Derm Case Based Questions

Question 1

A 30 y/o female patient arrives to your clinic with patches of brown hyperpigmentation on the face.

What is the diagnosis and treatment?

Answer 1

1. Melasma or Chloasma
2. Hydroquinone 4% cream

Question 2

A 50 y/o male patient comes to clinic with velvety lesions on the neck.

What is the diagnosis and treatment?

Answer 2

1. acanthosis nigricans
2. control of blood sugar

Question 3

An 80 y/o patient comes to clinic with round, brown, well-demarcated, velvety lesions.

What other qualities might the lesion have? what is the diagnosis?

Answer 3

1. greasy or stuck on appearance, scaly, (+/-) pruritis, pain, bleeding
2. Seborrheic Keratosis

Question 4

How would you classify a lesion that is:
* 6 mm
* well-demarcated
* unusual shape
* has irregular colors within the lesion
* is flat

Answer 4

as an atypical nevi

Question 5

A patient comes to your clinic with a solitary, blue, smooth macule on their thorax.

What is the diagnosis and treatment?

Answer 5

1. Blue nevus
2. observation

Question 6

a 25 y/o patient who frequently uses tanning beds comes to clinic with a nevus that has recently changed in size and color. It has recently started to bleed and crust.

What is the diagnosis and treatment?

Answer 6

1. melanoma
2. excision, +/- lymph biospy

Question 7

A 32 y/o male comes to clinic with pink, raised papules that appear to have rolled borders and a central depression.

What other characteristics might this lesion have? Diagnosis? Treatment?

Answer 7

1. overlying telangectasia, translucent/waxy/pearly
2. Nodular Basal Cell Carcinoma
3. MOHS/Excision

Question 8

A 19 y/o male comes to clinic with a scaly, eczema-like patch that has a white, rolled border.

What is the diagnosis and treatment?

Answer 8

1. Superficial BCC
2. Imiquimod 5% or -FU, radiation

Question 9

A 19 y/o female presents to clinic with a tan, flattened, rough papule.

What is the diagnosis and treatment?

Answer 9

1. actinic keratinosis
2. cryotherapy or imiquimod/5-FU

Question 10

A 50 y/o female presents to clinic with a circumscribed pink patch that is scaly. A biopsy shows that the atypica is limited to the epidermis.

What is the diagnosis and treatment?

Answer 10

1. SCC in situ
2. Cryotherapy follwed by 5-FU or imiquimod

Question 11

A 60 y/o female pateint presents to the clinic with a red, friable, pruritic, plaque. It is tender to touch.

What is the diagnosis and treatment?

Answer 11

1. Squamous Cell Carcinoma
2. surgical excision + MOHS

Question 12

A 7 y/o patient presents to clinic with wheals that are surrounded by an erythematous halo. Their chief complaint is that the lesions itch.

What is the diagnosis and treatment?

Answer 12

1. urticaria
2. 1st gen antihistamine

Question 13

A 50 y/o patient presents to clinic with swelling of the face that is painful. After taking her history, you learn she takes ACE inhibitors. She denies pruritis.

What is the diagnosis and treatment?

Answer 13

1. Angioedema
2. IV or oral glucocorticoids, 1st gen antihistamines

Question 14

A 70 y/o male presents to the clinic after erythematous, pruritic macules on the face developed into flaccid blisters which are easily breaking.

What other characteristics? Diagnosis? Treatment?

Answer 14

1. painful lesions (necrosis), mucosal membrane involvement, pos Nikolsky sign
2. Steven’s Johnson Syndrome
3. Stop offending med, IV IgG, corticosteroids, enteracept, cyclosporine

Question 15

A 25 y/o patient presents with a central bulla, with a dark red inflammatory zone, followed by a pale ring of edema, and a red halo on the periphery. They have a negative Nikolsky sign.

What are the lesions? what is the dx? what is the tx?

