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RC: Specialties Woo Hoo > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are nail findings in psoriasis?

A
  • *Nail pitting
  • Onycholysis
  • Yellow-brown colour
  • Thickening
  • Dystrophy
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2
Q

List some derm conditions that have nail pitting:

A
  • Psoriasis
  • Dermatitis (rough coarse pits)
  • Alopecia Areata (transverse rows of fine pits)
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3
Q

What is incontinentia pigmenti?

A 
Neurocutaneous disorder 
- association
> derm
> dental
> ocular
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4
Q

Are skin lesions in incontinentia pigmenti at risk of malignant changes?

A

No- they are benign

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5
Q

List findings associated w/ incontinentia pigmenti:

A

> Derm: alopecia, coarse hair
Dental: late dentition, hypodontia, impaction
Ocular: neovascularization, micropthalmos, strabismus, optic nerve atrophy
CNS: seizures, DD, hemiplegia or hemiparesis

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6
Q

What is pseudoporphyria

A

Skin condition
- Look like porphyria BUT without porphyrin metabolism issue
- Usually from NAPROXEN/ NSAID
= photosensitive + small hypo pigment scars in areas of trauma

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7
Q

Most common cause of pseudoporphyria

A

Naproxen

Tx: D/C due to permanent scars risk.

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8
Q

List two RF for pseudoporphyria

A
  • fair skin

- sun exposure area

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9
Q

What does pseudoporphyria look like?

A
  • vesicles + easy bruising

- > small hypo pigmented depressed scars in areas of small trauma

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10
Q

what does incontenti pigmenti look like?

A

Initial linear streak or vesicles that blister.

Classic= pigmented strip following Blashko lines

*always affect axillae + groin

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11
Q

T or F: most people with acne have endocrine abnormalities.

A

False

Testing for hyperandrogegism (i.e. PCOS) if (+) signs

  • pre puberty= acne, early odour, axillary or pubic hair, bone age ++, accelerated growth
  • postpuberty= infreq menses, hirsutism, alopecia, infertility, PCOS, clitromegaly, truncal obesity etc.
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12
Q

T or F: routine microbiologic testing recommended for patients with acne?

A

False

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13
Q

Do any acne treatments alter course of acne?

A

None except isotretinoin (accutane)

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14
Q

Is there evidence that diet triggers acne flares?

A

No; limited evidence.

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15
Q

Which season improves acne and which worsens?

A
  • Summer= improve

- Worsen= winter

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16
Q

What is the best routine cleansing regiment for people with acne?

A

Soap + water.

  • agents w/ keratolytic agent, salicylic acid may temporarily remove sebum but no significant change
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17
Q

Single or combo therapy should be used in patients with acne?

A

Combo therapy

*Note topical retinoid can be mono therapy if comedonal.

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18
Q

How to treat comedonal versus mild versus severe papulopustrular or nodular?

A

**Generally= Retinoid -> BP or Abx -> Isotretinoin

Comedonal= topical retinoid (or salicylic acid)

Mild Papulopustular= suggest inflam
= Benzoyl peroxide w/ topical ABX (i.e. topical dapsone, tetracycline, doxycycline) or Retinoid

*usually BP in am + retinoid night

Severe Papulopust. or Nodular
= topical retinoid + benzoyl peroxide + PO Abx
OR isotretinoin 1mg/kg/day

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19
Q

What is the only treatment for severe nodulocystic acne?

A

Isotretinoin

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20
Q

T or F: limited evidence for benefit of physical modalities for routine tx of acne (i.e. pulsed dye laser, glycol acid peel, salicylic acid peel)

A

T

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21
Q

Is Pregnancy is contraindication to isotretinoin (accutane)?

A

yes

Highly teratogenic.

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22
Q

What is baseline monitoring for isotretinoin?

A 
liver function
lipid panel (cholesterol, TG)
pregnancy test
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23
Q

What is the advantage of benzoyl peroxide over topical Abx?

A

Decreases P. acnes. resistance to Abx

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24
Q

How long do you have to wait for acne treatment until state ineffective?

A

6-8 weeks

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25
Q

Most common topical Abx in acne treatment?

A

Clindamycin

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26
Q

Girl with blackheads only + mild acne. What do you recommend?

A

Topical retinoid acid (aka topical tretinoin)

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27
Q

What are blackheads?

A

open comedones.

