Derm Modules 2 Flashcards
A 25y/o female presents to you with a rash over her eyelids after using a new cosmetic brand. What is the BEST test to confirm the cause of the rash depicted?
A) Indirect immunofluorescent antibody (IIF)
B) Patch Testing
C) Prick skin testing
D) Punch biopsy
E) Radioallergoserbent test (RAST)
B) Patch Testing
A 30y/o nurse is transferred to a new hospital and begins to develop red, painful, chapped hands. He has been working on a unit with multiple patients on contact precautions and has been washing his hands frequently with soap and water. On exam, there are multiple fissures and scaling, but no vesicles are seen. What is the most likely diagnosis?
A) Allergic contact dermatitis
B) Dyshidrotic dermatitis
C) Irritant contact dermatitis
D) Nummular dermatitis
E) Psoriasis
C) Irritant contact dermatitis
A 30y/o female is diagnosed with allergic contact dermatitis of the face, likely due to a nickel allergy from the frames of her glasses. What treatment would you recommend other than the avoidance of nickel?
A) Clobetasol ointment
B) Desonide cream
C) Flucanazole gel
D) Ketoconazole cream
E) Triamcinolone ointment
B) Desonide cream
You diagnose a 25y/o college student with contact dermatitis on the palm of her hands. She continues to have chronic scaly, erythematous, pruritic plaques despite use of Clobetasol oitnment twice daily for one month. The most appropriate next step is:
A) Order a RAST test
B) Punch biopsy of a plaque
C) Recommend increased hand washing
D) Refer to a dermatologist
E) Swtich to Triamcinolone cream twice daily
D) Refer to a dermatologist
A 78y/o nontoxic woman with a history of hypertension and coronary artery disease underwent dipyridamole stress echocariography. During this procedure, her blood pressure was monitored for 45 minutes. Two days later, an intensely pruritic, sharply demarcated, erythematous vesicular eruption developed on her right arm. Which is the most likely diagnosis?
A) Allergic contact dermatitis due to black rubber blood pressure cuff
B) Atypical seborrheic dermatitis triggered by sweating
C) Fixed drug eruption from the dipyridamole
D) Hospital-acquired cellulitis caused by staph aureus
E) Irritant contact dermatitis from soaps
A) Allergic contact dermatitis due to black rubber blood pressure cuff
You are evaluating a patient with a pruruitic eruption on the back. The patient recently had a surgical repair of a compound fracture of the femur and the primary team is worried that she has herpes zoster. Which of the following statements is the most accurate?
A) This is an acneiform eruption, which will resolve without treatment
B) This is an infection and she should be started on ora acyclovir
C) This is an infestation and hospital infection control should be notified
D) This is a delayed hypersensitivity reaction for which topical steroids can be given
D) This is a delayed hypersensitivity reaction for which topical steroids can be given
A 25 y/o woman notes a 2 month history of itchy, intermittent welts that appear all over her body, with individual lesions lasting less than a day. She noted that topical hydrocortisone 1% cream does not offer much relief. What is the best first line therapy for her condition?
A) Antihistamines
B) Aspirin
C) Corticosteroids
D) Methotrexate
E) NSAIDS
A) Antihistamines
Which of the following is the cardinal symptom of urticaria?
A) Anesthesia
B) Bullae
C) Paresthesia
D) Pruritis
E) Target lesions
D) Pruritis
A 63y/o man has been struggling with urticaria for over 3 years. He has been tested several times for allergies, but all have been negative. What is the most common cause for chronic urticaria?
A) Aspirin
B) Food allergies
C) Idiopathic
D) Medications
E) Preservatives
C) Idiopathic
There are several medications to treat urticaria, including antihistamines. Which of the following is considered the most potent treatment for urticaria?
A) Aspirin
B) First generation H1 antihistamines
C) H2 antihistamines
D) Second generation H1 antihistamines
E) Topical corticosteroids
B) First generation H1 antihistamines
A 9y/o boy ate ice cream topped with peanuts and began to develop erythematous wheals on the lips, face, and trunk. He has slights wheezing during the episode, but was not taken to the hospital and felt better within an hour. THe family presents for treatment options several weeks later. Which of the following is recommended?
A) A second-generation antihistamine taken in the evening
B) Applying topical corticosteroid during the day
C) Avoiding spicey foods
D) Epinephrine pen with sufficient instruction on how and when to use it
E) Methotrexate injection weekly
D) Epinephrine pen with sufficient instruction on how and when to use it
A 23y/o woman has had chronic urticaria for two years and is very frustrated. She denies difficulty breathing, throat tightness, and gastrointestinal symptoms. She has treid several second-generation antihistamines with only partial relief. She is concerned about sedation during the day. Which of the following would likely be helpful to add to her regimen?
A) A first gen antihistamine taken in the evening
B) Applying topical corticosteroid during the day
C) Avoiding spicy foods
D) Epinephrine pen with sufficient instruction on how and when to use it
E) Methotrexate injection weekly
A) A first gen antihistamine taken in the evening
The patient in this photo has a dermatomal grouping of vesicles on an erythematous base on his trunk. What is the most likely diagnosis?
