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USMLE Step 2 - Top 5% > Dermatology 💆🏽 > Flashcards

Dermatology 💆🏽 Flashcards

1
Q

immunomodulating medications (particularly TNF-α inhibitors) may ↑ the
risk for developing ? cancer

A

Lymphoma

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2
Q

What can be used to help
distinguish chronic eczema from tinea.

A

Potassium hydroxide (KOH) prep

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3
Q

Dx of atopic dermatitis

A

Characteristic exam findings and history are sufficient

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4
Q

What is erythema toxicum neonatorum? How to Mx

A
  • 1 to 3 days after delivery
  • presents with red papules, pustules, and/or vesicles with surrounding erythematous halos
  • ↑ eosinophils are present in the pustules or vesicles.
  • Resolves in 1 to 2 weeks with no treatment.
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5
Q

1st line for atopic derm flare

A

Topical corticosteroids

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6
Q

Best Tx for pruritus (night and day)

A

H1 blockers. A first-generation H1
-blocker (eg,hydroxyzine) would be appropriate for nighttime use.

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7
Q

Topical calcineurin inhibitors are used in what incidence inn atopic derm

A

useful as steroid-sparing agents for moderate to severe eczema for patients >2 years of age. A second line

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8
Q

Neomycin has a history of causing what kind of skin reaction?

A

contact dermatitis

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9
Q

Dx of contact dermatitis

A

exam and history are sufficient. Patch testing can be used to establish the causative allergen after the acute-phase
eruption has been treated.

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10
Q

Tx of contact dermatitis

A

topical corticosteroids and allergen avoidance. In severe cases = systemic corticosteroid

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11
Q

are patch test affected by steroid or by antihistamines

A

steroids only!

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12
Q

Tx of Seborrheic Dermatitis

A

adults = ketoconazole, selenium sulfide, or zinc pyrithione shampoos for the scalp
and topical antifungals (ketoconazole cream) and/or topical corticosteroids for other areas.
Cradle cap often resolves with routine bathing and application of emollients in infants.

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13
Q

meds that can worsen psoriasis

A

β-blockers,
lithium, and ACEi’s

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14
Q

dx of psoriasis?

A

exam findings and history are sufficient. Biopsy if uncertain

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15
Q

Local psoriasis Mx

A

topical steroids, calcipotriene (vitamin D derivative), and retinoids such as tazarotene or acitretin (vitamin A derivative).

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16
Q

Severe psoriasis/psoriatic arthritis Mx

A

Methotrexate or anti–tumor necrosis
factor (TNF) biologics (etanercept, infliximab, adalimumab). Other agents such as ustekinumab (anti-interleukin [IL]-12/23), secukinumab (anti-IL17), and ultraviolet (UV)
light therapy can be used for extensive skin involvement, except in immunosuppressed
patients who can develop skin cancer from UV light.

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17
Q

Dx for urticaria

A

Exam and history are sufficient. Positive dermographism may help. If in doubt, drawing a serum tryptase can help clinch the diagnosis.

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18
Q

Urticaria Tx

A

Treat urticaria with systemic antihistamines. Anaphylaxis (rare) requires intramuscular
epinephrine, antihistamines, IV fluids, and airway support

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19
Q

If a patient reacts within 1 to 2 days of starting a new drug, is it likely the drug causing it?

A

it is probably not the causative agent.

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20
Q

Mx of drug induced rash (generally)

A

Discontinue the offending agent; treat symptoms with antihistamines and topical steroids to relieve pruritus. In severe cases, systemic steroids and/or IV immunoglobulin (IVIG) may be used.

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21
Q

most common cause of erythema multiforme

A

HSV

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22
Q

erythema multiforme major vs minor
vs SJS

A

EM major = minor + mucous membrane involvement. SJS is unique to this and can become TEN, is nikolsky +ve (and is usually from drugs not microbes)

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23
Q

Tx of erythema multiforme

A

systemic corticosteroids are of no benefit. EM minor can be managed supportively; EM major should be treated as burns.

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24
Q

TEN vs SJS

A

The epidermal separation of SJS involves <10% of body surface area (BSA), whereas TEN involves >30% of BSA

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25
Q

Drugs causing SJS?

A

sulfonamides, penicillin, seizure medications (phenytoin, carbamazepine), quinolones, cephalosporins, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs)

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26
Q

Dx of SJS?

A

Biopsy needed = shows full-thickness eosinophilic epidermal necrosis.

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27
Q

Dx of SJS?

A

Biopsy needed = shows full-thickness eosinophilic epidermal necrosis.

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28
Q

Tx of SJS/TEN

A

Early diagnosis and discontinuation of offending agent = critical
+ thermoregulatory, electrolyte
help, wound dressings, fluids.
Data on pharmacologic therapy with steroids, cyclosporine, and IVIG are mixed.

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29
Q

Causes of erythema nodosum

A

NO cause (60% idiopathic)
Drugs: sulfa, iodides, penicillins
Oral contraceptives
Sarcoidosis
Ulcerative colitis/Crohn disease
Microbiology (TB, leprosy, histoplasmosis, chronic infection)

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30
Q

Patients with erythema nodosum may have a false-⊕ what?

A

Venereal Disease Research (non trep test)

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31
Q

erythema nodosum workup?

A

Clinical Dx. Workup with an ASO titer, PPD in high-risk patients, and CXR to rule out sarcoidosis, or inflammatory bowel disease workup based on the patient’s complaints.

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32
Q

most accurate dx test for b.pemphigoid and p.vulgaris?

A

skin biopsy and immunoflourescent ELISA

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33
Q

Stage this decubitus ulcer:
involves intact skin with nonblanchable
erythema.

A

stage 1

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34
Q

Stage this decubitus ulcer:
involves partial-thickness loss of dermis; however, deeper structures are
intact.

