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Medical Sciences B > Integumentary > Flashcards

Integumentary Flashcards

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1
Q

What questions do you ask a patient with a skin lesion?

A
  • When did it start?
  • How long has it been present?
  • Has it grown, spread or changed?
  • Does it come and go?
  • Has it occurred before?
  • Describe all events since it began.
  • Is it wet or dry?
  • Does it itch? When?Exacerbating/relieving factors?
  • Relationship to creams, makeup, foods, menstruation, season?
  • Associated symptoms?
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2
Q

Why must a chiropractor have good knowledge if integumentary system pathologies?

A
  • see lots of skin
  • see where patients can’t
  • proper referral vocabulary
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3
Q

What is the relationship between papule, nodule, and tumour?

A

From small to biggest:

papule -> nodule -> tumour

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4
Q

What is the relationship with vesicles and pustules?

A

From small to bigger:

vesicles -> pustules

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5
Q

macules

A
  • flat
  • circumscribed
  • discoloured
  • varying shapes and sizes
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6
Q

papules

A
  • raised
  • firm
  • circumscribed
  • < 1cm
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7
Q

wheals

A
  • circumscribed
  • elevated
  • itching and tingling
  • (hives)
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8
Q

nodules

A
  • larger papules (raised, firm, circumscribed)

* felt more deeply

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9
Q

tumours

A
  • larger nodules (raised, firm, circumscribed)

* felt very deeply

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10
Q

vesicles

A
  • defined
  • small
  • domed collections of fluid
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11
Q

bullae

A
  • large vesicles (defined domed collections of fluid)

* > 1cm

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12
Q

pustules

A
  • circumscribed
  • elevation
  • purulent fluid
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13
Q

telangiectasia

A

dilated superficial blood vessels

spider veins

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14
Q

What is a secondary skin lesion?

A

lesions that usually (but not always) follow a primary lesion

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15
Q

List the primary skin lesions

A
  • macule, papule, nodule, tumour
  • wheal
  • vesicle, bullae
  • pustule
  • telangiectasia
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16
Q

List the secondary skin lesions

A
  • scales
  • crusts
  • ulcers
  • Koebner’s special phenomenon
  • fissures
  • burrows
  • erosions
  • scar
  • lichenification
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17
Q

scales

A
  • masses of dead tissues
  • dry OR greasy
  • psoriasis: dry silvery
  • seborrhoeic dermatitis: greasy and yellow
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18
Q

crusts

A
  • masses of dried exudate, bacteria and leukocytes
  • dirty yellow
  • uneven, lumpy
  • not well defined edges
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19
Q

ulcers

A
  • irregularly shaped excavations in epidermis and dermis
  • from necrosis
  • always scar
  • described by shape, floor, base edge, secretions
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20
Q

Koebner’s special phenomenon

A
  • Patient with psoriasis or lichen planus

* features of their disease appears following trauma to the area

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21
Q

fissures

A

linear groove on surface of skin

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22
Q

burrows

A

passage made in tissues by parasitic insect larvae

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23
Q

erosions

A

loss of part of epithelium

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24
Q

scar

A

fibrous tissue replacing normal tissue

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25
Q

lichenification

A
  • thickened skin

* with increased prominence of skin markings

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26
Q

What are the classification categories of integumentary system disorders?

A

1) Inflammatory
2) Infections
3) Alteration in skin pigmentation
4) Disorders of hair follicles and sebaceous glands
5) Disorders of sweat glands
6) Neoplasia and differentiation alterations
7) others

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27
Q

List the inflammatory disorders of the integumentary system

A
  • dermatitis: allergic, atopic, contact
  • drug eruptions
  • eczema
  • erythema multiforme
  • erythema nodosum
  • lichen planus
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28
Q

List the bacterial infections of the integumentary system

A
  • boils
  • carbuncles
  • erysipelas
  • erythrasma
  • folliculitis barbae
  • impetigo
  • scalded skin syndrome
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29
Q

List the viral infections of the integumentary system

A
  • chicken pox
  • erythema infectiosum
  • herpes simplex
  • measles
  • pityriasis rosea
  • warts
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30
Q

List the fungal infections of the integumentary system

A
  • dermatophytoses
  • paronychia
  • pityriasis versicolour
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31
Q

List the alteration in skin pigmentation disorders of the integumentary system

A
  • albinism
  • melasma
  • vitiligo
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32
Q

List the hair follicles and sebaceous glands disorders of the integumentary system

A
  • acne rosacea
  • acne vulgaris
  • alopecia
  • hypertrichosis
  • milia
  • sebaceous cysts
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33
Q

List the “other” (not bacterial, viral or fungal) infections of the integumentary system

A
  • creeping eruption
  • pediculosis
  • scabies
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34
Q

List the disorders related to sweat glands of the integumentary system

A
  • hyperhidrosis

* miliaria

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35
Q

List the malignant neoplasias of the integumentary system ?

