Skin & Dermatology - MCQ Study online at quizlet.com/_w8w24 1.
2yo presents with abscess on buttoc ks, bro ther had same diseas disease e recently. There is no surrounding surroundi ng erythema and he is otherwise well. a) I and D b) start start clind a c) start septra and I and D d) IV vanco
L: a) I and D ________________________ _____________________________ _____ Taken fr om om:: UptoDate Both incision incision and drainage d rainage + antimicrobial antimicrobial therapy if (Grade (Gr ade 1B): - extensive surround ing cellulitis, cellulitis, -immunocompromised or underlying medical problem, -systemic signs of infection -Und er 3 months old old -abscess >5 cm, -multiple lesions _________________ ________ __________________ ____________ ___ See CPS statement statement on MRSA ab sc scess esses es - "Although definitive data are lacki lacking, ng, drainage d rainage alone appears to be a reasonable strategy for methicillin-resistant S aureus skin abscesses, with antibiotics antibiot ics reserved reserved for infants younger than thr ee months months of age, or for children wh o are systemical system ically ly un well, have un derlying medic medical al problems or or h ave significant significant surr ounding cellulitis" Tx: <1 mth mth = v anco IV 1 to 3 months months of age AND AN D below b elow = septra PO - no fever - no n o other systematic signs of illness
3 months months of age or older older AND AN D belo b elow w = I& D only - low-grade fever (<38. (<38.0°C) 0°C) or no n o fever - no n o other systemic signs of illness
3 months months of age or older AND below = Septra & keflex PO - significant surround ing cellulitis cellulitis - low-grade fever (<38. (<38.0°C) 0°C) or no n o fever - no n o other systemic signs of illness 2.
2 y/o w ith di ff ffuse use atopic atopic dermatitis dermatitis.. c. Tacrolimus He is compliant wi th steroid steroid ________ treatment trea tment but is not imp roving. NELSON: NELS ON: Pim Pimecrolimus ecrolimus cream for mild mild to moderate AD . Tacrolimus Tacrolimus ointment for moderate to What topical topic al agent agent could be the severe AD . Both are app roved for short-term short-term or intermittent intermittent long-term treatment treatment of AD in next line? patients ≥2 yr whose disease disease is un unresponsive. responsive. a. Methotrexate b. Tar c. Ta Tacrolimus crolimus d. Cyclosporine
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A 3-month-o ld i nfant has a diffuse eczematous pruritic rash o ver his head, trunk, and extremities. The presence of nodul es is noted. His brother recently had scabies. Proper treatment: a. 1% permethrin x 1 do se b. 5% permethrin x 1 dose c. 6% sulfur in petroleum x 3 do ses d. 10% crotamiton x ? doses e. Kwellada x 1 dose
b. 5% permethrin x 1 d ose _____________________________ CPS statement Scabies Etiology • Caused by Sar coptes mite; burrow into epidermis to lay eggs, which mature in 10-14 days • Infested humans do not manifest the typical symptoms for 3-4 wks Clinical • Hallmark = severe and paroxysmal itching; itch is worse than eruption looks • Lesion (classic) = linear papule or bur row; often in axillae, umbilicus, groin, foot, web spaces of finger s/toes • Infants - get diffuse erythema, scaling, pustules, vesicles; face and scalp often involved • Immunocompromised - may get a severe form, Norweigian or crusted scabies Treatment • Permetrin 5% cream over en tire body (12 hours overnight). May need to repeat 1 week later • Treat family contacts simultaneously • Wash linens, clothes from previous 2 days in h ot water, dry heat; wrap items in plastic for 7 days -If <2mths old - use 7% suplfur in petroleum x 3 days (n ot permithrin!) Prognosis • Pruritus may persist for 7-14 days after therapy b/c of prolonged hyp ersensitivity reaction
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A 3 year old bo y has atopic d ermatitis with a sudden exacerbation. Photo shown of (likely) impetiginized eczema (Difficult to d iscriminate between eczema herpeticum and eczema with imp etigo). What is the treatment? a. IV acyclovir b. IV cefazolin c. IV clo xacillin
L: b. IV Cefazolin _____________________________ a. IV acyclovir - if eczema herpeticum b. IV Cefazolin - if impetigo (coverage for both Staph and Strep is required) Dr W says aciclovir Q: when do you giv e PO vs. IV?
