Skin 1

Question 1

viral exanthem

Answer 1

rash accompanying a viral syndrome

Question 2

viral exanthem - most commonly looks like

Answer 2

erythematous, maculopapular rash, bilateral and symmetric, through can vary

Question 3

viral exanthem - may occur when during viral illness

Answer 3

at any point

Question 4

viral exanthem - may have associated what

Answer 4

systemic symptoms - fever, malaise, URI symptoms

Question 5

viral exanthem - pruritic or no?

Answer 5

could be

Question 6

viral exanthem - roseola findings
3

Answer 6

1. early childhood febrile illness
2. fever w/ rapid defervescence followed by rash
3. erythematous macular or maculopapular rash

Question 7

viral exanthem - measles findings
3

Answer 7

1. 3 C’s - cough, coryza, conjunctivitis
2. morbilliform (flat or raised red or pink bumps that may form together) eruption starting on the head - behind ears and forehead and progressing caudally (down)
3. Koplik’s spots - white/gray papules on buccal mucosa which are pathognomonic

Question 8

viral exanthem - rubella findings
1

Answer 8

rose pink coalescing (merging) macular lesions

Question 9

viral exanthem - parvovirus B19/5th disease findings
1

Answer 9

erythematous “slapped cheeks”, then reticulate (net lick) extremity eruption

Question 10

viral exanthem - coxsackie virus aka

Answer 10

hand foot and mouth dx

Question 11

viral exanthem - coxsackie virus/HFM findings
1

Answer 11

vesicular lesions on palms, soles, and oral surfaces

Question 12

viral exanthem - varicella zoster/chickenpox
3

Answer 12

1. vesicular rah on an erythematous base
2. lesions ranging from macules to papules to vesicles to crusts
3. trunk > extremities

Question 13

viral exanthem - herpes zoster/shingles
1

Answer 13

reactivation of varicella - vesicular rash in dermatomal distribution

Question 14

viral exanthem - molluscum contagiosum findings
1

Answer 14

umbilicated and flesh colored nodular lesions

Question 15

viral exanthem - epstein barr virus EBV findings
2

Answer 15

1. difficult to differentiate from strep pharyngitis - fever, tonsillitis, lymphadenopathy
2. confluent maculopapular rash may occur following tx of tonsillitis w/ amoxicillin/ampicillin for suspected strep pharyngitis

Question 16

viral exanthem - HSV findings
1

Answer 16

vesicular lesions to oral, labial, and/or genital surfaces

Question 17

viral exanthem - HPV finding
1

Answer 17

warts

Question 18

viral exanthem - img/testing

Answer 18

none usually; dx largely clinical

Question 19

at what age can child start to use hydrocortisone cream and why

Answer 19

2 years or old - it can delay growth and cause skin damage to those younger than 2.

Question 20

viral exanthem - tx options
3

Answer 20

supportive, consider -
1. antihistamines
2. bland emollients/calamine lotion
3. topical vs systemic analgesics

Question 21

viral exanthem - steroids?

Answer 21

do not shorten coarse, and not rec in children younger than 2

Question 22

viral exanthem - when do you consider antiviral tx (for suspected what case)

Answer 22

for suspected HSV - acyclovir, valacyclovir

Question 23

viral exanthem - emergent referral to optham. for what

Answer 23

suspected herpes ophthalmicus - Hutchinson’s sign (lesions to tip of nose) strong predictor of ocular involvement

Question 24

viral exanthem - when to refer to OBGYN

Answer 24

if rubella suspected in pregnant pt - can have fetal consequences

Question 25

viral exanthem - when to refer to ER 5

Answer 25

1. severe systemic sx 2. immunocompromised pts w/ severe sx 3. neonatal herpes 4. petechial/purpuric exanthem - meningitis, acquired thrombocytopenia 5. suspected herpes ophthalmicus

Question 26

contact dermatitis

Answer 26

inflammatory skin condition involving an erythematous, pruritic eruption following contact with an allergen or irritant

Question 27

contact dermatitis - if unknown exposure, inquire about 3

Answer 27

1. new soaps, lotions, detergents, topical meds, clothing or linens not pre washed 2. occupational exposure such as chemicals or latex 3. exposure to wooded areas or recent gardening

Question 28

acute contact dermatitis - PE findings 5

Answer 28

1. erythematous 2. macules 3. papules 4. vesicles 5. ulcerative lesions

Question 29

chronic contact dermatitis - PE findings 3

Answer 29

1. erythematous 2. dry 3. fissuring

Question 30

contact dermatitis - eruption is common where and why

Answer 30

hands d/t repetitive chemical or occupational exposure

Question 31

contact dermatitis - img/testing

Answer 31

none usually

Question 32

contact dermatitis - tx options in general 6

Answer 32

1. avoid the exposure 2. lotions 3. steroid ointment 4. systemic steroids 5. antihistamines 6. topical or systemic abx

Question 33

contact dermatitis - tx lotion example

Answer 33

calamine lotion

Question 34

contact dermatitis - steroid ointment overview 3

Answer 34

1. consider mid to high potency topical steroid ointments such as triamcinolone 0.1% or clobestasol 0.05% (2-3 x day prn) 2. avoid high potency steroids on face or genitalia or in children 3. consider low potency steroid for children such as hydrocortisone or desonide ointment

Question 35

contact dermatitis - best steroids for children 2

Answer 35

1. hydrocortisone 2. desonide

Question 36

contact dermatitis - desonide age

Answer 36

3 months or older

Question 37

contact dermatitis - desonide, pediatric instructions

Answer 37

for 3 months or older, BID foam or gel

Question 38

contact dermatitis - systemic steroids, consider if 2

Answer 38

rash involves >20% of surface area or significant involvement of face or genitalia

Question 39

contact dermatitis - systemic steroid rx PO

Answer 39

prednisone 0.5-1 mg/kg for 5-7 days, with 1-2 week taper after

Question 40

dermatitis personal review - IM injection

Answer 40

Kenalog IM injection, triamcinolone may be effective for dermatological conditions (Kenalog -40mg is standard and usually effective )

Question 41

contact dermatitis - antihistamines

Answer 41

diphenhydramine or hydroxyzine - often not effective in pruritis but may offer some relief and sleep aid if needed

Question 42

contact dermatitis - when to refer to ER

Answer 42

signs of systemic infection - fever, tachycardia, hypotension