CM- Intro to Skin and Derm Diagnosis Flashcards
What are the steps of the dermatology examinations?
- overall clinical appearance
- distribution of the lesion
- arrangement and shape of the lesion
- Type of lesion [primary or secondary]
- general medical history
- Derm history
- Review of systems, PMH, FHx, SHx
8 Physical exam - Lab procedures
What is acral?
Head, neck, extremities
What is the difference between extensor and flexor in terms of skin surface?
Extensor = anterior part of legs, posterior arms Flexor= anterior arms, posterior legs
What is meant by dermatomal?
Follows the distribution of a spinal nerve route
What is the difference between non-glabrous and glabrous skin?
Non-glabrous = hair-bearing Glabrous = non- hair-bearing
What are the seborrheic areas?
Areas with high concentrations of sebaceous glands like:
- brows
- nasolabial folds
What is meant if a skin lesion is intertriginous?
It is in areas where the skin folds on itself
What is meant if a skin lesion is koebnerization?
it is sites of trauma
What is a periungual skin lesion?
around the fingernails
What are the 7 arrangements of skin lesions?
- isolated
- scattered
- grouped [herpetiform, zosteriform]
- circular [annular, arciform, polycyclic]
- linear
- angular
- reticulated/mat-like
What are the 2 types of “grouped” arrangements for skin lesions? Describe the difference.
- Herpetiform - random grouping
2. Zosteriform - grouping in dermatomes
What are the 3 types of circular arrangements of skin lesions?
Annular - full circle
Arciform - incomplete ring
polycyclic- multiple rings
What are polycyclic arrangements of skin lesions suggestive of?
subacute cutaneous lupus erythematosus
What term describes a non-palpable change in skin color with distinct borders less than 1cm in size?
Is it a primary or secondary lesion?
Macule- primary
What term describes a non-palpable change in skin color with distinct borders that is over 1cm in size?
Is it primary or secondary?
Patch - primary
What term describes a palpable solid lesion less than 1cm in diameter?
Over 1cm in diameter?
Are these lesions primary or secondary?
Less than 1cm = papule
Over 1cm = nodule
Both are primary lesions
What term is given to a flat-topped elevation of skin that covers a relatively large area?
Is it primary or secondary?
Plaque- primary
What is a fluid-containing, superficial, thin-walled cavity less than 1cm in diameter? More than 1cm in diameter?
Is this lesion type primary or secondary?
1cm is a bulla
These are primary lesions
What term describes a lesion with concentric rings [like a target]?
Is is primary or secondary?
What does this lesion typically indicate the presence of?
Target [Iris] is a primary lesion.
It indicates the presence of Erythema multiforme [possible immune complex deposition]
What term describes a lesion made of incomplete rings? Is this a primary or secondary lesion?
What 3 things are on the DDx for a lesion like this?
Arciform - primary lesion DDx: 1. granuloma annulare 2. leprosy 3. T-cell Lymphoma
What term describes a skin lesion with a central depressed area?
Is it primary or secondary?
Umbilicated - primary
What term describes a pus containing, superficial, thin-walled cavity?
Is it primary or secondary lesion?
Pustule- primary lesion
You are performing a dermatological exam on a patient and note scratched or abraded skin. What term describes this?
Is this a primary or secondary lesion?
excoriation- secondary lesion
On dermatological exam, what term describes dried exudate [serous, purulent, hemorrhagic]?
Is it a primary or secondary lesion?
Crust- secondary lesion
What term describes a thick-walled nodule containing fluid? Pus?
Are these lesions primary or secondary lesion?
Cyst = fluid-filled Abscess = pus-filled
Both are secondary lesions
What term is used for sclerotic tissue that forms in response to injury?
Is it a primary or secondary lesion?
scar- secondary lesion
What term describes exaggerated skin markings?
Primary or secondary?
Lichenification - secondary
What term is used to describe the thinning of the epidermis, dermis, subcutaneous fat or a combination of all three?
Is this a primary or secondary lesion?
Atrophy- secondary lesion
You are examining the color of a skin lesion and note that it is violaceous. What does this tell you about the underlying cause of the lesion?
connective tissue disease
What features of a skin lesion can be discerned via palpation?
