Derm Flashcards
what is the pic showing
acrochordons → skin tags
pruritic lesion, tan to brown, waxy, stuck on appearance
seborrheic keratosis
asymptomatic papule, dimpled on either side when squeezed
following inflamed hair follicle
dermatofibroma
brown papule around eyes and malar cheeks
genetic
AA
dermatosa papulosa nigra
tx for dermatosis papulosa nigra least likely to cause hypopigmentation
liquid nitrogen
scattered light brown macule on dorsal hands and face
increasing in number, otherwise unchanged
dog walker in LA
solar lentigines
major criterion for neurofibromatosis (NF) 1 and important finding to look for on PE when screening pt’s
axillary freckling
pt’s w. neurofibromatosis 1 need to be followed closely for
development delays/learning disabilities
reddish papules on nose, chin, medial cheeks and small, scattered hypo pigmented macule
what PE finding would suggest tuberous sclerosis
dental enamel pits
gingival fibromas
larger hypopigmented macules
periungal fibromas
newborn w. 5 hypopigmented birthmarks 1-2 cm
tuberous sclerosis is suspected via genetics testing
how do you manage
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
pt w. Sturge Weber syndrome can have __ associated w. capillary malformations
soft tissue overgrowth
dt GNAQ mutation
capillary malformations (port wine stains) can be associated w. leptomeningealangiomatosis and sz in setting of sturgeon weber syndrome (SWS)
what is recommended for management
urgent refer to ophthalmology to screen for glaucoma
7 yo w. 2 months of hair loss w. scaling in a few small patches
how do you dx
fungal culture
10 yo boy has patches of hair loss of different lengths
parents cut hair so he’ll stop pulling
most likely dx?
trichotillosis
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
hairs will likely regrown on their own w.in 6-12 mo
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?
pregnancy/delivery
58 yo woman complains of gradual hair loss starting on top of scalp
worried about balding
rec for tx?
topical minoxidil
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
wear hair in natural, non pulling styles
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?
referral to derm
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
epstein-barr infxn
typical distribution: lateral tongue
mc in smokers
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?
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
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?
refer for anal typology or high res anoscopy
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
serum RPR and HIV
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?
reassure this is benign dt drug rxn
prescribe short course of triamcinolone for sx relief
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?
erythema toxicum neonatorum
common
erythematous macule/papules that rapidly progress to flaccid pustules on erythematous base
pustules loaded w. eosinophils
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?
neonatal acne is result of inflammatory rxn to pityrosporum (malassezia) species - self limiting condition that doesn’t require tx
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
numerous neutrophils and negative gram stain
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
numerous neutrophils and negative gram stain
5 day old in NICU for fever and blisters/vesicles - neonatal herpes
which is NOT useful to confirm
testing mom
useful tests for neonatal HSV
HSV antigen w. rapid immune fluorescence assay or enzyme assay
HSV PCR from surface site or CSF
culture
Tzank smear
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
langerhans cell histiocytosis
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
seborrheic dermatitis
low potency topical steroids and petrolatum or mineral oil
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?
leukocytoclastic vasculitis from abx
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
urgent surgery referral
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
urgent surgery referral
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
allergic contact dermatitis
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
cellulitis
52 yo f - several days of itching, redness, tightness on both lower legs - legs swell during the day - relieved w. sleeping - afebrile
dx?
stasis dermatitis
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
purpura fulminant
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?
leukocytoclastic vasculitis from henoch schonlein purpura
IgA driven after respiratory/urinary infxn
28 yo woman w. scattered red macule on legs, ankles, and feet
no panful or itchy
next step in dx?
diloscopy to see if they blanch
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
hence schonlein purport
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?
sepsis
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
reassurance
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
loratidine
27 yo f w. hives on neck, trunk, proximal extremities - pruritic and resolve w.in 1 day
how do you manage te
testing not necessary at this time
25 yo woman - itchy intermittent welts all over body that last 1 day
topical hydrocortisone does not help
best first line tx?
antihistamines
cardinal sx of urticaria
hives, Pruritis, itchiness
62 yo man w. urticaria x 3 years
has been tested for allergies - all negative
mc cause
idiopathic
what is most potent tx for urticaria
first gen antihistamines
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
epic pen w. instructions on how/when to use
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
first gen antihistamine taken in the evening
