Dermatology I highlights

Question 1

List the 8 characteristics of skin lesions you need to memorize (hint: there’s a mnemonic)

Answer 1

CLAMPS TN
1) Color
2) Location/distribution (extent, pattern)
3) Arrangement (grouped vs disseminated & confluence (yes or no)
4) Margination (well- or ill-defined)
5) Palpation (consistency, temperature, mobility, tenderness, depth)
6) Shape
7) Type (ie, papule, macule, pustule)
8) Number: single vs multiple (# of lesions)

Question 2

1) What is a macule patch?
2) What is a plaque patch?

Answer 2

1) A macule > 1cm diameter = patch
2) Flat or barely elevated plaque = patch

Question 3

True or false: wheals are always elevated

Answer 3

True

Question 4

Define urticaria

Answer 4

Multiple wheals/rash = urticaria “hives, whelps”

Question 5

True or false: you cannot cut off keloids, you can only inject them with steroids (which have the risk of atrophy)

Answer 5

True

Question 6

List 6 papulo-squamous diseases (papules and plaques)

Answer 6

1) Dermatitis
2) Eczema
3) Drug eruptions
4) Lichen planus
5) Pityriasis rosea
6) Psoriasis

Question 7

Differentiate between acute and chronic eczema/ dermatitis

Answer 7

1) Acute: pruritis, erythema, vesiculation
2) Chronic: pruritis, xerosis, lichenification

Question 8

1) Does dyshidrotic eczema come back?
2) Describe its vesicles

Answer 8

1) Yes; recurrent
2) Deep-seated pruritic, clear “tapioca-like”

Question 9

What is a major aspect of lichen simplex chronicus treatment?

Answer 9

D/c scratching

Question 10

What are the 2 kinds of contact dermatitis?

Answer 10

Irritant and allergic

Question 11

What is a key element of contact dermatitis?

Answer 11

Well-demarcated [erythema and edema]

Question 12

1) Where is stasis dermatitis usually found?
2) What is a key aspect of Tx?

Answer 12

1) Lower legs and ankles
2) Compression stockings

Question 13

True or false: stasis dermatitis is cellulitis

Answer 13

FALSE

Question 14

Atopic dermatitis:
1) Does it relapse?
2) What is a primary characteristic?
3) Who is it frequent in?

Answer 14

1) Yes
2) Itch-scratch cycle
3) Frequent /w personal or FHx AD, allergic rhinitis, & asthma

Question 15

What can be called “The itch that rashes”?

Answer 15

Atopic dermatitis

Question 16

When should you give PO steroids to pts with atopic dermatitis?

Answer 16

PO steroids only for severe intractable cases

Question 17

1) When is seborrheic dermatitis worse?
2) Name 2 groups it’s common in

Answer 17

1) Worse in fall/winter (dry environment and stress)
2) HIV, Parkinson’s

Question 18

1) What is a primary characteristic of cradle cap (seborrheic dermatitis on head)
2) Describe how seborrheic dermatitis looks like on rest of the body
3) Tx?

Answer 18

1) yellow greasy
2) Red, greasy, yellowish scales, sebacous glands
3) Mild topical steroids

Question 19

Who is perioral dermatitis most common in?

Answer 19

Females 20-45

Question 20

What condition spares vermillion border?

Answer 20

Perioral Dermatitis

Question 21

‘Dusky red to violaceous’ describes what lesions?

Answer 21

Fixed drug eruptions

Question 22

Name 2 drugs that can cause fixed drug eruptions

Answer 22

NSAIDs and oral contraceptives

Question 23

What are the 4 Ps of lichen planus?

Answer 23

Papule, purple, polygonal, pruritic (and flat topped)

Question 24

Is lichen planus usually on flexors or extensors?

Answer 24

Flexors

Question 25

Pityriasis rosea: 1) What is its first Sx? 2) What happens next?

Answer 25

1) Primary (“herald”) patch 2) “Christmas tree” pattern (lines of cleavage) on back

Question 26

Describe a herald patch

Answer 26

Salmon-red plaque with fine collarette peripheral scale

Question 27

What can be described as silver "scales" on a plaque? (Hint: when scraped, they reveal pinpoint bleeding)

Answer 27

Psoriasis

Question 28

Pityriasis rosea: 1) When does it resolve? 2) What is its probable etiology?

Answer 28

1) **Spontaneously in 6-12 weeks** 2) Reactivation HSV-7 & HSV-6

Question 29

What can occur after a strep (guttate) infection?

Answer 29

Psoriasis

Question 30

If a lesion is described as drop-like what may it be?

