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a;lskdjf > 2 - Derm H & P > Flashcards

2 - Derm H & P Flashcards

1
Q

Intro

A
  • The dermatology patient is handled a little differently in that the physical exam provides more clues than the history
  • Physical findings can be integrated with relevant historical data
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2
Q

4 general characteristics of skin lesions

A 
T = type
A = arrangement
D = distribution
S = shape
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3
Q

Primary lesions

A
  • Primary lesion: physical changes in the skin caused directly by the DISEASE PROCESS – types of primary lesions are rarely associated with a single disease entity
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4
Q

Secondary lesions

A
  • Secondary lesion: may arise from primary lesions or from external causes
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5
Q

Types of primary lesions

A

macule, patch, papule, nodule, tumor, plaque, papilloma, urticara (wheal, hive), vesicle, bulla, pustule, abscess, purpura, telangiectasia, comedo (clogged hair follicle), cyst

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6
Q

Macule

A

Flat, colored lesion,

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7
Q

Macule examples

A

Freckle, flat mole, rashes of rickettsial infections, measles, allergic drug eruptions, vitiligo (white), talon noir (black), café-au-lait (brown, hemosiderin, purpura

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8
Q

Patch

A

Large, >0.5 cm, flat lesion with a color different from the surrounding skin (i.e. large macule)

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9
Q

Patch examples

A

Port-wine stain, tattoo (asphalt embedded in skin), infections, drug eruptions

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10
Q

Papule

A

Solid lesion,

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11
Q

Papule examples

A

Wart, nevi, drug eruption, insect bite

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12
Q

Nodule

A

Solid, firm lesion, 0.5-1.0 cm in diameter, raised above the surface of the skin (i.e., large papule)

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13
Q

Nodule examples

A

Lipoma, fibroma, keratinous cyst, erythema nodosum, neoplasm

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14
Q

Tumor

A

Solid, firm lesion >1cm , raised

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15
Q

Tumor examples

A

Looks like one distinct lesion, in a plaque you can see distinct lesions

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16
Q

Plaque

A

Flat-topped, raised lesion, >1cm with either distinct or blended edges

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17
Q

Plaque examples

A

Distinct edges  psoriasis

Gradually blended with skin  eczema

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18
Q

Vesicle

A

Fluid-filled lesion,

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19
Q

Vesicle examples

A

Acute tinea, allergic contact dermatitis
NOTE –> if fluid is turbid (white fluid) with blister, it is caused by the presence of neutrophils, but does NOT signify infection***

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20
Q

Bulla

A

Fluid-filled, raised, translucent lesion, >0.5 cm

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21
Q

Bulla examples

A

Friction blister, bullous pemphigoid, bullosis diabeticorum

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22
Q

Pustule

A

Vesicle filled with leukocytes or pus,

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23
Q

Abscess

A

Pus-filled lesion >0.5 cm (large vesicle), usually indicates infection

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24
Q

Abscess examples

A

Paronychia (ingrown nail infection)

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25
Q

Cyst

A

Raised, encapsulated lesion, originates from invagination of epidermis into dermis, process continues until lesion detaches from epidermis and becomes completely lined by epidermis

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26
Q

Cyst examples

A

Inclusion cyst – most common cause of this is a foreign body infection

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27
Q

Wheal

A

AKA uticaria, hives

Raised, erythematous papule or plaque, usually representing short-lived dermal edema

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28
Q

Wheal examples

A

Allergic reaction to drugs, insect bites, sensitivity to cold, heat and pressure, sunlight

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29
Q

Angioneurotic edema

A

Larger localized area of edema than wheal

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30
Q

Telangiectasia

A

Dilated, superficial blood vessel

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31
Q

Telangiectasia examples

A

Scleroderma, ***long-term topical steroid therapy, necrobiosis lipoidica diabeticorum (see below)

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32
Q

Papilloma

A

Upward proliferation of dermal papillae – virus in EPIdermis (ONLY), but causes a reaction in the DERMIS (forming rete)

33
Q

Papilloma examples

A

Verruca (“wart”)

NOTE - a wart can be classified as a papilloma or a papule

34
Q

Purpura

A

Bruise

General term referring to extravasated blood and can also be considered a macule – a sign of vasculitis

35
Q

Purpura types

A

Three types - Petechia, ecchymosis, hematoma

36
Q

Petechia

A

Small circumscribed punctuate foci of extravasation

37
Q

Ecchymosis

A

Larger confluent area of extravasation

38
Q

Hematoma

A

Area of massive bleeding into the skin and underlying tissues

39
Q

Skin layers of vesicles and bulla

KNOW THIS

A

Subepidermal = bullous pemphigoid

Subcorneal = impetigo

Subgranular cell layer = friction blister

Spongiotic = contact dermatitis AND acute T. pedis (intercellular edema in epidermis)

40
Q

Steroid use

KNOW THIS

A

KNOW THIS - topical steroids do two things:
o Thin out the skin (more susceptible to trauma)
o Cause permanent telangiectasia