A 
Malignant:
• basal cell carcinoma
• Kaposi's sarcoma
• melanoma
• Paget's disease of the nipple
• squamous cell carcinoma
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36
Q

List the “other” disorders of the integumentary system

A
  • callus/corn
  • dermatitis herpetiformis
  • icthyosis
  • keratosis pilaris
  • pemphigus
  • pressure sores
  • psoriasis
  • solar keratosis
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37
Q

What is the relationship of ulcer and erosion?

A

erosion is a mini ulcer

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38
Q

List the types of dermatitis

A

Contact:
• irritant
• allergic

Atopic: eczema

Others:
• seborrhoeic
• varicose
• neurodermatitis
• nummular
• generalized exfoliative
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39
Q

Contact irritant dermatitis

A
  • chemical irritants
  • immediate-hrs after contact
  • affects everyone mostly the same way
  • ex: poison ivy
Features:
• erythema, swelling, vesicles/bullae, oozing/crusting, pruritus, burning
• secondary infection maybe
• later scaling, lichenification
• spreads maybe
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40
Q

Contact allergic dermatitis

A
  • delayed hypersensitivity reaction type 4
  • to an irritant
  • only affects some people
  • days-years to develop
  • AGENTS: drugs, plants, cosmetics, metals
  • photoallergic and phytotoxic: requires contact plus light exposure

Features: same as contact irritant dermatitis BUT not confined to exposed area

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41
Q

Seborrhoeic dermatitis

A
  • uncertain aetiology
  • “dandruff”
  • scales on scalp (maybe eyebrows, nose, external auditory canal, hairline)
  • dry or greasy
  • papules if severe
  • itchy or not

INFANTS: thick yellow crusts, fissures, scales

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42
Q

Varicose dermatitis

A
  • venous congestion/ incompetency
  • fibrin deposits around small blood vessels with vasoconstrictive reflexes
Features:
• rash on ankles
• erythema, scaling, oedema, brown
• varicose veins maybe
• Maybe secondary bact. inf. and ulceration
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43
Q

Neurodermatitis

A
  • psychogenic aetiology
  • chronic
  • pruritus complaint, no lesions at first
  • scratching until lesions
  • dry, scaly, hyperpigmented, thickened plaques well demarcated
  • exacerbated by stress
  • arms, lower legs, occiput most common
  • maybe anal region, vulva
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44
Q

Nummular dermatitis

A
  • unknown aetiology
  • middle-aged with dry skin
  • pruritic coin shaped lesions
  • start as papules and vesicles
  • then ooze and crust
  • anywhere, but buttocks and extensor surfaces common
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45
Q

Generalized exfoliative dermatitis

A
  • idiopathic (#1), or irritant systemic drug, secondary to other dermatologic disorder
  • severe
  • rapid inflammation
  • erythema, scaling, thickening
  • maybe crusting, pruritus
  • fever, generalized lymphadenopathy
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46
Q

What is cradle cap?

A

Seborrhoeic dermatitis (“dandruff”) in infants
• thick yellow crusts
• fissures and scales

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47
Q

Drug eruptions

A

• skin or mucous membrane eruptions following drugs
• most idiopathic or
-Hypersensitivity reaction (eg. penicillin)
-Excessive accumulation
-Interacting with genetic characteristic
-Pharmacological action (eg. steroids causing acne)

Feature:
• eruptions of any other dermatological condition
• localized or generalised
• usually eruptions characteristic to that drug

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48
Q

Eczema

A
  • atopic dermatitis, chronic superficial inflam.
  • idiopathic, Hx of asthma, hay fever
  • pruritus, itchyosis
  • flexor surfaces
  • red, vesicles, puffy, oozing cracks
  • exacerbated by mood, temperature, friction (wool)
  • Types: infantile, childhood, adult
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49
Q

What are some examples of drugs that can cause Drug Eruptions?

A
  • aspirin
  • penicillin
  • antibiotics
  • corticosteroids, phenothiazines
  • artificial sweeteners
  • dye tartrazine
  • anticoagulants
  • oral contraceptives
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50
Q

What is an “atopic” patient?

A
  • tendency to develop allergic responses to various allergens
  • particularly protein substances
  • often have eosinophilia and higher IgE levels
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51
Q

What is icthyosis?

A

dry, rough, scaly skin

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52
Q

Erythema multiforme

A
  • symmetrical erythematous, oedematous, bullous lesions
  • acute, recur
  • annular lesions with concentric rings (“target”)
  • palms, soles, face
  • fever, malaise, arthralgia
  • 50% are idiopathic
  • drugs (penicillin, sulphonamides), vaccines, infectious (herpes simple, coxsackie, echoviruses, pneumonia)
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53
Q

Erythema nodosum

A
  • inflam. skin
  • pre-tibial region
  • tender erythematous nodules
  • mostly young adults

FROM:
• kids- URT infection (streptococci)
• adults- strep. and sarcoidosis

Features:
• recur for yrs
• nodules change pink-> blue-> brown
• fever, arthralgia

