Dermatology

Question 1

28. Teenage female presents with blackheads only, mild acne, what do you recommend?
    a) Topical benzoyl peroxide gel
    b) Topical retinoic acid
    c) Accutane
    d) Topical clindamycin
    - —————————-
29. Teen with blackheads for two months. Management?
    a) Wash face
    b) Topical benzoyl peroxide
    c) Topical retinoids
    d) Systemic antibiotics
    - —————————-
30. Kid with mild comedones. First Rx?
    a) Benzoyl peroxide
    b) Topical retinoic A
    c) Tetracycline
    - —————————–
31. Teenage girl with mild acne: comedones only. What do you do?
    a) Benzoyl peroxide
    b) Topical retinoin A
    c) Accutane
    d) Oral antibiotics
    - —————————–
32. Girl with only blackheads. Best treatment?
    a) Topical tretinoin
    b) Topical benzoyl peroxide
    c) Oral antibiotic
    d) Accutane
    - —————————–
33. Teenage female presents with blackheads only, mild acne, what do you recommend?
    a) Topical benzoyl peroxide gel
    b) Topical retinoic acid
    c) Accutane
    d) Topical clindamycin

Answer 1

Topical retinoid

Good for comedones with only mild assoc’d acne

Question 2

1. 15 year-old male present with mild papular and comedogenic (? papulopustular, not comedogenic?) acne on face, trunk and back. Previously only using soap to wash his skin. Next step for treatment:
   a) Tetracycline PO
   b) Erythromycin cream
   c) Combination of topical retinoid and benzoyl peroxide
   d) Other topical

Answer 2

Topical retinoid + BP

Question 3

20. What to give to kid that failed topical acne tx?

A. Minocycline

Answer 3

PO ABx

Question 4

57. Benzoyl peroxide works by:
    a) Decreasing antibacterial resistance in p. acne
    b) Decreasing the duration of oral antibiotics
    c) Decreasing the need for oral antibiotics
    - ——————————-
58. Advantage of benzoyl peroxide?
    a) Decrease P acnes resistance to antibiotic
    b) Decrease duration for oral antibiotic
    c) Inhibits androgen effect of sebum
    d) Decrease need for antibiotic

Answer 4

Decreases P acne resistance to ABx

• decreases bacteria
• antiinflammatory

Question 5

71. What is the mechanism of Accutane?
    a) Decreased sebum production
    b) Decreased proprionibacterium
    c) Comeodolytic
    d) Increase follicular cell turnover
    - —————————
72. What is the mechanism of action of Accutane?
    a) Reduces infection with Propionibacterium acnes
    b) Decreases sebaceous gland production of sebum
    c) Increases follicular cell turnover

Answer 5

Decreases propionibacterium acnes?

• Reduces size and secretion of sebaceous glands
• Normalizes follicular keratinization
• Prevents new microcomedone formation
• Decreases the population of P. acnes
• Antiinflammatory effect

Question 6

2. A kid with asthma and eczema has an acute worsening of his eczema. What would you treat him with?
(PAGE 9)
a) Acyclovir
b) Steroids
c) Cefazolin
d) Vancomycin
---------------------
5. A 3 year old boy has atopic dermatitis with a sudden exacerbation.  Photo shown of (likely) impetiginized eczema.  What is the treatment?
a) IV acyclovir
b) IV cefazolin
c) IV cloxacillin
-----------------------
Boy with history of atopic dermatitis presents with rash similar to that seen in picture.  Difficult to discriminate between eczema herpeticum and eczema with impetigo.  Best treatment?
a) IV cefazolin
b) IV acyclovir
c) IV clindamycin
d) Topical steroids

Answer 6

Ancef

Question 7

11. Hemangioma over eye, what do you want to do first?
    a) Consider starting propranolol
    b) Call optho
    c) Wait 2 weeks then reassess

Answer 7

Call ophtho

Then Propranolol

Question 8

12. Vascular Malformation over unilateral upper face. What do you need to worry about?
    a) Glaucoma
    b) Ipsilateral hearing loss
    c) Cerebral malformation
    d) Hydrocephalus

Answer 8

Glaucoma

Sturge-Weber

• usually only on one side
• V1 distribution: forehead, temple, eyelid
• capillary malformation of skin, eye, brain
  1. Port wine stain (UL, V1)
  2. Glaucoma
  3. Leptomeningeal angioma
• Need ophtho Q6mo, consider MRI brain

Question 9

15. Picture of 9mo with large plaque hemangioma on the face, what would you NOT do?
    a) Echocardiogram
    b) MRI head
    c) Renal ultrasound
    d) Ophthalmology

