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Course 2 (MSK/Dermatology/Rheumatology) > Dermatology > Flashcards

Dermatology Flashcards

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1
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A

Keratoacanthoma

  • Variant of SCC
  • Rapid growth
  • Generally benign behavior
  • Carteriform (volcano) morphology
  • Can appear similar to BCC but the history will explain raid growth to help differentiate; BCC would take months to years to reach the stage of this lesion
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2
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Hutchinson’s sign: leeching of pigment onto skin around nail

  • Highly aggressive melanoma
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3
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Amelanotic Melanoma

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4
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Keratoancanthoma

  • Variant of SCC
  • Rapid growth
  • Generally benign behavior
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5
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Subungal Melanoma (involves nail matrix)

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6
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Talon Noir (Black heel)

  • Intraepidermal hemorrhage
  • Harmless, asymptomatic, due to trauma
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7
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Superficial Spreading Malignant Melanoma (SSMM)

  • Most common form of melanoma
  • Radial growth phase: 2-5 years
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8
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Superficial Spreading Malignant Melanoma (SSMM)

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9
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Lentigo Maligna Melanoma (sun exposed areas)

  • Prolonged radial growth phase (5-15 yrs)
  • Late vertical growth phase
  • Best prognosis type of melanoma (if diagnosed during radial growth phase)
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10
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Nodular Melanoma

  • Short or non-existent radial growth phase
  • Early vertical growth phase
  • Early metastasis
  • Poor prognosis
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11
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Acral Lentiginous Melanoma

  • Early metastasis
  • Digits, ears, nose
  • Aggressive variant of melanoma that generally portends a poor prognosis
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12
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Basal Cell Carcinoma (BCC)

  • Rolled edge
  • Translucent
  • Central ulcer is common
  • Telangectasia
  • Sun-exposed areas
  • Clinical variants
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13
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BCC

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14
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Cystic BCC

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15
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Broken down BCC

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16
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Advanced cystic BCC

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17
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Eroded cystic BCC or rodent ulcer

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18
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Pigmented BCC

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19
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Superficial BCC

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20
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Morpheaform BCC

  • Morphea-like (scar-like)
  • Sclerosis
  • Most aggressive variant
  • Therapeutic challenge; Mohs surgery
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21
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Actinic keratosis (precancerous lesion for SCC)

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22
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Actinic Keratosis (precancerous lesion for SCC)

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23
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Squamous Cell Carcinoma (SCC)

  • Low risk of metastases except for the following: lips, eyes, lesions arising from scars or in the context of immunsuppression
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24
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SCC

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25
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SCC

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26
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SCC of lip

  • Actinic cheilitis is the precursor lesion
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27
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Bowen’s Disease

  • Squamous cell carcinoma in situ
  • Sharply demarcated erythematous plaque with scale and/or crusting
  • Often 1-3 cm in diameter and found on the skin and mucous membranes
  • Evolves into SCC in 10-20% of cutaneous lesions and >20% mucosal lesions
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28
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Cherry Hemangioma or Capillary Hemangioma

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29
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Epidermal Inclusion Cyst

“Sebaceous cyst”

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30
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Xanthelasma

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31
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Pilar Cyst

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32
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Melasma

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33
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Halo Nevi

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34
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Sebhorrheic Keratosis

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35
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Herpes Simplex Type 1

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36
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Herpes Zoster

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37
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Genital Warts

Condyloma Acuminata

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38
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A

Cystic Acne

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39
Q

What is the etiology of acne vulgaris?

A

Acne Vulgaris Etiology

  • Increasing effect of hormones in puberty on target organ - follicular sebaceous unit
    • Androgens stimulate sebaceous glands to produce sebum
  • Increased sebum production
  • Hyperkeratinization of the follicular infundibulum
    • Hyperkeratinization at the follicular ostia (opening), blocks the secretion of sebum (microcomedones)
  • Overgrowth of Proprionbacterium acnes
    • P. acnes contain lipase which converts sebum to free fatty acids and produces pro-inflammatory mediators
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40
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A

Rosacea

  • Begins with flushing/blushing
  • Red complexion and telangectasia worsen
  • Next develop inflammatory papules and pustules
    • May settle with oral antibiotics
    • Maintenance with topical therapy
  • Chronic lifelong course, but usually controlled with treatment
  • Rare to see significant rhinophyma compared to the past
  • Some people feel stigma of looking like an alcoholic due to red bulbous nose
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41
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A

Perioral Dermatitis

  • Predominantly women aged 15-40 yrs
  • Young children and elderly also affected
  • Uniform sized tiny erythematous papules/pustules
    • May coalesce to form scaling erythematous patches
    • Can be itchy or burning at times
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42
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A

