Question 1

Bullous pemphigoid, Pemphigus vulgaris
1. Gold standard for diagnosis
2. Treatment

Accepted Answer

1. biopsy
2. systemic glucocorticoid (prednisone)

Question 2

1. Adult presenting with nonhealing blisters on the backs of the hands and the face. Sun seems to make it worse.
2. Diagnosis
3.  What key findings are likely to be in the patients history?
4. Treatment

Accepted Answer

1. porphyria cutanea tarda
2. urinary uroporphyrins
3. HIV, alcoholism, chronic hep C, oral contraceptive use
4. stop drinking alcohol and d/c estrogens

Question 3

Age difference of pemphigus vulgaris vs bullous pemphigoid?

Accepted Answer

1. PV = 30s and 40s
2. BP = 70s and 80s

Question 4

1. intercellular deposits of IgG in the epidermis
2. antibodies at the dermo-epidermal junction

Accepted Answer

1. pemphigus vulgaris
2. bullous pemphigoid

Question 5

Pressure on the skin resulting in localized urticaria

Accepted Answer

dermatographism

Question 6

1. Patient with a rash after starting penicillin. 
2. What is the pathophysiology?
3. Treatment

Accepted Answer

1. urticaria 
2. mediated by IgE and mast cell activation
3. H1 antihistamines

Question 7

1. Patient has small, target-like lesions on palms and soles
2. Usually caused by what virus?
3. Treatment

2. What

Accepted Answer

1. Erythema multiforme
2. herpes simplex
3. antihistamines and treat underlying infection

Question 8

Which drugs are known to cause hypersensitivity skin disorders?

Accepted Answer

1. NSAIDs
2. penicillins
3. sulfa drugs
4. phenytoin
5. phenobarbital

Question 9

What is the difference between Stevens-Johnson syndrome and Toxic epidermal necrolysis?

Accepted Answer

SJS involves <10 to 15% of the total body surface area while TEN may involve 30-100%

Question 10

Multiple painful, red, raised nodules on the anterior surface of the lower extremities.

Accepted Answer

Erythema nodosum

Question 11

How are fungal skin infections confirmed?

Accepted Answer

by scraping fungal material onto a slide and dissolving other material with KOH

Question 12

Treatment for:
1. Tinea capitis
2. Onychomycosis
3. Tinea versicolor

Accepted Answer

1. PO terbinafine or itraconazole
2. PO terbinafine or itraconazole
3. topical seleneum sulfide and ketoconazole shampoo

Question 13

Adverse reaction for oral:
1. terbinafine
2. ketoconazole

Accepted Answer

1. hepatotoxicity
2. gynecomastia, hepatotoxicity

Question 14

1. Child with crusty,rash oozing material. 
2. Why do you see this presentation on the skin?
3. Treatment

Accepted Answer

1. impetigo
2. it is superficial, limited to the epidermis, and purulent material easily escapes through the surface
3. mupirocin

Question 15

1. Man with bright red rash on face, fever. 
2. Treatment

Accepted Answer

1. erysipelas
2. cephalexin, dicloxacillin and attempt blood culture

Question 16

Patient presents with redness, swelling, warmth and tenderness under the skin of her leg.

Accepted Answer

cellulitis

Question 17

Treatment of cellulitis

Accepted Answer

1. po cephalexin, dicloxacillin
2. if fever, hypotension or signs of sepsis then iv oxacillin, nafcillin or cefazolin
3. also attempt blood culture

Question 18

Treatment of necrotizing fasciitis

Accepted Answer

1. ampicillin/sulbactam (unasyn) or piperacillin/tazobactam (zosyn)
2. clindmycin and penicillin if definitely streptococcus
3. ultimately surgical debridement is necessary

Question 19

Patient presents with crepitus, pain, high fever and an entry wound. What is the next step in management?

