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Flashcards in Examination Deck (85):
1

Macule

Corcumscribed
Flat lesion
Visible coz of change in color( hyper / hypopigmented/ erythematous)

2

Patch

Macule >0.5cm

3

Colour change in dermal and epidermal pigmentation

Slate grey

Brown

4

Papule

Small <0.5 cm
Elevated

Due to - hyperplasia of cells of epi/dermis , metabolic deposits in dermis , cellular infilterate in dermis

5

Nodule

Paule >0.5 cm

6

Plaque

Called plaque whether < or> 0.5 cm

ALTERED CONSISTENCY OF SKIN
May be raised/ depressed but surface area larger than height

7

Blisters

Fluid filled
2 types
1. Vesicle- < 0.5 cm
2.bulla -> 0.5 cm

8

Pustule

Pus filled whether 0.5 cm

9

Wheal

Evanescent elevated lesion due to edema of dermis/sc tissue

URTICARIA- white elevated lesion surrounded by erythema
Subsides in 24 hrs
Linear- dermatographic urticaria


ANGIOEDEMA
Extends into Sc tissue
Lasts 24- 48 hrs
Mc at mucocutaneous jxn

10

Pathognomic lesion of scabies

Burrow:

Serpentine
Thread like
Open end marked by papule

11

Comedones

Inspissated plugs of keratin and sebum in pilosebacious orifices

Open: black head- keratin plug is black
Closed: white head - covered by skin

12

Diff bw crust and scale

Scale- collection of cells of horny layer
Dry surface on removal

Crust- collection of epi cells, dried serum and sometimes blood.
Moist surface on removal

13

Silvery removable scale seen in

Psoriasis

14

Skin manifestations of tuberous sclerosis

1.angiofibroma/adenoma sebaceum-nose , nasolabial folds and cheeck

2.ask leaf macule-hypopigmented , trunk

3.shagreen patch-leathery, lumbosacral region

4.periungal fibromas/koenen tumor

15

X linked icthyoses

Only males
Deficiecy in steroid sulfate
Large dark , tightly adherent
Sites: generalised, flexures encroached
Ass: corneal opacities , cryptorchidism

16

Icthyosis vulgaris

AD
Deficiency in filagggrin
Both males and females
Small, branny , except on shins where large.
Pasted in centre with upturned edge.
Extensors of limbs, lower back.
Associated with- hyperlinear palms and soles, keratosis pilaris , atopic diathesis

17

NF1

SKIN
Cafe au lait macules(CALM)- uniformly pigmented, oval

Cutanoues neurofibroma-3 types
Dermal(button hole sign)
Plexiform(diffuse plaques ,wormy/knotty)
Subcutaneous

Intertiginous frekling/ crowe s sign( axillary and inguinal frekling)

EYES - optic glioma , lisch nodules

BONE-thining of cortex , sphenoidal dysplasia, pseudoarthrosis

PHEOCHROMOCYTOMA

18

NF2

Bilateral acoustic neuroma
Meningioma/gliomas
Mimimal cut manifestatiin
No lisch nodules

19

Acanthosis nigricans causes

BENIGN
Obesity
Hereditary
Hair- an syn(hyperandrogenic, insulin resistance, cushing)
Acral
Endocrine(hyper androg, cushing, DM)
Drugs(corticosteroids, OCPs)

MALIGNANT
Mc gastric adenoca , genitourinary

20

Lesion in acanthosis nigricans

Hyperpigmentation
Dirty look
Thickening
Velvety

21

Molecular defect in XP xeroderma pigmentosa

Defective repair of UV damaged DNA

Leading to development of skin cancers

22

Molecular defect in XP xeroderma pigmentosa

Defective repair of UV damaged DNA

Leading to development of skin cancers

23

XP lesion

Photosensitivity
Multiple frekles
Eventually actinic keratosi
Keratoacanthoma
BCC
SCC
Melanoma

24

Prototype lesion of Chronic plaque psoriasis

Mildly itchy papule /plaque
Well demarcated
Erthymatous base
Surmounted by scales
Indurated
Discoid

25

Koebner s phenomenon

When lesion develop at the site of trauma(scratch, surgical incisiin, tatoo, injury)

Aka isomorphic phenomenon


Seen in::
Psoriasis
Lichen planus
Vitiligo

26

Grattage test

Scales in the psoroatic plaque can be accentuated by grating with glass slide

27

Auspitz test

3 steps
Grattage test

As u continue to scrape ,glistening white membrane appears(berkleys membrane)

On removing memb punctate points becone visible

28

Sites of predilictiin for psoriasis

Usually bilateral symm
Pressure points(knees and elbow)
Extensors more
face uncommon(refractory)
Scalp(spillage to forehead and nape of neck)
Lumbosacral
Periumblical
Palms and soles
Flexual

