Derm

Question 1

open comodones

Answer 1

blackheads

Question 2

closed comodones

Answer 2

whitehead

Question 3

Impetigo etiology

Answer 3

S. aureus or strep

Question 4

Impetigo tx

Answer 4

Topical mupirocin for small number of non-bullous lesions

Oral therapy for anything else: dicloxacillin, cephalexin, or clindamycin

Suspect MRSA→ clindamycin or linezolid

Question 5

Lice tx

Answer 5

Permethrin 1% ​(shampoo & lotion), Ivermectin (Lindane restricted d/t neurotoxicity)

2nd tx in 7-10 days to kill any surviving nits

Can return to school after 1st tx

Mechanical wet combing is an alternative therapy for kids too young for medical therapy ( < 2 months)

Examine household & close contacts

Wash bedding & clothing in hot water w/ detergent, dry in hot drier x20min

Toys that can’t be washed should be placed in air-tight plastic bag x14days

Question 6

Lichen Planus presentation

Answer 6

Develop on flexor surfaces of extremities, mucous
membranes of skin, mouth, scalp, genitals, nails

Purple popular pruritic polygonal planar

Oral white lacy patches = ​Wickam striae

Koebner phenomenon, fine scales

Question 7

Lichen Planus tx

Answer 7

Typically resolves in 8-12mo

1st line = antihistamines, steroid ointment

2nd line = systemic steroids, UVB therapy

Question 8

Scarlet Fever presentation

Answer 8

Pharyngitis

Strawberry tongue

Sandpapery rash that is worse in the groin and axilla with desquamation of palms and soles

Question 9

Scarlet Fever tx

Answer 9

Penicillin VK or amoxicillin administered to prevent sequelae of rheumatic fever

Question 10

Scarlet Fever etiology

Answer 10

GAS

Question 11

Androgenetic alopecia

Answer 11

Male pattern baldness

Variable and unpredictable

Question 12

Androgenetic alopecia tx

Answer 12

Minoxidil solutions = most effective in recent onset and smaller areas of hair loss

Finasteride may also be effective

SE = loss of libido and ED

Question 13

Atopic derm presentation

Answer 13

Papules and plaques, with or without scales, are noted and may be associated with edema, erosion, and
crusts

MC on the flexural surfaces, neck, eyelids, forehead, face, and dorsum of the
hands and feet

pruritus and dry, scaly skin. Scratching leads to lichenification, fissures, and
worsening rash

Secondary infections caused by Staph aureus

Question 14

Atopic derm etiology

Answer 14

Type I IgE mediated hypersensitivity rxn

Question 15

Atopic derm tx

Answer 15

Antihistamines → ↓ itching

Topical corticosteroids = mainstay of the treatment; systemic corticosteroids should be
avoided

Tacrolimus and pimecrolimus are topical calcineurin inhibitors (immunomodulators) approved for moderate to severe atopic dermatitis
(less atrophy w/ prolonged use when compared to topical corticosteroids but may carry a potential to cause malignancy)

Hydration and topical emollients are key to management

Soaps, vigorous rubbing, frequent bathing, and irritant clothing such as wool should be avoided

UVB phototherapy is effective

Severe systemic cases may necessitate cyclosporine

Question 16

Contact derm etiology

Answer 16

Type IV T-cell mediated rxn

Question 17

Posion ivy tx

Answer 17

Tecnu, calamine lotion, oatmeal baths, astringents (witch hazel)

Question 18

Allergic vs contact derm etiology

Answer 18

Type IV T-cell mediated rxn

Allrgic → metallic salts, plants (poison ivy), fragrances, nickel, preservatives, formaldehyde, propylene glycol, oxybenzone, bacitracin, neomycin, bleached rubber, chrome, sorbic acid

Irritant → water, soaps, detergents, wet work, solvents, greases, acids, alkalis, fiberglass, dusts, humidity, chrome, lip licking or other trauma

Question 19

Allergic vs contact derm presentation

Answer 19

Eczematous (irritant), vesicular (allergic)

Allergic → Acute with macules, papules, vesicles, and bullae, chronic with lichenification, scaling, fissures, uncommon on scalp, palms, soles, or other thick-skinned areas that allergens can’t get through

Contact → Acute with bullae, erythema, and sharp borders, chronic with poorly-demarcated erythema, scales, and pruritus, fissured, thickened, dry skin, usually palmar

Question 20

Diaper Dermatitis etiology

Answer 20

Candida

Question 21

Diaper Dermatitis presentation

Answer 21

Red, well defined margins, pustules, vesicles, papules or scales

Satellite lesions

Common in dark, moist areas (axillae, under breast)

Question 22

Diaper Dermatitis treatment

Answer 22

Topical antifungals such as nystatin

Question 23

Perioral Dermatitis presentation

Answer 23

Papulopustules form on erythematous bases and may become confluent with plaques and scales

Vermilion border is spared, and satellite lesions are common

Question 24

Perioral Dermatitis treatment

Answer 24

Avoid topical steroids bc will aggravate the lesions

Topical metronidazole or erythromycin or oral minocycline, doxycycline, or tetracycline

Untreated lesions will fluctuate over time, similar to rosacea

Question 25

Type I drug rxn

Answer 25

IgE mediated​, immediate urticaria, angioedema

Question 26

Type II drug rxn

Answer 26

Ab-mediated​, cytotoxic (drugs in combo with cytotoxic antibodies)

Question 27

Type III drug rxn

Answer 27

immune​ ab-antigen complex​ drug mediated vasculitis and serum sickness

Question 28

Type IV drug rxn

Answer 28

delayed ​cell-mediated​ erythema multiforme

Question 29

Exanthematous Drug Eruption presentation

Answer 29

>2 d after drug Limited to skin Lesions initially appear on trunk and spread to extremities in symmetric fashion Erythematous macules and infiltrated papules, pruritus and mild fever may be present

