Skin: High Yield Questions

Front 1

What are the 3 types of acquired nevi? Please describe

Back 1

Junctional: Begin at the dermal-epdermal junction -flat

Compound: found at dermal-epidermal junction- elevated or dome like

Dermal: Found in the dermis - More pedunculated

Front 2

describe a small congenital nevus (size and malignancy potential)

Back 2

<1.5cm and low malignant potential

Front 3

describe a medium congenital nevus (size and malignancy potential)

Back 3

1.5-19.9 cm and malignant potential is questionable and are often prophylactically removed to be sure.

can depend on the location of the nevi, if easily observed then can just monitor. If in a difficult to monitor place, just get that bad boy out

Front 4

describe a large/giant congenital nevus (size and malignancy potential)

Back 4

5% or greater of body of greater than 20cm, definite increased risk with melanoma. Treatment is to remove if possible.

Front 5

this nevi is normally not going to be malignant and gets its color from the Tyndall effect. What is this? What is the Tyndall effect?

Back 5

Blue Nevus

TE=Scattering of light that depends on the depth of the pigment

Front 6

what is a dysplastic nevi? what does it look like?

Back 6

sign of increased cancer risk, has irregular borders (not round) and dark pigmentation. Often biopsied to determine whether they are a melanoma. Classic FRIED EGG APPEARANCE.

Front 7

A patient has a hamartomatous growth of smooth muscle fibers leaving a large brown macule with a patch of hair. What is this? what can it be associated with?

Back 7

Becker's Nevus

Can be associated with hypoplasia of ipsilateral limb or breast

Front 8

What is the most common type of melanoma, and where is it located?

Back 8

Superficial Spreading Type Melanoma

Found most often on the back of males and the legs of females.

Front 9

2nd most common melanoma and is commonly very aggressive, often resemble other skin lesions.

Back 9

Nodular Type Melanomas

Front 10

Lentigo Maligna is what? cause?

Back 10

an often non aggressive melanoma.

known as 'liver spots' by old people

due to sun

Front 11

melanoma occuring around the nails, palms, and soles (normally on the foot). VERY aggressive, and the only type of melanoma seen in pigmented races. What is this?

Back 11

Acral Lentiginous Melanoma (ALM)

Front 12

What is a Hutchinson's Sign? What does ti show?

Back 12

Dark band in the nail and proximal nail fold , indicates an ACRAL LENTIGINOUS MELANOMA

Front 13

What is the Breslow depth? used for what?

Back 13

Granular layer (stratum granulosum) to the deepest portion of the malignant cells
This is the determinant of the prognosis of the melanoma: >1mm in depth is recommendation for sentinel lymph node biopsy.

Front 14

when do you get a sentinel lymph node biopsy? What is this?

Back 14

when Breslow depth is greater than 1mm

this is getting rid of the lymph node that the melanoma is most likely to spread to

Front 15

What are the ABCDE's of melanoma?

Back 15

Asymmetry -
Border
Color – multiple colors
Diameter (>6mm)
Evolving – changing over time (especially if the patient notices)

Front 16

what happens to the epidermal cell cycle time in psoriasis?

Back 16

decreased by a factor of 8 (turns over faster)

Front 17

what is Auspitz sign? what do you see this with?

Back 17

bleeding upon removal of a scale

psoriasis

Front 18

what % of population is affected with psoriasis?

**TEST

Back 18

2-3%

Front 19

what moderates Psoriasis? (cause)

Back 19

T cells

Front 20

what is Kebnerization (sp)

Back 20

trauma leads to psoriasis formation in a person who is predisposed

Examples:
Pt gets a tattoo, breaks out in psoriasis

when a skin graft develops psoriasis

person scratches one place of psoriasis and it leads to more

Front 21

Reiter’s Triad?

Back 21

Urethritis, Conjunctivitis, Arthritis

and PSORIASIS OF THE PENIS (ballinitis)

ouch! ouch! ouch!

Front 22

Reiter's Disease is associated with what genotype?

*MUST KNOW

Back 22

HLA B27

Front 23

HLA B27 is the genotype for what disease?

Back 23

Reiter's Disease

Front 24

What drugs trigger psoriasis? 2

Back 24

Lithium

Beta Blockers

Front 25

discuss how guttate psoriasis will respond to treatment

***TEST

what caused this again?

Back 25

1.3 will clear and never have psoriasis again

1/3 will clear and get psoriasis again

1/3 will progress

cause: upper respiratory strep

pharengitis

Front 26

what causes guttate psoriasis?

Back 26

upper respiratory strep

pharengitis

Front 27

Patient has Urethritis, arthritis, ocular, oral, and skin lesions (psoriasis).

what does this person have?

Back 27

Reiter’s Disease

associated with psoriasis

Front 28

on a gram stain, how will staph a look?

Back 28

they are gram positive cocci

they will be little purple balls in CLUSTERS

Front 29

on a gram stain, how will strep pyogenes look?

Back 29

they are gram positive cocci

they will be little purple balls in CHAINS

learning tool: strep-strip-chain

Front 30

What is erythema multiform associated with (not what directly causes its activation, but what is the underlying cause)

Back 30

herpes simplex

mycoplasma

Front 31

what normally causes Steven Johnson's and Toxic Epidermal Necrolysis? #1?

Back 31

drug reaction

anti-convulsants

Front 32

what determines if you have SJS vs TEN?

Back 32

< 10% BSA = SJS
10% - 30% = SJS-TEN
> 30% = TEN

Front 33

what is a positive Nikolsky's Sign?

seen in?

Back 33

Epidermal detachment reproduced by mechanical pressure on an area of erythematous skin

SJS & TEN

Front 34

what must be involved for the diagnosis of SJS?

Back 34

oral mucosa + 2 or more sites

Front 35

Erythema Nodosum

caused by most often? what is it? where does it affect?

what type of biopsy would you use for this?

Back 35

Commonly caused by birth control pills,

tender ill-formed bruise-like spots.

(inflammation of the fat)

punch mutha ucka

Front 36

what is the characteristic lesion of small vessel vasculitis?

Back 36

PALPABLE PURPURA

Front 37

you see PALPABLE PURPURA, what does the person have?

Back 37

small vessel vasculitis

Front 38

you have a young child, who recently had an upper respiratory infection and severe abdominal pain. they also have palpable purpura. What does this patient have?

Back 38

Henoch-Schonlein Purpura

Front 39

how long does uticaria last for (hives)

Back 39

<24hours, no scale, no scar remains!!!

Front 40

Angioedema?

Back 40

swelling and no itching

Front 41

what is Seborrheic Dermatitis? caused by?

Back 41

Chronic, inflammatory disease

due to yeast (malassea furfur)

Front 42

if you see salmon colored plaques, what should you be thinking

Back 42

Pityriasis Rosea

Front 43

if you see plaques with islands of sparing, what should you think?

Back 43

Pityriasis Rubra Pilaris

Front 44

you have a patient with Benign, usually asymptomatic, distinctive, self-limiting patches. The etiology is unknown but possibly viral. You see a Collarette scale

what is this?

Back 44

Pityriasis Rosea

Front 45

What is a Herald Patch? What is it seen in?

Back 45

first lesion, usually the largest (pts think it was ringworm)

Seen In: Pityriasis Rosea

Front 46

a patient comes in with Lesions are oriented along skin lines giving the appearance of a Christmas tree. What do they have?

Back 46

Pityriasis Rosea

Front 47

a patient has many of the signs of Pityriasis Rosea. You should do a history though to see if the pt has?

Back 47

secondary syphilis

Front 48

what are the 5 P's

what are they for?

Back 48

papules, purple, polyangular, planar. puritic

Lichen Planus

Front 49

what is Lichen Planus associated with?

Back 49

Association with viral hepatitis

Front 50

if you see Wickham's striae, what does the patient have?

Back 50

Lichen Planus

Front 51

If a patient has a painless chancre what do they have? what is this?

Back 51

1º Syphilis

its a painless erosion

Front 52

patient comes in with Copper Penny oval papules and plaques on the palms. whats this ucka have?

Back 52

2º Syphilis

Front 53

what is the most infectious lesion with secondary syphilis? describe

Back 53

Condyloma Lata

Ooze fluid filled with spirochetes
Flesh colored smooth, papillated, cauliflower like vegetations
Occur on genital and perianal areas

Front 54

what is the most infectious stage of syphilis?

Back 54

2º Syphilis

Front 55

what is the treatment for Syphilis ?

