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CPD > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Etiology: pityriasis rosea

A

reactivation of HHV-7, primary infx w/ HHV-6, HHV-8, H1N1

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2
Q

SSx: pityriasis rosea

A

prodrome possible (HA, malaise, pharyngitis), some itching but usu asx; oval, minimally elevated scaling papules/plaques; “Herald” patch; “Christmas tree” distribution.

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3
Q

Age: pityriasis rosea

A

young adults

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4
Q

Distribution: pityriasis rosea

A

trunk

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5
Q

DDx: pityrias rosea

A

tinea corporis, tinea versicolor, drug eruptions, psoriasis, syphilis

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6
Q

What is a herald patch?

A

A larger lesion seen in pityriasis rosea

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7
Q

Etiology: lichen planus

A

idiopathic, possible Hep C role

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8
Q

SSx: lichen planus

A

angular, violaceous papules 2-4 mm; oral lesions, severe itching; new lesions are pink/white that change to PPPP, lacy reticulated pattern of whitish lines; lesions can become thick/red

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9
Q

Distribution: lichen planus

A

ankles, wrists, pubic region, lips, mouth

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10
Q

Dx: lichen planus

A

H&P, bx (accumulation of PMN’s, T-cell mediated cytotoxic rxn against basal cell keratinocytes), Hep C antibodies (16%)

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11
Q

DDx: lichen planus

A

leukoplakia, candidiasis, herpes stomatitis, carcinoma, aphthous ulcers, erythema multiforme, psoriasis, discoid lupus, drug eruptions

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12
Q

Etiology: drug eruptions

A

any drug but common drugs include penicillin, sulfonamides, quinidine (antibiotics)

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13
Q

SSx (exanthems): drug eruptions

A

most common, antibiotic cause; mild pruritic, measles-like rash w/ macules/papules. Symmetric distribution on trunk/extremities (can occur on palms/soles/mucus membranes). Not common in infants. Hx - include EBV, CMV for amoxicillin

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14
Q

SSx (urticaria): drug eruptions

A

common, IgE-mediated-antibiotic cause, non-IgE-NSAID cause; pruritus, burning of palms/soles; systemic sx (flushing, fatigue, tongue numbness, bronchospasm, n/v, palpitations, hypotension)

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15
Q

SSx (pustular): drug eruptions

A

“acne” on arms and legs

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16
Q

SSx (fixed drug eruptions): drug eruptions

A

circular, recurring at same site; erythematous patch/plaque/bulla/erosion; occurs hrs after ingestion; many drugs involved

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17
Q

Etiology: erythema multiforme

A

drugs, infx (HSV/mycoplasma), immunization, autoimmune dz, malignancy

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18
Q

Comparison: minor vs major erythema multiforme

A

minor - w/o mucosal involvement, major - w/ mucosal involvement (ano genital, oral, ocular)

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19
Q

SSx: erythema multiforme

A

onset 3-5 days, resolves within 2 wks; can recur; erythema/edema bullous lesions; sudden onset on face/extremities; symmetrical annular lesions (target); pruritic/painful; systemic sx possible (fever, weakness, malaise); mild to severe

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20
Q

Distribution: erythema multiforme

A

dorsal/palmar hands, soles, forearms, feet, face, elbows, knees, penis/vulva, mucus membranes

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21
Q

Population: erythema multiforme

A

50% < 20 yo, M > F

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22
Q

DDx: erythema multiforme

A

urticaria, drug eruptions, bullous pemphigoid, pemphigus, dermatitis herpetiformis, aphthous stomatitis, herpes stomatitis

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23
Q

Etiology: erythema nodosum

A

infx, drugs, malignancy, inflammatory/granulomatous dz (sarcoidosis)

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24
Q

SSx: erythema nodosum

A

indurate, painful nodules resembling bruises, color changing, successive crops of nodules; pretibial; systemic sx (fever, malaise, joint pain); resolution in 6 wks

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25
Q

Population: erythema nodosum

A

any age, but peaks at 20-30, F > M (6x)

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26
Q

Dx: erythema nodosum

A

H&P, Bx, ESR, CRP, ANA, CBC, chest x-ray, ASO-titer or pharyngeal cultures (GABHS)

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27
Q

What is miliaria?

