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Foundations II > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What type of benign skin lesion is typically soft, round, macules or papules with uniform color and border?

A

acquired melanocytic nevus

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2
Q

What type of benign skin lesion usually presents as changing blue to black, sometimes pink to red, papul or plaque that may ulcerate or bleed?

A

Nodular melanoma

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3
Q

What type of benign skin lesion typically appear sharply marginated, pigmented papular or macular after 4th decade and on?

A

seborrheic keratoses

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4
Q

What type of benign skin lesion presents as hyperkeratotic, exophytic, dome-shaped papules or plaques?

A

Verruca vulgaris (common wart)

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5
Q

What are keratin pseudocyts?

A

small white spots commonly found in seborrheic keratoses

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6
Q

What type of benign skin lesion is multiple, small, hyperpigmented, sessile to filiform, smooth-surfaced papules that usually arise on the cheeks and temples of darker skinned patients?

A

dermatosis papulosa nigra

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7
Q

What is the best treatment for dermatosis papulosa nigra?

A

electrodessication

*NOT liquid nitrogen!

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8
Q

What type of benign lesion is a small, white-gray SK on the dorsal feet or ankles of older, fair-skinned patients?

A

stucco keratoses

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9
Q

What is the fancy name for skin tags?

A

acrochordons

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10
Q

What type of benign skin lesions can be a marker for insulin resistance?

A

acanthosis nigricans

acrochordons

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11
Q

What type of skin lesion presents as a pearly papule or nodule with a smooth surface and often with telangiectasia?

A

basal cell carcinoma?

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12
Q

What type of skin lesion is round to oval, bright red, dome-shaped papules?

A

cherry angioma

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13
Q

What type of skin lesion is small, round, hemorrhagic macules?

A

petechiae

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14
Q

What type of benign skin lesion is firm, hyperpigmented, dome-shaped papule tumor with peripheral rim darkening?

A

dermatofibroma

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15
Q

What type of benign skin lesion is minimally elevated to thicker, rough, scaly papules with an underlying red base?

A

actinic keratosis

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16
Q

What skin findings are associated with cirrhosis?

A

jaundice
spider angiomas
palmar erythema
nail changes

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17
Q

What is the fancy name for sun spot, age spot, or liver spot?

A

solar lentigo

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18
Q

What type of benign lesion is due to sebaceous gland enlargement, yellow in color and umbilicated?

A

sebaceous hyperplasia

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19
Q

What type of benign skin lesion result from abnormal wound healing leading to overgrowth of scar tissue beyond the original scar site?

A

Keloid

-most common on upper trunk and earlobes

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20
Q

What has been the main treatment for keloids?

A

intralesional corticosteroid injections

*NOT surgery- reoccur!

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21
Q

What is the most common type of cutaneous cyst that is a mobile dermal nodule, often with an overlying punctum?

A

epidermal inclusion cyst

AKA sebaceous cyst- although comes from hair follicle

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22
Q

What benign skin lesion are tiny epidermoid cysts that are fixed yellow subepidermal papules?

A

milia

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23
Q

What type of benign skin lesion is a soft, rubbery, mobile, subcutaneous nodule?

A

lipoma

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24
Q

When warts spread due to trauma what is this called?

A

koebnerize

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25
Q

What is the fancy name for common warts?

A

verruca vulgaris

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26
Q

What virus causes verruca vulgaris?

A

HPV 2,4

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27
Q

What is the fancy name for flat warts?

A

Verrucae plana

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28
Q

What virus causes verrucae plana?

A

HPV 3,10

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29
Q

What virus causes palmoplantar warts?

A

HPV 1

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30
Q

What is the fancy name for external genital warts?

A

Condylomata acuminata

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31
Q

What virus causes Condylomata acuminata?

A

HPV 6, 11, 16, 18, 31 and more

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32
Q

When is the peak prevalence of warts?

A

adolescence (13-16 y/o)

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33
Q

What are mosaic warts?

A

plantar warts coalescing into large plaques

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34
Q

Acne vulgaris is a disorder of what?

A

pilosebaceous follicles

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35
Q

When does acne start, peak, and resolve by?

