Dermatology

Question 1

Topical treatments for psoriasis.

Answer 1

Corticosteroids, vitamin D analogues, calcineurin inhibitors, tars, anthralin, tazarotine

Question 2

Eosinophilic pustular folliculitis - timing, appearance, diagnosis (what NOT to miss), management

Answer 2

Timing = ~6 months, resolves by 3 years
Appearance = itchy papules/pustules on red base, localized to scalp + brows
Diagnosis = smear of pustule (eosino!), CBC (eosino!), r./o immunodeficiency (hyperIgE)
Management = CC's, anti-histamine, anti-inflammatory

Question 3

DDx for bruises

Answer 3

1. Skin: Mongolian spots, hemaniomas, erythema multiforme, cultural (cupping)
2. Coagulation d/o: hemophilia, vWD, ITP
3. Autoimmune: Vasculitis, ITP, SLE
4. ID: meningococcemia
5. Onc: Leukemia, neuroblastoma
6. Nutritional deficiency: Vitamin K
7. Systemic illness: DIC
8. Connect tissue d/o: Ehlers-Danlos, OI

Question 4

Dermatological complication thought to be secondary to ischemic injury from perinatal complications + what test would you order?

Answer 4

Subcutaneous fat necrosis - hyperCa

Question 5

DDx for dermatitis

Answer 5

• Atopic dermatitis
• Nummular dermatitis - circular
• Seborrheic dermatitis
• Irritant contact dermatitis
• Allergic contact dermatitis
• Scabies
• Immunodeficiency: Wiskott-Aldrich, Hyper-IgE Syndrome, SCID

Question 6

Langerhans cell histiocytosis - what two features may they have that seborreic dermatitis does not

Answer 6

Petechiae/purpura, otorrhea

Question 7

x3 causes of nail pitting

Answer 7

• Idiopathic
• Psoriasis
• Alopecia areata

Question 8

Unique features of Pityriasis rosea

Answer 8

• Herald patch
• Christmas tree distribution
• Collarette scale

Question 9

Treatment for Pityriasis rosea

Answer 9

• Should resolve by 3 months

- If symptomatic: topical steroids, anti-histamines

Question 10

What area of the body does atopic dermatitis spare?

Answer 10

Groin + axilla

Question 11

How does Guttate Psoriasis present + what is the treatment?

Answer 11

• Sudden onset multiple small papules
• Follows strep infection
• 10d penicillin

Question 12

Psoriasis comorbidities

Answer 12

• Metabolic syndrome - cardiovascular disease, HTN, DM
• Autoimmune - IBD, arthritis
• Mental health

Question 13

When do you check for uveitis in psoriasis?

Answer 13

If there is arthritis

Question 14

What two derm conditions are related to each other in distribution + by Malassezia?

Answer 14

• Seborrheic dermatitis

- Pityriasis Versicolour

Question 15

How to dx Pityriasis Versicolour

Answer 15

Clinical, can use wood’s lamp (yellow!)

Question 16

Main difference between Pityriasis Versicolour, Pityriasis Rosea, and Tinea Corporis?

Answer 16

• PV: many colours, coalescing
• PR: collarette scale, Herald/Christmas
• TC: ring-shaped (aka ring worm)

Question 17

How to tx Tinea Corporis?

Answer 17

• Scraping of lesion
• Topical anti-fungal BID until clear
• Avoid direct contact (e.g., wrestling)

Question 18

What age group must you ALWAYS work up for acne?

Answer 18

1-7 year old

Question 19

Oral Abx choice for acne + what must you also do

Answer 19

• Tetracyclines
• Erythromycin for <9 years
• ONLY to be used in combo with BPO

Question 20

Side effects of isotretinoin

Answer 20

• Teratogenic!
• Labs - bHCG, lipids, LE’s
• CNS: night blindness, headache, pseudotumor cerebri
• MSK: myalgia, arthritis
• Skin: dryness, photosensitivity, acne fulminans

Question 21

Tx for scabies including distribution of application

Answer 21

5% permethrin x8-14 hours, rpt 7 days later

-infant (scalp to toes), children (neck to toes)

Question 22

Tx for scabies

Answer 22

(1) 5% permethrin x8-14 hours, rpt 7 days later
- infant (scalp to toes), children (neck to toes)
(2) prophylaxis for household members
(3) bedding/clothing

Question 23

How does tinea capitis present?

Answer 23

• Single or multiple patches
• With or without partial alopecia
• Non-inflam = grey scale, black dots
• Inflam = erythema, scale, pustules, kerion
• Associated occipital LAD

Question 24

Dx with occipital LAD + alopecia

Answer 24

Tinea capitis

Question 25

Tx of tinea capitis

Answer 25

- Oral terbinafine x4-6 weeks - Anti-fungal shampoo for pt + household - Examine household members

Question 26

Dx of tinea capitis

Answer 26

Scraping for KOH + fungal culture

Question 27

DDx for alopecia

Answer 27

-Congenital Focal: - Alopecia areata - Tinea capitis - Trauma/traction - Trichotillomania Diffuse: - Telogen effluvium* - Anagen effuvium - chemo - Androgenetic alopecia - Alopecia areata - generalized type - Hypothyroidism - Lupus - Iron deficiency anemia

Question 28

What is telogen effluvium?

Answer 28

Diffuse alopecia develops 6 weeks to 4 months following an inciting event = severe emotional stress, surgery, medications, infection, or idiopathic

Question 29

When is the most rapid growth for hemangiomas?

Answer 29

Between 1-3 months

Question 30

When to consider treatment for hemangioma

Answer 30

- Cosmetically sensitive - Risk of ulceration - Impairment of function/vital structure

Question 31

x4 situations when hemangiomas may be associated with systemic disease

Answer 31

- >5 cutaneous IH's = risk of visceral lesion (liver most common) - Beard distribution = risk of airway lesion - Segmental facial lesion = risk of PHACE - Segmental lumbosacral/perineal lesion = LUMBAR

Question 32

Work-up for PHACE

Answer 32

- Derm referral - MRI/MRA head + neck - Echo + ECG - Optho

Question 33

Classic three findings for Sturge Weber Syndrome

Answer 33

- Capillary malformation/Port wine stain (forehead) - Glaucoma - Leptomeningeal capillary-venous malformation

Question 34

Most common cause of erythema multiforme

Answer 34

HSV

Question 35

What group of conditions is vitiligo typically associated with?

Answer 35

Autoimmune conditions

Question 36

Is there a prodrome for TEN/SJS?

Answer 36

yes - flu-like

Question 37

What are you at risk for if there is a large congenital melanocytic nevus?

Answer 37

melanocytosis of the leptomeninges - increased risk of seizures

Question 38

What derm condition can be thought of as mild atopic dermatitis and tends to be more pronounced in darker skin individuals?

Answer 38

Pityriasis alba

Question 39

What is it - herald patch?

Answer 39

Pityriasis rosea

Question 40

What class of medication to think of with photosensitivity skin reactions?

Answer 40

NSAIDs

Question 41

What chronic derm condition can be triggered by strep?

Answer 41

Psoriasis