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An 8 month old child is brought in wi th several small brownish nodules on his back and extremities. The parents have observed that when they touc h the no dule, wheals develop around i t, it it transiently becomes erythematous and their child starts to scratch it. What is the diagnosis? a. mastocytosis b. neurofibromatosis c. b enign congenital nevi
a. mastocytosis _____________________________ Taken from Nelsons - Mastocytosis Urticaria pigmentosa - spectrum of disorders (cutaneous to systemic) - 4 types; urticaria pigmentosa is the childhood variant that resolves without sequelae - Lesions - macules/papules/nodules, range in colour from yellow-brown; illdefined borders; larger ones have characteristic orange peel texture - stroking or trauma leads to urtication (Darier sign); dermatograph ism - often intensely pru ritic - Associated with systemic signs of hisamine r elease (flushing, syncope, headache, hy potension, wheezing, diarrhea) Treatment 1) avoid triggers (p hysical; ASA, opioids, etc), 2) PO antihistamines (hydroxyzine), 3) topical steroids for urticaria, 4) PO mast cell stabilizers (cromolyn, ketotifen) for diarr hea, abdo cramping Prognosis - spontaneous involution; if persists past 4 yrs, more likely a chronic form with high risk for systemic disease
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12 year old girl with a history of hypo pigmented flat scars follo wing mild trauma, as well as spontaneous vesicular lesions when exposed to sun. Whic h medication would this most likely be a side effect of: ** Many repeats a. Prednisone b. Naproxen c. Lisinopril d. Methotrexate
b. Naproxen (confirmed by Dr W) _____________________________ Photodermatoses: 1. Antibiotics - tetracyclines, quinolones (ie cipro), sulphonylureas 2. NSAIDs - naproxen 3. Diuretics - furosemide, thiazide L: All the sun-associated reactions I found for MTX say hy perp igmentation
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13 year old girl had scoliosis surgery 2 months ago. She no w presents with significant amount of hair loss. On exam she has diffuse hair loss with no underlying inflammation. What is the lik ely cause? a. Tricotillomania b. Tinea capitis c. Telogen effluviam d. Alopeica areata
c. Telogen effluviam _____________________________ Telogen effluvium - hair falls out in clumps, + hair pull test - Occurs 5wks- 3 mths after pr ecipitating cause: childbirth, febrile episode, surgery, acute blood loss (incl donation), sudden wt loss, d/c steroids or OCPs, psychiatric stress - No inflammatory rxn; follicles are intact; often not severe - Reassure that n ormal hair growth will return within ~3-6mths a. trichotillomania - assoc with anxiety dx or OCD, irr egular pattern with mixed lengths and stubbly hairs b. alopecia areata - exclamation point hairs, + nail findings (nail pitting or grooves), occ spots come and go. Associated with autoimmune diseases d. tinea capitis - itchy, may have scaling, pustules or kerion. 1/3 of family members are carriers Telogen= hair at the resting stage. Anagen=hair at the growing stage. Anagen effluviam in pts who got chemo or radiotherapy ( attacks growing hair)
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15 year old with co ncern regarding hypopigmented area with smooth border around a previous melanocytic nevus. Nonpainful, nonpruritic, no bleeding, not expanding. No c hange in col our of original nevus. Mother is quite worried. Y ou tell her: a. nevus should be excised b. there is less than 1% chance of malignancy c. tell her lesions will disappear d. tell her more lesions will appear on the trunk
c. tell her lesions will (LIK ELY) d isappear _____________________________ Dx: Halo Nevus Taken from Nelsons: -Primarily in children and y oung adults -most commonly on back -Development may coincide with pub erty or pregnancy -Usual outcome = subsequent d isappearance of the central nev us over several months, and re-pigmentation of de-pigmented halo -Increased incidence if also has vitiligo ____________________________________
Advantage of benzoyl peroxide? a. Decrease P acnes resistance to antibiotic b. Decrease duration for o ral antibio tic c. Inhibits androgen effect of sebum d. Decrease need for antibioti c
d. Decrease need for antibiotic J: a. Decrease P acnes resistance to antibiotic _____________________________ J: I think it decreases P acnes resistance to antibiotics Reasons: As per Wiki: "Benzoyl peroxide has a bactericidal effect on P. acnes bacteria associated with acne and does not induce antibiotic resistance" As per Lecture: "Add benzoyl peroxide to redu ce bacterial resistance"
K: agree with Jen, sounds like a description of halo nevus. This is an associated inflammatory reaction with a nevu s causing d epigmentation around the border. Not sure what the answer is though. They should be watched for melanoma/confusion with melanoma bu t are usually cosmetic. I think a an d d are not true so between b an d c. C is possible but n ot sure you can b e that definitive in derm at any time! Looking at the below, it seems to hint at some possible increased risk of malignan cy maybe.
