Week 3: Dermatology Flashcards

1
Q

What are the eight characteristics that the FNP should describe of every skin lesion?

A

Number

Size

Color

Shape

Texture

Primary lesion

Location (specific landmarks)

Configuration (describing patterns)

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2
Q

What are examples of primary lesions?

A

Erosions Ulcers Nodules Ecchymosis Petechiae Palpable purpura

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3
Q

Flat lesion

A

can’t palpate with eyes closed

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4
Q

Macule

A

flat and < 1 cm

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5
Q

Patch

A

flat and > 1 cm

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6
Q

Raised lesion

A

palpate with eyes closed

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7
Q

Papule

A

raised, < 1 cm, not fluid filled

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8
Q

Plaque

A

raised, > 1cm, not fluid filled

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9
Q

What are some terms used to refer to the shape of a lesion?

A

Circular

Oval

Annular: ring-like with central clearing

Nummular: coin like, no central clearing

Polygonal

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10
Q

What are some terms used to refer to the texture of a lesion?

A

Smooth Fleshy Verrucous / warty Scaly Fine and dry (Tinea pedis) Hard and keratotic (Actinic keratoses) Greasy (Seborrheic dermatitis)

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11
Q

What characteristics would you expect of actinic keratoses? What conditions mimic actinic keratoses?

A

Hard and keratotic

  • mimics superficial xerosis or seborrheic dermatitis
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12
Q

What characteristics would you expect of basal cell carcinoma (BCC)? What conditions mimic BCC?

A

pinky patch that doesn’t heal, possible focal scaling

mimics actinic keratosis and SCC in situ

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13
Q

What exam findings are concerning for malignant melanoma?

A

A - assymmetry

B - irregular border, esp notching

C- color, esp colors black, blue and red

D- diameter >6mm

E- evolving

E - elevated

F- firm

Growing

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14
Q

What are the characteristics of a spider angioma?

A

Fiery red, very small to 2cm

Central body, sometimes raised, surrounded by erythema and radiating legs

Pressure on body causes blanching of the spider

Face, neck, arms, upper trunk

Almost never below waist

normal/common on face and chest

Also seen in pregnancy and liver disease

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15
Q

What are the characteristics of a spider vein?

A

Blueish

Size variable; small to several inches

Shape: variable, spider, linear, irregular, cascading

pulsatility and effect: absent; pressure over center DOESN’T blanch but diffuse pressure blanches the veins

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16
Q

What are the characteristics of a cherry angioma?

A

Bright ruby read, purplish with age

1-3mm

Shape: round, flat, sometimes raised, may be surrounded by pale halo

Pulsatility and effect of pressure:

Absent, partial blanching, esp if pressure applied with edge of pinpoint

Location: trunk, extremities

Sig: none, increases in size and #’s w/ aging

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17
Q

What are some examples of sun damage? How do they present?

A

Solar lentigo: bilateral symmetric brown macules located on sun exposed skin, face, shoulders, arms, hands

Solar elastosis: Yellowish white macules or papule in sun exposed areas, foreheads

Actinic purpura: ecchymoses only on dorsal forearms and hands but NOT extending above “shirt sleeve” line on upper arm

Poikiloderma: red patches in sun damaged areas, esp V neck, with fine telangiectasis and both hyper and hypopigmentation

Wrinkles: increased sun damage and tanning lead to deeper wrinkles at earlier age

Cutis rhomboidalis nuchae: deeper wrinkles on posterior neck that “criss cross)

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18
Q

What are some abnormal nail findings?

A
  • paronychia: staph aures/strep; superficial infection of lateral nail folds; red swollen, tender
  • clubbing: vasodilation w/ inc blood flow, hypoxia, CHD, interstitial lung disease, lung cancer, IBD, malignancies
  • Habit tic deformity: depression on central nail; “christmas tree” ; repetitive trauma from rubbing index finger over thumb
  • melanonychia: increased pigmentation in nail matrix; streaks; normal ethnic variation
  • onycholysis: painless separation of opaque nail bed from pink nail bed; trauma, psoriasis, fungal infection, allergic reactions to nail cosmetics
  • onychomycosis: nail thickening and debris; from tinea pedis, fungal
  • terry nails: white nail plate with ground glass; liver disease, cirrhosis, HF, diabetes
  • transverse linear depressions (beau lines): temp disruption of proximal nail growth from systemic illness; severe illness, trauma, raynaud’s disease
  • pitting: punctuate depressions of nail plate by defective layering of superficial nail plate; psoriasis
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19
Q

Skin findings of someone with chronic renal disease?

