Adult - Derm

Question 1

What is the most common of all skin disorders?

Answer 1

acne

Question 2

Which acne symptoms are red flags that indicate the need for referral?

Answer 2

• scarring
• cyst formation

Question 3

First line (non-pharmocologic) treatment for acne

Answer 3

wash several times daily with mild soap

use oil-free products

Question 4

What is the order of pharmacologic treatment in acne?

Answer 4

1. comedolytics
2. topical combination agents: comedolytic + ABT
3. topical antibiotics
4. oral antibiotics
5. oral contraceptives

Question 5

First line pharmacologic treatment for acne

Answer 5

comedolytics:

benzoyl peroxide - bacteriocidal

trentoin (Retin-A)

Question 6

What is a potential side effect of retin-a (tretinoin)?

Answer 6

Increased sensitivity to sunlight

Question 7

What is the second pharmacologic step in acne treatment?

Answer 7

combination agents:

benzoyl peroxide + erythromycin = Benzamycin

benzoyl peroxide + clindamycin = Benzaclin

Question 8

What is the third pharmacologic step of acne management?

Answer 8

topical antibiotics:

clindamycin

Question 9

What is the** fourth** pharmacologic step of acne management?

Answer 9

Oral antibiotics:

tetracycline

why is tetracycline contraindicated in pregnancy and children under 9 years?

due to staining of teeth

Question 10

What is the** fifth** pharmacologic step of acne management?

Answer 10

oral contraceptives:

combination products are most effective

ortho tri-cyclen or estrostep

Question 11

What is a derm-related side effect of oral contraceptive therapy?

Answer 11

melasma - brown splotches on the skin

as opposed to the “mask of pregnancy” which is known as:

chloasma

Question 12

What are two additional therapies that could be used for acne treatment, though not in primary care?

Answer 12

dermabrasion

intralesional injections of the steroid triamcinolone

Question 13

Which two pathogens are the “major players” in skin infections in the community?

Answer 13

staph aureus

strep (usually Group A)

Question 14

Inflammation of the hair follicle -

term and pathogen

Answer 14

folliculitis

staph

Question 15

Localized infection originating from the hair follicle but now more involved -

term and pathogen

Answer 15

furuncle

“boil”

staph

Question 16

What does a CA-MRSA furuncle look like?

Answer 16

A spider bite

Question 17

A red, swollen, and painful cluster of boils that are connected to each other under the skin -

term and pathogen

Answer 17

carbuncle

staph

Question 18

What are the common causes of cellulitis in the community?

Answer 18

1. Strep pyogenes (Group A) - usual cause
2. Staph aureus - less common

Question 19

What are the common causes of cellulits in the inpatient population?

Answer 19

Gram NEGATIVE organisms -

E. coli

Klebsiella

Psuedomonas

Enterobacter

less frequently - Gram POSITIVE organisms

MRSA? CA-MRSA?

Question 20

In the outpatient, what 3 drugs can be used to treat CA-MRSA cellulitis?

Answer 20

• Bactrim (TMP/SMZ)
• Doxyclycline / minocyline
• Clindamycin

Which of these also covers Group A strep?

Clindamycin

Question 21

What additional drug class must be aded to Bactrim or Doxycyline / Minocycline in order to provide Group A strep coverage?

Answer 21

a beta lactam

Question 22

What are some examples of the beta lactams?

Answer 22

penicillin

amoxicillin

1st generation cephalosporin (Keflex)

Question 23

What cellulitis-treating antibiotic provides coverage for both staph and strep?

Answer 23

Clindamycin

Question 24

An acute infection of the upper dermis and superficial lymphatics; more superficial than cellulitis, typically more raised and demarcated

“look’s like big sunburn”

• condition and pathogen

Answer 24

Erysipelas

Strep

Known for insidious or rapid progression?

rapid

Question 25

Infection and abcess formation, typically in the axilla or groin - condition and pathogen

Answer 25

Hidradenitis suppurativa staph

Question 26

Characterized by honey colored crusts on an erythematous base - condition and pathogen

Answer 26

Impetigo staph

Question 27

Infection of the skin around the finger or toe nail - term and pathogen

Answer 27

**paronychia** staph

Question 28

Collection of blood between the fingernail and nail bed - term and management

Answer 28

**subungual hematoma** **trephination** - drilling a hole through the nail to relieve the pressure

Question 29

candida **balanitis - ** location?

Answer 29

candida of the penile head

Question 30

candida **intertrigo -** location?

Answer 30

candida in warm, moist folds of skin

Question 31

For most candida, what is management?

Answer 31

topical antifungals first oral antifungals only if topicals unsuccessful

Question 32

Four examples of antifungals?

