LE 1 - MED 1 Flashcards
- The layers of the skin from the deepest to the most superficial is
a. Basal, spinous, granular, stratum corneum
b. Basal, granular, spinous, stratum corneum
c. Granular, basal, spinous, stratum corneum
d. Spinous, basal, granular, stratum corneum
a. Basal, spinous, granular, stratum corneum
Rationale:
The skin, specifically the epidermis, has several layers. When considering these layers from the deepest to the most superficial, they are:
Stratum Basale (Basal layer): This is the deepest layer of the epidermis, where new skin cells are produced. Keratinocytes begin their journey here, proliferating and then migrating upwards.
Stratum Spinosum (Spinous layer): This layer is just above the stratum basale. As keratinocytes move up from the basal layer, they start to become more flattened and spiky, which gives this layer its name.
Stratum Granulosum (Granular layer): As keratinocytes progress upwards, they enter the granular layer where they begin to die and produce more keratin, a protein that gives skin its toughness and waterproofing capabilities.
Stratum Corneum: This is the most superficial layer of the epidermis. It consists of several layers of dead, flattened keratinocytes that are continuously shed and replaced from the layers below. It serves as a protective barrier against environmental elements and pathogens.
- A 20 year old female sought consultation due to vesicles she discovered 2 days after a date with a handsome young man. She denied being intimate except for a good night kiss. The organism causing this vesicular lesion is:
a. Herpes simplex 1
b. Herpes simplex 2
c. Treponema pallidum
d. Chlamydia trachomatis
a. Herpes simplex 1
Brief Rationale:
Herpes simplex 1 (HSV-1): Causes oral herpes, which manifests as cold sores or fever blisters. It’s transmitted via direct contact, including kissing, making it the most probable cause in this scenario.
Herpes simplex 2 (HSV-2): Primarily causes genital herpes, which is usually spread through sexual contact. Less likely to be contracted through kissing.
Treponema pallidum: Causes syphilis, which presents as a painless chancre, not vesicles. Transmission is typically sexual.
Chlamydia trachomatis: Causes chlamydia, a genital infection. It doesn’t cause vesicular lesions and is transmitted sexually.
- Punctate depression of the nails are seen in this condition
a. Psoriasis
b. Iron deficiency
С. Cirrhosis
d. leprosy
a. Psoriasis
Brief Rationale:
Psoriasis: One of the nail changes seen in psoriasis is “pitting,” which appears as punctate depressions on the nail surface.
Iron deficiency: Can lead to koilonychia (spoon-shaped nails), but not punctate depressions.
Cirrhosis: While cirrhosis can cause nail changes, like Terry’s nails or clubbing, it does not typically result in punctate depressions.
Leprosy: While leprosy can cause various nail changes due to nerve damage and secondary infections, punctate depressions are more classically associated with psoriasis.
- Brown macules and patches associated with papules and nodules with button holing
a. Neurofibromatosis
b. Tuberous sclerosis
c. Systemic lupus erythematosus
d. Dermatomyositis
a. Neurofibromatosis
Brief Rationale:
Neurofibromatosis: This condition is characterized by brown macules called “café-au-lait” spots and neurofibromas, which are nodular skin lesions. The “button holing” sign refers to the ability to push a portion of the neurofibroma into its underlying subcutaneous attachment.
Tuberous sclerosis: This is a genetic disorder that can cause various skin manifestations including hypomelanotic macules, facial angiofibromas, and shagreen patches, but not the specific combination described in the question.
Systemic lupus erythematosus (SLE): SLE can produce a malar rash or discoid lesions, but it does not result in brown macules with nodules and the characteristic button holing.
Dermatomyositis: This inflammatory muscle disease can lead to skin changes such as Gottron’s papules and a heliotrope rash, but it doesn’t cause the features described in the question.