Seborrheic Keratosis

  • Waxy, with a warty “stuck on” appearance, may be any color
  • One of the most common tumors
  • Genetic predisposition
  • Usually begin to appear in 40s, increase with age
  • Not related to sun exposure
  • No malignant transformation
  • Treatment: none, liquid nitrogen cryotherapy, electrodessication, curettage, surgical excision
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43
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A

Solar Lentigo

  • Found in 90% of people >60 yrs
  • Incidence increases with age, “age spots”, but may develop at any age
  • Well circumscribed, sun exposed areas
  • May fade slightly with avoidance of UV
  • Treatment: counsel regardng sun protective measures, light cryotherapy, intense pulse laser
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44
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A

Halo Nevus

  • Usually asymptomatic
  • Central nevus may or may not involute with time
  • Repigmentation often takes place over months or years; however, it does not always occur
  • More common in kids, usually multiple
  • Halo of regressing melanoma is irregularly shaped
  • New halo nevus in an older adult warrants a biopsy (this could be a regressing melanoma)
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45
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A

Blue Nevus

  • Early age of onset (8-15 yrs)
  • Well defined homogenous blue-gray/blue-black color
  • Commonly found on head and neck, dorsal hands and feet, presacral area
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46
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A

Spitz Nevus

  • Red or pigmented papule or nodule, usually in kids or young adults
  • Looks like melanoma on histology but doesn’t behave like melanoma
  • “Juvenile melanoma”
  • Grows rapidly, may reach size of 1cm within 6 months and then usually doesn’t change except color
  • Treatment: complete excision is required
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47
Q
A

Pigmented Spindle Cell Nevus of Reed

  • Variant of Spitz nevus
  • Small, well circumscribed dark brown to black papule
  • Characteristic starburst pattern on dermoscopy
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48
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A

Congenital Nevus

  • Large lesions have a 3-12% risk of developing melanoma
49
Q
A

Intradermal Nevus - raised, soft and fleshly papules of any color

50
Q
A

Nevus Spilus

  • Tan patch with superimposed “speckles” that develop over time
  • Common on trunk and extremities
  • Reports of melanoma developing within these lesions, therefore, following them with serial imaging is a good idea
51
Q
A

Dermatofibroma

  • Very common tumor in adults
  • Lower extremities
  • Firm, usually 5-10mm in size, + dimple sign
  • Etiology unknown, theory = reaction to insect bite
  • Spindly tumor, “scar-like” center, may produce worse scar or recur if biopsied
  • Biopsy only if diagnosis is in question or itchy
52
Q
A

Atopic Dermatitis - chronic/relapsig pruritic dermatitis usually associated with a personal or family history of atopy

  • Pathognesis: environment and genetics, mutations in filaggrin, barrier dysfunction, immune disregulation
  • Most cases are diagnosed before the age of 5yrs
  • 80% will develop allergic rhinitis or asthma later in childhood

Clinical Features

  • Acute: intense pruritus, erythematous papulovesicles, excoriations, exudation, secondary infection
  • Sbacute: excoriated, erythematous scaly papules and plaques
  • Chronic: lichenification

Distribution

  • Infancy: scalp, face, extensor extremities-spared, diaper area
  • Childhood: flexural
  • Adulthood: flexural, hands, face, nipples

Treatment: irritant avoidance, nonsoap cleanser, emollients, baths, topical corticosteroids, topical calcineurin inhibitors (tacrolimus, pimercrolimus)

53
Q
A

Sebhorrheic Dermatitis - a subactue or chronic dermatitis of unknown cause typically confiend to sebaceous gland-rich skin of the head and trunk but occasionally involving intertriginous areas

Clinical Presentation

  • Scalp, ears, face, central chest and intertriginous areas
  • Pink-yellow to red-brown plaques with bran like to greasy scale
  • No or minimal itching except scalp in adults
  • Infantile = onset 1 wk, cradle cap
  • Adult = scalp>face>central chest and intertriginous areas, dandruff is in same disease spectrum
54
Q
A

Nummular Dermatitis - coin shaped (discoid) plaques that vary from papulovesicular and exudative to red and scaly

Clinical Presentation

  • Symmetrical
  • Extremities
  • Well-demarcated
  • >50 yrs old; increases in prevalence as age increases
  • Usually very pruritic
  • Chronic course
  • Associated with xerosis, infection?, and other types of dermatitis
55
Q
A

Nummular dermatitis

56
Q
A

Contact Dermatitis - an inflammatory process caused by contact with an exogenous agent

