Step 2 Ck Dermatology

Front 1

what is HAIR-AN syndrome?

Back 1

Acanthosis Nigrans: Velvety hyperpigmentation of the skin associated with insulin resistance,
endocrine disorders
HyperAndrogenism
Insulin Resistance
Acanthosis Nigricans

Front 2

Causes of generalized
hyperpigmentation—

Back 2

“None of the skin is SPARED”
Sunlight
Pregnancy
Addison’s disease
Renal failure
Excess iron
(hemochromatosis)
Drugs (e.g., busulfan)

Front 3

Dx and treatment:
>>Velvety hyperpigmentation of the skin
>>may develop type 2 diabetes, dirty-appearing, prominent skin lines

Back 3

Dx: acanthosis nigrans
Tx: weight reduction for obesity
and insulin resistance or search for occult malignancy.
>>rule out DM.

Front 4

Histology shows hyperkeratosis and proliferation of melanocytes. what should be ruled out and tx

Back 4

Tx: weight reduction for obesity
and insulin resistance or search for occult malignancy.
Dx: acanthosis nigrans

Front 5

Common drugs causing
hyperpigmentation

Back 5

minocycline, amiodarone,
chloroquine, gold,
chlorpromazine, bleomycin,
5-FU, and daunorubicin.

Front 6

>>A slowly enlarging area of pink or brown macular patches is seen,predominantly affecting the flexor surfaces.

Back 6

Erythrasma

Front 7

pathogen that cause erythrasma?
predominant in what group of people?

Back 7

Corynebacterium minutissimum and other corneybacterium species.
predominant in diabetics

Front 8

what would be seen in wood's light and KOH prep in erythrasma?

Back 8

>>Wood’s light causes lesions to fluoresce coral pink or red
>>KOH prep is
-

Front 9

treatment of erythrasma?

Back 9

Rx: Topical or oral erythromycin

Front 10

hypersensitivities

Back 10

Anaphylactic—type I
Cytotoxic—type II
Immune complex—type III
Delayedhypersensitivity— type IV

Front 11

skin disorder characterized by pruritus. Persistent scratching → lichenification

Back 11

Atopic Dermatitis/Eczema

Front 12

allergic triad

Back 12

atopic dermatitis, asthma, and
hay fever

Front 13

Macule

Back 13

Flat area of skin discoloration < 1 cm in diameter.



.
.

Front 14

Papule

Back 14

Elevated area of skin < 1 cm in diameter.

Front 15

Plaque

Back 15

Elevated area of skin > 1 cm in diameter.

Front 16

Nodule

Back 16

Elevated and deep (continues beneath skin) area of skin > 0.5 cm in
diameter.

Front 17

Cyst

Back 17

Nodule containing fluid

Front 18

Vesicle

Back 18

Fluid-containing skin elevation < 0.5 cm in diameter

Front 19

Wheal

Back 19

Transient, pruritic, edematous papule or plaque.

Front 20

Bulla

Back 20

Fluid collection in elevated skin > 0.5 cm in diameter.

Front 21

Pustule

Back 21

Papule containing purulent fluid.



.

Front 22

Petechiae

Back 22

Nonblanching, flat, red/purple lesions caused by thrombocytopenia associated
microhemorrhages.

Front 23

Purpura

Back 23

Visible collection of extravasated RBCs.

Front 24

Telangiectasia

Back 24

Visible dilated capillaries on the surface of the skin.

Front 25

Hyperkeratosis

Back 25

Thickening of the stratum corneum

Front 26

Keloid

Back 26

Scar tissue hypertrophy.

Front 27

Scale

Back 27

Thick, detached areas of stratum corneum.

Front 28

Crust

Back 28

Dried exudate.

Front 29

Excoriation

Back 29

Shallow abrasion caused by scratching.

Front 30

Erosion

Back 30

Loss of epidermis above the basal layer.

Front 31

Ulcer

Back 31

Loss of epidermis and part or all of the dermis.

Front 32

Nevus

Back 32

Benign growth, such as a mole, that is a cluster of melanocytes.

Front 33

atopic dermatitis viral associations

Back 33

impetigo
cellulitis
HSV-1 skin infection (eczema herpeticum)Molluscum contagiosum.

Front 34

Bullous Pemphigoid autoantibodies

Back 34

BP1 and BP2 found in the basement membrane of the skin.

Front 35

tx pemphiguds vulgaris

Back 35

Oral steroids. Patients must continue steroids to prevent recurrence. Immunosuppressants
such as azathioprine can be used to ↓ steroid dose.
■ Severe cases may require plasmapheresis.
■ Lesions should be cared for as burns

Front 36

how is contact dermatitis diagnosed? Tx for mild and severe cases

Back 36

>> skin patch testing.
tx:
■ Mild cases: Cool compresses or oatmeal preparation; topical steroids 3–4 times a day to reduce pruritus.
■ Severe cases: An extended course of systemic corticosteroids may be required;
antihistamines to reduce pruritus

Front 37

recurrent erythema multiforme

Back 37

Think HSV infection with

Front 38

what would an erythema multiforme show on skin biopsy.

Back 38

Skin biopsy shows perivascular lymphocytes (mostly T cells) and necrotic keratinocytes

Front 39

what medication both a precipitating factor and a treatment for erythema nodosum.

Back 39

NSAIDs are both a precipitating factor and a treatment for erythema nodosum.

Front 40

treatment for erythema nodosum

Back 40

Supportive. Elevate leg, bed rest, potassium iodide, NSAIDs.
■ Systemic corticosteroids may be necessary for persistent cases

Front 41

Lichen Planus is associated with?

Back 41

Often induced by drugs and strongly associated with HCV

Front 42

Dx:purple, polygonal pruritic papules with an overlying network of white lines (Wickham’s striae)

Back 42

Lichen Planus

Front 43

treatment Lichen Planus for itch and severe cases.

Back 43

Topical steroids and oral antihistamines to reduce itch; severe cases require cyclosporine, oral prednisone, oral retinoids, and PUVA.

Front 44

Munro microabscesses

Back 44

(neutrophils in stratum corneum) seen in psoriasis

Front 45

psoriasis: mild and severe

Back 45

Topical steroids and topical calcipotriol for mild to moderate disease.
■ Phototherapy (PUVA/UVB) and immunosuppressants such as methotrexate for severe or generalized disease.
■ Biologic agents (e.g., infliximab, etanercept).

Front 46

young person with severe seborrheic dermatitis

Back 46

Suspect HIV

Front 47

what yeast is Seborrheic Dermatitis

Back 47

Pityrosporum yeast.

Front 48

The leading cause of (SJS/TEN)

Back 48

is sepsis from superimposed bacterial skin infections (S. aureus in the early stages; gram-
rods such as Pseudomonas in later stages).

Front 49

SJS skin biopsy:

Back 49

Perivascular mononuclear infiltrate and degeneration of the basal layer.

Front 50

TEN skin biopsy

Back 50

Full-thickness, predominance of macrophages and
dendrocytes and a strong immunoreactivity for TNF-α.

Front 51

tx: SJS/TEN

Back 51

Early diagnosis and elimination of offending agents
Hospitalize in the burn ICU to manage skin and fluid losses.

Front 52

With vitiligo, consider other
autoimmune diseases, name them

Back 52

pernicious anemia, thyroid
disease, Addison’s disease,
and type I DM

Front 53

tx .vitiligo

Back 53

Topical artificial tanning creams, steroid/tretinoin creams, or phototherapy
can be used. Lesions can be refractory

Front 54

what test should be done before administering isotretinoin

Back 54

Isotretinoin is teratogenic, so
women must have pregnancy
testing before and during
therapy.

Front 55

tx for mild moderate acne

Back 55

Mild acne: Topical clindamycin or erythromycin; benzoyl peroxide; topical
retinoids.
■ Moderate acne: The above regimen plus oral antibiotics such as tetracycline.
■ Severe nodulocystic acne: Oral isotretinoin (Accutane

Front 56

tx. for cellulitis/folliculitis

Back 56

For mild to moderate cases, give oral antibiotics (cephalexin or dicloxacillin)
× 7–10 days.
■ Hospitalize and give IV antibiotics in the presence of any signs of systemic
toxicity,

Front 57

Small, scaling, hyper- or hypopigmented macules that tend to enlarge and sometimes coalesce. (“spaghetti and
meatballs” on KOH prep

Back 57

PITYRIASIS VERSICOLOR
treatment topical antifungal agents and selenium sulfide shampoo.

