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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
Koplik spots
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
26
Hairy Leukoplakia
Ribbed whiteness on lateral tongue, will not come off HIV pts cause by EBV No tx needed... haart
27
Oral thrush
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
28
Macroglossia
``` associated with: Amyloidosis MM Acromegaly Down's syndrome ```
29
Strawberry tongue
associated with: Scarlet fever kawasaki syndrome
30
Exanthematous/morbilliform (blanching rash)
Sulfonamides, B lactam; PCN
31
Utricaria/angioedema
ASA, PCN, blood products, ACEi
32
Fixed drug reactions
Rash occuring at the same spot after rechallenge
33
Erythema multifomre
Recurrent HSV, mycoplasma, PCN, sulfa, phenytoin
34
Erythema Multiforme
Tetracyclins
35
Erythema multiforme
``` 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 ```
36
Erthematous skin rash-> blisters->necrolysis, denudation of skin, hmorrhagic crusting, hypotensive/tachy
Toxic epidermal myolysis (TEN) Etio - idopathic, Sulfa, macrolide, erythro, dilantin tx: D/c offending agent, IVF, IVIG, plasmaphereiss
37
Pt p.w generalized erythema, exfoliating dermatitis with bullae, pnch bx -
1. If cleavage plane is stratum corneum -> infectious etio | 2. If cleavage plane in stratum germinativum - > TEN 2/2 drugs - tx with IVIG
38
Pt call onset bullous lesions on chest after taking bactrim wtd?
See MD right away
39
Swimmers itch/Cercarial dermatitis
Pongds/lakes/oceans | Larvae enter skin and diet - skin eruption with itching
40
Sea Bather's eruption
Salt water jelly fish larvae get stuck between clothing - drying/showiering fresh water kills Skin eruption wtih ithcing
41
Psoriasis
Well defined erythematous skin lesion with DISTINCT SILVERY SCALES - puntate bleeding spot after peeling erythrodermic vs pustualr
42
Doebneer's phenomenon
abrasion leads to psoriatric lesion in spot
43
Erythrodermic psoriasis
``` 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 ```
44
Pustular Psoriasis
Pustual ponds of pus
45
Pt with bipolar d/o o lithium p/w psoriatric skin lesino
d/c lithium Ice pick like pittin gof nails Oncholysis (separation of distal nail from nail bed)
46
Treatment of psoriasis
``` Acitretin Topical Steroids Syntheic Vit D3 analog Methotx Psoralen + UV rays = PUVA ```
47
Addison's dz
hyperpigmented in oral mucosa and tan Low BP, high K MCC - autoimmune adrenalitis nice tan bu tpassing out
48
Subacute Cutanous lupus
``` Ro/La+ (SSA/SSB) Speckled ANA + Anti dsDNA NEG Anti-sm neg Ro ag - can cross placenta and cause CONGENITAL heart block in newborn ```
49
Discoid Lupus
ANA neg Anti DS-dna neg Anti Sm neg Lesional direct mmunofor +
50
CREST
``` C alcinosis cutis (Sq nodule) R aynaud's phenomenon E sophageal dysmotility S clerodactyly T elangiectasia ```
51
CREST most likely have which Ab
Anti centromere Abs
52
Erythema Nodosum
Red, painful warm nodules in shin | Young female - hilar LAD or inc' 1,25 OHD3 -> SARCOID
53
Erythema nodosum - pt in 20's with adb pain, cramping diarrhea +- hematochesia
Inflamm bowel dz (UC/CD)
54
Erthema nodosum other causes
``` Inflammatory bowel dz RA Leukemia Painful Tx: steroids NO ABx ```
55
Pellagra
Niacin def Dermatitis Diarrhea Dementia
56
Vit A def
Night blindness | White spots in conjunctiva
57
Vit C def (Scurvy)
Bleeeding gums, perifollicular hemorrhages in pt on BREAD AND TEA DIET
58
B2 def (Riboflavin)
Angular chelitis (inflamm of lips)
59
Vit B12 (cyanocobalamin) def
Atrophic glossitis (bald tongue) chelitis
60
Gum hypertrophy
Dilantin, nifedipine
61
Zinc deficiency
Eczemotoid red rash on nasolabial folds, ext surfaces/perineum, scrotum anal alrea Pt on TPN and dvelops rash and alopeica
62
Erythasma
well definesed reddish lesion in axilla, groin, toe webs G+ corynebacterium Wood lamp - bright red florescence Tx: Oral erythromycin
63
Erysipelas
Strep/staph | Tx: PCN
64
Disseminated gonnoccal infxn
ctx neg
65
You pt p/w fever, malaise, sore throat -> vesiclar lesions on tongue, buccal musosa -> later painful vessivular lesions on hand and feet -
Dx: Hand/foot/mouth dz | Coxsackie virus
66
Ecthyma gangrenoum
Neutropenic pt with pseduomonas infxn
67
Fever, h/a, myalgia, macular rash -> petechial rash (stopped blanching)
RMSF
68
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
``` Verruca vulgaris (common wart) Tx: Topical Salicyclic acid ```
69
Condyloma Lata (painless broad plaques)
Syphllis
70
Condyloma Acuminata (pedunculated or sessile)
HPV 6,11t?
