Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Andrews > Chapter 7 > Flashcards

Chapter 7 Flashcards

Objective-not fail

1
Q

Which of the following can induce menopausal related flushing: A. Oophorectomy B. Tamoxifen C. Leuprolide Acetate D. Hysterectomy E. A-C F. All the above

A

E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List medications associated with flushing:

A

Niacin CCB Cyclosporine Chemo Vancomycin Bromocriptine IV contrast ED medications Methylprednisolone Combo of SSRI + MOI (Serotonin Toxicity) Anesthesia Meds: Thiopental and Muscle Relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What labs should be ordered if an endogenous cause is suspected in flushing case?

A
  1. Urine catecholamins 2. Serotonin 3. Histamine metabolites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment for idiopathic flushing

A

Avoid triggers and sipping iced water to break flush -Avoid alcohol, caffiene, and spicy foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for menopausal flushing

A

Low dose oral/transdermal estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List endogenous causes of flushing

A
  1. Carcinoid Syndrome 2. Mastocytosis 3. Medullary thyroid carcinoma 4. Pheo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Niacin induced flushing is mediated by _____

A

Prostaglandin D2 -Should respond to ASA or laropiprant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnosis.

A

Erythema Palmare

AKA Persistent palmar erythema

Note: Usually ost marked on the hypothenar areas and associated with elevated estrogen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List common causes of erythema palmare

A
  1. Cirrhosis
  2. Hepatic metastases
  3. Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What labs should be performed to confirm diagnosis of erythema toxicum neonatorum

A

Smears of the pustules will demonstrate eosinophils

-Biopsy RARELY REQUIRED (would show folliculitis containing eosinophils and neutrophils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnoses

A

Erythema toxicum neonatorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe typical presentation of erythema toxicum neonatorum

A

2nd or 3rd of newborns life–present with broad erythematous flare on face, trunk, and proximal extremities

  • Confluent erythema on the face
  • small folicular papules/pustules

*usually disappears by tenth day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnosis?

A

Erythema Toxicum neonatorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the 3 zones seen in the classic EM lesion

A
  1. Central dusky purpura
  2. Elevated edematous, pale ring
  3. Surrounding macular erythema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

42 y/o female presents with a solitary unilateral erythematous plaques with a dusky center. The plaques are about 14 cm in diameter. Pt also c/o new bumps on her lower extremities. On exam the nodules are deep seated and tender.

What is the diagnosis?

A

Atypical variant of EM

Note: can present with erythema nodosum like lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

True or False?

Acyclovir suppression increases the frequency of lesions, while prednisone therapy prevents the lesions

A

FALSE.

Correct response is: Acyclovir suppression prevents the lesions and prednisone therapy seems to increase the frequency of attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

From a histology standpoint, what factors determine the extent of epidermal involvment of EM

A
  1. Duration of lesion
  2. Where in lesion biopsy was taken
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment for HSV associated EM

A
  1. Antivirals
  2. Sunscreen/Sunscreen lip balm daily to prevent UVB induced outbreaks
  3. (If above txt fails or genital HSV is the cause) Chronic suppressive doses of an oral antiviral drug should be used

-Valacyclovir 1g/day

-Famiciclovir 250mg/day

  1. If above dose is ineffective–double it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment for EM pt who fail to respond to antiviral suppression

A
  1. Dapsone
  2. Cyclosporine
  3. Thalidomide

Note: Most cases of HAEM are self limited and symptomatic treatment may be all that is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment for oral lesions of EM

A

Topical “swish and spit” of mixtures containing lidocaine, diphydramine, and kaolin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How to treat widespread EM unresponsive to first/second line therapies?

A

Management is same as for severe drug-induced SJS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis

A

Urticaria multiforme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How to distinguish EM from SJS based on morphology presentation

A

SJS presents with purpura or bullae in macular lesions of the trunk vs. erythematous macules that evolve over 24-48h into edematous papules/Centrally lesions become flatter, more purpuric and dusky forming the classic target lesions of EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnosis

A

EM secondary to sulfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diagnosis

A

EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diagnosis

A

EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Diagnosis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Diagnosis

A

EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Diagnosis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diagnosis?

