Dermatology

Question 1

7 key questions when getting derm history:

Answer 1

1- When? (Onset)
2- Where? (Site of onset)
3- Foes it itch or burn? (Symptoms)
4- Has it spread? How? ( pattern of evolution)
5- How have individual lesions changed? (Evolution)
6- Provocative factors? (Heat, cold, sun, exercise, travel history, drugs, pregnancy,season)
7- Previous treatments? (Topical or systemic)

Question 2

Other aspects for derm history taking (7)

Answer 2

1- Demographics (age, race occupation)
2- Constitutional symptoms (acute illness syndrome) (Chronic illness syndrome)
3- General history of the present illness
4- Past medical history (surgery, illnesses, hospitalization. Allergies, medications, social habits. Hx of atopy asthma, hay fever, eczema. Family medical history)
5- Social history (occupation, hobbies, exposures, travel, injection drugs)
6- Sexual history
7- Review of symptoms/systems

Question 3

Physical examination (3)

Answer 3

1- General appearance
2- Vital signs
3- Skin

Question 4

All of the skin should be examined, including what? (5)

Answer 4

1- Mucus membranes
2- Hair and scalp
3- Nail plate, nail fold, nail body
4- Peripheral lymph nodes
5- Genital area

Question 5

Name 7 primary skin lesions

Answer 5

Macule (less than 1cm)
Patch (more than 1cm)
Papule
Plaque
Nodule
Vesicule
Bulla

Question 6

Name 8 secondary lesions

Answer 6

1- Erosion
2- Ulcer
3- Fissure
4- Atrophy
5- Excoriation
6- Crust
7- Scale
8- Lichenfication

Question 7

Define a macule

Answer 7

Flat discoloration less than (any color) 1 cm. Not palpable. Should blanch under pressure.

Question 8

If a macule does not blanch under pressure, what is it?

Answer 8

Purpuric

Question 9

Define a patch

Answer 9

Circumscribed flat area of discoloration more than 1 cm in diameter. Not palpable. Any color. Blanches under pressure.

Question 10

Define a papule

Answer 10

Elevated small solid raised palpable bump. Generally 5-10mm in diameter.

Question 11

Describe a pustule

Answer 11

Small located inflamed pus filled, lesion.
Up to 1cm in diameter.

Question 12

Describe plaque

Answer 12

Small raised abnormal patch of tissue. 5-10mm in diameter.

Question 13

Describe a nodule

Answer 13

Growth of abnormal tissue. At least 1cm in diameter. Palpable.

Question 14

Describe a wheal.

Answer 14

Hive. Rounded flat top. Red red oedematous. Erythematous blanchable.

Question 15

Describe vesicle and Bullae. Difference between the two.

Answer 15

Fluid filled sacs. Vesicle 5-10mm. Bullae >10mm.

Question 16

Describe a cyst.

Answer 16

Sac like pocket. Filled with something. Usually more than 5mm in diameter.

Question 17

Define erosion

Answer 17

Breakdown outer layer of skin- epidermis only. Usually d/t trauma.

Question 18

Define ulcer.

Answer 18

Open sore d/t poor blood flow.

Question 19

Define fissure

Answer 19

Small linear crack in skin.

Question 20

Define atrophy.

Answer 20

Degeneration or thinning of skin.

Question 21

Define excoriation

Answer 21

Abrasion from scratching.

Question 22

Define crusts.

Answer 22

Outer coating formed from drying of a bodily exudate

Question 23

Define scales

Answer 23

Loss of outer layer of epidermis in large scale like flakes.

Question 24

Define Lichenification.

Answer 24

Thickened and hardened area of skin.

Question 25

Define petechia.

Answer 25

Nonblanchable puncate foci of hemorrhage into dermis.

Question 26

Define purpura.

Answer 26

Larger area of hemorrhage that may be palpable.

Question 27

Difference between hematoma and ecchymosis.

Answer 27

Solid collection of blood.

Question 28

Telangiectasia

Answer 28

Small dilated blood vessels.

Question 29

Define burrow.

Answer 29

Like a work inside your skin.

Question 30

Define comedome.

Answer 30

White and back head. Horny plug filling of pilosebaceous duct.

Question 31

Name ABCDE of melanoma.

Answer 31

Asymmetry Border Color Diameter Evolution

Question 32

Lesion on a photoexposed part of body, asymptomatic, not healing since at least 3 months. What am I?

Answer 32

Basal cell carcinoma.

Question 33

Often ulcerated or hyperkeratosic. Chronic wound or erythematosquamous plaque. Photoexposed area. What am I?

Answer 33

Squamous cell carcinoma

Question 34

Erythématosquamous, poorly delimitated on photo exposed area. Not cancerous.

Answer 34

Actinic Keratosis

Question 35

Describe the characteristic presentation of Tinea corporis.

Answer 35

Pruritic, annular, erythematous patch or plaque that grows centrifugally. As rash spreads outwards, centreal clearing develops.

Question 36

First line treatment of tinea corporis.

Answer 36

Topical imidazoles and allylamines.

Question 37

Name 6 common diseases that cause annular lesions.

Answer 37

1- Erythema migrans 2- Erythema multiforme 3- Lichen planus 4- Tinea corporis 5- Pityriasis rosea 6- Plaque psoriasis

Question 38

Name the Characteristic rash of lyme disease.

Answer 38

Erythema migrans.

Question 39

What antibiotic do you prescirbe to someone with erythema migrans?

Answer 39

Doxycycline, amoxicillin or cefuroxime.

Question 40

Describe plaque psoriasis lesions.

Answer 40

Pruritic, sharply demarcated, ertyhematous and round or ovoid with silver plaques that bleed easily with trauma.

Question 41

What is erythema multiforme?

Answer 41

Hypersensitivity reaction to infections or drugs.

Question 42

Describe erythema multiforme lesions.

Answer 42

Multiple raised, annular, target-like lesions with central erythema.

Question 43

Lichen planus: Describe lesion.

Answer 43

Vialaceous, flat topped papules with fine white or gray reticular laxy lines on top of the rash.

Question 44

Ddx for Acne

Answer 44

1- Rosacea 2- Folliculitis 3- Seborrheic dermatitis 4- Acne d/t medication or cosmetics 5- Miliaria

Question 45

Ddx for cellulitis (5)

Answer 45

1- Statis dermatitis 2- Deep vein thrombosis 3- Contact dermatitis 4- Erythema nodosum 5- Panniculitis

Question 46

Counselling for cellulitis (5)

Answer 46

1- Symptoms should improve within 24-48hrs of start of ATB treatment 2- RTC if no response after 72 hrs of tx 3- Rest, elevate, ice affected limb 4- Normal for skin to weep, flake or crack, 5- Must alleviate predisposing factors to prevent reccurent infection