Dermatology

Question 1

Describe how contact dermatitis appears in younger children
How is it treated?

Answer 1

It spares the inguinal folds.
Treat with frequent diaper changes and zinc oxide

Question 2

How does Candida diaper dermatitis differ from diaper dermatitis
How do you diagnose it?
How do you treat it?

Answer 2

It will have satellite lesions and involve the inguinal folds
Koh prep
NyStatin or clotrimazole

Question 3

Which type of skin pathology presents as coin shaped eczamatous lesions on the extensor surface of extremities that are uniform without any central clearing and can ooze, crust or have a scaling pattern
How do you treat this?

Answer 3

Nummular eczema
Topical steroids 

Question 4

If a child with eczema has a rash that is not improving with steroids and or antibiotics, think of what diagnosis?
How do you diagnose this?
How do you treat it?

Answer 4

Eczema herpeticum
HSV PCR or viral culture
Stop topical steroids and immunosuppression and start aCyclovir

Question 5

Which skin rash is a non-pruritic, inflammatory, flaky rash with white to yellow scales, usually formed in oily areas like the scalp.
How can you treat this?
What are the hypopigmented areas that can be left from this called?

Answer 5

Seborrheic dermatitis
Cleaning, antifungal, topical, mild steroids.
Pityriasis alba

Question 6

Which skin pathology is described as very well defined, red, flaky, rashes, covered with silver white patches.
What is Auspitz sign?
What is the main state of treatment?
Which three treatments can be used in severe disease

Answer 6

Psoriasis.
Bleeding when scales are removed.
Topical steroids or calcineurin inhibitors on the face.
Phototherapy, methotrexate, etantercept

Question 7

If psoriasis is in the diaper area, describe its relation to the inguinal folds
Which skin pathology is described as drop like psoriatic lesions?
This can be proceeded by what infection

Answer 7

It will involve them
Guttate psoriasis
Group, a strep infection

Question 8

If you see a patient that has skin findings, resembling eczema, but they also have petechiae or papules, this should guide you toward which diagnosis?
This is a type of cancer, which two other things can it be associated with?
How do you diagnose it?
How do you treat it?

Answer 8

Langerhans cell histiocytosis (X)
Lytic bone lesions like in the skull or diabetes insipidus
Skin biopsy,
steroids with or without chemotherapy

Question 9

If a patient is described as having eczema or seborrheic dermatitis type of rash with a high urine output, what is likely the diagnosis?
Which two types of rashes, spare the inguinal folds

Answer 9

Langerhans cell histiocytosis due to the association with diabetes insipidus
Eczema and contact dermatitis

Question 10

Which skin pathology is described as a chronic, inflammatory, dry, white, and somewhat scaly rash usually found in the genital area with no thickening or sclerosis?
Which skin pathology is a rash that looks like eczema, but is linear or popular and can follow the lines of blaschko?

Answer 10

Lichen sclerosis, look for a picture of a labia with a rash, usually no symptoms, but some may have itchiness
Lichen striatus

Question 11

A biotin or biotinidase deficiency may present with which three symptoms?
Which blood test can also be positive

Answer 11

Rash, alopecia, neurologic signs like ataxia or coma
Lactic acidosis

Question 12

Which skin pathology results in depigmented macules
It is often associated with what

Answer 12

Vitiligo.
Halo Nevi

Question 13

Which skin pathology is a rash that resembles fish scales and is often seen in a topic dermatitis
Which two treatments can be used

Answer 13

Ichthyosis vulgaris
 ammonium lactate or alpha hydroxy acid containing agents

Question 14

Which skin pathology is described as deep, bluish, necrotic and boggy looking ulcers.
It is associated with systemic diseases, like which one?

Answer 14

Pyoderma gangrenosum
Crohn’s disease

Question 15

Which skin pathology is usually a sign of pseudomonas infection and possibly sepsis in an immunocompromised patient
This is especially associated with which disease?
These lesions are often located where

Answer 15

Etyma gangrenosum
Leukemia.
Groin/diaper area

Question 16

Which skin pathology is a chronic skin condition with a circular lesion occurring under the skins surface with no scales.
How does this differ from ringworm?

Answer 16

Granuloma annulare
There is scaling in ringworm and no scaling in GA

Question 17

Which skin pathology is a condition in which there are pitted skin areas of pressure?
There will probably be a history of what in addition to this.

Answer 17

Pitted keratolysis
Strong foot odor

Question 18

Which skin pathology results in a heliotropic violaceous rash in the malar area?
Which 2 other skin findings may be present?
How do you diagnose this?
Which blood test will be high
They can also get which other skin disorder.

