Test 3 part 2 Flashcards
framework for musculoskeletal diagnosis first question
Is it musculoskeletal, secondary to systemic disease or secondary to visceral disease?
framework for musculoskeletal diagnosis
musculoskeletal structure breakdown
is it
Nonspecific (mechanical) back pain
Specific musculoskeletal back pain: clear relationship between anatomic abnormalities and symptoms
framework for musculoskeletal diagnosis
musculoskeletal structure breakdown
Specific musculoskeletal back pain
what falls here?
Lumbar radiculopathy due to herniated disk, osteophyte, facet hypertrophy, or neuroforaminal narrowing
Spinal stenosis
Cauda equina syndrome
framework for musculoskeletal diagnosis
under back pain due to systemic disease affecting the spine
falls into 2 big categories
Serious and emergent (requires specific and rapid treatment)
Serious but nonemergent (requires specific treatment but not urgently
framework for musculoskeletal diagnosis
under back pain due to systemic disease affecting the spine
Serious and emergent (requires specific and rapid treatment)
Neoplasia
Plasma cell myeloma (formerly multiple myeloma), metastatic carcinoma, lymphoma, leukemia
Spinal cord tumors, primary vertebral tumors
Infection
Osteomyelitis
Septic diskitis
Paraspinal abscess
Epidural abscess
framework for musculoskeletal diagnosis
under back pain due to systemic disease affecting the spine
Serious but nonemergent (requires specific treatment but not urgently)
Osteoporotic compression fracture
Inflammatory arthritis
framework for musculoskeletal diagnosis
under back pain due to Back pain due to visceral disease (serious, requires specific and rapid diagnosis and treatment)
Retroperitoneal
Aortic aneurysm
Retroperitoneal adenopathy or mass
Pelvic
Prostatitis
Endometriosis
Pelvic inflammatory disease
Renal
Nephrolithiasis
Pyelonephritis
Perinephric abscess
Gastrointestinal (GI)
Pancreatitis
Cholecystitis
Penetrating ulcer
Framework Big categories for arthritis
Monoarticular
polyarticular
Under Framework Big categories for arthritis
monoarticular
Inflammatory
Noninflammatory
Under Framework Big categories for arthritis
monoarticular
Inflammatory
Infectious
Crystalline
Under Framework Big categories for arthritis
monoarticular
Inflammatory
infectious
Nongonococcal septic arthritis
Gonococcal arthritis
Lyme disease
Under Framework Big categories for arthritis
monoarticular
Inflammatory
Crystalline
Monosodium urate (gout)
Calcium pyrophosphate dihydrate deposition disease (CPPD or pseudogout)
Under Framework Big categories for arthritis
monoarticular
NonInflammatory
Osteoarthritis (OA)
Traumatic
Avascular necrosis
Under Framework Big categories for arthritis
Polyarticular arthritis
Inflammatory
Rheumatologic
Infectious
Under Framework Big categories for arthritis
Polyarticular arthritis
Inflammatory
Rheumatologic
Rheumatoid arthritis (RA)
Systemic lupus erythematosus (SLE)
Psoriatic arthritis
Other rheumatic diseases
Under Framework Big categories for arthritis
Polyarticular arthritis
Inflammatory
infectious
Bacterial
viral
Postinfectious
Under Framework Big categories for arthritis
Polyarticular arthritis
Inflammatory
infectious
Bacterial
Bacterial endocarditis
Lyme disease
Gonococcal arthritis
Under Framework Big categories for arthritis
Polyarticular arthritis
Inflammatory
infectious
Viral
Rubella
Hepatitis B
HIV
Parvovirus
Under Framework Big categories for arthritis
Polyarticular arthritis
Inflammatory
infectious
Postinfectious
Enteric
Urogenital
Rheumatic fever
Under Framework Big categories for arthritis
Polyarticular arthritis
nonInflammatory
OA
tinel test
Carpal tunnel
painful arc test
rotator cuff
In young children, failure to spontaneously move an arm or leg can be a sign of
pseudoparalysis
Report of night pain by an adolescent is a
red flag for intraosseous pain of a bone tumor
Severe hip pain that develops over 1-4 days is typical of
osteomyelitis or septic arthritis in children and is an emergency condition
Neonates may not have a fever, but will refuse to feed
septic hip
Common in adolescent males
Painful swelling of the anterior aspect of the tibial tubercle
Caused by strenuous activity, esp. Of the quadriceps
Osgood Schlater Disease
causes of emergent lower extremity pain
compartment syndrome
cauda equina syndrome
_____ weakness causes difficulty in climbing stairs
Quadriceps
Pain and limping in children
may be incorrectly attributed to trauma instead of a more serious problem such as neoplastic tumors or bone infections
ducklike gait that reflects unilateral weakness of the gluteus medius muscle
Trendelenburg gait
an acute one sided limp because the pt takes quick soft steps to shorten the period of weight bearing on the involved extremity.
