Quick Questions PANCE

Question 1

Pathogenesis of Acne Vulgaris

Answer 1

1. propionibacterium infection
2. follicular hyperproliferation
3. increased sebum production
4. inflammation

Question 2

Folliculitis: MCC, RF, Tx

Answer 2

MCC: s. aureus (pseudomonas for hot tun)
RF: steroids, ABX, male, shaving
Tx: Topical mupirocin

Question 3

Rosacea Tx options for different types

Answer 3

For papulopustules: Topical metronidazole
For erythema: Topical brimonidine
For phymatous: PO isotretinoin/surgery

Question 4

Erythema multiforme: MCC, Types, Sx

Answer 4

MCC: Herpes Simplex Virus
Types: Minor and Major

Sx:
Minor- targeted lesions with dusky center, pale ring, erythematous halo on palms/soles and spreads to trunk; no mucosal involvement

Major: 2+ mucosal involvement (commonly oral w hemorrhagic crusting on vermillion zones)
*NEGATIVE NIKOLSKY SIGN

Question 5

Alopecia Areata: Patho, Assoc, Sx, Definitive Dx

Answer 5

Patho: autoimmune, follicle prematurely go from anlagen to telogen phase
Assoc: SLE, Addison’s Thyroid
Sx: sudden, circular hair loss, EXCLAMATION point hairs
Dx: punch bx (peribulbar lymphocytic inflammation infiltrates

Question 6

Androgenic alopecia: Patho, Tx options & ADRs

Answer 6

Patho: increased levels of DHT which causes shorter anlagen phase and longer telogen phase

Tx:
Topical Minoxidil (best for new onset, 4-6 mo of tx before effect) – vasodilator;
ADR: itching/flushing

PO Finasteride (5-alpha reductase inhibitor) stops conversion of testosterone to DHT
ADR: ED, increase risk of prostate CA

Question 7

Onychomycosis: MCC, Dx, Tx/ADR

Answer 7

MCC: Trichophyton rubrum (dermophytes)
Dx: Periodic acid-Schiff stain (PAS) = most sensitive
Tx: PO Terbinafine x 12 wks
ADR: HEPATOTOXICITY

Question 8

Paronychia: MCC of acute vs chronic

Answer 8

MCC acute: s. aureus
MCC chronic (>6 wks): candida

Question 9

Brown Recluse Spider Bite: Spider, Patho, Tx

Answer 9

Spider: brown violin on abdomen
Patho: cytotoxic venom –> local necrosis, bullae
Tx: local wound care, NSAIDS

Question 10

Black Widow Spider Bite: Spider, Patho, Tx

Answer 10

Spider: red hourglass on belly (lactrodectus Hesperus)

Patho: neurotoxin –> muscle pain, spasms, rigidity, convulsions

Tx: opioids, BZDs

Question 11

Erythema infectiousum: Cause, Patho, Sx, Complications

Answer 11

Cause: Parvovirus B19

Patho: virus destroys retics leading to decreased RBCs

Sx: viral sx –> “slapped cheek” w circumoral pallor –> lacy, reticular rash SPARES palms/soles

Complications: *Aplastic crisis in Sickle Cell/G6PD deficiency

Question 12

Hand-Foot-And-Mouth Disease: Cause, Sx, Complications

Answer 12

Cause: Coxsackie Type A virus (enterovirus)

Sx: grayish-yellow lesions on palms/soles (non-tender, non-pruritic), small, painful red vesicles on buccal mucosa

Complications: Myocarditis, Aseptic meningitis

Question 13

Measles: AKA, Sx, Complications, Tx option

Answer 13

AKA: Rubeola
Sx:
Prodrome of 3 Cs + Fever
Koplik spots
Rash: morbilliform, red, blanching rash, that begins on face (cephalocaudal spread)

Complications: Diarrhea (MC), PNA (MCC of measles-related deaths), AOM, encephalitis

Question 14

Seborrheic Keratosis: RF, Sx, Malignancy Risk, Tx

Answer 14

RF: elderly, fair-skinned, sun exposure

sx: warty, velvety lesions w/greasy “stuck on” appearance

Malignancy Risk: NOT pre-malignant, MC benign epidural skin tumor

no tx needed

Question 15

Actinic keratosis: Sx, Dx, Malignancy Risk, Tx (local & multiple)

Answer 15

Sx: rough/dry “sandpaper” feeling lesion on sun-exposed areas, pink/yellowish, slowly enlarging

dx: punch or shave biopsy

Malignancy Risk: precursor to squamous cell carcinoma

Tx:
Local: cryotherapy
Multiple: Topical Imiquimod or 5-FU cream

Question 16

Basal Cell Carcinoma: RF, Sx, Tx, Recurrence rate

Answer 16

RF: Xeroderma pigmentosum, fair skin, UV exposure

Sx: pearly, raised, rolled border w central erosion
nose and hands
telangietasias

Tx: Excision (Mohs for difficult) – locally invasive but rarely mets

Recurrence: 50% will have recurrence within 5 years

Question 17

Malignant melanoma: RF, MC type, Sx, Dx, Tx, Tumor marker, Prognostic factor

Answer 17

RF: >50 yo, Hx, no dermatologist, male, >3 burns by 20 yo, large # of nevi, tanning beds

MC type: Superficial Spreading (70%)

Sx: ABCDEs anywhere in body, nail discoloration

Dx: wide-excisional/full-thickness biopsy

tx: excision w LN bx

Tumor marker: S-100

Prognostic factor: more depth = worse prognosis

Question 18

Squamous cell carcinoma: Sx, Dx, Tx, Prognosis

Answer 18

Sx: enlarged nodule w SCALING, crusting, bleeding,
chronic scab/non-healing ulcer

Dx: Bx

Tx: excision

Prognosis: excellent (95% cure rate and rarely metastasize)

Question 19

Marjolin’s ulcer

Answer 19

squamous cell carcinoma arising from chronic inflammation

Question 20

Kaposi sarcoma: Patho, Assoc, Sx, Dx, Tx

Answer 20

Patho: endothelial tumor of skin/LN/GIT/Lungs

Assoc: HHV-8 and HIV **AIDS-defining illness (CD4 <100)

Sx: pink/red/vilet macule, papule, and nodules on cutaneous/mucosal surfaces
LAD

Dx: Bx (spindle cells mixed with vascular tissue)

Tx: Highly Active Antiviral Therapy (HAART)

Question 21

Perioral dermatitis: RF, Sx, Tx

Answer 21

RF: young women, topical steroid use

Sx: papulopustules around the mouth that spare the vermillion border

Tx: Discontinue topical steroids (alt. Topical flagyl/erythromycin)

Question 22

Seborrheic dermatitis: Patho, Sx, Tx