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BASIC Exam Study Guide > Other general dermatology > Flashcards

Other general dermatology Flashcards

1
Q

Name the diagnosis.

  • What are classic areas of involvement?
  • What lab value abnormality is notable?
  • What disorders or medications is this associated with?
A

Eruptive xanthoma

  • Numerous red-yellow papules on extensor surfaces, buttocks, intertriginous areas
  • Triglycerides > 3,000 mg/dL
  • Associated with type I, IV and V hyperlipidemias, oral retinoids
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2
Q

Name the diagnosis.

  • What are classic areas of involvement?
  • What lab value abnormality is notable?
  • What disorders or medications is this associated with?
A

Eruptive xanthoma

  • Numerous red-yellow papules on extensor surfaces, buttocks, intertriginous areas
  • Triglycerides > 3000 mg/dL
  • Associated with type I, IV and V hyperlipidemias, oral retinoids
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3
Q

Name the diagnosis.

  • What are classic areas of involvement?
  • What lab value abnormality is notable?
  • What disorders or medications is this associated with?
A

Eruptive xanthoma

  • Numerous red-yellow papules on extensor surfaces, buttocks, intertriginous areas
  • Triglycerides > 3,000 mg/dL
  • Associated with type I, IV and V hyperlipidemias, oral retinoids
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4
Q

Name the diagnosis.

  • What is the best treatment option?
A

Xanthelasma

  • Plane xanthoma on eyelids
  • Only 50% have hyperlipidemia
  • Surgery is best treatment option
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5
Q

Name the diagnosis.

  • What is the best treatment option?
A

Xanthelasma

  • Plane xanthoma on eyelids
  • Only 50% have hyperlipidemia
  • Surgery is best treatment option
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6
Q

What percentage of patients with xanthelasma have hyperlipidemia?

A

50%

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7
Q

Name the types of cutaneous xanthomas. (6)

A
  • Eruptive xanthomas
  • Tuberous xanthomas
  • Tendinous xanthomas
  • Plane xanthomas
  • Xanthelasma
  • Verruciform xanthoma
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8
Q

What is the classic histopathology of cutaneous xanthomas?

  • What is present in the dermis?
  • What may also be present?
A
  • Foam cells (macrophages with lipidized cytoplasm) in dermis
  • Foam cells are predominantly of superficial dermis in plane xanthomas and deeper in dermis/subcutis in tuberous and tendinous xanthomas
  • Touton giant cells may also be present
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9
Q

Name the diagnosis.

  • Where is this mainly found?
  • What disorders is this seen in?
A

Tuberous xanthomas

  • Yellow-pink indurated nodules
  • Mainly on elbows and knees
  • Most strongly associated with type II and III hyperlipoproteinemias
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10
Q

Name the diagnosis.

  • Where is this mainly found?
  • What disorders is this seen in?
A

Tuberous xanthomas

  • Yellow-pink indurated nodules
  • Mainly on elbows and knees
  • Most strongly associated with type II and III hyperlipoproteinemias
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11
Q

Name the diagnosis.

  • Where is this mainly found?
  • What disorders is this seen in?
A

Tendinous xanthoma

  • Firm nodules on Achilles tendon and extensor tendons of fingers/hands
  • Usually seen in type II hyperlipidemia ( > type III)
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12
Q

Name the diagnosis.

  • If this is found on the palmar/finger creases, what is it called, and what disorder is it pathognomonic for?
  • If this is found on the intertriginous areas and web spaces, what disorder is it pathognomonic for?
A

Plane xanthoma

  • Occurrence in palmar/finger creases (xanthoma striatum palmare) is pathognomonic for dysbetalipoproteinemia
  • Occurrence in intertriginous areas and web spaces of fingers usually diagnostic for homozygous familial hypercholesterolemia (type II hyperlipidemia)
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13
Q

Name the diagnosis.

  • If this is found on the palmar/finger creases, what is it called, and what disorder is it pathognomonic for?
  • If this is found on the intertriginous areas and web spaces, what disorder is it pathognomonic for?
A

Plane xanthoma

  • Occurrence in palmar/finger creases (xanthoma striatum palmare, as in this case) is pathognomonic for dysbetalipoproteinemia
  • Occurrence in intertriginous areas and web spaces of fingers usually diagnostic for homozygous familial hypercholesterolemia (type II hyperlipidemia)
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14
Q

Name the diagnosis.

