Usmle - Kaplan Iv - Skin

Front 1

What damages tissues and cells in SLE?

Back 1

Pathogenic autoantibodies (esp antinuclear antibodies) and immune complexes.

Front 2

What percentage of SLE occurs in women?

Back 2

90%

Front 3

SLE is associated with what manifestations?

Back 3

skin rash
arthritis
anemia
seizures
psychiatric illness
damage to kidneys, lungs, and heart

Front 4

Describe the characteristic malar "butterfly" rash of SLE

Back 4

Fixed erythema with sparing of the nasolabial folds, and exacerbation with sunlight exposure.

Front 5

What are the three cutaneous manifestations of SLE?

Back 5

malar "butterfly" rash
alopecia
maculopapular rash

Front 6

Lilac or heliotrope discoloration of the upper eyelids accompanied by periorbital edema

Back 6

dematomyositis

Front 7

What is the cutaneous manifestation of progressive systemic sclerosis, or scleroderma?

Back 7

Thick, dense skin secondary to dermal fibrosis.

Front 8

What is the cutaneous manifestation of RA?

Back 8

Subcutaneous nodules are seen in 20-30% of rheumatoid arthritis patients. They may arise anywhere on the body, but are most frequently found over the bony prominences. The nodules are characterised histologically by dense areas of fibrinoid necrosis with basophilic streaks and granules, surrounded by a palisade of cells, mainly fibroblasts and histiocytes.

Front 9

A disease of connective tissue characterised by swelling, dermatitis and inflammation of muscle tissue.

Symptoms include fever, malaise, difficulty swallowing, general weakness, muscle weakness (pelvic and shoulder girdle muscles) and skin and mucosal lesions.

Back 9

dermatomyositis

Front 10

hardening of skin

Back 10

scleroderma

Front 11

A chronic, progressive dermatosis characterised by boardlike hardening and immobility of the affected skin, with visceral involvement, especially of lungs, oesophagus, kidneys and heart. It may be accompanied by calcinosis, raynaud's phenomenon, and telangiectasis (crest syndrome). It includes acrosclerosis and sclerodactyly.

Back 11

systemic scleroderma

Front 12

Stiffness and tightness of the skin of the fingers, with atrophy of the soft tissue and osteoporosis of the distal phalanges of the hands and feet; a limited form of progressive systemic sclerosis occurring with Raynaud's phenomenon.

Back 12

acrosclerosis

Front 13

Stiffness and tightening of the skin of the fingers, with atrophy of the soft tissues and osteoporosis of the distal phalanges of the hands and feet.

Back 13

sclerodactyly

Front 14

What does a skin bx in lupus show?

Back 14

Granular deposition of Ig and complement along the DEJ. In discoid lupus these are confined to the area of the rash, while in SLE they can also be seen in clinically "normal" skin.

Front 15

What does a skin bx in dermatitis herpetiformis show?

Back 15

Granular deposits of IgA selectively localized to the tips of dermal papillae.

Front 16

What does a skin bx in pemphigus vulgaris show?

Back 16

A lacy network of IgG deposits in the intercellular spaces lining the keratinocytes.

Front 17

What does a skin bx in bullous pemphigoid show?

Back 17

Linear basement membrane depositions of Ig and complement.

Front 18

A chronic disease of the skin characterised by severe itching, extensive eruption of vesicles (blisters) and papules which occur in groups. May be associated with an occult malignancy in the elderly patient.

Treatment includes sulpha-based antibiotics. In some cases this condition may be associated with malabsorption. Relapses are common.

Back 18

dermatitis herpetiformis

Front 19

A serious form of pemphigus, occurring in middle age, in which cutaneous flaccid acantholytic suprabasal bullae and oral mucosal erosions may be localised a few months before becoming generalised; blisters break easily and are slow to heal; results from the action of autoimmune antibodies that localise to intercellular sites of stratified squamous epithelium.

Back 19

pemphigus vulgaris

Front 20

Form of pemphigoid (which also affects mucous membranes), in which blisters (bulli) form on the skin. Patients have circulating antibody (usually IgG) to basement membrane of stratified epithelium although the antibody titre does not correlate with the severity of the disease.

