CLIPP 32

Question 1

wheals vs petichiae/purpura, and purpura vs petichiae

Answer 1

wheals blanch and purpura/petechiae don’t..

purpora are larger than petchiae

Question 2

what is a wheal

Answer 2

blanching, edematous, thin erythematous papule or plaque, often with a rim of hypopigmentation
May be white to pale red and often appear and disappear over a period of hours

Question 3

atopic triad

Answer 3

asthma, eczema (atopic dermatitis), allergies (allergic rhinitis/hay fever)

Question 4

Roseola

Answer 4

A viral exanthem that classically follows 3-5 days of a febrile illness.
As the fever resolves, patients develop a pink, maculopapular rash that starts on the trunk and may spread to the face and extremities.
Caused by human herpes virus-6 (HHV-6

Question 5

Erythema infectiosum (Fifth Disease)

Answer 5

another viral exanthem - Rash starts on the face with a “slapped”-cheek appearance followed by a reticular (lacy) erythematous rash on the trunk and extremities.
Caused by parvovirus B19.

Question 6

erythema migrans

Answer 6

Lesion associated with early localized Lyme disease.
Starts as a red papule at the site of a tick bite.
Expands to form a large erythematous, annular patch.

Question 7

urticaria is due to

Answer 7

type 1 hypersensitvity

Question 8

classic urticaria lesion

Answer 8

very pruritic (bc histamine release from mast cells), erythematous, edematous wheal often w/ central pallor/hypopig. these lesions continually change with new ones appearing as old ones disappear and individual lesions don’t last more than 12- 24 hours. trigger sometime can be ID’d. usually asymmetric

Question 9

papular urticaria

Answer 9

common pediatric condition due to insect bites (i.e. kid will likely be outdoors a lot in hx) and is pruruitic, can be recurrent/chronic. lesions are 3-10mm

Question 10

rash in streptococcal infection

Answer 10

often scarlet fever, which is fine red sandpapery rash worst at creases; can cause ~ to uriticarial rash

Question 11

Erythema multiforme

Answer 11

symmetric, acute hypersensitivity reaction. dusky red macules become wheals become target lesions. lesions stay for 1-3 weeks and does not come and go. typically assoc w/ herpes.

Question 12

drug eruption

Answer 12

often urticarial, can be type 1 HS but could also be non-immuno triggers

Question 13

hives aka

Answer 13

acute urticaria, often caused by histamine release triggered by food etc or other common allergens

Question 14

tx acute urticaria/hives

Answer 14

anti histamines, cool and calm patient (not hot bath).

-oral pred rarely used if anti histamines don’t work. topical steroids not used bc area is typically large

Question 15

“cradle cap”

Answer 15

seborrheic dermatitis - eryhtematous plaques w/ red/yellow scale, typically on scalp but also on diaper area, ears or neck.

Question 16

3 clues pointing to eczema

Answer 16

atopic diathesis, posterior scalp, extensor surfaces

Question 17

candidal rash

Answer 17

7-10months old, diaper dermatitis, eryhtematous plaques w/ SATELLITE LESIONS

Question 18

psoriasis of scalp

Answer 18

thicker and less waxy scale than seborrheic dermatitis and more defined. may or may nor be pruriitc. may have family hx of this, may have other areas on body affected too.

Question 19

what causes seborrheic dermatitis in older people

Answer 19

malazzeia

Question 20

tx of seborrheic dermatitis in infants and adults

Answer 20

adults = ketoconazole cream

infants =baby oil, baby shampoo or maybe ketoconazole shampoo, and / or mild topical steroid

Question 21

blackheads vs whiteheads

Answer 21

blackheads = open comedones, whiteheads = closed comedones

Question 22

staph folliculitis, furunculitis

Answer 22

often waist or groin area, can be similar to cystic or nodular acne

Question 23

hidrenitis suppuritiva

Answer 23

pustular lesion causing occlusion of apocrine (vs pilosebascious in acne) and often co-infected w/ staph or strep. often affects axilla/groin areas unlike acne.

Question 24

rosacea

Answer 24

often in adults tho early form seen in adol. no comedones. worse w/ stress, spicy food, alcohol. impacts malar and nasal areas. tx w/ metro topically

Question 25

perioral dermaitits

Answer 25

adolescent variant of roscea w/ erhema, papules pustules but still NO comedones. not just perioral, also around eyes/nose

Question 26

psueodfollicutusi

Answer 26

papules, not pustules thus distinct from acne due to this. often in beard area w/ papules near hair follicles and occurs when hair shaved close grows back into folilcle

Question 27

eryhtema nodosum

Answer 27

Hypersensitivity reaction presenting as red, tender, nodular lesions on pretibial surface of the legs. Many possible etiologies, a few of which include infections, drugs, and inflammatory bowel disease. Primary lesions are nodules, not pustules.

Question 28

3 things known to exacerbate acne

Answer 28

mechanical (manipulation, or occlusion i.e. from helmet), make up, overzealous cleaning

Question 29

tx for mild vs mod vs severe acne

Answer 29

mild: BPO, retinoids mod: abx topically or orally, bcp severe: derm referral, isotretinoin

Question 30

4 key facts about retinoid timing

Answer 30

Retinoids need to be used at night, because they can cause photosensitization and lead to a significant sunburn. Tretinoin is also inactivated by oxidation of BPO (so the BPO cream should be applied in the morning). Tretinoin also must be applied to bone-dry skin or it may be significantly irritating. It is important to make sure teens know that retinoids can make acne transiently look worse.

