DERM 2 HY Step 2

Question 1

The assessment of pigmented skin lesions (suspected melanoma) should include the ABCDEs (Asymmetry, Border irregularities, Color variegation, Diameter, Evolving) rule; lesions with __ of the ABCDE criteria warrant an ____ biopsy.

Answer 1

Just one

excisional biopsy
(1-3mm margins)

Question 2

Excisional biopsy for suspected melanoma is also recommended for lesions with:
⬩itching, crusting, or bleeding
⬩ ____ changes
or + ugly duckling sign

Answer 2

sensory

ugly duckling sign (lesions that are significantly different in appearance from other pigmented spots)

Question 3

In-situ destruction via ___ or topical ___ is indicated for treatment of actinic keratosis.

Answer 3

cryotherapy
fluorouracil

(Actinic keratosis presents as small, roughened papules in sun-exposed areas (eg, scalp, face, hands) and typically is not pigmented)

Question 4

In Elderly,
typically presents as a slow-growing nodule with pearly, rolled borders. ± Central ulceration or telangiectatic vessel

Answer 4

BCC

(SCC is FAST growing)

Question 5

A nonhealing ulcer or a scaly nodule arising from chronic wounds, burns, or scars should undergo skin biopsy due to concern for what?

Answer 5

squamous cell carcinoma (SCC)

Question 6

Presents as erythematous silvery plaques with scales
The lesions are pruritic and most commonly occur at the extensor surfaces (knees) or hands, scalp, back, & nail plates.

Answer 6

Psoriasis

⬩Topical: high-potency glucocorticoids, vitamin D analogs, calcineurin inhibitors)
⬩Ultraviolet light/phototherapy
⬩Systemic: methotrexate, calcineurin inhibitors, retinoids,biologics

Question 7

a benign pigmented lesion with a well-demarcated border and a velvety or greasy surface. It can be nearly flat or be a thickened lesion often described as having a rough surface & stuck-on appearance.

Answer 7

Seborrheic keratosis

(no treatment & no biopsy- it is keratin cyst)

Question 8

nonpigmented cutaneous tumors that usually present as dome-shaped nodules with a central keratinous plug or crater.

Answer 8

Keratoacanthomas

(Surgical excision/Mohs surgery for concerns of cSCC)

Question 9

Pulsed dye ___ therapy is first-line management for port-wine stains

Answer 9

laser

Question 10

Topical __ is used to treat rosacea, which presents in adults with localized facial (nose/cheeks) erythema ± pustules and papules.

Answer 10

Topical Metronidazole (papulopustular type)
⎯
Laser or topical Brimonidine an α-2 agonist (erythematotelangiectatic type)

Question 11

the most common skin malignancy in patients on chronic immunosuppressive therapy for a history of organ transplant.

Answer 11

Squamous cell carcinoma (SCC)

Question 12

in infants is characterized by yellow, greasy scales of the face (eyebrows, nose) and scalp, as well as glistening, confluent erythema of intertriginous areas (neck folds, axillae, diaper area).

Rash typically self-resolves.

Answer 12

Seborrheic dermatitis

First-line
emollients, unscented shampoo
Second-line
Topical antifungals (selenium sulfide, ketoconazole)
Topical glucocorticoids
Topical calcineurin inhibitors (Pimecrolimus)

Question 13

Dx?
cauliflower-like lesions located in the anogenital region.
Caused by HPV 6/11 are associated with _____ of the anus, genitals, and throat.

Answer 13

Condylomata acuminata (anogenital warts)

Squamous cell carcinoma

Bx if immunocomp

Question 14

Molluscum contagiosum is a self-limited, skin infection caused by ____.
It is characterized by small pink or skin-colored papules with indented centers it spares the palms and soles

Answer 14

poxvirus

(can be sexually transmitted or self-innoculated)

Question 15

A manifestation of secondary syphilis characterized by flattened pink or gray velvety papules. These are seen most commonly at the mucous membranes and moist skin of the genital organs, perineum, and mouth.