Back 20

bullous pemphigoid

Front 21

Which autoantibodies are most specific for SLE?

Back 21

anti-DS-DNA
anti-Sm

Front 22

Anti-Jo-1 antibodies are associated with what?

Back 22

inflammatory myopathies

Front 23

Anti-SS-A/Ro and anti-SS-B/La are associated with what?

Back 23

Sjogren syndrome (anti-SSB/La is far more specific.)

Front 24

The second most common autoimmune rheumatic disease. Immune cells attack and destroy the exocrine glands that produce tears and saliva. 90% of cases occur in women, and the average age of onset is 40.

Back 24

Sjogren's syndrome

Front 25

The most serious of renal lesions of lupus, occuring in 35-40% of patients who are biopsied.

Back 25

Diffuse proliferative glomerulonephritis - marked glomerular changes w/ a marked increase in cellularity primarily related to the proliferation of endothelial and mesangial cells. Fibrinoid necrosis and hyaline thrombi are seen in the glomerular capillary beds. Some of the glomeruli have epithelial crescents that fill Bowman's space.

Front 26

Marked glomerular changes w/ a marked increase in cellularity primarily related to the proliferation of endothelial and mesangial cells. Fibrinoid necrosis and hyaline thrombi are seen in the glomerular capillary beds. Some of the glomeruli have epithelial crescents that fill Bowman's space.

Back 26

Diffuse proliferative glomerulonephritis

Front 27

With modern therapeutic management, what is the 10-year survival for SLE?

Back 27

More than 95%. The key appears to be good control of the initial acute phase.

Front 28

What is the treatment for SLE?

Back 28

Corticosteroids are the mainstay of tx, but should be used judiciously and with bone protection.
NSAIDs are helpful for mild inflammation.
Hydroxychloroquine and other anti-malarials reduce SLE activity and help w/ sx involving joints and skin.
Severe SLE requires immunosuppressives such as cyclophosphamide and azathioprine.

Front 29

Measles is also known as what?

Back 29

rubeola or morbili

Front 30

Rubeola is another term for what?

Back 30

Measles

Front 31

Morbili is another term for what?

Back 31

Measles

Front 32

A disease that most commonly affects children under 15 months of age. It is spread by respiratory droplets and has an incubation period of 9-12 days. The prodrome consists of fever, malaise, conjunctivitis, and prominent upper respiratory symptoms (nasal congestion, sneezing, coryza, and cough.) After 1-7 days, the exanthem appears, usually as a macular or maculopapular lesion on the scalp line and behind the ears. The rash spreads quickly over the face, then by the second or third day (unlike the more rapid spread of rubella) extends down the trunk to the extremities.

Back 32

Measles

Front 33

What are the three C's of the measles prodrome?

Back 33

cough
coryza (runny nose)
conjunctivitis

Front 34

Koplik's spots are pathognomonic for this disease but not often seen because they are transient and may disappear within a day of arising.

Back 34

Measles

Front 35

Primary infection with varicella zoster virus

Back 35

Chicken pox or varicella

Front 36

How is chicken pox spread?

Back 36

Direct contact with the lesions and by the respiratory route.

Front 37

Causes an initial viremia between days 4-6, seeding the liver, spleen, and lung. A secondary viremia occurs from days 11-20, resulting in infection of the epidermis. Characterized by a vesicular eruption consisting of delicate "teardrop" vesicles on an erythematous base.

Back 37

Chicken pox, aka varicella

Front 38

This rash begins with a prodrome of 1-5 days consisting of fever, malaise, sore throat, eye pain, headache, and red eyes. Pain on later and upward eye movement is characteristic. The exanthem begins on the face, spreads to cover the entire body within 24 hours, and resolves by 3 days.

Back 38

German measles, aka rubella

Front 39

This virus causes smooth-surfaced, firm, dome-shaped, pearly papules, averaging 3-5mm in diameter, with a characteristic central umbilication. Irritated lesions may become crusted or pustular. Lesions tend to be on the face, trunk, and extremities.

