Inflammatory Derm

Question 1

Extensor surfaces

Answer 1

elbows, knees, forearm, neck

Question 2

Thickening of the stratum corneum (Hyperkeratosis)

Retained nuclei in stratum corneum epidermis (parakeratosis) &

Epidermal thickening/hyperplasia (acanthosis) with

elongated clubbed interdigitations (rete ridges) corresponding to the typical erythematous plaques

Answer 2

Psoriasis

Question 3

characterized by hyperkeratosis and squamous dysplasia and is considered a premalignant lesion to squamous cell carcinoma. It is typically related to chronic ultraviolet exposure and is most common on sun-exposed areas of the scalp, ears, face, and dorsum of the hands.

Answer 3

Actinic keratosis

Question 4

Thinning of the epidermis is a common feature of

Answer 4

scleroderma

or topical glucocorticoid use

Question 5

Allergic contact dermatitis is a delayed-type hypersensitivity reaction.

Initially (sensitization), ______ cells mirgrate to regional lymph nodes and present haptens to naive T cells, leading to clonal expansion.

On re-exposure to the hapten, sensitized CD8+ T cells cause tissue destruction that manifests as pruritic erythema, vesicles, and/or bullae ___ days after exposure.

Answer 5

Langerhans
2-3

*Hapten: (antigen like Urushiol poison ivy)

Question 6

Bullous pemphigoid is caused by autoantibodies against ____ on keratinocytes.

Answer 6

hemidesmosomes

Question 7

Pemphigus vulgaris is caused by autoantibodies against ____ on keratinocytes

Answer 7

desmosomes

Question 8

Immune complex deposition in small cutaneous vessels causes

Answer 8

cutaneous small vessel vasculitis (CSVV)

Question 9

Medications that function as haptens (phenytoin, sulfonamides) can cause this condition.
Presents with nonblanchable purpura and petechiae

Answer 9

cutaneous small vessel vasculitis (CSVV)

Question 10

multiple target-shaped skin lesions on the trunk and/or extremities likely indicate

Answer 10

erythema multiforme (EM)

Question 11

Erythema multiforme is a target-shaped, inflammatory skin lesion that typically arises in the setting of infection, particularly with herpes simplex virus or Mycoplasma pneumoniae. It is caused by the deposition of infectious antigens in keratinocytes, leading to a strong ____ mediated immune response.

Answer 11

cell-mediated (cytotoxic T-cell)

Question 12

Dermatitis herpetiformis, a manifestation of _____ sensitivity, is caused by the subepidermal deposition of IgA. It is associated with pruritic papules and vesicles on the forearms, knees, and/or scalp

Answer 12

gluten

Question 13

a delayed-type hypersensitivity reaction that causes inflammatory nodules in the subcutaneous fat. Presents with tender, erythematous nodules on the bilateral shins.

Answer 13

Erythema nodosum

Question 14

Removal of the scale results in small bleeding points

due to dilated capillaries in dermal papillae

Answer 14

Psoriasis

Auspitz sign

Question 15

a common skin disorder characterized by activation of T helper cells and proliferation of keratinocytes

Answer 15

Psoriasis

Question 16

First-line treatment options for localized psoriasis include high-potency topical corticosteroids and vitamin D analogs. Vitamin D analogs inhibit T-cell and _____ and stimulate keratinocyte differentiation.

Answer 16

keratinocyte proliferation

Question 17

Spongiosis is intercellular epidermal edema that histologically appears as an increase in the width of spaces between cells. Spongiosis is often associated with ____

Answer 17

eczematous dermatitis
contact dermatitis
and others

Question 18

Common conditions displaying ____ include psoriasis, seborrheic dermatitis, and acanthosis nigricans.

Answer 18

acanthosis

Question 19

Acantholysis is the loss of cohesion between keratinocytes in the epidermis. It is a characteristic finding in the ____ family of disorders.

Answer 19

pemphigus

Question 20

Urticaria (hives) is due to increased permeability of the microvasculature, leading to ____ of the superficial dermis.

Answer 20

edema

Question 21

Presents with pruritic, purple/pink, polygonal papules and/or plaques on flexural surfaces
Hyperkeratosis (thickening of stratum corneum),
band-like lymphocytic infiltrates at dermoepidermal jxn,
Hypergranulosis (prominent granular layer),
sawtooth rete ridges,
scattered eosinophilic colloid bodies

Answer 21

Lichen planus

Flexural surfaces: wrists and ankles
*also: nails, oral mucous membranes, and genitalia

Question 22

A pruritic rash affecting the extensor surfaces, face, and/or extremities.
Presents in childhood usually with a history of other atopic disorders (allergic rhinitis, asthma).

