Studied by 2 people
simple vs complex febrile seizure
simple:
generalized seizure
lasts <15 min
do not recur in 24hr period
quickly return to baseline
complex:
focal onset
15min seizure
recurrent within 24hr
hemiparesis following seizure (Todd's paralysis)
What causes acne
increased sebum/oil production Follicular hyperkeratinization Proliferation of propionibacterium acnes inflammation
Describe different types of acne
Comedonal (noninflammatory): Open comedones (blackheads) and closed comedones (whiteheads)
Mild papulopustular and mixed acne: Open comedones, closed comedones, pustules
Moderate papulopustular and mixed acne: Open comedones, closed comdones, pustules, nodules
Severe acne: Open comedones, closed comedones, pustules, nodules, extreme inflammation"
What is the treatment of mild vs moderate vs severe acne (also medication ADE)
Mild (comedones only): Topical retinoids (Tretinoin, Tazarotene, Adapalene Gel) • Every 3rd night, then slowly increase • Increases cell turnover • SE: dryness; CI: pregnancy *alone or in combo BPO 2.5% *alone or in combo • SE: skin irritation Topical abx (clinda) *w/ BPO
Moderate: Add oral ABX Doxycycline • SE: GI, photosensitivity, teeth • CI: pregnancy, young children Erythromycin *okay in pregnancy Bactrim • SE: SJS/TEN, CI: pregnancy
Severe: Isotretinoins • SE: dryness, HA, SI, depression • CI: tetracyclines, pregnancy • Labs: LFTs, CBC, lipid monthly • 2 birth control methods, pregnancy test, no blood donation"
Describe pattern of androgenic alopecia What labs should be checked
Frontoparietal scalp recession and vertex thinning
check iron, TSH, vit D, testosterone, DHEAS-S
What is the cause of androgenic alopecia
genetics DHT (dihydrotestosterone) hormones age
what is the treatment of androgenic alopecia
Males: rogaine, propecia Females: rogaine, spironolactone hair transplants
What is the treatment of eczema
Topical steroids (flares) - mild to moderate potency
Calcineurin inhibitors (maintenance) - nonsteroidal anti-inflammatory immunosuppressant (steroid sparing) Tacrolimus (Protopic) or pimecrolimus (Elidel)
Lubricants like Aquaphor, CeraVe, vanicream
Avoid triggers
Antihistamines - sedating, for sleep disturbances (Benadryl)
Aluminum subacetate solution or Aveeno soaks for acute, weeping lesions
Oral/topical antibiotics PRN infection to cover S. aureus
Dilute bleach bath to decrease bacteria and severity
Difference between moisture trapping and candidal diaper dermatitis
Moisture trapping: red, painful, in buttock but spares folds
Candida: red, beefy, in the folds with satellite lesions
How to treat diaper dermatitis
Moisture trapping: barrier ointment with zinc oxide, low potency corticosteroids, topical mupirocin if infected
candida: nystatin
what rash is 1-2mm grouped erythematous papules and vesicles around the mouth with the vermillion border spared
how do you treat it?
perioral dermatitis
eliminate offending agents mild: topical pimecrolimus or erythromycin Moderate: oral tetracycline
Describe the different degree of burns
1st degree: superficial Depth: epidermis Dry, blanches w/ pressure, erythematous
2nd degree: superficial partial Depth: papillary Moist, blisters, blanches w/ pressure
2nd degree: deep partial Depth: reticular Wet or waxy dry, blisters that easily pop, blanches w/ pressure (delayed)
3rd degree: full thickness Depth: hypodermis Waxy white/grey/charred, dry, no blanching w/ pressure
Describe how to estimate BSA of burns
Rule of 9s: Estimates percentage of body burned:
Entire head and neck = 9%
Right arm = 9%
Left arm = 9%
Anterior torso = 18%
Posterior torso = 18%
Right leg = 18%
Left leg = 18%
Groin = 1%
Infants:
Head = 18%
Each arm = 9%
Anterior torso = 18%
Posterior torso = 18%
Each leg = 14%
Describe the parkland formula and what it is used for
For calculating volume of LR for burn patients
3mL x total body surface area of burn (%) x body weight (kg)
First half over first 8 hours
Second half over next 16 hours
Same formula but 4mL instead of 3mL in teenagers/adults
What rash can be immediate (urticaria) or delayed (vasculitis, rash eruption) that is morbiliform, generalized small red macules and/or papules resembling measles rash
drug eruption
can be fixed: rash shows up in same spot every time that drug is taken
What is the treatment of a drug eruption
stop offending agent antihistamines
what rash is an acute, self limiting hypersensitivity reaction triggered by various bacteria, viruses, or meds.
