dermatology questions totali by vale

Define MACULES and PATCHES and list the names of 10 diseases that appear with these lesions.

Define PAPULES and list the names of 10 diseases that appear with these.

What are the least cancerogenic serotypes of HPV?

1. List and define the types of Kaposi sarcoma.

1. State the differences between chancre and chancroid.

1. What are the worst complications in women affected by chlamydia?

 

1. What is the most important and quickest step in the diagnosis of gonorrhea?

1. State the most distinguishable clinical aspect of secondary syphilis.

 

1. What is the treatment of pubic lice?

1. List and explain 3 possible environmental triggers for psoriasis

1. What do you think is the most important cell in the pathophysiology of psoriasis & explain why?

1. What are the diagnostic hallmarks of psoriasis on dermoscopy?

 

1. Name the two most commonly used Severity Score Indexes for psoriasis

 

1. What are the classic signs of Psoriasis Vulgaris?

1. A 32-year-old male presents with a sudden onset of numerous small, droplet-shaped, erythematous papules and plaques on his trunk and proximal extremities. He reports a recent history of a streptococcal throat infection two weeks prior. He has no significant past medical history and no family history of psoriasis. The lesions are mildly pruritic but not painful. He denies any joint pain or other systemic symptoms. On physical examination, the patient has multiple small, erythematous, scaly papules and plaques distributed primarily on his trunk and proximal limbs. The lesions are well-demarcated and measure 1-10 mm in diameter. There is no evidence of nail involvement or joint swelling. Which type of psoriasis is presented in this case?

GUTTATE PSORIASIS

1. List and define what are the key histopathological features of the dermis and epidermis in psoriasis.

1. What are the possible clinical skin manifestations of type I/II/III/IV  hypersensitivity reactions?

1. List at least three cutaneous diseases associated with type I hypersensitivity reactions.

1. List at least three cutaneous diseases associated with type II hypersensitivity reactions.

1. List at least three cutaneous diseases associated with type III hypersensitivity reactions.

1. List at least three cutaneous diseases associated with type IV hypersensitivity reactions.

1. What are the treatments for type I/II/III/IV  hypersensitivity reactions?

1. Erysipelas: definition, pathogenesis, and manifestations​:

-          Definition: It is an acute superficial bacterial infection of the skin and lymphatics presenting with a characteristic red, shiny, raised, spreading plaque with a well-demarcated edge. È dell’ipoderma : acute bacterial dermal and subdermal infection with red shining plaques con step sign

-          Pathogenesis: It is usually caused by Group A Streptococcus (GAS) in facial presentations and Non-GAS in lower limb involvement and it needs a portal of entry as a start of the infection (Minor skin laceration, tinea pedis, surgical site incision, ulcers, eczema, insect bites etc.).

-          Manifestations: The "step sign" (segno del gradino) is a clinical feature typical of erysipelas. It is a sharp separation between the infected skin and the healthy skin, appearing as a well-defined border, almost like a "step." You touch the plaque: it's raised and palpable compared to the rest of the face.

1. Differential diagnosis between Erythrasma and Tinea cruris for etiology, clinical appearance, and diagnostic tests: (gli piace)

-          Etiology

-          ​​Tinea cruris: Caused by dermatophytes (Trichophytonrubrum, Epidermophyton floccosum).

-          Erythrasma: Caused by Corynebacterium minutissimum (a gram-positive bacterium).

-          Clinical Appearance

-          ​Tinea cruris: yellowish-brownish, scaly patches with well-defined, raised borders and central clearing. It’s often bilateral and symmetric.

-          ​Erythrasma: Patches with poorly defined margins, fine scaling, the color is CORAL RED. Typically, unilateral and asymmetric

-          Diagnostic Tests

-          ​​Tinea cruris:
Culture: Can identify dermatophytes.
Wood’s lamp: positive for yellow-green fluorescence.

-          ​Erythrasma:
Wood’s lamp: Positive, showing a coral-red fluorescence.
Gram stain and culture: Can confirm Corynebacterium minutissimum.

Illustrate the treatment of herpes simplex

-          Mild labial herpes: Topical acyclovir/penciclovir/idoxuridine cream.

