Psoriasis

Question 1

What is the Auspitz sign?

Answer 1

Bleeding of the scales if removed

This sign is associated with psoriasis.

Question 2

What percentage of patients with psoriasis will develop arthritis before any skin findings?

Answer 2

15%

This statistic highlights the potential systemic implications of psoriasis.

Question 3

What constellation is psoriasis part of according to HLA-B27?

Answer 3

PAIR (Psoriasis, Ankylosing spondylitis, IBD, Reactive arthritis)

This is an important association for the USMLE.

Question 4

In a case of a 17-year-old male with silvery plaque on elbow and forehead and bloody stool, what condition is most likely due to HLA-B27 association?

Answer 4

IBD

This association indicates a potential underlying inflammatory bowel disease.

Question 5

What condition should not be confused with psoriasis and IBD combo?

Answer 5

Dermatitis herpetiformis and Celiac disease combo

These are different conditions with distinct associations.

Question 6

What is the first-line treatment for plaque psoriasis?

Answer 6

Topicals first

The order of preference for topical treatments includes calcipotriene, triamcinolone, hydrocortisone, and coal tar.

Question 7

List the first-line topical treatments for plaque psoriasis in order.

Answer 7

• Calcipotriene (vitamin D derivative)
• Triamcinolone (corticosteroid)
• Hydrocortisone (corticosteroid)
• Coal tar

This order is important for effective treatment.

Question 8

What is a potential side effect of chronic application of topical steroids?

Answer 8

Dermal collagen thinning

This side effect makes topical steroids less preferred before topical vitamin D.

Question 9

When are oral medications indicated for psoriasis treatment?

Answer 9

If patient fails topicals or has systemic psoriasis (i.e., arthritis)

This indicates a more severe disease state.

Question 10

What is the first-line oral agent used for systemic psoriasis?

Answer 10

Oral methotrexate

This is highlighted in new NBME material.

Question 11

Which vitamin A derivative was noted in an old NBME as an oral medication for psoriasis?

Answer 11

Oral acitretin

Methotrexate was not listed in that context.

Question 12

What are plaques in psoriasis described as?

Answer 12

Silvery and scaly

Question 13

Where do plaques in psoriasis typically appear?

Answer 13

Over extensor regions (elbows) and on the face (i.e., forehead and lip)