DERMATOLOGY Flashcards
(152 cards)
1
Q
Scaly papule that soon forms erythematous plaques covered with a white scale
A
Psoriasis
2
Q
Hemorrhagic red papules that do not blanch with pressure
A
necrotizing vasculitis
3
Q
Target-shaped lesion that consist in part of erythematous plaques
A
erythema multiforme
4
Q
Pseudohyphae and budding yeasts is seen in
A
Candida infections
5
Q
“Spaghetti and meatballs” yeast forms are seen in
A
tinea versicolor
6
Q
A cytologic technique most often used in the diagnosis of herpesvirus infections (herpes simplex virus or varicella zoster virus)
A
Tzanck smear
7
Q
An opaque to transparent, brown-pink “apple jelly” appearance on diascopy
A
Granulomas
8
Q
Coral pink color under the wood’s lamp
A
Erythrasma
9
Q
A superficial, intertriginous infection caused by Corynebacterium minutissimum
A
Erythrasma
10
Q
Pale blue on wood’s lamp
A
Pseudomonas
11
Q
Yellow fluorescence on wood’s lamp
A
Tinea capitis
Caused by dermatophytes (e.g. Micrisporum canis or M. audouinii)
12
Q
A battery of suspected allergens is applied to the patient’s back under occlusive dressings and allowed to remain in contact with the skin for 48 h
A
Patch test
13
Q
Patch test is used to examine evidence of
A
delayed hypersensitivity reactions
14
Q
This is the most common type of melanoma
A
Superficial spreading melanoma
Such lesions usually demonstrate asymmetry, border irregularity, color variegation (black, blue, brown, pink, and white), a diameter >6 mm, and a history of change (e.g., an increase in size or development of associated symptoms such as pruritus or pain).
15
Q
A flat, colored lesion, <2 cm in diameter, not raised above the surface of the surrounding skin. A “freckle,” or ephelid, is a prototype
A
Macule
16
Q
A large (>2 cm) flat lesion with a color different from the surrounding skin
A
Patch
17
Q
A small, solid lesion, <0.5 cm in diameter, raised above the surface of the surrounding skin and thus palpable (e.g., a closed comedone, or whitehead, in acne).
A
Papule
18
Q
A larger (0.5 to 5.0 cm), firm lesion raised above the surface of the surrounding skin
A
Nodule
19
Q
A solid, raised growth >5 cm in diameter.
A
Tumor
20
Q
A large (>1 cm), flat-topped, raised lesion; edges may either be distinct (e.g., in psoriasis) or gradually blend with surrounding skin (e.g., in eczematous dermatitis).
A
Plaque
21
Q
A small, fluid-filled lesion, <0.5 cm in diameter, raised above the plane of surrounding skin. Fluid is often visible, and the lesions are translucent
A
Vesicle
22
Q
A vesicle filled with leukocytes
A
Pustules
The presence of pustules does not necessarily signify the existence of an infection
23
Q
A fluid-filled, raised, often translucent lesion >0.5 cm in diameter
A
Bulla
24
Q
A raised, erythematous, edematous papule or plaque, usually representing short-lived vasodilation and vasopermeability.
A
Wheal
25
A dilated, superficial blood vessel
Telangiectasia
26
A distinctive thickening of the skin that is characterized by accentuated skin-fold markings.
Lichenification
27
Excessive accumulation of stratum corneum
Scale
28
Dried exudate of body fluids that may be either yellow or red
Crust
29
Loss of epidermis without an associated loss of dermis.
Erosion
30
Loss of epidermis and at least a portion of the underlying dermis
Ulcer
31
Linear, angular erosions that may be covered by crust and are caused by scratching.
Excoriation
32
An acquired loss of substance. In the skin, this may appear as a depression with intact epidermis or as sites of shiny, delicate, wrinkled lesions
Atrophy
33
A change in the skin secondary to trauma or inflammation. Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character. Sites on hair-bearing areas may be characterized by destruction of hair follicles.
Scar
34
Small, firm, white papules filled with keratin
Milia
35
Coin-shaped lesion
Nummular
36
Skin that displays variegated pigmentation, atrophy, and telangiectases.
