Derma

Question 1

_____ is an autoimmune disease of unclear etiology in which the body essentially becomes allergic to its own skin

Answer 1

Pemphigus vulgaris

Question 2

Pathology of Pemphigus vulgaris

Answer 2

Antibodies are produced against antigens in the intercellular spaces of the epidermal cells. They attack the “glue” that holds the epidermal
cells together

Question 3

Pemphigus vulgaris is most often idiopathic, but _____

can occasionally cause

Answer 3

ACE inhibitors or penicillamine

Question 4

____occurs in patients age 30s and 40s, whereas ____

occurs in those age 70s and 80s.

Answer 4

pemphigoid Vulgaris

bullous pemphigoid

Question 5

Which is more serious?

pemphigoid Vulgaris

bullous pemphigoid

Answer 5

Pemphigus vulgaris is a much more serious and potentially life-threatening disease than pemphigoid

Question 6

The presence of the _____ (the easy removal of skin by just a little pressure from the examiner’s finger, pulling the skin off like a sheet) is seen in pemphigus vulgaris,
staphylococcal scalded skin syndrome, and toxic epidermal necrolysis

Answer 6

Nikolsky sign

Question 7

The lesions of ____ are painful, not pruritic.

Answer 7

pemphigus vulgaris

Question 8

pemphigus vulgaris

The most accurate diagnostic test is to biopsy the skin and to use immunofluorescent stains. These stains will detect _____

Answer 8

intercellular deposits of IgG and C3 in the epidermis

Question 9

Tx of pemphigus vulgaris

Answer 9

Treatment is with systemic glucocorticoids, such as prednisone. Topical steroids will not be sufficiently strong

Question 10

Tx of PV

For those in whom steroids are ineffective or not tolerated, you can use

Answer 10

azathioprine, mycophenolate, or cyclophosphamide.

Rituximab and IVIG are also effective.

Question 11

_____2× as common as pemphigus vulgaris and occurs in elderly persons age 70s and 80s. It can also be drug induced with sulfa drugs, including furosemide, penicillamine, and others.

Answer 11

Bullous Pemphigoid

Question 12

Pathology of Bullous Pemphigoid

Answer 12

The defect occurs at the dermo-epidermal junction, so the layer of skin that separates off is much thicker

Question 13

DX of Bullous Pemphigoid

Answer 13

The most accurate diagnostic test is a biopsy with immunofluorescent antibodies at the dermo-epidermal junction (basement membrane).

Question 14

TX of Bullous Pemphigoid

Answer 14

Systemic steroids, such as prednisone, are the standard means of treatment.

Question 15

Alternative TX of Bullous Pemphigoid

Answer 15

Tetracycline or erythromycin combined with nicotinamide is the alternative to steroids. Use topical steroids only if no oral lesions are present

Question 16

___ is a disorder of porphyrin metabolism. Deficiency
of the enzyme uroporphyrinogen decarboxylase results in an abnormally high accumulation
of porphyrins, which then leads to a photosensitivity reaction

Answer 16

Porphyria cutanea tarda

Question 17

Asscn of Porphyria cutanea tarda

Answer 17

porphyria cutanea tarda is associated with increased liver iron stores. Diabetes is found in 25% of patients.

HIV, alcoholism, liver disease, chronic hepatitis C, or a woman taking oral contraceptives

Question 18

SSx of Porphyria cutanea tarda

Answer 18

Fragile, nonhealing blisters are seen on the sun-exposed parts of the body, such as the backs of the hands and the face.

This leads to hyperpigmentation of the skin in general and hypertrichosis of the face

Question 19

Dx of Porphyria cutanea tarda

Answer 19

The diagnostic test is a level of urinary uroporphyrins. Uroporphyrins are elevated 2–5× above the coproporphyrins in this disease

Question 20

Tx of Porphyria cutanea tarda

Answer 20

The best initial step in management is to stop drinking alcohol (although it is unlikely to be effective) and to discontinue all estrogen use

Question 21

PCT

The most effective therapy to use if this is insufficient
is _______

Answer 21

phlebotomy to remove iron.

Question 22

the antimalarial drug ______increases the excretion of porphyrins

Answer 22

chloroquine

Question 23

______ is a hypersensitivity reaction most often mediated by IgE and mast cell activation, resulting in evanescent wheals and hives

Answer 23

Acute urticaria

Question 24

The most common causes of acute urticaria are:

Answer 24

allergic reactions to medications, insect bites, and foods, and occasionally, the result of emotions

Question 25

MC meds causing urticaria

Answer 25

aspirin, NSAIDs, morphine, codeine, penicillins, phenytoin, and quinolones

Question 26

MC food causing urticaria

Answer 26

The most common foods are peanuts, shellfish, tomatoes, and strawberries.

