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AliKhan Derm > General Dermatology Chapter 3 > Flashcards

General Dermatology Chapter 3 Flashcards

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Dermatology Board Prep flashcards
1
Q

List the 6 hair disorders with + fragility?

A

Bubble hair
Monilethrix, “beaded hair”
Pili torti, “tortuous hair”
“Bamboo hair”
Trichorrhexis nodosa, “broomstick hair”
Trichothiodystrophy, “tiger tail hair”

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2
Q

Most common mutation identified in LCH lesions?

A

BRAF V600E

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3
Q

Factor XIIIa is found in?

A

NON-LCH conditions:
Juvenile xanthogranuloma, xanthoma disseminatum, Rosai-Dorfman disease, Sinus histiocytosis with massive lymphadenopathy, and Erdheim-Chester disease

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4
Q

LCH tx?

A

BRAF V600e mutation not present, cutaneous LCH can be treated with immunosuppressing agents like corticosteroids, thalidomide, azathioprine, and MTX rather than vemurafenib, a BRAF kinase inhibitor that may be a valuable treatment for LCH patients with severe multisystem disease and detected BRAF V600e mutation.

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5
Q
A

Traumatic anserine folliculosis (TAF). Tx: Tretinoin 0.025%

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6
Q

PTCH1 mutations have been found in?

A

Gorlin syndrome, sporadic trichoepitheliomas, bladder carcinoma, and SCC of the esophagus

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7
Q

Accordion hand is a radiologic finding characteristic of?


A

Multicentric reticulohistiocytosis


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8
Q

Porphyria cutanea tarda can be a marker for?

A

Hereditary hemochromatosis

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9
Q

Costello syndrome have an increased risk of developing which?
A. SCC
B. Renal cell carcinoma
C. Rhabdomyosarcoma
D. Pneumothorax
E. Cardiac myxomas

A

C. Rhabdomyosarcoma

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10
Q

Which of these dermatophytes causes Tinea capitis without hair loss?
A. Trichphyton violacium
B. Microsporum lanosum
C. Epidermophyton floccusum
D. Trichophyton gypsum
E. Trichophyton rubrum

A

A. Trichphyton violacium

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11
Q

spindle lipoma’s develop on the?

A

posterior neck, upper back and shoulders

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12
Q

Which of the following is MOST likely to be found on physical examination of a patient with Gronblad – strandberg syndrome ?
A. Splenomegaly
B. Angioid streaks
C. Lymphadenopathy
D. Palpable purpura
E. Scaly plaques on the knees

A

B. Angioid streaks

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13
Q

Which of the following is associated with seborrhea?
A. Scleroderma
B. Pachydermoperiostosis
C. Steatocytoma multiplex
D. Piezogenic pedal papules E. Pseudoxanthoma elasticum

A

B. Pachydermoperiostosis

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14
Q

Maculae caeruleae (blue dots on the thigh) occur in Which of the following?
A. Tungiasis
B. Larva migrans
C. Onchocericoma
D. Pediculosis pubis
E. Cutaneous schistosomiasis

A

D. Pediculosis pubis

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15
Q

Waldenstrom hypergamma globulinemic purpura is most frequently associated with?
A. Rheumatoid arthritis
B. Lupus erythematosus
C. Lymphoma
D. Multiple myeloma
E. Sjogren’s syndrome

A

E. Sjogren’s syndrome

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16
Q

What disorders are associated with IgA gammopathy?

A

Sweet’s syndrome
Pyoderma gangrenosum
IgA pemphigus and subcorneal
pustular dermatosis
Erythema elevatum diutinum
POEMS syndrome

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17
Q

What disorders are associated with IgM gammopathy?

A

Schnitzler’s syndrome
Waldenström macroglobulinemia
Cryoglobulinemia

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18
Q

IgG-k is associated with?

A

Necrobiotic xanthogranuloma
Scleredema

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19
Q

IgG-lamda is associated with?

A

Scleromyxedema

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20
Q

Secondary eruptive xanthomas due to what drugs?

A

Oral retinoids, protease inhibitors, olanzapine, estrogen replacement

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21
Q

Tuberous xanthomas mainly occur on?

A

Elbows and knees; a/w type II and III

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22
Q

Firm nodules on Achilles tendon are?

A

Tendinous xanthomas seen in type II hyperlipidemia

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23
Q

Dysbetalipoproteinemia assoc. with Tuberoeruptive, tuberous, plane, palmar creases?

A

Type III

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24
Q

Histology of xanthomas?

A

Foam cells, macrophages w/ lipidized cytoplasm, in dermis

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25
Q

Preformed mediators?

A

“Preformed HHP”
Heparin
Histamine
Proteases

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26
Q

Urticaria include immune complex deposition, urticarial vasculitis, and what other meds?

A

NSAIDs, radiocontrast media, polymyxin B, ACE inhibitors (due to ↑ bradykinin), and dietary pseudoallergens

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27
Q

Most common drug causing urticaria?

A

b-lactams

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28
Q
A

Blanched vasoconstricted halos
around pink wheal
○ Responds better to propranolol than to antihistamines
○ Can reproduce lesions by intradermal
norepinephrine injections

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29
Q

Aquagenic urticaria can be commonly seen with?

A

cystic fibrosis

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30
Q

Schnitzler’s syndrome?

A

Chronic urticaria (burn > itch), fevers, bone pain, arthralgia/arthritis, ↑ ESR, and IgM gammopathy
■ Neutrophilic infiltrate on histopathology; anakinra is a good treatment part of urticarial vasculitis

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31
Q

Hereditary angioedema without urticaria?

A

■ Types I and II due to mutations in C1 inh
- Type I has ↓ C1 inh levels
- Type II has ↓ C1 inh function
■ Type III due to an activating mutation in Hageman factor (FXII)
■ All forms of HAE are autosomal dominant

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32
Q

↓ C1q levels?

A

seen in AAE only!
↓ C1 inh in type I HAE*

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33
Q

C1 inh deficiency tx?

A

Oral danazol is ToC for prophylaxis and C1 inh concentrate is ToC for acute attacks

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34
Q

Five major subtypes of Sweet’s syndrome?

A

Classic (60%–70%), cancer-associated
(10%–20%), inflammatory disease-related (10%–15%), drug-induced (5%), and pregnancy (2%)

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35
Q

For classic sweet’s gender and location predilection?

