PANCE/PANRE Study Guide Book

Question 1

Papule

Answer 1

raised, solid < 10 mm

Question 2

Nodule

Answer 2

Raised, solid > 10mm

Question 3

macule

Answer 3

Flat < 10mm

Question 4

Patch

Answer 4

flat > 10mm

Question 5

Plaque

Answer 5

plateau like > 10mm

Question 6

Vesicle-

Answer 6

Raised, contains serous fluid < 5mm

Question 7

raised, contains serous fluid > 5 mm

Answer 7

raised, contains serous fluid > 5 mm

Question 8

Pustule-

.

Answer 8

raised, contains purulent material

Question 9

Wheal-

Answer 9

elevated lesion from local edema, transient

Question 10

Crust-

Answer 10

hard surface, dried sebum, exudates, blood, necrotic skin

Question 11

Scale

Answer 11

horny epithelium with dry appearance

Question 12

Erosion

Answer 12

defect of epidermis (non scarring)

Question 13

Ulcer

Answer 13

defect of dermis or deeper (scarring)

Question 14

Types of Dermatitis

Answer 14

Contact Dermatitis, Atopic Dermatitis, Nummular Eczema, Seborrheic Dermatitis, Perioral dermatitis

Question 15

Treatment for dermatitis

Answer 15

Avoid offending agent. Burrow’s solution (aluminum acetate), topical steroids, zinc oxide (diaper rash)

Question 16

atopic dermatitis presentation

Answer 16

Pruritic papules and plaques

Question 17

atopic dermatitis etiology

Answer 17

IgE, type 1 hypersensitivity

Question 18

Nummular Eczema

Answer 18

coin Shaped/ discoid plaques

Question 19

SEBORRHEIC DERMATITIS

Answer 19

Cradle Cap: 
Erythematous/yellow, scaly crusted lesions.  
Location:  Infants- scalp. 
Adults/puberty- body folds.
Treatment: Ketoconazole shampoo

Question 20

Lichen planus:

Answer 20

5 P’s: purple, papule, polygonal, pruritis, planar Wickham striae
Treatment: Topical steroids

Question 21

Pityriasis rosea:

.

Answer 21

• Herald patch: Large oval plaque with central clearing and scaly border. 1st sign
• Pruritic erythematous plaque with central scale in —Christmas tree pattern on the trunk
• The disease is self-limiting

Question 22

Psoriasis:

Answer 22

Erythematous plaque with silver scaling on extensor surfaces
Types:
Psoriasis Vulgaris- most common.
Guttate- children. After URI. Small lesions
Inverse- intertriginous areas.
Pustular- contains pustules
Signs:
Auspitz sign (bleeds when scale is picked)
Koebner’s phenomenon (minor trauma causes new
lesion)
Treatment: Topical steriods.

Question 23

Erythema multiforme:

Answer 23

Causes: HSV, sulfa drugs

Target lesions on hands, feet and mucosa Treatment: Avoid trigger

Question 24

Steven Johnson syndrome/ Toxic epidermal necrolysis:

.

Answer 24

SJS is 3-10% of body, TEN is > 30% of body
Causes: drug reaction- most often sulfa drugs. Also other
antibiotics, anti-epileptics
Prodrome, then morbiliform lesions, blisters, necrotic
epidermis, Nikolsky sign (pushing blister causes further
separation from dermis)
Diagnosis: Biopsy- shows necrotic epithelium
Treatment: Treat underlying cause and supportive (burn
unit)

Question 25

Acne vulgaris

Answer 25

Open comedones (black heads), closed comodones (white heads), papules, pustules, nodules or cysts Treatment: Most acne- topical retinoids Cystic acne- tetracyclines then oral retinoids- isotretinoin (causes dry lips, liver damage, pregnancy category X)

Question 26

Rosacea:

Answer 26

Women aged 30-50 Facial erythema, telangiectasias, papules Triggers: heat, alcohol, spicy foods Treatment: metronidazole topical

Question 27

Actinic keratosis:

Answer 27

Presentation: Flesh-colored/pink/yellow-brown lesion with rough sandpaper feel at sun-exposed areas May progress to squamous cell carcinoma Treatment: Cryotherapy, electrodesiccation

Question 28

Seborrheic keratosis:

Answer 28

Brown-black stuck on waxy plaques | Treatment: Unnecessary. Excise for cosmetics

Question 29

Lice (Pediculosis):

Answer 29

Presentation: Pruritic scalp, body or groin. | Nits are observed as small white specs on hair shaft Treatment: Permethrin

Question 30

Scabies:

