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Ch 13 - Dermatopathology
Terms in this set (266)
From what embryologic tissue type is the epidermis derived?
From what embryologic tissue type is the dermis derived?
Mesoderm—depending on location in the embryo dermis may be derived from dermatome, lateral somatic, or neural crest tissue
What is the embryologic origin of cutaneous melanocytes?
Neural crest mesoderm
What are the three layers of the skin?
What types of epithelium is the epidermis?
Keratinized stratified squamous epithelium
What are the five layers of the epidermis?
What types of cells compose the stratum basalis?
Squamous cells which have a basophilic, cuboidal to columnar appearance distinct from the eosinophilic, mature-appearing squamous cells of the upper layers in the epidermis
What are the two layers of the dermis?
What are the small, encapsulated sensory receptors found in the dermis of the palms, soles, and digits of the skin (hint: they are also involved in light discriminatory touch of hairless skin)?
What is the name of tactile disks that mediate light crude touch?
What are the large encapsulated sensory receptors found in deeper layers of skin that are involved in pressure, coarse touch, vibration, and tension?
Where else are Pacinian corpuscles found?
Joint capsules; serous membranes; mesenteries
What structure connects epidermal basal cells to the underlying extracellular matrix of the basement membrane?
What structures join adjacent squamous cells together and provide anchoring points for intermediate filaments?
Desmosomes (macula adherens)
What is the function of Langerhans cells?
Antigen-presenting cells; main inducers of antibody response
From where does the epidermis regrow after trauma or removal?
From epidermally derived hair follicles and sweat glands in the dermis
What is a macule?
Flat, discolored (hypo- or hyper-pigmented) area of skin <1 cm in diameter
What is a patch?
Flat, discolored area of skin >1 cm in diameter
What is a papule?
Raised area of skin of any color that is <1 cm in diameter
What is a plaque?
Raised area of skin of any color that is >1 cm in diameter
What is a nodule?
A palpable, roughly round lesion arising in the dermis or subcutaneous tissues
What is a vesicle?
A raised, fluid-filled blister measuring <0.5 cm in diameter
What is a bulla?
A raised, fluid-filled blister measuring >0.5 cm in diameter
What is a pustule?
A blister that is filled with pus (generally bacteria and necrotic debris)
What is a wheal?
A "hive," generally a round lesion resulting from edema in the dermis
What is the term for dilated, superficial blood vessels?
What are petechiae?
Nonblanchable pin-point foci of hemorrhage in the skin
What is purpura?
A larger area of hemorrhage in the skin, may be palpable
Which test is designed to ascertain whether a skin lesion will blanch as a result of pressure?
What is an erosion?
The skin lesion that results when all or part of the epidermis is removed (ie, abraded), will not leave a scar
What is an ulcer?
Full-thickness loss of epidermis and loss of all or part of the epidermis, will leave a scar
Excessive keratin production leading to thickening of the stratum corneum
Visual appearance of thickened skin with prominent skin markings that occurs secondary to chronic scratching of itchy skin, can be associated with atopic dermatitis
Excessive cornification of the skin, giving it a scaly appearance
Excessive hairiness due to increased formation of hair follicles, may be regional or generalized
What is meant when describing a rash as "annular"?
The rash has a ring-like, possibly targetoid appearance. Lesions may be singular or multiple.
What is meant when describing a rash as "herpetiform"?
That the rash is distributed as grouped papules or vesicles, similar to a herpes simplex rash, but does not necessarily indicate a specific etiology
What is meant when describing a rash as "zosteriform"?
That the rash is distributed as clustered papules or vesicles in a dermatomal distribution, similar to a herpes zoster rash, but does not necessarily indicate a specific etiology
What is meant when describing a rash as "morbilliform"?
That the rash appears as erythematous maculopapules, similar to a measles rash, but does not necessarily indicate a specific etiology
What is meant when describing a rash as having "flexor distribution"? Give examples of this type of rash.
Flexor distribution (aka intertriginous) means that the rash is distributed over the body primarily involving skin covering flexor muscle groups (ie, anterior arm including wrist and elbow crease, posterior legs including knee crease, and femoral crease). Examples include: atopic dermatitis and inverse psoriasis.
What is meant when describing a rash as having "extensor distribution"? Give a classic example of this type of rash.
Extensor distribution means that the rash is distributed over the body primarily involving skin covering extensor surface of limbs (ie, elbows, knees). Psoriasis is classically described as involving extensor surfaces.