A

EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

10 y/o pt presents with recurrent episodes of hive like lesions. Per mom the lesions change colors in the middle. See attached image.

A

Urticaria Multiforme–it is a type of urticaria, histology never shows EM

-commonly misdiagnosed as EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

41 y/o female presents to clinic with cc of sore in mouth. She has previously been seen and treated with unknown meds by PCP and the lesions cleared but they have come and gone several times. On exam, pt has erythematous, eroded ulcers on the tongue and buccal mucosa. What is the treatment for her diagnosis?

A

Diagnosis is Oral EM

Treatment: Treat like HAEM with antivirals, sunscreen if lip involvment, and swish-spit with lidocaine/diphenydramine/kaolin for symtompatic relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What should you counsel patient on if you rx swish-spit treatment for EM?

A

Advise pt to chew carefully because the anesthetic effect ay dampen their gag reflex aka choking hazard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

True or False: In 45% of oral EM cases the oral cavity is the only site involved and 30% of cases both the oral cavity and lip are involved

A

True

Note: In 25% of oral EM cases the skin is involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Diagnosis

A

Recurrent oral EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Diagnosis

A

Recurrent oral EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Based on the pictures, what portions of the oral cavity are MC involved in this diagnosis?

A

Tongue, gingiva, and buccal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the typical histologic findings for EAC

A

Epidermis: mild focal spongiosis and parakeratosis

Dermis: Lymphocytes are organized tightly around blood vessels forming a pattern known as coat sleeve arrangement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pt presents to clinic with c/o rash. States the rash is on his stomach and top of his thighs and has been “off and on” over the past 7 months. On exam, pt has multiple annular erythematous that are about 5-8cm in diameter. Pt denies any symptoms related to rash. What is the appropriate treatment?

A

Diagnosis: EAC

Txt: While active, will respond to steroids or calcipotriol. Eventually spontaneously resolves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When diagnosing a patient with EAC what important considerations should you make?

A

Most cases are idiopathic. Some are associated with dermatophytosis or ingestion of molds (think blue cheese and tomatoes). Can also be due to medications and internal malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Diagnosis

A

EAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the diagnosis based on the picture? What is the characteristic finding with this disorder

A

EAC; trailing scale at the inner border of the annular erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Diagnosis

A

EAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the MC malignancy associated with the rash seen in picture?

A

Lung Cancer

Note: Eruption precedes the detection of malignancy be anaverage of 9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

treatment for erythema gyratum repens

A

If carcinoma is treated, lesions clear. Otherwise, eruption generally resistant to treatment .

Have been cases with Cetirizine and Topical corticosteroids helping.

46
Q

Besides internal malignancy, what other etiologies have been implicated for EGR? And how do you treat EGR when it is caused by them.

A
  1. Drug induced
  2. Secondary to pulm TB
    - D/c medication or treat underlying condition to resolve rash
47
Q

Pt presents with new onset rash that he says has been moving daily. On exam pt has erythematous concentric lesions with a trailing scale over his entire body. Pt c/o of severe itching. What is the diagnosis?

A

Erythema Gyratum Repens

Note: “Characteristically concentric, giving the skin a “wood grain” appearance

48
Q

38 y/o female presents to office with rash. She has no pertinent personal, social, or family history. On exam, you see the attached picture of the patients trunk. What is the diagnosis

A

Eosinophilic annular erythema

Note: Usually presents on trunk and is symmetric; favors females

49
Q

What conditions are associated with eosinophlic annular erythema?

A

None

50
Q

What is the histology findings in eosinophilic annular erthema

A

dense perivascular and interstitial lymphocytic infiltrate with many eosinophils (without flame figures)

51
Q

What is the treatment for eosinophilic annular erythema?

A

Spontaneous resolution can occur.

Hydroxychloroquine and/or prednisone when needed

52
Q

What is the classic finding on histology for well’s syndrome and what causes it?

