2/13 Dermatologic Dx and Trmt Flashcards Preview

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Flashcards in 2/13 Dermatologic Dx and Trmt Deck (59):
1

Primary Lesions

Macule
Patch
Papule
Plaque
Nodule
Tumor
Wheal
Vesicle
Bulla
Pustule

2

Secondary Lesions

Scale
Crust
Erosion
Ulcer
Fissure
Scar
Atrophy

3

Special Lesions

Excoriation
Comedone (Open, Closed)
Milia
Burrow
Lichenification
Telangiectasia
Petechiae
Purpura

4

What is this?

(defining characteristics + examples)

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Macule

circumscribed, flat discoloration of skin up to 0.5 cm;
Inflammatory:  produced by vasodilation of superficial vessels
Intrinsic pigment deposition; ex: freckles
Extrinsic pigment deposition; ex: tattoos

Ex: café au lait spots in neurofibromatosis 1 , Peutz-Jegher’s syndrome, melanoma
 

5

What is this?

(defining characteristics + examples)

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Patch

circumscribed, flat discoloration of skin larger than 0.5 cm

ex: melisma, tinea versicolor
 

6

What is this?

(defining characteristics + examples)

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Papule

circumscribed, elevated, superficial, solid lesion, up to 0.5 cm; usually broader than it is thick

ex: cutaneous sarcoidsosis, eruptive xanthomas, lichen spinulosis, mulluscum contagiosum, neurofibromas
 

7

What is this?

(defining characteristics + examples)

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Nodule

circumscribed, palpable, solid, round, or ellipsoidal lesion, larger than 0.5 cm (dermal or subcutaneous; most are greater than 1cm and up to 4-5cm)

Ex: soft nodules of neurofibromatosis, nodules of mycobacterium marinum, prurigo nodules with overlying scale
 

8

What is this?

(defining characteristics + examples)

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Plaque

circumscribed, elevated, superficial, solid lesion larger 0.5 cm

ex: necrosis lipoidica diabeticorum, granuloma annulare, urticarial
 

9

What is a tumor?

(defining characteristics + examples)

proliferation of cells or tissues, either benign or malignant.  Any of the other primary and secondary terms may be appropriate in the initial description of a tumor; e.g., nodule or plaque.  A large nodule is often referred to as a tumor. There are no size specificities for tumor.

10

What is this?

(defining characteristics + examples)

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Wheal

a special type of papule or plaque which is the response of the skin to histamine release and is characterized by the classic three features (triple response of Lewis) of edema, erythema, and a flare.  The edema fluid is bound, which contrasts this lesion with the vesicle and bulla.  A wheal is transitory or evanescent, seldom remaining in one location for more than 3 or 4 hours.

11

What is this?

(defining characteristics + examples)

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Vesicle

circumscribed collection of free clear, fluid, less than 0.5cm; fluid can be clear, serous, hemorrhagic, or pus-filled

ex: miliaria crystallina, dyshidrotic dermatitis, leukocytoclastic vasculitis, herpes zoster (chicken pox)
 

12

What is this?

(defining characteristics + examples)

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Bulla

circumscribed collection of free clear, fluid greater than 0.5cm; fluid can be clear, serous, hemorrhagic, or pus-filled

ex: herpes gestationis, toxic epidermal necrolysis, contact dermatitis, IgA dermatosis
 

13

What is this?

(defining characteristics + examples)

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Pustule

circumscribed collections of pus (contains leukocytes and free fluid) which are variable in size, but less than 0.5cm

ex: pustular psoriasis , steroid/medication-induced acne, folliculitis
 

14

What is this?

(defining characteristics + examples)

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Scale

Excess stratum corneum (most superficial layer of skin) that accumulates in flakes or plates, i.e., keratin.  Usually white or grey color. Example: Psoriasis 

15

What is this?

