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STEP2 > Derm > Flashcards

Derm Flashcards

1
Q 
Macule
Papule
Patch
Plaque
Vesicle
Bulla
A 
Flat lesion < 1cm
Raised lesion < 5mm
Macule > 1cm
Papule >5mm
Fluid filled lesion < 5mm
Vesicle > 5mm
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2
Q

Type 1 hypersensitivity names, path, examples*,

A

“Anaphylaxis, atopic” “IgE mediated”

Preformed IgE antibodies on MAST/basophils react to antigen ==> fast, massive vasoactive amine release

Anaphylaxis
Asthma
Hives 2/2 drug reactions

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3
Q

Type 2 hypersensitivity names, path, examples*

A

“Cytotoxic” “Antibody mediated”

IgM/IgG and complement form membrane attack complex ==> cell lysis

Goodpasture’s
Autoimmune hemolytic anemia
Erythroblastosis fetalis
Rheumatic fever

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4
Q

Type 3 hypersensitivity names, path, examples*

A

“Immune complex”
Antigen-antibody ==> complement ==> PMNs
SLE, glomerulonephritis, RA, polyarteritis nodosa

“Serum sickness”
Antibodies form over ~5 days ==> immune complexes form and lodge in membranes ==> complement fixation ==> tissue damage
Drug reaction

“Arthus reaction”
Preformed antibodies ==> vascular necrosis
2/2 vaccines

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5
Q

Type 4 hypersensitivity names, path, examples*

A

“delayed / cell mediated”

Sensitized T-lymphocytes release cytokines ==> macrophage damage (no antibody damage)

Transplant rejection
Contact dermatitis
Tb skin test

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6
Q

Atopic dermatitis / eczema path, presentation, dx, tx

A

Type 4 (?) skin rxn 2/2 many triggers (nickel, plants, emotional, climate etc.)

Presents different in different age groups**

  • Infants: SYMMETRIC, erythematous, edematous, pruritic papules on face, scalp, chest, & EXTENSOR surfaces
  • adolescents: dry, scaly, red papules on FLEXOR and neck
  • adults: lichenification on FLEXOR surfaces, eyelids, hands

Eosinophilia & IgE elevation

Moisturizers ==> topical steroids ==> tacrolimus [2wks maximum]

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7
Q

Erythema toxicum neonatorum presentation, dx, tx

A

Blanching papules
1-3 days post delivery
SPARING PALMS/SOLES

Clinical
Eosinophila

Benign: no tx

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8
Q

Contact dermatitis path**, presentation, dx, tx

A

Type IV hypersensitivity reaction (requires prior exposure ==> T-cell activation)

Red, edematous, vesicles/papules often in distribution of offending agent

Clinical dx
Patch testing can identify agent

Topical steroids

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9
Q

Eczema herpeticum path, presentation, dx, tx*

A

Systemic HSV infection 2/2 eczema (aka atopic dermatitis)

Infant with atopic dermatitis history
Numerous vesicles and erythema over area of previous dermatitis
FEVER, adenopathy

Clinical

IV acyclovir STAT!

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10
Q

Seborrheic dermatitis path, presentation*, dx, tx

A

Pityrosporum ovale yeast dermatitis with propensity for sebum & hair follicles

Infants: cradle cap (yellow scale on scalp)
Other: red-yellow, oily, scaly patches on ears, eyebrows, nose, scalp
*Common in Parkinson’s and AIDS patients

Dx: r/o contact dermatitis and psoriasis

Tx:

  • babies: routine bathing
  • adults: zinc pyrithione or selenium sulfide shampoos; topical antifungal or corticosteroid
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11
Q

Psoriasis path, presentation, dx, tx

A

T-cell inflammation in dermis ==> epidermal hyperplasia

Begins in teens, early adulthood
Red plaque, sharp demarcations, with SILVERY scale
EXTENSOR surfaces
Nail changes: oil spots, pitting, lifting

Auspitz’ sign: bleeding when scraped
Biopsy: thickened epidermis with preserved nuclei (parakeratosis) in stratum corneum (outermost epidermis) and neutrophilic inflammation; elongated rete ridges

Topical steroids
Keratolytic agents: tar, UV light
Vitamin D3
Methotrexate if severe

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12
Q

Urticaria (hives) path, presentation, dx, tx

A

Type 1 hypersensitivity reaction of MAST cell histamine & prostaglandin release

Rapid onset hives…

Clinical

Antihistamines
IM epinephrine
Airway management

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13
Q

Drug eruption path, presentation, dx, tx

A

Types 1-4 hypersensitivity…could be any!

