Rita's Derm Questions

Question 1

At what age do a stork bite/telangiectatic nevi/salmon patch over eyes disappear?

a) 6 mos
b) 12 mos
c) 15 mos
d) 18 mos

Answer 1

a) 6 mos

Question 2

What is the most common complication in a child with a severe case of GABHS impetigo?

a) Strep pneumonia
b) Rheumatic fever
c) Nephrotic syndrome
d) Glomerulonephritis

Answer 2

d) Glomerulonephritis

Question 3

What is the first line tx for well-localized impetiginized lesions?

a) penicillin
b) Bactroban (mupirocin)
c) Third-generation cephalosporin
d) Azithromycin

Answer 3

b) Bactroban (mupirocin)

Question 4

A child has a few flat slightly hypo pigmented lesions on the face and forearms. What is the most likely dx?

a) Tinea corporis
b) Pityriasis rosea
c) Pityriasis versicolor

Answer 4

b) Pityriasis rosea

–Tinea Corporis = well-demarcated, circular lesion

Question 5

In a well newborn exam, there are erythematous papules in newborn on chin, cheeks, and forehead? What is the most likely dx?

a) Neonatal acne
b) milia
c) Erythema toxic
d) Herpes simplex

Answer 5

a) Neonatal acne

–milia = “pinpoint white” papules

–erythema toxicum= more truncal, not localized to face

–herpes simplex = grouped vesicles

Question 6

A 5yo presents w/several papules with linear burrow lesion on the right foot. What is the most likely dx?

a) hand foot and mouth disease
b) scabies
c) Atopic dermatitis
d) Tinea corporis

Answer 6

b) scabies

Question 7

What is the natural hx of small strawberry hemangioma?

a) Tend to regress over time
b) Will get bigger
c) Need imaging

Answer 7

a) Tend to regress over time

Question 8

A 3yo girl presents with two circumscribed areas of baldness without any crusting, flaking. What is the most likely dx?

a) traction alopecia
b) tinea capitis
c) trichotillomania

Answer 8

c) trichotillomania

–“without any crusting, flaking” –> eliminates tinea capitis

–traction alopecia–> not well-circumscribed

Question 9

Which of the following is the first-line tx for tinea capitis?

a) griseofulvin
b) Nizoral
c) Amoxil

Answer 9

a) griseofulvin

Question 10

A child is treated with griseofulvin 20mg/kg/day for tinea capitis for 3 weeks. He is w/out improvement. What do you next?

a) continue for another 3 weeks
b) change to another oral anti fungal
c) Add Nizoral shampoo
d) Add topical antifungal

Answer 10

b) change to another oral antifungal

–topical antifungal: do not use. doesn’t get to root.
Nizoral shampoo is also a topical anti-fungal

Question 11

What is a painful, flat lesion on the foot?

a) verruca planus
b) molluscum contagiosum
c) abscess

Answer 11

a) verruca plants

molluschi contagiosum = umbilicated papules

Question 12

At what age can a mother apply sunscreen?

a) newborn
b) 3 mos
c) 6 mos
d) 9 mos

Answer 12

c) 6 mos

Question 13

What is not true about sunscreens?

a) prevents tanning
b) zinc oxide is an acceptable sunscreen
c) people with sulfonamide allergy should use a product containing PABA
d) can lead to skin cancer

Answer 13

d) can lead to skin cancer

Question 14

Which of the following is true about sunscreens?

a) do not use sunscreen for

Answer 14

a) do not use sunscreen for

Question 15

A 7yo has 3 small patches of hair loss with central clearing. The most appropriate management is:

a) Lotrimin
b) griseofulvin V
c) Elimite
d) nystatin cream

Answer 15

b) griseofulvin V

–is tinea capitis!

