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EOR Exam - Family Medicine > Dermatology Part 1 > Flashcards

Dermatology Part 1 Flashcards

1
Q

Define acanthosis nigricans.

A

Thickened, velvety, darkly pigmented plaques on the neck or axillae

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2
Q

What patients typically get acanthosis nigricans and what condition must be screened for when it is seen?

A

Common in obesity and diabetes –> must screen patents for DM when seen

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3
Q

What underlying condition may be present in a patient with acanthsis nigricancs?

A

Benign: obesity, drug-induced, DM, other endocrine disorders
Malignant: GI/GU malignancy, lymphoma

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4
Q

Define and describe acne vulgaris.

A

Open comedones (blackheads), closed comedones (whiteheads), papules and pustules on the face, neck, chest, and upper back.

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5
Q

In what patients is acne vulgaris most commonly seen and what is the most common causative organism?

A

Seen in adolescents.

Caused by propionibacterium acnes

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6
Q

What are the treatment options for acne vulgaris and what are any contraindications?

A

Mild: topical retinoids, topical abx, benzoyl peroxide
Moderate: add PO abx
Severe: isotretinoin - CI in pregnancy –> must use two forms of birth control

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7
Q

Define and describe actinic keratosis.

A

Patient will c/o rough bumps on the head with a PE that shows rough, scaly, erythematous papules on sun-exposed areas.

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8
Q

What patients get actnic keratosis and what condition must be investigated when seen?

A

Seen in men only, usually with an outdoor occupation or other Hx of sun exposure. May progress to squamous cell carcinoma.

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9
Q

What are the risk factors for developing actinic keratosis?

A

Sun exposure, fair skin

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10
Q

Define and describe alopecia areata.

A

Patches of smooth, non-scarring hair loss with patches of smaller hairs termed exclamation hairs

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11
Q

What is the most common cause of alopecia areata and what is the treatment?

A

Cause: autoimmune
Treatment: intralesional corticosteroids

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12
Q

Define and describe basal cell carcinoma.

A

Pearly papule with rolled borders and telangiectasia seen on the face, ears, or neck.

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13
Q

How is the diagnosis of basal cell carcinoma made and what is the treatment?

A

Dx: shave biopsy
Tx: surgical excision

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14
Q

T/F: Basal cell carcinoma is rare, but has a high mortality rate because it commonly metastasizes before being diagnosed.

A

False: It is the most common form of skin cancer, but rarely metastasizes.

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15
Q

Define and describe bullous pemphigoid.

A

Patient will c/o intensely pruritic papules that became large, tense blisters with a PE that shows tense firm blisters that do not extend with lateral pressure.

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16
Q

Define Nikolsky sign and state its significance relative to bullous pemphigoid.

A

NS: lateral pressure applied to the lesion causes it to sheer away from the underlying healthy epidermal layers. This is NOT present in bullous pemphigoid.

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17
Q

List the most common patient population, cause, and treatment for bullous pemphigoid.

A

Pop: patients > age 60
Cause: autoimmune
Treatment: corticosteroids and immunosuppressants

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18
Q

Define and describe cellulitis.

A

Patient c/o pain, redness, and swelling with a PE that shows tenderness, erythema with poorly demarcated borders, and lymphedema.

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19
Q

State the treatment and most common causative organisms of cellulitis.

A

Cause: staph and strep
Tx: Bactrim, doxycycline, linezolid –> admit to hospital if no improvement in 48 hours.

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20
Q

Describe condyloma acuminata

A

painless, cauliflower-like lesion on genitals.

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21
Q

What is the most common causative agent of condyloma acuminata and what condition must be considered when seen?

A

Cause: HPV 6 and 11 –> strong association with DU and rectal cancer

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22
Q

What comorbid conditions are commonly present in patients with atopic dermatitis?

A

Asthma and/or hay fever

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23
Q

Describe the common S/S of patents with atopic dermatitis.

A

Itchy, scaly rash that is worse in winter. PE will show thick, leathery, hyperpigmented areas - especially on flexor surfaces.

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24
Q

Differentiate the location of PE findings in atopic dermatitis in infants versus those in children and adults.

A

Infants: face and extensor surfaces of extremities

Kids/adults: flexor surface of the extremities –> face is less commonly involved.

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25
Q

What sequelae are patients with atopic dermatitis particularly susceptible to?

A

Compromised skin integrity leading to infections

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26
Q

Describe the skin findings associated with seborrheic dermatitis.

A

Superficial scales that are typically greasy and yellow.

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27
Q

In what patients is seborrheic dermatitis most common and where are the skin findings typically found?

A

Pediatrics –> scalp, central face, preauricular skin, and intertrigenous areas (skin folds

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28
Q

Describe the physical exam findings associated with perioral dermatitis.

A

irregularly grouped, discrete red papulopustules on a red base on the face, but spare the vermilion
border (the line just above upper lip)

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29
Q

In what patients will perioral dermatitis be seen?

A

Women age 16 - 45

30
Q

What is the treatment for perioral dermatitis?

A

metronidazole and erythromycin

31
Q

Describe the skin findings of dermatitis herpeteformis.

A

Multiple intensely pruritic papules and vesicles that occur in grouped arrangements

32
Q

In what comorbid conditions is dermatitis herpeteformis commonly seen?

A

Most common = celiac.

Other = thyroid disease

33
Q

What is the treatment for dermatitis herpeteformis?

A

Dapsone and a gluten free diet

34
Q

What are the most common causes of allergic dermatitis?

A

Nickel, poison ivy, soaps, clothing

35
Q

What type of hypersensitivity reaction is allergic dermatitis?

A

Type IV

36
Q

How is allergic dermatitis diagnosed and how is it treated?

