Flashcards in this deck (237)

• A patient with non-Hodgkin lymphoma receiving chemotherapy should receive annual vaccination for influenza.
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• Influenza can be complicated by lower respiratory tract infections such as pneumonia and bacterial superinfection.
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• Patients who are immunocompromised are at higher risk for severe illness from influenza.
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• The CDC recommends annual influenza vaccination for all individuals over 6 months.
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• The influenza vaccine can be administered as a trivalent or quadrivalent intramuscular injection or as a nasal spray.
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• The inactivated influenza vaccine is safe for immunocompromised patients.
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• The symptoms of influenza include fever, chills, myalgias, malaise, headaches, cough, nausea, and vomiting.
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• The measles-mumps-rubella vaccine is a live attenuated vaccine and is contraindicated in severely immunocompromised patients.
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• The meningococcal vaccine is indicated for all children and is a conjugate vaccine.
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• Boosters for the meningococcal vaccine are not routinely necessary in immunocompromised patients.
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• The pneumococcal vaccine is indicated for adults over age 65 and in high-risk conditions.
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• The influenza vaccine is crucial for patients with high-risk conditions to prevent influenza-related complications.
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• The recommended age for annual influenza virus vaccination is greater than 6 months.
  internal_medicine vaccination step2.
• Influenza can be complicated by lower respiratory tract infection (pneumonia) and bacterial superinfection.
  internal_medicine infectious_disease step2.
• Symptoms of influenza include fever, chills, myalgias, malaise, headaches, cough, nausea, and vomiting.
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• The influenza vaccine can be administered in two forms: trivalent or quadrivalent intramuscular injection of inactivated virus, or as a nasal spray of live attenuated virus.
  internal_medicine vaccination step2.
• Inactivated influenza vaccine is safe for immunocompromised patients via intramuscular injection.
  internal_medicine vaccination immunocompromised step2.
• Patients who are immunocompromised may be at higher risk for severe illness from influenza if they do not receive vaccination.
  internal_medicine immunocompromised step2.
• The correct answer in the context is the influenza vaccine.
  internal_medicine vaccination step2.
• The measles-mumps-rubella vaccine is a live attenuated vaccine and is contraindicated in severely immunocompromised patients due to the risk of viral reactivation.
  pediatrics vaccination immunocompromised step2.
• The meningococcal vaccine is a conjugate vaccine recommended for all children, with an additional serogroup B vaccine for those at increased risk.
  pediatrics infectious_disease step2.
• While meningococcal vaccine can safely be given to immunocompromised patients, boosters are not routinely necessary.
  internal_medicine vaccination immunocompromised step2.
• The pneumococcal vaccine is indicated for all adults over 65 years and those with high-risk conditions like chronic heart, renal, or liver disease.
  internal_medicine vaccination step2.
• A patient who received the pneumococcal vaccine 1 year ago does not need a booster dose.
  internal_medicine vaccination step2.
• Varicella vaccine is a live attenuated vaccine usually given in two doses during childhood.
  pediatrics vaccination step2.
• Zoster vaccine for shingles is recommended for adults greater than 60 years and is also a live attenuated vaccine.
  internal_medicine vaccination step2.
• The varicella vaccine is contraindicated in patients who are immunocompromised.
  internal_medicine vaccination immunocompromised step2.
• The educational objective emphasizes that the influenza vaccine is crucial for patients who may be at higher risk for severe illness and complications from influenza.
  internal_medicine vaccination step2.
• The most appropriate next step in diagnosis for a patient with recurrent episodes of vaginal candidiasis and genital herpes is HIV testing.
  obgyn internal_medicine step2.
• HIV testing is recommended for sexually active individuals over the age of 13, especially for those with high-risk sexual behavior.
  obgyn internal_medicine step2.
• Frequent HIV testing is indicated for those who have numerous sexual partners and rarely use barrier protection.
  obgyn internal_medicine step2.
• A patient with a history of recurrent genital herpes and vaginal candidiasis is suggested to have underlying immunodeficiency.
  obgyn internal_medicine step2.
