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Skin Muscle and Bone > SMB Week 2 > Flashcards

SMB Week 2 Flashcards

1
Q

Nevis typically appear during what age range?

A

In the first 3 decades of life

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2
Q

When do seborrheic keratoses typically appear?

A

During and after the 4th decade of life

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3
Q

A variant of SKs, these are small, hyper pigmented, sessile to filiform, smooth-surfaced papules appearing on the face and temples darker skin types.

A

Dermatosis Papulosa Nigra

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4
Q

Another name for skin tags

A

Acrochordons

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5
Q

Complication of removing SKs in darker skinned patients.

A

Dyspigmentation. Hyper pigmentation with curettage, hypo with liquid nitrogen.

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6
Q

What is the definitive treatment for an inflamed epidermal inclusion cyst?

A

I & D (but don’t excise due to risk of infection)

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7
Q

Where are melanocytes located?

A
  • In the basal layer of the epidermis

- In the matrix portion of the hair bulb

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8
Q

What is an “epidermal melanin unit?”

A

A melanocyte together with the 36 keratinocytes it’s dendrites supply.

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9
Q

Two types of melanin:

A
  • Eumelanin

- Pheomelanin

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10
Q

Melanin production is mediated by what enzyme?

A

Tyrosinase

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11
Q

Variations in skin color are due to what 3 things?

A

Number, size and aggregation of melanosomes

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12
Q

Which grouping of melanocytes is associated with darker skin, aggregated or non-aggregated?

A

Non-aggregated

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13
Q

Which form of contact dermatitis is concentration dependent?

A

Irritant contact dermatitis (ICD)

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14
Q

Which form of contact dermatitis involves papules prior to the formation of vesicles?

A

Allergic contact dermatitis (ACD)

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15
Q

Which form of contact dermatitis tends to have well-defined borders?

A

ICD

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16
Q

What are some of the features of chronic ICD?

A
  • Mostly appears on hands
  • Hyperkeratosis, scaling and fissures
  • Ill-defined borders and lichenification
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17
Q

What type of eczema has “tapioca”-like vesicles?

A

Dishidrotic eczema

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18
Q

What does the phrase “crescendo reaction” refer to?

A

The worsening of an allergic reaction with repeated exposure to the antigen

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19
Q

What does the phrase “outside job” refer to when describing contact dermatitis?

A

Often linear, artificial patterns.

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20
Q

Autoantibodies seen in patients with atopic dermatitis

A

IgE

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21
Q

Some common triggers of atopic dermatitis

A
  • Food
  • Clothing
  • Seasons (more common in winter)
  • Emotional stress
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22
Q

Most common symptom of atopic dermatitis

A

Itching (it’s often described as “the itch that rashes”)

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23
Q

Type of vesicular eczema seen on the hands and feet

A

Dishidrotic eczema

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24
Q

Treatment for ICD

A
  • Removal of irritant
  • Wet dressings with Burow’s solution
  • Topical glucocorticoids
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25
Q

Treatment for atopic dermatitis

A
  • Hydroxyzine or oral antihistamine for itching
  • Topical glucocorticoids
  • Topical Mupirocin for 2-ary infection
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26
Q

Treatment for lichen simplex

A
  • Topical glucocorticoids or tar preparations with occlusive dressing
  • Unna boot
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27
Q

Treatment for nummular eczema

A
  • Moisturizing cream
  • Topical glucocorticoids
  • Coal tar ointment
  • UVB light therapy
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28
Q

Treatment for dishidrotic eczema

A
  • Topical corticosteroids for small areas

- Prednisone for serious cases

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29
Q

Treatment for asteatotic dermatitis

A
  • Medium potency glucocorticoids
  • Emollients
  • Avoid soapy baths
  • Humidify room
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30
Q

What the average thickness of skin?

A

1.5 - 4 mm

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31
Q

What are some of the reasons for the increased incidence of non-melanoma skin cancer?

A
  • Aging population
  • Increased awareness
  • Increased leisure time
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32
Q

Etiology of basal cell carcinoma

A
  • Hedgehog pathway: loss of inhibition of cell growth

- P53 pathway: tumor suppressor genes inactivated

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33
Q

Etiology of squamous cell carcinoma

A
  • P53 pathway: tumor suppressor genes inactivated
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34
Q

Most common cancer

A

Basal cell carcinoma

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35
Q

Typical appearance of basal cell carcinoma

A
  • Waxy, pearly, papule
  • May be umbilicated with crust
  • Rolled border, telangiectasias
  • Common on face and periorbital region
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36
Q

Dx of basal cell carcinoma

A

Biopsy

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37
Q

Typical appearance of squamous cell carcinoma

A
  • Small, firm, skin-colored to pink papules or plaques
  • Often crusty
  • Common with transplant pts
  • Common in areas of prior trauma (scars, burns, etc.)
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38
Q

Which type of skin cancer is least likely to metastasize?

