Dermatology

Question 1

Male Pattern Baldness

tx?

Answer 1

post-pubertal androgens(5DHT) causes baldness in circular pattern at the crown.

tx: Topical Minoxidil or PO Finasteride(5a reductase inhib)

Question 2

Alopecia Areata

tx?

Answer 2

Ai disorder against hair = well defined bald spot anywhere! assoc w/ “exclamation point sign” = hair folicle is thick at end but narrow at base w/loss of pigment

tx: steroids

Question 3

Tinea Capitis

sx? dx? tx?

Answer 3

fungal infection causing circular balness w/all hairs at equal lengths

dx: KOH prep only! will now show up on wood lamp
tx: ORAL Griseofulvin

Question 4

Traction Alopecia

Answer 4

permanent scarring due to hair being pulled tight = xtream braiding. stop or will be permanent.

Question 5

Dacryocystitis

Answer 5

infection of the lacriminal sac under hte eye in the inner aspect. presents with pain, redness + swelling and when pushed may produce pus. tx w/abx

Question 6

in Antiphospholipid syndrome why do you have a prolonged PTT but still cause thrombosis?

Answer 6

PTT is prolonged bc it is part of the intrinsic pathway and the AP’s get in the way of the tests measurements. Its not actually prolonged it just appears that way bc of how the test is performed. this is why you actually get thrombosis but a long PTT but normal PT(measured idfferently.)

Question 7

what is thrombocytosis?

Answer 7

high platelet count

Question 8

ab to desmoglein

Answer 8

pemphigus vulgaris

Question 9

+nikolsky sign

Answer 9

pemphigus vulgaris

Question 10

tx of pemphigus vulgaris? age group seen in?

Answer 10

steroids! seen in 30-50 yo

Question 11

ab to hemidesmosomes?

Answer 11

bullous pemphigoid

Question 12

vesicles/bullea in oral mucosa + bullea all over body in 35 yo. dx?

Answer 12

pemphigus vulgaris +nikolsky sign. only PV involves oral mucosa

Question 13

tx of bullous pemphigoid?

Answer 13

steroids

Question 14

Dermatitis Herpetiformis

sx? tx?

Answer 14

cuntenous manifestions of celiac dz = IgA ab to Transglutaminase or Endomysial Ab = dx by looking for these ab!

• presents as ag-ab complex build up under skin = neutrophilic abscess = pruritic rash on butt, legs or extensor surfaces
  tx: avoid gluten

Question 15

tx of Porphyria Cutanea Tarda?

Answer 15

avoid the sun

Question 16

dx of Porphyria Cutanea Tarda?

Answer 16

coral red urine under wood lamp

Question 17

enzyme deficiency in Porphyria Cutanea Tarda?

Answer 17

uroporphyrinogen decarboxylase

Question 18

sx of Porphyria Cutanea Tarda?

Answer 18

bullae on sun exposed skin may be tirggered by: OCP, Alcohol, hepC, hemochromatosis

Question 19

triggers of Porphyria Cutanea Tarda?

Answer 19

OCP, Alcohol, hepC, hemochromatosis

Question 20

tx of psoriasis?

Answer 20

1. UV light 2. mild topical anti-steroidals

Question 21

pt w/”dandriff” on scalp, eyebrows and forehead. dx? tx?

Answer 21

seborrheic DERMATITIS(no keratosis thats old ppl splatter)

tx: selenium shampoo bc this is due to a fungus

Question 22

pt w/ pink rash that spares the palms or soles that then turns scaly. syphilis -. dx? tx?

Answer 22

pityriasis rosea. tx with steroids

Question 23

tx of contact dermatitis?

Answer 23

avoid + topical diphenhydramine or aloe creams

Question 24

purple papules with a lacy netowrk of white lines, itchy. seen in a person with hep C. dx? tx?

Answer 24

Lichen plantus

white lines = wickham striae
tx: topical steroids

Question 25

kid w/ dry, red, itchy vesicles w/crusted lesions around face + at diaper line. dx? tx?

Answer 25

atopic dermatitis = eczema

• may look like impetigo but found at other places
  tx: avoid + topical steroids

Question 26

adutl w/dry red lichenification around fossa’s. dx? tx?

Answer 26

eczema

tx: avoid + topical steroids

Question 27

contact dermatitis hsr type…

Answer 27

4

Question 28

What is Stasis dermatitis?

Answer 28

edema, erythema, brown disccoloration, scales = seen in areas fluid sits for long periods of time = tx cause

Question 29

pt w/annular, blanching red papules of varying size comes in after working outside in yard. dx? cause? tx?

Answer 29

urticaria = hives due to IgE mast cell activating causeing histamine to be released = T1 HSR.
tx: 1. antihistamine +steroids (if anaphylax add epi) 2. RAST to ID antigen so it can be avoided

may be caused by: bee sting, pressure, heat, food, contact dermatitis

Question 30

How long before you would see a drug reaction rash? how would you treat? sx?

Answer 30

7-14 d later see widespread, symmetric and pruritic rash. stop agent and give diphenhydramine

Question 31

What is Erythema-Multiforme? sx?

Answer 31

cutaneous IC depo due ot reaction wiht some drug. looks like target shaped lesion on skin +/- palms and soles and is self limitied. tx cause or stop drug.

ddx: syphilis vs SJS vs ErthMf.

Question 32

Steven johnson syndrome vs toxic epidermal necrolysis

Answer 32

both: +nikolsky +oral mucosa
SJS: <10% body fx, bx: basel cell degeneration

TEN: >30% body fx, bx: total thickness epidermal necrosis

**do not confuse w/PV

Question 33

Pt w/ negative hx presents with 1week pain in ankles w/ multiple pink to red nodules below the knee. What’s the next best test?

Answer 33

This is ERYTHEMA NODOSUM. Mc in lower legs.

Assoc: strep, sarcoidosis, TB, coccidio, IBD.’c etc

Initial workup: CBC, LFT, RFT, Antistrep O ab test, TB skin and CHEST X-RAY to look for infectious cause

Question 34

Ichthyosis Vulgaris sx? Tx?

Answer 34

Chronic skin disorder with diffuse dermal scaling due to inability of dead skin to fall off. Skin looks super dry like “fish scales”. Worse in winter and not helped by lotion.

Tx: keratolytics(tar, salicylic acid) & topical retinoids for sx control

Question 35

68 yo women with hx HA for 2 months now has LOV in R eye w/ swollen pale disc, ESR 85 + subclavicular bruit. Dx? Tx?

Answer 35

Pt has Giant cell arthritis! This is the most common presentation of GCA! Tx this with HD IV steroids to prevent further dmg.

Question 36

Dermatofibroma

Answer 36

Hyper pigmented nodule with center dimpling known as butt hole sign with a fibrous component. This is more common in women and often appears on the legs more than the arms. Canby itchy and painful but not always. Treatment is cryosurgery

Question 37

Patient describes what sounds like a SCC on skin but says it grew fast then randomly dissapearted. Dx?

Answer 37

Keratoacanthoma! Sometimes goes away on its own, if not remove with surgery as it is pre malignant

Question 38

Erythematous lesion with a sandpaper like brown to yellow scale. Dx? Early tx? Disseminated tx?

Answer 38

Actinic keratosis = early SCC!!

Tx w/ cryosurgery or 5FU

Question 39

Ash leaf spot

Answer 39

Single area of hypopigmentation that is positive on wood lamp. Pathognomic for tuberous sclerosis(GI polyps, seizures, shagreen patch(CT hamartoma on the back), sebaceum adenomas)