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54
Q

Lichen planus

A
  • recurrent inflam. of skin or mucous membranes
  • angular shaped papules
  • FROM: idiopathic or drugs
  • mainly in adults
  • flat topped, polygonal shiny violaceous scaly papules
  • few or many
  • nails maybe
  • resolves within 6/12
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55
Q

Furuncle

A

synonym for boils

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56
Q

Boils

A
  • acute, tender, inflam. nodules
  • staphylococci infection, usually S. pyogenes
  • inflam. nodule -> pustule -> purulent exudate
  • < 30mm
  • on breasts, buttocks, neck, face
  • recurrent maybe
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57
Q

Carbuncles

A
  • cluster of boils
  • staphylococci infection
  • infection spreads slow subcutaneous -> deep area -> slow healing -> scar
  • maybe fever
  • males > fem
  • neck
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58
Q

Erysipelas

A
  • cellulitis caused by beta haemolytic streptococcus
  • usually group A
  • well demarcated, red, shiny, oedematous, tender
  • limbs or face
  • systemic symptoms (malaise, fever)
  • maybe recurrent
  • maybe cause chronic lymphoedema
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59
Q

Erythrasma

A
  • superficial, bacterial (corynebacterium minutissimum)
  • affects intertriginous areas (between toes)
  • pink irregular margins -> sharply demarcated, brown, fine scales
  • looks like chronic fungal infection
  • more in diabetics
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60
Q

Folliculitis

A
  • bacterial infection of hair follicles
  • superficial or deep
  • chronic or acute
  • Staph. aureus (#1) or pseudomonas aeruginosa
  • harry areas
  • pustules or inflam. nodules
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61
Q

Impetigo

A
  • contagious superficial inflam.
  • Staph. aureus (#1) or beta haemolytic strep.
  • FROM infected nostrils, ears, dirty finger nails, towels, OR secondary to condition (scabies, eczema)
Features:
• thin wall vesicles and bullae 
• rupture with honey crusts
• itching -> scratching -> new site
• pea to coin size
• circular
• face and ears
• clears in month or so
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62
Q

Scalded skin syndrome

A
  • widespread of erythema and peeling
  • in immunocompromised
  • epidermolytic toxin from group 11 coagulate positive staph. enters blood
  • reservoirs: eye, nasopharynx, skin
  • epidemics occur
  • localized crusted lesion -> erythematous areas spread -> blisters -> desquamation of large area
  • systemic features
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63
Q

Chicken pox

A
  • Varicella-Zoster virus (herpes)
  • very communicable

Features:
• sudden onset slight fever (minimal constitutional symptoms)
• skin eruptions maculopapular for few hours -> vesicular for 3-4 days -> granular scab
• successive crops with various stages at once
• more in covered body parts
• also scalp, mucous membranes of mouth, URT, conjunctiva
• mild infections
• fever sever in adults

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64
Q

What is the reservoir, occurrence, and incubation period of Chicken pox?

A

Reservoir: humans

Occurence: 
• world wide
• 75% of pop. had it by 15yrs
• 90% of pop. had it by adulthood
• more in winter and early spring

Incubation period: 14-21 days

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65
Q

What is the transmission of Chicken pox? What is the period of communicability?

A
  • person to person by direct contact, droplet, airborne spread of resp. tract from chicken pox patient or vesicle fluid of zoster patient
  • indirect by discharges from vesicles and mucous membranes
  • very communicable

Not infective: scabs

Period of communicability: 1-2 days prior to rash, until all lesions crusted over

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66
Q

How does Chicken pox kill?

A
  • death in adults from viral pneumonia
  • death in kids from septic complications and encephalitis
  • neonates aged 5-10/7 have increased risk of severe generalized chicken pox with 30% mortality
  • infections during pregnancy may get congenital malformations
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67
Q

What is the diagnosis, prevention, susceptibility and resistance of Chicken pox?

A

Diagnosis: clinical exam or serological

Live, attenuate varicella virus vaccine

Universal susceptibility
One infection confers long immunity
Infection remains latent (recurs as shingles)

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68
Q

What are the synonyms for Erythema infectiosum?

A
  • slapped cheek disease

* fifth disease

69
Q

Erythema infectiosum

A
  • Parvovirus B-19 (a DNA virus)
  • human reservoir
  • worldwide
  • 4-20 days incubation period
  • spread by contact with resp secretions (cough) or mother to foetus
  • infectious until rash appears (on cheeks a week later)

Features:
• asymptomatic or
• mild self-limiting in kids (flu-like, mild fever, headache, myalgia, chills, cheek rash)
• In utero- severe anaemia, spontaneous abortion <5%

Diagnosis by rash or IgM antibodies to virus

Prevent by respiratory precautions, hand washing

70
Q

Herpes simplex infections (infectious agent, reservoir, occurence, incubation period, transmission, period of communicability)

A
  • Herpes virus (types 1 and 2)
  • human carriers
  • worldwide occurrence
  • 1 week incubation
  • contact with vesicles or saliva
  • communicable most within few days of onset
71
Q

What are the clinical features of Herpes simplex infections? (diagnosis, prevention)

A
  • initial infection severe, recurrent is mild
  • Herpes labialis (lip-cold sore)
  • Genital herpes
  • Herpetic gingivostomatitis (oropharyngeal cavity
  • vesicles erythematous base -> rupture -> crust
  • Diagnosis: symptoms or culture or PCR of fluid
  • Prevention: safe sex, antivirals
72
Q

What are the synonyms for Measles?