antalgic gait
circular outward swing of the leg and external rotation of the foot that requires less ankle movement. seen with pathology of the foot or ankle
circumduction gait
Certain antibiotics can cause _____ in children which produces joint pain and fever
Certain antibiotics can cause serum sickness in children which produces joint pain and fever
if a child walks without difficulty with shoes off, what is the problem
shoes are the problem. Inadequate shoe width is a common source of foot pain in children
lies with the thigh in a position of flexion, abduction or external rotation and cries when lower limb is moved
septic hip
Vague, nebulous discomfort in the front of the thighs, calves and behind the knees located outside of the joints in a child may indicate
growing pains
Pain in children __-__ may appear in rapid growth
Pain in children 6-12 may appear in rapid growth
In children, ligaments and joint capsules are 2-5x stronger than the epiphysis, _______ are more common than sprains
growth plate injuries
Asymmetric gluteal folds may indicate a
congenital dislocated hip
dysuria framework big categories
Skin: rash causing irritation with urination
Urethra
Male genital structures
female genital structures
bladder
kidney
dysuria framework big categories
skin
Herpes simplex
Irritant contact dermatitis
Syphilitic chancre
Erosive lichen planus
dysuria framework big categories
Urethra (urethritis from STI)
Gonorrhea
Chlamydia
Trichomoniasis
dysuria framework big categories
Male genital structures
1) Epididymis: epididymitis
2) Testes: orchitis
3) Prostate
A) BPH
B) Acute prostatitis
C) Chronic prostatitis
dysuria framework big categories
female genital structures
1)Vagina
A) Trichomoniasis
B) Bacterial vaginosis
C) Candidal infections
D) Atrophic vaginitis
2) Uterine/bladder prolapse
3) Cervix
A) Neisseria gonorrhoeae infection
B) Chlamydia trachomatis infection
dysuria framework big categories
Bladder
1) Acute cystitis
A) Uncomplicated (healthy women with no urinary tract abnormality)
B) Complicated (patients with any of the following: urinary obstruction; pregnancy; neurogenic bladder; concurrent kidney stone; immunosuppression; indwelling urinary catheter; male sex; systemic infection, such as bacteremia or sepsis)
2) Interstitial cystitis
3) Bladder cancer (with hematuria)
dysuria framework big categories
Kidney
Pyelonephritis
Renal cancer (with hematuria)
Dysuria or suprapubic pain or both with or without hematuria, frequency, urgency
Uncomplicated cystitis
Dysuria with vaginal irritation and discharge
Vaginitis
Fever, chills, nausea or vomiting, flank pain, CVA tenderness
Pyelonephritis
test for uncomplicated cystitis
Urine dipstick or urinalysis
test for Vaginitis
Pelvic exam with discharge examination by saline wet mount, whiff test, and KOH wet mount
test for Pyelonephritis
Urine dipstick or urinalysis
Urine culture
CT scan or ultrasound (if concern for obstruction or lack of clinical response)
Dysuria, urinary frequency, pain radiating to the low back, rectum or perineum
Malaise, fevers, chills, hesitancy
Acute prostatitis
Dysuria without radiation or flank pain
Complicated cystitis
Dysuria, penile discharge, pain with intercourse, testicular pain
Urethritis from STI
Signs of cystitis accompanied with hypotension, fever, lethargy, confusion, orthostasis, and SIRS
Urosepsis
Fever, chills, nausea or vomiting, flank pain, CVA tenderness
Pyelonephritis
test for Acute prostatitis
Digital rectal exam with gentle prostate exam
Urinalysis
Urine culture
Urine GC PCR
Basic metabolic panel
test for Urethritis from STI
Examination for penile discharge
Urine GC PCR
test for urosepsis
Complete blood count
Urinalysis
Urine culture
SIRS criteria
presents with dysuria, low back pain, perineal pain or ejaculatory pain with fever, chills, and myalgias. Patients often have associated urinary symptoms including frequency, urgency, or obstruction.
