*Dermatology Flashcards
1
Q
A
Neurofibromas
- multiple sessile, fleshy tumors
- non-tender, move w/ skin on exam
- assoc w/ neurofibromatosis type I (Von Recklinhausen dz)
2
Q
Von Recklinhausen disease
key derm findings
A
aka: neurofibromatosis type I
Key Findings
- cafe-au-lait macules
- axillary and inguinal freckling
- neurofibromas
- Lisch nodules
AD disorder results from a mutation in NF1 gene coding for neurofibromin
3
Q
A
LISCH NODULEs
-
hamartomas of the iris that do not affect vision
- Hamartoma: benign, noncancerous tumorlike malformation made up of an abnormal mixture of cells and tissues found in areas of the body where growth occurs
- associated w/ Neurofibromatosis Type I
4
Q
A
Beau’s Lines
- lines/indentations in the nail that result from delayed growth
- usually due to nutritional deficiency, or can be from injury or severe illness
- assoc. w/ Systemic Lupus Erythematosus
5
Q
what % of nail is subungual hematoma for nail bed laceration to be considered?
A
25% or more of the nail
6
Q
matrixectomy:
contraindication
A
infectious process
- infxn will drastically decrease effectiveness of matrixectomy
- insult to tissue in presence of infectious process may facilitate a deeper infxn → possibly an osteomyelitic one
7
Q
pityriasis rubra pilaris
A
- rare with reddish orange lesions involving hair follicles, mildly pruritic
- affects palms/soles w/ yellowish scale
- Islands of sparing – even when most of the body is red (erythrodermic)
- a papulosquamous disorder (inflammatory rxn)
- Most common is classic adult onset which _begins at scalp and moves caudally_
- _Affects palms/soles with a yellowish scale_ – well demarcated “PRP sandal”
8
Q
pityriasis rosea
A
- “salmon-colored lesion and peripheral collarette”
-
*Herald patch - 2-10 cm patch anywhere on body
- misdiagnosed as ringworm
- “Christmas tree” appearance on the back
9
Q
differential diagnosis for pityriasis rosea
A
secondary syphilis
- Comes weeks later after painless chancre**, **may resemble with papulosquamous lesion (palms/soles involved)
- Get sexual history, VDRL or RPR
- History – painless chancre, fevers, myalgias, lymphadenopathy
- Secondary syphilis very common on plantar foot in some patients with localized disease
10
Q
lichen planus
A
- acute eruption of itchy papules**, will usually settle in a few months, **start on inside of arms/legs and go up
- associated w/:
- Wickham’s striae - fine lacy network of lines on top of papules
- Koebner’s phenomenon
- can be assoc. w/:
- hepatitis C virus infxn
- SLE
- ulcerative colitis
- alopecia
- areata
- vitiligo
- dermatomyositis
- morphea
- lichen sclerosis
- myasthenia gravis
11
Q
6 P’s of Lichen Planus
A
- Planar (flat-topped)
- Purple
- Polygonal
- Pruritic
- Papules
- Plaques
12
Q
Koebner phenomenon
A
appearance of new skin lesions on previously unaffected skin secondary to trauma
13
Q
Wickham’s Striae
A
fine lacy network of lines on top of papules
14
Q
necrotizing fasciitis
A
- deep infxn of the SubQ tissue that causes progressive destruction of the fascia and fat
- infxn spreads through muscle fascia due to its relatively poor blood supply
- histo features:
- thrombosis of blood vessels
- extensive tissue destruction
- abundant bacteria spreading along fascial planes
- infiltration of acute inflammatory cells
15
Q
nec fasciitis
early stages → progression
A
- thrombosis of small blood vessels and destruction of superficial nerves → development of anesthesia → affected area is usually characterized by erythema, swelling, warmth, and tenderness
- over several days, skin can rapidly change from red-purple to patches of blue gray
- skin breakdown can occur w/in 3-5 days w/ formation of bullae that contain thick pink or purple fluid
16
Q
nec fasciitis
treatment
A
- only tx is surgical exploration and debridement of necrotic tissue, and delays in tx are assoc. w/ high morbidity and mortality
- broad-spectrum Abx regimens incl: carbapenem or beta-lactam-beta-lactamase inhibitor with clindamycin and an agent w/ activity against MRSA
17
Q
erythema nodosum
etiology
A
- occur as a delayed hypersensitivity response to a number of factors:
- oral contraceptives
- strep infxn
- sarcoidosis
- ulcerative colitis
- tuberculosis
- fungal infections
18
Q
Erythema nodosum
define
A
children and young adults, multiple tender erythematous nodules on anterior tibia** (sometimes on forearms), **inflammatory process of fat (panniculitis)
- Color change – red 🡪 purple 🡪 yellow-green
- Biopsy – most fully developed central portion, incisional type of biopsy
- Causes – strep infection, drugs, sarcoidosis, TB, IBD
- Treatment – bed rest and oral analgesics
- Will resolve in a few days, but 77% infection related resolve in 7 weeks, 30% idiopathic may last up to 6 months
19
Q
characteristic of
LICHENIFICATION
A
common consequence of pruritic skin disorders, including atopic dermatitis
characterized by:
- skin thickening and hardening
- exaggeration of normal skin lines
- hyperpigmentation
- scaling and pruritis
Most commonly found on anterior aspect of ankles and may be the result of repetitive scratching or rubbing
20
Q
filariasis
A
- mosquito-borne parasite that can result in alterations to the lymphatic system → pain, lymphedema, and severe disability
- round-worm parasite that lives 6-8 years, producing millions of immature larvae
- tx w/ albendazole and diethylcarbamazine
-
Sxs:
- lymphedema
- elephantiasis
- scrotal swelling in men can all occur, usually after a long latency
- Can present after travel to an endemic area, may be unilateral
21
Q
list some primary causes of lymphedema
A
- neurofibromatosis
- yellow nail syndrome
- distichiasis lymphedema syndrome
all result from congenital defects in the lymphatic system
22
Q
distichiasis lymphedema
syndrome
A
- a condition that affects the normal function of the lymphatic system
- sxs:
- puffiness or swelling of the legs and feet
- some patients may have spinal cysts
- **growth of extra eyelashes* (distichiasis), ranging from a few extra eyelashes to a full extra set on both the upper and lower lids; these grow out of its inner lining (not along the edge of the eyeball)
23
Q
cause and treatment?
A
trichophyton mentagrophytes
- the most common causative organism in white superficial onychomycosis
- characterized by dull white spots on the surface of the nail plate of one or several nails;
- if not treated, the diseased area will spread centrifugally and involve the entire nail plate;
- white areas can be scraped to yield a chalky scale for examination
- Tx: Terbinafine for dermatophyte onychomycosis
24
Q
A
lesion is suspicious for malignant melanoma
- asymmetry, border irregularity, diameter greater than 6 mm
- more likely to be dark black or blue or to have an irregular variation in color
- surgical excision is indicated, w/ wide margins and excision of related lymph nodes
- exposure to UV is a critical factor in development, but it does not have a direct relationship with amount of sun exposure
25
relationship b/w UV light and cancer
UV radiation can:
* suppress the skin's immune system
* induce melanocyte cell division and free radical production
* it can damage melanocyte DNA
26
layers of the epidermidis from
most superficial to most deep
“Come Let's Go See, Babe”
* Horny (stratum **c**orneum) – **_most superficial_** layer
* **_Stratum lucidum**_ (_**ONLY IN PALMS AND SOLES_**)
* Granular (stratum granulosum)
* Prickle (stratum spinosum)
* Basal (stratum germinativum) – **_deepest_** layer
27
what is the basement membrane
dermal - epidermal interface
(area of research interest because problems here can cause visible skin disease)
28
dermis anatomy
* Separated into **_papillary and reticular_**
* *Lots of collagen in reticular layer*
* Place where **_hair and glands begin_**
* **_Temperature regulation_** through control of cutaneous blood flow and sweating
* **_Mechanical protection_** of underlying structures
29
subcutaneous / subcutis
anatomy
* Consists of spongy connective tissue with energy-storing adipocytes (**_fat cells_**)
* The fat content of the subcutis is not the same in all body regions and differs in men and women
**_Zero fat in and around nail tissue_**
30
differences between hair and nails
31
when do nails begin to grown in utero?
