Dermatology Flashcards
1
Q
- Teenage female presents with blackheads only, mild acne, what do you recommend?
a) Topical benzoyl peroxide gel
b) Topical retinoic acid
c) Accutane
d) Topical clindamycin
- —————————- - Teen with blackheads for two months. Management?
a) Wash face
b) Topical benzoyl peroxide
c) Topical retinoids
d) Systemic antibiotics
- —————————- - Kid with mild comedones. First Rx?
a) Benzoyl peroxide
b) Topical retinoic A
c) Tetracycline
- —————————– - Teenage girl with mild acne: comedones only. What do you do?
a) Benzoyl peroxide
b) Topical retinoin A
c) Accutane
d) Oral antibiotics
- —————————– - Girl with only blackheads. Best treatment?
a) Topical tretinoin
b) Topical benzoyl peroxide
c) Oral antibiotic
d) Accutane
- —————————– - Teenage female presents with blackheads only, mild acne, what do you recommend?
a) Topical benzoyl peroxide gel
b) Topical retinoic acid
c) Accutane
d) Topical clindamycin
A
Topical retinoid
Good for comedones with only mild assoc’d acne
2
Q
- 15 year-old male present with mild papular and comedogenic (? papulopustular, not comedogenic?) acne on face, trunk and back. Previously only using soap to wash his skin. Next step for treatment:
a) Tetracycline PO
b) Erythromycin cream
c) Combination of topical retinoid and benzoyl peroxide
d) Other topical
A
Topical retinoid + BP
3
Q
- What to give to kid that failed topical acne tx?
A. Minocycline
A
PO ABx
4
Q
- Benzoyl peroxide works by:
a) Decreasing antibacterial resistance in p. acne
b) Decreasing the duration of oral antibiotics
c) Decreasing the need for oral antibiotics
- ——————————- - Advantage of benzoyl peroxide?
a) Decrease P acnes resistance to antibiotic
b) Decrease duration for oral antibiotic
c) Inhibits androgen effect of sebum
d) Decrease need for antibiotic
A
Decreases P acne resistance to ABx
- decreases bacteria
- antiinflammatory
5
Q
- What is the mechanism of Accutane?
a) Decreased sebum production
b) Decreased proprionibacterium
c) Comeodolytic
d) Increase follicular cell turnover
- ————————— - What is the mechanism of action of Accutane?
a) Reduces infection with Propionibacterium acnes
b) Decreases sebaceous gland production of sebum
c) Increases follicular cell turnover
A
Decreases propionibacterium acnes?
- Reduces size and secretion of sebaceous glands
- Normalizes follicular keratinization
- Prevents new microcomedone formation
- Decreases the population of P. acnes
- Antiinflammatory effect
6
Q
2. A kid with asthma and eczema has an acute worsening of his eczema. What would you treat him with? (PAGE 9) a) Acyclovir b) Steroids c) Cefazolin d) Vancomycin --------------------- 5. A 3 year old boy has atopic dermatitis with a sudden exacerbation. Photo shown of (likely) impetiginized eczema. What is the treatment? a) IV acyclovir b) IV cefazolin c) IV cloxacillin ----------------------- Boy with history of atopic dermatitis presents with rash similar to that seen in picture. Difficult to discriminate between eczema herpeticum and eczema with impetigo. Best treatment? a) IV cefazolin b) IV acyclovir c) IV clindamycin d) Topical steroids
A
Ancef
7
Q
- Hemangioma over eye, what do you want to do first?
a) Consider starting propranolol
b) Call optho
c) Wait 2 weeks then reassess
A
Call ophtho
Then Propranolol
8
Q
- Vascular Malformation over unilateral upper face. What do you need to worry about?
