Dermatology Flashcards Review

Questions and Answers

What percentage of total body surface area best estimates the extent of burns for the 52-year-old woman?

36% (correct)

45%

18%

What is the recommended method of burn assessment in children?

Lund-Browder chart

Which historical element is most likely to be obtained upon further questioning for the patient with a rash?

Fever preceded the onset of rash

Oral mucosal lesions preceded the onset of rash

A larger 2 to 5 cm erythematous patch preceded the diffuse rash (correct)

Travel to the Southeast USA occurred a week before the rash

Is the rash of pityriasis rosea contagious?

False Signup and view all the answers

Which of the following is the most likely diagnosis for the patient with a solitary nodule in the axilla?

Hidradenitis suppurativa Signup and view all the answers

What is another name for hidradenitis suppurativa?

Acne inversa Signup and view all the answers

What is the most appropriate next step in management for a patient with thickened and discolored toenails?

Potassium hydroxide examination of toenail scrapings Signup and view all the answers

What is the most common etiology of onychomycosis?

Dermatophyte infection Signup and view all the answers

Which of the following is the most likely diagnosis for a patient with a diffuse papulosquamous rash following a herald patch?

Pityriasis rosea Signup and view all the answers

Which of the following presents with an annular plaque with central clearing?

Tinea corporis Signup and view all the answers

Which infection is most commonly associated with erythema multiforme?

Herpes simplex virus Signup and view all the answers

What is the treatment of choice in those who develop erythema multiforme?

Supportive treatment Signup and view all the answers

Which statement is true about the condition of recurrent skin infections along the axilla?

Evidence supports an association between smoking and severity of disease Signup and view all the answers

What medications may be used in the treatment of hidradenitis suppurativa?

Antibiotics, retinoids, corticosteroids, anti-androgenic agents, estrogen derivatives, immunosuppressants, and 5-alpha-reductase inhibitors Signup and view all the answers

What is the best treatment for perioral dermatitis?

Metronidazole gel Signup and view all the answers

What is the recommended systemic treatment for perioral and periorbital dermatitis?

Oral tetracyclines, such as doxycycline Signup and view all the answers

Which management represents the best course for herpetic whitlow?

Analgesia and a clean dressing Signup and view all the answers

Which groups of patients are at increased risk of developing herpetic whitlow?

Health-care workers and nail salon workers Signup and view all the answers

What is the indicated management for a 17-year-old male with a scaly rash and itch?

Corticosteroid ointment Signup and view all the answers

What is the most likely diagnosis for a 3-week-old term girl with a worsening rash that has been present since birth?

Seborrheic dermatitis Signup and view all the answers

What is a known, transient complication of seborrheic dermatitis in dark-pigmented infants?

Postinflammatory hypopigmentation. Signup and view all the answers

Which piece of patient education should be given for managing vesiculobullous hand eczema?

Avoid prolonged exposure of the hands to water Signup and view all the answers

What is the most likely diagnosis for an 11-year-old girl with a scaly red patch that has spread outward?

Tinea corporis Signup and view all the answers

What kind of agar is used to grow dermatophytes in culture?

Sabouraud's agar. Signup and view all the answers

Which burn causes pressure and discomfort, extends into dermis, and may have thick-walled blisters?

Second-degree deep partial thickness burn Signup and view all the answers

Can succinylcholine be used for rapid sequence intubation in an acute burn patient?

Yes. Signup and view all the answers

What represents the appropriate management of a 17-year-old girl with a fluctuant axillary swelling?

Incision and drainage Signup and view all the answers

Why is trimethoprim-sulfamethoxazole (TMP-SMX) a poor choice for treating cellulitis?

TMP-SMX has poor coverage against group A streptococci. Signup and view all the answers

What is the most likely diagnosis for a rash on a 66-year-old woman that is painful and blistering?

Herpes zoster Signup and view all the answers

What finding is indicative of corneal ocular involvement in zoster ophthalmicus?

Pseudodendrites (no terminal bulb). Signup and view all the answers

Which louse is responsible for lice infestation of the head and scalp?