What is meant when describing a rash as having a "photosensitive" distribution?
That the rash is distributed over the body in a distribution primarily involving sun-exposed skin while sparing areas covered by clothing or shaded by other body parts (ie, nose or chin)
What is meant when describing a rash as having an "acral" distribution?
That the rash is distributed over the body primarily involving distal portions of the limbs (ie, hands, feet) and head (ie, ears, nose)
Congenital/Inherited What are nevi?
A nevus is any congenital lesion of the skin. Most often applied to melanocytic nevi (moles) which can be either congenital or acquired. Large congenital nevi (>20 cm) are associated with an increased risk of melanoma later in life.
What is a hemangioma?
The most common tumor of infancy, hemangiomas are benign vascular proliferations which can appear in the skin (most often on the face or scalp). Flat, larger lesions may be referred to as port-wine stains.
What are phakomatoses?
Phakomatoses are a family of neurocutaneous syndromes which have disorders of the central nervous system as well as the skin and retina. The five classic phakomatoses include: neurofibromatosis, tuberous sclerosis, ataxia telangiectasia, Sturge-Weber syndrome, and von Hippel-Lindau disease. Depending on the source, this group may also include incontinentia pigmenti and nevoid basal cell carcinoma syndrome.
What is the most common neurocutaneous disorder?
What are the multiple, light-brown, freckle-like lesions found in neurofibromatosis?
Café au lait spots
Café au lait spots usually grow along what structures?
On what chromosome is the mutation associated with NF type I found?
What are other manifestations associated with NF type I?
Optic gliomas; bone abnormalities; freckling of the axillary or genital area
Hypopigmented macules or ash-leaf spots on the trunk or lower extremities are associated with what disease?
What is the tuberous sclerosis triad?
Mental retardation; epilepsy; multiple angiofibromas
A unilateral port-wine stain of the forehead and upper eyelid is associated with what condition?
Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
Which nerve is associated with Sturge-Weber syndrome?
Ophthalmic branch of the trigeminal nerve
How is alkaptonuria inherited?
Autosomal recessive inheritance
What accounts for the discoloration of the skin and urine in alkaptonuria?
Deposition of homogentisic acid
Hemochromatosis has what manifestation in the skin?
Hyperpigmented bronze skin
Which connective tissue disorder is associated with hyperextensible fragile skin, loose joints, and a tendency toward easy bruising and bleeding?
What are possible life-threatening complications associated with Ehlers-Danlos disease?
Arterial or intestinal rupture
What is the name of the group of autosomal recessive diseases of premature aging?
Marfan syndrome is due to a defect in which gene?
On which chromosome is the mutation associated with Marfan syndrome located?
What is the most common cause of death in a Marfan patient?
Ascending aortic dissection
How is albinism generally inherited?
Autosomal recessive inheritance
What is lacking in the epidermis of albino patients?
What condition is associated with multiple neuromas on the eyelid, lips, distal tongue, and/or oral mucosa?
MEN, type 2B
Epidermolysis bullosa acquisita (EBA) is associated with which disease?
Inflammatory bowel disease, especially Crohn disease
What haplotype is frequently found in patients with EBA?
Which type of collagen is defective in osteogenesis imperfecta?
Type I collagen
Inflammatory/Autoimmune Which rash often described as a target lesion that has a red center, pale zone, and a dark outer ring (targetoid)?
What are the common causes of erythema multiforme?
Infections; antibiotics; radiation; chemicals; malignancy
What are the most common causes of nonscarring alopecia?
Telogen effluvium; androgenic alopecia; alopecia areata; tinea capitis; traumatic alopecia
What are the most common causes of scarring alopecia?
Cutaneous lupus; lichen planus; folliculitis planus; linear scleroderma
What is the treatment for rosacea?
Avoid precipitating factors; topical metronidazole; sulfur lotions; oral tetracyclines; isotretinoin
What condition has whitish-red nodules especially on digits and over joints, and is associated with uric acid accumulation?
Gout; the classic gouty tophus of the great toe is called podagra.
What is the most likely cause of xanthomas?
Sharply demarcated, silvery-white plaques on a patient's elbows and knees (extensor surfaces) are most likely a manifestation of what disorder?
What conditions can trigger psoriasis?
Trauma; infection; drugs
Which major histocompatibility markers are associated with psoriasis?
HLA-CW6; B13; B17; B27
What disorder has scaly, thickened plaques that develop in response to persistent rubbing of pruritic sites?