Answer 18

Dermatomyositis.
Gottrons papules, telangioectasias near the nail folds.
Muscle biopsy.
CK will be high
Calcinosis cutis

Question 19

SJS is diagnosed if what percentage of the body surface area is involved?
TEN requires what percentage at least to be involved
What is the Nikolski sign?

Answer 19

Less than 10%
Greater than 30%
Separation of the epidermis with firm pressure

Question 20

What is the asboe hansen sign?
At least how many mucus membranes must be involved in TEN/SJS
Which four groups of medication’s are associated with this?

Answer 20

The spread of a blister laterally when pressure is applied, seen in TEN and SJS
At least two
Aromatic seizure, medications, penicillins, NSAIDs, sulfa drugs

Question 21

If a newborn has increased, LFTs, petechiae, rash, scaling, thrombocytopenia and a third-degree AV heart block with bradycardia, you should think of what?
How do you diagnose?

Answer 21

Neonatal lupus.
Sending maternal anti ro or la antibody testing

Question 22

Which three rashes will be described with central clearing
Which three rashes will be described as central darkening/target lesions

Answer 22

Hives/urticaria, rheumatic fever (e marginatum) or tinea
SJS/TEN, brown recluse spider bite, Lyme disease

Question 23

Which pathology is described as a sack, leg growth, present at birth that can contain hair and teeth often associated with tufts or sinuses?
Why should they be removed?

Answer 23

 dermoid cysts.
Because they can get infected

Question 24

Which skin pathology is a benign, very common flesh colored nodule with a black punctum that develops at one month of age or later
Why would an answer for retinoic acid and benzyl peroxide twice daily for acne probably be wrong?

Answer 24

Epidermoid cyst
Because the benzyl peroxide inactivates retinoids, one should be used in the morning and one should be used later in the day

Question 25

How is inflammatory acne differentiated from Comodonal acne?
How are minor cases treated? How are severe cases treated?

Answer 25

 they will be acne with a red base.
Topical antimicrobials such as benzyl peroxide, clindamycin, erythromycin
In severe cases, you should use oral antibiotics like tetracycline, doxycycline, or erythromycin, if all else fails use isotretinoin

Question 26

Which three diagnosis should be considered in a younger child, such as seven with acne
Peg teeth, art teeth that are smaller than usual, sometimes tapered and look like fangs, they are associated with which two disorders

Answer 26

Exogenous steroid use, precocious puberty, tuberous sclerosis
Incontinentia pigmenti and hypohydrotic ectodermal dysplasia

Question 27

Describe Hutchinson teeth, what are they associated with?
Why do you want to avoid tetracycline until patients are at at least eight years of age?

Answer 27

They are smaller and more widely spaced with notches on the biting surfaces.
Congenital syphilis
Because it can cause yellow, brown, blue band, like staining of the teeth

Question 28

Describe the timeline of a hemangioma
What is the first line drug? If these appear in a more sensitive area, what are the two second line therapies?

Answer 28

Proliferation is greatest in the first six months, largest at one year, begin involving at two years of age and disappeared by 5–10 years
Propranolol, systemic, steroids, and pulse dye laser therapy

Question 29

What complication can occur due to large or multiple hemangiomas?
If hemangiomas present in the Lumbo sacral area, there is concern for what?

Answer 29

High output, heart failure
Spinal dysraphism or incomplete fusion of neural folds/tube

Question 30

In addition to a hemangioma, what are five other findings for which one other needs to be present to diagnose PHACES syndrome

Answer 30

Posterior fossa, malformation like dandy, Walker, art, cerebral, vascular anomaly, cardiac anomaly, like coarctation, eye anomaly, sternal defect

Question 31

Which syndrome presents with large congenital vascular tumors?
This can also cause a severe what?

Answer 31

Kasabach merritt syndrome
Consumptive coagulopathy in the form of thrombocytopenia and consumption of coagulation factors.

Question 32

Which skin pathology is a capillary malformation, unilateral and segmental, not crossing the midline starting as a pink/flat lesion that becomes dark red – purple and is permanent?
If they are on the face, they can be associated with what?

Answer 32

Port wine stain or nevus flammeus
Glaucoma

Question 33

Which syndrome presents with a port wine stain, with intracranial vascular malformations with or without glaucoma, seizure, cognitive defects?
What test should be done to look for intracranial vascular malformations?

Answer 33

Sturge Weber
MRI