Front 58

tx. for HSV erruptions: decrease viral shedding, recurrenc and have more than 6 out breaks per year

Back 58

Acyclovir ointment reduces the duration of viral shedding
■ Oral or IV acyclovir frequency and severity of recurrences.
■ Daily acyclovir suppressive therapy = > 6 outbreaks per year.

Front 59

Nonbullous impetigo

Back 59

Characterized by superficial pustules with surrounding
erythema.

Front 60

Bullous impetigo

Back 60

Begins as small, erythematous macules → thin-walled vesicles or bullae on an erythematous base. Caused by coagulase- staphylococci that produce exfoliatin, a toxin.

Front 61

lice treatments

Back 61

Permethrin shampoo or cream; decontaminate sources of reinfection such as combs, bed sheets, and clothing.

Front 62

describe scarlet fever

Back 62

Sandpaper-like rash on the trunk; “strawberry” tongue;
circumoral pallor. The rash desquamates after a few .
days.

Front 63

scarlet fever occurs in patients who has untreated disease and how to prevent rheumatic fever

Back 63

Occurs in patients with untreated streptococcal pharyngitis treat with penicillin to prevent rheumatic fever.

Front 64

If you see large molluscum
contagiosum lesions, think of?

Back 64

HIV

Front 65

what is Fournier’s gangrene?

Back 65

is necrotizing fasciitis of the perineal region

Front 66

treatment for necrotising fasciitis

Back 66

■ Surgery to explore deep fascia and muscle and to remove necrotic tissue.
■ Gram stain and culture of tissue to determine appropriate antibiotic therapy

Front 67

Necrotizing Fasciitis

Back 67

rapidly developing infection of skin and fascia that has high mortality without emergent treatment.
>>Caused by group A streptococci, mixed aerobicanaerobic bacteria, or Clostridium perfringens.

Front 68

tx. scabies for puritus, close contacts

Back 68

TREATMENT
■ Treat with 5% permethrin cream; give antihistamines for pruritus.
■ Treat close contacts; wash bedding and clothing to prevent reinfestation.

Front 69

Verrucae (Warts)
Caused by;
Hx/PE:
Rx:

Back 69

■ Caused by HPV.
■ Hx/PE: Usually occurs in older children; commonly found on the hands.
■ Rx: Salicylic acid, liquid nitrogen, curettage.

Front 70

lichen sclerous
cancer risk
diagnosis
tx

Back 70

>>risk of squamous cell carcinoma in rare cases.
>>biopsy shows hyperkeratotic epidermis with follicular plugging, progressing to atrophy
>>Short-term, high-potency topical glucocorticoids or oral hydrochloroquine

Front 71

Tuberous sclerosis
cutaneous manifestation

Back 71

Shagreen patches (thickened areas of skin), ash leaf spots (hypopigmentation), angiofibromas (red papules around the nose).

Front 72

Tuberous sclerosis: non dermatologic symptoms

Back 72

Periventricular tubers, seizures, mental retardation,kidney or heart tumors.

Front 73

Neurofibromatosis cutaneous manifestation

Back 73

Café-au-lait spots, axillary
freckling. scoliosis, seizures.

Front 74

Neurofibromatosis non dermatologic symptoms

Back 74

neurofibromas,Meningiomas, acoustic neuromas, Lisch nodules (iris lesions), optic nerve gliomas, renovascular hypertension,

Front 75

Sturge-Weber syndrome cutaneous manifestation

Back 75

Port-wine stain on the face (hemangioma) over the distribution of CN V1.

Front 76

Sturge-Weber syndrome cutaneous manifestation

Back 76

Seizures, mental retardation, visual impairment.

Front 77

von Hippel–Lindau cutaneous manifestation

Back 77

Hemangiomas.

