Dermatology

Question 1

What are risk factors for skin cancer?

Answer 1

> 50 y.o
male
fair/freckles/ ruddy complexion with light colored hair or eyes
sunburns easy
exposure to arsenic/coal tar and petroleum
repeated trauma or irritation to skin
overexposure to frost/wind/UV light/radium/x-rays
living near the equator or high altitude, family history of skin cancer
precancerous dermatoses such as actinic keratosis
dysplastic nevus

Question 2

“Slapped cheek” red rash on face
s/s fever, runny nose, H/A rash
transmitted via respiratory secretions
What condition is described here?

Answer 2

Fifth’s disease

Question 3

During adolescense is acne more common in Males or females?

Answer 3

During adolescence acne vulgaris is more common in males

Question 4

During adulthood acne is more common in women or men

Answer 4

During adulthood acne is more common in women

Question 5

When an adolescent comes to your clinic and asks about pathophysiology of acne, how would you explain?

Answer 5

There are different factors playing a role in acne vulgaris
Genetics play a key factor
There are also 4 different factors such as release of inflammatory markers into skin, follicular hyperkeratinization with subsequent plugging of the follicle, follicular colonization with Propionibacterium acnes, and excess sebum production

Question 6

What is your first line therapy for all patients with acne ?

Answer 6

Topical retinoid and antimicrobial cotherapy

Question 7

What is your key education with isotretinoin (Accutane) in teenagers

Answer 7

We as providers should use caution in teenagers suspected of depression and SI- suicidal ideation
we nee to make sure to always teach them to monitor their mood

Question 8

What is another key education for Isotretinoin as far as pregnancy concern?

Answer 8

Isotretinoin is teratogenic and is category X
No indication to use during pregnancy
Pt must take pregnancy tests monthly

Question 9

What are some side effects of isotretinoin (Accutane)

Answer 9

Dry lips (cheilitis)
hypertriglyceridemia
elevated hepatic enzymes

Question 10

What are your treatment (pharmacological and non-pharmacological) options for mild acne?

Answer 10

clean skin regularly
avoid oil-based make up
benzoyl peroxide or combinations with erythromycin or clindamycin as monotherapy

Question 11

What is the treatment option for moderate-severe acne?

Answer 11

Benzoyl peroxide with a topical retinoid or systemic antibiotic therapy, BCPs, Accutane (isotretinoin) for severe

Question 12

Pt comes to your clinic and says the acne meds not helping. He has been taking them for 2 weeks now
What is your answer will be?

Answer 12

Meds take 4-8 weeks to work sometimes longer so patience is needed.

Question 13

Cystic nodules is associated with what. stage of acne?

Answer 13

Stage 3 also has significant inflammation, severe papules/pustules, cystic nodules present, high risk for scarring and post-inflammatory hyperpigmentation

Question 14

If a child younger than 4 and comes to your clinic with pruritis and eczematous changes , what question will you make sure to ask while taking a thorough history?

Answer 14

Personal history of asthma or hay fever
or a history of atopic diseases in 1st-degree relatives?

Question 15

If mom brings an infant with atopic dermatitis (eczema)
where will you see the rash?

Answer 15

Infantile atopic dermatitis common on face

Question 16

Where would you expect to see rash in atopic dermatitis(eczema) in children up to 2 years?

Answer 16

Onset from birth and up to 2 years, pruritis, erythema and scaling of cheeks, sparing of perioral, perinasal areas, diper area( moist area) ,may involve flexors and extensors

Question 17

Where will provider expect to find pruritus ( the itch that rashes) and erythema in children and adults, what areas?

Answer 17

commonly found on flexor surfaces
not face like infants
pruritus and erythema scale Lichenification, antecubital and popleteal fossae, neck, eyelids, postauricular, wrists, may become generalized

Question 18

Atopic dermatitis is far more prevalent in children or adults?

Answer 18

It is much more prevalent in children and remember it is an itch that rashes

Question 19

What will be your treatment for someone with atopic dermatitiis?

