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PAM Semester 4 > Clin Med Derm Exam 1 > Flashcards

Clin Med Derm Exam 1 Flashcards

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1
Q

Functions of the skin

A 
Protects the underlying structures
Barrier against microbes
Prevents loss of fluids
Regulates body temp
Helps rid body of excess water and salt
Sensation, temp, pain, touch
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2
Q

3 layers of skin

A

Epidermis
Dermis
Subcutaneous

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3
Q

Layers of epidermis

outer to inner

A

Stratum corneum
Squamous cells
Basal layer

(melanin is also present)

thin 0.2mm

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4
Q

Melanin

A

Protects the deeper layers of the skin against the sun

Located in the epidermis

Produced by melanocytes

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5
Q

Stratum corneum

A

Horny layer

outermost layer

made up of dead keratinocytes

main cell of the epidermis (continually shed)

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6
Q

Squamous cells

A

Living keratinocytes

below the stratum corneum

in epidermis

these cells form keratin (a protein)

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7
Q

Basal layer

A

is the lowest part of the epidermis

formed from basal cells

these cells continually divide and form new keratinocytes

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8
Q

Taking a history (lesions)

evolution of lesion

A

Site of onset
Manner in which it progressed or spread
duration
periods of resolution in chronic cases

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9
Q

Taking a history (lesions)

S/S

A

Itching, burning, pain, numbness

does anything relieve it

time of day when worst

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10
Q

Taking a history (lesions)

Taking meds

A

Sulfa - SJS
Staph - rash - scalded skin
Amox +mono - Rash

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11
Q

Taking a history (lesions)

Associated systemic S/S

A

Malaise
fever
arthralgias
etc

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12
Q

Taking a history (lesions)

Exposures

A 
Plants
metals
detergents
soaps
etc
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13
Q

Taking a history (lesions)

Other….

A

Chronic or previous illnesses

History of allergies

Photosensitivity

Review of systems

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14
Q

Examination of skin

A

Inspection should be in well lit room
completely undressed patient

Exam is inspection heavy

Labs and biopsies can be used to confirm

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15
Q

Four basic features of cutaneous lesions

A

Type of primary lesions

Shape of individual lesions

Distribution of eruptions

Arrangement of eruptions

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16
Q

Characteristic’s of lesion

A 
size
shape
color
texture
elevation
exudates
configuration
location and distribution
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17
Q

Macule

A

Flat
less than 1 cm
change in normal skin color

freckles, flat moles, measles, petechiae

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18
Q

Patch

A

A large flat lesion
over 1 cm

vitiligo, port wine stains, Mongolian spots cafe au lait patches

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19
Q

Papule

A

Raised
superficial lesion
less than 1 cm

raised mole, white head, acne

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20
Q

Nodule

A

Raised

usually round

solid round ellipsoidal

over 1 cm

can be benign or malignant

(tumor over 2cm)

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21
Q

Tumor

A

Nodule over 2cm

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22
Q

Vesicle and bulla

A 
Circumscribed
elevated
superficial cavity
containing fluid
less than 1 cm

Bulla is over 1cm

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23
Q

Cyst

A

soft raised encapsulated lesion

semisolid/liquid content

isnt transparent like bulla

(cant unroof, pop)

