ABIM 2015 - Derm Flashcards
(428 cards)
1
Q
Which areas of the body are sites that are most commonly diagnosed with melanoma?
A
Backs of MEN, legs of WOMEN
2
Q
What are the dermatologic risks of phototherapy and immunosuppression?
A
Skin cancers
3
Q
What type of care is required by patients whom exhibit widespread erythema, peeling, sloughing or painful skin, acute onset of mucosal erosion (mouth, eyes, genitals), rapidly-progressing blisters/pustules, skin necrosis, purpura in patients with systemic illness or fever?
A
Emergent Dermatologic Consultation
4
Q
What patient population is at an especially high risk of developing aggressive Squamous Cell Carcinoma, other skin cancers, deep fungal infections and rapidly-growing nodules or plaques?
A
TRANSPLANT recipients (immunosuppressed)
5
Q
Clobetasol Propionate
A
Superpotent Topical Steroid
6
Q
Triamcinolone
A
High-Potency Topical Steroid
7
Q
Hydrocortisone
A
Low-Potency Topical Steroid
8
Q
These topical steroids MUST be avoided on the face, groin, axilla or atrophic skin and only used for short-term elsewhere?
A
Superpotency and High-Potency topical steroids
9
Q
How is Vulvar Lichen Sclerosus treated?
A
Superpotent (Clobetasol) Topical Steroids
10
Q
Best steroid for patients with WIDE-SPREAD (large surface area) dermatoses?
A
Triamcinolone
11
Q
Why do corticosteroids thin-out the skin if used long-term?
A
Because they inhibit collagen production
12
Q
Cigarette paper skin, skin atrophy and striae (stretch marks) are all caused by prolonged use of these medications?
A
Topical Corticosteroids
13
Q
What is a rare SYSTEMIC adverse effect of chronically used Superpotent Topical Corticosteroids?
A
Hypothalamic-Pituitary Axis suppression (>50 g/week of superpotent or >100 g/week of high-potency)
14
Q
Skin findings worsen in a patient after receiving appropriate topical corticosteroid therapy?
A
Allergic contact dermatitis to corticosteroid formulation
15
Q
What dermatologic therapy can lead to easy bruising from minimal trauma?
A
Chronic use of SYSTEMIC corticosteroids
16
Q
Topical and Systemic corticosteroids are considered Category C, are these safe for use in pregnancy?
A
YES
17
Q
Of ALL antihistamines, which is contraindicated for use during the first trimester?
A
Hydroxyzine
18
Q
Tetracyclines in pregnancy?
A
NO! can cause staining of teeth and affect developing bones, especially skull fontanelles (bulging)
19
Q
Isotretinoin, Methotrexate, Thalidomide, Flutamide, 5-FU, finasteride, Danazol, Estrogens?
A
Pregnancy Category X (DO NOT USE)
20
Q
Which TWO medications have their own government-mandated Pregnancy Prevention Programs?
A
Isotretinoin and Thalidomide
21
Q
Pregnancy Category D?
A
Human studies confirm risk to fetus however benefits of treatment may outweigh potential risk
22
Q
Skin findings of linear excoriations, small scattered erosions, scarring, hyper/hypo pigmentation, firm, hyperpigmented dome-shaped nodules with superficial erosions indicate what?
A
Clues that a patient has pruritus and has been scratching
23
Q
A non-immunologic, toxic-injury to the skin is called?
A
“IRRITANT” Contact Dermatitis (chronic hand-washing)
24
Q
Delayed-Hypersensitivity Reaction (TYPE-IV) caused by allergen-specific T-lymphocytes with rash with specific pattern of substance usually seen on skin (squares, etc.)?
A
“ALLERGIC” Contact Dermatitis (poison ivy, metals, bandaid, etc.)
25
How do you diagnose ALLERGIC Contact Dermatitis?
Epicutaneous Patch Testing
26
Why is patch testing NOT done with "IRRITANT" contact dermatitis?
Because it can scar and cause pigmentation changes
27
How is Prick or Scratch testing different than Patch testing?
RAST (prick/scratch) testing is for Type-I or IgE-mediaed allergies, NOT Type-IV (delayed hypersensitivity) testing
28
How are IRRITANT and ALLERGIC contact dermatitis treated?
Mid-to-High potency topical corticosteroids and avoidance of the offending substance
29
When would you opt to use systemic corticosteroids for the treatment of contact dermatitis?
If severe reaction (facial swelling, severe pruritus, extensive area affected, impairment of function or sleep
30
What testing best identifies the etiology of hand-eczema (most often work-related exposure)?
Patch testing
31
How do you best treat hand-eczema besides avoidance of causative substance?
Wearing rubber gloves and using a mid-to-high potency topical corticosteroid twice daily until it clears
32
Patients with recalcitrant (refractive) dermatitis to topical/systemic corticosteroids must be treated with what?
Immunosuppressant agents or PSORALEN + PUVA (UV A or B light therapy)
33
Erythematous patches on the lower leg with dry scale and fine fissures that occur usually in the winter on dry skin? How do you treat?
Xerotic eczema; non-soap cleansers, thick moisturizers and 2-3 weeks of low-to-mid potency topical corticosteroids if significant pruritus
34
Distinguished from Tinea Corporis by negative KOH test and no hyphae under the microscope, presents with coin-shaped patches that are very itchy, usually in patients with history of atopic eczema?
Nummular dermatitis
35
A dermatitis that occurs often on the lower legs of patients with venous insufficiency, >50 yo, with edema, erythema, brown discoloration, scaling and petechiae, however is CHRONIC, BILATERAL and often with PRURITUS?
Stasis Dermatitis
36
How is cellulitis different than Stasis Dermatitis?
Cellulitis is NOT pruritic, usually UNILATERAL, smooth not scaly, ACUTE, rapidly spreading and PAINFUL
37
Why should biopsy of stasis dermatitis be used only as a last resort (unusual location, recalcitrant to therapy or with normal venous studies?
Because the ulcer created by the biopsy may not heal (due to the poor blood flow of venous stasis)
38
How is stasis dermatitis treated?
Leg elevation, graduated support stockings, ORAL antibiotics if infection present
39
A chronic, pruritic skin condition that begins in childhood, with intermittent flares involving the wrists, hands, antecubital and popliteal fossae?
Atopic Dermatitis
40
Dermatitis flares caused by heat, stress, infection with red skin with serous crusting and erosions, commonly seen in patients with a history of environmental allergies, asthma?
Atopic Dermatitis
41
Type 2 T-helper (TH2) response with elevated IgE and eosinophils and dysregulation of (TH1) response - type of dermatitis?
Atopic Dermatitis
42
How is atopic dermatitis treated?
Topical Corticosteroids
43
What types of topical corticosteroids are used for the face and other thin-skin areas such as intertriginous (skin folds) areas?
Low-potency topical steroids (to avoid thinning of skin)
44
What are topical pimeCROLIMUS and taCROLIMUS used for?
Topical calcineurin inhibitors that CAN be used on the face and intertriginous (skin folds) areas when superpotent and high-potency corticosteroids can't
45
What is a disadvantage of soaps?
They dry the skin
46
What is a disadvantage of creams, lotions, solutions and gels?
Contain water, preservatives and alcohols that can sting and burn open skin
47
Best thick moisturizer?
Petroleum jelly
48
Recalcitrant dermatitis, eczema, vitiligo, cutaneous T-cell lymphoma can be treated how?
PSORALEN + UV A/B light or systemic immunosuppressants
49
What bacteria colonizes areas affected by chronic skin conditions including dermatitis?
