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PANCE review > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How are skin lesions described?

A

“MAD”
Morphology: shape, color, elevation, margination, etc.
Arrangement: single, grouped, arciform, annular, etc.
Distribution: localized, disseminated

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2
Q

diascopy

A

glass slide or diascope pressed on skin; blanching indicates intact capillaries

purpura does NOT blanch

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3
Q

KOH prep

A

mount skin scraping on KOH to dissolve keratin and cellular material; fungi not affected

identifies fungal or dermatophyte infection

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4
Q

Wood’s light exam

A

exam skin under UV light

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5
Q

telangiectasia

A

dilated, small, superficial blood vessels

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6
Q

Lichenification

A

thickened skin with distinct borders, often from excessive scratching or prolonged irritation

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7
Q

macerated

A

swollen and softened by increase in water content; appearance that skin gets when left in water too long

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8
Q

verrucous

A

irregular, rough, and convoluted surfaces

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9
Q

circumscribed, elevated lesion containing serous fluid or blood less than 5 mm and greater than 5 mm

A

vesicle

bulla

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10
Q

solid, palpable lesion less than 5 mm and greater than 5 mm

A

papule

nodule

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11
Q

flat, non-palpable lesion less than 1 cm and greater than 1 cm

A

macule

patch

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12
Q

petechiae

A

minute hemorrhagic spots that do NOT blanch by diascopy

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13
Q

types of contact dermatitis

A 
irritant (chemicals)
diaper rash (prolonged urine/feces contact)
allergic (type IV cell mediated hypersensitivity reaction)
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14
Q

acute itching and burning rash with well-demarcated areas of erythema

A

contact dermatitis

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15
Q

How is contact dermatitis confirmed in lab?

A

Patch test

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16
Q

contact dermatitis treatment

A

Avoid offending agent
Wet dressings with Burrow’s solution
Topical steroids
Supportive: clean with mild soaps, antihistamines for itch (Calamine lotion)

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17
Q

Auspitz sign

A

bleeding after scale removed

ex: psoriasis

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18
Q

Patch test

A

shows hypersensitivity reaction in skin allergies

ex: contact dermatitis

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19
Q

Darier sign

A

urticarial flare produced by rubbing skin

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20
Q

Nikolsky sign

A

rubbing skin causes blister

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21
Q

Atopic dermatitis also referred to as _______.

A

eczema

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22
Q

Atopic dermatitis symptoms

A
  • Dry itchy skin often involving FLEXURAL surfaces (back of knees, wrists, anterior elbow), face, dorsum of hands and feet
  • Lichenified skin
  • Secondary infections like staph
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23
Q

Atopic dermatitis treatment

A

Avoid dry air, limit bathing and soap use
Hydration and topical emollients
Antihistamines
Topical steroid

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24
Q

Presentation of contact dermatitis

A

Vesicles
Crusted lesions
Pruritus
The location and distribution are keys to dx

  • Linear vesicles on the forearms or lower legs are often poison ivy
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25
Q

How is impetigo ruled out as cause of rash?

A

Gram stain

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26
Q

eczema is in close association with what other conditions?

A

ATOPY: eczema, asthma, allergic rhinitis

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27
Q

signs/sx’s of seborrheic dermatitis

A
  • Flakey, dry, itchy skin

- Found in oily places such as body folds, face, scalp, genitalia

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28
Q

seborrheic dermatitis in adults commonly known as ______ and in infants its called _______.

A

dandruff

cradle cap

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29
Q

seborrheic dermatitis treatment

A
  • OTC dandruff shampoo (selenium sulfide)
  • UV radiation
  • Ketoconazole shampoo
  • Topical steroids for severe cases

cradle cap: olive oil compresses, baby shampoo

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30
Q

A skin disorder characterized by repetitive itching and scratching. This may be secondary to eczema, psoriasis, bug bites, psych disorders, etc.

