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Clinical physical diagnosis > Derm I > Flashcards

Derm I Flashcards

1
Q

How much does skin weigh, and area

A

4 lbs, 2 m squared

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2
Q

what are the main 3 layers of skin

A

epidermis, dermis and subcutaneous layer

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3
Q

what is in the dermis layer

A

appengages, blood vessels and nerve endings

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4
Q

what is in the subcutaneous layer

A

appendages and fat

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5
Q

what is the key to a good derm diagnosis?

A

good history and physical exam., negative is as importain as positive

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6
Q

what are the possible causes for a derm reaction

A

infection, infestation, sun, autimmune, allergy, cancer, environmental, hormonal etc.

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7
Q

how many historys question to ask?

A

ten10

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8
Q

What are the 10 history questions?

A

Where, when, location, sensation, changed appearance, worse/better, anyone else, recent travel, exposures, treated?

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9
Q

what are the additional history questions?

A

history of allergic reaction, exposures to chemicals, sun, general health travel history and medications

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10
Q

what are the general health questions to ask?

A

systemic diseases, diabetes, IBD, candida etc

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11
Q

ROS

A

concomitant symptoms and organ involvement

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12
Q

family history

A

make sure that you ask if family has atopy, autoimmune, malignancy

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13
Q

why ask about sexual history

A

syphilis, gonorrhea, warts herpes etc.

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14
Q

what lamp is helpful to see skin problems

A

woods lamp, although adequate light in general is importaint.

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15
Q

what are the categories for describing the lesion?

A

lesion type, configuration, texture, location/distribution, color, other

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16
Q

macule

A

flat, non palpable color change

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17
Q

papule

A

elevated, palpable, smaller <10mm

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18
Q

plaque

A

elevated, plateau like, larger, > 10mm

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19
Q

Nodule

A

firm papule, elevated, extends deeper into dermis or sub Q

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20
Q

what is a large nodule >10mm

A

a tumor

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21
Q

Vesicle

A

fluid filled blister, smaller <10mm

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22
Q

bullae

A

fluid filled blister, larger >10mm

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23
Q

Pustule

A

elevated lesion with pus

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24
Q

Urticaria

A

elevated lesion, transient, localized edema

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25
Q

Scale

A

accumulation of epithelium, dry, whitish

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26
Q

Crust

A

dried pus, blood or serous exudate. Ususally due to broken pustules or vesicles

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27
Q

Erosion

A

loss of top layer(epidermis)

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28
Q

Excoriation

A

linear erosion, cause by scratching

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29
Q

Ulcer

A

deep erosion, involves dermis, bleeding and scarring possible

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30
Q

Petechiae

A

small non blanchable foci of hemorace - tiny buruise

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31
Q

Purpura

A

larger area of hemorage, possibly palpable, large areas oare burises

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32
Q

Atrophy

A

paper thin wrinkled and dry skin, old lady hands

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33
Q

Telangiectasis

A

dialated superficial blood vesselse (spider veins)

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34
Q

What 6 words can describe lesion configuration?

A

Linear, annular, nummular, Target, serpiginous, Reticulated

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35
Q

Linear

A

in a line

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36
Q

Annular

A

ring with central clearing

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37
Q

nummular

A

circular, without central clearing

38
Q

Targetoid

A

ring with central duckiness

39
Q

Serpiginous

A

fungal and parasidic, looks like worm wiggled a path under skin

40
Q

Rediculated

A

lacy pattern

41
Q

What are the 4 words for tecture?

A

verrucous, lichenification, induration, umbilicated

42
Q

verrucous means what?

A

irrecular surface, like cauli flower, or warts

43
Q

Lichenification means what

A

epidermal thinkening, skin lines are accentuated from chronic irritation

44
Q

Induration

A

dermal thickening, skin is hard and rough

45
Q

difference between lichenification and induration,

A

induration is dermal thickening, while lichenification is epidermal thickening

46
Q

Unbilicated

A

raised bump with central indentation, like cherrio is under skin.

47
Q

What are the importain location issues?

