overdose!
|
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what does a zinc deficiency lead to?
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inhibits cellular proliferation and granulation tissue formation
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what is Zinc necessary for?
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Necessary co-factor for DNA and RNA synthesis
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what do steroids do to wound healing?
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INHIBIT ALL ASPECTS
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if you have someone on long term steroids, what can you give the patient in order to reverse the negative effect?
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Vitamin A
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in diabetes, what is risk of infection like compared to a normal person?
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Infection 5 times normal population
|
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Simple lacerations
Surgical incisions Most dog bites Kitchen knife wounds are example of wounds that can be closed by... |
primary intention
|
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if you have loss of soft tissue, contaminated wound left open what kind of wound healing would you have?
|
secondary intention
|
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if you have a wound with considerable granulation tissue that has to heal on its own, what type of healing is this
|
secondary intention
|
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Puncture wounds
Superficial abrasions Most ulcers Snake bites what type of wound closure does this use? |
secondary intention
|
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if you have a wound left open for 4-5 days, and is grossly contaminated, what type of wound closure do you use?
|
tertiary (you wait til the tissue looks a bit better after you clean it, then you sew that bad boy up)
|
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Uncontrollable hemorrhage (Pack and pressure)
Acute wounds with questionably viable tissue or with foreign bodies Human Bites! |
tertiary intention
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when do you use absorbable versus non absorbable sutures?
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Absorbable: inside the body
Non-Absorbable: outside the body |
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what do you use to flush out wounds? do you use peroxide, iodine, or povodine in a wound?
|
NORMAL SALINE
none of that other ish, that stuff hurts the wound |
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how long do you keep removable sutures in the skin?
what about in the face? |
7-10 days
face: 3-5 |
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what is the most common type of cancer?
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BCC
|
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basal cell carcinoma is mostly caused by what?
|
UV light
|
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the second most common type of skin cancer with the potential to metastasize with a high cure rate if caught early is what?
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SCC
|
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what are Actinic Keratosis?
|
are the earliest lesion in the development
pre-cancer with potential to lead to SCC |
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if you have a slow growing, rarely invasive carcinoma, that occurs in sun-exposed area what do you think you have? Where is it contained?
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Squamous Cell Carcinoma in situ
in the epidermis |
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if you have invasive skin cancer where does it go down to?
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the dermis
|
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what is a Keratoaconthoma
|
variant of SCC with potential for local destruction and metastasis
Rapidly enlarging nodules with a crater-like center Can involute spontaneously |
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Pt comes in, says they didn't have the lesion 6 weeks ago, and now its there. It rapidly developed, and then involuted. What did the patient have?
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Keratoaconthoma
|
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pearly papule with central ulceration is what?
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Nodular BCC
|
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what treatment is most appropriate for superficial lesions, cheap, but can leave a scar?
|
ED&C
|
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what is the treatment Most appropriate for superficial lesions
Currently recommended for superficial BCC’s and AK’s |
Aldara
|
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why use epinephrine with lidocaine? 3
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Reduces bleeding
Slows absorption of lidocaine Anesthesia longer lasting |
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when do you not use epinephrine with lidocaine ?
|
digital block
|
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what are the dosages for lidocaine toxicity with and without epi?
|
7 mg/kg max dose of lidocaine with epi
5 mg/kg max dose of lidocaine without epi |
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what type of biopsy do you use if you want to measure all the thickness of the skin (dermis, epi, fat)?
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Punch biopsy
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For a rash, what kind of biopsy do you use?
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Punch biopsy
|
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if you have an elevated lesion, and you are not worried about full thickness of the tissue, such as seborrheic keratoses, what type of biopsy would you use?
|
shave biopsy
|
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if someone has a melanoma what type of biopsy do you use?
|
Excisional Biopsy
|
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a Biopsy of entire lesion down to and including some subcutaneous fat
Most useful for biopsy of malignant melanoma is what type of biopsy |
Excisional Biopsy
|
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for an Excisional Biopsy, you need to do an elliptical excision. What does the length to width ratio need to be?
|
Length to width needs to be 3:1 to avoid dog ears
|
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Can heal with scarring
Hyperpigmentation Hypopigmentation Damage to nerve endings Doughnut wart these are all complications of what? |
Cryosurgery
|
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Electrodesiccation vs. Electrofulguration
touches skin? |
Electrodesiccation
|
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Electrodesiccation vs. Electrofulguration
works deeper? |
Electrodesiccation
|
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Tissue is removed in stages and mapped out to ensure complete removal of tumor
tissue is spared. What technique does this describe? |
Moh’s micrographic surgery
|
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Facial lesions in locations for higher risk of deep invasion
Large lesions Recurrent lesions Poorly differentiated SCC Morpheaform BCC Poorly demarcated border |
Moh’s micrographic surgery
|
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what is Dehiscence? What do you have to do after this occurs?
know |
when the surgical margin comes apart
have to let it heal by secondary intention |
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What can be used to confirm the presence of a fungal organism on the skin?
|
All can be identified by microscopy, aided by KOH digestion and simple staining
|
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What is Pityriasis (or tinea) versicolor? What kind of disease is it
|
this is a superficial fungal disease
chronic, mild infection of stratum corneum, results in scaly lesions. No inflammatory response. |
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a patient comes to you with splotchy looking skin with noted depigmentation/pigmentation at the site of growth. They also have scaly lesions. What does this patient likely have?
|
Pityriasis (or tinea) versicolor
|
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What causes Pityriasis (or tinea) versicolor?
|
Caused by Malassezia furfur ,
aka Pityrosporum orbiculare, ovale |
|
Your nurse hands you a slide from another physician and asks you to identify what the patient has so she can give the proper treatment. Under the scope with a KOH stain it looks like spaghetti and meatballs. What do they have?
|
Malassezia furfur: Pityriasis (or tinea) versicolor
fungi and yeast together |
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A patient comes in with itchy skin that fluoresces under the Wood's lamp. Under KOH microscopy you see fungi and yeast together, what do they have?
|
this is likely spaghetti and meatballs soooo
Malassezia furfur: Pityriasis (or tinea) versicolor |
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a patient comes in with non-scaling, non-inflammatory brown lesions on their hands. What do they have?