Question 30

Exanthematous Drug Eruption tx

Answer 30

Resolves a few days - week after med stopped Can continue med if not too severe and med cannot be subsuituted Topical steroids, oral antihistamines and reassurance Cold to help with itch

Question 31

1st deg burn

Answer 31

epidermis only, ✚ pain and ✚ erythema

Question 32

2nd deg burn

Answer 32

epi + dermis, ✚ pain, ✚ blisters ✚ erythema

Question 33

3rd deg burn

Answer 33

through dermis, white and painless w/ surrounding 2nd deg burns

Question 34

Parkland formula

Answer 34

LR @ 4ml x kg x BSA burn (half over 1st 8hrs, rest over next 16hrs)

Question 35

Adult burn %

Answer 35

``` head →9 trunk→ 18 back→ 18 each arm→9 each leg→18 genitalia→ 1 ```

Question 36

Ped burn %

Answer 36

``` head→18 trunk→18 back→ 18 each arm→ 9 each leg→ 14 genitalia→1 ```

Question 37

Pityriasis Rosea presentation

Answer 37

Herald patch= initial salmon-colored macule on trunk → general examthem Salmon colored oval/round papules with white circular scaling along clevage lines Very pruritic, christmas tree pattern, confined to trunk and proximal extremities May follow URI

Question 38

Pityriasis Rosea tx

Answer 38

Self-limited→ resolves in 6-12 wk For itch → topical steroids, PO anihistamines, moisturizeds, oatmeal baths +/- UVB light if severe

Question 39

Scabies presentation

Answer 39

Distribution is most common on the hands, wrists, genitalia, and axillary areas Lesions often are seen in the web spaces btwn fingers and toes, around the belt line, or at the edges of socks. Pruritic burrows, vesicles, or nodules with excoriations and crusting

Question 40

Scabies tx

Answer 40

1% lindane or 5% permethrin in a lotion or cream apply to the skin from the chin to the bottom of the feet and leave overnight (8 hr) then wash off in the AM Repeat tx in 7 days Antihistamines or topical steroids may help relieve the itching Lindane is more toxic and should be avoided in children younger than 2 yo, people with extensive dermatitis, and those who are pregnant or lactating. All bedclothes and clothing of infected pts and household contacts should be washed All close physical contacts should receive scabicide tx as well

Question 41

Tinea Versicolor presentation

Answer 41

Hypo or hyperpigmented macular lesions Esp on trunk Fine rim of scale

Question 42

Tinea Versicolor etiology

Answer 42

Malasezzia furfur (no really a tinea)

Question 43

Tinea Versicolor w/u

Answer 43

KOH prep for spaghetti and meatballs

Question 44

Tinea Versicolor tx

Answer 44

Topical selenium sulfide, pyrithione zinc, propylene glycol, ciclopirox, azole, or terbinafine ± UV light therapy Systemic ketoconazole if recurrent or refractory

Question 45

Tinea capitis tx

Answer 45

po griseofulvin, terbinafine, or itraconazole

Question 46

Tinea Barbae, manuum, corporis, cruis, faciale, pedis tx

Answer 46

po griseofulvin, terbinafine, or itraconazole, air exposure Topical terbinafine, naftifine, butenafine ± Soaks with aluminum acetate 2nd line: topical azole

Question 47

Tinea Unguium (onocomycosis) tx

Answer 47

1st line is oral terbinafine 2nd line is oral azole or ciclopirox topical lacquer 3rd line is repeat therapy or nail removal

Question 48

SJS vs TEN

Answer 48

SJS <10% TBSA and TEN >30%

Question 49

SJS & TEN presentation

Answer 49

Mucocutaneous blistering rxns most often caused by drug rxn Fever, photophobia, sore throat, mucosal inflammation, and sore mouth Lesions tend to be concentrated more on the trunk at first May be painful/sting Progression occurs over 4 days → diffuse erythema, necrotic epidermis, wrinkled surfaces, sheetlike loss of epidermis, and raised, flaccid blisters (Nikolsky sign)

Question 50

SJS and TEN w/u

Answer 50

✚ Nikolsky sign Anemia, lymphopenia Bx is diagnositc

Question 51

SJS and TEN tx

Answer 51

Prompt withdrawal of offending agent Transferto burn unit, gluid and electrolyte corrections Regrowth of skin takes 3 weeks (more in pressure-point area)

Question 52

Urticaria tx

Answer 52

Eliminate known cause Acute → PO H1 antihistamine, such as diphenhydramine, hydroxyzine, fexofenadine, or cetirizine Chronic → H2 antihistamine, such as famotidine or ranitidine, may be added to the H1 regimen EpiPen if concern for anaphylaxis

Question 53

Verrucae presentation

Answer 53

Skin warts→ flat or superficial Plantar warts→ deep Rough surface, cauliflower like

Question 54

Verrucae etiology

Answer 54

Caused by HPV Replicates in cutaneous and mucosal epithelium Common warts can occur on any surface of the skin while genital warts (condylomata) are spread through sexual contact HPV 16 and 18 are RF for dysplasia

Question 55

Verrucae tx

Answer 55

Spontaneous regression is typical over time Salicylic Acid for common warts Cryosurgery or E D&C (scar risk) Imiquimod (Aldara) Intralesional interferon if other tx fail Anogenital→ trichloroacetic Acid or topical podophyllin Surgical excision is successful but recurrence is common Vaccination for 16, 18, 6 and 11