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MCC Part 1 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Name the lesion:

<1cm flat discoloured lesion

A

Macule

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2
Q

Name the lesion:

>1cm flat discoloured lesion

A

Patch

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3
Q

Name the lesion:

<1cm palpable raised lesion

A

Papule

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4
Q

Name the lesion:

>1cm palpable raised lesion

A

Plaque

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5
Q

Name the lesion:

<1cm lesion with significant depth

A

Nodule

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6
Q

Name the lesion:

>1cm lesion with significant depth

A

Tumor

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7
Q

Name the lesion:

>1cm fluid-containing lesion

A

Cyst

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8
Q

Name the lesion:

dilated superficial blood vessels

A

Telangiectasia

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9
Q

Name the lesion:

elevated lesion containing pus

A

Pustule

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10
Q

Name the lesion:

<1cm elevated lesion containing serous fluid

A

Vesicle

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11
Q

Name the lesion:

>1cm elevated lesion containing serous fluid

A

Bulla

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12
Q

Name the lesion:

transient blanch able papule or plaque

A

Wheal

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13
Q

Name the lesion:

scratch mark on the skin

A

Excoriation

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14
Q

Name the lesion:

area of diffuse thickening with increase in surface skin markings due to rubbing or scratching

A

Lichenification

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15
Q

Name the lesion:

increased stratum corneal cells shedding

A

Scales

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16
Q

Name the lesion:

dried exudates of blood, serum or pus

A

Crusts

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17
Q

Name the lesion:

linear break in skin

A

Fissure

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18
Q

Name the lesion:

shallow complete or partial loss of epidermis, heals without scarring

A

Erosion

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19
Q

Name the lesion:

irregular excavations extending into the dermis or deeper

A

Ulceration

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20
Q

Name the lesion:

thinning or depression of skin

A

Atrophy

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21
Q

Name the lesion:

connective tissue formations that replace lost tissue

A

Scar

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22
Q

Name the lesion:

decreased skin pigment

A

Hypopigmentation

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23
Q

Name the lesion:

increased skin pigment

A

Hyperpigmentation

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24
Q

Name the lesion:

depigmentation

A

Complete absence of skin pigment

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25
Q

What does Rickettsia rickettsii cause?

A

RMSF

- serious illness caused by the tick-borne bacterium

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26
Q

Dx
- sudden onset fever, headache, rash
- history of tick bite
+/- nonspecific sx (myalgia, GI complaints)

A

RMSF

- can lead to irreversible damage to internal organs and death if not treated correctly

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27
Q

Ddx erythematous macules

- blanchable and diffuse lesions

A
  • drug eruption
  • infectious exanthems
  • secondary syphilis (palms and soles)
  • rheumatic fever (erythema marginatum)
  • RMSF (early stages, sparing palms and soles)
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28
Q

Ddx photodistributed macules

A

Phototoxic drug reaction

  • NSAIDs, quinolone, tetracyclines, amiodarone, phenothiazines
  • exaggerated sunburn: erythema, deem, vesicles/bullae

Photoallergic drug reaction

  • soaps, fragrances (photoallergen and UVA interaction)
  • pruritic eruption indistinguishable from allergic contact dermatitis

-> location face, V of upper chest, dorsa of hands and forearms, sun-exposed areas

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29
Q

Dx

  • erythema in malar distribution (butterfly rash) or
  • diffuse erythema in photodistribution
A

SLE lesions

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30
Q

Dx

  • violaceous, periorbital heliotrope rash with edma
  • erythema of neck and upper trunk (shawl sign)
  • violaceous papule over knuckles (Gottron papules)
A

Dermatomyositis lesions

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31
Q

Dx

  • overgrowth M. furfur
  • mottled distribution of round/oval hyper- or hypopigmented macules with fine scaling (positive grattinage)
  • often on trunk

How do you diagnose? Tx?

A

Tinea versicolour (Pityriasis Versicolor)

Dx via hyphae and spores on KOH prep (spaghetti and meatballs)

Tx

  • Selenium sufide lotion
  • oral Ketoconazole
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32
Q

Dx

  • autoimmune reaction against melanocytes; associated with other autoimmune diseases (pernicious anemia, Hashimoto thyroiditis, DMT1)
  • acquired dipigmented macules or patches with sharp margins
  • isolated or generalized; often around eyes, mouth, digits, extensor surfaces, low back, genitalia

How do you dx? Tx?

