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AliKhan Derm > Infectious disease Chapter 5 > Flashcards

Infectious disease Chapter 5 Flashcards

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Dermatology Board Prep flashcards
1
Q

Phenolic glycolipid-1 is important in identification of?

A

Mycobacterium Leprae

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2
Q

In patients with hepatitis C viral infections treated with interferon, appearance of what skin disease has been most commonly reported?

A

Sarcoidosis

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3
Q

Components in HPV important for binding/
entering epithelial cells?

A

L1 (major structural protein) and L2 (minor structural protein)

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4
Q

What proteins are responsible for HPV DNA replication and keratinocyte immortalization?

A

Early proteins E1–E7

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5
Q

What HPV proteins are expressed in superficial epidermis and encode structural proteins required for virion formation?

A

Late proteins (L1–L2)

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6
Q

What strains are in Butchers warts?

A

HPV-7 and HPV-2

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7
Q

HPV high-risk mucosal subtypes?

A

E6 and E7 in high-risk mucosal subtypes are oncoproteins.
- E6 -> ubiquitin-mediated p53 destruction -> decrease apoptosis, increase replication, increase mutations
- E7 -> binds RB -> loss of inhibition of E2F transcription factor -> increase expression of genes important for DNA replication

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8
Q

Which genus of HPV is mucosal , cutaneous and which is epidermal

A

Genus alpha (most of the mucosal and cutaneous HPV types) and beta (epidermodysplasia verruciformis [EV]- associated HPV types)

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9
Q
A
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10
Q

Palmar/plantar warts, HPV?

A

HPV-1, HPV-2, -4*, -27, and -57. Vs flat/plane (3,10,28)
Histology: “church spire” papillomatosis + hyperkeratosis, acanthosis (with elongated rete ridges), hypergranulosis, koilocytosis (granular layer); h dermal vessels

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11
Q

Flat/plane warts, HPV?

A

HPV-3, -10, -28, and -29.

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12
Q

Ridged warts retain normal dermatoglyphics strain?

A

HPV-60

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13
Q

Autosomal recessive disorder where host has susceptibility to genus b HPV types (HPV-3, -5, -8, -9, -12, -14, -15, -17, -19–25, -36–38, -47, -49)?

A

Epidermodysplasia verruciformis; mutations in TMC6 (EVER1) and TMC8 (EVER2) (encode transmembrane proteins in endoplasmic reticulum, which interact with Zn transporter 1 -> decreases Zn intracellularly -> decreases Zn-associated transcription factors); Acquired form may be seen in HIV

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14
Q

What is WHIM syndrome?

A

Immunodeficiency caused by a CXCR4 mutation— Autosomal dominant
Warts
Hypogammaglobulinemia
Infections (bacterial)
Myelokathexis (= a defective release of BM cells into the peripheral blood; causing neutropenia)

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15
Q

What is WILD syndrome?

A

Warts
Immunodeficiency
Lymphedema
Dysplasia

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16
Q

Dew drop on a rose petal is seen in:

A

Chicken pox

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17
Q

What is Buschke-Lowenstein tumor?

A

HPV-6 and HPV-11, cauliflower-like tumors that infiltrate deeply on external genitals and perianally

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18
Q

Red smooth plaque on glabrous penis/vulva that is HSIL or SCCIS; increased risk of progression to invasive SCC; has high-risk HPV types, called?

A

Erythroplasia of Queyrat

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19
Q

Epithelioma cuniculatum?

A

Is a keratinizing carcinoma the sole, HPV-2, -11, and -16

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20
Q

Heck’s disease?

A

HPV-13 and 32

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21
Q

How does HSV evade the immune system?

A

HSV decreases expression of CD1a by antigen-presenting cells [APCs], increases Langerhans cells apoptosis, decreases TLR signaling, interferes w/ MHC class I/II); CD8+ T cells and TLRs control infection

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22
Q

Herpes gladiatorum?

A

HSV-1 infection 2° to athletic contact, classically on lateral neck, side of face and forearm.

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23
Q

Branching dendritic corneal ulcer?

A

Ocular HSV

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23
Q

Biologic associated with increased risk of HSV encephalitis?

A

Natalizumab - indicated for Crohn’s + MS

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24
Q

Bodies seen in HSV?

A

Cowdry A inclusions = eosinophilic inclusion
bodies

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25
Q

Tx of acyclovir-resistant HSV?

A

Foscarnet or cidofovir

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26
Q

HHV-3 causes?

A

Varicella (chickenpox) and Herpes zoster (shingles)

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27
Q

Death in disseminated herpes zoster immunocompromised patients?

A

SIADH development

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28
Q

Which CN is affected by herpes zoster that results in hearing impairment or deafness?

A

CN-VIII - Vestibulocochlear nerve

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29
Q

Ramsay Hunt syndrome affects which nerve?

A

Disease of the geniculate ganglion of facial nerve (CN-VII). Causing ipsilateral facial nerve paralysis, dry mouth/ eyes, anterior two thirds of the tongue taste loss, and auditory (e.g., deafness and tinnitus).

