Dermatology ✋🏻 Flashcards

Question

Protection function of skin

Answer 1

- Skin is rich in blood vessels, through their constriction or dilatation heat loss is decreased or increased. - Evaporation of sweat. - Fat in subcutaneous tissue is poor conductor & prevents heat loss

Answer 2

- Examples of feelings reflected by skin: fear, shame & anger.

Answer 3

- Skin plays an important role in the immunological processes.

Answer 4

- from ergosterol by ultraviolet rays

Answer 5

Examples of which excreted by skin: NaCl, lactic acid, ammonia & some drugs.

Answer 6

Examples of sensations precipitated by skin: heat, cold, pain and touch.

Answer 7

Increased thickness of the horny layer

Answer 8

- Immature keratinization resulting in retention of nuclei in the cells of the horny layer.

Answer 9

Increased thickness of the prickle cell layer.

Answer 10

- Intercellular oedema in the prickle cell layer

Answer 11

- Loss of coherence between epidermal or epithelial cells.

Answer 12

- Preliminary History - Examination - Follow up history - Investigations

Answer 13

- Skin examination must be done in good light. - It should involve oral mucous membrane, hair, nails and lymph nodes. - The following points should be noticed during examination. 1. Distribution 2. Configuration 3. Morphology of individual lesion

Answer 14

- Linear - Circinate - Polycyclic (geographic) - Grouped - Discrete - Dermatomal - Koebner phenomenon

Answer 15

❶ Lichen planus ❷ Warts ❸ Psoriasis

Answer 16

❶ Tinea circinata ❷ Pityriasis rosea ❸ Impetigo ❹ Psoriasis

Answer 17

❶ Psoriasis ❷ Urticarial

Answer 18

❶ Warts ❷ Molluscum contagiosum ❸ Herpes simplex.

Answer 19

- Chicken pox.

Answer 20

❶ Herpes zoster ❷ Dermatomal vitiligo

Answer 21

Lesions appear in an area of trauma which is often linear as in: - Psoriasis - plane wart - lichen planus - vitiligo - Molluscum contagiosum.

Answer 22

Macule > 1 cm

Answer 23

- Circumscribed area of change in skin color without change of its texture up to 0.5 cm in diameter

Answer 24

- Similar to papule but deeply seated and > 0.5 cm in diameter

Answer 25

- solid palpable elevated lesion up to 0.5 cm in diameter

Answer 26

- Lichen planus, psoriasis, warts, prurigo, molluscum contagiosum

Answer 27

- Circumscribed area of abnormal skin formed by extension or coalescence of either papules or nodules.

Answer 28

- Lupus vulgaris, Lepromatous leprosy.

Answer 29

sac filled with expressible material either liquid or semisolid

Answer 30

**Shape:** flat topped, dome shape, umbilicated, conical, polyangular. **Color:** Skin colored, red, violet, brown, white or yellow. **Surface:** Smooth, rough, scaly, crusty.

Answer 31

Psoriasis, lupus vulgaris.

Answer 32

Cystic acne

Answer 33

- Localized visible collection of fluid up to 0.5 cm in diameter.

Answer 34

- Herpes simplex. - Herpes zoster.

Answer 35

- Localized visible collection of fluid > 0.5 cm in diameter.

Answer 36

- Bullous impetigo - Pemphigus

Answer 37

- Localized visible collection of pus. (It may be 1ry lesion)

Answer 38

- Pustular psoriasis - 2ry to bacterial infection of viral vesicle.

Answer 39

- Dried fluid (serum, blood. or pus) on the skin surface.

Answer 40

- Flat plate of horny layer formed by accumulation of excess keratin.

Answer 41

- Scales may be dry or greasy, large or small. - It may occur in many inflammatory diseases such as seborrheic dermatitis or psoriasis

Answer 42

- Evanescent elevated oedematous erythematous lesion. - Evanescent means that the lesion does not persist more than 48 hours.

Answer 43

- formed by dermal or dermal & hypodermal edema.

Answer 44

- Wheal is the 1ry lesion of urticaria.

Answer 45

Plug of keratin and sebum in a dilated pilosebaceous orifice.

Answer 46

When the plug is Superficial ---> open (black) comedo. Deep ----> closed (white) comedo.

Answer 47

- Comedo is the 1ry lesion of acne vulgaris.

Answer 48

- Superficial tunnel in the skin caused by mite that appears as black dot at the end of the burrow.

Answer 49

- It is tortuous, straight or S shaped skin coloured or grayish and 0.5-1.5 cm in length.

Answer 50

- It is the 1ry lesion of scabies.

Answer 51

- Loss of hair from a normally hairy area.

Answer 52

**Atrophic scar**: with thin and wrinkled skin. **Hypertrophic scar**: with elevated skin

Answer 53

- Skin biopsy - Dermoscopy - fungus lesions (Wood's light, Culture, M/E) - Patch test - Oral provocation test

Answer 54

Skin biopsy

Answer 55

(epiluminescence) using dermoscope: - Dermoscopes have built-in illumination, and are applied to the skin surface to enhance visibility of subcorneal structures.

Answer 56

❶ Doubtful pigmented lesions ❷ Other lesions such as scabies burrows ❸ Many skin neoplasms

Answer 57

- Wood's light - Culture - M/E

Answer 58

- On Sabouraud's agar media.

Answer 59

- Topical therapy plays a major role in dermatologic treatment. - It has many advantages, the most important of which is that: ❶ The active agent reaches the lesion directly and in a sufficient concentration ❷ slight or no systemic side effects.

Answer 60

Any topical preparation consists of 2 components: ❶ Active agent: e.g., antibiotics, corticosteroids. ❷ Vehicle (base): Vehicles may have some therapeutic effects and sometimes may be used alone without the addition of active agent.

Answer 61

- Example: water, alcohol, Ca hydroxide & glycerin. They are used in the preparation of solutions, lotions, tinctures, paints, creams

Answer 62

- **Ideally a vehicle should be:** Non-toxic, non-irritant and non-allergic. - **Forms of Vehicles:** Liquids, powders, creams or ointments.

Answer 63

- Usually applied to normal skin folds to reduce friction.

Answer 64

- Semisolid emulsion of oil in water. - They are used in subacute condition

Answer 65

- Greasy base used for dry hyperkeratotic or lichenified skin disease

Answer 66

- Non-greasy transparent, semisolid emulsions that liquefy on contact with the skin, drying as a thin greaseless, non-staining film. - They are suitable for treating hairy areas

Answer 67

Topical corticosteroids are commonly prescribed for treatment of many skin diseases including: ❶ Atopic dermatitis ❷ Discoid eczema ❸ Contact dermatitis, seborrheic dermatitis ❹ Psoriasis ❺ Lichen planus ❻ DLE (discoid lupus erythematous) ❼ Vitiligo ❽ Alopecia areata, and many others.

Answer 68

Topical steroids are available in the form of: - Creams - Ointment - Lotion It can be mixed with salicylic acids, calcipotriene, antifungal, or antibiotics. Many OTC (over the counter preparations) are also available containing TCS, antifungal, and antibacterial.

Answer 69

- Clobetasol propionate 0.05% [Dermovate ®]

Answer 70

- Mometasone furoate 0.1% (Elocon , Elica) - Betamethasone dipropionate (Diprosone)

Answer 71

- Betamethasone valerate (Betnovate, Betaderm, Betaval)

Answer 72

- Hydrocortisone butyrate (Texacort) - Prednicarbate (Dermatop) - Alclometasone dipropionate 0.05% (perderm, weak) - **Hydrortisone acetate (the weakest TCS)**

Answer 73

- Momenta (contain potent TCS) - Kenacomb, quadriderm, pandermal (contain moderately potent TCS) - Fucicort cream, Fusizon cream (contain moderately potent TCS) - Daktacort (contain hydrocortisone)

Answer 74

- Growth retardation in children - Iatrogenic Cushing syndrome.

Answer 75

- **prolonged use** of more potent steroids especially on: Delicate skin including child skin (any site), face, flexures, and genitalia. - Even hydrocortisone acetate can produce skin atrophy with prolonged use especially on thin skin

Answer 76

- TCS are used **once daily** in most of cases. - **Ultrapotent TCS and potent CS** should **not** be **prescribed** by **general practitioner**. - Any type of TCS should **not be prescribed without definite diagnosis**.

Answer 77

1- Being a dry mechanical barrier. 2- Its acidity. 3- Sebum secretion.

Answer 78

commonly attack skin appendages. - hair follicles. - sweat glands - periungual tissues.

Answer 79

skin proper

Answer 80

- Impetigo is a contagious superficial pyogenic infection of the skin - It represents the most common bacterial skin infection in children.

Answer 81

All, but Children are most often affected

Answer 82

- Staphylococcus aureus, - Streptococcus pyogenes (group A B-hemolytic Streptococcus spp.) - or both

Answer 83

1. Hot climate, high humidity, poor hygiene, overcrowding, skin trauma (minor abrasion), malnutrition. 2. Itchy skin diseases such as scabies, pediculosis, and atopic dermatitis. 3. Nasal carriers of S. aureus are at particular risk of developing impetigo.

