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Emergency Med > Dermatology Exam 2 > Flashcards

Dermatology Exam 2 Flashcards

1
Q

MC benign cutaneous neoplasm; tend to be hereditary

Discrete raised, rough, hyperkeratotic, papules to plaque. verrucous appearing “stuck on “ Greasy

Tx= None, Liquid N2 ( may recur after tx)

A

Seborrheic Keratitis

Chewed gum

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2
Q

2-3 mm dome shaped papules brown to clack.

Hyperkeratotic, pedunculated or verrucous papules
cheeks around eyes bilaterally. MC Africans / Hispanics

Tx=none Liquid N2–> hypopigment
Electrocautery, curette. Shave or excise tx 1 1st see response

A

Dermatosis papulosis Nigra

(Morgan Freeman)

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3
Q

AKA “Barnacles” from vascular insufficiency. (Xerosis) MC in elderly light skin pts w/ peripheral edema

1-10mm round, dry hyperkeratotic papules warty lesions
Stuck on lesion @ ankles, feet (dorsum) fore arms and hands

Tx= none (poor healing & infection) Will recur

A

Stucco Keratosis

Stuck on but at feet

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4
Q

skin colored to brown, soft pedunculated 1mm-1cm at eyelids, neck, goring, buttocks axilla & waist.

MC in obese

Tx= Large lesion- Excision
small lesion- Scissor excision, electro desiccation, cryo surgery

A

Acrochordon Skin Tags

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5
Q

3-10 mm slightly raised, pink-brown, sometimes scaly hard growths 1- 10 lesions that retract beneath skin surface.

MC @ ant lower legs (Shaving) reactive to trauma collection of fibroblasts, endothelial cells & histocytes

Pruritic or tender then asymptomatic. Dimples when squeezed.

Tx- Removal w punch biopsyor reg excision. cryosurgery to decrease color; If rapid growth = invasive tumor

A

Dermatofibromas (Nipple looking)

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6
Q

Small tumors of enlarged glands. Begin as small yellow papules, become dome shaped with central puncta.

Location =Face. Sun damage with oily skin > 30 y/o

collection of mature ____ Glands

Tx- none Curette, shave bx, electrosurgery, can extend into dermis and scar. (Differ w BCC w/ telangectasia)

A

Sebaceous Hyperplasia

Volcanic gland looking

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7
Q

Benign tumor adipose tissue MC. Soft pillow, mobile sub Q lesions. 1-10+ cm at trunk and extremeties

MC in mid 20s Asymptomatic. Tender if large and blood vessels component.

Tx- Excision or none (will not recur) if fast growing- consider malignant

A

Lipoma (Chaplin)

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8
Q

Sweat duct tumor. 1-3 mm small, firm, flesh, colored dermal papules. under eyes/lower lids;

Less common on forehead, chest, abdomen, Vulva. Young women 20-30s asymptomatic

Tx- None (risk scarring) cosmetic= electro desiccation & curettage.. elevation and excision shave w #11

A

Syringoma

Sandy eye granules

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9
Q

Tumors that grow on nerves throughout the body
(Nerve sheath tumor) flesh pinkish-white;

soft pedunculated, 2-20 cm button hole sign= invaginated through skin with pressure; firm waxy

Aillary freckles and café-au-lait spots( von recklinhausen NF1) VR -NF1

Tx - none (Bothersome = excise) 2 or more suspect VR NF1

A

Neurofibroma

Different size stuck spitballs

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10
Q

Raised red hyperpigmented firm shiny smooth surface. Abnormal large scar. extends beyond borders of wound

MC shoulders and chest; predisposed- 2ndary infx, may become painful or pruritic

Tx - No effective therapy; intralesion steroid/5FU, laser

A

Hypertrophic Scar Keloid

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11
Q

Epithelial tumor solitary discrete, smooth dome shaped red papule rapid expansion to 1-2 cm hyperkeratotic core

Limbs MC sun exposed surfaces MC > 60 y/o possible viral HPV; self resolves, but don’t wait = appears to SCC

TX excise send to path r/o SCC: recureent= Intralesion 5FU or methotrexate

A

Keratoacanthoma

Donut with Central core

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12
Q

Persistent localized rough feelin to skin- starts as are of increased vascularity. Erythema w scale. (ears and hand)

Sharp, adherent, yellow scale as lesion progresses. may resent as cutaneous horn (r/o SCC)
MC elderly w sun exposure (Pinna)

Tx- photo protection- complete skin exam ( Have all RF for SCC and BCC)

A

Actinic Keratosis

Yellow crusty nose

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13
Q

Lesion on superior aspect of pinna and tender, thin________ __________ __________.

