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MSK Block > Derm Week > Flashcards

Derm Week Flashcards

1
Q

What are the four layers of the epidermis?

A

stratum corneum, stratum granulosum, statum spinosum, stratum basale

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2
Q

How long does it take for a basal cell to reach the stratum corneum and how long does it stay there?

A

two weeks each (four weeks total)

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3
Q

What is the function of the stratum basale?

A

epidermal stem cells

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4
Q

What is the function of the stratum spinosum?

A

bulk of epidermis, contains desmosomes

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5
Q

What is the function of the stratum granulosum?

A

lipid granules for water-tight barrier

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6
Q

What is the function of the stratum corneum?

A

barrier of anucleated cells

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7
Q

What 2 important proteins are found in corneal cells?

A

keratin and filaggrin

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8
Q

What are the three types of epidermal cells and their function?

A

keratinocytes - main epidermal/barrier cells
melanocytes - secrete melanin to keratinocytes
Langerhans - APC

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9
Q

What is found in the dermis?

A 
blood/lymphatic vessels
hair follicles
sebaceous & eccrine glands
fibroblasts
mast cells
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10
Q

What is a small, flat lesion?

A

macule

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11
Q

What is a large, flat lesion?

A

patch

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12
Q

What is a large, raised lesion?

A

plaque

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13
Q

What is a small, raised lesion without fluid?

A

papule

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14
Q

What is a small, raised lesion with fluid?

A

vesicle

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15
Q

What is a large, deep papule?

A

nodule

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16
Q

What is a vesicle filled with pus?

A

pustule

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17
Q

What is the highest potency topical steroid?

A

clobetasol

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18
Q

What is the high potency topical steroid?

A

fluicinonide

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19
Q

What is the medium potency topical steroid?

A

triamcinolone

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20
Q

What are the two low potency topical steroids?

A

desonide, hydrocortisone

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21
Q

What are the 6 side effects of topical steroids?

A 
skin atrophy
telangiectasias
striae
acne
steroid rosacea
hypopigmentation
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22
Q

What are the 6 types of psoriasis?

A 
plaque
inverse/flexural
guttate
erythodermic
pustular
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23
Q

What is characteristic of guttate psoriasis?

A

raindrop-sized lesions after strep infection

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24
Q

What is characteristic of inverse psoriasis?

A

erythematous plaques in the flexural folds, without scaling

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25
Q

What is characteristic of pustular psoriasis?

A

clustered pustules, often after corticosteroid withdrawal

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26
Q

What is characteristic of psoriatic erythoderma?

A

erythematous skin, often the entire body

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27
Q

What are the extra-dermal manifestations of psoriasis?

A

nail pitting, arthritis

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28
Q

What should never be used to treat psoriasis?

A

oral steroids

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29
Q

What are the three systemic treatments for psoriasis?

A

phototherapy
methotrexate
biologics

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30
Q

What is the first step in management for red scaly rashes?

A

KOH exam

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31
Q

What are the hallmarks of pityriasis rosea?

A

herald patch, then Christmas tree rash, due to HHV6

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32
Q

What is the hallmark of secondary syphilis?

A

rash with palm and sole involvement

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33
Q

What are the hallmarks of nummular dermatitis?

A

multiple coin-shaped plaques, pruritic, weeping, crusting

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34
Q

What are the hallmarks of asteatotic dermatitis?

A

papular rash on arms, legs, or flank

looks like cellulitits

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35
Q

What are the hallmarks of pediculosis?

A

adult lice or nits attached to hair
visible to naked eye
treatment by removing nits or 1% permethrin lotion

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36
Q

What are the hallmarks of Sarcoptes (scabies)?

A

papules with burrows, often in the webs of fingers

treat with 5% permethrin cream or oral ivermectin

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37
Q

What are the hallmarks of seborrheic keratosis?

A

multiple pigmented, stuck-on growths, can’t be on palms/soles

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38
Q

What predisposes to acrochordons?

A

genetics, obesity, friction, marker for insulin resistance

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39
Q

What are small red moles?

A

cherry angiomas

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40
Q

What causes dermatofibroma formation?

A

minor trauma enduces spindle cell proliferation

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41
Q

What is important about solar lentigo?

A

sun exposure means higher risk for melanoma

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42
Q

What are the hallmarks of sebaceous hyperplasia?

A

multiple yellor or skin-colored papules

looks similar to basal cell carcinoma

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43
Q

What is a keloid?

A

overgrowth of scar tissue

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44
Q

What is treatment for a keloid?

