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Dermatology Flashcards

1
Q

What cell types are present in the epidermis?

A

◦Keratinocytes
◦Melanocytes
◦Langerhans cells

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2
Q

What is the function of keratinocytes?

A
  1. Barrier Function—Stratum Corneum
  2. Produce cytokines and inflammatory molecules
  3. Produce antimicrobial proteins & lipids
  4. Drug metabolism
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3
Q

What is the function of Melanocytes?

A
  1. Pigment-producing cells of skin
  2. Protect against Ultraviolet radiation
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4
Q

What is the function of Langerhans cells?

A
  1. Macrophage-like cells in epidermis
  2. Important for antigen recognition
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5
Q

What is the function of fibroblasts? Where are they located?

A
  1. Found in dermis
  2. Responsible for collagen, ground substance production
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6
Q

What is the first step in accessing a rash?

A

stand back, look at the entire process, pattern, and distribution

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7
Q

What is a macule?

A
  • A circumscribed, flat (NON-PALPABLE) discoloration
  • Can be any color
  • Few centimeters in diameter
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8
Q

What is a patch?

A
  • A circumscribed, flat (NON-PALPABLE) discoloration
  • Can be any color
  • More than a few centimeters in diameter
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9
Q

What is a papule?

A
  • elevated solid lesion
  • up to 1 cm in diameter
  • color varies
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10
Q

What is a Plaque?

A
  • circumscribed, elevated solid lesion
  • greater than 1 cm in diameter
  • Often formed by the confluence of papules
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11
Q

What is a nodule?

A
  • circumscribed, elevated, solid lesion
  • more than 1 cm in diameter
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12
Q

What is the difference between a papule, a nodule, and a tumor?

A
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13
Q

What is a tumor?

A
  • A circumscribed, elevated, solid lesion
  • Larger than a nodule
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14
Q

What is a wheal?

A
  • Firm, edematous plaque
  • results from infiltration of the dermis with fluid
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15
Q

What is a Pustule?

A
  • circumscribed collection of leukocytes and free fluid that varies in size
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16
Q

What is a vesicle?

A
  • A circumscribed collection of free fluid
  • up to 0.5 cm in diameter
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17
Q

What is a bulla?

A
  • circumscribed collection of fluid greater than 0.5 cm
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18
Q

What is the difference between a primary and a secondary lesion?

A
  • PRIMARY LESION:
    • Basic lesion that defines the disease process
  • SECONDARY LESIONS:
    • Lesions that evolve during the skin disease process, or created by scratching or infection
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19
Q

What are scales?

A

Excess dead epidermal cells that are produced by abnormal keratinization and shedding

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20
Q

What are crusts?

A

A collection of dried serum and cellular debris; a scab

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21
Q

What is an erosion?

A
  • Focal loss of epidermis
  • do not penetrate below Dermal-Epidermal junction
    • do not scar
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22
Q

What is an excoriation?

A
  • An erosion caused by scratching
  • Excoriations are often linear
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23
Q

What is an ulceration?

A
  • A focal loss of epidermis and dermis
  • heal with scarring
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24
Q

What is the difference between an erosion and an ulcer?

A
  • Erosion: doesn’t cross DEJ
  • Ulcer: loss of epidermis and dermis
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25
Q

What is a fissure?

A
  • A linear loss of epidermis and dermis with sharply defined, nearly vertical walls
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26
Q

What is atrophy?

A
  • A depression in the skin resulting from thinning of the epidermis or dermis
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27
Q

What is a scar? What type of damage does it imply? How does appearance change over time?

A
  • An abnormal formation of connective tissue
  • imply dermal damage
  • Change:
    • initially thick and pink
    • become white and atrophic
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28
Q

What is a comedone?

A
  • plug of sebaceous and keratinaceous debris lodged in the opening of a hair follicle (acne)
  • The follicular orifice may be widened (blackhead) or narrowed (whitehead)
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29
Q

What is Lichenification?

A
  • An area of thickened epidermis induced by scratching
  • The skin lines are accentuated so that the surface looks like a washboard
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30
Q

What is a burrow?

A
  • A narrow, elevated, tortuous channel in the skin created by a parasite
  • Ex: chiggers
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31
Q

What are milia?

A
  • small cysts under the skin
    • walls contain epidermis
  • scarring is present
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32
Q

What is a Cyst?

A
  • circumscribed lesion with a wall and lumen
  • lumen may contain fluid or solid matter
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33
Q

What is telangiectasia?

A
  • Dilated superficial blood vessels
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34
Q

What are petechiae?

A
  • circumscribed deposit of blood
  • less than 0.5 cm in diameter
35
Q

What are purpura?

A

circumscribed deposit of blood greater than 0.5 cm in diameter

36
Q

What are the hallmarks of Sturge-Weber Syndrome?

A
  • V1 Port-wine stain (superficial vascular malformation)
  • CNS manifestations
37
Q

Characteristics of dangerus mole

A

A = Asymmetry

B = Border

C = Change

D = Diameter (larger than a pencil eraser)

38
Q

What are the characteristics of Varicella-zoster virus?