Answer 32

miconazole clotrimazole fluconazole griseofulvin

Question 33

What are two fungal infections which are treated with selenium shampoo?

Answer 33

tinea capitus tinea versicolor

Question 34

Another name for herpes zoster is:

Answer 34

shingles

Question 35

Pharm options for herpes zoster have what suffix?

Answer 35

-cyclovir

Question 36

What is a red flag in herpes zoster?

Answer 36

**eye or face** involvement - ## Footnote ** refer right away**

Question 37

What medications can be used for post-herpetic neuralgia?

Answer 37

gabapentin (Neurontin) pregabalin (Lyrica)

Question 38

What are two significant side effects of gabapentin and pregabalin?

Answer 38

excessive sleep significant weight gain

Question 39

What vaccine can be used to prevent or mitigate herpes zoster? approved starting at what age?

Answer 39

zostavax age 50

Question 40

What are pre-malignant, small, rough patches on sun-exposed parts of the body?

Answer 40

actinic keratosis

Question 41

What type of skin cancer arises from actinic keratosis?

Answer 41

squamous cell carcinoma

Question 42

How is actinic keratoses treated?

Answer 42

liquid nitrogen

Question 43

What lesions are the precursors to squamous cell carcinoma?

Answer 43

actinic keratosis

Question 44

How long does it take for squamous cell carcinoma to develop from an AK?

Answer 44

over a few months

Question 45

Description of squamous cell carcinoma

Answer 45

firm, irregular papule or nodule with keratictic, scaly bleeding (yum)

Question 46

Treatment for squamous cell carcinoma

Answer 46

refer for: biopsy Mohs excision

Question 47

Benign, beige to black plaque, with a "stuck-on" appearance.

Answer 47

seborrheic keratosis

Question 48

Treatment in seborrheic keratoses

Answer 48

liquid nitrogen or none

Question 49

What is the most common type of skin cancer?

Answer 49

basal cell carcinoma

Question 50

Waxy, pearly, shiny lesion with central depression or rolled edge, and possibly with telangiectatic vessels.

Answer 50

basal cell carcinoma

Question 51

What is the treatment for basal cell carcinoma?

Answer 51

shave or punch biopsy and surgical excision

Question 52

Which skin cancer has the highest mortality rate?

Answer 52

melanoma

Question 53

What are the ABCs to remember with melanoma?

Answer 53

A - asymmetry B - border irrecularity C - color variation D - diameter \> 6 mm E - elevation E - enlargement

Question 54

What is an important detail to teach patients about applying steriods to their atopic dermatitis?

Answer 54

it is most effective when rubbed in very well

Question 55

What might be the underlying cause of an explosive onset derm disorder that an adult has never previously had?

Answer 55

HIV infection

Question 56

What is the only derm disorder for which tar shampoo is recommended?

Answer 56

psoriasis

Question 57

Yellow plaques as a result of fat build up under skin; often near inner canthus.

Answer 57

Xanthelasma **what is underlying cause?** hyperlipidemia

Question 58

What is the hallmark rash of Lyme disease?

Answer 58

erythema migrans

Question 59

What is the initial test for Lyme disease? confirmatory?

Answer 59

ELISA Western blot (same as HIV)

Question 60

What antibiotics are used for Lyme disease?

Answer 60

Doxycyline Amoxicillin

Question 61

What is the typical rash in Rocky Mountain Spotted fever?

Answer 61

maculo-papular petechial

Question 62

What is the testing for Rocky Mountain Spotted fever?

Answer 62

PCR (like infant HIV test)

Question 63

What is the treatment for Rocky Mountain Spotted Fever?

Answer 63

Doxycycline

Question 64

Hallmark distribution of smallpox lesions -

Answer 64

first lesions on face, palate, oral mucosa spread from there on any one part of the body, all lesions are at the same stage

Question 65

What is the causative agent of anthrax?

Answer 65

**bacteria**, though often referred to as "spores"

Question 66

Is there a vaccine for anthrax?

Answer 66

yes

Question 67

What are the two types of anthrax infections?

Answer 67

cutaneous inhalation

Question 68

What is the progression of the cutaneous form of anthrax?

Answer 68

pruritic papule ulcer surrounded by vesicles black necrotic eschar with edema eschar falls off leaving scar

Question 69

What is used to treat anthrax?

Answer 69

PCN ciprofloxacin (Cipro) doxycyline

Question 70

Treatment options for genital warts:

Answer 70

* **podophyllin** resin * **podofilox (Condylox)** * **cryosurgery** * **TCA** - trichloroacetic acid * **BCA** - bichloracetic acid