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Dermatology Flashcards

1
Q

Rash that typically effects periocular and flexural areas like posterior neck, antecubital and popliteal fossa?

A

atopic dermatitis

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2
Q

Red dry shins in an elderly person with multiple fine fissures?

A

Xerotic eczema

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3
Q

Common offender of contact dermatitis

A

Nickel
Rubber
Poison oak and Ivy
Neomycin and Bacitracin! (use Mupirocin for your patients instead!)

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4
Q

Treatment of eczema

A
  • do not over wash
  • emollients
  • short course of topical glucocorticoids ex. 1% topical hydrocortisone for face and intertriginous areas and 0.1% triamcinolone for other body sites
  • potent glucocorticoids for thick skin: palms, soles, thick eruptions
  • if really bad can use topical tacrolimus
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5
Q

What should you always select as part of eczema treatment?

A

emollients: trap water in skin, introduce water into skin and increase the water holding properties of skin

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6
Q

Where should you not use potent glucocorticoids?

A

face because of risk of steroid induced acne and cutaneous atrophy

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7
Q

Common causes of allergic contact dermatitis

A 
Rubber
Poison oak and poison ivy
neomycin and bacitracin
topical anesthetics
nickel
transdermal medication matches
strong soaps, fragrances or personal care products
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8
Q

Where should potent steroids NEVER be used?

A

Face because can cause steroid induced acne or cutaneous atrophy

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9
Q

What is the treatment for limited, localized plaques in psoriasis?

A

topical glucocorticoids, can rotate therapy with topical Vitamin D analogues, retinoids, anthralin or tar preparations

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10
Q

Are systemic glucocorticoids used to treat psoriasis?

A

no -> can cause erythroderma which is a dermatologic emergency

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11
Q

Dx: acute eruption of purple, pruritic, polygonal papule on wrists and ankles

A

lichen planus

tx: topical steriods

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12
Q

dx: one herald patch with many 0.5 - 2.0 cm red scaling patches?

A

Pityriasis rosea

Tx: topical steroids and antihistamines for itching

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13
Q

Tx for seborrheic dermatitis

A

selenium sulfide or zinc pyrithione shampoos or ketoconazole

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14
Q

Explosive onset of seborrheic dermatitis can be a sign of what?

A

HIV

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15
Q

How differentiate syphilis vs pityriasis rosea?

A

Pityriasis rosea doesn’t effect palms and soles

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16
Q

what therapeutic option should be avoided in moderate to severe acne?

A

oral or topical antibiotic mono therapy – increased antibiotic resistance

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17
Q

what acne medications should be avoided during pregnancy?

A

tetracycline, topical retinoids and oral isotretinoin

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18
Q

rash with satellite pustules is a key physical finding of what infection?

A

cutaneous candida

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19
Q

What derm infection has a characteristic spaghetti and meatballs appearance?

A

pityriasis versicolor

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20
Q

How can you distinguish between tinea cruris and candida intertrigo?

A

candida can involve the scrotum, whereas tinea does not

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21
Q

Treatment for most dermatophytes (except tinea capitis and onychomycosis)

A

topical anti fungal - ex. clotrimazole, terbinafine

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22
Q

treatment for confirmed onychomycosis, tinea capitis or resistant dermatophytes

A

oral terbinafine or itraconazole

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23
Q

treatment for pityriasis versicolor?

A

topical ketoconazole, selenium sulfide or zinc pyrithione

Discolored skin due to fungal infection

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24
Q

treatment for recurrent pityriasis versicolor?

