Diagnostic Quiz Questions

Basal Cell Nevus Syndrome - genetics - what gene - Clinical Manifestations

Basal cell nevus syndrome is an autosomal dominant syndrome caused by a mutation in PTC gene, which acts in the Sonic hedgehog pathway. Cutaneous manifestations of this genodermatosis include basal cell carcinomas, palmoplantar pits, epidermoids cysts. Other findings include odotogenic cysts, frontal bossing, bifid ribs, calcification of the falx cerebri and medulloblastomas.

BP230 is a member of what family of proteins? where are keratins 1/9 5/14 1/10 found

BP230 is a member of the plakin family and is homologous to desmoplakin and is intracellular. It attaches intermediate filaments to hemidesmosomal plaque. The remaining options are not part of the plakin family. keratins 1 and 9 are found on the palms and soles. 5 and 14 in the basal layer, 1 and 10 in the suprabasalar keratinocytes

Most common mutation in mucosal melanomas? Where should undermining be performed in the temple so as to avoid damage to the temperal nerve Which antifungal has a black box warning for CHF what drug can cause yellowing of the hands and sclera

KIT subcutaneous fat itraconazole quinacrine

Keratohylin Granules contain what?

Keratohyalin granules are found in the stratum granulosum (the granular layer), and contain the proteins involucrin, profilaggrin and loricrin. Profilaggrin is converted to filaggrin during the transformation of the granular layer to the cornified layer. This is a calcium-dependent process. Loricrin comprises 75% of the cornified envelope's mass.

Solar Urticaria - Lesions typically occur when? - can rarely be associated with what? Opthalmia Nodosa: Common cause? What is in Jessner's solution?

Rare cases of solar urticaria have been associated with erythropoietic protoporphyria (EPP), lupus erythematosus (LE), and with certain drugs. - lesions typically start 15-30mins after exposure and last for 1 hour Tarantulas release hair and can cause chronic granulomatous reaction called ophthalmia nodosa and loss of vision. The spider releases hair and can penetrate the skin as deeply as the reticular dermis. Jessner's solution is a combination of resorcinol, salicylic acid, and lactic acid in ethanol that is used as a superficial peeling agent.

Which human papillomavirus type is associated with giant condylomata of Bushke and Lowenstein (Bushke-Lowenstein tumor)? Best treatment for gonnococcemia?

6 and 11 This patient has gnathostomiasis caused by Gnathostoma dolorosi or spinigerum. It is commonly acquired from freshwater fish. It manifests with migratory intermittent erythematous urticarial plaques that recur every 2-6 weeks. The plaques move about 1 cm/day. Histology shows eosinophilic panniculitis. Treatment is surgical removal or albendazole. IV Ceftriaxone

lymphogranuloma venereum - Cause - Treatment What does methyl-green pyronin due?

: LGV is a sexually transmitted disease that is characterized by suppurative inguinal adenitis with matted lymph nodes, inguinal bubo with secondary ulceration, and constitutional symptoms. It is caused by Chlamydia trachomatis serotypes L1, L2, and L3. First line treatment is doxycycline 100mg bid for 3 weeks as well as treating the sexual partners. Gamma-Favre bodies are found in histiocytes in LGV Methyl-green pyronin stains DNA green. The other answer choices are not colors produced with methyl-green pyronin staining.

- a Ring block around the ear anesthetizes what areas - what provides sensation for the conchal bowl? - innervation of the tragus - innervation of the posterior ear

A ring block around the ear anesthetizes the entire ear, except for the conchal bowl and external auditory meatus. The vagus nerve provides the cutaneous sensation for the conchal bowl.The great auricular nerve innervates the majority of the posterior ear, as well as 3/4 of the anterior helix. The auriculotemporal nerve innervates the tragus, anterior helix and part of the superior helix.

which proteins are antigenic in paraneoplastic pemphigus Cicatricial pemphigoid - typical treatment

BPAg2, a 180kDa protein, is typically not found to be antigenic in paraneoplastic pemphigus. The proteins typically involved are: desmplakin 1 (250kDa), BPAg1 (230 kDa), Envoplakin (210kDa), Desmoplakin (210kDa), Periplakin (190 kDa), Desmogleins 1& 3 (160 and 130 kDa). Cicatricial pemphigoid is a heterogeneous group of subepithelial blistering diseases involving the mucous membranes and skin. The treatment of cictracial pemphigoid is predicated upon the extent, severity, and location of disease. Most regimens used are empiric and are based on clinical experience. With severe ocular involvement, most experts recommend aggressive treatment with the combination of cyclophosphamide and steroids.

The enzyme tyrisinase contains what element Matrix metalloproteases require what element The major component of the cornified layer is what?

copper Zinc loricrin

which meds have been known to cause drug induced BP? Pemphigus vulgaris is associated with what HLA types EBA - cause - two types

diabetes meds gliptins Patients with HLA-DRQ402, HLA-DR4 and HLA-DRw6 can be predisposed to the development of pemphigus vulgaris. Epidermolysis bullosa acquisita (EBA) is an autoimmune subepidermal bullous disorder of the skin and mucous membranes. The disease results from the production of immunoglobulin G (IgG) antibodies against type-VII collagen, a major component of anchoring filaments in the dermal-epithelial junction. The disease has two major forms of presentation: the classical (non-inflammatory) type and the inflammatory type. Classical EBA is mainly characterized by the following features: development of non-inflammatory tense blisters on trauma-prone areas, multiple milia cysts, minimal or no inflammation findings on histopathology. Alternatively, inflammatory EBA is defined by widespread inflammatory blistering eruptions and a neutrophil-rich inflammatory infiltrate on standard histopathology. In both cases, specialized immunopathological findings are further required to establish an accurate diagnosis.

Catepillars and disease Rocky mountain spotted fever is associated with which tick species

egalopye opercularis, also known as the puss caterpillar, has spines, which can cause hemorrhagic papules in a grip like pattern. Lonomia caterpillars cause a potentially fatal hemorrhagic syndrome and the treatment uses antilonomic serum.The saddleback caterpillar can cause swelling of the hands, nausea, and a bad rash that takes time to clear. Rocky Mountain Spotted FeverExplanation: The pictured tick is Dermacentor variabilis, which is responsible for Rocky Mountain Spotted Fever.

When do the lesions of PMLE usually appear Most common cause of phytophotodermatitis

hours to days after exposure The Apiaceae (formerly umbelliferae) family is the most common cause of phytophotodermatitis. The members of this family include cow parsley, celery, wild parsnip, false bishop's weed, giant hogweed, angelica, meadow grass, fennel, wild carrot, caraway, and coriander.

Dystrophic Epidermal bullosa is associated with what skin cancer what is seen on KOH for candidiasis

it is associated with SCC budding yeast and pseudohyphae

Sticky skin syndrome can be caused by a combination of which meds Most common cause of AGEP Keratins - Acid vs Basic Keratins - what chromosome are each found on?

keto and doxorubicin beta-lactams Acidic keratins (K9-20) are expressed from chromosome 17.Basic keratins (K1-8) are on chromosome 12

Most common hematologic abnormality in kids with measles culture medium for leishmaniasis Primary cause of tinea capitis in the US?

lymphopenia novy-MacNeal-Nicolle T Tonsurans

Most common cause of photoallergic dermatitis mechanism of action for capscaicin what is the cause of bakers itch? possible consequences of using phenol for peels?

sunscreens Repeated substance P release leads to eventual depletion of this chemical which causes pain transmission. Acarus (grain mite) causes so-called "baker's itch." nlike other peeling agents, phenol has the potential to cause severe adverse reactions which are exclusive to its use. They include atrophy, cardiac arrhythmias and laryngeal edema.

True leukonychia is caused by what? Mees lines are caused by what? Apparent leukonychia that dissapears with pressure represents a problem with what? Muehrckes lines Terry's lines

true leukonychia is due to a nail plate problem wherein the distal matrix is disordered. Mee's lines are due to arsenic poisoning. Apparent leukonychia disappears with pressure and represents a problem with the nail bed, not the nail plate. Apparent leukonychia may be indicative of overall health compromise. Muehrcke's lines are paired white bands and are a type of apparent leukonychia. Terry's lines are apparent leukonychia are associated with cirrhosis, the proximal 2/3rd of the nail is white.

PMLE most commonly occurs in whom? what are the causes of cutaneous larva migrans

PMLE most commonly appears in fair-skinned females during the first three decades of life. It may be related to type IV hypersensitivity. Cutaneous larva migrans is caused by the hookworms, Ancylostoma caninum and A. Brazilense. Toxoplasma gondii causes toxoplasmosis, which is usually minor and self-limiting but can have serious or even fatal effects on a fetus whose mother first contracts the disease during pregnancy or on an immunocompromised human or cat. Onchocerca volvulus is a nematode which is spread to humans by the bite of the blackfly (genus: Simulium). This causes onchocerciasis, also known as river blindness, which is the world's second leading cause of blindness. Shistosoma hematobium, S. japonicum & S. mansoni are flatworms that causes schistosomiasis, which is acquired by swimming or playing in infected water. Strongyloides stercoralis is a nematode which causes strongyloidiasis, which mainly affects the GI tract as well as red hive-like areas near the anus

POEMS Syndrome - What does it stand for Clear cell syringomas are associated with what? Eruptive syringomas may arise in whom? The most common cause of internal pruritus

POEMS syndrome is a rare multisystem disorder. POEMS stands for: Polyneuropathy Organomegaly Endocrinopathy Monoclonal gammopathy Skin changes Clear cell syringomas are associated with diabetes mellitus. Eruptive syringomas may arise in patients with skin type V and VI and in patients with Down's syndrome. Renal Failure

Pagetoid Reticulosis - What is it? - presentation

Pagetoid reticulosis is an indolent cutaneous T-cell lymphoma. Pagetoid reticulosis favors an acral distribution and typically presents as scaly oval plaques. Epidermotropism is present, with tumor cells being CD4 positive or CD8 positive. Another interesting immunohistochemical finding is the absence of CD45 expression.

Papillon Lefevre Syndrome - characterized by what? defect in what? First line therapy for sneddon wilkinson disease?

Papillon Lefevre Syndrome is an autosomal recessive syndrome characterized by transgredient PPK and periodontitis. There is a defect in cathepsin C. One sees dural calcification at the tentorium and choroid plexus.Tram track calcifications are seen in Sturge-Weber. Calcification of the falx cerebri, agenesis of the corpus callosum, and neuroblastoma may be seen in basal cell nevus syndrome. Hippocampal calcification is seen in lipoid proteinosis. First line therapy for subcorneal pustular dermatosis or Sneddon-Wilkinson disease is dapsone 50-200mg/day. Sulfapyridine, acitretin, PUVA, NB UVB, topical and systemic steroids, vitamin E and antibiotics have been reported to be helpful also

Pastias lines - describe, seen in what condition? what is the cause of this condition? treatment? Onychomadesis - classic cause?

Pastia's lines describes the linear petechiael streaks along body folds seen in scarlet fever, which results from pharyngitis due to erythrogenic toxin-producing strains of Group A Step. It most often affects children, who also typically have fever, sore throat, headache, a sandpaper-like eruption (tiny pink papules on erythematous background) and a strawberry tongue. Treatment is with penicillin or erythromycin for 10-14 days. Although rare, onychomadesis has been associated with enteroviral infections, including hand-foot-mouth syndrome due to Coxsackie virus. Onychomadesis is an idiopathic shedding of the nails beginning at the proximal end. It may be due to temporary arrest of the matrix during the infection. In most cases, the nails return normally.

NF1 + multiple juvenile xanthogranulomas puts you at higher risk of developing what? Alkaptonuria manifests where? Bazex-Dupre-christol syndrome

Patient with NF 1 who have multiple juvenile xanthogranulomas are at 20 times greater risk for developing juvenile chronic myelogenous leukemia. The patient has alkaptonuria. The ears are a common site of involvement and show visible darkening over time. The musculoskeletal system can be involved as well. Bazex-Dupre-Christol syndrome includes multiple BCC, follicular atrophoderma, hypohidrosis, milia, epidermoid cysts, and hypotrichosis.

Hair Dye allergen, what is it? Sebaceous gland - what is the major constituent of sebaceous lipid?

Patients that are allergic to permanent hair dyes are allergic to para-Phenylenediamine (PPD). The contact dermatitis can present as an erythematous rash on the hands or on the frontal scalp Triglyceride is the major constituent of sebaceous lipid, accounting for over 50% of the lipid. Wax esters constitute about 25% of sebaceous lipid and Squalene accounts for about 15%. The remainder is free cholesterol and cholesterol esters.Wax esters constitute about 25% of sebaceous lipid and Squalene accounts for about 15%. The remainder is free cholesterol and cholesterol esters.

Which wavelength of light causes the best cutaneous immunosuppression Most common cause of allergic contact derm due to sunscreen? Facts about UV radiation and carcinogenesisi

290-320nm (UVB) is most effective in suppressing cutaneous immunity; mechanisms include depletion of Langerhans cells, induction of regulatory T cells, and keratinocyte secretion of IL-10 and TNF-alpha. Benzophenone-3, also called oxybenzone, accounts for over 70% of all contact dermatitis to sunscreen ingredients. Mid-range UVR (280-320 nm) is more efficient in inducing neoplasia in mice, but long wave UVA, when added to UVB, may accelerate carcinogenesis. Suppressor T-cells induce susceptibility to tumors, and appear to arise in UV-irradiated hosts prior to tumors developing, thus playing a role in carcinogenesis. Cells from patients with AKs have less DNA repair capacity than controls. UVB is most effective in producing pyrimidine dimers, which may activate oncogenes, particularly in the formation of BCCs and SCCs.

accessory tragus - Linked to a defect in what? - can be associated with what syndrome - Features of this syndrome?

Accessory tragus is the most common congenital defect of the external ear and linked to maldevelopment of the first branchial arch. It can be associated with several syndromes including Goldenhar syndrome, in which epibulbar dermoid and vertebral defects are also common. An accessory tragus usually it appears as a small skin-colored tag or nodule arising near the tragus; it is composed of normal epidermis with dermal adipose tissue, pilosebaceous units, eccrine glands, elastic fibers, and cartilage. Together with ipsilateral facial hypoplasia, ear deformities, epibulbar dermoids, and vertebral abnormalities, accessory tragi are a cardinal feature of hemifacial microsomia (Goldenhar syndrome). Accessory tragi may be seen in a number of other multiple congenital anomaly syndromes, including Nager acrofacial dysostosis, Townes-Brocks syndrome, Treacher Collins-Franceschetti syndrome, VACTERL association, Wildervanck syndrome, and Wolf-Hirschhorn syndrome.

Actinic Reticuloid - a type of what? - typically affects whom? Clinical presentation? - Histo resembles what? - what type of testing may be positive?

Actinic reticuloid is a type of chronic actinic dermatitis. Ive et al. introduced the disease as a severe dermatosis with no apparent photoallergen. It generally affects elderly males and is characterized by infiltrated erythematous plaques on an eczematous background in exposed sites with lymphadenopathy.Histopathologically, it may resemble cutaneous T cell lymphoma. However, there is a trend towards a lower CD4+/CD8+ ratio. It is not considered a premalignant condition. Positive photo patch testing is common. It generally affects elderly males

What is the cause of suppurative nodules and sinus tracts especially in the craniofacial area in someone with poor dental hygiene? - what kind of granules does this organism have? - shape and gram stain - treatment of choice?

Actinomyces israelii is an anaerobic gram-positive rod which causes chronic suppurative nodules and sinus tracts with an exudate containing sulfur granules. It most commonly effects the cervicofacial area, especially near the mandible. The abdomen and thoracic areas can also be affected. The source of infection is endogenous and patients with poor oral hygiene, penetrating foreign bodies, and recent dental procedures are at increased risk. Treatment of choice is penicillin.

Which cell surface component of T cells is part of the second signal which in addition to T cell receptor binding leads to T cell activation?

Activation of T cells requires two signals. The first is T cell receptor binding to MHC molecule on the antigen presenting cell. THe second signal involves CD28 on T cell interacting with B7 molecules on the antigen presenting cells. CD80 is expressed on Langerhans cells after activation. CD1a is a Langerhans cell surface marker. T-cells play a key role within the adaptive immune system mediating cellular immunity and orchestrating the immune response as a whole. Their activation requires not only recognition of antigen/major histocompatibility complexes by the T-cell receptor but in addition co-stimulation via the CD28 molecule through binding to CD80, CD86, or as recently discovered, inducible co-stimulator ligand expressed by antigen-presenting cells. Apart from tight control of the co-stimulatory signal by the T-cell receptor complex, expression of the inhibitory receptor cytotoxic T-lymphocyte antigen-4 (CTLA-4) sharing its ligands with CD28 is required to avoid inappropriate or prolonged T-cell activation. CD4+ Foxp3+ regulatory T (Treg) cells, which are crucial inhibitors of autoimmunity, add another level of complexity in that they differ from conventional non-regulatory CD4+ T-cells by strongly depending on CD28 signaling for their generation and homeostasis. CTLA-4 is constitutively expressed by Treg cells where it serves as a key mediator of suppression, while conventional CD4+ T-cells express CTLA-4 only after activation.

Acute intermittent porphyria - can cause what electrolyte abnormality? Via what? - Typically seen in whom? - Clinical Features

Acute intermittent porphyria can cause hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion. Porphyria cutanea tarda, variegate porphyria, hereditary coproporphyria, and erythropoietic protoporphyria are not associated with hyponatremia. Acute intermittent porphyria manifests typically in adult women in their second through fourth decades of life. The attacks are often linked to menstrual cycles, highlighting the importance of endogenous steroids, especially progesterone, in pathogenesis. The most common presenting is severe abdominal pain, nausea, vomiting, diarrhea, or constipation. Neurologic symptoms may also develop, including flaccid paralysis, seizures, neuropsychiatric and urinary symptoms such as retention or incontinence and constipation. Many patients report passing red to brown urine that may darken when exposed to air, light and warmth. Such findings should alert clinicians to consider the diagnosis of acute porphyria. Hyponatremia is a common electrolyte abnormality that occurs during acute attacks. Factors that contribute to hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, vomiting and resuscitation with high volumes of dextrose solutions given intravenously.

Name the retinoids and which receptors they bind to

Alitretinoin is the only retinoid that binds all retinoic acid receptors (RAR) and retinoid X receptors (RXR). This question probes the examinee's knowledge of the receptor affinities of retinoids. Alitretinoin (9-cis-RA, choice 1) is a first-generation retinoid that binds all RAR and RXR and is used in treatment of Kaposi sarcoma. Tretinoin (all-trans-RA, choice 2) is another first-generation retinoid that binds all RAR but not RXR. Adapalene (choice 3) and tazarotene (choice 4) are third-generation retinoids that preferentially bind RAR-β/γ over RAR-α, but do not bind RXR. Bexarotene (choice 5) is third generation and binds RXR rather than RAR; it is used to treat cutaneous T-cell lymphoma.

