SKIN

Question 0

Solar / Acitinic Keratosis

Def’n, Pres, Comp / Prog?

Answer 0

Pre-malignant lesions caused by sun exposure.

PRES:
- Small rough papules or plaques- red or brown

COMP / PROG:
- Risk of SCC proportional to epithelial dysplasia

Question 1

Albinism

Seen In?

Answer 1

SEEN IN:

- Chediak-Higashi Sx (phagocyte dysfunction)

Question 2

Pityriasis Rosea

Pres, Course?

Answer 2

PRES:

• Multiple Papules
• “Herald patch” followed days later by “Christmas tree” distribution

Remits spontaneously in 6-8 wks.

Question 3

Bullous Pemphigoid

Def’n, Pres, IF Finding?

Answer 3

Autoimmune skin disorder with IgG against Hemidesmosomes.
** LESS SEVERE than Pemphigus Vulgaris **

PRES:
- Bullae: Tense. Contain Eosinophils.

IF:
- Linear pattern of antibodies at epidermal-dermal junction

Question 4

Pemphigus Vulgaris

Def’n, Locations (2),
Pres (2), Histo (2), IF Finding?

Answer 4

Autoimmune skin disorder with IgG antibody against Desmoglein.
** Potentially fatal **

Skin + Oral mucosa.

PRES:

• Bullae: Flaccid + Rupturing
• Nikolsky Sign + (separation of epidermis upon manual stroking of skin)

HISTO:

• Acantholisis
• Bullae (intraepidermal)

IF:
- Ab around epidermal cells in “reticular / net-like pattern”

Question 5

Dermatitis Herpetiformis

Def’n, Location, Assoc, Pres?

Answer 5

IgA deposits at tips of dermal papillae.

MC Location = Elbows

ASSOC: Celiac Disease

PRES:
- Papules + Pruritic vesicles

Question 6

Erythema Multiforme -> S-J Sx -> Toxic Epidermal Necrolysis

Def’n, Subtype, Assoc (5, incl 3 drugs), Pres (2), Histo (3)?

Answer 6

H-S rx char by targetoid rash (central necrosis surrounded by erythema) + bullae.

PRES:

• Targetoid rash
• Bullae

Stevens-Johnson Sx: EM with lip / oral mucosa involvement + fever ->
Diffuse sloughing of skin (resembling large burn).
Potential death.

ASSOC:

• Mycoplasma pneumoniae
• HSV
• Autoimmune Disease (ie SLE)
• Cancer
• Drugs: Penicillins, Sulfa drugs, Phenytoin

HISTO:

• Macules
• Papules
• Pustules

Question 7

Erythema Nodosum

Def’n, Location, Assoc (7)?

Answer 7

Infl lesions of subcutaneous fat.

MC on Ant Shins

ASSOC:

• Strep infections
• Coccidioidomycosis
• Histoplasmosis
• TB
• Leprosy
• Sarcoidosis
• Crohn Disease

Question 8

Lichen Planus

Def’n, Assoc, Locations (3), Pres (“4 Ps”)?

Answer 8

“Sawtooth inflitrate” of lymphocytes at epidermal-dermal junction.

ASSOC:
- Hepatitis C

Oral mucosa, Elbows, Wrists.

PRES = Purple Pruritic Polygonal Papules

Question 9

Psoriasis

Def’n, HLA, Location (3), Pres (Sign + 1), Histo (2)?

Answer 9

Excessive proliferation of keratinocytes.
Well-circumscribed red plaques with silvery scaling.

HLA-C.

Scalp, Elbows, Knees.

PRES:

• Auspitz Sign
• Red plaques: well-circumscribed w silvery scaling

HISTO:

• Parakeratosis
• Acanthosis

Question 10

Acanthosis Nigricans

Def’n, Locations (2), Assoc (2)?

Answer 10

Acanthosis with darkening of skin -> “velvety skin”.

MC on Neck + Axilla.

ASSOC:

• Hyperinsulinemia
• Visceral malignancy

Question 11

Seborrheic Keratosis

Def’n, Pres (Epi + Sign + 1), Histo?

Answer 11

Benign squamous proliferation.

PRES: Elderly

• Raised, pigmented, greasy / waxy plaques with “stuck-on” appearance
• Leser-Trelat Sign: Sudden appearance of MULTIPLE of these
  
  • ** Indicates underlying malignancy ***

HISTO:
- Horn Cysts: Keratin-filled pseudocysts

Question 12

Melanoma

Pres, Prognosis?

Answer 12

PRES:
- Brown-black lesion with fuzzy edge

PROG: ** DEPTH of lesion = most important prog factor **

Question 13

Basal Cell Carcinoma (BCC)

Pres (3 options, 4 subfeatures in 1st)?

Answer 13

PRES:

• “Pearly Pink Papule” with:
  
  • Rolled edges
  • Central ulcerated “crater”
  • “Palisading” nuclei
  • Dilated (telangiectatic) surrounding vessels
• Nonhealing Ulcers with infiltrating growth
• Scaling Plaque

Question 14

Squamous Cell Carcinoma

Precursor, MC Locations (4), Assoc, Pres, Biopsy Finding?

Answer 14

PRECURSOR = Solar / Actinic Keratosis

MC Locations = Face, Lower Lip, Ears, Hands

ASSOC:
- Can be sign of Mature Ovarian Teratoma

PRES:
- Ulcerative red lesion

BIOPSY:
- “Keratin pearls” (Skin Biopsy)

Question 15

Limited Scleroderma / CREST Sx

Def’n + Locations, Antibody, Pres (5: “CREST”)?

Answer 15

Scleroderma limited to Face + Fingers.

Anti-Centromere Antibody.

PRES:

• Calcinosis (formation of Ca deposits in any soft tis)
• Raynaud Phenomenon
• Esophageal Dysmotility
• Sclerodactyly (thickening / tightening of skin of fingers + toes)
• Telangiectasia (“spider veins”: small dilated bl vessels)

Question 16

Roseola (Exanthem Subitum)

Causative Bugs (2), Trans, Pres (Epi + 2)?

Answer 16

CB:

• • HHV-6
• HHV-7

TRANS: Saliva

PRES: Infants (usually)

• Several days of high fever -> Macular rash over body
• Febrile seizures (sometimes)

Question 17

Hand-Foot-Mouth Dz

Causative Bug, Pres (2)?

Answer 17

CB = Coxsackie A virus.

PRES: Vesicles

• Vesicular rash on palms + soles
• Vesicles + ulcers in oral mucosa

Question 18

Rubella

Pres (2)?

Answer 18

PRES:
- Rash begins at head and moves down (same as Measles) ->
Fine truncal rash.
- Postauricular lymphadenopathy

Question 19

Scarlet Fever

Causative Bug, Pres (4)?

Answer 19

CB = Strep pyogenes.

PRES:

• Erythematous “sandpaper”-like rash
• “Strawberry tongue”
• Fever
• Sore throat