Answer 15

Condyloma lata
(Look up appearance)

Question 16

nontender, firm, hyperpigmented nodules that are usually <1 cm. most commonly occur on the lower extremities.
Lesions have a fibrous component that causes the central area to dimple when pinched
some patients may develop lesions after trauma or insect bites.

Answer 16

Dermatofibromas
(s/t fibroblast proliferation)
If Asymptomatic, no treatment (cryo or shave off)

Question 17

Patients who are on high-dose immunosuppressive therapy after organ transplantation are at high risk for developing ____, an endothelial tumor associated with reactivation of HHV-8.
Lesions typically arise within the first year of therapy and appear as multiple violaceous, red, or brown papules that are non-tender & non-pruritic.

Answer 17

Kaposi sarcoma

(red spots that are otherwise asymptomatic)

Question 18

In the setting of behavioral/cognitive disorders (eg, attention-deficit hyperactivity disorder, intellectual disability) or family/personal history of seizures, this disease can present with Angiofibromas (red or flesh-colored, fibrous papules that are most commonly located in the malar region). Other common skin findings include ash-leaf spots (hypopigmented macules) and shagreen patches (thickened, leathery skin).

Answer 18

Tuberous sclerosis

Question 19

An autosomal dominant neurocutaneous disorder characterized by axillary freckling hyperpigmented café-au-lait macules and multiple soft, skin colored papules/nodules.

Answer 19

Neurofibromatosis type 1

(Neurofibroma nodules)

Question 20

an inflammatory reaction to drugs or certain infections (Mycoplasma pneumoniae) characterized by
⬩Acute flu-like prodrome
⬩Rapid-onset erythematous macules, vesicles, bullae
desquamation, and mucositis (mouth, eyes).
⬩Necrosis & sloughing of epidermis
Systemic signs include fever, hemodynamic instability, and altered level of consciousness.

Answer 20

Stevens-Johnson syndrome

Question 21

Treatment for fatal Stevens-Johnson syndrome?

Answer 21

Treatment is supportive:
aggressive IVFs and wound care.

(Secondary infections are common)

Question 22

Causes of Stevens-Johnson syndrome include:
⬩infection with Mycoplasms
⬩Vaccination
⬩ GVHD
⬩NSAID (Piroxicam)
and (5 more meds)

Answer 22

⬩ sulfonamides (TMP/SMX, acetazolamide, sulfamethoxazole)
⬩ aminopenicillins (Amoxicillin/clavulanate, Ampicillin)
⬩ Antiepileptics (LAMOTRIGINE, levetiracetam, Valproate, carbamazepine, phenytoin,)
⬩ Allopurinol (Gout)
⬩ Sulfasalazine (DMARD for RA)

Question 23

Staphylococcal scalded skin syndrome is usually seen in children age <6. It is a syndrome of acute exfoliation caused by what?

Answer 23

toxins produced by Staphylococcus aureus

Question 24

Presents with fever, rash, hypotension, and multi-organ injury.
The rash is characterized by diffuse erythema resembling sunburn, with desquamation involving the palms and soles

Answer 24

Toxic shock syndrome
(an inflammatory response caused by a staphylococcal exotoxin)

Question 25

benign, painless subcutaneous masses with normal overlying epidermis. They are usually soft to rubbery and irregular, and do not typically regress and recur.

Answer 25

Lipomas

Question 26

Presents as a dome-shaped, firm, freely movable cyst or nodule with a small **central black punctum** The lesion can remain stable or increase in size & may produce a cheesy white discharge; Usually resolves spontaneously.

Answer 26

Epidermal inclusion cyst (benign: contains squamous epithelium that produces keratin)

Question 27

a benign proliferation of melanocyte cells that presents within the first few months of life and are usually **solitary, hyperpigmented (black/brown) lesions with an increased density of overlying dark, coarse hairs** Initially flat, homogenous hyperpigmentation, they can grow during infancy and become heterogeneously pigmented and raised. If growing larger what is the NBSIM?

