Examination Flashcards
1
Q
Macule
A
Corcumscribed
Flat lesion
Visible coz of change in color( hyper / hypopigmented/ erythematous)
2
Q
Patch
A
Macule >0.5cm
3
Q
Colour change in epidermal and dermal pigmentation
A
epidermal pigmentation is brown
upper dermal pigmentation is purple
lower dermal pigmentation is blue/grey
4
Q
Papule
A
Small <0.5 cm
Elevated
Due to - hyperplasia of cells of epi/dermis , metabolic deposits in dermis , cellular infilterate in dermis
5
Q
Nodule
A
Paule >0.5 cm
6
Q
Plaque
A
Called plaque whether < or> 0.5 cm
ALTERED CONSISTENCY OF SKIN
May be raised/ depressed but surface area larger than height
7
Q
Blisters
A
Fluid filled
2 types
1. Vesicle- < 0.5 cm
2.bulla -> 0.5 cm
8
Q
Pustule
A
Pus filled whether 0.5 cm
9
Q
Wheal
A
Evanescent elevated lesion due to edema of dermis/sc tissue
URTICARIA- white elevated lesion surrounded by erythema
Subsides in 24 hrs
Linear- dermatographic urticaria
ANGIOEDEMA
Extends into Sc tissue
Lasts 24- 48 hrs
Mc at mucocutaneous jxn
10
Q
Pathognomic lesion of scabies
A
Burrow:
Serpentine
Thread like
Open end marked by papule
11
Q
Comedones
A
Inspissated plugs of keratin and sebum in pilosebacious orifices
Open: black head- keratin plug is black
Closed: white head - covered by skin
12
Q
Diff bw crust and scale
A
Scale- collection of cells of horny layer
Dry surface on removal
Crust- collection of epi cells, dried serum and sometimes blood.
Moist surface on removal
13
Q
Silvery removable scale seen in
A
Psoriasis
14
Q
Skin manifestations of tuberous sclerosis
A
- angiofibroma/adenoma sebaceum-nose , nasolabial folds and cheeck
- ask leaf macule-hypopigmented , trunk
- shagreen patch-leathery, lumbosacral region
- periungal fibromas/koenen tumor
15
Q
X linked icthyoses
A
Only males Deficiecy in steroid sulfate Large dark , tightly adherent Sites: generalised, flexures encroached Ass: corneal opacities , cryptorchidism
16
Q
Icthyosis vulgaris
A
AD
Deficiency in filagggrin
Both males and females
Small, branny , except on shins where large.
Pasted in centre with upturned edge.
Extensors of limbs, lower back.
Associated with- hyperlinear palms and soles, keratosis pilaris , atopic diathesis
17
Q
NF1
A
SKIN
Cafe au lait macules(CALM)- uniformly pigmented, oval
Cutanoues neurofibroma-3 types
Dermal(button hole sign)
Plexiform(diffuse plaques ,wormy/knotty)
Subcutaneous
Intertiginous frekling/ crowe s sign( axillary and inguinal frekling)
EYES - optic glioma , lisch nodules
BONE-thining of cortex , sphenoidal dysplasia, pseudoarthrosis
PHEOCHROMOCYTOMA
18
Q
NF2
A
Bilateral acoustic neuroma
Meningioma/gliomas
Mimimal cut manifestatiin
No lisch nodules
19
Q
Acanthosis nigricans causes
A
BENIGN Obesity Hereditary Hair- an syn(hyperandrogenic, insulin resistance, cushing) Acral Endocrine(hyper androg, cushing, DM) Drugs(corticosteroids, OCPs)
MALIGNANT
Mc gastric adenoca , genitourinary
20
Q
Lesion in acanthosis nigricans
A
Hyperpigmentation
Dirty look
Thickening
Velvety
21
Q
Molecular defect in XP xeroderma pigmentosa
A
Defective repair of UV damaged DNA
Leading to development of skin cancers
22
Q
Molecular defect in XP xeroderma pigmentosa
A
Defective repair of UV damaged DNA
Leading to development of skin cancers
23
Q
XP lesion
A
Photosensitivity Multiple frekles Eventually actinic keratosi Keratoacanthoma BCC SCC Melanoma
24
Q
Prototype lesion of Chronic plaque psoriasis
A
Mildly itchy papule /plaque Well demarcated Erthymatous base Surmounted by scales Indurated Discoid
25
Koebner s phenomenon
When lesion develop at the site of trauma(scratch, surgical incisiin, tatoo, injury)
Aka isomorphic phenomenon
```
Seen in:: Little Plans Kan Make Win Very Descent
Lichen planus
Psoriasis(characteristic)
kaposi sarcoma
molluscum contagiosum
warts
Vitiligo
DLE
```
true koebner
psoriasis
lichen
false
wart
molluscum
```
rare
darier
hailey hailey ds
erythema multtiforme
lichen sclerosi
lichen nitidus
```
26
Grattage test
Scales in the psoroatic plaque can be accentuated by grating with glass slide
27
Auspitz test
3 steps
Grattage test
As u continue to scrape ,glistening white membrane appears(berkleys membrane)
On removing memb punctate points becone visible
28
Sites of predilictiin for psoriasis
```
Usually bilateral symm
Pressure points(knees and elbow)
Extensors more
face uncommon(refractory)
Scalp(spillage to forehead and nape of neck)
Lumbosacral
Periumblical
Palms and soles
Flexual
```
29
Reiters syndrome
Antecedant inf(genital, enteric)
Arthritis
Iridocyclitis, conjuctivitis
Mucocutaneous(rupoid psoriasis- heaped up scales , keratoderma blennorrhagica , circinate balanitis)
30
Types of psoriasis
Chronic plaque
Guttat
Pustular
31
Guttate psoriasis
Childn and adoloscent
may be ppted by streptococcus infection
Lesions in shower
Trunk
32
Dactylitis seen in
Psoriasis
33
Nail changes in psoriasis
```
Pitting
Plate thickening
Subungual hyperkeratosis
Discolouration
Onycholysis
Oil spots
```
34
Histopathological findings in psoriasis
EPIDERMAL
Parakeratosis
Hyperkeratosis ( stratum corneum)
Acanthosis (diffuse epidermal hyperplasia:basale , spinosum)
Thin/no granular layer
Suprapapillary thinning- berkeley memb
Collection of neutrophils to form munro microabcess , spongiform pustule of kogoj
Club shaped elongated rete ridges
DERMAL
Dilation amd tortusity of capillaries
Lymphocytes
35
Tazarotene
Vit a derivative
36
Moa of macrolides
.
