Dermatology

Question 1

_______ prophylaxis should initially be considered in all burns patients.

Answer 1

Tetanus

Question 2

Dematographism is…

Answer 2

Local pressure to the skin may cause wheals in that area

Question 3

Darier’s sign is…

Answer 3

Localized urticaria appearing where the skin is rubbed

Question 4

Treatment of choice for post-op urticaria is ______.

Answer 4

Antihistamines!

Also eliminate precipitant factors, corticosteroids, H2 blockers

Question 5

Type I HSN is…

Answer 5

IgE-mediated: urticaria & angioedema. Immediate!

Question 6

Type II HSN is…

Answer 6

Ab-mediated, cytotoxic

Question 7

Type III HSN is…

Answer 7

Immune antibody-antigen complex

Question 8

Type IV HSN is…

Answer 8

Delayed (cell mediated)- Erythema Multiforme

Question 9

______ is the MC skin eruption.

Answer 9

Exanthematous/Morbiliform rash

-Generalized distribution of “bright-red” macules & papules that coalesce to form plaques. Rash typically begins 2-14 days after meds initiation. Ex- ABX, NSAIDS, Allopurinol, Thiazide diuretics

Question 10

____ rashes usually occur with minutes to hours after drug administration.

Answer 10

Urticarial

*MC triggers- ABX, NSAIDS, Opiates, Radiocontrast media

Question 11

Erythema Multiforme most commonly caused by:

Answer 11

Sulfonamides, PCN, Phenobarbital, Dilantin

Question 12

Most cutaneous drug rxns are self-limited if drug is discontinued.

Answer 12

Treatment- antihistamines and systemic corticosteroids

Epi for anaphylaxis

Question 13

______ is the most common type of skin CA in the US

Answer 13

Basal cell carcinoma

*Slow growing, locally invasive but very low incidence of METS

Question 14

Describe the appearance of BCC

Answer 14

Flat, firm area with small, raised, TRANSLUCENT/PEARLY/WAXY PAPULE AND CENTRAL ULCERATION & RAISED/ROLLED BORDERS

• Often friable (bleeds easily)
• *May have overlapping telangiectatic vessels

Question 15

How is BCC worked up?

Answer 15

Punch or shave bx

Question 16

How is BCC treated?

Answer 16

1. Electrodesiccation/curettage in non facial tumors

2. Mohs surgery for facial involvement

Question 17

______ is the 2nd MC skin cancer and is often PRECEDED BY ACTINIC KERATOSIS, HPV Infection

Answer 17

Squamous cell carcinoma

*Usually on lips, hands, neck, and head

Question 18

Describe appearance of SCC…

Answer 18

Red, elevated, thickened nodule with adherent white scaly or crusted, bloody margins

Question 19

What is the treatment of choice for SCC?

Answer 19

Wide local surgical excision

Also electrodessication & curettage, Mohs, radiation therapy

Question 20

UV radiation is associated with 80% of cases of ______.

Answer 20

Melanoma

*Aggressive, High METS potential

Question 21

_____ is the MC skin cancer related death.

Answer 21

Melanoma

Question 22

What are the 5 major subtypes of melanoma?

Answer 22

1. Superficial spreading: MC type
2. Nodular
3. Lentigo maligna
4. Acral lentiginous
5. Desmoplastic

Question 23

Describe the appearance of melanoma…

Answer 23

Irregular borders, dark blue/black color, usually ≥ 6mm in diameter

Question 24

______ is the most important prognostic factor for METS with Melanoma.

Answer 24

Thickness.

-10yr survival rate: <1mm= 95%; 1-2mm= 80%; 2-4mm= 55%; >4mm= 30%

Question 25

How is melanoma diagnosed?

Answer 25

Full thickness wide excisional bx + lymph node bx. *Shave biopsy discouraged!

Question 26

How is melanoma treated?

Answer 26

1. Complete wide surgical excision with lymph node biopsy or dissection 2. +/- adjuvant therapy in some high-risk

Question 27

MC cause of cellulitis is _____ & _____.

Answer 27

S. aureus & GABHS *Usually occurs after a break in the skin: underlying skin problems, trauma and surgical wounds

Question 28

Systemic infection with cellulitis is _____ (common/not common).

Answer 28

Not common--> if present may have fever, chills, +/- tender lymphadenopathy and lymphangitis, myalgias, bullae, hemorrhage and necrosis may develop

Question 29

_____ is the spread of a skin infection via lymphatic vessels. Seen as streaking from the infected area following the lymph vessels. Complications include bacteremia.

Answer 29

Lymphangitis

Question 30

Treatment of cellulitis includes...

Answer 30

Abx for 7-10 days - Cephalexin (Clinda or Erythro if PCN allergic) - Vanc and Linezolid PO for MRSA Animal bites- Augmentin Puncture wound through tennis shoe--> Cipro (covers Pseudomonas)

Question 31

Parkland formula for burns

Answer 31

4ml/kg/% TBSA IV for 1st 24 hours -1/2 in first 8 hours and the other 1/2 over the remaining 16 hours

Question 32

Rule of Nines for estimating burn size...

Answer 32

``` Adult- Head- 9% Neck- 1% Front trunk- 18% Back trunk- 18% UE 1- 9% UE 2- 9% LE 1- 18% LE 2- 18% ``` (For child each leg is 14% and the head is 18%)

Question 33

Pressure ulcer staging...

Answer 33

Stage 1- Intact skin with non-blanchable redness Stage 2- Partial thickness loss of dermis presenting as a shallow, open ulcer without slough Stage 3- Full thickness tissue loss, sub-cutaneous fat may be visible. Slough may be present. May show tunneling Stage 4- Full thickness tissue loss with exposed tendon or muscle. Slough or eschar may be present. *If base of ulcer is hidden then the ulcer cannot be staged.