Dermatology Review Flashcards
1
Q
what are the layers of the epidermis is order?
A
- stratum corneum
- stratum lucidum
- stratum granulosum
- stratum spinosum
- stratum basale
2
Q
How is sebum formed?
A
It is formed by the gland when the cells of the gland are broken down and is converted into lipids
3
Q
What are the abnormal skin colors?
A
palor (pale) cyanosis erythema jaundice/ scleral icterus ashen/dusky (grey)
4
Q
what is the most important question to ask about a mole?
A
Has is changed over time?
5
Q
What are the etiologies of acanthosis nigricans?
A
- hereditary benign
- endocrine disorders associated with IR
- obesity
- drug induced
- malignant
6
Q
what are the SE of local steroid use?
A
telangiectasias, purpura, epi/dermal/subcut atrphy, striae, hypopigmentation
7
Q
SE of systemic steroid use?
A
rebound rosacea and perioral dermatitis adrenal suppression (HPA) glaucoma and cataracts infections allergic reactions
8
Q
why do you not use a short course steroid pack for Rhus dermatitis?
A
because you can get rebound dermatitis that is worse than the original dermatitis
9
Q
What is the most sensitizing antibiotic?
A
neomycin
10
Q
what should you tell your patients that are sensitive to sunlight?
A
wear sunscreen and put it on a 1/2 hour before you go in the sun
stay out of the sun from 10-2
cover up
11
Q
what is a junctional nevus?
A
located at the dermal/ epidermal junction above the basement membrane
12
Q
What is a compound nevus?
A
nevus cells invade the papillary dermic and are found in both the epidermis and the dermis
13
Q
dermal nevus?
A
found exclusively in the dermis
14
Q
what is the natural progression of a nevus?
A
- it begins with a junctional nevus (flat, small, brown lesion: common in the first decade of life)
- next 2 decades the nevus becomes raised and it represents a dermal component or compound nevus (common in puberty)
- 7th and 8th decades the nevus looses its junctional component and dark pigmentation, undergoes fibroses and becomes a dermal nevus
15
Q
what is an atypical nevi?
A
asymmetrical
irregular border
irregular color
larger in size
16
Q
ABCDE’s
what is an ominous sign?
A
Asymmetry border irregularity/bleeding color diameter >6 mm elevation/evolving *bleeding or ulceration is an ominous sign
17
Q
what are the reasons for removing a mole?
A
- if it has undergone change
- if it is suspected to me a melanoma
- if it is benign appearing mole, in a patient at and increased risk of melanoma and the mole is in a area where the patient in unable to monitor it
18
Q
Describe a blue nevus?
A
“blue papule” commonly found in individuals of asian decent.
Can look like nodular malignant melanoma - so if it changes, rule this out.
19
Q
what is a halo nevus?
A
a benign lesion characterized by complete depigmentation surrounding the pigmented lesion
20
Q
what is the etiology of halo nevus?
A
autoimmune phenomenon- increased incidence of vitiligo associated with this condition
21
Q
what is the management and prognosis of halo nevus?
A
no treatment required is you are sure of the diagnosis
nevus may disappear and the depigmentation will resolve spontaneously
22
Q
what is the first sign of sun damage?
A
freckles
23
Q
what makes freckles different from lentigines?
A
freckles come and go with sun exposure and there is increased melanin production without melanocytic proliferation
24
Q
where characteristics of lentigines?
A
There are found only in sun exposed areas are represent a later complication of solar damage
There are permanent pigmented lesions
increased the number of melanocytes
25
What can you use to try and fade the lentigines?
Retin- A
26
Describe suborrheic keratosis lesion?
warty, greasy, oily
| "suck on appearance"
27
Describe the appearance of vitiligo?
chalk white to off white macules with generally round oval or elongated shape
borders flow into normal skin
28
what is the phenomenon associated with vitiligo?
keobner phenomenon- the appearance of a lesion in the area of trauma
29
List all of the possible treatments for managing vitiligo:
1. Do a complete ROS to rule out systemic or autoimmune causes
2. sunscreen in affected areas
3. cosmetic
4. repigmentaion via topical steriods, topical or systemic photochemotherapy
5. mini grafting
6. depigmentation via bleaching (last resort)
7. PUVA
30
What is important to rule out prior to mini-grafting?