Lichen simplex chronicus
Which disease results from the deposition of collagen in skin that causes a "hardened" and "thickened" appearance and is associated with Raynaud phenomenon?
What is scleroderma?
Also known as systemic sclerosis, scleroderma is a chronic disease characterized by accumulation of fibrous tissue in the skin and other organs. The etiology is unknown.
Which antibodies are associated with scleroderma?
Scl-70 (diffuse); anticentromere antibodies (localized)
What other conditions are associated with scleroderma?
Hypertension; gastrointestinal disease; pulmonary fibrosis; kidney disease
Which disease is associated with a rash on the face, particularly the malar areas?
Systemic lupus erythematosus (SLE)
Atopic dermatitis is associated with what conditions?
Asthma and allergic rhinitis. These three features together complete the "allergic triad."
Which test is often helpful in the evaluation of patients with chronic contact dermatitis?
Patch test—small amounts of potential irritants are topically applied to the skin and evaluated over a period of 4 to 7 days for an inflammatory reaction.
What is the most common presentation of contact dermatitis?
Hand eczema, most likely due to occupational exposure
Contact dermatitis is what type of hypersensitivity reaction?
Type IV (delayed hypersensitivity)
What is Reiter syndrome?
Classified as a seronegative spondyloarthropathy, Reiter syndrome is a form of rheumatoid-factor negative arthritis classically associated with urethritis, conjunctivitis, and anterior uveitis.
Eruptive forms of what condition may be associated with Reiter syndrome?
Which human leukocyte antigen (HLA) types are increased in frequency in patients with dermatitis herpetiformis?
HLA-B8; HLA-DR3; HLA-DQW2
Which rheumatologic disease is associated with a diffuse red rash of the trunk, periungual telangiectasis, proximal muscle weakness, myositis on muscle biopsy, and elevated creatine phosphokinase (CPK) and aldolase?
What is vitiligo?
Partial or complete loss of melanocytes within the epidermis
Vitiligo is most commonly associated with what conditions?
Thyroid disease; pernicious anemia; Addison disease; diabetes mellitus type 1
What are some clinical manifestations of type I hypersensitivity reactions?
Anaphylaxis; urticaria; exanthema; angioedema
Urticaria is what type of hypersensitivity reaction?
Immunoglobin E (IgE)-mediated, type I hypersensitivity reaction
Autoantibodies to desmosomes and desmogleins, the intercellular junctions of epidermal cells, are found in which disease?
Pemphigus vulgaris is associated with which type of autoantibody?
What are the clinical findings of pemphigus vulgaris?
Patients with pemphigus vulgaris present with multiple, large, often open bullae involving the oral mucosa and skin, especially the scalp, face, axilla, groin, and trunk. They are at high risk of mortality due to secondary infection of open bullae.
Patients with pemphigus vulgaris have an increased incidence of which haplotypes?
Touching normal-appearing skin with a sliding motion and having upper portions of the epidermis separate from the basal layer of the epidermis is what physical examination finding?
Nikolsky sign—and is positive (meaning that the layers separate) in pemphigus vulgaris
What are the clinical findings of bullous pemphigoid?
Patients with bullous pemphigoid present with multiple, variously sized, tense (unopened) bullae on erythematous skin distributed over inner thighs, flexor surfaces of the forearm, axillae, groin, and lower abdomen.
What do the autoantibodies in bullous pemphigoid target?
BP1 (bullous pemphigoid peptide 1) and BP2 (bullous pemphigoid peptide 2) in the basement membrane of the epidermis
Bullous pemphigoid is an autoimmune disorder that rarely affects which part of the body (in contrast to pemphigus vulgaris, which affects it frequently)?
Dermatitis herpetiformis is often associated with what condition?
Gluten-sensitive enteropathy (eg, Celiac disease)
Mantoux (PPD or TB) skin test, transplant rejection, and contact dermatitis are what type of hypersensitivity reaction?
Delayed hypersensitivity reaction, type IV
Infectious Viral Exanthems Describe the rash associated with herpes simplex type I:
Small recurrent painful vesicles involving oral mucosa; recurrent events may appear to be related to stressful life events or periods of other illness.
Describe the rash associated with herpes simplex type II:
Small recurrent painful papules and/or vesicles involving genital mucosa; primary infection may also be associated with fever, headache, vaginal or meatal discharge, and painful urination.
Which test can be used to assist in the diagnosis of herpes virus infection?
What is the treatment for herpes simplex?