Question 16

Which is the best tx for mild atopic dermatitis?

a) good moisturizing of affected areas
b) frequent bathing with mild soap
c) fluorinated hydrocortisone ointment

Answer 16

a) good moisturizing of affected areas

Question 17

A 10 month old presents with erythematous, well-demarcated diaper rash, which has satellite lesions and goes into the folds. Which would be the best choice for tx?

a) Nystatin
b) Desitin
c) Clotrimazole
d) Vitamin A&D ointment

Answer 17

a) Nystatin

nystatin = 1st line drug for candidiasis/diaper dermatitis

Question 18

What is the pathogenesis of the primary lesion of acne?

a) infection of the sebaceous gland
b) an immunologic response to bacteria
c) plugging of the sebaceous gland
d) inflammation of the deep dermal layer

Answer 18

c) plugging of the sebaceous gland

Question 19

You note superficial pearly papules with umbilicated centers. What is the most likely dx?

a) Molluscum contagiosum
b) Pityriasis rosea
c) Scabies
d) Verruca vulgaris

Answer 19

a) Molluscum contagiosum

pityriasis rosea = truncal, papulosquamous

Verruca vulgaris = single papule or few in a line

Question 20

You note multiple weepy lesions around 3yo’s upper lip. Closer inspection reveals honey colored crusts. What is the most likely dx?

a) herpes simplex
b) varicella
c) nummular eczema
d) impetigo

Answer 20

d) impetigo

nummular eczema = flat, dry, circular lesion

Question 21

During a physical, you note multiple brown macules, ranging in size from .5cm to 1.0cm on the trunk and arms. There is freckling in the axilla. You would:

a) educate about sunscreen application
b) explain the lesions will fade over time
c) screen the rest of the family and refer
d) document your findings and re-evaluate in 6 mos

Answer 21

c) screen the rest of the family and refer

–macules = cafe o’alit spots

–freckling in the axilla = hallmark of neurofibromatosis

Question 22

The best tx for the adolescent with mild to moderate acne is:

a) oral isotretinoin
b) topical tretinoin and benzoyl peroxide gel
c) Tetracycline orally
d) Clean with benzoyl peroxide wash

Answer 22

b) topical tretinoin and benzoyl peroxide gel

tretinoin = retinoid

Tetracycline = oral antibiotic
–> for severe, modular acne

Question 23

A child has a cluster of yellow-crusted vesicles on the right hand. When can he go back to school?

a) After the antibiotics are complete
b) 24 hrs after starting antibiotics
c) can go back right away

Answer 23

b) 24 hrs after starting antibiotics

Question 24

What is the most appropriate first aid for a burn on the hand?

a) ice
b) cold water
c) margarine

Answer 24

b) cold water

Question 25

Which of the following body sites are usually affected in young infants with scabies? a) finger webs and sides of the digits b) head and neck c) fingers and waistline d) umbilical and groin

Answer 25

b) head and neck

Question 26

Which of the following os the tx of choice for an 8yo with a pruritic rash b/t the fingers? a) Ivermectin b) Lindane c) Permethrin d) Hydrocortisone cream

Answer 26

c) Permethrin - -> = 1st line tx for scabies! - -> an insecticide/kills scabies and lice. brand name: Nix - -Ivermectin = shampoo for lice (Sklice) - -Lindane: treats scabies but has major ADE: seizures - -hydrocortisone cream: will reduce pain/inflamm. but will not treat

Question 27

A 10yo is placed on Griseofulvin for 4-6 wks for Tinea capitis. How long should the child be excluded from school? a) They can go back once they start on tx. b) 24 hrs after starting the tx c) 48 hrs after starting the tx c) 72 hrs after starting the tx

Answer 27

c) 48 hrs after starting the tx

Question 28

A child presents with mumps on the first day of illness. How long does the child need to be excluded from school? a) 2 days b) 5 days c) 7 days d) 9 days

Answer 28

b) 5 days

Question 29

A 5 yo is diagnosed with measles. He already has a rash when you see him. How long does the child need to be excluded from school? a) 2 days b) 4 days c) 7 days d) 9 days

Answer 29

b) 4 days

Question 30

An infant has candida dermatitis. What would you expect to find on physical exam? a) Lesions limited to the perianal region b) Pustular vesicular lesions in the diaper area c) Red confluent, papular lesions with sharply demarcated borders d) a macular, bright pink, shining rash in the diaper area with the inguinal folds spared

Answer 30

c) Red confluent, papular lesions with sharply demarcated borders

Question 31

A 15yo presents with a draining abscess under the arm. What is the best advice to give the pt? a) stay out of school until the abscess stops draining b) cover the drainage area and go to school c) cover the drainage area and you are not contagious d) Keep the area covered and do not participate in gym activities.

Answer 31

a) stay out of school until the abscess stops draining c) cover the drainage area and you are not contagious d) Keep the area covered and do not participate in gym activities. ...no clear answer! maybe depends on pain?