|
tinea nigra
|
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what causes tinea nigra
|
Exophiala werneckii
|
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what two things do you use to treat tinea nigra?
|
Salicylic acid,
Benzoic acid |
|
Itraconazole/ketoconazole, Selenium Sulfide, and Pyrithione zinc are all used to treat what?
|
Malassezia overgrowth
|
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what is black/white piedra?
|
infection on external hair
shaft, forming either black nodules (Piedraia hortae) or white nodules (Trichosporon beigelli). |
|
outside of the common cold, waht is the most common infectious agent in the world?
|
Trichophyton rubrum
|
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what causes tinea imbricata? what is it'?
|
Trichophyton concentricum
concentric rings of scales over trunk, legs, forearms |
|
what are the 2 types of tinea capitis?
|
ectothrix (conidia outside of hair shaft),
or endothrix (conidia inside of shaft) |
|
tinea unguium
|
fungal infection of the nails, causing thickening, fissuring,
colorization (brown, white, yellow). Trichophyton rubrum, T. mentagrophytes, Fusarium sp., Candida sp |
|
azoles, tolnaftate , terbinafine, and griseofulvin are all used to treat?
|
tinea unguium
|
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a patient comes in with wart-like cauliflower pigmented lesions of the foot. He likely has
|
chromoblastomycosis
|
|
after jumbling up your unlabeled slides (you clumsy doc you) you pick one up at random. You start looking at it and see copper penny spores, so you know this came from a patient with...
|
chromoblastomycosis
|
|
what is sporotrichosis
|
rose thorn disease) - ulcerative papule, spreads via
draining lymph channels, nodular granulomas, chronic |
|
today is not your day. you keep mixing up slides! you look at one and see asteroid bodies, so you know the patient has
|
sporotrichosis (rose thorn disease)
|
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what is the cause of sporotrichosis (rose thorn disease)
|
Sporothrix schenckii
|
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a man returns from a trip to the jungle and has reported stepping on something. Since then, he has small painless papules and nodules on his foot. What does he have?
|
mycetoma (Madura foot
|
|
what is mycetoma (Madura foot)
|
infection via thorns and
splinters. Small, painless papules and nodules, sinus tract formation leads to spread, deeper tissue infiltration. Can lead to bone destruction over a period of months/years. |
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if a person is not treated for mycetoma (Madura foot, what is a long term problem that can occur?
|
Can lead to bone destruction over a period
of months/years. |
|
a patient comes in with vasicular pustular eruptions on fingers/hands due to fungal infection
what are these? |
Ids
|
|
what is the major role of Langerhan's cells?
|
antigen-presentation to T cells
|
|
Allergic contact dermatitis is what type of reaction?
|
type IV HS
|
|
what mediates allergic contact dermatitis?
|
T cells (remember type IV HS)
|
|
patient comes in with large tense blisters in the legs and armpits. You see deposits of IgG and complement C3 at the dermal-epidermal junction. What does this patient have?
|
BULLOUS PEMPHIGOID - sub epidermal blistering disease
|
|
what type of blistering disease is BULLOUS PEMPHIGOID -
|
sub epidermal blistering disease
|
|
what kind of blistering disease is PEMPHIGUS?
|
intraepidermal blisters
|
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what type of blisters are seen with DERMATITIS HERPETIFORMIS
|
sub epidural
|
|
patient comes in with a hepataform lesion on the elbows, knees back and buttocks. There is IgA antibody at the dermal-epidermal junction and complement deposits. What does he have?
|
DERMATITIS HERPETIFORMIS
|
|
what disease is DERMATITIS HERPETIFORMIS associated with?
|
celiac sprue
Gluten-sensitive enteropathy |
|
if you see IgA antibodies at the dermal-epidermal junction what should you be thinking?
|
DERMATITIS HERPETIFORMIS
|
|
What is the Auspitz sign?
|
you scratch off a scale and a drop of blood appears on the skin
|
|
what cytokine causes keratinocytes to proliferate like mad?
|
IL-22 (produced by TH 17)
|
|
The cutaneous lesions of plaque psoriasis usually show four prominent features:
(***THESE FEATURES YOU SHOULD KNOW***) |
1) Lesions are sharply demarcated with clear-cut borders.
2) The surface consists of non-coherent silvery scales. 3) Under the scale, the skin has a glossy homogeneous erythema. 4) Auspitz sign is present within a few seconds of removing a scale, small blood droplets appear on the erythematous surface. |
|
what is the cause of thrush? what are the populations you see it in?
|
Candida Albicans
Infant Adolescent/Adult Geriatric |
|
what is phenotypic switching?
|
there are huge banks of genetic information within the colony of fungi, so they can use alternate sets of genes depending on their environment
|
|
What is the most common cause of thrush for geriatric patients?
|
not cleaning the dentures
leads to denture stomatitis (effects gums/palate) |
|
what will happen to pH of the vagina due to yeast infections? how is this helpful?
|
it normally goes down
this can help be diagnostic because with bacterial the pH goes up |
|
where does systemic candidiasis almost always originate from?
|
GI candida
|
|
70% of all women will be infected with this at some point. What is the cause?
|
Vaginitis (Vaginal Thrush)
candida |
|
a baby comes in with a large red rash around the butt, what do they have?
|
cutaneous candidiasis (diaper rash)
|
|
what type of agar do you use for the detection of staph?
|
Mannitol salts agar
because they Grow in presence of high concentrations of salt (NaCl > 7.5%) |
|
S. Aureus
Coagulase: +/-? |
+
|
|
Staph saprophyticus causes what kind of infection?
|
urinary tract
|
|
besides providing cell shape/rigidity, what does peptidoglycan do? (with respect to leukocytes)
|
Serves as a chemoattractant for polymorphonuclear leukocytes
Activates complement by the alternate pathway (C3b) |
|
how does gram positive bacteria lead to shock?
|
lysis of the bacteria
peptidoglycan and lipoteichoic acids lead to the release of inflammatory cytokines which will eventually lead to shock |
|
what is Protein A and what is its job? what is it on?
