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Derm USMLE

QuestionAnswer
describe pityriasis rosea symptoms, orgnaism HHV7; herald patch (often ring shaped or oval, scaly), then 1 wk later many itchy lesions on back that follow Langerhan's skin lines (Christmas tree appearance)
describe molloscum contagiosum, organism, bx, tx waxy papules w central depression (umbilicated), organism: poxvirus, bx: inclusion bodies; tx: freezing or currettage
seborrheic dermatits describe skin findings hyperpigment, lichenification, scaling in areas of oily skin, ie eyebrows, nasolabial fold, midchest, scalp **can be severe in AIDs pts
what can cause large regions of skin desquamation? TEN, SSSS, graft v host
differentiate TEN and SSSS TEN (toxic epidermyl necrolysis): usu adults and result of Rx (sulfonamides, allopurinol, phenytoin, carbamazepine); SSSS (Staph scalded-skin syndrome)=children, infxs; use bx to know for sure
Rx that can cause TEN sulfonamides, allopurinol, phenytoin, carbamazepine
bx TEN v SSSS TEN: full thickness epidermis damage (SSSS: superficial)
tx TEN same as for burns, skin coverage, maintain fluids and electrolytes
MC cause erythema multiforme HSV infx of lip (also Rx and mycoplasma)
erythema marginatum Rheum F
erythema nodosum pretibial, painful, assoc UC, sarcoid
erythema multiforme target lesion seen in HSV and Rx reaction (ie sulfa, PCN)
erythema migrans bull's eye w central clearing, seen in Lymes
list some causes of rash (incl 4 erythemas) erythema infectiosum ( slapped-cheek parvovirus B19); Roseola (HHV6) hi F, stops then rash; Rheum F (erythema marginum); erythema nodosum; typhus (trunk rash); RMSF, syph, coxsackie, eryth multiform (palm/sole rash); vasculitides (HSP); Lyme,
erythema infectiosum slapped-cheek --starts on cheek and proceeds to trunk and extremities ((caused by parvovirus B19))
dzs w blisters pemphigous, dermatitis herpetiformism, graft v host
compare pemphigus vulgaris and bullous pemphigoid blisters, dz severity pemphigus vulgaris: intraepidermal, blisters tear-severe dz; bullous pemphigoid: blisters below epidermis, don't tear
Abs in 2 pemphigus dzs pemphigus vulgaris: Ab to desmoglein so intraepidermal blisters that tear-severe dz ( acantholysis on bx); bullous pemphigoid: Ab to hemidesmosomes, blisters below epidermis, don't tear
compare pemphigus vulgaris and bullous pemphigoid involvement mucous mem pemphigus vulgaris: yes; bullous pemphigoid: no
which HPV assoc with squamous malignancies HPV 16, 18
appearance genital warts, tx cauliflower papule or nodule; tx: podophyllin, trichloroacetic acid, imiquimod, 5FU **on cervix monitor cytology/histology for malignancy
Rx for acne start with benzoyl peroxide, then topical clindamycin or oral tetracycline or erthromycin (tx Propionibacterium acnes); then topical tretinoin (retin-A), LAST isotretinoin (Accutane)
SE Isotretinoin (Accutane) teratogen, transient incrsd chol, TGA, LFTs and maybe depression
tinea versicolor, organism, tx small scaly patches of difft colors that can be hypopigment (don't confuse w vitliigo); organism: pityrosporum orbiculare; tx: topical selenium sulfide or topical imidazoles
vitiligo, describe, assoc unknown origin, depigmented patches of skin, assoc: autoimmune dzs like pernicious anemia, Addison, often have Abs to melanin and decrsd melanocytes
aka warts verrucae
aka mole nevocellular nevus
herpetitiformis dermatitis, describe, assoc intensely pruritc vesicles on extensors of elbows and knees, assoc celiac sprue (tx: avoid gluten)
describe lichen planus; assoc, tx 4Ps: pruritic, purple polygonal papules; assoc: Rx and Hep C; tx: topical steroids and anti his
tx lice: head, body, pubic, head: pyrethrin (RID) and remove nits, body: wash clothes&bedding, pubic: pyrethrin
scabies describe presentation, organism, tx intensely pruritic (esp at night), sarcoptes scabiei, mites burrow can see track and excoriated papules; tx permethrin or oral ivermectin (but pruritis will remain 2 wks after tx) **treat contacts
3 types of gangrene and causes dry: ischemia, wet: bacterial usu skin flora, gas: C perfringens
tx gas gangrene hyperbaric oxygen (since C perfringens is anaerobic) **this is an emergency
acanthosis nigricans, describe, assoc, tx hyperpigment, hyperkeratotic velvety in intertriginous zones (incl axillary), assoc with insulin resistance, obesity, and underlying adenocarcinoma (often GI); tx: topical steroid or retinoid, lose weight
rosacea, describe, tx looks like acne in middle aged ppl, often w rhinophyma (bulbous red nose), tx: topical metronidazole
