Internal-Medicine

46 2: Skin
be difficult to differentiate from squamous cell
cancer. (Wolff, p. 208)
8. (C) There are antibodies to skin basement
membrane, but unlike pemphigus, antibody
levels do not correlate with disease activity.
Bullous pemphigoid is most common in the
elderly, and the disease often starts with
urticaria-like and pruritic erythematous
lesions, before classic blisters occur. The blisters
arise from inflamed and normal skin, unlike
in pemphigus where they arise from normal
skin. As well, unlike pemphigus, mucosal
lesions are minimal or absent. (Wolff, p. 106)
9. (A) Patients with acanthosis nigricans should
be studied for a visceral carcinoma. There are
hereditary, drug-induced, and benign forms of
acanthosis nigricans as well. Given this
patient’s symptoms a gastric malignancy should
be ruled out. Diabetics get a benign form of
the disorder. Other dermatoses associated with
malignancy include dermatomyositis, flushing,
acquired ichthyosis, and thrombophlebitis
migrans. (Wolff, p. 86)
10. (A) Ointments are not used, but wet dressings
are applied several times a day, using Burow’s
solution or boric acid, and baths are also
included in the treatment. The key aspect of
care is prevention. When contamination does
occur, washing the affected area is the first
mode of treatment. Oral corticosteroids are
only used in severe cases. In less severe cases,
topical class I glucocorticoid preparations can
be helpful. (Wolff, p. 23)
11. (A) Ringworm of the skin is most common in
children because of their intimacy with animals
and other children. The lesions are round
or oval scaly patches. Secondary bacterial infection
is common with certain fungi. (Wolff, p. 707)
12. (A) Verrucae are viral in etiology. The human
papillomavirus is a DNA-containing virus of
the papovavirus group that includes animal
tumor viruses. Although most warts are not
felt to be premalignant; there is evidence to
show that genital warts are correlated with
malignancy. (Wolff, p. 776)
13. (C) This is likely a case of primary syphilis.
Serology is the most appropriate test; it can
remain negative for a period up to 1 month
after the infection is contracted. The serologic
test for syphilis usually is positive within 1 week
after the chancre appears. With therapy the chancre
heals rapidly, but will heal in 4–6 weeks
even without treatment. Genital chancres are
usually painless, unless superinfected, but
extragenital chancres (e.g., fingers) can be quite
painful. Biopsy is usually not necessary for
diagnosis, and the spirochetes are seen with
dark-field examination, not with Gram stain.
(Wolff, p. 915)
14. (D) In bullous pemphigoid, biopsy reveals
immunoglobulin G (IgG) deposits in the basement
membrane area. In pemphigus vulgaris,
the immune deposition and damage is
within the lower zone of the epidermis. IgA
deposits are seen in dermatitis herpetiformis.
(Wolff, p. 106)
15. (C) About 15% of patients with ulcerative colitis
will develop skin manifestations. Typical
lesions include erythema nodosum, pyoderma
gangrenosum (painless, but can heal with scarring),
aphthous ulcers, and ocular inflammation
(episcleritis, iritis, uveitis). The activity of
the skin manifestations typically parallels the
severity of the colonic disease. (Wolff, p. 148)
16. (C) Mycosis fungoides is best described as a
cutaneous T-cell lymphoma. Lesions may
remain confined to the skin for years, and internal
organ involvement occurs when the disease
advances into late stages. It is a disorder
involving T lymphocytes. Treatment is usually
palliative rather than curative. (Wolff, p. 528)
17. (C) Rhinophyma is a complication of rosacea. It
can be treated surgically by shaving off the
excessive tissue with a scalpel, but regrowth
occurs in time. There is very little evidence to
support the association between alcoholism
and rhinophyma. The other conditions do not
cause flushing or blushing-type appearance.
Psoriasis and seborrheic dermatitis have lesions
that have white dry scales. (Wolff, pp. 8–10)