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Dermatology Oral
dermatology oral topics-Dobosz
| Term | Definition |
|---|---|
| Non-gonococcal urethritis caused by: | Chlamydia trachomatis (MC) mycoplasma genitalium ureaplasma urelyticum trichomonas vaginalis adenovirus Herpes simplex virus |
| NGU: Route | through sexual contact with mucous membrane |
| signs and symptoms in Women: | Cervix main site of infections peak incidence with sexual activity (teens and ~25yo) UTIs asymptomatic in 90% |
| Chalmydia trachomatis causes: | non-gonococcal urethritis, vaginitis, cervicitis and proctitis |
| chlamydia trachomatis | gram-negative bacteria, mc cause of bacterial STIs in men and women. different serological subtyoes cause different diseases |
| trachoma (conjunctivits) | type A, B, Ba, or C |
| lymphogranuloma venerum | L1, L2, L3 |
| lower urinary tract infections together with complications, infections of anus, throat, and neonatal pneumonia | B, D, E, F, G, H, I, J, K |
| lymphogranuloma venereum | incubation period 3-30 days 1* stage is small, painless papule or pustule that can evolve into a small herpetiform ulcer lesion is at site of bact inoculation (vulva or post. wall of vagina or cervix in W, penis in M... but also perianal region or mouth |
| Cervicitis: | mucopurulent discharge in external part of cervix hypertrophic ectopia cervical meatus edematous, flushed and easily bleeds after injury 1/2 cases of cervicitis occurs with urethritis: -urinary urgency, dysuria mucipurulent discharge within urinary |
| main complications of C. Trachomatis infections in W: | endometritis adnexitis Fits-Hugh-Curtis syndrome (perihepatitis) bartholinitis Skenitis PD (ectopic prego, premature deliveries, low birth weight and infertility) |
| Chlamydial infections in M: | manifests as urethritis incubation 1-3 wks (typically 10-12 days) MC- watery mucous or mucopurulent urethral discharge and dysuria |
| Main complications in M | epididymitis prostatitis urethral stricture (lonlasting infections with many recurrences) |
| diagnosis of CHLAMYDIA INFECTION: | Molecular methods NAAT: PCR or LCR (very useful as screening tests, dont use sample from throat of anus) serological test- only in massive infetion (L1-3) immunoenzymatic method EIA- detects LPS antigen direct immunoflourescence cell culture |
| treatment for uncomplicated urethritis, cervicitis, and proctitis | 1st line: azithromycin doxycycline 2nd line: erythromyocin levofloxacine ofloxacine 3rd line:josamycin pregnant: azithromycin or amoxicilin |
| Reiters syndrome treatment | antibiotics nsaids rare: GCS mtx |
| chlamydia trachomatis treatment in new borns | erythromyicin |
| trichomonas vaginalis | metronidazole tinidazole ornidazole |
| reiters syndrome | epis. of peripheral arthritis of mroe than 1 mnth occuring with urethritis and/or cervicitis keratoderma blennorrhagicum circinate blanitis conjunctivits stomatits |
| Reiters syndrome typical triad | arthritis urethritis conjunctuvitis |
| gonorrhea | gram negative coccus NISSERIA GONORRHEA pili allows attachment to columnar ep in urethra, cervical canal, throat, anus and conjunctiva |
| gonorrhea | Major cause of urethritis in men and cervicitis in woman results in PID, infertility, ectopic prego and chronic pelvic pain |
| Gon in men: | Urethritis*** incub 2-5days symp. burning in urethral meatus, dysuria. urgency and painful erection secretions from urethra: -1st: seromucous -quickly purulent |
| physical exam of male urethra | red and swollen purulent, seromucous or mucous secretions noted |
| diagnosis of gonorrheal urethritis: | 1. purulent secretions from urethra with dysuric complaints 2. history of 2-5 day incub 3. bacterioscopic exam of secretions with gonococci in specimen and/or + culture or confirm of prescence of gonococcal DNA |
| Gon Complications: | epididymitis-pain and swelling of testis prostatitis pid paraurethritis paraurethral abcess cowperitis littritis tysonitis vesiculitis |
| Gon in Woman | Cervicitis MC- cervix mc site of infection cervix may appear normal or show signs of frank discharge |
| cervicitis: gon in w | up tto 7-% asymp incub N/A genital symp develop in most within 10 days of exposure symptoms: -vaginal pururitis and or mucopurulent discharge -intermen bleeding or menorrhagia |