A

steroid injection into the lesion

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45
Q

What is an epidermal inclusion cyst?

A

collections of debris (cells and oil) that smells bad

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46
Q

What are pilar cysts?

A

subcutaneous nodules, always on scalp

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47
Q

What are lipomas?

A

collections of fat under the skin, usually solitary, sometines tender

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48
Q

What is verruca vulgaris?

A

hyperkeratotic fungating papules and nodules, caused by HPV infecting basal cells

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49
Q

what is verrucae planae?

A

flat warts, often on dorsal hands, arms, or face

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50
Q

What are treatment options for warts?

A

cryotherapy, salicylic acid, waiting

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51
Q

What are the hallmarks of molluscum contagiosum?

A

dome-shaped, umbilicated papules, spread through direct contact

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52
Q

What is urticaria?

A

hives, caused by vascular reaction in the skin

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53
Q

What kind of hypersensitivity is urticaria?

A

Type 1

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54
Q

What is the most common cause of acute urticaria?

A

idiopathic

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55
Q

At what level of the skin does urticaria occur?

A

dermis

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56
Q

What is dermatographism?

A

urticaria from physical pressure

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57
Q

How does immunologic urticaria occur?

A

antigen binds IgE on mast cells

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58
Q

How does non-immunologic urticaria occur?

A

direct mast cell degranulation due to pressure or drugs

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59
Q

What is the treatment for urticaria?

A

high dose anti-histamines (4x dose on bottle of multiple drugs)

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60
Q

What is angioedema?

A

swelling in the subcutis, similar to urticaria but deeper

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61
Q

At what point should urticaria be biopsied?

A

6 weeks (can indicate systemic disease)

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62
Q

What is the most severe form of type 1 hypersensitivity?

A

anaphylaxis

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63
Q

What does atopic dermatitis affect?

A

usually cheeks, then extensor, then flexural, never nose

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64
Q

When does atopic dermatitis develop?

A

before age 5

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65
Q

How does atopic dermatitis start?

A

erythematous papules, can be weeping, crusting, or scaling

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66
Q

What is the atopic triad?

A

asthma, atopic dermatitis, allergic rhinitis

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67
Q

What is lichenification?

A

thickening of the skin that accentuates skin lines

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68
Q

What does eczema mean?

A

red and scaly

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69
Q

What causes atopic dermatitis?

A

multifactorial, including filaggrin mutation, impaired immune response, skin barrier dysfunction

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70
Q

What is the treatment for atopic dermatitis?

A

topical steroids and moisturization/skin care, especially vasoline

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71
Q

What is the second line therapy for atopic dermatitis?

A

topical calcineurin inhibitor

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72
Q

Is cream or ointment stronger?

A

ointment

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73
Q

How many kids with atopic dermatitis will develop allergic rhinitis or asthma?

A

more than half

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74
Q

What bacteria commonly infects atopic dermatitis?

A

staph aureus or GA strep

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75
Q

What is pityriasis alba?

A

patches with loss of pigment and scale, inflammatory cause

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76
Q

What fungi infect the skin?

A 
Malassezia
Candida
Trichophyton
Microsporum
Epidermophyton
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77
Q

What is tinea pedis?

A

athlete’s foot

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78
Q

What causes tinea pedis?

A

Trichophyton rubrum growing in food/showers

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79
Q

Where does tinea pedis occur?

A

between the toes (interdigital) or along the heel/bottom of foot (mocassin)

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80
Q

How does moccasin-type tinea pedis present?

A

one hand, two feel

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81
Q

What causes vesiculobullous type tinea pedis?

A

type 4 immune response to fungal antigen

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82
Q

What are the three classes of topical antifungals?

A

imidazoles (static)
allylamines (cidal)
ciclopirox (both)

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83
Q

What is onychomycosis?

A

chronic fungal nail infection

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84
Q

How is onychomycosis treated?

A

oral antifungals for three months

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85
Q

How does tinea corpis present?

A

erythematous ring with scale and central clearing

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86
Q

How is tinea corpis treated?

A

topical antifungals (oral if hair follicles are involved)

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87
Q

How does T tonsurans grow?

A

inside hair follicle, causing hair to break off

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88
Q

What are the two main causes of tinea capitis?

A

Microsporum canis

Trichophyton tinsurans

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89
Q

What is a complication of tinea corpus treatment

A

kerion - inflammatory response that discharges pus, can become infected

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90
Q

How is tinea capitis treated?

A

oral griseofulvin or terbinafine

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91
Q

What are the hallmarks of diaper candidiasis?

