DERMATOLOGY

Question 1

a Tzanck showing multinucleated epithelial giant cells?

Answer 1

VARICELLA ZOSTER

Tzanck smear is a cytologic technique most often used in the diagnosis of herpesvirus infections (herpes simplex virus [HSV] or varicella-zoster virus [VZV]). Multinucleated epithelial giant cells suggest the presence of HSV or VZV.

Question 2

38 year old male developed greasy scales overlying erythematous patches or plaques in the eyebrows, eyelids, glabella, and nasolabial folds, which he described as dandruff. What is the dx? and best management for this case?

Answer 2

Seborrheic dermatitis tx:
reatment with low-potency topical glucocorticoids in conjunction with a topical antifungal agent, such as ketoconazole cream or ciclopirox cream, is often effective. High-potency glucocorticoids should not be used on the face because this treatment is often associated with steroid-induced rosacea or atrophy.

Question 3

A 68 year old female presented with pruritic, erythematous, curvilinear plaques with scaling on the anterior surface of her both legs. She recently went to Northern Mongolia during the winter season. What is the best management of choice?

Answer 3

Asteatotic eczema, also known as xerotic eczema or “winter itch,” is a mildly inflammatory dermatitis that develops in areas of extremely dry skin, especially during the dry winter months. Asteatotic eczema responds well to topical moisturizers and the avoidance of cutaneous irritants.

Question 4

What organism causes the lesion shown below which produces the character

Answer 4

Corynebacterium minutissimum

Wood’s lamp will cause erythrasma (a superficial, intertriginous infection caused by Corynebacterium minutissimum) to show a characteristic coral pink color, and wounds colonized by Pseudomonas will appear pale blue.

Question 5

wounds colonized by _____will appear pale blue under wood’s lamp

Answer 5

wounds colonized by Pseudomonas will appear pale blue.

Question 6

True re: STASIS DERMATITIS

Diuretics may be required to adequately control chronic edema.

Patients with stasis dermatitis and stasis ulceration benefit greatly from leg elevation and the routine use of compression stockings with a gradient of at least 30–40 mmHg.

The typical initial site of involvement is the** medial **aspect of the ankle…

Glucocorticoids should not be applied to ulcers, because they may retard healing…

All are correct

Answer 6

ALL ARE CORRECT

Question 7

A 46 year old male came in your clinic due to progressive sharply demarcated intensely erythematous plaques with secondary pustules and scaling, initially started in the palms and soles before progressing to his arms and legs. He also reported undocumented febrile episodes. He recently used an unrecalled topical skin care product recommended by a friend. What is the best management of choice

Answer 7

Diagnosis: pustular psoriasis, patients may have disease localized to the palms and soles, or the disease may be generalized. Regardless of the extent of disease, the skin is erythematous, with pustules and variable scale. When it is generalized, episodes are characterized by fever (39°–40°C [102.2°–104.0°F]) lasting several days, an accompanying generalized eruption of sterile pustules, and a background of intense erythema; patients may become erythrodermic. Local irritants, pregnancy, m tions, infections, and systemic glucocorticoid withdrawal can precipitate this form of psoriasis. Oral retinoids are the treatment of choice in nonpregnant patients.

Question 8

Drugs that can cause Pityriasis rosea like

Answer 8

Pityriasis rosea–like drug eruptions are seen most commonly with:
* beta blockers,
* angiotensin-converting enzyme (ACE) inhibitors
* metronidazole,

Question 9

medications that can produce lichenoid eruptions

Answer 9

LICHENOID eruption include:
1. thiazides,
2. antimalarials,
3. quinidine,
4. beta blockers,
5. TNF inhibitors,
6. anti-PD-1/PD-L1 antibodies, and
7. ACE inhibitors.

Question 10

A 57 year old male presented with opacified and thickened nails and subungual debris. He has hypertension, heart failure, and was recently diagnosed with HIV. Which medications is appropriate for this patient?