You will be prescribing this, so I want you to know it

41
Q

lesion that is 7mm in diameter and is flat and non-palpable is called a

A

Patch

42
Q

The bulla of tinea pedis is most often associated with

A

Spongiotic blistering

43
Q

Necrobiosis lipoidica diabeticorum

A
  • Telangiectasis can be part of a larger disease called necrobiosis lipoidica diabeticorum
  • Skin lesion that appears on the shin of diabetic patients due to the blood vessel changes associated with diabetes = UNIQUE to diabetics
  • In the larger lesion of the necrobiosis lipoidica diabeticorum, you will see telangiectasis
44
Q

Types of secondary lesions

A

lichenification, crust, erosion, ulcer, excoriation, atrophy, scar

45
Q

Lichenification

A

Distinctive thickenings of skin characterized by accentuated skin-fold markings and feels thick and firm on palpation

46
Q

Lichenification examples

A

Lichen simplex chronicus – psychiatric patients who scratch (used to be called neurodermatitis, but had bad connotation)

47
Q

Crust

A

Dried exudate of body fluids that may be either yellow (serous) or red (hemorrhagic)

48
Q

Crust example

A

Acute tinea pedis

49
Q

Erosion

A

“superficial ulcer”

Loss of epidermis ONLY without an associated loss of dermis

50
Q

Erosion example

A

Pemphigus, herpes viruses

51
Q

Ulcer

A

Loss of epidermis AND at least a portion of the underlying dermis

52
Q

Excoriation

A

“Scratch”

Linear, angular erosions that may be covered by crust and are caused by scratching

53
Q

Excoriation example

A

Venous stasis dermatitis

54
Q

Atrophy

A

“Loss of skin”

Acquired loss of substance which may appear as a depression with intact epidermis or as a site of shiny delicate wrinkled lesions

55
Q

Atrophy example

A

Topical steroid usage, atrophie blanche (see below – IMPORTANT)

56
Q

Scar

A

Change to skin secondary to trauma or inflammation, may be erythematous, hypopigmented or hypertrophic

57
Q

Scar example

A

Keloid (ask “how do you scar?”)

Scar caused by your scalpel is included here

58
Q 
-	All of these are examples of secondary skin lesions, except: 
o	Scar
o	Nodule
o	Ulcer
o	Excoriation
o	Atrophy
A

Nodule

59
Q

Atrophie blanche

A
  • COMMON = you will be seeing a lot of this so KNOW IT NOW***
  • In an area of previous ulcer or skin breakdown, you get atrophy as the skin tries to heal itself
  • You will see white areas in the general area of venostasis dermatitis

(pronounced “blanch” – means “white” in French)

60
Q

Different arrangements or shapes of lesions

A 
Linear
Annular
Iris (target)
Margination 
Circinate
Arciform
Serpiginous
Gyrate
Zosterform
61
Q

Linear

A

Straight (poison ivy or Koebner phenomenon in psoriasis patients)

62
Q

Annular

A

Round or circular with central clearing (tinea pedis, capitis, corpus, etc.)
Sometimes tinea is called “ring worm” which does NOT mean it is a worm, but means that it forms a circle (usually not on the foot, but on head/body)

63
Q

Iris (target)

A

Bull’s eye lesion, annular w/ central internal activity zone (erythema multiforme like Steven Johnson Syndrome – medical emergency, sloughing of skin follows)

64
Q

Margination

A

Sharp or ill-defined

65
Q

Circinate

A

Round or circular

66
Q

Arciform

A

Partial circle

67
Q

Serpiginous

A

Meandering (cutanea larva migrans – after travel to tropics, worm inside skin)

68
Q

Gyrate

A

Connecting arcs

69
Q

Zosteriform

A

Dermatomal (herpes zoster follows dermatomes)

70
Q

General types of distribution of lesions

A 
Generalized
Localized 
Symmetric 
Asymmetric
Discrete
Confluent
Cleavage plane 
Grouped
71
Q

Generalized

A

Dispersed all over (i.e. drug eruption)

72
Q

Localized

A

Grouped or clustered into specific areas

73
Q

Symmetric

A

Opposite sides of body

74
Q

Asymmetric

A

One side only

75
Q

Discrete

A

Separate

76
Q

Confluent

A

Coalescing (smaller into larger)

77
Q

Cleavage plane

A

Arranged along lines of tension

78
Q

Grouped

A

Clustered (herpes zoster)

79
Q

Questions to ask during dermatology history taking

A 
-	Evolution of lesion
     o	Site of onset, manner in which eruption spread, duration, periods of resolution 
-	Symptoms
     o	Itching, burning, pain, numbness, anything relieving symptoms, time of day changes
-	Current or recent medications (prescription, OTC, etc.)
-	Associated systemic symptoms 
     o	Fever, malaise, arthralgias
-	Other
     o	Ongoing or previous illness
o	History of allergies
o	Presence of photosensitivity
o	Review of systems

a;lskdjf (11 decks)

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