Exam Questions to review Flashcards
Blisters below basal lamina is not caused by:
A. JEB
B. DEB
C. EB acquisita
D. PCT
E. DH
A. JEB
Intra-epidermal blister at the basal layer is not seen in:
A. Erythema multiforme
B. LE
C. LP
D. Epidermlysis bulosa
E. Pemphigus vulgaris
E. Pemphigus vulgaris
Hypotrichos is not a feature of:
A. Harlequin ichthyosis
B. KID syndrome
C. Netherton syndrome
D. Arthrogryposis-renal-dysfunction-cholestasis syndrome
E. TTD
A. Harlequin ichthyosis
Eosinophilic spongiosis is not a cause in Which of the following:
A. Pemphigus vulgaris
B. EBA
C. Linear IgA bullous dermatosis
D. Grover’s disease
E. Polymorphic eruption of pregnancy
B. EBA
Intra-epidermal blister at the granular layer is not seen in:
A. Friction blister
B. Pemphigus folaicious
C. Subcorneal pustular dermatosis
D. Herpes Virus infection
E. SSSS
D. Herpes Virus infection
Apoptotic keratinocytes is not presenting:
A. Acute cutaneous LE
B. Subacute cutaneous LE
C. Discoid lesion of LE
D. Tumid LE
E. Lupus panniculitis
D. Tumid LE
One of the following induced the release of inflammatory mediators from mast cells:
A. C2a
B. C3b
C. C4a
D. C5b
E. C2b
A. C4a
Tetracyclines have anti-inflammatory effects which include:
A. Increasing matrix metalloproteinase activity
B. Inhibit leukocyte chemotaxis
C. Increase production of TNFa
D. Increase production of IL1B
E. Decrease production of IL1B
E. Decrease production of IL1B
Profilagrin is evident in
A. Stratum corneum
B. Stratum granulosum
C. Stratum lucidum
D. Stratum basale
B. Stratum granulosum
One of the following is not a feature of epidrmophyton conidia:
A. They are smooth walled
B. Microconidia are numerous and diagnostic
C. It is club-shaped
D. May be solitary or clustred
E. The cell wall thickness is intermediate
B. Microconidia are numerous and diagnostic
Cobalt toxicity may leads to:
A. Coagulopathy
B. Diffuse nodular fibrosis
C. Burns
D. Lichenoid drug eruption
B. Diffuse nodular fibrosis
At how many weeks does the fetal basement membrane begin to develop?
7 weeks
Features of congenital generalized lipodystrophy?
Hyperhidrosis
Hypertrichosis - increased, often curly, scalp hair at birth
Acanthosis nigricans, often early onset and widespread
Coarse skin on the upper body
Hyperkeratotic epidermal papillomatosis (may represent an exaggerated form of AN)
Xanthomas
The most common associated malignancy in Dermatitis Herpetiforms is?
A. GI lymphoma
B. Gastric adenocarcinoma.
C. Colon adenocarcinoma.
D. Breast adenocarcinoma.
E. Castelman’s.
A. GI lymphoma
Which of the following are markers on dendritic cells?
A. CD20
B. CD11a
C. CD 86
D. CD 8
E. CD 1A
C. CD 86
Ecthyma gangrenosum, what is the pathophysiology of the formation of skin lesion?
A. Infection of the epidermis and superficial dermis
B. Embolic event
C. Perivascular invasion by organism with release of endotoxin
D. Invasion of bacteria to the vessel lumen
C. Perivascular invasion by organism with release of endotoxin
Ecthyma GANGrenosum = invasive infection by P. aeruginosa
Antifungal contraindicated in hx of porphyria?
Griseofulvin
tetracycline with highest risk of photosensitivity?
Demeclocycline
Terry’s nails seen in?
DM, congestive heart failure and liver cirrhosis
ATM gene function is?
DNA repair
UVA blocker?
Avobenzones & Meradimate*
Stain for endometrial origin of metastasis?
CK 7+, CK20-, ER/PR)+, CEA+
What is the best initial treatment of bleomycin-induced flagellate erythema in a patient without evidence of lung toxicity?