a) Glaucoma
b) Ipsilateral hearing loss
c) Cerebral malformation
d) Hydrocephalus
A
Glaucoma
Sturge-Weber
- usually only on one side
- V1 distribution: forehead, temple, eyelid
- capillary malformation of skin, eye, brain
1. Port wine stain (UL, V1)
2. Glaucoma
3. Leptomeningeal angioma - Need ophtho Q6mo, consider MRI brain
9
Q
- Picture of 9mo with large plaque hemangioma on the face, what would you NOT do?
a) Echocardiogram
b) MRI head
c) Renal ultrasound
d) Ophthalmology
A
Renal U/S
PHACES
- Posterior fossa brain malformation (cerebellar hypoplasia (same side as hemangioma), Dandy-Walker malformation)
- Hemangioma (segmental, >5cm)
- Arterial lesions (abnormal arteries in head or neck)
- Cardiac abnormalities (CoA, arch problems)
- Eye abnormalities (Morning glory disc, optic nerve hypoplasia, congenital cataracts)
- (Sternal abN)
10
Q
- Kid w hemangioma covering eye, what to do?
a) Refer to surgery for resection
b) Reassess in few months
c) Start propranolol
A
Start propranolol
refer to ophtho
11
Q
- 6 mo old kid with vascular malformations of upper face. Complication you need to monitor?
a) Ipsilateral hearing loss
b) Cerebral AVM
c) Glaucoma
- ———————— - Child with vascular malformation of upper face. What do you investigate for?
a) Glaucoma
b) AV malformation in brain
c) Hydrocephalus
A
Glaucoma
Most likely Sturge Weber
12
Q
- Child with large port wine stain overlying the upper 2/3 of his face. What complication do you anticipate?
a) Ipsilateral cerebral AVM
b) Glaucoma
- ———————— - Child with port-wine-stain on face over V1 distribution. What needs to be followed for?
a) Ipsilateral hearing loss
b) Glaucoma
- ———————— - Child with large port wine stain in a distribution of the 1st trigeminal nerve. What do you work him up for?
a) Optic glioma
b) Cerebral arteriovenous malformation
c) Glaucoma
d) Liver disease
A
Glaucoma
13
Q
- Strawberry hemangiomas, which is true:
a) Not present at birth
b) Equal sex predilection
c) Chew up platelets
d) Begin to involute in 2nd decade
- ————————— - What is true of strawberry hemangiomas?
a) Involution after the second decade of life
b) They are usually not present at birth
c) There is never an indication to treat
A
Not present at birth
Strawberry hemangioma = superficial hemangioma
- not present at birth, become apparent in first 2mo
14
Q
- Baby with large congenital (melanocytic?) nevus on face. What is she at risk for?
A
?Large congenital pigmented nevi -> at risk for leptomeningeal involvement + malignant melanoma
15
Q
- Term with forceps delivery, presented with jitteriness, has a red firm plaque on hand, what blood work is most likely to be found (likely talking about subcutaneous fat necrosis)
a) Hypercalcemia
A
Hypercalcemia
16
Q
- What is the best treatment for headlice if resistance is prevalent?
a) Permethrin
b) Resultz
- ————————— - What’s best to use in a resistant population for lice? [CPS]
a) Resultz
- ————————— - Which one of the following treatments for head lice decreases the resistance of lice to treatment?
a) Lindane
b) Isopropyl alcohol/terpineol (?myristate)
c) 1% permethrin
d) 5% permethrin
- ————————— - Head lice - which one is least likely to increase resistance?
a) Permethrin 1%
b) R&C
c) Lindane
d) Resultz shampoo
A
Resultz shampoo (noninsectidal, no resistance)
17
Q
- Which of the following head lice treatments most likely to have resistance:
a) Permethrim
b) Lindane
c) Permethrim with something else added
A
Permethrin
18
Q
Which of the following head lice treatment is most likely to be INeffective? (Sick Kids review)
a) Permethrin 1%
b) Lindane 1% (gamma benzene hydrochloride)
c) Permethrin + piperonyl butoxide
d) 50% isoprophyl myrisate (IPM 50%; Resultz)
A
Lindane 1%
slow killing time, more resistance, neurotoxicity + BM suppression
Probable carcinogen therefore no longer considered acceptable therapy
19
Q
- Child with lice. When can he go back to school?
