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OMS 1 > Derm Exam 2 > Flashcards

Derm Exam 2 Flashcards

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1
Q

lichenification

A

thickening of skin due to thickening of stratum corneum and stratum spinosum
-accentuates normal linear skin fold markings and feels thick and firm on palpation

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2
Q

tinea

A

superficial fungal infection that involves stratum corneum of skin/hair/nails
KOH to evaluate for presence of fungus
-tx: topical antifungals, capitis use oral terbinafine/griseofulvin, versicolor use selenium sulfide shampoo

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3
Q

pityriasis rosea

A

self limiting skin eruption of uncertain etiology
most 10-35 years
may be due to virus, some have prodrome
initial herald patch - annular pink patch or plaque w scale
later (1-2 weeks) - similar but smaller lesions appear on trunk/neck/proximal extremities (spare face/palms/soles)
follow christmas tree pattern
-tx: clear spontaneously 4-8 wks, oral antihistamines/topical steroids for pruritis, oral erythromycin/acyclovir/UV light to speed resolution

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4
Q

psoriasis

A

inflammatory genetic immune mediated disorder
mild 3-10% BSA
moderate 3-10% BSA
severe >10% BSA
tx: mild (topical steroids, vitamin D analogs, retinoids, calcineurin inhibitors, toars/anthralin, benvitimod, light therapy), moderate to severe (light therapy, systemic therapy, biologics, NOT ORAL STEROIDS)

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5
Q

plaque psoriasis

A

well demarcated salmon pink-red erythematous papules and plaques with silvery scale
symmetric distribution (extensor surfaces, lower back, scalp)
nail changes
auspitz sign (pinpoint bleeding)
koebner phenomenon - new lesions at sites of skin injury

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6
Q

guttate psoriasis

A

small drop like scaly papules mostly on trunk and extremities
follow group A strep infection

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7
Q

inverse psoriasis

A

involve intertriiginous areas (inguinal, perianal, genital, intergluteal, axillary, inframammary)

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8
Q

nummular dermatitis (nummular eczema)

A

idiopathic dermatitis
rash with itching and burning
multiple coin shaped erythematous plaques on extremities and trunk
may be scaly, but lack central clearing
dorsal hands common and extensor areas
tx: topical emollients/steroids, steroid injection, systemic steroids/methotrexate/cyclosporin

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9
Q

atopic dermatitis

A

chronic relapsing skin disease common in early infancy and childhood
fam history of asthma, allergic rhinitis, atopic dermatitis
dry skin, itchy
acute - intense pruritic erythematous papules and plaques
chronic - thickened hyperkeratotic plaques with lichenification
often face/scalp/extensor and moves to flexor surfaces
dennie morgan folds, allergic shiners, headlight sign, hertoghe sign
tx: emollients, steroids, calcineurin inhibitors, JAK inhibitors, PDE4 inhibitors, antihistamines

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10
Q

erythema annulare centrifugum

A

inflammatory reactive disorder that occurs in superficial and deep forms
single or multiple annular or arcuate erythematous plaques
trailing scale in superficial, scale absent in deep
caused by drugs
tx: self limited, topical steroids help current lesions, systemic steroids helpful but may return when drug is withdrawn

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11
Q

ABCDEs

A

a - asymmetry
b - border
c - color
d - diameter
e - evolving

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12
Q

ephelis

A

freckles, small light brown macules
sun exposed skin
usually multiple irregularly shaped 1-6 mm tan to brown macules
topical retinoid can lighten
laser is effective

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13
Q

lentigo

A

macular brown lesion
usually in fair skin
proliferative response of melanocytes to sun
uniform tan or brown oval to round macules or patches that are well demarcated
increased number of melanocytes
darker and more sparse than freckles
tx: avoid sun, excision/cryo, laser

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14
Q

congenital dermal melanocytosis

A

pigmented lesion usually present at birth (mongolian spot)
dispersed spindle shaped melanocytes in dermis only (interrupted migration to epidermis from neural crest)
usually solitary congenital lesion, usually lumbosacral area
blue to gray macular lesion
tx: usually regress over time, laser