Kebner phenomenon
31
what are the 2 manifestations of albinism?
1. depigmentation of skin and hair
2. ocular pathologies- iris translucencies
( send these patients to opthamology)
32
What are multiple cafe au lait lesion associated with?
neurofibromatosis, especially associated with axillary freckling
33
what is significant about a mongolian spot?
a lesion over the lumbosacral area may indicate underlying spinal cord defects
34
what is the clinical manifestations of Melasma?
irregular hyperpigmention of the skin seen in various shades of brown located over the sides of the face, forehead and sides of the neck
35
what is the cause of melasma?
related to pregnancy and oral contraceptive use and increases with sun exposure
36
Treatment of melasma?
reduce sun exposure and use sun block, it usually fades with delivery and cessation of OC's
- may or may not return with next pregnancy
- may never disappear completely
37
what is the characteristic lesion of erythema multiforme?
Target lesions
38
What disorder should you look into if someone has recurrent erythema multiforme?
Herpes simplex virus and if positive give oral acyclovir
39
what is the lesion associated with erythema chronicum migrans?
bulls eye lesion secondary to transmission of Borrelia burgdorferi by the ixodes tick
40
what are the associated symptoms of erythema chronicum migrans?
flulike: fever, sweats, chills, myalgia, and HA
41
what is erythema toxicum neonatorum?
common rash that occurs 48 hours after birth
42
describe the lesions oftoxicum neonatorum?
blotchy macular or papular erythema on the face, trunk and proximal limbs
occasional pustules on the face
- clears in 2-3 days (r/o neonatal herpes via Tzank smear)
43
what are the 3 manifestations of staphylococcal skin infections?
1. staphylococcal scalded skin syndrome
2. impetigo
3. MRSA
44
What are the signs and symptoms of impetigo?
```
erythematous sores-rupture and ooze
honey colored crusts
pruritus
painless fluid filled blisters
severe cases will have pus filled sores causing ulceration
```
45
what is impetigo contagiosa?
(non- bullous), erythematous sores ooze and form honey colored crusts
46
Bullous impetigo?
painless fluid filled blisters rupture, scap and form honey colored crusts
47
what is ecthyma?
more serious form of impetigo, penetrates to the dermis
48
what do you have to rule out if a patient has is lichen sclerosis?
SCC
49
what are the 4 P's of lichen planus?
purple, polygonal, pruritic, papular
50
what are the other manifestations of lichen planus?
white lacy network on the mucus membranes
may leave post-inflammatory hyperpigmentation
related to keober phenomenon
51
how can you prevent recurrence of sebaceous cyst?
remove the entire thing, including the sac
52
how do you know the lesion the lesion is an epidermiod/sebaceous cyst?
it is filled with semisolid fluid and has a central punctum
53
describe the lesions cushings striae
pink-purple striae present on flanks of abdomen, arms and thighs
increases depth and breadth caused by dermal atrophy
54
what are the 7 pregnancy integument changes?
```
spider nevi
palmer erythema
increased pigmentation of the areola, genitalia, linea alba, cholasma
increased hair growth
striae
nevi enlargement
increase in infectious skin conditions
```
55
define acute urticaria
present for <30 days categorized by large transient wheal
exposure to allergen evokes and urticarial response that is worse with re-exposure
related to parasites and penicillin
56
define chronic urticaria
present grater than 30 days
physical signs are identical to acute
no obvious cause in many cases
r/o systemic disease, SLE, necrotizing vasculitis, and lymphoma
57
define angioedema?
same as urticaria , but it involves deep dermis and subcutaneous tissue
58
what is dermographism?
due to direst pressure on the skin secondary to an exaggerated response from trauma
lesions fade in 30 min
resolves but can take years
59
what is pressure urticaria?
generally seen with prolonged pressure to buttocks or soles of feet
60
cholinergic urticaria?
develops as a response to exercise, emotion, or sweating
61
What is the definition of exfoliative dermatitis?
scaling and erythema over a large area of the body
| it eventually peels and may include hair and nail loss
62
what are the etiologies of exfoliative dermatitis?
topical or systemic drugs
cancer
dermatosis (idiopathic)
63
what is dermatitis medicamentosa due to?
medication :)
64
what do you worry about if nipple eczema does no go away for 3 weeks with treatment?