A

stage 2

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35
Q

Stage this decubitus ulcer:
involves full-thickness loss of epidermis and subcutaneous fascia; however,
muscle and bone are not exposed.

A

stage 3

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36
Q

Stage this decubitus ulcer:
involves full-thickness tissue loss with exposed
underlying structures such as muscle or bone.

A

stage 4

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37
Q

when is a decubitus ulcer Unstageable

A

Unstageable ulcers are covered with black
eschar, making it difficult to determine depth of injury.

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38
Q

Tx of decubitus ulcers

A

low-grade lesions = routine wound care, including hydrocolloid dressings.
High-grade lesions = surgical debridement.

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39
Q

Tx for gangrene generally

A

Emergency surgical debridement. Antibiotics should be given as an adjuvant to surgery. Hyperbaric oxygen can be used after debridement in gas gangrene.

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40
Q

acanthosis Tx

A

Typically not treated. encourage weight loss and treat the underlying issue.

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41
Q

lichen planus tx?

A

Mild cases = topical corticosteroids
severe disease = systemic corticosteroids and phototherapy

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42
Q

Severe/ocular rosacea tx?

A

oral doxycycline or macrolide. Can do lid scrubs too.

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43
Q

Phymatous rosacea tx?

A

oral isotretinoin or laser therapy

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44
Q

Papulopustular rosacea tx?

A

topical metronidazole. Tetracyclines second line

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45
Q

Erythematotelangiectatic rosacea tx?

A

topical brimonidine or laser therapy

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46
Q

main difference between secondary syphilis and pityriasis rosea in terms of presentation of rash?

A

syphilis involves the palms/soles… P.R. does not

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47
Q

Tx of P.R?

A

Supportive therapy: emollients and antihistamines.

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48
Q

who gets systemic GCs in vitiligo

A

For patients with rapidly progressive vitiligo

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49
Q

some options to treat stable vitiligo

A

Topical corticosteroids, tacrolimus ointment, JAK inhibitors, UV, and laser therapy

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50
Q

mutation associated with ichthyosis vulgaris

A

filaggrin (like atopic derm)

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51
Q

Tx for mild sunburn?

A

cool, moist compresses and emollients with aloe vera for topical relief and NSAIDs for pain relief.

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52
Q

Tx for Seb keratosis

A

Cryotherapy, shave excision, or curettage.

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53
Q

tx for actinic keratosis. Consider if local AK or field cancerization present

A

Cryotherapy if local AK , topical 5-FU/ topical imiquimod if diffuse AK or so called Field Cancerization. (recall diclo/imi joke). Patients should be advised to use sun protection.

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54
Q

what is marjolins ulcer

A

SCC coming from scar/wound

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55
Q

how to confirm SCC Dx

A

shave biopsy

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56
Q

Tx for SCC

A

Surgical excision or Mohs surgery

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57
Q

Multiple BCCs appearing early in life
and on non–sun-exposed areas suggest what?

A

Gorlins syndrome

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58
Q

how to confirm BCC Dx, then thus Tx it if positive. When to do MOHS. Second line treatment.

A

shave biopsy/or excisional biopsy. If positive do 4mm margin excision. Do MOHs surgery if high risk areas. Topical FU/ imiquimod 2nd line

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59
Q

Melanoma’s confined to the skin are Tx’d how?

A

are treated by excision with margins.

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60
Q

Tx for recurrent or metastatic melanoma?

A

radiation and chemo-therapy… also biologicals

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61
Q

most common HIV associated malignancy?

A

Kaposi

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62
Q

Tx for kaposi sarcoma? consider if HIV+, small/local, or systemic

A

HAART therapy if patient is HIV⊕. Small local lesions can be treated with radiation or cryotherapy. Widespread or internal disease is treated with systemic chemotherapy

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63
Q

Bacillary angiomatosis Tx of chocie

A

erythromycin (lesions look red too = erythro)

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64
Q

dermatitis that is chronic and resistant to treatment… consider what?

A

could be mycosis fungoides… so do biopsy (sezary cell!)

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65
Q

Persistent strawberry hemoangiomas may be treated with?

A

topical or oral β-blockers

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66
Q

PYOGENIC GRANULOMA is seen usually in what setting

A

pregnancy

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67
Q

Tx options for pyogenic granuloma

A

surgical excision, laser therapy, or topical silver nitrate.

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68
Q

NECROBIOSIS LIPOIDICA
= talk to me about it

A

Red-brown to yellow annular plaques found on the lower extremities of patients with DM. Usually pretibial and in women.

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69
Q

Tx for HSV infections

A

acyclovir… IV if severe or CNS

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70
Q

dermatitis herpetiformis Tx?

A

dapsone and a gluten-free diet

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71
Q

HSV lesions… best Dx, and quickest Dx?

A

Viral culture or PCR test of lesion. Direct fluorescent antigen is the most rapid test.

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72
Q

who requires the varicella Vx

A

children in two doses at ages 1 and 4. Also recommended for adults over 60 years of age. May be given to HIV patients with CD4+ cell count >200.

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73
Q

Tx for postherpetic neuralgia

A

neuropathic agents (gabapentin, pregabalin, tricyclic antidepressants)

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74
Q

Tx for preherpetic neuralgia

A

Pain control with NSAIDs

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75
Q

VZV infx Tx in adults

A

systemic acyclovir to treat symptoms and prevent complications

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76
Q

Who needs post exposure prophylaxis to VZV (within 5 or 10 days of exposure).

A

immunocompromised individuals,
pregnant women, and newborns should receive varicella-zoster immune globulin within 10 days of exposure. Immunocompetent adults should receive a varicella vaccine within 5 days of exposure.

