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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
Q

treatment for topical candida?

A

topical nystatin, miconazole, clotrimazole, ketoconazole or econazole

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26
Q

Who needs treatment for onychomycosis?

A

patients with PVD or diabetes to prevent development of cellulitis (HY)

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27
Q

Should you treat onychomycosis without KOH scrape or culture positive for dermatophytes?

A

NO

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28
Q

Should you treat dermatophytes with combo of topical anti fungal and steroids?

A

NO

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29
Q

Should you treat dermatophytes with oral ketoconazole?

A

NO, because of risk of hepatotoxicity

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30
Q

Molluscum contagiosum is associated with what infection?

A

HIV

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31
Q

What is the treatment for molluscum contagiosum?

A

cryosurgery or curettage, ART if assoc with HIV

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32
Q

If a patient has severe, complicated or recurrent zoster what should you test for?

A

HIV

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33
Q

Patient has vesicles in ears and diminished taste on anterior tongue and ipsilateral facial paralysis

diagnosis?

A

Ramsey-Hunt from Zoster

Refer to ENT

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34
Q

How diagnose VZV?

A

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
Q

Treatment for postherpetic neuralgia?

A

gabapentin, pregabalin, TCAs or topical lidocaine or capsaicin

36
Q

Who should get shingrix vaccine?

A

Adults > 50 yo regardless or prior infection or prior vaccination with Zostavax (live vaccine)

37
Q

Should you use steroids or topical antivirals to treat zoster?

A

NO

38
Q

How diagnose scabies?

A

microscopic identification using KOH or mineral oil; skin biopsy

39
Q

Treatment for scabies?

A

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
Q

Patient treated for scabies has persistent itching a week later, next step?

A

Do not re-treat for scabies, itching can continue for up to two weeks post treatment

41
Q

Treatment for bedbugs?

A

lesions resolve spontaneously

topical glucocorticoids and oral antihistamines for itch

eradicate bedbugs

42
Q

Rapid onset of multiple, itchy seborrheic keratoses can be a sign of what?

A

GI malignancy

43
Q

Treatment for warts?

A

salicylic acid
cryotherapy
no therapy (because likely to spontaneously resolve)
podophyllin often used for anogenital warts

44
Q

Actinic keratosis is a precursor to what?

A

squamous cell carcinoma

45
Q

Treatment for actinic keratosis?

A

liquid nitrogen or curettage

topical 5-FU or imiquimod cream if numerous lesions

Excision if >5mm or symptomatic or rapidly growing lesions

46
Q

Prevention of skin cancer in low risk adults?

A

sun avoidance
sun protective clothing

do NOT choose annual screening for low risk adults!

47
Q

How confirm diagnosis of squamous cell carcinoma?

A

punch or shave biopsy

48
Q

treatment for squamous cell carcinoma?

A

small lesions: electrodesiccation and curettage

most lesions require excision

49
Q

how diagnose basal cell carcinomas?

A

biopsy

50
Q

treatment for basal cell carcinoma?

A

simple excision

if high risk, on face or hands or high risk histology -> Mohs

51
Q

Dysplastic nevi carry an increased risk of?

A

melanoma

52
Q

How treat dysplastic nevi that develop risk features of melanoma?

A

remove and send for path

53
Q

What are the ABCDEs of melanomas

A 
Asymmetry 
Border irregularity 
Color variegation
Diameter >6mm
Evolution - lateral expansion or vertical growth
54
Q

What type of melanoma is responsible for most deaths?

A

nodular melanoma

55
Q

How treat melanoma?

A

complete excision

56
Q

when should you do a sentinel lymph node biopsy for melanoma?

A

if >1mm thick

57
Q

Do patients with local melanoma treated with complete excision need labs or further testing?

A

NO

58
Q

If a patient has wheals around their mouth what is the next step?

A

This is an emergency, needs to go to ED / be admitted for an airway watch

59
Q

Time frame for acute vs chronic urticaria

A

6 weeks is the cut off

60
Q

Should extensive testing be done for chronic urticaria

A

No, only “limited targeted laboratory testing” (whatever that means)

61
Q

If a patient with urticaria has:

  • elevated ESR and CRP
  • lesions persisting longer than 24 hours
  • purpuric papules

what is the next step?

A

likely vasculitic urticaria

dx: skin bx and get serum complement levels, hep B and C, cryoglobulins and SPEP

62
Q

If a patient with urticaria has:
- fever, adenopathy, arthralgia and antigen or drug exposure

what is the next step?

A

serum sickness

get CRP, ESR and complement levels

63
Q

If a patient with urticaria has:
- features of anaphylaxis, obvious allergen exposure

what is the next step?

A
  • immediate hypersensitivity reaction, treat with Epi
64
Q

If a patient with urticaria has:
- marked Eosinophilia

what is the next step?

A

parasitic infection is likely, possibly strong, filariasis or trichinosis (esp if have periorbital edema)

65
Q

Treatment for urticaria?

A

avoid ASA and NSAIDs

treat with non sedating antihistamines

can also use short term oral glucocorticoids

66
Q

Patient with documented PCN allergy needs PCN for neurosyphilis, next step?

A

skin testing (identifies 95% of people at risk for immediate reaction)

67
Q

Patient with Lyme is treated with PCN, then has fevers, HA, myalgia, rash and hypotension.

Dx?

A

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
Q

Common triggers for erythema multiforme?

A

HSV
Mycoplasma infections

tx: supportive

69
Q

What is the main difference between SJS and TEN?

A

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
Q

violaceous papules around the nose, including the ala or periorobitally and periorificially

A

Lupus Pernio

associated with sarcoid

71
Q

painful subQ nodules or plaques with overlying red-brown discoloration, superimposed angulated purpuric patches with central necrosis in patients with ESRD

A

calciphylaxis

72
Q

Tightening and thickening of skin following gadolinium in a patient with CKD

A

nephrogenic systemic fibrosis

73
Q

painful, exudative ulcer with a purulent base and ragged, edematous violaceous ‘overhanging’ border

A

pyoderma gangrenosum

74
Q

pruritic eruiption of papules and transient excoriated blisters on elbows, knees and buttocks

A

dermatitis herpetiformis

75
Q

skin fragility and small, transient, easily ruptured vesicles in sun exposed areas, mostly hands, and hypertrichosis

A

porphyria cutanea tarda

76
Q

juicy indurated edematous red-purple plaques and nodules, sharply demarcated from the adjacent skin

A

Sweet syndrome

77
Q

Patient with diffuse itchiness, no skin findings and normal labs - what’s likely dx?

A

Often medication induced:
hydrochlorothiazide, calcium channel blockers, opiates, or NSAIDs can also cause generalized pruritus without skin findings.

78
Q

What is cost-effective treatment of hand dermatitis?

A

topical emollients such as petrolatum and minimizing hand washing

high value care

79
Q

topical glucocorticoids should not be used with which other drug class?

A

topical antifungals

high value care

80
Q

If a patient has a persistent rash after being treated for scabies, what should you do?

A

Pruritus may persist for weeks after eradication of scabies and does not require retreatment.

high value care

81
Q

most spider bites are actually what?

A

misdiagnosed folliculitis or furuncles

high value care

82
Q

all forms of lupus benefit from what derm recs?

A

sun avoidance and a broad-spectrum sunscreen

high value care

83
Q

What should you do before treating for onychomycosis

A

To avoid unnecessary treatment, obtain culture or microscopic confirmation of onychomycosis.

high value care

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