Usmle - Kaplan Qb - Skin

Front 1

Dermatitis herpetiformis is strongly associated with what?

Back 1

gluten-sensitive enteropathy (celiac sprue)

Front 2

Ptients have excoriated groups of papules and vesicles on an erythematous base. The lesions tend to involve the extensor surfaces of the extremities and the buttocks. Microscopically, the lesions show subepidermal papillary dermal neutrophilic abscesses, with granular deposits of IgA and C3 in the dermal papillary tips. Patients may respond dramatically to dapsone therapy.

Back 2

dermatitis herpetiformis

Front 3

This disease produces large, tense blisters of the trunk, extremitites, intertriginous areas, and rarely the oral cavity, with typical patients being elderly.

Back 3

bullous pemphigoid

Front 4

A disease of the elderly that causes large, flaccid bullae and usually shows prominant oral involvement.

Back 4

pemphigus vulgaris

Front 5

Lifelong intermittent condition related to gluten-sensitive enteropathy
Papules and vesicles on the extensor surfaces of the extremities and the buttocks
Subepidermal papillary dermal neutrophilic abscesses
Granular deposits of IgA and C3 in the dermal papillary tips

Back 5

dermatitis herpetiformis

Front 6

Pruritic wheals that form after mast cells degranulate and trigger localized dermal edema and dilated superficial lymphatic channels. Mast cell degranulation is sometimes, but not always, triggered by IgE-antigen interactions.

Back 6

urticaria

Front 7

Munro abscesses are a characteristic of what?

Back 7

psoriasis

Front 8

Solar elastosis is found in what?

Back 8

actinic keratoses

Front 9

What is the treatment for shingles?

Back 9

famciclovir or valacyclovir are preferred, but acyclovir is also used

Front 10

doxepin is approved for use in the topical treatment of what?

Back 10

eczematous dermatitis (atopic dermatitis, eczema, or lichen simplex chronicus.)

Front 11

Used for immunosuppressed patients suffering from CMV infection. It inhibits the viral DNA polymerase by mimicking the pyrophosphate portion of nucleoside triphosphates.

Back 11

foscarnet (phosphonoformic acid)

Front 12

What does the Oka strain live attenuated vaccine protect against?

Back 12

Varicella zoster virus. It is administered during childhood on the same schedule as the MMR vaccine, and is effective as a prophylactic treatment even after exposure to VZD (but not once outbreak has occured.)

Front 13

Bullae with the cleavage plane above the basal layer of the epidermis suggest what?

Back 13

pemphigus vulgaris

Front 14

pemphigus vulgaris is caused by what?

Back 14

autoantibodies to desmoglein 1 or 3

Front 15

Is oral mucosa involved in pemphigus vulgaris?

Back 15

Yes, and it often preceedes skin lesions.

Front 16

What is the most common cause of Stevens-Johnson syndrome in the adult population?

Back 16

drugs

Front 17

Bullae with subepidermal cleavage planes suggest what?

Back 17

bullous pemphigoid

Front 18

Does bullous pemphigoid involve mucous membranes?

Back 18

Not usually.

Front 19

This disorder may be caused by autoantibodies against BP Ag1, BP Ag2, alpha-6 integrin, or laminin 5.

Back 19

bullous pemphigoid

Front 20

Painful vesicular lesions on the tongue are characteristic of what?

Back 20

HSV-1

Front 21

What are the characteristics of Herpesviridae?

Back 21

dsDNA
enveloped
icosahedral

Front 22

What are the characteristics of Poxviridae (e.g. smallpox and molluscum contagisum?)

Back 22

dsDNA
enveloped

Front 23

What are the two most important gram-positive, catalase-negative, beta-hemolytic cocci?

Back 23

Strep pyogenes (causes impetigo) or Strep agalactiae (normal flora in femal UGT and rectum, but can cause bacterial septicemia of the newborn.)

Front 24

A gram-positive, catalase-positive, beta-hemolytic coccus

Back 24

Staph aureus, which causes impetigo

Front 25

What are the two most important causes of impetigo in children?

Back 25

Strep pyogenes (gram-positive, catalase-negative, beta-hemolytic coccus)
Staph aureus (gram-positive, catalase-positive, beta-hemolytic coccus)

Front 26

A positive-sense, ssRNA virus that is non-segmented and naked belongs to which family?

Back 26

Picornaviridae, which includes coxsackiviruses, the agents of herpangina and hand, foot, and mouth disease.

Front 27

Coxsackieviruses cause blister-like lesions in the mouth.
If these are in the front of the buccal mucosae, this is ________, and if these are in the rear of the mouth on the palate and fauces, this is _________.

Back 27

in front of the buccal mucosae - hand, foot, and mouth disease
in the rear of the mouth on the palate and fauces - herpangina

Front 28

Common benign lesions of the skin of middle-aged and older individuals, that show hyperplastic epidermal cells with a basaloid appearance. Pseudo-horn cyst formations, in which small cystic spaces with keratin formation are seen in the epidermis, are characteristic.

Back 28

seborrheic keratoses

Front 29

koilocytic features are characteristic of what?

Back 29

verruca vulgaris (common warts)

Front 30

melanocytes in the upper level of the epidermis suggest what?

Back 30

melanoma

Front 31

What are the characteristics of Herpesviridae?

Back 31

dsDNA
enveloped
icosahedral

Front 32

What are the characteristics of Poxviridae (e.g. smallpox and molluscum contagisum?)

Back 32

dsDNA
enveloped

Front 33

What are the two most important gram-positive, catalase-negative, beta-hemolytic cocci?

Back 33

Strep pyogenes (causes impetigo) or Strep agalactiae (normal flora in femal UGT and rectum, but can cause bacterial septicemia of the newborn.)

Front 34

A gram-positive, catalase-positive, beta-hemolytic coccus

Back 34

Staph aureus, which causes impetigo

Front 35

What are the two most important causes of impetigo in children?

Back 35

Strep pyogenes (gram-positive, catalase-negative, beta-hemolytic coccus)
Staph aureus (gram-positive, catalase-positive, beta-hemolytic coccus)

Front 36

This layer of fascia invests the abdominal musculature.

