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(PA school) CAM I > Dermatology I scenarios > Flashcards

Dermatology I scenarios Flashcards

1
Q

How would you describe a pt’s spot that cannot be palpated?

A

Macule/ patch

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2
Q

How would you describe a liquidy-filled sac that’s firm? (i.e. not squishy & not hard)

A

Cyst

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3
Q

A small, solid bump is typically what?

A

Papule

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4
Q

A pt has white exudate come out of a bump. What type of skin lesion did they likely have?

A

Pustule

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5
Q

A pt has a flat or barely elevated plaque. What is this, and what is a potential Dx?

A

Patch; atopic dermatitis/ eczema

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6
Q

A pt has a defect in the epidermis only. Is this an ulcer?

A

No; an ulcer is a defect in dermis or deeper (heals with scar & usually indented)

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7
Q

A pt has pruritis, scaling, and fissuring. How would you differentiate from the two forms of eczema/ dermatitis?

A

1) Acute: pruritis, erythema, vesiculation
2) Chronic: pruritis, xerosis, lichenification

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8
Q

A pt has multiple wheals/rash[es], what can you call this?

A

Urticaria; “hives, whelps”

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9
Q

A pt has a well-defined bump with a thin roof; it’s filled with serum and blood. What is this called?

A

Vesicle/ bulla (aka blister)
Vesicle <0.5 cm
Bulla >0.5 cm

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10
Q

A pt having a scrape is an example of what kind of skin defect?

A

Erosion

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11
Q

What are the 8 things you need to describe abt a patient’s skin lesion?

A

CLAMPS TN
Color
Location/distribution (extent, pattern)
Arrangement (grouped vs disseminated & confluence (yes or no)
Margination (well- or ill-defined)
Palpation (consistency, temperature, mobility, tenderness, depth)
Shape
Type (ie, papule, macule, pustule)
Number of lesions

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12
Q

A pt has intense pruritis, erythema, and vesiculation that has just started. What is a potential Dx?

A

Acute ezcema

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13
Q

A pt has irregularly-shaped, elevated, edematous spots. They have well-demarcated borders but are not stable; they’ll disappear within 24-48 hours. What are they?

A

Wheals

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14
Q

A pt has a pemphigoid or a pemphigus. Both of these can be describe as what?

A

Vesicular bullae

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15
Q

What do your pts with erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis have in common?

A

They have a desquamation issue

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16
Q

A pt has had pruritis, xerosis, and lichenification for a while. This is characteristic of which form of eczema?

A

Chronic

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17
Q

A pt has all the Sx of dyshidrotic eczema, but you aren’t sure if the timeframe they’ve had it matches that Dx. What are the forms of dyshidrotic eczema?

A

Acute, chronic, & recurrent

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18
Q

A pt figures out that their laundry detergent was what was causing their dermatitis. What kind of dermatitis is this?

A

Irritant contact dermatitis

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19
Q

A pt has deep-seated pruritic, clear “tapioca-like” vesicles every so often.
1) What do they have?
2) How do you treat?

A

1) Dyshidrotic eczema (recurrent)
2) Strong steroids, IL steroids, or PO prednisone for severe cases

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20
Q

A 25 y/o female pt has localized lichenification in circumscribed plaques. What is likely the cause, and what is the main part of Tx?

A

Repetitive rubbing & scratching; D/c rubbing and scratching

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21
Q

A 55 y/o male pt has coin-shaped plaques of grouped small papules & vesicles on an erythematous base on his legs and arms. They are extremely itchy.
1) What is your Dx? Is this acute or chronic?
2) Tx options?

A

1) Nummular eczema; chronic
2) Moisturizer, topical steroid, PUVA or UVB

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22
Q

A pt has dermatitis from a nickel allergy. What type is this?

A

Allergic contact dermatitis

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23
Q

A pt has been working in their yard and has well-demarcated erythema and edema with non-umbilicated vesicles and papules. She reports they’re both stinging and itching.

1) What is their Dx?
2) Likely causes?

A

1) Allergic contact dermatitis
2) Plant exposure, chemical residues

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24
Q

A pt has burning, weeping well-demarcated erythema and edema, non-umbilicated papules.

1) What is likely the Dx?
2) Tx?
-Incl. Tx for if it was severe

A

1) Contact dermatitis
2) Remove etiologic agent, wet dressings/Burrow’s solution (OTC,) topical glucocorticoids
-PO prednisone (if severe)

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25
Q

Yellow greasy scales on scalp can be described as what?

