Spooky Skin (Melanoma)
Not so spooky skin (Benign tumors)
OCD at the PCP
To poke or not to poke? (Injections of the hands and wrists)
EDD is just a date anyway (late and postterm pregnancies)
100
Name 3 risk factors for melanoma
1. Older age
2. Early UV light exposure
3. Personal or family history
4. Fitzpatrick I and II skin types
5. Indoor tanning
Note - African Americans have lower incidence of melanoma but much higher mortality, partially thought to be because of much later diagnosis
100
Name this skin lesion.
I named him Ted! #lol
A keratoacanthoma is a dome-shaped nodule with a central crater and can be difficult to distinguish from squamous cell carcinomas even with dermoscopy. Because of this, they should be excised with 5 mm margins. These are most commonly on sun exposed areas of arms and legs.
100
Define obsessions and compulsions
Obsessions: intrusive and unwanted thoughts, images, or urges which cause distress
Compulsions: repetitive actions or thoughts patients are driven to do by obsessions (ie. washing, counting, praying)
100
Name 3 risks of corticosteroid injections
1. Infection
2. Cartilage damage
3. Skin depigmentation
4. Skin thinning
100
Define postterm and later term pregnancy
Postterm: >42 weeks
Later term: between 41w0d and 41w6d
200
Which age range should specifically be encouraged to use protective clothing and sunscreen to reduce risk of melanoma?
6 months to 24 years old
200
What kind of cyst is this?
Pilar cysts (trichilemmal cysts) are slow-growing, intradermal cysts derived from outer hair follicle root sheath tissue and are found primarily on the scalp Rapidly growing pilar cysts are definitively diagnosed and treated with complete surgical excision and monitoring for recurrence as these could have have malignant qualities.
200
What are the main nonpharmacologic and pharmacologic treatments for OCD?
Nonpharmacologic: CBT - specifically exposure and response prevention
Pharmacologic: SSRIs (fluoxetine, paroxetine, sertraline)
200
True or false: Steroid injection into ganglion cysts produces additional benefits than aspiration alone
False
200
Name 3 risks which significantly increase in postterm pregnancies (for mother or baby)
1. Neonatal mortality
2. Admission to NICU
3. Stillbirths (30x increase!)
4. Hypertensive disease (NNT 20)
5. Delivery via cesarean section (NNT 28)
300
Describe ABCDE and the ugly duckling sign as they relate to melanoma.
A- asymmetry
B-irregular borders
C-irregular coloration
D-diameter >6 mm (pencil eraser)
E-evolving (changes in size, shape, color)
Ugly duckling - looks different from other lesions
300
What kind of cyst is this and why should it be removed?
Dermoid cysts are subcutaneous and have embryological origins associated with craniofacial development. They contain a mixture of squamous epithelium, keratin, sebaceous glands, and hair. Dermoid cysts, depending on their location, can have intracranial extension if untreated.
300
Name a validated tool for OCD diagnosis and at least 2 screening questions
1. Yale-Brown Obsessive-Compulsive Scale
2. Florida Obsessive-Compulsive Inventory
3. Obsessive-Compulsive Inventory-Revised
300
Injecting in this location would assist with what pathology?
Trigger finger
300
ACOG recommends considering elective induction at _ gestation for low risk, nulliparous patients and recommends induction for all patients by _ gestation
Elective induction - 39 weeks
All patients - 42 weeks
400
What are the preferred type of biopsy to be done for suspicious lesions? 4 are mentioned in the article - name 3
1. Deep scoop shave
2. Saucerization
3. Punch biopsy
4. Full-thickness excision
Goal is 1-3 mm margins
400
Name 3 treatment options for benign skin lesions
Excision (keratoacanthomas, rapidly proliferating pilar cysts, and dermoid cysts)
Laser therapy (cherry angiomas)
Electrodessication (pyogenic granulomas)
Shave excision (acrochordons/skin tags, seborrheic keratoses, pyogenic granulomas)
Cryotherapy (acrochordons, seborrheic keratoses)
400
Name 3 common conditions misdiagnosed as OCD
400
When injecting in this location, what other things should be recommended to patients to do concurrently to get the most benefit?
For 1st carpometacarpal joint injections, patients should also be told to take NSAIDs and avoid repetitive movements
400
ACOG recommends antenatal monitoring for all pregnancies beginning at _ gestation to mitigate risks of perinatal morbidity and mortality
41 weeks
500
What is Breslow depth and how does it relate to melanoma?
Breslow depth < 0.8 mm - usually do not need additional treatment after wide local excision and have excellent prognosis
Breslow depth > 0.8 mm - often need lymph node biopsy, complete lymph node dissection, gene mutation analysis, and/or systemic immunotherapy
500
Name this lesion and the sign which helps to diagnosis it
Dermatofibromas originate from a dermal proliferation of fibroblasts after minor trauma, insect bites, viral infections, ruptured cysts, or folliculitis. They typically present as a solitary, firm, often hyperpigmented, 3- to 10-mm nodule and may be pruritic.
The lesions display dimple sign (Fitzpatrick sign), in which lateral pressure on the lesion produces a dimpling or retraction beneath the skin
500
There are 4 primary dimensions of common obsessions. Name 3
1. Contamination/cleaning
2. Worry about accidental harm/repeated checking
3. Seeking symmetry and order
4. Unacceptable thoughts and mental rituals
500
Due to risk of disease recurrence and adverse effects, steroid injections for this condition should be approached with caution. 
Palmar fibromatosis/Dupuytren Contracture
Most patients have recurrence within 1-3 years of injection
500
Name 3 risk factors for prolonged gestation