A

Lichen simplex chronicus

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31
Q

Describe rash of Lichen simplex chronicus

A
  • Lichenified skin with well defined borders
  • Plaques
  • Darkened skin
  • Scratch marks
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32
Q

Lichen simplex chronicus treatment

A
  • Must reduce scratching
  • Lotions and creams to keep skin moist
  • Antihistamine
  • Cortisone cream
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33
Q

Patients with dyshidrosis often have a history of _____.

A

atopy

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34
Q

sign of dyshidrosis

A

small clear vesicles in clusters (“tapioca” appearance) and occasionally bullae

usually on hands and feet

painful fissures if vesicles rupture, scaling, Lichenification

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35
Q

dyshidrosis treatment

A
  • Reduce stress in life
  • Avoid skin irritation by using gloves and cream to keep skin from drying out
  • Topical steroids
  • Wet dressing with Burrow’s solution
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36
Q

Some medications that commonly have derm side effects

A

Penicillin - rash

Percocet - itch

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37
Q

Itchy, shiny lesions which are solid and raised with white lines (Wickham striae).

A

Lichen Planus

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38
Q

The 4 P’s of Lichen Planus

A

Pruritic
Purple
Polygonal
Papules

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39
Q

Lichen Planus treatment

A
  • Strong topical steroid
  • Cyclosporine mouthwash if oral lesions
  • Systemic therapy may be necessary
  • Phototherapy
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40
Q

Hallmarks of pityriasis rosea

A

Herald patch - solitary pink plaque with raised borders, commonly on abdomen 1-2 weeks before rash breaks out

Salmon-colored papular rash eruption on trunk in Christmas tree pattern

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41
Q

pityriasis rosea treatment

A
  • Self limiting, typically 3-8 weeks

- May use lotion or antihistamines

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42
Q

Chronic autoimmune skin disorder characterized by red flaky, scaling skin that is dry and itchy

A

Psoriasis

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43
Q

Describe rash of psoriasis

A
  • salmon colored, well defined raised papules and plaques, dry/itchy with SILVER SCALES
  • most often scalp and EXTENSOR surfaces of elbows and knees
  • scratching causes more lesions (Koebner phenomenon), Auspitz sign
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44
Q

Associated symptoms of psoriasis besides rash

A

Onycholysis (separation of nail plate)

Arthritis in hands and feet

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45
Q

Psoriasis treatment

A 
Keep skin moist
Topical steroid or topical Vit D
Systemic steroid may be necessary if widespread
Tazarotene gel (topical retinoid)
Severe: PUVA, Methotrexate
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46
Q

3 variations of psoriasis

A

vulgaris - 80%
erythroderma - lesions all over body
guttate - disseminated pattern, often after strep throat
pustular - widespread pustules; life-threatening

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47
Q

What can occur if psoriasis tx suddenly stopped?

A

psoriatic erythroderma; can be fatal due to systemic inflammation and difficulty regulating body temp

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48
Q

Most common infection that predisposes patient to Erythema Multiforme

A

Herpes infection

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49
Q

Which medications most commonly cause SJS and TEN?

A

Sulfonamides, penicillin, phenytoin…..

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50
Q

Hallmark rash of erythema multiforme

A

target lesion- pink red ring with pale center

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51
Q

erythema multiforme treatment

A

Acyclovir if related to herpes flare up, otherwise self-limiting (2-6 wks)

Systemic steroids if severe

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52
Q

PE findings of SJS and TEN

A

High fever
Necrotic epidermis, loss of skin in sheets
Nikolsky sign

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53
Q

SJS and TEN treatment

A
  • d/c causative agent and send to burn unit

- fluid and electrolyte management very important

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54
Q

Initially a urticarial rash (hives) that turns into tense, large bullae typically in axillae, groin, and thighs

A

bullous pemphigoid

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55
Q

Starts as painful lesions in mouth and then clear fluid-filled vesicles or bulla break out on skin. Lesions are flaccid and easily ruptured with (+) Nikolsky sign

A

Pemphigus vulgaris

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56
Q

Pathophysiology of pemphigus vulgaris

A

autoimmune IgG mediated loss of cell-to-cell adhesion

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57
Q

Gold standard of diagnosing rashes

A

skin biopsy

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58
Q

Generic treatment for most rash outbreaks

A 
topical steroids for minor outbreak
systemic oral steroids for more severe
abx for secondary infection
fluid and electrolyte management
antihistamine for itch
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59
Q

Name for typical adolescent acne

A

acne vulgaris

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60
Q

How is mild acne treated?

