random

Question 1

paraneoplastic pemphigus

Answer 1

very rare, a/w malignancy, severe PV like mucus membrane lesions with dusky center like EM, Rapidly progressing. tx: find malignancy and treat

Question 2

bp presentation

Answer 2

early prodrome, itchy non bullous rash, tense large bullae form bilaterally, symmetrical on flexural surfaces, heals with milia

Question 3

mucous membrane pemphigoid

Answer 3

rare, 40-60 years old, chronic progressive and usually scars, painful mucosa erosions, tense blisters, sore throat, conjunctivitis. if severe or ocular need systemic rituximab and prednisone, ENT, gastro, optho consult.

Question 4

MMF cellcept

Answer 4

immunosuppression, slow onset 2-3 mo, off label for inflam skin conditions, 500mg nightly to reduce GI distress and then slowly weekly increase in 500mg increments, mycophenolate rems teratogenic in 1st trimester for childbearing females

Question 5

Azathioprine (Imuran)

Answer 5

immunosuppression, antiinflammatory, off label for AIBD. TPMT thiopurinemethyltranserase to measure activity in the RBCs, if low level do not use, if intermediate can start low at 1mg a day, if high start normal dose of 2-2.5mg/kg/day

Question 6

pemphigoid genstationis

Answer 6

urticarial plaques and papules, vesicles, ocurrs in 2nd and 3rd trimsters, in belly button, associated with graves and thyroid, risk to fetus low birth weight, preterm, can have blisters, can occur in future pregnancy and menses and OCPs

Question 7

polymorphous eruption of pregnancy

Answer 7

urticarial papules, late in 3rd, spares belly button, starts in striae, due to weight gain, no risk to fetus, resolves and 2 weeks after delivery and wont recur

Question 8

DH presentation

Answer 8

intensely itchy, extensor surfaces, excoriations and papulovesicular, clustered and herpetiform, symmetrical, 8-12 hour prodrome burning before vesicles form. dx- need a dIF to show granular deposition of IgA autoantibodies to epidermal transflutaminase. screen- thyroid disease, family members, gi consult

Question 9

DH mgmt

Answer 9

life long gluten free to control skin and gut and decrease lymphoma, no grains like wheat, barley, rye, spelt. Iodine and NSAIDs can induce eruptions. ROCs are OK. Dapsone.

Question 10

Dapsone

Answer 10

myeloperoxidase enzyme inhibition for DH, off label for other AIBD, vasculitis. G6PD. increases with sulfa, mtx, chloroquine

Question 11

hemolytic anemia in dapsone

Answer 11

can occur around 12 weeks, rbc and retic count drop,

Question 12

methemolobinemia in dapsone

Answer 12

ha, fatigue, weakness, cyanosis, pale, s/s hypoxia

Question 13

linear IgA

Answer 13

linear deposition of IgA in BMZ, antibodies to type 7 collagen, symptoms similar to BP, annular arcuate, may or may not look like MMF. Tx - dapsone

Question 14

epidermolysis bullosa acquisita

Answer 14

20-30s, 80-90s, associated with chrons and SLE - screen. trauma induced bullae on hands, feet, fingers, toes, heals with mila and scarring, no mucus membranes need punch with DIF. tx dapsone, topical steroids. avoid trauma

Question 15

ACLE

Answer 15

butterfly rash, patches and plaques, may be bullous or discound or erosions, waxes and wanes, photodistributed, duration: hours to days. risk of SLE > 90%. Multisystem, patients are sick. >90 percent progress to SLE

Question 16

Subacute cutaneous LE

Answer 16

annular, polycyclic with central clearing, psoriasiform, persistent with flares, photodistrib NOT usually below waist, <50 Percent progress to SLE, limited and less severe than ACLE

Question 17

first line for SLE

Answer 17

hydrocychloroquine or chloroquine - decreased efficacy in smokers, refer to rheum

Question 18

first line for skin only

Answer 18

class 2 and 3 TCS, intermittent to butterfly, TCIs, antimalarials

Question 19

hair with lupus

Answer 19

alopecia with non scarring, diffuse hair loss, broken frontal “lupus hairs” baby hairs in the frontal scalp

Question 20

hands in lupus

Answer 20

telang, erythema BETWEEN dorsal IPs, dilated capillary loops proximal nail folds

Question 21

DLE

Answer 21

AA, exacerbated by trauma and UVR. Discoid coin shaped thick dark plaques, carpet tack scale penetrating hair follicles, face, scalp, conchal bowl, Dx: h&e, ANA.