Answer 10

TERBINAFINE

Two other oral antifungal agents, itraconazole and terbinafine, are sometimes prescribed “off-label” for superficial fungal infections. Oral itraconazole is approved for onychomycosis. Itraconazole has the potential for serious interactions with other drugs requiring the P450 enzyme system for metabolism. Itraconazole should not be administered to patients with evidence of ventricular dysfunction or patients with known CHF.

Question 12

most common malignancy that is associated with acanthosis nigricans

Answer 12

GASTRIC

Acanthosis nigricans can be a reflection of an internal malignancy, most commonly of the gastrointestinal tract, and it appears as velvety hyperpigmentation, primarily in flexural areas.

Question 13

What is the most common manifestation of patients with Dermatomyositis

Answer 13

The most common manifestation is a purple-red discoloration of the upper eyelids, sometimes associated with scaling (“heliotrope” erythema; Fig. 59-3) and periorbital edema.

Question 14

CLinical feautures of genital ulcers

Answer 14

Question 15

Nonscarring alopecia (primary cutaneous disorders)

Answer 15

Question 16

key pathway in the pathophysiology of adverse drug reaction in contact dermatitis

Answer 16

the key pathway of ADE in contact dermatitis is T-lymphocyte-mediated macrophage inflammation

Question 17

A 40 year old male initially presented with cough and fever, and was given Cotrimoxazole by a local physician. He eventually developed high grade fever, sore throat, conjunctivitis, oral ulcerations, and acute onset of painful dusky, atypical, target-like lesions of hands and feet, eventually progressing of abdomen and bilateral legs with 40% desquamation. What is the best management for this case

Answer 17

Dx: TEN

The case presented is a case of toxic epidermal necrolysis (TEN). At this time, there is no consensus on the most effective treatment for SJS/TEN. The best outcomes stem from early diagnosis, immediate discontinuation of the suspected drug, and meticulous supportive therapy in an intensive care or burn unit. Early administration of systemic glucocorticoids, intravenous immunoglobulin, cyclosporine, or etanercept may improve disease outcomes, but randomized studies to evaluate potential therapies are lacking and difficult to perform.

Question 18

26 year old female patient comes to your clinic for skin eruptions characterized by multiple erythematous plaques with a target morphology, treated for UTI a few days prior given TMPSMX

Answer 18

The patient has erythema multiforme. This eruption is characterized by multiple erythematous plaques with a target or iris morphology. It usually represents a hypersensitivity reaction to drugs (e.g., sulfonamides) or infections (e.g., HSV).

Question 20

True or falseCyclosporine P 378 UV-light therapy is contraindicated in patients receiving cyclosporine as patients on cyclosporine has an increased risk of developing skin cancer when exposed to phototherapy

Question 21

:

TRUE OR FALSE
Cyclosporine P 378 UV-light therapy is contraindicated in patients receiving cyclosporine as patients on cyclosporine has an increased risk of developing skin cancer when exposed to phototherapy

Answer 21

TRUE

Question 22

large >2cm FLAT lesion with a color diff from the surrounding skin

Answer 22

PATCH

Question 23

primary skin lesion described as a large (0.5-5.0 cm) firm lesion raised above the surface of the surrounding skin:

Answer 23

Nodule

Question 24

a flat colored lesion <2cm not raised above the surrounding skin

Answer 24

MACULE

Question 25

solid raised growth >5cm in diameter

Answer 25

TUMOR

Question 26

large >1cm flat topped raised may either be distinct

Answer 26

Plaque seen in Psoriasis, eczematous dermatitis

Question 27

small lesion solid, <0.4 cm in diameter RAISED above the surface

Answer 27

Papule | (seen in closed comedone, acne, headache)

Question 28

small fluid lesion less than 0.5 cm in diameter, raised above the plane of surrounding skin

Answer 28

vesicle

Question 29

vesicle filled with leucocytes

Answer 29

PUSTULES

Question 30

a fluid filled, rased often translucent lesion 0.5cm in diameter

Answer 30

BULLA

Question 31

raised, eryhtematous edematous papule or plaque, representing short lived VASO DILATION AND PERMEABILITY

