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Minor Surgery & Dermatology > Conditions of the Skin and Nails > Flashcards

Conditions of the Skin and Nails Flashcards

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Dermatology Board Prep flashcards
1
Q

What skin lesion is flat, non-palpable 5-10 mm in size and shows a change in normal skin color? Give an example

A

Macule: Flat Freckles

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2
Q

What skin lesion is a plaque of dermal edema? Give an example.

A

Wheal: Hives, urticaria

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3
Q

What skin lesion is firm, palpable, incarcerated with base, and >10 mm in size? Give an example.

A

Nodule: Tumor

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4
Q

What skin lesion is raised, palpable with no base and is 5-10 mm? Give an example

A

Papule: Warts or mole

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5
Q

What skin lesion is a vesicle filled with purulent or cloudy exudate? Give an example

A

Pustule: acne pimple

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6
Q

What are the common signs and symptoms of actinic keratosis?

A

Begin as small rough spots, easier felt than seen: sandpaper-like texture
Hyperkeratotic, pearly, gray-white appearance, 3-10 mm in size; recurs if scraped off

1) Rough, scaly patch of skin
2) Appears as a non-healing sore
3) Often on sun-exposed areas
4) Precursor to SCC

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7
Q

What are the symptoms of basal cell carcinoma?

A

Skin colored papule/nodule with rolled, translucent “pearly” telangiectatic border, and depressed/eroded/ulcerated center.

Sides of the crater have telangiectatic (Spider like) vessels

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8
Q

How would you evaluate for a basal cell carcinoma?

A

Biopsy: If shallow lesion, do shave biopsy; otherwise punch or excisional biopsy may be more appropriate

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9
Q

What are the predisposing factors for squamous cell carcinoma?

A

WB: Sunlight exposure, pale skin, light colored eyes, blond, red hair, actinic keratosis

Primarily on sun- exposed skin in the elderly; chronic sun exposure
Actinic Keratosis
Arsenic Exposure
Most common complication during immunosuppressive therapy
M>F

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10
Q

Where are the lesions of squamous cell carcinoma found predominantly?

A

70% occur on the head and neck

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11
Q

How are the lesions of squamous cell carcinoma described ?

A

Indurated erythematous nodule/plaque with surface scale/crust +/- ulceration; may bleed easily, frequently, single but may be multiple

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12
Q

Which of the following skin lesions metastasize? Squamous cell or basal cell carcinoma?

A

Squamous Cell Carcinoma

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13
Q

Exposure to what toxic metal is associated with basal and squamous cell carcinoma?

A

Arsenic

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14
Q

What malignant tumor derived from the endothelia cells is seen in AIDS?

A

Kaposi Sarcoma: Spindle Cell Tumor

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15
Q

What are the common signs and symptoms of Kaposi’s Sarcoma?

A

Raised, round, or oval papules, that are red-purple that ulcerates

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16
Q

What are the predisposing risk factors for melanoma?

A

1) Slow onset of change in nevus
2) Pale skin, light colored eyes, blonde or red hair
3) Blistering sunburn as a child
4) Large quantity of moles
5) Family or personal Hx

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17
Q

What is the mnemonic for melanoma and what does it stand for?

A

ABCDEs
A:Asymmetry
B: Boarder irregularity
C: Contour or Color variation
D: Distribution or Diameter (enlarged): >6mm or size of pencil eraser
E: Evolving: changing in size, shape, or color

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18
Q

What are the best methods for evaluation for melanoma?

A

Clinical observation, dermoscopy, Excision Biopsy

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19
Q

What condition causes a malar rash on the face with pustules and papules on an erythematous base and telangiectasia?

A

Acne Rosacea

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20
Q

What types of things exacerbate ance rosacea?

A

Stress, alcohol (especially wine), spicy food, weather (heat, cold, wind, sun), vasodilators, histamine foods

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21
Q

Rhinophyma (lumpy nose) is associated with what disease?

A

Acne Rosacea

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22
Q

What class of herbs are well established for acne rosacea?

A

Alternatives: Arctium Lappa, Rumex Crispus, Taraxacum officinalis root

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23
Q

What does acne vulgaris have that acne rosace does not have?

