Robbins 25: Part 2

Question 1

Panniculitis

Answer 1

inflammation of adipose tissue in subQ fat

Question 2

What is erythema nodusum?

Answer 2

Type 4 delayed HS reaction to

1. Infection: B-hemolytic strep and TB
2. Crohns (precedes flair)
3. Sarcoidosis
4. Coccidiomycosis
5. Drugs: Sulfa and OCP

Question 3

Describe what erythema nodusum lesion looks like and describe the progression

Answer 3

1. Painful, red plaque and nodule; more readily palpated than seen
2. Over weeks, flattens => becomes bruise-like with NO residual scar

Question 4

What do you see in histology of erythema nodosum?

Answer 4

1. Septal panniculitis: inflammation of septa between fat lobules: edema + fibrin + exudation and neutrophils
2. Later: Septal fibrosis
   
   1. Lymphocytes
   2. Mulinucleated giant cells => septal fibrosis

Question 5

Pt’s with rosacea have high cutaneous levels of what; how does this play a role in the pathogenesis?

Question 6

Histologic diagnosis of erythma nodosum requires what?

Answer 6

Biopsy of deep wedge of tissue to reach subcutis

Question 7

What can infective agents can cause dermatoses?

Answer 7

1. HPV
2. Molluscum contagiosum
3. Impetigo
4. Fungal infections

Question 8

What is the most common type of wart (verruca) and where does it occur on body and how do they appear grossly?

Answer 8

• Verruca vulgaris: hands (dorsum) and periungual areas
• Appear as gray-white - tan, flat to convex, small papules w/ r_ough, pebble-like surface_

Question 9

MC causes of warts (verrucae)?

Answer 9

1. HPV 6 & 11 => anogenital warts
2. HPV 16 => in-situ SCC of genitals and bowenoid papulosis (similar to CIS, but regresses)
3. HPV 5 & 8 => high association with SCC, especially in ppl with epidermodysplasia verruciformis

Question 10

Sc of warts due to direct contact with HPV

Answer 10

1. Self limiting
2. regresses spontaneously in 6 months - 2 years

Question 11

Molluscum Contagiosum

1. MC in:
2. Due to:
3. Presentation:

Answer 11

1. Children and young adults
2. Direct contact with pox virus
3. Self limiting: MC in trunk and anogenital region
   
   1. Firm, pruritis, pink or skin colored umbilicated papules

Question 12

Molluscum Contagiosum

1. What stain is used
2. Histo

Answer 12

1. Giemsa stain
2. Mulluscum bodies = ellipsoid, homogenous, cytoplasmic inclusion

Question 13

Impetigo is most often caused by what?

Answer 13

S. aureus

Question 14

Pathogenesis of impetigo leading a blister is a from a bacterial toxin that does what?

Answer 14

Cleavage of desmoglein 1, protein responsible for cell-cell adhesion within uppermost epidermal layers

Question 15

What is impetigo?

Answer 15

Highly infectious bacterial infection of the skin (hand and face) due to Staph aeurus

Question 16

What does impetigo look like?

Answer 16

1. Erythemous macule => small pustules, which break into => shallow erosions that forms a honey-colored crust

Question 17

Fungal hyphae of dermatophytes causing tinea can be stained with what and will appear how?

Answer 17

Stained with PAS —> bright pink to red hyphae within stratum corneum

Question 18

types of panniculitis

Answer 18

1. erythema nodusum (painful)
2. erythema induratum

Question 19

An African-American patient with pulmonary disease/hypercalcemia and erthema nodusum should raise suspicious of what?

Answer 19

SARCOIDOSIS

Question 20

Adolescents and menopausal women with necrotizing vasculitis of sm-medium arteries and veins in deep dermis and subcutis + granulomatous inflammation w/ zones of caseous necrosis involving the fat lobule is associated with what?

Question 21

What is this

Answer 21

ringworm, due to a superficial fungal infection.

Question 22

SJS and TEN is commonly associated with what