Acute prostatitis
an infection of the prostate gland that occurs from an ascending urethral infection or through reflux of infected urine into the prostate through the ejaculatory or prostatic ducts.
Acute prostatitis
Acute prostatitis Frequent pathogens include
gram-negative coliform bacteria, E coli, Klebsiella, Proteus, enterococci, and Pseudomonas.
Sexually transmitted bacteria, such as Gonorrhea and Chlamydia, may also be the cause
low back pain, dysuria, and perineal pain, the disease may also present with nonspecific symptoms such as myalgias, malaise, or nausea and vomiting. Patients may also present with obstructive symptoms, such as, hesitancy, incomplete voiding, and weak stream.
Acute prostatitis
On physical exam, the prostate gland may be tender, warm, swollen, or firm.
Acute prostatitis
No rectal exam or prostate exam- can worsen infection
in acute prostatitis Urinalysis will show
consistent with cystitis (eg, leukocyte esterase, nitrites, or white blood cells)
May also be normal
presents with dysuria or suprapubic pain or both. Often, there is associated urinary frequency, urgency, or hematuria. There is usually no penile or vaginal discharge, CVA tenderness, nausea, vomiting, or fever.
Cystitis
cystitis
Most common bacterial pathogens include
Gram negatives: Escherichia coli (75–95%), Klebsiella pneumoniae, and Proteus mirabilis
Gram positives: Staphylococcus saprophyticus, Enterococcus faecalis, and group B streptococcus
Risk factors for cystitis
Sexual intercourse
Use of spermicides
Previous UTI
A new sexual partner in the past year
Cystitis in the elderly
Delirium, functional decline, or acute confusion may be the presenting symptoms of cystitis in elderly patients.
urinalysis findings suggestive of cystitis
Leukocyte esterase is an enzyme released by leukocytes and signifies pyuria. LR+ 12.3–48
The presence of nitrites indicates the presence of bacteria that convert urinary nitrates to nitrites.
White blood cells on urine microscopy (> 5 per high powered field)
Hematuria demonstrated by positive blood on dipstick or red blood cells (RBCs) on microscopy
Table 16-2 shows the sensitivity, specificity, and likelihood ratios of urinalysis and microscopy findings.
The negative likelihood ratio of leukocyte esterase and urine nitrite is only 0.3; the absence of these findings does not rule out cystitis.
Symptomatic premenopausal women should be or should not be treated despite negative midstream urine cultures.
should be
The diagnosis of cystitis should or should not be ruled out by a urinalysis that is negative for both leukocyte esterase and nitrites in the presence of a convincing clinical presentation.
should not be
typically presents with dysuria and flank or back pain, fever, chills, malaise, nausea and vomiting.
Pyelonephritis
an infection affecting the parenchyma of the kidney.
Pyelonephritis
Complicated pyelonephritis is present if the patient is
Male
Pregnant
Immunosuppressed
Has urinary obstruction, nephrolithiasis, foreign-body/catheters, or kidney dysfunction
CVA tenderness on physical exam suggests
pyelonephritis but is actually nondiagnostic
pyelonephritis
indications for admission
Unstable vital signs
Inability to tolerate oral medications
Concern for nonadherence
Pregnancy
Immunocompromised state
Concern for urinary tract obstruction or nephrolithiasis
presents with dysuria, urethral pruritus, and penile discharge. Patients may also have dyspareunia, abdominal pain, or testicular pain
Urethritis
cervicitis typically have cervical discharge, dysuria, and dyspareunia. They may also have spontaneous or postcoital vaginal bleeding.