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24
Q

Pustule

A

Circumscribed superficial cavity
contains purulent exudate

can vary in size and shape

(does not signify the existence of infection

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25
plaque
a plateau like elevation over 1 cm in diameter wider than it is high psoriasis
26
Wheal
Rounded pale red papule or plaque usually disappears within hours various sizes and shapes
27
Crusts
Develop when serum, blood, exudate dry on skin surface Impetigo ecthyma
28
Impetigo
Crust (honey colored) crust may be delicate thin and friable Can happen in adults but usually kids ABX
29
Ecthyma
Crust that involves the entire epidermis crust may be adherent and thick accompanied by necrosis of deeper tissues Ecthyma involves dermis
30
Desquamation
Desquamation (scaling) scales are flakes of the stratum corneum psoriasis actinic keratosis (solar)
31
Ulcer
Skin defect where there is a loss of epidermis and upper papillary dermis may extend to the subcutis (an erosion is a defect only involving the epidermis and heals without a scar)
32
Erosion
an erosion is a defect only involving the epidermis and heals without a scar secondary lesions
33
Scale
Flaky accumulation of excess keratin secondary lesions
34
excoriation
linear angular erosions caused by scratching secondary lesions
35
atrophy
epidermal thinning of skin with loss of normal skin surface markings dermal depression of skin surface due to loss of underlying collagen or dermal ground substance secondary lesions
36
scar
collection of fibrous tissue replacing normal dermal constituents secondary lesions
37
Maceration
Maceration occurs when skin is in contact with moisture for too long. Macerated skin looks lighter in color and wrinkly In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more vulnerable to infection secondary lesions
38
secondary lesions
lichenification thickening of skin with accentuation of normal skin surface markings most commonly due to chronic rubbing secondary lesions
39
Keloids
secondary lesion some people are predisposed very bad scarring
40
spider hemangioma
common in liver disease central arteriole with radiating thin walled vessels Blanches when compressed
41
telangiectasia
dilated superficial blood vessels Blanches when compressed can appear in older people only cosmetic
42
Cherry hemangiomas
do not blanch discrete papules benign proliferation of endothelial cells generally no tx
43
Dermatographism
A from of urticaria in which whealing occurs in the site and in the configuration of stroking of the skin
44
Lymphangitis
Red streak extends from the ankle to the groin Follows lymph channels IV ABX
45
Pedunculated
On a stalk | Squamous cell carcinoma
46
Verrucous
Wart like
47
Umbilicated
Containing a central depression | Basal Cell Carcinoma
48
Darier sign
Rubbing a lesion causes a urticarial flare
49
Auspitz sign
pin point bleeding after scale is removed | psoriasis
50
Nikolsky sign
Pushing a blister causes further separation of the dermis TEN
51
Photopatch test
Documents photoallergy
52
Patch test
Demonstrates hypersensitivity reaction
53
koebner phenonmenon
Minor trauma leads to new lesions at the site of trauma Psoriasis
54
Shagreen skin
An oval nevoid plaque Skin is colored or pigmented on the trunk and back and is associated with tuberous sclerosis
55
Types of eczematous eruptions
``` Atopic Dermatitis Contact Dermatitis Perioral Dermatitis Seborrheic Dermatitis Stasis Dermatitis Nummular Dermatitis Dyshidrosis Lichen simplex chronicus ```
56
Atopic dermatitis
Strong correlation with asthma poorly defined pruritic erythematous patches, papules and plaques edema with widespread involvement flexor surfaces, neck, eyelids, forehead, face, dorsum of hands and feet often begins in childhood Tx hydration, topical lotions, ointments, creams topical steroids, antihistamines
57
Lichen simplex chronicus
