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Derm Block 1 Flashcards

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Dermatology Board Prep flashcards
1
Q

Urticaria angioedema most concerning things to eval for?

A

Airway management

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2
Q

Definition of urticaria

A

W healing of the skin pruritic pink pale swelling of the superior dermis w Erythematous flare.

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3
Q

Mast Cell Degranulation induces what

And is associated with what disease

A

A histamine response;

-URTICARIA = firm edematous plaque.
Transient fade and recurrent.

Lesions come and go rapidly; generally 24 hours.

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4
Q

Acute urticaria rxn is defined as how long

A

6 weeks

Reproducible
Anaphylaxis reaction to allergen

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5
Q

Chronic urticarial rxn is defined as how long with what features

A

Greater than 6 weeks

Dx of exc. / no trigger small lesions recur over 6 weeks

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6
Q

Distro for urticarial

A

Skin localized and organized

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7
Q

Physical appearance of a urticaria rxn

A

Within 30-60 mins
Jewelry rxn
Aquagenic
Cholinergic

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8
Q

TXM of urticaria

Acute

A

IM/IV Benadryl
IM/IV CC
Epi

Avoid H1 antihistamine

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9
Q

TXM of uticaria chronic

A

2nd Gen Antihistamine
H2 Blockers
PO Steroids

Elimination diet

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10
Q

Circular uticaria is defined as what

A

Polycystic

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11
Q

Angioedema presentation

A

Deeper in the dermis and in the subcu or submucosal tissue.

Localized Burning Painful swelling (of one body part) FACE —> due to the amount of subcu tissue

+GI / Resp. Tract = dysphagia; dyspnea

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12
Q

Angioedema txm

A

ID allergen
IM/PO antihistamine
H1
PO steriods [EPI READY}

Air way precautions

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13
Q

Viral Exanthems

A

Measles
: Koplik : white spots on buccaneers mucosa
Erythematous
+ BLANCHING
+/- Fever

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14
Q

Where do viral exanthems show up

A

Face

With central spreading leaves a BROWN discoloration

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15
Q

TXM for viral exanthems

A

Supportive
REFER to HEALTH department

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16
Q

Hand Foot and Mouth presentation

A

ORAL -1st

Papules to vesicles
2-10 lesion can be painful

Mac Pap Lesions —> vesicles

[DORSAL aspect of fingers and toes]

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17
Q

HAND FOOT and Mouth TXM

A

Magic mouthwash
Oragel

Sxs relief

Dietary adjustments

+/- antipyretics

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18
Q

Erythema infectiosum 5th disease presentation

A

Slapped cheek rash = macular Erythematous Lacey appearance purpuric and vesicular lesions

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19
Q

5th dz txm

A

Supportive
Infection during prodrome period (w/o rash)

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20
Q

Kawasaki dz

A

7 weeks to 12 years old
Myco cutaneous
Lymph node syndrome

HIGH PAIN

no response to antipyretics
+Strawberry tongue
+Desquamation of fingers and toes

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21
Q

Kawasaki acute phase

A

Less than 7 days resolves
Conjunctival injection
Strawberry tongue
Tender edema of palms soles

Diffuse rash

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22
Q

About how long should Kawasaki disease resolve

A

6-8 weeks

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23
Q

Describe a cutaneous drug rxn

A

Looks like a viral exanthem
Macupapular morbilliform
ONSET 7-10 days
Fever variable

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24
Q

Common cutaneous eruption body manifestation

A

Glans penis
Lips
Hands
Face

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25
Q

Mgmt for a cutaneous drug reaction

A

Stop med!
Anti histamine
Topical PO steroid Class 3-5

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26
Q

What are two cutaneous drug reaction serious complications

A

Urticarial
Exanthematous rash

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27
Q

What is an example of a hypersentivity reaction

A

Erythema
Multiforme

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28
Q

EM Major presentation

A

Sever mucosal rash with airway restriction

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29
Q

EM minor reaction

A

Minor mucosal reaction

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30
Q

2 characteristics of EM

A

Bulla crust ring

Edematous outer ring

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31
Q

Distribution of EM

A

Dorsal hands and genitalia mucosa

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32
Q

What two things should be ruled out with EM

A

LUPUS and secondary Syphillis

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33
Q

Mgmt of EM

A

NONE
Sxs relief
Mild CC (prednisone 1-3 weeks)
Antihistamine
Local orajel

+/- antivirals after resolve of lesions

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34
Q

If there is ocular involvement with EM what needs to happen

A

STAT Opthalmology

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35
Q

Steven Johnson syndrome presentation

A

1st - URI
Malaise myalgia arthralgia
Fever 102 degree
Odynophagia
Papules-TRUNK first
Lesions - mucosal

Meds = Seizure ABX Gout

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36
Q

What meds are known to induce SJS

A

Allopurinol and Lamatrogine

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37
Q

Where does an SJS patient need to be admitted

A

Burn unit

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38
Q

Complications of SJS

A

Slough of upper and lower resp tract with blindness and ulcers

Mx the airway!!

