test 1 deck 6

Question 1

woman presents in mid 20s to late 30’s flares w/ very inflamed red papules and comedones on chin and jawline. dx__ trx__

Answer 1

adult female acne, oral contraceptives, tretinoin, erythromycin if all fails

Question 2

pt. presents w/ complaint of tiny pea shaped cyst above eyelids. they look like epidermial cyst, but have no openings. You suspect they are from sun damage. dx__ trx__

Answer 2

milia

solitary: excision
multiple: tretinoin .025%

Question 3

what is inflammatory acne?

Answer 3

one or more of

1. papules
2. pustules
3. nodules/cysts

Question 4

pt presents w/ pruritic follicular papules and pustules on chest, neck and back. They were recently prescribed PO corticosteroids. The patient is worried about scarring and wonder’s if they are allowed to take it again. dx__ trx__

Answer 4

steroid acne, d/c leads to fairly rapid clearing, no scarring should occur, they can take in the future, diphenhydramine/hydroxyzine for itch

Question 5

treatment for mild inflammatory acne?

Answer 5

start w/ retinoid and or benzoyl peroxide or top abx. -> f/u adujst dose ->consider adding oral abx if pustules remain at f/u: doxycycline/tetracycline min. 3 month trial

Question 6

baby presents 1 week after birth w/ red diffusely scattered 1 mm papules/vesicles on forehead, cheeks, and trunk. it’s august in san antonio and hot as heck and the baby is wearing winter clothing. The peds doctor says it looks like prickly heat from sweat retention and occlusion of eccrine gland. dx__ trx__

Answer 6

miliaria

red= miliaria rubra, skin= miliaria crystallina

self limited, cool compress, antihistamine, remove from heat

Question 7

pt. presents w/ small non-inflamed papules and comedones near hair line w/ application of oils/creams. dx__ trx

Answer 7

pomade acne/acne cosmetica, try to change ingrained habits, stop oil 1 month, add tretinoin .025%, if inflamed topical abx

Question 8

what is the MC infectious folliculitis?

Answer 8

staphyloccus folliculitis

Question 9

when do you have to stop isotrentinoin?

Answer 9

HA not relieved by tyelenol, HA w/ visual changes, mood swings w/ Suicidal ideation

Question 10

pt presents w/ grouped small pustules around the nares. They have a tenderness, low grade fever, and recently used occlusive topical steroid therapy. DX__ trx___

Answer 10

isolated: erythromycin, diclox 10 days
recurrent: cephalexin, rifmapin, bactroban to nares, wash w/ hibiclens TID, change pillow case and towel

Question 11

african american male presents w/ complaint of post-inflammatory hyperpigmentation, scarring and keloids in his beard, axilla, and groin. dx__ trx__

Answer 11

pseudofolliculitis barbae

modify shaving technique by hydrating beard and brushing beard w/ toothbrush or warm wash cloth. wash w/ benzoyl peroxide and use glycolic acid/shaving cream

topical abx, retin A, po abx for pustules

temproary profile <=3 months/ lifetime no greater than 1/4 inch

Question 12

acne vulgaris is an issue w/ what?

Answer 12

pilosebaceous unit

Question 13

pt. presents w/ complaint of round, smooth surfaced, soft, mobile mass w/ visible pore. the patient has oily sebaceous skin which makes sense because the upper pore is most likely filled w/ sebum. dx__ trx__

Answer 13

epidermal inclusion cyst,

removal w/ 11 blade, if inflamed intralesional injection

Question 14

what is the treatment for comedonal acne (non-inflammatory)?

Answer 14

retinoid @ bedtime->4-8 wks benzoly peroxide or top abx, patience closed comedones respond slowly

Question 15

treatment for nodulocystic acne?

Answer 15

derm referral: isotretinoin

Question 16

pt presents w/ transient erythema, telangectasia, rhinophyma, and swelling of cheeks and forhead. you suspect this may be caused by demodex folliculorum (a mite). The patient says they become easily flushed w/ ETOH, spicy food, hot drinks, hot climate, emotions/sun. DX__ trx__

Answer 16

acne rosacea,

mild to mod: metronidazole, doxy, sunscreen, avoid triggers

persistent/severe: accutane, rhinophyma (specialty surgery)

Question 17

african american pt. complaining of keloid on nape of neck. you know it’s of UNK etiology. dx__ trx__

Answer 17

acne keloidalis nuchae

no shaved haircuts/putualr or exudative= abx

3 step control

1. topical clindamycin 12 months
2. fluocinonide 12 months
3. tretinoin 3-6 onths

steroids, laser therapy, surgery

Question 18

pt. presents w/ multiple, firm, smooth movable 1-3 cm subQ cysts on scalp. it has a tough lining and isnt an EIC. dx__ trx__

Answer 18

pilar cyst (wen), trx excision

Question 19

treatment for mod-severe inflammatory acne vulagaris?

Answer 19

top abx and benzoyl peroxide, >10 pustules start oral abx, later consider topical retinoid -> difficult nodules get steroid injection (triamcinolone) -> if treatment failing then culture for amipicillin refer to derm for isotretinoin and for women OCP/spironolactone

Question 20

pt. presents w/ scarring in armpits, anogenital, and under breasts. They say they have a hx of fam. acne scarring. You know that this can be caused by hyperkaratosis over apocrine glands w/ a secondary infection. the patients is an overweight female that has finished puberty. the patient appears to have a double comedone morphology (blackheads w/ two or more communicating surface openings). DX__ trx__

Answer 20

d/c smoking,

mild: long term abx- mainstay, hot compress, I & D, intralesional steroid inj
extensive: surgical graft, isotretinoin

Question 21

what is non-inflammatory acne vulgaris?

Answer 21

closed comedones (white heads), open comedones (black heads)

Question 22

young woman w/ fair/delicate skin and hx or habitual use of moisturizing creams and topical steroid use presents w/ small red papules and pustules on chin and nasolabial fold. She has pustules on her cheeks adjacent to the nasolabial fold and a clear zone around the vermililion border. DX__ trx__

Answer 22

perioral dermatitis, doxy 2-4 weeks, 1% HC cream for inflammatin and if steroid induced pimecrolimus cream. d/c moisturizers and cosemetics