Answer 84

- Shape & Color - Site - Systemic Manifestations - Complication

Answer 85

Thin vesicles on erythematous base -> pustules rapidly rupture -> thick yellowish-brown crust

Answer 86

- face, scalp or anywhere except palms & soles

Answer 87

Fever & regional lymphadenitis in severe cases only

Answer 88

- In the legs, thighs, and buttocks the lesion may form thick crust which if removed reveal a purulent irregular ulcer (ulcerative impetigo or ecthyma), that heals after few weeks with scarring - Glomerulonephritis in nephrogenic strains of streptococci

Answer 89

Spontaneous cure in 2-3 weeks or persist, The crust dries and separates leaving erythema without scar

Answer 90

- Staphylococcus aureus

Answer 91

- Impetigo is a contagious superficial pyogenic infection of the skin - It represents the most common bacterial skin infection in children.

Answer 92

All ages, especially newborn and young children

Answer 93

1. Hot climate, high humidity, poor hygiene, overcrowding, skin trauma (minor abrasion), malnutrition. 2. Itchy skin diseases such as scabies, pediculosis, and atopic dermatitis. 3. Nasal carriers of S. aureus are at particular risk of developing impetigo.

Answer 94

- Shape & Color - Site - Systemic Manifestations - Complication

Answer 95

Flaccid bullae (1-5 cm) persist for 2-3 days -> rupture "less rapidly" -> thin brownish crust

Answer 96

- Face, trunk buttocks, perineum, axillae & extremities (including palms and soles)

Answer 97

Regional adenitis is rare

Answer 98

- Peripheral extension with central healing may give rise to circinate lesion (circinate impetigo)

Answer 99

- Strept (mainly) & staph

Answer 100

- Spontaneous cure in 2-3 weeks or persist. The crust dries and separates leaving erythema without scar

Answer 101

- Topical - Systemic antibiotic - Treatment of predisposing factors

Answer 102

for mild and localized infection. - Removal of the crust by olive oil. - Antiseptic lotion, e.g., K. permenganate. - Antibiotics, e.g., e.g., Mupirocin 2%, 2% fucidic acid, or neomycin- bacitracin,

Answer 103

- **B-lactamase-resistant penicillin** (e.g.or dicloxacillin or amoxicillin/clavulinic acid) or flucloxacillin 1-1.5gm/d (infant, children 25-50mg/d) - **first-generation cephalosporin** (e.g. cephalexin or cefadroxil). - **Clindamycin or Azithromycin** if the patient is sensitive to penicillin. or erythromycin 1g/d (40mg/kg in infants and children)

Answer 104

- They are given for 7-10 days and are indicated in: 1. Extensive lesions. 2. Fever. 3. Regional lymphadenitis. 4. Bullous impetigo. 5. Nephrogenic strain of streptococcal impetigo

Answer 105

- When pediculosis is present, it should be treated topically after control of impetigo because pediculocidal drugs are toxic, so they are not applied on raw areas.

Answer 106

- Chronic S. aureus carriage (nasal and perianal colonization with S. aureus) - Diabetes mellitus - Seborrhea (increase secretion of sebaceous gland), obesity, poor hygiene, and malnutrition, anaemia. - Immunodeficiency states - Itchy dermatoses - Fatigue and emotional stress

Answer 107

- Diabetes mellitus. - Malnutrition. - Prolonged steroid therapy.

Answer 108

- Heal with scar - In some patients, crops of lesions continue to develop for many months or years.

Answer 109

**Cavernous sinus thrombosis, Septicemia, Pyemia** - Boils on the upper lip, bridge of the nose, and maxilla (danger triangle) may lead to cavernous sinus thrombosis if squeezed without incision.

Answer 110

- Penicillinase resistant penicillin. - Surgical incision & drainage of pus.

Answer 111

1. **Rest and antipyretic** (usually paracetamol) with leg elevation. 2. **Penicillin** for 10-14 days is the drug of choice. - Aqueous penicilin C: for severe cases 600,000-2000,000 unt IV/6hr. - Oral penicillin: for mild cases 250-500 mg/6hr. For 10days. - Benzathine P: for rec. cases. 1,200,000 U. I.M/2-4ws for ms or ys - Erythromycin: 1-2 gm/day for 10 days. 3. **Erythromycin:** is an alternative therapy for those who are allergic to penicillin. 4. **Antibiotics** that covers both strept and staph are recommended in cellulitis (e.g. dicloxacillin, cephalexin, clindamycin, or combinations).

Answer 112

- Inflammation of skin areas between folds

Answer 113

- Group A streptococci

Answer 114

- Usually affects infant and young children Obese adults may be also affected

Answer 115

- The condition is precipitated by continuous friction and irritation in moist, deep skin folds of the neck, axillae, antecubital and popliteal fossae, behind the ears, under the breast, groin, and natal cleft.

Answer 116

- Simple intertrigo due to continuous friction in the deep moist fold. - Candida intertrigo (satellite lesions are characteristic) - Flexural psoriasis (characteristic scales) - Erythrasma. - Dermatophyte infection. - Seborrheic intertrigo

Answer 117

- Sharply demarcated **(well-defined)**, intensely **erythematous patches** or thin plaques are observed - May occur in the depth of the affected flexure **especially behind the ears** - **Longitudinal painful fissure** at angle of skin folds, skin around is red, moist and may be crusted

Answer 118

- Topical antiseptic. - Topical & systemic antibiotic.

Answer 119

- Chronic superficial infection of the skin caused by Corynebacterium minutissimum.

Answer 120

1- Warm humid climate. 2- Obesity. 3- Diabetes mellitus.

Answer 121

- Affects adults > children.

Answer 122

* Well-defined red brown or brown scaly patches. * Asymptomatic or itchy.

Answer 123

intertriginous areas e.g., groins, axillae, intergluteal clefts, sub mammary areas, or generalized covering the trunk & limbs.

Answer 124

- Wood's light ---> Coral Red Fluorescence.

Answer 125

Infects 1/3 world population, since 1998 incidence is increasing due to - AIDS - Diabetes - Immune-Supressed patients - Drug resistance

Answer 126

Mycobacterium tuberculosis

Answer 127

Non motile, aerobic, acid-fast bacillus (AFB)

Answer 128

- Organism gains access to macrophage, replicate then ingested by new macrophages and continue cycle >> Spread >> Specific Tissue reaction (granuloma) > chronicity

Answer 129

Lupus vulgaris

Answer 130

- disease usually starts in childhood and progresses very slowly.

Answer 131

- **Well-defined reddish-brown plaque** composed of **soft nodules that appear yellowish brown (apple jelly nodules)If pressed with a glass slide (Diascopy test)** - The lesion **enlarges slowly over years** with formation of **scar which may contain active nodules**. - The **scars are thick & contractile. (atrophic)**

Answer 132

progressive but spontaneous healing may occur.

Answer 133

Chronic mycobacterial disease. - primarily affecting peripheral nerves - secondarily involving skin and other tissues

Answer 134

By Mycobacterium leprae - **Droplet infection** from the oronasal mucosa of patients having lepromatous leprosy. - Susceptible: Children > adults

Answer 135

Leprosy is classified into 3 types according to: ~ Clinical picture. ~ Histopathological examination of skin lesion. ~ Bacteriological examination of skin smear. ~ Lepromin test

Answer 136

- It is an intradermal test using autoclaved lepromatous tissue as antigen.

Answer 137

- The test is positive in person having a high degree of immunity. - It is NOT of diagnostic value, but is valuable in assessment of the prognosis.

Answer 138

The 3 types of leprosy are: 1. Tuberculoid leprosy (T.T.). (paucibacillary) 2. Borderline leprosy (B.B.). (mullibacillary) 3. Lepromatous leprosy (L.L.). (mullibacillary)

Answer 139

- develops in persons with good immunity.

Answer 140

- The skin and peripheral nerves are the only tissues affected.

Answer 141

- **Solitary or few (1-5 in number)**. - **Well defined, dry, hairless**, insensitive erythematous or **hypopigmented patch or plaque**. - **Loss of sensation** starts by loss of light touch followed by temperature and finally deep touch. - The lesions occur **anywhere with exception of scalp, axillae, groins & perineum**.

Answer 142

- The lesions occur **anywhere with exception of scalp, axillae, groins & perineum**.

Answer 143

- The disease may be **purely neural** showing **pain and swelling of the affected nerve.** - The **nerve becomes irregularly, thickened, beaded, tender** - The most frequent affected nerves are **ulnar, median, radial, great auricular and superficial peroneal.** - There are **atrophy of interosseous muscles of the hand, wasting of thenar & hypothenar eminences, contracture of the hands, foot drop & anaesthesia.** - **Repeated trauma and burns to the insensitive limbs** will result in **bone damage and resorption with subsequent mutilations**

Answer 144

tuberculoid infiltrate of Epithelioid cells & Lymphocytes

Answer 145

- Lepra bacilli are absent from skin lesion.

Answer 146

is strongly positive indicating high degree of cell mediated immunity

Answer 147

- develops in person with low immunity.

