Clinical Perspectives in Skin Changes

Question 1

What type of rash is associated with Measles?

Answer 1

Brick red, irregular, maculopapular

Question 2

When does a measles rash appear?

How does it progress?

Answer 2

1) 3-4 days after onset of prodrome

2) Starts on face, moves down/out, and ends in palms and soles

Question 3

What is the key pathognomonic feature of measles?

Answer 3

Koplik spots on buccal mucosa

Question 4

What are some severe complications of measles?

Answer 4

Pneumonia and encephalomyelitis

Question 5

What does the classic maculopapular rash look like in an adult patient with measles?

Answer 5

Mostly on face and neck with more sparseness to trunk

Question 6

In children, erythema infectiosum is characterized by what classic appearance?

What other facial feature do we see?

There is a subsequent lacy, maculopapular, evanescent rash most commonly where?

Where is pruritus most affecting?

How is the fever?

Answer 6

1) Red “slapped cheek” appearance
2) Pale around mouth (Circumoral pallor)
3) Trunk and limbs
4) Palms and soles
5) Mild

Question 7

What is one of the most common causes of myocarditis in childhood?

Answer 7

Parvovirus

Question 8

Symptoms of parvovirus B19 infection can mimic those of

autoimmune states, such as?

Answer 8

1) SLE
2) Systemic sclerosis
3) Antiphospholipid syndrome
4) RA

Question 9

What rickettsial infection causes erythematous macules, abdominal pain mimicking appendicitis, conjunctival injection, palatal petechiae, edema of dorsal hands, and calf pain?

Answer 9

Ehrlichiosis

Question 10

Ehrlichiosis can affect what different systems?

Answer 10

1) Respiratory
2) Neurologic
3) Renal
4) Heart (pericarditis)

Question 11

What is classic finding do we see in Lyme disease?

Answer 11

Erythema migrans

Question 12

What occurs during stage 1 of Lyme disease?

Answer 12

Erythema migrans progresses into bullseye lesion

Question 13

Concomitant viral-like illness develops in most Lyme disease patients and is characterized by?

Answer 13

Myalgia, arthralgia, headache, fatigue

Question 14

What occurs during stage 2 of Lyme disease?

Answer 14

1) Bacteremia

2) Secondary skin lesions that are similar to primary lesions but smaller

Question 15

When does the stage 2, the early disseminated infection stage occur?

When does stage 3 occur?

Answer 15

1) Weeks to months later

2) Months to years later

Question 16

In about 4-10% of patients, how can Lyme disease affect the heart?

Answer 16

Myopericarditis, with atrial or ventricular arrhythmias and heart block

Question 17

What is the classical manifestation that occurs in stage 3 of Lyme disease?

Answer 17

Arthritis of knee or other large weight-bearing joints

Question 18

What is the common manifestation of EBV and may occur at any age?

Answer 18

Mononucleosis

Question 19

What test is used for Mononucleosis?

Answer 19

Heterophile agglutination test (Monospot)

Question 20

What are common physical findings of mononucleosis?

Answer 20

1) LAD especially posterior cervical chain
2) Upper lid edema (Hoagland sign)
3) Splenomegaly

Question 21

What group of bacteria is syphilis in?

What is the specific bacteria that causes it?

Answer 21

1) Spirochete

2) Treponema pallidum

Question 22

What are the primary lesions seen in the early (infectious) syphilis state?

Answer 22

Chancre and regional LAD

Question 23

What cardiovascular disease do we see in the late syphilis stage?

Answer 23

Aortitis

Question 24

What type of lesions are found on the skin and mucous membranes in secondary syphilis?

Answer 24

Condylomata lata

Question 25

What Coxsackievirus infection causes stomatitis, vesicular rashes, and nail dystrophies and onychomadesis?

Answer 25

Hand foot mouth disease

Question 26

What Coxsackievirus infection causes sudden onset fevers, headaches, myalgias, and petechiae on soft palate that ulcerate?

Answer 26

Herpangina

Question 27

What is the hallmark of HFMD?

Answer 27

Development of a vesicular eruption on the palms and | soles

Question 28

In HFMD, the vesicles quickly erode and form?

Answer 28

Yellow to gray, oval erosions | surrounded by an erythematous halo

Question 29

In classic HFMD, what do nearly all patients develop that involves the tongue buccal mucosa, hard palate, and, less frequently, the oropharynx?

Answer 29

Enanthem

Question 30

What are potential complications due to Coxsackievirus infection?

Answer 30

1) Pleurodynia (Bornhold dz) 2) Aseptic meningitis 3) Acute pericarditis

Question 31

Measles, Rubella, Erythema infectiosum, Infectious mononucleosis, Lyme disease, and Ehrlichiosis all cause what type of rash?

Answer 31

Diffuse Maculopapular rash

Question 32

TSS, Scarlet fever, and Erythema multiforme all cause what type of rash?

Answer 32

Desquamative skin changes

Question 33

What is characterized by abrupt onset of fever, vomiting, watery diarrhea, and non purulent conjunctivitis?

Answer 33

Toxic shock syndrome

Question 34

What is typical during recovery of TSS?

Answer 34

Desquamation especially of palms and soles

Question 35

What are some physical findings associated with TSS?

Answer 35

1) Sunburnt appearance | 2) Maculopapular rash

Question 36

Scarlet fever is typically caused by?