Accepted Answer

surgical debridement

Question 20

1. Multiple, painful vesicles on the genitals
2. Initial treatment
3. Treatment of resistant strain

Accepted Answer

1. herpes simplex
2. oral valcyclovir
3. foscarnet

Question 21

1. Vesicles in a dermatomal distribution on an erythematous base.
2. Treatment

Accepted Answer

1. Herpes zoster
2. oral valcyclovir

Question 22

1. Patient presents with single, pailess, ulcerating lesions on the genitals
2. Confirmation
3. Treatment

Accepted Answer

1. chancre from primary syphilis
2. darkfield examination
3. single dose if intramuscular penicillin or doxycycline for those allergic

Question 23

1. What is the causative agent of lice and crabs?
2. Treatment?

Accepted Answer

1. P humanus and P pubis
2. permethrin and OTC pyrethrins

Question 24

1. Causative agent of lyme disease
2. Treatment

Accepted Answer

1. borrelia burgdorferi
2. oral doxycycline

Question 25

Which disorders may manifest with the Nikolsky sign (3)?

Accepted Answer

1. pemphigus vulgaris
2. staphylococcal scalded skin syndrome
3. toxic epidermal necrolysis

Question 26

Treatment for scalded skin syndrome?

Accepted Answer

1. managed in a burn unit
2. oxacillin or other antistaphylococcal antibiotics

Question 27

1. Purplish lesions on the skin of an HIV patient
2. What is the best treatment?

Accepted Answer

1. Kaposi sarcoma
2. raise the CD4+ count;

Question 28

1. Autoimmune disease in which antibodies attack the hair follicles and destroy hair production
2. Treatment

Accepted Answer

1. Alopecia areata
2. majority resolves spontaneously but immediate localized steroid injection may prevent loss

Question 29

Loss of hair in response to overwhelming physiologic stres

Accepted Answer

Telogen effluvium

Question 30

Where does the rash of secondary syphilis present?

Accepted Answer

palms and soles of the feet

Question 31

Treatment for:
1. mild acne
2. moderate acne
3. severe acne

Accepted Answer

1. topical antibiotics and benzoyl peroxide
2. benzoyl peroxide and retinoids
3. oral antibiotics, oral isotretinoin

Question 32

Treatment of toxic shock syndrome

Accepted Answer

1. fluid resuscitation
2. empiric treatment with clindamycin plus vancomycin

Question 33

1. Velvety hyperpigmentation on patient's axillary region.
2. Most common causes?

Accepted Answer

1. acanthosis nigricans
2. hyperinsulinism or GI malignancy

Question 34

1. Patient with generalized itching and  pruritic vesicles and pustules in the webs of the hands
2. Treatment

Accepted Answer

1. scabies
2. permethrin

Question 35

Patient with a large rash on the back, spares the palms and soles and one large spot is visible.

Accepted Answer

pityriasis rosea

Question 36

Patient with a large rash on the back and covers the palms and soles.

Accepted Answer

secondary syphilis

Question 37

Young patient with a very itchy rash.

Accepted Answer

atopic dermatitis

Question 38

Topical infection, scraped with KOH and looks like spagnetti and meatballs under microscope.