A
  • rubeola

* morbilli

73
Q

Measles (infectious agent, reservoir, occurrence, incubation period)

A
  • measles virus of family paramyxoviruses (RNA virus)
  • human reservoir
  • prior to immunisation was epidemic every other year
  • now just in preschool, adolescents, young adults, immunosuppressed
  • 10/7 from exposure to onset of fever, 14/7 until rash
74
Q

What is the transmission and period of communicability of Measles?

A
  • droplet spread or direct nasal or throat secretion contact
  • very communicable
  • just beginning of prodrome to 4/7 after appearance of rash is most communicable
  • low a2/7 after rash
75
Q

What are the clinical features of Measles? how diagnosed?

A
  • acute
  • prodromal fever, conjunctivitis, coryza, cough
  • Koplik spots on ducal mucosa next to molars (lasts 24hrs)
  • red blotchy rash after 3-7 days (face -> spreads) -> 4-7/7 -> ends in desquamation
  • rarely: haemorrhage measles, mouth sores, protein losing enteropathy, dehydration, severe skin reactions

Diagnosed clinically (#1) or
• viral Ag in nasopharyngeal aspirate or
• virus isolation from blood, conjunctiva, nasopharynx, urine or
• rice in specific IgM Ab titre

76
Q

What are complications of Measles?

A

Due to virus replication or bacterial superinfection
• otitis media
• pneumonia
• encephalitis

77
Q

How is Measles prevented?

A
  • MMR vaccine (measles, mumps, rubella) at 12 months with booster at 4yrs
  • passive immunization with human immune globulin is value for post-exposure prophylaxis
  • live attenuated vaccine -> active immunity in 95% -> produce aninapparent or mild but non communicable disease
  • 5-30% mildly unwell, fever malaise
  • should not get pregnant 1-2/12 after vaccine
  • immune suppressed should not receive vaccine
78
Q

Who is susceptible to Chicken pox? and its resistance?

A
  • all persons susceptible
  • acquired immunity after disease is usually permanent
  • infants born to immune mother have immunity for 6-9/12
79
Q

Pityriasis rosea

A
  • macule, papules, scaly, oval, pink
  • trunk and proximal limbs, along natural skin creases
  • small outbreaks in schools and families
  • mild, self limiting in 6-10/52
  • starts with herald patch, then many more
80
Q

Warts

A
  • common
  • contagious, benign lesions
  • derived from epithelial cells
  • viral (HPV) (#1), syphilic, malignant, TB
  • hyperkeratosis (give its density), acanthosis and papillomatosis
  • difficult to treat when large in number
  • liable to recur
81
Q

List the different categories of warts? (with a distinguishing factor of each

A
  • Common (hand, foot, rough)
  • Plantar (pressure point foot)
  • Plane (flat, flesh colour, hard to see, face, hands, knee, young)
  • Filiform (thick, long, neck, middle aged)
  • Accumulate (cauliflower, soft, stink, genitals)
82
Q

Dermatophytosis

A
  • mycotic diseases of keratinized areas of body (hair, skin, nails)
  • caused by various fungi (dermatophytes)

Categories: capitis, unguium, corporis, cruris, pedis

83
Q

What are the synonyms of Dermatophytosis?

A
  • tinea

* ringworm

84
Q

Tinea capitis

A
  • scalp and beard
  • Reservoir: man, dogs, cats, cattle
  • Transmission: skin to skin or indirect (seats, barber clippers, toilet articles, hair on clothing)
  • common occurrence
  • 10-14/7 incubation
  • fungus persists on contaminated articles as long as lesions are present and viable (reinfection rare)

Features:
• gradual onset
• small papule spreads peripheral -> scaly bald patch
• kerions sometimes (raised suppurative lesions)
• spread to eyelids, neck, trunk

85
Q

Tinea unguium

A
  • nails, onychomycosis
  • chronic fungal
  • Reservoir: man (rare animals or soil)
  • Transmission: direct contact with skin or nail lesions, possible from indirect contact (ie. contaminated floors and shower stalls), low rate of transmission
  • common occurrence
  • unknown incubation
  • communicable as long as infected lesion is present
  • injury to nail predisposes to infection (reinfection infrequent)

Features:
• thicken, discoloured, brittle nails
• caseous material beneath nail
• chalky disintegrating nail

86
Q

Tinea corporis and cruris

A

Corporis: body
Cruris: groin and perianal (jock itch)
-fungal

  • Reservoir: man, animal soil
  • direct or indirect contact with lesions (floors, showers, benches)
  • worldwide, relatively frequent
  • 4-10/7 incubation
  • communicable as long as lesions are present, viable fungus lives on contaminated articles
  • widespread, aggravated by friction and excess perspiration in axillary and inguinal regions and when environmental temperature and humidity is high
Features:
• flat, spreading, ring shape
• red periphery, vesicular or pustular
• dry, scaly, or moist, crusted
• DDx from inguinal candidiasis and tuberculoid leprosy
87
Q