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77
Q

Tx for molluscum contagiosum

A

Curettage, cryotherapy, laser ablation, or applying cantharidin

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78
Q

How is respiratory papillomatosis acquired in infants?

A

Mothers with genital warts can transmit HPV to the infant by aspiration during delivery.

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79
Q

Most accurate test for HPV wart

A

PCR of the lesion

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80
Q

name 3 chemical treatments for HPV warts. Which are CI’d in pregnancy

A

podophyllin (contraindicated in pregnancy), trichloroacetic acid, and imiquimod (contraindicated in pregnancy).

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81
Q

Bullous impetigo is almost always caused by what bacteria. Meaning it can evolve into what?

A

exfoliative toxin-producing strains
of S aureus and can evolve into SSSS.

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82
Q

Do we need a gram/culture before starting Abx for impetigo?

A

No

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83
Q

Mild localized impetigo Tx

A

Topical antibiotics (mupirocin) are sufficient.

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84
Q

Severe impetigo (non-MRSA) or ecthyma Tx

A

Oral cephalexin or dicloxacillin.

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85
Q

Severe impetigo Tx (MRSA likely)

A

Oral trimethoprim-sulfamethoxazole, clindamycin, or doxycycline.

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86
Q

SSSS Tx

A

Nafcillin, vancomycin, and wound care.

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87
Q

When can a child return to school following impetigo

A

24 hours after the initiation of therapy.

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88
Q

Tx for scarlet fever

A

Penicillin

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89
Q

Tx for salmonella typhi

A

fluoroquinolones and third-generation cephalosporins

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90
Q

General cellulitis: Oral or topical Abx?

A

Oral. Infx too deep for topical

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91
Q

IV antibiotics are indicated when in cellulitis

A

if there is evidence of systemic toxicity, comorbid conditions, DM, extremes of age, or hand or orbital involvement.

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92
Q

Is the abx regime for cellulitis similar to impetigo?

A

Yes

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93
Q

Tx for suspected necr fasciitis.
Discuss Abx: if strep, to decrease exotoxin, and if anearobic?

A

Surgical emergency: Early and aggressive surgical debridement is critical.
Systemic broad-spectrum coverage is necessary. If Streptococcus is the
principal organism involved, penicillin G is the drug of choice. Clindamycin is added to ↓ exotoxin production. For anaerobic coverage, give metronidazole or a third-generation cephalosporin

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94
Q

What is Fournier gangrene

A

necr fasciitis localised to the groin area

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95
Q

what is eosinophilic folliculitis

A

Eosinophilic folliculitis can occur in AIDS patients, in whom the disease is intensely pruritic and resistant to therapy.

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96
Q

mild superficial folliculitis Tx

A

topical mupirocin

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97
Q

more severe folliculitis Tx

A

with cephalexin or dicloxacillin orally, escalating to clindamycin or doxycycline if MRSA is suspected

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98
Q

hot tub folliculitis Tx

A

self-limiting and does not usually require treatment—severe disease can be treated with ciprofloxacin.

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99
Q

Head or pubic lice Tx

A

Treat with topical permethrin, pyrethrin, benzyl alcohol, and mechanical removal.

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100
Q

Body lice Tx

A

Wash body, clothes, and bedding thoroughly. Rarely, topical permethrin is
needed.

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101
Q

scabies Tx

A

Patients should be treated with 5% permethrin from the neck down (head to toe for infants) for at least two treatments separated by 1 week, and their close contacts should be treated
as well. Oral ivermectin is also effective.

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102
Q

crusted scabies Tx

A

oral ivermectin and topical permethrin combo

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103
Q

bed bug Tx

A

Treat pruritis with topical steroids and antihistamines; use insecticides or heat to remove infestation.

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104
Q

Cutaneous Larva Migrans Tx

A

Ivermectin

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105
Q

does steroid induced acne respond to normal acne Tx

A

No! discontinue CSs is the only way

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106
Q

Mild acne Tx ideas

A

Topical retinoids are the most effective topical agent for comedonal acne. Topical benzoyl peroxide kills C acnes. Consider adding a topical antibiotic (clindamycin, erythromycin) if response to other topicals is inadequate.

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3
4
5
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107
Q

Moderate and severe acne Tx ideas

A

Topical treatment same as mild acne, add oral antibiotics such as doxycycline or minocycline. When acne is severe and all treatments are failing, oral retinoids (isotretinoin) are the most effective treatment. All other acne medications are stopped.

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108
Q

Isotretinoin monitoring required

A

liver function, cholesterol, and triglycerides. female patients must be on two forms of contraception and should have serial pregnancy (hCG) tests done

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109
Q

general succession on acne Tx

A

topical benzoyl peroxide, retinoid,
or antibiotic → oral antibiotic → oral isotretinoin

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110
Q

Tx of pilonidal cyst

A

incision and drainage of the abscess followed by sterile packing of the wound. Excision of sinus tract if present. Abx only if cellulitis present

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111
Q

Tuberculoid and lepromatous leprosy Tx

A

Treat tuberculoid leprosy with dapsone and rifampin. Add clofazimine for lepromatous or multibacillary leprosy

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112
Q

Bets initial test for tinea versicolor

A

KOH preparation of the scale revealing “spaghetti and meatballs” pattern
of hyphae and spores

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113
Q

Tx of tinea versicolor

A

topical ketoconazole or selenium sulfide (selsum blue)

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114
Q

Best initial test for suspected candida skin infx

A

KOH preparation of a scraping of the affected area. KOH dissolves the
skin cells but leaves the Candida untouched such that Candida spores and pseudohyphae become visible.

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115
Q

Most accurate test for candida skin infection Dx

A

culture

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116
Q

Oral candidiasis tx

A

Oral fluconazole tablets; nystatin swish and swallow, clotrimazole Troches.

