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MCCQE1 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

45 y-o patient thin blisters, (+) Nikolsky sign: skin detachment with gentle traction, and involvement of oral mucosa.

Dx, next step, tx?

A

Pemphigus vulgaris (antibodies against desmosomes)

Next step:
Biopsy with tombstone effect and immunofluorescence throughout the epidermis.

Tx:

  • 1st: high-dose steroids
  • When controlled: mycophenolate mofetil, rituximab
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2
Q

75 y-o patient with thick blisters, (-) Nikolsky sign and not involvement of oral mucosa.

Dx, next step, tx?

A

Bullous Pemphigoid (antibodies against hemidesmosomes)

Next step:
Biopsy showing intact epithelium and immunofluorescence lights up only the basement membrane

Tx:

  • Widespread disease: Systemic Steroids
  • Local disease: topical steroids
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3
Q

Patient with itchy vesicular lesion that looks like herpes on extensor regions of buttocks, (-) Nikolsky sign. The patient also has diarrhea, distension, weight loss.

Dx, next step, tx?

A

Dermatitis herpetiformis and celiac disease (IgA deposition on the dermis causing enlargement of papillae)

Next step:
• Anti-transglutaminase and anti-endomysial
• EGD and Bx of small bowel

Tx:

  • Dapsone for symptomatic relief.
  • Remove gluten from diet (wheat, rye (centeno), oat, barley (cebada))
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4
Q

Patient Blisters in sun-exposed areas (e.g., dorsum of hands), and Hypertrichosis.

Dx, next step, tx?

A

Porphyria Cutanea Tarda

Next step:
Uranalysis: Coral red urine under wood’s lamp

Tx: No sun exposure

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5
Q

Porphyria Cutanea Tarda associated with?

A

May not manifest until:

  • HCV
  • Hemochromatosis
  • Oral contraceptive pills (OCP)
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6
Q

Patient with Rash + scales + flakes in hair areas (e.g, scalp, and eyebrows). Dx and tx?

A

Seborrheic dermatitis

Tx: Selenium shampoo

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7
Q

Patient with erythematous patches, symmetric silver scales that bleeds when picked in extensor surfaces and Gluteal fold. On physical you notice small holes in nails and separation of nail from the nail bed.

Dx and tx?

A

Psoriasis

Tx:

  • 1st: UV light
  • 2nd: topical steroids
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8
Q

Patient with hx of lymphoma who now has erythematous patches, symmetric silver scales that bleeds when picked in extensor surfaces and Gluteal fold. On physical you notice small holes in nails and separation of nail from the nail bed.

Next step?

A

Bx the lesions

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9
Q

Patient with erythematous patches, symmetric silver scales that bleeds when picked in extensor surfaces andgGluteal fold. On physical you notice small holes in nails and separation of nail from the nail bed. In addition, the patient has joint pain.
Dx and tx?

A

Psoriatic arthritis

For skin lesions:

  • 1st: UV light
  • 2nd: topical steroids

For joint pain:

  • NSAIDs
  • DMARDs (hydroxychloroquine, methotrexate)
  • TNF-alfa-inhibitors (Etanercept) if severe disease
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10
Q

Patient with many flat, oval, salmon-coloured macules that have scales in the center without reaching the edge. Spare palms and soles.

Dx and tx?

A

Pityriasis Rosea

Tx: nothing; Self-limited disease (6 weeks)

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11
Q

Patient with many flat, oval, salmon-coloured macules that have scales in the center without reaching the edge. On physical you notice lesions on palms and soles as well.
Next step?

A

R/O syphilis and do a RPR

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12
Q

Patient who after the start of a new medication (ACE-i, thiazides, or loop diuretics) has intensely pruritic pink/purple flat-topped papules with a reticulated network of fine white lines.
Dx and tx?

A

Lichen Planus

Tx: topical steroids

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13
Q

Patient with chronic itchy symmetric lichenification (scaring) at the antecubital fossa, popliteal fossa and extensor. History of allergies, asthama, atopy.
Dx and tx?

