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Derm Flashcards

1
Q 
Macule
Papule
Patch
Plaque
Vesicle
Bulla
A 
Flat lesion < 1cm
Raised lesion < 5mm
Macule > 1cm
Papule >5mm
Fluid filled lesion < 5mm
Vesicle > 5mm
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2
Q

Type 1 hypersensitivity names, path, examples*,

A

“Anaphylaxis, atopic” “IgE mediated”

Preformed IgE antibodies on MAST/basophils react to antigen ==> fast, massive vasoactive amine release

Anaphylaxis
Asthma
Hives 2/2 drug reactions

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3
Q

Type 2 hypersensitivity names, path, examples*

A

“Cytotoxic” “Antibody mediated”

IgM/IgG and complement form membrane attack complex ==> cell lysis

Goodpasture’s
Autoimmune hemolytic anemia
Erythroblastosis fetalis
Rheumatic fever

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4
Q

Type 3 hypersensitivity names, path, examples*

A

“Immune complex”
Antigen-antibody ==> complement ==> PMNs
SLE, glomerulonephritis, RA, polyarteritis nodosa

“Serum sickness”
Antibodies form over ~5 days ==> immune complexes form and lodge in membranes ==> complement fixation ==> tissue damage
Drug reaction

“Arthus reaction”
Preformed antibodies ==> vascular necrosis
2/2 vaccines

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5
Q

Type 4 hypersensitivity names, path, examples*

A

“delayed / cell mediated”

Sensitized T-lymphocytes release cytokines ==> macrophage damage (no antibody damage)

Transplant rejection
Contact dermatitis
Tb skin test

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6
Q

Atopic dermatitis / eczema path, presentation, dx, tx

A

Type 4 (?) skin rxn 2/2 many triggers (nickel, plants, emotional, climate etc.)

Presents different in different age groups**

  • Infants: SYMMETRIC, erythematous, edematous, pruritic papules on face, scalp, chest, & EXTENSOR surfaces
  • adolescents: dry, scaly, red papules on FLEXOR and neck
  • adults: lichenification on FLEXOR surfaces, eyelids, hands

Eosinophilia & IgE elevation

Moisturizers ==> topical steroids ==> tacrolimus [2wks maximum]

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7
Q

Erythema toxicum neonatorum presentation, dx, tx

A

Blanching papules
1-3 days post delivery
SPARING PALMS/SOLES

Clinical
Eosinophila

Benign: no tx

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8
Q

Contact dermatitis path**, presentation, dx, tx

A

Type IV hypersensitivity reaction (requires prior exposure ==> T-cell activation)

Red, edematous, vesicles/papules often in distribution of offending agent

Clinical dx
Patch testing can identify agent

Topical steroids

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9
Q

Eczema herpeticum path, presentation, dx, tx*

A

Systemic HSV infection 2/2 eczema (aka atopic dermatitis)

Infant with atopic dermatitis history
Numerous vesicles and erythema over area of previous dermatitis
FEVER, adenopathy

Clinical

IV acyclovir STAT!

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10
Q

Seborrheic dermatitis path, presentation*, dx, tx

A

Pityrosporum ovale yeast dermatitis with propensity for sebum & hair follicles

Infants: cradle cap (yellow scale on scalp)
Other: red-yellow, oily, scaly patches on ears, eyebrows, nose, scalp
*Common in Parkinson’s and AIDS patients

Dx: r/o contact dermatitis and psoriasis

Tx:

  • babies: routine bathing
  • adults: zinc pyrithione or selenium sulfide shampoos; topical antifungal or corticosteroid
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11
Q

Psoriasis path, presentation, dx, tx

A

T-cell inflammation in dermis ==> epidermal hyperplasia

Begins in teens, early adulthood
Red plaque, sharp demarcations, with SILVERY scale
EXTENSOR surfaces
Nail changes: oil spots, pitting, lifting