Back 36

the deep fascia

Front 37

This layer of fascia lines the abdominal cavity. It forms the posterior layer of the rectus sheath below the arcuate line and the internal spermatic fascia of the spermatic cord.

Back 37

the transversalis fascia

Front 38

Multiple masses located at the gray-white matter junction is almost always what?

Back 38

metastatic disease

Front 39

A skin cancer notorious for occasionally producing isolated, late (up to 20 or more years after the initial resection and apprent cure) metastases that involve the CNS, viscera, distant skin, skeletal system, or distant LN's.

Back 39

melanoma

Front 40

The most frequent neoplasm of the brain.

Back 40

Glioblastoma multiforme.

Front 41

This malignant neoplasm of the brain develops from malignant degeneration of astrocytes in the white matter and presents as an ill-defined mass that expands the white matter with areas of necrosis and hemorrhage. This tumor is rarely multifocal.

Back 41

Glioblastoma multiforme

Front 42

How do intracerebral hemorrhages present?

Back 42

Acute and rapidly evolving neurologic deficits, headache, and coma.

Front 43

What is the most frequent cause of intracerebral hemorrhage?

Back 43

HTN

Front 44

What are the most common sites of hypertensive intracerebral hemorrhage?

Back 44

basal ganglia
cerebellum
pons

Front 45

What are the most frequent metastatic neoplasms in the brain?

Back 45

In men - lung cancer
In women - breast cancer

Front 46

What is the usual source of metastatic small cell carcinoma?

Back 46

lung cancer

Front 47

pustules that rupture to form a black eschar surrounded by edema are referred to as what?

Back 47

malignant pustules - can be seen in Bacillus infection

Front 48

What is the px of cutaneous Bacillus anthracis infection?

Back 48

Most cases remain localized, but death can occur as the result of bacteremia, meningitis, or pneumonia

Front 49

A large, boxcar-shaped, gram-positive rod that forms spores that look like bamboo shoots

Back 49

Bacillus (as in Bacillus anthracis)

Front 50

A yeast with a cigar-shaped tissue form, that causes mycetomae draining yellow granular pus through multiple sinus tracts.

Back 50

Sporothrix schenckii, the agent of rose-gardener's disease

Front 51

A gram-negative rod requiring cysteine that can persist for weeks or months. Most human infections occur in Arkansas and Missouri.

Back 51

Francisella tularensis, which causes tularemia

Front 52

A gram-negative rod with bipolar staining that does not form stable spores.

Back 52

Yersinia pestis, which causes bubonic plague

Front 53

The hallmark of this disease is the formation of black, necrotic lymph nodes that form at the site of the vector fleabite.

Back 53

Bubonic plague, caused by Yersinia pestis. The lesions described are buboes.

Front 54

A large spirochete that causes a localized, expanding, erythematous rash. Spread by the Ixodes tick.

Back 54

Borrelia burgdorferi, which causes Lyme disease

Front 55

The presence of individual adenocarcinoma cells in the skin (often overlying a breast cancer) is what?

Back 55

Paget disease

Front 56

What is the inheritance pattern of albinism?

Back 56

AR

Front 57

Albinos are at increased risk of which skin cancers?

Back 57

Squamous cell carcinoma (most common) and basal cell carcinoma (less common.)

Front 58

An eruption of pemphigus vulgaris may be triggered by what?

Back 58

drugs (thiols, penicillamine), physical injury (burns), cancer, pregnancy, other skin diseases, emotional stress.

Front 59

Pemphigus vulgaris is more common among people with what heritage?

Back 59

Jewish or Mediterranean

Front 60

What is the mortality rate of pemphigus vulgaris?

Back 60

5-15%

Front 61

What causes mortality in pemphigus vulgaris?

Back 61

Secondary infection due to the combination of open cutaneous sores and long-term use of corticosteroids.

Front 62

What complications can develop from the long-term use of corticosteroids to treat pemphigus vulgaris?

Back 62

Growth retardation in children, malignancies (including leukemias and lymphomas), osteoporosis, and adrenal insufficiency.

Front 63

An autoimmune skin condition that causes blistering lesions of the skin and mucous membranes. Dx is confirmed when bx demonstrates intraepithelial IgG and C3. Tx often involves long-term corticosteroid use, which contributes to the 5-15% mortality rate.

Back 63

pemphigus vulgaris

Front 64

An X-linked recessive disease of young boys characterized by recurrent infections, thrombocytopenia with hepatosplenomegaly, and eczema. Death usually occurs before the age of 6 due to infection or, less commonly, bleeding or malignancy.

Back 64

Wiskott-Aldrich syndrome

Front 65

What are the serum IgG levels in a young boy with Wiskott-Aldrich syndrome?

Back 65

IgA and IgE are elevated, whereas IgG is normal or low, and IgM is low.

Front 66

What is the tx for Wiskott-Aldrich syndrome?

Back 66

BMT from an HLA-identical sibling as early as possible is curative. Otherwise, splenectomy may correct the bleeding diathesis and increase platelet counts, but it makes the pt susceptible to infection and requires continuous antibiotic prophylaxis thereafter.

Front 67

What mutation causes Wiskott-Aldrich syndrome?

Back 67

A mutation in the Wiskott-Aldrich syndrome protein (WASP,) a cytoskeletal protein mainly expressed in hematopoietic cells.

Front 68

Which is associated with chronic, severe bullae formation on the skin AND oral mucosa?

Back 68

pemphigus vulgaris (oral lesions are rare in bullous pemphigoid)

Front 69

What happens if a patient with pemphigus vulgaris goes untreated?

Back 69

They become febrile, lose weight, and die within a year. Contrast this to patients with bullous pemphigoid, whose lesions tend to heal and patients do very well.

Front 70

What happens if a patient with bullous pemphigoid goes untreated?

Back 70

Lesions tend to heal and patients do very well. Contrast this to patients with pemphigus vulgaris, who become febrile, lose weight, and die within a year if untreated.

Front 71

The vesicles in this bullous disorder contain rounded acantholytic keratinocytes "floating" within.

