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HD 2 > Dermatology > Flashcards

Dermatology Flashcards

0
Q

top 4 categories of skin problems

A
  1. inflammatory disease
    # 2. infection
  2. tumors
  3. other
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1
Q

7 broad categories of skin disease

A
  1. dermatitis
  2. papulosquamous
  3. urticaria/erythema
  4. infection
  5. follicular
  6. tumors
  7. other
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2
Q

Wheels

A

(indicative of urticaria, NOT the same as urticarial vasculitis)
= pruritic dermal swellings sharply defined w/o surrounding erythema.
*EACH individual lesion lasts less than 24 hrs

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3
Q

Abscess

A

a furuncle or carbuncle (round, red, tender, may rupture) found on the back or thighs, that is a localized infection caused by Staph. aureus.
Tx: antibiotics, mupirocin, wash hands well w/ soap.

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4
Q

Scalded Skin Syndrome

A

Diffuse erythema w/ fever, followed by desquamation that travels from the head and shoulders to the trunk; usually in infants.
Caused by Staphylococcal toxins.
Tx: Nafcillin IV (emergency)

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5
Q

Bullous Impetigo

A

Clusters of vesicles on face, trunk, extremities and perineum that turn to bullae then crust over; in children ages 2-5.
Cause: Group II streptococci
Tx: Mupirocin, Dicloxacillin, or cephalexin

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6
Q

Non-bullous Impetigo

A

Clusters of vesicles which fill with pus then dry into “honey colored” crusts, mostly on the face.
Cause: streptococci, but may be contaminated w/ staph.
Tx: Mupirocin, Dicloxacillin or cephalexin

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7
Q

Erysipelas

A

Sharply demarcated erythema and swelling in adults, on the face, ears, or lower legs; acute onset often w/ initiating skin lesion.
* 4 telltale signs: Rubor (red), Calor (hot), Dolor (painful), tumor (swelling); hard to distinguish from cellulitis.
Cause: Group A strep or staph.
Tx: penicillin, cephalosporin or erythromycin

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8
Q

Scarlet Fever (rash)

A

** 1st 48 hrs: white coated “strawberry tongue,” turns red after 5 days; accompanying small papules on neck that spread. Followed by brawny desquamation.
Cause: group A strep
Tx: penicillin, erythromycin, dicloxacillin

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9
Q

Ecthyma

A

Deep infection in butt, thighs, or legs usually in tropics; = vesicle or pustule that becomes ulcer, scars.
Cause: Staph or strep pyogenes
Tx: penicillin, erythromycin, cephalosporin.

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10
Q

Ecthyma gangrenosum

A

red macule –> papule –> hemorrhagic bulla –> necrosis & gangrenous ulcer (w/ greenish tint & pink halo/edge)
* occurs in immunocompromised only*
Cause: pseudomonas
Tx: 3rd generation cephalosporins

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11
Q

haemophilus cellulitis

A

purple/red swelling of face, in children 6 mo - 3 years old; occurs w/ URI & otitis media usually.
=> “preseptal cellulitis” if affects eyelid (dangerous complication)
Cause: Haemophilus infection
Tx: IV cephalosporins

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12
Q

Rocky Mountain Spotted Fever

A

pale or red macules appearing 1st on wrists and ankles, then spreading to palms and soles of feet, = vasculitis.
Other Sx: fever, malaise, vomitting; Risk hepatomegaly.
Cause: rickettsia infection from tick bite (esp. in North/South Carolina)
Tx: doxycycline

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13
Q

cutaneous signs of gonococcemia

A

a few medium-small crusty pustules over red base on extremities, usually last ~4 days.
Other Sx: fever, myalgia, tenosynovitis; acute abdomen
Cause: gonorrhea infection spread to blood

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14
Q

Cutaneous signs of meningococcemia

A

diffuse petechia or hemorrhagic purpura on face and extremities; usually in children under 2.
Other Sx: sudden onset of fever and severe headache, stiff neck
Cause: Neisseiria meningitidis
Complication: “Waterhouse Fridericksen Syndrome” = massive bleeding into skin and adrenal glands from septicemia.

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15
Q

Onychomycosis

A

fungal infection of finger or toenails.
a) Distal = yellowish hyperkeratosis, most common (in anyone)
b) Proximal = white discoloration under proximal nail fold, in immunosuppressed (esp. AIDS)
Dx w/ KOH

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16
Q

Athlete’s Foot (tinea pedis)

A

a) interdigital - damp, flaky & itchy btwn toes
b) vesiculobullous - blisters on heel, insole or ball of foot
c) moccasin - diffuse scaliness across whole sole of foot
Dx w/ KOH, Tx = topical

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17
Q

tinea cruris (jock itch)

A

= contamination from tinea pedis, ringed expanding erythematous plaque on inner thighs & butt.
spares penis & scrotum
Dx w/ KOH, Tx = topical + treat tinea pedis.

