Step 2 Dit: Derm (Combined)

Front 1

what vaccines should be avoided in HIV px

Back 1

varicella zoster
intranasal influenza
oral polio
yellow fever
BCG
anthrax
oral typhoid
small pox

Front 2

what is the Rx for TTP

Back 2

large-volume plasmaphoresis

steroids

Front 3

iron, ferritin, transferrin, & TIBC:
Fe-Def Anemia

Back 3

IRON: decr'd
FERRITIN: decr'd
TRANSFERRIN: incr'd
TIBC: < 12%

Front 4

iron, ferritin, transferrin, & TIBC:
anemia of chronic ds

Back 4

IRON: decr'd
FERRITIN: incr'd
TRANSFERRIN: decr'd
TIBC: > 18%

Front 5

what are the characteristics of necrotizing fascitis

Back 5

unexplained excruciating pain beyond areas of infection

erythema with blistering/bullae

crepitus

DM'c pt with foot cellulitis & signs of systemic toxicity

Front 6

what is the general rx for necrotizing fasciitis

Back 6

IMMEDIATE EXTENSIVE SURGICAL DEBRIDEMENT

ANTIBIOTICS:
Empiric polymicrobial: imipenem +/- vanco
If clostridia: PCN G + clindamycin
If streptococci: PCN G +/- clindamycin

IVF's/DOPAMINE (for shock, if present)

Front 7

Rx for dry gangrene

Back 7

allow auto-amputation

Front 8

Rx for wet gangrene

Back 8

debridement or amputation

antibiotics (if cellulitis or gas gangrene)

Front 9

Dx & Rx
diabetic px with foot ulcer that smells very bad; pus drains from it and crepitus is felt; px is febrile & tachycardic

Back 9

Dx: wet gangrene with possible septic shock

emergent surgical exploration and debridement

possible amputation

Front 10

Rx for impetigo (uncomplicated)

Back 10

wash area

remove crust

topical antibiotic (e.g. mupirocin)

Front 11

glomerular disease a/w:
IF: granular pattern of immune complex deposition

Back 11

PSGN

Front 12

glomerular disease a/w:
LM: hypercellular glomeruli

Back 12

PSGN

Front 13

glomerular disease a/w:
IF: linear pattern immune complex deposition

Back 13

good pasture

Front 14

glomerular disease a/w:
EM: loss of epithelial foot process

Back 14

minimal change

Front 15

glomerular disease a/w:
EM: subendothelial humps & tram tracks appearnace

Back 15

MPGN

Front 16

glomerular disease a/w:
nephritis, deafness, cataracts

Back 16

alports

Front 17

glomerular disease a/w:
purpura on back of arms and legs, abdominal pain and IgA nephropathy

Back 17

HSP

Front 18

glomerular disease a/w:
anti dsDNA

Back 18

SLE

Front 19

dx & next step:
px with very painful irreducible inguinal mass

Back 19

dx: incarcerated hernia

tx: surgical resection

Front 20

what is the cause of aplastic anemia with thumb abnormalities, diffuse hypo or hyperpigmentation, cafe au lait spots and short stature

Back 20

fanconi anemia

Front 21

what acne Rx is a/w photosensitivity

Back 21

tetracyclines

Front 22

what organism causes acne

Back 22

propionibacterium acnes

Front 23

Rx options for acne

Back 23

topical retinoid
benzoyl peroxide
topical or oral antibiotics
OCP's
spironolactone
isotretinoin

Front 24

what SE of oral isotretinoin

Back 24

drying of skin & mucous membranes
incr'd TG's & hepatotoxicity
teratogenic
depression & suicidal ideation
pseudotumor cerebri (with concomitant tetracyclines)

Front 25

what should be avoided in a px with rosacea

Back 25

hot/spicy drinks/foods
alcohol, caffeine
exercise
extreme emotions
irritating skin products

Front 26

Rx for rosacea

Back 26

TOPICAL:
sulfacetamide
metronidazole cream/gel

SYSTEMIC:
tetracycline
doxycycline
minocycline
isotrentinoin/Accutane

RHINOPHYMA:
laser therapy

Front 27

what skin pathology is a/w teardrop vesicles

Back 27

varicella

Front 28

what time frame should varicella be treated

Back 28

first 72 hours

Front 29

when should acyclovir be used in varicella

Back 29

older than 12 y/o
household contacts
h/o chronic cutaneous or cardiopulmonary d/o's
those using inhaled steroids
those using chronic salicylates

Front 30

Rx for postherpetic neuralgia

Back 30

gabapentin
pregabalin
TCA
lidocaine patches (cut in shape of dermatome)
capsaicin cream