  • Where is this typically found?
  • Is this associated with a hyperlipidemia?
  • What is the histopathology of this? What occurs in the epidermis and dermal papillae?
A

Verruciform xanthoma

  • Verrucous plaque(s) typically in mouth or genital area
  • NOT associated with hyperlipidemia
  • Unique histology: papillomatous epidermal hyperplasia with foam cells in the dermal papillae
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15
Q

What is the suspected pathogenesis of cutaneous amyloidosis?

  • What is its histopathology?
A
  • Extracellular deposition of amyloid, a fibril protein in a cross-beta-pleated sheet
  • Basic histology: homogenous, eosinophilic, fissured masses that stain with Congo red and have green birefringence with polarized light
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16
Q

Name the diagnosis.

A

Lichen amyloidosis

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17
Q

Name the diagnosis.

A

Macular amyloidosis

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18
Q

Name the diagnosis.

A

Nodular amyloidosis

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19
Q

Name the diagnosis.

A

Nodular amyloidosis

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20
Q

Name the three types of localized cutaneous amyloidosis.

A
  1. Macular amyloidosis
  2. Lichen amyloidosis
  3. Nodular amyloidosis
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21
Q

What is the derivation of the amyloid in the following (i.e., what makes up the amyloid)?

  • Macular
  • Lichen
  • Nodular
A
  • Macular: Keratinocyte tonofilaments (usually keratin 5)
  • Lichen: Keratinocyte tonofilaments (usually keratin 5)
  • Nodular: IgG light chains
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22
Q

What does cutaneous amyloidosis stain with? (4)

A
  • Congo red (classic association)
  • Crystal violet
  • PAS
  • Thioflavin T
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23
Q

Describe primary systemic amyloidosis.

  • What is the usual underlying cause?
  • What are the notable exam findings?
  • What should be checked?
A
  • Amyloid light chain-type (AL) amyloidosis
  • Can involve several organ systems
  • Look for mucocutaneous lesions (30% of patients)
  • Due to underlying plasma cell dyscrasia
  • Waxy, translucent or purpuric papules/nodules/plaques
  • Ecchymoses/pinch purpura (eyelids, neck, anogenital, axillae)
  • Macroglossia
  • Carpal tunnel syndrome
  • Check UPEP/SPEP and immunofixation electrophoresis (IFE)
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24
Q

Describe secondary systemic amyloidosis.

