Dermatology Flashcards
(183 cards)
1
Q
What type of benign skin lesion is typically soft, round, macules or papules with uniform color and border?
A
acquired melanocytic nevus
2
Q
What type of benign skin lesion usually presents as changing blue to black, sometimes pink to red, papul or plaque that may ulcerate or bleed?
A
Nodular melanoma
3
Q
What type of benign skin lesion typically appear sharply marginated, pigmented papular or macular after 4th decade and on?
A
seborrheic keratoses
4
Q
What type of benign skin lesion presents as hyperkeratotic, exophytic, dome-shaped papules or plaques?
A
Verruca vulgaris (common wart)
5
Q
What are keratin pseudocyts?
A
small white spots commonly found in seborrheic keratoses
6
Q
What type of benign skin lesion is multiple, small, hyperpigmented, sessile to filiform, smooth-surfaced papules that usually arise on the cheeks and temples of darker skinned patients?
A
dermatosis papulosa nigra
7
Q
What is the best treatment for dermatosis papulosa nigra?
A
electrodessication
*NOT liquid nitrogen!
8
Q
What type of benign lesion is a small, white-gray SK on the dorsal feet or ankles of older, fair-skinned patients?
A
stucco keratoses
9
Q
What is the fancy name for skin tags?
A
acrochordons
10
Q
What type of benign skin lesions can be a marker for insulin resistance?
A
acanthosis nigricans
acrochordons
11
Q
What type of skin lesion presents as a pearly papule or nodule with a smooth surface and often with telangiectasia?
A
basal cell carcinoma?
12
Q
What type of skin lesion is round to oval, bright red, dome-shaped papules?
A
cherry angioma
13
Q
What type of skin lesion is small, round, hemorrhagic macules?
A
petechiae
14
Q
What type of benign skin lesion is firm, hyperpigmented, dome-shaped papule tumor with peripheral rim darkening?
A
dermatofibroma
15
Q
What type of benign skin lesion is minimally elevated to thicker, rough, scaly papules with an underlying red base?
A
actinic keratosis
16
Q
What skin findings are associated with cirrhosis?
A
jaundice
spider angiomas
palmar erythema
nail changes
17
Q
What is the fancy name for sun spot, age spot, or liver spot?
A
solar lentigo
18
Q
What type of benign lesion is due to sebaceous gland enlargement, yellow in color and umbilicated?
A
sebaceous hyperplasia
19
Q
What type of benign skin lesion result from abnormal wound healing leading to overgrowth of scar tissue beyond the original scar site?
A
Keloid
-most common on upper trunk and earlobes
20
Q
What has been the main treatment for keloids?
A
intralesional corticosteroid injections
*NOT surgery- reoccur!
21
Q
What is the most common type of cutaneous cyst that is a mobile dermal nodule, often with an overlying punctum?
A
epidermal inclusion cyst
AKA sebaceous cyst- although comes from hair follicle
22
Q
What benign skin lesion are tiny epidermoid cysts that are fixed yellow subepidermal papules?
A
milia
23
Q
What type of benign skin lesion is a soft, rubbery, mobile, subcutaneous nodule?
A
lipoma
24
Q
When warts spread due to trauma what is this called?
A
koebnerize
25
What is the fancy name for common warts?
verruca vulgaris
26
What virus causes verruca vulgaris?
HPV 2,4
27
What is the fancy name for flat warts?
Verrucae plana
28
What virus causes verrucae plana?
HPV 3,10
29
What virus causes palmoplantar warts?
HPV 1
30
What is the fancy name for external genital warts?
Condylomata acuminata
31
What virus causes Condylomata acuminata?
HPV 6, 11, 16, 18, 31 and more
32
When is the peak prevalence of warts?
adolescence (13-16 y/o)
33
What are mosaic warts?
plantar warts coalescing into large plaques
34
Acne vulgaris is a disorder of what?
pilosebaceous follicles
35
When does acne start, peak, and resolve by?
starts- 8-12
peaks- 15-18
resolves- 25
36
What percent of men and women will have acne until their 40's?
men-3%
| women- 12%
37
What is a comedone?
a clogged pore (pilosebaceous unit)
38
What are open and close comedones?
open- blackheads
| closed- whiteheads
39
What are the 4 factors involved in the formation of acne lesions?
1. increase in sebum production (influenced by androgens)
2. keratin and sebum plug the hair follicle and accumlate leading to hyperkeratosis
3. P. acnes (bacteria) proliferates in sebaceous follicle and cytokines are released
4. inflammatory response
40
What are the morphology classes of acne?
comendonal- white and blackheads
inflammatory- papules and pustules
nodulocystic- nodules and cysts
41
Along with the morphology of the acne, what is equally as important to describe?
the severity and presence of scarring.
