Chapter 3 - Principles of Diagnosis

Question 1

steps in dermatologic diagnosis (5)

Answer 1

• history
• physical - identify the morphology of basic lesion
• consider clinicopathologic correlations
• configuration or distribution of lesions
• laboratory tests

Question 2

the most important part of the physical examination is __

Answer 2

inspection

Dermatology is a visual specialty and diagnosis rests heavily on skin inspection

Question 3

Skin disorders are divided into 2 broad categories:

Answer 3

rashes and growths

Question 4

a discrete lesion resulting from proliferation of one or more of the skin’s components

Answer 4

growth

Question 5

an inflammatory process that usually is more widespread than a growth

Answer 5

rash

Question 6

for a rash, important diagnostic information can be obtained by noting ___

Answer 6

the arrangement of distributed

Question 7

the initial history can be abbreviated by asking 3 general questions:

Answer 7

how long?
does it itch?
how have you treated it?

Question 8

most common symptom for skin disorders is ___

Answer 8

itching

Question 9

__ can cause all types of skin rash

Answer 9

Drugs

Question 10

in patients with a generalized maculopapular eruption, the two most common causes are __

Answer 10

drugs and viruses

Question 11

chronic skin ulcer from persistent herpes simplex infection is a sign of ___

Answer 11

immunosuppression - AIDS

Question 12

__ is the leading cause of workers disability

Answer 12

Industrial dermatiis

Question 13

A complete “skin exposure history” is required whenever ____ is suspected

Answer 13

contact dermatitis

Question 14

what are the 3 essential requirements needed for the Physical exam?

Answer 14

undressed patient, clothed in an examining gown
adequate illumination - natural light or bright overhead lighting
an examining provider prepared to see what is there

Question 15

-

Answer 15

lesions that may accompany the presenting complaint

unrelated but important incidental findings

Question 16

what type of lighting can be used to detect subtle elevations?

Answer 16

side lighting

Question 17

what is used to accentuate pigmentary alternations in the skin, like vitiligo?

Answer 17

woods light

Question 18

an illuminated handheld magnifying device intended to help the clinican to diagnose melanoma clinically

Answer 18

dermatoscope

Question 19

why should you palpate the skin as well? (2)

Answer 19

• to assess the texture consistency and tenderness of the skin lesion
• to reassure patients that we are not afraid to tough their skin lesions

Question 20

the most important task in the physical examination is to _____

Answer 20

characterize the morphology of the basic lesion

Question 21

scale, lichenification, vesciles, bullae, pustules and crusts are all ___ alterations

Answer 21

epidermal

Question 22

erythema, purpura, and induration reflect changes in the __

Answer 22

dermis

Question 23

epidermal growths results from ___ of keratinocytes

Answer 23

hyperplasia

Question 24

__ accumulates hen the rate of stratum corneum production exceeds the rate of shedding

Answer 24

scale

Question 25

excessive accumulation of keratin

Answer 25

hyperkeratosis

Question 26

malignant epidermal growths usually feel ____

Answer 26

indurated

Question 27

term designate thickening of the dermis

Answer 27

indurated

Question 28

what are examples of hyperpigmented macules that results from increased melanin production

Answer 28

freckles

Question 29

__ and __ are examples of growths characterized by increased numbers of melanin-producing cells

Answer 29

nevi and melanomas

Question 30

dermal and subcutaneous growths result from ___ proliferative processes in the dermis or subcutaneous fat, most are fully appreciated by palpation

Answer 30

focal

Question 31

a ___ is often required for the diagnosis of a dermal nodule

Answer 31

skin biopsy

Question 32

thickened skin with accentuated skin markings

Answer 32

lichenification

Question 33

__ is the hallmark of chronic dermatitis

Answer 33

lichenification

Question 34

scaling eruptions are the result of thickened stratum ___

Answer 34

corneum

Question 35

fish skin

Answer 35

ichthyosis

Question 36

white or light tan and flakes off rather easily

Answer 36

scale

Question 37

dried serum and debris on the skin surface and is usually darker, most often yellow or brown, it is adherent and a weeping base is revealed