A

heat rash; accumulation of sweat beneath eccrine sweat glands resulting in obstruction of kerating at level of stratum corneum.

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28
Q

SSx: miliaria

A

pruritic, small/red papules, pustules occasionally

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29
Q

Population: miliaria

A

more common in kids/babies

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30
Q

Etiology: cellulitis

A

S. aureus, GAS (most common in adults); Hib, GAS, S. aureus (children); immunocompromised; IV drug use

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31
Q

SSx: cellulitis

A

local erythema, heat, edema, tenderness w/ lymphangitis and regional LA; systemic (fever, chills, tachycardia, HA, hypotension, delirium)

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32
Q

Distribution: cellulitis

A

lower legs (adults); cheeks, periorbital, head, neck (children)

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33
Q

DDx: cellulitis

A

DVT, gout, CPPD, septic arthritis, stasis dermatitis, insect bite, erysipelas

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34
Q

What is a cutaneous abscess?

A

localized collection of pus under the skin

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35
Q

SSx: cutaneous abscess

A

painful/tender/indurated/erythematous; varying size (1-3 cm); concomitant: local cellulitis, lymphangitis, LAD, fever

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36
Q

What is erysipelas?

A

superficial cellulitis with dermal lymphatic involvement (streaking)

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37
Q

Etiology: erysipelas

A

GAS, immunocompromised

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38
Q

SSx: erysipelas

A

shiny/indurated/well-demarcated plaques; high fever/chills/malaise/LAD or no systemic sx; may see vesicles/bullae/petechiae w/ itching/burning/pain; red/painful streaks along lymph; sudden onset

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39
Q

Complications: erysipelas

A

scarlet fever, fat necrosis, gangrene

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40
Q

Distribution: erysipelas

A

legs (most common), face

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41
Q

DDx: erysipelas

A

herpes zoster, contact dermatitis

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42
Q

What is erythrasma?

A

superficial intertriginous infx w/ Corynebacterium

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43
Q

SSx: erythrasma

A

pink/brown patches on genitals, scaling/fissuring/maceration, patches on trunk

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44
Q

Distribution: erythrasma

A

toe webs, between fingers, genitals, trunk

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45
Q

Dx: erythrasma

A

coral red fluorescence w/ Wood’s lamp, no hyphae, skin scraping w/ KOH

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46
Q

DDx: erythrasma

A

tinea, candida

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47
Q

Etiology: folliculitis

A

S. aureus, fungal, persistent trauma, systemic corticosteroids

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48
Q

SSx: folliculitis

A

pustule/inflammatory nodule surrounding a hair follicle; superficial or deep; mild itching/pain; abrupt onset; may be chronic

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49
Q

What is “hot tub” folliculitis?

A

caused by pseudomonas following exposure to contaminated water; high rate of infx in kids; occurs 8 hrs - 5 days post-hot tub; trunk/groin

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50
Q

Dx: folliculitis

A

H&P, KOH to r/o dermatophyte

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51
Q

DDx: folliculitis

A

acne, follicular keratosis

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52
Q

SSx: furuncle

A

acute/tender/swollen/painful nodule w/ central necrosis and pus d/c; mb recurrent; can rupture leaving violaceous scar

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53
Q

Etiology: furuncle

A

staph. aureus

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54
Q

Population: furuncle

A

uncommon in children

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55
Q

Dx: furuncle

A

H&P, culture to r/o MRSA

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56
Q

What is a carbuncle?

