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Alisha's NPLEX II Review > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Seborrheic keratosis

A

“stuck on”, verrucus appearance. Mots common benign tumor in the elderly. Brown or black.

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2
Q

Lichenification

A

chronic scratching causes skin growth (skin thickening)

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3
Q

Melanoma (always on the boards)

A

Most common in women, tumor marker S-100, METASTASIZES!

Risk: FHx, fair skin, actinic keratosis, outdoor work, sunburns
Superficial spreading: mc
Nodular: most aggressive
Lentigo: elderly, slow growing
Acral lentigious: most common in dark skin- palms, soles, nails- aggressive

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4
Q

Hyperkeratosis, pankeratosis, acantholysis, acanthosis

A

Hyperkeratosis: thickening of skin. Warts, corns, callouses.
Parakeratosis: thinning of the granular layer of the skin, like in psoriasis and dandruff
Acantholysis: cells lose their connections (desmosomes). Happens in pemphigus, not pemphigoid.
Acanthosis: diffuse epidermal hyperplasia, happens with insulin resistance

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5
Q

ABCDE

A

Assymetry, borders, color, diameter, elevation

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6
Q

Actinic keratosis

A

10% can change to SCC; rough, scaling appearance

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7
Q

Rehydration in: hypovolemia, DKA, etc

A

Hypovolemia: normal saline (0.9%)
DKA: 5% dextrose in hypotonic solution (they lose glucose , which pulls water out with it; need to rehydrate with both)

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8
Q

Case #1: woman with a large, red bump in her armpit says it came on several days ago after shaving. Dx, tx?

A

Ddx: *abscess (soft fluctuant mass, comes on quickly); not a sebaceous cyst (sebum from the sebaceous duct builds up, slow)
Tx: I&D with a field block
Tools: #11 scalpel and hemostat
(11s are sharp and pokey, good for poking holes in things)
Field block= diamond-shaped pattern around the lesion you are trying to remove
Aftercare: pack with iodoform gauze
If draining continues, it’s possible that the lesion was multilocular and was not drained completely

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9
Q

Case #2: Postaural, round, 2 cm mass, nontender

A

Sebaceous cyst- soft & mobile, may feel like a marble
Tx: incision and removal of the entire mass
Most appropriate anesthesia: 1% lidocaine with epi
Remove entire capsule to prevent recurrence
Suture behind the ears, remove 7-10 days (scalp)

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10
Q

Case #3: brown lesion on bra line, 41yo gravid female; 3mm papule with erythematous border; she has a sulfa, penicillin allergy

A

How to remove? Shave biopsy (want to keep tissue intact for pathologist to examine)

Which anesthetic is safe for 1st trimester pregnancy? Lidocaine

(When in doubt, just use lidocaine)

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11
Q

Dermatofibroma

A

secondary to trauma, increased fibroblasts, brown-firm like a BB

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12
Q

Epidermal inclusion cyst

A

Aka sebaceous cyst. Moveable capsule filled with keratin, sebum. Slow-growing.

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13
Q

Lipoma

A

SubQ nodules that recur. Small, moveable, rubbery.

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14
Q

Pilar cyst

A

Aka wen. An epidermal inclusion cyst on the scalp.

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15
Q

Hemangioma

A

DONT CUT IT. Especially cavernous hemangiomas.

Benign cluster of blood vessels.
One of the MC tumor in infants. Many self-resolve.

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16
Q

Seborrheic dermatitis

A

Cradle cap in children, dandruff in adults. Mildly itchy. Greasy, clear or yellow with scales.

Tx: Se+ sulfide shampoo, Zn+pyrithione

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17
Q

Acne vulgaris

A

Noninflammatory: open/closed comedones
Inflammatory: pustules, papules (<5mm), nodules (>5mm)

Avoid: B12, iodine
Tx: Zn, CU, Cr, Se, n3, VD, tea tree oil, retinoids, benzoyl peroxide, accurate (suicidality a risk, 2 forms of birth control). Clindamycin, doxycycline, OCPs

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18
Q

Vitaligo vs melasma

A

Melasma occurs during pregnancy and is hyperpigmentation

Vitaligo is an autoimmune disease that causes hypo pigmentation. Tx with Cu, vitamin D, phenylalanine

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19
Q

Kaposi’s sarcoma

A

round/oval papules or plaques, pink/red/purple on the legs, which ulcerate. Associated with AIDS and HHV8. Excision.