Answer 148

- skin, mucous membranes, eyes & testes are affected - Nerves affection is late.

Answer 149

- Consist of **symmetrically distributed multiple papules, nodules, plaques or rarely diffuse infiltration.** - lesions are **shiny erythematous, or of normal skin colour**. - **Hairs and sensations** over these lesions are **not impaired**. - **Exaggeration of the lines of the forehead** occurs, It becomes deeper as the skin thickened. - This, in addition to **thinning or loss of eyebrows** gives rise to a characteristic appearance **(leonine face)** - **Collapse of the nose** may result from septal perforation. - **Ear lobes** may become **thickened**.

Answer 150

- **papules and nodules** affecting lips, gums, palate, tongue, uvula & nasal mucosa. - Lesions of the **nasal mucosa** are associated with **epistaxis**.

Answer 151

Eyes may be involved resulting in - keratitis - iridocyclitis - iris atrophy.

Answer 152

if involved will cause - sterility - impotence - gynaecomastia.

Answer 153

dermis contains - foamy histiocytes with large number of leprae bacilli

Answer 154

Lepra bacilli are present in large number in: - skin lesion - nasal smear

Answer 155

- This type is immunologically unstable and usually evolves into one of the previous types.

Answer 156

- Lesions are intermediate in number between the two polar types. - The lesions are asymmetrically distributed and may take the form of nodules, plaques, annular lesions, and bizarre shaped bands. - Only the skin and nerves are affected.

Answer 157

- mixture of lepromatous and tuberculoid changes.

Answer 158

- Lepra bacilli are present in lesions but are fewer in number than in L.L.

Answer 159

- weakly positive or negative.

Answer 160

- Dermatophytes

Answer 161

Candida species

Answer 162

- **fungal infection of keratinous structures** (stratum corneum of skin, hair and nails) caused by a group of **keratinophilic filamentous fungi called dermatophytes**.

Answer 163

- Dermatophytes are keratinophilic fungi that grow only in dead keratinized tissue of stratum corneum of skin, within & around scalp hair and in nails **because they have keratinase enzyme that able to digest keratin.**

Answer 164

- According to their usual habitat - According to site of infection - Clinically

Answer 165

- Associated with humans only - Person to person through contaminated objects (clothes, combs, hats ,brushes and towels)

Answer 166

- Anthropophilic - Geophilic - Zoophilic

Answer 167

- Scalp infections like M.audouinii & T.tonsurans. - Foot and nail infections like Epidermophyton &T.rubrum

Answer 168

- Normally inhabit the soil. - Some species may cause infections in animals and man following contact with soil

Answer 169

- Agents of hair - Agents of skin - Agents of nails

Answer 170

- Associated with animals, Transmitted directly to humans by close contact with animals. - Not from human to human

Answer 171

1- microsporum canis (cats, dogs) 2- M.Equinium (hourses) 3- Trichophyton Verrucosum (cattle)

Answer 172

1. Trichophyton 2. Microsporum

Answer 173

1. Trichophyton 2. Microsporum 3. Epidermophyton

Answer 174

1. Trichophyton 2. Epidermophyton (rarely microsporum)

Answer 175

- Disease of children mainly, but it may affect adults also. - There are 4 types of tenia capitis

Answer 176

- Palms are diffusely dry, scaly & erythematous

Answer 177

- Non hairy, smooth skin (trunk-back dorsum of hand)

Answer 178

Lesion: include fissures, scales, maceration in toe web &scaling of sole **(athlete's foot)**

Answer 179

- children mainly, may affect adults - Nails are thickened, discoloured, lusterless & broken. - Nail plate may separate from nail bed aka (onycholysis)

Answer 180

- skin scrapping, nail scrapping or clipping, epilation of short length of affected hair.

Answer 181

- Direct microscopy - Culture - Hair perforation test

Answer 182

Lactophenol cotton blue (LPCB)

Answer 183

It may be helpful in differentiation of T. mentagrophytes from T. rubrum

Answer 184

- molecular diagnosis - Serology

Answer 185

PCR: detects fungal DNA frorn infected lesion. Also, species-specific primers are available.

Answer 186

- No role of serology in diagnosis X X. (Because it's a localized infection)

Answer 187

- Skin infection usually occur on **sites that becomes abnormally moist warm area** as axilla, groin, submammary fold and toe clefts. - (In infant >>napkin dermatitis).

Answer 188

- Usually finger or toe webs - Nail folds paronychia - Nail's onychia.

Answer 189

- Sabouraud's dextrose - CHROMagar Candida medium - Germ tube formation - Chlamydospores formation - Analytical profile index (API)

Answer 190

- On Sabouraud's dextrose agar at 25 or 37"C for 2 days

Answer 191

Superficial chronic infection of Stratum corneum

Answer 192

Discolouration is caused by inhibition of tyrosinase enzyme. (Used in melanin synthesis).

Answer 193

10-30% KOH: clusters of round yeast cell along non branched hyphae **(spagetti & meat balls appearance)**

Answer 194

- Malassezia furfur (Pityrosporum orbiculare) (Lipophilic yeast). - Present as normal flora in area rich in sebaceous gland.

Answer 195

- hortae (Exophiala) wernekii (pigmented) - Frequent in tropical areas

Answer 196

Brownish maculae on palms, fingers, face.

Answer 197

Fungal infection of the scalp hair

Answer 198

- Microscopic examination: Septate hyphae and yeast cells (brown in color) - Culture: black colonies.

Answer 199

Piedraia hortae

Answer 200

Frequent in tropical areas

Answer 201

Fungal infection of facial, axillary or genital hair.

Answer 202

trichosporon (yeast)

Answer 203

- Frequent in tropical and temperate zones

Answer 204

- Dermatophytes are the most common causative pathogen especially Trichophyton rubrum (about 70%). Other causes than dermatophytes include candida

Answer 205

- poorly absorbed from the GIT and is usually administered IV

Answer 206

- Amphotericin B binds ergosterol in fungal cell membrane >> form pores in cell membrane >>>cell content leak out>>> cell death

Answer 207

available as suspension, ointment, cream, powder and tablet (tablet for local use)

Answer 208

- only topically in Candida infections.

Answer 209

- They include nausea and bitter taste. - Category A in pregnancy

Answer 210

- Category A in pregnancy

Answer 211

**Topical:** - Miconazole - Clotrimazole **Systemic:** - Ketoconazole - Fluconazole

Answer 212

They are used topically for - Dermatophytic (tinea) - Candida infections.

Answer 213

They are available as - cream, gel, lotion - solution, spray - vaginal pessary, etc. - Clotrimazole lozenge is also available.

Answer 214

- It is orally effective - Ketoconazole is the most toxic among azoles, but it is less toxic than amphotericin B.

Answer 215

For oral and i.v. administration

Answer 216

Fluconazole is a drug of choice in - esophageal and - oropharyngeal candidiasis. A single oral dose usually eradicates vaginal candidiasis.

Answer 217

- All azoles inhibit the hepatic CYP450 3A4 isoenzyme to varying degrees. - Patients on concomitant medications that are substrates for this isoenzyme may have increased concentrations and risk for toxicity (e.g warfarin).

Answer 218

- Azoles are considered teratogenic, and they should be avoided in pregnancy unless the potential benefit outweighs the risk to the fetus

Answer 219

disulfiram-like reaction

Answer 220

- Active only against dermatophytes (orally,not-topically) - by depositing in newly formed keratin and disrupting microtubule structure

Answer 221

Inhibit the synthesis of beta-1,2 glucan

Answer 222

- A critical component of fungal cell walls (not membrane) - Back-up drugs given IV for disseminated and mucocutaneous Candida infections or invasive aspergillosis - Monitor liver function

Answer 223

- Clotrimazole, nystatin and fluconazole

Answer 224

- Nystatin and amphotericin B can be used in pregnancy but azoles are better avoided

Answer 225

Azoles, amphotericin B and caspofungin

Answer 226

dermatophytes and candida

Answer 227

systemic fungal infection

Answer 228

- esophageal &oropharyngeal candidiasis - vaginal candidiasis

Answer 229

- dermatophytes only

Answer 230

- Disseminated candidiasis - mucocutaneous candidiasis - Invasive aspergillosis

Answer 231

- candidal infection

Answer 232

IV infusion

Answer 233

**Dermatophyte infections (Tinea):** Caused by one of the three genera of dermatophyte - microsporum - Trichophyton - Epidermophyton. **Pityriasis versicolor:** Caused by malassezia furfur which is the pathogenic form of normal skin flora pityrosporum orbiculare *(yeast-like)* **Candidiasis (moniliasis):** Caused by candida (*yeast* reproduce by budding)

Answer 234

- These are fungi which have the ability to produce infection of the keratinized tissues as the skin, hair and nails.

Answer 235

- Dermatophyte infection of the scalp.

Answer 236

- Tinea capitis is mainly a disease of children, but it may affect adults.

Answer 237

There are 4 types of tinea capitis: - Scaly - Blak dot - Kerion (Inflammatory type) - Favus

Answer 238

- Microsporum audouinii & - Microsporum canis.