Front 31

what can be used to diagnose herpes reactivation

Back 31

tzanck smear
viral culture
serology (for antibodies)

Front 32

Rx for zoster

Back 32

ANTIVIRAL:
acyclovir
valacyclovir
famcyclovir

+ OPIODS (for analgesic)

Front 33

condition a/w auer rods

Back 33

AML

Front 34

when should confidentiality not be protected

Back 34

confidentiality waived by pt
homicidal/suicidal
contagious disease
child/elder neglect/abuse

Front 35

x ray finding a/w croup

Back 35

steeple sign

Front 36

x ray finding a/w epiglititis

Back 36

thumb print sign

Front 37

HPV types a/w skin warts

Back 37

HPV Types 1-4

Front 38

HPV types a/w genital warts but NOT a/w cervical cancer

Back 38

HPV Types 6 & 11

Front 39

HPV types a/w genital warts AND a/w cervical cancer

Back 39

HPV Types 16 & 18

Front 40

what is the first line Rx for condyloma acuminata

Back 40

trichloroacetic acid (TCA)

Front 41

characteristic features of tinea versicolor

Back 41

salmon color or white hypopigmented macules

lesions do not tan

KOH: hyphae and spores (spaghetti and meatballs)

Front 42

what is the appearance of molluscum contagiosum

Back 42

small (< 5mm) shiny papule with central umbilication;
usually flesh-colored

Front 43

Rx for tinea capitis

Back 43

griseofulvin
terbinafine
itraconazole

Front 44

Dx
42 yo diabetic woman with pruritis rash underneath her breasts

Back 44

Dx: intertrigo (candida infection)

KOH: pseudohyphae

Front 45

Rx for scabies

Back 45

permethrin

Front 46

Rx for pediculosis capitis (i.e. lice)

Back 46

permethrin cream
pyrethrin cream
malathion lotion

Front 47

what is malathion toxicity look like

Back 47

cholinergic symptoms

Front 48

what organism causes small areas of hypopigmentation that are more noticeable during the summer

Back 48

tinea versicolor (i.e. malassezia furfur)

Front 49

Rx for whipples disease

Back 49

TMP/SMX x 1 year

Front 50

complications of electrical burns

Back 50

cardiac dysrhythmias
neurological disturbances
myoglobinurea -> renal failure
bony injuries

compartment syndrome

Front 51

difference b/w alzheimer, picks, & lewy body dementia

Back 51

alzheimer = dementia

picks = dementia with personality changes

lewy body = dementia + parkinsonian sx's + visual hallucinations + falls/syncopal episodes

Front 52

Rx for seborrheic dermatitis (cradle cap)

Back 52

selenium sulfide (i.e. Selsun Blue)

olive oil
(massaging into cap helps remove scale when washing)

hydrocortisone 1% cream

Front 53

what Rx can cause erythema multiforme

Back 53

PCN's
sulfanamides
anticonvulsants
NSAIDs
OCP's

Front 54

difference between erythema multiforme, SJS, & TEN

Back 54

ERYTHEMA MULTIFORME:
milder
NO skin sloughing
usually no mucous membrane involvement
EM Major (severe form) always involves mucous membranes --> can become SJS

STEVENS-JOHNSON SYNDROME (SJS):
skin sloughing < 10% BSA
mucous membrane involvement

TOXIC EPIDERMAL NECROLYSIS (TEN):
skin sloughing > 30% BSA
mucous membrane involvement

Front 55

classic presentation of pityriasis rosea; what is tx

Back 55

single herald patch -->

christmas tree pattern (several days later)

Tx: self-limited

Front 56

pt populations a/w increase likelihood of lichen planus

Back 56

YOUNG PT'S: HIV

OLDER PTS: hep C

Front 57

classic presentation of lichen planus

Back 57

SKIN INVOVLEMENT:
pruritic purple polygonal papules and plaques
found on flexor surfaces of the extremities;
Wickham Striea on surface of papules plaques

MUCOUS MEMBRANE INVOLVEMENT:
Wickham Striea in lateral buccal mucosa;
erosive lesions (may become infected w/Candida)

GENITAL INVOLVEMENT:
usually limited to violaceous papules on the glans penis (men) and vulva (women)

Front 58

what are Wickham Striae

Back 58

white, lace-like pattern on the surface of papules/plaques &/or lateral buccal mucosa of Lichen Planus pt's

Front 59

Rx for lichen planus

Back 59

corticosteroids

acitretin (an oral retinoid)