37
Onychomycosis
Fungal infection of nail
Tinea unguim is fungal infection of nail plate due to dermetophyte
38
Interactions of Macrolides with CYP450
All are enz inhibitors(cla/erythro/telith) except AZITHROMYCIN
39
SE of macrolides
Git-epigastric pain
+motilin R -promotes int motility without affecting colon
Used in diabetic gastroparesis and postop ileus
But tolerance develops and flora eff :not used as prokinetic
Ototoxic:high dose
Hypersenstivity
Hepatitis:estolate
40
Excretion of macrolides
All in bile(azith/eryth/telithro) except clarithromycin
41
Macrolides spectrum
```
Gpc (not MRSA)
Clamydia
Mycoplasma
Mycobacteria
Spirochete
h.pylori
C. Jejuni
Legionella
H.influenza
```
42
Nail changes in tinea unguim
Thichened nail
Subungal hyperkeratosis which is friable
Onycholysis
Tunneling
43
Hidradenitis suppurativa
Apocrine glands
Occlusion - rupture - inflammation and infection
Axilla, perineum and genitalia
44
Chlamydial infection Rx
Axithromycin or doxycline
45
Role of minoxidil in alopecia
.vasodilation and angiogenic potential
Reduces miniaturization of terminal hair and also converts miniaturized hair into terminal hair
46
Spagetti amd meat ball appearance seen in
Malssazia furfur
47
CSF penetration of macrolides
Do not penetrate
48
KOH mount findings of candida
Budding yeast and pseudohyphae
49
Piyriasis versicolor caused by
Malassezia furfur
50
Lesion of pityriais versicolor
Distint Perifollicular macules (mostly hypopigmented , can be hyperpig )
51
KOH finding of pityriasis versicolor
Spaghetti and meat ball appearance (spores and short branched hyphae)
52
Typical lesion of dermatophytes
Annular/arcuate spreads centrigugally
Margin is active showing papules, vesicles , scaling , pustules
Centre is relatively clear though in chronic cases there is lichenification
53
What is ringworm
Tinea/ dermatophyte infection
54
Types of alopecia
Cicatracial and non cicatracial
55
Alopecia aereta
Non cicatracial with no inflammation( erythema , inflammation , paules)
Skin specific autoimmune
Exclamation marks
Commonly at scalp, beard , mostache , eyebrows , eyelashes
Regrowth with gey hair
Nail changes(pitting and thinning)
56
Androgenetic alopecia
Miniatrization of hair follicles(terminal into
vellus hair)
Males:Androgen dependant
Typical presentation -frontoparietal and frontal recession , thinning of vertx
Females - no typical presentation , diffuse hair loss , initially as widening of central parting
57
Telogen effluvium
All hair enter telogen phase and are shed simultaneously
```
Cause
Infections
Childbirth
Surgical trauma
Haemorrhage
Emotional stress
Drugs
```
58
Splinter haemorrhages seen in
Trauma
Psoriasis
Bacterial endocarditis
59
Paronychia
Inflammation of nail fold
60
Koilonychia
Spoon shaped nails seen in iron deficiency
61
Pitting in
psoriasis
alopecia aereta
Eczema
Coarse with other changes
Fine and thinning of nail plate
Coarse, deep irregular cross ridging
62
Beau 's line
Transverse grooves
After severe, acute illness
63
Aa for melanin synthesis
Tyrosine
64
Frekles
Fair skinned
Each lesion has color variation within and from others
Photoexposed parts(face, dorsolateral forearms , hands , neck)
Darken on sun exposure
AD
65
Melasma site
```
Symmetrically on
cheeks
Nose
Forehead
chin
```
66
Type of skin color change with clofazamine
Orange
67
Lentigenes
In any skin color
Well defined, uniform color
Any part of body including mucosa
No change in color after sunexposure
Seen in
PEUTZ JEGHERS
CRONKHITE CANADA SYNDROME
68
Minocyline skin pigment changes
Blue black
69
Vitiligo is due to anatomical/ functional defect in melanocytes
Anatomical
Absent
70
Koebners phenomenon seen in
Psoriasis
Vitiligo
Lichen planus
71
Site of predeliction for vitiligo
Any part
But areas prone to repeated friction and trauma( dorsae hand and feet , elbows and knees)
72
Characteristic lesion of LP
Itchy violaceous polygonal flat topped papules with wicham stria
73
5 Ps of LP
P pruritic
P purple
P polygonal
P plane topped
P papules
74
Pterygium of nail is diagnostic of
LP
75
Sites of prediliction of LP
Flexors of wrist
Ankles
Shins
Lower back
Associated changes:
Nail- thinning, trachyonychia , tenting, pterygium
Scalp: violaceous perifollicular , cicatracial alopecia
Palmoplantar : keratotic papule with central dull
76
Hostopathological changes in LP
No parakeratosis
Hyperkeratosis
Thickened granular layer
Basal cell degeneration ( max joseph spaces ,coloid bodies)
Saw toothed dermoepidermal jxn
Irregular saw toothed appearance due to basal cell loss
Lymphocytes lead to indistint DE jxn
Band like upper dermal infilterate
77
Dermatitis herpetiformis
Itchy(excoriation) ,grouped(herpetiformis ) , edematous paupules and small vesicles on normal/erythematous skin.
