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136 Cards in this Set
- Front
- Back
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this is sweat glands from axillary and groin, increased with stress
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apocrine
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this is sweat glands all over the body
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eccrine
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this is fatty substance secreted into hair follicles and skin
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sebaceous glands
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melanoma is located most commonly where and where is basal cell
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melanoma - hands and feet
basal - around eyes and finger nails, webs of fingers |
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what is a common widespread generalized rash
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systemic infection or allergic response - rubella
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what is intertriginous
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skin folds, in dark area
yeast - like warm moist dark places |
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what is a dermatomal distribution
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, erythematic vesicular lesions, with macules and honey crust lesions
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describe a photosensitivity pattern
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bilateral sun exposed areas, will see area where sun is spared
watch bc medications cause photosensitivity |
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this is a web like rash, vascular changes is what makes shape and color
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reticulated
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how is the distribution of thus dermatitis
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Poison ivy – initial place where oil comes into contact with skin is linear, then will spread and become diffuse and patchy – depends on how sensitive they are to the oils
Do not have to touch the plant, carried, once shower – then not contagious to others or if ooze – will not spread |
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what are diseases with target lesion
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syphilis - secondary
lyme disease erythema multiforme |
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what do you need to rule out when there is alopecia
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rheumatological disease
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what is the angle greater than for clubbing
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180
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what are beu's lines
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transverse depressions of the nail plates, bilaterally
seen with systemic disease |
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what are secondary lesions - 4
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scale
fissure crust ulcer |
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– < 1cm spot different in color; flat - neither elevated nor depressed.
Example: Freckles, flat nevi |
macule
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– > 1cm spot different in color; flat - neither elevated nor depressed.
Example: Vitiligo |
patch
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– circumscribed superficial solid elevation < 1cm
Example: Elevated nevi, warts, lichen planus |
papule
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circumscribed, superficial firm, rough elevation > 1cm; confluence of papules with flat - topped surface.
Example: Psoriasis |
plaque
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palpable solid round or elevated mass/lesion > 1cm
This may be above or beneath the skin |
nodule
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palpable solid round or elevated mass/lesion > 2cm
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tumor
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VESICLE – circumscribed, superficial elevation, papule with clear fluid <.5cm
Example: Herpes Zoster |
vesicle
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– circumscribed, superficial elevation, papule with clear fluid >.5cm; thin & translucent with serum, lymph fluid, blood or extracellular fluid within.
Example: Bullous Pemphigoid |
bulla
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circumscribed elevations of the skin, papule with cloudy fluid
Examples: Acne, Impetigo |
pustle
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rounded or flat-topped, pale-red papule or plaque characteristically evanescent, disappearing within hours; round, gyrate or irregular.
Example: Hive |
wheal
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Abrasion of the skin resulting in loss of epidermis; usually superficial and traumatic.
Examples: Scratched insect bites, scabies |
excoriation
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Linear crack or break in the epidermis; may be moist or dry
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fissure
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Diffuse area of thickened epidermis secondary to persistent rubbing, itching, or skin irritation with resultant increase in the skin lines and markings; often involves flexor surface of extremities.
Example: Atopic dermatitis |
lichenification
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- Irregularly shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound; caused by excessive collagen formation during healing
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keliod
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Small and short or long and tortuous tunnels in the epidermis.
Example: Small and short- scabies Long and tortuous - creeping eruptions |
burrows
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Plug of whitish or blackish sebaceous and keratinous material lodged in the pilosebaceous follicle usually seen on the face, the chest and/or back.
Example: Acne/ Blackhead |
comedone
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Whitish papules, 1-2 mm in diameter with no visible opening onto the skin surface.
Example: Whiteheads/acne, healed burns, healed bullous disease states, face of newborn babies |
milia
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Dilated superficial blood vessels that appear as fine irregular red lines.
Example: Spider angiomas |
telangiectasis
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used to describe inflammatory conditions of the skin, which appear erythematous and scaly with ill-defined borders.
Example: Atopic dermatitis |
eczema
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used to describe conditions, which manifest themselves as papules or plaques with scales.