A

starts- 8-12
peaks- 15-18
resolves- 25

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36
Q

What percent of men and women will have acne until their 40’s?

A

men-3%

women- 12%

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37
Q

What is a comedone?

A

a clogged pore (pilosebaceous unit)

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38
Q

What are open and close comedones?

A

open- blackheads

closed- whiteheads

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39
Q

What are the 4 factors involved in the formation of acne lesions?

A
  1. increase in sebum production (influenced by androgens)
  2. keratin and sebum plug the hair follicle and accumlate leading to hyperkeratosis
  3. P. acnes (bacteria) proliferates in sebaceous follicle and cytokines are released
  4. inflammatory response
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40
Q

What are the morphology classes of acne?

A

comendonal- white and blackheads
inflammatory- papules and pustules
nodulocystic- nodules and cysts

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41
Q

Along with the morphology of the acne, what is equally as important to describe?

A

the severity and presence of scarring.

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42
Q

What is the mechanism for topical retinoids?

A

Vitamin A derivatives that act by normalizing desquamation of follicular epithelium

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43
Q

What are common adverse effects of topical retinoids?

A 
dryness
pruiritus
erythema
scaling
photosensitivity
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44
Q

What are some available forms and names of topical retinoids?

A

tretinoin
adapalene
tazarotene
(cream, gel, lotion, solution)

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45
Q

What happens if you combine benzoyl peroxide and topical retinoids?

A

the benzoyl peroxide oxidizes the tertinoin

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46
Q

What topical retinoids should you use during pregnancy?

A

tertinoin and adapalene- other agents are preferred

tazarotene- contraindicated

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47
Q

What is the mechanism of benzoyl peroxide?

A

antibacterial and comedolytic properties- acts via the generation of free radicals that oxidize the proteins in P. acnes cell wall

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48
Q

What are common adverse effects of benzoyl peroxide?

A
  • bleaching of hair, fabric or carpet

- may irritate skin

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49
Q

What is the mechanism of topical antibiotics for acne?

A

reduce the number of P. acnes and reduce inflammation

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50
Q

What are forms of topical antibiotics for acne?

A

erythromycin 2% (solution, gel)

clindamycin 1% (lotion, solution, gel, foam)

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51
Q

What are common adverse effects to using topical antibiotics for acne?

A

irritating skin
dry skin
-when using retinoids or benzoyl peroxide- consider beginning on alternate days

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52
Q

Acne treatment targets what?

A

new lesions- not present ones

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53
Q

What is the most common cause of acne treatment failure?

A

lack of adherence- therapy needs to be continued for at least 8 weeks before a response can be evaluated (topical agents take 2-3 months to see effect)

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54
Q

Daily use of what kind of moisturizer may improve skin dryness and irritation?

A

ceramide moisturizers (maintains skin moisture barrier)

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55
Q

What type of diet may improve acne?

A

low glycemic diets

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56
Q

What is the mechanism of oral antibiotics for acne?

A

reduces P. acnes colonization of the skin and follicles

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57
Q

When do you use oral antibiotics for acne?

A

moderate to severe inflammatory acne

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58
Q

What are oral antibiotics usually combined with for the treatment of acne?

A

often combined with benzoyl peroxide to prevent antibiotic resistance

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59
Q

What are some names of oral antibiotics used to treat acne?

A

tetracycline
doxycycline
minocyclin

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60
Q

What are some adverse effects to oral antibiotics when treating acne?

A

GI upset
photosensitivity
minocycline- can cause vertigo, dizziness and hyperpigmentation
contraindicated for pregnancy or less than age 8

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61
Q

Do tetracyclines interfere with birth control pills?

A

no

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62
Q

What medication can cause hyperpigmentation after months to years of use for acne?

A

minocycline- patients on long-term use should be screened; if seen in gums or sclerae- d/c

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63
Q

What is the mechanism for isotretinoin?

A

it is a retinoic acid derivative that targets all four of the pathophysilogic factors involved in acne

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64
Q

When should you think about giving isotretinoin?

A

in severe nodulocystic acne that is failing other therapies- given i 5-6 month course

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65
Q

What are common side effects of isotretinoin?