A

Dx: patch test
Tx: topical steroids, PO steroids if severe –> typically will resolve spontaneously in 1 - 3 weeks

37
Q

What is the hallmark sign of a drug eruption?

A

Rash recurs in the same location each time the drug is used.

38
Q

What medications are most commonly responsible for drug eruptions?

A

Bactrim, tetracyclines, penicillins, quinolones, dapsone, NSAIDs, Tylenol, bartiturates, antimalarials

39
Q

What are the common S/S associated with dyshidrotic eczema?

A

Vesicles that appear to contain grains of tapioca and intense itching on the palms and sides of the fingers.

40
Q

Describe the S/S associated with eryspilas.

A

Deeply erythematous, sharply demarcated elevated shiny patch with fever, malaise, chills, nausea.

41
Q

What is typically the causative organism of eryspilas and what is the treatment?

A

Cause: Strep pyogenes
Tx: PCN, amoxicillin, azithromycin, or clarithromycin

42
Q

Describe the S/S associated with erythema mutiforme.

A

Target-like lesions with a central dark papule surrounded by a pale area and a halo of erythema found mostly on the palms and soles.

43
Q

What conditions typically manifest erythema multiforme?

A

HSV

44
Q

What drugs commonly elicit the development of erythema multiforme?

A

SOAPS –> Sulfa drugs, Oral hyperglycemics, Anticonvulsants Penicillin, nSaids

45
Q

Differentiate erythema multiforme minor and major.

A

Major involves the mucus membranes

46
Q

What infections most commonly cause viral exanthems (rash)?

A

Varicella, erythema infectiosum, roseola, measles (rubeola), rubella

47
Q

Define folliculitis and state the most common infectious cause.

A

Inflammation of the hair follicles –> Staph aureus

48
Q

Describe S/S associated with folliculitis.

A

Erythematous papules/pustules, usually not painful. Abscess may form in more severe cases.

49
Q

What is the treatment of folliculitis?

A

1: gentle cleansing and mild compresses –> keep dry
2: Topical clindamycin or erythromycin if infectious
3: PO abx in severe cases

50
Q

What areas of the body are likely to have a non-infectious folliculitis?

A

Warm, oily areas

51
Q

What is usually the causative agent in hot tub folliculitis?

A

Pseudomonas

52
Q

How is hot tub follicuitis treated?

A

Usually self-limiting. May use topical cream or PO cipro in severe/persistent cases.

53
Q

What are the common S/S associated with HSV?

A

Painful vesicles with erythematous base and erosions on the tongue, buccal mucosa, and lips.

54
Q

What lab test is used to diagnose HSV and what is the finding?

A

Multinucleated giant cells on Tzanck smear, but Dx is usually clinical.

55
Q

What is the most common causative agent of oral herpes and what is the treatment?

A

HSV-1 –> topical antivirals or PO acyclovir

56
Q

In what type of patient will hidradenitis suppurativa be seen?

A

Women with Hx of lesions that have waxed and waned over past few years.

57
Q

Describe the common S/S associated with hidradenitis suppurativa.

A

Tender nodules in her axillae and anogenital area where apocrine sweat glands are present. Lesions will often be malodorous with exudative drainage.

58
Q

What is the treatment for hidradenitis suppurativa?

A

intralesional triamcinolone, topical clindamycin

59
Q

What system is used to grade severity of hidradenitis suppurativa?

A

Hurley staging system

60
Q

What is the typical modality leading to histamine poisoning and what is the treatment?

A

Ingestion of dark fleshed, peppery tasting fish –> tuna, mahi-mahi, mackerel. Tx with antihistamines.

61
Q

Describe the 4 types of hypersensitivity reactions.

A

1: IgE degranulation of mast cells –> anaphylaxis, urticaria, angioedema –> requires prior exposure
2: IgG/M reaction with complement activation –> requires prior exposure.
3: IgG mediated with complement activation –> SLE, RA, serum sickness
4: T-cell activation against surface antigens –> contact dermatitis, transplant rejection, PPD skin test

62
Q

In what population is impetigo typoclaly seen and what is the causative organism?

A

Children ages 2-5 –> staph aureus and group A strep

63
Q

What are the risk factors for impetigo?

A

warm, humid conditions, poverty, crowding, and poor hygiene –> secondary impetigo can occur at sites of minor abrasions.

64
Q

Describe the S/S associated with impetigo.

A

Begins as papules that progress to vesicles and surrounding erythema. The vesicles eventually rupture and form a thick, adherent, golden crust. Regional lymphadenopathy is also a common finding.

65
Q

How is impetigo typically diagnosed?

A

Clinical but gram stain and culture to ID pathogen

66
Q

What is the treatment for impetigo?

A

Topical mupirocin or PO cephalexin if widespread

If MRSA –> doxycycline, clindamycin, or Bactrim

67
Q

How soon can children with impetigo return to school?

A

24 hours after starting abx

68
Q

In what patients is Kaposi’s sarcoma seen and what is the most common causative agent?

A 
AIDS patients (CD4 < 200)
Caused by HHV-8
69
Q

What are the classic findings in Lichen Planus?

A

Four P’s –> Papules that are Pruritic, Purple, and Polygonal. Will also have Wickham’s striae - fine, white lines.

70
Q

What is the treatment of Lichen Planus?

A

Corticosteroids

71
Q

Describe the S/S associated with Lichen Simplex Chronicus.

A

Multiple linear excoriations and thickened skin with generalized pruritis.

72
Q

Describe the treatment for a lipoma.

A

Minimize rubbing and scratching –> excision is definitive.

EOR Exam - Family Medicine (15 decks)

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