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DIT Level 3 > Clinical questions - Dermatology > Flashcards

Clinical questions - Dermatology Flashcards

1
Q

Melanoma characteristics

A

ABCDE

Asymmetry
Border irregularity
Color variability
Diameter >= 6mm
Evolving

If suspected, perform excisions biopsy. Shave bx will not tell you depth

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2
Q

Characteristics and treatment of Herpes Zoster

A

painful rash, groups of erythematous vesicles in dermatomal distribution - one sided but can become bilateral if disseminated disease

Tx:
within 72 hrs of onset start 7 day course of antivirals - acyclovir, valacyclovir, famciclovir

supportive analgesia

If over 50 yo - zoster vaccine

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3
Q

Lichen plants description, associated diseases, treatment

A

pruritic rash, often wrists and shins, composed of violaceous, polygonal papule

Unknown cause but associated with Hepatitis C infection and medications

Tx with topical corticosteroids

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4
Q

Scabies infection presentation and treatment

A

severe itching of skin, “whole body except head”. On exam multiple small, erythematous papule with occasional hemorrhagic crusts. raised gray colored tracts on webbing between fingers

Tx: 1st line topical permethrin; oral ivermectin

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5
Q

Congenital dermal melanocytosis

A

“mongolian spot” - blue-gray macule

MC in lumbosacral region
Fades in first 2 yrs of life

reassure and document in the medical record

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6
Q

Steven Johnson Syndrome/Toxic epidermal necrolysis presentation and treatment

A

fever, malaise, arthralgias
conjunctivitis, oral ulcers, erythematous target-like lesions over face, trunk, extremities
Over next few days develop bullies lesions with skin sloughing

Admit to ICU or burn unit
Stop drug
Wound care: dressings/debridements
Supportive care: IVF, elytes prn, pain control
Monitor for bacterial superinfection
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7
Q

SJS/TEN associated causes

A 
Drugs:
Allopurinol
Carbamazepine
Lamotrigine
Phenobarbital
Phenytoin
Sulfamethoxazole
sulfasalazine

Infectious:
Mycoplasma pneumoniae
CMV

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8
Q

Red man syndrome

A

pruritic erythematous rash involving face, neck, upper body associated with IV Vanc

Mechanism: direct mast cell activation

Tx:
Stop infusion of IV Vanc
Give diphenhydramine and ranitidine
After symptoms subside restart IV Vanc at slower rate

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9
Q

Erythema nodosum

A

painful reddish violet nodules over shins 2/2 hypersensitivity reaction
Dx confirmed by Bx

Causes
MC - Strep pharyngitis
Sarcoidosis
TB
Fungal:  coccidioidomycosis, histoplasmosis, blastomycosis
IBD
Pregnancy and OCP use
Idiopathic
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10
Q

Erythema multiforme

A

painful oral erosions and rash consisting of raised target lesions on trunk and extremities - immune mediated s/p infection

MC - HSV
Mycoplasma pneumonia

Self limited - resolves over a few weeks

Symptomatic tx:

  • pruritis: topical corticosteroids, oral antihistamines
  • Oral involvement: PO prednisone

No indication for acyclovir unless recurrent with HSV cause to ppx

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11
Q

erythema multiforme vs SJS/TEN

A

erythema multiforme s/p infection

SJS/TEN s/p drug administration

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12
Q

Stasis dermatitis

A

typically bilateral - if unilateral r/o cellulitis

2/2 chronic venous insufficiency
Tx: elevate legs, compression stockings, treat underlying cause of venous insufficiency

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13
Q

Scalded skin syndrome

A

infant with fever, irritability
erythematous rash around the mouth that generalizes and flaccid blisters appear. Upper layer of skin sloughs with gentle lateral pressure (+ Nikolsky sign)

Differentiated from SJS/TEN: no mucous membrane involvement

Bx to confirm Dx

2/2 exotoxin from S. aureus

Tx: IV Nafcillin or Oxacillin
Supportive: emollients, IVF, elytes prn

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14
Q

Actinic keratosis

A

erythematous scaly lesions, +/- horns, involving sun exposed areas, risk of transformation to SCC

Tx:
Cryotherapy
Curettage
Topical 5-FU
Topical imiquimod
Topical ingenue mebutate
Photodynamic therapy
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15
Q

Pemphigus vulgaris

A

Flaccid, easy to rupture bullae (+nikolsky)
almost always has oral lesions

Tx:
Systemic glucocorticoids: prednisone, prednisolone
+/- immunomodulator: azathioprine, mycophenolate

More severe than bullous pemphigoid - higher mortality rate

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16
Q

Bullous pemphigoid

A

Tense, hard bullae that are difficult to rupture
Oral lesions less common - 10-30%

Tx:
TOPICAL corticosteroids: clobetasol
+/- immunomodulator: azathioprine, mycophenolate

17
Q

Porphyria cutanea tarda

A

skin blisters with sun exposure
associated with chronic Hep C and other liver disease

Mechanism:
Defect in uroporphyrinogen decarboxylase (found in liver and RBCs) leads to elevated levels of uroporphyrinogen in blood and urine

Tx: 
Avoid triggers: EtOH, estrogens, polyhalogenated hydrocarbons
Phlebotomy to lower Fe load
Chloroquine
Treat underlying cause
18
Q

Pityriasis rosea

A

starts as erythematous plaque - “Harold’s patch”
1 week later has onset of multiple salmon-colored, oval plaques in a “Christmas tree” pattern over chest and back

Possibly related to HHV7 or HHV8 infection

Self limited, offer reassurance

If pruritic can use topical corticosteroids
If severe can use acyclovir to treat underlying infection cause

