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Fall 2014 - CM Dermatology > Derm Intro > Flashcards

Derm Intro Flashcards

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Dermatology Board Prep flashcards
1
Q

Dermatology visits account for _____% of all outpatient visits annually.

A

> 10%

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2
Q

List 6 functions of the skin.

A

PASSER

  • protection
  • absorption
  • secretion
  • sensation
  • excretion
  • regulation
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3
Q

What are the 3 major layers of the skin? (Think very basic.)

A
  1. epidermis
  2. dermis
  3. subcutaneous fat
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4
Q

Characteristics of the Epidermis

A
  • sloughs off
  • waterproofing
  • contains melanocytes –> discoloration, sunburns
  • replaced every 30 days
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5
Q

Characteristics of the Dermis

A
  • basement membrane
  • hair follicles, sweat glands, vasculature
  • provides skin strength and elasticity: prevents splitting of skin and foreign invasion
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6
Q

Characteristics of Subcutaneous Fat

A
  • insulation –> heat
  • cushioning
  • smooths and contours the skin: deep injury and scarring can mean the skin will not repair as smoothly
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7
Q

Describe primary flat lesions.

Name the different types.

How do you differentiate between them?

A
  • circumscribed flat area of discoloration without elevation and depression (non-palpable)
  • macule: < 1 cm, eg freckle
  • patch: > 1 cm, eg birthmark
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8
Q

Name and describe the one type of primary raised lesions.

A
  • plaque
  • well-circumscribed
  • elevated
  • superficial
  • solid
  • > 1 cm diameter
  • may be formed from confluent papules
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9
Q

Describe primary raised solid lesions.

Name the different types.

How do you differentiate them?

A
  • circumscribed, elevated/palpable, solid lesion
  • papule: < 1 cm
  • nodule: > 1 cm; usually found in dermal or SQ tissue; may be above, level with or beneath skin surface
  • tumor: > 2 cm; aka “mass”; can be above, level with or beneath skin surface
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10
Q

Describe primary raised filled lesions.

Name the different types.

How do you differentiate them?

A
  • small, superficial, circumscribed elevation of the skin
  • vesicle: < 0.5 cm w/ serous fluid
  • pustule: < 1 cm w/ purulent material (WBCs or pus); can be sterile or infected; eg zit
  • bulla: > 0.5 cm w/ serous fluid; eg blister
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11
Q

Primary Raised Lesion: Wheal

A
  • transient (comes and goes)
  • circumscribed, elevated papules or plaques
  • often with erythematous borders and pale centers
  • eg hives, TB test
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12
Q

Purpura

A
  • non-blanching (red color doesn’t fade to white w/ pressure)
  • violaceous (red-purple) discoloration of skin
  • may be palpable or non-palpable
  • is due to blood that extravasates outside vessel walls
  • non-palpable types: petechiae (5 mm)
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13
Q
  1. Primary Lesion

2. Secondary Lesion

A
  1. develop from disease process/condition; first basic skin change that is unchanged by outside forces
  2. modifications of primary lesions due to natural course of disease, itching, infection, other factors
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14
Q

Scale

A
  • visible shedding of stratum corneum (epidermal layer)

- eg skin peeling w/ sunburn

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15
Q

Crust

A

-dried exudate (could have been serous, purulent or hemorrhagic –> any sort of fluid that has dried on the skin)

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16
Q

Erosion

A
  • loss of superficial layers of upper epidermis
  • due to wearing away from friction or pressure
  • red
  • oozes/weepy
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17
Q

Ulcer

A
  • localized defect of irregular size and shape
  • loss of epidermis and some dermis
  • scars
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18
Q

Fissure

A
  • sharply-defined, linear or wedge shaped tears in epidermis
  • abrupt walls
  • skin very dry –> encourage patients to keep skin away from water and use emollients
  • can have bleeding if deep enough into dermis
  • eg cracked heels
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19
Q

Excoriations

A
  • skin abrasions
  • usually superficial due to scratching of skin
  • ice packs on itchy skin helpful
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20
Q

Lichenification

A
  • thickening of epidermis
  • results in accentuation of skin lines
  • due to excessive excoriations
21
Q

Scar

A
  • final stage of healing which involved deeper dermis
  • hypertrophic: any scar that goes beyond expected borders
  • keloidal: very excessive, overgrown scar; some people are more prone to keloids –> removal can make it worse
22
Q

Atrophy

A
  • thinning or depression of skin due to reduction of underlying tissue
  • can happen w/ weight gain (eg pregnancy or body builders)
  • eg stretch marks
23
Q

Sclerosis

A
  • hardening/induration of the skin

- caused by increase in collagen, other CT components (mucin), edema, or cellular infiltration