Staphylococcus Aureus
50
A chronic, multisystem inflammatory disease with both genetic and environmental factors, exacerbated by stress, infections, medication (interferons, TNF-alpha, lithium & ß-blockers)?
Psoriasis
51
The second most common type of psoriasis after plaque psoriasis which is often diagnosed in childhood and is triggered by this respiratory illness?
Streptococcal pharyngitis (strep throat)
52
What is the "Koebner" phenomenon experienced by patients with psoriasis, lichen, vitiligo and keratosis?
Development of PSORIATIC, LICHEN, VITILIGO or KERATOSIS lesions in the scars that develop following injury to the skin as it heals
53
Nail involvement in psoriasis indicates what condition?
Psoriatic arthritis
54
What dermatologic conditions mimic the appearance of psoriasis and erythema often necessitating skin biopsy for diagnosis?
Cutaneous T-cell lymphoma, Lupus, Dermatomyositis
55
When is SYSTEMIC (methotrexate, acitretin, TNF-alpha) rather than topical therapy recommended for patients with psoriasis?
When >10% body surface area is affected
56
An idiopathic, inflammatory disease that can affect the hair follicles, skin (wrists, ankles, back and trunk), nails and mucous membranes (oral/buccal and genital) with INTENSE pruritus and Wickham striae (fine white lines on lesions)?
Lichen Planus
57
What has a similar appearance to Lichen Planus but is caused by meds like ACE-I, thiazide diuretics, furosemide, ß-blockers and antimalarials?
Lichenoid Drug Eruption (LDE)
58
How is mild psoriasis treated?
Topical Corticosteroids or Topical Vit D analogues
59
How are psoriasis, lichen planus, pityriasis rosea and seborrheic dermatitis diagnosed?
KOH prep/Biopsy if needed
60
How are mild cases of psoriasis, lichen planus, pityriasis rosea and seborrheic dermatitis treated?
Topical corticosteroids
61
Patients allergic to metals (mercury, gold, palladium) can have what types of changes directly adjacent to their dental fillings?
Lichenoid (Lichen Planus)
62
What is the most serious risk of a chronic mucosal (oral/buccal, genital) lesion of Lichen Planus?
Squamous Cell Carcinoma
63
What dermatological disorder can cause scarring alopecia?
Lichen Planus (can affect hair follicles)
64
What maintenance therapy is used for Lichen Planus?
Topical Calcineurin Inhibitors
65
What is the ONLY medication that CAN result in REMISSION in Lichen Planus?
PSORALEN + PUVA (UV A)
66
A common dermatosis seen in 10-35 year olds, seen in fall and spring, begins with one, annular patch with trailing scale, days to weeks BEFORE onset of numerous, smaller patches on the trunk and proximal extremities?
Pityriasis rosea (herald patch, Christmas Tree distribution)
67
As Pityriasis Rosea is self-limited and spontaneously resolves, when do you treat with topical corticosteroids or UV-B light therapy?
If extensive or persistent (beyond 1-3 months)
68
A dermatitis seen commonly in HIV/AIDS and patients with neurologic diseases (Parkinson) that involves the scalp, eyebrows, side of nose and ears?
Seborrheic dermatitis
69
Is a biopsy helpful in a morbilliform (a combined macular/papular skin eruption) caused by medications?
NO
70
How is a MORBILLIFORM (coexistent macules & papules) drug reaction different than a drug HYPERSENSITIVITY syndrome?
Drug HYPERSENSITIVITY syndrome involves FACIAL EDEMA with papules coalescing into plaques and is treated with SYSTEMIC not topical corticosteroids
71
Puffy pink plaques with an annular configuration that occur within DAYS of initiation (antibiotics, contrast dye) with possible ANAPHYLAXIS is what type of a cutaneous drug reaction and how is it treated?
URTICARIAL; antihistamines AND possibly systemic corticosteroids (if severe) or EPINEPHRINE (if anaphylaxis)
72
Swollen, painful plaques on palms and soles after chemotherapy?
Hand-Foot syndrome (treat with analgesics)
73
Skin reaction that looks like acne but is NOT (does not respond to retinoids) that is seen with CETUXIMAN and SORAFENIB and is treated with antibiotics and low-potency topical corticosteroids?
ACNEIFORM reaction
74
What is the DANGER with use of Tyrosine Kinase Inhibitors ("inib"), Hydroxyurea and Voriconazole?
Cutaneous Squamous Cell Carcinoma
75
What is the DANGER with VORICONAZOLE?
Associated with Squamous Cell Carcinoma and Melanoma
76
Which drugs are the MOST COMMON cause of "Drug-Induced Hypersensitivity Syndrome" or "Drug-Induced Systemic Reactions" or "Drug Reaction With Eosinophilia and Systemic Symptoms?"
Anticonvulsants (anti-epileptic)
77
Epileptic patient took his medication and developed facial edema, fever, lymphadenopathy, wide-spread rash with purpura and skin necrosis?
Drug-Induced Hypersensitivity Syndrome
78
Severe drug reaction with SUDDEN onset of wide-spread erythema studded by small pustules with fever, leukocytosis and eosinophilia caused by antibiotics, antimalarials, diltiazem and terbinafine?
Acute Generalized Erythematous Pustulosis (AGEP)
79
How is Acute Generalized Erythematous Pustulosis (AGEP) treated?
Self-limited (2 weeks) or can use topical/systemic corticosteroids depending on severity
80
What is the preferred treatment of drug-induced SYSTEMIC reactions?
Systemic corticosteroids
81
A combination of new and resolving, NON-PRURITIC red-brown patches with "cayenne pepper" petechiae on the lower extremities mistaken for stasis dermatitis or vasculitis?
Pigmented Purpuric Dermatoses (mixed cryoglobulinemia)
82
Blockage and rupture of sweat glands when skin is occluded and hot such as in swaddled neonates, immobile, febrile or post-op patients or under pannus or breasts?
Miliaria (heat rash)
83
What is generally seen in combination with Miliaria (heat rash)? How is it treated?
Candida infection; cooling the patient, talctum powder, antifungal if candida
84
Erythematous papules on chest, back or flanks of hospitalized patients due to occlusion of the skin from fever and sweating?
Acantholytic Dermatosis (Grover Disease)
85
What are the two main types of acne?
Inflammatory and non-inflammatory
86
What is the presentation of non-inflammatory acne?
Comedones (white/blackheads)
87
What is the presentation of inflammatory acne?
PAINFUL erythematous pustules, nodules or cysts
88
What MUSt be done for a woman presenting with acne and a history of irregular menses, hirsutism, deepening voice or clitoromegaly?
Prompt endocrine screening (DHEA-S, testosterone and 17-hydroxyprogesterone)
89
A severe type of acne that presents with ABRUPT onset of widespread, severe, painful inflammatory cysts with a febrile and ill-feeling patient with sterile osteomyelitis presenting as bony lesions in the sternum and clavicle?
Acne Fulminans
90
How do you treat Acne Fulminans?
Referral to dermatology and Isotretinoin with systemic corticosteroids to minimize severe scarring
91
Young body builder presents with hundreds of small follicular papules and pustules in the SAME STAGE of evolution WITHOUT comedones, on the upper trunk, arms or face?
Corticosteroid-induced acneiform eruption
92
Bacterial folliculitis in HAIR-bering areas in athletes is caused by?
Staphylococcus Aureus
93
When is folliculitis on the face caused by E.coli (Gm neg)?