What is the most common complement deficiency and its associated conditions

Among the complement deficiencies, C2 deficiency is most frequently seen. Most of these patients are healthy. Diseases that occur with increased frequency in patients with C2 deficiency are SLE, SLE-like syndrome, frequent infections, anaphylactoid purpura, lethal dermatomyositis, vasculitis, disseminated cutaneous lupus erythematosus, and cold urticaria. TNF-alpha: an inflammatory cytokine produced by macrophages/monocytes during acute inflammation and is responsible for a diverse range of signaling events within cells, leading to necrosis or apoptosis. TGF-beta: a polypeptide member of the transforming growth factor beta superfamily of cytokines. It is a secreted protein that performs many cellular functions, including the control of cell growth, cell proliferation, cell differentiation, and apoptosis. IL-2: a 15-kDa cytokine predominantly secreted by activated T cells and represents a key player in the cell-mediated immune response in allograft rejection. FGF:a family of cell signaling proteins that are involved in a wide variety of processes, most notably as crucial elements for normal development.

Autoantibodies for the following conditions - CREST - MCTD -SLE - Polymyositis - scleroderma

Anti-centromeric antibodies are associated with CREST syndrome. Anti-RNP antibodies are associated with MCTD, anti-dsDNA, ssDNA, and Sm associated with SLE, anti-Jo-1 associated with polymositis, and anti-Scl 70 associated with PSS.

At what week can all the layers of the mature epidermis be identified and the epidermis is keratinized? Bullous pemphigoid - Associated with what neurologic conditions? - Antigen targets - Antigen targent for cicatricial pemphigoid?

At 24 weeks, all the layers of the mature epidermis can be identified, and the epidermis is keratinized Bullous pemphigoid is the most common immunobullous disorder and presents with tense vesicles/ bullae and pruritus. There has been as association of neurologic disorders, such as Parkinson's disease and dementia, with bullous pemphigoid. Autoantibodies are most commonly directed against the NC16A domain of BPAg2, also known as BP180 or collagen XVII.Autoantibodies to the C-terminal of BPAg1 can less commonly bullous pemphigoid. Autoantibodies to the C-terminal of BPAg2 can cause cicatricial pemphigoid. Defects in Alpha-6-beta-4 integrin result in JEB with pyloric atresia.

Pre-testing for allergy to collagen is required for which cosmetic filler? Brucellosis is caused by what? type of organism, clinical presentation, treatment?

Bellafill is a nonbiodegradable injectable filler composed of microspheres of polymethylmethacrylate which are suspended in bovine collagen. As with other types of injectable bovine collagen, patients must be tested for allergy to bovine collagen prior to treatment. Brucella species which cause Brucellosis are gram negative rods. Brucellosis, aka undulant fever, is characterized by an acute febrile illness with headache and joint pain. CNS and cardiac manifestations can also occur. It is acquired by contact with infected animals or contaminated dairy products. Treatment is with doxycycline and rifampin.

What can help distinguish between BCC/trichoep and MAC? what can distinguish BCC and trichoep?

Ber-Ep4 helps distinguish between BCCs/Trichoepitheliomas and microcystic adnexal carcinomas. Morpheaform BCC and desmoplastic trichoepithelioma are Ber-Ep4 positive where as microcystic adnexal carcinomas (MAC) are Ber-Ep4 negative. Other markers that help distinguish between BCCs and trichoepitheliomas are peanut agglutinin and CD34. Peanut agglutinin is positive in BCC and negative in trichoepithelioma vs CD34 which is negative in BCC and positive in the peritumoral fibroblasts of trichoepitheliomas.

Which CTCL is CD56+, which is EBV negative Langerhan cell stains

Both cutaneous gamma delta lymphoma and extranodal NK-T cell lymphoma are CD56+. However, only extranodal NK-T cell lymphoma is EBV + while cutaneous gamma delta lymphoma is EBV negative. Both these lymphomas have a 5-year survival rate that approaches 0% CD1a, S100, langerin, and peanut agglutinin

How does botulinum toxin A and B work? Which retinoid can cause hypothyroidism

Botulinum toxin type A is FDA approved for the treatment of glabellar wrinkles. Botulinum toxins act by a three step process of binding, internalization by receptor medicated endocytosis and enzymatic activation. It has specific light chain intracellular binding sites and different sites of action on different SNARE (synaptosomal associated protein receptor [SNAP]) proteins. The SNARE proteins are intimately involved in releasing acetylcholine at presynaptic terminals. Botulinum toxin A cleaves SNAP-25 whereas B cleaves synaptobrevin Bexarotene can cause a central hypothyroidism with low TSH and T4. You must titrate the levothyroxine dose to the free T4 as it is a central hypothyroidism which is defined as insufficient TSH to stimulate an otherwise normal thyroid gland.

Best Screening Test for Hereditary Angioedema

C4 is the best screening test for hereditary angioedema (Quinke's edema). There are two types of hereditary angioedema. In type I, there are low antigenic and functional levels of a NORMAL C1 esterase inhibitor protein. In type II, there is a normal or elevated level of a DYSFUNCTIONAL C1 esterase inhibitor. The low C4 level is a result of continuous activation and consumption of complement components.The other screening tests are less sensitive than checking C4 in hereditary angioedema.

CD 2 Molecules - Purpose - Bind to what? -

CD2 molecules are T cell surface receptors that bind to LFA-3 on endothelial cells and antigen presenting cells to participate in adhesion and activation. All lymphocyte adhesion (both antigen-specific and seemingly non-specific adhesive interactions) has to be based on specific receptor-ligand interactions. There are two molecular pathways of lymphocyte adhesion that have been shown to play a critical role in facilitation of antigen-specific recognition, namely CD2 and its ligand, lymphocyte function associated antigen-3 (LFA-3), and LFA-1 and its ligand, intercellular adhesion molecule-1 (ICAM-1). CD2 molecules are T cell surface receptors that bind to LFA-3 on endothelial cells and antigen presenting cells to participate in adhesion and activation.

Cadherins - Function - what is required to maintain normal function - two main subclasses Selectins and integrins due what What is the wavelength for narrowband UVB

Cadherins mediate cell adhesion and play a fundamental role in normal development. Calicum is required for the normal function of these adhesion molecules. There are two main subclasses, classic (E-, P-, N-) and desmosomal (desmoglein and desmocollin).Selectins and integrins are involved in leukocyte adhesion and diapedesis from vasculature into the interstitial tissue. Glycans provide multiple functions as cell markers. Narrow Band UVB is what range 311-313

Desmosomal connections are dependent on what ion IPEx - Most often mutation and what is the function of this gene? What is the main macrophage activating cytokine and is secreted by TH1 cells

Calcium FOXP3 is the most often mutated gene in IPEX syndrome. FOXP3 is critical in the function of regulatory T-cells. Interferon gamma is the main macrophage-activating cytokine, and is secreted by TH1 cells.

What is the cause of cellulite? most common in whom? what are the hormones that affect lipolysis in adipocytes?

Cellulite is caused by the herniation of subcutaneous fat, not lipoatrophy, within fibrous connective tissue. It is prevalent in almost all postpubertal females, but is more prevalent in Caucasian individuals than other races. It is most notable in the pelvic region, lower limbs, and abdomen. The adipocytes in the gluteofemoral region are larger and are influenced by female sex hormones. They are metabolically more stable and resistant to lipolysis. The hormones that acutely affect lipolysis in adipocytes are catecholamines (epinephrine and norepinephrine) and insulin.

Central Centrifugal Cicatricial Alopecia - describe the condition

Central centrifugal cicatricial alopecia is a slowly progressive, symmetric cicatricial alopecia centered on the crown or vertex. It is most often found in black women of African heritage. Early and mild disease can be effectively treated, even severe disease may be significantly improved with appropriate therapy. It is the most common form of scarring alopecia in any population that includes a significant number of black patients.

which suture has the highest tissue reactivity Which tetracycline can be used in patients with renal failure Brodalumab

Chromic Gut Doxy Brodalumab binds to the interleukin-17 receptor and so prevents interleukin 17 (IL-17) from activating the receptor. This mechanism is similar to that of another anti-psoriasis antibody, ixekizumab, which however binds to IL-17 itself.

Chronic actinic dermatitis - typically seen in whom? - clinical presentation? - what is used to diagnose these patients? - they have decreased what? should avoid being under what lights? - treatments?

Chronic actinic dermatitis (CAD) usually occurs in middle-aged to elderly males who present with a chronic, eczematous dermatitis in a photodistribution, though there is no history of current exposure to a photosensitizer. Phototesting is very helpful in diagnosing CAD. Patients may have a lowered threshold to shorter wavelength visible light in the blue-violet end of the spectrum. As such, incandescent bulbs with longer wavelengths, far from the blue-violet end of the visible spectrum, should be used instead of fluorescent bulbs, which have significant blue-violet radiation.The MEDB is markedly diminished, and the MEDB site may show an eczematous or infiltrated appearance. Many of these patients have a lowered MEDA as well. Many cases of this idiopathic disorder are thought to have begun as photoallergic contact dermatitis or as a drug photosensitivity with broadening of the photosensitivity to include the UVB range. It is unclear why photosensitivity persists when the photosensitizer is no longer present. Treatment includes strict sun avoidance and sun protection. Topical and oral steroids, oral azathioprine and cyclosporine, and PUVA have all been used to treat patients with CAD.

What is the only anesthetic that restricts blood vessels in the abscence of epinephrine? Why should thyroid levels be checked in when treating with potassium iodide? Which drug can cause hemorrhagic cystitis and lead to bladder carcinoma

Cocaine The Wolff-Chaifkoff effect, which is the inhibition of thyroid hormone synthesis from excess iodides which block organic iodides from binding in the thyroid, can be observed in patients on potassium iodide therapy. In patients with normal thyroid function, autoregulatory mechanisms allow for appropriate escape from this effect. In patients with impaired autoregulatory mechanisms, the Wolff-Chaikoff effect can lead to hypothyroidism. Cyclophosphamide disrupts DNA cross linkage. It is the treatment of choice for Wegener's granulomatosis and there is a risk for hemorrhagic cystitis. In up to 40% of patients, there is a risk for transitional cell bladder cancer.

What is the term used to describe the parallel nature of coherent light waves? What transplant patients are at highest risk of developing skin cancer

Collimation is the parallel nature of coherent light waves.Monochromaticity is the emission of a single wavelength. Coherence is the term for light waves traveling in phase. Energy is the fundamental unit of work. Power is the rate of energy delivery measured in watts. heart transplant patients. And skin cancers develop 3-5 years post transplant

A patient presents with chronic fissuring of the first three fingertips of his non-dominant hand. He works in a restaurant kitchen. Which of the following is the most likely cause of his dermatitis?

Correct choice: 2. Diallyl disulfide Explanation: In food handlers, sensitization to diallyl disulfide from chopping garlic and onions causes a characteristic dermatitis of the first three digits of the non-dominant hand. This question tests the examinee's knowledge of plant allergic contact dermatitis and the association of non-dominant fingertip dermatitis with garlic/onion chopping. Food preparers chopping garlic and onions can become sensitized to diallyl disulfide (choice 2), leading to distinctive fissuring and hyperkeratosis of the first three fingers of the non-dominant hand. The other choices are not associated with food handling. D-limonene (choice 1), the allergen in tea tree oil, does not produce a unique hand dermatitis. In gardeners or florists, dermatitis caused by primin (choice 3) from primroses and tuliposide A (choice 4) from Peruvian lilies tends to affect the dominant hand. Sequiterpene lactone (choice 5), found in members of the Asteraceae (Compositae) family, is the most common plant allergen, but does not typically cause dermatitis in food handlers

Corynebacterium tenuis causes what? clinical presentation What is Majocchis granuloma What causes erysipelas, malakoplakia, erysipeloid, erythrasma, pitted keratolysis

Corynebacterium tenuis is responsible for causing trichomycosis axillaris, a superficial bacterial overgrowth of axillary hairs characterized by circumferential yellow (most common), red, or black granular concretions. Majocchi's granuloma is a dermatophyte infection. Erysipelas is caused by beta-hemolytic group A streptococcus. Malakoplakia is usually caused by S. aureus, P. aeruginosa, or E. coli. Erysipeloid is caused by Erysipelothrix rhusiopathiae. Corynebacterium minutussimum is the causative organism in erythrasma and pitted keratolysis.

Cause of Herpangina Papilloma virus - what kind of virus? - cause of recurrent respiratory papillomatosis?

Coxsaccia A Virus Papilloma viruses are non-enveloped, double stranded DNA viruses. Cell mediated responses are primarily responsible for controlling papillomavirus infections. Unlike viruses such as HSV, HPV does not have enzymes required for replication of viral DNA, and is entirely dependent on the host cellular machinery. Recurrent respiratory papillomatosis can be caused by HPV-6 and 11, with verrucous lesions of the airways. It can occur as a juvenile or adult-onset form and present with hoarseness in children.

What stains highlight the pigment deposition of ochronosis hibernoma

Cresyl violet stains the pigment deposits in ochronosis black. Methylene blue will also stain the pigment black. Hibernoma: This is a rare neoplasm that typically occurs in 30-40 year old males as a slowly enlarging warm mass on scapular region, trunk, axilla or thigh. There are also myxoid & spindle cell variants that occur on the posterior neck/shoulder. The lesion enhances with contrast on CT and MRI fails to reveal fat septations which differs for that seen with other lipomas. Abnormalities in 11q13 and loss of MEN1 gene on 10q22 have been noted. Histologically: The lesion is composed of large polygonal adipocytes that have with multiple vacuoles and an eosinophilic granular cytoplasm with a central nucleus and prominent nucleolus. These cells are referred to as "Mulberry cells." Admixed among these larger adipocytes are smaller cells with a granular cytoplasm, mature white fat and some times spindle cells. Hibernoma are derived from brown fat. They occur in the subcutaneous or deeper soft tissues. Sections show a highly characteristic lesion composed of cells with a markedly enlarged cytoplasm filled with course vacuoles and eosinophilic granules. None are generally needed. Cytogenetic studies of hibernoma have shown deletions on chromosomes 10 and 11 but are not required for diagnosis.

AT what temperature must a superficial SCC be cooled in order to destroy the tumor What what temperature can benign lesions be destroyed

Cryosurgery destroys tumor if it is frozen to -50 to -60 degrees Celsius, for at least 2 cycles with a 60 second thaw. Benign lesions can be destroyed at temperatures around -25 degrees Celsius.

Hep C associations Acrokeratosis paraneoplastica - Most commonly associated with what?

Cutaneous manifestation associated with hepatitis C include necrolytic acral erythema, porphyria cutanea tarda, lichen planus, polyarteritis nodosa and mixed cryoglobulinemia. Mixed cryoglobulinemias is a systemic vasculitis with variable manifestations including palpable purpura, arthralgias and weakness. Acrokeratosis Paraneoplastica (aka Bazex) is always associated with malignancy. Most commonly, the associated malignancy is a squamous cell carcinoma of the upper aerodigestive tract. The skin disease usually follows the course of the malignancy.

Mycosel medium What are chlamydoconidia? What is tinea imbricata? cause?

Cycloheximide in Mycosel or Mycobiotic media (SDA with cycloheximide and chloramphenicol) inhibits rapidly growing nonpathogenic molds and some pathogens (Cryptococcus neoformans, some Candida species, Prototheca, Scytalidium species, yeast forms of Histoplasma and Blastomyces) but not microsporum gypseum. Chlamydoconidia are thick-walled round cells, resistant to the environment. Tinea imbricata or Tokelau, an unusual type of tinea corporis causing polycyclic scaly lesions, is endemic in the South Pacific Islands, Far East and C. & S. America. The etiology is usually infection caused by Trichophyton concentricum.

Denileukin difitox - what is it, what is it made of, what is it used to treat Leopard syndrome - inheritance, gene - clinical presentation

Denileukin diftitox is a fusion of a fragment of diphtheria toxin and IL-2. It binds to high affinity IL-2 (CD25) receptors on T cells. As the medication is internalized, the toxin leads to cell death. This medication has been approved for cutaneous T cell lymphoma. This patient likely has LEOPARD syndrome, an autosomal dominant disease caused by a gene mutation in PTPN11, which encodes Shp2 (tyrosine phosphatase). Other findings in LEOPARD syndrome include multiple lentigines, EKG abnormalities, ocular hypertelorism, pulmonic stenosis, abnormal genitalia, retarded growth, and deafness. LEOPARD syndrome is allelic to Noonan syndrome.

Most common cutaneous manifestation of diabetes? A patient is found to have an epithelioid blue nevus, what should be done next? - disease association, gene

Diabetic Dermopathy, or "shin spots", are the most common manifestation of diabetes mellitus. It presents as brown atrophic macules and patches on the shins. These occur in approximately 50% of diabetics and are due to microangiography. These patients are at risk for other vasculopathy-associated manifestations such as nephropathy, neuropathy, and retinopathy. Unfortunately, there are no effective treatments for the condition. Epithelioid blue nevi have been reported with and without association with cardiac myxomas as a component of the Carney complex (NAME/LAMB syndrome). Carney complex is an autosomal dominant disorder caused by mutations in PRKAR1A. Patients have cutaneous and atrial myxomas, blue nevi, ephelides, adrenocortical disease, and testicular tumors.

Diffuse normolipemic plan xanthoma - what is it? - clinical presentation, associated with what conditions? paraneoplastic pemphigus is associated with what conditions? Gastric carcinoma is associated with what? AML is associated with what skin condition?

Diffuse normolipemic plane xanthoma (DNPX) was first described by Altman and Winkelmann in 1962. It is a rare and non-inherited form of xanthomatosis. Clinically, the dermatosis is characterized by the presence of symmetric yellowish-orange plaques that favor the neck, upper trunk, flexural folds and periorbital region. It has been recognized to be associated with hematological diseases, especially with multiple myeloma and monoclonal gammopathy. Thymoma and Castleman's disease are associated with paraneoplastic pemphigus. Gastric adenocarcinoma is associated with acanthosis nigricans and tripe palms, as well as the suddent onset of multiple seborrheic keratoses (Sign of Leser-Trelat). AML is associated with Sweet's syndrome.

weird stuff

Doxorubicin when given with retinoids or ketoconazole may lead to sticky skin.A dermatomyositis-like reaction and leg ulcers may be seen with hydroxyurea. Epidermal growth factor receptors such as erlotinib and cetuximab can produce papulopustular eruptions. Capillary leak syndrome is seen with interleukins.

Treatment of secondary syphillis for those who are penicillin allergic? Focal epithelia hyperplasia - AKA, Cause - Commonly found in what body locations and what ethnicities

Doxy! on desensitize for tertiary syphillis and pregnancy Focal epithelia hyperplasia, also known as Heck's disease, is caused by HPV types 13, 32 and 57. It is most commonly found on the lower lip but also on the buccal mucosa, gums and tongue. It is mainly a disease of native Americans and Greenlander Eskimos.

