Derm

Question 1

Macule

Answer 1

Flat, colored lesion, not raised above the skin, less than 2 cm diameter

Question 2

Patch

Answer 2

Large flat lesion with color different than the skin

Greater than 2 cm diameter

Question 3

Nodule

Answer 3

firm lesion raised above the surface
Rounded with diameter and thickness roughly equal
Greater than 0.5 cm

Question 4

Papule

Answer 4

Small elevated solid lesion

Less than 0.5cm

Question 5

Plaque

Answer 5

Circumscribed, flat-topped lesion (plateau-like)
Greater than 1 cm
(Big papule)

Question 6

Tumor

Answer 6

solid raised growth

Greater than 5 cm

Question 7

Wheal

Answer 7

Rounded or flat-topped
Pale red papule or plaque that is characteristically evanescent
(disappearing within 24-48h)

Question 8

Vesicle-Bulla

Answer 8

Vesicle: less than 0.5 cm
Bulla: greater than 0.5 cm
Circumscribed, elevated, superficial cavity containing fluid

Question 9

Pustule

Answer 9

Circumscribed superficial cavity of skin containing purulent exudate

Question 10

Crusts

Answer 10

Develop when serum, blood or purulent exudate dries on the skin surface

Question 11

Scale

Answer 11

Flakes of stratum corneum

Question 12

Erosion

Answer 12

Defect of only the epidermis, not involving the dermis

Question 13

Ulcer

Answer 13

Skin defect that extends into the dermis or deeper

Question 14

Cyst

Answer 14

Soft, raised, encapsulated lesion filled with semisolid or liquid contents

Question 15

Purpura

Answer 15

Red-purple nonblanchable discoloration

Greater than 0.5cm in diameter

Question 16

Petechiae

Answer 16

Red-purple nonblanchable discoloration

Less than 0.5cm in diameter

Question 17

Telangiectasia

Answer 17

Dialated, superficial blood vessel presenting as fine, irregular, red lines

Question 18

Fissure

Answer 18

Linear crack or break from the epidermis to the dermis

Question 19

Lichenification

Answer 19

Distinctive thickening of the skin that is characterized by accentuated skin-fold markings

Question 20

Milla

Answer 20

Small, firm, white papules filled with keratin

Question 21

Seborrheic keratoses

Answer 21

Basal-like cells, hyperkeratosis, keratin-filled cysts
Most common benign skin tumor
Velvety warty lesion with “greasy/stuck on appearance”

Question 22

Tinea corporis

Answer 22

dermatophyte (fungal) infection

Corporis: ring shaped lesions, advancing scaly border with central clearing and scaly patches (on exposed skin or trunk

Question 23

Tinea capitis

Answer 23

dermatophyte (fungal) infection
Non-inflammatory: alopecia, hair breakage at level of scalp
Inflammatory: follicular pustules to furunculoisis or kerion, possible posterior lymphandenopathy

Question 24

Tinea barbae

Answer 24

Affects face unilaterally
Superficial: perifollicular papules and pustules with erythema
Inflammatory: most common, boggy-crusted plaques and seropurulent discharge,

Question 25

Actinic keratosis

Answer 25

or Solar keratosis Discrete, dry, rough, adherent scaly lesions Occur on habitually sun-exposed skin Can progress to SCCIS