Back 55

PENICILLIN G or DOXYCYCLINE (100mg)

Front 56

11 criteria of SLE

Back 56

MD SOAP BRAIN

M – Malar Rash
D – Discoid Lesions
S – Serositis
O – Oral Ulcers
A – ANA
P – Photosensitivity
B – Blood (Hematologic abnormalities)
R – Renal abnormalities
A – Arthritis
I – Immunologic (other autoantibodies)
N – Neurologic (Seizures, Psychosis)

Front 57

which type of lupus do you expect a negative ANA in?

Back 57

Discoid Lupus

Front 58

you see a scale that penetrates down into the follicular orifices creating a “carpet tack” appearance. what does this person have?

Back 58

Discoid Lupus

Front 59

lupus with atrophy, hypopigmentation and scarring is what kind of lupus?

Back 59

discoid lupus

Front 60

SS-A (Ro) is usually positive
SS-B (La) may be positive

what disease are we talking about?

Back 60

Subacute Lupus Erythematosus

Front 61

does Subacute Lupus Erythematosus spare the knuckles?

Back 61

yeah

Front 62

Dermatomyositis vs. SCLE

which affect knuckles?

Back 62

Dermatomyositis

Front 63

patient has ANA positive with anti-histone antibodies

what do they have

Back 63

Drug Induced Lupus Erythematosus

Front 64

child has Annular and polycyclic lesions. what is this?

Back 64

neonatal lupus

Front 65

what is associated with neonatal lupus?

Back 65

3rd degree congenital heart block

Front 66

if you have a woman with Dermatomyositis what MUST you look for?

Back 66

ovarian cancer

Front 67

you have a patient who has lost strength in the proximal muscles and has a heliotrope rash. What do they have?

Back 67

dermatomyositis

Front 68

if you see heliotrope erythema of eyelids, what do you have

Back 68

dermatomyositis

Front 69

if you see Gottron's papules, what does your patient have? what are they

Back 69

Dermatomyositis

Round, smooth, violaceous/red, flat-topped papules that occur over the knuckles and lateral aspects of the digits
Spares the area between the knuckles (Lupus spares the knuckles)

Front 70

if you see the autoantibody anti-Jo-1 antibody what does the patient have?

Back 70

dermatomyositis

Front 71

what is the most common cause of death in scleroderma?

Back 71

Pulmonary Dz

Front 72

What is Raynaud's phenomenon, what is it seen in?

Back 72

Vasospastic disorder precipitated by temperature changes

(blue fingers)

seen in sclerosis

Front 73

what is CREST syndrome?

Back 73

syndrome-variant of systemic scleroderma with the most favorable prognosis (limited systemic involvement)

Calcinosis cutis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Front 74

what are Anticentromere antibodies is associated with?

Back 74

CREST

Front 75

if you have ANA to Type II collagen what do you have?

Back 75

Relapsing Polychondritis

Front 76

Relapsing Polychondritis

Back 76

Primarily effects cartilage

Autoantibody to Type II collagen

Redness, swelling and pain of cartilaginous portion of the ear – spares the lobe

Front 77

Morphea

Back 77

Localized scleroderma

One or more circumscribed areas of purple discoloration--> progresses to a thickened, firm, hairless, ivory patch

Front 78

Sjogren’s Syndrome

Back 78

Autoimmune disorder that primarily affects secretory glands

DRY

Front 79

do discoid lesions scar

Back 79

roger roger

what's your vector Victor

Front 80

if you see IgA deposits in the upper dermis what does the person have?

Back 80

dermatitis Herpetiformis

Front 81

if you see gluten-sensitive enteropathy what might your patient also have

Back 81

Dermatitis Herpetiformis

Front 82

if you see Anti-endomesial antibodies

what does the pt have

Back 82

Dermatitis Herpetiformis

Front 83

which disease has an intraepidermal split?

Back 83

PEMPHIGUS

Front 84

IgG autoantibodies directed against the cell surface of keratinocytes destroy the adhesion between epidermal cells


What does this person have

Back 84

PEMPHIGUS

we were told about IgG with BP..which is what you may have been thinking. but note that it said between epidermal cells. remember that pemphigus is intraepidermal while BP is subepidermal

Front 85

dude comes in with oral lesions, he says his predominant symptom is he "hurts". He has underyling lymphoma. What does this guy have?

Back 85

PEMPHIGUS

Front 86

Autoantibodies to Desmoglein 1 and 3 correlate to what

Back 86

Pemphigus Vulgaris

Front 87

if you see only desmolein 1 what do you have?

Back 87

pemphigus foliaceus (lesser form of pemiphigus)

Front 88

dude comes in in a wheelchair with an EMT behind him from the nursing home. He is frail and covered in blisters all over the place. What symptom bothers you the most? This shit itches me like a motha ucka he says.

Whats this guy got?

Back 88

Bullous Pemphigoid

Front 89

if you see BP230 and BP180 autoantibodies, what does this person have?

Back 89

Bullous Pemphigoid

Front 90

Bullous Pemphigoid effects where?

Back 90

SUBEPIDERMAL

Front 91

what happens during the migratory phase in wound healing? 2

Back 91

angiogenesis and Epithelialization

Front 92

what cells flatten out to cover a wound?

Back 92

basal cells

Front 93

what contributes to contraction to pull the wound edges together to reduce defect? how long does this process last?

Back 93

myofibroblasts

12-15 days

Front 94

Please summarize the 4 phases of wound healing

Back 94

Inflammatory

Migratory

Proliferative

Scar Remodeling

Front 95

what happens in the inflammatory phase of wound healing (3)

Back 95

Hemostasis/vasoconstriction
Vasodilation
Phagocytosis

Front 96

what happens in the proliferative phase? 2

Back 96

Fibroplasia
Contraction

Front 97

vitamin C is necessary for what process? deficiency leads to?

Back 97

wound healing

scurvy

Front 98

Zinc toxicity inhibits ...?

Back 98

macrophage migration and phagocytosis—so be careful not to overdose!

Front 99

what does a zinc deficiency lead to?

Back 99

inhibits cellular proliferation and granulation tissue formation

Front 100

what is Zinc necessary for?

Back 100

Necessary co-factor for DNA and RNA synthesis

Front 101

what do steroids do to wound healing?

Back 101

INHIBIT ALL ASPECTS

Front 102

if you have someone on long term steroids, what can you give the patient in order to reverse the negative effect?

Back 102

Vitamin A

Front 103

in diabetes, what is risk of infection like compared to a normal person?

Back 103

Infection 5 times normal population

Front 104

Simple lacerations
Surgical incisions
Most dog bites
Kitchen knife wounds

are example of wounds that can be closed by...

Back 104

primary intention

Front 105

if you have loss of soft tissue, contaminated wound left open what kind of wound healing would you have?

Back 105

secondary intention

Front 106

if you have a wound with considerable granulation tissue that has to heal on its own, what type of healing is this

Back 106

secondary intention

Front 107

Puncture wounds
Superficial abrasions
Most ulcers
Snake bites

what type of wound closure does this use?

Back 107

secondary intention

Front 108

if you have a wound left open for 4-5 days, and is grossly contaminated, what type of wound closure do you use?

Back 108

tertiary (you wait til the tissue looks a bit better after you clean it, then you sew that bad boy up)

Front 109

Uncontrollable hemorrhage (Pack and pressure)
Acute wounds with questionably viable tissue or with foreign bodies
Human Bites!

Back 109

tertiary intention

Front 110

when do you use absorbable versus non absorbable sutures?

Back 110

Absorbable: inside the body

Non-Absorbable: outside the body

Front 111

what do you use to flush out wounds? do you use peroxide, iodine, or povodine in a wound?

Back 111

NORMAL SALINE

none of that other ish, that stuff hurts the wound

Front 112

how long do you keep removable sutures in the skin?

what about in the face?

Back 112

7-10 days

face: 3-5

Front 113

what is the most common type of cancer?

Back 113

BCC

Front 114

basal cell carcinoma is mostly caused by what?

Back 114

UV light

Front 115

the second most common type of skin cancer with the potential to metastasize with a high cure rate if caught early is what?

Back 115

SCC

Front 116

what are Actinic Keratosis?

Back 116

are the earliest lesion in the development

pre-cancer with potential to lead to SCC

Front 117

if you have a slow growing, rarely invasive carcinoma, that occurs in sun-exposed area what do you think you have? Where is it contained?

Back 117

Squamous Cell Carcinoma in situ

in the epidermis

Front 118

if you have invasive skin cancer where does it go down to?