Answer 31

WHEAL

Question 32

violacious to purple polygonal lesions

Answer 32

Lichenoid eruption

Question 33

oval to round plaques with trailing scale, eruption lines up in skinfolds

Answer 33

Pityriasis rosea

Question 34

sharply dermacated, plaques, on knees, elbows, scalps, intertirginous areas

Answer 34

psoriasis

Question 35

purple polygonal papules marked by severe pruritus, lacy white markings, especially associated with mucous membrane lesions

Answer 35

Lichen planus

Question 36

Polymorphous appearance, sharply deifined to ill demarcated scaly plaques, may be associated with hair loss

Answer 36

Dermatophytosis

Question 38

benign proliferations of nevomelanocytes characterized by regularly shaped hyperpigmented macules or papules of a uniform color

Answer 38

FIGURE 56-2 Nevomelanocytic nevus. Nevi are benign proliferations of nevomelanocytes characterized by regularly shaped hyperpigmented macules or papules of a uniform color.

Question 39

Answer 39

FIGURE 56-1 Superficial spreading melanoma. This is the most common type of melanoma. Such lesions usually demonstrate asymmetry, border irregularity, color variegation (black, blue, brown, pink, and white), a diameter >6 mm, and a history of change (e.g., an increase in size or development of associated symptoms such as pruritus or pain).

Question 40

secondary lesion- distincitive thickening of the skin

Answer 40

Question 41

secondary lesions?

Answer 41

Lichenification Scale Crust Erosion Ulcer Excoriation Atrophy

Answer 42

Question 42

Chalk-white macules, in Periorificial, trunk, extensor surfaces of extremities, flexor wrists, axillae

Answer 42

Vitiligo

Question 42

Indurated and possibly hyperkeratotic lesions often showing ulceration and/or crusting

Answer 42

squamous cell carcinoma

Question 42

Papule with pearly, telangiectatic border on sun-damaged skin

Answer 42

basal cell carcinoma

Question 43

Trunk (Christmas tree pattern); herald patch followed by multiple smaller lesions Symmetric erythematous papules and plaques with a collarette of scale

Answer 43

Pityriasis rosea

Question 43

Dermatomal, usually trunk but may be anywhere vesicles

Answer 43

HSV

Question 44

scaly hyper- or hypopigmented macules in chest back abdomen, proximal extremities

Answer 44

Tinea versicolor

Question 44

Brown plaques with adherent, greasy scale; “stuck on” appearance

Answer 44

Seborrheic keratosis

Question 45

Follicular pustules Papules, vesicles, pustules, often with **honey-colored crusts **in any hair bearing area, can occur anywhere as well

Answer 45

Folliculitis Impetigo

Question 46

Patches of erythema and scaling on background of hyperpigmentation associated with signs of venous insufficiency, ankles lower legs over MEDIAL Malleoli

Answer 46

Stasis dermatitis

Question 47

Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small-vessel vasculitis.

Answer 47

Necrotizing vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small-vessel vasculitis. (Courtesy of Robert Swerlick, MD; with permission.)

Question 47

Question 48

Answer 48

Meningococcemia. An example of fulminant meningococcemia with extensive angular purpuric patches.

Question 49

This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale.

Answer 49

Psoriasis Pathophysiology Autoimmune Mechanism Dysregulated T-cell mediated immune response (Th1, Th17 pathways). IL-23/IL-17 axis plays a major role. Overproduction of TNF-α, IL-17, IL-22, and IL-23 drives inflammation. Keratinocyte Hyperproliferation Abnormal differentiation and proliferation of keratinocytes, leading to thickened epidermis (acanthosis), parakeratosis (retention of nuclei in stratum corneum), and elongated rete ridges. Angiogenesis & Inflammation Increased vascularization in the dermis due to VEGF activation.

Question 50

Discrete and confluent, edematous, erythematous papules and plaques are characteristic of this whealing eruption

Answer 50

urticaria

Question 51

Answer 51

ERYTHEMA MULTIFORMEThis eruption is characterized by multiple erythematous plaques with a target or iris morphology. It usually represents a hypersensitivity reaction to drugs (e.g., sulfonamides) or infections (e.g., HSV).