-          Severe infections: oral acyclovir 200–400 mg five times daily for 5 days (1 tablet every 4 hours during waking hours, typically for a 5-day course. You skip the dose during the 8 hours of sleep (i.e., you don't take it during the night).
Why the 4-hour interval? It has been demonstrated that the Herpes virus replicates every 4 hours.

-          Secondary prophylaxis for frequent reactivation can be given as 400 mg once or twice daily. Higher doses are needed in immunocompromised patients. Caesarean section may be indicated in case of genital herpes in pregnancy (risk of ophthalmic infection of the infant).

1. Illustrate the treatment of herpes zoster

-          High-dose acyclovir (800 mg five times daily for 7 days) within 72 h of the onset of the eruption.

-          ​If the eye is affected/there is nerve compression: intravenous acyclovir (5 mg/kg every 8 h for 5 days) should be considered, and patients may require systemic steroids(prednisolone 40–60 mg daily) to prevent nerve paralysis in severe cases. IV è molto raro.

-Vitamin B supplements to reduce the risk of post-herpetic neuralgia (PHN).

Why does pytiriasis versicolor leave vitiligoid spots that disappear at the end of the treatment and sun exposure (after treatment)

Malassezia produces azelaic acid, a compound that inhibits tyrosinase, the enzyme responsible for melanin production. This leads to temporary hypopigmentation in affected areas, and in fact, Pityriasis versicolor became initially apparent as pale spots that fail to tan in the sunlight.

1. Clinical Case: An 18-year-old male presents to the emergency department with a skin lesion that he has noticed for about two weeks. He describes the lesion as a red, scaly area on his scalp, with well-defined edges. On physical examination, the lesion has a "ring-like" shape with a clear center and red borders. No signs of enlarged lymph nodes or fever.  The patient has no other symptoms but reports itching in the affected area. He has no significant history of skin diseases, although he has recently engaged in sports and shared equipment with other teammates. What is your diagnosis? Which kind of test would you use to confirm the diagnosis?

Diagnosis: TINEA CAPITIS

Confirmation: Gold Standard →FUNGAL CULTURE and MICROSCOPIC EXAMINATION

1. What are some of the criteria for the diagnosis of atopic dermatitis? (gli piace)

List 5 differences between ICD (irritant contact dermatitis) and ACD (allergic contact dermatitis).

. Which are the topical antifungals used in seborrheic dermatitis?

The two most common antifungals used in seborrheic dermatitis are ketoconazole and ciclopirox.

What are the clinical presentations/anatomical distribution of eczema according to age in atopic dermatitis?

Atopic dermatitis in infants and Children (0-5 Years) generally manifests at the levels of the cheeks, extensor surfaces of the legs and the trunk, nell’infante risparimio centro-facciale (0-5 anni solo gote- sparing ofperioral and periorbital). In Children-bambino (6-11 Years), it has a flexural distribution with other characteristic manifestations such as atopic dirty neck and "dry" eczema, with exudative lesions becoming crusts. In adolescents and adults the areas most involved are the folds, hands, wrists, feet, eyelids, head, neck, upper trunk, shoulders, and scalp.

Which are the most common sites of seborrheic dermatitis and why?

Describe the timing of patch test and the crescendo reaction.

What  is the target of Dupilumab?

Clinical Case: A 16-years old male complains of itching of the face. He has a personal and family history of atopy (allergic rhinitis and asthma). The dermatologic examination revealed an erythema with small vesicles at the level of the armpit, consistent with eczema. A previous treatment with topical corticosteroids had temporary results. The patient is otherwise fine and has no other complaints. Which is the most plausible diagnosis in this patient?

ATOPIC DERMATITIS

List 5 pathophysiological mechanism leading to blister formation

1. State how blisters' location differs in the mucosal-dominant PV versus the mucocutaneous type PV. Which autoantibodies profile do you expect in these two subtypes?