Tinea pedis

A
  • foot (athletes foot)
  • Reservoir: man
  • direct or indirect (contaminated floors, shower)
  • worldwide occurrence (adults>children, males>females)
  • unknown incubation
  • variable, infection may be unaparent. repeated attacks are frequent

Features:
• scaling, cracking
• between toes
• blisters containing thin, watery fluid

88
Q

Synonyms of Paronychia

A

whitlow

89
Q

Paronychia

A

• infection of periungal region

Acute: 
• through break in epithelium
• staph aureus. proteus sp, pseudomonas, candida 
• inflammation, pain
• maybe pus -> abscess

Chronic:
• mixed bacteria and fungi
• individuals with prolonged contact with water
• swelling, distortion of nail

90
Q

Pityriasis versicolor

A
  • chronic, symptomless, fungus infection
  • gradual onset
  • macular lesions
  • fawn or cafe au lait
  • well defined, varied sizes, may coalesce
  • resembles vitiligo
  • fine brawny scales
  • chest, back, axilla
91
Q

Creeping eruption

A
  • parasitic, pruritic skin infection
  • Anclyostoma braziliense (hookworm in dog or cat)
  • winding line
  • lower part of body that has contacted soil contaminated by larvae of worm
92
Q

Pediculosis

A

• individual infested by lice
• common in overcrowded or poor hygiene
• transmission by direct contact, clothing, combs, sexually
3 types:
• scalp and hair: Pediculosis humanus capitis
• Body: Pediculosis humans corporis
• Pubic hair: Phthirus pubis

93
Q

What are the clinical features of Pediculosis humanus capitis

A
  • pruritus of scalp
  • post-/supra-auricular, occipital areas mostly
  • scratching causes excoriations, bacterial invasion, post-auricular lymphadenopathy, dermatitis
  • nits (small white eggs on hair roots)
  • lice on scalp
94
Q

What are the clinical features of Pediculosis humans corporis?

A
  • pruritus
  • small red lesions, scratch marks, urticaria, infection
  • lice on clothes, not body
95
Q

What are the clinical features of Phthirus pubis?

A

• lice or nits in pubic or ano-genital region or their excreta in underwear

96
Q

Scabies

A
  • parasitic infestation of skin with severe pruritis
  • mite Sarcoptes scabiei
  • readily transmitted by direct contact (less by clothing and bedding)
  • symptoms 4-6weeks post infection
  • delayed hypersensitivity reaction
  • worse pruritus at night
  • papular eruption (many)
  • superficial burrows <1cm look like fine wavy lines
  • Finger webs, flexor surfaces wrist & elbow, axilla, areolas, male genitals, buttocks
97
Q

Albinism

A
  • melanocytes do not make melanin
  • rare
  • autosomal recessive
  • pale skin, white hair, pink eyes
  • sunburn easy, prone to skin cancer
98
Q

Synonymes of Melasma

A

chloasma

99
Q

Melasma

A
  • areas of hyperpigmentation
  • usually face
  • FROM: pregnancy or oral contraceptive pill
  • dark brown symmetrical areas
  • forehead, temples, upper cheeks
100
Q

Vitiligo

A
  • common
  • depigmentation of skin
  • unknown aetiology (maybe familial, autoimmune)
  • areas have no melanocytes
  • well demarcated areas
101
Q

Acne rosacea

A
  • chronic inflam. of central face
  • acneiform lesions and telangiectasia
  • unknown aetiology (things that cause persistent reflex flushing)
  • women > men (most peri-menopausal)
102
Q

What are the predisposing factors to Acne rosacea?

A
  • high sunlight exposure (farmers, sailors)
  • chronic alcoholism
  • spicy diet
  • hot drinks
  • maybe depressed
103
Q

What are the clinical features of Acne rosacea?

A
  • gradual bouts of facial flushing
  • papular and pustular lesions
  • chin, cheeks, nose, forehead, neck chest
  • no blackheads
  • maybe rhinophyma
  • men, alcoholics

Complications: conjunctivitis, iritis, keratitis

104
Q

rhinophyma

A

hypertrophy of nose

105
Q

Acne vulgaris

A
  • chronic inflam. of comedones, papules,, pustules, (sometimes cysts)
  • of sebaceous follicles and glands
  • puberty (androgens cause increase sebaceous gland activity)
  • exact cause unknown (maybe familial)
  • gradual onset of lesions on face, chest, back, back of neck
  • greasy skin
  • few to hundreds
  • dandruff
  • comedones, milia, pustules
106
Q

What is the pathology of Acne vulgaris?