| Diagnosis of gon cervicitis and urethritis: | 1. purulent secretion in the cervix or urethra 2. redness and edema of cervix with bleeding when material taken 3. burning or pain on urination 4. confirmed prescence of gonococci in cervix or urethral secretions (this determines diagnosis) |
| Complications of gon in women | bartholinitis skenitis vulvovaginitis PID |
| complications men and women in gon: | Fitz-hugh-curtis syndrome PID sepsis: -arthritis-dermatitis syndrome -meningitis -endocarditis |
| diagnosis of Gon | history taking and examination 1. bacterioscopic exam 2. culture 3. sugar fermentation method 4. PCR and LCR methods |
| treatment of gon | ceftriaxon follow up after treat: |
| syphilis | treponema pallidum ROT: penetration into damamged skin unaffected mucous membrane blood lab worker physical exam blood transfussion vertical-labour |
| stages of syphilis | 1. acuired -early --primary syphilis --secondary syphilis -late --latenet --tertiary syphilis |
| primary syphilis: | primary lesion chancre- small, single painless ulceration with firm base that secretes a discharge, smooth border usually accomp. by regional LN enlargment lesion heals spont 2-6 weeks with no scar after 3-4 wks of contact initial symptom |
| secondary syphilis: | hemato spread of trep. pallidum generalized LAD, primary and recurrent rashes 9 weeks after infection condyloma lata alopecia |
| primary rash: | macular or papular rash short lasting symmetirc diffused |
| reccurent rash | multiform (papules, pustules and ulcerations) long lasting asymmetirc |
| biett collarette: | 2*syphilis |
| primary syphilis in men | glans and coronal sulcus perineum scrotum perianal region |
| primary syphilis in women | labia post commissure clitoris urethral orifice |
| tertiary syphilis: | after several years of non treating infection can be latent of symptomatic mc symp related to CV or nervous system |
| complications of a chancre | 1. phimosis 2. paraphimosis 3. edema induratum |
| latenet syphilis: | no + physical finding no Cv or neuro disease difference between early latent (can infect) and late latent syphilis (can only infect infant transplacentally but otherwise not contagious) |
| tertiary syphilis: | starts 3-5 years after secondary syphilis syphylitic GUMMA- anywhere on skin, subcutaneous nodule- enlarge and fuse together- becomes red/brown-thickens- central necrosis-discharging ulcer lesions are asymmetric but grouped, with necrosis and heal with |
| CV syphilis: | mainly in aorta aneurysms in ascending aorta aortic regurgitation endoarteritis of coronary vessels |
| neurosyphilis | chronic meningitis gummata hemiparalysis general paresis tabes dorsalis asymp |
| tertiary syphilis: | Must do cytological andserological examination of CSF |
| congenital syphilis: | transfer of t. pallidum from mom to infant during pregnancy after 1st trimester or late pregnancy |
| early congenital syphylis: | papulosquamous lesions mc on face, trunk, palms, soles and diaper area |
| late congenital syphylis: | after 2yrs hutchinson triad: 1. hutchinson notched incisors 2. interstitial keratitis 3. deafness of 8th nerve saddle nose gummata saddle nose saber shins |
| diagnositic for syphilis: | Dark ground Microscopy for firm diagnosis of early syphilis (1* and 2*) specimens: -discharge from 1* ulcer or skin lesion -tissue -placenta |
| in order to diagnose syphilis its necessary to preform at least 2 blood serological tests: | 1. nontreponemal: -RPR-rapid plasma reaign -VDRL-veneral disease research lab -USR-unheated serum reaign 2. treponemal -FTA- flourscent trep agglutination -TPHA- trep pallidum hemoagglutination -TPPA- trp pal partical agglutination |
| treatment: | early, late and neuro: benzathine benzylpenicilin procaine benzylpenecillin doxycycline ceftriaxone congenital: cristalline penicillin 1st year of life procaine penicillin older child |
| atopic dermatitis: | chronic inflam dermatosis with persistent itching cause is complex: genetic, immuno, environ, and defect in skin barries usually in early childhood, before 1 and before 5yo |
| atopic dermatitis criteria | Hanifin and rajka: must have 3 major and 3 minor major: 1. puritis 2. typical morph and distribution 3. chronic relapsing dermatitis 4. personal or fam history of atopy (asthma, allergic rhinitis, atopic dermatitis) |