Usually 7+ days post-drug…so unlikely if 1-2 days after starting new drug

Symmetric, pruritic rash

Eosinophilia

Remove drug
Topical steroids & antihistamines

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14
Q

Erythema multiform “minor” (EM) path, presentation*, dx, tx, risks

A

Often 2/2 HSV or mycoplasma

Red, target-shaped lesions
+/- MINOR constitutional symptoms
PALMS/SOLES

Clinical

Symptomatic tx only… no steroids needed

Risk ==> progression to SJS or TEN (share single disease spectrum)*

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15
Q

Stevens-Johnson Syndrome (SJS, EM “major”) / Toxic Epidermal Necrolysis (TEN) path, presentation, dx*, tx

A

Immune-complex mediated hypersensitivity ==> exfoliating skin, often 2/2 erythema multiform or drugs: phenytoin, carbamazepine, penicillin, sulfonamides (TMP-SMX), allopurinol, NSAIDs

SJS < 10% BSA
-same targetoid lesions as EM minor, but more prominent in mucosal and widespread lesions
-more prominent constitutional symptoms than EM minor
TEN > 30% BSA

Massive mucocutaneous rash
Often targetoid lesions
Genital involvement
+ NIKOLKSY SIGN: sloughing with light touch

Biopsy:

  • SJS = basal epidermis degeneration
  • TEN = eosinophilic full thickness epidermal degeneration

Tx: systemic corticosteroids, IVIG

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16
Q

Erythema nodosum path, presentation, dx, tx

A

Panniculitis of legs, usually 2/2 infection, drugs, chronic inflammatory diseases

Painful pretibial nodules

Clinical dx
False + VDRL (like SLE)

Remove underlying cause or workup for trigger disease

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17
Q

Bullous pemphigoid path, presentation, dx, tx

A

Anti-bullous pemphigoid antigen and/or IgG & C3 attacking hemidesmosomes at BM dermal-epidermal junction

> 60 y/o
Tense, independent vesicles / bullae
Usually NOT mucosal
NEGATIVE Nikolsky’s sign

Clinical
Immuno: IgG and C3 deposits at dermal-epidermal junction

Prednisone

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18
Q

Pemphigous vulgarism path, presentation, dx, tx

A

Anti-desmoglein antibody (IgG) destroys keratinocyte adhesion WITHIN epidermis, often 2/2 drugs: ACEi’s, penicillamine, penicillin, phenobarbital

40-60y/o
Confluent, scaly erosions
Usually mucosal involvement
\+Nikolksy sign
More severe course than BP

Clinical but biopsy can be used

High dose prednisone + IVIG etc.

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19
Q

HSV 1&2 path, presentation**, dx, tx

A

Dormant in nerve ganglia but infect epidermal cells causing fusion of epidermal giant cells

Herpes…painful lesion of lips & genitals
Herpetic whitlow: swollen herpetic lesion on hand 2/2 genital herpes or contact with saliva (dentists…)

Biopsy: multinucleated giant cell on Tzank smear (doesn’t r/o VZV)

Acyclovir (IV if severe)

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20
Q

Dermatitis herpetiformis path, presentation, dx, tx

A

Celiac-related

Celiac hx
Pruritic papules and vesicles occurring bilaterally along elbow, knees, butt, neck, scalp

Immunoflouresence: IgA deposition at dermal papillae

Dapsone* + gluten free

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21
Q

Varicella zoster path, contagiousness, presentation, dx, tx

A

VZV…aka chicken pox
Passed via droplet or direct contact
10-20 day incubation
Contagious 24 hours pre-manifestation until lesions crust