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15
Q

acquired nevus

A

benign mole composed of melanocytes
most develop second to third decade and decline after 35
small with well defined border, single shade of pigment, well demarcated/symmetric/uniform, may darken or grow in pregnancy

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16
Q

stages of nevi

A

junctional - first decade, confined to epidermis
compound - 2nd/3rd decade, dermal and epidermal components
intradermal - aging further, only dermal component

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17
Q

common blue nevus

A

well circumscribed dome shaped papule, blue gray to blue black, usually solitary
elongated spindle shaped melanocytes in mid to upper dermis, increased collagen
mutation GNAQ or GNA11 genes
color bc tyndall effect

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18
Q

dysplastic nevus

A

atypical mole composed of benign melanocytes
flat (at least partially), large (>5 mm), pigmented with irregular shape/indistinct border/variable pigmentation
sun exposure important
first atypical feature usually smudging of outline
tx: observe, most will disappear, excise entire lesion if suspicious

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19
Q

cutaneous melanoma

A

malignant neoplasm due to malignant transformation of melanocytes
genetic predisposition and sun exposure
BRAF/NRAS/KIT genetic mutations
ABCDEs to identify
atypical melanocytes wtih enlarged and irregular nuclei and prominent nucleoli, upward spread of single melanocytes, lack of maturation depth, dermal mitosis, more single melanocytes than nests
tx: wide local excision, sentinel lymph node biopsy/lymph node dissection, refer to oncology

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20
Q

melanoma grading

A

in situ - confined to epidermis (horizontal growth)
invasive - beneath epidermis (vertical growth)

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21
Q

important prognostic parameters

A

breslow thickness - thicker is worse
ulceration - worse than nonulcerated
mitotic rate - higher is worse
spread to lymph nodes - more advanced and worse
regression due to t lymphocytes - >50% is worse
number of lumphocytes - fewer is worse

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22
Q

acanthosis nigricans

A

velvety hyperpigmented gray brown plaques
associated w obesity/endocrine disorders/familial/malignancy/drug reaction
mostly in axilla, neck
tx: weight loss, d/c causative drugs, treat insulin resistance, treat underlying malignancy, topical retinoids/vit D analogs

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23
Q

vitiligo

A

depigmented macules and patches
autoimmune theory - antibodies ad melanocyte specific t cells
genetic predisposition
more females
most commonly generalized and symmetric
wood lamp looks ivory white
MART1 confirm absence melanocytes
tx - JAK inhibitors, repigment (steroids, calcineurin inhibitors, UV therapy, laser), sx, depigmentation (monobenzyl ether of hydroquinone

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24
Q

tinea versicolor

A

superficial fungal infections caused by malassezia
asymptomatic hypopigmented or hyperpigmented eruption
spaghetti and meatballs on KOH
golden yellow/yellow green on wood lamp
tx - topical selenium sulfide, zinc pyrothione, ketoconazole or oral fluconazole/itraconazole

