DERMA

Question 1

Which treatment is appropriate in order to avoid overuse of topical corticosteroids and minimize likelihood of flares in atopic dermatitis?

Answer 1

EMOLLIENTS

Question 2

A 31/M, known to have asthma and allergic rhinitis, complains of difficulty sleeping due to pruritus of eczema. Which drug can benefit the patient?

Answer 2

Diphenhydramine

Question 3

May be used as prophylactic treatment for AD

Answer 3

Tacrolimus Ointment

Question 4

Systemic therapies used for wide spread and nonresponsive AD are

Answer 4

1. Cyclosporine 3-5 mg/kg/day 
(first line for refractory AD)
2. Mycophenolate mofetil 2 g/day
3. Methotrexate 10-22.5 mg/week
4. Azathioprine 1.5-2.5 mg/kg/day

Question 5

What are the most common causes of irritant contact dermatitis?

Answer 5

either “wet,” such as detergents, organic solvents, soaps, weak acids and alkalis,
or
“dry,” such as low humidity air, heat, powders and dusts

Question 6

Mainstay of diagnosis in allergic contact dermatitis. It has a sensitivity and specificity of 70-80%. Reproduces allergic contact dermatitis in an individual sensitized to a particular allergen.

Answer 6

Patch testing

Question 7

The optimum timing of readings is day ___. An additional reading at day 6 or 7 will pick up a ~10% more positives that were negative at days 2 and 4.

Answer 7

2 and 4

Question 8

A patient with chronic spontaneous urticaria reports persistent symptoms despite treatment with Cetirizine 10 mg tablet OD for the last 2 weeks. What should you do next?

Answer 8

Continue Cetirizine 10 mg tablet OD for another 2 weeks

Question 9

7. Which antihistamine is a standard treatment of acute spontaneous urticaria?

Answer 9

Loratidine

Question 10

Cutaneous expression of the atopic state (family hx of asthma, allergic rhinitis or eczema)

Answer 10

Dermatitis

Question 11

Characteristic defect in atopic dermatitis

Answer 11

Impaired epidermal barrier

Question 12

Mutation of this protein in the stratum corneum is responsible for Impaired epidermal barrier in atopic dermatitis

Answer 12

FILAGGRIN

Question 13

Clinical criteria for the diagnosis of atopic dermatitis

Answer 13

1. Pruritus and scratching
2. Course marked by exacerbations and remissions
3. Lesions typical of eczamatous dermatitis
4. Personal or family history of atopy (Asthma, AR, FOOD ALLEGIES, OR ECZEMA)
5. Clinical course lasting longer than 6 weeks
6. Lichenification of skin
7. Presence of dry skin

Question 14

Cutaneous stigma of AD

Answer 14

Perioral pallor
Extra fold of skin beneath lower eyelid ( DENNIE MORGAN FOLDS)
Increased palmar skin markings
Increased of cutaneous infections (esp STATUS AUREUS)

Question 15

Macrolide immunosuppressants derived from soil fungi for AD

Answer 15

Tacrolimus ointment

Pimecrolimus cream

Question 16

Preferred systemic antibiotics for secondary infections that exacerbates AD

Answer 16

DICLOXACILLIN (penicillinase resistance penicillines)

Cephalosporins (CEPHALEXIN)

Question 17

Preferred systemic antibiotics for secondary infections that exacerbates AD if Dealing MRSA 7-10days

Answer 17

TMP SMX
Minocycline
Doxycycline
Clindamycin

Question 18

May represent the end stage of a variety of pruritus and eczematous disorders.
Well circumscribed plaques with lichenified skin due to chronic scratching.

Answer 18

Lichen simplex chronicus

Question 19

Common areas involved in Lichen simplex chronicus

Answer 19

Posterior nuchal region

Dorsum of the feet or ankles

Question 20

Treatment of Lichen simplex chronicus

Answer 20

Break cycle of chronic itching by HIGH potency GC

IF RECALCITRANT: GC under occlusion or intralesion injection of GC

Question 21

Contact dermatitis caused by an inherent characteristic of a compound
And prior exposure is NOT NECESSARY

Answer 21

Irritant contact dermatitis

Question 22

Delayed type hypersensitivity mediated by memory T lymphocytes in the skin, occurring 12- 72H upon exposure, prior exposure is NECESSARY

Answer 22

Allergic contact dermatitis

Question 23

Most common type of ICD

Answer 23

Chronic low grade irritant dermatitis

MC in hands

Question 24

Control of pruritus Is essential for treatment of AD with

Answer 24

Antihistamine:
Diphenhydramine
Hydroxyzine
Doxepin

Question 25

A variant of hand eczema that appears as multiple , intensely pruritic, small pa pulse and vesicles occurring on thenar and hypothenar eminences and sides of fingers

