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CPD > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Nodule

A

firm papule > 10 mm, extending into dermis or subQ tissue

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2
Q

Tumor

A

large nodule > 10 mm

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3
Q

Vesicle

A

fluid-filled blister < 10 mm

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4
Q

Bullae

A

vesicles > 10 mm

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5
Q

Pustule

A

elevated pus-containing lesion

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6
Q

Urticaria (wheal/hive)

A

transient/soft/elevated lesion d/t localized edema

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7
Q

Scale

A

dry, whitish accumulation of epithelium

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8
Q

Crust

A

dried pus/blood/exudate on surface d/t broken pustules/vesicles

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9
Q

Erosion

A

loss of epidermis

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10
Q

Excoriation

A

linear erosion usu d/t scratching

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11
Q

Ulcer

A

deeper erosions involving the dermis, bleeding/scarring

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12
Q

Purpura

A

area of hemorrhage, mb palpable, doesn’t blanch

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13
Q

Atrophy

A

paper-thin wrinkled and dry-appearing skin

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14
Q

Scar

A

fibrous tissue replacement after injury

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15
Q

Telangiectasia

A

dilated superficial blood vessels

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16
Q

Ecchymosis

A

subQ purpura > 1 cm

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17
Q

Annular

A

rings with central clearing

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18
Q

Nummular

A

circular

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19
Q

Target

A

rings w/ central duskiness

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20
Q

Serpiginous

A

fungal/parasitic infx

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21
Q

Reticulated

A

lacy patter

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22
Q

Verrucous

A

irregular surface

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23
Q

Lichenification

A

epidermal thickening w/ accentuation of skin lines d/t chronic irritation

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24
Q

Induration

A

dermal thickening (hard/rough skin)

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25
Q

Umbilicated

A

raised lesion w/ a central indentation/dimple

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26
Q

What is acanthosis nigricans?

A

thickened/velvety hyperpigmentation of flexural surfaces

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27
Q

Sx: acanthosis nigricans

A

asx

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28
Q

Acanthosis nigricans can be associated with ____

A

insulin resistance (diabetes, obesity), internal malignancy (gastric cancer, estrogens)

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29
Q

Dermatographism

A

urticaria after stroking the skin

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30
Q

Diascopy

A

pressure to indicate blanching

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31
Q

Macule

A

flat non-palpable lesion < 1 cm

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32
Q

Darier’s sign

A

stroking lesions; intense/sudden erythema; wheal formation

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33
Q

Papule

A

raised lesion < 10 mm

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34
Q

Plaque

A

raised lesion > 10 mm

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35
Q

Patch

A

flat, non-palpable lesion > 1 cm

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36
Q

Nikolsky’s sign

A

bullae formation and erosion d/t gentle traction pressure

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37
Q

Auspitz’ sign

A

pinpoint bleeding after removal of plaques

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38
Q

Koebner’s phenomenon

A

development of lesions within areas of trauma

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39
Q

Wood’s lamp

A

UV light for fungi

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40
Q

Skin scraping

A

used for scabies/fungus

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41
Q

Yellow lesion

A

jaundice, heavy metal poisoning, myxedema, uremia

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42
Q

Green lesion

A

in fingernails, pseudomonas

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43
Q

Violet lesion

A

darkening cutaneous hemorrhage, vasculitis

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44
Q

Gray/blue lesion

A

cyanosis, metal deposits

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45
Q

Black lesion

A

melanocytic lesions, infx, arterial insufficiency

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46
Q

White lesion

A

tinea, pityriasis alba, vitiligo

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47
Q

Orange lesion

A

hypercarotenemia

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48
Q

Red lesion

A

erythema, increased blood flow

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49
Q

Pruritus

A

itching

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50
Q

Sx: acne vulgaris

A

comedones, papules, pustules, inflamed nodules, pyogenic cysts (rare)

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51
Q

Etiology: acne vulgaris

A

androgen stimulus, sebum, bacteria interaction, drug induction, diet

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52
Q

DDx: acne vulgaris

A

rosacea, perioral dermatitis, drug eruptions, folliculitis

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53
Q

What are the 3 most common dietary causes of acne vulgaris?

