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Board Review > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what drugs commonly cause Toxic Epidermal Necrolysis?

A

sulfa abx

phenytoin

phenobarbital

carbamazepine

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2
Q

what would you see with these lesion on a smear?

A

erythema toxicum neonatorum (ENT)

filled with eosinophils

not seen in premies

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2
Q

what infection is this rash associated with?

A

guttate psoriasis

strep infections (pharyngitis or perianal strep)

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3
Q
A

neonatal acne

birth-3 weeks

self-resolving

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3
Q

over what body parts should you be concerned about large congenital nevi?

A

neurocutaneous melanosis

scalp, midline neck, spine - may have leptomeningeal involvement

verterbral colum - may have spina bifida

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3
Q

what diseases/syndromes are associated with cafe-au-lait spots?

A

NF1

NF2

McCune-Albright

tuberous sclerosis

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4
Q

what is erythrodermic psoriasis?

A

exfoliative reaction

entire body is warm, red, scaly

cannot control body temperature

causes: sunburn, drugs (antimalarials, betablockers, lithium), infections (strep, viruses)

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5
Q

in what locations should you worry about hemangiomas?

A

beard distribution (airway involvement)

ocular (eye involvement)

midline lumbosacral (spinal dysraphism)

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6
Q

if you have bilateral facial port-wine stains, what workup do you need?

A

optho and radiology imaging

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6
Q

what infections (other than bacterial superinfection) are children with eczema at higher risk of?

A

widespread molluscum

or

widespread herpes (eczema herpeticum)

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8
Q

what is the difference between neonatal and infantile acne?

A

neonatal: birth-3wks, self-resolve
infantile: 3-4 months later, has comedones, may require trreatment, may be related to other conditions that cause androgen excess (tumor, CAH, etc)

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9
Q

what is this caused by?

A

Koebner phenomenon

psoriasis outbreak in the area of an abrasion

usually linear

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10
Q

what do you need to be worried about if you have more than 5 hemangiomas?

A

visceral involvement

at risk for heart failure, liver failure

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10
Q

what are some of the conditions associated with this painful rash?

A
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12
Q
A

Milia:

tiny, pinhead size

yellow-white

tiny, epidermal inclusion cysts

no treatment

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14
Q

what are the skin findings in zinc deficiency?

A

red, irritated, eczematous rash

around nose/face

in perianal area (burned diaper rash)

also can cause alopecia

commonly seen in children with diarrheal diseases

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15
Q

what is a shagreen patch?

A

plaque of thickened skin with a cobblestone or orange-peel texture often seen on the dorsal aspect of the trunk

seen with tuberous sclerosis

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16
Q

what is the underlying defect of oculocutaneous albinism

A

tyrosine deficiency

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16
Q
A

pitariasis rosea

herald patch

christmas tree pattern

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17
Q

where does the rash of measles start?

A

forehead and then goes down

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18
Q

what are patients with oculocutaneous albinism at higher risk of?

A

basal cell and squamous cell cancers

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18
Q

what drug causes hypertrophied gums?

A

phenytoin

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19
Q

what drug can cause necrotic skin patches 3-10 days after starting it?

A

warfarin

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19
Q

what happens if you try to remove a psoriatic plaque?

A

will have bleeding from capillaries underneath (auspitz sign)

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19
Q

what physical findings are associated with dermatomyositis?”

A

heliotrope rash

Gottron’s papules (eruptions over the knuckles)

rash over knees/elbows

nailbed teleangiectasias

tx with steroids +/- immunosuppresives

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20
Q
A

koplik spots

seen with measles (appear before rash)

small white papules on erythematous base

21
Q

what medicine is used for severe psoriasis?

A

acitretin (TNF-alpha inhibitor)

has black box warning: increased risk of leukemia and other cancers

can also use methotrexate or cyclosporine (esp if arthritis)

22
Q

what should you look for in a patient with x-linked icthyosis?

A

undescended testicles

underdeveloped penis or testicles

23
Q

what can this be associated with?

A

polyglandular syndrome!

autosomal recessive

look for:

diabetes

graves

addison/adrenal insufficiency

hyper/hypo thyroidism

pernicious anemia

24
Q
A

congenital herpes simplex

common around fetal scalp monitor or presenting part

more likely to happen if primary infection for mom or vesicles present

25
Q

what can this sometimes be associated with

A

psorasis

26
Q

what other physical findings are associated with psoriasis?

A

nail pitting and onycholysis (painless separation of the nail from the nail bed)

28
Q
A

sebaceous hyperplasia

in differential of milia

concentrated around nose/lips

due to increased exposure to adrogens in utero

self-resolving

28
Q

what is erythrasma

A

well-defined redding lesion with some scaling

found in axillae, under breasts, in between toes, and in groin

chronic infection

will fluoresce RED with woods lamp

tx with erythromycin and -azole cream

29
Q

hyperpigmented gingivia

A

addison’s disease

31
Q

how is this disease inherited?

