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Minor Surgery & Dermatology > Conditions of the Skin and Nails > Flashcards

Conditions of the Skin and Nails Flashcards

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1
Q

What skin lesion is flat, non-palpable 5-10 mm in size and shows a change in normal skin color? Give an example

A

Macule: Flat Freckles

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2
Q

What skin lesion is a plaque of dermal edema? Give an example.

A

Wheal: Hives, urticaria

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3
Q

What skin lesion is firm, palpable, incarcerated with base, and >10 mm in size? Give an example.

A

Nodule: Tumor

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4
Q

What skin lesion is raised, palpable with no base and is 5-10 mm? Give an example

A

Papule: Warts or mole

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5
Q

What skin lesion is a vesicle filled with purulent or cloudy exudate? Give an example

A

Pustule: acne pimple

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6
Q

What are the common signs and symptoms of actinic keratosis?

A

Begin as small rough spots, easier felt than seen: sandpaper-like texture
Hyperkeratotic, pearly, gray-white appearance, 3-10 mm in size; recurs if scraped off

1) Rough, scaly patch of skin
2) Appears as a non-healing sore
3) Often on sun-exposed areas
4) Precursor to SCC

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7
Q

What are the symptoms of basal cell carcinoma?

A

Skin colored papule/nodule with rolled, translucent “pearly” telangiectatic border, and depressed/eroded/ulcerated center.

Sides of the crater have telangiectatic (Spider like) vessels

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8
Q

How would you evaluate for a basal cell carcinoma?

A

Biopsy: If shallow lesion, do shave biopsy; otherwise punch or excisional biopsy may be more appropriate

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9
Q

What are the predisposing factors for squamous cell carcinoma?

A

WB: Sunlight exposure, pale skin, light colored eyes, blond, red hair, actinic keratosis

Primarily on sun- exposed skin in the elderly; chronic sun exposure
Actinic Keratosis
Arsenic Exposure
Most common complication during immunosuppressive therapy
M>F

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10
Q

Where are the lesions of squamous cell carcinoma found predominantly?

A

70% occur on the head and neck

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11
Q

How are the lesions of squamous cell carcinoma described ?

A

Indurated erythematous nodule/plaque with surface scale/crust +/- ulceration; may bleed easily, frequently, single but may be multiple

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12
Q

Which of the following skin lesions metastasize? Squamous cell or basal cell carcinoma?

A

Squamous Cell Carcinoma

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13
Q

Exposure to what toxic metal is associated with basal and squamous cell carcinoma?

A

Arsenic

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14
Q

What malignant tumor derived from the endothelia cells is seen in AIDS?

A

Kaposi Sarcoma: Spindle Cell Tumor

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15
Q

What are the common signs and symptoms of Kaposi’s Sarcoma?

A

Raised, round, or oval papules, that are red-purple that ulcerates

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16
Q

What are the predisposing risk factors for melanoma?

A

1) Slow onset of change in nevus
2) Pale skin, light colored eyes, blonde or red hair
3) Blistering sunburn as a child
4) Large quantity of moles
5) Family or personal Hx

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17
Q

What is the mnemonic for melanoma and what does it stand for?

A

ABCDEs
A:Asymmetry
B: Boarder irregularity
C: Contour or Color variation
D: Distribution or Diameter (enlarged): >6mm or size of pencil eraser
E: Evolving: changing in size, shape, or color

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18
Q

What are the best methods for evaluation for melanoma?

A

Clinical observation, dermoscopy, Excision Biopsy

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19
Q

What condition causes a malar rash on the face with pustules and papules on an erythematous base and telangiectasia?

A

Acne Rosacea

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20
Q

What types of things exacerbate ance rosacea?

A

Stress, alcohol (especially wine), spicy food, weather (heat, cold, wind, sun), vasodilators, histamine foods

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21
Q

Rhinophyma (lumpy nose) is associated with what disease?

A

Acne Rosacea

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22
Q

What class of herbs are well established for acne rosacea?

A

Alternatives: Arctium Lappa, Rumex Crispus, Taraxacum officinalis root

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23
Q

What does acne vulgaris have that acne rosace does not have?

A

Comedones: Plugging of hair follicle by keratin debris
Open- Blackhead
Closed- Whitehead

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24
Q

What vitamin may be contraindicated with acne vulgaris?

