CMS Final: Derm pt 1

which condition is characterized by an "itch scratch" cycle?

atopic dermatitis → scratching causes more inflammation

what histology findings are associated with atopic dermatitis?

spongiosis → characterized by intercellular edema within epidermis

what cause is seborrheic dermatitis linked to?

malassezia furfur

Where is seborrheic dermatitis commonly seen?

sebum rich areas of scalp, face and trunk

hallmark of seborrheic dermatitis?

greasy-yellow scale

what is the first line treatment for seborrheic dermatitis?

antifungal (ketoconazole) and low potency steroid (betamethasone)

which phase of contact dermatitis is associated with plaques of mild erythema with small dry scales?

subacute

which phase of allergic contact dermatitis is associated with demarcated erythema and edema with vesicles and/or papules, bullae, erosions?

acute

which phase of allergic contact dermatitis is associated with plaques of lichenifications, scaling, small round papules, excoriations, and erythema?

chronic

in which condition can a patch test cause sensitization?

poison ivy/oak dermatitis

which condition is caused by cytotoxic damage to keratinocytes?

irritant contact dermatitis

where is the most common location for irritant contact dermatitis?

hands

does irritant contact dermatitis spread?

NO

where is the most common location for stasis dermatitis?

medial ankle

what disease is characterized by inflammation of lower extremities occurring in pts with chronic venous insufficiency secondary to venous HTN?

stasis dermatitis

which condition has a hallmark of tapioca-like vesicles?

dyshidrotic eczema

conditions that involve palms and soles?

- dyshidrotic eczema
- chronic plaque psoriasis
- palmoplantar psoriasis
- TSS
- syphilis
- hand foot mouth disease
- RMSF

which condition is characterized by chronic inflammatory pruritic coin-shaped lesions?

nummular eczema

what is the first line treatment for nummular (discoid) eczema?

high potency topical steroids (1-3)

which type of psoriasis is characterized by well-demarcated erythematous plaques with overlying silvery scales?

chronic plaque psoriasis

which type of psoriasis is commonly located on scalp, gluteal cleft, extensors with painful fissures on palms/soles?

chronic plaque psoriasis

which type of psoriasis is associated with strep throat?

guttate

which condition has first line therapy of UV phototherapy?

Guttate psoriasis

what is the oil drop sign and which condition is it associated with?

oil drop sign = changes in nail bed to brown/tan color
associated with nail psoriasis

what is the treatment for palmoplantar psoriasis?

high potency topical steroids d/t presence of plaques on palms and soles

which joint is affected by psoriatic arthritis?

distal interphalangeal joint

what is the treatment of choice for dactylitis?

DMARDs (methotrexate) → should always be supplemented with folic acid

what is acne conglobata?

severe nodular form of acne in young males associated with sinus tracts

what is required to be present in order to diagnose acne vulgaris?

comedones

are comedones present in rosacea?

NO!!!!!!!!!!!!!!!!!!!!!!

which Fitzpatrick type/s has most risk for developing rosacea?

1 and 2

what are the aggrevating factors for rosacea?

- alcohol
- UV light
- smoking
- spicy food
- hot drinks/temperature
- stress

what is the treatment of choice for mild/moderate rosacea?

metronidazole gel

what is the risk when using high potency steroids on the face?

skin atrophy

what area of skin is spared in perioral dermatitis?

narrow area around vermillion border

do pilar cysts have a central punctum?

no

what is a translucent papule on dorsum of digital between DIP joint and proximal nail fold?

digital myxoid cyst → considered a pseudocyst bc it has no capsule

what is a painful fluctuant mass in sacrococcygeal region?

pilonidal cyst

what is strawberry tongue associated with?

scarlet fever

what disease are pastia lines seen in ?

scarlet fever

what is scarlet fever rash characterized by?

blanching, sandpaper rash

what is the first line of treatment for scarlet fever?

penicillin
*amox in kids

what disease is associated with diffuse skin pain and blanching erythema with superficial blistering and desquamation?

staph scalded skin syndrome

does SSSS have + or - nikolsky sign?

positive

what is the bacterial cause of SSSS?

exfoliative toxin A and B from Staph aureus → hematogenous dissemination into skin

are mucous membranes involved in SSSS?

