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Derm USMLE
| Question | Answer |
|---|---|
| describe pityriasis rosea symptoms, orgnaism | HHV7; herald patch (often ring shaped or oval, scaly), then 1 wk later many itchy lesions on back that follow Langerhan's skin lines (Christmas tree appearance) |
| describe molloscum contagiosum, organism, bx, tx | waxy papules w central depression (umbilicated), organism: poxvirus, bx: inclusion bodies; tx: freezing or currettage |
| seborrheic dermatits describe skin findings | hyperpigment, lichenification, scaling in areas of oily skin, ie eyebrows, nasolabial fold, midchest, scalp **can be severe in AIDs pts |
| what can cause large regions of skin desquamation? | TEN, SSSS, graft v host |
| differentiate TEN and SSSS | TEN (toxic epidermyl necrolysis): usu adults and result of Rx (sulfonamides, allopurinol, phenytoin, carbamazepine); SSSS (Staph scalded-skin syndrome)=children, infxs; use bx to know for sure |
| Rx that can cause TEN | sulfonamides, allopurinol, phenytoin, carbamazepine |
| bx TEN v SSSS | TEN: full thickness epidermis damage (SSSS: superficial) |
| tx TEN | same as for burns, skin coverage, maintain fluids and electrolytes |
| MC cause erythema multiforme | HSV infx of lip (also Rx and mycoplasma) |
| erythema marginatum | Rheum F |
| erythema nodosum | pretibial, painful, assoc UC, sarcoid |
| erythema multiforme | target lesion seen in HSV and Rx reaction (ie sulfa, PCN) |
| erythema migrans | bull's eye w central clearing, seen in Lymes |
| list some causes of rash (incl 4 erythemas) | erythema infectiosum ( slapped-cheek parvovirus B19); Roseola (HHV6) hi F, stops then rash; Rheum F (erythema marginum); erythema nodosum; typhus (trunk rash); RMSF, syph, coxsackie, eryth multiform (palm/sole rash); vasculitides (HSP); Lyme, |
| erythema infectiosum | slapped-cheek --starts on cheek and proceeds to trunk and extremities ((caused by parvovirus B19)) |
| dzs w blisters | pemphigous, dermatitis herpetiformism, graft v host |
| compare pemphigus vulgaris and bullous pemphigoid blisters, dz severity | pemphigus vulgaris: intraepidermal, blisters tear-severe dz; bullous pemphigoid: blisters below epidermis, don't tear |
| Abs in 2 pemphigus dzs | pemphigus vulgaris: Ab to desmoglein so intraepidermal blisters that tear-severe dz ( acantholysis on bx); bullous pemphigoid: Ab to hemidesmosomes, blisters below epidermis, don't tear |
| compare pemphigus vulgaris and bullous pemphigoid involvement mucous mem | pemphigus vulgaris: yes; bullous pemphigoid: no |
| which HPV assoc with squamous malignancies | HPV 16, 18 |
| appearance genital warts, tx | cauliflower papule or nodule; tx: podophyllin, trichloroacetic acid, imiquimod, 5FU **on cervix monitor cytology/histology for malignancy |
| Rx for acne | start with benzoyl peroxide, then topical clindamycin or oral tetracycline or erthromycin (tx Propionibacterium acnes); then topical tretinoin (retin-A), LAST isotretinoin (Accutane) |
| SE Isotretinoin (Accutane) | teratogen, transient incrsd chol, TGA, LFTs and maybe depression |
| tinea versicolor, organism, tx | small scaly patches of difft colors that can be hypopigment (don't confuse w vitliigo); organism: pityrosporum orbiculare; tx: topical selenium sulfide or topical imidazoles |
| vitiligo, describe, assoc | unknown origin, depigmented patches of skin, assoc: autoimmune dzs like pernicious anemia, Addison, often have Abs to melanin and decrsd melanocytes |
| aka warts | verrucae |
| aka mole | nevocellular nevus |
| herpetitiformis dermatitis, describe, assoc | intensely pruritc vesicles on extensors of elbows and knees, assoc celiac sprue (tx: avoid gluten) |
| describe lichen planus; assoc, tx | 4Ps: pruritic, purple polygonal papules; assoc: Rx and Hep C; tx: topical steroids and anti his |
| tx lice: head, body, pubic, | head: pyrethrin (RID) and remove nits, body: wash clothes&bedding, pubic: pyrethrin |
| scabies describe presentation, organism, tx | intensely pruritic (esp at night), sarcoptes scabiei, mites burrow can see track and excoriated papules; tx permethrin or oral ivermectin (but pruritis will remain 2 wks after tx) **treat contacts |
| 3 types of gangrene and causes | dry: ischemia, wet: bacterial usu skin flora, gas: C perfringens |
| tx gas gangrene | hyperbaric oxygen (since C perfringens is anaerobic) **this is an emergency |
| acanthosis nigricans, describe, assoc, tx | hyperpigment, hyperkeratotic velvety in intertriginous zones (incl axillary), assoc with insulin resistance, obesity, and underlying adenocarcinoma (often GI); tx: topical steroid or retinoid, lose weight |
| rosacea, describe, tx | looks like acne in middle aged ppl, often w rhinophyma (bulbous red nose), tx: topical metronidazole |