Answer 239

- Trichophyton tonsurans - Trichophyton violaceum.

Answer 240

Due to breaking of hair shafts at the skin surface.

Answer 241

animal fungi

Answer 242

There are two presentations: - Abcess like swelling - Well defined dull red plaque studded wit multiple pustules

Answer 243

**Trichophyton schoenleinii**

Answer 244

- A scutulum is a concave yellow crust surrounding the hair follicle opening and has a mousy odour

Answer 245

- From man to man through infected towels or in the barber's shop. - Infected animals transmit infection to farmers.

Answer 246

Dermatophyte infection of the beard and moustache areas of adult male.

Answer 247

Similar to tinea capitis.

Answer 248

- Tinea corporis is a dermatophyte infection of the (glabrous skin) of the trunk and extremities, excluding the hair, nails, palms, soles and groin.

Answer 249

1. Infected Person 2. Infected Animals (domestic animals) or soil-to-human spread. 3. Autoinoculation (from tinea capitis or pedis).)

Answer 250

- Scraping & M.E: scraping is done from the raised border of the lesion >>>> Spores & hyphae - Culture: on sabouraud's agar media

Answer 251

- Dermatophyte infection of the groins.

Answer 252

- Auto inoculation. - Sharing cloths & towels.

Answer 253

- Scraping,ME - culture

Answer 254

Similar to T. Circinata

Answer 255

1. Excessive use of water. 2. Hyperhidrosis. 3. Wearing occlusive shoes for long periods. 4. Hot weather. * All these conditions cause damage (maceration) of the skin and allow invasion and growth of dermatophytes.

Answer 256

**Tinea Pedis**

Answer 257

3 types: - Interdigital T. pedis - Scaly hyperkeratotic type - Vesiculo-bullous type

Answer 258

Common in adults than children and in males than females.

Answer 259

Interdigital T. pedis:

Answer 260

- Scraping, ME - Culture

Answer 261

Dermatophyte infection of the palmar skin.

Answer 262

1. Infected human 2. infected animal. 3. Auto inoculation (from tinea pedis).

Answer 263

- Trauma and maceration between fingers. - Poor peripheral circulation.

Answer 264

Similar to T.Pedis

Answer 265

- Onychomycosis is a fungal infection of the nails. - More than 50% of cases of nail dystrophy is due to onychomycosis

Answer 266

- The fungus invades the nail plate from the lateral nail fold or from the free edge. - Nail infections may be the only manifestation of fungus disease in a patient or in greater majority of cases they are associated with other types of dermatophyte infection

Answer 267

onychomycosis

Answer 268

1- Trauma to the nail. 2. Poor peripheral circulation. 3. Old age, where the linear growth of nail is slow.

Answer 269

- Nail clipping is put in 5% KOH solution for 24 hours then examined under microscope for fungus - culture

Answer 270

- Mild, Chronic superficial fungus infection of the horny layer of the skin caused by Malassezia furfur

Answer 271

**Malassezia furfur** (Pathogenic form of the normal skin flora, pityrosporum orbiculare).

Answer 272

Common skin disease, affecting adults more than children.

Answer 273

- Any site however the commonest sites affected are **trunk, neck & upper arms**, Face is commonly affected in children

Answer 274

- Spontaneous remission may occur in winter & recurrence usually occurs in summer - Healing may occur with hypopigmented macules which may disappear spontaneously or persist indefinitely.

Answer 275

Topical & Systemic

Answer 276

- Infection of the skin or mucous membranes by candida albicans.

Answer 277

Candida albicans

Answer 278

- Intertdigital candidiasis - Candidal intertrigo - Napkin candidiasis

Answer 279

- Common in housewives, cooks and those whose hands are frequently immersed in water.

Answer 280

- Oral Candidiasis - Candidal vulvovaginitis - Candidal balanitis

Answer 281

- oral thrush - Acute atrophic type - Chronic atrophic type (Denture stomatitis) - Chronic Hyperplastic leukoplakia -->Black hairy tongue - Angular Cheilitis (perleche) - Candidal Cheilitis

Answer 282

- TTT of predisposing factors - Topical - Systemic

Answer 283

- Herpes Simplex. - Chicken pox. - Herpes Zoster. - Warts. - Molluscum contagiosum. - Pityriasis Rosea

Answer 284

- Herpes Simplex

Answer 285

- H. virus type I: affects the skin and mucous membranes. - H. virus type II: affects the genitals.

Answer 286

Direct inoculation.

Answer 287

- Lesions are usually minimal or subclinical. - Develops in persons without pre-existing immunity to HSV - Severe cases occur in patients with immune defect, malignancy, malnutrition or atopic dermatitis.

Answer 288

- Two types are recognized primary and recurrent.

Answer 289

usually minimal or subclinical.

Answer 290

- Develops in persons without pre-existing immunity to HSV - Severe cases occur in patients with immune defect, malignancy, malnutrition or atopic dermatitis.

Answer 291

- The commonest form - Most cases occur in infants and young children

Answer 292

- The gums are swollen, red and easily bleed. - Vesicles rupture forming white erosions with red areola on oral mucosa

Answer 293

- High fever, malaise, dribbling, painful eating and foul breath

Answer 294

- Regional LNs (Submental) are enlarged and tender

Answer 295

- After 3-5 days fever subsides and complete recovery occurs in about 2 weeks

Answer 296

Conjunctivitis and keratitis - The eye lids are edematous - There may be vesicles on the surrounding skin

Answer 297

Regional LNs (preauricular) are enlarged and tender

Answer 298

It may cause corneal ulcer that leave scar which may result in impairment of vision. (Because it heals by fibrosis)

Answer 299

- Commonly seen in dentists and nurses

Answer 300

**Painful vesicles** - E.g., Herpetic whitlow: painful vesicles on fingertips that may be seen in young children, dentists and nurses (HSV1)

Answer 301

Recurrences in the same location

Answer 302

- Any site, but mainly on finger tips (classical site) - Inoculation may occur on the face, scalp and trunk in the form of multiple crops of vesicles on plaques of erythema and oedema.

Answer 303

Occasionally complicated by - bacterial superinfections or - systemic dissemination of HSV infection

Answer 304

Lesion of H.S. may appear - on the top of atopic dermatitis or - may be generalized.

Answer 305

- Vesicles which rapidly rupture forming erosions and painful white plaques on a red oedematous mucous membranes

Answer 306

- are seen in the genitals of both sex. - other sites include buttocks and perineum in both sexes - cervix in women.

Answer 307

- Inguinal lymph nodes are enlarged and tender.

Answer 308

- Genital H.S. in homosexual suffering from AIDS may present with chronic perianal ulceration.

Answer 309

- virus may remain hidden in a latent form within the sensory ganglion and sensory nerve which supply the infected area.

Answer 310

- May occur without any reason(spontaneously), but may follow the following precipitating factors: 1. Fever: influenza, pneumonia, malaria & meningococcal meningitis. 2. R.T.I (resp tract infection) 3. Mechanical trauma. 4. Sun exposure. 5. Emotional stress.

Answer 311

- Usually **around orifices especially around the mouth.** - However, they can be situated anywhere on the body. - **2ry leukoderma** may develop in site of lesion. - A characteristic feature of the disease is that it is **recurrent with reappearance of the vesicles on or near the same site.**

Answer 312

- The vesicles dry forming crust and healing occurs without scar within 7-10 days.

Answer 313

- Varicella is the primary infection with varicella-zoster virus.

Answer 314

- Droplet infection from the nasopharynx (main route). - Direct contact with the vesicular fluid.

Answer 315

10 - 20 days. *around from 2 wks to 3 wks*

Answer 316

- 2 days before and 8 days after the rash onset (when all vesicles have been crusted).

Answer 317

children more than adults.

Answer 318

- absent or 1-2 days of fever & malaise.

Answer 319

- Trunk (centripetal), face, scalp and limbs. - Oral mucosa especially palate may contain vesicles.

Answer 320

1. Rapid onset. 2. Polymorphic lesions: The presence of lesions in all stages of development is a hallmark of varicella. 3. Centripetal distribution (more profuse on the trunk than extremities).

Answer 321

symptomatic TTT & Systemic Anticirals

Answer 322

Required for most children (immunocompetent) (no specific treatment) - Antipyretic for fever:(avoid salicylate). - Antihistamine for itching. - Antibiotic for secondary infection. - Topical antiseptic.

Answer 323

- Acyclovir or Valacyclovir (which must be given within 24-72 hours of onset of lesion).

Answer 324

- Immunocompromised patients . - Varicella in pregnant woman. - Severe varicella in immunocompetent children - Neonatal varicella (Acyclovir IV Infusion)

Answer 325

- Varicella-zoster immune globulin: immediate post exposure prophylaxis - Live attenuated varicella vaccine (Varivax®): routine vaccination (active immunity).