Back 71

pemphigus vulgaris

Front 72

a bullous disorder where you see eosinophils within the blisters is more likely to be which - bullous pemphigoid or pemphigus vulgaris?

Back 72

bullous pemphigoid. The vesicles in pemphigus vulgaris mostly contain rounded acantholytic keratinocytes "floating" within.

Front 73

IgA deposits on the basement membrane is characteristic of which bullae-forming disease?

Back 73

dermatitis herpetiformis

Front 74

In this bullae-forming disease, vesicles form at the DEJ. The disease is associated w/ gluten sensitivity and celiac disease.

Back 74

dermatitis herpetiformis

Front 75

Which disorder has a positive Nikolsky sign - pemphigus vulgaris or bullous pemphigoid?

Back 75

Pemphigus vulgaris (due to IgG-mediated destruction of intercellular bridges between keratinocytes.) Bullous pemphigoid has a negative Nikolsky sign.

Front 76

The typical age of onset for pemphigus vulgaris is ________, while it is _______ for bullous pemphigoid.

Back 76

pemphigus vulgaris: 40-60
bullous pemphigoid: 60-80

Front 77

The lesions in pemphigus vulgaris are __________, while those in bullous pemphigoid are ____________.

Back 77

pemphigus vulgaris - painful vesicles and bullae with oral involvement
bullous pemphigoid - mostly asymptomatic vesicles and bullae with NO oral involvement

Front 78

It's a topical preparation with a broad spectrum of antimicrobial activity. Bactericidal against both gram-negative and gram-positive bacteria, as well as fungi. Destroys cell walls. Indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second- and third-degree burns.

Back 78

silver sulfadiazine

Front 79

A topical corticosteroid indicated for the tx of moderate to severe inflammatory conditions of the skin, including psoriasis.

Back 79

Betamethasone cream

Front 80

A topical synthetic vitamin D3 analog indicated for the tx of moderate plaque psoriasis in adults.

Back 80

Calcipotriene ointment

Front 81

Errythromycin topical solution is most commonly used for what?

Back 81

acne vulgaris

Front 82

Metronidazole cream is most commonly used for what?

Back 82

acne rosacea

Front 83

Tzanck smears are used to demonstrate what?

Back 83

multinucleated giant cells in the base of vesicles due to infections with varicella-zoster virus

Front 84

Immunocompromised patients with varicella are treated with what to prevent dissemination?

Back 84

acyclovir

Front 85

Orchitis is an important potential secondary complication of what disease that causes a rash in children?

Back 85

mumps

Front 86

Subacute sclerosing panencephalitis is a rare complication of what disease that causes rash in children?

Back 86

measles

Front 87

What is the inheritance pattern of xeroderma pigmentosum?

Back 87

AR

Front 88

Tzanck smears are used to demonstrate what?

Back 88

multinucleated giant cells in the base of vesicles due to infections with varicella-zoster virus

Front 89

Immunocompromised patients with varicella are treated with what to prevent dissemination?

Back 89

acyclovir

Front 90

Orchitis is an important potential secondary complication of what disease that causes a rash in children?

Back 90

mumps

Front 91

Subacute sclerosing panencephalitis is a rare complication of what disease that causes rash in children?

Back 91

measles

Front 92

What is the inheritance pattern of xeroderma pigmentosum?

Back 92

AR

Front 93

HSV-1 remains latent in which ganglion?

Back 93

the trigeminal root ganglion

Front 94

EBV remains latent in which cells?

Back 94

B cells

Front 95

VZV remains latent in which ganglia?

Back 95

dorsal root ganglia

Front 96

Cytomegaloviruses remain latent in which cells?

Back 96

macrophages

Front 97

HSV-2 remains latent in which ganglia?

Back 97

sacral ganglia

Front 98

The herpes family of viruses multiplies where?

Back 98

int he nucleus

Front 99

How is herpes treated in imimunocompromised patients or those with severe infection?

Back 99

acyclovir

Front 100

How is neurofibromatosis-1 (von Recklinghausen disease) inherited?

Back 100

AD

Front 101

NF-1 (von Recklinghausen disease) is characterized by what?

Back 101

Multiple neural tumors anywhere on or in the body
Numerous pigmented cutaneous lesions (cafe au lait spots)
Pigmented iris hamartomas (Lisch nodules.)

Front 102

Neural tumors seen in NF-1 (von Recklinghausen disease) are caused by what?

Back 102

Proliferation of fibroblasts or Schwann cells in the peripheral nerves, possibly due to ras inactivation.

Front 103

A mitochondrial disease characterized by neurologic abnormalities, infantile encephalopathy, and transient or permanent blindness due to optic nerve damage.

Back 103

Leber optic neuropathy

Front 104

A benign tumor-like nodule composed of an overgrowth of mature cells and tissues normally present in the affected part, but with disorganization and often with one element predominating.

Back 104

hamartoma

Front 105

A hamartoma of the iris commonly seen in NF-1

Back 105

Lisch nodule. These do not affect vision.

Front 106

A small, shallow, painful ulceration that usually affects the oral mucosa, but not underlying bone. May occasionally affect other body tissues, including those of the GI tract and the external genitals. They do not appear to be infectious, contagious, or sexually transmitted.

Back 106

aphtha - seen in aphthous stomatitis and hand-foot-and-mouth disease

Front 107

stomatitis

Back 107

generalized inflammation of the oral mucosa

Front 108

Generalized inflammation of the oral mucosa, with shallow, painful ulcers (also known as canker sores)

Back 108

Aphthous stomatitis

Front 109

These lesions are more common in the 10-20 year old group but can occur at any age. Etiology is unclear, but candidates include infection, trauma, and vitamin deficiency. The lesions are recurrent, small, necrotic, shallow, extremely painful lesions of the oral mucosa, with erythematous borders. Bx will demonstrate a mononuclear infiltrate.

Back 109

aphthous lesions

Front 110

A white membrane that covers the surface of the tongue and can be scraped off, particularly in someone with HIV, is probably what?

Back 110

candidiasis

Front 111

HSV-1 infections can cause a clustering of vesicles on which areas of the mouth?

Back 111

The oral mucosa, gingiva, and tongue can all be affected.

