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203 Cards in this Set
- Front
- Back
|
What marks transition from radial to vertical growth phase in melanoma?
|
loss of E-cadherin, gain of N-cadherin; VEGF expression
|
|
Expression of which marker correlates with hematogenous mets in melanoma, poor 5 yr survival, and tumor induced angiogenesis?
|
MMP2
|
|
What serologic marker in melanoma correlates with metastatic burden and is more predictive than MIA, LDH, albumin
|
S100B
|
|
High levels of what serologic marker is relatively protective in melanoma, showing a form of "immunity" to melanoma cells?
|
TA90-immune complex (detected by ELISA)
Lack of this in stage IB, IIA more likely to harbor distant mets, die from melanoma |
|
UV wavelength responsible for immediate and persistent pigment darkening
|
UVA
photooxidation of existing melanosomes |
|
What agents are not chemopreventive of NMSC?
|
vitamine E, beta-carotene, selenium
|
|
MC skin cancer in blacks and Asian Indians
|
SCC
|
|
MC site of SCC in blacks, Asian Indians
|
sun prtoected sites (LE > head/neck > genital)
Less clear UV association with SCC |
|
MC skin CA in Hispanics, Chinese Asians, Japanese
|
BCC
Associated with prolonged intense UV exposure in all ethnic groups |
|
MC variant of BCC in blacks, Asians
|
nodular BCC
|
|
Characteristics associated with acral lentiginous melanoma
|
3mm width, Hutchinson sign, solitary lesion on thumb, rapid incr. in size
|
|
Virulence factor for MRSA
|
virulence factor: Panton-Valentine leukocidin
CA-MRSA carries Staph cassette chromosome mec4A that codes for methicillin resistance |
|
Tx for MRSA
|
I&D
Add antibiotics if immunocompromised, >5cm abscess |
|
Most effective topical cleanser for MRSA
|
ethyl alcohol
|
|
Most reliable and identifiable risk factor for TEN
|
family history
|
|
HIV protein that contributes to HPV proliferation
|
tat protein
|
|
Relative increased risk of developing NMSC in HIV+ pt is?
|
3-5 fold increase
|
|
Chemical substitution that affects potency of topical steroid?
|
Halogenation at 9- alpha position enhances potency
Masking or removing 17-dihydroxyacetone side chain or 16-alpha hydroxy group increases lipophilicity for better SC penetration |
|
MC adverse effect of topical steroid use?
|
atrophy
|
|
Mechanism for atrophy with topical steroids?
|
Decreased fibroblast growth
Reduced synthesis of collagen and acid mucopolysaccharides |
|
Serum levels of what can distinguish erythroderma due to steroid withdrawal from eczema?
|
serum nitrous oxide levels: elevated in steroid withdrawal
|
|
Topical steroids with higher prevalence of contact sensitization?
|
Nonflourinated corticosteroids
Hydrocortisone, hydrocortisone 17-butyrate and budesonide |
|
Recommended limit of class I/II steroids to avoid HPA suppression in an adult?
|
< 50 grams/week
14g/week in kids can cause it |
|
Addition of what may prevent steroid-induced atrophy?
|
topical tretinoin
|
|
Systemic toxicity after topical administration seems to be more frequent in which patients?
|
patients with renal and hepatic disease
|
|
Which protein of Bartonella causes pits and indentations in erythrocyte membranes, resulting in hemolysis?
|
deformin
|
|
Treatment for bartonellosis (Carrion's disease)
|
chloramphenicol
pcn aminoglycosides |
|
Causes of tropical ulcers?
|
Fusobacterium sp
Bacillus fusiformis Treponema vincenti |
|
Treatment for tropical ulcers
|
Metronizadole and tetracycline
|
|
MC organism associated with tropical pyomyositis?
|
S. aureus
|
|
intradermal test with tuberculin is used to indicate active or past infection with Mycobacterium tuberculosis
|
Mantoux test
|
|
Mycobacterium ulcerans produces which soluble polypetide toxin that has both cytotoxic and immunosuppressive properties?
|
Mycolactone
|
|
Treatment for anthrax
|
penicillin
TCN, Cipro, E-mycin, chloramphenicol |
|
Causative organism in meliodosis?
