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Step 2 CK > Dermatology > Flashcards

Dermatology Flashcards

1
Q

ABCDE of Melanoma

A

A: asymmetry

B: border irregularity

C: color irregularity

D: diameter > 6mm

E: evolution

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2
Q

Treatment for melanoma

A

Surgical removal with significant removal of normal skin

Interferon injection is helpful in widespread disease

Melanoma has a strong tendency to metastasize to the brain and can also show up in unusual places

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3
Q

What type of cancer is greatly increased by organ transplant (i.e., long-term use of immunosuppressive drugs)

A

SCC

Look for vignette describing an ulcer that does not heal or continues to grow

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4
Q

The most common form of skin cancer

A

BCC

Waxy lesion that is shiny like a pearl

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5
Q

Treatment for BCC

A

Unlike melanoma, wide margins are not necessary and recurrence is < 5%

Mohs Micrographic Surgery: uses a dissecting microscope with immediate frozen section (loss of only the smallest amount of normal tisse)

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6
Q

What is the most common cause of Kaposi Sarcoma

A

AIDS

KS if from HHV-8, which is oncogenic

The lesion is reddish/purplish because it is more vascular than other forms of skin cancer

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7
Q

Apart from the skin, where else is Kaposi Sarcoma found?

A

GI tract and lungs

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8
Q

Does the way you acquire AIDS change the risk of acquiring Kaposi Sarcoma?

A

Yes

AIDS acquired through sexual contact is associated with KS; AIDS from injection drug use is rarely associated with it

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9
Q

Treatment for Kaposi Sarcoma

A

Antiretrovirals (majority of KS will disappear)

Intralesional injections of vincristine and interferon

Chemo and liposomal doxorubicin as a last resort

KS is NOT routinely treated with surgical removal

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10
Q

Pre-malignant skin lesions from high-intensity sun exposure

A

Actinic Keratoses

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11
Q

Treatment for Actinic Keratoses

A

A very small risk of SCC for each individual lesion

Removed by curettage, cryotherapy, laser, or topical 5-FU

Imiquimod is also effective

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12
Q

Do seborrheic keratoses have malignant potential?

A

No

They are removed for cosmetic reasons

The term seborrheic is synonymous with benign

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13
Q

Greasy-looking, yellowish scales on an erythematous base

Associated with Parkinson disease and HIV

A

Seborrheic dermatitis

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14
Q

What is atopic dermatitis caused by?

A

AKA Eczema

Associated with overactivity of mast cells and the immune system

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15
Q

Presentation of Eczema

A

Pruritis and scratching (separates eczema for psoriasis)

Lichenified skin

Superficial skin infections from staph

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16
Q

Treatment for atopic dermatitis

A

Stay moisturized, avoid bathing/soap/washcloths, cotton is better than wool

Topical corticosteroids for flares

Tacrolimus and pimecrolimus (T cell-inhibiting agents) provide longer-term control and help get patients off steroids

Antihistamines (doxepine)

Abx for impetigo

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17
Q

Silvery, scaly plaques

A

Psoriasis

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18
Q

Treatment for psoriasis

A

Topical high-potency steroids

Vitamin A and D (steroids cause skin atrophy)

Coal tar

Pimecrolimus and Tacrolimus

UV light, TNF inhibitors, and Methotrexate for extensive disease

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19
Q

What must be done before starting a patient on TNF inhibitors

A

Screen with a PPD because they can reactivate TB

20
Q

Transient dermatitis that starts out with a single lesion (herald patch) and then disseminates

A

Pityriasis Rosea

It can look like secondary syphilis but it spares the palms and soles

21
Q

Hypersensitivity reaction to a dermal infection with noninvasive dermatophyte organisms

A

Seborrheic Dermatitis (aka Dandruff)

Increased in AIDS and Parkinson disease

The term seborrheic is synonymous with benign

22
Q

Two causes of pemphigus vulgaris

A

idiopathic autoimmune

and

drug-induced form

23
Q

What drugs can lead to pemphigus vulgaris

A

ACE inhibitors

Penicillamine

Phenobarbital

Penicillin

24
Q

What happens during Pemphigus Vulgaris

A

Autoantibodies split the epidermis, resulting in:

Bullae that easily rupture

Involvement of the mouth

Fluid loss and infection

The most characteristic finding is the Nikolsy sign

25
Q

The most accurate test for pemphigus vulgaris

A

Biopsy

26
Q

Treatment for pemphigus vulgaris

A

Without treatment, pemphigus is a fatal disease

  1. Systemic steroids (prednisone)
  2. Azathioprine or mycophenolate to wean off steroids
  3. Rituximab (anti-CD20 antibodies) or IVIG in refractory cases
27
Q

How is bullous pemphigoid different from pemphigus vulgaris?

