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Dermatology Flashcards

1
Q

Flat discolored lesion

A

Less than 1 cm = macule
Greater than 1 cm = patch

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2
Q

Palpable raised lesion

A

Less than 1 cm = papule
Greater than 1 cm = plaque

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3
Q

Lesion with significant depth

A

Less than 1 cm = nodule
Greater than 1 cm = tumor

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4
Q

Fluid containing lesion

A

Greater than 1 cm = cyst

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5
Q

Elevated lesion containing serous fluid

A

Less than 1 cm = vesiscle
Greater than 1 cm = bullae

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6
Q

What causes Rocky Mountain spotted fever?

A

Rickettsia rickettsii tick bite

Sudden onset fever, headache, rash, myalgia, GI complaints

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7
Q

Common phototoxic drugs

A

NSAIDs, quinolones, tetracyclines, amiodarone, phenothiazine

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8
Q

Dermatomyositis lesions

A

Violaceous periorbital HELOPTROPE RASH with edema
Erythema of neck and upper trunk SHAWL SIGN
Violaceous papules over knucles GOTTRON PAPULES

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9
Q

Treatment for tinea versicolor (overgrowth of M furfur)

A

Selenium sulfide lotion
Oral ketoconazole

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10
Q

Define vitiligo

A

Autoimmune reaction against melanocytes associated with other autoimmune diseases such as pernicious anemia, Hashimoto’s thyroiditis or diabetes type 1

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11
Q

Itchy red macules and papules on the face spreading to the neck, trunk and extremities within 24 hours ± red rash on soft palate

A

Rubella

Post auricular lymph nodes
Resp spread
Careful in pregnant ladies

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12
Q

Small white spots on oral mucosa with erythematous macules and papules of face spreading cephalocaudally

A

Measles

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13
Q

Pink macules and papules on trunk spreading to neck and proximal extremities with surrounding white halos

A

Roseola

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14
Q

Skin changes in liver disease

A

Gynecomastia, jaundice, caput medua, loss of body hair, palmar erythema, peripheral edema, purpura, spider angioma

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15
Q

Skin changes in renal failure

A

Photodistributed or diffuse hyperpigmentation including palms and soles, pallor, yellow tinge

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16
Q

Skin changes in diabetes

A

Acanthosis nigricans, foot ulcers, itching, light brown slightly indented scaly patches (diabetic dermopathy), yellow skin and nails

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17
Q

Skin changes in Cushing syndrome

A

Acanthosis nigricans, acne, buffalo hump, hirsutism, telangiectasia, atrophic skin, striae

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18
Q

Skin changes in neurofibromatosis

A

Cafe au lair spots, freckles, neurofibromas

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19
Q

Skin changes in hyperlipidemia

A

Xanthomas

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20
Q

Finger clubbing should make you think of

A

CVD
Lung disease
GI disorders
Chronic methemoglobinemia

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21
Q

Hollow or spoon shaped nails should make you think of

A

Iron deficiency
Malnutrition
Diabetes
Old age

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22
Q

Transverse white lines/leukonychia should make you think of

A

Hypoalbuminemia
Chemotherapeutic agents
Poisons

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23
Q

Black spots on nails should make you consider

A

Hematoma or melanoma

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24
Q

Splinter hemorrhages of nails should make you think of

A

Trauma
Bacterial endocarditis
Blood dyscrasia

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25
Q

Blue green nails should make you think of

A

Pseudomonas or drug induced causes (azidothymidine AZT)

26
Q

Painful grouped vesicles on erythematous base located on distal finger

A

Herpetic whitlow
Self limiting
May consider antiviral therapy

27
Q

MCC noncicatricial (without scarring) alopecia

A

Androgenic alopecia

28
Q

Skin changes in liver disease

A

Gynecomastia, jaundice, caput medusa, loss of body hair, palmar erythema, peripheral edema, purpura, spider angiomas

29
Q

Skin changes in renal failure

A

Photodistributed or diffuse hyperpigmentation including palms and soles, pallor, yellow tinge

30
Q

Skin changes in diabetes

A

Acanthosis nigricans, foot ulcers, pruritis, light brown slightly indented scaly patches, yellow skin and nails

31
Q

What is pyoderma gangrenosum and what conditions is it associated with?

A

Inflammatory skin condition that is characterized by large ulcers usually on the lower body

Associated with ulcerative colitis, Crohn’s, rheumatoid arthritis

32
Q

Skin changes in neurofibromatosis

A

Cafe au lait macules, freckles, multiple cutaneous neurofibromas (neoplasm of peripheral Schwann cells that presents as soft nodule in the dermis of the skin)

33
Q

Skin changes in porphyria

A

Blisters, photosensitivity, hypertrichosis, pigmentation, skin fragility

Porphyrias are a group of rare, inherited or (less commonly) acquired metabolic disorders in which defective enzymes impair the biosynthesis of heme in the liver and/or bone marrow.

34
Q

Treatment for onychocryptosis

aka ingrown nails

A

Barrier placement between nail plate and fold
Excision of the portion of the nail plate pressing on the fold
Maybe antibiotics

35
Q

What is fingernail clubbing associated with?

A

CVD, lung disease, GI disorders, chronic methemoglobinemia

36
Q

What are spoon shaped nails associated with?

A

Iron deficiency, malnutrition, diabetes, old age

37
Q

What are white lines on nails associated with?