|
Burkholderia pseudomallei
Strong assoc with diabetes Kids: acute suppurative parotitis Treatment: ß-lactam Abx- |
|
Causative organism and treatment for glanders?
|
Burkholderia mallei
Sulfadiazine |
|
Genes for MRSA resistance carried by what?
|
staphylococcal chromosomal cassette mec type IVa (community acquired): Altered Penicillin Binding Protein 2a binding site
mec type II (hospital acquired) |
|
Most important virulence factor in MRSA?
|
Panton-Valentine-Leukocidin
|
|
The genome sequence of the prototypic CA-MRSA strains common to most regions is?
|
MW2
|
|
Lifetime risk of melanoma in giant congential nevus
|
6%
|
|
Antimicrobial peptide involved in adaptive immunity, brought to skin by T cells
|
granulysin
|
|
antimicrobial peptide involved in wound healing
|
LL37
|
|
antimicrobial peptides associated with atopic dermatitis
|
Reduced HBD-2 and LL37
|
|
Endogenous photoprotectant agst UVB induced photodamage, found in stratum corneum, derived from fillagrin catabolism
|
urocanic acid
|
|
Difference b/t trans and cisurocanic acid
|
UV exposure converts transurocanic acid to cisurocanic acid (an inducer of immunosuppression)
|
|
Pathogenesis of TEN
|
T cell mediated activation of keratinocyte death receptors (DRs)
FasL-Fas interaction activates procaspase 8 → caspase 8 → apoptosis Perforin/granzyme B: perforin punches holes, granzyme B enters and activates caspase 8 |
|
Most effective tx for lobomycosis?
|
Wide surgical excision of affected area
Clofazimine 300mg/d, must continue use 100mg/d for at least 2 years Antifungals ineffective! |
|
Difference b/t keloidal ears in leprosy vs lobomycosis
|
Keloids unilateral in lobomycosis
|
|
External glycoprotein synthesized by paracocci capable of inhibiting dermal dendrocyte functions & evade cellular immunity
|
gp43
|
|
Favo-Neto’s reaction is used to diagnose which fungus?
|
paracocci
|
|
TOC for lymphocutaneous sporotrichosis
|
itraconazole
|
|
Treatment of sporotrichosis in pregnant female
|
Wait until after delivery
Azoles: teratogenic potential SSKI: toxicity to fetal thyroid No risk of dissemination of sporo to fetus, sporo not worsened by pregnancy |
|
Geographic vascular malformations associated with?
|
lymphatic abnormalities
Progressive limb hypertrophy |
|
Incidence of SWS in pts with PWS in V1, V2
|
8%
Increase risk with inc. dermatomes and bilateral PWS |
|
Method of choice for diagnosis of Sturge Weber
|
MRI with enhancement
|
|
Which syndrome has a capillary malformation and venous varicosities of the lower extremity with the affected limb demonstrating decreased girth compared to the unaffected side?
|
Servelle-Martorell syndrome
|
|
MC anomaly in CMTC
|
limb hypoplasia
|
|
Which TLR plays an essential
role in the immune response to M leprae? |
TLR2: low in lepromatous, inreased in tuberculoid pole
IFN gamma upregulates TLR1 IL4 downregulates TLR2 |
|
T pallidum is
recognized by the innate cells through which TLR? |
TLR2 recognition of the rich surface LPs, which
act as natural immunologic adjuvants to facilitate the activation of the adaptive immune system and polarize the response toward TH1 |
|
XP pts have defect in which TLR?
|
Peripheral lymphocytes of XP
pts contained a yet-undefined defect in IFN production in response to poly-I:C that impaired NK cell activity (later determined to be TLR3) |
|
TLR upregulated
in monocytes around the pilosebaceous units in patients with inflammatory acne? |
TLR2
|
|
Highest level of COX-2 in the skin found in what?
|
SCC
COX-2 expression in epidermis is stimulated by UVB Results in increased prostaglandin E2 PGE2 levels correlate with development and metastasis of cancer |
|
Helper T cell profile in HIV
|
TH2
B cell proliferation |
|
Role of nef protein in HIV
|
Nef decreases MHC1 on cells leading to poor detection of deranged self-cells
|
|
Antiretroviral therapy decreases the incidence of which cancer?