| seborrheic keratosis | **if appear suddenly could be paraneoplastic; brown, warty papules appear stuck on, bx: hyperplasia of benign, basaloid epidermal cells |
| actinic keratosis, tx | precursor of squamous cell carcinoma; caused by light; tx cryosurgery or 5FU |
| squamos cell carcinoma, cause, px, grading, tx | 2nd most common (basal cell MC), can metastasize, arise from actinic keratoses; graded histologically; tx: excise |
| basal cell carcinoma, describe, px, grading, tx | most common, slow growing but won't met, appear in sun-exposed areas; tx options excision, incl Moh's surgery, superficial radiation (cure >95%) |
| melanoma, cause, px, grading, tx | cause: short intense sun, congenital dysplastic nevi, px most determined by depth of lesion, may met; grading by Clark's levels; tx: excision |
| lesion characteristics suggestive of melanoma | irregular color, contour/border, nodule and ulcer formation, diam >6mm, changes in these charact noted by pt or Dr., and pruritis |
| classic progression of melanoma lesion | start as shiny papule, enlarges and develops umbilicated center that gets peripheral telangiectasias |
| type of skin cancer seen in African Americans | acrolentiginous |
| Kaposi's sarcoma | vascular prolifer HHV8, **most common HIV associated malignancy, tx palliative |
| mycosis fungoides, aka, suspect when, stages | cutaneous T-Cell lymphoma, slow progression of T cells, stage I: patchy, plaque like, stage II: skin tumors, multicentric, reddish |
| cerebriform nuclei | characteristic of mycosis fungoides |
| common Rx that can cause Steven-Johnson syndrome | sulfa, PCN, Phenytoin, phenobarb, allopurinol, carbamzepine, cephalo, quinolones |
| describe S-J syndrome | morbillform rash that coalesces full thickness blistering, can have skin detach and involves eye/mouth |
| differentiate bw TEN and S-J syndrome | if <10%BSA=S-J, if >30%=TEN |
| tx bullous pemphigoid and pemphigous vulgaris | systemic steroids +/- other immunosuppress (ie azathioprine) |
| what are the dermatophytes? | microsporum, trichophyton, epidemiophyton |
| what dzs do dermatophytes cause? | tineas pedis and cruris (athlete's foot and jock's itch), tinea corporis, tinea capitis (ringworm, scalp caling) |
| how identify dermatophytes? | KOH preparation |
| what organism causes tinea versicolor? | pityrosporum orbiculare (yeast) |
| subtypes of basal cell cancer | nodular (MC, pearly nodule w telangiectasia), ulcerated, sclerosing (scarred area), superficial, pigmented (melanocytes), nevus syndrome (AD dz mltpl BCC from childhood, jaw cysts, CNS tumors) |
| subtypes of SCC | nodular (often w central ulceration), exophytic (friable, bleeds easily from Bowen's dz--intraepithelial form SCC), verrucous (resembles wart on mucus mem and plantar), SCC w cutaneous horn |
| MC cause of death from skin cancer is which type | melanoma |
| what % of melanoma arise from nevi | 50% |
| Staging clark's levels and TMN for skin cancer | Staging: I=epidermis, II=into derm, III=fill derm, IV=into reticular derm, V=into subQ fat; TMN: 1=no local/regional met, II=local/regional met; III=distant met |
| types of melanoma | superficial spreading (70%), nodular 15-30%, lentigo maligna, acral lentiginous |
| describe superficial spreading melanoma | mostly flat, variegated color w indistinct border, often back on men and legs of women, middle aged |
| describe nodular melanoma | discrete nodule, uniform, blueberry like, arises rapidly, no radial growth phase |
| describe lentigo maligna melanoma | arises in a lentigo maligna (melanoma in situ, blue/black color, usu pretty large, flat geographic shape) that develops a nodule, usus elderly face/neck/scalp |
| describe acral lentiginous melanoma | MC in dark skinned (Asian, AA), variegation of brown/black; often sole of foot |
| stages of decubitus ulcers | 1=nonblanching erythema, 2=partial thick loss, 3=into subQ, 4=into mscl, jt |
| Auspitz sign | bldg capillary when scale of psoriasis is removed |
| types of psoriasis | chronic/guttate (MC), pustular (intraepithelial PMN) |
| tx psoriasis (3) | topical steroids, calciopotriene (vit D derivative), tars (Smelly) |
| % of pts w psoriasis that get arthritis | 10% |
| mechanism of psoriasis | hyperproliferation of epidermal cells so they don't have time to keratinize properly **note: NOT pruritic |
| characteristics of psoriasis | non pruritic plaques on extensors, nail pitting and lifting of nailbed, |
| cause of leprosy | Mycobac leprae |
| tx leprosy | rifampacine + dapsone 6mos if 1-5 lesions, if >5lesion rifampicine, clofazimine,& dapson for 12 mos |
Created by:
ehstephns
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