A

Vitiligo

Dx - wood lamp to distinguish hypo pigmentation from depigmentation

  • no melanocytes on histology or microscopy
  • lab tests if thyroid disease, DM or pernicious anemia suspected

Tx

  • sun protection, camouflage preparations
  • regimentation with narrow band UVB, topical corticosteroids or topical immunomodulators
  • depigmentation for extensive disease with topical agents
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33
Q

Dx

  • often following acne, psoriasis, lichen plans, atopic dermatitis, trauma
  • often limited lesions to site of inflammation
  • indistinct borders
  • often darker skin types

Tx?

A

Postinflammatory hyperpigmentation

Tx
- observation (most cases resolve spontaneously)

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34
Q

Dx

  • F>M
  • if from sun exposure, triggered by pregnancy and exogenous hormones
  • acquired well-demarcated geographic-patterned macules and patches with irregular margins
  • commonly on central face (cheeks, forehead, nose, upper lip)

Tx?

A

Melasma

Tx

  • may regress spontaneously
  • skin-lightening agents: hydroquinone, azelaic acid, tretinoin, kogic acid
  • chemical peels
  • sun protection
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35
Q

Dx

  • adverse drug reaction occurring in same location
  • sharply marginated, round/oval, erythematous macules evolving to plaques, bullae, and erosions; recurrent episodes may leave prominent hyperpigmentated macules or patches

Dx? Tx?

A

Fixed drug eruption
- fixed because recurs at same location

Dx - clinical; drug challenge/ withdrawal

Tx
- stop offending agent

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36
Q

Dx

  • abnormal follicular keratinization, increased sebum secondary to androgens, Propionibacterium acnes (bacteria), inflammation
  • combination of comedones, papules, pustules, and if severe nodules and cysts

Dx? Tx?

A

Acne Vulgaris

Dx

  • non-inflammatory = open (black heads) and closed (white heads) comedones
  • inflammatory = papule, pustules, cysts, nodules; deep lesions leave scars
Tx
mild
- topical antibiotics (clindamycin/erythromycin)
- benzoyl peroxide
- topical retinoids
- salicylic acid
moderate
- add PO abx (minocycline/ doxycycline/ tetracycline)
- OCP/ antiandrogens in females
severe
- PO isotretinoin
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37
Q

Dx

  • pruritic, red macules and papules
  • begins on face and spreads to neck, trunk and extremities; takes 24h
  • red macules and papules are present on soft palate (Forchheimer sign)
A

Rubella

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38
Q

Dx

  • erythematous macules and papules
  • begin on face and spread cephalocaudally
  • small white spots (Koplik spots) can be on oral mucosa
A

Measles

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39
Q

Dx

  • bright red cheeks
  • followed by symmetric erythematous eruption on trunk and extremities
A

Erythema infectiousum

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40
Q

Dx

  • pink macules and papules
  • lesions surrounded by white halos
  • begins on trunk and spreads to neck and proximal extremities
A

Roseola

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41
Q

Dx

  • chronic inflammatory disorder of pilosebaceous units and vasculature of face
  • sebaceous hyperplasia and seborrheic dermatitis more common
  • erythema, telangiectasis, papules, and pustules of central face; no comedones (vs. acne)

Variants? Triggers? Tx?

A

Rosacea

Variants

  • Stage 1 -erythema and telangiectases
  • Stage 2 -papulopustular rosacea; nodules may be present if severe
  • Stage 3 -hyperplastic and phymatous rosacea (e.g. rhinopehyma) - coarse facial features plus soft tissue hyperplasia

Triggers

  • hot drinks, spicy food, EtOH
  • sun, heat

Tx

  • topical metronidazole
  • oral abx (minocycline/ doxycycline/ tetracycline)
  • laser for telangiectasia or rhinophyma
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42
Q

Dx

  • chronic, recurrent inflammatory skin condition with abnormal epidermal differentiation and hyper proliferation
  • commonly seen on elbows, knees, scalp, nails, intergluteal folds, palms and soles
  • consist of well-demarcated red papules and plaques with classic silvery scale
  • nail changes (pitting, oil drops, onycholysis, sublingual hyperkeratosis)

Tx?

