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CPD I > Dermatology II > Flashcards

Dermatology II Flashcards

1
Q

Erythema nodosum

A

Inflammation of the skin and SubQ tissue characterized by tender, red nodules on the shins
Cause: infection, drugs, malignancy, sarcoidosis. “BAD SICK”
S/Sx: indurated nodules that look like bruises, gradually changing color, nodules are very painful. Mostly pretibial. Systemic sx such as fever, malaise, joint pain. Spontaneous resolution in about 6 weeks.
Dx: underlying disorder! Sarcoidosis, malignancy, septisemia
DDx: lymphoma, pretibial myxedema, vasculitis

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2
Q

Milaria

A

Accumulation of sweat beneath eccrine sweat ducts results in obstruction by keratin at the level of the stratum corneum.
S/Sx: Pruritis is common. More found in kids/babies after a hot summer day.

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3
Q

Cellulitis

A

Acute bacterial infection of the skin in the dermis.
Cause: S. aureus, GAS, Hib, Immunocompromised individual
S/Sx: Local erythema, heat, edema and tenderness with lymphangitis (red streaks going up) and regional lymphadenopathy. Systemic sx may be present (fever, malaise, HA, etc.) Eye involvement = EMERGENCY!
PE: CHECK FOR LN AND STREAKING!
DDx: DVT, gout, septic arthritis, stasis dermatitis

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4
Q

Cutaneous abscess

A

Localized collection of pus under the skin.

S/Sx: painful, tender, indurated and erythematous

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5
Q

Erysipelas

A

Superficial cellulitis and dermal lymphatic involvement (streaking)
Cause: GAS
S/Sx: Shiny, raised, indurated and plaque-like lesions with distinct margins. Can present with systemic sx. Usually presents on the legs and face.
Complications: scarlet fever, septic

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6
Q

Erysipeloid

A

Same as erysipelas except caused by Erysipelothrix

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7
Q

Erythrasma

A

Superficial intertriginous (folds of skin at joints or adipose) infection with Corynebacterium.
Dx: skin scraping
DDx: seborrheic dermatitis, tina, candida

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8
Q

Folliculitis

A

Inflammation of the hair follicle
Cause: fungal, persistent trauma, systemic glucocorticoids
S/Sx: pustule or inflammatory nodule that surrounds the hair follicle. Superficial or deep. Mild itching or pain. Abrupt onset may be chronic.
“Hot tub” folliculitis - caused by pseudomonas infection from contaminated water

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9
Q

Furuncle

A

Acute tender nodule, usually caused by S. aureus (MRSA) (boil)
S/Sx: deep dermal, swollen, painful mass and DRAINS TO THE SURFACE (different from cellulitis)
Dx: culture for MRSA

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10
Q

Carbuncle

A

Cluster of furuncle with multiple draining orifices. More likely to get systemic sx.

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11
Q

Impetigo

A

Superficial acute skin infection with crusting.
Cause: S. pyrogenes, S. aureus
S/Sx: clusters of vesicles or pustules that rupture and develop honey colored crust. Forms satellite lesions. May be pruritic. Found on face, shins, and exterior forearms
Dx: culture to see if it’s MRSA

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12
Q

Candidiasis

A

Skin infection with Candida sp. most often Candida albicans
S/Sx: intertriginous, erythematous, well-demarcated, pruritic patches of varying sizes and shapes. Glistening. Satellite lesions. In babies: look for perianal erythema for diet issue.
Dx: exam, KOH prep, culture, probe
DDx: allergic derm, herpes, molluscum psoriasis, contact derm

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13
Q

Dermatophytoses

A

Fungal infections of keratin in the skin and nails

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14
Q

Tinea barbae

A

Infection of the beard area. Uncommon. Ringworm or follicular. Pruritic, painful and swollen. Risk of secondary bacterial infection

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15
Q

Tinea capitis

A

Infection of the scalp. More common in African-American and Hispanic populations living in close quarters. “Black dot” pattern and pustular.