Clinical Presentation

  • Hands>face>general>arms
  • Two types: allergic and irritant
  • Most common allergens: nickel sulfate, neomycin sulfate, balsam of peru, fragrance mix, thimerosal
  • Hands and face are most common sites for irritant contact dermatitis
  • Acute irritant contact dermatitis: peaks within minutes to hours, burning stinging, soreness, erythema, edema, bullae, necrosis and ulceration, sharply demarcated, asymmetry
57
Q
A

Erythema Nodosum - a reactive hypersensitivity reaction that may occur in response to a number of antigenic stimuli

  • The most common form of panniculitis
  • F>M, 20-30 yrs
  • Panniculitis refers to inflammation of the subcutaneous fat
  • Abrupt onset of ill-defined red, tender 2-4cm plaques or nodules on the anterior shins (occasionally elsewhere)
  • The majority of patients with EN have evidence of recent streptococcal infection or have no identifiable cause
    • Triggers: streptococcal infection, URTI, TB/virus/chlamydia/fungi, sacoidosis, IBD, drugs ex. OCP
  • Individual lesions last 2 wks and resolve with bruise like color changes
  • Ulceration not a feature (unlike some other kinds of panniculitis)
  • Many patients have fever and generalized aching associated with onset of the skin lesions
  • Arthralgia occurs in more than 50% of patients and begins during the eruptive phase or can even precede the eruption by 2-4wks
  • EN associated with hilar adenopathy and can be accompanied by gastrointestinal symptomatology
58
Q
A

Erythema Multiforme

  • Abrupt onset of tender/painful macules or papules primarily on the hands and forearms, feet are sometimes involved
  • The lesions are fixed and evolve to central blistering
  • Mucosal erosions may be seen on the lips in some patients
  • The single most important trigger is recent herpes simplex virus reactivation (it can be subclinical)
59
Q
A

Erythema Multiforme - lip erosions, mucositis

60
Q
A

Urticaria “Hives”

  • Itchy and transient; the events of urticaria and angioedema are due to activation of dermal mast cells and therefore, histamine
  • Wheal: red, edematous papule or plaque which may develop central blanching (makes a ring)
    • The plasma leakage is in the superficial dermis
    • Well-demarcated
    • No surface change (scaling, exudation or crusting)
61
Q
A

Angioedema

  • Angioedema arises from edema of the deep dermis, fat or the submucosal tissues
  • The swelling is often painful, poorly defined, pale or skin colored
  • Lesions can last 24-72 hrs
  • ~50% of patients with chronic urticaria have coexistent angioedema
62
Q
A

Exanthem

  • A rash of actue onset and widespread (symmetric) distribution
  • Consists of blanchable red spots
  • These spots can be macules or papules
63
Q
A

Exanthem - Maculopapular Eruption

  • The most common examples of exanthemous eruptions are often called maculopapular; synonymous with morbilliform
  • The spots are typically monomorphic
64
Q
A

Exanthem - Scarlatiniform eruption

  • Any rash of acute onset with a picture of diffuse (sunburn-like) erythema is appropriately called scarlatiniform
  • Scarlet fever: toxigenic process mediated by streptococcal exotoxin
    • Fever
    • Sore throat
    • Abdominal pain
    • Malaise
65
Q
A

Primary Syphilis - Chancre

  • Painless
  • Macule to papule to erosion to ulcer
  • Clean base with serous exudate
  • Indurated
  • 40-50% have multiple chancres
  • Chancre redux, pseudochancre redux
  • Can last weeks untreated
  • Balanitis presentation
  • 15% of people with secondary syphilis still have chancre when they present with rash
66
Q
A

Secondary syphilis - papulosquamous rash

  • Secondary syphilis is likely to be a generalized rash, it is one of few things that can cause an eruption on the palms and soles
67
Q
A

Secondary Syphilis - Condyloma Lata

  • Secondary syphilis involves rash, alopecia, bone pain, condyloma lata
68
Q
A

Congenital Syphilis - “Snuffles”

  • Congenital Syphilis: “snuffles”, hepatosplenomegaly, desquamation, long bone abnormalities, mucous patches, perforation of palate, hutchinson’s teeth, “mulberry molars”, bone/cartilage malformations, sabre shins
69
Q
A

Impetigo

  • S. Aureus
  • Group II, Phage type 71
  • Rapidly evolving generalized exfoliative disease of young infants
  • Organism at a distant site
  • Starts as a bulla but rubs off and then crusts are left
70
Q
A

Staph Scalded Skin/Bullous Impetigo

  • S. Aureus
  • Group II, Phage type 71
  • Epidermolytic toxin separates skin below the stratum corneum
  • Fragile bullae break easily
  • Systemic symptoms as a reaction due to endotoxin
71
Q
A