A

Psoriasis

10-30% associated with psoriatic arthritis

Tx
body lesions
- medium-high potency corticosteroid topical
- calcipqotriol
- tar
- antralin
- tazarotene 
- intralesional triamcinolone
- phototherapy (UVB, PUVA)
- systemic rx (methotrexate, acitretin, cyclosporin)
facial/ intertriginous lesions
- low-potency corticosteroid
- tacrolimus/pimecrolimus
scalp
- tar shampoo
- topical corticosteroid
- calcipqotriol solution
- tazarotene
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43
Q

What is Koebner phenomenon?

A
  • physical trauma to skin = psoriasis plaque to form
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44
Q

What is Auspitz sign?

A
  • scale removal (psoriasis) causes appearance of minute droplets of blood (not routinely tested)
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45
Q

Dx

  • acute or chronic inflammatory disorder affecting the skin, mucous membranes, nails
  • pruritic purple, polygonal, planar (flat-topped) papules and plaques mainly on inner wrists, torso and extremities; overlying Wickham striae often seen
  • white reticulated lesions of mucosal surfaces (lips, buccal mucosa)

Tx?

A

Lichen Planus
r/o drug-induced lichenoid reaction

Tx

  • topical corticosteroids
  • systemic agents in widespread cases (acitretin, cyclosporin)
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46
Q

Has lichen planus been associated with Hepatitis A, B or C?

A 
Hep C (rare cases)
- if pt has RF then test!
47
Q

Dx?

  • inflammatory acneiform skin condition
  • may be exacerbated by topical steroid abuse
  • 1-2mm erythematous papulopustules distributed personally, with sparing of vermilion border
  • occasional periorbital distrubution

Tx?

A

Perioral dermatitis

Tx

  • topical metronidazole
  • topical erythromycin
  • systemic abx (minocycline/ doxycycline/ tetracycline)
48
Q

What percentage of hemangioma regress by age 7?

A

70%

49
Q

What is a classic finding of a dermatofibroma?

A

Dimple sign

- pinching causes dimpling into surrounding skin

50
Q

Dx
- melanocytes nevi, or moles = pigmented macules, papules, or nodules arising from the proliferation of melanocytic nevus cells

Subtypes?

A

Nevus

  • junctional nevus
  • compound nevus
  • dermal nevus
  • congenital nevus
  • dysplastic/ atypical nevus
  • halo nevus
  • blue nevus
51
Q

Dx

  • derived from epidermis or epithelium of hair follicle
  • formed by cystic enclosure of epithelium within the dermis that becomes filled with keratin and lipid-rich debris
  • dermal-to-SC nodule connected with surface by keratin-filled pores
A

Epidermoid cyst

52
Q

Dx

- superficial white-yellow keratin containing epidermal cyst commonly found on cheeks and eyelids

A

Milium

53
Q

Dx

  • pseudocyst that presents at bay of nail of finger or toe or on distal interphalangeal joint
  • associated with Heberden node
A

Digital myxoid cyst

54
Q

Dx

  • hyper pigmented papules and plaques with warty surface and ‘stuck on’ appearance
  • increase incidence with age
A

Seborrheic keratosis

55
Q

Dx

  • smooth papules with central umbilication and telangiectasia
  • common in elderly and tx with cyclosporin
A

Sebaceous hyperplasia

56
Q

Dx

  • benign, soft, rounded or lobulated subcutaneous tumors that are easily movable against overlying skin
  • composed of normal fat cells and commonly found on neck, trunk, extremities
A

Lipoma

57
Q

Dx

  • common button-like nodule presenting on extremities
  • often domed, raised, dermal red-brown nodule, but may be depressed
  • can be associated with history of insect bite or ruptured cyst
A

Dermatofibroma

58
Q

Dx

  • result from fibrous repair tissues after injury
  • confined to original injury site vs. extend beyond original injury site
A

Hypertrophic scar = confined to injury site

Keloid scar = extend beyond injury site

59
Q

What is Gardner syndrome?

A
  • rare autosomal dominant condition associated with colon cancer, in which multiple epidermal inclusion cysts are found and is assisted with osteoma, extracolonic, and demoed tumors
60
Q

Dx

  • pearly papule or nodule with peripheral telangiectasis (multiple other presentations possible)
  • metastasis rare

Tx?

