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Dermatology Board Prep flashcards
1
Q 
Obligate Intracellular short rods
Endotoxin
Th1 response (with CD8 T Cells)
American Dog Tick
GA, NC, VA
Spring and Summer
Acute: Myalgias (calves), Fever, HA
Rash: Starts 2-6 days after exposure at ankles/wrists--> palms, soles, trunk
Complications: CNS changes and DIC
Serology, Weil-Felix test
A

Rickettsia rickettsii

RMSF

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2
Q

What is a Weil-felix test?

A

detects anti-rickettsial Abs in patient serum because they cross-react with Proteus antigens

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3
Q

Treatment for ALL Rickettsia diseases.

A

Doxycycline

can also use tetracyclin for Rickettsia prowazeki

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4
Q 
Obligate intracellular short rods
Endotoxin
Body Lice Feces
Flying Squirrels?
NOT in USA
Prodrome: 1-3 weeks of flu-like symptoms
Rash: 5-9 days after flu (spreads from trunk to extremities, NOT on palms/soles)
Complications: myocarditis, CNS, DIC, bacterial pneumonia
IFA, ELISA, 4X increase in Ab's
A

Rickettsia prowazeki

epidemic typhus

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5
Q 
Obligate intracellular short rods
Endotoxin
Rat Flea 
Rats/Opossums
Less severe prodrome
Rash only in 50% of patients
Symptomology + ELISA
A

Rickettsia Typhi

Murine/Endemic typhus

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6
Q 
Obligate intracellular short rods
Endotoxin
Lone Star Deer Tick
Southeastern US (ex. Memphis)
Prodrome: flu-like, N/V/D, conjunctivitis
Rash: in 60% of children, 30% of adults
Morulae in monocytes (macrophages)
A

Erlichia chaffeensis

Human monocytic Erlichiosis

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7
Q

Obligate intracellular short rods
Endotoxin
Ixodes blacklegged ticks
Counfusion, flu-like symptoms (if severe, dyspnea, hemorrhage, renal failure, neurologic problems)
RASH uncommon (suggests coinfection)
Morulae in Granulocytes (neutrophils, basophils, etc.)

A

Anaplasma phagocytophilia

Rocky mountain spotless fever

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8
Q 
Obligate intracellular short rod
Spore-like stage (resistant to drying)
Unpasteurized milk
Animal placenta/amniotic fluid
Ticks
Fever, HA, cough (possible atypical pneumonia)
Complications: hepatitis, endocarditis
NO RASH
Recovery spontaneous
A

Coxiella Burnetii

Q fever

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9
Q

Motile spirochete
(-) cultures from patient; (+) cultures from bug
Ixodes ticks (nymphal stage- long feed time 1-2 days)
NY, CT, PA, NJ (NE USA)
White-footed mouse
Rash: Erythema migrans (bulls eye rash)
Complicaitons: Bell’s palsy, myocarditis, Arthritis
ELISA–> confirm with western blot

A 
Borrelia burgdorferi
(Lyme Disesase)
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10
Q

How do you treat early lyme disease?

A

Doxycycline, Amoxicillin, or Tetracycline

Get DAT tick off!

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11
Q

How do you treat chronic lyme disease?

A

IV cephalosporins or penicillin G

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12
Q

How do spirochetes of the borrelia family adapt to host environments?

A

antigenic variation of OSPs

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13
Q 
Motile spirochete
(-) cultures from patient; (+) cultures from bug
Ixodes tick- High Desert of Western US
Body louse- rare in USA
Rodents
Fever for a week, recurrence 2 weeks later (10 times)
Skin rash uncommon
Spirochetes on blood smear
A

Borrelia hermsii/recurrentis

Relapsing Fever

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14
Q

What is the treatment for relapsing fever?

A

Tetracycline or Doxycycline

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15
Q

Fine spirochettes not visible with dyes
Dogs (shed bugs in urine)
Swimming (triathletes, sewer workers, etc.)
Urban poor
Early: fever, chills, conjunctival suffusion
Period of symptom relief
Later: meningitis, liver damage (jaundice with super high bilirubin), kidney dysfunction (uremia, Weil’s disease), lung hemorrhage

A 
Leptospira interrogans
(Leptosperosis)
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16
Q

How do you treat leptospira interrogans?