a) Now
b) After 1 day of treatment
c) After 1 week of treatment
A
Now
20
Q
- Shows picture of kid with round hairless patch and NO scales and well demarcated. What’s the association?
a) Autoimmune thyroiditis
b) Fungal infection
c) Anxiety disorder
A
Autoimmune thyroiditis
Alopecia arreata b/c no scale, even + well demarcated hairless Autoimmune diseases: - Hashimoto - Addison's - Pernicious anemia - UC - Myasthenia gravis - Vitiligo - T21
21
Q
- Area of alopecia scaly and itchy. Treatment?
a) PO terbinafine
b) Fluconazole
c) Topical terbinafine.
A
Alopecia WITH SCALE = tinea capitis
Treat with PO tebinafine x2-8wks
22
Q
- Kid with crohn’s on sulfasalazine and has hairless patch with slight scale.
a) Alopecia areata
b) Trichotillomania
- ———————— - Kid with crohns and hypothyroidism. Now with a new bald patch, smooth hair loss, distinct border. Dx?
a) Alopecia areata
b) Tinea capitus
c) Trichotillomania
- ———————– - Kid with celiac disease and hypothyroidism. Develops a new bald spot. Likely etiology?
a) Tinea capitis
b) Alopecia areata
A
Alopecia areata
Autoimmune. Round patch of smooth hair loss with distinct border.
shouldn’t have scale though
23
Q
- 13 year old girl had scoliosis surgery 2 months ago. She now presents with significant amount of hair loss. On exam she has diffuse hair loss with no underlying inflammation. What is the likely cause?
a) Tricotillomania
b) Tinea capitis
c) Telogen effluviam
d) Alopeica areata
A
Telogen effluviam
- occurs 1.5-3mo after precipitating cause (child birth, surgery, febrile episode)
- premature conversion of growth hairs (anagen) to resting hairs (telogen)
- no inflammation
- hair follicles intact
- not itchy
- Normal hair regrows in 3-6mo
24
Q
- A young boy has three circular patches of complete hair loss on his head. It is slightly itchy. His finger nails are normal. His mother had a similar episode when she was younger. What is the diagnosis?
a) Trichotillomania
b) Alopecia areata
c) Telogen effluvium
d) Tinea capitis
A
Alopecia areata
25
Q
- Kid with 10 tanned macules more varying from 5 to 15mm and normal physical examination. (No mention of family history). What would you do next to confirm the diagnosis?
a) MRI head
b) Ophthalmology
c) Echocardiogram
A
Opthalmology
Lisch nodules and optic gliomas
26
Q
- 12 year old girl with a history of hypopigmented flat scars following mild trauma, as well as spontaneous vesicular lesions when exposed to sun. Which medication would this most likely be a side effect of:
a) Prednisone
b) Naproxen
c) Lisinopril
d) Methotrexate
- ————– - Child with hypopigmented flat scars and vesicles post sun exposure. What is the agent?
a) Methotrexate
b) Naproxen
- ————— - Drug-induced photosensitivity caused by which drug (same options as old exam!)
a) Naproxen
b) Prednisone
c) Methotrexate
- ————— - Patient with hypopigmented macules with sun exposure. What caused them?
a) NSAID
b) Prednisone
c) Acetaminophen
Features
Cause
Tx
A
NaprOXen
O = sun
X = no!