Topical or oral acyclovir
What infection causes unilateral, painful vesicles along a dermatome of the face or trunk?
Shingles (herpes zoster)—reactivation of a latent varicella zoster virus (VZV) infection that is otherwise dormant in dorsal root ganglia
Which disease of childhood presents with acute vesicular eruptions that occur in successive crops, so that the rash typically consists of vesicles at different stages of resolution?
Primary varicella zoster virus (VZV) infection, also known as chicken pox
What is the classic description of a chicken pox vesicle?
"Dewdrop on a rose petal"
What are the classic six childhood exanthemas?
Measles (first disease)
Scarlet fever (second disease)
Rubella (third disease)
Duke disease (fourth disease)—term rarely used today, is controversial if this is truly a separate entity
Erythema infectiosum (fifth disease) or more commonly "slapped cheek disease"
Roseola (sixth disease)
What childhood exanthema is referred to as "first disease" and how does this present?
Measles—caused by infection with measles virus (paramyxovirus); presents with rash, cough, conjunctivitis, and coryza and Koplik spots on buccal mucosa. The rash is classically red-brown morbilliform (maculopapular) rash that spread from head to toe.
What ribonucleic acid (RNA) virus, spread by respiratory droplets, is also called rubeola?
What are Koplik spots?
Ulcerated lesions on the oral mucosa seen in measles
What childhood exanthema is referred to as "second disease" and how does this present?
Scarlet fever—caused by infection with Streptococcus pyogenes (group A beta-hemolytic), presents with sore throat and an erythematous popular rash involving face and trunk that spreads downward
What childhood exanthema is referred to as "third disease" and how does this present?
Rubella (aka German measles)—caused by infection with rubella virus (togavirus), presents with fever and an erythematous maculopapular rash that spreads from head to toe and may become confluent
What are the findings of congenital rubella?
Deafness, glaucoma, cataracts, congenital heart disease, and mental retardation
What childhood exanthema is referred to as "fifth disease" and how does this present?
Erythema infectiosum—caused by infection with parvovirus B19, presents with a lacy erythematous rash over the cheeks ("slapped cheek disease") that may then spread to trunk, arms, and legs
What are the other complications of fifth disease?
Nonimmune fetal hydrops (virus infects and destroys fetal red blood cells); more severe anemia in patients with other types of chronic anemia (like aplastic crisis in a sickle cell patient)
What childhood exanthema is referred to as "sixth disease" and how does this present?
Roseola (exanthema subitum)—caused by infection with human herpes virus-6 (HHV-6) or HHV-7, presents with fever, possibly diarrhea, and rash after defervescence of the fever. The rash is erythematous, maculopapular, and initially distributed over trunk and neck.
What is the causative agent of verruca vulgaris?
Human papillomavirus (HPV)
What HPV serotypes cause the common wart?
HPV-2—common warts, some forms of plantar warts
How does molluscum contagiosum appear clinically?
Flesh-colored umbilicated papules
How does molluscum contagiosum appear microscopically?
Epidermal hyperplasia producing a basin with molluscum bodies (Henderson-Patterson bodies)
What type of virus causes molluscum contagiosum?
What agent causes hand-foot-and-mouth disease?
Coxsackie virus type A16
What are the signs and symptoms of hand-foot-and-mouth disease?
Fever and malaise with small oval vesicles along creases of palms, soles, and lips
Which diseases cause rashes distributed on the hands and feet?
Syphilis; hand-foot-and-mouth disease; Rocky Mountain spotted fever
What is the etiologic agent for mononucleosis?
Epstein-Barr virus (EBV)
What are the classic laboratory criteria for diagnosing mononucleosis?
Lymphocytosis, presence of at least 10% atypical lymphocytes on peripheral smear, and a positive serologic test for EBV
What causes milker nodules?
What disease may follow paravaccinia infection?
What condition is described as having thin-walled vesicles or pustules that rupture to form golden-yellow crusts (honey-colored crusts)?
What is the most common bacterial infection of the skin in children?
What bacteria cause impetigo?
Staphylococcus aureus or Streptococcus pyogenes
What test is helpful to determine the organism involved in impetigo?
Culture of vesicle or pustule fluid contents and catalase tests (Staphylococcus is catalase positive, Streptococcus is catalase negative)
What is the infectious agent that causes scalded skin syndrome?
What is erysipelas ("St. Anthony's fire") and what is the causative organism?
Infection of the dermis by streptococcal species, most commonly Streptococcus pyogenes
How do patient with erysipelas present?
