Compiled Review Slides Flashcards
Primary lesion?
Plaque
(erythematous, scaling plaque - psoraisis)
primary lesion
Patch
Primary lesion?
Nodule
could also say Tumor
(Pilar cyst)
Describe
•D. RED-BROWN ANNULAR PLAQUE WITH A RAISED BORDER AND CENTRAL CLEARING
primary lesion?
Papule on the nose. Erythematous with a central erosion. Likely a basal cell skin cancer.
primary lesion?
burrow
primary lesion?
macule
This is a oval brown macule. It is a melanocytic nevus. A macule is < 5mm
primary lesion?
vesicle
There are many vesicles on the palm. There is also some erythema, scale and crust. This is a problem called pompholyx, otherwise known as dyshidrotic eczema.
THE PRIMARY CELL TYPE HAS A MULTILOBED NUCLEUS. THE CELL IS?
neutrophil
This is a type of non-infectious neutrophilic dermatosis, sometimes seen in association with inflammatory bowel disease and other conditions. It is called pyoderma gangrenosum, and it is characterized by numerous neutrophils and skin necrosis.
THE PRIMARY CELL TYPE SEEN IN THIS SKIN DISEASE HAS GRANULES CONTAINING SERINE PROTEASES. IT IS A?
Mast cell
This is a mast cell EM. The prior photo of urticaria pigmentosa shows generalized, numerous erythematous macules. These macules will form a wheal (urticate) when stroked. That is typical of mastocytosis, also called urticaria pigmentosa. Each macule contains numerous mast cells, and a biopsy makes the diagnosis
THE PRIMARY ANTIGEN PRESENTING CELL IN THE SKIN IS?
what does it stain for?
what kind of granules?
Langerhans cell
Remember these cells stain with CD1a and S100 and have Birbeck granules. EM photo of Birbeck granules (tennis racket appearance)
most likely diagnosis?
Impetigo
These are heavy crusts. The erosions are NOT sharply punched out and rounded, like you would expect if it were herpes.
most likely dx?
How does patient feel? how does red area feel?
erysipelas
The swelling and sharp demarcation are characteristic of erysipelas. The area involved is usually very tender. The patient usually feels quite ill.
allergic contact dermatitis and rosacea are in the differential diagnosis.
most likely dx?
hot tub folliculitis
Acne is NOT usually this uniform looking. Hot tub folliculitis often has pustules that look very monomorphic (the same) and uniform, with a spread of erythema away from the pustule of a few mm. This is also what staphylococcal folliculitis looks like.
THIS CONDITION IS ASSOCIATED WITH A RO ANTIBODY. WHAT IS THE MOST LIKELY DIAGNOSIS?
subacute lupus erythematosis
Ro/LA antibodies are associated with subacute cutaneous lupus erythematosis. The rash is typically seen in a sun-exposed distribution. It is red and scaling, and some call it psoriasis like or “psoriasiform”.
dx?
dermatomyositis
The tip off here is the upper eyelid location and the so-called “livid” or purple/violet hue. The livid erythema of the eyelids in dermatomyositis is referred to as a heliotrope.
dx?
scleroderma
note how tight and smooth the skin looks, and the contractures of the fingers
ulcerations are a common complication
dx?
lupus erythematosus
Discoid lupus results in this type of erythema, scaling, and in some cases, scarring. Usually the lesions are erythematous, flat topped papules and plaques in a sun exposed distribution.
dx?
lupus erythematosus
The tip off here is a young woman, the butterfly distribution of facial rash, and the violaceous hue (sort of violet-purple), a color characteristic of connective tissue diseases.
THIS MAN HAS ATOPIC DERMATITIS. WHAT OTHER DISEASE IS RELATED TO THIS SKIN DISEASE?
asthma
WHAT INFECTIOUS PROCESS CHARACTERIZED BY HONEY COLORED CRUSTS IS PRESENT IN THIS PATIENT WITH SEVERE ATOPIC DERMATITIS?
impetigo
Remember, impetigo is caused by strep or staph and often complicates atopic dermatitis. The base of the nose is a common place for it. Staph may be carried inside the nose.
WHICH IMMUNOGLOBULIN MIGHT BE ELEVATED IN THIS ATOPIC PATIENT?
IgE
TH2 PHENOTYPE IS SEEN IN WHICH DISEASE?
•A. ECZEMA•B. ALLERGIES•C. ASTHMA•D. ALL OF THE ABOVE
all
THIS SLIDE SHOWS WHAT COMMON PROBLEM IN ATOPICS?
•A. SENSITIVE SKIN•B. DRY SKIN•C. PRURITUS•D. INFECTED SKIN
dry skin
ONE OF THE BEST TREATMENTS FOR DRY SKIN IS:
•A. A LOTION•B. A GEL•C. A CREAM•D. A VITAMIN
A cream
thicker the better for dry skin. Clear bland ointment like plain vaseline petroleum jelly is the ideal moisturizer for an atopic patient.
ONE OF THE BEST TREATMENTS FOR ATOPIC DERMATITIS IS?
•A. AVOID STEROIDS•B. A TOPICAL STEROID•C. A CREAM•D. A VITAMIN
topical steroid
•A. ATOPIC DERMATITIS•B. IMPETIGO•C. PRURITUS•D. ALL OF THE ABOVE
all
dx?
psoraisis
Note the primary lesions: papules and plaques. Description: Multiple erythematous , scaling papules and plaques diffusely on the back.
THIS PATIENT ALSO HAS MARKED NAIL PITTING AND PLAQUES ON THE ELBOWS ANSD KNEES. WHAT IS THE DIAGNOSIS?
psoraisis
Description: Confluent erythema with scale and fissures on the palms.
THIS PATIENT HAS A PAINFUL JOINT AND NAIL CHANGES.WHAT IS THE DIAGNOSIS?
psoriatic arthritis
ALL FACTORS BELOW WORSEN PSORIASIS EXCEPT?
•A. PREDNISONE WITHDRAWAL•B. LITHIUM•C. HEPATITIS•D. STREPTOCOCCUS•E. TRAUMA
hepatitis
THE LARGE PLAQUE CAME FIRST, THEN THE DIFFUSE FLAT TOPPED SCALING PAPULES. WHAT IS THE DIAGNOSIS?
The first lesion was the herald patch of pityriasis rosea. This usually has a “Christmas Tree” distribution on the trunk of erythematous, scaling papules. The differential diagnosis is usually psoriasis and secondary syphilis.
NOTE THE VIOLACEOUS PAPULES WITH RETICULATE WHITE LACY PATTERN. WHAT IS THE DIAGNOSIS?
lichen planus
The lacy pattern seen in these violaceous papules is often referred to as Wickham’s striae.
dx?
pityriasis rubra pilaris
Pityriasis rubra pilaris is a “papulosquamous” dermatosis. It shows scaling erythema with typical islands of sparing where there is completely normal skin. It usually starts on the head and spreads inferiorly, resulting in erythroderma, or total body redness. The hands and feet show marked scaling, “keratoderma”
dx?
Herpes simplex
These vesicles are grouped and some are in varying stages, some grouped, some pustules.
dx?
molluscum
Molluscum are well defined papules that are smooth, with a rolled border and central crater containing infectious molluscum bodies.
cause?
HPV
dx?
Herpes simplex
Sharply demarcated, “punched out” erosions are typical of herpes simplex. Note how the center in some cases looks depressed, or “umbilicated”.
recurrence of what?
This is varicella zoster virus, or shingles.
A child developed low-grade fever, sore mouth and vesicles on the palm, soles and in the mouth. The vesicles had a red halo. What is the most likely diagnosis?
Hand Foot and Mouth disease
Erythema multiforme and secondary syphilis could have a similar appearance. It would, however, be unlikely that lesions would be confined to the palms, soles and mouth but this is possible.
Hand-foot-and-Mouth disease is a coxsackievirus infection that is more severe in children. The incubation period averages 3-6 days. The disease is highly contagious so that similar cases in close contacts helps support the diagnosis
The red halo is highly characteristic of Hand-Foot-and-Mouth disease.
Warts have a uniform papillomatous surface. Psoriasis has silvery scale, seborrheic keratosis have a haphazardly cracked pattern. The keratoacanthoma has a smooth surface with a central crust.
This child with atopic dermatitis developed the rapid onset of vesicles in areas where eczema was present. What is the diagnosis?
Eczema herpeticum
dx?
Contact Dermatitis
There are no papules to indicate rosacea. Also in this photo, appreciate the eyelid involvement. A drug rash could not be diagnosed by the face only—drug rashes are usually generalized in distribution. There are no typical findings to suggest psoriasis over other diagnoses, it would be a poor choice.
allergen?
nickel
this contact dermatitis could be casued by?
•A. A FRAGRANCE•B. A SHAMPOO•C. A CREAM•D. A LOTION•E. ALL OF THE ABOVE•
- A. A FRAGRANCE•B. A SHAMPOO•C. A CREAM•D. A LOTION•E. ALL OF THE ABOVE•
- TRUE ALLERGEN: FRAGRANCE/PERFUME
what type of eczematous dermatitis?
Chronic.
shows erythema, scaling, lichenification.
No crusts, vesicles or bullae
what type of eczematous dermatitis?
acute
characterized by bullae or vesicles, swelling and erythema
plant? cause of contact dermatitis
Poison ivy
note poison oak is common on the west coast
THE BEST WAY TO PROVE IF THIS IS A CONTACT DERMATITIS IS TO?
•A. TAKE A GOOD HISTORY•B. SEE HOW IT DOES WITH TREATMENT•C. GUESS•D. PERFORM PATCH TESTING
•A. TAKE A GOOD HISTORY•B. SEE HOW IT DOES WITH TREATMENT•C. GUESS•D. PERFORM PATCH TESTING
what type of eczema?
subacute
what is this?
patch testing
Patch testing : examples of allergic reactions seen when patch tests are removed.
Graded 1+ for mild, 2+ for moderate, 3+ for strong
dx?
tinea versicolor
This is caused by the yeast, Malassezia furfur
dx?
confirmatory test?
Tinea versicolor patches. They can be pink, hypopigmented or tan. The tan patches in this patient are what is abnormal, and a KOH can be performed yielding the classic spaghetti and meatballs appearance.
dx?
confirmatory test?
tinea
KOH will be + for hyphae
positive for what?
KOH Prep
+ hyphae (tinea)
what test?
positive for what?
KOH
+ for pseudohyphae (candida)
WHAT OTHER SKIN DISEASES CAN BE CONFUSED WITH TINEA?
•A. LUPUS•B. ECZEMA•C. CUTANEOUS T CELL
LYMPHOMA
•D. PSORIASIS•E. ALL OF THE ABOVE
•A. LUPUS•B. ECZEMA•C. CUTANEOUS T CELL
LYMPHOMA
•D. PSORIASIS•E. ALL OF THE ABOVE
All would cause tinea to grow or expand EXCEPT?
•A. Warm moist skin•B.Immunosuppression•C. Topical antibiotics•D. Topical steroids•
•A. Warm moist skin•B.Immunosuppression•C. Topical antibiotics•D. Topical steroids•
The differential diagnosis of this eruption includes all EXCEPT?
•A. Eczema•B. Tinea•C. Lupus•D. Lyme disease•E. All of the above
•A. Eczema•B. Tinea•C. Lupus•D. Lyme disease•E. All of the above
Should do a KOH from the border area
This lesion is loaded with neutophilic inflammation and fungal spores in the hair shaft. It is an example of :
•A. A Carbuncle•B. A Furuncle•C. An Infected epidermal cyst•D. A Kerion•E. Acne keloidalis
•A. A Carbuncle•B. A Furuncle•C. An Infected epidermal cyst•D. A Kerion•E. Acne keloidalis
THE ANCHORING FIBRILS OF THE BASEMENT MEMBRANE ZONE ARE MADE OF WHAT TYPE OF COLLAGEN?
Collagen VII
WHAT IS THE MOST LIKELY DIAGNOSIS IN THIS ELDERLY ITCHY PATIENT?
•A. BULLOUS IMPETIGO•B. PEMPHIGUS VULGARIS•C. DERMATITIS HERPETIFORMIS•D. EPIDERMOLYSIS BULLOSA SIMPLEX•E. BULLOUS PEMPHIGOID
Bullous Pemphigoid
These are tense bulla. There is some surrounding erythema on the thigh. MARKED ITCH AND PATIENT AGE make bullous pemphigoid more likely than bullous impetigo. Pemphigus is characterized by flaccid, often eroded bulla.
THE IMMUNOFLUORESCENT PATTERN SEEN HERE SUGGESTS A DIAGNOSIS OF WHAT?
•A. PEMPHIGUS VULGARIS•B. BULLOUS PEMPHIGOID
•A. PEMPHIGUS VULGARIS•B. BULLOUS PEMPHIGOID: LINEAR DEPOSITION OF IgG AT THE BASEMENT MEMBRANE ZONE
WHAT IS THE PRIMARY LESION IN THIS ELDERLY PATIENT WITH PEMPHIGUS VULGARIS?
•A. MACULE•B. FLACID BULLA•C. TENSE BULLA•D. EROSION•E. PATCH
•A. MACULE•B. FLACID BULLA•C. TENSE BULLA•D. EROSION•E. PATCH
THIS STRUCTURE CONTAINS THE BULLOUS PEMPHIGOID ANTIGENS AND INTEGRIN α6β4
•A. DESMOSOME•B. HEMIDESMOSOME•C. ANCHORING PLAQUE•D. LAMINA DENSA•E. SUB LAMINA DENSA•
•A. DESMOSOME•B. HEMIDESMOSOME•C. ANCHORING PLAQUE•D. LAMINA DENSA•E. SUB LAMINA DENSA•
ALL THE FOLLOWING ARE PRIMARY LESIONS IN ACNE EXCEPT?
•A. OPEN COMEDONES•B. PUSTULES•C. CYSTS•D. CRUSTS•E. CLOSED COMEDONES
•A. OPEN COMEDONES•B. PUSTULES•C. CYSTS•D. CRUSTS•E. CLOSED COMEDONES
dx?
Hidradenitis suppurativa
often occurs in the folds under the breasts, in the inguinal folds, axillary vault, or gluteal cleft. The distribution here is what is most characteristic of these inflammatory nodules.
WHAT IS THE MOST LIKELY DIAGNOSIS IN THIS MIDDLE AGED WOMAN?
•A. ACNE•B. ACNE FULMINANS•C. CYSTIC ACNE•D. SEBORRHEIC DERMATITIS•E. ROSACEA (GRANULOMATOUS)
•A. ACNE•B. ACNE FULMINANS•C. CYSTIC ACNE•D. SEBORRHEIC DERMATITIS•E. ROSACEA (GRANULOMATOUS)
Rosacea is more common in older woman, >40 to 60, is symmetric, and characterized by erythema, telangiectasias, and papules. When the papules are firm and longstanding, the inflammation histologically may be granulomatous. This is a subset of rosacea.
dx?
alopecia areata
The characteristic round patches of alopecia are without inflammation.
dx?
alopecia universalis
This is alopecia areata affecting the entire scalp, eyebrows, and eyelashes
what’s this?
Beau’s Lines. sign of toxin or chemo in system
dx?
melanoma
dx?
•LENTIGO MALIGNA MELANOMA
dx?
melanoma
?
melanoma
NOTE: this lesion demonstrates “A” and “B” of melanoma ABCD rule. This is the best choice of those above. It should be biopsied.
WHAT IS THE BEST CLUE TO THE DIAGNOSIS OF MELANOMA ?
•A. Erosion •B. Ulceration •C. Scaling •D. Pain •E. Blue black pigmentation near the erosion
Clues: pigment- blue/black near a glistening erosion.
- Using this instrument for examination of skin lesions is
● A.Dermatoscopy B.Magnifiscopy C.Melanomascopy D.Actinoscopy
● A.Dermatoscopy B.Magnifiscopy C.Melanomascopy D.Actinoscopy
The most common location for this skin cancer in women is?
Legs
Remember- the legs in women, the back in men are the most common locations. A complete skin exam includes these sites as well as the feet! Don’t forget or be lazy—take off the patient’s socks too and also look in the mouth and the scalp.
A high percentage of patients with melanoma have this mutation
•Keratin 5 and 14 •Tyrosinase •Lysyl hydroxylase •CDKN2A •Fibrillin
•Keratin 5 and 14 •Tyrosinase •Lysyl hydroxylase •CDKN2A – codes for p16 and ARF Tumor suppressor genes •Fibrillin
THIS IS A CHILD WITH MULTIPLE ITCHY BROWN MACULES THAT URTICATE WITH STROKING. THE CELLS IN THE INFILTRATE ARE?
Mast cells
A CHILD WITH A PAPULE THAT BLEEDS EASILY AND CAME UP AFTER A MILD TRAUMA.WHAT IS THE MOST LIKELY DIAGNOSIS?
pyogenic granuloma
THIS LESION IS MADE UP OF?
Capillaries
A pyogenic granuloma is a vascular tumor that often occurs in children, or in pregnancy. It is benign.
MULTIPLE SKIN FOLD FRECKELS, THESE TUMORS, AND LISCH NODULES.WHAT IS THE DIAGNOSIS?
•A. DYSPLASTIC NEVI •B. METASTATIC MELANOMA •C. SQUAMOUS CELL CARCINOMA •D. PYODERMA GANGRENOSUM •E. NEUROFIBROMATOSIS
•A. DYSPLASTIC NEVI •B. METASTATIC MELANOMA •C. SQUAMOUS CELL CARCINOMA •D. PYODERMA GANGRENOSUM •E. NEUROFIBROMATOSIS
WHAT IS NOT ASSOCIATED WITH THIS DISEASE?
•A. DYSPLASTIC NEVI •B. OPTIC GLIOMA •C. SKELETAL DYSPLASIA •D. NEW MUTATIONS CAUSE THE DISEASE IN 50% •E. LEARNING DISABILITIES
•A. DYSPLASTIC NEVI •B. OPTIC GLIOMA •C. SKELETAL DYSPLASIA •D. NEW MUTATIONS CAUSE THE DISEASE IN 50% •E. LEARNING DISABILITIES
THESE FACIAL PAPULES ARE FOUND IN TUBEROUS SCLEROSIS. THEY ARE:
A. NEUROFIBROMAS
B.HEMANGIOMAS
C.ANGIOFIBROMAS
D. DERMOID CYSTS
E. COMEDONES
A. NEUROFIBROMAS
B.HEMANGIOMAS
C.ANGIOFIBROMAS
D. DERMOID CYSTS
E. COMEDONES
Skin findings in tuberous sclerosis include facial angiofibromas (adenoma sebaceum), periungual fibromas, connective tissue nevi (Shagreen patch), and hypopigmented macules (ash leaf macules). TS is an autosomal dominant condition characterized by hamartomas. Patients often present with seizures.
Non-skin findings include neurological (seizures, developmental delay), eye (retinal hamartomas), renal (angiomyolipomas, polycystic kidneys), cardiac (rhabdomyomas), lungs (lymphangiomyomatosis).
THIS IS A BENIGN PUSTULAR ERUPTION COMMONLY SEEN IN THE NEWBORN PERIOD.
A. CUTIS MARMORATA
B. ERYTHEMA TOXICUM
C.ACRODERMATITIS
ENTEROPATHICA
D.HENOCH-SCHONLEIN
PURPURA
E. BIOTIN DEFICIENCY
A. CUTIS MARMORATA
B. ERYTHEMA TOXICUM
C.ACRODERMATITIS
ENTEROPATHICA
D.HENOCH-SCHONLEIN
PURPURA
E. BIOTIN DEFICIENCY
Erythema toxicum neonatorum is a benign eruption seen in the neonatal period. It is usually diffuse in distribution. The palms and soles are rarely affected. It may last for up to 2 weeks.
A WRIGHT OR GEIMSA STAIN OF THE PUSTULE FLUID WOULD SHOW THIS CELL IN ABUNDANCE
A. EOSINOPHIL
B. MAST CELL
C. NEUTROPHIL
D.LYMPHOCYTE
E. BASOPHIL
A. EOSINOPHIL
B. MAST CELL
C. NEUTROPHIL
D.LYMPHOCYTE
E. BASOPHIL
The cause of this condition is unknown. The diagnosis is usually based on the typical appearance and the skin smear filled with eosinophils. Erythema toxicum neonatorum is benign and spontaneously resolves within 3 weeks of life.
THIS INFANT HAS DIARRHEA, THIS RASH, AND ALOPECIA. Order:
A.SKIN CULTURE B.RAPID STREP ANTIGEN C.IMMUNOFLOURESCENCE OF SKIN D.SPINK5 MUTATIONAL ANALYSIS E.PLASMA ZINC LEVEL
A.SKIN CULTURE B.RAPID STREP ANTIGEN C.IMMUNOFLOURESCENCE OF SKIN D.SPINK5 MUTATIONAL ANALYSIS E.PLASMA ZINC LEVEL
This is an example of acrodermatitis enteropathica. This condition is due to zinc deficiency. There is usually periorificial dermatitis, acral dermatitis, and diaper dermatitis. All are characterized by some degree of erythema, scaling and erosion.
THIS IS HENOCH-SCHONLEIN PURPURA. THE LESIONS SEEN ARE:
A. FULL OF GRAM NEGATIVE BACTERIA
B. FULL OF GRAM POSITIVE BACTERIA
C. GIANT CELL VASCULITIS
D. LEUKOCYTOCLASTIC VASCULITIS DUE TO IGG IMMUNE COMPLEXES
E. LEUKOCYTOCLASTIC VASCULITIS DUE TO IGA IMMUNE COMPLEXES
A. FULL OF GRAM NEGATIVE BACTERIA
B. FULL OF GRAM POSITIVE BACTERIA
C. GIANT CELL VASCULITIS
D. LEUKOCYTOCLASTIC VASCULITIS DUE TO IGG IMMUNE COMPLEXES
E. LEUKOCYTOCLASTIC VASCULITIS DUE TO IGA IMMUNE COMPLEXES
In HSP, the affected child often develops arthralgias, abdominal pain, and may have renal involvement. Edema of the hands and feet may be a prominent finding. Children under three can have striking edema around the eyes, scalp, and ears. Patients with severe abdominal pain should be evaluated for intussusception with an abdominal ultrasound.
