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pediatric Boards > dermatology > Flashcards

dermatology Flashcards

0
Q

How are the vesicles in herpes differentiated from incontinentia pigmenti?

A

Incontinentia pigments has vesicles in a linear pattern and without an erythematous base

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1
Q

What would be found on Wright stain in a patient with herpes simplex ?

A

Multinucleated giant cells and eosinophilic intranuclear inclusions

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2
Q

What diagnosis presents as multiple pustules on non erythematous base with vesicles and brown macules in a newborn?

A

Neonatal pustular Melanosis

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3
Q

What is seen on tzanck smear in a patient suspected of neonatal pustular melanosis?

A

Neutrophils

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4
Q

What diagnosis presents as yellow pustules on erythematous base and occasional vesicles in a newborn ?

A

Erythema toxicum

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5
Q

What is seen on tzanck smear in a patient with erythema toxicum?

A

Eosinophils with occasional neutrophils

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6
Q

When does erythema toxicum neonatorum typically appear? What parts of the body should be free of the rash?

A

Not present at birth but presents shortly after

Spares the palms and soles

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7
Q

What diagnosis presents as lichenification with scratching behind the knees and elbows ?

A

Atopic dermatitis

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8
Q

How can you differentiate tinea pedis from atopic dermatitis of the foot?

A

Tinea is scaling and peeling whereas atopic dermatitis is dry and scaly
Tinea spares the dorsal foot which would also be involved if atopic dermatitis

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9
Q

How would you treat eczema that is not improving with emollients and steroids?

A

Antibiotics against staph aureus

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10
Q

What foods should be eliminated in patients with atopic dermatitis ?

A

food elimination is not recommended

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11
Q

What diagnosis presents as acute eczema that is not responding to antibiotics and presents with vesicles and crusted erosions?

A

Eczema herpeticum

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12
Q

What diagnosis presents as greasy yellow patches on scalp, face and skin folds in the first 2 months of life?

A

Seborrheic dermatitis

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13
Q

What is the appropriate treatment for seborrheic dermatitis ?

A

Topical antifungal or topical steroids

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14
Q

What diagnosis presents with lesions similar to seborrheic dermatitis with ear discharge and increased urine output ?

A

Histiocytosis x

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15
Q

What type of hypersensitivity reaction (types 1-4) is poison ivy? How can a rash be prevented after exposure?

A

Type 4

Washing with soap and water & removing infected clothes

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16
Q

What type of desensitization treatment can be used against poison ivy rash?

A

None

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17
Q

What diagnosis presents as red plaques with thick scales on the elbows or knees with pinpoint bleeding? What are these bleeding spots called?

A

Psoriasis

Auspitz sign

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18
Q

What diagnosis presents as small oval scaling plaques that are thick and parallel to the lines of skin stress?

A

Pityriasis rosea

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19
Q

What is the treatment for pityriasis rosea?

A

Exposure to sun

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20
Q

What diagnosis presents as dry skin with thin scales and a pasted on appearance?

A

Ichthyosis vulgaris

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21
Q

What are the 3 treatment options for ichthyosis vulgaris?

A

Keratolytic agents (ammonium lactate)
Alpha hydroxy acid
Urea containing emollients

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22
Q

How can you distinguish tinea corporis from granuloma annulare?

A

Annulare is not scaly but tinea is

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23
Q

What is the infectious agent to consider in a patient with a chronic painful papular lesion on the sole of the foot after swimming ?

A

Atypical mycobacterium

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24
Q

What treatment should you use in an 8 year old female with an itchy rash on the soles of her feet with minimal scaling with spares the interdigital skin, thickened skin and hyperlinearity of the soles?

A

Triamcinolone cream (Rx for juvenile plantar dermatosis)

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25
Q

What is the cause of granuloma annulare?

A

Cause unknown - it is a benign inflammatory condition without epidermal involvement

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26
Q

How can you confirm diagnosis of either Ssss or TEN?

A

Skin biopsy

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27
Q

How can you differentiate TEN from SSSS based on clinical exam?

