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Class12.rtf

class 12
dermatology
multiple causation: can have inner causes manifesting on the skin - there are some skin disorders, primary (begin on skin), should know- patients will also ask about something (like a mole) - raised, with cellular debris, pus, wbc, bacteria (more next week: acne) - looks the same, but filled with clear fluids (herpes, for example) - solid lesion (deposits of calcium etc that are not normal) - change in skin color (black and blue, is macule); flush with surrounding tissue - for example,herpes is a macular vesicular lesion - macular, all red, with vesicle lesion on top depigmentation.
- tends to run in families- doesn't tan- considered autoimmune - genetic flaw- problem in gene that makes tyrosinase - which converts tyrosine (amino acid) to melanin - so no pigment in skin, hair and eyes (no melanin) primary skin infections.
- arising from the skin
- three of these are fungal, and then a few bacterial and viral
dermatophytosis- caused by dermatophytes, fungi from species tinea- tinea is more commonly known as ringworm- it is pruritic- if it affects scalp, tinea capitas - ungiium, (graying patches of scalp??, or loss of hair)- could possibly be some other syndromes- hair regrows - reddish outline of lesion, within clear and some red spots- very few (no) lesions outside border - when we look at candida, satellite lesions - jock itch- oral and topical pruritis- if you keep scratching, can have secondary bacterial infections - usually between toes, some cracking (webspace) - there is a fungal infection that doesn't look like this- tinea versicolor - similar to vitiligo in appearance- can be red, yellow, pink, tannish (cream color) (versicolor = various colors)- these don't absorb uv light, so they don't tan (so depigmentation)- "surfer's rot", but not as highly communicable- faintly pruritic ("kinda feels good to scratch")- tx: nizoral shampoo (anti-fungal shampoo), 10 or 15 min, 2 or 3 nights- preventive, once a month (has a tendency to reoccur) candida, yeast- specifically candida albicans - opportunistic; immune system drops, pH altered etc - change in quantity of normal bacteria flora - women on antibiotics sometimes yeast infection - in mouth, vaginal canal, etc- looks like tinea, but satellite lesions outside the red border- tends to be dark moist (vaginal canal, groin, armpit)- this is pruritic (but not as bad as tinea)- western: topical anti-yeast lotion, oral anti-yeast meds- caprillic acid, garlic, acidopholis- not eating sugar (aids yeast) impetigo- bacterial, staph or strep- more common in children, very contagious- this is macular vesicular lesion - red is flat with surrounding skin, vesicle forms on top- there are vesicular lesions on an erythematous base - vesicle breaks open, honey colored oozes out, then crusts - gives it a "stuck on" appearance- no scarring - folliculitis- furuncles (boils)- carbuncles folliculitis- inflammation of the hair follicle- usu staph, staph aureus furuncles- has now spread from hair follicle- redness with white lesion - warm compresses help activate it (bring it to a head)- supposedly tenderizing a leaf of cabbage carbuncles- a group of furuncles that coalesce together- can have systemic symptoms (fever, malaise)- common on nape of neck- diabetics more prone, others with immune compromised so, folliculitis, topical antibiotics- furuncles: want it to come out, ooze and keep covered, antibiotic lotion- carbuncles, often oral antibiotics along with topical (penicillin) - hpv, human papilloma virus- cryotherapy, but notorious for reoccurrence- burning - HSV1 causes oral herpes- maculo vesicular lesion, fluid filled - HSV2 is genital - hangs out in sacral ganglia- 1 shows in trigeminal ganglia - runs along thoracic, along the ribs (thoracic intercostal nerve)- travels along dermatome- varicella (same which causes chicken pox)- can be from chicken pox (goes into ganglia)- not pruritic, but can be painful (can be some neuralgia)- erythematous base, vesicles forming , clear fluid, pop open and crust (like chickenpox)- never had cp? could potentially catch this from someone (but is difficult)- can go to mandibular branch (close to eyes)- rare, saw C8, t1 dermatitis.
- generic term (aka eczema), "wastebasket" term
- have to figure out why!
- many types, we discuss three
- contact dermatitis- eczema due to contact with offending substance- also mechanical contact dermatitis (poor fitting shoes) atopic dermatitis- aka atopy- is an allergic thing, definitely - chronic, inflammatory peeling of the skin, pruritic- more commonly infantile, and usu a family history of allergies- in the blood, high levels of IgE antibodies- could be food, whatever.key is to find out what seberiac dermatitis- infants or adults- inflammatory scaling disorders (such as dandruff)- if in infants, called "cradle cap"- can affect other areas- cause unkown- very pruritic - candida, would look a little like this in some places, but no scaling of skin scabies- burrows through epidermis, intense itching sensation, worse at night- lays egg in epidermis, larva come out to stratum cornea (outer layer)- burrow down again, nourish on keratin- can see in finger webs, little tiny lines, these are fecal matter- highly transmittable- insecticide lotion pediculosis, lice- capitas, head lice- see white little organisms at scalp- crabs, genital lice- body lice (corpora) bed bugs- 3 to 6 mm (visible)- live on host, suck blood, can hang out for long time (up to one year)- have to fumigate the house- pruritic- bite, see a red circumscribed lesion Rocky Mountain spotted fever- it's not the bite, it's the saliva for both - rickettsia rickettsi (organism) in saliva- likes rbc's, multiplies- goes to spleen, dies, organism released into blood - now symptoms- fever, h/a, muscle ache, n/v- a week after being infected - these symptoms followed by rash (wrist, ankles, palms, soles)- patient is pretty sick (hospitalization), antibiotics Lyme disease- borellia burgdorfi is the organism- transmits organism (above) from saliva- inflammatory disease, s/s: unique skin lesion called erythema chronicum migrans - usu on extremity, expands to trunk, buttocks- expands up to 50 cm- can be cardiac symptoms following, neurological, kidney or joint (weeks, months, year)- joint: lyme arthritis- all of these result of antigen antibody complex- prompt tx important

Source: http://www.bewellsf.com/tcm/pathophys/class12.pdf

Prmtckyanp-12.anp.110805

The following is a list of the most commonly prescribed drugs. It representsan abbreviated version of the drug list (formulary) that is at the core ofyour prescription-drug benefit plan. The list is not all-inclusive and doesnot guarantee coverage. In addition to using this list, you are encouragedto ask your doctor to prescribe generic drugs whenever appropriate. 2012 Express Scripts PLEAS

Resolução da assembleia da república n

Decreto-Lei n.º 393/90 de 11 de Dezembro O Decreto-Lei n.º 353-A/89, de 16 de Outubro, estabeleceu as regras sobre o estatuto remuneratório dos funcionários e agentes da Administração Pública e a estrutura das remunerações base das carreiras e categorias nele contempladas, desenvolvendo os princípios gerais de salários e gestão do pessoal da função pública constantes do Dete

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