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30
Q

Hutchinson’s sign in herpes zoster ophthalmicus is?

A

Involvement of the side and tip of nose indicates disease of the external division of the V1 nasociliary branch

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31
Q

Reye’s syndrome?

A

Encephalitis + fatty liver, with
concomitant aspirin use

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32
Q

What type of HHV is EBV?

A

HHV-4; Causes infectious mononucleosis, oral hairy leukoplakia, hydroa vacciniforme, Gianotti-Crosti syndrome, genital ulcers, Burkitt’s lymphoma, NK/T-cell lymphoma, post- transplant lymphoproliferative disorder, and nasopharyngeal carcinoma.

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33
Q

How is EBV transmitted?

A

Saliva and blood. EBV infects B cells via CR2/CD21 receptors.

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34
Q

Gianotti-Crosti syndrome and papular-purpuric glove and socks syndrome due to what virus?

A

More common w/ parvovirus B19, may occur in setting of Epstein-Barr virus (EBV) infection

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35
Q

What does Monospot test detect?

A

IgM heterophilic antibodies which are often present in EBV infection and may persist for months after infection; Positive heterophilic antibody (>1:40) and >10% atypical lymphocytes suggests acute infection

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36
Q

What is HHV-5?

A

Cytomegalovirus

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37
Q

First -line for CMV?

A

Ganciclovir (IV) and valganciclovir (oral)

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38
Q

HHV-6?

A

Roseola infantum
assoc. w/ Pityriasis Rosea, Rosai-Dorfman and DRESS syndrome

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39
Q

DRESS syndrome associated with?

A

HHV-6, EBV, CMV and HHV-7

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40
Q

HHV-8 etiologic factor for?

A

Kaposi sarcoma, multicentric Castleman disease, primary effusion lymphoma, and paraneoplastic pemphigus

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41
Q

S/E of smallpox vaccine?

A

LAD, ocular vaccinia, generalized vaccinia, single crusted papule at vaccination site, vesiculopustular, urticarial/morbilliform eruption, eczema vaccinatum (patients with atopic dermatitis, Darier, or Hailey- Hailey disease), EM/SJS, postvaccinial CNS disease, and progressive vaccinia (immunosuppressed patients; can cause death)

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42
Q

Cowpox vs. Orf?

A

Cowpox - Orthopox
Orf - Parapox

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43
Q

Orf paradox 6 lesions stages?

A

1- Maculopapular (umbilicated)
2- Targetoid
3- Acute (weeping nodule)
4- Regenerative (nodule w/ thin crust and black dots)
5- Papillomatous
6- Regressive (crust overlying resolving lesion) then self-resolves

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44
Q

Histology of Orf?

A

Intracytoplasic eosinophilic inclusion bodies, keratinocyte vacuolization, epidermal necrosis, finger-like acanthosis

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45
Q

What are Milker’s nodules?

A

“Pseudocowpox” papules at the site of contact (usually muzzles of calves and teats of cows

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46
Q

Chikungunya virus?

A

Single-stranded +sense RNA virus belonging to Togaviridae family

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47
Q

Chikungunya virus transmitted by?

A

Aedes aegypti

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48
Q

Chikungunya virus px?

A

High fever, marked joint symptoms, “Chikungunya” is an African word for “crooked/bent joints”, and neuropathic acral findings.
Skin: morbilliform eruption, mucosal aphthous-like ulcers, postinflammatory pigmentation of face/extremities

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49
Q

Zika virus?

A

ssRNA virus within the Flaviviridae family

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50
Q

Zika virus transmitted by?

A

A. aegypti and A. albopictus mosquitos

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51
Q

Classic cutaneous manifestation of Hepatitis B?

A

Polyarteritis nodosa. Also, Urticarial vasculitis, Urticaria, Erythema multiforme, Porphyria cutanea tarda, Pruritus

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52
Q

HIV is?

A

ssRNA in retroviridae family (HIV-1 > HIV-2 in causing AIDS)

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53
Q

Tx of choice for Erythema elevatum diutinum?

A

Dapsone

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54
Q

HIV most at risk of developing which carcinoma?

A

BCC > SCC > melanoma

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55
Q

HIV-associated disorders CD4+ <50?

A

Giant Mollusca, MAC, CMV-perianal ulcers, Large non-healing mucocutaneous HSV, papular pruritic eruption

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56
Q

HIV-associated disorders CD4+ <250?

A

Bacillary angiomatosis, Eosinophilic folliculitis, Seborrheic dermatitis, Cryptococcosis, Histolasmosis, Coccidioidomycosis, Botrymycosis, extensive Mollusca, Disseminated HSV

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57
Q

HIV-associated disorders CD4+ <500?

A

Kaposi sarcoma, Oropharyngeal candidiasis, herpes zoster, psoriasis, eruptive atypical melanocytes nevi

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58
Q

filler types for HIV-associated facial lipoatrophy?

A

Poly-L-lactic acid and calcium hydroxylapatite are approved for tx

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59
Q

Most common antiretroviral to cause DRESS?

