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Harrison's 19th Ed > Derma > Flashcards

Derma Flashcards

1
Q

Woods lamp

A 
Coral pink- erythrasma by corynebacterium minutissimun 
Pale blue- pseudomonas
Yellow fluorescence - tinea caputis 
Freckles- lesions are accentuated 
PIH - lesions fade under woods light 
Vitiligo - white 
Ash leaf spots- tuberous sclerosis
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2
Q

Multinucleated epithelial giant cells

A

HSV or VSV

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3
Q

KOH preparation

A

Hyphae- dermatophyte infection
Pseudohyphae with budding - candida
Spaghetti and meatball- tinea versicolor

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4
Q

Tzank smear-

A

herpesvirus infections, varicella zoster virus

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5
Q

Patch testing

A

Back
After 48 hourse
Detect delayed hypersensitivity

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6
Q

Eczema

A

Final common expression of some disorders
Common histology: spongiosis (intercellular edema of the epidermis)
Varied clinical findings

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7
Q

Most common location of seb derm

A

Scalp

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8
Q

Location of seb derm in the face

A

Eyebrows
Eyelids
Glabella
Nasolabial folds

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9
Q

Treatment seb derm

A

Low potency topical steroids plus anifungal agent (ketoconazole cream)
Antidandruff shampoo
High potency steroids for severe scalp involvement

Do not use topical steroids on the face! —> steroid induced rosacea or atrophy

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10
Q

Koebner phenomenon

A

Traumatized lesions develop lesions of psoriasis

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11
Q

Most common variety of psoriasis

A

Plaque type

Stable slowly enlarging plaques, remain unchanged for long periods of time

Most commonly involved areas: elbows knees gluteal cleft scalp

Symmetric involvement

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12
Q

Type of psoriasis which affect intertriginous areas

Axilla groun submammary region, navel

A

Inverse psoriasis

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13
Q

Most common type of psoriasis in children

A

Guttate (eruptive) psoriasis

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14
Q

Pustular psoriasis

A

Localized to palms and soles or generalized

erythematous skin w variable scale and pustules

Treatment of choice: oral retinoids

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15
Q

Eczema and Dermatitis

A 
Atopic Derm
Lichen Simplex Chronicus 
Contact Derm (Irritant and allergic derm) 
Hand eczema 
Nummular eczema 
Asteatotic eczema 
Stasis derm and ulceration 
Seb derm
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16
Q

Papulosquamous disorders

A

Psoriasis
Lichen planus
Pityriasis rosea

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17
Q

Purple polygonal papules
Severe pruritus
Lacy white markings
Assoc w mucous membrane lesions

Histo feature: interface dermatitis

A

Lichen planus

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18
Q

Acanthosis

Vascular proliferation

A

Psoriasis

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19
Q

Rash preceded by herald patch

Oval to round plaques with trailing scale

Affects trunk

Eruption lines in skin foldings “fir tree like appearance”

Spares palms and soles

A

Pityriasis rosea

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20
Q

Tx for psoriasis

A

Mid potency topical steroids
Long term use: tachyphylaxis and atrophy of the skin

Topical Vit D analogue (calcipotriene) and retinoid - limited psoriasis

UV light- widespread psoriasis
Mutagenic, increasing the risk for melanoma and nonmelanoma skin cancer
-contraindicated in patients receiving cyclosporine

STEROIDS- do not use! May develop life threatening pustular psoriasis

Methotrexate
Cyclosporine - calcineurin inhibitor
TNF inhibitors (etanercept adalimumab infliximab golimumab ustekinumab)

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21
Q

Mainstay of therapy Lichen Planus

A

Topical glucocorticoid

Most patients have spontaneous remission 6months to 2 years after onset of disease

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22
Q

Superficial bacterial infection of the skin commonly caused by S aureus, sometimes by B hemolytic strep