Back 118

the dermis

Front 119

what is a Keratoaconthoma

Back 119

variant of SCC with potential for local destruction and metastasis
Rapidly enlarging nodules with a crater-like center
Can involute spontaneously

Front 120

Pt comes in, says they didn't have the lesion 6 weeks ago, and now its there. It rapidly developed, and then involuted. What did the patient have?

Back 120

Keratoaconthoma

Front 121

pearly papule with central ulceration is what?

Back 121

Nodular BCC

Front 122

what treatment is most appropriate for superficial lesions, cheap, but can leave a scar?

Back 122

ED&C

Front 123

what is the treatment Most appropriate for superficial lesions
Currently recommended for superficial BCC’s and AK’s

Back 123

Aldara

Front 124

why use epinephrine with lidocaine? 3

Back 124

Reduces bleeding
Slows absorption of lidocaine
Anesthesia longer lasting

Front 125

when do you not use epinephrine with lidocaine ?

Back 125

digital block

Front 126

what are the dosages for lidocaine toxicity with and without epi?

Back 126

7 mg/kg max dose of lidocaine with epi

5 mg/kg max dose of lidocaine without epi

Front 127

what type of biopsy do you use if you want to measure all the thickness of the skin (dermis, epi, fat)?

Back 127

Punch biopsy

Front 128

For a rash, what kind of biopsy do you use?

Back 128

Punch biopsy

Front 129

if you have an elevated lesion, and you are not worried about full thickness of the tissue, such as seborrheic keratoses, what type of biopsy would you use?

Back 129

shave biopsy

Front 130

if someone has a melanoma what type of biopsy do you use?

Back 130

Excisional Biopsy

Front 131

a Biopsy of entire lesion down to and including some subcutaneous fat
Most useful for biopsy of malignant melanoma is what type of biopsy

Back 131

Excisional Biopsy

Front 132

for an Excisional Biopsy, you need to do an elliptical excision. What does the length to width ratio need to be?

Back 132

Length to width needs to be 3:1 to avoid dog ears

Front 133

Can heal with scarring
Hyperpigmentation
Hypopigmentation
Damage to nerve endings
Doughnut wart

these are all complications of what?

Back 133

Cryosurgery

Front 134

Electrodesiccation vs. Electrofulguration

touches skin?

Back 134

Electrodesiccation

Front 135

Electrodesiccation vs. Electrofulguration

works deeper?

Back 135

Electrodesiccation

Front 136

Tissue is removed in stages and mapped out to ensure complete removal of tumor

tissue is spared. What technique does this describe?

Back 136

Moh’s micrographic surgery

Front 137

Facial lesions in locations for higher risk of deep invasion

Large lesions
Recurrent lesions
Poorly differentiated SCC
Morpheaform BCC
Poorly demarcated border

Back 137

Moh’s micrographic surgery

Front 138

what is Dehiscence? What do you have to do after this occurs?

know

Back 138

when the surgical margin comes apart

have to let it heal by secondary intention

Front 139

What can be used to confirm the presence of a fungal organism on the skin?

Back 139

All can be identified by microscopy, aided by KOH digestion and simple staining

Front 140

What is Pityriasis (or tinea) versicolor? What kind of disease is it

Back 140

this is a superficial fungal disease

chronic, mild infection of stratum corneum, results in scaly lesions.

No
inflammatory
response.

Front 141

a patient comes to you with splotchy looking skin with noted depigmentation/pigmentation at the site of growth. They also have scaly lesions. What does this patient likely have?

Back 141

Pityriasis (or tinea) versicolor

Front 142

What causes Pityriasis (or tinea) versicolor?

Back 142

Caused by Malassezia furfur ,

aka Pityrosporum orbiculare,
ovale

Front 143

Your nurse hands you a slide from another physician and asks you to identify what the patient has so she can give the proper treatment. Under the scope with a KOH stain it looks like spaghetti and meatballs. What do they have?

Back 143

Malassezia furfur: Pityriasis (or tinea) versicolor

fungi and yeast together

Front 144

A patient comes in with itchy skin that fluoresces under the Wood's lamp. Under KOH microscopy you see fungi and yeast together, what do they have?

Back 144

this is likely spaghetti and meatballs soooo

Malassezia furfur: Pityriasis (or tinea) versicolor

Front 145

a patient comes in with non-scaling, non-inflammatory brown lesions on their hands. What do they have?

Back 145

tinea nigra

Front 146

what causes tinea nigra

Back 146

Exophiala werneckii

Front 147

what two things do you use to treat tinea nigra?

Back 147

Salicylic acid,
Benzoic acid

Front 148

Itraconazole/ketoconazole, Selenium Sulfide, and Pyrithione zinc are all used to treat what?

Back 148

Malassezia overgrowth

Front 149

what is black/white piedra?

Back 149

infection on external hair
shaft, forming either black nodules (Piedraia hortae)
or white nodules (Trichosporon beigelli).

Front 150

outside of the common cold, waht is the most common infectious agent in the world?

Back 150

Trichophyton rubrum

Front 151

what causes tinea imbricata? what is it'?

Back 151

Trichophyton concentricum


concentric rings of scales over trunk, legs, forearms

Front 152

what are the 2 types of tinea capitis?

Back 152

ectothrix (conidia outside of hair shaft),

or
endothrix (conidia inside of shaft)

Front 153

tinea unguium

Back 153

fungal infection of the nails, causing thickening, fissuring,
colorization (brown, white, yellow).

Trichophyton rubrum,
T. mentagrophytes, Fusarium sp., Candida sp

Front 154

azoles, tolnaftate , terbinafine, and griseofulvin are all used to treat?

Back 154

tinea unguium

Front 155

a patient comes in with wart-like cauliflower pigmented lesions of the foot. He likely has

Back 155

chromoblastomycosis

Front 156

after jumbling up your unlabeled slides (you clumsy doc you) you pick one up at random. You start looking at it and see copper penny spores, so you know this came from a patient with...

Back 156

chromoblastomycosis

Front 157

what is sporotrichosis

Back 157

rose thorn disease) - ulcerative papule, spreads via
draining lymph channels, nodular granulomas, chronic

Front 158

today is not your day. you keep mixing up slides! you look at one and see asteroid bodies, so you know the patient has

Back 158

sporotrichosis (rose thorn disease)

Front 159

what is the cause of sporotrichosis (rose thorn disease)

Back 159

Sporothrix schenckii

Front 160

a man returns from a trip to the jungle and has reported stepping on something. Since then, he has small painless papules and nodules on his foot. What does he have?

Back 160

mycetoma (Madura foot

Front 161

what is mycetoma (Madura foot)

Back 161

infection via thorns and
splinters. Small, painless papules and nodules, sinus
tract formation leads to spread, deeper tissue
infiltration. Can lead to bone destruction over a period
of months/years.

Front 162

if a person is not treated for mycetoma (Madura foot, what is a long term problem that can occur?

Back 162

Can lead to bone destruction over a period
of months/years.

Front 163

a patient comes in with vasicular pustular eruptions on fingers/hands due to fungal infection

what are these?

Back 163

Ids

Front 164

what is the major role of Langerhan's cells?

Back 164

antigen-presentation to T cells

Front 165

Allergic contact dermatitis is what type of reaction?

Back 165

type IV HS

Front 166

what mediates allergic contact dermatitis?

Back 166

T cells (remember type IV HS)

Front 167

patient comes in with large tense blisters in the legs and armpits. You see deposits of IgG and complement C3 at the dermal-epidermal junction. What does this patient have?

Back 167

BULLOUS PEMPHIGOID - sub epidermal blistering disease

Front 168

what type of blistering disease is BULLOUS PEMPHIGOID -

Back 168

sub epidermal blistering disease

Front 169

what kind of blistering disease is PEMPHIGUS?

Back 169

intraepidermal blisters

Front 170

what type of blisters are seen with DERMATITIS HERPETIFORMIS

Back 170

sub epidural

Front 171

patient comes in with a hepataform lesion on the elbows, knees back and buttocks. There is IgA antibody at the dermal-epidermal junction and complement deposits. What does he have?

Back 171

DERMATITIS HERPETIFORMIS

Front 172

what disease is DERMATITIS HERPETIFORMIS associated with?

Back 172

celiac sprue

Gluten-sensitive enteropathy

Front 173

if you see IgA antibodies at the dermal-epidermal junction what should you be thinking?

Back 173

DERMATITIS HERPETIFORMIS

Front 174

What is the Auspitz sign?

Back 174

you scratch off a scale and a drop of blood appears on the skin

Front 175

what cytokine causes keratinocytes to proliferate like mad?

