Skin Conditions Quiz: Case Presentations
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Questions and Answers

What is the mainstay treatment for this severe form of acne vulgaris?

  • Topical retinoids
  • Oral glucocorticoids
  • Increase isotretinoin dosage (correct)
  • Oral antibiotics

What is the best antibiotic treatment if coverage for methicillin-resistant Staphylococcus aureus is needed?

  • Dicloxacillin
  • Cephalexin
  • Amoxicillin
  • Doxycycline (correct)

Which of the following is a risk factor for developing lichen simplex chronicus?

  • Hepatitis C infection
  • Depression
  • Female sex
  • Genetic predisposition (correct)

What is the most likely diagnosis for a new-onset, swollen, pruritic rash that began as a few vesicles after gardening?

<p>Contact dermatitis (C)</p> Signup and view all the answers

Which dermatologic condition is most likely to occur in a 19-year-old woman with polycystic ovarian syndrome?

<p>Acne vulgaris (C)</p> Signup and view all the answers

What is the causative organism for tinea versicolor?

<p>Malassezia (B)</p> Signup and view all the answers

What is the most likely diagnosis of a lesion that is a slow-growing, erythematous nodule with a scaly appearance and ulceration?

<p>Squamous cell carcinoma (D)</p> Signup and view all the answers

Which of the following is a risk factor for melasma?

<p>Pregnancy (C)</p> Signup and view all the answers

What is the most likely diagnosis for a variably pigmented macule with irregular borders that has been growing on a woman’s thigh?

<p>Superficial spreading melanoma (C)</p> Signup and view all the answers

What is the best choice for first-line treatment of psoriasis with approximately 3% body surface area affected?

<p>Topical betamethasone dipropionate cream 0.05% (D)</p> Signup and view all the answers

Which of the following is the best initial treatment for tinea versicolor?

<p>Topical ketoconazole to be applied daily for two weeks (A)</p> Signup and view all the answers

Which cutaneous distribution of lesions differentiates the most likely disorder from other dermatoses?

<p>Fir-tree pattern distribution (C)</p> Signup and view all the answers

Which of the following additional findings is characteristic of the most likely diagnosis?

<p>Wickham striae (A)</p> Signup and view all the answers

Which of the following is the most likely diagnosis for pruritic bumps on the buttocks?

<p>Hidradenitis suppurativa (D)</p> Signup and view all the answers

Which of the following mechanisms is likely responsible for the reaction and rash after sulfamethoxazole-trimethoprim?

<p>Antigen exposure, sensitizing T cells, which then mediate tissue injury (A)</p> Signup and view all the answers

Which of the following best describes the appearance of nummular eczema on physical exam?

<p>Presence of multiple 'coin-shaped' erythematous plaques that are on the arms and legs (C)</p> Signup and view all the answers

Which of the following is the most likely diagnosis for a pink, pearly papule with a rolled border?

<p>Basal cell carcinoma (B)</p> Signup and view all the answers

Which of the following antibiotics is the best treatment for a patient with redness and swelling around the nail fold if methicillin-resistant Staphylococcus aureus needs to be covered?

<p>Oral clindamycin (C)</p> Signup and view all the answers

Which of the following is the best diagnosis for the thickened patch of skin on the anterior surface of the lower leg?

<p>Lichen simplex chronicus (D)</p> Signup and view all the answers

Which of the following is the most likely diagnosis for swelling and tenderness over the proximal nail fold?

<p>Paronychia (C)</p> Signup and view all the answers

Which of the following is the most likely diagnosis for redness and flushing affecting the central face?

<p>Rosacea (B)</p> Signup and view all the answers

Which patient population experiences an increased incidence of lichen planus?

<p>Patients with hepatitis C (C)</p> Signup and view all the answers

Which of the following treatment options is considered first line in the treatment of mild to moderate atopic dermatitis?

<p>Hydrocortisone (B)</p> Signup and view all the answers

Which factor is included in the ABCDE clinical prediction criteria for malignant melanoma risk?

<p>Asymmetry (A)</p> Signup and view all the answers

Which of the following is likely the first step in the pathogenesis of psoriasis?

<p>Keratinocytes that produce an inflammatory response (D)</p> Signup and view all the answers

Which of the following would be the initial test for a patient with sun-induced whitish patches?

<p>Potassium hydroxide preparation (A)</p> Signup and view all the answers

Which mechanism is most likely responsible for the pathogenesis of vitiligo?

<p>Autoimmune (D)</p> Signup and view all the answers

What is the next best step for a melanoma diagnosis confirmed by biopsy?

<p>Excision with wide margins (A)</p> Signup and view all the answers

Which of the following is an appropriate second-line therapy for acne vulgaris?