seborrheic keratosis **if appear suddenly could be paraneoplastic; brown, warty papules appear stuck on, bx: hyperplasia of benign, basaloid epidermal cells
actinic keratosis, tx precursor of squamous cell carcinoma; caused by light; tx cryosurgery or 5FU
squamos cell carcinoma, cause, px, grading, tx 2nd most common (basal cell MC), can metastasize, arise from actinic keratoses; graded histologically; tx: excise
basal cell carcinoma, describe, px, grading, tx most common, slow growing but won't met, appear in sun-exposed areas; tx options excision, incl Moh's surgery, superficial radiation (cure >95%)
melanoma, cause, px, grading, tx cause: short intense sun, congenital dysplastic nevi, px most determined by depth of lesion, may met; grading by Clark's levels; tx: excision
lesion characteristics suggestive of melanoma irregular color, contour/border, nodule and ulcer formation, diam >6mm, changes in these charact noted by pt or Dr., and pruritis
classic progression of melanoma lesion start as shiny papule, enlarges and develops umbilicated center that gets peripheral telangiectasias
type of skin cancer seen in African Americans acrolentiginous
Kaposi's sarcoma vascular prolifer HHV8, **most common HIV associated malignancy, tx palliative
mycosis fungoides, aka, suspect when, stages cutaneous T-Cell lymphoma, slow progression of T cells, stage I: patchy, plaque like, stage II: skin tumors, multicentric, reddish
cerebriform nuclei characteristic of mycosis fungoides
common Rx that can cause Steven-Johnson syndrome sulfa, PCN, Phenytoin, phenobarb, allopurinol, carbamzepine, cephalo, quinolones
describe S-J syndrome morbillform rash that coalesces full thickness blistering, can have skin detach and involves eye/mouth
differentiate bw TEN and S-J syndrome if <10%BSA=S-J, if >30%=TEN
tx bullous pemphigoid and pemphigous vulgaris systemic steroids +/- other immunosuppress (ie azathioprine)
what are the dermatophytes? microsporum, trichophyton, epidemiophyton
what dzs do dermatophytes cause? tineas pedis and cruris (athlete's foot and jock's itch), tinea corporis, tinea capitis (ringworm, scalp caling)
how identify dermatophytes? KOH preparation
what organism causes tinea versicolor? pityrosporum orbiculare (yeast)
subtypes of basal cell cancer nodular (MC, pearly nodule w telangiectasia), ulcerated, sclerosing (scarred area), superficial, pigmented (melanocytes), nevus syndrome (AD dz mltpl BCC from childhood, jaw cysts, CNS tumors)
subtypes of SCC nodular (often w central ulceration), exophytic (friable, bleeds easily from Bowen's dz--intraepithelial form SCC), verrucous (resembles wart on mucus mem and plantar), SCC w cutaneous horn
MC cause of death from skin cancer is which type melanoma
what % of melanoma arise from nevi 50%
Staging clark's levels and TMN for skin cancer Staging: I=epidermis, II=into derm, III=fill derm, IV=into reticular derm, V=into subQ fat; TMN: 1=no local/regional met, II=local/regional met; III=distant met
types of melanoma superficial spreading (70%), nodular 15-30%, lentigo maligna, acral lentiginous
describe superficial spreading melanoma mostly flat, variegated color w indistinct border, often back on men and legs of women, middle aged
describe nodular melanoma discrete nodule, uniform, blueberry like, arises rapidly, no radial growth phase
describe lentigo maligna melanoma arises in a lentigo maligna (melanoma in situ, blue/black color, usu pretty large, flat geographic shape) that develops a nodule, usus elderly face/neck/scalp
describe acral lentiginous melanoma MC in dark skinned (Asian, AA), variegation of brown/black; often sole of foot
stages of decubitus ulcers 1=nonblanching erythema, 2=partial thick loss, 3=into subQ, 4=into mscl, jt
Auspitz sign bldg capillary when scale of psoriasis is removed
types of psoriasis chronic/guttate (MC), pustular (intraepithelial PMN)
tx psoriasis (3) topical steroids, calciopotriene (vit D derivative), tars (Smelly)
% of pts w psoriasis that get arthritis 10%
mechanism of psoriasis hyperproliferation of epidermal cells so they don't have time to keratinize properly **note: NOT pruritic
characteristics of psoriasis non pruritic plaques on extensors, nail pitting and lifting of nailbed,
cause of leprosy Mycobac leprae
tx leprosy rifampacine + dapsone 6mos if 1-5 lesions, if >5lesion rifampicine, clofazimine,& dapson for 12 mos
Created by: ehstephns on 2010-12-05



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