Family Medicine Shelf Exam: Dermatology
What is the classic ABCDE criteria of suspicious skin lesions?
*A*symmetry *B*orders *C*olor *D*iameter >6mm *E*levation & *E*volving
What are 5 examples of low to high potency steroids?
*Low* potency: 1% hydrocortisone *Low-moderate* potency: 0.05% desonide *Moderate* potency: 0.1% triamcinolone *High potency*: 0.05% Flucinonide *Super-high potency*: 0.05% Clobetasol Propionate
What is the main bacteria of interest for cat bites?
*Pasturella*
What should be done if malignancy is found on biopsy?
If malignancy is found on biopsy, excision should be completed with 5mm margins
What is useful for fungi detection?
KOH prep *Will see hyphae of dermatophytes or pseudohyphae of yeast*
What type of melanoma is most common in the elderly on chronic sun damaged sekin?
Lentigo maligna
What type of vehicle should be used if lesion is in a hair covered area?
Lotion or liquid preparation
What is the recommended treatment for tinea corporis?
Miconazole or clitrimazole for 2 to 4 weeks
What type of vehicle should be used if the lesion is dry?
Ointment or moisturizing lotion
What is the general rule for closing wounds?
Only close wounds if <18 hours old, <24 hours on face 1) infection rate is lower the earlier a laceration is closed 2) if not infection is present at 3-5 days and approximation is desirable, the laceration may be closed to heal by secondary intention. Prophylatic antibiotics also given
What is a nodule?
Palpable solid (round) lesion, deeper than a papule
What are signs and symptoms of basal cell carcinoma?
Pearly papules often with central ulceration or multiple telangiectasis, upper lip
What is a wheal (hive)?
Pink edematous plaque - round or flat-topped and transient
What strength of steroid should be used on the soles of hands and feet?
Potent strength
What type of skin cancer is often appears as irregularly shaped plaques or nodules with raised borders, scaly, ulcerated, and bleeds easily?
Squamous cell carcinoma
What are the bacteria to cover for dog and cat bites?
Staph and strep
What are the bacteria to cover for in human bites?
Staph, strep, haemophilus, eikenella, and anaerobes
Why are systemic steroids contraindicated in people with Psoriasis?
Steroids can perpetuate severe flares
What is seborrhea?
Superficial inflammatory dermatitis with scaling and erythema
What is the most common type of melanoma?
Superficial spreading melonma
What is the most important factor for outcomes in melanoma?
Thickness of the tumor *Less than 1 mm thick = low rate of metastasis*
What is the recommended treatment for Psoriasis?
Topical steroids, vitamin D, UV light, topical retinoids Most common: pulsed, high potency steroids Systemic treatment: Methotrexate, cyclosporine
What is the treatment of choice for cat bites?
Treat cat bites with 10-14 days of oral amoxicillin-clavulanate
How is seborrhea treated?
Treat inflammation with steroids, malessezia with antifungals (Ketoconazole)
What is the recommended treatment for impetigo?
Treat with 7 - 10 days of cephalexin or dicloxacillin
T/F: Any nevus that exhibits any of the ABCDE signs should be excised with a 2-3 mm margin
True
T/F: Avoid using high potency steroid in children/ infants and on the face and genitals
True *Don't use high potency steroid for more than 2 weeks*
What type of vehicle should be used if a lesion is moist or weeping?
Use cream or gel
What strength of steroid should be used on the soles of face and genitals?
Weakest strength
What are Erysipelas?
A specific type of cellulitis with prominent lymphatic involvement causing raised, well demarcated lesions *Most often due to Beta Hemolytic Strep*
What is the most common type of melanoma in Asians and African Americans?
Acral Lentiginous melanoma *Common under the nails, on the soles of the feet, and on the palms of the hands*
What is the treatment of choice for spider bites?
Cellulitis following a spider bite should be treated with oral clindamycin or trimethoprim sulfamethoxazole due to MRSA suspicion
What is a bulla?
Circumscribed elevated collection of fluid (>5mm in diameter)
What is a vesicle?
Circumscribed elevated collection of fluid (up to 5 mm in diameter)
What is a macule?
Circumscribed flat discoloration (up to 5mm)
What color does erythrasma glow as under a woods light?
Coral red
What is a pustule?
Elevated collection of pus
What is a plaque?
Elevated solid lesion (> 5mm) often, a confluence of papules
What is a papule?
Elevated solid lesion (up to 5mm)
What is a contusion?
Epidermis is intact, but there is trauma to underlying soft tissue structures
T/F: Retinol is a versitile medication that can be used to treat acne in pregnant women and men. It CANNOT be used in children
False: Don't use retinol in women who are pregnant or may become pregnant
What is a patch?
Flat nonpalpable discoloration (>5mm)
What color does tinea capitus glow as under a woods light?
Green
What is the recommended treatment for Tinea capitis?
Griseofulvin, itraconazole, or terbinafine for 4-8 weeks
What is a common treatment for skin infections caused by staph aureus?
1) Cephalexin 2) Dicloxacillin 3) Clindamycin
What is Psoriasis?
1) Epidermal proliferation and inflammation due to chronic immune system alteration 2) Well circumscribed, red, scaling plaques with white thickened scales
What are risk factors for skin cancer?
1) Exposure to UV Radiation 2) Prior hx of skin cancer 3) Fair skin 4) Red/bonde hair 5) Propensity to burn easily 6) Chronic exposure to toxic compounds 7) Suppressed immune system
What are the recommended treatments for MRSA skin infections?
1) TMP-SMX 2) Rifampin 3) Clindamycin 4) Tetracyclines *Topical abx should only be used as monotherapy in mild and superficial bacterial skin infections*
What are the antiviral agents that are effective for treating primary and recurrent herpes simplex and herpes zoster?
1) acyclovir 2) Famciclovir 3) Valacyclovir