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39
Q

What is an SJS like syndrome that is progressive diffeuse and generalized detachment of epidermis

A

Toxic epidermal necrolysis

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40
Q

Skin presentation in toxic epidermal necrolysis

A

Localized
Painful
SUNBURNED LOOK
(Infectious sepsis)
Slight thump pressure will pull skin off - NIKOLSKY sign

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41
Q

Where does toxic epidermal necrolysis commonly effect

A

Mucous membranes
Eyes
Respiratory Tract

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42
Q

What is the defintion of SJS + TEN

A

Severe Erythema Multiforme

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43
Q

Epidermal involvement of SJS and TEN

A

Less than 10% = SJS

10-30% = SJS + TEN

Greater than 30% = TEN

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44
Q

Presentation of erythema nodosum

A

Arhtalgia
Arthritis
Malaise

Red nodes thata re first tense hard and painful and then
FLUCTUANT

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45
Q

Pyoderma gangrenosum is assoicated with what other disease process

A

IBD

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46
Q

Presentation of pyoderma gangrenosum

A

Lesions tender red macula’s that last months to years
Dusky red induration leading to GANGRENE

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47
Q

Acne vulgaris presentation

A

Puberty onset
Can have FAM HX
Pilosebacuos unit multifactorial disease excess sebaceous gland secretion

Non inflammatory = open and closed comdomes

Inflammatory = papules pustules nodules and cyst

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48
Q

Diagnosis of acne vulgaris is

A

Clinical

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49
Q

Explain mgmt of acne vulgaris

A

No quick fix.
Most benign first
4-8 weeks then reevaluate

Mild = soap and water frequent exfoliation
(Dont over dry)
(Avoid oil containing; caffeine; and stress)

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50
Q

What are the therapeutic targets in acne vulgaris
With what treatment first
Then what

A

COMDONES with retinoid treatment 1st!

Them benzoyl peroxide
With Clindamycin combo

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51
Q

Mild inflammatory acne can be treated with what

A

Topical ABX
Doxy / Tetracycline / minocycline
Min = 3 months trial

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52
Q

Mod to severe inflammatory txm of acne vulgaris

A

Topical retinoid
Topical benzoyl peroxide
ORal ABX
ALL 3 then;
Doxy/ TETRACYCLINE/ MINO

Singular nodules = intralesional steroid injections

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53
Q

What can women take that can help treat their acne

A

OCPs spirinolactone

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54
Q

Describe acne congloblata

A

Communicating cysts ; ulcerations tracks WITH formed under the skin

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55
Q

What is the combo of pyoderma faciale

A

Acne + rosacea fulminans

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56
Q

What is a good mgmt for acne congloblata

A

Isotratinoin
Intralesional steroids

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57
Q

What labs are required for isoretinion txm

A

CBC
UA
LFTS
Lipids
HCG !!!!!!!!!!

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58
Q

What should you d/c if you start accutane

A

Retinoids

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59
Q

What is the mgmt for women on accutane

A

HCG monthly during txm and 1 month after d/c
WITH two methods of birth control

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60
Q

Accutane patients should watch for what

A

Mood swings

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61
Q

Can accutane patients donate blood during txm

A

NO!

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62
Q

What are sings of possible ICH with accutane txm

A

HA with visual changes
not relived by OTC
Retinol checks might show papilledema (pseudo cerebri)

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63
Q

What is the common location of female adult acne

A

Chin and jawline

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64
Q

Mgmt for femal adult acne

A

OCP’s spirinolactone
Tretinoin
Erythromycin if refractory

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65
Q

Perioral dermatitis is most common with who

A

Young women

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66
Q

Perioral dermatitis common presentation

A

Female pustules on cheek adjacent to nasolabial folds with VERMILLION BORDER CLEAR ZONE

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67
Q

Mgmt for Perioral dermatitis

A

D/c. Facial mositurizers and cosmetics
Doxy 2-4 weeks
Hydrocortisone

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68
Q

Acne rosacea has an assocation with what?