A

erythematous plaques in skin creases with satellite papules, not responsive to rash cream

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92
Q

What predisposes to diaper candidiasis?

A

not changing diapers regularly (daycare)

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93
Q

How is diaper candidiasis treated?

A

nystatin or imidazole cream/ointment, avoid steroids

94
Q

How does irritant dermatitis present?

A

erythema on srufaces that touch diaper, spares folds

95
Q

How is irritant dermatitis treated?

A

zinc oxide paste

96
Q

What is candidal intertrigo?

A

candida infection of skin folds

97
Q

What are predisposing factors for candidal intertrigo?

A

DM
hot/humid
limited mobility
obesity

98
Q

How is candidal intertrigo treated?

A

topical nystatin or imidazoles

99
Q

What is a large blister called?

100
Q

What is a small blister called?

101
Q

What are the three common etiologies of blisters?

A

trauma, infection, inflammation

102
Q

What does HSV1 tend to infect?

A

mouth and nose

103
Q

What does HSV 2 tend to infect?

A

genitalie, buttocks, thighs

104
Q

What is herpetic whitlow and who tends to get it?

A

herpes infection on the fingers, common in dentists

105
Q

What is the best test for HSV1, HSV2, and VZV?

A

PCR from fluid swab

106
Q

What are three treatments for HSV?

A

acyclovir, famciclovir, valacyclovir

107
Q

What is dyshidrotic eczema?

A

vesiculopapular rash on palms, soles, and fingers

108
Q

What is the treatment for dyshidrotic eczema?

A

high strength topical steroids

109
Q

What kinds of vesicular rash present on the dorsal foot?

A

contact dermatitis, insect bites

110
Q

What kind of vesicular rash presents on the sides of feet and toes?

A

dyshidrotic eczema

111
Q

What kinds of vesicular rash present on the soles of the feet?

A

tinea pedis, dyshidrotic eczema

112
Q

What kind of vesicular rash presents on the balls and heels?

A

friction blisters

113
Q

What is the ddx for facial vesicles?

A

HSV, bullous impetigo

114
Q

What is the ddx for chest/back vesicles?

115
Q

What is the ddx for finger vesicles?

A

dyshidrotic eczema, contact dermatitis, herpetic whitlow

116
Q

What is the ddx for arm/leg vesicles?

A

contact dermatitis

117
Q

What is the ddx for genitalia vesicles?

118
Q

What is the ddx for foot vesicles?

A

dyshidrotic eczema, tinea pedis, contact dermatitis

119
Q

What are 4 causes of extensive blisters?

A

VZV (chicken pox)
pemphigus vulgaris
bullous pemphigoid
drug eruptions

120
Q

What causes seborrheic dermatitis?

A

Malassezia yeast

121
Q

Where does seborrheic dermatitis present?

A

scalp, hairline, eyebrows, eyelids, face, nosolabial folds, ears, central chest

122
Q

How is seborrheic dermatitis treated?

A

anti-dandruff shampoo and topical anti-fungal or steroids

123
Q

Where does rosacea present?

A

cheeks, nose, brow, chin, eyelids, eyes

124
Q

What is a complication of rosacea?

A

rhinophyma (hyperplasia of nasal sebaceous glands)

125
Q

How is rosacea treated?

A

chronic low-dose antibiotics, avoid triggers, lasers

126
Q

How is rhinophyma treated?

A

isotretinoin or surgery

127
Q

What are the two most common causes of allergic contact dermatitis?

A

poison ivy and nickel

128
Q

What is the most common facial rash in infants?

A

atopic dermatitis

129
Q

What is the most common facial rash in adolescents?

A

acne vulgaris

130
Q

What is an open comedo?

131
Q

What is a closed comedo?

A

whitehead, turns into a pustule

132
Q

What are the three types of acne?

A

comedonal
inflammatory
nodulocystic

133
Q

What 4 factors lead to acne?

A

hormones
sebaceous gland activity
hair follicle plugging
P. acnes bacteria

134
Q

How is mild comedonal acne treated?

A

topical retinoid

135
Q

How is mild inflammatory acne treated?

A

topical retinoid and topical clindamycin

136
Q

How is moderate inflammatory and mild nodular acne treated?

A

topical retinoid
topical clindamycin
oral antibiotic

137
Q

How is severe acne treated?

A

isotretinoin

138
Q

What are the cutaneous manifestations of AL amyloid?

A

pinch purpura
macroglossia
infilrated periorbital nodules and plaques

139
Q

What are the cutaneous manifestations of sarcoid?