- Round scaling patches of hair loss, hair broken off close to the surface of the scalp
a. Alopecia areata
b. Tinea capitis
c. trichotillomania
d. Seborrheic dermatitis of the scalp
b. Tinea capitis
Brief Rationale:
Alopecia areata: This is an autoimmune condition that results in non-scarring hair loss. Affected areas typically appear as smooth, round patches without scaling.
Tinea capitis: This is a fungal infection of the scalp. It presents as round patches of hair loss with scaling, and the affected hairs often break off just above the surface of the scalp, giving a characteristic “black dot” appearance.
Trichotillomania: This is a condition where individuals pull out their own hair. It results in irregularly shaped patches of hair loss, and the remaining hairs can have varying lengths. Broken hairs may be evident, but there isn’t the characteristic scaling seen in tinea capitis.
Seborrheic dermatitis of the scalp: This condition can cause redness, scaling, and itching of the scalp, but it doesn’t typically result in patches of hair loss with hairs broken off near the scalp surface as described.
- Nail plates turns white with a ground glass appearance, a distal band of reddish brown and obliteration of the lunula
a. Terry’s nails
b. Leukonychia
c. Beau’s lines
d. Mees’ lines
a. Terry’s nails
Brief Rationale:
Terry’s nails: This condition is characterized by the nail plates turning white with a ground glass appearance. There’s often a distal band of reddish-brown and the lunula (the crescent-shaped white area near the nail base) is typically obliterated.
Leukonychia: Refers to white spots or streaks on the nails. It doesn’t have the characteristic ground glass appearance, distal band, or obliterated lunula seen in Terry’s nails.
Beau’s lines: These are horizontal (transverse) depressions in the nail plate. They do not cause the nails to turn white or have a ground glass appearance.
Mees’ lines: These are white horizontal bands across the nails. They differ from Terry’s nails in appearance and do not have the ground glass appearance or the distinct reddish-brown band.
- White lines or bands that appear on fingernails or toenails which can be a symptom of underlying health conditions such as arsenic poisoning or kidney failure.
a. Terry’s nails
b. Leukonychia
c. Beau’s lines
d. Mees’ lines
d. Mees’ lines
Brief Rationale:
Terry’s nails: The nail plates turn white with a ground glass appearance, often with a distal band of reddish-brown. They can be a sign of liver disease, congestive heart failure, or other conditions but are not described as white lines or bands due to arsenic poisoning or kidney failure.
Leukonychia: White spots or streaks on the nails.
Beau’s lines: Horizontal (transverse) depressions in the nail plate.
Mees’ lines: White horizontal bands across the nails. They can be a symptom of several conditions, including arsenic poisoning and kidney failure.
- A superficial infection of the proximal and lateral nail folds adjacent to the nail plate.
a. Paronychia
b. Nail psoriasis
c. Lichen planus of the nail
d. onychomycosis
a. Paronychia
Brief Rationale:
Paronychia: This is an infection (which can be bacterial or fungal) of the skin surrounding the nail, specifically the proximal and lateral nail folds. Symptoms may include redness, swelling, and pain around the nail.
Nail psoriasis: While this can affect the nail and the surrounding area, its primary signs include nail pitting, discoloration, and sometimes onycholysis (separation of the nail from the nail bed). It isn’t an infection of the nail folds.
Lichen planus of the nail: This can lead to nail thinning, ridging, and sometimes complete loss of the nail. It doesn’t present as an infection of the nail folds.
Onychomycosis: This is a fungal infection of the nail itself, leading to discoloration, thickening, and sometimes crumbling of the nail. It does not primarily affect the nail folds.
- Risk factors to pressure ulcers does not include:
a. Fecal or urinary incontinence
b. Low serum albumin and hypotension
c. atherosclerosis
d. race
d. race
Brief Rationale:
Fecal or urinary incontinence: Presence of moisture, especially from urine or feces, can damage the skin and increase the risk of pressure ulcer development.
Low serum albumin and hypotension: Low serum albumin levels can indicate poor nutrition, which can compromise skin health and wound healing. Hypotension can reduce blood flow to skin and tissues, increasing the risk of ulcers.
