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QUESTION 2-1. You are at a wedding reception and one of the guests develops the rapid onset of pruritic, diffuse, raised, edematous papules and plaques surrounded by a zone of erythema without surface alteration. There is expansion and coalescence with areas of central clearing. After a few hours, the eruption spontaneously resolves. The patient reports that a similar eruption occurred a year ago that also spontaneously resolved within several hours. The image below represents the histopathological findings associated with this condition. The epidermis is unremarkable. Which of the following regarding this patient’s condition is INCORRECT?

image

A) Although this condition has characteristic clinical and histopathological findings, it is completely nonspecific in regards to etiology.

B) Some chronic forms of the condition are associated with IgG autoantibodies that cross-link the alpha subunit of the high-affinity IgE receptor on mast cells and basophils.

C) This patient most likely has the acute form of this condition since the two eruptions only lasted a few hours and occurred greater than 6 weeks apart.

D) Common inciting triggers for the acute form of this condition include hot and cold temperatures, exposure to water and UV light, stress, exercise, and vibration and direct pressure to the skin.

E) Severe swelling and edema of the lips, eyes, face, hands, and feet accompanied by airway obstruction is considered a medical emergency that may be treated with epinephrine.

QUESTION 2-2. A female patient with gestational diabetes presents in her 35th week of a twin pregnancy with pruritic and erythematous papules and plaques near striae of the abdomen and proximal thighs. There is sparing of the umbilical region. A biopsy is performed. Which of the following statements regarding the histopathological findings of this condition is INCORRECT?

Reproduced, with permission, from Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 6th ed. New York, NY: McGraw-Hill; 2009.

A) This condition typically exhibits folliculocentric neutrophilic infiltrates and intrafollicular pustules resulting in degeneration of the outer root sheath epithelium.

B) This condition typically exhibits superficial perivascular lymphocytic infiltrate with scattered eosinophils and papillary dermal edema.

C) Epidermal changes of lymphocyte exocytosis and spongiosis may be seen in one-third of cases.

D) Direct immunofluorescence occasionally reveals granular deposits of IgM or IgA with complement (C3) along the dermal–epidermal junction and within vessels.

E) Leukocytoclastic debris may be present, but vascular fibrin deposition and ...

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