Derm JB

Question 1

basal cell carcinoma dx

Answer 1

punch/shave bx

Question 2

basal cell carcinoma tx

Answer 2

electrodesiccation/ curettage MC in nonfacial
Mohs for recurrent or face
surgical excision
small superficial, nonfacial: imiquimod and 5FU

Question 3

basal cell carcinoma description

Answer 3

translucent, pearly, waxy papule
central ulceration
raised/rolled borders
telangiectasia, bleed easily

Question 4

bullous pemphigoid PE

Answer 4

• nikolskys sign

Tense bullae

Question 5

bullous pemphigoid tx

Answer 5

high potency topical CS (clobetasol)

systemic CS, antihistamines, immunosuppressants

Question 6

cutaneous anthrax PE

Answer 6

group of small bumps/blisters that may itch
swelling around sore
painless skin sore w/ black center (eschar)

Question 7

cutaneous candidiasis tx

Answer 7

head/nails: oral “azole”

everywhere else: topical antifungals

Question 8

dengue fever sx

Answer 8

biphasic rash (erythematous mottling, –> maculopapular rash that spares Palms and soles –> petechiae on extensor surfaces of limbs)

Question 9

dermatophytes (tinea) tx

Answer 9

topical azole 1st line

Question 10

dyshidrosis tx

Answer 10

high strength topical steroids
cold compress
systemic steroids

Question 11

Erythema multiforme major sx

Answer 11

prodrome to SJS/TEN
looks like bad ringworm: target lesion w/ involvement >1 mucus membranes
type IV hypersensitivity rxn
hx of HSV or mycoplasma pneumonia
Med hx (sulfa drugs, b lactam, phenytoin)

Question 12

erythema toxicum tx

Answer 12

spontaneously resolves in 1-2w

Question 13

guttate psoriasis sx

Answer 13

hx of psoriasis in the past: nail pitting, oil spots, auspitz sign, koebners phenomenon, psoriatic arthritis)
small erythematous papule w/ fine scales
sausage digits
Extensor surfaces

Question 14

Herpes type 3 (zoster) tx

Answer 14

acyclovir, valacyclovir famciclovir

give w/in 72h to prevent postherpetic neuralgia

Question 15

impetigo sx

Answer 15

vesicles, pustules w/ honey colored crust
regional lymphadenopathy
on surfaces of the face

Question 16

MCC impetigo

Answer 16

S. aureus

Question 17

impetigo dx

Answer 17

clinical dx

gram stain and culture if atypical presentation

Question 18

impetigo tx

Answer 18

mupirocin topically TOC
bacitracin
Extensive/systemic (fever): systemic abx (cephalic, dicloxacillin, clindamycin, erythromycin, azithromycin, clarithromycin)

Question 19

intertrigo sx

Answer 19

aggravated by heat, moisture, friction
candida: satellite lesions
itching, burning, pain, stinging

Question 20

lichen Planus sx

Answer 20

purple, polygonal, planar, pruritic, papules w/ fine scales and irregular borders
may develop koebners phenomenon

Question 21

molluscum contagiosum sx

Answer 21

single or multiple dome shaped flesh colored to pearly white, waxy papules w/ central umbilication
curd like material may be expressed if squeezed

Question 22

molluscum contagiosum tx

Answer 22

cantharidin

topical retinoids

Question 23

benign neoplasm of axilla tx (seborrheic keratosis/lipoma)

Answer 23

seborrheic keratosis: no tx, cosmetic management

lipoma: no tx, cosmetic management

Question 24

neurofibromatosis sx

Answer 24

> 6 cafe au lait spots, inguinal/axillary freckling, lisch nodules on the iris seen on slit lamp exam
soft fleshy skin tumors
optic pathway gliomas (afferent pupillary defect)

Question 25

increase incidence of oral lichen planus with

Answer 25

HCV infection

Question 26

pedunculosis pubis tx (crabs)

Answer 26

topical permethrin or pyrethrin
lindane 2nd line
ivermectin in refractory cases

Question 27

pemphigus vulgaris sx

Answer 27

oral mucosal erosions/ulcerations –> painful flaccid bullae
+ nikolsky sign
bullae ruptures easily, leaving painful denuded skin erosions that bleed easily

Question 28

pityriasis rosea dx

Answer 28

clinical dx

confirm w/ KOH to look for hyphae

Question 29

pityriasis rosea tx

Answer 29

2.5% selenium sulfide shampoo
imidazole cream
PO fluconazole

Question 30

psoriasis tx

Answer 30

mild/mod: high dose topical steroids 1st line

mod-sev: phototherapy, systemic tx (methotrexate, cyclosporine, retinoids, biologic agents)

Question 31

scabies dx

Answer 31

often clinical dx

skin scraping of the burrows with mineral oil to ID mites/eggs in microscopy

Question 32

scabies tx

Answer 32

permethrin topical head to toe for 8-14h
shower and repeat in 1wk
clothing/bedding should be placed in plastic bag for 72h then wash/dry in heat

Question 33

melanoma tx

Answer 33

complete wide surgical excision w/ lymph node bx or dissection
+/- adjunct therapy” alpha IF, immune therapy, radiotherapy

Question 34

SJS sx

Answer 34

fever and URI sx for 1-3d
painful oral and skin erythematous macule w/ purpuric centers
+ nikolskys sign

Question 35

tinea capitis tx

Answer 35

PO griseofulvin 1st line

PO terbinafine, itraconazole, or fluconazole 2nd line

Question 36

tinia cruris sx

Answer 36

“jock itch”: diffusely red rash on groin or scrotum

trichophyton infects keratinized tissues of skin, hair, nails

Question 37

tinea cruris dx

Answer 37

KOH

woods lamp: green fluorescence if due to microsporum

Question 38

tinea versicolor dx

Answer 38

KOH: hyphae and spores (spaghetti and meatballs)

woods lamp

Question 39

cat bite, open wound tx

Answer 39

augmentin