Atherosclerosis: This can reduce blood flow to peripheral tissues, compromising skin health and increasing the risk of pressure ulcers.
Race: While there might be some studies suggesting that certain races may have different risks for pressure ulcers, race in and of itself is not a direct risk factor for pressure ulcer development in the way that the other listed factors are.
- The skin forms a blister or sore partial thickness skin loss or ulceration involving the epidermis, dermis or both.
a. Stage 1 pressure ulcer
b. Stage 2 pressure ulcer
c. Stage 3 pressure ulcer
d. Stage 4 pressure ulcer
b. Stage 2 pressure ulcer
Brief Rationale:
Stage 1 pressure ulcer: The skin is not broken. It appears red on lighter skin and may not blanch when touched. On darker skin, the ulcer might have a blue or purple tint. It may be warm, swollen, and painful.
Stage 2 pressure ulcer: There is partial-thickness loss of skin, which may appear as a blister or a sore. This stage involves the epidermis and possibly the dermis.
Stage 3 pressure ulcer: The ulcer is a full-thickness skin loss, which may expose some subcutaneous tissue (but bone, tendon, and muscle are not exposed). It looks like a crater and might have a foul odor.
Stage 4 pressure ulcer: This is the most severe stage where there’s full-thickness skin and tissue loss. This ulcer might expose muscle, bone, or tendons.
- The nails grown this length during normal conditions
a. 0.1 mm daily
b. 0.25 mm daily
c. 0.5 mm daily
d. 1.0 mm daily
a. 0.1 mm daily
Brief Rationale:
Nails, particularly fingernails, grow at an average rate of about 0.1 mm per day. This translates to about 3 mm per month. Factors such as age, nutrition, genetics, and overall health can influence nail growth. Toenails tend to grow more slowly than fingernails.
- Clubbing of the nails is defined as
a. 180 degrees between the proximal nail fold and nail plate
b. Less than 180 degrees between the proximal nail fold and nail plate
c. More than 180 degrees between the proximal nail fold and nail plate
d. The absence of the “window” when two nails are facing each other
c. More than 180 degrees between the proximal nail fold and nail plate
Brief Rationale:
Nail clubbing is a physical sign characterized by bulbous enlargement of the ends of one or more fingers or toes and is associated with certain medical conditions. Clubbing is defined by an increased angle (more than 180 degrees) between the proximal nail fold and the nail plate. In the early stages of clubbing, the base of the nail becomes soft, and the skin next to the nail bed becomes shiny. As clubbing advances, the nails curve more, and the angle increases.
- Which of the following statements is NOT true?
a. Sebaceous glands open to the hair follicles
b. Eccrine sweat glands open directly to the skin surface
c. Apocrine glands open into hair follicles
d. Apocrine glands regulate temperature
d. Apocrine glands regulate temperature
Brief Rationale:
a. Sebaceous glands open to the hair follicles: This statement is true. Sebaceous glands produce sebum, an oily substance that helps to moisturize and protect the skin. They open into hair follicles.
b. Eccrine sweat glands open directly to the skin surface: True. Eccrine glands are the primary sweat glands of the human body and are found in most parts of the skin. They secrete sweat directly onto the skin surface to help regulate body temperature.
c. Apocrine glands open into hair follicles: True. Apocrine sweat glands are found mainly in the axillary and anogenital regions and open into hair follicles, not directly onto the skin’s surface.
d. Apocrine glands regulate temperature: False. Eccrine glands primarily function in thermoregulation. Apocrine sweat glands produce a thicker sweat that is associated with body odor. They are activated by emotional stress, sexual excitement, and other factors but are not primarily involved in temperature regulation.
- The lesion of larva migrans infection is best described as:
a. Serpiginous
b. Lichen-like
c. Burrows
d. Dermatomal
a. Serpiginous
Brief Rationale:
Larva migrans, also known as “creeping eruption,” is a skin infection caused by the larvae of certain species of nematodes (roundworms), most commonly by the hookworm species that infect animals.