A

B12

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25
What mineral may be contraindicated with acne vulgaris?
Iodine
26
What mineral may be indicated with acne vulgaris?
Zinc
27
What herb, used topically, is indicated for acne?
Melaleuca alternifolia
28
What herb is indicated for premenstrual acne?
Vitex agnus-castus
29
Which vitamins are indicated in the treatment of acne vulgaris?
Vitamin A, B5, B6, Folate
30
What is an acute spreading infection of the dermis and subcutaneous tissue?
Cellulitis
31
What are the signs and symptoms of cellulitis?
Involves the lower dermis/subcutaneous fat Erythema, warmth, swelling, and pain Borders are not elevated, poorly demarcated vesicles Regional lymphadenopathy Orange peal appearance skin
32
What homeopathic remedies might you suggest for cellulitis that is better with pressure and hot applications?
Pyrogenium
33
Describe the characteristics of a rash caused by candida albicans?
Erythematous with satellite lesions ( broken pieces spread out)
34
What drug could be used to treat the rash caused by candida albicans?
Nystatin, miconazole or clotrimazole
35
Describe the characteristics of a rash caused by a bed bug (cimicosis) ?
Small papules arranged in a line
36
What is inflammation of the hair follicle called?
Folliculitis
37
What are the clinical findings in folliculitis?
Pustule around the hair follicle
38
What is in the DDx for folliculitis?
Furunculosis Tinea Acne Contact Dermatitis Candidiasis Molluscum Contagiosum
39
What are some treatment options for folliculitis?
Good Hygiene Topical Antimicrobials that cover gram-positive organisms
40
What is a topical antimicrobial that covers gram-positive organism you might use empirically for folliculitis?
Erythromycin or Clindamycin Topical
41
What is the prodrome of herpes simplex infection?
Tingling, pain, burning or itching precedes appearance of crops of small fluid filled vesicles on erythematous base
42
How is herpes diagnosed?
Clinical or viral culture
43
What is the DDX for herpes simplex?
Impetigo Aphthous stomatitis Herpes Zoster Chancroid Varicella Syphilis
44
How soon after initial infection does the herpes simplex antibodies titer peak?
4-6 weeks
45
What drugs are indicated for herpes simplex infections?
Acyclovir, Valacylovir, or Famciclovir
46
What topical botanicals may be helpful for herpes simplex?
Larrea Tridenta Melissa officinalis Glycyrrhiza
47
What amino acid is helpful for herpes infection?
Lysine: Competitively inhibits synthesis
48
What amino acid may be associated with an increase in herpes simplex outbreaks?
Arginine: Required for reproduction
49
What are the common signs and symptoms of lichen planus?
6 P's: Pruritic, Polygonal, Planar (Flat-topped), purple, papules, and plaques Wickham Striae Usually symmetric distribution on flexor surface of arms shins, mouth, scalp and genitalia
50
What conditions are associated with lichen planus?
Autoimmune Disorders: Primary Biliary Cirrhosis DM Ulcerative Colitis Myasthenia Gravis Hepatitis C
51
What disease is a common benign viral disorder characterized by small umbilicated papules?
Molluscum Contagiousm
52
How is molluscum contagiousm transmitted?
Contact with infected person or contaminated object
53
What are the signs and symptoms of molluscum contagiosum?
Dome-shaped lesions with central crater (umbilicated papules) containing white papule without pruritus
54
What conditions are in the ddx for molluscum contagiosum?
Basal Cell Carcinoma Furunculosis Warts Pyoderma/Impetigo Lichen planus
55
What are some treatment options for molluscum?
Cryotherapy Curettage/Electrodessication Salicylic Acid Spontaneous remission in 6-9 months
56
Who is most at risk for developing necrotizing fasciitis?
DM Drug Use Immunosuppression Traumatic Wounds
57
What are the common signs and symptoms of necrotizing fasciitis?
Intense pain and tenderness Reaches past the border of erythema Crepitus Rapidly Spreading
58
What is the name of the inflammatory conditions caused by Staph, Strep, or Candida that may affect the nail fold?
Paronychia
59
What are the common signs and symptoms of pityriasis alba?
1)Ill-defined, scaly and slightly erythematous patches 2) Once the lesions resolve, the area becomes hypo-pigmented 3) Most commonly seen on the cheek
60
What are the common signs and symptoms of pityriasis rosea?
1) Herald Patch 2) Christmas Tree dermatomal pattern of skin lesions 3) Pruritis
61
What are the common signs and symptoms of scabies?
1) Extreme pruritus 2) Rash between the fingers, penis, scrotum, buttocks, groin, or axilla 3) Erythematous burrows with dark spot at one end 4) Excoriation from scratching
62
How is scabies diagnosed?
Skin scraping showing organism or eggs
63
What preventative strategy would you suggest to your patient with scabies?
Good Hygiene Protective clothing when working with infected people Clean bedding and clothing
64
What is a typical drug used to treat scabies ?
First Line: Permethrin Topical Second Line: Lindane or Ivermectin
65
What are the concerns about the topical anti-lice and anti-scabies drugs used?
They may be neurotoxic to children as well as arthropods
66
What is a red, scaly, greasy rash with minimal itching commonly seen on the eyebrows and scalp?
Seborrheic Dermatitis
67
What herb, used topically, is indicated in tinea infections?
Melaleuca alternifolia
68
What is terbinafine indicated?
Tinea infections, Onychomycosis
69
What are the routes of administration for terbinafine?