|
NHL
Does not decrease risk of Hodgkins but does improve survival |
|
Role of tat protein in HIV
|
increases proliferation of HPV
facilitates formation of KS |
|
The relative increased risk of developing
NMSC in an HIV infected person is |
3-5 fold
SCC:BCC=1:7 |
|
BCC in HIV+ pt is most commonly which
type? |
superficial
|
|
MC site of SCC in blacks
|
lower limb
|
|
Greatest risk of TEN after starting med?
|
1st 2 months
|
|
HLA association with TEN?
|
HLA-B12
|
|
Serum findings in TEN
|
↑ soluble IL-2 receptor (marker for activated T cells, levels mirror disease activity)
↑ activated T lymphocytes expressing the skin homing receptor, cutaneous lymphocyte antigen (CLA) ↑ soluble FasL in blood/serum |
|
treatment for acral erythema
|
Pyridoxine 100-300mg/day
|
|
What is capecitabine?
|
prodrug of 5-FU
Causes inflammation of AK's |
|
What chemo agent causes transverse pigmented bands in the nails?
|
idaribine (type of anthracycline)
|
chemo agent
|
Acral erythema from pegylated liposomal doxorubicin
|
|
Chemo agent that may cause drug-induced SCLE
|
docetaxel
|
|
MC malignancy to metastasize to the placenta
|
melanoma
|
|
Expression of estrogen receptors in melanoma?
|
ER beta expressed by severely atypical nevi and LM; ER alpha not expressed by melanocytic lesions
|
|
Types of melanoma that do not meet ABC criteria?
|
nodular, desmoplastic
|
|
% of psoriasis pts with nail involvement
|
50%
Lifetime incidence of nail involvment in those with cutaneous involvement is 80-90% |
|
Keratinization of nail matrix
|
without a granular layer
PNF, lateral nail fold with a granular layer |
|
Nail pitting due to problem with what?
|
ventral proximal nail fold
distal matrix |
|
Oil drop in psoriatic nails due to disease in what part of nail?
|
nail bed
|
|
5-FU improves which of the psoriatic nail findings?
|
subungual hyperkeratosis
pitting |
|
ILK is most effective at treating what psoriatic nail finding?
|
pitting/ridging
|
|
Psoriatic nail finding resistant to PUVA?
|
pitting
|
|
MOA of bacitracin and what org it covers
|
inhibits bacterial cell wall synthesis
covers gm + |
|
Polymyxin B covers which organisms?
|
gm -, pseudomonas
no gm + coverage |
|
MOA of mupirocin?
|
Inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl t-RNA synthetase
|
|
MC topical antibiotic sensitizer in pts with otitis externa
|
neomycin
|
|
Cross-reactions between neomycin, paraomycine, and buirsosin are thought to be caused by the common structure
|
Deoxystreptamine
|
|
Derivation of hair follicle and dermal papilla
|
follicle: ectoderm
dermal papilla: mesenchyme |
|
AA unique to internal root sheath and medulla
|
citrulline
|
|
At what level does trichilemmal keratinization begin?
|
isthmus
|
|
Layers of the cuticle (part of IRS)
|
Endocuticle
Exocuticle Exocuticular A-layer (High sulfur content) Fiber cuticle surface membrane (outermost) |
|
Anagen hairs differ from telogen hairs in that
|
Anagen hairs have both inner root and outer root sheaths, but telogen hairs do not
|
|
The composition of an anagen hair shaft, including both root sheaths, from innermost to outermost consists of:
|
Medulla, cortex, endocuticle, exocuticle, exocuticular A-layer, fiber cuticle surface membrane, IRS cuticle, Huxley layer, Henle layer, outer root sheath
|
|
Disseminated cocci vs self limited infections and Ab level
|
Low Ab titers and high DTH in self limited infections; high Ab titers and low DTH in disseminated
Titer correlates with disease severity |
|
TOC of cocci in pregnancy
|
amphotericin (azoles contraindicated)
|
|
Which type of skin cancer in AfAm has a definite link with UV?
