CM- Intro to Skin and Derm Diagnosis

Question 1

What are the steps of the dermatology examinations?

Answer 1

1. overall clinical appearance
2. distribution of the lesion
3. arrangement and shape of the lesion
4. Type of lesion [primary or secondary]
5. general medical history
6. Derm history
7. Review of systems, PMH, FHx, SHx
   8 Physical exam
8. Lab procedures

Question 2

What is acral?

Answer 2

Head, neck, extremities

Question 3

What is the difference between extensor and flexor in terms of skin surface?

Answer 3

Extensor = anterior part of legs, posterior arms
Flexor= anterior arms, posterior legs

Question 4

What is meant by dermatomal?

Answer 4

Follows the distribution of a spinal nerve route

Question 5

What is the difference between non-glabrous and glabrous skin?

Answer 5

Non-glabrous = hair-bearing
Glabrous = non- hair-bearing

Question 6

What are the seborrheic areas?

Answer 6

Areas with high concentrations of sebaceous glands like:

1. brows
2. nasolabial folds

Question 7

What is meant if a skin lesion is intertriginous?

Answer 7

It is in areas where the skin folds on itself

Question 8

What is meant if a skin lesion is koebnerization?

Answer 8

it is sites of trauma

Question 9

What is a periungual skin lesion?

Answer 9

around the fingernails

Question 10

What are the 7 arrangements of skin lesions?

Answer 10

1. isolated
2. scattered
3. grouped [herpetiform, zosteriform]
4. circular [annular, arciform, polycyclic]
5. linear
6. angular
7. reticulated/mat-like

Question 11

What are the 2 types of “grouped” arrangements for skin lesions? Describe the difference.

Answer 11

1. Herpetiform - random grouping

2. Zosteriform - grouping in dermatomes

Question 12

What are the 3 types of circular arrangements of skin lesions?

Answer 12

Annular - full circle
Arciform - incomplete ring
polycyclic- multiple rings

Question 13

What are polycyclic arrangements of skin lesions suggestive of?

Answer 13

subacute cutaneous lupus erythematosus

Question 14

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?

Answer 14

Macule- primary

Question 15

What term describes a non-palpable change in skin color with distinct borders that is over 1cm in size?
Is it primary or secondary?

Answer 15

Patch - primary

Question 16

What term describes a palpable solid lesion less than 1cm in diameter?
Over 1cm in diameter?

Are these lesions primary or secondary?

Answer 16

Less than 1cm = papule
Over 1cm = nodule

Both are primary lesions

Question 17

What term is given to a flat-topped elevation of skin that covers a relatively large area?
Is it primary or secondary?

Answer 17

Plaque- primary

Question 18

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?

Answer 18

1cm is a bulla

These are primary lesions

Question 19

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?

Answer 19

Target [Iris] is a primary lesion.

It indicates the presence of Erythema multiforme [possible immune complex deposition]

Question 20

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?

Answer 20

Arciform - primary lesion
DDx:
1. granuloma annulare
2. leprosy
3. T-cell Lymphoma

Question 21

What term describes a skin lesion with a central depressed area?
Is it primary or secondary?

Answer 21

Umbilicated - primary

Question 22

What term describes a pus containing, superficial, thin-walled cavity?
Is it primary or secondary lesion?

Answer 22

Pustule- primary lesion

Question 23

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?

Answer 23

excoriation- secondary lesion

Question 24

On dermatological exam, what term describes dried exudate [serous, purulent, hemorrhagic]?
Is it a primary or secondary lesion?

Answer 24

Crust- secondary lesion

Question 25

What term describes a thick-walled nodule containing fluid? Pus? Are these lesions primary or secondary lesion?