A

Abacavir, others include: efavirenz, nevirapine, TMP-SMX, and dapsone

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60
Q

HLA associated with Abacavir HSRxn?

A

HLA-B*5701, screen patients before initiating therapy

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61
Q

Bullous impetigo is due to?

A

Phage group II (types 55* and 71*) S. aureus produces exfoliatoxins A and B (ETA and ETB) cleaveing desmoglein 1 causing subcorneal/ intragranular acantholysis

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62
Q

Acquired hypertrichosis lanuginosa is associated with?

A

Lung cancer, Colon cancer, Breast cancer and Plamoplanter keratoderma

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63
Q

The Brunsting- perry variant of cicatricial pemphigoid:

A

Is localized to the head and neck

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64
Q

Langerin stain AKA?

A

CD207 NOT CD117 (mast cells)

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65
Q

Tx of widespread Bullous impetigo?

A

Oral b-lactamase–resistant PCN or first- generation cephalosporin (CSN; clindamycin or clarithromycin if PCN-allergic)

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66
Q

Non-bullous impetigo caused by?

A

S. pyogenes serotypes 1, 4, 12, 25, and 49. Poststreptococcal glomerulonephritis in 5%.

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67
Q

Name given to superficial form of S. aureus folliculitis?

A

Bockhart’s impetigo: small papulopustules on erythematous background

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68
Q

Name given to deep form of S. aureus folliculitis?

A

“sycosis barbae”: large red papulopustules +/– plaques with small pustules

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69
Q

Tx for pseudomonal folliculitis, from poorly chlorinated hot
tubs?

A

self-resolves; ciprofloxacin if severe

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70
Q

Gram -ve folliculitis tx?

A

Isotretinoin

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71
Q

Primary site for furuncles?

A

Head and neck

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72
Q

Definition of carbuncle?

A

Collection of furuncles, often deeper w/ multiple draining sinuses; most often affects thick skin of posterior neck, back, and thighs. Tx: doxycycline, TMP-SMX, and clindamycin.

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73
Q

MRSA pathogenesis?

A

Resistance: specific mecA genes* (from SCCmec types I–VI, mobile genetic elements) encodes mutated penicillin- binding protein, PBP2a* decreasing affinity for b-lactams

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74
Q

Virulence factor in community-associated MRSA?

A

Panton-Valentine leukocidin (PVL) virulence factor

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75
Q

Pathogenesis of Staphylococcal toxic shock syndrome (TSS)?

A

Production of toxic shock syndrome toxin-1 (TSST-1) by certain strains of S. aureus. TSST-1 acts as superantigen, binding to Vb region of TCR and class II MHC on APCs. Nonspecific activation of T cells 1 cytokine storm (increased TNF-a, IL-1, IL-6, TLR2, and TLR4)

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76
Q

Toxic shock syndrome (TSS)? tx?

A

b-lactamase–resistant antibiotics, clindamycin (suppresses toxin production)

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77
Q

What’s Pyomyositis?

A

S. aureus infection of skeletal muscle; usually have predisposing factors (immunosuppression, diabetes, trauma, and intravenous drug abuse [IVDA])

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78
Q

How to dx Pyomyositis?

A

MRI

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79
Q

What’s Botryomycosis?

A

Deep granulomatous and suppurative infection most frequently caused by S. aureus

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80
Q

Splendore-Hoeppli phenomenon?

A

Seen in histology of botromycosis. Histology: large granules w/ basophilic center (non-filamentous bacteria) and eosinophilic/hyaline periphery (Splendore-Hoeppli phenomenon; composed of IgG and C3 deposits), granules are surrounded by abscess and granulomatous inflammation, granules are PAS+, Giemsa+, and Gram+

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81
Q

Ecthyma is?

A

Deep variant of impetigo; most common in children; caused by S. pyogenes
p/w few vesicopustules, most commonly on legs n develop into “punched-out” ulcers with purulent base and hemorrhagic crust n slowly self-resolves w/ scarring

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82
Q

Tx for Perianal streptococcal skin infection?

A

Oral cefuroxime (1st-line) or PCN (slightly less effective)

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83
Q

Erythrasma is caused by?

A

Corynebacterium minutissimum (Gram- positive filamentous rod) vs. Corynebacterium tenuis seen in Trichomycosis axillaris

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84
Q

Erythrasma fluoresces “coral red” w/ Wood lamp due to?

A

Coproporphyrin III production

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85
Q

Pitted keratolysis is caused by?

A

Kytococcus sedentarius

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86
Q

Microbiology of Actinomyces israelii?

A

Gram-positive, non-acid fast, and anaerobic filamentous bacteria

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87
Q

Microbiology of Nocardiosis?

A

Gram-positive, weakly acid-fast, filamentous bacteria, AFB+, Fite > Ziehl-Neelsen and GMS+

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88
Q

Microbiology of Bacillus anthracis?

A

Gram-positive, spore-forming rod

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89
Q

Px of Bacillus anthracis?

A

“malignant pustule” that drains serosanguinous fluid, vesicle ulcerates to form painless/black/necrotic eschar w/ satellite vesicles and edema

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90
Q

The green in green nail syndrome?