A

Penicillin G

if severe, use Dosycycline

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17
Q

Pleomorphic G(-) Rod with polar flagella
Requires special culture medium
Kitten bites/scratches
Fever, enlarged LN on side of bite with long disease course
Complications: endocarditis, encephalitis, bacillary angiomatosis in immunocompromised (often confused with Kapsoi)
Diagnosis: Warthin-Starry silver stain

A

Bartonella Heneslae

Cat scratch fever

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18
Q

How do you treat bartonella heneslae?

A

you don’t (but doxy and erythromycin do work)

Azithromycin if lymphadenitis

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19
Q

Gram positive rods
D-glutamate capsule (hides PAMPs) and Toxins
Spores
Contact with cows/animal products into cut
Painless ulcer with eschar that develops within hours
Swelling, sepsis (bacteremia), necrosis, DEATH
Test samples in blood and from skin lesion

A

Bacillus anthrax (cutaneous form)

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20
Q

How do you treat anthrax?

A

60 days ciprofloxacin prophylaxis

If serious: IV cipro + ampicillin

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21
Q

Intracellular, Gram negative rod
No capsule
Endotoxin
Goats, Pigs, Cattle
Contaminated milk or imported goat cheese from Mexico/Mediterranean
Rising/falling fever, pancytopenia, enlarged lymph nodes, liver and spleen
Complications: osteomyelitis

A

Brucella spp.

Malta/undulant fever

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22
Q

How do you treat brucella?

A

tetracycline/doxycycline + rifampin

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23
Q

Intracellular Gram negative rod
Capsule
Endotoxin
Thailand/Australia (after rains or swimming in rice paddy)
Host cell lysis, utilization of actin network
Dormancy for years/decades
VERY contagious

A 
Burkholderia pseudomallei
(Meliodosis/Whitmore's disease)
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24
Q

Intracellular Gram negative rod
Capsule
Endotoxin (LPS not recognized by TLR4)
Ticks, lice and mice- touching infected animal hides
Arkansas and Missouri
Ulcer with progressions to granulomas with caseation/necrosis/abscess
Swollen painful lymph nodes and possible conjuncitivitis

A

Franciesella Tularensis

Tularemia

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25
Q

How do you treat franciesella tularensis?

A

streptomycin

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26
Q 
Intracellular Gram negative rod (bipolar stain)
Capsule
Endotoxin, Exotoxin
Western US (prarie dogs and fleas)
Swollen, tender lymph nodes (buboes)
Complications: septic shock due to bacteremia (DIC and cutaneous hemorrhage)
50% fatal
Giemsa or Wayson stain from smear of pus
A

Yersnia Pestis

Bubonic Plague

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27
Q

How do you treat bubonic plague?

A

Streptomycin + Tetracycline (treat ASAP)

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28
Q

List virus types that are DS DNA with envelopes.

A

Alpha Herpes Viruses
HHV-6 and HHV-7
Poxviruses

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29
Q

List virus types that are DS DNA with no envelope.

A

HPV

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30
Q

List virus types that are SS DNA with no envelope.

A

Parvovirus B19

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31
Q

List virus types that are (-)SS RNA

A

Measles

Mumps

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32
Q

List virus types that are (+)SS RNA with envelope

A

Rubella (togavirus)

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33
Q

List virus types that are (+)SS RNA with no envelope

A

Coxackievirus

Enterovirus

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34
Q

What do you automatically think of if you have a chronic ulcerative herpes attack for longer than 4 weeks?

A

AIDS (defining condition regardless of CD4 cell count)

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35
Q

When are individuals contagious with the chicken pox?

A

4 days before and 5 days after rash

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36
Q

Describe what chicken pox rash looks like.

A

Raindrop on a rosebud (tear-drop vesicle on erythematous base)

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37
Q

What is the chicken pox vaccine? Who gets it, when?

A

Varivax
live, attenuated VZV
children 1-12

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38
Q

What is the vaccination for shingles? Who gets it, when?

A

Zostavax
live, attenuated VZV with 14X the amount of virus
Adults over 60 who HAVE HAD CHICKENPOX

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39
Q

What is the most common viral exanthem before age 2?

A

Roseola

HHV-6/HHV-7

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40
Q

What is the classic finding in children with roseola before the rash.