A

Seborrheic dermatitis
(yellowish scales are bc of sebaceous glands)

26
Q

A pt has inflammatory papules with skin hyperpigmentation and scales on their lower legs and ankles.

1) What is likely the Dx? What’s it related to?
2) What is a mainstay of Tx?

A

1) Stasis dermatitis; vascular insufficiency
2) Compression stockings

27
Q

1) What kind of rash that has an “itch-scratch cycle” may be common in your pts w. Hx/ FHx AD, allergic rhinitis, & asthma?
2) What’s the etiology?

A

1) Atopic dermatitis
2) Skin barrier dysfunction, IgE reactivity

28
Q

A pt has itchy red, greasy plaques with yellowish scales on their scalp and face. What is this?

A

Seborrheic dermatitis

29
Q

A pt has been stressed and it’s December. They now have a dry rash that gets even more itchy when they scratch it. They likely have?

A

Atopic dermatitis

30
Q

A pt has a Dx of atopic dermatitis. You have tried having them avoid scratching, while also using wet dressings and topical steroids.

1) What are some things you could try before you use the last-resort treatment?
2) What is the last-resort treatment?

A

1) Topical/ PO antibiotics, hydration, emollients, topical calcineurin inhibitors, PO H1 antihistamines
2) PO steroids only for severe intractable cases

31
Q

Your pts with HIV or Parkinson’s are both at risk for what condition?

Hint: it’s worse in the winter, and sometimes better & sometimes worse in the summer.

A

Seborrheic dermatitis

32
Q

1) What sometimes presents similarly to dandruff?
2) What are your Tx options for this?

A

1) Seborrheic dermatitis
2) Selenium sulfide (Selsen BLUE, Head and Shoulders,) topical antifungals, tar shampoo (Neutrogena T-gel,) mild topical steroids

33
Q

You have a 35 year old female pt who has erythematous grouped papulopustules around her mouth, but not on the vermillion border.

1) What is this?
2) What are some potential causes?

A

1) Perioral dermatitis
2) Fluorinated toothpaste, topical corticosteroids

34
Q

You have a 20 y/o female pt with erythematous plaques with scales around her mouth that are not on the vermillion border?

1) Dx?
2) Tx options?

A

1) Perioral dermatitis
2) Eliminate steroids and irritants (cosmetics/skin care products) topical metronidazole, erythromycin or pimecrolimus

35
Q

A pt has multiple sharply-demarcated round and oval macules that are dusky red (almost violaceous). There are also some patches that have evolved to bulla & then erosion. The pt says there is some burning/ pain.

1) What are they likely experiencing?
2) What are 2 potential causes of this Dx?
3) Tx?

A

1) Fixed drug eruption
2) NSAIDs, OCPs
3) D/c drug, topical steroids (non-eroded), antibiotic ointment (eroded), PO steroids for severe mucosal lesions

36
Q

A pt has one sharply demarcated round erythematous macular patch that’s erythematous. They just took their first dose of a new medication. Pt reports no itching/ pain. What could it be?

A

The beginning of a fixed drug eruption.

37
Q

A pt has purple, polygonal, pruritic, flat topped papules on the creases of their arms and legs.

1) What Dx is this describing?
2) What is the cause of this?

A

1) Lichen planus
2) Idiopathic

38
Q

A 40 y/o pt’s oral and vaginal mucosa appear white and lacey. What is a potential cause?

A

Lichen planus

39
Q

It is autumn. A pt’s chart shows that 2 wks ago, they had an oval, salmon-red plaque/ patch ~2-5 cm with fine collarette peripheral scale spot appear on their abdomen.

Now, 2 weeks later, they’re back with a bunch of fine scaling papules & patches in a “Christmas tree” pattern (lines of cleavage) on their back.

1) Dx?
2) Probably etiology of this Dx?
3) What was that initial spot called?

A

1) Pityriasis rosea
2) Reactivation HSV-7 & HSV-6
3) Herald patch

40
Q

How might you treat a pt with pityriasis rosea?

A

PO or topical antihistamines, topical steroids, UVB phototherapy or natural sunlight, PO steroids

41
Q

An obese pt who has been stressed recently is experiencing joint pain and pruritic well-demarcated, erythematous plaques with silver “scales” (when scraped off reveal pinpoint bleeding) on their knees, palms, & elbows.

