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Dermatology
UWORLD Round 2 2021 Part 1
| Question | Answer |
|---|---|
| What is Xanthelasma? | Yellowish eyelid papule or plaque containing lipid-laden macrophages |
| What is another way to refer to Lipid-Laden macrophages? | Foam cells |
| What is a common clinical manifestation or feature of Primary and Secondary Hyperlipidemia? | Xanthelasma |
| What is a possible consequence of Cholestatic conditions? | Hypercholesterolemia leading to Xanthelasma |
| What is common cholestatic condition associated with development of hypercholesterolemia? | Primary Biliary Cholangitis (PBC) |
| What is a common dermatological feature of Primary Biliary Cholangitis (PBC)? | Xanthelasma |
| What is Psoriasis? | Common inflammatory skin disorder characterized by hyperkeratosis and epidermal hyperplasia |
| What is hyperkeratosis? | Overgrowth of Stratum corneum |
| What is Plaque Psoriasis presented? | Chronic well-demarcated plaques with a thick, silver scale, and mildly pruritic |
| What is the most common form of Psoriasis? | Plaque psoriasis |
| What are common risk factors for Plaque Psoriasis? | Obesity, smoking, hypertension, and heavy alcohol consumption |
| What are two common signs or clinical features of Plaque Psoriasi? | 1. Auspitz sign 2. Koebner phenomenon |
| What is the Auspitz sign? | Pinpoint bleeding of underlying dilated capillaries in rashes |
| What is the "Koebner phenomenon"? | Plaque forming in areas subjected or prone to trauma or fiction |
| What are the areas most common to develop Koebner phenomenon? | Extensor surface of elbows and knees, and dorsal surface of hands |
| What are Seborrheic Keratoses? | Pigmented macules or plaques with greasy surface and well-demarcated borders |
| What does a rapid onset of numerous seborrheic keratoses indicate? | Internal malignancy, especially Gastric adenocarcinoma |
| What dermatological sign or condition is often associated with Gastric carcinoma? | Rapid onset of numerous seborrheic keratosis |
| What is the Leser-Trelat sign? | Rapid onset of numerous seborrheic keratosis |
| What GI malignancy is strongly associated with Leser-Trelat sign? | Gastric adenocarcinoma |
| What skin conditions are associated with Insulin resistance? | Acanthosis nigricans and Multiple skin tags |
| What skin condition are associated with Hepatitis C? | 1. Porphyria cutanea tarda (PCT) 2. Cutaneous Leukocytoclastic vasculitis (palpable purpura) secondary to cryoglobulinemia |
| What dermatological condition associated with Celiac disease? | Dermatitis herpetiformis |
| What are common skin conditions of those immunosuppressed? | 1. Recurrent Herpes Zoster 2. Disseminated Molluscum Contagiosum |
| What is the skin condition associated with inflammatory bowel disease (IBD)? | Pyoderma gangrenosum |
| Description of dermatological rash caused by VZV | Unilateral vesicular rash localized on a single dermatome |
| Unilateral dermatomal distribution rash, is often seen with what infection? | Herpes Zoster Virus infection |
| What is the most common neurological complication of VZV infection? | Postherpetic neuralgia |
| How would Postherpetic neuralgia be described commonly? | Long-term residual pain at site of dermatomal rash distribution |
| What is Lichen planus? | Immune-mediated condition that present with pruritic, pink papules and plaques, often with lacy, scaly, white markings (Wickham striae) |
| Where is the most common locations for Lichen Planus to appear in the body? | Flexural surfaces of the wrist and ankles, but also can involve nails, oral mucous membranes, and genitalia |
| What immune-mediated condition is associated with a pink, pruritic rash in the wrists and ankles? | Lichen Planus |
| How is Rubella rash spread? | Begins on the face and spreads to the trunk and extremities |
| Which two common pathogens that produce a rash spreading from the face down to the trunk and extremities? | Rubella and Rubeola |
| What is another name of Rubella? | German measles |
| What is another name of Rubeola? | Measles |
| Measles. Rubella or Rubeola? | Rubeola |
| German measles. Rubella or Rubeola? | Rubella |
