Dermatology and Neurology

Abstract

As the internal medicine resident prepares for the difficult task of learning such a broad range of material that encompasses the specialty over 3 years, repetition becomes crucial for the retaining of knowledge. The first “prescription” for internal medicine residents that I work with in this preparation in our program is for selecting a specialty topic per month to devote a large amount of study time over that month and for that month to be the same in each of the 3 years. This strategy allows that internal medicine resident to focus on each specialty topic consistently every year for 3 years. An example would be ironically to review allergy and immunology as the topic for July which is the first specialty by alphabet but fits nicely in July given the material is not as voluminous as the other 11 specialty topics and July tends to be a month of transition for internal medicine residents whether it is the first month of residency for interns or the first month as a senior level resident in the second year.

The format of this section is done in A–Z manner so as to help keep the reader engaged and to help with recall of facts in a much easier fashion. An example from the allergy section is from the F letter which leads to fleeting infiltrates headliner that then leads to allergic bronchopulmonary aspergillosis being tied into that phenomenon of that ever-changing radiographic pattern. The 26 pearls or set of pearls for each letter of the alphabet set the stage for the internal medicine resident to pick up on necessary knowledge within that specialty topic in a consistent fashion every year for 3 years such that no stone is left unturned and encourages residents to further read for supplementation on the pearls that are given for each letter.

FormalPara Actinic Keratosis

Actinic keratoses are the precursor lesions to squamous cell cancer of the skin. Cryotherapy is used in treatment of actinic keratoses but other therapies can be used for widespread disease.

FormalPara Basal Cell Cancer

Basal cell carcinoma is the most common skin cancer in immunocompetent individuals. Patients with solid organ transplant will have a marked increase in squamous cell cancer formation.

FormalPara Carbamazepine

Carbamazepine is the preferred treatment of trigeminal neuralgia.

FormalPara Dopamine Receptor Agonists

Dopamine agonist receptor drugs such as ropinirole or pramipexole can cause increased gambling behavior and mania-type symptoms (such as starting numerous jobs but never finishing any of them).

FormalPara EEG Monitoring

Inpatient video EEG monitoring should be done as next step in all patients with history of questionable seizures, particularly if “pelvic thrusts” are part of the movements described in the seizure (as these are unusual movements in true seizure episodes).

FormalPara Fabry’s Disease Skin Manifestations

Fabry’s disease is associated with angiokeratomatosis diffusum corporis as one of its leading skin manifestations.

FormalPara Gold Side Effects Dermatology

Gold is associated with an exfoliative dermatitis in treatment very similar to the exfoliative state that can be seen in patients taking lamotrigine.

FormalPara Hemorrhagic Stroke

A patient having a hemorrhagic cerebellar stroke should be evaluated by the neurosurgery team in urgent fashion for a decompression surgery.

FormalPara Important Medication Note

Methotrexate patients must take folic acid daily to avoid neuropathy along with prevention of oral ulcerations that can occur with folic acid deficiency.

FormalPara JC Virus

Look out for progressive multifocal leukoencephalopathy (PML) caused by the JC virus in patients with HIV disease who have low CD 4 counts and present with mental status changes and visual field deficits with ataxia.

FormalPara Knowledge Check

A serum ceruloplasmin measurement is the first step in management when suspecting a patient with Wilson’s disease who has had seizures, liver disease, hemolytic anemia, and psychic overtones.

FormalPara Light Therapy

UV light therapy can be used in management for patients with psoriasis. Ensure that the patient does not have a mimicker of this condition which is subacute cutaneous lupus erythematosus which will worsen with UV Light therapy by checking to make sure anti-Ro (anti-SS-A) antibodies are negative.

FormalPara Metoclopramide

Metoclopramide can cause a myriad of neurological issues to include tardive dystonia, akathisia, and drug-induced Parkinsonism.

FormalPara Neurodermatitis

Watch out for manifestations of patients with chronic scratch-itch cycle to include lichen simplex chronicus and prurigo nodularis.

FormalPara ORF

Orf is a skin rash caused by the poxvirus which can come about from handling of sheep and other livestock.

FormalPara Progressive Supranuclear Palsy

Patients with progressive supranuclear palsy will present with a “Parkinson’s plus” type picture with bradykinesia, cogwheel rigidity, difficulty making turns, and tremor.

FormalPara Q-Fever

Coxiella burnetii can cause palpable purpura skin changes if there is associated endocarditis from the infection. Q-fever also likes to cause liver failure as well.

FormalPara Rigidity in Serotonin Syndrome

Rigidity is seen in less than half of cases of serotonin syndrome. More common neurological manifestations include hyperreflexia (clonus can be seen).

FormalPara Startle Myoclonus

Look for “startle myoclonus” in patients with rapidly progressive dementia when suspecting Creutzfeldt-Jacob disease.

FormalPara Torticollis

Botulinum toxin injections are used in the treatment of torticollis conditions.

FormalPara Ulcers of the Skin

The most common ulcerative skin lesion state associated with ulcerative colitis is pyoderma gangrenosum.

FormalPara Very Important Association

Look for multiple sclerosis if a patient has repeated episodes of trigeminal neuralgia or optic neuritis.

FormalPara Wilson’s Disease

Wilson’s disease which can be marked by seizures as part of its presentation is treated with D-penicillamine in acute stages and then treatment transitions to zinc for chronic therapy.

FormalPara X-CESS of Pyridoxine

Pyridoxine deficiency and excess can both cause a peripheral neuropathy.

FormalPara Youthful Seizure Disorder

Juvenile absence epilepsies may have an onset as late as age 16 and may have up to a quarter of patients suffer from myoclonic jerks. Valproic acid is first-line therapy for treatment of seizures from this condition.

FormalPara Zinc Deficiency

Acrodermatitis enteropathica is an inherited form of zinc deficiency with lifelong complications of alopecia, dermatitis, and secondary bacterial and fungal infections that can occur if zinc supplementation is not sustained.