71
Young woman pw uprotected sexual encougter with person with myultple sex partners and wart on penis - worried she might catch it wtd
PAp smear - | if neg - repeat pap 6-12 months
72
Molluscum Contagiosum
MC spreads to face Smooth umbilicated papules Pox virus tx: cryotherapy
73
Dew drop appearance, vesicular rash, in crops
Chicken pox
74
Herpes Zoster
Painful lesions | Tx: for post-herpetic nerualgia - > Desipramine
75
Pt with erythematous, annular scaly rash with central clearing, active advancing torder, scraping with KOH will reveal?
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
Tinea
``` Head - tinea capitis Beard - tinea Barbae Body - Tinea Corporis Tinea on superficial skin - Tinea Versicolor Feet - > Tinea Pedis ```
77
Pt with h/o tinea pedis with maceration beetween toes pw ertyema of foot - etio of cellulitis?
Streptococus - cocci in chains
78
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?
Tinea capitis tx: Griseofulvin Tierbinafine or ketoconazole
79
24yo F pw hair loss - gave birth to baby about 2 months ago wtd?
Reassurane - telogen Effluvium
80
Pt pw in summer after tanning - finds untannel areas - exam reveals hypopgmented patches - yeast like ball and sticks (meatball and spagehetti) on microscope dx?
Tinea Versicolor (superficial) Tx: oral ketoconazole Topical anti-fungal or selenium sulfide
81
55yo F with generalized itching esp at night - exam widespread EXCORIATIONS ring and middle finger spaces - 3yo granddaughter with simlar sx dx?
Scabies Tx: Permethin 5% - neck to toe wash off in AM PO ivermectin
82
Skin Ca
Basal Cell Ca SCC Melanoma
83
Cancer with skin findings
Peutz-jehers syndrome -> colonoscopy Sweeet syndrome -> underlying AMG Glucoagonomas ->
84
Basal Cell Ca
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
Squamous Cell CA
``` 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
AA pt with scar few years in R forarm recently enlarging
SCC (not keloid)
87
Middle aged lady comes back from vaca from florida, Gulf coast, carribbean pw lesion on back of neck - keratotic area with erythematous base
Actinic keratosis wtd? BX NOW
88
Dysplastic Nevi
Pigmented Irreguular borders Dysplastic nevi predisopse to melanoma esp in pts with fhx melanoma
89
45yo M brothe rdx with malignant melanoma - has multiple nevi andhas not seen changes in them wtd?
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
Lentigo maligna melanoma | Melanoma
``` Risk factors Multiple sun burn in chilhood dysplastic nevus >6mm diameter FHx melanoma >25 nevi Fiar blond hair Immune suppression ```
91
Most important prognostic factor for melnoma
Depth of tumor | <50% alive at 5 years
92
70yo P pw routine checkup - lesion on cheek bigger adn pigmented gradually over 10 years no itching, no other complaints wtd?
``` 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
40yo dx with melanoma - greatest risk factor is
Multiple sunburns during childhood
94
24yo routine checkup >25 moles no change in color or character wtd?
``` 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
High SPF lotion prects against
Solar keratosises and SCC (not melanoma or basal cell)
96
Avoid sun decreases ris of
Melanoma SCC BCC
97
55yo melanoma on leg LN+, further node dissection done - what will improve survival
Alpha interferon
98
60yo Pt with h/o renal tx on tacrolimus - what is most common CA in pt on immunosuppression?
Skin cancer
99
Pt on tacrolimus develops SCC - excised an tx'ed - wtd next?
