Dermatology Flashcards
(113 cards)
1
Q
What is a macule?
A
Flat <1cm
2
Q
What is a patch
A
Flat >1cm
3
Q
What is a Papule
A
Elevated palpable lesion <1cm
4
Q
What is a Plaque
A
Elevated lesion >1cm
5
Q
What is a vesicle
A
Fluid-containing blister <1cm
6
Q
What is a Bulla
A
Fluid containing blister >1cm
7
Q
What is a cyst
A
Epithelium-lined sac containing material or fluid
8
Q
What is a pustule
A
vesicle containing pus
9
Q
What is a wheal
A
transient edematous papule or plaque
10
Q
What is a scale
A
flaking off of the stratum corneum
11
Q
What is crust
A
exudate of dried serum, blood or pus
12
Q
What is an ulcer
A
Defect that extends through the epidermis and upper dermis
13
Q
What is Lichenification
A
Hypertrophy and thickening of the epidermis with accentuation of normal skin markings
14
Q
What is the mechanism of a Type I Hypersensitivity reaction
A
Ag cross-linking with preformed Surface-bound IgE on mast cells and basophils that triggers the release of vasoactive amines (Histamine)
Develops rapidly because the Ab is preformed
15
Q
What is the mechanism of a Type II Hypersensitivity reaction
A
Cytotoxic: IgM and IgG bind Ag on enemy cell resulting in lysis by complement or phagocytosis
16
Q
What is the mechanism of a Type III Hypersensitivity reaction
A
Immune-Complex: Ag-Ab complexes fix Complement attracting PMNs which release lysosomal enzymes
17
Q
What is the mechanism of a Type IV Hypersensitivity reaction
A
Delayed (Cell-Mediated): Sensitized T-Cells encounter an Ag and release lymphokines which lead to macrophage activation
18
Q
What is another name for Atopic Dermatitis
A
Eczema
19
Q
What is Eczema
A
Chronic, inflammatory dermatitis presenting in infancy and lasts into adulthood
20
Q
What is Eczema characterized by
A
Epidermal barrier dysfunction (Filaggrin deficiency)
21
Q
What triad is typically seen in patients with eczema
A
Atopic Triad: Family hx of asthma, eczema, and allergic rhinitis
22
Q
How does Eczema manifest in infants
A
Erythematous, edematous, weeping, pruritic vesicles, papules and plaques on on the face, scalp and extensor surfaces of extremities
Typically spares the diaper area
23
Q
How does Eczema manifest in Children
A
Dry, scaly, pruritic, excoriated vesicles, papules and plaques in the flexural areas and neck
24
Q
How does Eczema manifest in adults
A
Lichenification and dry fissured skin in a flexural distribution
Often involving the hand, wrist and neck
25
How is Eczema Diagnosed
Exam findings and Hx are sufficient
May see peripheral eosinophilia and Increased IgE
26
What is the first line treatment for Eczema
Topical Corticosteroids
27
What are other treatment options for Eczema
Topical Calcineurin Inhibitors (Tacrolimus)
H1 blockers (Hydroxyzine)
Aggressive Emollients
avoid harsh soap
limit hot showers
Phototherapy
Dupilumab
28
What type of reaction is Contact Dermatitis
Type IV Hypersensitivity upon reexposure to an allergen
29
How does Contact Dermatitis typically presents
Pruritus and eczematous rash with the distribution mimicking the contact event (Linear or angular)
30
How do you diagnose Contact Dermatitis
Clinical exam findings and Hx are sufficient
31
What is the best initial treatment for Contact Dermatitis
Topical Corticosteroids
Avoid allergen
Severe cases may require systemic corticosteroid use
32
What is Seborrheic Dermatitis
Chronic inflammatory condition caused by reaction to a yeast called Malassezia Furfur
33
What region of the body does Seborrheic Dermatitis typically impact
Areas with sebaceous glands: Eyebrows, nasolabial folds, posterior ears
34
How does Seborrheic Dermatitis present in infants
Severe, red diaper rash with yellow scale, erosions and blisters
Scalping and crusting on the scalp (cradle cap)
35
How does Seborrheic Dermatitis present in children/adults
ill-defined, red, scaly thin plaques around the ears, eyebrows, nasolabial folds, midchest and scalp
36
What patients can present with severe, widespread seborrheic dermatitis
HIV/AIDS
Psychotic disorders
Parkinson Disease
37
How do you diagnose Seborrheic Dermatitis