Back 39

Molluscum contagiosum

Front 40

A common cause of sudden, unexplained high fever in children 6-36 months old. The fever drops suddenly on about the 4th day, coincident with the appearance of a morbiliform erythema consisting of rose-colored discrete macules on the neck, trunk, and buttocks. Complete resolution of the eruption occurs in 1-2 days.

Back 40

Roseola

Front 41

1mm white papules on an erythematous base initially appearing on the buccal mucosa nearest to the lower molars.

Back 41

Koplik's spots - pathognomonic for measles and occur during the prodrome, although rarely seen.

Front 42

An enanthem of pinhead-sized red macules or petechiae on the soft palate and uvula.

Back 42

Forscheimer's sign - seen in rubella

Front 43

Causes small, rapidly ulcerating vesicles surrounded by a red areola on the buccal mucosa, tongue, soft palate, and gingiva.

Back 43

Hand-foot-mouth disease, frequently caused by coxsackieviruses.

Front 44

One or more yellowish white, slightly raised 2mm vesicles in the throat, most commonly on the anterior faucial pillars, tonsils, uvula, or soft palate, and usually surrounded by an intense areola.

Back 44

herpangina - caused by multiple types of coxsackieviruses and echoviruses

Front 45

Sharply marginated, erythematous macules, which become raised, edematous papules over 24-48 hours. Typically, a ring of erythema forms around the periphery, and centrally, the lesions become flatter, more purpuric, and dusky.

Back 45

Target sign - a cutaneous lesion seen in erythema multiforme.

Front 46

Pink-red macules (flat), that may have clear centres (iris lesions) or appear as a dusky violet colour. Most commonly from an allergic response to drugs (sulfas, penicillins, phenytoin, barbituates, phenolphthalein, or carbamazepine,) but occasionally secondary to an infection with HSV or Mycoplasma.

Back 46

erythema multiforme

Front 47

What treatment reduces mobidity and mortality of hospitalized children under 24 months old with measles?

Back 47

High dose vitamin A. Two doses of retinyl palmitate 24 hours apart are recommended for all children 6-24 months, immunodeficient children, children with malnutition, or recent immigrants from areas of high measles mortality.

Front 48

What is the role of the measles vaccine?

Back 48

A live virus vaccine is recommended at 15 months with a booster at 5 years. When given up to 5 days after exposure, vaccination may prevent infection.

Front 49

Children under 12 months old who are exposed to measles virus are given what?

Back 49

Immune serum globulin

Front 50

Is there an antiviral medication available for measles?

Back 50

No.

Front 51

How is measles treated in non-complicated, non-hospitalized cases?

Back 51

Supportive care, bed rest, analgesics, and antipyretics.

Front 52

What are the potential complications of measles infetion?

Back 52

otitis media
pneumonia
encephalitis
thrombocytopenic purpura

Front 53

Dysphagia, fever, headache, sore throat, and stiff neck should be associated with what?

Back 53

herpangina

Front 54

Photophobia, painful urination, and extensive respiratory and alimentary tract involvement can be complications of what?

Back 54

Stevens-Johnson syndrome

Front 55

What is the important rare long-term neurologic complication of measles?

Back 55

Subacute sclerosing panencephalitis. This occurs months to years after the initial measles infection and is characterized by progressive intellectual deterioration accompanied by seizures, loss of vision, and motor abnormalities. Death almost always occurs within 1-3 years, with aspiration pneumonia being a common cause. The only tx is supportive care and anti-convulsants.

Front 56

An autosomal recessive inherited disorder that leads to the progressive dysfunction of the cerebellum, spinal cord and peripheral nerves.

Symptoms usually begin in childhood before puberty and consist of an unsteady gait (ataxia), slurred speech (dysarthria) and jerky eye movements (nystagmus).

Other findings include kyphoscoliosis, hammer toe, heart disease and high arches. Congestive heart failure is a common complication. There is no known treatment and prognosis is poor.