  • What is it usually a sequela of?
  • What is it composed of?
  • Where does it deposit usually?
A
  • Sequela of chronic inflammatory disease
    • ​I.e., TB, scleroderma, ankylosing spondylitis
  • Made up of AA amyloid
  • Rarely deposited in skin; mainly kidneys, liver, spleen, adrenals, heart
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25
What composes the amyloid classically seen in hemodialysis patients? * What area is usually involved?
**A-beta-2M amyloid (a.k.a. beta-2 microglobulin)** * Usually no skin involvement, but may see subcutaneous nodules on the lower back
26
What disorder is this finding classically associated with?
**Primary systemic amyloidosis (amyloid light chain-type, AL)** **(Macroglossia)**
27
What disorder is this finding classically associated with?
**Primary systemic amyloidosis** **(Pinch purpura)**
28
What are the classic histology findings of **primary systemic amyloidosis**? * Where is amyloid deposited?
* Amyloid throughout the dermis and subcutis, in sweat glands and blood vessel walls
29
Name the diagnosis.
**Melasma** * Symmetric, light to dark brown/gray irregular patches on face * Three patterns: centrofacial, malar and mandibular * Four types: epidermal, dermal, mixed and indeterminate * Epidermal areas accentuated with **Wood's lamp**; dermal areas are not
30
Name the diagnosis.
**Melasma** * Symmetric, light to dark brown/gray irregular patches on face * Three patterns: centrofacial, malar and mandibular * Four types: epidermal, dermal, mixed and indeterminate * Epidermal areas accentuated with **Wood's lamp**; dermal areas are not
31
Name the diagnosis.
**Melasma** * Symmetric, light to dark brown/gray irregular patches on face * Three patterns: centrofacial, malar and mandibular * Four types: epidermal, dermal, mixed and indeterminate * Epidermal areas accentuated with **Wood's lamp**; dermal areas are not
32
What are some exacerbating factors of melasma? * What are environmental, hormonal, endocrine and medication causes?
* **Sun exposure** * **Estrogen** (pregnancy, OCPS, HRT) * Genetic influences * Thyroid dysfunction * Medications (phenytoin, phototoxic drugs)
33
What are the treatment options for **melasma**? * What topicals can be used? (3)
* Broad-spectrum sun protection/avoidance * Epidermal component can be treated with **hydroquinone, tretinoin, TCS,** resurfacing
34
Describe the histopathological findings of **melasma**. * What happens to melanin, melanophages and melanocytes?
* Increased melanin in all layers of epidermis * Increased melanophages * Normal-to-increased epidermal melanocytes
35
Name the diagnosis. * What is this due to? * What is this physical exam finding called? * What may also be seen?
**Pellagra** **Vitamin B3 (niacin) deficiency** * This physical exam finding is called **"Casal's necklace"** * Also see photosensitivity (esp. dorsal hands), cheilitis
36
Name the diagnosis. * What is this due to? * What is this physical exam finding called? * What may also be seen?
**Pellagra** **Vitamin B3 (niacin) deficiency** * This physical finding is called **"Casal's necklace"** * Also see **photosensitivity (esp. dorsal hands), cheilitis**
37
Name the diagnosis. * What is this due to? * What is the physical exam *buzzword*?
**Phyrnoderma** **(vitamin A deficiency)** * Keratotic follicular papules resembling *toadskin*
38
Describe cutaneous features of vitamin B6 (pyridoxine) deficiency. (4) * Who is considered to be at highest risk?
* Seborrheic dermatitis-like rash * Angular cheilitis * Glossitis * Intertrigo _Highest risk of deficiency in alcoholics_
39
Name the diagnosis. * What is this due to? * What may also be seen?
**Pellagra** **Vitamin B3 (niacin) deficiency** * Findings are Casal's necklace, photosensitivity (especially of dorsal hands), cheilitis
40
Name the diagnosis. * What is this due to? * What may also be seen? (3)
**Scurvy** **(vitamin C deficiency)** * Corkscrew hair * Perifollicular hemorrhage and hyperkeratosis * Hemorrhagic gingitivitis * **Splinter hemorrhage of nails**
41
Name the diagnosis. * What is this due to? * What may also be seen? (3)
**Scurvy** **(vitamin C deficiency)** * Corkscrew hair * Perifollicular hemorrhage and hyperkeratosis * **Hemorrhagic gingivitis** * Splinter hemorrhage of nails
42
Name the diagnosis. * What is this due to? * What may also be seen? (3)
**Scurvy** **(Vitamin C deficiency)** * **Corkscrew hair** * Perifollicular hemorrhage and hyperkeratosis * Hemorrhagic gingitivitis * Splinter hemorrhage of nails
43
What are the (4) classic Ds of pellagra, and what is the deficiency?
* Dermatosis, diarrhea, dementia, death * Deficiency of vitamin B3 (niacin)
44
What are some causes of pellagra (vitamin B3, or niacin, deficiency)? (6) * Hint: think about what is needed to make niacin. * What disorders? * What medications?