Front 112

A benign soft-tissue mass that usually forms in the gingiva. It can occur in young adults, especially pregnant women. The lesions are not painful.

Back 112

pyogenic granuloma

Front 113

A tumorlike mass of granulation tissue produced in response to minor trauma in some individuals. It is not suppuration producing, as the name suggests, but is highly vascular and bleeds readily.

Back 113

pyogenic granuloma

Front 114

Minor aphthous ulcers are smaller than _______ and tend to heal within ______ days.

Back 114

less than 10mm
heal within 7-10 days

Front 115

Do patients with aphthous ulcers have a family history of them?

Back 115

About half do.

Front 116

What is the most common form of basal cell carcinoma?

Back 116

noduloulcerative

Front 117

How does a basal cell carcinoma typically present?

Back 117

These are most commonly noduloulcerative, which begin as a pearly papule and progress to a larger lesion with rolled edges and central ulceration.

Front 118

Skin tumors composed of small cells forming dermal nests and strands with peripheral nuclear palisading, typically occuring on sun-exposed areas.

Back 118

basal cell carcinoma

Front 119

Do basal cell carcinomas metastasize?

Back 119

Basal cell carcinomas rarely metastasize, but can become locally mutilating if neglected.

Front 120

Dark-colorred, raised lesions that look "stuck onto" the face.

Back 120

Seborrheic keratoses - caused by benign basaloid cells

Front 121

Shallow ulcers with erythematous bases covered by a crust and surrounded by a wide, elevated, indurated border.

Back 121

Sqamous cell carcinoma - caused by malignant keratinocytes

Front 122

Form of basal cell carcinoma with a pearly or waxy nodule that may have central ulceration.

Back 122

Noduloulcerative (most common form.)

Front 123

Skin tumors composed of small cells forming dermal nests and strands with peripheral nuclear palisading, typically occuring on sun-exposed areas.

Back 123

basal cell carcinoma

Front 124

Do basal cell carcinomas metastasize?

Back 124

Basal cell carcinomas rarely metastasize, but can become locally mutilating if neglected.

Front 125

Dark-colorred, raised lesions that look "stuck onto" the face.

Back 125

Seborrheic keratoses - caused by benign basaloid cells

Front 126

Shallow ulcers with erythematous bases covered by a crust and surrounded by a wide, elevated, indurated border.

Back 126

Sqamous cell carcinoma - caused by malignant keratinocytes

Front 127

Form of basal cell carcinoma with a pearly or waxy nodule that may have central ulceration.

Back 127

Noduloulcerative (most common form.)

Front 128

cystic acne often requires treatment with _________, while pustular acne is often responsive to __________.

Back 128

cystic acne - isotretinoin
pustular acne - tetracycline

Front 129

How does tetracycline act?

Back 129

It prevents the binding of aminoacyl-tRNA to ribosomes

Front 130

This antibiotic blocks initiation complex formation, and is used for vancomycin-resistant infections.

Back 130

Linezolid

Front 131

These antibiotics can interfere with translation translocation, and are primarily used for gram-positive cocci, as well as Chlamydia, Mycoplasma, Legionella, and Campylobacter.

Back 131

Macrolides (such as erythromycin)

Front 132

Erythromycin is what type of antibiotic?

Back 132

a macrolide

Front 133

These antibiotics act via misreading at translation initiation, and are commonly used for treating gram-negative rods.

Back 133

Aminoglycosides (e.g. streptomycin, gentamicin.)

Front 134

This antibiotic acts by inhibiting ribosomal peptidyl transferase, although it is rarely used due to the risk of aplastic anemia.

Back 134

chloramphenicol

Front 135

What is the most predictive indicator of prognosis for a patient with malignant melanoma?

Back 135

The depth of the lesion (followed by the presence of ulceration.) The lymphatics of the superficial dermis lie about 1mm under the skin surface.

Front 136

This form of melanoma can have a good prognosis despite it's large size, if it has not extended into the superficial dermal lymphatic bed.

Back 136

superficial spreading melanoma (the most common form.)

Front 137

What are the three common genera of cutaneous fungi responsible for the bulk of athlete's foot (tinea pedis) cases?

Back 137

Trichophyton sp.
Microsporum sp.
Epidermophyton sp.

Front 138

This fungus causes a subcutaneous infection associated with pruning rose bushes.

Back 138

Sporothrix schenckii

Front 139

The agent that causes pityriasis versicolor

Back 139

Malassezia furfur

Front 140

Although the name suggests it might be a cutaneous infection, this is actually a systemic fungal infection with cutaneous manifestations.

Back 140

Blastomyces dermatitidis

Front 141

What would you expect to see on a KOH mount of skin scraping from a patient with tinea pedis?

Back 141

Arthroconidia and hyphae

Front 142

An AD d/o caused by a defect in the gene on ch15 encoding fibrillin, a 350 kD glycoprotein.

Back 142

Marfan syndrome

Front 143

What is the inheritance of Marfan syndrome?

Back 143

AD

Front 144

Which glycoprotein is affected in Marfan syndrome?

Back 144

fibrillin

Front 145

Fibrillin is a major component of what?

Back 145

Elastin-associated microfibrils, which are common in large blood vessels and the suspensory ligaments of the lens.

Front 146

An abnormality in this glycoprotein predisposes for cystic medial necrosis of the aorta (which may lead to aortic dissection), subluxation of the lens of the eye, and mitral valve prolapse.

Back 146

fibrillin (defective in Marfan syndrome)

Front 147

Ubiquitous matrix polymers that provide elastic properties in all extracellular matrix structures.

Back 147

Microfibrils

Front 148

Microfilaments, which are involved in the structural integrity of all cells, consist of polymers of what?

Back 148

actin

Front 149

Are there any known genetic conditions in humans associated with a defect in actin?

Back 149

No.

Front 150

Microtubules, composed of tubulin molecules, are primarily involved in what?

Back 150

Intracellular transport, such as the transport of chromosomes during mitosis and meiosis, as well as motility produced by cilia or flagella.

Front 151

An inflammatory skin d/o characterized by erythema, edema, pruritis, exudation, crusting, and scaling. Secondary bacterial infections and regional lymphadenitis may be present.