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25
pityriasis alba
1 or more groups of poorly marginated pink/tan macules/patches/plaques on cheeks neck or arms endemic - in low socioeconomic conditions atopic dermatitis related - due to atopic exacerbation and postinflammatory hypopigmentation mildly erythematous slightly scaling patch w indistinct margin to white patch with fine powdery scale (eventually lose scale) tx - symptomatic, emollients, sunscreen, steroids for pruritis
26
tuberous sclerosis
autosomal dominant hyperplasia of ectodermal and mesodermal cells (seizures, intellectual disability, congenital white spots) -mutations in tumor suppressor genes (TSC1 or TSC2) - affects function tuberin hamartin complex causing unregulated activation of mTOR -ash leaf spots and confetti like macules.patches, facial angiofibromas, fibrous facial plaque, shagreen patch, ungual fibromas -tx: for skin lesions surgical
27
oculocutaneous albanism
autosomal recessive disorder of melanin synthesis type II - most common, tyrosinase positive, loss of protein involved in tyrosine transport and decreased melanin production in melanosomes type I - tyrosinase negative, loss of tyrosinase activity and decreased malanin production in melanosomes
28
11 blade
I&D
29
10 blade
large excisions
30
15 blade
MOHS
31
suture size
measures tensile strengths 2-0 more strong than 5-0
32
shank
where needle attaches to suture
33
body
middle, strongest, where you grab
34
tip
sharp, dont handle
35
face
5-0 burried and epidermal
36
scalp
3-0 burried and epidermal
37
trunk
2-0 or 3-0 burried and 5-0 epidermal
38
extremities
3-0 or 4-0 burried and 5-0 epidermal
39
6 anatomical units of face
forehead, periorbital, nose, cheek, lips, chin keep repair within respective unit
40
skin tension lines
should cut along tension lines perpendicular to muscle
41
eliptical excision
ration 3:1 length:width
42
suture removal
eyelid 2-4 days face 4-6 days neck 5-7 days scalp 5-7 days trunk 5-12 days extremities 10-14 days
43
exanthem
rash that appears abruptly and affects several areas of skin simultaneously
44
drug reactions
most inflammation, generalized, symmetric imediate vs delayed
45
immediate drug reaction
less than 1 hour after administered dose urticaria, angioedema, anaphylaxis
46
delayed drug reactions
after 1 hour usually more than 6 hours exanthematous, fixed, systemic, vasculitis
47
type IV hypersentitivity reactions
exanthematous fixed drug reactions drug induced hypersensitivity syndrome (DIHS) also called drug related eosinophilia with systemic symptoms (DRESS)
48
exanthematous drug reactions
limited to skin appear on trunk and spread erythematous macules and papules often 7-10 days after drug started resolve days to weeks after drug is stopped can use topical steroids and oral antihistamines
49
risk factors for drug reactions
female prior history drug reactions recurrent drug exposure HLA types certain disease states
50
fixed drug eruptions
drug reaction with solitary eythematous plaque or patch will recur at same site with reexposure often mouth, genital, sacral areas lesions resolve within a few weeks noneroded lesions treated with topical steroids eroded esions treated with topical antimicrobial sometimes oral steroids
51
DIHS and DRESS
skin eruption with systemic symptoms and internal organ involvement usually macular exanthem, centrofacial swelling, fever, lymphadenopathy, involve liver and kidneys begin 1-12 weeks after drug started can persist and recur for many weeks after cessation stop drug, can use topical steroids and oral antihistamines, sometimes systemic steroids with very gradual taper
52
viral exanthems
resemble measles measles, rubella, roseola
53
measles
rubeola spread via respiratory droplets incubation 8-12 days contagious 1-2 days before symptoms macules and papules on face that spread cephalocaudally and centrifugally improvement within 2 days of appearance have joplik spots - blue white papules that may ulcerate in buccal mucosa usually have conjunctivitis serologically confirm supportive care
54
rubella
german measles/3 day measles direct or droplet contact from nasopharyngeal secretions shed 1 week before and 2 weeks after onset of disease rash occurs 14-17 days after exposure prodrome first then exanthem (pruritic pink/red macules and papules that start on face and spread to neck/trunk/extremities) 20% have petechial lesions on palate and uvula sometimes have arthritis infection in pregnancy can cause miscarriage, fetal loss, or congenital rubella syndrome diagnose with serology supportive care