A

Flame figures (dermal collagen with adherent eosinophil granules) due to dermal eosinophil degranulation

53
Q

What is believed to cause MOST cases of eosinophilic cellulitis

A

Arthropod reactions

-Also been associated with various disease states such as: varicella, mumps, parasties, immunizations, drug reaction, IBD, etc

54
Q

How would you treat this case? See pic.

A

Well’s Syndrome AKA Eosinophilic Cellulitis

  1. Any triggering factor (arthropods) should be eliminated
  2. Topical/Intralesional steroids
  3. PO antihistamines
  4. Tacrolimus ointment
  5. Minocycline
  6. UVB or PUVA
  7. Dapsone
  8. Low dose prednisone
    - Note: Although some cases may be due to exposure to TNF-a inhibitors–reports have shown adalimumab to work well
55
Q

Being such a smart PA you know that patients that present with reactive neutrophilic dermatoses tend to have simultaneous or sequential appearance of 2 or more of the conditions. What is the MC overlap?

A

Combo of typical sweet syndrome on upper body and erythema nodosum-like lesions on the legs

-In these patients, histo often enables a diagnosis of subq sweet’s syndrome on the EN like lesions

56
Q

What is another name for Sweet’s Syndrome?

A

Acute Febrile Neutrophilic Dermatosis

57
Q

Of the 4 subtypes of sweet’s syndrome which is the second most frequently occuring?

A

Associated with inflammatory disease (16%)

Note: MC is Classic type (71%); Associated with neoplasia in 11% of cases, and associated with prego in 2%

58
Q

50% of patients with Pyoderma gangrenosum have an associated dz. What is the most common dz and tx of PG?

A

IBD (both crohns & uc)

Tx: surgical removal of diseased intestine

59
Q

Most common types of PG associated with IBD

A

ulcerative and pustular

60
Q

What is bullous sweet syndrome?

A

more superficial and less destructive type of PG (bullous PG)

seen in pts with leukemia or PCV

red plaques become dusky and develop superficial erosions

61
Q

50 year old man comes into RDA with this on his arm. His disease seems to be progressing agressively. How do you diagnose and treat?

A

PG is a diagnosis of exclusion

(bx shows supperative folliculitis- NOT diagnostic)

Agressive dz = start strong tx with immunosuppressive agent

cyclosporine 5-10mg/kg/d

infliximab IV 5mg/kg

62
Q

What is the most common inherited autoinflammatory syndrome

A

FMF = familial mediterranean fever

autosomal recessive

recurrent attacks of 12-72h fever and monoarthritis with erythema

mutation in MEFV gene

mainstay tx: colchicine

resistant cases: rilonacept

63
Q

PAPA syndrome stands for

A

Pyogenic sterile Arthritis, PG, and Acne

autosomal dominant

caused by PSTPIP1 or CD2BP1 gene mutations

64
Q

TRAPS is similar to FMF but shows autosomal dominant inheritance, has longer bouts and does not respond to colchicine. Having eaten a smartie this morning you know that TRAPS responds to?

A
  1. acute treatment = NSAIDs or prednisone
  2. prevention = anti-TNF receptor antagonists or anakinra
65
Q

What is the difference between annular and nummular

A

annular = ring with central clearing

nummular = coin shaped lesion

66
Q

A 29 year old patient comes in with urticaria and a fever. After telling the front desk that you hate rashes, you find out that the urticaria has occured for 7 weeks, doesn’t itch, and has disabiling bone pain. Diagnose and treat.

A

Schnitzler syndrome

anakinra

rituximab

tocilizumab

rilonacept

canakinumab

67
Q

Urticaria d/t food allergens is seen in which foods. (Name 3)

A
  1. chocolate
  2. shellfish
  3. nuts / peanuts
  4. tomatoes, strawberries, melons, pork, cheese, garlic, eggs, milk, spices
68
Q

Which foods are shown to have cross-reaction with latex allergy

A
69
Q

True or False: In sweet’s syndrome, lesions that present as dusky bullous and necrotic lesions that overlap pyoderma gangrenosum are more common in patients with associated lymphomas

A

False

-MC in patients with associated leukemias

70
Q

What is the treatment for Sweet’s Associated with Pregnancy and what patient education should you provide?

