Dermatology Flashcards
a 75-year-old female who presents to the clinic with a large number of pruritic, tense, subepidermal bullae across her upper thighs. There was no mucosal involvement, a negative Nikolsky sign, and a skin biopsy showed subepidermal bullae filled with eosinophils and neutrophils.
what is the most likely diagnosis
bullous pemphigoid
how is bullous pemphigoid diagnosed
skin biopsy with direct immunofluorescence exam shows deposition of IgG and C3 basement membrane
what is the treatment of bullous pemphigoid
systemic corticosteroids
what is the treament of lice
permethrin topical
a 15-year-old male with pain, discomfort, and swelling above the anus and near his tailbone that comes and goes. He reports that the pain worsens when he sits or bends forward. Medical history is significant for metabolic syndrome. He is a high school student who spends hours playing on his Xbox. On physical exam, there is a tender and fluctuant mass that is erythematous.
what is the most likely diagnosis
pilonidal disease
what is the treatmetn of pilonidal disease
drainage and surgical removal of the cyst - look for sinus tract
a 64-year-old female with a 4 cm × 7 cm edematous, red, hot tender area on the left thigh. The lesion has gotten larger over the past 6 hours. She tells you she has also had a low-grade fever and some chills. On physical exam, there is a poorly demarcated 12cm red and tender plaque on her right calf. Some parts resemble an orange peel. There is a superficial cut in the middle of the plaque.
Whats the most likely diagnosis
cellulitis
what is the most common pathogen causing cellulitis in children
H. influenzae or strep pneumonia
how is cellulitis differentiated from erysipelas
cellulitis does not have sharp, well-defined borders unlike erysipelas
what is the treatment of mild cellulitis
cephlexin
cefuroxime
PCN allergy - Clindamycin
what is the treatment of puluent of MRSA cellulitis
Trimethoprim-sulfamethoxazone
clinda
doxycyclin
IV vanco/Linezolid
what is the presentation of atopic dermatitis
pruritic, eczematous lesions, xerosis (dry skin), and lichenification
what is the treatment of atopic dermatitis
topical corticosteroids and emollients
what is the treament of nummular eczema
high or ulta-high potency topical corticosteroids = first line
what is another name for cradle cap
seborrheic dermatitis
what is the treament of seborrheic dermatitis
ketoconazole shampoo
what is the treatment of perioral dermatitis
topical metronidazole
avoid steroids
an 11-year-old male complaining of intensely itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend whom he had a sleepover this past weekend, is also having similar symptoms.
what is the most likely diagnosis
scabies
an 11-year-old male complaining of intensely itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend whom he had a sleepover this past weekend, is also having similar symptoms.
given the most likely diagnosis - what is the treatment of choice
topical permethrin 5% - apply to entire body and was after 8-14 hours - repeat in one week
what type of spider bite presents with a necrotic wound and local tissue retraction?
brown recluse
what is the presentation of black widow bites
neurologic manifestations - may not see much at bite site: toxic reaction: nausea, vomiting, HA, fever, syncope and convulsions
a 19-year-old female with a painful rash on her left leg. She had a small bug bite in the same area about three weeks ago. Since then, the area has become red, painful, and hot. On physical exam, you note shiny, raised, indurated, and tender plaque-like lesions on the left leg. The redness is well-demarcated and hot to the touch. You send her home on penicillin.
what is her most likely diagnosis
erysipelas
what is the cause of erysipelas
streptococcus pyogenese
what is the treatment of erysipelas
Mild: Pen G
Mod: TMP-SNX
Severe: IMP or MER or ERTA IV and Linezolid
a 60-year-old woman with a severe drug-induced reaction on both lower limbs with few lesions elsewhere in addition to mucosal involvement of the mouth of two days duration. The insulting drug was sulfonamide, and the onset of the rash was within 48 hours of taking the drug. The rash comprised bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosions and peeling.
what is the most likely diagnosis
SJS
what percentage of the body does SJS effect
3-10%
what is the treatment of SJS
stop offending medications, early admission to burn unit, manage fluids/electrolytes, airway stability
IVIG
steroids
a 67-year-old male who presents to your clinic with a two-day history of a painful rash on his left flank radiating to his back. This was preceded by burning pain in the same region several days prior. The patient does not recall any history of childhood exanthems and is not up to date on his immunizations. Vital signs are stable. Physical exam reveals a maculopapular rash in a dermatomal distribution on the left flank and extending into the back.
what is the diagnosis?
Herpes zoster (shingles)
what is Hutchinsons sign
shingles lesion on the nose
early indicator of opthalmic shingles
what is zoster ophthalmicus
shingles involving CCN V, dendritic lesions on slit lamp exam
what is Ramsay-Hunt syndrome
zoster oticus
facial nerve (CN VII) otalgia, lesion on the ear, auditory canal and TM, facial palsy and auditory symptoms
who is the recombinant zoster vaccine recommended for
adults 50 and older
2 doses 2-6 months apart
a 60-year-old woman with a severe drug-induced reaction with extensive skin involvement covering > 30% of her body surface area. The insulting drug was anticonvulsant medication, and the onset of the rash was within 10 days of taking the drug. The rash comprised bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosion and peeling. On examination, her skin peels away in sheets when pressure is applied and rubbed.
what is the diagnosis
TEN
how is TENs diagnosed
biopsy (showing necrotic epithelium)
a 5-year-old girl with crusting facial lesions present for 3 days. The mother reports that prior to the development of the facial lesions, her daughter was scratching at insect bites. Examination reveals a red facial rash with a golden “honey-colored crust” and pruritus.
what is the most likely diagnosis
impetigo
what is the treament of impetigo
topical mupirocin, dicloxacillin, cephalexin for more sever illness
what is dariers sign
localized urticaria appearing where the skin is rubbed (histamine release)
what are the 4 C’s of measles (rubeola)
cough, coryza, conjunctivitis and cephalocaudal spread
what is the presentation of measles (rubeola)
Morbilliform - maculopapular, brick red rash on face beginning at hairline then progressing to palms and soles last - rash lasts 7 days
Koplik spots precede the rash by 24-48 hours
what is the presentation of rubella
3-day rash; first appears on face, spreads caudally to trunk and extremities, and becomes generalized in 24 hours; cephalocaudal spread
what part of the pregnency is rubella teratogenic
first trimester (causing deafness, cataracts, TTP and mental retardation)
what is the pathogen associated with Roseola
HSV 6 or 7
what is the only childhood exanthem that starts on the trunk and spreads to the face
Roseola (sixths disease)