Front 60

classic presentation of erythema nodosum

Back 60

pretibial nodules within subQ fat

painful & erythematous

Front 61

what is pathology & possible etiologies of erythema nodosum

Back 61

PATHOLOGY:
inflammation of SubQ fat spetea

POSSIBLE ETIOLOGIES = "SPIT BUDS"
S = streptococcal infection
P = pregnancy
I = IBS
T = TB

B = behcet's disease
U = unknown (idiopathic)
D = drugs
S = sarcoidoisis

Front 62

Rx for pityriasis rosea

Back 62

not necessary; self-limited in 4 - 6 wks

sunlight helps

Front 63

Rx for psoriasis

Back 63

topical steroids

calcipotriene
(Vit D3 analog - inhibits epidermal cell proliferation)

tazarotene
(topical retinoid - normalizes keratinocyte prolif)

coal tar (suppresses DNA synthesis)

anthralin

salicylic acid

UV light therapy

soriatane (isotretinoin)

steroid injections into lesions

alpha-TNF agents

oral retinoids, methotrexate, & cyclosporine

Front 64

before rx'ing any TNF-a agents, what must be done first & why

Back 64

PPD test

TNF-a agents (e.g. Enbrel) can reactivate latent TB

Front 65

why are oral steroids NEVER given to pt's with psoriasis

Back 65

Once oral steroids are d/c'd, psoriasis will come back with a vengeance

Front 66

Compare seborrheic dermatitis vs seborrheic keratosis vs actinic keratosis

Back 66

SEBORRHEIC DERMATITIS:
child: erythema & scaling of scalp (aka cradle cap)
adult: erythema & scaling in areas of sebaceous glands (brows, nasaolabial folds, face, external ear, scalp, upper trunk, body folds)
Tx: selsun blue, olive oil, hydorocortisone 1% cream

SEBORRHEIC KERATOSIS:
benign
"stuck-on" appearance
no tx necessary

ACTINIC KERATOSIS:
malignant (can progress to Sq Cell Cancer)
Tx: 5-FU or imiquimod +/- cryotherapy

Front 67

what are stages of decubitus ulcers

Back 67

STAGE I:
pressure related alteration of intact skin
(e.g. change in color, consistency, sensation, or temp)

STAGE II:
superficial ulcer, abrasion, or shallow crater

STAGE III:
full thickness skin loss w/damage to subQ tissues; deep crater

STAGE IV:
extensive destruction or necrosis;
damage to muscle, bone, or supporting structures

Front 68

sign & assoc'd disease:
deep palpitation of RUQ --> arrest of inspiration due to pain

Back 68

murphy's sign/cholecystitis

Front 69

sign & assoc'd disease:
fever, jaundic, RUQ pain, hypotension, AMS

Back 69

reynold's pentat/cholangitis

Front 70

sign & assoc'd disease:
RLQ pain on passive estension of the hip

Back 70

psoas sign/appendicitis

Front 71

sign & assoc'd disease:
RLQ pain on passive inetrnal rotation of flexed hip

Back 71

obturator sign/appendicitis

Front 72

sign & assoc'd disease:
LUQ pain and referred to left shoulder

Back 72

kehr's sign/splenic rupture

Front 73

sign & assoc'd disease:
ecchymosis of skin overlying the flank

Back 73

grey turner's sign/pancreatitis

Front 74

sign & assoc'd disease:
ecchymosis of skin overlying the periumbilical area

Back 74

cullen's sign/pancreatitis

Front 75

Rx for RSV brochiolitis

Back 75

albuterol

racemic epinephrine

supplemental O2

Front 76

whats becks triad & with what pathology is it assoc'd

Back 76

hypotension
distant heart sounds
distended neck veins

a/w cardiac tamponade

Front 77

classic appearance of porphyria cutanea tarda

Back 77

chronic blistering on sun-exposed areas
hypertrichosis
hyperpigmentation

a/w alcoholism and hep C

Front 78

compare pemphigus vulgaris vs bullous pemphigoid

Back 78

PEMPHIGUS VULGARIS:
nikolsky sign POS
flaccid bullae
oral lesions present (almost always)
anti-desmosome AB's
(epidermal adhesion molecules)

Tx: high-dose systemic steroids; tx wounds as burns
Px: poor; fatal if untx'd

BULLOUS PEMPHIGOID:
nikolsky sign NEG
tense bullae
oral lesions rarely present
anti-hemidesmosome AB's
(dermal-epidermal junction adhesion molecules)