A

Treatment: Can spontaneously resolve or clear with topical/systemic steroids

Education: No risk to fetus and could recur in future prego

71
Q

A 42 y/o female presents to the office with a c/o a rapidly changing painful rash. When you start to interview the pt. she states that she has been “feeling feverish recently” and complains of redness and pain that feels like pressure in her right eye.

On exam: Pt has multiple erythematous elevated plaques ranging from 3-8 cm in size located on her neck, chest, and arms. Some of the lesions are violaceous in color and have vesicles on the surface. Pt’s right eye is erythematous and edematous.

What is your diagnosis?

A

Classic Type Sweet’s Syndrome

Hints to Dx: Primary lesions are sharply marginated erythematous/violaceous and rapidly extending. Lesions are tender/painful.

  • 3/4 of patients have systemic findings. MC is fever (which she has). Can have various ocular findings–one of which is Dacyroadenitis (her secondary/assoc dx)
  • Sweet’s is MC in adult females
72
Q

What are some associated systemic findings with Sweets Syndrome?

A
  • MC is fever
  • Musculoskeletal: Arthritis, Arthralgia, Myalgia
  • Ocular: MC are conjuctivitis and episcleritis
  • Oral: Apthae ulcers
  • Pulmonary: Cough, dyspnea, pleuritis
73
Q

True or False: Patients with Sweet’s Syndrome associated with neoplasia, specifically hematologic malignancy, are more likely to have oral lesions resembling apthae.

A

True

-Lesions are found in 10% of these pts vs. 2-3% in classic type

74
Q

In Sweets Syndrome, patients presenting with pulmonary complaints will likely have what on their CXR?

A

Effusions and pulmonary infiltrates

75
Q

Pt presents to clinic for f/u 7 weeks after diagnosis of classic sweet’s syndrome. Patient is upset because she is still getting new lesions before the old lesions have a chance to clear. What should you tell this patient about her disorder?

A

Persistent cases of Sweet’s (which typically have new lesions eruption before old lesions resolve) may continue for YEARS.

Note: Most cases resolve in 3-6 weeks but can recur due to same precipitating cause (example-URI)

76
Q

What is the histo hallmark of Sweet’s Syndrome?

A

Nodular and diffuse dermal infiltrate of neutrophils with karyorrhexis and massive papillary dermal edema

77
Q

If pathology reveals a histologic variant of Sweet syndrome what test can you order to confirm Sweets Syndrome as the diagnosis?

A

Myeloperoxidase stains–will be + if Sweets

78
Q

True or False: Most cases of Sweets Syndrome are acute and self-limited, typially following a URI

A

True

79
Q

What 3 inflammatory disorders are associated with Sweet’s Syndrome?

A
  1. IBD
  2. Behcet Syndrome
  3. Peripheral ulcerative keratitis
80
Q

In neoplasia associated sweet’s syndrome, what common solid tumors do patients have?

A

GI (Men)

Breat (Women)

GU

81
Q

What criteria must be met to diagnose patient with sweet’s syndrome?

A

2 Major + 2/4 of Minor criteria

82
Q

What are the 2 major criteria that must be met to diagnose Sweets?

A
  1. Lesions presentation: Abrupt onset of erythematous plaques/nodules (occasionally with vesicles, pustules, bullae) presence of red edematous plaques
  2. Biopsy results: neutrophils, karyorrhexis, and marked papillary edema
83
Q

Name the 4 minor criteria of Sweet’s Syndrome

A
  1. Associated Symptoms/Conditions: Rash preceded by respiratory infection, GI infection, or vaccination OR associated with–Inflammatory dx or infection, Myeloproliferative d/o or other malignancy, or pregnancy
  2. Malaise and Fever
  3. Abnormal Labs (_>_3): ESR>20, elevated CRP, Leukocytosis>8000, or left shift wiht >70% neutrophils
  4. Excellent response to treatment
84
Q