Constitutional symptom prodrome
Pruritic rash anywhere EXCEPT palm/soles

Clinical

Self-limited

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22
Q

Herpes zoster path, presentation*, dx, tx

A

VZV recurrence in a nerve (aka shingles)

Painful prodrome ==> dermatomal papules evolving into vesicles & bullae ==> crusting in 10 days
*Most common in immunocompromised and elderly

Clinical dx

-cyclovir & pain control

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23
Q

Molluscum contagiousum path, contagiousness, presentation, dx, tx

A

Poxvirus* in children or HIV/AIDS immunocompromised spread by direct contact

Waxy, flesh-colored papule with central umbilication usually on trunk, limbs, anogenital area

Clinical but also express fluid onto slide to find inclusion or molluscum bodies

Physical destruction with freezing or acid

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24
Q

Warts / verrucae path, presentation, dx, tx

A

HPV via direct contact
16 & 18 can cause squamous malignancy

Cauliflower-like or velvety white lesion

Clinical

Genital: cryotherapy
Cervical: pap smear ==> colposcopy

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25
Q

Impetigo path, presentation*, dx, tx

A

Group A staph or strep skin infection

Common: macule ==> pustule ==> pops into honey color crusting, usually on face
Rare: bullous type on extremities, usually 2/2 S. aureus and can cause scalded skin syndrome (SSS)

Clinical

Topical antibiotic with staph/strep activity, like mupirocin

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26
Q

Scarlet fever path, presentation*, dx, tx

A

Strep pyogenes

Preceded by throat infection ==> fever, vomiting, headache ==> upper body papules with sandpaper texture
Strawberry tongue

Penicillin

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27
Q

S. typhi presentation dx, tx

A

Triad:
Truncal papules > 10
Fever
GI involvement

Floroquinolone + 3rd gen cephalosporin

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28
Q

Cellulitis path, presentation, dx, tx

A

Staph or group A strep ==> infection of skin & subQ

Hot, swollen, tender skin

Clinical, but culture for MRSA

Oral abx UNLESS: systemic signs (high fever, chills etc.), diabetic, hand or orbital involvement, old/young ==> IV nafcillin, cefazolin, vanc

29
Q

Necrotizing fasciitis path, presentation*, dx, tx

A

Strep pyogenes, staph aureus, E. coli, clostridium perfringens ==> infection of fascial plane

Often 2/2 trauma or surgery
Severe pain
Putrid discharge
Bullae
Gas production
Rapid erythema

XR or CT: gas in lesion
Biopsy @ edge of lesion: diagnostic

Emergent surgery
Penicillin G, if Strep
Metronidazole or 3rd gen cephalosporin if anaerobic

30
Q

Fournier’s gangrene

A

Necrotizing fasciitis of balls!

31
Q

Acne vulgaris path, presentation, dx, tx**

A

Hormone activation of sebaceous gland ==> comedone plugs ==> inflammation 2/2 Propionibacterium acnes

Blackhead/whitehead ==> topical tretinoin or benzoyl
Inflammatory ==> topical benzoyl + tretinoin ==> topical erythromycin ==> systemic erythromycin or tetracycline
Severe ==> oral isotretinoin (must check triglycerides, cholesterol, LFTs, and beta-HCG monthly)

32
Q

Tinea versicolor path, presentation, dx, tx

A

Fungal skin infection 2/2 Malassezia furfur

Hypo or HYPERpigmented skin lesions, often post-humid climate
SCALE with scraping though don’t appear scaly

KOH prep: spaghetti & meatballs hyphae and spores

Tx: ketaconazole or selenium sulfide

33
Q

Candida path, presentation, dx, tx

A

Candida fungus ==> oral or skin infection

Recent abx, steroids, DM, or HIV
Mouth: white lesions that DON’T scrape
Skin: erythematous patches with satellite lesions

KOH prep showing hyphae and psuedospores

Oral: oral fluconazole & nystatin wash
Skin: topical fluconazole or nystatin

34
Q

Dermatophyte path, presentation, dx, tx*

A

Fungi? Microsporum and Trichophyton

*Tinea corporis: red, scaly, pruritic, central clearing, well-circumscribed often in children or immunocompromised

