Local anesthetics

Local anesthetics come in one of two types, esters and amides.

Esters have one “i”, and amides have two “I’s” in their name.

eg Esters = cocaine, procaine, tetracaine

Amides= lidocaine

These two classes differ in their metabolism, and potential for sensitization.

• Esters are metabolized by plasma pseudocholinesterase, so individuals with dysfunctional pseudocholinesterase may be susceptible to toxic effects. In addition, PABA is a metabolite of ester anesthetics, and may result in allergic sensitivity.
  
• Amides are metabolized in the liver, and patients with impaired liver function may be at risk of toxic effects from high levels of amide anesthetics.

Gardner syndrome

An autosomal dominant inherited disorder associated with colon cancers.

• Triad of signs

1. Intestinal polyposis
2. Bony tumors eg osteoma
3. Soft-tissue lesions eg epidermoid cyst

• Displays an autosomal dominant inheritance pattern with complete penetrance and variable expressivity.
• Intestinal polyps become malignant in virtually 100% of patients if not treated.
• Polyps also develop in the upper gastrointestinal tract.
• Malignancies may occur in the brain and in the thyroid gland.
• The APC gene located at 5q21 is mutated.
• Extracolonic features precede intestinal polyposis.

Exacerbating causes of plaque psoriasis

TEA IS DRUG

Trauma/ Sunburn
Endocrine: postpartum
Alcohol

Infection: Steptococcus, HIV
S: Stress, Smoking, Sunburn

Drugs: Steroids, lithium, antimalarials, beta-blockers

Behcet's syndrome: Diagnostic Criteria

PROSE
Oral ulceration is central criterion, plus any 2 others

• Pathergy test
• Recurrent genital ulcer
• Oral ulcer (recurrent)
• Skin lesions (erythema nodosum, subcutaneous thrombophlebitis, cutaneous hypersensitivity)
• Eye lesions (iridocyclitis, chorioretinitis)

SLE Diagnosis

SOAP BRAIN MD
4 out of 11 criteria needed for diagnosis

• Serositis
• Oral ulcer
• Arthritis
• Photosensitivity
• Blood (cytopenia)
• Renal
• ANA
• Immune (dsDNA, anti-Sm)
• Neurological (seizures, stroke)
• Malar rash
• Discoid rash

Rash

Really Sick Children Must Take No Exercise
Number of days after fever onset that a rash will appear

1. Day: Rubella
2. Days: Scarlet fever/ Smallpox
3. Days: Chickenpox
4. Days: Measles (and see the Koplik spots one day prior to rash)
5. Days: Typhus & rickettsia (this is variable)
6. Days: Nothing
7. Days: Enteric fever (salmonella)

Leukocytoclastic vasculitis

VASCULITIS

Viral hepatis B/C
Autoimmune (SLE, RA, Sjogren)
Streptococcus, staphylococcus
Cryoglobulins
Ulcerative colitis, urticarial vasculitis
Lymphoproloferative ds esp hairy cell leukemia
Idiopathic
Thiazides, phenothiazine
Iodides, immune serum (from blood transfusions)
Sulfa-based drugs, penicillin

Erythroderma causes

SCALP ID

• Seborrheic dermatitis, Sezary syndrome
• Contact dermatitis
• Atopy/Allergy
• Lymphoma/leukemia
• Psoriasis/PRP
• Idiopathic
• Drug eruption

Painful Cutaneous Nodules

BENGAL CO.

• Blue rubber bleb nevus
• Eccrine spiradenoma
• Neurilemmoma / Neuroma
• Glomus tumor
• Angiolipoma/Angioleiomyoma/Angiosarcoma
• Leiomyoma
• Cutaneous endometriosis/Calcinosis cutis
• Osteoma Cutis

High Risk for Adverse Cutaneous DR

I AM MAD

• Infections (HIV, TB, EBV)
• Age (very young, very old)
• Malignancy esp hematological
• Multiorgan failure
• Autoimmune ds (Sjogren ds, SLE, RA)
• Drugs (polypharmacy)

Phototoxic drugs

FAT BIG

• F luoroquinolones
• A miodarone
• T etracyclines
• B enoxaprofen (most of the NSAIDS)
• I buprofen (least)
• G riseofulvin

Eczema precipitating factors

FASCIE

• Food
• Allergy
• Stress
• Cold (weather change)
• Infection (staphylococcus, scabies, herpes)
• Estrogen (pregnancy)

Incontinentia Pigmenti stages

V.V.H.H.

1. Vesicular
2. Verrucous
3. Hyperpigmentation
4. Hypopigmentation

X-Linked Recessive syndromes

CHAD's KINKY WIFE:

• Chronic Granulomatous Disease, Chondrodysplasia puncata
• Hunter's Disease
• Anhidrotic ectodermal dysplasia
• Dyskeratosis congenita
• SCID
• Menke's Kinky Hair disease
• Wisckott-Aldrich
• Ichtyosis, X-linked
• Fabry's disease
• Ehler's Danlos V and IX