• If the fourth-generation HIV test is positive, further testing to differentiate between HIV-1 and HIV-2 is indicated.
  obgyn internal_medicine step2.
• If the fourth-generation test is positive but antibody testing is negative, measuring the HIV viral load should be performed.
  obgyn internal_medicine step2.
• For a positive HIV test, initiating highly active antiretroviral therapy (HAART) is critical.
  obgyn internal_medicine step2.
• Fungal culture is unnecessary because vaginal candidiasis can be diagnosed by microscopy of vaginal secretion.
  obgyn internal_medicine step2.
• Genital herpes can be diagnosed clinically but requires laboratory confirmation during the first episode.
  obgyn internal_medicine step2.
• The gold standard for diagnosing herpes infection is viral culture, although PCR-based tests are preferred.
  obgyn internal_medicine step2.
• Vaginal candidiasis is characterized by a discharge with a cottage-cheese consistency.
  obgyn internal_medicine step2.
• The patient has a history of three episodes of candidal vaginitis and genital herpes.
  obgyn internal_medicine step2.
• The most appropriate next step in diagnosis for this patient with high-risk sexual behavior and recurrent episodes of vaginal candidiasis is HIV testing.
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• Routine screening for HIV is recommended for sexually active individuals over the age of 13 years.
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• Populations that require more frequent HIV screening include those with numerous sexual partners and injection drug users.
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• The patient's history of recurrent vaginal candidiasis and genital herpes strongly suggests underlying immunodeficiency.
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• Testing for HIV typically involves a fourth-generation combined HIV 1/2 antigen and antibody test.
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• If the fourth-generation HIV test is positive, further testing is needed to differentiate between infection with HIV-1 or HIV-2.
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• If antibody testing following a positive fourth-generation test is negative or indeterminate, the next step is to measure the HIV viral load.
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• A positive HIV test should prompt immediate initiation of highly active antiretroviral therapy (HAART).
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• Fungal culture is unnecessary for diagnosing vaginal candidiasis because yeast forms are readily appreciated on microscopy.
  obgyn step2.
• Genital herpes infection can be diagnosed clinically in the presence of characteristic lesions, but laboratory confirmation is necessary for the first episode.
  obgyn step2.
• The preferred method of screening for HPV infection is cervical cytology alone or together with a PCR-based assay.
  obgyn step2.
• Colposcopy is indicated only if the pap smear shows abnormal findings such as cervical dysplasia.
  obgyn step2.
• Recurrent infections suggest a state of immunodeficiency that is characteristic of HIV infection.
  internal_medicine step2.
• Testing for HIV is prudent for patients exhibiting symptoms such as recurrent vaginal infections, indicating possible HIV infection.
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• The educational objective emphasizes the need for HIV testing using a fourth-generation antigen/antibody test.
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• The patient is a 32-year-old African American man with iron deficiency anemia who has adhered to his medication regimen of ferrous sulfate for 6 months.
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• Laboratory studies showed that the patient's hemoglobin increased from 10.7 g/dL to 10.9 g/dL over 6 months.
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• The patient's red cell distribution width (RDW) is normal despite the anemia, suggesting hemostatic function may not be impaired.
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• The blood smear findings of microcytosis and target cells in this patient are indicative of thalassemia.
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• In this male patient, the absence of bloody vomiting, blood in stool, or blood in urine suggests that occult gastrointestinal bleeding is less likely.
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• The patient's serum iron levels revealed that he had a level of 60 µg/dL with a transferrin saturation of 25% six months ago and a level of 75 µg/dL with a transferrin saturation of 35% today.
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• Thalassemia is the most likely diagnosis for this patient because he has mild microcytic anemia with a normal red cell distribution width (RDW) and normal iron studies.
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• Celiac disease often presents with malabsorption and changes in gut lining rather than solely with anemia, making it less likely in this case.
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• Myelodysplastic syndrome typically involves abnormal blood counts and a high RDW, which is not seen in this patient.
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• Pure red blood cell aplasia would show marked reductions in reticulocyte count and red cells, which are not present here, confirming it's less likely.
