DERMATOLOGY

Question 1

RMSF

Answer 1

fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a
petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized.
DX: PCR essay with rickettsii Antigen
TREATMENT- doxycycline for everyone.

Question 2

Erythema Migraines

Answer 2

Target bullseye, usually appears in 7-14 days POST being bitten
by a deer tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via
ELISA, then confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or
cefuroxime. Older than 7 - Doxycycline

Question 3

Melanoma

Answer 3

Dark Moles, uneven texture, different colors, irregular, > 6mm, could be itchy

Question 4

Stevens Johnson Syndrome

Answer 4

Abruptly, hives, blisters, petechiae, purpura,
necrosis, sloughing of tissues. Extensive mucosal involvement. Prodrome of fevers with flu like
symptoms. Triggers: Allopurinol, anticonvulsants, PCN, sulfonamides, NSAIDS. HIV ppl have
higher risk for this syndrome.

Question 5

Psoriasis

Answer 5

Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails.
Scalp, elbows, knees, sacrum, intergluteal folds.
o (Koebner phenomenon- new psoriatic plaques form over skin trauma)
o (Auspitz sign- pinpoint bleeding when plaques are removed).
o TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic

Question 6

Acanthosis Nigricans

Answer 6

velvet hyperpigmented patches most common on back of neck or skin folds-
DM resistance

Question 7

Scabies

Answer 7

itching at bedtime. Permethrin cream treat everyone wash sheets and everything else in hot water

Question 8

Atopic Dermatitis (eczema)

Answer 8

Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE.
“small vesicles that rupture leaving painful, bright-red, weepy lesions” they become lichenified from
itching.
First line: Topical steroids. Avoid hot water/soaps. PO antihistamines

Question 9

Tinea Corporis

Answer 9

“ring like itchy rash, slowly enlarge central clearing”-Treatment: most respond to
topical antifungals, if severe do oral Lamisil

Question 10

Actinic Keratosis

Answer 10

Precursor to squamous cell carcinoma. “numerous dry round and pink to red
lesions” with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas.
Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which
causes ur skin to ooze, crust, scab, redness.

Question 11

Seborrheic Keratosis

Answer 11

soft round wart light tan to black “pasted on”. Asymptomatic and benign

Question 12

Cellulitis

Answer 12

Deep dermis poor demarcated lower legs. DVT

RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYELITIS

Question 13

Erysipelas

Answer 13

Group A strep, Upper dermis, clear demarcated, cheeks, shins.
TREATMENT- Dicloxacillin QID x 10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x 5d.
o MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim

Question 14

Basal Cell Carcinoma

Answer 14

pearly, waxy, skin lesions, atrophic, ulcerated center that does not heal

Question 15

Molloscum Contagiosum

Answer 15

white plug, dome shaped. Highly contagious

Question 16

Varicella Zoster Virus

Answer 16

“contagious 48 h. before, until all lesions crusted over” low grade fever,
generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules,
then vesicles erupt. “initially on trunk, then scalp and face” TREATMENT supportive,
antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best

Question 17

Acne Vulgaris (common acne)

Answer 17

mild (topicals only): *open/closed comedones w/ or w/o sm. papules. Retin-A, acne worsens 4-6
weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide.
o Moderate (topicals plus antibiotics): papules, pustules w/ comedones. Continue with topicals
combined with topical antibiotics. Then add ORAL antibiotics tetra, mino, doxy.
o Severe: with painful indurated nodule, cysts, abscesses, pustules. Accutane- check LFTs, 2 forms
of contraceptives, monthly prego testing, only prescribe 1-month supply.

Question 18

Acne Rosacea

Answer 18

chronic small acne like papules/pustules around nose mouth chin. TREATMENTMetrogel,
Azelex. Low dose tetracycline

Question 19

Impetigo

Answer 19

Gram positive. Itchy, pink-red lesions evolve into vesiculopustules that rupture; honeycrusted
lesions. If bullous: large blisters. Severe: Keflex, dicloxacillin. PCN Allergic: Azithro, clinda.
If NO BULLAE- Bactroban

Question 20

Scarlet fever (AKA Scarlatina)

Answer 20

“sandpaper textured-pink rash with sore throat” strawberry tongue,
rash starts on head and neck, spreads to trunk. The skin THEN desquamates

Question 21

LICHEN PLANUS

Answer 21

SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE
WHITE SCALES/FLAKES. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE.
INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep
C, medications, contact with chemicals.

Question 22

Spider bite

Answer 22

fever chills, n/v, located arms, upper legs, or the trunk. Bitten area becomes swollen, red,
and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs
to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc.

Question 23

Pityriasis rosea

Answer 23

itchy, herald patch, x-mas tree pattern, rash hands soles/feet think to test for
secondary syphilis RPR then VDRL are screening, then dx FTA-ABS