Paget's disease of the breast
65
why is actinic keratosis significant?
because is is a precancerous lesion found in older people with light complections in sun exposed areas
need biopsy to r/o SCC
66
what does actinic keratosis look like?
```
hyperkeratotic sclale
rough
course
"like sand paper"
reddish brown color
(papular or nodular)
```
67
how do you treat AK?
prevention, topical or systemic retinoids
68
what is lichen simplex chronicus?
"itch, scratch, itch"
initiating factor causes pruritus, and this leads to scratching, which leads to itching
on extensor surfaces*
also presents as lichenification*
69
what are the reasons to hospitalize someone who has a spider bite?
1. if there is an increase in the local infection in 24 hours
2. if the spider was a known brown reculse of black widow
3. if there are systemic manifestations over the whole body
70
what are the signs and symptoms of a brown reculse bite?
redness and swelling around the 2 bite marks
increased pain over next 2-8 hours
formation of dusky red or blue blister at the site that ruptures and sloughs off
71
what are the symptoms of a black widow spider?
dull numbing pain from bite site to abdomen and back within 1 hour
severe cramping in abdomen/muscles, nausea, vomiting, fever, body aches, malise, arthrasia, dizziness, tremor, sweating, facial swelling, rash, dyspnea
72
describe the lesions of acute atopic dermatitis?
poorly defines erythematous patches and plaques with or without a scale
73
describe the lesions of chronic atopic dermatitis?
lichenification, fissures, alopecia
74
describe the lesions of infantile atopic dermatitis?
skin redness, tiny vesicles with scaling, exudates, crusts and fissures
75
what surfaces is atopic dermatitis common on?
flexor surfaces
76
what surfaces are psoriasis on?
extensor surfaces
77
eruptive (guttate) psoriasis are described as "dropped lesions" most likely following what?
streptococcal pharyngitis
78
what is the common clinical presentation of contact dermatitis?
it starts with erythema and becomes a papulovesicular eruption with crusting
79
what it the etiology of warts?
HPV
80
which strains of HPV are associated with cervical cancer? genital warts?
16 & 18
| 6 & 11
81
what is significant about a keratocanthoma?
rapidly growing low grade (unlikely to metastasize) tumor that resembles SCC
excise the entire lesion
82
what are the signs and symptoms of SCC?
firm skin color to reddish brown nodules on damages skin (hard, thick nodules) with central ulceration
margins are firm and more raised than BCC
seen on sun exposed areas
83
what type of cell does a malignant SCC arise form?
keratinocytes
84
what are the precursor lesions of SCC?
actinic keratosis and leukoplakia
85
what are the risk factors for SCC?
HPV
UV radiation
SPT I and II
Actininc horn
86
what is the single most important prognosis factor for malignant melanoma?
tumor thickness and depth
87
what are the precursor lesions to malignant melanoma?
1. Lentigo maligna- precursor for LMN
2. congenital melanocytic nevi
3. clark's (dysplastic) melanocytic nevi-precursor for superficial spreading
88
define superficial spreading melanoma (SSM)?
most common form, 70% of all melanomas
prolonged radial growth phase
various shades of brown usually mixed with black
foci of red, blue and purple (patriotic)
vertical growth face is characterized by nodule formation, bleeding and ulceration
89
Define nodular melanoma (NM)?
```
8x more common in japaneese
2nd most common overall
arises quickly 4 mo- 2years
immediate vertical growth phase
colors are usually uniform
```
90
define lentigo maligna melanoma (LMN)?
uncommon and only occurs in sun exposed areas
flat stainlike macule with varying hues of black and brown with fleck of irregular pigmentation
eventually papular and nodular lesions arise
91
define acral lentiginous melanoma?
similar to LM or SSM but metastasizes early
flat, black- brown macule common on tips of fingers and toes, under nail bed
may also present on soles or palms
92
what is the number 1 prognostic factor for vertical invasion?