| minor criteria | minor: 1. xerosis 2. keratosis pilaris 3. dennie-morgan infraorbital folds |
| AD phases: | 1. infant (to the age of 2) 2. childhood phase (2-12) 3. teen and adult |
| AD dd | -seborrhoeic dermatitis -scabies -allergic CD -psoriasis -t cell lymphoma |
| treatment AD: | emoilents (depends on SCORAD) topical GCS, topical calcineurin inhibitors anibacterial or antiseptic UV 311 systemic anithistamines systemic GCS cyclosporin A MTX, azithromyacin, mycophenolate dupilumab |
| contact dermatitis (ECZEMA): | erythematous-nodular-vesicular lesions MC form allergic contact dermatitis and irritant CD |
| allergic CD due to | type IV gell-coombs immune rxn induced by haptens penetrating skin and bingind to various protiens |
| MC allergens in allergic CD | -chromium -nickel -cobalt -araphenylenediamine -cosmetics -gum compounds |
| clinical presentation of Allergic CD: | superficial inflammation 1* lesions are exudative nodules-> vesicles and erode. crust forms as exudate dries. If lesions turn chronic-> lichenification puruitis present |
| diagnosis of allergic contact dermatitis: | history, clinical presentation, chronic recurrent character, pururits postiive skin patch test |
| treatment of Allergic cD | ID and eliminate the cause avoid cause topicals: spray lotion, creams lichenification- ointments GCS- short pulses cyclosporine a, mtx, azithromyocin phototherapy |
| erythroderma: | generalized exfoliative dermatitis involves >90% of pts skin |
| Main cause of erythroderma | psoriasis atopic dermatitis eczema lichen planus drug rxn- or t celll lymphoma of skin idiopathic |
| treatment of erythroderma | id causitive factor, stop the usage usually pts are hospitilized need fluids and electrolytes topical steriods, sedative antihistamines, antimicrobial agents |
| impetigo | Bacterial infection, highly infectious affects superficial layer of epidermis seen in children between 2-5 yo |
| impetigo primary lesion | bulla with watery content blister ruptures within 24-48hrs leaving an erosion covered with a shiny crust in streptococcal impetigo the vesciles are smaller and when they ruputre they leave a honey coloured crust |
| impetigo treatment | -mupirocin -fusidic acid if LAD is present then you have to treat with systemic antibiotics |
| generalized psoriasis: | -plaque-type psoriasis -guttate psoriasis -generalized-pustular psoriasis -erythrodermic psoriasis |
| localized psoriasis: | -sebopsoriasis -inverse psoriasis -psoriasis of scalp -palmoplantaris nonpustular psoriasis localized plaque-type psoriasis: of extremities and or trunk |
| bowen disease: | SCC in situ presents as well-circumscribed, erythromatous plaque with scaly surface slow growing lesion that affects lower limbs usually penile shaft mc |
| erythroplasia of Queyrat | if lesions found on mucous membranes- present as velvety, smooth red ulcerations |
| bowens disease DD | eczema or psoriasis |
| melanoma: | malignant neuroectodernal melanocytic cells |
| rf for melanoma | UV exposire light skin phenotypes I and II genetic factors (family history) immunosuppression |
| melanoma presents | melanocytic patch or nodule develops due to melanocytic nevus or denovo first grows horizontal then vertical |
| clinical fts of melanoma | ABCD(E) a-symmetry b-borders c-colour d-diameter e-elevation |
| hot wo diagnose melanoma | dermatoscopy 2/3: asymm distribution, atypical pigment pattern, blue white amorphous structures (blue-white veil) |
| dermatomyositis | inflammatory myopathy of unknown origin |
| dermatomyositis clinical presentation: | involvement of shoulder and pelvic girdle pt had problem keeping hands up, have trouble doing hair, trouble climbing stairs (no issue handshake) |
| dermatomyositis skin symptoms: | 1. helitrope- lilac discolouration around eyes with swelling of eyelids (children lilac disease-erythema over entire face) 2. scarf syndrome- erythema around neck, shoulders and neckline 3. confluent erythema on sunexposed areas of skin |
| DM skin symptoms cont'd | 4. mechanics hands- like eczema 5. grottons sign- on the finger joins there is lilac colour with scales 6. teleangiectasia within nail bed 7. subcutaneous calcificatios (mc in child) 8. nonscarring alopecia and psoriasis like hairy scalp |
