Dermatology

Question 1

Lofgren syndrome is a tetrad of what symptoms?

Answer 1

Erythema nodosum
Anterior uveitis
Hilar adenopathy
Arthritis

Seen as part of sarcoidosis–this has a good prognosis

Question 2

What is pyoderma gangrenosum? How is it treated?

Answer 2

Cutaneous sterile ulcers that start off as an erythematous papule and expands into a deep ulcer with a grey border.
Associated with IBD– for example Crohn’s.
Treated with systemic steroids.

Question 3

Trichophyton is responsible for causing what type of tinea rash?

Answer 3

Tinea capitis and cruris (head and jock itch)– areas with hair because this fungus is an endothrix, or it invades the hair shaft. Also causes tinea pedis.

Question 4

Hypopigmented rash that starts on the trunk, scaly and becomes more visible when surrounding skin tans; what kind of rash is this?

Answer 4

Malassezia (tinea corporis)

Question 5

What is a kerion?

Answer 5

A pus filled abscess caused by an immune system response to an endothrix infection (such as trichophyton); treat with oral griseofulvin (systemic anti-fungal agent)

Question 6

Transient neonatal pustular melanosis is associated with which ethnicity?

Answer 6

African Americans

Question 7

True or False. The pustular lesions of TNPM can often form before birth and are common distributed along the neck folds, anterior/posterior trunk and proximal upper extremities.

Answer 7

True

Question 8

Name the rash. Often occurs due to an infectious trigger, papular or papulovesicular rash that occurs along the face, buttocks, and extensor surfaces of arms and legs. Spares the trunk.

Answer 8

Gianotti-Crosti syndrome or papular acrodermatitis.

Koebner phenomenon– lesions occur along areas of trauma.

Question 9

Name the rash. Hypopigmented, flat-topped papules that follow a curvilinear pattern along previous embryonic ectodermal lines of migration. Treatment of rash?

Answer 9

Lichen striatus. Will resolve on its own, corticosteroids don’t really hasten the process of healing. Supportive care.

Question 10

Name the rash. Red papules that can coalesce into vesicles and bullae, notably on the lateral aspects of fingers, palms and soles. Maybe has a history of excessively sweaty palms. What is the treatment?

Answer 10

Dyshidrotic eczema. Topical corticosteroids.

Question 11

Name the rash. Recurrent episodes of erythema over the face, nose and cheeks. Can be triggered by photosensitivity, stress/extremes in emotion, etc. Can see telangiectasis over these areas, may also have some ocular involvement. What treatment can be used?

Answer 11

Rosacea. Topical metronidazole surprisingly, especially if papulopustular component to it.

Question 12

Which medication used for acne can present with generalized arthralgias and myalgias? What labs do you have to monitor for this medication?

Answer 12

Isotretinoin. Monitor CBC (concern for myelosuppression), fasting triglycerides and liver-related labs (cholesterol, liver enzymes– concerns about hepatotoxicity).

Question 13

Name the rash. Child with history of eczema presenting with vesiculo or vesiculopustular lesions over areas of previous eczema.

Answer 13

Eczema herpeticum, complication of eczema caused by activation of HSV1/2.

Question 14

Diffuse brown maculopapular rash, also noted over the palms and soles. Generalized LAD and painless ulcer noted on the shaft of the penis. Diagnosis and treatment?

Answer 14

Syphilis and PCN. If concern about PCN allergy, you want to desensitize to PCN and still treat.

Question 15

Diffuse angiofibromas with multisystem involvement and history of seizure disorder. What notable skin findings do you see with this disorder? Genetic mode of inheritance?

Answer 15

Tuberous sclerosis.
Ash-leaf spots, shagreen patches, periungual fibromas.
Autosomal dominant.

Question 16

Difference between SJS and TEN?

Answer 16

SJS <10% epidermal detachment

TEN >30% epidermal detachment

Question 17

What is telogen effluvium? What is the treatment?

Answer 17

Hair loss secondary to a stressful event (death, illness, pregnancy). Reassurance, hair will grow back in a few months.

Question 18

Name the disorder. Parchment-like skin around the vulva/perineal region with complaints of itching and occasional bleeding in underwear area.

Answer 18

Lichen sclerosis.

Question 19

Name the disorder. Rash present at birth. Description of vesicular lesions along embryonal lines of distribution, then changes to swirls of hyperpigmented skin. Findings involve skin, teeth (peg teeth), nails and CNS (MR). Marked by prominent eosinophilia. What is the mode of inheritance of this disorder?

Answer 19

X-linked dominant, usually lethal to males.

Question 20

Name the rash. Discrete firm annular plaques, smooth without scale. Treatment?

Answer 20

Granuloma Annulare. Reassurance.

Question 21

What is ichthyosis vulgaris?

Answer 21

Excessive keratin deposition leading to fish-scale appearing dry skin on extensor surfaces, as well as hyperpigmentation of skin creases.

Question 22

Oculodermal melanocytosis is associated with which eye complication? Which ethnicity does it prefer?

Answer 22

Glaucoma; Asian and African American descent

Question 23

Preceding prodromal symptoms of fever and cough, now presenting with mucositis (eyes, mouth, anal mucosa)–diagnosis?

Answer 23

Mycoplasma-induced rash and mucositis.

Question 24

Port-Wine Stain syndromes?

Answer 24

Sturge-Weber: involves V1 branch of the trigeminal nerve
PHACES syndrome--
Posterior fossa anomalies
Hemangiomas (segmental)
Arterial anomalies 
Cardiac anomalies 
Eye anomalies

Question 25

Name the condition. Diffuse rash from head to toe, significant delays in developmental milestones, poor wound healing, poor growth milestones. What nutritional deficiency do they have?

Answer 25

Essential fatty acid deficiency. Linoleic acid deficiency, impairs fatty acid metabolism.

Question 26

Cutis aplasia management?

Answer 26

Conservative management mostly, will re-epithelialize within several weeks to months.

Question 27

Difference between juvenile plantar dermatosis and tinea pedis?

Answer 27

JPD does not involve the interdigital spaces vs tinea pedis does; also JPD usually before adolescence and tinea pedis does not occur until onset of adolescence

Question 28

Description of rash as scaly papules that appear drop-like with a preceding history of sore throat. What is the diagnosis?

Answer 28

Guttate psoriasis (post-strep infection).

Question 29

Acne in an infant after the immediate post-natal period, with cystic acne/comedones prompts you to check what lab?

Answer 29

17-hydroxyprogesterone (check level of androgens), infantile acne

Question 30

True or False. You cannot use both benzoyl peroxide and retinoids benzoyl peroxide inactivates retinoids.

Answer 30

True to an extent. You cannot use both at the same time, but you can use one during the day and the other at night.

Question 31

True or False. Antibiotics are paired with topical acne treatment for its anti-infectious capabilities.

Answer 31

False, paired for its anti-inflammatory effects (topical erythromycin, clindamycin, etc).

Question 32

Topical retinoids have a keratolytic/comedolytic effect.

Answer 32

True.

Question 33

Skin and joint findings in reactive arthritis

Answer 33

Can’t see (uveitis/conjunctivitis), can’t pee (urethritis), can’t climb a tree (arthritis).
Will have enthesitis or TTP of ligaments that attach to major joints.
GU skin findings– white hyperkeratotic plaques/lesions that cover the entire glans.

Question 34

Hot-tub folliculitis is caused by which bacteria?

Answer 34

Peudomonas