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Step 2 CK > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

ABCDE of Melanoma

A

A: asymmetry

B: border irregularity

C: color irregularity

D: diameter > 6mm

E: evolution

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2
Q

Treatment for melanoma

A

Surgical removal with significant removal of normal skin

Interferon injection is helpful in widespread disease

Melanoma has a strong tendency to metastasize to the brain and can also show up in unusual places

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3
Q

What type of cancer is greatly increased by organ transplant (i.e., long-term use of immunosuppressive drugs)

A

SCC

Look for vignette describing an ulcer that does not heal or continues to grow

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4
Q

The most common form of skin cancer

A

BCC

Waxy lesion that is shiny like a pearl

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5
Q

Treatment for BCC

A

Unlike melanoma, wide margins are not necessary and recurrence is < 5%

Mohs Micrographic Surgery: uses a dissecting microscope with immediate frozen section (loss of only the smallest amount of normal tisse)

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6
Q

What is the most common cause of Kaposi Sarcoma

A

AIDS

KS if from HHV-8, which is oncogenic

The lesion is reddish/purplish because it is more vascular than other forms of skin cancer

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7
Q

Apart from the skin, where else is Kaposi Sarcoma found?

A

GI tract and lungs

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8
Q

Does the way you acquire AIDS change the risk of acquiring Kaposi Sarcoma?

A

Yes

AIDS acquired through sexual contact is associated with KS; AIDS from injection drug use is rarely associated with it

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9
Q

Treatment for Kaposi Sarcoma

A

Antiretrovirals (majority of KS will disappear)

Intralesional injections of vincristine and interferon

Chemo and liposomal doxorubicin as a last resort

KS is NOT routinely treated with surgical removal

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10
Q

Pre-malignant skin lesions from high-intensity sun exposure

A

Actinic Keratoses

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11
Q

Treatment for Actinic Keratoses

A

A very small risk of SCC for each individual lesion

Removed by curettage, cryotherapy, laser, or topical 5-FU

Imiquimod is also effective

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12
Q

Do seborrheic keratoses have malignant potential?

A

No

They are removed for cosmetic reasons

The term seborrheic is synonymous with benign

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13
Q

Greasy-looking, yellowish scales on an erythematous base

Associated with Parkinson disease and HIV

A

Seborrheic dermatitis

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14
Q

What is atopic dermatitis caused by?

A

AKA Eczema

Associated with overactivity of mast cells and the immune system

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15
Q

Presentation of Eczema

A

Pruritis and scratching (separates eczema for psoriasis)

Lichenified skin

Superficial skin infections from staph

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16
Q

Treatment for atopic dermatitis

A

Stay moisturized, avoid bathing/soap/washcloths, cotton is better than wool

Topical corticosteroids for flares

Tacrolimus and pimecrolimus (T cell-inhibiting agents) provide longer-term control and help get patients off steroids

Antihistamines (doxepine)

Abx for impetigo

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17
Q

Silvery, scaly plaques

A

Psoriasis

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18
Q

Treatment for psoriasis

A

Topical high-potency steroids

Vitamin A and D (steroids cause skin atrophy)

Coal tar

Pimecrolimus and Tacrolimus

UV light, TNF inhibitors, and Methotrexate for extensive disease

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19
Q

What must be done before starting a patient on TNF inhibitors

Study These Flashcards
A

Screen with a PPD because they can reactivate TB

20
Q

Transient dermatitis that starts out with a single lesion (herald patch) and then disseminates

Study These Flashcards
A

Pityriasis Rosea

It can look like secondary syphilis but it spares the palms and soles

21
Q

Hypersensitivity reaction to a dermal infection with noninvasive dermatophyte organisms

Study These Flashcards
A

Seborrheic Dermatitis (aka Dandruff)

Increased in AIDS and Parkinson disease

The term seborrheic is synonymous with benign

22
Q

Two causes of pemphigus vulgaris

Study These Flashcards
A

idiopathic autoimmune

and

drug-induced form

23
Q

What drugs can lead to pemphigus vulgaris

Study These Flashcards
A

ACE inhibitors

Penicillamine

Phenobarbital

Penicillin

24
Q

What happens during Pemphigus Vulgaris

Study These Flashcards
A

Autoantibodies split the epidermis, resulting in:

Bullae that easily rupture

Involvement of the mouth

Fluid loss and infection

The most characteristic finding is the Nikolsy sign

25
The most accurate test for pemphigus vulgaris
Biopsy
26
Treatment for pemphigus vulgaris
Without treatment, pemphigus is a fatal disease 1. Systemic steroids (prednisone) 2. **Azathioprine** or **mycophenolate** to wean off steroids 3. Rituximab (anti-CD20 antibodies) or IVIG in refractory cases
27
How is bullous pemphigoid different from pemphigus vulgaris?
Much milder disease: bullae stay intact (less loss of fluid and infection) and mouth involvement is uncommon Nikolsky sign is absent
28
Treatment for Bullous Pemphigoid
Biopsy with immunofluorescent stains is the most accurate test before treatment Initial therapy = prednisone (azathioprine, cyclophosphamide, or mycophenolate to wean off) Mild cases respond to erythromycin, **dapsone,** and **nicotinamide**
29
Blistering skin disease of sun-exposed areas
Porphyria Cutanea Tarda: a hypersensitivity of the skin to abnormal porphyrins when they are exposed to light Look for a history of liver disease (**Hep C**, alcoholism), estrogen use, or iron overload
30
Test and Treatment of Porphyria Cutanea Tarda
Most accurate test = **increased uroporphyrins** in a 24-hour urine collection (PCT is d/t a uroporphyrin decarboxylase deficiency) Correct the underlying cause (stop alcohol, stop estrogens) and remove iron with phlebotomy
31
What is impetigo caused by?
Staph and Strep Invade the epidermis
32
Treatment of Impetigo
Mild = **mupirocin**, retapamulin, bacitracin Severe = dicloxacillin or cephalexin Community-acquired MRSA: doxycycline, **clindamycin**, and **TMP-SMX**
33
What is erysipelas
Much more severe disease than impetigo because it occurs at a deeper level Much more often from **Strep (GAS)** than Staph (untreated disease can be fatal) Presentation = look for a bright, red, hot swollen lesion of the face *Will **often involve the external ear** (this skin lacks a lower dermis and indicates a superficial infection, aka not cellulitis)*
34
Treatment for Erysipelas
Mild = oral medications Dicloxacillin, cephalexin, cefadroxyl Penicillin allergic: erythromycin, clarithromycin, or clinda MRSA: doxycycline, **clindamycin, TMP-SMX** Severe = IV medications Oxacillin, nafcillin, cefazolin Penicillin allergic: clindamycin, vancomycin MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
35
Folliculitis vs Furuncles vs Carbuncles
Folliculitis is the earliest and mildest Furuncles is a small abscess Carbuncle is a collection of furuncles
36
Only cephalosporin covering MRSA
Ceftaroline
37
Best initial test for fungal infections
KOH preparation (dissolves epidermal skin cells and leaves the fungi intact) Most accurate = fungal culture
38
Treatment for fungal infections
Topical antifungal agent if no hair or nails are involved (clotrimazole, ketoconazole, econazole, miconazole) The best initial therapy for hair (tinea capitis) and nail (tinea unguium) infections is **terbinafine**
39
Options for treating tinea capitis and unguium?
Terbinafine Intraconazole is close in efficacy Griseofulvin has less efficacy
40
Penicillins Sulfa drugs Allopurinol Phenytoin Lamotrigine NSAIDs
Drugs that commonly cause hypersensitivity reactions
41
Morbilliform rash Erythema Multiforme SJS TEN
Morbilliform = mildest reaction (no specific therapy) EM = widespread, small "target" lesions (prednisone may benefit some patients) SJS: very severe, sloughs off respiratory epithelium and may lead to respiratory failure (steroids not clearly beneficial, use **IVIG**) TEN: Nikolsky sign (**steroids definitely DO not help**, use IVIG)
42
Treatment of mild acne
Use topical antibacterials: benzoyl peroxide Add **topical antibiotics** if ineffective: clindamycin or erythromycin
43
Treatment of moderate acne
Add topical vitamin A derivates: tretinoin, adapalene, or tazarotene Add **oral antibiotics** if no response: minocycline or doxycycline
44
Treatment of severe acne
Add **oral** vitamin A (isotretinoin)
45
What must be done before starting a female on vitamin A derivates for acne
Pregnancy test (extremely teratogenic) Patients can only be treated if they are willing to use two forms of birth control (hormonal and barrier)
46
SSSS vs TSS
Different severities of the same event: a reaction to a toxin in the surface of Staph

Step 2 CK (18 decks)

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