DCNP

Question 1

A 19yo, 80kg has painful and severe nodulocystic acne with scarring. You start isotretinoin 40 mg BID. This patient should be observed for which potential adverse effect of isotretinoin therapy?

Answer 1

Fever and sternal pain

Question 2

Counseling regarding possible side effects of neurotoxins. You know that eyelid ptosis can be due to injection or leakage into

Answer 2

Levator palpebrae superioris

Question 3

Famciclovir for herpes zoster patient education

Answer 3

Take with food

Question 4

Most common site for distant metastasis of melanoma

Answer 4

Lung

Question 5

Antifungal for onychomycosis. PMH HTN takes metoprolol, simvastatin, baby aspirin. Appropriate dosing and duration of optimal therapy?

Answer 5

Intermittent dosing with fluconazole (off-label) 300 mg once weekly for about 3 to 6 months.

Question 6

Halo (Sutton’s nevus) in a 14-year-old. Parent concern melanoma.

Answer 6

Halo nevi usually have an organized area of depigmentation around the periphery of the lesion compared to regressing melanoma which has a disorganized pattern of hypo- or depigmentation.

Question 7

T/F. Patients with a history of more than five dysplasia nevi have a 50-fold greater risk of developing melanoma.

Answer 7

False (10-fold greater risk)

Question 8

T/F. Superficial spreading melanoma is the most common type of melanoma with the highest incidence in 4th to 5th decade.

Answer 8

True

Question 9

The most common type of skin cancer is:

Answer 9

Superficial basal cell skin cancer

Question 10

What genetic mutation is closely implicated with melanoma?

Answer 10

CDKN2A

Question 11

Drugs a/w SJS and TEN

Answer 11

Ace inhibitors
quinolones
aminopenicillins

Question 12

Rash while on vacation, both hands. Area blistered and is healing slowly but dark areas remain?

Answer 12

Phytophotodermatitis

Question 13

Infantile hemangioma expert referral:

Answer 13

5 mm lesion on the left breast

Question 14

12 yo M reported h/o high fever, pharyngitis, malaise. Reddish-orange, sandpaper-like papillae eruption and a “strawberry tongue” and treat him with oral PCN x 10 days. Complete treatment important to:

Answer 14

Prevent rheumatic fever

Question 15

21M rash x several yrs gets worse in summer. PCP selenium and ketoconazole, but returns. Don’t prescribe:

Answer 15

Oral ketoconazole

Question 16

Tinea versicolor treatment

Answer 16

-PO fluconazole 300 mg once weekly for two weeks
-PO itraconazole 200 mg daily for 5-7 days

Question 17

Most common cause of exfoliative erythroderma:

Answer 17

Idiopathic

Question 18

Laser likely to be most effective for treating Poikiloderma of Civatte?

Answer 18

CO2 fractional laser (10,600 nm)

Question 19

Xanthelasma

Answer 19

Order labs for fasting lipids

Question 20

Type IV skin, depigmented and atrophic plaque on right gluteal region x several years. PMH asthma, atopic dermatitis. Likely cause:

Answer 20

Side effects from IM triamcinolone for severe asthmatic event.

Question 21

6 M purpuric papules buttocks, knees, legs. Complaining of abdominal pain and leg pain. Intermittent fever, joint pain. What order next?

Answer 21

Order urinalysis with microscopy

Question 22

45F Caucasian seeking treatment for persistent redness and small broken blood vessels on her face. Sx worsening with burning, stinging, dryness. Telangiectasia w/o papules/pustules. Recommend:

Answer 22

oral beta blocker

Question 23

Most common site for metastasis of cutaneous SCC of the scalp is to:

Answer 23

parotid gland

Question 24

Diffuse pitting of the fingernail plate a/w which disease?

Answer 24

atopic dermatitis

Question 25

Counseling: 6 mon old before starting oral propranolol for an infantile hemangioma. Important education for prevention and early recognition of side effects

Answer 25

propranolol should be given w/ or after meals

Question 26

33F mutation of STS gene, husband unaffected. Considering pregnancy, would like to know risk of passing on X-linked icthyosis to her son.

