Dermatology Review Flashcards Preview

BL/DD USMLE and Basics > Dermatology Review > Flashcards

Flashcards in Dermatology Review Deck (70):
1

Epidermis layers

Stratum corneum
Stratum granulosum
Stratum spinosum
Stratum basalis

2

Zones of the Dermis

Papillary dermis
-upper layer
-thin collagen bundles
-interlocks with epidermal rete
-increases strength
-increases surface area

Reticular dermis
-deeper layer
-thick collagen bundles
-visible elastic fibers

3

1. Collagen – forms the tensile strength
2. Elastic fibers – allow for resilience
3. Ground substance – facilitates diffusion

Major constituents of the dermis

4

Acquired disorder of elastin

Solar elastosis

5

Congenital disorder of elastin

Pseudoxanthoma Elasticum

6

Acquired blistering disorder of DEJ

Bullous pemphgoid

7

Papillary dermis
-upper layer
-thin collagen bundles
-interlocks with epidermal rete
-increases strength
-increases surface area

Reticular dermis
-deeper layer
-thick collagen bundles
-visible elastic fibers

Zones of the Dermis

8

Congenital blistering disorder of DEJ

Epidermolysis bullosa

9

Proximal Subungual White Onychomycosis/ Trichophyton rubrum

Associated with HIV disease

10

Major constituents of the dermis

1. Collagen – forms the tensile strength
2. Elastic fibers – allow for resilience
3. Ground substance – facilitates diffusion

11

-upper layer
-thin collagen bundles
-interlocks with epidermal rete
-increases strength
-increases surface area

Papillary dermis

12

-deeper layer
-thick collagen bundles
-visible elastic fibers

Reticular dermis

13

Anagen Effluvium

Loss of growing hairs- Often due to chemotherapy

14

Telogen Effluvium

Hairs go into resting cycle
May be due to medications, post partum

15

Nummular Dermatitis

distinct, coin-shaped (nummular) or oval sores on their skin

16

Atopic Dermatitis

An itchy inflammation of the skin

17

Seborrheic Dermatitis

A skin condition that causes scaly patches and red skin, mainly on the scalp

18

Irritant Dermatitis

is inflammation of the skin typically manifested by erythema, mild edema, and scaling.

Irritant contact dermatitis is a nonspecific response of the skin to direct chemical damage that releases mediators of inflammation predominately from epidermal cells.

19

Four Types of Hypersensitivity Reactions

Type I: Anaphylactic Reactions
Type II: Cytotoxic Reactions
Type III: Immune Complex Reactions
Type IV: Delayed Type Hypersensitivity Reactions

20

Involves reactions to circulating antigens
Antibodies bind antigen and form immune complexes which deposit in organs
These immune complexes activate complement and cause damage due to inflammatory cascade
Example: serum sickness reactions

Type III: Immune Complex Reactions

21

Langerhans cells are the antigen presenting cell
Memory T cells then become sensitized to locally deposited antigens
Local reaction occurs and this does not involve antibodies

Type IV: Delayed Type Hypersensitivity Reactions

22

__________ produce IFN-gamma, IL-2 and TNF-beta, evoke cell-mediated immunity and phagocyte-dependent inflammation

Th1 cells

23

______ produce IL-4, IL-5, IL-6, IL-9, IL-10, and IL-13, and evoke strong Ab responses (IgE) with eosinophil accumulation

Th2 cells

24

Impetigo

yellow/honey crust

25

Neurofibromatosis Type 1: Diagnosis requires 2 or more of the following criteria

1. 6+ café au lait macules

2. 2+neurofibromas, or 1 plexiform neurofibroma

3. Axillary or inguinal freckling (Crowe’s sign)

4. Optic glioma

5. Two or more Lisch nodules

6. thinning of the long bone cortex

7. FDR with the disorder

26

Seborrheic Keratosis “Barnacles of Life”

Primary lesion
Color- white to gray to tan to brown to black
Exophytic papule- “stuck-on appearance”
Smooth to verrucous
Often friable
Surface often studded with small pits (pseudohorncysts

27

Growth patterns of moles

Intradermal nevus
Junctional nevus
Compound nevus

28

Malignant Melanoma
ABCDE Guidelines

A = Asymmetry
B = Border irregularity
C = Color variation
D = Diameter greater than 6 mm
E = Evolution (or change)
The Ugly Ducklin