Urethritis
Urethritis and cervicitis are usually due to
STI
usually
N gonorrhoeae and C trachomatis.
STIs that can cause Urethritis and cervicitis
N gonorrhoeae and C trachomatis.
Mycoplasma genitalium
Trichomonas
Herpes simplex virus (may also cause cervicitis)
Adenovirus
In a man with dysuria,_____ is often warranted.
In a man with dysuria, STI testing is often warranted.
Cervicitis can be diagnosed by
identifying mucopurulent endocervical discharge on pelvic exam. Sustained cervical bleeding caused by gentle passage of a swab in the cervical os may also be seen.
presents with fever, chills, hypotension, and lethargy or altered mental status. Symptoms of the underlying infection, such as dysuria or flank pain, are often present.
Urosepsis
presents with abnormal vaginal discharge, odor, irritation, itching, dysuria, or dyspareunia.
Vaginitis
Common infectious causes of vaginitis are
bacterial vaginosis, trichomoniasis, and candidiasis.
Bacterial vaginosis occurs when the normal flora of the vagina is replaced with
anaerobic bacteria most commonly, Gardnerella vaginalis.
Trichomoniasis is an STI caused by the
flagellated protozoan, Trichomonas vaginalis. It can also infect men, causing urethritis or silent infection.
Often occurs with changes in the vaginal environment such as high estrogen states (menses, pregnancy), antibiotic use, immunosuppression, or poorly controlled diabetes.
Vaginitis category
Vulvovaginal candidiasis
Caused by estrogen deficiency (most often postmenopausal) and results in thin, dry vaginal mucosa
Atrophic vaginitis
pH > 4.5
Bacterial vaginosis
Clue cells > 20% on wet mount
bacterial vaginosis
Leukocytes >epithelial cells
Trichomonas
Point of care DNA hybridization probe
Bacterial vaginosis
trichomonas
Candidiasis
At least 3 of 4 amsel criteria
Bacterial vaginosis
NAAT
Trichomonas
rapid POC antigen vaginal test
trichomonas
Male- testes, scrotum, and penis are the same size and shape as in a young child. No growth in pubic hair
Female- only the nipple is raised above the level of the breast, as in the child. No growth of a pubic hair.
Tanner 1
Male-enlargement of the penis, especially in length, further enlargement of testes; descent of scrotum. Dark, definitely pigmented, curly pubic hair around the base of penis.
Female- budding stage; bud-shaped elevation of the areola; areola increased in diameter and surrounding area slightly elevated. Initial, scarcely pigmented straight hair, especially along the medial border of the labia.
tanner 2
Male- enlargement of the penis, especially in length, further enlargement of testes; descent of scrotum. Dark, definitely pigmented, curly pubic hair around the base of penis.
Female- breast and areola enlarged. No contour separation. Sparse, dark, visibly pigmented, curly pubic hair on labia.
tanner 3
Male- continued enlargement of penis and sculpturing of the glans, increased pigmentation of scrotum. “Not quite adult” Pubic hair definitely adult in type but not in extent (no further than inguinal fold)
Female- Increasing fat deposits. The areola forms a secondary elevation above that of the breast. This secondary mound occurs in app. Half of all girls and some cases, persist into adulthood. Hair coarse and curly, abundant but less than adult.
tanner 4
Male- Scrotum ample, penis reaching nearly to bottom of scrotum. Hair spread to medial surface of thighs but not upward
Female- the areola is usually part of general breast contour and is strongly pigmented. Nipple projects. Lateral spreading; type and triangle spread of adult hair to medial surface of thighs.
