question

A 30-year-old non-smoker presents with bilateral puffiness and swelling of the fingers and joint pain. Cold exposure and stress cause episodes of blanching and cyanosis of the fingers. She is not on any medications.

answer

Scleroderma-CREST syndrome

question

This presents as a triad of autoimmunity, noninflammatory vasculopathy and collagen deposition with fibrosis commonly showing sclerotic, tight, puffy skin without wrinkles and finger pitting. Can show sclerosis of renal, pulmonary, CV and GI systems

answer

Scleroderma (systemic sclerosis)

question

This form of scleroderma involves widespread skin involvement with rapid progression, early visceral involvement associated with anti-Scl-70 Antibody:

answer

diffuse scleroderma

question

Anti-DNA topoisomerase I antibody:

answer

Anti-Scl-70 antibody

question

This scleroderma presents with limit skin involvement confined to fingers and face and is associated with CREST Syndrome and anti-centromere antibodies

answer

Limited scleroderma

question

What is CREST syndrome:

answer

-Calcinosis -Raynaud phenomenon -Esophageal dysmotility -Sclerodactyly -Telangiectasia

question

Decreased blood flow to skin due to small arteriolar vasospasm in response to cold or stress, color changes from white (ischemic) to blue (hypoxia) to red (reprofusion)

answer

Raynaud disease

question

This is secondary to a disease process like mixed CT disease, SLE or CREST showing digital ulceration color change at finger tips and can be treated with Ca channel blockers:

answer

Raynaud syndrome

question

3 layers of skin:

answer

-Epidermis -Dermis -Subcutaneous fat (hypodermis/subcutis)

question

5 layers of epidermis:

answer

-Stratum Corneum (keratin) -Stratum Lucidum -Stratum Granulosum -Stratum Spinosum (desmosomes) -Stratum Basale (stem cell site)

question

These prevent paracellular movement of solutes and are composed of claudins and occludins. they are the closest to the surface:

answer

Tight junction (zone occludes)

question

These are below the tight junctions and form "belt" connecting actin cytoskeletons of adjacent cells with CADherins (Ca-dependent adhesion proteins) -remember loss of E-cadherin promotes mets

answer

Adherens junction (Belt desmosome, zonula adherens) -contain actin filaments

question

These are structural support via intermediate filament interactions. Autoantibodies are directed here in pemphigus vulgarism:

answer

desmosome (spot desmosome, macula adherens) -contain desmoplakin and cytokeratin

question

These are channel proteins called connexons that permit electrical and chemical communication between cells:

answer

Gap junction -connexon with central channel

question

These maintain integrity of basolateral membrane by binding to collagen and laminin in the basement membrane:

answer

Integrins

question

These connect keratin in basal cells to underlying basement membrane. Autoantibodies to these are seen in bullous pemphigoid

answer

Hemidesmosome

question

A flat lesion with well circumscribed change in skin color <1cm (i.e. Freckle)

answer

Macule

question

These are macules >1cm (i.e. large birthmark or congenital nevus)

answer

Patch

question

These are elevated solid skin lesions <1cm (Ie mole-nevus or acne)

answer

Papule

question

These are papules >1cm (i.e. Psoriasis)

answer

Plaque

question

These are small fluid-containing blisters <1cm (i.e. chickenpox-varicella, shingles-zoster)

answer

Vesicle

question

These are large fluid-containing blisters >1cm (i.e. bullous pemphigoid)

answer

Bulla

question

These are pus containing vesicles (i.e. pustular psoriasis)

answer

Pustule

question

These are transient smith papule or plaque (i.e. Hives-urticaria)

answer

Wheal

question

These are flaking off stratum corneum (i.e. eczema, psoriasis, SCC)

answer

Scale

question

These are dry exudate (i.e. impetigo)

answer

Crust

question

This term describes increased thickness of the stratum corneum (i.e. in psoriasis or calluses)

answer

Hyperkeratosis

question

This term describes hyperkeratosis with retention of nuclei in stratum corneum (i.e. in psoriasis)

answer

Parakeratosis

question

This describes increased thickness of stratum granulosum seen in Lichen planus

answer

Hypergranulosis

question

This describes separation o epidermal cells (i.e. seen in Pemphigus vulgaris)