Question 52

a cytologic technique most often used in the diagnosis of herpesvirus infections (herpes simplex virus [HSV] or varicella-zoster virus [VZV])- placed on a glass slide, air-dried, and stained with Giemsa or Wright’s stain. Multinucleated epithelial giant cells suggest the presence of HSV or VZV; culture, immunofluorescence microscopy, or genetic testing must be performed to identify the specific virus

Answer 52

A Tzanck smear is a cytologic technique most often used in the diagnosis of herpesvirus infections (herpes simplex virus [HSV] or varicella-zoster virus [VZV])

Question 53

Answer 53

Vitiligo Characteristic lesions display an acral distribution and striking depigmentation as a result of loss of melanocytes.

Question 54

Diagnosis? 1. Pruritus and scratching 2. Course marked by exacerbations and remissions 3. Lesions typical of eczematous dermatitis 4. Personal or family history of atopy (asthma, allergic rhinitis, food allergies, or eczema) 5. Clinical course lasting >6 weeks 6. Lichenification of skin 7. Presence of dry skin

Answer 54

atopic dermatitis

Question 55

characterized by circular or oval “coinlike” lesions, beginning as small edematous papules that become crusted and scaly in thr trunk, extensor surfaces

Answer 55

Nummular eczema is characterized by circular or oval “coinlike” lesions, beginning as small edematous papules that become crusted and scaly. The etiology of nummular eczema is unknown, but dry skin is a contributing factor. Common locations are the trunk or the extensor surfaces of the extremities, particularly on the pretibial areas or dorsum of the hands. Nummular eczema occurs more frequently in men and is most common in middle age. The treatment of nummular eczema is similar to that for AD.

Question 55

deep-seated vesicles and scaling on palms and lateral fingers, and the disease is often associated with an atopic diathesis.

Answer 55

Dyshidrotic eczema. This example is characterized by deep-seated vesicles and scaling on palms and lateral fingers, and the disease is often associated with an atopic diathesis.

Question 56

Answer 56

Stasis dermatitis. An example of stasis dermatitis showing erythematous, scaly, and oozing patches over the lower leg. Several stasis ulcers are also seen in this patient.

Question 57

. Central facial erythema with overlying greasy, yellowish scale is seen in this patient.

Answer 57

Seborrheic dermatitis. Central facial erythema with overlying greasy, yellowish scale is seen in this patient. Tx: Treatment with low-potency topical glucocorticoids in conjunc- tion with a topical antifungal agent, such as ketoconazole cream or ciclopirox cream, is often effective. The scalp and beard areas may benefit from antidandruff shampoos, which should be left in place 3–5 min before rinsing. High-potency topical glucocorticoid solutions (betamethasone or clobetasol) are effective for control of severe scalp involvement. High-potency glucocorticoids should not be used on the face because this treatment is often associated with steroid-induced rosacea or atrophy.

Question 58

Type of psoriasis that is most common in children and young adults. It develops acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with many small erythematous, scaling papules, frequently after upper respiratory tract infection with β-hemolytic streptococci.* The differential diagno- sis should include pityriasis rosea and secondary syphilis.*

Answer 58

Guttate psoriasis (eruptive psoriasis)

Question 58

FDA Approved therapy for psoriasis

Answer 58

Question 58

side effects(Renal dysfunction, hypertension, hyperkalemia, hyperuricemia, hypomagnesemia, hyperlipidemia, increased risk of malignancies) of what psoriasis drug ?

Answer 58

Cyclosporine calcineurin inhibitor

Question 59

PDE4 inhibitor fda approved for Psoriasis

Answer 59

Apremilast

Question 59

Adverse effects of Methortrexate

Answer 59

Hepatotoxicity, pulmonary toxicity, pancytopenia, potential for increased malignancies, ulcerative stomatitis, nausea, diarrhea, teratogenicity

Question 60

FDA Approved Biologics for Psoriasis or Psoriatic Arthritis

Answer 60

Question 61

psoriasis medications that work via **Anti-TNF-α**

Answer 61

Etanercept (Ps, PsA; SC) Adalimumab (Ps, PsA; SC) Certolizumab (Ps, PsA; SC) Infliximab (Ps, PsA; IV) Golimumab (PsA; SC)

Question 62

showing multiple flat- topped, violaceous papules and plaques. Nail dystrophy, as seen in this patient’s thumbnail, may also be a feature.