Answer 26

50% risk for an affected son

Question 27

Most effective antiviral, decreasing risk of post-herpetic neuralgia:

Answer 27

valacyclovir 1 gm every 8 hrs for 7 days

Question 28

Ehlers-Danlos syndrome (EDS) characteristics:

Answer 28

mitral valve prolapse tissue fragility hyperextensible joints

Question 29

Nodular melanoma w/ Breslow thickness of 1.2 mm. Surgical margins with wide local excision?

Answer 29

1-2 cm

Question 30

28F w/ morphea that is spreading. She has an unremarkable past medical history and only medication is VitD. Initial systemic therapy:

Answer 30

hydroxychloroquine

Question 31

54F extremely pruritic vesicles and crusted excoriations on her trunk and extremities for the past 2 mons. Lesions clustered in rosettes (annular). Erosions in mouth. Histopath and DIF c/w linear IgA. 1st-line:

Answer 31

oral dapsone

Question 32

Most common cutaneous eruption in pts w/ sarcoidosis?

Answer 32

erythema nodosum

Question 33

Parents of a child w/ erythema infectiosum should include:

Answer 33

Females who are pregnant and exposed to the infection should be referred to their OB for monitoring.

Question 34

DIF for suspected dermatitis herpetiformis, immunohistochemical reports:

Answer 34

granular deposition of IgA at the BMZ

Question 35

Topical imiquimod for field cancerization, education includes:

Answer 35

-can cause severe inflammation and result in hypopigmentation -can cause flu-like sx -commonly causes pain, crusting, erythema

Question 36

Treating field cancerization, in area w/ numerous Aks in a region, purpose:

Answer 36

minimizes the formation of multiple primary squamous cell skin cancers

Question 37

Henoch-Schonlein Purpura (HSP)

Answer 37

arthritis, abdominal pain, rash

Question 38

Pemphigoid gestationis, counseling:

Answer 38

risk this can recur w/ subsequent pregnancies, menses, or hormonal contraceptives

Question 39

Dermatitis herpetiformis (DH), tx w/ oral dapsone and gluten avoidance. Which underlying condition would increase risk of methemoglobinemia?

Answer 39

glucose-6-phosphate dehydrogenase deficiency

Question 40

High-risk SCC characteristics

Answer 40

-immunosuppression -perineural, lymphatic or vascular involvement -size >2 cm on any body location

Question 41

Bites that need tx w/ oral abx

Answer 41

-cat bite on the hand -dog bite on the foot -cat bite after 24 hrs

Question 42

Nodular BCCs usually occur on:

Answer 42

head and neck

Question 43

Superficial BCCs are found primarily on:

Answer 43

torso

Question 44

Nikolsky sign

Answer 44

press on skin adjacent to a blister, skin shears away easily

Question 45

Skin conditions that increase r/o cellulitis

Answer 45

-tinea pedis -atopic dermatitis -venous stasis dermatitis

Question 46

Azathioprine

Answer 46

genetically low levels of TPMT (thiopurine methyltransferase) are at increased r/o bone marrow suppression

Question 47

% of pts w/ DLE go on to develop SLE

Answer 47

15

Question 48

Newborn infant w/ erythematous, polycyclic plaques, significant periorbital edema.

Answer 48

Check for s/s heart block or bradycardia. (Neonatal lupus erythematosus)

Question 49

Tinea cruris organism

Answer 49

Trychophyton rubrum

Question 50

Group A Streptococcus (GAS) complication if untreated:

Answer 50

glomerular nephritis

Question 51

Hereditary angioedema is caused by:

Answer 51

C1 esterase inhibitor deficiency or dysfunction

Question 52

MRSA infection treatment

Answer 52

-doxycycline 100 mg BID x 7 days -mupirocin 2% top oint TID x 7-10 days -dicloxacillin 250 mg QID x 7 days