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Baby boy who sucks thumb a lot. Picture of finger with vesicular-pustular lesions on an erythematous base and swelling of proximal phalynx. Mom says it seems to hurt the baby. Afebrile. Rest of exam normal. What do you do? a. cephalexin po b. inc ision and drainage c. acyclovir po d. topic al antibiotics
c. acyclovir po ??? _____________________________ Taken from Nelsons Herpetic whitlow (viral paronychia) - painful, localized infection of a digit with erythema +/vesiculopustular eruption - occurs in children who suck thumb / b ite nails, especially if they have herpetic gingivostomatitis. - Heralded by itching, pain, eryth ema 2-7 days after exposure. - May look like pus, bu t not much drains. Av oid incision as prolongs recovery. - Pain typically persists for ~10 days, and recovers within 20 days -There are no clinical trials assessing the benefit of antiviral treatment for herpetic whitlow. High-dose oral acyclovir started at the 1st signs of illness has been reported to abort some recurrences and redu ce the duration of others in adults.
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Child presents with rash, blisters at extremities (picture provided: full body, l ook s like lips are involved, has a foley in situ). Initially had viral prodrome, then had amoxicilli n for 7 days, after which the rash started. a. TEN b. Staph scalded skin syndrome c. D ermatitis herpeticum d. Erythema multiforme
a. TEN _____________________________ SJS and TEN -Triggers = D rugs > infectious. - Dru gs: NSAIDs, sulfonamides, antiepileptics, and antibiotics -Infections: mainly mycoplasma - >2 mucosal surface + fever +myalgia SJS <10% of skin surface involvement TEN > 30% skin surface involvement. Differentiating b/w TEN and SSSS: -both hav e +nikolsky sign. -Blister cleavage plane is intradermal in SSSS ( vs full thickness epideral in TEN) -Usually in infants and y oung toddlers in SSSS (v s young adults in TEN). -No mucosal involvement in SSSS (vs + mucosal involvement in TEN) - Sometime biopsy is needed to differentiate between the two.
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Child with large, bo ggy mass on head with small amount of purulent drainage. Scaly edges (pic given - loo ks like Kerion). Best treatment: a. Oral prednisone b. Oral terbinafine c. Top ical terbinafin d. Oral Keflex
b.oral terbinafine _____________________________ Tinea capitis -> ORAL terbinafine ***All other tinea infections are treated with TOPICAL terbinafine Kerion = boggy granulomatous mass; severe inflammatory response to dermatophyte infection -Fever, pain, and r eginla LAD are common -Permanent scarring and alopecia may result Tinea capitis - Caused by Microsporum audouinii, Trichophyton tonru rans, Microsporum canis - Lesion - infection of scalp, hair shafts; often get "black dot" alopecia - Diagnosis (all fungal infections) - Wood lamp, KOH stain, culture - First line: terbinafine (lamisil) po, x 4-6 weeks. - Topical therapy alone is ineffective; but may b e adjunct - It is NOT necessary to shave the scalp
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Child with large hemangioma a. ipsilateral cerebral AVM ( if referring to hemangioma) ... think PHAC ES synd rome overlying the upper 2/3 of his face. b. glaucoma (if r eferring to Port wine stain- not hemangioma) ... think Stu rge WEber syndrome What complication do you _____________________________ anticipate? Taken from Pediatrics 2013 article a. ipsilateral cerebral AVM Facial hemangiomas with ≥5cm in diameter should prompt evaluation for PHACES syndrome b. glaucoma (MRI + MRA, cardiovasc imaging + optho exam) PHACES Syndrome: -Posterior fossa malformations (structural an omalies) -Hemangiomas -Arterial anomalies (CNS are the most common extracutaneous features; neuro & cognitive impairments are greatest source of morbidity) -Cardiac defects (most common = CoA) -Eye abnormalities (uncommon; micropthalmia, optic nerve hypoplasia) -Sternal clefting/Supr aumbilical raphe syndrome ______________________________________ Sturge Weber Syn drome : 1.Unilateral port wine stain in distribution of trigeminal nerv e (V1) 2.Venous leptomeningeal an giomatosis associated with sz and cognitiv e defects 3. Glaucoma Only 8% of pts with facial port wine stain have Sturge Weber Syndrome Note: extent of the port wine doesn't correlate with the severity of the angiomatosis (may have angiomatosis in absence of Port Wine Stain)
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Child with lice. When can he go back to school? a. Now b. After 1 day of treatment c. After 1 week of treatment
a. Now _____________________________ See CPS statement
Child with port-w ine-stain on face over V1 distribution. What needs to be followed for? a. optic glioma b. cerebral arteriovenous malformation c. glaucoma d. liver disease (e. ipsilateral hearing loss - from another version of Q)
c. glaucoma _____________________________ Sturge Weber Syn drome : 1.Unilateral port wine stain in distribution of trigeminal nerv e (V1) 2.Venous leptomeningeal an giomatosis associated with sz and cognitiv e defects 3. Glaucoma 4. Seeizures 5. hemiparesis contralateral to facial lesion -Intracranial calcifications
Note: Do not treat prophylactically (as per CPS -->Examine close contacts, and treat IF louse found (ie avoid overtreatment if only nits found as is not considered an active infestation) "having nits close to the scalp does not necessarily indicate that a live lice infestation has occured or will occur."
