PANCE Prep- Derm

Question 1

What do the following describe?

1. Macule
2. Papule
3. Plaque
4. Vesicle
5. Bulla
6. Wheal
7. Pustule
8. Petechaie
9. Nodule
10. Patch

Answer 1

1. Macule: flat nonpalpable <10mm
2. Papule: solid, raised <5mm
3. Plaque: raised, flat-topped lesion >10mm
4. Vesicle: circumscribed, elevated fluid-filled <5mm
5. Bulla: circumscribed, elevated fluid-filled >5mm
6. Wheal: transient, elevated lesion (local edema)
7. Pustule: pus-filled vesicle or bulla
8. Petechaie: small punctate hemorhages that DONT blanch
9. Nodule: solid, raised >5mm
10. Patch: flat, nonpalpable >10mm

Question 2

Clinical Manifestation:

1. Smooth discrete circular patches of complete hair loss that develops over a period of weeks
2. Exclamation point hairs- short hairs broken off a few mm from the scalp at the margins of the patches with tapering near the proximal hair shaft
3. Nail pitting or fissuring

Answer 2

Alopecia areata *commonly associated w/ other autoimmune disorders (thyroid, Addison’s disease, etc) *non-scarring immune mediated hair loss targeting the anagen hair follicles

Question 3

Management of alopecia areata

Answer 3

if Local: inralesional corticosteroids

if extensive: topical corticosteroids

*may be observed if mild

**Relapse is common

Question 4

Clinical Manifestations:

Varying degrees of hair thinning and nonscarring hair loss MC affecting the temporal scalp, midfront scalp or vertex area of scalp

Answer 4

Androgenetic alopecia

Question 5

Management of androgenetic alopecia

Answer 5

1. Minoxidil
2. Oral Finasteride (5-alpha- reductase inhibitor) –> androgen inhibitor which inhibits the conversion of testosterone to DHT

Question 6

SE of finesteride

Answer 6

5-alpha-reductase inhibitor (androgen inhibitors)

1. Decreased libido or sexual function
2. ED

Question 7

Diagnose

Answer 7

Androgenetic Alopecia

Question 8

Diagnose

Answer 8

Alopecia Areata

Question 9

What is the atopic triad? and its pathophysiology

Answer 9

1. Eczema
2. Allergic rhinitis
3. Asthma

**Starts in childhood

Type 1 Hypersensitivity, IgE mediated: Altered immune reaction in genetically susceptible people when exposed to certain tiggers–> T cell mediated immune activation and increase IgE production

Question 10

Clinical Manifestations:

1. Prurtic, erythematous, ill defined blisters/papules/plaques –> later dries, crusts over and scales
2. +/- dermatographism (localized development of hives when the skin is stroked)

Answer 10

Atopic dermatits aka eczema

Question 11

Where is Eczema most commonly found

Answer 11

flexor creases (antecubital and popliteal folds)

-Starts on face in infancy and then spreads to extremities w/ age

Question 12

Treatment/plan for atopic dermatitis (eczema)

Answer 12

1. topical corticosteroids for 14 days (steroid before moisturizer)
2. antihistamines for itching (diphenhydrame, hydroxyzine)
3. Daily skin hydration w/ emollients: Eucerin or Aquaphor
4. Short baths a few times a week
5. Educate: Avoid irritants (soaps, detergents, freq. baths, perspiratoin, heat), Chronic condition
6. If infected: oral cephalexin or topical mupirocin x 7 days

Question 13

Diagnose

Answer 13

Atopic Dermatitis (Eczema)

Question 14

Clinical Manifestations:

Sharply defined discoid/coin-shaped* lesion especially on the dorsum of the hands, feet, and extensor surfaces (knees, elbows)

Answer 14

Nummular eczema

Question 15

Diagnose:

Answer 15

Nummular Eczema

*sharply defined discoid/coin-shaped lesions on dorsum of hands, feet, and extensor surfaces (knees, elbows)