- consistency - doughy, firm, hard, rubbery, soft
- tenderness
- fixed or mobile
- dry vs. wet
- surface features - smooth, velvety, pebbled
What layer of skin does the pathology involve if you see:
- scales- psoriasiform, eczematous, ichthyotic
- increased brown, grey, black pigmentation
- decreased brown, grey, black pigmentation
epidermis
What layer of the skin does the pathology involve if you see:
- edema
- red or violaceous pigment [with or without blanching]
- telagiectasias
- blue, green or yellow pigmentation
dermis
You are looking at a skin lesion that is red or violaceous. It blanches. Where is the pathology?
Red/violaceous indicates that the injury is in the dermis.
Blanching indicates that it is erythema [intravascular]
You are looking at a skin lesion that is red or violaceous. It does not blanch when pressed. Where is the pathology?
The red/violaceous indicates dermis involvement. The fact that is does not blanch means that it is purpura indicating the extravasation of blood components
You dermatology exam you note a lesion with poorly demarcated borders and fixation to underlying tissue. What layer of skin is the pathology involved?
Subcutis
What 3 features describe an epidermis lesion?
- scales - psoriasiform, eczematous, ichtyotic
- increased brown, black, grey
- decreased brown, black, grey
What 4 features describe a dermis lesion?
- red or violaceous pigment
- blanch = erythema
- no blanching = purpura - edema
- telangiectasia
- blue, green or yellow pigmentation
What 2 features describe a lesion in the subcutis?
- fixed to adjacent tissues
2. poorly demarcated border
Describe papulo-squamous lesions.
Papules [palpable lesions less than 1cm] coalescing into plaques with scale.
Describe erythrodermic lesions.
Erythema [intravascular pathology that blanches] and scales over most of the body surface area.
Describe ichthyosiform lesions.
Fish-like scales on skin.
- vulgaris
- acquired
- x linked
- drug rxn
Describe vesico-bullous lesions.
Vesicles [less than 1cm fluid filled, thin-walled] and bullae [fluid-filled sacs larger than 1cm] on the skin.
You are examining a patient and note blisters with papules, plaques, ulcers and erosions. How would you classify it?
vesiculo-bullous
Describe a pustular lesion.
What 5 things are on DDx?
Small pus-filled, superficial, thin-walled cavities on the skin.
DDx:
acne vulgaris, acne rosacea, drug rxn, pustular psoriasis and Reiters
Describe a sclerotic lesion.
What 5 things are on the DDx?
It is discreted scarred papules or plaques that may be atrophic.
- keloid
- scleroderma
- morphea [localized scleroderma]
- necrobiosis lipoidica diabeticorum [pretibial]
- lichen sclerosis
Describe a hypomelanosis, circumscribed skin lesion.
What 7 things are on DDx?
It is discrete macules [<1cm] with loss of pigment
- post inflammatory
- tinea versicolor
- vitiligo
- ash leaf macule of tuberous sclerosis
- discoid lupus
- leprosy
- arsenic
Describe hypermelanosis, circuscribed skin lesions.
What 10 things are on DDx?
Discrete areas with increased pigment [macules or patches].
- nevi
- freckles
- lentigines [benign]
- melasma [most common in pregnant]
- post-inflammatory
- drug rxn
- acanthosis nigricans
- cafe-au-lait
- melanoma [malignant]
- tinea versicolor
What is hypermelanosis diffuse?
What is the 7 things on the DDx?
Increased pigmentation of a person diffusely.
- tanning w/ UV
- scleroderma
- Addisons
- porphyria [increased heme]
- hemochromatosis
- wilson’s disease
- arsenic ingestion
What 9 things present with nodules WITHOUT inflammation?
- basal cell carcinoma
- lipoma
- sarcoidosis
- amyloidosis
- metastatic carcinoma
- xanthoma [cholesterol buildup. EXCLUDES eruptive]
- gout
- keratocanthoma
- rheumatoid nodule
What 6 things present with nodules WITH inflammation?
- acne vulgaris
- erythema nodosum
- vasculitis
- pyogenic abscess
- deep fungal infection
- leprosy
What 5 things present with purpura WITHOUT inflammation?
- senile
- thrombocytopenia
- kaposi sarcoma
- amyloidosis
- scurvy
What 2 things present with purpura WITH inflammation?
- vasculitis
2. bacterial sepsis
Describe nodulo-ulcerative lesions.
What is on the DDx?
papules, nodules, and/or plaques WITH ulcerations
- basal cell carcinoma
- squamous cell
- stasis ulcer
- pyoderma gangrenosum
- mycosis fungoides [cutaneous T cell lymphoma]
- syphilis [primary]
- chancroid
- arthropod bite