A

cluster of furuncles w/ multiple draining orifices

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57
Q

Distribution: carbuncle

A

neck, face, breasts, buttocks

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58
Q

Etiology: impetigo

A

S. pyogenes, S. aureus; warm/moist climate, poor hygiene

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59
Q

SSx: candidiasis

A

intertriginous, erythematous, well-demarcated, pruritic patches of varying sizes/shapes; glistening surface; satellite lesions around main area

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60
Q

SSx: impetigo

A

clusters of vesicles/pustules that rupture and develop honey-colored crust; scaling borders; satellite lesions; regional LA; mb pruritic

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61
Q

Distribution: impetigo

A

face, shins, extensor surface of forearms

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62
Q

Age: impetigo

A

common in children

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63
Q

DDx: candidiasis

A

dermatophytoses, allergic derm, herpes, molluscum, psoriasis, contact derm, strep cellulitis, seborrheic derm

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64
Q

Dermatophytoses - tinea cruris (“jock itch”)

A

Etiology: obesity, diabetes, immunocompromised; SSx: erythematous/well-demarcated patch on inner thigh(s); M > F; Dx - KOH prep; DDX - contact derm, psoriasis, Candida, erythrasma, seborrheic derm

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65
Q

DDx: impetigo

A

atopic derm, contact derm, perioral derm, HSV, HZV, tinea

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66
Q

Dermatophytoses - tinea capitis

A

Children most affected; hair loss, kerion (boggy/swollen/oozing plaque, immune rxn); Dx - KOH shows hyphae Wood’s lamp: silver-blue; DDx - psoriasis, seborrheic derm

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67
Q

Etiology: candidiasis

A

immunosuppression, sugar dysregulation, antibiotics, oral contraceptives

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68
Q

What is dermatophytoses?

A

fungal infx of keratin in skin/nails

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69
Q

Dx: dermatophytoses

A

H&P, Wood’s lamp, skin scraping, KOH prep

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70
Q

Dematophytoses - tinea corporis (“ringworm”)

A

SSx - pruritic, circular/oval, erythematous, scaling patch/plaque spreading centrifugally. central clearing with active advancing red/raised border; Dx - KOH shows hyphae, culture; DDx - pityriasis rosea, drug eruptions, nummular derm, erythema multiforme, tinea versicolor, psoriasis

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71
Q

What is a dermatophytid reactions (“id” rxn)?

A

distant site inflammatory rxn during fungal infx; sterile

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72
Q

Distribution: tinea versicolor

A

trunk, proximal upper extremities

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73
Q

Dx: tinea versicolor

A

direct microscopy (“spaghetti and meatballs”, broad hyphae and clusters of budding cells), Wood’s lamp (yellow to yellow-green fluorescence)

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74
Q

DDx: tinea versicolor

A

vitiligo, pityriasis rosea, tinea corporis, seborrheic derm, erythrasma

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75
Q

Etiology: cutaneous larva migrans (“creeping eruption”)

A

hookworm larva from dog/cat excrement

76
Q

SSx: cutaneous larva migrans

A

intense puritus, erythema, papules at site of entry; winding tail of inflammation (serpiginous, usu 3 wks after exposure)

77
Q

Distribution: cutaneous larva migrans

A

feet/ankles, buttocks, backs of legs/back

78
Q

DDx: cutaneous larva migrans

A

scabies

79
Q

SSx: lice (pediculosis)

A

severe pruritus, mb excoriations, red puncta, gray/white nits on hair shaft, brown specks of excrement

80
Q

Dx: lice

A

demo of living lice in wet hair using fine-toothed comb; fluorescence under Wood’s lamp

81
Q

DDx: lice

A

seborrheic derm, impetigo, insect bites

82
Q

Distribution: scabies

A

hands, arms, feet, gluteal fold, axilla, back of knees

83
Q

Dx: scabies

A

burrows are pathognomonic, H&P

84
Q

DDx: scabies

A

insect bites, fungus, eczema, folliculitis, impetigo

85
Q

SSx: molluscum contagiosum

A

smooth/flesh-colored/hard umbilicated dome; cheesy core; asx; 6-9 mos

86
Q

Age: molluscum contagiosum

A

any; most common in 3-9 yo

87
Q

Distribution: molluscum contagiosum

A

face, arms, chest, genitals

88
Q

Dx: molluscum contagiosum

A

H&P, bx (“molluscum bodies” in keratinocytes)

89
Q

DDx: molluscum contagiosum

A

folliculitis, milia, verrucae

90
Q

What is acanthosis nigricans?

