My personal MCQ Notes

 Important points for MCQs

SJS /TEN keratinocyte death is due to apoptosis IVIG in TEN-> blocks Fas mediated keratinocyte death Butcher cut neck - so warts HPV 2/7 Commonest cause of EM is Herpes not Drugs Most Carcinogenic is HPV 16 specially periungual SCC Mutation PYRIN -> FMF P55 TNFR mutation-> TRAPS MAX NBUVB session 300 (48h gap -> 3/wk) PUVA 200 -250(72h gap-> 2/Wk) leukotriene inhibitors associated with chrug strauss Baxarotene given in MF 2b and above BCC location sequence men women Atropine make Mastocytosis worse

Lipschutz vulval ulcer -young girls painful/ EBV or reactive after infections Bliateral / kissing- heterophile abs + Rx pain and CS

Papular/ urticarial variant of P rosea in children Papular in pregnancy Acyclovir then erythromycin

Orf large lesions excised.

then cryo /imiquimod/cidofovir Overall mortality from TEN is 50% red burning syndrome is due to topical CS withdrawl some say give oral Cs and tetracycline and isotretinoin as rosacea Kawaski due to staph/ strep superantigens cardiac aneurysm or any cardiac manifestation develops late 1-5 months so they can never be in diagnostic criteria of Kawasaki 26.84 Staph epidermidis does not cause folliculitis Insoculation in graft occurs after 2-3d ATRA causes genital ulcers Serpentine supravenous pigmentation occurs Only with 5FU Bleomycin -> acrosclerosis/ flagellate erythema

Petechia are most commonly due to platelet problems and <4mm Most common sarcoidosis finding is acute anterior uveitis although it can cause posterior uveitis

Short to long gamma /x / UV / visible/ IR/ micro radio

Mycobacterrium kansasii, marinum, simiae are photochromogenic Inflix IV and alefacept IM Alefacept 2011 out due to lymphopenia Aefacept eliminates memory Tcells- do weekly CD4 counts syncytial cells in granuloma are giant cells formed by fusion Methyl prednisolone least mineralocorticoid activity

serum bile acids is the most appropriate investigation in Intrahepatic cholestatsis of pregnancy as liver enzymes are not elevated till liver damage Chronic paronychia is an inflammatory dermatosis Fluconazole accelerates nail growth CRF -> lindsay but after renal TX -> leukonychia Acitretin -> acute paronychia Dermal necrosis Cryoglobulinemia Severe cellulitis Zygomycosis

Atopic pts have staph colonisation TL2 recognized Staph cell wall -> inflammation Staph superantigens -> inflammation staph entertoxin A-D-

Sensitivity to peanuts / shellfish/ fish persist but rest children outgrow HEparin inhibit antithrombin III Dabigatran Factor IIa

Dermopathic enteropathy in children with netherton / growth retard Tacrolimus causes flushing after alcohol ingestion systemic Mastocytosis-> mast cells proliferate in bone marrow and GI tract

Acrocyanosis young girls NOT triphasic continues in summers

Erythrocyanosis fatty areas NOT acral Dusky discorloration with KP / angiokeratomas/ telengietasia Complication-> nodular perniotic lesions/ oedema/ fibrosis

Trench foot/ immersion foot Non freezing injury to cold and wet conditions numbness skin changes legs and feet On rewarming worse edema/erythema/ pain Frost bite -> rapid rewarming 40-42C 20 min

Erosive mucosal LP has poorest prognosis LP figers > toes Most common finding longitudinal lines + thinning

Exfoliative dermatitis of unknown etiology - erythroderma

Gorham disease with Lymphatic proliferation and destruction of bone matrix Eccrine glands are everywhere except lips,clitoris. labia minora,ear meatus

Chronic urticaria >6weeks MC physical urticaria is immediate symptomatic dermographism LYME-> Erythema chronicum migrans will lead to oligoarthritis / facial palsy and heart block in that order of frequency Bile salts greater than 40umol/L poses highest risk

