Derm, part 2

Question 1

Hx/PE of lipomas

Answer 1

Soft, mobile subcutaneous mass with well-defined border

Often multiple, growing/spreading

Question 2

Lab and workup of lipomas

Answer 2

Bx

Question 3

DDx of lipomas

Answer 3

Sebaceous cyst-raised subdermal nodule usually with central opening +/- erythema and induration
Dermatofibroma- dermal nodule often result of previous trauma
Abscess
Subcutaneous tumor

Question 4

Health maintenance of lipomas

Answer 4

None

Question 5

Tx/meds of lipomas

Answer 5

Watchful waiting

Excision

Question 6

Hx/PE of lice/scabies

Answer 6

Family members with similar sx
Itching worse at night
Burrows between web spaces

Question 7

Lab and workup of lice/scabies

Answer 7

Adhesive tape test
No KOH, disrupts mites
Comb through hair looking for eggs

Question 8

DDx of lice/scabies

Answer 8

Viral exanthem
Eczema
Drug reaction

Question 9

Health maintenance of lice/scabies

Answer 9

Avoid contact (pets)

Question 10

Tx/meds for lice/scabies

Answer 10

Permethrin
-Can return to school/work in 24 hrs
Antihistamine for itching

Question 11

Hx/PE findings of spider bites vs. MRSA

Answer 11

Usually tells the story, i.e., bite vs hx similar
Induration: hardened surrounding tissue
Fluctuance: soft surrounding tissue
+/- fever, LAD, fatigue, myalgia, N/V

Question 12

Lab and workup of spider bites vs. MRSA

Answer 12

Culture and sensitivity

Question 13

DDx of spider bite vs. MRSA

Answer 13

Pyogenic granuloma
Black widow vs brown recluse
Abscess (non MRSA)

Question 14

Health maintenance of spider bite vs MRSA

Answer 14

Hibaclens for MRSA

Hygiene

Question 15

Tx/meds of spider bite vs MRSA

Answer 15

Antihistamine
Antivenin
Pain management
I and D- therapeutic
-Mark margins for monitoring tx
Abx
Sulfa or doxycycline
Steroids

Question 16

Hx/PE of skin cancer

Answer 16

SCC- scaley erythematous plaque
BCC- pearly flesh colored papule, telangiectasia
Sun exposure, chemical exposure, chemo/transplant

Question 17

Lab and workup of skin cancer

Answer 17

Bx

Question 18

DDx of skin cancer

Answer 18

Actinic keratosis

Keratocanthoma

Question 19

Health maintenance of skin cancer

Answer 19

Protective clothing, sunscreen

Prevention

Question 20

Tx/meds for skin cancer

Answer 20

Liquid nitro- superficial
Excision and bx
MOHS

Question 21

F/u for skin cancer

Answer 21

Every 6-12 mos full skin exam

Question 22

Hx/PE of paronychia

Answer 22

Nail biting, acrylics, trauma

Pain, erythema, pus drainage around nailbed

Question 23

Lab and diagnostic workup for paronychia

Answer 23

Gram stain
Culture/sensitivity
KOH
Tzanck smear

Question 24

DDx of paronychia

Answer 24

Herpetic whitlow

Felon

Question 25

Health maintenance for paronychia

Answer 25

Hygiene

Question 26

Tx/meds for paronychia

Answer 26

Warm soak Abx-moderate to severe Augmentin, cephalexin, clindamycin I and D

Question 27

Hx/PE of onychomycosis

Answer 27

Manicure/pedicure, trauma, infections | Thickening, discoloration, cracking

Question 28

Lab and workup for onychomycosis

Answer 28

KOH | Nail bx

Question 29

DDx of onychomycosis

Answer 29

Psoriasis | Onycholysis (trauma)

Question 30

Health maintenance of onychomycosis

Answer 30

Hygiene (bare feet) | Avoid pedicure/manicure

Question 31

Tx/meds for onychomycosis

Answer 31

Topical antifungal Systemic antifungal Nail removal

Question 32

Hx/PE of tinea

Answer 32

``` Family with similar, pet, travel Sweating/moisture Erythematous annular lesion with raised borders Caitus, corporis, pedis, crus -Versicolor-hypopigmentation ```

Question 33

Lab and workup of tinea

Answer 33

KOH | Bx

Question 34

DDx of tinea

Answer 34

Atopic dermatitis Candidiasis Granuloma annulare

Question 35

Health maintenance for tinea

Answer 35

Hygiene Avoid contact Loose fitting clothing

Question 36

Tx/meds for tinea

Answer 36

Topical antifungal- clotrimazole, ketoconazole | Systemic antifungal- if widespread or resistant