A

High fever despite the child feeling well–> can lead to a febrile seizure

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41
Q

Describe the roseola rash.

A

Begins on trunk and spreads to neck/proximal extremities (pink macules and papules surrounded by white halos)

42
Q

Can roseola ever get reactivated?

A

YES! it occurs in up to 48% of patients getting a hematopoietic stem-cell transplant! Commonly reactivates in brain.

43
Q

How do you treat roseola?

A

you don’t! self limited!

44
Q

4-10 year old
late winter/early spring
Prodrome: fever, HA, pruritis, coryza, myalgia
Slapped-cheeks for 1-4 days–> lace-like rash on extremities and trunk that lasts for 5-9 days
Recurrence up to months later due to “hot” things

A

Parvovirus B19

Erythema Infectiosum

45
Q

When are patients with Erythema Infectiosum most contagious?

A

in the prodromal period before the onset of rash

46
Q

Describe the “bi-phasic” pathogenesis of parvovirus B19.

A

1) Lytic (infectious) phase
2) Immunologic (non-infectious) Phase where IgG neutralizes circulating virus:
- Cytokines cause prodrome
- Cytotoxic T cell response that causes rash

47
Q

How do you diagnose erythema infectiosum?

A

IgM antibodies specific for parvovirus B19

48
Q

What are the top 3 major complications of erythema infectiosum?

A

1) Most common cause of APLASTIC CRISIS in patients with chronic hemolytic anemias.
2) Hydrops fetalis (massive edema of fetus)
3) Arthritis in older women

49
Q

Summer and Fall
Kids pooping in pool
URI with ulcerative lesions on tonsils/abdominal pain
Oval shaped, painful vesicles with erythematous halos on hands/feet
Resolves within 10 days

A

Hand Foot and Mouth Disease

Coxackievirus A16 or A6 and Enterovirus 71

50
Q

What class of bacteria cause hand foot and mouth disease?

A

picornaviridae

51
Q

Where do the picornaviridae viruses initially grow in HFMD?

A

lymphoid tissues (tonsils, Peyer’s patches)

52
Q

What are the two viruses of the paramyxovirus family we are studying?

A

Measles

Mumps

53
Q

What are the 3 distinctive factors of measles.

A 
H Protein (MV receptors) are CD46, CLAM and Nectin-4
Forms intracellular occlusion bodies
HIGHLY CONTAGIOUS
54
Q

Why does the measles rash occur?

A

Cytotoxic T cells attack measles virus-infected vascular endothelial cells in the skin

55
Q

What are the classic findings of measles presentation?

A 
3 C's: cough, coryza, conjunctivitis
High fever
Koplik spots-bluish-white abruptions in mouth
Morbilliform rash lasting >3 days
VERY SICK CHILD
56
Q

Describe the rash of measles.

A

Starts on face and spreads to trunk (body covered in 3 days!)

57
Q

How do you treat measles?

A

PREVENTION: get the MMR vaccine

Vitamin A supplementation
MMR vaccine within 72 hours of exposure
IG within 6 days of exposure

58
Q

Name some complicaitons associated with measles.

A

1) Immune suppression
2) Encephalomyelitis (ADEM or PIE)
3) Autoimmune demyelinating disease due to immune response to myelin basic protein
4) Encephalitis (MIBE, SSPE) due to mutations in matrix, H, or F proteins causing chronic CNS infection

59
Q

When are children with mumps contagious?

A

virus is shed in saliva up to 6 days before disease onset

60
Q

What is the presentation of mumps?

A

Prodrome of fever, malaise and anorexia
Chipmunk face (infection of parotid gland)
NO RASH

61
Q

What are the 2 major complications of mumps?

A

1) CNS virus replication- aseptic meningitis, deafness

2) Symptomatic gonadal involvement (in post-pubertal men) where testes swell up and lead to sterility

62
Q

How is rubella transmitted?

A

aerosols

mother to fetus via placenta

63
Q

What is congential rubella syndrome?

A 
congenital birth defects in the 1st and 2nd trimesters if mother has rubella and it crosses placenta:
-Mental retardation
-Motor disabilities
-Hearing loss
-CHF
-Cataracts
FETAL DEATH
64
Q

Where does translation of viral proteins and virus assembly of rubella occur?

A

cytoplasm

65
Q

For how long are children with rubella contagious?

