Dermatology

Question 1

a 75-year-old female who presents to the clinic with a large number of pruritic, tense, subepidermal bullae across her upper thighs. There was no mucosal involvement, a negative Nikolsky sign, and a skin biopsy showed subepidermal bullae filled with eosinophils and neutrophils.
what is the most likely diagnosis

Answer 1

bullous pemphigoid

Question 2

how is bullous pemphigoid diagnosed

Answer 2

skin biopsy with direct immunofluorescence exam shows deposition of IgG and C3 basement membrane

Question 3

what is the treatment of bullous pemphigoid

Answer 3

systemic corticosteroids

Question 4

what is the treament of lice

Answer 4

permethrin topical

Question 5

a 15-year-old male with pain, discomfort, and swelling above the anus and near his tailbone that comes and goes. He reports that the pain worsens when he sits or bends forward. Medical history is significant for metabolic syndrome. He is a high school student who spends hours playing on his Xbox. On physical exam, there is a tender and fluctuant mass that is erythematous.
what is the most likely diagnosis

Answer 5

pilonidal disease

Question 6

what is the treatmetn of pilonidal disease

Answer 6

drainage and surgical removal of the cyst - look for sinus tract

Question 7

a 64-year-old female with a 4 cm × 7 cm edematous, red, hot tender area on the left thigh. The lesion has gotten larger over the past 6 hours. She tells you she has also had a low-grade fever and some chills. On physical exam, there is a poorly demarcated 12cm red and tender plaque on her right calf. Some parts resemble an orange peel. There is a superficial cut in the middle of the plaque.
Whats the most likely diagnosis

Answer 7

cellulitis

Question 8

what is the most common pathogen causing cellulitis in children

Answer 8

H. influenzae or strep pneumonia

Question 9

how is cellulitis differentiated from erysipelas

Answer 9

cellulitis does not have sharp, well-defined borders unlike erysipelas

Question 10

what is the treatment of mild cellulitis

Answer 10

cephlexin
cefuroxime
PCN allergy - Clindamycin

Question 11

what is the treatment of puluent of MRSA cellulitis

Answer 11

Trimethoprim-sulfamethoxazone
clinda
doxycyclin
IV vanco/Linezolid

Question 12

what is the presentation of atopic dermatitis

Answer 12

pruritic, eczematous lesions, xerosis (dry skin), and lichenification

Question 13

what is the treatment of atopic dermatitis

Answer 13

topical corticosteroids and emollients

Question 14

what is the treament of nummular eczema

Answer 14

high or ulta-high potency topical corticosteroids = first line

Question 15

what is another name for cradle cap

Answer 15

seborrheic dermatitis

Question 16

what is the treament of seborrheic dermatitis

Answer 16

ketoconazole shampoo

Question 17

what is the treatment of perioral dermatitis

Answer 17

topical metronidazole
avoid steroids

Question 18

an 11-year-old male complaining of intensely itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend whom he had a sleepover this past weekend, is also having similar symptoms.
what is the most likely diagnosis

Answer 18

scabies

Question 19

an 11-year-old male complaining of intensely itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend whom he had a sleepover this past weekend, is also having similar symptoms.
given the most likely diagnosis - what is the treatment of choice

Answer 19

topical permethrin 5% - apply to entire body and was after 8-14 hours - repeat in one week

Question 20

what type of spider bite presents with a necrotic wound and local tissue retraction?