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117
Q

Esophageal candidiasis tx

A

Systemic fluconazole, echinocandins, amphotericin B.

118
Q

Superficial (skin) candidiasis tx

A

Topical antifungals; keep skin clean and dry.

119
Q

Vulvovaginal candidiasis tx

A

Topical antifungal, single dose of oral fluconazole.

120
Q

Diaper rash tx

A

Topical nystatin.

121
Q

Tinea (ringworm)
Best initial test: ?
Most accurate test: ?

A
  • KOH skin scraping showing hyphae
  • Fungal culture

Wood’s lamps exam can used for microsporon

122
Q
A
123
Q

indication to use oral antifungals for tinea infections

A

if escalation needed, captitis, nail involved, immunocomp (rest = give topicals)

124
Q

sporotricosis Tx

A

itraconazole

125
Q

Dx
Small papule following minor trauma. Rapidly enlarges to form ulcer despite antiseptics. 55 year old women. No fever. Pain and pustular, and has irregular violaceous boarders

A

Pyoderma Gangrenosum

126
Q

Tx for pyoderma gangrenosum

A

GCs

127
Q

Workup for pyoderma gangrenosum

A

Biopsy to rule out infx and ca

128
Q

Describe the rash in porphyria cutanea tarda

A

Painless blisters, heal with scarring, hyperpigmentation,

129
Q

Itchthyosis usually spares where

A

Spares axilla and face. Affects the extensor legs most

130
Q

When is deep shave biopsy, or punch biopsy ok in suspected melanomas?

A

Only if very large or in problematic place (face).

131
Q

Recall perianal dermatoses (3 of them)

A
132
Q

how would you describe the rash in SSSS

A

Sun burn - like

133
Q

SJS and TEN have what symptoms before cutaneous lesions

A

flu like prodrome

134
Q

limited vitiligo Tx?

A

topical steroids

135
Q

extensive/unresponsive vitiligo tx?

A

oral GCs or topical calcineurin inhib

136
Q

Dx this
Patient with bullae and erosion of skin, when using them a lot. Hx of oral ulcers as baby. Thickening of soles of feet

A

epidermolysis bullosa
(dx - biopsy and IF)
(tx - supportive)

136
Q

First line Tx for Tinea

A

topical azole/terbinefine. 2nd line is griseofulvin

137
Q

Dx this
chronic, scaly, irregular, erythematous, central hypopog and peripgery of outer pigmentation.

A

discoid lupus

138
Q

Tx of SSSS

A

naficillin or vanco. And supportive wound care

139
Q

common precipitants of guttate psoriasis

A

strep, RA (add more)

140
Q

causes of erythema nodosum

A

infx, IBD, sarcoid, abx, COCP

141
Q

which drugs can increase risk for lichen planus

A

ACEi’s, Bb and thiazides

142
Q

Lichen planus Tx

A

High dose GC’s

143
Q

what is neonatal cephalic pustulosis

A

papules and pustules usually around 3 weeks after birth, limited to the face. Self limited and requires soap and water washes. ketoconazole is severe

144
Q

molluscum C. mx

A

don’t need biopsy. go straight for liquid nitrogen cryotherapy. do HIV test if patient young/lesion in genital area/many lesions.

145
Q

First line Tx for Tinea

A

topical azole/terbinefine. 2nd line is griseofulvin

145
Q

patient has sudden onset of severe psoriasis… test for what?

A

HIV test!

146
Q

BCC Tx overview

A

Surgical excision.
Mohs for high risk or face CA

5FU or imiquimod 2nd line

147
Q

Dx and Tx

A

Keratosis Pilaris. Give emollient creams and topical keratolytics

148
Q

Sun protection advice

A

Avoid where can. Avoid 10am-5pm. Where clothes and hats. Sunblock above factor 30 (apply ~30 mins prior and reapply every 2hrs or after swimming).

149
Q

Treatment of Acute paronychia. And if it’s with abscess or Felon?

A

Can do warm soaks. If abcess or felon present, so incision and drainage. Oral antibiotics after

150
Q

When to use wet to dry dressing and what is it

A

It involves applying a moist dressing, such as saline-soaked gauze or a hydrogel, directly onto a wound bed. As the dressing dries, it adheres to the wound surface and absorbs excess wound exudate, debris, and bacteria. During the removal process, the dried dressing is gently peeled away, which helps in debriding the wound by removing dead tissue and promoting a clean wound bed. Wet-to-dry dressings are commonly used for wounds that require regular cleaning and debridement, such as infected or necrotic wounds

151
Q

What is moisture retaining, non adherent dressing

A

creates a moist environment while preventing the dressing from sticking to the wound. Good for clean wounds that are ready to heal (have granulation)

152
Q

Where are pressure ulcer most common

A

sacrum, ischial tuberosities, malleoli, heels, and 1st or 5th metatarsal head.

153
Q

Risk factors for pressure necrosis

A

impaired mobility, malnutrition, abnormal mental status (eg, dementia), decreased
skin perfusion, and reduced sensation.

154
Q

Mx overview for pressure ulcers

A

repositioning of the patient to reduce
pressure, pain control, and nutritional support. Shallow ulcers can be managed with occlusive or semipermeable
dressings to maintain a moist wound environment. Full-thickness wounds may require more complex dressings
and surgical intervention for debridement or closure.

155
Q

Strange symptom seen in HSP

A

Testicular swell and ache

156
Q

Describe the rash in secondary syphilis

A

Scaly and involves palmes and soles. Hx of chancre.

157
Q

HSP rash and arthritis is in upper or lower limbs more

A

Lower

158
Q

Ruptured baker cyst symptoms

A

A ruptured Baker cyst may cause pain, warmth, and erythema in the popliteal fossa and posterior
calf.