A
  • Itchy lesions at different stages
  • “dew drop on a rose petal”
39
Q

Patient presents with itchy lesions at different stages. They appear like dew drop on a rose petal. What is the disease?

A

Varicella Zoster virus

40
Q

Patient presents with cough, coryza, conjunctivitis, photophobia and fever in addition to a rash. What is the disease?

A

Rubeola (measles)

The three C’s: Cough, Coryza, Conjunctivitis (and Koplik spots)

41
Q

Patient presents with small, irregular bright-red spots with central bluish-white speck on buccal mucosa. He has no other symptoms. What are these spots called, and what is it a precursor for?

A
  • Koplik spots (rash on mucous membrane)
  • Measles (before rash spreads to the skin)
  • The three C’s: Cough, Coryza, Conjunctivitis (and K​oplik spots)
42
Q

What are the phases of Erythema Infectiosum?

A
  • Cause: Parvovirus B19
  • Three distinct phases
    • Slapped cheeks
    • Fishnet erythema
    • Recurrence
43
Q

Child presents with a four day high fever (102) but no other symptoms. What is the disease?

A

Roseola Infantum or “Fifth Disease”

(Pale-pink macular rash begins as fever fades)

44
Q

Patient presents with sore lesions in mouth as well as some rash on hands and feet. What is the disease? What is the cause?

A

Hand-foot-mouth disease

Coxsackie virus

45
Q

Patient presents with fever, pharyngitis, strawberry tongue, and rash that began on the neck and has spread. What is the disease?

A

Scarlet fever

(Strep Toxin)

46
Q

Patient presents with fever, headache, myalgia, photophobia and the rash pictured below. What is the disease? What causes it?

A
  • Rocky Mountain Fever
  • Cause: Rickettsia rickettsii
    • Tick-borne
47
Q

What are the clinical features of urticaria?

A

the 3 E’s

  • Erythema
  • Edema
  • Evanescent (dynamic time course)
48
Q

What are the causes of urticaria?

A
  1. viral
  2. food
  3. drug
  4. physical factors – sun, pressure, aquagenic, cold, exercise (acronym – SPACE)
49
Q

Patient presents with target lesions on palms, with oral mucosal involvement. What is the disease? What is the cause?

A
  • Erythema Multiforme Minor
  • Cause: HSV
50
Q

Patient presents with target lesions on palms, with oral mucosal involvement in addition to Stevens Johnson Syndrome. What is the disease?

A
  • Disease: Erythema Multiforme Major
51
Q

Patient presents with fever, fatigue, pharyngitis, adenopathy, liver or spleen involvement in addition to a rash. What disease is this?

A

Mononucleosis

3 “F”’s: Fever, Fatigue, (F)pharyngitis

52
Q

Patient presents with malar rash in areas exposed to the sun. There is also involvement in the conchal bowl of the ear. What disease is this?

A
  • Disease: Systemic Lupus Erythematosus
  • Other symptoms: DUMP
    • Discoid lupus
    • Ulcers (oropharyngeal, usually no pain)
    • Malar rash
    • Photosensitivity
  • Lab findings:
    • Antinuclear antibodies Other serologic tests (dsDNA, anti-Sm)
53
Q

Patient presents with puffy skin with yellowish tint, loss of lateral eyebrows, and dry, coarse brittle hair. What is the disease? With what underlying disease is it associated?

A

Myxedema

Hypothyroidism

54
Q

Patient presents with well demarcated areas of epidermal atrophy, leaving skin a red-yellow color. What is the disease? With what underlying disease is it associated?

A

Necrobiosis lipoidica

Diabetes mellitus

55
Q

Patient presents with firm flesh-colored to yellowish papules and plaques. What is the disease? With what underlying disease is it associated?

A

Xanthoma

Hyperlipidemia

56
Q

With what underlying disease is Xanthelasma associated?

A

hyperlipidemia

57
Q

Patient presents with blisters and scarring on the dorsal surfaces of hands. What is the disease? With which underlying disease is it associated?

A

Porphyria cutanea tarda

Associated with Hepatitis C
Directly related to alcohol intake

58
Q

What is the cause of non-bullous impetigo?

A

Beta Hemolytic Strep

59
Q

What is the cause of bullous impetigo?

A

Staph. aureus

60
Q

Patient presents with smooth domed papules with a central umbilication. What is the disease?

61
Q

What is the cause of Irritant Dermatitis? What is the response to a strong vs weak irritant?

A
  • Cause:
    • toxic injury to skin by chemical
  • Difference in response:
    • Strong irritant: Vesicles or bullae
    • Weaker irritant repetitively applied: dry, scaly eruption
62
Q

What is the pathogenesis of allergic contact dermatitis? What is the histological presentation?

