Derm

Question 1

Buzz words (3) for neonatal herpes

Answer 1

• clustered or grouped vesicles on an erythemarous base
• multinucleated giant cells
• eosinophilic intranuclear inclusions

Question 2

Buzz words (3) for transient neonatal pustular Melanosis

Answer 2

• multiple pustules, brown macules, vesicles and pustules on a NON erythematous base
• PMNs WITHOUT bacteria
• present at birth

Staphylococcus would have pmns with bacteria

Question 3

What are the foods known to trigger eczema? (5)

Answer 3

Milk, eggs, soy, wheat, peanuts

Without allergy testing it is not recommended to eliminate the food.

Question 4

Inflamed eczema that doesn’t respond to steroids or antibiotics would make you consider what diagnosis?

Answer 4

Eczema herpeticum

• vesicles, punched out lesions and crusted erosions are buzz words

Question 5

Eczema in an immunocompromised patient would make you think of?

Answer 5

Wiskott-Aldrich syndrome or hyperimmunoglobulin E syndrome

Question 6

What 2 things are typical examples that cause allergic contact dermatitis?

Answer 6

Jewelry and poison ivy

Question 7

This is a delayed hypersensitivity reaction that requires multiple exposures.

Answer 7

Allergic contact dermatitis

Vs. irritant there is no delay.

Question 8

What type of reaction is poison ivy?

Answer 8

Type 4

Question 9

Myths of poison ivy dispelled

Answer 9

• exposure during the winter CAN cause a rash
• exposure to aerosolized poison ivy CAN cause a rash
• fluid from vesicles does NOT spread rash
• rash is NOT contagious
• NO desensitization treatments available

Question 10

What is the auspitz sign and which which condition?

Answer 10

When plaques come off and leave behind bleeding spots the size of pins.

Psoriasis

Question 11

What is the treatment for Ichthyosis vulgaris?

Answer 11

Keratokytic agents like ammonium lactate. Also alpha hydroxy acid and urea containing emollients.

Question 12

Buzz word for granuloma annulare?

Answer 12

• NON-SCALING! Annular lesión without epidermal involvement.
• skin is intact

Question 13

Buzzword for staphylococcal scalded skin syndrome

Answer 13

Separation of the skin in sheets

Question 14

What are the triggers (2) for erythema multiforme minor?

Answer 14

HSV and medications

Question 15

How is the rash from erythema multiforme major (aka Steven Johnson)

Answer 15

Similar to EM minor (target lesions) but spreads more quickly and progresses to involve mucous membranes.

Question 16

What medications trigger erythema multiforme major?

Answer 16

Sulfa drugs, anticonvulsants and nsaids

Question 17

How do you distinguish staph scalded skin from toxic epidermal necrolysis?

Answer 17

Biopsy
TEN involves the dermis

TEN usually older children

Question 18

Buzz words for pyoderma gangrenosum

Answer 18

Boggy and blue ulcers with a necrotic base

Question 19

What is erythema chronicum migrans

Answer 19

Associated with Lyme disease. Bulls eye rash.

Question 20

What is erythema marginatum

Answer 20

Associated with rheumatic fever. Erythematous macule on the trunk that clears centrally.

Question 21

Treatment for scabies

Answer 21

Permethrin 5%

Question 22

What’s a clinical sign consistent with pubic lice

Answer 22

Maculae caerulae - blue-gray macules on the abdomen or inner thigh

Question 23

Thx for crabs in the eyelashes

Answer 23

Petroleum jelly

Question 24

How is papular urticaria different from scabies

Answer 24

Papular urticaria will be clustered eruthematous papules whereas scabies they will be linear not clustered.

Also no family members affected with papular urticaria

Question 25

What are the types of non inflammatory acne

Answer 25

``` Closed comedones (whiteheads) Open comedones (blackheads) ```

Question 26

"Acne" that is unresponsive to tx would make you think of?

Answer 26

Adenoma sebaceum (angiofibroma)

Question 27

What medications can lead to acne?

Answer 27

Steroids, phenobarbital and phenytoin

Question 28

What are side effects of isotretinoin

Answer 28

Dry lips, dry skin, dry eyes, nosebleeds and headaches

Question 29

What other physical finding will you see in a pt with alopecia areata

Answer 29

Nail pitting

Question 30

What should patients with urticaria pigmentosa avoid?

Answer 30

Narcotic pain reliever, nsaids, aspirin, radiocontrast material Because they release histamine **

Question 31

Treatment for tinea versicolor

Answer 31

Astringent or topical antifungal May use oral ketoconazole, fluconazole, and itraconazole. Topical selenium sulfide

Question 32

What are the stages of the rash for incontinente pigmenti

Answer 32

- blistering rash at birth: erythematous papules and vesicles in crops along the lines of blaschko that last 1-2 wks - swirls of warty growths - hyperpigmentation in a marble cake pattern in childhood - hypopigmentation in adulthood * pts may also have hair loss and eye/dental abnormalities

Question 33

How is incontinenta pigmenti inherited

Answer 33

X linked dominant

Question 34

In which side is glaucoma in pts with strurge Webber associated? Seizures?

Answer 34

Glaucoma - on same side as the port wine stain. Seizures on the contralateral side.

Question 35

Criteria for NF1 (8)? How many are required for diagnosis?

Answer 35

- 6 or more cafe au lait spots >5mm wide - lisch nodules - neurofibromas - optic nerve glioma - inguinal and axillary freckling - bony defects - FMH if NF1 (first degree) 2

Question 36

Inheritance pattern of NF1

Answer 36

Autosomal dominant on chromosome 17

Question 37

What are associated conditions for kids with NF1 and what must you monitor?

Answer 37

Pheochromocytoma and renal artery stenosis. Monitor for hypertension.

Question 38

Inheritance of NF2

Answer 38

Autosomal dominant in chromosome 22

Question 39

Presentation of NF2

Answer 39

Hearing loss or tinnitus due to acoustic neuromas (schwannoma). May also present with ocular symptoms due to cataracts or hamartomas of the retina.

Question 40

Criteria for tuberous sclerosis (8). How many required for diagnosis?

Answer 40

- more than 3 ash leaf spots - periventricular/cortical tubers (present as seizure) - sebaceous glands hyperplasia (adenomas described or shown in face do not confuse with acne) - shagreen patch (orange peel appearing skin) - sub/periungal fibroma - cardiac rhabdomyoma - retinal modular hamartomas - renal angiomyolipoma 2

Question 41

What is kasabach-merritt syndrome

Answer 41

Hemangioma that enlarged rapidly due to sequestration of platelets. Results in low platelet count and bleeding.

Question 42

What is darier sign and what condition is it associated with

Answer 42

Rubbing causes hives or bullae. Mastocytosis (urticaria pigmentosa)

Question 43

Risk factors for melanoma development in pediatric patients

Answer 43

White race, female gender, adolescent age group, immunodeficiency, solid organ transplant, childhood malignancy, the presence of xeroderma pigmentosum, dysplastic nevi, many melanocytic nevi, family history of melanoma.