Dermatology

Question 1

Common things that can trigger SJS-TEN?

Answer 1

Mycoplasma, vaccination and GVHD

Allopurinol, sulfonamides, anticonvulsants, sulfasalazine, NSAIDs

Question 2

Delineation between SJS and TEN?

Answer 2

SJS = 30% BSA involvement

Question 3

Steroid acne vs. adolescent acne

Answer 3

Steroid = monomorphous pink papules and absent comedones

Adolescent = pleomorphic inflammatory nodules with open and closed comedones

Question 4

Treatment for seborrheic dermatitis

Answer 4

Since the fungus malassezia is often involved, topical antifungal creams are effective

Question 5

Pathophysiology of scabies rash

Answer 5

Type IV hypersensitivity against the mite, feces and egg

Question 6

Scabies treatment

Answer 6

5% permethrin cream or oral ivermectin. Antihistamines can help with itching. Put bedding in bags for 2-3 days because the mite can only live away from human skin for a maximum of 3 days.

Question 7

What is responsible for GVHD?

Answer 7

Donor T-cells recognize host HLA-antigens as foreign and mount an immune response against host antigens in the skin, intestine and liver.

Question 8

Medications that can trigger bullous pemphigoid

Answer 8

Furosemide, NSAIDs, captopril, penicillamine and various antibiotics

Question 9

Why are the blisters seen in bullous pemphigoid tense? What pediatric condition can present with tense blistering?

Answer 9

Anti-hemidesmosome IgG antibodies result in sub-epidermal complement deposition and blistering. Linear IgA bullous dermatosis can present similarly in children.

Question 10

Why are the blisters seen in pemphigus vulgaris more flaccid?

Answer 10

Anti-desmoglein IgG antibodies result in intradermal antibody and complement deposition.

Question 11

Most common malignancy in women 25-29 years old

Answer 11

Melanoma

Question 12

Treatment of tinea corporis

Answer 12

Topical antifungals like terbinafine or systemic griseofulvin

Question 13

Treatment for pemphigus vulgaris

Answer 13

Steroids +/- azathioprine or MTX

Question 14

What is an acrochordon?

Answer 14

Skin tag

Question 15

Treatment of tinea versicolor

Answer 15

The condition is often due to malassezia globosa and can be treated with selenium sulfide or ketoconazole

Question 16

A patient presents with dry, rough skin with horny plates over the extensor surfaces that worsens in the winter. This condition is sometimes referred to as “lizard skin”.

Answer 16

Ichthyosis vulgaris

Question 17

Pathophysiology behind porphyria cutanea tarda? Diagnosis? Treatment?

Answer 17

Uroporphyrinogen decarboxylase deficiency. Confirmed with elevated urinary porphyrin level elevation. Treat with phlebotomy or hydroxychloroquine. Add IFN-alpha if HCV+

Question 18

Small, vascular, bright-red papular lesions that arise more commonly in the elderly

Answer 18

Cherry hemangioma

Question 19

Condition that has cavernous hemangiomas in the brain and viscera?

Answer 19

VHL

Question 20

Treatment of rosacea

Answer 20

Topical metronidazole

Question 21

Preferred method of evaluation for melanoma

Answer 21

Excisional biopsy to be able to quantify Breslow depth

Question 22

What is often in the vesicles that form on the skin secondary to contact dermatitis?

Answer 22

Typically they are sterile. They can also be colonized by coag-negative staph, which is a non-pathologic finding.

Question 23

Define:
Acanthosis

Parakeratosis

Dyskeratosis

Hyperkeratosis

Answer 23

Acanthosis: epidermal thickening

Parakeratosis: nuclei retained in stratum corneum

Dyskeratosis: abnormal keratinization

Hyperkeratosis: thickening of stratum corneum

Question 24

Treatment of molluscum contagiosum

Answer 24

They typically resolve. However, if the patient has HIV and the lesions are not resolving, you can give topical podophyllotoxin, cryotherapy or curretage

Question 25

Frostbite treatment

Answer 25

Rapid rewarming with warm water

Wait a few weeks for debridement

Question 26

Treatment for dermatitis herpetiformis

Answer 26

Gluten-free diet + dapsone (relieves pruritis)

Question 27

A 52-year-old male presents with erythematous papules and pustules on his cheeks and nose for several years. He also is embarrassed by the erythema on his nose and worries that his friends think he’s an alcoholic. The most appropriate next step is:

Answer 27

Metronidazole cream twice daily

Question 28

A 16-year-old male presents to your office for his health maintenance visit. He has not used any treatment for his acne and has severe nodular cystic acne. The MOST appropriate initial treatment plan is:

Answer 28

Oral doxy, topical tretinoin and benzoyl peroxide with follow-up in 3 months

Question 29

A 28 year-old mother of two developed a minimally pruritic rash on her wrist over the past 2 months. She used clotrimazole cream daily for 2 weeks without resolution. She was prescribed topical triamcinolone which decreased the redness and itching but did not resolve the rash after using it for 3 weeks. KOH exam was floridly positive. What is the next appropriate treatment?

Answer 29

Naftifine cream or gel twice daily for 4 weeks

Question 30

For a patient with seborrheic dermatitis of the scalp, what advice would you give with regard to using anti-dandruff shampoos?

Answer 30

Leave them in for at least 10 minutes before rinsing out

Question 31

This patient has a 2 day history of this painful, rapidly evolving, vesiculobullous eruption on the face, including the periorbital area. He feels unwell, but does not report a viral prodrome. No other areas of the body are affected. What is your diagnosis?

What is the most appropriate management course for this patient?

Answer 31

Eczema Herpeticum

Admission to hospital for IV acyclovir and urgent ophthalmologic evaluation

Question 32

A 6-year-old gymnast presents with the following skin rash that developed on her leg over the past few days. She has had no cold symptoms or fever and overall feels well. What would you do to confirm the diagnosis?

Answer 32

Bacterial culture

Question 33

Treatment of impetigo outbreak

Answer 33

PO abx + antibacterial soap