1. Clinical Case: A 30-year-old man presents to your clinic with a complaint of recurrent blistering lesions located on both elbows and knees. He reports that these skin eruptions have been persistent for approximately two years. His medical history is notable for type 1 diabetes mellitus and autoimmune thyroiditis. He shares that he has had a deep-seated aversion to hospitals since his childhood diagnosis of diabetes, and generally avoids medical facilities unless absolutely necessary. He finally sought medical attention due to intense pruritus, which has become intolerable and is significantly affecting his daily activities. A review of his family history reveals that his maternal grandparents emigrated from Sweden to the UK, reportedly because his grandfather was diagnosed with lymphoma (though the patient is unsure of the specific type). On examination, he appears pale, of short stature, and has a lean build. Nikolsky sign is negative.  Multiple erythematous vesicles are observed in a symmetrical pattern on the medial aspects of his buttocks. Direct immunofluorescence testing reveals granular IgA deposits along the apical part of papillae at dermoepidermal junction. What is the most likely diagnosis?

DERMATITIS HERPETIFORMIS, which is a cutaneous manifestation of Celiac Disease

1. Clinical Case: A 58‐year‐old male with a history of mild hypertension and recently unexplained weight loss of 10 pounds over 2 months presents to the dermatology clinic with severe, painful oral erosions that have progressively worsened over the past month. The patient initially noticed persistent soreness and ulcerations on his buccal mucosa and tongue, which made eating and speaking difficult. Soon after, he developed polymorphous skin lesions that varied in appearance—ranging from flaccid bullae to erosive patches and papules with a lichenoid quality—distributed over his trunk, axillae, and extremities. Nikolsky sign is positive. He also recently has had trouble breathing. What is the most likely diagnosis?

PARANEOPLASTIC PEMPHIGUS

1. What’s the clinical sign that helps differentiating Pemphigus Vulgaris from Bullous Pemphigoid? Explain how it is elicited

1. State one form of a NON-autoimmune pemphigus and explain why

Hailey Hailey disease is a form of non-autoimmune pemphigus and is charatecterized by a genetic condition, with an autosomal dominant mutation on the ATP2C1 gene localized on the short arm of chromosome 3 that gene codes information for calcium transport. This leads to partial loss of cohesion between keratinocytes .

1. What are the two main classes of Epidermolysis Bullosa?

Epidermolysis Bullosa is divided into Acquired and Inherited forms. Inherited is further divided into simplex, junctional and dystrophic.

1. In which condition can Pautrier microabscesses be observed?

MYCOSIS FUNGOIDES

1. List the six clinical main subtypes of basal cell carcinoma.

1. Explain when Mohs micrographic surgery is preferred for treatment of basal cell carcinoma.

1. List the treatment used in actinic keratosis: those indicated for single lesions and those used for field cancerization. (gli piace)

Treatments for actinic keratoses are divided into two main categories:

1. Treatments for single lesions:

   1. Cryotherapy

   2. Curettage and cautery

   3. Laser therapy

2. Treatments for field cancerization:

   1. Photodynamic therapy

   2. Topical treatments, including:

      1. 5-Fluorouracil (cream formulations, sometimes combined with salicylic acid)

      2. Imiquimod

      3. Diclofenac

      4. Tirbanibulin

What are the main risk factors for developing cutaneous squamous cell carcinoma?

Describe the signalling pathway involved in BCC and its mutations. (bella da lasciare così)

The Hedgehog (Hh) signalling pathway is a key molecular pathway during embryonic development. In adults, however, this pathway is normally inactive or significantly downregulated. It is crucial in the pathogenesis of basal cell carcinoma (BCC)….

1)    List the endogenous risk factors of melanoma:

1)    List the exogenous risk factors of melanoma:

1)    Please define the ugly duckling sign and what it is used for.

Which are the 3 main dermoscopic patterns of nevi?

1)    What is the main germline mutation of melanoma?

1)    What is the key sign that allows us to distinguish between subungual melanoma vs. a benign melanocytic nevus of the nail matrix? (define in 1 sentence)

Hutchinson’s Sign - melanonychia with necessary extension into the perionychium.

1)    Explain the clinical progression to lentigo maligna melanoma:

1)    Which gene is most frequently associated with Acral Lentiginous Melanoma? (explain relevance in 1 sentence)

1)    Briefly explain what (1) pale (scar-like) areas, and (2) nodular appearance refer to in the setting of Superficial Spreading Melanoma?

