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COMLEX > Derm > Flashcards

Derm Flashcards

1
Q

Young children, outbreaks common in daycare

  • Low fever; mouth and throat pain; vesicular lesions on tongue, buccal mucosa, pharynx or lips
  • Nonpruritic skin lesions on hands, feet, buttocks, legs, or arms that are maculopapular, vesicular, or pustular
  • mucosal lesions rapidly progress to vesicles that erode and become surrounded by an erythematous halo
A

coxsackie A, hand foot and mouth disease

  • nonenveloped, linear ssRNA virus
  • MC in summer/early fall
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2
Q

proliferation of endothelial cells caused by human herpesvirus-8 (HHV-8) in immunocompromised individuals (AIDS)

  • lesions may be cutaneous or visceral
  • nearly all patients develop skin lesions, and there are usually multiple lesions on both sides of the body with a symmetrical distribution
  • mucous membrane involvement is common
  • may be painful, but are not pruritic
A

Kaposi sarcoma

- lungs and GI tract commonly involved

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3
Q

nonenveloped, linear ssDNA virus

  • “slapped cheek”
  • children aged 3-15
  • spread via aerosolized respiratory droplets
A

Erythema Infectiosum aka Fifths disease

  • caused by parvovirus B19
  • low-grade fever, headache, coryza, pharyngitis, nausea, and malaise
  • rash starts on face, followed by lacelike rash on the trunk and extremities
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4
Q

9-12 month old who develops high (4 day) fever

- followed by a macular rash over the body

A

Roseola

- HHV6, enveloped, linear dsDNA virus

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5
Q

what is the other name for measles?

A

Rubeola

  • maculopapular rash begins on the face and, over 48 hours, starts to coalesce into patches and plaques that spread caudally to the trunk and extremities, including palms and soles
  • transmitted via respiratory droplets
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6
Q

fever, exudative pharyngitis, and a scarlatiniform rash

- rash begins initially on the groin and armpits and proceeds to involve the trunk and then the face and extremities

A

Scarlet fever, S. pyogenes
- occurs due to a delayed-type skin reactivity to pyrogenic exotoxins (erythrogenic toxins A, B, C) production from the bacteria

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7
Q

dimorphic fungus, caused by landscaping/gardening scratches

  • Days to weeks after cutaneous inoculation, a papule develops at the site of inoculation
  • primary lesion ulcerates; drainage from the lesion is not grossly purulent and has no odor
  • similar lesions occur along lymphatic drainage channels
A

Sporothrix schenckii

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8
Q

hot tub folliculitis

A

pseudomonas

- has sweet, grape-like odor when cultured

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9
Q

fever, fatigue, body aches, generalized weakness, and a tender erythematous rash

  • asymmetric polyneuropathy, can cause both motor and sensory deficits
  • associated with HBV infection, usually within the last 6 months
A

PAN

- small-med vessels, particularl renal, cardiac, and GI

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10
Q

Young Asian female (< 40 years old), weak upper extremity pulses

A

Takayasu arteritis

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11
Q

Older females, unilateral headache, jaw claudication may lead to blindness
- Associated with polymyalgia rheumatica

A

Giant cell arteritis

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12
Q

Asian children, conjunctival injection, strawberry tongue, desquamating rash on hands and feet
- aortic dissection, AMI

A

Kawasaki

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13
Q

Heavy smokers, autoamputation of digits, Raynaud phenomenon

A

Thromboangiitis Obliterans

Buerger disease

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14
Q

p-ANCA (anti-MPO), lungs and kidney affected, similar to Wegener’s, but no nasopharyngeal involvement

A

microscopic polyangiitis

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15
Q

c-ANCA (anti-proteinase 3), upper airway, lungs, kidneys, saddle-nose deformity

A

GPA aka Wegener’s

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16
Q

P-ANCA, high eosinophilia, mononeuritis multiplex

A

Eosinophilic granulomatosis w/Polyangitis aka Churg-Strauss
- Mononeuritis multiplex is a painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas

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17
Q

Often after URI or gastroenteritis, 90% occurs in children

- palpable purpura, arthritis/arthralgias, abdominal pain, hematuria

A

IgA Vasculitis (Henoch-Schönlein purpura)

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18
Q

what is the medical name for cradle cap?