A

BCC

Tx

  • surgical excision
  • Mohs micrographic surgery
  • electrodissection and curettage
  • cyrotherapy
  • radiation
  • topical imiquimoc, 5-fluorouracil
  • photodynamic therapy
61
Q

Dx

  • sharply demarcated scaling or hyperkeratotic papule, plaque or nodule
  • metastasis 5-10%

Tx?

A

SCC

Tx

  • surgical excision
  • photodynamic therapy for superficial SCC (in situ)
  • topical imiquimod (Bowen disease)
62
Q

What is potential precursor to SCC? Tx?

A

Actinic keratosis

- cyrotheraphy or imiquimod

63
Q

RF BCC and SCC?

A

RF

  • UV light (esp UVB)
  • ionizing radiation exposure
  • chronic immunosuppression
  • smoking
  • phototherapy with psoralens
  • chronic ulcers/ scars
  • arsenic ingestion
  • actinic keratoses
64
Q

Prevention BCC and SCC?

A
  • sun avoidance and protection
  • avoidance or protection from carcinogenic chemicals (arsenic)
  • regular skin self-exam
65
Q

ABCDE malignant melanoma? Does it metastasize?

Tx?

A 
Asymmetry
Border irregularities
Color variegation
Diameter >6mm
Evolution
  • mets common
Tx
surgical excision 
- in situ = 0.5 cm margins
- <2mm thick = 1 cm margins
- >2mm thick = 2 cm margins
\+/- LN dissection, adjuvant tx with chemo (interferon alpha 2-b)
66
Q

RF malignant melanoma? Prevention?

A

RF

  • skin type I/II (fair, red hair, blue eyes)
  • dysplastic nevus syndrome
  • congenital nevi
  • multiple atypical nevi
  • personal hx melanoma
  • FHx atypical nevi or melanoma
  • excessive sun exposure, especially sunburns during childhood and tanning bed use
  • immunosuppression
  • genetic markers (CDKN2A mutation)

Prevention

  • sun avoidance and sun protection
  • screen pt with FHx, dysplastic and multiple nevi
  • regular skin self-exam
67
Q

What is the most common clinicopathologic subtype primary cutaneous T-cell lymphoma? How does it present? Treatment?

A

Mycosis fungoides

  • presents has thin scaly red plaques in ‘bathing suit’ distribution - can progress to plaques, nodules or tumors
  • leonine facies if extensive infiltration

Tx

  • topical corticosteroid
  • nitrogen mustard
  • narrow band UVB, PUVA
  • total body electron beam therapy
68
Q

Dx
- autoimmune bullous skin disease affecting middle-aged or elderly pt
+/- pruritus
- widespread blistering eruption on erythematous or normal skin base
- erosions may be present after vesicles/ bullae burst
- flexure areas, groin and axilla are commonly involved
- oral lesions less common

Tx?

A

Bullous pemphigoid

Tx

  • topical strong steroids for localized disease
  • PO prednisone/ steroid-sparing agents (methotrexate azathioprine, mycophenolate mophetil)
69
Q

Dx

  • serious autoimmune blistering disease affecting pt 50-60 yr
  • painful skin lesions and/or oral mucosae
  • pruritus uncommon
  • flaccid blisters or epidermal bulla, or residual erosions
  • mouth ulcers common and often initial presentation
  • hyper pigmented patches can be seen after lesions healed
  • nonscarring

Tx?

A

Pemphigus Vulgaris

Tx

  • hospital admission to burn unit prn
  • Prednisone high dose then steroid-sparing agents started early disease while tapering prednisone: azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide, IVIG
  • Abx if secondary infection
70
Q

What is Nikolsky sign?

A

Rubbing skin causes separation of epidermis and formation of new blister

71
Q

What is Asboe-Hanson sign?

A

Rubbing lesion in lateral direction causes it to extend

72
Q

Dx

  • common viral infection affecting oral-facial vermilion border or genital mucosa
  • subclinical primary episode or several days of fever, malaise, lymphadenopathy, oral mucosal erosions
  • may be reactivated by stress, fever, UV light, trauma
  • grouped umbilicated vesicles on erythematous base; burning and itching may be preceding

Dx? Tx?

