The Dermatologist’s Board Review - January

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to www.galdermausa.com/Our-Commitment/Resident-Education.aspx. Also, there is a website dedicated to the Pre-Board for registration-www.preboard.com. The program will be available from April 15, 2016 to November 15, 2016.

1. These benign hair follicle tumors are part of an inherited syndrome associated with chromophobe and oncocytic types of renal tumors. Additional important pathology is likely to be found in the:

BOARD REVIEW ANSWERS:

1. Fibrofolliculomas and trichodiscomas (Birt-Hogg-Dubé syndrome)

These benign hair follicle tumors are part of an inherited syndrome associated with chromophobe and oncocytic types of renal tumors. Additional important pathology is likely to be found in the:

a) Lung

The Birt-Hogg-Dubé syndrome is an automated dominant condition characterized by skin tags and benign hair follicle tumors (fibrofolliculomas and trichodiscomas) that occur most often on the head and neck. There is an increased incidence of lung cysts and spontaneous pneumothorax is increased as well. Some families have been described in whom a link to colonic polyposis has been proposed. The disease has been mapped to a mutation in the 17p11.2 gene, which encodes folliculin.

Reference

Shavartsbeyn M, Mason AR, Bosenberg MW, Ko CJ. Perifollicular fibroma in Birt-Hogg-Dubé syndrome: an association revisited. J Cutan Pathol. 2012;39(7):675-679. 

2. Flushing

This patient developed a flushing reaction during cancer chemotherapy. The most likely cause is:

e) Doxorubicin 

Chemotherapeutic agents associated with flushing reactions include doxorubicin, mithramycin, dacarbazine, cisplatin, and interferon alpha-2.

Reference

Castells M. Rapid desensitization of hypersensitivity reactions to chemotherapy agents. Curr Drug Saf. 2006;1(3):243-251. 

3. Basal cell carcinoma

In this surgical procedure, which of the following was used safely in the patient, who is allergic to lidocaine?

e) Procaine 

Procaine (Novocain) and tetracaine are amino-ester type anesthetics; the other choices and lidocaine (Xylocaine) are amino-amide type anesthetics.

Reference

Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90-101. 

4. Anti-epiligrin cicatricial pemphigoid

This patient has a blistering disorder characterized by circulating immunoglobulin G autoantibodies directed against laminin 5 in the epithelial basement membrane. The most common disease associated is:

d) Visceral adenocarcinoma

his mucosal predominant autoimmune blistering disease has been associated with an increased incidence of internal cancer. 

Reference

Young AL, Bailey EE, Colaço SM, Engler DE, Grossman ME. Anti-laminin-322 mucous membrane pemphigoid associated with recurrent metastatic prostate carcinoma: hypothesis for a paraneoplastic phenomenon. Eur J Der- matol. 2011;21(3):401-404. 

Bruce Thiers, MD, FAAD, is a professor with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, SC.

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to www.galdermausa.com/Our-Commitment/Resident-Education.aspx. Also, there is a website dedicated to the Pre-Board for registration-www.preboard.com. The program will be available from April 15, 2016 to November 15, 2016.

1. These benign hair follicle tumors are part of an inherited syndrome associated with chromophobe and oncocytic types of renal tumors. Additional important pathology is likely to be found in the:

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to www.galdermausa.com/Our-Commitment/Resident-Education.aspx. Also, there is a website dedicated to the Pre-Board for registration-www.preboard.com. The program will be available from April 15, 2016 to November 15, 2016.

1. These benign hair follicle tumors are part of an inherited syndrome associated with chromophobe and oncocytic types of renal tumors. Additional important pathology is likely to be found in the:

BOARD REVIEW ANSWERS:

1. Fibrofolliculomas and trichodiscomas (Birt-Hogg-Dubé syndrome)

These benign hair follicle tumors are part of an inherited syndrome associated with chromophobe and oncocytic types of renal tumors. Additional important pathology is likely to be found in the:

a) Lung

The Birt-Hogg-Dubé syndrome is an automated dominant condition characterized by skin tags and benign hair follicle tumors (fibrofolliculomas and trichodiscomas) that occur most often on the head and neck. There is an increased incidence of lung cysts and spontaneous pneumothorax is increased as well. Some families have been described in whom a link to colonic polyposis has been proposed. The disease has been mapped to a mutation in the 17p11.2 gene, which encodes folliculin.