42
What is the mechanism for topical retinoids?
Vitamin A derivatives that act by normalizing desquamation of follicular epithelium
43
What are common adverse effects of topical retinoids?
```
dryness
pruiritus
erythema
scaling
photosensitivity
```
44
What are some available forms and names of topical retinoids?
tretinoin
adapalene
tazarotene
(cream, gel, lotion, solution)
45
What happens if you combine benzoyl peroxide and topical retinoids?
the benzoyl peroxide oxidizes the tertinoin
46
What topical retinoids should you use during pregnancy?
tertinoin and adapalene- other agents are preferred
| tazarotene- contraindicated
47
What is the mechanism of benzoyl peroxide?
antibacterial and comedolytic properties- acts via the generation of free radicals that oxidize the proteins in P. acnes cell wall
48
What are common adverse effects of benzoyl peroxide?
- bleaching of hair, fabric or carpet
| - may irritate skin
49
What is the mechanism of topical antibiotics for acne?
reduce the number of P. acnes and reduce inflammation
50
What are forms of topical antibiotics for acne?
erythromycin 2% (solution, gel)
| clindamycin 1% (lotion, solution, gel, foam)
51
What are common adverse effects to using topical antibiotics for acne?
irritating skin
dry skin
-when using retinoids or benzoyl peroxide- consider beginning on alternate days
52
Acne treatment targets what?
new lesions- not present ones
53
What is the most common cause of acne treatment failure?
lack of adherence- therapy needs to be continued for at least 8 weeks before a response can be evaluated (topical agents take 2-3 months to see effect)
54
Daily use of what kind of moisturizer may improve skin dryness and irritation?
ceramide moisturizers (maintains skin moisture barrier)
55
What type of diet may improve acne?
low glycemic diets
56
What is the mechanism of oral antibiotics for acne?
reduces P. acnes colonization of the skin and follicles
57
When do you use oral antibiotics for acne?
moderate to severe inflammatory acne
58
What are oral antibiotics usually combined with for the treatment of acne?
often combined with benzoyl peroxide to prevent antibiotic resistance
59
What are some names of oral antibiotics used to treat acne?
tetracycline
doxycycline
minocyclin
60
What are some adverse effects to oral antibiotics when treating acne?
GI upset
photosensitivity
minocycline- can cause vertigo, dizziness and hyperpigmentation
*contraindicated for pregnancy or less than age 8*
61
Do tetracyclines interfere with birth control pills?
no
62
What medication can cause hyperpigmentation after months to years of use for acne?
minocycline- patients on long-term use should be screened; if seen in gums or sclerae- d/c
63
What is the mechanism for isotretinoin?
it is a retinoic acid derivative that targets all four of the pathophysilogic factors involved in acne
64
When should you think about giving isotretinoin?
in severe nodulocystic acne that is failing other therapies- given i 5-6 month course
65
What are common side effects of isotretinoin?
dry skin, chapped lips, elevated liver enzymes, and hypertriglyceridemia
66
Females must use how many forms of contraception during isotretinoin therapy?
2 forms- and continue for one month after treatment
67
What is the initial therapy given for mild acne: comedones with fe inflammatory lesions?
topical retinoid OR benzoyl peroxide
68
What is the initial therapy given for moderate acne: comedones with marked number of inflammatory lesions?
combination therapy with topical retinoid and benzoyl peroxide +/- topical antibiotic
69
What is the initial therapy given for severe acne: extensive inflammatory lesions with diffuse scaring?
combination therapy with oral antibiotic, topical retinoid and benzoyl peroxide +/- topical antibiotic (if doesn't work consider isotretinoin)
70
What are possible causes of mid-childhood acne (acne between 1-7)?
```
adrenal tumor
gonadal tumor
congenital adrenal hyperplasia
cushing syndrome
precocious puberty
```
71
What is the side effect of using tetracyclines in children younger than 8?
damage tooth enamel and developing bones
72
In most post-adolescent women, what type of therapy can improve acne?
antiandrogen therapy- hormonal acne even though their serum hormone levels are usually normal
73
What medications are commonly used for hormonal acne?
spirnolactone and oral contraceptives
74
What are the side effects of spirnolactone?
diuresis, hyperkalemia, irregular menses, feminization of a male fetus during pregnancy
75
What is the mechanism of spirnolactone in treating hormonal acne?
androgen-receptor blocker
| inhibitory of 5-alpha reductase
76
What can trigger acne rosacea?