Clark's levels
levels 1 & 2 are a good prognosis
3 & 5 is increasingly poor
93
what does Brelow's determine?
5 year survival rate based on the measuring from the granular layer in the epidermis to the deepest tumor cells in the dermis
94
what is hutchinson sign?
on paranikia that occur with malignant melanoma
95
what are the primary lesions of acne vulgaris?
open comedomes- back heads
closed comedomes- white heads
papules and pustules
nodules and cysts
96
what are the secondary lesions of acne vulgaris?
scarring and pitting
| excoriations
97
what are associated findings with acne vulgaris?
complaints of pain, pruritus, emotional upset and depression
98
what are the 2 steps in the pathophysiology of acne?
1. hyperkeratosis and thickening of the hair follicle above sebaceous duct forming a blockage
2. follicle ruptures into the dermis causing an inflammatory reaction
99
what is stage I of rosacea?
redness persists over time and telangiectasias develop
100
what is stage II of rosacea?
papules and pustules are present
101
what is stage III of rosacea?
persistent deep erythema, dense telangiectasias, papules and pustules
102
what happens in the final stage of rosacea?
Rhinophyma
103
what medication should you use as well as not use for perioral dermatitis?
it responds well to topical abx and never use steroids on the face
104
what are the clinical manifestations of a primary episode of HSV?
begins with area of erythema
papules and grouped vesicles evolve to eventually form erosions and crusts
patient also complains of fever and regional lymphadenopathy
105
what are the clinical manifestations of recurrent episodes of HSV?
begins with tingling and discomfort which starts as macule to papule and then vesicles to erosions to crusts
precipitated by stress, trauma, sunlight, pregnancy, fever, and menses
106
how is HVS different from HZ?
it is a reactivation of dormant VZV
pain first then rash along a dermatome
rash is papular and vesicular
107
define primary syphilis
chancre present- painless ulcer with indurated edge
yellow base
heals spontaneously in 1-3 months
108
define secondary syphilis?
- fever and widespread rash on the genitalia,soles, palms and face
- chodylomata lata are present in this stages-moist pink-tan papules in pernium and perianal areas
- syphilitic anetoderma
- patches of redness, scaling and alopecia of the scalp are common
109
what issyphilitic anetoderma?
skin feels slack due to loss of elastic tissue and dermal substance
in secondary syphilis
110
define tertiary shypilis?
Gumma is the hallmark
brownish red papules in an annular pattern that may ulcerate
ulcers may have vertical punched out wall and the base has a yellow slough
111
what is the difference between pemphigus and bullous pemphigoid?
pemphigus are flaccid blisters and painful erosions of the skin and mm
pemphigiod is a tense bulla with clear fluid that is symmetrical surrounded by redness and often begins in the inner thighs
112
what are the skin lesions in memingococcemia?
petechiae
transient urticarial macular/ papular lesions
purpura associated with poor prognosis
113
what is the problem with the memingococcemia vaccine?
only gets < 20% of isolates and does not protect for the most lethal strain so there is a high risk of mortality
114
what does PUPPP stand for?
Pruritic, urticarial papules and plaques of pregnancy
115
what are the clinical manifestations of henoch schonlein syndrome?
* renal, skin, GI, knees and joints, constitutional symptoms with fever
1. skin lesions- palpable purpura
2. arthralgia in joints
3. bloody diarrhea and abdominal pain
4. CVA tenderness hematuria, proteinuria
116
what does henoch schonlein syndrome follow?
GABHS and viral infections
117
what is polyarteritis nodosa?
serious systemic immune complex mediated disorder involving arteries in different organs
118
what are the symptoms of polyarteritis nodosa?
Related to the involved organs
| patient fells unwell, febrile, wt loss, achy limbs, abdominal pain
119
what are the cutaneous lesions of polyarteritis nodosa?
```
only in 15%
nodules
eccchymoses, gangrene and embolic infarcts of the nail folds
livedo reticulars
* very high morbidity and mortality
```