A

Comedones: Plugging of hair follicle by keratin debris
Open- Blackhead
Closed- Whitehead

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24
Q

What vitamin may be contraindicated with acne vulgaris?

A

B12

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25
Q

What mineral may be contraindicated with acne vulgaris?

A

Iodine

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26
Q

What mineral may be indicated with acne vulgaris?

A

Zinc

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27
Q

What herb, used topically, is indicated for acne?

A

Melaleuca alternifolia

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28
Q

What herb is indicated for premenstrual acne?

A

Vitex agnus-castus

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29
Q

Which vitamins are indicated in the treatment of acne vulgaris?

A

Vitamin A, B5, B6, Folate

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30
Q

What is an acute spreading infection of the dermis and subcutaneous tissue?

A

Cellulitis

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31
Q

What are the signs and symptoms of cellulitis?

A

Involves the lower dermis/subcutaneous fat
Erythema, warmth, swelling, and pain
Borders are not elevated, poorly demarcated vesicles
Regional lymphadenopathy
Orange peal appearance skin

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32
Q

What homeopathic remedies might you suggest for cellulitis that is better with pressure and hot applications?

A

Pyrogenium

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33
Q

Describe the characteristics of a rash caused by candida albicans?

A

Erythematous with satellite lesions ( broken pieces spread out)

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34
Q

What drug could be used to treat the rash caused by candida albicans?

A

Nystatin, miconazole or clotrimazole

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35
Q

Describe the characteristics of a rash caused by a bed bug (cimicosis) ?

A

Small papules arranged in a line

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36
Q

What is inflammation of the hair follicle called?

A

Folliculitis

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37
Q

What are the clinical findings in folliculitis?

A

Pustule around the hair follicle

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38
Q

What is in the DDx for folliculitis?

A

Furunculosis
Tinea
Acne
Contact Dermatitis
Candidiasis
Molluscum Contagiosum

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39
Q

What are some treatment options for folliculitis?

A

Good Hygiene
Topical Antimicrobials that cover gram-positive organisms

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40
Q

What is a topical antimicrobial that covers gram-positive organism you might use empirically for folliculitis?

A

Erythromycin or Clindamycin Topical

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41
Q

What is the prodrome of herpes simplex infection?

A

Tingling, pain, burning or itching precedes appearance of crops of small fluid filled vesicles on erythematous base

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42
Q

How is herpes diagnosed?

A

Clinical or viral culture

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43
Q

What is the DDX for herpes simplex?

A

Impetigo
Aphthous stomatitis
Herpes Zoster
Chancroid
Varicella
Syphilis

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44
Q

How soon after initial infection does the herpes simplex antibodies titer peak?

A

4-6 weeks

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45
Q

What drugs are indicated for herpes simplex infections?

A

Acyclovir, Valacylovir, or Famciclovir

46
Q

What topical botanicals may be helpful for herpes simplex?

A

Larrea Tridenta
Melissa officinalis
Glycyrrhiza

47
Q

What amino acid is helpful for herpes infection?

A

Lysine: Competitively inhibits synthesis

48
Q

What amino acid may be associated with an increase in herpes simplex outbreaks?

A

Arginine: Required for reproduction

49
Q

What are the common signs and symptoms of lichen planus?

A

6 P’s: Pruritic, Polygonal, Planar (Flat-topped), purple, papules, and plaques

Wickham Striae

Usually symmetric distribution on flexor surface of arms shins, mouth, scalp and genitalia

50
Q

What conditions are associated with lichen planus?

A

Autoimmune Disorders:
Primary Biliary Cirrhosis
DM
Ulcerative Colitis
Myasthenia Gravis
Hepatitis C

51
Q

What disease is a common benign viral disorder characterized by small umbilicated papules?

A

Molluscum Contagiousm

52
Q

How is molluscum contagiousm transmitted?

A

Contact with infected person or contaminated object

53
Q

What are the signs and symptoms of molluscum contagiosum?

A

Dome-shaped lesions with central crater (umbilicated papules) containing white papule without pruritus

54
Q

What conditions are in the ddx for molluscum contagiosum?

