2014-03-07 USMLE Derm - USMLE Derm Flashcards Preview

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Flashcards in 2014-03-07 USMLE Derm - USMLE Derm Deck (172):
1

Define macule and give an example

- flat spot less than 1 cm
- freckles

2

Define patch adn give an example

- flat spot greater than 1cm
- port wine stain

3

Define papule and give 3 examples

- solid elevated palpable lesion less than 1cm
- wart, acne, lichen planus

4

Define plaque and give an example

- solid flat topped elevate palpable lesion greater than 1cm
- psoriatic patch

5

Define nodule and give 2 examples

- palpable solid lesion greater than 1cm (not flat topped)
- small lipoma, erythema nodosum

6

Define vesicle and give 2 examples

- elevated, circumscribed lesion less than 5mm containing fluid
- small blister
- chickenpox, HSV

7

Define bulla and give 2 examples

- elevated, circumscribed, fluid filled lesion greater than 5mm
- large blister
- contact dermatitis, pemphigus

8

Define wheal and give an example

- itchy transiently edematous area
- allergic reaction

9

General definition of vitiligo

depigmentation of unknown etiology

10

Vitiligo is often associated with

autoimmune conditions like pernicious anemai and hypothyroidism

11

Patients with vitiligo may have antibodies to

melanin

12

Biopsy in vitiligo may show

absense of melanocytes

13

Puritis is often a clue to these diseases:

- obstructive biliary disease
- uremia
- polycythemia rubra vera
- atopic dermatitis
- scabies
- lichen planus

14

Puritis after a warm shower may be a clue to

polycythemia rubra vera

15

Pruritis with obstructive biliary disease is classically ________

primary biliatry cirrhosis

16

The most common form of contact dermatitis in women

nickel dermatitis (jewlery)

17

Contact dermatitis is usually this type of reaction

type IV hypersensitivity

18

List three classic offending agents for contact dermatitis

nickel, deoderant, poison ivy

19

Describe the rash of contact dermatitis

- well circumscribed
- only in areas of exposure
- red
- itchy
- often with vesicles or bullae

20

Testing and treatment of contact dermatitis

- patch test
- avoid offending agent

21

Major features of atopic dermatitis

- chronic
- begins in 1st year of life
- rash is red, itchy, weeping on head and arms sometime diaper area

22

Main symptoms of atopic dermatitis

itching and skin breaks lead to possible infection risk

23

Treatment of atopic dermatitis

- avoid dry soaps
- antihistamines
- topical steroids

24

What is blepharitis?

seborrheic dermatitis of the eyelid

25

3 common subtypes of seborrheic dermatitis

- cradle cap
- dandruff- blepharitis

26

Classic findings of seborrheic dermatitis

scaling skin on scalp and eyelids

27

Treatment of seborrheic dermatitis

dandrum shampoo (selenium sulfide)

28

fungal infection on the trunk is called

tinea corporis

29

describe the lesion of tinea corporis

- red
- ring-shaped
- raised borders
- clear centrally while they expand peripherally

30

fungal infection on the feet is called

tinea pedis

31

describe the lesion of tinea pedis

- macerated
- scaling web spaces
- itches

32

thicked distorted toenails are often

onychomycosis

33

Most important part of treatment for tinea pedis

good foot hygeine

34

fungal infection of the nails is called

tinea unguium or onychomycosis

35

fungal infection of the scalp is called

tinea capitis

36

is tinea capitis contagious?

yes, very

37

an inflammed boggy granuloma of the scalp is called

kerion

38

Describe the characteristics of tinea capitis

- sclay patches of hair loss
- boggy granulomas (kerions)

39

technical name for jock itch and what type of infection

- tinea cruris (crural folds)
- fungal infection

40

Most skin fungal infections are caused by

Trichophytan species

41

How do you confirm a tinea infection?

scraping of sking with KOH prep or by culture

42

Pharmacologic treatment of tinea infections

- tinea capitis: oral agent
- onychomycosis: oral agent
- others can be treated with topical and/or oral

43

Typical oral and topical treatments for tinea

- terbinafine, fluconazole
- topical imidazoles (miconazole, clotrimazole, keotoconazole)

44

Differentiation of causative organism in tinea capitus

- if hair fluoresces under the wood's lamp = microsporum
- otherwise = trichophyton

45

Physical appearance of thrush

white patches on tongue or buccal mucosa that can be scraped off

46

When is candial infection considered normal/non-concerning

- children
- vulvovaginitis in women esp when pregnant or on antibiotics

47

Thrush without good explanation should prompt consideration of...