Sites: extensors and pressure points
Dermoepidermal split
Granular IgA deposits at tips of dermal papilla
Dermal papillary tip neutrophilic abcesses
Associated: gluten sensitive enteropathy
78
Bullous pemphigoid
AI
Linear deposits of IgG Abs and C3 at dermoepidermal jxn (against hemidesmosomes)
Lesion: itchy , large , tense bulla , rupture less readily , roof of bulla just settles down as the contents are absorbed , heal with milia( small pearly paules ) ,
Bulla spread sign and nikolsky sign negative
79
Pemphigous
Intraepidermal bullous disorder
AI
Acantholysis
IgG auto Abs against DESMOGLEINS
Types:2 main
Pemphigous vulgaris
Pemphigous foilaceous
80
Pemphigous vulgaris
Lesion: flaccid bullae- rapidly rupture - painful erosions - heal slowly
Bedside test:
NIKOLSKY SIGN- tangential pressure on normal skin results in new bulla formation
BULLA SPREAD SIGN/ ASBOE HANSEN SIGN : spread of bulla on applying pressure on prexisting bulla
MUCOSAL LESION: universal
Site: scalp, face , flexures , trunk
SPLIT: Intraepidermal
Suprabasal
81
Pemphigous foilaceous
Lesion: superficial bulla - rupture rapidly - so only scale crust seen
MUCOSAL LESION : rare
Site: initially seborrhic distribution , becomes generalised
SPLIT: intreepidermal
Subcorneal / granular layer
82
Epidermal necrolysis
Cause: drugs-anticonvulsants , antibacterials , NSAIDS, allopurinol
Lesion: deeply erythematous(purpuric), may develop bulla , peel off in sheets , denuded area
Mucosal : eyes and mouth frequently
Site: face , trunk and proximal extremities
Depending on BSA
1. SJS :<10 %
2. SJS-TEN : 10 - 30 %
3. TEN : >30 %
83
Psedohyphae
Pseudohyphae" are distinguished from true hyphae by their method of growth, relative frailty and lack of cytoplasmic connection between the cells.
They are the result of a sort of incomplete budding where the cells elongate but remain attached after division
84
Isotretinoin
Moa: (all causes)
1. inhibit sebum production
2. Normalizing follicular epidermal hyperproliferation
3. dec P.acne
4. reducing inflammation
Use: severe acne
Side effects:
Dry skin, cheiltis, hair loss,dryness of eyes , nose bleeds
Teratogenic , contraception using 2 diff methods during and 1 mth after Rx
Not to donate blood
Pseudotumor cerebrii
Liver fxn test
Hypertriglycerides
Myalgia, bertebral hyperostosis, altered night vision
85
Retinoids
```
RITA
Retinoic acid
Isotretinoin
Tazarotene
Adapalene
```
Moa:
Especially for comedones
Increasing epidermal cell turnover
Increasing dehiscence of atratum corneum
86
layers of epidermidis from below upward are
basal cell layer (stratum basale )
prickle cell layer (stratum spinosum)
granular cell layer(stratum granulosum )
horny cell layer ( stratum corneum )
87
skin is thickest at
palms ,soles,back ie 3mm
88
skin is thinnest at
eyelids
89
dermis is divided into
* papillary dermis
| * reticular dermis
90
stratum lucidum is found in
palms and soles
91
subcutaneous tissue is absent in
eyelids and male genitalia
92
basement membrane zone is made up of
•lamina lucida
•lamina densa
•sublamina
densa
93
keratinocytes r derived from
ectodermally derived
94
melanocytes are derived from
neural crest cells
95
melanocytes r found in
hair follicles
choroid
iris
skin
96
epidermal melanin unit is formed from
36 keratinocytes/melanocyts
| melanocytes give their melanosomes to the keratinocytes
97
where r merkel cells found
clustered near unmylinated sensory nerve ending to form touch spots or hair discs or iggo discs at the bottom of rete ridges
98
epithelium of skin is
stratified squamous epithelium
99
melanocytes are present in
stratum basale
100
normal turnover time of epidermis is
28 days ie 4 weeks
| but turnover time in psoriasis 4days
101
lines of blaschko represent
developmental growth pattern of skin
102
stratum lucidum is present in bw
stratum granulosum and stratum corneum
103
which layer of epidermis is underdeveloped in very low birth weight infants in initial 7 days
stratum corneum
104
odland bodies are present in
upper spinous layer
105
malpighian
| layer includes
basal and spinous layer
106
langerhans cells are seen in
malpighian layer
107
birbeck granules are present in
langerhans cells they possess characteristic rod or racquet
108
wht is rosacea
chronic conditions characterized by diffuse inflammation of centrofacial area with seborrhea,telangiectasia, papules,pustules, nodules
109
etiology of rosea
anything that is too hot too cold too spicy
role of mite demodex and bacteria h pylori
there is pronounced flushing in response to heat ,emotional stimulation alcohal,hot drink ,spicy food
110
topical DOC for roscea
metronidazole
111
oral DOC for rosacea
doxycycline
112
types of roscea
* erythematotelangiectatic
* papulopustular
* rhinophymatous
* ocular rosacea
113
sites of predilection for acne roscea
convexity of face involved
| characteristic sparing of periorbital and perioral region and flexural region
114
treatment of grade 1 acne
benzoyl peroxide +topical retinoids
115
treatment of grade 2
| acne
grade 1+topical antibiotic
116
treatment of grade 3 acne
grade 2+ oral antibiotics
| hormonal therapy
117
treatment of grade 4 acne
retinoids oral indicated in nodulocystic acne not responsive to conventional treatment
118
drugs causing acne
```
hormones and steroids
gonadotropin
androgens
antiTB drugs
anti epileptic
phenytoin
phenobarbitone
halogens
bromides
iodides
halothane
```
119
grade 1 acne is
primarily comedones
120
grade 2 acne is
comedones + papules
121
grade 3 acne is
comedones +pustules +papules
122
grade 4 acne
nodulocystic acne nodules and cysts leading to scars ,abscess
123
steroids are contraindicated in roscea t/f
true
124
types of acne are
* acne vulgaris
* acne conglobata
* acne fulminans
* occupational acne
* drug induces
* acne excoriee
125
primary differentiating feature bw acne vulgaris and acne roscea