answer

Acantholysis

question

This describes epidermal hyperplasia (increase in spinosum layer) (i.e. in acanthuses nigricans)

answer

Acanthosis

question

This disorder describes normal melanocyte number with decrease melanin production due to deficiency in tyrosinase active or defective tyrosine transport, with an increase risk of skin cancer:

answer

Albinism

question

This shows hyper pigmentation associated with pregnancy (mask of pregnancy) or OCP use

answer

Melasma (chloasma)

question

This shows irregular areas of complete depigmentation caused by autoimmune destruction of melanocytes

answer

Vitiligo

question

What follicles are affected in acne:

answer

pilosebaceous

question

Obstruction of pilosebaceous follicles without inflammation is called:

answer

comedones

question

Pruritic eruption commonly on skin flexures associated with other atopic disease like asthma, allergic rhinitis, food allergies with elevated IgE in serum typically presenting on face in infancy and then antecubital fosssae

answer

-Atopic dermatitis (eczema)

question

This type IV hypersensitivity reaction follows exposure to an allergen, lesions occur at the site of contact (will see clear markings of contact)

answer

Allergic contact dermatis

question

This is a comm, benign finding on the skin, melanoma can arise in congenital atypical forms:

answer

Melanocytic nevus

question

What nevi are papular?

answer

Intradermal

question

What nevi are flat macules:

answer

junctional

question

This is composed of papulse and plaques with silvery scaling, especially on the knees and elbows.

answer

Psoriasis

question

These are the findings of what disease: ? stratum spinosum ? stratum granulosum preservation of the nuclei within the hyperkeratotic stratum corneum extension of the rete pegs into the basal layer neutrophils in the stratum corneum infiltration of T cells and dendritic cells in plaques

answer

Psoriasis

question

This sign is given if pinpoint bleeding spots from exposure of dermal papillae when psoriatic scales are scraped off

answer

Auspitz sign

question

This inflammatory facial skin disorder is characterized by erythematous papules and pustules but no comedones. May be associated with facial flushing in response to external stimuli (ETOH or heat or Demodex folliculorum (mite) presence)

answer

Rosacea

question

Which form of rosacea can cause rhinophyma (bulbous deformation of the nose)

answer

Phymatous

question

This describes Flat, greasy, pigmented squamous epithelial proliferation with Keratin-filled cysts (horn cysts) that looks stuck on. Lesionsare on the head, trunk and extremities commonly benign neoplasm of olde rpatients

answer

Seborrheic keratosis

question

This sudden appearance of multiple seborrheic keratoses indicating underlying malignancy (typically GI adenocarcinoma or lymphoid) is called what:

answer

Leser-Trelat sign

question

A 72-year-old male visits his dermatologist with several brown plaques on his neck, back, shoulders and arms. He says that the vast majority of the lesions appeared over the past month. Upon physical examination, the lesions appear greasy and coin-like and are of variable size. The appearance of this patient's lesions is associated with which of the following

answer

Leser-Trelat sign associated with internal malignancy

question

These are caused by HPV, they are soft, tan-colored cauliflower-like papules of epidermal hyperplasia, hyperkeratosis, koilocytosis

answer

Verrucae (warts)

question

Warts on genitals:

answer

Condyloma acuminatum

question

These are pruritic wheals that form after Type I hypersensitivity mast cell degranulation, characterized by superficial dermal edema and lymphatic channel dilation.

answer

Uritcaria (hives)

question

This is a rare blood vessel malignancy typically occurring in the head, neck and breast region of elderly pts on sun-exposed areas or associated with radiation therapy and chronic post mastectomy lymphedema. these are very aggressive and very difficult to resect

answer

Angiosarcoma

question

Vinyl chloride and arsenic are associated with what malignancies:

answer

Hepatic angiosarcoma

question

These benign capillary skin papules found in AIDs pts caused by bartonella henselae infection frequently mistaken for Kaposi, can differentiate by presence of neutrophilic infiltrate

answer

Bacillary angiomatosis

question

These are benign capillary hemangioma of the elderly that do not regress and are associated with increased age

