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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
What does Rickettsia rickettsii cause?
RMSF | - serious illness caused by the tick-borne bacterium
26
Dx - sudden onset fever, headache, rash - history of tick bite +/- nonspecific sx (myalgia, GI complaints)
RMSF | - can lead to irreversible damage to internal organs and death if not treated correctly
27
Ddx erythematous macules | - blanchable and diffuse lesions
- drug eruption - infectious exanthems - secondary syphilis (palms and soles) - rheumatic fever (erythema marginatum) - RMSF (early stages, sparing palms and soles)
28
Ddx photodistributed macules
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
29
Dx - erythema in malar distribution (butterfly rash) or - diffuse erythema in photodistribution
SLE lesions
30
Dx - violaceous, periorbital heliotrope rash with edma - erythema of neck and upper trunk (shawl sign) - violaceous papule over knuckles (Gottron papules)
Dermatomyositis lesions
31
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?
Tinea versicolour (Pityriasis Versicolor) Dx via hyphae and spores on KOH prep (spaghetti and meatballs) Tx - Selenium sufide lotion - oral Ketoconazole
32
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?
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
33
Dx - often following acne, psoriasis, lichen plans, atopic dermatitis, trauma - often limited lesions to site of inflammation - indistinct borders - often darker skin types Tx?
Postinflammatory hyperpigmentation Tx - observation (most cases resolve spontaneously)
34
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?
Melasma Tx - may regress spontaneously - skin-lightening agents: hydroquinone, azelaic acid, tretinoin, kogic acid - chemical peels - sun protection
35
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?
Fixed drug eruption - fixed because recurs at same location Dx - clinical; drug challenge/ withdrawal Tx - stop offending agent
36
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?
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 ```
37
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)
Rubella
38
Dx - erythematous macules and papules - begin on face and spread cephalocaudally - small white spots (Koplik spots) can be on oral mucosa
Measles
39
Dx - bright red cheeks - followed by symmetric erythematous eruption on trunk and extremities
Erythema infectiousum
40
Dx - pink macules and papules - lesions surrounded by white halos - begins on trunk and spreads to neck and proximal extremities
Roseola
41
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?
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
42
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?
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 ```
43
What is Koebner phenomenon?
- physical trauma to skin = psoriasis plaque to form
44
What is Auspitz sign?
- scale removal (psoriasis) causes appearance of minute droplets of blood (not routinely tested)
45
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?
Lichen Planus r/o drug-induced lichenoid reaction Tx - topical corticosteroids - systemic agents in widespread cases (acitretin, cyclosporin)
46
Has lichen planus been associated with Hepatitis A, B or C?
``` Hep C (rare cases) - if pt has RF then test! ```
47
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?
Perioral dermatitis Tx - topical metronidazole - topical erythromycin - systemic abx (minocycline/ doxycycline/ tetracycline)
48
What percentage of hemangioma regress by age 7?
70%
49
What is a classic finding of a dermatofibroma?
Dimple sign | - pinching causes dimpling into surrounding skin
50
Dx - melanocytes nevi, or moles = pigmented macules, papules, or nodules arising from the proliferation of melanocytic nevus cells Subtypes?
Nevus - junctional nevus - compound nevus - dermal nevus - congenital nevus - dysplastic/ atypical nevus - halo nevus - blue nevus
51
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
Epidermoid cyst
52
Dx | - superficial white-yellow keratin containing epidermal cyst commonly found on cheeks and eyelids
Milium
53
Dx - pseudocyst that presents at bay of nail of finger or toe or on distal interphalangeal joint - associated with Heberden node
Digital myxoid cyst
54
Dx - hyper pigmented papules and plaques with warty surface and 'stuck on' appearance - increase incidence with age
Seborrheic keratosis
55
Dx - smooth papules with central umbilication and telangiectasia - common in elderly and tx with cyclosporin
Sebaceous hyperplasia
56
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
Lipoma
57
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
Dermatofibroma
58
Dx - result from fibrous repair tissues after injury - confined to original injury site vs. extend beyond original injury site
Hypertrophic scar = confined to injury site Keloid scar = extend beyond injury site
59
What is Gardner syndrome?
- 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
Dx - pearly papule or nodule with peripheral telangiectasis (multiple other presentations possible) - metastasis rare Tx?
BCC Tx - surgical excision - Mohs micrographic surgery - electrodissection and curettage - cyrotherapy - radiation - topical imiquimoc, 5-fluorouracil - photodynamic therapy
61
Dx - sharply demarcated scaling or hyperkeratotic papule, plaque or nodule - metastasis 5-10% Tx?
SCC Tx - surgical excision - photodynamic therapy for superficial SCC (in situ) - topical imiquimod (Bowen disease)
62
What is potential precursor to SCC? Tx?
Actinic keratosis | - cyrotheraphy or imiquimod
63
RF BCC and SCC?
RF - UV light (esp UVB) - ionizing radiation exposure - chronic immunosuppression - smoking - phototherapy with psoralens - chronic ulcers/ scars - arsenic ingestion - actinic keratoses
64
Prevention BCC and SCC?
