Dermatology

Question 1

Appearance: Lichen planus

Answer 1

• Pruritic, violaceous, polygonal, flat-topped papules with white lacy lines (Wickham striae) - Most common site: flexor aspect of the wrists - Mucous membranes: Milky-white papules with white lacework on the buccal mucosa

Question 2

Repeated mechanical trauma (friction) and other types of physical trauma such as scratching, chronic pressure, or cuts along with allergic or irritant contact reactions may trigger vitiligo on areas such as the neck, elbows, and ankles . Also called “isomorphic response,” which describes the development of skin disease in sites of skin trauma.

Answer 2

Koebner phenomenon

Question 3

Staph. aureus and atopic dermatitis

Answer 3

Staph superantigens activate T cells, macrophages

Question 4

Punched out erosions in atopic dermatitis

pain and pustular lesions secondary to a viral infection (usually HSV-1), which can spread rapidly leading to severe morbidity and mortality

Answer 4

Eczema herpeticum

Rx: acyclovir

Question 5

aggresive T-cell lymphoma: erythroderma, finely scaly and indurated

Answer 5

Sezary syndrome

Rx: extracorporeal photopheresis (ECP), romidepsin

Question 6

— are topical immunomodulatory agents that affect the T-cell and mast-cell function and inhibit the synthesis and release of multiple proinflammatory cytokines.

Unlike topical corticosteroids, TCIs do not induce skin atrophy, striae, or telangiectasias and are increasingly used for the treatment of facial vitiligo.

Answer 6

Tacrolimus and pimecrolimus

Question 7

a calcium and calmodulin dependent serine/threonine protein phosphatase which activates the T cells of the immune system.

Answer 7

Calcineurin

Question 8

Low risk basal cell ca, not morpheaform, not recurrent: Rx

Answer 8

Curretage, electrodessication

Question 9

Bisphosphonate therapy: 10 year risk has to be above

Answer 9

20%

Question 10

Bacterial endocarditis abx prophylaxis

Answer 10

1. Prosthetic valve
2. Valve repair with prosthetic material
3. Heart transplant + valvulopathy
4. History of endocarditis
5. Certain CHDs

Question 11

Exposure to HIV+ needlestick: testing of stuck person

Answer 11

1. HIV antibody
2. HBsAg antibody
3. Hep C antibody
4. CBC
5. LFT
6. Creatinine

Question 12

Pneumonia: OnDx

Answer 12

Calculate PSI

The PSI stratified adults with radiographic evidence of pneumonia into five classes for risk of death from all causes within 30 days of presentation. Predictor variables were based upon the medical history, physical examination, and selected laboratory and radiographic findings readily available at the time of patient presentation. In contrast with previous prediction rules, the PSI application uses two steps that parallel decision-making processes the physician usually follows during a patient encounter. Step 1 of the rule identifies patients in the lowest risk class (risk class I) based upon the absence of 11 demographic, comorbid conditions, and physical examination findings.

These factors consist of:

●Age >50 years

●The presence of coexisting conditions:

• Neoplastic disease
• Heart failure
• Cerebrovascular disease
• Renal disease
• Liver disease

●The presence of physical examination abnormalities:

• Altered mental status
• Pulse ≥125/minute
• Respiratory rate ≥30/minute
• Systolic blood pressure <90 mmHg
• Temperature <35°C or ≥40°C

If one or more Step 1 risk factors are present, the evaluation of illness severity proceeds to Step 2 (table 1); if no Step 1 factors exist, patients are assigned to the lowest severity risk class I. The second step stratifies the remaining patients into risk classes II, III, IV, or V based upon the total amount of points assigned to each risk factor identified. A total point score is computed by adding the patient age in years (years minus 10 for females) and the points for each applicable risk factor. Total scores of 70 or under correspond to class II, 71 to 90 to class III, 91 to 130 to class IV, and over 130 to class V (calculator 1).

Question 13

Elevated PA pressure + elevated PCWP

Answer 13

Pulmonary venous hypertension

Left heart failure

Question 14

Erythematous, lichenified Rash around 31 year old woman’ neck, wrists, ear lobes

History of AD

Answer 14

Nickel sensitivity

Question 15

tinea corporis: Rx

Answer 15

terbinafine

Question 16

Verapamil or Diltiazem: OnPrescribe

Answer 16

Reduce simvastatin to 10 mg

Question 17

Acute gastroenteritis 24-28 hour incubation, fever, non-bloody diarrhea

Answer 17

Norovirus

Question 18

Newly diagnosed afib: determination of need for beta blocker

Answer 18

ambulatory electrocardiography

Question 19

Post-traumatic, recurrent anterior instability of shoulder not responsive to PT. Rx

Answer 19

Surgery

Question 20

Carcinoid: most useful test

Answer 20

d (5-HIAA),

Due to its relatively low specificity, we do not recommend the use of serum chromogranin A (CgA) as a screening test

●Once the biochemical diagnosis of the carcinoid syndrome is confirmed, usually by an elevated 24-hour excretion of 5-HIAA, the tumor must be localized. Two techniques, standard cross-sectional imaging and diagnostic imaging with radiolabeled somatostatin analogs, have a complementary role in tumor localization. For diagnostic workup of carcinoid syndrome, we generally perform helical, contrast-enhanced, triple-phase computed tomography (CT) scans of the abdomen and pelvis (see ‘Computed tomography’ above). Contrast-enhanced magnetic resonance imaging (MRI) of the abdomen and pelvis is an acceptable alternative and is preferred by some physicians because of its greater sensitivity for liver metastases. (See ‘Magnetic resonance imaging’ above.)

Uptake of radiolabeled somatostatin analogs can assist in identifying an otherwise occult primary site. Where available, functional imaging with Gallium Ga-68 DOTATATE PET/CT is preferred over 111-Indium pentetreotide (OctreoScan) due to its greater sensitivity. (See ‘Functional PET imaging with 68-Ga DOTATATE’ above and ‘Indium-111 pentetreotide (OctreoScan)’ above.)