| diagnosis of dermatomyositis: | levels of muscle enzymes: creatine kinase aspargine aminotransferase (aspat) lactate dehydrogenease (LDH) anti-p155 antibodies- marker for DM and cancer skin-muscle biopsy (must be taken) electromyography |
| treatment of DM | systemic GCS methotrexate antimalarials mycofenolate mofetil azathioprine cyclosporin A use sunscreens |
| CI in DM | physical activity is CI in active phase of disease but need rehab |
| utricaria: | 1* lesion is a wheal with angioedema raised white/pink lesion disappears within 24 hrs itching is characterisitic for it |
| ACUTE URTICARIA | less than 6 weeks common in child and adults anaphylactic rxn severe cause: food, meds, infectious factors, hymenoptera venom, pollen |
| CHRONIC URTICARIA | symp constantly present or relapsing for over 6 weeks |
| inducible urticaria | -cold -heat -delay pressure -dermagraphism -light -cholinergic -vibrational -contact -water |
| diagnositc urticaria: | history basic labs-RBC count, WBC, urine, feces, bacteria screening skin prick test- in suspected IgE mediated allergies to airborne allergens, foods... find cause and eliminate |
| treatment of urticaria | avoid precipitating factors treat coexisting diseases pharmacotherapy- antihistamines |
| basal cell carcinoma | local malignancy slow growing rare metastasis mc nodular bcc. 2nd mc is superficial bcc irregular, wellcircumscribed, erythromatous plaque |
| squamous cell carcinoma | more invasive and aggressive with tendancy to metastiasize localized sun injured skin precancerous is actinic keratosis bowen disease- scc in situ |
| basal cell carcinoma dermatoscopic fts | arborizing vessels ulcerations blue-grey globules leaf-like strucutre (asymetric) |
| treatment of NMSC: | noninvasive: topical- 5 fluoruricil, imiquimod, interferon, photodynamic therapy radiotherapy destructive methods: cryosurgery, curettage, electrocoagulation, laser therapy surgery: resection |
| lichen planus | immune related disorder provoked by psychological stress, drugs ect presents as purple, polygonal. planar papules with glossy surface with wickham striae |
| lichen planus diagnosis | histopathological exam: -streaky infiltration of t lymohocytes in dermal epidermal aread -focal proliferation of granulomatous layer -epidermal acanthosis -vacuolar degen, basal layer |
| lichen planus treatment | local gcs and tarcolimus focal admin into hypertrophic lesions extensive- phototherapy, systemic Gcs and acitretin severe- mtx, cyclosproin A |
| condyloma acuminata | mc clinical presentation of HPV HPV 6 and 11 califlower like warts |
| condyloma acuminata treatment | cryosurgery electrocoagulation laser vaporization |
| sjogren syndrome | women 40-60s dry eyes, mouth and other mucous membranes, vasculitis, enlarged salivary glands high risk lymphomas |
| sjogren syndrome diagnose | + rf anti RO anti LA anemia hypergammaglobulinemia |
| sjogren syndrom treatment | atrificial tears saliva subs systemic lesions- GCS and immunosuppressives |
| SLE diagnosis | 4/11 criteria 1. malar rash 2. discoid rash 3. photosensitivity 4. oral ulcers 5. nonerosive arthritis 6. pleuritis or pericarditis 7.renal disorders 8. neuro 9. hemato 10. immuno 11. + antinuclear antibody |
| SLE skin | lesions found 80% face- inflamm severe trunk- scarring and erythematoud edematous lesions acral lesions: raynounds syndrome, erythematous patches on dorsal hands and fingertips, teleangiectasia |
| scleroderma | initial phase of inflammation of skin that turns into fibosis resutling in thickening and hardening if the ski 2 types: limited cutaneous and diffused cutaneuous |
| CREST | Calcifications Raynauds syndrome esophageal dysmotility sclerodactyly teleantegisa |
| diagnosis of scleroderma | clinical presentation ANA type histopathology evaluatuon tests for organ involvment by: chest xray lung functional tests ECG renal function parameters |
| scleroderma treat | 3 pathophyisiological factors: inflammation- GCS, AZA MTX mycofenolate mofetil fibrosis- UVA and PUVA vascular lesions- CCB, phosphodiesterase inhib, prostacyline analogues |
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