55
congenital rubella syndrome
sensironeural deafness intellectual disability eye abnormalities congenital heart disease
56
roseola infantum
HHV6 spread via respiratory droplets and saliva can have subclinical infection, fever without rash, or present w exanthem reactivation in immunocompromised prodrome then pink papules and macules with pale halo on trunk that spread to neck and extremities self limiting, supportive care
57
toxic erythema
scarlet fever (strep) staph scalded skin syndrome (exfoliative toxin) toxic shock syndrome (staph TSS1)
58
connective tissue disease
lupus dermatomyositis
59
lupus
systemic cutaneous - localized to skin (discoid, lupus panniculus, tumid lupus) neonatal - passed from mother to infant drug induced ANA - sensitive but not specific anti double stranded DNA antibody - high specificity but 70% sensitivity anti smith antibody - specific but 30% sensitive tx cutaneous - sun avoidance, topical steroids, topical calcineurin inhibitors, antimalarials, dapsone, systemic steroids tx systemic - NSAIDs, hydroxychloroquine, steroids, methotrexate
60
dermatomyositis
necrotizing disease of striated muscle with inflammatory cutaneous lesions muscle weakness + skin lesions skin lesions - gottron papules (symmetric papules and plaques over PIP and MCP), heliotrope rash (periorbital edema), gottron sign (nonscaling erythematous macules over PIP and MCPs), V neck sign, alopecia, calcinosis cutis, mechanics hands ANA - non specific anti jo 1 - highly specific antibodies to Mi 2 - highly specific tx - oral steroids, methotrexate, topical steroids
61
localized erythema
cellulitis/erysipelas absecc/furuncle/carbuncle
62
cellulitis
very common infection of dermis that begins at wound spreading red, warm, tender area with edema 80% gram positive organisms animal bites - pasteurella human bites - eikenella tx non purulent - for strep A and staph tx purulent - for MRSA tx unusual - cover additional bacteria likely to be involved
63
erysipelas
superficial cellulitis with marked dermal lymphatic involvement pain, superficial edema, sharp margin high white count immediate empiric antibiotic therapy monitor
64
abscess
collection of pus in dermis and deeper skin tissue painful, tender, fluctuating, erythematous nodule I&D antibiotics
65
furuncle
acute, round, tender, circumscribed, perifollicular abcess
66
carbuncle
collection of furuncles
67
furuncle/carbuncle tx
warm compress I&D antibiotics
68
newborn skin
less hairy, less sweat, less sebaceous gland excretion thinner, fewer intercellular attachments, fewer melanosomes cant handle thermal stress and sunlight increased penetration of toxic substances
69
vernix
made during last trimester, its a protective membrane dead epithelial cells, fine hairs, sebaceous secretions lubricates skin, antibacterial, antifungal washes off or shed in first week
70
erythema toxicum neonatorum
obstruction of pilosebaceous orifice appears at 24-48 hours as erythematous macules and patches usually fade in 5-7 days and gone in 2-3 weeks with no hyperpigmentation
71
transient neonatal pustular melanosis
lesions present at birth 3 phases (vesicles, rupture vesicles, hyperpigmented brown macules) commonly forehead or mandibular area vesicles resolve after 5 days but hyperpigmentation may last 3 months
72
miliaria
obstructed eccrine sweat ducts bc overheating or over swaddling crystallina - tiny flaccid vesicles rubra - papules and pustules profunda - deeper papules and pustules
73
epstein pearls
developmental cysts
74
milia
pilosebaceous follicles clogged by keratin pin point pearly white papule usually disappear in first month but can persist for 3
75
neonatal cephalic pustulosis
occurs at 1-2 weeks inflammed papules and pustules but no comodones face, chest, back, groin may persist up to 8 months but resolve without scarring
76
sebaceous gland hyperplasia
secondary to maternal androgen stimulation 1 mm yellow macules or papules over pilosebaceous units of nose and cheeks usually resolve by 4-6 months
77
acrocyanosis
hands, feet, and periorbital become bluish color because of vasoconstriction resolves in 24-48 hours
78
cutis marmorata
mottles dusky erythema on extremities and trunk when exposed to cold during first 2-4 weeks because immature autonomic control of blood vessels
79
physiologic desquamation
begins at 24-36 hours and may not be complete for 3 weeks appears first around ankles characterized by scale
80
heel stick nodules
repeated blood sampling causes dystrophic calcification asymptomatic usually resolve 18-30 months
81
caput succedaneum
