Dermatology

Question 1

immunocompromised patient with fever and rapidly developing rash of painless red macules that develop into pustules and then punched out gangrenous ulcers

Answer 1

Ecthyma gangrenosum

- gram negative bacteremia with pseudomonas

Question 2

Patient with swelling of the face, lips and hands after stressful event and dental procedure

Answer 2

Hereditary angioedema

• deficiency of C1 inhibitor –> inc bradykinin
• swelling w/out urticaria
• colicky abdominal pain
• laryngeal edema
• Low C4 and C1 inhibitor
• Tx: C1 inhibitor concentrate

Question 3

intensely pruritic erythematous papules, vesicles, and bullae that occur symmetrically grouped in clusters on extensor surfaces, back, and buttock

Answer 3

Dermatitis herpetiformis

Tx: dapsone and gluten free diet

Question 4

hypersensitivity reactions

Answer 4

type 1 (immediate): IgE mediated (anaphylaxis, urticaria, eczema)
type 2 (cytotoxic): IgG & IgM mediated (AI hemolytic anemia, goodpasture)
type 3 (immune complex): Ab-Ag complex (serum sickness, post-strep glom, lupus nephritis)
type 4 (delayed): T-cell mediated (contact derm, PPD)

Question 5

42 year old with fever, sore throat, malaise, headache, LAD, rash that began on his trunk now spreading to the whole body, several gray mucosal patches in the mouth.

Answer 5

Syphilis

Question 6

Erythema multiforme is associated with

Answer 6

HSV and mycoplasma infections

Question 7

Patient with well demarcated, raised rash on the face that came on rapidly with a fever of 102.6

Answer 7

Erysipelas - caused by strep pyogenes

Question 8

Infections after burns

Answer 8

• immediately after: gram + (staph)

- 5+ days after: gram - (pseudomonas), fungi (candida)

Question 9

Hep C is associated with which skin condition

Answer 9

Porphyria cutanea tarda

• fragile, photosensitive skin that develops vesicles amd bullae with trauma or sun exposure
• tx: phlebotomy or hydroxycholorquine

Question 10

impetigo tx

Answer 10

limited skin involvement: topical abx (muporpcin)

ectensive skin involvement: oral abx (cephalexin, dicloxacillin, clindamycin)

Question 11

Pt presents with fever, severe pain and crepitus over the lower abdomen, perineum, and scrotum with crepitus. Leukocytosis is also present

Answer 11

Fournier gangrene

- needs early surgical exploration and debridement

Question 12

Drugs associated with photosensitivity

Answer 12

Abx: tetracyclines
Antipsychotics: chlorpromazine, prochlorperazine
Diuretics: furosemide, HCTZ
Others: amiodarone, promethazine, piroxicam

Question 13

Pt has blisters, bullae, and scarring on the dorsum of her hands. She has been diagnosed with hepatitis C but has not been treated. Her only medication is an OCP.

Answer 13

Porphyria cutanea tarda

• elevated plasma and urine porphyrin levels
• disorder of heme synthesis
• deficiency of uroporphyrinogen decarboxylase

Question 14

Severe burn with chronic scarring and non-healing wound develops a draining nodule

Answer 14

squamous cell carcinoma

Question 15

Cyst with a central punctum (small, dilated pore-like opening)

Answer 15

epidermal inclusion cyst

Question 16

hot tub folliculitis tx

Answer 16

caused by pseudomonas

• oral fluoroquinolone
• topical gentamicin

Question 17

Drugs most commonly associated with SJS

Answer 17

allopurinol, NSAIDs, antibiotics, anticonvulsants

Question 18

infant TBSA

Answer 18

18% head
9% each arm
14% each leg
36% trunk

Question 19

adult TBSA

Answer 19

9% head
9% each arm
18% each leg
36% trunk (18% for anterior trunk and 18% for posterior trunk)

Question 20

parkland burn formula

Answer 20

% BSA (body surface area affected) x weight (kg) x 4 (mL/kg)
1/2 administered in first 8 hours
1/2 administered in next 16 hours

Question 21

beefy red rash in skin folds of diaper

Answer 21

candidiasis dermatitis

Question 22

Pt with hx of Chrons has rapidly expanding ulcer on her leg. Ulcer has a purulent base with irregular, violaceous border

Answer 22

Pyoderma gangrenosum

• associated with IBD, inflammatory arthritis, malignancy
• starts as a pustule, papule or nodule
• tx with glucocorticoids

Question 23

Nail finding with psoriasis

Answer 23

Oncholysis - seperation of nail from nail bed

Question 24

Necrotizing fasciitis

Answer 24

Streptococcus pyogenes, Staphylococcus aureus, and Clostridium perfringens
- Abx: vanc, penicillin, clindamycin

Question 25

warfarin induced skin necrosis

Answer 25

rapid decline in protein c

- in pts w/ underlying hereditary protein c deficiency

Question 26

18 month old with numerous, painful clear vesicles over erythematous skin on both cheeks as well as a few scattered lesions with overlying dark-red crusting. Patient has a hx of atopic dermatitis

Answer 26

eczema herpeticum (HSV 1)

Question 27

Dermatitis and diarrhea in a Northern African immigrant who is vegetarian

Answer 27

Pellagra (niacin deficiency)

- dermatitis, diarrhea and dementia

Question 28

what diseases are associated with psoriasis

Answer 28

HIV and strep pharyngitis

Question 29

how to prevent warfarin induced skin necrosis

Answer 29

proper bridging

Question 30

child with widespread fluid-filled blisters (hands, feet, buttocks), positive nikolsky’s sign, no mucosal involvement, conjunctivitis

Answer 30

SSSS