Pustule that forms characteristic yellow brown honey colored crust

A

Impetigo

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23
Q

Deep non bullous variant of impetigo that causes punched out ulcerative lesions

Caused by primary or secondary infection w S pyogenes

Deeper infection than impetigo that resolves w scars

A

Ecthyma

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24
Q

Boil/ furuncle
Caused by Staph aureus

Treated with beta lactam antibiotics

Warm compress
Nasal mupirocin

A

Furunculosis

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25
Q

Fungi that infect skin, hair, nails

A

Dermatophytes

Include members of the genera trichiophyton, microsporum and epidermophyton

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26
Q

Most common dermatophyte infection

A

Tinea pedis

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27
Q

Tinea cruris

A

Dermatophyte infection the groin

Males > female

Scaling erythematous eruption sparing the scrotum

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28
Q

Most common involved area in tinea pedia

A

Web space between 4th and 5th digit

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29
Q

Tinea unguium or onychomycosis

A

Occurs w tinea pedis

Opacified thickened nails and subungal debris

Distal lateral variant is most common

Proximal subungal onychomycosis - marker for HIV infection and other immunocompromised states

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30
Q

Tinea capitis

A

Predominantly caused y trichophyton tonsurans

Kerion- caused by T tonsurans, markedly inflammatory dermatosis with edema and nodules

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31
Q

Diagnosis of tinea

A

Skin scrapings
NAil scrapings
Hair

Culture or direct microscopic examination W KOH

Nail clippings may be sent for PAS stain

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32
Q

Cutaneous neoplasms caused bu papillomaviruses

A

Warts

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33
Q

Typical wart

A

Verruca vulgaris

Sessile dome shaped

Causative agent also cause plantar warts (verruca plana) and filiform warts

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34
Q

HPV types that are major risk factors for intraepithelial neoplasia and squamous cell carcinoma of the cervix anus vulva and penis

A

HPV 16 and 18

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35
Q

Most useful and convenient method for treating warts in almost any location

A

Cryotherapy with liquid nitrogen

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36
Q

Treatment for genital warts

A

Podophyllin solution - moderately effective but associated with marked local reactions

Topical imiquimod - potent inducer of local cytokine release

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37
Q

Clinical hallmark of acne vulgaris

A

Comedone
White- closed
Black- open

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38
Q

Systemic medications that can produce acneiform eruptions/ exacerbate preexisting acne

A 
Oral contraceptive pills
Lithium 
Isoniazid 
Androgenic steroids 
Halogens 
Phenytoin 
Phenobarbital
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39
Q

Treatment for acne vulgaris

A

Minimal to moderate pauci-inflammatory disease : local therapy
Retinoic acid benzoyl peroxide salicylic acid
Adjuncts: topical azelaic acid erythromycin clindamycin or dapsone

Moderate to severe acne with prominent inflammatory component : systemic therapy
Tetracycline 250-500 mg bid or doxycycline 100mg bid

Severe nodulocystic acne : isotretinoin (synthetic retinoid)
Side effects: teratogenic, depression, extremely dry skin, cheilitis, hypertriglyceridemia

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40
Q

Inflammatory disorder predominantly affecting the central face

seen almost exclusively in adults
More common in women

(+) erythema telangiectasia superficial pustules but not associated with comedones

Assoc w tendency for facial flushing

A

Acne rosacea

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41
Q

Rosacea can be associated with inflammatory eye involvement

Keratitis
Blepharitis
Iritis and recurrent chalazion

May be life threatening

A

Okay.

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42
Q

Treatment of acne rosacea

A

Topical for mild disease
Metronidazole, sodium sulfacetamide, azeleic acid

Oral for more severe disease
Tetracycline 250-500 bid
Doxycyline 100 bid
Minocycline 50-100 bid

Telangiectasia- laser therapy

Topical steroids- AVOID, may elicit rosacea

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43
Q

Meds that cause pityriasis rosea-like drug eruptions

A

Beta blockers
ACE I
Metronidazole

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44
Q

Meds that cause lichenoid eruption

A 
Thiazides
Antimalarials
Quinidine 
Beta blockers 
ACEIs
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45
Q