- immunodeficiency
- diabetes

48

Treatment of trush

- topical with nystatin or imidazoles
- systemic for resitant disease

49

Systemic therapies for thrush

- nystatin
- ketoconazole

50

Multiple patches of various size and color on the torso in a young adult =

tinea versicolor

51

Characteristics of tinea versicolor

- young adults
- multiple patches of various size and color on the torso
- patches fail to tan (often noted in summer)

52

Diangosis of tinea versicolor

- clinical
- KOH prep

53

Treatment of tinea versicolor

- selenium sulfide shampoo
- topical imidazoles

54

Classic areas for scabies

- finger web spaces
- flexor surfaces of the wrist

55

Treatment of scabies

- permethrin
- technically lidocaine can be used but has a risk of neurotoxicity especially in young children
- remember to treat all contacts

56

Pediculosis =

lice

57

The technical name for lice is

pediculosis

58

head lice is called

pediculus capitis

59

body lice is called

pediculus corporis

60

pubic lice is called

phthirus pubis

61

Treatment of lice

- permethrin

62

Genital warts that are associated with cancer

HPV 16 and 18 are associated with cervical cancer

63

Warts are most commonly seen ________

in older children, on the fingers

64

Are warts infectious?

yes

65

Warts are caused by

human papillomavirus

66

Typical treatments for warts

- salicylic acid
- liquid nitrogen
- curettage

67

Scabies is caused by

sarcoptes scabei

68

Halmark lesion of scabies

burrow on:
- finger web spaces
- flexor surfaces of the wrist

69

Treatment of scabies

Permethrin
- be sure to treat contacts

70

Pediculosis =

lice

71

Lice is also called

pediculosis

72

Pediculus capitis is common in

school children

73

Pediculus corporis usually involves

poor hygeine

74

Phthirus pubis is

sexually transmitted lice

75

Diagnosis of lice is made by

seeing lice on hair shafts

76

Treatment of lice

- permethrin
- decontaminate combs, hats, sheet, clothing

77

Warts are caused by

human papillomarvirus (HPV)

78

Warts in children are often seen

on the hands

79

Genital warts are caused by

HPV 16 and 18

80

Genital warts are associated with

cervical cancer

81

Treatment of warts

- salicylic acid
- liquid nitrogen
- curettage

82

molluscum contagiosum is a

poxvirus

83

Molluscum contagiosum is common in

- children
- STD
- don't forget autoinnoculation

84

Appearance of mollusceum contagiosum

- skin-colored
- smooth
- waxy papules
- central depression (umbilitated)

85

A 0.5cm waxy skin colored umbilicated papule =

molluscum contagiosum

86

Characteristic pathologic appearance of molluscum contagiousum

inclusion bodies

87

Treatment of molluscum contagiousum

- freezing
- curettage

88

5 common "medical" descriptions of acne

- comedones (whiteheads/blackheads)
- papules
- pustules
- inflammed nodules
- superficial pus-filled cysts

89

Gland that gets blocked in acne

pilosebaceous glands

90

Organism often involved in acne

Propionibacterium acnes

91

Acne is NOT related to

- exercise
- sex
- masturbation

92

Progression of treatment options for acne

- topical benzoyl peroxide
- topical clindamycin
- oral tetracycline or erthromycin
- topical tretinoin
- oral isotretinoin

93

Antibiotic for eradication of propionibacterium acnes

erythromycin

94

Side effects of oral isotretinoin

- dry skin
- dry mucosae
- muscle and joint pain
- abnormal LFTs

95

This looks like acne but usually starts in middle age

Rosacea

96

Rhinophyma =

bulbous red nose

97

Bulbous red nose in rosacea =

rhinophyma

98

Rosacea often also has

rhinophyma and blepharitis

99

Pathogenesis of rosacea

unknown (but not related to diet)

100

Treatment of rosacea

- topical metronidazole
- oral tetracycline

101

Signs of virilization

- hirsutism
- deepening voice
- clitoromegaly
- frontal balding

102

Most common cause of virilization

idiopathic

103

Hirsutism is often a sign of

virilization

104

More common causes of hirsutism

- androgen secreting ovarian tumor
- corticosteroids
- Cushing syndrome
- Stein-Leventhal syndrome
- minoxidil
- phenytoin
- other drugs

105

Stein-Leventhal syndrome =

polycystic ovarian disease

106

Psychiatric disorder where one pulls out hair

trichotillomania

107

trichotillomania =

pathological hair pulling

108

What is alopecia areata

- form of baldness
- idiopathic
- associated with antimicrosomal and other antibodies
- seen with lupus, syphilis, after chemo

109

Key features of male-pattern baldness

- benign
- requires androgen expression
- considered genetic

110

Classic lesions of psoriasis

- dry
- NOT pruritic
- well-circumscribed
- silvery
- scaling
- papules/plaques
- on extensor surfaces/scalp

111

A dry well-circumscribed, silvery, scaling papule on the scalp or extensor surfaces =

psoriasis

112

Family history for psoriasis

often positive

113

Psoriatic arthritis is RF

negative

114

People with psoriasis often have nails that are

pitted

115

Psoriasis is most often seen in

- whites
- onset early adulthood

116

General treatment of psoriasis

- UV light
- lubricants
- topical corticosteroids
- keratolytics

117

Examples of keratolytics (such as in treatment of psoriasis)