A

F > M, 3:1
Favors head, neck and upper extremities

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36
Q

Extracutaneous features of sweet’s?

A

Fever (50%–80%), malaise,
preceding URI or flu-like symptoms, leukocytosis (70%), arthralgias/arthritis, ocular involvement (conjunctivitis, episcleritis, scleritis, retinal vasculitis, and iridioyclitis), cardiac involvement (aortitis, cardiomegaly, coronary artery occlusion)

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37
Q

Lab abnormalities in Sweet’s?

A

■ ↑ ESR/CRP (90%)
■ Leukocytosis: neutrophilia
w/ ↑ band forms “left shift”

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38
Q

Triggers for sweet’s?

A

Infections: streptococcus, yersiniosis; HIV, hepatitis C
Drugs: G-CSF, GM-CSF, ATRA, TMP-SMX, minocycline, OCPs
Cancer: AML

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39
Q

Histiocytoid Sweet’s will show infiltrate of?

A

Deep dermal infiltrate of CD163+ macrophages

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40
Q

Mimickers of Sweet’s syndrome?

A
  • CANDLE syndrome (Chronic Atypical Neutrophilic Dermatosis with Lipoatrophy and Elevated temperature): autoinflammatory disorder of children with mutations in PSMB8 gene that can mimic Sweet’s
  • Marshall syndrome: rare childhood disease that has Sweet’s-like lesions that resolve w/ acquired cutis laxa at affected sites
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41
Q

Pyoderma gangrenosum in kids?

A

on head and anogenital region
a/w IBD or leukaemia

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42
Q

Bullous PG?

A

More superficial, less destructive than classic PG, More widespread, a/w hematologic malignancy (AML,
CML, MDS, polycythemia vera)

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43
Q

Painless cribriform ulcers w/
verrucous growths on trunk of PG?

A

Vegetative PG

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44
Q

What’s the cause of Behçet’s disease?

A

Multifactorial (infectious trigger?); circulating immune complexes and neutrophil dysregulation → vascular injury 1st common sx: aphthous stomatitis

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45
Q

Behcet’s number cause of mortality?

A

Ocular (90%), including blindness

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46
Q

MAGIC syndrome?

A

MAGIC syndrome = features of Behçet’s + relapsing polychondritis

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47
Q

Hypereosinophilic syndrome (HES) criteria?

A

■ Peripheral blood eosinophilia, eosinophils >1500/mm3 and/or tissue hypereosinophilia (e.g., eosinophils
> 20% of cells in bone marrow)
■ No evidence of infectious, allergic, or other underlying causes
■ Symptoms/signs of end-organ involvement (due to eosinophil products)
HES divided into primary (neoplastic; 75%) versus secondary (reactive; 25%)

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48
Q

Neoplastic Hypereosinophilic syndrome fusion gene?

A

FIP1L1-PDGFRA fusion gene, tx with Imatinib if fusion gene present

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49
Q

Hypereosinophilic syndrome die from?

A

Congestive heart failure, they need regular echocardiograms

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50
Q

Immune reaction to antigen (e.g., tinea pedis, other dermatophyte infections, other fungi, viruses, parasites), drug, pregnancy, malignancies?

A

Erythema annulare centrifugum

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51
Q

Mild spongiosis, focal parakeratosis, and perivascular lymphohistiocytic infiltration, which is tight and dense “coat sleeve” is seen in?

A

Erythema annulare centrifugum

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52
Q

Agar for Borrelia?

A

Barbour-Stoenner-Kelly medium

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53
Q

Most common malignancy in Erythema gyratum repens?

A

Lung (most common) > breast and GI
Lesions develop 1 year pre-cancer to 1 year post-cancer diagnosis, and resolve once cancer treated

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54
Q

Cutibacterium acnes activates TLR-2 on macrophages then activates what part of the inflammasome?

A

NLRP3 of neutrophils

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55
Q

Effect of tretrinoin on acne?

A

downregulate TLR-2 expression

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56
Q

Severe eruptive nodulocystic acne, without systemic manifestations (vs. acne fulminans)?

A

Acne conglobata

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57
Q

Common sites for neonatal acne?

A

Cheeks and nasal bridge

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58
Q

Infantile acne tx?

A

Topical retinoids, topical antibiotics, or in moderate-severe cases azithromycin or isotretinoin

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59
Q

Type of occupational acne caused by exposure to chlorinated aromatic hydrocarbons (found in electrical conductors, insulators, and insecticides/fungicides/ herbicides)?

A

Chloracne, preferred sites are face, neck (including retroauricular),
axilla, scrotum, and penis

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60
Q

SAPHO (Chronic recurrent multifocal osteomyelitis) stands for?

A

Synovitis
Acne
Pustulosis
Hyperostosis
Osteitis

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61
Q

PAPA syndrome AD mutation in?

A

CD2-binding protein 1 (CD2BP1; aka PSTPIP1)

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62
Q

“bull’s head” sign may be seen on X-ray?

A

SAPHO (Chronic recurrent multifocal osteomyelitis)

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63
Q

HAIR-AN?

A

Hyper Androgenism
Insulin Resistance
Acanthosis Nigricans
Unique subtype of PCOS

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64
Q

Mutation in fibroblast growth factor receptor 2, FGFR2?

A

Apert syndrome (Acrocephalosyndactyly)

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65
Q

Molecules inflamed in rosacea?

A

Kallikrein 5, TPRV, cathelicidin LL-37, and TLR2 are upregulated

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66
Q

Haber’s syndrome?

A

Genodermatosis w/ rosacea-like eruption and verrucous lesions

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67
Q

common in Asians, Smooth, firm, yellow-brown to red 1 to 3 mm
monomorphous papules with apple jelly color on diascopy in butterfly distribution, heals w/scarring is likely?

A

Lupus miliaris disseminatus faciei

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68
Q

Gram-negative folliculitis is seen in?

A

Patients receiving prolonged antibiotic treatment (esp. tetracyclines)

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69
Q
A

Eosinophilic pustular folliculitis (Ofuji’s disease) + Peripheral eosinophilia; Tx: oral indomethacin

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70
Q

Tx of Trichodysplasia spinulosa?

A

Topical cidofivir, tazarotene gel, oral
valganciclovir

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71
Q

Tx of Pseudofolliculitis barbae?