tanner 5
Male- hair spread along linea alba (occurs in 80% of men)
Further extension laterally, upward, or dispersed (occurs in 10% of women)
tanner 6
microscopic hematuria with negative culture
check
BP BUN Creatinine Urine protein Red cell casts
normal GFR
> = 60
Painless hematuria sometimes with blood clots
Smoking history
Male sex
Toxin exposure
Age over 40
Bladder cancer
test for Bladder cancer
Cystoscopy
Urine cytology
CT urogram
hematuria, bladder pain
flank/abdominal pain, renal colic
stone disease
test for stones
Bladder : Noncontrast CT
Cystoscopy
Ureter or kidney: Non contrast CT
Urgency frequency, nocturia, urge incontinence, stress incontinence, hesitancy, poor flow, straining, dysuria
Benign prostatic hypertrophy
test for BPH
rectal exam
Abdominal pain, recent/concurrent urinary tract infection, fever, chills, urinary retention, recent prostate biopsy
Prostatitis
must not miss
hematuria
Prostate cancer
test for prostate cancer
Rectal exam
Prostate-specific antigen
must not miss
Hematuria
Flank pain
Abdominal mass
Renal cell carcinoma
imaging for Renal cell carcinoma
CT scan
Episodes of gross hematuria (tea-colored urine) that coincide with respiratory infections
IgA nephropathy
test for IgA nephropathy
Urinalysis with microscopy
Serum creatinine
Renal biopsy
Family history of hematuria without history of chronic kidney disease
Thin basement membrane nephropathy
test for Thin basement membrane nephropathy
Urinalysis with microscopy
Serum creatinine
Renal biopsy
Antecedent group
A streptococcal pharyngitis 1–3 weeks prior to episode of gross hematuria, often with high BP and edema
Infection-related glomerulonephritis
test for Infection-related glomerulonephritis
Urinalysis with microscopy
Serum creatinine
Antibodies to streptococcal antigens
Serum complement levels
Hematuria with strong family history of progressive renal disease and sensorineural hearing loss
Alport syndrome
test for Alport syndrome
Urinalysis with microscopy
Serum creatinine
Family history
Renal biopsy
presents as painless visible (gross) hematuria in an older male smoker. However, episodes of gross hematuria may be intermittent, and thus asymptomatic nonvisible (microscopic) hematuria may be the only sign for some patients. If present, symptoms may include dysuria or obstructive symptoms.
Bladder Cancer
what gender and race is bladder cancer most prevalent
white male
Occupations associated with a higher risk of ____ include miners, bus drivers, rubber workers, motor mechanics, leather workers, blacksmiths, machine setters, hairdressers, and mechanics.
Occupations associated with a higher risk of bladder cancer include miners, bus drivers, rubber workers, motor mechanics, leather workers, blacksmiths, machine setters, hairdressers, and mechanics.
______ cancer is a must not miss diagnosis in patients with gross hematuria not due to an infection.
Urothelial
useful for detecting carcinoma in situ.
Hexaminolevulinate fluorescence cystoscopy
patients aged 40 years or older, or with visible urinary blood clots, require _____ even if the bleeding is glomerular.
cystoscopy
what is the gold standard for diagnosing bladder cancer
white light flexible cystoscopy
most commonly presents with visible hematuria within 12–72 hours of a mucosal (typically an upper respiratory) infection. It can also be discovered upon detection of asymptomatic, non-visible hematuria with or without proteinuria during routine medical screening.
IgA Nephropathy
most common cause of primary glomerulonephritis worldwide.
IgA Nephropathy
IgA Nephropathy Occurs with greatest frequency in
Asians and whites.
IgA Nephropathy A definitive diagnosis can only be made by
renal biopsy with immunofluorescence or immunoperoxidase studies for IgA deposits.
new onset of hematuria, proteinuria, and edema, often with hypertension and mild acute kidney injury, following or concurrent with an infection.
Infection-Related Glomerulonephritis (IRGN)
the 2 most common sites of infection leading to IRGN,
URI and skin infections
pathogens most commonly attributed to IRGN
group A streptococci, specifically Streptococcus pyogenes.
Presents with hematuria, proteinuria, and edema, often accompanied by hypertension and mild acute kidney injury
Urinary output usually improves after 5–7 days, followed rapidly by resolution of edema and normalization of BP
Acute nephritic syndrome (
Present in many patients with mild, self-limited streptococcal infections
Characterized by low-grade proteinuria (< 1 g/day), pyuria, and nonvisible (microscopic) hematuria; often goes undetected
Subclinical or asymptomatic GN
presents with the triad of hematuria, flank pain, and a palpable abdominal mass but now is far more commonly detected incidentally as a renal mass seen on a radiographic examination done for other reasons.