1. **Hartnup disease** 2. Alcoholism 3. **Carcinoid** syndrome 4. **Isoniazid** 5. **Azathioprine** 6. Malabsorption
45
What nutritional deficiency is this?
**Acquired zinc deficiency** * Perianal, perioral and acral erosions
46
What nutritional deficiency is this?
**Zinc deficiency** * Perianal, perioral and acral erosions * Can look like a diaper rash
47
Name the diagnosis. * What is in the tissue? * At what sites is this most common?
**Gout** * Monosodium urate crystals in tissue * Gouty tophi (firm white-yellow subcutaneous nodules) * Most common on: * Ear helix * Skin over small joints (fingers, toes)
48
Name the diagnosis. * What is in the tissue? * At what sites is this most common?
**Gout** * Monosodium urate crystals in tissue * Gouty tophi (firm white-yellow subcutaneous nodules) * Most common on: * Ear helix * Skin over small joints (fingers, toes)
49
Name the diagnosis. * What is in the tissue? * At what sites is this most common?
**Gout** * Monosodium urate crystals in tissue * Gouty tophi (firm white-yellow subcutaneous nodules) * Most common on: * Ear helix * Skin over small joints (fingers, toes)
50
Name the diagnosis.
**Colloid milium** * Happens in adults on photodamaged skin (yellow papules in photo-exposed areas) * Also a juvenile form
51
Name the diagnosis.
**Colloid milium** * Happens in adults on photodamaged skin (yellow papules in photo-exposed areas) * Also a juvenile form
52
What is the definition of **hirsutism**?
* Increased terminal hair growth in a female with a "male pattern" * E.g., upper lip, cheeks, central chest, suprapubic area, back * Related to increased androgens
53
What are the four major causes of **hirsutism**?
* PCOS * Congenital adrenal hyperplasia (CAH) * Neoplastic * Constitutional hirsutism (no hormonal abnormalities are present)
54
What enzyme is deficient in **congenital adrenal hyperplasia**? * What is therefore present in excess?
**21-hydroxylase** * Leads to increased 17-OH-progesterone level
55
What is the treatment options for **hirsutism**? * What orals? What topicals? What procedures?
* **Antiandrogens** (spironolactone, leuprolide, finasteride) * **OCPS** * Topical eflornithine (a.k.a. Vaniqa) * Metformin * Depilatory agents or lasers
56
What hormone plays a role in **androgenetic alopecia**? * What is the converting enzyme?
**Dihydrotestosterone (DHT)** * **5α-reductase** converts testosterone to DHT
57
What are the key histology findings in **androgenetic alopecia**? * What types of hairs are more abundant and less abundant? * What phase is shortened?
* **Increased vellus and miniaturized hairs** * **Decreased terminal hairs** * **Shortened anagen phase** (a.k.a. "catagen/telogen shift") * **Increased fibrous streamers** * Fibromucinous tracts underneath miniaturized hairs * Hairs cycling more rapidly out of anagen phase
58
What is the pattern of hair loss of **androgenetic alopecia** in men?
* Progressive **frontotemporal hairline** recession * Thinning over frontal crown and vertex scalp
59
What is the pattern of hair loss of **androgenetic alopecia** in women? * What is preserved? * Where does thinning occur? * What is the physical exam *buzzword*?
* **Preservation of frontal hairline** with progressive **thinning from vertex** to frontal scalp * Increased central part width creates ***"Christmas tree" pattern***
60
What are the treatment options for **androgenetic alopecia**? (6) * Which of these (2) are FDA approved?
1. **Minoxidil - FDA approved** 2. **Finasteride - FDA approved** 3. Dutasteride 4. Spironolactone 5. Low level laser 6. Hair transplant
61
How does **minoxidil** work? * How does it affect hair growth and scalp circulation? * Where on the scalp is it believed to help the most?
* **Lengthens anagen phase** * Increases blood flow * Note: effect is better on vertex scalp than frontal scalp
62
How does **finasteride** work in androgenetic alopecia? * What does it impair the conversion of by inhibiting what enzyme? * For whom is it FDA approved?
* **Type II 5 alpha-reductase inhibitor** * Decreases conversion of testosterone to **DHT** * Only FDA approved for hairloss in males
63
What is the work up for **itch without rash** (if one were to do a million dollar systemic work up)? * Think of at least 10 tests, etc., and why you would obtain them.
1. CBC (polycythemia vera) 2. BMP (chronic kidney disease) 3. LFTs (biliary pruritus) 4. SPEP, UPEP (multiple myeloma) 5. TSH (hyperthyroidism) 6. Hgb A1c (diabetes) 7. HIV test 8. Medication reconciliation (e.g., opiates) 9. Pemphigoid panel (early BP) 10. CXR (adenopathy, occult malignancy)

BASIC Exam Study Guide (11 decks)

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