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20
Q

Solar lentigo

A

“liver spots”, benign, from sun exposure

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21
Q

Erythema nodosum

A

Lesion of subQ fat, usually anterior shins. Caused by sarcoid, TB, leprosy, histoplasmosis, coccidiomycosis, Crohn’s disease, cancer, NSAIDs, or idiopathic.

Elevate legs, compression, wet bandages

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22
Q

BCC

A

Most common HUMAN cancer. SLOW-growing. Mets are rare. May look pearly with a rolled border, teleangelectasia. Sun-exposed areas, upper lip. Highly curable when removed.

Arsenic exposure is a risk.

Types:
Nodular (mc), superficial, ulcerative, and pigmented

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23
Q

SCC

A

FAST-growing. May develop from actinic keratosis. Mets are common. Indurated, ulcerated, crusty, may bleed. Lower lip.

Arsenic exposure also a risk

24
Q

Cellulitis

A

GAS in the DERMIS. Can lead to necrotizing fasciitis, erysipelas (lymph involvement, skin looks like an orange peel).

Tx: Keflex, Trimethoprim-Sulfamethoxazole

25
Q

Lymphangitis

A

red streaking along lymph nodes

26
Q

Erysipelas

A

strep infection of superficial lymphatics due to immunocompromised, trauma, ulceration or skin injury

27
Q

Statis dermatitis

A

chronic venous insufficiency due to DM or being bed-ridden

28
Q

Genital warts and cervical cancer

A

Genital warts: HPV 6, 11

Cervical dysplasia: 16, 18, 31, 33

29
Q

Roseola infantum

A

6th disease. HHV6/7. Maculopapular rash with high fever.

30
Q

Rubella

A

Cranial-caudal maculopapular rash with CLAD and fever

31
Q

Measles

A

3 Cs: cough, coryza, conjunctivitis
Koplik’s spots.

Worst side effect: subacute sclerosing pan encephalitis

32
Q

Impetigo

A

Staph or strep; honey-colored; tx is muprocin

33
Q

HSV

A 
Prodrome with itch, fever
1: oral
2: genital
Antibodies arise in 4-6 weeks. 
Tx with lysine, avoid arginine
34
Q

Herpes zoster

A

Shingles. Along a dermatome, neurotic pain and blisters.

Tx: levodopa, UV light, vaccine (zostavax)

35
Q

Molluscum contagiosum

A

Viral infection, can be an STI (pox virus). Waxy, pink with central pit. Usually go away in 6-9 months

Tx: vitamin B9, salicylic acid, electrodessication or cry

36
Q

Tinea versicolor (pityriasis versicolor)

A

Will look gold under the Woods lamp. Caused hypo pigmentation. KOH+. Tx: terbinafine, ketoconazole

37
Q

Dyshydrotic eczema

A

Aka pompholyx. IgE reaction to nickel, etc. Weeping vesicles on hands and feet.

38
Q

Pityriasis rosea

A

Mc in 10-20yo, occurs after URI, first you see a herald patch, may be Christmas-tree shaped. Resolved in 1-3 months. If severe, topical steroids, UV light, erythromycin o acyclovir

May be caused by HHV7

39
Q

Erythema multiforme

A

Acute, self-limiting. Symmetrical lesions with concentric rings (target lesions). Caused by infection- HSV, mycoplasma pneumonia; drugs (sulfa, antiseizure, barbiturates, Abx, allopurinol); idiopathic (50%!)