The larvae in the skin produce:
a. Serpiginous: True. The term “serpiginous” refers to a wavy or snake-like pattern, which describes the appearance of the track left behind as the larva migrates through the skin.
b. Lichen-like: False. This term usually describes skin lesions that look like lichen from trees or rocks. It’s not a descriptor used for larva migrans.
c. Burrows: False. While burrows are a tunnel-like pattern in the skin, they are commonly associated with scabies, where the mite digs into the skin.
d. Dermatomal: False. A dermatomal pattern typically refers to a skin distribution that follows a sensory nerve, as seen in conditions like shingles (herpes zoster). Larva migrans doesn’t follow this pattern.
- A flat pigmented circumscribed area less than 1 cm in diameter is:
a. macule
b. papule
c. patch
d. wheal
a. macule
macule vs patch
Brief Rationale:
macule: A flat, circumscribed area that is a change in the color of the skin that is less than 1 cm in diameter. It’s not raised or depressed compared to the surrounding skin.
papule: A solid, raised lesion that is less than 1 cm in diameter. It can be brown, purple, pink, or red in color.
patch: Similar to a macule, but it is larger than 1 cm in diameter.
wheal: A raised, itchy area of skin that’s often a sign of an allergic reaction. It can be a part of urticaria (hives).
- An elevated circumscribed fluid filled lesion less than 0.5cm is:
a. wheal
b. papule
c. vesicle
d. cyst
c. vesicle
Blister: Vesicle vs Bulla
Brief Rationale:
wheal: A raised, itchy area of skin, often transient, that can be part of urticaria (hives). It’s more of a reaction than a fluid-filled lesion.
papule: A solid, raised lesion that is less than 1 cm in diameter. It’s not filled with fluid.
vesicle: An elevated, circumscribed, fluid-filled lesion that is less than 0.5 cm in diameter. Examples include blisters from burns or herpes simplex lesions.
cyst: A nodule consisting of an encapsulated liquid or semiliquid material, typically larger than a vesicle.
- Palpable circumscribed lesion larger and deeper than 1cm in diameter and extends into the dermal area is:
a. nodule
b. papule
c. vesicle
d. pustule
a. nodule
Papule vs Nodule
Brief Rationale:
nodule: A palpable, circumscribed lesion that is larger and deeper than a papule, typically greater than 1 cm in diameter, and extends into the dermal (and sometimes subdermal) areas.
papule: A solid, raised lesion that is less than 1 cm in diameter.
vesicle: An elevated, circumscribed, fluid-filled lesion less than 0.5 cm in diameter.
pustule: A circumscribed elevation of the skin containing purulent exudate (pus). It is similar in size to a vesicle but contains pus.
- An example of a disease with vesicles (fluid-filled, <0.5 cm) is:
a. Acne vulgaris
b. Rubella
c. Roseola
d. Chicken pox
d. Chicken pox
Vesicle: Chicken pox, Shingles, Poison ivy
Brief Rationale:
Acne vulgaris: Typically presents with pimples, blackheads, and whiteheads. While it might have pustules (filled with pus), it doesn’t typically produce vesicles.
Rubella (German measles): Presents with a fine, pink rash and other symptoms. It does not typically produce vesicles.
Roseola: Causes a high fever followed by a pink-red raised or flat rash, but not vesicles.
Chicken pox (Varicella): Characterized by an itchy rash that turns into fluid-filled blisters (vesicles) and then crusts over. It’s a classic example of a vesicular rash.
- A minute slightly raised tunnel in the epidermis found in a web of fingers can be created by?
a. Larva migrans
b. Yeast infection
c. Scabies
d. Larva migrans
c. Scabies
Brief Rationale:
Larva migrans: Refers to the “creeping eruption” caused by hookworm larvae. It typically presents as serpiginous tracks on the skin but doesn’t create tunnels in the epidermis like scabies.
Yeast infection: Yeast infections, particularly those caused by Candida species, can lead to skin rashes and other manifestations but do not cause minute tunnels in the skin.
