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Step 3 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are three causes of Pemphigus Vulgaris?

A

Idiopathic
ACEi
Penicillamine

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2
Q

What type of Bullae are associated with Pemphigus Vulgaris?

A

Painful

Fragile/Thin/Flaccid –> Nikolsky +

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3
Q

What conditions have a positive Nikolsky’s Sign? (3)

A

1) Pemphigus Vulgaris
2) Toxic Epidermal
Necrolysis
3) Staph Scalded Skin
Syndrome

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4
Q

What is the most accurate test for Pemphigus Vulgaris?

A

Bx of lesion

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5
Q

What is the treatment for Pemphigus Vulgaris?

A

First line: Fluids/Steroids

Second line: Azathioprine, Mycophelolate, Cyclophosphamide

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6
Q

What conditions are associated with Porphyria Cutanea Tarda?

A

Alcoholism

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7
Q

What features distinguish Acute Intermittent Porphyria from Porphyria Cutanea Tarda?

A

AIP: Abdominal Pain and Psychosis

these are not seen in PCT

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8
Q

How is Porphyria Cutanea Tarda treated?

A

Stop inducing agent
Sunscreen/long sleeved clothing
Phlebotomy (to remove iron; use Defuroxamine if cannot do phlebotomy)
Chloroquine (promote excretion of porphyria)

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9
Q

What is the best initial test for Porphyria Cutanea Tarda?

A

Urine Uroporphyrins

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10
Q

What features distinguish Pemphigoid from Pemphigus Vulgaris?

A 
Pemphigoid: Involves dermal-epidermal junction 
Anti-desmoglein Ab's
Intact bullae
Less mortality
Elderly pts 
No oral lesions
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11
Q

What is the best dx’ic test for Bullous Pemphigoid?

A

Bx with immunofluorescent Ab

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12
Q

What is the treatment for Pemphigoid?

A

Steroids

Alternative: Tetracylcine, Erythromycin w/ Nicotinamide

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13
Q

What are the common drugs associated with hemolysis, acute hypersensitivity skin rxn, and allergic interstitial nephritis?

A 
Penicillins
Allopurinol
Rifampin
Sulfa Drugs
Quinidine
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14
Q

What is the treatment for urticaria?

A

Chronic: Non-sedating Antihistamines

Mild/Moderate: Antihistamines

Severe: Antihistamines, add Steroids

Unknown Trigger: Patch Testing

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15
Q

What are the factors associated with Chronic Urticaria?

A

Dermographism (pressure)
Cold
Vibration

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16
Q

What is the treatment for Morbilliform Rash?

A

Antihistamines

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17
Q

What infections are associated with Erythema Multiforme?

A

Mycoplasma and Herpes related infections

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18
Q

How is Erythema Multiforme distinguished from Lyme disease?

A

EM: Small lesions (esp on palms and soles)

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19
Q

What is the treatment for Erythema Multiforme?

A

Stop offending Agent Antihistamines

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20
Q

What is the difference between Erythema Multiforme and Stevens-Johnson Syndrome (SJS)?

A

EM: No mucosal lesions

SJS: Mucosal surfaces affected

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21
Q

How are SJS and Toxic Epidermal Necrolysis distinguished?

A

SJS: 20% total body surface area affected

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22
Q

What is the best initial test to establish a dx of dermatological fungal infections?

A

KOH prep of scraping/swab

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23
Q

What is the best initial therapy for superficial fungal infection involving hair or nail?

A

Terbinafine or
Itraconazole

(for 6wks-fingers, 12wks-toes)

Can use any topical antifungal for all other fungal infections (ketoconazole, miconazole, clotrimazole, econazole)

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24
Q

What is the most common adverse effect of terbinafine use?

A

Hepatotoxicity (Check LFT’s)

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25
Q

What are the common ORAL empiric drugs used to treat superficial bacterial skin infections?

A

Dicloxacillin, Cefadroxil, or Cephalexin

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26
Q

What is the treatment for Impetigo?

A

Mupirocin or Bacitracin (topical Ab)

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27
Q

What sequela can occur 1-2 weeks following bacterial skin infection?

A

Glomerularnephritis

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28
Q

What is the most common organism associated with Erysipelas?

A

Group A Strep (Pyogenes)

29
Q

What is the typical presentation of a pt. with Erysipelas?

A

Fever, chills, bacteremia and

Bright Red Swollen Rash (esp on face)

30
Q

What is the treatment for pt with Strep confirmed Erysipelas?

A

Penicillin or Ampicillin

PO or IV meds

31
Q

What skin layers are involved in Cellulitis?

A

Epidermis, Dermis, and Subcutaneous layers

32
Q

What are the typical organisms associated with Necrotizing Facsiitis?

