DCNP Flashcards
A 19yo, 80kg has painful and severe nodulocystic acne with scarring. You start isotretinoin 40 mg BID. This patient should be observed for which potential adverse effect of isotretinoin therapy?
Fever and sternal pain
Counseling regarding possible side effects of neurotoxins. You know that eyelid ptosis can be due to injection or leakage into
Levator palpebrae superioris
Famciclovir for herpes zoster patient education
Take with food
Most common site for distant metastasis of melanoma
Lung
Antifungal for onychomycosis. PMH HTN takes metoprolol, simvastatin, baby aspirin. Appropriate dosing and duration of optimal therapy?
Intermittent dosing with fluconazole (off-label) 300 mg once weekly for about 3 to 6 months.
Halo (Sutton’s nevus) in a 14-year-old. Parent concern melanoma.
Halo nevi usually have an organized area of depigmentation around the periphery of the lesion compared to regressing melanoma which has a disorganized pattern of hypo- or depigmentation.
T/F. Patients with a history of more than five dysplasia nevi have a 50-fold greater risk of developing melanoma.
False (10-fold greater risk)
T/F. Superficial spreading melanoma is the most common type of melanoma with the highest incidence in 4th to 5th decade.
True
The most common type of skin cancer is:
Superficial basal cell skin cancer
What genetic mutation is closely implicated with melanoma?
CDKN2A
Drugs a/w SJS and TEN
Ace inhibitors
quinolones
aminopenicillins
Rash while on vacation, both hands. Area blistered and is healing slowly but dark areas remain?
Phytophotodermatitis
Infantile hemangioma expert referral:
5 mm lesion on the left breast
12 yo M reported h/o high fever, pharyngitis, malaise. Reddish-orange, sandpaper-like papillae eruption and a “strawberry tongue” and treat him with oral PCN x 10 days. Complete treatment important to:
Prevent rheumatic fever
21M rash x several yrs gets worse in summer. PCP selenium and ketoconazole, but returns. Don’t prescribe:
Oral ketoconazole
Tinea versicolor treatment
-PO fluconazole 300 mg once weekly for two weeks
-PO itraconazole 200 mg daily for 5-7 days
Most common cause of exfoliative erythroderma:
Idiopathic
Laser likely to be most effective for treating Poikiloderma of Civatte?
CO2 fractional laser (10,600 nm)
Xanthelasma
Order labs for fasting lipids
Type IV skin, depigmented and atrophic plaque on right gluteal region x several years. PMH asthma, atopic dermatitis. Likely cause:
Side effects from IM triamcinolone for severe asthmatic event.
6 M purpuric papules buttocks, knees, legs. Complaining of abdominal pain and leg pain. Intermittent fever, joint pain. What order next?
Order urinalysis with microscopy
45F Caucasian seeking treatment for persistent redness and small broken blood vessels on her face. Sx worsening with burning, stinging, dryness. Telangiectasia w/o papules/pustules. Recommend:
oral beta blocker
Most common site for metastasis of cutaneous SCC of the scalp is to:
parotid gland
Diffuse pitting of the fingernail plate a/w which disease?
atopic dermatitis
Counseling: 6 mon old before starting oral propranolol for an infantile hemangioma. Important education for prevention and early recognition of side effects
propranolol should be given w/ or after meals
33F mutation of STS gene, husband unaffected. Considering pregnancy, would like to know risk of passing on X-linked icthyosis to her son.
50% risk for an affected son
Most effective antiviral, decreasing risk of post-herpetic neuralgia:
valacyclovir 1 gm every 8 hrs for 7 days
Ehlers-Danlos syndrome (EDS) characteristics:
mitral valve prolapse
tissue fragility
hyperextensible joints
Nodular melanoma w/ Breslow thickness of 1.2 mm. Surgical margins with wide local excision?
1-2 cm
28F w/ morphea that is spreading. She has an unremarkable past medical history and only medication is VitD. Initial systemic therapy:
hydroxychloroquine
54F extremely pruritic vesicles and crusted excoriations on her trunk and extremities for the past 2 mons. Lesions clustered in rosettes (annular). Erosions in mouth. Histopath and DIF c/w linear IgA. 1st-line:
oral dapsone
Most common cutaneous eruption in pts w/ sarcoidosis?
erythema nodosum
Parents of a child w/ erythema infectiosum should include:
Females who are pregnant and exposed to the infection should be referred to their OB for monitoring.