lichenification thickening of skin with accentuation of skin markings well defined lichenified plaques and or papules occurring in areas of chronic scratching Progression from atopic derm due to scratching topical steroids or tar preparations
58
Contact dermatitis
Acute well defined areas of erythema and plaques Can have vesicles, crusts and urticaria Itching and burning Exposure to metals, fake jewelry, nickel solvents, oils, dust, enzymes etc Patch testing Avoid offending agent treat itching Steroids if severe
59
Nummular Dermatitis
Coin shaped lesion plaque small vesicles that have joined together may have crust Pruritic and inflammatory occurs in winter Emollients and topical steroids Triamcinolone Crude coal tar
60
Perioral Dermatitis
Papulopustules around mouth May have satellite lesions Rule out staph with culture Tx: metronidazole or erythromycin Avoid steroids (will worsen)
61
Seborrheic dermatitis
Yellowish red often greasy or white dry scaling varying sizes Very greased Dandruff is this on scalp Occurs where sebaceous glands are most active scalp, face, ears, chest, groin Tx: Topical steroids, ketoconazole, topical sulfa
62
Stasis Dermatitis
Inflammatory scales, papules, crusting edema and varicosities Ulcers in 30% Seen in CHF Swollen and weeping (dry is better) Doppler / venography biopsy Tx compression stockings and topical steroids
63
Dyshidrosis
Dishwasher dermatitis Small vesicles under the skin Tapioca appearance Can crack and become painful Burrows cool dressing Potent steroids used under occlusive dressing x 2 weeks Oral steroids if severe
64
KOH Lab
To rule out fungus
65
Papulosquamous diseases
``` Acrochordons Drug eruptions Lichen planus Pityriasis Rosea Psoriasis ```
66
Acrochordons
Skin tags In areas of friction Obese and diabetic No need to remove but can
67
Drug eruptions
itchy rash symmetric measles like eruption Can also be a fixed eruption violaceous pruritic sharply demarcated patch Remove offending agent Systemic prednisone antihistamines ie mono + amox = rash AIDs + Sulfa = reaction
68
Drug induced photosensitivity
Rash limited to sun exposed areas Carbamazepine, amiodarone, doxy, furosemide, phenothiazines, sulfonamides
69
Sun exposed Distribution porphyria cutanea tarda
Associated with hep C Blisters and erosions
70
Lichen planus
Flat topped shiny violaceous papules with surface lines Wickham striae Flexor aspects of wrists lumbar area, eyelids, shins scalp Can e on mucosa or glans penis (may ulcerate) Biopsy and immunofluorescence Tx: Topical steroids Systemic steroids
71
Pityriasis Rosea
Herald patch (largest) (forms first) Dull pink, fawn colored plaques Round Christmas tree pattern most likely viral, will resolve in 3-8 weeks treat itching
72
Pityriasis Alba
White scaly macular Worsens with sun indistinct borders Tx low potent steroids topical
73
Psoriasis
Well marginated erythematous plaques Silvery white scales Removal will result in blood droplet (auspitz) common on Joints, may have arthritis Pruritic Scratching leads to more lesions Koebners phenomenon 2% of population Chronic, recurrent ``` Topical glucocorticoids Coal tar Phototherapy Methotrexate acitretin Biologics - enbrel, remicade, humira, stelara ```
74
Psoriasis Variant | Psoriatic erythroderma
Lesions involving entire skin and is an exfoliative and serious condition
75
Psoriasis Variant | Guttate
drop like acute eruption disseminated pattern typically appearing after strep pharyngitis
76
Pustular (von zumbuschs syndrome)
an abrupt life threatening condition characterized by widespread pustules that join to form lakes of pus Fever, malaise, leukocytosis
77
Psoriasis | Severity
Mild <2% BSA Moderate 3-10% Severe >10% Most patient have mild 25% have mod/severe
78
Cream vs ointment
Cream no as effective as ointment Good for dry rashes ointments penetrate deeper
79
Desquamation
Staph TSS & SSS Erythema Multiforme SJS TEN
80
Staph toxic shock syndrome
