DERM

Question 1

steven johnsons vs TEN

Answer 1

SJS = <10% bsa
10-30 either
TEN = >30% bsa

Question 2

acne tx

when do you use topical retinoids?
when do you use topical abx?
oral abx?
oral isotretinoin?

Answer 2

topical ret for comedonal acne

add topical abx when it is inflammatory (<5mm papules)

add oral abx when severe

add oral isotretinoin when acne is severe and unresponsive to topical ret and abx

Question 3

hhv8?
associated with?
looks like?

Answer 3

kaposi sarcoma
AIDS
purpleish plaque in older mediterannean men

Question 4

melanoma likes to metastasize to…

Answer 4

the brain

Question 5

actinic keratosis

Answer 5

slow to progress to sq cell cancer
premalignant

t with topical imiquimod of 5FU

Question 6

seborrheic keratosis

Answer 6

stuck on “liver spots”
no malignant potential
benign!

Question 7

___ ifx is common with eczema due to scratching

Answer 7

staph

Question 8

what med group causes reactivation TB

Answer 8

tnf inhibitors

always screen w ppd

Question 9

pityriasis
presentation?
tx?

Answer 9

starts as herald patch (1 salmon lesion) and then disseminates
spares palms and soles

tx usually self resolving but can use steroids or UV lights

Question 10

another name for dandruff

Answer 10

seborrheic dermatitis

can treat with topical steroids and antifungals

Question 11

pemphigous vulgaris vs bullous pemphigoid

Answer 11

PV - autoab split the epidermis –> blisters that rupture easily, involves mouth, + nikolsky sign, dx with biopsy, tx prednisone and wean to azathiprine or mycophenylate

BP - milder, bullae stay intact, no mouth
dx biopsy
tx same as above or erythromycin, dapsone and nicotinamide

Question 12

porphyria cutanea tarda

Answer 12

deficiency of uroporphyrin decarboxylase leads to blisters in sun-exposed areas with hx of hepC/alc liver dz, estrogen use, or iron overload (hemochromatosis)

look for face and hands involvement

dx increased uroporphyrins in 24 hr urine

Question 13

impetigo vs erysipelas

Answer 13

impetigo is superficial ifx of epidermis with staph or strep = oozing, weeping, crusting
mild tx is mupirocin or bacitracin

erysipelas is deeper ifx in dermal lymphatics with fever/chills, usually strep, bright red hot and swollen lesion, mild oral med and severe IV

Question 14

skin ifx is caused by which staph?

Answer 14

staph aureus!!! staph epi is normal to the skin flora

Question 15

furuncle vs carbuncle

Answer 15

furuncle is a small abscess around a hair follicle (one step past folliculitis)
carbuncle is a collection of furuncles

Question 16

good meds for mild staph skin ifx

Answer 16

oxacillin
nafcillin
doxacillin
dicloxacillin

Question 17

for any “tinea”
best initial test?
most accurate test?
tx?

Answer 17

dermatophyte/fungal ifx

best initial test is KOH prep
most accurate is culture
tx with topical antifungal or oral if hair and nails are involved (terbinafine or itraconazole)

Question 18

side effect from ketoconazole?

Answer 18

gynecomastic (antiandrogenic)

Question 19

drugs that cause hypersensitivity reactions

what are the severities of rashes

Answer 19

penicillins
sulfa (thiazides, furosemide, and sulfonylureas)
allopurinol
phenytoin
lamotrigine
NSAIDs

morbilliform rash –> erythema multiforme (widespread target lesions) –> SJS (severe with mucous membrane involvement, tx IVIG) –> TEN (SJS + nikolsky sign, tx IVIG)

DO NOT USE STEROIDS FOR SJS AND TEN

Question 20

SSSS

Answer 20

staph scalded skin syndrome

looks like TEN (even has a nikolsky sign) but ALSO involves life threatening organ invovlement (cns, renal, liver, etc)

Question 21

tx for mild, mod, and severe acne

Answer 21

mild - benzoyl peroxide + can add topical erythromycin/clindamycin

mod - add topical vitamin A….if no response, can switch to oral abx (minocycline or doxycycline)

severe - add oral vitamin A isotretinoin to oral abx

Question 22

oral vitamin A isotretinoin side effects

Answer 22

hyperlipidemia

teratogenic (get pregnancy test AND barrier+hormonal birth control systems in place)