Question 53

Notalgia paresthetica

Answer 53

intense focal itch on scapula; linear excoriations and patch of dark brown hyperpigmentation

Question 54

Most common (90%) sx of pts w/ SLE

Answer 54

Myalgia and arthralgia (90%) insidious onset of fatigue low grade fever weight loss hair thinning

Question 55

Mycophenolate mofetil

Answer 55

Enrollment in Risk Evaluation and Mitigation Strategies (REMS) program

Question 56

Glycopyrrolate, contraindicated in this condition:

Answer 56

pyloric stenosis

Question 57

Classic EDS, most important referral:

Answer 57

cardiology

Question 58

45M w/ recent patchy hair loss. W/o scale, erythema, or lymphadenopathy. Labs to order:

Answer 58

CBC, ferritin, TSH, ANA titer, RPR

Question 59

Organism, immunocompetent, erysipelas

Answer 59

Group A streptococcus

Question 60

Labs to order for chronic pruritus of unknown origin:

Answer 60

CBC w/ diff, CMP, TSH, stool/ova and parasites

Question 61

Follicular occlusion triad:

Answer 61

pilonidal cyst, HS, acne conglobata

Question 62

Absolute C/I for injection of botulinum toxin:

Answer 62

infection at site of injection

Question 63

Bullous pemphigoid drug associations:

Answer 63

loop diuretics, NSAIDs, spironolactone, phenothiazines, gliptins, biologics

Question 64

Avoid abobotulinumtoxin toxin A in patient w/ allergy to:

Answer 64

milk

Question 65

iPledge labs required:

Answer 65

LFTs, Lipid panel or TG, hcg

Question 66

DH disease flare, potential trigger:

Answer 66

NSAIDs

Question 67

Hydroxychloroquine

Answer 67

-baseline ophtho exam, then q5 yrs -more frequent if >70 y/o

Question 68

Meds w/ r/f pseudotumor cerebri:

Answer 68

doxycycline, isotretinoin, COC

Question 69

Photosensitive drugs

Answer 69

doxycycline, minocycline, isotretinoin

Question 70

Common AE a/w neurotoxins:

Answer 70

pain, bruising, redness

Question 71

Sudden onset of hundreds of SKs

Answer 71

Review age appropriate health screenings and any positive ROS.

Question 72

Laser treatment that involves the dermis and collagen, usually safer for pts w/ dark skin?

Answer 72

Nd: YAG 1064 nm

Question 73

Herpes zoster, most commonly affects the ____ spinal region.

Answer 73

thoracic

Question 74

Meds to take w/ food, decreased absorption on an empty stomach:

Answer 74

-spironolactone -griseofulvin -isotretinoin

Question 75

Staphylococcus aureus, involved in:

Answer 75

furuncles, carbuncles, folliculitis

Question 76

Black widow spider bite treatment:

Answer 76

ice/elevation, tetanus ppx, antiemetics

Question 77

Not a candidate for tx w/ neurotoxin

Answer 77

conjunctivitis (active infection)

Question 78

Most difficult tattoo color to remove w/ laser

Answer 78

light green

Question 79

Erythrasma treatment:

Answer 79

clindamycin lotion

Question 80

Acquired palmoplantar keratoderma

Answer 80

Presents in an asymmetric distribution

Question 81

Non-purulent cellulitis tx:

Answer 81

dicloxacillin 500 mg QID

Question 82

Periorificial dermatitis

Answer 82

erythematous papules around mouth and eyes that sometimes burn. pmh AD, asthma

Question 83

Although rare, anal cancer is more likely to develop in pts who have a h/o:

Answer 83

condyloma acuminata

Question 84

Botulinum toxin, a protein derived form C. botulinum

Answer 84

inhibits the release of acethylcholine, which reduces the ability of muscles to contract

Question 85

Favre-racouchot disease increased risk:

Answer 85

smokers

Question 86

Ablative laser treatments

Answer 86

mostly involves the epidermis

Question 87

Ablative laser treatments

Answer 87

mostly involves the epidermis

Question 88

Absolute contraindication of TNF alpha inhibitors

Answer 88

chronic infections

Question 89

Leading cause of heart disease in children

Answer 89

Kawasaki disease

Question 90

MISC vs Kawasaki disease, differentiating lab

Answer 90

SARS-CoV-2 IgG

Question 91

FDA approved therapy for pemphigus vulgaris

Answer 91

Rituximab

Question 92

Eruption that starts on the infant's face and then spreads to the trunk and extremities. Well-appearing. Diffusely scattered tiny papules and pustules on head, trunk and extremities.