When overgrowth of the bacteria occurs during prolonged antibiotic treatment of acne
94
How is MILD (comedomal) acne treated?
Topical antibiotic + Benzoyl peroxide AND topical retinoid
95
How is MODERATE acne (comedomes and papules/pustules) treated?
Topical AND oral antibiotic + Benzoyl peroxide AND topical retinoid
96
How is SEVERE (nodular/cystic) acne treated?
Oral antibiotics
97
How is SEVERE RECALCITRANT acne treated?
Oral Isotretinoin with referral to dermatologist
98
What are the typical skin washes used for acne?
Benzoyl peroxide, Salicylic/Azelaic acid
99
What are the typical TOPICAL antibiotics used to treat acne?
Clindamycin, Erythromycin
100
What are the typical ORAL antibiotics used to treat acne?
Doxycycline, Tetracycline, Minocycline, Erythromycin
101
Why is the use of Benzoyl peroxide important in the treatment of acne with TOPICAL or ORAL antibiotics?
Because it reduces the resistance of Propionibacterium acnes to the antibiotics used
102
What agent is used in combination with Oral Contraceptive pills to improve their effect on acne treatment?
Spironolactone (drospirenone)
103
What can painful acne cysts be treated with at the dermatologist's office?
Injection of cyst with Triamcinolone
104
Inflammatory vascular condition causing acneiform eruption presenting as flushing of the face with bulbous nose and dry, gritty feeling in the eyes with conjunctival injection triggered by hot liquids, spicy foods, exercise, stress and alcohol?
Rosacea
105
How are vascular rosacea and periorificial dermatitis treated?
TOPICAL metronidazole, azelaic acid or sodium sulfacetamide
106
How is pustular rosacea treated?
Oral Tetracycline
107
Follicular occlusion with painful, draining nodules and sinuses in the axilla, groin and under breasts with sterile abscesses?
Hidradenitis Suppurativa
108
How is Hidradenitis Suppurativa treated?
Oral Tetracycline
109
What treatment allows for analgesia of painful dermatological nodules and cysts?
Intra-lesional injection of Triamcinolone
110
What dermatological condition is very strongly worsened by smoking and obesity?
Hidradenitis Suppurativa
111
What therapy is definitive for Hidradenitis Suppurativa?
Surgical excision and grafting
112
Folliculitis, furuncles, carbuncles, impetigo, cellulitis, ecthyma, scalded skin syndrome and erysipelas are all caused by?
Staph aureus OR Strep pyogenes
113
When is culture of folliculitis important?
When suspecting MRSA
114
How is folliculitis treated?
TOPICAL antibacterial washes (clorhexidine), TOPICAL antibiotics (mupirocin) or ORAL antibiotics
115
What is suspected in recurrent folliculitis?
MRSA (check nares and perianal area)
116
Besides bacteria, what else can cause folliculitis?
Fungi and HSV
117
When an abscess involves a follicle, it is called? When these coalesce into larger lesions they are called?
Furuncle; Carbuncles
118
When are skin abscesses treated with antibiotics?
If cellulitis is present, if systemic symptoms exist (fever) and in immunosuppressed or patients with heart valves or joint prostheses
119
What are first-line therapies for MRSA?
Tetracyclines (doxycycline, minocycline), clindamycin or TMP-SMX
120
What is an excellent medication to use in a patient with jaundice-caused pruritus not responsive to cholestyramine?
Rifampin
121
A CONTAGIOUS and pruritic skin infection caused by Staph aureus or Strep pyogenes in healthy people that has a bullous and non-bullous form?
Impetigo
122
How is impetigo treated?
Topical (mupirocin) or Oral antibiotics
123
What is cellulitis?
Infection of deeper layers of the skin (scratching, injury or hematogenous spread)
124
How do you treat cellulitis?
ß-lactam antibiotic (cephalexin or dicloxacillin) or same as MRSA antibiotics (clindamycin, TMP-SMX, tetracycline)
125
What bacteria are suspected in cellulitis BESIDES Staph aureus?
ß-hemolytic strep (thus requiring ß-lactam antibiotics for treatment)
126
How do you treat an immunocompromised patient with cellulitis?
Broad-spectrum antibiotics as with MRSA (clindamycin, TMP-SMX, tetracyclines, linezolid)
127
What should be done preventatively in patients with lower extremity cellulitis?
Check for DVT with US
128
DEEPER skin infection than Cellulitis is called?
Erysipelas (dermis and lymphatics)
129
What bacteria is involved in Erysipelas (FACE) in the young, women and elderly and how is it treated?
Group A Strep; PENICILLIN
130
Infection in intertriginous areas (axilla, groin), caused by Corynebacterium and fluoresces coral red on wood lamp?
Erythrasma
131
How is erythrasma treated?
Clindamycin, erytheromycin (macrolides) or topical antifungals (azoles)
132
Stinky feet with pitted lesions caused by excess sweat and bacteria (Corynebacterium, Kytococcus, Actinomyces)? How is it treated?
Keratolysis (topical erythromycin or clindamycin
133
Moccasin distribution of SCALING fungal infection?
Tinea Pedis
134
How are all Tineas treated?
Topical (azole) antifungals (oral only if recurrent)
135
Dry SCALING on one hand and two feet?
Tinea Manum
136
Dry SCALING of scalp and hair loss, usually in children?
Tinea Capitis
137
Symmetrical SCALING in the inguinal folds sparing the scrotum?
Tinea Cruris
138
How can you test for Tinea if needed?
KOH prep of advancing edge of lesion demonstrating hyphae (fungus)
139
How long are tineas treated for?
Until COMPLETELY cleared
140
SCALED oval patches either hyper or hypo pigmented involving skin and hair follicles usually on chest, upper back and abdomen (high sebaceous gland concentration) with hyphae and spores on KOH prep?
Tinea Versicolor (pityriasis versicolor)
141
How is Tinea Versicolor treatment DIFFERENT than the other Tineas?
Selenium; or topical/oral antifungals if very limited involvement or very wide spread
142
Besides AZOLE antifungals, what can be used for cutaneous candidiasis treatment? Prevention?
Nystatin; Zinc Oxide paste (barrier cream)
143
Grouped, PAINFUL, BURNING vesicular lesions that recur, generally found in oral mucosa?
HSV-1
144
Grouped, PAINFUL, BURNING vesicular lesions with ulceration that recur, generally found in genital region?
HSV-2
145
Grouped, PAINFUL, BURNING vesicular lesions that recur, generally found in dermatomal distribution?
Herpes Zoster (varicella zoster) - chicken pox reactivation
146
What CAN occur ONLY during INITIAL infection with HSV besides severe local pain and burning?
Fever, malaise, tender lymphadenopathy
147
What are the prodromal symptoms of HSV recurrence?
Burning and stinging at site of eruption before eruption
148
Which HSV type can cause pharyngitis and aseptic meningitis?
HSV-2
149
What is common with HSV-2, Syphilis, Chancroid, Lymphogranuloma Venerum and Granuloma Inguinale?
ALL cause GENITAL ULCERS
150
What can test for but not differentiate HSV type?
Tzank smear
151
What can rapidly test for AND differentiate HSV?
PCR or DFA (direct fluorescent antibody)
152
What is the gold standard for HSV type diagnosis but takes 2 weeks for result?
Viral culture
153
What is recommended for treatment of HSV infection when lesions occur and when is the BEST time to treat?
ORAL agents (acyclovir, valcyclovir, famcyclovir); at onset of PRODROME symptoms
154
Recurrent herpes zoster infection should raise suspicion of?