Answer 62

Lichen planus

Question 63

anti IL 12 and IL 23 treatment for psoriasis

Answer 63

Ustekinumab

Question 64

Anti-IL-23 treatment for psoriasis

Answer 64

RISA TILDRA GUSEL 23 Risankizumab (Ps; SC) Tildrakizumab (Ps; SC) Guselkumab (

Question 64

multiple round to oval erythematous patches with fine central scale are distributed along the skin tension lines on the trunk,

Answer 64

Pityriasis rosea. papulosquamous eruption of unknown eti- ology occurring more commonly in the spring and fall. Its first mani- festation is the development of a 2- to 6-cm annular lesion (the herald patch). This is followed in a few days to a few weeks by the appearance of many smaller annular or papular lesions with a predilection to occur on the trunk

Question 65

Anti-IL-17

Answer 65

SE-XE-BRODA == 17 Secukinumab (Ps, PsA; SC) Ixekizumab (Ps; SC) Brodalumab (Ps; SC)

Question 65

with inflammatory papules, pustules, and comedones. (

Answer 65

acne vulgaris Treatment of acne vulgaris is directed toward elimination of come- dones by normalizing follicular keratinization and decreasing seba- ceous gland activity, the population of C. acnes, and inflammation

Question 65

Erythroderma Figure

Answer 65

Question 65

Answer 65

Prominent facial erythema, telangiectasia, scattered papules, and small pustules are seen in this patient with acne rosacea. tx: Acne rosacea can be treated topically or systemically. Mild disease often responds to topical preparations of metronidazole, sodium sulfacetamide, azelaic acid, ivermectin, brimonidine, or oxyme- tazoline. More severe disease requires oral tetracyclines in suban- timicrobial, modified-release preparations. Residual telangiectasia may respond to laser therapy. Topical glucocorticoids, especially potent agents, should be avoided because chronic use of these prep- arations may elicit rosacea. Application of topical agents to the skin is not effective treatment for ocular disease.

Question 66

non-scarring alopecia causes

Answer 66

Question 67

Tx for Upper trunk and neck (shawl- like distribution), groin Young adults Macules have fine white scale when scratched with golden flouroscense, on wood's lamp skin biopsy: hyphal forms and budding yeast in stratum corneum

Answer 67

Pityriasis (tinea) versicolora Tx? Selenium sulfide 2.5% shampoo; topical imidazoles; oral triazoles Pathogenesis: Invasion of stratum corneum by the yeast Malassezia Yeast is lipophilic and produces C9 and C11 dicarboxylic acids, which in vitro inhibit tyrosinase

Question 68

Flaccid bullae are easily ruptured, resulting in multiple erosions and crusted plaques. B. Involvement of the oral mucosa, which is almost invariable, may present with erosions on the gingiva, buccal mucosa, palate, posterior pharynx, or tongue may elicit the separation of the epidermis (Nikolsky’s sign).

Answer 68

Pemphigus vulgaris Histology: acantholytic blister formed in suprabasal layer of epidermis Cell surface deposits of IgG on keratinocytes autoantigens Dsg3 (plus Dsg1 in patients with skin involvement)

Question 69

olymorphic autoimmune subepidermal blistering disease usually seen in the elderly. Initial lesions may consist of urticarial plaques; most patients eventually display tense blisters on either normal-appearing or erythematous skin

Answer 69

BULLOUS PEMPHIGOID The major histocompatibility complex class II allele HLA-DQβ1*0301 is prevalent in patients with BP. Though most cases occur sporadi- cally, BP can be triggered by medications (e.g., furosemide, dipeptidyl peptidase-4 inhibitors, immune checkpoint inhibitors), ultraviolet light, or ionizing radiation. Several studies have shown that BP is associated with neurologic diseases (e.g., stroke, dementia, Parkinson’s disease, and multiple sclerosis).

