Bullous dermatoses. Erytema exudativum multiforme. Etiology. Pathogenesis. Clinical features. Diagnostics. Treatment.

1. What is the fundamental histomorphological changes in true pemphigus?

1) Spongiosis;

2) Acanthosis;

3) Acantholysis;*

4) Hyperkeratosis;

5) Parakeratosis.

2. Select the description that characterize the diagnosis of erythema exudative multiforme:

1) One or several maculae of bright red colour leaving persistent pigmentation;

2) Erythemal maculae with cyanotic hue in the centre which slightly sinks down. Patient feels burning and itching;*

3) Bullae, erosion, Nikolsky's sign is positive;

4) Papules, bullae, vesicles, crusts:

3. The most important laboratory research for verification of the diagnosis of vulgar pemphigus is:

1) Plating of bulla’s contents on flora;

2) The clinical examination of blood;

3) Examination of blood for electrolytes;

4) Detection of acantholytic cells in impression smears;*

5) Examination of a contained of bulla on eosinophils.

4. What secondary morphological lesions are distinguished in the course of clinical evolution of vulgar pemphigus?

1) Secondary hyperpigmentation maculae;*

2) Erosion;*

3) Crusts;*

4) Scars;

5) Lichenification.

5. Patients with Duhring's disease complain on:

1) Pain;

2) Itch;*

3) Sensation of a fall of temperature of extremities;

4) Sensation of crawling of “horripilation” on skin surface;

5) Parasthesia.

6. Factors of etiology and pathogenesis in the toxico-allergic form of erythema exudativum multiforme can be:

1) Herpes-virus infection;

2) Tetracycline;*

3) The causative agent of parotitis;

4) Mycoplasma;

5) Vaccines.*

7. What is the most important diagnostic symptom for diagnosis of pemphigus:

1) Koebner's phenomenon;

2) Nikolsky's sign;*

3) Baltser's iodine test;

4) Mantoux test;

5) Isomorphic reaction.

8. Smears of acantholytic cells (Tzanck) are painted:

1) By the Gram-method;

2) By the Ziehl-Neelsen method;

3) By the Romanovsky-Giemsa;*

4) By the Burri method;

5) By the Morozov method.

9. In what bullous dermatosis patients very often have gluten sensitivity?

1) Vulgar pemphigus;

2) Pemphigus foliaceus;

3) Duhring's disease;*

4) The Stevens-Johnson syndrome;

5) Pemphigus seborrhoicus.

10. For treatment patients with erythema exudativum multiforme such medicines are prescribed:

1) Salicylates;*

2) Antibiotics;*

3) Hormonal corticosteroid preparations;*

4) Immunosuppressants;

5) Diaminodiphenylsulphones (DDS).

11. In what layer of a skin can bullas locate in true pemphigus?

1) Papillary layer;

2) Basal layer;

3) Prickle-cell layer;*

4) Granular layer;

5) Horny layer.

12. Bullae in Duhring's disease are always located:

1) Subcorneal bulla;

2) Intraepidermal bulla;

3) Subepidermal bulla;*

4) Subdermal bulla;

5) Subhypodermal bulla.

13. Select the description that characterize the diagnosis of Duhring's disease:

1) One or several maculae of bright red colour leaving persistent pigmentation;

2) Erythemal maculae with cyanotic hue in the centre which slightly sinks down. Patient feels burning and itching;

3) Bullae, erosion, Nikolsky's sign is positive;

4) Papules, bullae, vesicles, crusts.*

14. Acantholytic Tzanck cells are revealed by means of research:

1) Histological;

2) Bacteriological;

3) Cytological;*

4) Fluorescent;

5) Serological.

15. Erythema exudativum multiforme is characterized by such clinical signs:

1) Inflammatory maculae;*

2) Bullae;*

3) Absent of symptoms;

4) Affection of a skin and mucous membranes;*

5) Affection of joints.