Answer 326

- **IV acyclovir** * women who are not immune to varicella but are exposed may be treated with VZIG

Answer 327

**Category B** - Safe in pregnancy(category B) Fetal risk not demonstrated in animal studies but there are no controlled studies in pregnant women, or animal reproduction studies have shown an adverse effect that was not confirmed in controlled studies in women during first trimester and there is no evidence of risk in later trimesters)

Answer 328

- Infants whose mothers develop varicella 5 d. before delivery or 2 d. following delivery should receive VZIG after birth. - Infants who develop varicella during the first 2 w. of life should be treated with IV acyclovir.

Answer 329

- Acute condition characterized by grouped vesicles along course of sensory nerve.

Answer 330

**Varicella zoster virus** - Latency: H.Z. results from reactivation of latent virus that persists in sensory ganglia after recovery from chicken pox.

Answer 331

HZ usually affects healthy persons, but it might be precipitated by one of the following: - Immunosuppressive states by disease as AIDS or drugs - Local trauma (to spinal cord)or pressure (usually trivial) - Radiotherapy - malignancy.

Answer 332

- Fever, headache, malaise - Neuralgic pain : 1st symptom - Lesions - regional lymph nodes are tender and affected

Answer 333

- It is localized to areas supplied by one or more sensory nerves. - May precede eruption by 1 week - The severity of pain increases in old age & may be absent in children. (Pain is proportional to age)

Answer 334

- A characteristic feature of the disease is that it is nearly always **unilateral** - Along the distribution of one or more of sensory nerves **(dermatomal distribution)** - The lesion appears in the form of **several groups of vesicles on an erythematous(red) base** arranged in a continuous or interrupted band. - The **early vesicles contain clear fluid**, but after few days the contents **become turbid** and **dry to form crust** which usually **separates within 2-4 weeks**. - **Edematous papules and plaques may precede the appearance of vesicles**, and **progression to pustules or bullae can occur**

Answer 335

- The most common sites affected are thoracic area followed by cervical, trigeminal (including ophthalmic branch) and lumbosacral areas.

Answer 336

* Abortive * Gangrenous * Haemorrhagic * An eruption of varicella with HZ

Answer 337

- Topical - Systemic - TTT of PHN

Answer 338

- antiseptic, antibiotic.

Answer 339

- Must be given within 7 days after the onset of skin lesions. - Acyclovir, Famciclovir and Valacyclovir

Answer 340

- Patient older than 50 years. - Immunocompromised patients. - Ophthalmic zoster. - Ramsay Hunt syndrome. - Antibiotic: For neuralgic pain: (Tegretol 200-800mg/d, tryptizol 25-100mg/d, neurosurgical advice)

Answer 341

- Gabapentin (Neurontin® or pregabalin) - Tricyclic antidepressants (CA) as Amitriptyline (tryptizol 25-100mg/d) and nortriptyline. - Carbamazepine(Tegretol 200-800mg/d) - Other lines: lidocaine patches, narcotic analgesics, and nerve blocks + Neurosurgical advice

Answer 342

- Pityriasis rosea is an acute self-limiting skin disease, characterized by distinctive skin eruption.

Answer 343

May be viral

Answer 344

- More common in young adults (children & young adult) (power) - More common in autumn and spring.

Answer 345

- Classic - Special types

Answer 346

- trunk, neck & proximal parts of extremities. - However, involvement of the face and scalp is common especially in children.

Answer 347

- spontaneous remission usually occurs in 4-6 weeks with exception of some cases which persist for longer period. - Temporary hyper or hypopigmentation may follow resolution of the lesions.

Answer 348

1. Abortive type: Herald patch is not followed by the secondary eruptions. 2. Inverted type: eruption is restricted to extremities and face with sparing of trunk. 3. Localized: one area 4. Generalized: trunk, extremities, face 5. Pityriasis circinate et marginate: few, large, ingroin or axilla, maybe confluent, persist for months

Answer 349

- Reassurance. - Avoid soap, hot bath and woolen clothing. - Antihistamines for itching. - Antipruritic topical agent or mild steroid for irritable lesions. - UVR.

Answer 350

- Benign, usually self-regressing infectious new growth of the skin and adjacent mucous membranes caused by human papilloma virus (HPV).

Answer 351

- Recurrence is common even after treatment due to the presence of HPV DNA in the normal-appearing skin surrounding HPV-associated lesions.

Answer 352

1. Common warts (Verrucae vulgares) 2. Plane wart. 3. Plantar wart. 4. Filiform wart. 5. Digitiform wart. 6. Genital wart (Condyloma acuminatum).

Answer 353

pressure areas of the soles or palms.

Answer 354

- Genital HPV is the most common STDs in western countries. - Nonsexual transmission is possible (during labor, autoinoculation or spread from nearby nongenital site). - In children, sexual abuse must be excluded.

Answer 355

- Begin as small elongated red soft papule, often pedunculated. - The papule enlarges in size and divides at its free margin into lobules giving malodorous cauliflower-like masses with dry surface. - Subclinical infection is common.

Answer 356

- External genitalia and the perineum, perianally. - Lesions may extend into the vagina, cervix, urethra, or anal canal

Answer 357

- May resolve spontaneously but may persist in 10-30% of cases.

Answer 358

- Persistent infection with HPV types with high oncogenic potential, is the major cause of cervical cancers and a subset of vaginal, vulvar, penile, anal and oropharyngeal neoplasias

Answer 359

Because of the benign and self-limited nature of warts, aggressive treatments that cause scarring should be avoided especially in children - Electrocautery - Cryotherapy - Chemicalcautery - Others

Answer 360

- Used in painful and resistant warts, but carries risk of scarring. - NOT used in 1. plantar wart 2. larger wart more than 1cm 3. warts on the small joints of toes and fingers 4. large periungual warts (nail dystrophy).

Answer 361

- Using coz snow or liquid nitrogen, cause destruction by freezing

Answer 362

Salicylic acid, if multiple use formalin

Answer 363

Salicylic acid, Imiquimod

Answer 364

Podophyllin, if resistant use interferon

Answer 365

Retinoic topical, Imiquimod

Answer 366

Levimizole

Answer 367

proactive vaccine for genital HPV infection

Answer 368

- Molluscum contagiosum is a pox virus skin infection caused by Molluscum Contagiosum virus (MCV) with characteristic shiny pearly-white umbilicated papules.

Answer 369

- Contact with patient or contaminated objects - Auto inoculation.

Answer 370

- Spontaneous regression may occur in some lesions within 6-9 months.

Answer 371

- Face, trunk, and genital areas are the sites of predilection. - However, any site may be affected.

Answer 372

- Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - Non-nucleoside Reverse Transcriplase Inhibilors NNRTIs) - Protease Inhibitors (Pls)

Answer 373

**Nucleoside Reverse Transcriptase Inhibitors (NRTIs):** - Zidovudine [Azidothymidine (AZT)] **Other Nucleoside Reverse Transcriptase Inhibitors (NRTIs):** - Didanosine, Stavudine, Emtricitabine and Lamivudine

Answer 374

**The common side effects:** - Bone marrow suppression, anaemia and neutropenia. **Initial stages of therapy commonly seen:** - Nausea, vomiting, abdominal discomfort, headache, and insomnia **Long-term therapy:** - May cause hepatotoxicity, myopathy with fatigue and lactic acidosis.

Answer 375

- They are effective orally. - Lamivudine is a commonly used agent in antiretroviral therapy because of its efficacy and low toxicity.

Answer 376

1- peripheral neuritis 2- pancreatitis, gastrointestinal disturbances 3- lactic acidosis 4- skin rashes, etc.

Answer 377

Nevirapine & Efavirenz

Answer 378

1- Skin rashes, pruritus. 2- Fever, nausea. 3- CNS disturbances like headache, confusion, insomnia, bad dreams, amnesia, etc.

Answer 379

Lopinavir, Saquinavir, Ritonavir (navir)

Answer 380

- Drug interactions are a common problem for PIs, because they potent inhibitors of CYP450 isoenzymes. - Drugs that rely on metabolism for their termination of action on CYP450 isoenzymes, may accumulate to toxic levels. **Examples of potentially dangerous interactions with PIs include excessive bleeding with warfarin**

Answer 381

- Retroviruses contain RNA-dependent DNA polymerase (reverse transcriptase) enzyme. - They cause selective depletion of CD4 cells leading to a profound decrease in cell-mediated immunity. - Hence, the infected person is prone to severe opportunistic infections and lymphoid malignancies.

Answer 382

- Doctors, nurses, technicians and other healthcare workers who have had accidental exposure to HIV infection with surgical instruments, blood transfusion or needle-prick injury

Answer 383

The need for postexposure prophylaxis (PEP) depends on 1. The degree of exposure to HIV (viral load) 2. The HIV status of the exposure source.

