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Step 2 CK > Derm > Flashcards

Derm Flashcards

1
Q

Dx any dermal malignancy

A

Bx

Never shave

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2
Q

Dx any dermal malignancy

A

Bx

Never shave

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3
Q

Who gets skin CA

A

More sun

Pale skin

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4
Q

Features of melanoma

A 
Assymetry
Borders irregular
Colours not uniform
Diameter >6mm
Evolving
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5
Q

Worst prognostic sign of melanoma

A

Growing

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6
Q

Dx melanoma

A

Full thickness Bx

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7
Q

Rx melanoma

A

Surgical removal including a significant amount of normal skin
IFN injection for widespread

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8
Q

Where does melanoma metastasize to

A

Brain

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9
Q

Who gets squamous cell skin CA

A

Sun
Organ transplant
- Long term immunosuppresive meds

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10
Q

What does SCC look like

A

Ulcer that doesn’t heal and continues to grow

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11
Q

Management of SCC

A

Bx and remove

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12
Q

MCC skin CA

A

Basal cell carcinoma

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13
Q

What does BCC look like

A

Waxy lesion that is shiny like a pearl

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14
Q

Dx BCC

A

Shave and bx

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15
Q

Rx BCC

A

Mohs micrographic surgery

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16
Q

What is Mohs micrographic surgery

A

Removal of skin CA under dissecting microscope with immediate frozen section
Lose very small amount of NL tissue

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17
Q

What is Mohs micrographic surgery best for

A

Delicate areas like eyelid or ear

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18
Q

Who gets Kaposi (HHV8)

A

AIDS (via sexual contact, NOT IVDU)

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19
Q

Where does Kaposi manifest

A

Skin
GI
Lung

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20
Q

What doesn Kaposi look like

A

Reddish/Purple lesions
More vascular
Cuboidal epithelium

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21
Q

CD4 in Kaposi

A
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22
Q

Rx Kaposi

A

Rx AIDS w/ antiretrovirals (goes away when CD4 ↑)
Vincristine or IFN intralesional injection
Chemo w/ liposomal doxorubicin if all else fails

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23
Q

What is actinic keratosis

A

Premalignant

High intensity sun exposure

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24
Q

What can actinic keratosis convert to

A

SCC

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25
Q

What is Imiquimod used for

A

Actinic keratosis
Molluscum contagiosum
Condyloma acuminatum

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26
Q

What is Imiquimod used for

A

Actinic keratosis
Molluscum contagiosum
Condyloma acuminatum

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27
Q

Who gets skin CA

A

More sun

Pale skin

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28
Q

Features of melanoma

A 
Assymetry
Borders irregular
Colours not uniform
Diameter >6mm
Evolving
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29
Q

Worst prognostic sign of melanoma

A

Growing

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30
Q

Dx melanoma

A

Full thickness Bx

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31
Q

Rx melanoma

A

Surgical removal including a significant amount of normal skin
IFN injection for widespread

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32
Q

Where does melanoma metastasize to

A

Brain

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33
Q

Who gets squamous cell skin CA

A

Sun
Organ transplant
- Long term immunosuppresive meds

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34
Q

What does SCC look like

A

Ulcer that doesn’t heal and continues to grow

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35
Q

Management of SCC

A

Bx and remove

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36
Q

MCC skin CA

A

Basal cell carcinoma

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37
Q

Rare AE of Tacrolimus and pimecrolimus

A

Develop lymphoma

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38
Q

Dx BCC

A

Shave and bx

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39
Q

Rx BCC

A

Mohs micrographic surgery

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40
Q

What is Mohs micrographic surgery

A

Removal of skin CA under dissecting microscope with immediate frozen section
Lose very small amount of NL tissue

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41
Q

What is Mohs micrographic surgery best for

A

Delicate areas like eyelid or ear

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42
Q

Who gets Kaposi (HHV8)

A

AIDS (via sexual contact, NOT IVDU)

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43
Q

Where does Kaposi manifest

A

Skin
GI
Lung

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44
Q

What doesn Kaposi look like

A

Reddish/Purple lesions
More vascular
Cuboidal epithelium

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45
Q

CD4 in Kaposi

A
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46
Q

Rx Kaposi

A

Rx AIDS w/ antiretrovirals (goes away when CD4 ↑)
Vincristine or IFN intralesional injection
Chemo w/ liposomal doxorubicin if all else fails

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47
Q

What is actinic keratosis

A

Premalignant

High intensity sun exposure

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48
Q

What can actinic keratosis convert to

A

SCC

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49
Q

How to remove actinic keratosis

A 
Curettage
Cryotherapy
Laser
Topical 5-fluorouracil
Imiquimod
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50
Q