A

Pyocyanin pigment production

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91
Q

Blue-green purulent exudate, “moth-eaten” appearance to skin surface, with “mousy” or “grape-like” odor?

A

Pseudomonal pyoderma

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92
Q

Cutaneous lesion indicative of P. aeruginosa septicemia?

A

Ecthyma gangrenosum

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93
Q

Dense neutrophilic infiltrate, and extra- and intracellular organisms (within endothelial cells—Rocha-Lima inclusions) seen w/ Warthin-Starry stain is?

A

Bacillary angiomatosis and verruga peruana

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94
Q

Culturing Bartonella?

A

B. bacilliformis—PCR, culture, immunologic testing
B. henselae and B quintana—PCR assay (rapid, sensitive), serologies (sensitive, specific; not for B. quintana), chocolate agar culture (slow!)

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95
Q

Typhus group?

A

R. typhi and R. prowazekii

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96
Q

Scrub typhus?

A

R. tsutsugamushi

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97
Q

Spotted fever group?

A

R. rickettsii, R. conorii, R. akari, R. africae, R. japonica, and R. australis

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98
Q

Tx for Carrion’s disease?

A

= Bartonellosis, 1st-line Chloramphenicol plus b-lactam antibiotic

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99
Q

Mediterranean spotted fever vector?

A

Rhipicephalus sanguineus (brown dog tick)

100
Q

Tx for pregnant woman with RMSF?

A

Chloramphenicol is treatment of choice for pregnant patients but risk of “gray baby syndrome”

101
Q

Rickettsialpox vector?

A

Liponyssoides sanguineus (house mouse mite). Px w/ papulovesicle at bite site then progresses to eschar then widespread cutaneous eruption

102
Q

Epidemic typhus vs. Endemic typhus vector?

A

Epidemic - Pediculus humanus var. corporis (human body louse)
Endemic - Xenopsylla cheopis (Oriental rat flea)

103
Q

p/w Fever + similar systemic symptoms as spotted fever group + erythematous macules and papules initially on axillae?

A

Typhus group always starts in axilla. This px is specifically Endemic typhus

104
Q

Tx for typhus?

A

Doxycycline in all types of typhus

105
Q

Scrub typhus AKA?

A

Orientia tsutsugamushi transmitted by the Larval trombiculid mites* “chiggers”

106
Q

Most common in Southern United States; p/w fever, myalgias, thrombocytopenia, leukopenia, and maculopapular or petechial rash (30%–40%) most commonly on trunk, extremities?

A

Human monocytic ehrlichiosis (HME)
(Ehrlichia chaffeensis) <– this is a rickettsia-like bacteria

107
Q

Reservoir for Human monocytic ehrlichiosis (HME) (Ehrlichia chaffeensis)?

A

white-tailed deer (no eschar seen)

108
Q

Ixodes scapularis and Ixodes pacificus (same as Lyme and Babesiosis) also transmit?

A

Human granulocytic anaplasmosis (Anaplasma phagocytophilum)

109
Q

Q fever AKA?

A

Coxiella burnetii - transmitted by sheep and cattle

110
Q

Main virulence factor in mennigiococcemia?

A

polysaccharide capsule* and the endotoxin* causes septic shock and purpura fulminans

111
Q

Neisseria meningitides (gram-negative diplococcus) Quadrivalent vaccine protects against?

A

Types A/C/Y/W-135

112
Q

Microbiology of Brucellosis (Malta fever)?

A

Gram-negative coccobacillus

113
Q

What can you get from infected horses, mules, or donkeys?

A

Glanders caused by gram-negative bacillus, Burkholderia mallei.

114
Q

What are the 4 forms of Glanders?

A

1- “Localized” - hemorrhagic, ulcerative papulopustule at inoculation site
2- “Chronic” - multiple soft tissue nodules “farcy buds”* on skin overlying lymphatics
3- “Septicemic form” - mortality rate 95% without treatment and 50% w/ treatment
4- “Pulmonary form—mortality similar to septicemic form

115
Q

Gram-negative bacillus Burkholderia pseudomallei causes?

A

Melioidosis caused by direct contact w/ contaminated water or soil

116
Q

Risk factors of Melioidosis?

A

Diabetes, CKD, immunosuppression, and IV drug abuse

117
Q

Chronic granulomatous infection as a result of the inability of macrophages to kill phagocytosed E. coli, usually in immunocompromised, causes?

A

Malakoplakia

118
Q

Malakoplakia usually affects what areas?

A

Most commonly affects GU tract; may affect skin of perianal/genital region (ulcerated abscesses and soft polypoid lesions)

119
Q

Michaelis-Gutmann bodies seen with granulomatous malakoplakia around the “von Hanzemann cells” stain with?

A

Von Kossa, PAS, Perls, Giemsa
Von Hanzemann cells stain CD68, lysozyme, alpha-1-antitrypsin

120
Q

What are von Hansemann cells vs. Michaelis-Gutmann bodies?