19
Q

Isotretinoin

A

Used to treat severe nodular acne that has not responded to topical or oral medications

Extremely teratogenic, can cause spontaneous abortions, severe fetal malformations

Provide counseling and education
Must have 2 negative pregnancy tests prior to starting, with frequent repeat testing throughout treatment course
Use 2 forms of birth control

Monitor labs:
Lipids - cause hyperlipidemia
LFTS - hepatotoxicity
CBC - bone marrow suppression

20
Q

Classic description of nodular basal cell carcinoma

A

papular, nodular lesion
curly or translucent look to it
telangectasia

21
Q

Treatment for lice

A 
Permethrin MC but growing resistance
Malathion
Benzyl alcohol
Spinosad
Ivermectin

2nd line - lindane, risk of neurotoxicity

22
Q

atopic dermatitis

A

dry, pruritic skin with erythematous patches with scaling on exam. Often involve face, neck, flexor surfaces (antecubital and popliteal fosse)

1/3 of children develop asthma

23
Q

Classic description of cutaneous squamous cell carcinoma

A

Involves head and neck MC but can be anywhere

Papule, plaque, or nodule
Ulceration - “non-healing”, “poorly healing”
Crusting
Hyperkeratosis in well differentiated lesions

24
Q

Furuncle vs carbuncle

A

“Painful boil”

Furuncle: small abscess around 1 hair follicle
Carbuncle: multiple follicules involved

Smaller: apply warm compresses

Larger:
-I&D
+/- abx to cover MRSA: Clinda, bactrim

25
Q

Impetigo

A

Superficial infection 2/2 S. aureus (MC), S. progenies

On exam: Papule lead to vesicles which progress to pustules that become honey colored crusted lesions

Tx:
Topical mupirocin or retapamulin
More severe: PO dicloxacillin or cephalexin

26
Q

Erysipelas

A

Infection involving upper dermis 2/2 S. progenies

On exam: Painful raised red lesions with clear demarcations

Tx:
PO PCN or amor
More severe: IV rocephin or cefazolin

27
Q

Cellulitis

A

Infection involving deeper dermis and subQ fat 2/2 S. aureus, S. pyogenes, and others

On exam: spreading warmth with edema and redness that has indistinct borders

Tx:
PO dicloxacillin or cephalexin
More severe: cefazolin or clinda
MRSA coverage with clinda, bactrim, or IV Vanc

28
Q

Necrotizing soft tissue infection

A

MC: Grp A Strep, may be polymicrobial

Presentation: Fever, toxic appearing, crepitus under skin, pain out of proportion to exam findings
Dx made surgically

Tx:
Surgical debridement
IV broad spectrum abx - carbapenem or beta lactam/beta-lactamase inhibitor + Clinda + MRSA coverage
(i.e. mero + clinda + IV Vanc or Zosyn + clinda + IV Vanc)

29
Q

tinea unguium

A

dermatophyte infection of the toe nail - aka onychyomycosis

Tx: PO terbinafine, itraconazole or griseofulvin (high risk of recurrence) for 6-12 weeks
-Monitor LFTs

30
Q

Tinea pedis

A

Dermatophyte infection of the foot - aka athletes foot

Topical terbinafine, naftifine, or clotrimazole for 1-4 weeks

31
Q

Tinea corporis

A

Dermatophyte infection of the body

Topical terbinafine, naftifine, or clotrimazole for 1-4 weeks

32
Q

Tinea capitis

A

Dermatophyte infection of the scalp

PO griseofulvin, terbinafine, itraconazole for up to 12 weeks

33
Q

Seborrheic keratoses

A

multiple, greasy appearing, warty, hyperpigmented plaques with “stuck on” appearance

Benign so most appropriate management is reassurance

Cosmetic removal with cryosurgery followed with curettage

34
Q

Toxic Shock syndrome

A

Rash looks like a sunburn without sun exposure, fever, altered mental status. Often associated with menstrual cycle, but can be post-op, or surgical wound infection

On exam erythematous macular rash involving whole body including palms, soles, mucous membranes

2/2 S. aureus exotoxin

Tx:
Remove source of infection
- Pelvic exam, explore wound
Supportive care: IVF, vasopressors
Abx: Clinda + Vanc
35
Q

Condylomata acuminata

A

Genital warts 2/2 HPV

Many resolve on own

Tx:
Topical: podophyllin, Trichloroacetic acid, 5-FU
Immunomodulators: imiquimod, IFNalpha
Cryosurgery
Laser surgery
Surgical excision - large lesions sent for path to r/o SCC

36
Q

Psoriasis

A

Thick erythematous plaques with silver scales involving scalp, extensor surfaces (elbows, knees)

Immune mediated

Mild:

  • Emollients
  • Topical corticosteroids: hydrocortisone, betamethasone, clobetasol
  • Topical calcineurin inhibitor: Tacrolimus
  • Topical retinoids
  • Topical vit D

Severe:

  • Phototherapy
  • Systemic tx:
  • -MTX
  • -Cyclosporine
  • -Retinoids
  • -Biologics: adalimumab, etanercept, infliximab
37
Q

Seborrheic dermatitis

A

erythematous, greasy-appearing, scaly plaques involving eyebrows and nasolabial folds, +/- scalp

Possibly d/t malassezia

Tx:
Antifungal shampoo: selenium sulfide, ketoconazole
Face: 
Topical corticosteroids
Topical antifungal
38
Q

Conditions associated with a + Nikolsky sign

A

SJS/TEN
Pemphigus vulgaris
Staphylococcal scalded skin syndrome

DIT Level 3 (32 decks)

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