Interface change is never seen in psoriasis. If its seen with psoriasiform hyperplasia think of lichenoid drug reaction Resistance to local anesthetics is seen in EDS - hypermobile Excessive aquagenic wrinkling - cystic fibrosis Hunters reflex/ lewis is normal reaction to cold-> glomus body labia Majora NOT MONS is most involved in Psoriasis Linear IgA has 50% oral mucosa involvement BP 10- 20% Vulval LSA 5% SCC risk Penile / extragenital -> penile / extragenital almost no risk

PUVA /NBUVB can reactivate HSV infection PUVA max 200 NBUVB 300 soy allergy-> NOT give isotretinoin as formulations have soya Merkel cells are component of dermis P53 is marker of apoptosis Th0-> Th1-> IL12 (last of Th1) Th0-> Th2-> IL4 (first of Th2)

IL-10 decreases antigen presentation/ cytokine production macrophage activation IL-10 DOES NOT decrease phagocytosis but decreases intracellular killing

Atopic pts have >90% colonization with staph aureus which can be reduced by topical antiseptic/ CS/Tac/PUVA

IL 12 is implicated in Atopic dermatitis and protects from psoriasis CS down-regulates IL12

In Atopic dermatitis what is the activity of macrophages ? SLE/Scleroderma overlap called Sjogren /SLE . which causes Ichthyosis

Nail polish allergy does not have sign on or around nails eyelids / face / neck chest are involved Dentist ->hand dermatitis due to Acrylates Surgeon-> graulomatous inflammation due to talc Lipstick has eosin -> photoACD Mercaptobenzo-thiazole is present in rubber caused ACD , its not a preservative Chloracne -> malar + retroauricular

Increase PDE activity and decrease c-AMP levels Heber syndrome??

SLE NOT sjogren Azo dye cross react with chlorpropamide - anti diabetic Isotretinoin does not cause EM, rifampicin does Griseofulvin damages sperm-> 3m Contraception Amiodrone causes pigmentation but not lichenoid eruption Oral LP with Diabetes Grover no follicular plugging eyelid Ca in order bcc,scc,melanoma, sebaceous ca

dry mouth , blurred vision, urinary retention, constipation, flushing

ingrown toenail due retinoids , indinavir ,MTX Arsenic does not cause hair loss but concentrates in hair - later can be detected

Minoxidil Not effective in fronto-temporal recession - good in vertex balding 10-12% hair density increase is expected gained hair lost after 4-6m 5% is better than 2% (Women dose)

pitting/Beaus due to Proximal nail matrix Latex cross reacts with fruits like banana kiwi lychee but not peanuts

Biologic DLQI /PASI > or equal to 10 Anti TNF avoided in NYHA 3/4 1/2 but <50% also avoid

ALL porphyrias always has sensitivity to visible light -> sunblock (UVA/UVB) not helpful solar urticaria mainly to UVA but others too CAD 50% to visible

Diclofenac gel topical is ONLY liscenced for Actinic keratosis

Cyclic neutropenia 21d interval neutropenia ulcerative gingivostomatitis alveolar bone loss-> antibiotics prevent

Crude coal tar /UVA can also cause pustular psoriasis Oral SCC commonest on floor of mouth MTX should be first line for morphoea

Which statin can be combined with ciclosporin? Pravastatin-> not metabolised through CYP3A4 pathway

Impetigo/cellulitis= GAS - pyogenes

Ritters= SSSS -> vanco / tobra -> not fluclox ssss- no mucosa involved TEN involved actinomycetoma have hard colonies Tuberculous chancre is primary inoculation - very rare ulcer with undermined edges Exogenous Russel body = plasma Giant histios= Mikulickz Rhinosclerema

Dermatomyositis Enzymes +++ steroid myopathy + EMG + EMG ->N Muscle biopsy Dermatomyositis -> C5-9 deposition Muscle infarct / atrophy HLA 1 DM upregulated TVC- single warty- exposed area

Erythematous / violet plaque- lupus vulgaris Extend on one side leaving scarring on other Central scarring - Lupus vulgaris- apple jelly+ Central clearing - tinea Central crusting - leishmaniasis

