Board Vitals Dermatology Flashcards
Patient presents with recurrent epistaxis, and telangiectasia on the face, hands and oral cavity, visceral arteriovenous malformations and positive family history.
Diagnosis?
Hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu disease
How is hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu disease inherited?
Autosomal dominant
Young patient with telangiectasias and progressive issues with balance and co-ordination that start in childhood.
Diagnosis?
Ataxia-telangiectasia
How is ataxia-telangiectasia inherited?
Autosomal recessive
What is the most important factor determining prognosis of a patient with a melanoma?
Depth of the mole
What age group and sex does bullous pemphigoid affect?
Elderly men
What is the difference between bullous pemphigoid and pemphigus vulgaris?
Bullous pemphigoid - tense bullae that do not involve mucosa
Pemphigus vulgaris - flaccid bullae that frequently involve mucosa
What antibodies are found in bullous pemphigoid?
Antibodies against hemidesmosome proteins
What antibodies are found in pemphigus vulgaris?
Antibodies against desmosome proteins
How many types of heparin induced thrombocytopenia are they?
2 (HIT-1 & HIT-2)
What is heparin-induced thrombocytopenia type 1?
Transient fall in platelets within 1 - 2 days of starting heparin, which is not clinically significant.
What is heparin-induced thrombocytopenia type 2?
Heparin induced thrombocytopenia along with thrombosis (HIT + thrombosis = HITT). This is clinically significant.
What causes heparin-induced thrombocytopenia type 2 (HIT-2)?
Formation of IgG antibodies against endogenous platelet factor 4 (PF4) in complex with heparin
How long after onset of heparin therapy does HIT-2 occur?
5 - 10 days (unless immune system primed from previous exposure)
By what percentage do the platelets usually fall in HIT-2?
More than 50%
What is the treatment of allergic contact dermatitis?
Steroids
When are oral steroids used instead of topical steroids in case of allergic contact dermatitis?
- More than 20% body area involved.
- Face, neck, hands or groin involved.
What chronic autoimmune blistering condition is associated with celiac disease?
Dermatitis herpetiformis
What percentage of celiac disease patients have dermatitis herpetiformis?
More than 90%
Is dermatitis herpetiformis more common in men or women?
Men
Is dermatitis herpetiformis autoimmune?
Yes
What medication can treat dermatitis herpetiformis?
Dapsone
What needs to be done before initiating dapsone for dermatitis herpetiformis?
Screen for glucose-6-phosphate dehydrogenase deficiency
How long does it take for dapsone to lead to clearance of lesions from dermatitis herpetiformis?
24 - 48 hours
Are patients with dermatitis herpetiformis at increased risk of enteropathy-associated lymphoma?
Yes
Does dapsone treatment for dermatitis herpetiformis decrease the risk of enteropathy-associated lymphoma?
No
Patient has a well-circumscribed, brown macule, with a ‘moth-eaten’ border and uniform pigmentation in sun-exposed area.
Diagnosis?
Solar lentigo
Patient has an asymmetric, brown macule, with variegated pigmentation in sun-exposed area.
Diagnosis?
Lentigo maligna
What is another name for acrochordons?
Skin tags or cutaneous papilloma
Skin lesion that is:
A pearly, flesh-colored and telangiectatic vessel with a rolled border.
Diagnosis?
Basal cell carcinoma
Skin lesion that is:
Erythematous, hyperkeratotic papules that may ulcerate.
Diagnosis?
Squamous cell carcinoma
Skin lesion that is:
Broader based, pedunculated lesion.
Diagnosis?
Neurofibroma
Skin lesion that is:
Slightly elevated papules and plaques, with broad base, and are not pedunculated.
Diagnosis?
Seborrheic keratosis
Which is darker - melanoma or seborrheic keratosis?
Melanoma
What skin condition is associated with ulcerative colitis?
Pyoderma gangrenosum
Should you do surgical therapy for pyoderma gangrenosum?
No
Patient with symmetrical, pruritic rash that erupted 1 - 2 weeks after dermatitis.
Diagnosis?
Autoeczematization reaction (also called Id or dermatophytid reaction)
Patient presents with monomorphic papules without comedones in a patient taking glucocorticoids.
Diagnosis?
Steroid-induced acne
Which has a malar rash on the face…
Acute cutaneous lupus or subacute cutaneous lupus?
Acute cutaneous lupus
Which lupus causes scarred, scaly plaques that may be hyperpigmented at the periphery?
Discoid lupus
Patient has scaly pink plaques with raised annular margins, on sun exposed areas - most are 0.5 to 2 cm and some are confluent.
Diagnosis?
Subacute cutaneous lupus
For squamous cell carcinoma should you do a shave biopsy or a deep punch biopsy?
Deep punch biopsy
What enzyme is deficient in porphyria cutanea tarda?