Question 16

Treatment/Plan for contact dermatitis

Answer 16

1. Avoid irritants
2. Topical Corticosteroid

Question 17

Describe and diagnose

Answer 17

Contact dermatitis (diaper rash) with possible candidiasis satellite lesions

erythematous macular rash along the skin folds where the diaper rubs, with possible annular satellite lesions

Question 18

Treatment/Plan for diaper rash

Answer 18

1. Frequent diaper changes
2. hydrocortisone 1% cream or a diaper rash ointment such as Desitin or A & D.
3. Candida diaper rash (satillite lesions)- Nystatin cream for 7 days

Question 19

Clinical Manifestations:

1. Pruritic “tapioca-like” tense VESCILES* on the soles, palms and fingers (lateral digits)
2. Triggers: sweating, emotional stress, warm and humid weather, metals (nickel)

Answer 19

Dyshidrosis (dyshidrotic eczema) (Pompholyx)

Question 20

Describe/Diagnose and treat

Answer 20

Dyshidrosis (dyshidrotic eczema)- tense VESICLES

1. Topical steroids (med-high) ointment preferred
2. cold compresses

Question 21

Clinical Manifestations:

Scaly, well-demarcated, rough hyperkeratotic plaques w/ exaggerated skin lines*

Answer 21

Lichen Simplex Chronicus (neurodermatitis)

1. skin thickening in pts w/ eczema
2. secondary to repetitive rubbing/scratching- itch/scratch cycle

Question 22

Describe/Diagnose and Treat

Answer 22

Lichen Simplex Chronicus (neurodermatitis)- scaly, well-demarcated rough hyperkeratotic plaques w/ exaggerated skin lines

1. topical steroids (high strength)
2. Educate: Avoid scratching the lesions (can use antihistamines)

Question 23

What are the 5 P’s of Lichen Planus

Answer 23

1. Purple
2. Polygonal
3. Planar
4. Pruritic

. Papules w/ fine scales and irregular borders

Question 24

Describe the clinical manifestations of lichen planus

Answer 24

1. 5 P’s: purple, polygonal, planar, pruritic papules w/ fine scales and irregular borders
2. MC on flexor surfaces of extremities, SKIN, MOUTH, SCALP, GENITALS, NAILS, and mucous membranes
3. +/- Koebner’s phenomenon: new lesions at sites of trauma
4. Wickham Striae***- fibe white lines on the skin lesions or on the oral mucosa, nail dystrophy

Question 25

Describe/Diagnose and Treat

Answer 25

Lichen Planus- purple, polygonal, planar, prurtic papules w/ fine scales and irregualr borders and wickham striae (fine white lines on the skin lesions or on the oral mucosa) 1. Topical corticosteroid 2. antihistamines for itch 3. 2nd line: PO steroids

Question 26

There is an increased incidence of ___ skin rash with hepatitis C

Answer 26

lichen planus

Question 27

Clinical Manifestation: 1. Herald patch\* (solitary salmon-colored macule) on the trunk 2-6cm in diameter--\> general exanthem 1-2 weeks later: smaller, very pruritic 1 cm round/oval salmon colored papules w/ white circulare (collarette) scaling along cleavage lines\* in a christmas tree pattern\* \*Confied to trunk and proximal extremities (face usually spared)

Answer 27

Pityriasis rosea

Question 28

Treatment of Pityriasis rosea

Answer 28

1. NONE NEEDED: Resolves in 6-12 weeks 2. antihistamines, topical corticosteroids for pruritis 3. can mimic syphilis so order RPR if pt is sexually active 4. Educate: generally thought not to be contagious but unknown cause- possibly viral

Question 29

Describe and Diagnose

Answer 29

Pityriasis rosea ## Footnote 1. Herald patch\* (solitary salmon-colored macule) on the trunk 2-6cm in diameter--\> general exanthem 1-2 weeks later: smaller, very pruritic 1 cm round/oval salmon colored PAPULES w/ white circulare (collarette) scaling along cleavage lines\* in a christmas tree pattern\* \*Confied to trunk and proximal extremities (face usually spared)