Best contraceptive for treating acne

Drospirenone. While some hormonal contraceptive methods are used to treat acne, some have been shown to worsen acne. Combined oral contraceptives (COC) and the vaginal ring improved acne, whereas depot injections, subdermal implants, and hormonal intrauterine devices worsened acne. Within the COC category, drospirenone was the most effective at treating acne. Combined oral contraceptives (COC) and the vaginal ring improved acne, whereas depot injections, subdermal implants, and hormonal intrauterine devices worsened acne.

Dyskeratosis congenita - clinical features

Dyskeratosis congenita has premalignant oral leukoplakia in addition to cutaneous poikiloderma and nail dystrophy. Pachyonychia congenita also has leukoplakia, but it is benign in nature. Additional features of pachyonychia congenita are thickened nails with nail bed hyperkeratosis and palmoplantar keratoderma. Keratosis follicularis, also known as Darier\'s disease, is characterized by benign whitish papules on the oral mucosa, cutaneous keratotic papules in seborrheic distribution, and longitudinal erythronychia with V-nicking of the distal nail plate. Papillon-Lefevre has gingivitis, without oral leukoplakia, and acral hyperkeratosis. Anhidrotic ectodermal dysplasia does not have leukoplakia. It consists of anhidrosis or hypohidrosis, hypotrichosis, and anodontia.

What mediates the adhesion of langerhans cells to keratinocytes Classic Vohwinkel syndrome is caused by mutation in what? Cutaneous manifestations of marphans - Caused by mutations in what?

E-cadherin Classic Vohwinkel syndrome is caused by mutations in connexin 26, a gap junction protein. Ichthyotic Vohwinkel syndrome is caused by mutations in loricrin and has ichthyosis but not deafness. Marfan syndrome is an autosomal dominant disorder caused by mutations in fibrillin 1 and 2. Patients have tall stature, arachnodactyly, pectus excavatum, high-arched palate, joint laxity, ectopia lentis with upward dislocation, dilated aorta with rupture, mitral valve prolapse, striae, and elastosis perforans serpiginosa.

Flying squirrels can carry what infections? Most common cause of contact dermatitis in florists

Flying squirrels can carry many infections, including Toxoplasma gondii, Staphylococcus sp., and Rickettsia prowazekii (via the body louse, causing epidemic typhus). Calcium oxalate is present in the bulbs and stems of Narcissus (daffodil), the most common cause of irritant contact dermatitis in florists.

Cutaneous anthrax toxins - what are the two toxins released? - how does lethal toxin exert it affects? What is the target antigen of linear IgA

Edema factor is a portion of the edema toxin, one of two exotoxins secreted by Bacillus anthracis. Edema factor causes gelatinous edema of anthrax skin lesions by inducing an increase in cyclic adenosine monophophate levels. Lethal toxin, the other exotoxin, works by releasing tumor necrosis factor-alpha and interleukin-1 beta Linear IgA Bullous Dermatosis is due to a target antigen that is a 97kDa protein component of BPAG-2

What lab abnormality is associated with cholesterol emboli?

Eosinophilia

Epidermal nevus syndromes - Clinical Manifestations MEN2B - Clinical manifestations

Epidermal nevus syndrome has many findings, including: sporadic inheritance, nevus unius lateris, capillary malformations, cafe au lait macules, mantal retardation and seizures, deafness, hemiparesis, hemihypertrophy of limbs, kyphoscoliosis and rare solid tumors. A biopsy is helpful to rule out epidermolytic hyperkeratosis. If positive, the patient's offspring are at risk for generalized epidermolytic hyperkeratosis. This patient has multiple endocrine neoplasia type IIb (MEN IIb) characterized by pheochromocytoma, thyroid cancer, and rare parathyroid carcinoma as well as mucosal neuromas cutaneously. These patients have a marfanoid body habitus. This syndrome is caused by the RET proto-oncogene.

Eruptive Xanthomas - associated with what underlying conditions? causes of dorsal pterygium?

Eruptive xanthomas generally occur in patients with triglyceride levels of 2000mg/dl or greater. Associations include poorly-controlled diabetes mellitus, retinoids, estrogens, excessive alcohol consumption (leading to pancreatitis) and familial hyperlipidemias types I, IV and V. Clinically, they appear as crops of firm, non-tender yellowish papules with an erythematous border. Most commonly, they occur on the extensor surfaces, but they can be diffuse. A reduction in triglycerides and/or tight glucose control usually results in a reduction in the number of lesions. Dorsal pterygium (scarring of the proximal nail fold) is caused by lichen planus, acrosclerosis, onychotillomania, Lesch-Nyhan syndrome, chronic GVHD, SJS/TEN and cicatricial pemphigoid.

What is another name for roseola? Cause of ecthyma

Exanthem subitum Group A strep Blueberry muffin lesions can be seen in the setting of prenatal infections (e.g. TORCH), severe anemia (e.g. Hemolytic Disease of the newborn) and neoplastic diseases (e.g. rhabdomyosarcoma). It has also been reported with LCH.

Pemphigoid Gestationis - Presentation - seen in whom - antigen target

Explanation: Herpes gestationis (HG) typically occurs in the second or third trimester, and clinically presents as urticarial papules and plaques around the umbilicus which progress to involve the rest of the body. HG has been associated with Grave's disease. Hormonal factors influence the disease manifestation. This condition can be seen in pregnant women, menstruating women, and women taking oral contraceptives. Pemphigoid gestationis is an autoimmune blistering disease, which basically means that an individual's immune system starts reacting against his or her own tissue. Immunoglobulin type G (IgG) autoantibodies (known as the PG factor) cause the damage. In pemphigoid gestationis, the target is a protein known as BPAG2 (also called BP180), found within the basement membrane, which is the zone between the epidermis and the dermis (the top and middle layers of skin). BPAG2 is within the hemidesmosome, the cell component that sticks the epidermal keratinocyte cells to the dermis. The antibody attack results in inflammation and separation of the epidermis from the dermis allowing fluid to build up and create a blister. Most patients present with an intensely itchy hive-like rash during mid to late pregnancy (13 to 40 weeks gestation). Initially, there are itchy red bumps around the belly button Within days to weeks, the rash spreads to other parts of the body including the trunk, back, buttock, and arms. The face, scalp, palms, soles and mucous membranes are usually not affected. After 2-4 weeks, large, tense fluid-filled blisters form Some patients may have no blisters but instead, have plaques (large raised patches)In some cases, pemphigoid gestationis occurs throughout pregnancy. Symptoms may lessen or spontaneously resolve towards the end of the pregnancy but this is short-lived, as 75-80% of women will experience a flare-up around delivery. In most cases, symptoms resolve days later after giving birth, however, in some, the disease remains active for months or years. Commencement of menstrual periods, use of oral contraceptives or further pregnancies may cause flare-ups.

Major specturm that contributes to drug induced photosensitivity What is the active spectrum responsible for vitamin D3 synthesis

Explanation: UVA (315-400 nm) is the major contributor to drug-induced photosensitivity. Common drugs causing phototoxic eruptions include tetracyclines, furosemide, thiazides, sulfonamides, NSAIDS, oral retinoids, amiodarone, and phenothiazines. UVB (290-315 nm) is more erythemogenic and associated with photocarcinogenesis. Vitamin D3 synthesis occurs in response to cutaneous exposure to UVB (Wavelength: 290-320nm).Cutaneous Vitamin D3 production does not occur in response to UVC (200-290nm), UVA2 (320-340nm), UVA1 (340-400nm), or Visible light (400-700nm).

alopecia areata - gene - link to what other autoimmune conditions - associated with what lab abnormality Asboe-Hansen Sign What antigen is not found in paraneoplastic pemphigus

Familial alopecia areata has been associated with persistent thrombocytopenia. Alopecia areata has recently been linked to the ULBP3 gene.Alopecia areata is associated with other autoimmune disorders such as thyroid disease and vitiligo The Asboe-Hansen sign as applies to blister formation refers to lateral dissection of the blister when pressure is applied directly to the blister. This is also called the "bulla-spread phenomenon" because pressure on an intact bulla gently forces fluid to wander under the skin away from the pressure site. BPAG1

- what are the two methods by which suture is broken down? how are synthetic and natural absorbable sutures absorbed? - What is responsible for the following tattoo pigments? -red, white, yellow, brown, black, which is most commonly associated with phototoxic reactions

Fast absorbing gut is made up of a natural fiber. Natural fibers include those that are absorblable such as surgical gut, and those that are nonabsorbable such as silk. Absorbable natural sutures are broken down by proteolysis.Synthetic absorbable sutures are broken down by hydrolysis. The other mechanisms listed are not involved in the break-down of sutures. Allergic reactions have been reported with several different types of tattoo pigment. The most commonly associated tattoo pigment, however, is mercuric sulfide. Tattoos with mercuric sulfide appear red in color.Titanium dioxide (white tattoo color), Cadmium sulfide (yellow tattoo color), Ferric oxide (brown tattoo color), and Iron oxide (black tattoo color) are less commonly associated with allergic reactions. Of note, Cadmium sulfide is the tattoo pigment most commonly associated with phototoxic reactions.

What Causes Favus

Favus is a chronic dermatophyte infection defined by the presence of yellowish crusts in the hair follicles called scutula. Prolonged infections lead to cicatricial alopecias of the scalp and glabrous skin. The infection is most commonly caused by Trichophyton schoenleinii.

Which syndrome is characterized by multiple keratoacanthomas beginning in childhood? inheritance Grybowski syndrome is characterized by what What is seen in Muir torre syndrome How about Rombo

Ferguson Smith is familial (AD), and is characterized by regressing keratoacanthomas beginning in childhood. Grybowski is a non-familial disorder in which patients develop generalized eruptive keratoacanthomas beginning between age 40 to 60. Keratoacanthoma centrifugum marginatum is most commonly a solitary lesion occurring later in life. Muir Torre is a syndrome characterized by gastrointestinal or genitourinary neoplasms which precede development of sebaceous neoplasms and keratoacanthomas by one to two decades. Rombo is not associated with keratoacanthomas, but is associated with multiple basal cell carcinomas, atrophoderma vermiculatum, hypotrichosis, and milia.

Fifths disease What should you consider in infants whom have failed treatment for seborrheic dermatitis

Fifths Disease or erythema infectiosum, is caused by parvovirus B19, a single-stranded DNA virus. There are a few clinical presentations including slapped cheeks, a diffuse lacy rash on the trunk that spreads gradually toward the distal extremities, papular-pruritic "gloves-and-socks" syndrome and aplastic crisis which does not have concomitant rash. That they actually have langerhans histiocytosis

What is the stain for melanin? what are stains for melanocytes What are immunocytomas? Cancer risk in transplant pts: Increased risk for SCC, BCC, melanoma, which is highest?

Fontana-Masson is a silver stain and stains melanin black.S-100, HMB 45, MART-1 (Melan-A) are melanocyte stains. S-100 also decorates Langerhans cells, acrosyringium, and neural crest-derived cells. These indolent tumors present as solitary or multiple nodules usually on the extremities. The cells have been reported to have CD-20 (B cell marker) and have been reported to be bcl-2 positive. The risk of skin cancer in organ transplant patients is dramatically increase and may be more aggressive. In one study, SCC had a 65x increased incidence, BCC 10x, and melanoma 3.4x.

Lesser sign of trelat is associated with what malignancy Necrobiotic Xanthogranuloma - where do lesions occur? - typically associated with what?

GI malignancy The patient has necrobiotic xanthogranuloma. Lesions develop periorbitally and in flexural areas, often extend deeply into the dermis or subcutis, and heal with scarring. These lesions are typically associated with a monoclonal gammopathy, usually IgG. Patients with necrobiotic xanthogranuloma rarely develop myeloma. Leukopenia and hepatosplenomegaly are also often seen.

Giant congenital Nevi - Can be associated with what? - What should be ordered - greater than how many satellite lesions is greatest risk for neurocutaneous melanosis

Giant congenital nevi overlying the spinal column and skull can be associated with neurocutaneous melanosis. Presenting symptoms include increased intracranial pressure, spinal cord compression, and/or leptomeningeal melanoma. An MRI should be performed in these children to rule-out CNS involvement. Greater than 20 satellite lesions around the giant CMN is the greatest risk factor for presence or risk of neurocutaneous melanosis.

What are the clinical findings of Goltz syndrome? Mast cell stains

Goltz syndrome is characterized by distinct raspberry-like papillomas at junctions of mucosa and skin. Other findings include the following: skin atrophy, ulcerations, hernia-like outpouchings of fatty tissue, syndromic facies, and lobster claw deformity. Mast Cell Stains: - leder -toludine blue - geimsa - tryptase

Granuloma Annulare - what are the subtypes - The subcutaneous variant is most common in whom? - can localized lesions ulcerate? do they heal with scaring? - what systemic condition is seen in those with generalized GA?

Granuloma annulare is the entity pictured. Subtypes include localized GA, generalized GA, macular GA, subcutaneous GA, and perforating GA. The subcutaneous variant is most common in children; there is often a history of trauma to the area.Localized lesions never ulcerate, and heal without scarring; 75% of localized lesions clear within 2 years. The perforating variant classically involves the dorsa of the hands. Diabetes is present in 20% of patients with the generalized variant. Localized is most common in adults and generalized typically only occurs in adults.

Guarnieri Bodies - Associated with what? The number one location for DFSP metastasis is?

Guarnieri bodies are eosinophilic intracytoplasmic inclusions associated with variola infection (smallpox), however they can also be seen in infections with other pox viridae including vaccinia, cowpox, and parapox. These inclusions represent aggregates of viral particles. The number one location for DFSP metastasis is? Lungs

Which HLA is most associated with psoriasis

HLA-Cw6 is associated with a 9-15x greater risk for developing psoriasis. All of the other HLA antigens listed are associated with various types of psoriasis, but at with lesser strength of association. HLA-B27: About 95% of affected individuals with ankylosing spondylitis carry the tissue antigen HLA-B27. The frequency of HLA B13, B17, B37 and Cw6 was investigated in patients with psoriasis vulgaris. A highly significant increase in the frequency of the four HLA antigens tested was found. The highest relative risk was calculated for Cw6

Duration Hair phases Black nail discoloration anonychia blue lunulae abscent nail plate green discoloration? Why?

Hairs remain in telogen phase for 3-4 months before they are released.The length of anagen phase varies for hairs of different parts of the body and determines the ultimate length of the hair. Scalp hair may remain in anagen for 3-5 years. The duration of catagen phase is typically 3-4 weeks. Proteus infection of the nail is associated with black discoloration of the nail plate.Multiple myeloma may be associated with anonychia. Wilson disease classically exhibits blue lunulae. COIF presents with absence of the nail plate. Pseudomonal infections of the subunguium may produce a green discoloration due to production of pyocyanin pigment.

How does cantheradin create a blister in hair transplants, do follicular unit grafts or single hair grafts have better survival? The marginal mandibular nerve innervates what? what happens to smile if nerve is injured

How does cantheradin create a blister? Desmosomal adhesions are interrupted by proteases with eventual tonofilament detachment. Seager et. al examined the survival rate of single hair grafts and compared them to follicular unit grafts in a single patient. They found that there was a much higher survival rate in the follicular unit grafts. They hypothesized that the extra tissue surrounding the follicular unit grafts protected them from crush injury. The marginal mandibular nerve innervates the depressor anguli oris, depressor labii inferioris, mentalis, orbicularis oris, risorius, and platysma muscles. Depression and retraction of the lip is controlled by depressor anguli oris, depressor labii inferioris, and mentalis muscles. An injury to the marginal mandibular nerve would thus cause an inability to smile, and interfere with depression and retraction of the lip on the affected side. The mouth would seem normal at rest, but crooked when attempting to smile.

where are non HA fillers likely to cause nodules? most photosensitizing tetracycline? A

Hyaluronic acid. Poly-L-lactic acid (Sculptra), polymethyl methacrylate (Artefill/Artecoll), silicone and calcium hydroxyapatite (Radiesse) are all much more likely to cause nodules in the perioral area than hyaluronic acid fillers. The tetracycline family of antibiotics are bacteriostatic and act by inhibiting protein synthesis. Each member of the family may cause photosensitivity, but demeclocycline is the most photosensitizing. Azathioprine is a purine analog that is used as a steroid-sparing agent in a variety of dermatologic inflammatory disorders. Azathioprine is converted into 6-mercaptopurine before being converted into the terminal active metabolite, 6-thioguanine, by the hypoxanthine guanine phosphoribosyltransferase pathway. Other inactive metabolites are produced via xanthine oxidase and thiopurine methyltransferase.

Hyperkeratotic follicular nasal papules are associated with what condition? sign of lesser trelat is associated with what? necrolytic migratory erythema is associated with what? Concentric erythematous rings are called what and associated with what? Tripe palms with and without acanthosis nigricans are associated with what?

Hyperkeratotic follicular nasal papules have been associated with multiple myeloma. A sudden increase in number and size of seborrheic keratoses is called the sign of Lesser-Trelat and can be seen in gastric or colon carcinoma. Erythema and vesiculation in periorificial and acral areas is characteristic of necrolytic migratory erythema most often associated with pancreatic cancer. Concentric erythematous rings with trailing scale is a feature of erythema gyratum repens most commonly seen in lung cancer. Tripe palms with acanthosis nigricans (AN) is more likely due to gastric cancer, whereas tripe palms without AN is more likely due to lung cancer.

Horizontal white lines on the nails are caused by what? Bullous diabeticorum typically presents where?

Longitudinal leukonychia or transverse white bands are caused by trauma to the nail matrix. on the legs

liver enzymes inhibited by itraconazole, fluconazole, terbinafine

Itraconazole is an inhibitor of CYP 3A4, whereas fluconazole inhibites CYP 2C9 significantly more than minimal inhibitory role of CYP 3A4. Terbinafine inhibits CYP 2D6.

IL-23 plays a critical role in the pathogenesis of psoriasis. Which of the following cytokines is critical for IL-23-mediated epidermal hyperplasia in psoriasis?