Secondary syphilis derm lesions

A

Scattered red brown papules w thin scale
Involves palms and soles
Can resemble ptyriasis rosea

Interval bet primary chancre and secondary stage: 4-8 weeks

Spontaneous resolution without therapy occurs

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46
Q

When majority if skin surface is erythematous

A

Erythroderma

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47
Q

Major etiologies of erythroderma

A

Cutaneous disease (psoriasis and dermatitis)
Drugs
Systemic disease- most commonly CLTL
Idiopathic

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48
Q 
Erythroderma 
\+ 
Fever and peripheral eosinophilia 
Facial swelling hepatitis 
Myocarditis thyroiditis allergic interstitial nephritis
A

DRESS

DIHS (drug induced hypersensitivity reaction)

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49
Q

Most common malignancy associated with erythroderma

A

CTCL

Cutaneous t cell lymphoma

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50
Q

Major forms of alopecia

A

Scarring and non scarring

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51
Q

Scarring alopecia

A

Assoc w fibrosis inflammation and loss of hair follicles

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52
Q

Non scarring alopecia

A

Hair shafts minimized or absent

Preserved hair follicles

Reversible nature

Causes common
Androgenic alopecia 
Telogen effuvium 
Alopecia areata 
Tinea capitis 
Early phase of traumatic alopecia

Uncommon causes
SLE
2ndary syphilis

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53
Q

Drugs that cause alopecia

A 
Warfarin 
Heparin 
PTU 
Carbimazole 
Isotretinoin 
Acitretin 
Lithium 
Beta blockers 
Interferons 
Colchicine 
Amephetamines
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54
Q

Alopecia in SLE

A

Scarring - secondary to discoid lesions

Non scarring - flares of systemic disease
May involve entire scalp or just the front cap

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55
Q

Alopecia in secondary syphilis

A

Scattered poorly circumscribed patches of alopecia with a moth east appearance

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56
Q

Firgurate skin lesion
Numerous mobile concentric arcs and wavefronts that resemble the grain in wood

Search for malignancy!

A

Erythema gyratum repens

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57
Q

Cutaneous manifestation of lyme disease

A

Erythema migrans

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58
Q

Pustular lesion

Large areas of erythema studded with multiple sterile pustules in addition to neutrophilia

A

Acute generalized exanthematous pustulosis (AGEP)

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59
Q

Telangiectasia

Reticulated hypo and hyperpigmentation

Wrinkling secondary to epidermal atrophy

Telangiectasias

Seen in skin damaged by ionizing radiation and in autoimmune(dermato)

A

Poikiloderma

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60
Q

Telangiectasia in SSc

Face, oral mucosa and hands

A

Mat telangiectasia

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61
Q

Periungal telangiectasias are pathognomonic of which autoimmune connective tissue diseases?

A

SLE
Dermatomyositis
Systemic sclerosis

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62
Q

AV malformations of the dermal microvasculature

Eccentric punctum with radiating legs when skin is stretched over the lesion

Appears during adolescence and adulthood

Major symptoms of GI bleeding and epistaxis

A

Hereditary hemorrhagic telangiectasia (Osler Rendu Weber Disease)

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63
Q

Autoantibody mediated intraepidermal blistering diseases

A

Pemphigus

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64
Q

Loss of cohesion between epidermal cells

A

Acantholysis

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65
Q

Separation of the epidermis on manual pressure to the skin

A

Nikolsky’s sign

66
Q

Mucocutaneous blistering disease that predominantly occures in patients > 40 years

Typically begins on mucosal surfaces then progress to involve the skin

A

Penphigus vulgaris

67
Q

Biopsy of PV

A

Intraepidermal vesicle formation secondary to loss of cohesion between epidermal cells

Basal keratinocytes remain attached to epidermal basement membrane

68
Q

Autoantibodies of PV

A

IgG autoantibodies to desmogelins (Dsgs)

Early PV - IgG to Dsg3

Advanced PV- Ig autoantibodies to Dsg3 and Dsg1

69
Q

Bad prognostic factors for PV

A

Advanced age
Widespread involvement
Requirement for high doses of steroid with or without other immunosuppresives for control of disease