Question 27

Acute urticaria lasts____weeks in duration and two-thirds of cases are self-limited.

Answer 27

<6

Question 28

Urticaria is treated with______

Answer 28

H1 antihistamines

Question 29

What should never be used for urticaria

Answer 29

Astemizole and terfenadine should never be used and are no longer marketed; they cause potentially fatal rhythm disturbances particularly when combined with other medications, such as macrolide antibiotics, because of their effect on the hepatic P450 system.

Question 30

What to be done when trigger cant be avoided?

Answer 30

“desensitization” when the trigger cannot be avoided, e.g., a beesting in a farmer

Question 31

______ must be stopped prior to desensitization because they inhibit epinephrine, which may be used if there is an anaphylactic reaction

Answer 31

Beta-blocker medications

Question 32

____ is a milder version of a hypersensitivity reaction compared with urticaria. This is the “typical” type of drug reaction and is lymphocyte mediated

Answer 32

A morbilliform rash

Question 33

Characteristic rash of morbiliform rash

Answer 33

It is a generalized, maculopapular eruption that blanches with pressure.

Question 34

Erythema Multiforme MCC

Answer 34

most common cause of EM is a reaction to infection

Question 35

MC characteristic feature of morbiliform rash

Answer 35

The most characteristic feature of EM is target-like lesions that occur especially on the palms and soles

Question 36

characteristic rash of morbiliform rash

Answer 36

These lesions can also be described as “iris-like.” Bullae are not uniformly found. EM of this type usually does not involve mucous membranes

Question 37

SJS usually involves ____ of the total body surface area, and the overall mortality rate is ____

Answer 37

<10 to 15% <5 to 10%.

Question 38

Best initial Tx for SJS

Answer 38

The best initial therapy for severe disease is IV | immunoglobulins. Other therapies of unclear value are cyclophosphamide, cyclosporine, and thalidomid

Question 39

_____is the most serious version of a cutaneous | hypersensitivity reaction. Mortality may be as high as 40 to 50%.

Answer 39

Toxic epidermal necrolysis (TEN)

Question 40

TEN has certain features similar to staphylococcal scalded skin syndrome; however, TEN is drug induced as opposed to being caused by a _____ coming from an organism.

Answer 40

toxin

Question 41

Dx test for TEN

Answer 41

The diagnosis is usually clinical. The most accurate diagnostic test is a skin biopsy, which will reveal full thickness epidermal necrosis. A skin biopsy is usually not necessary

Question 42

MCC of death in TEN

Answer 42

Sepsis is the most common cause of death, but prophylactic systemic antibiotics are not indicated. Systemic steroids are not effective and may, in fact, decrease survival.

Question 43

_____ is a localized inflammatory condition of the skin or panniculitis. It is secondary to recent infections or inflammatory conditions. It is also associated with pregnancy.

Answer 43

Erythema nodosum (EN)

Question 44

MCC of Erythema nodosum (EN)

Answer 44

The most common causes of EN are recent streptococcal infections, coccidioidomycoses, histoplasmosis, sarcoidosis, inflammatory bowel disease, syphilis, TB, and hepatitis.

Question 45

SSx of EN

Answer 45

Erythema nodosum consists of multiple painful, red, raised nodules on the anterior surface of the lower extremities

Question 46

Skin infection characterized by multiple macules (usually asymptomatic), varying in color from white to brown.

Answer 46

Tinea versicolor

Question 47

Tinea versicolor etiology

Answer 47

Pityrosporum orbiculare (Malassezia furfur).

Question 48

SSx of tinea versicolor

Answer 48

Tan, brown, or white scaling macular lesions that tend to coalesce; found on chest, neck, abdomen, or face. Lesions do not tan

Question 49

Tx of tinea versicolor

Answer 49

Topical selenium sulfide, clotrimazole, ketoconazole, or oral itraconazole.

Question 50

Describe Intertriginous Candida infection

Answer 50

Well-demarcated, erythematous, itchy, exudative patches, usually rimmed with small red-based pustules that occur in the groin, gluteal folds (diaper rash), axilla, umbilicus, and inframammary areas.

Question 51

Describe Candida vulvovaginitis

Answer 51

White or yellowish discharge with inflammation of the vaginal wall and vulva. Common in pregnant women and patients with diabetes mellitus

Question 52

TX of Candida infxn

Answer 52

Topical nystatin, clotrimazole, miconazole, ciclopirox, econazole, or terconazole

Question 53

The most common bacterial organisms to cause skin infections of any kind are ______ and _____

Answer 53

Staphylococcus | and Streptococcus

Question 54

If a patient is allergic to penicillin, but the reaction is only a rash, then _____ can be safely used

Answer 54

cephalosporins