erythema multiforme
describe erythema multiforme rash
sudden onset symmetrical erythematous macules, papules, and target lesions that favor extremities like palms and soles and extensor surfaces puritic
erythematous/purpuric center w/ or w/o bullae, surrounding halo of lighter erythma and edema and 3rd red ring
what causes erythema multiforme
type 4 sensitivity reaction HSV usually
What is the treatment of erythema multiforme
treat underlying cause- stop offending med, acyclovir for herpes
treat symptoms: antihistamines, topical steroids, prednisone for oral lesions
derm referral if uncertain if SJS/TEN
What rash has different stages of lesions with small red lesions that progress from macules to papules to vesicles to pustules that crust over
all over body and very itchy, fever, malaise, low fever
varicella/chicken pox
what causes varicella
herpes zoster
what is the treatment of chicken pox/varicella
supportive care: ibuprofen, tylenol, cool compress, oatmeal bath
acyclovir in teens and adults at risk of complications
NO ASPIRIN: reyes syndrome causing swelling of liver and brain
prevent with varivax
what rash is a maculopapular rash that begins on the head and face and progresses down. symmetric and diffuse. cough, stuffy nose, conjunctivitis, fever
koplik spots (little white spots in the mouth)
measles/Rubeola
What rash is maculopapular beginning on the head and face and progressing down and is diffuse and symmetric. Not as much fever, cough, etc.
lymphadenopathy postauricular and suboccipital
rubella (rubella virus)
What rash is generalized and subtle pink that begins several days after a fever resolves. rash begins on trunk and spreads to face.
Roseola
What causes roseola
HHV-6
what causes erythema infectiosum/Fifth disease
parvovirus B19
What rash has a mild viral prodrome with fever then slapped cheek rash with generalized lacy reticular erythematous rash all over body
erythema infectiosum/fifth disease
describe molluscum and how its treated
firm skin colored round 3-5mm, central umbilication with central curd like core. painless
treatment: benign neglect, direct lesion trauma with cryotherapy, cantharidin, salacylic acid, tretinoin, curettage, imiquimod
What causes molluscum
pox virus
describe impetigo
begins with single red papulovesicle progressing to one or many honey-crusted lesions weeping serous drainage around nose and mouth.