Question 31

doxycycline side effects (5)

Answer 31

photosensitivity, dental staining in children under age 9, teratogenicity, esophagitis i.e. stay upright for 30 min after taking, and pseudotumor cerebri

Question 32

dimethylglyoxime test

Answer 32

home test for nickel

Question 33

chronic contant dermatitis type of rxn

Answer 33

is delayed t4 hypersensitivity, takes 24-72h from start of contact and can occur even w prior tolerance. resolves w/i days to weeks of avoidance

Question 34

tx contact dermaitits

Answer 34

emollient lkike vaseline, aquaphor. remoev offending agent. can try medium potency topical steroid

Question 35

chronic vs acute contact dermaitist

Answer 35

acute will have vesicles, edema and erythema w/ itching

Question 36

toxicodendron/rhus genus

Answer 36

poison ivy, oak, sumac contain urshiol which is active in all seasons and on pets/objects

Question 37

is urshiol tranfersed by blister fluid?

Answer 37

NO

Question 38

tx urshiol exposure

Answer 38

wash hands w/i 30 min w/ soap/water or detergent, topical steroids/oral antihistamines if severe rash and itching. use oral steroids if widespread or increasing in size, for 10-14d

Question 39

impetigo

Answer 39

weeping honey colored crusts often below the nares, due to strep or staph

Question 40

tx impetigo

Answer 40

mupircoin. but b/c of mrsa, watch for abscess formation

Question 41

4 key steroid side effects

Answer 41

hypopig, telangiectasia, suppression HPA axis, skin breakdown/atrophy

Question 42

classes of steroids and their potency, and an example of each

Answer 42

``` mild - class 7,6 (hydrocortisone acetate) med - class 5,4 (triamcinolone acetonide) potent - class 3,2 (betamethasone propionate) super potent - class 1 (clobetazol) -1000x diff between mild and super potent ```

Question 43

a reason infants absorb more steroid

Answer 43

bc of occlusive dressings like diapers

Question 44

pediculosis capitis

Answer 44

head lice

Question 45

tx of lice prophyalctically and missing school

Answer 45

can't tx proph. | otherwise healthy child shouldn't miss school due to nits (i.e. lice ova)

Question 46

current rx for lice

Answer 46

permethrin - repeated applications 2-3x in weekly intervals benzyl alcohol if kid is older than 6 mos malthion - if kid is older than 2y. use malthion or benzyl alcohol if failed permethrin/pyrethin or if resistance to it. also should wet comb w/ fine comb regardless.

Question 47

Lindane

Answer 47

former lice tx but can --> neurotoxicity

Question 48

scabies sx

Answer 48

itching, wosrt at night, often fingers toes wrists and elbows. often see linear lesions, can ultimately -->impetigo or even cellulitis

Question 49

scabies tx and after its gone

Answer 49

two applications of permethrin 5% cream, one week apart, for all affected household members. (oral ivermectin if allergic to permethrin) can get post scabetic itch due to inflammation of infestation for a few weeks

Question 50

ringworm aka

Answer 50

tinea corporis, a superficial fungal infxn

Question 51

classic ringworm lesion and its dx

Answer 51

annular w/ raised borders and scaly, pururitc, w hypo pig in middle or brown. dx w/ koh, see branches and rod shaped septated hyphae

Question 52

tinea versicolor - what iti s, predispose by, tx

Answer 52

aka malazeia. predispose by sweat, sun, humidity tx = selium sulfide shampoo

Question 53

which type of tine requires systemic tx, and w what

Answer 53

tine capitis - griseofulvin 6-8weeks - i.e. any involvement of scalp w/ tines -->systemic tx

Question 54

kerion

Answer 54

allergic response occurring in tine capitits - weepy boggy lesion requring oral steroids that goes away once fungus infection is controlled

Question 55

what can make tine worse

Answer 55

if misdiag as eczema and tx w/ steroid

Question 56

nummular eczema

Answer 56

coin shaped lesions on butt and legs

Question 57

pityriasis alba vs roesa

Answer 57

alba: hypo pig (due to fewer melanocytes/emlanosomes) on face, neck, upper trunk, prox extremities and assoc w/ sun exposure. don't confuse w/ versicolor! rosea: crhistmas tree distinction on back and trunk, upper thighs and groin. has herald patch

Question 58

christmass tree skin lesion

Answer 58

pityriasis rosea

Question 59

herald patch

Answer 59

pityriasis roesa

Question 60

home tx of warts and molluscum that works best

Answer 60

salicylic acid

Question 61

3 causes diaper rash

Answer 61

irritant is most common and spares intertrigenous creases and tx w/ barrier cream like zinc oxide, bactieral (strep perianal group a) may sees bloody streaks in stool, tx w/ oral abx, candida has satellite lesions and tx w/ nystatins, maybe azoles

Question 62

certain __ conditions can present w diaper rash

Answer 62

infalmmatory conditions - all have alarm sx of irritability, poor growth, fever etc -examples include zinc/nutrition deficiency, malabsorption, langerhans histiocytosis (crusty weepy bloody diaper reash lesions)

Question 63

key sx that can be seen in atopic dermatitis

Answer 63

licehnification in skin flexures

Question 64

psoriaris pathophys

Answer 64

hyperprolif of keratinocytes

Question 65

type of virus that is the molluscum virus

Answer 65

poxviurs