16. It is necessary to differentiate Duhring's disease with:

1) Psoriasis;

2) Scabies;*

3) Pemphigus vulgaris;*

4) Toxico-allergic dermatitis;*

5) Eczema.*

17. The most characteristic morphological elements for Duhring's disease are:

1) Erythematous maculae;

2) Papulae;

3) Bullae;

4) Vesicles;

5) All above-listed is true.*

18. Acantholysis – it is:

1) Melting of intercellular connections in the prickle-cell layer;*

2) Degenerative changes are in the prickle-cell layer;

3) Increase of horny layer;

4) Growth of granular layer;

5) Disturbance of process of keratinization and occurrence of nucleus in cells of horny layer.

19. What is the primary morphological element, typical for a pemphigus vulgaris:

1) Bulla;*

2) Microvesicle;

3) Papula;

4) Wheal;

5) Pustule.

20. Pathohistological changes (acantholysis) in case of localization of lesions in a pemphigus vulgaris on the oral mucosa are found in:

1) Granular layer;

2) Stratum spinosum;*

3) Germinative layer;

4) Lamina propria;

5) Submucosa.

21. The most typical localization of lesions in case of true pemphigus is:

1) Scalp;

2) Face;

3) Oral mucosa;*

4) Elbows and knees;

5) Palms and soles.

22. For confirmation of diagnosis of dermatosis herpetiformis it is necessary to conduct a skin test for determination of the heightened sensibility to:

1) Sulphonamides;

2) Antibiotics;

3) Novocaine;

4) Iodides;*

5) Bromide.

23. What signs are characteristic for dermatosis herpetiformis?

1) Recurrent course;*

2) Polymorphism of rash;*

3) Intense itch;*

4) Positive Nikolsky's sign;

5) Frequent affection of mucous membranes.

24. What clinical forms are related to the acantholyticpemphigus?

1) Vulgaris;*

2) Psoriasiform;

3) Vegetans;*

4) Pustular;

5) Seborrhoicus.*

25. It is necessary to differentiate pemphigus vulgaris with:

1) Stevens-Johnson syndrome;*

2) Psoriasis;

3) Lyele’s syndrome;*

4) Duhring's disease;*

5) Scabies.

26. What is the most effective drug for treatment of pemphigus patients?

1) Penicillin;

2) Sulphadimethoxin;

3) Phthivazid;

4) Prednisolone;*

5) Delagil.

27. For treatment of Duhring's disease are most often prescribed:

1) Antibiotics;

2) Vitamin;

3) Antihistaminics;

4) Preparations of the sulphone series (DDS);*

5) Antimalarial agents.

28. In the case of external treatment of Duhring's disease such medicines are prescribed:

1) 1-2% Sol. Methyleni coerulei;*

2) 2-5% iodine tincture;

3) Ointments containing corticosteroid;*

4) 33% sulphur ointment;

5) 2% salicylic acid ointment.

29. In case of long duration intake of hormonal corticosteroid preparations it is necessary to prescribe:

1) Diet with limitation of carbohydrates;*

2) Antihistaminics;

3) Potassium preparations;*

4) Calcium preparations;*

5) Gastroprotectors.*

30. For external treatment of the oral mucosa in pemphigus vulgaris such medicines are prescribed:

1) Solutions of aniline dyes;

2) Application of vitamin А;

3) Application of hormonal corticosteroid ointments;

4) Adherent dental paste “Solcoseril”;

5) All above-listed is true.*

31. Such complications can appear in case of long duration intake of hormonal corticosteroid preparations:

1) Stomach ulcer;*

2) Diabetes;*

3) Osteoporosis;*

4) Disturbance from cardiovascular system;*

5) Immunity decrease.*

32. For external treatment of the skin in pemphigus vulgaris such medicines are prescribed:

1) Solutions of aniline dyes;*

2) Warm baths with solution potassium permanganate;*

3) Lotions;

4) Corticosteroid ointments;*

5) Daily change of linen.*

33. The dose of tablet of prednisolone traditionally is:

1) 0,25;

2) 0,5;

3) 0,05,

4) 0,005;*

5) 0,0005.

