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2018 ABIM Awesome Review > Dermatology 3% > Flashcards

Dermatology 3% Flashcards

1
Q

Acute Excema

A

Vesiuclar
Bullae
Erythema

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2
Q

Subacute Eczema

A

Crust/Erythema

No bullae/vesicles

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3
Q

Chronic Eczema

A

Lichenification

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4
Q

Exogenous cauase of eczema

A

Contact dermatitis

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5
Q

Endogenous eczema

A

Atopic dermatitis

Seborrhic dermatitis

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6
Q

Atopic Dermatitis

A 
aw Asthma/rhinitis
inc'd IgE
Childhood erythematous pruritic rashes
Later in adulthood scabbed/excoriated lesions (on flex surfaces)
Tx: Hydrants, emollients
low dose hydrocortisone
white flakes
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7
Q

Seborreheic dermatitis

A

white flakes face/scalp, upper chest aud canal
Caused by Pityrosporum
Severe caes in HIV pts
Tx: Oral/topical ketoconazole - selenium sulfide

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8
Q

40yo ex IVDU with severe seborrheic dermatitis wtd?

A

HIV test

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9
Q

Sebhorrheic keratosis

A

Warty brownish plaques in elderly (barnacles of elderly)
Give a stuck upon skin impression on face, back neck in exposed an dnon-exposed areas
can be pigmented or dark
NON malignant (not even pre-malginanct)
No tx required (except cosmetic if wanted)

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10
Q

Contact Dermatitis

A

Delayed type IV rxn - necket, chromium oleoresin (poisony ivy/oak) rubber
Tx: cool compresses, local steroids

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11
Q

Young female lac on finger while chopping vegeetables - clenaed and sutured - abx cream applied with occlusive dresseing- 3 days later c/o itching sensation and pain - on exam band aid uncovered - suture lin clean but surrouding erythem adn eruptive vesuicular lesions dx?

A

contact dermatitis

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12
Q

Med records clerk pw vesicular lesions itchy on fingers dx?

A

contact dermatitis

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13
Q

Lady with itchiness and eczema of upper yelids etio?

A

nailpolish

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14
Q

Pt p/w poson ivy exp w/in 2 hrs wtd?

A

Showering

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15
Q

Milia -

A

small keratin containing cyts on eleids, cheeks, nose, forehead
Tx: I&D

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16
Q

Open/closed comedone

A

topical tretinoin

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17
Q

Papular acrne (inflamm acne)

A

benozylperoxide + erythromycin

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18
Q

Cystic/nodular acne: sevre acne

A

acutane-> iso tretinoin

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19
Q

Female with severe acne wants accutane wtd?

A

Must be on OCP, and alt contraception aduring and oe month after completeing tx since accutean teratogen

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20
Q

Pt with predominatly comedone acne wtd?

A

Topical benzoyl peroxide, top tretinoin

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21
Q

Acne Rosacea

A

Acne like lesions in face - middle aged women
Flushing with exertion or sun exposure
Fine telangiectasies and scatter papuules -
Tx: oral tetracycline, topical flagyl**

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22
Q

Lichen Planus

A 
Papulosquamous lesions of skin/MM
Purpl papules with whie lines on surface
Can occus with use of NSAIDS
Cutaneous gravet vs host rx resembenls this
Tx: High potency topical steroids
r/o hep C
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23
Q

Hidradentits suppurativa

A

chronic inflamm/scarry invovling apocrine gland areas
tx: tetra/erythomycin
Surgery
Quit smoking

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24
Q

middle aged woman pw recurreing episodes lumps in axilla - drains serous fluid - episodes resolve after sponatous draiing - no change in LN - has cath for 2 month sand loves gardening

A

Hidrandenitis suppurative

tx: Quit smoking

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25
Q

Koplik spots

A

Small white vesicles on erythematous base
seen in measles (rubeola), *salt granules?
precede skin lesions by several days
fever malaise, coryza, cough, conjunctivitis
rash starts on face and spreads to trunk
maculopapular CONFLUENT rash