Back 175

IL-22 (produced by TH 17)

Front 176

The cutaneous lesions of plaque psoriasis usually show four prominent features:
(***THESE FEATURES YOU SHOULD KNOW***)

Back 176

1) Lesions are sharply demarcated with clear-cut borders.

2) The surface consists of non-coherent silvery scales.

3) Under the scale, the skin has a glossy homogeneous erythema.

4) Auspitz sign is present within a few seconds of removing a scale, small blood
droplets appear on the erythematous surface.

Front 177

what is the cause of thrush? what are the populations you see it in?

Back 177

Candida Albicans

Infant
Adolescent/Adult
Geriatric

Front 178

what is phenotypic switching?

Back 178

there are huge banks of genetic information within the colony of fungi, so they can use alternate sets of genes depending on their environment

Front 179

What is the most common cause of thrush for geriatric patients?

Back 179

not cleaning the dentures

leads to denture stomatitis (effects gums/palate)

Front 180

what will happen to pH of the vagina due to yeast infections? how is this helpful?

Back 180

it normally goes down

this can help be diagnostic because with bacterial the pH goes up

Front 181

where does systemic candidiasis almost always originate from?

Back 181

GI candida

Front 182

70% of all women will be infected with this at some point. What is the cause?

Back 182

Vaginitis (Vaginal Thrush)

candida

Front 183

a baby comes in with a large red rash around the butt, what do they have?

Back 183

cutaneous candidiasis (diaper rash)

Front 184

what type of agar do you use for the detection of staph?

Back 184

Mannitol salts agar

because they Grow in presence of high concentrations of salt (NaCl > 7.5%)

Front 185

S. Aureus

Coagulase: +/-?

Back 185

+

Front 186

Staph saprophyticus causes what kind of infection?

Back 186

urinary tract

Front 187

besides providing cell shape/rigidity, what does peptidoglycan do? (with respect to leukocytes)

Back 187

Serves as a chemoattractant for polymorphonuclear leukocytes

Activates complement by the alternate pathway (C3b)

Front 188

how does gram positive bacteria lead to shock?

Back 188

lysis of the bacteria

peptidoglycan and lipoteichoic acids lead to the release of inflammatory cytokines which will eventually lead to shock

Front 189

what is Protein A and what is its job? what is it on?

Back 189

protein embedded in the cell wall of staph a

anti-opsonin effect

Binds the Fc portion of IgG leaving the Fab portion free to bind with specific antigen

Front 190

what is Fibronectin-binding protein (FnBP)

Back 190

promotes binding to mucosal cells for staph a

Front 191

what is catalase? why is it important?

Back 191

breaks down hydrogen peroxide [H202] (producing water and oxygen)

released by staph

can be used to determine if staph over strep

Front 192

please compare free and bound coagulase

Back 192

Free = released from cell -->clot formation;

Bound = on cell surface --> agglutination

Front 193

what property of the microcapsule slime layer of staph have?

Back 193

ANTIPHAGOCYTIC

Front 194

abscess formation is associated with what

Back 194

staph infection

due to coagulase

Front 195

what is an enterotoxin?

Back 195

exotoxin secreted in the GI tract

there are 6 types (A,B,C,D,E, G)

Resist gut enzymes and low pH
Found in 30-50% of strains
Most common kind of food poisoning in U.S.
Ingestion → vomiting and diarrhea within 2-6 hours

Front 196

you have a 30 people show up with explosive vomiting and diarrhea, they all claim to have come from the same picnic, what is the cause?

Back 196

enterotoxins release from staph (likely aureus)

Front 197

what 2 exotoxins behave as superantigens?

Back 197

Toxic Shock Syndrome toxin

Enterotoxin

Front 198

what are superantigens?

Back 198

bind on the side of the binding site btw a MCH and T cell

lead to unregulated T-cell activation

leads to serious damage due to release of cytokines in toxic amounts

Front 199

what is the number 1 cause of bacteremia?

Back 199

Staphyloccus aureus

Front 200

endoccarditis can be caused by which staph?

Back 200

Staphyloccus aureus

Front 201

where do you most often encounter staph on the body?

Back 201

25-50% colonize external nares

Front 202

what causes Scalded skin syndrome? what population is it normally seen in?

Back 202

Epidermolytic toxins A and B (released from staph a)

normally in infants

Front 203

if you have a pt with an abscess, what is an important non pharmacological treatment?

Back 203

incision and drainage

Front 204

what is the most common community acquired strain of staph a?

Back 204

USA300

Front 205

USA300 has what that makes it so strong?

Back 205

Panton-Valentine-leucocidin (PVL)

pore former

Front 206

what do we use to treat USA300 normally?

Back 206

Sulfonamides: Blocks synthesis of dihydropteroic acid

trimethoprim: Blocks synthesis of tetrahydofolate

Front 207

a man gets a new hip from replacement surgery, he ends up getting an infection of the joint. what is the cause of this infection?

Back 207

Staphylococcus epidermidis

Front 208

Strep. pyogenes

Hemolysis type?

Back 208

Beta

Front 209

strep neumonae uses what type of hemolysis

Back 209

alpha hemolysis

Front 210

beta hemolysis

Back 210

clearing

is a complete lysis of red cells in the media around and under the colonies: the area appears lightened and transparent

Front 211

gamma hemolysis

Back 211

no hemolysis

Front 212

alpha-hemolysis

Back 212

is present the agar under the colonies is dark and greenish

aka you will see greening

Front 213

S. agalactiae

hemolysis type?

Back 213

Beta

Front 214

Entercoccis faecalis

hemolysis type?

Back 214

gamma

Front 215

Group A Streptococci (Streptococcus pyogenes) have a capsule made of ?

Back 215

hyaluronic acid

adds to virulence

Front 216

What are M proteins? Seen on?

Back 216

structural virulence factors for Group A Streptococci (Streptococcus pyogenes)

Anti phagocytotic

Front 217

Scarlet fever is caused by what?

Back 217

Strep. pyogenes

Front 218

invasive infections of wounds are associated with what?

Back 218

Strep. pyogenes

Front 219

Erysipelas is what?

Back 219

infection of layers between skin seen in Strep. pyogenes

Front 220

Rheumatic fever is caused by what

Back 220

group A strep

Strep. pyogenes

URI initiated

Front 221

what is scarlet fever ?

Back 221

Erythrogenic toxin produced by lysogenic Grp A streptococci causes rash

Front 222

a patient comes to you with a rash on their tongue. when they stick it out, their tongue appears to look like a strawberry. what does this person have? caused by what?

Back 222

scarlet fever

Erythrogenic toxin produced by lysogenic Grp A streptococci causes rash

Front 223

f a patient with a group A strep caused infection from a wound was left untreated, what could potentially develop?

Back 223

glomerular nephritis

Front 224

What is Exotoxin A? what releases it?

Back 224

Causes ADP-ribosylation of elongation factor 2 → inhibits protein synthesis

released by Pseudomonas aeruginosa (gram negative)

Front 225

what causes ecthyma gangrenosum?

Back 225

Pseudomonas aeruginosa

Front 226

a patient has cystic fibrosis pneumonia and gets an infection, what is it likely due to?

Back 226

Pseudomonas aeruginosa

Front 227

A patient comes to your office complaining of an ear ache. He states that because it is summer he has been spending a great deal of time in the pool. You can likely diagnose _____ due to ______

Back 227

otitis externa (swimmers ear) due to Pseudomonas aeruginosa

Front 228

The guys from time machine hot tub all come to your office complaining of a weird rash that has appeared on their butts. Putting aside all their freaky exploits, what do you start thinking based on the amount of time they spent in the hot tub

Back 228

folliculitis caused by Pseudomonas aeruginosa

Front 229

patient presents with a swollen and inflamed pinna of the ear. She has green-colored pus with a fruit like odor. She reports having had her ear pierced 2 days prior. What is the likely etiologic agent?

Back 229

Pseudomonas aeruginosa or staph aureus

Front 230

a patient comes in with symptoms that are similar to pseudomonas but the oxidase test is negative. what is likely the cause?

Back 230

Acinetobacter (either anitratus or baumanii)

Front 231

you are working in Iraq with wounded soldiers. A patient presents to you with an infection that appears to be multiple drug resistant. What are you thinking is the problem?

Back 231

Acinetobacter baumanii

Front 232

If you are bed ridden, what type of bacterial increase will you have?

Back 232

have increased Gram-negative rods (replacing the normal gram positive seen in the mucousal membranes)

Front 233

what is decubitus ulcer?