A

Bunch of tiny curled hairs
Tx: Stop shaving; laser hair removal,

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72
Q

Follicular occlusion tetrad?

A

Acne conglobata
Hidradenitis suppurativa
Dissecting cellulitis of the scalp
Pilonidal cyst

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73
Q

HS mutation?

A

“Gamma-secretase complex” (nicastrin, presenilin 1, presenilin enhancer 2) leading to atypical disease with diffuse involvement and many cysts

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74
Q

Systemic anticholinergics for treating hyperhidrosis?

A

Glycopyrrolate, propantheline, and oxybutynin

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75
Q

3 types of eccrine bromhidrosis?

A

■ Keratogenic: bacterial degradation of stratum corneum macerated by excess eccrine sweat
■ Metabolic: abnormal secretion of amino acids or breakdown products as seen in heritable metabolic disorders (e.g., phenylketonuria has mousy odor and maple syrup urine disease has sweet odor)
■ Exogenous: odorogenic compounds such as garlic, asparagus, curry, DMSO, penicillins

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76
Q

Red sweat?

A

clofazimine and rifampin

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77
Q

Yellow sweat?

A

lipofuscin

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78
Q

Blue/green sweat?

A

copper

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79
Q

Brown sweat?

A

dihydroxyacetone-containing self-tanning products

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80
Q

Fox-fordyce disease is also called?

A

Apocrine miliaria

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81
Q

Tx for Fox-fordyce disease?

A

Tretinoin, topical CS, TCIs, topical antibiotics, microwave ablation, and surgical excision; pregnancy can lead to improvement

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82
Q
A

Cutis rhomboidalis nuchae—solar elastosis variant affecting posterior neck with geometrically patterned leather-like wrinkled skin

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83
Q
A

Poikiloderma of Civatte: reticular reddish-brown telangiectatic patches on lateral neck (central submental region spared)

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84
Q

Same as Favre-Racouchot syndrome but clusters of white/yellow papules instead?

A

Colloid milium

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85
Q

Enzyme deficient in Porphyria cutanea tarda?

A

Uroporphyrinogen decarboxylase

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86
Q

Skin findings in PCT?

A

Skin fragility, vesicles, bullae, erosions, milia, scarring, hyperpigmentation, and hypertrichosis in photodistributed areas, Classic photo is hemorrhagic blisters on dorsal hands

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87
Q

Tx for PCT?

A

Avoid precipitating factors (alcohol & estrogen), sun avoidance, treat underlying conditions (if any), phlebotomy, low-dose (twice weekly) hydroxychloroquine

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88
Q

X-linked dominant protoporphyria is due to mutation in?

A

ALAS2 gene
Encodes 5-ALA synthase
↑↑ plasma protoporphyrin

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89
Q

Variegate porphyria enzyme?

A

Protoporphyrinogen oxidase

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90
Q

Hereditary coproporphyria deficiency?

A

Coproporphyrinogen III oxidase

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91
Q

Congenital erythropoietic porphyria (Gunther’s disease) deficiency?

A

Uroporphyrinogen III synthase

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92
Q

Erythrodontia seen with?

A

Congenital erythropoietic porphyria (Gunther’s disease)

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93
Q

Tx of Congenital erythropoietic porphyria (Gunther’s disease)?

A

strict photoprotection, hypertransfusions,
and iron chelation such as with deferoxamine; splenectomy may be considered, use of ascorbic acid and a-tocopherol has been advocated, ocular lubricants, and allogeneic bone marrow transplantation

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94
Q

Tx of Erythropoietic protoporphyria (ferrochelatase def.)?

A

strict photoprotection, oral b-carotene,
afamelanotide may be helpful in some patients, and hypertransfusion/plasmapheresis/exchange transfusion may be helpful in some patients; liver transplantation may be necessary with hepatic failure

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95
Q
A

Chondrodermatitis nodularis helicis chronica, Tender pink crusted papules on cartilaginous portions of ear helix and antihelix

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96
Q
A

Traumatic auricular hematoma; trauma to external ear → subperichondrial hematoma → cauliflower ear over time if not treated, seen with wrestlers

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97
Q
A

Black heel (talon noir): cluster of black pinpoint macules on posterior heel, Athletic trauma → rupture of supercial dermal vessels → hemoglobin in stratum corneum

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98
Q

Amyloidosis histology?

A

homogenous, eosinophilic, fissured
masses that stain with Congo red and have green birefringence with polarized light
Amyloid also stains positively with crystal violet, periodic acid–Schiff (PAS), and thioflavin T

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99
Q
A

Lichen amyloidosis
Rippled, hyperpigmented, pruritic papules/plaques on extensor surfaces (esp. shins), Seen in MEN 2A

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100
Q

Nodular amyloidosis, derived from Ig light chains, is assoc with?

A

Sjögren’s (25%), scleroderma and rheumatoid arthritis, Progression to systemic amyloidosis in 7%

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101
Q

Mediators of itch?

A

Histamine
Trypsin
Serotonin
Papain
Bradykinin
Substance P
VIP
Kallikrein

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102
Q

When is itch worse in CKD?

A

Worst at night and 2 days post-hemodialysis

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103
Q

Generalized pruritus is related to?

A

Hyperthyroidism vs. localized genital/perianal pruritus in diabetes mellitus

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104
Q

Drug-induced pruritus?

A

Opioids
Cocaine (formication)
Chloroquine
CTLA-4 or PD-1 inhibitors
BRAF inhibitors
EGFR inhibitors
Hydroxyethyl starch

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105
Q

Tx of choice for delusions of parasitosis?

A

Pimozide
QT prolongation on EKG, extra-pyramidal side effects, and drug-drug interactions

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106
Q

Burning mouth syndrome types?

A

Type I - better in morning and worsens through day
Type 2 - constant
Type 3 - sporadic periods of activity and remission

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107
Q

Notalgia paresthetica spinal level?

A

Medial scapular borders at T2–T6

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108
Q

Localized numbness, burning, tingling, allodynia, or pruritus of anterolateral thigh secondary to pressure on lateral femoral cutaneous nerve as it passes under the inguinal ligament, often seen in middle-aged obese males?