Answer 92

erythema toxicum neonatorum and will resolve in a couple of weeks.

Question 93

Atopic dermatitis pathogenesis:

Answer 93

-increase in Th2, Th22, and Th17 -increase in IL-4, IL-10, IL-13 -environmental exposure to smoking can trigger

Question 94

Photosensitive skin reaction like to Hepatitis C and hemochromatosis:

Answer 94

Porphyria cutanea tarda

Question 95

First line therapy for patient w/ LPP:

Answer 95

Potent TCS

Question 96

Locally advanced BCC, unable to tolerate a surgical procedure, what options?

Answer 96

-radiation -hedgehog pathway inhibitor -PD1 inhibitor

Question 97

High-risk SCC, follow-up includes:

Answer 97

-exam of regional lymph node basins -clinical exams q6 mons

Question 98

KA treatment options:

Answer 98

-commonly found to have features of SCC -can spontaneously involute and resolve w/o therapy -most are treated surgically

Question 99

Therapies that can decrease the risk of SCC:

Answer 99

-nicotinamide 500 mg BID -daily sunscreen -oral acitretin

Question 100

Immunosuppressant with decreased risk in organ transplant recipients (OTRs)?

Answer 100

sirolimus

Question 101

Field therapy least likely to result in scarring or abnormal pigmentation:

Answer 101

PDT w/ aminolevulinic acid

Question 102

Loss of _____in the bulge is postulated to contribute to permanent loss of hair in cicatricial alopecias.

Answer 102

hair follicle stem cells

Question 103

Acute paronychia w/o and abscess treatment options:

Answer 103

-warm soaks -topical mupirocin -oral dicloxacillin

Question 104

Field cancerization therapy tx w/ lowest recurrence at 1 year and lowest need for a second treatment?

Answer 104

topical 5-fluorouracil

Question 105

First-line therapy for lice in a 2 month old infant is:

Answer 105

permethrin 1% OTC

Question 106

Sudden onset of a rash, small red, non-follicular pustules that spread from neck to chest and axillae. Severe malaise and fever 103. Recent strep pharyngitis, rxd amoxicillin.

Answer 106

Acute generalized exanthematous pustulosis

Question 107

Mastocytosis diagnostic clue

Answer 107

Positive Darier's sign

Question 108

Educating patients of 4 yo w/ mastocytosis include the avoidance of mast cell degranulation:

Answer 108

heat and friction

Question 109

Granuloma annulare facts:

Answer 109

-affects F>M -may be a/w DM2 and thyroid dz -histology: palisading granuloma and mucin deposition -spontaneous resolution is expected in localized disease

Question 110

FDA approved tx for genital herpes simplex?

Answer 110

topical acyclovir 5%

Question 111

Topical dapsone 5% mixed with ____ may cause a temporary orange discoloration of the skin and facial hair.

Answer 111

BPO

Question 112

T/F gene expression profiling of melanoma predicts the risk of recurrence and metastasis.

Answer 112

True

Question 113

Melanoma tumor characteristics for staging:

Answer 113

Tumor: Breslow depth and presence of ulceration Nodes: early nodal invasion Metastasis: spread to distant organs or elevated LDH.

Question 114

Genetic mutation involved in ichthyosis vulgaris:

Answer 114

Steroid sulfatase (STS)

Question 115

Common side effects of dupilumab

Answer 115

-conjuctivitis -URI -HSV