A

hygiene, diet, etc.
topical retinoids
topical salicylic acid

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61
Q

How is acne treated if inflammatory lesions present?

A

topical benzoyl peroxide, erythromycin, clindamycin, or sodium sulfacetamide

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62
Q

How is severe or cystic acne treated?

A
  • Add abx like tetracycline, erythromycin, or clindamycin

- refer to dermatologist for Accutane (isotretinoin)

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63
Q

I came in to see my physician assistant because of…

Face appears flushed
Small papulopustules
Facial telangiectasia
Rhinophyma (enlarged nose) may be seen

A

Acne Rosacea

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64
Q

Acne Rosacea treatment

A
  • Remove aggravators (sun, emotional stress, spicy food, heavy exercise, alcohol)
  • Metronidazole most effective
  • topical abx or oral abx if very severe
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65
Q

What to warn patient about Accutane?

A

side effects: dry eyes and mouth, mood swings, joint pain, visual changes, leukopenia

TERATOGENIC - patient put on birth control

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66
Q

If ________ left untreated 20% will go on to squamous cell carcinoma.

A

actinic keratosis

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67
Q

Describe actinic keratosis lesion

A

2-10 mm macules or papules
pink or hyper pigmented
feel like sandpaper

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68
Q

Actinic keratosis treatment

A

Typically liquid nitrogen

5% 5-FU cream

69
Q

lesion with “stuck on appearance”

A

seborrheic keratosis

70
Q

seborrheic keratosis treatment

A

they are benign so usually do nothing

71
Q

Lice treatment

A

Permethrin 1% cream

72
Q

presentation of scabies

A

severe itching
burrowing of skin
commonly web spaces of hands

73
Q

Scabies treatment

A

Permethrin 5% cream; applied once to whole body overnight and rinse in the morning, all family and sexual partners should be treated

74
Q

Where are brown recluse spiders located? how are bites treated?

A

only mid southeastern states

tx: wash it, keep it clean, +/- abx

75
Q

Symptoms of black widow bite? how are bites treated?

A

sx: pain, muscle cramping, tachycardia; may have N/V
tx: antivenom

76
Q

shiny, pearly nodule

A

basal cell carcinoma

77
Q

basal cell carcinoma treatment

A

Mohs surgery

+/- radiation in elderly

78
Q

systemic disease caused by herpes virus 8

A

Kaposi Sarcoma

79
Q

Kaposi Sarcoma typically very slow developing, but in conjunction with ______ it progresses quickly.

A

AIDS

80
Q

I came in to see my physician assistant because of…

Red or purple plaques on the skin and mucosal surfaces
GI lesions
Difficulty swallowing
Pulmonary lesions
Difficulty breathing
Cough
Chest pain
A

Kaposi Sarcoma

81
Q

Lesion that is most common cause of cancer

A

basal cell carcinoma

82
Q

Kaposi Sarcoma treatment

A

No cure
Treat AIDS with anti-retroviral therapy
Radiation
Cryotherapy

83
Q

Characteristics of mole that make it a melanoma

A 
A = asymmetry
B = irregular borders
C = color changes
D = diameter +6mm
E = evolving over time
F = firm
G = growing
84
Q

How can melanoma be dx’d?

A

biopsy
dermoscopy
CT/PET scan

85
Q

Melanoma treatment

A

Prevention is key! - sun protection, no tanning beds

Surgical excision
Sentinel lymph node biopsy
Radiation/Chemo

86
Q

How to predict survival rates of melanoma?

A

tumor thickness

87
Q

I came in to see my physician assistant because of…

A growing nonhealing rough, bumpy, scaly patch
Lesions have a variable appearance
90% are found on the head and neck

A

squamous cell carcinoma

88
Q

squamous cell carcinoma treatment

A

Mohs surgery

Chemo/Radiation

89
Q

Most common kind of alopecia

A

androgenetic baldness

90
Q

Causes of scarring alopecia

A

trauma, infections, radiation, scleroderma, etc.

91
Q

Androgenetic baldness tx

A

Minoxidil 5% solution applied BID

Treat underlying cause

92
Q

onychomycosis

A

fungal infection of toenail
typically painless
thickened, brittle; white, yellow, or green

93
Q

How is fungal nail dx’d?

A

KOH prep, culture

94
Q

Treatment of onychomycosis

A
  • systemic antifungal (Terbinafine first line)
  • topical antifungal (Ciclopirox)
  • good hygiene
95
Q

common cause of paronychia

A

staph aureus infection of skin around nailbed

96
Q

Paronychia treatment

A
  • warm soaks
  • abx (Cephalexin, Dicloxacillin) then an I&D if abscess
  • hydrocortisone cream prn
97
Q

Warts found typically in the gential/anal area. Sexually transmitted by the human papillomavirus (HPV) types 6 and 11

A

Condyloma acuminatum

98
Q

Condyloma acuminatum tx

A

No true cure

  • Prevention: safe sex, Gardasil protects against some HPV types
  • Laser removal
  • Cryosurgery
99
Q

HPV types 16 and 18 are linked to _______.

A

cervical cancer

100
Q

Vesicles location: HSV type 1 are usually _____ and type 2 are ______.

A

oral (cold sore)

genital

101
Q

Herpes Simplex tx

A

No true cure

  • Typically self limiting
  • Topical antiviral (5% acyclovir)
  • Oral antiviral (acyclovir, valacyclovir)
  • Tylenol and ibuprofen
102
Q

Describe wart of molluscum contagiosum

A 
Flesh colored
Dome shaped
Pearly or waxy
Umbilicated
Not painful or pruritic
103
Q

How is molluscum contagiosum transmitted?

A

wet skin to skin contact -> “water warts”

sexual activity

104
Q

What virus leads to chicken pox?

A

varicella zoster

105
Q

Hallmarks of chicken pox rash

A
  • Dew drops on a rose petal

- Lesions appear in crops: you get a certain number of lesions on day 1 and then more appear on day 2 and so on

106
Q

How is chicken pox positively dx’d in lab?

A

Fluid taken from the vesicles and prepared with a Tzanck smear will show multinucleated giant cells

107
Q

chicken pox treatment

A
  • Supportive care
  • Do not give aspirin to kids under 19
  • Prevent or treat secondary infections
  • Antiviral may be appropriate in the immunocompromised
  • A live attenuated virus is used for vaccination. It is always given twice
108
Q

I came in to see my physician assistant today because of…

Severe burning pain and hypersensitivity before vesicular lesions are visible
Typically affect one dermatome

A

Shingles (Zoster)

109
Q

Shingles treatment

A

Acyclovir x 7 days

110
Q

Define exanthem

A

widespread rash

111
Q

Koplik spots are pathognomonic for ______.

A

measles

clusters of white spots on buccal mucosa. fade as rash begins to appear

112
Q

Characteristics of measles rash

A
  • Red blanching maculopapular rash
  • Appears 3-5 days after first signs of illness
  • Starts behind ears, moves to face/neck, then travels down (imagine bucket of red paint poured over head)
  • Pruritic
  • Lesions darken to brown and fade in order they appeared
113
Q

Measles treatment

A

Supportive care
Self limiting disease only progressing with secondary infection
Live attenuated vaccine is given at 12 months old and a booster is given before a child enters school

114
Q
  • Symptoms of strep throat
  • Rash: like painful sunburn with tiny bumps that blanch with pressure.
    Feels like “sandpaper”
  • Bright red swollen strawberry tongue
A

Scarlet Fever

115
Q

Scarlet Fever tx

A

abx x 10 days

116
Q

How does Rubella present?

A
  • Flu like symptoms for about a week

- Rash on the face which spreads to the trunk and out to the extremities; typically fades after about three days

117
Q

Rubella tx

A

Live attenuated virus for vaccination

Supportive treatment

118
Q

Rash of erythema infectiosum (Fifth Disease)

A

SLAPPED CHEEK
Red macular rash on cheeks with circumpolar pallor
Lacy red rash on trunks, arms, upper legs

119
Q

Erythema Infantum (Roseola) signs/sx

A
  • High fever up to 105 for several days then drops, rash appears
  • Pink maculopapular rash
  • Lasts a few hours up to 3 days
120
Q

Erythema Infantum (Roseola) tx

A
  • Supportive care

- Monitor fever closely (number one cause of febrile seizures)

121
Q

Cellulits most commonly caused by ________ and _______ infections.

A

staphylococcus and streptococcus

122
Q

Describe skin of cellulitis

A

warm, red, swollen
lymphadenopathy
fever/chills

123
Q

Cellulitis treatment

A

Oral penicillinase resistant penicillin – dicloxacillin or a cephalosporin
If admitted IV cephalosporins
Draw out the margins to follow the treatment

124
Q

How is erysipelas different than cellulitis?

A

more superficial

125
Q

How is impetigo caused?

A

skin to skin contact

very poor hygiene

126
Q

Signs of impetigo

A

Lesions: thick crusted, honey colored scabs

127
Q

Define dermatophyte infection

A

ringworm fungal infection affecting skin, hair, and/or nails

128
Q

Examples of dermatophyte infections

A 
tinea pedis - foot (athletes foot)
tinea cruris - groin (jock itch)
tinea corporis - trunk, legs, arms, neck
tinea barbae - beard area
tinea unguium - nails
tinea capitus - head
129
Q

Signs of ringworm

A
  • Red raised ring with a central clearing and distinct borders
  • Itching, stinging and burning
130
Q

Labs helpful to dx ringworm

A

KOH prep to confirm fungus

Woods light or culture may be useful

131
Q

Dermatophyte tx

A
  • Topical creams, ointments, lotions, sprays, and powders
  • Keep area clean and dry

No steroids!!!

132
Q

Chronic fungal infection with tan or pink macules that don’t tan; sx’s worse in hot or humid climates

A

tinea versicolor

133
Q

KOH of tinea versicolor reveals what?

A

yeasts in spaghetti and meatball appearance (round yeasts with filaments)

134
Q

tinea versicolor treatment

A

Topical:
Selenium Sulfide lotion 2.5% x 7 days; Ketoconazole shampoo used weekly

Systemic:
Ketoconazole 200 mg daily x 7 days (delivered through sweat to skin. Do not shower for 8 hours after taking)
Fluconazole 300 mg two doses 14 days apart

135
Q

epidemiology of Acanthosis Nigricans

A

African Americans younger than 40 yo

136
Q

causes of acanthoses nigricans

A
  • May be inherited

- May be due to underlying endocrine disorders: DM 2, PCOS, Hypo or hyperthyroidism, Cushing’s disease, Acromegaly

137
Q

Pregnant female comes in with skin discoloration upon sun exposure. The lesions are tan or brown and have clear borders. Likely dx?

A

melasma

138
Q

Causes of melasma

A

pregnancy or oral contraceptive

139
Q

Patient comes in for brown or black poorly defined area of thickened or velvety skin in skin folds

A

Acanthosis Nigricans

140
Q

I came in to see my physician assistant because of…

Depigmentation of the skin
Usually begins in the extremities
Well defined Irregular borders

A

vitiligo

141
Q

Vitiligo treatment

A

UV light therapy
PUVA – UV light with psoralen which makes the skin more susceptible to the light
Melanocyte transplant

142
Q

Differentiate first, second, and third degree burns

A

First degree – NO blisters (Don’t consider when assessing Total surface area of the burn since doesn’t affect outcome or factor into electrolyte management)

Second degree – blistering

Third degree – no hair or sweat glands

143
Q

Rule of nines for estimating surface area

A 
Palm is 1%
Head and neck 9%
Each arm is 9%
Each leg is 18%
Anterior trunk 18%
Posterior trunk 18%
Genitalia 1%
144
Q

How are burns treated?

A

First degree burns: cool compresses

Second and third degree burns:

  • Don’t pop blisters!
  • Tetanus shot
  • Silver sulfadiazine to protect wounds from infection
  • Fluids and Electrolytes
  • Surgical debridement of wounds often necessary
145
Q

Parkland formula for fluids in first 24 hrs of second and third degree burns

A

Total SA burned (%) x Wt (kg) x 4ml
Give half in first 8 hrs and second half over next 16 hrs

Example: 180 lb man with both arms completely burned
81 kg x 18 x 4 = 5832 ml = 5.9 liters lets round to 6 liters
Give 3 liters of Ringers lactate in the first 8 hours and 3 liters over the next 16 hours

  • Use rule of 9 to estimate SA *
146
Q

I came in to see my physician assistant today because of…

Chronic cysts which vary in size from the size of pea the size of a baseball. They are extremely painful and inflamed. Located on underarms, inner thighs, groin and buttocks.

A

Hidradenitis Suppurativa

147
Q

Hidradenitis Suppurativa tx

A
  • Reduce predisposing factors: Weight loss, stop OCPs, wear loose fitting clothing
  • Abx
  • Incision and drainage prn
  • Steroid injection
148
Q

A benign tumor of fat cells. They are soft, mobile and usually non tender.

A

lipoma

149
Q

This can be a cyst, an abscess, a sinus or a fistula near the natal cleft of the buttocks.

A

Pilonidal Disease

150
Q

Wheal and flare reaction to animal dander, insect bites, pollen, shellfish, nuts, stress, etc.

A

Urticaria (Hives)

151
Q

Perioral dermatitis treatment

A

AVOID topical steroids (typically the cause)

Use metronidazole, erythromycin, or oral minocycline or doxycycline

152
Q

Chronic venous insufficiency due to valvular incompetency leading to dermatitis, edema, hyper pigmentation, fibrosis, and ulceration

A

stasis dermatitis

153
Q

Lab studies for chronic venous insufficiency

A

Doppler U/S

154
Q

Well-circumscribed plaques that are highly pruritis, setting up a cycle of itch-scratch lesions

A

Lichen simplex chronicus

155
Q

Pathophysiology of psoriasis

A

greatly increased epidermal cell turnover; 28x normal

156
Q

Treatment of bullous pemphigoid and pemphigoid vulgaris

A

Systemic prednisone
Immunosuppressants
Azathioprine

157
Q

How can acne vulgaris and acne rosacea be distinguished?

A

acne rosacea has no comedones

158
Q

Bacteria in hot tubs that causes folliculitis

A

Pseudomonas

159
Q

Oral griseofulvin can treat what derm disorder

A

tinea capitus

160
Q

tan-pink well demarcated WAXY plaque with raised borders; often associated with diabetes

A

necrobiosis lipoidica

161
Q

Rash caused by zinc deficiency?

A

scaling red rash

162
Q

Signs of aplasia cutis congenita?

A

asymptomatic ulcerations of scalp

163
Q

Dome-shaped nodule with “dimple sign”

A

dermatofibroma

164
Q

What are solar lentigines?

A

asx brown macules from sun; no malignancy risk

165
Q

Sign of dermatomyositis?

A

periocular erythema and edema

proximal muscle weakness

166
Q

widespread vesicles with gingival involvement, fever, and adenopathy likely from what bug?

A

HSV

167
Q

xanthomas commonly caused by what?

A

hyperlipidemia

168
Q

DDX of target lesion

A

Lyme disease

Erythema multiforme caused by HSV

PANCE review (18 decks)

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