A

Much milder disease: bullae stay intact (less loss of fluid and infection) and mouth involvement is uncommon

Nikolsky sign is absent

28
Q

Treatment for Bullous Pemphigoid

A

Biopsy with immunofluorescent stains is the most accurate test before treatment

Initial therapy = prednisone (azathioprine, cyclophosphamide, or mycophenolate to wean off)

Mild cases respond to erythromycin, dapsone, and nicotinamide

29
Q

Blistering skin disease of sun-exposed areas

A

Porphyria Cutanea Tarda: a hypersensitivity of the skin to abnormal porphyrins when they are exposed to light

Look for a history of liver disease (Hep C, alcoholism), estrogen use, or iron overload

30
Q

Test and Treatment of Porphyria Cutanea Tarda

A

Most accurate test = increased uroporphyrins in a 24-hour urine collection (PCT is d/t a uroporphyrin decarboxylase deficiency)

Correct the underlying cause (stop alcohol, stop estrogens) and remove iron with phlebotomy

31
Q

What is impetigo caused by?

A

Staph and Strep

Invade the epidermis

32
Q

Treatment of Impetigo

A

Mild = mupirocin, retapamulin, bacitracin

Severe = dicloxacillin or cephalexin

Community-acquired MRSA: doxycycline, clindamycin, and TMP-SMX

33
Q

What is erysipelas

A

Much more severe disease than impetigo because it occurs at a deeper level

Much more often from Strep (GAS) than Staph (untreated disease can be fatal)

Presentation = look for a bright, red, hot swollen lesion of the face

Will often involve the external ear (this skin lacks a lower dermis and indicates a superficial infection, aka not cellulitis)

34
Q

Treatment for Erysipelas

A

Mild = oral medications

Dicloxacillin, cephalexin, cefadroxyl

Penicillin allergic: erythromycin, clarithromycin, or clinda

MRSA: doxycycline, clindamycin, TMP-SMX

Severe = IV medications

Oxacillin, nafcillin, cefazolin

Penicillin allergic: clindamycin, vancomycin

MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline

35
Q

Folliculitis vs Furuncles vs Carbuncles

A

Folliculitis is the earliest and mildest

Furuncles is a small abscess

Carbuncle is a collection of furuncles

36
Q

Only cephalosporin covering MRSA

A

Ceftaroline

37
Q

Best initial test for fungal infections

A

KOH preparation (dissolves epidermal skin cells and leaves the fungi intact)

Most accurate = fungal culture

38
Q

Treatment for fungal infections

A

Topical antifungal agent if no hair or nails are involved (clotrimazole, ketoconazole, econazole, miconazole)

The best initial therapy for hair (tinea capitis) and nail (tinea unguium) infections is terbinafine

39
Q

Options for treating tinea capitis and unguium?

A

Terbinafine

Intraconazole is close in efficacy

Griseofulvin has less efficacy

40
Q

Penicillins

Sulfa drugs

Allopurinol

Phenytoin

Lamotrigine

NSAIDs

A

Drugs that commonly cause hypersensitivity reactions

41
Q

Morbilliform rash

Erythema Multiforme

SJS

TEN

A

Morbilliform = mildest reaction (no specific therapy)

EM = widespread, small “target” lesions (prednisone may benefit some patients)

SJS: very severe, sloughs off respiratory epithelium and may lead to respiratory failure (steroids not clearly beneficial, use IVIG)

TEN: Nikolsky sign (steroids definitely DO not help, use IVIG)

42
Q

Treatment of mild acne

A

Use topical antibacterials: benzoyl peroxide

Add topical antibiotics if ineffective: clindamycin or erythromycin

43
Q

Treatment of moderate acne

A

Add topical vitamin A derivates: tretinoin, adapalene, or tazarotene

Add oral antibiotics if no response: minocycline or doxycycline

44
Q

Treatment of severe acne

A

Add oral vitamin A (isotretinoin)

45
Q

What must be done before starting a female on vitamin A derivates for acne

A

Pregnancy test (extremely teratogenic)

Patients can only be treated if they are willing to use two forms of birth control (hormonal and barrier)

46
Q

SSSS vs TSS

A

Different severities of the same event: a reaction to a toxin in the surface of Staph

Step 2 CK (18 decks)

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