A degeneration of underlying collagen

Tx- excise it and special pillow for sleeping

A

Chondrodermatitis Nodularis Helicis

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14
Q

Well defined borders, slightly elevated, red scaly plaques; very slow lateral growth.

Not localized to visible lesion (extends to follicles)

Low grade malignancy F/U q 6 mths slow growth

Tx= Electro desiccation and Curettage (ED and C)
LN2; Excision; Large =5 FU cream

A

Bowen’s Disease (AKA SCC In Situ)

Non regular/circular raised red w plaque

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15
Q

Women- MC LEs (Labia or oral mjucosa); Men- Scalp and ears. (Glans Uncircumcised)

Assoc. w/ HPV 8 Moist, red smooth, slightly raised plaque

Tx- 5FU Aldara or Laser

A

Erythroplasia of queyrat

Bowen’s Disease

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16
Q

2nd MC skin Cancer; UVA UVB MC precursor
Red, scaly persistent; hypertrophic lesion w ulcer or horn lip=ulcer

> M;W elderly sun exposed asymptomatic
Tx- ED and C (Small) Excision w Margins (Large)

Examine Lymph nodes F/U 12 mths
A

Squamous Cell Carcinoma (SCC)

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17
Q

pink/skin colored pearly firm, dome shaped papule has rolled border “ rodent ulcer”; bleed scabbing sore

MC invasive skin Cancer 85 % head and neck; Superficial= trunk > 40 y/o

sun induced malignant proliferation of basal layer of epidermis. Most Important RF= Inability to tan

Tx- Detect early; refer to derm-Mohs Micrographic sx

A

Basal Cell Carcinoma (BCC) Rarely mets

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18
Q

A, B C D E of Nevi examination

A
  • Asymmetry *Border irregularity
  • Color variation * Diameter
  • Evolving (Size, shape or new lesion)
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19
Q

Sharply circumscribed uniform colored papules or macules Common, enlarge in pregnancy/Puberty

Anywhere including palms, soles, mucosa: Common in exposed areas. w or w/o hair

TX- follow up w ABCs ; >100 F/U 6-12 mths ; Sx excision in suspected lesions

A

Melanocytic Nevus (Mole)

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20
Q

What are the three types of melanocytic Nevus?

A

Junction Nevi

Compound Nevi

Dermal Nevi

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21
Q

Type of Melanocytic nevi that nests in the epidermis/dermal junction. flat or slightly elevated

Light Brown-Brown black w uniform pigment < 0.5-0.8cm MC in child hood after age 2

A

Junctional

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22
Q

Melanocytic Nevus nests into the dermis: slightly elevated to dome shaped, smooth or warty surface with or without hair

Uniformly round, oval and symmetric; white periphery = Halo nevus

A

Compound

raised Nipple like

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23
Q

All nevus cells in Dermis, sometimes in fat cells. Dome-shaped verrucous MC, pedunculated, sessile (raised)

Broad based, Skin colored, brown to black with hair lighter with age; common in adults

A

Dermal (Gua- a mole)

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24
Q

Considered a special Nevi: found at birth 1-20 cm. Most grow proportionally w child

Increased risk of malignancy if >=5% BSA or >20 Cm

Tx- Small= observe Med= remove @ puberty Large=Increased incidence of malignant melanoma even w removal

A

Congenital Melanocytic Nevi

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25
Q

AKA speckled lentiginous nevus; MC in adolescence, at birth or early infancy; Hairless oval irregular shape brown macule

Dotted w darker brown to black papular spots not related to sun exposure.

Tx- None Rare malignancy

A

Nevus Spilus

Spotted Macule

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26
Q

Either brown macule, a patch of hair or both. No nevus cells. Unilateral upper back or shoulder, upper arm, submammary

Never reported malignancy; This____ plus assoc. w ipsilateral breast or limp hypoplasia, scoliosis, Spina B.