Renal Cell Carcinoma
have isolated hematuria with normal kidney function, no or minimal proteinuria, and a uniformly thinned glomerular basement membrane (GBM) on electron microscopy analysis of biopsy specimen.
Thin Basement Membrane Nephropathy
most common cause of persistent hematuria in children and adults
Thin Basement Membrane Nephropathy
The only way to definitively diagnose TBMN is by
kidney biopsy and electron microscopy.
Absence of menarche by age 16 years with normal pubertal growth and development.
Primary Amenorrhea
The absence of menarche by age 14 years with lack of normal pubertal growth and development
Primary Amenorrhea
Absence of menarche 2 years after sexual maturation is complete.
Primary Amenorrhea
Absence of menstruation for at least three cycles in those with established normal menstruation or 9 months in those with previous oligomenorrhea (menstrual periods occuring at intervals of greater than 35 days, with only four to nine periods in a year
Common cause: due to pregnancy, lactation, and menopause
secondary amenorrhea
If pregnant with bleeding… rule out
ectopic pregnancy
onset of menstruation
9-17 yrs old
median age of menstruation
12 years old, 2-3 years from thelarche (breast budding) to menarche
If once had menses and stops it is
secondary amenorrhea
Sudden amenorrhea
more likely
pregnancy or stress
Gradual amenorrhea
indicates PCOS
Ovarian failure
ovarian failure is considered premature younger than age
40
Palpate the scrotum to assess for undescended testicles. Holding a finger in the inguinal canal prevents the testicles from slipping into the canal when palpating the scrotum. The left scrotal sac usually hangs lower than the right.
Dains-Scrotal pain
(positive Prehn sign)
Elevation of an affected testicle may relieve discomfort
Dains-Scrotal pain
characteristic of epididymitis
occurs from dilated veins in the scrotal sac and usually occurs on the left side. A varicocele is often more prominent when the patient is standing and regresses with the patient in the prone position.
It is classically described as a bag of worms
A Varicocele
(a cystic swelling on the epididymis) is not as large as a hydrocele but does not transilluminate.
spermatocele
a nontender collection of fluid in the scrotum. It will transilluminate but may make testicular palpation difficult.
hydrocele
Sudden onset of testicular pain that radiates to groin, may have lower abdominal pain. Exquisitely tender testicle, testicle may ride high bc of shortened spermatic cord; cremasteric reflex absent; elevation of affected testicle does not relieve pain (negative Prehn sign)
Torsion-
abrupt onset over several hours; febrile; pain in scrotum or testicles. Tender, swollen, epididymitis or testicles; elevation of affected testicle may lessen discomfort. Positive Prehn sign, may have fever.
Epididymitis
occurs with menstrual cycles
Cyclic Breast Pain -
40-50 years of age
Localized pain that is sharp, stabbing, burning and throbbing
Cysts, fibroadenomas, duct ectasia, mastitis, breast injury and breast abscesses are associated
Noncyclic Mastalgia
Inflammation of the breast tissue with swelling, tenderness, chills, fever and increase pulse rate
Mastitis/ Abscess
Subareolar ducts become blocked with desquamating secretory epithelium, necrotic debris and chronic inflammatory cells
Pain, tenderness, inflammation, nipple discharge and possibly nipple retraction
Mammary Duct Ectasia
Area of erythema and pain can precede the development of grouped vesicles
Herpes Zoster
Heaviness, burning, tenderness in the breast
Rapid increase in size
Inverted nipple
Peau d’orange physical exam
Inflammatory Breast Cancer
XXY - in males
Gynecomastia and prepubertal testes
Breast pain is usually the first sign
Klinefelter Syndrome
Naegele rule
the EDD can be estimated by taking the LMP, adding 7 days, subtracting 3 months, and adding 1 year
Given during every pregnancy (27-36 weeks)
Caregivers in direct contact with the infant should also receive
TDAP
how do you assess the fundal height
If gestational age is >20 weeks, when the fundus should reach the umbilicus. With a plastic or paper tape measure, locate the pubic symphysis and place the “zero” end of the tape measure where you can firmly feel that bone. Then extend the tape measure to the very top of the uterine fundus and note the number of centimeters measured. Through subject to error between 16 and 36 weeks, measurement in centimeters should roughly equal the number of weeks of gestation. (May under detect newborns who are small for gestational age).