Answer 36

Group A strep (pyogenes)

Question 37

What is the most common cause of tonsillopharyngitis in children and adolescents?

Answer 37

Streptococcus pyogenes

Question 38

What are some characteristics of the rash seen in scarlet fever?

Answer 38

1) Prominent on neck, axilla, groin 2) Circumoral pallor 3) Desquamation involves hands and feet

Question 39

What key clinical feature is seen with scarlet fever?

Answer 39

Strawberry tongue

Question 40

What is a rare cutaneous or mucocutaneous eruption | characterized by “target” lesions, predominantly on the face and extremities?

Answer 40

Erythema multiforme

Question 41

Most cases of Erythema multiforme are related to what infections?

Answer 41

1) HSV | 2) Mycoplasma pneumoniae

Question 42

What highly contagious exanthem usually begins on the face and scalp and spreads rapidly to the trunk, with relative sparing of the extremities?

Answer 42

Varicella

Question 43

How do the lesions of Varicella progress? When does each occur?

Answer 43

1) Rose-colored macules to papules, vesicles, pustules, and crusts 2) At the same time

Question 44

With varicella, when do lesions of all stages present?

Answer 44

At the same time

Question 45

What immunoglobulin is involved with pemphigus?

Answer 45

IgA

Question 46

What may exacerbate the painful skin lesions of pemphigus?

Answer 46

Exposure to UV radiation

Question 47

Because PV blisters are fragile, the most common skin lesions observed in patients are?

Answer 47

Erosions resulting from broken blisters

Question 48

Gonococcemia is caused by bacterial infection from what organism? What the distinct characteristics of this bacteria?

Answer 48

1) Neisseria gonorrhoeae | 2) Gram-negative, aerobic diplococci

Question 49

Disseminated gonococcal infection results in a classic triad of?

Answer 49

1) Dermatitis 2) Migratory polyarthritis 3) Tenosynovitis

Question 50

What skin findings do we see with gonococcemia?

Answer 50

1) Small macules | 2) Hemorrhagic vesiculopustular on an erythematous base located on palms and soles

Question 51

What may the skin lesions develop in gonococcemia?

Answer 51

Necrotic centers

Question 52

Meningococcemia is caused by what bacterial infection?

Answer 52

Neisseria meningitidis

Question 53

Disseminated meningococcal infection may present in what different ways?

Answer 53

1) Meningitis alone 2) Acute meningococcemia with or without meningitis 3) Chronic meningococcemia

Question 54

In severe cases of meningococcemia, necrosis of the skin and underlying tissue may necessitate?

Answer 54

Amputation

Question 55

In acute meningococcemia, what type of rash is most common?

Answer 55

Petechial rash on extremities

Question 56

Acute meningococcemia with disseminated intravascular coagulation may produce?

Answer 56

Purpura fulminans

Question 57

Traditionally, Thrombotic Thrombocytopenic Purpura is characterized by the pentad which consists of?

Answer 57

1) Microangiopathic Autoimmune Hemolytic Anemia 2) Thrombocytopenia 3) Neurologic symptoms 4) Fever 5) Renal failure

Question 58

What is often required to initiate clinical TTP?

Answer 58

An additional inflammatory trigger (such as infection, surgery, pancreatitis, or pregnancy)

Question 59

The classic form of TTP is idiopathic TTP, which is the result of a severe deficiency in?

Answer 59

ADAMTS13

Question 60

What is the most common form of cutaneous cancer?

Answer 60

Basal cell carcinoma

Question 61

What is the common physical presentation for basal cell carcinoma?

Answer 61

Umbilicated and bleeding

Question 62

What is a nonhealing ulcer or a small red, conical, hard nodules nodule?

Answer 62

Squamous Cell Carcinoma

Question 63

What is the common physical presentation for Squamous Cell Carcinoma?

Answer 63

Keratinization

Question 64

What are mutation is a risk factor for melanoma?

Answer 64

p16 mutation

Question 65

The back is the most common location for melanoma for which sex? The lower extremities followed by trunk is common for which sex?

Answer 65

1) Men | 2) Women

Question 66

Which criteria of melanoma screening carries the greatest sensitivity and specificity at predicting the metastatic potential of a lesion?

Answer 66

Color

Question 67

Palpable purpura is caused by? Non-palpable purpura is caused by?

Answer 67

1) Vasculitis and infection | 2) Autoimmune

Question 68

What is the most common biopsy technique that is less time consuming, has good cosmetic result but is limited to processes occurring to the depth of the mid dermis?

Answer 68

Shave biopsy

Question 69

What technique is able to provide full thickness skin sample but may not be adequate for processes in the subcutaneous tissue due to limitations with depth?

Answer 69

Punch Biopsy

Question 70

What technique can produce adequate sample down to the subcutaneous tissues but has longer healing time and greater potential for scarring?

Answer 70

Excisional Biopsy

Question 71

What procedures may be used for vesiculobullous diseases for routine histology or immunofluorescence studies?

Answer 71

Punch or shave

Question 72

What procedures may be used for lesions that are suspected to be of melanocytic origin?

Answer 72

Excision or punch biopsy (for small lesions)

Question 73

What procedure may be used for suspected melanoma?

Answer 73

Avoid biopsy and refer to derm

Question 74

What type of skin rash may occur from contact dermatitis?

Answer 74

Desquamative