(defining characteristics + examples)

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Crust

collections of dried serum, blood, or purulent exudate, and cellular debris dries on the skin surface– “scab”. Usually yellow-brown when formed from purulent exudate, red-black when formed by blood
Ex: atopic dermatitis, impetigo 

16

What is this?

(defining characteristics + examples)

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Atrophy

depression in the skin resulting from thinning of the epidermis, dermis, or subcutaneous fat.

Ex: morphea, anteoderma, lichen sclerosus,
 

17

What is this?

(defining characteristics + examples)

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Erosion

localized losses of epidermis.  Usually, some superficial dermal tissue loss as well, but superficial or thin in comparison to ulcers and heals without scarring.

Ex: disseminated herpes infection in immunocompromised patient, pemphigus, vesicant exposure
 

18

What is this?

(defining characteristics + examples)

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Ulcer

loss of epidermis plus variable degrees of the dermis.  Variable in depth, size, and shape. Heal with scarring.

Ex: pyoderma gangrenosum, disseminated herpes infection in immunocompromised patient, stasis dermatitis
 

19

What is this?

(defining characteristics + examples)

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Fissure

linear losses of epidermis and dermis which have sharply defined, abrupt walls; a slit

20

What is this?

(defining characteristics + examples)

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Scar

abnormal formations of connective tissue replacing tissue lost or altered by some pathologic process.  Always implies dermal damage.  Cicatrix is a synonym.  Types:

Atrophic:  thinned
Hypertrophic (keloid)
Striae:  a stretch mark

21

What is this?

(defining characteristics + examples)

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Excoriation

erosions caused by scratching.  Often linear distribution or fingernail size.

22

What is this?

(defining characteristics + examples)

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Comedone

plugs of sebaceous and keratinous material lodged in the openings of the pilosebaceous follicles. The primary lesions of acne vulgaris.  Commonly known as blackheads and whiteheads.

Open comedo:  a “blackhead”- an open follicle stuffed with sebaceous and keratinous material.

Closed comedo:  a “white head” follicular dilatation not as marked; skin appears to cover the follicular orifice.

23

What is this?

(defining characteristics + examples)

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Milia

small, superficial keratin cysts

24

What is a burrow?

(defining characteristics + examples)

linear or curvilinear papule that house parasites such as the scabies mite 

25

What is this?

(defining characteristics + examples)

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Lichenification

areas of thickened epidermis.  The major sign of the thickening is increased prominence of the skin lines, although scaling and low grade inflammation are usually seen as well

26

What is this?

(defining characteristics + examples)

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Telangiectasia

dilations of superficial cutaneous vessels.  Often linear or branch-like; will blanch

ex: rosacea, essential Telangiectasia
 

27

What is this?

(defining characteristics + examples)

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Erythema

Localized redness of the skin or mucosa; will blanch (color change is due to increase blood flow, not leakage of blood into the skin as in purpura)

Ex: erysipelas, dermatomyositis, early lyme disease
 

28

What is this?

(defining characteristics + examples)

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Erythroderma

Generalized redness that may be associated with desqsumation (normal process in which the cornified/outermost layer of the epidermis is sloughed in fine scales or sheets); will blanch (color change is due to increase blood flow, not leakage of blood into the skin as in purpura)

Ex: scalded skin syndrome, pityriasis, rubra pilaris, erythrodermic psoriasis
 

29

What is this?

(defining characteristics + examples)

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Ecchymosis

Extravasation of blood into the skin or mucous membranes; areas of flat color change my progress from blue-black to brown-yellow- or green; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin

Ex: bruise, steroid purpura, purpura fulminans
 

30

What is this?

(defining characteristics + examples)

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Petechiae

circumscribed deposits of blood or blood pigments that result from tiny hemorrhages; less than 0.5cm but usually smaller, 1-2mm macules; usually brown in color; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin

ex: Rocky mountain spotted fever, subacute bacterial endocarditis
 

31

What is this?

