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Clinical Medicine I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Seborrheic Keratosis (SK)

A

age-related benign hyperpigmentation
appears “STUCK ON”- warty, greasy
tan to black raised papule

Treatment: cryotherapy, curettage, biopsy

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2
Q

Keratoacanthoma

A

RAPIDLY GROWING benign neoplasm
resembles SCC
round, flesh-colored nodule

Treatment: biopsy

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3
Q

Actinic Keratosis (AK)

A

often precursor to SCC
SUN EXPOSURE
“barnacles on a boat” - scale or dry patch

Treatment: 5-FU cream, cryo, curettage

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4
Q

Basal cell carcinoma (BCC)

A

“PEARLY” or “WAXY” hard nodule or papule with depressed center
teleangiectasia
rolled borders

Treatment: biopsy, Mohs micrographic surgery

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5
Q

Squamous cell carcinoma (SCC)

A

ULCERATED hard plaque, papule or nodule
more aggressive than BCC but still low metastatic risk

Treatment: surgical resection, Mohs, may require chemo

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6
Q

Malignant melanoma

A

originates in melanocytes
often metastasize to lungs, brain and lymph nodes
SUN EXPOSURE

4 subtypes:

  1. superficial spreading (70%) - radial spreading
  2. lentigo maligna - horizontal growth in situ
  3. acral letiginous - spreads superficially (most common in African Americans)
  4. nodular - MOST AGGRESSIVE = rapid vertical growth with little to no radial growth - inflammed nodule

Treatment: wide surgical excision with clear margins, elective regional lymph node dissection, chemo, immunotherapy, follow up every 3 months

  • Staging determines thickness and DEPTH OF PENETRATION
  • ulcerated = worse prognosis
ABCDs
A - asymmetry
B - irregular borders
C - variegated color
D - diameter >6mm
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7
Q

Mycosis fungoides (cutaneous T cell lymphoma)

A

localized erythematous patches or plaques on trunk
pruritic with lymph node swelling

Treatment: biopsy

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8
Q

Measles (Rubeola)

A

etiology: Paramyxovirus
contagious via droplets (even after person leaves room)

3 C’s = cough, coryza (nasal inflammation), conjunctivitis

Koplik spots - white tiny papules on buccal mucosa
spreads head to toe and coalesces

Complications: diarrhea, otitis media, pneumonia, encephalitis

Treat symptoms

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9
Q

Erythema infectious (5th disease)

A

etiology: Parvovirus B-19
transmitted via droplets

non-specific flu-like before rash
malar rash - “SLAP CHEEK”
“LACY” body rash on extensor surfaces

Complications: transient aplastic crisis (anemia) requiring blood transfusion
HYDROPS FETALIS - increased fluid while pregnant may cause fetal loss

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10
Q

Rubella (German measles)

A

etiology: rubella virus
transmitted via droplets

erythematous papules/purpura
“3 day measles”
head to toe progression
arthritis in adults

Complications: congenital rubella syndrome (LETHAL) - “BLUEBERRY MUFFIN” appearance, hearing loss, mental retardation, CV and ocular defects

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11
Q

Roseola infantum

A 
etiology: most commonly herpes virus 6
transmission sporadically (mostly infants)

3-5 days high fever with ABRUPT END followed by blanching erythematous maculopapular rash spreading from neck to trunk THEN face and extremities

Treat supportively with antipyretics

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12
Q

Hand, Foot and Mouth

A

etiology: Coxsackie A16 virus
mostly children
transmission usually fecal-oral

sore throat and vesicles on buccal mucosa
vesicles on hands, feet and butt that may create ulcers

Complications: decreased oral intake, dehydration, ASEPTIC MENINGITIS

Treatment: prevent with good hygiene, lidocaine gel for adults

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13
Q

Molluscum contagiosum

A

etiology: POX virus
very contagious transmitted via direct physical contact or with contaminated fomites

autoinoculation
pearly papules with UMBILICATION (2-5mm)

usually spontaneously resolves 6-12 months
treat if in genital region –> cryo, curettage, cantharidin (causes blistering - good for children)

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14
Q

Condyloma Acuminatum (genital warts)

A

etiology: HPV
transmitted via sexual contact

cauliflower-like lesions
pruritic
perinanal growth

Treat with topical cream or surgery

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15
Q

Verruca Vulgaris (common warts)

A

etiology: HPV
more common in children/young adults
transmitted via skin-to-skin contact

raised, rough surface lesions
tiny pigmented thrombosed capillaries
common on hands and feet (plantar)

spontaneous resolution in 1-2 years (recurrence common)

*15 blade scrape off prior to treatment
duct tape

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16
Q

Varicella (Chicken Pox)

