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Step III
Step III - Derm 1
| Question | Answer |
|---|---|
| What is the pathophys behind pemphigus vulgaris | Autoimmune attacking intracellular epidermal cells |
| What are the possible etio of pemphigus vulgaris | Idio / penicillamine / ACE (-) |
| Nokolsky’s sign is present in what dzs | pemphigus vulgaris / staph scaled skin / TEN |
| Most accurate test for pemphigus vulgaris | Skin bx |
| What is the best initial tx for pemphigus vulgaris | Steroids eg prednisone |
| Tx for pemphigus vulgaris when initial treatment fails | Azathioprine / mycophenolate / cyclophosphamide |
| Most accurate test for bullous pemphigoid | Skin bx w/ IF Abs |
| What is the best initial tx for bullous pemphigoid | Systemic steroids eg prednisone |
| Tx for bullous pemphigoid after initial tx fails | Erythromycin + nicotinamide OR tetracycline |
| Compare and contrast bullous pemphigoid and pemphigus vulgaris in terms of mouth involvement and age group | PV: 30-40s, mouth involved; BP: 70-80s, no mouth involvement |
| What is known etio of bullous pemphigoid | Drug induced eg sulfa |
| What makes pemphigus foliaceus different from BP and PV | More superficial skin surface |
| What are some causes of pemphigus foliaceus | ACEI and NSAIDs |
| Most accurate test for pemphigus foliaceus | Skin bx |
| What is the best initial tx for pemphigus foliaceus | Steroids |
| Pt has photosensitivity, alcoholic, DM, chr Hep C, hemochromatosis, OCP. Dx | Porphyria cutanea tarda |
| Pt has photosensitivity, non healing blisters on sun exposed areas, facial hypertrichosis, hyperpigmented skin | Porphyria cutanea tarda |
| Diagnostic study for Porphyria cutanea tarda | Urine uroporphyrin (higher than copro in urine) |
| Tx for Porphyria cutanea tarda | Lifestyle changes: stop EtOH, estrogen use; use sunblock, deferoxime to remove iron stores or phlebotomy, chloroquine to (+) excretion of porphyrins |
| MCC urticaria | Meds, insect bites, food, emotion, latex contact |
| MCC chr urticaria | Pressure on skin, cold, vibration |
| What is the best initial tx for urticaria | H1 antihistamine |
| Tx for severe urticaria | Add steroids |
| Chr Tx for urticaria | Non-sedating anti-histamine (Claritin, allegro, etc) |
| Tx for urticaria if trigger can’t be avoided | Desensitization |
| Generalized maculopapular rash that blanches with pressure a/w allergies to certain meds | Morbilliform rash |
| Tx for Morbilliform rash | Anti-histamines |
| Target like lesions found on palms and soles a/w drugs and infection | Erythema multiforme |
| Causes of EM | PCN, phenytoin, NSAIDs, sulfa, herpes simplex, mycoplasma |
| Tx for EM | Anti-histamines OR tx infection |
| Hypersensitivity response that involves mucous membranes, reaction covers <10-15% of body, a/w allergy to drugs, may cause respiratory compromise | SJS |
| Tx for SJS | Nothing has been proven; steroids will NOT work; move pt to burn unit |
| Hypersensitivity response that covers 30-100% of body, drug induced, high mortality, (+) Nikolsky sign | TEN |
| Most accurate test for TEN | Skin bx |
| What type of tx would not help and may actually aggravate TEN | Prophylactic antibx and steroids |
| Pt has dark sharply demarcated spots on body that don’t go away and a/w continued use/exposure of certain drugs | Fixed drug reaction |
| Tx for fixed drug reaction | Topical steroids |
| Painful red raised nodules in LE, tender to palpation, no ulceration, duration ~ 6wks | Erythema nodosum |
| Erythema nodosum is a result of what type of conditions | Secondary to infection or inflammatory conditions |
| Causes of Erythema nodosum | Recent strep, hepatitis, histo, IBD, pregnancy, coccidio, sarcoidosis, syphilis, enteritis (yersinia) |
| Tx for Erythema nodosum | Analgesic, NSAIDs; tx underlying condition |
| What is the best initial tx for fungal infx | KOH |
| Most accurate test for fungal infx | Fungal culture (up to 6wks) |
| In what cases would it be necessary to definitively isolate the fungus | Hair and nails |
| Most efficacious Rx for hair and nail infx | PO terbinafine or itraconazole; nails = 6wks; toes = 12wks |
| If pt is put on terbinafine what do you need to follow and why | LFTs; hepatotoxic |
| Alternative tx for fungal infx less efficacious and longer duration | Griseofulvan 6-12mos |
| AE of systemic use of ketoconazole | Hepatotoxic and gynecomastia |
| PO drugs for bacterial skin infections | Diclox, cephalexin, cefadroxyl |
| IV equivalent of PO drugs for bacterial skin infx | Ox/naf, cefazolin |
| Pts allergic to PCN and have only a RASH can safely use this class of drugs d/t <1% cross reactivity | Cephalosporins |
| Pts allergic to PCN and have ANAPHYLAXIS can safely use these classes of drugs | Macrolides and Fluoroquinolones |
| What is a sequelae of impetigo | Glomerulonephrx |
| What are the two bugs that cause impetigo | Staph and strep pyogenes |
| What skin layer is affected in impetigo | Epidermis only |
| What skin layer is affected in erysipelas | Epidermis and dermis |
| Etio of erysipelas | Strep pyo |
| Fever, chills, bacteremia, bright red angry swollen face | Erysipelas |
| Rx tx for erysipelas | Systemic PO or IV Antbx for strep; PCN G/ampicillin |
| Infection of dermis and SubQ +/- fever, HYPOtn, sepsis | Cellulitis |
Created by:
DrINFJ
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