Pediculus humanus capitis Signup and view all the answers

What medication is indicated for the treatment and prevention of head lice and scabies?

Permethrin. Signup and view all the answers

What is the most likely diagnosis for a 32-year-old man with a rash after yard work?

Dyshidrotic eczematous dermatitis Signup and view all the answers

What is the recommended treatment for dyshidrotic eczematous dermatitis?

Steroids can be administered topically, intralesionally, or systemically depending on the severity. Signup and view all the answers

Why should fluorodinated corticosteroids not be applied to the face?

Repeated use can produce permanent cutaneous atrophy. Signup and view all the answers

Which of the following is the most likely etiology of the disease in a woman with high fevers, severe headaches, and a rash?

Rocky Mountain spotted fever Signup and view all the answers

What is the treatment of choice for Rocky Mountain Spotted Fever in the pediatric population?

Doxycycline. Signup and view all the answers

Which of the following diseases presents with small grouped vesicles on an erythematous base?

Herpes simplex Signup and view all the answers

What is the treatment for herpes simplex?

Acyclovir, valacyclovir, and famciclovir. Signup and view all the answers

What management is indicated for a man with herpes zoster presenting with chest pain?

Oral acyclovir for 7 days Signup and view all the answers

When are patients with herpes zoster considered to no longer be infectious?

Once the herpes zoster lesions are crusted over. Signup and view all the answers

What is the most likely diagnosis for a woman with flesh-colored, non-tender, papillary growths in the genital area?

Condyloma acuminata Signup and view all the answers

Which medications commonly used to treat condyloma acuminata should be avoided during pregnancy?

Podophyllin, podophyllotoxin, and imiquimod. Signup and view all the answers

What is the cause of a rash consistent with shingles in a patient presenting with back pain, headache, and cough?

Varicella-zoster virus Signup and view all the answers

What is the most common location for zoster to occur in?

Thorax, followed by the face (trigeminal nerve). Signup and view all the answers

What treatment is indicated for a patient with tinea corporis?

Clotrimazole cream Signup and view all the answers

What is the most common serious side effect of treatment with oral ketoconazole?

Hepatic toxicity. Signup and view all the answers

What is the next best step in managing a patient bitten by a stray cat?

Irrigate wound, leave open to drain, and prescribe amoxicillin-clavulanate prophylaxis Signup and view all the answers

How is a previously vaccinated person who has had a potential rabies exposure treated?

Two intramuscular doses of vaccine; the first dose should be given on day 0, as soon after exposure as possible, and the other three days later. Signup and view all the answers

What is the most likely diagnosis for a man with purple-brownish plaques on his feet?

Kaposi sarcoma Signup and view all the answers

What is the appropriate treatment for Iatrogenic Immunosuppression-Associated Kaposi sarcoma?

Discontinue immunosuppressive medications. Signup and view all the answers

Which of the following sutures is absorbable?

Vicryl (Polyglactin) Signup and view all the answers

What has a greater risk of infection, cutaneous or subcutaneous sutures?

Subcutaneous. Signup and view all the answers

What is the most likely diagnosis for a woman with chronic, pruritic papulovesicular lesions and Celiac disease?

Dermatitis herpetiformis Signup and view all the answers

Which gender predominates in newly diagnosed cases of Celiac disease?

Women. Signup and view all the answers

Which method is optimal for rewarming a frostbitten extremity?

Submerge in warm circulating water (37°C - 39°C) Signup and view all the answers

What is the phenomenon of 'core temperature after-drop' in frostbite management?

When large areas are rewarmed, vasoconstriction is relieved and cold, hyperkalemic and acidic blood returns to the central circulation. Signup and view all the answers

Which diagnostic test will confirm the suspected diagnosis of scabies?

Skin scraping and microscopy Signup and view all the answers

What is the first line medication for the treatment of scabies?

Permethrin 5% cream. Signup and view all the answers

What is the expected finding on physical examination for a patient with Lyme disease after a tick bite?

Annular erythematous patch with central clearing Signup and view all the answers

What is a common complication within 24 hours of initiation of antibiotic treatment of Lyme disease?

The Jarisch-Herxheimer reaction. Signup and view all the answers

What is the most likely etiology of toenail discoloration in a 66-year-old man?