pressence of open and closed comedones in acne vulgaris
126
hallmark of acne vulgaris is
comedones
127
etiology of acne vulgaris
* obstruction of pilosebaceous unit
* excessive sebum production
* propionibacterim
* insulin like growth factors
* increased interleukin 1 alfa
128
most common side effects of retinoids is
skin rash
129
treatment of choice for mild to moderately comedones, papulopustular and nodules
topical retinoids +oral antibiotics
130
treatment of choice for severe nodular acne conglobata
oral isotretinoin
131
a pt taking treatment for acne develops blueblack muddy hyperpigmentation causative drug is
minocycline
132
side effects unique to minocycline are
drug induced lupus and blue black pigmentation
133
max dose of isotretinoin
120-150 mg it is given as 0.5 to 1 mg /kg/day
134
eccrine glands are located in
present all over the body
especially
palms,soles,axilla
except vermilion border of lips ,nails,labia minora and inner aspect of prepuce
135
difference bw opening of sebaceous and eccrine glands
eccrine gland open directly under skin
| whereas sebaceous glands open into hair follicle
136
difference between
| ans control of eccrine and apocrine glands
eccrine gland is under control of sympathetic and cholinergic but apocrine glands are only under control of sympathetic adrenergic
137
treatment of local hyperhidrosis
• topically aluminium chloride hexahydrate
•iontophoresis
passing of current low voltage across skin
•botulinum inj
138
manifestations of acute generalized hypohidrosis
heat stroke it is a emergency
139
manifestations of chronic generalised hypohidrosis
seen in hypohydrotic ectodermal dysplasia with frontal bossing ,saddle nose,everted lips,peg shaped teeth
140
wht is miliaria crystallina and its manifestations
when duct ruptures just below stratum corneum
| manifests as tint,clear,crystalline vesicles
141
wht is miliaria rubra and its manifestations
duct ruptures in epidermis
| manifests as small ,erythematosus papules often surmounted by vesicles
142
wht is milaria profunda and its manifestations
when duct ruptures below dermoepidermal
junction
manifests as large,skin coloured papules
143
apocrine acne is another name of
hidradenitis suppurativa
144
hidradenitis supprativa is disease of
apocrine gland
145
```
true about apocrine gland is all except
•modified sweat gland
•modified sebaceous glands
•present in groin and axilla
•inf is known as hidradenitis supprativa
```
modified sebaceous glands
146
name disorders of eccrine sweat glands
hyperhydrosis
anhydrosis
miliaria
147
name type disorders of apocrine sweat glands
```
bromhidrosis
osmidrosis
chromhidrosis
foxfordyce ds
hidradenitis supprativa
```
148
bromhidrosis is due to
asfoetida
onion
garlic
149
most common cells found in stratum spinosum
langerhans cells
| they aredendc i
150
types of hair in human body
•lanugo hair 》fine,soft hair which are shed in utero rarely retained k/a congenital hypertrichosis lanuginosa
•Terminal hair》long ,coarse,medullated
hair present on scalp,eyebrows, and eye lashes ,beard ,moustaches
•vellus hair 》fine ,short ,nonmedullated hair present on most parts of body
151
stages of hair cycle are
* anagen》phase of activity and growth
* catagen 》phase of involution
* telogen 》phase of resting
152
difference between bulb of anagen and telogen
anagen 》angulated bulb
| telogen 》club shaped bulb
153
clinical features of alopecia areata
hair loss presents as discoid patch of alopecia
no inflammatory or atrophy
•pressence of exclamation marks hair at periphery of region
•regrowth begins from centre of lesion new hair is fine and grey but gradually regain normal colour
154
treatment of alopecia areta with single lesion <6mnths
observe spontaneous recovery
155
treatment of single or few lesions >6mnths or rapid progress
topical steroids/topical minoxidal/topical psoralen+UVA
156
extensive lesions
| alopecia totalis/universalis
oral steroids
| oral psoralen
157
wht is miniaturisation of hair follicles
it is progressive conversion of terminal
hair follicles into vellus hair follicles
ie conversion of medullated to non medullated hair
158
cause of androgenic alopecia
miniaturisation is induced by increased end organ sensitivity mediated by 5a reductase which converts testosterone to 5 DHT in scalp
159
how is androgenic alopecia graded in males
Hamilton-norwood scale
160
how is androgenic alopecia graded in females
ludwig scale
161
clinical features androgenic alopecia in males
frontoparietal recession with thinning of vertex
162
clinical features of androgenic alopecia in females
widening of central parting
163
wht is telogen effluvium
anagen phase of several adjoining hair follicles is aborted and all enter telogen phase at same time all hair are shed simultaneously
164
cause of teloven effluvium
```
infectious diseases like malaria, dengue
child birth
surgery
emotional
drugs like retinoids,anticonvulsants
```
165
trichogram finding of telogen effluvium
telogen count>20%
166
causes of cicatricial alopecia
* lichen planopilaris
* DLE
* Pseudopelade of brocq ie scarring alopecia with no cause identified presents as patches of cicatricial alopecia with foot prints in snow
167
ophiasis is
patients lose hair in band like manner at the periphery of scalp
168
trachyonychia is
nail plates are grey brown and hve rough surface due to longitudinal striations as if sandpapered it affects all nails known as twenty nail dystrophy
169
wht is leuconychia
white nails seen in pts if hypoalbuminemia
170
half and half nails r seen in
chronic renal failure 1/2nails white and 1/2nails red
171
Terry nails are
proximal 4/5th of nail is white and distal tip is normal
| seen in liver disease
172
beus lines are
transverse grooves appear simultaneously on all nails plates
seen in viral illness ,peripheral nerve injury surgery,Kawasaki ds
173
diagnosis of telogen effluvium is confirmed by