Exam findings and History are sufficient
38
How do you treat Seborrheic Dermatitis
Ketoconazole ,Selenium Sulfide , orZinc Pyrithione Shampoos
Topical Antifungals (ketoconazole cream)
Topical corticosteroids
39
What is Psoriasis
T-Cell-Mediated inflammatory dermatosis characterized by well-demarcated, erythematous plaques with silvery scales
40
Where are lesions in psoriasis typically located
Extensor surfaces: Elbows and knees
Nail pitting, oil spots and Onycholysis (lifting of nail plate)
41
What is the Koebner Phenomenon
Lesions initially appear small but become confluent and provoked by local irritation or trauma in Psoriasis
42
What are characteristic findings that help aid the diagnosis of Psoriasis
Auspitz sign: pinpoint bleeding on removal of scale
Silvery scales
43
What histological findings are seen in psoriasis
thickened epidermis
elongated rete ridges
absent granular cell layer
parakeratosis: nuclei in stratum corneum
Munro microabscesses: neutrophilic infiltrate in Statum Corneum
44
How to treat Local Psoriasis
topical steroids
Calcipotriene (Vit D)
Retinoids: tazarotene or acitretin (Vit A)
45
How to treat severe Psoriasis
Methotrexate
Anti-TNF biologics: Etanercept, Infliximab, Adalimumab
Ustekinumab: anti-IL 12/23
Secukinumab: anti-IL17
UV light therapy (cannot use if immunosuppressed)
46
What is another name for Urticaria
Hives
47
What causes Urticaria
release of histamine and prostaglandins from mast cells in a type I hypersensitivity reaction
48
What does Urticaria look like
Sharply demarcated edematous plaques with surrounding erythema (wheal and flare)
each lesion lasts <24 hours
Chronic if >6 weeks
49
What lab value can you measure to assist with diagnosing Urticaria
Tryptase: co-released with histamine from mast cells
50
How to treat Urticaria
Systemic Antihistamines
If anaphylaxis: IM Epinephrine, Antihistamines, IVF and airway support
50
What is Erythema Multiforme
cutaneous reaction pattern with classic targetoid lesions
50
When do non-anaphylactoid drug reactions occur
7 to 14 days after exposure
51
Describe the lesions in Erythema Multiforme
start as erythematous, dusky macules that develop into targetoid lesions
commonly affects the palms and soles
52
Describe a targetoid lesion
central, dusky blister surrounded by a pale edematous ring with a peripheral halo of erythema
53
What is the difference between Erythema Multiforme Major and Minor
Minor: limited to the skin
Major: involves mucous membranes
54
What is the treatment for Erythema Multiforme
symptomatic treatment
treat EM Major as burns
55
What is Erythema Nodosum
Panniculitis (inflammatory process of Subq adipose tissue) that is triggered by infection, drugs and chronic inflammatory diseases
56
What does Erythema Nodosum look like
Painful, erythematous nodules on the patient's anterior shin which slowly spread turning purple or brown
57
What lab test may be falsely Positive in Erythema Nodosum
VDRL
58
How do you treat Erythema Nodosum
Treat underlying disease
Cool Compresses
bed rest
NSAIDS
59
What autoantibodies are present in Bullous Pemphigoid
Ab to hemidesmosomes (Ag 1 and 2)
60
How do the blisters appear in Bullous Pemphigoid
Firm, stable
61
What is the Nikolsky sign in Bullous Pemphigoid
Negative
62
What is the typical patient age in Bullous Pemphigoid
>60
63
What is the most accurate test for Bullous Pemphigoid
Skin biopsy with ELISA
64
How do you treat Bullous Pemphigoid
Topical high-potency corticosteroids
Systemic corticosteroids and doxycycline
65
What antibodies are present in Pemphigus Vulgaris
Ab against desmosomes (desmogleins 1 and 3)
66
What is unique about blisters in Pemphigus Vulgaris
more erosions than intact blisters due to lack of keratinocyte adherence
67
What is the Nikolsky sign in Pemphigus Vulgaris
Positive
68
What is the usual Age group for Pemphigus Vulgaris
40-60
69
What are common triggers for Pemphigus Vulgaris
ACE-I
Penicillamine
Phenobarbital
Penicillin
70
What is the treatment for Pemphigus Vulgaris
High-dose Steroids + Immunomodulatory therapy
71
What is Pyoderma Gangrenosum
Neutrophilic Dermatosis associated with IBD, RA, and mallignancy
72
How does Pyoderma Gangrenosum Present
papules or pustules that rapidly progress to painful ulcers with violaceous borders with a purulent base
73
What is associated with HHV-1
Oral vesicles and Ulcers
Temporal Lobe Encephalitis
74
What is associated with HHV-2
Genital Lesions
Viral Meningitis
75
Treatment for HHV-1 and HHV-2
Acyclovir
Valacyclovir
Famciclovir
IV Acyclovir for severe, immunocompromised or CNS involvement
76
What is HHV-3
Varicella Zoster Virus
Chickenpox
Shingles
77
Treatment for HHV-3
Acyclovir/Valacyclovir within 72 hours of onset of rash
IV Valacyclovir for severe infections
vaccines available
78
What is another name for HHV-4
Ebstein Barr Virus
79
What is HHV-4 associated with
Infectious Mononucleosis
Burkitt and Hogdkin Lymphoma
Nasopharyngeal Carcinoma
Posttransplant Lymphoproliferative Disease
80
what is another name for HHV-5
Cytomegalovirus (CMV)
81
What is the treatment for HHV-5
IV Ganciclovir
Oral Valganciclovir
82
What is another name for HHV-6/HHV-7
Roseolovirusis
83
What can HHV-6/7 Cause
Roseola Infantum in children: high fevers followed several days later by macular rash with centrifugal spread
84
What is HHV-8 Associated with
Kaposi Sarcoma
85
What is the Most accurate test for Human Herpesviruses (HHV)
Virul culture or PCR or lesion
86
What is the most rapid test for HHV
Direct fluorescent Ag
87
What type of stain do you use for HHV and what is visualized
Tzanck Smear showing Multinucleated Giant Cells
88
How do the lesions in VZV appear
Pruritic lesions in crops over 2 to 3 days that evolve from red macules to vesicles that crust over
May be in different stages of development
89
What is the timeframe for Acute Herpetic Neuralgia
Less than 30 days from rash onset
90
What is the timeframe for Subacute Herpetic Neuralgia
30 days to 4 months from rash onset
91
What is the timeframe for Postherpetic Neuralgia
Longer than 4 months from rash onset
92
At what age is the VZV vaccine given
1 and 4 years
Adults >60
HIV with CD4 >200
93
What agents are used to control Postherpetic Neuralgia
Gabapentin
Pregabalin
TCAs
94
Postexposure Prophylaxis for VZV
Immunocompromised/Pregnant/Newborns: VZV IG within 10 days
Immunocompetent: VZV vaccine within 5 days
95
What is the appearance of Molluscum Contagiosum
tiny, flesh-colored dome shaped waxy papules with central umbilication
Typically spares the palms and soles
96
What is the most accurate test for Molluscum Contagiosum
Wright and Giemsa Stain showing large inclusions of molluscum bodies
97
Treatment options for Molluscum Contagiosum
Currettage
Cryotherapy
Laser ablation
Cantharidin (blistering agent)
98
What HPV subtypes are considered benign
6 and 11 (genital warts: Condyloma Acuminatum)
99
What HPV types are considered to have malignant potential
16 and 18
100
What is the most accurate test for HPV in Warts
PCR of the lesion
101
Treatment options for warts
Cryotherapy, laser therapy, excision
Podophyllin (contraindicated in pregnancy)
Trichloracetic Acid
Imiquimod (contraindicated in pregnancy)
102
What causes Nonbullous Impetigo
S. Aureus
Group A Strep
103
Describe the lesions in Nonbullous Impetigo
Pustules and honey-colored crusts on an erythematous base
Often on face, mouth, nose or ears
104
What Causes Bullous Impetigo
Exfoliative toxin of S. Aureus
105
Describe the lesions in Bullous Impetigo
flaccid bullae that form crust when they rupture
confined the area of infection
106
What is Ecthyma
Ulcerative lesions that extend into the dermis with punched out appearance of ulcers with yellow-crust
107
How to treat Mild localized Impetigo
Topical Abx: Mupirocin
108
How to treat Severe non MRSA Impetigo or Ecthyma
Oral Cephalexin or Dicloxacillin
109
How to treat Severe MRSA Impetigo
Oral TMP-SMX, clindamycin or doxycycline
110
How to treat Staph Scalded Skin Syndrome
Nafcillin
Vancomycin
Wound care
111
When can a child with Impetigo return to school
24 hours after the start of treatment