A
  • Path:
    • immunologic, T-cell mediated reaction (type IV)
  • Histology:
    • Intercellular edema (spongiosis)
    • Intraepidermal vesicles
    • Lymphocytic and eosinophilic dermal infiltrate
63
Q

Patient presents with superficial, flaccid blisters and severe oral ulcerations. What is the disease? What is the pathology?

A
  • Disease: Pemphigous Vulgaris
  • Pathology:
    • autoimmune
    • acantholysis (loss of cohesion between keratinocytes)
    • Intraepidermal
64
Q

Patient presents with tense blisters and pruritus. What is the disease? What is the pathogenesis?

A
  • Disease: Bullous pemphigoid
  • Pathology
    • Circulating autoantibodies directed against the epidermal basement membrane zone
    • Subepidermal
65
Q

What is a common cause of dermatitis herpetiformis? What is the pathology?

A

Hypersensitvity to dietary gluten with or without clinically apparent gluten-sensitive enteropathy

Pathology:

  • Antigen-antibody complexes are deposited in the skin
  • subepidermal vesicles and pruritus
66
Q

What is the difference between eumelanin and phaeomelanin?

A
  • Eumelanin
    • brown-black
  • Phaeomelanin
    • yellow-red
67
Q

Patient presents with hypopigmented macules that are sharply demarcated and bilaterally symmetric. What is the disease?

A

Vitiligo

(Michael Jackson had this)

68
Q

What are the three stages of a hair’s life cycle? How many do you lose per day?

A
  • Anagen phase
    • Actively growing hairs
    • Grow for 2-6 years
  • Catagen phase
    • Involuting hairs (end of active growth)
  • Telogen phase
    • resting (club) hairs
    • Phase lasts weeks to months
  • Lose ~100 hairs/day
69
Q

What disease has excess hair production due to excessive androgen production?

A

Hirsuitism

70
Q

Patient presents with well-defined, erythematous papules and plaques with silvery scales. What is the disease? With what disease is it commonly associated?

A

Psoriasis

30% have arthritis

71
Q

What is the Koebner phenomenon?

A

Lesions occur at areas of trauma
(talked about in psoriasis and Lichen planus)

72
Q

What are the clinical manifestations of Lichen Planus? With what is it associated?

A

Clinically—P’s
Purple, planar polygonal, pruritic papules and plaques

“Flat-topped violaceous papules and plaques”
“Lacy reticular patches” on mucous membranes

Associated with Hep C

73
Q

Patient presents with flat-topped violaceous papules and plaques and lacy patches on mucous membranes. What is the disease? With what underlying disease is it associated?

A

Lichen planus

74
Q

Patient presents with a rash that was preceded by ithchiness. Lab tests show elevated IgEs. What is the disease?

A

Atopic dermatitis

“itch that rashes”

75
Q

Patient presents with white scales and no erythema. What is the disease?

A

Ichtheosis

scales brown or white

76
Q

Patient presents with wart-like macules and papules with a velvety surfece. It is only present on cutaneous surfaces (none on mucous membranes). What is the disease?

A

Seborrheic Keratosis

(Long axis is oriented along skin tension lines)

77
Q

What are Actinic keratosis and actinic cheilitis? What is it a risk marker for?

A
  • Pre-malignant lesion of keratinocytes
    • Actinic keratosis on the skin
    • Actinic cheilitis on the lips
  • Appears in sun-exposed areas
  • Risk marker for:
    • squamous cell carcinoma
    • melanoma
78
Q

Patient presents with a pink dome-shaped papule on the face with pearly, rolled borders and telangiectasia. What is the disease? What is the prognosis?

A

Basal cell carcinoma

Prognosis is good; rarely metastasizes

79
Q

Patient presents with dry, red, scaly, hyperkeratotic papules and macules on the face and scalp. What is the disease? What is the prognosis?

A

Actinic Keratosis
Prognosis depends on speed of detection.

precancerous lesion and will eventually evolve into squamous cell carcinoma

80
Q

Patient presents with small, red, hard, scaly papules and plaques. What is the disease? What is the prognosis?

A

Squamous Cell Carcinoma

Prognosis depends on depth upon detection. Rarely metastasizes, but does so more frequently than basal cell carcinoma.

81
Q

Patient presents with a pigmented, asymmetrical lesion that has increased in size in the last 6 months. The patient complains of itching. What is the disease? What is the prognosis?

A

Melanoma

Prognosis is poor: high rate of metastasis

82
Q

What is the difference between SLE, DLE, and SCLE?

A
  • SLE (systemic lupus erythematosus) 4 of 11 ARA criteria (systemic disease)
  • DLE (discoid lupus erythematosus) primarily cutaneous
  • SCLE (subacute cutaneous lupus erythematosus)
83
Q

Patient presents with blanchable erythema and malar rash with a photo-distribution. What is the disease?

A

Acute Lupus Erythematosus

84
Q

Patient presents with erythema with telangiectasias, scales with follicular plugging, and scarring alopecia. What is the disease?

A

Chronic (Discoid) Lupus Erythematosus

ICM II (12 decks)

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