club like swelling at root end called club hairs and length of hair shorter thn surrounding hair due to premature stoppage
174
anagen effluvium causes
```
•radiotherapy to head
•systemic chemotherapy
esp alkylating agent eg cyclophosphamide
•mercury ,boric acid,thallium
•colchicine poisoning
•vit a poisoning
,severe protein malnutrition
```
175
onychogryphosis
nail is severly distorted ,thickend ,opaque
| brownish nails seen in pressure foot wear in elderly
176
onycholysis is seen in
* psoriasis
| * reiter syndrome
177
muehreke's lines
hypoalbuminemia
178
koenen's periungal fibroma is seenin
tuberous
| sclerosis
179
fordyce disease mainly involves
lips >buccal mucosa
180
sebaceous glands found in eyelids are
meibomin glands
181
sebaceous glands found in nipples
Montgomery's gland
182
sebaceous glands found in genitalia are k/a
tysoris gland
183
pilosebaceous unit includes
sebaceous gland +hair follicles
184
largest gland and greatest density of sebaceous glands are found in
face and scalp
185
give classification of sweat glands
```
#•eccrine sweat gland》hyperhydrosis
anhydrosis
#•eccrine sweat duct
》 miliaria
# apocrine sweat gland
•bromhidrosis
•osmidrosis
•chromhidrosis
•fox-fordyce disease
•hidradenitis supprativa
```
186
causes of cicatericial
| alopecia
```
5L,4F,3S
•lichen planus
•leprosy
•lupus vulgaris
•linear scleroderma
•lupus erythematosus (DLE)
•favus and kerion
•follicular degeneration syndrome(pseudo pelade of broq)
•frontal fibrosing alopecia of kossard
•syphilis
•sarcoidosis
•secondaries
```
187
type of alopecia in DLE
cicatericial
| whereas in SLE there is non cicatericial
188
is ther e alopecia in psoriasis
no alopecia inspite of extensive scalp involvement
189
exclamation marks hair is pathognomic of
alopecia areata
190
alopecia areta is associated with
exclamation sign
atopy
pitting nails
191
male with patchy loss of scalp hair and grey hair in eyebrows and beard diagnosis is
alopecia areata
192
pterygium of nail is characteristically seen in
lichen planus
193
oil drop and pitting nail dystrophy is seen in
psoriasis
194
nail change in alopecia areta is
* fine stippled pitting of nails
| * trachyonychia
195
name infections involving nails
```
paronychia
bacterial
viral herpes and HIV
fungal
tinea
```
196
dermatoses
| involving nail
* psoriasis
* lichen planus
* eczema
* dariers disease
197
nail changes in psoriasis
* pitting of nails (thimble nail)
* oil drop nails
* onycholysis (detachment of nail plate)
* discoloration of nail plate
* subungal hyperkeratosis
198
asymmetric involvement of toe >fingers nail, yellow discoloration , nail thickening and tunneling indicates diagnosis of
tinea unguium which can be confirmed by KOH mounting
199
immediate pigmentation is caused by exposure to
UVA
200
delayed pigmentation is caused by exposure of
both UVA and UVB
201
colour of melanin when it is
| in epidermis
brown
202
colour of melanin when it is in dermis
bluish grey due to tyndall effect
203
causes of hyperpigmentation
```
#epidermal pigmentation
1. increased number of melanocytes
•lentigenes
• cafeaulait macules
•malignant melanoma
2.increased activity of melanocytes
•freckles
•exposure to UV light
•PUVA treatment
•endocrine disorders
#dermal pigmentation
•Mongolian spots
•naevus of ota
```
204
lesions of vitiligo
* depigmented macules which hve 3 shades trichome depigmented center, surrounded by hypopigmented rim and normal skin
* macules hve scalloped outline and form geographical patterns
* koebners phenomenon is +
* leucotrichia
205
characteristic of segmental vitiligo
•depigmented macules r dermatomal and stops short of midline
most commonly seen along 5th nerve
206
types of vitiligo
```
segmental
focal
acrofacial
vulgaris is most common
universalis
```
207
sites of predilection of vitiligo
sites of repeated trauma
208
wht is freckles
```
ill defined brown macules
which darken on sun exposure
occur on photoexposed
areas
photoprotected area and mucosa is spared
```
209
wht r lentigenes
dark brown to black macules also involves mucosa and photoprotected areas
seen in peutzjegher,,cronkhite Canada
210
difference bw vitiligo and OCA
#VT》
•begins later in life
•depigmented area may regress or progress
•eye changes r not seen
•partial or near complete response to treatment
```
#OCA
•present at birth
•eye changes are present
```
211
difference bw piebaldism and OCA
```
piebaldism
•present at birth
•localised areas of depigmented macules with islands of hyperpigmentation
•white forelock +
•depigmented eye brow and lashes
OCA
•at birth
•generalized depigmentation
•all hair hve pigment dilution
•photophobia, translucent irides,red reflex
```
212
piebaldism is frequently associated with
waardenburg syndrome characterized by dystopia canthorum ie lateral displacement of inner canthi,but normal interpuppilary distance broad nasal root,sensorineural hearing loss and piebaldism
213
eye changes must be present to make diagnosis of albinism t/f
true
214
morphology of seborrheic keratosis lesions
usually multiple lesions start as macules and change into papules with distinctive stuck on morphology greasy surface
currant bun appearence
215
currant bun appearence is found in
seborrheic keratosis
216
cause of melanocytic naevi
clustered proliferation of melanocytes
217
wht r Mongolian spots
bluish ill defined macules present on lumbosacral region
| regress by 4 yrs
218
other name of pityriasis versicolor
tinea versicolor
219
causative agent of tinea versicolor
pityriasis versicolor is caused by malassezia furfur
220
pathogenesis of pityriasis versicolor
PV represent shift of host and resident yeast flora yeast becomes pathogenic in hot and humid climates it realeses azelaic acid thus causing hypopigmentation
221
morphology of pityriasis versicolor lesion s
hypopigmentation sometimes erythematosus or hyperpigmented
so called versicolor
scaly perifollicular macules
surmounted by branny scales which can be accentuated by scratching with glassslide
222
perifollicular character is invariably retained in
pityriasis versicolor
223
KOH mount shows _____ in case of pityriasis versicolor
spaghetti and meat ball appearence
224
difference between pityriasis and vitiligo
there is no scales in vitiligo but scaling is present in pityriasis
• in vitiligo repigmentation
starts perifollicular after treatment
but in case of pityriasis lesion itself are perifollicular
225
causative agent of pityriasis rosea
unknown HHV-7 Is frequently associated
226
1 st lesion in case of pityriasis rosea is
herald patch
227
wht is herald patch
characteristic annular lesion with wrinkled salmon pink centre and collarete of scales at periphery
scales are attached just within leading edge and free towards centre
228
fir tree appearence is characteristically seen in
pityriasis rosea long axis of patches runs downward
| and outward from spine along the lines of ribs
229
main diffrential of pityriasis rosea is
secondary syphilis
230
course of pityriasis rosea is
```
•self limiting
its clinical features are
•Her
•young
•mother
•smokes 》secondary syphilis like lesion
•fir tree
• cigarette paper collarette of scales
```
231
characteristic lesions of pityriasis rubra pilaris
•scaly
pink to orange
follicular papules
grouped papules coalese to form large plaques these papules spread in cephalocaudal direction there are islands normal unaffected skin (nappy claires )
keratodermic sandals
follicular accentuation
it can progress to genralised erythrodermal
232
nutmeg grater feel occurs in
it is present in pityriasis rubra pilaris
| follicular lesion on dorsal aspect of digits
233
keratodermic sandals are found in
pityriasis rubra pilaris
| yellow brown discoloration of palms and soles
234
piebaldism is
autosomal dominant conditions characterized by congenital stable areas of vitiligo like amelanotic patches of skin which remains unchanged for life with white forelock and islands of normal or hypermelanotic skin
235
congenital
| unilateral single stable well defined hypopigmented patch is mostly
nevus achromicus
236
vitiligo is mostly associated with
* diabetes mellitus
* alopecia areata
* addison's ds
* thyroid disease
237
pityriasis rosea like drug eruptions are seen in
```
GAMB
G gold
A ace inhibitor
M metronidazole
B beta blockers
```
238
lichenoid like drug eruptions are seen in
```
A Anti Gold Thai
Queen
A》ace inhibitor
anti》antimalarial
Gold
Thiazide
quinidine
```
239
```
an adult presents with oval scaly hypopigmented macules over chest and back the diagnosis is
•leprosy
•lupus vulgaris
•pityriasis versicolor
•lichen planus
```
pityriasis versicolor
240
24 yr old man had multiple, small, hypopigmented macules on upper chest and back for last 3 mnths .the macules were circular,arranged around the follicles many had coalesced to form large sheets .the macules had fine scales he had similar lesions 1 yr ago which subsided on treatment
the most appropriate investigation to confirm diagnosis is
KOH preparation of scales
241
```
all are given for treatment of pityriasis versicolor except
•selenium sulphate
•clotrimazole
•ketoconazole
•griseofulvin
```
griseofulvin it is used systematically for dermatophytes but is ineffective topically and has no role in treatment of versicolor or candidiasis
242
wht is pityriasis alba
present characteristically with recurrent scaly hypopigmented macules on cheeks and face of young children it requires no active treatment
243
treatment of ptyriasis rubra pilaris is
* oral retinoids
* methotrexate
* photochemotherapy
244
wavelength of woods lamp is
320-400nm UVA light with nickel oxide and silicon filter to diagnose pityriasis versicolor, tinea capitis ,vitiligo, porphyria, pseudomaonas pyocyanea
erythrasma
245
color of wood s lamp in case of tinea capitis
yellow green fluorescence
246
color of woods lamp on case of pityriasis versicolor
golden yellow or apple green
247
color of woods lamp in case of erythasma and acne
coral red /pink
248
pseudomonas pyocyanea
yellow green
249
colour of woods lamp in case of vitiligo
total white
250
colour of woods lamp in tuberous sclerosis ash leaf macules
blue white
251
SCC of skin gives ____ colour of flourescence on wood lamp
red flourescence
252
non scaly hypopigmented macules are seen in
```
1.indeterminate leprosy
more common in children
more common in pts belonging to high leprosy prevalence
anaesthetic
epidermal atrophy
2. tuberous sclerosis
ash leaf macules
shahgreen patch
adenoma sebaceum
seizure ,mental retardation
3.vitiligo
sharply defined
non pigmented patches
anywhere
```
253
recurrent scaly non anaesthetic hypopigmented macules
```
▪pityriasis alba
(predominately face involvmemt)
self limiting benign condition mostly affecting head and neck region around face in children
macule with powdery white scales
▪pityriasis versicolor
scales are dust like fine or furfaceous
```
254
pityriasis rubra pilaris starts feom
face as scaly macules
255
characteristic histological hallmark of atopic dermatitis is
spongiosis of epidermis
| lesions show hyperkeratosis and acanthosis
256
diagnostic criteria of atopic dermatitis is
```
hanifin and rajka criteria
major criteria is
pruritis
involvement of face snd convexities in infant <2yrs and flexures in older children and adults
tendency to chronicity
personal or family history
```
257
finding of infantile phase of atopic dermatitis
begins after 3 mnths
starts from face
napkin area is spared
excoristion and lichenification
after 6 mnths when itching tendency develops
when child begins to crawl extensor surface of knee is involved
258
presentation of atopic dermatitis in s child
develops after 2-3yrs
involving flexural aspect
side of neck show reticulate pigmenta
259
hertoghe sign is
thining of lateral half of eyebrows seen in atopic dermatitis