HIV infection or malignancy
155
When should treatment of herpes zoster begin?
Within 24-72 hours of ERUPTION
156
What should be done if herpes zoster (shingles) involves the face (1st distribution of trigeminal nerve)?
Emergent ophthalmology evaluation
157
What are warts caused by?
HPV
158
What are anogenital warts called?
Condylomata acuminata
159
Does surgical removal of warts treat HPV?
NO
160
Do women with genital warts require more frequent PAP smears than the regular population?
NO
161
What should be suspected if genital warts appear to be bizarre or recalcitrant to therapy?
Transformation into Squamous Cell Carcinoma
162
Besides surgery, what are other good treatments for warts?
Salicylic acid, cryotherapy, Topical IMIQUIMOD
163
What HPV strains are covered by the HPV vaccine?
Cancer types (6, 11, 16, 18)
164
What TOPICAL immunomodulatory medication works well for warts, molluscum contagiosum, actinic keratosis and Squamous Cell Carcinoma in Situ (Bowen Disease)?
IMIQUIMOD
165
Asymptomatic, small firm papules with with central depression caused by a poxvirus and can occur on ANY skin surface?
Molluscum Contagiosum
166
Adults and children with this disease can have EXAGGERATED responses to mosquito bites, with blisters and wheals?
CLL
167
How is scabies diagnosed?
Scraping of lesions and examination with KOH or mineral oil
168
What is used to treat scabies infestation (person affected and ALL family members who live with patient and close contacts)
Topical PREMETHERIN cream, applied neck to toe, repeated again in 7-10 days; Oral IVERMECTIN (for persistent infection)
169
What dermatologic condition is a risk factor for Bartonella quintana endocarditis?
Body lice (homeless)
170
How is lice treated initially? If not resolved?
Topical Premetherin, malathione or Oral Ivermectin; Lindane (neurotoxic)
171
Best medication for head lice?
SPINOSAD (topical insecticide)
172
"Breakfast, Lunch and Dinner" bites, treatment is symptomatic only with topical corticosteroids and antihistamines?
Bed Bugs
173
Spider bite with nausea, vomiting, fever, myalgia and can develop a painful necrotic wound? How is it treated?
Brown Recluse Spider; Supportive with wound care
174
What is the best management for wound healing?
Keeping them MOIST and OCCLUDED (petroleum jelly)
175
Why is petroleum jelly better than topical antibiotics for NON-INFECTED cuts, scrapes and burns?
Same outcome WITHOUT possibility of allergic reactions/contact dermatitis from antibiotics
176
What topical antibiotics are recommended for SECONDARILY INFECTED cuts, scrapes and burns?
Mupirocin
177
What is the difference between a 1st degree burn and a second degree burn?
1st degree burn is DRY; 2nd degree burn is MOIST
178
What is the initial treatment for both 1st and second degree burns?
Outpatient analgesia, NSAIDS, cool compresses and gentle skin care
179
What is done with open blisters from a burn?
Gentle debridement and non-adherent gauze (petrolatum)
180
How are 2nd degree burns treated differently than 1st degree burns?
2nd degree burns are monitored for infection and tetanus prophylaxis is given if immunization is unknown
181
What is done with patients who present with burns >10% body surface area, burns involving the face, hands/feet, genitals, perineum or major joints, 3rd degree burns, electrical/chemical burns, inhalation injury and burns+trauma?
Referral to a BURN CENTER
182
What are the three most common types of skin cancer?
Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma
183
This skin cancer does not metastasize however causes significant local tissue destruction and has telangiectasias?
Basal Cell Carcinoma
184
What is REQUIRED for diagnosis of basal cell carcinoma?
BIOPSY
185
What is the best treatment for Basal Cell carcinoma and is especially used on the face?
Mohs surgery
186
How are less aggressive subtypes of basal cell carcinoma treated?
Simple excision, cryotherapy, electrodessication and curettage, pthotodynamic therapy or topical imiquimod
187
What is morpheaphorm basal cell carcinoma?
A more aggressive type of basal cell carcinoma
188
Very SCALY macules or papules usually found on face or dorsum of hands usually easier to feel rather than see, due to sun exposure?
Actinic Keratosis
189
What is actinic keratosis a precursor for?
Invasive Squamous Cell Carcinoma
190
Besides Topical imiquimod, cryotherapy and photodynamic therapy, what else is used to treat actinic keratosis?
5-FU
191
What is Bowen Disease?
Squamous Cell Carcinoma in Situ, a non-invasive form of Squamous Cell Carcinoma
192
How is Bowen disease treated?
Same as actinic keratosis, cryotherapy, topical imiquimod, 5-FU or excision
193
A red, volcano-like nodule with a central keratinic plug, a subtype of squamous cell carcinoma, which grows rapidly treated by excision?
Keratoacanthoma
194
A history of blistering sunburns, especially before 18 yo, presence of multiple nevi, having fair skin and freckles are all risk factors for?
Melanoma
195
A skin lesion with asymmetry, irregular borders, multiple colors, diameter >6 mm with enlargement over time is likely?
Melanoma
196
What is the MOST important prognostic feature of melanoma?
Tumor depth (Breslow depth)
197
What is an Acral Lentiginous Melanoma and where is it found?
Melanomas found on the nails or hands and feet of patients with dark skin types
198
What is the diagnostic technique of choice for melanoma?
Excisional Biopsy
199
This type of skin cancers are much more aggressive in immunosuppressed patients?
Squamous Cell Carcinoma
200
Exposure to UV light, arsenic, ionizing radiation, HPV, cigarette smoke and being immunosuppressed places a patient at high-risk of?
Squamous Cell Carcinoma
201
What is a Marjolin ulcer?
An aggressive form of Squamous Cell Carcinoma which can arise from a burn injury scar, years after burn
202
How is Squamous Cell Carcinoma treated?
Radiation and Mohs surgery/excisional surgery
203
What else is done for patients with melanoma besides excision of tumor if higher-risk lesion?
Sentinel lymph node biopsy
204
How is METASTATIC melanoma treated?
Interferon + Chemotherapy
205
Benign pigmented lesions usually found in older adults and have a "stuck-on" appearance?
Seborrheic Keratosis
206
How and when is seborrheic keratosis treated?
Curettage or cryotherapy, only necessary if inflamed
207
What type of nevi appear in hoards on back/chest/arms, are darkly pigmented (melanocytic) and pose a higher risk of transformation into melanoma?
Dysplastic nevi
208
What is recommended for Dysplastic Nevi?
Rigorous screening, surveillance, self-examination and regular physician examinations, NOT routine removal
209
What are HALO Nevi and why are these important?
Nevi that are undergoing a process of destruction by an immune-mediated response leaving a white halo around them; because melanoma can undergo a similar process
210
Single or multiple small, pink or yellowish papules on the face WITHOUT telangiectasias and WITHOUT translucency, often associated with rosacea?
Sebaceous Hyperplasia
211
Small, flesh-colored asymptomatic papules that are common and benign however can present as multiple in conjunction with axillary freckling, cafe-au-lait spots and Lisch (brownish) nodules on the iris?
Neurofibromas; Neurofibromatosis-I
212
Benign, soft, fleshy and pedunculated papules occurring in areas of friction such as neck, axillae and groin and the presence of multiple such lesions is associated with insulin resistance, obesity and DM-II. Often found in patients with acanthosis nigricans?
Acrochordons (Skin Tags)
213
Benign vascular lesion (usually red and non-blanching) found in adults and mainly on the trunk?