A

Atopic dermatitis (eczema)

Tx:

  • Avoid trigger
  • Emulsions to alleviate itch
  • Short-term topical steroids
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14
Q

Patient with erithematous itchy lesion in a finger with the shape of a ring.
Dx and tx?

A

Contact dermatitis (type IV hypersensitivity )

Tx:

  • Avoid trigger
  • Topical steroids for itch
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15
Q

Patient with heart failure and lowe limb edema who has erythema, brown discoloration, and scaling (flaking) of skin. It looks like bileteral celulitis.
Dx and tx?

A

Stasis dermatitis

Tx:

  • Diuretics
  • Compression stockings
  • Elevation of legs
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16
Q

Healthcare professional with dry, erythematous hands. Dx and tx?

A

Hand dermatitis for excessive hand washing.

Tx:

  • Stop excessive hand washing
  • Protective gloves
  • Avoid harsh soaps
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17
Q

Patient who after a bee sting has annular, blanching red papule of varying size that blanches when pushed. BP is normal.
Dx and tx?

A

Urticaria (hives)

Tx:

  • Avoid trigger
  • Anti-histamines
  • Steroids
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18
Q

Patient who after a bee sting has annular, blanching red papule of varying size that blanches when pushed. BP is low.
Dx and tx?

A

Urticaria (hives) + anaphylaxis

Tx:

  • IM epinephrine first!
  • Anti-histamines
  • Steroids
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19
Q

Hospitalized patient who 14 days after the start of a new medication has a pink, morbilliform rash that is widespread, symmetric, and pruritic.
Dx and tx?

A

Drug reaction

Tx:

  • Stop culprit drug
  • Mild Sx: Diphenhydramine
  • Severe sx: steroids
  • If anaphylaxis–> IM epinephrine
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20
Q

Patient with rash or blister in the same one spot 24 hrs after the same drug every time it’s administered.
Dx and tx?

A

Fixed drug reaction (no contraindication to antibiotics)

Tx: Avoid the drug

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21
Q

Patient with target shaped lesions in knees, face, fingers, palms and soles.
Differential?

A

Syphilis
Lyme disease
Erythema multiforme

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22
Q

Patient who after initiating a drug (Sulfa, Anticonvulsants, NSAIDs, HIV meds, and PCN) has target shaped lesions in knees, face, fingers, palms and soles.

Dx and tx?

A

Erythema multiforme

Tx:

  • Remove culprit drug
  • Topical steroids
  • Watch out for Steven-Johnson if mucosal invovement
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23
Q

Differential of widespread loss of sheets of skin and (+) Nikolsky Sign.

A
  • Pemphigus vulgaris (30-50 y-o, no fever, blistering)
  • Steven-Johnson Syndrome (< 10% of body surface; basal cell degeneration on Bx)
  • Toxic Epidermal Necrolysis (> 30% of body surface; full-thickness epidermal necrosis on Bx)
  • Staphylococcus Scalded Skin Syndrome (infant, fever, no mucosal involvement)
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24
Q

Patient with widespread loss of sheets of skin and (+) Nikolsky Sign after initiating a drug (Sulfa, Anticonvulsants, NSAIDs, HIV meds, and PCN).

< 10% of body surface
Basal cell degeneration on Bx
Mucosal invovement

Dx and tx?

A

Steven-Johnson Syndrome

Tx:

  • Stop all meds (even steroids)
  • Burn unit
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25
Q

Patient with widespread loss of sheets of skin and (+) Nikolsky Sign after initiating a drug (Sulfa, Anticonvulsants, NSAIDs, HIV meds, and PCN).

> 30% of body surface
Full-thickness epidermal necrosis on Bx
Mucosal invovement

Dx and tx?

A

Toxic Epidermal Necrolysis

Tx:

  • Stop all meds (even steroids)
  • Burn unit
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26
Q

5 y-o patient, with fever and sloughing of skin that stats in skin folds. No mucosal involvement.

Dx and tx?

A

Staphylococcus Scalded Skin Syndrome

Tx: Nafcillin

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27
Q

ABCDE in dermatology?