Answer 27

congenital melanocytic nevus (CMN) surgical removal (risk of melanoma if too big)

Question 28

Presents as flat, **gray-blue** patches that are poorly circumscribed and will fade with time. They are classically located on the lower back and sacrum, and are more common in Asian and African American populations.

Answer 28

Congenital dermal melanocytosis (Mongolian spots)

Question 29

flat, hyperpigmented macules that can be isolated or associated with McCune-Albright syndrome or neurofibromatosis.

Answer 29

Café au lait spots

Question 30

A vascular birthmark seen on infants face or body. Red to purple, blanchable patches that do not regress. respect the midline. Association?

Answer 30

Nevus Flammeus (Port-Wine-Stain) Sturge Weber → seizures

Question 31

A vascular birthmark seen on infant's eyelids and nape of neck. Blanching pink patches that fade with time.

Answer 31

Nevus Simplex

Question 32

Treatment of Plaque psoriasis includes:

Answer 32

⬩topical high-potency glucocorticoids, **betamethasone, fluocinonide** ⬩Vitamin D derivatives, **calcipotriene** ⬩topical retinoids ⬩calcineurin inhibitors **tacrolimus** (chosen for the face and other sensitive areas)

Question 33

A skin infection most frequently due to Pseudomonas aeruginosa. It presents as hemorrhagic pustules with surrounding erythema that rapidly progress to form necrotic ulcers. Patients typically have systemic symptoms (eg, fever), but focal pain is less prominent. High Risk: DM2

Answer 33

Ecthyma gangrenosum (picture looks like black dry dead wound)

Question 34

characterized by pain and ulceration in the distal extremities, primarily the digits. Seen in **smokers** and patients are typically age <45.

Answer 34

Thromboangiitis obliterans

Question 35

An inherited disorders characterized by epithelial fragility (bullae, erosions, ulcers) triggered by minor trauma. ⬩ friction-induced blisters ⬩ oral blisters with bottle-feeding ⬩ patients may have chronic thickening of the skin of the feet. Treatment is supportive.

Answer 35

Epidermolysis bullosa

Question 36

Hidradenitis suppurativa is a chronic, relapsing condition characterized by inflammatory occlusion of folliculopilosebaceous units. There is a strong association with what?

Answer 36

**tobacco** use (smoking) *also obesity & diabetes

Question 37

Chronic & recurrent lesions in intertriginous areas (axilla, thighs, groin) Mild: painful nodules, draining abscesses (foul smelling) Moderate: sinus tracts & scarring Severe: extensive sinus tracts Diagnosis?

Answer 37

Hidradenitis suppurativa

Question 38

Treatment for Hidradenitis suppurativa?

Answer 38

Mild: topical **clindamycin** Moderate: **steroid injections** oral tetracyclin Severe: TNF-α inhibitors (adalimumab) **surgical excision**

Question 39

Complication for Hidradenitis suppurativa?

Answer 39

Squamous Cell Carcinoma (depression & suicide)

Question 40

**Eczema herpeticum** or HSV infection associated with **atopic dermatitis** & presents with **painful vesicles** that evolve into "punched-out" erosions with **hemorrhagic crusting** Due to the risk of visceral dissemination and death, systemic ___ should be initiated immediately.

Answer 40

acyclovir or valacyclovir

Question 41

Infectious complications of atopic dermatitis include (4)

Answer 41

**Eczema Herpeticum** Impetigo Molluscum Contagiosum Tinea Corporis (Ringworm)

Question 42

5 "Ps": pruritic, purple/pink, polygonal papules & plaques Lacy, white network of lines (Wickham striae)

Answer 42

Lichen planus

Question 43

Treatment of Lichen Planus

Answer 43

Topical high-potency glucocorticoids: **Betamethasone** Clobetasol Discontinuation of the offending medication ⎯ (Widespread lesions: systemic glucocorticoids and phototherapy)

Question 44

drug-induced Lichen Planus (lichenoid drug reaction) associated with what medications (2-3)

Answer 44

**ACE inhibitors Thiazide diuretics** Beta blockers & Hydroxychloroquine

Question 45

presents with white papules and plaques on the **oral mucosa/mouth** ; variants may also show erythematous mucosal atrophy or ulceration. It is often associated with **hepatitis C**.