|
protein embedded in the cell wall of staph a
anti-opsonin effect Binds the Fc portion of IgG leaving the Fab portion free to bind with specific antigen |
|
what is Fibronectin-binding protein (FnBP)
|
promotes binding to mucosal cells for staph a
|
|
what is catalase? why is it important?
|
breaks down hydrogen peroxide [H202] (producing water and oxygen)
released by staph can be used to determine if staph over strep |
|
please compare free and bound coagulase
|
Free = released from cell -->clot formation;
Bound = on cell surface --> agglutination |
|
what property of the microcapsule slime layer of staph have?
|
ANTIPHAGOCYTIC
|
|
abscess formation is associated with what
|
staph infection
due to coagulase |
|
what is an enterotoxin?
|
exotoxin secreted in the GI tract
there are 6 types (A,B,C,D,E, G) Resist gut enzymes and low pH Found in 30-50% of strains Most common kind of food poisoning in U.S. Ingestion → vomiting and diarrhea within 2-6 hours |
|
you have a 30 people show up with explosive vomiting and diarrhea, they all claim to have come from the same picnic, what is the cause?
|
enterotoxins release from staph (likely aureus)
|
|
what 2 exotoxins behave as superantigens?
|
Toxic Shock Syndrome toxin
Enterotoxin |
|
what are superantigens?
|
bind on the side of the binding site btw a MCH and T cell
lead to unregulated T-cell activation leads to serious damage due to release of cytokines in toxic amounts |
|
what is the number 1 cause of bacteremia?
|
Staphyloccus aureus
|
|
endoccarditis can be caused by which staph?
|
Staphyloccus aureus
|
|
where do you most often encounter staph on the body?
|
25-50% colonize external nares
|
|
what causes Scalded skin syndrome? what population is it normally seen in?
|
Epidermolytic toxins A and B (released from staph a)
normally in infants |
|
if you have a pt with an abscess, what is an important non pharmacological treatment?
|
incision and drainage
|
|
what is the most common community acquired strain of staph a?
|
USA300
|
|
USA300 has what that makes it so strong?
|
Panton-Valentine-leucocidin (PVL)
pore former |
|
what do we use to treat USA300 normally?
|
Sulfonamides: Blocks synthesis of dihydropteroic acid
trimethoprim: Blocks synthesis of tetrahydofolate |
|
a man gets a new hip from replacement surgery, he ends up getting an infection of the joint. what is the cause of this infection?
|
Staphylococcus epidermidis
|
|
Strep. pyogenes
Hemolysis type? |
Beta
|
|
strep neumonae uses what type of hemolysis
|
alpha hemolysis
|
|
beta hemolysis
|
clearing
is a complete lysis of red cells in the media around and under the colonies: the area appears lightened and transparent |
|
gamma hemolysis
|
no hemolysis
|
|
alpha-hemolysis
|
is present the agar under the colonies is dark and greenish
aka you will see greening |
|
S. agalactiae
hemolysis type? |
Beta
|
|
Entercoccis faecalis
hemolysis type? |
gamma
|
|
Group A Streptococci (Streptococcus pyogenes) have a capsule made of ?
|
hyaluronic acid
adds to virulence |
|
What are M proteins? Seen on?
|
structural virulence factors for Group A Streptococci (Streptococcus pyogenes)
Anti phagocytotic |
|
Scarlet fever is caused by what?
|
Strep. pyogenes
|
|
invasive infections of wounds are associated with what?
|
Strep. pyogenes
|
|
Erysipelas is what?
|
infection of layers between skin seen in Strep. pyogenes
|
|
Rheumatic fever is caused by what
|
group A strep
Strep. pyogenes URI initiated |
|
what is scarlet fever ?
|
Erythrogenic toxin produced by lysogenic Grp A streptococci causes rash
|
|
a patient comes to you with a rash on their tongue. when they stick it out, their tongue appears to look like a strawberry. what does this person have? caused by what?
|
scarlet fever
Erythrogenic toxin produced by lysogenic Grp A streptococci causes rash |
|
f a patient with a group A strep caused infection from a wound was left untreated, what could potentially develop?
|
glomerular nephritis
|
|
What is Exotoxin A? what releases it?
|
Causes ADP-ribosylation of elongation factor 2 → inhibits protein synthesis
released by Pseudomonas aeruginosa (gram negative) |
|
what causes ecthyma gangrenosum?
|
Pseudomonas aeruginosa
|
|
a patient has cystic fibrosis pneumonia and gets an infection, what is it likely due to?
|
Pseudomonas aeruginosa
|
|
A patient comes to your office complaining of an ear ache. He states that because it is summer he has been spending a great deal of time in the pool. You can likely diagnose _____ due to ______
|
otitis externa (swimmers ear) due to Pseudomonas aeruginosa
|
|
The guys from time machine hot tub all come to your office complaining of a weird rash that has appeared on their butts. Putting aside all their freaky exploits, what do you start thinking based on the amount of time they spent in the hot tub
|
folliculitis caused by Pseudomonas aeruginosa
|
|
patient presents with a swollen and inflamed pinna of the ear. She has green-colored pus with a fruit like odor. She reports having had her ear pierced 2 days prior. What is the likely etiologic agent?
|
Pseudomonas aeruginosa or staph aureus
|
|
a patient comes in with symptoms that are similar to pseudomonas but the oxidase test is negative. what is likely the cause?
|
Acinetobacter (either anitratus or baumanii)
|
|
you are working in Iraq with wounded soldiers. A patient presents to you with an infection that appears to be multiple drug resistant. What are you thinking is the problem?
|
Acinetobacter baumanii
|
|
If you are bed ridden, what type of bacterial increase will you have?
|
have increased Gram-negative rods (replacing the normal gram positive seen in the mucousal membranes)
|
|
what is decubitus ulcer?
|
pressure related injury (not moved you develop this)
mixed infection of Staphylococcus aureus, Streptococcus pyogenes |
|
an infant comes to your office with swelling around the eyes, what do they likely have?
|
cellulitis due to Haemophilus influenzae
|
|
diabetes foot, cellulitis, and primary syphilis are all examples of what
|
exogenous infections
|
|
what is an endogenous infection?
|
may become infected from the blood stream or by direct extension of an infection site deep within the tissues
|
|
secondary syphilis, gangrene, and meningococcemia are examples of what?