Only 8% of pts with facial port wine stain have Sturge Weber Syndrome Note: extent of the port wine doesn't correlate with the severity of the angiomatosis (may have angiomatosis in absence of Port Wine Stain) __________________ Taken from Nelsons - Port wine Stain -Present at birth -Gows with child -persists; may darken with age
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Full term baby delivered after traumatic forceps delivery. Now 1 month o ld with vomiting, lethargy and firm red plaque on back of hand. What lab test would you check. a. Glucose b. calcium c. p otassium d. Alk P e. creatinine
b. calcium _____________________________ Taken from Nelsons
Girl w ith onset of itchy rash x 1 week over her trunk and back. What is her most likely diagnosis? (doesn't describe the features of the rash at all) a. Pityriasis rosea b. Tinea corporis c. Nummular eczema d. P soriasis
a. Pityriasis rosea _____________________________ Pityriasis Rosea: URTI-->Herald Patch (oval scaly PATCH)... 1 to 2wks later -> Christmas tree distribution of oval scaly PLAQUES.
Subcutaneous fat necrosis - Cause is unknown; mostly in term or post-term babies, ischemic injury (ie preeclampsia, birth trauma, asphy xia, prolonged hypothermia), in first 4 weeks of life - Lesion - asymptomatic, rubber y to firm, erythematous plaques or nodules - Complication - hypercalcemia (manifests as lethargy, poor feeds, vomiting, FTT, irritability, seizures, short QT or renal failure) - always do a Ca level! - Treatment - none ( unless hypercalcemia - encourage hyd ration and renal Ca excretion with Lasix, and limit dietary Ca and vit D) ; typically inv olute within weeks to months.
Herald patch can be confused with: 1) Tinea Corp oris: Elevated border with central clearing + always loss of hair 2) Nummular Eczema: CRUSTI NG er osions 3) Tinea Versicolor: hyper or hyp opigmented scaling MACULES (not raised) NOTE: All of the above can be itchy! PATCH: Herald patch vs Tinea Versicolor -Both can be scaly -Versicolor is a pigmen tation problem. PLAQUE: Tinea Corporis vs Nu mmular Eczema -If crusting (2ry to edema in eczema)--> Nummular eczema. -If central clearing--> Tinea Corp oris Rx: -Tinea: Topical terbinafine, ciclopirox, clotrimazole, ketoconazole. -PR: Reassurance. Sun light may help.
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Hemangioma over eye, what do you want to do first? a) Consider starting propranolol b) Call optho c) Wait 2 weeks then reassess
b) Call optho _____________________________ a) Consider starting propranolol - tru e for most significant hemangiomas b) Call optho - I'm wonder ing if this should be done because of risk of loss of vision if the hemangioma is obstructing vision an d may lead to blindness c) Wait 2 weeks then reassess - definitely not the r ight answer!
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Kid w hemangioma covering eye, what to do? a. Refer to surgery for resection b. Reassess in few months c. Start propranolol
c. Start propranolol vs a. refer to Optho (as per other versions of question) _____________________________ Taken from Pediatrcs 2013 article TREATMENT OPTIONS: 1) Propranolol - first-line therapy 2) Timolol (topical β-blocker) - may have a particular role in superficial lesions. 3) Pulsed dye & other laser modalities - may be useful as adjunctive or "mop-up" therapy. 4) Surgical excision - occasionally optimal therapeutic intervention; for large pedu nculated lesion located in a site where a surgical scar will be less noticeable. NOTE: -Facial lesions raise concern for PHACES -Lumbosacral and perineal lesions raise concern for associated spinal cord, renal, and genital anomalies.