A

single/multipule, what body parts, random or not, symmetric or not, sun exposure or not, does it cross mid line.

48
Q

What what is the word for red

A

erythema -

49
Q

what causes erythema

A

increased blood flow to skin

50
Q

What causes orange

A

hypercarotenemia

51
Q

what causes yellow

A

jaundice, heavy metal poisoning, myxedem or uremia

52
Q

what causes green in fingernails

A

pseudomonas

53
Q

what may cause violet

A

darkening cutaenous hemmorage(bruise) or vasculitis

54
Q

Grey blue skin

A

cyanosis, metal deposits

55
Q

Black

A

melanocytic lesions, infections, arterial insufficiency

56
Q

what would turn skin white

A

tinea, pityriasis alba, vitilago

57
Q

what is Dermatographism

A

urticaria after stroking skin, swelling

58
Q

Diascopy

A

pressure to indicate blanching

59
Q

What type of lesions do blanch

A

inflammatory ones

60
Q

What type of lesions don’t blanch

A

hemorrhagic lesions

61
Q

Dariers sign

A

if you stroke lesion it suddenly cause erythema and wheal/urticaria

62
Q

Nikolsky sign

A

bullae formation that spreads with tracton

63
Q

Auzpitz sign

A

pinpoint bleeding after plaques removed

64
Q

Koebners phenomenon

A

development of lesions withing areas of trauma

65
Q

What is puritis

A

itching

66
Q

what stimulates itching

A

chemical and physical syimulation of cutaneous nerve ending, external or internal.

67
Q

what mediates iching

A

histamine, kallekrein and some peptidases

68
Q

for itching what must be included in history

A

drug and occupational exposures

69
Q

What type of testing for puritis

A

biopsy, CBC, liver, kidney, thyroid function, unerlying malignancy evaltuation, immunoglobulins.

70
Q

what is the most common cause of puritis

A

dry skin

71
Q

what may help determine cause of puritis

A

if there is or there is not a skin eruption

72
Q

Urticaria

A

Migratory erythemous puritic plaques, Hives

73
Q

what determines if urticaria is chronic?

A

greater than >6 weeks

74
Q

what basically causes urticaria

A

release of histamine

75
Q

Etiology of urticaria can be what 5 things

A

infection, IgE allergy, medications, autoimmune, malignancy

76
Q

Is autoimmune urticaria common

A

nope

77
Q

What are the importaint history questions for urticaria

A

duration, triggers, frequency, concomitant, respiratory system, drugs, travel and FH

78
Q

What is included in urticaria PE

A

check for infection, or systemic disease

79
Q

Testing for urticaria

A

CBC, allergy testing, thyroid studies, and biopsy if unsure

80
Q

what is acne vulgaris

A

obstruction of pilosebaceous unit.

81
Q

what can acne vulgaris present with

A

open or closed comedones, papules, pustules, inflamed nodules, pus filled cysts and deep purulent sacs

82
Q

what are some main causes of acne vulgaris

A

androgen stimulations, sebum, bacteria interaction, drug, diet

83
Q

major diet triggers for acne vulgaris

A

sugar, milk, bromine.

84
Q

who is morelikly to have acne vulgaris

A

men and people under 35

85
Q

common distribution for acne vulgaris

A

face, back chest and upper arms

86
Q

S/Sx for acne vulgaris 5

A

comedones, papules, pustules, nodules and cystes

87
Q

what are the three grades of acne vulgaris severity

A

mild, moderate and severe

88
Q

describe mild acne vulgaris

A

< 30 lesions

89
Q

moderate acne vulgaris

A

30-125 lesions

90
Q

severe acne vulgaris

A

> 5 cysts or > 125 lesions

91
Q

what labs for acne vulgaris

A

Serum testosterone, FSH, LH, DHEA-s, and bacterial/fungal cultures

92
Q

Roseacea

A

chronic inflammatory disorder characterized by facial flushing, telangiectasias, erythema, papules, pustules and possibley rhinophyma

Clinical physical diagnosis (7 decks)

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