A

milk, sugar, bromine

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54
Q

Population: acne vulgaris

A

puberty to ~35, M > F

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55
Q

Distribution: acne vulgaris

A

face, chest, back, upper arms

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56
Q

Labs: acne vulgaris

A

serum total/free testosterone w/ DHT, FSH, LH, DHEA-S, bacterial/fungal cultures to r/o infx folliculitis

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57
Q

Dx: acne vulgaris

A

mild - < 30 lesions, mod - 30-125 lesions, severe - > 5 cysts / > 125 lesions

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58
Q

Etiology: rosacea

A

idiopathic, higher rates of H. pylori and SIBO

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59
Q

Population: rosacea

A

30-60, fair complexion, blushers, pts susceptible to flushing episodes d/t stimuli (alcohol, spicy foods, temp extremes, emotions), eye involvement

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60
Q

Distribution: rosacea

A

central area of face and scalp

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61
Q

SSx: rosacea

A

“pre-rosacea” - flushing episodes, vascular phase - frequent flushing, inflammatory phase (papules, pustules, nodules, cysts), late-stage/rhinophyma

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62
Q

Dx: rosacea

A

1 or more primary features: flushing, nontransient erythema, papules/pustules, telangiectasia
1 or more secondary features: burning/stinging, plaques, dry appearance, edema, ocular manifestation, peripheral location, phymatous changes

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63
Q

DDx: rosacea

A

SLE, acne vulgaris, drug eruptions, granulomas, perioral dermatitis, infx folliculitis, seborrheic dermatitis, carcinoid, chronic topical glucocorticoids

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64
Q

What is bullous pemphigoid?

A

chronic pruritic bullous eruptions, uncommon

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65
Q

Etiology: bullous pemphigoid

A

autoimmune, drug-induced (diuretic, NSAIDs)

66
Q

SSx: bullous pemphigoid

A

prodromal phase (eczematous, pruritic, utricaria-like skin lesions becoming tense bullae), bullae rupture leaving erosions

67
Q

Distribution: bullous pemphigoid

A

trunk, lower legs, extremity flexures, axillary/inguinal folds

68
Q

Population: bullous pemphigoid

A

> 60

69
Q

DDx: bullous pemphigoid

A

pemphigus vulgaris, dermatitis herpetiformis, erythema multiforme, drug eruptions

70
Q

Dx: bullous pemphigoid

A

H&P, biopsy (subepidermal bullae with eosinophilia), direct immunofluorescence (IgG and/or C3 in basement membrane), serum antibody titers (Anti-BP 180)

71
Q

What is dermatitis herpetiformis

A

autoimmune, chronic, recurring, intensely pruritic with symmetrical groups of inflamed vesicles/papules/hives

72
Q

Etiology: dermatitis herpetiformis

A

autoimmune, celiac dz (asx)

73
Q

Distribution: dermatitis herpetiformis

A

symmetrical extensor aspects, sacrum, base of head

74
Q

Population: dermatitis herpetiformis

A

20-50, M > F

75
Q

Dx: dermatitis herpetiformis

A

H&P, biopsy (subepidermal clefting/papillary dermal tips w/ neutrophils and eosinophils), direct immunofluorescence (IgA), TTG, anti-endomysial Ab, jejunal bx

76
Q

DDx: dermatitis herpetiformis

A

pemphigus, bullous pemphigoid, dermatitis, herpes, insect bites, scabies

77
Q

What is pemphigus vulgaris?

A

rare, potentially fatal blistering disease

78
Q

Etiology: pemphigus vulgaris

A

autoimmune

79
Q

SSx: dermatitis hereptiformis

A

burning, severe stinging/itching, lasting weeks to years

80
Q

Distribution: pemphigus vulgaris

A

oral lesions often precede skin lesions (50-70%), groin, scalp, abdomen, back, upper legs, axilla, umbilicus

81
Q

Population: pemphigus vulgaris

A

> 60, F > M, Ashkenazi Jews

82
Q

Dx: pemphigus vulgaris

A

H&P, biopsy (intraepidermal bulla/separation of epidermal cells, eosinophil infiltrate, IgG, C3), Immunofluorescence, serum anti-Dsg 3 anti-Dsg 1, Nikolsky’s sign

83
Q

Prognosis: pemphigus vulgaris

A

hospitalization universally required, 15% mortality

84
Q

DDx: pemphigus vulgaris

A

HSV, HZV, bullous pemphigoid, canker sores, paraneoplastic pemphigus (bx to r/o)

85
Q

How are all cornification disorders diagnosed?

A

H&P

86
Q

What are calluses and corns?

A

epidermal thickening from pressure or friction

87
Q

Comparison: calluses and corns

A

calluses - usu asx, intact skin lines

corns - mb painful w/ pressure, yellowish core, interrupts skin lines

88
Q

What is ichthyosis?

A

scaling/flaking of skin

89
Q

Distribution: ichthyosis

A

shins, outer arms most common

90
Q

Distribution: callus/corn

A

feet, toes

91
Q

DDx: ichthyosis

A

dry skin, acquired ichthyosis

92
Q

Comparison: acquired vs inherited ichthyosis

A

acquired - sudden onset

inherited - gradual onset

93
Q

What is keratosis pilaris?