Auspitz’ sign: bleeding when scraped
Biopsy: thickened epidermis with preserved nuclei (parakeratosis) in stratum corneum (outermost epidermis) and neutrophilic inflammation; elongated rete ridges

Topical steroids
Keratolytic agents: tar, UV light
Vitamin D3
Methotrexate if severe

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12
Q

Urticaria (hives) path, presentation, dx, tx

A

Type 1 hypersensitivity reaction of MAST cell histamine & prostaglandin release

Rapid onset hives…

Clinical

Antihistamines
IM epinephrine
Airway management

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13
Q

Drug eruption path, presentation, dx, tx

A

Types 1-4 hypersensitivity…could be any!

Usually 7+ days post-drug…so unlikely if 1-2 days after starting new drug

Symmetric, pruritic rash

Eosinophilia

Remove drug
Topical steroids & antihistamines

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14
Q

Erythema multiform “minor” (EM) path, presentation*, dx, tx, risks

A

Often 2/2 HSV or mycoplasma

Red, target-shaped lesions
+/- MINOR constitutional symptoms
PALMS/SOLES

Clinical

Symptomatic tx only… no steroids needed

Risk ==> progression to SJS or TEN (share single disease spectrum)*

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15
Q

Stevens-Johnson Syndrome (SJS, EM “major”) / Toxic Epidermal Necrolysis (TEN) path, presentation, dx*, tx

A

Immune-complex mediated hypersensitivity ==> exfoliating skin, often 2/2 erythema multiform or drugs: phenytoin, carbamazepine, penicillin, sulfonamides (TMP-SMX), allopurinol, NSAIDs

SJS < 10% BSA
-same targetoid lesions as EM minor, but more prominent in mucosal and widespread lesions
-more prominent constitutional symptoms than EM minor
TEN > 30% BSA

Massive mucocutaneous rash
Often targetoid lesions
Genital involvement
+ NIKOLKSY SIGN: sloughing with light touch

Biopsy:

  • SJS = basal epidermis degeneration
  • TEN = eosinophilic full thickness epidermal degeneration

Tx: systemic corticosteroids, IVIG

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16
Q

Erythema nodosum path, presentation, dx, tx

A

Panniculitis of legs, usually 2/2 infection, drugs, chronic inflammatory diseases

Painful pretibial nodules

Clinical dx
False + VDRL (like SLE)

Remove underlying cause or workup for trigger disease

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17
Q

Bullous pemphigoid path, presentation, dx, tx

A

Anti-bullous pemphigoid antigen and/or IgG & C3 attacking hemidesmosomes at BM dermal-epidermal junction

> 60 y/o
Tense, independent vesicles / bullae
Usually NOT mucosal
NEGATIVE Nikolsky’s sign

Clinical
Immuno: IgG and C3 deposits at dermal-epidermal junction

Prednisone

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18
Q

Pemphigous vulgarism path, presentation, dx, tx

A

Anti-desmoglein antibody (IgG) destroys keratinocyte adhesion WITHIN epidermis, often 2/2 drugs: ACEi’s, penicillamine, penicillin, phenobarbital

40-60y/o
Confluent, scaly erosions
Usually mucosal involvement
\+Nikolksy sign
More severe course than BP

Clinical but biopsy can be used

High dose prednisone + IVIG etc.

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19
Q

HSV 1&2 path, presentation**, dx, tx

A

Dormant in nerve ganglia but infect epidermal cells causing fusion of epidermal giant cells

Herpes…painful lesion of lips & genitals
Herpetic whitlow: swollen herpetic lesion on hand 2/2 genital herpes or contact with saliva (dentists…)

Biopsy: multinucleated giant cell on Tzank smear (doesn’t r/o VZV)

Acyclovir (IV if severe)

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20
Q

Dermatitis herpetiformis path, presentation, dx, tx

A

Celiac-related

Celiac hx
Pruritic papules and vesicles occurring bilaterally along elbow, knees, butt, neck, scalp