A

dry skin, chapped lips, elevated liver enzymes, and hypertriglyceridemia

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66
Q

Females must use how many forms of contraception during isotretinoin therapy?

A

2 forms- and continue for one month after treatment

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67
Q

What is the initial therapy given for mild acne: comedones with fe inflammatory lesions?

A

topical retinoid OR benzoyl peroxide

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68
Q

What is the initial therapy given for moderate acne: comedones with marked number of inflammatory lesions?

A

combination therapy with topical retinoid and benzoyl peroxide +/- topical antibiotic

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69
Q

What is the initial therapy given for severe acne: extensive inflammatory lesions with diffuse scaring?

A

combination therapy with oral antibiotic, topical retinoid and benzoyl peroxide +/- topical antibiotic (if doesn’t work consider isotretinoin)

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70
Q

What are possible causes of mid-childhood acne (acne between 1-7)?

A 
adrenal tumor
gonadal tumor
congenital adrenal hyperplasia
cushing syndrome
precocious puberty
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71
Q

What is the side effect of using tetracyclines in children younger than 8?

A

damage tooth enamel and developing bones

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72
Q

In most post-adolescent women, what type of therapy can improve acne?

A

antiandrogen therapy- hormonal acne even though their serum hormone levels are usually normal

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73
Q

What medications are commonly used for hormonal acne?

A

spirnolactone and oral contraceptives

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74
Q

What are the side effects of spirnolactone?

A

diuresis, hyperkalemia, irregular menses, feminization of a male fetus during pregnancy

75
Q

What is the mechanism of spirnolactone in treating hormonal acne?

A

androgen-receptor blocker

inhibitory of 5-alpha reductase

76
Q

What can trigger acne rosacea?

A 
alcohol
sunlight
hot beverages or heat
spicy food
emotional stress
*many patients have ocular involvemen*
77
Q

What is the treatment for acne rosaea?

A

topical and oral treatments to improve papules and pustules- but cannot reverse underlying erythema and flushing

78
Q

What is described as erythematous papules and pustules without scaling usually located around the mouth, nose and eyes?

A

periorifical dermatitis

79
Q

What typically causes periorifical dermatitis?

A

most patients have a history or current use of topical steroid- rash often improves with cessation

80
Q

What is the medication treatment for periorifical dermatitis?

A

oral tetracycline for patients >8
erythromycin for patients <8
topical: metronidazole, erythromycin, pimecrolimus

81
Q

What are the peak onset ages for psoriasis?

A

20-30 and 50-60

82
Q

Is psoriasis genetic?

A

strong genetic component:

30% have first-degree relative with it

83
Q

What is the cycle of psoriasis?

A

waxes and wanes- few spontaneous remissions

84
Q

What causes psoriasis?

A

chronic immune-mediated disease predominately with skin and joint manifestations

85
Q

What are the different types of psoriasis?

A

plaque- scaly, erythematous patches, papules and plaques
Inverse/Flexural- erythematous patches located in skin folds
Guttate- presents with dew drop-like lesions 1-10 mm pink papules with fine scale
Erythrodermic- generalized erythema covering nearly entire body surface with varying degrees of scaling
Pustular- pustules

86
Q

What are the different types of pustular psoriasis?

A

von Zumbusch- (rare) generalized pustues

Palmoplantar- pustules on palms and soles

87
Q

Where does Guttate Psoriasis usually occur on the body?

A

trunk and extremities

88
Q

What often preeceds Guttate Psoriasis?

A

strep pharyngitis

89
Q

What often triggers pustular psoriasis?

A

corticosteroid withdrawal

90
Q

What type of psoriasis can be life threatening?

A

generalized pustular psoriasis

-should be hospitalized and dermatology consult

91
Q

What else occurs on the palms and soles that is indistinguishable from palmoplantar psoriasis?

A

skin lesions of reactive arthritis

92
Q

Is palmoplantar psoriasis plaque or pustular?

A

can be either plaque or pustular

93
Q

Besides pustular psoriasis, which other type of psoriasis may require hospitilization?

A

psoriatic erythroderma

94
Q

What is psoriatic erythroderma psoriasis associated with?

