Dermatology

Question 1

What do you do if you see this rash?

Answer 1

tx for lyme - oral doxycycline or amoxicillin

Question 2

How to tx fungal infections of skin?

Answer 2

topical ketoconazole, clotrimazole, econazole, terbinafine, miconazole

Question 3

How do you treat primary and secondary syphilis?

Answer 3

one dose of IM penicillin

if allergic - desensitize and tx wtih penicillin or doxy for 2 weeks

*pt can develop what looks like sepsis/anaphylaxis due to killing off the syphilis and endotoxin release. tx with NSAIDs or aspirin

Question 4

What is this and how do you tx?

Answer 4

chronic dz, not fungal *maybe autoimmune

tx with selenium sulfide every 2-3 weeks to reduce color difference

Question 5

How to treat psoriasis?

Answer 5

Use salicyclic acid to remove the scaly material, then use topical steroids

In severe dz can use coal tar or anthralin derivatives (creams)

*can also use vit D (calcipotriene) and vit A (tazarotene) derivatives

Question 6

What is the best initial test for syphilis?

Answer 6

darkfield exam

*RPR and VDRL will not be positive yet when chancre is present

Question 7

How to treat fungal infections of the nails?

Answer 7

oral terbinafine or itraconazole

(at least 6 wks for fingernails and 12 wks for toenails)

check liver fx and don’t drink

*could do griseofulvin for fingernails for 6-12 months (less efficacy but less toxic)

Question 8

How does secondary syphilis present?

Answer 8

generalized copper-colored, maculopapular rash on palms and soles of feet, otherwise feeling well.

*can also have mucous patch, alopecia areata, condylomata lata

Question 9

How do you treat Lyme disease that is causing cardiac abnormalities (heart block) or neurologic symptoms (bilateral CN7 palsy)?

Answer 9

IV Ceftriaxone for 14-28 days

tele monitoring

Question 10

How to confirm HSV dx?

Answer 10

Tzanck smear of ulcer showing multinucleated giant cells

viral culture (takes 24-48 hrs)

Serology can tell you chronic or new (but not really useful)

Question 11

How to treat herpes zoster?

Answer 11

1. oral acyclovir, valacyclovir, and famciclovir
2. aluminum acetate soaks can be helpful for skin lesion pain
3. analgesics for post-herpetic neuralgia - gabapentin, amitriptyline, lidocaine patch, pregabalin
4. in immunocompromised - use IV acyclovir and hospitalization

Question 12

How to treat herpes simplex?

Answer 12

suppress the disease based on active lesions

tx wtih oral acyclovir, famiciclovir, or valacyclovir

Question 13

What is the work up with erythema nodosum?

Answer 13

CXR (look for sarcoid, TB), if neg…

labs, infectious work up

can be idiopathic

Question 14

How can you confirm herpes zoster (usually don’t need to, just clinical)?

Answer 14

Tzanck test and viral culture

Question 15

What are characteristics of melanoma?

Answer 15

asymmetry

irregular borders

Color variation

diameter > 6 mm

Question 16

What is this diagnosis and how do you get rid of it?

Answer 16

melanoma

excision

Question 17

How do basal cell cancers present?

Answer 17

most common skin cancer

shiny or pearly appearance

Question 18

What is the Ramsay Hunt Syndrome?

Answer 18

Herpes Zoster that causes cranial nerve 7 palsy

*lose sense of taste and ipsilateral facial palsy

look for vesicles in the ear canal

Question 19

How do you dx and tx squamous cell cancer?

Answer 19

biopsy

treat with surgical removal or radiotherapy if the lesion cannot be treated surgically

Question 20

What causes tinea versicolor and what does it look like on KOH?

Answer 20

malassezia furfur

“spaghetti and meatballs pattern”

Question 21

What is seen with tinea versicolor?

Answer 21

light skin - often well demarcated hyperpigmented lesions over back/shoulders/abdomen worse in summer/spring

dark skin - can look hypopigmented

Question 22

What is the natural history fo lyme disease?

Answer 22

rash at 7-10 days, goes away in a couple weeks, then joint pain and can progress to cardiac manifestations or neurologic manifestations

Question 23

How to treat fungal infections of the scalp or beard?

Answer 23

1. terbinafine or itraconzaole oral is best
2. could also do oral griseofulvin for 6-8 wks

Question 24

How to dx superficial fungal infections?

Answer 24

KOH test of leading edge of lesion

*KOH desolves tissue, but leaves fungus

Question 25

What causes erythema nodosum?

Answer 25

inflammation of the skin that is commonly assoc with infections/inflammatory conditions (pregnancy, strep, coccidio, histoplasmosis, sarcoidosis, IBD, syphilis, hepatitis, TB

Question 26

Who should get the herpes zoster vaccine?

Answer 26

everyone at age 60!

helps decrease shingles by 50% and post-herpetic neuralgia by 66%

Question 27

What is this?

Answer 27

HSV (could be 1 or 2)

Question 28

How does primary syphilis present?

Answer 28

genital chancre (can happen in oral cavity too) - painless ulcer with heaped-up, indurated edges

Question 29

How do squamous cell carcinomas present?

Answer 29

common on lip, sun-exposed areas

often ulcerates

Question 30

What test do you use for secondary syphilis?

Answer 30

VDRL and RPR test

Then confirm with treponemal specific tests

Question 31

How do you dx and tx basal cell carcinoma?

Answer 31

need a shave or punch biopsy

tx is surgical removal - Mohs microsurgery is best (go until you have clean margins)

Question 32

How do you treat eczema from mild to severe?

Answer 32

moisturize w/ ointments

topical steroids

tacrolimus

Question 33

What is the natural hx of erythema nodosum?

Answer 33

lasts 4-6 wks

do not ulcerate

very tender

Question 34

What is this dz?

Answer 34

Herpes Zoster (Shingles)

Question 35

What is the most common type of melanoma?

Answer 35

superficial spreading melanoma