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Derm

Terms in this set (22)

A 32 year old woman walks into the emergency department two weeks after a fall from a bus. She tripped stepping off the bus and landed with her right hip on the last stair. The fall was only a few feet in distance. She noted very little immediate pain, and there was no pain at all by the next day. However, the next week her right hip began to "burn." After a day's burning sensation she developed a rash involving the hip region (see Figure). She denies any chest pain, shortness of breath, nausea or vomiting. Physical examination shows a unilateral, erythematous, maculopapular rash extending from below her umbilicus to her back in a band-like pattern. There are no open lesions or cuts. What is the appropriate management of this patient?
[image]
Figure courtesy of eMedicine.com
A. Obtain an X-ray for fat emboli.
B. Discharge home with a first-generation cephalosporin for a bacterial process.
C. Discharge home for rest and ice for the next few days for a late-appearing post-traumatic process.

D. Discharge home with analgesics and an antiviral.
E. Refer to orthopedics for evaluation of possible right hip fracture.
...
A 58 year old construction worker who has no primary care doctor comes to the emergency department because of a non-pruritic rash above his ankles (see Figure). Physical examination reveals bilateral erythematous and swollen ankles that are mildly warm but non-tender to touch. His overlying skin of both legs show mild scaling and thickened skin. There is no puncture site or visible opening in the skin, although he has prominent varicose veins bilaterally (see Figure). His temperature is 37C (98.6F). He appears to be in no acute distress. What is the most likely diagnosis?
[image]
Figure courtesy of eMedicine.com
A. eczema
B. cellulitis
C. psoriasis
D. necrotizing fasciitis

E. stasis dermatitis
e
A patient with no medical history presents to the emergency department for a second opinion. Nearly a week ago, there was a rapid onset of malaise, headache, backache, and fever. A rash began to appear on the leg a few days after the initial symptoms and the patient presented to a hospital-affiliated walk-in clinic for assessment. The patient had no respiratory symptoms but was noted to have some lesions on the tongue. At the time of his assessment at the walk-in clinic, the fever had resolved and the patient was diagnosed as having a viral syndrome. At the walk-in clinic, a digital photograph of the rash was taken and inserted into his computer records (see top of Figure). It is now 3 days after the initial walk-in clinic visit. You are working in the emergency department where the patient presents complaining of a recurrence of high fevers and a spread of the rash which now involves the face, extremities, and torso (see bottom of Figure). What diagnosis is most consistent with the history and accompanying images?
[image]
Image courtesy of eMedicine.com
A. varicella-zoster virus
B. measles
C. insect bites with secondary infection
D. erythema multiforme

E. smallpox
e
A patient develops a rash that starts as multiple bilateral target-like macules and papules on the palms and soles. It progresses to widespread sloughing of the skin requiring admission to the burn unit. Which of the following etiologic agents has NOT been implicated in this syndrome?
A. penicillins
B. sulfa antibiotics
C. barbiturates

D. recent immunization
E. corticosteroids
e
A 53 year old man with non-insulin dependent diabetes mellitus presents with pain, redness, and swelling of the right foot and lower leg, accompanied by a temperature of 102. X-rays reveal no subcutaneous gas and show no evidence of osteomyelitis. The patient has been admitted on three previous occasions for cellulitis of the right foot and notes that this episode is identical. Which of the following antibiotics is the most appropriate initial therapy for a presumed diagnosis of cellulitis?
A. intravenous nafcillin
B. intravenous cefazolin

C. oral dicloxacillin
D. intravenous ampicillin-sulbactam
E. intravenous gentamicin
d
Which of the following is FALSE regarding the common skin disorder, seborrheic dermatitis?
A. differential diagnosis includes Tinea capitis, psoriasis of scalp, cutaneous lupus erythematosus
B. uncommon between infancy and puberty
C. found in skin folds and hair-bearing of face scalp, chest and groin
D. characterized by erythema and waxy scaling

E. initial therapy often consists of high dose topical steroids
e
Of the following, which is most likely distributed in a Christmas-tree pattern on the posterior thorax?
A. eczema
B. acanthosis nigrans

