Practice Questions Flashcards
A 60 year old male presents with an itchy back.
HPI: Pt started seeing spots on his back increasing in number in the last 1-2 years. He lives alone so no one can check his back and he cannot see it well, so he is unsure exactly what the spots look like or if they are changing. The itch started about 6 months ago. He has not pain attention but does not think there are similar lesions elsewhere on the body. He has not used anything for the itch. He uses Irish Spring soap and showers BID using hot water. He does not use moisturizer. He denies fever, chills, joint pain, n/v/d/ weight changes.
PMH: HTN, high cholesterol
Meds: HCTZ, Lipitor, MVT daily
NKDA
Physical Exam: A&O x3, pleasant cooperative white male. Skin exam reveals numerous tan and uniform medium brown waxy stuck on papules scattered throughout the back. There are a few linear crusted excoriations on the lower and upper back. No lesions suspicious for skin cancer on back. The remainder of the skin exam is unremarkable
Working diagnosis: Seborrheic keratosis
Treatment: None required, address pruritis and lifestyle changes. Change soap, use lukewarm water while showering, moisturize.
F/u?: Annually for skin checks
A 20 y/o presents with itching and rash on back, arms and legs for 3 weeks.
HPI: Pt noted a rash that started a few weeks ago just on the back. It started with one spot and then blossomed. It now affects the back, arms, legs and abdomen. The itch can be intense. She thinks her roommate may also have had a rash recently. She is taking Benadryl for the itch with moderate relief, but it causes extreme drowsiness. She denies use of any new products. She uses a Bath and Body Works shower gel and Jergens lotion. She c/o fatigue but attributes that to Benadryl. She denies fever, chills, n/v/d.
PMH: non-contributory
Meds: BCP
Allergies: PCN (rash)
Physical Exam: There are scattered pink to erythematous oval scaly patches throughout the abdomen, back and proximal ant and post upper and lower extremities.
Working Dx: Pityriasis rosea
Treatment: Treat pruritis with topical steroids or topical antipruritic
F/u?: yes, call if worsening
A 16-year-old male presents to your office with a rash that has developed over the last 24 hours. The rash consists of well circumscribed erythematous pruritic wheals. His history is contributory for use of latex gloves in science class. He states his mother frequently changes laundry soaps based on what is on sale, so he is unsure about new soap use. He is on no medications and has no allergies to medications. What diagnostic study is indicated for this patient?
A) None
B) Patch testing
C) Skin biopsy
D) Serum IgE testing
B) Patch testing
A 32-year-old female complains of episodes of her face stinging, with a red rash that waxes and wanes in the central face. On exam you note scattered papules and pustules with background mild macular erythema. In counseling this patient, what would be the best recommendation?
A) Apply a topical steroid
B) Refer to isotretinoin therapy
C) Eliminate use of all sunscreens
D) Avoid spicy food and alcohol
D) Avoid spicy food and alcohol
A 20 year old woman presents with sharply demarcated, oval patches of hair loss, which have occurred during the past 3 weeks. There is no tenderness, erythema, scaling or pruritis of the scalp. The hair loss probably represents which of the following?
A) Mechanical pulling
B) Fungal infection
C) Autoimmune reaction affecting hair follicles
D) Result of an androgen secreting tumor
C) Autoimmune reaction affecting hair follicles
A patient presents to the clinic after a 14 day course of doxycycline antibiotic for Lyme disease with a thick white coating on the tongue and buccal mucosa. What is the appropriate treatment recommendation for this condition?
A) Cephalosporin antibiotic
B) Anti yeast suspension
C) Oral steroids
D) Narcotic analgesic
B) Anti yeast suspension