A
  • plugging of hair follicles by keratin -> retention of sebum -> comedone -> infected with skin bacteria
  • milia and comedones

Factors:
• obstruction of pilo-sebaceous canal
• skin lipid changes
• bacterial involvement of follicles

107
Q

Comedone vs Milia

A

Both happen in acne vulgaris

  • blackhead
  • happens in acne vulgaris
  • black tip due to oxidation of sebaceous material
  • surrounded by inflammatory infiltrate
  • sometimes pus
Milia :
• white head
• happens in acne vulgaris
• white and not black because not exposed -> no oxidation
• on face or scrotum
• sebaceous cyst
108
Q

Alopecia

A
  • partial or complete loss of hair
  • idiopathic or age, drugs, hair pulling, local disease, systemic, genetic

Types :
• Non scarring- partial hair loss
• Scarring- follows skin inflam. or injury
• Areata- circumscribed area
• Toxic- temporary, months after febrile illness
• Trichotillomania- kids, hairs of varying lengths

109
Q

Hypertrichosis synonyms

A

hirsutism

110
Q

Hirsutism

A 
• excessive hair growth
FROM :
• familial tendency
• endocrine with excess androgen
• post-menopausal
• Drugs (corticosteroids, androgenic steroids)
111
Q

What are the synonyms for sebaceous cyst

A
  • keratinous cyst

* wen

112
Q

Sebaceous cyst

A
  • cystic lesion containing sebaceous, follicular and keratinous material
  • accumulation of sebaceous material under skin
  • slow growing
  • globular
  • firm to touch
  • non-tender unless secondary infection
  • material iside is greasy, cream-yellow, malodorous
113
Q

Hyperhidrosis

A
  • overactivity of sweat glands
  • excessive perspiration
  • generalized or local (axilla, groin, palms, soles, under breasts)
  • moist skin, maybe discoloured, malodorous
FROM:
• psychogenic
• skin disease
• fever
• hyperhyroidism
• CNS disorder (rare)
114
Q

Synonyms for Miliaria

A

prickly heat

115
Q

Miliaria

A
  • acute pruritic inflam. skin with retention of sweat
  • pruritus or prickly feeling
  • minute superficial (transparent or red) OR deep, large painful lesions
  • targets where many sweat glands

FROM: excess environm. temp & humidity -> swelling of horny epidermis layer -> sweat can’t reach skin -> irritation of epidermis or dermis

116
Q

What is an Angioma?

A
  • hyperplasia of blood or lymphatic vessels
  • NOT tumours
  • overgrowth of blood vessels in localized area
  • many types
117
Q

List the types of Angiomas with a small description of each?

A
  • Vascular nevi: post wine stain (flat, pink, at birth, permanent)
  • Haemangiomas:
  • capillary (strawberry, elevated, red, develops, fades)
  • cavernous (elevated, purple, large, permanent)
  • spider angioma (projections, red, oestrogen)

• Lymphangioma (elevated, not red)

118
Q

What is the most common malignancy of the skin?

A

basal cell carcinoma

119
Q

Basal cell carcinoma

A
  • from sun exposure
  • > 40yrs, males
  • slow growing
  • pin head - pea size
  • shiny, raised edges
  • may ulcer or not
  • maybe crust that bleeds
  • depressed centre with rolled border
120
Q

What are the complications of neglected Basal cell carcinoma?

A
  • deep tissue invasion and metastasis in local nodes

* local extension into complex structures

121
Q

Dermatofibroma

A
  • common
  • lesion of fibroblast tissue
  • unknown aetiology
  • papule or nodule
  • red-brown
  • most common on legs
122
Q

Dysplastic naevi

A
  • common pigmented lesion
  • maybe familial
  • single or multiple
  • large
  • variegated colours
  • irregular borders
  • macular and papular sections
123
Q

Kaposis sarcoma

A
  • malignancy of foci in dermis, extending into epidermis
  • FROM: herpes type 8 or AIDS form

Features in AIDS patient:
• papules, nodules, plaques start super body then spread
• round or oval
• pink, red, purple, brown
• maybe visceral or lymph node involvement

Features in non-AIDS patient:
• purple-brown papules, nodules and plaques on lower limbs
• invasion into deeper tissues
• maybe visceral and node ivolvement

124
Q

Keloid

A
  • hypertrophied scar

* excessive number of fibroblasts, blood vessels, collagen at wound site

125
Q

Keratoacanthoma

A
  • benign, nodular skin lesion with sloping edges and ulcerated centre
  • probably from sun exposure, fair people
  • fast growing nodule
  • starts fleshy papule -> keratotic core with fleshy rim -> maybe fleshy umbilicate nodule
  • usually 1cm
  • resolves spontaneously in 3/12 -> scar
  • DDx basal cell carcinoma or squamous cell carcinoma
126
Q

Lipoma

A
  • very common
  • benign tumour from adipocytes
  • unknown aetiology
  • most upper body
  • often multiple
  • soft, mobile, subcutaneous
  • usually asymptomatic
127
Q