Trichophyton rubrum Signup and view all the answers

What structure does the fungi invade first to gain access to the nail bed?

Hyponychium. Signup and view all the answers

What is the likely diagnosis for an eight-year-old girl with itchy bumps on her legs after insect bites?

Papular urticaria Signup and view all the answers

What is the family of mosquitoes that most commonly inflict insect bites?

Family Culicidae (order Diptera). Signup and view all the answers

What baseline screening test is recommended prior to starting a patient on hydroxychloroquine for lupus?

Ophthalmologic exam Signup and view all the answers

What is the most common complaint of patients with lupus?

Fatigue. Signup and view all the answers

Which pathogen is most frequently implicated in erysipelas?

Streptococcus pyogenes Signup and view all the answers

What bacteria has a gram stain showing gram-positive cocci in chains?

Streptococcus. Signup and view all the answers

Which statement is true regarding a 16-year-old boy presenting with symptoms ofsecondary syphilis?

The rash is a result of a sexually transmitted infection Signup and view all the answers

What are the manifestations of tertiary syphilis?

Neurosyphilis, cardiovascular involvement, and gumma formation. Signup and view all the answers

What is the maximum amount of 1% lidocaine without epinephrine that can be used for a child weighing 15 kg?

7.5 ml Signup and view all the answers

What are some methods to decrease pain associated with injection of lidocaine?

Warming the solution, buffering the solution with sodium bicarbonate, and injecting into the wound rather than through intact skin. Signup and view all the answers

Which of the following is the most likely diagnosis?

Cellulitis Signup and view all the answers

Which microbes would be necessary to empirically cover for in choosing an antibiotic treatment for uncomplicated cellulitis?

Streptococcus and Staphylococcus. Signup and view all the answers

Which of the following anesthetics is a suitable alternative to lidocaine for a patient allergic to it?

Procaine Signup and view all the answers

What is another name for procaine?

Novocain Signup and view all the answers

Which of the following is the most likely diagnosis for a 34-year-old woman with patches of pale skin?

Vitiligo Signup and view all the answers

What tool may be helpful for identifying vitiligo in lightly pigmented individuals?

Wood lamp. Signup and view all the answers

Which of the following is the most likely causative agent for hand-foot-and-mouth disease?

Coxsackievirus A Signup and view all the answers

What is the classic dermatologic finding of tertiary syphilis?

Gummas. Signup and view all the answers

Which of the following is associated with an erythematous rash and caused by a bacterial infection?

Scarlet fever Signup and view all the answers

What is the name and causative agent of the fifth common childhood exanthemous disease?

Fifth disease or Erythema Infectiosum caused by parvovirus B19. Signup and view all the answers

Which of the following lesion characteristics is most concerning for melanoma?

Color variation Signup and view all the answers

What are the most common sites of metastatic disease with melanoma?

Brain, liver, and bone. Signup and view all the answers

Which organism is most likely responsible for a bright red, painful, well-demarcated rash on the face?

Streptococcus pyogenes Signup and view all the answers

What is the treatment of choice for erysipelas caused by methicillin-resistant Staphylococcus aureus?

Trimethoprim-sulfamethoxazole, clindamycin. Signup and view all the answers

Which of the following is the first-line treatment for scabies?

Permethrin cream Signup and view all the answers

For non-crusted scabies, how should permethrin cream be applied?

Apply all over body overnight once and reapply in 14 days if mites are still present. Signup and view all the answers

Which of the following is concerning for melanoma?

Areas of pigment regression Signup and view all the answers

What is the prognostic indicator of a melanoma lesion?

Depth of invasion. Signup and view all the answers

Which of the following oral antibiotics will cover community-acquired methicillin-resistant Staphylococcus aureus (MRSA)?

Doxycycline Signup and view all the answers

For what indication is oral vancomycin most useful?

C.difficile colitis. Signup and view all the answers

What is the most likely diagnosis of a small flesh-colored nodule with a pearly border?

Basal cell carcinoma Signup and view all the answers

Does smoking increase the risk of basal cell carcinoma?