A

BCC

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39
Q

Squamous cell carcinoma in situ is known as:

A

Bowen’s disease

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40
Q

Skin cancer common on lower legs of women

A

Bowen’s disease

41
Q

Treatment for actinic keratoses

A
  • Liquid nitrogen
  • Topical chemotherapy (5-fluorouracil)
  • Imiquimod (immunomodulator)
  • Ingenol mebutate (plant substance that induces cell death)
  • Lasers or CO2 resurfacing
42
Q

Rare slow-growing tumor found in anogenital region. May arise from apocrine glands or keratinocytic stem cells.

A

Extra-mammary Paget’s disease

43
Q

What is EMPD sometimes misdiagnoses as?

A

Eczema or similar disease

44
Q

Tissue preserving surgical method for treating non-melanoma skin cancer:

A

Mohs Micrographic Surgery

45
Q

Oral medication blocking hedgehog pathway, used to treat non-melanoma skin cancer

A

Vismodegib

46
Q

Indications for Mohs micrographic surgery:

A
  • Large size
  • Facial location
  • Aggressive histology
  • Ill defined borders
  • Immunosuppressed
47
Q

Papulosquamous vs eczematous conditions:

A

Papulosquamous:

  • Papules and plaques
  • Little to no crust, erosion, vesicles
  • Sharply demarcated

Eczematous:

  • Plaques
  • Erosions, crust, excoriations, vesicles
  • Not well-demarcated
48
Q

Things that can worsen psoriasis:

A
  • Alcohol abuse
  • Smoking
  • Obesity
  • Stress
  • Strep throat
  • Cold weather
  • Medication changes
  • Koebner
49
Q

True or false: People with severe psoriasis are at an increased risk of MI

A

True

50
Q

What makes someone a good candidate for systemic treatment of psoriasis?

A
  • BSA > 5%
  • Failure of local therapy or poor quality of life
  • Vulnerable area involvement
  • Concomitant arthritis
51
Q

Topical treatments for psoriasis:

A
  • Corticosteroids

- Calcineurin inhibitors

52
Q

Systemic tx for psoriasis:

A

Older:
- Methotrexate, cyclosporine, acitretin, UV light therapy
Newer:
- Biologics

53
Q

Etiology of pityriasis rosea:

A

HHV 6 and 7

54
Q

Treatment for lichen planus

A
  • Topical corticosteroids, IL steroids, tacrolimus

- Systemic steroids, acitrenin, antimalarials

55
Q

Etiology of mycosis fungoides

A

Type of cutaneous T cell lymphoma

56
Q

Etiology of lichen planus

A

Unknown. Probably autoimmune.

57
Q

Sezary syndrome, seen with mycosis fungoides:

A

erythroderma, LAD, atypical lymphocytes in skin and blood

58
Q

Dx of lichen planus

A
  • epidermal hyperplasia

- band like lymphcytic infiltrate in dermis

59
Q

Presents with violaceous, flat topped, polygonal papules, wickham striae, and can result in scarring alopecia and nail destruction.

A

Lichen planus

60
Q

Treatment for pityriasis rosea

A

Self-limiting. Treat symptomatically with:

  • antihistamines
  • UVB
  • topical steroids
61
Q

Self-limiting disease that presents with a herald patch and a christmas tree distribution

A

Pityriasis rosea

62
Q

Typical distribution of lichen planus

A
  • Trunk and extremities (flexural wrists, ankles)

- Oral and genital

63
Q

True or false: melanomas typically start from existing nevi.

A

False: only about half start from existing nevi.

64
Q

Melanoma in situ:

A
  • confined to epidermis

- tends to occur on face in older puts

65
Q

Newer prognostic test for melanoma invasiveness

A

Sentinel node biopsy

66
Q

Amelanotic melanoma

A

Melanoma that affects non-melanin producing melanocytes

67
Q

ABCDE’s of melanoma

A
  • Asymmetric
  • Border
  • Color
  • Diameter (> 6mm)
  • Evolution
68
Q

Some risk factors for melanoma

A
  • Red or blond hair
  • 3 or more blistering sunburns before age 20
  • 3 or more outdoor summer jobs before age 20
  • Family Hx
  • Hx of NMSC
69
Q

The single most important factor in melanoma survival:

A

Depth of invasion

70
Q

What’s the next most important factor in melanoma survival?

