Dermatology 1

Question 0

Melanoma confirmed - treatment?

If widespread?

Tends to metastasize to?

Answer 0

Wide excision

Interferon

Brain

Question 1

Patient with skin lesion positive for ABC and diameter over 6 mm - suspected diagnosis? Best initial step?

Answer 1

Melanoma; full thickness biopsy that removes entire lesion (not shave biopsy)

Question 2

Patient with history of organ transplant presents with skin lesion – suspected diagnosis? Typical description of lesson?

Answer 2

Squamous cell carcinoma; ulcer that does not heal

Question 3

Patient presents with waxy lesion, shiny like a pearl – suspected diagnosis?

Confirm diagnosis with?

Treatment?

Answer 3

Basal cell carcinoma; shave biopsy

Mohs micrographic surgery (no need for wide excision)

Question 4

Most common form of skin cancer?

Answer 4

Basal cell carcinoma

Question 5

Why is Kaposi’s sarcoma purpleish? Found in what organ systems?

Found in what type of AIDS?

Answer 5

More vascular

Skin, G.I. tract and lung

Sexual contact (not IV drug use)

Question 6

Treatment of Kaposi sarcoma ?

Answer 6

#Antiretrovirals – will treat majority of Kaposi Sarcoma
#Intralesional injections of vincristine or interferon
#If above fails, chemotherapy with liposomal doxorubicin

Question 7

Sun-exposed patient presents with erythematous/brownish plaque – likely diagnosis? Risk of? Management?

Answer 7

Curettage, cryotherapy, laser, 5-FU

Actinic keratosis (premalignant)

Squamous cell carcinoma

Question 8

Imiquimod used for?

Answer 8

Molluscum contagiosum and condyloma acuminata

Question 9

Hyperpigmented “stuck on” lesions – diagnosis? Management?

Answer 9

Seborrheic keratosis

Not premalignant - remove with surgery, cryotherapy or laser for cosmetic reasons

Question 10

Patient with history of asthma and allergic rhinitis – likely skin lesion? Onset? Natural history?

Answer 10

Atopic dermatitis (eczema)

Before five

1) Overactivity of mast cells leads to pruritis
2) pruritis leads to lichenification
3) scratching leads to potential infection

Question 11

Effect of food allergies on atopic dermatitis?

Immunoglobulin levels in atopic dermatitis?

Medical therapy?

Answer 11

None

Elevated IGE

#Topical steroids for flares
#Tacrolimus and pimecrolimus 
#Antihistamines
#Antibiotics for impetigo
#phototherapy for recalcitrant disease

Question 12

Tacrolimus and pimecrolimus - mechanism?

Potential complication?

Answer 12

T cell inhibiting Agents

Lymphoma

Question 13

Antihistamines to use in atopic dermatitis?

Answer 13

If mild - Nonsedating (loratidine, fexofenadine, certirizine)

If severe - hydroxyzine, diphenhydramine, doxepin

Question 14

Antibiotics for mild impetigo? Severe?

If MRSA?

Answer 14

#Bacitracin
#mupirocin (RNA-synthase inhibitor)
#retapamulin 

#Dicloxacillin 
#Cephalexin

#Docycycline
#clindamycin
#Bactrim

Question 15

Depression associated with this skin disease?

Answer 15

Psoriasis

Question 16

Psoriasis – treatment for local disease

Extensive disease?

Answer 16

#High potency steroid 
#Vitamin A and D (to help mitigate steroids)
#Coal tar
#Tacrolimus, and pimecrolimus for face and penis (to avoid steroids)

#UV light
#TNF inhibitors
# Methotrexate (last resort for psoriasis)

Question 17

Maculopapular syphilis-like a rash that spares palms and soles?

Answer 17

Pityriasis rosea

Transient but if symptomatic treat with steroids or UV light

Question 18

Seborrheic Dermatitis? Increased with what diseases? Treatment?

Answer 18

Hypersensitivity reaction to dermal infection from noninvasive dermatophytes

Parkinson’s and aids

#Steroids (cortisone, alclometasone)
#Antifungal agents (ketoconazole)