Dermatology Flashcards
12% of the PAEA EORE
A 15-year-old adolescent presents with concerns about persistent facial acne. Upon examination, you note the presence of comedones, papules, and pustules predominantly on the forehead and nose. The patient reports mild discomfort and embarrassment due to the acne. Which of the following is the most appropriate initial management strategy for this patient?
a) Oral antibiotics
b) Topical retinoids
c) Oral isotretinoin
d) Over-the-counter benzoyl peroxide
What pathogen causes acne vulgaris?
Topical Retinoids
Cutibacterium
A 16-year-old female presents with severe nodulocystic acne vulgaris. She reports previous unsuccessful treatment with topical agents and oral antibiotics. She has no significant medical history. Upon examination, you note numerous inflammatory papules, pustules, and deep nodules on her face, chest, and back. What is the most appropriate next step in management?
a) Initiating combination oral contraceptive pills
b) Referral to a dermatologist for consideration of isotretinoin therapy
c) Prescribing a higher dose of oral antibiotics
d) Recommending topical corticosteroids for spot treatment
What oral antibiotics are commonly used to treat acne?
Referral to a dermatologist for consideration of isotretinoin therapy
Minocycline or Doxycicline
A 13-year-old male presents with concerns about his facial acne. He has been using an over-the-counter benzoyl peroxide wash for the past month without improvement. His medical history is unremarkable. Physical examination reveals open and closed comedones, as well as scattered inflammatory papules and pustules on his cheeks and chin. What is the most appropriate next step in management?
a) Prescribing oral antibiotics
b) Recommending a combination of topical benzoyl peroxide and a retinoid (like adapalene)
c) Referring to a dermatologist for consideration of isotretinoin therapy
d) Initiating hormonal therapy with spironolactone
Recommending a combination of topical benzoyle peroxide and a retinoid
What are some of the retinoid medications available to treat acne?
What is the MOA of retinoids in the treatment of acne?
- Tretinoin (Retin-A, Renova)
- Adapalene (Differin)
- Tazarotene (Tazorac, Avage)
- Trifarotene (Aklief)
Help with skin cell turnover and reduces inflammation
A 17-year-old male athlete presents with concerns about his severe acne affecting his face, back, and chest. He is particularly worried about scarring and asks about the most effective treatment. He has no significant medical history. On examination, you note numerous comedones, inflammatory papules, pustules, and deep nodules on the affected areas. What is the most appropriate initial treatment option for this patient?
a) Oral antibiotics
b) Oral isotretinoin
c) Topical retinoids
d) Oral contraceptives
Oral isotretinoin
Severe nodulocystic acne vulgaris, especially when associated with scarring and failure of previous treatments, often requires systemic therapy with isotretinoin. This medication is highly effective but requires close monitoring due to potential side effects.
A 16-year-old female presents with concerns about her acne and irregular menstrual cycles. She reports oily skin and frequent breakouts on her face, chest, and back. She has tried various over-the-counter acne treatments without success. Physical examination reveals multiple comedones, papules, and pustules on her face and truncal areas. What is the most appropriate next step in management?
a) Oral isotretinoin
b) Referral to an endocrinologist for evaluation of possible polycystic ovarian syndrome (PCOS)
c) Initiation of oral contraceptives containing estrogen and progesterone
d) Recommending a combination of topical benzoyl peroxide and clindamycin
What is hirsutism?
Referral to an endocrinologist for evaluation of possible PCOS
Acne in females associated with irregular menstrual cycles and hirsutism may indicate an underlying hormonal disorder such as polycystic ovarian syndrome (PCOS). Referral to an endocrinologist for further evaluation and management is appropriate in this case.
Excess hair growth around the face and chin caused by excess androgens
What are the side effects of isotretinoin?
Dry skin, dry mouth, dry lips, increase in cholesterol, increase in triglycerides, harm to liver, teratogenic
What labs need to be monitored while a patient is on oral isotretinoin?
How many forms of birth control are required while on isotretinoin?
- Liver function tests (LFTs): Isotretinoin can cause liver toxicity. LFT’s should be checked before starting isotretinoin and regularly during treatment.
- Lipid profile: Isotretinoin is known to increase serum lipid levels, including triglycerides and cholesterol. Monitoring fasting serum lipid levels is necessary before starting isotretinoin and periodically during treatment.
- Complete blood count (CBC): Isotretinoin can rarely cause hematologic side effects, such as thrombocytopenia and leukopenia. Monitoring the CBC, including white blood cell count, platelet count, and hemoglobin/hematocrit levels, is recommended before starting isotretinoin and periodically during treatment.
- Pregnancy testing: Isotretinoin is highly teratogenic and can cause severe birth defects if taken during pregnancy. Therefore, pregnancy testing is required before starting isotretinoin treatment and monthly during treatment.
2 forms of birth control
What is another term for androgenetic alopecia?
When does it most commonly onset?
Pattern Balding
Late teenage years or early adulthood, more common in men
What treatments are available for androgenetic alopecia?
What hormone causes androgenetic alopecia?
- Topical: Minoxidil/Rogaine 2%, %5; *hair loss first before regrowth
- Finasteride 1 mg ⇒ inhibits T and DHT
- Spironolactone ⇒ blocks DHT
Dihydrotestosterone (DHT), testosterone and prolactin also play a role
A 6-month-old infant presents with red, scaly patches on the cheeks and scalp. The mother reports that the rash seems to worsen after feedings and during dry weather. On examination, you note erythematous plaques with overlying scales. What is the most likely diagnosis?
a) Atopic dermatitis
b) Contact dermatitis
c) Diaper dermatitis
d) Perioral dermatitis
Atopic Dermatitis
Where is atopic dermatitis most likely to present?
What type of sensitivity is atopic dermatitis?
Infant: face and scalp
Child: flexural surfaces (especially anticubital fossa)
IgE, type 1 hypersensitivity
A 7-year-old child presents with a chronic, relapsing rash characterized by erythematous papules and plaques with excoriations. The rash is symmetrically distributed on the flexural surfaces of the elbows and knees. The child has a family history of allergic rhinitis and asthma. What is the most likely diagnosis?
a) Atopic dermatitis
b) Contact dermatitis
c) Diaper dermatitis
d) Perioral dermatitis
Atopic Dermatitis
A 5-year-old child presents with a rash on the face and neck. The rash consists of small, red papules and pustules around the mouth. The child has been using a steroid cream prescribed for another skin condition. What is the most likely diagnosis?
a) Atopic dermatitis
b) Contact dermatitis
c) Diaper dermatitis
d) Perioral dermatitis
Perioral Dermatitis
Perioral dermatitis is a facial rash characterized by small, red papules and pustules around the mouth, nose, and eyes. It is often aggravated by the use of topical corticosteroids, which can lead to a rebound flare-up upon discontinuation.
Using topical corticosteroids on the face, especially in young children, can lead to various adverse effects, including perioral dermatitis. This condition typically requires discontinuation of the steroid cream and may be treated with topical antibiotics or other non-steroidal medications under the guidance of a healthcare provider.
What is the etiology of contact dermatitis?
What are some of the treatments for contact dermatitis?
Allergic or irritant etiology
Allergic: Nickel, poison ivy, etc. Type 4 hypersensitivity
Irritant: a direct toxic effect of an offending agent on the skin (cleaners, solvents, detergents, urine, feces)
Antihistamines, steroids, or zinc oxide (diaper rash)
A 2-month-old healthy baby boy presents to your office with his mom complaining of a rash in the diaper area for three days. She applied Monistat cream topically 5 days ago, and the rash cleared up but has now returned. On physical exam, you note an elevated, erythematous rash in the diaper area with satellite pustules. What is the most likely diagnosis?
What is the treatment?
Diaper Dermatitis, Candida Type
Nystatin, Clotrimazole, Econazole x 2 wks
What is the treatment for perioral dermatitis?
Metronidazole, avoid topical steroids
You are the physician assistant on call and receive a phone call from a mother whose 5-year old child got into alkaline drain cleaner and spilled it on his lower extremities. You can hear the child crying in the background. The nearest emergency room is 30 minutes away. What instructions do you give the mother?
The initial step with chemical burns is to irrigate them. The mother should put the child in the shower for 30 minutes because it is important to wash away the offending agent. She should then bring the child to the ED.
Describe the degrees of burns?
1st degree (sunburn): Erythema of involved tissue, skin blanches with pressure, the skin may be tender
2nd degree (partial thickness): Skin is red and blistered. The skin is very tender
3rd degree (full thickness): Burned skin is tough and leathery. Skin is non-tender
4th degree: Into the bone and muscle
What are the percentages in the rule of 9’s in children?
- Head 18%
- Each arm 9%
- Chest 18%
- Back 18%
- Each leg 18%
What body surface area of burns require fluid resusitation in kiddos?
What fluid replacement is most commonly used?
Greater than 10%
Lactated ringers (LR) = LR 3 ml x wt(kg) x % BSA
A 5-year-old child is brought to the emergency department with burns sustained from pulling a pot of boiling water off the stove. Upon examination, the child has erythema and blistering on both anterior lower extremities and the anterior trunk. Using the Rule of Nines, what is the estimated TBSA involvement?
A) 18%
B) 27%
C) 36%
D) 9%
B) 27%
According to the Rule of Nines, each lower extremity accounts for 18% of the TBSA, and the anterior trunk accounts for 18%. Therefore, the total TBSA involvement is 18% (lower extremity) + 18% (lower extremity) + 18% (anterior trunk) = 54%. However, because the burns are only on the anterior portion of the lower extremities and trunk, we take half of each, resulting in 27%.
A 10-year-old boy presents with partial-thickness burns on his right arm, covering approximately 10% of his TBSA. What is the most appropriate initial management for his burns?
A) Apply cold compresses
B) Administer intravenous fluids and cover the burns with a sterile dressing
C) Cover the burns with a sterile dressing only
D) Administer analgesics orally
Administer intravenous fluids and cover the burns with a sterile dressing
This is because the child has greater than 10% TBSA. In children with greater than 10% TBSA intravenous fluids should be given to prevent hypovolemic shock. The initial management of partial-thickness burns involves covering the burns with a sterile, non-adherent dressing to prevent infection and promote healing.
A 2-year-old girl sustains burns from hot bathwater. Upon examination, the burns are limited to her lower extremities and buttocks, with areas of erythema and blistering. What is the most appropriate classification of these burns?
A) Superficial burns (first-degree)
B) Partial-thickness burns (second degree)
C) Full-thickness burns (third degree)
D) Deep partial-thickness burns (fourth degree)
Partial-thickness burn (second degree)
Partial-thickness burns involve damage to the epidermis and part of the dermis, resulting in blistering and erythema. These burns are painful and can take several weeks to heal.