Answer 45

Oral lichen planus (LP) ⎯ Tx :topical high-potency glucocorticoids

Question 46

**Erythema nodosum** is a delayed hypersensitivity reaction characterized by tender, erythematous nodules, most often on the shins. Common triggers include: ⬩ infection ⬩ ____ ⬩ sarcoidosis ⬩ malignancy medications, such as: ⬩penicillins ⬩ ____ ⬩ ____

Answer 46

inflammatory bowel disease sulfonamides (TMP-SMX for cystitis) oral contraceptives

Question 47

Toxicodendron plants (poison ivy/oak/sumac) are a frequent cause of _____. Intensely pruritic, erythematous, vesicular rash involves exposed skin, forming **linear streaks** where skin has brushed against the plant leaves. However, diffuse or atypical patterns can be seen after exposure to contaminated clothes, pets, or smoke from burning plants.

Answer 47

allergic contact dermatitis Tx: Avoidance of suspected allergen Topical or systemic **corticosteroid**

Question 48

Atopic dermatitis often has ____ complications that should be considered when standard therapy ( **topical corticosteroids** ) for a flare is ineffective.

Answer 48

infectious (Impetigo)

Question 49

Impetigo (nonbullous impetigo) classically presents with golden crusts, weeping, or purulence, and treatment involves ___ or ___.

Answer 49

topical **mupirocin** or if Bullous impetigo/ecthyma, or severe/widespread nonbullous impetigo use: cephalexin dicloxacillin clindamycin, TMP-SMX, doxycycline (MRSA coverage) (Impetigo can be s/t eczema flair)

Question 50

Treatments for Eczema (Atopic Dermatitis) (3)

Answer 50

Topical emollients First line: topical **corticosteroids** (Hydrocortisone-Triamcinolone-Clobetasol) Second line: topical calcineurin inhibitors (**pimecrolimus**)

Question 51

Clinical features Acute: **pruritic, erythematous patches & papules** Infant: extensor surfaces, trunk & face Child/adult: flexural creases Chronic: lichenified plaques Diagnosis?

Answer 51

Atopic dermatitis (eczema)

Question 52

Presents with: ± Viral prodrome Pruritus Singular, round scaly lesion on trunk then several oval pink/red macules in a following indent/cleavage lines Diagnosis & Tx?

Answer 52

**Pityriasis rosea** (Herald's Patch & Christmas Tree pattern) Tx: **Reassurance** (spontaneous resolution) Treatment of pruritus (**antihistamines**)

Question 53

Patient with **scaly, erythematous plaques** involving the **extensor** surfaces of the extremities, scalp, and sacrum with **pinpoint bleeding** following scraping of the scales (Auspitz sign) has typical features of _____.

Answer 53

psoriasis ⎯ Extradermal manifestations include: psoriatic arthritis, nail pitting, and **conjunctivitis/uveitis**

Question 54

Certain infections, especially ___ and ___ (which can also trigger guttate psoriasis), are associated with psoriasis.

Answer 54

HIV streptococcal pharyngitis

Question 55

Dermatitis herpetiformis (DH) causes intensely pruritic erythematous papules, vesicles, and bullae that occur symmetrically in grouped clusters on the extensor surfaces of the elbows, knees, back, and buttocks. it is an autoimmune reaction to **gluten** associated with **celiac disease** (causing diarrhea and weight loss). Treatment is with what?

Answer 55

**Dapsone** gluten-free diet

Question 56

an autoimmune disorder characterized by painful, flaccid bullae, mucosal erosions, and separation of the epidermis from the dermis on light friction. The roof of the bullous lesions is fragile and rapidly desquamates, leaving raw ulcers.