(defining characteristics + examples)

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Purpura 

circumscribed deposits of blood or blood pigments greater than 0.5cm; usually palpable; violaceous in color; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin

ex: acute meningococcemia, Henoch-Schoenlein purpura, vasculitis
 

32

How are skin/exams lesions characterized?

Patient description (age, sex, color, general state of health)
Distribution (generalized, localized, bilateral, symmetrical vs asymmetrical, patchy)
Arrangement (discrete, confluent, grouped, well/ill-defined)
Configuration or shape
Primary vs Secondary
Characteristics/Quality
(size, shape, color, primary lesions, secondary lesions)

Involvement of the mucous, hair, nails?

33

what term describes these lesions?

(disk-like, targetoid, or annular)

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targetoid

(annular = cleared in center, like a ring or donut)

34

what term describes these lesions?

(Itchy, polycyclic, arcuate, or whorled)

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polycyclic

35

what is the primary lesion?

(papule, plaque, macule, patch)

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Plaque.

Due to scale, could have some flaking off if you scraped.

Larger than 1/2 cm, palpable.

36

What is the secondary lesion?

(erythema, scale, crust, kissing)

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Scale. 

Remember scale is a skin product, crust is a blood product.

Crust may be blood (scab) or serous (like a popped blister)

37

what color is this lesion?

(pink, bright red, red and white, violaceous)

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bright red. 

38

what is the morphology of this lesion?

(serpiginous, annular, whorled, linear)

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serpiginous

39

what is the primary lesion?

(macule, papule, vesicle, blister)

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Vesicle

(blister is not a derm word, papule is not fluid-filled, macule is flat)

40

morphology of these vesicles?

(arcuate, grouped, clumped, serpiginous)

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Grouped.

(clumped is not a derm word)

This is a good example where the description can help the diagnosis. a 3cm plaque of grouped vesicles localized to the forearm is very suggestive of shingles.

41

definition of a plaque?

anything palpable on the skin greater than 1/2 cm.

May be a collection of grouped vesicles as below (shingles). He called this a "3 cm plaque consisting of grouped vesicles"

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42

morphology of these urticaria? 

(arcuate, grouped, linear, serpiginous)

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linear

arcuate = semi-circular

43

morphology seen here?

(arcuate, polycyclic, serpiginous, reticulate)

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reticulate

44

what is the morphology seen here? 

(arcuate, whorled, serpiginous, reticulate, crazy-pants)

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Whorled

45

what is this morphology 

(annular, papular, half-circular, serpiginous)

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annular

46

what is this lesion? (the black marks)

(papule, plaque, open comedone, closed comedone)

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open comedone

47

what is this lesion? (the raised oval ones)

(papule, plaque, cyst, ulcer)

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cyst

48

what is the secondary lesion?

(erosion, ulcer, fissure, atrophy)

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atrophy

49

what is this secondary lesion? (the dark areas within the red zone)

(scar, cyst, crust, scale)

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crust

50

what is the lesion on the cheek?

(purpura, petchiae, telangiectasia, burrow)

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telangiectasia

51

what lesion is near the lateral canthus?

lichenification, open comedone, patch, plaque

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plaque

52

best description for these non-blanching lesions?

papules, eccymoses, telangiectasias, petechiae

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petechiae

53

morphology of this skin finding?

purpuric, retiform, polycyclic, annular

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retiform

54

best descr for these non-blanching lesions?

vesicles, pustules, palpable purpura, eccymoses

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palpable purpura

55

This patient has....

redness, acral erythroderma, acral erythema, aches and pains

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acral erythema

56

best description for these lesions?

vesicle, nodule, bump, painful

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nodule

57

morphology of this rash?

annular, whorled, polycyclic, targetoid

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annular AND polycyclic

58

the shape of this plaque is...

round, annular, targetoid, crescentic

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annular

59

the secondary lesion is....

excoriation, erosion, ulcer, scale, nasty

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ulcer.

and nasty.