Answer 384

- Monophosphorylated by viral thymidine kinase (K), - Then further bioactivated by host-cell kinases to the triphosphate - Acyclovir triphosphate is both a substrate for and inhibitor of viral polymerase when incorporated into the DNA molecule

Answer 385

- Minor with oral use - More obvious with IV - Crystalluria (maintain full hydration) and neurotoxicity (agitation, headache, confusion) - Acyclovir is not hematotoxic

Answer 386

Similar to that of acyclovir First phosphorylation step is viral-specific; involves : 1. thymidine kinase in HSV - phosphotransferase (UL97) in cytomegalovirus (CMV) - Triphosphate form inhibits viral DNA polymerase and causes chain termination

Answer 387

Of Ganciclovir - HSV, VZV, and CMV - Mostly used in prophylaxis and treatment of CMV infections, including retinitis, in AIDS and transplant

Answer 388

- Dose-limiting hematotoxicity (leukopenia, thrombocytopenia), - Mucositis, fever, rash, crystalluria(maintain hydration); - Seizures in overdose

Answer 389

- Scabies is a contagious disease caused by a mite, the female Sarcoptes scabiei; which invade the epidermis and form a burrow.

Answer 390

2 weeks- 2 months.

Answer 391

Burrows which may be present in a few or large numbers.

Answer 392

The difference from human scabies are: - Shorter I.P. - Self-limiting after eliminating the source of infection.

Answer 393

- localized or generalized according to the mode of exposure. Webs & genitalia are free.

Answer 394

papules, wheals or papulovesicles with absence of burrows.

Answer 395

not transmitted from human to human.

Answer 396

- has Atypical distribution of lesions with involvement of scalp, face, neck, palms and soles.

Answer 397

- Persistent reddish brown pruritic nodules may occur after treatment of scabies. - The sites of predilection are axillae, male genitalia, groins, umbilicus or anywhere. - These nodules represent hypersensitivity reaction to mites.

Answer 398

- The lesions and the course are modified by the application of topical or systemic steroids. - Scabies has unusual extent and distribution.

Answer 399

- This type represents an abnormal host immune response to the mite.

Answer 400

- Mentally retarded. - Patients with poor cutaneous sensation - Patients with severe systemic diseases like leukemia and DM. - Patients with severe immunosuppression (e.g., AIDS).

Answer 401

- Large crusts on the hands and feet with subungual hyperkeratosis. - Erythematous scaly plaques occur on the face, neck, scalp and trunk and may become generalized. - Itching may be absent - The number of the invading mites may reach up to 2 millions, so these patients are highly contagious and may initiate epidemics of scabies.

Answer 402

- General Treatments - Topical Scabicides - Systemic Scabicidies

Answer 403

- Like classic scabies but lesion is more common in the area with contact with bed

Answer 404

- Difficulty to see the burrows due to frequent bathing.

Answer 405

- Like classic scabies but NOT maybe sexually transmitted (In this case u must search for other venereal diseases)

Answer 406

* Popular urticaria * Eczema * Erythema multiform

Answer 407

- Boiling of cloths, bed linens, towels. - The mites cannot survive at temperature about 50°C for longer than 5min. - It cannot survive at room temperature in blanket or clothing for more than 2w - Treatment of all members of the family except in animal scabies. - Treatment of infested animals.

Answer 408

- The drug of choice is permethrin, with malathion as an alternative. - It is suggested that topical agents should be removed from the nipples before breast feeding, and then reapplied.

Answer 409

1- Intralesional injection of steroid 2- Surgical excision.

Answer 410

- Pediculosis is caused by lice which are small gray-brown, blood sucking parasites

Answer 411

- Each female lays many eggs which appear as white nits firmly attached (cemented) to the hair shaft - Each nit hatches within a week.

Answer 412

- Pediculosis Capitis occurs on the hair of the scalp, mainly above the ears and occiput. - Beard and moustache may be infested.

Answer 413

- Pediculosis capitis is communicated by direct contact, sharing hats, combs & brushes.

Answer 414

- Although the disease is more common in children, it may occur in adults

Answer 415

- There is itching of the scalp this causes scratching with impetigo and cervical lymphadenopathy. - The general health may be impaired from septic absorption.

Answer 416

- P. Capitis - P. Corporis - P. Pubis

Answer 417

(Crab lice, Pthirus pubis)

Answer 418

- The pubic louse is sexually transmitted and is mostly found in young adults.

Answer 419

- Pubic lice infest the pubic and perineal hair - It may also infect the eye lashes

Answer 420

- Crab lice cause severe itching in the pubic region with 2ry eczema and infection. - The lice firmly adhere to the base of hairs - They can be skin-coloured or mimic haemorrhagic crusts.

Answer 421

- Urticaria is an acute skin disorder characterized by formation of wheals - It may be allergic or non-allergic.

Answer 422

- From Allergic Reaction nearby the mast cells - From Non-Allergic Reaction, i.e., direct action of certain stimuli on mast cells.

Answer 423

- Angioedema (diffuse swelling in certain areas of thin skin & loose SC tissue such as eye lids, lips, genitalia) may occur with wheals. - General symptoms may indicate involvement of internal organs such as 1. GIT (nausea, vomiting, dysphagia) 2. respiratory tract (hoarseness, wheezing and dyspnea).

Answer 424

- Sudden appearance of itchy wheals that last from few hours up to 48 hours, then fade away (evanescent) and new lesions may appear, a feature distinguishing urticaria from other urticarial like lesions of the skin.

Answer 425

- Acute urticaria: the lesions usually disappear within a few hours or days - Chronic urticaria: the disease persists for more than 6 weeks - Spontaneous improvement may occur even in absence of diagnosis or treatment.

Answer 426

Hypersensitivity to insect bites such as fleas and mosquitoes.

Answer 427

- The eruption occurs mainly on the limbs. - The trunk may show few lesions.

Answer 428

- It is frequently seen in children moving to new areas where mosquitoes prevail.

Answer 429

**4 major criteria:** 1. pruritis 2. Typical morphology and distribution for age group 3. Chronic or chronically relapsing dermatitis 4. Personal or family history of atopy

Answer 430

- AD is a **common chronic relapsing pruritic inflammatory skin disease** with a wide range of manifestations frequently associated with **personal or other family history other atopic diseases**

Answer 431

- Atopy is a **Genetically determined immune mediated disorder** in which there is an **increased liability to certain diseases**, e.g., asthma, allergic rhinitis, hay fever and atopic dermatitis.

Answer 432

- The cardinal symptom is pruritus. (itching) - Dry scaly skin - Crusted lesions on face, scalp, trunk & extremities - Lichenification (with chronic course)

Answer 433

Genetic defect in fillagerin gene leading to defective skin barrier

Answer 434

- Emotional stress - Low humidity & Cold weather - Seasonal allergies, flowers pollen. - Cigarette smoke - Exposure to harsh detergents, soaps - Rough clothes, Synthetic fibres or wool - Dust, Animal fur or sand - Perfumes, Cosmetic products

Answer 435

1- Infantile atopic dermatitis. 2- Childhood atopic dermatitis. 3- Adulthood atopic dermatitis.

Answer 436

- Edematous Erythematous discrete & confluent papules. - Severe itching > Oozing & crusting plaques.

Answer 437

- About 50% of cases clear by the age of 2 years. - The remainder proceeds into childhood phase. - About 30-50% of infantile eczema subsequently develops asthma

Answer 438

2 months - 2 years

Answer 439

The usually affected site: - The face, particularly the cheeks. - Scalp - Neck - Extensor aspects of the extremities - Trunk.

Answer 440

2-12 years

Answer 441

- The lesions are less exudative (i.e., dry skin) & tend to lichenify especially in the flexures (Flexural eczema, Besnier's prurigo)

Answer 442

- About 50% of cases may clear by the age 12 years - Otherwise, it changes into the adult phase.

Answer 443

- Antecubital & popliteal fossae - Neck - Wrists - Ankles - Around the mouth & around the eyes. 1. Sometimes, only one site is involved. 2. may affect the extensors &

Answer 444

- This means that about 60%-75% of all cases of infantile and childhood AD go into remission by 12 years of age. (But in others, disease activity persists into adolescence & adulthood)

Answer 445

> 12 years - Similar to the childhood phase in showing areas of lichenification in the flexures

Answer 446

- It is difficult to assess the prognosis in individual case. - It is worse if both parents are affected. (About 30-50% of infantile eczema subsequently develops asthma)

Answer 447

1- Bacterial infection. 2- Viral infections (warts and mollusca contagiosa). 3- Eczema herpeticum (herpes simplex viral infection of eczematous skin).

Answer 448

- General Measures - Regular Emollient therapy - Topical Anti-inflammatory Therapy - Systemic therapy

Answer 449

- Avoid exposure to irritants, wool, synthetic cloths or other rough fabrics, dust mites. - Careful drug taking is advised particularly with penicillin, antitetantic serum and other drugs known to induce anaphylactic reaction.

Answer 450

(ointment or water in oil creams): Basic line in treatment of all cases.

Answer 451

- Topical corticosteroids ointment: the main line - Topical calcineurin inhibitors (CIs) : Tacrolimus 0.03% and 0.1% ointment and pimicrolimus 1% cream. - Zinc oxid cream

Answer 452

- Crops of severely Itchy, deeply seated vesicles on palms & soles. - Remission within 2 wks + Recur

Answer 453

**Topical:** - Drying lotion. - Topical steroid. **Systemic:** - Antibiotic. - short course steroid.

Answer 454

- It is a non-specific dermatitis characterized by oval or round dry scaly patches which subside with hypopigmentation.