Answer 30

Presentation: Pruritic papules. S shaped or linear burrows on skin. Often in web spaces. Diagnosis: microscropic observation of mite, egg or feces after skin scrape Treatment: Permethrin

Question 31

Spider bites:

Answer 31

Brown recluse- necrotic wound | Black widow- neurologic manifestation (muscle ache, spasm, rigidity)

Question 32

Basal cell carcinoma:

Answer 32

Raised pearly borders, telangiectasis, central ulcer (Rodent ulcer) Treatment: Excise with clear margins

Question 33

Squamous cell carcinoma:

Answer 33

Hyperkeratotic macule, scaling | Treatment: Excise with clear margins

Question 34

Melanoma:

Answer 34

``` ABCDE: Asymmetry, Border is irregular, Color variability (blue, red, white), Diameter (> 6 mm), Evolution ```

Question 35

Kaposi sarcoma:

Answer 35

Violaceous papular lesions associated with AIDs Caused by Human Herpes Virus 8

Question 36

Alopecia:

Answer 36

Alopeica areata- oval shaped well demarcated hair loss Autoimmune cause. Treatment: Clobetasol Adrogenetic alopecia (male pattern baldness)- top of head Telogen effluvium- Diffuse hair loss Occurs after stress, illness, medication. Self limiting Traction alopecia- tight hairstyles

Question 37

Onychomycosis:

Answer 37

Thick, yellow, brittle nails | Treatment: Oral terbinafine

Question 38

Paronychia:

Answer 38

Inflammation around nail. Organism: Staphylococcus sp Treatment: Warm soaks, drain visible pus, anti-staph antibiotic

Question 39

Condyloma acuminatum (genital warts):

Answer 39

Cause: HPV (Types 6 and 11) | Flesh colored, cauliflower appearance

Question 40

Exanthems:

Answer 40

Measles(Rubeola) Measles virus. Koplik spots (grains of sand on erythematous base), cough, coryza. Caudocephalic spread of maculopapular rash Rubella (German Measles) Rubella virus. 3 days. Caudocephalic spread of maculopapular rash. Lymphadenopathy. Teratogenic in pregnancy (worst outcomes in first trimester) Roseola Human Herpes Virus 6 or 7.  Fever, then subsequent macular rash beginning on trunk. Erythema Infectiousum / Fifth disease Parvovirus B19. Slapped cheek with lace-like rash Hand-foot-mouth: Coxksackie virus. children <10 years old with vesicles on pharynx, mouth, hands, feet

Question 41

Herpes Simplex:.

Answer 41

Presentation: Grouped vesicles on erythematous base.

Question 42

Molluscum contagiosum:

Answer 42

Poxvirus | Pearly papule with umbilicated center

Question 43

Varicella zoster virus:

Answer 43

Chicken pox- Dew drop on rose petal Shingles- Pain precedes rash in dermatomal pattern Hutchinson’s sign- lesion on nose.  Concern for eye involvment

Question 44

Verrucae:

Answer 44

Cause: HPV Verruca vulgaris- skin colored papillomatous papules. Hands Verruca plana- flat warts. Face, arms, legs Plantar warts- bottom of foot. Rough surface. Dark spot (thrombosed capillaries)

Question 45

Cellulitis:

Answer 45

Warm erythematous tender skin with induration or fluctuance | Organism: Staphylococcus aureus is most common Treatment: Dicloxacillin

Question 46

Erysipelas:

Answer 46

Distinct sharp, raised, demarcated border, more superficial than cellulitis.  Fever, chills. Organism: Group A strep Treatment: Dicloxacillin

Question 47

Impetigo:

Answer 47

Organism: Staphylococcus aureus is most common Nonbullous- Honey colored crusts around nose and mouth. Bullous- thin walled vesicles Treatment: Mupriocin ointment

Question 48

Candidiasis:

Answer 48

Presentation: Beefy red plaques with satellite lesions Location: Groin in infants, under breast folds in adults Treatment: Nystatin cream.  Ketoconazole for failure

Question 49

Dermatophyte:

Answer 49

Tinea pedis (foot), tinea cruris (groin), tinea corporis (body), tinea barbae (beard area), tinea capitis (head) Organism: Trichophyton Annular erythematous patch with scaly borders and central clearing. Pruritis. KOH prep: Segmented hyphea and spores Treatment: Topical ketoconazole Tinea versicolor: Organism: Malassexia furfur Presentation: Hypo or hyper pigmented macules on upper trunk. KOH prep: Curved hyphea and spores/spaghetti and meatballs Treatment: ketoconazole shampoo