A

Meralgia paresthetica
A/w Obesity, pregnancy, prolonged sitting, tight clothing, heavy wallets in pant pockets

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109
Q
A

Trigeminal trophic syndrome
- Self-induced lesions of central face triggered by paresthesias/dysesthesias secondary to impingement or damage of sensory portion of trigeminal nerve
- Frequently occurs after treatment for trigeminal neuralgia w/ ablation of Gasserian ganglion

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110
Q

Neurodegenerative disease → defective lacrimation, absence of tongue papillae, taste disturbance and ↑ salivation, impaired regulation of temperature and bp,↓ pain sensation, absent tendon reflexes, hyperhidrosis, transient erythema of trunk, vomiting crises, and acrocyanosis of hands?

A

Familial dysautonomia/Riley-Day syndrome
AR inheritance of IKBKAP (locus 9q31)

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111
Q

Most common complication of parotidectomy?

A

Auriculotemporal nerve syndrome or Frey syndrome
Most common cause in children is nerve damage from forceps delivery, starts after starting solid foods

112
Q
A

Punctate keratosis of the palmar creases, 1-5 mm small plugs in creases of palms or fingers primarily in African American patients

113
Q

Kwashiorkor vs. Marasmus

A

Kwashiorkor: ↓ protein intake
♦Dyschromia
♦Hypopigmentation following trauma
♦“peeling, flaky paint” appearance
♦“Flag sign”
♦Compromised wound healing
♦Edema
Marasmus: ↓ energy/calorie intake
♦Thin, dry, pale, wrinkled, loose skin
♦Lanugo-like hair
♦Purpura
♦ Impaired hair and nail growth
♦“monkey facies”—↓ buccal fat pads

114
Q

Excess Beta-carotene seen in?

A

Diabetes, nephrotic syndrome, and hypothyroidism, carrots, squash

115
Q

Phrynoderma (keratotic follicular papules resembling toadskin), night blindness, xerophthalmia deficiency of?

A

Vitamin A

116
Q

Oral-ocular-genital syndrome (cheilitis, angular stomatitis, seborrheic dermatitis-like rash, tongue atrophy/glossitis, genital and perinasal dermatitis) seen w/ deficiency of?

A

Vitamin B2 (riboflavin)

116
Q

Selenium deficiency?

A

Hypopigmentation of skin, brittle hair, leukonychia, xerosis

117
Q

Vitamin B3 (niacin) excess?

A

Flushing, pruritus, acanthosis nigricans

118
Q

B3 or niacin deficiency is seen with?

A

Hartnup dz, alcoholism, carcinoid syndrome, isoniazid, 5-FU, azathioprine

119
Q

Vitamin B6 (pyridoxine) def?

A

Periorificial seborrheic dermatitis-like rash, angular cheilitis, intertrigo, atrophic glossitis

120
Q

Folic acid AKA?

A

Vitamin B9, Goat milk diet can predispose

121
Q

Vitamin E excess causes?

A

Petechiae, ecchymoses

122
Q

Infections that cause dystrophic calcification?

A

Onchocera volvulus and Taenia solium

123
Q

Px in Takayasu’s arteritis?

A

Purpura, Erythematous subcutaneous nodules, EN-like lesions, PG-like lesions and Raynaud’s

124
Q

Cutaneous fx of Type I (IgM, lymphopriliferative) cryoglobulinemia?

A

○Purpura, livedo reticularis, livedo racemosa, ulceration
○Cold-induced acrocyanosis of helices
○Raynaud phenomenon

124
Q

Cutaneous fx of Type II and III cryoglobulinemia?

A

○Palpable purpura and urticarial lesions ○Systemic findings common

125
Q
A

Livedoid vasculopathy (atrophie blanche)
Tx: ASA, Pentoxyfilline, Anticoagulation (rivaroxaban)

126
Q
A

Schamberg’s: cayenne-pepper purpura on the lower extremities (esp. shin, ankles) that can extend; middle-aged to older adults

127
Q
A

Purpura annularis telangiectodes of Majocchi: annular patches with punctate petechiae on trunk and lower extremity in adolescent/young-adult women

128
Q

What’s Levamisole-induced vasculitis?

A

Levamisole is an antihlmithic agent may be found in cocaine which ↑ its stimulant effects and bulk, purpura and necrosis of the earlobes (but also nose, cheek, extremities), LCV-like lesions, ecchymoses, and systemic vasculitis

129
Q

Degos disease skin fx?

A

Crops of small erythematous papules that develop a central depression, ivory scar, peripheral erythema and surrounding telangiectasias (similar to atrophie blanche)

130
Q

Livedo racemosa?

A

Cutaneous manifestation of Sneddon syndrome (=vasculopathy)
Livedo racemosa = larger branching and incomplete rings (vs. smaller complete rings of LR)

131
Q

Erythromelalgia, plunging red, painful feet into ice cold water, genetic mutation (seen with type 2) is due to?

A

SCN9A mutations, Na+ channel subunit mutation ↓ sympathetic neuron activity, and ↑ pain receptor sensitivity

132
Q

Pathophysiology of livedo reticularis?

A

secondary to vasospastic response to cold
and improves with heat; processes that → ↓ blood flow to and within skin or ↓ blood draining out of skin → deoxygenated blood in venous plexus → livedo appearance

133
Q

Sarcoidosis + EN + hilar lymphadenopathy, is?

A

Lofgren’s syndrome

134
Q

Histo of Erythema nodosum?

A
  • Septal panniculitis with thickening, fibrosis of septae
  • Neutrophils seen particularly in early lesions
  • Miescher’s microganulomas: small histiocytic aggregates surrounding a central stellate cleft
135
Q

Bruised, tender plaques on lower extremities → ulceration/necrosis → oily discharge, is?

A

Alpha1-antitrypsin deficiency panniculitis

136
Q

Anisotrichosis?

A

↑ variability in hair shaft size

137
Q

Barrel-shaped spores?

A

Coccidioides immitis

138
Q

Most reliable method for distinguishing between Trichophyton rubrum and T. mentagrophytes is?

A

Hair perforation test
Positive in T. mentagrophytes

139
Q

What causes tinea nigra?

A

Phaeoannellomyces wernecki

140
Q

Club shaped, and smooth walled, they grow singly or in clusters?

A

Epidermophyton floccosum

141
Q

Pseudohyphae show?

A
  1. Constrictions at the septae
  2. Branching at the septae
  3. Terminal cell is smaller than the others
142
Q

Which human papillo viurs (HPV) type is implicated in papillomatosis cutis carcinoides di Gottron?