A

symmetric red-brown papules and plaques

non-caseating granulomas on biopsy

140
Q

What is necrobiosis lipoidica?

A

necrotizing skin condition in diabetics

141
Q

What is Sweet’s syndrome?

A

Acute febrile neutrophilic dermatosis

142
Q

How is Sweet’s syndrome treated?

A

systemic steroids

143
Q

What is calcific uremic arteriolopathy?

A

subcutaneous nodules that form ulcers, associated with ESRD

144
Q

What are the 4 possible skin findings in neurofibromatosis?

A

neurofibromas
cafe-au-lait macules
axillary/inguinal freckles
plexiform neurofibroma

145
Q

What are the 4 possible skin findings in tuberous sclerosis?

A

facial angiofibromas
hypomelaotic macules
shagreen patch
periungual fibromas

146
Q

What is pyoderma gangrenosum?

A

chronic ulcerative skin disease, associated with IBD, heme malignancies

147
Q

How is pyoderma gangrenosum treated?

A

topical and systemic steroids

148
Q

What is lichen sclerosus?

A

inflammatory disease that leads to scarring, often on genitals

149
Q

How is lichen sclerosus treated?

A

high strength topical steroids

150
Q

What causes port wine stain? Treatment?

A

congenital capillary malformation

treat with laser

151
Q

How does Kaposi Sarcoma present and what is the cause?

A

dark, violaceous plaques/nodules, often in HIV pts

Caused by HHV-8

152
Q

What is hidradenitis suppurativa?

A

inflammation of the hair follicles causing abscesses, nodules, and sinuses, often in the axilla

153
Q

What defines an immediate drug reaction?

A

within 1 hour

154
Q

What defines a delayed drug reaction?

A

after 1 hour, usually after 6 hours

155
Q

What disease leads to signigicantly increased risk of drug reactions?

156
Q

What is the most common cutaneous drug reaction?

A

exanthematous

157
Q

What is an exanthematous reaction?

A

erythematous macules/papules, usually a week after starting a drug

158
Q

What is the treatment for exanthematous reactions?

A

antihistamines and topical steroids

159
Q

What is a fixed drug eruption?

A

solitary erythematous patch with central bulla, often recurs in the same spot

160
Q

What is Drug-Induced Hypersensitivity Syndrome?

A

diffuse skin eruption with fever, internal organ involvement, and facial swelling

161
Q

What CBC abnormality is common in DIHS?

A

eosinophilia

162
Q

What is the timing for DIHS?

A

presents 3wks - 3mo

163
Q

What medications are common in DIHS?

A

allopurinol, sulfa, penicillin, anticonvulsants, abacavir

164
Q

What is the treatment for DIHS?

A

stop meds

prolonged systemic steroids

165
Q

What is Stevens-Johnson Syndrome?

A

erythematous erosions and macules with extensive necrosis and detachment of epidermis and mucosa

166
Q

What is the difference between SJS and toxic epidermal necrolysis?

A

SJS involves <10% of BSA

TEN involves >30%

167
Q

What drugs are associated with SJS/TEN?

A 
Sulfa
Allopurinol
Tetracyclines
Anticonvulsants
NSAIDs
168
Q

What is diascopy?

A

checking purpura for blanching

169
Q

What defines petechiae?

170
Q

What defines ecchymoses?

171
Q

What is the cause and cutaneous findings in scurvy?

A

vitamin C deficinecy

petechiae and hemmorhagic gums

172
Q

What is purpura fulminans?

A

large ecchymotic patches on extremeties, seen in sepsis/DIC

173
Q

What is seen in Rocky Mountain Spotted Fever?

A

faint macules on wrists and ankles with petechiae on the trunk and extremeties

174
Q

What causes palpable purpura?

A

vasculitis

175
Q

What is Henoch-Schonlein Purpura?

A

small vessel vasculitis in the skin, characterized by IgA deposition
Presents with nonblanching macules/papules on legs

176
Q

How does polyarteritis nodosa present?

A

erythematous nodules in skin, proteinuria, anemia

177
Q

What is tinea versicolor?

A

fulgal rash with hypo or hyperpigmented macules on back and chest

178
Q

What is the treatment for tinea versicolor?

A

dandruff shampoo, azole creams, oral fluconazole

179
Q

What is melasma?

A

brown pigmented patches on the face, usually in women

180
Q

What makes melasma worse?

181
Q

What is the treatment for melasma?

A

suncreen, hydroquinone (bleaching agent)

182
Q

What is minocycline pigmentation?

A

blue-grey discoloration of the skin from minocycline

183
Q

Where does minocycline pigmentation occur?

