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Dermatology - Chapters > Chapter 11- Inflammatory Papules > Flashcards

Chapter 11- Inflammatory Papules Flashcards

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1
Q

Characterized by discrete, small, erythematous papules that do NOT become confluent (run together/become one) =

A

inflammatory papules

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2
Q

comedones and pustules accompany papules in ______.

A

acne

**comedones - primary sign of acne ; dilated hair follicle with bacteria

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3
Q

______ coalesce into plaques in atopic dermatitis.

A

eczematous papules

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4
Q

T/F Plaques and papules are present in psoriasis.

A

true

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5
Q

Acute skin reactions appear as _____, and more chronic reactions appear as ______ .

A

hives ; inflammatory papules

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6
Q

Bees, waspas, and fire ants _____.

A

sting

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7
Q

Mosquitoes, fleas, flies, bedbugs, and lice _____

A

bite

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8
Q

What is the leading caue of allergic insect sting reactions in the USA? What about tin the southern USA?

A

yellow jackets

southern - fire ants

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9
Q

This insect bites in groups of three, infest bats and birds, hides in cracks and crevices, and attacks a sleeping victim.

A

Bed Bug

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10
Q

What do fleas, spiders, bedbugs, and lice have in common?

A

all indoor insects

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11
Q

Papules occur only in people who are _____ and ____ the insects.

A

allergic and attract

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12
Q

The reaction to a ______ is usually an immediate hive, often with a central punctum, that resolves in a few hours

A

sting

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13
Q

What produces multiple itching hives, that quickly progress to painful papulovesicles and pustules?

A

fire ants

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14
Q

What produces a severe local necrotic reaction with ulceration?

A

recluse spider

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15
Q

what favors the legs and areas of tight fitting clothing, where they produce inflammatory papules an vesicles, and occasionally even bullae?

A

Chiggers

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16
Q

______ attach to the hair and are called “crabs”

A

Pubic lice - Pediculosis pubis

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17
Q

What should be suspected in the presence of itching of the scalp, particularly the occiput or peripheral scalp?

A

Head lice - Pediculosis capitis

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18
Q

body lice =

A

Pediculosis corporis

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19
Q

T/F Flea bites and bedbugs usually occur in streaks of tree: “breakfast, lunch, dinner”.

A

true

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20
Q

urticarial reaction =

A

hives

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21
Q

when a hive has a central punctum, its cause is ____

A

an insect bite

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22
Q

When only excoriations are found, ______ is in the PA’s differential diagnosis of inflammatory papules

A

Dermatitis herpetiformis

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23
Q

Excoriations may also lead to secondary infection and a diagnosis of _____.

A

impetigo

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24
Q

An uncommon idiopathic disorder, _________ , presents with scattered necrotic papules and vesicles that can resemble insect bites but are usually more generalized and symmetric.

A

Mucha-Habermann disease

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25
Q

The diagnosis of an inflammatory papule is performing a biopsy, which shows a wedge- shaped superficial and deep cellular infiltrate, so dense tha tit may be mistaken for what???

A

malignant lymphoma

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26
Q

What gent do you use to chemically kill lice?

A

NIX - permethrin creme rinse

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27
Q

Adult lice can live on human host for ____ days. Nits (eggs) can live for ____ days.

A

3; 10

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28
Q

T/F Most treatments for lice are pediculicidal, but not ovoidal (kills the lice but not the eggs). Therefore treatment usually requires 7-10 days.

A

true

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29
Q

T/F Successful treatment of flea bites includes fumigation of the home.

A

true - smoke or fumes

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30
Q

Permethrin and DEET is effective in deterrent of insect bites, especially _____.

A

ticks

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31
Q

What form of symptomatic therapy is used for itching?

A

topical steroids and antihistimines

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32
Q

Lice and Tecks both use what for initial therapy?

A

permethrin

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33
Q

Fleas and bedbugs both use what for initial therapy?

A

house fumigation

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34
Q

An alternative for lice treatment is topical ________ and _____.

A

topical benzyl alcohol and malathion

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35
Q

what immunoglobulin mediates an anaphylactic reaction to stings?

A

igE

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36
Q

Patients with anaphylactic reactions require promo therapy with what?

A

epinephrine, antihistimines, systemic steroids

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37
Q

A persistant local reaction to the bite of an infected deer tick is a characteristic of what?

A

Lyme disease and is called erythema migrans

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38
Q

The primary mechanism for insect bite reactions is _____.

A

allergic

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39
Q

What is characterized by monomorphic, follicle based papules with a central horny spine and are located predominantly on the extensor upper arms and thighs, with the face less commonly affected?

A

Keratosis Pilaris

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40
Q

Almost one half of the population is affected by keratosis pillars, but it is most common in _______, especially people with _____ skin. Also a positive family history is usually present

A

adolescents; dry skin

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41
Q

A patient presents with rough bumps along the extensor of upper arms and thighs that will not go away with washing, especially scrubbing. It is not pruiritic or painful. You then examine the patent and see individual, small, follicular papules with a central horny spine. What do you suspect?