```
alcohol
sunlight
hot beverages or heat
spicy food
emotional stress
*many patients have ocular involvemen*
```
77
What is the treatment for acne rosaea?
topical and oral treatments to improve papules and pustules- but cannot reverse underlying erythema and flushing
78
What is described as erythematous papules and pustules without scaling usually located around the mouth, nose and eyes?
periorifical dermatitis
79
What typically causes periorifical dermatitis?
most patients have a history or current use of topical steroid- rash often improves with cessation
80
What is the medication treatment for periorifical dermatitis?
oral tetracycline for patients >8
erythromycin for patients <8
topical: metronidazole, erythromycin, pimecrolimus
81
What are the peak onset ages for psoriasis?
20-30 and 50-60
82
Is psoriasis genetic?
strong genetic component:
| 30% have first-degree relative with it
83
What is the cycle of psoriasis?
waxes and wanes- few spontaneous remissions
84
What causes psoriasis?
chronic immune-mediated disease predominately with skin and joint manifestations
85
What are the different types of psoriasis?
plaque- scaly, erythematous patches, papules and plaques
Inverse/Flexural- erythematous patches located in skin folds
Guttate- presents with dew drop-like lesions 1-10 mm pink papules with fine scale
Erythrodermic- generalized erythema covering nearly entire body surface with varying degrees of scaling
Pustular- pustules
86
What are the different types of pustular psoriasis?
von Zumbusch- (rare) generalized pustues
| Palmoplantar- pustules on palms and soles
87
Where does Guttate Psoriasis usually occur on the body?
trunk and extremities
88
What often preeceds Guttate Psoriasis?
strep pharyngitis
89
What often triggers pustular psoriasis?
corticosteroid withdrawal
90
What type of psoriasis can be life threatening?
generalized pustular psoriasis
| -should be hospitalized and dermatology consult
91
What else occurs on the palms and soles that is indistinguishable from palmoplantar psoriasis?
skin lesions of reactive arthritis
92
Is palmoplantar psoriasis plaque or pustular?
can be either plaque or pustular
93
Besides pustular psoriasis, which other type of psoriasis may require hospitilization?
psoriatic erythroderma
94
What is psoriatic erythroderma psoriasis associated with?
fever, chills and malaise
95
What is auspitz sign?
bleeding after removal of scale in psoriasis
96
What is koebner phenomenon?
lesions induced by trauma in psoriasis
97
How can you describe the distribution of chronic plaque psoriasis?
typically symmetric and bilateral
98
What is the most common form of psoriasis?
plaque psoriasis- affects 80-90%
99
Systemic treatment of psoriasis target what?
cytokines and immune cells that cause skin proliferation
100
What type of psoriasis can you use topical steroids in and what are the side effects?
all types
| -skin atrophy, hypopigmentation, striae
101
What type of psoriasis can you use Calcipotriene (vitamin D derivative) and what are the side effects?
use in combo or rotation w/ topical steroids for added benefit
-skin irritation, photosensitivity (but can still use light therapy)
102
What type of psoriasis can you use Tazarotene (Topical retinoid) and what are the side effects?
plaque- best used in combo with topical corticosteroids
| -skin irritation, photosensivity
103
What type of psoriasis can you use coal tar in, and what are the side effects?
plaque
| -skin irritation, odor, staining of clothes
104
What type of psoriasis can you use calcineurin inhibitors in and what are the side effects?
off label use for facial and interginous psoriasis
| -skin burning and itching
105
There is a positive correlation between increased BMI and what in psoriasis?
prevalence and severity
106
Patients with psoriasis have a greater risk of what disease?
cardiovascular disease
107
30% of psoriasis pts also have what type of arthritis?
psoriatic arthritis
108
What type of medication should never be given in psoriasis and why?
oral steroids- will severely flare psoriasis upon discontinuation
109
In moderate to severe psoriasis what should be supplemented with topical treatment?
systemic treatment
110
What are types of systemic treatment for psoriasis?
1. phototherapy
2. new oral meds- methotrexate, acitretin, cylclosporin, apremilast
3. biologic agents
111
What type of psoriasis does not typically work well with phototherapy treatment?
thick plaques
112
What is dactylitis?