A

fever, chills and malaise

95
Q

What is auspitz sign?

A

bleeding after removal of scale in psoriasis

96
Q

What is koebner phenomenon?

A

lesions induced by trauma in psoriasis

97
Q

How can you describe the distribution of chronic plaque psoriasis?

A

typically symmetric and bilateral

98
Q

What is the most common form of psoriasis?

A

plaque psoriasis- affects 80-90%

99
Q

Systemic treatment of psoriasis target what?

A

cytokines and immune cells that cause skin proliferation

100
Q

What type of psoriasis can you use topical steroids in and what are the side effects?

A

all types

-skin atrophy, hypopigmentation, striae

101
Q

What type of psoriasis can you use Calcipotriene (vitamin D derivative) and what are the side effects?

A

use in combo or rotation w/ topical steroids for added benefit
-skin irritation, photosensitivity (but can still use light therapy)

102
Q

What type of psoriasis can you use Tazarotene (Topical retinoid) and what are the side effects?

A

plaque- best used in combo with topical corticosteroids

-skin irritation, photosensivity

103
Q

What type of psoriasis can you use coal tar in, and what are the side effects?

A

plaque

-skin irritation, odor, staining of clothes

104
Q

What type of psoriasis can you use calcineurin inhibitors in and what are the side effects?

A

off label use for facial and interginous psoriasis

-skin burning and itching

105
Q

There is a positive correlation between increased BMI and what in psoriasis?

A

prevalence and severity

106
Q

Patients with psoriasis have a greater risk of what disease?

A

cardiovascular disease

107
Q

30% of psoriasis pts also have what type of arthritis?

A

psoriatic arthritis

108
Q

What type of medication should never be given in psoriasis and why?

A

oral steroids- will severely flare psoriasis upon discontinuation

109
Q

In moderate to severe psoriasis what should be supplemented with topical treatment?

A

systemic treatment

110
Q

What are types of systemic treatment for psoriasis?

A
  1. phototherapy
  2. new oral meds- methotrexate, acitretin, cylclosporin, apremilast
  3. biologic agents
111
Q

What type of psoriasis does not typically work well with phototherapy treatment?

A

thick plaques

112
Q

What is dactylitis?

A

“sausage digit” of 2nd toe and interphalangeal joint destruction

113
Q

What is onychodystrophy?

A

nail pitting and onycholysis

114
Q

When is psoriatic arthritis better and more painful?

A

worse after inactivity- better with movement

115
Q

Does the severity psoriasis and arthritis correlate?

A

severity may not correlate

116
Q

Is psoriatic arthritis continuous?

A

usually has flares and remissions

117
Q

How often are nails involved in psoriasis and in what types?

A

all types of psoriasis
fingernails- 50%
toenails- 35%

118
Q

What is subungual hyperkeratosis?

A

abnormal keratinization of distal nail bed (in psoriasis)

119
Q

What is oil drop sign?

A

irregular area of yellow-orange discoloration visible through the nail plate (in psoriasis)

120
Q

What types of medications can make psoriasis worse?

A 
Systemic corticosteroid treatment
Beta Blockers
Lithium
Antimalarials
Interferons
NSAIDS
121
Q

What is the formal name for athlete’s foot?

A

tinea pedis

122
Q

What is the most common fungal infection seen in developed countries?

A

tinea pedis

123
Q

What is tinea pedis caused by?

A

fungus trichophyton rubrum

124
Q

What is the most common type of athlete’s foot and what does it look like?

A

interdigital- scaling and redness between toes

125
Q

How would you describe moccasin type athletes foot?

A

hyperatotic- sharp marginated scale distribute along lateral borders of feet, heels, and soles

  • often associated with onychomycosis
  • often affects one hand too- “one hand, two feet syndrome”
126
Q

How would you describe vesiculobullous type of athletes foot?

A

grouped 2-3 mm vesicles often on arch or instep, often scale on sole

127
Q

What is the easiest and most cost effective method used to diagnose fungal infections of the hair, skin and nail?

A

KOH microscopy- dissolves kertinocytes and can see hyphae

128
Q

What is the first and second line therapy for tinea pedis, corporis, and cruris?