Back 233

pressure related injury (not moved you develop this)

mixed infection of Staphylococcus aureus, Streptococcus pyogenes

Front 234

an infant comes to your office with swelling around the eyes, what do they likely have?

Back 234

cellulitis due to Haemophilus influenzae

Front 235

diabetes foot, cellulitis, and primary syphilis are all examples of what

Back 235

exogenous infections

Front 236

what is an endogenous infection?

Back 236

may become infected from the blood stream or by direct extension of an infection site deep within the tissues

Front 237

secondary syphilis, gangrene, and meningococcemia are examples of what?

Back 237

endogenous infections

Front 238

Impetigo is caused by what ?

Back 238

Grp A strep & S. aureus

Front 239

what causes Necrotizing fasciitis

Back 239

Mixed anaerobic and facultative organisms Grp A strep

Front 240

what causes cellulitis? where does it affect?

Back 240

Grp A strep and/or S. aureus


dermis/fat

Front 241

what causes bullous impetigo?

Back 241

staph a

Front 242

a patient comes in with what appears to be a rash caused by candidia. you shine a wood's lamp on it and it is coral red in appearance. what does the person have?

Back 242

Erythrasma

Front 243

what is Sycosis Barbae? cause?

Back 243

Infection of coarse hairs of the beard (Staphylococcus aureus)

Front 244

what causes Furunculosis or boils

Back 244

Staphylococcus aureus

Front 245

A 47-year-old woman presents to her primary care physician with a several-year history of chronic skin infections and painful, 1- to 3-mm red pustules in her groin. Many of the pustules have broken and are draining a foul-smelling, puslike fluid mixed with blood. You recognize inflammation of the apocrine sweat glands. What does this person have and what is the cause?

Back 245

Hidradenitis Suppurativa (Staphylococcus aureus)

Front 246

patient has one finger that is red and a clear line is moving up the arm. What does the patient have, and what is the cause?

Back 246

Lymphangitis
(Streptococcus pyogenes)

Front 247

a patient has a rapidly spreading bacteria on the face that can move within hours causing tissue destruction. What does this person have. Caused by?

Back 247

Cellulitis due to flesh eating bacterium (Streptococcus pyogenes)

Front 248

if you see a cat or a dog bite what should you be thinking?

Back 248

Pasteurella multocida

Front 249

An otherwise healthy, 7 1/2-year-old girl had a two-week history of a swelling behind her left ear. She had no systemic illness and noted no improvement with a course of amoxicillin–clavulanate. Examination revealed a red, tender, retroauricular fluctuant lymph node measuring 2 by 2 cm behind her left earlobe. No other lymph nodes were enlarged. The child remembered being scratched by a cat two weeks earlier, shortly before the mass appeared.

what is this?

Back 249

Bartenella henselae (cat scratch disease)

Front 250

full blown anaphylaxis include what 4 things

Back 250

urticaria (hives), and/or angioedema,with HoTN and bronchospasm.

Front 251

what type of HS rxn is anaphylaxis?

Back 251

Type I

Front 252

what mediates anaphylaxis?

Back 252

IgE

Front 253

is an anaphylactoid reaction IgE mediated?

Back 253

no

substances cause a direct breakdown of the mast cell and basophil membrane

Front 254

with anaphylactoid reaction do you have to be pre-exposed, or do you get it on first contact?

Back 254

it can occur on first exposure (this is the major difference from anaphylaxis)

Front 255

radiopaque contrast media, fluorescein, NSAID’s, thiamine, opiates cause what kind of reaction?

Back 255

Anaphylactoid reaction

Front 256

1/3 of anaphylactic episodes are triggered by ...

Back 256

FOOD

Front 257

what is the difference in upper and lower respiratory response to anaphylaxis?

Back 257

Upper Respiratory: Congestion, rhinorrhea, sneezing, itchy eyes, tearing of eyes, conjunctival injection


Lower Respiratory: Bronchospasm, throat/chest tightness, hoarseness, wheezing, SOB, cough, hypoxia

Front 258

for an adult, where is the best place to give epi?

Back 258

IM or SC in the THIGH

Front 259

what dosage of diphenhydramine (benadryl) do you give to an adult as 2nd line treatment

Back 259

50-100mg

Front 260

describe the symptoms of a bite from a coral snake

Back 260

described as anticlimactic. There is little or no pain or swelling at the site of the bite, there may be no obvious bite marks, and other symptoms can be delayed for 12 hr. However, if untreated by antivenin, the neurotoxin begins to disrupt the connection between the brain and muscles,--the earliest symptoms may begin as nausea, vomiting and sweating, then as the neurotoxin continues to disrupt things it may cause lethargy, slurred speech, dble vision, drooping eyelids, difficulty swallowing and muscular paralysis—eventually leading to respiratory or cardiac failure

Front 261

a patient gets bitten by a pit viper, what happens at the site of bite?

Back 261

Hemorrhagins cause vascular leaking leading to local and systemic bleeding

Front 262

for a snake bite patient do you want to apply suction, ice, incision, or tourniquets?

Back 262

NO

Front 263

a patient says he was bitten by something but doesnt know what. the bite shows blanched circular patch w/surrounding red perimeter and central punctum. what bit this person?

Back 263

black widow

Front 264

what does the neurotoxin do from black-widow spiders?

Back 264

The toxin is of the latrotoxin type and it can trigger a massive exocytosis from presynaptic nerve terminals in a variety of neurosecretory cells. Acetylcholine, norepi, dopamine, glutamine and enkephalin systems are all susceptible to the toxin.

Front 265

bites from a brown recluse spider can become what?

Back 265

necrotic

Front 266

a patient says he was bit by a spider that was in his dresser. he didn't think much of it at the time, but now it formed a blister, then develop a dark depressed center over the ensuing 24-48 hr, culminating in a dry eschar that subsequently ulcerates

what bit him

Back 266

brown recluse

Front 267

patient comes in with a pustule and says doc I got bit by a spider. You ask if they have seen the spider to get a better idea. they say they didn't actually see any spiders. what do you think they might have (ON TEST)

Back 267

community acquired MRSA


Methicillin-resistant Staphylococcus aureus

Front 268

if in the field, what is the best way to treat a snake bite? 4 things

Back 268

1. apply pressure/immobilization bandage (help to prevent/slow the spread of the toxin

2. apply elastic wrap like you would a sprained ankle. They recommend wrapping away from the heart first then toward the heart. Get as low as you can and go as hi as you can . Then place a splint over this.

3. Keep the patient quiet and inactive—do not let them get up and walk around

4. Keep the limb a little below heart level

Front 269

What are plantars warts?

Back 269

skin—caused by HPV. Plantar warts grow on the plantar, or bottom, surface of the feet.
They tend to be found in areas of pressure, eg heel and ball of foot. Plantar warts often grow into the deeper layers of skin because of the pressure they receive d/t their location

Front 270

a patient comes to you with a wart on the bottom of their foot. you see small black dots on the wart. what does this patient have? what caused it? what are the black dots?

Back 270

Plantar Warts

HPV

dots=thrombosed capillaries

Front 271

SPINGOMYELINASE D activates complement, induces keratinocyte apoptosis, and neutrophil chemotaxis. What releases it?

Back 271

Brown Recluse

Front 272

if you are looking at a stain and you see multinucleated giant cells (synctia) what are you looking at?

Back 272

Herpesvirus

Front 273

is reactivation normally symptomatic or asymptomatic? are they transmissible?

Back 273

they are often asymptomatic but still transmissible

Front 274

what is responsible for maintaining the latent state of herpes viruses?

Back 274

Latency-associated RNA transcript,

continually expressed,
influence cellular functions.

Front 275

what is one of the most frequent causes of encephalitis?

Back 275

HSV 1

Front 276

what is one of the most frequent causes of meningitis

Back 276

HSV 2

Front 277

which HSV causes conjunctivitis? 1, 2, or both?

Back 277

HSV 1

Front 278

which HSV causes genital herpes? 1, 2, or both?

Back 278

both

Front 279

primary clinical presentation of herpes simplex virus type 1?

Back 279

nfection of the mouth (Gingivostomatitis)

babies get it from kisses and whatnot

Front 280

what is Herpes labialis

Back 280

cold sores”;lips, reactivation of latent virus (due to disease, trauma), recurrent (adolescents/adults).

Front 281

what is keratoconjunctivitis? what is it seen in?