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Kid wi th 10 tanned macules more varying from 5 to 15mm and normal physical examination. (No mention o f family history). What would you do next to co nfirm the diagnosis? a. MRI head b. Ophthalmology c. Echocardiogram
b. Ophthalmology _____________________________ to look for Lisch nodules and optic gliomas (ie. r/o NF) From Nelsons: a. MRI head - look for optic glioma. Only in 15%. b. Ophthalmology - Look for Lisch n odules (present in 40% at age of 4yo and 100% in adulthood) an d secondar y effect of optic glioma (pr essure on chiasma) c. Echocardiogram NF1-->pheochromocytoma and renal artery stenosis-->HTN NF2--> B/U acoustic neuroma (hearing loss, tinnitus)
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Kid wi th bright red perianal rash a) Candida perianal b) strep perianal infectio n c) contact dermatitis d) sexual abuse
b) Strep if its only perianal _____________________________L: since they describe it as bright red then I think is a) Diaper/Contact dermatitis -Irritant: spares folds (can't r each it), red macular/patch +/- ulceration -Rx: barrier (pertrolum or Zinc oxide) +/- 1% HC Candida Dermatitis -Involves folds, satellite lesions, bright red , beefy appearan ce -Rx: 1% HC + clotrimazole Seborrheic Dermatitis -Involves folds, YELLOW ! -Rx: 1% HC +/- antifungal - Tends to be in < 6mo or adulthood, non itchy, postauricular, salmon base with yellow greasy scale; responds well and fast to steroid HINTS: hemorrhagic-->histiocytosis Perioral dermatitis + alopecia + diarrhea and poor wt gain--> Acrodermatitis Enteropathica (hereditary zinc deficiency) Well demarcated with thick scale--> Psoriasis
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Kid with celiac disease and hypothyroidism. Develops a new bald spot. Likely etiolo gy? a. Tinea capitis b. Alopecia areata
b. Alopecia areata _____________________________ Taken form Nelsons Alopecia areata -Exclamation point hairs. -Associated with atopy, nail pits/ridges/dystrophy, cataracts, & autoimmune disorders such as hypothyroidism, vitiligo, pernicious anemia & ulcerative colitis. -Rapid & complete loss of hair in r ound or oval patches on the scalp & body. Trichotillomania - assoc with anxiety dx or OCD, irr egular pattern with mixed lengths and stubbly hairs Telogen effluvium - hair falls out in clumps (diffuse), positive hair pull test, often assoc with stressful ev ents, infections Tinea capitis - itchy, may have scaling, pustules or kerion. 1/3 of family members are carriers
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Kid with crohns and hypothyroidism. Now with a new bald patch, smooth hair loss, distinct border. Dx? a. Alopecia areata b. Tinea capitus c. Trichotillomania
a. Alopecia areata _____________________________ Taken from Nelsons Alopecia areata -Exclamation point hairs. -Associated with atopy, nail pits/ridges/dystrophy, cataracts, & autoimmune disorders such as hyp othyr oidism, vitiligo, pernicious anemia & u lcerative colitis. -Rapid & complete loss of hair in r ound or oval patches on the scalp & body. Trichotillomania - assoc with an xiety dx or OCD, irregular pattern with mixed lengths and stubbly hairs Telogen effluv ium - hair falls out in clumps (diffuse), p ositive hair pull test, often assoc with stressful ev ents, infections Tinea capitis - itchy, may have scaling, pustules or kerion. 1/3 of family members are carriers
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Kid with crohn's on sulfasalazine and has hairless patch with slight scale. a. alopecia areata b. trichotillomania
a. alopecia areata (if no scaling & autoimmune disease) c. Tinea Capitis (if scaling + immunodef) _____________________________ Taken from Nelsons: Tinea capitis - itchy, may have scaling, pustules or kerion. 1/3 of family members are carriers. Alopecia areata -Exclamation point hairs. -Associated with atopy, nail pits/ridges/dystrophy, cataracts, & autoimmune disorders such as hyp othyr oidism, vitiligo, pernicious anemia & u lcerative colitis. -Rapid & complete loss of hair in r ound or oval patches on the scalp & body. Trichotillomania - assoc with an xiety dx or OCD, irregular pattern with mixed lengths and stubbly hairs Telogen effluv ium - hair falls out in clumps (diffuse), p ositive hair pull test, often assoc with stressful ev ents, infections ___________________________ L: I would have gone for a) given the autoimmunity but I agree that the scaling throws you off
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Patient with red rash and +ve Nikolsky sign. Lip and eye changes. Diagnosis? a. strep toxic shock b. TEN
b. TEN _____________________________ SJS and TEN -Triggers = D rugs > infectious. - Dru gs: NSAIDs, sulfonamides, antiepileptics, and antibiotics -Infections: mainly mycoplasma - >2 mucosal surface + fever +myalgia - + Nikolsky sign I N TEN SJS <10% of skin surface involvement TEN > 30% skin surface involvement. DDx: -Strep Toxic Shock - Erythr oderma without Nikolsky's sign -EM - only oral mucosal involvement, if at all (other mucosal surfaces are spared) -SSSS - no mucosal invovlement (+ Nikolsky sign) _________________________ Note: Nikolsky sign is positive in: -SSSS -TEN - almost always present -Pemphigus vulgaris
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Photo of nail pitting. Di agnosis is: a. psoriasis b. fungal infection c. traumatic d. chemical reaction/exposure e. ecto dermal dysplasia
a.Psoriasis
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Photo of tinea capitis. a. shave the child's hair and treat with selenium shampoo daily for 14 days b. treat the entire family with selenium shampoo daily for 14 days c. treat with oral griseofulvin for 4-6 weeks d. he should not attend school until treatment is complete e. refer to a psychiatrist
c. treat with oral gr iseofulvin for 4-6 weeks (old question, as now 1st line is lamisil bc of less toxicity (ie transaminitis) _____________________________ Taken from Nelsons Tinea capitis - Caused by dermatophyte - Infection of scalp & hair shafts; often get "black dot" alopecia - Diagnosis (all fungal infections) - Wood lamp, KOH stain, culture Treatment: 1) PO griseofulvin (1st line) up to 8-12 weeks - stop wh en fungal cultures neg 2) alternatives - itraconazole, terbinafine po, x 4-6 weeks. Notes: - Topical therapy alone is ineffective for CAPITIS; b ut may be adjunct - It is NOT necessary to shave the scalp -Add itionally, griseofulvin is older therapy, weinstein now suggests terbenafine
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Picture of 9mo with large plaque hemangioma on the face, what wo uld you NOT do? a. Echocardiogram b. MRI head c. Renal ultrasound d. Ophthalmology
c. Renal ultrasound _____________________________ Taken from Pediatrics 2013 article
Picture o f erythema multiforme on arm and has ulcers in her mouth - what woul d the cause be a) mycoplasma b) NSAIDs
a) mycoplasma _____________________________ J: If HSV is listed, that is the most common, but can also be mycoplasma...
