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step3 > 2014-03-07 USMLE Derm - USMLE Derm > Flashcards

2014-03-07 USMLE Derm - USMLE Derm Flashcards

1
Q

Define macule and give an example

A
  • flat spot less than 1 cm

- freckles

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2
Q

Define patch adn give an example

A
  • flat spot greater than 1cm

- port wine stain

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3
Q

Define papule and give 3 examples

A
  • solid elevated palpable lesion less than 1cm

- wart, acne, lichen planus

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4
Q

Define plaque and give an example

A
  • solid flat topped elevate palpable lesion greater than 1cm

- psoriatic patch

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5
Q

Define nodule and give 2 examples

A
  • palpable solid lesion greater than 1cm (not flat topped)

- small lipoma, erythema nodosum

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6
Q

Define vesicle and give 2 examples

A
  • elevated, circumscribed lesion less than 5mm containing fluid
  • small blister
  • chickenpox, HSV
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7
Q

Define bulla and give 2 examples

A
  • elevated, circumscribed, fluid filled lesion greater than 5mm
  • large blister
  • contact dermatitis, pemphigus
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8
Q

Define wheal and give an example

A
  • itchy transiently edematous area

- allergic reaction

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9
Q

General definition of vitiligo

A

depigmentation of unknown etiology

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10
Q

Vitiligo is often associated with

A

autoimmune conditions like pernicious anemai and hypothyroidism

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11
Q

Patients with vitiligo may have antibodies to

A

melanin

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12
Q

Biopsy in vitiligo may show

A

absense of melanocytes

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13
Q

Puritis is often a clue to these diseases:

A
  • obstructive biliary disease
  • uremia
  • polycythemia rubra vera
  • atopic dermatitis
  • scabies
  • lichen planus
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14
Q

Puritis after a warm shower may be a clue to

A

polycythemia rubra vera

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15
Q

Pruritis with obstructive biliary disease is classically ________

A

primary biliatry cirrhosis

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16
Q

The most common form of contact dermatitis in women

A

nickel dermatitis (jewlery)

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17
Q

Contact dermatitis is usually this type of reaction

A

type IV hypersensitivity

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18
Q

List three classic offending agents for contact dermatitis

A

nickel, deoderant, poison ivy

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19
Q

Describe the rash of contact dermatitis

A
  • well circumscribed
  • only in areas of exposure
  • red
  • itchy
  • often with vesicles or bullae
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20
Q

Testing and treatment of contact dermatitis

A
  • patch test

- avoid offending agent

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21
Q

Major features of atopic dermatitis

A
  • chronic
  • begins in 1st year of life
  • rash is red, itchy, weeping on head and arms sometime diaper area
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22
Q

Main symptoms of atopic dermatitis

A

itching and skin breaks lead to possible infection risk

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23
Q

Treatment of atopic dermatitis

A
  • avoid dry soaps
  • antihistamines
  • topical steroids
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24
Q

What is blepharitis?

A

seborrheic dermatitis of the eyelid

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25
Q

3 common subtypes of seborrheic dermatitis

A
  • cradle cap

- dandruff- blepharitis

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26
Q

Classic findings of seborrheic dermatitis

A

scaling skin on scalp and eyelids

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27
Q

Treatment of seborrheic dermatitis

A

dandrum shampoo (selenium sulfide)

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28
Q

fungal infection on the trunk is called

A

tinea corporis

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29
Q

describe the lesion of tinea corporis

A
  • red
  • ring-shaped
  • raised borders
  • clear centrally while they expand peripherally
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30
Q

fungal infection on the feet is called

A

tinea pedis

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31
Q

describe the lesion of tinea pedis

A
  • macerated
  • scaling web spaces
  • itches
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32
Q

thicked distorted toenails are often

A

onychomycosis

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33
Q

Most important part of treatment for tinea pedis

A

good foot hygeine

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34
Q

fungal infection of the nails is called

A

tinea unguium or onychomycosis

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35
Q

fungal infection of the scalp is called

A

tinea capitis

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36
Q

is tinea capitis contagious?

A

yes, very

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37
Q

an inflammed boggy granuloma of the scalp is called

A

kerion

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38
Q

Describe the characteristics of tinea capitis

A
  • sclay patches of hair loss

- boggy granulomas (kerions)

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39
Q

technical name for jock itch and what type of infection

A
  • tinea cruris (crural folds)

- fungal infection

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40
Q

Most skin fungal infections are caused by

A

Trichophytan species

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41
Q

How do you confirm a tinea infection?