| What are the main features that indicate Rubella rather than Rubeola infection? | 1. Postauricular lymphadenopathy 2. Spreads faster and does not darken or coalesce |
| What is the viral family of Rubella? | Togavirus |
| What type of viral family of Rubeola? | Paramyxovirus |
| How do androgenic steroids affect the skin? | Stimulate follicular epidermal hyperproliferation and excessive sebum production, thereby promoting acne development |
| What are some results of chronic topical corticosteroid use? | Atopic dermatitis, characterized by dermal atrophy |
| What is the dermal description or condition of atopic dermatitis? | Atrophy/thinning of dermis |
| What are the features seen with dermal atrophy? | Loss dermal collagen, drying, cracking, and/or tightening of the skin |
| What type of hypersensitivity reaction is Contact dermatitis? | Type IV (delayed-type) |
| What cells are involve in the first event of Contact dermatitis? | Langerhans cells |
| What is the initial pathogenesis of Contact dermatitis? | Langerhans cells presents as haptens to naive T cells, leading to clonal expansion |
| What is the second pathogenic course upon re-exposure on haptens that cause Contact dermatitis? | Sensitized CD8+ T cells are recruited to skin and destroy tissue |
| What is the consequence of release of IFN-gamma by T cells in association to Contact Dermatitis? | Amplified the immune response |
| What is the most common congenital anomaly? | Accessory nipple |
| What gives rise to an accessory nipple? | Failed regression of the mammary ridge in utero |
| If not asymptomatic, what are the symptoms seen with accessory nipples? | Tender along with breast tissue during times of hormonal fluctuation |
| What is the most common cause of nonpurulent cellulitis? | B-hemolytic streptococcus, (particularly Group A strep) |
| What is the most common cause of purulent cellulitis? | S. aureus infection |
| What malignancy is associated with Programmed-Death receptor 1 (PD-1)? | Melanoma |
| What is PD-1? | A checkpoint inhibitor that downregulates the cytotoxic T cell response |
| What is downregulated by PD-1? | Cytotoxic T cell response |
| Common PD-1 inhibitor (drug) | Pembrolizumab |
| How does Pembrolizumab work? | Restore the T-cell response, allowing cytotoxic T cells to invade the tumor and induce apoptosis of neoplastic cells |
| What dermatological condition is often associated with absolute neutropenia? | Ecthyma gangrenosum |
| What is Ecthyma gangrenosum? | Cutaneous necrotic disease with a strong association to Pseudomonas aeruginosa bacteremia |
| What bacterium is associated most commonly with development of Ecthyma gangrenosum? | Pseudomonas aeruginosa |
| What is the pathogenesis of Ecthyma gangrenosum? | Pseudomonas bacteria, causes perivascular invasion and release of tissue destructive exotoxins, cause vascular destruction and insufficient blood flow to patches of skin that then become edematous and necrose |
| What is the value indicates neutropenia? | < 500 cells |
| What is Photoaging? | Product of excess exposure to UV A-wavelengths and is characterized by epidermal atrophy with flattening of rete ridges |
| What are consequences of photoaging? | 1. Epidermal atrophy flattening of rete ridges 2. Decreased collagen fibril production 3. Increased degradation fo collagen and elastin in the dermis |
| What is another name for Cutaneous warts? | Verruca vulgaris |
| What pathogen (virus) most commonly causes cutaneous warts? | HPV |
| How are the cutaneous warts described grossly? | Rough, skin-colored papules |
| What are findings in biopsy fo a cutaneous wart? | Epidermal hyperplasia, Thickened stratum corneum, Papilloma formation, Cytoplasmic vacuolization (Koilocytosis) |
| What condition is often seen with Acantholysis? | Herpes simplex labialis |
| What is acantholysis? | Intraepidermal fracturing |
| How is Tinea corporis presented? | Round or ovoid lesions with a raised, scaly border and central clearing |
| What is the most common cause of Tinea corporis? | Trichophyton rubrum infection |
| How does Trichophyton infection causes Tinea corporis? | Infracts keratinized matter in the S. corneum of the superficial epidermis but does not invade the dermis and subcutaneous tissues |