Immunoflouresence: IgA deposition at dermal papillae

Dapsone* + gluten free

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21
Q

Varicella zoster path, contagiousness, presentation, dx, tx

A

VZV…aka chicken pox
Passed via droplet or direct contact
10-20 day incubation
Contagious 24 hours pre-manifestation until lesions crust

Constitutional symptom prodrome
Pruritic rash anywhere EXCEPT palm/soles

Clinical

Self-limited

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22
Q

Herpes zoster path, presentation*, dx, tx

A

VZV recurrence in a nerve (aka shingles)

Painful prodrome ==> dermatomal papules evolving into vesicles & bullae ==> crusting in 10 days
*Most common in immunocompromised and elderly

Clinical dx

-cyclovir & pain control

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23
Q

Molluscum contagiousum path, contagiousness, presentation, dx, tx

A

Poxvirus* in children or HIV/AIDS immunocompromised spread by direct contact

Waxy, flesh-colored papule with central umbilication usually on trunk, limbs, anogenital area

Clinical but also express fluid onto slide to find inclusion or molluscum bodies

Physical destruction with freezing or acid

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24
Q

Warts / verrucae path, presentation, dx, tx

A

HPV via direct contact
16 & 18 can cause squamous malignancy

Cauliflower-like or velvety white lesion

Clinical

Genital: cryotherapy
Cervical: pap smear ==> colposcopy

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25
Impetigo path, presentation*, dx, tx
Group A staph or strep skin infection Common: macule ==> pustule ==> pops into honey color crusting, usually on face Rare: bullous type on extremities, usually 2/2 S. aureus and can cause scalded skin syndrome (SSS) Clinical Topical antibiotic with staph/strep activity, like mupirocin
26
Scarlet fever path, presentation*, dx, tx
Strep pyogenes Preceded by throat infection ==> fever, vomiting, headache ==> upper body papules with sandpaper texture Strawberry tongue Penicillin
27
S. typhi presentation dx, tx
Triad: Truncal papules > 10 Fever GI involvement Floroquinolone + 3rd gen cephalosporin
28
Cellulitis path, presentation*, dx, tx*
Staph or group A strep ==> infection of skin & subQ Hot, swollen, tender skin Clinical, but culture for MRSA Oral abx UNLESS: systemic signs (high fever, chills etc.), diabetic, hand or orbital involvement, old/young ==> IV nafcillin, cefazolin, vanc
29
Necrotizing fasciitis path, presentation*, dx, tx
Strep pyogenes, staph aureus, E. coli, clostridium perfringens ==> infection of fascial plane ``` Often 2/2 trauma or surgery Severe pain Putrid discharge Bullae Gas production Rapid erythema ``` XR or CT: gas in lesion Biopsy @ edge of lesion: diagnostic Emergent surgery Penicillin G, if Strep Metronidazole or 3rd gen cephalosporin if anaerobic
30
Fournier's gangrene
Necrotizing fasciitis of balls!
31
Acne vulgaris path, presentation, dx, tx**
Hormone activation of sebaceous gland ==> comedone plugs ==> inflammation 2/2 Propionibacterium acnes Blackhead/whitehead ==> topical tretinoin or benzoyl Inflammatory ==> topical benzoyl + tretinoin ==> topical erythromycin ==> systemic erythromycin or tetracycline Severe ==> oral isotretinoin (must check triglycerides, cholesterol, LFTs, and beta-HCG monthly)
32
Tinea versicolor path, presentation*, dx*, tx
Fungal skin infection 2/2 Malassezia furfur Hypo or HYPERpigmented skin lesions, often post-humid climate SCALE with scraping though don't appear scaly KOH prep: spaghetti & meatballs hyphae and spores Tx: ketaconazole or selenium sulfide