Answer 20

brown recluse

Question 21

what is the presentation of black widow bites

Answer 21

neurologic manifestations - may not see much at bite site: toxic reaction: nausea, vomiting, HA, fever, syncope and convulsions

Question 22

a 19-year-old female with a painful rash on her left leg. She had a small bug bite in the same area about three weeks ago. Since then, the area has become red, painful, and hot. On physical exam, you note shiny, raised, indurated, and tender plaque-like lesions on the left leg. The redness is well-demarcated and hot to the touch. You send her home on penicillin.
what is her most likely diagnosis

Answer 22

erysipelas

Question 23

what is the cause of erysipelas

Answer 23

streptococcus pyogenese

Question 24

what is the treatment of erysipelas

Answer 24

Mild: Pen G
Mod: TMP-SNX
Severe: IMP or MER or ERTA IV and Linezolid

Question 25

a 60-year-old woman with a severe drug-induced reaction on both lower limbs with few lesions elsewhere in addition to mucosal involvement of the mouth of two days duration. The insulting drug was sulfonamide, and the onset of the rash was within 48 hours of taking the drug. The rash comprised bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosions and peeling. what is the most likely diagnosis

Answer 25

SJS

Question 26

what percentage of the body does SJS effect

Answer 26

3-10%

Question 27

what is the treatment of SJS

Answer 27

stop offending medications, early admission to burn unit, manage fluids/electrolytes, airway stability IVIG steroids

Question 28

a 67-year-old male who presents to your clinic with a two-day history of a painful rash on his left flank radiating to his back. This was preceded by burning pain in the same region several days prior. The patient does not recall any history of childhood exanthems and is not up to date on his immunizations. Vital signs are stable. Physical exam reveals a maculopapular rash in a dermatomal distribution on the left flank and extending into the back. what is the diagnosis?

Answer 28

Herpes zoster (shingles)

Question 29

what is Hutchinsons sign

Answer 29

shingles lesion on the nose early indicator of opthalmic shingles

Question 30

what is zoster ophthalmicus

Answer 30

shingles involving CCN V, dendritic lesions on slit lamp exam

Question 31

what is Ramsay-Hunt syndrome

Answer 31

zoster oticus facial nerve (CN VII) otalgia, lesion on the ear, auditory canal and TM, facial palsy and auditory symptoms

Question 32

who is the recombinant zoster vaccine recommended for

Answer 32

adults 50 and older 2 doses 2-6 months apart

Question 33

a 60-year-old woman with a severe drug-induced reaction with extensive skin involvement covering > 30% of her body surface area. The insulting drug was anticonvulsant medication, and the onset of the rash was within 10 days of taking the drug. The rash comprised bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosion and peeling. On examination, her skin peels away in sheets when pressure is applied and rubbed. what is the diagnosis

Answer 33

TEN

Question 34

how is TENs diagnosed

Answer 34

biopsy (showing necrotic epithelium)

Question 35

a 5-year-old girl with crusting facial lesions present for 3 days. The mother reports that prior to the development of the facial lesions, her daughter was scratching at insect bites. Examination reveals a red facial rash with a golden “honey-colored crust” and pruritus. what is the most likely diagnosis

Answer 35

impetigo

Question 36

what is the treament of impetigo

Answer 36

topical mupirocin, dicloxacillin, cephalexin for more sever illness

Question 37

what is dariers sign

Answer 37

localized urticaria appearing where the skin is rubbed (histamine release)

Question 38

what are the 4 C's of measles (rubeola)

Answer 38

cough, coryza, conjunctivitis and cephalocaudal spread

Question 39

what is the presentation of measles (rubeola)

Answer 39

Morbilliform - maculopapular, brick red rash on face beginning at hairline then progressing to palms and soles last - rash lasts 7 days Koplik spots precede the rash by 24-48 hours

Question 40

what is the presentation of rubella

Answer 40

3-day rash; first appears on face, spreads caudally to trunk and extremities, and becomes generalized in 24 hours; cephalocaudal spread

Question 41

what part of the pregnency is rubella teratogenic

Answer 41

first trimester (causing deafness, cataracts, TTP and mental retardation)

Question 42

what is the pathogen associated with Roseola

Answer 42

HSV 6 or 7

Question 43

what is the only childhood exanthem that starts on the trunk and spreads to the face

Answer 43

Roseola (sixths disease)