40
Q

Drug eruptions

A

1-3 weeks after drug (mc is 7 days after)

Can be morbiliform (maculopapular, measles-like)

41
Q

Nail infections

A

Paronychia: infection of the nail bed, usually staph, strep or candida. warm compress, reflex
Felon: subQ abscess under nail bed, can occur after paronychia
Onchomycosis (Tinea unguium): nail fungus. Tx with meulalucca, terbimafine anti fungal

42
Q

Pemphigus vulgaris vs bullous pemphioid

A

PemphiguS: Superficial. 40-60yo. + Nikolsky (Asboe-Hansen) sign, blister will spread. Can be deadly. Intraepidermal bullae with anti-epithelial cell Abs against desmosomes (anti-desmoglein-3 IgG). Type II hypersensitivity. Tx: steroids, methotrexate

PemphigoiD: Deep. 60-80yo. Less serious. Blister intact in sub epidermal space. Usually flexors/trunk. Linear deposition of anti-basement membrane IgGgs. Also Type II reaction.

43
Q

Erythema migrans

A

Bullseye

From a tick bite- B. burgdorferi

44
Q

Stevens-Johnson Syndrome

A

Toxic Epidermal Necrolysis
Emergency!

Flu-like symptoms, blisters, pneumonia, sepsis and organ failure.

Cause: lamotrigine, carbamazepine, allopurinol, sulfonamide antibiotics, and nevirapine (HIV antiviral); Mycoplasma pneumoniae, CMV, and HIV

Tx: no accepted standard. Fluids, analgesics, ophthalmologist consult (can affect eyes)

May be due to CYP variant that slows processing of some drugs.

45
Q

SLE

A

Discoid or malaria rash, worse in the sun, IgG/IgM

46
Q

Granuloma annulare

A

Chronic skin condition, circular small flesh papules, increase in size, hands and feet. Idiopathic, but may be associated with endocrine disease (thyroid disorders and diabetes)

47
Q

Contact dermatitis

A

Irritant or allergic

Delayed hypersensitivity reaction

48
Q

Dermatitis herpetiformis

A

Celiac disease

IgA deposits cause itchy papules and vesicles

49
Q

Atopic derm

A

Eczema, IgE reaction, eosinophilia, asthma, hayfever associated

Effects flexor surfaces

Tx: Psorinum, sulphur, vitamin C, steroids, emollients, tacrolimus 0.03% (calcineurin inhibitor), dupilimab if severe (inhibits IL4 and IL13)

50
Q

Psoriasis

A

Auspitz phenomenon, Kobner’s phenomenon
Nail pitting, arthritis
Areas of friction like scalp, extensor surfaces

Types: plaque (mc), guttate (GABHS or viral trigger), pustular, inverse, erythrodermic

51
Q

Lichen simplex

A

Red, scaling, itching constantly. can be unilateral.

52
Q

Lichen planus

A 
Wicham straie
5 Ps (pruritus, planar (flat), purple, polygonal papules)
Palms and wrists
Associated with hepatitis C
Mucosal lesions, nail involvement
Tx: steroids, immunosuppressants
53
Q

Hairy leukoplakia

A

white, painless patches on the tongue that CANT be scraped off. Caused by EBV, usually in HIV patient.

54
Q

Infestations

A

Black widow spider: NEUROtoxic, painless bite
Brown recluse: NECROtoxic, painful
Scabies: serpiginous lesions, worse at night, don’t extend above the neck, common in wrist creases. Tx: permethrin.
Pediculosis (lice): tx with permethrin, washing clothes and bedding in hot water

55
Q

Necrotizing fasciitis

A

Infection of the fascia which secondary necrosis of the subQ. Type I: polymicrobial. Type II: beta-strep

Will see increase in serum CK. IV penicillin and clindamycin. Surgical debridement.

56
Q

Acanthosis nigrans

A

Dark velvety appearance of skin on the posterior neck and flexural folds. Associated with DM, obesity, CA, insulin resistance.

57
Q

Most common human cancer

A

BCC

Slow growing, doesn’t often met, prognosis good if caught early

Alisha's NPLEX II Review (19 decks)

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