A

seborrheic dermatitis

  • greasy-looking, yellow scales on an erythematous base
  • or scaly, oily, salmon-colored plaques
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19
Q

what is the medical name of eczema?

A

atopic dermatitis

  • causes intense pruritis
  • extensor surfaces (in adults)
  • dry, scaly, or excoriated erythematous papules
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20
Q

rash begins as vesicles and pustules filled with serous fluid that rupture and turn into honey-colored crusted lesions on an erythematous base

A

impetigo

- S. aureus or S. pyogenes

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21
Q

superficial, painful blisters that rupture very easily

  • autoantibodies against desmosomes
  • type II hypersensitivity reaction
A

pemphigus vulgaris

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22
Q

tense bullae at the subepidermal or dermal-epidermal junction

  • autoantibodies against hemidesmosomes
  • do not easily rupture
A

bullous pemphigoid

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23
Q

Treatment of tinea corporis?

A

topical antifungals miconazole, clotrimazole, or ketoconazole

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24
Q

cutaneous lesions during infancy or early childhood and consists of reddish-orange or yellowish-brown scaly papules, erosions, or petechiae in the groin, intertriginous regions, and scalp

A

langerhans histiocytosis

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25
Q

what is the Auspitz sign and when would you see it?

A

scratching of a silvery psoriasis plaque, leads to microbleeding

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26
Q

hyperkeratosis, parakeratosis, acanthosis, rete pegs are elongated, dermal papillae are elongated and hypervascular, mitotic figures above the basement membrane

A

psoriasis

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27
Q

Abundant dermal and epidermal lymphocytes with epidermal necrosis

A

erythema multiforme

- Severe cases can transform into Stevens-Johnson syndrome, with necrosis of much of the epidermis and possible death

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28
Q

Irregular acanthosis, a band of lymphocytes below the epidermis, and a damaged basal layer

  • occurs on the flexor surfaces, especially the wrists
  • patients often have white, lace-like lesions in the mouth
A

lichen planus

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29
Q

Septate branching hyphae within the stratum corneum

A

tinea corporis

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30
Q

what causes tinea versicolor/pityriasis versicolor?

- hypopigmented or hyperpigmented macules and patches normally localized to sebum-rich areas like the chest or back

A

malassezia furfur

  • organism degrades lipids in the skin leading to a production of acids that damage melanocytes and cause the macules and patches of discoloration
  • spagetti and meatball on KOH!
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31
Q

flesh-colored or erythematous, asymptomatic annular plaques with a firm, ropy border and central clearing. They begin as small lesions and may show slow, centrifugal growth
- usually on dorsal surfaces of hands/feet, wrists/ankles

A

Granuloma annulare

- punch bx needed to confirm

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32
Q

“dew drops on a rose petal” or small vesicles on an erythematous base that are extremely pruritic

A

varicella zoster

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33
Q

anti-histone Ab?

A

drug-induced lupus

- isoniazid, procainamide, hydralazine

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34
Q

Anti-microsomal antibodies?

A

Hashimoto’s thyroiditis

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35
Q

what is the bad complication of measles?

A

subacute sclerosing panencephalitis (SSPE)

  • often fatal, progressive, degenerative disease of the CNS
  • typically an asymptomatic period of 6-15 years between the initial infection and the development of SSPE
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36
Q

Congenital albinism is often due to a deficiency in what?