Example: Psoriasis |
papulosquamous
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what is the difference between male pattern and female pattern baldness
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female - more diffuse - widening and thinning hair
male - gradual, androgenic |
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what are normal changes with nails that occur with age
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nail become dry and brittle
flat and concave longitudinal ridging or hyperkeratosis can develop |
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what is hyperkeratosis seen in
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psoriasis, idiopathic, inflammatory or could be fungal, should culture to rule out
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this is chronic acneform with vascular dilation on the central face
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acne rosacea
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red bulbous nose of rosacea; occurs mostly in men
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rhinophyma
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what is the clinical presentation for acneform rosacea
age of onset sx |
30-50 years
fair skinned facial flushing, with increases in skin temperature, ingestion of hot or spicy food, and alcohol consumption blepharitis and dry eye edema with eyelids and nasolabial folds, flushing, telangacia, papules and pustules |
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what are differentials for acne form rosacea
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Acne vulgaris; seborrheic dermatitis; contact dermatitis; lupus; photosensitivity
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what is the hallmark treatment for acne form rosacea and what are other treatment choices
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HALLMARK: Metronidaazole - Metrogel apply BID
others: sulfate lotion BID; clindamycin lotion BID Oral: Tetracycline and Erythromycin 500mg PO BID for 4-6 weeks reduce to QD with significant improvement and then taper aviod contact triggers |
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when do you prescribe gel vs cream medications
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gel - oily skin
cream - dry skin |
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what does acne vulgaris result from
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result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland
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what are the 4 factors that contribute to acne
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1. follicular epidermal hyper-proliferation plugging of the follicle
2. excess sebum (produced by androgen dependent sebaceous glands) 3. the presence and activity of Propionibacterium acnes 4. inflammation |
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what are common manifestations of acne in adult females
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no acne until an adult,
chin/mandible peri oral areas premenses flaring menopause is the cure |
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Lesions are non-inflammatory comedones located on forehead, chin, nose, and paranasal area
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comedomes
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what are open vs close comedomes
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open - black heads
closed - white heads |
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usually occurs in teens after first phase of non-inflammatory acne; also occurs in women in their 20s; Scattered small papules or pustules with minimum comedones
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mild inflammatory acne
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more generalized eruption
can be on face and upper trunk with papules, pustules, and comedones reflects the presence of a very destructive type of inflammation |
inflammatory acne, final phase
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what are general treatment options for
comedomal mild inflammatory cystic ance |
comedomal - Retin A
mild inflammatory - topical retinoid, oral antibiotics, cystic - vitamin a analog |
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what is the actions of retinoids
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normalizes desquamation and reduce inflammatory responce
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what is the action of antibiotics
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reduce microorganisms and reduce inflammation
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what is the action of benzoyl peroxides
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normalizes desquamation and reduce microorganisms
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what is the action of hormones
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reduce sebum
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what is an important question when someone is coming in with acne
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know if any changes in medications
OCP - start and can worsen |
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how long to see a change in acne
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2-3 months
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what are the topical antibiotics for acne
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Erythromycin 2% Solution or Gel; apply BID
Clindamycin 1% solution, lotion or gel; apply BID Sulfacetamide/Sulfur; (Sulfacet, Clenia) Benzamycin Gel (combination of clindamycin and benzoyl peroxide; apply BID |
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what are oral antibiotics for acne
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Doxycycline *
Minocycline * Tetracycline* Erythromycin (safe in pregnancy) Typically start with BID dosing, then reduce to daily maintenance |
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what are anti-androgen medications for acne
what do you need to check before starting and what are symptoms a patient has you would prescribe this for |
orthotricyclin
yaz aldactone Labs: check potassium and BP sx: menstraul irregularities, hirsutism, mandibular and chin acne |
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what acne treatment is ok in pregnancy
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erythromycin gel and alpha hydroxy
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when do you refer out if sx not getting better for acne
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3 months
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how much steroid cream is needed for the whole body
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30-45grams
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how is absorption of topical steroids on the skin
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site dependent = scrotom the most, soles worst
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what are SE of steroids and how long should they be used on the face
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<7 days
SE skin atrophy tachyphylaxis, steriod rosacea, glaucoma, infection |
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where are the most commonly seen areas of atopic dermatitis