Change tacrolimus to sirolimus
100
Pt on sirolmus develops SOB/pulm infiltrates - BAL lymphocytes and macros - wtd?
d/c sirolimus
101
Cutaneous T cell lymphoma
Mycosis fungoides | Sezary syndrome
102
Mycosis fungoides
cut T cell lympohoma itchy - discrete colaseing patches, plaques, nodules LN and other organs affected
103
Sezary Syndrome
``` Late stage mycosis fungoides skin rash pruritis sezary cells (lymhpocytes with hyperchromic and convoluted nuclei) tx: topical nitrogen mustalrd Psoralen PUVA ```
104
Padgets dz of nipple
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
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
Autosomal domiant vasc d/o with red to violet telangiectasia on lips, tongue, extremities Can bleed - epistaxis or GIB -> IDA
106
Peutz Jegher's syndrome
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
Sweets syndrome
Pain/painless necutrophilic infiltrate need BM bx r/o AML
108
Blistering skin lesions - Pemphigus Vulgaris
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
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?
Pemphigus vulgaris
110
Bullosu Pempohigoid
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
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?
Mixed cryoglobulinemia
112
Dermatitis Herpetiformis (aw Celiac sprue, Hep C)
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
Granuloma annulare
Ring worm like lesion w/o scaling in extrem in young women/children SELF LIMITING in months/years
114
Pityriasis Rosea
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
Vitiligo
``` Macular depigmentation aw other autoimmun dz's (ab vs melanocytes) Addison's dz/adrenal insuff Graves DM Thyroid dysfxn Pernicious anemia ```
116
Cafe au lait spots
Brown macular lesions that occur in neurofibromatosis (von Reckling hausen dz) If pt has HTN -> r/o PHEO
117
Acanthosis nigricans
Hyperpigmented skin witih THICKENED, VELVETY appearance Axillae, backa dn sides of neck, inguinal creases, inframmamory Obese pts aw GASTRIC ADENOCA PCO Insulin resistance
118
Kaposi's sarcoma
HHV8 | tx: ART-> doxorubicin/daurorubicin
119
Eruptive xanthomas
Hyperlipidemias 1,4,5
120
Exposure to HIV ppx
Ralteglavir + 2NRTI
121
Necrobiosis lipioidica diabeticorum
Diabetic foot ulcers, if infected then... Aggressive debridement, broad spectrum abx if NOT infected - total contact cast to keep pressure off ulcer
122
Chronic venous ulcers
Zn impregnated dressing (una boot)
123
Chnronic venous ulcers WITH PAIN
Occulsive dressing
124
Best way to monitor for prevention of Diabetic foot ulcers
Monofilament testing
125
Utricaria
``` Acute Drugs - abx, antipyrietcs Infxn - viral, bacterial, parasitic, foods Chronic Physical factors - heat, cold touch press Infxn: SLE Serum sickness Pregnancy ```
126
Pt with raised erythematous area with itching for past on/off pt takes loratadine when she stops it it gets worse
Start Raniditidine
127
Pt with recurrent itching wheezing SOB, dizziness wit hypotensive crisis - abd pain and diarrhea, exam may or may not reveal hepatslpenomegaly dx?
Systemic mastocytosis | screening test - serum tryptase
128
Atheroembolism s/p cath - painful don't blanch
dx: fundus shows small crystals Skin bx no serum complement Tx: supportive care, control BP
129
Melasma
Mask like hyperpigmentation Etio - pregnancy, OCP tx: sunscreen bleaching agent (hydroquinoone cream)
130
Exopthalmos
with hyperthyroidism | Tx: steroids, surgery
131
Pseduohypoparathyroidism
low Ca, high Phos normal PTH -> endo organ resistance Pt with short stature, short neck Short metacarpalals and phalangeals, SOFT TISSUE Ca+
132
Nail d/o
Leukonychia Paronychia Koilonychia
133
Leukonychia
white spots in nail hypoalbuminemia Renal failure
134
Posriasis
placing hands in water for long periods Pain redness swelling of nail folds Dx: paronychchia Dx: staph, candida
135
Koilnychia
IDA inc'd TF sat
136
Fish handlers
non-TB mycobacterium
137
Onchyomycosis
Fungal, candida scrape KOH prep Tx: terbinafin or griseofulvin
138
Splinter hemorrhage
Endocarditis - c/w IV abx | Trichinellosis -> bear meat
139
Oncholysis
``` Lifting off of the nail Idiopathic Trauma Psoriasis Hyperthyroid ```
140
Which of the following is manifestation of hyperthyroid
Oncholysis
141
Clubbing
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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