Question 26

Tinea cruris

Answer 26

``` dermatophytosis of the groin region well marginated annular plaques with a scaly raised border which extends from the inguinal fold Pruritus and pain common Can have central clearing Dx: KOH prep (buds and hyphae) Tx: oral or topical antifungals ```

Question 27

Sebaceous cysts

Answer 27

Blocked glands or swollen hair follicles Lump is usuallly not painful Dx: clinical Tx: Steroid, I&D, excision

Question 28

Tinea versicolor

Answer 28

Overgrowth of yeast (malassezia furfur) AKA: pityriasis versicolor Effects trunk, neck, arms. May be hypo or hyperpigmented

Question 29

Dermatofibroma

Answer 29

Benign, very common, button-like dermal nodule, usually occurring on the extremities Dimple sign

Question 30

Psoriasis

Answer 30

Chronic multisystem inflammatory immune disorder Raise, dark red plaque/papules with silver scales - Nail pitting, oil drop under nail - Auspitz sign (punctate bleeding with removal of plaque) - Koebner phenomenon: skin lesions at lines of trauma - Psoriatic arthritis: 30% of patients (hands, wrist, especially DIP) - Sausage digit - pencil and cup deformity on x-ray

Question 31

Treatment of psoriasis

Answer 31

Mild to moderate: Vitamin D analogs (calcipotriene), topical retinoids Potent topical Corticosteroids UVB phototherapy

Question 32

Candidiasis

Answer 32

Most common in: esophagus, vagina, mouth, cutaneous, GI tract Dx: KOH Tx: fluconazole

Question 33

MRSA in SSTI (skin and soft tissue infection) | Treatment?

Answer 33

I&D ABX: clindamycin, trimethoprim-sulfamethoxazole tetracyclines and linezolid

Question 34

Difference between erysipelas and cellulitis

Answer 34

Erysipelas involves upper dermis and superficial lymphatics | Cellulitis involves deeper dermis and subcutaneous fat

Question 35

Microbe causing erysipelas

Answer 35

Vast majority caused by beta-hemolytic streptococci

Question 36

Microbe causing cellulitis

Answer 36

Most common are beta-hemolytic streptococci

Question 37

Erythrasma

Answer 37

Superficial infection of the skin caused by Corynebacterium minutissimum Gram positive, bacillus Often found between toes typically macerated, scaly plaques Or erythematous to brown patches or thin plaque in intertriginous areas Dx: coral-red fluorescence with Wood's lamp

Question 38

Signs and symptoms of cellulitis

Answer 38

Local: macular erythema (margins flat, NOT sharply demarcated) -Swelling - Warmth - Tenderness Systemic: fevers, chill +/- tender lymphadenopathy +/- lymphangitis myalgias, vesicles, bullae, hemorrhge, necrosis

Question 39

Treatment of cellulitis

Answer 39

Abx 7-10 days: cephalexin, dicolzacillin..., if MRSA: vanco if dog or cat bite: augmentin if puncture: cover for pseudomonas: cipro

Question 40

Basal cell carcinoma description

Answer 40

5 clinical types: nodular, ulcerating, pigmented, sclerosing and superfical Typical: Papule with pearly telangiectatic border on sun damaged skin

Question 41

Lichen planus

Answer 41

4 P's: purple, polygonal, papules, pruritis | Gray lines: wickham's striae

Question 42

Squamous cell carcinoma

Answer 42

Indurated and possibly hyperkeratotic lesions | Often showing ulceration and or crusting

Question 43

Rosacea

Answer 43

s/sx: erythema, telangiectases, papules, pustules Blush area of cheeks, nose, forehead and chin Tx: topical metronidazole, sunscreen

Question 44

Hidradentitis Suppurativa

Answer 44

Chronic abscess of apocrine sweat glands or sebaceous cysts with tract formation S/sx: red inflammatory nodules/abcessess most commonly found in axilla, under breasts, groin or buttucks Tx: I&D, systemic abx, surgical if recurrrent

Question 45

Dyshidrotic eczema

Answer 45

AKA: pompholyx (which means bubble) Vesicular hand dermatitis Triggered by sweating, emotional stress, warm weather, metals S/sx: deep vesicles on palms, soles, sides of fingers and toes. "TAPIOCA PUDDING" Tx: topical steroids, cold compresses

Question 46

Furuncles | Carbuncles

Answer 46

Localized skin infection usually by S. aureaus Furuncle: boil Carbuncle: coalescing furuncles Tx: less than 2.5cm treat with moist heat Larger require drainage

Question 47

Benzoyl peroixide

Answer 47

1st line tx of mild-moderate acne vulgaris w/o inflammation

Question 48

retinoids

Answer 48

Vitamin A derivatives Tretinoin: used for acne vulgaris and solar lentigines Adapalene: 1st line for comedones and inflam acne AE: irritation, dryness, peeling skin, photosensitivity

Question 49

Topical antibiotics

Answer 49

Clindamycin: Indic: BV, severe acne AE: dryness/itching/burning, HA, back pain, constipation, oily skin Erythromycin: Indic: Acne vulgaris use with BPO AE: erythema, dryness/oiliness/itching/peeling/burining Tetracycline: Indic: BV, rosacea CI: use with ETOH AE: vaginal discharge, HA, vaginal candidiasis, GI upset, skin irritation, metallic taste, only if have adult teeth Remember to use together with topical retinoids

Question 50

Keratolytics

Answer 50

salicylic acid: indic: Seb derm, psoriasis, dandruff, remove warts, mild acne AE: burning, peeling, scaling, dryness Pt ed: mood changes, nausea, hearing issues, dizziness

Question 51

Permethrin

Answer 51

Indication: scabies, live lice CI: don't use in kids younger than 2 months

Question 52

Crotamiton

Answer 52

Indications: 2nd line treatment for scabies

Question 53

Lindane

Answer 53

Indications: 2nd line treatment for scabies, use after all else has failed CI: xeizure disorders AE: neurologic toxicity

Question 54

Ivermectin

Answer 54

Anthelminthic | Indication: resistant lice and crusted Norwegian scabies