A

HSV-1 and HSV-2

Dx

  • Tzanck smear - multinucleate giant epithelial cells
  • viral culture or PCR from lesion swab
  • antibody testing of fluid from base of vesicle

Tx

  • often supportive
  • PO antiviral may reduce pain, viral shedding, healing time if within 72h
  • topical antivirals not beneficial
73
Q

What is herpes on fingertip?

A

Herpetic whitlow

74
Q

What is eczema secondarily infected with herpes?

A

Eczema herpeticum

75
Q

Dx

  • primary infection with VZV (chickenpox)
  • reactivation can be triggered with immunosuppression of stress
  • clusters of erythematous papules and vesicles commonly following pain in unilateral dermatomal distribution
  • lesions eventually crust and desquamate

Tx? Complication?

A 
Herpes Zoster (shingles)
- can result in postherpetic neuralgia

Tx

  • supportive
  • PO antiviral may reduce pain, viral shedding and healing time if within 72h
  • topical no benefit
76
Q

Dx

  • acute life-threatening mucocutaneous disorder with extensive necrosis and detachment of epidermis
  • often caused by drugs (carbamazepine, phenytoin, allopurinol, lamotrigine, NSAIDs, sulfa drugs)
  • life-threatening because multi system involvement
  • purpuric and erythematous macules -> flaccid blisters involving trunk, upper limbs, mucous membranes (buccal, genital, ocular)
  • positive Nikolsky sign

Tx?

A

Stevens-Johnson Syndrome
- <10% BSA
Toxic Epidermal Necrolysis
- >30% BSA

  • overlap = 10-30% BSA re: total area of detached/ detachable epidermis

Tx

  • d/c culprit drug
  • supportive (burn unit, ICU), ophthalmology assessment
  • abx if infection
  • IVIG (controversial)
77
Q

What is pruritus?

A
  • sensation provoking desire to scratch
78
Q

What type of hypersensitivity reaction is urticaria?

A
  • type I (IgE mediated)
79
Q

Dx

  • hypersensitivity reaction characterized by severe pruritus and dry skin; associated with personal of FHx of atopy (asthma, eczema, hay fever)
  • aggravated by inhalants, winter, wool, emotional stress, excessive hand washing, foods
  • erythematous patches/ papules/ plaques
  • associated scales, crusts, excoriations from scratching or secondary infection
  • lichenification, fissures and Dennie-Morgan folds

Stages?

A

Atopic dermatitis

Stages

  • infantile - extensor surfaces, face, scalp
  • childhood - flexural surface, lichenification
  • adult - hand eczema, xerosis
80
Q

What is thickening of skin with accentuated skin markings?

A

Lichenification

81
Q

Where are Dennie-Morgan folds?

A
  • infraorbital eyelid fold
82
Q

Dx

  • excoriations from scratching; commonly start on palms and soles then generalized
  • jaundice

Causes? Tx?

A

Causes

  • PBC (pruritus = presenting sx in 50%)
  • renal disease
  • cholestasis of pregnancy
  • cholestasis from drugs

Tx

  • bile acid resins (cholestyramine, colestipol)
  • opioid antagonist (naloxone)
83
Q

What endocrine disorders can cause pruritus?

A
  • thyrotoxicosis (increased blood flow)
  • hypothyroid (xerosis)
  • DM (anhidrosis, infection)

gastric carcinoid - histamine flush

84
Q

General tx for pruritus?

A

Topical

  • cooling agents (menthol)
  • emolients
  • topical corticosteroids
  • anesthetics
  • capsaicin

Phototherapy - UVB

Systemic

  • H1 antihistamines (hydroxyzine, doxenin)
  • systemic corticosteroids
  • opioid receptor antagonist

Other

  • TENS
  • acupuncture
85
Q

Alopecia vs. cicatricial alopecia?

A

alopecia = hair loss

cicatricial alopecia = hair loss with fibrosis and scar tissue (scarring alopecia)

86
Q

Most common cause of noncicatricial alopecia in men and women?

A

Androgenic alopecia

87
Q

What deficiencies can cause depigmentation of hair shaft?

A
  • protein and copper deficiency
88
Q

What is increased daily hair loss triggered by physical or mental stressor to body?