answer

Cherry hemangioma

question

These cavernous lymphangioma of the neck are associated with Turner syndrome

answer

Cystic hygroma

question

This benign, painful, red-blue tumorr, commonly under fingernails arises from modified smooth muscle cells of thermoregulatory glomus body;

answer

glomus tumor

question

This endothelial malignancy most commonly of the skin but also the mouth, GI tract and respiratory tract is associated with HHV-8 and HIV is frequently mistaken for bacillary angiomatosis, but has lymphocytic infiltrate

answer

Kaposi sarcoma

question

This polypoid lobulated capillary hemangioma that can ulcerate and bleed is associated with pregnancy and trauma

answer

Pyogenic granuloma

question

Benign capillary hemangioma of infancy appears in the first few weeks of life, grows rapidly then regresses spontaneously by 5-8 years

answer

Strawberry hemangioma

question

This is a very superficial skin infection from Staph a or Strep P, is highly contagious with honey colored crusting

answer

Impedigo

question

This highly contagious superficial skin infection presents with bullae and is usually caused by staph a

answer

Bullous impetigo

question

This infection involves the upper dermis and superficial lymphatics, usually from Strep pyogenes, presents with well-defined demarcation between infected and normal skin

answer

Erysipelas

question

This acute, painful, spreading infection of deeper dermis and subcutaneous tissues, usually from strep p or staph a often starting with a break in skin from trauma or another infection

answer

cellulitis

question

This is a collection of pus from a walled-off infection within deeper layers of skin, typically from Staph a infection

answer

Abscess

question

This is a deeper tissue injury, usually from anaerobic bacteria or S pyogenes resulting in crepitus from methane and Co2 production "flesh-eating bacteria" causes bullae and purple color of the skin

answer

Necrotizing fasciitis

question

This exotoxin mediated infection destroys keratinocyte attachments in stratum granulosum only (intra-epdermal desmosomes) (vs toxic epidermal necrolysis which destroys epidermal-dermal jx) is characterized by fever and generalized erythematous rash with sloughing of the upper layers of the epidermis that heals completely

answer

Staph Scalded Skin Syndrome

question

This sign is dislodgement of intact superficial epidermis by a small force, indicating a plane of cleavage in the skin

answer

Nikolsky sign (seen in SSS)

question

Staph SSS typically affects what individuals:

answer

-Newborns and children -Adults with renal insufficiency

question

These are umbilicated papules from a poxvirus frequently seen in children but maybe sexually transmitted in adults

answer

Molluscum contagiosum

question

This presents with multiple crops of lesions in various stages from vesicles to crusts and can reactivate in a dermatomal distribution unless it is disseminated

answer

VZV varicella: chickenpox vs zoster: shingles

question

This precancerous irregular, white, painless plaque on lateral tongue that cannot be scraped off seen with EBV infection occurs in HIV pts or immunosuppressed so transplant.

answer

Hairy leukoplakia

question

This is a potentially fatal autoimmune skin disorder caused by IgG directed against desmoglein that forms flaccid intraepidermal bullae caused by acantholysis (keratinocytes in stratum spinosum) and oral mucosal involvement. Fluorescence reveals antibodies around epidermal cells in a reticular (net-like) pattern and is Nikolsky sign +

answer

Pemphigus vulgaris

question

This is less severe disorder involves IgG against hemidesmosomes in the basement membrane causing Tense blisters containing eosinophils affecting skin but sparing oral mucosa, nikolsky -, linear pattern at epidermal-dermal junction on Immunoflourescence

answer

Bullous pemphigoid

question

A 50-year-old female presents to her physician with vesicles and tense blisters across her chest, arms, and the back of her shoulders. Physical examination reveals that blistering is not present in her oral mucosa, and the epidermis does not separate upon light stroking of the skin. The patient most likely suffers from a hypersensitivity reaction located

answer

Bullous pemphigoid

question

This presents as pruritic papules, vesicles, and bullae on elbows with deposits of IgA at tips of dermal papillae often associated with Celia disease and can be treated with dapsone and gluten free diet:

answer

Dermatitis herpetiformis

question

This is associated with infection (mycoplasma pneumo or HSV), drugs (sulfa-drugs/beta lactams, phentoin), cancer, auto immune disease where pet presents with multiple type of lesions (macules, papules, vesicles, target lesions)