Pseudoporphyria
- features of porphyria but normal porphyrin metabolism
- 10% of JIA pts taking naproxen
- bullous photodermatosis
- heal with scarring + milia
- skin fragile + easy bruising after minor trauma
Causes
- UV radiation + tanning beds
- Meds: NSAIDS - naproxen most common
- Chronic renal failure + HD
Tx
- Stop offending agent
- photoprotection
- gradual improvement - - can continue for months after drug stopped
27
Q
- 12 y.o. girl with a history of hypopigmented flat scars following mild trauma, as well as spontaneous vesicular lesions when exposed to sun. Which medication would this most likely be a side effect of:
a) Prednisone
b) Naproxen
c) Lisinopril
d) Methotrexate
- —————— - Girl that gets vesicles with sun exposure and hypopigmented flat scars with mild trauma
a) Prednisone
b) Naproxen
c) Methotrexate
d) Linolid
Features
Cause
Tx
A
Pseudoporphyria
- normal porphyria metabolism
- 10% of pts of JIA on naproxen
- can occur months
- bullous photodermatitis
- heals with scarring + milia
- fragile skin + easy bruising with mild trauma
Causes
- UV radiation + tanning beds
- Drugs: NSAIDS - naproxen most common
- CRF + HD
Tx
- stop the agent
- avoid sun
- gradual improvement
28
Q
- Patient with red rash and +ve Nikolsky sign. Lip and eye changes. Diagnosis?
a) Strep toxic shock
b) TEN
- ——————– - Picture of an infant with a diffuse erythematous rash with mucous membrane involvement. Looks unwell. Patient was recently treated with amoxicillin. Blistering seen distally with positive Nikolsky sign on areas of blistering. What is the likely diagnosis?
a) Staph scalded skin
b) TEN
c) Toxic shock syndrome
- ——————– - Child presents with rash, blisters at extremities (picture provided: full body, looks like lips are involved, has a foley in situ). Initially had viral prodrome, then had amoxicillin for 7 days, after which the rash started.
a) TEN
b) Staph scalded skin syndrome
c) Dermatitis herpeticum
d) Erythema multiforme
- ——————– - A 12-year old boy presents with a history of a URTI, treated with Amoxil for 7 days. Then develops a rash (which had bullae on his limbs), with a positive Nikolsky sign. (picture provided.
a. SSSS
b. TEN
A
TEN
29
Q
- Kerion treatment
a) Lamisil po
b) Lamisil topical
c) PO keflex
- ———————– - Child with large, boggy mass on head with small amount of purulent drainage. Scaly edges (pic given – looks like Kerion). Best treatment:
a) Oral prednisone
b) Oral terbinafine
c) Topical terbinafine
d) Oral Keflex
A
Oral Lamisil/terbinafine x 8-12wk (stop when fungal Cx negative)
kerion = elevated, boggy granulomatous masses due to severe inflammatory response
30
Q
- Illustration of tinea capitus. Treatment?
a) Oral lamisil (terbinafine)
b) Topical Lamisil
c) PO steroids
d) PO cephalexin
- ——————— - Kid with a picture like that shown below. What do you treat it with?
a) Topical ketoconazole
b) Oral Lamisil
c) PO cephalexin
d) PO corticosteroids.
- ———————- - Treatment of tinea capitis?
a) PO lamisil
b) Topical fluconazole
c) Topical steroids
- ———————– - What is the treatment for Tinea capitis?
a) Topical steroids
b) Topical antifungal
c) Oral Lamisil
A
Oral lamisil/terbinafine
31
Q
- Child sucks on finger. Lesions on finger for 10 days. Finger hurts when mom touches it. Picture of a finger with vesicles and erythema (herpetic whitlow). What is your management?
a) PO cephalexin
b) Incision and drainage
c) PO acyclovir
d) Flamazine dressing
- ———————– - Picture of herpetic whitlow x 10 days. Painful, swollen with erythema and ulcerated. Treatment?
a) Cephalexin po
b) Flamazine dressing
c) PO acyclovir x 2 weeks
- ——————— - Picture similar to that given. What is the best tx?
