PANCE/PANRE Study Guide Book Flashcards
Papule
raised, solid < 10 mm
Nodule
Raised, solid > 10mm
macule
Flat < 10mm
Patch
flat > 10mm
Plaque
plateau like > 10mm
Vesicle-
Raised, contains serous fluid < 5mm
raised, contains serous fluid > 5 mm
raised, contains serous fluid > 5 mm
Pustule-
.
raised, contains purulent material
Wheal-
elevated lesion from local edema, transient
Crust-
hard surface, dried sebum, exudates, blood, necrotic skin
Scale
horny epithelium with dry appearance
Erosion
defect of epidermis (non scarring)
Ulcer
defect of dermis or deeper (scarring)
Types of Dermatitis
Contact Dermatitis, Atopic Dermatitis, Nummular Eczema, Seborrheic Dermatitis, Perioral dermatitis
Treatment for dermatitis
Avoid offending agent. Burrow’s solution (aluminum acetate), topical steroids, zinc oxide (diaper rash)
atopic dermatitis presentation
Pruritic papules and plaques
atopic dermatitis etiology
IgE, type 1 hypersensitivity
Nummular Eczema
coin Shaped/ discoid plaques
SEBORRHEIC DERMATITIS
Cradle Cap: Erythematous/yellow, scaly crusted lesions. Location: Infants- scalp. Adults/puberty- body folds. Treatment: Ketoconazole shampoo
Lichen planus:
5 P’s: purple, papule, polygonal, pruritis, planar Wickham striae
Treatment: Topical steroids
Pityriasis rosea:
.
- Herald patch: Large oval plaque with central clearing and scaly border. 1st sign
- Pruritic erythematous plaque with central scale in —Christmas tree pattern on the trunk
- The disease is self-limiting
Psoriasis:
Erythematous plaque with silver scaling on extensor surfaces
Types:
Psoriasis Vulgaris- most common.
Guttate- children. After URI. Small lesions
Inverse- intertriginous areas.
Pustular- contains pustules
Signs:
Auspitz sign (bleeds when scale is picked)
Koebner’s phenomenon (minor trauma causes new
lesion)
Treatment: Topical steriods.
Erythema multiforme:
Causes: HSV, sulfa drugs
Target lesions on hands, feet and mucosa Treatment: Avoid trigger
Steven Johnson syndrome/ Toxic epidermal necrolysis:
.
SJS is 3-10% of body, TEN is > 30% of body
Causes: drug reaction- most often sulfa drugs. Also other
antibiotics, anti-epileptics
Prodrome, then morbiliform lesions, blisters, necrotic
epidermis, Nikolsky sign (pushing blister causes further
separation from dermis)
Diagnosis: Biopsy- shows necrotic epithelium
Treatment: Treat underlying cause and supportive (burn
unit)
Acne vulgaris
Open comedones (black heads), closed comodones (white
heads), papules, pustules, nodules or cysts Treatment:
Most acne- topical retinoids
Cystic acne-
tetracyclines then oral retinoids- isotretinoin (causes
dry lips, liver damage, pregnancy category X)
Rosacea:
Women aged 30-50
Facial erythema, telangiectasias, papules
Triggers: heat, alcohol, spicy foods
Treatment: metronidazole topical
Actinic keratosis:
Presentation:
Flesh-colored/pink/yellow-brown lesion with rough
sandpaper feel at sun-exposed areas
May progress to squamous cell carcinoma Treatment:
Cryotherapy, electrodesiccation
Seborrheic keratosis:
Brown-black stuck on waxy plaques
Treatment: Unnecessary. Excise for cosmetics
Lice (Pediculosis):
Presentation: Pruritic scalp, body or groin.
Nits are observed as small white specs on hair shaft Treatment: Permethrin
Scabies:
Presentation: Pruritic papules. S shaped or linear burrows on skin. Often in web spaces.
