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Gen Med: Dermatology > Lecture 1: Intro > Flashcards

Lecture 1: Intro Flashcards

1
Q

What are the layers of the skin?

A
  1. Epidermis
  2. Basement membrane
  3. Dermis
  4. Subcutaneous layer
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2
Q

What are the functions of the skin?

A
  1. Protection from UV through melanin
  2. Resist mechanical shock
  3. Thermoregulation
  4. Mediates sensation
  5. Protects from environment
  6. Affects social/sexual communication
  7. immune barrier to pathogenic org.
  8. assists in Vitamin D synthesis
  9. Assists in toxin excretion
  10. Regulates body fluid loss
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3
Q

How much vitamin D synthesis is performed in the skin?

A

10-15%

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4
Q

What are the categories/terms used to describe skin lesions?

A
  1. Size
  2. Color and descriptive terms
  3. Primary skin lesions
  4. Secondary skin lesions
  5. Special skin lesion
  6. Arrangement
  7. Distribution
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5
Q

What are primary skin lesions?

A

nitial lesions, not altered by trauma, manipulation or natural regression over time

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6
Q

What are secondary skin lesions?

A

How the lesions looks over time or after manipulation (ie. scratching, picking, leaking, bursting)

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7
Q

Define depigmented skin

A
  1. Absent of melanocytes, no melanin therefore no color
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8
Q

How is skin typed?

A
  1. Albino
  2. Caucasian
  3. Mediterranean
  4. Hispanic
  6. Darkly pigmented: african american
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9
Q

What disease causes depigmentation of the skin?

A

Vitilago

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10
Q

Define hypopigmentation

A
  1. Normal number of melanocytes, but Decreased production of Melanin
  2. Lighter than skin color
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11
Q

Define Hyperpigmented skin

A
  1. Normal # of Melanocytes but
    Increased production of Melanin
  2. Darker than skin color
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12
Q

What causes hypopigmented skin?

A

Psoriasis?

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13
Q

Define erythematous skin

A

redness of skin

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14
Q

Define atrophic skin, in the epidermal and dermal layers

A
  1. thinning of skin
  2. Epidermal - “cigarette paper”wrinkling
  3. Dermal/Subcutis – Depression in skin
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15
Q

Define lichenified skin lesions

A
  1. Focal area of thick skin
  2. Produced by chronic manipulation
  3. Accentuated skin lines – “washboard”
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16
Q

Define verrucous skin lesions

A

Hyperkeratotic or Wart Like

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17
Q

Define Umbilicated skin lesions

A

Central “belly button” like depression

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18
Q

What terms are used to describe primary skin lesions?

A 
MACULE   -   PATCH
PAPULE   -   PLAQUE
NODULE
PUSTULE   -   CYST
VESICLE   -   BULLAE
WHEAL
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19
Q

Define macule skin lesions

A
  1. Small
  2. Flat circumscribed skin discolorations
  3. Lacking surface elevation or depression
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20
Q

Define patch skin lesions

A
  1. Large
  2. Flat circumscribed skin discolorations
  3. Lacking surface elevation or depression
  4. A very large macule
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21
Q

Define papule skin lesions

A
  1. Elevated solid lesion

2. <5mm

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22
Q

Define plaque skin lesions

A
  1. Elevated solid confluence of papules
  2. > 5mm
  3. Lacking a deep component
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23
Q

Define nodule skin lesions

A
  1. Elevated solid lesion
  2. > 5mm
  3. A larger and deeper paple
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24
Q

Define pustule skin lesions

A
  1. Papule that contains
    Purulent material
  2. <5mm
  3. Not necessarily infected
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25
Q

Define cystic skin lesions

A

Nodule that contains

fluid or semisolid material

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26
Q

Define vesicular skin lesions

A
  1. Papule that contains clear fluid
  2. <5mm
  3. called hemorrhagic vesicle if filled with blood
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27
Q

Define bullae skin lesions

A
  1. Localized fluid collection
  2. A large vesicle
  3. > 5mm
  4. called hemorrhagic bullae if filled with blood
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28
Q

