Derm

Question 1

What are the primary and secondary lesion types in HSV?

Answer 1

Primary: clustered vesicles
Secondary: pustules

Question 2

What are the signs/symptoms of HSV?

Answer 2

May have prodrome of pain
Pain/burning (herpes hurt)
Commonly seen on mouth (HSV-1) & genitals (HSV-2)

Question 3

What are the diagnostic tools that can be used for HSV?

Answer 3

Tzanck smear
Serology
PCR
Pt report/exam

Question 4

What is the treatment for HSV?

Answer 4

Acyclovir (400mg TID)
Valacyclovir (1000mg BID)
Both for 7-10 days

Question 5

What are the characteristics of Staphylococcal Scalded Skin Syndrome (SSSS)?

Answer 5

More seen in children < 5
Diffuse redness of the skin w/scalding
Diagnosed based of H&P, but can culture/biopsy

Question 6

What is the treatment for SSSS?

Answer 6

Admit
Start IV abx such as Nafcillin (100-150mg/kg per day in divided doses q6 hrs)
Supportive care

Question 7

What are the signs/symptoms of pityriasis rosea?

Answer 7

Itchy, salmon colored rash that starts with a herald patch and changes to plaques in 1-2 weeks
Follows skin cleavage planes

Question 8

What is the treatment for pityriasis rosea?

Answer 8

Self-limiting lasting 3-8 weeks
Antihistamines, emollients, UVB

Question 9

What are the signs/symptoms of herpes zoster?

Answer 9

“Dew drops on a rose petal”
Itchy, tingling, painful rash that follows a dermatome distribution
May have a prodrome, aches, low grade fever

Question 10

What is the treatment for herpes zoster?

Answer 10

Antiviral (Acyclovir, Valacyclovir) within 72 hrs
Pain relief (NSAIDs, narcs if severe)
Gabapentin for neuropathic pain relief

Question 11

What are the characteristics of rosacea?

Answer 11

Common in women 30-50 yo
Symmetric flushing & telangiectasias on cheeks, nose, chin, or forehead
Can have episodic burning/stinging

Question 12

What is the treatment of rosacea?

Answer 12

NO topical steroids
Avoid triggers/things that cause flushing (heat, alcohol, stress)
Topical abx (if pustules/papules), switch to oral abx if topicals fail

Question 13

What are the characteristics of atopic dermatitis (eczema)?

Answer 13

“the itch that rashes”
Starts in childhood
Red patches w/papules
Can be on flexural surfaces (inside elbow), neck, face, back of hands
NOT on flexural surfaces in infants

Question 14

What is the treatment for atopic dermatitis (eczema)?

Answer 14

Avoid triggers
Moisturize w/ointment
Antihistamines for itch
Topical steroids

Question 15

What commonly presents in children following a viral infection?

Answer 15

Viral exanthem

Question 16

What are the signs/symptoms of viral exanthem?

Answer 16

Red macules widely spread on the trunk that blanche w/recent history of viral infection

Question 17

What is the treatment of viral exanthem?

Answer 17

It clears w/the infection

Question 18

What are the signs/symptoms of stasis dermatitis?

Answer 18

Heaviness/aching in the legs that gets better w/rest
Itchy
Hyperpigmentation (if long term)
Rash must be on the legs for dx

Question 19

What is the treatment for stasis dermatitis?

Answer 19

Compression stockings
Elevate legs
Treat the cause of the edema

Question 20

What are the signs/symptoms of molluscum contagiosum?

Answer 20

Dome shaped, flesh colored, umbilicated papules on the face, trunk, &/or genitalia

Question 21

What is the treatment for molluscum contagiosum?

Answer 21

Conservative (self-limited)
Education on contagiousness
Maybe cryotherapy, curettage, or Imiquimod

Question 22

What is the treatment for furuncles/carbuncles?

