hair & digit d/o

Question 1

rapid, painless, not itchy smooth, discrete circular patches of total hair loss over period of weeks (rapid); immune-mediated

Answer 1

alopecia areata

Question 2

hair loss condition commonly associated with thyroid dz, pernicious anemia, addisons, SLE, (autoimmune dz)

Answer 2

alopecia areata

Question 3

alopecia areata prognosis

Answer 3

regrowth in 1 to 3 months; new hair is same color and texture

Question 4

nail changes often seen with alopecia areata

Answer 4

pitting or transverse lines

Question 5

which condition has exclamation point hair? what causes it?

Answer 5

alopecia areata
follicles prematurely entering telogen causing fractures as they reach the surface

Question 6

short hair broken off few mm from scalp with tapering near proximal hair shaft

Answer 6

exclamation point appearance

Question 7

observation + (4 tx )used in alopecia areata

Answer 7

Intralesional injection w/ kenalog (first line)
IV methylpredinisolone for 3 days
anthralins once daily
immunomodulators

Question 8

which tx used in alopecia areata causes itching

Answer 8

anthralin

Question 9

genetically predetermined progressive loss of terminal hairs on scalp in characteristic pattern; elevated DHEAS level

Answer 9

androgenetic alopecia

Question 10

which part of the scalp has androgen-sensitive follicles?

Answer 10

crown

Question 11

sign of male pattern androgenic alopecia

Answer 11

frontotemporal recession followed by vertex

Question 12

3 medications that should be avoided with hair loss

Answer 12

warfarin
anti-seizure meds
gemfibrozil

Question 13

2 tx for male androgenic alopecia

Answer 13

finasteride (oral)
minoxidil (topical)

Question 14

indication for finastride

Answer 14

men over 18 with androgenic alopecia

Question 15

with which two tx should you wait 12 mo before making decision about efficacy in androgenic alopecia

Answer 15

minoxidil
finastride

Question 16

which medication is category X and causes defects in male fetuses

Answer 16

finastride

Question 17

which medication can be used for both male and female androgenic alopecia & the differences in strength

Answer 17

minoxidil– 2% in female, 5% in male

Question 18

discontinuation of finastride vs. minoxidil will cause loss of effect in _____ months

Answer 18

finastride: 1 year
minoxidil: 4-6 months

Question 19

which androgenic alopecia medication carries reversible sexual SE of less libido and ED?

Answer 19

finastride

Question 20

which medication can cause painful gynecomastia that resolves with continued use or after stopping tx?

Answer 20

finastride

Question 21

medication that causes initial telogen effluvium 2-8wks after initiation but is self limiting with continued use

Answer 21

minoxidil

Question 22

ADR of scalp irritation, dryness, scaling, itching, redness

Answer 22

minoxidil

Question 23

female pattern androgenic alopecia

Answer 23

thinning between frontal and vertex without affecting frontal hairline

Question 24

female pattern androgenic alopecia

Answer 24

thinning between frontal and vertex without affecting frontal hairline

Question 25

medication that blocks DHT receptors and androgen biosynthesis to prevent further hair loss; used in FEMALE androgenic alopecia

Answer 25

spironolactone

Question 26

why is pregnancy a contraindication for spironolactone

Answer 26

risk of feminization of male fetus

Question 27

which medication for female androgenic alopecia causes liver cancer & hepatitis with higher doses?

Answer 27

spironolactone

Question 28

premature termination of anagen stage causing high # of normal hairs to enter telogen phase & affects 50% of hair

Answer 28

telogen effluvium-- follicle is NOT diseased

Question 29

etiologies include acute blood loss, childbirth, crash diets, meds, thyroid dz, stress

Answer 29

telogen effluvium

Question 30

removing hair manually causing reduced density NEVER baldness

Answer 30

trichotillomania

Question 31

what triggers trichotillomania

Answer 31

stress and maybe OCD

Question 32

tx of trichotillomania

Answer 32

behavioral health/counseling clomipramine (TCA) short term +/- fluoxetine

Question 33

d/t variation in proper fit of nail plate in usual nail groove; sharp spicules of nail margin develop as foreign body in nail groove