A

HPV 11
I.e. Bushcke-Lowenstein

143
Q

Where do you see Gamma-Favre bodies?

A

Lymphogranuloma venereum (LGV)

144
Q

Streptococcus Iniae has been shown to cause?

A

Hand cellulitis in fish handlers

145
Q

Causative organism in Whitmore disease is?

A

Burkholderia pseudomallei
AKA Melioidosis

146
Q

Mikulicz is the histologic hallmark of?

A

Rhinoscleroma

147
Q

Treatment of choice for Oroya Fever?

A

Chloramphenicol

148
Q

Xenopsylla cheopis transmits?

A

Murine typhus

149
Q

All of the following are potential causes of a false positive RPR except:
1. Systemic Lupus Erythematosus (SLE)
2. Pregnancy
3. Malignant Melanoma
4. Lepromatous Leprosy
5. Malaria

A
  1. Malignant Melanoma
150
Q

The treatment of choice for Loiasis is?

A

Diethylcarbamazine (DEC)

151
Q

Xenopsylla cheopis is the vector responsible for?

A

Endemic typhus

152
Q

Erythema infectiosum is caused by a?
1. RNA virus
2. Herpes virus
3. Double stranded DNA virus
4. Single stranded DNA virus
5. None of these answers are correct

A
  1. Single stranded DNA virus
153
Q

Acrodermatitis chronica atrophicans is caused by?
1. Borrelia burgdorferi
2. Borrelia burgdorferi senso stricto
3. Borrelia garinii
4. Borrelia afzelii

A
  1. Borrelia afzelii
154
Q

Erythema gyratum repens is known to be associated with all of the following malignancies except:
1. Lung carcinoma
2. Breast carcinoma
3. Cervical carcinoma
4. Bladder carcinoma
5. Gastric carcinoma

A
  1. Gastric carcinoma
155
Q

A 55 year old patient presents with new onset brown macules on arms, legs, face and palms. She gives a 3 month history of diarrhea, abdominal cramps, weight loss and protein-losing enteropathy. The most likely diagnosis is:
1. Peutz-Jeghers syndrome
2. Cowden disease
3. Ulcerative colitis
4. Cronkhite-Canada syndrome
5. Plummer-Vinson syndrome

A
  1. Cronkhite-Canada syndrome
156
Q

A patient with congenital hypertrophy of retinal epithelium is most likely to have:
1. An autosomal dominant mutation in the MSH2 gene
2. Pheochromocytoma
3. Adenomatous polyposis
4. Tram-track calcifications on head radiograph
5. Peg-shaped teeth

A
  1. Adenomatous polyposis
157
Q

Tripe palms, “acanthosis palmaris,” are a cutaneous manifestation associated with which of the following malignancies?
1. Renal carcinoma
2. Lung carcinoma
3. Prostate carcinoma
4. Colon carcinoma
5. Pancreatic carcinoma

A
  1. Lung carcinoma
158
Q

Patients with Werners syndrome typically experience which of the following types of cardiac disease?
1. Hypertrophic cardiomyopathy
2. Aortic aneurysms
3. Premature atherosclerosis
4. Cardiomegaly
5. Mitral valve prolapse

A
  1. Premature atherosclerosis
159
Q

Which of the following statements about arthroconidia is correct?
1. Arthroconidia are formed by budding
2. Arthroconidia are formed by fragmentation of hyphae
3. Arthroconidia are thick-walled round cells
4. Arthroconidia are spores that are produced in a sac

A
  1. Arthroconidia are formed by fragmentation of hyphae
160
Q

Fungal culture reveals smooth, club-shaped macroconidia attached to hyphae in groups. No microconidida are seen. The organism is:
1. Microsporum canis
2. Epidermophyton floccosum
3. Trichophyton rubrum
4. Microsporum gypseum

A
  1. Epidermophyton floccosum
161
Q

Which disease is associated with increased cholesterol sulfate levels?
A. Lamellar ichtyosis
B. Non –bullous congenital Ichtyosiform erythroderma
C. X – linked Ichtyosis
D. Epidermolytic hyperkeratosis

A

C. X – linked Ichtyosis

162
Q

One of the followings IS NOT FDA- approved indication for treatment of the following clinical diseases by interferones:
A. Condyloma acuminata
B. AIDS –associated Kaposi, s sarcoma
C. Melanoma
D. Actinic keratosis

A

D. Actinic keratosis

163
Q

Dermoscopy showing Glomerular vessels is seen with?

A

Bowen’s

164
Q

The SITE of action of antifungal drugs class polyens is:
A. Blocks DNA synthesis
B. Disrupts mitotic spindle
C. Binds cell membrane sterols
D. Interferes with cell membrane synthesis via inhibition of squalene epoxidase

A

C. Binds cell membrane sterols

165
Q

One of the following is a 4th generation cephalosporin?
A. Cefapime
B. Cephalexin
C. Cefaclor
D. Cefotaxime
E. Ceftriaxone

A

A. Cefapime

166
Q

Suffix ximab in the nomenclature of biological agents indicates to What of the following ?
A. Blocker of interaction between interleukin- 1 and its receptor
B. Chimeric monoclonal antibody
C. Humanized monoclonal antibody
D. Human monoclonal antibody

A

B. Chimeric monoclonal antibody

167
Q

Episodic angioedema, hypereosinophilia, weight gain and fever are characteristic of:
A. Kimura disease
B. Gleich syndrome
C. Melkersson – Rosenthal syndrome
D. Larva migrans

A

B. Gleich syndrome

168
Q

Histology of AA?

A
169
Q

Possible mutation in Central centrifugal cicatricial alopecia?

A

PADI3 mutation in some patients. A/w use of chemical relaxers, hot combs, traumatic hairstyles, pomades

170
Q

“doll hairs,” polytrichia = fusion of follicular infundibulae, seen in what alopecia?

A

Central centrifugal cicatricial alopecia

171
Q

Graham-Little syndrome?

A

■ Associated with LPP
■ Scarring hair loss on scalp
■ Non-scarring hair loss of axilla and pubic areas
■ Keratosis pilaris-like spinous follicular papules on trunk

172
Q

Neutrophilic alopecia’s?

A

Folliculitis decalvans
Dissecting cellulitis

173
Q

Mixed alopecia’s?

