Derm SAQ Flashcards
- A 3 week old baby has a rash in intertrigonal and covered areas. (picture of rash)
A. What is the diagnosis?
B. What do you recommend to parents?
A. Miliaria rubra
b/c neonatal rash in skin folds + covered areas d/t block of sweat glands
B. Regulate environmental temps + remove excessive clothing
Can use topical steroids for refractory lesions
- 14 years old girl with severe acne (photo showed). She had been treated with benzoate without improvement.
A. What would be the next step in treatment?
B. Her mother thinks she has a hormonal problem. List 4 possible issues associated to her acne.
A. Topical retinoids + topical benzoyl peroxide + PO antibiotics
- consider OCP
- consider Accutane if these do not work
B.
- PCOS
- Atypical CAH
- Steroid use
- Ovarian/adrenal tumour
- Post GAS.
a) What is it?
b) What are four other associated conditions with this rash?
A. Erythema nodosum
- Hypersensitivity reaction
- Erythematous nodules on extensor surfaces (most often pre-tibial)
- Tense + painful. Do not usually ulcerate
- May have systemic Sx
- Tx
- Treat underlying disease
- Sx relief: NSAIDs, salicylates, colchicine
B.
- IBD
- Sarcoidosis
- Mycoplasma
- TB
- GAS
- Bartonella henselae
- Yersinia
- Picture of a boy with an angiofibroma. In question they mention: he came in with seizures.
A. What is the condition he has?
B. What is the inheritance pattern?
A. Tuberous Sclerosis
- likely infantile spasms
B. AD
- Baby with diabetes insipidus (key is the picture looks like a diaper dermatitis but there are petechial lesions as well)
A. What is your diagnosis?
B. What test would you do to confirm your diagnosis?
A. Langerhaans Cell Histiocytosis
- Seborrheic dermatitis-like
- Yellow, scale on red base
- Scalp, axillae, groin, chest
- Petechiae! (+/- thrombocytopenia)
- Non-pruritic
B. Tissue biopsy
- They showed the exact picture, stated kid has pain then developed rash.
What two things would you do immediately for the management?
- Consult opthalmology
- Swab for HSV PCR then start IV acyclovir
Herpes zoster opthalmicus (shingles aroudn eye involving V1)
7.2 month old baby who is breastfed, growing well. However, he has this rash and is often irritable at night.
List 3 different classes of medications and ROUTE you would use.
Atopic dermatitis
- Topical corticosteroids:
- Hydrocortisone 1% to face + groin
- Betamethasone valerate 0.05% to rest of body
- Desonide
- Topical calcineurin inhibitor (tacrolimus)
- PO Antihistamine
8.Picture of an elbow with thick, silvery scale. Stem mentions it bleeds when you peel it away.
Diagnosis?
Psoriasis
- Auspitz sign: bleeding when psoriatic plaque removed
- Koebner phenomenon: new lesions occurs in areas of previous trauma
- Description of child with hypopigmented patches (vitiligo) and hypotension. Labs show low Na, high K and low glucose.
Diagnosis?
Adrenal insufficiency - most likely Addison’s
Vitiligo due to autoimmune destruction of melanocytes
- A four year old boy has a small flat nevus on his left shoulder which he has had since birth. His mother is concerned about melanomas.
A. What would you tell her to do to prevent the nevus from become cancerous?
B. What are four things she should watch for (be specific)?
A. Sun protection
- Use sunscreen
- Avoid sun during high UV hours (10AM-3PM)
- Wear hat, long sleeves + pants outside
- Avoid commercial tanning
B. Watch for
- Asymmetry (if lesion is bisected, one half is not identical to other half)
- Border irregularity
- Color changes (presence of multiple shade)
- Diameter >=6mm
- Evolution (change in size, shape, color, or new lesions) - take photos
- Photo of umbilicated skin-coloured macules on kid’s abdomen.
Diagnosis?
Molluscum contagiosum
- Umbilicated, waxy, flesh colored papules
- Photo of heliotrope rash & other stuff (bad photo).
A. Diagnosis?
B. Name 3 investigations to confirm this diagnosis.
C. What medication would you treat with?
A. Dermatomyositis
- Classic rash: heliotrope rash of the eyelids, gottron papules
- AND 3 of
- Symmetric, proximal weakness
- Elevated muscle enzyme >=1/4: CK, AST, LDH, aldolase
- EMG changes: short, small polyphasic motor unit potentials; fibrillations
- Muscle Bx: necrosis, inflammation
B.
- Lab tests: CK, LDH, AST, aldolase
- EMG
- Muscle biopsy
C. Corticosteroids
- Child develops 3cm slightly scaly patch on cheek. Week later develops lots more 0.5-1cm patches on trunk along lines of skin folding. He is scratching.
Diagnosis?
Ptyriasis rosea
- Obese Aboriginal adolescent.
A. Identify picture
B. What condition causes this?
A. Acanthosis nigricans
B. Insulin resistance
- 2 Pictures of a 4 week infant with a papular, pustular rash, on erythematous base on face and trunk. (upper chest) Well child.
A. What is your diagnosis?
B. How do you manage this problem?
A.
- Erythema toxicum: usually appears in 1-3d, disappears after 1wk
- Neonatal pustular melanosis: almost always present at birth, disappears after 2-3d
- HSV: clear vesicles on erythematous base, kissing lesions
- Miliaria rubra: affects skin folds. Itchy/stinging worse with sweating. Resolves if cause removed. Can use topical CS, or top ABx)