"sausage digit" of 2nd toe and interphalangeal joint destruction
113
What is onychodystrophy?
nail pitting and onycholysis
114
When is psoriatic arthritis better and more painful?
worse after inactivity- better with movement
115
Does the severity psoriasis and arthritis correlate?
severity may not correlate
116
Is psoriatic arthritis continuous?
usually has flares and remissions
117
How often are nails involved in psoriasis and in what types?
all types of psoriasis
fingernails- 50%
toenails- 35%
118
What is subungual hyperkeratosis?
abnormal keratinization of distal nail bed (in psoriasis)
119
What is oil drop sign?
irregular area of yellow-orange discoloration visible through the nail plate (in psoriasis)
120
What types of medications can make psoriasis worse?
```
Systemic corticosteroid treatment
Beta Blockers
Lithium
Antimalarials
Interferons
NSAIDS
```
121
What is the formal name for athlete's foot?
tinea pedis
122
What is the most common fungal infection seen in developed countries?
tinea pedis
123
What is tinea pedis caused by?
fungus trichophyton rubrum
124
What is the most common type of athlete's foot and what does it look like?
interdigital- scaling and redness between toes
125
How would you describe moccasin type athletes foot?
hyperatotic- sharp marginated scale distribute along lateral borders of feet, heels, and soles
- often associated with onychomycosis
- often affects one hand too- "one hand, two feet syndrome"
126
How would you describe vesiculobullous type of athletes foot?
grouped 2-3 mm vesicles often on arch or instep, often scale on sole
127
What is the easiest and most cost effective method used to diagnose fungal infections of the hair, skin and nail?
KOH microscopy- dissolves kertinocytes and can see hyphae
128
What is the first and second line therapy for tinea pedis, corporis, and cruris?
1st- imidazoles (fungistatic)
2nd- allylamines (fungicidal)
-topical cover twice a day for a month
129
What is the formal name for ringworm?
tinea corporis- dermatophytosis of the skin usually affecting trunk and limbs
130
How would you describe ring worm appearance?
margin of lesion is active with central area healing
| - annular lesion with central clearing
131
What is the formal name for jock itch?
tinea cruris
132
When should you use oral antifungals rather than topical?
- poor response to topical tx
- animal is suspected source of infection
- large body area involved
133
What oral antifungal is first line, how long do you give it and what should you monitor?
Terbinafine
7-14 days
check LFTs if giving more than 7 days
134
What is onychomycosis and what usually causes it?
chronic fungal infection of nailbed- usually starts as tinea pedis
135
What is necessary before prescribing oral antifungals for onychomycosis?
confirmation of fungus- culture
| -resistant to topical treatment
136
What is the first line treatment of oncyhomycosis?
oral Terbinafine for 12 weeks
137
How many people are cured from oncyhomycosis?
50% of patients
138
What are the risks of taking Terbinafine?
hepatotoxicity
reversible taste disturbance
drug interactions (P450, CYP2D6 inhibitor)
skin reactions
139
What causes tinea versicolor- AKA pityriasis versicolor?
not a dermatophyte- colinization of lipophilic yeast- Malassezia
140
When does tiniea versicolor tend to appear?
annully in summer months
141
How would you describe tinea versicolor?
well demarcated tan, salmon or hypopigmented of hyperpigmented patches commonly on trunk and arms
142
What do you see under microscope with tinea versicolor?
"spaghetti and meatball" pattern
| short hyphae and small round spores
143
What are the first second and third line treatments for tinea versicolor?
1st- shampoo w/ selenium sulfide 2%
2nd- imadazole creams
3- oral medications Fluconazole or Itraconazole
144
What is candidal intertrigo?
inflammation of large skin folds (breasts, butt, inguinal creases, under abdomen)
145
What causes candidal intertrigo?
collinization of candida yeast
146
What are the classic signs and symptoms of candidal intertrigo?
burns more than itches
| satellite macules, papules or pustules around the erythema in the fold
147
What is the first line treatment for candidal intertrigo?
clotrimazole cream (an Imidazole)- better than nystatin
148
What medication class is not effective for candida yeast?
allylamines
149
What medication can you give for candidal intertrigo that rapidly improves the itching and burning?
low-strength corticosteroid
| -ointments burn less than creams
150
What is seborrheic dermatitis and inflammatory reaction to?
normal flora on oil producing skin- Malassezia yeast
151
Can seborrheic dermatitis be cured?
no- chronic condition that can be controlled but not cured
152
How does seborrheic dermatitis present?
erythematous scaling patches on the scalp, hairline, eybrows, eyelids, central face, nasolabial folds, external auditory canals, or central chest
-often hypopigmented in dark skinned pts
153
How do you treat seborrheic dermatitis?
topical ketoconazole-reduces yeast count
low potency topical steroid
antidandruff shampoo
154
What type of skin type does squamous cell most commonly occur in?
white/fair skin
155
What body location does squamous cell usually occur?
head, neck, forearms, dorsal hands (sun-exposed areas)
156
For African Americans, what part of their skin gets squamous cell more?
incidence of sun-protected and sun-exposed skin presents equally
157
Do you have report squamous cell and basal cell carcinoma?
