Dermatology 2

Question 0

Pemphigus vulgaris – clinical features? Clinical sign?

Answer 0

#Easily ruptured bullae
#Mouth involvement
#Fluid loss infection widespread (like a burn)

Nikolsky sign

Question 1

Pemphigus vulgaris – causes?

Answer 1

#drug induced (ACE inhibitors, penicillamine, phebobarbitol, penicillin)
#autoimmune

Question 2

Pemphigus vulgaris - diagnosis and management?

Answer 2

Biopsy showing antibodies on a immunofluroescent studies

#Systemic steroids
#Azathioprine or mycophenolate to wean patient off steroids
#Rituximab 
#IVIg in refractory cases

Question 3

Bullous Pemphgoid vs Pemphigus vulgaris - bullae? Mouth involvement? Infection rates?

Answer 3

Intact versus rupture easily

Uncommon versus common

Less lots of fluid and infection vs more

Question 4

Patient presents with intact bullae and negative Nikolaky sign – suspected diagnosis? Most accurate test? Best initial therapy? (Subsequent therapy?)

If mild, can treat with?

Answer 4

Bulbous pemphigoid

Biopsy with immunofluorescence stains

Prednisone (later steroid alternatives)

#Dapsone
#Nicotinamide

Question 5

Patient presents with blistering skin disease on the backs of hands and face – suspected diagnosis? Specific history to get?

Answer 5

Porphyria cutanea tarda (rash on sun exposed areas)

#Hepatitis C, or liver disease from alcohol
#Estrogen use
#Hemachromatosis

Question 6

Patient presents with blisters on sun exposed areas – diagnosis? Deficiency? most accurate diagnostic test? Treatment?

Answer 6

Porphyria cutanea tarda

Uroporphyrin decarboxylase

24-urine for uroporphyrins

#stop EtOH and estrogens
#phlebotomy

Question 7

Oral vs IV medications for cellulitis, folliculitis, furuncles, carbuncles?

If penicillin allergic?

If MRSA?

Answer 7

Mild disease (oral meds)
#dicloxacillin, cephalexin, cefadroxyl
#Penicillin allergic – erythromycin, clarithromycin, clindamycin
#MRSA – doxycycline, clindamycin, Bactrim

Severe disease (IV)
#Oxacillin, nafcillin, cefazolin
#Penicillin allergy – clindamycin, vancomycin
#MRSA – vancomycin, daptomycin, tigecycline, ceftaroline

Question 8

Anti-staph penicillins?

Answer 8

OX-CLOX-DICLOX-NAF

Question 9

Staph infection - Switch to these if patient develops penicillin induced rash? Anaphylactic reaction?

Answer 9

Switch to cephalosporins

If mild infection: macrolides, clindamycin, doxycycline, Bactrim

If severe infection: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline

Question 10

Location of body:

1. Tinea corporis
2. Tinea manus
3. Tinea pedis
4. Tinea cruris
5. Tinea unguium

Answer 10

1. Body
2. Hand
3. Foot
4. Groin
5. Nail

Question 11

Fungal skin infection – best initial test? Most accurate test? Best initial therapy if hair/nails not involved?

Best initial therapy if hair and nails involved?

Answer 11

KOH prep

Fungal culture

Topical Antifungal

Terbinafine Or itraconazole

Question 12

Topical antifungals?

Answer 12

#Clotrimazole
#Ketoconazole
#Econazole
#Miconazole
#Nystatin
#Ciclopirox

Question 13

Side effect of oral ketoconazole?

Answer 13

Gynecomastia (anti-androgenic)

Question 14

Patient with oral/vaginal candidiasis best initial test? Most accurate test? Best initial treatment?

Answer 14

KOH prep

Fungal culture

Topical antifungal

Question 15

Drugs that cause hypersensitivity skin reactions?

Answer 15

#Penicillins
#Sulfa drugs (including thiazides, furosemide, sulfonylureas)
#Allopurinol
#Phenytoin
#Lamotrigene
#NSAIDs

Question 16

Drugs that cause hypersensitivity skin reactions also cause?

Answer 16

#Hemolysis 
#Interstitial nephritis
#Drug induced thrombocytopenia

Question 17

Hypersensitivity skin reactions in order of the severity? Therapies?

Answer 17

Morbilliform rash (skin intact without mucous membrane involvement – no therapy)

Question 18

In addition to drug reactions, erythema multiforme also seen with?

Answer 18

Herpes or Mycoplasma

Question 19

Staphylococcal scalded skin syndrome findings vs Toxic shock syndrome?

Answer 19

Like TEN, including Nikolsky sign

Versus
#Same skin findings AND:
#Hypotension
#Renal dysfunction (elevated BUN and creatinine)
#Liver dysfunction
#Delirium (CNS involvement)

Question 20

Treatment of staphylococcal scalded skin syndrome him and toxic shock syndrome?

Answer 20

Oxacillin or Nafcillin or cefazolin

Question 21

Side effect of isotretinoin?

Answer 21

Hyperlipidemia

Question 22

Before placing person on vitamin A derivative, must?

Answer 22

If female, pregnancy test and place on hormonal and barrier birth control