Clinical case: A 35-year-old patient presents to our attention with a histopathological report of melanoma with a Breslow thickness of 0.9mm, non-ulcerated and without mitoses. What is the next surgical step?

Widening of the surgical scar to 1 cm (allargamento) and simultaneously Sentinel Lymph Node Biopsy (SLNB)

1)    How is Breslow thickness measured and what is its significance in melanoma diagnosis?

What is the 4-step model of melanoma progression? (da studiare ANCHE per anatomia patologica)

a)      A driver mutation (i.e. BRAF mutation) makes the cell hyperactive in growth signaling

b)      Escaping primary senescence (i.e. CDKN2A loss). Loss of CDKN2A allows cells to skip the natural “aging” stop signals (senescence)

c)      Overcoming apoptosis (i.e. TP53 mutation)

d)      Immortalization (i.e. TERT-p mutation): mutations in TERT promoter switch on telomerase, making the cell immortal

List the most important drugs in treatment of metastatic melanoma.

Tyrosine kinase inhibitors:

a)      BRAF/MEK inhibitors used in combination therapy for BRAF mutated melanomas: Dabrafenib (BRAFi) and Trametinib (MEKi). 

b)      cKIT inhibitors for KIT mutated melanomas: Imatinib.

Immune checkpoint inhibitors:

a)      Ipilimumab which is an anti-CTLA4 monoclonal antibody.

b)      Nivolumab and pembrolizumab which are anti-PD1 monoclonal antibodies.

1)     What are the typical dermoscopy features that enable us to distinguish between acral melanoma and acral nevus?

1. Describe urticaria lesions:

1. What is the treatment of choice for urticaria? Give examples of some common side effects.

The treatment of choice are second generation H1 antihistamines

Corticosteroids (quasi sempre nella fase iniziale trattamento), poi scali corticosteroide + istaminico

Ciclosporina (second line)

Omalizumab (third line) se resistenti a ciclosporina

1. List at least five triggers of thermal urticaria

-          Warm or cold environmental temperature changes;

-          Water temperature when bathing/showering (both cold or hot);

-          Hot/cold drinks or food;

-          Warm sunlight

-          Local skin warming (heating pad)

1. A 17-year-old boy presents with a 6-month history of small, itchy weals appearing within minutes of exercise or hot showers. They resolve within an hour. He occasionally feels flushed and lightheaded during episodes. What is the most likely diagnosis, and how would you confirm it?

The most likely diagnosis is CHOLINERGIC URTICARIA  which can be confirmed by clinical observation and provocation testing.

1. Describe the role of C1INH involved with angioedema?

C1INH inhibits plasma kallikrein and Factor XIIa. These enzymes are involved in the production of bradykinin, a potent vasodilator at the base of angioedema’s pathology. In C1INH deficiency or dysfunction, bradykinin levels rise excessively, leading to:

-          Vasodilation

-          Increased vascular permeability

-          Fluid leakage into tissues →swelling (angioedema).

This is the primary mechanism in hereditary angioedema (HAE) types I and II and in acquired angioedema related to C1INH

1. A 52-year-old man presents with sudden, painless tongue and facial swelling without urticaria. He has been on ramipril for hypertension for 3 years. C4 is low. What is the diagnosis?

ACE-INHIBITOR INDUCED ANGIOEDEMA

 

1. How to differentiate Urticaria from Urticarial Vasculitis?

1. Name at least 3 different types of acne.

Acne Vulgaris, Adult Acne, Acne Keloidalis, Infantile Acne, Acne Excoriée, Acne Conglobata, Acne Fulminans.

 

1. What kind of treatments can be used for scarring management.

Peels, microneedling, laser therapy, punch excision, and laser therapy plus lipofiller

1. What is the main clinical distinguishing point between acne and rosacea?

The absence of comedones and presence of facial flushing in Rosacea.

1. What are the main areas of presentation of rosacea?

1. Name at least 2 microbial cofactors in acne rosacea?

Demodex folliculorum and Helicobacter pylori.

1. What are the pathologies that go in differential diagnosis with Erythematotelangiectatic Rosacea?

Systemic Lupus Erythematosus (SLE), Acne Vulgaris, Seborrheic Dermatitis, Contact Dermatitis, syndrome da carcinoide , perioral dermatitis , photodermatitis .