What is Imiquimod used for

A

Actinic keratosis
Molluscum contagiosum
Condyloma acuminatum

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51
Q

What is seborrheic keratoses

A

Liver spots on elderly, benign
“stuck on” appearance
Removed w/ cryotherapy, surgery, laser for cosmetic reasons

52
Q

What is atopic dermatitis (Eczema) associated with

A

Overactivity of mast cells and immune system

53
Q

What is in the Hx of a pt w/ eczema

A

Asthma
Allergic rhinitis
FHx of atopic disorders
Onset

54
Q

MC presentation of eczema

A

Pruritis and scratching

Often on face

55
Q

Pathogenesis of eczema

A

Pruritis and scratching
Scaly, rough areas of thickened skin
Superficial staph infections

56
Q

Where does eczema usually manifest

A

Face, neck, behind knee

57
Q

Skin care in eczema

A

Moisturize
Avoid bathing, soap, washcloths
Cotton instead of wool

58
Q

What is elevated in atopic dermatitis

A

IgE

59
Q

Medical therapy of eczema

A 
Topical steroids
Tacrolimus and pimecrolimus (less AE than steroids)
Antihistamines
ABX when impetigo occurs
UV light (severe recalcitrant disease)
60
Q

Antihistamines for mild eczema

A

Cetirizine
Fexofenadine
Loratidine

61
Q

Antihistamines for severe eczema

A

Doxepine
Hydroxyzine
Diphenhydramine

62
Q

Rare AE of Tacrolimus and pimecrolimus

A

Develop lymphoma

63
Q

What causes psoriasis

A

Abs attacking epidermis

64
Q

Presentation of psoriasis

A

Silver scaly plaques
NOT itchy
Extensor surfaces
Extensive disease associated with depression

65
Q

Rx local psoriasis

A 
Topical high potency steroids
Vitamin A and D ointment
- Calcipotriene
Coal tar
Pimecrolimus and tacrolimus on delicate areas
66
Q

Steroids used in local psoriasis

A

Fluocinonide
Triamcinolone
Betamethasone
Clobetasol

67
Q

Rx extensive psoriasis

A

UV light
Anti-TNF
MTX

68
Q

Pityriasis rosea features

A

Idiopathic transient dermatitis
Herald patch that disseminates
Spares palms and soles

69
Q

Rx symptomatic Pityriasis rosea

A

Steroids or UV

70
Q

Differentiate Pityriasis rosea from secondary syphilis

A

Syphilis is VDRL or RPR positive in all cases

71
Q

MCC contact dermatitis

A

Poison ivy

Rx w/ steroids

72
Q

Features of seborrheic dermatitis

A

Hypersensitivity to dermal infection w/ noninvasive dermatophytes
Increased in AIDS and parkinson

73
Q

Rx seborrheic dermatitis

A

Topical steroids AND antifungals

74
Q

What drugs are pemphigus vilgaris associated with

A

ACEIs
Penicillamine
Phenobarbitol
PCN

75
Q

Most accurate test for cellulitis

A

Inject sterile sale and aspirate for Cx

Staph > strep

76
Q

Most accurate test for pemphigus vulgaris

A

Bx w/ auto-Abs

77
Q

Rx pemphigus vulgaris

A

Systemic steroids
Azathioprine or mycophenolate
Rituximab or IVIG if refractory

78
Q

Why is bullous pemphigoid less severe than pemphigus vulgaris

A

Bullae stay intact (less loss of fluid and infection)

Mouth not involved

79
Q

Most accurate test for bullous pemphigoid

A

Bx w/ immunofluorescent stain

80
Q

Best initial therapy for bullous pemphigoid

A

Prednisone

Wean off w/ azathioprine, cyclophosphamide, mycophenolate

81
Q

Mild bullous pemphigoid responds to

A

Erythromycin
Dapsone
Nicotinamide

82
Q

What does PCT usually affect

A

Backs of hands and face

83
Q

What is in the Hx of a pt w/ PCT

A

Chronic liver disease (hep C, alcoholism)
Estrogen use
Fe overload (hemochromatosis)

84
Q

Most accurate test for PCT

A

Increased uroporphyrins in 24hr urine collection

85
Q

What is the defect in PCT

A

Deficiency of uroporphyrin decarboxylase

86
Q

Rx PCT

A

Rx underlying cause (stop estrogen, stop alcohol)

Remove Fe w/ phlebotomy

87
Q

Features of impetigo

A

“Honey coloured”

Weeping, crusting, oozing, draining skin

88
Q

Causes of impetigo

A

Staph

Strep (group A beta hemolytic)