Poikiloderma
37
A configuration of skin lesions formed from coalescing rings or incomplete rings
Polycyclic lesions
38
Erythema with greasy yellow-brown scale
Seborrheic dermatitis
39
Violaceous flat-topped papules and plaques
Lichen planus
40
Skin-colored or red-brown macule or papule with dry, rough, adherent scale
Actinic keratosis
41
Papule with pearly, telangiectatic border on sun- damaged skin
Basal cell carcinoma
42
Usual site of basal cell carcinoma
Face
43
Indurated and possibly hyperkeratotic lesions often showing ulceration and/or crusting
Squamous cell carcinoma of the skin
44
Usual site of squamous cell carcinoma of the skin
Face (especially lower lips, ears)
45
Brown plaques with adherent, greasy scale; “stuck on” appearance
Seborrheic keratosis
46
Symmetric erythematous papules and plaques with a collarette of scale
Pityriasis rosea
47
Most frequent skin reaction to drugs
Morbilliform rash – 91%
Urticaria – 6%
48
Populations that are at high risk for cutaneous drug reactions (4)
1. Elderly
2. Autoimmune disease
3. Hematopoietic stem cell transplant recipient
4. Acute EBV or HIV infection
49
CD4 count in HIV disease that have 40- to 50-fold increased risk of ADR to sulfamethoxazole and increased risk of severe hypersensitivity reactions
CD4 < 200
50
Drugs can trigger mediator release either by these 2 mechanism
1. Direct mast cell degranulation
| 2. IgE-specific antibodies
51
NSAIDs trigger mediator release by
Direct mast cell degranulation
“anaphylactoid” reaction
52
Radiocontrast media trigger mediator release by
Direct mast cell degranulation
“anaphylactoid” reaction
53
Penicillin trigger mediator release by
IgE-specific antibodies
54
Caused by tissue deposition of circulating immune complexes with consumption of complement
Serum sickness
55
Common cause of serum sickness
Monoclonal antibodies and similar drugs
56
Symptoms of serum sickness usually develop how many days after drug exposure
6 or more days
Latent period – time needed to synthesize antibody
57
An important mechanism underlying the most common drug eruptions (morbilliform eruptions)
Delayed hypersensitivity
58
Genetic determinants may predispose individuals to severe drug reactions by affecting either drug metabolism or immune responses to drugs; most commonly
HLA haptotypes
59
Drugs that can exacerbate plaque psoriasis (6)
1. NSAIDs
2. Lithium
3. Beta blockers
4. TNF antagonists
5. Interferon α
6. ACE inhibitors
60
A drug used to treat psoriasis that May induce psoriasis (esp palmoplantar) in patients being treated for other conditions
TNF antagonists
61
Drugs that can worsen pustular psoriasis (2):
1. Antimalarials
| 2. Withdrawal of systemic glucocorticoids
62
Follicular papular or pustular eruptions of the face and trunk resembling acne can be caused by what drug
epidermal growth factor receptor (EGFR) antagonists
Severity of the eruption correlates with a better anticancer effect
Typically responsive to and prevented by tetracycline antibiotics
63
Markers of drug-induced SLE (4)
1. ANA
2. Antihistone
3. Anti-dsDNA
4. p-ANCA
64
Drugs that may cause pemphigus (2)
1. D-penicillamine
| 2. ACE inhibitors
65
Drugs that may cause bullous pemphigoid (2)
1. Furosemide
| 2. PD-1 inhibitors
66
Drugs that may cause linear IgA bullous dermatosis
Vancomycin
67
A condition of sclerosing skin with rare internal organ involvement caused by gadolinium contrast
Nephrogenic systemic fibrosis
68
Mechanism of photosensitivity eruption is almost always
Phototoxicity
69
Blistering may occur in drug-related pseudoporphyria, particularly caused by
NSAIDs – most common
70
Drug that may result in severe photosensitivity, accelerated photoaging, and cutaneous carcinogenesis
Voriconazole
71
Drug that can cause a UV-recall reaction characterized by an erythematous, slightly scaly eruption at sites of prior severe sun exposure
Methotrexate
72
Blue-gray pigmentation can be caused by what 2 drugs
1. long-term minocycline
| 2. amiodarone
73
Gray-brown pigmentation can be caused by what drugs (3)
1. Phenothiazine
2. Gold
3. Bismuth
74
Red-brown pigmentation can be caused by what drug and what do you call this condition?
