Dermatology Flashcards
How would you diagnose melanoma?
a. asymmetry
b. border irregularities
c. color irregularities
d. diameter greater than 6 millimeters
e. evolution (changing in appearance over time)
Biopsy any suspicious lesion
What kind of biopsy will you do for malignant melanoma?
Full thickness biopsy
DO NOT do a shave biopsy
Besides sunlight, this type of cancer is greatly increased by organ transplant secondary to the long-term use of immunosuppressive drugs.
Squamous Cell Cancer
This is the most common form of skin cancer. It is described as a waxy lesion that is shiny like a pearl.
Basal Cell Carcinoma
This is the best procedure in removing skin cancer for delicate areas like the eyelid or ear.
Mohs Micrographic Surgery
This skin cancer is from human herpes virus 8 and the most common cause is AIDS. The lesion is more reddish/purplish because it is more vascular than other forms of skin cancer. It can also be found in the GI tract and in the lung.
Kaposi Sarcoma
These are premalignant skin lesions from high-intensity sun exposure in fair-skinned people. They have a very small risk of squamous cell cancer for each individual lesion.
Actinic Keratoses
These lesions are extremely common in the elderly. They are hyperpigmented lesions commonly referred to as liver spots. They give a “stuck on” appearance. Although they may look like melanoma to some people, they have no premalignant potential.
Seborrheic Keratoses
This is a common skin disorder associated with overactivity of mast cells and the immune system. There will most probably be a history of asthma, allergic rhinitis, family history of atopic disorders, onset before age 5, very rare to start after age 30.
Atopic Dermatitis (Eczema)
These are used in acute flares of atopic dermatitis.
Topical Corticosteroids
These are T cell-inhibiting agents that provide longer-term control and help get the patient off steroids. They are systemically in organ transplant recipients to prevent organ rejection and keep patients off steroids. They are used topically for atopic dermatitis because this disorder is a form of immune system hyperactivity.
Tacrolimus and Pimecrolimus
What will you give when impetigo occurs in the presence of atopic dermatitis?
Cephalexin
Mupirocin
Retapamulin
This is a treatment option for severe recalcitrant disease in atopic dermatitis.
Ultraviolet light (phototherapy)
This is characterized by silvery, scaly plaques that are not itchy most of the time.
Psoriasis
These are topical high-potency steroids used in Psoriasis.
Fluocinonide
Triamcinolone
Betamethasone
Clobetasol
These agents help patient with Psoriasis get off steroids.
Vitamin A and Vitamin D
What should you do before using TNF inhibitors (etanercept, adalimumab, infliximab) in Psoriasis?
Screen with PPD ; agents can reactivate tuberculosis
This is an idiopathic, transient dermatitis that starts out with a single lesion (herald patch) and then disseminates. It can look like secondary syphilis but it spares the palms and soles.
Pityriasis Rosea
It is a hypersensitivity reaction to a dermal infection with noninvasive dermatophyte organisms.
Seborrheic Dermatitis (Dandruff)
This has both an idiopathic autoimmune form and a drug-induced form. It is associated with ACE inhibitors, Penicillamine, Phenobarbital, Penicillin.
Pemphigus Vulgaris
This is the loss of “denuding” of skin from just mild pressure.
Nikolsky sign
Nikolsky sign is a characteristic finding of this disease.
Pemphigus Vulgaris
This is the most accurate diagnostic test for Pemphigus Vulgaris.
Biopsy
These are agents you can use to wean off patient with Pemphigus Vulgaris on steroids.
Azathioprine or mycophenolate
What shall you give patients with Pemphigus Vulgaris in refractory.
Rituximab or IVIG
Autoantibodies split the epidermis resulting in bullae that easily rupture, with the involvement of the mouth, fluid loss and infection if widespread disease. What is the diagnosis?
Pemphigus Vulgaris
This disease presents with bullae that stay intact and less loss of fluid and infection. Mouth involvement is uncommon and nikolsky sign is absent.
Bullous Pemphigoid
This is the most accurate test for Bullous Pemphigoid.
Biopsy with immunofluorescent stains
This is the best initial therapy for Bullous Pemphigoid.
