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PANCE Dermatology

QuestionAnswer
Classic locations of psoriasis vulgaris? Extensor surfaces: knees, elbows, scalp and nails. Mean age 30yo. Autoiummune etiology due to exo/endogenous stratum corneum damage attracts Ab's->epithelial turnover->hyperplasia and scales.
Demographic of acne rosacea? 30-50yo females (3 females:1 males).
Spread of pemphigus vulgaris? Small vesicles on mouth/nose -> rest of body due to keratinocytes. + Nickolsky sign (blistering when rubbed). 40-60yo. Bullous pemhigoid RARE and has tense bullae.
Etiology of M.furfur? Competitive inhibition of tyrosinase -> melanocyte toxicity from dicarboxylic azalaic acid when in hyphal form (M.furfur from T.versicolor). Tx: selenium sulfide shampoo or po ketoconazole.
Top etiologies of Impetigo contagiosa? S.aureus (bullous vs. non-bullous) >> S.pyogenes (sensitive to PCN). GBS in newborns. Impetitgo can lead to scalded skin syndrome and poststrep glomerulonephritis. Tx for BULLOUS impetigo is po Cephalexin?erythro/Mupirocin (or clox, diclox, and azithro).
Location of dermatitis herpetiformis? Scalp, shoulders, anterior knees/elbows, and small of back.
Location of Lichen Planus? Mouth, anterior forearms, genitalia, small of back and posterior calf.
Location of Seborrheic rashes? Scalp and chin, posterior head/neck/shoulders, sternum, perianal region, groin, umbilicus.
Most common Type IV (delayed) hypersensitivity rxn? Allergic contact dermatitis (mediated by T-lymphocytes). Nickel watches and poison ivy top offenders. Paraphenylenediamine in hair dyes.
In angioedema, with an asthmatic patient, what is most likely to cause skin lesions? ASA. Epi 1st line if hypotensive vs. antihistamines if normotensive. Bactrim does not cause hives, but does caus SJS.
Most common drug used in suicide attempts in US? Acetaminophen (causes liver toxicity).
Actinic keratosis vs. seborrheic keratosis? AK: premalignant for SCC. Rough texture & adherent with POOR BORDERS. Tx 5-FU, cryotx, curretage and excision. Scraping->Auspitz sign. Present in numbers. SK: Waxy pigmented scale, STUCK ON appearance usually TEMPLE and TRUNK with DEFINED BORDERS. NO BX
Volcano-shaped lesion with central keratotic center? Keratoacanthoma.
Most common skin cancer? BCC.
Most metastatic potential of skin cancers? (Malignant) Melanoma.
Classic ulceration at the vermillion border of the lip is what? SCC. p53 mutation. R/O BOWEN DISEASE (indolent SCC eczematous vs. psoriasiform).
Best location for bx of suspected BCC/SCC? Full-thickness bx. at EDGE of lesion for path and staging. Only 1-2MM border for BCC/SCC and 2CM for MELANOMA.
Most common location for dermatofibroma? Redish-brown papule or nodule on legs.
Discoloration, loss of sensation and cyanosis around wound can denote? Necrotizing fasciitis.
Pt. with marked weight loss and otherwise healthy could have what Vitamin deficiency? Vitamin A (oil-soluble vitamins are A,D,E,K) as it supports retinal pigment and epithelial tissues, mucous membranes and adrenal cortex. Vitamin C for collagen, Vitamin E for cell membrane stabilization.
Etiology of Pytiriasis rosea? HHV 7.
Treatment for keloids? Intralesional corticosteroid injection.
Long-duration ester local anesthetic? Tetracaine.
Woods lamp positive disease causing sharply demarcated scaly patches in the genitocurual creases? Erythrasma with "coral red immunoflourescence". Tx Erythromycin 250mg PO QID x7d. Tinea cruris is NOT Woods lamp +.
Order of wound healing? Neutrophils line wound edges w/in 24h -> continuous epithelial cover in 24-48h -> macrophages replace neutrophils as granulation tissue fills in -> fibroblasts create collagen fibers by Day 5. Full healing may take 1 year.
6yo child with ALL develops vesicular rash and sister just recovered from Chicken Pox. What is most serious potential complication? Pneumonia -> IV acyclovir + Ig. NO ASA DUE TO VZV.
