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Flashcards in Green PANCE book :) Deck (124)
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1

What is the first step in an accurate diagnosis of skin disease?

Thorough history!

2

What should be investigated as part of the history?

Past medical history, medication history, family history, psychological factors, recreational and employment risk, and diet and environmental/travel exposures

3

What is the Darier sign?

Rubbing a lesion causes urticarial flare

4

What is the Auspitz sign?

Pinpoint bleeding after a scale is removed

5

What is the Nikolsky sign?

Pushing a blister causes further separation of the dermis

6

What is the Photopatch test?

Documents photoallergy

7

Patch test?

Demonstrates hypersensitivity reaction

8

Koebner phenomenon?

Minor trauma leads to new lesions at site of trauma

9

How is Diascopy performed?

Glass slide or diascope pressed against the skin

10

What are the results of diascopy?

Blanching indicates intact capillaries; extravasated blood (purpura) does not blanch

11

What does a KOH prep affect?

Dissolves keratin and cellular material but does not affect fungi

12

What does KOH prep identify?

dermatophyte infection

13

How do you prepare a Potassium hydroxide preparation (KOH prep)?

Microscopic examination of skin scrapings mounted in KOH

14

What type of instruments facilitate specimen collections?

Blunt and sharp instruments

15

What type of examination is used to assess changes in pigment or fluoresce infectious lesions?

Wood's light examination

16

What is the MAD criteria?

How to describe a lesion; M: morphology, A: arrangement, D: distribution

17

What is Shagreen skin?

Oval-shaped nevoid plague. Skin is colored or pigmented on the trunk or back and is associated with tuberous sclerosis

18

What is used to facilitate the examination of warts?

Acetowhitening using acetic acid

19

Which is indicated if pathologic confirmation is necessary?

Biopsy- excisional, incisional, shave or punch

20

Dilated, small, superficial blood vessel

Telangiectasia

21

What kind of light should the physical exam be carried out under?

Natural or direct lighting

22

Thickened skin with distinct borders, often result of excessive scratching or prolonged irritation

Lichenification

23

Swollen and softened by an increase in water content (appearance when skin left in water too long)

Macerated

24

Irregular, rough, and convoluted surfaces

Verrucous

25

Solid, palpable lesion

Papule

26

Solid, palpable lesion >5mm in diameter

Nodule

27

Flat, non palpable lesion

Macule

28

Flat, non palpable lesion >10mm in diameter

Patch

29

Plateau-like lesion >10mm in diameter, mat be a group of confluent papules

Plague

30

Circumscribed, elevated lesion containing serous fluid

Vesicle

31

Circumscribed, elevated lesion containing serous fluid >5mm in diameter

Bulla

32

Transient, elevated lesion caused by local edema

Wheal

33

Minute hemorrhagic spots that cannot be blanched by diascopy

Petechiae

34

Hard, rough surface formed by dried sebum, exudate, blood, or necrotic skin

Crust

35

Heaped up piles of horny epithelium with a dry appearance

Scale

36

Vesicle or bulla containing purulent material

Pustule

37

Defect of the epidermis; heals without a scar

Erosion

38

Defect that extends into the dermis or deeper; heals with a scar

Ulcer

39

Are eczema and dermatitis used interchangeably?

YES :)

40

Caused by chemical irritants, such as cleaners, solvents, and detergents in contact with the skin

Irritant contact dermatitis

41

What is irritant contact diaper dermatitis?

Diaper rash; due to prolonged contact with urine, feces, or detergents from washable diapers

42

What bacterial infection is irritant contact diaper dermatitis often associated with?

superimposed Candida infection characterized by satellite lesions

43

What type if allergy does allergic contact dermatitis denote?

Allergic type IV cell-mediated hypersensitivity reaction

44

What are the common causes of allergic contact dermatitis?

Occupational or personal contact with irritants, such as cleaning supplies, solvents, oils, abrasives, oxidizing or reducing agents, dust, nickel, enzymes, and plants ( eg poison ivy)

45

What do patients complain of in contact dermatitis?

Itching and burning in the affected area

46

What types of acute lesions are seen with contact dermatitis?

Well demarcated areas of erythema and possibly exudative lesions, vesicles, erosions, and crusts may develop

47

What types of chronic lesions are seen with contact dermatitis?