Answer 22

Atopic dermatitis

Question 23

Chronic lesions often show white, lacy markings known as Wickham striae over the plague

Answer 23

Lichen planus

Question 24

Severe cases of Erythema Multiforme can affect oral mucous membranes and the tongue.

Typically develops as erythematous, round papules that evolve into target lesions with a dusky central area, a dark red inflammatory zone surrounded by a pale ring, and an erythematous halo in the lesion’s periphery.

EM is most frequently associated with infections like (2)

Answer 24

Herpes simplex virus
Mycoplasma

*Sulfonamides, cancers, collagen diseases, fungal infections

Question 25

Characterized by rapid onset of erythematous macules with necrosis and skin sloughing especially of mucosal surfaces like the mouth.  Systemic signs (fever, hypotension) are common.

Answer 25

Stevens-Johnson syndrome

Question 26

Dermatitis herpetiformis (DH) is characterized by erythematous pruritic papules, vesicles, and bullae that appear symmetrically on the extensor surfaces (elbows, knees), upper back, and buttocks due to deposition of IgA at the _____ junction.

Answer 26

dermoepidermal *Celiac's disease

Question 27

The immune response against gliadin in Celiac's also targets tissue transglutaminase, leading to the production of IgA and IgG tissue transglutaminase autoantibodies.  In the skin, these antibodies ____ with epidermal transglutaminase,

Answer 27

cross-react

Question 28

Small-bowel histologic findings: ``` Small bowel intraepithelial lymphocytosis Crypt hyperplasia (elongation) Progressive villous atrophy (height shrinkage) ```

Answer 28

Celiac's disease

Question 29

This condition is characterized by skin fragility and blistering lesions in sun-exposed areas. Labs: Elevated urinary porphyrin levels (uroporphyrin, heptacarboxyl porphyrin)

Answer 29

Porphyria cutanea tarda

Question 30

a group of conditions characterized by pruritic, erythematous, papulovesicular rash, with blisters and ulcers and weeping drainage.   Histo: Spongiosis & edema

Answer 30

Eczematous dermatitis (eczema)

Question 31

New topical cream then a few days later an erythematous, papulovesicular, weeping lesion.  This is likely _____, a form of eczema caused by a type IV (delayed) hypersensitivity reaction to an antigen on the skin surface. 

Answer 31

acute allergic contact dermatitis (ACD)

Question 32

Dyskeratosis is abnormal, premature keratinization of individual keratinocytes below the stratum granulosum.  May be found in diseases such as

Answer 32

squamous cell carcinoma

Question 33

In a susceptible child, a febrile maculopapular rash that begins on the face and spreads to the trunk and extremities is suggestive of ____ or _____  The additional finding of postauricular (behind the ears) lymphadenopathy is most suggestive of _____.

Answer 33

measles (Rubeola) rubella (German measles) rubella (Togavirus)

Question 34

characterized by a transient maculopapular rash that appears for a few days on the chest and trunk once the patient's fever subsides.

Answer 34

Roseola (HHV-6) | aka exanthem subitum (roseola infantum)

Question 35

This illness is first characterized by redness of the cheeks (“slapped-cheek” appearance), followed by a maculopapular rash on the extremities and trunk.

Answer 35

Parvovirus is responsible for fifth disease (erythema infectiosum)

Question 36

a group of inherited disorders characterized by epithelial fragility (bullae, blisters, erosions, ulcers) triggered by minor trauma (usually on hands, soles of feet, mouth) 

Answer 36

Epidermolysis bullosa

Question 37

It is caused by mutations impairing keratin filament assembly in the intraepidermal and dermoepidermal adhesion complexes

Answer 37

Epidermolysis bullosa

Question 38

Intraepidermal cleavage plane are visible on histology

Answer 38

Epidermolysis bullosa

Question 39

Atopic dermatitis is a multifactorial disorder but is commonly seen in association with loss of function mutations in ____ and other epidermxal barrier proteins.

Answer 39

filaggrin

Question 40

Intense pruritus Infants: red, crusted lesions involving extensor surfaces & face Children & adults: flexural eczema & lichenification

Answer 40

Atopic dermatitis

Question 41

Disrupted skin barrier increases antigen exposure and hypersensitivity Associated with asthma & allergic rhinitis

Answer 41

Atopic dermatitis

Question 42

Initially, Langerhans cells present haptens to naive T cells, leading to clonal expansion.  On reexposure, sensitized CD8+ T cells are recruited to skin and destroy tissue.  Release of ____ by T cells further amplifies the immune response.

Answer 42

interferon gamma

Question 43

blistering rash began as tender papules that quickly progressed to form vesicles and flaccid bullae that rupture easily and crusted over

Answer 43

Bullous Impetigo

Question 44

The blistering in Bullous Impetigo is caused by production of exfoliative toxin A, a serine protease that targets _____ in the superficial epidermis, by some strains of S aureus. 