A

etiology: varicella-zoster virus (VZV), a herpes virus
transmitted via droplets or direct contact
highly contagious

generalized pruritic vesicular rash
crusts over in 6 days (no longer contagious)
3 STAGES: papule –> blister –> ulcer

Complications: group A strep, encephalitis

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17
Q

Herpes zoster (Shingles)

A

etiology: varicella-zoster virus (VZV)
reactivation of latent VZV from dorsal root ganglia
more common in elderly or immunocompromised

acute neuritic pain 3-5 days prior to eruption
pruritic, allodynia, fever
DERMATOMAL DISTRIBUTION (usually thoracic)
grouped vesicles on a erythematous base

usually resolves 2-6 weeks

Complications: POST HERPETIC NEURALGIA (PHN)
HERPES ZOSTER OPTHALMICUS (HZO) - sight-threat

Treatment: start early with antivirals –> famciclovir, valacyclovir

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18
Q

Herpes Simplex Virus (HSV)

A

HSV-I (herpes labialis)
HSV-II (herpes genitalis)

virus remains remains latent in nerve root ganglion following primary infection
GROUPED VESICLES ON AN ERYTHEMATOUS BASE
crusting at later stages
burning, tingling, pruritic

Treatment: start early with antivirals (same as shingles)

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19
Q

Acanthosis Nigricans

A

hyperpigmented VELVETY plaques
commonly neck and skin folds
more in Hispanic, AA, Native Americans

Treat underlying condition –> obesity, diabetes

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20
Q

Melasma

A

acquired hyperpigmentation
melanocytes increase pigment when stimulated by UV light or increased hormone levels

“MASK OF PREGNANCY”

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21
Q

Lipomas

A

subcutaneous soft-tissue tumors
benign, soft and mobile
surgical removal

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22
Q

Epithelial inclusion cyst

A

cutaneous cyst
soft, mobile nodule –> fluctuant
often central puncture that starts to drain

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23
Q

Tinea capitis

A

etiology: tricophyton and microsporum species
risk factors: decreased personal hygiene, overcrowding, low SES
acquired via direct contact or with contaminated fomites

scaly patches with alopecia
kerion - boggy, edematous painful plaque
favus - yellow crusts “honeycomb”

KOH prep - “spaghetti and meatballs” - spores and hyphae
dermscopy - hair grows in tortuous manner

Treatment: fluconazole, itraconazole (oral antifungal)

24
Q

Tinea corporis (ring worm)

A

etiology: T. rubrum
common in athletes with skin-to-skin contact

pruritic, annular, erythematous plaque
central clearing
advancing border
scaling across the top

KOH prep

Treatment: topical antifungals (-azole)

  • nystatin doesn’t work
  • do NOT treat with topical steroids –> changes appearance and doesn’t work – can cause skin atrophy/striae
25
Q

Tinea cruris (jock itch)

A

etiology: T. rubrum
usually from auto inoculation of tinea pedis or onychomycosis

well-marginated, annular plaque with scaly raised border
inguinal fold to inner thigh (scrotum typically spared)
pruritic and painful

KOH prep

Treatment: topical antifungals, daily talcum powder

26
Q

Tinea pedis (“athlete’s foot”)

A

etiology: T. rubrum
acute - self-limited, pruritic, painful vesicles/bulla after sweating
chronic - slowly progressive with erosions/scales between toes and interdigital fissures

KOH prep

Treatment: topical antifungals, oral (ie. fluconazole), proper footwear

27
Q

Onychomycosis

A

etiology: T. rubrum or candida (yeast)

4 subtypes:

  1. Distal subungual (most common) - discoloration starts distally and spreads to cuticle
  2. Proximal subungual - opposite of distal
  3. White superficial - dull, soft white spots that can be scraped off for sample
  4. Yeast - thickening of nail with yellow/brown discoloration sometimes accompanied by paronychia

KOH prep

Treatment: oral terbinafine or fluconazole
*check liver function because meds can be hard on liver

28
Q

Candidal Intertrigo

A

infectious or noninfectious inflammatory condition of 2 closely opposed (intertriginous) skin surfaces

erythematous, macerated plaques and erosions
pruritic
SATELLITE papules/pustules

KOH prep

Treatment: nystatin, topical or oral antifungals, weight loss

29
Q

Tinea Versicolor (pityriasis versicolor)

A

etiology: malassezia – normal skin flora that becomes pathologic
risk factors: tropical climates, hyperhidrosis, genetics

macules, patches, plaques on trunk and UE
hypopigmentation, hyperpigmentaion or erythematous
typically asymptomatic

KOH prep or Wood’s Lamp (fluorescence)

Treatment: topical or oral antifungals

30
Q

Acne Rosacea

A

common skin disorder on central face persisting for months, not well understood

Subtypes:
1. erythematotelangiectatic - flushing and skin sensitivity
treat with light therapy and behavior modifications (avoid triggers)

  1. papulopustular - papules and pustules on central face with inflammation
    treat with topical or oral -cyclines and -mycins
  2. phymatous - tissue hypertrophy with irregular contours (mostly on the nose)
    treat with surgery
  3. ocular (50% of rosacea cases) - may precede, coincide or follow other rosaces –> dry eyes, pain, pruritic, blurry vision, etc.
    treat with referral to ophthalmologist

Triggers: emotions, alcohol, sunlight, exercise, cosmetics, etc.