Back 151

atopic dermatitis

Front 152

This dermatitis often improves by age 3 or 4, but periodic exacerbations may occur into adulthood. Older children and adults tend to have more localized lesions, typically w/ erythema and lichenification.

Back 152

atopic dermatitis

Front 153

Where is atopic dermatitis usually seen in older children and adults?

Back 153

The antecubital and popliteal fossas, eyelids, neck, and wrist.

Front 154

A streptococcal, or less commonly staphylococcal, acute infection of subcutaneous tissues that causes local erythema, tenderness, and freqently lymphangitis and regional lymphadenopathy. The skin is usually warm, edematous, and erythematous, and may exhibit a "peau d'orange" appearance.

Back 154

cellulitis

Front 155

Itchy, dry skin that may progress to well-demarcated, hyperpigmented, lichenified plaques of oval, irregular, or angular shape.

Back 155

Lichen simplex chronicus

Front 156

A type of atopic dermatitis characterized by chronic pruritus, resulting in thick leathery hyperpigmented skin.

Back 156

Lichen simplex chronicus

Front 157

An inflammatory scaling disease, usually affecting the scalp and face. It may initially resemble atopic dermatitis in infants, but, unlike atopic dermatitis, it tends to remain confined to the head and scalp.

Back 157

seborrheic dermatitis

Front 158

Alopecia areata is caused by what?

Back 158

An autoimmune attack on hair follicles, with antibodies usually directed against anagen-phase hair follicle structures.

Front 159

Over 80% of patients with alopecia areata have this HLA type

Back 159

HLA DQ3

Front 160

Does hair grow back after alopecia areata?

Back 160

Most cases involve a localized patch of hair, which regrows within 1 year in half of cases. The hair that does regrow may be gray or depigmented.

Front 161

alopecia areata of the entire body surface

Back 161

alopecia universalis

Front 162

alopecia areata of the entire scalp

Back 162

alopecia totalis

Front 163

How is alopecia areata treated?

Back 163

topical steroids are typically tried, but treatment is often unsuccessful.

Front 164

What is the treatment of choice for pemphigus vulgaris?

Back 164

corticosteroids

Front 165

A pruritic rash with bluish-gray spots in the oral mucosis is a sign of what?

Back 165

measles (Koplik spots)

Front 166

Smal red skin spots that spare the face are hallmarks of what infection?

Back 166

Rocky Mountain spotted fever

Front 167

Widespread blisteirng with pruritis but sparing of the oral mucosa.

Back 167

bullous pemphigoid

Front 168

pemphigus vulgaris is caused by autoimmune destruction of ______, while bullous pemphigoid is caused by a similar attack on __________.

Back 168

pemphigus vulgaris - desmosomes - attach keratinocytes to one another
bullous pemphigoid - hemidesmosomes - attack the stratum basalis cells to the basement membrane

Front 169

erythematous patches with pale, vesicular, or eroded centers

Back 169

target lesions - associated w/ erythema multiforme

Front 170

Stevens-Johnson syndrome is a severe, life-threatening version of what?

Back 170

erythema multiforme

Front 171

erythema multiforme and Stevens-Johnson syndrome are produced by what?

Back 171

Immune complex deposition in dermal blood vessels.

Front 172

In about half of patients, there is no precipitating cause, but in others, triggers can include infections (HSV, enteroviruses, Mycoplasma pneumoniae, Chlamydia, histoplasmosis); drugs (penicillin, sulfonamides, phenytoin, aspirin, corticosteroids, cimetidine, allopurinol, oral contraceptives); neoplasia (leukemia, lymphoma, multiple myeloma, internal malignancy, sarcoidosis); or foods (notably the emulsifiers in margarine.

Back 172

erythema multiforme (and its more severe form, Stevens-Johnson syndrome.)

Front 173

"blueberry-muffin babies," who have multiple petechiae, ecchymoses, macules, papules, and plaques have what?

Back 173

congenital cytomegalovirus infection

Front 174

How does HSV trigger erythema multiforme?

Back 174

Expression of the HSV antigens by infected keratinocytes triggers CD8+ cytotoxic effector cells, inducing apoptosis.

Front 175

These cells are diagnostic for HPV.

Back 175

Koilocytic cells - cells infected w/ HPV that have enlarged nuclei and perinuclear vacuolization.

Front 176

Cowdry-type inclusions, droplet-like masses of acidophilic material surrounded by clear halos within nuclei, are diagnostic for what?

Back 176

herpesviruses

Front 177

Gurarnieri bodies, acidophilic inclusion bodies composed of viral particles and proteins at the location of virus replication and assembly, are diagnostic for what?

Back 177

smallpox virus

Front 178

Negri bodies, eosinophilic, sharply outlined inclusion bodies in the cytoplasm of certain nerve cells (especially in Ammon's horn of the hippocampus) are pathognomonic for what?

Back 178

rabies

Front 179

Owl's eye inclusions, large inclusion bodies surrounded by a halo, are diagnostic for what?

Back 179

cytomegalovirus

Front 180

This virus infects the stratum basale of the skin and promotes outgrowth of that layer. It causes the skin to thicken and promotes production of keratin. Infected cells develop an enlarged nucleus with perinuclear vacuolization (koilocytes) that is diagnostic.

Back 180

HPV

Front 181

What are the two major causes of impetigo, and how can they be distinguished?

Back 181

Staphylococcus aureus (catalase positive) and Streptococcus pyogenes (catalase negative.)

Front 182

Used to distinguish group B streptococi from other streptococci.

Back 182

The CAMP test

Front 183

Which test is used to distinguish Staph aureus from all other staphylococci?

Back 183

The coagulase test - staph aureus is positive, all other staph are negative.

Front 184

Which test is used to distinguish Staph aureus from enterococci and streptococci?

Back 184

Staph aureus is catalase positive, while enterococci and streptococci are catalase negative.

Front 185

The immunodiffusion test used to identify toxin-producing strains of Corynebacterium diptheriae.

Back 185

The ELEK test

Front 186

The oxidase test is used to identify what?

