Spring Derm Flashcards
A 41 year old male experiences a painful, solitary bulla at the same location on his glans penis intermittently after episodes of constipation. He takes a laxative each time he experiences constipation. Which of the following drug reactions is the most likely Dx?
A) Drug-induced hypersensitivity syndrome
B) Exanthematous drug eruption
C) Fixed drug eruption
D) Stevens-Johnson Syndrome
E) Vasculitis
C) Fixed drug rxn
Genital skin is a common site of occurrence
A man developed a diffuse red papular eruption 3 weeks after starting allopurinol for elevated uric acid. Skin lesions became confluence and were associated with anasarca, recurrent high fevers, arthralgias, myalgias, decreased urinary output, and proteinuria. Laboratory studies revealed a leukocytosis with dramatic eosinophilia, and elevated liver enzymes. Which drug rxn?
A) Drug-induced hypersensitivity syndrome
B) fixed drug eruption
C) Stevens-Johnson Syndrome
D) Toxic epidermal necrolysis
E) Vasculitis
A) Drug-induced hypersensitivity syndrome
Should be considered for any pt with diffuse papular eruption and systemic S/Sx
A 32 yo woman presents to the emergency room with a rash covering 25% of her body surface area which began 2 weeks after starting TMP/SMX for a urinary tract infection. She also has oral and conjunctival erosions. What is Dx?
A) Disseminated zoster
B) Drug-induced hypersensitivity syndrome
C) Fixed drug eruption
D) Sepsis
E) Stevens-johnson syndrome/toxic epidermal necrolysis
E) Sevens-johnson syndrome/toxic epidermal necrolysis
10%-30% detached and detachable skin = SJS
40 yo male who presented to ER with a diffuse pruritic rash that began on his trunk and spread peripherally. The rash started 10 days after he began taking ampicillin for “food poisoning”. There are no mucosal lesions or systemic sx. What is Dx?
A) disseminated zoster
B) Drug induced hypersensitivity syndrome
C) Exanthematous drug eruption
D) Fixed drug eruption
E) SJS
C) Exanthematous Drug eruption
hx of 10 day hiatus btw meds and rash onset as well as the clinical appearance of the rash in this case, are both typical of an exanthematous drug eruption
A toddler presents to clinic with the lesions found in this photo. What is best decription?
Dome-shaped, umbilicated papules
Molluscum contagiosum
You dx a healthy 6 yo boy with molluscum contagiosum (multiple, but not widespread). Which of the following treatments would you recommend? A) oral acyclovir B) reassurance C) Topical salicylic Acid D) Topical benzoyl peroxide E) Topical corticosteriods
B) reassurance
3 yo girl presents with these papules on her abdomen. What causes this eruption? A) bacteria B) fungus C) vascular D) virus
D) Virus
Mother brings her 9 yo daughter with molluscum contagiosum. The mother shares with you that she has 2 other kids home. She wants to know whether her other kids are at risk of catching virus. you tell her?
A) Not contagious once the skin lesions appear
B) trans through airborne resp droplets
C) Trans though skin-skin contact and fomite exposure
D) Trans through fecal-oral route
E) Trans by pets
C) transmitted though skin-skin contact and fomite exposure
Which of the following is true regarding molluscum contagiosum?
A) all the lesions should be covered with a bandaid to avoid spread to others
B) Children should stay home from day care if they have molluscum
C) The eruption is self limiting and can last months to years
D) the eruption should be treated to avoid systemic involvement
C) the eruption is self liming and can last months to years
A 27 yof presents with multiple koebnerized molluscum on her face. While reviewing her PMH you learn she had HIV and takes antiretroviral therapy. What is your next step?
A) Offer the pt antihistamines to provide itch relief
B) perform excisional biopsies
C) recommend that lesions be removed with curettage or cryosurgery
D) refer the pt to derm
E) Tell the pt that the lesion will resolve on their own
D) refer to derm
For a pt with molluscum contagiosum, which of the following findings would indicate referral to a dermatologist?
A) Erythematous halos developing around multiple molluscum
B) Lesions are present in groups or linear patterns in more than one location
C) pt has concomitant poorly controlled atopic dermatitis
D) Pt non-responsive to 4 weeks of tx with 5% permethrin cream
E) Pt non-responsive to 4 weeks tx c mupirocin ointment
C) pt has concomitant poorly controlled atopic dermatitis
Patchy hyperpigmentation on the forehead is commonly seen in which condition.
Melasma
Of the following, what is the most important aspect of prevention and tx of melasma? A) ammonium lactate lotion B) hydroquinone 4% cream C) Ketoconazole 2% cream D) Low potency topical steroid E) Sun Protection
E) sun protection
Melasma can spread and/or worsen c sun exposure.