A

Demodex folliculorum

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69
Q

Acne reosacea presentation

A

Telagiactasia
Erythematous papules and pustules
Chin and forehead
Flush vasodilation

May burn or sting

70
Q

Mgmt for acne rosacea

A

Avoid triggers
Metronidazole
Azelazlic acid

71
Q

What is an enlarged nose known as
Assoc with what dz?

A

Rhinophyma ; association with rosacea

72
Q

Mgmt for pomade acne cosmetics

A

Lifestyle changes benzoyl peroxide
+ Tretinoin @ bedtime
Inflamed lesions = Top ABX

73
Q

Common locations for steroid acne

A

Face and neck
Back and chest

74
Q

Milia clinical presentation

A

Small epidermal cyst without openings
Tiny white pea chaped papules 1-2 mm diameter
Asx

Response to sun damage and physical trauma
At any age

75
Q

Mgmt for Milia solitary few lesions

A

Incise over lesion and extract content = cannot be expressed

76
Q

Forehead cheek and trunk heat rash presentation

A

Prickly sweat retention
1 mm papule or vesicle
Skin colored —> red
Stings that are pruritic

77
Q

TXM of heat rash

A

Self limited
Remove clothing

78
Q

Hidradenitis Suppurative presentation

A

Between skin and subcutaneous tissue
Apocrine gland wiht secondary bacterial infection

+/- strictures

Mild severe erythema pain
Double comedomes
Sinus tract development
Scarring

79
Q

HS locations

A

Axial
Robin
Under breasts

80
Q

Mgmt of HS

A

Stop smoking
Long term (I and D) with large cysts or abscess
Hot compress
Communicating cysts and scarring active disease = surgical excision and Grafts
+/- Isoretinion

81
Q

Who commonly is affected by staph follicilitis

A

Health care workers and family members

82
Q

Mgmt for staph folliculitis

A

Local = topical muprocoin or Clindamycin
Eruptions = PO dicloxicilin or cephalexin
Recurrent = Clindamycin

83
Q

What is the name of the foreign body hair reaction associated with black males that shave

A

Psuedofollicilitis barbae

“Razor Bumps”

84
Q

Pseudo folliculitis barbae primary locations

A

Beard
Axilla
Groin

85
Q

Pseudo barbae mgmt

A

Modify shaving
Hydrate
Wash wiht benzoly peroxide
Glycolic acid or aveeno
Shave with the grain

Top steroid Group 6-7

Large lesions = group 2-3

LASER HAIR REMOVAL (ingrown hairs)

86
Q

Acne keloidalis nuchae (AKN) is a ______ formation where?

A

Keloid

Back of the neck

87
Q

3 step plan for control of AKN

A

Topical Clindamycin BID
Fluocinide
Tretinoin

Oral steroids and intralaser

88
Q

Epidermal inclusion cyst presentation

A

@ PUBERTY / OILY SKIN
Excess sebum and large swelling
Occluded and dysfucntional
Round smooth mass soft MOBILE dysfunction pore

89
Q

Mgmt of epidermal inclusion cyst

A

No TXM req’d
Removal of non inflamed lesion along skin lines

90
Q

Pilar cyst called a _____. Presentation

A

WEN
Firm smooth MOBILE
Asx
Solitary tough lining keratinized different from
90% on the scalp

91
Q

How does a Pilar cyst differ from a EIC

A

Solitary tough lining that is KERATINIZED

92
Q

Psoriasis presentation

A

Immune mediated skin or joint inflamm disease
Hyperkaratosis

EXTENSOR SURFACES
Red discrete flat topped scales with papules that CAOALESCE to form round to oval plaques

+Koebner phenomenons induce

93
Q

Chronic psoriasis presentation

A

Disable emotional and physical
Childhood to adult presentation

94
Q

What sign is common for psoriasis

A

AUSPITZ SIGN = small pinpoint bleeding after scales have been removed

95
Q

RF for psoriasis (3)

A

Genetics

Meds : Lithium and Beta blockers Tetracyclines and NSAIDS

Past Hx

96
Q

Mgmt of psoriasis

A

Centered on patient
Worse with stress / meds
Psychosocial adjustment

97
Q

Less than 5% of body surface with psoriasis txm

A

CC Topical BEsT (Clobetasol/Fluiconinide)

Class 1 or 2 to taper

Traimcinolone for plaques

98
Q

What can be used prior to steroids to remove scales of psoriasis

A

Salicylic acid to decrease to help the steroid work better

99
Q

What are topical treatments for psoriasis

A

Vit D3 analogs
Top Vit D
Calciopotrien / Hydrate
Top Tazoprotene (rentinoid agent gel or cream)