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26
Q

Hairy Leukoplakia

A

Ribbed whiteness on lateral tongue, will not come off
HIV pts
cause by EBV
No tx needed… haart

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27
Q

Oral thrush

A

earliest opportunistic infection
Commonly seen in HIV pts T cell < 200 or inhaled steroids for asthma
Tx: oral nystatin swish/spit or fluconazole if severe

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28
Q

Macroglossia

A 
associated with:
Amyloidosis
MM
Acromegaly
Down's syndrome
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29
Q

Strawberry tongue

A

associated with:
Scarlet fever
kawasaki syndrome

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30
Q

Exanthematous/morbilliform (blanching rash)

A

Sulfonamides, B lactam; PCN

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31
Q

Utricaria/angioedema

A

ASA, PCN, blood products, ACEi

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32
Q

Fixed drug reactions

A

Rash occuring at the same spot after rechallenge

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33
Q

Erythema multifomre

A

Recurrent HSV, mycoplasma, PCN, sulfa, phenytoin

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34
Q

Erythema Multiforme

A

Tetracyclins

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35
Q

Erythema multiforme

A 
targetoid lesion
MM may be involved
Pt with recurrent EM -> r/o HSV
tx/ppx acyclopvir
\+Cough/CXR infiltrate -> cold agglutins -> myoplasma infxn
Phenytoin, sulfa, PCN
More sevrere with mucocutan -> SJS
Tx: admit, remove agen
IVIG/steroids
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36
Q

Erthematous skin rash-> blisters->necrolysis, denudation of skin, hmorrhagic crusting, hypotensive/tachy

A

Toxic epidermal myolysis (TEN)
Etio - idopathic, Sulfa, macrolide, erythro, dilantin
tx: D/c offending agent, IVF, IVIG, plasmaphereiss

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37
Q

Pt p.w generalized erythema, exfoliating dermatitis with bullae, pnch bx -

A
  1. If cleavage plane is stratum corneum -> infectious etio

2. If cleavage plane in stratum germinativum - > TEN 2/2 drugs - tx with IVIG

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38
Q

Pt call onset bullous lesions on chest after taking bactrim wtd?

A

See MD right away

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39
Q

Swimmers itch/Cercarial dermatitis

A

Pongds/lakes/oceans

Larvae enter skin and diet - skin eruption with itching

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40
Q

Sea Bather’s eruption

A

Salt water jelly fish larvae get stuck between clothing - drying/showiering fresh water kills
Skin eruption wtih ithcing

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41
Q

Psoriasis

A

Well defined erythematous skin lesion with DISTINCT SILVERY SCALES - puntate bleeding spot after peeling
erythrodermic vs pustualr

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42
Q

Doebneer’s phenomenon

A

abrasion leads to psoriatric lesion in spot

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43
Q

Erythrodermic psoriasis

A 
Erythematous skin with silver scales
Pt unable to regulate temp
dehydration, hypo/hyperthermia, hypoalbum, Anemia chronic disease
Precip by
Sunburn
Vira/bacterial infxn
Anti malarial, gold lithium
BB
Anti NF tx
Systemic steroids
ETOH and malignancy DO NOT exacerbate
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44
Q

Pustular Psoriasis

A

Pustual ponds of pus

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45
Q

Pt with bipolar d/o o lithium p/w psoriatric skin lesino

A

d/c lithium
Ice pick like pittin gof nails
Oncholysis (separation of distal nail from nail bed)

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46
Q

Treatment of psoriasis

A 
Acitretin
Topical Steroids
Syntheic Vit D3 analog
Methotx
Psoralen + UV rays = PUVA
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47
Q

Addison’s dz

A

hyperpigmented in oral mucosa and tan
Low BP, high K
MCC - autoimmune adrenalitis
nice tan bu tpassing out