A. Permanent discontinuation of bleomycin
B. Antihistamines and topical steroids
C. Oral corticosteroids
D. Topical ketoconazole
E. Avoid sun exposure
B. Antihistamines and topical steroids
BIFE is typically self-limited and resolves upon cessation of bleomycin. Oral antihistamines and topical steroids are found improve the itching associated with BIFE.
For lungs, initiate Systemic glucocorticoids
A huge hyper pigmented and hyperkeratotic plaque on the abdomen of a diabetic is?
A. Acquired ichthyosis
B. Retention hyperkeratosis
C. Confluent and reticulated papillomatosis (CARP)
D. Drug-induced acanthosis nigricans (AN)
E. Erythrasma
D. Drug-induced acanthosis nigricans
Pathogenesis is induction by insulin and Insulin like Growth Factor.
Drugs that can cause drug-induced AN: injected insulin or Nicotinic cid (20%)
Rash on the chest + mucin on bx think of?
Reticular erythematous mucinosis (REM)
Remember* possible association with internal malignancy and thyroid disease. Hashimoto disease and hyperthyroidism, and malignancies of the lung, breast, and colon.
Stain for mucin?
A. Masson trichrome
B. Prussian blue
C. Gomori trichrome
D. Alcian blue
E. Grocott methenamine silver stain
D. Alcian blue
Tx for Cutaneous sarcoidosis, verrucous subtype?
A. Topical corticosteroids
B. Intralesional corticosteroids
C. Systemic glucocorticoid therapy
D. Methotrexate
E. Antimalarials
C. Systemic glucocorticoid therapy
Best drug for neuroparacoccidioidomycosis?
TMP-SMX
Which of the following is true regarding elephantiasic pretibial myxedema?
A. The disease is most often found in association with hypothyroidism
B. While there are different presentations of pretibial myxedema, the most uncommon is the elephantiasic variant
C. The disease is often responsive to topical corticosteroids and supportive treatment
D. Elephantiasic pretibial myxedema resolves after control of underlying thyroid disease
E. The main cause of elephantiasic pretibial myxedema is chronic lymphedema
B. answer
There are four distinct variants of pretibial myxedema: non-pitting, plaque- like, nodular, and elephantiasic. The elephantiasic variant is the most uncommon and it occurs in less than 1% of patients with pretibial myxedema.
Primary cutaneous marginal zone lymphoma vs. Marginal zone lymphoma?
Patients with PCMZL tend to be younger, with no systemic systems, express IgG, IgA, or IgE, and have a predominant of Th1 cytokine inflammatory background. Marginal zone lymphoma patients tend to be older, have systemic symptoms and show expression of IgM.
Which is the most likely diagnosis?
A. Sebaceous carcinomas
B. Trichilemmomas
C. Cylindromas
D. Amelanotic melanomas
E. Neurofibromas
C. Cylindromas
Cylindromas, solitary or multiple, usually arise on the scalp as firm, rubbery, pink-to-red or bluish papulonodular lesions. When they are numerous, covering the entire scalp, they cause hair loss (‘‘turban tumor’’). Histologically they consist of dermal nodules without connection to the overlying normal-appearing epidermis. Subcutaneous extension may occur. They show lobular growth with a typical jigsaw puzzle pattern. A thick periodic acid-Schiff-positive basal membrane covers each lobule characterized by peripheral palisading of small hyperchromatic cells and larger central cells with vesicular nuclei. Cellular pleomorphism and mitoses are usually absent
Question 2: Which syndrome would you suspect with “turban tumors” cylindromas?
A. Muir-Torre syndrome
B. Cowden syndrome
C. Brooke-Spiegler syndrome
D. Tuberous sclerosis
E. Type I neurofibromatosis
C. Brooke-Spiegler syndrome
Brooke-Spiegler syndrome is a rare autosomal dominant syndrome mutation in CYLD with numerous adnexal tumors, mainly localized on the scalp and face, histologically cor- responding to spiradenomas, cylindromas, and trichoepitheliomas. Malignant transformation of lesions occurs in 5% to 10% of patients, heralded by rapid tumor growth, bleeding, or ulceration. The occurrence of malignant transformation of trichoepithelioma into basal cell carcinoma is very rare or even questioned by some authors, arguing it actually represents unrecognized cases of basal cell carcinoma or collisions of two independent neoplasms, namely basal cell carcinoma and trichoepithelioma. Additionally, patients have an increased risk of developing adenocarcinoma of the salivary glands. Regular clinical follow-up is fundamental, as the risks of malignant transformation and disease severity are not assessable ex ante on the basis of only genotypic and phenotypic characteristics. Acral melanoma was a casual association in our case.