Answer 455

- It is more common in atopics but not confined to them. - It is mainly seen in children and young adults.

Answer 456

- The face is the most frequently involved site. Other areas as the neck, arms & trunk may be involved.

Answer 457

Most cases subside in few months. Recurrence may occur.

Answer 458

topical emollient.

Answer 459

- Eczema is a severe dermatitis (inflammation of the skin) characterized by itching, oozing & burning sensation.

Answer 460

induced by a wide range of external or internal factors.

Answer 461

- Contact dermatitis is an inflammatory skin disease induced by exposure to external injury; chemical or physical.

Answer 462

results from exposure of the skin to an irritant

Answer 463

- An agent that is capable of producing dermatitis on the first exposure

Answer 464

- The reaction of the skin to irritant depends on the potency of irritant - Strong irritants > acute eczema with vesiculation and even necrosis of the skin. - Repeated contact of Mild irritants → may cause subacute or chronic eczema. (Housewife eczema)

Answer 465

- It is an Immunological process - An eczematous rash develops after contact with an agent to which delayed hypersensitivity reaction has developed (Type IV Reaction).

Answer 466

- It results from exposure of the skin to a Sensitizer (contact allergen)

Answer 467

- An agent that is Not capable of producing dermatitis on the first exposure but causes dermatitis after a latent period on further exposure.

Answer 468

The dermatitis may be acute, subacute or chronic.

Answer 469

- occur after activation of an irritant by UVR.

Answer 470

localized to areas of exposure

Answer 471

- Tar & psoralen paint, - Plants (phytophotodermatitis) - Phototoxic (Jelly fish) CD occur after activation of the irritant jelly fish secretion by UVR on coming out of water

Answer 472

- occur after activation of a sensitizer by UVR

Answer 473

- Perfumes - Cosmetics - Sunscreen.

Answer 474

- by micro-organism products.

Answer 475

- erythema, pustules - oozing, crust - maybe dry & scaly

Answer 476

- Around discharging ear. - Wound, ulcer & sinuses. - Scalp in Pediculosis. - Trunk in scabies.

Answer 477

- Topical drying lotion: KMn04,saline. - Topical Abic-steroid combination - Systemic Abic.

Answer 478

1. Avoid contact 2. Protect skin 3. Check early signs of dermatitis

Answer 479

- Acute self- limited skin disease characterized by target or iris lesion.

Answer 480

1- Elimination of cause 2- Symptomatic and supportive 3- prevention (Recurrent cases): Oral acyclovir (400 mg twice daily for 6 months) to prevent recurrence of herpes associated E.M

Answer 481

- E.M. usually fades within 2-4 weeks - E.M tends to recur (in 30% of cases)

Answer 482

- Inflammation of subcutaneous fat (panniculitis) presents as an acute self-limited painful nodular erythematous eruption.

Answer 483

- spontaneous resolution in about 2-6 weeks without residual scarring, - however, recurrence may occur

Answer 484

1- Treatment of the cause. 2- Bed rest and supportive bandages. 3- Non-steroidal anti-inflammatory drugs (NSAIDs) 4- potassium iodide for 2 weeks in severe cases

Answer 485

- Drug reaction is harmful, unintended, response to drug in therapeutic dose.

Answer 486

- allergic or non-allergic

Answer 487

The important forms of the drug eruptions include: - Severe life -threatening drug reactions - Other reactions

Answer 488

Sulfonamides, NSAIDs

Answer 489

- recurs in the same sites each time the drug is administered.

Answer 490

- Well-defined round or oval plaque of erythema & oedema. Bulla may develop on the top - Healed lesion is hyperpigmented (dark brown to violet)

Answer 491

- lips, anogenital area (glans penis), but can occur anywhere.

Answer 492

1- abrupt onset symmetric cutaneous eruption 2- History of drug intake. 3- De-challenge test: The eruption improves when the suspected drug is stopped. (clear in 2 weeks on withdrawal) 4- Re-challenge (oral provocation test)

Answer 493

- Elimination of the offending drug - Symptomatic treatment: 1. Antihistamines. 2. Topical steroid. 3. Systemic steroids in severe cases.

Answer 494

(Stevens-Johnson Syndrome & Toxic epidermal necrolysis)

Answer 495

of URT symptoms; High fever, painful skin and weakness.

Answer 496

- Erythematous and purpuric macules on trunk and proximal limbs → flaccid blisters → epidermal detachment and large confluent oozing erosions - Nikolsky sign is positive (firm sliding pressure on normal appearing skin → detachment of intact superficial epidermis)

Answer 497

mainly localized to face upper trunk, and hands

Answer 498

- Involvement in 90% of cases ( always at least two sites) - Erythema and painful erosions of buccal, ocular, and genital mucosa

Answer 499

is possible (pulmonary, GIT, renal)

Answer 500

- Mortality rate is up 25%. - Death may be due to sepsis, electrolyte imbalance or organ failure.

Answer 501

- Early(immediate) withdrawal of suspected drugs. - Rapid initiation of supportive care in intensive care burn unit

Answer 502

- Autoimmune disease in which autoantibodies are formed against intercellular bridges of the prickle cell layer. - This results in acantholysis and formation of intraepidermal bullae

Answer 503

- Characterized by flaccid bullae arising upon normal skin and mucous membranes. - The bullae rupture easily leaving painful erosions & Crusts - Painful erosions on mucous membrane.

Answer 504

Rare chronic disease, usually affects adults. (4-5th decades)

Answer 505

- Infection, fluid & electrolyte imbalance may result in death.

Answer 506

in STS-TEN & Pemphigus vulgaris

Answer 507

- commonly involved are scalp, intertriginous area and umbilicus, but in severe cases any site can be involved.

Answer 508

- Refer to dermatologist - Systemic steroids & immunosuppressive (cytotoxic) drugs.

Answer 509

- Psoriasis - Lichen Planus - DLE

Answer 510

- Psoriasis is a genetically determined common skin disease characterized by: chronic relapsing nature and variable clinical features.

Answer 511

1- Psoriasis vulgaris. 2- Erythrodermic psoriasis 3- Pustular psoriasis. 4- Arthropathic psoriasis.

Answer 512

- Trauma to the apparently normal skin may elicit new psoriatic lesions.

Answer 513

- Removal of scales by scraping gives rise to small bleeding points which is pathognomonic for psoriasis

Answer 514

Plaque Psoriasis

Answer 515

Salmon Pink Erythema

Answer 516

Silvery white scales

Answer 517

+ve Koebner phenomenon +ve Auspitz sign

Answer 518

- Elbows, knees and lower sacrum. - However, any site may be affected

Answer 519

No hair loss

Answer 520

Fine silvery scales

Answer 521

Palms & Soles

Answer 522

- Itching is common & fissuring is often seen in the gluteal crease

Answer 523

Localized to groins, gluteal crease, axillae and sub-mammary areas

Answer 524

trunk and proximal extremities

Answer 525

- Usually occurs in children and young adults following acute streptococcal infection

Answer 526

- The lesions may subside after about 6 weeks without treatment or change to plaque type

Answer 527

- The entire skin is red and covered with scales.

Answer 528

Macroscopic sterile pustules appear. - Localized to palms and soles. - Generalized pustular psoriasis.

Answer 529

Psoriasis associated with arthropathy.

Answer 530

The disease is usually chronic with remission and relapse.

Answer 531

- Topical - Phototherapy - Systemic

Answer 532

- Steroids - Salicylic Acid - Tar - Calcipotriol (vitamin D analogue)

Answer 533

- Application on face, flexures & genitals. - Erythroderrnic and generalized pustular psoriasis. - Severe acne & folliculitis.

Answer 534

- Antimitotic & anti-inflammatory. (Topical, intralesional) - They are applied alone or in combination with salicylic acid. - Intralesional injection of steroid is used in localized small resistant lesion. - Also, it is used for nail psoriasis by injection in the nail fold. However.

Answer 535

- Keratolytic agent which is used to remove the scales. It is usually used in combination with steroid, tar or anthralin.

Answer 536

(vitamin D analogue) - It inhibits proliferation of keratinocytes. - It is applied twice daily with maximum dose of 100 gm weekly for 6 week - This drug may increase serum calcium.

Answer 537

Antimitotic 2-5% tar ointment is applied at night, and then removed in the next day by mineral oil before exposure to UVB. (goekerman technique)

Answer 538

- UVB (broad band or narrow band) exposure 3 times weekly in mildly erythemogenic dose.

Answer 539

- Methotrexate. (given once weekly, hepatotoxic and myelotoxic) - PUVA (psoralen+ UVA). - Retinoids (acitretin), etretinate: teratogenic. - Cyclosporine: nephrotoxic. - Biologic therapy as TNFa blockers (as adalimumab, etanercept) and IL-17 antagonists (as sekicinumab)

Answer 540

should be used only by specialist in: - Extensive psoriasis vulgaris not responding to topical therapy. - Erythrodermic psoriasis. - Pustular psoriasis. - Arthropathic psoriasis

Answer 541

Cause flare at withdrawl

Answer 542

- a chronic sometimes acute disease of the skin and mucous membranes, with distinctive clinical and pathological features.