Scabies: Caused by the mite Sarcoptes scabiei, scabies leads to the formation of minute slightly raised tunnels (burrows) in the epidermis. These burrows are a classic sign of scabies and can be especially visible in the web spaces between the fingers.
- Common benign brown raised papules that feel slightly greasy and velvety or warty and have a stuck appearance
a. Seborrheic keratosis
b. Verruca plana
c. Verruca vulgaris
d. Actinic keratosis
a. Seborrheic keratosis
Brief Rationale:
Seborrheic keratosis: These are common benign skin growths that appear as brown, black, or light tan patches on the skin. They can be slightly elevated and have a greasy or warty surface. Their appearance often looks like they are “stuck on” the skin, making them easy to distinguish.
Verruca plana: Also known as flat warts, they are smooth, skin-colored or slightly pigmented, flat-topped papules. They do not have the greasy or “stuck on” appearance.
Verruca vulgaris: Common warts caused by human papillomavirus (HPV). They are rough, skin-colored bumps that often appear on the hands and fingers.
Actinic keratosis: These are rough, scaly patches on the skin that develop from years of exposure to the sun. They are precancerous lesions and do not have the “stuck on” appearance of seborrheic keratoses.
- Most common of all skin cancers with nil possibility of metastasis.
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma
d. Keratoacanthoma
a. Basal cell carcinoma
Brief Rationale:
Basal cell carcinoma (BCC): It is the most common type of skin cancer and has a very low metastatic potential. In fact, metastasis is exceedingly rare with BCC. It grows slowly and primarily causes local damage.
Squamous cell carcinoma (SCC): The second most common type of skin cancer. While it has a greater potential to metastasize compared to BCC, its metastatic risk is still relatively low but not nil.
Malignant melanoma: A more aggressive form of skin cancer with a significant risk of metastasis, especially if not detected early.
Keratoacanthoma: Often considered a variant of squamous cell carcinoma, keratoacanthoma grows rapidly but usually regresses spontaneously. Its potential for metastasis is debated, but it’s generally considered low.
- Fiery red up to 2 cm with a central body seen in liver disease.
a. Spider angioma
b. Purpura
c. Spider vein
d. Cherry angioma
a. Spider angioma
Brief Rationale:
Spider angioma: Also known as spider telangiectasia, it appears as a red spot (central body) from which small blood vessels (capillaries) radiate. It looks somewhat like a spider, hence the name. They can be associated with liver disease, especially cirrhosis, as well as other conditions like pregnancy.
Purpura: Refers to red or purple discolorations on the skin that don’t blanch when pressure is applied. They can be due to various causes, including bleeding disorders.
Spider vein: Also known as telangiectasias, these are small, dilated blood vessels near the surface of the skin or mucous membranes. They can appear anywhere on the body but often on the legs and face. They differ from spider angiomas in appearance and associations.
Cherry angioma: A common skin growth due to an overgrowth of blood vessels. They are bright red and can be found almost anywhere on the body. They are not specifically associated with liver disease.
- An acne scar that has a greater width than depth:
a. Box scar
b. Ice pick scar
c. Pock mark
d. Atrophic scar
a. Box scar
- The most number of hair is in this stage
a. anagen
b. catagen
c. telogen
d. Telogen effluvium
a. anagen
Brief Rationale:
Anagen: This is the active growth phase of hair follicles. The majority of hairs (about 85-90% in a healthy scalp) are in this stage at any given time, and it can last several years.
Catagen: A short transitional phase that lasts approximately 2-3 weeks. During this phase, the hair stops growing and detaches itself from the blood supply, and is then named a club hair.
Telogen: The resting phase, during which old hair falls out to make room for new anagen hairs. About 10-15% of all hairs are in this phase at any given time.
Telogen effluvium: This isn’t a phase of hair growth, but rather a condition. It’s a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase. It can be caused by various factors including physical stress, emotional stress, hormonal changes, dietary deficiency, and medications.