A) Allergic contact dermatitis
B) Fixed drug eruption
C) Atopic dermatitis
D) Herpes simplex type 2
E) Herpes zoster
E) Herpes zoster
A 50y/o woman presents to you with blisters on her abdomen. Which of the following is the best description of these lesions?
A) Linear erythematous papules
B) Dermal nodules
C) Grouped vesicles on an erythematous base
D) Erythematous, scaly plaques
E) Erythematous patches
C) Grouped vesicles on an erythematous base
You diagnose a 17y/o female with genital herpes simplex. She has no health insurance. Which of the following would you prescribe?
A) Oral acyclovir
B) Oral cephalexin
C) Oral flucanazole
D) Oral gancycloir
E) Oral valcyclovir
A) Oral acyclovir
This 40y/o man comes to you with this finding on the bottom of his left foot. He has no other skin changes elsewhere. He volunteers that it appeared today after he wore a new pair of boots to his construction job and they felt like they were “rubbing”. He took some naproxen this evening becaouse of the pain but takes no other medications. What is the most likely diagnosis?
A) Allergic contact dermatitis
B) Bullous impetigo
C) Erythema multiforme
D) Fixed drug eruption
E) Friction blister
E) Friction blister
A 30y/o woman present to you with this finding. You perform a complete skin exam and find that she has simmilar findings on the other arm but no other skin changes. She reports that they are itchy but she’s afraid to scratch them so she put bandaids over them to protect them. She otherwise feels well and reports that she recently had a conference and stayed in a hotel. What is the most likely diagnosis for this patient?
A) Allergic contact dermatitis
B) Bullous insect bites
C) Cellulitis
D) Herpes zoster
E Pemphigus vulgaris
B) Bullous insect bites
This 7y/o boy is brought into the office by his mother for this rash on his cheek. He has no other rashes elsewhere. He says it is more painful than itchy. He has never had anything like it before. He feel well otherwise. What is the most likely diagnosis?
A) Acne
B) Allergic contact dermatitis
C) Erythema multiforme
D) Herpes simplex
E) Varicella zoster
D) Herpes simplex
This 66y/o woman present with this itchy and painful rash. It began on her neck and spread around her trunk. She also had some “soreness in her mouth about that time too”. She has taken hydrochlorothiazide and simvastatin for over 7 years. She has not treated this rash in any way. What is the most appropriate next step?
A) Apply nystatin ointment to affected areas
B) CT scan and lumbar practice
C) Order silvadene cream to apply twice daily
D) Urgent dermatology consultation
E) Urgent surgical consultation for debridement
D) Urgent dermatology consultation
This 5y/o girl is brought ingto the urgent clinic by her parents for this rash. It sarted 1 day ago and began on her face and trunk. The girl wouldn’t eat because her mouth was sore and now she’s “hot” and lethargic. She normally doesn’t take medicine, but her parents say she has been taking “an antibiotic” for the past 3 days. What is the most likely diagnosis for this patient?
A) Atopic eczema
B) Bullous impetigo
C) Pemphigus vulgaris
D) Stevens Johnson Syndrome
E) Urticaria
D) Stevens Johnson Syndrome
A 5y/o girl developed a rash on her hand that was itchy. She was treated by her pediatrician with a topical steroif and it initially improved, but then worsened and became bullous (developed blisters). A course of oral antibiotics was not helpful. What is the most likely diagnosis?
A) Atopic dermatitis
B) Bullous impetigo
C) Dyshidrotic eczema
D) Tinea of the hand (manuum)
E) Tinea versicolor
D) Tinea of the hand (manuum)
A 12y/o boy developed scaly, dark patches on the upper chest. They were not symptomatic. What is the most likely diagnosis?
A) Atopic dermatitis
B) Bullous impetigo
C) Dyshidrotic eczema
D) Tinea cruris
E) Tinea versicolor
E) Tinea versicolor
This is a 22y/o man with a three month history of a rash on his face. He has tried no treatment. The appearance of the scale bothers him byt the rash is otherwise asymptomatic. On exam, he has some scaling in his external ear canals and in his eyebrows. What is the most likely diagnosis?
A) Acne
B) Acute malar rash of lupus erythematosus
C) Roasacea
D) Seborrheic dermatitis
D) Seborrheic dermatitis
A 31y/o woman has a 1-2 year history of increasing redness on her face. She also reports some “bumps like pimples” that come and go. She tried some OTC acne washes but they really irritated her skin. What is her most likely diagnosis?
A) Acute malar rash of lupus erythematosus
B) Acne vulgaris
C) Atopic eczema
D) Rosacea
D) Rosacea
This 19y/o man has treated his acne with oral antibiotics for three months, topical reinoids nightly, and topical antibiotics in the morning. He continues to get new painful nodules on his temples. What is the most appropriate next step in treatment?