|
BCC
Melanoma and SCC less clearly related to UVR SCC: MC skin CA in blacks and Asian Indians; predisposing factors: burns, radiation site,s ulcers, DLE, GA, leprosy; 25% mortality rate |
|
Excretion of imuran?
|
via kidney
Purine analog |
|
How are toxic metabolities produced with imuran?
|
6-MP to 6-thioinosine-5-monophosphate acted on by IMPD and TMPT--lymphs lack purine slavage so drug is lymph specific
|
|
Imuran pregnancy category?
|
D
|
|
Tx for emotional flushing?
|
nadolol
|
|
Flushing more common in what types of tumors in carcinoid syndrome?
|
Tumors distal to portal circulation
|
|
First line chemo agent in aggressive KS?
|
doxorubicin, daunorubicin
|
|
Tx for eumycetoma and actinomycetoma
|
eumycetoma: azole and surgery
actinomycetoma: streptomycin, dapsone |
|
HLA associated with bad prognosis in rheumatoid arthritis
|
HLA-DRw3
protective: HLA-DRw2 |
|
% of familial melanoma with loss of function mutation in CDK2NA
|
25%
AKA: p16INK4a |
|
1st and most frequent sign of recurrent metastatic melanoma?
|
palpable node
|
|
Definition of type 1 and type 2 errors in epidemiologic studies
|
type 1=alpha: false rejection of null hypothesis
type 2=beta: failure to reject null hypothesis |
|
sensitivity
|
positive in disease (TP/TP+FN)
|
|
specificity
|
negative in health
|
|
Whcih analyses vary with prevalence?
|
PPV, NPV
|
|
antimicrobial peptide that plays key role in fighting leprosy?
|
granulysin: 6x more common in tuberculoid than lepromatous, expressed only by hematopoietic cells like T-cells
|
|
What does human beta defensin bind?
|
HBD1: constitutively expressed; HBD-2: increased with inflammation, binds CCR6 which activates macrophages, activates TLR4
|
|
Prevalence of psoriatic arthritis in psoriasis patients
|
25%
|
|
Apoptosis induced by which cells in TEN?
|
cytotocix CD56+ T lymphocytes
|
|
Mechanism of TEN?
|
Drug acts as prohapten--becomes reactive during metabolism (SMX-nitroso, allopurinol to oxypurinol)
|
|
Gold standard for evaluation of AVM
|
MRI
|
|
Metabolism of cyclosporine
|
Metabolized in liver by P450, largely excreted through bile, must be adjusted only for liver failure not renal failure
|
|
Mechanism of how systemic steroids cause osteoporosis
|
decrease Ca absorption, suppresion of new bone formation by osteoblasts
|
|
Lasers for yellow-orange-red pigment
|
Q-switched NDYag 532, PDL 510nm
|
|
What allergies are a contraindication to use of smallpox vaccine?
|
polymyxin B, neomycin, streptomycin, chlortetracycline
|
|
Cells providing major source of IL10?
|
Macrophages
Endotoxin, GC, vitamin D3, calcipotriol increase expression of IL10R on fibroblasts |
|
2 types of anetoderma?
|
Schweninger-Buzzi: no preceding erythema
Jadassohn-Pellizzari : preceding macular erythema or papular urticaria |
|
MC location for anetoderma
|
upper trunk, proximal extremities
|
|
Associations with secondary anetoderma?
|
UP, syphilis, acne, varicella, Lyme, leprosy, HIV, LCH, SLE, hypothryoidism, Graves, Addison's, APLS, etc
|
|
Organs affected in CA-MRSA pulonary syndrome
|
Lungs and bones of children, may be fatal
|
|
Low number of which cell portend poor prognosis in TEN?
|
Neutropenia
|
|
Lesions of bullous EM are positive for what?
|
interferon gamma
|
|
Gene associated with AD inheritance of capillary malformations
|
CMC1 gene encoding RASA1 which activates Ras-GAP
|
|
MC locations of microcystic lymphatic malformations
|
limbs,axillae, chest
Pathogenesis likely includes VEGF/VEGFR |
|
Gene recently discovered to be implicated in melanoma development
|
MITF
|
|
Parakeratosis of hyponychium causes what?
|
onycholysis
|
|
Gene associated with sporadic cases of TS?
