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PSBIM > DERMATOLOGY > Flashcards

DERMATOLOGY Flashcards

1
Q

Scaly papule that soon forms erythematous plaques covered with a white scale

A

Psoriasis

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2
Q

Hemorrhagic red papules that do not blanch with pressure

A

necrotizing vasculitis

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3
Q

Target-shaped lesion that consist in part of erythematous plaques

A

erythema multiforme

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4
Q

Pseudohyphae and budding yeasts is seen in

A

Candida infections

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5
Q

“Spaghetti and meatballs” yeast forms are seen in

A

tinea versicolor

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6
Q

A cytologic technique most often used in the diagnosis of herpesvirus infections (herpes simplex virus or varicella zoster virus)

A

Tzanck smear

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7
Q

An opaque to transparent, brown-pink “apple jelly” appearance on diascopy

A

Granulomas

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8
Q

Coral pink color under the wood’s lamp

A

Erythrasma

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9
Q

A superficial, intertriginous infection caused by Corynebacterium minutissimum

A

Erythrasma

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10
Q

Pale blue on wood’s lamp

A

Pseudomonas

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11
Q

Yellow fluorescence on wood’s lamp

A

Tinea capitis

Caused by dermatophytes (e.g. Micrisporum canis or M. audouinii)

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12
Q

A battery of suspected allergens is applied to the patient’s back under occlusive dressings and allowed to remain in contact with the skin for 48 h

A

Patch test

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13
Q

Patch test is used to examine evidence of

A

delayed hypersensitivity reactions

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14
Q

This is the most common type of melanoma

A

Superficial spreading 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).

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15
Q

A flat, colored lesion, <2 cm in diameter, not raised above the surface of the surrounding skin. A “freckle,” or ephelid, is a prototype

A

Macule

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16
Q

A large (>2 cm) flat lesion with a color different from the surrounding skin

A

Patch

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17
Q

A small, solid lesion, <0.5 cm in diameter, raised above the surface of the surrounding skin and thus palpable (e.g., a closed comedone, or whitehead, in acne).

A

Papule

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18
Q

A larger (0.5 to 5.0 cm), firm lesion raised above the surface of the surrounding skin

A

Nodule

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19
Q

A solid, raised growth >5 cm in diameter.

A

Tumor

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20
Q

A large (>1 cm), flat-topped, raised lesion; edges may either be distinct (e.g., in psoriasis) or gradually blend with surrounding skin (e.g., in eczematous dermatitis).

A

Plaque

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21
Q

A small, fluid-filled lesion, <0.5 cm in diameter, raised above the plane of surrounding skin. Fluid is often visible, and the lesions are translucent

A

Vesicle

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22
Q

A vesicle filled with leukocytes

A

Pustules

The presence of pustules does not necessarily signify the existence of an infection

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23
Q

A fluid-filled, raised, often translucent lesion >0.5 cm in diameter

A

Bulla

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24
Q

A raised, erythematous, edematous papule or plaque, usually representing short-lived vasodilation and vasopermeability.

A

Wheal

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25
Q

A dilated, superficial blood vessel

A

Telangiectasia

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26
Q

A distinctive thickening of the skin that is characterized by accentuated skin-fold markings.

A

Lichenification

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27
Q

Excessive accumulation of stratum corneum

A

Scale

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28
Q

Dried exudate of body fluids that may be either yellow or red

A

Crust

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29
Q

Loss of epidermis without an associated loss of dermis.

A

Erosion

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30
Q

Loss of epidermis and at least a portion of the underlying dermis

A

Ulcer

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31
Q

Linear, angular erosions that may be covered by crust and are caused by scratching.

A

Excoriation

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32
Q

An acquired loss of substance. In the skin, this may appear as a depression with intact epidermis or as sites of shiny, delicate, wrinkled lesions

A

Atrophy

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33
Q

A change in the skin secondary to trauma or inflammation. Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character. Sites on hair-bearing areas may be characterized by destruction of hair follicles.