A

Acne keloidalis
Erosive pustular dermatosis
Acne necrotica

174
Q

Pseudoepitheliomatous epidermal hyperplasia is seen in?

A

Deep fungal infections
Leishmaniasis
Atypical mycobacteria
Tuberculosis verrucosa cutis

175
Q

Histology of Acne keloidalis nuchae will show?

A
  • Mixed (lymphoplasmacytic and neutrophilic) perifollicular inflammation at the isthmus and lower infundibulum
  • Lamellar fibroplasia
  • Loss of sebaceous glands
176
Q

Most common causes of acquire generalized hypertrichosis?

A

Minoxidil, phenytoin, and cyclosporine

177
Q

SPINK5 gene encodes?

A

Serine protease inhibitor LEKTI

178
Q

“Cupid’s bow” upper lip; doughy skin; diffuse hypopigmentation (tyrosinase requires copper!) seen with?

A

Menkes hair disease, XLR, ATP7A (→ defective copper transport)

179
Q

Features of Bazex-Dupre-Christol?

A

Pili torti, basal cell carcinomas, milia, follicular atrophoderma, hypohidrosis, hypotrichosis

180
Q

Features of Netherton’s?

A

1- Ichthyosis linearis circumflexa
2- Atopy
3- Hair abnormality: trichorrhexis invaginata, trichorrhexis nodosa

181
Q
A

Pili bifurcate

182
Q

Beau’s lines are seen in?

A

Mechanical trauma
Chemotherapy
Stress on body/systemic illness

183
Q

Mee’s lines?

A

Arsenic or thallium

184
Q

Koilonychia?

A

Normal in kids
Iron-deficiency, I,e. Plummer-Vinson

185
Q

Subungual hyperkeratosis → thickened nail is termed?

A

Onychauxis

186
Q

Red lunulae causes?

A

SLE, alopecia areata, rheumatoid arthritis, dermatomyositis, cardiac failure, CO poisoning

187
Q

Lester iris seen with?

A

Nail-Patella syndrome

188
Q

Causes of acute vs. chronic paronychia?

A

Acute - Staph aureus
Chronic - Candida

189
Q

Subungual exostosis?

A

Subungual bony growth → nodule → nail plate elevation

190
Q

Most common nail tumor?

A

Myxoid cysts - digital mucous cyst

191
Q

Causes of fissured tongue?

A

A/w Melkersson-Rosenthal syndrome, Down syndrome, Cowden syndrome

192
Q

Causes of Smooth tongue (atrophic glossitis)?

A

Vitamin deficiency (e.g., B1, B2, B6, B12, iron (e.g., Plummer-Vinson), folate), or other disorders (e.g., Sjögren’s syndrome)

193
Q

Most common tumor of the oral cavity?

A

Fibroma
Pink smooth papule usually on buccal mucosa
Usually along bite line

194
Q

Morsicatio buccarum?

A

White ragged, shredded surface changes of anterior buccal mucosa bilaterally due to habitual chewing of mucosa

195
Q

White sponge nevus of buccal mucosa is due to mutations in?

A

Keratin 4 and 13

196
Q

Gingival hypertrophy causes?

A

Phenytoin, nifedipine, cyclosporine

197
Q

Orofacial granulomatosis seen in?

A

Melkersson-Rosenthal syndrome
Possibly also sarcoidosis and Crohn’s

198
Q

Enlargement, eversion, of lower lip with pinpoint erythema (inflammation of secretory ducts) + sticky mucoid film is termed?

A

Cheilitis glandularis
Adult men with h/o sun exposure ↑ SCC risk

199
Q

Unilateral facial vitiligo, or poliois, with visual/hearing impairment on the same side is?

A

Alezzandrini syndrome

200
Q

Chemical leukodermas?

A

Phenols, catechols, arsenic, PPD, merury, imiquimod, azelaic acid, methylphenidate patches, and sulfhydryls

201
Q

Associations with hypomelanosis of Ito?

A

30% of patients also have CNS, musculoskeletal, or ophthalmologic abnormalities

202
Q

Normal number of melanocytes with ↓ melanosomes is seen in?

A

Nevus depigmentosus

203
Q

3 patterns of melasma?

A

Centrofacial, malar, and mandibular
Four types: epidermal (accentuated by wood’s lamp), dermal, mixed, and indeterminate
↑ Melanin in all layers, ↑ melanophages, ↑ epidermal melanocytes

204
Q

Prurigo pigmentosa tx?

A

Tetracyclines and dapsone

205
Q

Mutation in Familial progressive hyperpigmentation?

A

Mutation of KIT ligand gene (KITLG)

206
Q

Caput secundum and the midline?

A

its a ‘cap’, crosses the midline

207
Q
A

Halo scalp ring
Occurs after prolonged labor, associated with caput secundum, may have necrosis or scarring

208
Q

Nail fold capillaries in morphea?

A

Dilated capillary loops alternating w/ capillary drop out

209
Q

Irregular telangiectasias w/ radiating vessels are seen with?

A

Hereditary hemorrhagic telangiectasia

210
Q

Biomarker for skin and lung fibrosis
and pulmonary arterial HTN in scleroderma is?

A

CXCL4

211
Q

Tx for pulmonary disease in scleroderma?

A

○ ILD: cyclophosphamide, rituximab, Mycophenalate mofetil*, HSCT, and adjuvant N-acetylcysteine
○ PAH: endothelin receptor antagonists (e.g., bosentan), PDE-5 inhibitors, prostacyclin analogs (e.g., iloprost), lung transplant

212
Q

Tx option for digital ulcers in scleroderma?

A

IV iloprost, ASA/clopidogrel

213
Q

Shulman syndrome is also called?

A

Eosinophilic fasciitis, px in fourth to sixth decades, unknown, but TGF-beta* is elevated

214
Q

“Dry river bed” or “groove sign” = linear depressions of veins within indurated skin is seen in?

A

Eosinophilic fasciitis (Shulman syndrome)

215
Q

What areas are spared in eosinophilic fasciitis?

A

Spares Face, hands & feet
Key feature = rapid onset of symmetric edema/ induration and pain in extremities in a/w peripheral eosinophilia
Lacks Raynaud phenomenon*

216
Q

Pathogenesis of nephrogenic systemic fibrosis?