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48
Q

Subacute Cutanous lupus

A 
Ro/La+ (SSA/SSB)
Speckled ANA +
Anti dsDNA NEG
Anti-sm neg
Ro ag - can cross placenta and cause CONGENITAL heart block in newborn
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49
Q

Discoid Lupus

A

ANA neg
Anti DS-dna neg
Anti Sm neg
Lesional direct mmunofor +

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50
Q

CREST

A 
C alcinosis cutis (Sq nodule)
R aynaud's phenomenon
E sophageal dysmotility
S clerodactyly
T elangiectasia
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51
Q

CREST most likely have which Ab

A

Anti centromere Abs

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52
Q

Erythema Nodosum

A

Red, painful warm nodules in shin

Young female - hilar LAD or inc’ 1,25 OHD3 -> SARCOID

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53
Q

Erythema nodosum - pt in 20’s with adb pain, cramping diarrhea +- hematochesia

A

Inflamm bowel dz (UC/CD)

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54
Q

Erthema nodosum other causes

A 
Inflammatory bowel dz
RA
Leukemia
Painful
Tx: steroids
NO ABx
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55
Q

Pellagra

A

Niacin def
Dermatitis
Diarrhea
Dementia

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56
Q

Vit A def

A

Night blindness

White spots in conjunctiva

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57
Q

Vit C def (Scurvy)

A

Bleeeding gums, perifollicular hemorrhages in pt on BREAD AND TEA DIET

58
Q

B2 def (Riboflavin)

A

Angular chelitis (inflamm of lips)

59
Q

Vit B12 (cyanocobalamin) def

A

Atrophic glossitis (bald tongue) chelitis

60
Q

Gum hypertrophy

A

Dilantin, nifedipine

61
Q

Zinc deficiency

A

Eczemotoid red rash on nasolabial folds, ext surfaces/perineum, scrotum anal alrea
Pt on TPN and dvelops rash and alopeica

62
Q

Erythasma

A

well definesed reddish lesion in axilla, groin, toe webs
G+ corynebacterium
Wood lamp - bright red florescence
Tx: Oral erythromycin

63
Q

Erysipelas

A

Strep/staph

Tx: PCN

64
Q

Disseminated gonnoccal infxn

65
Q

You pt p/w fever, malaise, sore throat -> vesiclar lesions on tongue, buccal musosa -> later painful vessivular lesions on hand and feet -

A

Dx: Hand/foot/mouth dz

Coxsackie virus

66
Q

Ecthyma gangrenoum

A

Neutropenic pt with pseduomonas infxn

67
Q

Fever, h/a, myalgia, macular rash -> petechial rash (stopped blanching)

68
Q

Verrucous wart - Young pt wtih papule on finger for several months gradually inc’d in size - pain occasionally while holding a pen - verrucous 1/2cm papules on sides of finger in the DIP

A 
Verruca vulgaris (common wart)
Tx: Topical Salicyclic acid
69
Q

Condyloma Lata (painless broad plaques)

70
Q

Condyloma Acuminata (pedunculated or sessile)

A

HPV 6,11t?

71
Q

Young woman pw uprotected sexual encougter with person with myultple sex partners and wart on penis - worried she might catch it wtd

A

PAp smear -

if neg - repeat pap 6-12 months

72
Q

Molluscum Contagiosum

A

MC spreads to face
Smooth umbilicated papules
Pox virus
tx: cryotherapy

73
Q

Dew drop appearance, vesicular rash, in crops

A

Chicken pox

74
Q

Herpes Zoster

A

Painful lesions

Tx: for post-herpetic nerualgia - > Desipramine

75
Q

Pt with erythematous, annular scaly rash with central clearing, active advancing torder, scraping with KOH will reveal?

A

Septae branching hypae (Tinea)
Tx: Topical azol (terabine, ketoconazole)
Chronic tinea pedis MC form of tinea pedis
Slowly progressive prurtiic, ertyematous lesions between toes - fissues, ext into sold and side and top of foot

76
Q

Tinea

A 
Head - tinea capitis
Beard - tinea Barbae
Body - Tinea Corporis
Tinea on superficial skin - Tinea Versicolor
Feet - > Tinea Pedis
77
Q

Pt with h/o tinea pedis with maceration beetween toes pw ertyema of foot - etio of cellulitis?