70
Q

Treatment of PV

A

Mainstay is systemic steroids

Moderate to severe PV: prednisone 1mg/k/d

Immunosuppressive
Azathioprine 2-2.5 mkd
MMF 20-35 mkd
Cyclophosphamide 1-2 mkd

Severe, treatment resistant:
Plasmapheresis
IV immunoglobulin
Rituximab

71
Q

Pemphigus folaceaus vs PV

A

More superficial blistering
Mucous membranes almost always spared

IgG autoantibody: IgG to Dsg1

72
Q

Subspidermal blisters

Lower abdomen groin flexor surfaces

Major histocompatibility complex HLA BQB1*0301

A

Bullous pemphigoid

73
Q

Antibodies of Paraneoplastic pemphigus

A

IgG to cytoplasmic proteins wc are members of the plakin family and cell surface proteins that are members of cadherin family

74
Q

Neoplasms assoc with paraneoplastic pemphigus

A 
NHL 
CLL 
Thymoma 
Spindlecell tumors 
Waldenstorm’s macroglobulinemia 
Castleman’s disease
75
Q

Pemphigus blistering disease

Assoc w thymoma and myasthenia gravis

Drug induced pemphigus

A

Pemphigus foliaceus

76
Q

Antibodies in bullous pemphigoid

A

Linear deposits of IgG and C3 in epidermal basement membrane

77
Q

Treatment of bullous pemphigoid

A

Systemic glucocorticoids

Severe, more extensive lesions: high dose steroids plus immunosuppressives

Azathioprine
Mycophenolate mofetil
Cyclophosphamide

78
Q

Intensely pruritic papulovesicular disease

Symmetrically distributed over extensor surface

Alsmost all casess associated with gluten sensitive enteropathy

A

Dermatitis herpetiformis

79
Q

IF findings of dermatitis herpetiformis

A

Granular deposits of IgA

Biopsy of small bowel: blunting of intestinal villi and lymphocytic infiltrate of lamina propria

80
Q

Mainstay of treatment of DH

A

Dapsone 50-200 mg/d

Response: withing 24-48 hiurs

Wof: hemolysis and methemoglobinemia in doses > 100mg/d

81
Q

Similar to dermatitis herpetiformis

But no assoc enteropathy

A

Linear IgA disease

82
Q

Treatment of linear IgA disease

A

Dapsone

Not responsive to gluten free diet

83
Q

Cutaneous signs of dermatomyositis precede or follow myositis by weeks to years

A

Ok

84
Q

Most common manifestation of DM

A

Purple red discoloration of eyelids

Heliotrope rash

85
Q

Violaceous flat topped papules over the doral interphalangeal joints

Pathognomonic of dermatomyositis

Occurs in 1/3 of dermatomyositis patients

A

Gottron’s papules

86
Q

Thin violaceous papules and plaques on the elbows and knees of patients with dermatomyositis

A

Gottron’s sign

87
Q

In long standing dermatomyositis

Areas of hypopigmentaion, hyperpigmentation mild atrophy and telangiectasia

A

Poikiloderma

Rare in sle and scleroderma- may distinguish DM

88
Q

SLE cutaneous manifestation

A

Acute
Subacute
Chronic discoid types

89
Q

Butterfly rash
Sudden in onset
Associated w exacerbation of SLE

A

Acute cutaneous LE

90
Q

IF findings in acute cutaneous LE

A

Deposits of immunoglobulins and complement of epidermal basement membrane zone

91
Q

Treatment acute cutaneous LE

A

Control of systemic disease

Photoprotection

92
Q

Widespread photosensitive nonscarring eruption

Resembles psoriasis

Papulosquamous form and annular form

+ anti Ro antibodies

A

Subacute lupus erythematosus

93
Q

Treatment of SCLE

A

Aminoquinoline antimalarial drugs

Photoprotective measures

94
Q

Chronic cutaneous LE

Discrete lesions in the face scalp and/or external ears

Erythematous papules pr plaques with thick adherent scale that occludes hair follicles