A

pallor

xerosis

uremic frost (crystallized urea)

pruritus

half & half nails

calciphylaxis (Ca accumulates in small blood vessels of fat and skin tissues)

blood clots, painful skin ulcers, infxns

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20
Q

skin findings of somone with crohn’s disease?

A
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Enterocutaneous fistulas
  • Aphthous ulcers
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21
Q

skin findings of somone with Cushing disease?

A

Striae

Atrophy

Purpura

Ecchymoses

Telangiectasis

Acne

Moon facies

Buffalo hump

Hypertrichosis

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22
Q
A
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23
Q

skin findings of someone with diabetes

A

Pruritus

Diabetic dermopathy

Acanthosis nigricans

Candidiasis

Neuropathic ulcers

Necrobiosis lipoidica

Eruptive xanthomas

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24
Q

skin findings of Dyslipidemias

A

Xanthomas (tendon, eruptive, tuberous; Lesions on skin with cholesterol and fat)

Xanthelasma

25
Q

skin findings of Hypothyroidism

A

Dry, rough, pale skin

Coarse and brittle hair

Myxedema (think coma!!!)

Alopecia (lateral 3rd of eyebrows to diffuse)

Skin cool to touch

Thin and brittle nails

26
Q

skin findings of hyperthyroidism

A

Warm, moist, soft, velvety skin

Thin and fine hair

Alopecia

Vitiligo

Pretibial myxedema (in graves disease)

Hyperpigmentation (local or generalized)

27
Q

skin findings of Kawasaki disease

A

Mucosa erythema

Lips, tongue, pharynx

Strawberry tongue

Cherry red lips

Polymorphous rash (trunk)

Erythema of palms and soles

Desquamation of fingertips

28
Q

skin findings of liver disease

A

Jaundice

Spider angiomas

Telangiectasias

Palmar erythema

Terry nails

Pruritus

Purpura

Caput medusae

29
Q

skin findings of leukemia/lymphoma

A

Pallor

Exfoliative erythroderma

Nodules

Petechiae

Ecchymoses

Pruritus

Vasculitis

Pyoderma gangrenosum

Bullous disease

30
Q

skin findings of meningococcemia

A

Angular stellate purpuric patches

Plaques with gunmetal gray center

Ecchymoses

Bullae

Necrosis

31
Q

skin findings of Neurofibromatosis

A

Neurofibromas

Cafe-au-lait spots

Freckling in axillae (Crowe sign)

Plexiform neurofibroma

32
Q

skin findings of Systemic lupus erythematosus

A

palmar erythema (mid cheeks, spans bridge nose)

Relative sparing of nasolabial folds

Periungual erythema

Interphalangeal erythema

33
Q
A
34
Q

In considering the APGAR, what does the score tell use about the newborn’s skin?

A

skin: 0 (pale, blue) 1 (pink body, blue extremities), 2 (pink all over)

35
Q

How would you assess an infant’s skin for hydration?

A

Check turgor for hydration

Roll a fold of loosely adherent skin on Abdomen wall between thumb and forefinger

Tenting = NO NORMAL

36
Q

Where would you assess an infant’s skin for cyanosis? What would you consider on the DDx for an infant with cyanosis?

A

Acrocyanosis (blue cast on hands and feet when exposed to cold) very common first few days

Central cyanosis at any age = congenital heart disease

Best area to look for central cyanosis: tongue and oral mucosa (NOT nail beds, lips, or extremities)

37
Q

What are the four common dermatologic conditions in the newborn? How do they present?

A

Miliaria rubra: scattered vesicles on erythematous base; face/trunk; From obstructed sweat gland ducts; Disappears w/in few weeks

Erythema toxicum: erythematous macules with central pinpoint vesicles scattered diffusely over entire body; “flea bites”, disappear w/in 1st few weeks of birth

Pustular melanosis: small vesiculopustular over brown macular base; lasts several months; common in black infants

Milia: pinhead-sized smooth, white raised areas without surrounding erythema on nose, chin, forehead; retention of sebum in openings of sebaceous glands

38
Q

What would be considering abnormal findings in the newborn skin assessment? What would be the DDx for these?

A
  • jaundice: abnormal if present within 24 hours (hemolytic disease of newborn); normal on 2nd or 3rd day, peaks day 5, gone 1 week
  • midline hair tuft: over lumbosacral spinal region; Spinal cord defect
39
Q

What are some benign birthmarks found in infants? What do they look like?

A

Eyelid patch - fades w/in 1st year

Salmon patch / stork bite / angel kiss

Cafe au lait spots: Isolated lesions have no significance but multiple lesions with sharp vorders suggest neurfibromatosis; light brown pigmented lesions have borders and uniform

monogolian spots/Slate blue patches: common dark skinned babies

Harlequin dyschromia: Transient cyanosis of ½ of body or 1 extremity, from vascular instability

40
Q

In the pediatric population, what are some wart-like lesions and how do they appear on exam?