fundal height If >4cm than expected:
consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma.
fundal height if <4cm than expected:
low amniotic fluid, missed abortion, intrauterine growth retardation, or fetal anomaly.
fetal HR is normally audible as early as
10-12 weeks gestation
fetal HR location 10-18 weeks
located along the midline of the lower abdomen
fetal HR >18 weeks
FHR is best heard over the back or chest and depends on fetal position. The leopold maneuvers can help identify the position.
fetal HR normal
110-160
Presents in adolescence with chronic, waxing and waning lesions.
inflammatory papules, pustules, comedones, and nodulocysts over the face, chest, and back
Acne Vulgaris
Flesh- colored, translucent, or slightly red papule or nodule, with rolled border.
Most common head or neck of older adults
Friable, bleeding easily and developing crust (Telangiectasias)
Most common malignant tumor in humans
Asymptomatic and rarely causes pain
Highest risk- fair hair and eyes, easy freckling, and propensity for sunburn… less likely for people with darker skin
Basal Cell Carcinoma
Cluster of tense blisters on exposed skin (>/=1cm) and surrounding skin is normal.
Caused by dermal hypersensitivity reactions to antigens from the saliva of insects (bedbugs, fleas, mosquitos, mites are typical)
Bullous Arthropod Bites
Most common in infants & children
Presents as flaccid, transparent bullae in the intertriginous areas
Rupture easily leaving a rim of scale and shallow moist erosion
Causative agent staphylococcus aureus
Bullous Impetigo
Elderly patients
1-2 cm tense blisters and bright red, urticarial plaques
Begin on lower extremities and progress upward
Autoimmune disease
Occur sporadically
Asymptomatic to intense pruritic
Bullous Pemphigoid
Small, round or oval lesions on the back and trunk. Lesions often have somewhat silvery, adherent scales.
Small (0.5-1.5cm)
Upper trunk and proximal extremities
May involve face, ears, and scalp
May involve areas with minor skin trauma (koebner phenomenon)
Last 3-4 months
Seen in young adults preceded by a streptococcal throat infection
Increase risk for developing psoriasis vulgaris in 3-5 years
Increase incidence in families
NO PICTURE IN TEXT
Guttate Psoriasis
Dark brown or black macule or papule in a middle aged person
Pigment variation throughout and irregular borders
Upper back in males
Leg in females
Whites are 26 times more likely to develop than blacks
Melanoma
Extremely pruritic rash of numerous, round, crusted lesions on the lower extremities
Well demarcated coin shaped lesions composed of minute vesicles and papules on an erythematous base. Overlying crust, frequently with a weeping exudate.
Severely pruritic
Remitting and relapsing course
Nummular Dermatitis
Multiple small, oval, scaly plaques with central trailing scale on the trunk and proximal extremities. A “herald patch”, the first to develop is often the largest.
May be pruritic
Two weeks after first patch smaller patches firm…”fir tree” pattern
Hx of prodrome of mild malaise, nausea, headache, and low-grade fever may be present.
Pityriasis Rosea
Seen in patients with bleeding disorders or vascular damage
petechiae - capillary hemorrhages that present as non blanching, pinpoint, red spots over dependent body parts (lower extremities)
Purpura- larger hemorrhages into the skin
Nonpalpalbe hemorrhage- usually thrombocytopenia
Palpable purpura can be a sign of serious illness (e.g. rocky mountain spotted fever, acute meningococcemia, disseminated gonococcal infection).
Purpura/ Petechiae
Adults with a facial rash
Gradual development of telangiectasias and persistent centrofacial erythema sometimes with inflammatory red papules and papulopustules. Comedones absent.
Often hx of easy flushing
May worsen with sun exposure, ingestion of spicy foods, thermally hot foods/ liquids, emotional stress, and exercise.
More common in women vs men
Peaks in middle age, usually after acne, but can overlap
Sun exposure can trigger
Ocular rosacea is common
Rosacea
Oval macules… papules and plaques…copper/red to hyperpigmented in color
Present diffusely over the entire body then palms, soles and mucosal surfaces at a later stage.