IL-23 and Th17 cells producing IL-17A and IL-22 are found in excess in skin affected by psoriasis. IL-6, IL-22, and IL-17A have all been shown to be critical in mediating epidermal hyperplasia in psoriasis in response to IL-23. Psoriasis is a chronic inflammatory skin disease primarily driven by Th17 cells. IL-23 facilitates the differentiation and induces complete maturation of Th17 cells. Lesional psoriatic skin has increased levels of IL-23 and recent studies show that intradermal injections of IL-23 induce a psoriasis-like skin phenotype in mice. Psoriasis is a chronic systemic inflammatory disease causing erythematous and scaly skin plaques; up to 30% of patients with psoriasis develop Psoriatic Arthritis (PsA), which is characterized by inflammation and progressive damage of the peripheral joints and/or the spine and/or the entheses. The pathogenic mechanisms driving the skin disorder in psoriasis and the joint disease in PsA are sustained by the activation of inflammatory pathways that can be overlapping, but also, at least partially, distinct. Cytokines members of the IL-23/IL-17 family, critical in the development of autoimmunity, are abundantly expressed within the cutaneous lesions but also seem to be involved in chronic inflammation and damage of the synovium though, not in all patients. IL-2, IL-12, TNF-alpha, and IFN-gamma are not critical in playing an interactive role with IL-23 in psoriasis. IL-6 is essential for development of the IL-23-elicited responses. Despite producing high levels of IL-22, IL-6−/− mice were unable to express the high-affinity IL-22 receptor chain and produced minimal IL-17A in response to intradermal injections of IL-23. This provides evidence for the critical role played by IL-6 in IL-23-induced skin inflammation and show that IL-6 is required for expression of IL-22R1A.

IL4 IL5 IL10 TNFa INF-gamma Rothmund Thomson - gene - Clinical Features

IL-4 is the cytokine that polarizes the immune response towards Th2.IL-5 is an eosinophil growth factor. IL-10 is a general down-regulator of immunity. TNF and IFN-gamma are TH1 cytokines, not TH2 cytokines. IFN-gamma is secreted by TH1 cells, and is the main macrophage-activating cytokine. The patient described has Rothmund-Thomson syndrome (or poikiloderma congentiale), an autosomal recessive disease localized to chromosome 8 and believed to be due to a DNA helicase mutation (RECQL4). 40-50% of patients will develop juvenile cataracts before puberty. Other clinical features include alopecia, dystrophic nails, short stature, hypogonadism and dental dysplasia. Affected children may be identified early in life by their small size, their tendency to sunburn easily, and from the appearance of their skin, teeth and bones. Rothmund-Thomson syndrome is slightly more common in females than males.

Antibodies -IgA is found where and can activate what? -IgG is how common and can it cross the placenta? -IgD is it found in circulation? -IgE is involved in what types of reactions? -IgM can activate what forms of compliment?

IgA is found in mucous membrane secretions and is able to agglutinate antigens and activate the alternate but not the classic complement pathway.IgG is the antibody that can cross the placenta and the most common antibody found in circulation. IgD is not found in circulation other than in hyper-IgD syndrome, an autosomal recessive disorder caused by mutations in the mevalonate kinase gene. A significant elevation of serum IgD is seen in 95% of these patients. IgE is an anaphylactic antibody that is involved in nearly all immediate allergic and anaphylactic type reactions. IgM is the antibody produced in the early stages of antibody responses. It is a pentamer which can agglutinate antigen and active the classic complement pathway.

What immunoglobulin levels are decreased in wiskott-aldrich syndrome What are the earliest seen findings of tuberous sclerosis

IgM Ash-leaf macules are the earliest finding in tuberous sclerosis. Retinal hamartomas, lymphangiomyomatosis and periungual fibromas also occur with tuberous sclerosis. Bulbar telangiectasias are seen in Ataxia-telangiectasia.

immediate pigment darkening - most commonly caused by what spectrum - pathophysiology Delayed tanning is the result of exposure to what?

Immediate pigment darkening occurs during and immediately after exposure, and is due to alteration (e.g. oxidation) and redistribution of existing melanin. It is most prominent with UVA. Delayed tanning is usually the result of an exposure to UVB, and it peaks approximately 3 days after sun exposure. Fair skin (skin type II) usually tans only with UVB doses above the erythema threshold, i.e. only with prior sunburn. Darker skin (skin types III and higher) also has a significant tanning response to suberythemogenic doses, i.e. without a prior sunburn. A UVB-induced tan is characterized by an increased number of melanocytes, increased melanin synthesis, increased arborization of melanocytes, and increased transfer of melanosomes to keratinocytes. A UVA-induced tan, such as from the use of a tanning bed, provides 5-10 times less protection against a sunburn from subsequent UV exposure than a UVB-induced tan, probably because a UVA-induced tan is characterized by less pronounced epidermal thickening and hyperkeratosis.

Which immunoglobulin cannot activate compliment

Immunoglobulins (Ig) differ in their ability to activate complement. IgM is the largest Ig, is the major Ig in the primary immune response, and consists of a pentamer that activates the classic complement pathway. IgG is the most abundant Ig and the major Ig in the secondary immune response. Four subclasses of IgG exist based on the amino acid residue sequences of their constant region, IgG1 through IgG4. IgG1 and IgG3 are potent activators of the classic complement pathway, IgG2 is less effective and IgG4 is unable to do so.

The special stain that can show maturation of dermal component and decreases expression with descent into the dermis in a normal melanocytic lesion is:

In a normal proliferating melanocytic nevus, HMB45 shows maturation of the dermal component with decrease expression with descent into the dermis.

Risk factors for post transplant CTCL gonorrhea is grown on what medium? Lowenstein-Jensen medium cultures what?

In a recent case series and review it was shown that the following are associated with post-transplant CTCL: renal transplant, cyclosporine, tacrolimus, and male sex. There have been 29 cases of post-transplant CTCL documented in the literature to date. The Lowenstein-Jensen medium is used to culture mycobacteria most commonly. Neisseria gonorrheae is be grown on chocolate agar in 10% CO2. Thayer-Martin, Martin-Lewis or New York City medium also allow for N. gonorrheae growth. Agar supplemented with heme (x-factor) and nicotinamide (v-factor) is needed for Hemophilus influenzae cultures. Sheep blood agar is useful for identifying hemolytic strains of streptococcus and staphylococcus.

When does acrodermatitis enteropathica typically present? Most common cause of paraneoplastic pemphigus in children? Presentation of paraneoplastic pemphigus. indirect immunoflourescence with what shows what?

In acrodermatitis enteropathica, there is decreased absorption of zinc from the infant's gastrointestinal tract. The zinc in breast milk has greater availability than nonmaternal sources thus protecting the child from disease expression until weaning. Castleman's tumor is the most common cause of paraneoplastic pemphigus in children. Paraneoplastic pemphigus presents with painful stomatitis and varied skin lesions. Indirect immunofluorescence with rat bladder substrate shows intercellular IgG.

During embryogenesis, the periderm cells contain what? and give rise to what? Human MHC is located on what chromosome

In week 7 of embryogenesis the surface ectoderm produces two layers. The external layer is the periderm which contains glycogen and gives rise to the stratum corneum by week 21. The other layer is the stratum germinativum. The MHC is highly polygenic and polymorphic, and this contributes to the ability of of the immune system to respond to a multitude of different and rapidly evolving pathogens. The MHC is located on chromosome 6 in humans.

Best initial screening test for both hereditary and acquired angioedema? high or low? - what about C1q levels? stains for eccrine and apocrine glands

Initial screening test in angioedema for both inherited and acquired should include C4, which is low. C3 is normal in angioedema. C1q is low in acquired angioedema but normal in the hereditary type. Bradykinin is elevated in both inherited and acquired angioedema.C3 is normal in angioedema. C1q is low in acquired angioedema but normal in the hereditary type. Bradykinin is elevated in both inherited and acquired angioedema. Eccrine glands are s-100 and CEA + Apocrine glands are GCDFP-15+

Name some intermediate fillaments? At any one time what % of hairs are in anogen phase?

Intermediate filaments are composed of keratins, vimentin, desmin, peripherin, glial fibrillary acidic proteins, neurofilaments, nuclear laminins, and nestin. These are part of cytoskeletal elements. Microtubules are not intermediate filaments Most (~90%) hair follicles are in anagen (growth) phase. The longer a hair follicle is in anagen phase, the longer the hair can grow. Hairs of the scalp grow approximately 0.4 mm per day, and thus the date of one's next hair cut can be accurately calculated.Approximately 1% of hairs are in catagen (transitional) phase, whereas ~9% of hairs are in telogen (resting) phase

Klippel-Trenaunay Syndrome - triad? Struge-Weber Proteus Syndrome Bannayan Riley Ruvalcaba

Klippel-Trenaunay syndrome is characterized by the Triad of port-wine malformations in association with deep venous system malformations, superficial varicosities, and bony and soft tissue hypertrophy. Sturge-Weber syndrome has 2 essential components: Facial port-wine stain and homolateral leptomeningeal angiiomattosis. The port wine stain most commonly involves the areas innervated by the ophthalmic(V1) and maxillary (V2) divisions of the trigeminal nerve. Complications of leptomeningeal angiomatosis are epilepsy, mental retardation, and occasionally, contralateral hemiplegia. Proteus Syndrome is characterized by vascular malformations including nevus flammeus, hemihypertrophy, macrodactyly, verrucous epidermal nevus, soft-tissue subcutaneous masses, and cerebriform overgrowth of the plantar surface. Bannayan Riley Ruvalcaba syndrome may include multiple cutaneous and visceral venous, capillary, and lympathtic malformations, macroephaly, pseudopapilledema, systemic lipoangiomatosis, spotted pigmentation of the penis, hamartomatous intestinal polyps, and rarely trichilemmonmas. (multiple subcutaneous lipomas as well as acanthosis nigricans).

What are Krause End bulbs? What are papillary nerve endings What are meissners corpuscles What are pacinian corpuscles

Krause end bulbs are mucocutaneous receptors found on the glans penis, clitoris, labia minora, perianal area, and vermillion border of the lips. Papillary nerve endings are free nerve endings found at the orifice of the hair follicle and particularly sensitive to cold. Meissner's corpuscles are ovoid, elongated mechanoreceptors located in the dermal papillae of digital skin that detect touch and light pressure. Pacinian (Vater-Pacini) corpuscles exist in the deep dermis and within the subcutis in weight-bearing sites and function as adapting mechanoreceptors that respond to vibrational stimuli.

DIF findings? - linear IgA - granular IgA and C3 - intercellular IgG 4 - Linear C3 at the BM Hereditary PMLE - seen in what ethnicities? similar to what condition? more likely to do what? presentation? treatment UVA range

Linear IgA is found in linear IgA and chronic bullous deiseasae of childhood. Granular IgA and C3 in the dermal papillae is found in dermatitits herpetiformis. Intercellular IgG4 throughout the epidermis is found in pemphigus vulgaris. Linear C3 at the basemement membrane bullous pemphigoid Hereditary PMLE of Native Americans is similar to actinic prurigo but persists much more frequently into adulthood. Chelitis and conjunctivitis are common.75% of patients have a positive family history. It presents with a papular, excoriated, eczematous dermatitis that occurs predominantly on the face. It may be treated with thalidomide. UVAII320-340, UVAI 340-400

What location for SCC is most likely to lead to metastasis? Endothrix vs ectothrix causes of tinea capitis Most sensitive microscopic test for fungal infection? Cause of hand cellulitis in fish handlers?

Lip: 13% ectothrix: M. canis, M. audouinii, M. ferruginosum, M. distortium, M. gypseum and occasionally T. rubrum. Endothrix: trichophyton species Calcofluor White Streptococcus iniae has been demonstrated to cause hand cellulitis from puncture wounds sustained form the dorsal fin, fish bone or knife of usually a tilapia. Treatment with PCN is curative.

Facts about liposuction - Is liposuction intended for weightloss? - is moderate obesity a relative contraindication? - what is the upper limit of fat extraction? - What type of anesthesia should be used?

Liposuction is not intended for weight reduction. Moderate obesity is relative contraindication, while severe obesity is an absolute contraindication to liposuction. The upper limit of fat extraction in one setting is 4500-5000mL, according to American Academy of Dermatology guidelines. Beyond this, fluid shifts can occur, resulting in cardiovascular compromise.Liposuction does not improve the appearance of cellulite. Tumescent anesthesia in the office for liposuction has a high safety profile. The serious complications seen in liposuction are associated with general anesthesia, not with procedures performed with local tumescent anesthesia. Although deaths have been reported during liposuction, none has occurred when patients were treated with tumescent anesthesia alone. Office-based tumescent liposuction performed by dermatologic surgeons is safe and has a lower complication rate than hospital-based procedures.

Lupus panniculitis - what is seen on path? - what type of panniculitis Subcutaneous panniculitis like T cell lymphoma - histo sclerosing panniculitis pancreatic panniculitis - histo

Lupus panniculitis is characterized by hyalinization of the fat with a lymphoplasmocytic infiltrate, as depicted here. It is a lobular panniculitis without vasculitis. Subcutaneous panniculitis like T cell lymphoma has atypical cells rimming the fat lobules. Sclerosing panniculitis is lipodermatosclerosis which has lipomembranous change. Pancreatic panniculitis has liquefactive fat necrosis and saponificatoin of the fat.

lymphogranuloma venereum - cause of disease? - late stage complications? Valuable adjuvant test for acrodermatitis enteropathica?

Lymphogranuloma venereum presents as a painless ulcer and is caused by Chlamydia trachomatis serotypes L1, L2, L3. While buboes can be aspirated, they should not be incised and drained. Transmission occurs through sexual contact, but can occur via skin-to-skin contact. Complications of late stage disease include proctocolitis, perirectal abscesses, rectovaginal fistulas, and anal fistulas. The diagnosis of zinc deficiency should be consideredi in at-risk individuals with acral or periorificial dermatitis. Chronic diaper dermatitis in an infant should lead to the evaluation for zinc deficiency. A low serum zinc level can usually confirm the diagnosis. If normal or near normal a low serum alkaline phosphatase, a zinc-dependent enzyme, may be a valuable adjunctive test.

Lymphomatoid papulosis is what type of disease? - clinical presentation which CD is positive in the following situations - vascular or fibrous neoplasms - natural killer cells - monocytes and macrophages

Lymphomatoid papulosis is a T-cell lymphoproliferative disorder characterized by recurrent crops of erythematous necrotic papulo-nodules. Histology reveals a wedge-shaped dense mixed dermal infiltrate, including atypical T lymphocytes that stain positive for CD30 (Ki-1).CD31 is typically positive in vascular neoplasms. CD34 positivity usually occurs in vascular or fibrous neoplasms. CD56 is the archetypal phenotypic marker of natural killer cells but can actually be expressed by many more immune cells, including alpha beta T cells, gamma delta T cells, dendritic cells, and monocytes. CD68 is highly expressed by monocytes and tissue macrophages, including Kupffer cells, microglia, histiocytes and osteoclasts, and to a lesser extent on dendritic cells and peripheral blood granulocytes.

MED testing - what is it used for? - when should the test be read what are the mosquitoes that cause malaria, yellow fever, dengue

MED testing should be read 24 hours after delivery of the doses. An additional reading at 15 minutes is important when solar urticaria is a consideration. Anopheles mosquitoes cause malaria. Aedes mosquitos cause yellow fever and dengue. They are both Culicidae Most mosquitoes prefer black skin, young skin, warm to cool skin and scented skin. They also refer bright colors also.

MEN1 MEN2a MEN2b NF type 2 - genetics - clinical manifestations?

MEN IIA, MEN IIB, Von Hippel Lindau and neurofibromatosis are all associated with pheochromocytoma. MEN 1 = Parathyroid tumors, pancreatic tumors, and pituitarytumors. MEN 2a = Medullary thyroid cancers (MTC), pheochromocytoma, and parathyroid tumors. MEN 2b = Medullary thyroid cancers, pheochromocytoma and neuromas. Neurofibromatosis type II is an autosomal dominant disorder caused by mutations in schwannomin/merlin. Clinical features include cutaneous schwannomas and neurofibromas, bilateral vestibular schwannomas, and juvenile posterior subcapsular lenticular opacities. Optic gliomas are usually seen in NF1.

What induces T cell anergy Fas and FasL interaction promote what? Anti-Jo targets what?

MHC/TCR engagement occurs without costimulatory molecules. Fas-FasL interactions promote apoptosis on the target cell, not stimulation. IL-2 is a stimulatory molecule, produced by Th1 T-cells. It does not produce anergy. HLA-DM facilitates loading of proteins processed by antigen presenting cells into the MHC class II molecule before being brought to the cell surface. Anti Jo-1 antibody is typical of autoimmune diseases that involve muscle, including dermatomyositis. It is an antibody targeting histidyl transfer RNA synthetase.

What is Malakoplakia? - most frequently arises in the setting of what? - common sites of involvement? cutaneous involvement? - key histopath findings? stain positive for what?

Malakoplakia is a multi-organ inflammatory granulomatous disease that most frequently arises in the setting of immunosuppression. Common sites of involvement include the genitourinary, lung, lymph nodes and bone. Cutaneous involvement is rare, and typically presents as asymptomatic papules, nodules, or plaques. Lesions may have associated erosions or ulcerations, and sinus tracts may be seen. While skin lesions are non-specific, histopathology reveals foamy dermal histiocytes known as von Hansemann cells which contain basophilic granular inclusions. The latter are known as Michaelis-Gutmann bodies and are considered pathognomonic for malakoplakia. Michaelis-Gutmann bodies are comprised of calcium, iron, and phosphate salts, and hence stain positively with von Kossa, Perls, and PAS, respectively. The pathophysiology of malakoplakia is thought to arise from an acquired defect in macrophage activation in response to bacterial infection, most commonly E. coli. Treatment for cutaneous lesions is surgical excision, although recurrence is not uncommon.

Meibomian glands found where? Montgomerys tuberclles found where? Molls glands are what type of glands? Hair growth rate what is a major component of anchoring filaments?

Meibomian glands of the eyelids are modified sebaceous glands. Sebaceous glands are found everywhere on the skin except the palms and soles. Montgomery's areolar tubercles consist of several sebaceous lobules feeding into a lactiferous duct. Ceruminous glands are apocrine glands of the external ear canal. Apocrine glands in the eyelids are Moll's glands. Hair grows at an average of 0.4 mm/day. Anchoring filaments (smaller than anchoring fibrils) emanate perpendicularly from the hemidesmosome and stretch from the plasma membrane to insert into the lamina densa. Of note, Laminin-332 (aka epiligrin or laminin-5) is a major component of anchoring filaments.

Mixed cryoglobulinemia is characterized by what? - commonly associated with what infection? - patients with the above infection in conjunction with mixed cryoglobulinemia are at increased risk for developing what? - explain the pathophysiology behind the symptoms of cryoglobulinemia

Mixed cryoglobulinemia is characterized by LCV and the finding of monoclonal or polyclonal IgG and IgM cryoglobulins in the blood. Mixed cryoglobulinemia is commonly associated with HCV infection. Patients with HCV-associated mixed cryoglobulinemia are at an increased risk of developing non-Hodgkins lymphoma, approximately 35 times the general population. Cryoglobulinemia is a rare disorder characterized by the presence of abnormal immunoglobulin proteins in the blood that can precipitate out into tissues at low temperatures and causing inflammation and damage. Immunoglobulins are the class of proteins that make antibodies in response to foreign substances (antigens) introduced into the body. In the case of cryoglobulinemia, the abnormal immunoglobulins form complexes (cryoglobulins) and precipitate (leach) out of the blood at cold temperatures. This causes restricted tissue blood flow and systemic inflammation, which leads to many clinical signs and symptoms including skin lesions, arthralgia (joint pain), arthritis, vascular purpura (purple skin marks), livedo (marbling pattern), and bleeding conditions. Cryoglobulinemia often occurs in association with other diseases, particularly autoimmune or infectious diseases (this is known as secondary cryoglobulinemia). When it occurs without an associated disease it is called idiopathic or essential cryoglobulinemia.