a) PO acyclovir
b) Topical mupirocin
c) Flamazine dressings
d) Oral corticosteroids
- ——————— - Herpetic whitlow picture. What is the correct therapy?
a) PO Keflex
b) PO acyclovir
c) Flamazine dressing
A
PO acyclovir x ~10d
Treat to prevent ecezma herpeticus
32
Q
- 2yo presents with abscess on buttocks, brother had same disease recently. There is no surrounding erythema and he is otherwise well.
a) I and D
b) Start clinda
c) Start septra and I and D
d) IV vanco
A
I+D
CPS MRSA
Uncomplicated skin abscesses in prev well children can be managed with drainage alone unless
1) <3mo
2) assoc’d cellulitis
3) Fever or other systemic signs of illness
MRSA abscess mgmt
- Always do I+D and cultures
- 0-1mo: IV vanco -> amox clav
- 1-3mo: TMP-SMX even if well
- > 3mo: if well -> I+D + wait for Cx. If unwell, signs of cellulitis, systemic illness -> I+D, start TMP-SMX + keflex
33
Q
- Kid with bright red perianal rash
a) Candida perianal
b) strep perianal infection
c) contact dermatitis
d) Sexual abuse
A
Strep perianal
- well demarcated perianal erythema. May involve vulva + vagina.
- anal pruritus, painful defecation, blood-streaked stools
- Unusual to have systemic Sx + fever
34
Q
- Picture of erythema multiforme on arm and has ulcers in her mouth - what would the cause be?
a) Mycoplasma
b) NSAIDs
A
Mycoplasma
Mycoplasma Induced Rash + Mucositis
35
Q
- Girl with onset of itchy rash x 1 week over her trunk and back. What is her most likely diagnosis? (doesn’t describe the features of the rash at all)
a) Pityriasis rosea
b) Tinea corporis
c) Nummular eczema
d) Psoriasis
A
Pityriasis rosea
b/c acute and distribution of trunk + back
36
Q
- 15 year old with concern regarding hypopigmented area with smooth border around a previous melanocytic nevus. Nonpainful, nonpruritic, no bleeding, not expanding. No change in colour of original nevus. Mother is quite worried. You tell her:
a) Nevus should be excised
b) There is less than 1% chance of malignancy
c) Tell her lesions will disappear
d) Tell her more lesions will appear on the trunk
- ——————– - Description of a halo nevi. What do you tell mom?
a) No risk of malignancy –
b) Increased risk of malignancy
- ——————- - Picture - hypopigmented area surrounding a hyperpigmented center. What do you tell the parents?
a) This will spread to all over her trunk
b) Spontaneous resolution
c) 1% chance of progression to melanoma
d) Will become a neurofibroma
A
Lesion will disappear
Halo nevi
- commonly on back
- puberty or pregnancy
- pigmented nevi develop pale halos
- disappear over months, repigments
- only excise if worried about central lesion
37
Q
- An 8 month old child is brought in with several small brownish nodules on his back and extremities. The parents have observed that when they touch the nodule, wheals develop around it, it it transiently becomes erythematous and their child starts to scratch it. What is the diagnosis?
a) Mastocytosis
b) Neurofibromatosis
c) Benign congenital nevi
A
Mastocytosis
- Solitary mastocytoma
- wheals or bullae
- thick, pink/yellow skin, orange peel
- pruritic
Darier sign: stroke lesion to produce urticaria
- No Tx or topical steroids for blisters - Urticaria pigmentosa
- 0-2yo
- same as mastocytoma
- lesions can become hyperpigmented
- Tx: avoid triggers (hot baths, rubbing skins, drugs, stress) - Systemic mastocytosis
- increase in mast cells in other tissues - Diffuse cutaneous mastocytosis
- develops after 1mo
- same as mastocytoma
- Tx: may need phototherapy
Tx
- Oral antihistamines
- H1 receptor antagonist first line (hydroxyzine)
- H2 RA if pruritus or gastric hypersecretion