Clofazimine
Drug-induced lipofuscinosis
75
Hyperpigmentation of the face, mucous membranes, and pretibial and subungual areas can be caused by what drug
Antimalarials
76
Generalized yellow discoloration can be caused by
Quinacrine
77
Warfarin necrosis of the skin occurs between the how many days of therapy with warfarin
3-10 days
78
Common sites of warfarin necrosis of the skin (3)
1. Breasts
2. Thighs
3. Buttocks
Usually in women
79
Drug induced hair loss that occurs during growth
Anagen effluvium
Occurs within days of drug administration Antimetabolite or other chemotherapeutic drugs
80
Drug induced hair loss that occurs during resting phase of growth
Telogen effluvium
Delay is 2-4 months following initiation of new medication
81
Drug-induced nail disorder characterized by transverse depression of the nail plate
Beau’s line
82
Drug-induced nail disorder characterized by detachment of the distal part of the nail plate
Onycholysis
83
Common drugs that cause onycholysis (5)
1. Tetracyclines
2. Fluoroquinolones
3. Retinoids
4. NSAIDs
5. Chemotherapeutic agents
84
Drug-induced nail disorder characterized by detachment of the proximal part of the nail plate
Onychomadesis
Caused by temporary arrest of nail matrix mitotic activity
85
Common drugs that cause onychomadesis (4)
1. Carbamazepine
2. Lithium
3. Retinoids
4. Chemotherapeutic drugs
86
Drug-induced nail disorder characterized by inflammation of periungal skin
Paronychia
87
Common drugs that cause paronychia (4)
1. Systemic retinoids
2. Lamivudine
3. Indinavir
4. Anti-EGFR monoclonal antibodies
88
Drug reaction that is marked by dysesthesia and an erythematous, edematous eruption of the palms and soles
Acral erythema
Toxic erythema of chemotherapy
89
Chemotherapeutic drugs that cause acral erythema (6)
1. Cytarabine
2. Doxorubicin
3. Methotrexate
4. Hydroxyurea
5. Fluorouracil
6. Capecitabine
90
Chemotherapeutic drug that cause marked hair textural changes
Erlotinib
91
Chemotherapeutic drug that cause follicular eruptions and focal bullous eruptions at palmoplantar, flexural sites or areas of frictional pressure
Sorafenib
A tyrosine kinase inhibitor
92
Most common of all drug-induced reactions
Morbiliform eruptions
93
More severe reaction of morbilliform eruptions is characterized by
Nonblanching, dusky, or bright-red macules
94
Certain medications that carry very high rates of morbilliform eruptions (2)
1. Nevirapine
| 2. Lamotrigine
95
The 2nd most frequent type of cutaneous reaction to drugs
Urticaria
96
Deep edema within dermal and subcutaneous tissues
Angioedema
97
Anaphylactoid reaction characterized by flushing, diffuse maculopapular eruption, and hypotension and what drug causes it?
Red man syndrome
Vancomycin
98
DRESS or DIHS has morbilliform eruptions that most frequently involve which part of the body
Face
99
Systemic manifestations of DRESS or DIHS (in descending order) (8)
1. Lymphadenopathy
2. Fever
3. Leukocytosis – eosinophilia or atypical lymphocytosis
4. Hepatitis
5. Nephritis
6. Pneumonitis
7. Myositis
8. Gastroenteritis
100
Drug that most frequently induces DIHS with renal involvement
Allopurinol
101
Drug that most frequently induces DIHS with cardiac and lung involvement
Minocycline
102
Drug that most frequently induces DIHS and wherein GI involvement is almost exclusively seen
Abacavir
103
Medications that typically lack eosinophilia in DIHS (3)
1. Abacavir
2. Dapsone
3. Lamotrigine
104
Cutaneous reaction in DIHS usually begins ____ after the drug is started and _____ after drug cessation
2-8 weeks
persists
105
Reactivation of herpes virus (HHV 6 and 7, EBV, and CMV) – frequently reported in this drug related syndrome
DIHS or DRESS
Worse clinical prognosis if with reactivation
106
Mortality rate of DIHS / DRESS
10%
107
Most fatalities of DIHS / DRESS is caused by
liver failure
108
Management of DIHS / DRESS (6)
1. Systemic glucocorticoids 1.5-2 mg/kg/d prednisone equivalent
2. Mycophenolate mofetil
3. Immediate withdrawal of culprit drug
4. Cardiac evaluation (because of severe long-term complications of myocarditis)
5. Monitor for resolution of organ dysfunction
6. Monitor for development of late-onset autoimmune thyroiditis and diabetes (up to 6 months)
109
Drug reaction that is characterized by blisters and mucosal/epidermal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation, and involve <10% of TBSA