29

Reiters syndrome

Antecedant inf(genital, enteric)
Arthritis
Iridocyclitis, conjuctivitis
Mucocutaneous(rupoid psoriasis- heaped up scales , keratoderma blennorrhagica , circinate balanitis)

30

Types of psoriasis

Chronic plaque
Guttat
Pustular

31

Guttate psoriasis

Childn and adoloscent
may be ppted by streptococcus infection
Lesions in shower
Trunk

32

Dactylitis seen in

Psoriasis

33

Nail changes in psoriasis

Pitting
Plate thickening
Subungual hyperkeratosis
Discolouration
Onycholysis
Oil spots

34

Histopathological findings in psoriasis

EPIDERMAL
Parakeratosis

Hyperkeratosis ( stratum corneum)

Acanthosis (diffuse epidermal hyperplasia:basale , spinosum)

Thin/no granular layer

Suprapapillary thinning- berkeley memb

Collection of neutrophils to form munro microabcess , spongiform pustule of kogoj

Club shaped elongated rete ridges

DERMAL
Dilation amd tortusity of capillaries

Lymphocytes

35

Tazarotene

Vit a derivative

36

Moa of macrolides

.

37

Onychomycosis

Fungal infection of nail

Tinea unguim is fungal infection of nail plate due to dermetophyte

38

Interactions of Macrolides with CYP450

All are enz inhibitors(cla/erythro/telith) except AZITHROMYCIN

39

SE of macrolides

Git-epigastric pain

+motilin R -promotes int motility without affecting colon

Used in  diabetic gastroparesis and postop ileus

But tolerance develops and flora eff :not used as prokinetic

Ototoxic:high dose

Hypersenstivity

Hepatitis:estolate

40

Excretion of macrolides

All in bile(azith/eryth/telithro) except clarithromycin

41

Macrolides spectrum

Gpc (not MRSA)
Clamydia
Mycoplasma
Mycobacteria
Spirochete
h.pylori
C. Jejuni
Legionella
H.influenza

42

Nail changes in tinea unguim

Thichened nail
Subungal hyperkeratosis which is friable
Onycholysis
Tunneling

43

Hidradenitis suppurativa

Apocrine glands

Occlusion - rupture - inflammation and infection

Axilla, perineum and genitalia

44

Chlamydial infection Rx

Axithromycin or doxycline

45

Role of minoxidil in alopecia

.vasodilation and angiogenic potential

Reduces miniaturization of terminal hair and also converts miniaturized hair into terminal hair

46

Spagetti amd meat ball appearance seen in

Malssazia furfur

47

CSF penetration of macrolides

Do not penetrate

48

KOH mount findings of candida

Budding yeast and pseudohyphae

49

Piyriasis versicolor caused by

Malassezia furfur

50

Lesion of pityriais versicolor

Distint Perifollicular macules (mostly hypopigmented , can be hyperpig )

51

KOH finding of pityriasis versicolor

Spaghetti and meat ball appearance (spores and short branched hyphae)

52

Typical lesion of dermatophytes

Annular/arcuate spreads centrigugally

Margin is active showing papules, vesicles , scaling , pustules

Centre is relatively clear though in chronic cases there is lichenification

53

What is ringworm

Tinea/ dermatophyte infection

54

Types of alopecia

Cicatracial and non cicatracial

55

Alopecia aereta

Non cicatracial with no inflammation( erythema , inflammation , paules)
Skin specific autoimmune
Exclamation marks
Commonly at scalp, beard , mostache , eyebrows , eyelashes
Regrowth with gey hair
Nail changes(pitting and thinning)

56

Androgenetic alopecia

Miniatrization of hair follicles(terminal into
vellus hair)

Males:Androgen dependant
Typical presentation -frontoparietal and frontal recession , thinning of vertx

Females - no typical presentation , diffuse hair loss , initially as widening of central parting

57

Telogen effluvium

All hair enter telogen phase and are shed simultaneously

Cause
Infections
Childbirth
Surgical trauma
Haemorrhage
Emotional stress
Drugs

58

Splinter haemorrhages seen in

Trauma
Psoriasis
Bacterial endocarditis

59

Paronychia

Inflammation of nail fold

60

Koilonychia

Spoon shaped nails seen in iron deficiency

61

Pitting in
psoriasis
alopecia aereta
Eczema

Coarse with other changes

Fine and thinning of nail plate

Coarse, deep irregular cross ridging

62

Beau 's line

Transverse grooves

After severe, acute illness

63

Aa for melanin synthesis

Tyrosine

64

Frekles

Fair skinned

Each lesion has color variation within and from others

Photoexposed parts(face, dorsolateral forearms , hands , neck)

