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Clerkship (CC3) > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How do you describe a skin lesion?

A

Start with whether it is raised (papule, plaque, nodule, vesicle, pustule), flat (macule, patch), or lowered (erosion, ulcer).

Then describe the size, shape, color, texture, configuration and distribution.

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2
Q

What is the diagnosis?

A

Moderate comedonal acne without evidence of scarring

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3
Q

What is the diagnosis?

A

Severe nodulocystic acne

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4
Q

What are 4 causative factors for acne?

A

Androgens, bacteria in the follicle, follicular plugging, sebum secretion

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5
Q

What is the first-line treatment for moderate nodular acne without scarring?

A

Topical benzoyl peroxide OR topical retinoid + tetracycline / doxycycline or minocycline

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6
Q

What is appropriate treatment for severe nodular acne or acne with scarring and keloids?

A

Referral to dermatologist for isotretinoin

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7
Q

What are common side effects of isotretinoin?

A

Xerosis, cheilitis, elevated liver enzymes, hypertriglyceridemia.

Monitor for mood changes and depression in individuals with severe acne

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8
Q

How would you treat hormonal acne?

A

Spironolactone / OCP

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9
Q

Describe the lesion. What is the diagnosis?

A

Facial erythema with papules and pustules on the nose and cheeks; scattered papules and pustules on forehead and chin.

Rosacea

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10
Q

What should you always ask patients with rosacea?

A

If they have ocular symptoms ; refer to opthalmology

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11
Q

What is the diagnosis?

A

Erythematotelangiectatic rosacea

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12
Q

What is the diagnosis?

A

Phymatous rosacea

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13
Q

How do you treat rosacea?

A

Avoid triggers (things that make you flush)

Use sunscreen

Add oral antibiotic if there are papules or pustules

Offer laser or bromidine for telangiectasias and erythema

Counsel the patient that it is not curable.

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14
Q

What is the diagnosis?

A

SCC

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15
Q

What must you do to diagnose SCC?

A

Shave biopsy

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16
Q

What are risk factors for SCC?

A

Fair skin, sun exposure, if in non-sun exposed area consider HPV, arsenic or smoking.

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17
Q

How do you manage SCC?

A

Excision, can use radiation or 5-FU cream if in situ or poor surgical candidate.

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18
Q

What is the diagnosis?

A

Actinic Keratosis. Can occur on lips; it’s a thick scaly plaque that feels like sandpaper.

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19
Q

What is the diagnosis?

A

BCC

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20
Q

Do you treat AK?

A

Yes, because it is precancerous. Use liquid nitrogen cryotherapy or 5-FU cream

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21
Q

What is the diagnosis?

A

Nodular BCC

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22
Q

What are the differences in etiology between BCC and SCC/AK

A

BCC -> keratinocyte in basal layer of epidermis.

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23
Q

Is the diagnosis and management of SCC and BCC the same?

A

Yes.

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24
Q

What is the diagnosis?

A

Ulcerated BCC

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25
Q

What is the diagnosis?

A

Superficial BCC

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26
Q

What is the diagnosis?

A

Pigmented BCC

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27
Q

What is the diagnosis?

A

Morpheaform BCC

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28
Q

What is the diagnosis?

A

Sebhorreic Keratosis

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29
Q

What is the diagnosis?

A

Acrochordon

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30
Q

What is the diagnosis?

A

Cherry angioma

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31
Q

What is the diagnosis?

A

Dermatofibroma

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32
Q

What is the lesion?

A

Sebaceous hyperplasia

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33
Q

How do you treat keloids?

A

Intralesional cortisoid injection q4weeks

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34
Q

What is the diagnosis?

A

Epidermal inclusion cyst

35
Q

What is the diagnosis?

A

Milia

36
Q

What is the diagnosis?

A

lipoma

37
Q

Should you use cryotherapy for benign lesions in darker skin?

A

No, electrodessication is preferred because melanocytes are very sensative to cold.

38
Q

What is the atopic triad?

A

Asthma, atopic dermatitis, allergic rhinitis

39
Q

What is the classic symptom of atopic dermatitis?

A

Rash that itches. Often accompanied by xerosis.

40
Q

How does the distribution of atopic dermatitis change with age?

A

Infants -> cheeks, forhead, scalp and extensor surfaces

Older children, teens -> lichenified eczematous plaques, flexural areas

Adults: similar to older adults, may involve hands, wrists, ankles feet and face.

41
Q

How do you treat atopic dermatitis?

A

Gentle skin care

Lots of moisturizers

Topical anti inflammatory

Anti-pruritius (antihistamine)

Antibiotic if existing skin infection

42
Q

What is the diagnosis?

A

Pityriasis alba

43
Q

How do you estimate body surface area.

A

1 patient’s palm = 1% body surface area

44
Q

How do you calculate how many grams to give?

A

1 fingertip unit, 500mg = 2% BSA.

So multiply by BSA, frequency, days.