- sun avoidance and protection - avoidance or protection from carcinogenic chemicals (arsenic) - regular skin self-exam
65
ABCDE malignant melanoma? Does it metastasize? | Tx?
``` 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
RF malignant melanoma? Prevention?
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
What is the most common clinicopathologic subtype primary cutaneous T-cell lymphoma? How does it present? Treatment?
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
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?
Bullous pemphigoid Tx - topical strong steroids for localized disease - PO prednisone/ steroid-sparing agents (methotrexate azathioprine, mycophenolate mophetil)
69
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?
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
What is Nikolsky sign?
Rubbing skin causes separation of epidermis and formation of new blister
71
What is Asboe-Hanson sign?
Rubbing lesion in lateral direction causes it to extend
72
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?
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
What is herpes on fingertip?
Herpetic whitlow
74
What is eczema secondarily infected with herpes?
Eczema herpeticum
75
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?
``` 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
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?
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
What is pruritus?
- sensation provoking desire to scratch
78
What type of hypersensitivity reaction is urticaria?
- type I (IgE mediated)
79
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?
Atopic dermatitis Stages - infantile - extensor surfaces, face, scalp - childhood - flexural surface, lichenification - adult - hand eczema, xerosis
80
What is thickening of skin with accentuated skin markings?
Lichenification
81
Where are Dennie-Morgan folds?
- infraorbital eyelid fold
82
Dx - excoriations from scratching; commonly start on palms and soles then generalized - jaundice Causes? Tx?
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
What endocrine disorders can cause pruritus?
- thyrotoxicosis (increased blood flow) - hypothyroid (xerosis) - DM (anhidrosis, infection) gastric carcinoid - histamine flush
84
General tx for pruritus?
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
Alopecia vs. cicatricial alopecia?
alopecia = hair loss | cicatricial alopecia = hair loss with fibrosis and scar tissue (scarring alopecia)
86
Most common cause of noncicatricial alopecia in men and women?
Androgenic alopecia
87
What deficiencies can cause depigmentation of hair shaft?
- protein and copper deficiency
88
What is increased daily hair loss triggered by physical or mental stressor to body?
Telogen effluvium
89
What is autoimmune disease causing localized round or oval patches of hair loss? Or all scalp hair lost? Or all body hair lost?
Alopecia Areata scalp = alopecia totalis body = alopecia universals
90
Investigations for alopecia?
- CBC - ferritin - TSH - if fungus suspected: microscopic exams and fungal culture +/- scalp biopsy, ANA, androgens
91
What is the separation of nail plate from nail bed?
Onycholysis
92
What is the severe thickening of the nail plate with deformed shape?
Onychogryphosis
93
What is a chronic fungal infection where the nail plate becomes yellowed, thickened, and dystrophic?
Onychomycosis
94
Organisms causing infections of nails (acute vs. chronic)?
Acute: S. aureus Chronic: C. albicans
95
Ddx finger clubbing
- CVD - lung disease - GI disorders - chronic methemoglobinemia
96
Ddx koilonychia (hollow/sppon shaped)
- iron deficiency - malnutrition - DM - old age
97
Onychomycosis fungal infection organisms?
- T rubrum | - T. mentagrophytes
98
Ddx transverse grooves/ Beau lines?
- acute significant systemic disease
99
Ddx transverse white lines/ transverse leukonychia
- hypoalbuminemia - chemo drugs - poisons
100
Ddx pitting to nail
- psoriasis - alopecia areata - eczema - paronychia - inflammatory damage
101
What nail change can tetracycline cause?
Yellowing of nail
102
Ddx splinter hemorrhages
- trauma (most common) - bacterial endocarditis - blood dycrasias
103
What is onychocryptosis?
Ingrown nails - inflammation and soft tissue hypertrophy +/- secondary infection occurring when lateral edge of nail plate impinges on nail fold
104
Is generalized red rash with fever, vesicles, mouth lesions, purpura and/or generalized scaling concerning?
Yes - investigate promptly
105
What are derm emergencies?
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
Stigmata of liver disease?
- jaundice - gynecomastia - caput medusa - loss of body hair - palmar erythema - peripheral edema - purpura - spinner angioma
107
Stigmata renal disease?
- photo distributed or diffuse hyper pigmentation (inc palms and soles), pallor, yellow tinge
108
Stigmata DM?
- acanthuses nigricans - foot ulcers - pruritus - light brown slightly indented scaly patches (diabetic dermopathy) - yellow skin and nails
109
Underlying conditions of pyoderma gangrenosum?
- UC - Crohn disease - RA
110
Stigmata Cushing syndrome?
- acanthosis nigricans - acne - buffalo hump - hirsutism - telangiectasia - striae - atrophic skin
111
Stigmata Neurofibromatosis
- cafe au last macules - freckling - multiple cutaneous neurofibromas
112
Stigmata Porphyria
- blister formation - photosensitivity - hypertrichosis - pigmentation - skin fragility
113
Stigmata hyperlipidemia
- xanthomas

MCC Part 1 (22 decks)

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