Answer 15

1. target lesions
2. Erythema multiforme
3. stop offending irrtant, systemic corticosteroids

Question 16

A 5 y/o girl reports to the ER after reporting being bitten by a spider. She had burning where she was bitten and the bite become red. She also has fever, nausea, and vomiting.

What bit her? What will the bite progress to? Treatment?

Answer 16

1. Brown Recluse Spider
2. erythema at bite site becomes blanched bite with red halo, followed by hemorrhagic bulla that undergoes eschar formation
3. wound care, tetanus vax PRN, NSAIDs, debridement is necrotic

Question 17

a 10 y/o boy presents to clinic with muscle pain and spams in his legs and back. He was bitten by a spider that had an hourglass on its belly.

What is the spider? what does the bite look like? what is the tx?

Answer 17

1. Black Widow Spider Bite
2. blanched, circular patch w/ erythematous perimeter and central punctum
3. wound control, tetanus vax PRN, NSAIDs, benzos for muscle spasms
4. Anti-venom is reserved for refractory sx

Question 18

A 50 y/o patient presents to clinic with a spreading, erythametous, purulent, tender plaque on their leg.

What is the diagnosis and treatment?

Answer 18

1. purulent cellulitis
2. clindamycin, TMP/SMX, or doxy + amox

Question 19

A 70 y/o patient presents to clinic with bright red, plaque-like edema that is well-demarcated. They have a fever, chills, and a headache.

What is the diagnosis and treatment?

Answer 19

1. Erysipelas
2. Empiric Abx: PCN V, amox, clinda, azithro

Question 20

A 25 y/o male presents to clinic with red streaks that are extending from an erythematous, tender plaque. They also have a fever and chills.

Dx of the plaque? Dx of the streaks? Oral tx of the streaks?

Answer 20

1. cellulitis
2. lymphangitis
3. cephalexin, dicloxacillin

Question 21

A 55 y/o female presents to clinic with well-demarcated erythematous patches that have overlying silver scales.

What 2 tell tale signs are associated with this? Dx? Tx?

Answer 21

1. Koebner Phenomenon, Auspitz Sign
2. Plaque Poriasis
3. Topical steroids, calcipotreien. tazarotene, or coal tar

Question 22

a 35 y/o female presents with erythematous patches covered with yellow greasy scales on the scalp.

What is the diagnosis and treatment?

Answer 22

1. Seborrheic Dermatitis
2. Ketoconazole or Ciclopirox, topical steroid if inflammation is present

Question 23

a 35 y/o female presents with erythematous patches covered with yellow greasy scales on the face.

What is the diagnosis and treatment? Tx for severe or refractory?

Answer 23

1. Seborrheic Dermatitis
2. topical antifungals, hydrocortisone
3. Antifungals PO

Question 24

A 16 y/o male presents to clinic with an erythematous plaque that is scaling in a christmas tree pattern.

What is the diagnosis and treatment? what was the initial lesion most li

Answer 24

1. Pityriasis Rosea
2. Self limiting, triamcinolone if needed
3. Herald patch- small, salmon colored lesion on the trunk

Question 25

A 35 y/o female patient comes to clinic complaining of erythematous satellite macules surrounding the skin folds. | What is the dx and tx? what is likely the most dominant sx?

Answer 25

1. Intertrigo 2. Topical Antifungal (imidoles) 3. Topical anti-inflammatory (desonide or hydrocortisone) 4. burns more than itches

Question 26

A 30 y/o patient presents to clinic complaining of scaly, patchy, hair loss and associated erythema and pruritis on the scalp. | What is the diagnosis and treatment? what is the most likely pathogen?

Answer 26

1. Tinea Capitis 2. Griseofulvin PO + anti-fungal shampoo 3. *T. tonsurans* or *M. canis*

Question 27

A 10 y/o male presents to clinic complaining of pruritic, erythematous, scaly patches on their chest which have central clearing. | What is the diagnosis and treatment? what is the most likely pathogen?