A

Streptococus - cocci in chains

78
Q

38yo M bald patch which started over past several weeks - exam with “black spots (broken hair follicles) microscopic exam reveals broken hair follicles woods lamp bright green florescence - dx?

A

Tinea capitis
tx: Griseofulvin
Tierbinafine
or ketoconazole

79
Q

24yo F pw hair loss - gave birth to baby about 2 months ago wtd?

A

Reassurane - telogen Effluvium

80
Q

Pt pw in summer after tanning - finds untannel areas - exam reveals hypopgmented patches - yeast like ball and sticks (meatball and spagehetti) on microscope dx?

A

Tinea Versicolor (superficial)
Tx: oral ketoconazole
Topical anti-fungal or selenium sulfide

81
Q

55yo F with generalized itching esp at night - exam widespread EXCORIATIONS ring and middle finger spaces - 3yo granddaughter with simlar sx dx?

A

Scabies
Tx: Permethin 5% - neck to toe wash off in AM
PO ivermectin

82
Q

Skin Ca

A

Basal Cell Ca
SCC
Melanoma

83
Q

Cancer with skin findings

A

Peutz-jehers syndrome -> colonoscopy
Sweeet syndrome -> underlying AMG
Glucoagonomas ->

84
Q

Basal Cell Ca

A

Most common cause skin CA
Arises from epidermal basal cells
Etio: UV radiation aw sun exposure - sun expoed areas
Translucent pearly papules with telangiectasiasas (rodent eatten appearnce)
Speads by local extension - low metastatic potential (<0.1%)

85
Q

Squamous Cell CA

A 
keratinizing epidermal cells in exposed areas hands, forearms, ears, lower lip (lower lip highest met potential)
arises from ACTINIC KERATOSIS
fiars skin
higher met pot than basal cell
Lower lip -> 13% mets
86
Q

AA pt with scar few years in R forarm recently enlarging

A

SCC (not keloid)

87
Q

Middle aged lady comes back from vaca from florida, Gulf coast, carribbean pw lesion on back of neck - keratotic area with erythematous base

A

Actinic keratosis
wtd?
BX NOW

88
Q

Dysplastic Nevi

A

Pigmented
Irreguular borders
Dysplastic nevi predisopse to melanoma esp in pts with fhx melanoma

89
Q

45yo M brothe rdx with malignant melanoma - has multiple nevi andhas not seen changes in them wtd?

A

Photograph nevi and follow periodically
Check for nevi in family and f/u
Counsel on avoiding sun exp and use sunscreen
(do not need to remove all nevi now)

90
Q

Lentigo maligna melanoma

Melanoma

A 
Risk factors
Multiple sun burn in chilhood
dysplastic nevus >6mm diameter
FHx melanoma
>25 nevi
Fiar blond hair
Immune suppression
91
Q

Most important prognostic factor for melnoma

A

Depth of tumor

<50% alive at 5 years

92
Q

70yo P pw routine checkup - lesion on cheek bigger adn pigmented gradually over 10 years no itching, no other complaints wtd?

A 
Bx lesion r/o lentigo maligna melanoma
Lentigo Maligna seen after age 60 in chronic sun exposed areas
PRECURSOR TO MELANOMA
tx wit hexcision bx
Laser/liquid nitrogen INAPPROPRIATE
93
Q

40yo dx with melanoma - greatest risk factor is

A

Multiple sunburns during childhood

94
Q

24yo routine checkup >25 moles no change in color or character wtd?

A 
avoid sun exposure
picture documentation and f/u
tanning saloons DO NOT DEC risk
self exams for:
A symetry
B order irregularity
C olor variation
D iameter >6mm
95
Q

High SPF lotion prects against

A

Solar keratosises and SCC (not melanoma or basal cell)

96
Q

Avoid sun decreases ris of

A

Melanoma
SCC
BCC

97
Q

55yo melanoma on leg LN+, further node dissection done - what will improve survival

A

Alpha interferon

98
Q

60yo Pt with h/o renal tx on tacrolimus - what is most common CA in pt on immunosuppression?