Answer 33

onychocryptosis (ingrown nail)

Question 34

3 top causes of onychocryptosis

Answer 34

nail plate forced out of groove by too small shoe trauma cutting nail in curvilinear way

Question 35

3 sx of stage one of onychocryptosis and how its tx

Answer 35

redness, edema, focal tenderness tx: change shoes & nail education

Question 36

stage 2 of onychocryptosis and how its tx (2)

Answer 36

crusting and purulence at nail fold tx: stretch tissue away from nail & elevate nail; warm soaks

Question 37

stage 3 of onychocryptosis & tx (2)

Answer 37

chronic infection with protuberant granulation tissue tx: nail margin removal; matrix ablation if chronic

Question 38

is abx necessary with onychocryptosis

Answer 38

some say yes some say no

Question 39

spontaneous separation of nail plate form distal free margin, progressing proximally

Answer 39

onycholysis

Question 40

what causes discoloration with onycholysis

Answer 40

secondary yeast infection

Question 41

how is onycholysis tx (1) and what happens if untreated

Answer 41

tx: address thing that exacerbates it if untreated can cause nail bed scarring

Question 42

complete nail shedding from proximal portion

Answer 42

onychomadesis

Question 43

tho onychomadesis is mostly idiopathic, what 3 things could contribute

Answer 43

hand, foot & mouth dz intensive hygienic measures causing maceration candida or allergic contact dermatitis

Question 44

most common cause of onychonmycosis

Answer 44

dermatophyte (Trichophyton rubrum)

Question 45

___ rarely causes onychomycosis

Answer 45

candida

Question 46

how to differentiate tinea unguium from other onychomycosis

Answer 46

tinea starts at distal corner of nail and involves nail & bed junction then spreads proximally as a streak in nail

Question 47

4 risk factors of onychomycosis

Answer 47

fam hx old poor health; prior trauma warm climate

Question 48

before doing direct microscopy of KOH in DMSO to screen for fungi, you must first ____

Answer 48

clip & clean nail w/ alcohol first

Question 49

drug of choice to treat onychomycosis

Answer 49

terbinafine (oral)

Question 50

second drug for onychomycosis that covers candida with hepatotoxicity & drug interations

Answer 50

Itraconazole

Question 51

when can you start tx for onychomycosis

Answer 51

+ KOH or PAS

Question 52

bacterial inflammation of lateral & proximal nail fold causing rapid with erythema, edema, pain within 2-5 days of biting nail or pulling nail (minor local trauma)

Answer 52

paronychia

Question 53

closed space bacterial infection of fingertip pulp (subQ) causing abscess, edema and rapid increasing pressure

Answer 53

felon

Question 54

consequence of felon if not tx? (2)

Answer 54

the rapid increased pressure could compromise blood flow and lead to necrosis of skin and pulp osteomyelitis or osteitis

Question 55

HSV of finger tip which appears as a verrucous mass or bacterial infection; in healthcare workers esp dental

Answer 55

herpetic whitlow

Question 56

tx of paronychia

Answer 56

drain the pus Abx is not needed

Question 57

tx of felon

Answer 57

surgical incision/ I&D

Question 58

tx of herpetic whitlow (include dose)

Answer 58

acyclovir 400mg PO TID x 10 days

Question 59

Brownish, thickening of nails d/t tight fitting shoes or trauma; usually one direction; tx with removal or sanding

Answer 59

nail hypertrophy

Question 60

secondary to nail manipulation or mild trauma; disappears with nail growth

Answer 60

nail bands/leukonychia punctata

Question 61

secondary to biting or picking at proximal nail fold; longitudinal bands w/ yellow discoloration

Answer 61

habit-tic deformity

Question 62

painful, inward folding of lateral edges needing surgical removal of nail

Answer 62

pincer nail

Question 63

transverse depressions in all nails weeks after stressful event; also in DM, measles, myocarditis; resolve & regrows normally

Answer 63

beau lines

Question 64

two nail signs of internal disease

Answer 64

beau lines terrys nails

Question 65

white or light pink proximal with normal pink distal band; Associated w/ CHF, cirrhosis, DM or aging

Answer 65

Terrys nails