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• Occult gastrointestinal bleeding would most likely present with positive stool guaiac tests or significant changes in iron studies, which are absent in this case.
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• Normal iron studies indicate the absence of iron deficiency as a cause of the patient's anemia, leading to the diagnosis of thalassemia.
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• The management of thalassemia in this patient would focus on monitoring and treating complications rather than immediate iron supplementation due to normal iron levels.
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• In diagnosing microcytic anemia, a key consideration is the patient's iron studies, including serum iron and ferritin levels.
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• Patients with thalassemia often maintain normal iron levels despite chronic anemia, as seen in this patient who presented with a normal RDW.
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• Thalassemia is characterized by one or more alleles of the a- or β-globin genes being rendered nonfunctional.
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• The normal adult hemoglobin (HbA) consists of two a-globin subunits and two β-globin subunits.
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• In patients with β-thalassemia, the normal HbA cannot be effectively assembled, leading to the formation of insoluble tetramers from excess a-globin chains.
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• Patients with a-thalassemia trait often exhibit minimal decreases in hemoglobin and may be asymptomatic.
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• Microcytosis and the presence of target cells on a peripheral blood smear are characteristic of both a- and β-thalassemia.
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• Patients with thalassemia trait may be incorrectly diagnosed as having iron deficiency anemia.
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• Celiac disease can lead to iron deficiency anemia, typically presenting with increased RDW.
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• Occult gastrointestinal bleeding is associated with iron deficiency anemia that should respond to oral iron therapy.
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• Microcytic anemia associated with myelodysplastic syndrome is typically not isolated, as it presents with cytopenias of various lineages.
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• A transferrin saturation level of 18 to 20% is often used to exclude iron deficiency anemia.
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• Iron studies in a patient with thalassemia should return normal.
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• Thalassemia is most likely diagnosed in patients with mild microcytic anemia and normal red cell distribution width (RDW).
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• In thalassemia, one or more alleles of either the α- or β-globin genes is rendered nonfunctional.
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• Normal adult hemoglobin consists of two α-globin subunits and two β-globin subunits, forming a unique conformation called hemoglobin A (HbA).
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• Patients with β-thalassemia have difficulty assembling the normal HbA molecule, leading to the formation of excess α-globin chains.
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• The severity of α-thalassemia depends on the number of non-functional α-globin alleles.
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• Microcytosis and the presence of target cells on peripheral blood smear are characteristic of both α- and β-thalassemia.
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• Patients with thalassemia trait may be incorrectly diagnosed with iron deficiency anemia because oral iron therapy will have no effect on their hemoglobin concentrations.
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• A transferrin saturation of 18% to 20% is often used to exclude iron deficiency anemia.
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• Celiac disease typically presents with microcytic anemia, an increased RDW, and transferrin saturation below 20%.
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• Myelodysplastic syndrome often presents with cytopenias but microcytic anemia in isolation is atypical.
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• Occult gastrointestinal bleeding should respond to oral iron therapy, unlike in patients with thalassemia.
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• Pure red blood cell aplasia results in complete destruction of erythrocyte precursors and presents with profound anemia.
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• Normal human hemoglobin A consists of two α-globin and two β-globin subunits; mutations in these lead to thalassemia.
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• In thalassemia trait or thalassemia minor, patients present with mild microcytic anemia and normal iron studies.
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• Peripheral blood smear in thalassemia may reveal target cells.
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• A 23-year-old man with sickle cell disease presents with low back pain and nausea. He rates the pain as 8 on a 10-point scale.
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• His vital signs are within normal limits, but he has pale conjunctivae and a hemoglobin concentration of 7.2 g/dL.
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• The patient's serum urea nitrogen concentration is 32 mg/dL and serum creatinine is 2.6 mg/dL.
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• In addition to administration of oxygen and 0.9% saline, the most appropriate next step in pharmacotherapy is intravenous morphine.
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• Patients with sickle cell disease commonly experience acute painful episodes due to vaso-occlusive phenomena.
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• In children with sickle cell disease, pain is often concentrated in the hands or feet.