Answer 19

Moisturizers/lubricants… very important …. petrolatum, aquafor, atopiclair, mimyx

Topical steroids—- hydrocortisone, triamcinolone, betamethasone
Immonomodulators—- tacrolimus, pimecrolimus omalizuman,
Probiotics, orla antihistamine
Cool wet dressings—-DO NOT APPLY HEAT PADS
Maintain cool room temperatures at night

Question 20

You need to educate your patient on eczema triggers…. What are they?

Answer 20

Dry skin—- so moisturize skin with petrolatum, aquaphor, atopiclair, mimix

Irritants
Stress—- is a big one
Heat/ SWEATING—- no hot tubs
Infections— stay away from bugs and those who carry them
Allergens—- think of asthma and asthma irritants

Question 21

What age group is impetigo common?

Answer 21

2-5 years old

Question 22

Is impetigo bacterial or viral infection?

Answer 22

It is bacterial

Question 23

What causes impetigo, what organisms and where is mostly seen?

Answer 23

Staphylococcus aureus
A streptococci
or mix of both
any body site but more likely in the diaper area

Question 24

There are two types of impetigo……
nonbullous and bullous think of where you will see them

Answer 24

nonbullous impetigo—- honey- colored crusts on the face and extremities
bullous impetigo— large flaccid bullae more likely in intetriginous areas

Question 25

Treatment for nonbullous impetigo which is 70% of cases

Answer 25

topical antimicrobial—mupirocin (Bactroban)

Question 26

Treatment for bullous impetigo which 30 % cases

Answer 26

oral antimicrobials such as augmentin,,,, keflex( cephalexin), clindamycin, doxycycline

Question 27

What is the most common bacterial infection in children?

Answer 27

Impetigo

Question 28

If you given a picture with impetigo around umbilicus what would be your treatment plan?

Answer 28

Systemic appropriate abx: such as augmentin, keflex, doxycycline, clindamycin

Question 29

How long does it take for impetigo to resolve?

Answer 29

1-2 weeks without scarring or sequelae

Question 30

Pt comes with folliculitis after being in several days ago in jacuzzi with his friends.
He is asking you to rx abx, what is your teaching?

Answer 30

Folliculitis is caused by pseudomonas aeruginosa and usually settles by itself within a few days

Question 31

A patient comes to your clinic that has recently travelled to tropical country and comes with tracks of red itchy lesions or thread like lesions, says they growing each day
When you assess this patient where do expect to see these lesions and what is your diagnosis with differentials?

Answer 31

I expect to find the thread-like red itchy lesions on a patient’s hands, feet, upper thighs, buttocks

This diagnosis is cutaneous larvae migrans—— so the hookwarm the creeping eruption is causing the tracks of itchy red marks

Differentials—– tinea, urticaria, scabies.

Question 32

What is your treatment for cutaneous larvae migrnas?

Answer 32

Ivermectin antihelmintics , abendazole po, thiabendazole suspension topically

Question 33

Is lichen planus infectious skin condition ?

Answer 33

No, it is chronic, inflammatory cutaneous and mucous membrane reaction unknown etiology

Question 34

What are some differentials with pt coming with flat topped polyangular purple papules, reticulated whitish lines (lacey)

Answer 34

drug eruption
psoriasis
thrush
leukoplakia
cancer
Hep C

Question 35

What is your treatment plan for lichen planus.

Answer 35

steroids—- orabase
aristacort
antihistamine for itching
cancer treatment

Question 36

How can you rememember lichen planus lesions?

Answer 36

In Planus p stands for purple papules

Question 37

How can you prevent herpes zoster?

Answer 37

Protection
condoms
avoid triggers sun and stress
shingrix vaccine 50+ get vaccine regardless you have chickenpox or not

Question 38

How soon should you start treatment for herpes zoster (shingles)?

Answer 38

initiate treatment within 72 hours with acyclovir (zovirax), valcyclovir (valtrex) po, topical therapy creams abreva and denavir ….. make sure you provide adequate analgesia with lidocaine gel
nonpharm—– keep them clean and dry