A

scraping of sking with KOH prep or by culture

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42
Q

Pharmacologic treatment of tinea infections

A
  • tinea capitis: oral agent
  • onychomycosis: oral agent
  • others can be treated with topical and/or oral
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43
Q

Typical oral and topical treatments for tinea

A
  • terbinafine, fluconazole

- topical imidazoles (miconazole, clotrimazole, keotoconazole)

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44
Q

Differentiation of causative organism in tinea capitus

A
  • if hair fluoresces under the wood’s lamp = microsporum

- otherwise = trichophyton

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45
Q

Physical appearance of thrush

A

white patches on tongue or buccal mucosa that can be scraped off

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46
Q

When is candial infection considered normal/non-concerning

A
  • children

- vulvovaginitis in women esp when pregnant or on antibiotics

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47
Q

Thrush without good explanation should prompt consideration of…

A
  • immunodeficiency

- diabetes

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48
Q

Treatment of trush

A
  • topical with nystatin or imidazoles

- systemic for resitant disease

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49
Q

Systemic therapies for thrush

A
  • nystatin

- ketoconazole

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50
Q

Multiple patches of various size and color on the torso in a young adult =

A

tinea versicolor

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51
Q

Characteristics of tinea versicolor

A
  • young adults
  • multiple patches of various size and color on the torso
  • patches fail to tan (often noted in summer)
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52
Q

Diangosis of tinea versicolor

A
  • clinical

- KOH prep

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53
Q

Treatment of tinea versicolor

A
  • selenium sulfide shampoo

- topical imidazoles

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54
Q

Classic areas for scabies

A
  • finger web spaces

- flexor surfaces of the wrist

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55
Q

Treatment of scabies

A
  • permethrin
  • technically lidocaine can be used but has a risk of neurotoxicity especially in young children
  • remember to treat all contacts
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56
Q

Pediculosis =

A

lice

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57
Q

The technical name for lice is

A

pediculosis

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58
Q

head lice is called

A

pediculus capitis

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59
Q

body lice is called

A

pediculus corporis

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60
Q

pubic lice is called

A

phthirus pubis

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61
Q

Treatment of lice

A
  • permethrin
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62
Q

Genital warts that are associated with cancer

A

HPV 16 and 18 are associated with cervical cancer

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63
Q

Warts are most commonly seen ________

A

in older children, on the fingers

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64
Q

Are warts infectious?

A

yes

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65
Q

Warts are caused by

A

human papillomavirus

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66
Q

Typical treatments for warts

A
  • salicylic acid
  • liquid nitrogen
  • curettage
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67
Q

Scabies is caused by

A

sarcoptes scabei

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68
Q

Halmark lesion of scabies

A

burrow on:

  • finger web spaces
  • flexor surfaces of the wrist
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69
Q

Treatment of scabies

A

Permethrin

- be sure to treat contacts

70
Q

Pediculosis =

A

lice

71
Q

Lice is also called

A

pediculosis

72
Q

Pediculus capitis is common in

A

school children

73
Q

Pediculus corporis usually involves

A

poor hygeine

74
Q

Phthirus pubis is

A

sexually transmitted lice

75
Q

Diagnosis of lice is made by

A

seeing lice on hair shafts

76
Q

Treatment of lice

A
  • permethrin

- decontaminate combs, hats, sheet, clothing

77
Q

Warts are caused by

A

human papillomarvirus (HPV)

78
Q

Warts in children are often seen

A

on the hands

79
Q

Genital warts are caused by

A

HPV 16 and 18

80
Q

Genital warts are associated with

A

cervical cancer

81
Q

Treatment of warts

A
  • salicylic acid
  • liquid nitrogen
  • curettage
82
Q

molluscum contagiosum is a

A

poxvirus

83
Q

Molluscum contagiosum is common in

A
  • children
  • STD
  • don’t forget autoinnoculation
84
Q

Appearance of mollusceum contagiosum

A
  • skin-colored
  • smooth
  • waxy papules
  • central depression (umbilitated)
85
Q

A 0.5cm waxy skin colored umbilicated papule =

A

molluscum contagiosum

86
Q

Characteristic pathologic appearance of molluscum contagiousum

A

inclusion bodies

87
Q

Treatment of molluscum contagiousum

A
  • freezing

- curettage

88
Q

5 common “medical” descriptions of acne

A
  • comedones (whiteheads/blackheads)
  • papules
  • pustules
  • inflammed nodules
  • superficial pus-filled cysts
89
Q