What is the treatment for Sweets Syndrome

A

Systemic Steroids

oral prednisone 1mg/kg/day

-Continue for several weeks to prevent relapse

85
Q

Name 3 of the 8 medications listed as possible txts for chronic or refractory sweets syndrome

A
  1. NSAIDS
  2. Dapsone
  3. Colchicine
  4. Doxy
  5. CLofazimine
  6. Cyclosporine
  7. Potassium Iodide
  8. Sulfapyridine
86
Q

What is the treatment for this condition?

A

Prednisone and Dapsone

87
Q

You are seeing a new patient for recurring rash on hands. On exam you note the palmar side of their hand is clear but the dorsal side appears edematous with numerous pustules and plaques. See attached pic. What is your diagnosis?

A

Neutrophilic dermatosis of the dorsal hands

Note: Best considered a localized variant of Sweet Syndrome

88
Q

Diagnosis?

A

Neutrophilic Dermatosis of the Hands

89
Q

diagnosis?

A

Histiocytoid Sweets Syndrome

90
Q

Diagnosis?

A

Lymphocytic Sweets Syndrome

91
Q

diagnosis?

A

Sweets in AML patient

92
Q

Diagnosis?

A

Sweet’s in an SLE pt

93
Q

Diagnosis?

A

Sweets in a Leukemia Patient

94
Q

A 9 year old boy is seen in clinic for a worsening rash. Mom states the rash started off as small red bumps but has progressively gotten worse. On exam, pt has large urticarial, targetoid plaques with hypopigmented centers. This morphology is characteristic of what disease?

A

Marshall Syndrome

Note: Characterized by skin lesions resembling sweet’s syndrome which are followed by acquired cutis laxa

95
Q

What 2 organs should you be considered about in a patient diagnosed with Marshall Syndrome and why?

A

heart and lungs

In this syndrome, elastic tissue is destroyed

96
Q

What associated deficiency is seen in Marshall Syndrome?

A

alpha1 antitrypsin deficiency

97
Q

A patient previously diagnosed with Marshall syndrome is seen in your office. What would you expect of the now healed lesions

A

As lesions resolve the elastic tissue is destroyed. This produces soft, wrinkle, skin-colored protuberant plaques that can be pushed into the dermis

98
Q

Describe the histology of marshall syndrome

A

Neutrophilic dermatosis (identical to sweet’s)

Occasionally an eosiniphilic infiltrate is seen

99
Q

Diagnosis?

A

angioedema

Note: eyelid, lips, earlobes, external genitalia, mucous membranes of mouth, tongue, larynx

100
Q

Diagnosis?

A

exercise-induced urticaria

Note: appear 5-30 minutes after start of exercise (some pts only have this after eating celery before exercise)

suppressed by antihistamines + H2 antihistamine

101
Q

Diagnosis?

A

Cholinergic Urticaria

Note: produced by acetylcholine on mast cell.

Spare palms/soles.

102
Q

Diagnosis?

A

Dermatographism

(MC type of physical urticaria)

103
Q

Diagnosis?

A

Urticaria secondary to Hep B

104
Q

Diagnosis?

A

Acute urticaria

105
Q

Diagnosis?

A

enlarging ulcer of PG

106
Q

Diagnosis?

A

Cold urticaria

  • after provacative test of ice cube x 3 minutes
107
Q

Diagnosis?

A

annular and polycclic urticaria

108
Q

Associated diseases?

A

dermatographism may occur in:

  1. hypo/hyperthyroid
  2. infectious dz
  3. diabetes mellitus
  4. onset of menopause
109
Q

What induces this rash?

A

increasing body temp

  1. exercise
  2. warm bath

–> cholinergic urticaria

110
Q

Diagnosis?

A

positive ice cube test =

  1. primary cold urticaria
  2. familial cold autoinflammatory synd.

Note: develops on rewarming

Andrews (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions