Dermatology

Question 1

Bulla

Answer 1

• A vesicle >5mm in diameter

Question 2

Cyst

Answer 2

• An elevated, circumscribed area of the skin filled with liquid or semisolid fluid

Question 3

Macule

Answer 3

• A flat circumscribed area of color change that is brown, red, white, or tan

Question 4

Nodule

Answer 4

• Elevated, firm, circumscribed, and palpable
• Can involve all layers of the skin
• > 5mm in diameter

Question 5

Papule

Answer 5

• Elevated area of the skin

- Palpable, firm, circumscribed lesion <5mm in diameter

Question 6

Plaque

Answer 6

• Elevated, flat-topped, firm, rough, superficial papule > 2cm in diameter
• Papules can coalesce to form plaques

Question 7

Pustule

Answer 7

• Elevated and superficial
• Similar to vesicle, but filled with pus
• <5mm in diameter

Question 8

Vesicle

Answer 8

• Elevated, circumscribed, superficial, fluid-filled blister <5mm in diameter

Question 9

Wheal

Answer 9

• Elevated, irregularly-shaped area of cutaneous edema
• Solid, transient, changing and of variable diameter
• red, pink, pale, or white in color

Question 10

Crust

Answer 10

• Dried serum, blood, or purulent exudate
• Slightly elevated
• Of variable size

Question 11

Excoriation

Answer 11

• Loss of epidermis
• Linear
• Usually due to scratching

Question 12

Lichenification

Answer 12

• Rough, thickened epidermis
• Accentuated skin markings
• Caused by rubbing or scratching (eg. chronic eczema, lichen simplex)

Question 13

Scale

Answer 13

• Heaped up keratinized cells, flaky exfoliation
• irregular, thick or thin, dry or oily, of variable size
• Silver, white, or tan in color

Question 14

Telangectasia

Answer 14

• fine, irregular red lines from capillary dilation

Question 15

Keloid

Answer 15

• Enlarging scar

- Grows beyond a wound

Question 16

Fissure

Answer 16

• crack or break in the epidermis or dermis

Question 17

Erosion

Answer 17

• Loss of part of the epidermis following a rupture of vesicle or bulla

Question 18

Ulcer

Answer 18

• Loss of epidermis or dermis

Question 19

Atrophy

Answer 19

• Thinning of the skin surface

Question 20

Transillumination of skin

Answer 20

• Used to determine the presence of fluid in masses and cysts
• Use a darkened room
• If fluid filled, will turn red

Question 21

Wood’s lamp

Answer 21

• Can be used to evaluate epidermal, hypopigmented or hyperpigmented lesions, and to determine fluorescing lesions

Question 22

Lesion

Answer 22

• Any pathologic skin change
• Primary: those that occur as initial spontaneous manifestations of a pathological process
• Secondary: Those that result from later evolution of or external trauma to a primary lesions

Question 23

Primary Lesions

Answer 23

• Macule
• Papule
• Vesicle
• Pustule
• Patch
• Plaque
• Bulla
• Cyst
• Wheal
• Purpura

Question 24

Secondary Lesions

Answer 24

• Excoriation
• Crust
• Lichenification
• Scales
• Erosion
• Ulcer
• Fissure

Question 25

Pedunculated

Answer 25

- a lesion having a stalk at the base

Question 26

Sessile

Answer 26

- A lesion without a stalk

Question 27

Annular

Answer 27

- Lesions with central clearing

Question 28

Reticulated

Answer 28

- Lesions with lacy or networked pattern

Question 29

Hair

Answer 29

- Vellus hair: fine hair covering body - Terminal hair: scalp, pubic, and axillary areas, on arms and legs, and in the beard - Hirsutism: growth of terminal hair in a male distribution on a female

Question 30

Acne Vulgaris: 3 types

Answer 30

- Comedonal: open = blackhead, closed = whitehead - Inflammatory: usually pustules and papules - Nodular/cystic: scarring

Question 31

Acne Grading Scale

Answer 31

- 0: None - 1: Few comedones - 2: Mild comedones, few papules, minimal erythema - 3: comedones, papules, pustules, erythema - 4: moderate comedones, greater number of papules and pustules extending to chest, shoulders and back; increasing erythema - 5: Comedones, increasing number of papules, pustules, nodules with erythema - 6: all of the above with scarring and possible hyperpigmentation

Question 32

Acne: Patho

Answer 32

- Androgen stimulation - Plugging of pilosebaceous follicles - Swelling of follicular ducts - Gram positive anaerobic bacteria causing inflammation and papules and pustules

Question 33

Acne: Presentation

Answer 33

- Duration - Past treatments and how long - Menstrual history - Contraceptive methods - Family Hx - Allergies - Seasonal and hormonal factors - Cosmetics - Hair styling products - Headbands, hats, helmets, tight bras, chin straps - Diet: high carbs and dairy - Drugs: androgens, lithium, topical/oral steroids, isoniazid, phenobarbital)

Question 34

Acne: Management

Answer 34

- Limit face washing and avoid harsh/abrasive cleaners - Cosmetics and emollients should be limited to those with non-comedogenic, non-irritating, hypoallergenic products - Daily moisturizers with sun protection factors may alleviate dryness and prevent phototoxicity - Patients w/dry or sensitive skin may benefit from the extra emollients found in a cream vehicles - Gels are preferred for patients with oily skin, b/c they are more drying and reduce shine - Non-Rx products may be used as primary or adjunctive Tx - Benzoyl peroxide (1-10%) monotherapy and salicylic acid (2%) used BID are good starting point w/mild acne

Question 35

Acne: Retinoids (Names)

Answer 35

- Tretinoin (Retin-A) - Adalpalene (Differin) - Tazarotene (Tazorac) - Azelaic acid (Azelex) 20% cream

Question 36

Retinoids: Basics

Answer 36

- Keratolytics that prevent development of the comedones and are a reasonable first line med for all varieties of acne - Most patients will remain on topical retinoids throughout the treatment - Retinoids demonstrate well-documented anti-inflammatory properties