A

A result of gadolinium-containing contrast exposure (2-4 weeks) in the setting of acute kidney injury or severe chronic kidney disease (CKD) that leads to fibrosis of skin and internal organs

217
Q

Features of of nephrogenic systemic fibrosis?

A

■ Insidious onset of symmetrically distributed, painless,
hyperpigmented and indurated “patterned plaques”
(reticular or polygonal morphology)
■ “pseudocellulite” or cobblestone appearance
■ Marked woody induration with peau d’orange changes
■ Puckering or linear banding due to focal areas of bound-down skin on proximal extremities
■ Dermal papules: browny to skin-colored papules or nodules with absent epidermal change
■ Scleral plaque (exam favorite!): white-yellow plaques w/dilated capillaries in patients < 45 yo (above this age, less specific)

218
Q

Histology of nephrogenic systemic fibrosis is similar to?

A

Scleromyxedema, but fibrosis extends more deeply into fat and fascia
■ ↑ Collagen
■ ↑ Spindled fibrocytes (positive staining for CD34 and procollagen I)
■ ↑ Mucin (stains with Prussian blue)

219
Q

Types of scleredema?

A

Type I: Preceded Strep pharyngitis
Type II: Assoc. w/ IgG-kappa
Type III: “Sceredema diabeticorum” IDDM

220
Q

POEMS skin features?

A

Sclerotic skin changes favoring extremities, hyperpigmentation
Hypertrichosis
Hyperhidrosis
Digital clubbing
Leukonychia

221
Q

Nephrogenic systemic fibrosis, is a form of sclerodermoid changes due to ‘exogenous’ substances, what are other types?

A

Toxic oil syndrome - Eruption, ‘flu-like’ sx’s
Eosinophilia-myalgia syndrome - Fever, fatigue, severe myalgia’s, due to ingestion of contaminated L-tryptophan
Polyvinyl chloride
Bleomycin - Pulmonary fibrosis, Raynaud’s
Taxanes (docetaxel, paclitaxel) - Diffuse edema on legs
Nephrogenic systemic fibrosis
Sclerosis at injection sites - Vitamin K (Texier’s disease), silicone or bleomycin injections

222
Q

Keratotic crusted plug surrounding epithelial hyperplasia (“crab-claw”) grabbing pink elastic fibers in superficial dermis seen in?

A

Elastosis perforans serpiginosa

223
Q

Primary (idiopathic) anetoderma types?

A

Jadassohn-Pellizzari - inflammatory
Schweninger-Buzzi - non-inflammatory

224
Q

Atrophoderma vermiculatum?

A

Variant of follicular atrophoderma that is on face/cheeks exclusively
Seen in: ROMBO, Nocolau-Balus, and scrotal tongue

225
Q

Pathogenesis of granuloma annulare?

A

Unknown etiology; most likely Th1-type delayed hypersensitivity reaction to a variety of triggers, trauma, isomorphic Koebner response, insect bites, tuberculin skin test, mycobacterial, viral infection, drugs, or UV radiation

226
Q

Generalized granuloma annulare is associated with?

A

Hyperlipidemia (up to 45%), type I diabetes, HIV, thyroid disease, malignancy (clinical pattern atypical—e.g., palms and soles)

227
Q

Most common histologic form of granuloma annulare?

A

Interstitial: dermal mucin between collagen fibers

228
Q

Severe granuloma annulare tx?

A

Triple antibiotic regimens (minocycline, ofloxacin, and rifampin), TNF-a inhibitors, phototherapy, antimalarials, nicotinamide, isotretinoin, dapsone, pentoxiphylline, PDT

229
Q

Multinucleated foreign body GCs than are typically seen in GA; phagocytosed elastic fibers within histiocytes and GCs (“elastophagocytosis”); no collagen alteration or lipid deposition, lacks mucin is seen in?

A

Annular elastolytic giant cell granuloma on face on sun exposed areas

230
Q

Interstitial granulomatous dermatitis and arthritis (IGDA) and palisaded neutrophilic granulomatous dermatitis (PNGD)?

A

Types of granulomatous dermatitides existing on a spectrum assoc. w/ other systemic diseases like RA (in both) or SLE and ANCA vasculitides (more with PNGD)

231
Q

Granulomatous drug eruption seen with?

A

CCBs, statins, TNF-a inhibitors
Months to years after drug initiation*

232
Q

Dermoscopy of necrobiosis lipoidica?

A

Early lesions - comma-shaped vessels Older lesions - irregular arborizing vessels

233
Q

Histological features of necrobiosis lipoidica?

A

“Square biopsy sign”
Plasma cells
Multinucleated giant cells
Horizontally arranged (“layered”) palisaded granulomatous inflammation

234
Q

Ophthalmic manifestations in necrobiotic xanthogranuloma (periorbital region most commonly)?

A

50% have ophthalmic manifestations Ectropion, keratitis, uveitis, and proptosis
Majority also have endocardial involvement and hepatosplenomegaly common, strongly associated with IgG-kappa monoclonal gammopathy

235
Q

Genetic predisposition for cutaneous Crohn’s disease?

A

NOD2
Results in early-onset sarcoidosis called ‘Blau’ syndrome
+ defective microbial clearance, mucosal compromise or altered gut flora balance (dysbiosis) → exaggerated Th1 and Th17 response to gut flora → granulomatous lesions in gut and skin

236
Q

Tx of cutaneous Crohn’s?

A

First line: oral metronidazole, topical/intralesional steroids, and TCIs
Severe cases: oral steroids, sulfasalazine, MTX, MMF, cyclosporine, thalidomide, AZA, 6-MP, and TNF-a inhibitors

237
Q

Sarcoidosis inflammatory pattern?

A

Upregulation of CD4+ Th1 cells
↑ IL-2, IFN-g, TNF-a, and monocyte chemotactic factor → monocytes leave circulation and enter peripheral tissues, including skin, where they form granulomas → granulomas have potential to result in end-organ dysfunction

238
Q

Drug-induced sarcoid?

A

■ Hepatitis C patients on treatment (IFN-a, ribavirin)
■ HIV patients on HAART
■ Other meds: TNF-a inhibitors, vemurafenib, ipilimumab, and alemtuzumab

239
Q

Sarcoid Variants?

A

Lupus pernio
Darier-Roussy
Löfgren syndrome
Heerfordt syndrome (“uveoparotid fever”)
Mikulicz syndrome
Blau syndrome
Drug-induced cutaneous sarcoid

240
Q

Lupus pernio is associated with?