Back 281

pinking of the eye, due to herpes

can be recurrent

can leave scars on the cornea

Front 282

an infant is brought to you with red spots and patches especially around places of eczema and dermatitis. you see these on the face and especially around the mouth. what do they likely have

Back 282

eczema herpeticum

Front 283

what is herpetic whitlow? who is affected

Back 283

herpes acquired by docs who didnt wear gloves while treating ppl with herpes

see it on the finger

can be seen in babies who suck their thumb

Front 284

a patient comes to your office with a few lesions on the hands, tongue and buttock. the lesions look like bulls-eyes or targets. what do they have?

Back 284

erythema multiforme

associated with Herpes

Front 285

in erythema multiforme is virus found in the lesion?

Back 285

no, it is strange

they detect viral protein and nucleic acid, but no whole virus

Front 286

what is auto-inoculation of herpes?

Back 286

it is the fact that it can spread either from mouth to genitals or vice versa

Front 287

where does varicella-zoster virus sit dormant?

Back 287

in neurons of the spinal cord

Front 288

an adult male comes in with painful rashing that starts midline on the stomach and spreads in a line to the back...what does your patient have?

Back 288

herpes zoster (shingles)

Front 289

infections of herpes varicella-zoster virus leads to what?

Back 289

CHICKENPOX NOT SHINGLES

Front 290

what are the 2 ways you can contract chickenpox?

Back 290

Droplet (respiratory) transmission, contact with lesions

Front 291

infant presents with a high fever for about 2 days. after being watched in the ER to make sure no serious damage has occured the fever subsides and a rash appears. what is going on with the child?

Back 291

they have HHV 6 (known as Roseola)

Front 292

what leads to Kaposi's sarcoma?

Back 292

HHV 8

Front 293

a patient presents with a spindle cell tumor on the surface of the skin. It is brownish to deep red (noting that it is highly vascularized) what does this person have, and what causes it?

Back 293

Kaposi's sarcoma

HHV8

Front 294

what is Molluscum Contagiosum

Back 294

poxvirus skin infections

bump filled with cheesey material

can be contracted sexually (seen in teenagers)

Front 295

a teenage male presents in your office with a large bump on the skin. He claims that he tried to "pop it like a zit" and a white cheesey material came out. upon questioning you find out the teen is sexually active. What is your diagnosis?

Back 295

Molluscum Contagiosum

Front 296

you normally lose 15ml/hr with intact skin, with a full burn how much do you lose?

Back 296

200ml

Front 297

what do burns lead to 4

Back 297

Loss of vascular integrity
Increased capillary permeability
Increased interstitial fluid volume
Diminution of blood volume

Front 298

primary cause of burn for 3-14

Back 298

flame

Front 299

primary cause of burn for 15-60

Back 299

industrial accidents

Front 300

60+ primary cause of burn?

Back 300

accidents

Front 301

80% of all burns occur?

Back 301

in the home

Front 302

first degree burn depth?
2nd?
3rd?

Back 302

Epidermis


partial thickness into dermis


full thickness through dermis and into or through adipose layer

Front 303

what type of burn is associated with erythema, pain, minimal edema, and dry?

Back 303

1st

Front 304

how do you treat first degree burn?

Back 304

remove clothing

apply cool compress

soothing lotion (optional)

Front 305

what forms with a 2nd degree burn?

Back 305

bulla (blisters)

Front 306

pt comes in with bulla, edema, mottled red or pink skin, moist, and painful. what degree burn do they have?

Back 306

2nd

Front 307

if you have greater than 10% of body surface area affected, how do you treat 2nd degree burn?

Back 307

do not cool them down (can lead to hypothermia)

send to hospital

Front 308

a patient comes to you with a burn that is dry, white/charred, leathery in appearance and almost painless

what type of burn is this?

Back 308

3rd

Front 309

a burn that Penetrates through the entire dermis and will result in a great deal of edema is what kind of burn

Back 309

3rd

Front 310

please list the ABCDEs of the primary survey for burn

Back 310

Airway and C-spine control

Breathing

Circulation

Disability : mini-neurologic exam

Exposure : undress the patient

Front 311

what is a homograft vs a xenograft?

Back 311

homograft (cadaver)

xenograft (pig)

Front 312

if you can feel a radial pulse, what is systolic BP

femoral?

carotid?

Back 312

80

70

60

Front 313

for fluid replacement, how much do you give (parkland formula)

Back 313

2-4 ml IV solution/kg body weight/% BSA in 24 hours

give half over the first 8 hours

give rest of next 16

Front 314

describe AMPLE for the secondary survey

what is this for?

Back 314

A - allergies
M- medications
P - past history
L - last meal
E - event

for burn

Front 315

how do you figure the % burn surface area?

Back 315

use the anterior surface of the palm of the patients hand

Front 316

what is the rules of nine?

Back 316

used for extent and depth of the burn

head: 4.5 in front 4.5% in back
arms: 4.5 in front 4.5% in back
legs: 9% front 9% back
chest: 18%

Front 317

pt has a burn that is Full thickness > 5 % BSA

what do you do

Back 317

transfer to burn unit

Front 318

pt has a burn that is Partial thickness > 20 % BSA

what do you do

Back 318

transfer to burn unit

Front 319

pt has a burn that is associated with fractures or other major injuries

what do you do

Back 319

transfer to burn unit

Front 320

what % full thickness burn is required for hospitalization?

Back 320

2%

Front 321

what is the most common type of infection seen with a burn

Back 321

Pseudomonas

due to the water

Front 322

what complication occurs in up to 30% over the first 72 hours of a burn patient?

Back 322

Curling ulcers

Front 323

what is the treatment for alkali chemical burns?

Back 323

irrigate (drip fluid on them for 8 hours)

Front 324

how does sulfur mustard work?

Back 324

Binds irreversibly to skin

Destroys DNA

causes the outer layer of the epithelium to separate from the dermis resulting in bulla.

Front 325

what is commonly associated with electrical burns?

Back 325

myoglbinuria (presence of myoglobin in the urine)

Front 326

a patient comes in with a lacelike rash on their arms as well as a rash on the cheeks of the face. What is the likely cause of this?

Back 326

B19 parvovirus

Front 327

Transient aplastic crisis (TAC) is what? what causes it?

Back 327

affects precursor cells to red blood cells; see persistent anemia
in immunodeficiency

caused by B19 parvovirus

Front 328

what stage in erythropoesis do you have infection via B19

Back 328

at the proerythroblast stage it is expressing a large amount of P-antigen which the B19 virus can affect

Front 329

what will you see in a blood smear of someone with B19 PV?

Back 329

you wont have reticulocytes (they aren't produced)

Front 330

in addition to proerythroblasts, what expresses P-antigen? what effect can this have?

Back 330

P-antigen? what effect can this have?

Granulocytes and megakaryocytes have them

B19 can thus disrupt monocyte and platelet formation

this is small though

Front 331

What is the major receptor for the B19PV?

Back 331

p antigen

Front 332

before the rash occurs in erythema infectiosum what would you see in a blood smear?

Back 332

no reticulocytes

due to B19PV

Front 333

when does gloves and socks sydrome occur ?

what about Fifth's Disease?

Back 333

gloves and socks: at the time of the infection of B19pv

5ths: later than infection

Front 334

What is non-immune hydrops fetalis?

Back 334

B19PV infection during pregnancy

greatest chance of adverse outcome is between 11 and 23 weeks of gestation.

affects the liver of child leading to anemia

fatality rate of 50%

Front 335

a patient with known and managed sickle cell disease comes to your office and is seriously anemic. Upon blood smear you find no reticulocytes. you immediately order a transfusion because your patient has?

Back 335

Transient Aplastic Crisis (TAC)

B19PV

Front 336

what is responsible for 95% of malignant cervical carcinoma?

Back 336

HPV

Front 337

what does the E7 gene of papilloma virus cause?

Back 337

retinoblastoma gene

no stop signal for growth

Front 338

what does the E6 gene of HPV do?

Back 338

inhibits p53

promotes telomerase

Front 339

what is a condyloma?

Back 339

mucocutaneous warts seen in HPV

high potential for malignancy

Front 340

what is acanthosis?

Back 340

hyperplasia of prickle cells in skin that leads to development of wart in HPV

Front 341

what are koilocytes?

Back 341

site of virus replication for HPV

Front 342

what is persistent lanugo and when do you see it?

Back 342

peach fuzz!

seen in premature babies

Front 343

A mother brings her newborn in less than a month after birth. She is worried that the baby has persistent dry skin. Should she be worried?

Back 343

no. newborns will lose all of their skin in the first month making it dry

they molt

Front 344

what is acrocyanosis?