Cherry Hemangioma
214
Firm pink to brown papule on skin with darker brown ring on periphery, found after insect bites or shaving injury and dimples when squeezed?
Dermatofibroma (benign)
215
Brown macules found in older people especially in sun-exposed areas, benign but if found on face and have irregular pigmentation these need to be biopsied, why?
Solar Lentigines "liver spots"; because may be lentigo maligna
216
How are hypertrophic scars and keloids treated?
Intra-lesional corticosteroid injections
217
Friable, red vascular papules that are often painful and bleed easily, arise spontaneously especially in pregnant women and grow very rapidly that consist of a collection of capillaries?
Pyogenic granulomas (not actually pyogenic nor granulomas)
218
Subcutaneous nodule that is benign, has a central punctum and if drained, contains a white, cheesy and malodorous keratinaceous material?
Epidermal Inclusion Cysts (must remove cyst wall if treated)
219
What is the main cause of pruritus?
Dry Skin
220
A condition in which stroking or rubbing your skin causes a pruritic acute wheal and flare reaction?
Dermatographism
221
What should be done for diffuse itching without a rash?
Search for underlying systemic cause
222
Malignancies (especially hematologic or lymphomas), cholestatic liver disease, renal disease, iron deficiency, hypo/hyper thyroid disease, certain medications and HIV infection can all cause what common symptom?
Pruritus
223
What are notalgia paresthetica and brachioradial pruritus?
Neuropathic itching conditions resulting from inflammation or damage to sensory nerves
224
Which antihistamines are best for treatment of pruritus?
The most sedating types
225
Which are the two common topical antihistamines?
Doxepin and Diphenhydramine
226
What agents are used for neuropathic pruritus?
Gabapentin, Pregabalin and UV-B therapy
227
How long do urticarial lesions (wheals) last for?
No longer than 24 hours
228
Uritcarial lesions that last LONGER than 24 hours, resolve leaving a bruise and present with burning or tingling are what and what do they require?
Urticarial Vasculitis; must be biopsied for diagnosis
229
What must be done for patients whom have extensive urticarial eruptions around the mouth?
Monitored closely for possible admission in case of airway obstruction
230
What is the predominant cause of urticaria?
Viral URI's
231
What is considered acute vs chronic urticaria?
6 weeks
232
What MUST ALL patients with ACUTE urticaria be evaluated for?
Anaphylaxis
233
What are the three (3) most common triggers for anaphylaxis?
Bee stings, food allergies, medications
234
What are known mast-cell degranulators that can make urticaria worse?
Exercise, heat/cold, friction, vibration, pressure and venoms
235
What are common medications that induce mast-cell degranulation?
Aspirin, alcohol, narcotics (codeine and morphine), scopolamine and some anesthetics
236
What is first-line therapy for urticaria?
Anti-histamines 4-8 weeks NOT just for flare-ups
237
What is second-line treatment for urticaria if antihistamines fail?
Tapered oral corticosteroids
238
Patients who fail to respond to antihistamine therapy should be diagnosed with what?
CHRONIC urticaria
239
What is CHRONIC urticaria treated with?
Colchicine, Dapsone, Hydroxychloroquine, mycophenolate mofetil, methotrexate
240
What should ALL patients with angioedema be trained to do?
Be able to use an Epi-Pen
241
What should be considered when an adult presents with unexplained BLISTERING or erosions of the skin, especially of the MOUTH, EYES or VULVA?
Autoimmune blistering disease
242
How are autoimmune blistering diseases diagnosed (3 tests)?
1. BIOPSY
2. Blood tests for circulating Ab's
3. Direct Immunofluorescence Microscopy
243
What is a symblepharon?
Fusion of the eyelid to the eye globe in autoimmune blistering disease involving the eye
244
Tender, fragile blisters and erosions involving skin and mucous membranes, biopsy shows suprabasilar clefting and DESMOGLEIN 3 Auto-Ab with INTERcellular deposition of IgG
Pemphigus Vulgaris
245
Scaling and crusted lesions on face and upper trunk, NO mucosal involvement with DESMOGLEIN 1 Auto-Ab?
Pemphigus foliaceus
246
Bullous disease associated with underlying neoplasms (NHL, CLL) involving mostly mucous membranes (oral, conjunctival, esophageal, laryngeal)?
Paraneoplastic pemphigus
247
No mucous membrane involvement however this vesicopustular eruption with clear blisters transforms to pustules, involves trunk and proximal extremities with IgA antibodies and deposition of intracellular IgA at the epidermal surfaces?
IgA Pemphigus
248
Presents in the elderly on trunk and limbs with tense blisters after INTENSE pruritus or urticarial lesions with linear IgG deposition in basement membranes without mucosal involvement?
Bullous Pemphigoid
249
Bullae usually seen in elderly on conjunctiva, affects mucous membranes including oral mucosa and is associated with CANCER?
Cicatricial Pemphigoid
250
Involves ELBOWS, KNEES, BACK, SCALP and BUTTOCKS with SEVERELY pruritic grouped vesicles with neutrophilic infiltrate and granular IgA deposition in the DERMIS?
Dermatitis Herpetiformis
251
ALL patients with Dermatitis Herpetiformis have this disease?
Celiac Disease
252
Mechanically-induced bullae on extensor areas that heal with scarring, associated with SLE and IBD?
Epidermolysis Bullosa Acquisita
253
How are autoimmune blistering diseases treated?
Systemic corticosteroids or immunosuppressants (azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide), RITUXIMAB and Dapsone
254
What autoimmune dermatologic disease is associated with LYMPHOMA?
Paraneoplastic Pemphigus
255
Patients with Dermatitis Herpetiformis ALL have Celiac Disease, this places them at risk for what GI malignancy?
GI tract LYMPHOMA (treatment is gluten-free diet)
256
Malar rash is seen in? What is Discoid rash seen in?
SLE; Cutaneous Lupus
257
What is SUBACUTE Cutaneous Lupus Erythematosus (SCLE) caused by?
Medications
258
What medications typically cause Subacute Cutaneous Lupus Erythematosus?
HCTZ, Calcium Channel Blockers, ACE-I, terbinafine and TNF-alpha inhibitors
259
What does the presence of Anti-Histone Ab's suggest?
Medication-Induced Lupus
260
What antibodies are Subacute Cutaneous Lupus Erythematosus positive for?
anti-Ro/SSA, anti-La/SSB and anti-histone Ab's
261
Do the lesions of Cutaneous Lupus (Discoid Lupus) scar?
NO
262
What is the lupus band test?
Biopsy of a lupus lesion demonstrating Ig deposition
263
Patients with long-standing lupus with scarring are at an increased risk of what?
Skin cancer within the lupus lesion - any change in lesions warrants close evalaution
264
What should you do if you notice a change in a scar or chronic cutaneous lesion of lupus?
Closely evaluate for possible cancer transformation
265
What is an ESSENTIAL part of therapy for ALL lupus forms?
Protection from UV-light as this EXACERBATES lupus
266
What must lupus patients be monitored for as a result of their aggressive protection from sun light?
Vitamin D deficiency
267
What is first-line systemic therapy for lupus?
Hydroxychloroquine
268
If Hydroxychloroquine does not work for lupus, what else can be used?
Other anti-malarial agents as well as mycophenolate mofetil, methotrexate, dapsone, cyclosporine, thalidomide
269
Heliotrope Rash, Gottron Papules, telangiectasias of proximal nail folds with frayed cuticles, positive ANA and muscle inflammation?