|
TSC2
Equal incidence of both genes in familial cases |
|
% of fetuses affected by melanoma metastasizing to placenta?
|
35%, most common sites of involvement are skin, liver
|
|
Why do women with psoriasis improve during pregnancy?
|
increased progesterone down regulates T-cell proliferative response
|
|
Reactivation of VZV occurs in about what % of people during their lifetime?
|
25%
|
|
What is impaired in pts with XP?
|
unscheduled DNA synthesis (non-S phase or repair DNA synthesis)
In the variant group this is normal (post replication repair or packaging is defective) |
|
What is reliable makrer for proliferative activity in epidermal cells, found primarily in the basal layer?
|
onrithine decarboxylase
|
|
MC human enzyme defect
|
G6PD deficiency, X-linked recessive
MC clinical manifestation is neonatal jaundice and acute hemolytic anemia |
|
Incidence of EN in sarcoidosis
|
10%
|
|
Characteristics of sarcoidosis in blacks vs whites
|
Blacks: 3x more common in whites, later onset than other ethnic groups, more chronic and fatal course
|
|
Ab associated with CNS lupus
|
N-methyl D aspartate receptor (NMDA)
|
|
Predisposing factor for eczema herpeticum in a child with atopic dermatitis?
|
early onset AD
High IgE levels |
|
Types of angioedema not associated with urticaria?
|
HAE 1,2 and AAE
|
|
Neonatal LE syndrome without systemic manifestations associated with which Ab
|
U1-RNP
|
|
MC dermatomes affected in zoster?
|
T5, T6
|
|
Characteristic arthropathy in multicentric reticulohistiocytosis
|
symmetrical, DIP joints
Characteristic joint space widening w/o periosteal bone growth |
|
Medication linked to development of HS
|
lithium
|
|
Genoderm linnked to HS?
|
KID sndrome
Connextin 26 is expressed on palms and soles but also sweat glands and hair follicles Also PC2 |
|
Disease with best established relationship to HS
|
Besides follicular occlusion tetrad, Crohns has been linked
|
|
Staging system for HS
|
Hurley's
1) abscee formation w/o sinus tracts and cicatrization 2) one or more widely spearated recurrent abscesses w/ tract formation and scars 3) multiple interconnected tracts and abscesses throughout an entire area |
|
MOA of cellcept
|
inhibits de novo purine synthesis (specifically guanosine nucleotides) by non competetive, reverseible inhibition of inosine monophosphate dehydrogenase
|
|
MC side effect of cellcept
|
GI (esp diarrhea)
Less common is increased risk of CMV infection in transplant pts |
|
Drug interactions with cellcept
|
Reduced nevirapine when coadministered
Increased MMF with salicylates and probenecid Decrease MMF with firampin, FQ, metronidazole, cholesyramine, antacids, Ca, Fe |
|
TLR activated by bacterial flagellin subunits such as those of T. pallidum
|
TLR5
|
|
Recurrent cellulitis or furunculosis may be associated with the inherited deficiency of this protein involved with TLR
|
IL1-rceptor associated kinase 4
|
|
TLR activated by LPS of gm neg bacteria and by C. albicans
|
TLR4
|
|
A point mutation in which TLR is associated with increased susceptibility to lepromatous leprosy
|
TLR2
|
|
Cause of indurated granulomatous central facial plaque and neurologic symptoms (encephalitis)
|
Amebiasis caused by Balamuthia mandrillaris
Tx with ampho B, followed by itraconazole, albendazole, and miltefosin for at least 6 months |
|
Chancre: indurated red or violaceous nodule with regional LAD 48 hours after bite, later forms eschar--what disease?
|
African sleeping sickness, usually secondary to T. rhodesiense (v. rare in T gambiense)
Transmitted by tsetse fly |
|
Characteristics of rhodesian sleeping sickness
|
More virulent, acute neuro manifestations and cardiac failure (myocarditis)
|
|
Characteristics of Gambian form of sleeping sickeness
|
Winterbottom's sign
No chancre Late meninoencephalitic stage (chronic disease) Kerandel deep delayed hyperesthesia: delayed bilateral pain out of proportion to insult to soft tissue during CNS involvement |
|
Three most specific signs of African trypanosomiaisis
|
Chancre
Targetoid macular trypanids Kerandel deep delayed hyperesthesia |
|
Finding in the CSF that is pathognomonic for meningoencephalitic stage of trypanosomiasis?
