Clinical Perspectives In Skin Changes - Dr. Tyler

Question 1

Nodule is what and examples

Answer 1

papule or lesion that extends into the dermis and SUBQ,

• cysyts
• lipomas
• fibromas

Question 2

when do you see vesicles

Answer 2

acute allergic contact dermatitis
dermatitis herpetiform
chicken pox (at different stages)

Question 3

when do you nee pustules

Answer 3

bacterial infections
folliulitis
pustular psoriasis

Question 4

when do I see Bullae

Answer 4

blister bigger then 10mm
irritant contact dermatitis
allergic contact dermatitis 
burns / bites
drug reactions 
pemphigous vulgaris**, bullous pemphigoid**

Question 5

I see Petichiae when

Answer 5

foci of hemorrhage

from platelet problems, vasiculitis, infections, Rocky Mountain spotted fever, Rickettsia

Question 6

Purpura is seen when

Answer 6

PALPABLE : ** Leukocytoclastic vasiculitis , palpable, vasculitis
NON-PALPABLE : hemorrhage, microvascular occlusions + ischemic hemorrhage
(can be seen in coagulopathy)

Question 7

urticaria

Answer 7

wheals, hives
elevated
pruretic, red, sharp boarders*
usually from hypersensitivity, bites, drugs, autoimmunity, usually lasts up to 24hrs

Question 8

Scale

Answer 8

Excessive accumulation of stratum corneum (flaking of skin)

Question 9

Crust

Answer 9

dried body fluid (serous = yellow, hemorrhagic = red)

Question 10

Excoriation

Answer 10

linear defects in epidermis (usually from scratching)

Question 11

Erosion

Answer 11

Loss of epidermis , with dermis in tackt

Question 12

Ulcer

Answer 12

full thickness destruction of epidermic and dermis

Question 13

Fissure

Answer 13

linear break in epidermis usually along skin lines

Question 14

Lichenification

Answer 14

visible thickening in skin causing accentuated skin fold markings

Question 15

Atrophy

Answer 15

loss of substance (depressed or shiny delicate skin on epidermis)

Question 16

Nummular

Annular

Answer 16

coin like circular

ring like with clear center(fungal)

Question 17

Target lesions is seen in what

Answer 17

Erythema multiforme

Question 18

Seroinginous lesions

Answer 18

linear, branched, curving (parasitic)

Question 19

Reticulated lesions

Answer 19

lacy, network looking

Question 20

Herpetiform

Answer 20

groups of papules or vesicles (Herpes)

Question 21

Herpesvirus 1 and 2

Answer 21

stomatits (lip), GU lesions, Bell’s palsy, encephalitis

Question 22

Herpes Varicella rash

Answer 22

pruritic, centrifugal, papular changing to vesicular to pustular to crusting all at once
= chicken pox or shingles

Question 23

Herpes Zoster rash

Answer 23

tingling pain, eruption of vesicles in dermatome distribution, pustules, crusting,
- usually on face and shoulders

Question 24

what is something that a person with Herpes zoster can get

Answer 24

Post- herpetic neuralgia

Question 25

Meningitis SX

Answer 25

fever, H,V, delirium, = Petechial rash (skin and oral) = + Brudzinski, + Kernig sign = purulent spinal fluid (GRAM - diplococci)

Question 26

rash in meningitis

Answer 26

perichiae | disseminated intravascular coagulation (DIC) can happen especially if patient is in septic shock = Purpura fulminans

Question 27

Seborrheic Keratosis

Answer 27

benign papules + plaques, brown, black, velvety, warty surface (3mm - 20mm) = look stuck on = no tx needed (can be mistaken as melanoma)

Question 28

Actinic Keratosis

Answer 28

``` macules and papules (0.2cm - 0.6cm) =flesh colored pink, some hyperpigmentation = sandpaper = tender = sunexposed areas = premalignant, can become SCC ```

Question 29

rosacea

Answer 29

red papules all over face (red papule rash) | overgrowth of nose epithelium

Question 30

Seborrheic dermatitis

Answer 30

scalp, face, chest, umbilicus, back, eyelids, GU, = yellow dandruff oily = pruritus = high it parkinsons disease

Question 31

BCC looks like what

Answer 31

pearly papule, red, 6mm or bigger = sun exposed areas = nonhealing ulcer = 2nd most common skin cancer

Question 32

risk of BCC

Answer 32

history of bleeding | intense intermittent sun exposure esp light skinned

Question 33

SCC looks like what

Answer 33