Question 69

Answer 69

Acute cutaneous lupus erythematosus (LE). A. Acute cutaneous LE on the face, showing prominent, scaly, malar erythema. Involvement of other sun-exposed sites is also common. B. Acute cutaneous LE on the upper chest, demonstrating brightly erythematous and slightly edematous papules and plaques.

Question 70

Answer 70

Gottron’s papules. Dermatomyositis often involves the hands as erythematous flat-topped papules over the knuckles. Periungual telangiectasias are also evident.

Question 71

Answer 71

Dermatomyositis. Periorbital violaceous erythema characterizes the classic heliotrope rash.

Question 72

Question 73

Answer 73

cleroderma showing acral sclerosis and focal digital ulcers.

Question 74

Answer 74

Scleroderma often eventuates in development of an expressionless, masklike facies.

Question 79

Adverse drug rxn type Vasculitis, serum sickness, drug- induced lupus

Answer 79

Type III Immune Complex IgG + Antigen

Question 80

Adverse drug reaction type ? SJS/TEN Morbilliform eruption

Answer 80

Type IVc T lymphocyte– mediated cytotoxic T lymphocyte inflammation

Question 81

rare reaction (0.01–0.1%) usu- ally occurs between the third and tenth days of therapy with ___ usually in women. Common sites are breasts, thighs, and buttocks Lesions are sharply demarcated, erythematous, or purpuric, and may progress to form large, hemorrhagic bullae with necro- sis and eschar formation.

Answer 81

Warfarin necrosis

Question 82

Uritcaria Angioedema Anaphylaxis?

Answer 82

Type I IGe Mediated

Question 82

Drug-induced hemolysis, thrombocytopenia (e.g., penicillin)

Answer 82

Type II IgG mediated cytoxicity

Question 82

Tuberculin skin test, contact dermatitis

Answer 82

Type IVa T lymphocyte– mediated macrophage inflammation

Question 82

DIHS Morbilliform eruption

Answer 82

Type 4b T lymphocyte– mediated eosinophil inflammation L-4, IL-5, IL-13 TH2 cells Eosinophils

Question 82

Answer 82

Toxic erythema of chemotherapy.

Question 82

Answer 82

Allergic contact dermatitis (bullous) due to adhesive tape.

Question 82

Answer 82

Morbilliform drug eruption.

Question 82

presents with a prodrome of fever and flu-like symptoms for several days, followed bythe appearance of a diffuse morbilliform eruption, usually involving the face

Answer 82

Drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/DRESS DIHS is a systemic drug reaction also known as DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome; because eosinophilia is not always present, the term DIHS is preferred. Clinically, DIHS presents with a prodrome of fever and flu-like symptoms for several days, followed bythe appearance of a diffuse morbilliform eruption, usually involving the face

Question 83

Answer 83

60-5 Fixed drug eruption

Question 83

characterized by blisters and mucosal/epider- mal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation with >30% detachment

Answer 83

TEN

Question 83

10–30% epidermal detachment

Answer 83

SJS TEN overkap

Question 83

medications that cause DIHS /DRESS

Answer 83

** allopurinol** classically induces DIHS with renal involvement; cardiac and lung involvement are more common with **minocycline**; gastrointestinal involvement is almost exclusively seen with **abacavir**; and some medications typically do not induce eosinophilia (**abacavir**, **dapsone**, **lamotrigine**). The cutaneous reaction usually begins 2–8 weeks after the drug is started and persists after drug cessation. Signs and symptoms may continue for several weeks, especially those associated with hepatitis. The eruption recurs with rechallenge, and cross-reactions among aromatic anticonvulsants, including **phenytoin**, **carbamazepine**, and **phenobarbital**, are com- mon. Other drugs causing DIHS include antibacterial sulfonamides and other antibiotics. Hypersensitivity to reactive drug metabolites, **hydroxylamine** for **sulfamethoxazole** and arene oxide for aromatic anticonvulsants, may be involved in the pathogenesis of DIHS. R