| Which layer of the skin is the only one affected by Tinea corporis? | Superficial layer of the epidermis (S. corneum) |
| How is Dermatitis herpetiformis characterized? | Erythematous pruritic papules, vesicles, and bullae that appear symmetrically on extensor surfaces |
| What condition is strongly associated with Dermatitis herpetiformis? | Celiac disease |
| What are some histological findings of Dermatitis herpetiformis? | 1. Small intestinal intraepithelial lymphocytosis 2. Crypt hyperplasia 3. Villous atrophy |
| What antibodies (+) in Celiac disease, and is highly suggestive of such condition? | IgG tissue transglutaminase autoantibodies |
| How Lichen planus presented? | Pruritic, pink/purple, polygonal papules and plaques, that can affect the flexural surfaces of the wrist and ankles, along with nails, oral mucus membrane and genitalia |
| Which areas of the body are most likely affected in Lichen planus? | Flexural surfaces of wrist and ankle |
| What are some histological findings of Lichen planus? | 1. Hyperkeratosis 2. Lymphocytic infiltrates at the dermoepitelial junction 3. Hypergranulosis 4. Sawtooth rete ridges 5. Scattered eosinophilic colloid bodies |
| Histological findings show sawtooth rete ridges, scattered eosinophilic colloid bodies, and prominent granular layer of the skin. Suggested dx? | Lichen planus |
| Condition characterized by loss (absence) of epidermal melanocytes. | Vitiligo |
| What two autoimmune disorders are often associated with development of Vitiligo? | Autoimmune thyroiditis and type 1 Diabetes mellitus |
| What condition's rash is often described as "well-defined, variably sized patches of hypopigmentation"? | Vitiligo |
| What is Bullous impetigo? | Superficial infection caused by S. aures that is most common in young children |
| What bacteria causes Bullous impetigo most often? | S. aureus |
| Blistering skin rash with tan-to-honey-colored crusts, in children with a severe fever. Dx? | Bullous impetigo |
| What causes the blistering in Bullous impetigo? | Exfoliative toxin A, which targets Desmoglein-1 in epidermal cellular junctions and causes loss of cell adhesion |
| What toxin is associated with blistering in Bullous impetigo? | Exfoliative toxin A |
| Which condition targets Desmoglein-1 leading to eventual blistering? | Bullous impetigo caused by S. aureus infection |
| What is the resultants of targeting Desmoglein-1 with Exfoliative toxin A in Bullous impetigo? | Loss of cell adhesion |
| Sporotrichosis, is it of bacterial, fungal, or viral pathologic origin? | Fungal |
| What is Sporothrix schenckii? | Dimorphic fungi that causes a subcutaneous mycosis |
| What common dimorphic fungus is known to cause a subcutaneous mycosis? | Sporothrix schenckii |
| What is the most common way S. schenckii is transmitter? | Thorn prick |
| How is Sporotrichosis clinically manifested? | Nodules atha spread along lymphatics |
| What does Imiquimod work? | Activating Toll-like receptors and upregulating NF-kB |
| What condition is often treated with Imiquimod? | HPV-infected cells in anogenital warts |
| Widely used topical immunomodulatory gaetn that stimulates a potent cellular and cytokine-based immune response to aberrant cells, especially those infected with HPV. | Imiquimod |
| What are the antiproliferative effects of Imiquimod? | 1. Inhibition of angiogenesis 2. Induction of apoptosis |
| What are the first line of treatments for localized psoriasis? | Topical corticosteroids and Vitamin D analogues |
| How do vitamin D analogs work in the treatment of localized Psoriasis? | Inhibit T cell and keratinocyte proliferation and stimulate keratinocyte differentiation |
| Which kind of medication or drugs are complementary to vitamin D analogs in the treatment of Psoriasis? | Topical corticosteroids |
| Which immunomodulatory agent is known to activate Toll-like receptors and upregulate NF-kB? | Imiquimod |
| What are Actinic Keratoses (AK)? | Small (< 1cm), erythematous epidermal lesions with adherent scale that are the result of chronic sun exposure |
| What are the histological findings of Actinic Keratoses? | 1. Keratinocyte atypia 2. Hyperkeratosis 3. Parakeratosis |