Perists for years and expand slowly

Carpet tracking when scales are removed - relatively specific finding

A

Discoid lupus erythematosus

95
Q

Progression of skin lesions of scleroderma

A

Commences distally on the fingbers and spreads proximally accompanied by resorption of bone of the fingertips

96
Q

Clinical features of scleroderma

A

Contractures
Calcinosis cutis

Smooth unwrinkled brotaut skin over the nose
Shrinkage of tissue around the mouth
Perioral radial furrowing

Matlike telangiectasia

97
Q

Cold induced blanching cyanosis and reactive hyperemia

White blue red

A

Raynaud’s phenomenon

98
Q

Localized thickening and sclerosis of skin

Predominantly on the trunk

Begins as erythematous or flesh colored plaques that become sclerotic w centrl hypopigmentation

A

Morphea

May be localized or generalized

Skin biopsy indistinguishable from scleroderma

99
Q

Treatment of morphea

A

Physical therapy to prevent contractions

Phototherapy

Methotrexate +- glucocorticoids

100
Q

Most frequent cutaneous drug reactions

A

Morbilliform rash

Urticaria

101
Q

Immediate drug reactions

A

Release of mediators of inflammation by tissue mast cells or circulating basophils

Histamine 
Leukotrienes 
Prostaglandins 
Braykinins 
Platelet activating factor 
Enzymes proteiglycans

IgE mediated

102
Q

Meds/drus that cause direct mast cell degranulation or anaphylactoid reactions

A

NSAIDs

Radiocontrast media

103
Q

Mot frequent cause of IgE dependent reactions to drugs

Require prior sensitization

A

Penicillins

Muscle relaxants in general anesthesia

104
Q

Tissue deposition of circulating immune complexes w consumption of complement

Characterized by fever, arthritis, nephritis, neuritis, edema, urticarial, papular or purpuric rash

A

Serum sickness

105
Q

Drugs that can cause serum sickness

A 
Cephalosporins 
Monoclonal antibodies (infliximab, rituximab, omalizumab)

Develop 6 days or more after exposure to a drug

106
Q

Classsification of adverse drug reactions

A

Type I
IgE, urticaria angioedema anaphylaxis

Type II
IgG mediated
Drug induced hemolysis, thrombocytopenia

Type III
Immune complex
IgG+ antigen
Vasculitis, serum sickness, drug induced lupus

107
Q

Classification of adverse drug reactions

A

IVa
T lymphocyte- mediated macrophage inflammation
Tuberculin skin test, contact dermatitis

IVb
T lymphocyte-mediated
Eosinophil inflammation
Drug induced hypersensitivity syndrome (DIHS) , morbilliform reaction

IVc
T lymphocyte-mediated
Cytotoxic T lymphocyte inflammation
SJS/TEN, morbilliform eruption

IVd
T lymphocyte mediated neutrophil inflammation
Acute generalized exanthematous pustulosis (AGEP)

108
Q

Drugs that exacerbate plaque psoriasis

A 
NSAIDs 
Lithium 
Beta blockers 
TNF Antagonists 
IFN 
ACE I
109
Q

Drugs that worsen pustular psoriasis

A

Antimalarials

Withdrawal of systemic glucocorticoids

110
Q

Drug that treats psoriasis but can induce psoriasis in other conditions (esp palmar-plantar)