A

von Hansemann cells are large macrophages w/ eosinophilic cytoplasm and Michaelis-Gutmann bodies: round, laminated, calcified basophilic intracytoplasmic inclusions; comprised of incompletely killed bacteria within calcified phagolysosomes

121
Q

Tularemia microbiology?

A

Gram-negative coccobacillus

122
Q

Tx for Tularemia (Francisella tularensis)?

A

Streptomycin

123
Q

H. influenza microbiology?

A

Gram-negative coccobacillus

124
Q

What is Rhinoscleroma?

A

Chronic granulomatous infection of nose and upper respiratory tract

125
Q

Microbiology of Rhinoscleroma?

A

Gram-negative rod, non-motile

126
Q

Mikulicz cells?

A

Seen in Rhinoscleroma that is caused by klebsiella = macrophages with phagocytose bacteria

127
Q

Phases of Rhinoscleroma?

A

Three clinical phases:
○Catarrhal phase - rhinitis, obstruction from soft tissue edema
○Granulomatous/infiltrative phase - granulomatous nodules in upper respiratory tract, epistaxis, dysphonia, anesthesia of soft palate, and Hebra nose
○Sclerotic phase - extensive scarring requires tracheotomy and nasal reconstruction

128
Q

Hx of Rhinoscleroma?

A

Dense pan-dermal infiltrate of Mikulicz cells containing bacteria (seen w/ Warthin-Starry, Giemsa) and Russell bodies

129
Q

Rat-bite fever (“Haverhill fever”) is caused by?

A

Streptobacillus moniliformis

130
Q

Classic triad of rat bite fever?

A

Paroxysmal fever, migratory polyarthritis,
and acral rash

131
Q

Gram-negative bipolar bacillus?

A

Yersinia pestis –> Plague shows characteristic “safety pin” appearance of bacteria on gram or giemsa stain

132
Q

Most commonly affects men >40 years old who have predisposing factors: liver disease (hemochromatosis, cirrhosis, or alcoholism), diabetes?

A

Vibrio vulnificus from shellfish

133
Q

Vibrio vulnificus px with?

A

Hemorrhagic bullae; Tx: doxycycline

134
Q

Organisms from dog bites?

A

Pasteurella multocida, Pasteurella canis, or Capnocytophaga canimorsus

135
Q

Organism from cat bites?

A

P. multocida

136
Q

Organisms from human bites?

A

Eikenella corrodens (a/w chronic
infections), S. aureus (a/w severe infections), Peptostreptococcus, Enterococcus, and Bacteroides

137
Q

Features of second stage of Lyme disease “Early disseminated”?

A

Early disseminated stage is a result of hematogenous spread of spirochetes if initial phase untreated
♦Borrelial lymphocytoma strongly a/w B. afzelii* and B. garinii* p/w firm, plum-colored tender nodule on earlobes (children), or nipple/areola (adults)
♦Arthritis (60%): monoarticular (knee)
♦Neurologic abnormalities (10%): Bell’s palsy
♦Cardiac complications (5%): AV block, myopericarditis

138
Q

Features of third stage of Lyme disease “Chronic”?

A

♦Acrodermatitis chronica atrophicans strongly a/w B. afzelii* and B. garinii* occurs months to years after initial infection in middle-aged women; two clinical phases: erythematous plaques with “doughy”/ swollen skin on distal extremities (early phase; easily treated/reversible) n progresses to atrophic “cigarette-paper” skin w/ telangiectasias and subcutaneous fibrous nodules overlying joints
♦Other: encephalopathy, neuropathy, and chronic arthritis

139
Q

What are the non-venereal treponematoses?

A

Yaws, pinta, and endemic syphilis (bejel)
All caused by Treponema pallidum subspecies

140
Q

Yaws is caused by?

A

T. pallidum pertenue

141
Q

Yaws is characterized by how many stages?

A

1° stage: indurated, red, painless papules that enlarges to 1–5 cm, then ulcerates (“Mother Yaw”); occurs at site of inoculation; lower extremities most common
2° stage: multiple, smaller, symmetrical, widespread eruption w/ “daughter yaws” face and intertriginous most common; hyperkeratotic plaques on soles (“crab yaws”); osteoperiostitis, polydactylitis, periosteal thickening
3° stage: necrotic and ulcerative abscesses that heal with severe/deforming scars; palmoplantar keratoderma; bony damage
“Skin + bone disease” “Yaws = Jaws”

142
Q

Pinta is caused by?

A

T. pallidum carateum

143
Q

Pinta stages?

A

1° stage: legs w/ papules surrounded
by red halo; enlarges to 10 cm plaques
2° stage: smaller scaly papules and psoriasiform plaques erupt (“pintids”) and change in color from red to blue to brown
to gray/black
3° stage: symmetric vitiligo-like lesions over bony prominences w/ atrophic epidermis; palmoplantar hyperkeratosis;

144
Q

Endemic syphilis/“bejel” is caused by?

A

T. pallidum endemicum (mucosal disease “ENDemic syphilis attacks ENside surfaces”)

145
Q

Early congenital syphillis features <2 years old?