Reference

Shavartsbeyn M, Mason AR, Bosenberg MW, Ko CJ. Perifollicular fibroma in Birt-Hogg-Dubé syndrome: an association revisited. J Cutan Pathol. 2012;39(7):675-679. 

2. Flushing

This patient developed a flushing reaction during cancer chemotherapy. The most likely cause is:

e) Doxorubicin 

Chemotherapeutic agents associated with flushing reactions include doxorubicin, mithramycin, dacarbazine, cisplatin, and interferon alpha-2.

Reference

Castells M. Rapid desensitization of hypersensitivity reactions to chemotherapy agents. Curr Drug Saf. 2006;1(3):243-251. 

3. Basal cell carcinoma

In this surgical procedure, which of the following was used safely in the patient, who is allergic to lidocaine?

e) Procaine 

Procaine (Novocain) and tetracaine are amino-ester type anesthetics; the other choices and lidocaine (Xylocaine) are amino-amide type anesthetics.

Reference

Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90-101. 

4. Anti-epiligrin cicatricial pemphigoid

This patient has a blistering disorder characterized by circulating immunoglobulin G autoantibodies directed against laminin 5 in the epithelial basement membrane. The most common disease associated is:

d) Visceral adenocarcinoma

his mucosal predominant autoimmune blistering disease has been associated with an increased incidence of internal cancer. 

Reference

Young AL, Bailey EE, Colaço SM, Engler DE, Grossman ME. Anti-laminin-322 mucous membrane pemphigoid associated with recurrent metastatic prostate carcinoma: hypothesis for a paraneoplastic phenomenon. Eur J Der- matol. 2011;21(3):401-404. 

Bruce Thiers, MD, FAAD, is a professor with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, SC.

BOARD REVIEW ANSWERS:

1. Fibrofolliculomas and trichodiscomas (Birt-Hogg-Dubé syndrome)

These benign hair follicle tumors are part of an inherited syndrome associated with chromophobe and oncocytic types of renal tumors. Additional important pathology is likely to be found in the:

a) Lung

The Birt-Hogg-Dubé syndrome is an automated dominant condition characterized by skin tags and benign hair follicle tumors (fibrofolliculomas and trichodiscomas) that occur most often on the head and neck. There is an increased incidence of lung cysts and spontaneous pneumothorax is increased as well. Some families have been described in whom a link to colonic polyposis has been proposed. The disease has been mapped to a mutation in the 17p11.2 gene, which encodes folliculin.

Reference

Shavartsbeyn M, Mason AR, Bosenberg MW, Ko CJ. Perifollicular fibroma in Birt-Hogg-Dubé syndrome: an association revisited. J Cutan Pathol. 2012;39(7):675-679. 

2. Flushing

This patient developed a flushing reaction during cancer chemotherapy. The most likely cause is:

e) Doxorubicin 

Chemotherapeutic agents associated with flushing reactions include doxorubicin, mithramycin, dacarbazine, cisplatin, and interferon alpha-2.

Reference

Castells M. Rapid desensitization of hypersensitivity reactions to chemotherapy agents. Curr Drug Saf. 2006;1(3):243-251. 

3. Basal cell carcinoma

In this surgical procedure, which of the following was used safely in the patient, who is allergic to lidocaine?

e) Procaine 

Procaine (Novocain) and tetracaine are amino-ester type anesthetics; the other choices and lidocaine (Xylocaine) are amino-amide type anesthetics.

Reference

Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90-101. 

4. Anti-epiligrin cicatricial pemphigoid

This patient has a blistering disorder characterized by circulating immunoglobulin G autoantibodies directed against laminin 5 in the epithelial basement membrane. The most common disease associated is:

d) Visceral adenocarcinoma

his mucosal predominant autoimmune blistering disease has been associated with an increased incidence of internal cancer. 

Reference

Young AL, Bailey EE, Colaço SM, Engler DE, Grossman ME. Anti-laminin-322 mucous membrane pemphigoid associated with recurrent metastatic prostate carcinoma: hypothesis for a paraneoplastic phenomenon. Eur J Der- matol. 2011;21(3):401-404. 

Bruce Thiers, MD, FAAD, is a professor with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, SC.