Dermatology, Musculoskeletal, and Bone Health Lecture Review (copy)

A comprehensive set of question-and-answer flashcards covering acne, osteoarthritis, sunburn/UV exposure, musculoskeletal OTC therapy, and osteoporosis as presented in the lecture notes.

What are the four major pathophysiologic factors that cause acne vulgaris?

Increased sebum production, hyperproliferation of ductal epidermis, Propionibacterium acnes colonization, and inflammation

Name two environmental factors that can exacerbate acne.

Heat/humidity/pressure/friction and seasonal worsening in winter compared with summer

How is mild acne defined on the grading scale?

Few to several papules or pustules with NO nodules

What is a closed comedone commonly called?

White head

Why are open comedones black?

Dark color comes from oxidized lipids and melanin

Describe a pustule in acne.

What characterizes a nodule in acne?

Deep dermal inflammatory lesion ≥5 mm that is warm, tender, and firm

Primary treatment goals for acne include long-term control, adherence, and symptom relief—True or False?

True

List two important non-pharmacologic acne measures.

Wash face ≤2 times daily with mild soap; avoid aggravating factors such as high-glycemic diet and stress

Which three common OTC topical agents exfoliate to correct keratinization in mild-moderate acne?

Topical retinoids, salicylic acid, and benzoyl peroxide

Name two oral antibiotics used for moderate-severe inflammatory acne.

Erythromycin and tetracycline (minocycline acceptable)

Which acne medication is teratogenic yet provides prolonged remission?

Isotretinoin

Give four drug classes commonly responsible for drug-induced acne.

Systemic corticosteroids, antiepileptics, lithium, halogens (iodine) / cobalt / vitamin B12

Differentiate primary vs. secondary osteoarthritis etiology.

Primary OA is idiopathic; secondary OA is linked to other disease, trauma, or metabolic disorders

List five major risk factors for osteoarthritis.

Obesity, older age (>65 y), female gender > 45 y (male < 45 y), joint trauma history, certain occupations/athletics

First-line pharmacologic therapy for knee or hip OA is _.

Acetaminophen

Which agents are preferred first-line for hand/wrist OA?

NSAIDs

State two cornerstone non-pharmacologic OA interventions.

Weight loss (diet/exercise) and physical/occupational therapy

Which ultraviolet band is called “sunburn radiation” and has wavelength 290-320 nm?

UVB

What percentage of UVA vs. UVB reaches the earth?

96 % UVA and < 4 % UVB

Give three personal risk factors for severe sunburn.

Fair skin that burns easily, history of blistering sunburns, use of photosensitizing or immunosuppressive drugs (others: red/blond hair, light eyes, family melanoma)

Define the UV-blocking mechanism of chemical sunscreens.

Form film on skin that absorbs ≥ 85 % of UVR 290-320 nm, preventing epidermal penetration

Which chemical sunscreen provides the best UVA1 coverage?

Avobenzone

Name two sunscreen ingredients banned in Hawaii for environmental impact.

Oxybenzone and octinoxate

What is the general rule for applying sunscreen amount and timing?

Apply ~1 oz (nine portions) 15-30 min before exposure

How often should non-water-resistant sunscreen be reapplied?

Every 2 hours and after swimming, sweating, or towel-drying

List two physical (inorganic) sunscreen agents and their UV coverage.

Zinc oxide or titanium dioxide; both cover UVB, UVA1, and UVA2 broadly

State the CHESS counseling acronym for sun protection.

Clothing, Hat, Eyeglasses, Sunscreen, Shade

What does the RICE acronym stand for in acute musculoskeletal injury?

Rest, Ice, Compression, Elevation

How long and how often should ice be applied after an acute strain/sprain?

15-20 minutes, 3-4 times/day for 1-3 days

Give adult OTC dosing for ibuprofen.

200-400 mg every 4-6 h PRN; max 1200 mg/day

Which counterirritant ingredient produces a cooling sensation by activating cold receptors?

Menthol

Capsaicin’s analgesic mechanism involves depletion of which neuropeptide?

Substance P

How many days may topical lidocaine patches be used continuously for self-treatment?