29

1. 6+ café au lait macules

2. 2+neurofibromas, or 1 plexiform neurofibroma

3. Axillary or inguinal freckling (Crowe’s sign)

4. Optic glioma

5. Two or more Lisch nodules

6. thinning of the long bone cortex

7. FDR with the disorder

Neurofibromatosis Type 1: Diagnosis requires 2 or more of the following criteria

30

UVR Effects on the Skin

-Damage to DNA, RNA, lipids, proteins
-Pro-inflammatory effects
-Immunosuppressive effects
-Induction of innate defenses
-Induction of apoptosis
-Vitamin D synthesis

31

Photodermatoses

Connective Tissue Disease

Lupus Erythematosus
Dermatomyositis
Mixed Connective Tissue Disease (MCTD or Sharp’s Syndrome

32

Acanthosis Nigricans TREATMENT

Treat the underlying disorder
Keratolytics such as ammonium lactate or urea cream

33

Dermatomyositis
CLINICAL

Photodistributed, violaceous poikiloderma
Favors scalp, periocular and extensor skin sites
Heliotrope = Eruption on the upper eyelids +/- periorbital edema

34

Samitz sign

= ragged cuticles

*Dermatomyositis CLINICAL

35

Gottron’s papules

lichenoid papules overlying knuckles, elbows, knees

Dermatomyositis CLINICAL

36

Dermatomyositis - MALIGNANCY

Age appropriate malignancy screen including: mammogram, CXR, colonoscopy, PAP smear, PSA, CBC

37

Skin Defenses Against Ultraviolet Radiation

-DNA Repair
-Apoptosis of Cells with DNA Damage
-Defenses Against Reactive Oxygen
-Melanin

38

Ointments vs. creams

To lubricate, creams must be applied every 2 hours; ointments only every 12 hours

Creams require preservatives that may cause contact irritation or allergy

39

Pyoderma Gangrenosum - TREATMENT

Conservative wound care

AVOID SURGERY AND DEBRIDEMENT

Oral and topical anti-inflammatory agents such as steroids

40

Purple, polygonal, pruritic papules

Wickham’s striae: an overlying lace-like pattern of white lines on the surface

Lichen Planus

41

Inflammatory Bowel Disease relates to?

Pyoderma Gangrenosum

42

Acanthosis Nigricans ASSOCIATIONS

Familial: AD, rare, onset in childhood
Obesity
Diabetes mellitus: Insulin Resistance
Endocrinopathies

43

Macule

flush
less 1 cm

44

Papule

solid
raised
less 1 cm

45

Lichen Planus ASSOCIATIONS

Hepatitis C
Prevalence of HCV was 2-13.5 fold higher in patients with LP than with controls
In one study, 12 of 22 pts (55%) with LP were HCV positive

46

Patch

flush
>1 cm

47

Acanthosis Nigricans - MALIGNANCY

Malignancies include adenocarcinoma of the stomach (60%), lung and breast cancer

48

Wickham’s striae:

an overlying lace-like pattern of white lines on the surface

49

Plaque

raised
larger than 1 cm

50

Nodule

cystic elevation greater 1 cm

51

Bulla

circumscribed
elevated
clear/bloody fluid
> 1cm

52

Scale

flakes on skin surface

53

Tumor

solid/cystic elevation over 2 cm

54

Vesicle

circumscribed
elevated
clear/bloody fluid
< 1cm

55

Flat area of color change
Less than 1.0 cm

Flat: Macule

56

Atrophy

depression on skin surface
loss of epi/dermis

57

Flat area of color change
Greater than 1.0 cm

Flat: Patch

58

Discrete, solid, elevated body
Less than 1.0 cm in diameter
May be further classified by surface change
Scale, Crust

Papule

59

Erosion

depression with loss of epidermis

60

Pustule

vesicle containing purulent exudate

61

Ulceration

loss of at least some of dermis

62

Crust

dried exudate

63

Wheal

circumscribed flat top
firm elevation
well demarkated
palpable

64

Solid, flat-topped, elevated area of skin
Greater than 1.0 cm and broader than thick
May be further classified by surface change

Plaque

65

Firm and well-defined lesion
May be dermal or subcutaneous
Greater than 1.0 cm

Nodule

66

Fluid filled cavity or elevation
Form within or just below epidermis
Less than 1.0 cm in diameter

Vesicle

67

Fluid filled “blister”
Greater than 1.0 cm in diameter

Bulla

68

Circumscribed elevation that contains pus
Less than 1.0 cm in diameter
Color usually whitish-yellow

Pustule

69

Individuals with truncation mutations in the gene coding for filaggrin are strongly predisposed to a severe form of dry skin,________, and/or eczema.

ichthyosis vulgaris

70

Guttate psoriasis is associated with _____

strep infection