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28
Q

Major Accutane side effects:

A
  1. highly teratogenic
  2. benign intracranial HTN
  3. depression w/ SI
  4. hepatitis (LFTs)
  5. hyperlipidemia (cholesterol, TG monitoring)
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29
Q

Describe the pathophysiology of acne (aka comedogenesis):

A

**Keratinization - Sebum - Bacteria - Inflammation

  1. Abnormal keratinization of follicular epithelium (impaction of keratinized cell)
  2. +++ Sebum
  3. Proliferation of Propionibacterium in follicles
  4. Inflammation
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30
Q

Child sucks on fingers. Vesicles on fingers with central area of ulceration and erythema. What is it? Tx?

A

Herpetic Whitlow

  • pain ++
  • min. 1 finger
  • swell, red, tender
  • heal within 2-3 wk; no tx
  • if immunocompromised or severely infected= acyclovir
  • do not lance
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31
Q

Do you ever lance herpetic whitlow?

A

NO

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32
Q

Which flesh coloured wart is caused by pox virus?

A

Molluscum Contagiosum

  • commonly 1-10 y.o.
  • skin to skin or indirect
  • can appear anywhere (except palm, sole, scalp)
  • Tx: reassure
  • wash hand, no sharing towel, covering lesion necessary
  • If Tx: cantharidin (beetle juice), cryosurgery (liquid nitrogen), curettage (painful)
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33
Q

Is the entire molluscum rash contagious?

A

yes

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34
Q

Tinea capitis treatment:

A
  1. Griseofulvin
  2. Alternative= Terbinafine (Lamisil) PO
  3. Alternative= PO Itraconazole
    • Adjunct Shampoo (i.e. selenium shampoo)

Do not need to shave the head.

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35
Q

Hair broken with black dots on scalp. What type of infection is this?

A

Tinea capitis

  • hair broken off by follicle
  • black dot on scalp
  • +/- fever, pain, local lymphadenopathy
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36
Q

Contagious skin infection from mite with burrow and red papule btwn finger, flexure, genital. ++ Itching (worse at night), papular, higher risk in First Nation, young, immunocompromised, bed sharing, poverty, overcrowding. Household has same thing. What is this?

A

Scabies.

  • Sarcoptes scabiei
  • Skin-to-skin (live off skin max 24 hr)
  • usually papule (can be vesicle, pustule, nodule)
  • itch worse at night
  • peds: predilection from wrist + palm
  • gold Dx: direct visualization via KOH or bx
  • ink test (cover lesion w/ ink and remove w/ alcohol w/ tracking of burrows seen)
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37
Q

Who gets treated if one person has scabies?

A

Entire household contact (even without symptoms)

Goal: avoid re-infestation as symptom can take several wk to appear.

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38
Q

1st line treatment for scabies:

A

5% permethrin topical

  • entire body
  • min. 8-12 hr/put O/N
  • re-tx in 7d
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39
Q

Why was lidocaine withdrawn as 2nd line Scabies tx:

A

Due to neurotoxicity.

Current 2nd line:

  • benzyl benzoate
  • sulphur jelly
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40
Q

When do you use PO ivermectin for scabies?

A

PO x 1. IF:

  • immunocompromised
  • institutional/ comm outbreak
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41
Q

How do you prevent scabies reinfection?

A
  1. Treat all household member regardless of symp.
  2. All bed linen + clothing next to skin= HOT wash + HOT dry
  3. If no hot water, put in sealed plastic bag x5-7d
  4. Vacuum floors
  5. Improve living conditions for First Nations
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42
Q

Alopecia with hair falling in clumps. No itch. (+) hair pull test.

A

Telogen Effluvium.

  • reassure that normal hair growth return within 3-6 mo.
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43
Q

Alopecia due to hair pulling/ release tension. No itch. Anxiety + OCD tendency. Irregular pattern w/ mixed length + stubby hair.

A

Trichotillomania.

  • If due to OCD= Tx clomipramine or fluoxetine
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44
Q

Alopecia. VERY ITCHY. Scales, pustules, kerion. Spots stay.

A

Tinea Capitis

Tx: anti fungal (Griseofulvin or Terbinafine or Itraconazole).+ adjunct shampoo

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45
Q

AI alopecia. No itch. exclamation point hairs on exam. regular pattern. nail pits + grooves.

A

Alopecia Areata

  • resolution within 6-12 mo.
  • recurrence common
  • topical steroids effective in some
  • intradermal injection option
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46
Q

What is Nikolsky sign?

A

with slight pressure the skin wrinkles and slide off and separate w/ dermis.

I.E. staphylococcal scalded skin, TEN

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47
Q

Population in Staph Scalded Skin:

A

infants +

always < 6

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48
Q

Bullous impetigo versus SSSS?