Tx- Too large to remove; Hair removal laser tx and pigment

A

Becker’s Nevus

Xavier

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27
Q

compound or dermal nevus that develops a white border; MC in adolescence, may herald onset of vitiligo

1 or > hypopigment to white lesions that contain a central brown, red , black nevus. No melanin in halo
Trunk= MC never palms or soles; Woods lamp-white

BX if suspect malignant

A

Halo Nevus

28
Q

Blue black lesions dermal melanocytes(flattened) before birth migratory arrest. MC scalp and presacral

dermatomal pattern Birth to childhood blue black “Tyndall effect” melanin deeper in skin Asians, African; butt or back confused w abuse

TX none fades during 1st few years

A

Mongolian Spot

29
Q

Blue-black pigmentation in 1st-2nd branch of trigeminal nerve; Affects sclera, conjunctiva and surrounding skin
of eye

No visual changes; At birth or later darken w age. Common in Asians esp. females

Tx Laser to lighten lesions (Monito Glaucoma)

A

Nevus of Ota

30
Q

Hairless red or reddish brown, dome shaped papule/nodule 0.3-1.5 cm appear suddenly

MC in children- neck, head and lower extremities Histologic similarity to melanoma

A

Spitz Nevus (AKA Benign Juvenile Melanoma)

31
Q

Slightly elevated round, regular < 5mm large amount of pigment in dermis MC on extremity dorsum of hands

Confused w malignant melanoma; develops in childhood Tx - remove cosmetic

A

Blue Nevus

Blue Black round

32
Q

Brown-black macules on lower lip; MC in young adult women; Resemble freckles but no change w sun exposure

Cryotherapy or laser if desired

A

Labial Melanotic Macule

33
Q

Begin to appear near puberty to 4th decade; >5mm flat or raised center “ Fired Egg” -look for ABCDEs

Dark or irregular shades of brown and pink irregular borders; MC at back upper lower limbs sun protected areas; screen family members

Dx 3 of following: >5mm, irreg. border, irreg. margin, varying shades, popular macular components; refer opthalmaogy

Tx- Bx and excise w/ margins f/u 6-12 mths

A

Dysplastic Nevus

multiple asymmetric freckles

34
Q

Raised variations in pigment and borders, alteration of skin; Hx of atypical moles 5th MC cancer Dx age 57

Incr. Risk >100 moles congenital nevus. 20 cm; chronic tanning, repeated sunburns; Back MC in men; Arms legs in women: Non cutaneous MM mouth nose eyes

Superficial spreading MC Blue nodule or black or brown black macule pigment (Lentigo Maligna)

A

Malignant Melanoma

35
Q

Brown black and tendency to remain flat under nail late, sudden appearance of pigment at proximal nail fold (Hutchinson’s sign) very poor prognosis

Palms soles terminal phalanges and mucous membranes

A

Acral Lentiginous (Malignant Melanoma)

36
Q

Malignant melanoma level I (Depth)

A

Restricted to 98% of epidermis

37
Q

Malignant melanoma level II

A

Papillary Dermis

38
Q

Malignant melanoma level III

A

fill papillary dermis

39
Q

Malignant melanoma level IV

A

reticular Dermis

40
Q

Malignant melanoma level V

A

invade subcutis 44%

41
Q

Malignant melanoma growth that is ______ has a better prognosis. Once changes it changes to_______ prognosis worsens and development is rapid.