Later stage thick scales may cover the plaques
Hx of transient, painless, genital ulcer in the preceding weeks can often be obtained
Nonpruritic
Secondary syphilis
Firm but somewhat indistinct nodule or plaque may become ulcerated or bleed easily and become crusted
May come from actinic keratoses on the sun exposed skin of middle aged people
UV radiation is a major risk factor
Squamous cell carcinoma
Patient with fever, malaise, headache, and myalgias who is taking a potentially causative medication.
After one week of symptoms a macular rash develops on the chest and face. Lesions then blister and rapidly erode. Skin is usually excruciatingly tender.
Stevens- Johnson Syndrome
round , pink plaques with small peripheral papules and a rim of scales.
Centrifugal spread of the fungus from the initial site of infection
Neck and back most common location
Tinea Corporis
Itchy rash with large or small, palpable, red areas over the entire body.
Can be acute (<6 weeks) or chronic (>6 weeks)
Rash and pruritis respond to antihistamines
Mucous membranes present as angioedema
Urticaria
Usually a rash over a single unilateral dermatome
Closely grouped vesicles on an erythematous base
2-3 days become pustular and then crust over after 7-10 days.
Pain and paresthesias may occur along the involved dermatome often follow for a few days.
Caused by reactivation of VZV in a dorsal root ganglion
Most commonly in elderly population.
Varicella Zoster Virus [VZV]
lesion without elevation or depression, < 1 cm
Macule:
lesion without elevation or depression, > 1 cm
patch
any solid, elevated “bump” < 1 cm
Papule:
raised plateau-like lesion of variable size, often a confluence of papules
plaque
solid lesion with palpable elevation, 1–5 cm
Nodule
solid growth, > 5 cm
tumor
encapsulated lesion, filled with soft material
cyst
elevated, fluid-filled blister, < 1 cm
vesicle
elevated, fluid-filled blister, > 1 cm
bulla
elevated, pus-filled blister, any size
pustule
inflamed papule or plaque formed by transient and superficial local edema
wheal
a plug of keratinous material and skin oils retained in a follicle; open comedone has a black inclusion, closed comedone appears flesh-colored or pinkish
Comedone:
Autoimmune blistering disorder
Bullous pemphigoid
Epidermolysis bullosa acquisita
Pemphigus vulgaris
Blistering disorder
Hypersensitivity syndromes
Stevens-Johnson syndrome
Toxic epidermal necrolysis
blistering disorder
infectious
Herpes simplex
Impetigo
Staphylococcal scalded skin
Varicella zoster
Dermal reaction patterns
Erythema nodosum
Granuloma annulare
Sarcoidosis
Urticaria
Folliculopapular eruptions (perifollicular papules)
Acne vulgaris
Folliculitis
Perioral dermatitis
Rosacea
Prodromal pain symptoms
Localized lesions in a dermatomal distribution
Varicella zoster virus
Acute onset, intertriginous location
Most common in children
Bullous impetigo
Pruritus
Lack of constitutional symptoms
Exposure history
Bullous arthropod bites
May present with early urticarial lesions and pruritus
Later intact blisters
Bullous pemphigoid
Rapidly progressive rash with associated mucosal lesions
SJS
Presents after acute pharyngitis
Discrete small red papules and plaques with adherent silvery scale
Guttate psoriasis
Classically starts with a single “herald patch” 1–2 weeks prior to disseminated eruption
Primarily truncal distribution with “tree-like” appearance
Pityriasis rosea
Solitary or few lesions
Annular lesions with a leading edge of scale
Pruritic
Tinea corporis
Well-defined plaques with crust and papulovesicles
Pruritic
Symmetric distribution on extremities
Nummular dermatitis
Palms and soles involved
Thinner plaques without adherent scale
Secondary syphilis
postmenopausal women have an ____ risk of breast cancer
decreased
decreased estrogen causes increased/decreased breast pain
increased
fetal heart tones 20 weeks
umbilicus
gram neg UTI
Proteus
how do you tell basal from squamous
histology