Back 344

Cyanosis of the hands, feet and sometimes lips

Caused by increased tone of peripheral arterioles, usually in response to chilling

Front 345

What is Cuits Marmorata

Back 345

Netlike, reddish-blue mottling of the skin

Occurs symmetrically over trunk and extremities

Normal response to chilling

Caused by variable vascular constriction and dilation

Usually transient – resolves with rewarming

Can be a sign of sepsis

Front 346

What is Ichtyosis

Back 346

babies have distorted skin that is pulled very tight (face and extremities)

have trouble feeding, sometimes breathing, and with maintaining body temp

Front 347

a baby is born with superficial bullae on the upper limbs (mostly on thumb). It later resolves itself and goes away. What was this?

Back 347

a suckling blister

from sucking on the thumb

Front 348

what is miliaria crystallina?

miliaria rubra?

Back 348

Miliaria Crystallina – clear vesicles over the head, neck and upper trunk

Miliaria Rubra (prickly heat) – erythematous papulopustular eruption at sites of occlusion or flexural areas

Front 349

You have a baby with numerous "fleabite" lesions everywhere except the palms and soles of the hands and feet. You take a sample from the lesion but before you look under a microscope you already know what you are going to find...

Back 349

Eosinophils associated with Erythema Toxicum Neonatorum

Front 350

a child is born and he starts to have pustules forming all over his body including the palms and soles, with no red blotch around them. The next day, the pustules get a bit bigger and start to develop a scale, the scale eventually is gone and leaves a hyperpigmented macule. What does this kid have?

Back 350

Transient Neonatal Pustular Melanosis

Front 351

Transient Neonatal Pustular Melanosis

please give progession

Back 351

Pustule

Scale

Pigmented macule

Front 352

an asian child is brought to your office with a Flat, gray to bluish-black macules from the accumulation of melanocytes in the dermis. The nurse worries that the child is being abused because it is found on the lumbosacral area. You disagree saying it is simply...

Back 352

Mongolian Spots

Front 353

where do you normally find a giant congenital nevi? what do 95% of them have?

Back 353

Frequently in the distribution of a dermatome

Over 95% have a hairy component

Front 354

a child has a red tumor like growth on their shoulder. You have them lean upside down and you notice that the growth gets larger. What does this kid have?

Back 354

Hemangiomas

it is filling with blood

Front 355

a patient comes in and you discover that they have hemolytic anemia and thrombocytopenia. upon physical examination you note a large Hemangioma on the leg. you know the patient has

Back 355

Kasabach-Merritt Syndrom

Front 356

Kasabach-Merritt Syndrome
causes what ? 4

Back 356

Thrombocytopenia

Microangiopathic hemolytic anemia

Coagulopathy from red blood cell and platelet trapping

Activation of the clotting system within the hemangioma

Front 357

2 babies are brought to your office. One has a v like red mark on the back of the neck, and the other has a symmetrical lesion between the eyes. When they cry, you can see the lesions become more apparent. What do these kids have? ***

will they go away?

Back 357

Salmon Patch (stork bite)

fade in first year of life

Front 358

what is Sturge-Weber Syndrome

Back 358

Port-wine stain over the ophthalmic branch of the trigeminal nerve

causes:
Intracranial calcifications
Seizure disorder
Hemiparesis
Glaucoma
Mental retardation

Front 359

a patient has a port wine stain on the leg that leads to local overgrowth of soft tissue and bone. what do they have

Back 359

Klippel-Trénaunay-Weber Syndrome

Front 360

what is TORCH

Back 360

Toxoplasmosis
Other (syphilis)
Rubella
Cytomegalovirus
Herpes

congenital infections

Front 361

how does a patient get Congenital Toxoplasmosis

Back 361

changing cat litter.

Front 362

a child is born with hydrocephalus, chorioretinitis, and intracerebral calcifications. It grows up to have microcephaly. What does it have?

Back 362

Congenital Toxoplasmosis

Front 363

a baby is born ends up developing large oval maculopapular or papulosquamous lesions on the palms and soles. What do they have?

Back 363

Early Congenital Syphilis

Front 364

What are Rhagades?

what do you see them in?

Back 364

Perioral fissures and scarring

Early Congenital Syphilis

Front 365

you have a child with horizontal radiopaque bands in bone metaphases, Lymphadenopathy, hepatosplenomegaly (HSM)
Rhinitis (snuffles)
Anemia and jaundice

what does this kid have?

Back 365

Early Congenital Syphilis

Front 366

Osteochondritis (horizontal radiopaque bands in bone metaphases)

should make you think

Back 366

Early Congenital Syphilis

Front 367

a patient comes in with small upper central incisors that are barrel shaped and have notches in the center. What are these called? what are they associated with?

Back 367

Hutchinson teeth

Late congenital syphilis

Front 368

what is Sabre shin? what is it associated with?

Back 368

Anterior tibia hypertrophy resulting in a bowed appearance

Late congenital syphilis

Front 369

what is the classic triad of Congenital Rubella

Back 369

Cataracts
Deafness
Heart malformations

Front 370

if you see blueberry muffin rash what should you be thinking?

Back 370

Congenital Rubella

Front 371

if you see a Vesicle with erythematous halo around the base what is it

Back 371

HERPES

Front 372

if you see a focal seizure (one arm shakes), hepatic disease, and DIC that all start around the 4-8 day of life mark, what are you thinking

Back 372

disseminated herpes

Front 373

if you see focal seizures what are you thinking?

Back 373

HERPES

Front 374

Erythema Toxicum Neonatorum if cut open you see?

what about Transient Neonatal Pustular Melanosis?

Back 374

Erythema Toxicum Neonatorum : eosinophils

Transient Neonatal Pustular Melanosis: Neutraphils

Front 375

if you have a child with focal seizures and bloody lumbar puncture, what do they have?

Back 375

Encephalitic neonatal herpes

Front 376

What are the 3 C's and what are they associated with

Back 376

the 3 C's of measles

cough, coryza*, and conjunctivitis

coryza=runny nose

Front 377

if you see Koplik spots and high fever, what does a patient have?

Back 377

measles

Front 378

how does measles spread on the body?

Back 378

cephalocaudal (head to tail)

Front 379

Measles is primarily spread by…

Surface contamination
Contact with lesions
Respiratory droplets
Poor hygiene

Back 379

Respiratory droplets

Front 380

if you see Nonspecific, “rose-pink” macules and papules on the trunk that was preceeded by low grade fever and rhinorrhea and malaise, what would your patient likely have?

Back 380

Rubella (German or 3 Day Measles)

Front 381

what causes Erythema Infectiosum ?

Back 381

Parvovirus B19

Front 382

what is the prodrum to roseola infantum?

Back 382

3 to 5 days of high fever (101-106°)

Front 383

how does the rash seen in roseola appear/spread?

Back 383

starts on trunk and spreads to the limbs

Front 384

dew-drop on a rose petal describes what?

Back 384

Varicella (Chicken Pox)

Front 385

what does a patient have who presents with Grey-white vesicular lesions on the palms of the hands and dorsum of feet, maculopapular eruption on the buttocks

Back 385

Hand-foot-and-mouth disease

Front 386

a patient is brought into the hospital with severe dehydration and signs of anorexia. Upon examination you find Painful erosions and vesicles in the mouth in addition to a few gray vesicular lesions on the hands. What caused the patients condition?

Back 386

Hand-foot-and-mouth disease

Front 387

what is the prodrome for erythema multiforme?

Back 387

NONE! you will be fine then covered in a shit ton of lesions

Front 388

if you see High fever, pronounced constitutional symptoms, and varying degrees of generalized target lesions, bullae, epidermal detachment, and mucosal erosions (of at least two sites)

what does the person have?

Back 388

Stevens-Johnson Syndrome

Front 389

if you have a patient with necrosis evolving into vesicles, bullae, and then detach leaving raw, denuded skin along with a positive nikolsky sign, what does your patient have?

Back 389

Stevens-Johnson Syndrome

Front 390

what is a Nikolsky sign? What is it seen in?

Back 390

after exerting light pressure on an area of erythema, the epidermis becomes wrinkled and peels off like wet tissue paper


Stevens-Johnson Syndrome

Front 391

Stevens-Johnson Syndome vs. Toxic Epidermal Necrolysis

amount of skin involved?

Back 391

SJS: <10%

TEN: >30%

Front 392

drugs—sulfa, PCN, NSAIDS, anticonvulsants can strangely enough lead to what problem in infants?

Back 392

Toxic epidermal necrolysis and Stevens-Johnson syndrome

Front 393

what normally leads to Toxic epidermal necrolysis and Stevens-Johnson syndrome
in children?