A

Verruca vulgaris (Dry, rough warts on hands)

Verruca plana (small, flat warts)

Plantar warts

Molluscum contagiosum

Adolescent acne

41
Q

What are some commons skin lesions during childhood and how do they appear on exam?

A

Bacterial (impetigo, furuncle or boil, folliculitis, carbuncle)

fungal (cadidiasis, tinea (capitis, corporis, veriscolor, pedis, cruris, unguium)

viral (verrucace [common, plantar, flat], molluscum contagiosum, herpes simplex type 1 & 2)

infestations (pediculosis, pediculosis capitis, scabies)

inflammatory disorders (atopic dermatitis, diaper dermatitis, seborrheic dermatitis, contact dermatitis, acne vulgaris)

42
Q
A

cutis mamorata

Premature infants or first few months of life, trunk/legs

Infants with conventional hypothyroidism or Down syndrome

If acrocyanosis doesn’t disappear within 8 hrs or with warming, consider congenital heart disease

in cold environment

43
Q
A

erythema toxicum

Very very common in NB

Day 2-3 days of life

Erythematous macules with central pinpoint macule

Diffuse, flea bite looking

44
Q
A

Pustular Melanosis

More common in black infants

Vesicle pustules that form over brown macular base

Last several months

Resolves w/o tx

45
Q
A

Miliaria Rubra

Scattered vesicles on erythematous base on face

Caused by obstruction of sweat glands

Disappear spontaneously

No intervention needed, just reassurance

46
Q
A

Diaper Dermatitis

Skin is raw, excoriated, sloughed off

Caused by irritant, stool, diaper

Use barrier cream, letting air get to the area

Common

47
Q
A

Candida / yeast infection of diaper area

Erythematous papules with some satellite lesions

Any rash > 72 hrs in diaper area has to do with yeast and will be treated as yeast

48
Q
A

impetigo

Bacterial infection of skin caused by strep or staph
Very contagious
Moist vesicles on erythematous base
When vessels rupture, produce honey colored cresting
Bullous impetigo present as larger lesions
When erupt = see red, shiny rough skin under
By staph

49
Q
A

Molluscum Contagiosum

Very very common in peds
Caused by pox virus
Pearly, colored dome shaped papules with central umbilication
Form in clusters , even linear
If scratch = spread

50
Q
A

head lice

Difficult to dx

Significant pruritis

Overnight worsens

Occipital or postauricular areas

Lice is oval shaped, firmly attached to hair shaft

(½ inch up from scalp)

Whitish gray nit attached to shaft

51
Q
A

Fifth disease (erythema infectiosum)

caused by parvovirus B19

Starts with mild fever, rhinitis, h/a

Slapped cheap appearance 3-5 days into the illness

Once rash shows, no longer contagious

5th disease bc 5th disease we used to see in childhood illness

52
Q
A

Coxackie Virus (Hand, foot, mouth disease)

Sometimes pruritic

Mouth lesions very uncomfortable

a/s with anorexia, sore throat, LOA, very very fussy kids/infants

Supportive care for tx

53
Q
A

Roseola

By herpes virus

Most kindergartens exposed by 5

Very common under 2 yo

2-3 days of high fever and irritability

Break out in rash over trunk and extremities

Pink maculopapular rash

54
Q
A

varicella/chicken pox

“Dew drop on a rose petal”

Vesicle on erythematous base

Pruritis, fever, unwell sx’s

Lesions become infected with staph → sepsis → death

55
Q
A

measles

High fever, cough, runny nose, diffuse pinkish

Red macupapulses forming together

56
Q

What does blanching indicate? nonblanching?

A

blanchable: erythematous/inflamed; erythematous wheel suggest inflammation

nonblanching (petechiae, purpura, vascular structures like cherry angioamas, vascular malformations): NOT erythematous but rather red, purple, violaceous/purple

57
Q

petechia/pupura

A

deep red or reddish purple fading over time

petechia, 1-3mm; pupura larger

shape: rounded, sometimes irregular; flat

NON-blanchable

significance: blood outside vessels suggest bleeding disorder; palpable purpura in vasculitis

58
Q

ecchymosis

A

purple or purplish blue, fading to green yellow and brown with time

variable in size, larger than petechiae (>3mm)

shape: rounded, oval, irregular; may have central cubcutaneous fat nodule (hematoma)

NON-blanchable

significance: trauma, bleeding disorders