s. aureus is normal flora Super antigens: cause an exaggerated dysregulated hyperimmune cytokine response Macular erythroderma Usually not purulent, but can desquamate Multi systemic infection ``` CDC Definition Fever over 102 Rash - Diffuse macular erythroderma Hypotension SBP <90 or drop of 15 Desquamation 3-7 days after onset (palms/soles) ``` ``` Check labs - CBC, CMP,CPK, LDH, cultures Tx: Consult ID ICU admit Shock management ABX - Vanc, zosyn, cef, meropenem Clind usually best if known ```
81
“Staph” Scalded Skin Syndrome
Under 5 Treat Staph with penicillinase-resistant penicillin Treat skin like burn usually to burn unit Can be drug induced
82
Erythema multiforme
Target lesion eruptions usually on hands and feet fever malaise weakness Drug reactions (pen, sulfons) HSV Mycoplasma other drugs: phenytoin, barbs, allopurinol avoid trigger if hsv use antivirals Antihistamines and nsaids Systemic steroids if severe
83
SJS
Desquamation Generalized macular eruption which rapidly become necrotic Positive nikolsky sign mouth, lips, genitalia = 90% SJS = 10% BSA SJS/TEN = 10-30% TEN >30% Drugs that can cause Sulfonamides, quinolones, cephs, tetra, barbs, carbamazepine, phenytoin, valproic acid, allopurinol, steroids Dx: clinical or biopsy Tx Burn unit if necrotic Pain control, fluids, electrolytes Steroids and ABX are controversial
84
Vesicular bullae
Bullous Pemphigoid | Pemphigus Vulgaris
85
Bullous Pemphigoid
vesicles and bulla Generalized or local some may be hemorrhagic severe pruritis progresses to tenderness Axilla, thighs, groin, mucous membranes autoimmune patients over 60 Biopsy, immunofluorescence to confirm High dose prednisone
86
Pemphigus Vulgaris
vesicles or bulla that rupture and leave a crust oral lesions appear first skin lesions 6-12 months later Nikolskys sign weakness, malaise, pain, burning sensation No pruritus Auto immune Middle aged adults Biopsy, immunofluorescence to confirm Prednisone then add immunosuppressant azathioprine or methotrexate
87
Acneiform lesions
Acne vulgaris Rosacea Folliculitis
88
Acne vulgaris
Open and closed comedones, inflammatory papules and pustules, nodules and cysts. common, genetic component considered an inflammatory disease Labs Tx: cleaning, antibacterials, clinda Systemic isotretinoin (accutane) oral contraceptives
89
isotretinoin (accutane) monitoring
``` Triglycerides q 4-8 wks, stop if >800 CBC LFTs Cat X prescribe 2 types of contraception doesnt affect fetus with men taking it ```
90
Rosacea
chronic inflammatory disease Scattered small inflammatory papulopustules cheeks, chin, forehead, nose enlarged nose face appears flushed telangiectasia Triggers- heat, sun, alcohol, spicy food metronidazole oral abx tetra
91
Folliculitis
papules and pustules at hair follicles clean topical - clinda, erythromycin, mupirocin oral ABX if severe Staph or strep Barbae is from shaving Hairs curl in
92
Verrucous lesions
Seborrheic keratosis | Actinic keratosis
93
Seborrheic keratosis
Verrucated, velvety stuck on beige, brown or black plaque Benign No tx Can be linked to gastric cancer
94
Actinic keratosis
scaly erythematous sun exposed skin can be painful fair skinned people is precancer and will progress to squamous cell carcinoma ``` Tx: cryosurg fluorocil Aldara cream electrodessication peels ```
95
Neoplasms
Basal cell carcinoma Squamous cell carcinoma Kaposi Sarcoma Melanoma
96
Basal cell carcinoma
Most common skin cancer Doesn't usually metastasize (just destroys surrounding tissue) Donut sign Pearly papule with telangiectasias sun damaged skin Commonly bleed Surgery, Mohs, cryo, electro
97
Basal cell carcinoma Types
Noduloulcerative (most common) Superficial (mimics eczema) Pigmented (may be mistaken for melanoma) Morpheaform (plaquelike lesion with telangiectasia) Keratotic (basosquamous carcinoma)
98
Squamous cell carcinoma
indurated and keratotic papules or nodules ulcerating and or crusting Second most common type of skin cancer Rarely metastasize but can in immunocompromised Surgery, Mohs, cryo, electro
99
Kaposi sarcoma