Back 56

Friedreich's ataxia

Front 57

A form of dementia characterised by a slowly progressive deterioration of social skills and changes in personality leading to impairment of intellect, memory, and language.

Back 57

Pick's disease

Front 58

A rare, usually fatal, transmissible encephalopathy occurring in middle life, in which there is partial degeneration of the pyramidal and extrapyramidal systems accompanied by progressive dementia and sometimes muscle wasting, tremor, athetosis, and spastic dysarthria. A familial form has been shown to exhibit autosomal dominant inheritance. The more common sporadic form is probably caused by mutations that produce abnormal prion proteins (prions).

Back 58

Creutzfeldt-Jakob disease

Front 59

Recommended as a preventive measure for children older than 15 months of age exposed to measles.

Back 59

Administration of the live viral vaccine.

Front 60

In which disorder, pemphigus vulgaris or bullous pemphigoid, do you see mucosal bullae?

Back 60

pemphigus vulgaris

Front 61

An autoimmune blistering disorder characterized by formation of thin-walled, relatively flaccid, easily ruptured bullae that appear on either apparently normal skin and mucous membranes or on erythematous bases. The bullae usually rupture to form erosions with raw surfaces that ooze and bleed easily. The denuded areas soon become partially covered with crusts that enlarge by confluence. The mouth lesions appear first in 60% of cases. The short-lived bullae quickly rupture to involve most of the mucosa with painful erosions. Cutaneous lesions are commonly seen in the groin, scalp, face, neck, and axillae.

Back 61

pemphigus vulgaris

Front 62

An autoimmune disease characterized by large, tense, subepidermal bullae with a predilection for the groin, axillae, and flexor surfaces. Involvement of hte pharynx, mucosa, or eye are rare. After the bullae rupture, large denuded areas are seen, but these do not materially increase in size, and usually heal spontaneously.

Back 62

bullous pemphigoid

Front 63

A hemorrhagic, vesiculopustular eruption accompanied by bouts of fever, and arthralgia of one or more joints. The skin lesions begin as tiny erythematous macules that evolve into vesicopustules on a deeply erythematous base.

Back 63

Gonococcal dermatitis (in gonococcemia)

Front 64

Primary syphilis generally presents with what?

Back 64

A nontender, clean-based ulcer on the genitals.

Front 65

Slight pressure on an intact bullae causes peripheral spreading of the lesion.

Back 65

Nikolsky sign - due to a lack of cohesion in the epidermis, so the upper layers can easily be made to slip laterally by slight pressure or rubbing.

Front 66

A variant of bullous pemphigoid resulting in scarring, primarily of the mucosa.

Back 66

Cicatrical pemphigoid

Front 67

A bullous disorder characterized by mechanobullous eruption with noninflammatory scarring that occurs in the elderly population.

Back 67

Epidermolysis bullosa acquisita

Front 68

A split papule is a cutaneous manifestation of what?

Back 68

Secondary syphilis

Front 69

A target sign is characteristic of what?

Back 69

erythema multiforme

Front 70

Characterized by large, fragile bullae, suggestive of pemphigus. When these rupture, they leave circinate, weepy, or crusted lesions. The majority of these are caused by phage 71 coagulase-positive Staph aureus.

Back 70

bullous impetigo

Front 71

Skin erythema and desquamation caused by phage type 71.

Back 71

Exfoliative toxin-induced rash

Front 72

blistering of the skin that occurs in response to skin trauma

Back 72

mechanobullous (usually seen in epidermolysis bullosa acquisita)

Front 73

Form of epidermolysis bullosa characterised by trauma-induced, subepidermal blistering with no family history of the disease. Direct immunofluorescence shows IgG deposited at the dermo-epidermal junction.

Back 73

epidermolysis bullosa acquisita

Front 74

Bacterial antigens that activate all T-lymphocytes that have a T-cell receptor with a particular beta-sequence. As a consequence, large numbers of T-cells are activated and systemic reactions such as shock are induced.

Back 74

superantigens

Front 75

What is the best diagnostic tool in early pemphigus vulgaris?