260
head light sign is seen in
chelitis and inflammation of skin on and around lips
261
antenna sign is seen in f
follicular opening are filled with horny plugs seen in atopic dermatitis
262
diagnostic lesion of nummular eczema
well demarcated coin shaped erythematosus plaque arising from confluence of thin walled papules and papulovesicles
later central clearing and peripheral extension leads to annular ring shaped lesion
secondary lesions in a mirror shaped configuration on opposite side of bodu and reactivation of apparently dominant lesions is very characteristic
263
most serious complications of atopic dermatitis is
widespread herpes simplex virus1 infection resulting in kaposi varicelliform eruption
264
clinical featured eczema herpeticum
history of herpes labialis in a parent in previous wks
after incubation period of 5-12 days ,multiple itchy vesiculopustular lesions erupt in disseminated pattern
vesicular lesion are umblicated tend to crop become hrgic and leave large areas of denudation which is prone to superadded bacterial infections
these lesions tend to occur on areas of atopic dermatitis
265
most common area of irritant contact dermatitis
hands it is due to chronic contact of patient with wet work ,soaps or detergents
266
most common agent causing allergic contact dermatitis
nickel
267
gold standard test for diagnosis of allergic dermatitis is
patch test
268
patch test is read after
48 hrs
269
early fernadez reaction is read after
2 days
270
in TB induration is read after
3 days
271
skin doubling time in psoriasis is
4 days
272
kveim test is read after
2 weeks
273
late mistuda reaction is read after
3 weeks
274
normal skin doubling time is
4 weeks
275
wht is urticaria
edema involving superficial layer of dermis
276
wht is angioedema
localised edema of deeper layers of dermis
| involving subcutaneous tissue
277
most common site for urticaria
extremities and face
278
most common site for angioedema is
periorbital and lips
279
wht causes cholinergic urticaria
pruritic wheals of large size surrounded by erythema attacks are precipitated by fever,hot bath,excercise
as any activity which increases core body temp stimulates release of cholinergic nerve ending
280
most common manifestations of mastocytosis is
urticaria pigmentosa
281
clinical features of urticaria pigmentosa
pale yellow tan to red dish brown macules to raised papules develop in symmetrical distributions
highest conc on trunk and thighs
lesions are not sharp they are pigmented
282
wht is dariers sign
urticaria, erythema and itching around the lesion ie a brown patch after mild trauma including scratching or rubbing of lesion is seen in urticaria pigmentosa
283
diagnosis of atopic dermatitis is by
clinical examination
284
diagnosis of contact dermatitis is made by
patch test
285
a diagnosis of donovnosis made by
microscopic finding of donovan bodies or safety pin appearence
286
diagnosis of syphilis is by
dark fields
| VDRL
287
diagnosis of chancroid
gram staining school of fish or rail road appearence
288
tinea diagnosis is by
KOH smear
289
diagnosis of lupus vulgaris is by
biopsy
290
an infantpresentewith erythematosushrash on cheeks and extensor aspect of limbs mother has a history of bronchial ashtma likely diagnosis is
atopic dermatitis
291
atopic dermatitis is most severe in which season
rainy seasons
292
drugs causing exanthematous eruption are
| ec
beta lactama
sulfonamides
NRTI
phenylbutazone
293
after wht time of drug ingestion fixed drug eruption appear
30 min to 8-16 hrs
294
most common site involved in fixed drugs eruption are
genital and perianal skin lesions evolve from macules to . bullae and lead to ulceration
heal with hyperpigmentation
lesion appear at the same site everytime the drug is taken
295
lichen nitidis characteristically involves which sites
shaft of penis
| trunk ,flexures of upper extremities dorsae of hands
296
difference between lichen nitidus and lichen planus
lichen nitidus is aysmptomatic wheras lichen planus is itchy
no wickham's stria in lichen nitidus
297
histological findings in lichen planus
```
thickened granular layer
basal cell degeneration
max josephs spaces
colloid bodies ie necrotic basal cells become incorporated into inflammed pappilary dermis and form eosinophilic cytoid/civatte bodies
saw tooth dermoepidermal junction
```
298
histological changes in psoriasis
* hyperkeratosis
* acanthosis
* munro microabscess if neutrophils collect in stratum corneum
* torturous capillaries
* spongiform pustule of kogoj if neutophils collect in spinous layer
* increased epidermal cell turn over 4 days normal 4 wks
299
wht are papulosquamous
| disorders
elevated lesions ,papules or plaques with scales
300
primary papulosquamous disorders are
```
psoriasis
parapsoriasis
all pityriasis except pityriasis versicolor as it has macules
lichen planus
bowens disease
seborrheic dermatitis
```
301
systemis causes of papulosquamous disease
secondary
syphilis
sarcoidosis
SLE
302
grattage test
scratching with glass slide accentuate scale formation
303
auspitz sign
removal of scales lead to appearence
| of punctuate /pin point bleeding
304
oral form of psoriasis is
geographical tongue benign migratory glossitis or glossitis areata migrans
305
lesions of psoriasis are surrounded by a ring called
wornoff ring there are lesions which are mildly or not pruritic
306
difference between psoriatic arthritis and rheumatic arthritis
psoriatic arthritis 》
•MHC class 1 disease fibroblastic response ,sacroilitis,enthesitis ,dactylitis ,and juxtaarticular new bone formation is present whereas such findings are not present in rheumatoid arthritis
RA
MHC class 2
307
psoriatic arthritis characteristically involves which joint
DIP
308
commonest complication of psoriasis is
erythrodermic psoriasis seen due to use of irritant substances and withdrawal of systemic steroids