A

Anti TNF

111
Q

Associated with new onset SLE

A

IL2
IFN alpha
Anti TNF alpha

Assoc w anti histones

112
Q

Exacerbate subacute sle

A

Minocycline and thiazide diuretics

113
Q

Drug induced bullous pemphigoid

A

Furosemide

114
Q

Drug assoc w linear IgA bullous dermatitis

A

Vancomycin

115
Q

Can induce sweet syndrome and pyoderma gangrenosum

A

GCSF

116
Q

Drug related pseudoporphyria

A

NSAIDs

117
Q

Can cause melasma

A

Oral contraceptives

118
Q

Drug induced lipofuscinosis with characteristic red brown discoloration

A

Clofazimine

119
Q

Warfarin necrosis of the skin

A

Occurs during 3rd-10th day if therapy with warfarin

Breast thighs and buttocks

In heterozygous protein C deficiency

120
Q

Treatment of warfarin induced necrosis

A

Vitamin K
Heparin
Surgical debridement
Intensive wound care

121
Q

Anagen vs telogen effluvium

A

Anagen - growth
Within days of drug administration

Telogen - resting
2-4 months following initiation of new medication

Non scarring alopecia, reversible

122
Q

Drugs that cause hair loss:

A

Anti neoplastic drugs - alkylating agents, bleomyci, vinca alkaloids, platinum compounds

Anticonvulsants- carbamazepine, valproate

Anihypertensive drugs- beta blockers

Antidepressants
Antithyroid drugs
Oral contraceptives
Cholesterol lowering agents

123
Q

Inflammation of periungal skin

A

Paronychia

124
Q

Transverse depression of the nail plate

A

Beau’s lines

125
Q

Detachment of distal part of the nail plate

A

Onycholysis

126
Q

Detachment of proximal part of nail plate

Caused by temporary arrest of nail matrix mitotic activity

A

Onychomadesis

127
Q

Red man syndrome

Histamine related anaphylactoid reaction

Flushing diffuse maculopqpular eruption hypotension

A

Vancomycin

128
Q

Pruritus is a common complication of

A

Antimalarial therapy

But is associated with almost all drug eruptions

129
Q

Most common of all drug induced reactions

A

Morbilliform or maculopapular eruptions

Develop within 1 week of initiation of therapy and last less than 2 weeks

130
Q

Drugs that carry high rates of morbilliform reaction

A

Nevirapine and Lamotrigine

131
Q

Second most frequent type of cutaneous drug reaction

A

Urticaria

Pruritic red wheals lasting more than 24 hrs

Most frequently with
ACE I , aspirin NSAIDS penicillin and blood products

132
Q

Mechanisms of drug induced urticaria

A

IgE dependent
Occurs within 36 hours of drug exposure

Circulating immune complexes
Assoc w serum sickness like reactions 6-12 days after first exposure

Non immunologic activation of effector pathways

133
Q

Characterized by one or more sharply demarcated, dull red to brown lesions sometimes with central bulla

Lesion appears in the same location upon rechallenge of the drug

Lesions often involve the lips, hand, face, genitalia, and oral mucosa

A

Fixed Drug Eruptions

134
Q

Drug that induces a cutaneous vasculitis accompanied by leukoplenia and splenomegaly

IF: immune-complex deposition

Allopurinol thiazides sulfonamides antimicrobials NSAIDs

Presence of eosinophils in perivascular infiltrate

A

PTU

135
Q

TEN vs AGEP

A

Skin biopsy:
AGEP
Neutrophil collection and sparse necrotic keratinocytes in the upper part of the epidermis

TEN
full thickness epidermal necrosis

136
Q

Most common cause of drug induced hypersensitivity syndrome

A

Allopurinol

With renal involvement

137
Q

Reactivation of what viruses is seen in drug induced hypersensitivity syndrome?

A

Herpes virus 6
EBV
Herpes viruses

Associated with worse outcomes

138
Q

Treatment of drug induced hypersensitivity syndrome

A

Systemic glucocorticoids 1-2 mkd

Slow taper over 8-12 weeks

Others:
MMF

139
Q

Other organ involvement in DIHS

A

Minocycline- cardiac and lung involvement

Abacavir - GI involvement

140
Q

SJS and TEN

A

Full thickness epidermal necrosis
Without substantial dermal inflammation

SJS <10%
10-30 dettachment SJS/ TEN overlap syndrome
TEN >30% overlap

141
Q

Drugs that cause SJS/ TEN

A 
Sulfonamides 
Nevirapine
Allopurinol 
Lamotrigine 
Aromatic anticonvulsants 
NSAIDs
142
Q