A

Scar

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34
Q

Small, firm, white papules filled with keratin

A

Milia

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35
Q

Coin-shaped lesion

A

Nummular

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36
Q

Skin that displays variegated pigmentation, atrophy, and telangiectases.

A

Poikiloderma

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37
Q

A configuration of skin lesions formed from coalescing rings or incomplete rings

A

Polycyclic lesions

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38
Q

Erythema with greasy yellow-brown scale

A

Seborrheic dermatitis

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39
Q

Violaceous flat-topped papules and plaques

A

Lichen planus

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40
Q

Skin-colored or red-brown macule or papule with dry, rough, adherent scale

A

Actinic keratosis

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41
Q

Papule with pearly, telangiectatic border on sun- damaged skin

A

Basal cell carcinoma

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42
Q

Usual site of basal cell carcinoma

A

Face

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43
Q

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

A

Squamous cell carcinoma of the skin

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44
Q

Usual site of squamous cell carcinoma of the skin

A

Face (especially lower lips, ears)

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45
Q

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

A

Seborrheic keratosis

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46
Q

Symmetric erythematous papules and plaques with a collarette of scale

A

Pityriasis rosea

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47
Q

Most frequent skin reaction to drugs

A

Morbilliform rash – 91%

Urticaria – 6%

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48
Q

Populations that are at high risk for cutaneous drug reactions (4)

A
  1. Elderly
  2. Autoimmune disease
  3. Hematopoietic stem cell transplant recipient
  4. Acute EBV or HIV infection
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49
Q

CD4 count in HIV disease that have 40- to 50-fold increased risk of ADR to sulfamethoxazole and increased risk of severe hypersensitivity reactions

A

CD4 < 200

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50
Q

Drugs can trigger mediator release either by these 2 mechanism

A
  1. Direct mast cell degranulation

2. IgE-specific antibodies

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51
Q

NSAIDs trigger mediator release by

A

Direct mast cell degranulation

“anaphylactoid” reaction

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52
Q

Radiocontrast media trigger mediator release by

A

Direct mast cell degranulation

“anaphylactoid” reaction

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53
Q

Penicillin trigger mediator release by

A

IgE-specific antibodies

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54
Q

Caused by tissue deposition of circulating immune complexes with consumption of complement

A

Serum sickness

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55
Q

Common cause of serum sickness

A

Monoclonal antibodies and similar drugs

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56
Q

Symptoms of serum sickness usually develop how many days after drug exposure

A

6 or more days

Latent period – time needed to synthesize antibody

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57
Q

An important mechanism underlying the most common drug eruptions (morbilliform eruptions)

A

Delayed hypersensitivity

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58
Q

Genetic determinants may predispose individuals to severe drug reactions by affecting either drug metabolism or immune responses to drugs; most commonly

A

HLA haptotypes

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59
Q

Drugs that can exacerbate plaque psoriasis (6)

A
  1. NSAIDs
  2. Lithium
  3. Beta blockers
  4. TNF antagonists
  5. Interferon α
  6. ACE inhibitors
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60
Q

A drug used to treat psoriasis that May induce psoriasis (esp palmoplantar) in patients being treated for other conditions

A

TNF antagonists

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61
Q

Drugs that can worsen pustular psoriasis (2):

A
  1. Antimalarials

2. Withdrawal of systemic glucocorticoids

62
Q

Follicular papular or pustular eruptions of the face and trunk resembling acne can be caused by what drug

A

epidermal growth factor receptor (EGFR) antagonists

Severity of the eruption correlates with a better anticancer effect
Typically responsive to and prevented by tetracycline antibiotics

63
Q

Markers of drug-induced SLE (4)

A
  1. ANA
  2. Antihistone
  3. Anti-dsDNA
  4. p-ANCA
64
Q

Drugs that may cause pemphigus (2)