<p>Oral doxycycline (C)</p> Signup and view all the answers

Which of the following is the most likely diagnosis for raised lesions on elbows and knees with an overlying silvery scale?

<p>Plaque psoriasis (C)</p> Signup and view all the answers

Which of the following is the most likely diagnosis for an itchy rash that followed a headache and sore throat?

<p>Pityriasis rosea (B)</p> Signup and view all the answers

Which of the following pharmacologic agents would be most effective in managing facial erythema in rosacea?

<p>Topical brimonidine (B)</p> Signup and view all the answers

Which of the following diagnoses is likely for a woman with a new painful lesion on the right lateral forehead?

<p>An infiltrated papule (A)</p> Signup and view all the answers

Which genus of bacteria is most commonly associated with the development of acne vulgaris?

<p>Cutibacterium (B)</p> Signup and view all the answers

Which condition is best diagnosed as shown in the provided image?

<p>Tinea capitis (A)</p> Signup and view all the answers

Which medication is contraindicated in a pregnant patient with acne vulgaris?

<p>Topical tazarotene (B)</p> Signup and view all the answers

Which of the following is the most important prognostic factor for patients with malignant melanoma?

<p>Breslow level (B)</p> Signup and view all the answers

Which of the following is the most common type of skin cancer in the United States?

<p>Basal cell carcinoma (D)</p> Signup and view all the answers

What finding differentiates rosacea from lupus erythematosus?

<p>Exacerbation with heat (C)</p> Signup and view all the answers

Which of the following is the best treatment for an erythematous greasy-appearing rash on the central face?

<p>Ketoconazole shampoo (D)</p> Signup and view all the answers

What is the mechanism of action for terbinafine used in the treatment of onychomycosis?

<p>Inhibits the enzyme squalene epoxidase, preventing synthesis of ergosterol, which is needed to build fungal cell walls (D)</p> Signup and view all the answers

What skin condition is known as 'the itch that rashes'?

<p>Atopic dermatitis</p> Signup and view all the answers

What skin condition is characterized by lichenified plaques in a flexural distribution?

<p>Atopic dermatitis</p> Signup and view all the answers

Which of the following best describes the rash concerning for psoriasis seen in the patient?

<p>Well-demarcated erythematous plaques with silvery scales (D)</p> Signup and view all the answers

Flashcards

Severe acne vulgaris treatment

Increasing isotretinoin dosage is the mainstay treatment for severe acne vulgaris, when other medications are ineffective.

MRSA nail fold infection antibiotic

Dicloxacillin is the best antibiotic for a painful, red swelling of the lateral nail fold if methicillin-resistant Staphylococcus aureus (MRSA) coverage is necessary.

Lichen simplex chronicus risk factor

Psychological stress, including depression can increase the risk of developing Lichen Simplex Chronicus.

Vesicular rash after gardening cause

Contact dermatitis is a likely cause for a rash following gardening, especially with vesicles or blisters.

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PCOS and dermatologic condition

Patients with polycystic ovarian syndrome (PCOS) are particularly susceptible to acne vulgaris due to increased androgens.

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Tinea versicolor organism

Malassezia is the causative organism in tinea versicolor.

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Likely face lesion diagnosis

Squamous cell carcinoma is the most likely diagnosis for a slow-growing, erythematous nodule with ulceration.

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Melasma risk factor

Lighter skin tones and pregnancy are risk factors increasing melasma incidence.

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Variably pigmented macule diagnosis

Lentigo maligna melanoma is the most likely diagnosis for a variably pigmented macule, with irregular borders, located on the anterior thigh.

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Psoriasis first-line treatment

Topical betamethasone dipropionate cream is the best initial treatment for psoriasis, especially on a small area.

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Tinea versicolor treatment

Oral fluconazole once per week for four weeks is the best initial treatment for tinea versicolor.

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Distribution of lesions

A zosteriform distribution of lesions, along a nerve root, differentiates herpes zoster from other dermatoses.

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Hepatitis C rash

A purple, papular, pruritic, and polygonal rash on the ankles and volar wrists is characteristic of a drug eruption in patients with Hepatitis C.

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Folliculitis cause

Poor hygiene and sweating are risk factors for bacterial folliculitis.

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Drug eruption mechanism

Antigen exposure causing the release of vasoactive substances is the likely mechanism for a drug-induced rash.

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Nummular eczema

Round, erythematous, scaly plaques with raised, narrow borders and central clearing characterize nummular eczema.

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Basal cell carcinoma

A pearly papule with a rolled border and telangiectasia is characteristic of basal cell carcinoma.