Answer 44

Desmoglein 1

Question 45

The blistering in Bullous Impetigo is caused by production of _____, a SERINE protease that targets desmoglein 1 in the superficial epidermis, by some strains of S aureus. 

Answer 45

Exfoliative toxin A

Question 46

Desmoglein is a ___ component of desmosomes in epidermal cellular junctions;

Answer 46

cadherin

Question 47

Patients with psoriasis frequently develop additional complications, including (3)

Answer 47

Psoriatic arthritis (HLA-B27) Yellow pitting, thickened nails Uveitis

Question 48

a common extradermal manifestation of systemic sclerosis (scleroderma).

Answer 48

Pulmonary fibrosis

Question 49

Formation of lesions at sites of trauma (Köbner phenomenon)

Answer 49

Lichen Planus

Question 50

scattered, scaly, pink plaques

Answer 50

Lichen Planus

Question 51

BP is caused by antibodies against hemidesmosomes along the basement membrane of the

Answer 51

dermal-epidermal junction

Question 52

causes the entire epidermis to separate from the dermis, forming subepidermal, nonacantholytic TENSE blisters.

Answer 52

Bullous Pemphigoid

Question 53

Immunofluorescence shows IgG and/or C3 deposits in a linear pattern along the basement membrane.

Answer 53

Bullous Pemphigoid

Question 54

Intraepidermal cleavage Acantholysis (detached keratinocytes) "Tombstone cells" along basal layer

Answer 54

Pemphigus Vulgaris

Question 55

Immunofluorescence shows Net-like intercellular IgG

Answer 55

Pemphigus Vulgaris

Question 56

Predominantly elderly Tense bullae Rare oral/mucosal involvement

Answer 56

Bullous Pemphigoid

Question 57

Middle-aged or elderly Flaccid bullae Oral/mucosal involvement Positive Nikolsky sign

Answer 57

Pemphigus Vulgaris

Question 58

It presents with painful flaccid bullae and erosions affecting the skin and mucosal membranes.  The bullae spread laterally with pressure and new blisters may form with gentle rubbing.

Answer 58

Pemphigus Vulgaris

Question 59

Physical examination is notable for multiple skin patches with necrotic centers and occasional ulcerations + NEUTROPENIA

Answer 59

``` Ecthyma gangrenosum (Pseudomonas aeruginosa) ```

Question 60

The most common cause of nonpurulent cellulitis is

Answer 60

Group A streptococcus | Streptococcus Pyogenes

Question 61

The most common cause of purulent cellulitis is

Answer 61

Staphylococcus aureuS

Question 62

a highly contagious disease that presents with an intensely pruritic rash (usually worse at night) involving the flexor surfaces of the wrist, lateral surfaces and webs of the fingers, elbow extensor surfaces, and axillary folds.  Patients usually have excoriations with small, crusted, red papules scattered around the affected areas. 

Answer 62

Scabies

Question 63

The lepromin skin test will be POSITIVE in patients with ______ as they exhibit a strong CD4+ TH1 cell-mediated immune response to Mycobacterium leprae.  Patients with ______ will test NEGATIVE due to their weak TH1 cell-mediated immune response

Answer 63

tuberculoid leprosy lepromatous leprosy

Question 64

Affected tissues show extensive accumulation of acid-fast bacilli within macrophages and often a TH2 cytokines. Patients develop more numerous, poorly demarcated plaques that are widespread across the body.  Leonine facies. Degeneration/loss of the nose and digits.

Answer 64

lepromatous leprosy

Question 65

localized inflammation damages the skin and cutaneous nerves, leading to the development of a small number of hypopigmented, well-demarcated plaques with decreased/absent sensation

Answer 65

tuberculoid leprosy | TH1 cytokines

Question 66

Vesicle base reveals intranuclear inclusions in keratinocytes and multinucleated giant cells (positive Tzanck smear).

Answer 66

VZV

Question 67

Tinea corporis presents with round or ovoid lesions with a raised, scaly border and central clearing.  Trichophyton r is the most common cause and infects ____ matter in the stratum corneum of the superficial EPIDERMIS but does NOT invade the dermis.

Answer 67

keratinized

Question 68

Cutaneous wart (verruca vulgaris).caused by

Answer 68

human papillomavirus

Question 69

typically present as rough, skin-colored papules.  Biopsy shows epidermal hyperplasia, thickened stratum corneum (hyperkeratosis), disrupted papilloma formation, and cytoplasmic vacuolization (koilocytosis)

Answer 69

Cutaneous wart (verruca vulgaris)

Question 70

Herpangina (oral blisters or ulcerations) Extremity blisters, vesicles, ulcerations Aseptic meningitis Myocarditis SUMMER SUMMER SUMMER

Answer 70

Enterovirus