DIF for suspected dermatitis herpetiformis, immunohistochemical reports:
granular deposition of IgA at the BMZ
Topical imiquimod for field cancerization, education includes:
-can cause severe inflammation and result in hypopigmentation
-can cause flu-like sx
-commonly causes pain, crusting, erythema
Treating field cancerization, in area w/ numerous Aks in a region, purpose:
minimizes the formation of multiple primary squamous cell skin cancers
Henoch-Schonlein Purpura (HSP)
arthritis, abdominal pain, rash
Pemphigoid gestationis, counseling:
risk this can recur w/ subsequent pregnancies, menses, or hormonal contraceptives
Dermatitis herpetiformis (DH), tx w/ oral dapsone and gluten avoidance. Which underlying condition would increase risk of methemoglobinemia?
glucose-6-phosphate dehydrogenase deficiency
High-risk SCC characteristics
-immunosuppression
-perineural, lymphatic or vascular involvement
-size >2 cm on any body location
Bites that need tx w/ oral abx
-cat bite on the hand
-dog bite on the foot
-cat bite after 24 hrs
Nodular BCCs usually occur on:
head and neck
Superficial BCCs are found primarily on:
torso
Nikolsky sign
press on skin adjacent to a blister, skin shears away easily
Skin conditions that increase r/o cellulitis
-tinea pedis
-atopic dermatitis
-venous stasis dermatitis
Azathioprine
genetically low levels of TPMT (thiopurine methyltransferase) are at increased r/o bone marrow suppression
% of pts w/ DLE go on to develop SLE
15
Newborn infant w/ erythematous, polycyclic plaques, significant periorbital edema.
Check for s/s heart block or bradycardia. (Neonatal lupus erythematosus)
Tinea cruris organism
Trychophyton rubrum
Group A Streptococcus (GAS) complication if untreated:
glomerular nephritis
Hereditary angioedema is caused by:
C1 esterase inhibitor deficiency or dysfunction
MRSA infection treatment
-doxycycline 100 mg BID x 7 days
-mupirocin 2% top oint TID x 7-10 days
-dicloxacillin 250 mg QID x 7 days
Notalgia paresthetica
intense focal itch on scapula; linear excoriations and patch of dark brown hyperpigmentation
Most common (90%) sx of pts w/ SLE
Myalgia and arthralgia (90%)
insidious onset of fatigue
low grade fever
weight loss
hair thinning
Mycophenolate mofetil
Enrollment in Risk Evaluation and Mitigation Strategies (REMS) program
Glycopyrrolate, contraindicated in this condition:
pyloric stenosis
Classic EDS, most important referral:
cardiology
45M w/ recent patchy hair loss. W/o scale, erythema, or lymphadenopathy. Labs to order:
CBC, ferritin, TSH, ANA titer, RPR
Organism, immunocompetent, erysipelas
Group A streptococcus
Labs to order for chronic pruritus of unknown origin:
CBC w/ diff, CMP, TSH, stool/ova and parasites
Follicular occlusion triad:
pilonidal cyst, HS, acne conglobata
Absolute C/I for injection of botulinum toxin:
infection at site of injection
Bullous pemphigoid drug associations:
loop diuretics, NSAIDs, spironolactone, phenothiazines, gliptins, biologics
Avoid abobotulinumtoxin toxin A in patient w/ allergy to:
milk
iPledge labs required:
LFTs, Lipid panel or TG, hcg
DH disease flare, potential trigger:
NSAIDs
Hydroxychloroquine
-baseline ophtho exam, then q5 yrs
-more frequent if >70 y/o
Meds w/ r/f pseudotumor cerebri:
doxycycline, isotretinoin, COC
Photosensitive drugs
doxycycline, minocycline, isotretinoin
Common AE a/w neurotoxins:
pain, bruising, redness
Sudden onset of hundreds of SKs
Review age appropriate health screenings and any positive ROS.
Laser treatment that involves the dermis and collagen, usually safer for pts w/ dark skin?