45
Q

How many grams do you give to cover an adult (1 application)

A

30g

46
Q

What is the diagnosis?

A

Tinea pedis

47
Q

Name the 4 types of tinea pedis

A

Moccasin (may also be 1 hand, 2 feet)

Vesicobullus

Interdigital

Vesicular

48
Q

How do you diagnose tinea?

A

KOH; parallel walls, septated and branching hyphae

49
Q

How would you treat tinea?

A

Terbinafine cream BID, 4 weeks

50
Q

What is the diagnosis?

A

tinea corporis — typcal would be a “ringworm” with central clearing

51
Q

What is tinea cruris?

A

Jock itch, tinea in groin.

52
Q

When would topical antifungals be required?

A

Poor response to topical agensts, animal is the suspected source of infection, large surface area. Give terbinafine 7-14 days once daily.

53
Q

What is the diagnosis? What is the next step?

A

onychomycosis; get a fungal culture of subungual debris.

54
Q

How do you treat onychomycosis?

A

Oral terbinafine (but must confirm susceptibility of organism first) for 12 weeks.

Must monitor liver function, may have taste disturbance, skin reactions, drug interactions.

55
Q

What is the diagnosis?

A

Melanoma.

56
Q

What are the risk factors for melanoma?

A

Age, fair skin, blue eyes, blond hair, freckles

Lots of nevi, atypical nevi

Immunosuppression

Personal or family history of melanoma

UV exposure (esp before puberity, tanning booths)

Genetic syndroms

57
Q

What is the diagnosis?

A

Superficial spreading melanoma

58
Q

What is the diagnosis?

A

Nodular melanoma

59
Q

What is the diagnosis?

A

Lentigo maligna melanoma

60
Q

What is the diagnosis?

A

Acral lentiginous melanoma

61
Q

What is the diagnosis?

A

amelanoic melanoma

62
Q

What is the next step if you suspect melanoma?

A

Biopsy the lesion and do a total body skin exam

63
Q

What are the ABCDEs of melanoma?

A

Asymmetry

Border

Colour

Diameter (>pencil eraser)

Evolving

64
Q

What are some sun safety tips for patients?

A

Use SPF30 or more to all exposed skin with broad spectrum protection

Cover up or seek shade

Watch out near snow, water and sand

Don’t tan for vitamin D

Avoid tanning beds

Check your skin regularly (every month).

65
Q

What is the prevalence of psoriasis? What is the typical age of onset?

A

2$

Camel distribution (20-30 / 50-60)

66
Q

What is the diagnosis? What often precedes flares?

A

guttate psoriasis; strep pharyngitis

67
Q

What is the diagnosis?

A

Flexural (inverse) psoriasis

68
Q

What is the diagnosis? What must you do if this is generalized?

A

Pustular psoriasis; hospitalization and derm consult.

69
Q

What is the diagnosis?

A

palmoplantar psoriasis

70
Q

What is the diagnosis?

A

plaque psoriasis

71
Q

What are 4 key relevant questions for the psoriasis history?

A

Any family history? (1/3 of patients have positive FHx)

Medication history (esp. corticosteroid withdrawal, beta blockers, lithium, anti-malarias, interferon)

PMH (also ask about arthritis, cardiac disease, infections)

Social Hx (smoking, alcohol and obesity are risk factors)

72
Q

What are key areas for plaque psoriasis?

A

scalp, ears, elbows/knees (extensor surfaces), umbilicus, gluteal cleft, nail, recent injury/trauma

73
Q

What is the first line treatment for localized psoriasis?

A

High-potency topical steroid

74
Q

What is the diagnosis?

A

Psoriatic onychodystrophy (nail psoriasis)

75
Q

What is the diagnosis?

A

Psoriatic arthritis

76
Q

What are some alternatives to steroids for topical treatment of psoriasis?

A

calcineurin inhibitors (tacrolismus), calcipotriene, salicylic acid, tar

77
Q

For systemic treatment of psoriasis what is the appropriate agent?

A

Phototherapy

Immunosuppression w Methotrexate / cyclosporine

Biologics e.g. TNF-alpha inhibitors (infliximab, etanercept, adalumimab) or an IL 12/23 blocker (ustekinumab)

78
Q

Should you use a systemic steroid to treat psoriasis?

A

No, because while it may be effective in the short term, steroid withdrawal often causes worsening flare-up of the psoriasis.

79
Q

What is the diagnosis and the most likely causative organism?

A

Verruca vulgaris; human papillomavirus.

80
Q

What is the first line treatment for warts?

A

Cryotherapy or salicylic acid

81
Q

What is the preferred treatment for warts on the face?

A

topical tretinoin

82
Q

What is the diagnosis? What is the most likely infection?

A

genital warts; HPV-6 or HPV-11 (but may also be accompanied by HPV 16/18 which leads to cervical cancer)

83
Q

What treatment options are available for genital warts?

A

Cryotherapy

Topical imiquimod

Topical podophyllin

Clerkship (CC3) (12 decks)

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