Characteristic times of onset to drug reaction

A

Morbilliform eruptions - 4-14 days

AGEP 2-4 days

SJS/TEN - 5-28 days

DIHS - 14-48

143
Q

Vasculopathy plus intravascular thrombosis

Associated with venous hypertension

A

Livedoid vasculopathy

144
Q

Most commonly found on lower extremities

Ulcerative lesion withc characteristic appearance of undermined necrotic violaceous edge and peripheral erythematous halo

Most common associated conditions: ulcerative colitis and crohn’s disease

A

Pyoderma gangrenosum

145
Q

Size of purpura vs petechiae

A

Petechiae 2 mm and below

Purpura 3 mm and above

146
Q

Classification of purpura

A

Palpable

Nonpalpable 
Most commonly primary cutaneous disorders 
Trauma 
Solar - extensor surfaces forearms
Capillaritis - lower extremities 
Steroid induced- more widespread
147
Q

Purpura assoc with thrombi formation within vessels

A 
DIC 
monoclonal cryoglobinemia 
Thrombocytosis 
TTP 
APS 
Reaction to warfarin and heparin
( warfarin induced necrosis, seen more often in women, and in areas with abundant subcutaenous fat)
148
Q

Waldenstrom’s hypergammaglobulinemic purpura

A

Chronic disorder
Petechiae on lower extremitties
Circulating complexes of IgG-Anti IgGmolecules

Exacerbations in prolonged standing

149
Q

Palpable purpura classification

A

Vasculitic and embolic

150
Q

Vasculitis most commonly associated with palpable purpura

A

Leukocytoclastic vasculitis

LCV

151
Q

Subtype of acute LCV

More commonly in children and adolescents after URTI

Majority are lower extremity lesions, involve thw buttocks

Deposits of IgA within dermal blood vessels

A

Henoch schonlein purpura

152
Q

Vasculitic vs embolic purpura

A

Vasculitis- circular edge/ borders

Emboli- irregular border

153
Q

Common causes of infectious emboli

A 
Gram negative cocci (meningococcus, gonococcus) 
Gram neg rods (enterobacteriaceae) 
Gram positive cocci (staph) 
Rickettsia 
Aspergillus
154
Q

Lesions that begina as edematous erythematous papules or plaques then develop central purpura and necrosis

Classically associated with Pseudomonas aeruginosa but can be caused by Klebsiella, Eschirichia and serratia

A

Ecthyma gangrenosum

155
Q

Subdivision of erythema multiforme

A

EM minor
- due to HSV

EM Major

  • due to HSV, mycoplasma pneumoniae, drugs
  • mucous membrane involvement
  • hemorrhagic crusts of the lips are characteristic
156
Q

SSSS is distinguished from TEN by the following features:

A

younger age group (primarily infants),
more superficial site of blister formation,
no oral lesions,
shorter course,
lower morbidity and mortality rates, and
an association with staphylococcal exfoliative toxin (“exfoliatin”), not drugs

157
Q

Blistering disorders associated w staphylococcal infection

A

SSS

Bullous impetigo

158
Q

Clinical manifestation of SSS

A

initial findings are redness and tenderness of the central face, neck, trunk, and intertriginous zones. This is followed by short-lived flaccid bullae and a slough or exfoliation of the superficial epidermis. Crusted areas then develop, characteristically around the mouth in a radial pattern

159
Q

SSSS Vs bullous impetigo

A

In SSSS, the site of staphylococcal infection is usually extracutaneous (conjunctivitis, rhinorrhea, otitis media, pharyngitis, tonsillitis), and the cutaneous lesions are sterile, whereas in bullous impetigo, the skin lesions are the site of infection.

Impetigo is more localized than SSSS and usually presents with honey-colored crusts

160
Q

There are several types of porphyria, but the most common form with cutaneous findings is

A

porphyria cutanea tarda (PCT)

Harrison's 19th Ed (13 decks)

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