Derm Case Based Questions Flashcards
A 30 y/o female patient arrives to your clinic with patches of brown hyperpigmentation on the face.
What is the diagnosis and treatment?
- Melasma or Chloasma
- Hydroquinone 4% cream
A 50 y/o male patient comes to clinic with velvety lesions on the neck.
What is the diagnosis and treatment?
- acanthosis nigricans
- control of blood sugar
An 80 y/o patient comes to clinic with round, brown, well-demarcated, velvety lesions.
What other qualities might the lesion have? what is the diagnosis?
- greasy or stuck on appearance, scaly, (+/-) pruritis, pain, bleeding
- Seborrheic Keratosis
How would you classify a lesion that is:
* 6 mm
* well-demarcated
* unusual shape
* has irregular colors within the lesion
* is flat
as an atypical nevi
A patient comes to your clinic with a solitary, blue, smooth macule on their thorax.
What is the diagnosis and treatment?
- Blue nevus
- observation
a 25 y/o patient who frequently uses tanning beds comes to clinic with a nevus that has recently changed in size and color. It has recently started to bleed and crust.
What is the diagnosis and treatment?
- melanoma
- excision, +/- lymph biospy
A 32 y/o male comes to clinic with pink, raised papules that appear to have rolled borders and a central depression.
What other characteristics might this lesion have? Diagnosis? Treatment?
- overlying telangectasia, translucent/waxy/pearly
- Nodular Basal Cell Carcinoma
- MOHS/Excision
A 19 y/o male comes to clinic with a scaly, eczema-like patch that has a white, rolled border.
What is the diagnosis and treatment?
- Superficial BCC
- Imiquimod 5% or -FU, radiation
A 19 y/o female presents to clinic with a tan, flattened, rough papule.
What is the diagnosis and treatment?
- actinic keratinosis
- cryotherapy or imiquimod/5-FU
A 50 y/o female presents to clinic with a circumscribed pink patch that is scaly. A biopsy shows that the atypica is limited to the epidermis.
What is the diagnosis and treatment?
- SCC in situ
- Cryotherapy follwed by 5-FU or imiquimod
A 60 y/o female pateint presents to the clinic with a red, friable, pruritic, plaque. It is tender to touch.
What is the diagnosis and treatment?
- Squamous Cell Carcinoma
- surgical excision + MOHS
A 7 y/o patient presents to clinic with wheals that are surrounded by an erythematous halo. Their chief complaint is that the lesions itch.
What is the diagnosis and treatment?
- urticaria
- 1st gen antihistamine
A 50 y/o patient presents to clinic with swelling of the face that is painful. After taking her history, you learn she takes ACE inhibitors. She denies pruritis.
What is the diagnosis and treatment?
- Angioedema
- IV or oral glucocorticoids, 1st gen antihistamines
A 70 y/o male presents to the clinic after erythematous, pruritic macules on the face developed into flaccid blisters which are easily breaking.
What other characteristics? Diagnosis? Treatment?
- painful lesions (necrosis), mucosal membrane involvement, pos Nikolsky sign
- Steven’s Johnson Syndrome
- Stop offending med, IV IgG, corticosteroids, enteracept, cyclosporine
A 25 y/o patient presents with a central bulla, with a dark red inflammatory zone, followed by a pale ring of edema, and a red halo on the periphery. They have a negative Nikolsky sign.
What are the lesions? what is the dx? what is the tx?
- target lesions
- Erythema multiforme
- stop offending irrtant, systemic corticosteroids
A 5 y/o girl reports to the ER after reporting being bitten by a spider. She had burning where she was bitten and the bite become red. She also has fever, nausea, and vomiting.
What bit her? What will the bite progress to? Treatment?
- Brown Recluse Spider
- erythema at bite site becomes blanched bite with red halo, followed by hemorrhagic bulla that undergoes eschar formation
- wound care, tetanus vax PRN, NSAIDs, debridement is necrotic
a 10 y/o boy presents to clinic with muscle pain and spams in his legs and back. He was bitten by a spider that had an hourglass on its belly.