1. John is a 38-year-old male who presents with complaints of intermittent facial redness and visible blood vessels on his cheeks and nose with no involvement of nasogenial sulcus for the past 2 years. He states that the redness is more noticeable after drinking alcohol, exposure to hot weather, or physical exertion. He denies any significant pain but mentions occasional burning or stinging sensations. John does not have a history of acne vulgaris or other dermatologic conditions. His mother had similar symptoms, which were attributed to "rosy cheeks." He tried using moisturizers and sunscreens, but without improvement. What is the most likely diagnosis?

ACNE Rosacea

1. Which structure of the hair follicle contains matrix cells responsible for hair shaft production?

Hair bulb.

1. During which phase of the hair cycle does apoptosis-driven follicular regression occur?

Catagen.

1. What distinguishes scarring from non-scarring alopecia?

Irreversible follicle destruction and replacement with fibrous tissue.

1. What is a typical clinical finding in alopecia areata in dermoscopy evaluation?

1. Anna, a 32-year-old woman complains of sudden patchy hair loss. On examination, there are round, non-scarring alopecic areas without scaling or erythema, exclamation mark hairs and yellow dots. Short, tapered hairs are visible at the margins of the patches. She reports no itching or pain. What is the most likely diagnosis?

ALOPECIA AREATA

1. Luisa, a 62-year-old postmenopausal Caucasian woman, presents to the dermatology clinic with a 6-month history of progressive hairline recession. She describes a gradual loss of hair along the frontal scalp, accompanied by mild itching in the affected areas. She denies any systemic symptoms, recent illness, or new medications. On examination, there is a band-like area of scarring alopecia along the frontotemporal hairline, with perifollicular erythema and scaling. The eyebrows appear thinned, especially laterally. A “lonely hair sign” is observed—single terminal hairs remaining in otherwise bald, scarred skin. The remainder of the scalp appears unaffected. There is no nail or mucosal involvement. What is the most likely diagnosis? how do you make a definitive diagnosis?

FRONTAL FIBROSING ALOPECIA (FFA). Diagnosis is made by biopsy of the scalp

1. What is the difference between true and apparent leukonychia?

1. Describe anonichia and name 2 pathologies that can cause it.

 

1. Define onichodyina and list 4 causes of this condition.

Definition: Pain, which can be acute or chronic, in the nail system.

Possible causes:

-          Trauma,

-          Infection,

-          Psoriasis,

-          Eczema,

-          Subungual tumors especially glomic tumor,

-          Raynaud's Syndrome,

-          Acute and Chronic Perionyxis,

-          Pachyonychia,

-          Onycholysis,

-          Onychocryptosis (ingrown toenail),

-          Tile nails,

-          Pincer nails

-          Spesso onico-algia, onico-dinia – evento ischemico e vasocostrittivo

Which patients most commonly present with Muehrcke’s lines?

1. Define onycholysis and list 3 causes?

Definition: Separation of the nail bed from the nail plate.

Possible cause:

-          Repetitive trauma,

-          Psoriasis,

-          Bullous Diseases,

-          Dermatophyte Infections/onycomycosis

1. List the 4 conditions that all share nail curvature alterations.

(1)Parrot beak nails; (2)Tile-shaped nails; (3)Pincer nails; (4)Clubbed nails

1. Give the 2 main nail signs of psoriasis

Onycholysis and irregular Pitting (diverso da quello dell’alopecia areata).

1. Differences between acute and chronic paronychia.

Define PLAQUES and NODULES and list the names of 10 diseases that appear with these lesions.

Define VESICLES and BULLAE (or BLISTERS) and list the names of 6 diseases that appear with these lesions.

Define Pustule and list the names of 4 diseases that appear with this lesion.

 

1. ⁠Define Crusts and list the names of 5 diseases that appear with this lesion.

 

1. ⁠Define Sclerosis and list the names of 3 diseases that appear with this lesion.

Pathognomonic lesions.

-          Burrows (“Cunicolo”), Pathognomonic for Scabies

-          Scutulum, Pathognomonic for Tinga Favosa