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Internal Medicine > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is Nikolsky’s sign?

A

Lateral pressure on border of intact blister results in dislodgment of the normal epidermis and extension of the blister

Seen in:
Pemphigus
Staph scaled skin syndrome
Toxic epidermal necrolysis

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1
Q

What is hidradenitis suppurative?

A

Recurrent occlusion of hair follicles in intertriginous regions; nodules develop into spontaneously draining abscesses, forming sinus tracts, acneiform scars, thickened plaques, fibrotic bands

Women age 20-40
Risk: Obesity, tobacco, FHx

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2
Q

Which skin conditions involving bullae are caused by exfoliative toxin-producing S aureus?

A

Bullous impetigo (localized)
Staph scalded skin syndrome (systemic)

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3
Q

What fluid is preferred for volume resuscitation in burn victims?

A

Lactated Ringer’s - a balanced fluid

Chloride is normal (unlike normal saline, which is supraphysiologic and can cause hyperchloremic metabolic acidosis)

LR contains sodium lactate - hepatically metabolized to bicarb to help correct acidosis and maintain normal blood pH

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4
Q

North American snake venom can cause what symptoms?

A
  1. Tissue injury –> necrosis
  2. Myotoxicity –> cardiovascular collapse (hypotension)
  3. Coagulopathy (oozing)
  4. Neurotoxicity
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5
Q

North American snake bite antivenoms

A
  1. Crotalidae polyvalent immune Fab (ovine) (CroFab/FabAV) - all NA snakes
  2. Crotalidae Immune F(ab’)2 (equine) (Anavip/Fab2AV) - just rattlesnakes
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6
Q

Describe appearance of secondary angiosarcoma

A

Purpuric papulonodular lesions and red, bruise-like plaques without distinct borders on breast, axilla or upper arm

Often from breast cancer radiotherapy or LN dissection with subsequent lymphedema
Occurs 4-8 years later

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7
Q

Black widow bite

A
  1. Muscle pain
  2. Muscle cramps
  3. Abdominal rigidity
    Nausea and vomiting within hours
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8
Q

Pilonidal disease vs hidradenitis suppurativa

A

Pilonidal is single fluctuant mass in midline gluteal cleft

HS is multiple recurrent painful nodules in any intertriginous area (axillae, inguinal, perineal)

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9
Q

Folliculitis appearance

A

Multiple small, pruritic pustules

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10
Q

Why inject 1% lidocaine mixed with sodium bicarbonate during digital block?

A

Decreases pain during anesthetic injection (lidocaine marketed in acidic form to increase stability and shelf life)

1 mL 8.4% sodium bicarb to 10 mL 1% lidocaine

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11
Q

Why inject 1% lidocaine mixed with epinephrine during digital block?

A

Decreased bleeding
Decreased absorption into systemic circulation
Prolonged duration of analgesia

Contraindicated in those with increased risk of digital ischemia since arteries so close to nerves

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12
Q

Excisional biopsy margins for melanoma in situ

A

0.5 cm - 1 cm

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13
Q

Burn victim - skin treatment

A

Regular dressing changes with topical antimicrobial agents
Early (within 5d) wound excision and grafting to remove eschar, which topical agents cannot penetrate and which serve as nidus for infection
Skin grafts or substitute

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14
Q

Leser-Trelat sign

A

Sudden appearance of many seborrheic keratoses, suggesting of occult internal malignancy

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15
Q

All patients with porphyria cutanea tarda should be screened for…

A

Hep C

Vesicles, bullae on sun-exposed skin

Treat with serial phlebotomy or hydroxychloroquine while treating Hep C

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16
Q

Guttate psoriasis

A

Widespread, erythematous, scaly papules/plaques
After Strep or those with RA
Treat with topical glucocorticoids, UV, or vit D analogs

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17
Q

Dermatofibroma
Epidermal inclusiom cyst
Lipoma

A

Dermatofibroma - lower extremities, hyperpigmented, dimpling
Epidermal inclusion cyst - central punctum, spontaneously resolved and recurs
Lipoma - soft rubbery and irregular, normal overlying epidermis

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18
Q

Dyshidrotic eczema

A

Recurrent, acute, pruritic rash with deep-seated vesicles that preferentially affect hands, soles, and sides of fingers

Contrast with nummular eczema - coin-shaped, scaly plaques mostly in lower extremities

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19
Q

Lichen simplex chronicus

A

Neurodermatitis - thickened excoriated plaques from persistent scratching and itching

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20
Q

Where is atopic dermatitis?