34. What factors take place in pathogenesis of infectious allergic form of erythema exudativum multiforme?

1) Overcooling;*

2) Virus infection;*

3) Contact with erythema exudativum multiforme patient;

4) Stressful situations.

35. What factors take place in pathogenesis of infectious allergic form of erythema exudativum multiforme?

1) Intake of medicines;

2) Foci of chronic infection;*

3) Hypersensitivity to bacterial allergens;*

4) Immunodeficiency disorders.*

36. What are the primary morphological elements, typical for erythema exudativum multiforme?

1) Maculae;*

2) Bullae;*

3) Tubercles;

4) Pustules.

37. What are the primary morphological elements, typical for erythema exudativum multiforme?

1) Vesicles;*

2) Bullae;*

3) Papulae;*

4) Nodules.

38. What are the secondary morphological elements, typical for erythema exudativum multiforme?

1) Erosions;*

2) Ulcers;

3) Crusts;*

4) Excoriations.

39. What are the secondary morphological elements, typical for erythema exudativum multiforme?

1) Scales;

2) Scars;

3) Erosions;*

4) Pigmental maculae.*

40. The most typical localization of lesions in case of erythema exudativum multiforme are:

1) Skin of backside of the hand;*

2) Skin of backside of the foot;*

3) Extensor surface of forearms;*

4) Skin of anterior side of the abdomen;

5) Mucous membrane of the oral cavity.*

41. The most typical localization of lesions in case of erythema exudativum multiforme are:

1) Scalp;

2) Lateral surface of the thighs;

3) Genitals;*

4) Skin of the palms.*

42. The most typical localization of lesions in case of erythema exudativum multiforme are:

1) Flexor surface of forearms;

2) Skin of the soles;*

3) Mucous membrane of the oral cavity;*

4) Buttock surface.

43. What form is related to the complicated forms of erythema exudativum multiforme?

1) Lyele’s syndrome;

2) Senear-Usher syndrome;

3) Stevens-Johnson syndrome;*

4) Rosenthal’s syndrome.

44. It is necessary to differentiate erythema exudativum multiforme with:

1) Pemphigus;*

2) Scabies;

3) Lichen ruber planus;

4) Duhring's disease.*

45. It is necessary to differentiate erythema exudativum multiforme with:

1) Secondary period of syphilis;*

1) Pemphigus;*

2) Psoriasis;

3) Allergic dermatitis.*

46. For treatment of erythema exudativum multiforme are prescribed:

1) Salicylates;*

2) Corticosteroids;*

3) Disintoxication therapy;*

4) Antibiotics.*

47. For treatment of erythema exudativum multiforme are prescribed:

1) Sulphonamides;

2) Solutions of aniline dyes;*

3) Antiparasitic ointments;

4) Corticosteroid ointments.*

48. For treatment of erythema exudativum multiforme are prescribed such ointments:

1) Elocom;*

2) Advantan;*

3) With erythromycin;

4) Herpevir.

49. For treatment of erythema exudativum multiforme are prescribed such ointments:

1) Betamethasonum;*

2) 10% sulfur ointment;

3) Locoid;*

4) Lamikon.

50. What clinical forms are related to the erythema exudativum multiforme?

1) Vegetans;

2) Toxico-allergic;*

3) Exudativum;

4) Infectious allergic.*

51. A 53 years old patient complains of appearance a big bullae with flabby cover on mucous membranes of the oral cavity. It appeared without any apparent reason. Bullae quickly transformed into bright red erosions. Process accompanied with sharp morbidity that made difficult food intake. What is the most probable diagnosis?

1) Erythema exudativum multiforme;

2) Pemphigus vulgaris;*

3) Herpes simplex;

4) Toxicodermia;

5) Duhring's disease.

52. A 55 years old patient complains of a pain during food intake, presence of erosions on mucous membranes of the mouth. She was ill more than a month ago.

