Dermatology

Question 1

_____ is an autoimmune disorder that arises typically in the 6th decade of life. Bullous formation occurs.

Answer 1

Bullous Pemphigoid

*There may be prodrome of urticarial or papular lesions

Question 2

Behavior of bullae…

Answer 2

Typically they collapse and crust. At times bleeding erosions occur.

Question 3

Where do lesions frequently occur in bullous pemphigoid?

Answer 3

Axillae, thighs, groin, and abdomen

Question 4

How is bullous pemphigoid diagnosed?

Answer 4

Biopsy and immunofluorescence will confirm

Question 5

Treatment of bullous pemphigoid is?

Answer 5

Systemic prednisone at high doses until remission then low doses for maintenance

*Mild cases can be treated with topical steroids

Question 6

Most dangerous spider is the ______.

Answer 6

Brown recluse

Question 7

Timing of symptom onset with spider bites:

Answer 7

Generally patient begins to feel pain 3 hours after bite

-Systemic symptoms begin 4-6 hours after the bite

Question 8

_____ (type of spider) can cause neurologic overstimulation.

Answer 8

Black widows

*Muscle aches, spasms, rigidity

Question 9

Reaction to a brown recluse involves:

Answer 9

Initial bite is painless. It evolves into a firm erythematous lesion that heals over several days to weeks.

-lesion becomes necrotic in 3-4 days and can extend to the muscle and be as large as the palm

Question 10

Neurologic manifestations of black widow bites are treated with ____ and ____.

Answer 10

Diazepam and calcium gluconate

Question 11

Brown recluse bites may be treated locally with:

Answer 11

Wound cleansing and analgesia. Usually wound decreases significantly in 5-10 days

*Update tetanus!

Question 12

In viral exanthems (infections) rash is usually preceded by prodrome of:

Answer 12

Fever, malaise, sore throat, N/V, abdominal pain

Question 13

The MC viral exanthems of childhood are:

Answer 13

o Rubeola (measles)
o Rubella (German measles)
o Varicella (chicken pox)
o Roseola (sixth disease)
o Erythema infectiosum (fifth disease)

Question 14

Koplik’s spots (gray-white oral lesions on the buccal mucosa opposite the lower molars) are found in the prodromal phase of _____ (what disease state).

Answer 14

Measles- first disease

Question 15

Clinical manifestation of measles rash-

Answer 15

Maculopapular rash in hairline and spreads to trunk, extremities (cephalad to caudal pattern)

-May also note cervical lymphadenitis, splenomegaly, and mesenteric LAD with abdominal pain. Otitis media, pneumonia, and diarrhea are common in infants.

Question 16

How is Measles treated?

Answer 16

Self-limiting 7-10 days.

Rx–> symptomatic hydration and antipyretics. Otitis media is MC complication.

Question 17

Characteristic signs of Rubella (German Measles) are:

Answer 17

Retroauricular, posterior cervical, and posterior occipital LAD accompanied by an erythematous, maculopapular, discrete rash that starts on the face and then spreads – it resolves in 3 days (rash is less prominent than with measles)

*Treatment- supportive

Question 18

____ peaks between 6 months and 2 years. It’s known as Sixth disease. Rash follows 3-7 days of high fever.

Answer 18

Roseola

Question 19

_____ is defined as lesions that appear in crops over 3-4 days. Can have up to 500. They crust in 3-5 days. There is a prodrome of fever, malaise, and anorexia.

Answer 19

Varicella

• Starts on trunk and spreads peripherally
• *DEW DROP ON ROSE PETAL
• **Contagious until lesions crust (usually 1 week)

Question 20

Clinical dx of Varicella can be:

Answer 20

Tzanck smear for multinucleated giant cells

Question 21

Treatment of Varicella involves:

Answer 21

Symptomatic

• Antihistamines for pruritus
• Acyclovir in teens
• IVIG if immunocompromised and exposed
• Administration of vaccine w/in 72 hours of exposure can prevent or lessen severity

Question 22

____ is the reactivation of VZV.

Answer 22

Zoster/Shingles!

Question 23

_____ is caused by human parovirus B19, with the class “slapped cheeks” appearance.

Answer 23

Erythema Infectiosum- Fifth Disease

*Not contagious with rash!

Question 24

3 rashes with fifth disease:

Answer 24

1. Slapped cheeks
2. Maculopapular
3. Lacy arms and legs

Question 25

Pronounced pain at the site with a unilateral, dermatomal distribution is key for the diagnosis of _____.

Answer 25

Herpes Zoster

• Tzanck prep and viral PCR can confirm
• *Treat with Acyclovir or Valacyclovir

Question 26

____ is a superficial cellulitis with lymphatic involvement caused mostly by GAS.

Answer 26

Erysipelas

• Onset is acute!!
• *S&S- painful macular rash with raised borders. Lymphangitis and lymphadenitis are common. Purpura, bullae, and necrosis may accompany the erythema.
• **Treat- parenteral Ceftriaxone or Cefazolin

Question 27

Treatment of pilonidal sinus involves:

Answer 27

Surgical drainage, may be supplemented with abx

• Drain in ED and pack loosely with gauze
• F/u with sitz baths
• Follicle removal may be required with unroofing of sinus tracts