Dermatology Part 2

Question 1

What is the medical name for the bullseye-type lesion scene in Lyme Disease?

Answer 1

Erythema migrans

Question 2

Describe the S/S associated with each stage of Lyme disease.

Answer 2

1: erythema migrans, fever, fatigue, malaise, etc.
2: arthritis, myocarditis, bilateral Bell’s palsy
3: chronic arthritis and encephalopathy

Question 3

What is the most common causative agent of Lyme Disease and what is the treatment?

Answer 3

Cause: Borrelia burgdorferi
Tx: doxycycline, amoxicillin in kids or pregnant

Question 4

What are the “ABCDE” S/S associated with melanoma?

Answer 4

A: asymmetry
B: border irregularity
C: color variation
D: diameter
E: evolution

Question 5

What is the most important factor in determining the severity of melanoma?

Answer 5

Depth

Question 6

How is melanoma treated?

Answer 6

Excision –> interferon reduces recurrence

Question 7

Describe melasma and state in what patients it will be seen.

Answer 7

Dark, well-demarcated, patches on the face. Seen in pregnancy or patients taking OCPs.

Question 8

What is the treatment for melasma?

Answer 8

Sunscreen and sun avoidance with combo therapy –> tertinoin plus hydroquinone or flucinolone.

Question 9

In what patients is moluscum contagiosum seen and what is the common presentation?

Answer 9

Seen in school aged children –> multiple waxy, dome-shaped papules with umbilicated appearance (small central pit) that spare the palms and soles and have no systemic symptoms.

Question 10

What is the causative agent of moluscum contagiosum and what is the treatment?

Answer 10

Poxivirus –> self-limiting infection

Question 11

Differentiate the treatment of community acquired MRSA from that of hospital acquired.

Answer 11

Community: PO doxycycline, clindamycin, or Bactrim
Hospital: IV vancomycin

Question 12

Describe the S/S associated with nummular eczema.

Answer 12

Small, grouped vesicles coalesce to form coin-shaped plaques with erythematous base and well-demarcated borders –> crusting/excoriations common

Question 13

In what patients and at what time is nummular eczema more commonly seen?

Answer 13

Men > women, seen in young adults and elderly –> more common in winter.

Question 14

Define onychomycosis and state the treatment.

Answer 14

Under nail fungus –> treatment is PO terbinafine after LFTs are checked.

Question 15

Define and describe paronychia.

Answer 15

Staph aureus infection of the lateral nail fold.

Question 16

What is the common term for pediculosis capitis and what are the S/S?

Answer 16

Head lice –> child with pruritis on the head and visible nits (eggs) or lice.

Question 17

What is the treatment for pediculosis capitis?

Answer 17

Permethrin on day 0 and repeated on day 9

Question 18

What are the S/S of pilonidal disease?

Answer 18

painful, fluctuant area (abscess) at sacrococygela cleft

Question 19

What is the treatment of pilonidal disease?

Answer 19

Surgical drainage with abx

Question 20

Describe the S/S of pityriasis rosea

Answer 20

Large lesions (herald patch) followed one week later by a rash on the back/trunk in a Christmas-tree distribution.

Question 21

What is the treatment of pityriasis rosea

Answer 21

Self-limiting –> topical corticosteroids or PO antihistamines for symptoms.

Question 22

Describe the S/S associated with psoriasis.

Answer 22

Rash with silvery scales, Auspitz sign, nail pitting, and Koebner phenomenon on the extensor surfaces.

Question 23

Define Auspitz Sign and Koebner phenomenon.

Answer 23

Ausptiz: scale removal produces blood droplets
Koebner: plaque formation on site of prior trauma

Question 24

What is the first line treatment for psoriasis?

Answer 24

Topical corticosteroids

Question 25

Describe the S/S associated with Rocky Mountain Spotted Fever.

Answer 25

Abrupt onset of severe headache, photophobia, vomiting, diarrhea, and myalgia with a maculopapular rash on the palms and soles.

Question 26

What is the causative agent and treatment of Rocky Mountain Spotted Fever?

Answer 26

Cause: rickettsia Treatment: Doxycycline

Question 27

Describe the S/S of rosacea.

Answer 27

acne-like rash on the forehead, cheeks and nose that gets worse with ingestion of ETOH, hot drinks and spicy foods.

Question 28

What is the treatment of rosacea?

Answer 28

Topical metronidazole

Question 29

What are the common S/S associated with scabies?

Answer 29

Small papules, vesicles, and burrows in webbed spaces of fingers and toes with pruritis described as "the worst itching of my life".

Question 30

What is the first line treatment for scabies?

Answer 30

Permethrin cream applied to the entire body and washed off after 8 hours.

Question 31

Describe the S/S associated with seborrheic keratosis.

Answer 31

Lesion, flat or raised, smooth or velvety with a “stuck-on” appearance noted on the face, shoulders, chest, and back

Question 32

Describe the relationship of seborrheic keratosis to cancer.

Answer 32

Does not lead to cancer but a biopsy is required to rule it out.

Question 33

Describe the progression of a brown recluse spider bite.

Answer 33

Initial bite is painless --> dark colored, depressed center 1-2 days after bite --> dry eschar and ulceration --> necrosis

Question 34

What is the treatment for a brown recluse spider bite?

Answer 34

No antivenin available --> wound care, pain control, td vaccine, supportive care, dapsone may be considered.

Question 35

What is the classic PE finding associated with Steven Johnson syndrome?

Answer 35

Vesicles and bullae involving < 10% of the body surface area but present on mucous membranes

Question 36

What is the most common cause of Steven Johnson syndrome and what is the treatment?

Answer 36

Cause: medications, usually Bactrim Tx: refer to burn center, steroids are mainstay

Question 37

What rash is commonly associated with SLE?

Answer 37

Malar (aka butterfly) rash

Question 38

What medications are most likely to induce SLE?

Answer 38

HIPPS --> Hydralazine, Isoniazid, Procainamide, Phenytoin, Sulfonamides

Question 39

Define telogen effluvium and list the most common causes.

Answer 39

Transient, diffuse hair loss caused by child birth, major illness/surgery, stress, medications, malnutrition

Question 40

Differentiate the treatment of tinea capitis from treatment of tinea in other areas.

Answer 40

Tinea capitis must be treated with systemic antifungal agents because topical agents do not penetrate the hair.

Question 41

Describe toxic epidermal necrolysis.

Answer 41

Mucocutaneous blistering disorder, most often caused by drug reaction - sulfonamides, aminopenicillins, quinilones, cephalosporins, phenytoin, vlaproic acid, allopurinol, steroids.

Question 42

Differntiate toxic epidermal necrolysis from Steven Johnson Syndrome.

Answer 42

TEN has a high fever, more epidermal separation and loss than SJS, and cover a larger TBSA ( > 30%)

Question 43

Describe the S/S associated with varicella zoster.

Answer 43

Painful, papulovesicular rash preceded by tingling or hyperesthesia with a dermatomal rash that does not cross midline.

Question 44

Describe Hutchinson's sign as it relates to varicella zoster.

Answer 44

Zoster infection at the tip of the nose that often precedes ophthalmic involvement.

Question 45

What is the treatment for varicella zoster?

Answer 45

Antivirals --> acyclovir, valacyclovir, and famciclovir

Question 46

Define verrucae and state the causative organism.

Answer 46

Plantar wart --> HPV

Question 47

What is the most common treatment for verrucae?

Answer 47

Salicylic acid plasters

Question 48

Describe the S/S associated with vitiligo.

Answer 48

White, non-scaling, well-demarcated areas of hypopigmentation on the neck, upper back, and chest.