Skin:
RMSF- Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you
develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and
becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti
Antigen TREATMENT- doxycycline. EXAM
Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days
POST being bitten by a deer tick. Rash is hot to touch with rough texture, flu like
symptoms. DX: B. Burgdorferi via ELISA, then confirm with western blot. Increased
ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7
Doxycycline. EXAM
Melanoma- Dark Moles, uneven texture, different colors, irregular, >6mm, could be
XAM
itchy. E
Stevens Johnson Syndrome- Classic is target or bulls-eye. Abruptly, hives, blisters,
petechiae, purpura, necrosis, sloughing of tissues. Extensive mucosal involvement.
Prodrome of fevers with flu like symptoms. Triggers: Allopurinol, anticonvulsants, pcn,
sulfonamides, NSAIDS. HIV ppl have higher risk for this syndrome.
Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted
fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.
(Koebner phenomenon- new psoriatic plaques form over skin trauma)
(Auspitz sign- pinpoint bleeding when plaques are removed).
TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or
immunologic.
Acanthros Nigricans- velvet hyperpigmented patches most common on back of neck or
skin folds- DM resistance.
Scabies- itching bedtime. Primethrin cream treat everyone wash sheets and everything
else in hot water.
Atopic Dermatitis (eczema)- Inherited. Extremely itchy. On flexural folds, neck, hands.
Inc. IgE. “small vesicles that rupture leaving painful, bright-red, weepy lesions” they
become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO
antihistamines. EXAM
Tinea Corporis- “ring like itchy rash, slowly enlarge central clearing”-Treatment: most
respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending
Actinic Keratosis- Precursor to squamous cell carcinoma. “numerous dry round and pink
to red lesions” with a rough and scaly texture. Does not heal. Slow growing in sun
,exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg.
(5-FU cream)- which causes ur skin to ooze, crust, scab, redness. EXAM
Seborrheic Keratosis- soft round wart light tan to black pasted on. Asymptomatic and
benign.
Cellulitis- Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS.
DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS.
Erysipelas- Group A strep, Upper dermis, clear demarcated, cheeks, shins.
TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do
Azithro x5d.
MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.
Basal Cell Carcinoma- pearly, waxy, skin lesions, atrophic, ulcerated center that does not
heal.
Molloscum Contagiosum- white plug, dome shaped. Highly contagious. EXAM
Varicella Zoster Virus- “contagious 48 h. before, until all lesions crusted over” low grade
fever, generalized lymphadenopathy, intense itching, erythematous macules, papules
develop over macules, then vesicles erupt. “initially on trunk, then scalp and face”
TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours
works best. EXAM
Acne Vulgaris (common acne)- ON EXAM
mild (topicals only) *open/closed comedone w/ or w/o sm. papules. Retin-A, acne
worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin,
benzoyl peroxide.
Moderate (topicals plus antibiotics)- papules, pustules w/ comedones. Continue with
topicals combined with topical antibiotics. Then add ORAL antibiotics tetra, mino, doxy.
Severe- with painful indurated nodule, cysts, abscesses, pustules. Accutane- check LFTs,
2 forms of contraceptives, monthly prego testing, only prescribe 1 month supply.
Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin.
TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM
Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that
rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro,
clinda. If NO BULLAE- Bactroban. EXAM
Scarlet fever (Scarlantina)- “sandpaper textured-pink rash with sore throat” strawberry
tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates.
EXAM
, LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT
MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS
CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF
ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals.
EXAM
Spider bite: fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes
swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center,
which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis
of the skin, abx ointment at first, watch etc. Exam
Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to
test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS.
EXAM
HEAD/EARS/EYES/NOSE/THROAT
Herpes keratitis- fluorescein dye “fern like” CN V. Abrupt onset of pain.
Corneal Abrasions- Round/Irregular. Was on EXAM.
Acute Angle-closure glaucoma- acute/severe halos, cupping optic nerve, cloudy cornea,
mid-dilated oval pupil. ER STAT. EXAM
Primary Open Angle Glaucoma- CN2 gradual changes in peripheral vision LOST
FIRST, then second central vision.
Cataracts is on EXAM in elderly night vision issues. Opaque EXAM
Age-Related Macular Degeneration – Painless loss of “central vision” reports straight
lines appear curved. Periphery is preserved. Give asmler grid.
Retinal Detachment- Floaters, curtain, flashes of light. Painless. EXAM
Cholesteatoma- cauliflower, foul-smell, hearing loss. If erodes bones in face affects CN
VII. SURGERY
Canker sores- Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic
mouthwash.
Papilledema- optic disc swollen w/ blurred edges due to increased ICP. EXAM
Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy).
Retinal Hemorrhages. EXAM
Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms.
ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED
RMSF- Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you
develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and
becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti
Antigen TREATMENT- doxycycline. EXAM
Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days
POST being bitten by a deer tick. Rash is hot to touch with rough texture, flu like
symptoms. DX: B. Burgdorferi via ELISA, then confirm with western blot. Increased
ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7
Doxycycline. EXAM
Melanoma- Dark Moles, uneven texture, different colors, irregular, >6mm, could be
XAM
itchy. E
Stevens Johnson Syndrome- Classic is target or bulls-eye. Abruptly, hives, blisters,
petechiae, purpura, necrosis, sloughing of tissues. Extensive mucosal involvement.
Prodrome of fevers with flu like symptoms. Triggers: Allopurinol, anticonvulsants, pcn,
sulfonamides, NSAIDS. HIV ppl have higher risk for this syndrome.
Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted
fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.
(Koebner phenomenon- new psoriatic plaques form over skin trauma)
(Auspitz sign- pinpoint bleeding when plaques are removed).
TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or
immunologic.
Acanthros Nigricans- velvet hyperpigmented patches most common on back of neck or
skin folds- DM resistance.
Scabies- itching bedtime. Primethrin cream treat everyone wash sheets and everything
else in hot water.
Atopic Dermatitis (eczema)- Inherited. Extremely itchy. On flexural folds, neck, hands.
Inc. IgE. “small vesicles that rupture leaving painful, bright-red, weepy lesions” they
become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO
antihistamines. EXAM
Tinea Corporis- “ring like itchy rash, slowly enlarge central clearing”-Treatment: most
respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending
Actinic Keratosis- Precursor to squamous cell carcinoma. “numerous dry round and pink
to red lesions” with a rough and scaly texture. Does not heal. Slow growing in sun
,exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg.
(5-FU cream)- which causes ur skin to ooze, crust, scab, redness. EXAM
Seborrheic Keratosis- soft round wart light tan to black pasted on. Asymptomatic and
benign.
Cellulitis- Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS.
DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS.
Erysipelas- Group A strep, Upper dermis, clear demarcated, cheeks, shins.
TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do
Azithro x5d.
MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.
Basal Cell Carcinoma- pearly, waxy, skin lesions, atrophic, ulcerated center that does not
heal.
Molloscum Contagiosum- white plug, dome shaped. Highly contagious. EXAM
Varicella Zoster Virus- “contagious 48 h. before, until all lesions crusted over” low grade
fever, generalized lymphadenopathy, intense itching, erythematous macules, papules
develop over macules, then vesicles erupt. “initially on trunk, then scalp and face”
TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours
works best. EXAM
Acne Vulgaris (common acne)- ON EXAM
mild (topicals only) *open/closed comedone w/ or w/o sm. papules. Retin-A, acne
worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin,
benzoyl peroxide.
Moderate (topicals plus antibiotics)- papules, pustules w/ comedones. Continue with
topicals combined with topical antibiotics. Then add ORAL antibiotics tetra, mino, doxy.
Severe- with painful indurated nodule, cysts, abscesses, pustules. Accutane- check LFTs,
2 forms of contraceptives, monthly prego testing, only prescribe 1 month supply.
Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin.
TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM
Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that
rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro,
clinda. If NO BULLAE- Bactroban. EXAM
Scarlet fever (Scarlantina)- “sandpaper textured-pink rash with sore throat” strawberry
tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates.
EXAM
, LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT
MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS
CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF
ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals.
EXAM
Spider bite: fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes
swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center,
which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis
of the skin, abx ointment at first, watch etc. Exam
Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to
test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS.
EXAM
HEAD/EARS/EYES/NOSE/THROAT
Herpes keratitis- fluorescein dye “fern like” CN V. Abrupt onset of pain.
Corneal Abrasions- Round/Irregular. Was on EXAM.
Acute Angle-closure glaucoma- acute/severe halos, cupping optic nerve, cloudy cornea,
mid-dilated oval pupil. ER STAT. EXAM
Primary Open Angle Glaucoma- CN2 gradual changes in peripheral vision LOST
FIRST, then second central vision.
Cataracts is on EXAM in elderly night vision issues. Opaque EXAM
Age-Related Macular Degeneration – Painless loss of “central vision” reports straight
lines appear curved. Periphery is preserved. Give asmler grid.
Retinal Detachment- Floaters, curtain, flashes of light. Painless. EXAM
Cholesteatoma- cauliflower, foul-smell, hearing loss. If erodes bones in face affects CN
VII. SURGERY
Canker sores- Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic
mouthwash.
Papilledema- optic disc swollen w/ blurred edges due to increased ICP. EXAM
Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy).
Retinal Hemorrhages. EXAM
Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms.
ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED
