1. Choose a category.You will be given the answer.You must give the correctquestion. Click to begin.

2. Click here forFinal Jeopardy 3. Do Not MissI Read You(Like Braille)PotentPotables10 Point20 Points30 Points40 Points50 PointsSeeing Red10 Point 10 Point 10 Point 10 Point20 Points 20 Points 20 Points 20 Points30 Points40 Points50 Points30 Points 30 Points 30 Points40 Points 40 Points 40 Points50 Points 50 Points 50 PointsCancer?I Can, Sir! 4. Most common acquired new growths inCaucasians (adults averaging about 20) 5. What are common moles(nevomelanocytic nevi)?Board Very common, small (1 cm), circumscribed, acquiredpigmented macules, papules, or nodules Composed of groups of melanocytic nevus cellslocated in the epidermis, dermis, and, rarely,subcutaneous tissue benign, acquired tumors arising as nevus cell clustersat: the dermal-epidermal junction (junctional NMN) invading the papillary dermis (compound NMN) and ending their life cycle as dermal NMN withnevus cells located exclusively in the dermiswhere, with progressive age, there will befibrosis. 6. These two lesions can be mistaken for eachother, one is cancerous, the other is benign. 7. BoardWhat is a key distinguishingfactor between:Keratoacanthoma Dermatofibroma formerly considered apseudocancer, it is now regarded asa variant of SCC Relatively common, rapidlygrowing epithelial tumor w/potential for destruction andmetastasis; however, in most casesspontaneous regression A dome-shaped nodule with centralkeratotic plug Treatment is by excision very common, button-like dermalnodule usually on the extremities as aresult of an insect bite possibly a histiocytic reaction Significant only because of itscosmetic appearance or its beingmistaken for other lesions, such asmalignant melanoma when it ispigmented (+) Dimple sign 8. These are three underlying lesions seenafter biopsy of a cutaneous horn. 9. What lesion should be biopsieddue to potential risk of invasiveSCC/BCC?Board >50% of lesions have a benign base, but Hypertrophic (solar) actinic keratosis SCCIS (Bowen's) invasive SCC BCC SCC SK Wart many others have been reported 10. This lesion was initially misdiagnosed aseczema, psoriasis, and dermatophytosis(on the Checklist)Patches/plaques stage:randomly distributed, well-and/or ill defined patchesand plaques; may be scalyand appear in various shadesof red.Plaque and earlynodular stage: reddish-brownishscaly, andcrusted plaques and flatnodules.Tumor stage:Scaly and crustedeczema-like plaques turnnodular or ulcerate. 11. What the heck is Mycosis fungoides?Board Most common cutaneous lymphoma (T cell) Arises in mid-late adulthood with 2:1 malepredominance Related features are pruritus, may beintractable; alopecia, palmoplantarhyperkeratosis, and bacterial infections Categorized as patch, plaque, or tumor stage Extensive infiltration cancause leonine facies Confluence may lead toerythroderma 12. These two LR statistics describethe likelihood of the followinglesions being cancerous: 13. What do lesions at risk for melanoma look like if theA) ABCDE = 0 (LR+ 0.07) (NPV 0.9%)B) ABCDE = 5 (LR+ 98 to 107) (PPV 92.2%)BoardSimel, David; Drummond Rennie (2008-08-25). THERATIONAL CLINICAL EXAMINATION : EVIDENCE-BASEDCLINICAL DIAGNOSIS (Jama & Archives Journals)(p. 482). McGraw-Hill. Kindle Edition.ABCDE(JAMA)MultivariateFindings forMelanoma [LR(+)]5 positive 98>/= 4 8.3>3 3.3>2 2.6>1 1.50 0.07ABCDE(EE+)MultivariateFindings forMelanoma [LR(+)]5 positive 107>/= 4 8.3>3 3.3>2 2.6>1 1.5EE+: Pigmented Lesion -> Melanomahttps://www.essentialevidenceplus.com/content/hpcalc/testsum.cfm?sx=106&testtype=H 14. This procedure is helpful in diagnosingmany conditions, particularly in thedistinction of benign and malignantgrowth patterns in pigmented lesions.. 15. What is the purpose ofDermoscopy/Dermatoscopy?(epiluminescence microscopy)Board 16. The 4 Ps of Lichen Planus 17. What is characterized by purple,polygonal, pruritic papules?Boardpolygonal In the mouth milky-whitereticulatedpapules; maybecome erosive andeven ulcerate. Main symptom:pruritus; in themouth, pain. Therapy: sx, notcurative. Acitretin(C), glucocorticoiduse (I). 18. The presenting complaints for thispatient with palpable purpura 19. What is Henoch-Schonlein purpura?bowel angina, bowel ischemia withbloody diarrhea, hematuria and redcell casts, and arthritis.Board 20. This is the test used to diagnosethe following multisytem diseaseSeen in patients who are neglected children, alcoholic, homeless,etc., with bleeding gums and loose teeth. 21. When would I check aVitamin C level?Board Scurvy is an acute or chronic disease of infancy and of middle/old age Humans are unable to synthesize ascorbic acid and require it as anessential dietary vitamin. Deficiency of vitamin C leads to reduction incollagen formation with associated capillary fragility Precipitating factors: Pregnancy, lactation, and thyrotoxicosis when thereare increased requirements of ascorbic acid; most common in alcoholism. With no vitamin C intake, symptoms of scurvy occur after 13 months. Lassitude, weakness, arthralgia, and myalgia. 22. Three items in the workup forthis patientCRASH and Burn:ConjunctivitisRashArthritisStrawberry tongueHands (skin peeling)and Burn: fever >5 days 23. What is the mnemonic for Kawasakis disease?1. Chem: LFTs2. Heme: WBC>18K, Plthigh, ESR elevated3. UA: Pyuria4. EKG: PR & QTprolongation, ST and Twave changes5. Echo: Coronary aneurysm(20% of cases)MANAGEMENT Hospitalize and monitor for cardiac andBoardvascular complications IVIG 2 g/kg over 10 h Aspirin 100 mg/kg per day until feverresolves or until day 14 of illness,followed by 5 to 10 mg/kg per day untilESR and platelet count have returned tonormal Glucocorticoids ContraindicatedAssociated with a higher rate ofcoronary aneurysms. 24. The description, stage and treatmentof Acne vulgaris shown below. 25. What does stage II acne(inflammatory acne,papules and pustules) look like?BoardComedones OnlyFor this treatment, topical retinoids are themainstay of treatment. Choices includetretinoin, adapalene, and tazaroteneModerate to Severe Inflammatory AcneOral antibiotics including the tetracyclines(minocycline, doxycycline, tetracycline) arethe first-line choicesInflammatory Acne (Papules and Pustules),Mild to Moderate SeverityTopical antibiotics are the treatment of choice for thesepatients. Choices include benzoyl peroxide, azelaic acid,clindamycin, erythromycin, and dual agents combiningbenzoyl peroxide with either erythromycin orclindamycinSevere Papulonodular AcneOral isotretinoin is indicated for severe papulonodularacne 26. The rash below with tear-drops of silverscale which can follow strep infections. 27. What is Guttate Psoriasis?BoardMultiple small scaly plaques with adherent silverscale that tend to affect most of the body. Usuallythe trunk, upper arms and thighsThe diagnosis of guttate psoriasis is made by thecombination of history, clinical appearance of therash, and evidence for preceding infection.The rash comes on very quickly, usually within acouple of days, and may follow a streptococcalinfection of the throat. It tends toaffect children and young adults and has a goodchance of spontaneously clearing completelyGutta is Latin fortear drop; guttatepsoriasis looks likea shower of red,scaly tear drops thathave fallen down onthe body 28. When erythema and warmth arepresent, this is the key factor thathelps distinguish this conditionfrom cellulitis. 29. What is the importance ofmarking the border of stasisBoarddermatitis?Ddxcellulitis: redness,swelling, pain, fever,a red streak up theleg and swollennodes in the groinTreatment: Topical glucocorticoids(short term). Topical antibiotictreatments (e.g., mupirocin) whensecondarily infected. Culture formethicillin-resistantStaphylococcus aureus (MRSA). 30. Four potential complications of apatient with the following progressionof lesions. 31. BoardWhat does the followingmnemonic help us recall?Bells PalsyArthritisKardiac arrhythmiaEncephalopathya key Lyme Pie 32. 3 Key Features thatDifferentiateIrritant Contact Dermatitis (80%)fromAllergic Contact Dermatitis (20%) 33. Board 34. This condition is oftenseen in the summertime. 35. What is miliaria?Board Miliaria crystallina caused by obstruction of the sweat ducts close to thesurface of the skin appears as tiny superficial clear blisters that break easily. Miliaria rubra (prickly heat) occurs deeper in the epidermis results in very itchy red papules Miliaria profunda results from sweat leaking into the dermis Miliaria pustulosa pustules due to inflammation and bacterial infectio 36. Two severecomplications tomonitor for if there isan outbreak of thiscondition in thetrigeminal nerve 37. What is herpes zosterophthalmicus and RamsayHunt Syndrome?Board 38. The treatment for these coinshaped lesions, common in thewintertime 39. When do you use emollients and moderate-high potencycorticosteroids?BoardNummular eczemachronic, pruritic, inflammatorydermatitis occurring in the formof coin-shaped plaques(nummularis in latin: like acoin) composed of groupedsmall papules and vesicles onan erythematous base.1. Emollients2. Moderate-to-highpotency corticosteroids1. Clobetasolpropionate 0.05% (I;$12-14/15g)2. Fluocinonide 0.05%(II; $18/15g)3. Triamcinolone 0.5%DDx: Atopic dermatitis, contact (III; $13/15g)dermatitis, psoriasis, tinea corporis. 40. This lesion gradually goesaway over this time period. 41. What is a hemangioma ofinfancy?Board Proliferative phase: 3 to 9 months, enlargingrapidly during the first year Involution phase: the HI regresses, graduallyover 2 to 6 years and is usually complete bythe age of 10 Involution varies greatly betweenindividuals and is not correlated with size,location, or appearance of the lesion. 80% of the time, there is no skin change. 42. Under Woods Lamplight, this lesionappears coral red. 43. BoardWhat device can diagnose these conditions?DarkFreckles and melasma (Circumscribed hypermelanosis)are more evident (darker)Benign Blue Spot (Mongolian sacral spot, dermal melanin)does not become accentuatedLightVitiligo has exaggerated areas of whitenessTuberous sclerosis and tinea versicolor are hypomelanotic(and duller areas of whiteness)ColorsDermatophytosis with Microsporum canis in thehair shaft (green to yellow)Pityriasis versicolor (Yellow fluorescence)Pseudomonas abscesses (pale blue)Intertrigo erythrasma with Corynebacteriumminutissiumum (coral pink-red)OtherPorphyria (pinkish-red urine; addition of dilute HCl intensifiesthe fluorescence)Corneal abrasions & dendrites with application of fluorescein(although cobalt blue light and slit lamp are ideal)http://www.pcds.org.uk/p/skin-disease-examinationWolff, Klaus (2009-02-19). Fitzpatrick's Color Atlas and Synopsis of ClinicalDermatology : Sixth Edition (Fitzpatrick's Color Atlas & Synopsis of ClinicalDermatology) (Kindle Locations 845-874). McGraw-Hill. Kindle Edition. 44. This combinationantifungal/corticosteroidis expensive, uses ahigh-potency steroid andshould never be ordered. 45. Why does Lotrisone(Betamethasone/Clotrimazole)have a bad reputation?BoardBetamethasone costs $23 for 15gClotrimazole costs $18 for 15 gLotrisone costs $53 for 15g 46. Daily Double!First Line Treatment for this condition 47. When would I treat with topicalCS and a vitamin D analogue or aretinoid?BoardClobetasol 0.05% $12-14/15g (NNT = 2)Fluticasone propionate ointment 0.005% safe on face/groin $17/15gCalcipotriene (vitamin D agent) 0.005% ~$340/60? (NNT vs placebo = 2)Tazarotene (retinoid) ?$? (NNT vs placebo = 6) 48. This patient used this alternative tonitrogen freezing to avoidhypopigmentation. 49. When are second-line agents likeimiquimod or topical 5-FU (Carac)appropriate for actinic keratoses?Board Cryotherapy with liquid nitrogen is effective and cheap). Imiquimod [B] (usually causes strong local irritation) 3% diclofenac gel [B] needs prolonged use >3 months beforemore permanent treatment results can be expected. 5-FU is most effective therapy for actinic keratosis, but less welltolerated and more costly {LOE1a}AK statsRisk of progression:0% to 0.5% perlesionRate of regression15% to 63% perlesionRate of recurrence:15% to 53%.12 packets of imiquimod (Aldara) cost $170compared with $730 for a 30 g tube of 5-FU cream 50. These different patterns of toeinfections require differentapproaches for treatment 51. What is the difference between:Distal and Lateral Subungual OnychomycosisSuperficial White OnychomycosisProximal Subungual Onychomycosis Debridement: weekly, in DLSO, nailbed should be removed; in SWO, it can beBoarddebrided with a curette Topical lacquer: Ciclopirox (Penlac, $42) typically only effective for SWO Systemic agents: Terbinafine (250mg/d x6 wk for fingers, 12-16 wk for toes), $6.50/ Itraconazole 200mg/day x6wk for fingers (for dermatophytes/candida only),$16.50/ 52. What are the Top Ten offendingagents that can cause these conditions? 53. Medications most commonly implicated in Stevens-Johnson syndrome or toxic epidermal necrolysis.Medications Odds RatioSulfonamide antibiotics (Bactrim) 172Carbamazepine (Tegretol) 90Corticosteroids 54Phenytoin (Dilantin) 53Allopurinol 52Phenobarbital 45Valproic acid (Depakene) 25Cephalosporins 14Piroxicam (Feldene) 12Quinolones 10Aminopenicillins 6.7BoardAntibioticsAllopurinolAnti-convulsantsCorticosteroidsNSAID (oxicam) 54. Make your wager 55. These are thelesions that can bereadily identifiedthroughdermoscopy 56. BoardBenign melanocytic lesions:Congenital melanocytic naevi,Lentigines - lentigo simplex; solar lentigo; ink-spot lentigoBenign melanocytic naevi (common moles)Blue naevi; Spitz naevi; Atypical melanocytic naevi