Facial hemangiomas with ≥5cm in diameter should prompt evaluation for PHACES syndrome (MRI + MRA, cardiovasc imaging + optho exam) PHACES Syndrome: -Posterior fossa malformations (structur al anomalies) -Hemangiomas -Arterial anomalies (CNS are the most common extracutaneous features; neuro & cognitive impairments are greatest source of morbidity) -Cardiac defects (most common = CoA) -Eye abnormalities (uncommon; micropthalmia, optic nerve hypoplasia) -Sternal clefting/Supraumbilical raphe syndrome
Taken from Nelsons Erythema Multiforme -Numerous morphologic manifestations; classic lesion = donut-shaped, target-like papules with erythematous outer border, inner p ale ring, and dusky p urp le to necrotic center -Usually asymptomatic, although bur ning sensation or p uritis may be p resent -Typically extensor surface of forearm; may h ave oral lesions (esp ver million border of lips and buccal mucosa) but other mucosal surfaces are spared -Lesions remain fixed for 72 h rs (unlike urticaria that fade within 24hrs) -Triggers = I nfectious > d rugs (90% vs 10%) - Infections: HSV (MOST COMMON), but Mycoplasma is also possible, esp in children - D rugs: NSAID s, sulfonamides, antiepileptics, and antibiotics -Tx: supportive; NSAI DS an tihistamine (d o not alter length of disease). Do not use steroids! Acyclovir my b e used as a prophylaxis is recurrent SJS and TEN -Triggers = Drugs > infectious. - D rugs: NSAID s, sulfonamides, antiepileptics, and antibiotics -Infections: mainly mycoplasma - >2 mucosal surface + fever +myalgia SJS <10% of skin surface involvement TEN > 30% skin surface inv olvement. Differentiating b/w TEN and SSSS: -both hav e +nikolsky sign. -Blister cleavage plane is intrader mal in SSSS (v s full thickness epideral in TEN) -Usually in infants and young toddlers in SSSS (vs young adu lts in TEN). No mucosal involvement in SSSS (vs + mucosal involvment in TEN) - Sometime biopsy is needed to differentiate between the two.
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Shows picture of kid wit h round hairless patch and NO scales and well demarcated. What's the association? a. Autoimmune thyroiditis b. Fungal infection c. Anxiety disorder
a. Autoimmune thyroiditis _____________________________ Alopecia areata -Exclamation point hairs. -Associated with atopy, nail pits/ridges/dystrophy, cataracts, & autoimmune disorders such as hypothyroidism, vitiligo, pernicious anemia & ulcerative colitis. -Rapid & complete loss of hair in r ound or oval patches on the scalp & body. DDx: 1) Trichotillomania - assoc with anxiety d x or OCD, irregu lar pattern with mixed lengths and stubbly hairs 2) Telogen effluvium - hair falls out in clumps (d iffuse), positive hair pull test, often assoc with stressful ev ents, infections 3) Tinea capitis - itchy, may have scaling, pustules or kerion. 1/3 of family members are carriers
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Strawberry hemangiomas, which is true: a. Not present at birth b. Equal sex predilectio n c. Chew up platelets d. Begin to invol ute in 2nd decade
a. Not present at birth _____________________________ -Common; affect ~5% of all infants -majority of hemangiomas are n ot clinically ev ident at b irth b ut become apparen t within th e first day s to 3 months of life - 2-3x more common in Females -Also more common in white (non-hispanic), premature, LBW, multiple gestation pregn ancy, mothers of advanced maternal age, placenta prev ia, preeclampsia (taken from 2103 Pediatrcs article) -50 percent of hemangiomas have involuted by age five years, 70 percent by age seven, and 90 percent by age nine - Kasabach-Merritt phenomenon is now known to be associated with two other types of vascular tumors: kaposiform hemangioendothelioma and tufted angioma... is not associated with true infantile hemangiomas
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Teenage female presents with black heads only, mild acne, what do you recommend? a. Topical benzoyl peroxide gel b. Topic al retinoic acid c. Accutane d. Topic al clindamycin