Synonym for Melanocytic naevi

A

moles

128
Q

Melanocytic naevi

A
  • common (avrg. 50 per person, increase with age)
  • pigmented skin lesion
  • potential to become malignant
  • proliferation of pigment cells in epidermis or dermis
  • inherited tendency
  • flat or elevated
  • flesh coloured or dark-brown
  • macules and papules
129
Q

List the clinical variants of Melanocytic naevi

A
  • Giant hairy naevus
  • Halo naevi
  • Blue naevus
130
Q

Giant hairy naevus

A
  • type of melanocytic naevi
  • large, hairy, congenital nevi
  • pigmented plaques >1cm
  • present with hair at birth
  • not homogenous
  • get irregularly papular and hypertrophic with age
  • high chance of malignant transformation if big
  • if on neck -> may proliferate and block CSF -> hydrocephalus
131
Q

Halo naevi

A
  • type of melanocytic naevi
  • occur in young adulthood
  • depigmentation around them
  • mole may fade, leaving the ring
  • no pathological significance
132
Q

Blue naevus

A
  • type of melanocytic naevi
  • dark grey-blue or blue-black dermal papule with smooth surface
  • young adulthood onset
  • represents pigment cell proliferation deep in dermis
  • no malignant potential
  • DDx for melanoma
133
Q

What is the relationship of Melanocytic naevi to melanoma?

A
  • 20% of melanomas start as moles

* moles under trauma do NOT have more chance of being malignant

134
Q

Melanoma

A
  • malignant growth derived from melanocytes or pigmented cells
  • arise from skin or mucous membranes
135
Q

List the classifications of Melanoma

A
  • Lentigo maligna
  • Superficial spreading
  • Nodular
  • Acral-lentiginous (rare)
136
Q

What is the aetiology of Melanoma?

A
  • 80% from normally pigmented skin (rest from moles)
  • fair skinned people
  • if dark skin: palms, soles, mucous membranes
137
Q

Lentigo maligna melanoma

A
  • 30% of melanomas
  • macule (confined to epidermis)
  • slow, dark, on face
  • elderly white
  • irregular border, indistinct edges
  • multiple shades
  • eventually develop invasive node
  • may metastasise but less aggressive than other types
  • 100% cure if treated in slow stage (before nodule)
138
Q

Superficial spreading melanoma

A
  • 50% of melanomas
  • slightly elevated plaque
  • anywhere
  • irregular border, blurring pigment into surrounding skin,
  • various shades
  • maybe rim of pink
  • fragile, bleed, ooze
  • small plaque (epidermis and dermis) 6-24months -> highly invasive nodule
  • 90% cure if treated before nodule
  • poor prognosis if nodule stage
139
Q

Nodular melanoma

A
  • 20% of melanomas
  • sudden as papule or nodule -> metastasize in weeks into dermis and blood vessels -> initial lesion may leave
  • blue-black-brown
  • easily bleeds
  • pink rim
  • poor prognosis unless quick excision
140
Q

How do you know it is a melanoma and not just a mole?

A
  • rapid growth
  • diffusion or pigment into surrounding skin (ink blob)
  • inflammation surrounding skin
  • bleeding, oozing, crusting
  • Asymmetry, Borders irregular, Colour uneven, Diameter large
141
Q

Paget’s disease of the nipple

A
  • ductal carcinoma of breast with overlying dermatitis of areola
  • unknown aetiology
  • breast lump, unilateral dermatitis of the areola
142
Q

Pyogenic granoloma

A
  • vascular nodule of granulation tissue
  • not from bacteria or granuloma
  • develops at sight of recent injury
  • nodular, brown, blue-black, dark red
  • rapid growth
  • friable, may bleed easy
  • DDx of melanoma or skin malignancy
143
Q

Synonym for Seborrheic warts

A

Seborrheic keratoses

144
Q

Seborrheic warts

A
  • superficial skin lesions, pigmented, warty appearance
  • not viral origin, not seborrhoea
  • unknown aetiology
  • middle aged white people
  • familial predisposition
  • more risk by sun damage
  • light-dark brown patches
  • trunk, scalp, face
  • papular, 1-2cm, round, flat surface
  • keratin cap easily peeled off
145
Q

Skin tags

A
  • very common
  • small, pedunculate lesions
  • predominantly on neck, axilla, groin
  • skin colour or hyper pigmented
  • rare symptoms
146
Q

Squamous cell carcinoma

A

• invasive tumour from Malpighian layer of epithelium
• sun exposed skin of fair people
• elderly
• from skin or mucous membrane OR pre-existing lesion:
-leukoplakia, senile keratosis, chronic inflammation sites
• gradual onset
• opaque, skin colour, fleshy papule, nodule or plaque
• scaly, keratotic or eroded
• ulceration, inverted edge
• oozing, bleeding
• metastasize widely
• more aggressive if risen from pre-existing lesion

147
Q

Callus

A
  • well defined area of hyperkeratosis
  • site exposed to repetitive trauma
  • pressure, friction
  • hands, feet, over bony prominence
  • superficial
  • roughened skin
148
Q