How does molluscum evade the immune system? How is streptococcus iniae most commonly acquired? most common area of infection? most common cause of cutaneous and furuncular myiasis in the US?

Molluscum contagiosum virus, like other viral and bacterial pathogens, attempts to exploit the host immune system to avoid destruction. In this case, molluscum contagiosum virus usesIL-18 binding protein, which blocks the host helper T (Th1) response by reducing local IFN-gamma production. Streptococcus iniae most commonly causes bacteremic cellulitis of the hand in persons who have recently handled fresh fish. S. iniae is a fish pathogen that causes sporadic infection in tilapia, yellowtail, rainbow trout, and coho salmon. Treatment of choice is with penicillin antibiotics. Dermatobia hominis is most common agent of cutaneous and furuncular myiasis in North America. Complications of myiasis are tetanus and secondary bacterial infection.

Mycetomas - can be caused by what to things? - how can the causative agent be identified? - Fungi: dark or black, white pail or unstained - Actinomyces: white/yellow, brown

Mycetomas are caused by true fungi (eumycetoma) or filamentous bacteria (actinmycetoma). The causative agent can be suspected from the colour of the grains. 1) Eumycetoma a. Dark or black grains Madurella mycetomatis Trematosphaeria grisea (formerly Madurella grisea) Exophiala jeanselmei Medicopsis romeroi (formerly Pyrenochaeta romeroi) Falciformispora senegalensis (formerly Leptosphaeria senegalensis) Falciformispora thompkinsii Curvularia lunata b. White, pail or unstained grains Acremonium spp. Fusarium spp Neotestudina rosatii Aspergillus nidulans Aspergillus flavus Microsporum ferrugineum Microsporum audouinii Microsporum langeronii Scedosporium apiospermum Scedosporium boydii (formerly Pseudallescheria boydii) 2) Actinomycetoma a. White to yellow grains Nocardia brasiliensis Nocardia otitidiscaviarum (formerly Nocardia caviae) Actinomadura madurae Pleurostomophora ochracea b. Brown grains Streptomcyes somaliensis Red to pink grains Actinomadura pelletieri

The most common cause of a longitudinal groove of the nail plate is: chronic bullous disease of childhood

Myxoid Cyst Chronic bullous disease of childhood is believed to be a variant of linear IgA bullous disease, since the two diseases are characterized by antibodies to the 97kDa antigen that is a part of BPAg2. Children present with extremely pruritic blisters in circular arrangements. Pathology shows a subepidermal bulla with neutrophils at the dermo-epidermal junction; the DIF shows IgA deposition at the basement membrane in a linear fashion.

Atopic Derm

Natural measles infection has been noted to improve atopic dermatitisExplanation: Natural measles infection has been noted to improve atopic dermatitis.Atopic dermatitis typically begins in infancy, with ~50% in the first year of life and an additional 30% between 1 and 5 years. Most children with AD eventually develop allergic rhinitis or asthma later in childhood. Many outgrow AD as respiratory allergy develops. S. aureus is found in over 90% of AD skin lesions. Decreased expression of innate antimicrobial peptides, such as human beta-defensin and cathelicidins, such as LL 37, may explain the increased susceptibility to colonization and skin infection with S. aureus in patients with atopic dermatitis.

Nephrogenic systemic fibrosis - seen most commonly in the setting of what? - presentation? death is caused by what?

Nephrogenic systemic fibrosis is a chronic fibrosing disorder seen most commonly in the setting of renal failure. There is a reported association also with gadolinium as contrast in an MRI. Patients present with woody indurated plaques or nodules primarily of the extremities, with occasional involvement of the trunk. Fulminant and fatal disease is rare, occurring in about 5% of cases. Death is due to impaired ventilation secondary to fibrosis of respiratory muscles. Nephrogenic fibrosing dermopathy is rare and a relatively new disorder. Its natural history is not well understood. Some patients make a gradual recovery or gain improved mobility, but it is progressive in most.Many patients die as a complication of their kidney disease or transplant surgery. A minority of patients, approximately 5%, have a fulminant course with rapid progression. Nephrogenic fibrosing dermopathy may contribute to death by restricting mobility leading to falls, fractures and the ensuing complications.

Neurofibromatosis - gene and inheritance - clinical presentation Maffucci Syndrome - clinical features

Neurofibromatosis I occur due to a microdeletion at 17q11.2 involving the NF1 gene, which encodes for neurofibromin. It is an autosomal dominant disorder characterized by numerous benign tumors (neurofibromas) of the peripheral nervous system, cafe au lait macules, freckling in the area of the armpit (Crow's sign), two or more growths on the iris of the eye (known as Lisch nodules or iris hamartomas), tumor on the optic nerve (optic glioma), abnormal development of the spine (scoliosis), the temple (sphenoid) bone of the skull, or the tibia (one of the long bones of the shin) and a first degree relative (parent, sibling, or child) with NF1. Maffucci syndrome is characterized by superficial and deep venous malformations of distal extremities, enchondromas, and short stature. Enchondromas are the most common neoplasm.

First cells to migrate into a new wound

Neutrophils Explanation: Neutrophils migrate with monocytes concurrently, but arrive first in great numbers because of their abundance in circulation. Chemoattractants for the neutrophils are fibrinogen, fibrin split products, C5a and leukotrienes. If wound contamination is controlled, neutrophil migration ceases within a few days and they become entrapped within the wound clot, undergo apoptosis or are phagocytosed by macrophages.Monocytes are bone-marrow derivied phagocytic cells in the blood stream which, once undergoing diapedesis into tissue, become macrophages. These cells are the main cell type to mediate wound healing but are not the first cell type to the scene. Lymphocytes do not play a major role in wound healing and mast cells have virtually no role in wound healing.

Nevus anemicus - Cause - Most common location - Clinical presentation

Nevus anemicus is caused by localized hypersensitivity to catecholamines and most commonly found in the upper chest Nevus anemicus (nevus anemicus) is an uncommon capillary vascular malformation or birthmark in which there is a localized area of pale skin. Nevus anemicus is usually a single, asymptomatic pale patch that does not become reddened on rubbing. It tends to be roughly round, oval or linear in shape. Satellite macules may be seen around the main patch. A mosaic form with multiple anemic nevi can appear reticulate, or net-like. It does not cause any symptoms. Nevus anemicus most often affects the trunk, but can occur at any body site. Sometimes, other vascular anomalies are noted closeby, such as capillary malformation (port wine stain)

Which common contact allergen is detected via the dimethylglyoxime test? Which interlukin attracts neutrophils

Nickel is found in virtually all metals of common use. It is the most common sensitizer in women, and is detected by the dimethylglyoxime test. A nickel-testing kit can obtained from a dermatologist, pharmacist or online supplier. The 2-bottle or single solution formula contain 1% dimethylglyoxime and 10% ammonium hydroxide. To use this test, apply a drop from each bottle (or from the single one) on to the metal item to be tested. Use a cotton bud to rub gently - observe the color on the bud. If it remains clear, the item has no free nickel and will not cause dermatitis. If the cotton bud has stained pink, the item contains nickel and may cause dermatitis if it touches the skin of someone allergic to nickel. The chemicals will not harm jewelry. IL8 attracts neutrophils

Nocardia brasiliensis, causes what that can be mistaken for what? Best Treatment for herpetic whitlow

Nocardia brasiliensis is a common cause of actinomycotic mycetoma and the ulcerative, draining lesions can be misdiagnosed as sporotrichosis. herpetic whitlow is best treated by acyclovir

Causes of a false positive RPR

Non-treponemal tests for syphilis measure antibodies against phospholipids released from treponemes and damaged host cells. False positive non-treponemal tests can occur in the setting of pregnancy, autoimmune diseases, other spirochete infections, and infectious diseases such as leprosy and malaria. It does not occur in cases of melanoma. The lesion is low immune or lepromatous leprosy, which is associated with TH2 cytokines including IL-4, IL-5, IL-10, and IL-13.Tuberculoid leprosy is associated with Th1 cytokines including IFN-gamma, IL2, IL12, IL15, IL18 and IL23.

Oral hairy leukoplakia

Oral hairy leukoplakia is characterized by a white patch with a corrugated surface on the side of the tongue. It is generally asymptomatic. Oral hairy leukoplakia is seen most commonly in patients with defective cell-mediated immunity, in particular HIV infection. Oral hairy leukoplakia is associated with EBV opportunisitc infection, among other viruses. 33% of patients with HIV will have oral hairy leukoplakia. Hairy leukoplakia is a condition that is characterized by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or in the mouth. It is a form of leukoplakia, which refers to white patches on the mucous membranes of the mouth often arising in response to chronic irritation. Hairy leukoplakia occurs primarily in HIV-positive individuals. When associated with HIV/AIDS, hairy leukoplakia may be one of the first signs of infection with HIV. It was originally thought that this condition only ever occurred in people with HIV but there have since been cases in other people with immunodeficiency such as organ transplant recipients and chemotherapy patients. It is often the first sign that the immune system is weakening and that the person may be at increased risk of a more serious infection waiting to manifest. Hairy leukoplakia has also been found in patients with Behcet syndrome and ulcerative colitis. In addition, men who are HIV positive who are smokers of more than a pack of cigarettes a day are at much greater risk of developing the condition. The risk of developing hairy leukoplakia doubles with each 300-unit decrease in CD4 count.

Exposure to sheep can cause what two bacterial diseases In children what can mimick severe refractory seb derm? Cockayne Syndrome - genetics - clinical presentation

Orf aka infectious pustular dermatitis and anthrax Langerhans cell histiocytosis Cockayne Syndrome is an autosomal recessive disorder caused by a mutation of an unknown gene that results in the inability to repair cyclobutane dimers induced by UV exposure. Cutaneous findings include photosensitivity, "bird-headed" facies, and "Mickey Mouse" ears. Statements A-D are true regarding the syndrome. Cockayne syndrome is characterized by dwarfism, low weight for height, Sunken eyes due to periorbital fat atrophy; senile "bird-like" facies, beak-like nose, prognathism. At presentation: there is acute photosensitivity, healing with hyperpigmentation; later: there is wrinkling, loss of subcutaneous fat, and poikiloderma.

PCT and hepaticerythropoietic porphyria - associated with elevated what? Monilethrix - what are they?

PCT and HEP are associated with elevated isocoproporphyrins in the stool. This is an image of monilethrix, which upon trichoscopy reveals a beaded appearance of hair due to periodic thinning of the hair shaft.

Nethertons syndrome - Presentation - Gene Autoantibody targets for pemphigus vulgaris, pemphigus foliaceous, dermatitis herptiformis

Patients with Netherton's syndrome have trichorrhexis invaginata. This syndrome also includes ichthyosis linearis circumflexa, atopy, trichorrhexis nodosa. They have a mutation in the SPINK5 gene with mutation in the serine protease inhibitor. The answer is pemphigus vulgaris, which typically has autoantibodies to desmoglein 3. While mixed forms of pemphigus can occur, the histology in this case confirmed pemphigus vulgaris.Pemphigus foliaceous has antigens to Dsg1. Bullous pemphigoid typically has antigens to BP180 and BP230. Dermatitis herpetiformis has antigens to transglutaminase 3.

Nethertons syndrome Yellow nail syndrome - characterized by what - associated with what? - associated with what drug exposure

Patients with Netherton's syndrome have trichorrhexis invaginata. This syndrome also includes ichthyosis linearis circumflexa, atopy, trichorrhexis nodosa. They have a mutation in the SPINK5 gene with mutation in the serine protease inhibitor. Yellow nail syndrome is characterized by slowly growing, yellow nails that are excessively curved. The lunulae and cuticles are absent. It has been associated with a array of pulmonary diseases including tuberculosis, asthma, pleural effusion, bronchiectasis, sinusitis, bronchitis, and COPD. Associated with penecillamine

someone diagnosed with sabies and has a sunflower allergy should not be given which medication? best and least costly initial treatment for steroid atrophy

Patients with allergies to plants in the Asteraceae or Compositae family (chrysanthemum, ragweed, sunflower, artichoke, arnica, daisy, and marigold) should not be given permethrin, as it may cross react. The relevant potential allergen is sesquiterpene lactone. First best and least costly treatment option for steroid induced atrophy is normal saline injections

Homocystinuria - have elevated levels of what? - caused by a deficiency of what? Alopecia areata - describe the hair loss

Patients with homocystinuria have elevated serum homocysteine and methionine levels due to a deficiency of cystathionine beta synthase. Alopecia areata presents with discrete, round or oval patches of non-scarring hair loss. Initial sparing of non-pigmented hair may occur leading patients to report rapid whitening of the hair. Similarly, initial regrowth of hair may include white or grey hairs.

Peutz Jeghers syndrome - Genetics - Gene - Presentation Muir torre and burt hogg dube genes

Peutz-Jeghers Syndrome is an autosomal dominant syndrome. 50% of patients have mutations in the STK11 gene, which encodes a serine threonine kinase. It presents with periorificial and mucosal lentigines beginning in infancy, as well as hamartomatous intestinal polyps with intussusception and bleeding; there is an increased risk of gallbladder, pancreatic, breast, ovarian, and testicular cancers. Muir-Torre Syndrome results from mutations in MLH1, MSH2, or MSH6 (DNA mismatch repair genes). Bannayan-Riley-Ruvalcaba Syndrome occurs due to a mutation in PTEN. Birt-Hogg-Dubbe Syndrome results from a FLCN (folliculin) mutation. Lastly, Cronkhite-Canada Syndrome is rare, acquired, nonhereditary syndrome; no specific gene mutation has yet been found to cause this syndrome.

Best Treatment for Melasma

Photoprotection General measures Discontinue hormonal contraception. Year-round life-long sun protection. Wear a broad-brimmed hat. Use broad-spectrum very high protection factor (SPF 50+) sunscreen applied to the whole face daily, year-round. It should be reapplied every 2 hours if outdoors during the summer months. Sunscreens containing iron oxides are preferred, as they screen out some visible light as well as ultraviolet radiation. Alternatively or as well, use a make-up that contains sunscreen. Use a mild cleanser, and if the skin is dry, a light moisturizer. Cosmetic camouflage (make-up) is invaluable to disguise the pigment. Topical therapy Tyrosinase inhibitors are the mainstay of treatment. The aim is to prevent new pigment formation by inhibiting the formation of melanin by the melanocytes. Hydroquinone 2-4% as cream or lotion, applied accurately to pigmented areas at night for 2-4 months. This may cause contact dermatitis (stinging and redness) in 25% of patients. It should not be used in higher concentration or for prolonged courses as it has been associated with ochronosis (a bluish grey discoloration similar to that seen in alkaptonuria). Azelaic acid cream, lotion or gel can be applied twice daily long term and is safe in pregnancy. This may also sting. Kojic acid or kojic acid dipalmitate is often included in formulations, as it binds copper, required by L-DOPA (a cofactor of tyrosinase). Kojic acid can cause irritant contact dermatitis and less commonly, allergic contact dermatitis The mechanism of action of cysteamine cream is unclear but is thought to involve inhibition of tyrosinase. A study of 50 patients with melasma found cysteamine cream to be significantly more effective than a placebo cream. Ascorbic acid (vitamin C) also acts through copper to inhibit pigment production. It is well tolerated but highly unstable, so is usually combined with other agents. Methimazole (antithyroid drug) cream has been reported to reduce melanin synthesis and pigmentation in hydroquinone-resistant melasma. New agents under investigation include zinc sulfate mequinol, arbutin and deoxyarbutin (from berries), liquorice extract, rucinol, resveratrol, 4-hydroxy-anisole, 2,5-dimethyl-4-hydroxy-3(2H)-furanone and/or N-acetyl glucosamine Other active compounds used for melasma include: Topical corticosteroids such as hydrocortisone. These work quickly to fade the colour and reduce the likelihood of contact dermatitis caused by other agents. Potent topical steroids are best avoided due to their potential to cause adverse effects. Soybean extract, which is thought to reduce the transfer of pigment from melanocytes to skin cells (keratinocytes) and to inhibit receptors. Tranexamic acid has been used experimentally for melasma as a cream or injected into the skin (mesotherapy), showing some benefit. It may cause allergy or irritation. The superficial or epidermal pigment can be peeled off. Peeling can also allow tyrosinase inhibitors to penetrate more effectively. These must be done carefully as peels may also induce post-inflammatory pigmentation. Topical alpha hydroxyacids including glycolic acid and lactic acid, as creams or as repeated superficial chemical peels, remove the surface skin and their low pH inhibits the activity of tyrosinase. Topical retinoids, such as tretinoin (a prescription medicine) are effective. Tretinoin can be hard to tolerate and sometimes causes contact dermatitis. Do not use during pregnancy. Salicylic acid, a common peeling ingredient in skin creams, can also be used for chemical peels, but it is not very useful in melasma. The most successful formulation has been a combination of hydroquinone, tretinoin and moderate potency topical steroid. This has been found to result in improvement or clearance in up to 60-80% of those treated. Many other combinations of topical agents are in common use, as they are more effective than a single agent. However, these products are often expensive.

Pityriasis amiantacea - Presentation, can mimic what?, treatment Bazex-Dupre-Christol - Classic triad

Pityriasis amiantacea is a condition seen in pediatric patients that improves with age. There is thick scale and matted hair that may mimic seborrheic dermatitis or psoriasis. Treatment is keratolytics. Bazex-Dupré-Christol syndrome is a rare genodermatosis that manifests with the classical triad of basal cell carcinoma, follicular atrophoderma, and hypotrichosis; yet it may be accompanied by milia, ichthyosis, neurological symptoms, and visceral malignancies. Symptom onset is nonsimultaneous, and hence the diagnosis is often made late and the opportunity of counseling and following up is missed. Though the gene responsible for this syndrome is yet nonspecified, it is confirmed to be localized to the long arm of chromosome X.

Name the types of PRP patients with acrodermatitis enteropathica have low levels of what? what hairs are not androgen dependent?

Pityriasis rubra pilaris (PRP) is classically categorized into 5 types (although it should be noted that a sixth type is increasingly-recognized). Type IV (circumscribed juvenile form) is the most common type to occur in children.PRP Types I and II are adult forms. Type III (classic juvenile form) and Type V (atypical juvenile form) occur in children, but less commonly than Type IV. Patients with acrodermatitis enteropathica have low levels of zinc and alkphos Eyebrows, eyelashes, and vellus hair are not androgen-dependent, thus there is no difference between these areas of hair growth in men and women.