A 
If only one positive--> Bx
•	Asymmetry
•	Borders (irregular)
•	Colour (mixed colours)
•	Diameter (> 5mm)
•	Evolution
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28
Q

Old patient with a Large, Greasy, Brown, Crusted lesion that hasn’t changed. Dx?

A

Seborrheic keratosis

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29
Q

Patient how is a farmer/construction worker/sailor who has an erythematous lesion with a sandpaper-like yellow scale.
Dx and next step and tx?

A

Actinic keratosis (pre-malignant lesion wich evolves into Bowen’s disease and then into squamous cell carcinoma)

Next step: Bx

Tx:

  • Local ablation with cryosurgery
  • 5 Fluorouracil (5-FU) cream for diffuse lesions
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30
Q

Patient how is a farmer/construction worker/sailor who has a fleshy, erythematous, and crusted or ulcerated lesion in lower lip. Dx and tx?

A

Squamous cell carcinoma

Tx: resection

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31
Q

Patient with a fleshy, erythematous, and crusted or ulcerated lesion in sun-exposed area that resolves in 6 weeks on its own. Dx?

A

Keratoacanthomas

32
Q

Patient with AIDS who has a purple lesion. Dx and tx?

A

Kaposi sarcoma

Tx:

  • HAART
  • Fails to resolve with HAART–> Local or systemic chemotherapy
33
Q

Patient with small scaly macules of varying colour and areas that don’t tan.
Dx, next step and tx?

A

Tinea Versicolor

Next step: KOH showing “spaghetti and meatballs”

Tx:

  • Selenium shampoo or,
  • Ketoconazole
34
Q

Patient with small sharply demarcated depigmented macules or patches with irregular borders that can coalesce.
Dx, next step and tx?

A

Vitiligo
Next steps:
- Wood’s lamp test
- Bx: absence of melanocytes

Tx:

  • Local disease: high-potency topical steroids
  • Extensive disease: UV light
35
Q

Cause of albinism?

A

Normal number of melanocytes. But defect in tyrosinase activity, which is needed to produce melanin

36
Q

Patient with white forelock.

Dx?

A

Piebaldism (problem with melanocyte migration)

37
Q

Child with hypopigmented spots, elevated patched of fleshy plaques and hyperplastic blood vessels.
Dx and next steps?

A

Ash Leaf spot (path: Tuberous sclerosis)

Shagreen patches: Elevated patched of fleshy plaques
Adenoma sebacceum: Hyperplastic blood vessels

Next steps:

  • Wood’s lamp
  • CT scan to identify tubers (benign tumors)
38
Q

Tx of Male Pattern Baldness?

A

Tx:

  • Minoxidil
  • Finasteride
39
Q

Patient with well-defined circular bald spot. On a closer look, you see small hairs within the bald-spot that appear to be floating because the hair shaft gets progressively narrower and loses pigment close to the scalp.
Name of the sing, dx and tx?

A

Exclamation mark sign

Dx: Alopecia Areata

Tx: steroids

40
Q

Patient with a circular bald spot with all hairs at equal length.
Dx, next step, and tx?

A

Tinea Capitis

Next step: KOH

Tx: oral Griseofulvin (to prevent permanent hair loss)

41
Q

Woman with history of OCD, PTST and major depressive disorder who has patchy alopecia with hair regrowth at different lengths.

Dx and next step?

A

Trichotillomania

Next step: shaving a “window” into the scalp and assessing equal hair growth within the window

42
Q

Child with honey-crusted lesion in face.

Dx and tx?

A

Impetigo

Tx:

  • Amoxicillin
  • If PNC allergic or no response–> Clindamycin
43
Q

Adult with a dark red, well-demarcated, indurated lesion that appears to climb up the extremity.

Dx and tx?

A

Erysipelas

Tx: Amoxicillin

44
Q

Patient with whiteheads and blackheads in the face.

Dx and tx?

A

Acne

Tx: topical retinoids

45
Q

Patient with pustules, and inflamed and whiteheads and blackheads in the face.

Dx and tx?

