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IDIS > DERM: Nodules & Papules I & II > Flashcards

DERM: Nodules & Papules I & II Flashcards

1
Q

verrucae / condyloma acuminatum - pathogenesis

A
  • HPV infects underdifferentiated epithelial cells in the stratum basal then -> ascends thru upper layers -> infects terminally differentiated squamous cells = koilocytes
    • HPV 6, 11 (m/c - low malignant risk)
    • HPV 16, 18 (high malignant risk)
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2
Q

verruca vulgaris - presentation

A

d/t HPV

  • = common wart: papules that are
    • keratotic
    • velvet textured / rough
    • tend to occur on the hands
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3
Q

condyloma acuninatum - presentation

A

d/t HPV

  • = anogenital wart
    • cauliflower-surfaced
    • pedunculated
    • on genitalia / urethra / perianal / tissue OR lips
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4
Q

verrucae vulgaris / condyloma acuminatum - diagnosis

A

= presence of koilocytes:

  • altered squamous epithelial cells with irregular nuclei:
    • pyknotic, dense nucleus
    • surrounded by clear perinuclear space (halo)
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5
Q

identify picture. what is its significance?

A

koilocytes: HPV infected squamous epithelial cells with abnormal nuclei: pyknotic & surrounded by clear pernuclear space

diagnostic of verrucae / condyloma accunimanatum

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6
Q

identify each picture

A
  1. verruca vulgaris: keratotic, velvet textured common warts typically on hands
  2. condyloma accuminatum: cauliflower-surfaced, pendunculated, anogenital warts
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7
Q

verrucae / condyloma acuminatum

  • prognosis
  • therapy
  • prevention
A
  • prognosis: m/c dissapear w/in 2 years
  • therapy: removal - cryosurgery / curretage OR topicals
  • prevention: safe sex & HPV vaccine (Gardasil 9)
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8
Q

condyloma latum - pathogenesis

A

= genital secondary syphyllis

treponema pallidum (a highly infectious STI) creates chanrce at innoculation site

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9
Q

condyloma lata - presentation

A

= treponema pallidum

  • skin: papules that are
    • hypertrophic
    • smooth & flat
    • white
    • moist
  • systemic: general prodrome
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10
Q

condyloma latum

  • diagnosis
  • prognosis
  • therapy
  • prevention
A

= treponema pallidum

  • diagnosis:
    • RPR / VDLR then FTA-ABS - m/c
    • spirochetes in darkfield microscopy, also
  • prognosis - follows that of syphyllis
  • therapy - benzanthine penicillin G
  • prevention - safe sex
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11
Q

identify picture - why is it significant?

A

darkfield microscopy showing spirochetes (treponema pallidum) - dx of condyloma latum

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12
Q

kaposi sarcoma - pathogenesis

A
  • HHV-8 infection of endothelial cells (capillary lining) leading to -> angioproliferative diseases, the progression of which depends on the demographic infected
    • IC (AIDS / transplant recipients): fulminant (rapid) progression
    • genetic predisposition: indolent (slow) progression
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13
Q

kaposi sarcoma - presentation

A

HHV -8

  • systemic:
    • genetic (indolent): lymphedema (leg edema)
    • fulminant lesions: joint, GI
  • skin: reddish-purple vascularized macules -> progress into tumors / nodules
    • genetic (indolent) lesions: on lowers limbs
    • fulminant lesions:
      • sun-exposed skin
      • mucous membranes
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14
Q

kaposi sarcoma - diagnosis

A
  • spindled endothelial cells with
    • extravasated RBCs
    • hemosiderin laden macrophaeges
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15
Q

kaposi sarcoma

  • prognosis
  • therapy
  • prevention
A
  • prognosis: is a latent incurable infection (HHV-8) though asymptomatic (rarely, multi-organ failure in fulminant pts)
  • therapy:
    • removal
    • radiation
    • chemotherapy
  • prevention: avoid contracting HIV
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16
Q

identify lesions

A

kaposi sarcoma

reddish-purple vascularized macular / maculopapular nodes on exposed skin / mucous membranes

17
Q

cutaneous tuberculosis

  • pathogenesis
  • presentation
  • diagnosis
A
  • pathogenesis. m tuberulosis (acid-fast aerobic bacillus) forms caseating (necrotic) granulomas
    • ​can be triggered by BCG vaccination
  • presentation: depends on if infection of primary or secondary:
    • primary: enters skin via trauma sites
      • no prior exposure to TB - > papule / nodule (“innoculation chancre”
      • rrior exposure to TB -> warty lesions (“verrucosa cutis”)
    • secondary: patient with TB In lung that dissseminates
      • tuburculoid granulomas
        • red-brown
        • painless
        • on the head or the neck
  • diagnosis:
    • Mantoux test / IGRA test (no false + from vax)
    • lesions beomes yellow-brown “apple jelly” upon application of pressure
19
Q

leprosy / hansen’s disease

  • pathogenesis
  • presentation
  • diagnosis
  • prevention:
A
  • pathogenesis: m. leprae (acid fast bacillus) -> type IV hypersenstivity reaction -> granulomas (caseating and non-caseating)
  • presentation: 3 forms - all hypoesthetic
    • tuberculoid form: mild, confined to skin and peripheral nerves
      • ceseating granulomas (necrotic): tuberculoid granulomas:
        • ​on buttocks / back / extremities / face
    • lepreomatous form: severe, in cool superficial locations:
      • non-caseating granulomas: surrounded by foamy macrophages
    • ENL (erythema nodosum leprosum): major cause of blindness
  • complications:
    • possible orchitis
    • erythema nodosum lepromus - a reaction to therapy for leprosy / hansens
      • = ​panniculitis: red, hot painful papules
  • prevention: BCG vaccine
20
Q

compare and contrast the etiological agents of

  • cutaneous tuberulosis
  • leprosy / hansen’s disease
A
  • both are acid fast aerobic bacillus
    • m. tuberulosis:
      • NOT an obligate intracellular pathogen
      • growth NOT restricted at 37 C
    • m. leprae is
      • obligate intracellulate
      • growoth restricted at 37 C
21
Q

what type of mycobacterium infection leads thickened dermis with no visible lesions?

A

diffuse lepromatus

22
Q

treatment of leprosy / hansen’s can lead to what reaction?

how does it present?

A
  • erythema nodosum (panniculitis): lesions that are
    • red
    • hot
    • painful
23
Q
A

endemic opportunistic cutaneous mycosis -> granulomas -> erythema nodosum

coccidioies - thick-walled spherules containing endospores

m/c in SW: CA, AZ, NM, TX

24
Q
A

endemic opportunistic cutaneous mycosis -> granulomas -> erythema nodosum

coccidioies - culture (mold): arthroconidia

m/c in SW: CA, AZ, NM, TX

25
Q
A

endemic opportunistic cutaneous mycosis

blastomycosis: broad-based budding yeasts

in N&C america: missippi, ohio, great lakes

26
Q
A

endemic opportunistic cutaneous mycosis

blastomycosis: culture (mold) - hyphae with lollipop microconidia

in N&C america: missippi, ohio, great lakes

27
Q
A

endemic opportunities cutaneous mycosis

histoplasmosis: narrow based budding in chains

N&C america - Missippo, Ohio, Great lakes AND from bat droppings

28
Q
A

endemic opportunities cutaneous mycosis

histoplasmosis: culture (mold) tubuerlate macroconidia

N&C america - Missippi, Ohio, Great lakes AND from bat droppings

IDIS (12 decks)

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