Define wheal skin lesions

A
  1. Firm edematous plaque
    That is evanescent (coming and going) and pruritic
  2. Hives
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29
Q

What terms are used to describe secondary skin lesions

A

SCALE - CRUST
EROSION - ULCER
FISSURE - EXCORIATION
SCAR

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30
Q

Define scale skin lesions

A

Thickened Stratum Corneum

secondary to keratinocyte hyperproliferation

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31
Q

Define crust skin lesions

A

Collection of cellular debris

Dried serum, blood = Scab

32
Q

Define erosion skin lesions

A

Superficial focal loss of epidermis

Heals without scarring

33
Q

Define ulcer skin lesions

A

Full thickness focal loss of epidermis and dermis

Heals with scarring

34
Q

Define fissure skin lesions

A

Verticle loss of epidermis and dermis Sharply defined walls

“Cracking” skin

35
Q

Define excoriation skin lesions

A

Linear erosion induced by scratching

36
Q

Define scarring

A

A collection of new connective tissue
Implies dermoepidermal damage
May be hypertrophic (too much collagen-raised scar) or atrophic (too little collagen-depressed scar)

37
Q

What terms are used to describe special lesions?

A 
TELANGIECTASIAS
PETECHIAE   -   PURPURA
COMEDONES
TARGET LESIONS
STRIAE
BURROW
38
Q

Define TELANGIECTASIAS

skin lesions

A

Small dilated superficial blood vessels

Blanchable

39
Q

Define petechiae

skin lesions

A

Extravasation of RBC’s into Dermis
Non-Blanchable
<5mm

40
Q

Define purpura

skin lesions

A

Extravasation of RBC’s into Dermis
Non-Blanchable
>5mm
Can turn into ecchymosis

41
Q

Define comedomes

skin lesions, open vs. closed

A

Folliculocentric collection of sebum and keratin
Closed Comedone = “whitehead”
Open Comedone = blackhead, due to oxidation bc exposed to air

42
Q

Define target

skin lesions

A

Consist of three zones
Center bulls eye
Second pale zone
Third rim of erythema

43
Q

Define striae

skin lesions

A

Irreversible atrophic violaceous linear damage to skin “stretch marks”
Secondary to Topical Steroids overuse
Cushings Syndrome or Excessive rapid growth

44
Q

Define burrows

skin lesions

A

Elevated channel in the superficial epidermis

Produced by parasites (Scabies, Hookworm)

45
Q

What terms are used to describe the characteristic arrangements of skin lesions? When are they used?

A 
ANNULAR
GYRATE
DERMATOMAL
LINEAR
GROUPED
KOEBNERIZATION
Remember to use them in the “description template” just after the type of skin lesions
46
Q

Define annular

skin lesions

A

Ring shaped

47
Q

Define gyrate

skin lesions

A

From Latin – “to turn in a circle”

48
Q

Define dermatomal

skin lesions

A

Follows neurocutaneous dermatomes

49
Q

Define linear

skin lesions

A

Skin lesions in a linear configuration

50
Q

Define grouped

skin lesions

A

Skin lesions in a grouped configuration

51
Q

Define koebnerization

skin lesions

A

Traumatized skin produces lesions

Koebner Phenomenon occurs with only certain skin diseases (LP, LN, PSOR)

52
Q

What terms are used to describe specific patterns of distribution?

A

Bilateral - Unilateral
Flexural - Extensor
Malar

53
Q

What diagnostic techniques in dermatology?

A 
Skin Scrapings
Woods Lamp
Cultures
Patch Test
Skin Biopsies
54
Q

What are the types of skin scrapings?

A

KOH, Tzanck Smears, and Scabies Smears

55
Q

What are the different solvents used in skin scrapings?

A
  1. KOH Stain = Potassium Hydroxide
  2. Tzanck Smear = Giemsa, Wrights, or Sedi stains
  3. Scabies Smear = Mineral Oil, KOH, Saline
56
Q

What is the most sensitive in office skin scraping technique?

57
Q

What is KOH skin scraping used for?

A

Can aid in identifying

Tinea/Candida infections

58
Q

HOW IS A KOH SKIN SCRAPING DONE CORRECTLY WHEN LOOKING FOR TINEA?