Back 75

DIF - intercellular IgG is found throughout the epidermis or oral epithelium, including normal skin. In acantholytic areas, C3 deposition is also reliably found. DIF may still be positive many years after clinical remission.

Front 76

The seperation of keratinocytes from one another, beginning with detachment of tonofilaments from desmosomes.

Back 76

acantholysis

Front 77

Acantholysis, clefts, and blister formation in the intraepidermal areas due to IgG autoantibodies are seen in what blistering disorder?

Back 77

pemphigus vulgaris

Front 78

Balloon degeneration and reticular changes are both histologic markers of what lesions?

Back 78

HSV-induced

Front 79

Serous exudates between cells of the epidermis, with an inflammatory infiltrate in the dermis.

Back 79

spongiosis

Front 80

Accumulation of neutrophils underneath the stratum corneum. This can be seen in a number of different disorders, including fungal infection, staphylococcal scalded-skin syndrome, and psoriasis.

Back 80

subcorneal pustulosis

Front 81

What is the standard therapy for pemphigus vulgaris?

Back 81

Corticosteroids - prednisone is usually given alone or in combination with other immunosuppressants. In addition, pemphigus antibody titers are performed every four weeks, watching for a fall in titer. Medication is continued until the clinical disease is suppressed and pemphigus antibody disappears from the serum.

Front 82

Often used for the tx of onychomycosis.

Back 82

Oral antifungals

Front 83

Effective in the treatment of pemphigus, but infrequently used due to bone marrow suppression and nephrotoxicity.

Back 83

gold therapy

Front 84

Penicillamine is used to treat what?

Back 84

Wilson syndrome - an AR disorder where there is excessive quantities of copper in the tissues, particularly the liver and central nervous system.

Front 85

A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents.

It is characterised in the acute stage by erythema, oedema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oosing and vesiculation and crusting and scaling and in the more chronic stages by lichenification or thickening or both, signs of excoriations and hyperpigmentation or hypopigmentation or both.

Back 85

atopic dermatitis

Front 86

cradle cap is an example of what?

Back 86

seborrheic dermatitis

Front 87

pityriasis capitus

Back 87

dandruff

Front 88

These lesions typically have a lichenified, papular, slightly scaly appearance. The classic locations are the antecubital and popliteal fossa, flexor wrist, eyelids, face, and around the folds of the neck. Often there are intermingled excoriated papules, suggesting the pruritic nature of these lesions.

Back 88

atopic dermatitis

Front 89

Patients with atopic dermatitis often have a family history of what?

Back 89

asthma, hay fever, and eczema

Front 90

eczema is a loose term for what?

Back 90

atopic dermatitis

Front 91

lesions with a yellowish exudate and crust overlying an erythematous base are said to be what?

Back 91

impetiginized

Front 92

fungal infections commonly occur where in children?

Back 92

on the face and scalp

Front 93

psoriasis tends to occur where?

Back 93

Over extensor surfaces of the extremities, scalp, and intergluteal fold. In children, it can also be seen in diaper areas. Typically, lesions tend to be covered by thick, silvery scales.

Front 94

Where do spider bites tend to occur?

Back 94

On the lower extremities. With widespread involvement, one can see bites in different stages ranging from erythematous to urticarial to bulla formation and necrotic centers.

Front 95

It is characterised clinically by the presence of rounded, circumscribed, erythematous, dry scaling patches of various sizes, covered by greyish white or silvery white, umbilicated and lamellar scales, which have a predilection for the extensor surfaces, nails, scalp, genitalia and lumbosacral region. Central clearing and coalescence of the lesions produce a wide variety of clinical configurations, including annular or circinate, discoid or nummular, figurate and gyrate arrangements.

Back 95

psoriasis

Front 96

A common chronic, squamous dermatosis, marked by exacerbations and remissions and having a polygenic inheritance pattern. The most distinctive histological findings are Munro microabscesses and spongiform pustules.

Back 96

psoriasis

Front 97

A microscopic collection of polymorphonuclear leukocytes found in the stratum corneum in psoriasis.

