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Internal Medicine

Bullous pemphigoid, Pemphigus vulgaris 1. Gold standard for diagnosis 2. Treatment 1. biopsy 2. systemic glucocorticoid (prednisone)
1. Adult presenting with nonhealing blisters on the backs of the hands and the face. Sun seems to make it worse. 2. Diagnosis 3. What key findings are likely to be in the patients history? 4. Treatment 1. porphyria cutanea tarda 2. urinary uroporphyrins 3. HIV, alcoholism, chronic hep C, oral contraceptive use 4. stop drinking alcohol and d/c estrogens
Age difference of pemphigus vulgaris vs bullous pemphigoid? 1. PV = 30s and 40s 2. BP = 70s and 80s
1. intercellular deposits of IgG in the epidermis 2. antibodies at the dermo-epidermal junction 1. pemphigus vulgaris 2. bullous pemphigoid
Pressure on the skin resulting in localized urticaria dermatographism
1. Patient with a rash after starting penicillin. 2. What is the pathophysiology? 3. Treatment 1. urticaria 2. mediated by IgE and mast cell activation 3. H1 antihistamines
1. Patient has small, target-like lesions on palms and soles 2. Usually caused by what virus? 3. Treatment 2. What 1. Erythema multiforme 2. herpes simplex 3. antihistamines and treat underlying infection
Which drugs are known to cause hypersensitivity skin disorders? 1. NSAIDs 2. penicillins 3. sulfa drugs 4. phenytoin 5. phenobarbital
What is the difference between Stevens-Johnson syndrome and Toxic epidermal necrolysis? SJS involves <10 to 15% of the total body surface area while TEN may involve 30-100%
Multiple painful, red, raised nodules on the anterior surface of the lower extremities. Erythema nodosum
How are fungal skin infections confirmed? by scraping fungal material onto a slide and dissolving other material with KOH
Treatment for: 1. Tinea capitis 2. Onychomycosis 3. Tinea versicolor 1. PO terbinafine or itraconazole 2. PO terbinafine or itraconazole 3. topical seleneum sulfide and ketoconazole shampoo
Adverse reaction for oral: 1. terbinafine 2. ketoconazole 1. hepatotoxicity 2. gynecomastia, hepatotoxicity
1. Child with crusty,rash oozing material. 2. Why do you see this presentation on the skin? 3. Treatment 1. impetigo 2. it is superficial, limited to the epidermis, and purulent material easily escapes through the surface 3. mupirocin
1. Man with bright red rash on face, fever. 2. Treatment 1. erysipelas 2. cephalexin, dicloxacillin and attempt blood culture
Patient presents with redness, swelling, warmth and tenderness under the skin of her leg. cellulitis
Treatment of cellulitis 1. po cephalexin, dicloxacillin 2. if fever, hypotension or signs of sepsis then iv oxacillin, nafcillin or cefazolin 3. also attempt blood culture
Treatment of necrotizing fasciitis 1. ampicillin/sulbactam (unasyn) or piperacillin/tazobactam (zosyn) 2. clindmycin and penicillin if definitely streptococcus 3. ultimately surgical debridement is necessary
Patient presents with crepitus, pain, high fever and an entry wound. What is the next step in management? surgical debridement
1. Multiple, painful vesicles on the genitals 2. Initial treatment 3. Treatment of resistant strain 1. herpes simplex 2. oral valcyclovir 3. foscarnet
1. Vesicles in a dermatomal distribution on an erythematous base. 2. Treatment 1. Herpes zoster 2. oral valcyclovir
1. Patient presents with single, pailess, ulcerating lesions on the genitals 2. Confirmation 3. Treatment 1. chancre from primary syphilis 2. darkfield examination 3. single dose if intramuscular penicillin or doxycycline for those allergic
1. What is the causative agent of lice and crabs? 2. Treatment? 1. P humanus and P pubis 2. permethrin and OTC pyrethrins
1. Causative agent of lyme disease 2. Treatment 1. borrelia burgdorferi 2. oral doxycycline
Which disorders may manifest with the Nikolsky sign (3)? 1. pemphigus vulgaris 2. staphylococcal scalded skin syndrome 3. toxic epidermal necrolysis
Treatment for scalded skin syndrome? 1. managed in a burn unit 2. oxacillin or other antistaphylococcal antibiotics
1. Purplish lesions on the skin of an HIV patient 2. What is the best treatment? 1. Kaposi sarcoma 2. raise the CD4+ count;
1. Autoimmune disease in which antibodies attack the hair follicles and destroy hair production 2. Treatment 1. Alopecia areata 2. majority resolves spontaneously but immediate localized steroid injection may prevent loss
Loss of hair in response to overwhelming physiologic stres Telogen effluvium
Where does the rash of secondary syphilis present? palms and soles of the feet
Treatment for: 1. mild acne 2. moderate acne 3. severe acne 1. topical antibiotics and benzoyl peroxide 2. benzoyl peroxide and retinoids 3. oral antibiotics, oral isotretinoin
Treatment of toxic shock syndrome 1. fluid resuscitation 2. empiric treatment with clindamycin plus vancomycin
1. Velvety hyperpigmentation on patient's axillary region. 2. Most common causes? 1. acanthosis nigricans 2. hyperinsulinism or GI malignancy
1. Patient with generalized itching and pruritic vesicles and pustules in the webs of the hands 2. Treatment 1. scabies 2. permethrin
Patient with a large rash on the back, spares the palms and soles and one large spot is visible. pityriasis rosea
Patient with a large rash on the back and covers the palms and soles. secondary syphilis
Young patient with a very itchy rash. atopic dermatitis
Topical infection, scraped with KOH and looks like spagnetti and meatballs under microscope. Tinea Versicolor



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