HIV associated Ichthyosis on legs

HPV 16 is resident of anogenital area -DISH Pox DS DNA-DD

MC primary HIV menifestation Fever> rash Scrofuloderma - children - multiple sinus with discharge Violaceous perilesional skin MC cervical LN PEriorifial- autoinoculation

Tuberculid -> mycobacterial hypersensitivity 3 characteristicsTuberculin test + Lesion AFB Good respose to ATT

Erythema induratum over posterior leg that ulcerates Lobular panniculitis Acitretin half life 2d Etretinate 100d

stasis eczema in early stages have cellulitis with itching crusting and later develop lipodermatosclerosis Red scaling/ fissure in subacute stage only in late stage only has lichenification

Keratolysis exfoliativa is non inflammatory vesicles never occur

Fingertip eczema difficult to treat stops before DIP Scaling and fissuring more pronounced in Psoriasis

LSC/ Neurodermatitis is well defined area Epoxy resins in plastics  Vitiligo

loss of melanocytes 20- 30 y -> No bimodal Segmental and non segmental types only Strongest with thyroid , other AI too Hypochromic vitiligo - vitiligo minor

Max cumulative dose of isotretinoin - 120 - 150mg/kg

100g cumulative for minocycline BPO bactiricidal + anti inflammtory activity + comedolytic NO effect on sebum production

Macrocomdeone best Rx cautery

EBV causes acne fulminans like lesions in mild acne G- folliculitis - isotretinoin best but ampicillin / trimethoprim ALSO

Diffuse vitiligo patch has faster repigmnetation Vitiligo has hyperpigmented borders Melanotoxic compounds from nerve endings / keratinocytes or antibodies from blood Also self destruction of melanocytes

Hydroquinone inhibits tyrosinase JXG associated with NF but not TS

Syringomas onset at puberty Cryptococcocis in hodgkin disease Deniluekin deftitox inhibits protein synthesis in cells leading to their death Porphyrin damage by complement and mast cell pathyway

Autoimmune progesterone dermatitis gets worse before pregnancy Laser alters the tattoo ink particles which are subsequently phogocytosed MC site of ulcerated SCC is lip Bowens common on Arms Leser trelat gastric & keratotic spicules -> MM MC alopecia areata Association = Atopic dermatitis LGV on coronal sulcus- ulcer and LAD sparate times chanroid simultaneous Sjogren No aphthous

Livedo reticularis

if asymmetrical->look for secondary cause Must Do ANCA Erythema ib agne -> malignant Frost bite shiny white -> ulcerate Pain better on rewarming , trench foot pain worse on rewarming raynaudes investigation -> nail fold capillaroscopy atopic dermatitis predisposes to CAD UVA damages fibroblasts = aging= star factor UVB = burn - cancers= very carcinogenic = SPF

Ig A pemphigus responds to dapsone PV and EB simplex clevage at Basal layer BP much better respose with Antiinflammatory drugs than Pv because it has the most inflammatory infiltrate on histo Tin tack- DLE -Pem folia + cut lesihmaniais Highest concentration abs in dermatomyositis ANti Jo1 Immnuoreactants absent in / DIF negative in Systemic sclerosis dermatomyositis calcification 1-3y after and on major joints Calcification in elastic fibers

HLA B-8 high conversion of DLE to SLE Lupus anticoagulant/ anti histone present in Drug induced LE GN not a feature of ANA negative SLE Reduce GVHD chance by giving rituximab ->Deplete B cells EDS does not have striae / Marfan does (also EPS) Cutaneous vasculitis can involve any organ MC anca associated microscopic polyangiitis Digital infarcts +vasculitis= rheumatoid arthritis Urticarial vasculitis can have associated angioedema Chickenwire erythema on trunk is prodrome of hereditary angioedema

Bullous Pemphigoid oral lesion 10-20% cases /IgA 50%

Lymphoma and myeloid leukemia ssociation less with lymphoid leukemia Pyodermatitis pyostomatitis = cerebriform tongue Scleromyxoedema IL 1/ 6 / TGF b Most accurate test for DH would be DIF as subepidermal blisters with neutros in many

chancre heals in 3-8 weeks HPV / wart -> viral replication only in fully differentiated basal keratinocytes/ spinous-> nucleus