A

keratin disorder where horny plugs fill opening of hair follicles

94
Q

Etiology: keratosis pilaris

A

nutritional deficiency, genetic, more common in atopy

95
Q

SSx: keratosis pilaris

A

keratotic follicular papules

96
Q

Population: keratosis pilaris

A

worse in children, resolves/improves w/ adulthood

97
Q

Distribution: keratosis pilaris

A

upper arms, thighs, buttocks, face in children

98
Q

What is atopic dermatitis?

A

immune-mediated skin inflammation w/ genetic component usu

99
Q

Etiology: atopic dermatitis

A

genetics (atopy), food/environmental allergies, aggravations (dry skin, SIBO, stress, allergens, tight clothes, sweating, nutritional deficiencies)

100
Q

SSx: atopic dermatitis

A

red/weeping/crusted lesions, intense pruritus, lichenification, may have palmar hyperlinearity, keratosis pilaris, hand/foot involvement, chelitis, susceptibility to cutaneous infx

101
Q

Distribution: atopic dermatitis

A

Infantile phase (cheeks, perioral, scalp, extensor tops of feet/elbow w/ exudate), Childhood phase (flexural surfaces, lichenification), Adult phase (flexural, hands, upper eyelids, diffuse over body)

102
Q

Population: atopic dermatitis

A

begins very young, parents with atopy

103
Q

Dx: atopic dermatitis

A

H&P, culture to r/o infx, eosinophilia, food allergy/sensitivity testing, vit D, GI assessment (dysbiosis, 3hr lactulose breath test for methane, hydrogen)

104
Q

DDx: atopic dermatitis

A

seborrheic dermatitis, contact derm, nummular derm, Candida, scabies, tinea

105
Q

What is contact dermatitis?

A

acute inflammation of skin caused by irritants or allergens

106
Q

Etiology: contact dermatitis (irritant)

A

chemicals, soap, acids, alkaline chemicals, oils, water, wood dust, fiberglass, body fluids

107
Q

Etiology: contact dermatitis (allergic)

A

hypersensitivity rxn, drugs, latex, metals, cosmetics, lotion, sunscreen, nail polish, fragrances, poison ivy/oak

108
Q

SSx: contact dermatitis (irritant)

A

erythema, dryness, painful cracking/fissuring; when acute, papules w/ weeping/edema; when chronic, lichenification/excoriations/scaling

109
Q

Distribution: contact dermatitis

A

hands, mouth, wherever body was exposed to allergen

110
Q

SSx: contact dermatitis (allergic)

A

intense pruritus, mild erythema to hemorrhage, vesiculization, ulceration

111
Q

Dx: contact dermatitis

A

H&P, patch testing when ACD doesn’t respond to treatment

112
Q

DDx: contact dermatitis

A

seborrheic derm, atopic derm, nummular derm, tinea

113
Q

What is lichen simplex chronicus?

A

chronic pruritus causing extreme scratch-itch cycle w/o demonstrable cause

114
Q

SSx: lichen simplex chronicus

A

pruritus, dry/scaling skin, hyperpigmentation, erythematous, violaceous, irregular lichenified plaques

115
Q

Distribution: lichen simplex chronicus

A

back of neck, wrists, ankles/pubic region, usu NOT present on back, abd, face, upper legs

116
Q

Dx: lichen simplex chronicus

A

H&P, KOH wet mount to r/o tinea, bx, patch testing to identify allergen

117
Q

DDx: lichen simplex chronicus

A

tinea, lichen planus, psoriasis

118
Q

What is nummular dermatitis?

A

inflammation of the skin in a coin-shaped pattern

119
Q

Population: nummular dermatitis

A

mid-aged w/ dry skin, M > F, no hx of eczema

120
Q

Etiology: nummular dermatitis

A

idiopathic

121
Q

SSx: nummular dermatitis

A

intense pruritus, inflamed coin-shaped lesions, vesicles, crusting/scaling

122
Q

Distribution: nummular dermatitis

A

extensor surfaces, buttocks, trunk, often begins on legs; 1-50 lesions

123
Q

Dx: nummular dermatitis

A

H&P, patch testing, culture to r/o s. aureus, bx, KOH wet mount

124
Q

DDx: nummular dermatitis

A

psoriasis, tinea corporis, cutaneous T-cell lymphoma scabies, seborrheic dermatitis, fungus, Paget’s dz when on breast

125
Q

What is seborrheic dermatitis?

