Master the Boards: Dermatology

Question 1

What type of biopsy may be done in suspected basal cell carcinoma?

Answer 1

A shave biopsy is ok

Question 2

What is the pathogenic origin of Kaposi sarcoma?

Answer 2

Human herpes virus 8

Question 3

Kaposi sarcoma is red-purple because it is more vascular. Besides the skin what other two areas may it be found in?

Answer 3

GI tract

Lung

Question 4

How is Kaposi sarcoma treated?

Answer 4

Generally no surgery. Treat AIDS or HIV with antiretrovirals and generally regresses.

Occasionally can use intralesional vincristine or interferon injections

Question 5

Should actinic keratosis be removed?

Answer 5

Yes, they should be removed with curettage, cryotherapy, laser, or topical 5-FU

Question 6

Overactivity of mast cells leads to what common skin disorder?

Answer 6

Eczema

Question 7

Levels of what Ig are elevated in atopic dermatitis (eczema)?

What are general skin care measures for tx?

Answer 7

IgE

Avoid irritants (bathing, soap, washcloths)
Stay moisturized
Cotton is less irritating than other clothing

Question 8

What are topical treatments of atopic dermatitis?

Answer 8

Steroids
Tacrolimus and pimecrolimus

*Antihistamines can also be used (including doxepine in severe disease)

Question 9

What are topical treatments for local psoriasis?

Answer 9

Steroids
Vitamin A and vitamin D ointment
Coal tar preparation
Tacorlimus and pimecrolimus on more delicate areas

Question 10

What is treatment for extensive psoriasis?

Answer 10

UV light
Anti-TNF drugs (e.g. etanercept, adalimumab, and inflliximab)
Methotrexate

Question 11

Patient presents with a single lesion which disseminates but spares the palms and soles. What is the likely dx?

Answer 11

Pityriasis Rosea

The single lesion was the Herald patch which can spread to form a “Christmas tree” like rash distribution

Question 12

What is tx of Pityriasis roasea?

Answer 12

Usually remits on own but UV light and steroids can be used

Question 13

What agents are helpful for seborrheic dermatitis (aka dandruff)?

Answer 13

Topical steroids and topical antifungals (e.g. ketocanzole)

These are helpful bc it is a hypersensitivity reaction to dermal infection with noninvasive dermatophytes

Question 14

What common drug is associated with pemphigus vulgaris?

Answer 14

ACEi

Also penicillin, phenobarbital, and penicillamine

Question 15

What disease presents with blisters which easily rupture, oral involvement, and fluid loss and infection?

What is Nikolsky sign (positive in this condition)?

Answer 15

Pemphigus vulgaris

Nikolsky sign: removal of superficial layer os skin with slight pressure

Question 16

What is treatment of pemphigus vulgaris?

Answer 16

Systemic steroids (prednisone)
Azathioprine or mycophenolate to wean patients off steroids
Rituximab or IVIG in refractory cases

Question 17

What disease presents with tense bullae?

What is the best initial therapy?

Mild disease responds to what other meds?

Answer 17

Bullous pemphigoid

Prednisone

Mild: Erythromycin, dapsone, and nicotinamide

Question 18

Porphyrea cutanea tarda leads to blistering of the hands and feet. What two conditions is it associated with?

Answer 18

HCV

Hemochromatosis (iron overload)

Question 19

Porphyrea cutanea tarda is a deficiency of what enzymes activity and what builds up?

What are underlying causes (environmental; 2)?
What procedural treatment helps?

Answer 19

Uroporphyrin decarboxylase defect leading to increased uroporphyrins (detected in urine)

Estrogen and alcohol
Phlebotomy to remove iron

Question 20

Impetigo due to community-acquired MRSA can be treated with what agents (3)?

Answer 20

Doxycycline
Clindamycin
TMP/SMX

Question 21

Skin infections with group A Strep (i.e. Strep pyogenes) can have what harmful sequela?

Answer 21

Post-strep glomerulonephritis

NOT rheumatic fever

Question 22

What is a more severe disease, impetigo or erysipelas?

Which more commonly has a leukocytosis?

Answer 22

Erysipelas is more severe since deeper involvement and more likely to have fever and leukocytosis

(More commonly due to Strep)

Question 23

Place the following in order of size (from small to large)

Carbuncle
Folliculitis
Furuncle

Answer 23

Folliculitis

Question 24

Generally what is the best initial test for detecting fungal infection?

What is the most accurate test?

Answer 24

Initial: KOH

Accurate: Fungal culture

Question 25

What is a major side effect of ketoconazole?

Answer 25

Antiandrogenic (gynecomastia)

Question 26

What is the best initial therapy for tinea capitis (hair) and tinea unguium (nail)?

Answer 26

Terbinafine | Itraconazole close in efficacy

Question 27

What are drugs which commonly cause hypersensitivity reactions? (6)

Answer 27

``` Penicillin Sulfas NSAIDs Lamotrigine Phenytoin Allopurinol ```

Question 28

Erythema multiforme can be a precursor to more severe infections like Stevens-Johnson syndrome. However, what are other pathogenic causes?

Answer 28

Herpes or Mycoplasma

Question 29

Sloughing off of epithelium and mucous membrane involvement is due to ______. What is tx?

Answer 29

Stevens-Johnson syndrome IVIG (Steroids are NOT helpful)

Question 30

Toxic shock syndrome (TSS) and Staph scalded skin syndrome (SSSS) are both caused by _____. What is tx?

Answer 30

Staphyloccous Oxacillin or nafcillin if sensitive

Question 31

What is the order of drug treatment for acne based on severity?

Answer 31

``` Topical benzoyl peroxide topical clindamycin/erythromycin topical vitamin A derivatives (e.g. tretinoin) oral antibiotics oral vitamin A/isotretinoin. ```

Question 32

What type of biopsy is recommended in melanoma?

Answer 32

Full thickness bx