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Monday, September 1, 2014

Dermatology List of Most Commons for Physician Assistant Students


Most PA programs teach in a systems-based style of learning with “block” style approaches to navigating through the mounds of medical factoids we must learn and know. It’s often talked about how PA students should start their own lists of “most commons” in medicine for each block or system in preparation for course examinations and the PANCE. It has come to my attention that this is most definitely the case. As such, I’ve decided to create a list of most commons for each block we cover, the first being Dermatology!

Most Commons in Dermatology:
  1. Most common treatment for keloids: triamcinolone acetonide (corticosteroid) in concentrations of 10-40 mg/mL at 4-6 week intervals
  2. Most common cutaneous cyst: epidermal inclusion cyst (EIC), also known as cutaneous cysts
  3. One of Top 3 Skin problems in children: verruca vulgaris
    1. Most common primary treatment: cryotherapy and salicylic acid (cure rate improved by combining both therapies)
  4. Human Papilloma Virus (HPV) is one of the most common STIs causing Condylomata Acuminate, also known as External Genital Warts (EGW)
  5. Most common type of psoriasis: Plaque Psoriasis (affects 80-90% of patients).
  6. Most common clinical pattern seen in Psoriatic Arthritis:
    1. Oligoarthritis - swelling and tenosynovitis of one/few hand joints.
  7. The “Butterfly Rash”
    1. Many facial rashes are described as malar or “butterfly” rashes
    2. Most commonly, they are either: seborrheic dermatitis or rosacea, NOT systemic lupus erythematosus (SLE)
  8. Most common dermatologic condition in infants: Diaper Rash (diaper candidiasis)
  9. Tinea Capitis is most commonly caused by Trichophyton tonsurans (human to human or fomite to human transmission) in the US
    1. Most common in school aged children (4-14) in US
    2. Most common worldwide pathogen: Microsporum canis (animal to human)
  10. Most common fungal infection in developed countries: tinea pedis (athlete’s foot)
  11. Most common type of Onychomycosis: Distal Subungual Onychomycosis (DSO)
  12. Most common skin cancer: basal cell carcinoma
    1. Most common subtype: nodular
  13. Most common form of ichthyosis: ichthyosis vulgaris
  14. Most common variation of albinism: oculocutaneous albinism (autosomal recessive)
    1. Second most common: ocular albinism
  15. Most common sex chromosome disorder: Klinefelter Syndrome (x-linked recessive)
  16. Most common subtype of melanoma: Superficial Spreading Type
  17. Most common drug eruption: Exanthematous



Extras:
  1. The “Dimple Sign” - often exhibited by dermatofibromas. Pinch on either side and observe a dimple due to scar-like tethering of the dermis.
  2. The “Auspitz Sign” - bleeding after removal of scale. Exhibited by Plaque Psoriasis.
  3. Pruritic Lesions
    1. Keloid Scars
    2. Psoriasis
    3. Atopic Dermatitis
    4. Allergic Contact Dermatitis
    5. Tinea Corporis
    6. Candida Intertrigo
    7. Pityriasis Rosea
    8. Nummular Dermatitis
    9. Squamous Cell Carcinoma (sometimes)
  4. Koebnerizing Lesions (Koebner phenomenon) - linear mode; spreads with trauma or scratching
    1. Molluscum Contagiosum (MC)
    2. Verruca Vulgaris
    3. Plaque Psoriasis
  5. Systemic Lupus Erythematosus - “mimics rosacea”
  6. Atopic Dermatitis - the “itch that rashes”
    1. The “itch” is the primary symptom and precedes onset
    2. Also seen in Allergic Contact Dermatitis
  7. Red Rashes
    1. Greasy scale and redness
      1. Seborrheic dermatitis
    2. Tender Papules
      1. Acne vulgaris, rosacea
    3. Worse with exercise, heat, hot foods, alcohol
      1. Rosacea
    4. Eyebrows, nasal creases, external auditory canals
      1. Seborrheic dermatitis
    5. Cheeks and chin
      1. Acne vulgaris, acne rosacea, atopic dermatitis
    6. Nose
      1. Acne vulgaris, acne rosacea
      2. Spared in atopic dermatitis
    7. Know Location, History, and Age to help differentiate red rashes on the face
  8. When to run a KOH test
    1. “All that scales, must be scraped”
    2. First step in diagnosing a scaling annular rash on the body is to perform a KOH exam to rule out fungus
  9. Tinea Versicolor
    1. KOH Prep reveals “Spaghetti and Meatballs” pattern
      1. Short hyphae and small round spores
  10. Allylamines are NOT effective for Candida species
    1. Nystatin ONLY works for Candida, not dermatophytes