A

Telogen effluvium

89
Q

What is autoimmune disease causing localized round or oval patches of hair loss? Or all scalp hair lost? Or all body hair lost?

A

Alopecia Areata
scalp = alopecia totalis
body = alopecia universals

90
Q

Investigations for alopecia?

A
  • CBC
  • ferritin
  • TSH
  • if fungus suspected: microscopic exams and fungal culture
    +/- scalp biopsy, ANA, androgens
91
Q

What is the separation of nail plate from nail bed?

A

Onycholysis

92
Q

What is the severe thickening of the nail plate with deformed shape?

A

Onychogryphosis

93
Q

What is a chronic fungal infection where the nail plate becomes yellowed, thickened, and dystrophic?

A

Onychomycosis

94
Q

Organisms causing infections of nails (acute vs. chronic)?

A

Acute: S. aureus
Chronic: C. albicans

95
Q

Ddx finger clubbing

A
  • CVD
  • lung disease
  • GI disorders
  • chronic methemoglobinemia
96
Q

Ddx koilonychia (hollow/sppon shaped)

A
  • iron deficiency
  • malnutrition
  • DM
  • old age
97
Q

Onychomycosis fungal infection organisms?

A
  • T rubrum

- T. mentagrophytes

98
Q

Ddx transverse grooves/ Beau lines?

A
  • acute significant systemic disease
99
Q

Ddx transverse white lines/ transverse leukonychia

A
  • hypoalbuminemia
  • chemo drugs
  • poisons
100
Q

Ddx pitting to nail

A
  • psoriasis
  • alopecia areata
  • eczema
  • paronychia
  • inflammatory damage
101
Q

What nail change can tetracycline cause?

A

Yellowing of nail

102
Q

Ddx splinter hemorrhages

A
  • trauma (most common)
  • bacterial endocarditis
  • blood dycrasias
103
Q

What is onychocryptosis?

A

Ingrown nails
- inflammation and soft tissue hypertrophy +/- secondary infection occurring when lateral edge of nail plate impinges on nail fold

104
Q

Is generalized red rash with fever, vesicles, mouth lesions, purpura and/or generalized scaling concerning?

A

Yes - investigate promptly

105
Q

What are derm emergencies?

A

Vesiculobullous disorders

  • SJS/TEN
  • pemphigus vulgaris
  • bullous pemphigoid

Infections

  • hemorrhagic fevers
  • Leprosy (reversal rxn on tx) mucormycosis
  • necrotizing fasciitis
  • neonatal HSV
  • RMSF
  • still disease, trichinosis, tularaemia

Autoimmine

  • systemic and neonatal lupus erythematosus
  • dermatomyositis

Inflammatory cutaneous disorders

  • acne fulminans
  • acute drug eruption
  • acute pustular psoriasis
  • exfoliative erythroderma
  • Kawasaki syndrome
  • pyoderma gangrenosum
  • scarring alopecia
106
Q

Stigmata of liver disease?

A
  • jaundice
  • gynecomastia
  • caput medusa
  • loss of body hair
  • palmar erythema
  • peripheral edema
  • purpura
  • spinner angioma
107
Q

Stigmata renal disease?

A
  • photo distributed or diffuse hyper pigmentation (inc palms and soles), pallor, yellow tinge
108
Q

Stigmata DM?

A
  • acanthuses nigricans
  • foot ulcers
  • pruritus
  • light brown slightly indented scaly patches (diabetic dermopathy)
  • yellow skin and nails
109
Q

Underlying conditions of pyoderma gangrenosum?

A
  • UC
  • Crohn disease
  • RA
110
Q

Stigmata Cushing syndrome?

A
  • acanthosis nigricans
  • acne
  • buffalo hump
  • hirsutism
  • telangiectasia
  • striae
  • atrophic skin
111
Q

Stigmata Neurofibromatosis

A
  • cafe au last macules
  • freckling
  • multiple cutaneous neurofibromas
112
Q

Stigmata Porphyria

A
  • blister formation
  • photosensitivity
  • hypertrichosis
  • pigmentation
  • skin fragility
113
Q

Stigmata hyperlipidemia

A
  • xanthomas

MCC Part 1 (22 decks)

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