A

Basal Cell Carcinoma
Furunculosis
Warts
Pyoderma/Impetigo
Lichen planus

55
Q

What are some treatment options for molluscum?

A

Cryotherapy
Curettage/Electrodessication
Salicylic Acid
Spontaneous remission in 6-9 months

56
Q

Who is most at risk for developing necrotizing fasciitis?

A

DM
Drug Use
Immunosuppression
Traumatic Wounds

57
Q

What are the common signs and symptoms of necrotizing fasciitis?

A

Intense pain and tenderness
Reaches past the border of erythema
Crepitus
Rapidly Spreading

58
Q

What is the name of the inflammatory conditions caused by Staph, Strep, or Candida that may affect the nail fold?

A

Paronychia

59
Q

What are the common signs and symptoms of pityriasis alba?

A

1)Ill-defined, scaly and slightly erythematous patches
2) Once the lesions resolve, the area becomes hypo-pigmented
3) Most commonly seen on the cheek

60
Q

What are the common signs and symptoms of pityriasis rosea?

A

1) Herald Patch
2) Christmas Tree dermatomal pattern of skin lesions
3) Pruritis

61
Q

What are the common signs and symptoms of scabies?

A

1) Extreme pruritus
2) Rash between the fingers, penis, scrotum, buttocks, groin, or axilla
3) Erythematous burrows with dark spot at one end
4) Excoriation from scratching

62
Q

How is scabies diagnosed?

A

Skin scraping showing organism or eggs

63
Q

What preventative strategy would you suggest to your patient with scabies?

A

Good Hygiene
Protective clothing when working with infected people
Clean bedding and clothing

64
Q

What is a typical drug used to treat scabies ?

A

First Line: Permethrin Topical
Second Line: Lindane or Ivermectin

65
Q

What are the concerns about the topical anti-lice and anti-scabies drugs used?

A

They may be neurotoxic to children as well as arthropods

66
Q

What is a red, scaly, greasy rash with minimal itching commonly seen on the eyebrows and scalp?

A

Seborrheic Dermatitis

67
Q

What herb, used topically, is indicated in tinea infections?

A

Melaleuca alternifolia

68
Q

What is terbinafine indicated?

A

Tinea infections, Onychomycosis

69
Q

What are the routes of administration for terbinafine?

A

Oral, powder, cream

70
Q

What are the contraindications for terbinafine?

A

SLE, Liver disease (hepatotoxic): must check liver enzymes, before and during treatment

71
Q

What is tinea versicolor now called?

A

Pityriasis versicolor

72
Q

Describe the lesions of tinea versicolor

A

Superficial cutaneous fungal infection characterized by well-demarcated hypo-pigmented or hyper-pigmented macules or patches usually located on the chest and back.

73
Q

How do you clinically evaluate a patient for tinea versicolor?

A

1) Clinical observation
2) Fungal elements in KOH prep “Spaghetti and meatballs” appearance
3) Fluoresces gold under wood’s lamp

74
Q

What are epidermal (sebaceous) cysts characterizes by?

A

Central well or punctum

75
Q

What skin lesion develops on older individuals that are scaly and have a greasy stuck on appearance?

A

Seborrheic Keratosis

76
Q

What characteristics of these lesions may raise concern if you did not know what they were?

A

They usually have color variations, are larger than 6 mm, may have irregular borders and are elevated. This ranks them higher on the ABCDE for melanoma. However, they are benign.

77
Q

What causes warts?

A

HPV (Human Papilloma Virus)

78
Q

What are symptoms of a plantar wart?

A

Solitary papule, often tender, covered by a thick callus, frequently surrounded by smaller warts

79
Q

What are some treatment options for warts?

A

1) No treatment: 65-90% regress spontaneously within 2 years
2) Salicylic Acid OTC topical
3) Adhesiotherapy: duct tape
4) Cryotherapy
5) Chemotherapeutic agents: 5-fluorouracil, bleomycin
6) Intralesional Immunotherapy: Candida Albicans inections into warts to stimulate immune response

Verrucae Vulgaris=Warts

80
Q

What herbs may be indicated for warts?

A

Chelidonium Majus
Podophyllum pelatum
Thuja occidentalis
Melissa officinalis

81
Q

What sign is absent in bullous pemphigoid?