A

Snuffles, perioral fissures, dactylitis, Parrot’s pseudoparalysis, syphilitic pneumonitis, epiphysitis, marasmic syphilis, pemphigus syphiliticus, and hepatitis

146
Q

Late congenital syphillis features >2 years old?

A

Keratitis, mulberry molars, Hutchinson’s teeth (notched/peg-shaped incisors), rhagades (linear scars at angles of mouth), saddle nose, Higoumenakis syndrome, Clutton’s joints, optic atrophy, corneal opacities, and eighth nerve deafness

147
Q

Treponemal and non-treponemal serologic studies?

A

Treponemal - FTA-ABS, MHA-TP, FTA-ABS-19S-IgM, SPHA
Non-treponemal - RPR, VDRL; IgG/IgM to cardiolipin

148
Q

First serologic test to become positive in syphilis?

A

RPR and VDRL

149
Q

What stains spirochetes?

A

Warthin-Starry stain

150
Q

What “bodies” are seen in chlamydia?

A

“Gamma-Favre bodies” in macrophages on Giemsa stain

151
Q

What “bodies” are seen in Granuloma inguinale?

A

“Safety pin” Donovan bodies on Wright or Giemsa stain of smears.
Granuloma inguinale is caused by intracellular Gram-negative bacillus

152
Q

What is TB verruca cutis?

A

Reinfection via inoculation, in patients w/ previous infection w/ moderate to high immunity; #1 form of cutaneous TB; warty/verrucous, growing papule may heal over years

153
Q

Hematogenous dissemination from lung, most often in immunosuppressed patients; pinpoint blue-red crusty papules n small scars

A

Acute miliary TB

154
Q

Hansen’s disease = ?

A

Leprosy

155
Q

Microbiology of leprosy?

A

Obligate intracellular, weakly acid-fast bacillus that parasitizes macrophages and Schwann cells

156
Q

Leprosy cultures on?

A

Cannot be cultured in vitro n must be cultivated in mouse footpads or in armadillos

157
Q

What is the Ridley-Jopling scale?

A

Divides leprosy into two polar forms (Lepromatous/LL [Th2 response] and Tuberculoid/ TT [Th1 response]), and three borderline forms (BL, BB, and BT)

158
Q

Severe necrotizing vasculitis w/ thrombosis in patients from Mexico and South America with diffuse lepromatous leprosy is called?

A

Lucio phenomenon

159
Q

Names of the 2 reactions states in leprosy?

A

Type 1 (reversal reaction; Th1) and Type 2 (erythema nodosum leprosum; Th2)

160
Q

Ulceration of existing leprosy lesions and preferential targeting of nerves is called?

A

A type 1 reversal reaction, Th1, cell-mediated reaction (in BL).
Tx: Prednisone

161
Q

Multisystem vasculitis and EN-like lesions scattered at previously unaffected leprosy skin sites is called?

A

Type 2, erythema nodosum leprosum reaction, highest risk with BL and LL patients receiving antimicrobial therapy; treatment = thalidomide

162
Q

Leprosy type that has a grenz zone?

A

Lepromatous leprosy LL

163
Q

Culturing M. marinum?

A

M. marinum grows best at 31°C (3 weeks required for growth), as opposed to the usual 37°C for most other mycobacteria

164
Q

Rapid growing mycobacteria?

A

Mycobacterium fortuitum, chelonae, and abscessus

165
Q

Nonfluorescent dermatophytes?

A

T. mentagrophytes, T. rubrum, M. nanum, T. megninii, T. gypseum, and T. verrucosum

166
Q

Favus?

A

T. schoenleinii

167
Q

Kerion caused by?

A

M. canis, T. verrucosum, T. mentagrophytes, and T. tonsurans

168
Q

Majocchi granuloma and Tinea corporis caused by?

A

T. rubrum

169
Q

What causes Tinea barbae?

A

T. verrucosum, T. mentagrophytes,
T. tonsurans, and T. rubrum

170
Q

Tinea cruris caused by?

A

T. rubrum, E. floccosum, and
T. interdigitale

171
Q

What causes vesiculobullous tines pedis?

A

T. mentagrophytes

172
Q

What causes black piedra?

A

Piedra hortae

173
Q

What causes white piedra?

A

Trichosporon asahii (most strongly linked to white piedra; may cause disseminated disease in immunocompromised patients), T. ovoides, T. inkin, and T. cutaneum

174
Q

Tinea nigra is caused by?

A

Hortaea werneckii

175
Q

Sporotrichoid spread mnemonic?

A

“No SALT”
Nocardia, Sporotrichosis, Atypical mycobacteria, Leishmaniasis, Tularemia

176
Q

Cigar-shaped budding yeast?

A

Sporotrichosis from soil; Tx of choice: Itraconazole

177
Q

“pop bead” or “chain of coins” appearance seen in?

A

Lobomycosis with species: Lacazia (Loboa loboi)

178
Q

Px of Lobomycosis?

A

Keloid-like verrucous fibrotic nodules that can ulcerate; ear helix #1 site; men>women

179
Q

Actinomycetoma different grain colors?