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18
Q

tinea corporis vs. versicolor

A

Corporis: expanding erythematous & scaly circular plaque; on face, trunk or extremities
Versicolor: brown, pink or hypopigmented scaly patches on trunk;
* “spaghetti & meatballs” appearance under microscope

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19
Q

Candidiasis

A

a) Intertriginous/Diaper: broad erythematous plaque in moist areas (axilla, submammary, inguinal)
b) Perinychia: thickened, red nailfolds
c) Thrush: in mouth (mucosal surfaces) –> Chronic Mucocutaneous if child w/ T cell deficiency.
Cause: yeast (candida), = opportunistic, esp. immunocompromised but not excusively!

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20
Q

Sebhorreic keratosis

A

common benign epidermal growth, esp. on face/trunk & age 30+;
= well-marginated pigmented papule or plaque.
Tx: liquid N, curettage or shave excision

21
Q

actinic keratosis

A

pre-cancerous epidermal growth,
= rough, scaly, red plaque/papule, esp. on sun-exposed areas.
** 10% convert to squamous cell carcinoma!**
Tx: cryoTx, acid peel, curettage. best = prevention!

22
Q

warts (verruca vulgaris)

A

benign epidermal hyperplasia due to HPV infection,
- common, plantar, periungual, mosaic (if transplant/immunosupr.)…
*esp. in school children or ppl w/ risks (athletes, animal exposure)
**spread w/ contact!
Tx: salicylic acid, 3M duct tape, cryotherapy, candida Ag, laser…

23
Q

molluscum contagiosum

A

Soft, domed papules from poxvirus infection of epidermal cells;
- esp. in kids (face, trunk, extremities) or genitals in adults
Tx: spontaneously remit, or cryoTx. *hard to Tx in AIDS (persistant)

24
Q

Condyloma acuminatum

A

= genital warts (epidermal hyperplasia from HPV infection),
** oncogenic –> cervical carcinoma, squamous cell carcinoma!
Spread: sexually OR non-sexually (skin/mucosal surf. contact)
Tx: salicylic acid, cryotherapy, excision, laser, etc.

25
Q

Corns (clavus)

A

localized epidermal thickening secondary to chronic friction/P;
= tender, mostly on toes/feet, translucent w/ intact skin lines.
Complications: ulcers, infection, osteomyelitis… (esp. if diabetic)
Tx: paring, change footwear

26
Q

Freckle vs. Lentigo

A

Both: hyperpigmented macules
Freckles (ephelis) = increased melanin (normal # melanocytes)
Lentigo = increased # melanocytes (Tx w/ laser, cryoTx)

27
Q

Nevi

A

= moles (junctional: dark, dermal: pale, complex),
*increased risk melanoma w/…
#1: giant congenital nevus (w/ CNS involvement!)
2. large congenital nevus (>20 cm)
3. atypical (small, appear over time): MAY precede melanoma

28
Q

melasma

A

patchy macular hyperpigmentation, esp. on face;
from hormones (ie: pregnancy, contraceptive) & UV exposure.
* harder to treat if dark skin tones.

29
Q

Epidermal cyst

A

inflammation of epithelial lining of hair follicle infundibulum (@ top),
–> tender & inflamed, w/ central punctum +/- foul odor.
Tx: excise remove lining or will recur

30
Q

Pilar cyst

A

tender, inflamed outer sheath of hair follicle root;
* no central punctum, mostly on scalp.
Tx: excise

31
Q

Hemangioma

A

benign proliferation of blood vessels in dermis.
- cherry: acquired/senile, will not go away
- of infancy: present @ birth. a) rapidly enlarge (1/3), or b) self-resolve –>1/3 go away completely.
Tx: evaluate early, excise if enlarging! (may ulcerate or fibrose)

32
Q

dermatofibroma

A

focal dermal fibrosis, w/ thickening & hyperpigmentation;
from minor trauma (ie: shaving), w/ “dimple sign.”
Tx: excise/laser

33
Q

Keloid

A

excessive collagen proliferation after initial (minor) trauma,
Tx: intralesional kenalog/steroid, pulse dye laser…
do NOT excise bc will grow back!