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16
Q

Tinea corporis (Ring Worm)

A

Pruritic circular or oval, erythematous, scaling, patch/plaque that spreads centrifugally.

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17
Q

Tinea cruris (Jock itch)

A

Erythematous patch high on the inner aspect of one or both thighs.

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18
Q

Tinea pedis (Athletes foot)

A

Common. Intensely pruritic, sometimes painful, erythematous vesicles or bullae between the toes or on the soles.

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19
Q

Tinea versicolor

A

Superficial fungus infection with Malassezia furfur.
S/Sx: hypopigmented, hyperpigmented, or erythematous macules with scaling patches. Lesions are asx. Dx: tongue depressor scrape gives some flaking.

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20
Q

Cutaneous Larva Migrans

A

Caused by hookworm larva from animal feces.
S/Sx: intense pruritis, erythema and papules at site of entry, winding tail (serpiginous)
DDx: scabies

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21
Q

Lice (Pediculosis)

A

Wingless, blood sucking insects that infect the head or pubis.
S/Sx: severe pruritis. Red puncta from bites. Nits from hair shaft
Dx: Nits are GLUED to hair shaft about 1cm away from scalp. Will NOT come off.

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22
Q

Scabies

A

Infection of skin with mite.
S/Sx: burrows are fine, wavy lines 2-10mm long, covered in lichenified skin. Intensely pruritic, esp. at night. Pruritis will continue after tx due to allergic response not active infection. Usu. on hands and arms.

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23
Q

Molluscum contagiosum

A

Caused by the pox virus in epidermal cells
S/Sx: Smooth, flesh colored umbilicated dome, hard; cheesy core; may become inflamed or secondarily infected. Asx. Happens in immunocompromised individuals. 3-9 years is the primary age range.
Dx: appearance, biopsy showing “molluscum bodies”
DDx: Folliculitis, milia, verrucae

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24
Q

Warts (Verrucae vulgaris)

A

Benign contagious neoplasms caused by HPV
Common wart: dome shaped, round or irregular, rough; colors can be gray, yellow, brown, black, skin colored. Asx. Interrupted skin lines.
Filliform wart: long narrow small warts, soft, seen on eyelids, face, neck
Flat wart: smooth, flat yellow brown or flesh colored, back of hands, lower legs and face
Plantar wart: soles of the feet, single or multiple; painful and callused. Different from corns/calluses - black puncta present
Mosaic wart: multiple plantar warts
Condylloma accuminata: soft moist papules or plaques on perineum, external genitalia, anus, vagina, cervix

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25
Q

Varicella (chickenpox)

A

Acute, highly contagious vesicular eruption caused by a primary infection with varicella
S/Sx: Prodrome with malaise, chills, HA, sore throat, anorexia and dry mouth. Rash starts and itching is severe. Lesions are papules, macules, vesicles, pustules and crusts all at the same time. Mostly distributed on the trunk. Infectious to 2 days before lesions appear until after they crust over.
DDx: contact derm, zoster, folliculitis, impetigo

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26
Q

Herpes simplex

A

Recurrent viral infection with intraepidermal infection by HSV 1 or 2
S/Sx: single or clustered vesicles. Primary infection has systemic sx. Prodrome. Heal in 2-6 weeks. Found on the mouth, eyes, and genitals.
Herpetic whitlow: infects distal phalanx with a very painful lesion that swells.
Dx: Tzanck smear or culture
DDx: impetigo, eczema, zoster, hand foot and mouth dz, apthous stomatitis

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27
Q

Herpes zoster (shingles)

A

Latent varicella infection
S/Sx: virus remains in the nerve roots and erupts along the associated dermatomes (doesn’t cross the midline). Pain and itching for 2-3 days then rash. Severe pain, scarring, post herpatic neuralgia (debilitating).
Dx: pathognomic rash
DDx: MI, pleurisy, migraine - before lesions appear. HSV, primary varicella - after