Uroporphyrinogen decarboxylase
Why does tinea versicolor lead to hypopigmented lesions?
Azelaic acid-mediated melanocyte suppression
Biopsy of skin lesion shows S-100 producing cells proliferation.
Diagnosis?
Melanoma
Biopsy of skin lesion shows peripheral palisading cells with retraction artifact and mucin.
Diagnosis?
Basal cell carcinoma
Biopsy of skin lesion shows pauci-septate broad, ribbonlike hyphae.
Diagnosis?
Mucormycosis
Biopsy of skin lesion shows inflammation of the pilosebaceous unit.
Diagnosis?
Acne vulgaris
A non-healing pressure ulcer develops exophytic granulation tissue with regional lymphadenopathy.
Diagnosis?
Marjolin ulcer
What is the next best step when a patient may have a Marjolin ulcer?
Biopsy
What is the difference between actinic keratosis and squamous cell carcinoma?
Actinic keratosis does not have invasion into the dermis, whereas squamous cell carcinoma is ulcerated and invasive.
Pink, dome-shaped papule or papule with raised or rolled border in sun exposed area; slowly growing.
Diagnosis?
Basal cell carcinoma
Which exanthema starts as a herald patch?
Pityriasis rosea
What is the treatment of pityriasis rosea?
Moisturizer and calamine lotion
Pleural biopsy histopathology shows sheets of pleomorphic cells, epithelial in appearance with eosinophilic cytoplasm and fairly well-defined cell borders.
Diagnosis?
Malignant mesothelioma
Pleural biopsy histopathology shows golden brown fusiform rods with translucent centers.
Diagnosis?
Asbestosis
Pleural biopsy histopathology shows concentrically arranged hyalinized collagen fibers surrounding an amorphous center.
Diagnosis?
Silicosis
Historypathology (of pleural biopsy) shows invasive glandular cells with abundant mucin.
Diagnosis?
Adenocarcinoma of lung
Histopathology (of pleural biopsy) shows caseating granuloma with epithelioid histiocytes and multinucleated giant cells.
Diagnosis?
Tuberculosis
Patient presents with pruritic, erythematous, coin-shaped lesions of the extremities.
Diagnosis?
Nummular eczema
What is the treatment of contact dermatitis?
Steroids
Patient presents with rash outbreaks that come and go and are worsened with emotional stress, heat and sun exposure. The physical exam reveals telangiectasia on her bilateral eyelids and an erythematous rash with papules over the nose and cheeks, including the nasolabial folds.
Diagnosis?
Acne rosacea
What are first line topical treatments for acne rosacea?
Topical metronidazole
Topical sulfacetamide
What is the difference between cutaneous lupus erythematosus and systemic lupus erythematosus?
Cutaneous lupus erythematosus does not involve any other organs (just skin involvement)
What is the diagnosis if a patient presents with a photosensitive malar rash sparing the nasolabial folds and joint pain?
Systemic lupus erythematosus
What is the diagnosis if a patient presents with a photosensitive malar rash, joint pain and proximal muscle weakness?
Dermatomyositis
Woman presents with persistent redness on her cheeks with prominent telangiectasias.
Diagnosis?
Rosacea
Ocular rosacea may cause a gritty sensation in the eyes blepharitis and conjunctivitis.
True or false?
True
What is the first line therapy for mild non-inflammatory acne?
Topical retinoids
What is the second line therapy for mild non-inflammatory acne?
Topical benzoyl peroxide along with an antibiotic
Should oral contraceptives be used in mild acne or moderate to severe acne?
Moderate to severe acne
An elderly male presents with flat-topped, purple, polygonal, pruritic papules on his anterior wrists. Fine, lace-like white lines on buccal mucosa.
Diagnosis?
Lichen planus
Are venous or arterial ulcers typically located at the malleoli?
Venous ulcers
What is the best treatment for venous ulcers?
- Leg elevation
- Compression therapy
What are patients with oculocutaneous albinism at risk for?
Skin cancer - especially squamous cell carcinoma
What is the treatment of dermatomyositis?
Prednisone with methotrexate or azathioprine
When should you use azathioprine instead of methotrexate in dermatomyositis?
Patients with interstitial lung disease, underlying liver disease or those unwilling to abstain from alcohol.
What can distinguish between pityriasis rosea and dermatophyte infection?
KOH preparation of skin scrapings
Anti-nuclear antibodies are usually positive in lupus.
True or false?
True
What is the treatment of aphthous ulcers?
Chlorhexidine rinse and topical steroids
Are aphthous ulcers associated with inflammatory bowel disease, celiac disease, Behcet’s disease and HIV?
Yes
What infections can be diagnosed by segmented hyphae on KOH preparation?
Dermatophyte infections (Tinea pedis)