A 50 yof presents for yearly f/u on populopustular rosacea. She is doing well on minocycline 100mg qd and metronidazole cream 1-2 a day. She is asking for refills and asking about long term SE. When looking for early signs of minocycline-induced pigmentation, at which of the following sites is the pigment first noticed? A) anterior lower legs B) Dorsal forearms C) scalp D) sclera E) Urine
D) sclera
Minocycline-induced pigmentation tends to be first noticed at mucosal sites
A 55 yo AA female presents for eval of an intermittently itchy rash on the legs for several months. WHat is the most likely dx? A) cellulitis B) Diabetic dermopathy C) Drug Eruption D) Stasis dermatitis E) Tinea corporis
D) stasis dermatitis
In addition to compression stockings, leg elevation, and management of underlying CVD and fluid status, which of the following is the best tx option for stasis dermatitis? A) Bacitracin ointment B) Clotrimazole cream C) intravenous vancomycin D) Lidocaine gel E) triamcinolone 0.1% ointment
E) Triamcinolone 0.1% ointment
A 30 yo AA female c hx of DM2 and obesity presents for evaluation of new dark spots on the back of her neck. The spots are asymptomatic. Her mother has a similar change on her neck and so the pt is wondering if it could possibly be an inherited condition. What is the next best step in management?
A) discuss relationship with insulin resistence and importance of weight loss
B) obtain a comprehensive hx and physical exam to rule out a relationship to occult cancer
C) Prescribe ketoconazole 2% shampoo as a body wash 3 times per week
D) prescribe triamconolone cream
A) Discuss relationship with insulin resistance and importance of weight loss
A 10 yof presents with a several day hx of scalp pruritis. Which of the following tx recommendations would you recommend?
A) 1% permethrin lotion applied to clean hair for 10 min, retreat in 4 weeks
B) 1% permethrin lotion applied to clean, dry hair for 10 min, retreat in 1 week
C) 1% permethrin lotion applied to wet hair for 10 min retreat in 1 week
D) 1% permethrin lotion applied to wet hair for 10 min retreat in 4 weeks
B) 1% permethrin lotion applied to clean, dry hair for 10 minutes. Retreatment in 1 week.
Permethrin is an insecticide that acts on nerve cells membranes to disrupt the sodium channel transport. Eggs hatch q 8-10 days.
A 42 yom presents with a 2 week hx of total body pruritus. On exam there are numerous excoriated papules on the abdomen, buttocks, glans penis, and scrotum. Which of the following is most likely to confirm the dx? A) Bacterial culture B) KOH prep C) Skin bx D) skin scraping E) Viral culture
D) Skin Scraping
Quick and easy way to identify scabies. Cover burrow or papule with glycerol, mineral oil, or immersion oil in order to prevent loss of mite and other forensic evidence
A 36 yof presents with 1 week hx of erythematous macules with center puncta in a linear distribution over her back. She recently attended a wedding with her BF and stayed at a hotel for the weekend. The rest of her exam is unremarkable. What is the best course of management for this pt?
A) 1% permethrin cream applied overnight with reapplication in 7 days
B) 5% permethrin cream applied overnight with reapplication in 7 days
C) OTC antihistamines and topical steroids as needed and instruction for the pt to contact exterminator
D) Viral serology for HIV, HBV, HCV
C) OTC antihistamines and topical steroids as needed and instruction for the pt to contact exterminator
Bedbug rashes are typically self-limiting (erythematous papules with hemorrhagic central puncta or wheals in linear classic “breakfast, lunch, dinner” distribution).
A 40 yom from Arkansas presnts to the ER with progressively enlarging erythematous lesion with centrally-located purpura on his right calf. He says he noticed a pinching sensation and a brown spider a few hours ao. He states that his Lt calf is beginning to itch and the lesion is becoming painful. He does not have other complaints. What is appropriate initial management?
A) Early surgical debridement
B) RIcE of the injured site, tetanus booster as needed, and close monitoring for systemic sx or necrosis
C) rotation of heat packs and ice to site
D) systemic steroids
B) RIcE of the injured site, tetanus booster as needed, and close monitoring for systemic sx or necrosis (no compression though)
A 43 yom presents to ER in mid-june with painful red-purple papules and nodules on Rt forearm. Lesions began about 2 months prior. He tried OTC topical abx but no other treatments. He works as a landscaper and stores his equipment in old shed, so he is worried that these are spider bites. Temp 38.3c, BP 122/60, HR 90. What feature of this scenerio is the only consistent with brown recluse spider bite? A) Elevated B) number of lesions C) time of year D) Red center
C) time of year
NOT Recluse Mnemonic
NOT Red, elevated, chronic
A 26 yof in her first trimester with her second prego, presents with a 2month hx of diffuse pruritic rash. She has erythematous papules in the webs of her fingers, flexor surfaces of wrists, axillary folds, and both breasts. You conduct a skin scraping and make a dx of scabies. Which 2 of the following treatments could be used for this pt?
A) 1% lindane lotion applied topically form neck to feet, rinsed after 6 hrs, and repeated in 7 days
B) 5% permethrin cream applied topically overnight from neck to feet, rinsed off after 8-12 hours, and applied for a second time 1 week later
C) 5-10% precipitated sulfur applied topically from neck to feet overnight, rinsed the following morning and repeated over 3 consecutive days
D) 200mcg/kg oral ivermectin taken a total of 2 times with each dose taken 1 week apart
B) 5% permethrin cream applied topically overnight from neck to feet, rinsed off after 8-12 hours, and applied for a second time 1 week later
50 yom with new dx of scabies, confirmed by a skin scraping which revealed the presence of mites and mite eggs. You prescribe 5% permethrin cream to be applied overnight to the entire body and instruct the patient to apply the permethrin twice (2 doses, separated by one week). How much cream should you dispense to the patient? You are... A) 15 grams B) 30 grams C) 60 grams D) 120 grams
C) 60 grams
It takes 30g to cover average adult body for one application. 2 doses would require 60g.