Anogenital carcinoma in situ HPV 18 Fungal sexual reproductive structure is Cleistothecium Trichomycosis nodularis = black piedra Histoplasma grows within the cells of reticuloendothelial system

Crusted scabies Painless ulcer + raised border+ no LAD Leishmaniasis Life span of scabies is 4-6w

Schistosomiasis/ cysticercosis treated with praziquantel Trichomonas vaginalis more common in blacks

Leishmania old world incubation period weeks to 3 years new world 2-8 weeks Post traumatic eczema like Koebner - Sephanous donor site

Pompholyx histology Lymphos eosinophils generalized hypertrichosis = hyperthyroidism

Coeliac has aphtous ulcer but IBD does not??

Proriasis may also have aphthous specially psoriatic arthritis Acromegaly ↑ GH ↑ IGF-1

For MCQ Behcet does not have conjunctivitis but Posterior uveitis aka retinal vasculitis anterior uveitis is less common, but In contrast Sarcoidosis has both anterior and posterior uveitis

Behcet has 2 features on histopathology- Leucocytoclastic vasculitis + thrombosis. but SWeet only has neutrophilic dermatosis no LCV

HLA B-51 and IL8 has role in behcet

OCPs/ BB/ Ciclosporin may cause raynauds Alefacept is a fusion protein

Thiopurine methyltransferase NOT amino transferase Most effective is PUVA->PLC/PLEVA just like MF

Tachyphylaxis within a week

Increase hydration of skin -> increased absorption of topical drugs Hypopigmented sarcoidosis first line is PUVA

Drug induces granuloma annulare by Anti TNF a

Erythrocin does not cause eXanthematous drug reaction Gold -> exanthematous and MC pityriasiform drug reactions

C2 low-> SLE/ GN/ HSP/ Pneumococcal - NOT staph C3 low-> Meningococcal NLE -> NO GN Maceration by water is the crucial factor in napkin dermatitis

capecitacibine = 5fU

dihydropteroate synthetase

IgE mediated reaction after food allergen

Which is a rick factor for melanoma? Asymmetrical smile after botox Drug sensitisation Different routes?

Red man syndrome All porokeratosis have malignant potential except? DH association AV Malformation NOT excision Venous/ lymphatic malformation telengiectasia/ capillary malformation HHD heal without Goiter nails Whipple skin signs and biopsy

Tuberculosis

NO LAD in What TB form

colicky abdominal pain , Rhinitis , urticaria BUt NOT Eosinophilc esophagitis Non hodgkin marginal mandibular nerve injury IM-> most likely to induce sensitization. Oral -> least Vancomycin Punctate Hashimoto thyroiditis DM1 Embolization Sclerotherapy pulse dye laser scar /keloid formation Distal onycholysis / plummer nails hyperpigmentation with photo accenutation / vasculitic lesion - PAS + particles in intestinal bx

TVC Tuberculin reaction can be altered by Tuberculin sensitivity once acquired remains life long?

Primary infection in non immune subject leads to ATT to prevent resistance ATT effective against dormant/ persistant bacilli BCG is used as immunotherapy in Lupus vulgaris common site in Pakistan Tuberculoid Leprosy only 2 organs affected Fernandez Giant cells/ No grenz ZOne Sabies mite life. Eggs in lifetime? Safest sulphur then permethrin in Pregnancy Recurrent pyoderma of scalp- keep scabies in DD pyoderma gangrenosum mortality TRAPS RX Prebullous Pemphigoid gestationis and Polymorphic eruption pf pregnancy looks alike. What is different ?

Parvovirus infection can cause death in what trimester?

Secondary systemic amyloidosis does not affect what organ?

Dyskeratosis congenita?