Plaques and scaling with lichenification. Satellite papules and excoriations are common.

48

What lab studies will support a diagnosis of contact dermatitis?

Patch test that results in similar reactions

49

What is the main tx for contact dermatitis?

Avoid/remove the offending agent

50

A chronic relapsing disorder that occurs in childhood. Type I immunoglobulin E-mediated hypersensitivity reaction..

Atopic dermatitis

51

What other conditions are seen with atopic dermatitis (triad)?

Asthma and allergic rhinitis

52

-Papules and plaques (with or without scales) may be associates with edema, erosion, and crusts -Patient complains of pruritus and dry, scaly skin

Atopic dermatitis

53

What bacteria most commonly causes secondary infection in atopic dermatitis?

Staph aureus

54

Where on the body is atopic dermatitis most often seen?

Flexural surfaces, neck, eyelids, forehead, face, and dorsum of the hands and feet

55

Dermatographism is characteristic in which dermatitis?

Atopic dermatitis

56

What is the treatment for atopic dermatitis?

  • Antihistamines to help reduce itching
  • Topical corticosteroids are the mainstay of tx
  • hydration and topical emollients are key to management 
  • Avoid: soaps, vigorous rubbing, frequent bathing, and irritant clothing (wool)

57

Pruitic inflammatory disorder that typically affects young adults and the elderly. Typically occurs in fall and winter.

Nummular dermatitis 

58

Small, grouped vesicles coalesce to form coin-shaped plaques with an erythematous base and clearly demarcated borders most commonly on the extremeties. Crusting and excoritations can occur.

Nummular dermatitis

59

Tx for Nummular dermatitis?

Responds to moisturizers and topical steroids. Tar baths or UVB phototherapy can be helpful for refractory cases

60

Dermatitis where sebacious glands are most active (body folds, face, scalp, genitalia). Common during infancy and puberty and in young to middle aged adults

Seborrheic dermatitis 

61

Scattered yellowish or gray, scaly macules and papules with a greasy look. Sticky crusts found behind the ears. Manifests as cradle cap in infants and dandruff in adults.

Seborrheic dermatitis 

62

Tx for seborrheic dermatitis

  • Shampoos containing selenium or zinc and ketoconazole shampoo for acute flare ups
  • tar shampoo or topical steroids for severe cases
  • cradle cap: olive oil compresses and baby shampoo
  • UV radiation can also be helpful

63

Papulopustules form on erythematous bases and may become confluent with plaques and scales. Vermillion border is spared and satillite lesions are common

Perioral dermatitis

64

What causes perioral dermatitis?

Often young women with a history of prior topical steroid use in the area 

65

What tx should you avoid with perioral dermatitis?

TOPICAL STEROIDS...they caused it silly ;)

66

Tx for perioral dermatitis?

Topical metronidazole or erthyromycin 

67

Chronic venous insufficiency due to valvular incompetency leads to edema, dermatitis, hyperpigmentation fibrosis, and ulceration

Stasis dermatitis 

68

Who is more often effected by Stasis dermatitis?

Women are 3x more often effected. Pregnancy will exacerbate this

69

What will a patient complain of in stasis dermatitis?

heaviness or aching in the legs that is aggrevated by standing and alleviated by sitting

70

Inflammatory papules, scales, and crusts. Stippled pigmentation and excoriations. Ulcerations can be seen in 30% of patients. 

Stasis dermatitis

71

What will confirm chronic insufficiency in stasis dermatitis?

Doppler studies, sonography, or venography

72

Tx for stasis dermatitis?

  • Chronic insufficiency: compression stockings
  • Vascular bypass, endothelial thermal ablation, or angioplasty/stenting of obscured veins MAY benefit severly compromised areas

73

What is lichenification?

Long-term manifestation of atopic dermatitis due to repetitive scratching and rubbing

74

Well-circumscribed plaques that are highly pruritic. Sets up a cycle of itch-scratch lesions

Lichen simplex chronicus

75

Solid, firm, thick plaques with little to no scaling. Light touch precipitates a strong desire to scratch. Common areas include nuchal area, scalp, ankles, lower legs, upper thighs, exterior forearms, or genitial areas

Lichen simplex chronicus

76

What lab studies should be done for lichen simplex chronicus?