A

white grains > N. asteroides
red grains > A. pelletieri
yellow grains > Streptomycin somaliensis

180
Q

Actinomycetoma tx?

A

Streptomycin/amikacin 1 TMP-SMX

181
Q

Eumycetoma tx?

A

Surgical debridement

182
Q

Fonsecaea pedrosoi causes?

A

Chromoblastomycosis

183
Q

Pseudoepitheliomatous hyperplasia (PEH), granulomatous dermal inammation with medlar bodies (pigmented muriform cells, “copper pennies”) is seen in?

A

Fonsecaea pedrosoi

184
Q

Diseases with parasitized macrophages?

A
185
Q

tuberculoid granuloma with
intracellular 2 to 4 mm yeast in histiocytes (looks like leishmaniasis, but see yeast have surrounding halo and are more evenly distributed throughout histiocyte cytoplasm; lacks “marquee sign” and kinetoplast seen in?

A

Histoplasmosis; geographically: Ohio and Mississippi River valley from inhaled bird and bat droppings

186
Q

Granulomatous dermal inflammation
with unipolar budding yeast (8–18 mm) (broad-based
buds

A

Blastomycosis; Geography: Eastern USA, Great Lakes, Ohio, and Mississippi River valleys

187
Q

Coccidioidomycosis geography?

A

Desert Southwest United States (esp. Central Valley/San Joaquin Valley, California), Mexico, and Central America

VS. Paracoccidioidomycosis which is SOUTH America and Mexico

188
Q

Microscopy of coccidioidomycosis?

A

Large (up to 100 mm) spherules
containing endospores; also has PEH and granulomatous inflammation

189
Q

Px of Coccidioidomycosis?

A

Face #1 site; verrucous nodules or papules (can be molluscum-like), pustules, abscesses, or ulcerative lesions but Pulmonary manifestations are most common presentation

190
Q

Microscopy: PEH, granulomatous dermal inflammation w/ multipolar budding yeast, mariner’s wheel or Mickey Mouse?

A

Paracoccidioidomycosis

191
Q

Paracoccidioidomycosis px?

A

Granulomatous ulcerative oropharyngeal and perioral involvement in 70% of adults; cutaneous lesions can be contiguous, hematogenous, or via inoculation; clinical appearance of ulcers with infiltrated borders (verrucous) and hemorrhagic dots, and associated LAD (can be massive)

192
Q

Candida species in chronic paronychia?

A

C. parapsilosis

193
Q

Candida species with fluconazole resistance?

A

C. glabrata and C. krusei

194
Q

Candida species with oropharyngeal candidiasis in HIV patients?

A

C. dubliniensis

195
Q

Candida microscopy?

A

KOH = yeast and pseudohyphae

196
Q

What allows candida to adhere to mucosal surfaces?

A

Chitin, mannoprotein, and glucan

197
Q
A

“Median rhomboid glossitis” caused by mucocutaneous candida

198
Q
A

“erosio interdigitalis blastomycetica” caused by candida usually affects third web space of fingers; also fourth web space of toes

199
Q

Microscopy: single-celled sphere with a double cell wall and thick capsule (“halo” appearance), may have one or more buds (blastoconidia); collections of organisms look like soap bubbles is?

A

Cryptococcosis; C. neoformans and C. gattii

200
Q

Stains for cryptococcosis?

A

India ink, PAS, mucicarmine, GMS, and Fontana-Masson

201
Q

Virulence factor for cryptococcosis?

A

Glucuronoxylomannan polysaccharide capsule

202
Q

Septate hyphae with 45° angle
branching?

A

Aspergillosis and Fusarium

203
Q

Most common species of Aspergillosis?

A

Aspergillus fumigatus most common
A. flavus second most common
A. niger causes otomycosis

204
Q

Most common fungus cultured in burn patients?

A

Fusarium solani

205
Q

What can be acquired by inhalation or possibly abrasions with bamboo rat exposure as a risk factor?

A

Penicilliosis
* Species: P. marneffei is only pathogenic species
* Geography: Southeast Asia

206
Q

Penicilliosis lesions?

A

Papules with central necrosis and molluscum-like lesions; face, arms, and
trunk

207
Q

Broad ribbon-like nonseptate hyphae with 90° angle branching?

A

Zygomycosis i.e. mucormycosis

208
Q

Phaeohyphomycosis is due to?

A

Dematiaceous (pigmented) fungi: Exophiala jeanselmei

209
Q

Hyphae are pigmented/brown, and stain positive with Fontana-Masson?

A

Phaeohyphomycosis

210
Q

Introduced into skin via trauma in contaminated water. Microscopy shows organisms with a morula-like appearance on H&E is?

A

Protothecosis
* Species: Prototheca wickerhamii, not a fungus but an algae. Px: olecranon bursitis

211
Q

Very large, up to 300 mm sporangia
containing trophozoites in dermis, is most likely?

A

Rhinosporidiosis

212
Q
A

Rhinosporidiosis px with slow-growing friable, red-purple, soft, lobulated, mucosal polyps, particularly on nose (associated with epistaxis), and conjunctivae in young men

213
Q

Dermatobia hominis, human botfly causes?

