last flex case

Question 1

Scaly, annular, erythematous plaques on glabrous skin. Borders are raised, with outer edge active and scaly** (leading edge scale)**.

Answer 1

tinea corporis (ringworm)

Question 2

+/- central clearing. Positive KOH (visualized septate hyphae, long and straight or wavy)

Answer 2

tinea corporis dx

Question 3

type 4 hypersensitivity; Indurated, smooth, raised border, nonscaly, skin colored annular plaques and papules, usually on the extremities; typically asymp. & more in females before 4th decade

Answer 3

granuloma annulare

Question 4

Small, fawn-covered, oval patches with fine, trailing edge scales, following the cleavage lines. Begins with a “herald patch” (AKA Christmas Tree pattern) and occurs fall & spring.

Answer 4

pityriasis rosea

Question 5

tx of pityriasis rosea

Answer 5

topical or systemic steroids
UVA & UVB

Question 6

Well circumscribed annular, nonscaly, plaques (wheals), with raised borders and blanched centers. Highly pruritic. Last 90 min-24 hrs

Answer 6

urticaria

Question 7

the application of topical glucocorticoids to an unrecognized fungal infection. As a result, the clinical appearance of the initial rash is altered, becoming less scaly, more extensive, pustular, and pruritis

Answer 7

tinea incognito

Question 8

often waxes and wanes with winter; may improve with sun or humidity exposure or with moisturizer use. Does not involve face or scalp; coin-shaped plaques often on extremities

Answer 8

nummular eczema

Question 9

1+ annular or oval erythematous patches as a result of systemic exposure to a drug; resolve w/ hyperpigmentation left; recurs at same spot with rexposure to drug

Answer 9

fixed drug eruptions

Question 10

rosacea tx

Answer 10

topical metronidazole

rosacea may look like SLE

Question 11

lesion isnt very impressive in features but on exam theres a “notch” in the superior pole, as well as some mild degree of pigment heterogeneity

Answer 11

malignant melanoma in situ

Question 12

Superficial benign fibrous histiocytoma- common solitary cutaneous, hard nodule; more common on LE and asymptomatic; dimple sign

Answer 12

dermatofibroma

Question 13

2 tx for dermatofibroma

Answer 13

reassurance unless rapidly enlarging
surgical elliptical excisional biopsy

Question 14

when do you refer an AK (7)

Answer 14

• Failed cryotherapy
• Painful or growing
• Pigmented changes
• Hyperkeratotic
• Young patient w/ AK
• Near a previous skin cancer scar
• Hard to treat location (lips, ears, etc.)

Question 15

XRT is a RF of which carcinoma while tanning bed is a RF of which?

Answer 15

XRT— BCC
tanning bed– SCC

Question 16

hx of sunburn is associated with ____ while sex & age is associated with _____

which type of carcinoma

Answer 16

sex & age— BCC
sunburn— SCC

Question 17

personal family hx of skin cancer is associated with _______

Answer 17

BCC

Question 18

personal hx of AK or bowens; prior skin cancer is associated with

Answer 18

SCC

Question 19

immune suppressing drugs is associated with

Answer 19

BCC

Question 20

weakened immune sys is associated with

Answer 20

SCC

Question 21

exposure to arsenic is associated with

Answer 21

BCC

Question 22

asymptomatic small **umbilicated papules **; poxvirus spread skin to skin

Answer 22

molluscum contagiosum

Question 23

MC tx (2)

Answer 23

sharp curette works nicely
light cryotherapy in adults

Question 24

any itchy penile rash should immediately suggest this; especially if also in interdigital webspaces and on volar wrist

Answer 24

scabies

Question 25

does itching go away with tx of scabies?

Answer 25

not always, it can last for weeks even though the mite has been killed; can take antihistamine for it

Question 26

dx if suspecting scabies

Answer 26

do saline exam NOT KOH

Question 27

which abx also works on lice?

Answer 27

TMP/SMX

Question 28

initial symptom is formation of a papule at the inoculation site, followed by solitary or **regional lymphadenopathy** within 1-2 weeks. In most patients, the disease resolves spontaneously within 2-4 months

Answer 28

Cat scratch dz (from Bartonella henselae)

Question 29

#1 cat BITE etiology

Answer 29

pasteurella multicoda

Question 30

if someone is bitten by a camel, what abx do you use? (combo)

Answer 30

Doxy + Cipro

Question 31

hot tub folliculitis agent & how its tx

Answer 31

Pseudomonas aeruginosa fluoroquinolone

Question 32

sudden onset of erythema; heat; swelling; and a raised, indurated plaque. **More superficial than cellulitis, with better demarcation**; pt often complains of fever & chills (but not always); what is it & how do you tx it

Answer 32

Erysipelas PO PCN G/VK

Question 33

spider bites usually have a ____ center

Answer 33

necrotic

Question 34

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