159
Q

Risk factors for lichen planus

A

• Hepatitis C
associations • Medications: ACE inhibitors, thiazide diuretics

160
Q

Formation of lesions at sites of trauma. Called what? Seen mainly in?

A

Köbner phenomenon, seen in Lichen Planus

161
Q

Prognosis of cutaneous LP vs mucosal oral LP

A

Unlike cutaneous LP, which is self-limited and often resolves within
2 years, oral LP often has a prolonged course with relapsing symptoms over many years.

162
Q

Bed bugs presentation

A

Pruritic, small puncta & maculopapules in
linear groups (“breakfast, lunch, dinner”
patter) on unclothed skin

163
Q

One sentence to describe scabies rash

A

Pruritic burrows or hemorrhagic crusts in
intertriginous areas

164
Q

Source in infx in SSSS… neonates vs kids

A

In neonates, the source of infection is often the umbilicus or circumcision site, whereas in older children, there may be nasopharyngeal colonization or a primary skin lesion (eg, pustule)

165
Q

Type II reaction rashes and Type III reaction rashes

A

Type Il rashes are more likely to manifest as blisters or bullae (eg, pemphigus vulgaris, bullous pemphigoid) than papules. Type Ill rashes tend to be more erythematous and maculopapular.

166
Q

Neonatal cephalic pustulosis

A

Reaction to malazzazzia in 3 wk year olds. Presents as acne. Not due to sebaceous gland stimulation like normal acne. Mx with soap and wash, unless severe you can do topical CS or ketoconazole

167
Q

Miliaria Rubra

A

Erythematous, papular rash on occluded & intertriginous areas, due to overheating.

Mx Avoid overheating (eg,
cool environment,
thin/cotton clothing)

If severe, topical
corticosteroid

168
Q

Erythema toxicum neonatorum

A

• Birth to
age 3
days
• Pustules with
erythematous
base on trunk &
proximal
extremities

Mx Observation
• Resolves within a
week

169
Q

Milia

A

Milia
• Birth presentation
• Firm, white
papules on face
Observation
Resolves within a
month

170
Q

Neonatal
pustular
melanosis

A

• Birth presentation

Nonerythematous
pustules
-
evolve into
hyperpigmented
macules with
collarette of scale
• Diffuse, may
involve palms &
soles

Observation
Pustules resolve
within days
Hyperpigmentation
may last months

171
Q

Contrast acute and chronic tinea pedis

A

Acute: pruritus, burning pain,
erythematous vesicles/bullae
• Chronic: pruritus, erythema,
interdigital
scales/fissures/erosions with
extension onto the sole, side, or
dorsum of the foot

172
Q

Tinea pedis interdigital vs moaccasin

A

Tinea pedis most commonly occurs between the toes (interdigital pattern), but in chronic cases can cause a hyperkeratotic rash extending up the sides of the feet (moccasin pattern).

173
Q

Erythema neonatorum toxicarum presentation

A

ETN typically presents by age 3 days in full-term neonates. The rash usually begins as small, poorly
demarcated erythematous macules and papules that classically involve the trunk and proximal extremities but may occur anywhere except the palms and soles (where no hair follicles are present). Lesions often evolve into small, firm pustules on erythematous bases. The rash is asymptomatic, and infants are otherwise well- appearing.

174
Q

Pseudofollicultis Barbae is due to follicle penetration. What are the two types

A

through the lateral wall of the follicle
(transfollicular penetration) or by curving back down into the skin after exiting the follicle (extrafollicular
penetration).

175
Q

Mx overview of pseudofollicutlits barbae

A

Discontinuation of shaving is first-line
treatment and results in improvement in a few weeks. Subsequently, adjustment of shaving routine (eg, single
blade, warm compresses prior to shaving) or use of alternative shaving methods (eg, hair clippers to leave hair
longer) can be adopted. Chemical depilatories, laser hair removal, and topical eflornithine (which slows hair
growth) can also be used.

176
Q

3 causes of Nikolsky positive

A

(positive Nikolsky sign, seen in staphylococcal scalded skin syndrome, TEN and pemphigus vulgaris).

177
Q

Can cherry hemangiomas be seen on mucosa

A

No

178
Q

D element to the ABCDE of melanoma, is what

A

Diameter of more than 6mm

179
Q

Pyogenic granuloma. Facts

A

Usually less than 1cm
High in fingers and Muscosa
Seen in high estrogen states like preg
Resolve postpartum
Bleed with minor trauma

180
Q

How is nickel allergenic

A

Nickel (eg, belt buckles, watches, jewelry) is a common trigger for chronic ACD; corrosion of metal alloys by electrolytes in sweat releases soluble metal ions that trigger the hypersensitivity reaction.

181
Q

How do topical retinoids work? How does benzoyl peroxide work

A

topical retinoid (eg, tazarotene, tretinoin), which inhibits comedogenesis, and benzoyl peroxide, which has bactericidal activity against C acnes.

182
Q

Common drugs causing photosensitivity

A

Antibiotics
Tetracyclines (eg, doxycycline)
Antipsychotics
Chlorpromazine, prochlorperazine
Diuretics
Furosemide, hydrochlorothiazide
Others
Amiodarone, promethazine, piroxicam

183
Q

Advice to patients starting tetracyclines regarding sun

A

Patients being
prescribed tetracyclines should be advised to minimize sun exposure and use appropriate sunscreens and
barrier solar protection when outdoors.