Yes. Signup and view all the answers

Study Notes

Pityriasis Rosea

Presenting symptoms include a mildly pruritic rash on the back and trunk, spreading over a week.
Characterized by a herald patch (2 to 5 cm erythematous oval plaque) preceding diffuse rash.
Rash follows a "Christmas tree" pattern, adhering to skin cleavage lines.
Self-limited course, typically lasting 4 to 7 weeks without treatment, though antihistamines may relieve itching.
History of travel to Southeast USA raises concern for infectious etiologies like Rocky Mountain Spotted Fever.

Hidradenitis Suppurativa (HS)

Chronic skin condition with recurrent painful nodules in intertriginous areas (e.g., axilla).
Associated with scarring, keloids, and mechanical stress; more frequent in obese individuals and smokers.
Initial presentation includes erythema; lesions can form sinus tracts and comedomes over time.
Treatment includes a combination of medical management and surgical intervention for abscesses.

Onychomycosis

A fungal nail infection with forms including distal subungual onychomycosis.
Initial symptoms may cause pain and disfigurement; diagnosis confirmed by potassium hydroxide examination of nail scrapings.
First-line treatment for confirmed cases is oral terbinafine, but liver function tests should be monitored due to hepatotoxic risks.

Erythema Multiforme (EM)

Often triggered by herpes simplex virus (HSV), leading to lesion symptoms including macules and target-like formations.
Characterized by symmetrical rash distribution and often affects palms and dorsal surfaces of hands/feet.
Management typically involves supportive care, including antihistamines and pain relief.

Perioral Dermatitis

Defined by erythematous micro-papules around the mouth with potential itching and burning.
Best treated with metronidazole gel; topical steroids may exacerbate the condition.
Recommended systemic treatment includes oral tetracyclines like doxycycline.

Herpetic Whitlow

Localized herpes simplex virus infection presenting as painful, vesicular lesions on fingertips.
Analysis and clean dressing provide initial care, with topical acyclovir potentially shortening illness duration.

Atopic Dermatitis (AD)

Characterized by itchy, scaly rash with potential chronicity; most common in flexural areas of the body.
Effective management includes topical corticosteroids to reduce inflammation and itching.
Associated with a history of asthma and can be exacerbated by environmental factors.

Rocky Mountain Spotted Fever (RMSF)

Tick-borne illness caused by Rickettsia rickettsii, prevalent in parts of North America.
Characterized by high fever, headaches, and a maculopapular rash starting on wrists and ankles, progressing to trunk.
Immediate antibiotic treatment is crucial, particularly with febrile presentations in endemic regions.### Rocky Mountain Spotted Fever (RMSF)
RMSF presents with fever, petechial rash, and vomiting after tick exposure.
Doxycycline is the first-line antibiotic therapy, initiated before laboratory confirmation.
Doxycycline is effective against Lyme disease, ehrlichiosis, and relapsing fever.
Treatment should start immediately to improve outcomes.

Tick-Borne Illnesses

Babesiosis: Characterized by influenza-like symptoms, hemolytic anemia, jaundice, and renal failure.
Ehrlichiosis: Presents with fever, chills, cough, malaise, and headache; rash is less common than in RMSF.

Herpes Simplex Virus

Herpes simplex presents as small grouped vesicles on an erythematous base (dew drop on a rose petal).
HSV-1 causes oral lesions; HSV-2 is primarily linked to genital lesions.
Common treatments include acyclovir, valacyclovir, and famciclovir.

Herpes Zoster (Shingles)

Caused by reactivation of the varicella-zoster virus; risks increase with age.
Symptoms include burning pain, rash in a dermatomal distribution, and potential postherpetic neuralgia.
Antiviral therapy is recommended to reduce pain and hasten recovery.
Patients are non-infectious when zoster lesions are crusted over.

Condyloma Acuminata (Genital Warts)

Caused by HPV types 6 and 11; presents as non-tender, flesh-colored, papillary growths.
Often treated with trichloroacetic acid, cryotherapy, or surgical excision.
Avoid podophyllin and imiquimod during pregnancy.