A

1st- imidazoles (fungistatic)
2nd- allylamines (fungicidal)
-topical cover twice a day for a month

129
Q

What is the formal name for ringworm?

A

tinea corporis- dermatophytosis of the skin usually affecting trunk and limbs

130
Q

How would you describe ring worm appearance?

A

margin of lesion is active with central area healing

- annular lesion with central clearing

131
Q

What is the formal name for jock itch?

A

tinea cruris

132
Q

When should you use oral antifungals rather than topical?

A
  • poor response to topical tx
  • animal is suspected source of infection
  • large body area involved
133
Q

What oral antifungal is first line, how long do you give it and what should you monitor?

A

Terbinafine
7-14 days
check LFTs if giving more than 7 days

134
Q

What is onychomycosis and what usually causes it?

A

chronic fungal infection of nailbed- usually starts as tinea pedis

135
Q

What is necessary before prescribing oral antifungals for onychomycosis?

A

confirmation of fungus- culture

-resistant to topical treatment

136
Q

What is the first line treatment of oncyhomycosis?

A

oral Terbinafine for 12 weeks

137
Q

How many people are cured from oncyhomycosis?

A

50% of patients

138
Q

What are the risks of taking Terbinafine?

A

hepatotoxicity
reversible taste disturbance
drug interactions (P450, CYP2D6 inhibitor)
skin reactions

139
Q

What causes tinea versicolor- AKA pityriasis versicolor?

A

not a dermatophyte- colinization of lipophilic yeast- Malassezia

140
Q

When does tiniea versicolor tend to appear?

A

annully in summer months

141
Q

How would you describe tinea versicolor?

A

well demarcated tan, salmon or hypopigmented of hyperpigmented patches commonly on trunk and arms

142
Q

What do you see under microscope with tinea versicolor?

A

“spaghetti and meatball” pattern

short hyphae and small round spores

143
Q

What are the first second and third line treatments for tinea versicolor?

A

1st- shampoo w/ selenium sulfide 2%
2nd- imadazole creams
3- oral medications Fluconazole or Itraconazole

144
Q

What is candidal intertrigo?

A

inflammation of large skin folds (breasts, butt, inguinal creases, under abdomen)

145
Q

What causes candidal intertrigo?

A

collinization of candida yeast

146
Q

What are the classic signs and symptoms of candidal intertrigo?

A

burns more than itches

satellite macules, papules or pustules around the erythema in the fold

147
Q

What is the first line treatment for candidal intertrigo?

A

clotrimazole cream (an Imidazole)- better than nystatin

148
Q

What medication class is not effective for candida yeast?

A

allylamines

149
Q

What medication can you give for candidal intertrigo that rapidly improves the itching and burning?

A

low-strength corticosteroid

-ointments burn less than creams

150
Q

What is seborrheic dermatitis and inflammatory reaction to?

A

normal flora on oil producing skin- Malassezia yeast

151
Q

Can seborrheic dermatitis be cured?

A

no- chronic condition that can be controlled but not cured

152
Q

How does seborrheic dermatitis present?

A

erythematous scaling patches on the scalp, hairline, eybrows, eyelids, central face, nasolabial folds, external auditory canals, or central chest
-often hypopigmented in dark skinned pts

153
Q

How do you treat seborrheic dermatitis?

A

topical ketoconazole-reduces yeast count
low potency topical steroid
antidandruff shampoo

154
Q

What type of skin type does squamous cell most commonly occur in?

A

white/fair skin

155
Q

What body location does squamous cell usually occur?

A

head, neck, forearms, dorsal hands (sun-exposed areas)

156
Q

For African Americans, what part of their skin gets squamous cell more?

A

incidence of sun-protected and sun-exposed skin presents equally

157
Q

Do you have report squamous cell and basal cell carcinoma?

A

No- non melanoma doesn’t have to be reported- so the rates are under-reported

158
Q

What is squamous cell in non sun-exposed areas related to?

A

chemical carcinogen exposure (ex. arsenic)

159
Q

What items are included in the group 1- most dangerous cancer-causing entities/substances of the skin?

