17: Skin Changes

Question 1

The term maculopapular in medicine

Answer 1

Used loosely and improperly to describe many red rashes - should be avoided

Question 2

Scale vs crust

Answer 2

Scale: excess accumulation of stratum corneum
Crust: dried accumulation of body fluids - can be yellow or red

Question 3

Excoriation

Answer 3

Excoriation: linear defects in epidermis, usually due to scratching

Question 4

Ulcer vs erosion

Answer 4

Ulcer: full thickness destruction of epidermis into underlying dermis
Erosion: loss of epidermis without loss of dermis

Question 5

Lichenification

Answer 5

Visible thickening of skin resulting in accentuated skin-fold markings

Question 6

Nummular

Answer 6

Circular or coin-shaped

Question 7

Serpiginous lesions

Answer 7

Linear, branched, and curving elements

Question 8

Reticulated lesions

Answer 8

Have a lacy or networked pattern

Question 9

Herpetiform

Answer 9

Grouped papules or vesicles

Question 10

Treatment for Seborrheic keratosis

Answer 10

No tx needed - can be frozen off or curetted if they itch/are inflamed

Question 11

ABCDE method of screening for malignant melanoma

Answer 11

1. Asymmetry: is often not uniform
2. Border: irregular shape or border
3. Color: melanoma often more than one color
4. Diameter: larger than 6mm
5. Evolution: characteristics change over time

Question 12

Most significant factor for melanoma prognosis

Answer 12

Tissue depth

Question 13

Papules associated with dermatomyositis

Answer 13

Gottron’s papules

Question 14

Dermatomyositis

Answer 14

Rare chronic immune-mediated disorder that affects skin and/or proximal skeletal muscles

Question 15

Increased risk with dermatomyositis

Answer 15

Malignancy and is associated with celiac dz

Question 16

Pathognomonic findings of dermatomyositis

Answer 16

Periorbital erythema, violaceous papules over joints of dorsal hands (Gottron’s papules)

Question 17

Two conditions that acanthosis nigricans mimics

Answer 17

Addisons dz, mastocytosis

Question 18

Pretibial myxedema

Answer 18

Pink, waxy, indurated plaque on lower leg, associated with Grave’s disease

Question 19

Criteria for strep pharyngitis diagnosis and the five parts to it

Answer 19

Centor clinical criteria

1. Temp greater than 38
2. Tender anterior cervical adenopathy
3. Lack of a cough
4. Tonsillar exudate

Question 20

Nikolsky sign and what condition its positive in

Answer 20

Slight lateral pressure on skin -> sloughing of epidermis

Positive in pemphigus vulgaris

Question 21

Vasculitis

Answer 21

Inflammation and damage in blood vessel walls - can be limited to skin or be a multisystem disorder

Question 22

Where are small vs medium sized vessel vasculitises found?

Answer 22

Small vasculitis: epidermis

Medium vasculitis: dermis

Question 23

Four examples of large vessel vasculitis

Answer 23

1. Giant cell arteritis
2. Polymyalgia rheumatica
3. Takayasu arteritis
4. Aortitis

Question 24

Four most common medium/small artery vasculitises and which one is NOT associated with ANCA auto-Abs?

Answer 24

1. Polyarteritis nodosa: not associated with ANCA auto-Abs
2. Eosinophilic granulomatosis w polyangiitis
3. Granulomatosis with polyangiitis
4. Microscopic polyangiitis

Question 25

Four other small vessel vasculitises to remember

Answer 25

1. Hypersensitivity vasculitis 2. IgA vasculitis 3. Cryoglobulinemia 4. Goodpasture syndrome