Answer 56

Pemphigus vulgaris

Question 57

Neonatal ____ presents with erythematous papules and pustules limited to the face and scalp around age 3 weeks. Management is typically limited to daily cleansing with gentle soap and water, and self-resolution without scarring

Answer 57

cephalic pustulosis (baby acne)

Question 58

Allergic contact dermatitis is a _____ hypersensitivity reaction caused by activation of **memory T cells**

Answer 58

delayed-type

Question 59

**Ichthyosis vulgaris** is a lifelong, inherited disorder characterized by diffuse dry and rough skin with fish-like scales. These features are most noticeable on the extensor legs and during the winter. ±Palmar hyperlinearity. There is no associated erythema or other cutaneous lesions (vesicles, papules) to indicate an alternate diagnosis. Treatment is what?

Answer 59

Moisturization Long baths to remove scales Keratolytics (eg, urea, alpha-hydroxy acid, salicylic acid)

Question 60

causes pruritic, erythematous plaques with a greasy, yellow scale that predominantly affect the scalp and face. Diagnosis and **treatment**?

Answer 60

Seborrheic dermatitis Tx: Topical antifungal (ketoconazole, selenium sulfide)

Question 61

can be associated with Parkinson disease **and** HIV.

Answer 61

Seborrheic dermatitis

Question 62

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are similar disorders distinguished by

Answer 62

the percentage of involved skin SJS involves <10% of BSA TEN involves >30% **widespread** (TEN is more than 10%) and SJS/TEN overlap syndrome involves 10%-30%

Question 63

Allergic contact dermatitis type IV (cell-mediated) hypersensitivity reaction is treated with what?

Answer 63

topical corticosteroid (**Hydrocortisone, Triamcinolone**) allergen avoidance

Question 64

Systemic ____ causes induration and **hardening of the skin** most commonly at the hands/fingers and face. Ulcerations are typically located at the fingertips.

Answer 64

Systemic sclerosis (scleroderma)

Question 65

**woman** with chronic, scaly, irregular, erythematous plaques with ulceration and **central hypopigmentation** surrounded by **hyperpigmentation**. Most commonly affects **sun-exposed** regions of the head and neck . This presentation is consistent with what?

Answer 65

**discoid lupus erythematosus (DLE)** the most common form of chronic cutaneous lupus erythematosus.

Question 66

Pemphigus vulgaris or bullous pemphigoid? Onset at >60

Answer 66

**bullous pemphigoid** (Pemphigus is 40-60)

Question 67

Pemphigus vulgaris or bullous pemphigoid? **Painful, Flaccid** bullae → erosions (Nikolsky Sign +)

Answer 67

Pemphigus vulgaris

Question 68

Pemphigus vulgaris or bullous pemphigoid? **Mucosal surfaces** are almost always affected, with the oral mucosa being the most common initial site

Answer 68

Pemphigus vulgaris

Question 69

Pemphigus vulgaris or bullous pemphigoid? **Pruritic, Tense** bullae → ± erosions ± urticarial rash No Mucosal involvement (rare)

Answer 69

bullous pemphigoid

Question 70

Pemphigus vulgaris or bullous pemphigoid? INTRAepidermal cleavage

Answer 70

Pemphigus vulgaris

Question 71

Pemphigus vulgaris or bullous pemphigoid?SUBepidermal cleavage

Answer 71

bullous pemphigoid

Question 72

Pemphigus vulgaris or bullous pemphigoid? **Fish-Net-like** intercellular IgG against **desmosomes**

Answer 72

Pemphigus vulgaris

Question 73

Pemphigus vulgaris or bullous pemphigoid? **Linear** IgG against **hemidesmosomes** along basement membrane

Answer 73

bullous pemphigoid

Question 74

The diagnosis of pemphigus vulgaris & bullous pemphigoid must be confirmed with a ___ because therapy involves agents with significant toxicity like (2)

Answer 74

skin biopsy systemic corticosteroids Rituximab

Question 75

Acne mechanica is an acneiform eruption caused by ____-related damage to pilosebaceous follicles. It can result from pressure from crutches, bra straps, turtlenecks, sports padding, helmets, and heavy backpacks

Answer 75

pressure

Question 76

Rash is characterized by a **recurrent pruritic, vesicular** rash that primarily affects the **palms, soles, and sides of the digits**.