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• Pain in sickle cell disease can also develop in the abdomen, back, chest, and long bones.
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• Rapid assessment is critical to determine concomitant disorders, including acute chest syndrome, myocardial infarction, and venous thromboembolism.
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• The rapid administration of analgesia, often with opiate medication, is crucial in managing acute pain in sickle cell disease.
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• Patients with sickle cell disease may require higher doses of opiate medications due to chronic exposure.
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• Reversal of hypoxia, hypovolemia, and acid/base disturbances should be prioritized in managing pain crises.
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• Oral medications like celecoxib and oxycodone may not provide sufficient analgesia for acute pain in sickle cell disease.
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• Given the patient's low oral intake, a parenteral route of administration is preferred for analgesia.
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• Incorrect answers to the question included oral celecoxib, oral oxycodone, intramuscular ketorolac, and intravenous meperidine.
  step2. internal_medicine
• The most appropriate medication to administer to a patient experiencing an acute painful episode in sickle cell disease is intravenous morphine.
  internal_medicine step2
• Vaso-occlusive phenomena are common in patients with sickle cell disease.
  internal_medicine step2
• Acute painful episodes, sometimes referred to as pain crises, are a manifestation of vaso-occlusive phenomena in sickle cell disease.
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• In children, pain during a sickle cell crisis is often concentrated in the hands or feet.
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• Pain can also develop in the abdomen, back, chest, and long bones during a crisis.
  internal_medicine step2
• Rapid assessment of the patient is critical to determine if there are concomitant disorders such as acute chest syndrome, myocardial infarction, venous thromboembolism, or infection.
  internal_medicine step2
• The rapid administration of analgesia is crucial for treating acute painful episodes in sickle cell disease.
  internal_medicine step2
• Patients with sickle cell disease require substantially higher doses of opiate medications due to chronic exposure, compared to opiate-naive patients.
  internal_medicine step2
• Reversal of inciting features such as hypoxia, hypovolemia, and infection should be prioritized in the management of sickle cell pain.
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• Oral medications such as oral celecoxib and oral oxycodone may be appropriate for chronic pain but are not sufficient for acute painful crises in sickle cell patients.
  internal_medicine step2
• Intramuscular ketorolac is not preferred for acute painful episodes in sickle cell disease because it is unlikely to produce the required level of analgesia.
  internal_medicine step2
• Intravenous meperidine is rarely used for acute pain due to its challenging pharmacodynamics and kinetics.
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• The best-next-step in managing an acute painful episode in a patient with sickle cell disease is to promptly administer intravenous opiates.
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• For effective management of pain crises, some centers use an individualized and predefined pain pathway for treatment.
  internal_medicine step2
• Missing key features such as acute chest syndrome at assessment can lead to inadequate treatment of pain in sickle cell disease.
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• The educational objective emphasizes the need for rapid assessment to identify concomitant disorders, which should coincide with administration of intravenous opiates.
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• The greatest risk factor for cerebral infarction in this patient is hypertension.
  neurology internal_medicine step2
• Uncontrolled hypertension is associated with an approximately two-fold increase in the risk for ischemic stroke.
  neurology internal_medicine step2
• Initiation of antihypertensive therapy is an important component of stroke prevention.
  neurology internal_medicine step2
• Lifestyle modifications for stroke prevention include weight loss, dietary modification, smoking cessation, and regular exercise.
  neurology internal_medicine step2
• Abnormal serum lipid concentrations have not been consistently demonstrated as a risk factor for all stroke subtypes.
  neurology internal_medicine step2
• Family history of cerebral infarction is described as an important, non-modifiable risk factor.
  neurology internal_medicine step2
• Increases in serum glucose concentration are significant for ischemic stroke in the context of diabetes mellitus.
  neurology internal_medicine step2
• While abnormal serum lipid concentrations may play a modest role, hypertension is considered more significant in the development of ischemic strokes.
  neurology internal_medicine step2
• The patient's fasting serum glucose concentration is 180 mg/dL.