How can you distinguish genetic and drug induced porphyrea cutanea tarda? - What is the cause of genetic PCT - What are the common causes of drug induced PCT

Porphyria cutanea tarda (PCT) can be due to a genetic mutation in UROD. Pseudo-PCT is most commonly secondary to drugs such as naproxen, NSAIDs, tetracycline, furosemide, and hemodialysis. The main differentiating factor is that urine, serum, and fecal porphyrins are normal in pseudo-PCT. Pseudoporphyria can look histologically exactly like PCT with DIF with IgG, IgM, IgA, C3 at DEJ and around vessels.

Treatment of choice for PCT, second line options? Hypertrichosis lanuginosa aquisita - causes? - associations?

Porphyria cutanea tarda (PCT) is caused by a deficiency in the enzyme uroporphyrinogen decarboxylase. Phlebotomy is the treatment of choice and may improve enzymatic activity by removing iron, an inhibitor of the enzyme. Antimalarials and erythropoietin are alternative therapies. Oral iron supplementation may worsen PCT. Naproxen is a common cause of pseudoporphyria. Hypertrichosis lanuginosa aquisita could be due to thyrotoxicosis, corticosteroids, phenytoin, and spironolactone. It is abrupt onset of downy, soft non-pigmented hair on the face and can be associated with glossistis and lung carcinoma.

Pseudoxanthoma elasticum is caused by mutations in which gene how about cutis laxa, marfan, and ehlers-danlos

Pseudoxanthoma elasticum is caused by mutations in the ABCC6 gene, which is an ATP-using cell transporter.Elastin and lysyl oxidase mutations cause cutis laxa, fibrillin 1 mutations cause Marfan syndrome, and collagen 5 mutations cause Ehlers-Danlos syndrome

Psoriasis has been linked to what other skin condition Retinoids upregulate production of which forms of collagen

Psoriasis is a T-cell-mediated immunological disease characterized by epidermal proliferation. The nature of the antigen(s) responsible for T-cell activation is still unknown. It has been suggested that the human papillomaviruses (HPVs) associated with epidermodysplasia verruciformis (EV), including the oncogenic HPV5, may contribute to the pathogenesis of psoriasis. In one study, the early detection of several EV-HPV genotypes in children supports the link between psoriasis and EV-HPVs and suggests a putative role for these viruses in the pathogenesis of psoriasis. 1 and 3

What is Romana's sign? Rothschilds sign Russels sign Raynauds sign

Romana's sign is the unilateral eyelid swelling & conjunctivitis seen at the site of the bite of the "assassin" or "kissing" bug, aka the Reduviid bug. It is a member of the Triatoma species. They transmit Chagas' disease (American Trypanosomiasis) by carrying Trypanosoma cruzi. This is typically seen in Central and South America. Rothschild's sign is alopecia of the lateral 1/3 of the eyebrows, secondary to hypothyroidism. Russell's sign is the development of callouses on the dorsal dominant hand due to repeated self-induced vomiting over long periods of time. Raynaud's sign is the development of acrocyanosis.

- cause of roeseola? clinical presentation - What are the three rapid grower mycobacteria and their treatment of choice?

Roseola infantum may be cause be either human herpes virus types 6 or 7. It is the sixth of the traditional exanthems of childhood. A diffuse, maculopapular eruption is typically preceded by a prodrome of fever and either respiratory or gastrointestinal symptoms. The infection usually occurs in the spring and the fall and nearly all children are seropositive for the virus by the age of 4. Chelonae, asbcessus, fortuitum; clarithromycinExplanation: These three are rapid grower mycobacteria and the treatment of choice is clarithryomycin. Minocycline can also be used, but it considered second line in WHO treatment.

UVB blockers Sweet syndrome - can be associated with what hematologic malignancy

Salicylates, PABA, Padimate O, and cinnamates are primarily UVB blockers. Avobenzone (Parsol 1789) is primarily a UVA blocker. Photostability of avobenzone may be a problem if it is combined with octyl methoxycinnamate. Sweet's syndrome, or acute febrile neutrophilic dermatoses, is often associated with AML and G-CSF. Histologically, there is marked dermal edema with a prominent infiltrate composed of neutrophils with leukocytoclasia. There is an absence of extensive vascular damage.

What is lofgrens syndrome?

Sarcoidosis presenting with fever, cough, joint pains, hilar adenopathy and erythema nodosum is known as Lofgren's syndrome. Erythema nodosum is the most common nonspecific cutaneous finding in sarcoidosis. Lofgren's syndrome occurs frequently in Scandinavian whites and is uncommon in American blacks. Type I (familial lipoprotein lipase deficiency or apoprotein CII deficiency) hyperlipoproteinemia has increased chylomicrons as a feature, and presents with eruptive xanthomas and lipemia retinalis. For the other hyperlipoproteinemias, the associated lipid abnormalities are as follows: Type IIa -- increased LDL; Type IIb -- increased LDL and VLDL; Type III -- increased IDL; Type IV -- increased VLDL. Type V has increased chylomicrons and increased VLDL.

Shamberg disease - most common form of what? peak frequency in whom? clinical presentation? Lichen Aureus Purpura annularis telangiectoides of majocchi Pigmented purpuric lichenoid dermatitis of Gougerot and Blum Eczematid-like purpura of Doucas and Kapetanakis is a rare variant of pigmented purpura

Schamberg disease is the most common orm of pigmented purpura. It can occur in children and has a peak frequency in middle-aged to older men. It is characterized by yellow-brown patches with an oval to irregular outline. There are pinpoint peteachiae within patches - likened to cayenne pepper. It occurs in successive crops and favors the lower legs.2 - Lichen aureus is a rare variant of pigmented purpura which is characterized by a solitary patch or purpuric macules, papules and patches primarily on the lower extremities. 3 - Purpura annularis telangiectoides of Majocchi is uncommon and occurs in adolescents and young adults, especially women. It is characterized by 1-3 cm annular plaques that may slowly expand. There are punctate telangiectasias and petechiae within the border. The location is the trunk and proximal lower extremities. - Pigmented purpuric lichenoid dermatitis of Gougerot and Blum is a rare variant of pigmented purpura that occurs in middle-aged to older men. It is an admixture of two ypes of lesions: Schamberg-like, purpuric red-brown lichenoid papules. It is chronic and occasionally pruritic. - Eczematid-like purpura of Doucas and Kapetanakis is a rare variant of pigmented purpura characterized by scaly petechial or purpuric macules, papules and patches. It is pruritic and mostly on the lower extremities.

What hereditary skin disorder is associated with the RAS-ERK-MAPK pathway

Skin disorders associated with the RAS-ERK-MAPK pathway include: Cardio-facio-cutaneous syndrome, Costello, LEOPARD, NF, and Noonan. Rothmund-Thompson is a RecQ DNA helicase defect. Carney complex and Tuberous sclerosis are associated with the cAMP & AMP activated protein kinase pathway. Griscelli syndrome involves defective vesicle trafficking/transport

What are the findings in schnitzlers syndrome? sweets and subcorneal pustular dermatosis are associated with what? what is associated with IgG monoclonal gammopathy?

Schnitzler's syndrome is associated with IgM monoclonal gammopathy. This question tests the examinee's knowledge of monoclonal gammopathies of note in dermatology. Of the answer choices, only Schnitzler's syndrome (choice 1) is associated with IgM monoclonal gammopathy, in association with chronic urticaria, bone pain, and fevers. Sweet's syndrome (choice 2) and subcorneal pustular dermatosis (choice 5) are associated with IgA gammopathy; scleredema (choice 3), with IgGκ; and scleromyxedema (choice 4), with IgGλ.

A middle-aged man presents with many 2-3 mm, firm, waxy closely aligned papules in a widespread symmetrical pattern throughout his head and neck, upper trunk, hands, forearms and thighs. The papules are arranged in a strikingly linear array. The surrounding skin is shiny and indurated and the glabella has deep longitudinal furrowing. Deep furrowing also is present on the trunk and extremities. A biopsy showed: mucin in the upper and mid-reticular dermis, increase collagen deposition, and a marked proliferation of irregularly arranged fibroblasts. Which of the following is the most likely diagnosis? Grenz Zone diff

Scleromyxedema Grenz zone differential: Lepromatous leprosy, cutaneous B cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, acute myelomonocytic leukemia, leiomyosarcoma, and Botryoid rhabdomyosarcoma.

Scrofuloderma - what is it? - most common presentation? - how is the diagnosis made?

Scrofuloderma is a tuberculous or nontuberculous mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures such as lymph nodes, bone, or lung. It most commonly presents as a neck abscess secondary to a tuberculosis infection of the cervical lymph nodes. It is manifested by the development of painless subcutaneous swellings that evolve into cold abscesses, multiple ulcers, and draining sinus tracts. The diagnosis is based on positive Mantoux test/PPD test, histologic features of caseating granulomatous inflammation, culture, and favorable response to anti-tuberculosis therapy.

Scrofuloderma Necrotizing periodontitis - caused by what? a sign of what?

Scrofuloderma is a tuberculous or nontuberculous mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures such as lymph nodes, bone, or lung. It most commonly presents as a neck abscess secondary to a tuberculosis infection of the cervical lymph nodes. It is manifested by the development of painless subcutaneous swellings that evolve into cold abscesses, multiple ulcers, and draining sinus tracts. The diagnosis is based on positive Mantoux test/PPD test, histologic features of caseating granulomatous inflammation, culture, and favorable response to anti-tuberculosis therapy. This is necrotizing periodontitis, caused by a mixed bacterial infection (normal flora). It is a marker of severe immunosuppression. This can present with painful, hemorrhagic, necrotic gingivae with ulcers of the interdental papillae. This will require a referral to a peridontist for debridgement and antibiotic/chlorhexidine rinses.

The histologic finding of "shoulder parakaratosis", parakeratosis with prediliection for the follicular ostia, is characteristic of pityriasis rubra pilaris as well as: A 32-year-old woman presents to clinic with hypertrophic plaques on the external nares. Biopsy revealed findings consistent with Rhinoscleroma. Findings are most likely to include: - Cause - Special biopsy finding?

Seb Derm Rhinoscleroma is caused by Klebsiella rhinoscleromatis. Biopsy findings include Mikulicz cells, which are foamy macrophages containing bacteria, and Russel bodies. Russel bodies are immunoglobulin inclusions in plasma cells. Pustolo-ovoid bodies are seen in granular cell tumors. Verocay bodies are palisading nuclei arranged in rows with peripheral eosinophilic cytoplasm characteristic of Schwannomas. Weibel-Palade bodies are organelles that are seen on macroscopy of endothelial cells.

Sezary Syndrome - what is sezary syndrome? biased immune response? CD4 vs CD8? loss of what?

Sezary syndrome is the leukemia phase of mycosis fungoides (cutaneous T-cell lymphoma) and is usually a TH2-biased CD4+ leukemia with loss of CD7. Preformed mediators include tryptase, histamine, serotonin, and heparin.Newly formed mediators include prostaglandin D2, leukotriene C4, and platelet activating factor

What is the best predictor of renal involvement in those with HSP occurs in who, Precipitating cause

Spread of purpura to the upper trunk Explanation: Henoch-Schonlein Purpura occurs mostly in children. There is an antecedent URI in 75% of cases. HSP involves the skin, synovia, GI tract, and kidneys. Long-term morbidity results from renal disease, which is predicted by the spread of purpura to the upper trunk. Skin lesions of adults show blisters and necrosis. Renal involvement occurs in 40-50% of patients and typically presents with microscopic hematuria (40%), often accompanied by proteinuria (25%). Although the appearance of cutaneous lesions often precedes the development of nephritis, the latter is clinically evident within 3 months. In pediatric patients, risk factors for the development of nephritis include age >8 years at onset, abdominal pain, and recurrent disease. Depending upon the series, persistent renal disease has been observed in 8-50% of patients, emphasizing the need for longitudinal monitoring until all abnormalities resolve. Fortunately, only 1-3% of children develop long-term renal impairment. Poor prognostic factors include renal failure at the time of onset, nephrotic syndrome, hypertension, and decreased factor XIII activity.

Stains for amyloid

Stains for amyloidosis include: Congo Red, Thioflavin T, Crystal Violet, Methyl violet, Pagoda red no. 9, PAS + diastase, amyloid P-component antibody.

What are stanozolol and danazol? Used in the treatment of what? Keratin 20 is an immunohistochemical markers for what? S-100 is a stain for what? what can be used to differentiate DF and DFSP marker for lymphatics?

Stanozolol and Danazol are synthetic derivatives of testosterone with anabolic properties. They have potent fibrinolytic activity to be used in the treatment of cryofibrinogenemia, lipodermatosclerosis, and livedoid vasculitis. Keratin 20 is reliable immunohistochemical markers for Merkel cells as it is restricted to these cells in the skin.Keratin 7 can be used as a marker for Paget's Disease. S-100 is frequently used to stain neural cells and melanocytes. Factor XIIIa can be used to differentiate a dermatofibroma from dermatofibroma sarcoma pertuberans (positive in DF; negative in DFSP). LYVE-1 is a marker for lymphatics. CD34 + In DFSP and negative in DF

Anagen effluvium - typically seen after the administration of what? - is it reversible? -

Stimulus induces the abrupt cessation of mitotic activity in the rapidly dividing hair matrix cellsExplanation: It is frequently seen following administration of cancer chemotherapeutic agents. Stimulus induces the abrupt cessation of mitotic activity in the rapidly dividing hair matrix cells.Occurs within days to weeks following exposure to the inciting agent and is entirely reversible. Frequent causes include antimetabolites, alkylating agents, miotic inhibitors, thallium, boron, doxorubicin, nitrosureas and cyclophosphamide.

Common cause of bacteremic cellulitis in the hand of persons who handle fresh water fish? Treatment of choice? causes of zinc deficiency?

Streptococcus iniae most commonly causes bacteremic cellulitis of the hand in persons who have recently handled fresh fish. S. iniae is a fish pathogen that causes sporadic infection in tilapia, yellowtail, rainbow trout, and coho salmon. Treatment of choice is with penicillin antibiotics. Zinc deficiency can be seen in premature or term infants being weaned off breast milk, which is usually high in zinc content, as well as in parenteral nutrition use, alcoholism because of poor nutritional intake, malabsorption, IBD, diets high in grains containing phytate which binds zinc, and metabolic stress.

Subcutaneous fat necrosis of the newborn - Clinical Presentation - believed to be a result of what? - Associated lab abnormality

Subcutaneous fat necrosis of the newborn is a rare condition characterized by firm, reddish or purple nodules which appear on the arms, thighs, buttocks, back and cheeks. This condition is believed to result from cold injury. Crystallization occurs within the lipocytes, and this can be seen on histopathology with an associated granulomatous reaction. This is thought to occur due to the higher melting point of neonatal fat, which contains more saturated fatty acids. Onset of this condition occurs within the first two weeks of life and usually resolved over a period of weeks to months. Occasionally, lesions heal with atrophy. Hypercalcemia is an infrequent complication of subcutaneous fat necrosis of the newborn. Associated symptoms can include irritability, weight loss, vomiting and failure to thrive. Repeated serum calcium tests are advised until one month after all the cutaneous lesions have resolved.

Superantigen detection Pemphigus vulgaris HLA associations Which immunoglobulin is best at activating complement

Superantigens are able to bypass many elements of the normal immune response. They are not processed by antigen presenting cells. Instead, they bind directly to the MHCII complex and interact with T cells in a relatively non-specific fashion. Whereas conventional antigens require recognition in all 5 elements of the T-cell receptor (V-alpha, J-alpha, V-beta, D-beta, J-beta), superantigens are recognized by V-beta alone. Pemphigus vulgaris is associated with HLA-DR4 or DR6. IgM

what is swimmers itch? how is it attained? causative agent? mechanism for blisters in bullous impetigo?

Swimmer's itch also known as Clam Digger's itch is caused by the cercarial forms flatworms of the family Schistosomatidae. The mode of infection is penetration of skin while bathing in infested fresh or salt water in Northern United States and Canada. The clinical characteristics are pruritic papules and papulovesicles on uncovered skin Bullous impetigo is caused primarily by staphylococcus aureus phage type 71. This bacteria produces exfoliative toxin A binds to desmoglein 1 and produces produces the blisters characteristic of bullous impetigo.

What dermatophyton causes endothrix

T. tonsurans, T. violaceum, T. soudanense, T. gourvilli, T. yaoundei, and occasionally T. rubrum cause an endothrix pattern. T. schoenleinii causes favus in which hyphae and air spaces are seen in the hair shaft. A bluish-white fluorescence pattern is seen with Wood's lamp. Clinically, patients have thick yellow cup-shaped crusts (scutula); scarring and secondary infection may result. M. canis, M. audouinii, M. ferruginosum, M. distortium display a yellow fluorescence on Wood's lamp examination.Organisms that cause an ectothrix pattern of tinea capitis include M. canis, M. audouinii, M. ferruginosum, M. distortium, M. gypseum and occasionally T. rubrum.

A child presents with sparse, fine hair, thin nails and loose skin in infancy. He has a pear-shaped, broad nose and on X-ray has cone-shaped epiphyses. Which of the following genes is mutated in this syndrome? What HLA type is Bechets Disease Associated with?

TRPS1 is the gene mutated in Tricho-rhino-phalangeal syndrome. TRPS1 is a putative zinc finger transcription factor that is passed in an autosomal dominant fashion. HLA B51

Antifungal medications - mechanism of action of terbinafine, azoles, griseofulvin What is a serogate marker for MTX induced liver fibrosis

Terbinafine is an allylamine antifungal that is fungicidal. It works via noncompetitive inhibition of squalene epoxydation. Amphotericin is also fungicidal. The azoles are fungistatic and inhibit 14-alpha-demthylase to prevent ergosterol synthesis. Griseofulvin disrupts microtubule formation. procollagen 3

An 8 year old native American boy presents to your clinic with erythematous edematous plaques and papules with hemorrhagic crusts on his face, neck, and lower arms. You also notice pitted linear scars in the same anatomic locations, as well as cheilitis and conjunctivitis. What is the best systemic treatment for this boy? Which hypoglycemic agent is most likely to cause photosensitivity Butchers nodules are caused by what? Common warts genital warts plantar warts

Thalidomide for actinic prurigo sulfonylureas HPV 2 and 7 HPV 24 causes common warts. HPV 6 and 11 are found in genital warts; 1 is for plantar warts and types 13 and 32 are seen in Heck's Disease (focal epithelial hyperplasia).

Cafe au lait macules associated with what conditions What are the pustules of erythema toxicum neonatorum filled with? B12 deficiency is characterized by what?

