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Clin Med Dermatology- Diagnosis by Presentation

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1.

2 year old presents with diffuse red skin


with scaling with some blistering. It is
determined that causative agent is Staph.

Staphylococcal
Scalded Skin
Syndrome

2.

3 year old girls presents with honey


colored crusts around mouth. When
scraped, the crust is removed and leaves
denuded area.

Impetigo

3 year old presented with bright red, soft


spot on cheek. It is smooth, barely
palpable and has defined margins. Patient
also has pain, malaise, chills and fever.

Erysipelas

4 year old presents with asymptomatic,


erythematous scaling patch on the scalp
which has been slowly enlarging. The area
has hair that was broken off flush with
the scalp.

Tinea Capitis

4 year old presents with papules on a red


based surrounding his mouth. Mother
states he licks his lips a lot.

Perioral
dermatitis

6.

4 year old recently diagnosed with tinea


capitis presents because it has worsened.
On exam, the area of the scalp appears
boggy, weepy and is tender with some
scarring and alopecia.

Kerion

7.

6 year old presents with small, drop-like


psoriatic plaques after having recently
being diagnosed with a strep infection.

8.

9.

3.

4.

5.

10.

11.

12.

13 year old girl presents with nodules to


axillae and groin. She states they are
tender and painful. Drainage noted to a
few of the nodules

Hidradenitis
suppuritiva

13.

15 year old male patient presents with


multiple open and closed comedones
over face and neck, with some pustules
present.

Acne vulgaris

14.

40 year old male presents with episodic


burning, stinging, and flushing of skin,
especially when drinking alcohol. He
states he notices the redness is symmetric
on his face. On exam, some telangectasias
noted to cheeks and nose, as well as some
hyperplasia and phyma (large nodules).

Rosacea

15.

African american patient presents with


several round, pale-white macules on
arms and face.

Vitiligo

16.

Child presenting with intensely pruritic


dry skin that becomes a rash after itching
("the itch that rashes"). At first it was
erythematous patches with papules, but
has developed into scaly, oozing and
crusting vesicles.

Atopic
dermatitis
(eczema)

Guttate
psoriasis

17.

Elderly male presents with tense vesicles


and bullae on erythematous skin with
urticarial plaques.

Bullous
pemphigoid

7 year old presents with and itchy,


erythematous area with central clearing
on inner thigh

Tinea Corporis

18.

Infant presents bright red lesion on neck.


Mother states it has been progressively
getting larger.

Capillary
hemangiomata

7 year old presents with intensely


pruritic, erythematous, circumscribed
wheals with central pallor on a raised
plaque, which seem to come and go.

Urticaria
(hives)

19.

Mother presents with newborn with small


1-2mm white to yellow subepidermal
papules on his nose.

Milia

20.

Exanthems

8 year old presents with a "sandpaper"


rash on upper trunk and axillae. On oral
exam, patient also has "strawberry
tongue"

Scarlet Fever

Patient presents 1 week after starting a


new medication with an erythematous
rash which is bilateral and symmetric, and
pruritic.

21.

12 year old complaining of fever, sore


throat and fatigue who has now
developed red macules and papules with
a dusky colored center on hands a feet
("target lesions"). The rash appears to be
spreading toward the trunk. Mother
reports patient tried a new medication
yesterday.

Erythema
multiforme.
This can
progress to
StephensJohnson
Syndrome and
further to Toxic
Epidermal
Necrolysis

Patient presents complaining of possible


STD's. Examination of genitals reveal
painless lesions/growths.

Condyloma
Acuminata
(venereal
warts)

22.

Patient presents stating they recently felt


tired, achy and fatigued with a burning
sensation to their genitalia. Over the past
few days, they developed superficial,
painful, clustered vesicles (in different
stages) to the genitalia.

Herpes
Simplex

23.

Patient presents with 3cm "Fatty" nodule


on lower back.

Lipoma

24.

Patient presents with a plaque with


lichenification to her lower leg that is
intensely pruritic. No scale is noted.

Lichen simplex
chronicusfrom scratching
too much

35.

Patient presents with itching and


tingling that progressed to sharp
radicular pain and rash in a
dermatomal distribution unilaterally.

Herpes Zoster
(Shingles)

25.

Patient presents with asymmetric lesion


on her back, with irregular borders,
varied coloration, elevated and is 10mm
in size. She said she noticed it recently
when she found blood on her sheets after
sleeping. She says it is tender to touch.

Melanoma

36.

Patient presents with itching &


burning in hairy areas, especially the
inner thigh, legs and scalp. Pustules
noted in hair follicles.