33
Candida path, presentation, dx, tx
Candida fungus ==> oral or skin infection Recent abx, steroids, DM, or HIV Mouth: white lesions that DON'T scrape Skin: erythematous patches with satellite lesions KOH prep showing hyphae and psuedospores Oral: oral fluconazole & nystatin wash Skin: topical fluconazole or nystatin
34
Dermatophyte path, presentation*, dx*, tx*
Fungi? Microsporum and Trichophyton *Tinea corporis: red, scaly, pruritic, central clearing, well-circumscribed often in children or immunocompromised Tinea pedis: athletes foot Tinea cruris: jock itch Tinea capitis: similar to seborrheic dermatitis KOH prep showing hyphae Antifungal: terbinafine*, itraconazole, griseofulvin
35
Lice path, presentation, dx*, tx
Parasite of hair, skin, or pubes ("crabs") Intense itching Visible on CLOTHES, not people Pyrethrin or permethrin ("RID") + ETOH wash
36
Scabies path, presentation*, dx, tx*
Arthropod burrows into skin and forms tunnels Intense itching, especially at night and after hot showers Vesicles with linear track (burrowing), especially hands between knuckles and genitals Clinical / visible Permethrin or ivermectin
37
Gangrene path, presentation, dx, tx
Dry: vascular insufficiency ==> cold, blue Wet: bacterial infection ==> bruised & pustulent Gas: C. perfringens ==> pale / red 2/2 trauma AMPUTATE Abx are given but only to preserve healthy tissue Hyperbaric O2: kills anaerobic Clostridium
38
Acanthosis nigricans presentation*, associations*
Dark hyperkeratotic skin under arms, genitals 2/2 DM, PCOS, cushing, obesity, or PARANEOPLASTIC GI malignancy in older people
39
Lichen planus path, presentation, dx, tx
Inflammatory dermatosis Flat topped, violaceous, polygonal plaque often @ trauma site Steroids
40
Rosacea presentation*, dx, tx
Facial erythema and telangiectasias in middle aged folk, usually those who flush easily Precipitated by hot/cold, emotion Topical metronidazole ==> daily doxy
41
Pityriasis rosea path, presentation, dx, tx
Unclear but perhaps 2/2 human herpes virus Often young adults Herald patch: initial oval plaque ==> progresses to truncal oval plaques with fine "cigarette paper" scaling, often in christmas tree pattern on back Clinical: r/o Tinea corporis with KOH Self-limited but antipruritics help
42
Seborrheic keratosis path, presentation*, dx, tx
Unknown etiology Stuck-on, crusty brown-blue lesions Clinical Cryotherapy, 5FU
43
Actinic keratosis path, presentation*, dx, tx
Pre-malignant squamous cell carcinoma Red with white, "sandpaper" scaly plaque on sun-exposed area Biopsy to r/o SCC? ==> cryotherapy, topical imiquimod or 5-FU
44
Squamous cell carcinoma path*, risk factors, presentation*, dx, tx
Squamous cord with keratin pearls in vermillion zone Sun exposure = #1 ARSENIC exposure on hands Chronic trauma (non-healing lesions should be suspected*) Ulcerating, crusting plaque Often on lip Biopsy ==> excise
45
Basal cell carcinoma path*, commonality, risk factors, presentation*, dx, tx
Spindle cells with palisaded basal cells Most common skin cancer ==> locally destructive but no real metastatic potential UV light Waxy, rolling border with telangiectasias RARELY if ever on lips Excision
46
Melanoma subtypes, dx, tx
Lentigo: arises on lentigo 2/2 sun-damage Superficial spreading Nodular: rapid vertical growth, reddish brown Acral: on hands or feet in patch Amelanotic Excisional biopsy to get Breslow depth If >1mm ==> sentinel node biopsy
47
Kaposi's sarcoma path, presentation, dx, rule out, tx
Associated with HSV8 ==> vascular proliferation Many violaceous plaques Biopsy & clinical Rule out: Bartonella infection "bacillary angiomatosis"! Excision