Credits:
UT Southwestern PA Program

4 comments:

  1. Paul,

    You seem to have so much knowledge about the PA program, I thought I'd ask you a quick question. Do you know if UTSW has accepted F-1 students in the past? Do they require work permits in order to be accepted or to be part of the rotations in 2nd year? I am a Canadian citizen and have lived in Dallas most of my life, but still have to deal with this international business. Your research skills have been so impressive, I wonder if you could lead me on a good path. (I have contacted UTSW directly, just waiting on a response).

    ReplyDelete
    Replies
    1. This is from a female 2014 UTSW PA student:
      "I was on J2 visa (my husband J1 worked for UTSW) when I came to USA. Then, I switched to a H1 visa to have my independent visa ( so I don't need to worry if my husband lost the job),
      I worked about 5 years in a UTSW research lab. Before I started PA school, I swiched to H4 to get in-state tuition. I remember asking the same questions he/she is having now, and my resource was based on international office of UTSW.

      1. Based on the information I got, yes UTSW accepts F1 students, especially the graduate school and MD school. PA school I haven't heard too many previous cases, but International office people told me, they can issue me visa if I prefer F1. I eventually switched to F1 because of the tuition. ( but UTSW PA program also gives part of out-state student scholarship, so F1 student might only pay instate tuition by receiving the scholarship).
      2. We don't need work permits for the rotation year. because we are not receiving any payment or salary or compensation during our rotation ( not like MD resident program).

      The international office staff at UTSW are really helpful and professional, and they are located on NL 3rd floor. If you have very specific questions about other visa types or how long it takes to issue a visa, they can help.

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  2. Oh my goodness Paul, you are truly an amazing friend! I did hear back from them, and while they did not mention the 2nd point in as much detail, they did tell me that some students in the past were F-1's and did get the scholarship so that they would qualify for in-state tuition. I am pretty sure that the medical school does not take F-1's as they do not let US citizens apply (it also states so on the website).

    It is a relief, however, to hear that I do not need to worry as much. Hopefully now just my own credentials will count, rather than my visa status. They were truly professional and helpful, as you said. Thank you very much for your reply! And please help the kind lady as well! :)

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  3. Hi Paul,

    I'm a rising senior biotechnology major, and I've just made the decision to pursue a career as a physicians assistant instead of applying to biomedical engineering programs after graduation. I am hoping to specialize in dermatology, but I've had a lot of trouble finding information online about how to make it happen. I was hoping you'd be willing to provide some insight.

    My first question is about relevant HCE. Because I hadn't been working towards a PA program until very recently, I know I will have to take at least one year off to get my hours. I was thinking that I could earn my CMA certification and (hopefully) work in a dermatology practice for 1-2 years before I apply. However, I've seen that a lot of applicants get their EMT certification or work as techs in hospitals. Do you think that schools would prefer to see more generalized HCE (such as EMT work) over more narrow, specific experience (like as a CMA in a dermatology office)?

    My second question is about how to specialize in dermatology. From what I've read online, this specialization comes mostly after graduation. However, a lot of the job postings I've seen require previous experience. Do you know if most programs include dermatology as a unit in their clinical training? And if not, do you know of any other options for getting experience in an actual PA position in dermatology?

    Thank you so much! Your posts have been so helpful in navigating this process.

    ReplyDelete