A

UV tanning beds
cigarettes
plutonium

160
Q

What does squamous cell look like?

A

various morphologies- papule, plaque, nodule, exophytic (grows outward), indurated, friable (bleeds with minimal trauma)
-usually asymptomatic, may be pruitic and tender

161
Q

What is another name for Squamous cell in situ, and what makes this diagnosis?

A

Bowmen’s disease

-kaertinocyte atypia is confined to the pidermis and does not go past the dermal-epidermal junction

162
Q

What are common clinical signs of squamous cell in the nail bed?

A

-male age 50-69

warty, subungual hyperkeratosis, onycholysis, oozing, destruction of nail plate

163
Q

What are the non-surgical options for treating squamous cell?

A 
radiation- for poor surgical candidates
5-Fluorouracil cream (interferes w/ DNA synthesis)
Imiquimod cream (synthetic immune response modifier)
Diclofenac gel (downregulates enzymes and increases apoptosis)
Ingenol Metubate (causes cellular death followed by inflammatory response)
Photodynamic therapy (In-situ)
164
Q

What locations on the body are at risk of higher metastasis of squamous cell?

A

ears, non-hair bearing lip, scalp, masc of face region, in scars, chronic ulcers, burns sinus tracts or genitalia

165
Q

What are the follow-up guidelines for people who have non-metastatic squamous cell?

A

every 3-6 months for 2 years, every 6-12 months for 3 years, then annually for life

166
Q

Actinic Keratosis is a premalignant lesion and have the potential to turn into what type of cancer, and how often?

A

squamous cell- but risk of transformation within a year is 8%

167
Q

What gene is affected by UV exposure putting you at higher risk for actinic keratosis?

A

p53 tumor suppressor gene

168
Q

How is actinic keratosis typically diagnosed?

A

by feel (feels like sandpaper- but not indurated)

169
Q

What is the fancy name for age spots and what causes them?

A

Solar Lentigo or Lentigines

-UV damage

170
Q

What is the fancy name for old people’s skin easily brusing?

A

Actinic (senile) Purpura

171
Q

What is actinic keratosis of the lips called, and where does it most often occur?

A

actinic cheilitis- most often on lower lip

172
Q

How often should patients with actinic keratosis get skin exams and why?

A

every 6-12 months because they are at increased risk of developing non-melanoma and melanoma skin cancers

173
Q

How much sunscreen is the recommended amount of sunscreen to cover expose skin?

A

1 ounce- 1 shot glass

174
Q

What is the most common type of cancer?

A

skin cancer as a group (basal cell, squamous cell and melanoma combined)

175
Q

What is the most common type of skin cancer?

A

basal cell

176
Q

Where does basal cell occur in the skin?

A

basal layer of the epidermis

177
Q

What gene is usually involved in basal cell carcinoma?

A

PTCH tumor suppressor gene (altered by UV radiation)

178
Q

What is the Fitzpatrick Skin Classification and what are they?

A

I- white, always burns, no tan
II- white, always burns, minimal tan
III- white, burns minimally, tans moderately and gradually
IV- light brown, burns minimally, tans well
V- brown, rarely burns, tans deeply
VI- dark brown/black, never burns, tans deeply

179
Q

What is the most common subtype of basal cell?

A

nodular- pearly papule or nodule with overlying telangiectasias (most often seen on head and neck)

180
Q

What subtypes of basal cell are there?

A 
nodular
ulcerated- rolled borders
superficial- pink patch maybe w/ scaling
pigmented- can be nodular or superficial
morpheaform/infiltrative/scelrotic- appears scar-like
181
Q

What type of skin conditions mimic basal cell?

A
  • sebaceous hyperplasia- enlarged oil glands (telangiectasias wrap around the oil gland rather than over the lesion like in BCC)
  • fibrous papule (doesn’t have telangiectasisas of pearly texture)
182
Q

Does basal cell metastasize?

A

rarely- but patients are at risk for developing other non-melanoma and melanoma skin cancers

183
Q

There is insufficient evidence to recommend specific follow-up for BCC what do most experts agree on?

A

every 6-12 months for 2 years

Foundations II (1 decks)

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