Section 4: Scaling Disorders and Papulosquamous dermatitis Flashcards Preview

Dermatology USMLE Step 3 > Section 4: Scaling Disorders and Papulosquamous dermatitis > Flashcards

Flashcards in Section 4: Scaling Disorders and Papulosquamous dermatitis Deck (15):
1

Psoriasis

Silvery scales develop on the extensor surfaces. Psoriasis can be local or enormously extensive.

  1. List one common accompaniment
  2. What is Koebner phenomenon?
  3. True or False: All patients should use emollients?
  4. Place of salicylic acid in psoriasis

.

 

 

  1. Nail pitting
  2. Koebner phenomenon is the development of lesions to the site of an epidermal injury
  3. True
  4. Salicylic acid is used to remove heaped up collections of scaly material so the other therapies can make contact

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9072-9084). Kaplan Publishing. Kindle Edition.

2

Psoriasis

  1. List some common emollients used in psoriasis
  2. Rx for localized psoriasis
  3. Rx for severe disease
  4. Long term side effect of topical steroids
  5. Disadvantage of one of the agents used in (3)
  6. Altenative to 2 and 3 above
  7. Examples of (6)

  1. Eucerin, Lubriderm, Aquaphor, and Vaseline or mineral oil.
  2. Topical steroids
  3. Topical steroids, coal tar or anthralin derivatives
  4. Skin atrophy
  5. Coal tar is messy
  6. Topical vitamin D and vitamin A derivatives.
  7. The vitamin D derivative most frequently used is calcipotriene. Tazarotene is a topical vitamin A.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9072-9084). Kaplan Publishing. Kindle Edition.

3

Psoriasis

  1. Rx when > 30 % of BSA is affected
  2. Agent with most rapid way to control extensive disease
  3. Rx of most severe, widespread and progressive psoriasis
  4. Disadvantage of (3)
  5. Newer agents (biological agents)

  1. Ultraviolet light
  2. Ultraviolet light
  3. Methotrexate
  4. High toxicity; liver fibrosis
  5. Immunomodulatory biological agents
    • Alefacept
    • Efalizumab
    • Etanercept
    • Infliximab

4

Xerosis/ Asteatotic Dermatitis

Xerosis and dry skin are managed with humidifiers and emollients

  1. List some examples of emollients
  2. Rx for inflammed skin

  1. Examples of emollients
    • Lubriderm
    • Eucerin
    • Vaseline
    • Dermasil
    • Mineral oil
    • Lac-Hydrin
  2. Topical steroids (can be used briefly)

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9092-9098). Kaplan Publishing. Kindle Edition.

5

Atopic Dermatitis

Features of atopic dermatitis

  •  High IgE levels
  • Red, itchy plaques of the flexor surfaces

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9092-9098). Kaplan Publishing. Kindle Edition.

6

Atopic dermatitis

List the preventive measures

  • Keep the skin moist with emollients,
  • Avoid hot water
  • Avoid drying soaps
  • Use only cotton clothes, because these patients are extremely sensitive to drying

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9099-9120). Kaplan Publishing. Kindle Edition.

7

Atopic dermatitis

Management of active disease

  • Topical steroids
  • Antihistamines
  • Coal tars
  • Phototherapy
  • Antistaphylococcal antibiotics, if there is impetiginization of the skin
  • Topical immunosuppressants, such as tacrolimus and pimecrolimus, can be used to decrease dependence on steroid use
  • Every effort has to be made to avoid scratching
  • The topical tricyclic doxepin can be used to help stop pruritus

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9099-9120). Kaplan Publishing. Kindle Edition.

8

Seborrheic Dermatitis

An oversecretion of sebaceous material, as well as a hypersensitivity reaction to a superficial fungal organism underlies seborrheic dermatitis. These patients present with “dandruff,” which may also occur on the face. Scaly, greasy, flaky skin is found on a red base on the scalp, around the eyebrows, and in the nasolabial fold.

  1. What is the name of the fungal organism?
  2. Rx?

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9099-9120). Kaplan Publishing. Kindle Edition.

  1. Pityrosporum ovale
  2. Rx include:
    • Low-potency topical steroids, such as hydrocortisone
    • Topical antifungal, such as ketoconazole or selenium sulfide
    • Zinc pyrithione used as a shampoo

9

Stasis dermatitis

This is a hyperpigmentation that is built up from hemosiderin in the tissue. It occurs over a long period from venous incompetence of the lower extremities leading to the microscopic extravasation of blood in the dermis.

 

  1. True or False: This condition is reversible
  2. How to prevent progression

  1. False. It cannot be reversed
  2. Elevation of the legs and lower extremity support hose.

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9121-9137). Kaplan Publishing. Kindle Edition.

10

Contact dermatitis is hypersensitivity reaction to certain substances.

  1. List them
  2. What substance is implicated if contact dermatitis present as linear streaked vesicles
  3. Diagnostic test
  4. Rx

 

  1. Hypersensitivity reaction over the area of contact to
    • Soaps
    • Detergents
    • Latex
    • Sunscreens
    • Neomycin 
    • Jewelry
  2. Poison ivy. Diagnostic Testing A definitive diagnosis can be determined with patch testing
  3. Patch testing
  4. Properly identifying and removing the causative agent; antihistamins and topical steroids

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9121-9137). Kaplan Publishing. Kindle Edition.

11

Pityriasis Rosea is a pruritic eruption. It is erythematous and salmon colored and resembles secodary syphilis

  1. How does it begin?
  2. How its rash different from that of secondary syphilis
  3. True or False: VDRL and RPR tests are negative
  4. What is the classic description of its lesion at the back?
  5. Prognosis
  6. Rx of very itchy lesion

  1. “Herald patch” 70– 80 percent of the time
  2. Spares the palms and soles
  3. True
  4. Christmas tree
  5. Mild and self-limited and usually resolves in 8 weeks without scarring
  6. Topical steroids

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9138-9153). Kaplan Publishing. Kindle Edition.

12

Acne

Pustules and cysts occur and rupture, releasing free fatty acids that cause further irritation. The discharge, although purulent, is odorless.

What is the contributing organism?

Propionibacterium acnes

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9138-9153). Kaplan Publishing. Kindle Edition.

13

Acne

Rx of mild disease

  1. Topical antibiotics, such as clindamycin, erythromycin, or sulfacetamide. In addition, the bacteriostatic agent benzoyl peroxide is used.
  2. Topical retinoids are used if these attempts to control the load of bacteria locally are ineffective.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9138-9153). Kaplan Publishing. Kindle Edition.

14

Acne

Rx of moderate disease

Benzoyl peroxide, combined with the retinoids

  • Tazarotene
  • Tretinoin
  • Adapalene

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9149-9162). Kaplan Publishing. Kindle Edition.

15

Acne

  1. Rx of severe disease
  2. Major disadvantage of (1)
  3. Test to do before Rx
  4. Precautionary measure

  1. Oral antibiotics, such as minocycline, tetracycline, clindamycin, and isotretinoin
  2. Oral retinoic acid derivatives are strong teratogens.
  3. Check urine pregnancy test
  4. Should take oral contraceptives if a female of childbearing age

 

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 9149-9162). Kaplan Publishing. Kindle Edition.