309
rupioid psoriasis is seen which syndrome
reiter syndrome
HLA B27 preceding chlamydia and shigella dysentr6
circinate balanitis and keratoderma blennorhagicum
310
von zumbusch disease is
generalized pustular psoriasis
suddenly developing skin first becimes erythrodermic and then sheets of sterile pustules develops over trunk and limbs tht confluent to form lake of pus
311
pustular psoriasis of pregnancy is k/a
impetigo herpetiformis
312
Toc for psoriasis type chronic plaque psoriasis on face ,neck flexures ,and genitalia
topical corticosteroids
| even low concentrations tar and dithranol is tolerated
313
TOC for psoriatic erythroderma and psoriasis with AIDS
systemic retinoid +PUVA is drug of choice
| even in case of gross edema no diuretic is given as with treatment of psoriasis diuresis will occur
314
DOC for psoriatic arthritis is
methotrexate
315
safest drug for treatment of pustular psoriasis is
prednisone
316
pustular psoriasis of pregnancy is called
impetigo herpetiformis
317
which UV rays is used in treatment for photochemotherapy
UV A
| puva
318
uv rays causing sun burns,skin cancers is
UVB
319
circulating lymphocytes are most senstive to
UV-C filtered by ozone layer
320
interface dermatitis is seen in
lichen planus
321
causes of erythroderma are
pityriasis rubra pilaris, psoriasis
lichen planus
eczema, drugs
322
treatment of exfoliative dermatitis
steroids
323
other name of exfoliation dermatitis
erythroderma
324
microabscess are found in
psoriasis
| mycosis fungoides
325
pautrie microabscess are found in
mycosis fungoides
326
munro microabscess are made up of
seen in stratum corneum
| only contains neutrophils
327
PUVA is used in
```
psoriasis
mycosis fungoides
sezary syndrome
vitiligo
atopic dermatitis
generalized licen planus
urticaria pigmentosa
generalized granuloma annulare
cutaneous graft vs host
```
328
wht is pseudo koebners phenomenon
autoinoculation seen in infectious diseases like plane warts ,molluscum contagiosum
eczematous lesions
329
clinical features of lichen planus are
Wickham's
I infilteration of lymphocytes ie interface dermatitis
C ivatte bodies
K oebner phenomenon
Ha hepatitis C,hyperpigmentation
M mucosal involvement
S spontaneous healing,scarring alopecia, SCC ,steroids are mainstay of therapy
330
lichen scrofulosorum and lichnen nitidus are not variants of lichen planus t/f
true
331
hepatitis c is associated with
lichen planus
sjogren syndrome
porphyria cutanea tarda
332
only definatiive
| indication of systemic steroids in psoriasis is
impetigo herpetiformis ie genralised pustular psoriasis in pregnancy
333
pathogenesis of pemphigus
igG antibodies agnst polypeptide complexes present in intercellular substance of epidermis leads to kkeratinocyte realesing serine proteasee which dissolve intercellular substance
keratinocyte then seprate from adjoining cells
334
Patients present with the following signs:
1. Hyperkeratotic papules present over the seborrheic area of the body.scalp,forehead,nasolabial folds,retroauricular groove
2. V-shaped nicking present at the tip of the nails.
3. Red and white longitudinal nail lines.
4. oral mucosa has cobble stone appearence
wht is likely diagnosis
dariers ds
335
Microscopically the lesions show a "dilapidated brick wall" appearance in the epidermis
is seen in
Hailey–Hailey disease, or familial benign chronic pemphigus[1]:559 or familial benign pemphigu
336
tzank smear finding of herpes simplex and herpes zoster
eosinophilic cowdry type A intranuclear inclusion bodies
337
nikolsky sign is seen in
```
pemphigus all types not pemphigoid
steven Johnson
TEN
SSSS
epidermolysis bullosa simplex and dystrophic
herpes
leukemia
mycosis fungoides
```
338
level of split in EB simplex
basal or suprabasal
| defect is in keratin 5 and 14
339
level of split in EB Junctional
Lamina lucida of basement membrane zone and defect in laminin gene
340
level of split in dystrophic EB
below lamina densa of BMZ defect is in collagen 7
341
mitten like deformity with digits encased in epidermal coccon is seen in
epidermolysis bullosa
342
gold standard for confirm level of bulla is in
electron microscopy
343
how is epidermolysis bullosa acquisita differentiated from porphyria cutanea tarda and bullus pemphigoid
PCT hve deposited of immune complexes also around blood vessels in addition to dermoepidermal junction
BP AND EBA
direct and indirect immunoflorescence on salt split skin
if deposit on roof side of dermoepidermal junction then it is bullous pemphigoid and on floor side of dermoepidermal junction it is EBA
344
mucous involvement is in
pemphigus follacious
pemphigus vulgaris
bullous pemphigoid i
in PF 》mucosa is always spared
in PV》
nearly all pts hve mucosal lesions
in BP》mucosal involvement is infrequent but if present it is limited to buccal mucosa mostly
345
fishnet pattern is seen in
pemphigus vulgaris
346
linear florescent pattern in blood vessels is found in
porphyria cutanea tarda
bullous pemphigoid
epidermolysi s bullosa acquisita
347
contact leucoderma
external chemicals destroying melanocytes
| causing vitiligo patches
348
wht is urticaria pigmentosa
it is a tumor of mast cells where mast cells irritate the basal melanocytes and lead to inc brown pigmentation of the skin
⬇️
when these patches are scratched this leads to break down of those mast cells thus lesions become red and erythematosus
⬇️
dariers sign
349
target /bulls eye lesion are seen in
erythema multiforme
350
tinea incognito is seen with
steroids
351
wht is norweign scabies
scabies seen in HIV +ve patients
⬇️
immune response to scabies is very poor due to which there are no itching, no scratching no removal of mite no of mite
no of mites reach till 20000
⬇️
characteristically there is hyperkeratosis and crusting
352
wht is nodular scabies
more inflammation to scabies resulting in nodules formation