Folliculitis

  • S. Aureus
  • Small white pustules around the opening of a hair follicle
  • Factors such as depilatories, shaving, elevated ambient temperature and humidity are predisposing conditions
72
Q
A

Furuncle

  • Deeper folliculitis AKA boil
  • Tender and hot
  • Single draining opening
73
Q
A

Carbuncle

  • Multiple deep communicating furuncles
  • Multiple draining openings
  • S. Aureus
74
Q
A

Ecthyma

  • Punched out deep ulcers
  • Strep pyogenes
  • Often heal with scarring
75
Q
A

Cellulitis

  • Deeper seated infection
  • S. Aureus
  • Local erythema and swelling which spreads rapidly
  • May be associated with lymphangitic spread
  • Skin will often show superficial necrosis after several days without treatment
  • Systemic symptoms often present; B-symptoms, sepsis
76
Q
A

Lymphangitis

  • Inflammation tracking up lymphatic vessels
  • Can happen with chemotherapy
  • Strep infection
77
Q
A

Erysipelas

  • Acute beta hemolytic group A strep
  • Involving superficial dermal lymphatics
  • Sharply marginated painful plaque
  • May have systemic symptoms
78
Q
A

Varicella

  • Herpes zoster virus (HZV)
  • Acute episode results in chicken pox
  • Dew drop on a petal
  • Febrile illness
  • Lesion appear in 3 successive crops
  • Heal in 10-14 days
79
Q
A

Zoster

  • Reactivation of HZV
  • Like all herpes viruses, the lesions are grouped vesicles on an inflammatory base
  • Dermatomal in distribution
  • Major complication is post herpetic neuralgia
80
Q
A

Verruca Vulgaris

  • Warts
  • Human papilloma virus
81
Q
A

Verruca Plana

82
Q
A

Molluscum Contagiosum

  • Pox (DNA) virus
  • Umbilicated papules
  • In sexually active adults it is considered an STI
83
Q
A

Dermatophyte Infection

  • Three majory genera: trichophyton, microsporum, and epidermophyton
  • This is a red and scaly patch, it can be blisters/pustules or annular plaques
  • The reaction on the skin is the host response
  • Microsporum is endemic in cats so people can be infected by their cats
84
Q
A

Kerion

85
Q
A

Tinea Pedis

86
Q
A

Tinea Unguis

87
Q
A

Candidiasis

  • Candida albicans
  • Mouth - oral thrush
  • Skin folds
    • Intertrigo
    • Satellite lesions common
88
Q
A

Candidiasis

  • Candida albicans
  • Mouth - oral thrush
  • Skin folds
    • Intertrigo
    • Satellite lesions are common
89
Q
A

Tinea Versicolor

  • Malassezia globosa
  • Species of yeast
  • A normal colonizer of adult skin
  • ‘Funny’ rash on the chest with a very fine scale on the surface
  • The small patches are versicolor: can be red, brown or white
    • This may be caused by heat and the organism attraction to sebum in the skin
90
Q
A

Scabies

  • Sarcoptes scabeii
  • Intesely pruritic
  • Burrows found on hands in adults
  • In young children also found on occipital scalp and feet
91
Q
A

Scabies

  • Scabies lifecycle:
    • Adult females deposit eggs as they burrow
    • Eggs hatch releasing larvae
    • Larvae molt into nymphs, larvae and nymphs are found in short burros called molting pouches
    • Mating occurs after the male penetrates the molting pouch of the adult female
    • Impregnated females extend their molting pouches into burrows, laying eggs
  • Transmission is person to person and fomites ex. bedding and clothing
  • Mites are found predominantly between fingers and on the wrists
  • Rash presents on back, buttocks, elbows, knees, axilla, genital areas
92
Q
A

Lice

93
Q

What are the 3 most common causes of alopecia?

A
  1. Alopecia areata
  2. Telogen effluvium
  3. Androgenic alopecia
94
Q

What is the pathognomonic feature of alopecia areata?

A

Exclamation point hairs

95
Q

In alopecia areata, what factors suggest poorer prognosis?

A. Younger age at onset

B. Ophiasis pattern

C. Extent of involvement

D. All of the above

E. None of the above

A

D. All of the above: younger age at onset, ophiasis pattern, extent of involvement

96
Q

How would you classify her alopecia?

A. Scarring diffuse

B. Scarring patterned

C. Non-scarig diffuse

D. Non-scarring patterned

A

D. Non-scarring patterned

97
Q

What are the steps for the initial management of a major burn?