31
Q

Scabies

A

etiology: host-specific mite
transmission via direct contact
host harbors, excavates a BURROW in stratum corneum to lay eggs that then hatch in 10 days

initial lesion/burrow
severe pruritis, worse at night
primarily webbed spaces and groin (spares back and head)

Immunocompromised = CRUSTED SCABIES

Treatment: scabicide repeated in 1-2 weeks (eggs hatch)
antihistamines for itching

32
Q

Bee stings

A

etiology: Hymenoptera species
*remove stingers ASAP
can cause anaphylaxis –> treat with IM epinephrine

local rxn - swelling and erythema for 1-2 days
treat with cold compress

large local rxn - exaggerated erythema and swelling resolves in 5-10 days
treat with cold compress, prednisone, NSAIDs, antihistamines

secondary bacterial infection = worse symptoms 3-5 days post sting that may cause fever and should be treated with antibiotics

33
Q

Spider bites

A

Widows
blanched circular patch with red perimeter
central punctum
venom triggers catecholamine release –> sweating, N/V, h/a, ab pain, muscle spasms
TREAT - antiemetics, local wound care, tetanus

Recluse
specific geographical region
known for ulcerative necrotic bite –> dark, depressed center 1-2 days post-bite
painless initially followed by severe pain 2-8 hours later
usually resolved in 1 week

Hobo
no deaths or necrosis
not aggressive or found in the house

34
Q

Vitiligo

A

acquired skin depigmentation via autoimmune process against melanocytes (none found in epidermis)
onset 20s-30s –> family history plays a role

milk-white macules with well-defined borders
slowly progressive
spontaneous repigmentation in 10-20%

Treatment: corticosteroids, UV light, skin grafts

35
Q

Hidradenitis Suppurativa (acne inversion)

A

chronic inflammatory skin disorder involving the hair follicle

follicular occlusion –> follicular rupture –> associated immune response

inflammatory nodules
sinus tracts (2 lesions connect)
scarring
comedones (black heads)

Treatment: weight loss/diet, smoking cessation, hygiene, corticosteroids, retinoids, antibiotics

Complications: fistulae, SCC, depression/suicide, lymphatic obstruction

36
Q

Atopic dermatitis (eczema)

A

type I hypersensitivity reaction (IgE mediated)
“the itch that rashes” - pruritic

ATOPIC TRIAD:
atopic dermatitis
sinus rhinitis (hay fever)
asthma

ill-defined erythematous scaly patches (mild)
edematous papules and vesicles (severe)

infants = face, scalp and extensor surfaces
adults = flexor surfaces, hand/feet

Complications: excoriation, lichenification, painful fissures, secondary cellulitis

Treatment: avoid triggers, rubbing/scratching, use emollients, antihistamines prn pruritis, topical steroids if necessary

37
Q

Lichen simplex chronicus

A

secondary skin condition from excessive scratching or rubbing

dry,leathery appearance with pigmentation
common on back of neck, wrists, forearms, lower legs

Treatment: topical steroids and moisturizers

38
Q

Dyshidrotic eczema

A

deep-seated vesicles with TAPIOCA appearance
coalesce and rupture
80% on hands
INTENSELY PRURITIC
emotional stress and hot weather triggers

39
Q

Keratosis pilaris (“chicken skin”)

A

keratinization disorder
horny plugs in hair follicles

rough, raise papules
improves with age

Treatment: scrubs, topical retinoids, salicylic acid

40
Q

Contact dermatitis

A

Allergic
delayed hypersensitivity (ie poison ivy, nickel, latex)
linear appearance with lots of vesicles
TREAT with bacitracin

Irritant (80%)
repeated friction/mechanical irritation (i.e. water, detergents, saliva, etc)
treat with bland emollient (oil based)

41
Q

Seborrheic Dermatitis

A

yeast
mild dandruff to more extensive inflammatory dermatitis

Infants - yellow, greasy scales “CRADLE CAP”
Adults - greasy scales and yellow-red coalescing macules, patches and papules