edema on scalp from pressing on cervix crosses suture lines and soft to palpation decrease within a few days
82
cephalohematoma
swelling over scalp bc subperiosteal bleeding (use of forceps/vacuum) increase in size on second or third day does not cross suture lines may take weeks to resolve jaundice may occur
83
seborrheic dermatitis
erythema with greasy yellow scale scalp, axilla, groin, flecural areas usually self limited and resolves after a few months mild steroids or ketoconaxole can be used may have postinflammatory hyperpigmentation
84
irritant diaper dermatitis
bright red and sometimes scaly perianal pathces/papules/plaques sparing inguinal folds candida infect goes into inguinal folds tx - diaper changes, cleanse, emollients, hydrocortisone, treat infection
85
vascular neoplasm
infantile hemangioma - absent at birth, significant post natal growth then slow spontaneous involution -superficial : strawberry in superficial dermis and bright red -deep : cavernous in deep dermis or subcutis and appear like masses -mixed 3-5-7-9 rule can ulcerate, anatomical distortion can use beta blockers, steroids, laser, excision
86
vascular malformation
nevus simplex - stork bite salmon pink macules and patches bc capillary malformations of skin, fades over first 2 years port wine stain - blood vessels permanently dilated, permanent, can use pulsed dye laser
87
inherited epidermolysis bullosa
vesicles/bulla form after minor trauma (hands and feet when learning to crawl or walk) autosomal dominant mutation encoding keratin 5 and/or 14 linear deposition of IgG and C3 along BM tx - prevent friction
88
SJS
painful mucosal blistering and epidermal detachment <10% BSA prodrome then 1-2 weeks 2 tone target lesions
89
TEN
epidermal attachment >30% BSA commonly associated with sulfa drugs
90
erythema multiforme
localized to extremities 3 tone target lesions
91
staph scalded skin syndrome
superficial blistering bc staphs exfoliative toxin prevalent in children renal disease and immunosuppression dx - culture + nikolsky sign tx - antibiotics, fluids, wound care
92
kawasaki disease
rarely in adults systemic inflammation with fever (mucous involvement, erythema on lips/oral mucosa, rash, extremity changes, cervical lymphadenopathy) no nikolsky sign tx - self limited but can cause coronary artery aneurisms
93
neonatal erythroderma
presents at birth or first month of life involving >90% BSA bc SSSS, inflammatory disorders, congenital ichthyoses, immunodeficiency, errors of metabolism
94
dengue
islands of white on a sea of red
95
meningococcemia
neisseria meningitis prodrome then rash (petechiae then stellate purpura with central grey hue) tx - antibiotics
96
henoch schoenlein purpura
autoimmune vasculitis mainly in children can impact any organ system but mainly skin and kidneys purpura, abdominal pain, arthritis IgA vasculitis tx - supportive
97
bullous pemphigoid
subepidermal blistering disorder stop drug if relevant, topical steroids and antibiotics
98
necrotizing fasciitis
local erythema, edema, tenderness systemic toxicity occurs type I - polymicrobia type II - monomicrobial dx/tx - surgical
99
pemphigoid gestationis
autoimmune destruction of hemidesmosomes 2nd or 3rd trimester of pregnancy exacerbations after delivery recur in subsequent pregnancy linear IgG and C3 along BM tx - topical steroids, oral steroids, antihistamines risk - preterm delivery and small for age infant
100
PUPP
3rd trimester mostly first pregnancy erythematous urticarial papules surrounded by pale halo often start in abdominal striae usually spares umbilicus no maternal or fetal risk general resolves within days postpartum tx - topical steroid, oral prednisone, antihistamines
101
syphilis
STI, spirochete treponema primary - chancre (macule turns ulcer) secondary - prodrome, new onset scaly eruption confirm with serological tests (nontreponemal and treponemal) tx - penicillin G
102
melasma
hyperpigmentation regresses within a year after delivery tx - sun avoidance, hydroquinone, tretinoin, steroids
103
rule of 9s
head is 9 each arm is 9 each side of trunk is 18 each leg is 18 perineum is 1
104
in a baby
head is 18 each side of trunk is 18 each arm is 9 each leg is 13.5 perineum is 1 -add 0.5 to each leg and subtract 1 from head every year after 1
105
first degree burn
epidermis only
106
second degree burn
partial thickness superficial - epidermis and superficial dermis deep - epidermis papillary and reticular dermis
107
third degree
full thickness entire dermis and some subq often not painful
108
fourth degree burns