A

Management of Major Burn

  • Remove clothes - stop the burning process
  • Major burn = Trauma
  • Follow ATLS protocol
    • Airway, Breathing, Circulation (ABCs)
    • Complete primary survey and obtain history
    • Secondary survey
98
Q

In a major burn patient, how do you address circulation (ABCs)?

A

Circulation

  • Start 2 large bore peripheral IVs
  • Ringer’s Lactate
  • In order to calculate the amount of fluid, need to know:
    • History and amount time since burn occurred
    • Depth of burn
    • Total body surface area burned
99
Q

How do you determin the amount of IV fluid required in a major burn patient?

A

Parkland Formula: Ringer’s Lactate

  • Amount of IV fluid required in 24 hrs = 4cc x wt (kg) x % TBSA burn
  • Give half of fluid in first 8 hrs
  • Give second half in the next 16 hrs
100
Q

How do you monitor fluid resuscitation of a major burn patient?

A

Fluid Resuscitation Monitoring

Urine output via Foley Catheter

  • Aim for 0.5-1.0cc/kg/hr
    • Color of urine: electrical burns and myoglobinuria (renal failure, compartment syndrome)
  • Assess: mental status, capillary refill, temperature of extremities
  • Investigations: electrolytes, creatinine, urea
101
Q

Define macule.

A

A macule is a lesion that is <1cm and flat.

102
Q

Define papule.

A

A papule is a lesion that is <1cm and elevated.

103
Q

Define a patch.

A

A patch is a lesion that is >3cm and flat.

104
Q

Define a plaque.

A

A plaque is a lesion that is >3cm and elevated.

105
Q

Define a vesicle.

A

A vesicle is a fluid filled lesion <1cm.

106
Q

Define a bullae.

A

A bullae is a fluid filled lesion >1cm.

107
Q
A

Pityriasis Rosea

  • Herald patch occurs before the rest of the eruption
  • Occasionally is preceded by mild URTI
  • Crop of lesions appear rapidly over the trunk, neck, upper arms and legs; lesions follow Langer’s skin lines
  • Often seen in clusters
  • Spontaneously resolve in 1-2 mths
  • Recurrences extremely rare
  • Salmon colored, trailing scale, oval
108
Q
A

Lichen planus

  • PAPULE
  • Flat topped, polygonal, purple papules
  • Idiopathic, pruritic, inflammatory condition
  • Ankles, wrists, mouth, genitalia
  • Can have Koebner’s phenomenon
  • Lesions often hypertrophic over lower legs
  • Buccal mucosal lesions are common; white streaks in reticulated ‘lacey’ pattern
109
Q
A

Lichen planus

  • PAPULE
  • Flat topped, polygonal, purple papules
  • Idiopathic, pruritic, inflammatory condition
  • Ankles, wrists, mouth, genitalia
  • Can have Koebner’s phenomenon
  • Lesions often hypertrophic over lower legs
  • Buccal mucosal lesions are common; white streaks in reticulated ‘lacey’ pattern
110
Q
A

Herpes Simplex

  • HSV 1 and 2
  • Grouped vesicle on an erythematous base
  • Vesicles
  • Primary infection and recurrences
  • Sites of predeliction:
    • HSV1 labial skin
    • HSV2 genital skin
    • Neonatal herpes
111
Q
A

Impetigo

  • Primarily caused by group 2 S. Aureus
  • Usually neonates or young children
  • Fragile bullae which rupture leaving weeping and crusted patches
112
Q
A

Hemangioma

  • Common, 3% of population
  • Red “strawberries”
  • Obviously vascular
  • Involute spontaneously in 90% of cases
  • No treatment unless growth interferes with a vital structure such as the eye or oropharynx
113
Q

What are the ABCDEs of lesions?

A
114
Q

What are the nail changes present in psoriasis?

A

Nail pits

Onycholysis: nail plate separation

Oil drop sign

115
Q
A

Auspitz’s Sign - individual silvery scales are plucked form psoriatic plaques, tiny pinpoint capillary bleeding may be seen

116
Q

True or false. Dark field microscopy is the most sensitive test for syphilis.

A

FALSE

117
Q

The RPR (Rapid Plasma Reagin) is specific for syphilis. T or F.

A

FALSE. It is NOT specific.

118
Q

Endocarditis does not cause a false positive test in the context of syphilis screening. T or F.

A

FALSE. Endocarditis can give a biologic false positive test.

119
Q

For contact dermatitis which would of the following would you complete?

Prick testing

Scratch testing

Punch biopsy

Patch testing

A

PATCH testing

Course 2 (MSK/Dermatology/Rheumatology) (14 decks)

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