bullous impetigo: larger bullae or vesicle with yellow crust
What is MCO of impetigo
strep and staph (MRSA included)
Consider culture if known MRSA colonized, systemic sx, severe local sx, immunosuppression, lack of improvement with tx
what is the treatment of impetigo
topical mupirocin ointment
oral keflex if widespread of bullous
if MRSA: bactrim
what is the treatment of lice
permithrin- leave in hair for 10 min then rinse and repeat in 7 to 14d
suffocation with alcohol
place things that cant be washed in plastic bags for 2 weeks. wash clothes and linens in hot water
signs of lice
head lice: nits on base of hair, intensely pruritic
body lice: found on seams of clothing, itchy, maculae ceruleae (blue/gray macules)
pubic lice: itchy pubic area with visible nits
how to treat body and pubic lice
body: good hygiene, wash clothes
pubic: permethrin cream, treat sexual contacts, wash clothes
describe scabies rash
intensely pruritic, excoriated papules, pustules, curvilinear burrows on intertrigenous zones
commonly seen in finger webs, wrists, axilla, breasts, buttock, penis
confirm with skin scrapings under microscope
how do you treat scabies
permethrin 5% cream from neck down 8-12hrs then wash off, repeat in 1 week
antihistamines, topical corticosteroids for pruritis
describe pityriasis rosea
acute, self-limiting, red and scaly exanthem
starts with herald patch (one big scaly pink patch) then 1-2 weeks later gets truncal rash in christmas tree pattern along langer lines. spares palms and soles
lasts 2-12 weeks
what is the treatment of pityriasis rosea
self limiting
topical steroids, camphor, menthol, antihistamines for itch
acyclovir if severe
what rash is due to chronic inflammatory autoimmune disease affecting skin and mucus membranes
lichen planus
what rash has increased incidence with hepatitis C
lichen planus
describe lichen planus
planar, purple, polygonal, pruritic, papules, plaques
flexor surfaces of wrists, forearms, legs, inside mouth
what is wickham striae
lesions often covered by lacy, reticular white lines associated with koebner's phenomena
what is the treatment of lichen planus
high potency topical steroids antihistamines systemic steroids in severe cases
What causes tinea infections
trichophyton Microsporum fungi
cruris: heat and humidity with poor hygiene
Pedis: heat and humidity, contact with contaminated floor
Describe different tinea infections
Capitus: scalp, scaly patches with black dots, kerion (inflammatory plaque with pustules and thick crusting, rxn to fungal infection)
Corporis: annular, scaly lesions with raised borders with central clearing
cruris: groin and inner thighs, well marginated, erythematous plaques in folds, pruritis
pedis: Erythema, scale, pruritis, may have vesicular or pustular lesions, or fissures on feet and between toes
unguium: thickened nails with debris, discoloration
Describe treatment of tinea infections
unguium and Capetis: oral griseofulvin
pedis, cruris, corporis: topical antifungals (clotrimazole, terbinafine), systemic only if severe, powders, good hygiene
Describe tinea versicolor and its cause
cause overgrowth of malassezia yeast
hyop/hyperpigmentated round lesions that do not tan, fine scale. usually on chest and back
how to treat tinea versicolor
topical antifungals: pyrithione zinc shampoo (head and shoulders), selenum sulfide (selsun) ketoconazole 2%, clotrimazole
oral antifungals if severe/widespread: itraconazole, ketoconazole
how to diagnose tinea versicolor
clinical
woods lamp: fluoresce yellow-orange or blue-green
KOH prep: spaghetti and meatballs- hyphae and spores
differentiate erythrasma and intertrigo
Erythrasma: chronic bacterial, in skin folds, coral red fluorescence (Wood's lamp), hyperpigmentation
Intertrigo: W/ Candidal infection if: satellite papules/pustules; in skin folds
tinea crurus: well marginated erythematous plaques, spaghetti and meatballs on KOH
Diagnostics of tinea capitus
KOH: slender filaments that look like tree branches or streaks
Woods lamp: green tint if microsporum, trichophyton does not fluoresce
differentiate SJS vs TEN
what causes SJS/TEN
medications: antibiotics, NSAIDs, anticonvulsants, infection, idiopathic
describe SJS/TEN
erythematous macules, bullae, erosions, desquamation