NO

what is the treatment of choice for SSSS?

oxacillin or nafcillin

does scarlet fever rash affect palms and soles?

NOOO

what condition is associated with a pruritic maculopapular rash with desquamation of palms and soles?

toxic shock syndrome

what microbe is hot tub folliculitis associated with?

pseudomonas →treat with cipro***

what is the first line of treatment for impetigo?

Mupirocin

does impetigo infect the dermis?

NO → epidermis only

which toxin causes bullous impetigo?

staph aureus toxin

what condition is characterized by "punched out" ulcers covered with yellow crust?

ecthyma

does ecthyma extend into dermis?

YES

which population is erysipelas commonly found in?

young kids and older adults

which disease is Milian's ear a distinguishing feature for?

erysipelas

cellulitis vs. erysipelas: which is always non-purulent?

erysipelas

→ +/- purulence for cellulitis

which population is cellulitis commonly found in?

middle aged and older adults

is cellulitis localized to upper dermis?

NO → deeper dermis and subcutaneous tissue is affected

which has clear demarcation--erysipelas or cellulitis?

erysipelas***

what is the etiology of lymphangitis from an animal bite?

pasteurella multocida

what is the cause of lymphangitis from a cat bite?

bartonella henslae

what is the cause of lymphangitis from fish exposure?

Erysipelothrix

what condition is lymphangitis commonly seen with?

cellulitis

what is characterized by painless violet/brown-red indurated wart-plaques? and what disease is it associated with?

verrucosa cutis → associated with TB

what is the gold standard for dx of cutaneous TB?

mycobacterial culture

What is Hansen's disease also known as?

leprosy

what are common manifestations of leprosy?

hypopigmented/red patches, diminished sensation, painless wounds on hands/feet, hair loss

what is the treatment for tuberculoid leprosy?

dapsone and rifampin

what is the treatment for lepromatous leprosy?

dapsone, rifampin, clofazimine x2 years

what are complications of leprosy?

paralysis, corneal ulcers, digit loss, saddle-nose

what condition shows up as coral-red fluorescence on woods lamp?

Erythrasma

which microbe causes erythrasma?

corynebacterium

what symptom triad is associated with meningitis?

1. sudden onset fever
2. AMS
3. nuchal rigidity

what is a serious complication of meningitis?

purpura fulminans → associated with DIC

what is the gold standard for dx of meningitis?

blood or CSF culture

what is the first line of treatment for meningitis?

rocephin IV

which phase of cutaneous meningitis is associated with maculopapular rash?

early

which phase of cutaneous meningitis is associated with petichiae and purpuric/hemorrhagic bullae?

late

are chancres of syphilis painful or painless?

painless!!

what is the treatment of choice for syphilis?

Penicillin G

what are condyloma lata and what disease are they associated with?***

wart-like, pink papules on mucous membranes → associated with syphilis

which stage of syphilis is associated with gummas and neurosyphilis?

late (tertiary)

Are chancroids painful or painless?

PAINFUL

which condition are bubos (swollen inflamed lymph nodes) associated with?

chanchroids → caused by H. ducreyi

condyloma lata vs. condyloma acuminata
on test

condyloma lata: flat, wart-like soft lesions caused by secondary syphilis

condyloma acuminata: cauliflower genital warts caused by HPV

which stage of syphilis do you see condyloma lata in?

secondary

which condition is associated with regional proximal LAD?

cat scratch disease

what is the first line of treatment for cat scratch disease?

azithromycin

what is german measles also known as?

Rubella

which condition are koplik spots often found in?

Rubeola AKA "measles"

does rubella have a low or high fever in prodome phase?

low grade --> Rubeola has high fever

which condition is associated with a rash that begins at hairline and spreads craniocaudal and centrifugally?

rubeola

What are Forchheimer spots and what are they associated with?

red macules/petechiae on soft palate → associated with rubella (german measles)

what type of exanthem is seen in rubella?

pink/red non-confluent maculopapular rash sparing palms and soles → spreads from face to trunk

what is Roseola also known as?

6th disease → bc caused by HHV-6

what is the only viral exanthem that begins on the trunk?

roseola

which disease is characterized by acute onset high fever and a nonpruritic blanching rash that begins on the trunk?

Roseola

what is the common cause of hand, foot and mouth disease?

coxsackie A16, A6, and enterovirus A71