A

Clostridia

Strep (anaerobic)

33
Q

What is the typical presentation/physical exam findings in a pt with Necrotizing Fasciitis?

A 
High Fever
Point of entry
Palpable crepitus
Pain (out of proportion to skin wound)
Bullae
34
Q

What is the next step in management for a pt presenting with pain, high fever, palpable crepitus, portal of entry on skin?

A

Surgery for debridement

surgery is diagnostic and therapeutic

35
Q

What is the standard treatment for Necrotizing Fasciitis?

A 
Debridement
IV Antibiotics (b-lactam/b-actamase)

[If confirmed strep-use penicillin and clindamycin]

36
Q

What is the treatment for paronychia?

A

Incision and antistaph systemic antibiotics

37
Q

What is the next step in management for a pt presenting with crops of vesicular lesions either on lip, genetalia, or in a dermatologic distribution?

A

Acyclovir administration

38
Q

What are 3 complications of Varicella infection?

A

Pneumonia
Hepatitis
Dissemination of infection

39
Q

What is the next step in management for a pt with multiple recurrent Herpes outbreaks being treated with Acyclovir?

A

Switch to Foscarnet

Might also do HIV test

40
Q

What is the best initial test for a pt presenting with an ulcerative lesion on their lip?

A

Tzanck Smear

41
Q

What is the most effective treatment for post herpetic neuralgia?

A

Gabapentin

42
Q

What is the maximum amount of time a non-immune adult has to receive Varicella IVIG following exposure to chickenpox?

A

96 hrs (4 days)

43
Q

What is the advantage in using Imiquomod to treat (remove) warts?

A

No damage to normal tissue

No pain

44
Q

What is the best initial test for Primary Syphilis?

A

Darkfield Microscopy

45
Q

What is the best initial test for Secondary Syphilis or a pt presenting without an ulcer?

A

VDRL/RPR and confirm with FTA!!

46
Q

What is the treatment for neurosyphilis?

A

IV penicillin

47
Q

What disease is associated with Chondylomata lata?

A

Secondary Syphilis

48
Q

What infection is associated with Chondylomata acuminata?

A

HPV infection (warts)

49
Q

What is the next step in treating a pregnant patient dx with syphilis or a pt with neurosyphilis??

A

Desensitization and Penicillin

50
Q

What is the treatment for a pt with primary or secondary syphilis?

A

IM Penicillin (single shot)

If allergic to penicllin-use Doxycycline for 2 wks

51
Q

What are the possible manifestations of Secondary Syphilis?

A

Skin: Chondylomata lata, mucous patch, alopecia, maculopapular copper-colored rash involving palms and soles

52
Q

What is the best way to test for Scabies?

A

Mineral oil application to area then Scrape

53
Q

What is the first line treatment for Scabies and Pediculosis?

A

Permethrin

54
Q

What is the best treatment for Norwegian Scabies?

A

Ivermectin (PO)

55
Q

What is an alternative treatment for Pediculosis?

A

OTC Pyrethrins

56
Q

What is the treatment for CNS or cardiac Lyme disease?

A

IV Ceftriaxone

57
Q

What can be used to distinguish between Toxic Shock Syndrome and Staph Scalded Skin Syndrome?

A

TSS: Hypotension - Shock

SSSS: Normal BP

58
Q

How can Toxic Epidermal Necrolysis be distinguished from Staph Scalded Skin Syndrome?

A

TEN: Drug induced

SSSS: Bacterial toxin induced

59
Q

What tests are used to dx Anthrax infection?

A

Gram stain and Culture of lesion

60
Q

What is the treatment for Anthrax?

A

Ciprofloxacin or Doxycycline

61
Q

What type of bx is used to dx possible melanoma?

A

Full thickness

thickness of lesion is best prognostic indicator

62
Q

What type of bx is used to dx Basal Cell Carcinoma?

A

Shave/Punch Bx

63
Q

What is the treatment for Melanoma?

A

Excision of Lesion and Interferon (to resude recurrence)

64
Q

What is the treatment for Basal Cell Carcinoma?

A

Mohs microsurgery (get immediate frozen sections to determine if all cancer is removed)

65
Q

What is the causal agent for Kaposi Sarcoma?

A

HHV-8

66
Q

What is the first line treatment for a pt with Kaposi Sarcoma?

A

optimize HAART

67
Q

What is an alternative treatment for pt with Kaposi Sarcoma not responding to standard therapy?

A

Liposomal Adriamycin and vinblastine

68
Q

What is the mechanism of action of topical retinoid cream?

A

Regulate Follicular Keratinization (one cause of pimples)

Step 3 (12 decks)

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