Back 97

Munro microabscess

Front 98

HLA associated with psoriatic arthritis and Reiter syndrome, among other conditions.

Back 98

HLA B27

Front 99

the triad of nongonococcal urethritis, conjunctivitis, and arthritis, frequently with mucocutaneous lesions

Back 99

Reiter syndrome

Front 100

What is the first-line treatment of atopic dermatitis?

Back 100

topical corticosteroids

Front 101

This treatment modulates the immune response in the skin in atopic dermatitis. However, the risk of future skin cancer makes it undesirable in children.

Back 101

UV light

Front 102

These skin cancers usually have a prolonged, noninvasive, horizontally oriented growth phase in which the lesion enlarges asymmetrically. The upper back of both sexes and the shins in women are the most common sites. There is a tendency to multicoloration, not just with different shades of tan, but also black, red, brown, and white.

Back 102

malignant melanoma

Front 103

What is the ABCD criteria?

Back 103

indications of a malignant melanoma - asymmetry, border irregularity, color variegation, and diameter > 6mm.

Front 104

A common skin cancer composed of one or a few small, waxy, semitranslucent nodules forming around a central depression that may or may not be ulcerated, crusted, and bleeding. The edge of larger lesions has a characteristic rolled border. Telangiectasias course through the lesion. Bleeding on slight injury is common.

Back 104

basal cell carcinoma

Front 105

Multiple, oval, slightly raised, light brown to black, sharply demarcated papules or plaques, located on the chest and back.

Back 105

seborrheic keratoses

Front 106

Found cheifly on the chronically sun-exposed surfaces of the face, ears, and backs of hands and forearms. Usually multiple and discrete, but they can be flat or elevated, verrucous or keratotic, and red, pigmented, or skin-colored.

Back 106

solar (actinic) keratoses

Front 107

Approximately one in how many Americans will have a malignant melanoma in their lifetime?

Back 107

1/72

Front 108

There is a familial tendency to develop this skin cancer, especially in patients with multiple congenital nevi.

Back 108

malignant melanoma

Front 109

Sunlight plays more of a role in which skin cancers - melanoma or nonmelanoma?

Back 109

Sunlight is a more direct etiologic factor in nonmelanoma skin cancer.

Front 110

What is the correct workup for a suspected malignant melanoma?

Back 110

Tissue biopsy, followed by CBC, LFTs, and CXR if confirmed.

Front 111

What would the biopsy of a malignant melanoma show?

Back 111

Atypical melanocytes scattered singly and in irregular nests, presence of mitoses, inflammatory reaction, and the absence of dermal stroma.

Front 112

Basaloid lobules extending from the basal layer, showing clefting and palisading border is characteristic of which skin cancer?

Back 112

basal cell carcinoma

Front 113

Hyperkeratosis and keratin horns are characteristic in the biopsy of what?

Back 113

seborrheic keratosis

Front 114

Nests of nevoid cells are seen in the biopsy of what?

Back 114

normal melanocytic nevi

Front 115

Squamous proliferation with atypia and invasion into the dermis is typical of what?

Back 115

squamous cell carcinoma

Front 116

A benign skin lesion resulting from excessive growth of the top layer of skin cells. It usually is found in persons over 30 years old and may be few or numerous.

Back 116

seborrheic keratosis

Front 117

What is the most common subtype of malignant melanoma?

Back 117

superficial spreading (70%) - this presents as a flat or nearly flat brown lesion with variable black, blue, or pink discoloration, and a size typically greater than 6mm, on the trunk or legs.

Front 118

An uncommon subtype of melanoma that is often found in dark-skinned individuals and occurs on the palms, soles, or beneath the nail plate.

Back 118

acral lentiginous melanoma

Front 119

A rare, nonpigmented form of melanoma that appears pink or flesh-colored. More frequently found in metastases than primary lesions, and is presumed to represent a deterioration in the cancer cells' genetic structure that leads to an impaired ability to synthesize melanin.

