dermatology Flashcards
black neonate-Small pustules on a nonerythematous base; these usually are present at birth; erythematous macules with a surrounding collarette of scale
a) HSV
b) Neonatal erythema toxicum
c) Pustular melanosis
d) Miliaria
pustular melanosis
Teenage boy with acne, currently on topical antibiotic and benzoyl peroxide in the AM, and topical retinoids in the PM. No symptomatic improvement. What is your next step in management?
- Minocycline
- Clindamycin
- Isotretintoin
- Cefazolin
minocylline
mild-retinoid
mild-mod - benzyl peroxide +/- abx
mod- retinoid + benzyl peroxide + oral abx
severe - above +/- isoretinoin (accutane)
Toddler with long history of eczema currently receiving treatment with topical steroids comes in with an acute worsening of his rash, as shown below. What is the best treatment? Cefazolin Acylovir Reassurance Topical nystatin
cefazolin
A girl comes in complaining of this itchy rash. What is the diagnosis? (this was the exact photo on the exam)
Pityriasis rosea
tinea corpea
eczema
pityriasis rosea
A 5 year old boy has had a one week history of fever and cough. He was started on amoxicillin. He develops this rash (there was a blurry photo of what looked like Erythema Multiforme). What is the most likely etiology of the rash?
Mycoplasma
HSV
Amoxicillin
mycoplasma
other causes of EM - hsv, drug reactions,
ebv, vmc, parvo, coxsackie, HIV, salmonella,
NSAID, sulfonamides, tyl
3 year old boy has atopic dermatitis with a sudden exacerbation. Photo shown of (likely) impetiginized eczema. What is the treatment?
a. IV acyclovir
b. IV cefazolin
c. IV cloxacillin
hsv- acyclovir
impetigo - cefaz
impetigo, mild cases are treated with topical mupirocin and wider spread infections with PO antibiotics (usually Keflex). IV antibiotics would only be if ++ unwell or unable to tolerate PO. Similar with eczema herpeticum - if more localized and well can do PO acyclovir, if not then IV.
Picture of erythema multiforme on arm and has ulcers in her mouth - what would the cause be
a) mycoplasma
b) NSAIDs
c) HSV
hsv
Kid with bright red perianal rash
a) Candida perianal
b) strep perianal infection
c) contact dermatitis
d) Sexual abuse
strep perianal
Candidal infection: Classically presents with beefy red plaques, satellite papules, and superficial pustules that leave a collarette of scale once ruptured. In contrast to simple irritant diaper dermatitis, candidal infections commonly involve the skin folds. There also may be a history of diarrhea, recent antibiotic use, or oral thrush.
Vascular Malformation over unilateral upper face. What do you need to worry about?
a) Glaucoma
b) Ipsilateral hearing loss
c) Cerebral malformation - no, leptomeningeal vascular malformation
d) hydrocephalus
glacuoma *vascular malf = sturge weber
Sturge-Weber Syndrome: Characterized by a facial capillary malformation (port wine stain) and an associated leptomeningeal capillary-venous malformation (leptomeningeal angioma) involving the brain and eye. These vascular malformations are associated with specific neurologic and ocular abnormalities. Seizures in 80% Hemiparesis, stroke-like episodes Intellectual disability Behavioural issues Visual field defects Glaucoma (predominant ocular manifestation, in 30-70%, d/t abnormal blood vessels) Increased incidence of GH deficiency
Baby with large congenital (melanocytic?) nevus on face. What is she at risk for?
Melanocytosis of the leptomeninges
Congenital melanocytic nevi (CMN) are classically defined as melanocytic nevi present at birth or within the first few months of life.
Complications include melanoma, neurocutaneous melanosis and other malignancies (rhabdomyosarcoma, liposarcoma, and malignant peripheral nerve sheath tumors, have been reported in the setting of large CMN).
Risk factors for NCM are:
Large (>40cm estimated final size)
Multiple satellite nevi
More than 2 medium sized nevi
A kid with asthma and eczema has an acute worsening of his eczema. What would you treat him with?
looked like impetigo
Acyclovir
Steroids
Cefazolin
Vancomycin
G tube with granulation tissue
Reassure
Silver nitrate cautery
Topic ABx
Fungal abx cream
reassure
silve rnitrate only if getting larger
do nothing” approach is reasonable if tube secure to skin and area dry. To prevent worsening, apply NS compresses 3-4 times per day. Consider course of steroid cream. If large granulation tissue present, can use silver nitrate but this is painful!