- coal tar
- slicylic acid
- anthralin

118

Age for pityriasis rosea

adults

119

Scaly slightly erythematous ring-shaped lesion on the trunk =

"hearld patch" of pityriasis rosea

120

Lesions of pityriasis rosea

- scaly red itchy ring shaped
- starts with hearld patch on trunk
- 1 weeks later many more appear
- follow langerhan's skin cleavage lines
- often in "Christmas tree"

121

Rash with "Christmas tree" pattern

pityriasis rosea

122

General course of pityriasis rosea

spontaneously remits in 1 month

123

Ddx of pityriasis rosea

syphilis

124

Treatment of pityriasis rosea

reassurance

125

Features of lichen planus:

"The 4 P's":
- pruritic
- purple
- polygonal papules

126

pruritic purple polygonal papules =

lichen planus

127

Classic location of lichen planus

wrists and/or ankles

128

Typical course and treatment of lichen planus

-self-limited and resolves within a few years
- symptomatic treatment for itching

129

2 major drug causes of photosensitivity

- tetracycline
- phenothiazines

130

Classic lesions of erythema multiforme

- target of iris lesions

131

Infection that can cause erythema multiforme

- herpes

132

Erythema multiforme is usually caused by

- drugs
- infections

133

Characteristic feature of Stevens-Johnson syndrome

Erythema multiforme with mucosal involvement

134

Treatment of erythema multiforme

supportive

135

Typical description of erythema nodosum

- inflammatory
- subcutaneous tissue and sin
- tender red nodule

136

Classic location of erythema nodosum

- shins (pre-tibial)

137

Classic causes of erythema nodosum

- unknown
- streptococcal
- sarcoidosis
- coccidiomycosis
- ulcerative colitis

138

pemphigus vulgaris is an _______ disease

autoimmune

139

Typical age for pemphigus vulgaris

middle and older age

140

Typical lesions of pemphigus vulgaris

- multiple bullae starting with oral mucosa
- blisters slough and leave raw skin

141

Multiple bullae starting with oral mucosa, blisters then slough =

pemphigus vulgaris

142

Biopsy of pemphigus vulgaris shows

(stain for antibody)
- lacelike/fishnet immunofluoresence

143

Treatment of pemphigus vulgaris

corticosteroids

144

Death from pemphigus vulgaris is often due to

- secondary skin infection
- fluid loss

145

Compare biopsy results of pemphigus vulgaris vs bullous pemphigoid

- lacelike/fishnet = vulgaris
- linear = pemphigoid

146

Dermatitis herpetiformis is a tip-off for

gluten sensitivity (celiac disease)

147

Pathology of dermatitis herpetiformis

IgA deposits (even in unaffected areas)

148

Pruritis vesicles, papules and wheals on extensor aspects of elbows and knees +/- face/neck =

dermatitis herpetiformis

149

Treatment of dermatitis herpetiformis

gluten-free diet

150

3 major causes of new onset excessive perspiration

- hyperthyroidism
- pheochromocytoma
- hypoglycemia

151

Reasons to bioby/excise a mole

- enlarges
- irregular borders
- darkens/inflammed
- changes color
- bleeds
- itches
- painful

152

Characteristics of dysplastic nevus syndrome

- genetic
- often >100 nevi
- family history of melanoma

153

Keratocanthoma often mimics

squamous cell skin cancer

154

Classic description/course of keratocanthoma

- rapid onset
- grows to full size in 1-2 months
- fleshy lesion with central crater with keratinous material

155

Classic locations for keloid

upper back, chest, deltoid

156

Classic appearance of basal cell skin cancer

- shiny purple
- grows slowly
- umbilicated center
- often later ulcerates
- peripheral telangeictasias

157

Shiny purples slow growing lesion =

basal cell cancer

158

Metastatic tendency of basal cell carcinoma

almost never

159

Risks for basal cell carcinoma

- sunlight
- light skinned

160

Features of actinic keratoses

hard, sharp, red, scaly

161

Hard sharp red scaly lesion in sun exposed area =

actinic keratoses

162

If a burn scar becomes nodular, warty or ulcerated, think_____

squamous cell cancer

163

Squamous cell cancer may have pre-cursor _____ lesions

actinic keratoses

164

Squamous cell skin cancer is also known as

Bowen disease

165

Actinic keratoses is precursor lesion of

squamous cell cancer

166

Best and worst prognostic types in melanoma

- best: superficial spreading
- worst: nodular

167

Black dots on palms, soles or under nails =

melanoma

168

Prognosis in melanoma is related to

vertical depth on invasion

169

Kaposi sarcoma is classically associated with

AIDS

170

Paget disease of the nipple, must rule out

breast adenocarcinoma

171

Classic nutritional cause of stomatitis

- B-complex vitamins
- Vitamin C

172

What are the main B-complex vitamins (deficiency may cause stomatitis)

- riboflavin
- niacin
- pyridoxine