Up to 7 days

Define osteoporosis in one sentence.

A skeletal disorder characterized by low bone mass, microarchitectural deterioration, reduced strength, and elevated fracture risk

List three hormones/nutrients critical to bone mineral density.

Calcium, vitamin D, parathyroid hormone (calcitonin and phosphorus also significant)

Why does estrogen deficiency accelerate bone loss?

It increases osteoclast formation and survival and promotes urinary calcium loss with reduced gut absorption

Give two medications that can induce secondary osteoporosis through vitamin D metabolism.

Phenobarbital and phenytoin

What height loss indicates high risk of vertebral fracture in osteoporosis?

1.5 inches (≈ 3.8 cm)

Non-pharm prevention of osteoporosis focuses on what four lifestyle measures?

Adequate calcium/vitamin D, weight-bearing & muscle-strengthening exercise, limited alcohol, smoking cessation

Name two bisphosphonates approved for osteoporosis prophylaxis.

Alendronate and risedronate (others ibandronate, zoledronic acid)

What are the two primary treatment goals in established osteoporosis?

Minimize bone loss/increase BMD and reduce falls/fractures

Which biologic monoclonal antibody is FDA-approved for osteoporosis and marketed as Prolia?

Denosumab

How often is zoledronic acid infused for osteoporosis treatment?

Once yearly (5 mg IV)

Which OTC analgesic is first-line for pain in osteoarthritis but has a suggested maximum daily dose of 3250 mg?

Acetaminophen

Tendons connect to bone, whereas ligaments connect to bone.

Muscle; bone

Differentiate strain vs. sprain.

Strain = injury to muscle/tendon (twist/pull); Sprain = ligament injury

Grade III sprain signifies what?

Complete ligament tear

Identify two exclusions for self-treating musculoskeletal pain.

Severe pain > 6/10, pain > 10 days duration (others: < 2 years old, infection signs, pregnancy, abdominal pain, etc.)

Why should heat not be applied to inflamed areas?

Heat intensifies vasodilation and may worsen inflammation

Explain the mechanism of rubefacient counterirritants such as methyl salicylate.

Vasodilation of cutaneous blood vessels to create a sensation of warmth and distract from deeper pain

List two ADEs associated with chemical sunscreen ingredients like PABA or cinnamates.

Contact dermatitis and photosensitivity reactions

Which sunscreen active is water-resistant and mainly covers UVB?

Ensulizole

What are the two main methods of wound healing?

Regeneration (epithelial only) and scarring (deeper tissue involvement)

Histamine, bradykinin, and prostaglandin E all contribute to which three cardinal signs in acute injury?

Erythema, edema, and hyperalgesia

In acne therapy, which topical retinoid is pregnancy category X due to teratogenicity?

Tazarotene

Which antibiotic–benzoyl peroxide combination reduces P. acnes resistance development?

Topical clindamycin plus benzoyl peroxide

What counseling point should be given regarding sunscreen and DEET insect repellent?

Apply sunscreen BEFORE applying DEET

How long should a lidocaine patch remain on the skin per application?

Up to 12 hours on, then 12 hours off

Which oral anti-androgenic therapy may be used in severe acne to decrease sebaceous activity?

Agents with antiandrogen effect (e.g., hormonal therapy/spironolactone)

What type of acne lesion is considered the first clinically visible sign of acne?

Closed or open comedone

Name two vitamins or nutrients whose high intake can paradoxically increase bone loss/fracture risk.

High salt and excess vitamin A

What musculoskeletal therapy uses low-voltage electrical stimulation for pain relief?

TENS (Transcutaneous Electrical Nerve Stimulation)

Explain why hydrocortisone is the exception among systemic corticosteroids for drug-induced acne.

Hydrocortisone lacks the ability to inhibit protein synthesis and is less acne-genic

Which chemical sunscreen stabilizer is often paired with ecamsule for better light stability?

Octocrylene

State the recommended adult dosing for naproxen sodium in OTC musculoskeletal pain.

220 mg every 8-12 h; two tablets (440 mg) may be taken for first dose

Which topical NSAID is dosed as 4 g four times daily for the lower extremities?

Diclofenac gel (Voltaren)