No- non melanoma doesn't have to be reported- so the rates are under-reported
158
What is squamous cell in non sun-exposed areas related to?
chemical carcinogen exposure (ex. arsenic)
159
What items are included in the group 1- most dangerous cancer-causing entities/substances of the skin?
UV tanning beds
cigarettes
plutonium
160
What does squamous cell look like?
various morphologies- papule, plaque, nodule, exophytic (grows outward), indurated, friable (bleeds with minimal trauma)
-usually asymptomatic, may be pruitic and tender
161
What is another name for Squamous cell in situ, and what makes this diagnosis?
Bowmen's disease
| -kaertinocyte atypia is confined to the pidermis and does not go past the dermal-epidermal junction
162
What are common clinical signs of squamous cell in the nail bed?
-male age 50-69
| warty, subungual hyperkeratosis, onycholysis, oozing, destruction of nail plate
163
What are the non-surgical options for treating squamous cell?
```
radiation- for poor surgical candidates
5-Fluorouracil cream (interferes w/ DNA synthesis)
Imiquimod cream (synthetic immune response modifier)
Diclofenac gel (downregulates enzymes and increases apoptosis)
Ingenol Metubate (causes cellular death followed by inflammatory response)
Photodynamic therapy (In-situ)
```
164
What locations on the body are at risk of higher metastasis of squamous cell?
ears, non-hair bearing lip, scalp, masc of face region, in scars, chronic ulcers, burns sinus tracts or genitalia
165
What are the follow-up guidelines for people who have non-metastatic squamous cell?
every 3-6 months for 2 years, every 6-12 months for 3 years, then annually for life
166
Actinic Keratosis is a premalignant lesion and have the potential to turn into what type of cancer, and how often?
squamous cell- but risk of transformation within a year is 8%
167
What gene is affected by UV exposure putting you at higher risk for actinic keratosis?
p53 tumor suppressor gene
168
How is actinic keratosis typically diagnosed?
by feel (feels like sandpaper- but not indurated)
169
What is the fancy name for age spots and what causes them?
Solar Lentigo or Lentigines
| -UV damage
170
What is the fancy name for old people's skin easily brusing?
Actinic (senile) Purpura
171
What is actinic keratosis of the lips called, and where does it most often occur?
actinic cheilitis- most often on lower lip
172
How often should patients with actinic keratosis get skin exams and why?
every 6-12 months because they are at increased risk of developing non-melanoma and melanoma skin cancers
173
How much sunscreen is the recommended amount of sunscreen to cover expose skin?
1 ounce- 1 shot glass
174
What is the most common type of cancer?
skin cancer as a group (basal cell, squamous cell and melanoma combined)
175
What is the most common type of skin cancer?
basal cell
176
Where does basal cell occur in the skin?
basal layer of the epidermis
177
What gene is usually involved in basal cell carcinoma?
PTCH tumor suppressor gene (altered by UV radiation)
178
What is the Fitzpatrick Skin Classification and what are they?
I- white, always burns, no tan
II- white, always burns, minimal tan
III- white, burns minimally, tans moderately and gradually
IV- light brown, burns minimally, tans well
V- brown, rarely burns, tans deeply
VI- dark brown/black, never burns, tans deeply
179
What is the most common subtype of basal cell?
nodular- pearly papule or nodule with overlying telangiectasias (most often seen on head and neck)
180
What subtypes of basal cell are there?
```
nodular
ulcerated- rolled borders
superficial- pink patch maybe w/ scaling
pigmented- can be nodular or superficial
morpheaform/infiltrative/scelrotic- appears scar-like
```
181
What type of skin conditions mimic basal cell?
- sebaceous hyperplasia- enlarged oil glands (telangiectasias wrap around the oil gland rather than over the lesion like in BCC)
- fibrous papule (doesn't have telangiectasisas of pearly texture)
182
Does basal cell metastasize?
rarely- but patients are at risk for developing other non-melanoma and melanoma skin cancers
183
There is insufficient evidence to recommend specific follow-up for BCC what do most experts agree on?
every 6-12 months for 2 years