With a rapidly enlarging erythematous, swollen, warm, indurated, skin lesion, typically with a sharply demarcated raised boarder. Patients may also have fever.\
What is cellulitis and what are the common causative organisms?
Inflammation and often infection of the subcutaneous connective tissue; most commonly caused by Staphylococcus or Streptococcus species
What is the rapid developing infection of the skin and fascia that may lead to death if not treated quickly?
What are the organisms responsible for necrotizing fasciitis?
Group A streptococci or Clostridium perfringens
What is erythrasma and which bacteria are associated with this condition?
A chronic bacterial infection of overlapping skin folds, generally appearing as red-brown patches with sharp borders; usually caused by Corynebacterium
What is the most common type of bacterial infection in burn victims?
Pseudomonas aeruginosa infections
What is the typical primary syphilis skin manifestation?
Painless indurated genital or lip ulcer (chancre)
What are the typical secondary syphilis skin manifestations?
There are several possible forms, including maculopapular lesions distributed on palms and soles, warts (condylomata lata) involving the anogenital region, symmetric nonpruritic erythematous rash involving the trunk and extremities, or alopecia.
Name the three stages of Lyme disease:
Stage 1: tick bite, erythema migrans
Stage 2: disseminated infection—fever, chills, arthritis, meningitis, and so forth
Stage 3: persistent infection—usually nervous system damage like encephalitis or peripheral neuropathy
What type of rash is seen in spotted fever?
An inward or centripetal spreading rash
What is the vector for Rocky Mountain spotted fever (Rickettsia rickettsii)?
What is used to test for typhus and Rocky Mountain spotted fever?
A positive Weil-Felix reaction—tests for cross-reaction of antirickettsial antibodies with Proteus antigen
What is the treatment for Rocky Mountain spotted fever?
Tetracyclines or chloramphenicol
What disease does Rickettsia prowazekii cause?
What is the vector of R. prowazekii?
Human body louse
What type of rash is seen in typhus?
An outward or centrifugal-spreading rash
How do the rickettsiae cause severe tissue damage?
Organisms infect endothelial cells and cause vascular leakage, which results in hypovolemic shock, pulmonary edema, renal failure, and central nervous system (CNS) damage.
What does Rickettsia akari cause?
Rickettsialpox—papule at the site of a mouse bite degenerates into an eschar, then chills, fever, eventually papulovesicular rash
What is special about Q-fever?
It is the only rickettsial infection transmitted by aerosol; there is no arthropod vector and no rash.
Which type of plague causes painful enlargement of inguinal nodes (buboes)?
What is the plague native to the United States that lives in squirrels and prairie dogs?
What are the cutaneous manifestations in Whipple disease?
Hyperpigmentation of scars and sun-exposed skin (melanoderma)
What is the easiest and quickest way to determine if the etiology of a skin rash is a fungus?
KOH preparation—will see fungal forms on microscopy
What are the cutaneous mycoses?
A group of skin infections caused by organisms including Malassezia furfur, Cladosporium werneckii, and dermatophytes. Infections manifest differently according to distribution on the body. Members of this group include: tinea versicolor, tinea pedis, tinea capitis, tinea barbae, and tinea cruris.
Dermatophytes include members of which genera?
Trichophyton; Microsporum; Epidermophyton
What organism is responsible for tinea versicolor?
Which form of M. furfur generally causes disease?
What does the rash of tinea versicolor look like?
Groups of variably sized, either hypo-or hyperpigmented, macules with a fine peripheral scale
What is used to treat tinea versicolor?
Topical miconazole; selenium sulfide
Describe the rash of tinea pedis:
Primary infection features erythematous and scaling skin, primarily confined to the web spaces between digits.
What is the treatment for tinea pedis ("athlete's foot")?
Topical or oral antifungals
Describe the rash of tinea capitis:
Usually in children, can present on the scalp with hair loss, erythema, and scale or may be asymptomatic hair loss
What is the most likely etiologic organism of tinea capitis?
What is the treatment for tinea capitis?
What does disseminated disease of coccidioidomycosis manifests as on the skin?
Verrucous plaques (usually on face); subcutaneous abscesses; pustular lesions
Neoplastic Skin carcinogenesis is primarily thought to be caused by the accumulation of mutations in which tumor suppressor gene?
What is the most common type of skin cancer?
Basal cell carcinoma
What is the neoplasm that is often described as a pearly, red macule, papule, or nodule that is found on sun-exposed areas of the head or neck?