prodrome of fever, malaise, cough, HA, conjunctivitis 1-3 weeks after exposure, followed by skin lesions 1-3 days
may demonstrate Nikolsky sign: skin sloughing at gentle touch
what is the treatment of SJS/TEN
STAT derm referral and skin bx d/c offending medication ICU, wound care, pain meds
what rash is a rapid eruption of erythmatous, edematous, raised, pruritic, blanching wheals of various shapes, sizes, and evanescence. dermatographism
ranging from itchy to anaphylaxis
urticaria
what is the treatment of urticaria
antihistamines epinepherine IM if anaphylaxis avoid known triggers
describe a verruca vulgaris and what causes them
cause: HPV
filiform, flat, cauliform hyperkeratotic, black dots when shaved
how are warts treated
self resolve without treatment destruction with salicylic acid, cryotherapy, cantharidin, TCA, duct tape occlusion, imiquimod
MCO of acute otitis media
H flu Strep pneumo Morexella cararrhalis
what is the presentation of acute otitis media
rapid onset ear pain commonly preceded by viral URI (fever, HA, rhinorrhea, postnasal drip, cough), ear tugging, N/V
red bulging TM, purulent effusion, dull light reflex, absent or decreased mobility on pneumatic otoscopy
lymphadenopathy, conjunctivitis is H flu
what is the treatment of acute otitis media
what are complications of acute otitis media
Acute mastoiditis: mastoid inflammation or infection
Choleasteatoma: overgrowth of squamous epithelium in middle ear and mastoid air cells destroying ossicles
describe presentation of viral vs bacterial pharyngitis
Viral: slower onset sore thorat, cough, hoarseness, rhinorrhea, sinus congestion, ear pain, fever, conjunctivitis, pharyngeal edema, tonsillar exudate, cervical adenopathy, fever
bacterial: rapid onset sore throat with dysphagia, fever, lack cough and URI sx, bilateral tonsillar erythema and edema, tender cervical adenopathy, sandpaper rash, palatal petechia
Describe the centor criteria
testing for bacterial pharyngitis (strep throat)
fever >38C/100.4F
Tonsillar exudates
Lymphadenopathy
No cough
<15yo +1
44yo -1 16-44 0
2 points swab them
if negative and still suspect, get throat culture
Treatment of viral vs bacterial pharyngitis
Viral: supportive care
bacterial: amoxicillin, supportive care
when to get tonsillectomy?
consider in kids >3 episodes in each 3 years, >5 episodes in each of 2 years, and >7 episodes in one year
what are complications of acute bacterial pharyngitis
rheumatic fever: autoimmune response to strep, inflammation- myocarditis, endocardiits, valvulitis, joint pain, muscle pain, movement disorders, tissue changes
PANDAS: pediatric autoimmune neuropsychiatric disorders. seen in kids with OCD or tic disorders
peritonsillar abscess, poststreptotoccal glomerulonephritis
describe types of sinusitis
Allergic: most common, IgE-mediated +/- allergy testing
Non-allergic rhinits: malignancy, pregnancy, vasomotor, mediation-induced, atrophic Usually seen later in age
Vasomotor rhinitis: non-allergic & non-infectious dilation of blood vessels (ex. temperature change, strong smells, humidity)
**Rhinits medicamentosa: caused by overusing nasal decongestants, leading to a rebound affect ""addicted to nasal sprays"" (ex. Affrin)
Symptoms of allergic vs non-allergic sinusitis
Allergic: pale nasal mucosa due to infiltration of area with eosinophils May have ""allergic shiner"" (purple discoloration around eyes or nasal bridge) May have nasal polyps with cobblestone mucosa of conjunctiva Swollen/red turbinates
Non-allergic: absence of nasal or ocular itching & prominent sneezing Red turbinates Nasal congestion & post nasal drainage are prominent May have year-round symptoms
treatment of acute sinusitis
oral antihistamines, nasal antihistamines, nasal corticosteroids
MCO of rhinitis
almost always viral- rhinovirus, influenza, parainfluenza
If bacterial: strep pneumoniae
What are signs of bacterial rhinitis and not viral
onset of persistent sx >10 days severe symptoms or high fever >102F purulent drainage lasting 3-4 days
worsening symptoms or signs characterized by new onset of fever, headache, increased nasal drainage following URI that lasted 5-6 days and were initially improving "double sickening"
what are symptoms of rhinitis
nasal inflammation and obstruction discolored nasal drainage absent transillumination of sinuses tenderness over sinuses