Answer 27

1. Tinea Corporis 2. Topical antifungal (imidole or allyamine) 3. *T. rubrum* or *Microsporum* spp

Question 28

A 42 y/o patient presents to clinic with an erythematous, scaly, patch on her hand. It has started to peel and it is slightly pruritic. | What is the diagnosis and treatment? what is the most likely pathogen?

Answer 28

1. Tinea manuum 2. Topical anti-fungal 3. *Trichophyton* spp

Question 29

A 28 y/o male presents to clinic complaining of annular, pruritic, hyperpigments patches near his groin. They are diffusely erythematic. He does not have any on his scrotum. | What is the diagnosis and treatment? what is the most likely pathogen?

Answer 29

1. Tinea cruris 2. *T. rubrum* 3. Topical antifungal (clotrimazole)

Question 30

A 22 y/o male presents to clinic with scaling and redness between his toes. | What do you use to diagnose? What is the dx? What is the tx? pathogen?

Answer 30

1. KOH prep 2. Tinea Pedis 3. topical antifungal (allyamines) 4. *T. rubrum*

Question 31

A 36 y/o female presents to clinic with well-demarcated, hyperpigmented macules on her trunk and arms. There is no visible scale, but one appears when the lesion is rubbed. | What is the diagnosis and treatment? what is the most likely pathogen?

Answer 31

1. Tinea Versicolor 2. Ketoconazole cream/ fluconazle PO 3. *Malassezia furfur*

Question 32

A 40 y/o male comes to clinic complaining of recent hair loss. He has noticed it on his frontal hair line, and temples. | What is the diagnosis and treatment?

Answer 32

1. Cicatrical baldness / androgenetic alopecia 2. Minoxidil foam or finasteride/dutasteride PO

Question 33

A 26 y/o female patient comes to clinic complaining of hair loss at the root. There is no associated pruritis, erythema, and she is not pulling it out. | What is the diagnosis and treatment? What labs should you order?

Answer 33

1. Telogen Effluvium 2. Reassurance. No tx 3. TSH, T4, CBC, iron studies, vit D, RPR

Question 34

A 30 y/o male patient comes to clinic complaining of patchy hair loss. There is no assosciated erythema or pruritis. | What is the diagnosis and treatment? How will new hair look?

Answer 34

1. Alopecia areata 2. Intralesional triamcinolone, topical potent corticosteroids, topical minoxidil 3. white, thin

Question 35

An 18 y/o female patient is reported to clinic with hair loss. There is no associated scale or inflammation. Her regrowth is of varing lengths and there are black dots on the scalp indicating short hairs are present. | What is the diagnosis and treatment? How is her hair loss occuring?

Answer 35

1. Trichotillomania 2. Screen for mood disorders, treat for underlying cause. 3. Hair pulling/tugging.

Question 36

A 60 y/o patient reports to clinic with red, flat papules that blanch with pressure. They are friable upon contact/trauma. | What is the diagnosis and treatment?

Answer 36

1. Cherry Angioma 2. observation

Question 37

A 57 y/o female patient presents to clinic with a pruritic, glistening, friable, erythematous, papule. | What is the diagnosis and treatment?

Answer 37

1. pyogenic granuloma 2. biopsy & excision

Question 38

A 45 y/o male patient presents to clinic with non-pruritic, painless, red papules on his lower extermities. | What is the diagnosis and treatment?

Answer 38

1. Kaposi Sarcoma 2. Refer to oncology (chemotherapy/rad); ART therapy initiation

Question 39

A 79 y/o female presents to clinic with erythematous hyperpigmented patches with scaling and crusting. What is the diagnosis and treatment? What will you find in the lower extermity upon PE?

Answer 39

1. Stasis Dermatitis 2. topical corticosteroids; oral prednisone 3. edema, increased leg circumference, variscosities

Question 40

A 79 y/o patient is reporting to clinic with a superficial non-blanchable erythematous macule on their calcaneus. | What is the diagnosis and treatment? How does this advance?