JV cataract in RTS and werner - pangeria

but senile appearance in werner only

Premature greying - check B12- macrocytosis Book syndrome -> hypodontia / PP hyperhidrosis Most important defect on PKU is incraesed Phenylalanine

food induced flushing is not caused by carotene Corn > oats in DH prevention In acute attack of porphyria -> increase protoporphrin in feces

HEP like EPP in infancy but BListers ++ Later milder form of CEP

Calciferol YES Tuberculous chancre INH main bactericidal( main sterilizing is Rifampicin) Streptomycin Malignant melanoma and Leprosy Trunk / buttocks Nerves /Skin IV HSN to soluble components of lepromin Tuberculoid leprosy 30d. 60-90 (4-6w)

16% 8y. 20-60% recurrence

First CS then etanercept Baby not affected in PEP

Any but more in second. It does not cause fetal anomilies. Skeletal muscles Esophageal stricture/ Portal hypertension

Micinois + proliferation of histiocytes-> hereditary progressive mucinous histiocytosis NXG pretibial + eyelids but ulceration prominant and monoclonal gammopathy Frontal fibrosing alopcia looks like ophiasis IL CS most helpful in paronychia ,SU hyperkeratosis , thickening / ridging only 50% helpful in onycholysis/ pitting

Actinic Keratosis TOC -> Cryo therapy BCC on scalp -> radiotherapy SCC is most frequent complication of Actinic keratosis >> Leukoplakia Genetic predisposition >> UV trigger for BCC

Tripe palms always in Males Paraneoplastic dermatosis can be typical or atypical but never indolent Bowen related to sun exposure -> skin / mucosa/ head n neck / extremities Intertriginous / nail It has more scaly than eroded appearance- Not pruritic Bowen well defined

Extramammary Paget - maybe ill defined - more eroded appearance- strawberry and cream Not on sun exposed mainly apocrine areas Elederly women- Pruritis must

Acropachy= clubbing Thyroid acropachy = hyperthyroidism + clubbing + periosteal new bone formation covid 5 skin manifestations

1. acral pseudo chillblains

2. vesicular

3. Urticaria

4. MP

5. livedo/ necrosis Children -> kawasaki like mucositis-> cracked lips/ strawberry tongue/ conjunctival congestion -> 4-5w after covid there maybe recurrent mucositis Most common site of Molluscum in AIDS is face Hutchison sign in Zoster means involvement of cornea Vaccinia causes different skin eruptions/ LAD/Eczema vacciniforme / Encephalopathy BUT NOT hepatitis We wont give chicken pox ZIG in pregnant female if she is exposed. we will do the serology first When poxvirus infects cells it causes cell rounding / clumping/ degeneration/vacuolation but NOT apoptosis BulloUs pemphigoid -> self limiting course type 7 collagen Only in anchoring fibrils NOT filaments Clabar like swelling but upper body Eating fish , or an animal that eats fish->Gnathostomiasis eosinophils in fat septa/ blood eosinophilia Albendazole 21d

Pakistan leishmania major wet recedevans-> tropica -> dry

BB is rarest most unstable  As we go from TT to LL pole lepromin test decreases Cd4:8 which is normally 2:1 reverse and >10 in sezary IL2 ,12 inf changes to 5,10. (Th1 to th2) Deficient sensory loss changes to diffuse glove and stocking loss Foam cells with globi and grenz zone in LL

MC leprosy is / satellite/BT MC ac to Rooks is Borderline Lepromatous Rarest BB punched out/ inverted saucer/ Swiss cheese BB MC CN facial Peripheral ulnar then posterior tibial Doubling time 11 to 14d Blindness is due to lagophthamos and exposure keratitis Pure neuritic Skin smear negative but nerve thickness Nerve biopsy for confirmation

Lucio leprosy skin smooth red and shiny Lazarine malnourished ulcerative Release from rx If completed 6m therapy in 9m PB 12m in 18m MB Foot drop laterla popliteal= peroneal Newborn with diarrhoea-> Perianal diaper dermatitis

Primary biliary cirrhosis is associates with Lichen planus immunoreactants are not found in lichen planus

521 Vitiligo least likely to start in 5th decade Mees occur in both thallium and arsenic, Plamoplantar keratosis in Arsenic only In bloom erythema , NOT poikiloderma Rothmund thompson Juvenile catarct + acral keratosis (SCC) + scarcoma AEC have erosive scalp dermatitis-> need surgical intervention