The "coast of Maine" café au lait macule is associated with McCune-Albright syndrome and polyostotic fibrous dysplasia and NF The pustules of erythema toxicum neonatorum are filled with eosinophils This condition is vitamin B12 deficiency and is characterized by glossitis and hyperpigmentation in sun exposed areas and creases. Neurologic abnormaolities and megaloblastic anemia can be seen. The symptoms can mimic folic acid deficiency.

Mazzotti reaction - presentation, seen in what setting? Treatment for onchocerciasis? penicillamine may lead to low levels of what? Cisplatin can cause what?

The Mazzotti reaction is characterized by urticaria, fever, chills, sweats, abdominal pain, arthralgias, and lymphadenopathy. Hypotension and tachycardia may also be present, and the reaction can be life threatening. Mazzotti reactions are most often associated with the administration of diethylcarbamazine for the treatment of onchocerciasis, but may be seen during treatment with other anti-helminthics, such as suramin. The pathogenesis of Mazzotti reactions is thought to be consequent to abrupt release of parasitic antigens during cell death, prompting an intense inflammatory cascade. Currently, ivermectin is the treatment of choice for onchocerciasis, which has a lower incidence of associated Mazzotti reactions (approximately 10%).Capecitabine frequently causes hand-foot syndrome. Penicillamine may lead to low levels of vitamin B6 and require supplementation of B6. Cisplatin can cause ototoxicity. Ipilimumab can produce severe inflammatory states that damage organs such as the colon (colitis) and thyroid (thyroiditis and thyrotoxicosis).

indirect immunofluorescent substrates - what is best for pemphigus foliaceous, paraneoplastic pemphigus, pemphigus vulgaris, bullous pemphigoid Pemphigus foliaceous can be worsened by which drugs antigen target of cicatricial pemphigoid

The best indirect immunofluorescent substrate for pemphigus foliaceous is guinea pig esophagus. Pemphigus foliaceous has antigens against desmoglein 1 and typically presents as erosions on the chest.Rat Bladder is the best substrate for IIF in paraneoplastic pemphigus. Monkey esophagus is the best substrate for IIF in pemphigus vulgaris. Salt-split skin is the best substrate for IIF in bullous pemphigoid. piroxican, captopril, penecilimine C-terminus of BPAG2

HPV proteins - which subtypes of HPV can cause SCC - what are the two types of proteins? - what are the target for HPV vaccines?

The case demonstrates squamous cell carcinoma (SCC) arising from condyloma accuminata. The development of SCC is caused by high-risk human papillomavirus (HPV) types, such as HPV 16 and 18. The DNA of the HPV virus is divided into the early (E) region and late (L) region which are involved in active infection. The early proteins E1 and E2 are the first to be expressed after infection and control the transcription of the viral genome. E5, E6 and E7 influence the keratinocyte cell cycle to continue viral replication. E6 and E7 act as oncoproteins in high-risk HPV types. E6 is responsible for ubiquitin-mediated destruction of p53, which normally arrests the cycle cycle in G1 or induces apoptosis. E7 binds Rb, which stops it from inhibiting E2F, leading to transcription of genes for DNA replication.The late proteins L1 and L2 form the viral capsid and are the target for HPV vaccines. L1 binds to proteoglycans in epithelial basement membrane, exposing L2 for binding to the wound keratinocyte. Exposure to UV light can lead to UV signature mutations which are Cytosine → Thymine transitions and cyclobutane pyrimidine dimers. While UV light-associated mutations are associated with SCC on sun-exposed skin, they are not relevant to the SCC in this case.

Glucagon tumor - produced by what cells associated with what skin condition? Cryoglobulins - name the types of cryoglobulinemia - which is always linked to a B cell disorder? - which is associated with Hep C?

The cells secreting the glucagon tumor are the alpha islet cells of the pancreas. This patient has necrolytic migratory erythema which is associated with pancreatic glucagonoma, malignancies, liver disease, malabsorption states, and inflammatory bowel disease. The stem describes a case of Type I cryoglobulinemia, which is typified by monoclonal IgM or IgG (no rheumatoid factor activity). Type I cryoglobulins are always linked to a B-cell lymphoproliferative disorder, that is, multiple myeloma, Waldenström macroglobulinemia, chronic lymphocytic leukemia, B-cell non-Hodgkin lymphoma, or hairy cell leukemia.Mixed cryoglobulinemias are characterized by monoclonal IgM (or IgG) with polyclonal IgG (Type II) or polyclonal IgM complexed with polyclonal IgG (Type III). Mixed cryoglobulinemias (type II or III) are associated with hepatitis C virus (HCV) infection, systemic autoimmune diseases, lymphoproliferative disorders, and other chronic infections.

Lasers - Best Treatment of Poikiloderma of civatte? - how does IPL work? its wavelength - PDL wavelength - NDYAG wavelength

The condition shown is poikiloderma of civatte, caused by sun exposure. The best treatment for poikiloderma of civatte is IPL as it targets the hemoglobin in the vessels as well as the melanin in the lentigines, thus the best wavelength is 515-1200nm. The pulse dye laser is 585nm which would only treat the red. The Nd:YAG 1064nm would not be a good choice as it would not treat the erythema. The 810nm diode is a poor choice and the CO2nm at 10600 would not treat the red or the brown.

- What dressing type is ideal for wounds with alot of exudate? - What dressing is ideal for wounds with minimal exudate - What dressing is good for dry necrotic wounds?

The correct answer is alginate dressings (Choice 3) which are polysaccharides derived from kelp and algae that are ideal for highly exudative wounds. Other advantages of alginates are that they confer hemostatic benefits and are suitable for use in sinuses.Hydrocolloid dressings (Choice 1), which are waterproof gel or foam within polyurethane films, are not suitable for this patient as these dressings are good for mildly exudative wounds. Hydrogel dressings (Choice 2), hydrophilic polymer holding significant amount of water, are not suitable for this patient as these dressings are best for dry, necrotic wounds. Films (Choice 4), thin layers of elastic polyurethane, provide a barrier against bacteria and are not the best choice for highly exudative wounds. Foams (Choice 5), hydrophobic polyurethane sheets with hydrophilic surface, are ideal for mildly to moderately exudative wounds.

Cutaneous manifestations of tuberous sclerosis

The earliest and most common cutaneous manifestation of tuberous sclerosis are hypomelanotic macules (ash leaf spots), typically presenting at birth or early infancy. 3 or more of these lesions are considered a major criteria in diagnosis. Melanocyte numbers are normal. Confetti-like macules, on the other hand, are usually not apparent until the second decade of life. Facial angiofibromas occur in approximately 75% of patients, and tend to become more prominent with age. Periungual fibromas are considered a major feature for diagnosis, usually presenting around puberty to early adulthood. Skin lesions are found in 60-70% of cases of tuberous sclerosis.

First hair follicles form at what gestational age? When do the rest develop? Can new follicles develop in adult skin?

The first primordial hair follicles form at 9 weeks gestation on the eyebrows, upper lip and chin. The remaining follicles develop at 4-5 months in a cephalad to caudal direction. New follicles cannot develop in adult skin.

What is the function of glycosaminoglycans/proteoglycans in the dermis

The function of glycosaminoglycans/proteoglycans in the dermis is to regulate water-binding capacity. The other listed options are not functions of glycosaminoglycans / proteoglycans. The dermal fibril networks and cells are embedded in an amorphous extrafibrillar material that binds water and provides the hydrated consistency of the skin. Previously, this amorphous material was presumed to be biologically unstructured and inert and was called "ground substance". This prediction turned out to be incorrect; the extrafibrillar matrix is molecularly and structurally diverse, highly organized, and biologically active. It contains a number of proteoglycans and glycoproteins, hyaluronic acid, and water. The functions of the extrafibrillar matrix are adapted to the biologic needs of each tissue. For example, during embryonic development, water-binding proteoglycans and glycosaminoglycans form a hydrated milieu for cell migration and proliferation. During development and tissue remodeling, glycoproteins of the extrafibrillar matrix are essential for formation of the correct tissue architecture.

Phototesting results of chronic actinic dermatitis solar urticaria can be caused by what spectrum of light maximal tumescent lidocaine dose for lipo-suction best suture for the buccal mucosa

The hallmark of CAD is a lowered MEDB. Often the patients have a lowered MEDA. It is felt that many of CAD patients began with photoallergic contact dermatitis, so some have positive photopatch tests. most by UVA but also UVB and visible light 45-55mg/kg silk

What anatomic structure delineates the nail bed and the distal groove

The hyponychium is the structure that delineates the anatomic region between the nail bed and the distal groove, where the nail plate detaches of the distal portion of the digit. The corneal layer of the hyponychium accumulates in part under the free margin of the nail plate. In most cases, the hyponychium is covered by the distal nail plate, however, it may become visible in the case of nail biters

What is the most common digital manifestation of systemic lupus? what stain can be used for BCC? What are the diff findings of LP?

The most common digital manifestation is systemic lupus is raynaud phenomenon The correct answer is toluidine blue. Toluidine blue staining shows dark blue BCC tumor cells and a magenta-colored stroma around the tumor cells. CEA is used to stain adenocarcinoma, extramammary Paget\'s disease, and eccrine neoplasms. Desmin stains muscle. GFAP stains neurologic cells including astrocytes and Schwann cells. Factor 13A is used to stain dermatofibroma. Shaggy fibrin deposition at the DEJ, which is the single best indicator in the diagnosis of LP, was found in 56% of cases according to one study evaluating the DIF fndings in patients with LP.

Cutaneous mastocytosis diagnosis - most common form of mastocytosis? - How is it diagnosed Silver preferentially deposits where in the skin

The most common form of cutaneous mastocytosis is urticaria pigmentosa. It is diagnosed by measuring serum tryptase levels. The new diagnostic method is measurement of tryptase in bone-marrow blood, which is a new, sensitive marker of the mast cell burden in bone marrow of patients with systemic mastocytosis. silver preferentially deposits in eccrine glands

Most common subtype of molluscum? most common in HIV patients? up to what age is vertical transmission of perianal warts likely?

The most common subtype of molluscum contagiosum virus is MCV-1. In HIV patients, however, MCV-2 is more common. MCV-3, MCV-4, and MCV-5 are not common subtypes of molluscum contagiosum virus infections in HIV patients. In any child with peri-anal warts, the possibility of sexual contact must be excluded. Fortunately, in infants up to 12 months of age, the most common route of acquisition of the human papilloma virus is vertical transmission at the time of delivery. Anogenital warts in children may be perinatally acquired, transmitted during the routine care of children, autoinoculated from other sites of infection, or acquired as a result of sexual abuse. In most studies, proven abuse is uncommon in children with anogenital warts who are younger than 3 years of age.

A patient has multiple skin colored papule that when lanced, express clear fluid. On histology, the cyst is lined by eosinophilic cuticle with a thin squamous epithelium and mature sebaceous glands attached to the wall. The most likely defect is What keratins are present hyperproliferative plaques of psoriasis

The patient has steatocystoma multiplex that is linked to the defect in keratin 17, 10. The lesions usually occur in the second and third decades of life. It also occurs sporadically and is inherited in the benign form.The other keratins are not characteristically associated with seatocystoma multiplex. Keratins 6 and 16

- what is ramsey hunt syndrome - symptoms? causative agent, what ganglion is involved? -

The question stem describes Ramsay-Hunt syndrome, which is characterized by unilateral vesicles on palate, tongue, earlobe, and eardrum, in association with neurologic symptoms including vertigo, difficulty speaking, difficulty eating, hearing loss, and facial droop. The syndrome is caused by varicella-virus infection of the geniculate ganglion. Ramsay Hunt syndrome is a rare peripheral facial neuropathy. It is a type of shingles due to reactivation of the varicella zoster virus (VZV) in the geniculate ganglion of cranial nerve VII, which supplies the facial nerve. Ramsay Hunt syndrome is characterized by unilateral facial weakness and painful blisters — either in the ear canal on the same side as the facial palsy or inside the mouth. Sometimes, the involvement of cranial nerve VIII results in auditory (hearing) and/or vestibular symptoms (dizziness). Infection can also spread to cranial nerves III, IV, V, VI, IX, X, XI and XII. Blisters may be absent in some patients, in which case the infection is known as zoster sine herpete. Ramsay Hunt syndrome is also known as herpes zoster oticus, geniculate ganglionitis, Ramsay Hunt disease and Hunt syndrome.

How long after cutaneous infiltration of lidocaine with epinephrine is maximal vasoconstriction achieved?

The use of epinephrine with local anesthesia has two main advantages. Firstly, the epinephrine is a vasoconstrictor and assists in controlling bleeding during surgery. Secondly, and also a direct result of its vasoconstrictive effects, epinephrine helps prolong the duration of the anesthetic agent 100% to 200% by delaying its absorption from the surgical site. Although the anesthetic properties of lidocaine take effect within the first few minutes of infiltration, the vasoconstrictive effects of epinephrine require approximately 15 minutes to fully develop.The remainder of the options are either too soon for maximal epinephrine effect after injection or after the optimal time of effect.

hair transplant

The use of follicular-unit grafts, which contain one to four hair follicles, represents the advancement in both surgical technique and aesthetic outcome in the field of hair transplantation. The grafted hair follicles typically begin to grow within 8 to 10 weeks of implantation and are expected to survive for the individual's lifetime. Hair transplantation is done in a doctor's office and can take between 4 to 8 hours depending on the extent of the transplantation. Traditionally, hair transplantation has been performed in multiple planned sessions that are spaced 3-6 months apart. A typical session might average between 150 and 300 grafts. However, more recently the trend is to place more grafts per session. It is not uncommon for sessions to involve 750 to 2000 grafts. The purported benefit of these 'mega sessions' is a reduced number of hair transplantation visits to achieve hair restoration in a shorter period of time. The possible downfall is reduced overall graft survival where grafts are packed very close together. The procedure is usually done under local anesthetic and does not cause too much discomfort. In most cases, immediately after the hair transplant the hairs fall out of the grafts and do not regrow for 1-3 months. The donor sites gradually heal to leave slight scarring but this is concealed by "lifetime" hair growing around the site. Patients need to be aware that hair transplantation does not produce an instantaneous head of hair but the results are seen over time.

What is the name of the condition when a tarantual hair is in the eye? What is the family name for tarantulas?

Theraphosidae (tarantulas) are large, brown to black, hairy spiders frequently found in the southwest. They are of dermatologic importance due to urticating hairs. Tarantula bites generally do not produce any systemic toxicity. The spider releases hairs in the direction of the perceived attacker; hairs can penetrate the skin as deeply as the reticular dermis. If they injure the cornea, they can cause a chronic granulomatous reaction (ophthalmia nodosa) and loss of vision. Tarantulas (Family Theraphosidae) are typically large hairy spiders, up to 15 cm in diameter, normally non-aggressive. Their urticating hairs are thrown at skin and eyes. Tarantulas are an important cause of ophthalmia nodosa.

- most common cause of infection after human bites - cause of infection after dog bite in immunocompromised individuals? - infectious agents in dog and cat bites? what is seen most frequently?

There have been several reports of Capnocytophaga from dog bites producing sepsis in immunocompromised victims.A bite from a vaccinated dog can still result in a serious infection (although vaccination may prevent against rabies). Eikenella corrodens is the most common cause of infection following human bites. Cat bites most frequently result in Pasteurella multocida infections, while dog bites result in Pasteurella canis. However, most bites are polymicrobial with mixed aerobes and anaerobes. Infrequently systemic infections may result in brain or lung abscess, endocarditis, or sepsis. Rickettsialpox is not transmitted via dog bites, but rather through the bite of the mouse mite.

You diagnose a patient with multiple epidermal tumors that on histopathology shows a fibrous pink orb with epithelial strands coming through the follicular center. The patient most likely has a mutation in which gene?

This describes a fibrofolliculoma, a tumor seen in Birt-Hogg-Dubé syndrome. This is an autosomally dominant syndrome due to a mutation in FLCN - folliculin (Choice 3), a tumor suppressor gene. Patients show these skin lesions and have an increased risk for renal cell carcinoma, spontaneous pneumothoraces, pulmonary cysts, and medullary carcinoma of the thyroid. CYLD is mutated in Brooks-Spiegler syndrome, characterized by multiple adnexal tumors often located on the scalp. p53 is an important tumor suppressor gene, mutations of which lead to tumor syndromes such as Li-Fraumeni syndrome. The p53 gene product is inhibited by the E6 gene product of HPV, which is a major virulence factor of HPV. RAS is an oncogene which is inappropriately activated in diseases such as Neurofibromatosis, leading to multiple tumors. ECM1 is a gene which is mutated in Lipoid proteinosis. Autoantibodies to ECM-1 are seen in Lichen Sclerosus.

Xeroderma pigmentosum - Subtypes, each is most common where? - clinical presentation - Cause

This is xeroderma pigmentosum. XPC is the most common subtype in the US. In this subtype there are no neurologic symptoms. In XPA, which is the most common subtype in Japan, there are often severe neurologic symptoms. Xeroderma pigmentosum (XP) is a very rare skin disorder where a person is highly sensitive to sunlight, has premature skin aging and is prone to developing skin cancers. Xeroderma pigmentosum is caused by cellular hypersensitivity to ultraviolet (UV) radiation, as a result of a defect in the DNA repair system. Xeroderma pigmentosum has also been called DeSanctis-Cacchione syndrome. At least seven different gene abnormalities or complementation groups have been described in different families (XPA to XPG) resulting in varying disease severity. XPA and XPC are relatively common XPE is fairly rare XPG is severe XPF is mild.

Aplasia cutis congenita? - characterized by what? - can be associated with what other abnormalities? - what should be one before biopsy? what % of children not treated for kawasakis will develop coronary artery aneurysms? If infants have hemangiomas of the beard area, where else should be evaluated? Why?

This kodachrome is of aplasia cutis congenita. This is a localized developmental defect involving variable skin thickness. It typically occurs along developmental suture lines on the scalp. It can rarely be associated with underlying bony abnormalities, skeletal abnormalities, brain malformations, cleft lip, and syndactyly. The hair collar sign is a ring of dark, long hair at the periphery of aplasia cutis congenita. An MRI should be performed prior to any biopsy given the potential for underlying connection to the CNS. what % of children not treated for kawasakis with develop coronary artery aneurysms? 25% infants with hemangiomas of the beard area should be evaluated for hemangiomas under the tounge which could lead to airway obstruction

Types of Flaps - Mustarde flap - Rieger flap - O-Z - Abbe flap

This patient had a Mustarde flap, a rotation flap from the lateral canthus or cheek that close the lower eyelid or infraorbital defect. The flap taps into a tissue reservoir on the temple and cheek which helps to negate the risk of lower lid ectropion during repair.A Rieger flap is a dorsal nasal rotation flap with backcut at the glabella; it is also knows as a hatchet flap or glabellar turn-down flap. O to Z is a double rotation flap. A bilobed is a transposition flap most often used on the nose. Finally, and Abbe flap, or a lip-switch flap, is a lower lip flat of mucosa, muscle, skin, and subucutis that is transposed superiorly to the repair an upper lip defect based on inferior labial artery blood supply.