100
Q

Diffuse thick psoriasis txm

A

Calcipotrien and betamethasone lotion

101
Q

More than 5% of the body psoriasis txm

A

Biologics 1st = Entanercept / Infliximab

Methotrexate
Cyclosporine
Amit Retinoin
Isoretinon
UVA

102
Q

What dz can cause psoriatic arthritis to persist

A

RA

103
Q

Mainstay txm for guttate psoriasis

A

UVA

With Vit D3

Spont resolve

104
Q

With guttate psoriasis what test should you get to manage

A

Strep - viral URI get culture

105
Q

Guttate psoriasis presentation

A

Sudden scales with papules

not on palms or soles

106
Q

Classic locations for guttate psoriasis

A

Elbow and knee plaques

107
Q

Distro for psoriasis

A

Truncal extremities
Nail pitting

108
Q

Pustular psoriasis presentation

A

Deep seated
Creamy yellow
Mid PALM
Evolves to a dusky red crust

109
Q

Mgmt for psoriasis

A

Class 1 top steroid
ABX if 2ndary infxn
Emollient
Seep skin supple
Acitretinoin
Cyclopsorine
Methotrexate
Biologics

110
Q

Common locations for pustual psoriasis

A

Hands
Palms
Soles of feet

111
Q

Common timeline for pustular psoriasis

A

Hardens then falls off

112
Q

What is a generalized variant of pustular psoriasis

A

Von Zumba (with known psoriasis)

Toxic febrile LEUKOCYTOSIS
Numerous tiny pustules evolve and then coalesce

113
Q

What happens if you push on the LAKES of PUS for Von Zumbusch

A

Pools opposite

114
Q

Psoriasis inversion locations

A

Flexor areas
Red plaques with increased pain
Nail changes : Onychosis and subcungal debris
Oil spots

115
Q

What are oil spots

A

Locales sedation on the nail plate in psoriasis inversus

116
Q

Seborrheic DERM presentation

A

Chronic!
Confined to skin with high sebum
Pattern of different age groups
Hygiene dependent

117
Q

MC cutaneous manifestation in AIDS pts

A

Seborrheic derm

118
Q

Etiology of Seborrheic derm

A

M. Furfur

119
Q

Morphology of Seborrheic derm

A

Fine white yellow greasy flakes
Cradle cap with scalp vertex
Inflamed pruritic red papules

120
Q

Mgmt for Seborrheic derm

A

Freq wash
With wash anti Seborrheic shampoo
Top anti fungal
Top steroid
(Hydrocortisone or desonomide on the FACE)

121
Q

Seborrheic derm on the eye txm

A

Baby shampoo

122
Q

Putyriasis rosea presentation

A

Young adults
COLD MONTHS
Viral origin - HHV 6/7

Suddne
Herald Patch (LARgE)
Hyperpigmentation

Macula’s and papules

“Christmas branches”

123
Q

Distro for pityriasis rosea

A

Proximal extremities
Hands palms soles

124
Q

Best mgmt for pityroasis rosea

A

NONE

125
Q

Severe pityriasis rosea txm

A

Group 5 steroids

R/O syphilis

126
Q

Intense pruritc lesion

Planar
Polygonal
Purple
Papules

A

Lichen Planus

127
Q

What do you have to do to visualize best lichen plain

A

Emerson oil shows :

Wickhams straie
W/ Lacey pattern

128
Q

What are concerning locations for lichen planus (4)

A

Oral lesions
Nail involvement
Scalp
Genital

129
Q

What dz is associated with lichen planus

A

Hep C

130
Q

Dx of lichen planus

A

1st clinical / biopsy

131
Q

Mgmt of local lichen planus

A

Top 1/2 steroid
+/- occlusion
Intralesional steroid every 3-4 weeks

132
Q

Mucous membrane mgmt for lichen planus

A

Steroid adhesive base
[azathiporine]

133
Q

Generalized Lichen planus txm

A

Prednisone with taper
Hydroxyzone

134
Q

If lichen planus is refractive consider what?