|
endogenous infections
|
|
Impetigo is caused by what ?
|
Grp A strep & S. aureus
|
|
what causes Necrotizing fasciitis
|
Mixed anaerobic and facultative organisms Grp A strep
|
|
what causes cellulitis? where does it affect?
|
Grp A strep and/or S. aureus
dermis/fat |
|
what causes bullous impetigo?
|
staph a
|
|
a patient comes in with what appears to be a rash caused by candidia. you shine a wood's lamp on it and it is coral red in appearance. what does the person have?
|
Erythrasma
|
|
what is Sycosis Barbae? cause?
|
Infection of coarse hairs of the beard (Staphylococcus aureus)
|
|
what causes Furunculosis or boils
|
Staphylococcus aureus
|
|
A 47-year-old woman presents to her primary care physician with a several-year history of chronic skin infections and painful, 1- to 3-mm red pustules in her groin. Many of the pustules have broken and are draining a foul-smelling, puslike fluid mixed with blood. You recognize inflammation of the apocrine sweat glands. What does this person have and what is the cause?
|
Hidradenitis Suppurativa (Staphylococcus aureus)
|
|
patient has one finger that is red and a clear line is moving up the arm. What does the patient have, and what is the cause?
|
Lymphangitis
(Streptococcus pyogenes) |
|
a patient has a rapidly spreading bacteria on the face that can move within hours causing tissue destruction. What does this person have. Caused by?
|
Cellulitis due to flesh eating bacterium (Streptococcus pyogenes)
|
|
if you see a cat or a dog bite what should you be thinking?
|
Pasteurella multocida
|
|
An otherwise healthy, 7 1/2-year-old girl had a two-week history of a swelling behind her left ear. She had no systemic illness and noted no improvement with a course of amoxicillin–clavulanate. Examination revealed a red, tender, retroauricular fluctuant lymph node measuring 2 by 2 cm behind her left earlobe. No other lymph nodes were enlarged. The child remembered being scratched by a cat two weeks earlier, shortly before the mass appeared.
what is this? |
Bartenella henselae (cat scratch disease)
|
|
full blown anaphylaxis include what 4 things
|
urticaria (hives), and/or angioedema,with HoTN and bronchospasm.
|
|
what type of HS rxn is anaphylaxis?
|
Type I
|
|
what mediates anaphylaxis?
|
IgE
|
|
is an anaphylactoid reaction IgE mediated?
|
no
substances cause a direct breakdown of the mast cell and basophil membrane |
|
with anaphylactoid reaction do you have to be pre-exposed, or do you get it on first contact?
|
it can occur on first exposure (this is the major difference from anaphylaxis)
|
|
radiopaque contrast media, fluorescein, NSAID’s, thiamine, opiates cause what kind of reaction?
|
Anaphylactoid reaction
|
|
1/3 of anaphylactic episodes are triggered by ...
|
FOOD
|
|
what is the difference in upper and lower respiratory response to anaphylaxis?
|
Upper Respiratory: Congestion, rhinorrhea, sneezing, itchy eyes, tearing of eyes, conjunctival injection
Lower Respiratory: Bronchospasm, throat/chest tightness, hoarseness, wheezing, SOB, cough, hypoxia |
|
for an adult, where is the best place to give epi?
|
IM or SC in the THIGH
|
|
what dosage of diphenhydramine (benadryl) do you give to an adult as 2nd line treatment
|
50-100mg
|
|
describe the symptoms of a bite from a coral snake
|
described as anticlimactic. There is little or no pain or swelling at the site of the bite, there may be no obvious bite marks, and other symptoms can be delayed for 12 hr. However, if untreated by antivenin, the neurotoxin begins to disrupt the connection between the brain and muscles,--the earliest symptoms may begin as nausea, vomiting and sweating, then as the neurotoxin continues to disrupt things it may cause lethargy, slurred speech, dble vision, drooping eyelids, difficulty swallowing and muscular paralysis—eventually leading to respiratory or cardiac failure
|
|
a patient gets bitten by a pit viper, what happens at the site of bite?
|
Hemorrhagins cause vascular leaking leading to local and systemic bleeding
|
|
for a snake bite patient do you want to apply suction, ice, incision, or tourniquets?
|
NO
|
|
a patient says he was bitten by something but doesnt know what. the bite shows blanched circular patch w/surrounding red perimeter and central punctum. what bit this person?
|
black widow
|
|
what does the neurotoxin do from black-widow spiders?
|
The toxin is of the latrotoxin type and it can trigger a massive exocytosis from presynaptic nerve terminals in a variety of neurosecretory cells. Acetylcholine, norepi, dopamine, glutamine and enkephalin systems are all susceptible to the toxin.
|
|
bites from a brown recluse spider can become what?
|
necrotic
|
|
a patient says he was bit by a spider that was in his dresser. he didn't think much of it at the time, but now it formed a blister, then develop a dark depressed center over the ensuing 24-48 hr, culminating in a dry eschar that subsequently ulcerates
what bit him |
brown recluse
|
|
patient comes in with a pustule and says doc I got bit by a spider. You ask if they have seen the spider to get a better idea. they say they didn't actually see any spiders. what do you think they might have (ON TEST)
|
community acquired MRSA
Methicillin-resistant Staphylococcus aureus |
|
if in the field, what is the best way to treat a snake bite? 4 things
|
1. apply pressure/immobilization bandage (help to prevent/slow the spread of the toxin
2. apply elastic wrap like you would a sprained ankle. They recommend wrapping away from the heart first then toward the heart. Get as low as you can and go as hi as you can . Then place a splint over this. 3. Keep the patient quiet and inactive—do not let them get up and walk around 4. Keep the limb a little below heart level |
|
What are plantars warts?
|
skin—caused by HPV. Plantar warts grow on the plantar, or bottom, surface of the feet.