Tinea pedis: athletes foot

Tinea cruris: jock itch

Tinea capitis: similar to seborrheic dermatitis

KOH prep showing hyphae

Antifungal: terbinafine*, itraconazole, griseofulvin

35
Q

Lice path, presentation, dx*, tx

A

Parasite of hair, skin, or pubes (“crabs”)

Intense itching

Visible on CLOTHES, not people

Pyrethrin or permethrin (“RID”) + ETOH wash

36
Q

Scabies path, presentation, dx, tx

A

Arthropod burrows into skin and forms tunnels

Intense itching, especially at night and after hot showers
Vesicles with linear track (burrowing), especially hands between knuckles and genitals

Clinical / visible

Permethrin or ivermectin

37
Q

Gangrene path, presentation, dx, tx

A

Dry: vascular insufficiency ==> cold, blue
Wet: bacterial infection ==> bruised & pustulent
Gas: C. perfringens ==> pale / red 2/2 trauma

AMPUTATE
Abx are given but only to preserve healthy tissue
Hyperbaric O2: kills anaerobic Clostridium

38
Q

Acanthosis nigricans presentation, associations

A

Dark hyperkeratotic skin under arms, genitals

2/2 DM, PCOS, cushing, obesity, or PARANEOPLASTIC GI malignancy in older people

39
Q

Lichen planus path, presentation, dx, tx

A

Inflammatory dermatosis

Flat topped, violaceous, polygonal plaque often @ trauma site

Steroids

40
Q

Rosacea presentation*, dx, tx

A

Facial erythema and telangiectasias in middle aged folk, usually those who flush easily
Precipitated by hot/cold, emotion

Topical metronidazole ==> daily doxy

41
Q

Pityriasis rosea path, presentation, dx, tx

A

Unclear but perhaps 2/2 human herpes virus

Often young adults
Herald patch: initial oval plaque ==> progresses to truncal oval plaques with fine “cigarette paper” scaling, often in christmas tree pattern on back

Clinical: r/o Tinea corporis with KOH

Self-limited but antipruritics help

42
Q

Seborrheic keratosis path, presentation*, dx, tx

A

Unknown etiology

Stuck-on, crusty brown-blue lesions

Clinical

Cryotherapy, 5FU

43
Q

Actinic keratosis path, presentation*, dx, tx

A

Pre-malignant squamous cell carcinoma

Red with white, “sandpaper” scaly plaque on sun-exposed area

Biopsy to r/o SCC? ==> cryotherapy, topical imiquimod or 5-FU

44
Q

Squamous cell carcinoma path, risk factors, presentation, dx, tx

A

Squamous cord with keratin pearls in vermillion zone

Sun exposure = #1
ARSENIC exposure on hands
Chronic trauma (non-healing lesions should be suspected*)

Ulcerating, crusting plaque
Often on lip

Biopsy ==> excise

45
Q

Basal cell carcinoma path, commonality, risk factors, presentation, dx, tx

A

Spindle cells with palisaded basal cells

Most common skin cancer ==> locally destructive but no real metastatic potential

UV light

Waxy, rolling border with telangiectasias
RARELY if ever on lips

Excision

46
Q

Melanoma subtypes, dx, tx

A

Lentigo: arises on lentigo 2/2 sun-damage
Superficial spreading
Nodular: rapid vertical growth, reddish brown
Acral: on hands or feet in patch
Amelanotic

Excisional biopsy to get Breslow depth

If >1mm ==> sentinel node biopsy

47
Q

Kaposi’s sarcoma path, presentation, dx, rule out, tx

A

Associated with HSV8 ==> vascular proliferation

Many violaceous plaques

Biopsy & clinical

Rule out: Bartonella infection “bacillary angiomatosis”!

Excision

48
Q

Mycosis fungoides path, presentation, dx, tx

A

Cutaneous T-cell lymphoma

Early: psoriatic plaque, non-specific
Late: red-brown nodular tumors and lymphadenopathy

Sezáry cells: cerebriform lymphocytes
Any non-healing dermatitis needs biopsy to rule this out!