Gland that gets blocked in acne

A

pilosebaceous glands

90
Q

Organism often involved in acne

A

Propionibacterium acnes

91
Q

Acne is NOT related to

A
  • exercise
  • sex
  • masturbation
92
Q

Progression of treatment options for acne

A
  • topical benzoyl peroxide
  • topical clindamycin
  • oral tetracycline or erthromycin
  • topical tretinoin
  • oral isotretinoin
93
Q

Antibiotic for eradication of propionibacterium acnes

A

erythromycin

94
Q

Side effects of oral isotretinoin

A
  • dry skin
  • dry mucosae
  • muscle and joint pain
  • abnormal LFTs
95
Q

This looks like acne but usually starts in middle age

A

Rosacea

96
Q

Rhinophyma =

A

bulbous red nose

97
Q

Bulbous red nose in rosacea =

A

rhinophyma

98
Q

Rosacea often also has

A

rhinophyma and blepharitis

99
Q

Pathogenesis of rosacea

A

unknown (but not related to diet)

100
Q

Treatment of rosacea

A
  • topical metronidazole

- oral tetracycline

101
Q

Signs of virilization

A
  • hirsutism
  • deepening voice
  • clitoromegaly
  • frontal balding
102
Q

Most common cause of virilization

A

idiopathic

103
Q

Hirsutism is often a sign of

A

virilization

104
Q

More common causes of hirsutism

A
  • androgen secreting ovarian tumor
  • corticosteroids
  • Cushing syndrome
  • Stein-Leventhal syndrome
  • minoxidil
  • phenytoin
  • other drugs
105
Q

Stein-Leventhal syndrome =

A

polycystic ovarian disease

106
Q

Psychiatric disorder where one pulls out hair

A

trichotillomania

107
Q

trichotillomania =

A

pathological hair pulling

108
Q

What is alopecia areata

A
  • form of baldness
  • idiopathic
  • associated with antimicrosomal and other antibodies
  • seen with lupus, syphilis, after chemo
109
Q

Key features of male-pattern baldness

A
  • benign
  • requires androgen expression
  • considered genetic
110
Q

Classic lesions of psoriasis

A
  • dry
  • NOT pruritic
  • well-circumscribed
  • silvery
  • scaling
  • papules/plaques
  • on extensor surfaces/scalp
111
Q

A dry well-circumscribed, silvery, scaling papule on the scalp or extensor surfaces =

A

psoriasis

112
Q

Family history for psoriasis

A

often positive

113
Q

Psoriatic arthritis is RF

A

negative

114
Q

People with psoriasis often have nails that are

A

pitted

115
Q

Psoriasis is most often seen in

A
  • whites

- onset early adulthood

116
Q

General treatment of psoriasis

A
  • UV light
  • lubricants
  • topical corticosteroids
  • keratolytics
117
Q

Examples of keratolytics (such as in treatment of psoriasis)

A
  • coal tar
  • slicylic acid
  • anthralin
118
Q

Age for pityriasis rosea

A

adults

119
Q

Scaly slightly erythematous ring-shaped lesion on the trunk =

A

“hearld patch” of pityriasis rosea

120
Q

Lesions of pityriasis rosea

A
  • scaly red itchy ring shaped
  • starts with hearld patch on trunk
  • 1 weeks later many more appear
  • follow langerhan’s skin cleavage lines
  • often in “Christmas tree”
121
Q

Rash with “Christmas tree” pattern

A

pityriasis rosea

122
Q

General course of pityriasis rosea

A

spontaneously remits in 1 month

123
Q

Ddx of pityriasis rosea

A

syphilis

124
Q

Treatment of pityriasis rosea

A

reassurance

125
Q

Features of lichen planus:

A

“The 4 P’s”:

  • pruritic
  • purple
  • polygonal papules
126
Q

pruritic purple polygonal papules =

A

lichen planus

127
Q

Classic location of lichen planus

A

wrists and/or ankles

128
Q

Typical course and treatment of lichen planus

A
  • self-limited and resolves within a few years

- symptomatic treatment for itching

129
Q

2 major drug causes of photosensitivity

A
  • tetracycline

- phenothiazines

130
Q

Classic lesions of erythema multiforme

A
  • target of iris lesions
131
Q

Infection that can cause erythema multiforme

A
  • herpes
132
Q

Erythema multiforme is usually caused by

A
  • drugs

- infections

133
Q

Characteristic feature of Stevens-Johnson syndrome

A

Erythema multiforme with mucosal involvement

134
Q

Treatment of erythema multiforme

A

supportive

135
Q

Typical description of erythema nodosum

A
  • inflammatory
  • subcutaneous tissue and sin
  • tender red nodule
136
Q

Classic location of erythema nodosum

A
  • shins (pre-tibial)
137
Q

Classic causes of erythema nodosum

A
  • unknown
  • streptococcal
  • sarcoidosis
  • coccidiomycosis
  • ulcerative colitis
138
Q

pemphigus vulgaris is an _______ disease

A

autoimmune

139
Q

Typical age for pemphigus vulgaris

A

middle and older age

140
Q

Typical lesions of pemphigus vulgaris

A
  • multiple bullae starting with oral mucosa

- blisters slough and leave raw skin

141
Q

Multiple bullae starting with oral mucosa, blisters then slough =

A

pemphigus vulgaris

142
Q

Biopsy of pemphigus vulgaris shows

A

(stain for antibody)

- lacelike/fishnet immunofluoresence

143
Q

Treatment of pemphigus vulgaris

A

corticosteroids

144
Q

Death from pemphigus vulgaris is often due to

A
  • secondary skin infection

- fluid loss

145
Q

Compare biopsy results of pemphigus vulgaris vs bullous pemphigoid

A
  • lacelike/fishnet = vulgaris

- linear = pemphigoid

146
Q

Dermatitis herpetiformis is a tip-off for

A

gluten sensitivity (celiac disease)

147
Q

Pathology of dermatitis herpetiformis

A

IgA deposits (even in unaffected areas)

148
Q

Pruritis vesicles, papules and wheals on extensor aspects of elbows and knees +/- face/neck =

A

dermatitis herpetiformis

149
Q

Treatment of dermatitis herpetiformis

A

gluten-free diet

150
Q

3 major causes of new onset excessive perspiration

A
  • hyperthyroidism
  • pheochromocytoma
  • hypoglycemia
151
Q

Reasons to bioby/excise a mole

A
  • enlarges
  • irregular borders
  • darkens/inflammed
  • changes color
  • bleeds
  • itches
  • painful
152
Q

Characteristics of dysplastic nevus syndrome

A
  • genetic
  • often >100 nevi
  • family history of melanoma
153
Q

Keratocanthoma often mimics

A

squamous cell skin cancer

154
Q

Classic description/course of keratocanthoma

A
  • rapid onset
  • grows to full size in 1-2 months
  • fleshy lesion with central crater with keratinous material
155
Q

Classic locations for keloid

A

upper back, chest, deltoid

156
Q

Classic appearance of basal cell skin cancer

A
  • shiny purple
  • grows slowly
  • umbilicated center
  • often later ulcerates
  • peripheral telangeictasias
157
Q

Shiny purples slow growing lesion =

A

basal cell cancer

158
Q

Metastatic tendency of basal cell carcinoma

A

almost never

159
Q

Risks for basal cell carcinoma

A
  • sunlight

- light skinned

160
Q

Features of actinic keratoses

A

hard, sharp, red, scaly

161
Q

Hard sharp red scaly lesion in sun exposed area =

A

actinic keratoses

162
Q

If a burn scar becomes nodular, warty or ulcerated, think_____

A

squamous cell cancer

163
Q

Squamous cell cancer may have pre-cursor _____ lesions

A

actinic keratoses

164
Q

Squamous cell skin cancer is also known as

A

Bowen disease

165
Q

Actinic keratoses is precursor lesion of

A

squamous cell cancer

166
Q

Best and worst prognostic types in melanoma

A
  • best: superficial spreading

- worst: nodular

167
Q

Black dots on palms, soles or under nails =

A

melanoma

168
Q

Prognosis in melanoma is related to

A

vertical depth on invasion

169
Q

Kaposi sarcoma is classically associated with

A

AIDS

170
Q

Paget disease of the nipple, must rule out

A

breast adenocarcinoma

171
Q

Classic nutritional cause of stomatitis

A
  • B-complex vitamins

- Vitamin C

172
Q

What are the main B-complex vitamins (deficiency may cause stomatitis)

A
  • riboflavin
  • niacin
  • pyridoxine

step3 (10 decks)

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