Carcinoid syndrome is a recognised cause of pellagra

B carotene excess can cause Gastric carcinoma Scleredema if with diabetes or gammopathy poor prognosis Vit A dose 50K to 2lac REM treated with HCQ

Dystrophic EB pt develops dilated cardiomyopathy due to selenium deficiency

ACD is checked by patch test- type IV HSN HCQ retinopathy- can be switched to mepacrine / quinacrine

LE/ hydroa vacciniforme/ actinic prurigo donot give immediate reaction to light Ash leaf macules are due to abnormal melanin synthesis and abnormal melanosome transfer but Melanosomes and melanocytes are present

EBA gold standard immuno-electron microscopy DH not associated with Dermatomyostis but yes with thyroid disease MC Morphoea -> plaque morphoea Morphoea profunda / guttate are rare Duputren in old male whites smoking diabetes Pyeronni disease no associiated with Diabetes

Garder has desmoid tumor . Cowden has storiform collagenoma- sclerotic fibroma

Deep bruise like erythema is erythema nodosum- contusiforme Mainly lipase is responsible for pancreatic panniculitis Trichoepitheliomas -> Brooke speigler/ Bazex dupre/ Rombo all 3 Klipel taunaunay is sporadic Cardiac rhambdomyomas are earliest finding in tuberous sclerosis , then Ash leaf macules To diagnose porphyria do urinary and then total porphyrins DITRA presents as von zumbush psoriasis with fever- as early as 1w infant Aquagenic PPK associated with cystic fibrosis Diffuse PPK associated with K1/9 Cornelia de lange , no lymphedema but ++ trichomegaly/ hypertrichosis, intellectual defect, low pitched cry

Define eryhthroderma?

Extreme state of skin dysmetabolism with extensive erythema and scaling Psoriasis have equal sex incidence but men have serious disease

Lp commonly involves tongue and causes scarring alopecia P rosea clears in 3-6 weeks maybe upto 3m aluminum does not cause contact dermatitis

NApkin , lip lick and housewife hand dermatitis are examples of Irritant contact dermatitis Housewife dermatitis is more on back of hands Metal contact dermatiitis more common in females Pompholyx is worse in summers

Cytokeratin

Epithelial tumors Lichen + macular amyloidosis Carcinoma en cuirasse Nodular amyloidosis maybe regarded as plasmactoma is CK negative KID, fanconi ,rothmund, all have SCC

DOwn syndrome has macroglossia NOT geographic tongue Atopic, psoriasis, reiter PRP have

botox for hyperkinetic lines is type A

Aminoglycosides,CCB,Digoxin, Penicillamine -> potentiate Botox action-> contraindicated Antimalarials not contraindicated silicone injection is best for deep glabellar lines cardiotoxicity with Phenol peels

Tuberculosis

Tuberculin skin test lifelong ++ IF active TB in community Strong tuberculin reaction Not very strong in acute viral infections/ sickness positive test 10 tuberculin units in sarcoidosis 100 IU is positive Heaf test 1/100 dilution = 1tu -> to determine if BCG vaccine was needed Previously early and late syphilis divider 2y Blue color in nodule with erythema rim is exam hint for ORF

Previously paul bunnell test for mononucleosis now Heterophile, anti VCA, anti EBNA

Aspergillus reproduces sexually with cleistothecium trichomycosis nodularis = black piedra EED dapsone Rx of choice Leishmaniasis is not common in lahore Most common new world Leishmania brazilienses

Entamoeba histolytica in caecum Larva migrans best Rx - ivermectin (IA)

Pompholyx/ dyhidrotic eczema -> lymphocytic infiltrate Diarrhea with kid have perianal diaper dermatitis

Pemphigoid gestationis blister at lamina lucida Basement membrane always present

Col 7 Laminin nidogen HEparan sulphate Perlecan

Supraorbital blocks vertex

CD43 myeloid leukemia -> leukemia cutis Erbium yag is an ablative laser tumors that are thethered to deeper structures first do imaging then excise