| Why does AK needs to regularly monitored? | Small percentage of Actinic Keratosis progress into invasive Squamous cell carcinoma |
| If AK leads to cancer, which malignancy is developed? | Invasive Squamous cell carcinoma of the skin |
| __________ __________, are caused by HPV and typically present as skin-colored with a dry, whitish surface. | Cutaneous warts |
| How is HPV most commonly transmitted? | Direct contact |
| What is the key histological finding of HPV-warts? | Koilocytosis |
| What is Koilocytosis? | Cytoplasmic vacuolization |
| What is Erythema multiforme? | A cell-mediated inflammatory disorder of the skin characterized by erythematous papules that evolve into "target" lesions |
| What cells mediate the E. multiforme development? | CD8+ T cells |
| Which is most common viral pathogen in the development of E. multiforme? | Herpes Simplex virus |
| What are minor associative causes of E. multiforme? | Sulfonamides, malignancies, and Collagen vascular diseases |
| What are Glomus tumors? | Slow-growing, usually benign tumors in the carotid arteries (major blood vessels in your neck), the middle ear or the area below the middle ear (jugular bulb) |
| Are Glomus tumor mostly malignant or benign? | Benign |
| What is the glomus tumor associated with the nails? | Glomangioma |
| What is the feature lesion of Glomangioma? | Red-Blue lesion under the nail |
| What is the function of the Dermal Globus bodies? | Control of the Thermoregulatory |
| What cells originate the Glomangioma in the nails? | Modified smooth muscle cells that control the thermoregulatory functions |
| Common name of herpes zoster | Shingles |
| What causes Shingles? | Reactivation of VZV in the Dorsal Root of the Ganglia (sensory neurons) |
| Is the ganglia affected by Shingles of motor or sensory functionality? | Sensory |
| What viral infection affects the Dorsal root of the ganglia? | Varicella Zoster Virus infection |
| How is the rash produced by Shingles manifested clinically? | Painful vesicular rash in dermatomal distribution |
| Is the dermatomal rash due to VZV reactivation painless or painful? | Painful |
| Tender vesicular rash in dermatomal distribution. Dx? | Shingles |
| What are the light microscopic findings of herpes zoster? | Intranuclear inclusion and Multinucleated giant cells |
| What does a (+) Tzank test represent? | It depicts intranuclear inclusions and multinucleated giant cells in herpes 3 infection |
| What are the skin biopsy findings of Shingles? | Acantholysis of keratinocytes and intraepidermal vesicles |
| Acantholysis forming suprabasal blisters. Dx? | Pemphigus vulgaris |
| What is the IM main fidingin Pemphigus vulgaris? | IgG deposition in a reticular pattern around keratinocytes |
| Is the IgG deposition in Pemphigus vulgaris around keratinocytes in a linear or reticular (net-like) pattern? | Reticular pattern |
| Target desmosomal protein (Desmoglein-3) | Pemphigus vulgaris |
| What is the target of autoantibodies present in Pemphigus vulgaris? | Desmosomal proteins (Desmoglein 3) |
| Which condition is attacked by body own immunity the Desmoglein-3 ? | Pemphigus vulgaris |
| Pemphigus vulgaris. Autoantibodies against desmosomes or hemidesmosomes? | Desmosomes |
| What rash is seen with a Poxvirus infection? | Molluscum contagiosum |
| What are key or featured histological findings of Molluscum contagiosum? | Eosinophilic cytoplasmic inclusions (molluscum bodies) |
| What are the "molluscum bodies"? | Eosinophilic cytoplasmic inclusion |
| Which rash often grossly described as Umbilicated, skin-colored papules? | Molluscum contagiosum |
| How is Dermatitis herpetiformis described? | Grouped vesicles and extensor surfaces |
| What is the LM description and findings in Dermatitis herpetiformis? | Accumulation of neutrophils on the tips of dermal papillae (microabscess) |
| Which dermatological condition is associated with microabscess in dermal papillae? | Dermatitis herpetiformis |
| How is the Granulomatous response clinically? | Tender, erythematous, brown and purple papule, nodules, or plaque |
| What is Granulomatous inflammation? | Chronic inflammation characterized by aggregates of activated macrophages that assume an epithelioid appearance |