24
Q

Necrosis

A
  • death of skin tissue
  • usually black in color
  • MUST be removed from body
25
Q

Comedone

A
  • darkened plug of sebum and keratin
  • occludes pilosebaceous follicles
  • can be open (black head) or closed (white head)
26
Q

Cyst

A
  • encapsulated, raised lesion
  • filled with solid or liquid material
  • often fluctuant: if you push, the fluid can displace and “give in”
  • skin cyst different than cyst on an organ
27
Q

Burrow

A
  • linear or serpiginous (snake-like) tunnels within the epidermis
  • eg mites, scabies
28
Q

Telangiectasia

A
  • dilated, superficial blood vessels
  • small but visible
  • often happens with excess sun exposure
  • eg spider veins
29
Q

Xerosis

A

dry skin

30
Q

Pigmentation

A
  • change in intensity of the brown colors (melanin) normally inherent in skin
  • hyper or hypopigmentation
31
Q

Poikiloderma

A
  • combo of cutaneous pigmentation, atrophy and telangiectasia
  • produces a mottled appearance of skin
  • common with DM
32
Q

Define distribution.

Give some examples of the distribution of derm conditions.

A
  • location on the body, eg head, torso, etc
  • random, symmetric, flexures vs extensors, exposed vs intertriginous (skin on skin) sites, sites of pressure, photo-distributed vs non-sun exposed, acral (palms and soles)
33
Q

Configuration Arrangement Types:

  1. Discrete
  2. Confluent
A
  1. each lesion easily separated from the others

2. edges of the lesions blend into one another

34
Q

Configuration Arrangement Types:

  1. Isolated
  2. Scattered
  3. Grouped
A
  1. just one lesion in an area
  2. lesions are discrete, multiple and distributed in no discernible pattern
  3. lesions appear close together with normal skin between groups
35
Q

Configuration Arrangement Types:

  1. Linear
  2. Dermatomal
A
  1. in a line

2. distributed in one spinal nerve or spinal nerve equivalent branch; eg herpes zoster (shingles)

36
Q

Configuration Shape Types:

  1. Annular
  2. Polycyclic
A
  1. ring-like, circular

2. shape made up of tangential rings

37
Q

Configuration Shape Types:

  1. Arcuate
  2. Serpiginous
A
  1. arc or crescent shaped

2. shaped like a snake

38
Q

Configuration Shape Types:

  1. Iris/target
  2. Reticulate
  3. Glaborous
A
  1. shaped like a bulls-eye (eg Lyme disease)
  2. net-like, lacy pattern
  3. shiny and smooth surface; bald
39
Q

Why would finding a dermatological condition on an acral surface be important?

A
  • acral is palms of hands or soles of feet

- very few derm. things happen here so it narrows down differential diagnosis quickly

40
Q

Why would family history be important for a dermatology patient?

A

-important for determining autoimmune nature of some derm conditions

41
Q

What characteristics might be used to describe a lesion?

A
  • location/distribution on the body
  • number: single? 4? several?
  • size/shape
  • color
  • texture
  • configuration: pattern and arrangement
  • surrounding skin (eg erythema)
  • borders
42
Q

What is important to take into account when making a derm. diagnosis?

A
  • age
  • lesion distribution, characteristics
  • under and overdiagnosis
  • race
  • need for referral
  • confirmatory procedures
  • “common things are common”: top 50-100 diagnoses
43
Q

Elliptical Excision

A
  • anesthetize
  • excise in elliptical shape with length 3x the width
  • undermine edges (separate dermis and epidermis) to suture without puckering
44
Q

Shave Biopsy/Excision

A
  • anesthetize and make a wheal around lesion

- excise in scooping manner to get underlying dermis/SQ

45
Q

Punch Biopsy

A
  • anesthetize
  • place punch 90 degrees to skin and rotate with downward pressure until reaching SQ
  • lift gently and cut bottom
46
Q

What is a KOH procedure used for?

A
  • scrape the scaly lesion and add KOH to slide

- helps determine if it is a fungal infection –> spores, hyphae, budding

47
Q

What is a Tzanck smear used for?

A
  • “unroof” an intact vesicle at the base and collect fluid on swab
  • used to confirm herpes or varicella infection
48
Q

Dermoscopy

A

-can help determine benign vs malignant by magnifying algorithmic patterns

49
Q

Wood’s Light

A
  • shine light on skin to see some organisms that will glow under black light
  • coral/pink: erythrasma
  • pale blue: Pseudomonas
  • yellow/green: Microsporum
  • green/gold: tinea versicolor
  • white: vitiligo

Fall 2014 - CM Dermatology (11 decks)

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