Tx. for polymorphous rash, cervical lymphoadenopathy and strawberry tongue? ASA + IV Ig for Kawasaki's Disease.
Use Rule of Nines for over what age? >14yo.
Range of nevi? Dysplastic/melanocytic -> Halo -> Junctional -> Compound -> Intradermal.
Parkland Formula for 1st 24h IV fluid? 4ml/kg x % BSA + 2000mL D5W for maintenance fluid.
Rash that starts on face and spreads "head to toe"? Measles. Esp. if Koplik Spots are mentioned.
Levido reticularis caused by? Vasomotor instability of dermal blood vessels (not confused with Raynound's with venous spasm in saphenous system).
Tx for black widow spider bite? Narcotic analgesic + methocarbamol (muscle relaxant) + calcium gluconate (dec. regidity). Antivenin for very young or elderly.
Best management for AK? Liquid nitrogen/cryosurgery (not curettage). Account for pt's age.
Treatment options for skin infections? po diclox -> IV vanc if MRSA.
Signs of scleroderma (systemic sclerosis)? Telangiectasias, pigment changes, dysphagia, GI dysmotility and pulmonary fibrosis. Raynaud's and polyarthralgias in 90% of pts.
Rx for typical staph or step skin infection? topical Mupirocin for 2w -> po Keflex. NO STEROIDS!
Common offender for a fixed drug eruption? Acetaminophen.
CLASSIC STREP INFECTIONS? (PCNs -> Cephalosporins esp. Cefalexin): otitis media, streptococcal pharyngitis, bone and joint infections, pneumonia, cellulitis, UTIs and prophy for bacterial endocarditis.
CLASSIC STAPH INFECTIONS? (Mupirocin or Diclox->Keflex): Focal: Blepharitis, chalazion, stye & subq abscesses (boils or furuncles) or deep carbuncles->Osteomyelitis, septic arthritis, endocarditis, septicemia, nec. pneumonia. TSS/SS, gastroenteritis Diffuse skin infxns: Impeti
Organism causing 12 yo w/ HYPERKERATOTIC PAPULES on both hands? Simple warts from HPV. Hands and fingers most common for verruca vulgaris.
ANNULARLY shaped lesions in a general dist'n in a teenager is associated with what? DM (granuloma annulare). May be seen in thyroid and SLE affected pts.
2mo old BOTTLE FED infant with sharply defined scaling red facial rash that is unresponsive to hydrocortisone 2.5% ointment that is irratible and has diarrhea? ORDER CBC w/ Zn LEVEL to r/o ZINC DEFICIENCY being only bottle-fed.
4mo old with dry, itchy rash that does not resolve, but only slightly improves, and uses baby wash and lotion but screams when the lotion is applied? Atopic dermatitis (S.AUREUS) from overuse of soaps, cold-dry environments, illness, stress, itchy clothing and allergies. Lotions sting the degraded skin barrier. Improves with warm, humid environments. Use soap-free cleansers and topic steriods.
Swollen and painful, small BUMP on radial dorsum of WRIST with jelly-like consistency? Ganglion cyst from defect in joint capsule or tendon sheath.
Treatment for cold uticaria? Antihistamines -> ebastine.
12yo with palmar surface lesions for less than a week which bleed profusely with minimal provocation thought to be a BUG BITE? Pyogenic granuloma. Starts with minor trauma like a bug bite with collarette scale. Tx is shave excision and ablation of the underlying vessels.
Koplik spots are associated with what viral exanthem? Rubeola...for buccal mucosa. Red (brick) brown rash from face->feet with fever, nasal d/c, conjunctivitis and cough.
Progression of lamellar ichthyosis? Born with a membrane that sheds in a few weeks and replaced with large, gray scales w/o resolution. Fissures on hands and feet common.
Etiology of guttate psoriasis? Group A Strep infection.
Cause of 2 day old with macules and central vesicles and pustules which spare the palms and soles w/o fever? Erythema toxicum. Benign in newborns and resolves spontaneously.
Etiology of finger-sized bruises/yellow-brown macules that urticate when stroked? Urticarial pigmentosa from NSAIDS, temperature extremes, codeine and scopolamine accumulating mast cells
Created by: ed24