A

BI= local dx. Spread adjacent if blister ooze.

SSSS= toxin act at remote skin= spreading rash + slough

49
Q

SSSS vs. TEN/SJS

A

TEN:

  • allergic rxn (usually med)
  • severe MM ++
  • necrosis of full epidermal layer

SSSS:

  • toxin from staph
  • no MM (will do perioral)
  • intraepidermal cleavage
50
Q

Most common areas of SSS in neonate?

A

SSSS= staph scalded skin sys

  • diaper
  • umbilicus
51
Q

Tx for staph scalded skin?

A
  • Cloxacillin or Cephalosporin
  • ** Clinda
  • High risk MRSA or doesn’t respond= Vanco
52
Q

Do you give steroids in SSS?

A

NO!

Slows down healing.
Avoid NSAID due to affect on kidney.

53
Q 
1 wk after amox.
Red rash.
Generalized.
Spare folds.
(+) MM.
(+) Nikolsky's sign.
DX?
A

Toxic epidermal necrolysis.

not SSS due to MM and spare fold

54
Q

Most common precipitants for SJS or TENS?

A 
Sulphonamides
Pen/ Amox
Anticonvulsant (phenobarb, phenytoin)
NSAID
Allopurinol
55
Q

what % distinguish SJS versus TEN

A

BSA < 10%= SJS
BSA > 30%= TENS
in between is overlap dx

56
Q

Tx of impetigo

A

Mupirocin 2% TID x 10-14d

Keflex IF strep, widespread, deep oral involvement.

57
Q

What is Gianotti-Crosti?

A

Papular Acrodermatitis.

  • Immunologic rxn to viral infection/immunization (1 wk after)
  • monomorphic firm papule
  • no MM
  • benign and self-resolving (up to 2 mon)
58
Q

Genital warts are caused by?

A

HPV 6 + 11

“Cauliflower like mass”

Inoculation during birth, sexual abuse, spread cutaneous.

59
Q

Infant + small brown nodules on back and limbs. When touch wheal develops and then itchy. Dx?

A

Mastocytosis

- ++ mast cell in dermis
Type= urticaria pigmentosa
= most common; infant
- early bullous or urticaria lesion that fade.
- macular, nodular, brown
- stroke-> red+ wheal, itch
- spontaneous resolution; no tx needed
60
Q

Plaque with scales. Pinpoint bleeding with removal of scale. What is this?

A

Psoriasis

Auspitz sign= pinpoint bleeding with removal of scale.

61
Q

List 3 treatment modalities for psoriasis?

A

Emollient +

  1. Topical: steroids (solo if mild dx)
  2. Topical: Calcipotriol
  3. Topical: Tar Shampoo
  4. Phototherapy
  5. Systemic Tx: Immuno-suppressant (MTX)
  6. Systemic: Biologic (TNF-alpha inhibitor- infliximab)
62
Q

Describe plaque psoriasis:

A
  • red plaque
  • sharply demarcated
  • thick silvery scale
63
Q

Key difference btwn Atopic dermatitis vs. Psoriasis vs. Tinea:

A

Tinea= annular, scaly, RED RAISED BORDER (thicker outside) + CENTRAL CLEARING, SPREAD if on steroids

Eczema= red, poorly defined, scaly, ++ ITCHY, flexure

Psoriasis= ROUND, WELL defined, silvery white SCALE, rare in flexures

64
Q

Rash that follows Langer’s line. Initial large lesion on lower back. What is this?

A

Pityriasis Rosea.

  • Herald Patch
  • Langer line= Xmas tree
65
Q

How long do you expect pityriasis rose to last? What tx do you offer? Contagious or not?

A

Rash ~ last up to 12 weeks.
Reassure. Emollient if scaling and PO antihistamine if need.
Not contagious.

66
Q

What are infantile hemangioma?

A

Benign
Vascular
Neoplasm

67
Q

What is the most common neoplasm/ tumor of infancy?

A

Hemangioma

68
Q

infantile hemangioma RF:

A

prem
low BW
F
white

69
Q

When do infantile hemangioma involute?

A

95% by 9 y.o.

70
Q

When do you tx infantile hemangiomas

A

Location: airway, eye, face
Number: >5
Size > 5 cm

71
Q

What is the first line tx for infantile hemangioma?

A

PO propanolol.