Answer 40

1. Stage 1 Decubitis Ulcer 2. wound protection, preventive measures 3. Stage 2: extends into dermis (bulla/abraision) ; Stage 3: full thickness damage, but extend to SubQ ; Stage 4: through fascia into muscle, bone, tendon

Question 41

A 28 y/o male patient came to clinic with small pustules that are rapidly forming into an ulcer with purple border. He describes them as extremely painful. | What is the diagnosis and treatment?

Answer 41

1. Pyoderma Gangrenosum 2. Topical (stuper potent steroids, tacrolimus); systemic (steroids, cyclosporine, tacrolimus, cellcept, thalidomide, TNF-Inhibitors)

Question 42

A 37 y/o female patient recently began taking Allopurinol. Today, she is at clinic with an erythematous rash that is coalescing on the trunk into plaques. | What is the diagnosis and treatment?

Answer 42

1. Drug Eruption- Type 4 2. Oral anti-histamines, could do short course corticosteroids PO

Question 43

A patient is calling your clinic to determine if they need to go to the ER. They are complaining of hypopigmentation of their skin. It looks to be milky white. They do not describe any associated pruritis, but it has grown. | Should they go to the ER? What is the diagnosis and treatment?

Answer 43

1. No 2. Vitiligo 3. could try high potentcy corticosteroids

Question 44

A 15 y/o male patient is at clinic complaining of vesicles on an erythematous base on their lips. | What is the diagnosis and treatment?

Answer 44

1. HSV-1 2. Valacyclovir PO

Question 45

A 19 y/o female patient is reporting to clinic complaining painful, ulcers, on an erythematous base near her genitals. | How might these lesions have started? What is the dx and tx?

Answer 45

1. as multiple, shallow, tender, grouped vesicles 2. HSV-2 3. Valacyclovir, acyclovir, or famciclovir

Question 46

A 60 y/o male is presenting to clinic today complaining of a rash on his left forearm. It began with sensory loss in the region but rapidly became grouped vesicles that are painful. It has not spread anywhere else since it began 4 days ago. | What is the diagnosis and treatment? How to prevent adverse sx?

Answer 46

1. Herpes Zoster 2. Valacyclovir must be prescribed within 72 hrs of onset. Manage symptomatic pain. 3. Shingrix vax to prevent post-herpetic neuralgia

Question 47

A patient comes to clinic with atopic dermatitis. Which other conditions do they likely have?

Answer 47

1. eczema 2. allergic rhinits 3. asthma

Question 48

A 20 y/o female patient comes to clinic complaining of an erythematous, scaly, pruritic papule in her axilla. | What is the diagnosis and treatment? What other sx does she likely have?

Answer 48

1. Atopic Dermatitis 2. topical corticosteroids, emollients, anti-histamines 3. xerosis | if severe: tx is dupliumab

Question 50

A 25 y/o male patient comes to clinic with an erythematous papular rash that has intense local pruritis and burning. The rash has a linear distribution around his watch band. | What is the diagnosis and treatment?

Answer 50

1. contact dermatitis 2. topical corticosteroids + general measures (10d prednisore taper if severe)

Question 51

A 22 y/o male patient presents to clinic with a recurrent, pruritic, vesicular rash on his palms. | What is the diagnosis and treatment?

Answer 51

1. Dyshidrotic eczema (pompholyx) 2. mild/mod: topical corticosteroids 3. severe: corticosteroids PO, potent topical

Question 52

A 5 y/o female patient presents to clinic complaining that a previously papular rash has devloped into a honey colored crust around her lips. | What is the diagnosis and treatment? what is the likely pathogen?

Answer 52

1. non-bullous impetigo 2. Mupirocin 3. *S. aureus* or *Staph*

Question 53

A 2 y/o male patient presents to clinic complaining of a rash where vesicles are forming large bulla which are rapidly rupturing. After rupture, they are forming a thin crust. | What is the diagnosis and treatment for a severe pt? what is the pathoge

Answer 53

1. bullous impetigo 2. cephalexin or dicloxacillin 3. *S. aureus*

Question 54

A 16 y/o patient presents to clinic with acne. She has open and closed comedones with some erythema. There is no associated pain or inflammation. | How would you classify her acne? Should she begin isotretinoin?