| What is a common cause for a granulomatous response to be initiated? | Foreign bodies retention |
| Does high glucose level improve or impair wound healing? | Impairment wound healing |
| How does high glucose levels impair wound heal? | Elevated blood glucose induce the release of ROS and proinflammatory cytokines from neutrophils while inhibiting the production of anti-inflammatory cytokines and growth factors |
| What is a common anti-inflammatory cytokine inhibited by hyperglycemia? | IL-10 |
| What is another way to refer to Atopic dermatitis? | Eczema |
| What causes Atopic dermatitis? | Impairment of the skin's barrier function |
| What is Atopic dermatitis? | Common, chronic inflammatory disorder caused by a deficient barrier functionalities of the skin |
| How is eczema presented? | Pruritic and erythematous papules and plaques and is associated with atopic diseases |
| What are some atopic diseases associated with Eczema? | Allergic rhinitis and asthma |
| What are the main histological and/or microscopic findings of warts? | Epidermal hyperplasia and cytoplasmic vacuolization |
| What dermatological conditions are caused by HPV? | 1. Cutaneous warts 2. Condyloma acuminata |
| Gross description of cutaneous warts: | Small black spots represent capillaries |
| Besides condyloma acuminata, what other skin condition is often seen with HPV infection? | Cutaneous warts |
| How is Staphylococcal Scalded Skin syndrome caused? | Occurs in infants and children due to the production fo Exfoliative Exotoxins by S. aureus |
| What bacteria is known to cause Staphylococcal Scalded Skin syndrome? | S. aureus |
| Which condition is due to production of exfoliative exotoxins by S. aureus? | Staphylococcal Scalded Skin syndrome |
| In Staph SS syndrome, what protein is attacked by the exotoxins? | Desmoglein in desmosomes |
| Are desmosomes or hemidesmosomes affected in Staphylococcal Scalded Skin syndrome? | Desmosomes |
| Which condition is often seen with epidermal blistering, shedding, due to toxin action on desmosomal protein? | Staphylococcal Scalded Skin syndrome |
| Are mucus membranes spared or affected in SSSS? | Mucous membranes are spared |
| Autoimmune bullous disease charetezied by autoantibodies directed against desmosomal proteins (desmoglein). Dx? | Pemphigus vulgaris |
| What is an important relation or similarity between the pathogenesis of Pemphigus vulgaris and Staph Scalded Skin syndrome? | Both conditions are due to attack on desmosomal protein, Desmoglein |
| Bacterial toxin attacking desmoglein. Dx? | Staphylococcal Scalded Skin syndrome |
| How is the rash in SSSS presented? | Painful bullae and erosions affecting the skin and mucosal membranes |
| What is the Asboe-Hansen sign? | Bullae spread laterally with pressure |
| Condition (+) Asboe-Hansen sign and (+) Nikolsky sign, involving exotoxin? | Staphylococcal Scalded Skin syndrome |
| Autoantibodies against hemidesmosomal proteins. Dx? | Bullous pemphigoid |
| How are the bullae of Bullous pemphigoid? | Tense and remain intact as the entire epidermis separates from the dermis |
| Does Pemphigus vulgaris or Bullous pemphigoid involve the mucous membranes? | Pemphigus vulgaris |
| Target-shaped, inflammatory skin lesion that typically arises from infection such as HSV ro Mycoplasma pneumoniae? | Erythema multiforme |
| What causes Erythema multiforme? | Deposition of infectious antigens in keratinocytes. ledading to strong CD8+ T-cell - mediated immune response |
| Other than HSV, what other pathogen associated infection causes Erythema multiforme? | Mycoplasma pneumoniae |
| What class of drugs are used to treat hair loss? | 5-alpha reductase inhibitors |
| What is prevented by 5-a reductase inhibitors? | Conversion of Testosterone into DHT |
| Why does a person treated with Finasteride for hair loss, often develops mild gynecomastia? | The accumulation of testosterone due to inhibition of DHT production, leads to more testosterone available to convert into Estradiol by aromatase |
| Which enzyme converts testosterone into Estradiol? | Aromatase |
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