Diagnosis: microscropic observation of mite, egg or feces after skin scrape
Treatment: Permethrin
Spider bites:
Brown recluse- necrotic wound
Black widow- neurologic manifestation (muscle ache, spasm, rigidity)
Basal cell carcinoma:
Raised pearly borders, telangiectasis, central ulcer (Rodent ulcer)
Treatment: Excise with clear margins
Squamous cell carcinoma:
Hyperkeratotic macule, scaling
Treatment: Excise with clear margins
Melanoma:
ABCDE: Asymmetry, Border is irregular, Color variability (blue, red, white), Diameter (> 6 mm), Evolution
Kaposi sarcoma:
Violaceous papular lesions associated with AIDs Caused by Human Herpes Virus 8
Alopecia:
Alopeica areata- oval shaped well demarcated hair loss
Autoimmune cause.
Treatment: Clobetasol
Adrogenetic alopecia (male pattern baldness)- top of head Telogen effluvium- Diffuse hair loss
Occurs after stress, illness, medication.
Self limiting
Traction alopecia- tight hairstyles
Onychomycosis:
Thick, yellow, brittle nails
Treatment: Oral terbinafine
Paronychia:
Inflammation around nail.
Organism: Staphylococcus sp
Treatment: Warm soaks, drain visible pus, anti-staph antibiotic
Condyloma acuminatum (genital warts):
Cause: HPV (Types 6 and 11)
Flesh colored, cauliflower appearance
Exanthems:
Measles(Rubeola)
Measles virus.
Koplik spots (grains of sand on erythematous base),
cough, coryza. Caudocephalic spread of maculopapular rash
Rubella (German Measles)
Rubella virus.
3 days. Caudocephalic spread of maculopapular rash.
Lymphadenopathy.
Teratogenic in pregnancy (worst outcomes in first
trimester)
Roseola
Human Herpes Virus 6 or 7.
Fever, then subsequent macular rash beginning on
trunk.
Erythema Infectiousum / Fifth disease
Parvovirus B19.
Slapped cheek with lace-like rash
Hand-foot-mouth:
Coxksackie virus.
children <10 years old with vesicles on pharynx, mouth,
hands, feet
Herpes Simplex:.
Presentation: Grouped vesicles on erythematous base.
Molluscum contagiosum:
Poxvirus
Pearly papule with umbilicated center
Varicella zoster virus:
Chicken pox- Dew drop on rose petal
Shingles- Pain precedes rash in dermatomal pattern
Hutchinson’s sign- lesion on nose. Concern for eye
involvment
Verrucae:
Cause: HPV
Verruca vulgaris- skin colored papillomatous papules.
Hands
Verruca plana- flat warts. Face, arms, legs
Plantar warts- bottom of foot. Rough surface. Dark spot
(thrombosed capillaries)
Cellulitis:
Warm erythematous tender skin with induration or fluctuance
Organism: Staphylococcus aureus is most common Treatment: Dicloxacillin
Erysipelas:
Distinct sharp, raised, demarcated border, more superficial than cellulitis. Fever, chills.
Organism: Group A strep
Treatment: Dicloxacillin
Impetigo:
Organism: Staphylococcus aureus is most common
Nonbullous- Honey colored crusts around nose and
mouth.
Bullous- thin walled vesicles
Treatment: Mupriocin ointment
Candidiasis:
Presentation: Beefy red plaques with satellite lesions
Location: Groin in infants, under breast folds in adults
Treatment: Nystatin cream. Ketoconazole for failure
Dermatophyte:
Tinea pedis (foot), tinea cruris (groin), tinea corporis (body), tinea barbae (beard area), tinea capitis (head)
Organism: Trichophyton
Annular erythematous patch with scaly borders and central clearing. Pruritis.
KOH prep: Segmented hyphea and spores
Treatment: Topical ketoconazole
Tinea versicolor:
Organism: Malassexia furfur
Presentation: Hypo or hyper pigmented macules on upper trunk.
KOH prep: Curved hyphea and spores/spaghetti and meatballs
Treatment: ketoconazole shampoo