Darken on sun exposure
AD

65

Melasma site

Symmetrically on
cheeks
Nose
Forehead
chin

66

Type of skin color change with clofazamine

Orange

67

Lentigenes

In any skin color

Well defined, uniform color

Any part of body including mucosa

No change in color after sunexposure

Seen in
PEUTZ JEGHERS
CRONKHITE CANADA SYNDROME

68

Minocyline skin pigment changes

Blue black

69

Vitiligo is due to anatomical/ functional defect in melanocytes

Anatomical

Absent

70

Koebners phenomenon seen in

Psoriasis
Vitiligo
Lichen planus

71

Site of predeliction for vitiligo

Any part

But areas prone to repeated friction and trauma( dorsae hand and feet , elbows and knees)

72

Characteristic lesion of LP

Itchy violaceous polygonal flat topped papules with wicham stria

73

5 Ps of LP

P pruritic

P purple

P polygonal

P plane topped

P papules

74

Pterygium of nail is diagnostic of

LP

75

Sites of prediliction of LP

Flexors of wrist

Ankles

Shins

Lower back

Associated changes:
Nail- thinning, trachyonychia , tenting, pterygium

Scalp: violaceous perifollicular , cicatracial alopecia

Palmoplantar : keratotic papule with central dull

76

Hostopathological changes in LP

No parakeratosis

Hyperkeratosis

Thickened granular layer

Basal cell degeneration ( max joseph spaces ,coloid bodies)

Saw toothed dermoepidermal jxn
Irregular saw toothed appearance due to basal cell loss
Lymphocytes lead to indistint DE jxn

Band like upper dermal infilterate

77

Dermatitis herpetiformis

Itchy(excoriation) ,grouped(herpetiformis ) , edematous paupules and small vesicles on normal/erythematous skin.

Sites: extensors and pressure points

Dermoepidermal split
Granular IgA deposits at tips of dermal papilla
Dermal papillary tip neutrophilic abcesses

Associated: gluten sensitive enteropathy

78

Bullous pemphigoid

AI

Linear deposits of IgG Abs and C3 at dermoepidermal jxn (against hemidesmosomes)

Lesion: itchy , large , tense bulla , rupture less readily , roof of bulla just settles down as the contents are absorbed , heal with milia( small pearly paules ) ,

Bulla spread sign and nikolsky sign negative

79

Pemphigous

Intraepidermal bullous disorder
AI
Acantholysis
IgG auto Abs against DESMOGLEINS

Types:2 main
Pemphigous vulgaris
Pemphigous foilaceous

80

Pemphigous vulgaris

Lesion: flaccid bullae- rapidly rupture - painful erosions - heal slowly

Bedside test:
NIKOLSKY SIGN- tangential pressure on normal skin results in new bulla formation

BULLA SPREAD SIGN/ ASBOE HANSEN SIGN : spread of bulla on applying pressure on prexisting bulla

MUCOSAL LESION: universal

Site: scalp, face , flexures , trunk

SPLIT: Intraepidermal
Suprabasal

81

Pemphigous foilaceous

Lesion: superficial bulla - rupture rapidly - so only scale crust seen

MUCOSAL LESION : rare

Site: initially seborrhic distribution , becomes generalised

SPLIT: intreepidermal
Subcorneal / granular layer

82

Epidermal necrolysis

Cause: drugs-anticonvulsants , antibacterials , NSAIDS, allopurinol

Lesion: deeply erythematous(purpuric), may develop bulla , peel off in sheets , denuded area
Mucosal : eyes and mouth frequently

Site: face , trunk and proximal extremities

Depending on BSA
1.SJS :<10 %
2. SJS-TEN : 10 - 30 %
3.TEN : >30 %

83

Psedohyphae

Pseudohyphae" are distinguished from true hyphae by their method of growth, relative frailty and lack of cytoplasmic connection between the cells.

They are the result of a sort of incomplete budding where the cells elongate but remain attached after division

84

Isotretinoin

Moa: (all causes)
1.inhibit sebum production
2.Normalizing follicular epidermal hyperproliferation
3.dec P.acne
4.reducing inflammation

Use: severe acne

Side effects:
Dry skin, cheiltis, hair loss,dryness of eyes , nose bleeds

Teratogenic , contraception using 2 diff methods during and 1 mth after Rx

Not to donate blood

Pseudotumor cerebrii

Liver fxn test

Hypertriglycerides

Myalgia, bertebral hyperostosis, altered night vision

85

Retinoids

RITA
Retinoic acid
Isotretinoin
Tazarotene
Adapalene

Moa:
Especially for comedones
Increasing epidermal cell turnover
Increasing dehiscence of atratum corneum