A

Skin cancer

99
Q

Pt on tacrolimus develops SCC - excised an tx’ed - wtd next?

A

Change tacrolimus to sirolimus

100
Q

Pt on sirolmus develops SOB/pulm infiltrates - BAL lymphocytes and macros - wtd?

A

d/c sirolimus

101
Q

Cutaneous T cell lymphoma

A

Mycosis fungoides

Sezary syndrome

102
Q

Mycosis fungoides

A

cut T cell lympohoma
itchy - discrete colaseing patches, plaques, nodules
LN and other organs affected

103
Q

Sezary Syndrome

A 
Late stage mycosis fungoides
skin rash
pruritis
sezary cells (lymhpocytes with hyperchromic and convoluted nuclei)
tx: topical nitrogen mustalrd
Psoralen PUVA
104
Q

Padgets dz of nipple

A

MC cause of eczematous lesion of nipple is CONTACT dermatitis
If doesn’t respond to adequate tx consider PADGETs dz
aw dutal CA of breast
Tx: Wide excision

105
Q

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

A

Autosomal domiant vasc d/o with red to violet telangiectasia on lips, tongue, extremities
Can bleed - epistaxis or GIB -> IDA

106
Q

Peutz Jegher’s syndrome

A

Pigmented lesions on lips/mouth
aw multiple hemartomatous polyps in GI tract - inc’d malignancy
Beefy red tongue aw glucoagonoma - also aw skin rash, central clearing (necrolytic migratory erythema
Occurs in perineum and prioral areas with chelitis
Hyperglycemia, islet tumor, wt loss
Needs colonoscopy

107
Q

Sweets syndrome

A

Pain/painless
necutrophilic infiltrate
need BM bx r/o AML

108
Q

Blistering skin lesions - Pemphigus Vulgaris

A

Multiple oral ulcers
large LOOSE bulae some with denuded skin
Intraepidermal bulle ab vs Desmoglein 1/3 proteins
Pressure applied to one end cause ext at hoter end
Nikolsky sign - ruptures easily

109
Q

60yo M 10 day ho severe oral sores and reash on trunk/upper arms, on exam mulple oral erosion on buccal mucosa and tongue - numberou edematous papules and bullae presssure applied to edge of blister causes extension dx?

A

Pemphigus vulgaris

110
Q

Bullosu Pempohigoid

A

TENSE blisters
>60yo
Pressure on one end DOES NOT extend other end
Do NOT rupture easily
Ab vs Bullous pemphigoid angtigen 1/2 - dermal/epidermal jnct
IgG+, C3/eos deposition at jnc
Tx: Oral tetracyclin/steroids

111
Q

Pt pw comoplints of lesions on legs, which hasn’t gotten better in couple months - pt received blood tx in 1990 dx with Hep C - exam palpable purpura in extrem - B/Cr 60/7.2
CH50 and C4 dec - dx?

A

Mixed cryoglobulinemia

112
Q

Dermatitis Herpetiformis (aw Celiac sprue, Hep C)

A

Grouped bullous/vesicular lesions in pt with fatigue, aneia and fatty, foul smelling stools
Very prurtic
Endosocpy neg for bleed, atrophic villi, small bx shows MONONUCLEAR INFITRATE in LAMINA PROPRIA (CELIAC SPRUE)
tx: Dapsone
aw Hep C

113
Q

Granuloma annulare

A

Ring worm like lesion w/o scaling in extrem in young women/children
SELF LIMITING in months/years

114
Q

Pityriasis Rosea

A

HERALD patch - followed by more lesions 1-2 wks later
Pruritic small papulosquamous oval lesions in young adults/children
Christmas tree patten, summer months
Tx: symptomatic, self limited