72
Q

What is PHACE Syndrome:

A 
P= posterior fossa anomalies
H= hemangioma (large segment of face)
A= arterial (cervical or cerebral)
C= cardiac (coarc, VSD)
E= eye (fetal vasc., morning glory)
\+/- S = sternal, umbilical raphia etc.
73
Q

What is the PHACE workup:

A
  • Echo
  • Baseline MRI + MRA
  • Ophtho
  • Ensure hearing passed
  • Ensure no signs of hypothyroidism
  • Ensure Neurodevelopment, SLP (brain), Dental hypoplasia
74
Q

X-men Storm character… white hair… makes you think of?

A

Piebaldism

  • AD
  • associated with Waardenburg Syndrome
75
Q

List some features of Waardenburg Syndrome

A
  • AD
  • piebaldism (white hair)
  • deaf
  • heterochromia (diff eye colours)
  • wide set eyes
  • low hairline
76
Q

How many NF can you have till we are worried?

A

5

77
Q

NF1 vs. NF2 vs. TS

A

NF1= AD

  • optic glioma
  • axillary or groin freckling
  • neurofibromas

NF2= AD= neuro

  • vestibular schwannoma
  • eye + hearing + SC issue

TS= AD

  • ash leaf spot
  • shagreen patch
  • cardiac rhabdomyoma
  • ungal (nail)
  • sz
78
Q

What is the most common disorder seen with multiple cafe au lait?

A

NF1

79
Q

Axillary or groin freckling + cafe au lait=

A

NF1

80
Q

NF1 mnemonic?

A

need 2/7= CAFEFOGS

  • Cafe au lait (min. 6 > 5mm in pre puberty and >15mm in post-puberty)
  • Axillary freckling
  • Fibroma (min. 2 of any type- cutaneous, subcut, plexiform)
  • Eye= lisch nodules (brown spots on iris)
  • FHX
  • Optic Tumour (Glioma)
  • Skeletal: bowing, pseudoarthrosis of tibia
81
Q

CAFE FOGS mnemonic is what?

A

NF1

  • Cafe au lait (min. 6 > 5mm in pre puberty and >15mm in post-puberty)
  • Axillary freckling
  • Fibroma (min. 2 of any type- cutaneous, subcut, plexiform)
  • Eye= lisch nodules (brown spots on iris)
  • FHX
  • Optic Tumour (Glioma)
  • Skeletal: bowing, pseudoarthrosis of tibia
82
Q

hypo pigmented circle with nevi in middle

A

Halo Nevus

  • body reacting to mole
  • spontaneous regression
83
Q

Atopic dermatitis. 1st line.

2nd line. 3rd line pharmacotherapy.

A 
1st= topical corticosteroids
2nd= topical calcineurin inhibitors (i.e. tracolimus, protopic)
3rd= systemic (cyclosporine, steroids, Mycophenolate Mofetil, MTX)
84
Q

What is erythema multiforme?

A

polymorphous eruption of targeted lesions

  • any site +/- MM
  • once there = stay
  • HSV, Mycoplasma pneumonia, Meds (sulfa, anti-sz, penicillin), viral
  • Tx: remove, oral histamine +/- topical corticosteroid
  • resolve within 3wk

EM Minor= no MM= “Bull eye”
EM Major= MM= targeted, MM, <10% BSA; meds

85
Q

SJS vs. EM Major

A

SJS= widespread blister with flat rash/macular + no target + MM severe

EM Major= MM= targeted, MM, <10% BSA

86
Q

Erythema:

  • Multiforme
  • Migrans
  • Marginatum
A

Multiforme: infection, meds, target, bull’s eye + pruritic; feet -> centripetal, 3 weeks

Migrans: rash appear migrate outward with central clearing; Lyme

Marginatum: trunk but face clear, ring like, no itch, transient eruption, few days, (+) strep (Jones Criteria)

87
Q

T21 Alopecia Likely?

A

Alopecia Areata

88
Q

Natural hx of alopecia areata?

A

Resolve within 6-12 mo.

Recurrence common

Topical steroid can be effective in some; +/- intradermal injection

89
Q

Describe erythema toxicum

A
  • benign
  • peak DOL #2
  • firm 1-2mm yellow-white papule on red flare base
  • palm + sole fine
  • resolve by 2 wk
90
Q

Describe neonatal acne

A
  • mean onset= 3 wk
  • follicular comedone
  • like teen (forehead + cheek)
  • self resolve; disappear within 6 month
91
Q

How do you treat poison ivy?

A
  1. Immediate decontamination
  2. Wash skin + supportive (cool wet cloth, calamine lotion, oatmeal bath)
  3. Systemic antihistamine
  4. Topical steroid
  5. +/- systemic steroid
92
Q

Summer + linear vesicles + pruritic!!! Could be (think plant in summer)

A

Poison Ivy

Tx:
- decontaminate + wash skin
- systemic antihistamine
- topical steroid
\+/- systemic steroid
93
Q

What it the natural history of infantile hemangioma?