A

mouth and eye

can be in bones, thyroid, scars, shins

184
Q

What medications cause hyperpigmentation?

A

minocycline
amiodarone
hydroxychloroquine

185
Q

What is stasis dermatitis?

A

eczematous eruption overlying venous stasis and edema

186
Q

What is the treatment for stasis dermatitis?

A

compression and topical steroids

avoid topical antibiotics

187
Q

What is postinflammatory hyperpigmentation?

A

darkening of the skin around sites of inflammation, especially in those with darker skin

188
Q

What can be seen with Wood’s light?

A

de-pigmentation

189
Q

How does vitiligo present?

A

areas of depigmentation, often on the face, hands, or area of trauma

190
Q

What causes vitiligo?

A

autoimmune, anti-melanocytes

191
Q

What is the treatment for vitiligo?

A

topical steroids
topical tacrolimus
phototherapy

192
Q

What are the three questions to ask about a pigmented lesion?

A

remained the same for a year?
symmetric with distinct borders and one color?
similar to other moles?

193
Q

What is the risk of melanoma in congenital nevi?

A

no increased risk in small/med.

5-10% in large

194
Q

At what age is an acquired nevus worrisome?

195
Q

What makes an atypical nevus?

A

macular base with raised center

196
Q

What are the two most common mutations in familial melanoma?

A

CDKN2A

CDK4

197
Q

Where does melanoma occur?

A

usually in sun-exposed areas, but can be anywhere

198
Q

What is the most important prognostic factor for melanoma?

A

Breslow depth

199
Q

What is the most common subtype of melanoma?

A

superficial spreading

200
Q

What are the five subtypes of melanoma?

A 
superficial spreading
nodular
lentigo maligna
acral lentiginous
amelanotic
201
Q

What causes squamous cell carcinoma of the skin?

A

UV light-induced mutation of p53

202
Q

What is actinic keratosis?

A

premalignant SCC, presents as a rough, scaly plaque

203
Q

What are actinic purpura?

A

easy bruising and perivascular inflammation, common in elderly

204
Q

What is the most common skin cancer?

A

basal cell carcinoma

205
Q

What is the etiology of basal cell carcinoma?

A

PTCH mutation

206
Q

What are the 2 subtypes of basal cell carcinoma?

A

nodular

superficial

207
Q

What are the possible variations of basal cell carcinoma?

A

ulcerated
pigmented
morpheaform

208
Q

When is Mohs Micrographic Surgery indicated?

A

need to spare tissue
aggressive subtypes
large or recurrent tumors

209
Q

What is Mohs Micrographic Surgery?

A

precise treatment for skin cancer that maximizes conservation of tissue

210
Q

What is the major species of bacteria in the skin?

A

Staph epidermidis

211
Q

What is a common cause of impetigo?

A

Group A Strep

212
Q

What immune factors do keratinocytes have?

A

TLRs, cytokines, antimicrobial peptides

213
Q

What are antimicrobial peptides?

A

b-defensins, irregularly congregate in bacterial membranes and form pores

214
Q

What response does S. epidermidis invoke in immune function?

A

stimulates enhanced barrier function

215
Q

What bacteria have superantigens?

A

Staph aureus and Strep pyogenes

216
Q

What response do superantigens cause?

A

toxic shock syndrome

217
Q

What is the predominant symptom of cellulitis?

218
Q

What are cellulitis risk factors?

A

trauma
inflammation
edema
systemic infection

219
Q

What is the outpatient treatment for cellulitis?

A

cephalosporin

220
Q

What is erysipelas?

A

a type of cellulitis with dermal lymphatic involvement and edema

221
Q

What is the treatment for abscess?

A

I&D, sometimes with antibiotics

222
Q

What is a furuncle?

A

a perifollicular abscess (boil)

223
Q

What is a carbuncle?

A

a site where multiple furuncles have ruptured and coalesced

224
Q

What is folliculitis?

A

pustules of infection within hair follicles

225
Q

What is the most common cause of folliculitis?

226
Q

What is the cause of hot tub folliculitis?

A

pseudomonas

227
Q

What causes honey-colored crust?

228
Q

What causes bullous impetigo?

A

staph exotoxin that ruptures hemidesmosomes

229
Q

Why does strep scalded skin syndrome happen?

A

kidneys aren’t able to clear the strep toxin

230
Q

What is necrotizing fasciitis?

A

quickly spreading infection of the fascia, high mortality

231
Q

What is the treatment for necrotizing fasciitis?

A

surgical debridement and antibiotics

MSK Block (19 decks)

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