28
Q

Roseola infantum

A

Infection of infants or young children with HHV-6 or 7.
S/Sx: 10 day incubation, with 3-5 days of high fever which subsides when the rash appears. May see convulsions. Generally, child is alert and active. Cervical and posterior cervical LAD. Rash is present for a few hours to a few days. Prominent rash on chest and abdomen, less so on face and extremities.
Dx: Hx and PE
DDx: measles, rubella, enteroviral infections, erythema infectiosum, scarlet fever, drug allergy

29
Q

Hand Foot and Mouth Dz

A

Febrile disorder caused by Coxsackie virus.
S/Sx: vesicular eruption of skin and mucosa, may have fever, myalgia, LA, abd pain, lack of appetite, poor nursing. Lesions in mouth are painful. Heal in 7 days. Found on tongue, palms of hands and feet, occasionally buttocks and genitals
Dx: Hx and PE
DDx: varicella, herpes, herpangina, aphthous stomatitis

30
Q

Viral exanthems

A

Blood borne viruses initiating a vascular response in the skin. Most present with a prodrome of fever and malaise.

31
Q

Measles (Rubeola)

A

Extremely communicable viral infection by a paramyxovirus. Spread from secretions from nose, mouth, and throat.
S/Sx: prodrome 3-4 days of fever, coryza, conjunctivitis, and photophobia, cough, koplik spots. Rash appears after 2-3 days of initial sx and is morbiliform, maculopapular, and blanching. Lasts 5-6 days. Begins on the face and spreads cephalocaudally and centrifugally.
Dx: clinical - ID of koplik spots. ELISA and titer for Ab. presence and conc.
DDx: Scarlett fever, rubella, drug rxns, roseola, erythema infectiosum.

32
Q

Rubella (german measles)

A

Infection caused by the RNA rubella virus.
S/Sx: usually mild incubation about 14-21 days, with a brief prodrome of fever and malaise, with a similar fainter rash starting on the face and moving downward. Rash is more pinpoint pink maculopapules and make have petechiae on the soft palate. Mild dz to asx. First appears on the face, spreads to trunk and extremeities, then generalized within 24hrs.
Dx: characteristic LAD and rash. Only worry about pregnant mothers and newborns (ELISA test)
DDx: measles, scarlet fever, drug rxn, erythema infectiosum

33
Q

Vitiligo

A

Idiopathic condition lacking melanocytes.
S/Sx: pigmented areas that are sharply demarcated and often symmetric. Spots are white with not scale. Patchy and irregular, ranging from focal spots, to entire body segments or most of the skin surface. Assoc. w/ AI dz, pernicious anemia, SLE, and addison’s dz.
Dx: Obvious on examination, CBC, blood glucose (looking for cause)
DDx: tinea versicolor, postinflammatory hypopigmentation, chemically induced depigmentation, pityriasis alba

34
Q

Melasma/chloasma

A

Macular hyperpigmentation of the face usually seen in pregnant women or using OCP, more in dark skinned races due to hormone effects and UV exposure. Usually on the face. Fades completely once cause is removed.
DDx: postinflammatory hyperpigmentation

35
Q

Lentigines

A

flat, tan or brown spots on sun-exposed areas, usually face or back of hands. Due to chronic sun exposure.

36
Q

Alopecia

A

Baldness
Non-scarring: male and female pattern baldness (androgenic - Dx: pulling 2-3 dozen hairs and >5 come out. Triggered by weight loss, pregnancy, illness, chemo); alopecia areata (autoimmune, toxic, genes, infections, drugs, vaccines, stress - smooth, circular, discrete areas of hair loss); trichotillomania (psychological disorder where pt pulls hair out); tinea capitis
Scarring alopecia: cutaneous lupus, deep bacterial infection, ulcers, granulomas, syphilis, tinea
Dx: ratio of anagen and telogen hairs to assess if there is normal ratio of resting hairs.