They tend to be found in areas of pressure, eg heel and ball of foot. Plantar warts often grow into the deeper layers of skin because of the pressure they receive d/t their location |
|
a patient comes to you with a wart on the bottom of their foot. you see small black dots on the wart. what does this patient have? what caused it? what are the black dots?
|
Plantar Warts
HPV dots=thrombosed capillaries |
|
SPINGOMYELINASE D activates complement, induces keratinocyte apoptosis, and neutrophil chemotaxis. What releases it?
|
Brown Recluse
|
|
if you are looking at a stain and you see multinucleated giant cells (synctia) what are you looking at?
|
Herpesvirus
|
|
is reactivation normally symptomatic or asymptomatic? are they transmissible?
|
they are often asymptomatic but still transmissible
|
|
what is responsible for maintaining the latent state of herpes viruses?
|
Latency-associated RNA transcript,
continually expressed, influence cellular functions. |
|
what is one of the most frequent causes of encephalitis?
|
HSV 1
|
|
what is one of the most frequent causes of meningitis
|
HSV 2
|
|
which HSV causes conjunctivitis? 1, 2, or both?
|
HSV 1
|
|
which HSV causes genital herpes? 1, 2, or both?
|
both
|
|
primary clinical presentation of herpes simplex virus type 1?
|
nfection of the mouth (Gingivostomatitis)
babies get it from kisses and whatnot |
|
what is Herpes labialis
|
cold sores”;lips, reactivation of latent virus (due to disease, trauma), recurrent (adolescents/adults).
|
|
what is keratoconjunctivitis? what is it seen in?
|
pinking of the eye, due to herpes
can be recurrent can leave scars on the cornea |
|
an infant is brought to you with red spots and patches especially around places of eczema and dermatitis. you see these on the face and especially around the mouth. what do they likely have
|
eczema herpeticum
|
|
what is herpetic whitlow? who is affected
|
herpes acquired by docs who didnt wear gloves while treating ppl with herpes
see it on the finger can be seen in babies who suck their thumb |
|
a patient comes to your office with a few lesions on the hands, tongue and buttock. the lesions look like bulls-eyes or targets. what do they have?
|
erythema multiforme
associated with Herpes |
|
in erythema multiforme is virus found in the lesion?
|
no, it is strange
they detect viral protein and nucleic acid, but no whole virus |
|
what is auto-inoculation of herpes?
|
it is the fact that it can spread either from mouth to genitals or vice versa
|
|
where does varicella-zoster virus sit dormant?
|
in neurons of the spinal cord
|
|
an adult male comes in with painful rashing that starts midline on the stomach and spreads in a line to the back...what does your patient have?
|
herpes zoster (shingles)
|
|
infections of herpes varicella-zoster virus leads to what?
|
CHICKENPOX NOT SHINGLES
|
|
what are the 2 ways you can contract chickenpox?
|
Droplet (respiratory) transmission, contact with lesions
|
|
infant presents with a high fever for about 2 days. after being watched in the ER to make sure no serious damage has occured the fever subsides and a rash appears. what is going on with the child?
|
they have HHV 6 (known as Roseola)
|
|
what leads to Kaposi's sarcoma?
|
HHV 8
|
|
a patient presents with a spindle cell tumor on the surface of the skin. It is brownish to deep red (noting that it is highly vascularized) what does this person have, and what causes it?
|
Kaposi's sarcoma
HHV8 |
|
what is Molluscum Contagiosum
|
poxvirus skin infections
bump filled with cheesey material can be contracted sexually (seen in teenagers) |
|
a teenage male presents in your office with a large bump on the skin. He claims that he tried to "pop it like a zit" and a white cheesey material came out. upon questioning you find out the teen is sexually active. What is your diagnosis?
|
Molluscum Contagiosum
|
|
you normally lose 15ml/hr with intact skin, with a full burn how much do you lose?
|
200ml
|
|
what do burns lead to 4
|
Loss of vascular integrity
Increased capillary permeability Increased interstitial fluid volume Diminution of blood volume |
|
primary cause of burn for 3-14
|
flame
|
|
primary cause of burn for 15-60
|
industrial accidents
|
|
60+ primary cause of burn?
|
accidents
|
|
80% of all burns occur?
|
in the home
|
|
first degree burn depth?
2nd? 3rd? |
Epidermis
partial thickness into dermis full thickness through dermis and into or through adipose layer |
|
what type of burn is associated with erythema, pain, minimal edema, and dry?
|
1st
|
|
how do you treat first degree burn?
|
remove clothing
apply cool compress soothing lotion (optional) |
|
what forms with a 2nd degree burn?
|
bulla (blisters)
|
|
pt comes in with bulla, edema, mottled red or pink skin, moist, and painful. what degree burn do they have?
|
2nd
|
|
if you have greater than 10% of body surface area affected, how do you treat 2nd degree burn?
|
do not cool them down (can lead to hypothermia)
send to hospital |
|
a patient comes to you with a burn that is dry, white/charred, leathery in appearance and almost painless
what type of burn is this? |
3rd
|
|
a burn that Penetrates through the entire dermis and will result in a great deal of edema is what kind of burn
|
3rd
|
|
please list the ABCDEs of the primary survey for burn
|
Airway and C-spine control
Breathing Circulation Disability : mini-neurologic exam Exposure : undress the patient |
|
what is a homograft vs a xenograft?
|
homograft (cadaver)
xenograft (pig) |
|
if you can feel a radial pulse, what is systolic BP
femoral? carotid? |
80
70 60 |
|
for fluid replacement, how much do you give (parkland formula)
|
2-4 ml IV solution/kg body weight/% BSA in 24 hours
give half over the first 8 hours give rest of next 16 |
|
describe AMPLE for the secondary survey
what is this for? |
A - allergies
M- medications P - past history L - last meal E - event for burn |
|
how do you figure the % burn surface area?
|
use the anterior surface of the palm of the patients hand
|
|
what is the rules of nine?
|
used for extent and depth of the burn
head: 4.5 in front 4.5% in back arms: 4.5 in front 4.5% in back legs: 9% front 9% back chest: 18% |
|
pt has a burn that is Full thickness > 5 % BSA
what do you do |
transfer to burn unit
|
|
pt has a burn that is Partial thickness > 20 % BSA
what do you do |
transfer to burn unit
|
|
pt has a burn that is associated with fractures or other major injuries
what do you do |
transfer to burn unit
|
|
what % full thickness burn is required for hospitalization?