Corn

A

*same as callus but painful or tender

  • well defined area of hyperkeratosis
  • MTPs and IPs
  • pressure or friction
  • hard or soft
  • painful or tender
149
Q

Dermatitis herpetiformis

A
  • chronic, pruritic skin diseases of cluster of papules, vesicles, urticaria like lesions
  • Acompanied by gluten sensitive enteropathy
  • IgA in most lesions
  • gradual onset
  • intensely pruritic
  • mainly extensor surfaces, symmetrical
150
Q

Keratosis pilaris

A
  • plugs of horny material fill and block orifices of hair follicles
  • unknown aetiology
  • common
  • multiple small, pointed
  • lateral arms, buttocks, thighs
151
Q

Pemphigus

A
  • autoimmune disorder of bullae and erosions on skin and mucous membranes
  • many types
  • uncommon
  • FROM: autoimmune response where IgG forms to surface antigens on cells of epidermis -> decrease in cohesiveness of epidermal keratinocytes -> blistering
  • middle aged and elderly
  • in areas in which stratified squamous epithelium is found
  • first in mouth
  • bullae -> rupture -> painful erosions and crusting
152
Q

Synonyms of Pressure sores

A
  • bedsores
  • trophic ulcer
  • decubitus ulcers
153
Q

Pressure sores

A

• areas of ulceration over bony prominences as a consequence of prolonged pressure from external objects

FROM:
• intrinsic or extrinsic factors -> prolonged pressure on tissues -> ischaemic necrosis -> ulceration
• Extrinsic: immobilized, bed ridden
• Intrinsic: malnutrition, anaemia, tissue atrophy, infection, poor circulation, lost sensation

Features:
• erythema (early) 
• abrasions, shallow craters, blisters
• infection may be superimposed
• necrosis deepens, crater gets bigger
• necrosis of muscles, tendons, bones, joints (later), cellulitis, septic arthritis, osteomyelitis
154
Q

Synonym for Solar keratosis

A

actinic keratosis

155
Q

Solar keratosis

A
  • rough horny lesion on areas exposed to sunlight
  • rare malignant change -> squamous cell carcinoma
  • from chronic sunlight exposure
  • usually on fair skinned individuals >40
  • pink/red macules or fleshy papules covered by adherent grey, white or yellow scale
  • indistinct margins are common
  • scale periodically
  • painful to remove prematurely -> bleed
  • tender
  • pinhead to coin size
  • malignant if inflammation or induration edges
156
Q

Icthyosis

A
  • dry skin
  • varies in severity
  • scaling and peeling if severe
  • caused by environmental conditions, skin disorders, hereditary
157
Q

Psoriasis

A
  • chronic inflammatory disease of defined papules or plaques
  • lesions red with silvery scales
  • rarely acute or life threatening
  • unknown aetiology, maybe familial
  • Predisposing factors: trauma (laceration of skin), acute infections (tonsillitis), psychological upset
158
Q

What is the epidemiology of Psoriasis?

A
  • affects 1-2% of individuals
  • less in Asians and Africans
  • male = female
  • common on 15-30yrs
  • more common in cooler climates, winter
159
Q

What are the clinical features of Psoriasis?

A
  • gradual, occasionally explosive
  • partial remissions
  • papular, dry and scaly
  • silver scaly lesions on erythematous base
  • removal causes bleeding
  • edges well defined
  • on extensor surfaces (knees and elbows)
  • scalp, sacral region, chest, face, abdomen, genitalia
  • Koebner’s phenomenon
  • psoriatic arthropathy in 5-10%
  • nail pitting
160
Q

What are common causes of Scaly skin?

A 
dead tissue
• psoriasis
• excess scratching
• dermatitis
• aging
161
Q

What are the common causes of vesicles or bullae?

A 
fluid filled sacs (blisters)
• irritation to skin (trauma)
• dermatitis
• herpes simplex
• herpes zoster
• impetigo
162
Q

What are the common causes of pustules?

A

pus filled sacs
• acne (#1)
• insect bites
• smallpox

163
Q

What are the common causes of Pruritus?

A 
Itchy skin
• dry skin (Icthyosis)
• eczema
• drug reactions
• psychological
164
Q

What are the common causes Hirsutism?

A

Hairiness
• excess androgens (metabolic syndrome, ovarian cysts, ovarian tumours, adrenal gland tumours)
• testosterone supplements
• genetics

165
Q

What are the common causes of wheals?

A 
circumsised raised itchy bump
• mosquito bite
• infection
• hives
• drug reaction
166
Q

What are the common causes of skin ulceration?

A

excavation through epidermis and dermis
• venous leg ulcers
• pressure sores
• infection

167
Q

List the benign neoplasms of the integumentary system?

A
  • lipomas
  • Keratoacanthoma
  • melanocytes naevi
168
Q

List the disorders of alteration in differentiation of the integumentary system?

A
  • angiomas
  • Keloid
  • dermatofibroma
  • dysplastic naevi
  • pyogenic granoloma
  • seborrhoeic keratoses
  • skin tag

Medical Sciences B (23 decks)

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