Phototherapy

49
Q

Staph scalded skin syndrome path, presentation, tx

A

Staph aureus toxin against desmoglein 1

Fever prodrome
Diffuse erythema, starting on face ==> flaccid bullae and perioral crusting
+Nikolsky

Oxacillin or vancomycin

50
Q

Scary neonatal diseases passed from mom presentation, tx

A

VZV or herpes

Fever
VESICULAR rash ==> disseminated multi organ failure

Acyclovir!

51
Q

Sunscreen recommendation

A

30+ applied 15-30 minutes before going outdoors

Reapply q2 hours

52
Q

Henoch schonlein purpura (HSP) path, presentation, dx, tx

A

IgA vasculitis

Tetrad: symmetric LE palpable purpura, abdominal pain (colicky), renal disease (glomerulonephritis), arthralgia
NO THROMBOCYTOPENIA
Often 2/2 recent infection, especially children

Dx: clinically if LE purpura + one of above…or biopsy

NSAIDs & supportive care

53
Q

Cherry hemangioma path, presentation*

A

Benign vascular tumor

Sharply circumscribed cherry-looking thing in adults

54
Q

Rubella other name, path, presentation*, dx, tx

A

German measles

RNA togavirus 2/2 droplets

Mild fever
Pink maculopapular rash initially on face spreading downward & outward
Nonexudative conjunctivitis
Lasts <3 days
Pregnant women:  causes miscarriage

Clinical

Supportive care

55
Q

Measles presentation*

A

Severe fever

Slowly spreading dark red-brown rash

56
Q

Mumps presentation*

A

Low-grade fever
Parotitis
No rash

57
Q

Infantile hemangioma presentation*

A

Big strawberry looking hemangiomas on a baby’s ass

58
Q

Cavernous hemangioma presentation*

A

Soft blue mass

59
Q

Cystic hygroma presentation*

A

Dilated lymph space on neck that transilluminates

60
Q

Icthyosis vulgaris presentation*

A

Normal skin at birth progressing to dry, scaly, horny skin over extensor limbs

61
Q

Chalazion presentation, dx, tx

A

Painful swelling progressing to painless rubbery non-red lesion

MUST biopsy…risk of sebaceous gland carcinoma or BCC

Remove

62
Q

Warfarin-induced skin necrosis presentation, tx

A

Pain without lesion ==> bullae and necrosis on breasts, butt, thighs, abdomen
Roughly a week post-warfarin

Vitamin K administration
Heparin instead of warfarin

63
Q

Angioedema path, presentation, dx, tx

A

Hereditary or acquired (ACE inhibitor) C1 inhibitor deficiency ==> C2b and bradykinin elevation

Facial, laryngeal, extremity, genital swelling
Colicky abdominal pain 2/2 GI swelling
*No anaphylactic trigger…thus no tachycardia etc.

INTUBATE

64
Q

Graft Versus Host Disease (GVHD) path, presentation

A

Donor T cells target host skin, GI, liver

Face, PALM, SOLE rash
GI sx: +blood
Liver: LFTs elevation & jaundice

65
Q

Porphyria cutanea tarda path, presentation*, dx, tx

A

Deficiency of uroporphyrinogen decarboxylase

Painless blisters and skin fragility on dorsal hands
Hyperpigmentation of face
Associated with Hep C (?)

Elevated urinary porphyrin

Phlebotomy
Hydroxychloroquine

66
Q

Vitiligo path, presentation

A

Autoimmune melanocyte destruction
Associated with: pernicious anemia, DM1, alopecia, autoimmune thyroid etc.

Depigmentation beginning peri-orally and acridly

67
Q

Erysipelas path, presentation*, tx

A

Strep

Patch ==> raised, tense, indurated plaque
Usually on cheek
2/2 trauma or pharyngitis

Penicillin

68
Q

Senile purpura path, presentation

A

Loss of vascular connective tissue elasticity in elderly

Echymoses
Normal heme labs

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