Question 83

describes cases in which the total body surface area of blistering and eventual detachment is <10%

Answer 83

SJS Patients with SJS/TEN initially present with fever >39°C (102.2°F); sore throat; conjunctivitis; and acute onset of painful dusky, atypical, target-like lesions (Intestinal and upper respiratory tract involvement are associated with a poor prognosis, as are older age and greater extent of epidermal detachment. A

Question 83

Drugs that most commonly cause SJS/TEN

Answer 83

Drugs that most commonly cause SJS/TEN are **sulfonamides, allopurinol, antiepilep- tics (e.g., lamotrigine, phenytoin, carbamazepine), oxicam NSAIDs, β-lactam and other antibiotics, and nevirapine.** Frozen-section skin biopsy may aid in rapid diagnosis.

Question 84

Answer 84

Target like lesion in SJS Patients with SJS/TEN initially present with fever >39°C (102.2°F); sore throat; conjunctivitis; and acute onset of painful dusky, atypical, target-like lesions

Question 85

Tx for SJS TEN

Answer 85

immediate discontinuation of the suspected drug, and meticulous supportive ther- apy in an intensive care or burn unit. Fluid management, atraumatic wound care, infection prevention and treatment, and ophthalmologic and respiratory support are critical. Early administration of systemic glucocorticoids, intravenous immunoglobulin, cyclosporine, or etaner- cept may improve disease outcomes, but randomized studies to evalu- ate potential therapies are lacking and difficult to perform

Question 86

Question 87

four (4) main questions to answer regarding a suspected drug eruption:

Answer 87

There are four main questions to answer regarding a suspected drug eruption: 1. Is the observed rash caused by a medication? 2. Is the reaction severe or evolving with systemic involvement? 3. Which drug or drugs are suspected, and should they be withdrawn? 4. What recommendation can be made for future medication use?

Question 87

drugs that causes Drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/DRESS))

Answer 87

Anticonvulsants, sulfonamides, allopurinol, minocycline

Question 87

Answer 87

Cutaneous small-vessel vasculitis (CSVV, leukocytoclastic vasculitis

Question 88

Dx? diffuse, deep red morbilliform eruption with facial involvement; facial and acral swelling Fever, lymphadenopathy, hepatitis, nephritis, myocarditis, eosinophilia, atypical lymphocytosis drinking allopurinol

Answer 88

Drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/DRESS)

Question 89

Fritzpatrick classification of skin type and sunburn sensitivity

Answer 89

Question 89

Monitoring for methotrexate tx

Answer 89

LFTs, CBC, renal function (every 4-8 weeks)

Question 89

Algorithm for the diagnosis of a patient with photosensitivity

Answer 89

Question 89

Cyclosporine

Answer 89

BP, renal function (every 2-3 months)

Question 89

Biologics monitoring labs?

Answer 89

TB testing before initiation

Question 90

CASPAR Criteria

Answer 90

Question 91

pathophysiology of psoriasis

Answer 91

1. Autoimmune Mechanism * Dysregulated T-cell mediated immune response (Th1, Th17 pathways). * IL-23/IL-17 axis plays a major role. * Overproduction of TNF-α, IL-17, IL-22, and IL-23 drives inflammation. 2. Keratinocyte Hyperproliferation * Abnormal differentiation and proliferation of keratinocytes, leading to thickened epidermis (acanthosis), parakeratosis (retention of nuclei in stratum corneum), and elongated rete ridges. 3. Angiogenesis & Inflammation * Increased vascularization in the dermis due to VEGF activation.

Question 91

Epidemiology of psoriasis

Answer 91

* Prevalence: Affects 2-3% of the global population. * Age of Onset: Bimodal peaks at 15-30 years (early onset) and 50-60 years (late onset). * Gender: Equal prevalence in males and females. * Genetics: Strong genetic component; associated with HLA-Cw6.