|
elevated IgM level
|
|
TOC for early hemolymphatic stage of T gambiense and T rhodesiense infections b/f CNS invasion
|
suramin
Alternative pentamidine |
|
TOC for Gambian and Rhodesian African sleeping sickness once involvement of CNS has occurred
|
melarsoprol (can cros BBB)
alternative: nitrofurazone |
|
Tx of Chagas disease for early acute stages
|
nifurtimox, benznidazole
No tx for indeterminate, and symptom-specific support for chronic |
|
TOC for toxoplasmosis
|
Sulfadiazine + pyrimethamine
|
|
Cutaneous manifestations of pneumocystosis
|
erythematous or skin colored papules or nodules usually in the ear or EAC
|
|
Zoonotic cutaneous leish primarily caused by
|
L. major
|
|
MCC death in RDEB pts
|
metastatic SCC
|
|
MC skin cancer in EBS-Dowling Meara
|
BCC
|
|
Species of caterpillars that contain toxins causing potentially fatal coagulation defects
|
Lonomia
|
|
Bandler syndrome
|
Multiple hyperpigmented macules and intestinal vascular malformations
Allelic to PJS Macules persist throughout life |
|
Drug reactions with azathioprine?
|
Allopurinol
Induces warfarin resistance Sulfasalazine increases active thioguanine, increases heme SE Septra: neutropenia, leukopenia Captopril: induces leukopenia |
|
Number of individuals with very low TPMT activity
|
1 in 300
|
|
Pathway involved in azathioprine activity
|
CD28 signal transduction pathway (6 thioguanine intereacts with rac 1)
|
|
CD4 response associated with effective immune response to cocci
|
Th1
|
|
Organs commonly involved in disseminated cocci
|
Skin, bones, meninges, joints
|
|
MCC cutaneous and furuncular myiasis in N. America
|
Dermatobia hominis
|
|
MCC furuncular myiasis, especially in Africa
|
Cordylobia anthropophagia
|
|
MCC US acquired furuncular myiasis
|
Cuterebra
|
|
Cause of migratory myiasis
|
Gasterophilis intestinalis (invades lower levels of epi), Hypoderma spp (invades subq fat)
|
|
Causes of wound myiasis
|
Cochliomyia hominivorax, Chrysomya bessiana, W magnifica
|
|
Common associated clinical features in pts with solar urticaria
|
dermographism
|
|
Most sensitive and specific test to diagnose pheochromocytoma
|
24 hour urine unfractionated metanephrines
|
|
Cholesterol crystal emboli visible in the retinal arterioles are called:
|
Hollenhurst plaques
|
|
In which subset of MF patients with skin of color is phototherapy most effective?
|
Hypopigmented MF
|
|
In a pt with skin of color and hyperpigmented MF, what is first choice for phototherapy?
|
PUVA
|
|
Which of the following side effects of interferon therapy is more pronounced in patients with skin of color?
|
vitiligo
|
|
MC orthopedic finding in NF1
|
scoliosis
10% of pts, usually by age 10 |
|
MC complication of NF1 in children
|
learning disabilities
|
|
What is considered the most specific sign in NF1?
|
axillary freckling
|
|
Hypermethylation of the MLH1 promoter or
mutations in BRAF-600E suggest what type of mutation--somatic or germline mutations? |
somatic
|
|
BRAF-600E mutations are highly associated with what mutations in MTS?
|
somatic mutations of MLH1
|
|
Toxin associated with pufferfish
|
tetrodotoxin
|
|
Irukandji syndrome
|
discrete lesions, severe pain at the sting site, headache, backache, joint pains, nausea, and vomiting. Pulmonary edema and heart failure may ensue; from contact with jellyfish Carukia barnesi
|
|
Most venomous fish in the world
|
stone fish
|
|
small catfishes that are capable of penetrating natural human orifices
|
candirus
|
|
Causes of swimmer's itch (cercarial dermatitis)
|
Schistosoma and Trichobilharzia
|
