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2 - Derm H & P Flashcards

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1
Q

Intro

A
  • The dermatology patient is handled a little differently in that the physical exam provides more clues than the history
  • Physical findings can be integrated with relevant historical data
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2
Q

4 general characteristics of skin lesions

A 
T = type
A = arrangement
D = distribution
S = shape
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3
Q

Primary lesions

A
  • Primary lesion: physical changes in the skin caused directly by the DISEASE PROCESS – types of primary lesions are rarely associated with a single disease entity
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4
Q

Secondary lesions

A
  • Secondary lesion: may arise from primary lesions or from external causes
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5
Q

Types of primary lesions

A

macule, patch, papule, nodule, tumor, plaque, papilloma, urticara (wheal, hive), vesicle, bulla, pustule, abscess, purpura, telangiectasia, comedo (clogged hair follicle), cyst

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6
Q

Macule

A

Flat, colored lesion,

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7
Q

Macule examples

A

Freckle, flat mole, rashes of rickettsial infections, measles, allergic drug eruptions, vitiligo (white), talon noir (black), café-au-lait (brown, hemosiderin, purpura

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8
Q

Patch

A

Large, >0.5 cm, flat lesion with a color different from the surrounding skin (i.e. large macule)

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9
Q

Patch examples

A

Port-wine stain, tattoo (asphalt embedded in skin), infections, drug eruptions

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10
Q

Papule

A

Solid lesion,

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11
Q

Papule examples

A

Wart, nevi, drug eruption, insect bite

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12
Q

Nodule

A

Solid, firm lesion, 0.5-1.0 cm in diameter, raised above the surface of the skin (i.e., large papule)

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13
Q

Nodule examples

A

Lipoma, fibroma, keratinous cyst, erythema nodosum, neoplasm

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14
Q

Tumor

A

Solid, firm lesion >1cm , raised

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15
Q

Tumor examples

A

Looks like one distinct lesion, in a plaque you can see distinct lesions

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16
Q

Plaque

A

Flat-topped, raised lesion, >1cm with either distinct or blended edges

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17
Q

Plaque examples

A

Distinct edges  psoriasis

Gradually blended with skin  eczema

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18
Q

Vesicle

A

Fluid-filled lesion,

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19
Q

Vesicle examples

A

Acute tinea, allergic contact dermatitis
NOTE –> if fluid is turbid (white fluid) with blister, it is caused by the presence of neutrophils, but does NOT signify infection***

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20
Q

Bulla

A

Fluid-filled, raised, translucent lesion, >0.5 cm

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21
Q

Bulla examples

A

Friction blister, bullous pemphigoid, bullosis diabeticorum

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22
Q

Pustule

A

Vesicle filled with leukocytes or pus,

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23
Q

Abscess

A

Pus-filled lesion >0.5 cm (large vesicle), usually indicates infection

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24
Q

Abscess examples

A

Paronychia (ingrown nail infection)

