Dermatology First Aid Step 2

Front 1

Name the layers of the epidermis

Back 1

stratum basalis
stratum spinosum
stratum granulosum
stratum corneum

Front 2

dark, thick, velvety plaques under arms, breasts, in groin and on neck. Associated w/ insulin resistance and a predictor of DMII.
Dx?
Rx?

Back 2

Acanthosis Nigricans
Rx. treat underlying disorder (obesity, malignancy, diabetes, cushings, etc.)

Front 3

Enlarging pink or browm macular patches on flexor surfaces. Asymptommatic. Caused by corynebacterium. prevalent in diabetics and warm climates.
Dx?
Rx?

Back 3

Erythrasma diagnosed by Wood's light causing lesions to fluoresce pink.
Rx: topical or oral erythromycin

Front 4

Scaly, pruritic patches and plaques on flexor surfaces and neck. Associated with asthma and allergies and/or a family history.
Dx?
Rx?

Back 4

Eczema
Rx: avoid triggers, use mild soaps, add steroids, tacrolimus, phototherapy or methotrexate as needed

Front 5

presensitized mast cells and basophils bind to antigen and reaction develops rapidly. examples include anaphylaxis, asthma, and local wheal and flare. Type of Reaction?

Back 5

Type I
(anaphylactic and atopic)

Front 6

IgM or IgG bind to antigen leading to lysis by complement or phagocytosis. examples include Rh disease, Goodpasture's syndrome and rheumatic fever. Type of Reaction?

Back 6

Type II (cytotoxic)

Front 7

sensitized T cells encounter antigen and release lymphokines. examples included TB skin test, transplant rejection, contact dermatitis. Type of Reaction?

Back 7

Type IV (delayed,
cell-mediated)

Front 8

antigen antibody complexes activate complement. Examples include serum sickness, SLE, RA, or the arthus reaction. Type of Reaction?

Back 8

Type III

Front 9

large, pruritic, non-painful bullae filled with serous/bloody fluid. rarely involves mucous membranes. negative nikolsky. fluorescence at dermal-epidermal junction. autoantibodies to BP1 and BP2.
Dx?
Rx?

Back 9

Bullous Pemphigoid
Rx: topical or oral steroid

Front 10

shallow, painful blisters on epidermal and mucosal surfaces. autoantibodies to desmocollins and desmogleins. positive nikolsky. intercellular fluorescence and acantholysis. Dx?
Rx?

Back 10

Pemphigus
Rx: oral steroids, plasmaphoresis for severe cases, lesions should be cared for as burns

Front 11

cutaneous disorder d/t drugs, infection, vaccinations, or malignancy. mild myalgias/malaise. raised erythematous plaques on extremities. biopsy shows perivascular lymphocytes and necrotic keratinocytes. Dx?
Rx?

Back 11

Erythema multiforme
Rx: mild cases resolve spontaneously, discontinue inciting agent, acyclovir for HSV

Front 12

painful, erythematous pretibial nodules d/t drug hypersensitivity, infection, sarcoid, rheumatic fever, or IBD. accompanied by fever, rash, and malaise. elevated ESR, positive ASO titer, false positive VRDL. Dx?
Rx?

Back 12

Erythema Nodosum
Rx: treat underlying cause, elevate leg, KI, NSAIDS, corticosteroids

Front 13

polygonal, purple, pruritic papules on inner wrists and lower legs with overlying network of white lines (wickham's striae). induced by drugs and strong association w/ HCV. Bx shows hyperkeratosis.
Dx?
Rx?

Back 13

Lichen Planus
Rx: topical steroids and oral antihistamines, for serious cases can use UV, cyclosporine, oral steroids

Front 14

dark red plaques with scales over extensor surfaces d/t epidermal proliferation. non-pruritic. also nail pitting, and onycholysis. can have joint stiffness in DIP joints. increased ESR & uric acid. Dx?
Rx?

Back 14

Psoriasis
Rx: topical steroids and calcipotriol for mild cases, immunosuppressants and phototherapy for severe dz

Front 15

pruritic, yellowish, greasy, scaling patches seen on scalp, ears and face. Dx?
Rx?

Back 15

seborrheic dermatitis
Rx: hydrocorisone and topical antifungals for face, body and interitriginous areas, medicated shampoos for scalp

Front 16

coalescing red macules and flaccid blisters with full-thickness epidermal loss d/t drug reaction. oral lesions present. + Nikolsky. Dx?
Rx?

Back 16

Dx: SJS <10% Body surface and perivascular mononuclear infiltrate with degeneration of basal layer on bx
TEN >30% BSA, full-thickness epidermal necrosis with macrophages and dendrocytes and reactivity to TNF-alpha
Rx: discontinue offending agent, pain control, IVIG, admit to burn unit

Front 17

areas of depigmentation d/t loss of melanocytes. associated with thyroid disease, pernicious anemia, addison's dz, and DMI. Dx?
Rx?

Back 17

Vitiligo
Rx: artificial tanning creams, steriods, or phototherapy.

Front 18

comedones on face,neck, arms, back, butt. associated with change in androgen levels. Dx?
Rx?

Back 18

Acne Vulgaris
Rx: topical clinda or erythro, benzoyl peroxide and topical retinoids for mild cases, add tetracycline for moderate cases. Isotretinoin for most severe cases.

Front 19

red, hot, swollen, skin lesions d/t infection of subcutaneous tissue. Dx?
Rx?

Back 19

Cellulitis, or folliculitis if hair follicle involved
Rx: oral antibiotics for mild cases. hospitalize cases w/ systemic, hand, or orbital involvement.

Front 20

small, scaling, hyper or hypopigmented macules on chest and back. can be pruritic. spaghetti and meatballs on KOH prep. Dx?
Rx?