A

Keratosis Pilaris

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42
Q

A PA should inform patient being diagnosed with Keratosis Pilaris that the disease will become worsen during what time of the year? They should be relieved that the disease will eventually improve when?

A

worsens in the winter; improves with age.

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43
Q

T/F Keratosis pilaris is polymorphic.

A

false. monomorphic

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44
Q

What are the most common areas infected with Keratosis pillaris?

A

extensors of arms and thighs & face (but uncommon)

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45
Q

When Keratosis pillaris affects the face of a patient, what else would you expect to see that differs from when the extensor surfaces of arms and thighs are affected?

A

there will be a background erythema commonly seen

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46
Q

T/F Laboratory work up and biopsy are not necessary in diagnosis of Keratosis pillars.

A

true - straightforward

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47
Q

How do you distinguish acne from keratosis pillars involving the cheek?

A

Look for pustules and comedones that are diagnostic of acne

48
Q

How does Lichen spinulosus differ from keratosis pillaris?

A

Lochen spinulosius is located mostly on the abdomen, but it can be seen on extensor of arms, knees, and neck

49
Q

How do you differ between lichen nitridus and Keratosis pillars?

A

Lichen nitrides are flat topped papules and not as rough as keratosis pillaris ; also … koebnerization (linear streaks of papules) is seen in lichen nitrides not keratosis pilaris

50
Q

Therapy for Keratosis pillars would be what?

A
  1. reassurance and education
  2. emollient cream - urea 20%, salicylic acid 6%, ammonium lactate 12%
  3. tretinoin cream .05% - alternative therapy
51
Q

what are the 4 P’s that characterize Lichen planus?

A
  1. Purplish
  2. Planar
  3. Pruritus
  4. Polygonal
  5. Papule
52
Q

idiopathic inflammatory disorder of the skin. papules are flat with white dots and lines. purplish papules that favor flexor wrists and distal lower extremities

A

Lichen Planus

53
Q

T/F Lichen Planus can affect hair, skin, nails, and mucous membranes.

A

true

54
Q

What will confirm Lichen Planus in a patient?

A

biopsy

55
Q

T/F Lichen Planus disorder is both uncommon and rare.

A

false. it is uncommon but not rare

56
Q

What would be the most important / careful history of a patient to take if a PA suspects Lichen Planus?

A

drug history - lichen planus-like eruptions can be induced by drugs

57
Q

What is a patients main complaint when coming in with Lichen Planus?

A

itching - which is usually severe

**mucous membrane involvement can result in painful erosions

58
Q

The primary lesion of Lichen Planus is purple, polygonal, flat topped papule. The surface has a fine reticulate pattern of white dots and lines called ______.

A

Wickham’s striae

59
Q

How can you view Wickham’s striae in a patient presenting with Lichen Planus?

A

closely- drop of oil on the papule and use a hand held lens

60
Q

where are the favored locations for lichen plans?

A

wrists and ankles - but palms, soles, and genitalia can be affected

61
Q

The papules of Lichen Planus are sometimes arranged in streaks, resulting from the trauma of scratching called _______.

A

Koebner’s phenomenon

62
Q

T/F Mucous membrane involvement is common in Lichen Planus and is the sole manifestation of the disease

A

true

63
Q

T/F tThe hair and nail follicles are occasionally involved with dystrophic changes and even scarring in Lichen Planus.

A

true

64
Q

What is most commonly confused with Lichen Planus?

A

Discoid Lupus

65
Q

When Lichen Planus presents with only a FEW scattered papules, it can be confused with _____.

A

insect bites

66
Q

_____ can mimic Lichen Planus

A

Drug Eruptions

67
Q

Thiazides, Phenothaizines, Gold, Quinidine, Quinacrine, Chloroquine all causes ______ .

A

lichen planus-like eruptions

68
Q

The course of Lichen Planus can be months to years. BUT 2/3 of patients experience _______.

A

spontaneous resolutions within 1 year

69
Q

Patients with ______ involvement in Lichen Planus usually have a longer course.

A

mucous memebrane involvement

70
Q

T/F Recurrences are almost absolute in patients with Lichen Planus.

A

false - very uncommon - in less than 20%

71
Q

What are two complications of mucous membrane lichen planus?

A
  1. candidiasis

2. squamous cell carcinoma

72
Q

T/F Patients who have undergone bone marrow transplantation have showed occurrences of lichen planus-like eruptions. But the cause of Lichen Planus is still unknown

A

true

73
Q

Because of the intense pruritus in some patients with scabies, only excoriations are seen. A misdiagnosis of ________ could easily be made.

A

neurotic excoriations

74
Q

A widespread disease of scabies may be misdiagnosed as ______.

A

essential dermatitis

75
Q

What is diagnostic of scabies?

A

mits or eggs; and black dot at the burrow

76
Q

What laboratory method would be used to diagnose scabies?

A

skin scaling with no.15 blade. biopsy usually not necessary

77
Q

What is the drug of choice for scabies?