A

Ulceration

71
Q

The most common skin cancer in whites:

A

BCC

72
Q

The most common skin cancer in blacks:

A

SCC

73
Q

In non-whites, melanoma arises most often in which areas?

A

Non-sun exposed areas

74
Q

In whites, melanoma arises most often in which areas?

A

Sun-exposed areas

75
Q

DRESS

A

Drug Rash with Eosinophilia and Systemic Symptoms:

  • Later onset than most drug eruptions
  • Facial edema, blisters
  • Systemic Sx
  • Tx with systemic or topical steroids
76
Q

Common causes of fixed drug eruptions

A
  • Tetracyclines
  • Sulfa
  • NSAIDS
  • barbiturates
  • phenylphthalein
77
Q

Erythema Multiforme

A
  • Target lesions on acral extremities, palms/soles
  • Associated with HSV
  • No giant multinucleated cells
  • Acyclovir 400 mg bid prophylaxis
  • Topical steroid Tx
78
Q

Antibodies seen with pemphigus and pemphigoid

A

IgG

79
Q

Histologically, the hallmark of blistering diseases like pemphigus and pemphigoid.

A

Acantholysis (loss of intercellular connections, i.e., the chicken wire)

80
Q

True or false: Nikolsky’s sign is present in bullous pemphigoid

A

False: blisters do not spread with pressure

81
Q

Age of onset for bullous pemphigoid:

A

Usually after age 60

82
Q

Age of onset for pemphigus vulgaris

A

Usually in 50’s

83
Q

Clinical presentation of pemphigus vulgaris as opposed to bullous pemphigoid:

A 
BP:
- Later onset (> age 60)
- Less mucosal involvement (10%)
- Bullae
PV:
- Mucosal involvement (usually starts in mouth)
- May see erosions instead of bullae
- Earlier onset (50's)
84
Q

Tx for bullous pemphigoid and pemphigus vulgaris:

A
  • Prednisone
  • Azathioprine or mycophenolate
  • Retuximab
  • Methotrexate
  • Abx for 2-ary infections
    (not a complete list)
85
Q

What mutation is seen in atopic dermatitis?

A

Filaggrin gene

86
Q

Maintenance control of atopic dermatitis:

A
  • Topical steroids 2x/week

- Steroids 2x/week + Calcineurin 3x/week

87
Q

Pt education about calcineurin inhibitors:

A
  • May cause burning/stinging
  • Safe around eyes, mouth, genitals
  • Works best on thin skin
  • Use sunscreen (skin cancer risk)
88
Q

Causative bacteria in acne:

A

propionibacterium acnes

89
Q

Pt education for spironolactone for acne treatment:

A
  • Will lower BP
  • Diuretic
  • Potassium sparing, so no potassium supplements
  • Need to stay on it for 3 months for results
90
Q

Topical treatments for rosacea:

A
  • Azaleic acid
  • Metrocream or gel
  • Sodium sulfacetamide
91
Q

Treatment of perioral dermatitis:

A
  • Metrogel
  • Clindamycin
  • Doxycycline
  • Protopic or Elidel
92
Q

Mnemonic for therapy for bullous pemphigoid:

A

PT Doesn’t Do Mixed Martial Arts:

  • Prednisone
  • Tetracyclines
  • Dapsone
  • Dermatology consult
  • Methotrexate
  • Mycophenolate or Azathioprine
93
Q

Mnemonic for therapy for pemphigus vulgaris:

A

MR. DAMP

  • Methotrexate
  • Rituximab
  • Dermatology consult
  • Azathioprine
  • Mycophenolate
  • Prednisone
94
Q

Types of urticaria:

A
  • Acute: IgE mediated Type 1 rxn
  • Chronic: Auto IgG against Fce mast cell receptors
  • Physical: pressure, solar, vibratory, cold, hot
  • Others: direct mast cell binding by substances
95
Q

Options for systemic Tx of atopic dermatitis:

A
  • Immunosuppressants: Prednisone, Azathioprine/Mycophenolate, Cyclosporine, FK=506 (Tacrolimus)
  • Immunomodulators: Methotrexate, interferon gamma
  • Anti-inflammatory drugs: antihistamines, leukotriene inhibitors, anti-IgE
96
Q

True or false: Atopic dermatitis is an IgE mediated condition

A

False: It’s a skin disease with allergies, not an allergic skin disease.

97
Q

Potency classes for topical steroids are based on what?

A

The ability to vasoconstrict.

98
Q

General principles for topical steroid application:

A
  • Start with more potent and move to less
  • bid application is sufficient
  • Use non-fluorinated on face and intertrigenous areas
  • High potency over thick skin (knees, elbows, feet)
  • Low potency over thin skin (face, axilla, groin)

Skin Muscle and Bone (7 decks)

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