Derm

Question 1

Ddx of rash on palms? 4-5 things

Answer 1

Question 2

EM minor vs EM major

Answer 2

Major involves mucous membranes

Question 3

Description of EM rash

Answer 3

Erythematous papuls, often become target lesion , on palms and dorsal surface forearms (but also anywhere)

Question 4

EM triggers

Answer 4

Most commonly HSV, but can be any virus, bacterial infection, fungal infection or meds

Question 5

TX of EM

Answer 5

Topical steroids and oral prednisone (short course) for EM major (aka mucous membrane involvement)

Question 6

What the 5 “dangerous rashes”

Answer 6

Question 7

Painful and tender symmetric erythematous rash, think… (things)

Answer 7

SJS/TEN
SSSS

Question 8

SJS vs TEN

Answer 8

SJS= <10% tbsa
tEN = > 30% t sa
10-30= SJS/ten overlap syndrome

Question 9

Rash description SJS/TEN

Answer 9

Tender symmetric erythema, can be bullae, can be target lesions. Will have + Nikolsky sign and involvement of two or more mucous membranes

Question 10

most common age for SSSS?

Answer 10

<6, very uncommon in adults

Question 11

description of rash for SSSS?

Answer 11

very similar to TEN (however mucous membranes not involved), will have + Nikolsky, tender erythema and will have “sand-paper” like feel

Question 12

mgmt of SSSS

Answer 12

admit, +/- ICU if severe. need abx that cover MRSA and correction of fluids/electrolytes

Question 13

when do exanthematous (aka morbiliform) drug eruptions occur?

how to manage them?

Answer 13

1-2 weeks after starting, type 4 immune reaction (instead of anaphylactic type reactions which is within minutes to hours)

mgmt = cetrizine, topical steroids and stopping offending agent

Question 14

triggers of urticaria?

Answer 14

meds, infection, food allergies, emotional stress, cold/heat, exercise

Question 15

mgmt of urticaria?

Answer 15

-if any concern for anaphylaxis –> epi
-otherwise H1 blocker (eg cetirizine) and avoid trigger if ID’d

Question 16

what is DRESS

Answer 16

drug eruption with eosinophilic and systemic symptoms

morbiliform drug eruption that becomes confluent and is associated with fever, malaise and multiorgan involvement.

happens 2-8 weeks after exposure.

Question 17

what is exfoliative dermatitis aka erythroderma?

Answer 17

can be life threatening (mortality up to 30%) , diffuse epidermal cell turnover

causes: exacerbation of existing dermatitis, psoriasis, or drug reaction.

it is leathery, tight, scaly skin invoving >90 tbsa and is very itchy.

Question 18

exfoliative dermatitis aka erythroderma mgmt?

Answer 18

emergent derm consult, admission, topical steroids and correct andy temperature or electrolyte abns

Question 19

What does erysipelas look like

Answer 19

Question 20

Signs and symptoms of nec fasciitis

Answer 20

Pain out of proportion
Rapidly progressive erythema (derm exam can be normal initially)
Bullae or crepitus
Systemic toxicity

Question 21

Mgmt of nec fasc

Answer 21

Broad spectrum
Resuscitation
Emergent surgical consult

Question 22

when is oral treatment indicated for VZV?

Answer 22

if pt presents within 72 hours of symptom onset or if new lesions still appearing

Question 23

3 types of lice that infest humans?

Answer 23

head, body and pubic

Question 24

how is lice diagnosed? and treated?

Answer 24

visualization of lice (size of sesame seed) or their eggs.

tx= permethrin shampoo, cream or rinse

Question 25

how long can lice live on inanimate objects?

Answer 25

2 days

Question 26

how long can scabies live no inanimate objects?

Answer 26

2-3 days

Question 27

pathognomonic skin finding with scabies?

Answer 27

burrows, waxy, up to 1 cm long, gray white and threadlike, not always present though

Question 28

2 treatment options for scabies?

Answer 28

permethrin cream or ivermectin oral

Question 29

Causes of erythema nodosum

Answer 29

Question 30

What is erythema nodosum, what does it look like, how is is treated

Answer 30

-Delayed hypersensitivity rxn to a trigger
-Tender erythematous subq nodules (usually on legs)
- mgmt is treatment of underlying cause and symptomatic mgmt (resolves in 6 wks to 6 months)

Question 31

3 disease (all serious) with + nikolsky sign

Answer 31

Staph scale red skin syndrome
SJS/TEN
Pemphigus vulgaris

Question 32

Pemphigus vulgaris vs bullous pemphigoid
Pt ages, lesions, nikolsky sign and mgmt

Answer 32