SJS
110
Drug reaction that is characterized by blisters and mucosal/epidermal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation, and involve 10-30% of TBSA
SJS-TEN overlap
111
Drug reaction that is characterized by blisters and mucosal/epidermal detachment resulting from full-thickness epidermal necrosis in the absence of substantial dermal inflammation, and involve >30% of TBSA
TEN
112
Painful mucosal erosions and target lesions with acral distribution and limited skin detachment and is associated with HSV
Erythema multiforme
113
Clinical features of SJS/TEN (4)
1. Fever >390C
2. Sore throat
3. Conjunctivitis
4. Acute onset of painful dusky, atypical, target-like lesions
114
Factors associated with poor prognosis in SJS / TEN (4)
1. GI involvement
2. Upper respiratory tract involvement
3. Older age
4. Greater extent of epidermal detachment
115
Mortality rates of SJS and TEN
10% - SJS
| 30% - TEN
116
Rare reaction pattern that is secondary to medication exposure in >90% of cases characterized by diffuse erythema or erythroderma, high-spiking fevers, innumerable pinpoint pustules most pronounced in body fold areas
Acute generalized exanthematous pustulosis
117
Difference between AGEP from SJS (2)
1. Erosions are more superficial
| 2. No prominent mucosal involvement
118
Principal DDx for AGEP
Acute pustular psoriasis
119
Most commonly implicated in drug-induced vasculitis
β-lactam
Almost any drug can cause vasculitis
120
Most common drugs that cause drug-induced ANCA vasculitis (3)
1. PTU
2. Methimazole
3. Hydralazine
121
Long-term exposure to minocycline can cause this reaction that is characterized by perivascular eosinophils on skin biopsy
Drug-induced polyarteritis nodosa
122
Cutaneous drug eruption that is always drug-induced
fixed drug eruptions
123
Most cases of drug eruptions occur during the first course of treatment with a new medication, except for
IgE-mediated urticaria and anaphylaxis
Need presentization and develop a few minutes to a few hours after rechallenge
124
Characteristic timing of onset following drug administration:
Morbilliform eruption
AGEP
SJS/TEN
DIHS
Morbilliform eruption – 4-14 days
AGEP – 2-4 days
SJS/TEN – 5-28 days
DIHS – 14-48 days
125
A key diagnostic tool for identifying the inciting drug that compile all current and past medications/supplements and the timing of administration relative to the rash
Drug chart
126
It is now recommended that 1st degree family members of patients with severe cutaneous reactions also should avoid causative agents. This recommendation is most relevant for what drugs (2)
sulfonamides and antiepileptic medications
127
Type of ADR that is IgE-mediated
Type I
128
Type of ADR that is IgG-mediated
Type II
129
Type of ADR that is secondary to immune complex
Type III
130
Type of ADR that is T lymphocyte– mediated macrophage inflammation
Type IVa
131
Type of ADR that is T lymphocyte– mediated eosinophil inflammation
Type IVb
132
Type of ADR that is T lymphocyte– mediated cytotoxic T lymphocyte inflammation
Type IVc
133
Type of ADR that is T lymphocyte– mediated neutrophil inflammation
Type IVd
134
Urticaria is what type of ADR?
Type I
135
Angioedema is what type of ADR?
Type I
136
Anaphylaxis is what type of ADR?
Type I
137
Drug-induced hemolysis is what type of ADR?
Type II
138
Thrombocytopenia is what type of ADR?
Type II
139
Vasculitis is what type of ADR?
Type III
140
Serum sickness is what type of ADR?
Type III
141
Drug-induced lupus is what type of ADR?
Type III
142
Tuberculin test is what type of ADR?
Type IVa
143
Contact dermatitis is what type of ADR?
Type IVa
144
DIHS is what type of ADR?
Type IVb
145
SJS/TEN is what type of ADR?
Type IVc
146
AGEP is what type of ADR?
Type IVd
147
Morbiliform eruptions is what type of ADR?
Type IVb and IVc
148
Most common culprit drugs for SJS/TEN? (4)
1. Sulfonamides
2. Anticonvulsants
3. Allopurinol
4. NSAIDs
149
Most common culprit drugs for DIHS/DRESS? (4)
1. Anticonvulsants
2. Sulfonamides
3. Allopurinol
4. Minocycline
150
Most common culprit drugs for AGEP? (3)
1. β-Lactam antibiotics
2. Calcium channel blockers
3. Μacrolide antibiotics
151
Most common culprit drugs for serum sickness? (3)
1. Antithymocyte globulin
2. Cephalosporins
3. Monoclonal antibodies
152
Most common culprit drugs for angioedema? (3)
1. ACE inhibitors
2. NSAIDs
3. Contrast dye