what is the treatment of viral vs bacterial rhinitis
viral: supportive care
bacterial: augmentin 10-14d if sx present 10-14d and worsening
switch to quinolones if no improvement after 3-5 days CT if still no improvement
what are possible complications of rhinitis
orbital cellulitis, abscess formation, mucocele formation, cavernous sinus thrombosis, osteomyelitis, otitis media
MCO of viral vs bacterial conjunctivitis
viral: adenovirus
bacterial: strep pneumo, H. flu, Moraxella catarrhalis, staph aureus
symptoms of viral conjunctivitis
red conjunctiva, watery or mucoserous discharge, gritty pain, burning, or irritation. assoc. with pharyngitis, fever, cough, body aches
cobblestoning of conjunctiva
absence of purulent discharge, pain with EOM, swelling around eye, foreign body sensation
what diagnostics are done for conjunctivitis
fluorescein stain to r/o corneal abrasion
what is the treatment of viral vs bacterial vs allergic conjunctivitis
viral: self limiting, wash hands, antihistamine drops
bacterial: abx drops- erythromycin, trimethoprim-polymyxin B, cipro if contact wearer, return to school after drainage resolves or 24hrs after abx
allergic: antihistamine eyedrops
what are symptoms of bacterial conjunctivitis
purulent discharge- green, white, yellow, thick and globby
copious discharge, conjunctival erythema with no ciliary injection
what are symptoms of allergic conjunctivitis
itching, bilateral erythema and watery discharge, chemosis, allergic shinners
Describe opthalmia neonatorum (neonatal conjunctivitis)
discharge, redness, swelling chemical: day 1 after birth from silver nitrate gonococcal: purulent conjunctivitis with exudate and swelling of lids around 2-5 days after birth chlamydia seen around days 5-7 after birth
how is opthalmia neonatorum diagnosed
clinical dx culture with gram stain and PCT
how is opthalmia neonatorum treated
erythromycin eye ointment HSV: ganciclovir gel severe and dont suspect HSV- topical corticosteroids (lotepredenol)
MCO of epiglottitis
who is it typically seen in
H flu B (vaccine mostly prevents it)
children 2-4 but now seeing in older kids
symptoms of epiglotitis
rapid onset stridor, difficulty swallowing, muffled voice, sore throat, pain with neck palpation drooling, dysphagia, distress, tripoding
Dx: laryngoscopy showing red and swollen epiglottis, lateral neck xray with thumbprint sign
how is epiglotitis treated
immediate referral to ED ICU admit needed to manage airway, intubate and antibiotics
Ceftriaxone
describe anterior vs posterior epistaxis
anterior: kiesselbach plexus, from one nostril when sitting/standing, nose picking, drug use, dry air, allergic rhinitis
posterior: blood flows down back of throat, due to malignancy, anticoagulation, aneurysm, bleeding disorder
what is the treatment of epistaxis
vasoconstrictor: alpha-1 adrenergic receptor agonsit
pressure on bridge of nose with icepack
elevate head
nasal packing- rhinorocket removed by ENT
chemical/electrical cautery only if source can be visualized
symptoms of mastoiditis
fever postauricular tenderness erythema bulging tympanic membrane protrusion of auricle
how is mastoiditis diagnosed
CT with contrast showing fluid in mastoid air cell
how is mastoiditis treated
middle ear drainage via myrinotomy IV abx: vancomycin and ceftriaxone if suspect pseudomonas: cefepime or zosyn if complicated: surgical removal of mastoid bone
difference between periorbital and orbital cellulitis symptoms
periorbital: unilateral ocular pain, red and swollen eyelid, mild fever, inability to open eye, no changes in EOM or visual acuity, no proptosis, no chemosis
orbital: ocular pain, eyelid swelling, systemically ill with fever, pain with EOM, proptosis, chemosis, vision loss, nasal drainage, tenderness
diagnosis of periorbital vs orbital cellulitis
CT
cause of periorbital vs orbital cellulitis
periorbital: secondary to another infection, sinus infection MC with staph or S. pyogenes, insect or animal bite
orbital: complication of rhinosinusitis- strep
treatment of periorbital vs orbital cellulitis
periorbital: oral abx, close follow up in 24hrs, if no improvement consider orbital cellulitis
orbital cellulitis: immediate referral to ED, need IV abx, consider surgery
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