  neurology internal_medicine step2
• The patient's serum LDL-cholesterol concentration is 170 mg/dL.
  neurology internal_medicine step2
• Family history of cerebral infarction is not as important as hypertension in assessing stroke risk.
  neurology internal_medicine step2
• Lifestyle modification is crucial for preventing stroke, especially for those with hypertension.
  neurology internal_medicine step2
• Hypertension is the greatest modifiable risk factor for cerebral infarction and contributes to cardiac and renal failure.
  neurology internal_medicine step2
• Uncontrolled hypertension is associated with an approximately two-fold increase in the risk for ischemic stroke.
  neurology internal_medicine step2
• Even with well-controlled hypertension, the risk for ischemic stroke is incompletely eliminated.
  neurology internal_medicine step2
• Initiation of antihypertensive therapy is important for stroke prevention, along with lifestyle modifications.
  neurology internal_medicine step2
• Lifestyle modifications for stroke prevention include weight loss, dietary modification, and smoking cessation.
  neurology internal_medicine step2
• Abnormal serum lipid concentrations have not been consistently shown to be a significant risk factor for all stroke subtypes.
  neurology internal_medicine step2
• Family history of cerebral infarction is an important non-modifiable risk factor but not as significant as hypertension.
  neurology internal_medicine step2
• An increase in serum glucose concentration is a significant risk factor for ischemic stroke when associated with diabetes mellitus.
  neurology internal_medicine step2
• Smoking history is an important modifiable risk factor for ischemic stroke, but the relative risk is less than that of hypertension.
  neurology internal_medicine step2
• The American Heart Association states that family history is not as important as hypertension and has not been consistently demonstrated as a risk factor in large studies.
  neurology internal_medicine step2
• Risk factors for cerebral infarction include: hypertension, abnormal serum lipids, family history, and smoking.
  neurology internal_medicine step2
• Aspirin is an antiplatelet agent that irreversibly inactivates cyclooxygenase.
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• The conversion of arachidonic acid to thromboxane A2 is prevented by aspirin, reducing platelet activation.
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• In large doses, salicylate poisoning causes a respiratory alkalosis due to hyperventilation.
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• Salicylate poisoning leads to a delayed anion-gap metabolic acidosis due to effects on the electron transport chain.
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• The production of lactate and ketoacids contributes to metabolic acidosis in salicylate toxicity.
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• Symptoms of acute salicylate toxicity include hyperventilation, gastrointestinal upset, and tinnitus.
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• Chronic salicylate ingestion may present with mild symptoms such as tinnitus and nausea.
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• Management of salicylate toxicity involves systemic alkalinization with sodium bicarbonate infusion.
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• Patients with severe altered mental status may require dialysis as part of salicylate toxicity management.
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• Hyponatremia is unlikely in salicylate poisoning, which helps differentiate between causes of metabolic acidosis and patient diagnosis.
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• Salicylate toxicity is characterized by an increased anion gap and compensated metabolic acidosis.
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• Choice A indicates hyponatremia, which is unlikely in salicylate poisoning.
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• Choice B indicates hypokalemia, an unlikely finding in salicylate toxicity.
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• Choice D indicates hyperkalemia, typically associated with renal insufficiency, not salicylate toxicity.
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• Choice F indicates hyperkalemia, which is not typical for salicylate toxicity.
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• Aspirin prevents the conversion of arachidonic acid to thromboxane A2.
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• Thromboxane A2 is involved in platelet activation.
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• Decreased synthesis of thromboxane A2 reduces platelet activation.
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• Salicylate poisoning can cause respiratory alkalosis due to stimulation of respiratory centers.
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• Acute salicylate toxicity leads to a delayed anion-gap metabolic acidosis.
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• Salicylate's decoupling effects on the electron transport chain result in increased anaerobic metabolism.
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• In salicylate toxicity, increased anaerobic metabolism produces lactate and ketoacids.
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• Patients with acute salicylate toxicity may present with hyperventilation and gastrointestinal upset.
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• Chronic salicylate ingestion may lead to mild symptoms such as tinnitus and nausea.