Tx for Nevoid hyperkeratosis of the nipple and areola (NHNA) and dermatitis neglecta?
A. Corticosteroids
B. Keratolytic agents
C. Surgical and ablative procedures
D. Retinoids
E. Vitamin D analogs
B. Keratolytic agents
Keratolytic agents such as urea, salicylic acid, or lactic acid have been used as first-line treatments because of their safety and efficacy in the treatment of NHNA, improving hyperkeratosis by producing lysis of the stratum corneum. Recurrence of the lesions has been reported after cessation.
Pathophysiology of nodular solar elastosis?
There is glycosylation of elastin by chronic ultraviolet radiation. Histology will show Masses of elastotic material filling the reticular dermis, separated from the atrophic epidermis by a thin grenz zone
What are the special stains used to confirm the diagnosis of Benign Cephalic Histiocytosis?
A. Giemsa stain
B. Toluidine blue stain
C. CD117 marker
D. CD68 marker
E. S100 marker
D. CD68 marker
CD68 marker is a marker for macrophages. CD68 is a protein highly expressed by cells in the monocyte lineage, including monocytic phagocytes, osteoclasts, and circulating macrophages, and by tissue macrophages, Kupffer cells, and microglia. It may play a role in macrophage phagocytic activities.
Histology* –> Diffuse infiltrate of histiocytes, mainly in the upper dermis. The cells have oval or reniform vesicular nuclei and ill-defined pale cytoplasm.
Which of the following is a reported treatment option for Multicentric ReticuloHistiocytosis?
A. Gold salts (sodium aurothiomalate)
B. Chlorambucil
C. Sulfasalazine
D. Methotrexate
E. Minocycline
D. Methotrexate
Methotrexate is the most effective treatment. It controls both arthritis and skin lesions. It is the first choice of treatment.
Most common malignancies associated with multicentric reticulohistiocytosis?
Most commonly breast cancer, ovarian adenocarcinoma, ovarian neuroectodermal tumor, cutaneous squamous cell carcinoma, melanoma, papillary serous endometrial cancer, nasopharyngeal cancer, and hepatocellular carcinoma.
Which of the following immunostains would be most specific for the diagnosis of myeloid leukemia cutis?
A. BCL2
B. CD34
C. CD117
D. Myeloperoxidase
E. Ki-67
D. Myeloperoxidase
Myeloperoxidase is a lysosomal enzyme specific to cells with a monocytic lineage, including the myeloblasts that are constituent cells in myeloid sarcoma.
Ki-67, also known as Mib-1, is a nuclear marker expressed in all active stages of the cell cycle.
Which of the following is not a cutaneous manifestation of essential thrombocythemia?
A. Livedo reticularis
B. Erythromelalgia
C. Polyarteritis nodosa
D. Raynaud phenomenon
E. Lower extremity ulcers
C. Polyarteritis nodosa
Polyarteritis nodosa is a medium-vessel vasculitis often affecting numerous organs, while classically sparing the lungs. It is commonly associated with hepatitis B infection, and may also be triggered by blood dyscrasias such as hairy cell leukemia. However, Essential thrombocythemia is not a known trigger of polyarteritis nodosa.