Tx: topical steroids (e.g. clobetasol cream)
Px: better than VP

Front 79

type of melanoma a/w:
MC type of melanoma

Back 79

superficial spreading melanoma

Front 80

type of melanoma a/w:
non-pigmented melanoma

Back 80

amelanotic melanoma

Front 81

type of melanoma a/w:
dark papule on legs or trunk that bleeds with minor trauma

Back 81

nodular melanoma

Front 82

type of melanoma a/w:
palms, soles, or beneath nail plate in px with dark skin

Back 82

acral lentiginous melanoma

Front 83

type of melanoma a/w:
dark lesion larger than 6mm with irregular asymmetric borders

Back 83

superficial spreading melanoma

Front 84

most important prognostic feature of melanoma

Back 84

depth of lesion

Front 85

classic appearance of basal cell carcinoma

Back 85

pearly papule

with telangiectasia

and rolled edges (if ulcerated)

Front 86

classic appearance of squamous cell cancer

Back 86

papule or ulcer

scaling or keratinization

irregular or disordered appearance

either painless or painful

Front 87

Skin cancers likely to metastasize (melanoma vs SqCC vs BCC) & which is them MC type of skin cancer

Back 87

Melenoma >>

Sq Cell Carcinoma >>

Basal Cell Carcinoma (MC type of skin cancer)

Front 88

What type of biopsy should be performed for skin cancer (melanoma vs SqCC vs BCC)

Back 88

SqCC: shave bx

BCC: shave bx

Melanoma: punch/excisional bx
(depth matters: > 0.76 mm = incr'd risk of mets)

Front 89

next step in px with testicular torsion confirmed with an ultrasound

Back 89

manual detorsion

surgical detorsion

bilateral testicular orchioplexy

Front 90

what are causes of hypovolemic hyponatremia

Back 90

hypovolemic hyponatremia = prerenal hyponatremia

diuretics (esp TZD's)
Addison's (salt-wasting)
fluid loss + excessive free-water intake

Front 91

Dx
fever, rash, elevated Cr and eosinophilia

Back 91

acute interstitial nephritis (AIN)

aka allergic interstitial nephritis

aka drug-induced interstitial nephritis

Front 92

dermatologic condition a/w:
obesity, diabetes and malignancy (esp if > 50 y/o)

Back 92

acanthosis nigricans

Front 93

dermatologic condition a/w:
pigmented plaques that appear to be "stuck on" skin

Back 93

seborrheic keratosis

Front 94

dermatologic condition a/w:
black velvety plaques on flexors and intertriginous areas

Back 94

acanthosis nigricans

Front 95

dermatologic condition a/w:
rough lesions in sun exposed area, easier to feel than see

Back 95

actinic keratosis

Front 96

dermatologic condition a/w:
circular rash with central clearing on trunk or arms

Back 96

tinea corporis

Front 97

what endocrine test should be ordered in a 31 yo woman with patches of hypopigmentation on her skin

Back 97

Dx: vitiligo (a/w thyroid disease)

Lab: TSH

Front 98

type of hemangioma:
purple red lesion that does not regress with age

Back 98

port wine stain

Front 99

type of hemangioma:
infant with bright-red lesions that regress over months-years

Back 99

strawberry hemangioma

Front 100

type of hemangioma:
benign small red papule that appears on skin with age

Back 100

cherry hemangioma

Front 101

type of hemangioma:
benign small red papule with radiating blanching vessels

Back 101

spider angioma

Front 102

type of hemangioma:
blue (or red) compressible mass that does not regress

Back 102

cavernous hemangioma

Front 103

type of hemangioma:
red-pink nodule on a child that is often confused with melanoma

Back 103

spitz nevus

Front 104

rx for a newborn with an uncomplicated strawberry hemangioma on the face

Back 104

reassurance (to parents)

observation

Front 105

Rx for androgenic alopecia (i.e. excess Testosterone
--> male-pattern baldness)

Back 105

MEN: finasteride +/- minoxidil

WOMEN: minoxidil +/- spironolactone

Front 106

when are infantile hemangiomas (i.e. strawberry hemangiomas) worrisome;
how are they treated

Back 106

WORRISOME IF:
periorbital
in the airway
a/w high-ouput heart failure

TX: systemic steroids

Front 107

clinical features of alopecia areata

Back 107

asymptomatic, inflammatory, non-scarring areas of complete hair loss

may be precipitated by stress

Front 108

what is tx for alopecia areata

Back 108

Fluocinolone oil &/or shampoo

intralesional steroid injection

topical minoxidil

Anthralin cream

Front 109

what is another name for stress-related hair loss; what is Tx

Back 109

aka Telogen Effluvium

Tx: reassurance (self-resolving)