Answer 25

Dyshidrotic eczema

Question 26

For hand eczema, examine for Dermatophyte infection by

Answer 26

KOH Preparation and Culture

Question 27

Circular or OVAL “COINLIKE” lesion, frequently in Middle aged men, usually located at the TRUNK, Extensor surfaces of extremities (pretibial areas of dorsum of the hands)

Answer 27

NUMMULAR ECZEMA

Question 28

Also known as WINTER ITCH , mc develops on Lower legs of elderly during dry times of the year. Mild inflammatory variant of dermatitis

Answer 28

XEROTIC ECZEMA OR ASTEOTIC ECZEMA

Question 29

Caused by venous incompetence of the LOWER EXTREMITIES + chronic edema, most commonly affecting MEDIAL ASPECT of the ankle over a distended vein and may proceed to chronic dermal fibrosis recognized as BRAWNY edema of the skin

Answer 29

Statis dermatitis

Question 30

Treatment for Statis dermatitis

Answer 30

1. Elevation of legs 2. Use of compression stocking with gradient >30-40mmhg 3. Emollients 4. Mid potency Topical GC 5. Avoid irritants

Question 31

(+)blister and mucosal or epidermal detachment resulting form FULL THICKNESS epidermal necrosis in the absence of substantial dermal inflammation

Answer 31

SJS/TEN

Question 32

Blister developing on TARGET LESIONS, dusky orpurpuric macular in which MUCOSAL involvement is significant, and total body surface area blistering and eventual detachment is <10% Rare confluence

Answer 32

SJS

Question 33

total body surface area blistering and eventual detachment is 10-30%

Answer 33

SJS/TEN OVERLAP

Question 34

total body surface area blistering and eventual detachment is >30% +confluence erythema

Answer 34

TOXIC EPIDERMAL NECROLYSIS

Question 35

Most common drugs associated with SJS AND TEN

Answer 35

``` Allopurinol Sulfonamide NSAID - OXICAM AROMATIC ANTICONVULSANT (phenytoin, carbamazepine, phenobarbitone) Lamotrigine (anticonvulsant) NEVIRAPINE ```

Question 36

Pustular eruptions + high spiking fever + leukocytosis - innumerable pinpoint pustules overlying a diffuse edematous erythema 20% oral lesions

Answer 36

AGEP | Acute generalized exanthematous pustulosis

Question 37

Adverse drug reaction for type I

Answer 37

IgE mediated Urticaria Anaphylaxis Angioedema

Question 38

Adverse drug reaction for type II

Answer 38

IgG mediated DRUG INDUCED Hemolysis THROMBOCYTOPENIA

Question 39

Adverse drug reaction for type III

Answer 39

Immune complex Vasculitis Serum sickness Drug induced lupus

Question 40

Adverse drug reaction for type IVA

Answer 40

T cell mediated MACROPHAGE inflammation: Tuberculin skin test Contact dermatitis

Question 41

Adverse drug reaction for type IVB

Answer 41

T cell mediated EOSINOPHILS inflammation: MORBILLIFORM ERUPTIONS DRUG INDUCED HYPERSENSITIVITY REACTION (DIHS)

Question 42

Adverse drug reaction for type IVC

Answer 42

T cell mediated CYTOTOXIC inflammation: MORBILLIFORM ERUPTIONS SJS/TEN

Question 43

Adverse drug reaction for type IVD

Answer 43

T cell mediated NEUTROPHIL inflammation: AGEP acute generalized exanthematous pustulosis

Question 44

(+)mucositis in 30%, Diffuse, red morbilliform eruption with facial involvement, facial and acral swelling. (Fever, LAD, hepatitis, nephritis, carditis, eosinophilia, atypical lymphocytosis)

Answer 44

Dress or DIHS

Question 45

Urticarial serpiginous or polycystic dash, purpuric eruption along the sides of the feet and hands is characteristic

Answer 45

Serum sickness or serum sickness reactions

Question 46

Seen with urticaria or swelling of the face with respiratory distress and cardiovascular collapse

Answer 46

ANGIOEDEMA

Question 47

Associated with red man syndrome, a histamine related AnaPhylactoid reaction characterized by FLUSHING, DIFFUSE MACULOPAPULAR ERUPTION AND HYPOTENSION

Answer 47

Vancomycin

Question 48

Commonly implicated in vasculitis

Answer 48

B lactams