You are called to see a newborn with the following rash. What is it? on neck red pimples Herpes simplex virus Miliaria Erythema toxicum Neonatal pustular melanosis
erythema toxicum
15 year-old male present with mild papular and comedogenic (? papulopustular, not comedogenic?) acne on face, trunk and back. Previously only using soap to wash his skin. Next step for treatment:
a. Tetracycline PO
b. Erythromycin cream
c. Combination of topical retinoid and benzoyl peroxide
d. Other topical
combo - retnioid and benzoyl
Hamilton Review Lecture: Topical retinoid good for comedones, benzoyl peroxide for inflammatory acne (+/- topical antibiotic)
Girl with onset of itchy rash x 1 week over her trunk and back. What is her most likely diagnosis? (doesn’t describe the features of the rash at all)
a. Pityriasis rosea -
b. Tinea corporis
c. Nummular eczema
d. Psoriasis
pityriasis rosea
hows picture of kid with round hairless patch and NO scales and well demarcated. What’s the association?
a. Autoimmune thyroiditis
b. Fungal infection
c. Anxiety disorder
thyroiditis
Alopecia areata is a chronic immune-mediated disorder that targets anagen hair follicles and causes nonscarring hair loss. The condition most commonly presents with discrete patches of alopecia on the scalp.The association of alopecia areata with autoimmune
Picture of 9mo with large plaque hemangioma on the face, what would you NOT do?
a. Echocardiogram
b. MRI head
c. Renal ultrasound
d. Ophthalmology
RENAL u/s first to 2 weeks of life. · RF for hemangioma o Prematurity o Low birth weight o Female sex o White race
P – posterior fossa brain defect (Dandy-Walker malformation, cerebellar hypoplasia)
· H – large segmental facial hemangioma
· A – arterial cerebrovascular abnormalities (aneurysms, stroke)
· C – coarctation
· E – eye abnormalities
· S – sternal raphe defects (pits, scars, supraumbilical raphe)
Kid with 10 tanned macules more varying from 5 to 15mm and normal physical examination. (No mention of family history). What would you do next to confirm the diagnosis?
a. MRI head
b. Ophthalmology
c. Echocardiogram
optho for NF Need at least 2 of the following features CROPLAND Cafe au lai Six or more cafe au lait macules >5mm in diameter in prepubertal and >15mm in diameter in postpubertal individuals. Relative with NF1 Optic pathway gliomas Pseudoarthroses Lisch nodules Axillary or inguinal freckling Neurofibromas Dysplasia of the sphenoid bone
- Kid w hemangioma covering eye, what to do?
a. Refer to surgery for resection
b. Reassess in few months
c. Start propranolol
propranolol
reason to intervene
1) ulceration
2) ptho involvement
3_ subglottic
Contraindication to propanolol: cardiogenic shock sinus bradycardia hypotension greater than first degree heart block heart failure bronchial asthma hypersensitivity to propanolol
Term with forceps delivery, presented with jitteriness, has a red firm plaque on hand, what blood work is most likely to be found (likely talking about subcutaneous fat necrosis)
a) Hypercalcemia
hypercalceimia
Subcutaneous fat necrosis:
o Typically affects term and postterm newborns, usually follows perinatal complications such as: birth asphyxia, hypothermia, meconium aspiration syndrome, newborn failure to thrive, forceps delivery, and maternal htn and/or diabetes
o Clinical features: multiple firm nontender subcutaneous nodules or large plaques that appear 1-4 weeks after birth
resolve 1-2 month- upto 6 months
o Treating the hypercalcemia: hydration, furosemide (be careful to not dehydrate), corticosteroids, bisphosphonates
What’s best to use in a resistant population for lice? [CPS]
a. Resultz
Treatment with approved topical insecticide (2 applications 7-10 days apart) is recommended for active infestation
options in Canada: pyrethins or permethrin 1%
When there is evidence of treatment failure – using a full course of topical treatment from a different class of medication is recommended
options in Canada: (1) Resultz (contains isopropyl myristate 50% and ST-cyclomethicone 50%; approved for children ≥4 years of age)
(2) NYDA: 92% silicone oil dimethicone, can be for children ≥2years.
(3) Benzyl alcohol lotion 5% - expensive but can be used ≥6 months
Another lovely CPS statement - Head lice infestations: A clinical update
12 year old girl with a history of hypopigmented flat scars following mild trauma, as well as spontaneous vesicular lesions when exposed to sun. Which medication would this most likely be a side effect of:
a. Prednisone
b. Naproxen
c. Lisinopril
d. Methotrexate
naproxen
This is pseudoporphyria → it mimics porphyrea cutanea tarda (PCT) but there are no abnormalities in porphyrin metabolism (ie. they have normal porphyrin levels).
pseudoporphyria has been reported in ~10% of children taking naproxen for JIA (also associated with chronic renal failure/hemodialysis, tanning beds)
pseudoporphyria: most often caused by meds including: NSAIDs, abx, diuretics and antineoplastic agents
Clinical presentation: bullae and vesicles typically localized to the dorsum of the hands, forearms and face (may occur on lower legs and feet). Skin fragility and easy bruising after minor trauma. Bullae heal with scarring and milia.
in drug-induced pseudoporphyria, cutaneous lesions continue to develop even after the offending drug has been discontinued
Child with lice. When can he go back to school?
a. Now
b. After 1 day of treatment
c. After 1 week of treatment
Now
Area of alopecia scaly and itchy. Treatment?
a. PO terbinafine
b. fluconazole
c. topical terbinafine.
po terbinafine
. Teenage female presents with blackheads only, mild acne, what do you recommend?
a. Topical benzoyl peroxide gel
b. Topical retinoic acid
c. Accutane
d. Topical clindamycin
topical retinoid
From last year’s lecture •If mostly comedonal: retinoid •If mostly inflammatory: –Retinoid & –Anti-inflammatory •BP or topical antibiotic or COMBINATION (BP & antibiotic) •Treat for 2-3 months then re-assess