Answer 30

Guttate psoriasis

Question 31

What is an important Tx for plaque psoriasis?

Answer 31

Topical steroids

Question 32

What condition is characterized by target-shaped lesions and herpes simplex virus?

Answer 32

Erythema multiforme

Question 33

1) What is the most common cause of erythema multiforme? 2) List a common PE Finding

Answer 33

1) Herpes simplex virus (HSV) 2) Target lesions on oral& genitals and/ or palms& soles

Question 34

What is the easiest way to differentiate between erythema multiforme major and minor?

Answer 34

Major always has mucosal involvement, minor does not

Question 35

True or false: erythema multiforme can be found on palms and soles

Answer 35

True

Question 36

When should PO steroids be used for erythema multiforme?

Answer 36

For disabling oral lesions

Question 37

1) Are SJS and TEN acute or chronic? Explain 2) What is their primary characteristic?

Answer 37

1) **Acute, life-threatening mucocutaneous reaction** 2) Necrosis and detachment of epidermis

Question 38

1) What is affected 90% of the time in SJS and TEN? 2) Where are these rarely present?

Answer 38

1) Mucous membranes affected 2) Palms/soles

Question 39

What is a condition that can be drug-induced by anti-seizure meds?

Answer 39

SJS/ TEN

Question 40

What condition is characterized by painful skin sloughing off, conjunctival burning, and painful mouth lesions?

Answer 40

SJS/ TEN

Question 41

True or false: SJS/ TEN typically have symmetric lesions

Answer 41

True

Question 42

1) What is the main Tx for SJS/ TEN? 2) What is a controversial Tx?

Answer 42

1) Admit to ICU or burn center, d/c offending agent/drug 2) Systemic glucocorticoids (contraindicated late in disease course)

Question 43

1) What does Bullous pemphigoid (vesiculobullous disease) often start with? 2) Who does it often occur in? 3) How would you describe the bullae?

Answer 43

1) Urticarial eruption. 2) Elderly patients (60-80yrs) 3) Tense

Question 44

1) What kind of condition is pemphigus (vesiculobullous disease)? 2) Who does it often occur in? 3) What is a key characteristic of the vesicles/ bullae?

Answer 44

1) Autoimmune disease 2) Adults 40-60 3) Easily rupture

Question 45

Which has vesicles/ bullae that are tense, pemphigus or bullous pemphigoid?

Answer 45

Bullous pemphigoid

Question 46

What **must** be present to Dx acne vulgaris?

Answer 46

Comedones

Question 47

1) What causes acne? 2) Name a medication that can contribute to acne

Answer 47

1) Propionibacterium acnes (P. acnes) 2) Steroids

Question 48

What are the 2 types of comedones? Describe each

Answer 48

1) Open= blackheads 2) Closed – white heads

Question 49

List 2 treatments for mild acne vulgaris

Answer 49

1) Topical antibiotics 2) Benzoyl peroxide

Question 50

1) What acne vulgaris Tx cannot be used during pregnancy? 2) What works best?

Answer 50

1) Topical retinoids 2) Combination therapy

Question 51

PO Isotretinoin is used for acne vulgaris when? What is the brand name?

Answer 51

When it's severe; Accutane

Question 52

What is extremely teratogenic?

Answer 52

PO Isotretinoin

Question 53

What can PO Isotretinoin not be used with? Why?

Answer 53

Tetracycline; can cause pseudotumor cerebri

Question 54

PO Isotretinoin can cause what levels to be elevated?

Answer 54

1) Elevated triglycerides 2) Mild to moderate elevations of transaminases

Question 55

What is characterized by "flushing & blushing” and telangiectasias?

Answer 55

Rosacea

Question 56

List what can cause rosacea flare ups

Answer 56

Hot liquids, spicy foods, alcohol/wine, aged cheese, exposure to sun & heat, stress

Question 57

Rhinophyma is found in the late stage of what?

Answer 57

Rosacea

Question 58

Where is folliculitis found?

Answer 58

Hair bearing skin

Question 59

1) What is the most common etiology of folliculitis? 2) What else can cause it?

Answer 59

1) Staph aureus 2) Pseudomonas aeruginosa (hot tub)

Question 60

What medication can bleach stuff?

Answer 60

Benzoyl peroxide

Question 61

List 4 characteristics of the lesions associated with Hidradenitis suppurativa

Answer 61

1) Double comedones 2) Abscesses 3) Sinus tracts 4) "Bridge” scars

Question 62

True or false: Erythema multiforme always occurs on the palms and soles

Answer 62

False