A) Continue same regimen for another 3-6 months
B) Add oral steroid
C) Add topical steroid
D) Refer to a dermatologist
D) Refer to a dermatologist
This 4 month old male infant was brought to the dermatology clinic by his adoptive mother for evaluation of an itchy rash that has been present most of his life He gets a bath every few days with a gently non-soap clenser. She applies a generic petrolatum ointment daily. Which of the following is the most likely diagnosis?
A) Atopic dermatitis
B) Contact dermatitis
C) Pityriasis alba
D) Psoriasis
E) Tinea corporis
A) Atopic dermatitis
A 7y/o male child has a diagnosis of atopic dermatitis. They have been using hydrocortisone 2.5% ointment twice per day for a few weeks with minimal improvement. Which of the following is the next best step in management?
A) Increased the frequency of hydrocortisone 2.5% ointment to TID
B) Increase the potency to triamcinolone 0.1% ointment BID
C) Mix the topical steroid with petrolatum ointment
D) Start a topical calineruin inhibitor BID
E) Start a topical phosphodiesterase inhibitor BID
B) Increase the potency to triamcinolone 0.1% ointment BID
This patient with a history of atopic dermatitis has similar lesions on the upper and lower extremities. Which of the following is the next best step in the evaluation of this patient?
A) Apply a potent topical steroid
B) Apply topical antibiotics
C) Obtain a skin bacterial culture
D) Perform a skin biopsy
C) Obtain a skin bacterial culture
This 3 month old infant has an itchy rash on the ankles. Which of the following the most likely diagnosis?
A) Atopic dermatitis
B) Candida intertrigo
C) Impetigo
D) Psoriasis
E) Scabies
A) Atopic dermatitis
A 68y/o male comes to your clinic for evaluation of high blood pressure and high cholesterol. He asks you in passing about some dryness and mild itching on both of his feet for several years that has not improved with OTC hydrocortisone 1% cream and moisturizers. What is the next step in determining the diagnosis?
A) Patch testing for allergic contact dermatitis
B) Potassium hydroxide test
C) Biopsy to rule out skin cancer
D) Bacterial swab culture
B) Potassium hydroxide test
A 26y/o Lebanese male presents with two years of white spots on his neck, upper chest, and back that are more noticeable in the spring and summer months and get better in winter. You perform a KOH exam in the office as shown. What treatment would you recommend?
A) Desonide cream
B) Pimecrolimus cream
C) Oral prednisone
D) Selenium sulfide wash
E) Ultraviolet light therapy
D) Selenium sulfide wash
Ms. Hernandez is a 40y/o Asian-Indian female who presents with several months of worsening pruritic dry scaly skin between the toes and over the lateral aspects of her right foot. More recently, she developed blisters on the plantar aspect of the foot beneath the toes that opened and started peeling. She does not report any skin changes on her left foot or anywhere else on her body. She did not have any change in her shoes or skin care regimen. Which diagnosis is MOST likely?
A) Contact dermatitis (eczema)
B) Dyshidrotic eczema
C) Friction blisters
D) Psoriasis
E) Tinea pedis
Tinea pedis
A potassium hydroxide test is performed and you see the following through the microscope. What are the findings?
A) Budding yeast forms, no hyphae
B) Mites, eggs, and scybala
C) Multinucleated giant cells
D) Normal keratinocytes (skin cells) only
E) Septate branching hyphae
E) Septate branching hyphae
This 54y/o white males present with several years of erytheme and greasy scale on his central face, including the glabella, eyebrows, and nasolabial folds. The most appropriate next step is:
A) Avoidance of spice foods, alcohol, or hot liquids
B) Clobetasol cream twice daily
C) Ketoconazole cream once to twice daily
D) Moisturizers 2-3 times daily
E) Topical retinoid cream
C) Ketoconazole cream once to twice daily
A 28y/o white female developed an itchy rash on her wrist about 2 months ago. She used clotrimazole cream daily for 2 weeks without much help. She was prescribed topical triamcinolone which decreased the redness and itching, but now the rash is expanding after 3 weeks of treatment. A KOH exam was floridly positice. What is the next appropriate treatment?
A) Naftifine cream or gel twice daily for 4 weeks
B) Nystatic cream or ointment twice daily for 6 weeks
C) Oral ketoconazole 400mg daily for 5 days
D) Oral terbinifine 250mg for 4 weeks
E) Selenium sulfide shampoo for 2 weeks then 2-3 times per week
D) Oral terbinifine 250mg for 4 weeks
A 32y/o healthy black male complains of five years of progressive thickening and discoloration of his first toenails and he is worried it is spreading to other toes. Which of the following do you recommend first?
A) Ciclopirox nail lacquer twice daily
B) Empirically begin oral fluconazole 150mg weekly
C) Empirically begin oral ketoconazole 400mg daily
D) Empirically begin oral terbinifine 250mg daily
E) Perform fungal culture or KOH to confirm diagnosis
E) Perform fungal culture or KOH to confirm diagnosis