What is the spider? what does the bite look like? what is the tx?
- Black Widow Spider Bite
- blanched, circular patch w/ erythematous perimeter and central punctum
- wound control, tetanus vax PRN, NSAIDs, benzos for muscle spasms
- Anti-venom is reserved for refractory sx
A 50 y/o patient presents to clinic with a spreading, erythametous, purulent, tender plaque on their leg.
What is the diagnosis and treatment?
- purulent cellulitis
- clindamycin, TMP/SMX, or doxy + amox
A 70 y/o patient presents to clinic with bright red, plaque-like edema that is well-demarcated. They have a fever, chills, and a headache.
What is the diagnosis and treatment?
- Erysipelas
- Empiric Abx: PCN V, amox, clinda, azithro
A 25 y/o male presents to clinic with red streaks that are extending from an erythematous, tender plaque. They also have a fever and chills.
Dx of the plaque? Dx of the streaks? Oral tx of the streaks?
- cellulitis
- lymphangitis
- cephalexin, dicloxacillin
A 55 y/o female presents to clinic with well-demarcated erythematous patches that have overlying silver scales.
What 2 tell tale signs are associated with this? Dx? Tx?
- Koebner Phenomenon, Auspitz Sign
- Plaque Poriasis
- Topical steroids, calcipotreien. tazarotene, or coal tar
a 35 y/o female presents with erythematous patches covered with yellow greasy scales on the scalp.
What is the diagnosis and treatment?
- Seborrheic Dermatitis
- Ketoconazole or Ciclopirox, topical steroid if inflammation is present
a 35 y/o female presents with erythematous patches covered with yellow greasy scales on the face.
What is the diagnosis and treatment? Tx for severe or refractory?
- Seborrheic Dermatitis
- topical antifungals, hydrocortisone
- Antifungals PO
A 16 y/o male presents to clinic with an erythematous plaque that is scaling in a christmas tree pattern.
What is the diagnosis and treatment? what was the initial lesion most li
- Pityriasis Rosea
- Self limiting, triamcinolone if needed
- Herald patch- small, salmon colored lesion on the trunk
A 35 y/o female patient comes to clinic complaining of erythematous satellite macules surrounding the skin folds.
What is the dx and tx? what is likely the most dominant sx?
- Intertrigo
- Topical Antifungal (imidoles)
- Topical anti-inflammatory (desonide or hydrocortisone)
- burns more than itches
A 30 y/o patient presents to clinic complaining of scaly, patchy, hair loss and associated erythema and pruritis on the scalp.
What is the diagnosis and treatment? what is the most likely pathogen?
- Tinea Capitis
- Griseofulvin PO + anti-fungal shampoo
- T. tonsurans or M. canis
A 10 y/o male presents to clinic complaining of pruritic, erythematous, scaly patches on their chest which have central clearing.
What is the diagnosis and treatment? what is the most likely pathogen?
- Tinea Corporis
- Topical antifungal (imidole or allyamine)
- T. rubrum or Microsporum spp
A 42 y/o patient presents to clinic with an erythematous, scaly, patch on her hand. It has started to peel and it is slightly pruritic.
What is the diagnosis and treatment? what is the most likely pathogen?
- Tinea manuum
- Topical anti-fungal
- Trichophyton spp
A 28 y/o male presents to clinic complaining of annular, pruritic, hyperpigments patches near his groin. They are diffusely erythematic. He does not have any on his scrotum.
What is the diagnosis and treatment? what is the most likely pathogen?
- Tinea cruris
- T. rubrum
- Topical antifungal (clotrimazole)
A 22 y/o male presents to clinic with scaling and redness between his toes.
What do you use to diagnose? What is the dx? What is the tx? pathogen?
- KOH prep
- Tinea Pedis
- topical antifungal (allyamines)
- T. rubrum