Dermatomysositis
270
Erythematous papules over the bony prominences of the hands and fingers are found in?
Dermatomyositis - Gottron Papules
271
The presence of antisynthetase antibodies in patients with dermatomyositis, usually found in those who also have mechanic hands (thickened hyperkeratotic scale of lateral aspects of digits) correlates with what other disease?
Interstitial lung disease (anti-Jo-1 & anti-Mi-2)
272
Violaceous erythema over the "V" of the neck, upper back and deltoids "shawl sign" is seen in what disease?
Dermatomyositis
273
What symptom can differentiate dermatomyositis from lupus?
Intense pruritus (shawl sign, Gottron papules, heliotrope rash)
274
20%-25% of patients with dermatomyositis have what?
AN UNDERLYING CANCER
275
What should you ALWAYS check for in a patient with dermatomyositis?
Underlying CANCER (age-related cancers, ovarian cancer)
276
What is the MOST common type of cancer found in women with dermatomyositis?
OVARIAN CANCER
277
How is dermatomyositis treated?
Like lupus (aggressive sun-light protection, anti-malarial drugs, other immunosuppressant drugs)
278
For how long after diagnosing dermatomyositis is a patient at risk for cancers if none are found at diagnosis?
3 years
279
A discoloration of the vasculature attributed to SLOW blood flow, usually on the lower extremities and associated with the medication AMANTADINE?
Livedo Reticularis
280
Patients with Livedo Reticularis and Migraines are at an increased risk of what?
STROKE
281
A dermatologic representation of abnormal platelet quantity, function, infectious process or abnormal vasculature with pin-point foci of extravasated erythrocytes?
Petechiae
282
What congenital syndrome and vitamin deficiency both present with purpura (coalesced petechiae)?
Ehlers-Danlos syndrome and Vitamin C deficiency
283
Cutaneous small vessel vasculitis, due to the injury of small vessels and resultant bleeding into the dermis, presents as what cutaneous manifestation?
Palpable purpura
284
How is the underlying vasculitis causing palpable purpura diagnosed?
By skin biopsy
285
What is urticarial vasculitis (persistent urticarial plaques lasting longer than 24 hours and presenting with pain and burning rather than pruritus) associated with in >50% of cases?
Autoimmune disease
286
What medications are associated with cutaneous small vessel vasculitis causing palpable purpura?
NSAIDS, ß-lactam antibiotics and diuretics
287
The pathologic process in cutaneous small vessel vasculitis causing palpable purpura is mediated by what?
Neutrophils
288
How do you treat cutaneous small vessel vasculitis?
Limb elevation, Topical corticosteroids, NSAIDS, colchicine, dapsone and antihistamines
289
A variant of leukocytoclastic vasculitis seen in children and young adults with IgA in the affected vessels, follows an infection with palpable purpura on the lower legs and buttocks, associated with arthritis, arthralgia and abdominal pain with patients being at risk of kidney disease months after the initial eruption?
Henoch-Schonlein Purpura (HSP)
290
What is the most common cutaneous manifestation of Rheumatoid Arthritis (RA)?
Rheumatoid nodules (firm, asymptomatic and found over extensor joints)
291
What RA medication exacerbates the nodules seen in RA?
Methotrexate
292
A rare complication of chronic RA with severe, seropositive RA presenting as purpura, livedo reticularis or cutaneous ulcerations?
Rheumatoid vasculitis
293
What is the most common cutaneous issue in patients with chronic kidney disease and/or ESRD?
Intense, refractory, unremitting pruritus as well as very dry skin
294
How do you treat the dry skin and pruritus in chronic kidney disease/ESRD patients?
Topical emollients, petrolatum, topical corticosteroids and phototherapy
295
What can occur in patients with ESRD in states of extremely dysfunctional calcium and phosphorus balance leading to calcification of the lumen of arteries with ischemia and necrosis?
Calciphylaxis
296
Intensely painful necrosis in ESRD patients with high risk of sepsis and mortality?
Calciphylaxis - arterial calcification
297
What treatments are there for ESRD patients with calciphylaxis?
Sodium thiosulfate, wound care and surgical debridement
298
How is hyperparathyroidism treated?
Cinacalcet or parathyroidectomy
299
A patient undergoes MRI with gadolinium and experiences distal extremity skin thickening with fibrosis, limited mobility and distal edema that becomes fixed and indurated with a woody-feel with erythematous plaques and nodules?
Nephrogenic Systemic Fibrosis
300
How is Nephrogenic Systemic Fibrosis diagnosed?
Skin biopsy
301
What is the only effective treatment for Nephrogenic Systemic Fibrosis?
Kidney transplant
302
What two cutaneous malignancies are organ transplant recipients at risk for?
Basal Cell Carcinoma and Squamous Cell Carcinoma
303
What cutaneous malignancy are renal transplant recipients at a high-risk for?
Squamous-Cell Carcinoma
304
Violaceous papules, nodules and plaques of this disease occur at sites of trauma, surgical scars or tattoos?
Cutaneous sarcoidosis
305
What is cutaneous sarcoidosis treated with?
Antimalarial drugs, methotrexate or systemic corticosteroids
306
What is the most common infection associated with Erythema Nodosum?
Streptococcus
307
What are the most common medications associated with triggers of Erythema Nodosum?
Antibiotics, oral contraceptives and hormone therapy
308
What two systemic diseases are associated with Erythema Nodosum?
Sarcoidosis and IBD
309
Patient with systemic disease or with strep infection or was on hormonal therapy or antibiotics or took oral contraceptives and after a low-grade fever, malaise and arthralgia, developed barely-noticeable tender subcutaneous nodules on their lower extremities leaving a dull, brown circular patch as they resolved?
Erythema Nodosum
310
What condition does a patient have that presents with Erythema Nodosum, Arthritis, B/L Hilar Lymphadenopathy with fever and uveitis?
An acute form of Sarcoidosis called Lofgren syndrome which resolves in 2-3 years
311
How is Erythema Nodosum treated?
NSAIDS or systemic immunomodulatory drugs if resistent
312
Inflammation of the SEPTAE of fat lobules?
Erythema Nodosum
313
What two cutaneous manifestations are seen in IBD?
Erythema Nodosum (more in UC) and Pyoderma Gangrenosum
314
Rapidly ulcerating painful pustules with a "juicy" edematous rolled border that also exhibits pathergy (new lesions occur at sites of trauma) associated with IBD and ALL?
Pyoderma Gangrenosum
315
What is the first-line treatment of pyoderma gangrenosum?
Corticosteroids
316
How do you treat refractory pyoderma gangrenosum?
Immunomodulators such as cyclosporine, infliximab, thalidomide, mycophenolate mofetil, azathioprine, methotrexate, IVIG, dapsone, colchicine
317
How is Pyoderma Gangrenosum diagnosed?
By exclusion
318
Besides Rifampin and Cholestyramine, what other agent is used for treatment of refractory pruritus in end-stage liver disease patients?
Naltrexone
319
Patients with end-stage liver disease, extensive alcohol use, HCV and hemochromatosis are at a great risk of developing skin fragility with small vesicles developing in sun-exposed areas (dorsum of hands) with small milia, hyperpigmentation and small scars?
Porphyria Cutanea Tarda (treat with phlebotomy and anti-malarial agents)
320
How is porphyria cutanea tarda (associated with HCV) diagnosed?
Urine porphyrins are elevated
321
Palpable purpura in the lower extremities of patients with HCV, Waldenstrom macroglobulinemia, Multiple Myeloma and SLE?
