Derm Flashcards

1
Q

what is the pic showing

A

acrochordons → skin tags

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2
Q

pruritic lesion, tan to brown, waxy, stuck on appearance

A

seborrheic keratosis

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3
Q

asymptomatic papule, dimpled on either side when squeezed

following inflamed hair follicle

A

dermatofibroma

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4
Q

brown papule around eyes and malar cheeks

genetic

AA

A

dermatosa papulosa nigra

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5
Q

tx for dermatosis papulosa nigra least likely to cause hypopigmentation

A

liquid nitrogen

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6
Q

scattered light brown macule on dorsal hands and face

increasing in number, otherwise unchanged

dog walker in LA

A

solar lentigines

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7
Q

major criterion for neurofibromatosis (NF) 1 and important finding to look for on PE when screening pt’s

A

axillary freckling

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8
Q

pt’s w. neurofibromatosis 1 need to be followed closely for

A

development delays/learning disabilities

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9
Q

reddish papules on nose, chin, medial cheeks and small, scattered hypo pigmented macule

what PE finding would suggest tuberous sclerosis

A

dental enamel pits

gingival fibromas

larger hypopigmented macules

periungal fibromas

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10
Q

newborn w. 5 hypopigmented birthmarks 1-2 cm

tuberous sclerosis is suspected via genetics testing

how do you manage

A

baseline MRI of brain and EEG dt CNS involvement and sz potential

MRI of brain at dx and q 1-2 years after in asymptomatic pt < 25 yo

and baseline EEG

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11
Q

pt w. Sturge Weber syndrome can have __ associated w. capillary malformations

A

soft tissue overgrowth

dt GNAQ mutation

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12
Q

capillary malformations (port wine stains) can be associated w. leptomeningealangiomatosis and sz in setting of sturgeon weber syndrome (SWS)

what is recommended for management

A

urgent refer to ophthalmology to screen for glaucoma

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13
Q

7 yo w. 2 months of hair loss w. scaling in a few small patches

how do you dx

A

fungal culture

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14
Q

10 yo boy has patches of hair loss of different lengths

parents cut hair so he’ll stop pulling

most likely dx?

A

trichotillosis

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15
Q

30 yo woman has 2 patches of hair loss that shed suddenly - a few hairs grow w.in them

there is no scale and skin feels smooth

what do you tell her about prognosis

A

hairs will likely regrown on their own w.in 6-12 mo

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16
Q

35 yo woman w. normal menstrual periods c.o sudden hair loss throughout cal over past few weeks

not getting much sleep w. 6 mo old breastfeeding through the night

she notices ore hairs in drain and in shower and on hairbrush

most likely cause?

A

pregnancy/delivery

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17
Q

58 yo woman complains of gradual hair loss starting on top of scalp

worried about balding

rec for tx?

A

topical minoxidil

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18
Q

45 yo woman c.o gradual loss of hair on front of scalp w, similar change on sides

what do you recommend to prevent further hair loss

A

wear hair in natural, non pulling styles

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19
Q

36 yo woman w. 1 year of progressive hair loss

she notices scaling around follicles w. tender sensation, shiny scalp, w.o hair follicles in patches

course of action?

A

referral to derm

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20
Q

43 yo presents for eval of white spots on tongue that have ben present for at least 1 mo

not painful or itchy, don’t bleed - no fever or pain w, swallowing

PMH: HIV, has not been taking meds - most recent CD4 was 152

PE: white corrugated plaques on lateral margins of tongue - can not be scraped off

what causes these lesions

A

epstein-barr infxn

typical distribution: lateral tongue

mc in smokers

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21
Q

28 yo w. 6 mo hx of bumps in anal area - sometimes itchy w. bleeding

transgender w. assigned male natal sex

smokes daily, multiple sex partners - unprotected anal ex

has been treated for both syphilis and gonorrhea in the past

PE: soft, verrucous vegetative, exophytic plaques from anal verge, no genital lesions

next step?

A

serum HIV and RPR

given extensive condyloma and lifestyles, need to r.o HIV and syphilis reinfection

condyloma lata of syphilis can mimic HIV induced condyloma.warts

22
Q

previous pt is HIV (+) w. CD4 75 - she is on ART

bx shows condylaoma and squamous intraepithelial lesion w. high risk orogenic HPV detected on in situ hybridization

you start ablative tx w. topical imiquimod - she continues to be concerned about nonspecific anal pain, tenesmus, and rectal bleeding

what is the next step?

A

refer for anal typology or high res anoscopy

23
Q

29 yo w. hx etoh abuse - asymptomatic purplish lesions on palms/soles/legs x a few weeks

sore spot on penis a few months ago

sexually active both men and women w.o protection

what do you do next

A

serum RPR and HIV

24
Q

34 yo woman - diffuse itchy rash x 3 weeks

started on chest and shoulders, spread to back, and, arms/legs - mildly pruritic

recent dx HIV

PE: erythematous plaques w, trace overlying scale on trunk, shoulders, thighs/extremities - no mucosal involvement - afebrile

next step?

A

reassure this is benign dt drug rxn

prescribe short course of triamcinolone for sx relief

25
Q

3 day old male - 24 hr hx small white-yellow papule and pustules w. erythematous botchy skin

areas involved: face, trunk, extremities

swab from pustule shows numerous eosinophils

pt afebrile and healthy

most likely dx?

A

erythema toxicum neonatorum

common

erythematous macule/papules that rapidly progress to flaccid pustules on erythematous base

pustules loaded w. eosinophils

26
Q

18 day old female w. 5 day hx of red pimples on both cheeks

dx: neonatal acne

mom is breastfeeding and concerned that her diet could be affecting baby

what do you tell her?

A

neonatal acne is result of inflammatory rxn to pityrosporum (malassezia) species - self limiting condition that doesn’t require tx

27
Q

female newborn w. widespread rash involving face, trunk, extremities

lesions: pustules and hyper pigmented macules w. discrete scaling: transient neonatal pustular melanosis

you perform a swab - what will you find on the smear

A

numerous neutrophils and negative gram stain

27
Q

female newborn w. widespread rash involving face, trunk, extremities

lesions: pustules and hyper pigmented macules w. discrete scaling: transient neonatal pustular melanosis

you perform a swab - what will you find on the smear

A

numerous neutrophils and negative gram stain

28
Q

5 day old in NICU for fever and blisters/vesicles - neonatal herpes

which is NOT useful to confirm

A

testing mom

29
Q

useful tests for neonatal HSV

A

HSV antigen w. rapid immune fluorescence assay or enzyme assay

HSV PCR from surface site or CSF

culture

Tzank smear

30
Q

10 day old baby boy w. multiple reddish brown papules and nodules at different sizes - some w. crusting on scalp/face/trunk and diaper area - some look petechial

afebrile, otherwise healthy

most likely dx

A

langerhans cell histiocytosis

31
Q

4 mo old has cradle cap since birth w. several erythematous plaques and greasy scales on scalp and retro articular areas w. excoriation 2/2 to scratching

mom uses organic baby shampoo

how do you manage

A

seborrheic dermatitis

low potency topical steroids and petrolatum or mineral oil

32
Q

49 yo woman admitted w. fever/dyspnea - treated for pan complicated by uncontrolled dm

on day 7 she developed bright red itchy spots on both legs but was afebrile and ready for d/c

most likely dx?

A

leukocytoclastic vasculitis from abx

33
Q

43 yo diabetic male in ED for 6 hr of very painful rapidly growing red/purple plaque on left thigh - started w. follicle/boil near site of insulin injxn

center has small erosion and is darker than surrounding tissue

pt has been waiting for an hour and redness has grown ~ 1 cm and is tender

what do you do

A

urgent surgery referral

33
Q

43 yo diabetic male in ED for 6 hr of very painful rapidly growing red/purple plaque on left thigh - started w. follicle/boil near site of insulin injxn

center has small erosion and is darker than surrounding tissue

pt has been waiting for an hour and redness has grown ~ 1 cm and is tender

what do you do

A

urgent surgery referral

34
Q

50 yo male c.o severe itching and redness on both legs x several weeks w. weeping

he is afebrile and uses moisturizers or OTC remedies bid

no hx swelling

most likely dx

A

allergic contact dermatitis

35
Q

42 yo woman c.o redness and pain on left thigh x 2 days - odd shape moving up leg - blister in the center - afebrile

most likely dx

A

cellulitis

36
Q

52 yo f - several days of itching, redness, tightness on both lower legs - legs swell during the day - relieved w. sleeping - afebrile

dx?

A

stasis dermatitis

37
Q

consult for new rash on 16 yo girl w. lesions scattered on legs - described as dark purple patch w. overlying vesicle that does not fade when pressed on

most appropriate morphologic term for finding

A

purpura fulminant

38
Q

same pt as last card - lesions scattered on legs - confirmed petechiae and ecchymosis on bilateral legs that stop at waist

mild abd pain, fatigue, myalgia, arthralgia

platelets: 165, BP 106/82

most likely cause?

A

leukocytoclastic vasculitis from henoch schonlein purpura

IgA driven after respiratory/urinary infxn

39
Q

28 yo woman w. scattered red macule on legs, ankles, and feet

no panful or itchy

next step in dx?

A

diloscopy to see if they blanch

40
Q

7 yo boy in urgent care w. abd pain, joint aches, rash on legs/feet

no hx nose bleeds or bruising or bleeding

most likely dx

A

hence schonlein purport

41
Q

38 yo m w. hx Crohn’s

recently tx w. azathioprine and prednisone - he was well until 3 days ago when he developed worsening abd pain

no recent sick contacts or travel

he has somnolence, fever, abd pain, new rash

t: 102.1, HR: 117, RR: 14, BP: 86/54

most likely cause of purpuric rash?

A

sepsis

42
Q

69 yo f - increase in marks on forearm x 1-2 months - otherwise well except for pain in knees dt OA

takes hydrochlorothiazide for HTN, naproxen bid, MV

next step in management

A

reassurance

43
Q

32 yo w. hives x 8 weeks - no new meds

not painful, no pigmentation or other marks

no respiratory sx or lip/tongue swelling - does not want to take meds tat make her sleepy

what med do you recommend

A

loratidine

44
Q

27 yo f w. hives on neck, trunk, proximal extremities - pruritic and resolve w.in 1 day

how do you manage te

A

testing not necessary at this time

45
Q

25 yo woman - itchy intermittent welts all over body that last 1 day

topical hydrocortisone does not help

best first line tx?

A

antihistamines

46
Q

cardinal sx of urticaria

A

hives, Pruritis, itchiness

47
Q

62 yo man w. urticaria x 3 years

has been tested for allergies - all negative

mc cause

A

idiopathic

48
Q

what is most potent tx for urticaria

A

first gen antihistamines

49
Q

9 yo m eats iced cream w. peanuts and develops erythematous wheals on lips/face/trunk

slight wheezing, not taken to hospital and felt better w.in 1 hr

fam comes in for tx several weeks later

what do you recommend

A

epic pen w. instructions on how/when to use

50
Q

23 yo w. chronic urticaria x 2 years

has tried second gen antihistamines w. only partial relief

concerned about daytime sedation

what do you recommend

A

first gen antihistamine taken in the evening