Folliculitis

37.

Dyshidrotic
eczema.

26.

Patient presents with brown verrucous


(stuck on) lesion on face. Base of lesion
lies on flat horizontal plane flanked by
normal epidermis on other side.

Seborrheic
keratosis

Patient presents with itchy vesicles on


her fingers and palms, that appear like
"tapioca". She reports recently
spending a lot of time outside in her
garden in the heat.

38.

Patient presents with "jock itch"

Tinea cruris

27.

Patient presents with centripetal


distribution of healing vesicles in various
stages. Vesicles are on erythematous
bases.

Varicella

39.

Basal cell
carcinoma

28.

Patient presents with" coin shaped"


vesicles on a red base over the trunk and
extensor surfaces of legs.

Nummular
eczema

Patient presents with pearly bordered,


translucent nodule on his cheek with
intralesional telangectasias. He states
it has been slowly enlarging, and it
bleeds easily.

40.

Cellulitis

29.

Patient presents with discoloration of the


great toe. It is determined to be caused by
a fungal agent.

Onychomycosis

Patient presents with poorly


demarcated infection of dermis and
subcutaneous tissue on lower leg. It is
indurated, warm and erythematous.

41.

Patient presents with discrete, flesh


colored, 4mm "pearly dome shaped
umbilicated" papules on trunk and
genitalia.

Molluscum
ContagiosumNOT pearly
penile papules

Patient presents with "poring" of eyes,


creamy white skin, and cream colored
hair. Nystagmus noted to eyes with
some iris translucency.

Albinism

30.

42.

31.

Patient presents with gray, greasy scaling


to the scalp, eyebrows, base of eyelashes
and mustache.

Seborrheic
dermatitis
(Dandruff)

Stasis dermatitiscaused by venous


stasis

32.

Patient presents with grayish white, flesh


colored skin lesion with papillae and a
hyperkeratotic surface.

Verrucae
(warts)- can be
plana (pink,
light brown, or
tan) and/or
filiform
(threadlike,
hairlike)

Patient presents with rash over legs


that appear swollen. She is overweight
and reports her legs swell often, and
that over the past few months she has
noticed this rash, which now also
appears to have caused some
hyperpigmentation. There are also a
few crusts and ulcers noted.

43.

Patient presents with red, scaling,


keratotic, slightly elevated lesion with
an irregular border and shallow ulcer
to his nose. He says he picks on it
frequently because it gets "Crusty".

Squamous cell
carcinoma

44.

Patient presents with salmon colored


plaques along skin cleavage planes
that itches from time to time. She
states she noticed a small red spot on
her shoulder about a week ago, but
that it went away and then the rash
developed.

Pityriasis Rosea

45.

Patient presents with several "cafe-aulait" macules. On exam, freckling


noted in axillae.

Neurofibromatosis

33.

34.

Patient presents with hypertrophic scar


that extends beyond wound margin a
year after the injury occurred.

Keloid

Patient presents with intensely pruritice


and burning rash with vesciles that are
wet, crusty and weepy. The vesicles are
noted to be in a linear patter.

Allergic
dermatitisType IV cell
mediated
allergic
response after
contact with
irritant

46.

Patient presents with soft, skin colored pedunculated papule in his axilla.

Skin tag
(acrochordon)

47.

Patient presents with well defined plaque on a red base with silver scales on both elbows. He states it is
itchy and sometimes burns. On exam, pitting is also noted on the nails. Patient has positive Koebner's
sign and Auspitz sign.

Psoriasis
Koebner's signscratching leads to
more lesions.
Auspitz signremove scale and
get pinpoint
bleeding.

48.

Patient presents with well demarcated dermal nodule with central punctum.

Epidermoid cyst

49.

Patient recently seen for folliculitis, now presenting with similar complaint but infections seems to have
spread to adjacent tissue.

Furuncle

50.

Patient with >30% skin necrosis and widespread erythema, with blisters and denuding of skin. Exam
shows positive Nikolsky sign.

Toxic Epidermal
Necrolysis
Nikolsky signpushing a blister
makes it bigger.

51.

Woman presents with itching to the genitals. On exam, there is a superficially denuded, beefy red area in
the skin folds. Some white plaques are present that bleed when removed. On pelvic exam, white curdlike substances are noted to the mucus membranes.

Candidiasis

52.

Woman presents with pruritis and pain to hands. Hands are red, chapped, dry with fissures. She is a
homemaker and states it is worse after washing the dishes.

Irritant Dermatitis