A

Flexural surfaces

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21
Q

Comedonal vs inflammatory vs nodular/cystic acne treatment

A

Comedonal: Topical retinoids; salicylic/azelaic/glycolic acid
Inflammatory: Mild is topical retinoids + benzoyl peroxide, moderate add topical antibiotics (clindamycin or erythromycin), severe add oral antibiotics
Nodular/cystic: Moderate is topical retinoid + benzoyl peroxide + topical antibiotics, severe add oral, unresponsive severe add oral isotretinoin

Oral includes doxycycline

Can also use spironolactone, contraindicated if not using contraception

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22
Q

Skin disorders related to underlying Hep C

A
  1. Porphyria cutanea tarda - erythema and bullae in sun-exposed areas
  2. Lichen planus - pruritic, pink/purple papules and plaques predominantly at wrists/ankles
  3. Leukocytoclastic vasculitis - palpable purpura
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23
Q

Stuck-on appearance, well-demarcated border, velvety or greasy surface

A

Seborrheic keratosis

24
Dome-shaped nodule with central keratinous plug
Keratocanthoma
25
Selenium sulfide is used to treat which infections?
Tinea versicolor Seborrheic dermatitis of the scalp
26
Tazarotene
Topical retinoid
26
Adverse effects of oral isotretinoin
Teratogenic Hypertriglyceridemia Pseudotumor cerebri Must be on 2 forms of contraception
27
Plaque psoriasis vs Tinea capitis
Tinea capitis mostly affects children, has alopecia, and kerion (tender, boggy mass) Plaque psoriasis is typically symmetric in distribution
28
Appearance of new lesions on skin following trauma
Koebner phenomenon - associated with psoriasis, vitiligo
29
Epidermolysis bullosa
Group of inherited disorders characterized by epithelial fragility (bullae, erosions, ulcers) triggered by minor trauma EB simplex involves keratin gene mutation
30
Epidermolysis bullosa - diagnosis
Biopsy with IF microscopy; genetic testing for confirmation
31
Pityriasis rosea
Numerous small, oval, scaly plaques over trunk and proximal (not distal) extremities
32
When is biopsy indicated for actinic keratosis?
High-risk features: size >=1cm, induration/ulceration, rapid growth, therapeutic failure
33
Actinic keratosis treatment - isolated vs diffuse
Isolated: Cryotherapy Diffuse: Topical fluorouracil, imiquimod, tirbanibulin
34
Mutation in what gene can predispose to atopic dermatitis?
Filaggrin gene
35
Atopic dermatitis - second-line after topical steroids
Topical calcineurin inhibitors (e.g. pimecrolimus)
36
Minoxidil mechanism of action
Direct vasodilator - increases blood flow to scalp
37
Telogen effluvium
Diffuse hair loss in response to physiologic stress (e.g. pregnancy)
38
Alopecia areata - treatment
Limited (<50% scalp) - intralesional or topical (children) steroids Extensive - Oral JAK inhibitors (e.g. baricitinib) or topical immunotherapy (e.g. diphenylcyclopropenone)
39
Which organism is purulent in cellulitis (Staph aureus vs beta-hemolytic Strep)
Staph aureus
40
Diseases with erythema nodosum
1. Infectious - e.g. Strep pharyngitis 2. Autoimmune - e.g. sarcoidosis 3. Inflammatory - e.g. IBD
41
Burn wound sepsis vs SIRS criteria
Burn wound sepsis: 1. Temp >39 or <36.5 (>38 or <36 in SIRS) 2. Pulse >90 in both 3. RR >30 (vs >20) 4. Refractory hypotension SBP <90 (vs WBC <4, >12, or >10% bands)
42
Papulopustular rosacea - treatment
First line: topical metronidazole, azelaic acid, or ivermectin Second line: oral tetracyclines More than just chronic erythematous rash
43
What precipitates rosacea?
Hot/spicy foods, alcohol, sun, high ambient temperatures
44
What immunodeficiency is associated with prolonged and diffuse molluscum contagiosum?
Impaired cellular immunity (e.g. HIV) - consider HIV testing if they are large (>1 cm), numerous, or widespread
45
Malignant acanthosis nigricans is associated with what neoplasms?
GI and GU - would appear suddenly in middle-aged or elderly
46
Who gets dermal angiosarcoma?
Previous radiation therapy
47
Besides local trauma and infections, what medications can trigger plaque psoriasis?
Some include: Antimalarials Indomethacin Propranolol
48
Vitamin D analogs (e.g. calcipotriene) can be used to treat what?
Plaque psoriasis that is limited
49
Systemic plaque psoriasis - treatment
Methotrexate, apremilast, TNF inhibitors, calcineurin inhibitors
50
Can discoid lupus cause permanent hair loss?
Yes
51
Pyogenic granuloma
Vascular tumor - red, friable papule that grows rapidly over weeks or months Not ulcer, don't confuse with pyoderma gangrenosum
52
Herald patch followed by eruption of papules and plaques on trunk and proximal extremities
Pityriasis rosea - self-limited condition
53
2nd degree burn - superficial vs deep partial thickness characteristics
Deep partial thickness: more white/waxy, nerve damage, no blanching and possibly less pain
54
Hordeolum vs chalazion
Hordeolum is painful acute eyelid gland infection (stye) Chalazion is painless inflammatory cyst due to blocked eyelid gland Hordeolum may become chalazion once infection self-resolves
55
Ichthyosis vulgaris - gene
Filaggrin mutation - important for maintaining hydration of skin
56
Red-brown/yellow annular plaques in lower extremities, classically pretibial skin, may ulcerate in center
Necrobiosis lipoidica - associated with diabetes
57
Parkland formula for fluids in burn victims
4 x weight (kg) x %BSA Administer half over first 8 hr, then half over next 16 hr

Internal Medicine (23 decks)

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