A

SSSS is superficial and exfoliated skin will not be red whereas TEN is full thickness involvement and red

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28
Q

What diagnosis would you consider in a well-appearing child with maculopapular rash with central clearing of some lesions and a few lesions on the mouth ?

A

Erythema multiform minor (not Stephens Johnson because child is well appearing)

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29
Q

What diagnosis should you consider in a patient with fever and rash as well as hypotension ?

A

Toxic shock syndrome

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30
Q

What presents as boggy blue ulcers with a necrotic base?

A

Pyoderma gangrenosum

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31
Q

What diagnosis presents as linear erythematous papules on the wrists, Scilla and groin? What is the treatment?

A

Scabies - permethrin

32
Q

What is the treatment for head lice?

A 
Permethrin cream (repeat in one week) in all household members 
or malathion
33
Q

What should you do if a patient diagnosed with lice continues itching after treatment with premethrin?

A

Steroid cream - this is an inflammatory reaction and does not indicate treatment failure

34
Q

What diagnosis presents with blue-gray macules on abdomen and inner thigh?

A

Pubic lice (crabs)

35
Q

How long can Pubic lice last without a blood meal? How long can fresh eggs last on the hair shaft before hatching ?

A

36 hours without a blood meal

10 days until eggs hatch

36
Q

What are the 2 first line treatment options for pubic lice?

A

Permethrin or pyrethrin

37
Q

What are two alternative Pubic lice treatments and why are they not first line choices?

A

Malathion (flammable and irritating)

Lindane (neurotoxicity)

38
Q

What is the treatment of pubic lice on the eyelashes ?

A

Petroleum jelly TID x 10 days

39
Q

What is the diagnosis in a toddler with 2 months of recurrent pruritic rash of clustered red papules that tend to erupt at night. No one else in the family has a similar rash.

A

Popular urticaria

40
Q

What is the appropriate treatment for popular urticaria?

A

Eliminate causative agent (ex. bug bite)

41
Q

What diagnosis should you consider in a child with perioral dermatitis with alopecia and poor growth ?

A

Acrodermatitia enteropathica (zinc deficiency)

42
Q

What is the inheritance pattern of acrodermatitis enteropathica?

A

Autosomal recessive

43
Q

How can you differentiate zinc deficiency from biotin deficiency?

A

Biotin deficiency also has oral rash and alopecia but also presents with ataxia

44
Q

What are closed comedones?

A

Whiteheads - follicles that are plugged but covered with epithelium

45
Q

What are open comedones?

A

Blackheads - plugged follicles with no epithelial covering (black color is due to melanin NOT dirt)

46
Q

What should you do in a 7 y/o patient who presents with acne? Why?

A

This could be a sign of precocious puberty and needs to be worked up

47
Q

What are the 4 stages of acne development ?

A

Abnormal follicle keratinization
Excessive sebum production
Bacterial proliferation
Inflammation

48
Q

What is the cause of excessive sebum production?

A

Androgen production

49
Q

What are the 2 main types of acne ?

A

Inflammatory and noninflammatory

50
Q

What is the cause of inflammation in a patient with acne?

A

Bacteria triggers the complement pathway

51
Q

What may be the diagnosis in a patient with “acne” that is resistant to treatment? Exam shows red papules on the nose and cheeks

A

Adenoma sebaceum (angiofibromas)

52
Q

What are two medications that may lead to acne?

A

Steroids and anticonvulsants

53
Q

What are 4 main topicals used for acne and how do they work?

A

Benzoyl peroxide - bacteriocidal
Clinda / erythromycin - bacteriocidal and anti-inflammatory
Azelaic acid - for post inflammatory hyperpigmentation
Tretinoin - vitamin A derivative that prevents acne by halting hair follicle plugging

54
Q

What would be the indication to use PO antibiotics for acne?

A

Severe inflammatory acne especially in trunk

55
Q

What is the mechanism of action of isotretinoin (accutane) in treatment of acne?

