16- skin lesion

Question 1

primary skin lesion (vs secondary)

Answer 1

uncomplicated lesions that represent initial pathologic change, uninfluenced by secondary alterations such as infection, trauma, or therapy.

Question 2

size difference between macule and patch, or papule and plaque, or a vesicle and a bulla

Answer 2

1 cm in diameter

Question 3

what commonly affects extensor surfaces of joints, and what impacts flexor surface of joints

Answer 3

flexor: atopic eczema
extensor: psoriasis

Question 4

what affects palms and soles

Answer 4

erythema multiforme, 
secondary syphilis 
 eczema.
coxsackie
rocky mountain spotted fever

Question 5

Annular macules are observed in

Answer 5

drug eruptions, secondary syphilis and lupus erythematosus.

Question 6

squamous cell carcinoma

Answer 6

scaly and erythematous but, unlike actinic keratoses, tend have a raised base.

patch, plaque, or nodule, sometimes with scaling and/or an ulcerated center.

Borders are often irregular and bleed easily.

Unlike basal cell carcinomas, the heaped-up edges of a squamous cell carcinoma are fleshy rather than clear in appearance.

Question 7

actinic keratosis

Answer 7

scaly keratotic patches that are often more easily felt than seen.

A history of significant sun exposure is a risk factor for actinic keratosis.

Question 8

basal cell carcinoma

Answer 8

plaque-like or nodular with a waxy, translucent appearance, often with ulceration and/or telangiectasia.

Usually there is no associated itching or change in skin color.

Basal cell carcinoma is common on the face and on other exposed skin surfaces but may occur anywhere.

Question 9

melanoma

Answer 9

Lesions that are growing, spreading or pigmented, or those that occur on exposed areas of skin are of particular concern for melanoma.

dark brown or black.

Slowly spreading irregular outline in the initial phase.

Since not all malignant melanomas are visibly pigmented, physicians should be suspicious of any lesion that is growing or that bleeds with minor trauma.

More than half of melanoma in women occurs on the legs.

Question 10

percentges of prevalence of skin cancers

Answer 10

squamous: 20%

basal 60%

melanoma 1% (but 60% of deaths)

Question 11

lichen planus

Answer 11

2-10 mm flat-topped papules with an irregular, angulated border (polygonal papules)- multiple

located on the flexor surface of wrists and and on the legs immediately above the ankles.

Question 12

Seborrheic keratoses

Answer 12

Elevated hyperpigmented lesions with a well-circumscribed border, stuck-on appearance, and variable tan-brown-black color and are most commonly located on the face and trunk.

Question 13

different forms of topical steroids

Answer 13

Creams:

• It can be used in nearly any area and therefore most often prescribed.
• It is cosmetically most acceptable.
• It has a drying effect with continuous use, therefore best for acute exudative inflammation.

Ointments:

• petroleum jelly, with little or no water.
• desirable for drier skin and has a greater penetration of medicine than a cream and therefore has enhanced potency.

Lotions :

• contain alcohol, which has drying effect on an oozing lesion.
• useful in the scalp area because they penetrate easily and leave little residue.

Gels
- jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy.

Question 14

indications for group 1 and 2 potency steroids (strongest)

Answer 14

Psoriasis, lichen planus, severe hand eczema, and alopecia areata.

Question 15

indications for group 3,4,5 steroids

Answer 15

Atopic dermatitis, nummular eczema, stasis dermatitis, and seborrheic dermatitis.

Question 16

indications for group 6, 7 steroids (weakest)- hydrocortisone 1%

Answer 16

Dermatitis in eyelids and diaper area, mild dermatitis on face, and mild intertrigo.

Question 17

The most common side effect of topical corticosteroid is

Answer 17

skin atrophy.

It also can cause hypopigmentation. This is more apparent with darker skin tones.

Question 18

can topical steroids cause systemic effects?

Answer 18

yes, if high and ultra high potency corticosteroids

Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension and other systemic side effects have been reported.