Basal cell carcinoma
What skin cancer is microscopically characterized by nests of basophilic cells ringed by palisading basophilic cells?
Basal cell carcinoma
Which neoplasm is often described as a red papule, nodule, or plaque that may be hyperkeratotic or ulcerated on sun-exposed skin?
Squamous cell carcinoma
Arsenic exposure is associated with which type of skin cancer?
Squamous cell carcinoma
Which neoplasm is microscopically characterized by nests of atypical squamous epithelial cells and keratin pearls?
Squamous cell carcinoma
Actinic keratosis lesions may transform into what type of skin cancer if left untreated?
Squamous cell carcinoma
What are some risk factors for squamous cell carcinoma?
Sun exposure; ionizing radiation; actinic keratosis; immunosuppression; arsenic; industrial carcinogens
What are tan/brown plaques or papules that have a "stuck on" appearance and may be found anywhere on the body of adults, except the palms and soles?
From what cell type does melanoma arise?
Large (>20 cm) congenital nevi and dysplastic nevi may be precursor lesions for what type of cancer?
Which clinical criteria are used to help diagnose melanomas?
Asymmetry; Border irregularity; Color variation; Diameter
*ABCDs of melanoma
How is dysplastic nevus syndrome inherited?
Autosomal dominant inheritance
On which chromosome is the gene associated with dysplastic nevus syndrome located?
What is the peak age range for incident melanoma?
40 to 70 years of age
What are the risk factors for melanoma?
Sunburns; chronic sun exposure; fair skin; dysplastic nevi
What is the most common subtype of melanoma?
Superficial spreading melanoma
Which type of melanoma has the best prognosis?
Lentigo maligna melanoma
Which type of melanoma has the worst prognosis?
What is the most common type of melanoma in dark-skinned individuals?
What is the most important prognostic parameter for melanoma?
Depth (Breslow thickness)
In what condition would you find cytoplasmic Birbeck granules through electron microscopy?
Langerhans cell histiocytosis (formerly Histiocytosis X)
In Langerhans cell histiocytosis, proliferation of which cell type is usually found in the epidermis?
Langerhans cells (macrophages)
What are the histologic findings in cutaneous T-cell lymphoma (CTCL) (aka mycosis fungoides)?
Epidermotropic lymphocytes (Sézary-Lutzner cells) and Pautrier microabscesses
What is CTCL called when there is blood involvement?
What type of cutaneous neuroendocrine carcinoma microscopically resembles metastatic small cell carcinoma from the lung?
Merkel cell carcinoma
Which HPV serotypes cause condyloma acuminatum?
HPV 6 and HPV 11
Which autosomal recessive disease is characterized by defective DNA repair and photosensitivity?
Patients with xeroderma pigmentosa usually develop which skin lesions?
Basal cell carcinoma; squamous cell carcinoma; actinic keratosis; melanoma in childhood
Exposure to ultraviolet (UV) light causes what type of dimers in epidermal cells?
Traumatic/Degenerative What is the most common type of collagen in a keloid?
Type III collagen
What are the risk factors for keloid formation?
African American race, <30 years of age, and increased skin tension in a wound
Single or multiple bright red papules measuring a few millimeters in diameter that occur predominantly on the trunks and limbs of patients over 40 years are what type of lesions?
Cherry angiomas (senile angiomas)
What skin condition is described as dark, rough-looking, or velvety skin in the axilla or on the back of the neck?
What may be associated with acanthosis nigricans?
Long-standing hyperglycemia, some underlying lymphoproliferative disorders
What is the most common cause of burns in children?
Scalds from hot liquids
What is the most common cause of burns in adults?
Accidents with flammable liquids
Which kind of burn affects only the epidermis?
Which kind of burn usually blisters and affects the dermis and adnexal structures?
Which type of burn involves the entire thickness of the skin, including variable amount of underlying fat and causes loss of sensation in affected areas?
The scar that follows a deep second-and third-degree burn is composed of what?
Drugs/Toxins Which drugs cause erythema multiforme or "target" lesions?
Aspirin; penicillin; sulfonamides; phenytoin; corticosteroids; cimetidine; allopurinol; oral contraceptives
Which drugs cause Stevens-Johnson syndrome?
Sulfa drugs; carbamazepine; phenytoin; valproic acid; phenobarbital; quinolones; cephalosporins; allopurinol; corticosteroids; aminopenicillins
What is Stevens-Johnson syndrome?
A systemic form of erythema multiforme that often occurs with fever, erosions, and hemorrhagic crusts of lesions involving the lips and oral mucosa, may also involve the urethra and genital and perianal areas
What are patients with Stevens-Johnson syndrome more susceptible to due to the rash?
Secondary infection of skin which may result in life-threatening sepsis
Which drugs may induce acne?
Lithium; steroids; androgens; oral contraceptive pills
Which marker is associated with a genetic susceptibility to fixed-drug reactions?
What do you call a symmetrical, hyperpigmented lesion of the forehead and cheeks that occurs in women who are on oral contraceptives or pregnant?
What are some common drugs that are associated with hyperpigmentation?
Bleomycin; minocycline; amiodarone; chloroquine; gold; chlorpromazine; 5-fluorouracil (FU); daunorubicin; busulfan
Which groups of patients have an increased risk of an adverse drug reaction?
Women; patients with Sjögren syndrome; AIDS patients
Which drug causes red man syndrome usually during rapid intravenous infusion?
Metabolism What is the most likely vitamin deficiency that manifests as petechiae, ecchymoses, abnormal hair growth, bleeding gums, and poor wound healing?
Vitamin C (scurvy)
Which vitamin deficiencies have cutaneous manifestations?
Vitamin C; Vitamin A; Nicotinic acid; Riboflavin; Pyridoxine
What are some skin manifestations of kwashiorkor?
Dry skin; patches of hypopigmentation; skin peeling; peripheral edema; thin hair shafts
Patients with carcinoid syndrome may have which skin manifestation?
Episodes of flushing of the head, neck, and sometimes trunk
What are the metabolic causes of hyperpigmentation?
Porphyria cutanea tarda; hemochromatosis; Vitamin B12 deficiency; folic acid deficiency; pellagra; malabsorption; Whipple disease
An 8-month-old presents with large, easily ruptured flaccid bullae, with large areas of desquamation of skin and a positive Nikolsky sign. What is the most likely diagnosis?
Staphylococcal scalded skin syndrome
A sexually active 23-year-old patient presents with painful vesicles on his penis and a slight fever. He refers to having the same type of vesicles multiple times a year. Multinucleated giant cells and ballooning of nuclei are seen microscopically. What is the likely diagnosis?
Herpes simplex infection
A 16-year-old presents with multiple dome-shaped, umbilicated, waxy papules on the face and chest. What is the most likely diagnosis?
A 35-year-old patient with acquired immunodeficiency syndrome (AIDS) presents with multiple brownish/purplish macules on the trunk and lower extremities. What is the likely diagnosis?
Kaposi sarcoma (human herpes virus 8 [HHV 8])
A 7-year-old presents with multiple hard, rough-surfaced papules on his fingers and elbows. What is the most likely diagnosis?
Verruca vulgaris (common wart)
A 24-year-old man from the Northeast, visits the physician because of a centrifugally spreading, erythematous lesion on his right leg. The patient noticed the rash after he went hiking. What is the most likely diagnosis?
Erythema chronicum migrans (Lyme disease)
A mother brings her 5-year-old son to the physician because she noted her son scratching a pinkish lesion on his neck. Upon examination, the physician notes a ring-shaped scaling plaque with central clearing and elevated borders. What is the most likely diagnosis?
A 22-year-old man presents with a rash that first appeared on his palms and soles, and then spread to his face and trunk. The rash initially appeared about 6 days after a camping trip in North Carolina. What is the most likely diagnosis?
Rocky Mountain spotted fever
A 26-year-old woman from Texas complains of small hypopigmented spots on her upper back that usually disappear in the winter months. What is the likely diagnosis?
Tinea versicolor (Malassezia furfur)
A 25-year-old sexually active man presents with a painful, nonindurated genital ulcer, and tender regional lymphadenopathy. What is the most likely diagnosis?
A 35-year-old homeless woman visits a shelter physician because of multiple, extremely pruritic papules in her axilla, groin, and finger webs. The patient indicates her husband also has the same lesions. What is the most likely diagnosis?
A 15-year-old boy on the school swim team visits the dermatologist because of itchiness on both his feet. He states he is not on any medication and has not had it before. Upon inspection, the physician notes erythematous, dry scaling lesions on both feet. What is the most likely diagnosis?
A 67-year-old woman visits her dermatologist because of small reddish papules/pustules predominantly on her cheeks, nose, chin, and forehead. She states that her face becomes worse if she uses hot water or is in warm weather. What is the most likely diagnosis?