A

Antibacterial
Reduces sebum production
Anti inflammatory

56
Q

What are side effects of isotretinoin use and what needs to be monitor before and during use?

A

Dry skin/nosebleeds/headache

Teratogenic - rule out pregnancy!

57
Q

What diagnosis presents as black dots on the scalp (aka broken hairs) and tender boggy areas of induration (kerions)?

A

Tinea capitis

58
Q

What is the gold standard of diagnosis and treatment for tinea capitis?

A

Fungal culture

Griseofulvin 6-12weeks (routine labs not indicated)

59
Q

What 3 conditions should you consider in a patient who presents with alopecia totalis?

A

Nutritional deficiency
Hypothyroidism
Lupus or other chronic systemic illness

60
Q

What is the cause of hair loss which presents with different lengths of hair shafts ?

A

Trichotillomania

61
Q

What is the cause of sudden complete areas of hair loss in round patches but no inflammation on exam?

A

Telogen effluvium - triggered by stressful events

62
Q

You are presented with a child with areas of complete hair loss and nail pitting in a patient who presents with her hair in braids, what is the diagnosis and treatment?

A

Alopecia areata - reassurance or corticosteroids

63
Q

What diagnosis presents as pigmented lesions that turn into hives and develop into blisters with rubbing? What is that “sign” called?

A

Urticaria pigmentosa

Darien sign

64
Q

What is the treatment/recommendations for patients with urticaria pigmentosa?

A

No treatment - avoid narcotics, NSAIDs and radiocontrast

65
Q

What is the underlying problem in patients with xeroderma pigmentosa ? How is it inherited ?

A

Enzyme deficiency prevents UV damaged DNA repair leading to high rates of skin cancer
Autosomal recessive

66
Q

What diagnosis should you consider in a patient with port wine stain on the face along the trigeminal nerve distribution who also has cognitive deficits and seizures? What test should be done ?

A

Sturge weber - MRI to find venous leptomeningeal angiomatosis (does not correlate to size of port wine stain)

67
Q

Other than dermatological and neurological findings, what else is associated with sturge weber?

A

Glaucoma

68
Q

What are the diagnostic criteria for neurofibromatosis type 1?

A 
Two of the following:
>6 cafe au lait spots (>5 mm)
Lisch nodules 
Neurofibroma
Optic nerve glioma
Freckling (axillary/inguinal)
Bony defects 
Family hx of NF1
69
Q

What is the inheritance of neurofibromatosis type 1?

A

Autosomal dominant but 50% are spontaneous mutations in chromosome 17

70
Q

What are the causes of HTN often seen in patients with neurofibromatosis type 1?

A

Pheochromocytoma or renal artery stenosis

71
Q

How is neurofibromatosis type 2 different from type 1?

A

Presents with acoustic neuromas (schwannoma) which causes hearing loss or tinnitus
Also the defect is on chromosome 22 not 17

72
Q

What are the criteria for diagnosis of tuberous sclerosis ?

A 
Presence of 2 of the following:
Ash leaf spots x 3
Periventricular tubers
Sebaceous gland hyperplasia
Shagreen patch
Subungal fibrous
Cardiac rhabdomyoma
Retinal nodular hamartomas
Renal angiomyolipoma
73
Q

What is the typical progression of capillary hemangiomas?

A

Present at birth and gradually get larger but resolve by age 9

74
Q

What is kasabach Merritt syndrome ?

A

Rapidly progressive hemangioma due to platelet sequestration causing low platelets

75
Q

Which type of congenital Nevus is most likely to transform into a melanoma?

A

Giant congenital nevi

76
Q

What virus causes erythema infectious and what’s another name for this disease?

A

Parvovirus - fifth disease

77
Q

What is the cause of erythema chronicum migrans and what other 3 symptoms are commonly seen?

A

Lyme disease - carditis, arthritis and neuritis

78
Q

What is the name of the rash associated with rheumatic fever?

A

Erythema marginatun

pediatric Boards (23 decks)

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