34
Q

Lipoma

A

benign accumulation of subcutaneous fat,
* usually asymptomatic.
Tx: excision (if needed)

35
Q

Basal cell carcinoma (“BCC”)

A

malignant neoplasm from basal cells of follicular epidermis,
*most common skin cancer, from UV exposure.
* Metastasis = rare; many types, morpheaform = most aggressive.
Tx: Mohs surgery (#1), or excision & radiation

36
Q

Squamous cell carcinoma (“SCC”)

A

keratinocyte malignancy in epidermis (thick, extends into dermis);
Risks: solid organ transplant pts, UV or radiation exposure, actinic keratosis (= precursor)
* Locally invasive, + metastasizes. *p53 mut/Ras activation
Tx: Mohs surgery (#1)

37
Q

melanoma

A

malignant melanocyte neoplasm; No Sxs, *most deadly skin cancer.
Precursors: congenital or atypical nevi, may be de novo
- superficial spreading = most common
- Nodular (vertical growth) = deadliest
Also: Lentigo malignans (elderly), ocular, or apigmented (skin color!)
Tx: Surgery (prevention is better)
check sentinel lymph nodes for metastasis!

38
Q

Dermatitis (types, general characteristics)

A

Histo: superficial perivascular inflammation, with dermal edema, hyperplasia, & hyperkeratosis.
Types (7): atopic, contact, dyshydrotic, nummular, neurodermatitis, sebhorreic, stasis.

39
Q

“Atopic triad”

A

the 3 main problems that typically coexisit with ATOPIC dermatitis:

  1. atopic dermatitis
  2. asthma
  3. allergic rhinitis
40
Q

atopic dermatitis

A

series of remissions & exacerbations, w/ skin hyperirritability;
Onset: infancy, presentation changes over time (NOT an allergic rxn)
- infancy: on face, elbows & knees (extensor surfaces)
- adulthood: on neck, inner elbow/knee, & ankles (flexor surfaces)
–> w/ lichenification in adulthood, decrease severity as age.
associated w/ fillagrin mutation!
Tx: moisturize, topical steroids, antihistamines/antibiotics, UV Tx…

41
Q

Hannifin-Rajka dermatitis

A

chronic, recurrent atopic dermatitis w/ pruritis; + family Hx.
(same pattern as standard atopic dermatitis)
* MUST also have 3 minor features (facial/ocular involvement, hyerreactivity, etc.)

42
Q

pathogenesis of atopic dermatitis

A

Atopic Langerhan’s cells hyperstimulate T cells,
–> excessive T cell reaction to antigen (penetrates skin barrier)
==> cytokine activation & immune/inflammatory response.
(cytokines = in chronic phase)

43
Q

Common atopic dermatitis complications

A

secondary infections (bc of irritated, compromised skin),

  • eczema herpeticum: HSV on face, w/ pustular papules & fever.
  • molluscum contagiosum: widespread papules w/ central plug
  • impetigo: staph aureus –> honey colored crusts
44
Q

Contact dermatitis

A

= allergic rxn to skin exposure.
- type I: IgE rxn (esp. to Latex)
- type IV (DTH): T cell mediated, severe (poison ivy, metals, fragrances, etc.)
*need >1 exposure to react (>1 wk btwn, 2nd rxn appears 8-24 hrs after actual exposure)
Dx: T.R.U.E. test (controlled patch exposure to allergens)
Tx: avoid the causative allergen/material

45
Q

pathogenesis of DTH contact dermatitis

A

(5 steps)

  1. Sensitization (7-21 days): Ag into epidermis, binds to dermal dendritic cell, APC to lymph nodes, presents Ag to naive T cells.
  2. Memory: Ag-specific T cell expansion (w/ CCL27 expression)
  3. “Challenge” (2nd exposure): 8 hrs - 5 days to recognize the Ag
  4. Inflammatory Rxn: vasodilate, activate endothelium –> release mediators & recruit leukocytes (inflammation phase)
  5. Resolution: macrophages remove allergen.
46
Q

Pompholyx (dyshydrotic dermatitis)

A

=> large, blistering bullae/vesicles on palms & soles.
itchy & painful, but NOT inflammatory!
* may dry into crusty plaques on fingers or feet.
Dx: scrape to rule out tinea.

47
Q

Sebhorreic dermatitis

A

greasy yellow scale on face/ears, scalp, axilla, or groin.
* not usually itchy.
Causes: hormones (& pregnancy), immune abnormalities/Malassezia furfur, neuro diseases (esp. Parkinson’s!)

48
Q

stasis dermatitis

A

= dermatitis on legs (common in adults!), chronic inflammation.
Cause: chronic venous insufficiency bc valve incompetency
*may ulcerate!
Tx: compression, topical corticosteroids

49
Q

Nummular dermatitis

A

circular red, itchy spots of inflammation on legs.
= combo of stasis & atopic dermatitis,
Tx: emollients, topical corticosteroids

50
Q

Neurodermatitis

A
  1. lichen simplex chronicus: itchy, leathery, hyperpigmented plaque;
    • cause: habitual scratching (psych.)
  2. prurigo nodularis: hard keratotic nodules on extensor surfaces;
    • cause: obsessive picking of skin (psych.)
      Tx: anxiolytics (manage OCD), topical/intralesional steroids

HD 2 (14 decks)

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