Question 30

Pathophysiology of Psoriasis: keratin hyperplasia (proliferating cells in the ___ + ___ due to ___ and \_\_\_\_--\> greater epidermal thickenss and increased epidermis turnover)

Answer 30

Stratum basale + stratum spinosum due to T cell activation and cytokine release

Question 31

Clinical Manifestations: 1. raised, dark-red palques/papules w/ thick silver/whilte scales\* MC on extensor surface of elbows, knees, scalp, nape of neck 2. Nail pitting- yellow/brown discoloration under the nail (oil spot\*\*) 3. Auspitz sign- punctate bleeding w/ removal of plaque/scale 4. Koebners phenomenon: new lesions at site of skin trauma

Answer 31

Plaque Psoriasis

Question 32

Describe and diagnose

Answer 32

Plaque Psoriasis: ## Footnote 1. raised, dark-red palques/papules w/ thick silver/whilte scales\* MC on extensor surface of elbows, knees, scalp, nape of neck 2. Nail pitting- yellow/brown discoloration under the nail (oil spot\*\*) 3. Auspitz sign- punctate bleeding w/ removal of plaque/scale 4. Koebners phenomenon: new lesions at site of skin trauma

Question 33

Treatment and Plan for Plaque Psoriasis

Answer 33

1. Mild-mod: topical steroids (high strength)+/- Vit. D analogs (Calcipotriene) 2. Mod-severe: phototherapy (UVB), methotrexate (systemic tx)

Question 34

Describe and diagnose

Answer 34

Guttate psoriasis- small, erythematous PAPULES with fine scales, discrete lesions and confluent papules

Question 35

Clinical Manifestations: 1. hyper/hypopigmented, well-demarcated round/oval MACULES w/ fine scaling. Often coalesce into patches on the trunk, face, extremities 2. The involved skin fails to tan w/ sun exposure

Answer 35

Pityriasis (tinea) versicolor

Question 36

How do you diagnose and treat tinea versicolor?

Answer 36

Dx: 1. KOH prep frob skin scraping: hyphae and spores- "spaghetti and meatball appearance" 2. Wood's lamp: yellow-green fluorescene \*\*Overgrowth of the yeast Malassezia furfur- part of normal skin flora\*\* TX: Topical antifungals: selenium sulfide\*\*, sodium sulfacetamine, "azoles" (itraconazole or fluconazole) if widespread or fail topical tx

Question 37

Describe and diagnose

Answer 37

Tinea Versicolor- hypopigmented, well demarcated round/oval macules with fine scaling

Question 38

Clinical Manifestations: 1. erythematous plaques with fine white scales (MC on scalp) (dandruff), eyelids, beard mustache, nasolabial folds, trunk (chest) and intertriginous regions of the groin

Answer 38

Seborrheic dermatitis | (Aka "cradle cap in infants")

Question 39

Describe/Diagnose and treat

Answer 39

Seborrheic dermatitis 1. Topical selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream) or steroids 2. oral antifungals

Question 40

Acral lentiginous melanoma may occur where?

Answer 40

on the palm, sole, nail bed, or mucus membrane

Question 41

\_\_ is characterized by cough, coryza, and conjunctivitis, along with a fever as a prodrome. Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash

Answer 41

Rubeola (measles)

Question 42

Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash and are pathognomonic for \_\_\_.

Answer 42

rubeola

Question 43

\_\_\_ produces erythematous red tender nodules, especially on the shins.

Answer 43

Erythema nodosum

Question 44

Medications are most frequently implicated in toxic epidermal necrolysis. These usually include:

Answer 44

1. analgesics (NSAIDs), 2. antibiotics (Ampicillin) and 3. anticonvulsants (Carbamazepine)

Question 45

\_\_ is the acquired loss of pigmentation due to the absence of epidermal melanocytes presenting on the back of hands, face, or body folds.