Moniliform blepharosis is a cutaneous feature seen in:
a. Necrobiotic xanthogranuloma
b. Lipoid proteinosis
c. Syringomas
d. Cicatricial pempegoid
e. Rosacea
b. Lipoid proteinosis
“string of beads on eyelid”
A major feature in the diagnostic criteria of tuberous sclerosis is:
a. Dental enamel pits
b. Lymphangiomyomatosis
c. Gingival fibromas
d. Confetti skin lesions
e. Retinal achromic patch
Answer: b. Lymphangiomyomatosis
a. Dental enamel pits MINOR
b. Lymphangiomyomatosis
c. Gingival fibromas MINOR
d. Confetti skin lesions MINOR
e. Retinal achromic patch MINOR
Erdheim – Chester disease is a variant of:
a. Generalized eruptive histiocytosis
b. Multicentric reticulohistiocytosis
c. Progressive nodular histiocytosis
d. Xanthoma disseminatum
d. Xanthoma disseminatum
The type of erythema that can be seen in Sjogren’s syndrome is:
a. Erythema multiforme
b. Erythema gyratum repens
c. Erythema marginatum
d. Erythema annulare centrifugum
a. Erythema multiforme
An example of idiopathic cutaneous necrotizing venulitis is:
a. Cryoglobulinemia
b. Churg-Strauss syndrome
c. Acute hemorrhagic edema of infancy
d. Sjogren’s syndrome
c. Acute hemorrhagic edema of infancy
HHV7 infects?
A. Endothelial cell
B. Keratinocyte
C. T – cell
D. B – cell
C. T – cell
HHV-7 infects CD4+ T cells, epithelial cells in the salivary glands, and cells in the lungs and skin. HHV-7 is frequently shed in saliva at high levels throughout life in most adults and children. The virus has been detected in breast milk and establishes latency in CD4+ cells.
“deck chair sign” is seen in?
“Papuloerythroderma of Ofuji”, Elderly Japanese men. NOT Eosinophilic pustular folliculitis (Ofuji’s disease) which is seen in 30 yo Japanese men
Sneddon’s syndrome is?
Persistent livedo reticularis associated with systemic arterial thrombi; labile hypertension, recurrent neurologic symptoms. = Vascular coagulopathy
One of the following is polyenes antifungal drugs:
A. Ketoconazole
B. Itraconazole
C. Terbinafine
D. Amphotericine B
D. Amphotericine B
PTCH mutation is not characteristic for one of the following?
A. Gorlin syndrome
B. Trichoepithelioma
C. Bladder carcinoma
D. SSS of the esophagi
E. Lymphoma
E. Lymphoma
PTCH1 mutations have been found in sporadic trichoepitheliomas, bladder carcinoma, and SCC of the esophagus.
Profilagrin:
A. Is a large calcium binding Glycoproteins
B. ITS gene has been mapped 1q21
C. Consists of 15 – 20 repeating copies of filagrin
D. Its terminal domain contains calcium binding region used to assembly the molecule
E. Undergoes hydrolysis to release hydrogen
B. ITS gene has been mapped 1q21
Tumors associated with which of the following?
Cowden’s
Garner’s
Basal cell nevus syndrome
Muir-Torre syndrome
TS
Elderly, not responding to antifungals?
Onychomatricoma is a rare benign fibroepithelial tumor that is distinguished by clinical features including, splinter hemorrhages in the proximal nail plate, thickened yellow nail plate, and a longitudinal overcurvature. Pathognomonic fx is ‘Honeycomb-like (woodworm-like) cavities’
Annular elastolytic giant cell granuloma (AEGCG). The hallmarks of AEGCG are annular erythematous plaques with central clearing in the setting of distinct histologic findings of multinucleated giant cells with elastolysis and elastophagocytosis. Although elastin staining is required for definitive diagnosis, other features on the H&E slide, including rare intracytoplasmic elastin fibrils, aid in the diagnosis. Other features include the absence of necrobiosis and mucin deposition.
The histopathology of a dermal tumor consisting of anastomosing basophilic cells with ductal differentiation in a cribriform pattern without evidence of primary visceral adenocarcinoma is most consistent with?
Primary cutaneous cribriform carcinoma (PCCC). The histopathology of a dermal Answers:
tumor consisting of anastomosing basophilic cells with ductal differentiation in a cribriform pattern without evidence of primary visceral adenocarci- noma is most consistent with PCCC. PCCC is a rare, indolent form of cutaneous adenocarcinoma most commonly located on the upper extremities. It is characterized by small sieve-like spaces of variable size and shape and is surrounded by desmoplastic stroma; it is usually confined to the dermis.