Answer 25

``` Cyst = fluid-filled Abscess = pus-filled ``` Both are secondary lesions

Question 26

What term is used for sclerotic tissue that forms in response to injury? Is it a primary or secondary lesion?

Answer 26

scar- secondary lesion

Question 27

What term describes exaggerated skin markings? | Primary or secondary?

Answer 27

Lichenification - secondary

Question 28

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?

Answer 28

Atrophy- secondary lesion

Question 29

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?

Answer 29

connective tissue disease

Question 30

What features of a skin lesion can be discerned via palpation?

Answer 30

1. consistency - doughy, firm, hard, rubbery, soft 2. tenderness 3. fixed or mobile 4. dry vs. wet 5. surface features - smooth, velvety, pebbled

Question 31

What layer of skin does the pathology involve if you see: 1. scales- psoriasiform, eczematous, ichthyotic 2. increased brown, grey, black pigmentation 3. decreased brown, grey, black pigmentation

Answer 31

epidermis

Question 32

What layer of the skin does the pathology involve if you see: 1. edema 2. red or violaceous pigment [with or without blanching] 3. telagiectasias 4. blue, green or yellow pigmentation

Answer 32

dermis

Question 33

You are looking at a skin lesion that is red or violaceous. It blanches. Where is the pathology?

Answer 33

Red/violaceous indicates that the injury is in the dermis. | Blanching indicates that it is erythema [intravascular]

Question 34

You are looking at a skin lesion that is red or violaceous. It does not blanch when pressed. Where is the pathology?

Answer 34

The red/violaceous indicates dermis involvement. The fact that is does not blanch means that it is purpura indicating the extravasation of blood components

Question 35

You dermatology exam you note a lesion with poorly demarcated borders and fixation to underlying tissue. What layer of skin is the pathology involved?

Answer 35

Subcutis

Question 36

What 3 features describe an epidermis lesion?

Answer 36

1. scales - psoriasiform, eczematous, ichtyotic 2. increased brown, black, grey 3. decreased brown, black, grey

Question 37

What 4 features describe a dermis lesion?

Answer 37

1. red or violaceous pigment - blanch = erythema - no blanching = purpura 2. edema 3. telangiectasia 4. blue, green or yellow pigmentation

Question 38

What 2 features describe a lesion in the subcutis?

Answer 38

1. fixed to adjacent tissues | 2. poorly demarcated border

Question 39

Describe papulo-squamous lesions.

Answer 39

Papules [palpable lesions less than 1cm] coalescing into plaques with scale.

Question 40

Describe erythrodermic lesions.

Answer 40

Erythema [intravascular pathology that blanches] and scales over most of the body surface area.

Question 41

Describe ichthyosiform lesions.

Answer 41

Fish-like scales on skin. - vulgaris - acquired - x linked - drug rxn

Question 42

Describe vesico-bullous lesions.

Answer 42

Vesicles [less than 1cm fluid filled, thin-walled] and bullae [fluid-filled sacs larger than 1cm] on the skin.

Question 43

You are examining a patient and note blisters with papules, plaques, ulcers and erosions. How would you classify it?

Answer 43

vesiculo-bullous

Question 44

Describe a pustular lesion. | What 5 things are on DDx?

Answer 44

Small pus-filled, superficial, thin-walled cavities on the skin. DDx: acne vulgaris, acne rosacea, drug rxn, pustular psoriasis and Reiters

Question 45

Describe a sclerotic lesion. | What 5 things are on the DDx?

Answer 45

It is discreted scarred papules or plaques that may be atrophic. 1. keloid 2. scleroderma 3. morphea [localized scleroderma] 4. necrobiosis lipoidica diabeticorum [pretibial] 5. lichen sclerosis

Question 46

Describe a hypomelanosis, circumscribed skin lesion. | What 7 things are on DDx?

Answer 46

It is discrete macules [<1cm] with loss of pigment 1. post inflammatory 2. tinea versicolor 3. vitiligo 4. ash leaf macule of tuberous sclerosis 5. discoid lupus 6. leprosy 7. arsenic

Question 47

Describe hypermelanosis, circuscribed skin lesions. | What 10 things are on DDx?

Answer 47

Discrete areas with increased pigment [macules or patches]. 1. nevi 2. freckles 3. lentigines [benign] 4. melasma [most common in pregnant] 5. post-inflammatory 6. drug rxn 7. acanthosis nigricans 8. cafe-au-lait 9. melanoma [malignant] 10. tinea versicolor

Question 48

What is hypermelanosis diffuse? | What is the 7 things on the DDx?

Answer 48

Increased pigmentation of a person diffusely. 1. tanning w/ UV 2. scleroderma 3. Addisons 4. porphyria [increased heme] 5. hemochromatosis 6. wilson's disease 7. arsenic ingestion

Question 49

What 9 things present with nodules WITHOUT inflammation?

Answer 49

1. basal cell carcinoma 2. lipoma 3. sarcoidosis 4. amyloidosis 5. metastatic carcinoma 6. xanthoma [cholesterol buildup. EXCLUDES eruptive] 7. gout 8. keratocanthoma 9. rheumatoid nodule

Question 50

What 6 things present with nodules WITH inflammation?

Answer 50

1. acne vulgaris 2. erythema nodosum 3. vasculitis 4. pyogenic abscess 5. deep fungal infection 6. leprosy

Question 51

What 5 things present with purpura WITHOUT inflammation?

Answer 51

1. senile 2. thrombocytopenia 3. kaposi sarcoma 4. amyloidosis 5. scurvy

Question 52

What 2 things present with purpura WITH inflammation?

Answer 52

1. vasculitis | 2. bacterial sepsis

Question 53

Describe nodulo-ulcerative lesions. | What is on the DDx?

Answer 53

papules, nodules, and/or plaques WITH ulcerations 1. basal cell carcinoma 2. squamous cell 3. stasis ulcer 4. pyoderma gangrenosum 5. mycosis fungoides [cutaneous T cell lymphoma] 6. syphilis [primary] 7. chancroid 8. arthropod bite