Nd: YAG 1064 nm
Herpes zoster, most commonly affects the ____ spinal region.
thoracic
Meds to take w/ food, decreased absorption on an empty stomach:
-spironolactone
-griseofulvin
-isotretinoin
Staphylococcus aureus, involved in:
furuncles, carbuncles, folliculitis
Black widow spider bite treatment:
ice/elevation, tetanus ppx, antiemetics
Not a candidate for tx w/ neurotoxin
conjunctivitis (active infection)
Most difficult tattoo color to remove w/ laser
light green
Erythrasma treatment:
clindamycin lotion
Acquired palmoplantar keratoderma
Presents in an asymmetric distribution
Non-purulent cellulitis tx:
dicloxacillin 500 mg QID
Periorificial dermatitis
erythematous papules around mouth and eyes that sometimes burn. pmh AD, asthma
Although rare, anal cancer is more likely to develop in pts who have a h/o:
condyloma acuminata
Botulinum toxin, a protein derived form C. botulinum
inhibits the release of acethylcholine, which reduces the ability of muscles to contract
Favre-racouchot disease increased risk:
smokers
Ablative laser treatments
mostly involves the epidermis
Ablative laser treatments
mostly involves the epidermis
Absolute contraindication of TNF alpha inhibitors
chronic infections
Leading cause of heart disease in children
Kawasaki disease
MISC vs Kawasaki disease, differentiating lab
SARS-CoV-2 IgG
FDA approved therapy for pemphigus vulgaris
Rituximab
Eruption that starts on the infant’s face and then spreads to the trunk and extremities. Well-appearing. Diffusely scattered tiny papules and pustules on head, trunk and extremities.
erythema toxicum neonatorum and will resolve in a couple of weeks.
Atopic dermatitis pathogenesis:
-increase in Th2, Th22, and Th17
-increase in IL-4, IL-10, IL-13
-environmental exposure to smoking can trigger
Photosensitive skin reaction like to Hepatitis C and hemochromatosis:
Porphyria cutanea tarda
First line therapy for patient w/ LPP:
Potent TCS
Locally advanced BCC, unable to tolerate a surgical procedure, what options?
-radiation
-hedgehog pathway inhibitor
-PD1 inhibitor
High-risk SCC, follow-up includes:
-exam of regional lymph node basins
-clinical exams q6 mons
KA treatment options:
-commonly found to have features of SCC
-can spontaneously involute and resolve w/o therapy
-most are treated surgically
Therapies that can decrease the risk of SCC:
-nicotinamide 500 mg BID
-daily sunscreen
-oral acitretin
Immunosuppressant with decreased risk in organ transplant recipients (OTRs)?
sirolimus
Field therapy least likely to result in scarring or abnormal pigmentation:
PDT w/ aminolevulinic acid
Loss of _____in the bulge is postulated to contribute to permanent loss of hair in cicatricial alopecias.
hair follicle stem cells
Acute paronychia w/o and abscess treatment options:
-warm soaks
-topical mupirocin
-oral dicloxacillin
Field cancerization therapy tx w/ lowest recurrence at 1 year and lowest need for a second treatment?
topical 5-fluorouracil
First-line therapy for lice in a 2 month old infant is:
permethrin 1% OTC
Sudden onset of a rash, small red, non-follicular pustules that spread from neck to chest and axillae. Severe malaise and fever 103. Recent strep pharyngitis, rxd amoxicillin.
Acute generalized exanthematous pustulosis
Mastocytosis diagnostic clue
Positive Darier’s sign
Educating patients of 4 yo w/ mastocytosis include the avoidance of mast cell degranulation:
heat and friction
Granuloma annulare facts:
-affects F>M
-may be a/w DM2 and thyroid dz
-histology: palisading granuloma and mucin deposition
-spontaneous resolution is expected in localized disease
FDA approved tx for genital herpes simplex?
topical acyclovir 5%
Topical dapsone 5% mixed with ____ may cause a temporary orange discoloration of the skin and facial hair.
BPO
T/F gene expression profiling of melanoma predicts the risk of recurrence and metastasis.
True
Melanoma tumor characteristics for staging:
Tumor: Breslow depth and presence of ulceration
Nodes: early nodal invasion
Metastasis: spread to distant organs or elevated LDH.
Genetic mutation involved in ichthyosis vulgaris:
Steroid sulfatase (STS)
Common side effects of dupilumab
-conjuctivitis
-URI
-HSV