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neck, chest, AC, hands, groin, knees
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what is the treatment for atopic
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topical steriods BID
oral antihistamines - zyrtec, allegra, claritin 10mg/d UVB refer after 2 weeks Emollients! |
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what is dyshydrosis
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increased water on the skin
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what are symptoms of dyshydrosis
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itchy vesicles on palms, after 3-4 weeks they erode then scale, and lichenifcation
itchy |
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what is the treatment for dyshydrosis
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avoid allergy
erythro x 10 days topical steriods cold compresses refer after 2 weeks |
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what are common causes of contact dermatitis
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poison ivy
nickel topical medications adhesives |
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what is the treatment for contact dermatitis
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topical steriods
oral if severe or chronic oral antihistamines topical anti-puritic - aveeno cool compresses |
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what is the cause and sx of stasis ulcers
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CV insufficiency
itchy, scale, ulcer, hyperpigmented. of not treated becomes indurated and fibrotic |
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what is the tx for stasis ulcers
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treat venous issue
elevate and compress una boot hydrocolloid if weeping |
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when do you suspect a drug eruption
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anyone taking medications
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what are common medications that cause drug rashes and what are the treatments
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antibiotics, NSAIDS, cytokines, chemo, psycotrophic, sz, sulfa
tx: antihistamines and oral steriods |
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how are allergic responses related to route - IV vs topical vs Chronic use
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IV - worse response, anaphylaxis
topical - delay allergy response allergic sensitization with chronic use |
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what are common causes of skin reactions - meds
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benedryl
digoxin folic acid tetracycline codiene steriods morphine iron |
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what is Nikolsky sign
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symptoms of SJS when slough of epidermis with lateral pressure
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what is confluent erythema
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angioedema, swelling, palpable purpura, fever dyspnea and hypotension
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this is a reaction from a virus, will come and go
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erythema multiforme
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this is a rad pack with purple gray centers on arms face soles of feet and palms
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erythema multiforme - HSV
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what is the treatment for erythema multiform
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steriods, lidocaine, acyclovir, resolve on own
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this is chronic inflammation from pityrosporium oval and with environmental factors such as stress
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seborrheitc dermatitis
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where is seborrhatic most commonly at
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hair line, and skin folds - eye brow, nasolabial folds, ears
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what is the descriptions of seborrhatic
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fine dry white and yellow scales, on inflamed base
if severe red plaques with white scales that are diffuse and not well cic |
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what is the treatment for seborrhatic
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coal
selenium and ketoconazole shampoo topical steroids if shampoo does not work |
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what is the treatment for seborrhatic on the face
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hydrocortisone lotion or ketoconozole
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what is the treatment for impentigo
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mupirocin TID x 7-10 days
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what are causes of cellulitis
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hflu
strep staph after trauma and break in skin |
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what are symptoms of cellulitis
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red hot pain
edema fever and chills enlarged lymph |
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what are sx of GAS cellulitis
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erysipelas - superficial with clear margins on LE face or ears with lymph enlargement - streaking seen
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what is the treatment of cellulitis from an animal bite
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augmentin
f/u 2-4 days |
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what is the treatment for uncomplicated cellulitis
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oxacillin
cephalaxin erythrmoycin azythromycin |
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where are the locations of carbuncles
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deep in dermis, back of neck and lateral thigh
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what is the treatment for folliculitis, carbuncles and faruncles
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folliculitis - benzyol peroxide or erythro or clinda
carb/faruncles - warm heat, I and D, oral dicloxacillin or cephalxen |
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what is the treatment for candida
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nystatin x 10 days
expose to light and keep dry F/U 2 weeks |
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how do you diagnose tinea vescicolor
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woods lamp
KOH |
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what are sx of tinea vescicolor
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macules of differ colors on upper trunk
worse with heat humidity and pregnancy and steroids hypopigmentation |
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what is the treatment for tinea vescicolor
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selsun blue leave in for 24h and wash off
can use as proph sulcanozole oral diflucan or ketoconazole |