Cryoglobulinemia
322
This disease, associated with HCV and can cause glomerulonephritis, neuropathy, arthritis, pulmonary inflammation. Patients have elevated Rheumatoid Factor low and complement (C4)?
Cryoglobulinemic vasculitis
323
Besides addressing the underlying disorder, how is cryoglobulinemia treated?
Cyclophosphamide, plasmapharesis, high-dose corticosteroids and rituximab
324
Painful erythema of the distal hands and feet however can also involve intertriginous areas and can blister, caused by this type of drug therapy?
Hand-Foot Syndrome caused by chemotherapy with cytarabine, 5-FU, capecitabine, methotrexate, docetaxel, paclitaxel and anthracyclines ("rubicin")
325
Which chemotherapeutic drug can induce cutaneous lupus?
5-FU and capecitabine (5-FU prodrug)
326
Seen in AML, IBD, infections as well as caused by medications such as granulocyte colony stimulating factor, trans-retinoic acid, TMP-SMX and minocycline and presents with fever, arthralgia, myalgia and juicy, indurated plaques with sharp borders and vigorous edema that can ulcerate and demonstrates pathergy?
Sweet Syndrome
327
All patients with Sweet Syndrome should be evaluated for what?
Underlying malignancy, especially AML and myelodysplastic syndrome
328
In patients with myelodysplastic sydrome, developing Sweet Syndrome signifies what?
Transformation to AML
329
How do you treat Sweet Syndrome?
Corticosteroids
330
What chemotherapeutic medication can induce Sweet Syndrome?
Thalidomide (and lenalidomide)
331
Pigmentation of the oral mucosa signifies what disease?
Addison disease (adrenal insufficiency)
332
Acanthosis nigricans can signify what two conditions?
Insulin resistance and underlying internal malignancy
333
What cutaneous condition can be seen in Type-I DM?
Vitiligo (cross autoimmune response against melanocytes)
334
Why should tenia pedis be treated aggressively in patients with DM?
Because it can lead to ulcers (ketoconazole)
335
Thinning of the skin which feels warm, moist and smooth with generalized hyperhidrosis, thin and softer-than-normal hair as well as "plummer nail" (nail plate concavity with distal nail separation) are seen in?
HYPERthyroidism
336
Cool, dry, pale skin with dry and brittle hair and hair loss with lateral thinning of the eyebrows and generalized myxedema?
HYPOthyroidism
337
What is the most common cutaneous issue with patients with HIV and low CD4 counts (
Photosensitivity
338
Which patients are at high-risk of secondary skin infections with molluscum, herpes simplex and herpes zoster as well as cutaneous malignancies such as cutaneous lymphoma, Kaposi sarcoma and squamous cell carcinoma?
HIV patients with low CD4 counts
339
An acute painful and scarring dermatosis with target/"iris" lesions that favors the extremities, affects ONLY one or two mucosal sites and although it can be caused by medications, it is usually caused by INFECTION (HERPES)?
Erythema Multiforme (EM)
340
Target or "IRIS" lesions on the palms and soles of a 20-40 year old patient, 1-3 weeks after infection with HERPES?
Erythema Multiforme (EM)
341
What is the difference between SJS and TEN?
SJS affects 30%
342
What is the most common cause of SJS and TEN?
Medications
343
Which medications cause SJS/TEN?
Anti-seizure (carbamazepine, lamotrigine, phenytoin), sulfonamides, ß-lactams, pantoprazole, NSAIDS, sertraline, tramadol and allopurinol
344
How long after taking an offending medication can patients develop SJS/TEN?
4-28 days (within 8 weeks)
345
Skin pain with coalescing vesicles, bullae and erosions with shearing off of the epidermis with lateral pressure involving ≥2 mucosal surfaces (eyes, mouth, genitals, nasopharynx)?
SJS/TEN
346
What is used to measure the severity (mortality) of SJS/TEN?
The SCORTEN test (blood gluc, presence of CA, age >40, HR >120, >10% body surface area on day 1, HCO3 28)
347
What viral and what bacterial infection is implicated in Erythema Multiforme (EM)?
Virus: HSV; Bacteria: Mycoplasma pneumoniae
348
Short courses of systemic corticosteroids and immunosuppressive therapy works for which of EM/SJS/TEN?
Only for Erythema Multiforme (EM)
349
How are SJS/TEN treated?
Aggressive supportive skin care as in a BURN UNIT with fluid, electrolyte and nutrition
350
What is the significant cause of mortality in SJS/TEN which is why dermatologist consultation is recommended?
Infection - treat with EMPIRIC antibiotics
351
Inflammation of 80-90% of the skin surface with edema, severe pruritus, erosions and scaling with lymphadenopathy?
Erythroderma
352
What are the causes of erythroderma?
Uncontrolled existing dermatosis, medication reaction or idiopathic
353
Erythematous reaction that begins on the scalp and becomes generalized with small islands of normal skin in between?
Erythroderma
354
Scabies, lymphoma, medications, dermatosis can all cause this severe erythema of 80-90% of the skin?
Erythroderma
355
What is found in a CBC with differential of a patient with a reaction to medication?
Eosinophilia
356
How is erythroderma treated besides electrolytes, hydration and treatment of any underlying infection or cessation of offending drug?
Topical/oral corticosteroids, systemic antihistamines, oral retinoids, UV-therapy, and if severe, immunosuppressants such as azathioprine, methotrexate, mycophenolate mofetil
357
Signs such as alopecia, nail dystrophy, thickening of the palms and soles in a patient with erythroderma suggest what?
Chronic underlying condition such as cutaneous T-cell lymphoma, graft-vs-host disease or psoriasis
358
What type of alopecia is permanent?
The one that occurs with SCARING
359
How is the etiology of alopecia diagnosed?
Scalp biopsy
360
What do polycystic ovarian syndrome (hormonal imbalance), thyroid dysfunction, iron deficiency, side effects of ß-blockers, anticonvulsants, oral retinoids and warfarin all have in common?
Non-scaring, reversible alopecia
361
What are the three best available treatment for male and female-pattern balndess?
Topical minoxidil, oral finasteride, hair transplantation
362
Asymptomatic round/oval areas of total hair loss without erythema or scale, with tapered "exclamation point" hairs (shafts are thicker distally and narrower near the scalp) where the melanocyte is the target being destroyed thereby causing regrowth of white hairs at first?
Alopecia Aerata
363
What is the treatment of alopecia aerata (autoimmune disease)?
Intralesional triamcinolone injections
364
What autoimmune hair-loss disease suggests that these patients have a higher risk for type 1 DM and autoimmune thyroiditis as well as other autoimmune conditions?
Alopecia aerata
365
A diffuse, non-scaring alopecia triggered by a stressful event such as serious illness, surgery or childbirth and is commonly seen in women postpartum?
Telogen Effluvium
366
How is telogen effluvium treated?
It is not, it resolves on its own
367
This scaring alopecia begins on the crown of the head and expands outward, is most commonly seen in black women and is caused by thermal or chemical trauma?
Central Centrifugal Cicatricial Alopecia
368
How is Central Centrifugal Cicatricial Alopecia treated?
Topical and intralesional corticosteroids
369
This scaring alopecia presents with perifollicular inflammation involving the superior scalp which progresses slowly over years?
Lichen Planopilaris
370
What type of psoriasis is common in patients whom present with nail findings (onycholysis, pitting, oild drop)?