Question 32

A child has pruritic papules between the fingers. What is the best tx? a) Lindane b) Permethrin c) Ivermectin d) Hydrocortisone

Answer 32

b) Permethrin

Question 33

A 5 mos old has red excoriated skin with numerous pustules in the diaper area. What is the most likely dx? a) Candidal diaper dermatitis b) Irritant diaper dermatitis c) Staphylococcal diaper dermatitis d) Atopic dermatitis

Answer 33

c) Staphylococcal diaper dermatitis

Question 34

A child has linear, vesicular rash following a dermatome and is on the left side of the trunk. It does not cross the midline. What is the most likely dx? a) Scabies b) Impetigo c) Herpes zoster d) Tinea corporis

Answer 34

c) Herpes zoster

Question 35

The NP gives a patient griseofulvin. What are the best instructions to give the parents? a) to enhance absorption, give with a high fat meal b) tx should be continuous until the hair is starting to grow back c) the most common side effects include nausea and a HA d) labs to monitor liver functions should be done every 2 weeks

Answer 35

a) to enhance absorption, give with a high fat meal

Question 36

A slightly obese 14yo was sent to the school based health clinic due to a pink, itchy, slightly scaly rash on the upper, inner aspect of the thighs. What is the most likely dx? a) Scabies b) Tinea cruris c) Contact dermatitis d) Urticaria

Answer 36

c) Contact dermatitis -- Tinea cruris: see over pubic area

Question 37

A 3yo has a fine pink truncal rash. There was a previous hx of fever for 2 days. When is the child no longer contagious? a) When the child's fever is gone b) When the child's rash is gone c) 10 days before the sx appear d) 3 days before the onset of sx

Answer 37

a) When the child's fever is gone --true for most viral exanthems

Question 38

A child has a non-blistering red sunburn. What is the recommended tx? a) Cool baths and wet compresses b) Application of petroleum to soothe the skin c) Cover the area with a cotton shirt d) A cool shower several times/day

Answer 38

a) Cool baths and wet compresses --> to reduce pain

Question 39

A child has an ash leaf hypopigmented macule on the trunk. What is the most likely dx? a) Congenital myopathies b) Sturge Weber syndrome c) Tuberous sclerosis d) Duchenne muscular dystrophy

Answer 39

c) Tuberous sclerosis

Question 40

A 7 month old has a small congenital nevi that appeared at age 3 months. What is the best management of the patient? a) Referral to derm b) Reassurance c) Monitor at well-child visits

Answer 40

c) Monitor at well-child visits

Question 41

A 9yo has small discrete papules with mild redness on the edges of the scalp around the face. There is some hair shaft breakage. What is the most likely dx? a) Traction alopecia b) Trichotillomania c) Tinea capitis d) Alopecia areata

Answer 41

a) Traction alopecia "small discrete papules" --> folliculitis

Question 42

A child presents with painful red fingers and toes, a maculopapular rash, hypertension, peripheral neuropathy, and kidney dysfunction. What is the most likely dx? a) Lead poisoning b) Cyanide poisoning c) Mercury poisoning d) sulfide poisoning

Answer 42

c) Mercury poisoning

Question 43

What substance can cause methemoglobinemia? a) Tylenol b) Benzocaine c) Fennel seed

Answer 43

b) Benzocaine

Question 44

What color is the blood in methemoglobinemia? a) black b) red c) brown d) orange tinted

Answer 44

c) brown

Question 45

You are seeing a child with a positive strep test. When do you screen the siblings? a) on dx of the child b) when the child becomes symptomatic c) you do not need to worry as contagiousness is limited d) on every visit for the next month

Answer 45

b) when the child becomes symptomatic

Question 46

A 12yo presents with arthralgias and a butterfly facial rash over the cheeks and nose. The child has mild hematuria. What is the most likely dx? a) Parvovirus b) Streptococcal pharyngitis c) Lupus erythematous d) Lyme disease

Answer 46

c) Lupus erythematous ***butterfly facial rash*** --> lupus!

Question 47

A child has grouped vesicles on the right side of his chest. He reports a burning sensation in the area of the vesicles. What is the most likely dx? a) Herpes simplex b) Fixed drug reaction c) Varicella zoster d) Allergic contact dermatitis

Answer 47

c) Varicella zoster