black charred skin affects muscle of bone
109
tx of burns
maintain adequate oxygenation pain control wound care fluid resuscitation (parkland formula, goal urine output 1ml/kg/hr)
110
parkland formula
4 ml x weight (kg) x % BSA half over first 8 hours second half over remaining 16 hours children - 3 ml x weight (kg) x % BSA
111
pyogenic granuloma
solitary vascular papule or nodule with glistening red to brown friable surface (fingers, lips, mouth, trunk, toes) early - granulation tissue later - polyploid and lobular pattern of vessels w fibrous septae tx - laser, excision, C&E
112
cherry hemangioma
red brown papule that blanches with pressure dilated capillaries tx - electrocautery, shave and electrocautery, pulsed dye laser
113
bacillary angiomatosis
vascular proliferation usually in HIV pts caused by bartonella red to purple papules that may increase to nodules solitary or multiple lesions lobular capillary prolieration separated by CT cured with abx
114
glomus tumor
derived from smooth muscle glomus body (temp regulators) pink purple papules or nodules, tender and painful tx - excision
115
kaposi sarcoma
HHV8 usually in HIV often in legs red brown to blue purple macule that evolves to patch/papule/plaque/nodule tx - surgery, radiation, cryo, laser, chemo, immunomodulators
116
angiosarcoma
at site of previous radiation in face/neck/scalp red to purple macules/patches/plaques/nodules tx - sx, radiation, chemo
117
paronychia
infection of nail folds
118
onychomycosis
fungal infection of nail
119
subungal hematoma
blood under nail
120
clubbing
thickening of nail beds soft tissue
121
koilonychia
curving of anail
122
beau lines
horizontal lines bc interuption nail bed mitosis
123
muehrcke lines
transverse white bands disappear when pressure applied
124
terry nails
nails white except distal 2 mm
125
SK
proliferating keratinocytes secrete melanocyte stimulating cytokines triggering adjacent melanocytes stuck on quality but color and texture can vary dermatosis papulosa nigra - multiple small SKs on face acanthosis, papillomatosis, hyperkaratosis with horn pseudocyst tx - cryo, curettage
126
acrochordon
skin tag tx - snip, shave, electrodessication, cryo
127
AK
pre SCC keratinocyte origin may be tender, erythematous papule/plaque w rough gritty scale tx - cryo, 5FU, imiquimod
128
BCC
from nonkeratinizing keratinocytes originating in basal layer usually head/neck histology - nests of purple hyperchromic cells nodular - pearly papule with rolled border and telangiectasia, can be ulcerated superficial - pink/translucent, raised border, telangiectasia, pathc or thin plaque morpheaform - ivory/colorless, flat/atrophic, indurated, resemble scars
129
SCC
malignant tumor of keratinocytes variable morphology - may present as cutaneous horn clusters of atypical keratinocytic cells with eosinophilic cytoplasm and form keratin pearls
130
keratoacanthoma
dome shaped papule with central keratin filled crater variation of SCC
131
verruca vulgaris
wart HPV
132
granuloma annulare
self limiting and asymptomatic solitary lesions annular papules/plaques with raised borders tx - steroids, cryo, calcineurin inhibitors, laser, imiquimod, phototherapy
133
epidermoid cyst
keratin filled epithelial lined cyst usually plugged pilosebaceous unit tx - excision, I&D if infected
134
pilar cyst
arise in epithelium between orifice of sebaceous gland and arrector pili no granular layer tx - excision
135
pilomatricoma
children usually solitary skin colored cystic nodule on head/neck/upper extremity encapsulated mass of basophilic cells that evolve into eosinophilic shadow/ghost cells tx - excision
136
dermatofibroma
button like dermal nodule, dimple sign tx - excision, cryo
137
lipoma
painless slowly enlarging mass of subq tissue tx - excision
138
neurofibroma
oten solitary lesion hyperplasias of nerve elements can be pushed down through skin with pressure can be excised but frequently recur
139
erythema nodosum
type IV hypersensitivity usually strep infection painful and symmetric tender, erythematous, warm nodules and plaques usually on anterior of lower legs lasts 3-6 weeks with no ulceration or scarring tx - treat infection, NSAIDs, sometimes systemic steroids
140
alopecia
androgenic - genetic, sensitive to androgens, short anagen phase telogen effluvium - response to trigger, more in telogen phase, 5 or more in hair pull test areata - immune mediated, focal patches of nonscarring hair loss, spontaneous regrowth can occur traction - due to hairstyles

OMS 1 (16 decks)

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