Question 1

Q: A previously healthy 16-year-old boy comes to the physician because of a pruritic rash on the chest that has become progressively larger over the past 10 days. It is not painful. He is sexually active with two female partners and uses condoms inconsistently. He works part-time as a lifeguard. He has no family history of serious illness. He does not smoke. He drinks 5–6 beers on weekends. His temperature is 36.7°C (98°F), pulse is 66/min, and blood pressure is 110/70 mm Hg. A photograph of the rash is shown below. Which of the following is the most appropriate next step in management?

Topical miconazole. **Topical miconazole** - The rash described, especially in a lifeguard who is frequently exposed to moisture, suggests **tinea corporis** (ringworm), a **dermatophyte fungal infection**. - **Topical imidazole antifungals** like miconazole are the first-line treatment for localized tinea infections. *Phototherapy* - **Phototherapy** (e.g., UVB or PUVA) is used for chronic widespread dermatoses like **psoriasis** or severe **atopic dermatitis**, not typically for localized fungal infections. - This rash is likely **infectious** and requires an antifungal agent for resolution. *Reassurance* - The rash is described as **progressively larger** and **pruritic**, indicating an active and symptomatic process that requires intervention, not just reassurance. - Delaying treatment could lead to further spread or secondary bacterial infection. *Topical erythromycin* - **Topical erythromycin** is an **antibiotic** used to treat bacterial skin infections, such as **acne vulgaris** or impetigo. - It would be ineffective against a fungal infection like tinea corporis. *Topical hydrocortisone* - **Topical hydrocortisone** is a **corticosteroid** that reduces inflammation and itching. - While it might temporarily alleviate symptoms, it can actually worsen fungal infections by suppressing the local immune response, leading to **tinea incognito**.

Question

A previously healthy 16-year-old boy comes to the physician because of a pruritic rash on the chest that has become progressively larger over the past 10 days. It is not painful. He is sexually active with two female partners and uses condoms inconsistently. He works part-time as a lifeguard. He has no family history of serious illness. He does not smoke. He drinks 5–6 beers on weekends. His temperature is 36.7°C (98°F), pulse is 66/min, and blood pressure is 110/70 mm Hg. A photograph of the rash is shown below. Which of the following is the most appropriate next step in management?

Accepted Answer

Topical miconazole

Answer

Phototherapy

Answer

Reassurance

Answer

Topical erythromycin

Answer

Topical hydrocortisone

Antifungals — MCQs

Antifungals — MCQs

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