Answer 45

Vitiligo

Question 46

\_\_\_\_ is the treatment of choice for isolated superficial actinic keratosis.

Answer 46

Cryotherapy

Question 47

Multinucleated cells found on Tzanck smear indicate \_\_\_

Answer 47

herpes

Question 49

Ring-shaped lesions with scaly borders and central clearing are most likely caused by ____ which can be diagnosed by \_\_\_\_

Answer 49

- fungal infection - Microscopic examination of scrapings reveals hyphae on KOH prep

Question 50

\_\_ is the most common cause of skin cancer

Answer 50

Basal cell cancer \*usually occurring on sun-exposed areas.

Question 51

\_\_ is one of the major Jones criteria for the diagnosis of acute rheumatic fever

Answer 51

Erythema marginatum

Question 52

People living in warm, tropical climate, people wearing occlusive clothing or shoes, obese patients, and those with hyperhidrosis are at increased risk for ____ which can be diagnosed by \_\_\_\_

Answer 52

- erythrasma - demonstration of a coral red fluorescence.

Question 53

Acetowhitening is used to facilitate the diagnosis of \_\_\_

Answer 53

condyloma acuminata lesions.

Question 54

Potassium hydroxide tests are used to rule out the presence of \_\_\_

Answer 54

dermatophyte (fungal and yeast) infections.

Question 55

Wood's light fluoroscopy is used in the assessment of:

Answer 55

dermatophyte infection and a bacterial infection known as erythrasma.

Question 56

\_\_ is used to kill the scabies mite

Answer 56

Permethrin

Question 57

Telangiectatic vessels are often visible skin findings with \_\_

Answer 57

basal cell carcinoma.

Question 58

\_\_\_ is an acute eruption of fine scaling fawn-colored papules and plaques that are distributed along the cleavage lines of the trunk. A single plaque, called a herald patch, precedes the secondary eruption by 1-2 weeks.

Answer 58

Pityriasis rosea -rash along cleavage lines of trunk is often referred to as a Christmas tree pattern.

Question 59

\_\_ is a common benign plaque in the elderly that characteristically has a velvety or warty surface associated with a stuck on appearance and greasy feel.

Answer 59

Seborrheic keratosis

Question 60

\_\_\_ most commonly are seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders.

Answer 60

Lentigines

Question 61

\_\_ usually present as small patches of flesh-colored, pink or yellow-brown lesions often with an erythematous component. The lesions are better felt than seen, having a rough, sandpaper feel and are often tender to palpation.

Answer 61

Actinic keratosis

Question 62

Wood’s light examination reveals a “milk-white” fluorescence over the lesion.

Answer 62

Vitiligo

Question 63

Those who received a killed MMR virus immunization between __ and __ should receive a live attenuated booster vaccination

Answer 63

1963 and 1967

Question 64

Tx of Molluscum contagiosum

Answer 64

1. mechanical (curettage, laser, or cryotherapy with liquid nitrogen or nitrous oxide cryogun), 2. chemical (trichloroacetic acid, tretinoin), or 3. immunologic (imiquimod)

Question 65

If the area of affected skin of Impetigo is limited, __ is an effective therapy

Answer 65

mupirocin \* topical mupirocin therapy and has been shown to be more effective than the other topical antibiotics (i.e., neomycin, bacitracin, polymyxin B, and gentamicin).

Question 66

Malignant acanthosis nigricans is associated with \_\_

Answer 66

with an intestinal cancer such as gastric carcinoma

Question 67

Describe The Rules of Nines for Burns

Answer 67

1. head and neck, 9%; 2. arm (each), 9%; 3. trunk (anterior), 18% 4. trunk (posterior), 18% 5. leg (each), 18%; 6. genitalia, 1%

Question 68

\_\_ is described as the “mask of pregnancy.”

Answer 68

Melasma, also referred to as chloasma,