A

itraconazole or fluconazole, single dose

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25
treatment for topical candida?
topical nystatin, miconazole, clotrimazole, ketoconazole or econazole
26
Who needs treatment for onychomycosis?
patients with PVD or diabetes to prevent development of cellulitis (HY)
27
Should you treat onychomycosis without KOH scrape or culture positive for dermatophytes?
NO
28
Should you treat dermatophytes with combo of topical anti fungal and steroids?
NO
29
Should you treat dermatophytes with oral ketoconazole?
NO, because of risk of hepatotoxicity
30
Molluscum contagiosum is associated with what infection?
HIV
31
What is the treatment for molluscum contagiosum?
cryosurgery or curettage, ART if assoc with HIV
32
If a patient has severe, complicated or recurrent zoster what should you test for?
HIV
33
Patient has vesicles in ears and diminished taste on anterior tongue and ipsilateral facial paralysis diagnosis?
Ramsey-Hunt from Zoster Refer to ENT
34
How diagnose VZV?
direct fluorescent Ab or PCR studies on scraping from active vesicular lesions that haven't yet crusted OR a viral culture from pustule if diagnosis is unclear
35
Treatment for postherpetic neuralgia?
gabapentin, pregabalin, TCAs or topical lidocaine or capsaicin
36
Who should get shingrix vaccine?
Adults > 50 yo regardless or prior infection or prior vaccination with Zostavax (live vaccine)
37
Should you use steroids or topical antivirals to treat zoster?
NO
38
How diagnose scabies?
microscopic identification using KOH or mineral oil; skin biopsy
39
Treatment for scabies?
Treat all family members and close contacts Topical permethrin Oral Ivermectin if relapsed (but not for kids or pregnant or lactating women) - FYI itching can linger but that's not an indication to re-treat Wash clothing, linens and towels with hot water and dry with high heat
40
Patient treated for scabies has persistent itching a week later, next step?
Do not re-treat for scabies, itching can continue for up to two weeks post treatment
41
Treatment for bedbugs?
lesions resolve spontaneously topical glucocorticoids and oral antihistamines for itch eradicate bedbugs
42
Rapid onset of multiple, itchy seborrheic keratoses can be a sign of what?
GI malignancy
43
Treatment for warts?
salicylic acid cryotherapy no therapy (because likely to spontaneously resolve) podophyllin often used for anogenital warts
44
Actinic keratosis is a precursor to what?
squamous cell carcinoma
45
Treatment for actinic keratosis?
liquid nitrogen or curettage topical 5-FU or imiquimod cream if numerous lesions Excision if >5mm or symptomatic or rapidly growing lesions
46
Prevention of skin cancer in low risk adults?
sun avoidance sun protective clothing do NOT choose annual screening for low risk adults!
47
How confirm diagnosis of squamous cell carcinoma?
punch or shave biopsy
48
treatment for squamous cell carcinoma?
small lesions: electrodesiccation and curettage most lesions require excision
49
how diagnose basal cell carcinomas?
biopsy
50
treatment for basal cell carcinoma?
simple excision if high risk, on face or hands or high risk histology -> Mohs
51
Dysplastic nevi carry an increased risk of?
melanoma
52
How treat dysplastic nevi that develop risk features of melanoma?
remove and send for path
53
What are the ABCDEs of melanomas
``` Asymmetry Border irregularity Color variegation Diameter >6mm Evolution - lateral expansion or vertical growth ```
54
What type of melanoma is responsible for most deaths?
nodular melanoma
55
How treat melanoma?
complete excision
56
when should you do a sentinel lymph node biopsy for melanoma?
if >1mm thick
57
Do patients with local melanoma treated with complete excision need labs or further testing?
NO
58
If a patient has wheals around their mouth what is the next step?
This is an emergency, needs to go to ED / be admitted for an airway watch
59
Time frame for acute vs chronic urticaria
6 weeks is the cut off
60
Should extensive testing be done for chronic urticaria
No, only "limited targeted laboratory testing" (whatever that means)
61
If a patient with urticaria has: - elevated ESR and CRP - lesions persisting longer than 24 hours - purpuric papules what is the next step?
likely vasculitic urticaria dx: skin bx and get serum complement levels, hep B and C, cryoglobulins and SPEP
62
If a patient with urticaria has: - fever, adenopathy, arthralgia and antigen or drug exposure what is the next step?
serum sickness get CRP, ESR and complement levels
63
If a patient with urticaria has: - features of anaphylaxis, obvious allergen exposure what is the next step?
- immediate hypersensitivity reaction, treat with Epi
64
If a patient with urticaria has: - marked Eosinophilia what is the next step?
parasitic infection is likely, possibly strong, filariasis or trichinosis (esp if have periorbital edema)
65
Treatment for urticaria?
avoid ASA and NSAIDs treat with non sedating antihistamines can also use short term oral glucocorticoids
66
Patient with documented PCN allergy needs PCN for neurosyphilis, next step?
skin testing (identifies 95% of people at risk for immediate reaction)
67
Patient with Lyme is treated with PCN, then has fevers, HA, myalgia, rash and hypotension. Dx?
Jarisch-Herxheimer reaction related to dying spirochetes releasing endotoxin. Begins within 2 hours of treatment, resolves by 48 hours, supportive mgmt and continue antibiotics!
68
Common triggers for erythema multiforme?
HSV Mycoplasma infections tx: supportive
69
What is the main difference between SJS and TEN?
the amount of epidermal detachment or necrosis. 2 or more mucosal surfaces are involved in most patients. SJS <10% TEN >30% yes, there is overlap!
70
violaceous papules around the nose, including the ala or periorobitally and periorificially
Lupus Pernio | associated with sarcoid
71
painful subQ nodules or plaques with overlying red-brown discoloration, superimposed angulated purpuric patches with central necrosis in patients with ESRD
calciphylaxis
72
Tightening and thickening of skin following gadolinium in a patient with CKD
nephrogenic systemic fibrosis
73
painful, exudative ulcer with a purulent base and ragged, edematous violaceous 'overhanging' border
pyoderma gangrenosum
74
pruritic eruiption of papules and transient excoriated blisters on elbows, knees and buttocks
dermatitis herpetiformis
75
skin fragility and small, transient, easily ruptured vesicles in sun exposed areas, mostly hands, and hypertrichosis
porphyria cutanea tarda
76
juicy indurated edematous red-purple plaques and nodules, sharply demarcated from the adjacent skin
Sweet syndrome
77
Patient with diffuse itchiness, no skin findings and normal labs - what's likely dx?
Often medication induced: hydrochlorothiazide, calcium channel blockers, opiates, or NSAIDs can also cause generalized pruritus without skin findings.
78
What is cost-effective treatment of hand dermatitis?
topical emollients such as petrolatum and minimizing hand washing high value care
79
topical glucocorticoids should not be used with which other drug class?
topical antifungals high value care
80
If a patient has a persistent rash after being treated for scabies, what should you do?
Pruritus may persist for weeks after eradication of scabies and does not require retreatment. high value care
81
most spider bites are actually what?
misdiagnosed folliculitis or furuncles high value care
82
all forms of lupus benefit from what derm recs?
sun avoidance and a broad-spectrum sunscreen high value care
83
What should you do before treating for onychomycosis
To avoid unnecessary treatment, obtain culture or microscopic confirmation of onychomycosis. high value care

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