48
Mycosis fungoides path, presentation, dx, tx
Cutaneous T-cell lymphoma Early: psoriatic plaque, non-specific Late: red-brown nodular tumors and lymphadenopathy Sezáry cells: cerebriform lymphocytes Any non-healing dermatitis needs biopsy to rule this out! Phototherapy
49
Staph scalded skin syndrome path, presentation*, tx*
Staph aureus toxin against desmoglein 1 Fever prodrome Diffuse erythema, starting on face ==> flaccid bullae and perioral crusting +Nikolsky Oxacillin or vancomycin
50
Scary neonatal diseases passed from mom presentation*, tx*
VZV or herpes Fever VESICULAR rash ==> disseminated multi organ failure Acyclovir!
51
Sunscreen recommendation
30+ applied 15-30 minutes before going outdoors | Reapply q2 hours
52
Henoch schonlein purpura (HSP) path, presentation*, dx*, tx
IgA vasculitis Tetrad: symmetric LE palpable purpura, abdominal pain (colicky), renal disease (glomerulonephritis), arthralgia NO THROMBOCYTOPENIA Often 2/2 recent infection, especially children Dx: clinically if LE purpura + one of above...or biopsy NSAIDs & supportive care
53
Cherry hemangioma path, presentation*
Benign vascular tumor Sharply circumscribed cherry-looking thing in adults
54
Rubella other name, path, presentation*, dx, tx
German measles RNA togavirus 2/2 droplets ``` Mild fever Pink maculopapular rash initially on face spreading downward & outward Nonexudative conjunctivitis Lasts <3 days Pregnant women: causes miscarriage ``` Clinical Supportive care
55
Measles presentation*
Severe fever | Slowly spreading dark red-brown rash
56
Mumps presentation*
Low-grade fever Parotitis No rash
57
Infantile hemangioma presentation*
Big strawberry looking hemangiomas on a baby's ass
58
Cavernous hemangioma presentation*
Soft blue mass
59
Cystic hygroma presentation*
Dilated lymph space on neck that transilluminates
60
Icthyosis vulgaris presentation*
Normal skin at birth progressing to dry, scaly, horny skin over extensor limbs
61
Chalazion presentation*, dx*, tx
Painful swelling progressing to painless rubbery non-red lesion MUST biopsy...risk of sebaceous gland carcinoma or BCC Remove
62
Warfarin-induced skin necrosis presentation*, tx*
Pain without lesion ==> bullae and necrosis on breasts, butt, thighs, abdomen Roughly a week post-warfarin Vitamin K administration Heparin instead of warfarin
63
Angioedema path*, presentation*, dx, tx
Hereditary or acquired (ACE inhibitor) C1 inhibitor deficiency ==> C2b and bradykinin elevation Facial, laryngeal, extremity, genital swelling Colicky abdominal pain 2/2 GI swelling *No anaphylactic trigger...thus no tachycardia etc. INTUBATE
64
Graft Versus Host Disease (GVHD) path*, presentation*
Donor T cells target host skin, GI, liver Face, PALM, SOLE rash GI sx: +blood Liver: LFTs elevation & jaundice
65
Porphyria cutanea tarda path, presentation*, dx, tx
Deficiency of uroporphyrinogen decarboxylase Painless blisters and skin fragility on dorsal hands Hyperpigmentation of face Associated with Hep C (?) Elevated urinary porphyrin Phlebotomy Hydroxychloroquine
66
Vitiligo path*, presentation*
Autoimmune melanocyte destruction Associated with: pernicious anemia, DM1, alopecia, autoimmune thyroid etc. Depigmentation beginning peri-orally and acridly
67
Erysipelas path, presentation*, tx
Strep Patch ==> raised, tense, indurated plaque Usually on cheek 2/2 trauma or pharyngitis Penicillin
68
Senile purpura path*, presentation*
Loss of vascular connective tissue elasticity in elderly Echymoses Normal heme labs

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