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1

 Ident each of these eczematoid dermatitises.

  1. atopic dermatitis
  2. contact 
  3. stasis

2

Type of dermatitis?

Vesicular dermatitis - herpes zoster

 

3

Type of dermatitis

Bullous dermatitis

 

4

A 45 y/o male presents with rectal bleeding due to rectal adenocarcinoma. He is examined and the following is seen. He reports that two years ago he had only a few of the skin lesions.

These are?

What is this sign?

seborrheic keratosis

sign of leser trulat - indicates multiple malignancies likely

 

5

A pregnant 36 y/o female presents with nausea and vomiting. Lab tests are normal except for an elevated alkaline phosphatase. Skin exam shows the following. This patient most likely has metastasis to the?

Liver

6

This 15 y/o female with “the itch that rashes” is most prone to what infection?

What is this disease process d/t?

  • Staphylococcus
  • IgE mediated

7

Staph biofilms can block sweat glands, what protein is involved in the innate immune system that is activated in areas where blocked sweat ducts arise in eczema?

Toll like receptor 2

 

8

An 8 year old child has a history of staphylococcal abscesses, a prior episode of pneumonia with pneumatoceles, high IgE levels,

eosinophilia, and rash as shown. He has lost none of his teeth. The primary problem in this patient is?

 

Job syndrome (Hyper IgE)

phagocytic attraction - phagocytes are working but not getting there.  IL-8 is defective.

9

What are three examples of phagocytic dysfunctions (would see delayed umbilica seperation)

 

1.“Not enough” (neutropenia)

2.“Can’t get there” [LAD - no integrin CD11/CD18 - high WBCs –

      recurrent bacterial infections, Hyper IgE (Job’s)–decreased IL8/

      NCF]

3.“There, but don’t function” (abscesses everywhere) (CGD/NBT

       test;   G6PDD; Chediak Higashi/giant granules in WBCs and

       platelets)   

10

What are 5 examples of combined B and T cell immunodeficiency disorders?

1.Ataxia telangiectasia (Louis-Bar)

2.Wiskott Aldrich (thrombocytopenia and eczema)

3.SCID  (Alymphocytosis or Glanzmann – Riniker Syndrome)

4.Nezelof’s syndrome (thymic dysplasia with normal globulins)

5.Graft versus host  disease    

11

Wiskott-Aldrich has eczema with a combined what?

Immunodeficiency

 

12

Job syndrome has eczema plus what?

A neutrophil problem

 

13

A 40 y/o male presents with a pruritic left ankle rash which has been present for two years. Remainder of his exam is normal. This is?

lichen simplex chronicus

14

This 60 y/o male complains of dry itching skin with these lesions found in the winter. He bathes nightly. This is which eczema.

A.Nummular

(coin shaped lesions)

15

What are the two common locations for lichen simplex chronicus?

T4

Ankles

 

16

What probably caused the “flare up” in this case?

A.Stopping steroids 

B.Trip to Florida 

C.Lack of sun tan oil

D.Staph infection 

E.Jelly fish stings

"I want you to know this"

Stopping steroids

17

What are two things that can lead to a psoriasis flare up like this?

  • HIV (flare up may be a marker)
  • Steroid withdrawal

Other things - beta blockers, lithium, interferon

 

 

18

This disease is associated with MI, ASHD, metabolic

syndrome, NAFLD, IBD, and depression. What is not

associated with this rash?

A. + ASOT

B. “Herald patch”

C. Arthritis

D. Koebner’s reaction

E. Nail pits

B. “Herald patch”

 

This is psoriasis

 

19

What organism is associated with psoriasis flare ups?

Streptococcal infections

 

20

This patient has arthritis with: 

A.ankylosing spondylitis. 

B.sarcoid.

C.Lyme disease.

D.nummular eczema

E.psoriasis.

Psoriasis

21

Assuming these patient’s have the same condition, what is the diagnosis?

A. Psoriasis

B. Onychomycosis

C. Lichen planus

D. Candidiasis

E. SLE

Psoriasis

22

These patients should be tested with:

A.serum assay.

B.culture.

C.KOH prep.

D.Tzanck test.

E.NBT.

KOH prep - for fungus

23

KOH prep reveals mycelium.  Infection at the sites pictured here may also be termed tinea faciei.  

What are three common pathogens?

Where do the fungi lodge?

  1. T. tonsurans,
  2. T. rubrum,
  3. T. mentagrophytes
  •  Fungi lodge in the stratum corneum.

24

This patient has trichophyton rubrum and also has: 

A. psoriasis.

B. alopecia.

C. paronychia.

D. eczema.

E. AIDS

Aids

25

This truncal rash produced a dull yellow fluorescence under wood’s light. The patient’s rash became more prominent with sun tanning. This is:

A. Cornyebacterium.

B. Malassezia.

C. Proprionobacterium.

D. acanthosis.

E. erythema ab igne.

Malassezia furfur

26

How might malassezia furfur be described?

spaghetti and meatballs

 

27

What does tinea versicolor worsen with?

What organism is associated with this?

Tinea versicolor = worsens with Cushings, malnutrition or immunosuppression

M. Furfur

 

28

This 20 year old woman has been using what on her face?

A.Steroids

B.Vitamin A

C.Tetracycline

D.Metronidazole

E.Hydrogen peroxide

Steroids - malassezia folliculitis

 

29

This rash shows pink fluorescence under Wood’s

light. This is:

A. Tinea

B. Trichophyton

C. Corynebacterium

D. Aspergillus

E. Pityrosporum

C. Corynebacterium

30

Wood's light is fluorescent lamp emitting "long wave" ultraviolet A.  Certain infections fluoresce on exposure to the light.  What are they?

1.Bacterial infection in skin flexures due to erythrasma (Corynebacterium minutissimum) fluoresces coral-pink.