Answer 9

Renal U/S

PHACES

• Posterior fossa brain malformation (cerebellar hypoplasia (same side as hemangioma), Dandy-Walker malformation)
• Hemangioma (segmental, >5cm)
• Arterial lesions (abnormal arteries in head or neck)
• Cardiac abnormalities (CoA, arch problems)
• Eye abnormalities (Morning glory disc, optic nerve hypoplasia, congenital cataracts)
• (Sternal abN)

Question 10

17. Kid w hemangioma covering eye, what to do?
    a) Refer to surgery for resection
    b) Reassess in few months
    c) Start propranolol

Answer 10

Start propranolol

refer to ophtho

Question 11

36. 6 mo old kid with vascular malformations of upper face. Complication you need to monitor?
    a) Ipsilateral hearing loss
    b) Cerebral AVM
    c) Glaucoma
    - ————————
37. Child with vascular malformation of upper face. What do you investigate for?
    a) Glaucoma
    b) AV malformation in brain
    c) Hydrocephalus

Answer 11

Glaucoma

Most likely Sturge Weber

Question 12

37. Child with large port wine stain overlying the upper 2/3 of his face. What complication do you anticipate?
    a) Ipsilateral cerebral AVM
    b) Glaucoma
    - ————————
38. Child with port-wine-stain on face over V1 distribution. What needs to be followed for?
    a) Ipsilateral hearing loss
    b) Glaucoma
    - ————————
39. Child with large port wine stain in a distribution of the 1st trigeminal nerve. What do you work him up for?
    a) Optic glioma
    b) Cerebral arteriovenous malformation
    c) Glaucoma
    d) Liver disease

Answer 12

Glaucoma

Question 13

76. Strawberry hemangiomas, which is true:
    a) Not present at birth
    b) Equal sex predilection
    c) Chew up platelets
    d) Begin to involute in 2nd decade
    - —————————
77. What is true of strawberry hemangiomas?
    a) Involution after the second decade of life
    b) They are usually not present at birth
    c) There is never an indication to treat

Answer 13

Not present at birth
Strawberry hemangioma = superficial hemangioma
- not present at birth, become apparent in first 2mo

Question 14

3. Baby with large congenital (melanocytic?) nevus on face. What is she at risk for?

Answer 14

?Large congenital pigmented nevi -> at risk for leptomeningeal involvement + malignant melanoma

Question 15

18. Term with forceps delivery, presented with jitteriness, has a red firm plaque on hand, what blood work is most likely to be found (likely talking about subcutaneous fat necrosis)
    a) Hypercalcemia

Answer 15

Hypercalcemia

Question 16

6. What is the best treatment for headlice if resistance is prevalent?
   a) Permethrin
   b) Resultz
   - —————————
7. What’s best to use in a resistant population for lice? [CPS]
   a) Resultz
   - —————————
8. Which one of the following treatments for head lice decreases the resistance of lice to treatment?
   a) Lindane
   b) Isopropyl alcohol/terpineol (?myristate)
   c) 1% permethrin
   d) 5% permethrin
   - —————————
9. Head lice - which one is least likely to increase resistance?
   a) Permethrin 1%
   b) R&C
   c) Lindane
   d) Resultz shampoo

Answer 16

Resultz shampoo (noninsectidal, no resistance)

Question 17

45. Which of the following head lice treatments most likely to have resistance:
    a) Permethrim
    b) Lindane
    c) Permethrim with something else added

Answer 17

Permethrin

Question 18

Which of the following head lice treatment is most likely to be INeffective? (Sick Kids review)

a) Permethrin 1%
b) Lindane 1% (gamma benzene hydrochloride)
c) Permethrin + piperonyl butoxide
d) 50% isoprophyl myrisate (IPM 50%; Resultz)

Answer 18

Lindane 1%

slow killing time, more resistance, neurotoxicity + BM suppression
Probable carcinogen therefore no longer considered acceptable therapy

Question 19

23. Child with lice. When can he go back to school?
    a) Now
    b) After 1 day of treatment
    c) After 1 week of treatment

Answer 19

Now

Question 20

14. Shows picture of kid with round hairless patch and NO scales and well demarcated. What’s the association?
    a) Autoimmune thyroiditis
    b) Fungal infection
    c) Anxiety disorder

Answer 20

Autoimmune thyroiditis

Alopecia arreata b/c no scale, even + well demarcated hairless
Autoimmune diseases:
- Hashimoto
- Addison's
- Pernicious anemia
- UC
- Myasthenia gravis
- Vitiligo
- T21

Question 21

24. Area of alopecia scaly and itchy. Treatment?
    a) PO terbinafine
    b) Fluconazole
    c) Topical terbinafine.

Answer 21

Alopecia WITH SCALE = tinea capitis

Treat with PO tebinafine x2-8wks

Question 22

31. Kid with crohn’s on sulfasalazine and has hairless patch with slight scale.
    a) Alopecia areata
    b) Trichotillomania
    - ————————
32. 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
    - ———————–
33. Kid with celiac disease and hypothyroidism. Develops a new bald spot. Likely etiology?
    a) Tinea capitis
    b) Alopecia areata

