Derm

Question 1

Rash pruritic, begins with a herald patch that’s erythematous, round, and clears centrally with a peripheral scale, spreads downward/ centrifugally

Answer 1

Pityriasis rosea; thought to be virally mediated

Question 2

Rash on palms and soles, red and often scaled. Sx headache, fever, anorexia, myalgias, and diffuse lymphadenopathy

Answer 2

Rash of secondary syphilis

Question 3

Acute eczematous rash, lesions are arranged linearly

Answer 3

Contact dermatitis causes an acute eczematous rash and results from a type IV hypersensitivity reaction to an allergen (poison Ivy)

Question 4

Melanoma ABCDE’s

Answer 4

Asymmetric, Border irregular, Color varies, Diameter>6mm, Enlarging

Question 5

Rash nonpruritic or painful, pigmentation can be hypo- or hyperpigmented or salmon pink; dx test?

Answer 5

KOH prep shows both spores and hyphae of the yeast Malassezia furfur (Pityrosporum ovale) in “spaghetti and meatballs” pattern.

Question 6

Hep C pt p/w lesions (on his wrists, ankles, scalp) that are shiny, violaceous, sharply demarcated, confluent papules containing fine white lines in a lacy pattern

Answer 6

Lichen planus; remember the “5 P’s”: Purple, Polygonal, Pruritic, Papules, and Planar, and Wickham’s striae.

Question 7

Tetrad of arthralgias, abdominal pain, purpuric rash (often on buttocks), and renal disease.

Answer 7

Henoch-Schönlein purpura (HSP), a small-vessel vasculitis

Question 8

Pruritic erythematous plaques with fine, greasy, yellow, loose looking scales

Answer 8

Seborrhaic dermatitis (frequent in Parkinsons and AIDs)

Question 9

Erythema Nodosum - painful inflammation of subcutaneous fat, erythematous nodules on ant surface of legs; a/w?

Answer 9

Sarcoidosis, TB, Strep, Coccidiomycosis, Histoplasmosis, IBD (Crohns and UC), Leprosy

Question 10

Reticular lacy skin erythema that blanches with pressure? Dx?

Answer 10

Livido Reticularis from atheroembolus to peripheral arterioles

Question 11

Pt w/ crohns dz p/w leg ulcer that has purulent base and ragged violaceous border; dx? a/w?

Answer 11

Pyoderma gangrenosum, neutrophilic (on bx) inflammatory ulcer, a/w crohns, UC, RA, AML; rx corticosteroids

Question 12

Pustule w/ surrounding erythema evolves into necrosis, dx?

Answer 12

Ecthyma gangeronsum via Pseudomonas Areugenosa

Question 13

Painful inflammatory lesions of subcutaneous fat, usually on anterior shins. Idiopathic or a/w sarcoidosis, coccidioidomycosis, histoplasmosis, TB, streptococcal infections, leprosy, and Crohn disease

Answer 13

Erythema nodosum

Question 14

Axilla (or groin or scalp) inflammatory purlent nodules or abscess with scarring?

Answer 14

Hydradenitis supporitiva

Question 15

Painful swelling on the inner aspect of eye, inflammation erythema of medial cathus with purulent discharge; dx?

Answer 15

Dacryocystitis via staph or beta-hemolytic strep w/ nasolacrimal duct obstruciton; rx PO antibiotix warm compression

Question 16

Painful red tender abscess over lower or upper eyelid?

Answer 16

Hordeolum Staph infection

Question 17

Hard painless rubbery nodule on eyelid?

Answer 17

Chalazion, chronic granulomatous inflammation from blocked Meibomian gland

Question 18

Painful watery red eye w/ vesicles and dendritic ulcers; dx?

Answer 18

Herpes simplex keratitis, multi-nucleated giant cells on scrapings

Question 19

IgG antibody against desmoglein (component of desmosomes). Flaccid intraepidermal bullae; oral mucosa also involved. Nikolsky sign (separation of epidermis upon manual stroking of skin).

Answer 19

Pemphigus vulgaris (bullae are Vulnerable)

Question 20

IgG antibody against hemidesmosomes (epidermal basement membrane; antibodies are “bullow” the epidermis). Tense blisters containing eosinophils affect skin but spare oral mucosa.

Answer 20

Bullous pemphigoid

Question 21

Erythema multiforme: multiple types of lesions—macules, papules, vesicles, and target lesions (look like targets with multiple rings and a dusky center showing epithelial disruption); a/w?

Answer 21

Associated with infections (e.g., Mycoplasma pneumoniae, HSV), drugs (e.g., sulfadrugs, β-lactams, phenytoin), cancers, and autoimmune disease.