Answer and Explanation 18

18.   The correct answer is both A and B.  This is a severe case of pemphigus.  This is an auto immune disorder and steroids will also help with the progression.  This patient is going to need wound management similar to a burn patient.  Vancomycin and Rocephin would be helpful for secondary infections or if Stephen Johnson Syndrome was suspected.

Question 18

18.  Your patient is a 64 year old male who presents with the rash in the picture below.

Based upon the above information, what is the best management option?

A.  Start the patient on glucocorticoids

B.  Transfer the patient to a burn center

C.  Start the patient on 1 gram of Vancomycin IV

D.  Start the patient on Rocephin 1 gram IV

E.  Both A and B

Answer and Explanation 17

17. B is the correct answer.  The lesion is characteristic of a malignant melanoma.  It has some of the key characteristics of a malignant melanoma.  It has asymmetry where half over half of the lesion is not like the other.  It has an irregular border.  It has multiple colors within the lesion. Most importantly its diameter is bigger than a pencil eraser.  A benign nevus usually has a normal variation in color and is smaller than a pencil eraser.   A Basal Cell Carcinoma is a firm small raised or flat area that can be shiny or waxy.  They have been known to bleed with minor injury.  BCC may range from a few millimeters to several centimeters in diameter.  Squamous cell carcinoma often usually look like scaly red patches, open sores or elevated growths with a central depression.  These may be crusty or bleed.

Question 17

17.   What is the diagnosis of the skin lesion depicted below?

A.  Benign Nevus

B.  Malignant Melanoma

C.  Basal Cell Carcinoma

D.  Squamous Cell Carcinoma

Answer and Explanation 16.

16.  D is the correct answer.  Aphthous ulcers have not been tied to AIDS.  It is not unusual to see patients with fulminant AIDS to have herpes simplex lesions, Kaposi Sarcoma or Molluscum Contagiosum.

Question 16

16.  Which of the following is not an skin manifestation of AIDS?

A.  Herpes Simplex

B.  Kaposi Sarcoma

C.  Molluscum Contagiosum

D.  Aphthous Ulcers

Answer and Explanation 15

15.  B is the correct answer.  This rash is characteristic of impetigo.  It has this yellowish crusty material on the surface of a plaque.  Causative organisms include staph aureus and strep pyrogenes.  Oral and topical antibiotic therapy should be targeted at that.  Herpes zoster has more of a vesicular or ulcerated appearance and does not have a crusty surface.  Tinea has more of a desquamation appearance to it and does not have the yellow crusty material.  Eczema is typically a lighter more pink patchy lesion.