Mast Cell Stains Merkel cell Stain Most common mutation in melanoma

Tryptase, toludine blue, CD117, Giemsa CK20 is useful for diagnosing merkel cell Most common mutation in melanoma is BRAF

Lupus vulgaris - what is this? - lesions occur in whom? cause? lesions typically occur where? - appearance on diascopy? What is necrolytic acral erythema? seen in what patients? treatment?

This patient has lupus vulgaris, a pauci-bacillary manifestation of tuberculosis infection. Lesions occur in sensitized patients with a moderate to high immune response and are due to hematogenous, lymphatic, or contiguous spread from a distant site of infection. Lesions typically occur on the head and neck. "Apple jelly" color on diascopy is described in lupus vulgaris, but can also be seen in cutaneous lesions of sarcoidosis. Necrolytic acral erythema is characterized by hyperkeratotic well-defined plaques on the lower extremities, seen occasionally in patients with hepatitis C virus infection. Treatment consists primarily of treating the underlying infection. Diet supplementation with zinc has been shown to improve necrolytic acral erythema, even in the presence of normal serum zinc levels.

Pustular psoriasis of pregnancy - aka - clinical presentation, lab findings - Typically occurs when? Most common complication - Treatment

This patient has pustular psoriasis of pregnancy which is also called "impetigo herpetiformis." It is characterized by red plaques with a peripheral ring of pustules that are distributed symmetrically in flexural areas and trunk and extremities. Patients can have elevated ESR and leukocytosis as well as hypocalcemia. There is a risk of fetal morbidity and mortality secondary to placental insufficiency and maternal mortality secondary to cardiac or renal failure. Premature labor may be associated with cholestasis or pregnancy. Patients with herpes gestationis may have a risk of premature labor and small for gestational age. Microcephaly may occur with isotretinoin taken during pregnancy. Pustular psoriasis of pregnancy (PPP) is a life-threatening condition for both the pregnant mother and fetus, and must be efficiently and accurately diagnosed and treated. This condition has historically been classified as a unique, separate dermatosis of pregnancy. However, current opinion and data suggest that it may be a variant of generalized pustular psoriasis. PPP typically occurs in the third trimester and is characterized by widespread coalescent pustules, desquamation, and systemic symptoms. Clinical features and histopathologic evaluation aid in diagnosis. The most common complication is placental insufficiency. Treatments during pregnancy include high-dose corticosteroids, cyclosporine, narrow-band ultraviolet B radiation, infliximab, granulocyte and monocyte adsorptive apheresis, and systemic antibiotics. Both the mother and fetus should be closely monitored with appropriate laboratory studies for the duration of the pregnancy and postpartum.

Treatment options for M. Marinum or fish tank granuloma? What produces the dorsal nail plate, the ventral nail plate is produced by what? pitting in psoriasis is a defect in what part of the nail?

This patient most likely has contract Mycobacterium marinum, otherwise known as "fish tank granuloma." A reasonable approach to treatment of M. marinum consists of treatment with two antibiotics for one to two months after resolution of symptoms. One approach consists of clarithromycin combined with ethambutol OR rifampin. For minimal disease, some favor single-drug therapy with clarithromycin, minocycline or doxycline. The proximal nail matrix produces the dorsal nail plate. Defective keratinization in this region is therefore responsible for the pitting seen in alopecia areata, psoriasis, eczema, and other cutaneous diseases.The distal nail matrix produces the ventral nail plate and is visible as the lunula.

Contact dermatitis to tincture of benzoin is probably a reaction to what ingredient? Side effects of PUVA?

This patient who has a contact dermatitis to tincture of benzoin is probably reacting to its allergenic ingredient Balsam of Peru, which has healing and antibacterial properties.Ammonium persulfate is a bleaching agent for hair and flour, not to be confused with ammonium thioglycolate, a perming agent. Black rubber mix can produce unique lichenoid and purpuric reactions. Eugenol is found in cloves. Epoxy resin is found in glues and plastics Side effects of PUVA include side effects which are due to phototoxic effects including pruritus, photo-onycholysis, friction blisters, ankle edema and hypertrichosis. In addition, there are adverse effects from methoxypsoralen including gastrointestinal and neurologic effects, hepatotoxicity, and exanthems

Steatocystomas can be found in what conditions? Pilomatricomas are found in what conditions? Trichoepitheliomas are seen in what?

This photo has a histologic image of steatocystoma - It is lined by a characteristic eosinophilic crenulated cuticle (shark tooth lining), sebum typically falls out during processing, and sebaceous glands attach to cyst wall on the outside. Steatocystoma multiplex can occur in Type II Pachyonychia congenita (Jackson-Lawler syndrome), which involves mutations in KRT17. It will have findings of natal teeth and less severe PPK than type I pachyonychia congenita. Trichodiscomas occur in Birt-Hogg-Dube syndrome which has fibrofolliculomas, trichodiscomas, achrochordons, lipomas, oral fibromas, renal cell carcinoma, medullary thyroid carcinoma, and colon cancer. Pilomatricomas occur in Gardner syndrome and Rubinstein-Taybi syndrome. Trichoepitheliomas occur in Rasmussen syndrome, Rombo syndrome, and Brooke-Spiegler syndrome. Hutchinson's teeth are widely spaced, peg-shaped upper incisors that occur in congenital syphilis.

Lichen Sclerosis - Associated with what autoantibody -Piebaldism gene association -Cowden syndrome -Birt-hogg-dube -Familial cylindromatosis

This photo shows lichen sclerosis, which in 80% of cases has been associated with IgG1 autoantibodies against ECM-1. It presents with white, polygonal, and flat-topped papules or plaques surrounded by erythema.ECM-1 has also been found to be mutated in lipoid proteinosis. Piebaldism has been associated with mutations in the c-kit proto-oncogene. Cowden syndrome is associated with a PTEN mutation. Birt-Hogg-Dube syndrome is associated with a FLCN (folliculin) mutation. Familial cylindromatosis is associated with a CYLD mutation.

pustular newborn disease - which disease is associated with eosinophils, and which is associated with neutrophils

This scenario most likely describeds erythema toxicum neonatorum, which would show perrifollicular subcorneal pustules with eosinophils on biopsy.Subcorneal pustules with neutrophils is consistent with transient neonatal pustular melanosis, which typically presents at birth.

Nail polish allergen Spitz nevus histology Hibernomas arise where? Histology

Tosylonomide formaldehyde resin is found nail polish and is a common cause of allergic contact dermatitis involving the eyelid(s) in women. The above lesions describes a spitz nevus. They occur most commonly in children and seen on the face, trunk, or extremities. An atypical spitz nevus is regarded as having an uncertain malignant potential. Kamino bodies are seen in Spitz nevus that are eosinophilic cytoplasmic extracellular globules in the junctional region. Hibernomas commonly arise in the neck, axillae, and posterior shoulder. The cells are multivacuolated and resemble mulberries; the cells are filled with mitochondria, as are the cells in normal brown fat.

Trachyonychia Terrys nails What is a tuberculid

Trachyonychia: Trachyonychia means rough nails. If all nails are affected, It is known as Twenty Nail Dystrophy, probably due to lichen planus. Terry's nails: Terry nail is seen in liver cirrhosis. White proximal nail, reddened distal nail. A tuberculid is a cutaneous immunologic reaction to tuberculosis elsewhere in the body. By definition, cultures and stains for M. tuberculosis are negative. Erythema induratum of Bazin/Nodular vasculitis present as erythematous or cyanotic nodules on the posterior calves. 85% of cases occur in women.

Woodslamp wavelength?

Trichophagia is more common in individuals who have trichotillomania. This chewing behavior frequently can lead to the formation of trichobezoars in the stomach or small intestines. Trichobezoars can result in anemia, abdominal pain, hematemesis, nausea and/or vomiting, bowel obstruction, perforation, gastrointestinal (GI) bleeding, acute pancreatitis, and obstructive jaundice. Woods lamp wavelength is 365 Theraphosidae (tarantulas) are large, brown to black, hairy spiders frequently found in the southwest. They are of dermatologic importance due to urticating hairs. Tarantula bites generally do not produce any systemic toxicity. The spider releases hairs in the direction of the perceived attacker; hairs can penetrate the skin as deeply as the reticular dermis. If they injure the cornea, they can cause a chronic granulomatous reaction (ophthalmia nodosa) and loss of vision. Tarantulas (Family Theraphosidae) are typically large hairy spiders, up to 15 cm in diameter, normally non-aggressive. Their urticating hairs are thrown at skin and eyes. Tarantulas are an important cause of ophthalmia nodosa.

Most common cause of one hand two feet syndrome What is the most common cause of herpes labialis recurrence what is the most common tumor arising from nevus sebacceous

Trichophyton Rubrum UVB Trichoblastoma

What is the cause of white piedra? Eosinophilic folliculitis - presentation - occurs in what patients, when specifically?

Trichosporon ovoides (formerly known as T. beigelii) produces white piedra. Eosinophilic folliculitis is characterized by markedly pruritic follicular papules, urticarial and/or pustular, that favor the face, scalp, and upper trunk. It occurs in the setting of immunosuppression, including from HIV infection and following allogeneic hematopoietic stem cell transplantation. In HIV-infected patients, the CD4 count is usually <200 cells/mm3; it may also be a manifestation of IRIS (immune reconstitution inflammatory syndrome). Histologically, lesions are characterized by spongiosis and exocytosis of eosinophils and lymphocytes into the follicular epithelium.

Trichothiodystrophy - caused by what? characterized by what?

Trichothiodystrophy is characterized by sulfur-deficient hair with alternating light and dark bands under polarized light. Cysteine and Methionine levels are decreased in hair and nails of patients with trichothiodystrophy. Other sulfur containing amino acids include: Gluthathione, Taurine, and Homocysteine. Testing hairs for decreased sulfur content is an indirect method of determining this.

Fly vectors - african sleeping sickness - new and old world leishmaniasis - Onchocerciasis

Tsetse fly, (genus Glossina), also spelled tse-tse, also called tik-tik fly, any of about two to three dozen species of bloodsucking flies in the housefly family, Muscidae (order Diptera), that occur only in Africa and transmit sleeping sickness (African trypanosomiasis) in humans. Deer flies are bloodsucking insects considered pests to humans and cattle. Simulium is a genus of black flies, which may transmit diseases such as onchocerciasis. The sandfly belonging to the genus Lutzomyia is the vector of New World Leishmaniasis. Sandflies of the genus Phlebotomus are the vectors of Old World Leishmaniasis.

Tuberculoid leprosy - what type of immune response, lepromin test?, describe the lesions when do melanocytes begin producing melanin? Menkes Disease - inheritance, gene, clinical findings?

Tuberculoid leprosy has a TH1 cytokine profile of IFN gamma, IL-2, IL-12. It is paucibacillary, Lepromin test +. There is less than 3 lesions and anesthetic and anhidrotic lesions. Melanocytes begin produing melanin in the third month of gestation X-linked recessiveExplanation: Menkes kinky hair syndrome is an x-linked recessive disorder caused by defects in ATP7A, an ATP-dependent copper transporter. It is characterized by pili torti, trichorrhexis nodosa, short, britle hair, lax skin, CNS deterioration, seizures, and tortuous arteries. Menkes disease, an X-linked condition of copper deficiency caused by an abnormal copper-transporting ATPase, that results in mental retardation, motor deficiency, growth failure and skin hypopigmentation. The hair is thin, whitish and likened to "steel wool".

Turner Syndrome - genotype - clinical features

Turner's syndrome results from nondysjunction during gametogeneiss leading to the XO genotype. Clinical features include short stature, redundant neck folds/webbed neck, multiple pigmented nevi, low set hairline, triangular facies, low-set ears, ptosis, wide-set nipples, shortened 4th and 5th metacarpals, hypoplasia of lymphatics, coarctation of the aorta, and horseshoe kidneys.

Nail changes - LP - Darier's Disease - Psoriasis - Scleroderma - Dermatomyositis Common drug causes of cicatricial pemhigoid

Twenty-nail dystrophy, nail plate splitting and pterygium formation are nail changes associated with Lichen Planus.Darier's disease is associated with longitudinal red and white streaks of the nail plate and V-shaped knicking distally. Psoriasis is associated with many nail abnormalities including pitting, onycholysis and oil-spots. Scleroderma may cause nail fold capillary dilation and destruction while patients with dermatomyositis may exhibit nail fold telangiectasias and frayed cuticles. clonidine, sulfa drugs

EBA - Target Antigen, also target antigen in what disease?

Type VII collagen is present in the basement membrane of stratified squamous epithelia in the anchoring fibrils. It is the target antigen in epidermolysis bullosa acquista and bullous lupus erythematosus. Mutated collagen 7 occurs in dominant and recessive dystrophic epidermolysis bullosa. Epidermolysis bullosa acquisita (EBA) is a prototypic organ-specific autoimmune disease induced by autoantibodies to type VII collagen causing mucocutaneous blisters. In the inflammatory (bullous pemphigoid-like) EBA variant, autoantibody binding is followed by a lesional inflammatory cell infiltration, and the overall clinical picture may be indistinguishable from that of bullous pemphigoid, the latter being the most common autoimmune bullous disease. The last decade witnessed the development of several mouse models of inflammatory EBA that facilitated the elucidation of the pathogenesis of autoantibody-induced, cell-mediated subepidermal blistering diseases and identified new therapeutic targets for these and possibly other autoantibody-driven disorders.

What wavelength of light is required to make vit D? What are the steps? PUVA bulbs admit what wavelength of light? steam autoclave can do what to sharp instruments?

UVB converts 7-dehydrocholesterol in the skin to previtamin D3 which will be converted in the liver to true vitamin D PUVA bulbs admit a wavelength of 350-360 Steam autoclave can dull sharp instruments

Uncombable Hair Syndrome - gene - clinical findings Klinefelter syndrome - clinical findings

Uncombable hair syndrome is characterized by pili trianguli et canaliculi. On examination of the hair, it is triangular with a canal-like groove runs along the shaft. The clinical findings are that of blond, shiny, "spun glass" hair. It is an autosomal dominant syndrome with no known gene locus. Klinefelter syndrome is associated with varicose veins and leg ulcers as well as tall stature, gynecomastia, small testes and infertility.

What is the mutation associated with uveal melanoma what is the jarisch herxheimer reaction? Seen in what setting?

Uveal melanoma mutation is GNAQ The Jarisch-Herxheimer reaction occurs in over half the. patients with early syphilis within a few hours of starting. treatment with penicillin. It usually takes the form of fever, malaise, sweating, and headache, and it is often associated. The Jarisch-Herxheimer reaction (JHR) is a transient immunological phenomenon seen commonly in patients during treatment for syphilis, and it manifests clinically with short-term constitutional symptoms such as fever, chills, headache and myalgias, besides exacerbation of existing cutaneous lesions. The complex interplay of its underlying patho-physiological mechanisms continues to elude modern medicine, ever since it was described over a century ago. An increase in the incidence of JHR may be expected among patients co-infected with HIV and other infectious diseases including syphilis.

Small pox vaccine - What is used for the vaccine and who gets it? - What reaction is consider adequate immunization? Seabathers eruption vs Swimmers itch?

Vaccinia virus is used to vaccinate high-risk individuals against smallpox virus. Development of a vesicle or ulcer with 4 cm of surrounding erythema is a reaction considered to have a high rate of adequate immunization. Seabather's eruption characteristically involves areas covered by swimwear, as a result of coelenterate larvae becoming trapped underneath bathing suits. The causative organisms are larval forms of Edwardsiella lineata (sea anemone) and Linuche unquiculata (thimble jellyfish). Swimmer's itch, or cercarial dermatitis, is a maculopapular eruption associated with penetration of the skin by cercaria of non-human schistosomes. Cutaneous larva migrans is often reported in travelers returning from tropical regions, usually found as a pruritic erythematous serpiginous eruption on the soles of the feet, buttocks, or abdomen. Swimming pool granulomas are typically focal lesions occuring due to exposure of a non-tubercoloid mycobacterium.

Histo findings of Varicella zoster - causes what two diseases - Histo findings Triangular nails are seen in what condition? what is the mutation?

Varicella zoster virus is the causative agent in chicken pox and shingles, where recrudescence from latency in the dorsal root ganglion causes a dermatomal distribution of painful vesicles and erosions. Biopsy of herpes viruses reveals cells with multinucleation, margination of the chromatin, and Cowdry Type A bodies, which are intranuclear eosinophilic amorphous bodies surrounded by a clear halo. Triangular lunulae are seen in nail-patella syndrome which is characterized by mutation in LMX1b

what is the vector for verruga peruana what virus causes measles most common internal manifestation of systemic sclerosis is what? Name the RNP antibodies

What is the vector for verruga peruana - Verruga Peruana is caused by infection with B. bacilliformis, which is transmitted by the sandfly, Lutzomyia verrucarum. Measels is caused by a paramyxovirus Most common internal manifestation of systemic sclerosis is esophageal dysfunction RNP antibodies target small ribonucleoproteins. These include SS-A (Ro), SS-B (La), Sm, and U1RNP. The total amount of antibody has more diagnostic value than the mere presence of antibody.

which dermatophyte species are positive on woods lamp? why? why are cornybacterium, pseudomonas positive on woods lamp what is the most specific microscopic fungal test? what is it specific for? what is specific for chitin

Wood's light positive dermatophytes (M. canis, M. audouinii, M. distortum, M. ferrugineum, T. schoenleinii, and sometimes M. gypseum) fluoresce secondary to pteridine.Corynebacterium can fluoresce as well due to production of coproporphyrin III. Pseudomonas fluoresces from production of pyocyanin. The other organisms do not react with a Wood's light. Calcoflur is the most specific fungal microscopic test. hlorazol black E is chitin specific. Calcofluor white is glucan specific. Gomori Methenamine Silver (GMS) and Fontana-Masson are histology stains. KOH is a rapid, easy, reliable method for diagnosing fungal infections, but is not chitin-specific.

Yellow skin and diabetes - occur in what % of patients - half of these patients have elevated what? beaded appearance of hair is called what?

Yellow skin may occur in up to 10% of diabetic patients and is characterized by diffuse yellow-orange skin. Half of these patients have elevated serum carotene levels. The suggested is cause is elevated consumption of yellow fruits and vegetables in the setting of impaired hepatic metabolism of carotene and subsequent non-enzymatic glycosylation of dermal collagen. This is an image of monilethrix, which upon trichoscopy reveals a beaded appearance of hair due to periodic thinning of the hair shaft.

Best way to diagnose herpes Cryoglobulinemia is associated with what infection? Parvovirus B19 is what type of virus?

lesional PCR Cryoglobulinemia is associated with HEP CCCCC Parvovirus B19 is what type of virus? SSDNA