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• Mild salicylate toxicity may present with an increased anion gap and compensated metabolic acidosis.
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• Management for salicylate toxicity involves systemic alkalinization using sodium bicarbonate infusion.
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• Patients may need dialysis in severe cases of salicylate toxicity with altered mental status.
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• Salicylate poisoning is unlikely to cause hyponatremia (Choice A), as it does not typically impact sodium levels.
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• Hypokalemia is unlikely in salicylate toxicity (Choice B); it generally does not affect potassium serum concentrations.
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• Salicylate toxicity would not result in hyperkalemia (Choices D and F); hyperkalemia is seen in conditions like renal insufficiency.
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• In salicylate toxicity, the bicarbonate concentration would not be normal or increased (Choices D, E, F).
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• Early stages of salicylate poisoning show respiratory alkalosis but not mild metabolic alkalosis (Choice E).
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• Symptoms of salicylate toxicity include hyperventilation, hyperthermia, and tinnitus.
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• A 23-year-old woman presents with a lesion on her lip characterized by a grouping of discrete, clear, fluid-filled vesicles that are 5 mm in diameter, indicative of herpes simplex.
  internal_medicine neurology step2
• The prodromal symptoms of herpes labialis may include burning, tingling, and itching before the appearance of vesicular lesions.
  internal_medicine neurology step2
• Herpes simplex virus (HSV) commonly affects the oral-labial margin, often leading to painful ulcers with an erythematous border.
  internal_medicine neurology step2
• The diagnosis of herpes labialis is confirmed with viral culture or polymerase chain reaction testing from the base of the lesion.
  internal_medicine neurology step2
• Reactivation of HSV may occur from latency in the trigeminal ganglion, producing painful vesicles with associated lymphadenopathy.
  internal_medicine neurology step2
• Treatment of herpes labialis includes antiviral agents that inhibit viral DNA polymerase, such as acyclovir, valacyclovir, and famciclovir.
  internal_medicine neurology step2
• Chickenpox is caused by the varicella-zoster virus (VZV), presenting with a diffuse rash of fluid-filled vesicles, unlike the localized lesions seen in herpes simplex.
  internal_medicine neurology step2
• Unlike herpes simplex, erythema multiforme presents with targetoid lesions on palms and soles and is often triggered by drugs and certain infections.
  internal_medicine neurology step2
• Herpes zoster (shingles) manifests with multiple vesicular lesions in a unilateral, dermatomal distribution.
  internal_medicine neurology step2
• The correct diagnosis for a patient presenting with tingling, burning sensation in the lip followed by vesicles is herpes simplex.
  internal_medicine neurology step2
• For herpes simplex treatment, antiviral choices may vary based on severity and include agents such as acyclovir and valacyclovir.
  internal_medicine neurology step2
• Herpes labialis typically begins with the formation of vesicles at the oral-labial margin, which lyse and progress to shallow, painful ulcers with an erythematous border.
  internal_medicine neurology step2.
• Many patients with herpes labialis experience prodromal symptoms such as burning, tingling, itching, or pain for several days prior to vesicular lesions.
  internal_medicine step2.
• Herpes labialis is most often caused by HSV-1, but can also be caused by HSV-2.
  internal_medicine neurology step2.
• Following initial infection, HSV may be latent in the trigeminal ganglion until reactivation occurs.
  internal_medicine neurology step2.
• Reactivation of HSV causes painful vesicles and punched-out erosions on the lip with associated lymphadenopathy.
  internal_medicine neurology step2.
• Reactivation of HSV can be triggered by stress, sunlight, or local trauma such as dental procedures.
  internal_medicine neurology step2.
• The diagnosis of herpes labialis is confirmed with a viral culture or polymerase chain reaction test from the base of the lesion if uncertain.
  internal_medicine step2.
• Treatment for herpes labialis includes antiviral agents that inhibit viral DNA polymerase, such as acyclovir, valacyclovir, and famciclovir.
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• These antiviral agents are chosen based on severity and recurrence of herpes labialis.