A
  1. D-penicillamine

2. ACE inhibitors

65
Q

Drugs that may cause bullous pemphigoid (2)

A
  1. Furosemide

2. PD-1 inhibitors

66
Q

Drugs that may cause linear IgA bullous dermatosis

A

Vancomycin

67
Q

A condition of sclerosing skin with rare internal organ involvement caused by gadolinium contrast

A

Nephrogenic systemic fibrosis

68
Q

Mechanism of photosensitivity eruption is almost always

A

Phototoxicity

69
Q

Blistering may occur in drug-related pseudoporphyria, particularly caused by

A

NSAIDs – most common

70
Q

Drug that may result in severe photosensitivity, accelerated photoaging, and cutaneous carcinogenesis

A

Voriconazole

71
Q

Drug that can cause a UV-recall reaction characterized by an erythematous, slightly scaly eruption at sites of prior severe sun exposure

A

Methotrexate

72
Q

Blue-gray pigmentation can be caused by what 2 drugs

A
  1. long-term minocycline

2. amiodarone

73
Q

Gray-brown pigmentation can be caused by what drugs (3)

A
  1. Phenothiazine
  2. Gold
  3. Bismuth
74
Q

Red-brown pigmentation can be caused by what drug and what do you call this condition?

A

Clofazimine

Drug-induced lipofuscinosis

75
Q

Hyperpigmentation of the face, mucous membranes, and pretibial and subungual areas can be caused by what drug

A

Antimalarials

76
Q

Generalized yellow discoloration can be caused by

A

Quinacrine

77
Q

Warfarin necrosis of the skin occurs between the how many days of therapy with warfarin

A

3-10 days

78
Q

Common sites of warfarin necrosis of the skin (3)

A
  1. Breasts
  2. Thighs
  3. Buttocks

Usually in women

79
Q

Drug induced hair loss that occurs during growth

A

Anagen effluvium

Occurs within days of drug administration Antimetabolite or other chemotherapeutic drugs

80
Q

Drug induced hair loss that occurs during resting phase of growth

A

Telogen effluvium

Delay is 2-4 months following initiation of new medication

81
Q

Drug-induced nail disorder characterized by transverse depression of the nail plate

A

Beau’s line

82
Q

Drug-induced nail disorder characterized by detachment of the distal part of the nail plate

A

Onycholysis

83
Q

Common drugs that cause onycholysis (5)

A
  1. Tetracyclines
  2. Fluoroquinolones
  3. Retinoids
  4. NSAIDs
  5. Chemotherapeutic agents
84
Q

Drug-induced nail disorder characterized by detachment of the proximal part of the nail plate

A

Onychomadesis

Caused by temporary arrest of nail matrix mitotic activity

85
Q

Common drugs that cause onychomadesis (4)

A
  1. Carbamazepine
  2. Lithium
  3. Retinoids
  4. Chemotherapeutic drugs
86
Q

Drug-induced nail disorder characterized by inflammation of periungal skin

A

Paronychia

87
Q

Common drugs that cause paronychia (4)

A
  1. Systemic retinoids
  2. Lamivudine
  3. Indinavir
  4. Anti-EGFR monoclonal antibodies
88
Q

Drug reaction that is marked by dysesthesia and an erythematous, edematous eruption of the palms and soles

A

Acral erythema

Toxic erythema of chemotherapy

89
Q

Chemotherapeutic drugs that cause acral erythema (6)

A
  1. Cytarabine
  2. Doxorubicin
  3. Methotrexate
  4. Hydroxyurea
  5. Fluorouracil
  6. Capecitabine
90
Q

Chemotherapeutic drug that cause marked hair textural changes

A

Erlotinib

91
Q

Chemotherapeutic drug that cause follicular eruptions and focal bullous eruptions at palmoplantar, flexural sites or areas of frictional pressure

A

Sorafenib

A tyrosine kinase inhibitor

92
Q

Most common of all drug-induced reactions

A

Morbiliform eruptions

93
Q

More severe reaction of morbilliform eruptions is characterized by

A

Nonblanching, dusky, or bright-red macules

94
Q

Certain medications that carry very high rates of morbilliform eruptions (2)

A
  1. Nevirapine

2. Lamotrigine

95
Q

The 2nd most frequent type of cutaneous reaction to drugs

A

Urticaria

96
Q

Deep edema within dermal and subcutaneous tissues

A

Angioedema

97
Q

Anaphylactoid reaction characterized by flushing, diffuse maculopapular eruption, and hypotension and what drug causes it?