Front 78

von Hippel–Lindau cutaneous manifestation

Back 78

Retinal vascular hamartomas, renal cell cancer, syndrome pheochromocytomas, polycythemia.

Front 79

When numerous seborrheic
keratoses acutely erupt, Dx

Back 79

“sign of Leser- Trélat” and can be a sign of underlying malignancy (e.g., gastric cancer

Front 80

tx for seboherric dermatitis

Back 80

cryosurgery or curettage for cosmetic purposes

Front 81

tx for basal cell carcinoma

Back 81

curettage, surgical excision, Mohs’ micrographic surgery
(serial excisions with fresh-tissue microscopic examination to maximize
cosmesis), cryosurgery, and radiation.
■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun exposure.

Front 82

tx: actinic keratosis

Back 82

Rx:
■ Cryosurgery, topical 5-FU, curettage, or chemical peel.
■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun
exposure.

Front 83

tx: SCC

Back 83

Rx:
■ Surgical excision, Mohs’ micrographic surgery, or radiation.
■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun
exposure

Front 84

tx. kaposi sarcoma

Back 84

Rx: Antiretrovirals for HIV; chemotherapy for lesions (radiation, intralesional
vinblastine, liquid nitrogen cryotherapy

Front 85

biopsy of kaposi sarcoma

Back 85

proliferation of small vessels and slitlike intercellular spaces with extravasated RBCs.

Front 86

Bx: SCC

Back 86

Biopsy shows irregular masses of anaplastic epidermal cells proliferating down to the dermis

Front 87

Bx: actinic keratosis

Back 87

dysplastic squamous epithelium (hyperkeratosis,
with cells of the lower epidermis showing loss of polarity, pleomorphism,
and hyperchromatic nuclei) without invasion into the dermis

Front 88

Bx: basal cell carcinoma

Back 88

characteristic basophilic cells palisading with retraction

Front 89

Bx: mycosis fungoides

Back 89

Biopsy shows infiltrate of atypical lymphocytes with convoluted cerebriform
nuclei in the upper dermis and microabscesses in the epidermis (Pautrier’s microabscesses).

Front 90

Tx:Mycosis fungoides.

Back 90

PUVA photochemotherapy, topical nitrogen mustard, total-body electron
beam irradiation, ultra-high-potency topical steroids, systemic and topical
retinoids.

Front 91

complication of mycosis fungoides

Back 91

Sézary’s syndrome, secondary sepsis to high grade lymphoma

Front 92

what is rhinophyma?

Back 92

Men can develop (large, porous, lobulated nose) when they have roscea

Front 93

treatment for rosacea

Back 93

■ Avoid precipitating factors.
■ Topical metronidazole, sulfur lotions, and oral tetracycline or isotretinoin are options

Front 94

histology of erythyma multiforme

Back 94

Perivascular T lymphocytes;

Front 95

histology of SJS

Back 95

Perivascular mononuclear cells
with eosinophils in the
papillary dermis; degeneration
of the basal layer; subepidermal
blister formation.

Front 96

histology of TEN

Back 96

Full-thickness, eosinophilic
necrotickeratinocytes.epidermal necrosis; cell-poor infiltrate with predominance of macrophages and dendrocytes; strong immunoreactivity for TNF-α.

Front 97

Location: pemphigous vulgaris vs. bullous pemphigoid

Back 97

PV: Mucous membranes, skin.
BP: Only the skin; usually the arms and
thighs.

Front 98

Autoantibody target: pemphigous vulgaris vs. bullous pemphigoid

Back 98

PV: Desmocollins, desmogleins.
BP: BP1 and BP2

Front 99

Location of Intercellular: pemphigous vulgaris vs. bullous pemphigoid

Back 99

PV: Epidermal-dermal junction.
BP: autoantibodies

Front 100

Location of blister: pemphigous vulgaris vs. bullous pemphigoid

Back 100

PV: Intraepidermal, shallow.
BP: Subepidermal, deep.

Front 101

Nikolsky’s sign: pemphigous vulgaris vs. bullous pemphigoid

Back 101

PV: positive
BP: negative

Front 102

Symptoms: pemphigous vulgaris vs. bullous pemphigoid

Back 102

PV: Painful
BP: Itchy