184
Q

Difference between phototox and photoallergy

A

Topical (eg, sunscreens) and systemic medications can cause photoallergic reactions, in which ultraviolet light alters the structure of the drug, which then induces a delayed hypersensitivity reaction. These skin manifestations are typically eczematous in appearance. Whereas phototox from say tetracycline or amiodarone will generate react with UV to generate free radicals

185
Q

Eczema herpeticum. And Tx

A

Painful vesicular rash

Herpes simplex type 1

“Punched-out” erosions & hemorrhagic herpeticum crusting

Tx with systemic cyclovirs

186
Q

Ichthyosis vulgaris overview

Gene
Presentation
Histology feature
Tx?

A

Loss of fillagrin gene. Diffuse scaling of skin, palmer hyperlinearity, increased atopic disease. Dx is clinical but can do biopsy which shows absent granular layer. Tx with warm baths, emollients and moisturiser and consider keratolytics

187
Q

Anal Strep derm presentation . Tx?

A

Infants through school-
aged children
• Bright, sharply
demarcated erythema of
perianal/perineal area
• Oral antibiotics (eg,
amoxicillin)

188
Q

Tx of diaper contact derm

A

Topical barrier (eg,
petrolatum, zinc oxide)

189
Q

Perinatal baby rash: Erythematous papules,
plaques? Spares skinfolds….

Candida or diaper?

A

Diaper

190
Q

Perinatal baby rash
Beefy-red, confluent
plaques
• Involves skinfolds
Satellite lesions

Candida or diaper

A

Candida

191
Q

Standard interventions to prevent pressure ulcers in high-risk patients include:

A

• Proper patient positioning
• Mobilization
• Careful skin care
• Moisture control
• Maintenance of nutrition

192
Q

Intermittent pneumatic compression vs stockings…. Use?

A

Intermittent pneumatic compression devices are used to prevent deep venous thrombosis in patients
with contraindications to anticoagulant therapy. Stocking are used to orient venous insuff

193
Q

How would you describe the rash of discoid lupus

A

chronic, scaly, irregular, erythematous plaques with ulceration and central hypopigmentation
surrounded by hyperpigmentation.

194
Q

Patient with discoid lupus…. How many get SLE? What signs can show you they are at high risk of getting SLE

A

(SLE) eventually develops in up to 30% of patients. Risk factors for progression
to SLE include widespread lesions, concurrent arthralgias/arthritis, and high antinuclear antibody titers.

195
Q

How would you device the rash of PCT

A

fragile blisters and erosions. Sun exposed areas

196
Q

What to do in case of nodular melanoma instead of ABCDE

A

7-point checklist. The typical ABCDE is more for superficial melanoma

197
Q

What is the 7 point checklist for melanoma

A

(1 major or 3 minor is
suspicious)
• Major criteria: change in size, shape, or color
• Minor criteria: size 7 mm, local inflammation, crusting/bleeding,
sensory symptoms

198
Q

Infants with epidermolysis bullosa l.. presentation

A

Infants with EB simplex may develop oral blisters with bottle-feeding, but mild cases often do not lead to definitive diagnostic testing.

199
Q

Dx and Tx of epidermolysis bullosa

A

Suspected EB warrants biopsy of a fresh blister for immunofluorescence microscopy; genetic testing is available for confirmation. Treatment primarily involves careful wound care and supportive measures.

200
Q

What is Idiopathic guttate hypomelanosis

A

Idiopathic guttate hypomelanosis is a common finding with aging and is characterised by small macules in sun-exposed areas.

201
Q

Tinea vs vitiligo.

Which is depig which is apigmentation

A

Tinea = depig

Vitiligo = apigmentation

202
Q

Guttate psoriasis description, and main preceding infx?

A

scattered, scaly, erythematous papules or small plaques, typically following an acute streptococcal infection.

203
Q

Sudden-onset, severe psoriasis
• Recurrent herpes zoster
› Disseminated molluscum contagiosum
Severe seborrheic dermatitis

test for what?

A

HIV test

204
Q

Multiple skin tags… 3 diseases associated with it

A

Preg, insulin resistant, crohns

205
Q

Main causes of erythema nodosum

A

infection (eg, Streptococcus), inflammatory bowel disease (eg, Crohn disease), sarcoidosis, and malignancy. It can also be triggered by medications, such as penicillins, sulfonamides (eg, trimethoprim-sulfamethoxazole) and oral contracentives

206
Q

Two main superinfx in eczema

A

HSV and impetigo

207
Q

How would you describe the prodrome of TEN/SJS

A

Acute influenza-like prodrome

208
Q

Can a patient have vitiligo only on the genital or oral mucosa.

A

Yes (recall weird vulval Q)

209
Q

Blisters, bulla, scarring, hypopigmentation/hyperpigmentation on sun-exposed skin (eg, back of hands, forearms, face). Dx?

A

PCT

210
Q

Dx?

A

Nummular eczema

211
Q

Miliaria rubra pathophys

A

In infants when, eccrine sweat glands within the epidermis are not fully developed or have delayed patency. As a result, hot or humid environments lead to sweat accumulation within the glands and an inflammatory reaction.

212
Q

Mx overview of Miliaria rubra

A

Management involves avoidance of overbundling and synthetic fabrics and switching to thin clothing made of
breathable material (eg, cotton). Overheating and sweating can also be reduced by creating a cooler
environment (eg, air conditioning, fan) when possible. If the rash is severe or associated with pruritus, topical
low/mid-potency corticosteroids may be used as adjunctive therapy.

213
Q

Lichen lands from drugs induced cause.

A

Drug-induced LP typically has a more diffuse presentation than idiopathic LP, which is frequently limited to the flexor surfaces of the wrists and ankles, oral mucosa, and genitalia.

