CM Derm II

jmanderson's version from 2016-03-06 16:05

Derm emergencies


Question Answer
Dx this - hx of tick, late spring, rash starts day 3 (starts at hands and feet, goes to trunk - spreads CENTRIPETALLY); HIGH FEVER; FLU; abdominal pain; lymphohistiocytic vasculitis on punch bx; rickettsiae on DIFrocky mountain spotted fever
What is the main causative organism of Toxic Shock Syndrome?15-35 yo (staph); 20-35 yo (strep); S. pyogenes MC
Dx this and give organism - from surgical packing left in place; rash starts on trunk (spreads CENTRIFUGALLY); high fever, flu, erythema on palms and soles, strawberry tongue conjunctivitis; rapid progressiontoxic shock syndrome - Staph aureus
Dx this - gray/blue discorloration; woody firm induration, on extremities, extreme pain, cellulits not responding to ABX, watery drainage w/ odor, high CKNecrotizing Fasciitis
What is special about the rash in Acute Meningococcemia?petechial eruption (ALL OVER) -> ecchymosis -> ischemic necrosis (fever, chills, hypotension, meningitis, pneumonia, arthritis, pericarditis, DIC)
Dx and tx this - young kid, sickle cell anemia and asplenic, petechial erruption all over, tissue bx with Gm (-) diplococci?Acute meningococcemia (Neisseria) - tx with IV PCN, prophylaxis of ppl pt has had contact with

benign and premalignant tumors of skin


Question Answer
Dx this - solitary pink papule on the face (@ upper lip and cheek); endophytic proliferation of keratinocytes + squamous eddysinverted follicular keratosis
Dx this - velvety hyperpigmentation of the intertriginous surfaces (e.g., neck and axillae)acanthosis nigracans
What is Acanthosis Nigracans commonly associated with…?gastric CA, DM, and Obesity (and often exhibit skin tags and papillomatosis)
Again, papillomatosus is often associated with…?pituitary/thyroid disorders, DM and obesity (which may respond to minocycline)
Dx this - hyperpigmented verrucuous confluent papulesConfluent and Reticulated Papillomatosus (CARP)
Dx this - soft benign dermal nodules w/ central punctum on the face and chest (areas w/ hair follicles), arising from the follicular infundibulumepidermal inclusion cysts (EIC)
Dx this - soft tumor of infancy that rapidly forms and progresses within the first 12 mo of lifeinfantile hemangioma
How do you treat Infantile Hemangioma?NOTHING (involutes on its own naturally)
topical sx -> Rx timolol (avoids mucosae and ulcerated lesions)
systemic Sx -> Rx steroids or propranolol
Dx this - After minor truama; rapidly growing, friable, red papule that ulcerates on the gingiva, fingers, lips, face, and tongue; proliferating capillaries grouped into lobules by dense fibrous bandspyogenic granuloma
How do you Tx warts first line?Cryotherapy
Definitive tx for warts?Cut it out and burn the base

malignant skin tumors


Question Answer
Actinic Keratosis w/ Flag sign --> At risk of developing intoSCC (as a precursor lesion)
Risk factors for the development of BCC?UVL exposure, light hair and eye color, northern European ancestry, and inability to tan
Subtype of nodular BCC w/ increased melanization; hyperpigmented translucent papule which may also be erodedPigmented BCC
Pigmented BCC is difficult to distinguish from…Nodular Melanoma
Clark Level Scale @ 5 (And what is eroded?)Subcutaneous tissue
Risk factors for melanomaFreckles, Atypical nevi, Family history, Easily burned/fair skin,
Worst melanoma; Tend to be thicker, reaching greater depths upon finding and diagnosis (Thus, it’s probably metastasized by the time it has been biopsied!)Amelanotic melanoma
Growing freckle w/ irregular borders; Not the worst skin malignancymelanoma in situ
Appears white, making it hard to identify and realize it needs to be biopsiedsuperficial spreading melanoma
On the soles of feet in African Americans  Goes unnoticed so it’s diagnosed later than it should beacrolentiginous melanoma
Dx this - >60 yo, chronic sun exposure, Hutchinson's freckle (malignant change takes several yrs)Lentigo Maligna type of melanoma
How do you surveillance patients post-melanoma?PET scan (except brain – MRI)
Differentiate between Tx b/w SCC and BCC(SCC – more aggressive Tx / BCC – only invades basal membrane, so not as bad / Melanoma – needs wide margins at the edges and depth)
Important marker and TSG; mutations induced by UV radiation; part of p16INK4A pathwayp53
Important marker (melanoma); part of MAPK pathwayBRAF
ABCDE of melanomaAsymmetry, Border, Color, Diameter, Evolution