A 12-year-old boy visits his physician because of a "slap-like" red mark on his cheek and a rash on his arms that appeared 1 day after the cheek rash. Upon physical examination, the physician notes malar erythema and a maculopapular rash on his extremities. What is the most likely diagnosis?
Fifth disease (erythema infectiosum) caused by Parvovirus B19
A 16-year-old girl is given ampicillin for complaints of fatigue, fever, sore throat, and lymphadenopathy. Two days later, she returns with a cutaneous rash on her face. What is the most likely underlying diagnosis in this patient?
A 23-year-old farmhand presents to the dermatologist with multiple red-violaceous nodules on the hand, fever, and history of diarrhea. During the examination, the patient states he is in charge of the cows on the farm. What is the most likely diagnosis?
A 45-year-old rancher visits a dermatologist because of a black 2-cm lesion on his hand. He states that the lesion was itchy and had a reddish color a day or two ago. What is the most likely diagnosis?
Anthrax (Bacillus anthracis)
A 36-year-old migrant worker from Mexico visits the physician because of small disfiguring nodules forming on his ears and hands. The patient also states that he is losing sensation in the affected areas. What is the most likely diagnosis?
Leprosy (Mycobacterium leprae)
An inner-city child is brought to the physician because of patches of hair loss. His mother states that he has had this problem for at least a month. The lesions are painless and have some scaling. What is the most likely diagnosis?
A 54-year-old man visits the dermatologist because of a dark brown-black 5-mm freckle in between his third and fourth toe. The patient stated that he noticed the freckle about a year and a half ago. The dermatologist biopsies the lesion and under the microscope, the pathologist sees atypical confluent melanocytes with asymmetrical proliferation. What is the most likely diagnosis?
A 40-year-old man has a rash of scaly red patches on his trunk, face, and extremities. A biopsy is taken and superficial dermal infiltrates of T lymphocytes and a collection of atypical lymphocytes are seen within the epidermis. What is the most likely diagnosis?
Cutaneous T-cell lymphoma (Mycosis fungoides)
A 59-year-old man visits his family physician because of loss of appetite, weight loss, and fatigue. During the physical examination, the physician notes dark, rough-looking skin in the axilla region. What should the physician suspect?
An endocrine disorder or a visceral malignancy
A 39-year-old man comes to the physician because he has noted a bluish-black color on his ears, nose, and sclera. The patient also states that his urine is sometimes very dark. What is the most likely diagnosis?
A 45-year-old patient presents with intense skin hyperpigmentation, areas of epithelial desquamation, diarrhea, and confusion. What is the most likely deficient vitamin?
Niacin (nicotinic acid)
A 35-year-old woman visits her physician because she recently noticed multiple small nodules on the back of her ankle. The patient's vital signs are normal and she has no prior clinical illnesses. A blood test is taken with the following results—sodium 142, glucose 100, creatinine 1.0, blood urea nitrogen (BUN) 17, cholesterol 310, triglycerides 412. What do the small nodules likely represent?
A mother brings her 7-year-old son to the physician because of two small masses on his right chest. The mother states that the child is adopted and does not know the child's family medical history. On examination, 3- and 4-cm masses are palpated overlying his right pectoralis muscle, small tan lesions are seen on his back and right arm, and a small growth is seen on his iris. What is the most likely diagnosis?
Neurofibromatosis (NF) 1
A 16-year-old boy with a clinical history of acne visits his family physician because he has a red rash on his face and various exposed parts. During the examination, he states the rash occurred after he spent a couple of hours outside playing football. What medication is he most likely taking?
A 75-year-old woman patient with history of heart problems visits her dermatologist because her skin has begun to turn a light blue color. She is embarrassed to go in public because children say she looks like a "smurf." What medication did her cardiologist most likely give her?
A 24-year-old woman presents to the dermatologist because of target-like lesions on her right arm. The patient states she is taking some type of antibiotic for a urinary tract infection (UTI). What drug class most likely caused the lesions?
A 32-year-old woman visits her family physician because of rapid weight gain, profuse sweating, sudden abnormal hair growth, and easy bruising. Upon physical examination, the physician notes purplish striae on the abdomen, telangiectasia, thin skin, and an increase of fatty tissue on her back at the level of C6. What is the most likely diagnosis?
A 3-year-old boy presents to the physician with a photosensitive rash, cerebellar ataxia, mental disturbances, and aminoaciduria. Niacin levels are within normal range. What is the most likely diagnosis?
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