Dermatology

Question 1

What are keloids? Next best step in mgmt?

Answer 1

Keloid: excessive collagen deposition at wound sites that tend to grow outside the boundary of the original wound and have “crab-like” projections from original wound site.

- Tend to recur following excision
- Painful

Tx: intra-lesional corticosteroids after liquid N2 cryotherapy

Question 2

What is the mechanism behind photoxicity from medications? What meds are responsible?

Answer 2

Non-immune reaction where ROS are formed after UV light interacts with the medications –> only occurs on sun-exposed areas

*Doxycycline, thiazides, sulfonamides, fluoroquinolones, NSAIDs

Question 3

Multiple small, light-brown, pedunculated lesions on a person’s neck. What are they?

Answer 3

Acrochordon (“skin tags”)

Question 4

Small keratotic papules on the palms and soles of a retired miner. He has had no sun exposure in these areas. The biopsy shows invasive SCC arising from SCC in situ. Chronic exposure to what compound is most likely responsible?

Answer 4

Arsenic

*Aside from sunlight, arsenic is MCC

Wart-like keratosis on palms & soles, particularly over eminences.

Question 5

What is cutaneous larva migrans?

What does rash look like?

Tx?

Answer 5

Hookworm infection that lives in tropical areas and found in soil or sand.

Pruritic, red papules –> serpinginous red/brown lesion from larva migration in skin

Tx: thiabendazole

Question 6

Preferred method of assessing suspected melanoma?

What are ABCDEs?

Answer 6

Excisional biopsy –> if (+) then do wide surgical excision

Asymmetry
Border irregularity
Color differences
Diameter >6mm
Evolution over time

Question 7

Most important factor for resection of melanoma?

Answer 7

DEPTH of tumor

Question 8

Describe a chalazion?

Answer 8

Painful swelling that progresses to a nodular rubbery lesion –> a granulomatous condition that develops when meibomian gland becomes obstructed.

If persistent despite treatments –> may be sebaceous carcinoma or basal cell carcinoma

Question 9

Person with sun-exposure and non-healing ulcer on the bottom lip?
What is on histology?

Answer 9

Squamous cell carcinoma

Invasive cords of squamous cells w/ keratin pearls

Question 10

What does pyoderma gangrenosum look like?

What is associated with it?

Answer 10

Inflammatory pustule/vesicle that rapidly progresses into an ulcer w/ purulent base and ragged violaceous borders

• *Associated with:
  1) Inflammatory bowel disease (Crohn, UC)
  2) Arthropathies (RA)
  3) Hematologic conditions (AML)

Question 11

In a lesion suspicious of melanoma, what is best initial treatment method?

Answer 11

Excisional biopsy –> narrow margins first

Question 12

Pruritic erythematous plaques with fine, loose, yellow, and greasy-looking scales starting on the face. What is it?

What 2 systemic diseases is this associated with?

Answer 12

Seborrheic dermatitis

Parkinsonism, HIV

Question 13

Rash with rosy hue and telangectasias interspersed throughout the rash usually on nose, cheeks, and chin?

What else can precipitate this?

Answer 13

Rosacea

Hot drinks, heat, emotion, rapid body temp changes

Question 14

What are the 3 types of acne vulgaris and treatments for each?

Answer 14

Mild (non-inflam) comedonal acne –> topical retinoids

Mod-sev inflammatory acne –> above + topical Abx

Unresponsive acne –> oral isotretinoin

Question 15

Newborn develops blanching, non-painful, erythematous papillose and pustules throughout body except for palms and soles. What is it? Tx?

Answer 15

Erythema toxic neonatorum (ETN)

*Blanching, red papules/pustules after birth

Resolves spontaneously

Question 16

Waxy, greasy, “stuck-on” and well-circumscribed - what is it?

Answer 16

Seborrheic keratosis

Question 17

Pearly, rolled border with overlying telangiectasia - what is it?

Answer 17

Basal cell carcinoma

Question 18

Ring-shaped, scaly patches with central clearing and distinct borders on the trunk that are very itchy?

Answer 18

Tinea corporus (ringworm)

Question 19

What type of surgery is employed for removal of BCC on the face?

Answer 19

Mohs surgery

Question 20

Child with papular, scaly rash affecting head, face, and neck?

Answer 20

Sehorrheic dermatitis

Question 21

Small, red, cutaneous papules most common in aging adults?

Answer 21

Cherry hemangiomas

Question 22

Bright red lesions that grow rapidly during first weeks of life and resolve by age 5-8?

Answer 22

Strawberry hemangiomas

Question 23

Intensely pruritic rash on wrist, sides of fingers and finger webs. Small, crusted, red papules are seen. What do you suspect?

Tx?

Answer 23

Scabies

Topical permethrin

Question 24

Tingling and burning of the hand with a vesicular rash?

Answer 24

Herpetic whitlow

Question 25

What things tip you off to contact dermatitis?

Answer 25

History of atopy (allergies) Occupation needing to wear GLOVES (latex) Just on hands (pruritus, erythema, swelling, vesicles)

Question 26

Man has 2 days of pain, itching, and rash over L side of his neck. He initially had red papules that developed into vesicles and bullae. He is also on infliximab for RA therapy. What does he have? Tx?

Answer 26

``` Herpes zoster (shingles) *Dermatomal distribution w/ pain sometimes prior to rash ``` *Immunocompromised status predisposes to shingles Tx: acyclovir, fam-, valacy-

Question 27

Non-healing, painless bleeding skin ulcer that develops associated with chronic scar - what do you think?

Answer 27

Squamous cell carcinoma | Marjolin's ulcer

Question 28

Description of actinic keratosis?

Answer 28

Red papules with central scaling (from hyperkeratosis) *Sandpaper-like texture Sun-exposed areas --> face, ears, scalp, dorsum of hands/arms

Question 29

Hypopgimented areas that do not tan or hyper pigmented areas with salmon-colored changes. They scale on skin scraping?

Answer 29

Tinea versicolor

Question 30

Child with history of atopic dermatitis had eczema 1 week ago and was treated with topical steroids. Now he has numerous umbilicated vesicles over erythematous skin of both cheeks. What is most likely cause?

Answer 30

Eczema herpeticum **HSV associated with atopic dermatitis --> vesicles over area of dermatitis