Question 19

which tinea need to be treated with systemic antifungal agents? (oral) and with what medication

Answer 19

Tinea capitis- Griseofulvin or terbinafine

Tinea unguium (onychomycosis)- Griseofulvin or itraconazole

Question 20

Incisional / punch biopsy

Answer 20

Incisional biopsy means taking out a part of the skin lesion
Punch biopsy is a specific incisional biopsy using a cylindrical dermal biopsy tool.

convenient and available from two to eight millimeters in size.

Question 21

excisional biopsy

Answer 21

involves removing the whole lesion with a two to three millimeter margin, depending on the nature of the lesion.

strong suspicion of malignant melanoma.

Question 22

shave biopsy

Answer 22

feasible when the lesion is elevated above the surface.

Question 23

Most widely used treatment for cutaneous squamous-cell carcinomas (SCCs), particularly high risk lesions.

Answer 23

surgical excision

well defined, small (<2mm)

Question 24

Patients with any nonmelanoma skin cancer greater than two centimeters, lesions with indistinct margins, recurrent lesions, and those close to important structures, including the eyes, nose, and mouth, should be considered for referral for

Answer 24

complete excision via Mohs micrographic surgery, with possible plastic repair.

cosmetically sensitive areas

Question 25

when is Topical 5-fluorouracil (5-FU) for skin lesions

Answer 25

it is widely used in these diseases when other treatment modalities are impractical and for patients who refuse surgical treatment

Question 26

when and how is cryotherapy used for skin lesions

Answer 26

Useful for small, well defined, low risk invasive SCCs and Bowen’s disease.

Destroys malignant cells by freezing and thawing.

Question 27

when is radiation used for skin lesions?

Answer 27

An option for the initial management of small, well-defined, primary SCCs, especially older patients and those who are not surgical candidates.

Question 28

when is radiation contraindicated for skin lesions?

Answer 28

contraindicated on tumors located on trunk and extremities. These areas are subjected to greater trauma and tension than skin on the head and neck, and they are more prone to break down and ulcerate as a result of the atrophy and poor vascularity of irradiated tissue.

Question 29

symptoms of prostatitis

Answer 29

include pain (in the perineum, lower abdomen, testicles and penis, and with ejaculation), bladder irritation, bladder outlet obstruction, and sometimes blood in the semen.

Question 30

Recommended Evaluation of Suspected Benign Prostatic Hypertrophy

Answer 30

A. Presence of classic lower urinary tract symptoms (LUTS).
B. Examination of prostate.
C. Urinalysis.
D. Serum prostate specific antigen (PSA).

G. Serum BUN and creatinine.

Question 31

Complications of untreated BPH

Answer 31

urinary tract infections
acute urinary retention
obstructive nephropathy

Question 32

what should min. urinary flow rates be? and what about min. voided volume

Answer 32

15 ml/sec

150 ml

Question 33

Post-void residual urine volume can be determined by

Answer 33

in-out catheterization,
radiographic methods,
ultrasonography.
The bladder scanner, which can be used in an office,

Question 34

Behavior modifications to decrease lower urinary tract symptoms:

Answer 34

avoiding fluids prior to bedtime or before going out
reducing consumption of mild diuretics such as caffeine and alcohol
limiting the use of salt and spices
maintaining voiding schedules
Do not take decongestants like Sudafed.
Do not take antihistamines like Benadryl.

Question 35

which med decreases urinary symptoms in most men with mild to moderate BPH

Answer 35

Alpha-adrenergic antagonists (zosins)

Question 36

which meds are more effective in men with larger prostates

Answer 36

5-alpha-reductase inhibitors: finasteride and dutasteride.

Question 37

when should surgery be considered for BPH?

Answer 37

if bladder outlet obstruction is creating a risk for upper urinary tract injury such as:
hydronephrosis, renal insufficiency, or lower urinary tract injury such as urinary retention, recurrent urinary tract infection, or bladder decompensation

or if combo treatment doesnt work

Question 38

which melanoma is seen more often in dark-skinned people, and typically appears on the palms and soles of feet, including under the nails.

Answer 38

Acral lentiginous melanoma