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2012-06-26 03:11:11
step II

step II
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  1. Macule v. papule
    • Both under 1 cm
    • A macule is flat
    • A papule is raised
  2. Patch v. plaque
    • Both over 1 cm
    • A patch is flat
    • A plaque is raised
  3. Vesicle v. bulla
    • Both are elevated, fluid filled lesions
    • A vesicle is under 5 mm
    • A bulla is over 5 mm
  4. What is vitiligo?
    Skin depigmentation, associated with AI diseases such as Addison's, pernicious anemia, type I DM, and hypothyroidism
  5. Atopic dermatitis
    • Chronic, allergic-type condition
    • Begins in first year of life
    • Red, itchy skin on head, arms, and trunk
    • Family hx of allergies or asthma
    • Tx with antihistamines and topical steroids
  6. Seborrheic dermatitis
    • Scaling skin on hair areas of the head (scalp, eyebrows, beard), forehead, nasolabial folds, and ears
    • Tx with dandruff shampoo, topical steroids, and/or ketoconazole cream
  7. Annular lesion on body or trunk with well-defined, scaly margins and healing centers
    Tinea corporis (dermatophytosis)
  8. Superficial skin infection that fluoresces under Wood's lamp
    Microsporum sp (trichophyton sp do not fluoresce)
  9. How are fungal infections diagnosed and treated?
    • Dx with KOH prep of skin scraping
    • Treat tinea capitis and onychomycosis with oral antifungals
    • Treat all other fungal infections with topical antifungals (azoles, griseofulvin for severe infections)
  10. How is candidiasis treated?
    • Topical nystatin or azoles
    • Oral nystatin or ketoconazole for severe infection
  11. Visible burrows in the skin in the finger web spaces and flexor surfaces of the wrists
    • Scabies (sarcoptes scabei)
    • Treat with whole body permethrin cream
    • Treat patient + family
  12. Multiple patches of various size and color, typically on the torso, that do not tan with the rest of the skin
    • Tinea versicolor, aka pityriasis versicolor (malassezia furfur)
    • Treat with selenium sulfide or topical azoles
  13. Why is permethrin preferable to lindane for tx of scabies and lice?
    Lidane is neurotoxic
  14. What do HPV serotypes 6 and 11 cause?
    • Warts
    • Can treat with salicylic acid, liquid nitro, and curettage
    • (serotypes 16 and 18 are carcinogenic)
  15. Treatment options for acne
    • First line--topical benzoyl
    • If that doesn't work, try topical clinda or oral tetracyclin (to tx propionibacterium)
    • If that doesn't work, try topical tretinoin
    • Oral tretinoin is a last resort (effective but side effects include myalgias, elevated LFTs, and teratogenicity)
  16. What is rosacea?
    • Looks like acne, begins in middle age
    • Associated with rhinophyma (bulbous, red nose) and blepharitis
    • Treat with topical metro or oral tetracyclins
  17. Describe the typical psoriatic lesions
    • Dry, scaly, well-circumscribed, silvery, scaling papules and plaques
    • Not pruritic
    • Found on scalp and extensor surfaces
  18. What is pityriasis rosea?
    • Benign skin rash
    • Begins with a scaly, oval, erythematous lesion called a "herald patch"
    • Herald patch is followed by many similar lesions that spread out across the torso in a "christmas tree" pattern, and itch
    • Remits within about a month
    • Need to r/o herpes
  19. Lichen planus
    • Pruritic, purple, polygonal papules, found on wrists and lower legs
    • May be associated with whitish, lacy lesions on the oral mucosa
  20. What drugs classically cause photosensitivity?
    • Tetracyclins
    • Phenothiazines (neuroleptics)
    • OCPs
  21. What does erythema multiforme look like, and what are some possible etiologies?
    • Target lesions (round, erythematous, with central clearing)
    • Caused by IgM immune complex deposition in superficial vasculature

    • Drugs (sulfa drugs, penicillin)
    • Herpes infection
    • Stevens-Johnson
  22. What is erythema nodosum?
    • Inflammation of subQ, usually in the pretibial region
    • Associated with sarcoidosis, coccidioidomycosis, and UC
  23. Pemphigus vulgaris
    • AI disease, associated with anti-desmoglein antibodies
    • Presents in middle age with extensive blistering that starts in the oral mucosa and spreads all over the body
    • Positive Nikolsky sign
    • Dx on punch biopsy
    • Tx with oral steroids
  24. Bullous pemphigoid
    • AI skin disease, associated with IgG autoantibodies against hemidesmosomes
    • Tense bullae, all over skin (rarely in oral mucosa)
    • Linear staining on immunofluorescence
    • Negative Nikolsky
  25. What disease is associated with dermatitis herpetiformis?
    Celiac (lots of IgA deposits in skin)
  26. Keratoacanthoma
    • Flesh-colored lesion with a central crater, containing keratin
    • Typically on face
    • Rapid onset, grows to full size within 2 months, and then spontaneously involutes
    • No tx needed
    • Easy to confuse with skin cancer
  27. What does the classic lesion of basal cell carcinoma look like?
    • Shiny papule in sun-exposed are that slowly enlarges and develops an umbilicated center and peripheral telangiectasias
    • Rarely metastasizes, but can be locally invasive
  28. What does actinic keratosis look like, and what is it associated with?
    • Thick, scaly lesion in sun-exposed area (scalp, shoulders, back)
    • Can develop into squamous cell carcinoma
  29. What is Bowen's disease?
    • Squamous cell carcinoma in situ
    • Excise!
  30. What is stomatitis, and what is it associated with?
    • Inflammation of the oral mucus membranes
    • (angular stomatitis--fissuring of the corners of the mouth)
    • Associated with vit B deficiencies (riboflavin, niacin, pyridoxine) or vit C deficiency