Back 186

Neisseria (which is positive.)

Front 187

A gram-positive, catalase-negative cocci that results in honey-crusted lesions of impetigo.

Back 187

Strep pyogenes

Front 188

A gram-positive, catalase-positive cocci that results in impetigo with blister-like skin lesions.

Back 188

Staph aureus

Front 189

Involvement of the palms and soles by a rash is unusual, and ________ should come to mind.

Back 189

Secondary syphilis, caused by Treponema pallidum.

Front 190

Syphilis that takes the form of a painless, buton-like mass called a chancre.

Back 190

Primary syphilis

Front 191

Rare form of syphilis that has a propensity for involving the aorta and CNS and can cause "gummas" (granulomatous-like lesions) in many sites, including liver and bone.

Back 191

Tertiary syphilis

Front 192

A thin, spirillar bacterium, motile by means of an internal flagellum or axial filament

Back 192

spirochete

Front 193

Treponema pallidum is what type of prokaryote?

Back 193

a spirochete - a psirillar bacterium, motile by means of an internal flagellum or axial filament.

Front 194

This gram-negative diplococcus is oxidase-positive, and may cause a sparse pustular rash.

Back 194

Neisseria gonorrhoeae

Front 195

An intracellular prokaryote that elicits the Weil-Felix reaction

Back 195

Rickettsia ricketsii, or another member of the rickettsial family

Front 196

This rash begins on the ankles and wrists and spreads towards the midline. It does not typically involve the palms and soles.

Back 196

Rocky Mountain spotted fever

Front 197

A single-stranded, positive-sense RNA virus that is naked and icosahedral.

Back 197

Picornavirus - think coxsackieviruses, herpangina, and hand-foot-and-mouth disease.

Front 198

Secondary syphilis presents how?

Back 198

A maculopapular rash that is diffuse and includes palms and soles.

Front 199

A skin infection usually caused by Strep pyogenes (but sometimes others including Staph) characterized by large, erythematous patches.

Back 199

erysipelas

Front 200

Classically seen in preschool children.
Highly infectious; can spread through day care.
Tx is typically penicillins/topical preparations (MRSA currently rare)

Back 200

impetigo

Front 201

This skin cancer commonly occurs in settings of either heavy sun exposure or tobacco use (chewing, cigar, pipe.)

Back 201

squamous cell carcinoma

Front 202

What is the tx for squamous cell carcinoma?

Back 202

Bx should be performed upon suspicion, because tx requires wide excision w/ subsequent reconstructive plastic surgery.

Front 203

What proportion of lingual or mucosal squamous cell carcinomas have metastasized by the time of dx?

Back 203

1/3

Front 204

If sun exposure is the predisposing factor to a squamous cell carcinoma, the precursor lesion is typically what?

Back 204

An actinic cheilitis (actinic lesion of the lip mucosa) at the vermillion of the lower lip.
If the squamous cell carcinoma is not caused by sun exposure, the precursor lesion is typically an actinic keratosis.

Front 205

If sun exposure is the predisposing factor to a squamous cell carcinoma, the precursor lesion is usually _______, while if sun exposure is not the predisposing factor, it is often a __________.

Back 205

sun exposure - actinic cheilitis
other factors - actinic keratosis

Front 206

Tumor-like dermal collections of foamy histiocytes containing cholesterol and lipids, which may also contain multinucleated giant cells (Touton giant cells) with clustered nuclei and foamy cytoplasm.

Back 206

Xanthomas

Front 207

Xanthomas are caused by what?

Back 207

They may be idiopathic, or related to hyperlipidemia or lymphoproliferative malignancies (e.g. leukemias and lymphomas.)

Front 208

nevus cells are what type of cell?

Back 208

melanocytes

Front 209

Benign nevus cells are seen in what?

Back 209

the common nevus, or mole

Front 210

Malignant nevus cells are a feature of what?

Back 210

malignant melanoma

Front 211

Microscopic blisters at the DEJ are a feature of what?

Back 211

dermatitis herpetiformis

Front 212

Munro microabscesses, small collections of neutrophils in the cornified epidermis, occur in what disorder?

Back 212

psoriasis

Front 213

A typically benign and self-limited condition caused by a poxvirus, transmitted through direct contact.

Back 213

molloscum contagiosum

Front 214

A poxvirus that reproduces in the cytoplasm and produces intracytoplasmic inclusion bodies

Back 214

molloscum contagiosum

Front 215

Molluscum contagiosum is a poxvirus that replicates where?

Back 215

In the cytoplasm.

Front 216

This family of viruses captures a nuclear membrane envelope and replicates in the nucleus.

Back 216

Herpesviridae
(HSV, CMV, EBV, VZV)

Front 217

Which two important viruses utilize reverse transcriptase?

Back 217

HIV, and HBV

Front 218

dsDNA; replicates in cytoplasm; carries DNA-dependent RNA polymerase in to the cell; envelope is virus-encoded

Back 218

Poxviridae

Front 219

All of the DNA viruses except for Poxviruses replicate where?

Back 219

in the cytoplasm

Front 220

What are the six DNA viruses?

Back 220

Parvovirus
Papovavirus
Poxvirus
Herpesvirus
HepaDNAvirus
Adenovirus (A-DNA-virus)

Front 221

A hyperplastic lesion of sun-damaged skin that predisposes to squamous cell carcinoma

Back 221

actinic keratosis

Front 222

dysplastic nevi may be a precursor to what?

Back 222

melanoma

Front 223

hyperplasia of the stratum spinosum of the epidermis

Back 223

acanthosis

Front 224

thickened, hyperpigmented zones of skin often with a velvet-like texture involving mostly the flexural areas

Back 224

acanthosis nigricans

Front 225

The benign type of this disorder (which constitutes about 80% of cases), develops gradually and usually occurs in childhood or during puberty. It may be genetic (AD), associated w/ obesity or endocrine abnormalities (particularly pituitary or pineal tumors, or diabetes,) or part of a number of rare congenital syndromes.

Back 225

acanthosis nigricans

Front 226

Abnormal production of epidermal growth-promoting factors by a variety of tumors can cause these two conditions.

Back 226

seborrheic keratoses
acanthosis nigricans

Front 227

The malignant form of acanthosis nigricans is often associated with what underlying condition?

Back 227

GI adenocarcinoma - acanthosis nigricans may precede clinical sx

Front 228

The epidermis and underlying enlarged dermal papillae undulate sharply to form numerous repeating peaks and valleys. Variable hyperplasia may be seen, along with hyperkeratosis and slight basal cell layer hyperpigmentation.

Back 228

acanthosis nigricans

Front 229

Cafe au lait spots in neurofibromatosis are caused by what?

Back 229

Hyperpigmentation of the overlying skin of a neurofibroma.
Remember that cafe-au-lait spots are common in the general population. The presence of more than three or four suggests NF.

Front 230

keratin pearls are a feature of which skin cancer?

Back 230

squamous cell carcinoma

Front 231

a skin cancer that stains positively with S-100 is probably what?

Back 231

a melanoma

Front 232

How does re-epithelialization occur to heal a large area where the epidermis has been lost but the dermis is intact?

Back 232

Epithelial stem cells contained in dermal skin appendages (e.g. hair follicles, sweat glands) grow into new epithelium. Intact epidermis along the wound edges also proliferates.

Front 233

Crotamiton, Ivermectin, Lindane, Permethrin cream, and sulfur in petrolatum can all be used to treat what?

Back 233

scabies - an ectoparasite infection from the mite Sarcoptes scabei.

Front 234

What causes the pruritis of scabies?

Back 234

A delayed hypersensitivity reaction to the mite (Sarcoptes scabei,) its feces, or its eggs.

Front 235

How is scabies treated in pregnant women or small children?

Back 235

sulfur in petrolatum

Front 236

Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus (e.g. folic acid, thyroid hormones)

Back 236

Category A drugs

Front 237

No evidence of risk in humans. Either animal findings show risk (but human findings do not) or, if no adequate human studies have been done, animal findings are negative. (e.g. zidovudine)

Back 237

Category B drugs

Front 238

Risk cannot be ruled out. Human studies are lacking and animal studies are either positive for fetal risk or lacking as well. However, potential benefits may justify the potential risk. (e.g. aspirin, crotamiton)

Back 238

Category C drugs

Front 239

Evidence of risk. Investigational or postmarketing data show risk to fetus. Nevertheless, potential benefits may outweigh the risk. (e.g. ACE-I's, anticonvulsants.)

Back 239

Category D drugs

Front 240

Contraindicated in pregnancy. Studies in animals or human,s or investigational or postmarketing reports, have shown fetal risk which clearly outweighs any possible benefit to the patient (e.g. statins, oral contraceptives, clomiphene, misoprostol, high-dose vitamin A)

Back 240

Category X drugs

Front 241

The erythema characteristic of SLE occurs in a malar distribution how commonly?

Back 241

About half of the time. It may also be seen on the extremities and trunk. Urticaria, bullae, maculopapular lesions, and ulcerations may also occur.

Front 242

Is immunoglobulin deposition at the DEJ diagnostic for SLE?

Back 242

No; similar deposits are seen in scleroderma and dermatomyositis.

Front 243

What can be seen histologically in the rash of a patient with SLE?

Back 243

Liquefactive degeneration of the basal layers of the epidermis, edema at the dermal junction, and deposition of immunoglobulins and complement at the DEJ.

Front 244

Cells similar to fibroblasts growing in a storiform ("pinwheel") pattern are characteristic of what?

Back 244

dermatofibrosarcoma protuberans, a slow-growing type of fibrosarcoma

Front 245

Lamellated collections of keratin that occur in seborrheic keratoses, a type of benign epithelial tumor of the skin.

Back 245

Horn cysts

Front 246

Pautrier microabscesses (microscopic lesions in the epidermis composed of atypical mononuclear cells) are a feature of what?

Back 246

mycosis fungoides, a cutaneous T-cell lymphoma

Front 247

A sawtooth DEJ is a feature of what inflammatory skin condition?

Back 247

lichen planus

Front 248

Statsis dermatitis is a common complication of chronic lower-leg edema secondary to what?

Back 248

CHF, venous incompetency, or both.

Front 249

Brown, edematous skin around both ankles suggests what?

Back 249

stasis dermatitis - this can ulcerate

Front 250

A severe skin condition w/ acute widespread erythema and epidermal peeling due to staphylococcal exotoxin.

Back 250

Scalded skin syndome - usually seen in infants, young children, and adults who are immunocompromised or have renal failure.

Front 251

What are the permenant sequelae of staphylococcal scalded skin syndrome?

Back 251

Survivors usually have no permenant sequelae

Front 252

Causes severe erythema witha peak incidence in children 4-8. Occurs after an episode of sore throat and fever. The rash appears sandpaper-like and does not peel.

Back 252

Scarlet fever

Front 253

This can appear similar to staphylococcal scalded-skin syndrome, but occurs in older patients, often in association with a new medication.

Back 253

Toxic epidermal necrolysis (TEN)

Front 254

A severe erythema that typically occurs in teenagers or adults, with an acute onset of fever, myalgias, vomiting, diarrhea, and hypotension. May progress to multiorgan failure and death.

Back 254

Toxic shock syndrome

Front 255

Suspect what in an infant who develops generalized severe erythema and flaccid bullae?

Back 255

Staphylococcal scalded-skin syndrome

Front 256

in a simple dysplasia of the skin, abnormal cells are confined to what?

Back 256

the lowermost layers of the epidermis

Front 257

the term used when normal epithelium is replaced by another mature, differentiated epithelium

Back 257

metaplasia

Front 258

If a carcinoma disrupts the basement membrane, or establishes nests of cells in the dermis, it is considered what?

Back 258

invasive

Front 259

Abnormal keratinocytes extending through the full thickness of the epidermis leaving the basement membrane intact is what?

Back 259

carcinoma in situ

Front 260

A facial or scalp port-wine nevus (facial angioma, or nevus flammeus) suggests what?

Back 260

Sturge-Weber disease

Front 261

phacomatosis

Back 261

a slowly progressive neurocutaneous disorder (neurofibromatosis, Von Hippel-Lindau syndrome, tuberous sclerosis, or Sturge-Weber syndrome.)