A

Hypoalbuminemia, chemotherapy, poisons

38
Q

What are nail splinter hemorrhages associated with?

A

Trauma (MCC)
Bacterial endocarditis, blood dyscrasias

39
Q

What are black nails associated with?

A

Hematoma, melanoma

Always biopsy when melanoma is suspected

40
Q

Where does herpetic whitlow normally present?

A

Erythematous base located on the distal finger

41
Q

What are red painful lesions around the nail fold called and what are they commonly caused by?

A

Paronychia

Causes: MCC S. aureus if acute, if in someone who does “wet” work then think C. albicans

Rx: Topical glucocorticoids, minimize irritants and water exposure, give topical antibacterial/antifungal as needed

42
Q

What tests should you do in abnormal hair loss?

A

1st: CBC, ferritin, TSH, microscopic exam and fungal culture (if suspected)
2nd: Scalp biopsy, ANA, androgens

43
Q

What is depigmentation of the hair shaft caused by?

A

Protein or copper deficiency

44
Q

How do you treat itching from PBC?

A

Bile acid binding resin (cholestyramine or colestipol), opioid antagonists (naloxone)

45
Q

What endocrine disorders can present with itching?

A

Thyrotoxicosis, hypothyroid, diabetes

46
Q

What type of cancer can be associated with itching?

A

Gastric carcinoid because of histamine flush

47
Q

What drugs are associated with Steven Johnson syndrome?

A

Carbamazepine, phenytoin, allopurinol, lamotrigine, NSAIDs, sulfa

Rx: Identification of culprit drug, supportive care on burn unit or ICU, ophthalmology consult

Life threaning because of multisystem involvement

Acute life threatening mucocutaneous disorders with extensive necrosis and detachment of the epidermis

48
Q

What is the treatment for shingles?

A

Often supportive
Treat if severe or disseminated
Give oral antiviral if initiated within 72 hours to reduce pain, viral shedding and healing time

TOPICAL antiviral is of no benefit

Clusters of erythematous papules and vesicles commonly following pain in a unilateral dermatomal distribution

49
Q

What tests are done for the diagnosis of herpes simplex?

A

Tzanck smear - look for multinucleated epithelial cells
Viral culture
Viral PCR
Antibody testing of fluid from base of vesicle

HSV 1 = oral HSV 2 = genital sometimes oral

50
Q

What is a common initial presentation of pemphigus vulgaris?

A

Mouth ulcers

Look for pts with painful skin or oral mucosa lesions
Itching is uncommon

Serious autoimmune blistering diease affecting pts 50-60 yo

51
Q

How do you differentiate pemphigus vulgaris from bullous pemphigoid?

A

PV usually starts in the oral mucosa and move across the face and scalp, BP will start at the extremitites towards the flexural surfaces and trunk

PV middle aged (POSITIVE nikolsky), BP elderly (NO nikolsky)

PV autoAB against desmoglein vs BP autoAB against hemidesmisomes

Autoimmune bullous skin disease affecting middle aged or elderly

PV may require hospital admission, BP can generally be treated with topical and/or oral steroids or methotrexate, azathioprine

52
Q

What is the classic finding of dermatofibroma?

A

Dimple sign

Common button like nodule presenting on extremities

53
Q

Clinical features of malignant melanoma

A

Asymmetry
Border irregularities
Color variation
Diameter > 6 mm
Evolution

54
Q

Hypertrophic scar vs keloid

A

Hypertrophic scars are confined to the original injury site vs keloids which extended beyond the original injury site

55
Q

How does BCC present?

Basal cell carcinoma

A

Pearly papule or nodule with peripheral telangiectasias

Lots of other presentations possible but this is MC?

56
Q

What should CDKN2A mutation make you suspect?

A

Malignant melanoma

57
Q

Side effects of isotretinoin

A

Tertaogen, depression, suicidal ideation

Warn patients

58
Q

Rosacea vs acne

A

Acne has comedones where as acne does

59
Q

How to treat psoriasis?

A

Skin:
Medium - high potency corticosteroid cream or ointment
Calcipotriol ointment
Tar
Anthralin
Tazarotene gel or cream
Intralesional triamcinolone
Phototherapy
Methotrexate, acitretin, cyclosporine

Scalp:
Tar shampoo
Topical corticosteroid lotion, solution, foam
Calcipotriol solution
Tazarotene gel

Face:
Low potency corticosteroid cream or ointment
Tacrolimnus ointment

Auspitz sign: scale removal = appearance of minute droplets of blood

Chronic, recurrent inflammatory skin condition with abnormal epidermal differentiation and hyperproliferation

60
Q

Lichen planus pnemonic

A

Acute or chronic inflammatory disorder affecting the skin, mucous membranes, and nails

Plantar
Purple
Pruritic
Polygonal
Papules

Mainly seen on inner wrists, torso, extremities
Sometimes present as white reticulated lesions of mucosal surfaces (lips and buccal mucosa)

ASSOCIATED WTIH HEPATITIS C SOMETIMES - SCREEN PTS

Tx: Difficult. Try corticosteroid creams. Maybe systemic agents if bad.

61
Q

Eczema vs psoriasis

A

Eczema: ill defined, itchy, microvesicles, lichenification

Psoriasis: well defined, silvery, symmetric, salmon red

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