A

Chronic sarcoid lung (75%) and upper respiratory tract (50%) disease
Px w/ violaceous (rather than red-brown) papules coalescing into infiltrative plaques; nose, earlobes, cheeks = most common sites; “beaded” appearance along the nasal rim

241
Q

Features of Darier-Roussy, variant of subcutaneous sarcoid?

A

Painless*, firm, deep-seated mobile nodules, Darier-Roussy is a form of subcutaneous sarcoid

242
Q

Heerfordt syndrome vs. Mikulicz syndrome?

A

“Heerfordt syndrome” = Uveitis + parotid gland enlargement + fever + cranial nerve palsy
“Mikulicz syndrome” = enlargement of salivary, lacrimal, and parotid glands

243
Q

Not routinely performed, but what is the Kveim-Siltzbach test?

A

Injecting suspension of sarcoidal spleen into the skin of a patient w/ sarcoidosis → sarcoidal granuloma at injection site

244
Q

Histiocytoses stain positively for?

A

CD1a, S100, and Langerin (CD207) is most specific, stains Birbeck granules

245
Q

Granuloma pattern with diffuse palisading and interstitial, horizontal “tiers” characteristic of?

A

Necrobiosis lipoidica

246
Q

Red tattoos?

A

Mercuric sulfide, aka cinnabar px as Lichenoid dermatitis or pseduo-lymphoma

247
Q

Sarcoidal or foreign body granulomas with needle- shaped or round crystals that are white and birefringent on polarized light?

A

Talc powder (hydrous magnesium silicate)

248
Q

Persistent, soft brown papules in axilla can be due to?

A

Zirconium in antiperspirants

249
Q

Dense neutrophilic infiltrate with
birefringent rhomboidal crystals seen with?

A

Zinc foreign body rxn

250
Q

Non-Birefringent Foreign Body Granulomas?

A

Aluminum, beryllium, zirconium

251
Q

Macrophage stain?

A

Positively w/ CD68 and HAM56

252
Q

Langerhans cell histiocytosis mutation?

A

BRAF V600E activating mutation (50%–60%) → ↑ fibrosarcoma kinase activity → activation of RAS-RAF-MEK-ERK-MAP kinase pathway

253
Q

Histology of Langerhans cell histiocytosis?

A

Dense proliferation of Langerhans cells (with reniform nuclei), regulatory T cells (FoxP3+, CD4+), and eosinophils in papillary dermis, with single and nested LCH cells in the epidermis
■ S100+, CD1a+, Langerin (CD207)+, CD68+

254
Q

Tx for seborrheic-like LCH?

A
  • Mild cutaneous disease:
    Potent topical steroids, spontaneous resolution; diffuse disease: steroids + vinblastine
  • Multisystem LCH: Vinblastine/prednisone for 1 year; other options: cladribine, cytarabine, clofarabine; emerging options: BRAF inhibitors, MEK inhibitors, sorafenib
255
Q

Staining patterns for Non-LCH?

A
  • All are CD68+, +/- Factor XIIIa+
  • All are negative for Langerin
  • S100 is negative in all (except ICH and Rosai-Dorfman)
  • CD1a is negative in all (except ICH)
256
Q

Historically known for intracytoplasmic “ comma-shaped/worm-like” bodies seen with?

A

Benign cephalic histiocytosis

257
Q

Complement deficiencies associated with lupus?

A

C1q/r/s, C2, and C4
Screening test for complement levels? CH50

258
Q

Drug-induced SCLE?

A

HCTZ, terbinafine, TNF-a inhibitors, PPI’s, CCB’s, griseofulvin

259
Q

Biologics that can be used for SLE?

A

Belimumab [monoclonal human antibody that inactivates BLyS causing apoptosis and inhibition of B-cell maturation], anifrolumab

260
Q

Jessner’s lymphocytic infiltrate of skin?

A

Photosensitive eruption, Possibly a variant of LE, appears on head, neck and upper back

261
Q

Dermatomyositis with malignancy associated autoantibodies?

A

TIF1-g (p155) or NXP-2 (p140)
Ovarian + GI CA’s*
Note: p140 in kids, indicates calcinosis cutis and contractures but not malignancy

262
Q

Antisynthetase syndrome is characterized by?

A

○ Antisynthetase autoantibodies (Jo-1, PL-7, PL-12, OJ, EJ)
○Acute disease onset
○Mechanics hands*
○ILD*
○Constitutional symptoms
○Raynaud phenomenon
○Non-erosive arthritis

263
Q

Schirmer test?

A

Whatman paper wick fold over
lower eye, if tear film migrates < 5 mm in 5 minutes = positive test
for Sjogren’s

264
Q

HLA in relapsing polychondritis?

A

HLA-DR4
Autoantibody titers against type II collagen correlate w/ disease activity

265
Q

1 cause of mortality in relapsing polycondritis?

A

Airway collapse and pneumonia

266
Q

MAGIC syndrome?

A

MAGIC = Behçet’s disease + relapsing polychondritis
Mouth And Genital ulcers with
Inflamed Cartilage

267
Q

Felty syndrome?

A

Seropositive RA characterized by neutropenia, splenomegaly, and refractory leg ulcers, resembling PG
↑ Risk of lymphomas/leukemias
Tx: G-CSF, +/- splenectomy

268
Q

Bone feature characteristic of Adult Still’s disease?

A

Carpal ankylosis - limited
range of motion with minimal pain
Life-threatening = Macrophage Activation Syndrome

269
Q

Gluten-free safe foods?

A

rice, oats or corn
‘ROCk’

270
Q

DIF of ‘chicken wire’ appearance in PV versus PF?

A

PV — predominantly in lower epidermis (vs. PF)
PF — chicken-wire pattern evident in more superficial layers

271
Q

Another name for dariers?

A

Keratosis follicularis

272
Q

Drug-induced blistering?

A

Linear IgA bullous dermatosis: vancomycin
Pemphigus: penicillamine, captopril
Bullous pemphigoid: diuretics (esp furosemide)

273
Q

Anti-Jo1 and Anti-PL7?

A

Anti-synthetase syndrome = myositis, mechanic’s hands, Raynaud’s and severe ILD

AliKhan Derm (13 decks)

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