Module 6 - Derm III & IV Flashcards
35yo female comes to the office because a mole on her left calf has changed. On physical exam of the left posterior lower leg, there is a 12mm, asymmetrical, variegated blue-black macule with raised pink plaque in the upper half of the lesion.
Which of the following is the most appropriate clinical management of this lesion
Excisional Surgery
60yo male presents with a slowly developing facial lesion first noticed 4-5 mo ago. He describes it as non-painful and non-pruritic but notes it to be extremely scaly. He denies a history of similar lesions or dermatologic disease. Exam reveals a 1cm, firm nodule at the right temple with heavy keratinization. There is no fluctuance or skin discoloration.
Which of the following is the most likely diagnosis
Squamous Cell Carcinoma
56yo, right hand dominant, carpenter presents to your clinic complaining of a prolonged bruise under his left thumbnail. He states that he first noticed it 1yr ago. PE reveals a nontender left thumb with 6mm macular lesion located under the distal nail bed. It is mixed dark brown and black in color, with irregular borders. The most likely diagnosis is …
Melanoma
19yo male comes to the office to discuss treatment for chronic dry skin, and pruritic inflammatory lesions of the flexor surfaces of the neck, hands and wrists. PMHx is significant for allergic rhinitis in the spring and fall. on PE the skin lesions are excoriated, and lichenified with crusted patches.
Which of the following prevention strategies can help minimize the symptoms in this patient?
Avoid rubbing or scratching
wrongs:
- consume hot liquids
- limit sun exposure
- take hot baths
Pt suspected of having seborrheic dermatitis, the most common site of involvement would be the ..
Scalp
Pt with atopic dermatitis should be advised to..
avoid cutaneous irritants
wrongs:
- take hot water baths or showers
- begin a prophylactic antibiotic
- use high potency glucocorticoid on skin after bathing
Which of the following interventions is the treatment of choice for actinic keratosis?
Cryotherapy
wrongs:
- mohs surgery
- radiation therapy
- acid peels
19yo male presents with a lesion on his right forearm that is occasionally pruritic. On exam a 2cm ring of erythema with a scaly border and central clearing is noted.
A suspected diagnosis is confirmed by the presence of
hyphae on a KOH prep
wrongs:
- multinucleated cells on Tznack smear
- positive patch test
- gram positive cocci on gram stain
72yo farmer comes to the office for evaluation of a pearly ulcerated papule on his right nostril. The papule has been bleeding off and on for the past couple weeks.
Which of the following findings would be most concerning of the PE of this patient?
telangiectasia
wrongs:
- cherry angioma
- spider angioma
- pyogenic granuloma
elderly pt women presents to your clinic complaining of unilateral facial pain and painful lesions. She also complains of blurred vision in the ipsilateral eye. On exam she has several vesicles with an erythematous base, some of the lesions with crusts. They are distributed in a dermatomal pattern and involve the skin overlying the maxillary region and the tip of her nose.
Which of the following is the next most appropriate intervention in the care of this patient?
referral to ophthalmologist
wrongs:
- KOH prep
- culture for bacteria
- application of corticosteroids
Herpes Simplex *
KNOW FIRST EPISODE INFO
- FIRST INFX is most severe and lasts longer - may start after incubation period of 4-6 days (can range 1-26 days after exposure)
- painful vesicles: burning
- occurs in clusters: brown with surrounding erythema, tender lymph nodes surrounding
- ulceration subsequently occurs and lesions crust over
- heals in immunocompetent pts in 2-3 weeks without treatment
Majority of oral cases HSV1
Majority of genital cases HSV2
- HSV1 is the most common new case of genital herpes
Herpes Simplex Testing and Primary Prevention**
NAAT-PCR differentiates HSV1 and HSV2
- can also IgG test: diagnosis
primary:
widespread education
urging use of barrier protection
prophy antiviral therapy
Herpes Treatment *
Acyclovir:
Famciclovir: Recurrence: 1000mg BID x 1 day
Valacyclovir: Labial (Lips) 2000mg BID x 1 day
Once infected, infected for life
Asymptomatic shedding is possible
(before and after active infection, random)
Herpes Zoster *
Shingles
Dermatome - 20% adjacent dermatomes
RARELY CROSSES THE MIDLINE
- earliest sx: headache, fever, malaise
- followed by: burning, itching, hyperesthesia, paresthesia
Herpes Zoster Complications*
Common Complications:
- PHN: treat early and will prevent risk of this. persist 3mo+ after
- Secondary Bacterial infection (itching prob)
- facial lesions can spread to eye and facial nerves and affect vision
- tell pt to call provider immediately if has facial lesions so it can be watched closely
- contagious when vesicles are open and draining
Uncommon Complications:
- peripheral motor neuropathy
- facial palsy
- ophthalmic zoster
Shingrix Vaccine *
preferred over zostavax
50yo+ and immunocompromised
- had shingles in past
- rec if had zostavax 8 weeks prior
- have health cond: CKD, DM, RA, COPD
- can rec. other vax at same time flu pna
- taking low dose immuno.
2 DOSES 2-6 MONTHS APART
admin IM deltoid 1-1.5in needle
Drug Treatment for Shingles *
start within 72 hours to relieve symptoms and prevent complications
Antivirals:
- valacyclovir: 1000mg TID x 7 days
- famciclovir: 500mg TID x 7 days
- acyclovir: 800mg QID x 7 days
Pain:
- acetaminophen/NSAID
- tricyclic antidepressants
(amytriptiline 25mg at bedtime)
- lidocaine patch 5%
max 3 at a time
12hr off 12hr on
- gabapentin 100-600 TID
Primary Prevention: VACCINE
Psoriasis *
- macular and papular lesions PLAQUES silvery white scales, on elbows and knees (outside) gluteal scalp
- trigger meds: BB, antimalarials, stress
Acne Rosacea (Rosacea) *
- metronidazole cream 0.75% BID after washing
- azelaic acid 15% BID
- doxycycline 100mg (pref 40) daily
most common in ages 30-50
women > men
women: chin and cheeks
inflammatory paps and pusts, erythema, water eyes, facial distribution is symmetric
eye symptoms = refer opth
comedomes DONT appear
ACNE *
goal of treatment: decrease propionbacterium acne proliferation
Mild:
MODERATE: benzoyl peroxide + retinoid
idk listen to slide.