Objectively: there are large erosion of bright red colour on unchanged cover of gums, the soft palate and arculus. Mucous easily is traumatized and exfoliated at a place of friction. In impression smears - Tzanck's cells are found. What is your diagnose?

1) Duhring's disease;

2) Lyell's syndrome;

3) Erythema exudativum multiforme;

4) Stevens-Johnson syndrome;

5) Pemphigus vulgaris.*

53. A 44 years old patient complains of unpleasant sensations in a throat at swallowing, hoarse voices, and eruptions of bullas on her skin surface of the trunk. She was sick for 2 months. At first there were unpleasant sensations in a throat and a hoarseness and then noticed bullas on a skin. She doesn’t know what the cause of illness was. She treated herself by rinsing with decoction of plants, smearing with Lugol's iodine. There was some improvement periodically, but all symptoms of disease did not disappear. What is the most possible preliminary diagnosis?

1) Acantholytic pemphigus;*

2) Duhring's disease;

3) Secondary syphilis;

4) Herpes zoster;

5) Erythema exudativum multiforme.

54. A 47 years old patient complains of a pain in oral cavity. The pain increases at food intake and talking.

Objectively: bilateral oval erosions form against an unaltered background in retromolar zone, painful during palpation. Nikolsky's sign is positive. What is the most probable diagnosis?

1) Erythema exudativum multiforme;

2) Chronic recurrent aphthous stomatitis;

3) Acute herpetic stomatitis;

4) Pemphigus vulgaris;*

5) Bullous form of lichen ruber planus.

55. A 60 years old patient complains of the general weakness, a body temperature 37,5ºС throughout days, occurrence itching eruptions. During examination of the skin of a trunk, buttocks, inguinal-femoral folds there were revealed grouped, tense vesicles and bullas in size from a pea to the wood nut, papules on erythemal background, with serous exudation. Peripheral lymph nodes were increased, a dense consistence. In blood and contents of bullas and vesicles – eosinophilia. What is the most probable diagnosis?

1) Allergic dermatitis;

2) True acute eczema;

3) Vulgar pemphigus;

4) Duhring's disease;*

5) Erythema exudativum multiforme.

LESSON 18

Methods for examination of a patient in venereal diseases. The causative agent of syphilis. Conditions and routes of infection with syphilis. Pathogenesis. Experimental syphilis. Classification.

1. Treponema pallidum was discovered in:

1) 1885;

2) 1890;

3) 1895;

4) 1905;*

5) 1910.

2. What method of diagnosing is used in everyday practice for the reveal of T. pallidum?

1) Cultivation on nutrient mediums;

2) Staining by the Romanovsky-Giemsa;

3) Staining by methylene blue;

4) Examination of native preparations in dark field illumination of the microscope;*

5) Silvering By the Morozov.

3. T. pallidum is a microorganism of:

1) Spiral shaped;*

2) Globe-shaped;

3) Rod-shaped;

4) Thread shaped;

5) Irregular shape.

4. Which possible routes of infection with syphilis can be?

1) Sexual;*

2) Community acquired;*

3) Transfusion of blood;*

4) Faecal-oral;

5) Transplacental.*

5. What physiological secretion and excreta can be contagious in syphilis?

1) Saliva;*

2) Sweat;

3) Urine;

4) Milk;*

5) Sperm.*

6. T. pallidum has such types of its movements:

1) Back and forth;*

2) All-round;

3) Rotatory;*

4) Pendulum-like;*

5) Wave-like.*

7. How many spirals has T. pallidum?

1) 2-4;

2) 6-8;

3) 8-14;*

4) 14-16;

5) 16-18.

8. The incubation period in syphilis lasts:

1) 2-4 years;

2) 3-4 weeks;*

3) 6-8 weeks;

4) 10 days;

5) 9-12 weeks.

9. The cause of a prolonged incubation period in syphilis can be intake of:

1) Sulphonamides;

2) Antibiotics;*

3) Metronidazole;*

4) Polyvitamins;

5) Disinfectants.