A

thickened, velvety hyperpigmentation of flexural surfaces; asx

91
Q

Distribution: warts

A

hands, knees, genitalia, feet

92
Q

SSx: varicella

A

prodrome (malaise, chills, HA, sore throat, anorexia, dry mouth), rash, pruritus, macules/papules/pustules/crusts/vesicles

93
Q

Distribution: varicella

A

begins on trunk, spreads to face/extremities

94
Q

Prognosis: varicella

A

infectious 2 days before lesions until all lesions crust over

95
Q

Dx: varicella

A

H&P, characteristic rash, culture/Tzanck smear

96
Q

DDx: varicella

A

other viral dz, contact derm, zoster, folliculitis, impetigo

97
Q

Etiology: chickenpox

A

primary infx with varicella (HHV-3)

98
Q

Dermatophytoses - tinea pedis (“athlete’s foot”)

A

intense pruritus, erythematous vesicles/bullae between toes or on soles; unilateral/bilateral; Dx - skin scraping; DDx - dyshidrotic eczema, contact derm, psoriasis

99
Q

SSx: tinea versicolor

A

asx hypopigmented/hyperpigmented macules w/ scaling patches

100
Q

SSx: scabies

A

burrows w/ fine/wavy lines in the skin covered by lichenified skin; intense pruritus, esp. at night; erythematous papules w/o many burrows

101
Q

Etiology: molluscum contagiosum

A

pox virus

102
Q

What is leser-trelat?

A

sudden eruption of many seborrheic keratosis (visceral adenocarcinoma)

103
Q

Dx: herpes zoster

A

pathognomonic rash, Tzanck smear, culture

104
Q

Etiology: shingles

A

latent varicella (HHV-3) infx

105
Q

Distribution: herpes simplex

A

mouth, eyes, genitals

106
Q

SSx: herpes simplex

A

single/clustered vesicles, systemic sx (fever, malaise, myalgia, HA, LA), prodrome (tingling), vesicles which rupture and ulcerate, painful

107
Q

DDx: rubeola infantum

A

measles, rubella, enteroviral infx, erythema infectiosum, scarlet fever, drug allergy

108
Q

SSx: rubeola infantum

A

10 day incubation, 3-5 days of high fever, febrile convulsions, rash (30%), LA

109
Q

Distribution: rubeola infantum

A

prominent macular rash on chest/abdomen, less so on face/extremities

110
Q

Etiology: hand foot and mouth dz

A

coxsackie virus

111
Q

DDx: herpes zoster

A

before rash (MI, pleurisy, migraine), after lesions (HSV, primary varicella)

112
Q

What is herpetic whitlow?

A

infx of distal phalanx w/ painful, swelling lesion

113
Q

Distribution: hand foot and mouth dz

A

buccal mucosa, tongue, palms, soles, buttocks, genitals

114
Q

Population: hand foot and mouth dz

A

< 5 yo most common

115
Q

DDx: hand foot and mouth dz

A

varicella, herpes, herpangina, aphthous stomatitis

116
Q

Etiology: measles (rubeola)

A

paramyxovirus

117
Q

Etiology: roseola infantum

A

HHV-6 or 7

118
Q

DDx: herpes simplex

A

impetigo, eczema, zoster, hand/foot/mouth dz, aphthous stomatitis

119
Q

SSx: herpes zoster

A

latent in nerve root, erupts along dermatome, radicular pain/itching for 2-3 days followed by herpetic rash; systemic sx

120
Q

Dx: measles

A

koplik spots/rash, anti-measles IgM/IgG (four-fold increase), CBC (leukopenia, T-cell cytopenia, thrombocytopenia), CXR (interstitial pneumonitis)