A

Virus shedding occurs for around 1 month after initial expsoure

66
Q

What causes the rash in rubella?

A

antigen/antibody mediated vasculitis

67
Q

Describe the rubela rash.

A

Morbilliform rash that begins on the face and spreads to neck trunk and extremities OVER 24 HOURS! and lasts around 3 days

68
Q

What is Forchheimer’s sign?

A

20% of patinets with rubella have petechial lesions on soft palate and uvula

69
Q

Who gets the MMR vaccine?

A

infants 15 months or older

70
Q

What is the virus type with the LARGEST GENOME?

A

Pox Virus

71
Q

Describe pox virus replication.

A

Use own DNA-dep-RNA poly to replicate in cytoplasm of infected cells (DO NOT NEED NUCLEUS)

72
Q

Who gets small pox?

A

no one– it is eradicated

73
Q

What caused the small pox rash?

A

cytotoxic T cells attacking virus-infected cells

74
Q

How long did the rash in small pox last?

A

crusted within 2-3 weeks; but some patients would die!

75
Q

Describe the small box rash.

A

Started on face and extremities and spread to trunk.

76
Q

What was the name of the vaccine that helped to eradicate small pox?

A

Vaccinia (live vaccine of a lab strain of pox virus)

77
Q

Who gets molluscum contagiosum?

A

Children= like wrestlers or public pool users (on face, trunks, and limbs)
Young adults= sexual transmission (lower abdomen)

78
Q

Describe molluscum contagiosum lesions?

A

flesh-colored papules with “cup-shaped crater” and pearly white core
Koebner Phenomenon present!

79
Q

What is the BOTE sign?

A

Beginning of the End (the lesions look worse before they get better)

80
Q

What are the characteristic histiologic findings of molluscum contagiosum?

A

Henderson-Patterson bodies (intracytoplasmic inclusion bodies that push keratinocyte nuclei to side)

81
Q

Explain how E2, E6 and E7 are associated with cancer?

A

E2 (transcriptional regulator) can get lost when the viral genome is incorporated into human genome. This causes overexpression of E6 (degrades p53) and E7 (inactiates Rb protein) which can lead to malignancy because tumor suppressor genes are lost.

82
Q

What are the most common cancer forming strains of HPV?

A

16 and 18

83
Q

What are the most common genital wart (condylomata acuminata) forming strains of HPV?

A

6 and 11

84
Q

What strains of HPV cause hand warts (verruca vulgaris)?

A

2 and 4

85
Q

What strain of HPV causes plantar warts?

A

1

86
Q

What strains of HPV cause flat warts on face (verrucae planae)?

A

3 and 10

87
Q

What vaccine has L1 capsid proteins of HPV 16 and 18 only?

A

Ceravix

88
Q

What vaccine has L1 capsid proteins of HPV 6, 11, 16 and 18?

A

Gardasil

89
Q

Who gets Gardasil?

A

males and females 11-26

90
Q

Who gets Ceravix?

A

females 10-25

91
Q

What are the black dots in warts?

A

thrombosed capillaries

92
Q

What is a side effect of cryotherapy?

A

nail dystrophy

93
Q

What is the name of the treatment for verruca vulgaris from an extract of a blistering insect?

A

cantharidin

94
Q

What is the most common treatment for flat warts?

A

tretinoin

95
Q

How do palmoplantar verruca differ from verruca vulgaris?

A

veruca vulgaris are exophytic and palmoplantar are endophytic

96
Q

What is a common therpay used for anogenital warts?

A

imiquimod (topical immunomodulator)

97
Q

If you have anogenital warts and HIV, what are you at increased risk for?

A

anal SCC

98
Q

What is Hansen’s disease? What causes it?

A

Leprosy is a chornic granulomatous disease that affects peripheral nerves and superficial tissues (espeically nasal mucosa)! It is caused by Mycobacterium Leprae

99
Q

How is Tuberculoid leprosy different from Lepromatous leprosy?

A

Tuberculoid is less severe (has Th1 mediators) and involves single skin lesions
Lepromatous leprosy has no Th1 mediators, so it is a progressive disease with edema, rhinitis, ear lobe infiltration, face/buttocks/limb lesions, loss of cartilages/testicles and symptoms associated with peripheral nerve infections

100
Q

How long is the incubation period for leprosy?

A

2-7 years

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