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Derm OSCE

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hevexiha's version from 2017-05-15 03:51

Section 1

Question Answer
Diagnosis for HSV?Tzank smear
Unilateral, pain, itching, 2-5 days before outbreak, grouped vesicles on erythematous base, single dermatomeHerpes Zoster (Shingles) Tx: Rest, symptomatic, acycolovir antiviral
Dew drop on a rose petal, pruritic vesicles on erythematous base, crops. Contagious until lesions crusted over.Varicella (Chicken Pox) Tx: Symptomatic
Highly contagious, 3 C's (cough, coryza, conjuctivitis), Koplik spots, red maculopapular rash on face, ears, neck, spreads inferiorly Measles (Rubeola) Tx:Symptomatic antipyretic, antitussives, fluids
Dz of infants/young children, abrupt fever, then erythematous maculopapular rash chest and abdmRoseola Tx: Symptomatic
Benign, viral skin infection, peraly white, flesh colored dome shaped papules w/central depression, highly contagiousMolluscum Contagiosum Tx: None, self limiting, fade w/in year
3 day measles, malaise, lymphadenopathy, rash starts on face and decends, coincides w/fever, HA, mm painRubella (German Measles) Tx: Symptomatic
Slapped cheek rash, lacy retiuclar pattern on butt and extensor surfaces, then marked improvement or severity of rash, lasts 1-2wksErythema Infectiosum (5ths dz, slapped cheek syndrome) Tx: Symptomatic
Small vesicles in mouth, hands, feet, butt; vesicles, bullae, ulcers; hallmark is normal gingiva, 7 daysHand, foot, mouth dz Tx: Symptomatic
Flesh colored papules with rough surfaceCommon Warts (HPV) Tx: Freeze, scalpel, acid
Deep, raised, discrete lesions w/rough surface, blackened, painfulPlantar Warts (HPV) Tx: Freeze, scalpel, acid
Flat topped flesh colored papulePlane Wart (HPV) Tx: Freeze, scalpel, acid
Flesh tone, raised plaqueMosaic Wart (HPV) Tx: Freeze, scalpel, acid
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Section 2

Question Answer
Superficial, intial vesicle, pustule, rupture, honey colored crust with stuck on appearance, itchy Impetigo Tx: Gentle washing 2-3x qday + antbx (erythromycin, cephalexin)
Vomit, high fever, sore throat, macular goose pimpl rash on trunk, then spreads; beefy red tonsils, petechiae on palate, white strawberry tongueScarlet Fever Tx: Abx (penicillin or erythromycin) + APAP
Prodrome of chills, malaise, fever, HA, V, erythematous patch, sharply demarcated, hot, HALLMARK raised border peau d'orange appearance Erysipelas Tx: Abx (PenV, PenG, or macrolide)
Diffuse, non-pus infection thru epidermis and dermis, spreading, local pain/tender, fever, red, chillsCellulitis Tx: Abx (PenG iv; clindamycin, cephalexin, erythromycin PO)
Prodrome fever, chills, V/D, HOTN, rash, diffuse erythroderma, organ failureToxic shock syndrome (TSS) Tx: remove FB, aggresive fluid replacment, inpt IV abx clinda, vanco for MRSA
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Section 3

Question Answer
Erythematous, well defined, central clearing, circular or half moon shape, scaly Tinea capitis (scalp/hair), Corporis (face, trunk, extremities), Cruris (groin) Tx: Topical antifungal x 7 days
Pruritic, red lesions btwn toes, fissures, opaque white scales on soles, sides, dorsum of feet Tinea Pedis Tx: Topical antifungal cream bid x 4 wks
Scaling, itchy papules or bullae, doesn't have classic ringworm lookTinea Manus Tx: Topical or oral antifungals
Fungus inhibits melanocyte function, fawn or salmon colored papules w/fine scaling, chest, shoulders back, summer months after tanningTinea Versicolor Tx: remove scales w/soap n water; Selsun Blue shampoo
Sore, red, raw fissure at angles of mouthAngular cheilitis; Dx: KOH prep; Tx: Antifungal cream, hygiene
Milky white patches in mouth, red base, pinpoint bleeding, babies, immunocompromisedOral candidiasis; Dx: KOH prep; Tx: Antifungal rinse or cream
White, cheeselike discharge, itchy, red macules, satellite lesionsCandida Vulvovaginitis (vagina, vulva mucosa); Candida Intertrigo (skin folds); Candida Balantis (glans penis); Dx: KOH prep; Tx: Topical miconazole, fluconazole, or antifungal
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Section 4

Question Answer
Parasite infection of head (capitis), body (corporus), pubic hair (pubis); itchy scalp, visualize nitsPediculosis (Lice) Dx: visually or woods lamp; Tx: Nix (Permetherin), RID
Intensely itchy, inflammatory burrows, pinpoint vesicles, webs of fingers, excoriation at infection site or nadules Scabies; Dx: scrape skin to view mites/eggs; Tx: Permethrin, clean everything, itching up to 1 month after tx
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Section 5

Question Answer
Inflammatory, epidermins, dermis, itchy, red, fissuring, scalingEczema Tx: Hydration, oatmeal baths, steriods limited use
Genetic allergic condition, chronic relapsing, itchy eczema, classic red, scaling, oozing on face; assoc w/asthma and allergies Atopic Dermatitis: children outgrow; Tx: Oatmeal baths, petroleum, Eucerin
Acute, cutaneous reaction to external substance, sharply defined, red patches, oozing, itchy, burning Contact Dermatitis; Tx: remove offending agent, anti-itch, topical zinc
Chronic, superficial, inflammatory rash, sebum rich areas of body with hair, scalp, eyebrows, face, yellow, red, white greasy scales, burning itchySeborrheic Dermatitis (Cradle Cap) Tx: Acute topical steriods, Selsun Blue shampoo
Inflammatory, autoimmune, chronic, well defined, salmon plaques, silvery white scales, koebner phenomenon (develops at site of trauma), Auspitz sign (pinpoint bleeding when picked). extensor surfaces, scalp, intergluteal cleft, nailsPsoriasis (Gutatte = after strep infection) Tx: DERM, emollients, UVB therapy, topical steriods, systemic methotrexate or cyclosporine
Lichenfication from reflex habit to itchLichen Simplex Chronicus Tx: behavior modification, PO anti-histamines, topical steroid
White, adherent polygonal scale, central tacking, extensor surfaces and flexural foldsItchthyosis Vulgaris; Tx: Topical retinoid, topical corticosteroid
Clear vesciles on palms, soles, fingers, itchy, burn, pain, recurrentDishydrotic Eczema; Tx: self resolving
Females, keratinization of hair follicles, red papules w/light red haloKeratosis Pilaris Tx: Karatolytics, emollients
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Section 6

Question Answer
Clubbing of nailsThink lung, liver, heart, bowel
Subungual hematoma Blood under nail, puncture w/cautery tool
Onycholysis Painless separation of nail from nail bed
Leukonychia White spots on nail, from trauma
Bacterial infection of nail fold, inflammation, red, pus, throb, traumaAcute paronychia Tx: PO abx or I & D + soak
Funfal infection, no pain, redness, absent cuticle, boddy, caused by freq water immersionChronic paronychia Tx: PO abx or I & D + soak, topical, or PO antifungal
Chronic fungal or yeast infection of nail, discoloration, thickeningOnychomycosis Dx: KOH prep; Tx: LT PO antifungal
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Section 7

Question Answer
Skin TagAcrochordon Tx: Excision
Keratotic lesion w/telangiectasias, itchy, burn, small, multiple red, pink, brown macules, papules, plaques, rough to palpation; sun related, face, scalp, neck, hands, pre-malignant SCCActinic keratosis Dx: biopsy Tx: sun protection, topical 5 fluorouracil, excision
Benign proliferation of skin, sun exposure, brown because of melanocytes, juntional, compound, dermal, halo, flame, congenital hairy, blue, mongolian spot, dysplasticNevi (moles) ABCDE: asymmetry, border, color, dia > 6mm, elevation/evolution
Benign, light brown spot, hyperpig patch, size and number increase with ageCafe au Lait spot
Rapid growing from sun exposure, confused for SCC, nodule w/central keratotic plug, leaves pitted scar, firm, tenderKeratocanthoma Tx: assume SCC, excise or biopsy
Bluish, blackish macule, lumbar sacral region in newborns, Asians, AA, fade in childhoodMongolian spot
NO PALMS/SOLES; oval epidermal tumor, brown w/stuck on appearance, plaque, scaling, papules, pigmented, crumbles when picked, crusty top negates mealonmaSeborrheic keratosis Tx: biopsy for cancer, FREEZE
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Section 8

Question Answer
MC form of skin cancer, slow grow, non-heal sore, pearl white to pigment, telangiectasias, rolled border, face, ears, scalp, upper trunk, rarely metastasizesBasal Cell Carcinoma (BCC) Tx: sunscren, biopsy, MOHs
Second MC skin cancer, sun exposure, slow, red base, yellow white adherent scale, nodules, central keratin plug, metastases on mucous membranes of bodySquamous Cell Carcinoma (SCC) Tx: biopsy, MOHs, good prognosis
Malignant proliferation of melanocytes, sun exposure, superficial spread, hyperpig, painless, itch less, invasive Melanoma Tx: biopsy, good prognosis
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Section 9

Question Answer
Inflammed cells w/hair follicle, infection, chemical irritation, injury, hot tubs, pools, staph and pseudo; multi sm papules and pustules, red base, central hair, itchy, cluster groups Folliculitis Tx: Topical antifungal, consider MRSA in diff cases
Ingrown hairs, red, papule/pustule at point of entryPseudofolliculitis Tx: Topical abx
5 P's Pruritic, Planar, Polyangular, Purple, Papules; flexural surfaces, mucous membranes, koebner phenomenon (injury site), wickham striae (white lines in papules), nail tentingLichen Planus Tx: Topical corticosteroids, assoc w/ hep C
Herald patch, oval, slightly raised, 1-2 wks later scaling, red, itchy, lesions follow lines of cleavage, trunk, arms, legs, XMAS tree distPityriasis Rosea Tx: self limiting 4 wks, topical corticosteroid
Mast cells, histamine release, wheel, transient, papular, itchy, meds, foods, stress, viral, solar, insect bite, transfusionoUrticaria Tx: H1 blocker, topical or PO steroid
Hypersensitivity reaction, palms, dorsum, soles, extensor surfaces, face, bilateral and symmetric, HALLMARK target lesions, preceding infectionErythema Multiforme Tx: underlying condition, remove drugs
Non-inflammatory lesions (open and closed comedones) Mild Acne Vulgaris Tx: topical retinoid (Tretinoin) +/- topical antimicrobial, salicyclic acid
Inflammatory papules and pustules w/ noninflammatory lesions Moderate Acne Vulgaris Tx: topical retinoid (Tretinoin) + PO abx (Doxycycline or Ortho Tri-Cyclen) +/- benzoyl peroxide
Inflammatory lesions and scarring with some noninflammatory lesions Severe Acne Vulgaris Tx: Isotretinoin
Facial flushing, red, telangiectasias, acne, lesions, vascular dialation on cheeks, chin, forehead, noseRosacea Tx: topical metronidazole
Acute, tender, cyst like abscess in axilla, genital area, intertriginous, obesity, recurrent, itchy, redHidradenitis Suppurativa Tx: lose weight, avoid tight clothes, stop smoke
Clear vesicles, itch, red, prickly heat, flesh colored papules, inability to sweat, heat exhaustionMiliaria Tx: cooling off, topical lotions calamine, topical steroids, abx
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Section 10

Question Answer
MC STI in US, pink papules, cauliflower lesions, mucous membranes of skin, itch, irritated Condylomata Acuminata (genital warts, HPV) Tx: Imiquimod cream, cryotherapy, gardasil vaccine
Single, painless ulcer chanre; flu like prodrome then macular papular rash all over, plams, soles; septic blood effecting multi organs Syphilis Dx: dark field microscopy Tx: PenG
Viral, rapid progression CNS infection, 100% fatal once sx develop; incubation, prodrome, neuro, coma, deathRabies Tx: local wound tx, passive immuno rabies immune globulin, active immunization w/ human diploid cell vaccine
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Section 11

Question Answer
Primary lesionsMacule, patch, papule, nodule, tumor, vesicle, pustule, bulla, cyst, plaque, telangiectasia, wheal
Secondary lesionsCrust, scale, lichenification, erosion, isolated
CharacteristicsAnnular, polycyclic, reticulate, ulcer, scare, atrophy, striae, sclerosis, exoriation, fissure, necrosis
DistributionDiscrete, scattered, serpiginous, glaborous
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Section 12

Question Answer
Inflammatory phaseGranulocytes, lymphocytes, IGs released = pus
Proliferative phaseEpithelialization, neovascularization, collagen synthesis
Remodeling3rd stage
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Section 13

Question Answer
Lidocaine (MC)Onset: 4-10min, Duration: 30-120min
MepivacaineOnset: 6-10min, Duration: 90-180min
BupivacaineOnset: 8=10min, Duration: 240-480min
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Section 14

Question Answer
Superficial 1st degree burnHair, epidermis, dry, red, blanches w pressure
Superficial partial thickness, 2nd degree burnAbove + dermis, nerve endings, blisters, moist, red, blancehs w pressure
Deep partial thickness, 2nd degree burnBlisters, patchy to white, does not blanch, can only feel pressure
Full thickness, 3rd degree burnAbove + fat, mm, seat glands, waxy white to charred grey or black, can only feel deep pressure
Down to bone, 4th degree Above + bone
Face front/back = 9; Arm front/back = 9; chest front = 18; back = 18; genital = 1, leg front/back = 18Rule of Nines
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Section 15

Question Answer
Oil to normal skinGels, solutions, lotions
Normal skinGels, solutions, lotions, creams
Normal to dry skinLotions and creams
How long before you see improvement?6-8 wks
3 OC approved for acne tx?Ortho Tric-Cyclen, Estrostep, Yaz
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Section 16

Question Answer
Dermatitis Hydrocortisone ointment
Tinea corporis Clotrimazole cream
AcneBenzoyl peroxide gel or lotion
ScabiesLindane lotion
Seborrheic dermatitis Lidex solution (Rx in water)
Tinea pedisMiconazole powder
Diaper dermatitis Zinc oxide paste
Ointments are more potent thanCreams
Creams are more potent thanLotions
Topical corticosteroids (LOW)Dexamethasone, hydrocortisone
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