A

Sample correct area
Tops of vesicles
Leading edge of Annular Lesions
Deep Scrapings of Nails for subungual debris

59
Q

What is the Tzanck smear used for? What are the limitations?

A
  1. Standard microscopic test for rapid Dx of Herpes infection
  2. cannot distinguish between the types of herpes (HSV ½ or VZV)
60
Q

What is the desired target of Tzanck smear?

A

Looking for Atypical Keratinocytes with Lg Nuclei

Multinucleated Giant Cells

61
Q

HOW IS A TZANCK SMEAR DONE?

A 
1. Sample correct area
A. Scrape base of  “vesicle/bulla”
B. Sample only a “Fresh” lesion
2. Follow these steps
A. Use #15 blade to correct area and transfer to slide
B. Stain with either Giemsa, Wrights, or Sedi stain 
C. Coverslip 
D. Look for “Multinucleated Giant Cells”
62
Q

What is the etiology of scabies?

A

Caused by a mite Sarcoptes Scabiei var. hominis

63
Q

How is scabies diagnosed?

A

Diagnosis is made by identifying the female mite, her eggs, or fecal material under the microscope

64
Q

HOW IS A SCABIES SMEAR DONE?

A
  1. Sample correct area
    A. Scrape “Burrows”, vesicles, or papules
    B. Have patient point with index finger to itchy area
    C. Important to sample - finger webs, flexural wrists, genitalia
  2. Follow these steps
    A. Apply Mineral oil to sample area
    B. Use #15 blade and vigorously scrape area
    (ok to scrape til small amount of bleeding)
    C. Coverslip
    D. Look for Female Mite, Eggs, or Fecal Material
    E. Mites also seen using KOH or Saline wet mount Preps
65
Q

What is the Wood’s lamp exam?

A

Fluorescing affected areas with invisible

“Black Light” (long wave UV radiation)

66
Q

What does the Wood’s lamp exam aid in identification of? What are the diagnostic colors of certain pathogens?

A
  1. Tinea Capitis infections (non T. Tonsurans) = yellow-green
  2. Tinea Versicolor – dull yellow
  3. Erythrasma – coral red
  4. Pseudomonal – green
  5. Vitiligo – accentuates epidermal pigment if present
67
Q

What are the best methods for bacterial culture swab?

A
  1. Best yield when superficial infection
  2. Swab vigorously area of most inflammation
  3. Results in about 1 wk
68
Q

What are the best methods for viral culture swab?

A

Keep Refrigerated
Best to sample base of fresh vesicle or bullae
Results in about 1 wk

69
Q

What are the best methods for fungal culture swab?

A
  1. DTM – Turns Red if Dermatophyte is present (no ID)Results over several wks
  2. Sabouraud’s Dextrose Agar – Used to ID type of Dermatophyte Results over a month
70
Q

What is the test of choice to differentiate between contact allergic vs. irritant dermatitis?

A

Patch test

71
Q

Define allergic contact dermatitis

A
  1. Immunologically mediated

2. An acquired sensitivity affecting certain individuals

72
Q

Define irritant contact dermatitis

A
  1. Is not immunologically mediated

2. Due more to chemical damage to skin

73
Q

When are skin biopsies the best diagnostic technique?

A

For cutaneous neoplasms that cannont be Dx clinically

74
Q

When are skin biopsies a helpful diagnostic technique?

A

In inflammatory skin disorders of uncertain etiology

75
Q

What are skin biopsy samples used for?

A

H&E histology examination

Specialized studies such as Immunofluorescence, electron microscopy, cultures, special stains, PCR studies, etc.

76
Q

What are the different types of skin biopsies? What are the most common types?

A 
CURETTE BIOPSY
SCISSOR BIOPSY
SHAVE BIOPSY
PUNCH BIOPSY
INCISIONAL BIOPSY
EXCISIONAL BIOPSY
2. Shave and punch
77
Q

What are the in office treatment procedures for derm?

A

Lasers, Light Therapy, Phototherapy, and PDT
Resurfacing Procedures
Injectables

Gen Med: Dermatology (10 decks)

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