Oval purple papule with faint yellow green halo Aids/HIV 3rd world violaceous papules and nodules with edema Violaceous nodules on the upper gingiva, covering the teeth Human Herpesvirus type 8 Biopsy, Labs for HIV, Hep CXR, stool occult Tx no cure, palliative excision, Systemic treatment interferon
100
Classic Kaposi sarcoma
middle-aged men of Southern and Eastern European origin violaceous, or bluish-black macules and patches Abdomen, lymph nodes, usually starts on legs,
101
Kaposi sarcoma | subtypes
Subtypes ``` Classic KS African Cutaneous KS African Lymphadenopathic KS AIDS-Associated KS Immunosuppression-Associated KS ```
102
African cutaneous Karposi sarcoma
Nodular, infiltrating, vascular masses occur on the extremities, mostly men between the ages of 20-50 Endemic in tropical Africa
103
African Lymphadenopathic Karposi sarcoma
Lymph node involvement with or without skin lesions can happen in children under 10 aggressive and often fatal within 2 years
104
AIDS-Associated Karposi Sarcoma
Cutaneous lesions Red to purple macules rapidly progress head, neck, trunk, mucous membranes systemic involvement HIV
105
Immunosuppression-Associated Karposi sarcoma
similar to classic renal transplants cancer patients chemo treatments
106
Melanoma
``` ABCD Black brown pink colored macule, papule, nodule >6mm in diameter Asymmetric irregular border color variation ``` 25% arise from exisiting moles 75% from normal skin Early detection is key Tumor markers, Lactate dehydrogenase and S100B marker US for lymph nodes Tx: excision Iplilmumab Metastatic stage 3 melanoma
107
Types of melanoma
1. Superficial Spreading Melanoma 2. Lentigo Maligna Melanoma 3. Acral Lentiginous 4. Nodular
108
Superficial Spreading Melanoma
Most common type of malignant melanoma demonstrates color variegation (black, blue, brown, pink, and white) and irregular borders.
109
Lentigo Maligna Melanoma
Characterized by a single, flat, freckle-like macule with an irregular border, usually on the face. Very long radial growth phase before invasion ``` Lentigo maligna(hutchinson’s melanotic freckle) is precursor lesion Most common in elderly and in sun-exposed areas(esp face) ``` Often confused with a solar lentigo or a seborrheic keratosis
110
Acral Lentiginous Melanoma
Occurs on palms and soles, mucosal surfaces, in nail beds and mucocutaneous junctions Similar to lentigo maligna melanoma but with more aggressive biologic behavior Metastasize easily, are often mistaken for plantar warts or subungual hematomas
111
Nodular melanoma
Starts as a papule which becomes an elevated nodule with irregular borders and variegation in color. Generally poor prognosis because of invasive growth from onset Must be differentiated from a hemangioma, angiokeratoma, or pigmented basal cell carcinoma. Rapidly growing
112
Melanoma staging
Sentinel lymph no biopsy best baseline Stage 1 & 2 5-10 year survival Stage 3 38-78% survival Stage 4 metastasis 6-9 month survival without treatment
113
Insects and parasites
Lice Bedbugs Scabies Spiders
114
Lice
scalp, body, pubic hair Can see under microscope nits on hairshaft Permethrin, malathion, ivermectin Special combs petroleum jelly suffocates lice reapply in 7-10 days to kill newly hatched lice
115
Bed bugs
Bugs feed at night on blood bites do not transmit disease or infection can survive up to a year without a host
116
Scabies
burrows, pruritic vesicles web spaces of hands and feet, genitalia, axillary Mineral oil on burrow, scrape, look at under microscope 5% permethrin
117
Spider bites
Black widow causes pain prick at bite | Brown recluse does not cause pain prick at bite
118
Black widow
Black widow cause neurologic overstimulation Myalgia, spasms, rigidity Tx with valium & calcium gluconate
119
Brown recluse
Lesion is sinking macule slightly eroded at center Infarction of the skin rapid coagulation within vessels Avoid debridement until completely evolved Analgesics, clean Wound decreases in 5 - 10 days
120
Hair and nails
``` Alopecia areata Androgenic alopecia Onychomycosis Paronychia Nail conditions recognition ```
121
Alopecia areata