Psoriatic arthritis
371
What disease causes "20-nail dystrophy" with nail pterygium formation?
Lichen planus
372
This disease can have all of the nail findings of psoriatic arthritis as well as "20-nail dystrophy" and nail pterygium formation?
Lichen planus
373
A SINGLE nail, with longitudinal melanonychia is suggestive of what?
An underlying melanocytic lesion such as Subungual melanoma
374
What is the most common type of melanoma in Asians and Blacks?
Subungual Acral Lentiginous Melanoma
375
What nail changes are seen in patients undergoing chemotherapy?
Beau Lines - as chemotherapy halts the growth process
376
Invasion of the nail plate by dermatophytes causing thickening and discoloration, does NOT usually affect all the nails?
Onychomycosis
377
How does treatment of Onychomycosis differ for fingers and toes?
Terbinafine (lamisil) for both, for toes its a longer duration
378
When is treatment medically INDICATED for onychomycosis?
When symptomatic (bothersome, painful) AND if other comorbidities are present such as DM
379
What is REQUIRED prior to starting antifungal therapy for onychomycosis?
Confirmation by either KOH, fungal culture or histology of scrapings
380
What must be tested for PRIOR to starting TERBINAFINE (lamisil) for treatment of onychomycosis?
Liver chemistries
381
Mucosal membrane malignancies are seen more frequently in patients with what history?
Those who use tobacco (smoke or chew) and those who drink alcohol
382
What is the most common location for oral melanoma?
The palate
383
When should pigmented macules on the lower lips, buccal mucosa, gingivae and palate be biopsied?
When they appear irregular in pigmentation or atypical
384
Buccal, tongue or genital lesions that are inflammatory, ulcerate and become tender with Wickham striae (white lacy streaks) ?
Lichen Planus
385
How is lichen planus diagnosed when it affects mucosal surfaces?
Biopsy
386
How is lichen planus treated when it affects mucosal surfaces?
Topical corticosteroids or calcineurin inhibitors (cyclosporine, tacrolimus)
387
Lichen planus carries a risk of what cancer?
Squamous cell carcinoma
388
Well demarcated, ISOLATED, painful, shallow ulcers on the tongue, gingivae and oral mucosa that are usually self-limited, also seen in IBD?
Aphthous Ulcers
389
Recurrent aphthous ulcers in the mouth and genital areas accompanied by ocular symptoms, joint pain and systemic symptoms (fever)?
Behçet Disease
390
Asymptomatic white plaques with a wavy, wrinkled appearance on the lateral aspects of the tongue that are adherent and CANNOT be scraped off, caused by EBV and is typically seen in HIV patients and is a PRE-CANCEROUS condition?
Oral Hairy Leukoplakia
391
Asymptomatic erythematous red plaques on the lateral aspects of the tongue that are adherent and CANNOT be scraped off and is a severely dysplastic if not already a CANCEROUS condition?
Erythroplakia
392
Erythema, scaling and fissuring of the lower lip due to chronic sun damage is a precancerous condition known as?
Actinic Cheilitis
393
How is actinic cheilitis treated (precancerous condition of the lip)?
Cryotherapy, topical 5-FU, imiquimod, photodynamic and laser therapy
394
Black patches on the dorsum of the tongue caused by hypertrophied papillae with bacterial and yeast overgrowth however is benign?
Black Hairy Tongue
395
How is Black Hairy Tongue (benign) treated?
Gentle scraping of the tongue with toothbrush or tongue scraper
396
What is the most COMMON malignancy of the mouth and vermilion lip in a person with chronic sun exposure, tobacco and alcohol use?
Squamous Cell Carcinoma
397
Patients who wear dentures are particularly prone to what oral disease that causes burning and alteration of taste?
Oral Candidiasis
398
What are the three common type of foot and leg ulcers?
Venous stasis, arterial or neuropathic
399
Lower extremities below the knees with visible or palpable varicose veins with presence of acute or chronic edema, with sclerotic and discolored skin (yellowish-brown)?
Venous stasis
400
What is essential treatment for VENOUS stasis ulcers?
COMPRESSION (elastic support stockings or UNA boot) and hydrocolloid or foam dressings (debridement)
401
What should be assessed PRIOR to using compression for treating venous stasis ulcers?
Arterial status (don't want to compress arteries)
402
What should you suspect if in treating a venous stasis ulcer you detect a foul odor or patient experiences increased erythema and pain?
Infection
403
What is infection of a venous stasis ulcer treated with?
First generation cephalosporin (cephalexin, cephazolin)
404
What is considered maintenance treatment to prevent recurrence of venous stasis ulcers?
Elastic compression stockings
405
In patients with SEVERE peripheral vascular disease, where do arterial ulcers generally form?
Over bony prominances
406
These types of lower extremity ulcers are sharply demarcated and "punched out" extremely painful and pain worsens with leg elevation, area is cool to touch?
Arterial ulcers
407
What Ankle-Brachial Index (ABI) score is considered positive for arterial compromise?
408
What is a normal Ankle-Brachial Index (ABI)?
1.0-1.4
409
What does the Ankle-Brachial Index score predict?
Presence of Peripheral Artery Disease (PAD)
410
What is considered an ABNORMAL Ankle-Brachial Index?
1.4
411
How are arterial ulcers treated?
Gentle wound care, moist dressings, debridement
412
What is done to save a limb when arterial ulcers are refractory to medical treatment?
Revascularization surgery to avoid amputation
413
Ulcers that occur under the metatarsal heads in patients with poor sensation in those limbs, are painless and if not treated early can cause osteomyelitis?
Neuropathic ulcers
414
How are neuropathic ulcers treated?
By debridement and offloading of pressure
415
In what patients are dry skin (xerosis) causing pruritus, herpes zoster, chronic tenia pedis, onychomycosis, seborrheic keratoses, cherry angiomas and lentigines commonly found?
Elderly
416
Where are actinic keratoses found mostly and why are these important in elderly?
Sun-exposed areas (face, dorsal hands, arms); because of prevalence and pre-cancerous nature
417
What can occur in a dark-skinned individual after an inflammatory skin condition?
Hyper or Hypo pigmentation
418
How is hyper/hypo pigmentation of the skin REDUCED after an inflammatory skin condition in dark-skinned individuals?
Hydroquinone
419
How are keloids treated?
Intralesional corticosteroid injections, surgical resection followed by radiation therapy
420
What is Pseudofollicular Barbae?
Ingrown hairs with inflammation and papules with scarring in individuals with very small, tightly-curled hairs after shaving
421
What is Dermatosis Papulosa Nigra?
The equivalent of seborrheic keratosis but seen in dark-skinned individuals as benign stuck-on papules, usually on the face
422
What are the two most commonly-found skin cancers in dark-skinned individuals?
Squamous Cell Carcinoma and Acral Melanoma
423
Autoimmune disease that causes destruction of the melanocyte with depigmentation and is associated with other autoimmune diseases, especially thyroid disease?
Vitiligo
424
What should ALWAYS be checked for in a patient with Vitiligo?
Thyroid function tests (TSH)
425
How is vitiligo treated?
Phototherapy, topical corticosteroids, topical calcineurin inhibitors (tacrolimus, cyclosporine), total chemical destruction of remaining skin pigment
426
When you see "PALPABLE PURPURA" think of what process?
VASCULITIS
427
What is indicative on biopsy that the diagnosis is Sweet Disease?
Neutrophilic infiltrate and edema
428
What is indicative on biopsy that the diagnosis is Henoch-Schonlein Purpura (HSP)?
IgA deposition
