Dermatology

Question 1

What types of medications commonly cause Stevens-Johnson syndrome?

Answer 1

Antibiotics: sulfonamides Anticonvulsants Allopurinol NSAIDs *Note some of these drugs may cause other issues, such as DRESS syndrome, but if there are mucocutaneous lesions, think SJS.

Question 2

Clinical Manifestation: Stevens-Johnson syndrome

Answer 2

1. Sudden onset of mucocutaneous lesions 2. Systemic signs of toxicity (fever, tachycardia, hypotension, altered level of consciousness, conjunctivitis seizures and coma)

Question 3

Treatment: Mild manifestations of drug allergy (i.e. pruritus and urticaria) without systemic symptoms

Answer 3

1. antihistamines 2. discontinuation of the offending drug

Question 4

Mechanism of action: Drug induced type 1 hypersensitivity reactions

Answer 4

1. Exposure to drug results in drug-specific IgE formation 2. IgE antibodies occupy receptors on mast cells and basophils 3. Upon re-exposure to the drug, IgE and mast cells/basophils mediate the hypersensitivity response

Question 5

Diagnosis: 8 year old girl with: -scaly erythematous patch that has progressed to alopecia with small black dots -posteror auricular lymphadenopathy

Answer 5

Black Dot Tinea Capitus (BDTC) Note, BDTC is most often seen in African-American children. It can be transmitted by human-to-human contact or spread by fomites on a shared comb.

Question 6

Treatment:

Black Dot Tinea Capitis

Answer 6

Oral griseofulvin (1st line)

Question 7

Diagnosis:

Black Dot Tinea Capitis

Answer 7

KOH preparation to exam the hair shaft for spores

Question 8

Treatment:

Frostbite injuries

Answer 8

Rapid re-warming with warm water (40-44 degrees C)

Note, re-warming with dry heat is ineffective and can cause skin damage. Also, you should not debride ANY skin until after the re-warming process. True demarcation between viable and dead tissues takes time.

Question 9

Treatment:

Comedonal acne (noninflammatory acne)

Answer 9

1. Topical retinoids
2. Organic acid preparations: salicyclic acid, azelaic acid or glycolic acid

Note, if acne is widespread and on areas like the back and upper arms an oral antibiotic (i.e tetracycline) is most practical.

Question 10

Treatment:

Inflammatory acne

Answer 10

topical retinoids and benzoyl peroxide

Note, moderate-to-severe inflammatory acne benefits from the addition of topical antibiotics.

Question 11

Treatment:

Which types of acne are usually treated with (1) oral antibiotics or (2) isotretinoin

Answer 11

severe recalcitrant acne

Question 12

Diagnosis:

verrucous papilliform lesions located in the anogenital region

Answer 12

condylomata acuminata (anogenital warts) due to HPV

Note, serotypes 16 & 18 are especiallly associated with squamous cell carcinoma of the anus, genital organs and throat.

Question 13

What is the simplest and effective way to prevent or reduce the incidence of decubitus ulcer formation?

Answer 13

Patient repositioning every two hours

Question 14

Diagnosis:

54 year old man with telangiectasias over the cheek, nose and chin caused by consuming hot drinks, emotion & heat.

Answer 14

Rosacea

Question 15

Treatment:

Rosacea

Answer 15

Topical antibiotics (i.e. metronidazole)

Question 16

What diagnosis should be the top differential in a patient with a changing moles?

Answer 16

ALWAYS suspect a malignant melanoma.

Remember the ABCDE’s (Asymmetry, Border irregularities, Color variation, Diameter > 6mm, Enlargement)

Question 17

Diagnosis:

Hypopigmented areas of skin that do not tan

Answer 17

Tinea Versicolor

Question 18

Treatment:

Tinea Versicolor

Answer 18

1. Topical selenium slfide
2. Ketoconazole

Note, pigmentation can take several months to resolve.

Question 19

Diagnosis:

days to weeks after exposure to an allergen, an intensely pruritic erythematous rash with vesicles appear at the site of exposure

Answer 19

Contact dermatitis