A

Negative Nikolsky’s Sign (slight rubbing does not cause outer layer of the blistered skin to come off)

82
Q

Where are the lesions in bullous pemphigoid most often located?

A

Flexors of forearms, axillae, medial thighs, mouth, groin abdomen

83
Q

How is bullous pemphigoid diagnosed?

A

Skin biopsy show show-epidermal blisters and anti-basement membrane auto Igs.

Immunofluoresnce shows linear deposition of IgG and C3 along basement membrane

84
Q

What autoimmune condition is associated with dermatitis herpetiformis?

A

Celiac Disease

85
Q

Which develops faster, allergic contact dermatitis or irritant contact dermatitis?

A

Irritant contact dermatitis

86
Q

What mineral is indicated therapeutically in cases of atopic dermatitis?

A

Zinc

87
Q

What does chronic scratching cause?

A

Lichenification

88
Q

Which diseases are associated with lichenification?

A

Atopic Dermatitis
Scabies
Lichen Simplex Chronicus

89
Q

What other conditions are associated with atopic dermatitis?

A

Atopic Conditions: Asthma, Allergic, Rhinitis, Family History of Atopic Conditions

90
Q

Where are the lesions usually seen in atopic dermatitis?

A

On flexor surfaces

91
Q

What homeopathic remedies might have you consider in atopic dermatitis?

A

Itchy skin remedies like sulphur, Psorinum, Petrolselinum

92
Q

What herbs could be used for atopic dermatitis?

A

Matricaria recutita
Berberis spp
Galium Aparine
Arctium Lappa

93
Q

What nutrient might you consider in atopic dermatitis to stabilize mast cells?

A

Vitamin C

94
Q

What skin disease has a symmetrical distribution if lesions with concentric rings (target lesions)?

A

Erythema Multiforme

95
Q

What types of triggers cause erythema multiforme?

A

Drug reaction, vaccination, HSV and other bacterial and viral infections

96
Q

What disease of autoimmune origin is characterized by intra-epidermal bullae?

A

Pemphigus vulargis

97
Q

What are the clinical findings for pemphigus vulgaris?

A

Intra-epidermal blisters or bullae that arise from normal-looking skin and become painful erosions

98
Q

How is pemphigus vulgaris diagnosed?

A

(+) Nikolsky’s sign: Slight rubbing causes detachment of the epidermis, positive Tzank smear

99
Q

What disease shows the Auspitz sign?

A

Posriasis, Auspitz sign is when a flake is removed, a pinprick of blood will be present

100
Q

Psoriasis most commonly affects which part of the body?

A

Extensor surfaces

101
Q

What herb is well established in the treatment of psoriasis?

A

Berberis aquifolium

102
Q

What herbs are theoretically contraindicated in psoriasis?

A

Immune stimulant herbs: Echinacea

103
Q

What vitamin is indicated topically in psoriasis?

A

Vitamin D

104
Q

What are 2 major factors in the severity of psoriasis?

A

Stress and alcohol intake

105
Q

What homeopathic remedy is indicated for psoriasis in a person with thick crusts on elbows, desires vinegar, and is ameliorated by vigorous motion?

A

Sepia

106
Q

What is the etiology of vitiligo?

A

Cause is unknown, but may be autoimmune or familial, is associated with Vitamin D deficiency

107
Q

What are the clinical findings of vitiligo?

A

Completely depigmented (hypopigmented) patche or macules with no scaling. Sunburn easily, course unpredictable and progressive

108
Q

What mineral may be indicated for for vitiligo?

A

Copper

109
Q

What vitamin may be indicated for vitiligo?

A

Vitamin D3

110
Q

What amino acid may be indicated in vitiligo?

A

Phenylalainine

111
Q

What causes stasis dermatitis?

A

Aka gravitational dermatitis, chronic venous insufficiency

112
Q

What are the signs and symptoms of stasis dermatitis?

A

Erythematous, hyper-pigmented eruptions
Dilated superficial veins
Mild Scaling, edema or ulceration
Most commonly found on medial ankle

Minor Surgery & Dermatology (2 decks)

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