A

inflammation of the skin in high-density areas of sebaceous glands (scalp, eyebrows, eyelids, face)

126
Q

Etiology: seborrheic dermatitis

A

nutritional deficiency, malazzezia fungi

127
Q

SSx: seborrheic dermatitis

A

gradual onset, well-demarcated/erythematous plaques, greasy-looking/yellow scales, no hair loss, papules possible, cradle cap in newborns

128
Q

Distribution: seborrheic dermatitis

A

scalp, external ear, center of face, eyebrows, axilla, nasolabial folds, upper trunk, intertriginous areas

129
Q

Population: seborrheic dermatitis

A

biphasic (infants, adolescence, peeks 30-50), M > F, HIV+/Parkinson’s/neuroleptic meds

130
Q

Dx: seborrheic dermatitis

A

H&P, KOH/fungal culture if indicated

131
Q

DDx: seborrheic dermatitis

A

atopic derm, contact derm, psoriasis, tinea, cutaneous lupus, rosacea

132
Q

What skin condition can be a presenting sign for HIV?

A

seborrheic dermatitis

133
Q

What is stasis dermatitis?

A

persistent dermatitis of the lower legs (esp ankle)

134
Q

Etiology: stasis dermatitis

A

chronic venous insufficiency

135
Q

SSx: stasis dermatitis

A

brown pigmentation over time, edema/petechiae, erythema/fissures, dry/weeping/crusting, pruritic; varicosities/cellulitis; stasis ulcers can penetrate to bone; heaviness/aching/edema in legs; 2nd infx w/ s. aureus is common

136
Q

Population: stasis dermatitis

A

pts with DVT/surgery/trauma/ulceration

137
Q

Dx: stasis dermatitis

A

H&P, veinous studies, ankle brachial index; if DVT, protein S/C, factor V Leiden, fibrinogen, homocysteine

138
Q

DDx: stasis dermatitis

A

cellulitis, contact derm, tinea

139
Q

What is polymorphous light eruption?

A

idiopathic, reccurent photodermatitis following acute sun exposure

140
Q

SSx: polymorphous light eruption

A

2hrs-5days after sun exposure, burning/itching/erythema to exposed skin, papular/papulovesicular, 7-10 days

141
Q

Population: polymorphous light eruption

A

all ages/races/genders; most common in young females

142
Q

Dx: polymorphous light eruption

A

H&P, ANA/anti-SSA/anti-SSB to r/o SLE

143
Q

DDx: polymorphous light eruption

A

SLE, photodrug rxn, porphyria tarda, solar urticaria

144
Q

What are chronic effects of sunlight associated with aging?

A

fine/coarse wrinkles, rough/leathery texture, mottled hyperpigmentation, telangiectasia

145
Q

What is actinic keratosis?

A

precancerous neoplasm d/t UV exposure

146
Q

SSx: actinic keratosis

A

rough/scaling macule/papule/plaque 1-10 mm, reddish/pink, ill-marginated with rough scale, can develop into thin/adherent transparent scale that becomes thick/yellow/horn-forming

147
Q

Distribution: actinic keratosis

A

face, lips, backs of hand, shoulders, legs

148
Q

Population: actinic keratosis

A

increases w/ age, usu in blondes/redheads with light skin (skin type I/II)

149
Q

Dx: actinic keratosis

A

bx to r/o SCC

150
Q

DDx: actinic keratosis

A

seborrheic keratoses, SCC

151
Q

What is psoriasis?

A

chronic recurring inflammation of epidermis/dermis w/ increased epidermal proliferation leading to scaling; immune-related

152
Q

Etiology: psoriasis

A

genetics, environmental triggers, infx, physical/psychological stress, medications

153
Q

Population: psoriasis

A

biphasic (20-30 and 50-60), M = W, smoking/obesity/HIV predispose

154
Q

SSx: psoriasis

A

dry/well-demarcated/erythematous papules/plaques topped with silvery scales; can itch but usu asx; limited/systemic; better in summer; Systemic sxs: arthritis, fever, chills, pitting in nails

155
Q

7 Types of psoriasis

A

plaque psoriasis (classic), guttate psoriasis (sudden onset w/ strep infx/steroid withdrawal), pustular psoriasis (small pustules on palms/soles), inverse psoriasis (flexor surfaces/intertriginous areas), nail psoriasis, generalized pustular (generalized pustules w/ fever), erythrodermic psoriasis (total body erythema w/ chills/skin pain)

156
Q

Which types of psoriasis are emergencies?

A

generalized pustular psoriasis, erythrodermic psoriasis

157
Q

Distribution: psoriasis

A

scalp, extensor surfaces, buttocks, back; nails, eyebrows, axilla, umbilicus, anogenital region

158
Q

Dx: psoriasis

A

H&P, Auspitz sign, bx w/ thickening of epidermis

159
Q

DDx: psoriasis

A

seborrheic derm, eczema, pityriasis rosea, tinea capitus, SCC, dermatophytoses, cutaneous lupus, dermatitis, lichen simplex chronicus

160
Q

What should you ask every patient with urticaria?

A

Do you have any breathing issues or sensations on the lips during itching?

161
Q

How long can it take late stage rosacea to set in?

A

15 years or more

CPD (8 decks)

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