89
Q

Erysipelas and impetigo can cause

A

Glomerulonephritis but not rheumatic fever

90
Q

Rx mild impetigo

A

Topical

  • Mupirocin
  • Retapamulin
  • Bacitracin
91
Q

Rx severe impetigo

A

Oral

  • Dicloxacillin
  • Cephalexin
92
Q

Rx impetigo due to community acquired MRSA

A

Doxy
Clinda
TMP/SMX

93
Q

Why is erysipelas more severe than impetigo

A

Deeper in the skin

94
Q

What causes erysipelas

A

Strep > staph

95
Q

Presentation of erysipelas

A

Bright red hot swollen lesion on face

Leukocytosis

96
Q

Treatment rule for erysipelas

A

Treat for staph and strep unless there is a definitive diagnosis

97
Q

Rx mild erysipelas (same as for cellulitis, folliculitis, furuncles, carbuncles)

A

Diclox, cephalexin, cefadroxyl
PCN allergic: erythro, clarithro, clinda
MRSA: Doxy, clinda, TMP/SMX

98
Q

Rx severe erysipelas (same as for cellulitis, folliculitis, furuncles, carbuncles)

A

Ox, clox, cefazolin
PCN allergic: Clinda, vanco
MRSA: vanco, linezolid, dapto, tige, ceftaroline

99
Q

What does cellulitis look like

A

Warm, red, swollen, tender

Legs > arms

100
Q

Most accurate test for cellulitis

A

Inject sterile sale and aspirate for Cx

Staph > strep

101
Q

Features of folliculitis, furuncles, carbuncles

A

Folliculitis is small and mild hair follicle infection
Furuncle is small abscess
Carbuncle is collection of furuncles

102
Q

Get around PCN rash in skin infections

A

Use cephalosporins

103
Q

Get around PCN anaphylaxis in mild skin infections

A

Macrolides, clinda, doxy, TMP/SMX

104
Q

Get around PCN anaphylaxis in severe skin infections

A

Vanco, linezolid, dapto, tige, ceftaroline

105
Q

What is a severe skin infection

A

Fever
Chills
Bacteremia

106
Q

Best initial test for fungal infection

A

KOH prep

107
Q

Most accurate test for fungal infection

A

Fungal Cx

108
Q

Best initial therapy for fungal infection (no hair or nail)

A

Topical antifungal agent

109
Q

Best initial therapy for fungal infection with hair or nail involvement

A

Terbinafine

Itraconazole

110
Q

What are topical antifungal agents

A 
Clotirimazole
Ketoconazole
Miconazole
Nystatin (candida only)
Ciclopirox
111
Q

AE ketoconazole

A

Antiandrogenic

Oral can cause gynecomastia

112
Q

Best initial test/most accurate test for vaginal fungal disease

A

Same as oral

If presentation is clear then next best step is topical antifungal

113
Q

Drug hypersensitivity presentation

A

Morbilliform rash
Erythema multiforme
SJS
TEN

114
Q

Drugs that can cause any HS presentation

A 
PCNs
Sulfas
Allopurinol
Phenytoin
Lamotrigine
NSAIDs
Rifampin
Quinidine
115
Q

Drugs that cause skin HS can also cause

A

Hemolysis
Interstitial nephritis
Drug induced thrombocytopenia

116
Q

Causes of chronic urticaria

A

Pressure, cold, vibration

117
Q

Rx urticaria

A

Antihistamines (non-sedating)

Sedating antihistamines are for anaphylaxis

118
Q

Appearance of erythema multiforme

A

5cm is lyme

119
Q

Appearance of SJS

A

Mucous membrane involvement
May lead to resp failure
Rx w/ IVIG

120
Q

Appearance of TEN

A

Rash, mucous membrane involvement
Positive nikolsky sign
Rx w/ IVIG

121
Q

What is “fixed” reaction

A

Drug HS only happens on one part of body

122
Q

Aside from drugs, what is erythema multiforme associated with

A

Mycoplasma

HSV

123
Q

What is staph scalded skin syndrome and toxic shock syndrome

A

Different severeties of a reaction to a staph surface toxin

124
Q

Features of SSSS and TSS

A

Hypotension
Renal dysfunction
Liver dysfunction
CNS involvement

125
Q

Rx SSSS and TSS

A 
Supportive care
Antistaph ABX (Ox, Naf, cefazolin)
ABX do not reverse disease
126
Q

Progression of acne rx

A

Benzoyl peroxide (topical ABX if ineffective)
ADD topical vit A
Oral ABX if fail
ADD oral vit A to oral ABX

127
Q

Important to consider when administering vit A derivative in acne

A

Teratogenic so do a pregnancy test

Step 2 CK (21 decks)

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