Back 20

tinea versicolor caused by Malassezia furfur
Rx: topical antifungal and selenium sulfide shampoo

Front 21

pruritic ring shaped scaling plaques with central clearing and raised borders. hyphae seen on KOH prep. Dx?
Rx?

Back 21

tinea corporis (ringworm)
Rx: topical antifungal. oral antifungals for tinea capitis

Front 22

painful, recurrent vesicular eruptions on erythematous mucocutaneous surfaces. multinucleated giant cells on Tzank smear. Dx? Rx?

Back 22

Herpes Simplex
Rx: acyclovir reduces viral shedding and frequency and severity of recurrences

Front 23

a common, contagious, childhood infection with pruritic facial lesions and yellowish crusts. Dx? Rx?

Back 23

impetigo
Rx: wash with mild soap, topical mupirocin for coag(+) S.aureus, systemic abx for other staph/strep species

Front 24

2-5mm dome shaped papules with central umbilication. asymptommatic. seen on face trunk and extremities in kids and genitals and perianal area in adults. inclusion bodies on wrights and giemsa stain. Dx? Rx?

Back 24

Molluscum contagiosum d/t poxvirus infx.
Rx: resolve spontaneously over months to years. can be removed by cryotherapy, curettage, or TCA application

Front 25

rapidly developing skin and fascia infection with swelling, tenderness, induration or bullae with pain and fever. Dx? Rx?

Back 25

necrotizing faciitis caused by Group A Strep, C.perfringens, or mixed bacteria
Rx: emergent surgery to remove necrotic tissue, culture tissue and treat w/ abx.

Front 26

mild childhood dz presents with diffuse pruritic round/oval erythematous papules convered w/ "cigarette paper" white scale. Christmas tree pattern on trunk and a solitary patch precedes the rash(herald patch). Dx? Rx?

Back 26

Pityriasis Rosea associated with HHV-6 infx
Rx: self limited dz, can treat pruritis

Front 27

itching worse at night and after hot showers, papules and vesicles can be seen. skin scraping reveals mites or eggs with KOH. Dx? Rx?

Back 27

Scabies (Sarcoptes scabiei)
Rx: permethrin cream, treat close contacts as well.

Front 28

painful, unilateral, vesicular eruptions in a dermatomal distribution. Dx? Rx?

Back 28

varicella zoster
Rx: antivirals w/in 72 hours of lesions

Front 29

white, sharply demarcated confluent macules, papules, and plaques usually in anogenital area of postmenopausal women. may be pruritic and painful. Bx shows hyperkeratotic epidermis. Dx? Rx?

Back 29

lichen sclerosus
Rx: short term high potency glucocorticoids or hydrochloroquine

Front 30

thickened areas of skin(shagreen patches), hypopigmentation(ash leaf spots), red papules around nose(angiofibromas), seizures, mental retardation, periventricular tubers.
Dx?

Back 30

Tuberous sclerosis

Front 31

Cafe-au-lait spots, neurofibromas, axillary freckling, acoustic neuromas, lisch nodules, optic nerve glioma, meningiomas. Dx?

Back 31

neurofibromatosis

Front 32

Port wine stain on face (over distribution of V1), seizures, mental retardation, visual impairment. Dx?

Back 32

Sturge-Weber syndrome

Front 33

hemangiomas, retinal hamartomas, renal cell cancer, pheo, polycythemia. Dx?

Back 33

von Hippel-Lindau

Front 34

brown, stuck on appearance on face, trunk, upper extremity. uniform appearance over entire surface. Dx? Rx?

Back 34

Seborrheic keratosis
Rx: no treatment necessary, but can be removed for cosmetic purposes

Front 35

bleeding or scabbing sore on head or neck or pearly papules of variable size. associated with sun exposure. Bx shows basophilic cells palisading. Dx? Rx?

Back 35

Basal Cell Carcinoma
Rx: dependent upon location curettage, surgical excision, Moh's, cryosurgery or radiation

Front 36

asymptommatic, rough papule with poorly demarcated base and white superficial scaling. premalignant. caused by sun exposure. Bx dysplastic squamous epithelium. Dx? Rx?

Back 36

Actinic keratosis
Rx: cryosurgery, 5-FU, curettage or chemical peel.

Front 37

red-purple thin plaques on skin and mucosa. almost always seen in AIDS pts. Dx? Rx?

Back 37

Kaposi's Sarcoma (d/t HHV-8)
Rx: Antiretrovirals for HIV, chemotherapy for lesions

Front 38

changing pigmented skin lesion found on sun-exposed areas and soles of feet that can be itchy. Characterized by asymmetry, irregular borders, various colors, and >6mm diameter. Bx shows melanocytes with atypia, and melanocytic invasion into the dermis. Dx? Rx?

Back 38

Melanoma
Rx: surgical excision and lymph node dissection may be necessary. Stage determined by depth of invasion (Breslow stage)

Front 39

thin scaling patches in sun-protected areas that progress to plaques to nodules to tumors. associated with "lion-like" facies and intractable pruritis.
Bx shows infiltrate of atypical T-lymphocytes in the dermis. Dx? Rx?

Back 39

Mycosis Fungoides
Rx: PUVA, topical nitrogen mustard, high potency topical steroids, total electron beam irradiation

Front 40

small papules, erythema, and telangiectasias in a symmetric distribution on cheeks chin and forehead. Flushing worsened by heat, spicy food, alcohol, caffeine, and sun. Dx? Rx?

Back 40

Rosacea
Rx: avoid precipitating factors, topical metronidazole, sulfur lotions, or oral tetracycline are options

Front 41

What is rhinophyma?

Back 41

large porous lobulated nose that can develop in men with Rosacea