121
Q

SSx: hand foot and mouth dz

A

vesicular eruption of skin/mucosa, fever, myalgia, LA, abd pain, poor nursing, painful lesions in mouth

122
Q

Distribution: herpes zoster

A

along dermatome, never crosses midline

123
Q

Distribution: rubella

A

face first, spreads to trunk/extremities

124
Q

DDx: measles

A

during prodrome (many), during rash (scarlet fever, rubella, drug rxns, roseola, erythema infectiosum, rocky mtn spotted fever, infx mononucleosis, kawasaki dz, TSS)

125
Q

SSx: measles

A

prodrome (fever, conjunctivitis, photophobia, koplik spots, cough, coryza), rash 2-3 days later (maculopapular, blanching), 5-6 days

126
Q

What are Koplik spots?

A

1-3 mm white/gray/blue elevations w/ erythematous base on buccal and vaginal surface; prodrome of measles

127
Q

DDx: rubella

A

measles, scarlet fever, drug rashes, erythema infectiosum

128
Q

Distribution: measles

A

begins on face, spreads to neck, trunk, extremities

129
Q

Etiology: vitiligo

A

idiopathic; associated w/ thyroid dz, pernicious anemia, SLE, addison’s dz

130
Q

SSx: rubella

A

mild incubation - 14-21 days, brief prodrome (fever, malaise), faint rash (maculopapules, petechiae on soft palate), asx to mild dz

131
Q

Dx: vitiligo

A

exam, Wood’s lamp, thyroid function, CBC, fasting blood glucose

132
Q

What is trichotillomania?

A

psychological disorder related to OCD where pt pulls out hair

133
Q

Dx: alopeica

A

ratio of anagen and telogen haris

134
Q

What is hirsuitism?

A

excess hair in females in areas that are not normally hairy

135
Q

DX: hirsuitism

A

serum free/total testosterone, DHEA-S, FSH, LH, prolactin, TSH

136
Q

SSx: vitiligo

A

hypopigmented areas, well-demarcated, often symmetric, white w/ no scale, focal spots to entire body segments

137
Q

DDx: vitiligo

A

tinea versicolor, post-inflammatory hypopigmentation, chm-induced depigmentation, pityriasis alba

138
Q

Risk factors: onychomycosis

A

swimming, tinea pedis, psoriasis, diabetes, immunodeficiency, genes, FHx

139
Q

SSx: onychomycosis

A

asx patches of white/brown/yellow discoloration and deformity of nails; thickening

140
Q

DDx: onychomycosis

A

psoriasis, eczematous conditions, senile ischemia, trauma, lichen planus, iron deficiency

141
Q

Distribution: dermatofibroma

A

lower extremity

142
Q

What is melasma / chloasma?

A

macular hyperpigmentation of face, usu in pregnant women, dark-skin

143
Q

Etiology: alopecia

A

autoimmune, genes, infx, drugs (chemo), vaccines, stress, pregnancy

144
Q

What is onychomycosis?

A

fungal infx of nail plate/bed

145
Q

SSx: dermatofibroma

A

epidermal thickening/hyperpigmentation, small red/brown papule; no growth; usu solitary, non-tender, “dimple sign”

146
Q

SSx: epidermal cyst

A

contains keratin, flesh-colored/moveable nodule, central punctum, non-tender

147
Q

Distribution: epidermal cyst

A

face, base of ears, trunk

148
Q

What is a keloid?

A

excess fibroblastic proliferation following trauma/scarring

149
Q

SSx: keloid

A

elevated/shiny/firm/protuberant nodule at site of injury

150
Q

What is a lipoma?

A

subQ nodule of adipocytes

151
Q

Distribution: lipoma

A

trunk, forearms, neck

152
Q

SSx: lipoma

A

rubbery/moveable/asx nodule, overlying skin normal, slow-growing

153
Q

DDx: lipoma

A

epidermal cyst

154
Q

What are nevi?