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MRSA nail infection

Oral clindamycin is the best treatment for a suspected MRSA infection in the nail bed.

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Lichen simplex chronicus

Thickened patch of skin on the lower leg, chronically scratched, describes lichen simplex chronicus.

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Paronychia

Pain and swelling of a finger/toe at the proximal nail fold is usually paronychia.

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Study Notes

Patient Presentations with Skin Discoloration and Lesions

  • 22-year-old man: Presented with hypopigmented, whitish, oval-shaped macules on his abdomen, likely tinea versicolor. Initial treatment: topical ketoconazole for two weeks.
  • 42-year-old woman: Presented with a persistent, light pinkish-orange, slightly scaly annular patch on her lower abdomen resistant to topical antifungal. Developed new lesions, similar in color but smaller. History of influenza without antiviral treatment. Likely diagnosis: zosteriform distribution of lesions differentiates from other dermatoses.
  • 40-year-old woman: Presented with purple, papular, pruritic, and polygonal rash on ankles and volar wrists. Characteristic of erythema migrans, but additional findings are not provided.

Patient Presentations with Skin Lesions and Conditions

  • 25-year-old man: Presented with erythematous, pruritic, tender bumps on his buttocks, sometimes with pustules. Likely diagnosis: Staphylococcus aureus folliculitis.
  • 27-year-old woman: Presented with a morbilliform rash (rash resembling measles) over her torso and extremities, improves with diphenhydramine. No hives, pustules, or petechiae; mucous membranes spared. Rash likely a reaction to sulfamethoxazole-trimethoprim. Mechanism: antigen exposure causing release of vasoactive substances.
  • 24-year-old man: Presented with nummular eczema with round, erythematous, scaly plaques with raised borders. This condition is part of atopic dermatitis. Skin condition includes increased skin lines.
  • 65-year-old woman: Presented with a 1cm pink, pearly papule on her face with rolled border and telangiectasia. Likely diagnosis: basal cell carcinoma.
  • 27-year-old man: Presented with redness and swelling along the lateral nail fold of his index finger. Likely needs treatment for methicillin-resistant Staphylococcus aureus with antibiotics such as oral clindamycin.
  • 32-year-old woman: Presented with well-demarcated erythematous plaques with silvery scales on elbows. Likely diagnosis: psoriasis.
  • 30-year-old woman: Presented with uneven tanning after sunbathing. Whitish patches were seen under her arms and chest. Likely diagnosis of vitiligo. Initial treatment is antinuclear antibody testing.
  • 35-year-old man: Presented with redness on forehead, cheeks, and nose with telangiectasias. Likely diagnosis is rosacea.
  • 68-year-old man: Presented with a slowly-growing, 6 mm erythematous nodule on his face with scaly appearance and ulceration. Likely diagnosis is squamous cell carcinoma.
  • 35-year-old woman: Presented with erythematous, well-defined, symmetric plaques on elbows and knees with silvery scale. History of similar lesions in family. Likely diagnosis of plaque psoriasis.
  • 28-year-old woman: Presented with well-demarcated pale macules and patches on hands and near lips. Likely diagnosis of vitiligo.
  • 72-year-old woman: Presented with painful yellowed toenail, with hyphae noted in potassium hydroxide preparation. Likely diagnosis of fungal nail infection (onychomycosis). Treatment is oral terbinafine.
  • 67-year-old man: Presented with a 0.8 cm erythematous, tender papule with central hyperkeratosis on the forehead. Likely diagnosis is actinic keratosis which is different from squamous cell carcinoma, which has infiltration.
  • A 19-year-old woman: Presented with increased serum androgen levels, likely due to polycystic ovarian syndrome. This may lead to acne vulgaris as a potential condition.
  • A 68-year-old man: Presented with a slowly growing lesion on the face, with findings of a 6mm well-demarcated erythematous nodule with scaly appearance and ulceration, likely diagnosis is squamous cell carcinoma.
  • A 28-year-old man: Presented with psoriasis, with erythematous plaques and silvery scales on anterior and posterior aspects of the torso. Likely needing topical medication such as betamethasone or tacrolimus.

Other Important Concepts

  • Various risk factors: Factors like UV exposure, medications, and family history can play a role in skin disorders. For example, a history of influenza and lack of antiviral treatment could influence diagnosis.
  • Diagnostic tests: Different tests (KOH prep, biopsy, etc.) are used to aid in diagnosis.

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Description

Test your knowledge on various skin conditions through detailed patient presentations. Each case provides unique symptoms and possible diagnoses, challenging you to identify the correct dermatological issues. Perfect for students and professionals in the medical and healthcare fields.

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