Answer 22

Warm compress, incise & drain once mature
Maybe abx that cover staph

Question 23

What is a more superficial cellulitis that is only caused by strep?

Answer 23

Erysipelas

Question 24

What are the signs/symptoms of erysipelas?

Answer 24

Bright, red, glistening, smooth, hot well demarcated plaque that is often on the cheek

Question 25

What is the treatment for erysipelas?

Answer 25

IV abx w/strep coverage

Question 26

What presents with a painful, hot, firm, red patch with advancing borders?

Answer 26

Cellulitis

Question 27

What is the treatment for cellulitis?

Answer 27

Oral abx if not severe IV abx if severe Cover for staph and strep

Question 28

What presents as white plaques commonly in the skin folds that are itchy and bleed when removed?

Answer 28

Candidiasis

Question 29

What is the treatment for candidiasis?

Answer 29

Nystatin or Clotrimazole 1 dose oral Diflucan

Question 30

What presents with scaling/hair loss on the scalp of a small child?

Answer 30

Tinea capitis

Question 31

What is the treatment for tinea capitis?

Answer 31

Oral antifungals (Griseofulvin or Terbinafine)

Question 32

What diagnostic tool is used for androgenetic alopecia (male pattern baldness)?

Answer 32

The Hamilton classification

Question 33

What is the treatment for androgenetic alopecia (male pattern baldness)?

Answer 33

Oral finasteride (anti-androgen) Topicals Wigs Hair transplant

Question 34

What are the signs/symptoms of scarlet fever?

Answer 34

Red rash on the upper trunk that has a "sandpaper" feel Strawberry tongue

Question 35

What is the treatment for scarlet fever?

Answer 35

Scarlet fever is a result of untreated/under treated group A strep Treat w/penicillin and Clindamycin

Question 36

What is the treatment for severe acne vulgaris?

Answer 36

Topical benzoyl peroxide If that does not work alone, add topical retinoid/abx

Question 37

What commonly presents with itching/burning in hair bearing areas such as inner thighs, buttocks, face, scalp, etc.?

Answer 37

Folliculitis

Question 38

How do you treat folliculitis?

Answer 38

Remove triggers Topical antibiotics (superficial) Oral antibiotics (if deep or local doesn't work) Consider coverage for pseudomonas if recently in hot tub

Question 39

What commonly presents in children with honey-colored crusted lesions?

Answer 39

Impetigo

Question 40

What is the treatment for impetigo?

Answer 40

Topical mupirocin (if limited) Cephalexin (if systemic abx req.)

Question 41

What can commonly present with swelling of the lips and eyelids that results from a reaction to a particular drug (commonly seen with ACE inhibitors)?

Answer 41

Angioedema

Question 42

What is the treatment for angioedema?

Answer 42

If drug induced, stop the drug Work up for allergic reaction and give epi if anaphylactic Antihistamines & maybe short course of systemic steroids

Question 43

What is the treatment for tinea corporis (ring worm) and tinea cruris (jock itch)?

Answer 43

Topical antifungal (-azoles)

Question 44

What presents as a well defined plaque that has a red base and silver scales and is commonly seen extensor surfaces?

Answer 44

Psoriasis

Question 45

What are 2 diagnostic assessments for psoriasis?

Answer 45

Koebner: scratching leads to more lesions Auspitz: remove scale & get pinpoint bleeding

Question 46

What is the treatment for psoriasis?

Answer 46

Topical corticosteroids (if limited) Retinoids, Methotrexate, biologics (if mod-severe) Avoid systemic steroids

Question 47

What presents with greasy yellow or grey scales over erythematous patches or plaques, and is commonly seen in patients w/Parkinson's or HIV?

Answer 47

Seborrheic dermatitis

Question 48

What is the treatment for seborrheic dermatitis?

Answer 48

Depends on the location Scalp: antifungal shampoo (ketoconazole) Face: low potency corticosteroid cream or topical antifungal Trunk: topical antifungals, topical corticosteroids