|
2%
|
|
what is the most common type of infection seen with a burn
|
Pseudomonas
due to the water |
|
what complication occurs in up to 30% over the first 72 hours of a burn patient?
|
Curling ulcers
|
|
what is the treatment for alkali chemical burns?
|
irrigate (drip fluid on them for 8 hours)
|
|
how does sulfur mustard work?
|
Binds irreversibly to skin
Destroys DNA causes the outer layer of the epithelium to separate from the dermis resulting in bulla. |
|
what is commonly associated with electrical burns?
|
myoglbinuria (presence of myoglobin in the urine)
|
|
a patient comes in with a lacelike rash on their arms as well as a rash on the cheeks of the face. What is the likely cause of this?
|
B19 parvovirus
|
|
Transient aplastic crisis (TAC) is what? what causes it?
|
affects precursor cells to red blood cells; see persistent anemia
in immunodeficiency caused by B19 parvovirus |
|
what stage in erythropoesis do you have infection via B19
|
at the proerythroblast stage it is expressing a large amount of P-antigen which the B19 virus can affect
|
|
what will you see in a blood smear of someone with B19 PV?
|
you wont have reticulocytes (they aren't produced)
|
|
in addition to proerythroblasts, what expresses P-antigen? what effect can this have?
|
P-antigen? what effect can this have?
Granulocytes and megakaryocytes have them B19 can thus disrupt monocyte and platelet formation this is small though |
|
What is the major receptor for the B19PV?
|
p antigen
|
|
before the rash occurs in erythema infectiosum what would you see in a blood smear?
|
no reticulocytes
due to B19PV |
|
when does gloves and socks sydrome occur ?
what about Fifth's Disease? |
gloves and socks: at the time of the infection of B19pv
5ths: later than infection |
|
What is non-immune hydrops fetalis?
|
B19PV infection during pregnancy
greatest chance of adverse outcome is between 11 and 23 weeks of gestation. affects the liver of child leading to anemia fatality rate of 50% |
|
a patient with known and managed sickle cell disease comes to your office and is seriously anemic. Upon blood smear you find no reticulocytes. you immediately order a transfusion because your patient has?
|
Transient Aplastic Crisis (TAC)
B19PV |
|
what is responsible for 95% of malignant cervical carcinoma?
|
HPV
|
|
what does the E7 gene of papilloma virus cause?
|
retinoblastoma gene
no stop signal for growth |
|
what does the E6 gene of HPV do?
|
inhibits p53
promotes telomerase |
|
what is a condyloma?
|
mucocutaneous warts seen in HPV
high potential for malignancy |
|
what is acanthosis?
|
hyperplasia of prickle cells in skin that leads to development of wart in HPV
|
|
what are koilocytes?
|
site of virus replication for HPV
|
|
what is persistent lanugo and when do you see it?
|
peach fuzz!
seen in premature babies |
|
A mother brings her newborn in less than a month after birth. She is worried that the baby has persistent dry skin. Should she be worried?
|
no. newborns will lose all of their skin in the first month making it dry
they molt |
|
what is acrocyanosis?
|
Cyanosis of the hands, feet and sometimes lips
Caused by increased tone of peripheral arterioles, usually in response to chilling |
|
What is Cuits Marmorata
|
Netlike, reddish-blue mottling of the skin
Occurs symmetrically over trunk and extremities Normal response to chilling Caused by variable vascular constriction and dilation Usually transient – resolves with rewarming Can be a sign of sepsis |
|
What is Ichtyosis
|
babies have distorted skin that is pulled very tight (face and extremities)
have trouble feeding, sometimes breathing, and with maintaining body temp |
|
a baby is born with superficial bullae on the upper limbs (mostly on thumb). It later resolves itself and goes away. What was this?
|
a suckling blister
from sucking on the thumb |
|
what is miliaria crystallina?
miliaria rubra? |
Miliaria Crystallina – clear vesicles over the head, neck and upper trunk
Miliaria Rubra (prickly heat) – erythematous papulopustular eruption at sites of occlusion or flexural areas |
|
You have a baby with numerous "fleabite" lesions everywhere except the palms and soles of the hands and feet. You take a sample from the lesion but before you look under a microscope you already know what you are going to find...
|
Eosinophils associated with Erythema Toxicum Neonatorum
|
|
a child is born and he starts to have pustules forming all over his body including the palms and soles, with no red blotch around them. The next day, the pustules get a bit bigger and start to develop a scale, the scale eventually is gone and leaves a hyperpigmented macule. What does this kid have?
|
Transient Neonatal Pustular Melanosis
|
|
Transient Neonatal Pustular Melanosis
please give progession |
Pustule
Scale Pigmented macule |
|
an asian child is brought to your office with a Flat, gray to bluish-black macules from the accumulation of melanocytes in the dermis. The nurse worries that the child is being abused because it is found on the lumbosacral area. You disagree saying it is simply...
|
Mongolian Spots
|
|
where do you normally find a giant congenital nevi? what do 95% of them have?
|
Frequently in the distribution of a dermatome
Over 95% have a hairy component |
|
a child has a red tumor like growth on their shoulder. You have them lean upside down and you notice that the growth gets larger. What does this kid have?
|
Hemangiomas
it is filling with blood |
|
a patient comes in and you discover that they have hemolytic anemia and thrombocytopenia. upon physical examination you note a large Hemangioma on the leg. you know the patient has
|
Kasabach-Merritt Syndrom
|
|
Kasabach-Merritt Syndrome
causes what ? 4 |
Thrombocytopenia
Microangiopathic hemolytic anemia Coagulopathy from red blood cell and platelet trapping Activation of the clotting system within the hemangioma |
|
2 babies are brought to your office. One has a v like red mark on the back of the neck, and the other has a symmetrical lesion between the eyes. When they cry, you can see the lesions become more apparent. What do these kids have? ***
will they go away? |
Salmon Patch (stork bite)
fade in first year of life |
|
what is Sturge-Weber Syndrome
|
Port-wine stain over the ophthalmic branch of the trigeminal nerve
causes: Intracranial calcifications Seizure disorder Hemiparesis Glaucoma Mental retardation |
|
a patient has a port wine stain on the leg that leads to local overgrowth of soft tissue and bone. what do they have
|
Klippel-Trénaunay-Weber Syndrome
|
|
what is TORCH
|
Toxoplasmosis
Other (syphilis) Rubella Cytomegalovirus Herpes congenital infections |
|
how does a patient get Congenital Toxoplasmosis
|
changing cat litter.
