DSA Skin Assessment

Question 1

What is acne vulgaris?

Answer 1

chronic inflammatory dz of pilo-sebaceous follicles (characterized by comedones, papules, pustules, nodules & scars)

usually on face, chest, back & shoulders beginning at puberty

Question 2

Open v closed comedones

Answer 2

open (black head, dilated central opening filled w/ blackened keratin)

closed (white head)

Question 3

What is atopic dermatitis?

Answer 3

chronic, relapsing, pruritic condition often assoc w/ allergic rhinitis or asthma

sxs of itching leading to excoriated skin lesions & lichenification

Question 4

What is important to making diagnosis of atopic dermatitis?

Answer 4

PMH, allergies & FH

Question 5

Acute v chronic eczema

Answer 5

acute: red, vesicles, bullae, crusting
chronic: lichenification, scaling, hyper & hypo pigmented

Question 6

What is seborrheic dermatosis?

Answer 6

ranges from dandruff to fulminant rash

lesions are dry, itchy, red, greasy found on scalp, eyebrows, nasal & lip folds, eyelip margins

Question 7

What is seborrheic keratosis?

Answer 7

warty scaly lesion w/ stuck on appearance, well circumscribed

usually tan to dark brown to black, more common in middle aged & elderly

Question 8

What is dermatofibroma?

Answer 8

firm 0.5-2cm papules or nodules (round or ovoid w/ well defined border)

flesh, yellow to red or black in color

Question 9

Where do you find dermatofibromas?

Answer 9

tend to be on extremities, especially legs

Question 10

How do you confirm dermatofibromas?

Answer 10

squeeze the margin & lesion will dimple (dimple/Fitzpatrick sign)

Question 11

What is rosacea?

Answer 11

chronic inflammatory condition w/ relapsing-remitting course (develops btwn ages 30-50)

facial flushing & localized redness, telangiectasias & papules/pustules on nose, cheeks, brow & chin

Question 12

Where is rosaecea usually not seen?

Answer 12

on nasolabial folds, extrafacial involvement is rare

Question 13

What is a sebaceous cyst?

Answer 13

cyst wall composed of squamous epithelium w/ macerated keratin & lipid-rich debris

common on face, trunk, extremities, mouth or genitals

Question 14

What is a nevus (mole)?

Answer 14

pigmented lesion that usually arises in childhood

pigmented lesions less common after age 50

Question 15

Junctional nevi v compound nevi

Answer 15

junctional are flat (macular) & compound are elevated relative to surrounding skin (papular)

Question 16

What is erythema multiforme?

Answer 16

target lesions that are well-defined, circular, red macules or papules )<3cm)

will have 3 distinct color zones & central zone w/ crust

Question 17

Distribution of erythema multiforme?

Answer 17

first appear in symmetrical distribution on acral sites & progress in centripetal fashion

Question 18

What is erythema multiforme associated with?

Answer 18

dz processes (HSV, mycoplasma pneumonia, group A strep & EBV)

triggered by drugs (penicillin)

Question 19

What is eruptive xanthoma?

Answer 19

dome shaped yellow-orange, firm papules that appear abruptly & all @ same stage of development

Question 20

What is dermatomyositis?

Answer 20

violaceous rash w/ systemic manifestations (fatigue, malaise, myalgies)

may also have proximal muscle weakness & dysphagia

Question 21

What is commonly involved if pt has dermatomyositis?

Answer 21

respiratory, CV (tachy or bradycardia, CHF)

40% of pts w/ malignany

Question 22

Heliotrope rash

Answer 22

violaceous edematous periorbital erythema, may be slightly scaly

Question 23

Atrophic dermal papules

Answer 23

red or violaceous, scaly, flat-topped papules on dorsal MCP joints

Question 24

Nail fold telangiectasia

Answer 24

erythema & telangectasias @ base of nails w/ prominent capillary loops

Question 25

Shawl sign

Answer 25

photoexacerbated macular or poikilodermatous erythema of upper back & posterior neck/shoulders

Question 26

What is actinic keratosis/solar keratosis?

Answer 26

pre-cancerous lesion found on sun exposed areas may progress to SCC w/o treatment increase in frequency w/ increasing age

Question 27

Describe actinic keratosis

Answer 27

begin as rough localized lesion that develop white-to-yellow surface scale, has gritty feel & base may have light, mild-brown pigment

Question 28

What is solar lentigo?

Answer 28

age spot, assoc w/ multiple sunburns in fair-skin idividuals benign tan to brown (hyperpigmented) pigmented macule related to UV radiation

Question 29

What are malignant lesions?

Answer 29

``` BCC Infiltrating BCC Superficial BCC Melanoma Cutaneous squamous cell ca ```

Question 30

What is the most common cancer of the skin?

Answer 30

Basal cell carcinoma (BCC)

Question 31

BCC

Answer 31

more common in Ms, smooth pearly papule or nodule w/ rolled borders & orverlying telangiectasia, nodular lesion on sun exposed area (85% on head & neck) most commonly involves nose

Question 32

Infiltrating BCC

Answer 32

may present as slightly raised or depressed, indurated, thin, pink to white scar-like plaque w/ possible scale, crust, erosion overlying telangiectasias

Question 33

Superficial BCC

Answer 33

well defined red patch or thin plaque w/ rolled borders expands HORIZONTALLY over time & undergoes many superficial changes (atrophy, hypopigmentation)

Question 34

Melanoma

Answer 34

age: median ddx in 60s location: any skin w/ melanocytes most melanomas are pigmented & can be flat, nodular lesions on palms, soles or nails

Question 35

ABCDEs of melanoma

Answer 35

``` Assymmetry Borders (irregular?) Change in color Diameter >6mm Evolution ```

Question 36

Cutaneous squamous cell cancer

Answer 36

present as variable hyperkeratotic papule or nodules that may be smooth, plaque-like, exophytic, warty w/ variable color avg onset is mid-60s, on any surface skin (including mucosa) but usually on sun-exposed areas

Question 37

What does presence of actinic keratosis predispose to?

Answer 37

AK indicates an individual is @ higher risk of developing sCC, 80x more likely in fair-lighter skin types

Question 38

Flat lesions (macule v patch)

Answer 38

you cannot palpate lesion w/ eyes closed macule is flat & <1cm while patch is flat & >1cm

Question 39

Raised lesions

Answer 39

you can palpate lesion w/ eyes closed

Question 40

What are the non-fluid filled raised lesions?

Answer 40

papule is <1cm nodule is solid >1cm plaque is flat & elevated lesion >1cm

Question 41

What are the fluid-filled raised lesions?

Answer 41

vesicle (raised & <1cm) pustule (raised, pus-filled lesions <1cm) bulla (raised, >1cm, fluid filled)

Question 42

What is distinctive about erythema lesions?

Answer 42

if you press down on them, they will NOT blanch