Answer 54

1. mild mixed or moderate? 2. No- only do isotretinoin for severe acne.

Question 55

A 45 y/o patient reports to clinic complaining of an erythematous macular rash with telangiectasia on their face. There are some pustules, but no comedones. | What is the diagnosis and treatment? What other 2 sx may they have?

Answer 55

1. Rosacea 2. topical metronidazole, ivermectin, or sulfacetamide 3. Rhinophyma or ocular sx

Question 56

A 63 y/o patient reports to clinic with small, white, painless papules on their forehead. They would like these extracted for cosmetic reasons. | What is the diagnosis and treatment? How to extract?

Answer 56

1. Milia 2. observation 3. cryotherapy or manual extraction

Question 57

A 16 y/o male is reporting to clinic with clusters of erythematous papules on his chin. He does typcially grow a beard on his chin, but shaved it due to the irritation. | What is the diagnosis and treatment?

Answer 57

1. Folliculitis 2. topical mupirocin, clindamyin w/ benzyl peroxide, or erythromycin 3. if severe, cephalexin or dicloxacillin

Question 58

A 42 y/o female patient reports to clinic complaining of erythematous papues which have coalesced into plaques with scales. The lesions are surrounding her lips. | What is the diagnosis and treatment? What is spared by the lesions?

Answer 58

1. Perioral Dermatits 2. Topical pimecrolimus, metronidazole, or erythromycin (PO tetracyclines if severe) 3. Vermillion border is spared

Question 59

A 32 y/o male patient is reporting to clinic with erosions that have devloped into painful, flaccid bulla that rupture easily. 1. Where was their first lesion? 2. What will be positive? 3. What testing to order? 4. What is the dx? 5. What is the tx?

Answer 59

1. intra-orally 2. Pos Nikolsky sign 3. punch biopsy (IgG throughout epidermis, basal keratinocytes in tombone rows) or ELISA anti-desmoglein or anti-epithelail 4. Pemphigus Vulgaris 5. systemic glucocorticoids, wound care (can add rituximab, azathioprine, mycophenolate)

Question 60

An 86 y/o male patient presents to clinic complaining of a pruritic, eczematous plaque that developed into multiple large bulla that are not rupturing. 1. what will be negative? 2. what tests to do? 3. what is the dx? 4. what is the tx?

Answer 60

1. Nikolsy sign negative 2. punch biopsy (linear C3, IgG along dermal-epidermal junction, sub-epidermal blistering, eosinophilia) or ELISA (BP antigen 230 or 180) 3. Bullous Pemphigoid 4. Localized : high potentcy corticosteroids + doxy ; Severe: systemic corticosteroids

Question 61

A 23 y/o female patient presents to clinic with chronic blistering in sun exposed areas. There is scarring after the blisters heal. | What is the diagnosis and treatment? what is she likely prescribed?

Answer 61

1. Porphyria Cutanea Tarda 2. tx of the underlying cause (liver disease, tobacco use, estrogen use) 3. OCPs

Question 62

A patient presents to the clinic with frim, hyperkeratotic papules that have brown punctuations. | What is the dx and tx? What should you never do? pathognomic sx?

Answer 62

1. Verruca Vulgaris 2. warts are self limiting, OTC salicylic acid PRN 3. biopsy 4. thrombosed capillaries

Question 63

a 62 y/o patient is reporting to clinic with erythematous, large, painless, soft, cauliflower like lesions on the anogenital mucosa. | What is the diagnosis and treatment? caused by what virus?

Answer 63

1. Condyloma ccuminata 2. imiquimod, podophyllotoxin; cryotherapy PRN 3. HPV

Question 64

A 7 y/o female patient presents to clinic with small, pink, dome shaped papules that have central umbilication. | What virus causes? where on body are they? Dx and Tx?

