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Senior - Derm 1 > 1 - Diagnosis > Flashcards

1 - Diagnosis Flashcards

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Dermatology Board Prep flashcards
1
Q

Slide 3

A

Anatomy review

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2
Q

Functions of epidermis

A

Barrier to pathogens

Water regulation

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3
Q

Thinnest epidermis

A

0.3mm (eyelids)

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4
Q

Thickest epidermis

A

3mm (back)

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5
Q

What are the 5 layers of

A
  1. Basal - constantly dividing keratinocytes (melanocytes located here)
  2. Spinosum - keratinocytes connected by desmosomes (Langerhans cells located here)
  3. Granulosum - keratinocytes lose nuclei and continue to flatten, appear granular
  4. Lucidum - appear lucent, very thin, in thickest skin area
  5. Corneum - consists of dead cells, primary barrier function
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6
Q

Recommended approach to skin disease:

A

History

Physical (distribution, primary lesion, secondary and/or special lesions)

DDx

Tests

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7
Q

Brief Hx should include

A

Duration, rate of onset, location, sxs

FHx

Allergies

Occupation

Previous w/u and Txt?

Meds

PMH

Sexual contact(s)

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8
Q

Examining the lesion

A

Distribution pattern and extent of the eruption by having pt disrobe

Examine carefully (hands lens, magnification, good lightning)

Check for secondary and special lesions

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9
Q

Make sure to include in your PE:

A

Mucous membranes

Genital and anal regions

Hair

Nails

Peripheral lymph nodes

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10
Q

Describe the lesion:

A

Number

Size (cm)

Color

Primary lesions, secondary lesions, special lesions

Distribution

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11
Q

Slide 12

A

Good example of how to be super descriptive and wow your derm preceptor

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12
Q

Intertriginous means:

A

Under a skin fold (i.e. under-boob)

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13
Q

Most skin diseases begin with:

A

A basic lesion that if referred to as a primary lesions

ID’ing the primary lesion is critical

Allows for the formulation of DDx

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14
Q

Examples of primary lesions

A

Macule

Papule

Plaque

Nodule

Pustule

Vesicle

Bulla

Wheal

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15
Q

What is a macule?

A

Circumscribed, flat discoloration

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16
Q

What is a patch?

A

Some refer to a macule that is greater than 1cm as a “patch”

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17
Q

What is a papule?

A

An elevated solid lesions up to 0.5cm in diameter; color varies

May become confluent and form plaques

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18
Q

What is a plaque?

A

A circumscribed, elevated, superficial, solid lesion more than 0.5cm in diamteter

Often formed by the confluence of papules

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19
Q

What is a nodule?

A

A circumscribed, elevated, solid lesions more than 0.5cm in diameter

A large nodule is referred to as a tumor

20
Q

What is a pustule?

A

A circumscribed collection of leukocytes and free fluid that varies in size

21
Q

What is a vesicle?

A

A circumscribed collection of free fluid up to 0.5cm in diameter

22
Q

What is a bulla?

A

A circumscribed collection of free fluid more than 0.5cm in diameter

23
Q

What is a wheal?

A

Hive

A firm, edematous plaque resulting from infiltration of the dermis with fluid

Wheals are transient and may last only a few hours

24
Q

Secondary lesions

A

Develop during the process of skin dz

Or are created by scratching or infection

Ex. Scale, crust, erosion, ulcer, fissure, atrophy, scar

25
Q

Scales

A

Excess dead epidermal cells that are produced by abnormal keratinization and shedding

26
Q

Crust

A

A collection of dried serum and cellular debris

A scab

27
Q

Erosion

A

A focal loss of epidermis

Erosions do NOT penetrate below the dermoepidermal junction and therefore heal without scarring

28
Q

Ulcer

A

A focal loss of epidermis AND dermis

Heal with scarring

29
Q

Fissure

A

A linear loss of epidermis and dermis with sharply defined, nearly vertical walls

30
Q

Atrophy

A

A depression in the skin resulting from thinning of the epidermis or dermis

31
Q

Scar

A

Abnormal formation of connective tissue implying dermal damage

After injury or surgery, scars are initially thick and pink but with time become white and atrophic

32
Q

Examples of special skin lesions

A

Excoriation

Comedone

Milia

Cyst

Burrow

Lichenification

Telagniectasia

Petechiae

Purpura

33
Q

Excoriation

A

An erosion caused by scratching

Often linear

34
Q

Comedone

A

A plug of sebaceous and keratinous material lodged in the opening of a hair follicle

The follicular orifice may be dilated (blackhead) or narrowed (whitehead)

35
Q

Milia

A

A small, superficial keratin cyst with no visible opening

Common in newborns

36
Q

Cyst

A

A circumscribed lesion with a wall and a lumen

Lumen may contain fluid or solid matter

37
Q

Burrow

A

A narrow, elevated, tortuous channel produced by a parasite

38
Q

Lichenification

A

An area of thickened epidermis induced by scratching

The skin lines are accentuated so that the surface looks like a washboard

39
Q

Telangiectasia

A

Dilated superficial blood vessels

40
Q

Petechiae

A

A circumscribed deposit of blood LESS than 0.5cm

41
Q

Purpura

A

A circumscribed deposit of blood GREATER than 0.5cm

42
Q

Tests

A

Biopsy (shave, punch, excisional)

KOH (fungus)

Skin scraping (scabies)

Gram stain

Cx (fungal, bacterial)

Cytology (Tzanck prep for herpes)

Wood’s lamp (fungal, bacterial)

Patch testing (allergies)

Blood (RPR/VDRL, CBC, ESR, HIV)

Dermoscopy (pigmented lesions, R/O MM)

43
Q

Don’t prescribe meds unless you:

A

Have an actual diagnosis established

Experimentation is tempting, and then if that fails refer to derm…don’t do it.

44
Q

What are the four main treatment categories?

A

Topical

Systemic

Surgical

Phototherapy

45
Q

We dont have a diagnosis for your rash

A

So were gonna rub some money on it and see what happens

Senior - Derm 1 (7 decks)

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