A
  • Precursor (colour change)
  • Proliferation (rapid phase done by 5 mon, till 12 mo)
  • Plateau till 18 mon
  • Regression till 10 y.o.
  • Residua (50% of pt)
94
Q

Beard distribution of hemangioma means=

A

Subglottic hemangimoa

95
Q

Most common complication of infantile hemangioma?

A

Ulceration

96
Q

What’s the difference between capillary malformation and Hemangioma?

A

Hemangioma
= tumour
rapid growth + resolve

Capillary
= vascular malformation
- growth w/ child + persist

97
Q

When do you worry about acquired nevi?

A

ABCDE

  • asymmetry
  • irregular not sharp border
  • colour (typically even pigment)
  • diameter (>6mm= flag)
  • evolution/change
98
Q

1st line treatment for Vitiligo?

A

Strong topical steroids

99
Q

White Eczema?

A

Pityriasis Alba

  • usually summer
  • (+) eczema hx
  • hypo pigment
  • fine white scale
    Tx: steroid
100
Q

Monomorphous punched out lesions w/ red base

A

Eczema Herpeticum

101
Q

Eczema herpeticum treatment

A

*Confirm w/ Cx from lesions.

If unwell, < 1, poor PO= IV acyclovir.

If well, local, U?O and fluid ok= acyclovir x 10d

Saline compress help wound healing

102
Q

Treatment for Warts?

A
    • no tx
  • destructive
    *> salicylic acid
    > cryotherapy
    > curettage
    > laser
    • duct tape
  • others…
103
Q

SJS-TEN Management?

A
  1. Admit
  2. Supportive
  3. R/O med, infection
  4. IVIG
    +/- steroids
104
Q

What’s drug hypersensitivity Syndrome?

A

Morbilliform drug eruption +
… fever/ lymph/ pharyngitis/ Eosino./ LFT

  • Non IGE
  • 3-10d after med

Tx: D/C drug
antihistamine
topical steroid

105
Q

List complications of atopic dermatitis:

A
  • infection
  • pigmentary changes
  • scarring or lichenification
  • sleep deprivation
  • bullying
  • depression
106
Q

What are patients with psoriasis at increased risk for:

A
  • Psoriatic arthritis
  • Metabolic syndrome
  • Cardiovascular dx
107
Q

Acne severity scale:

A

Mild= comedones +/- few inflammatory lesion

Mod= comedones + signif inflam lesion

Severe= persistent, scarring, nodular

108
Q

Rock hard= firm, lobulated nodule that is blue-purple or flesh. Is benign growth of hair follicle. Name?

A

Pilomatricoma

Don’t resolve on own

109
Q

Big, Soft, Deep= Soft blue-purple irregular nodule. Painful. At birth and grow w/ child. Does not regret.

A

Vascular malformation

110
Q

Flesh coloured mobile nodule. May express substance

A

Epidermal Cyst

111
Q

Yellow-orange plaque w/ no hair that has been present since birth.

A

Nevus Sebaceous

  • abN sebaceous glands
  • grow proportionately w/ child
  • persists
  • Sx removal if nodules (as risk CA)
112
Q

Domed papule that bleeds and crusts often.

A

Pyogenic Granuloma.

  • benign growth of blood vessel
  • can regress
  • histology confirm dx
    thus curettage + excise
113
Q

T or F: Incontinentia Pigmenti is X linked dominant?

A

True

114
Q

T or F: irritant contact dermatitis involves butt creases

A

False

  • inner, upper thigh, buttock but SPARE crease
115
Q

Nutritional deficiency that can present as dermatitis?

A

Zinc deficiency

  • Acrodermatitis enteropathica
  • AR
  • diarrhea
  • perioral, aural, diaper dermatitis
  • irritable
    Tx: zinc supp
116
Q

Seborrheic dermatitis won’t get better… R/O

A

LCH

- Langerhans Cell Histiocytosis

117
Q

Neonatal lupus rash usually =?

A

“Racoon Face”

Discrete round scaly papule.

  • from maternal (usually asymp.) antibodies
  • +/- heart block
    +/- cardiomyopathy
118
Q

Term w/ OB trauma. Rock Hard nodule.

A

Subcutaneous Fat Necrosis.

119
Q

Which do you have to check in BW for kids w/ subcutaneous fat necrosis?

A

Hypercalcemia

*check until lesion gone

RC: Specialties Woo Hoo (31 decks)

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