b. Topical retinoic acid - standard cometolytic therapy _____________________________ Taken from Lecture - Acne Rx: Mild: -If mostly comedonal - give retinoid (i.e., Tretinoin) -If mostly inflammatory ( pustules/papules, nodular) - give Retinoid + anti-inflammatory (benzoyl peroxide (bacteriocidal) and/or topical abx such as clindamycin or erythromycin) ** Treat for 2-3 months then reassess - if not better, try other topical or treat as Moderate Moderate: -oral Abx (tetracyclin, d oxycycline or minocycline) -Hormonal therapy (OCP) Severe: -Treat as moderate, but if not successful within 6 mths --> Consider Isotretinoin (Accutane) ( must r/o pregnancy as it is teratogenic)
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Teenage girl with mild acne: comedones only. What do you do ? ** a. benzoyl peroxide b. top ical retinoin A c. accutane d. o ral antibiotics
b. topical retinoin A _____________________________ Taken from Lecture - Acne Rx: Mild: -If mostly comedonal - give retinoid (i.e., Tretinoin) -If mostly inflammatory ( pustules/papules, nodular) - giv e Retinoid + anti-inflammatory (ben zoyl per oxide (bacteriocidal) and /or topical abx such as clindamycin or erythr omycin) ** Treat for 2-3 months then reassess - if not better, try other topical or treat as Moderate Moderate: -oral Abx (tetracyclin, d oxycycline or minocycline) -Hormonal therapy (OCP) Severe: -Treat as moderate, but if not successful within 6 mths --> Consider Isotretinoin (Accutane) (must r/o pregnancy as it is teratogenic)
34.
Trichotillomania is a. related to OCD b. normal behaviour c. eventually resolves
a. related to OCD _____________________________ Taken from Nelsons Trichotillomania • Hair loss from pulling; cannot be due to hallucinations, dellusions or inflammatory skin condition • Compulsive pulling, twisting and breaking of hair; irregular areas of incomplete hair loss; most often crown and occipital & parietal areas • Remaining hair are of various lengths and blunt-tipped due to breakage • Scalp appears normal (occ hemorrhage, crusting, and chronic folliculitis) • Trichophagy (resulting in trichobezoars) may complicate disorder • Long-term repeated trauma may be irr eversible/permanent • Tx: related to OCD; may try clomipramine of fluoxetine + b ehavioural interventions. Nacetylcysteine may b e helpful
35.
Two pictures of rash co nsistent with Incontinentia Pigmenti. Which of the following is not associated with this problem: a. alopecia b. seizures c. developmental delay d. malignant changes in the skin e. dental problems
d. malignant chan ges in the skin _____________________________ Taken from Nelsons Incontinentia Pigmenti - Rare, heritable, multisystem ectodermal disorder - D erm, dental, ocular abn ormalities - 4 phases o 1st (neonatal - 4mo): erythematous linear streaks and plaques of vesicles (+eosinophils) that are most pronounced on limbs & circumferentially on trun k (D dx: HSV, bu llous impetigo, mastocytosis - but linear config is unique) o 2nd: blisters on distal limbs resolve, become dr y an d hyp erketotic, form ver rucous plaques. Involute within 6 months o 3rd (Pigmentary stage): - h allmark of IP, can overlap with any of the other stages. Hyperpigementation distributed in macular whorls, reticulated patches, flecks, and linear streaks that follow Blachko lines. Axill & gr oin are inv ariably affected. Fade by adoelsecence o 4th: hairless, anhidrotic, hypopigmented patches or streaks; mainly flexor aspects of lower legs - Associated with: o Hair: Alopecia, or hair that is lusterless/wiry/coarse. o Dental anomalies (late, hypodentia, conical teeth, impaction). o CNS (developmental delay, seizures, microcephaly, spasticity, paralysis. o Ocular (neovasc, micropthalmos, strabismus, cataracts, optic nerve atrophy, RETINAL DETACHMENT) o Nails: Dystrophy (rare) o Skeletal defects (rare) - Dx: Clinical
36.