214
Q

Main bacteria to cause cellulitis via nail puncture

A

Pseudomonas aeruginosa

215
Q

When to do X-ray to check for osteomyelitis in DM ulcer

A

Therefore, foot imaging (eg, ×-ray, MRI) is generally recommended for all diabetic foot ulcers that
are:
• deep (eg, exposed bone, positive probe-to-bone testing).
• long-standing (eg, present >7-14 days).
• large (eg, ≥2 cm).
• associated with elevated erythrocyte sedimentation rate/-reactive protein.
• associated with adjacent soft tissue infection.

216
Q

RFs for Tinea

A
  • Concurrent dermatophyte infection (autoinoculation)
    • Occlusive clothing
  • Obesity
    • Peripheral artery disease
    • Diabetes mellitus
    • HIV infection
    • Systemic glucocorticoid therapy
217
Q

3 skin conditions associated with HCV

A

porphyria cutanea tarda (erythema and
bullae in sun-exposed areas), **lichen plans* (pruritic, pink/purple papules and plaques predominantly located at
wrists and ankles), and leukocytoclastic vasculitis (palpable purpura).

218
Q

What is telegen effluvium

A

Acute, diffuse, noninflammatory hair loss

Clinical findings
• Scalp & hair fibers appear normal
• Hair shafts easily pulled out (hair pull test)
Triggers
• Severe illness, fever, surgery
• Pregnancy, childbirth
• Emotional distress
• Endocrine & nutritional disorders

219
Q

What is the hair pull test and how does it relate to telogen effluvium

A

. In the hair pull test, small tracts of hair (50-60 fibers) are pulled firmly; extraction of >10%-15% of fibers is abnormal and suggests TE.

220
Q

What is trichorrhexis nodosa

A

Trichorrhexis nodosa is characterized by fragility of hair with breaking of strands.

221
Q

Angiosarcoma and breast cancer relationship

A

patients with breast cancer who undergo radiation therapy or axillary lymph node dissection (with subsequent chronic lymphedema) are at substantially increased risk of secondary angiosarcoma approximately 4-8 years after therapy.

222
Q

Bullous pemphioid vs pemphigus vulgaris (itch or pain)

A

Itch and pain resp.

223
Q

bullous pemph and pemph vulgaris have a prodrome of what rash

A

Urticaria/eczematous

224
Q

Associated disorders with bullous pemphigoid

A

Neuro disorders. Like Parkinson’s and Alzheimer’s

225
Q

Pathergy in pyoderma gangrenosum

A

Small injury will form ulcer in days/weeks

226
Q

Risk factors for onychmycosis

A

Age, DM, PVD

227
Q
A

Koilonychyia

228
Q

Explain the sensory, ANS, motor owners to diabetic neuropathy/ulcer

A

Sensory: awareness, and pressure on first

ANS: lower blood flow foot, dry skin which is more vulnerable to fissuring

Moto: unopposed large lower leg muscle clawing, increased pressure on metatarsal head

229
Q

How to tell a lipoma from an epidermal inclusion cyst

A

Lipoma are usually soft Irregular. Epidermal inclusion cyst are firm, regular, and do not change shape with pinched. Inclusion cyst may recur also

230
Q

Insitu SCC vs invasive SCC appearance

A

Insitu is bowens, and appears as a flat patch that is well demarked. If invades becomes nodular and ulcerative.

231
Q

Tinea Mannum

A

superficial mycosis of the palm, dorsum, or interdigital folds of one or both hands. Usually annular and looks like Dr Fotinis issue. Associated with Tinea pedis

232
Q

Dx this:

Recurrent, acute episodes
• Deep-seated, pruritic vesicles & bullae at hands & feet

A

Acute palmoplantar eczema (dyshidrotic eczema)

233
Q

Tx of Acute palmoplantar eczema (dyshidrotic eczema)

A

• Topical emollients
• High/super high-potency topical corticosteroids

234
Q

Is whitlow painful or pruritic

A

Painful

235
Q

Congenital melanoma… size matters?

A

Yes. Large ones have higher melanoma risk. So remove them. Smaller ones are often removed more for cosmetic reasons

236
Q

Red flags for Mongolian blue spots

A

Different colours, fade quickly, tender. Likely bruises

237
Q

Nevis simplex vs negus flammeus

A

Nevus simplex lesions are typically located on the eyelids, glabella, and nape of the neck and fade
with time; nevus flammeus lesions (port-wine stains) do not regress with time and are usually unilaterally located on the face.

238
Q

presents with enlarging vesicles, which progress into flaccid bulla filled with yellow fluid.
The lesions rupture, leaving a classic collarette of scale (eg, resembles a collar or necklace) at the periphery of the lesion. Dx?

A

Bullous impetigo (staph)

239
Q

Bullous impetigo vs herpes signs

A

Impetigo grows rapidly and scales

240
Q

Cradle cap is caused by what infection

A

Seborrhoeic dermatitis – Malassezia. Not tinea capitis

241
Q

Management for a child with cradle cap/a bit of other seborrhoeic dermatitis

A

Cradle cap yourself resolve. But can do non-medical shampoos.

If persistent can start to add low-dose steroid, topical antifungal et cetera

242
Q

IGA nephropathy weird finding

A

Scroll to swell

243
Q

Neonatal Catholic pustulosis. How do you treat, and what is the likely cause

A

Just treat with the daily cleansing with soap and water. If severe can do corticosteroid/ketoconazole topically.