37
Q

Hirsuitism

A

Excess hair in females in areas not normally hairy

Dx: serum free/total testosterone, DHEA, FSH, LH, prolactin, TSH, often related to PCOS

38
Q

Onychomycosis

A

Fungal infection of the nail plate or bed
Cause: usually caused by dermatophytes but can also be caused by yeast. Risks: age, swimming, psoriasis, tinea, DM, DI, immunocompromised, genetic, family
S/Sx: nails have asx patches of white, brown, or yellow discoloration and deformity, may thicken.
Dx: appearance, KOH, culture
DDx: Nail dystrophies, psoriasis, eczematous conditions, trauma, lichen planus, Fe def.

39
Q

Paronychial infections

A

Periungual infection
S/Sx: develops along nail margin, becomes painful, warm, erythematous, and swollen. Pus along the nail margin, or beneath the nail.
Dx: PE

40
Q

Dermatofibroma

A

Benign proliferation of fibroblasts.
S/Sx: epidermal thickening and hyperpigmentation; small red to brown papule. Does not grow. Can follow an insect bite or trauma. Firm. Non-tender. Most often on legs and adults.
DDx: nevi, BCC, dermatofibroma protuberans (malignant)

41
Q

Epidermal cyst

A

Epidermally lined cyst containing keratinous material in the dermis
S/Sx: contains kerating; firm, flesh colored moveable nodule, central punctum, non-tender on face, ears, and trunk.
DDx: sebaceous cysts, lipoma, Gardner’s syndrome, Malignancy

42
Q

Keloid

A

Excess fibroblastic proliferation following trauma and scarring.
S/Sx: elevated, shiny, firm, can have “claw-like” extensions. More common in African and Asian pop.
Dx: PE
DDx: hypertrophic scar

43
Q

Lipoma

A

Subcutaneous nodules of adipocytes
S/Sx: rubbery nodule below dermis that moves. Asx. Grows slowly. Found on the trunk, forearms, and neck
Dx: Hx and PE. Watch for rate of growth (fast = biopsy)
DDx: epidermal cysts

44
Q

Nevi (moles)

A

Circumscribed, often pigmented or flesh colored macules, papules or nodules composed of melanocytes.

45
Q

Lentigo

A

Hyperpigmented macule due to increased melanocytes; darker, sparser, does not darken or multiply with sun

46
Q

Junctional nevus

A

light brown-black, usu. flat but can be slightly raised, pigmented on palms, soles, genitals.

47
Q

Compound nevus

A

light to dark brown, smooth and dome-shaped or papillomatous, may be elevated; involved epidermis and dermis

48
Q

Intradermal nevus

A

elevated, flesh-colored to brown; smooth, dome-shaped, papillomatous or pedunculated with a soft, rubbery texture. Can be hairy, warty, or speckled with brown pigmentation or pseudo-horn cysts

49
Q

Halo nevus

A

pigmented compound or intradermal nevus; surrounded by a halo of depigmented skin; immune phenomenon

50
Q

Atypical/dysplastic nevus

A

irregular pigmented nevus from tan to dark brown; indistinct borders, mild asymmetry, can be flat or elevated areas in the same mole; may be genetic; large and mostly on covered areas; usu see many on the person. Risk of developing melanoma!

51
Q

Seborrheic keratosis

A

Benign neoplasm resulting in pigmented superficial lesions that usu appear warty, or may be smooth papules.
S/Sx: “stuck on”, warty, well-circumscribed, often scaly hyperpigmented lesions. Close inspection shows presence of horn cysts or dark keratin plugs. On trunk, face and upper extremities. Generally older adults.
DDx: warts, nevi, melanoma, BCC

52
Q

Acrochordon

A

Pedunculated fibroma or skin tag
S/Sx: asx, fleshy skin tumor; skin colored or pigmented. Can be on narrow stalks. Soft. Irritated by friction and easily bleeds. Crohn’s dz assoc. Seen on the neck, axilla, groin, under breasts, eyelids
DDx: warts, nevi, neurofibromas

53
Q

Infantile hermangioma

A

Benign proliferation of blood vessels in dermis.
S/Sx: Deep, cavernous, superficial, “strawberry”. Bright red, raised, might have purplish-blue appearance. Most common tumor of infancy. Grow near eyes, ears, or mouth.
DDx: vascular growths, vascular malformations.