Answer 22

Alopecia areata
Autoimmune. Round patch of smooth hair loss with distinct border.
shouldn’t have scale though

Question 23

54. 13 year old girl had scoliosis surgery 2 months ago. She now presents with significant amount of hair loss. On exam she has diffuse hair loss with no underlying inflammation. What is the likely cause?
    a) Tricotillomania
    b) Tinea capitis
    c) Telogen effluviam
    d) Alopeica areata

Answer 23

Telogen effluviam

• occurs 1.5-3mo after precipitating cause (child birth, surgery, febrile episode)
• premature conversion of growth hairs (anagen) to resting hairs (telogen)
• no inflammation
• hair follicles intact
• not itchy
• Normal hair regrows in 3-6mo

Question 24

81. A young boy has three circular patches of complete hair loss on his head. It is slightly itchy. 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

Answer 24

Alopecia areata

Question 25

16. Kid with 10 tanned macules more varying from 5 to 15mm and normal physical examination. (No mention of family history). What would you do next to confirm the diagnosis? a) MRI head b) Ophthalmology c) Echocardiogram

Answer 25

Opthalmology | Lisch nodules and optic gliomas

Question 26

21. 12 year old girl with a history of hypopigmented flat scars following mild trauma, as well as spontaneous vesicular lesions when exposed to sun. Which medication would this most likely be a side effect of: a) Prednisone b) Naproxen c) Lisinopril d) Methotrexate - -------------- 26. Child with hypopigmented flat scars and vesicles post sun exposure. What is the agent? a) Methotrexate b) Naproxen - --------------- 27. Drug-induced photosensitivity caused by which drug (same options as old exam!) a) Naproxen b) Prednisone c) Methotrexate - --------------- 51. Patient with hypopigmented macules with sun exposure. What caused them? a) NSAID b) Prednisone c) Acetaminophen Features Cause Tx

Answer 26

NaprOXen O = sun X = no! Pseudoporphyria - features of porphyria but normal porphyrin metabolism - 10% of JIA pts taking naproxen - bullous photodermatosis - heal with scarring + milia - skin fragile + easy bruising after minor trauma Causes 1. UV radiation + tanning beds 2. Meds: NSAIDS - naproxen most common 3. Chronic renal failure + HD Tx - Stop offending agent - photoprotection - gradual improvement - - can continue for months after drug stopped

Question 27

55. 12 y.o. girl with a history of hypopigmented flat scars following mild trauma, as well as spontaneous vesicular lesions when exposed to sun. Which medication would this most likely be a side effect of: a) Prednisone b) Naproxen c) Lisinopril d) Methotrexate - ------------------ 56. Girl that gets vesicles with sun exposure and hypopigmented flat scars with mild trauma a) Prednisone b) Naproxen c) Methotrexate d) Linolid Features Cause Tx

Answer 27

Pseudoporphyria - normal porphyria metabolism - 10% of pts of JIA on naproxen - can occur months - bullous photodermatitis - heals with scarring + milia - fragile skin + easy bruising with mild trauma Causes 1. UV radiation + tanning beds 2. Drugs: NSAIDS - naproxen most common 3. CRF + HD Tx - stop the agent - avoid sun - gradual improvement

Question 28

52. Patient with red rash and +ve Nikolsky sign. Lip and eye changes. Diagnosis? a) Strep toxic shock b) TEN - -------------------- 53. Picture of an infant with a diffuse erythematous rash with mucous membrane involvement. Looks unwell. Patient was recently treated with amoxicillin. Blistering seen distally with positive Nikolsky sign on areas of blistering. What is the likely diagnosis? a) Staph scalded skin b) TEN c) Toxic shock syndrome - -------------------- 74. Child presents with rash, blisters at extremities (picture provided: full body, looks like lips are involved, has a foley in situ). Initially had viral prodrome, then had amoxicillin for 7 days, after which the rash started. a) TEN b) Staph scalded skin syndrome c) Dermatitis herpeticum d) Erythema multiforme - -------------------- 75. A 12-year old boy presents with a history of a URTI, treated with Amoxil for 7 days. Then develops a rash (which had bullae on his limbs), with a positive Nikolsky sign. (picture provided. a. SSSS b. TEN

Answer 28

TEN

Question 29

34. Kerion treatment a) Lamisil po b) Lamisil topical c) PO keflex - ----------------------- 46. Child with large, boggy mass on head with small amount of purulent drainage. Scaly edges (pic given – looks like Kerion). Best treatment: a) Oral prednisone b) Oral terbinafine c) Topical terbinafine d) Oral Keflex

Answer 29

Oral Lamisil/terbinafine x 8-12wk (stop when fungal Cx negative) kerion = elevated, boggy granulomatous masses due to severe inflammatory response