C. pityriasis rosea
D. atopic dermatitis
E. candidiasis
c
A Wood's light is an ultraviolet source that emits light of 365nm wavelength resulting in different fluorescent patterns when directed at different organisms. Which of the following correctly matches the organism to its fluorescent pattern?
A. Pseudomonas - yellow or green
B. Porphyria cutanea - urine color change to orange or yellow
C. Erythrasma - red or pink
D. Tinea versicolor - green or yellow

E. All of the above
e
Which of the following is true regarding topical corticosteroid use?
A. Hydrocortisone is the preferred agent for areas of the body characterized by thickened skin (e.g. palms and soles).
B. Potency is measured by the ability to induce vasoconstriction.
C. Fluorinated steroids should be used in pregnant woman.
D. To achieve large differences in potency, it is more effective to vary the dose of a particular steroid than to change the type of steroid.

E. Once initiating topical steroids, it is best to maintain the same application schedule without interruption until the symptoms no longer remain.
b
A 19 year old male presents to the emergency department with allergic-mediated pruritis over large portions of his body. Which of the following is true regarding this condition?
A. There is no role for therapies such as Domeboro solution (1:10 diluted aluminum sulfate soaks), potassium permanganate baths, and oat-meal baths.
B. Topical antihistamine agents should be encouraged to manage the pruritis.
C. Second generation antihistamines such astemizole, fexofenadine, and loratadine are more effective but cause increased levels of sedation and should be avoided if possible.
D. H2 antagonists such as ranitidine or famotidine have never been shown to provide benefit.

E. Oral doses of antihistamines should be encouraged initially.
e
The rate at which a topical medication absorbs into the skin is determined in large part by the "vehicle," or medication base. Which of the following is true regarding medication bases?
A. Alcohol-free bases are best for exudative lesions such as poison ivy dermatitis.
B. Gels are composed of petroleum jelly and do not contain water.

C. Bases containing alcohol are best for dry scaly conditions or denuded areas.
D. Ointments are greaseless mixtures of propylene glycol and are contraindicated for dry lesions.
E. Creams are a mixture of oils, water and preservatives and are best used for acute rather than chronic conditions.
e
A 45 year old male presents to the emergency department with sharp pains on the right side of the head. Upon exam, there are vesicular eruptions with crusting lesions on the patient's right forehead terminating in the patient's right eyebrow. The lesions are depicted in the figure below. The patient is extremely sensitive to light in his right eye. Which of the following is false regarding this patient?
[image]
Photo courtesy of eMedicine.com
A. These lesions can occur anywhere on the body.
B. Acyclovir is an accepted treatment of this condition.
C. Treatment is most effective if given within 72 hours of when the eruption begins.
D. The patient probably had chicken pox as a child

E. A Tzanck preparation can distinguish Herpes simplex virus from herpes zoster virus infection.
e
A 19 year old with eczema (atopic dermatitis) presents to the urgent care clinic demonstrating pustules within an area affected by his chronic eczema. A Tzanck preparation yields positive results, confirming the diagnosis of eczema herpeticum. Which of the following is FALSE regarding this condition?
A. It can be caused by either HSV or VZV.
B. Oral or, if necessary, IV acyclovir is used to treat this condition.
C. It is often mistaken as an exacerbation or a superimposed impetigo infection.

D. Death from this condition is very rare.
E. Constitutional symptoms and adenopathy are often present.
d
A 20 year old college female recently returned from spring break after hiking in the Virginia woods approximately two weeks prior to her presentation to the E.D. One day prior to presentation, she developed fever, chills, and anorexia. In the emergency department, she complains of headache, photophobia, and myalgias. On exam, one notices a disseminated, non-blanching, papular rash. Which of the following statements regarding this condition is FALSE?

A. A skin biopsy shows a necrotizing vasculitis.
B. Characteristically the rash begins on the trunk and spreads to the extremities.
C. If untreated, fatality rates range between 25-50%; however, treatment reduces the rate to 10%.
D. It is caused by the tick borne parasite Rickettsia rickettsii.
E. 95% of patients develop symptoms between the period of April 1 and September 30.
b
A 12 year old boy complains of a pruritic rash on his inner thighs and under his axilla. The rash is unresponsive to topical and oral antihistamines. On examination, one notes circular, raised nodules on an erythematous base. The rash appears as shown in Figure A below. (Figure B depicts a hand rash of identical etiology in an older patient.) Which of the following statements is FALSE regarding this rash?
[image]
Photo courtesy of eMedicine.com
A. The organism involved does not penetrate the dermis for it relies on oxygen for survival.
B. Antibiotic therapy is contraindicated because it may exacerbate the underlying condition.
C. The parasite is a mite known as Sarcopetes scabii.
D. Treatment is permethrin 5% cream applied to skin for 8-12 hours.

E. Often this condition occurs in young adults by sexual contact or in the elderly hospitalized population.
b
A 42 year old male presents to the emergency department with a 5-day history of a pruritic vesiculobullous rash on his right forearm. The rash has spread to involve his left palm and elbow (see Figure). He reports that he developed the rash 48 hours after working in the woods last week with his brother, who developed a similar rash. Antihistamines have decreased the pruritis, but the rash has continued to spread. Appropriate management of this patient's exposure can include all of the following EXCEPT:
[image]
A. continued antihistamine therapy

B. drainage of large bullae for cosmetic purposes
C. avoidance of contact with the rash to reduce spreading of the oleoresin antigen
D. careful washing of all clothing that was worn in the woods
E. oral steroid treatment
c
A 67 year old known alcoholic female is brought to the emergency department by EMS after being found somnolent with the odor of alcohol on her breath. After the primary survey is completed and she is stabilized, she is found to have scaly, sharply marginated, bright red eczematous plaques, vesicles and pustules in her perioral and anogenital areas (see Figure for a similar appearing rash). Consistent with this exam, she is also noted to have a red, glossy tongue and loss of her nails. With what nutritional deficiency are these findings associated?
[image]
A. phosphorus
B. calcium
C. potassium
D. magnesium

E. zinc
e
For several conditions of internal malignancies there may be associated cutaneous manifestations. The conditions below all describe common dermatological conditions associated with malignancy EXCEPT:
A. dermatomyositis
B. pruritis
C. pemphigus

D. acanthosis nigricans
E. erythema nodosum
c
Dermatological anthrax may occur wherever spores come into contact with the skin. Of the following options, which statement is FALSE concerning dermatological anthrax:

A. Initial diagnosis is usually made by Gram's stain analysis.
B. The organism most likely to cause dermatological anthrax is Bacillus anthracis.
C. Mortality rates are over 20-30% lower than for pulmonary anthrax.
D. Antibiotics do not affect the course of local disease.
E. Characteristic lesion is a black escar preceded by a vesiculopapular lesion 1 week prior.
A
Drug-induced urticaria is a common side effect of many drugs. Which statement about urticaria is FALSE?
A. Nonimmunological urticaria may be caused by degranulation of mast cells.
B. Drug-induced urticaria may be immunological or nonimmunological.
C. Association with malignancy is not strong enough to investigate for possible cancer when urticaria of unknown origin exists.

D. Penicillins and opiates are the most common offenders.
E. Steroids should always be used in treatment to avoid possible anaphylaxis.
e
A 50 year-old male presents with a chief complaint of chronic nasal itching and "a sore that won't go away" over the past few months. Of the following choices, which is the most appropriate management?
[image]
A. CT scan of the face for signs of nasal or facial trauma
B. screening of the eyes for zoster opthalmicus
C. prescription of topical steroid cream and follow-up in 5-7 days
D. provision of an antibiotic-soaked dressing and reassessment in the E.D. within 48 hours

E. urgent or next-day outpatient follow-up in Dermatology Clinic
e
The patient in the figure presents with findings of petechiae and mucosal lesions after beginning to take a sulfonylurea for diabetes. He is nontoxic, afebrile, and has no allergic symptoms. Based upon the most likely diagnosis, which of the following statements is true?
[image]
A. Prothrombin time is usually twice normal.
B. Intra-articular bleeding is commonly seen with this patient's condition.

C. Steroids are usually indicated in adults.
D. Intracranial hemorrhage is not a major concern unless the platelet count falls below 2,500/mm3.
E. Platelet transfusions are indicated if platelet count is below 100,000/mm3.
c
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