Back 119

amelanotic melanoma

Front 120

Occurs in about 15% of melanoma cases. Grows slowly over a period of years to decades, and is usually found as part of a large (often more than 3 cm) precursor lesion on sun damaged skin of the head, neck, and arms.

Back 120

lentigo maligna melanoma

Front 121

Occurs in 15-30% of melanoma cases, and is most often seen on legs and trunks. Tends to grow rapidly (weeks to months) and causes a darkly colored papule or nodule that may bleed with minor trauma.

Back 121

nodular melanoma

Front 122

What is the most important determinant of prognosis in melanoma?

Back 122

Tumor thickness - this can be measured as the Breslow depth (measured vertically in mm from the top of the granular layer or base of a superficial ulceration, to the deepest site of tumor involvement.) Thicker tumors have a greater risk of metastasis.

The next most important risk factor is the presence of ulceration.

Front 123

Is melanoma effectively treated by chemotherapy?

Back 123

No. The response rate is less than 20%.

Front 124

What is the 5-year survival rate of malignant melanoma?

Back 124

It varies from over 90% (if the tumor is thin and without metastases) to less than 20% (if distant metastases are present.)

Front 125

A common skin disorder characterized by round, circumscribed, erythematous, dry, scaling plaques of various sizes, covered by grayish white, imbricated (overlapping like shingles on a roof,) and silvery scales.

Back 125

psoriasis

Front 126

Psoriatic lesions have a predilection for which parts of the body?

Back 126

The scalp, extensor surfaces of the limbs, elbows, knees, and sacral region. Eruptions develop slowly and are usually symmetrical, and may vary from one to more than a hundred lesions. Itching or burning may be present and may cause extreme discomfort.

Front 127

Drug eruptions usually present how?

Back 127

As morbilliform erythematous lesions, initially involving the trunk and extending to the extremities. The lesions tend to be papular, coalescing into plaques without well-defined borders.

Front 128

This dermatitis is pustular and bullous, and presents most commonly in infants or patients on long term TPN.

Back 128

dermatitis due to zinc deficiency

Front 129

This disorder shows epidermal hyperplasia (acanthosis), often with fusion of rete ridges. Another distinctive feature is the presence of subcorneal and intracorneal pustules (Munro microabscesses) containing aggregated neutrophils.

Back 129

psoriasis

Front 130

Basal cell liquefaction with band-like chronic inflammatory infiltrate in the papillary dermis is suggestive of what?

Back 130

lichen planus or another lichenoid lesion

Front 131

Hyperkeratosis with intra-epidermal clefts containing "corps ronds" suggests what?

Back 131

Darier's disease (keratosis follicularis)

Front 132

A slowly progressive autosomal dominant disorder of keratinization characterised by pinkish-to-tan papules that coalesce to form plaques. These lesions become darker over time and commonly fuse, forming papillomatous and warty malodorous growths.

Back 132

keratosis follicularis (Darier's disease)

Front 133

Dyskeratotic round cells occurring in the epidermis, with a central round basophilic mass surrounded by a clear halo; characteristically found in keratosis follicularis.

Back 133

corps ronds

Front 134

Large intraepidermal clefts in the suprabasal region suggest what?

Back 134

pemphigus vulgaris

Front 135

Large subepidermal blisters with sparse inflammatory infiltrate suggests what?

Back 135

bullous pemphigoid

Front 136

What is the mainstay of treatment for psoriasis?

Back 136

topical corticosteroids

Front 137

What are two classic drugs that exacerbate psoriatic lesions?

Back 137

beta blockers and lithium

Front 138

Nail changes in someone with psoriasis is commonly associated with what?

Back 138

development of psoriatic arthritis (asymmetrical distal interphalangeal joint involvement and nail damage)

Front 139

What is the prognosis of psoriasis?

Back 139

Persistant and recurrent lesions.

The course is unpredictable. Psoriasis usually begins on the scalp or elbows and may remain localized, or completely disappear, recur, or spread.

Front 140

A variant of psoriasis that is exacerbated by URI's.

Back 140

guttate psoriasis