Question 22

mgmt. DLE

Answer 22

prevent flares, sun protection, avoid scarring. treat with ILK and high potent topical steroids

Question 23

chilblain lupus/perniosis

Answer 23

chronic, rare. risk for those who are thin, raynauds, in warm climates, PVD. tender itchy erythematous nodules when exposed to cold. dx h&e, cryoglobulins, ANA, anti-RO/SSA

Question 24

mgmt. chilblain lupus

Answer 24

avoid cold, tight clothing, warm extremities, topical CCS,

Question 25

lupus pernio

Answer 25

aka cutaneous sarcoid, acral locations, red yellow apple yellow urticarial papules and nodules, NOT temp induced (like perniosis/chiliblain)

Question 26

mgmt. lupus pernio

Answer 26

h&e, if nose and mouth need pulm eval, CCS

Question 27

antimalarials

Answer 27

hydroxycholorquine, chloroquine, quinacrine HCQ <6.5mg/day, CQ <3.0. Takes 4-6 weeks for effect, can exac pso, blue gray pigment if tx for more than 3 months - reversible. contraindicated in g6pd, MG, don’t use HCQ and CQ together, need eye exam first year at baseline

Question 28

systemic scleroderma

Answer 28

sclerosis of visceral organs and skin, may have CREST (60%), rapid progressive, hardening fixed plaques, stiff hands and feet, raynauds, mgmt. by rheum

Question 29

morphea

Answer 29

localized scleroderma, circumscribed ivory purple plaques that drop off at border can be linear, face

Question 30

morphea mgmt

Answer 30

may burn out and no treatment, stays localized after 5 years, if over joints or cosmetically disfiguring, can do topical or oral CCS, antimalarials, UVB, all off label, maintain function and PT

Question 31

raynauds phenomenon

Answer 31

intermittent vasoconstriction of small artiers, occurs with other CTD (scleroderma, lupus, RA, sjogrens) pale cold numn white blue increased in cold, refer to rhem, monitor for other symptoms of AID

Question 32

sjogrens syndrome

Answer 32

primary - keratoconjunctivitis dry eyes, xerostomia - dry mouth, extraglandular: vasculitis, pruritic, annular erythema, vaginal dryness, refer to rheum, lubricants, avoid heat cant sweat, MMF or prednisone can help

Question 33

DM

Answer 33

inflammation of muscle and skin, muscle weakness, idiopathic/genetic/environmental, children or 50 year olds, UVR exacerbate, risk for malignancy with ovarian cancer

Question 34

polymyositis

Answer 34

no skin symptoms just muscle weakness on both sides of body

Question 35

amyopathic

Answer 35

no muscle symptoms

Question 36

DM clinical presentation

Answer 36

insidious onset of proximal muscle weakness, hair loss non scarring, heliotrope, gottrons papules, periungual erythema and telangiectasias, shawl sign - violet plaques on trunk, photosensitive

Question 37

dx DM

Answer 37

muscle bx CT guided, h&e interface dermatitis

Question 38

gottrons papules

Answer 38

erythema scaling and plaques OVER IP and MCP joints

Question 39

HSV recurrence drugs

Answer 39

A 800 TID 2 DAYS
F 750 BID 1 DAY
V 2 BID 1 DAY

Question 40

HSV PRIMARY

Answer 40

A 400 TID X 7-10 DAYS

V 1GM BID X 10 DAYS

Question 41

hsv suppressive

Answer 41

valtrex 500mg once daily

or A 400mg BID

Question 42

Shingles treatment

Answer 42

A 800 5X A DAY 7 DAYS
F 500 TID 7 DAYS
V 1G TID 7 DAYS