Back 393

Mycoplasma infection

Front 394

patient starts with macules and papules that progress into non-blanching papules on the legs and buttocks. What does this child likely have?

Back 394

Henoch-Schönlein Purpura (vasculitis)

Front 395

A 5 year old boy is brought to the ER with abdominal pain and rash. When you examine him you note palpable, non-blanching purpura and petechiae on his lower extremities and buttocks. His knees are slightly swollen and his abdomen is diffusely tender. What you might you expect to find when the lab results are ready?

Thrombocytopenia
Hematuria
Macrocytic anemia
Microcytic anemia

Back 395

Hematuria

Front 396

you give a patient amoxicillin and later the patient develops fever, they are covered in hives (urticarial), arthritis, and periarticular swelling. What happened?

Back 396

Serum Sickness-Like Reaction

Front 397

if you see 5+ days of fever, non-exudative conjuctivitis (pink eye with no pus), swollen feet, oral mucous membrane changes, polymorphous rash, and Cervical lymphadenopathy

what do they have?

Back 397

Kawasaki Disease

Front 398

what is the most serious complication of Kawasaki Disease

Back 398

cardiac problems

Front 399

what is microcomedone?

Back 399

the plug that makes the start of acne

[Cornified cells adhere to the follicular wall and form a plug (open & closed comedone)]

Front 400

biggest reason to use antibiotics for dermatology?

Back 400

anti-inflammatory!!

Front 401

what do topical retinoids do? what level do they work at? what types of acne do they treat

Back 401

Reverse the abnormal pattern of keratinization – reduce follicular plugging

Works at the level of the microcomodone (precursor of all acne)

All forms of acne

Front 402

what is the biggest down fall of retinoids?

Back 402

cause erythema and irritation when you first start using them

may get worse before you get better

Front 403

What type of drug is benzoyl Peroxide? What does it work against

Back 403

Antibacterial – effectively reduced P. acnes counts

Front 404

what kind of drug is sprionolactone?

Back 404

Androgen Receptor Blocker

used to treat acne

Front 405

you treat a patient with scabies and they beg to know how long the itch will last. You tell them

Back 405

you can itch up to a month after Rx

Front 406

Can you find scabies on the head of an adult? child?

Back 406

it is not common on an adult head

can be on a child's head

Front 407

3 members of a family come in complaining of unbearable itch even on the palms of the hands, that worsens at night. What do they likely have?

Back 407

Scabies!

Front 408

where do warts commonly occur?

Back 408

at sites of trauma

allows for the virus to enter (this is why kids get them on their hand, and why others get plantar warts)

Front 409

what is rhinophyma? is it permanent?

Back 409

you get deformed shape of the nose due to chronic rosacea causing hyperplasia of sebacious gland

Front 410

if you see honey crust on the face of a child what do you have?

Back 410

impetigo

Front 411

what is the difference in healing between ulcers and erosion?

Back 411

ulcers: scarring

erosion: no scaring

Front 412

what is lichenification

Back 412

Area of thickened epidermis induced by scratching


Skin lines are accentuated

Front 413

if you see accentuated skin lines that were induced by scratching what do you have?

Back 413

LICHENIFICATION

Front 414

How many classes of steroids are there

Back 414

7

Front 415

What class of steroid is most potent? which is over the counter?

Back 415

most potent: 1

weakest: 7

Front 416

What is tachyphylaxis?

Back 416

with time patient uses their topical corticosteriod less and less

when corticosteroids quit working over time

Front 417

when you go to stop a steroid, what is an important consideration?

Back 417

Rebound phenomenon- worsening of the existing condition after termination of topical corticosteroids

Front 418

what is a static antifungal?

cidal?

Back 418

static: stops the growth (supresses)

cidal: kills the growth (use in a difficult to treat place)

Front 419

when you occlude corticosteroids what does this do?

Back 419

increases the potency of the corticosteroid

Front 420

a patient comes in with Waxy brown “stuck on” plaques, what does he have

Back 420

Seborrheic Keratosis

Front 421

a patient comes in with a small circular spot on the lower legs. upon touch it feels like a scar under the skin. When you pinch it, it compresses with attempts to elevate (aka a dimple sign) What is this

Back 421

Dermatofibroma

Front 422

a patient comes in with numerous lesions on the buttock. The patient doesnt tells you that they scratch, but as you watch them they are going to town on the lesions. The patient has?

Back 422

Prurigo Nodularis

patient has a psychiatric issue that makes them want to scratch really really badly. The lesions

Front 423

patient comes in with a dark blue spot on the ear. to see if it is melanoma, you push on it until it blanches. Because it was able to blanch you know it was a ?

Back 423

Venous lake

Front 424

a patient comes in with 6 cafe au lait spots. What might they have?

Back 424

Can be associated with neurofibromatosis

Front 425

what is Keratosis Pilaris

Back 425

little red spots commonly seen on the back of the arm, anterior thigh, and cheek

not folliculitis (that has pustules)

Front 426

what causes hand foot and mouth disease?

Back 426

Coxsackie A16

Front 427

person suddenly has bright red swelling of the lateral nail fold

what does this person have? what caused it?

Back 427

Acute Paronychia

staph and strep

Front 428

patient comes in with a redness on the proximal nail fold and the cuticle is missing

what does this person have?
what caused it?

Back 428

Chronic Paronychia

Candida

Front 429

patient comes in with a green fingernail... what caused this? what do you treat with (general)?

Back 429

Pseudomonas infection

antibiotic

Front 430

a patient comes in with round patches of hair loss that are perfectly smooth. What does this person have? what was the cause? who is the prognosis worst for?

Back 430

Alopecia Areata

Auto-immune hair loss

prognosis is worst for kids, least likely to come back

Front 431

patient has hair loss that is not regularly shaped and patchy, and the hair has differing lengths. what is this? Dx? Tx?

Back 431

Trichotillomania

Dx: Hair shave
Tx: Referral for counseling/psychiatric medications

Front 432

what are the 3 types of acquired melanocytic nevi?

Back 432

Junctional- nevus cells remain at DE junction

Compound- nevus cells found at DE junction and in the dermis

Dermal- nevus cells found in the dermis

Front 433

What is a Becker's Nevus?

Back 433

Hamartomatous growth of smooth muscle fibers

Can consist of a brown macule, a patch of hair, or both

Can be assosiated with hypoplasia of ipsilateral limb or breast, or skeletal anomalies

Malignancy has never been reported

Front 434

if you have a nevi with “fried egg” appearance
Irregular and dark pigmentation
Irregular borders what type of nevi is it? what is it a marker for

Back 434

dysplastic

marker for increased risk of melanoma

Front 435

what is the most common type of melanoma? occurs where

Back 435

Superficial spreading Type


back and legs

Front 436

a man comes into the office with a melanoma on the toe and and part of the sole of their foot. What is this? What type of patient was it? is it aggressive?

Back 436

Acral lentiginous type malignant melanoma

likely a black or asian person

VERY AGGRESSIVE cut that shit out

Front 437

what is Hutchinson's sign?
What is it a sign of?

Back 437

Appearance of a pigmented band with extension into the proximal or lateral nail fold


Suggests acral lentiginous melanoma (ALM)

Front 438

what are the ABCDE's of malignant melanoma

Back 438

Asymmetry
Border (is it smooth?)
Color (more color=bad)
Diameter (larger=bad)
Evolving (any changes noted by the patient)

Front 439

what is the Breslow Depth?

Back 439

Measured from the granular layer to the deepest portion of malignant cells

Front 440

Breslow Depth greater than 1mm means what?

Back 440

higher risk for metastasis

Recommend sentinel lymph node biopsy

this shit is serious

Front 441

if you have a >1mm Breslow thickness what are you going to do?

Back 441

sentinel lymph node biopsy

Front 442

female presents with Nodular erythematous eruption that is usually limited to the extensor aspects of the extremities. She notes that she is on birth control. What does she have?

Back 442

Erythema Nodosum

Front 443

f you see plaques with islands of sparing, what should you think?

Back 443

Pityriasis Rubra Pilaris

Front 444

if you see salmon colored plaques, what should you be thinking

Back 444

Pityriasis Rosea

Front 445

you have a patient with Benign, usually asymptomatic, distinctive, self-limiting patches. The etiology is unknown but possibly viral. You see a Collarette scale

Back 445

Pityriasis Rosea

Front 446

a patient comes in with Lesions are oriented along skin lines giving the appearance of a Christmas tree. What do they have?

Back 446

Pityriasis Rosea

Front 447

if you see Wickham's striae, what does the patient have?

Back 447

Lichen Planus