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Clin Med III: Dermatology > Intro/Approach to Derm Pt > Flashcards

Intro/Approach to Derm Pt Flashcards

1
Q

why are bumps/blemishes important findings on routine exam?

A

Need to be able to distinguish between between benign vs. malignant

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2
Q

MC compliants for skin lesions?

A
  1. rashes
  2. bumps
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3
Q

Generalized red rash with fever

A
  1. Viral Exanthems
  2. Rickettsial Exanthems
  3. Drug Eruptions
  4. Bacterial Infections
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4
Q

Generalized red rash with blisters and prominent mouth lesion

A
  1. Erythema multiforme (major)
  2. TEN
  3. Pemphigus
  4. Bullous pemphigoid
  5. Drug eruptions
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5
Q

Generalized red rash with pustules

A
  1. Pustular psoriasis
  2. Drug eruptions
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6
Q

Generalized rash with vesicles

A
  1. Disseminated herpes simplex
  2. Generalized herpes zoster
  3. Varicella
  4. Drug eruptions
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7
Q

Generalized red rash with scaling over whole body

A

Exfoliative erythroderma

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8
Q

Generalized wheals and soft tissue swelling

A
  1. Urticaria
  2. Angioedema
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9
Q

Generalized purpura

A
  1. Thrombocytopenia
  2. Purpura fulminans
  3. Drug eruptions
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10
Q

Generalized purpura that can be palpated

A
  1. Vasculitis
  2. Bacterial endocarditis
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11
Q

Multiple skin infarcts

A
  1. Meningococcemia
  2. Gonococcemia
  3. Disseminated intravascular coagulopathy
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12
Q

Localized skin infarcts

A
  1. Calciphylaxis
  2. Atherosclerosis obliterans
  3. Atheroembolization
  4. Warfarin necrosis
  5. Antiphospholipid antibody syndrome
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13
Q

Facial inflammatory edema with fever

A
  1. Erysipelas
  2. Lupus
  3. Dermatomyositis
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14
Q

Why should you examine first before history is taken as the initial approach?

A

For pt’s perspective
- diagnostic accuracy > when objective examination is approached w/o preconceived ideas

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15
Q

For a general skin exam, what are you looking at?

A

“Reading the skin” (SKIN, HAIR, NAILS)

  • General - Examine ALL skin surfaces - undress patient when applicable
  • Focused - Exam in area of concern
  • Detailed - Examine the individual lesions
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16
Q

For an entire skin exam, what parts of the body are you looking at?

A
  1. Mucous membranes
  2. Genital and anal region
  3. Hair and nails
  4. Lymph nodes
    - Reading the skin = reading text
    Type of lesion
    Color
    Margination
    Consistency
    Shape
    Arrangement
    Distribution
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17
Q

how do you “Read the skin?”

A
  • Type of lesion
  • Color
  • Margination
  • Consistency
  • Shape
  • Arrangement
  • Distribution
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18
Q

characteristics of describing a lesion?

A
  • Location
  • Onset
  • Characteristic
  • Aggravating factors
  • Treatments
  • Evolution
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19
Q

Types of lesions

A
  1. Macule
  2. Papule
  3. Plaque
  4. Nodule
  5. Wheal
  6. Vesicle or bulla
  7. Pustule
  8. Crusts
  9. Scales
  10. Erosion
  11. Ulcer
  12. Scar
  13. Atrophy
  14. Cyst
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20
Q

Flat, nonpalpable lesions usually < 10 mm in diameter
a change in color and are not raised or depressed compared to the skin surface.

A

Macules

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21
Q

A ____ is a large macule.

A

patch

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22
Q

Elevated lesions usually < 5 mm in diameter that can be felt or palpated

A

Papule
Ex: nevi, warts

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23
Q

Palpable lesions > 10 mm in diameter that are elevated or depressed compared to the skin surface.
may be flat topped or rounded

A

Plaque
Ex: psoriasis and granuloma annulare

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24
Q

Firm lesions that extend into the dermis or subcutaneous tissue. >5mm

A

Nodule
Ex: cysts, lipomas, and fibromas.

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25
Q

Small, clear, fluid-filled blisters < 10 mm in diameter.

A

Vesicles

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26
Q

Vesicles are characteric for what certain conditions?

A

herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders.

27
Q

Clear fluid-filled blisters > 10 mm in diameter. These may be caused by burns, bites, irritant or allergic contact dermatitis, and drug reactions.

A

Bulla
Classic autoimmune bullous diseases include pemphigus vulgaris and bullous pemphigoid.

28
Q

Vesicles that contain pus.

29
Q

This lesion is common in bacterial infections and folliculitis and may arise in some inflammatory disorders including pustular psoriasis.

30
Q

Wheals or hives are characterized by elevated lesions caused by localized edema.
pruritic and red

31
Q

common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight.

32
Q

how long do urticarias last?

33
Q

Heaped-up accumulations of horny epithelium that occur in disorders such as psoriasis, seb derm, and fungal infections.

34
Q

Consist of dried serum, blood, or pus. can occur in inflammatory or infectious skin diseases (ex: impetigo).

35
Q

Open areas of skin that result from loss of part or all of the epidermis.
can be traumatic or can occur with various inflammatory or infectious skin diseases.

36
Q

a linear erosion caused by scratching, rubbing, or picking.