Front 262

the port-wine stain seen in Sturge Weber syndrome may overly what?

Back 262

meningial angiomas - these can cause focal or generalized seizures, sometimes with hemiparesis, sensory changes, or hemianopia.

Front 263

What is the inheritance pattern of Sturge-Weber syndrome?

Back 263

Most cases are actually sporatic rather than genetic.

Front 264

Acoustic neuromas are a feature of what phacomatosis (slowly progressive neurocutaneous d/o)?

Back 264

NF-II

Front 265

Cerebellar hemangioblastomas are a feature of what phacomatosis (slowly progressive neurocutaneous d/o)?

Back 265

Von Hippel-Lindau syndrome

Front 266

Subependymal and cortical tumors are features of what phacomatosis (slowly progressive neurocutaneous d/o)?

Back 266

tuberous sclerosis

Front 267

Nevus flammeus (port-wine stain) on the face or scalp and ipsilateral leptomeningial angiomatosis are seen in what d/o?

Back 267

Sturge-Weber syndrome

Front 268

The presentation of a fine, non-blotchy rash that begins in the hairline and then spreads to the torso, in a child who is not very ill, is characteristic of what?

Back 268

rubella, or German measles

Front 269

IgM specific for rubella can be detected in the serum of an infected patient how long after development of the rash?

Back 269

1-2 days

Front 270

This disease can cause a congenital infection characterized by ocular problems (cataracts, retinopathy, microphthalmos, glaucoma), cardiovascular problems (patent ductus arteriosus, ventricular septal defect, pulmonary stenosis), deafness, thrombocytopenic purpura, hepatosplenomegaly, CNS problems, and bony lesions.

Back 270

rubella (German measles)

Front 271

Causes a blotchy, maculopapular, erythematous rash that begins on the face and spreads downward. Koplik spots may be seen on the buccal mucosa.

Back 271

Measles

Front 272

Which children are sicker, those with measles or those with rubella?

Back 272

those with measles are usually much sicker

Front 273

Prodrome: cough, coryza, conjunctivitis, high fever
Enanthem: Koplik spots
Exanthem: Macules on the hairline and face, spreading to the trunk and extremities
Complications: pneumonia, subacute sclerosing panencephalitis

Back 273

measles

Front 274

Prodrome: mild constitutional sx
Exanthem: Macules of the hairline, face, and neck, spreading to the trunk and extremities.
Complications: congenital syndrome

Back 274

rubella (German measles)

Front 275

Prodrome: low-grade fever, malaise, upper respiratory tract sx
Exanthem: crops of papules, vesicles, crusts at the same time; central to peripheral
Complications: superinfection, zoster, pneumonia, hepatitis, encephalitis, congenital disorder

Back 275

varicella

Front 276

Prodrome: mild URI sx
Exanthem: slapped-cheek, then to trunk, then central clearing; lacy
Complications: aplastic anemia

Back 276

fifth disease or erythema infectiosum (parvovirus B-19)

Front 277

Prodrome: URI sx, abrupt-onset high fever which breaks
Exanthem: Fever falls just before fine macular rash on trunk appears, which spreads to extremities
Complications: pneumonia

Back 277

roseola

Front 278

Prodrome: sore throat
Enanthem: exudative pharyngitis, strawberry tongue
Exanthem: fine maculopapular rash that feels like sandpaper, especially in the antecubitus and inguinal areas; Pastia lines (lines of confluent petechiae found in skin creases, particularly the flexor surface of the elbow
Complications: GN, ARF

Back 278

scarlet fever

Front 279

Measles and rubella can be distinguished how?

Back 279

Children with measles are generally sicker, and have a prodrome of cough, coryza, conjunctivitis, and high fever. They may present with Koplik spots.
Children with rubella have milder constitutional symptoms and no Koplik spots.

Front 280

What is the most common cause of malignant external otitis?

Back 280

Pseudomonas aeruginosa

Front 281

External otitis is usually self-limited, but may in some cases penetrate the epithelium and invade the underlying soft tissue, cartilage, and bone, leadint to what?

Back 281

osteomyelitis and cranial nerve palsies (sx: ear pain and discharge, hearing loss, and facial nerve paralysis.)

Front 282

Malignant external otitis is most common among whom?

Back 282

elderly diabetic patients

Front 283

A gram-negative bacillus that is oxidase-positive, aerobic, and produces blue-green pigments that causes otitis externa

Back 283

Pseudomonas

Front 284

A gram-negative bacillus requiring factors X and V that causes otitis media

Back 284

Haemophilus

Front 285

A gram-negative, oxidase-negative, non-lactose fermenting bacillus that usually causes diarrhea

Back 285

Enterobacteriaceae

Front 286

A gram-positive, catalase-negative, alpha-hemolytic coccus that is the most common cause of otitis media

Back 286

Strep pneumoniae

Front 287

A gram-positive, catalase-negative, beta-hemolytic coccus that causes otitis media

Back 287

Strep pyogenes

Front 288

A gram-negative bacillus that is oxidase-positive, aerobic, and produces blue-green pigments that causes otitis externa

Back 288

Pseudomonas

Front 289

A gram-negative bacillus requiring factors X and V that causes otitis media

Back 289

Haemophilus

Front 290

A gram-negative, oxidase-negative, non-lactose fermenting bacillus that usually causes diarrhea

Back 290

Enterobacteriaceae

Front 291

A gram-positive, catalase-negative, alpha-hemolytic coccus that is the most common cause of otitis media

Back 291

Strep pneumoniae

Front 292

A gram-positive, catalase-negative, beta-hemolytic coccus that causes otitis media

Back 292

Strep pyogenes

Front 293

A gram-positive, catalase-negative, beta-hemolytic coccus that is the most common cause of neonatal septicemia and meningitis in the US.

Back 293

Strep agalactiae

Front 294

An elderly diabetic patient with inflammation and discharge from the pinna probably has what?

Back 294

malignant otits externa, due to Pseudomonas aeruginosa infection. Tx w/ antipseudomonal penicillins.