``` nonhealing ulcer or warty nodule = from long-term sun exposure = ear, temple, lip, oral, GU (can metastasize) = common in light skinned transplant pts = most common skin cancer ```

Question 34

Psoriasis looks like

Answer 34

thick, well demarcated salmon color plaque = silvery scale on top = EXTENSOR muscels, scalp, palms, feet = pitting nails

Question 35

inverse psoriasis

Answer 35

on flexor muscels

Question 36

psoriasis is associated with what

Answer 36

1. metabolic syndrome 2. Cardiovascular disease 3. 30% have psoriatic arthritis

Question 37

how does psoriasis happen

Answer 37

chronic inflammation of papulosquamous and immune mediated skin disorder

Question 38

what makes psoriasis come or worse

Answer 38

``` stress koebner phenomena (trauma) cold, hot infection (strep, HIV) mediactions (NSAIDS, sterioids, antimalaria) ```

Question 39

erythema migrans

Answer 39

bulls eye lesions | Borrelia burgdorferi = lymes disease

Question 40

erythema multiforme

Answer 40

target lesions can have a bullae halo around it, center is red patch/plaque rings of light then dark red around

Question 41

what causes erythema multiforme

Answer 41

Herpes Simplex | Mycoplasma pneumoniae

Question 42

SLE looks like

Answer 42

pruritis sensitive to sunlight arthralgia, myalgia, fatigue, malaise, fever, night sweats, headache, hair loss, visual changes (diffuse nonscarring nondescript lesions) = butterfly rash

Question 43

Dermatomyositis

Answer 43

chronic immune mediated disorder of skin and proximal skeletal muscles = pruritus and rash looks like other dermatitis = usually associated with celiac disease = scarly red patches in scalp, knuckles (Gottrons papules) = difficulty climbing stairs or raising arms = photosensitive

Question 44

pt with dermatomyositis are in risk for

Answer 44

malignancy

Question 45

acanthosis nigracans

Answer 45

velvet like hyperpigmented plaques lateral neck of DM

Question 46

Pretibial myxedema

Answer 46

pink, waxy, indurated plaque on lower leg (looks like a wet shiny raw leg) = Graves disease (hyperthyroidism)

Question 47

Erythema nodosum

Answer 47

non-granulomatous lesions = associated with sarcadosis* = usually anterior tibia (lower legs) = tender*, red, subcutaneous nodule*

Question 48

Erythema infectiosum

Answer 48

Parovirus B15, fifth disease = fiery slapped cheek appearence, circumoral pallor = lacy rash (trunk limbs) = malaise, H, D, pruritus , fever before rash**

Question 49

scarlet fever

Answer 49

strawberry tongue ** = from toxin B-hemolytic strep (usually from exudative pharyngitis) =sunburn like rash, fine red papules = sandpaper skin **

Question 50

Streptococcal pharyngitis

Answer 50

strep, sudden onset feverm sore throat, pain swallowing, tneder cervical LN, malaise, N purulaent exudate, red pharynx, tonsilsm soft palate = Centor clinical criteris = fever, tneder cervical LN, NO cough, pharyngotonsillar exudate****

Question 51

Measles

Answer 51

fever malaise, conjunctivities, coryza, COUGH, rash, KOPLIK SPOTS (befroe teh other body rash comes) blanching skin red rash (dots on trunk and can move to extremities)

Question 52

Nikolsky sign

Answer 52

some lateral pressure on skin cases epidermis to slough or blister to rupture (pulling away with 2 fingers on either side of blister only not on blister the skin next to it)

Question 53

where is Nikolsky sign seen

Answer 53

Pemphigoid Vulgaris (NOT pemphigus bullous)

Question 54

Bullous pemphigoid

Answer 54

starts on legs then spreads after years elderly usually from UV exposure, drugs like PCN - Type 2 hypersensitive

Question 55

Pemphigoid vulgaris

Answer 55

autoimmune, large superfiical loose bullae peel off leaving denuded skin oral mucosa and skin

Question 56

Vasculitis

Answer 56

inflammation and damage to BVs = small vessels in epidermis = medium vessels in dermis

Question 57

large BV vasculitis

Answer 57

giant cell arteritis polymyalgia rheumatica aortitis Takayasu arteritis

Question 58

Medium vaculitis

Answer 58

=polyarteritis nodosa = NO ANCA autoantibodies** | =Granulomatosis

Question 59

small vasculitis

Answer 59

``` = Hypersensitivity vasculitis =IgA =Cryoglobulinemia =Goodpasture syndrome =Anti-Glomerular BM ```

Question 60

most important determinant is dx prognosis of melanoma

Answer 60

tissue depth