A

Red man syndrome

Vancomycin

98
Q

DRESS or DIHS has morbilliform eruptions that most frequently involve which part of the body

A

Face

99
Q

Systemic manifestations of DRESS or DIHS (in descending order) (8)

A
  1. Lymphadenopathy
  2. Fever
  3. Leukocytosis – eosinophilia or atypical lymphocytosis
  4. Hepatitis
  5. Nephritis
  6. Pneumonitis
  7. Myositis
  8. Gastroenteritis
100
Q

Drug that most frequently induces DIHS with renal involvement

A

Allopurinol

101
Q

Drug that most frequently induces DIHS with cardiac and lung involvement

A

Minocycline

102
Q

Drug that most frequently induces DIHS and wherein GI involvement is almost exclusively seen

A

Abacavir

103
Q

Medications that typically lack eosinophilia in DIHS (3)

A
  1. Abacavir
  2. Dapsone
  3. Lamotrigine
104
Q

Cutaneous reaction in DIHS usually begins ____ after the drug is started and _____ after drug cessation

A

2-8 weeks

persists

105
Q

Reactivation of herpes virus (HHV 6 and 7, EBV, and CMV) – frequently reported in this drug related syndrome

A

DIHS or DRESS

Worse clinical prognosis if with reactivation

106
Q

Mortality rate of DIHS / DRESS

A

10%

107
Q

Most fatalities of DIHS / DRESS is caused by

A

liver failure

108
Q

Management of DIHS / DRESS (6)

A
  1. Systemic glucocorticoids 1.5-2 mg/kg/d prednisone equivalent
  2. Mycophenolate mofetil
  3. Immediate withdrawal of culprit drug
  4. Cardiac evaluation (because of severe long-term complications of myocarditis)
  5. Monitor for resolution of organ dysfunction
  6. Monitor for development of late-onset autoimmune thyroiditis and diabetes (up to 6 months)
109
Q

Drug reaction that is characterized by blisters and mucosal/epidermal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation, and involve <10% of TBSA

A

SJS

110
Q

Drug reaction that is characterized by blisters and mucosal/epidermal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation, and involve 10-30% of TBSA

A

SJS-TEN overlap

111
Q

Drug reaction that is characterized by blisters and mucosal/epidermal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation, and involve >30% of TBSA

A

TEN

112
Q

Painful mucosal erosions and target lesions with acral distribution and limited skin detachment and is associated with HSV

A

Erythema multiforme

113
Q

Clinical features of SJS/TEN (4)

A
  1. Fever >390C
  2. Sore throat
  3. Conjunctivitis
  4. Acute onset of painful dusky, atypical, target-like lesions
114
Q

Factors associated with poor prognosis in SJS / TEN (4)

A
  1. GI involvement
  2. Upper respiratory tract involvement
  3. Older age
  4. Greater extent of epidermal detachment
115
Q

Mortality rates of SJS and TEN

A

10% - SJS

30% - TEN

116
Q

Rare reaction pattern that is secondary to medication exposure in >90% of cases characterized by diffuse erythema or erythroderma, high-spiking fevers, innumerable pinpoint pustules most pronounced in body fold areas

A

Acute generalized exanthematous pustulosis

117
Q

Difference between AGEP from SJS (2)