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what are sx of tinea capitus
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erythema with scale and patchy hair loss can be boggy - Kerion
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what is the treatment for capitus
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grisofulven x 4-8 weeks take with food and check LFTs after 2 weeks
selenium x 2 weeks |
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what are sx of tinea corporus
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erythema, demarcated, vescicular border, hypopignemented itchy
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what are symptoms of tinea cruris
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males, demarcated scales, itchy and no scotal involvement
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what are sx of tinea pedis
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vescicular papular scaly and itchy
in between toes |
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this is distal thickening and yellowing of toe nails, can occur with ring worm
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onchymycosis
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what is the treatment of tinea
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ketoconozole cream 2-6 weeks
lamisil 4 weeks pedis requires longer treatment if resistant PO lamisal or diflucan FU 2 weeks check CBC and LFTs |
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these are mite burrows where larvae hatch and mature in 14 days cause itching
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scabies
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what is the primary vs secondary lesions of scabies
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primary - burrow, gray and pinpoint serous fluid and papules
secondary scaling from scars |
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what is the treatment of scabies
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elimite cream - 8-14 hours then bathe
safe in pregnancy launder clothes or put in bag x 7 days itching will last several weeks |
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what is the most common way lice is transmitted
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inanimate objects - fomite
or direct contact |
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what is the most common type of lice
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pubic - 90%
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what is the treatment for lice
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Nix cream - leave on for 10 minutes and then re treat 7-10 days after
Lindane shampoo |
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this is a chronic hyper proliferative inflammatory state, triggers by trauma, infection stress and meds
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psoriasis
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what are history symptoms to cue you into psoriasis
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chronic dandruff
autoimmune disease ears scale no itching nail pitting DIP arthritis |
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what does psoriasis look like
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silver white plaques
well demarcated band together bleeding points elbows, knees scalp bilateral and symmetric |
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what is the treatment for psoriais
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>10% refer
topical steriods daily moisturizer dovenox NSAID cream for maintenance Tazorac or Protopic - vitamin A refer after 2 weeks |
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which medications and infections flare psoriasis
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BB
lithium strep infection |
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this is a viral rash, with a herald patch first then after 7-14d have rupture of lesions on trunk - parrellel
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pitryiasis rosea
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what is the treatment for pityriasis rosea
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will resolve on own
control itch sunlight |
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this is a chronic inflammation of the mucosa, seen in 30-70 year olds, immune
on flexor surfaces, reticulated patter, in mouth |
lichen planus
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what happens to the nails in lichen planus
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loose nails
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what are the 5 Ps in Lichen Planus
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pruritic
planar - flat polyangular plaque papules purple |
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what is the treatment of lichen planus
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triamicolone BID x 1-2 weeks
control itch |
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what is the treatment for post hepatic neuralgia
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lyrica
neurotin TCAs Lidocaine |
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what is the treatment of shingles
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wet compresses
burrows bactroban x 10days oral valtrex or famcyclovir if less then 72 hours or if new lesions still form >72 hours FU 2-3 days then 7-10 days |
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cutaneous viral infection, burning 4-5 days before with prodrome of fever, chills, body aches, HA then clusters of vesicles form and crust
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shingles
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this is a benign viral rash, white or flesh colored dome papules with center divot
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molluscum
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what is the treatment of molluscum
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liquid nitrogen
tretinoin |
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this is a lesion first a macule on the trunk in the middle aged, usually brown with a stuck on appearance
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seborratic keratosis - tx with cryotherapy
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pedunculated fleshy tan small round polyps
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skin tags
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hyperpigemented pedunculated papules on blacks and asains, marker of aging
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dermatosis papulosa nigra
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this is a dictate mature vascular papule, marker of aging
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cherry angioma
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hyperpigemented macules with irregular borders to sun exposed areas
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solar lentigo
liver spots - face and hands |
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this is tumor of sebaceous gland soft and yellow papule on face or forehead - marker of agine
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senile sebacous hyperplasia
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