2.Pityriasis versicolor fluoresces yellow (Malassezia).

3.Cat ringworm Microsporum canis fluoresces green.

31

This 65 y/o patient with preexisting psoriasis will most likely be in need of:

A.Antibiotics.

B.Fluids.

C.Surgery.

D.B12.

E.OMT.

Exfoliative dermatitis - must replace fluids since loss d/t weeping is significant

 

32

This woman is on BCPs, has hepatitis C and an elevated ALT. The man complains of increased temporal hair growth  and has been exposed to polychlorinated aromatic hydrocarbons. What do they have?

A. HUD deficiency 

B. Low hepatic iron

C. High ACE levels 

D. Diabetes 

E. Congenital disease

HUD deficiency - hepatic uroporphyrinogen decarboxylase (UROD is what everyone else calls it)- porphyria cutanea tarda

 

Test question 

33

How would you dx porphyria cutanea tarda?

  • Fluorescence of urine with a Wood light examination.
  • caterpillar bodies

34

This patient is suffering from a bilateral pneumonia with bullous myringitis and a dry cough. He has: 

A. Herpes. 

B. Mycoplasma. 

C. Coxsackie virus.

D. pemphigus. 

E. Rickettsia.

B. Mycoplasma. - frequent cause of erythema multiforma

 

 

35

This woman was placed on  piroxicam 3 weeks ago. She has 20% of her body involved with erythema and targetoid lesions. Her dermatitis was preceeded by fever, chills, headache and GI upset. Labs show anemia and neutropenia. Which is most likely present?

A. Erythema Multiforme

B. Kawasaki’s disease

C. SJS/Toxic Epidermal Necrolysis

D. Systemic Lupus Erythematosis.

E. Staphylococcal Scalded Skin Syndrome

C. SJS/Toxic Epidermal Necrolysis

Stevens johnson syndrome

36

What are SJS and TEN almost invariably d/t?

Drugs

 

37

What drugs cause SJS and TEN?

West (caucasians): 1. oxicam NSAIDs, ie perioxicam (Feldene)

           2. sulfas

           

East (asians): 1. carbamazepine (Tegretol) – HLA - B*1502

         2. allopurinol – HLA - B*5801

38

These seizure patient have over 30% of the body involved with fever, conjunctivitis, pharyngitis, GI ulcers, tracheal erosions, pancytopenia and sepsis. They have:

A. SSSS. 

B. erythema multiforme. 

C. pemphigoid. 

D. TEN.               

E. Kawasaki’s disease.

D. TEN.               

39

If over 30% then is it TEN or SJS?

TEN

40

These patients most likely have:

A. Erythemia rhusiopathiae 

B. Erythema marginatum    

C. Erythrasma     

D. St Anthony’s fire 

E. Erythema ab Igne

D. St Anthony’s fire - erysipilus to everyone else

 

41

Which organism presenting as below is associated with colon, gyn, or lymphoreticular malignancies.

A.Streptococcus

B.Clostridium septicum

C. Anareobes

D. Enterococcus

E. E coli

B.Clostridium septicum

42

This patient spent the preceding day in a spa. Today she has which folliculitis?

A.Traumatic

B. Pityrosporum

C. Eosinophilic

D. Pseudomonal

E. Staphylococcal

pseudomonal

 

43

What causes eosinophilic folliculitis?

HIV

 

44

This inmate complained of a “spider bite” which occurred two weeks ago. He works as a tattoo artist.  He most likely has:

A.Pneumococcus. 

B. Bacillus anthracu.s 

C. MRSA. 

D. E coli. 

E. Camplobacter.

C. MRSA. 

45

This child may be in danger of:

A.Glomerulonephritis.

B.Hepatitis C.

C.coronary artery aneurysms.

D.Rye’s syndrome.

E.Encephalitis.

A.Glomerulonephritis.

46

This disease is characterized by the presence of:

A.telangiectasia

B.comedones

C.flushing 

D.malar rash

E.rhinophyma

B.comedones

47

Which of the following is involved in acne?

A.Corynebacterium diptheriae

B.Corynebacterium minutissimum

C.Propionibacterium acnes

D.Acintobacter baumanni

E.Arcanobacterium haemolyticum

C.Propionibacterium acnes

48

 What is the conjectured cause of this condition?

A. Demodex mite (Bacillus olernius)

B. Corynebacterium

C. Pityrosporum

D. Borrelia

E. Tinea

Many have SIBO* and

respond to rifaximin.

A. Demodex mite (Bacillus olernius carried on the mite)

 

This is rosacea 

49

This patient has a tremor and was asked to smile. The cause of this rash is:

A.Monilia. 

B.Malassezia furfur*

C.Coxsackie A16.      

D.Streptococcus.

E.Staphylococcus.

B.Malassezia furfur*

Likes to grow on parkinsons patients

50

These painless, mucoid, grey white, broad based condylomas are

most compatible with:

A. Veneral warts

B. Verruca vulgaris

C. Syphilis

D. Herpes

E. HPV

HPV

51

This man spends a lot of time in the woods with ioxides scapularis.

What might this patient develop in the near future?

•A. Bell’s palsy

•B. Renal cancer

•C. Thrombocytopenia

•D Streptococcus

•E. Urethritis

•A. Bell’s palsy

52

What are the stages of lyme disease?

Stage I:  Flu syndrome with rash (ECM)

Stage II: Dissemination: heart, joints, nerves and skin (heart block, Bell’s palsy, migratory arthralgias, ECM)

Stage III: Late: joints and CNS and PNS (oligoarthritis, encephalitis/memory loss - sleep disturbances, neuropathies/paresthesias)

Be aware of Southern Tick-associated rash illness (STARI)-Borrelia lonestari

53