Treatment: Selenium sulfide or ketoconazole shampoo

42
Q

Pityriasis Rosea

A

benign VIRAL skin eruption
large primary patch on trunk - “HAROLD PATCH”
secondary rash of fine scaled papules and plaques 1-2 weeks later in a “CHRISTMAS TREE” pattern

Treatment: self-limiting goes away in 6-12 weeks, oral antihistamines (ie. claritin, zyrtec, benedryl) to help symptoms

43
Q

Lichen Planus

A

4 P’s - purple, pruritic, polygonal, papules
50% mouth, wrists, back, shins, scalp
WICKAM’S STRIAE = fine white lines on top of plaques

Treatment: topical or oral steroids, self-limiting 18 months

44
Q

Psoriasis

A

chronic, recurrent, hyper proliferative skin disease
thickened red plaques with silvery scale
pitted nails, onycholysis, “OIL SPOTS”

Comorbidities: IBS, heart disease, metabolic syndrome

Vulgaris (most common)
AUSPITZ SIGN - removal of scale = punctate bleeding
KOEBNER PHENOMENON = plaques develop in areas of skin injury

Treatment: depends on type and severity sunshine/baths/emollients/rest
oral steroids = worse flare-up upon discontinuation
coal tar
phototherapy and Vit D analogs
retinoids

45
Q

Discoid Lupus

A

purple-red plaques and scales with spiny projections when scale is removed
may see permanent hair loss or loss of pigmentation

lesions well-localized on head, neck, face and ears

Labs: ANA, double stranded DNA

Treatment: protect from sunlight and photosensitizing drugs (tetracyclines), injectable steroids into lesions once a month

46
Q

Porphyria Cutanea Tarda

A

sub-epidermal blistering of skin on DORSUM of hand
may be associated with ingestion of estrogens, liver disease or hepatitis

Treatment: phlebotomy, stop potential meds, sun protection

47
Q

Folliculitis

A

commonly caused by Staph aureus
pustules with hair growing out of them
pruritic and burning

complication: abscess

Treatment: antibiotics

48
Q

Erythema migrans

A

pathogenesis: Borrelia burgdorferi
rash 3-32 days post tick bite (Lyme disease)
slightly raised, warm red with central clearing “TARGET”

Treatment: systemic antibiotics (ie. amoxicillin)

49
Q

Erythema multiforme

A

immunologica reaction caused by circulating immune complexes
viral, bacterial, fungal, or drug eruption (typically NSAIDs, antibiotics or sulfonamides)
TARGET lesions

Treatment: symptomatic with either topical or systemic steroids, anti-viral if indicated

50
Q

Erysipelas

A

B. hemolytic streptococci
superficial form of cellulitis seen on cheeks
pain, malaise, chills

edema, warm to touch, spreading and well-circumscribed papule/plaque

Treatment: IV antibiotics against Group A strep and staph
*can become toxic if not treated quickly

51
Q

Cellulitis

A

bacterial infection of staph or group A strep
*deeper than erysipelas –> diffuse spreading
at risk: venous insufficiency and DM

swelling and STREAKING erythema and pain

Treatment: oral or IV antibiotics

52
Q

Impetigo

A

bullous - intraepidermal bacterial infection of skin caused by Staph
non-bullous (most common) - lesions begin as papules and progress to vesicles with erythema

auto inoculation with satellite lesions
YELLOW CRUST appears over ruptured bull

Treatment: topical antibiotics (ie Bactroban), oral antibiotics (ie Dicloxicillin)

53
Q

Toxic Epidermal Necrolysis

A

similar to Stevens-Johnson syndrome, but affects skin surface more (30% vs 10%)
caused by meds
bullae and SLOUGHING off of epidermal layers

54
Q

Dermatitis Herpetiformis

A

intensely pruritic vesicular disease
IgA deposits in dermal papillae
75% have GLUTEN SENSITIVITY

Treatment: Dapsone

55
Q

Pressure ulcers

A

pressure of soft skin over bony prominences causing ulcerations
best treatment is PREVENTION
categorized by stages 1-4

56
Q

Hormonal effects on skin

A

Glucocorticoids
atrophy, striae, purpura
moonface/buffalo hump (Cushing’s disease)

ACTH
adrenal failure (Addison's disease) causing hyper pigmentation of the skin especially the gingiva

Androgens (effects pilosebaceous unit)
increased sebum, acne, androgen alopecia and hirsutism

Growth hormone
epidermal hyperplasia and hyperpigmentation

Insulin-resistant DM
Acanthosis nigricans (velvety)

Norepinephrine
profuse sweating

Thyroid hormone excess (hyperthyroidism and Grave’s Dss)
warm moist skin
pretibial myxedema - thickening of skin on anterior tibia

Hypothyroidism
dry cool skin and generalized thickening

Parathyroid hormone
metastatic calcification (rare)

Clinical Medicine I (4 decks)

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