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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
Q

Dome-shaped nodule with central keratinous plug

A

Keratocanthoma

25
Q

Selenium sulfide is used to treat which infections?

A

Tinea versicolor
Seborrheic dermatitis of the scalp

26
Q

Tazarotene

A

Topical retinoid

26
Q

Adverse effects of oral isotretinoin

A

Teratogenic
Hypertriglyceridemia
Pseudotumor cerebri

Must be on 2 forms of contraception

27
Q

Plaque psoriasis vs Tinea capitis

A

Tinea capitis mostly affects children, has alopecia, and kerion (tender, boggy mass)

Plaque psoriasis is typically symmetric in distribution

28
Q

Appearance of new lesions on skin following trauma

A

Koebner phenomenon - associated with psoriasis, vitiligo

29
Q

Epidermolysis bullosa

A

Group of inherited disorders characterized by epithelial fragility (bullae, erosions, ulcers) triggered by minor trauma

EB simplex involves keratin gene mutation

30
Q

Epidermolysis bullosa - diagnosis

A

Biopsy with IF microscopy; genetic testing for confirmation

31
Q

Pityriasis rosea

A

Numerous small, oval, scaly plaques over trunk and proximal (not distal) extremities

32
Q

When is biopsy indicated for actinic keratosis?

A

High-risk features: size >=1cm, induration/ulceration, rapid growth, therapeutic failure

33
Q

Actinic keratosis treatment - isolated vs diffuse

A

Isolated: Cryotherapy
Diffuse: Topical fluorouracil, imiquimod, tirbanibulin

34
Q

Mutation in what gene can predispose to atopic dermatitis?

A

Filaggrin gene

35
Q

Atopic dermatitis - second-line after topical steroids

A

Topical calcineurin inhibitors (e.g. pimecrolimus)

36
Q

Minoxidil mechanism of action

A

Direct vasodilator - increases blood flow to scalp

37
Q

Telogen effluvium

A

Diffuse hair loss in response to physiologic stress (e.g. pregnancy)

38
Q

Alopecia areata - treatment

A

Limited (<50% scalp) - intralesional or topical (children) steroids
Extensive - Oral JAK inhibitors (e.g. baricitinib) or topical immunotherapy (e.g. diphenylcyclopropenone)

39
Q

Which organism is purulent in cellulitis (Staph aureus vs beta-hemolytic Strep)

A

Staph aureus

40
Q

Diseases with erythema nodosum

A
  1. Infectious - e.g. Strep pharyngitis
  2. Autoimmune - e.g. sarcoidosis
  3. Inflammatory - e.g. IBD
41
Q

Burn wound sepsis vs SIRS criteria

A

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
Q

Papulopustular rosacea - treatment

A

First line: topical metronidazole, azelaic acid, or ivermectin
Second line: oral tetracyclines

More than just chronic erythematous rash

43
Q

What precipitates rosacea?

A

Hot/spicy foods, alcohol, sun, high ambient temperatures

44
Q

What immunodeficiency is associated with prolonged and diffuse molluscum contagiosum?

A

Impaired cellular immunity (e.g. HIV) - consider HIV testing if they are large (>1 cm), numerous, or widespread

45
Q

Malignant acanthosis nigricans is associated with what neoplasms?

A

GI and GU - would appear suddenly in middle-aged or elderly

46
Q

Who gets dermal angiosarcoma?

A

Previous radiation therapy

47
Q

Besides local trauma and infections, what medications can trigger plaque psoriasis?

A

Some include:
Antimalarials
Indomethacin
Propranolol

48
Q

Vitamin D analogs (e.g. calcipotriene) can be used to treat what?

A

Plaque psoriasis that is limited

49
Q

Systemic plaque psoriasis - treatment

A

Methotrexate, apremilast, TNF inhibitors, calcineurin inhibitors

50
Q

Can discoid lupus cause permanent hair loss?

A

Yes

51
Q

Pyogenic granuloma

A

Vascular tumor - red, friable papule that grows rapidly over weeks or months

Not ulcer, don’t confuse with pyoderma gangrenosum

52
Q

Herald patch followed by eruption of papules and plaques on trunk and proximal extremities

A

Pityriasis rosea - self-limited condition

53
Q

2nd degree burn - superficial vs deep partial thickness characteristics

A

Deep partial thickness: more white/waxy, nerve damage, no blanching and possibly less pain

54
Q

Hordeolum vs chalazion

A

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
Q

Ichthyosis vulgaris - gene

A

Filaggrin mutation - important for maintaining hydration of skin

56
Q

Red-brown/yellow annular plaques in lower extremities, classically pretibial skin, may ulcerate in center

A

Necrobiosis lipoidica - associated with diabetes

57
Q

Parkland formula for fluids in burn victims

A

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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