answer

Erythema multiforme

question

This is characterized by fever, bullae formation and necrosis, sloughing of the skin at dermal-epidermal junction, high mortality rate typically involving two mucous membranes (eyes and mouth) and may appear like erythema multiform. Associated with horrible adverse drug interaction

answer

Stevens-johnson syndrome

question

This is a more severe form of SJS with ;30% of body surface involved

answer

Toxic epidermal necrolysis (TEN)

question

This is described as epidermal hyperplasia causing symmetric, hyper pigmented thickening of skin, especially in axilla or on neck, and is highly associated with insulin resistance (diabetes, obesity, Cushing syndrome) or visceral malignancy (Gastric adenocarcinoma)

answer

Acanthosis nigricans

question

This premalignant lesion is caused by sun exposure, showing small/rough/erythematous or brownish papules or plaques with risk of Squamous cell carcinoma proportional to free of epithelial dysplasia

answer

Actinic keratosis

question

A 33-year-old archeologist was on a dig in Arizona. After returning home he developed flu-like symptoms with a nonproductive cough, mild chest pain, fever, and painful red nodules are his lower extremities. The are no infiltrates or effusions on CXR. A mild eosinophilia is noted on peripheral blood.

answer

Erythema nodosum

question

This painful inflammatory lesion of subcutaneous fat usually on anterior shins is often idiopathic but can be associated with underlying disease (sarcoid, coccidiodmycosis, histo, TB, Strep, leprosy, IBD) is a IV hypersensitivity reaction

answer

Erythema nodosum

question

This Pruritic, Purple, Polygonal, Plantar, Papules, and Plaques are associated with

answer

Lichen Planus

question

Mucosal involvement (white reticular lines) with lichen plans is called:

answer

Wickham striae

question

This skin disorder is associated with HCV and shows sawtooth infiltrate of lymphocytes at dermal-epidermal junction

answer

Lichen Planus

question

"Herald patch" followed days later by other scaly erythematous plaques often in a "christmas tree" distribution on the trunk showing multiple plaques with collarette scale that is self resolving in 6-8 weeks

answer

Pityriasis rosea -treat with sun exposure?

question

Acute cutaneous inflammatory reaction due to excessive UVB radiation causing DNA mutations and inducing apoptosis of keratinocytes. This can lead to impetigo, skin cancers (basal cell carcinoma, squamous cell carcinoma, melanoma)

answer

Sunburn -UVA are your tanning rays

question

The most common skin cancer:

answer

Basal cell carcinoma

question

This cancer is highly associated with sun-exposure is locally invasive, but rarely metastasizes. Shows pink, pearly nodules, commonly with telangiectaiass, rolled borders, central crusting or ulceration, and can appears non healing ulcers with infiltrative growth or as scaling plaques if superficial. They have "palisading" nuclei

answer

Basal cell Carcinoma

question

This is the second most common skin cancer

answer

Squamous cell carcinoma

question

This is associated with excessive exposure to the sun, immunosuppression and occasionally arsenic exposure that commonly appears above the neck and on hands. It is locally invasive, may spread to lymph nodes and will rarely metastasize. Ulcerative red lesions with frequent scales are characteristic and is associated with chronic draining sinuses:

answer

Squamous cell carcionma

question

This scaly plaque is a precursor to squamous cell carcinoma:

answer

Actinic keratosis

question

This is a variant of squamous cell carcinoma that grows rapidly in 4-6weeks and may regress spontaneously over months:

answer

Keratoacanthoma

question

This common skin tumor has significant risk of metastasis, is S-100+ and BRAF mut driven, associated with skin exposure so fair-skinned pts are at greater risk. Look for Asymmetry, Border irregularity, color variation, diameter ;6mm and Evolution over time

answer

Melanoma

question

4 types of Melanoma:

answer

-Superficial spreading -Nodular -Lentigo maligna -Acral lentiginous

question

What correlates with risk of metastasis for melanoma:

answer

Depth of invasion

question

Primary treatment for melanoma:

answer

Excision

question

Primary treatment for unresectable melanoma in BRAF V600E+ pts:

answer

Verumafenib (BRAF kinase inhibitor)

USMLE First Aid 2016 Dermatology – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards