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PANCE Review > Dermatology > Flashcards

Dermatology Flashcards

1
Q

dermatologic terminology

A

MAD:

Morphology - type of individual lesion

  • primary lesion: macule, patch, papule, plaque, nodule, vesicle, bulla, pustule
  • secondary lesion: crusts, erosions, ulcers, fissures, scars, scale

Arrangment - solitary, grouped, linear

Distribution - where located on body

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2
Q

skin cancer risk factors

A 
fair complexion
light hair/eyes
hx of blistering sunburn (child)
inc. sun exposure 
family hx
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3
Q

actinic keratosis (solar keratosis) - characteristics and tx

A

pre-malignent lesion
- can transition to squamous cell carcinoma

sun-exposed areas (ears, face)
small, lightly pigmented
rough to touch (scaly, flaky)

tx: cryosurgery (liquid nitrogen)
- 5-fluorouracil (Efudex)
- imiquimod (Aldara)

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4
Q

squamous cell carcinoma - characteristics

A

arises from actinic keratosis

varied appearance: usually sun-exposed areas; can slowly erode
- if lasting over 1 month, consider SCC until proven otherwise

cure rates high if treated

can have METS

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5
Q

Bowen’s disease

A

squamous cell carcinoma (SCC) in situ - confined to original location (no METS)

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6
Q

squamous cell carcinoma - treatment

A

excision is best treatment

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7
Q

basal cell carcinoma - characteristics and tx

A

slowly enlarging nodule with central depression and pearly border

  • 90% on head and neck (sun-exposed areas)
  • telangiectasias (tiny blood vessels)
  • bleeding common
  • metastasis rare

tx: surgical excision

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8
Q

melanoma - characteristics

A

arises from pre-existing dysplastic nevi (mole)

  • flat or raised
  • vary in appearance
  • vary in color (red, white, black, blue)
  • can appear anywhere on body

prognosis: related to thickness (how deep it has penetrated skin)
- Breslow depth

Hutchinson’s sign: periungual pigmentation (around nails)

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9
Q

mole evaluation - ABCDEs

A

More likely melanoma (vs. nevi):

A: asymmetry
B: border irregular
C: color mottled (vs. consistent)
D: diameter > 6mm
E: evolving (changing)
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10
Q

melanoma - tx

A

surgical excision

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11
Q

seborrheic keratoses - characteristics and tx

A

benign age-related plaques (older population); common

beige-brown-black

“waxy, stuck-on lesion”; can have “rough” appearance

3-20mm diameter

tx: none needed

NOTE: sudden, acute eruption should alert you to internal malignency

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12
Q

atopic dermatitis - characteristics

A

pruritic (“itch that rashes”) - results in exudative to lichenified eruption

  • face, neck, upper trunk, wrists, hands, flexural folds (elbows and knees)
  • personal of family hx of allergic manifestations
  • more common in kids
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13
Q

atopic dermatitis - treatment

A

therapeutic lifestyle (avoid itching, keep moisturized)

topical corticosteroids

systemic steroids only for extensive severe cases

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14
Q

contact dermatitis (irritant)

A

result of chemical exposure

  • erythema, scaling, well-demarcated
  • area affected: hands most common
  • everyone will have a reaction with sufficient exposure
  • can be acute or chronic
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15
Q

contact dermatitis (allergic)

A

develops after exposure to chemicals to which individual has been sensitized

  • initially confirmed to area of contact, later spreads
  • progression: erythema-papules-vesicles-erosions-crusts-scaling
  • ex: poison ivy
  • not everyone will have a reaction
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16
Q

contact dermatitis (allergic and irritant) - treatment

A 
avoid irritants
topic steroids: calm things down
Burow's solution: helps to dry up lesion if wet
oral antihistamines: for itching
emollients: hydrate if dry
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17
Q

diaper dermatitis - characteristics and tx

A

type of contact dermatitis from prolonged exposure to urine/feces

  • often get overlying candida infection (satellite lesions)
  • erythematous patches with pustules

tx:

  • nystatin (rx - mycostatin)
  • clotrimazole (OTC)
  • miconazol (OTC)
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18
Q

nummular eczema

A

“coin-shaped” plaques of papules/vesicles on erythematous base

  • mild to severe pruritus
  • on extremities
  • adults (typical = older male, ETOH abuse)

tx:

  • hydration and systemic antihistamines
  • topical steroids
  • phototherapy if resistant
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19
Q

perioral dermatitis (aka muzzle rash) - characteristics and tx

A

tender, small red papules, pustules

  • spares vermillion border
  • tingling, burning
  • mainly adult females (age 16-45)
  • tends to be chronic

tx:

  • topical metronidazole (Flagyl), erythromycin
  • NOTE: avoid steroids (will worsen)
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20
Q

seborrheic dermatitis - characteristics and tx

A

red, scaly rash (M>F), pruritus varies

  • nasal folds, eyebrows, eyelids, postauricular, scalp
  • seen w/ oily skin/hair
  • common, recurs (chronic)
  • may be fungal

tx:
- frequent cleansing of area
- shampoo w/ selenium sulfide (head and shoulders), ketoconazole
- mild topical steroid (1% hydrocortisone)
- ketoconazole cream (2%)

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21
Q

stasis dermatitis - characteristics and tx

A

vascular etiology: redness, scaling, ulcerations

  • often in lower extremities
  • large area of skin change

tx: geared to improving blood flow
- compression stockings

Weeping lesions: burow’s compresses, petroleum jelly, topical hydrocortisone, ABX if infected

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22
Q

dyshidrosis (pompholyx, dyshidrotic eczema) - characteristics and tx

A

disorder of hands and feet
- adults (30s)

pruritus w/ sudden onset of “tapioca-like” blisters; later scaling and fissures

tx:

  • topical corticosteroids
  • oral prednisone if severe
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23
Q

lichen simplex chronicus (circumscribed neurodermatitis) - characteristics and tx

A

intense itching causes self-perpetuating scratch-itch cycle

  • circumscribed, lichenified lesions
  • neck and extremities common
  • see exaggerated skin lines

tx:
- patient education
- STOP scratching!!
- occlusion to prevent further trauma
- topical steroids

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24
Q

lichen planus (P’s) - characteristics and tx

A

lesions are plentiful, pruritic, purple, polygonal, papular, planar

  • Wickham’s striae on surface (white, lacy pattern on skin)
  • oral (erosions) and nail (splintering) manifestations
  • Koebner’s phenomenon (new lesion develops in area of minor trauma)
  • Note: can be associated with Hep C (test)

tx:
- topical steroids w/ occlusion
- oral steroids (severe)
- photo therapy (large areas)

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25
Q

Koebner’s phenomenon

A

new lesion develops in area of minor trauma

- see with lichen planus and psoriasis

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26
Q

pityriasis rosea - characteristics and tx

A

oval erythematous to fawn-colored discrete lesions w/ collarette scale

  • Herald patch (days to wks prior) - annular lesion with central clearing
  • mainly on chest, trunk along cleavage lines (“christmas tree pattern”)
  • mainly seen in young females

completely BENIGN

tx:

  • self-limiting
  • resolves in 6 wks
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27
Q

drug eruptions -characteristics and tx

A

widely varying presentations

  • days to wks into tx
  • usually self-limiting (occasionally severe = skin peeling)

Penicillin and sulfa drugs most common

immune compromised at increased risk

tx:
- discontinue offending drug
- supportive care

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28
Q

erythema multiforme (EM) - characteristics and tx

A

symmetrical, target lesions (<2 cm)

  • mainly children, young adults
  • commonly spares trunk
  • related to herpes simplex, but most idiopathic:
  • NOTE: drugs are not often cause

tx:
- supportive (oral antihistamines, topical steroids)

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29
Q

Stevens-Johnson syndrome (SJS) - characteristics and tx

A

fever, HA, cough, aches, EM-like rash

  • asymmetric areas of dusky erythema with truncal involvement
  • mucous membranes involved (oral, anus, genitals)
  • skin blisters, epidermis shears off; susceptible to infection
  • SJS: < 10% body SA affected

cause: almost always drugs (ABX, anticonvulsants, NSAIDs)
tx: life-threatening (requires specialized managment in burn unit)

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30
Q

toxic epidermal necrolysis (TEN) - characteristics and tx

A

fever, HA, cough, aches, EM-like rash

  • asymmetric areas of dusky erythema with truncal involvement
  • mucous membranes involved (oral, anus, genitals)
  • skin blisters, epidermis shears off; susceptible to infection
  • TEN: > 30% body SA affected

cause: almost always drugs (ABX, anticonvulsants, NSAIDs)
tx: life-threatening (requires specialized management in burn unit)

31
Q

bullous pemphigoid - characteristics and tx

A

pruritic blisters on normal or erythematous skin; rupture & crust

  • autoimmune disorder
  • usually >60 y/o
  • constitutional sxs rare

tx: mos - yrs
- topical potent steroids if limited
- oral steroids if widespread
- dapsone: oral lesions

32
Q

psoriasis (plaque-type) - characteristics and tx

A

silvery scales on bright red, well demarcated plaques

  • chronic dz (waxes and wanes)
  • genetic predisposition (extreme cell turn-over)
  • scalp, extensor surfaces of elbows and knees most common areas
  • can get nail pitting and joint problems

Note: positive Auspitz sign (pin-point bleeding where scale is scraped off)
- see Koebner’s phenomenon

Tx: localized

  • topical corticosteroids (ointment and cover)
  • tar preparations
  • avoid stress and ETOH

Tx: generalized dz
- phototherapy (UVB outpatient or UVA more severe)

33
Q

guttate psoriasis -characteristics and tx

A

teardrop-shaped, pink/salmon, scaly plaques

  • usually on trunk
  • NOTE: almost always a hx of strep throat infection

Tx: UV-B phototherapy, natural sunlight

34
Q

tinea corporis -characteristics and tx

A

dermatophyte infection
- transmitted directly or by animals

round, angular lesion; scaly patch with central clearing and slightly raised border
- sharply marginated

Dx: put scale in KOH = hyphae

Tx:

  • topical azoles, terbinafine
  • continue tx for 1-2 wks after cleared
35
Q

tinea pedis (aka athlete’s foot)

A

asymptomatic scaling in between toes or on other surfaces of feet
- most common in young, adult men

Dx: hyphae on KOH exam

Tx:

  • prevention: shower shoes
  • dry/scaly: topical azaleas, terbinafine
  • macerated: Burow’s wet dressings (aluminum acetate)
36
Q

tinea versicolor (pityriasis versicolor) - - characteristics and tx

A

yeast on skin

hypopigmented lesions on upper trunk, neck, shoulders

  • can be hyper pigmented on darker skin
  • adolescents and young adults in summer
  • recurrence common

Dx: blunt hyphae and budding spores w/ KOH (“spaghetti and meatballs”)

Tx:

  • topical selenium sulfide lotion/shampoo
  • topical or systemic ketoconazole
37
Q

folliculitis

A

inflammation or obstruction of hair follicles (bumps)

  • itching and burning in hairy areas
  • pustules in hair follicles
  • many causes (obesity inc. risk)

tx: varies depending on cause
- gram stain, culture needed

irritated: remove irritant (lotion, loosen colar)
infection: oral ABX with staph coverage (cephalosporins, clindamycin, augmentin)

38
Q

pseudofolliculitis barbae

A

dots on beard area from ingrown hairs

tx: let beard grow out; use electric razor, shave in direction of hair growth (not against)

39
Q

cellulitis

A

bacterial infection of dermis and subcutaneous tissue
- pain, erythema, edema, warmth, fever, lymphadenopathy

GAS and S. aureus most common

Tx:

  • mild: oral ABX
  • severe: admit for IV ABX
40
Q

erysipelas (aka St. Anthony’s Fire) - characteristics and tx

A

bacterial infection that involves dermis and lymphatics

  • mostly in adults (cheeks common)
  • prodromal sxs (fever, chills, fatigue) followed by fiery red rash (well demarcated, shiny - like orange peel, smooth, hot)

Note: can spread very quickly so needs to be recognized quickly… and treated

Tx: IV ABX first 48 hrs, supportive care

41
Q

impetigo - types, characteristics, tx

A

causes by staph aureus or strep pyogeness

  • more common in kids
  • highly infectious

multiple presentations:

  • nonbullous: transient, small, vesicle/pustules w/ honey-colored crusts
  • bullous: superficial fragile bullae on normal skin

Tx:

  • mupirocin (bactroban); bacitracin for small areas
  • oral ABX for larger area and bullous
42
Q

verrucae (warts)

A 
viral infection
caused by HPV
presentations:
 - common wart (hands)
 - plantar warts (feet)
 - flat warts

Benign

Tx:

  • OTC salicylic acid
  • cryotherapy
  • CO2 laser surgery
  • surgical excision
  • duct-tape occlusion
43
Q

condylomata acuminata -characteristics and tx

A

viral sexually-transmitted infection

  • HPV types 6 and 11
  • see warts

Can be painful, friable, and/or pruritic

Highly infectious (but partner screening is not recommended)

Tx: goal is removal of symptomatic warts; cannot eradicate infection
- Podofilox (Condylox), imiquimod (Aldara), cryotherapy

44
Q

herpes simplex -characteristics and tx

A

viral infection (HSV 1 and HSV 2)

  • herpes simplex labialis (cold sores)
  • genital herpes (STD)

Prodrome (tingling) then painful, vesicular lesions on erythematous base

Tx: prophylaxis if frequent (anti-virals)
- acyclovir, famciclovir, valacyclovir)

45
Q

herpes zoster (shingles) -characteristics and tx

A

re-activation of varicella zoster in nerve root - activates when people become immunocompromised or older; travels down nerve root

  • vesicles in unilateral, dermatomal pattern
  • vesicles rupture and crust over
  • post-herpetic pain can persist for months or yrs
  • if in eye = ophthalmic emergency!

tx:
- anti-viral (acyclovir, valacyclovir, famciclovir)
- supportive
- oral steroids in immunocompetent helps reduce pain

Note: prevention through vaccination

46
Q

molluscum contagiosum -characteristics and tx

A

viral infection - DNA pox virus
- transmit via direct contact

HINT: Pearly, dome-shaped papules with central umbilication

Benign / self-limited

  • kids: trunk, face
  • adult: inner thigh, genital (sex-transmit)

Tx:

  • will resolve spontaneously
  • currettage, cryosurgery to get rid of if wanted
47
Q

acne vulgaris - characteristics

A 
Primary: comedones (black heads and white heads), papules, pustules, cysts
Secondary: pits and scars (severe)
 - common in adolescents and adults
 - mainly on face and chest
 - improves in summer
48
Q

acne vulgaris - treatment

A

mild: topical
- retinoids (runic acid, tazarotene)
- benzoyl peroxide
- clindamycin, erythromycin

moderate:
- add oral ABX (minocycline or doxycycline)

severe:
- systemic isotretinoin, intralesional injection triamcinolone

49
Q

rosacea -characteristics and tx

A

papules/pustules, erythema, telangiectasias on nose, cheeks, chin forehead

  • NO comedones
  • middle-aged (females)

tx:
- metronidazole (Flagyl) - antibacterial and antiprotozoa

50
Q

vitiligo -characteristics and tx

A

hypopigmented, nonscaling patches on face, hands, arms, legs, genital area

  • BENIGN
  • autoimmune etiology (?)

Tx:

  • topical corticosteroids, UVB/PUVA
  • protective sunscreen
51
Q

acanthosis nigricans - characteristics and tx

A

symmetrical, hyper pigmented, velvety plaques in any location

  • axillae, groin, posterior neck common
  • associated w/ obesity, insulin resistance, meds

tx/management:

  • screen for internal malignancy, DM, insulin resistance
  • weight loss
  • cosmetic tx
52
Q

burns - general info and estimation of body surface area affected

A

ABCs
- check airway, breathing, circulation

Transfer is based on severity of burn and amount of surface area affected

Rule of 9’s - 9% head, arms, 18% legs and front/back of trunk

53
Q

burns - transfer criteria

A

partial thickness (2 degree) and > 10% TBSA

full thickness burns (3 degree), in any age group

burns to face, hands, feet, genitalia, major joints

electrical, chemical, inhalation burns

pediatric burns w/out qualified personnel

54
Q

burns - degrees (1st, 2nd, 3rd)

A

first-degree: redness w/o changes to texture, intact sensation (superficial)

second-degree: blister formation, pink to mildly pale, intact sensation (partial thickness)

third-degree: white, leathery, no sensation (full thickness)

55
Q

burns - treatment

A

gently drape burns with dry material

do not damage skin

do not break blisters

chemical burns: irrigation, irrigation, irrigation

56
Q

hidradenitis suppurativa -characteristics and tx

A

chronic inflammatory dz of apocrine glands

  • tender, inflammatory nodules, abscess formation, scarring, sinus tracts
  • waxes and wanes
  • postpubertal females most common (obese)

Tx:

  • reduce friction and moisture
  • oral ABX for acute exacerbations
  • I&D abscesses
  • intralesional steroids for nodules
57
Q

urticaria -characteristics and tx

A

pruritic, pink or red wheals of varying size, well-defined
- any area of body

  • can be acute or chronic
  • can be allergic vs. non allergic (hx is key)

Tx:

  • antihistamines
  • short course of steroids (if needed)
  • avoid triggers
58
Q

dermatographism

A

raised skin to trauma

59
Q

melasma -characteristics and tx

A

hyper-pigmentation of sun exposed areas

  • females, reproductive age
  • hormons, meds, thyroid, cosmetics (?)

Tx: tough

  • SUN avoidance
  • hydroquinone cream (depigmenting agent)
60
Q

lipomas -characteristics and tx

A

benign tumor of mature fat cells

  • mobile, round, discrete, 2-10cm
  • slow growing, non-painful
  • overlying skin is normal

Tx:

  • removal via excision or liposuction
  • fine needle aspiration will r/o liposarcoma
61
Q

liposarcoma - characteristics

A

not mobile, overlying skin may be ulcerated, faster growing

Any concern: fine needle aspiration

62
Q

epidermoid cyst - characteristics and tx

A

firm, round, mobile mass formed from implantation of epidermal elements in dermis
- can express foul-smelling, cheese-like material

Tx:

  • none needed
  • triamcinolone if inflamed, oral ABX if infected
  • I&D, excision
63
Q

kaposi sarcoma

A

cancerous tumor of endothelial cells (line vessels that carry blood and lymph)

  • mucocutaneous nodules/plaques
  • purplish-brown, firm to hard
  • associated with LE lymphedema
  • asymptomatic, can develop anywhere
  • associated with HIV/ AIDS
64
Q

decubitus ulcers - definition

A

ischemia due to immobility-related pressure (“pressure sores”)
- wetness, poor nutrition

65
Q

decubitus ulcers - stages

A

stage I: intact skin w/ impending ulceration

stage II: partial-thickness loss involving epidermis, possibly dermis

stage III: full-thickness loss with extension into subcutaneous tissue

stage IV: full-thickness loss w/ extension into muscle, bone, tendon, or jt capsule

66
Q

pediculosis (lice) -characteristics and tx

A

oval 1-2 mm nits (eggs) seen on hair

  • pruritus w. excoriation
  • can be in hair, body, of genital region
  • spread by contact

Tx: all intimate contacts

  • body: topical permethrin (also scabies)
  • pubic: permethrin cream rinse (1%)
  • head: permethrin cream rinse (1%)

clean/dispose of infected clothing, linen

67
Q

Scabies -characteristics and tx

A

Cause by mite

  • extremely pruritic
  • vesicles and pustules in “runs” / burrows
  • spread by physical contact

Tx:

  • permethrin 5% cream, use 2x one week apart
  • antihistamines (itching continues for several wks even if mites killed)
  • clean clothing and bedding
  • tx contacts
68
Q

black widow spider bite - characteristics and tx

A

generalized muscle spasms, pain, and rigidity

  • female has red, hourglass on underside
  • most venomous spider in US

Tx:

  • supportive care
  • parenteral opioids (pain meds)
  • muscle relaxants
  • calcium gluconate 10%
69
Q

brown recluse spider bite - characteristics and tx

A

progressive local necrosis possible, fever, chills, N/V

Tx: no agreed upon best tx
- excision of bite site

70
Q

alopecia areata - characteristics and tx

A

rapid hair loss, round patches

  • benign, cause unknown, waxes and wanes
  • HINT: exclamation point hairs

Tx:
- intra-lesional corticosteroid (triamcinolone)
- photo therapy
Minoxidil (Rogaine)

71
Q

androgenetic alopecia - characteristics and tx

A

typical hair loss
effects both men and women
- men: receding hairline at temples and hair loss at vertex
- women: loss of hair over central scalp, no frontal loss

Tx:

  • minoxidil (Ragaine)
  • finasteride (propecia) - men only
72
Q

onychomycosis - characteristics and tx

A

dystrophic nail growth from fungal infection

  • yellowish nails with lines
  • microscopy and culture helpful

risk factors: age, family hx, warm climate, poor health

tx:

  • oral antifungals (long course): terbinafine, itraconazole
  • topical generally ineffective

Note: slow regrowth

73
Q

paronychia

A

breakdown of protective barrier b/t nail and nail fold

Acute:

  • erythema, pain, swelling
  • history of nail trauma (S. aureus #1 organism)
  • tx: I&D if abscessed, oral ABX and warm soaks

Chronic:

  • worsens with water exposure (dishwashers)
  • candida is #1 organism
  • tx: keep dry, topical antifungals
74
Q

dermatologic manifestations of systemic disease

A

viral exanthems

infectious diseases

sexually transmitted diseases

nutritional disorders

cutaneous markers of internal malignancy

PANCE Review (16 decks)

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