A

excoriation

37
Q

Result from loss of the epidermis and at least part of the dermis

38
Q

Causes of this lesion include venous stasis dermatitis, physical trauma with or without vascular compromise (eg, caused by decubitus ulcers or peripheral arterial disease), infections, and vasculitis.

39
Q

Nonblanchable punctate foci of hemorrhage.

A

Petechiae
Causes include platelet abnormalities (eg, thrombocytopenia, platelet dysfunction), vasculitis, and infections (eg, meningococcemia, Rocky Mountain spotted fever, other rickettsioses).

40
Q

Larger area of hemorrhage that may be palpable.

A

Purpura
Purpura may indicate a coagulopathy. Large areas of purpura may be called ecchymoses or, colloquially, bruises.

41
Q

this lesion is considered the hallmark of leukocytoclastic vasculitis.

A

Palpable purpura

42
Q

Thinning of the skin, which may appear dry and wrinkled, resembling cigarette paper.

A

atrophy
Atrophy may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases, including cutaneous T-cell lymphoma and lupus erythematosus.

43
Q

this lesion is also may result from long-term use of potent topical corticosteroids

44
Q

Areas of fibrosis that replace normal skin after injury.
can become hypertrophic or thickened and raised.

45
Q

hypertrophic scars that extend beyond the original wound margin.

46
Q

Foci of small, permanently dilated blood vessels
may occur in areas of sun damage, rosacea, systemic diseases (especially systemic sclerosis), or inherited diseases (eg, ataxia-telangiectasia, hereditary hemorrhagic telangiectasia) or after long-term therapy with topical fluorinated corticosteroids.

A

Telangiectases

47
Q
  • Cavity containing liquid or solid or semisolid materials and it may be superficial or deep.
  • Visual appears superficial and most often dome shaped
  • skin colored, yellow, red or blue
48
Q

What is the ABCDE checklist?

A
  • Asymmetry
  • border
  • color
  • diameter
  • evolution
49
Q

components of asymmetry/arrangement?

ABCDE

A
  1. Do these two sides match?
  2. What is the arrangement?
    - Grouped or scattered?
50
Q

Questions about border

ABCDE checklist

A
  1. Well defined or ill defined?
    -Regular or irregular
51
Q

Questions about color?

ABCDE checklist

A
  1. changing?
    - multiple colors?
52
Q

components of distribution/diameter

A
  1. Localized
  2. Generalized
  3. Linear
  4. Dermatomal
  5. Extensor
  6. Flexor
  7. Intertriginous
  8. Confluent
  9. Morbilliform
  10. Is it >6mm - HIGH RISK
53
Q

questions about elevation/enlargement?

ABCDE checklist

A
  1. Is it elevated?
    - Is the elevation regular or irregular?
  2. Has the lesion grown or changed?
    - How quickly?
54
Q

Other things to consider when evaluating the shape while checking for ABCDE?

A
  1. Annular → ring
  2. Nummular → looks like coins
  3. Linear → straight line
  4. Polycyclic → incomplete rings coalescing
  5. Arcuate → arc shaped
  6. Reticular → lacy or net like
  7. Geographic → large and vary greatly with borders
  8. Serpiginous → wavy pattern
  9. Targetoid → resembles a target
  10. Whorled → marble like
55
Q

How to evaluate the arrangement, patterns, and distribution of a lesion?

A
  1. Number - Single or multiple
  2. Arrangement
    - Grouped
    - Disseminated
  3. Confluence - Yes or no
  4. Distribution
    - Extent
    — Isolated
    — Localized
    — Generalized
    — Universal
    - Pattern
    — Symmetric
    — Exposed areas
    — Sites of pressure
    — Intertriginous area
    — Follicular localization
56
Q

constitutional sx that are for acute illness?

A
  • Headaches
  • Chills
  • Fever
  • Weakness
57
Q

Constitutional sx for chronic illness?

A
  • Fatigue
  • Weakness
  • Anorexia
  • Weight loss
  • Malaise
58
Q

components of the Hx of a skin lesion?

A
  • When → onset
  • Where → site of onset
  • Does it itch or hurt → symptoms
  • How has it spread → pattern
  • How have individual lesions changed → evolution
  • Provocative factors → heat, cold, sun, exercise, travel history, drug ingestion, pregnancy, season
  • Previous treatment → topical or systemic
59
Q

PMHx of a derm pt

A
  1. Surgeries
  2. Illnesses - Hospitalizations
  3. Allergies - Especially drug allergies
  4. Medications - Present and past
  5. Habits - Smoking, alcohol, drug abuse
  6. Atopic history - Asthma, hay fever, eczema
  7. FHx - Derm related and non derm related
  8. Social history - Occupation, Hobbies, Exposures, Travel, IVDU
  9. Sexual history
    - At risk for HIV - Blood transfusions, IVDU, Sexually active/multiple partners, STD history
  10. Standard ROS
60
Q

What is the fitzpatrick Skin Type Scale

61
Q

what is a Dermoscopy

A

hand lens with built in lighting and magnification

62
Q

what is a diascopy?

A

firmly pressing a glass slide over lesion to determine capillary dilation (erythema) or blood extravasation (purpura)

63
Q

What is a woods lamp?

A

UV long wave light (black light)

64
Q

what is a biopsy/what types?

A

shave/punch/excisional

Clin Med III: Dermatology (13 decks)

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