A
  1. Erosions are more superficial

2. No prominent mucosal involvement

118
Q

Principal DDx for AGEP

A

Acute pustular psoriasis

119
Q

Most commonly implicated in drug-induced vasculitis

A

β-lactam

Almost any drug can cause vasculitis

120
Q

Most common drugs that cause drug-induced ANCA vasculitis (3)

A
  1. PTU
  2. Methimazole
  3. Hydralazine
121
Q

Long-term exposure to minocycline can cause this reaction that is characterized by perivascular eosinophils on skin biopsy

A

Drug-induced polyarteritis nodosa

122
Q

Cutaneous drug eruption that is always drug-induced

A

fixed drug eruptions

123
Q

Most cases of drug eruptions occur during the first course of treatment with a new medication, except for

A

IgE-mediated urticaria and anaphylaxis

Need presentization and develop a few minutes to a few hours after rechallenge

124
Q

Characteristic timing of onset following drug administration:

Morbilliform eruption
AGEP
SJS/TEN
DIHS

A

Morbilliform eruption – 4-14 days
AGEP – 2-4 days
SJS/TEN – 5-28 days
DIHS – 14-48 days

125
Q

A key diagnostic tool for identifying the inciting drug that compile all current and past medications/supplements and the timing of administration relative to the rash

A

Drug chart

126
Q

It is now recommended that 1st degree family members of patients with severe cutaneous reactions also should avoid causative agents. This recommendation is most relevant for what drugs (2)

A

sulfonamides and antiepileptic medications

127
Q

Type of ADR that is IgE-mediated

A

Type I

128
Q

Type of ADR that is IgG-mediated

A

Type II

129
Q

Type of ADR that is secondary to immune complex

A

Type III

130
Q

Type of ADR that is T lymphocyte– mediated macrophage inflammation

A

Type IVa

131
Q

Type of ADR that is T lymphocyte– mediated eosinophil inflammation

A

Type IVb

132
Q

Type of ADR that is T lymphocyte– mediated cytotoxic T lymphocyte inflammation

A

Type IVc

133
Q

Type of ADR that is T lymphocyte– mediated neutrophil inflammation

A

Type IVd

134
Q

Urticaria is what type of ADR?

A

Type I

135
Q

Angioedema is what type of ADR?

A

Type I

136
Q

Anaphylaxis is what type of ADR?

A

Type I

137
Q

Drug-induced hemolysis is what type of ADR?

A

Type II

138
Q

Thrombocytopenia is what type of ADR?

A

Type II

139
Q

Vasculitis is what type of ADR?

A

Type III

140
Q

Serum sickness is what type of ADR?

A

Type III

141
Q

Drug-induced lupus is what type of ADR?

A

Type III

142
Q

Tuberculin test is what type of ADR?

A

Type IVa

143
Q

Contact dermatitis is what type of ADR?

A

Type IVa

144
Q

DIHS is what type of ADR?

A

Type IVb

145
Q

SJS/TEN is what type of ADR?

A

Type IVc

146
Q

AGEP is what type of ADR?

A

Type IVd

147
Q

Morbiliform eruptions is what type of ADR?

A

Type IVb and IVc

148
Q

Most common culprit drugs for SJS/TEN? (4)

A
  1. Sulfonamides
  2. Anticonvulsants
  3. Allopurinol
  4. NSAIDs
149
Q

Most common culprit drugs for DIHS/DRESS? (4)

A
  1. Anticonvulsants
  2. Sulfonamides
  3. Allopurinol
  4. Minocycline
150
Q

Most common culprit drugs for AGEP? (3)

A
  1. β-Lactam antibiotics
  2. Calcium channel blockers
  3. Μacrolide antibiotics
151
Q

Most common culprit drugs for serum sickness? (3)

A
  1. Antithymocyte globulin
  2. Cephalosporins
  3. Monoclonal antibodies
152
Q

Most common culprit drugs for angioedema? (3)

A
  1. ACE inhibitors
  2. NSAIDs
  3. Contrast dye

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