A

SCC

135
Q

Lichen sclerosis presentation

Early and Late

A

Vulvovaginal perianal groin
Pruritic painful
Dyspareunia
Dry

Early = smooth small pink ivory flat top

Late = papules and plaques

136
Q

TXM for lichen sclerosis

A

Top steroid
PUVA

137
Q

What presents with a woody induration red border that advances to a tough yellow violaceous patch

That burns and stings

A

Necrobioiss lipodica

138
Q

Necro lipodica is assoc with what dz

A

DM

139
Q

Distro for necro lipiodica

A

Tib fib region

140
Q

Rare chronic ulcerated lesion of necro lipodica can result in what

A

SCC

141
Q

Mgmt for necro lipodica

A

Topical Steriod
Intralesional steroid
Oral steroid - systemic sxs
Pentoxifylline (with results in 1 month)

142
Q

Granuloma annular presentation

A

Lesions persis and reels with time
Dorsal surface
Increasing diameter rings
Red papules

143
Q

Mgmt for granuloma annulare

A

Spont resolve ! Common!

Top steroid
Intralesional steroid

Disseminated = multi granuloma = PUVA

144
Q

Acanthodii’s Nigeria can rxn pattern

A

Velvety texture that becomes leathery
Symmetrical brown thickened skin
Warty papillomatous

145
Q

Associations that can caues acnthosis nigricans (5)

A

Hypothyroid

Drugs : NICOTINE ESTROGEN CC

Insulin resistance

Malignancy

Pradar willi syndrome

146
Q

Distro for Acanthosis nigricans

A

Axilla = MC

Flexor
Neck
Areola

147
Q

Mgmt for acanthosis nigracans

A

ASX = no txm

Soft wart lesions = ammonium lactate
Retinoin cream for thick skin
TXT cause

148
Q

Xanthoma is a what

A

Lipid abnormality

Superficial flat yellow and inner and outer canthens

arond the eyes = no lipid assoc

149
Q

Eruptive xanthoma =

A

Yellow in sudden crops
Extensor arm surfaces
Legs
Butt
Clear rapidly!

150
Q

Tuberous xanthoma presentation

R/O what?

A

Asx but very large!

Slowly evolves

R/O Biliary cirrhosis
Does not clear with txm of triglycerides

151
Q

Tendinous xanthoma presentation

A

Smooth deeply situated Achilles attachment
Back of ankle; top of knee

152
Q

Tendinous xanthoma txm

A

Dyslipidemia txm
Trichlorectic acid
TCA

153
Q

Kaposi sarcoma presentation

A

AIDS pts

Rapid onset trunk multiple lesions
Slightly raised RUST colored poor demarcation
Red and purple nodules with plaques

+/- mucocutaneous lesions
Ulcerate and Bleed

154
Q

Screen for what in kaposi sarcoma

A

HIV

155
Q

TXM for kaposi

A

Liquid nitrogen cryotherapy
Excisional surgery
Intralesional chemo = vinblastine

Large/Sever = Radiotherapy

156
Q

Hyperthyroid skin manifestation

A

Moist warm skin
Thyroid acropachy
Digital clubbing / Plummer nails : concave onycholysis

Periosteal changes
Pretibial mxedema

157
Q

Early hyperthyroid skin

A

Bilateral asymmetric firm non putting nodules
Pink SKIN Color PURPLE

158
Q

Late hyperthyroid presentation

A

Confluent symmetric peritibila exageered hair follicles
ORANGE PEEL

159
Q

Hypothyroid skin manifestations

A

Yellow cool waxy skin
Carotinuria
Wrinkle
Dry skin
Pale coarse hair

Pretibial mxedema

160
Q

Pemphigus presentation

Assoc with what dz

A

IgA Ab

Blister or bubble

AI blister dz of skin and mucous

Cell to cell adhesion molecules in desomosomes

Myasthenia Gravis

161
Q

Universal involvement of mucosa with painful erosions intact oral blisters friable! Precedes blisters by weeks or months

A

Pemphigus vulgaris

162
Q

Does Pemphigus vulgaris itch

A

NO!

163
Q

End result of Pemphigus vulgaris

A

Ooze non healing

164
Q

Mgmt for Pemphigus vulgaris

A

Derm consult!

165
Q

How will Pemphigus vulgaris be managed

A

Immune modulators and immune supresents
Syst GC
Rituximab

166
Q

Bulbous pemphigoid presentation and age group

A

Subendothelial blister dz
Local pruritic Multiforme
Yellow / Red serous plaques that crust
After 60 years old

167
Q

Mgmt bullous pemphigoid

A

Mid local = Groupd 1 top steroid

Severe = systemic txm

168
Q

Dermatitis herpetiformis

A

Chronic intents burn pruritic BURN papules or vessels
Grouped together on extensor surfaces
Symmetric unROOFED excoriations

169
Q

What is the reason for punch biopsy in dermatitis herpetiformis

A

Check for celiac disease

170
Q

TXM for dermatitis herpetiformis

A

Dapsone
Gluten free diet

DERM (1 decks)

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