Circular patchy shape can be seen with SLE Unknown cause totalis = complete scalp hair loss Universalis Total body, scalp ahir loss Tx: intralesion cortisone, topical
122
Androgenic alopecia
progressive balding normal male pattern baldness with varying patterns Tx minoxidil finasteride (propecia) Hair transplant Finestaride is androgen inhibitor Minoxidil is vasodialator
123
Hirsutism
male pattern hair in females cultural and ethnic genetic connection Treat cause
124
Onycomycosis
Thick discolored nails T. Rubrum = most common cause Candida effects finger nails more than toe nails Lab = KOH, PAS stain Tx: topical antifungal Terbinafine (not with liver issues) Itraconazole Can be from trauma (long nails), psoriasis, candida pseudomonas infection, hyperthyroid
125
Paronychia
erythema, swelling, pain, proximal nail fold Acute I&D Oral ABX if needed Topical steroid if needed
126
Splinter hemorrhages
Seen in subacute bacterial endocarditis Can also be seen in trauma, vasculitis, leukemia, lupus
127
Beaus lines
Transverse grooves in nails ``` Seen in infection poor nutrition chemotherapy alcoholism stress ```
128
Koilonychia
Spoon nail Irion deficient anemia
129
Terrys nails
"White nails" ``` Seen in Cirrhosis Heart failure diabetes mellitus Hyperthyroid malnutrition ``` 2/3's of nailbed is white
130
Mees bands
White transverse line seen in arsenic thallium chemotherapy hodgkins lymphoma
131
Clubbing
Smoking Bronchogenic carcinoma ``` Seen in bronchiectasis empyema pulmonary fibrosis Bronchogenic carcinoma Cystic fibrosis ```
132
Viral diseases
``` Condyloma Acuminatum Condyloma Lata Exanthems Herpes Simplex Herpetic Whitlow Molluscum Contagiosum Verrucae Varicella Zoster Echovirus 9 ```
133
Condyloma Acuminatum
Soft skin colored fleshy warts Ano-genital, oral mucosa Biopsy with immunofluorescence No cure for HPV Trichloroacetic acid or topical podophyllin (hurts) miquimod cream, podofilox Cyrosurg, surg, electro, laser, cautery etc
134
Condylomata Lata
Verrucous intertriginous plaques seen in secondary syphillis
135
Exanthems
Rash Generalized macular and or papular eruption associated with systemic infection usually not itchy Tx symptoms
136
Measles (Rubeola)
1st disease Rash starts on face and spreads down the trunk 4D'S 3 C's 4 days cough, Coryza, conjunctivitis Koplick spots ("O") Highly contagious Dx: igm antibodies Tx supportive
137
Scarlet fever
2nd disease non itchy rash on trunk and extremities Erythema marignatum strawberry tongue Cause= post strep pharyngitis untreated can lead to rheumatic heart disease Tx:ABX
138
German measles (Rubella)
3rd disease milder than measles similar presentation rash on face then to body Supportive treatment coryza type symptoms supportive treatment
139
Erythema Infectiosum
5th disease Slapped cheek parvovirus B19 Rash AFTER low grade fever goes away can cause hepatitis self limiting
140
Papular purpuric glove and sock syndrome
Can come from a variety of viruses coxsackie, parvo b19, CMV EBV, etc looks like RMSF can cause fetalis hydrops Dx viral serology, IGM, IGG, PCR Tx symptoms Looks like hand foot mouth but with no mouth involvement No wrist involvement (wrist involved with RMSF)
141
Exanthema Subitum (Roseola
6th disease HHV6 and HHV7 <3yrs Rash after super high fever 104 watch for seizures
142
Hand foot and mouth
Coxsackie virus
143
HSV 1
Oral
144
HSV 2
Genital
145
HSV
Labs direct microscopy Tzank smear (gold standard) Culture must unroof lesion PCR (not during active phase) tx: Antivirals acyclovir if eye keratitis - trifluiridine
146
Herpetic whitlow
Cluster of lesion on digits Very painful and pruritic dental workers thumb sucking Dx viral culture or PCR tx: Antivirals acyclovir (must be oral) I&D makes it worse
147
Molluscum contagiosum
Discrete flesh colored waxy, pearly, dome shaped , umbilicated 2-6mm papules pox virus biopsy immunofluorescence self limiting
148
Verrucae
Wart flat with cauliflower surface biopsy to rule out cancer Tx salycylic acid is best cryo, surg, elctro

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