Prednisone
This is a blistering skin disease of sun-exposed areas in those with history of liver disease (hepatitis C, alcoholism), estrogen use, iron overload (hemochromatosis)
Porphyria Cutanea Tarda
This disease is most frequently tested in association with PCT.
Hepatitis C
This is the most accurate diagnostic test for Porphyria Cutanea Tarda.
Increased uroporphyrins in a 24-hour urine collection
Porphyria Cutanea Tarda is a hypersensitivity of the skin to abnormal ________ when they are exposed to light.
porphyrins
How would you treat Porphyria Cutanea Tarda.
Stop alcohol
Stop estrogens
Remove iron with phlebotomy
This is the most superficial of the bacterial skin infections caused by staphylococcus and streptococcus invading the epidermis, resulting in weeping, crusting, oozing, and draining of the skin.
Impetigo
How would you treat mild impetigo?
Mupirocin
Retapamulin
Bacitracin
How would you treat severe impetigo?
Dicloxacillin or cephalexin
How would you treat impetigo with community-acquired MRSA?
Doxycycline
Clindamycin
Trimethoprim/sulfamethoxazole (TMP/SMX)
This skin disease invades dermal lymphatics and causes bacteremia, leukocytosis, fever, and chills. It is more often from Streptococcus than Staphylococcus.
Erysipelas
This presents most commonly as a bright, red, hot swollen lesion on the face.
Erysipelas
How would you treat mild Erysipelas?
Dicloxacillin, cephalexin, cefadroxyl
Penicillin allergic: erythromycin, clarithromycin or clindamycin
MRSA: doxycycline, clindamycin, Trimethoprim/sulfamethoxazole (TMP/SMX)
How would you treat severe Erysipelas?
Intravenous medications:
Oxacillin, Nafcillin, Cefazolin
Penicillin allergic: clindamycin, vancomycin
MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
This is an infection of the soft tissue of the skin. It extends from the dermis into the subcutaneous tissue. The skin is warm, red, swollen, and tender.
Cellulitis
What is the most common etiology of Cellulitis?
Staphylococcus aureus
What will you use if the reaction to penicillin is a rash?
Cephalosporins
What will you use if the reaction to penicillin is anaphylaxis?
Mild: macrolides, clindamycin, doxycycline, or TMP/SMX
Severe: vancomycin, linezolid, daptomycin, tigecycline, or ceftaroline
What is the best initial test for Fungal Infections?
KOH preparation
The most accurate test for fungal infections?
Fungal culture
What is the best initial therapy for fungal infections?
Topical antifungal agent if no hair or nails are involved.
What is the best initial therapy for hair (tinea capitis) and nail (tinea unguium) infections?
Terbinafine
What is the adverse effect of oral ketoconazole?
Gynecomastia
This is the mildest reaction in drug reactions. Skin stays intact without mucous membrane involvement.
Morbilliform rash
This is a widespread drug reaction, presenting with small “target” lesions, most are on the trunk. No mucous membrane involvement. May also be from herpes or mycoplasma.
Erythema multiforme
This is a very severe drug reaction that involves mucous membranes. Sloughs off respiratory epithelium and may lead to respiratory failure.
Stevens-Johnson syndrome
How would you treat SJS and TEN?
IVIG
This is a drug reaction with rash and mucous membrane involvement with positive Nikolsky sign.
Toxic epidermal necrolysis (TEN)
This is a skin reaction to a toxin in the surface of Staphylococcus as well as hypotension, renal dysfunction (elevated BUN and creatinine), liver dysfunction, CNS (delirium).
Toxic Shock Syndrome (TSS)
These are the most effective medications for SSSS and TSS in the absence of penicillin allergy.
Oxacillin and Nafcillin
This drug is interchangeable to Oxacillin and Nafcillin in the treatment of SSSS and TSS.
Cefazolin
Treatment for mild acne.
Use topical antibacterials such as benzoyl peroxide
If ineffective, Clindamycin or Erythromycin
Treatment for moderate acne
Add topical vitamin A derivatives such as tretinoin, adapalene, or tazarotene
If no response, add minocycline or doxycycline
Treatment for severe acne
add oral vitamin A, isotretinoin
