Norton Part 9

Question 1

what is the pathogenesis of acne vulgaris

Answer 1

obstruction of sebaceous follicles by sebum promotes proliferation of Propionibacterium acnes (anaerobe)

Question 2

where is acne vulgaris distributed

Answer 2

face, chest, and upper back

Question 3

what type of lesions are commonly seen in acne vulgaris patients

Answer 3

both obstructive and inflammatory lesions

Question 4

what obstructive lesions are seen in acne vulgaris

Answer 4

closed comedones ("whiteheads")- flesh colored dome shaped papule
open comedones ("blackheads")- dilated pore filled with keratinous material (not dirt)

Question 5

what is the progression of the lesion in acne vulgaris

Answer 5

papules/pustules to nodules to cysts

Question 6

what are the risk factors for acne vulgaris

Answer 6

male
puberty
cushings
oily complextion
androgen excess

Question 7

what are the 4 components of acne vulgaris

Answer 7

keratinization of lower portion of the follicular infundibulum with development of a keratin plug blocking outflow of sebum to skin surface
hypertrophy of sebaceous glands with puberty
lipase-synthesizing bacteria (p. acnes) colonizing upper and midportion of hair follicle
inflammation of the follicle associated with release of cytotoxic and chemotactic factors

Question 8

acne rosacea is what type of disorder

Answer 8

a chronic inflammatory disorder that affects blood vessels and pilosebacous units

Question 9

when does acne rosacea usually occur

Answer 9

b/w 30-50

Question 10

what are some triggers of acne rosacea

Answer 10

sun exposure
alcohol
spicy foods
exercise
stress
temperature extremes

Question 11

what are the four stages of acne rosacea

Answer 11

1. flushing episodes (pre-rosacea)
2. persistent erythema and telangiectasis
3. pustules and papules
4. rhinophyma

Question 12

what is rhinopehyma and where is it seen

Answer 12

skin on nose becomes thick and greasy, hyperplasia of sebaceous glands, connective tissue and vasculature
seen in acne rosacea

Question 13

what sites is acne rosacea normally found

Answer 13

nose and cheeks including nasolabial folds

Question 14

what is seen histologically in acne rosacea

Answer 14

perifollicular infiltrate of lymphocytes surrounded by dermal edema and telangiectasia
in rhinophyma- hypertrophy of sebaceous glands and follicular plugging by keratotic debris

Question 15

what is panniculitis

Answer 15

inflammation of fat lobules or the connective tissue septa separating fat lobules

Question 16

what is erythema nodosum

Answer 16

inflammatory reaction of the connective tissue septa separating fat lobules
not a disease but a fraction to various etiologies

Question 17

erythema nodosum is most common in what patients and located where

Answer 17

females 20-30

usually on anterior aspect of tibia

Question 18

what is seen in erythema nodosum

Answer 18

fever, malaise, and joint pain may precede the rash
painful, red, subcutaneous, elevated nodules
nodules are indurated and poorly circumscribed
bilateral but not symmetrical

Question 19

what are some causes of erythema nodosum

Answer 19

idiopathic
strep
sarcoidosis
inflammatory bowel disease
fungal infection 
pregnancy
meds- OCPs, sulfa, amiodarone, antibiotics
syphilis
TB

Question 20

what is the workup for erythema nodosum

Answer 20

chest X-ray to r/o TB and sarcoidosis
VDRL test to r/o syphilis
CBC, ESR, CRP and cultures as appropriate

Question 21

what is seen histologically in erythema nodosum

Answer 21

septal panniculitis (little to no necrosis of lobule)

early: widening of septa from fibrin, edema and neutrophilic infiltrate
chronic: mononuclear cells and granulomatous inflammation of septum with fibrosis

Question 22

what is a verrucae (wart)

Answer 22

benign growths caused by infection of epidermal cells with human papilloma virus (HPV)

Question 23

verrucae (warts) generally occur in what population

Answer 23

children and young adults

Question 24

how are warts transmitted

Answer 24

skin to skin contact

Question 25

intralesional brown-black dots are pathognomonic of what and represent what

Answer 25

verrucae (warts) | represent thrombosed vessels

Question 26

the common wart (verruca vulgaris) is most common where

Answer 26

elbows knees fingers palms

Question 27

what does the common wart (verruca vulgaris) present as

Answer 27

flesh-colored papule with hyperkeratotic surface

Question 28

the flat wart (verruca plana) presents how

Answer 28

flesh colored, slightly raised papule and flat surface

Question 29

where are flat warts (verruca plana) usually found

Answer 29

chin dorm of hands leg

Question 30

plantar wart (verruca plantaris) presents as what

Answer 30

flesh-colored papule with hyperkeratotic surface

Question 31

what wart is found on the underside of the foot and may cause pain if on pressure areas

Answer 31

plantar wart (verruca plantaris)

Question 32

what cases plantar warts (verruca plantaris)

Answer 32

HPV 1

Question 33

what is the most common STD

Answer 33

anogential wart (condyloma acuminatum)

Question 34

what causes anogenital warts (condyloma acuminatum)

Answer 34

HPV 6 and 11 (STDs)

Question 35

soft, fleshy pink papillomas on the genitalia, perineum, and anus are seen in what

Answer 35

anogential warts (condyloma acuminatum)

Question 36

what is seen histologically in verrucous

Answer 36

exophytic "church spike" of "veracious" acanthosis koilocytes (cells with vacuolated cytoplasm) infected ells may show prominent keratohyline granules

Question 37

moluscum contagiosum is caused by what

Answer 37

poxvirus

Question 38

how is moluscum contagiosum spread

Answer 38

skin to skin contact and is highly contagious

Question 39

what does moluscum contagiosum present as

Answer 39

asymptomatic smooth, dome-shaped papule with central umbilication flesh colored and translucent

Question 40

papules with a cheezy core that can be expressed are seen in what

Answer 40

moluscum contagiosum

Question 41

what is seen histologically in moluscum contagiosum

Answer 41

``` cup-shaped lesion with scalloped border verrucous acanthosis (epidermal hyperplasia) molluscum bodies in cells of stratum corner and stratum granulosum (ovoid, homogeneous, cytoplasmic inclusion bodies) ```

Question 42

impetigo is distinguished from contact dermatitis how

Answer 42

painful leasions in impetigo

Question 43

what is the most common form of impetigo

Answer 43

nonbullous

Question 44

what sites is nonbullous impetigo found

Answer 44

face and extremities

Question 45

honey colored crust when vesicles rupture is seen in what

Answer 45

nonbullous impetigo

Question 46

what does nonbullous impetigo present as

Answer 46

papules that progress to vesicles on erythematous base

Question 47

bullous impetigo is seen in what patients and where

Answer 47

young children | trunk is more frequently affected

Question 48

bullous impetigo presents as what

Answer 48

vesicles tha tenlarge to form flaccid bullae w/ clear yellow fluid contents later becomes darker and more turbid ruptured bull leave thin brown vrust

Question 49

what is the most common cause of impetigo (both kinds)

Answer 49

staph aureus

Question 50

what is seen histologically in impetigo

Answer 50

accumulation of neutrophils under stratum corneum