A

tyrosinase

- enzyme needed for converting tyrosine to melanin

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37
Q

hypopigmentation of the skin due to lack of tyrosine

- but it is often associated with peculiar body odor and altered brain function including intellectual disability

A

phenylketonuria

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38
Q

IgM antibodies that recognize the Fc portion of IgG

A

rheumatoid factor

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39
Q

porphyria cutanea tarda

A

?

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40
Q

middle aged men

  • benign neoplasm of fat cells
  • MC benign soft-tissue neoplasm in adults
  • round, painless, moveable mass usually found encased in a thin fibrous capsule
  • mature univacuolated adipocytes with small nuclei
A

lipoma

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41
Q

most common sarcoma of adulthood. It usually arises in deep soft tissues of the extremities and retroperitoneum
- lipoblasts, with multiple cytoplasmic vacuoles of lipid that scallop the nucleus, and myxoid stroma

A

liposarcoma

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42
Q

benign, soft tissue mass composed of smooth muscle, most commonly found in the uterus

A

leiomyoma

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43
Q

virulence factor of S. pygenes involved in blocking phagocytosis by interfering with C3b binding for opsonization
- antibodies can bind to heart antigens by a process of molecular mimicry and cause rheumatic fever, a type II hypersensitivity reaction

A

M protein

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44
Q

virulence factor of S. pygenes that act as superantigens
- responsible for the development of scarlet fever rash as well as severe clinical manifestations like necrotizing fasciitis and TSS

A

Spe toxins (SpeA, SpeB, SpeC, SpeF)

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45
Q

when do you see pyoderma gangrenosum?

A

UC

  • 2nd MC skin infection in IBD, after erythema nodosum
  • remember the association of UC and PSC!
46
Q

what does parainfluenza virus cause in young children?

A

croup

47
Q

what is the tx for Sporothrix schenckii?

A

itraconazole

48
Q

parasite is transmitted by the black fly, which is found in Africa, Yemen, and parts of South America

  • majority of cases are found in the continent of Africa
  • second-leading infectious cause of blindness worldwide
A

onchocerciasis

  • aka river blindness
  • tx: ivermectin
49
Q

parasite that causes swelling of the skin and presence of subcutaneous worms

  • infects the conjunctiva of the eye, in which worms are visible
  • rarely leads to blindness
  • transmitted by Chrysops flies (including the deer fly, horse fly, and mango fly
A 
Loa Loa (loiasis)
- tx:  diethylcarbamazine
50
Q

spiking fevers, hepatosplenomegaly, and pancytopenia

  • transmitted by the sandfly
  • commonly found in India
A

Kala-azar, aka visceral leishmaniasis

- parasite Leishmania donovani.

51
Q

what is the precursor for SCC of the skin?

A 
actinic keratosis ("solar keratosis")
- patch of epidermis where the cells show features of precancer (abnormal nuclei, irregular arrangement) but have not yet invaded
52
Q
  • neurofibromas anywhere along the path of cutaneous nerves
  • irregularly shaped, evenly pigmented, brown macules (café-au-lait spots)
  • Lisch nodules
  • pheochromocytomas
  • optic gliomas
  • increased tumor susceptibility
A

neurofibromatosis type 1 (AD)

- mutation of tumor-suppressor gene on the long arm of xsome 17

53
Q

inheritance pattern of cystic fibrosis, Tay-Sachs disease, glycogen storage diseases, and phenylketonuria?

A

AR

54
Q

inheritance pattern of hemophilia A, Hunter syndrome, and G6PD deficiency?

A

X-linked R

55
Q

deficiency in the essential amino acid tryptophan

- defects in intestinal absorption and renal tubular reabsorption

A

Hartnup dz

  • Tryptophan is the precursor to nicotinamide and nicotinate — 2 forms of niacin (vitamin B3)
  • leads to a deficiency in niacin -> pellagra
56
Q

essential AA that is important precursor to tyrosine, necessary for thyroid hormone, dopamine, and melanin formation

  • hypopigmentation from decreased melanin
  • mental retardation from decreased Dopa and NE
  • musty urine
A

phenylketonuria

  • defects in phenylalanine hydroxylase lead to an accumulation of phenylalanine and deficiency of tyrosine, thyroid hormone, dopamine, and melanin
  • conversion/excretion of phenylalanine -> phenyl ketones = musty urine
57
Q

high fevers, intense headaches, myalgias, and tender lymphadenopathy in axillary, inguinal, and cervical regions
- can also necrose the fingertips

A

Yersinia pestis

- effective bioterrorism weapon

58
Q

MPO-ANCA (p-ANCA)?