A

circumscribed, oft pigmented/flesh-colored macules/papules/nodules composed of melanocytes

155
Q

DDx: nevi

A

melanoma, seborrheic keratosis, skin tag, wart

156
Q

Morphology: atypical/dysplastic nevus

A

irregular/pigmented nevus, indistinct borders, genetic, usu appear in multiples, greater risk for melanoma, > 6 mm

157
Q

Distribution: seborrheic keratosis

A

trunk, face, upper extremities

158
Q

DDx: seborrheic keratotis

A

warts, nevi, melanoma, pigment basal cell carcinoma

159
Q

DDx: acrochordon

A

warts, nevi, neurofibromas

160
Q

Distribution: acrochordon

A

neck, axilla, groin, under breasts, eyelids, perianal skin tags common in Crohn’s

161
Q

What is the most common tumor of infancy?

A

hemangioma

162
Q

Distribution: hemangioma

A

head and neck

163
Q

Morphology: hemangioma

A

bright red, raised, if deep can look violaceous

164
Q

What are nevus flammeus and port-wine stain?

A

capillary malformations present at birth

165
Q

Population: nevus araneus

A

increases in pregnancy and chronic liver dz

166
Q

Morphology: cherry angioma

A

freq round, smooth, dome-shaped, bright to dark-red lesions; do not blanch, 1-4 mm

167
Q

DDx: pyogenic granuloma

A

melanoma or malignant tumor

168
Q

SSx: pyogenic granuloma

A

yellow-to-deep red, fast-growing, friable nodule, does not blanch

169
Q

Distribution: basal cell carcinoma

A

face, neck, scalp most common; shoulders, arms

170
Q

DDx: basal cell carcinoma

A

nevi, seborrheic keratosis, dermatitis, scars, molluscum, SCC

171
Q

Morphology (nodular): basal cell carcinoma

A

starts as papules, slow-growing into “rodent ulcer” (shiny pearly border, telangiectasia, central ulcer), alt crust/heal

172
Q

DDx: dermatofibroma

A

nevi, basal cell carcinoma

173
Q

DDx: epidermal cyst

A

sebaceous cysts, lipoma, if firm r/o malignancy, if strange locations r/o Gardner’s syndrome (colon cancer)

174
Q

Population: keloid

A

africans/asians most common

175
Q

Population: basal cell carcinoma

A

more common > 40

176
Q

Comparison: lentigo vs freckles

A

lentigo - increased melanocyte density

freckle - increased melanin production

177
Q

Warning signs that previously benign lesion becoming malignant melanoma

A

change in size, shape, color; new lesion, inflammation, sensory change, crusting/bleeding

178
Q

Morphology: seborrheic keratosis

A

warty, well-circumscribed, hyperpigmented lesions, horn cysts, dark keratin plugs

179
Q

Morphology: nevus flammeus and port-wine stain

A

flat pink blanchable marks (nevus flammeus), reddish-purple appearing anywhere and becoming darker (port-wine stain)

180
Q

Morphology (superficial spreading): malignant melanoma

A

Most common melanoma; women’s legs / men’s torsos; variegated/indurated plaque w/ irregularly raised border

181
Q

Location (acrolentiginous): malignant melanoma

A

areas of no hair (soles, palms, nails)

182
Q

DDx: SCC

A

actinic keratosis, seborrheic keratosis, basal cell carcinoma

183
Q

SSx: acrochordon

A

asx skin tags, flesh-colored tumor, pedunculated, soft

184
Q

Morphology (lentigo-maligna): malignant melanoma

A

face or sun-exposed, tan/brown macule w/ darker spots, irregular border, plaque w/ raised edges/colored spots, in situ for yrs

185
Q

Morphology (nodular): malignant melanoma

A

dark, protuberant papule/plaque varying in color; fast growing

186
Q

DDx: malignant melanoma

A

basal cell carcinoma, seborrheic keratosis, benign nevi/lentigo, dermatofibroma, warts

187
Q

SSx: SCC

A

usu on sun-exposed areas; usu starts as red papules/plaque w/ rough/scaly surface; occ cutaneous horns; ulcerate/bleed

CPD (8 decks)

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