Oral, powder, cream
70
What are the contraindications for terbinafine?
SLE, Liver disease (hepatotoxic): must check liver enzymes, before and during treatment
71
What is tinea versicolor now called?
Pityriasis versicolor
72
Describe the lesions of tinea versicolor
Superficial cutaneous fungal infection characterized by well-demarcated hypo-pigmented or hyper-pigmented macules or patches usually located on the chest and back.
73
How do you clinically evaluate a patient for tinea versicolor?
1) Clinical observation 2) Fungal elements in KOH prep "Spaghetti and meatballs" appearance 3) Fluoresces gold under wood's lamp
74
What are epidermal (sebaceous) cysts characterizes by?
Central well or punctum
75
What skin lesion develops on older individuals that are scaly and have a greasy stuck on appearance?
Seborrheic Keratosis
76
What characteristics of these lesions may raise concern if you did not know what they were?
They usually have color variations, are larger than 6 mm, may have irregular borders and are elevated. This ranks them higher on the ABCDE for melanoma. However, they are benign.
77
What causes warts?
HPV (Human Papilloma Virus)
78
What are symptoms of a plantar wart?
Solitary papule, often tender, covered by a thick callus, frequently surrounded by smaller warts
79
What are some treatment options for warts?
1) No treatment: 65-90% regress spontaneously within 2 years 2) Salicylic Acid OTC topical 3) Adhesiotherapy: duct tape 4) Cryotherapy 5) Chemotherapeutic agents: 5-fluorouracil, bleomycin 6) Intralesional Immunotherapy: Candida Albicans inections into warts to stimulate immune response Verrucae Vulgaris=Warts
80
What herbs may be indicated for warts?
Chelidonium Majus Podophyllum pelatum Thuja occidentalis Melissa officinalis
81
What sign is absent in bullous pemphigoid?
Negative Nikolsky's Sign (slight rubbing does not cause outer layer of the blistered skin to come off)
82
Where are the lesions in bullous pemphigoid most often located?
Flexors of forearms, axillae, medial thighs, mouth, groin abdomen
83
How is bullous pemphigoid diagnosed?
Skin biopsy show show-epidermal blisters and anti-basement membrane auto Igs. Immunofluoresnce shows linear deposition of IgG and C3 along basement membrane
84
What autoimmune condition is associated with dermatitis herpetiformis?
Celiac Disease
85
Which develops faster, allergic contact dermatitis or irritant contact dermatitis?
Irritant contact dermatitis
86
What mineral is indicated therapeutically in cases of atopic dermatitis?
Zinc
87
What does chronic scratching cause?
Lichenification
88
Which diseases are associated with lichenification?
Atopic Dermatitis Scabies Lichen Simplex Chronicus
89
What other conditions are associated with atopic dermatitis?
Atopic Conditions: Asthma, Allergic, Rhinitis, Family History of Atopic Conditions
90
Where are the lesions usually seen in atopic dermatitis?
On flexor surfaces
91
What homeopathic remedies might have you consider in atopic dermatitis?
Itchy skin remedies like sulphur, Psorinum, Petrolselinum
92
What herbs could be used for atopic dermatitis?
Matricaria recutita Berberis spp Galium Aparine Arctium Lappa
93
What nutrient might you consider in atopic dermatitis to stabilize mast cells?
Vitamin C
94
What skin disease has a symmetrical distribution if lesions with concentric rings (target lesions)?
Erythema Multiforme
95
What types of triggers cause erythema multiforme?
Drug reaction, vaccination, HSV and other bacterial and viral infections
96
What disease of autoimmune origin is characterized by intra-epidermal bullae?
Pemphigus vulargis
97
What are the clinical findings for pemphigus vulgaris?
Intra-epidermal blisters or bullae that arise from normal-looking skin and become painful erosions
98
How is pemphigus vulgaris diagnosed?
(+) Nikolsky's sign: Slight rubbing causes detachment of the epidermis, positive Tzank smear
99
What disease shows the Auspitz sign?
Posriasis, Auspitz sign is when a flake is removed, a pinprick of blood will be present
100
Psoriasis most commonly affects which part of the body?
Extensor surfaces
101
What herb is well established in the treatment of psoriasis?
Berberis aquifolium
102
What herbs are theoretically contraindicated in psoriasis?
Immune stimulant herbs: Echinacea
103
What vitamin is indicated topically in psoriasis?
Vitamin D
104
What are 2 major factors in the severity of psoriasis?
Stress and alcohol intake
105
What homeopathic remedy is indicated for psoriasis in a person with thick crusts on elbows, desires vinegar, and is ameliorated by vigorous motion?
Sepia
106
What is the etiology of vitiligo?
Cause is unknown, but may be autoimmune or familial, is associated with Vitamin D deficiency
107
What are the clinical findings of vitiligo?
Completely depigmented (hypopigmented) patche or macules with no scaling. Sunburn easily, course unpredictable and progressive
108
What mineral may be indicated for for vitiligo?
Copper
109
What vitamin may be indicated for vitiligo?
Vitamin D3
110
What amino acid may be indicated in vitiligo?
Phenylalainine
111
What causes stasis dermatitis?
Aka gravitational dermatitis, chronic venous insufficiency
112
What are the signs and symptoms of stasis dermatitis?
Erythematous, hyper-pigmented eruptions Dilated superficial veins Mild Scaling, edema or ulceration Most commonly found on medial ankle

Minor Surgery & Dermatology (2 decks)

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