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Step III

Step III - Derm 1

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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