onychocytes begin to develop
**_10_th_-17_th _week in utero_**
32
what forms the nail plate?
formed by mostly **_nail matrix_** – some contribution from nail bed, shape contributed from matrix and phalanx
33
differences between:
apocrine and eccrine
glands
34
Nikolsky sign
**a skin finding in which the top layers of the skin slip away from the lower layers when rubbed**
35
staphylococcal scalded skin syndrome
36
Bullous pemphigoid
37
Staphylococcus Toxic Shock Syndrome
38
Erythema Multiforme
39
toxic epidermal necrolysis
40
exanthematous reaction
("morbiliform" eruption on trunk/ extremities)
41
Urticaria
42
angioedema
43
fixed drug eruption rash
44
DRESS Syndrome
“Drug Reaction w/ Eosinophilia and Systemic Symptoms”
45
Erythema Multiforme
46
Urticaria
47
polyarteritis nodosa
48
erythema nodosum
49
polyarteritis nodosa
50
Livedo reticularis
51
?
52
Seborrheic dermatitis
53
Seborrheic dermatitis
54
Allergic contact dermatitis
55
Irritant Contact Dermatitis
56
Psoriasis
57
Psoriasis
58
Psoriasis
59
Stevens-Johnson Syndrome
on the spectrum of immune-mediated reaction that can be from:
erythema multiforme → SJS → toxic epidermal necrolysis
60
Porphyria Cutanea Tarda
61
Porphyria Cutanea Tarda
62
pemphigus vulgaris
63
atopic dermatitis
64
Lichen Simplex Chronicus
65
Allergic Contact Dermatitis
66
Psoriatic nails
67
Pustular Psoriasis
68
Guttate Psoriasis
69
Guttate Psoriasis
70
Plaque Psoriasis
71
Psoriasis
72
Melanoma
73
Tinea Corporis
(ringworm)
74
Seborrheic Keratosis
75
Kaposi's Sarcoma
76
Kaposi's Sarcoma
77
Lentigo Melanoma
78
Superficial Spreading Melanoma
79
Melanoma
80
Nodular Melanoma
81
Benign Melanocytic Nevi
82
Benign Melanocytic Nevi
83
Benign Melanocytic Nevi
84
Acral Lentiginous Melanoma
(tends to occur on palms of hands and soles of feet, \*OR under nail plates)
85
**nodular** basal cell carcinoma
86
Keratoacanthoma
87
**Exophytic** Squamous Cell Carcinoma
88
**Nodular** Squamous Cell Carcinoma
89
Basal Cell Carcinoma
90
**Nodular** Basal Cell Carcinoma
91
**Pigmented** Basal Cell Carcinoma
92
**Ulcerating** Basal Cell Carcinoma
93
**Superficial Multicentric** Basal Cell Carcinoma
94
**Mycosis Fungoides** (Cutaneous T-Cell Lymphoma)
95
Mycosis Fungoides (CTCL)
96
Acne Rosacea
97
SLE Diagnostic criteria
| (4-Skin-RASHNIA)
98
Systemic Lupus Erythematosus
99
Acrochordon
(Skin Tags)
100
Candida Albicans
(Intertrigo)
101
Impetigo
102
Varicella
103
Molluscum Contagiosum
104
Plantar Wart
Assoc. w/ HPV
Painful at pressure points
105
Verruca Vulgaris
("common wart")
cauliflower lesion with red/black dots (thrombosed capillaries)
disrupts finger prints
106
4 HPV wart types?
Condyloma Acuminata is anogenital warts
107
Herpetic Whitlow
| (HSV Infection)
108
Shingles
| (caused by ZVZ)
109
Pityriasis Rosea
110
Pityriasis Rosea
(Herald Patch - salmon-colored lesion with peripheral collarette)
111
Pityriasis
(Tinea Versicolor)
Malasezzia Globosa - spaghetti and meatballs hyphae appearance
112
Pityriasis
| (Tinea Versicolor)
113
Vitiligo
114
Cellulitis
115
Erysipelas
by **Strep Pyogenes**!
116
Cellulitis versus Erysipelas
117
Dermatomyositis
| (Gottron's Sign)