A

Acne

Tx: topical retinoids +Benzoyl Peroxide

46
Q

Patient with severe pustules and nodulocysts in a big area of the face.

Dx and tx?

A

Acne

Tx: Doxycycline or erythromycin

47
Q

Paciente with severe refractory acne. S/he has already been treated with topical retinoids, Benzoyl Peroxide, and Doxycycline without improvement.

Tx?

A

Next step: Urinary pregnancy test

Tx: Isotretinoin

48
Q

Patient with interdigital maceration and scaling between toes.

Dx and tx?

A

Tenia pedis (athlete’s foot)

Tx: topical antifungal

49
Q

Patient with round expanding plaque with moderate scaling and central clearing.

Dx and tx?

A

Tinea corporis

Tx: topical antifungical

50
Q

You suspect tinea unguium (onychomycosis) in a patient.

Next step and tx?

A

Next step: KOH

Tx: Oral Terbinafine or itraconazole

51
Q

Old patient with mole with “Stuck-on” appearance. It’s large, greasy, brown and crusted.
Dx?

A

Seborrheic keratosis

52
Q

Red plaques with silvery-white scales and sharp margins.

A

Psoriasis.

53
Q

The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

A

Basal cell carcinoma.

54
Q

Honey-crusted lesions.

55
Q

A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.

A

Cellulitis.

56
Q

+ Nikolsky’s sign.

A

Pemphigus vulgaris.

57
Q

(-) Nikolsky’s sign.

A

Bullous pemphigoid.

58
Q

A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

A

Acanthosis nigricans. Check fasting blood glucose to rule out diabetes.

59
Q

Rash in dermatomal distribution.

Dx?

A

Varicella zoster.

60
Q

Flat-topped papules.

A

Lichen planus.

61
Q

Iris-like target lesions / Target shaped lesion.

A

Erythema multiforme.

62
Q

A lesion characteristically occurring in a linear pattern
in areas where skin comes into contact with clothing or
jewelry.

A

Contact dermatitis.

63
Q

Presents with a herald patch, Christmas-tree pattern.

A

Pityriasis rosea.

64
Q

A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

A

Alopecia areata (an autoimmune process).

65
Q

Pinkish, scaling, flat lesions on the chest and back; KOH prep has a “spaghetti-and-meatballs” appearance.

A

Pityriasis versicolor.

66
Q

Four characteristics of a nevus suggestive of melanoma.

A

Asymmetry, border irregularity, color variation, and large diameter.

67
Q

A premalignant lesion from sun exposure that can lead to squamous cell carcinoma.

A

Actinic keratosis.

68
Q

“Dewdrops on a rose petal.”

A

Lesions of 1° varicella.

69
Q

“Cradle cap.” Seborrheic dermatitis.

A

Treat with antifungals.

70
Q

Associated with Cutibacterium acnes and changes in androgen levels.

A

Acne vulgaris.

71
Q

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

A

Herpes simplex.

72
Q

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

Dx?

A

Lichen sclerosus.

73
Q

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

A

Squamous cell carcinoma.

74
Q

Patient with pearly lesion in sun-exposed area. The patient says that it bleeds easily and fails to heal.

Dx, next step, tx?

A

Basal cell

Next step:

  • Excisional Bx
  • Incisional Bx if lesion is too big or in the face
  • *Punch is the wrong answer**

Tx: resection

  • On the face: Mohs surgery
  • Limb: Excisional Bx
75
Q

Patient with well-defined red papule, non-healing ulcer, or lower lip hyperpigmentation.

Dx, next step, tx?

A

Squamous cell carcinoma

Next step:

  • Excisional Bx
  • Incisional Bx if lesion is too big or in the face
  • *Punch is the wrong answer**

Tx: resection

  • On the face: Mohs surgery
  • Limb: Excisional Bx
76
Q

Patient with jet black lesion without any hair.

Dx, next step?

A

Melanoma

Next step:
If large lesion/ low suspicion= Punch
If small lesion/ high suspicion= Excisional lesion

MCCQE1 (19 decks)

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