A

Horizontal; Vertical

42
Q

80% of Malignant melanomas arise on areas normally

A

covered by clothing

43
Q

Skin types and suggested Sunscreen Type I

A

Always burn easily, never tans Celtic Irish heritage SPF 25-30

44
Q

Skin types and suggested Sunscreen Type II

A

Burns easily tans slightly ( Fair skin individuals Blonde)

SPF 25-30

45
Q

Skin types and suggested Sunscreen Type III

A

Sometimes burns then tans gradually SPF 15

46
Q

Skin types and suggested Sunscreen Type IV

A

Burns minimally always tans well Dark Hispanic & Asians SPF 15

47
Q

Skin types and suggested Sunscreen Type V

A

Burns rarely, tans deeply (Middle eastern, asian black) SPF 15

48
Q

Skin types and suggested Sunscreen Type VI

A

Almost never burns, deep pigment

49
Q

Protection against UV damage

A

SPF of 15-30 daily
Apply 15-30 min. prior to exposure
Re-apply every 2 hrs or after exposure to water
Avoid su exposure peak hrs 10a.m - 3 p.m
wear dark , loose, dry clothing tight weave, brim hat

50
Q

UVA agents are effective against _____ nm wavelength

A

320-400

51
Q

UVB agents effective against_______ nm wavelength

A

290-320-

52
Q

Sun induced wrinkling on back of neck that forms a rhomboidal pattern

A

Cutis rhomboidalis

53
Q

Photoaging pigmentation Red brown reticulated pigmentation with talangiectasias, atrophy, prominent hair follicles, chest and back

A

Poikiloderma of Civatte

54
Q

Photoaging papular change Comedones and cysts around the eyes

A

Favre Racouchot

55
Q

Photoaging papular change yellow papules dull to birght that may coalesce to from plaques

A

Solar Elastosis

56
Q

Photoaging change treatments:

A

prevention is key

Retinoids (3-6 mths)

Chemical peels, dermabrasion or lasers

57
Q

Related to Niacin deficiency characterized by Dermatitis, diarrhea, and Dementia 3 Ds

phase I Symmetric erythema, sunburn, worse w re-exposure; Bullae after erythema then rupture brown scale

Phase II late cutaneous phase: lesion becomes hard, rough, cracked, blackish and brittle “ goose skin”

Butterfly Malar ( Lupus) Casal’s necklace or Kravat. Hand glove or gauntlet spares the heel

Tx Niacin 50-100mg ASA 325

A

Pellagra

58
Q

Contraindications to niacin

A

Hypersensitivity Peptic ulcer dz

Hepatic dz active Gout

Arterial hemorrhage * causes Acanthosis Nigrans

59
Q

MC light induced skin Dz seen by PCPs UVA>UVB
MC female fairskin inversely related to latitude Singapore and Sweden

Exposure incr. tolerance= “Hardening”: Nonscarring pruritic rash in sun exposed areas symmetric papule MC V exposed area, back of hands, forearms lower legs

Dx Immunofluorescence Bx to R/O SLE
TX=steroids; Psoralen (PUVA) Antimalarials

A

Polymorphous Light eruption

60
Q

Intensely itchy papules, plaques, nodules-face MC
Hemorrhagic crust, lichenification, Actinic cheilitis feature

Native americans North, central S. America

TX=steroids; Psoralen (PUVA) Antimalarials

A

Actinic Prurigo

61
Q

Phototoxic Agents

A

Lime and Doxy TCNs, Sulonomides, Ibuprofen Naproxen, Amiodorone Diltiazem

62
Q

Acquired symmetric brown hyperpigmentation involves face and neck of genetically predisposed women DPP> LPP

Slowly develop w/o inflammation faint or dark; Pregnancy, OCPs, Estrogen progesterone, Thyroid, phenytoin Dysfunction; may resolve post partum or OCP DC

Tx difficult, Hypopgmentation agents chem peels, lasers

A

Melasma (Chloasma) Mask of pregnancy

63
Q

Melasma Tx

A

Hydroquinone (Most effective Bleaching Agent)

Triluma Combo Hydroquinone, tretinoin, Fluocinolone

64
Q

Tan to brown macules due to localized proliferation of melanocytes from exposure to sunlight

lesions round, ovalwith slight irregular ill defined border scattered , discrete lesions, stellate, sharply defined few mm> 1cm cytokines mediated response to UV

Tx- None; Cryotherpay Topical retinoids

A

Solar Lentigo (Grandma spots)

65
Q

Asymptomatic white spots or arms or legs of middle aged or elder 2-5mm white spots sharp demarcated borders

Tx- Avoid sun or UV light : Tretinoin, LN2, steroids, Dermabrasion

A

Idiopathic Guttate Hypomelanosis IGH (White spots)

Emergency Med (2 decks)

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