54
Q

Nevus flammeus and Port-Wine Stain

A

Capillary malformations that are present at birth.
S/Sx: Flat pink marks disappear within a few months if around the eye. Port-wine stains are reddish-purple and may appear anywhere, becoming darker with time. Enlarge proportionally to child’s growth.

55
Q

Nevus Araneus

A

S/Sx: pink/red, faintly pulsatile vascular lesion with a central arteriole and projections resembling spider legs. Blanchable. Happens during pregnancy or chronic liver dz on the face, neck upper chest, shoulders, and hands.

56
Q

Cherry angiomas

A

Frequently round, smooth, dome-shaped, bright-to-dark-red lesions that do not blanch with applied pressure. Usually 1-4mm in diameter

57
Q

Pyogenic granuloma

A

Vascular nodule of proliferating capillaries.
S/Sx: yellow to deep red in color. Grow rapidly. Friable nodule under a thin layer of epidermis. Does NOT blanch. On face neck and fingers
Dx: biopsy
DDx: melanoma or other malignancy

58
Q

BCC

A

Superficial, slow growing papule or nodule that derives from epidermal basal cells.
S/Sx: Highly variable appearance. 3 forms: nodular (60%) - starts as a papule that slowly grows into a “rodent ulcer” with a shiny pearly border, telangiectasia and a central ulcer. Superficial (30%) - slightly scaly papule or plaque that is light red in color; the lesion may be atrophic in the center and usually is rimmed with fine translucent micropapules. Morpheaform (10%) - lesions are smooth, flesh-colored, or very lightly erythematous papules or plaques that are frequently atrophic. Found on face, neck and scalp then shoulders and arms
Dx: biopsy
DDx: nevi, seborrheic keratosis, scars, molluscum, SCC

59
Q

Malignant melanoma

A

Arises in melanocytes in skin and mucus membranes, eyes, or CNS.
S/Sx: Vary a great deal in appearance but are usu pigmented. Major: change in size/new lesion, change in shape, change in color. Minor: diametes >=7mm, inflammation, crusting or bleeding, sensory change.
DDx: BCC, seborrheic keratosis, benign nevi/lenitgo, dermatofibroma, warts.

60
Q

Lentigo-maligna melanoma

A

15% of melanoma: slow onset and progression on face or sun exposed areas; 2-6cm flat, tan or brown macule with darker spots, irregular border and surface, or a plaque with raised indurated edges, colored spots, nodules.

61
Q

Superficial spreading melanoma

A

2/3 of melanoma arise from a pre-existing lesion. Diagnosed when smaller than lentigo melanoma. Mostly on women’s legs and men’s torsos. Plaque with irregular raised, indurated tan or brown areas, with white, red black or blue-black spots

62
Q

Nodular

A

Dark protuberant papule or plaque varying in color; grows fast; may not be pigmented.

63
Q

Acrolentiginous

A

Arise in areas of non-hair bearing skin; soles, palms, and subungual skin.

64
Q

SCC

A

Malignant tumor of epithelial keratinocytes that invades the dermis.
S/Sx: Usu on sun exposed areas; appearance is highly variable, but usu starts as a red papule or plaque with a scaly rough surface, or sometimes is nodular like a war. Can form cutaneous horns. Eventually ulcerates or bleeds, invades tissue and can metastasize.
DDx: actinic keratosis, seborrheic keratosis, BCC

65
Q

Acquired cutaneous paraneoplastic syndromes

A

A group of skin findings assoc. with internal malignancy.

66
Q

Acanthosis Nigricans

A

Thickened, velvety hyperpigmentation on flexural surfaces. Assoc with insulin resistance or internal malignancy.

CPD I (7 decks)

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