It’s most likely reaction to Malassezia

244
Q

Why might somebody with recurrent blistering on the back of the hands, fatigue and low haemoglobin, and history of high LFTs

A

Porphyria cutanea tarda patient secondary to chronic hep C

245
Q

Baby groin rash. Beefy read satellite lesions Skin folds involved. Versus plaques/papules sparing skinfolds. Versus well defined rash around anus with fissures

A

Candida, diaper rash, strep perianal dermatitis

246
Q

Have a quick look at discoid lupus on the Internet. Should be able to see hyperpigmented edges, hypopigmented centres within ulceration in the middle

A
247
Q

Woman with hair loss and sitting around the vertex in mid scalp

A

This is normal female pattern hair loss. Can give me an minoxidil

248
Q

If someone is having recurrent tineawhat is important to do

A

Search other areas, like the foot, due to autoinoculation ri

249
Q

If two excisional biopsy of skin cancer, and it’s margina are CA positive do what

A

Remove an extra 4 mm off the margins

250
Q

Telogen effluvium

A

Just a lot of hair coming out. Triggered by stress, and a crime, poor nutrition, illness, fever, surgery. Do the whole hair tug test (more than 20% of five as well come out)

251
Q

How does psoriasis look if it’s on the hands of scalp

A

Often is small plaques. Have a quick look on the Internet

252
Q

Russian back, small red macules on Lines of tension

A

Pityiariasis

253
Q

Name me to hypertensive medication is that a risk factors for lichen planus

A

Thiazide and ACE inhibitor

254
Q

Clear sign to tell between bullous impetigo and contact dermatitis

A

Impetigo is going to be more painful, where is dermatitis will be very itchy

255
Q

When and why do we do an x-ray on chronic ulcers of the foot for example

A

Essentially to rule out osteomyelitis. Chronic/deep/large/systemic symptoms can point towards a high risk of osteomyelitis

256
Q

Treatment for erythema multiform

A

Antihistamine and topical glucocorticoid

257
Q

What is aCute Paronychia and a felon

A

And infection of the nail. Can form an abscess, and can reach the pulp of the nail bed which is a felon. Paronychia alone you can do warm soak. Abscess or fell on you need oral antibiotics and incision and drainage

258
Q

Discuss the dressings for infected tissue

A

Start off with wet to dry. This allows removal of devitalise tissue. Eventually you should get a nice red and moist wound (granulation). Now do moist retaining non-adherent dressing, which can allow the granulation tissue to form

259
Q

The D in ABCDE, is what

A

Diameter, above 6 mm

260
Q

When would you decide on topical five FU or imiquimod versus cryotherapy for actinjc keratosis

A

If it’s more diffuse, or the signs of field cancerisation (cirrhosis, pigment change) et cetera pick the topical ones

261
Q

Long term immunomodulators can increase risk of

A

Lymphoma

262
Q

Eosinophilia has a role in Dx atopic dermatitis

A

No

263
Q

Other than nasolabial fold, Where else can seborrhoeic dermatitis be found commonly

A

Eyebrows and posterior ears, scalp. Also of course cradle cap

264
Q

Other than Parkinson’s… who else gets diffuse seb derm

A

Psychotic disorders and HIV

265
Q

Name three medication psoriasis

A

ACEI, BB, Li

266
Q

Local psoriasis management

A

Topical corticosteroids, topical vitamin D, topical vitamin A

267
Q

If somebody has extensive is psoriasis. Which are following treatments is CI in an immunosurpressrd 

A

UV… can cause skin cancer

268
Q

How long after drug exposure does a patient usually have medication induced morbilliform rash. If it’s not within this time period what do you consider

A

It’s usually one to 2 weeks after medication. If patient has it a couple of days after medication, it’s probably not the cause 

269
Q

What is the difference between erythema multiform E minor and major. Is there any risk aggression to toxic epidermal necrolysis

A

Minor only on the skin, major also on the mucous membrane. There is no risk of progression

270
Q

EM, TEN, SJS are what reaction

A

Type 4

271
Q

Management of EM minor and major

A

Symptomatic treatment. Supportive, major should be treated as a burn. No corticosteroid

272
Q

Comprehensive list of TEN causing Medz

A

Sulfas , penicillin, most seizure medication, quinolones, cephalosporins sporrans, steroids, NSAID

273
Q

Other than well known ones: main causes of erythema nodosum

A

Behcets, other chronic infx (strep, yersinia etc.) sulfas, OCP

274
Q

Often erythema nodosum patients have false non strep test….

A
275
Q

If erythema nodosum persists after cold compress NSAID etc

A

Give KI

276
Q

Lim bullous pemphigoid. Before the blisters, what occurs

A

Eczematous or uriticarial like lesions

277
Q

Pyoderma G. Painful or painless

A

Painful

278
Q

Most rapid test for HSV

A

Flourescent Ag test. (PCR or culture best though). Tzanck smear more supportive Dx

279
Q

General rule for time frame of when to give antiviral in HSV or VZV in severe or immunocomp

A

Within 72 hours of symptoms to really help

280
Q

If someone has severe frequent HSV recurrences. What to do

A

Daily acyclovir

281
Q

Consider what, in an HSV infx lasting more than 1month. And even resistant to Tx

A

AIDs

282
Q

Key overview of management for varicella. Consider if child, adult. Consider treatment for acute, subacute, postherpetic neuralgia.

A

For child, self-limited. Adults should have systemic acyclovir. For acute and subacute neuralgia give NSAID. For postherpetic give neuropathic S

283
Q

Molluscum contagiosum. Treatment in adults for children

A

Adults can do various methods of removal. In children usually resolve and Are left on treated.

284
Q

Treatment overview of gangrene

A

Surgical debride meant. Antibiotics can be given, but are often ineffective due to lack of blood flow. Hyperbaric oxygen gas gangrene

285
Q

Papulopustular rosacea treatment

A

Topical metronidazole

286
Q

Oval Erica matters plaques covered in a white find scale (cigarette paper

A

Pityriasis Rosa

287
Q

Do you need to do steroids for pityriasis

A

No

288
Q

First line therapy for hydradenitis

A

Topical clindamycin, or oral antibiotics. Drainage, wound care, even surgical excision and skin graft.

289
Q

Itchthyosis is worse in what weather

A

Cold dry

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