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Master the Boards > MTB - Dermatology > Flashcards

MTB - Dermatology Flashcards

1
Q

ab’s to intercellular space of epidermal cells

A

pemphigus vulgaris

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2
Q

causes of pemphigus vulgaris:

A

idiopathic
ACE inhibitors
Penicillamine

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3
Q

3 diseases that have positive Nikolsky’s sign

A

pemphigus vulgaris
TEN
SSSS

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4
Q

are the lesions in pemphigus painful or pruritic?

A

painful

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5
Q

most accurate dx test - pemphigus vulgaris

A

biopsy of the skin

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6
Q

DOC: pemphigus vulgaris

A

glucocorticoids - prednisone

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7
Q

what drugs can be used in pemphigus if steroids are ineffective?

A

azathioprine
mycophenolate
cyclophosphamide

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8
Q

dz characterized by tense bullae formation, usually in an elderly person

A

bullous pemphigoid

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9
Q

Dx. test - bullous pemphigoid

A

biopsy w/ immunofluorescent abs

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10
Q

Tx. bullous pemphigoid

A

systemic steroids (prednisone)
alternatives:
- tetracycline
-erythromycin w/ nicotinamide

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11
Q

Pemphigus Foliaceus

A

blistering dz assoc with other autoimmune diseases or drugs (ACE inhibitors or NSAIDs); much more superficial than pemphigus

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12
Q

a patient presents with nonhealing blisters on sun-exposed parts of the body, hyperpigmentation of the skin and hypertrichosis of the face - dx?

A

porphyria cutanea tarda

- abnormal photosensitivity reaction

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13
Q

porphyria cutanea tarda is associated with…

A 
alcoholism
liver disease
hep C
OCP use
liver dz - chronic hepatitis, hemochromatosis
diabetes
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14
Q

Dx test - porphyria cutanea tarda

A

urinary uroporphyrins

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15
Q

Tx. porphyria cutanea tarda

A
  • stop drinking alcohol
  • stop estrogen use
  • use barrier sun protection
  • use phlebotomy or deferoxamine
  • chloroquine (increases excretion of porphyrins)
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16
Q

uriticaria

A

hypersensitivity reaction mediated by IgE and mast cell activation resulting in wheals and hives and pruritus.

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17
Q

Medications causing uriticaria

A 
aspirin
NSAIDs
morphine/codeine
penicillins
phenytoin
quinolones
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18
Q

MCC of uriticaria

A 
medications
insect bites
foods
emotions
contact w/ latex
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19
Q

Management - uriticaria

A

severe and acute? first generation anti-histamines

chronic? newer gen, nonsedating anti-histamines

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20
Q

morbilliform rash

A

typical type of drug reaction - generalized maculopapular eruption that blanches with pressure; mediated by lymphocytes

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21
Q

tx. morbilliform rash

A

antihistamines

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22
Q

causes of erythema multiforme

A 
penicillins
phenytoin
NSAIDs
sulfa drugs
infection w/ herpes simplex or mycoplasma
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23
Q

describe erythema multiforme

A

targetlike lesions esp. on palms and soles; does not involve mucosal membranes

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24
Q

Tx. erythema multiforme

A

antihistamines

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25
Q

Stevens-Johnson syndrome

A

Hypersensitivity reaction involving < 10-15% of BSA and mucous membrane involvement (oral cavity and conjunctivae)

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26
Q

What meds can cause SJS?

A 
penicillins
sulfa drugs
NSAIDs
phenytoin
phenobarbital
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27
Q

Management of SJS

A

pts should be managed in burn unit (high risk for infection, dehydration and malnutrition)
meds to try: IVIG, cyclophosphamide, cyclosporine, thalidomide

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28
Q

Toxic Epidermal Necrolysis

A

most serious version of cutaneous hypersensitivity

- involves from 30-100% of BSA w/ mortality of 40-50% (MCC of death is due to sepsis)

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29
Q

Dx. TEN

A

skin biopsy

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30
Q

fixed drug reaction

A

localized allergic drug reaction that recurs at precisely the same anatomic site on skin w/ repeated drug exposure leaving a hyperpigmented, sharply demarcated spot

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31
Q

tx. fixed drug reaction

A

topical steroids

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32
Q

causes of erythema nodosum

A 
pregnancy
recent streptococcal infection
coccidioidomycosis
histoplasmosis
sarcoidosis
IBD
syphillis
hepatitis
enteric infections - Yersinia
33
Q

tx. erythema nodosum

A

analgesics, NSAIDs

34
Q

best initial test for fungal infection of the skin

A

KOH prep

35
Q

most accurate test for fungal skin infection

A

culture of fungus (take up to 6 weeks)

36
Q

Tx. onychomycosis or tinea capitis

A

oral terbinafine or itraconazole
6 weeks - fingernails
12 weeks - toenails

37
Q

s/e: terbenafine

A

hepatotoxic –> monitor LFTs periodically

38
Q

s/e: systemic ketoconazole

A

hepatotoxicity

gynecomastia

39
Q

which anti-fungal does NOT come in a topical form

A

fluconazole

40
Q

Tx. mild bacterial skin infections

A

dicloxacillin, cephalexin (Keflex) or Cefadroxil (Duricef)

41
Q

Tx. moderate-severe bacterial skin infections

A

IV oxacillin/nafcillin or IV cefazolin

42
Q

pt with bacterial skin infection, gets a rash with penicillin - what drug can you use?