Question 30

35. Illustration of tinea capitus. Treatment? a) Oral lamisil (terbinafine) b) Topical Lamisil c) PO steroids d) PO cephalexin - --------------------- 47. Kid with a picture like that shown below. What do you treat it with? a) Topical ketoconazole b) Oral Lamisil c) PO cephalexin d) PO corticosteroids. - ---------------------- 70. Treatment of tinea capitis? a) PO lamisil b) Topical fluconazole c) Topical steroids - ----------------------- 78. What is the treatment for Tinea capitis? a) Topical steroids b) Topical antifungal c) Oral Lamisil

Answer 30

Oral lamisil/terbinafine

Question 31

38. Child sucks on finger. Lesions on finger for 10 days. Finger hurts when mom touches it. Picture of a finger with vesicles and erythema (herpetic whitlow). What is your management? a) PO cephalexin b) Incision and drainage c) PO acyclovir d) Flamazine dressing - ----------------------- 39. Picture of herpetic whitlow x 10 days. Painful, swollen with erythema and ulcerated. Treatment? a) Cephalexin po b) Flamazine dressing c) PO acyclovir x 2 weeks - --------------------- 40. Picture similar to that given. What is the best tx? a) PO acyclovir b) Topical mupirocin c) Flamazine dressings d) Oral corticosteroids - --------------------- 79. Herpetic whitlow picture. What is the correct therapy? a) PO Keflex b) PO acyclovir c) Flamazine dressing

Answer 31

PO acyclovir x ~10d | Treat to prevent ecezma herpeticus

Question 32

8. 2yo presents with abscess on buttocks, brother had same disease recently. There is no surrounding erythema and he is otherwise well. a) I and D b) Start clinda c) Start septra and I and D d) IV vanco

Answer 32

I+D CPS MRSA Uncomplicated skin abscesses in prev well children can be managed with drainage alone unless 1) <3mo 2) assoc'd cellulitis 3) Fever or other systemic signs of illness MRSA abscess mgmt - Always do I+D and cultures - 0-1mo: IV vanco -> amox clav - 1-3mo: TMP-SMX even if well - >3mo: if well -> I+D + wait for Cx. If unwell, signs of cellulitis, systemic illness -> I+D, start TMP-SMX + keflex

Question 33

10. Kid with bright red perianal rash a) Candida perianal b) strep perianal infection c) contact dermatitis d) Sexual abuse

Answer 33

Strep perianal - well demarcated perianal erythema. May involve vulva + vagina. - anal pruritus, painful defecation, blood-streaked stools - Unusual to have systemic Sx + fever

Question 34

9. Picture of erythema multiforme on arm and has ulcers in her mouth - what would the cause be? a) Mycoplasma b) NSAIDs

Answer 34

Mycoplasma Mycoplasma Induced Rash + Mucositis

Question 35

13. Girl with 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) Psoriasis

Answer 35

Pityriasis rosea | b/c acute and distribution of trunk + back

Question 36

40. 15 year old with concern regarding hypopigmented area with smooth border around a previous melanocytic nevus. Nonpainful, nonpruritic, no bleeding, not expanding. No change in colour of original nevus. Mother is quite worried. You 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 - -------------------- 41. Description of a halo nevi. What do you tell mom? a) No risk of malignancy – b) Increased risk of malignancy - ------------------- 42. Picture - hypopigmented area surrounding a hyperpigmented center. What do you tell the parents? a) This will spread to all over her trunk b) Spontaneous resolution c) 1% chance of progression to melanoma d) Will become a neurofibroma

Answer 36

Lesion will disappear Halo nevi - commonly on back - puberty or pregnancy - pigmented nevi develop pale halos - disappear over months, repigments - only excise if worried about central lesion

Question 37

80. An 8 month old child is brought in with several small brownish nodules on his back and extremities. The parents have observed that when they touch the nodule, wheals develop around it, it it transiently becomes erythematous and their child starts to scratch it. What is the diagnosis? a) Mastocytosis b) Neurofibromatosis c) Benign congenital nevi

Answer 37

Mastocytosis 1. Solitary mastocytoma - wheals or bullae - thick, pink/yellow skin, orange peel - pruritic Darier sign: stroke lesion to produce urticaria - No Tx or topical steroids for blisters 2. Urticaria pigmentosa - 0-2yo - same as mastocytoma - lesions can become hyperpigmented - Tx: avoid triggers (hot baths, rubbing skins, drugs, stress) 3. Systemic mastocytosis - increase in mast cells in other tissues 4. Diffuse cutaneous mastocytosis - develops after 1mo - same as mastocytoma - Tx: may need phototherapy Tx - Oral antihistamines - H1 receptor antagonist first line (hydroxyzine) - H2 RA if pruritus or gastric hypersecretion