Answer 76

Dyshidrotic eczema (acute palmoplantar eczema)

Question 77

Dyshidrotic eczema (acute palmoplantar eczema) treatment is with what?

Answer 77

high- and super high–potency topical corticosteroids (**betamethasone**) dipropionate

Question 78

presents with localized vesicles and pustules on an erythematous base usually on the finger tips of children and teens. The lesions are painful but not typically pruritic.

Answer 78

Herpetic whitlow

Question 79

The classic tetrad of findings seen with ____ includes: **lower extremity palpable purpura** arthralgia/arthritis abdominal pain and/or renal disease. The vasculitis can also involve the scrotum, causing **scrotal pain** and swelling.

Answer 79

Henoch-Schönlein purpura (IgA vasculitis)

Question 80

Pemphigus vulgaris or bullous pemphigoid? ± Prodrome of eczematous/urticaria-like rash

Answer 80

bullous pemphigoid

Question 81

Pemphigus vulgaris or bullous pemphigoid? Associated Disorders: Dementia Parkinson disease Depression, Bipolar disorder

Answer 81

Bullous pemphigoid

Question 82

Treatment of Bullous pemphigoid (2)

Answer 82

Topical: high-potency corticosteroids, **Betamethasone, Clobetasol** Systemic: corticosteroid, **doxycycline**

Question 83

**Erythema multiforme** is an acute inflammatory disorder characterized by erythematous, round papules that evolve into **target lesions** It is associated with certain infections, especially ____, as well as medications, malignancies, and connective tissue diseases.

Answer 83

herpes simplex

Question 84

A fungal infection acquired by direct traumatic inoculation of the skin. It is characterized by **ulcerating pustular nodules** at the site of inoculation and associated **lymphatic channels**

Answer 84

Sporotrichosis

Question 85

The characteristic skin lesion in Lyme disease (transmitted by the Ixodes tick) is _____, a slowly expanding erythematous macule (Targetoid lesion) or patch with central clearing.

Answer 85

erythema migrans

Question 86

characterized by thickened, excoriated plaques caused by persistent scratching and rubbing. It is associated with **anxiety** disorders and typically occurs in areas that are easy to reach.

Answer 86

Lichen simplex chronicus (neurodermatitis)

Question 87

an idiopathic inflammatory disorder that presents with **round, pruritic, scaly plaques** most commonly on the extremities. It is often associated with dry skin. Treatment includes topical glucocorticoids, emollients, and avoidance of harsh soaps.

Answer 87

Nummular eczema

Question 88

Treatment of Tinea capitis is with what (2)?

Answer 88

Oral **griseofulvin** or **terbinafine**

Question 89

Head rash presents with Scaly, erythematous patch with hair loss on scalp ± Black dots in affected area ± Tender lymphadenopathy

Answer 89

Tinea capitis (Transmission via direct contact or from fomites)

Question 90

___ characterized by scaling, lichenification, and fissuring and commonly affects the hands. It is caused by exposure to chemical (detergents, solvents) or physical (metals, fiberglass) irritants.

Answer 90

**Chronic irritant contact dermatitis** Treatment: emollients, topical corticosteroids, and irritant avoidance.

Question 90

a chronic inflammatory disease characterized by white, atrophic plaques with intense pruritus affecting the skin, nails, hair, and/or mucous membranes. It most commonly affects the **anogenital area** of **postmenopausal women**. +/- dyspareunia, dysuria, painful poops Advanced disease: ulceration, hemorrhage, lichenification, vulvar skin thinning/fragility

Answer 90

Lichen sclerosus

Question 91

Although **Lichen sclerosus** is benign, it is associated with an increased risk of ____. Diagnosis should be confirmed via **punch biopsy**

Answer 91

squamous cell carcinoma

Question 92

Treatment of Lichen Sclerosus (commonly seen in vulva) is what?

Answer 92

First-line: superpotent topical steroids (**clobetasol**, betamethasone) Second-line: topical calcineurin inhibitors (**tacrolimus**) If necessary, **surgical excision**