10. A shortened of incubation period in syphilis is observed:

1) In case of complicated by the secondary infection of hard chancre;

2) In case of development of atypical chancre;

3) In case of development of plural hard chancres;

4) In case of development of ulcerous hard chancre;

5) In case of heavy concomitant infection.*

11. What period of syphilis does occur in case of “transfusion” syphilis?

1) Incubation;

2) Primary;

3) Secondary;*

4) Tertiary;

5) Congenital.

12. After an infection with syphilis, usually, the Wassermann's reaction becomes positive in:

1) 3-4 weeks;

2) 6-8 weeks;*

3) 9-12 weeks;

4) 3-4 months;

5) 2-4 years.

13. Development of syphilis without chancre is possible in case of:

1) Intake of antibiotics by persons which are in a incubation period;

2) Concomitant heavy infection;

3) Blood transfusion;*

4) Domestic route of infection;

5) Homosexual contact.

14. A material for examination of T. pallidum is took from:

1) Hard chancre;*

2) Erosive papules syphilids;*

3) Roseola;

4) Gummatous lesions;

5) Tubercular lesions.

15. From viewpoint of contagion, the most contagious lesions in syphilis can be:

1) Chancre;*

2) Roseola;

3) Erosive papules;*

4) Leucoderma;

5) Gumma.

16. A prolonged of incubation period in syphilis is observed:

1) In case of heavy concomitant infection;

2) In case of the bipolar hard chancre;

3) In case of treatment with penicillin, tetracycline of concomitant diseases in incubation period of syphilis;*

4) In case of treatment with sulphonamides of concomitant diseases in incubation period of syphilis;

5) In case of treatment with antiviral medicines.

17. In case of histological examination of syphilids basic changes appear in:

1) Epidermis;

2) Blood and lymphatic vessels of the skin;*

3) Muscles;

4) Hypodermis;

5) Dermis.

18. Which from the following diseases are regarded to classic venereal diseases?

1) Syphilis;*

2) Scabies;

3) Hepatitis B;

4) AIDS;

5) Gonorrhoea.*

19. Which from the following diseases are regarded to the sexually transmitted disease?

1) Syphilis;*

2) Chancroid;*

3) Gonorrhoea;*

4) Trichomoniasis;*

5) Cholera;

6) Scabies;*

7) AIDS.*

20. Which animals can be infected experimentally with syphilis?

1) Monkeys;*

2) Cows;

3) Rabbits;*

4) Armadillo.

21. What kind of immunity develops in patients with syphilis?

1) Adaptive;

2) Active;

3) Passive;

4) Infectious;*

5) Cellular;

6) Non-sterile;*

7) Acquired;

8) Concomitant;

9) Transplacental.

22. Which from following factors can prolong an incubation period in syphilis?

1) Senile age;

2) Chronic concurrent infections;

3) Intoxications;

4) Infection from a patient with tertiary syphilis;

5) Treatment with medicine of imidazole group;*

6) Treatment with corticosteroids;

7) Treatment with antibiotics in small doses;*

8) All above-listed is true.

23. The manner of viability of treponema is:

1) Facultative aerobe;

2) Facultative anaerobe;*

3) Obligate aerobe;

4) Obligate anaerobe.

24. Which forms of existence of T. pallidum are distinguished?

1) Spiral;

2) Cysts;

3) Granular;

4) L- forms;

5) All above-listed is true.*

25. Which stages of primary syphilis are distinguished?

1) Seronegative;*

2) Seropositive;*

3) Early;

4) Active;

5) Latent.*

26. Which stages of secondary syphilis are distinguished?

1) Early;*

2) Active;

3) Passive;

4) Latent;*

5) Recurrent.*

27. Which stages of tertiary syphilis are distinguished?

1) Early;

2) Active;*

3) Latent;*

4) Passive.

28. Which possible routes of infection with syphilis can be?

1) Contact;*

2) Community acquired;*

3) Droplet transmission;

4) Faecal-oral;

5) Transfusion of blood;*

6) Transmissible;

7) Transplacental;*

8) Sexual.*

LESSON 19

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