1) Probable Dx? What’s another Sx of this Dx?
2) 2 differential diagnoses?
3) How would you rule out these DDxs?

A

1) Psoriasis (chronic); can cause pitting in nails
2) Eczema & Lichen simplex chronicus
3) Biopsy

42
Q

A pt who has recently had strep (guttate) has diffuse drop-like scattered (scaly) red to pink lesions.

1) What is a potential Dx? What are 2 DDxs?
2) 2 Tx options?
3) Is it ever self-remitting?

A

1) Guttate Psoriasis; pityriasis rosea, tinea corporis
2) Phototherapy, topical corticosteroids
3) May self remit in several weeks to several months; may progress to plaque psoriasis (<30%)

43
Q

A pt has plaques with silver “scales” and pitting in their nails.

1) Potential Dx?
2) Tx options for this Dx?

A

1) Plaque psoriasis
2) Topical Steroids and emollients: meds need to be able to penetrate skin
-Kenalog intralesional injections - scalp
-UVB light therapy
-Biologic Agents: Humira, Remicade, Embrel, Methotrexate (needs annual labs and CXR)

44
Q

A 15/yo male pt who just started a new medication has target lesions on his oral and genital mucosa, as well as his pharynx. He also has a fever and arthralgias.

1) Dx?
2) Tx?

A

1) Erythema multiforme major (secondary to drug rxn)
2) PO antihistamines; wet dressings

45
Q

A 19y/o male pt has target-like lesions on his arms, legs, and face. He has no systemic Sx or mucosal involvement.

1) Dx?
2) Etiology?

A

1) Erythema multiforme minor
2) Most commonly due to herpes simplex virus

46
Q

Over the past 13 days, a pt has had lesions on their palms, soles, & feet develop. They have turned from macules, to papules, and now they are vesicles and bullae.

1) Dx?
2) Tx options?

A

1) Erythema multiforme
2) Topical corticosteroids, PO antihistamines, Wet dressings

47
Q

A young pt has macular lesions on their eyes, in their mouth, and on their face that are beginning to turn into papules and vesicles.

1) Dx? How can you confirm?
2) How would you treat them?
3) What are other Tx options for this Dx?

A

1) Erythema multiforme; biopsy
2) Ophthalmology referral for ocular lesions
-Topical corticosteroids
-PO steroids for disabling oral lesions
-Medicated (lidocaine, diphenhydramine) mouthwash for oral mucosal lesions
3) PO antihistamines, Wet dressings

48
Q

A pt with cancer is suddenly having an acute, life-threatening mucocutaneous reaction involving necrosis and detachment of epidermis after having arthralgias & fever for the past few days.
Their mucous membranes are affected, but not their palms and soles.

1) What do they likely have?
2) How would you differentiate this condition?

A

1) Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN)
2) SJS = <10% epidermal detachment, TEN = >30% detachment (overlap 10-30%)

49
Q

A pt who has just started anti-seizure meds started running a fever yesterday, and is now experiencing painful skin sloughing off with conjunctival burning and mouth lesions.

1) Dx? How long can the pt expect it to last?
2) Tx options?

A

1) Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN); 8-12 days
2) Admit to ICU or burn center, d/c offending agent/drug
-IV fluids and electrolytes (treat as burn patient)
-Narcotics for pain
-IVIG (if started early)

50
Q

A pt with HIV who just started a new NSAID has had arthralgias for the past 3 days and is now experiencing conjunctival burning and painful mouth lesions.

1) What could this be the start of?
2) What are 2 Tx options that generally aren’t the norm?

A

1) Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN)
2) Systemic glucocorticoids controversial (contraindicated late in disease course)
-Surgical debridement not recommended

51
Q

A 70 y/o pt has pruritic, tense, bullae scattered around their body, but also in a few groups around their axillae, medial thigh, legs, & elbows. Their nurse says that it started with a urticarial eruption.

1) Dx?
2) 2 Tx options?

A

1) Bullous pemphigoid (vesiculobullous disease; autoimmune in nature)
2) PO or topical steroids 50-100 mg QD, or immunosuppressives

52
Q

A pt has vesicles and bullae that easily rupture on their scalp, umbilicus, groin, face, and chest. Nikolsky sign is positive.