A

Elimite = a permethrin cream

**it has to be applied over the ENTIRE body surface, including under the finger nails

78
Q

T/F An infant patient is diagnosed with scabies, the PA should tell the parents not to bother treating themselves, an infant isn’t as contagious as an adult.

A

FALSE!! all family members who live in the same house hold as the patient being treated with scabies should also apply the cream. Highly contagious.

79
Q

Which drug is recommended when scabies breaks out in a nursing home?

A

Ivermectin (oral dose)

80
Q

How long does itching persist after treatment of scabies?

A

1-2 weeks

81
Q

_______ is found in immunocompromised patients such as patients with AIDS

A

crusted scabies - Norwegian scabies

**easily misdiagnosed as eczema or psoriasis but when you look close burrows and mites are usually numerous and confirms scabies diagnosis

82
Q

Is it easier to transmit scabies form human to human contact or from bedding and clothing to human?

A

human to human is easier ; a stuy during 2nd World War confirmed that it was difficult to transmit scabies from bedding to human

83
Q

Also in the study during 2nd World War, the incubation time from inoculation to itching was _______ long.

A

1 month

84
Q

Also in the study during 2nd World War, they found that if Scabies is left untreated, ______ occurs.

A

progressive itching

85
Q

T/F In the study during 2nd World War, they found that the hypersensitivity to the reaction of scabies provided protection in a way that made it difficult to reinfest previously infested patients.

A

true

86
Q

heat rash, represents an inflammatory reaction around a sweat duct

A

miliaria

87
Q

clinically how does miliaria appear?

A

as multiple small papules

88
Q

what is the main presenting complaint of patients with miliaria?

A

pruirtus

89
Q

Who is miliaria commonly found in?

A

infants

90
Q

WHERE is miliara more commonly found?

A

warm, humid environments particularly in skin that has ben occluded

91
Q

What is the most common form of miliaria ?

A

mililaria ruba

92
Q

multiple discrete small red papules that occur most often on the trunk, particularly the back

A

miliaria ruba

93
Q

Clinically how does miliiaria tuba present?

A

multiple small, discrete uniform size papules not associated with hair follicles.

94
Q

What is th eless common variant of miliaria?

A

miliara crystallina

95
Q

superficial non inflamed vesicles containing crystal-clear fluid (dewdrops) commonly seen in infants

A

miliaria crystallina

96
Q

How can you tell the difference between miliaria rubra and contact dermatitis?

A

papules tend to be confluent rather than discrete and itching is often more pronounced in contact dermatitis

97
Q

How can you tell the difference between miliaria and folliculitis?

A

in miliaria the pustules are usually smaller and more numerous, and do NOT have a centrally placed hair, although, sometimes the two conditions co-exist because they may share the same predisposing factor

98
Q

small non-inflamed superficial epidermal duration cysts often found on the face of young infants

A

milia

99
Q

Gram staining and culture will rule out ____ when forming a differential diagnosis of miliaria?

A

folliculitis

100
Q

Candida is identified using ____

A

hydroxde prep

101
Q

T/F Therapy for a patient with miliaria would include cooling measures, air exposure, and topical steroid, but avoid overuse of the steroid because it can cause more occlusion.

A

true

102
Q

What will cause miliaria to resolve spontaneously within days?

A

decreasing heat and increasing air exposure

103
Q

Heather has hydrated herself to a point where there has been swelling of the stratum corneum and compromise of the ductal lumina. After occlusion, sweat extravastes into the epidermis, where it produces an irritant reaction. This occurs within the epidermis at the level of the granular cell layer. This is the pathogenesis of _______.

A

miliaria ruba

104
Q

Where does the sweat duct obstruction occur in miliaria crystalline?

A

in the stratum corneum

105
Q

an infestation of th epidermis with the “itch” mite. Burrows are usually found. The “WORST ITCH OF THE PATIENTS LIFE”

A

scabies

106
Q

what is characteristic of scabies.

A

burrows are usually found and are diagnostic. Inflammatory papules resulting from host hypersensitivity however constitute the more frequent and obvious finding

107
Q

T/F Scabies is a very uncommon disease.

A

FALSE! very common - school age children, hyper endemic among rural populations of less developed countries. Immobilized geriatric patients in nursing homes, patients with HIV/AIDS, and medically compromised patients (DOWN SYNDROME) are predisposed to infestation with high mite counts.

108
Q

what is the major complain of patients with scabies?

A

generalized pruritus

109
Q

What is the incubation time from inoculation to onset of pruritus in scabies?

A

1 month

110
Q

T/F Scabies is often severe enough to interrupt sleep.

A

true

111
Q

What history should be taken when a patient is suspected of scabies?

A

usually family members and friends often also itch - pet history

112
Q

Itching papules and small nodules on the penis should be considered _______ . unless otherwise proven.

A

scabies

113
Q

What is the predominant condition of scabies?

A

small inflammatory papules

114
Q

______ is usually generalized but favor locations included the finger webs, wrists, elbows, axillae, girdle area, and feet.

A

scabies

115
Q

Where are nodules of scabies most commonly found? If you look closely what do you see?

A

hands ; black dot which represents the adult mite

Dermatology - Chapters (18 decks)

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