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25
Cyst
Raised, encapsulated lesion, originates from invagination of epidermis into dermis, process continues until lesion detaches from epidermis and becomes completely lined by epidermis
26
Cyst examples
Inclusion cyst – most common cause of this is a foreign body infection
27
Wheal
AKA uticaria, hives Raised, erythematous papule or plaque, usually representing short-lived dermal edema
28
Wheal examples
Allergic reaction to drugs, insect bites, sensitivity to cold, heat and pressure, sunlight
29
Angioneurotic edema
Larger localized area of edema than wheal
30
Telangiectasia
Dilated, superficial blood vessel
31
Telangiectasia examples
Scleroderma, ***long-term topical steroid therapy, necrobiosis lipoidica diabeticorum (see below)
32
Papilloma
Upward proliferation of dermal papillae – virus in EPIdermis (ONLY), but causes a reaction in the DERMIS (forming rete)
33
Papilloma examples
Verruca (“wart”) | NOTE - a wart can be classified as a papilloma or a papule
34
Purpura
Bruise General term referring to extravasated blood and can also be considered a macule – a sign of vasculitis
35
Purpura types
Three types - Petechia, ecchymosis, hematoma
36
Petechia
Small circumscribed punctuate foci of extravasation
37
Ecchymosis
Larger confluent area of extravasation
38
Hematoma
Area of massive bleeding into the skin and underlying tissues
39
***Skin layers of vesicles and bulla*** KNOW THIS
Subepidermal = bullous pemphigoid Subcorneal = impetigo Subgranular cell layer = friction blister Spongiotic = contact dermatitis AND acute T. pedis (intercellular edema in epidermis)
40
Steroid use KNOW THIS
KNOW THIS - topical steroids do two things: o Thin out the skin (more susceptible to trauma) o Cause permanent telangiectasia You will be prescribing this, so I want you to know it
41
lesion that is 7mm in diameter and is flat and non-palpable is called a
Patch
42
The bulla of tinea pedis is most often associated with
Spongiotic blistering
43
Necrobiosis lipoidica diabeticorum
- Telangiectasis can be part of a larger disease called necrobiosis lipoidica diabeticorum - Skin lesion that appears on the shin of diabetic patients due to the blood vessel changes associated with diabetes = UNIQUE to diabetics - In the larger lesion of the necrobiosis lipoidica diabeticorum, you will see telangiectasis
44
Types of secondary lesions
lichenification, crust, erosion, ulcer, excoriation, atrophy, scar
45
Lichenification
Distinctive thickenings of skin characterized by accentuated skin-fold markings and feels thick and firm on palpation
46
Lichenification examples
Lichen simplex chronicus – psychiatric patients who scratch (used to be called neurodermatitis, but had bad connotation)
47
Crust
Dried exudate of body fluids that may be either yellow (serous) or red (hemorrhagic)
48
Crust example
Acute tinea pedis
49
Erosion
"superficial ulcer" Loss of epidermis ONLY without an associated loss of dermis
50
Erosion example
Pemphigus, herpes viruses
51
Ulcer
Loss of epidermis AND at least a portion of the underlying dermis
52
Excoriation
"Scratch" Linear, angular erosions that may be covered by crust and are caused by scratching
53
Excoriation example
Venous stasis dermatitis
54
Atrophy
"Loss of skin" Acquired loss of substance which may appear as a depression with intact epidermis or as a site of shiny delicate wrinkled lesions
55
Atrophy example
Topical steroid usage, atrophie blanche (see below – IMPORTANT)
56
Scar
Change to skin secondary to trauma or inflammation, may be erythematous, hypopigmented or hypertrophic
57
Scar example
Keloid (ask “how do you scar?”) | Scar caused by your scalpel is included here
58
``` - All of these are examples of secondary skin lesions, except: o Scar o Nodule o Ulcer o Excoriation o Atrophy ```
Nodule
59
***Atrophie blanche***
- COMMON = you will be seeing a lot of this so KNOW IT NOW*** - In an area of previous ulcer or skin breakdown, you get atrophy as the skin tries to heal itself - You will see white areas in the general area of venostasis dermatitis (pronounced “blanch” – means “white” in French)
60
Different arrangements or shapes of lesions
``` Linear Annular Iris (target) Margination Circinate Arciform Serpiginous Gyrate Zosterform ```
61
Linear
Straight (poison ivy or Koebner phenomenon in psoriasis patients)
62
Annular
Round or circular with central clearing (tinea pedis, capitis, corpus, etc.) Sometimes tinea is called “ring worm” which does NOT mean it is a worm, but means that it forms a circle (usually not on the foot, but on head/body)
63
Iris (target)
Bull’s eye lesion, annular w/ central internal activity zone (erythema multiforme like Steven Johnson Syndrome – medical emergency, sloughing of skin follows)
64
Margination
Sharp or ill-defined
65
Circinate
Round or circular
66
Arciform
Partial circle
67
Serpiginous
Meandering (cutanea larva migrans – after travel to tropics, worm inside skin)
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Gyrate
Connecting arcs
69
Zosteriform
Dermatomal (herpes zoster follows dermatomes)
70
General types of distribution of lesions
``` Generalized Localized Symmetric Asymmetric Discrete Confluent Cleavage plane Grouped ```
71
Generalized
Dispersed all over (i.e. drug eruption)
72
Localized
Grouped or clustered into specific areas
73
Symmetric
Opposite sides of body
74
Asymmetric
One side only
75
Discrete
Separate
76
Confluent
Coalescing (smaller into larger)
77
Cleavage plane
Arranged along lines of tension
78
Grouped
Clustered (herpes zoster)
79
Questions to ask during dermatology history taking
``` - Evolution of lesion o Site of onset, manner in which eruption spread, duration, periods of resolution - Symptoms o Itching, burning, pain, numbness, anything relieving symptoms, time of day changes - Current or recent medications (prescription, OTC, etc.) - Associated systemic symptoms o Fever, malaise, arthralgias - Other o Ongoing or previous illness o History of allergies o Presence of photosensitivity o Review of systems ```

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