Accepted Answer

Tinea Versicolor

Dermatology

Internal Medicine

Question	Answer
Bullous pemphigoid, Pemphigus vulgaris 1. Gold standard for diagnosis 2. Treatment	1. biopsy 2. systemic glucocorticoid (prednisone)
1. Adult presenting with nonhealing blisters on the backs of the hands and the face. Sun seems to make it worse. 2. Diagnosis 3. What key findings are likely to be in the patients history? 4. Treatment	1. porphyria cutanea tarda 2. urinary uroporphyrins 3. HIV, alcoholism, chronic hep C, oral contraceptive use 4. stop drinking alcohol and d/c estrogens
Age difference of pemphigus vulgaris vs bullous pemphigoid?	1. PV = 30s and 40s 2. BP = 70s and 80s
1. intercellular deposits of IgG in the epidermis 2. antibodies at the dermo-epidermal junction	1. pemphigus vulgaris 2. bullous pemphigoid
Pressure on the skin resulting in localized urticaria	dermatographism
1. Patient with a rash after starting penicillin. 2. What is the pathophysiology? 3. Treatment	1. urticaria 2. mediated by IgE and mast cell activation 3. H1 antihistamines
1. Patient has small, target-like lesions on palms and soles 2. Usually caused by what virus? 3. Treatment 2. What	1. Erythema multiforme 2. herpes simplex 3. antihistamines and treat underlying infection
Which drugs are known to cause hypersensitivity skin disorders?	1. NSAIDs 2. penicillins 3. sulfa drugs 4. phenytoin 5. phenobarbital
What is the difference between Stevens-Johnson syndrome and Toxic epidermal necrolysis?	SJS involves <10 to 15% of the total body surface area while TEN may involve 30-100%
Multiple painful, red, raised nodules on the anterior surface of the lower extremities.	Erythema nodosum
How are fungal skin infections confirmed?	by scraping fungal material onto a slide and dissolving other material with KOH
Treatment for: 1. Tinea capitis 2. Onychomycosis 3. Tinea versicolor	1. PO terbinafine or itraconazole 2. PO terbinafine or itraconazole 3. topical seleneum sulfide and ketoconazole shampoo
Adverse reaction for oral: 1. terbinafine 2. ketoconazole	1. hepatotoxicity 2. gynecomastia, hepatotoxicity
1. Child with crusty,rash oozing material. 2. Why do you see this presentation on the skin? 3. Treatment	1. impetigo 2. it is superficial, limited to the epidermis, and purulent material easily escapes through the surface 3. mupirocin
1. Man with bright red rash on face, fever. 2. Treatment	1. erysipelas 2. cephalexin, dicloxacillin and attempt blood culture
Patient presents with redness, swelling, warmth and tenderness under the skin of her leg.	cellulitis
Treatment of cellulitis	1. po cephalexin, dicloxacillin 2. if fever, hypotension or signs of sepsis then iv oxacillin, nafcillin or cefazolin 3. also attempt blood culture
Treatment of necrotizing fasciitis	1. ampicillin/sulbactam (unasyn) or piperacillin/tazobactam (zosyn) 2. clindmycin and penicillin if definitely streptococcus 3. ultimately surgical debridement is necessary
Patient presents with crepitus, pain, high fever and an entry wound. What is the next step in management?	surgical debridement
1. Multiple, painful vesicles on the genitals 2. Initial treatment 3. Treatment of resistant strain	1. herpes simplex 2. oral valcyclovir 3. foscarnet
1. Vesicles in a dermatomal distribution on an erythematous base. 2. Treatment	1. Herpes zoster 2. oral valcyclovir
1. Patient presents with single, pailess, ulcerating lesions on the genitals 2. Confirmation 3. Treatment	1. chancre from primary syphilis 2. darkfield examination 3. single dose if intramuscular penicillin or doxycycline for those allergic
1. What is the causative agent of lice and crabs? 2. Treatment?	1. P humanus and P pubis 2. permethrin and OTC pyrethrins
1. Causative agent of lyme disease 2. Treatment	1. borrelia burgdorferi 2. oral doxycycline
Which disorders may manifest with the Nikolsky sign (3)?	1. pemphigus vulgaris 2. staphylococcal scalded skin syndrome 3. toxic epidermal necrolysis
Treatment for scalded skin syndrome?	1. managed in a burn unit 2. oxacillin or other antistaphylococcal antibiotics
1. Purplish lesions on the skin of an HIV patient 2. What is the best treatment?	1. Kaposi sarcoma 2. raise the CD4+ count;
1. Autoimmune disease in which antibodies attack the hair follicles and destroy hair production 2. Treatment	1. Alopecia areata 2. majority resolves spontaneously but immediate localized steroid injection may prevent loss
Loss of hair in response to overwhelming physiologic stres	Telogen effluvium
Where does the rash of secondary syphilis present?	palms and soles of the feet
Treatment for: 1. mild acne 2. moderate acne 3. severe acne	1. topical antibiotics and benzoyl peroxide 2. benzoyl peroxide and retinoids 3. oral antibiotics, oral isotretinoin
Treatment of toxic shock syndrome	1. fluid resuscitation 2. empiric treatment with clindamycin plus vancomycin
1. Velvety hyperpigmentation on patient's axillary region. 2. Most common causes?	1. acanthosis nigricans 2. hyperinsulinism or GI malignancy
1. Patient with generalized itching and pruritic vesicles and pustules in the webs of the hands 2. Treatment	1. scabies 2. permethrin
Patient with a large rash on the back, spares the palms and soles and one large spot is visible.	pityriasis rosea
Patient with a large rash on the back and covers the palms and soles.	secondary syphilis
Young patient with a very itchy rash.	atopic dermatitis
Topical infection, scraped with KOH and looks like spagnetti and meatballs under microscope.	Tinea Versicolor

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