Dermatology

Question 1

Acne vulgaris: Hx/CC/PE

Answer 1

teenager w/
♣	Blackheads
♣	Whiteheads
♣	Cysts
♣	Pustules

Question 2

Acne vulgaris: Tx

Answer 2

Mild cases:

• Keep skin clean, but not dried out. Wash twice a day but avoid over washing
• Some data shows worsening symptoms with a diet high in sugar and milk products

Moderate cases: topical keratolytic/comedolytics
- retinoids
- azelaic acid
- salicylic acid
OR abx/keratolytic
- benzoyl peroxide (DOC, low resistance)
*allow 4-6 wks to work

More severe cases: Oral Terapies

• Tetracycline is the historical favourite
• Erythromycin
• allow 2-4wks to work
• OCP (for hirsutism, PCOS, premenstrual flares)
• spironolactone (for poor OCP candidates)
• Accutane – may only be prescribed by a dermatologist with special approval due to the possibility of severe side effects. (dry eyes and mouth, mood swings, joint pains, visual changes, leukopenia, + teratogenic)

Question 3

Acne vulgaris prognosis

Answer 3

usually ends by age 25

Question 4

Measles/Rubeola (First Disease) - how to prevent?

Answer 4

MMR vaccine (to prevent death)

Live attenuated vaccine is given at 12 months old and a booster is given before a child enters school.

Question 5

Measles/Rubeola (First Disease) - S/SXS or clinical presentation?

Answer 5

• Fever
• Malaise
• Coryza
• Cough
• Conjunctivitis
• Koplik spots are pathognomonic (These a clusters of white spots on the buccal mucosa. These fade as the rash begins to appear.)
• Rash:
• • Appears 3-5 days after first signs of illness and may last up to a week.
• • Begins behind the ears moves to the face and neck and then travels down
• • Red blanching macule
• • Pruritic
• • Lesions darken to brown and fade in the order that they appear

Question 6

Measles/Rubeola (First Disease)- lx

Answer 6

Clinical diagnosis

Viral culture

Question 7

Measles/Rubeola (First Disease)- Tx

Answer 7

• Supportive care
• Self limiting disease (7-10 days) only progressing with secondary infection (complication = subactue sclerosing panencephalitis)

Question 8

Scarlet Fever (2nd Disease) - Clinical presentation

Answer 8

Strep throat with a rash

Question 9

Scarlet Fever (2nd Disease) - infecting agent

Answer 9

GAS

Question 10

Scarlet Fever (2nd Disease) - S/SXS

Answer 10

1) pharyngitis
2) Sandpaper Rash:
- Like a painful sunburn with tiny bumps that blanch with pressure.
- May be itchy
- Starts on neck, face and chest with circumoral pallor.
- Lasts about 6 days and desquamates (peels)

3) Bright red swollen strawberry tongue

Question 11

Scarlet Fever (2nd Disease) - Tx

Answer 11

Antibiotics x 10 days

Pen V or Amox to prevent sequelae of rheumatic fever

Question 12

Rubella/German Measles (Third Disease) - Also called?

Answer 12

3 Day Measles

Question 13

Rubella/German Measles (Third Disease) - What is the infecting agent?

Answer 13

Rubella virus

Question 14

Rubella/German Measles (Third Disease) - How to prevent?

Answer 14

MMR vaccine

Question 15

Rubella/German Measles (Third Disease) - What’s one of the biggest issues with this disease?

Answer 15

If a pregnant mother gets rubella within the first 20 weeks of pregnancy there is a 20% risk of spontaneous abortion. In addition to this the child may have severe permanent congenital defects.

Question 16

Rubella/German Measles (Third Disease) - Hx/Clinical presentation/CC?

Answer 16

• Flu like symptoms for about a week:
• -Mild fever
• -Conjunctivitis
• -Arthralgias
• -Postauricular and occipital adenopathy
• Maculopapular Rash on the face which spreads to the trunk and out to the extremities
  (typically fades after about three days)

Question 17

Rubella/German Measles (Third Disease) - Dx

Answer 17

Clx

Question 18

Rubella/German Measles (Third Disease) - Tx

Answer 18

Supportive care, resolves in 3 days

Question 19

Erythema Infectiosum (Fifth Disease) - Also called?

Answer 19

Slapped cheek

Question 20

Erythema Infectiosum (Fifth Disease) - What is the infecting agent?

Answer 20

Parvovirus

Question 21

Erythema Infectiosum (Fifth Disease) - When is the patient no longer considered contagious?

Answer 21

when the rash is seen

Question 22

Erythema Infectiosum (Fifth Disease) -

Answer 22

-Mild flulike illness
(general malaise, headache, arthralgia)

• Rash at days 10-17: initially appears as flushed cheeks (+ pale ring around mouth), then encompasses whole body as a maculopapular rash, becoming lacy in the arms and upper legs
• Fever (Low grade)
• Migratory arthritis in older patients that can last 6-8 weeks
• “Papular purpuric glove & sock syndrome” in older adolescents, lasts 1-2 weeks

Question 23

Erythema Infectiosum (Fifth Disease) - Ix/Dx

Answer 23

Clx

Question 24

Erythema Infectiosum (Fifth Disease) - Tx

Answer 24

Supportive w/ NSAIDs for arthralgias and fever

Question 25

Roseola (Sixth Disease) - infecting agent?

Answer 25

human herpes virus 6 and 7 (HHV-6/7)

Question 26

Roseola (Sixth Disease) -who does this generally effect (epidemiology)?

Answer 26

Affects young children, 6 mo to 3 years (generally <2y/o)

Question 27

Roseola (Sixth Disease) - clinical presentation?

Answer 27

-High fevers to 105 for 3-7 days with no rash - Rash after fever goes away - - pink, maculopapular - - starts on trunk - - lasts hrs - 3days

Question 28

Roseola (Sixth Disease) - Ix/Dx

Answer 28

Clx

Question 29

Roseola (Sixth Disease) - Tx

Answer 29

Supportive care Monitor fever closely. Roseola is the number one cause of febrile seizures. - give antipyretics and hydrate