Answer 543

- Psychic stress is a predisposing factor. - Lichen planus may be more common among patients suffering from HCV.

Answer 544

The surface of the papule may show white fine dots and lines known as (Wickham's striae).

Answer 545

- itchy flat topped, polygonal violaceous papules.

Answer 546

Papules Purple Polygonal (flat topped) Pruritic Peripheral extremities + oral Positive Koebner Pterygium in nail

Answer 547

- Localized inflammatory skin disease characterized by plaques of erythema, scaling and atrophic scar.

Answer 548

**Discoid lupus erythematosus (DLE)**

Answer 549

adults 20-40 years. (4 decade) {Female: male = 2:1}

Answer 550

- Face especially the butterfly area, scalp, arms, legs, dorsum of hands and retro-auricular areas. - However, any site may be affected including oral mucosa. - Lesions on the scalp cause scarring alopecia.

Answer 551

- Spontaneous regression may occur with or without scar. - Calcification - Spread to other area - In 6-6.5% of DLE patients they may change to SLE.

Answer 552

- Antimalarial drugs as hydroxychloroquine in cases not responding to topical steroid. - Prednisone 15 mg/d. - Etretinate

Answer 553

- A common erythematous scaling eruption that is localized to the seborrheic sites.

Answer 554

Pityrosporum ovale may play a role.

Answer 555

eczematous form is estimated at 5%

Answer 556

- Usually begins in adolescence (9-11 years) (with puberty) peak at age 40 - Uncommon in preadolescent childhood (exclude t.capitis) - Infantile SD

Answer 557

More common in males than females. (M > F)

Answer 558

- Scalp, behind ears, face - Pre-sternal and interscapular areas - flexures (umbilicus, axilla, infra-mammary, inguinal fold, perineum or anogenital crease.

Answer 559

- Scalp - Ears - Eyebrows & Beard - Galbrous skin - Nasolabial fold - Eyelid margin

Answer 560

Diffuse fine white (branny) or greasy scales

Answer 561

- Non inflammatory (dandruff) (pityriasis capitis) - Inflammatory (seborrheic eczema)

Answer 562

**Non inflammatory (dandruff) (pityriasis capitis) SD**

Answer 563

- retro-auricular scaling, crusting and fissuring. Persistent non purulent otitis externa may occur.

Answer 564

fine scaling

Answer 565

diffuse redness.

Answer 566

greasy scales.

Answer 567

seborrheic blepharitis.

Answer 568

erythematous patches with maceration and oozing.

Answer 569

- Scaling Intertrigo - Non-Scaling Intertrigo - Crusted Fissures - Weeping Dermatitis - Sebopsoriasis

Answer 570

- Sharply marginated erythema and greasy scaling

Answer 571

- Due to sweating, secondary infection, and inappropriate treatment, - Erythema, maceration, oozing, crusting.

Answer 572

**May be erythema only**

Answer 573

- features of both psoriasis and SD.

Answer 574

- Erythrodermic: rare - HIV infection - Parkinson's disease (with seborrhoea)

Answer 575

- SD inearly infancy due to stimulation of sebaceous glands by maternalandroge

Answer 576

- simulates SD in adult, but the scaling on the scalp is thick forming yellowish brown heaped lesion (cradle cap).

Answer 577

- Begins 2-8 weeks after birth

Answer 578

- The lesions usually subside within 3-4 weeks. - May persist for several months

Answer 579

- Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous apparatus, characterized by formation of comedones.

Answer 580

4 major factors (multifactorial disorder) are involved in the pathogenesis of acne in the genetically predisposed person. - Increased sebum secretion - Hyperkeratosis of pilosebaceous duct - Propionibacterium acne (P. acne) colonizes pilosebaceous duct - Inflammation

Answer 581

- which may result from increased local synthesis of androgen in sebaceous glands or increased response to it.

Answer 582

- Pilosebaceous duct and contributes in the formation of comedones and pustules.

Answer 583

initiated by P:acne

Answer 584

results from the irritant effect of excess sebum.

Answer 585

result in comedones which consist of horny cells, sebum, and bacteria.

Answer 586

- If obstruction is deep: comedones are closed with narrow orifice (white head). - If obstruction is superficial: the comedones are open and have a patulous orifice (black head).

Answer 587

pilosebaceous duct

Answer 588

Invisible hyperkeratotic plug made of sebum and keratin in follicular canal

Answer 589

- Adolescence of both sexes. (12-24 years ) mainly - May start at 10 years and persist up 50 years

Answer 590

- Skin coloured - No visible follicular opening. - Often inconspicuous and require adequate lighting and stretching of the skin to be seen

Answer 591

face, back, chest and shoulders.

Answer 592

1- Mild acne: comedones with little or no papules. 2- Moderate acne: comedones, papules and pustules. 3- Severe acne: nodules and cysts predominate.

Answer 593

- Comedolytic agents - Antibacterial agents

Answer 594

Topical retinoids

Answer 595

Retinoic acid (0.05-0.1%) is used in gradually increasing concentration

Answer 596

It may cause dryness & irritant dermatitis. (Most common side effect)

Answer 597

- no resistance has mild comedolytic effect. - It may cause contact dermatitis.(irritant)

Answer 598

erythromycin and clindamycin are effective in pustular lesions. (not alone)

Answer 599

- Antibiotics - Antiandrogens - Isotretinoin - Dapsone - Miscellanous therapy - TTT of scars

Answer 600

- Doxycycline: 100mg/day is the antibiotic of choice in acne. - This dose is given until acne clears then dec. the dose gradually for 6 months - Erythromycin and Azithromycin are good alternatives. - clindamycin

Answer 601

- Reduce inflammation - Reduce P: acne population> reducing bacterial production of inflammatory factors as FFA - Intrinsic anti-inflammatory - Reduce PMN (poly morphonuclear leukocytes) migration

Answer 602

used only in females with severe nodulocystic acne

Answer 603

1- contraceptive as Yasmin 2- Cyproterone acetate (with OCPs diane) 3- Spironolactone (K sparing diuretic but has antiandrogen effect)

Answer 604

- It decreases sebum secretion - Decrease P. acne. - Decrease follicular hyperkeratosis - has anti-inflammatory effect

Answer 605

It is teratogenic drug with serious side effects, so it should be used only in severe acne and by highly experienced dermatologists.

Answer 606

Anti-inflammatory drug used in severe acne with special precautions.

Answer 607

**Comedonae removal:** - If comedones are resistant **intralesional steroids:** - Triamcinolone acetonide (2-5 mg/ml) - Used for large inflammatory nodules/cysts

Answer 608

- Dermabrasion, laser resurfacing, deeper chemical peels - Filler substances - Punch excision (ice-pick) scar

Answer 609

A disorder of the sweat duct in which obstruction of the sweat ducts at various levels occurs in association with excessive sweating >> sweat retention

Answer 610

Common in: - Neonates: immature eccrine sweat ducts - Adults: living in hot humid condition **Resolve in cool environment**

Answer 611

1- Hot humid condition. 2- Excessive clothing. 3- Obesity. 4- Febrile illness.

Answer 612

- The disease occurs in the tropics and subtropics - Affects persons of all ages and both sexes.

Answer 613

- Any site - Pin head size

Answer 614

- The eruption consists of closely set red papules, vesicles - It is associated with itching, prickling, or burning sensation. - In infants the eruption may be generalized, and it may occur in any season depending on the habits of overclothing.

Answer 615

impetigo, folliculitis, and boils.

Answer 616

- Physiological - Pathological (Alopecia)

Answer 617

loss of hair from normally hairy area

Answer 618

- Cicatricial or scarring alopecia (permanent) - non Cicatricial or nonscarring (transient)

Answer 619

- Conginetal - Aquired

Answer 620

- Circumscribed (Patterned) - Diffuse

Answer 621

developmental defect

Answer 622

circumscribed non scarring hair loss with normal skin

Answer 623

- Circumscribed area of hair loss, nonscarring with normal skin - Positive exclamation mark! (tapered proximal end of the hair shaft) - May affect scalp, face or body hair

Answer 624

Bad prognosis in the following conditions: 1- Alopecia totalis, universalis and ophiasis 2- Alopecia areata with nail pitting 3- Alopecia areata in atopics

Answer 625

1- Nail pitting 2- Atopy (atopic dermatitis) 3- Vitiligo 4- Cataract

Answer 626

acquired idiopathic depigmentation (leukoderma) of the skin

Answer 627

1- Emotional stress 2- Sun burn 3- Physical trauma (Koebner's phenomenon)

Answer 628

- Milky white depigmented macules or patches affecting any area. - Hair and mucous membranes may be affected **Sites:** face, hand, feet. back are sires of predilection

Answer 629

1- Unpredictable 2- Stationary 3- Spontaneous re-pigmentation 4- Slowly progressive 5- Rapidly progressive

Answer 630

1- Pityriasis alba 2- Pityriasis versicolor (hypopigmented type) 3- Post inflammatory hypopigmentation 4- Albinism 5- Post-burn and post-chemical depigmentation