Mehlman skin fungal/scabies/lice/candida

Question 1

M. Malassezia fur fur (tinea versicolor) is extremely HY!!!
Definition?

Answer 1

Clasically causes hypopigmentation+hyperpigmentation on the trunk, back, shoulders. This is caused by fatty acid breakdown in the skin.
Skin findings get prominent after sun-exposure or tanning.

Question 2

M. Malassezia/ extremely HY Tx?

Answer 2

Topical selenium

Also: topical ketoconazole, terbinafine

Question 3

M. Tinea capitis. Tx?

Answer 3

griseofulvin for PATIENT ONLY

one Q: Tx for patient or patient+ contact
A: ONLY FOR PATIENT

Question 4

M. Tinea capitis. best way to prevent infection. Use shampoo vs avoid sharing of hat?

Answer 4

AVOID SHARING

anti-fungal shampoo doesnt matter

Question 5

M. Tx for tinea corporis (ring-worm)?

Answer 5

topical miconazole or clotrimazole

Question 6

M. Tx for tinea pedis (athletes foot)?

Answer 6

topical terbinafine or topical -azoles.

usmle wont list both as options.

Question 7

Tx topical miconazole or clotrimazole?

Answer 7

Tx for tinea corporis (ring-worm)

Question 8

Tx topical terbinafine or topical -azoles?

Answer 8

Tx for tinea pedis (athletes foot)

Question 9

Tx griseofulvin for PATIENT ONLY?

Answer 9

Tx for tinea corporis

also prevention - avoid hat sharing

Question 10

M. Tx for onychomycosis (fungal nail infection)?

Answer 10

ORAL terbinafine (6 weeks for fingernail; 12 weeks for toenails)
usmle won’t as duration, just interesting fact

also (UW): itraconazole

Question 11

Tx ORAL terbinafine?

Answer 11

Tx for onychomycosis (fungal nail infection)

Question 12

M. Cutaneous candida. DM versus Obesity. what has higher risk?

Answer 12

!!!!!!DM is the biggest risk factor for cutaneous candida in comparision to obesity.

Question 13

M. Cutaneous candida. DM versus Obesity. Case?

Answer 13

48F + BMI 67 + red, moist, 8x12 cm elipse under one of the breast. what is the biggest risk factor?
A: INSULIN RESISTANCE!!! exceedingly HY
wrong answer is obesity

Question 14

M. both DM1 and DM2 have same risk for candida. they just commonly assess DM2 since it presents in obese people, and they want you to know that DM is more important than obesity for candida.

Answer 14

.

Question 15

M/UW. Scabies. Scabies + lice (pediculosis) –> Tx?

Answer 15

Permethrin

Question 16

M/UW. Scabies. Case
Homeless lives in shelter for 4 months + red dots on hand + topical fungals didnt work –> what next best Tx?

Answer 16

Permethrin

Question 17

M/UW. Scabies. Scabies associated pyoderma (scabies + pus) –> what mcc?

Answer 17

infected by S. aureus or Group A Strep (S. pyogenes)

Question 18

M/UW. Lice.
Pediculosis capitis = head lice.
Pediculosis corporis = body lice.
Tx?

Answer 18

Permethrin

Question 19

UW table scabies. cause?

Answer 19

Sarcoptes scabiei mite infestation

Question 20

UW table scabies. pathogenesis?

Answer 20

mites burrow into the skin and lead to delay type IV hypersensitivity reaction to mite, feces eggs

Question 21

UW table scabies. spread?

Answer 21

direct person to person contact

Question 22

UW table scabies. diagnosis?

Answer 22

Light microscopy of skin scraping. It reveals mites, ova, feces

Question 23

UW table scabies. CP?

Answer 23

Extremely pruritic pathognomonic burrows and small, erythematous papules
Rash located on interdigital web spaces, flexor wrists, extensor elbows, axillae, umbilicus and genitalia

Question 24

UW table scabies. Tx? 2

Answer 24

topical 5 proc. permethrin
OR
Oral ivermectin

Question 25

UW table scabies. Also: bedding and clothing should be cleaned or placed in a plastic bag for >= 3 days.

Answer 25

.

Question 26

M. Chronic mucucutaneous candidasis. HY.
mechanism?

Answer 26

T cell dysfunction –> answer will be ,,defect in cell-mediated immunity”.

Question 27

M. Chronic mucucutaneous candidasis.
Case: 17F + Hx of cutaneous candidal infections since childhood + 1y HX autoimmune thyroiditis + 2 yr Hx of DM1; what mechanism of disease?

Answer 27

Defect in cell mediated immunity
OR
T cell (if they ask which cell if affected)

Question 28

M. Oropharyngeal candidasis –> Tx?

Answer 28

use nystatin mouthwash

Question 29

M. Chronic mucucutaneous candidasis.
USMLE like concept
,,Autoimmune disease go together”
and
,,autoimmune disease and immunodeficiencies fo together”

Answer 29

.

Question 30

M. Esophageal candidasis –> Tx?

Answer 30

oral azole
Odynophagia in immunocompromised patient is esophageal candidasis until proven otherwise.

Question 31

M. Vaginal candidasis –> Tx?

Answer 31

topical nystatin –> if it doesnt work, go to ORAL azole.

Nystatin is used first because the correct medicine is technically to do LFT’s before giving an oral azole, whereas nystatin has shown efficacy and can be given right away.

Question 32

UW. Tinea versicolor diagnostics?

Answer 32

KOH preparation shows hyphae and yeast cells in ,,spaghetti and meatballs” pattern

Question 33

UW. Tinea corporis cause?

Answer 33

Trichophyton rubrum

Question 34

UW. Tinea corporis 2nd line Tx?

Answer 34

if topical not effective, 2nd line ORAL antifungals, eg terbinafine, griseofulvine

Question 35

UW. Tinea corporis risk factors?

Answer 35

Athletes who have skin-to-skin contact; humid environment; contact to infected animals

Question 36

UW. tinea pedis, cause?

Answer 36

Trichophyton spp

Question 37

UW. tinea pedis, risk factors?

Answer 37

barefoot walking in public areas (pool, athletic venue)

Question 38

UW. tinea pedis, Tx?

Answer 38

1st - topical azoles or terbinafine
2nd - oral antifungal (eg fluconazole)
also: keep feet dry and get rid of old shoes

Question 39

UW. onychomycosis, risk factors?

Answer 39

Advanced age, tinea pedis, DM, peripheral vascular disease

Question 40

M. Scabies lesions can be defined as ….

Answer 40

linear burrows

Question 41

M. Scabies disseminated disease can occur in ……?
Tx = ?

Answer 41

in HIV
Tx = oral ivermectin

Question 42

M. Tinea vesicolor. What region, what patients?

Answer 42

Sub-tropical, eg Florida
patient goes surfing/to the beah