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• Chickenpox is caused by primary infection with varicella-zoster virus (VZV) and does not present with localized vesicular lesions at the oral-labial margin.
  internal_medicine neurology step2.
• Erythema multiforme is characterized by targetoid lesions and may be associated with fever and myalgias.
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• Erythema nodosum presents as erythematous, painful, immobile nodules on the shins.
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• Erythema nodosum lesions are typically bilateral and between 2 and 5 centimeters in diameter.
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• Erythema nodosum may be associated with conditions such as inflammatory bowel disease, sarcoidosis, and bacterial or viral infections.
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• Many patients with mild symptoms from herpes labialis may not require oral antiviral therapy.
  internal_medicine step2.
• An otherwise healthy 42-year-old man presents with a progressive rash over his arms and back. The rash is likely to be psoriasis.
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• Psoriasis is primarily caused by immune dysregulation leading to keratinocyte proliferation.
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• The most common form of psoriasis is plaque psoriasis, also known as psoriasis vulgaris.
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• Plaque psoriasis typically presents with sharply defined, erythematous plaques with white scale.
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• In psoriasis, removal of the white scale causes Auspitz sign, which is characterized by pinpoint bleeding.
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• Common nail changes in psoriasis include nail pitting.
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• If psoriasis is refractory to topical therapies, potential management options include phototherapy, methotrexate, and biologic medications.
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• The correct answer for a rash that is mildly itchy and has a characteristic appearance is F) Psoriasis.
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• Why is atopic dermatitis incorrect for this presentation? It typically presents with pruritic eczema rather than plaque-like lesions.
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• Bullous pemphigoid is not the diagnosis here because it present with blisters instead of well-defined plaques.
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• Dysplastic nevi are characterized by atypical moles and not scaly patches.
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• Tinea corporis, or ringworm, would present with a scaling ring rather than patches seen in psoriasis.
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• What distinguishes the rash of psoriasis from pityriasis rosea? Psoriasis has sharply defined edges compared to less clear borders in pityriasis rosea.
  internal_medicine step2
• Psoriasis is a common inflammatory skin condition caused by immune dysregulation leading to keratinocyte proliferation.
  internal_medicine dermatology step2.
• The most common presentation of psoriasis is plaque psoriasis or psoriasis vulgaris.
  internal_medicine dermatology step2.
• Plaque psoriasis presents with multiple, sharply defined, erythematous cutaneous plaques with a white scale.
  internal_medicine dermatology step2.
• The lesions in plaque psoriasis are commonly pruritic and removal of the white scale causes pinpoint bleeding (Auspitz sign).
  internal_medicine dermatology step2.
• Nail changes in psoriasis are most commonly nail pitting.
  internal_medicine dermatology step2.
• Other forms of psoriasis include pustular psoriasis, psoriatic arthritis, and guttate psoriasis.
  internal_medicine dermatology step2.
• Treatment of psoriasis includes topical therapies such as corticosteroids and Vitamin D analogs.
  internal_medicine dermatology step2.
• If psoriasis is refractory to topical therapies, then phototherapy, methotrexate, or biologic medications may be considered.
  internal_medicine dermatology step2.
• Atopic dermatitis is also known as eczema.
  internal_medicine dermatology step2.
• Atopic dermatitis lesions may be found in flexural creases or on extensor surfaces.
  internal_medicine dermatology step2.
• Bullous pemphigoid is characterized by antibodies against hemidesmosome and presents with tense bullae.
  internal_medicine dermatology step2.
• Dysplastic nevi are benign melanocytic lesions that may rarely transform into cutaneous melanoma.
  internal_medicine dermatology step2.
• Lichen simplex chronicus results from repetitive rubbing or itching of the skin.
  internal_medicine dermatology step2.
• Pityriasis rosea often follows a viral infection and is characterized by the acute onset of a pruritic patch.
  internal_medicine dermatology step2.
• In pityriasis rosea, the patches commonly involve the trunk and proximal extremities.
  internal_medicine dermatology step2.
• The image shows widespread erythematous, scaly rash, consistent with plaque psoriasis.
  internal_medicine dermatology step2.