Derm

Question 1

Acanthosis nigrans

Answer 1

Thickened hyperpigmented zones of skin with a velvet like area usually involving the flexuaral areas( axilia, skin folds of neck, groin,etc)
Benign 80%- ad trait with variable penetrance, associated with obesity and endocrine issues, congenital syndrome; usually appear in childhood or during puberty
Malignant- older adults associated with gastrointestinal adenocarcinoma

Question 2

Acanthosis

Answer 2

Hyperplasia of the stratum spinosum

Question 3

Seborrheic keratosis

Answer 3

Middle aged older adults
Coin like plaques tan to dark brown (vary in size)
Horn like cysts on histo (whorls of keratin)
Leser-trelat sign- large numbers of plaques associated with paraneoolastic syndromes / GI carcinoid

Question 4

Progression of dermatitis

Answer 4

acute (weeping erethymatous rash/spongiosis)–> subactute (crusting over of rash scaling and hyperkeratosis) –> chronic (lichenification from itching, scaling, hyperpigmentation)

Question 5

Atopic dermatitis

Answer 5

Type 1 IgE mediated hypersentivity

Face in kids, flexor surface (antecubital and popliteal fossa) in adults

Question 6

Contact dermatitis

Answer 6

Type IV T cell mediated

Metals (nickle), plants (poison ivy), and chemicals (household cleaners, meds)

Question 7

MC type of contact dermatitis

Answer 7

irritant contact

non immunological rxn; toxic effect of chemical on local skin

Question 8

Girl playing soccer develops rash on legs, face, and arms, what drug is she on and what is this?

Answer 8

contact photodermatitis

Tetracycline (sulfa, thiazides)

Question 9

Ring shaped patches of allopecia on scalp with erythema and scaling

Answer 9

Tinea capitus MC in children

1. ) Trichophyton tonsurans
2. ) Micosporum canis (Woodlamp + )

Question 10

MC cause of tinea

Answer 10

Trichophyton rubrum

Question 11

MCC diaper rash and onccyomycosis

Answer 11

candida albicans

Question 12

High fever, metal confusion, diarrhea, hypotension, erythematous rash associated with a drug rxn

Answer 12

TSS nafcillin

Question 13

What does actinic keratosis progress to?

Answer 13

Squamous cell carcinoma

Question 14

What is actinic keratosis associated with?

Answer 14

sun (UVB) damage, arsenic

Question 15

Where is psorasis most commonly found?

Answer 15

Scalp and pressure areas like the elbow

Question 16

Development of a rash at areas of trauma

Answer 16

Koebner phenomenon, psoriasis

Question 17

Munro microabcesses

Answer 17

collection of neutrophils in the stratum corneum (associated with psoriasis)

Question 18

Single oval shaped scaly pink patch on trunk that develps into papules on the back that follow line of cleavage

Answer 18

pityriasis rosea

herald patch followed by christmas tree distribution

Question 19

When is psoriasis associated with a destructive arthritis ?

Answer 19

If patient is HLA B27

Question 20

What population do you see scalded skin syndrome in?

Answer 20

neonates
granulosum layer
no scarring

Question 21

Atopic triad

Answer 21

atopic dermatitis
allergic rhinitis
asthma

Question 22

What type of hypersensitivity rxn is pemphigus vulgaris ?

Answer 22

Type II, IgG to desmoglian

Question 23

What do the basal cells look like on histology in pemphigus vulgaris?

Answer 23

tombstones

Question 24

What does the dermal epidermal junction look like in lichen planus?

Answer 24

Sawtooth from lymphocytic infiltrate

Question 25

dermatitis hepatiformis is what type of hypersensitivity rxn?

Answer 25

Type III, IgA and gluten deposition at tips of dermal papilae

Question 26

What type of antibodies are present in dermatitis hepatiformis?

Answer 26

anti-reticulin antibodies

Question 27

What is erythema multiforme called when it involves 2 or more mucous membranes?

Answer 27

SJS

Question 28

How do you get erythema multiforme?

Answer 28

1. Disease (mycoplasma, HSV) 2. Drugs (sulfa, beta lactams, phenytoin) 3. Autoimmune (lupus, preg) 4. Cancer

Question 29

Pathogenesis of acne

Answer 29

Increased keratin of follicular epithelium--> increased sebum production--> propionobacterium acnes / bacterial lipase, cleaves FA and creates further inflammation most common in adolescents

Question 30

acne roseacea

Answer 30

inflammatory disease of pilocebateous unit of middle aged people Can be brought on be heat and alcohol can evolve into rhinophyma

Question 31

How does cellulitis spread?

Answer 31

can cause lymphangiitis by elaboration of hylauronidases that let the s. pyogenes infection spread through the subcutaneous tissue

Question 32

What type of lesion does SLE produce?

Answer 32

skin lesions associated with epidermal atrophy

Question 33

Pathogenesis of SLE

Answer 33

antibodies to epidermal basement membrane or antiDNA antibody anitigen deposition in basement membrane --> degeneration of basal layer at dermal epidermal junction-->lymphoid infiltrate and atrophic epidermis

Question 34

Grenz zone

Answer 34

narrow zone beneath the epidermis in leprotamous leprosy that is free of bacteria , under the grenz zone are fomay macrophages with organisms

Question 35

MCC of inflammation in subcutaneous fat

Answer 35

erythema nodosum

Question 36

MC malignant tumor of the skin

Answer 36

basal cell carcinoma

Question 37

Do basal cell carcinomas metastisize?

Answer 37

No

Question 38

Pearl colored nodule with prominent vascular channels under the surface

Answer 38

basal cell carcinoma

Question 39

MC cancer associated with immumosuppresive therapy

Answer 39

squamous cell carcinoma

Question 40

ulcer at orifice of chronically draining sinus that does not improve with antibiotics

Answer 40

squamous cell carcinoma

Question 41

What is SCC associated with?

Answer 41

XP, immunosuppression, arsenic posioning, sun damage

Question 42

What is a phenotypic marker for underlying adenocarcinoma of the stomach

Answer 42

acanthosis nigrans

Question 43

are freckles pre-malignant?

Answer 43

no

Question 44

flat hyperpigemented lesion of forehead and cheeks in women

Answer 44

``` pregnancy mask (or OCP use) melasma/chloasma ```

Question 45

MC nevi in adults

Answer 45

intradermal nevus | raised papule , pigmented cells only in dermis

Question 46

nevi all over the body

Answer 46

dysplastic nevus syndrome | precursor to maligancy

Question 47

MC type of melanoma

Answer 47

Superficial spreading | mostly women over 50, lower extremities and back MC sites,

Question 48

Malignancy on sun exposed face of elderly people

Answer 48

lentigo maligna

Question 49

MC type of melanoma in blacks

Answer 49

acral lentigenous melanoma | palms, soles, and subungal (don't confuse hematoma)

Question 50

Best system of staging for melanoma

Answer 50

Breslow system Measured depth less than 0.76 mm no metastatic potential greater than 1.7 can metastisize to LNs

Question 51

Hyperpigmented spots on the skin that when scratched become intensely puritic and red

Answer 51

urticaria pigmentosa | pressure causes mast cells to release histamine which sets up a urticarial rxn