A

microscopic polyangiitis (MPA)

  • Renal biopsy and pulmonary biopsy are common and most frequently show pauci-immune glomerulonephritis, which is often diffuse and necrotizing with crescentic formation
  • usually lacks granulomatous inflammation in the tissue surrounding the vasculitic small vessels -> DIFFERENT FROM GPA
59
Q

PR3-ANCA (c-ANCA)

A

granulomatosis w/ polyangiitis (GPA)

- NOTE: c-ANCA = cytoplasmic staining form

60
Q
  • café au lait spots
  • axillary freckling
  • neurofibromas of peripheral nerves
  • pigmented nodules in the iris (Lisch nodules)
A

neurofibromatosis type 1 (AD)

- inactivation of the tumor suppressor gene NF1 found on Chromosome 17

61
Q

mutation in HFE gene?

A

hemochromatosis

62
Q

Gram-negative pleomorphic bacterium (coccobacillus)

  • MC presentation in adults is ulceroglandular — a punched out ulcer at the site of inoculation with suppurative lymphadenopathy
  • can also contaminate the eyes and lungs
  • in central-southern states (pt hunting in Missouri/Arkansas)
A

tularemia

63
Q

what disease is transmitted by the dermacentor (dog) tick?

A

rocky mountain spotted fever

64
Q

what is the tx for MRSA?

A

IV vancomycin

- binds the D-alanyl-D-alanine portion of the cell wall to block glycopeptide polymerization

65
Q

what is the MC side effect of vancomycin?

A

Flushing, known as “red man” syndrome

- can be avoided by a slower infusion rate and co-administration with antihistamines

66
Q

what is the MC side effect of metronidazole?

A

disulfram rxn

67
Q

what bad side effect is most commonly associated with sulfonamides, penicillins, ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, and allopurinol

A

Steven-Johnson syndrome

68
Q

when would you see pigmented hamartomas in the iris called Lisch nodules?

A

NF type 1

69
Q

proliferations of the cells of the peripheral nerves, especially Schwann cells and fibroblasts

A

neurofibromas

70
Q

when would you see bilateral acoustic neuromas, which histologically are schwannomas?

A

neurofibromatosis type 2

- meningiomas, spinal ependymomas, cataracts, and neuropathies

71
Q

what is a common side effect of tetracycline

A

photosensitivity

72
Q

what is the quadruple therapy for PUD?

A

Bismuth subsalicylate
an H2 blocker such as ranitidine
metronidazole
tetracycline

73
Q

what does a negative nitroblue tetrazolium (NBT) staining indicate?

A

Chronic Granulomatous Disease

  • NBT test displays the reactive oxygen species produced by NADPH oxidase; a positive test stains as a blue color indicating the presence of oxidase and subsequent reactive oxygen species
  • CGD is caused by a defect in NADPH oxidase which impairs oxygen-dependent microbial killing in phagocytes. Therefore, because the oxidase enzyme is lacking in CGD, the NBT test will be negative
74
Q

oval, slightly raised 2-cm to 5-cm plaque or patch with a peripheral scaly appearance

  • secondary eruption consists of lesions of the same appearance but smaller and in a tree-like pattern
  • usually on trunk and proximal extremities
A

pitryasis rosacea

- tx is supportive, and the rash resolves spontaneously within 6-10 weeks

75
Q

diffuse maculopapular rash in a sexually active pt that can involve the trunk, palms, and soles

A

secondary syphilis

- rash generally appears 2-6 months after a primary syphilis infection

76
Q

neonate with intrauterine growth restriction, jaundice, hepatosplenomegaly, periventricular calcifications
- once born, petechiae/purpura, chorioretinitis, jaundice, seizures, sensorineural hearing loss

A

CMV

- blueberry muffin baby

77
Q

triad of eye problems (cataracts), deafness, and congenital heart disease (most often PDA)

A

congenital rubella

78
Q

baby born with notched teeth and saddle nose?

A

congenital syphilis

79
Q

why are tetracyclines are not indicated in pregnant or pediatric patients?

A

they can cause tooth enamel discoloration and growth abnormalities

80
Q

what is preferred tx for lyme dz in pregnancy?

A

beta-lactam antibiotics (amoxicillin or ceftriaxone), which inhibit transpeptidase

81
Q

bind to the 23S rRNA of the 50S subunit and inhibit protein synthesis by blocking translocation

A

macrolides

- erythromycin, azithromycin, and clarithromycin

82
Q

what maternal infection can cause hydrops fetalis?

A

parvovirus B19

83
Q

premature infant w/significant rhinitis (“snuffles”), hemolytic anemia, thrombocytopenia, a skin rash involving the palms and soles, and hepatomegaly

A

syphilis

- sabre shins, saddle nose deformity

84
Q

what is the treatment for scabies?

A

permethrin
- targets the sodium voltage-gated channels in the parasite leading to death of the insect

can also give ivermectin if not pregnant
- causes an increase in cell membrane permeability with eventual death of the parasite

85
Q

what is the tx for Loa Loa?

A

diethylcarbamazine (DEC)
- antihelminthic drug that acts by inhibiting arachidonic acid metabolism in filarial microfilaria, which disrupts their membranes and makes them more susceptible to immune attack

86
Q

tinea capitis fungus that produces many large football-shaped macroconidia

A

Microsporum

87
Q

what is Leser-Trélat a sign of?

- sudden appearance of multiple pruritic seborrhic keratoses

A

possible GI malignacy

- watch out for fatigue (likely iron deficiency anemia) and signs of GI obstruction with constipation.

88
Q

what is acanthosis nigrcans a sign of?

A
  • insulin resistance

- gastric adenocarcinoma

89
Q

Lyme dz with co-infection causing hemolytic anemia, splenomegaly and jaundice

A

babesia microti

- maltese cross under microscope

90
Q

Edema toxin produced by what, is an adenylate cyclase that increases cAMP levels by catalyzing the reaction of ATP to cAMP?

A

Bacillus anthracis

91
Q

what organism causes overactivation of host cell adenylate cyclase through inhibition of the adenylate cyclase inhibitory Gi alpha subunit protein

A

Bordetella pertussis

92
Q

what organism ADP-ribosylates the Gs alpha subunit protein, increasing the protein’s adenylate cyclase activity and increasing cAMP levels

A

V. cholera

93
Q

what gram-negative bacillus that is extremely difficult to culture; and is best grown in cysteine-glucose-blood agar?

A

Francisca tularensis
- similar to yersinia, but has an ulceroglandular lesion that grows, and will rupture, producing a yellow exudate that may turn black

94
Q

neurotoxin can cause muscle pain in the extremities, abdomen, and back

  • other sx include cramping, abdominal pain, weakness, headache, nausea, vomiting, and tremor
  • bites are very rarely life threatening, and sometimes there is localized diaphoresis in the affected muscle groups
A

black widow bite

95
Q

what organism is MC associated with burn victims?

A

pseudomonas

- tx: aminoglycosides (bind 30s), penicillin

96
Q

spongiosis of the epidermis along with epidermal acanthosis and hyperkeratosis

A

atopic dermatitis

  • flexor surfaces in adults
  • extensor surfaces kids <2
97
Q

painful blisters on hands and forearms

  • darkened urine
  • excess hair growth on the face, forearms, and hands
  • hyperpigmentation/hypopigmentation of the hands
  • risk factors include alcoholism, hepatitis C, and iron overloaded states
A

porphyria cutanea tarda (AD)

  • deficiency in uroporphyrinogen III decarboxylase, an enzyme involved in 5th step of heme synthesis
  • results in porphyrins being deposited in the skin causing cutaneous fragility leading to blistering of the hands, forearms, and face
98
Q

what vessels are most at risk for ischemia and necrosis with vasoconstriction caused by epinephrine?

A

end organs with small capillaries (fingers/toes, ear)

99
Q

dermacentor tick, but saddleback fever?

- cycles with a fever for 2-3 days followed by absence of fever 2-3 days

A

colorado tick fever

100
Q

skin thickening w/ systemic sx
- dysphagia, arrhythmias, mild proteinuria and hypertension, and respiratory complications with a restrictive lung defect

A

diffuse systemic sclerosis

  • anti-DNA-topoisomerase (anti-Scl-70) Ab is highly specific for systemic sclerosis
  • Anticentromere Abs are more characteristic of *limited scleroderma (CREST syndrome)
101
Q

joint pain/swelling, fatigue, muscle weakness, and sclerodactyly
- positive, speckled antinuclear antibody and an anti-U1-RNP antibody

A

mixed CT disease

102
Q

dysplastic nevus syndrome, is associated with an increased risk of what?

A

pancreatic cancer

  • numerous (> 50) nevi and a first degree family member with melanoma
  • likely has familial atypical mole and multiple melanoma syndrome (FAMMM syndrome) aka dysplastic nevus syndrome
103
Q
  • eruptive xanthomas result from what?

- tuberous and planar xanthomas result from what?

A
  • eruptive xanthomas -> hypertriglyceridemia

- tuberous and planar xanthomas -> hypercholesterolemia

104
Q

what are the most important prognostic indicators for malignant melanoma?

A

depth and ulceration

105
Q

radiographic findings of a lesion with a lytic center and surrounding ring of sclerosis?

A

osteomyelitis

106
Q

what drug is used to treat Pasteurella multocida infections resistant to first-line treatment of dog or cat bites

A

Imipenem/cilastatin

  • Imipenem = beta-lactamase–resistant cell wall synthesis inhibitor
  • cilastatin = renal dehydropeptidase I inhibitor
  • Combining the 2 drugs allows the dose of imipenem to be reduced, thereby decreasing the risk of adverse events
107
Q

what causes scalded skin syndrome?

  • presents with a fever and generalized erythematous rash
  • rash becomes pustular and bullous, and if a shearing force is applied by a finger, will show sloughing of the upper layers of the epidermis (Nikolsky sign) that heals completely without scarring
A

caused by the exfoliative toxins produced by Staphylococcus aureus
- typically seen in newborns

108
Q

a superantigen, which binds MHC-II and T-cell receptors outside of the antigenic groove, nonspecifically activating large numbers of T cells to stimulate release of IFN-γ and IL-2
- is responsible for the symptoms of high fever, low blood pressure, rash, and multiple-organ abnormalities

A

toxic shock syndrome toxin-1 (TSST-1)

109
Q

mutation in nucleotide excision repair?

A

Xeroderma pigmentosum

  • fair skinned baby, severe sun sensitivity
  • areas of hypo/hyper-pigmented skin
  • can develop skin malignancy as early as 5-6 y/o
110
Q
  • chronic hyperkeratosis
  • lymphocytic infiltrates at dermo-epidermal junction
  • scattered, eosinophillic colloid (civatte) bodies in papillary dermis
  • thickened stratum granulosum with sawtooth rete ridges
A

lichen planus

  • white lacey appearance
  • 6 P’s
  • on flexoral surfaces of wrists, ankles

COMLEX (14 decks)

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