115
Q

Vitiligo

A 
Macular depigmentation aw other autoimmun dz's (ab vs melanocytes)
Addison's dz/adrenal insuff
Graves
DM
Thyroid dysfxn
Pernicious anemia
116
Q

Cafe au lait spots

A

Brown macular lesions that occur in neurofibromatosis (von Reckling hausen dz)
If pt has HTN -> r/o PHEO

117
Q

Acanthosis nigricans

A

Hyperpigmented skin witih THICKENED, VELVETY appearance
Axillae, backa dn sides of neck, inguinal creases, inframmamory
Obese pts
aw GASTRIC ADENOCA
PCO
Insulin resistance

118
Q

Kaposi’s sarcoma

A

HHV8

tx: ART-> doxorubicin/daurorubicin

119
Q

Eruptive xanthomas

A

Hyperlipidemias 1,4,5

120
Q

Exposure to HIV ppx

A

Ralteglavir + 2NRTI

121
Q

Necrobiosis lipioidica diabeticorum

A

Diabetic foot ulcers, if infected then…
Aggressive debridement, broad spectrum abx
if NOT infected - total contact cast to keep pressure off ulcer

122
Q

Chronic venous ulcers

A

Zn impregnated dressing (una boot)

123
Q

Chnronic venous ulcers WITH PAIN

A

Occulsive dressing

124
Q

Best way to monitor for prevention of Diabetic foot ulcers

A

Monofilament testing

125
Q

Utricaria

A 
Acute
Drugs - abx, antipyrietcs
Infxn - viral, bacterial, parasitic, foods
Chronic
Physical factors - heat, cold touch press
Infxn:
SLE
Serum sickness
Pregnancy
126
Q

Pt with raised erythematous area with itching for past on/off pt takes loratadine when she stops it it gets worse

A

Start Raniditidine

127
Q

Pt with recurrent itching wheezing SOB, dizziness wit hypotensive crisis - abd pain and diarrhea, exam may or may not reveal hepatslpenomegaly dx?

A

Systemic mastocytosis

screening test - serum tryptase

128
Q

Atheroembolism s/p cath - painful don’t blanch

A

dx: fundus shows small crystals
Skin bx
no serum complement
Tx: supportive care, control BP

129
Q

Melasma

A

Mask like hyperpigmentation
Etio - pregnancy, OCP
tx: sunscreen
bleaching agent (hydroquinoone cream)

130
Q

Exopthalmos

A

with hyperthyroidism

Tx: steroids, surgery

131
Q

Pseduohypoparathyroidism

A

low Ca, high Phos normal PTH -> endo organ resistance
Pt with short stature, short neck
Short metacarpalals and phalangeals, SOFT TISSUE Ca+

132
Q

Nail d/o

A

Leukonychia
Paronychia
Koilonychia

133
Q

Leukonychia

A

white spots in nail
hypoalbuminemia
Renal failure

134
Q

Posriasis

A

placing hands in water for long periods
Pain redness swelling of nail folds
Dx: paronychchia
Dx: staph, candida

135
Q

Koilnychia

A

IDA inc’d TF sat

136
Q

Fish handlers

A

non-TB mycobacterium

137
Q

Onchyomycosis

A

Fungal, candida
scrape KOH prep
Tx: terbinafin or griseofulvin

138
Q

Splinter hemorrhage

A

Endocarditis - c/w IV abx

Trichinellosis -> bear meat

139
Q

Oncholysis

A 
Lifting off of the nail
Idiopathic
Trauma
Psoriasis
Hyperthyroid
140
Q

Which of the following is manifestation of hyperthyroid

A

Oncholysis

141
Q

Clubbing

A

Familial
Hypertropic osteoarthropahy
Lung - CA, empyema idiopathic lung fibrosis (circulating immune complex)
Heart - congential HDz, bacterial endocarditis
GI cirrhosis, IBD
Cancer
Pregnancy

2018 ABIM Awesome Review (14 decks)

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