|
|
a child is born with hydrocephalus, chorioretinitis, and intracerebral calcifications. It grows up to have microcephaly. What does it have?
|
Congenital Toxoplasmosis
|
|
a baby is born ends up developing large oval maculopapular or papulosquamous lesions on the palms and soles. What do they have?
|
Early Congenital Syphilis
|
|
What are Rhagades?
what do you see them in? |
Perioral fissures and scarring
Early Congenital Syphilis |
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you have a child with horizontal radiopaque bands in bone metaphases, Lymphadenopathy, hepatosplenomegaly (HSM)
Rhinitis (snuffles) Anemia and jaundice what does this kid have? |
Early Congenital Syphilis
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Osteochondritis (horizontal radiopaque bands in bone metaphases)
should make you think |
Early Congenital Syphilis
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a patient comes in with small upper central incisors that are barrel shaped and have notches in the center. What are these called? what are they associated with?
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Hutchinson teeth
Late congenital syphilis |
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what is Sabre shin? what is it associated with?
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Anterior tibia hypertrophy resulting in a bowed appearance
Late congenital syphilis |
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what is the classic triad of Congenital Rubella
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Cataracts
Deafness Heart malformations |
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if you see blueberry muffin rash what should you be thinking?
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Congenital Rubella
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if you see a Vesicle with erythematous halo around the base what is it
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HERPES
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if you see a focal seizure (one arm shakes), hepatic disease, and DIC that all start around the 4-8 day of life mark, what are you thinking
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disseminated herpes
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if you see focal seizures what are you thinking?
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HERPES
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Erythema Toxicum Neonatorum if cut open you see?
what about Transient Neonatal Pustular Melanosis? |
Erythema Toxicum Neonatorum : eosinophils
Transient Neonatal Pustular Melanosis: Neutraphils |
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if you have a child with focal seizures and bloody lumbar puncture, what do they have?
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Encephalitic neonatal herpes
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What are the 3 C's and what are they associated with
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the 3 C's of measles
cough, coryza*, and conjunctivitis coryza=runny nose |
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if you see Koplik spots and high fever, what does a patient have?
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measles
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how does measles spread on the body?
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cephalocaudal (head to tail)
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Measles is primarily spread by…
Surface contamination Contact with lesions Respiratory droplets Poor hygiene |
Respiratory droplets
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if you see Nonspecific, “rose-pink” macules and papules on the trunk that was preceeded by low grade fever and rhinorrhea and malaise, what would your patient likely have?
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Rubella (German or 3 Day Measles)
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what causes Erythema Infectiosum ?
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Parvovirus B19
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what is the prodrum to roseola infantum?
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3 to 5 days of high fever (101-106°)
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how does the rash seen in roseola appear/spread?
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starts on trunk and spreads to the limbs
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dew-drop on a rose petal describes what?
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Varicella (Chicken Pox)
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what does a patient have who presents with Grey-white vesicular lesions on the palms of the hands and dorsum of feet, maculopapular eruption on the buttocks
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Hand-foot-and-mouth disease
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a patient is brought into the hospital with severe dehydration and signs of anorexia. Upon examination you find Painful erosions and vesicles in the mouth in addition to a few gray vesicular lesions on the hands. What caused the patients condition?
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Hand-foot-and-mouth disease
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what is the prodrome for erythema multiforme?
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NONE! you will be fine then covered in a shit ton of lesions
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if you see High fever, pronounced constitutional symptoms, and varying degrees of generalized target lesions, bullae, epidermal detachment, and mucosal erosions (of at least two sites)
what does the person have? |
Stevens-Johnson Syndrome
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if you have a patient with necrosis evolving into vesicles, bullae, and then detach leaving raw, denuded skin along with a positive nikolsky sign, what does your patient have?
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Stevens-Johnson Syndrome
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what is a Nikolsky sign? What is it seen in?
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after exerting light pressure on an area of erythema, the epidermis becomes wrinkled and peels off like wet tissue paper
Stevens-Johnson Syndrome |
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Stevens-Johnson Syndome vs. Toxic Epidermal Necrolysis
amount of skin involved? |
SJS: <10%
TEN: >30% |
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drugs—sulfa, PCN, NSAIDS, anticonvulsants can strangely enough lead to what problem in infants?
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Toxic epidermal necrolysis and Stevens-Johnson syndrome
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what normally leads to Toxic epidermal necrolysis and Stevens-Johnson syndrome
in children? |
Mycoplasma infection
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patient starts with macules and papules that progress into non-blanching papules on the legs and buttocks. What does this child likely have?
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Henoch-Schönlein Purpura (vasculitis)
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A 5 year old boy is brought to the ER with abdominal pain and rash. When you examine him you note palpable, non-blanching purpura and petechiae on his lower extremities and buttocks. His knees are slightly swollen and his abdomen is diffusely tender. What you might you expect to find when the lab results are ready?
Thrombocytopenia Hematuria Macrocytic anemia Microcytic anemia |
Hematuria
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you give a patient amoxicillin and later the patient develops fever, they are covered in hives (urticarial), arthritis, and periarticular swelling. What happened?
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Serum Sickness-Like Reaction
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if you see 5+ days of fever, non-exudative conjuctivitis (pink eye with no pus), swollen feet, oral mucous membrane changes, polymorphous rash, and Cervical lymphadenopathy
what do they have? |
Kawasaki Disease
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what is the most serious complication of Kawasaki Disease
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cardiac problems
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what is microcomedone?
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the plug that makes the start of acne
[Cornified cells adhere to the follicular wall and form a plug (open & closed comedone)] |
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biggest reason to use antibiotics for dermatology?
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anti-inflammatory!!
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what do topical retinoids do? what level do they work at? what types of acne do they treat
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Reverse the abnormal pattern of keratinization – reduce follicular plugging
Works at the level of the microcomodone (precursor of all acne) All forms of acne |
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what is the biggest down fall of retinoids?