A

Myiasis

214
Q

Vector for leishmaniasis?

A

Sandflies, Phlebotomus (old world) or Lutzomyia (new world)

215
Q

New World leishmaniasis?

A

L. mexicana, L. amazonensis, L. braziliensis (mucocutaneous)

216
Q

Most common agent in diffuse cutaneous leishmaniasis, usually in immunocompromised?

A

L. amazonensis (Americas), L. aethiopica (Africa)

217
Q

What is kala-azar?

A

Visceral leishmaniasis, old > new world most commonly L. donovani (India, Sudan, Bangladesh; most common cause in adults), L. infantum (Europe; often a/w HIV), L. chagasi

218
Q

Kala-azar or black fever will present with?

A

Specific: papules, ulcers at bite site
Non-specific: purpura, hyperpigmentation (“black fever”), kwashiorkor changes (brittle hair
w/ discoloration), purpura

219
Q

Leishmaniasis culture?

A

Novy-McNeal-Nicolle medium
PCR is most sensitive and specific test

220
Q

Lesions arising up to 20 years after presumed recovery from untreated visceral leishmaniasis as nodules, verrucous papules, or hypopigmented macules, is?

A

Post-kala-azar dermal leishmaniasis

221
Q
A

“Marquee sign” = amastigotes with kinetoplasts are arrayed around periphery of parasitized histiocyte cytoplasm

222
Q

Leishmaniasis tx?

A

■ Cutaneous and mucocutaneous leishmaniasis: pentavalent antimony (e.g., sodium stibogluconate), miltefosine, pentamidine, intralesional 0.2% ciprofloxacin 1 long-pulsed Nd:YAG
■ Visceral leishmaniasis: amphotericin B (ToC)

223
Q

Trypanosomiasis is caused by?

A

T. brucei gambiense - West Africa
T. brucei rhodesiense - East Africa
Vector: tsetse fly (Glossina)

224
Q

What is trypanids?

A

Erythematous, urticarial or macular diffuse eruptions [6–8 weeks] seen in Trypanosomiasis

225
Q

Trypanosomiasis tx?

A

Suramin or pentamidine if early Melarsoprol (E. African) or eflornithine (W. African) if CNS involvement

226
Q

Ancylostoma braziliense cause?

A

Cutaneous larva migrans

227
Q

Strongyloides stercoralis causes?

A

Larva current, moves 5–10 cm/hr, (cutaneous larva migraines moves slower 1-3cm/hr

228
Q

Loeffler’s syndrome is?

A

= chronic strongyloidiasis which affects
lungs and GI tract and eosinophilia

229
Q

Simulium fly, leopard skin, onchocercomas, causes?

A

Onchocerciasis (“River blindness”)

230
Q

In Onchocerciasis, “River blindness”, if given diethylcarbamazine and an itchy eruption develops shortly after giving med in infected patient, is called?

A

Mazzotti reaction

231
Q

Visible worms in adult eyes is called?

A

Loiasis

232
Q

Chronic—granulomatous reaction in lymphatics causing lymphedema, elephantiasis, hydrocele causes?

A

Filariasis

233
Q

Edwardsiella lineata (sea anemone) and Linuche unguiculata (thimble jellyfish cause?

A

Seabather’s eruption

234
Q

Schistosoma, during the cercarial stage (snails are a vector) cause?

A

Swimmer’s itch, “cercarial dermatitis”

235
Q

Primary dermatologic manifestation is periorbital edema (as a result of type I allergic reaction) and petechiae during parasite migration (esp. splinter hemorrhages) with peripheral eosinophilia and IgE are clues; muscle biopsy is diagnostic are indicative of?

A

Trichinosis

236
Q

What can you get by eating raw sushi?

A

Gnathosomiasis

237
Q

Gnathosomiasis px as?

A

GI symptoms + fever early on;
nodular migratory panniculitis

238
Q

Free-living amoeba that can cause chronic ulcers?

A

Acanthomoeba

239
Q

Free-living amoeba that can cause painless, red, and granulomatous plaque on central face?

A

Balamuthia

240
Q

Free-living amoeba that can cause fulminate, fatal acute necrotizing meningoencephalitis?

A

Naegleria

241
Q

GI-associated amoeba causing amebic colitis, +/- liver, lung involvement?

A

Entamoeba histolytica

242
Q

Toxin in Fire ants?

A

Solenopsin D (piperidine alkaloid)

243
Q

Bed bugs?

A

Cimex lectularius

244
Q

Exaggerated bite reactions occur with?

A

CLL, chronic EBV

245
Q

Immune reaction substance in bed bugs?

A

Nitrophorin

246
Q

B. henselae causes?
B. quintana causes?

A

B. henselae -> cat scratch disease, bacillary angiomatosis
B. quintana -> bacillary angiomatosis

247
Q

Train-track appearance of urticaria or hemorrhage and ophthalmia nodosa are seen in?

A

Lepidopterism (caterpillar dermatitis) due to direct contact with hairs and toxin-mediated reactions

AliKhan Derm (13 decks)

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