Answer 64

1. Poxviridae 2. areas of high friction 3. Molluscum Contagiosum 4. if asx, observe. If not asx, curettage

Question 65

An 88 y/o patient recently recovered from COVID and was in the ICU. His daughter called the clinic to ask about transverse depressions in all of his nails. Should he report back to the ER for this? | What is the diagnosis?

Answer 65

1. No 2. Beau lines

Question 66

A 39 y/o patient reports to clinic complaining of subungual hyperkeratosis and scaling under the nail. They also report having pitting and brittle nails. | What is the diagnosis and treatment? most likely pathogens?

Answer 66

1. onychomycosis 2. terbinaifne PO 3. *T. rubrum* or *T. interdigitale* or *C. albicans*

Question 67

A 26 y/o female is reporting to clinic complaining of erythema, swelling, and pain around her nail bed. She does endorse nail biting. | What is the dx and tx for moderate disease? Tx for non-nail biters?

Answer 67

1. paronychia 2. augmentin (nail biting) 3. cephalexin or dicloxacillin

Question 68

A 46 y/o male patient presents to clinic complaining of a severe, throbbing pain on the pad of the fingertip. They endorse recently having skin trauma to the area. | What is the diagnosis and treatment?

Answer 68

1. felon 2. w/out fluctuance: elecation, water/saline soaks, cephalexin PO 3. w/ fluctuance: I & D

Question 69

A 65 y/o female patient is reporting to clinic worried about a soft, painless, mobile lump she found on her arm. Should she have this biopsied? If no, when would she? Diagnosis?

Answer 69

1. No 2. Biopsy with pain, if it rapidly grows, becomes firm, or restricts movement 3. Lipoma

Question 70

A 43 y/o male patient comes to clinic complaining that his skin colored, mobile lump that had a central punctum is not painful, erythematous, and foul smelling. What did he have? What is it now? What is treatment now?

Answer 70

1. Epidermal Inclusion Cyst 2. ruptured, infected cyst 3. I & D

Question 71

A 62 y/o male patient reports to clinic with an erythematous, tender, indurated nodule. A culture of the purulent discharge shows *S. aureus*. | What is the diagnosis and treatment? what could this develop into?

Answer 71

1. Furuncle/Carbuncle 2. I & D with TMP-SMZ, doxy, or clinda 3. cellulitis

Question 72

A 30 y/o female patient presents to the clinic with painful, deep-seated, inflammatory nodules in the intertriginous skin. There are no sinus tracks or scarring. | What is the diagnosis and treatment?

Answer 72

1. Hidradenitis Suppurativa 2. Lesions only, so topical clindamycin with lifestyle modifications

Question 73

A 55 y/o male, incarcerated patient presents to clinic complaining of multiple, small papules with linear burrows. He endorses pruritis. | What is the diagnosis and treatment? What may be seen on his genitals?

Answer 73

1. Scabies 2. Permetherin 3. red, itchy wheals or nodules

Question 74

A 12 y/o male reports an itchy scalp. You look at his hair and can see many white fragments near the hair shafts. | What is the diagnosis and treatment?

Answer 74

1. Pediculosis (lice) 2. Permetherin, fine tooth comb to remove nits

Question 75

A 55 y/o male patient presents to clinic with a purple, planar, pruritic, papular rash that has started scaling. | What is the diagnosis and treatment? What will the borders look like?

Answer 75

1. Lichen Planus 2. High potentcy topical corticosteroids, anti-histamines PO 3. wickham's striae (fine, gray-white lines on the skin)

Question 76

A 34 y/o patient presents to clinic with scaly, well-demarcated, rough, kyperkeratotic plaques. They report frequently scratching this area of their skin. | What is the diagnosis and treatment?

Answer 76

1. Lichen Simplex chronicus 2. high potency topical corticosteroid, antihistamine

Question 77

A 28 y/o female presents to clinic with diffuse excoriations and lichenification. She reports that she has a tendency to scratch at the skin sometimes. | What is the diagnosis and treatment? what else needs to be addressed?

Answer 77

1. neurodermatitis 2. antihistamines, topical corticosteroids, wound care 3. treat underlying mood disorder.