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cause erythema and irritation when you first start using them
may get worse before you get better |
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What type of drug is benzoyl Peroxide? What does it work against
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Antibacterial – effectively reduced P. acnes counts
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what kind of drug is sprionolactone?
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Androgen Receptor Blocker
used to treat acne |
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you treat a patient with scabies and they beg to know how long the itch will last. You tell them
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you can itch up to a month after Rx
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Can you find scabies on the head of an adult? child?
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it is not common on an adult head
can be on a child's head |
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3 members of a family come in complaining of unbearable itch even on the palms of the hands, that worsens at night. What do they likely have?
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Scabies!
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where do warts commonly occur?
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at sites of trauma
allows for the virus to enter (this is why kids get them on their hand, and why others get plantar warts) |
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what is rhinophyma? is it permanent?
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you get deformed shape of the nose due to chronic rosacea causing hyperplasia of sebacious gland
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if you see honey crust on the face of a child what do you have?
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impetigo
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what is the difference in healing between ulcers and erosion?
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ulcers: scarring
erosion: no scaring |
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what is lichenification
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Area of thickened epidermis induced by scratching
Skin lines are accentuated |
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if you see accentuated skin lines that were induced by scratching what do you have?
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LICHENIFICATION
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How many classes of steroids are there
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7
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What class of steroid is most potent? which is over the counter?
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most potent: 1
weakest: 7 |
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What is tachyphylaxis?
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with time patient uses their topical corticosteriod less and less
when corticosteroids quit working over time |
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when you go to stop a steroid, what is an important consideration?
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Rebound phenomenon- worsening of the existing condition after termination of topical corticosteroids
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what is a static antifungal?
cidal? |
static: stops the growth (supresses)
cidal: kills the growth (use in a difficult to treat place) |
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when you occlude corticosteroids what does this do?
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increases the potency of the corticosteroid
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a patient comes in with Waxy brown “stuck on” plaques, what does he have
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Seborrheic Keratosis
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a patient comes in with a small circular spot on the lower legs. upon touch it feels like a scar under the skin. When you pinch it, it compresses with attempts to elevate (aka a dimple sign) What is this
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Dermatofibroma
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a patient comes in with numerous lesions on the buttock. The patient doesnt tells you that they scratch, but as you watch them they are going to town on the lesions. The patient has?
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Prurigo Nodularis
patient has a psychiatric issue that makes them want to scratch really really badly. The lesions |
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patient comes in with a dark blue spot on the ear. to see if it is melanoma, you push on it until it blanches. Because it was able to blanch you know it was a ?
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Venous lake
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a patient comes in with 6 cafe au lait spots. What might they have?
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Can be associated with neurofibromatosis
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what is Keratosis Pilaris
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little red spots commonly seen on the back of the arm, anterior thigh, and cheek
not folliculitis (that has pustules) |
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what causes hand foot and mouth disease?
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Coxsackie A16
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person suddenly has bright red swelling of the lateral nail fold
what does this person have? what caused it? |
Acute Paronychia
staph and strep |
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patient comes in with a redness on the proximal nail fold and the cuticle is missing
what does this person have? what caused it? |
Chronic Paronychia
Candida |
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patient comes in with a green fingernail... what caused this? what do you treat with (general)?
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Pseudomonas infection
antibiotic |
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a patient comes in with round patches of hair loss that are perfectly smooth. What does this person have? what was the cause? who is the prognosis worst for?
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Alopecia Areata
Auto-immune hair loss prognosis is worst for kids, least likely to come back |
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patient has hair loss that is not regularly shaped and patchy, and the hair has differing lengths. what is this? Dx? Tx?
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Trichotillomania
Dx: Hair shave Tx: Referral for counseling/psychiatric medications |
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what are the 3 types of acquired melanocytic nevi?
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Junctional- nevus cells remain at DE junction
Compound- nevus cells found at DE junction and in the dermis Dermal- nevus cells found in the dermis |
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What is a Becker's Nevus?
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Hamartomatous growth of smooth muscle fibers
Can consist of a brown macule, a patch of hair, or both Can be assosiated with hypoplasia of ipsilateral limb or breast, or skeletal anomalies Malignancy has never been reported |
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if you have a nevi with “fried egg” appearance
Irregular and dark pigmentation Irregular borders what type of nevi is it? what is it a marker for |
dysplastic
marker for increased risk of melanoma |
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what is the most common type of melanoma? occurs where
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Superficial spreading Type
back and legs |
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a man comes into the office with a melanoma on the toe and and part of the sole of their foot. What is this? What type of patient was it? is it aggressive?
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Acral lentiginous type malignant melanoma
likely a black or asian person VERY AGGRESSIVE cut that shit out |
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what is Hutchinson's sign?
What is it a sign of? |
Appearance of a pigmented band with extension into the proximal or lateral nail fold
Suggests acral lentiginous melanoma (ALM) |
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what are the ABCDE's of malignant melanoma
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Asymmetry
Border (is it smooth?) Color (more color=bad) Diameter (larger=bad) Evolving (any changes noted by the patient) |
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what is the Breslow Depth?
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Measured from the granular layer to the deepest portion of malignant cells
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Breslow Depth greater than 1mm means what?
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higher risk for metastasis
Recommend sentinel lymph node biopsy this shit is serious |
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if you have a >1mm Breslow thickness what are you going to do?
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sentinel lymph node biopsy
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female presents with Nodular erythematous eruption that is usually limited to the extensor aspects of the extremities. She notes that she is on birth control. What does she have?
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Erythema Nodosum
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f you see plaques with islands of sparing, what should you think?
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Pityriasis Rubra Pilaris
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if you see salmon colored plaques, what should you be thinking
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Pityriasis Rosea
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you have a patient with Benign, usually asymptomatic, distinctive, self-limiting patches. The etiology is unknown but possibly viral. You see a Collarette scale
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Pityriasis Rosea
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a patient comes in with Lesions are oriented along skin lines giving the appearance of a Christmas tree. What do they have?
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Pityriasis Rosea
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if you see Wickham's striae, what does the patient have?
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Lichen Planus
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