A

cephalosporins are OK (Cefadroxil or cefazolin)

43
Q

pt with bacterial skin infection, anaphylaxis allergy to penicillin - what can you use to treat his infection?

A

macrolides - erythromycin, azithromycin, clarithromycin

newer FQs

44
Q

MC organisms causing necrotizing fasciitis

A

Streptococcus

Clostridia

45
Q

CF: necrotizing fasciitis

A 
very high fever
portal of entry to skin
pain out of proportion to superficial appearance
bullae
palpable crepitus
46
Q

Dx. necrotizing fasciitis

A

elevated CPK
Imaging showing air in the tissue/necrosis
best initial step: SURGERY (debridement)

47
Q

Tx. necrotizing fasciitis

A

Ampicillin/Sulbactam
Ticarcillin/Clavulanate
Piperacillin/Tazobactam
if strep infection: Clindamycin + Penicillin

48
Q

what has the best efficacy for decreasing the risk of postherpetic neuralgia from herpes zoster

A

rapid admin of acyclovir

49
Q

most effective analgesic for postherpetic neuralagia

A

gabapentin

50
Q

Criteria for Toxic Shock Syndrome

A 
fever > 102
systolic BP < 90
desquamative rash
vomiting
involvement of mucous mbs of eye, mouth and genitals
51
Q

Lab findings in TSS

A

elevated Cr, CPK, LFTs

lowers platelets

52
Q

Tx. TSS

A
  1. IVF
  2. pressors ie DA
  3. antistaph meds: oxacillin, nafcillin or cefazolin (if MRSA - vancomycin, linezolid)
53
Q

Staphylococcal Scalded Skin Syndrome

A

Skin infection mediated by toxin released by staphylococcus causing sloughing off of superficial layers of epidermis (granular layer) in sheets (positive Nikolsky); no other organ involvement like as in TEN

54
Q

Tx. SSSS

A

manage in a burn unit

Oxacillin/Nafcillin

55
Q

Tx. Anthrax

A

Ciprofloxacin

Doxycycline

56
Q

Tx. seborrheic dermatitis

A

liquid nitrogen or curretage

- removal only for cosmetic purposes

57
Q

Tx. actinic keratosis

A

cryotherapy, topical 5FU, imiquimod, topical retinoic acid, curettage

58
Q

chemotherapy for Kaposi’s sarcoma

A

liposomal Adriamycin and vinblastine

59
Q

Tx. psoriasis

A
  1. emollients
  2. salicylic acid - removes crust
  3. topical steroids (if localized)
  4. topical vitamin D (calcipotriene) and vitamin A (tazarotene) (chronic psoriasis)
60
Q

if psoriasis covers > 30% of BSA, treatment?

A

PUVA therapy

61
Q

severe, widespread and progressive psoriasis - tx?

A

methotrexate

62
Q

seborrheic dermatitis

A

oversecretion of sebaceous material; HS rxn to a superficial fungal organism (pityrosporum ovale)

63
Q

Tx. seborrheic dermatitis

A

low potency topical steroids - hydrocortisone
topical antifungals
zinc pyrithione shampoo

64
Q

stasis dermatitis

A

hyperpigmentation that is built up hemosiderin in tissue from long periods of venous incompetence of LE (no way to reverse this)

65
Q

Tx. keloid scars

A

intralesional corticosteroids

- recurrence after treatment is common

66
Q

Tx. psoriasis localized to the skin

A

topical high potency steroids (betamethasone 0.05%)

67
Q

Tx. psoriasis that involves > 30% of the body surface area

A

phototherapy with UVB radiation

68
Q

when is MTX used in psoriasis?

A

severe psoriasis
psoriatic arthritis
psoriasis involving the nails

69
Q

drugs that may exacerbate psoriasis lesions

A
  1. beta blockers
  2. antimalarial drugs
  3. NSAIDs
  4. ACE inhibitors
  5. lithium
70
Q

stage 1 pressure ulcers

A

nonblanchable erythema of intact skin

71
Q

stage 2 pressure ulcers

A

superficial ulcers causing a partial thickness of epidermis, dermis or both

72
Q

stage 3 pressure ulcers

A

full thickness loss with damage to subcutaneous tissue that may extend to but not through any underlying fascia

73
Q

stage 4 pressure ulcers

A

very deep ulcers causing full thickness loss with extensive destruction that may damage adjacent muscle, bone or supporting structures

74
Q

tx. stage 3 or 4 pressure ulcers

A

pack with saline moistened gauze or cover with occlusive dressing

75
Q

most accurate test for dx of psoriasis

A

skin biopsy
- epidermal hyperplasia or hyperproliferation with neutrophillic infiltrate into stratum corneum and thinned to absent granular layer of epidermis

76
Q

initial drug of choice for psoriatic arthritis

A

Methotrexate

- once weekly low dose regimen

77
Q

topical treatments for psoriasis

A

low potency steroids (hydrocort) - face, intertriginous areas, thin plaques
high potency steroids (thick plaques)
anthralin - mild psoriasis
calcipotriene - moderate plaque psoriasis

78
Q

clinical associations with alopecia areata

A
  1. exclamation point hairs, esp at periphery
  2. nail pitting
  3. other autoimmune conditions: thyroid dz, vitiligo, pernicious anemia
79
Q

drugs implicated in telogen efflivum

A 
beta blockers
anticoagulants
systemic retinoids
anticonvulsants
antithyroid medications

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