A

incontinenia pigmenti

x-linked (thought to be fatal in males)

also associated with delayed eruption of teeth

teeth often cone shaped

alopecia

blindness

32
Q

what ANA pattern is associated with cutaneous lupus?

A

speckled

have SS-A or SS-B (Ro/La) antigens

33
Q

what is PHACES syndrome?

A

P: posterior fossa abnormalities

H: hemangioma (usually involve trigmeninal distribution)

A: arterial anomalies (intracerebral arteries)

C: cardiac defects (coarct)

E: eye abnormalities

S: sternal clefting

34
Q

what is this rash seen on a well-appearing baby?

A

cutis marmorata

reticular lacy pattern seen when baby is cold

skin returns to normal when warm

usually goes away by 6 months of age

35
Q

what is associated with ash leaf spots?

A

tuberous sclerosis

36
Q

what is the Nikolsky sign?

A

seperation of skin with minimal pressure

seen in SSSS, TEN, and pempigus vulgaris

37
Q

does the Ro (SS-A) or La (SS-B) antigen cause heart block in neonates?

A

Ro (SS-A) - can cross the placenta

number one cause of neonatal heart block

usually don’t have skin findings (periorbital erythema, round/annular patches)

38
Q

what causes this type of alopecia?

(focus on second picture)

A

tinea capitis

breakage at the scalp with “salt and pepper” apperance

39
Q

what is the underlying defect in x-linked icthyosis?

A

sulfatase deficiency

40
Q

what else should you look for in a patient with this finding?

A

hearing loss (Wardenberg syndrome)

or

other neurologic deficits (Wolf-Hirschorn)

42
Q

what other condition do you need to worry about with a port-wine stain?

A

if in opthalmic branch of trigeminal nerve (V1) then worry about Sturge-Weber syndrome

ipsilateral cerebral vascular malformation

(seizures, MR, contralateral hemiplegia, glaucoma)

43
Q
A

peutz-jeghers syndrome

(multiple intestinal haramtomas/polyps)

45
Q

what is the risk of melanoma with congential nevi?

A

yes.

very small for small to medium nevi

5-15% for large nevi

large nevi often in dermatome distribution

46
Q

what would you seen on smear of these pustules?

A

transient pustular melanosis

pustules that turn to pigmented macules

neutrophils on smear

48
Q

what is associated with lower extremity port-wine stains?

A

Klippel-Trenaunay syndrome

vascular malformation of limb

associated soft tissue overgrowth or limb overgrowth

varicose veins

50
Q
A

miliaria rubia

caused by sweat retention/overheating

often on head and neck

miliaria crystallina: similar but clear fluid filled vesicles

51
Q

what is the natural course of infantile hemangiomas?

A

may or may not be present at birth

grow rapidly

stabilize for 6-10 months

then begin to involute around age 2

50% gone by age 5

52
Q
A

NF1

6 or more spots and axiallary/groin freckling is diagnostic for NF1!

53
Q

what is the medical term for port-wine stain?

A

nevus flammeus

54
Q
A

erythema multiforme

palms and soles frequently involved

fixed lesions

associated with HSV, mycoplasma,

55
Q

what infection is this rash associated with?

A

congenital rubella

(also CMV)

56
Q
A

Incontinentia pigmenti.

A, Linearly distributed vesicles on an erythematous base are seen on the legs of this neonate.
B and C, Subsequently, lesions evolve into warty papules, which can have thick overlying crusts.
D, Splotchy hyperpigmented patches replaced the warty lesions by 8 months of age.
E, In many cases the hyperpigmentation appears in swirls and streaks.
F, These hypopigmented reticulated lesions on the leg of an affected child’s mother represent old scars in areas of prior hyperpigmentation.

57
Q

how is oculocutaneous albinism inherited?

A

autosomal recessive

58
Q

what syndrome consists of

basal cell carcinoma in childhood

dysmorphic facies

palmoplantar pits

skeletal defects

jaw cysts

ovarian tumors

A

Gorlin Syndrome

autosomal dominant

60
Q

what causes erysipelas?

A

group A strep infection

rapidly enlaring cellultiis with clear borders

culture the leading edge

61
Q

what other physical finding may you find in a child with this disease?

A

pitted fingernails

occasionally associated with autoimmune diseases

if total hair loss - less likely to grow back

topical steroids can be tried but not super effective

62
Q
A

Cutis Aplasia Congenita

abscence of skin

25% have underlying abnormalities

multiple spots: trisomy 13

midline defect: spinal dysraphia

63
Q

name some of the side effects of isotretinoin

A

pseudotumor cerebri

depression

psychosis

pancreatitis

hypertriglyceridemia

hearing loss

vision loss

skeletal abnormalities

64
Q

what other nutritional deficiency can result in symptoms similar to zinc deficiency?

A

biotin

can also have CNS symptoms

common in kids on hyper al

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