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Specialty E2 Derm (202 cards mostly set up as MC questions)

Terms in this set (202)

patch
greater than 1cm wide spot on the skin that you can see but not feel.
macule
less than 1cm wide spot on the skin that you can see but not feel.
papula
A raised lesion less than 1 cm that lies primarily in the more superficial dermis. (Attached to skin, part of skin)
plaque
Palpable raised lesion on the skin that is wider than 1 cm.
nodule
a small knot of tissue that lies in the mid to deep dermis that raises the superficial skin and is palpable.
vesicle
fluid filled papula. A small blister with clear or honey colored fluid. Less than 1 cm.
bulla
A large blister > 1cm.
pustule
a small papule that is filled with leukocytes and thin fluid calle liquor puris.
erosion
a skin lesion characterized by loss of part or all of the epidermis. May occur after a vesicle peels off. Will not lead to a scar.
ulcer
a skin lesion characterized by loss of the epidermis and part of the dermis. May contain necrotic tissue. Will heal with scarring. Aka a "sore".
tinea versicolor
Diagnose this skin condition:
Caused by malassezia spp., which are yeast-like fungus that degrade lipids in the skin and produce acids that damage melanocytes. Spaghetti and meatballs appearance on microscope with KOH prep. Treat with selenium sulfide, topical and/or oral antifungal.
1,2
Macules can:
1) Feel flat
2) Be any shape
3) feel raised
4) contain fluid
extensor, flexor
Psoriasis tends to be on _____ surfaces.
Eczema tends to be on ____ surfaces.
distribution
The derm term which means location on the body
configuration
the derm term which means how the lesions are arranged or relate to each other.
1 (IgG attack on hemidesmosomes BP180 of the basement membrane. "Basal layer comes off the Basement membrane in Bullous --> B B B)
Subepidermal
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
destruction of hemidesmosomes
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
Oral mucosa is spared
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
tense bullae which do not rupture easily. Clinically milder picture.
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
occurs more in elderly, age 60-80
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2 (pemphiGUS -- muCUS or vulgar words come out of your mouth)
May commonly involve mucosal surface
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
tense bullae on erythematous base with eosinophils
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
linear deposition of IgG and C3 along the basement membrane seen on direct immuno-fluorescence.
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
A scarring, chronic, recurrent disease of the elderly. Affects mucosal surfaces. More likely to affect mucosa, pharynx, genitals, esophagus, eyes, than skin. IgG and C3 along BM in DIF.
1) Cicatricial pemphigoid
2) pemphigoid gestaionis
3) PUPP pruritic papules and plaques of pregnancy
4) Pregnancy prurigo
5) erythrodermic bullous pemphigoid
t
t/f there is no scarring associated with bullous pemphigoid
2
Pruritic dermatosis. Vesicular eruption on abdomen with mucosal sparing. 4-7th month of pregnancy. Can recur in subsequent pregnancies. Umbilical involvement common. Resolves by 6 months postpartum. 5% of babies will have lesions.
1) Cicatricial pemphigoid
2) pemphigoid gestationis
3) PUPP pruritic papules and plaques of pregnancy
4) Pregnancy prurigo
5) erythrodermic bullous pemphigoid
2
umbilical involvement common
1) Cicatricial pemphigoid
2) pemphigoid gestaionis
3) PUPP pruritic papules and plaques of pregnancy
4) Pregnancy prurigo
5) erythrodermic bullous pemphigoid
3
Dermatitis which appears during pregnancy. Spares the umbilicus. Lesions appear in striae. Negative DIF.
1) Cicatricial pemphigoid
2) pemphigoid gestaionis
3) PUPP pruritic papules and plaques of pregnancy
4) Pregnancy prurigo
5) erythrodermic bullous pemphigoid
4
Dermatitis which appears during pregnancy. There are no blisters. It is an atopic reaction that is widespread throughout the body. Negative DIF.
1) Cicatricial pemphigoid
2) pemphigoid gestaionis
3) PUPP pruritic papules and plaques of pregnancy
4) Pregnancy prurigo
5) erythrodermic bullous pemphigoid
1
Antibody to tissue transglutaminase
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
1
granular IgA deposition in dermal papillae. Also, antibody mediated activation of complement followed by neutrophilic papilitis.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
1
Treatment is gluten avoidance or dapsone
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
2
Widespread vessicles and bullae most commonly on the trunk and mucous membranes. Grouped vessicles: "Clusters of jewels".
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
2
May be induced by vancomycin
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
2
Neutrophilic papilitis with IgA along the BM (not in the papillae)
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
3
Decreased activity of uroporphyrinogen decarboxylase.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
3
Most commonly sporadic mutation. Hemocromatosis genes may allow this disease to occur with iron overload. Is also associated with EtOH, estrogens, hep C.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
3 (sun exposed areas)
Tense bullae on normal appearing background, typically on the hands. But could be on other areas
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
3
Urine will fluoresce under wood's light
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
3
Superficial blood vessels have circumferential IgG deposition.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
3
Treatments involve avoiding EtOH, estrogens. Phlebotomy. Low dose chloroquine.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
4
Blisters appearing on sun exposed skin in patients who are on dialysis or take medications such as NSAIDs, tetracycline. Serum/urine porphyrin will be normal.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
5
Non-scarring, subepidermal, cell poor bullae without evidence of autoimmunity, and without DIF findings.
1) Dermatitis herpetiformis
2) Linear IgA Bullous Dermatosis (LABD)
3) Porphyria Cutanea Tarda
4) Pseudoporphyria
5) Bullous Diabeticorum
2
Jewish man age 50 presents with painful flaccid vesicles which easily rupture, erode, and crust. More blisters can be easily formed by sliding a finger over skin near existing blisters.
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2
Autoantibodies against Desmoglien 1 and 3 (which compose desmosomes between keratinocytes in the stratum spinosum which is just above the basal layer)
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2 (basal layer remains attached to basement membrane while the suprabasal layers slough off. The basal cells look upright and rounded like tombstones)
Tombstone appearance on light microscopy. #boards
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2
oral mucosal is affected
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2
Nikolsky sign: you can rupture bullae or extend old ones with mild skin pressure)
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2
Clinically more severe course. Can be fatal.
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2
Intraepidermal blister with eosinophils
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
2
Chicken wire distribution of IgG or C3 on DIF.
1) Bullous Pemphigoid
2) Pemphigus Vulgaris
1
Targets DSG1. Spares mucosa. Causes exfoliative erythroderma --> more superficial blisters and bullae.
1) Pemphigus foliaceus
2) Impetigo
3) Friction Blister
4) Pemphigus vulgaris
2
s aureus, s pyogenes. Children. Hands and face.
1) Pemphigus foliaceus
2) Impetigo
3) Friction Blister
4) Pemphigus vulgaris
2
Bacterial toxin cleaves DSG1.
1) Pemphigus foliaceus
2) Impetigo
3) Friction Blister
4) Pemphigus vulgaris
3
Cell poor blister below stratum corneum (top layer of epidermis) usually on feet.
1) Pemphigus foliaceus
2) Impetigo
3) Friction Blister
4) Pemphigus vulgaris
1
Aka benign familial pemphigus. AD inheritance. Defect in ATP2C1 Ca++ pump which leads to decr cell cohesion.

Age 10-40, vesicles, bullae leading to crusting erosions that look like impetigo. Seen in intertriginous areas. Treat with tetracycline and topical steroids.

1) Hailey-Hailey disease
2) Darier's disease
3) Grover's disease
1
AD inheritance. Defect in ATP2C1 Ca++ pump which leads to vesicles, bullae leading to crusting erosions. Seen in intertriginous areas.
1) Hailey-Hailey disease
2) Darier's disease
3) Grover's disease
2
AD inheritance. ATP2A2 gene. Scaling papules in seborrheic distribution (places that get greasy like chest, back, forehead, scalp, groin). Treat with sunscreen, avoiding rubbing, retinoids.
1) Hailey-Hailey disease
2) Darier's disease
3) Grover's disease
3
Abrupt onset of pruritic crops of lesions on trunk and proximal extremities that occurs with sweating, heat, and in bed-ridden patients. Treat with topical steroids or phototherapy.
1) Hailey-Hailey disease
2) Darier's disease
3) Grover's disease
ok
skipped wound healing and intentions OK?
aspirin, asthma, atopy (freq assoc with nasal polyps, rhinorrhea, COX-1 inhibition)
List the things in Samter's triad.
6
Present in intertriginous folds. Skin scraping should show tunnels and perhaps offending organism.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
1
Itch that rashes.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
1
Chronic, pruritic, inflammatory disorder which typically develops by age 5 and clears by age 15. Commonly seen on cheeks, forehead, scalp, extensor surfaces. May have lichenified plaques. Xerosis is common throughout the course.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
1
50-80% will have another allergic/atopic condition like asthma, or rhinitis.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
1 (ASA, asthma, atopy)
Samter's triad is associated with:
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
1
Treatment is primarily rehydration of the skin, avoiding triggers, mild antiinflammatory steroids, antibiotics like bactriban to cover staph. Hydrocortisone ointment would work.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
1,2,3
Filaggrin mutation is seen in these 3 conditions.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
4
A variant of atopic dermatitis with facial patches of hypopigmentation which can be dry and scaly in the winter. Woods lamp and KOH prep are negative.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
5
Type IV hypersensitivity.
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
5
IE poison oak, ivy, sumac. Urushiol
1) Atopic dermatitis
2) Ichthyosis vulgaris
3) Harlequin baby
4) Pityriasis alba
5) Allergic contact dermatitis
6) Scabies
urticaria
___ is characterized by wheals surrounded by erythema. Pruritis. Swelling of the upper dermis. Will blanch with pressure. Most is acute, but may be chronic (>6 weeks). Variable etiology. Common pathophys is mast cell degranulation, Histamine, vasodilation, venous constriction, cap permeability.
dermatographism
a type of physical urticaria where localized wheal or edema appears minutes after the skin is rubbed.
1 (this is type IV HS rxn--contact dermatitis, which would not cause urticaria. Others are mast cell mediated. Morphine goes directly for mast cells. Penicillin triggers IgE)
Which would NOT cause urticaria?
1) Laundry detergent
2) Morphine
3) NSAIDs
4) Drawing on the skin in a sensitized individual
5) penicillin
3 (H1 antihistamines 1st or 2nd generation may work depending on the drug. 1sst generation H blockers cause sedation.)
Which is FALSE about urticaria?
1) Individual wheals rarely last over 12 hours.
2) Acute urticaria is urticaria lasting less than 6 weeks
3) Oral H2 blockers are treatment of choice
4) Chronic urticaria typically resolves on its own after 2-5 years.
50
___% of urticaria is found to be idiopathic
angioedema
Which condition is this?
Sudden and severe interstitial swelling that does not respond to epi, antihistamines.
I, IV
atopic dermatitis is type ____ hypersensitivity
Contact dermatitis is type ____
angioedema (loss of control of complement. Complement overactivation occurs, looks like allergy but will not respond to epi)
C1 inhibitor deficiency.
angioedema
Pt presents with swelling of hands, feet, airway. The edema is nonpitting, non-pruritic. The swelling continues to worsen. You try giving epi and it doesn't do anything. You try giving H1 blocker and it doesn't do anything. You perform a needle cricothyroidotomy.
angioedema
the edema in this condition is subcutaneous (interstitial) or submucosal.
ACEI, bradykinin (lower risk after an ARB)
Angioedema may occur months to years after starting this medication: ____.

This effect is mediated by ____.
stevens-johnson, toxic epidermal necrolysis (TEN)
Erythema multiforme (hypersensitivity rash with epidermal necrosis surrounded by erythema) with oral mucosa/lip involvement is termed _____ syndrome. A severe form of this occurs when there is a sloughing of the skin resembling a large burn. This is called ____. It is usually due to adverse drug reaction.
kawasaki
Which disease?
Asian children < 4 yo.
Conjunctival injection
Rash (polymorphous --> desquamating)
Adenopathy, cervical.
Strawberry tongue
Hand-foot change (edema, erythema)
Fever
"CRASH and burn" - burn for fever
may develop coronary aneurysms, thrombosis, rupture, death. Treat with IV IG and high dose ASA.
lamotrigine
classic anti-epileptic drug which causes stevens-johnson syndrome
3 (steven john has epileptic ALLergy to Sulfa drugs and penicillin. ALL for allopurinol)
Which would NOT cause stevens-johnson syndrome (or TEN) #boards
1) Epileptics
2) Allopurinol
3) Amiodarone
4) Sulfonamides
5) Penicillins
stasis dermatitis
Erythematous, pruritic, scaling patches on the lower extremities due to impaired venous circulation. Chronic changes in the lower extremities include edema, skin hyperpigmentation and ulcer formation.
vasculitis
An inflammatory process of the blood vessels that appears as palpable purpuric papules. Also known as leukocytoclastic ____. (process mediated by neutrophils).
3
hemosinderin deposits
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
3
Chronic leg ulcers are caused by ____ about 75% of the time.
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
1
A patient presents with an ulcer on the lower leg. He says he bumped his leg hard against a table there recently. It has a punched out appearance with a pale base. The nearby skin is shiny and atrophic. The patient has leg pain when walking and you feel diminished pulses in the feet.
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
0.9,1.2
Normal ankle brachial index is between __ and __
supine
In what position should the patient be when you measure ankle-brachial index (ABI)?
1
ankle-brachial index (ABI) is decreased.
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
1
DO NOT use compression dressings to treat.
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
3 (Stasis dermatitis)
A patient presents with erythematous brown hyperpigmented plaque with fissuring and scale. There is asymmetry between the legs. It itches. Palpation suggests fibrotic process. The contralateral leg has varicosities.
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
3
Lichenification is associated with
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
lichenification
____ is when the skin becomes thickened and leathery. This often results from continuously rubbing or scratching the skin. It can occur in venous stasis/insufficiency.
1 (arterial insufficiency)
Lipodermatosclerosis is associated with venous insufficiency. This is when subcutaneous fat is replaced with fibrosis, (scarring of the fat) impeding lymphatic and venous drainage leading to edema. This can lead to fat necrosis.

Which of the following is NOT a complication of venous insufficiency:
1) Punched out well demarcated ulcers on normal base
2) recurrent ulcers
3) Cellulitis
4) Contact dermatitis
5) Venous thrombosis
steroids
Treat stasis dermatitis with compression wraps, elevation, and high dose/potency _____.
unna boot (for venous insufficiency)
What is this describing?
-Gauze impregnanted with ZnOx and calamine wrapped with a little pressure from foot to knee. With another layer on top that gets looser as it goes up from foot to knee.
callus, osteomyelitis
Pre-ulcerous version of a diabetic foot ulcer is a ____. Patients with diabetic foot ulcers should be evaluated for ___ at the ulcer site.
2
purpura: petechiae or ecchymosis depending on size.
1) Disease of supply/arteries
2) Disease of capillaries/vasculitis
3) Disease of drainage/veins
diascopy (pressure with a glass slide to see if skin blanches)
this test can distinguish vasodilation from RBC extravasation when there is vasculitis. IE it can help in determining if redness is purpura or if redness is just swelling. Purpura does not blanch with pressure.
n meningitidis
In infectious purpura, there is a rash. From that rash you can culture _____.
4 (n meningitidis. Could be RMSF)
Infectious purpura is associated with all of the following EXCEPT:
1) meningococcemia
2) Sepsis
3) DIC
4) External trauma
5) Waterhouse-Friderichsen syndrome
DIC
purpura and petechia in a septic patient should raise concern for this emergent condition: ______
HSP (henoch-schonlein purpura)
This condition is a small blood vessel vasculitis. Most commonly affects children. Presents with joint, abdominal and kidney issues. Preceeded by an infection that leads to IgA-C3 deposition.
1(thins)
Which is FALSE about derm changes with aging??
1) There is thickening of the skin
2) Reduced lipids content
3) Slower wound healing
4) Lower immune function
5) Reduced collagen and elastin
3 (decr anagen growth, increased telogen resting phase)
Which is FALSE about derm changes with aging??
1) Dermal papillae flatten
2) Easier bruising
3) Shorten duration of anagen and telogen phases of hair growth
4) Decreased hair density
5) Reduced follicle melanocytes so hair grays.
tretinoin (retinoid)
____ at high concentration for a long period has been shown to successfully treat photodamage in skin (IE aging).
seborrheic dermatitis
Diagnose this condition:
-greasy scale in the hairline, nasolabial fold.
-May follow dandruff.
-More common in PD
-Treat with Selenium sulfide or ketoconazle shampoos.
rosacea
Diagnose this condition:
-erythema, erythematous papules and papulopustules on cheeks, forehead, chin
-Leads to thickening of skin, particularly the nose
-Recurrent facial flushing
-Chronic condition with flares
-Cause unknown
-Tx is to reduce sun exposure, irritants, and things that cause facial flushing/vasodilation
-Severe cases can be treated with oral isotretinoin or surgery
rhinophyma
rosacea on the nose with thickened skin
xerosis
Dry skin
neurodermatitis (central cause)
Diagnose this condition:
-aka lichen simplex chronicus
-Lesions from chronic scratching
-Tx steroids, emolient, behavioral mod
3
tinea pedis or fungal between the toes. Need to keep areas dry. Topical antifungal.
1) Impetigo
2) Vitiligo
3) Intertrigo
2
Autoimmune destruction of melanocytes.
1) Impetigo
2) Vitiligo
3) Intertrigo
1
Staph or strep infection, typically on the face, with honey-colored crusts.
1) Impetigo
2) Vitiligo
3) Intertrigo
squamous cell
A cutaneous horn is a proliferation of keratinocytes that may have a ____ cancer at the base.
onychomycosis
dermatophyte infection of the nail bed. Treatment may take months with a oral -conazole or terbinafine. Relapse rate is high.
zoster (ophthalmicus. V1 distribution. shinges/vzv/herpes zoster etc. Indicates that V1 is involved. Patient is at risk of losing vision. Oral antiviral treatment urgently needed)
Diagnose this condition:
-Hutchinson's sign: vessicles on the tip of the nose.
ramsay-hunt
When herpes zoster involves the cranial nerves 7 or 8 it is called ____ syndrome. Can lead to facial palsy, tinnitus, vertigo, deafness.
seb k (seborrheic keratitis)
Diagnose this condition:
-Benign tan gray black waxy warty papules and plaques with stuck-on appearance.
-Squamous proliferation.
-Keratin pseudocysts seen on histology
-Smooth borders
-Confused with melanoma
leser-trelat, GI (visceral)
the sudden appearance of multiple seborrheic keratoses is called ______ sign, and may suggest underlying carcinoma of the _____.
BCC
Diagnose this condition:
-Ulcerated pearly papule with rolled border.
Salmon patch/nevus simplex
______: pink macule at glabella, eyelid, nape of neck; benign, fades with time. PEDS.
Erythema toxicum
white papule with surrounding erythema, very common, benign, eosinophils. PEDS.
TNPM(Transient neonatal pustular melanosis)
________: small pustule without erythema, ruptures leaving hyperpigmented macule; common in infants of color, benign, neutrophils
Milia
______: retained keratin, cluster of tiny papular lesions, usually on face, benign. PEDS.
CDM(Congenital dermal melanocytosis)
_____: slate gray/blue/greenish macule, mostly low back and shoulders, VERY common in Asian infants, benign, fades slowly. Not a bruise.
1
Your peds patient has a preauricular pit. What is next step in management:
1) hearing test
2) MRI
3) Screen for kidney disease
4) Refer to derm
5) Wound care
1
A punched out skin defect at the scalp which heals with scarring and needs wound care.
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
2
A skin defect on the scalp that indicates a possible CNS malformation. Needs neuroimaging like MRI in addition to wound care.
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3
Autosomal dominant.
Presentation consists of a combination of:
-Forehead plaque
-Ash leaf spot
-Shagreen patch
-Facial angiofibroma
-Seizures 2/2 brain tubers
-Cardiac rhabdomyoma
-Renal angiomyolipoma
-Dysplastic lung musculature
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3
A pediatric patient presents with a plaque on their forehead. You are concerned for:
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3
A pediatric patient presents with a ash leaf spot on the flank. You are concerned for:
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3
A pediatric patient presents with a hypomelanotic macule with crisp margins, slightly scallpoed borders, which lights up with a wood's lamp. You are concerned for:
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3 (shagreen patch)
A pediatric patient presents with a bumpy plaque on the lower back/buttocks. You are concerned for:
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3
a 5 year old patient presents with what looks like acne. There are papules with malar distribution without inflammation. You are concerned for:
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
3
Treatment involves regular cns imaging, renal monitoring, lung monitoring, other monitoring.
A pediatric patient presents with a plaque on their forehead. You are concerned for:
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
4
Café au lait are small, 5mm or more,
Axillary freckling:
- Underarm or groin
Neurofibroma:
Lisch nodules
Sphenoid dysplasia
- Wing of sphenoid absent on one side.
1) Aplasia cutis congenita
2) Aplasia cutis congenita: hair collar sign
3) Tuberous Sclerosis
4) NF-1
5) NF-2
McCune albright syndrome
diagnose this condition:
-Large cafe au lait macule with irregular Coast of Maine borders.
4 (not likely to be tested. But may be on boards)
Mutation in GPCR signaling. Presents with large cafe au lait spot, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities. Patient with genetic mosaicism can survive (women). #boards
1) Sturge Weber syndrome
2) Neonatal cephalic pustulosis / Baby acne
3) Acne Vulgaris
4) McCune Albright syndrome
1
Port wine stain on the face. May have CNS findings, especially when V1 or V2 distribution. Not genetic. DO MRI for leptomeningeal angioma. DO EYE exams for glaucoma.
1) Sturge Weber syndrome
2) Neonatal cephalic pustulosis / Baby acne
3) Acne Vulgaris
4) McCune Albright syndrome
2
at 3-4 weeks of age, baby gets erythematous papules. Best treatment is no treatment. Topical ketoconazole if many lesions.
1) Sturge Weber syndrome
2) Neonatal cephalic pustulosis / Baby acne
3) Acne Vulgaris
4) McCune Albright syndrome
3
Ineffective desquamation, sebum production, inflammation.
1) Sturge Weber syndrome
2) Neonatal cephalic pustulosis / Baby acne
3) Acne Vulgaris
4) McCune Albright syndrome
3,4
Which will NOT promote acne (PICK 2)
1) Stress
2) Hair products
3) food
4) dirt
5) Medications
3
Treat with Benzoyl peroxide, topical retinoids, topical antibiotics (with BP at same time), salicylic acid, oral antibx like tetracycline, oral contraceptives in females, isotretinoin.
1) Sturge Weber syndrome
2) Neonatal cephalic pustulosis / Baby acne
3) Acne Vulgaris
4) McCune Albright syndrome
isotretinoin
acne med which is a serious teratogen. Patients must have 2x pregnancy tests, 2x forms of birth control, and pregnancy test every month to get their refill.
1
AD mutation of PTCH on chromo 9. Allows SHH oversignaling to promote cell growth.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
1
Gorlin syndrome is assoc with
1) BCC
2) SCC
3) Melanoma
1
Syndrome with numerous BCC's, keratocysts of jaw, paloplantar pits, rib & vertebral anomalies, ovarian fibromas.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
1
Rolled borders with ulceration and telangiectasia
1) BCC
2) SCC
3) Melanoma
1
nodular, morpheaform (scarred areas), superficial (like eczema), and pigmented variants (looks like seb K or melanoma)
1) BCC
2) SCC
3) Melanoma
2
Assoc with immunosuppressives, transplant patients.
1) BCC
2) SCC
3) Melanoma
2
Actinic keratosis is precancerous:
1) BCC
2) SCC
3) Melanoma
2
When on the lip and ear, there is higher chance of metastasis.
1) BCC
2) SCC
3) Melanoma
2
SCC in the site of a previous burn.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
3
low grade/well differentiated SCC, commonly on the foot, or in sinus tract. Recurrence is common. Mets are rare.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
3
Can arise in anogenital area, in condyloma accuminatum, HPV 6, 11.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
4
Flesh colored dome shaped nodules with a central keratin-filled plug imparting a crater-like topography.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
5
squamous dysplasia with excess keratin, rough sandpaper consistency. Not full thickness.
1) Gorlin syndrome
2) Marjolin's ulcer
3) Verrucous carcinoma
4) Keratoacanthoma
5) Actinic keratosis
1
Scaly patch, full thickness dysplasia.
Atypical squamous cell. Sun-exposed areas
1) Bowen's disease
2) Bowenoid papulosis
3) Xeroderma pigmentosum
4) Merkel cell carcinoma
5) Sister Mary Joseph Nodule
2
SCC in situ, HPV related, small reddish brown papules, anogenital areas
1) Bowen's disease
2) Bowenoid papulosis
3) Xeroderma pigmentosum
4) Merkel cell carcinoma
5) Sister Mary Joseph Nodule
3
Autosomal recessive inability to repair DNA dmg from UV. Actinic keratosis at early age. Extreme risk of skin cancer, median age onset 8.
1) Bowen's disease
2) Bowenoid papulosis
3) Xeroderma pigmentosum
4) Merkel cell carcinoma
5) Sister Mary Joseph Nodule
4
Cancer of neural crest derived cell involved in tactile sensation. Treat aggressively with surgery. sentinel node biopsy. Technically a neuroendocrine tumor.
1) Bowen's disease
2) Bowenoid papulosis
3) Xeroderma pigmentosum
4) Merkel cell carcinoma
5) Sister Mary Joseph Nodule
5
An umbilical tumor that is from a tumor in the pancreatic tree.
1) Bowen's disease
2) Bowenoid papulosis
3) Xeroderma pigmentosum
4) Merkel cell carcinoma
5) Sister Mary Joseph Nodule
1
Scaly eroded erythematous patch involving nipple. Steroids won't work. Biopsy may reveal:
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
1
Underlying ductal carcinoma
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
2
Presents in anogenital region. Need biopsy to rule out contact dermatitis, candidiasis, lichen
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
3
Aka cutaneous pleomorphic undifferentiated sarcoma. Sun exposed areas. Elderly. Firm solitary nodule w or wo ulceration.
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
3
Pleomorphic spindle cell tumor with increased mitotic activity. Must rule out SCC, melanoma, angiosarcoma.
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
4
Can be idiopathic, assoc with lymphedema, post-irradiation. Poor px. Vascular looking lesion on an older person.
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
5
Related to LAD, irradiation, common in setting of breast cancer treatment. A sort of vascular tumor that spreads and has poor prognosis.
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
6
HHV-8
1) mammary paget's disease
2) Extramammary paget's disease
3) Atypical Fibroxanthoma (AFX)
4) Angiosarcoma
5) Sewart-Treves Syndrome
6) Kaposi Sarcoma
1
Fibrovascular core surrounded by benign squamous epith. Looks like a papilloma.
1) Fibroepithelial Polyp / Acrochordon
2) Epidermoid cyst
3) Dermoid cyst
4) Steatocystoma
5) Seborrheic keratosis
3
Single subcutaneous nodule at birth on lateral aspect of upper eyelid. May contain adnexal structures, hair follicles, sebaceous glands.
1) Fibroepithelial Polyp / Acrochordon
2) Epidermoid cyst
3) Dermoid cyst
4) Steatocystoma
5) Seborrheic keratosis
2
Solitary nodule filled with keratin
1) Fibroepithelial Polyp / Acrochordon
2) Epidermoid cyst
3) Dermoid cyst
4) Steatocystoma
5) Seborrheic keratosis
1
Benign hair follicle tumor. Sporadic.
1) Trichilemmoma
2) Cowden's disease
3) Pilomatrixoma
4) Birt-Hogg Dube syndrome
2
Multiple hair follicle tumors. AD mutation of TSG PTEN. High risk for breast and thyroid cancer. Oral lesions. Acral keratoses (pals, soles). (not in First aid).
1) Trichilemmoma
2) Cowden's disease
3) Pilomatrixoma
4) Birt-Hogg Dube syndrome
3
Ghost cell histology. Solitary firm nodule on head>upper limb>neck>trunk. Derived from hair follicle.
1) Trichilemmoma
2) Cowden's disease
3) Pilomatrixoma
4) Birt-Hogg Dube syndrome
4
Mutation in BHD on chromo 17
1) Trichilemmoma
2) Cowden's disease
3) Pilomatrixoma
4) Birt-Hogg Dube syndrome
4
Mutation in the gene for folliculin. ASsoc with renal and lung tumors and other hair tumors. Multiple fibrofolliculomas, multiple trichodiscomas
1) Trichilemmoma
2) Cowden's disease
3) Pilomatrixoma
4) Birt-Hogg Dube syndrome
1
Often presents at birth on head neck scalp. Benign, but secondary tumors can arise within it, so most get removed. Assoc with hair loss, yellowed area from sebum.
1) Nevus Sebaceous
2) Sebaceous hyperplasia
3) Sebaceous adenoma
4) Sebaceoma
5) Muir-Torre syndrome
2
Yellow dome-shaped papules on elderly person misdiagnosed as BCC.
1) Nevus Sebaceous
2) Sebaceous hyperplasia
3) Sebaceous adenoma
4) Sebaceoma
5) Muir-Torre syndrome
5
Related to HNPCC. MSH2 gene most common -- related to mismatch repair. Sebaceous, visceral GI, bladder, endometrium, breast tumors.
1) Nevus Sebaceous
2) Sebaceous hyperplasia
3) Sebaceous adenoma
4) Sebaceoma
5) Muir-Torre syndrome
5
diagnosed by lack of staining for DNA repair genes/enzyme?
1) Nevus Sebaceous
2) Sebaceous hyperplasia
3) Sebaceous adenoma
4) Sebaceoma
5) Muir-Torre syndrome
dermatomyositis
Diagnose this condition:
Rare inflammatory muscle disease with a heliotropic (red edematous erythema) rash on upper palpebral area, with grotton's sign (red-purple keratotic macules on extensor surface of finger joints), calcinosis, proximal muscle weakness, elev Creatinine kinase, or aldolase,
dermatomyositis
Diagnose this condition:
-Heliotrope rash
calcinosis, raynaud's, esophageal dysfunction, sclerodactyly, telangiectasia
CREST syndrome: what do the letters stand for?
localized scleroderma
En coup de Sabre: looks like face was cut with a blade of a sword. It is associated with what overlying condition?
Reiter's syndrome (can't pee, can't see, can't climb a tree)
Diagnose this condition:
Reactive arthritis, urethritis (with dysuria and clear or purulent discharge), conjunctivitis and uveitis.
sweet's syndrome
Diagnose this condition:
-rapid onset of skin lesions which are tender erythematous plaques and nodules. ASsoc with underlying malignancy. Fever. AKA acute febrile neutrophilic dermatosis.
diabetes
Granuloma annulare is assoc with _____
1
Monosodium urate crystals in synovial fluid
1) Gout
2) Pseudogout
3) Rheumatoid arthritis
4) Psoriatic arthritis
2
calcium pyrophosphate deposition (CPPD)
1) Gout
2) Pseudogout
3) Rheumatoid arthritis
4) Psoriatic arthritis
3
Levido reticularis
1) Gout
2) Pseudogout
3) Rheumatoid arthritis
4) Psoriatic arthritis
4
inflammatory articular disease with nail dystrophy, oncolysis, pitting, hyperkeratosis. can have psoriatic plaques dactilytis, nail changes.
1) Gout
2) Pseudogout
3) Rheumatoid arthritis
4) Psoriatic arthritis
sarcoidosis
erythema nodosum is assoc with many things but one systemic disease is ____
peutz-jegher's
____ syndrome is a hereditary intestinal polyposis syndrome with melanotic macules, intestinal polyps, intussuception, and increased cancer risk. It has mucocutaneous lesions of hyperpigmentation in the mouth, on the hands, and feet.
osler-weber-rendu
___ syndrome is characterized by recurrent spontaneous epistaxis, mucocutaneous telangiectasias (small red dots on the lips and palms), and visceral AV malformations.
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