Vascular Malformation over unilateral upper face. What do you need to wo rry about? a) Glaucoma b) Ipsilateral hearing loss c) C erebral malformation d) hydrocephalus
a) Glaucoma _____________________________ Sturge Weber Syn drome : 1.Unilateral port wine stain in distribution of trigeminal nerv e (V1) 2.Venous leptomeningeal an giomatosis associated with sz and cognitive defects 3. Glaucoma 4. Seizures 5. hemiparesis contralateral to facial lesion -Intracranial calcifications Only 8% of pts with facial port wine stain have Stur ge Weber Syn drome Note: extent of the port wine doesn't correlate with the severity of the angiomatosis (may have angiomatosis in absence of Port Wine Stain) __________________ Taken from Nelsons - Port wine Stain -Present at birth -Gows with child -persists; may darken with age
37.
What is the best treatment for headlice if resistance is prevalent? a. Lindane b. Isopropyl alcohol/terpineol (myristate) c. 1% permethrin d. 5% permethrin
b. Isopropyl alcohol/terpineol (myristate) (Myristate/cyclomethicone solution = Resultz) _____________________________ Taken from CPS statement Topical insecticides •Pyrethr ins (risk of allergic rxn if allergic to ragweed) & Permethrin 1% (synthetic pyrethr oid; no risk of allergic rxm) •Lindane - 2nd line therapy - most neur otoxic, can cause BM suppression. •Malathion - not appr oved in Canad a NOTE: Resistance against topical insecticides is documented outside of North America Topical Non-Insecticide •Resultz = non-insecticidal, new • Works b y d issolving waxy exoskeleton of louse, leading to dehy dration & death • Also not ovicidal, therefore need 2 applications one week apart • Use in children ≥ 4yo • Minimal side effects, safe Oral Agents (TMP-SMX or Iv ermectin) • Limited data to support its use Wet combing or n atural products: • No evidence _____________________________ -Use of lindane should b e restricted d ue to the potential for n eurologic side effects and the dru g's relatively low efficacy. - Permethrin not for younger than 2 mo
38.
What is the mechanism of Accutane? a. Decreased sebum pro ductio n b. Decreased prop iobacterium c. Comeodolytic d. Increase follicular cell tu rnover
a. Decreased sebum production _____________________________ Taken from Nelsons Note: Accutane = isotretinoin
39.
What to give to k id that failed topic al acne tx? a. Minocycline
a. Minocycline _____________________________ Taken from Lecture - Acne Rx: Mild: -If mostly comedonal - give retinoid (i.e., Tretinoin) -If mostly inflammatory ( pustules/papu les, nodular) - give Retinoid + anti-inflammatory (benzoyl peroxide ( bacteriocidal) and/or topical abx such as clindamycin or erythr omycin) ** Treat for 2-3 months then reassess - if not better, try other topical or treat as Moderate Moderate: -oral Abx (tetracyclin, d oxycycline or minocycline) -Hormonal therapy (OCP) Severe: -Treat as moderate, but if n ot successful within 6 mths --> Consider I sotretinoin ( Accutane) (must r/o pregnancy as it is teratogenic)
40.
Which o f the following is true of molluscum: a. it is pruritic b. high infectivity c. contagious for entire rash d. lesions scar when healing
B or C? _____________________________ Dr W also unsure of answer, and said that lesions scar when healing, so can also be true) Taken from Nelsons Molluscum • Poxvirus; large dsDNA virus. 2 types (1 is most contagious) • Contagious - by direct contact or from fomites; spread by autoinoculation • Affects mainly age 2-6yo, severe eczema, immunocompromised • Incubation period ≥2 weeks • Discrete, pearly coloured , smooth, dome-shaped papu les (1-5mm); central umbilication; may be itchy • Primarily found on face, eyelids, neck, axillae, thighs, genitals (but not commonly by sexual transmission) • Pustular eruption - immunologic rxn; no abx! Atrophic scars often seen after rxn • Self-limited; avg attack 6-9mths, but can persist for yrs • Avoid shar ed b aths, towels, • Tx of choice: curettage (if older) or cantharidin (if younger ; never on face) • If overtreated scarring results!
41.
A young boy has three circular patches of complete hair loss on his head. It is slightly itc hy. His finger nails are normal. His mother had a similar episode when she was younger. What is the diagnosis? a. trichotillomania b. alopecia areata c. telogen effluvium d. tinea capitis
d. tinea capitis _____________________________ Taken form Nelsons (Tables 654-3/4 - differentiates all 4 conditions!) Trichotillomania - assoc with anxiety dx or OCD, irregular pattern with mixed lengths and stubb ly hairs Alopecia areata - exclamation point hairs, + nail findings (nail pitting or grooves), occ spots come and go Telogen effluvium - hair falls out in clumps, + hair pull test, often assoc with stressful ev ents, infections Tinea capitis - itchy, may have scaling, pustules or kerion. 1/3 of family members are carriers This question is a bit vague, so no point in deb ating further ...I think it could still be B, as not all A.A has nail findingsJ; for me, it was also the itchyness that made me point away from AA.