Answer 37

crust

Question 38

__ are usually associated with vesicles, bullae, pustules and malignant growths

Answer 38

crusts

Question 39

__ occur when fluid accumulates within or beneath the epidermis, occur either intraepidermally or subepidermally

Answer 39

vesicles and bullae

Question 40

__ blisters are tense and less easily broken

Answer 40

subepidermal blister

Question 41

__ blisters are flaccid and easily ruptured

Answer 41

intraepidermal blister

Question 42

hypopigmentary changes are accentuated with _____ examination

Answer 42

woods light

Question 43

t/f erythema is blanchable

Answer 43

true, the increased blood in the skin is contained within dilated blood vessels

Question 44

t/f purpura is blanchable

Answer 44

false, blood has extravasated from disrupted blood vessels into the dermis so not blanchable

Question 45

test for blanchability is ___ - simply applying pressure with a finger or glass slide and observing color changes

Answer 45

diascopy

Question 46

__ rashes are subdivided into generalized, localized and specialized types

Answer 46

erythematous

Question 47

a special type of blanchable, transient, erythematous lesion of the skin

Answer 47

wheal / hive

Question 48

purpuric rashes are subdivided into __ and ___ categories

Answer 48

macular and papular

Question 49

flat and nonpalpable

Answer 49

macular purpura

Question 50

elevated and palpable

Answer 50

papular purpura

Question 51

what type of purpura occur in 2 settings: conditions associated with increased capillary fragility and bleeding disorders

Answer 51

macular purpura

Question 52

disruption and necrosis of the blood vessel caused by inflammatory reaction are called __

Answer 52

necrotizing vasculitis (papular purpura)

Question 53

idiopathic disorder of increased collagen deposition

Answer 53

scleroderma

Question 54

totally devoid of epidermis and some or all of the dermal tissue is missing, may extend down to the bone

Answer 54

ulcer

Question 55

__ processes can result in ulcerations that do not heal, for this reason, all chronic ulcers should be biopsied

Answer 55

malignant

Question 56

loss of hair

Answer 56

alopecia

Question 57

to determine whether alopecia is scarring or non scarring, look for the presence or absence of __

Answer 57

follicular openings

Question 58

inflammation and scaling in the nail bed result in separation of the nail plate from the bed

Answer 58

onycholysis

Question 59

what are the 4 types of configurations of a rash

Answer 59

linear grouped annular geographic

Question 60

a flat skin lesion recognizable because its color is different from that of the surrounding normal skin

Answer 60

macule

Question 61

a macule with some surface change, either slight scale or fine wrinkling

Answer 61

patch

Question 62

small elevated skin lesions less than 0.5 cm in diameter

Answer 62

papules

Question 63

an elevated plateau like lesion greater than 0.5 cm in diameter but without substantial depth

Answer 63

plaque

Question 64

elevated, marble like lesions more than 0.5 cm in both diameter and depth

Answer 64

nodules

Question 65

blisters filled with clear fluid, less than 0.5 cm

Answer 65

vesicle

Question 66

blister filled with clear fluid, great than 0.5 cm

Answer 66

bullae

Question 67

vesicles filled with cloudy or purulent fluid

Answer 67

pustules

Question 68

liquid debris that has dried on the surface of the skin

Answer 68

crust

Question 69

__ results from breakage of vesicles, pustules, or bullae

Answer 69

crust

Question 70

visibly thickened stratum corneum, dry and usually whitish

Answer 70

scale

Question 71

visible and palpable thickening of the skin with accentuated skin markings

Answer 71

epidermal thickening - lichenification

Question 72

dermal thickening resulting in the skin that feels thicker and firmer than normal

Answer 72

induration induration is in the DERMIS

Question 73

a thin, linear tear in the epidermis

Answer 73

fissure

Question 74

wider but is limited in depth, confined to the epidermis

Answer 74

erosion

Question 75

defect devoid of epidermis as well as part of all of the dermis

Answer 75

ulcer

Question 76

loss of skin tissue

Answer 76

atrophy

Question 77

a papule or plaque of dermal edema, central pallor and irregular borders

Answer 77

wheal

Question 78

superficial blood vessels enlarged sufficiently to be clinically visible

Answer 78

telangiectasia

Question 79

serpiginous tunnel or streak is caused by a ___ organism

Answer 79

burrowing -- scabies

Question 80

noninflammatory lesions of acne that result from keratin impaction in the outlet of the pilosebaceous canal

Answer 80

acne - comedo

Question 81

contact dermatitis from poison ivy will demonstrate a ____ configuration

Answer 81

linear

Question 82

herpes simplex will demonstrate a ___ configuration

Answer 82

grouped

Question 83

tinea corporis will demonstrate a ___ configuration

Answer 83

annular scaling patch

Question 84

when morphology and configuration (or distribution) appear to conflict, who wins??

Answer 84

morphology