Tinea Corporis (Ringworm)

Causes annular, erythematous lesions with central clearing; treated with topical antifungals like clotrimazole.
Transmission occurs via person-to-person contact; the condition is often misdiagnosed.

Animal Bites

Cat bites require irrigation, open drainage, and amoxicillin-clavulanate prophylaxis due to infection risks.
Post-exposure rabies prophylaxis is required based on the exposure type.

Kaposi Sarcoma (KS)

A systemic tumor associated with human herpesvirus 8, presenting with purplish skin lesions.
Diagnosis confirmed through skin biopsy; treatment may include radiotherapy or chemotherapy.

Sutures in Surgery

Vicryl is an absorbable suture; good for subcutaneous and mucosal closures.
Nonabsorbable sutures include nylon, prolene, and silk, which are less reactive.

Dermatitis Herpetiformis

Indicative of Celiac disease, manifests as pruritic, papulovesicular lesions primarily on extensor surfaces.
Resolves with a gluten-free diet; diagnosis confirmed via immunofluorescence biopsy.

Celiac Disease

Predominantly diagnosed in women, comprising 75% of new cases.

Histamine Fish Poisoning

Symptoms arise from consuming improperly stored fish, leading to flushing, headache, and palpitations.
Fast onset of symptoms typically occurs within one hour of eating the affected fish.

Seborrheic Dermatitis

Common in infants, characterized by greasy, salmon-colored patches with yellow scales.
Typically asymptomatic and self-limiting; may require topical corticosteroids for severe cases.### Erythema Toxicum
Extremely common benign rash in neonates.
Manifests as blotchy macules and papules, typically on face, trunk, and proximal extremities.
Appearance described as "flea-bitten," not flaky.
Lesions fade within 5-7 days but may recur for several weeks.

Seborrheic Dermatitis in Infants

Transient complication includes postinflammatory hypopigmentation.
Particularly noted in dark-pigmented infants.

Dyshidrotic Eczematous Dermatitis

Presents as intensely itchy hands with tapioca-grain-like vesicles.
Common in adults, often linked to a history of atopy.
Treatment involves topical corticosteroids and educating patients to avoid prolonged water exposure.
Patients may need to wear cotton-lined vinyl gloves and regularly apply moisturizers post-hand washing.

Tinea Corporis

Diagnosis based on classic erythematous, raised, and scaly plaques that clear in the center.
Exam of the entire body surface area is important for multiple lesions.
First-line treatment is a topical azole antifungal.
Confirmation can be achieved using KOH preparation of skin scrapings.

Burn Classification

Second-degree deep partial thickness burns extend into the reticular dermis.
Characterized by pressure, discomfort, leathery white appearance, and thick-walled blisters.
Healing time varies; superficial partial thickness burns usually heal in 7-10 days, while deep partial thickness burns take 3-6 weeks.

Frostbite Management

Gentle, active rewarming is essential using warm circulating water (37°C - 39°C).
Signs of frostbite include erythema, blisters, and decreased sensation.
Avoid hot water or passive warming methods as they may cause further injury.

Scabies Diagnosis and Treatment

Confirmed via skin scraping and microscopy to visualize mites or feces.
Permethrin 5% cream is the first-line treatment.
Commonly presents with severe itching, particularly at night, and burrows in skin folds.

Lyme Disease

Caused by Borrelia burgdorferi, transmitted by Ixodes dammini ticks.
Early manifestation includes erythema migrans, characterized by an annular erythematous patch with central clearing.
Empiric treatment includes doxycycline; alternatives for pregnant women or young children include amoxicillin.
Common complication of antibiotic treatment is the Jarisch-Herxheimer reaction.

Onychomycosis

Distal lateral subungual onychomycosis is primarily caused by Trichophyton rubrum.
Symptoms often present as thickened, yellow-brown toenails.

Dermatophyte Culture

Sabouraud's agar is the medium used for growing dermatophytes in culture.

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Test your knowledge with these dermatology flashcards focusing on clinical case presentations. Each card presents a real-world scenario that requires you to identify historical elements and differential diagnoses related to dermatologic conditions. Perfect for medical students and professionals honing their skills in dermatology.