1) Dx?
2) Tx?

A

1) Pemphigus (vesiculobullous disease; autoimmune in nature)
2) Dermatologist, high dose steroids and immunosuppression

53
Q

A white 15 year old male pt has white heads, cysts, and nodules on his face, especially his cheeks. He describes these lesions as painful. He reports a family Hx of cystic acne. He is refractive to all topical acne medications and washes tried, both OTC and prescribed.

1) What may be the Dx?
2) What may be making it worse for him?
3) Tx? What must you do before you Tx?

A

1) Severe Acne vulgaris (familial cystic acne)
2) Occlusion/ pressure [resting hand on cheeks while in class], sweat, pomade, androgens, stress
3) Since refractive, can use the worst Tx:
-PO isotretinoin
-Must check lipids and transaminases prior to therapy
-Cont. Tx. for moderate acne as well (PO antibiotics + topical antibiotics + retinoid + benzoyl peroxide)

54
Q

A 14 year old female has blackheads and gets papules and pustules occasionally, more so in the winter.

1) What is the cause of the blackheads?
2) Can you Dx her with acne vulgaris?
3) What may be contributing to her Dx?
4) Tx?

A

1) Follicular plugging (of pilosebaceous units).
2) Yes (meets comedone criteria b/c of blackheads). Likely mild acne vulgaris.
3) OCPs, stress, cosmetics, sweat, occlusion/ pressure (hand on face), androgens.
4) Long-term goal is scar prevention; remove plugging, treat bacteria
-Topical antibiotics (clindamycin and erythromycin 3%, 5% BID) and benzoyl peroxide gels (2%, 5%, 10%) bleaches fabrics can get in combo
-Topical retinoids: gradual increase in strength from 0.01%, 0.025%, 0.05% cream, gel, liquid, or ointment (retinoic acid, adapalene (now OTC), tazarotene; can NOT use if pregnant)

55
Q

How would you treat a moderate case of acne vulgaris differently than a mild case?

A

Same regimen for minor plus PO antibiotics (Minocycline 50-100mg/d or doxycycline 50-100mg BID tapered to 5o mg/d as acne lessens.)
Spironolactone 25-50mg QD.

56
Q

A pt’s, 45F, Sxs are described as “flushing & blushing” on her face with telangiectasias. No comedones.

1) Dx?
2) What may be triggering this?
3) What can you tell her the duration is?
4) Tx?

A

1) Rosacea
2) Hot liquids, spicy foods, alcohol/wine, aged cheese, exposure to sun & heat, stress
3) Days, weeks, or months
4) Reduce or eliminate alcohol & caffeine
Metronidazole gel or cream, ivermectin cream
Topical antibiotics

57
Q

A pt has “flushing and blushing” with rhinophyma, metophyma, blepharophyma, otophyma, and gnatophyma.

1) Dx?
2) Tx options?

A

1) Rosacea
2) Reduce or eliminate alcohol & caffeine
-Metronidazole gel or cream, ivermectin cream
-Topical antibiotics; PO antibiotics better than topical (minocycline, doxycycline, TCN) in papulopustular rosacea
-PO isotretinoin for severe disease
-Surgery for rhinophyma; telangiectasia (lasers)

58
Q

A male pt has inflammation of the hair around his skin follicles.

1) Dx?
2) Etiology?
3) Tx options?

A

1) Folliculitis
2) Likely staph aureus or pseudomonas aeruginosa
3) Benzoyl peroxide wash (bleaches) topical mupirocin, clindamycin, erythromycin. If no improvement –>PO Cephalexin.

59
Q

If a female pt has hidradenitis suppurativa, where is she most likely to have it? What abt for male pts?

A

1) Axillae
2) Anogenital region

60
Q

A female pt, who is obese and smokes, has double comedones, red nodules/abscesses, sinus tracts, and “bridge” scars along her axillae.

1) Dx?
2) Course of the condition?
3) Tx?

A

1) Hidradenitis suppurativa
2) Usual spontaneous remission at >35 y/o
3) A combination of:
I-ntralesional steroids, then I&D abscess
-Prednisone for severe pain & inflammation
-Surgery (excision, skin grafting)
-PO antibiotics (chronic low-grade disease)
-Isotretinoin for early disease
-adalimumab (Humira)
-Psychological

(PA school) CAM I (29 decks)

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