  • KOH prep to rule out fungal infection
  • Biopsy: shows hyperplasia and hyperkeratosis

77

Management of lichen simplex chronicus

Stopping the itch-scratch cycle. Antihistamines to reduce itching 

78

Tx of lichen simplex chronicus

Occulusive dressing w or w/o topical steroids or tar prep

79

What is characteristically seen before Pityriasis rosea?

Herald patch 

80

What causes Pityriasis rosea?

Viral (Human herpes virus 7)

81

What does the herald patch look like?

Solitary, round or oval pink plaque with a raised border and fine adherent scales in the margin. Usually precedes rash by 1 week

82

Where does the Pityriasis rash start? What does it look like?

Trunk as round or oval, salmon-colored, slightly raised papular and macular lesions usually about 1cm in diameter 

83

What does the distribution of the Pityriasis rosea resemble?

Christmas tree-like distribution 

84

Tx for Pityriasis rosea

Self limiting (usually 3-8 weeks) other than lotions or emoillents for the scales 

85

What prodrome can be seen before the onset of the Pityriasis rosea rash?

Mild URI

86

Viral disease of the skin and mucous membranes caused by poxvirus

Molluscum contagiosum 

87

Where are lesions commonly seen in adults in Molluscum contagiosum?

Groin areas and lower abdomen 

88

Can Molluscum contagiosum be trasmitted through sexual activity?

YES! Wrap that shit ;)

89

Delicate, flesh-colored, waxy dome-shaped, umbilicated papules that range in size from 3-6 mm and appear in groups. A white-curd like material can be expressed from under the depression of the lesions

Molluscum contagiosum 

90

What labs should be done for Molluscum contagiosum?

Biopsy may be needed for immunocompromised patients to rule out fungal dissemination

91

Tx for Molluscum contagiosum

Self limiting, but sometimes local destruction of lesions need to be done in more severe cases

92

What are the 4 P's in Lichen planus?

  • Purple
  • Polygonal
  • Pruritic
  • Papule 

93

Lesions are flat-topped, shiny, violaceous papules with fine white lines on the surface (Wickham straie). Typically grouped. 

Lichen planus 

94

Where does Lichen planus most commonly occur on the body?

Flexor aspect of the wrists, lumbar area, eyelids, shins, and scalp

95

What phenomenon can be seen with Lichen planus?

Koebner phenomenon

96

Where can mucosal lesions be seen in Lichen planus?

Vagina, glans, penis, and mouth

97

What varients can be seen with lichen planus?

Follicular, vesicular, actinic, and ulcerative lesions

98

What labs are needed to confirm lichen planus dx?

Biopsy and immunofluroescence 

99

What should you screen for with lichen planus?

Hep. C because higher prevelance of anti-hep. C virus antibodies in patients with lichen planus 

100

Tx for lichen planus?

Topical steroids with occlusive dressings 

101

What tx if used for oral lesions in lichen planus?

Cyclosporine mouthwash 

102

What is the tx for severe cases of lichen planus?

  • Intralesional steroids or topical tretinion for severe localized lesions
  • Systemic therapy
  • Psoralens plus Ultraviolet A radiation therapy for generalezed eruptions 

103

Develops in people younger than 40 years old. Eruptions follow stress or occur in hot, humid weather. Half of affected people also have atopic background

Dyshidrotic eczemtous dermatitis 

104

What is seen in early disease of dyshidrotic eczematous dermatitis?

  • Pruritis common
  • small vesicles in clusters (tapioca-like appearance)
  • occasionally bullae form on fingers, palms, and soles

105

What is seen in late disease of dyshidrotic eczematous dermatitis?

  • Papules, scaling, lichenification, and erosions from ruptured vesicles
  • painful fissures may develop
  • predilection for hands and feet 

106

What labs need to be done with dyshidrotic eczematous dermatitis to rule out other disease?

  • Culture to rule out secondary infection
  • KOH prep to rule out dermatophytosis 

107

Tx for dyshidrotic eczematous dermatitis?

Wet dressings with Burrow's solution

108

Additional tx for more severe dyshidrotic eczematous dermatitis?

  • Fissures treated with topical collodion
  • topical and severe steroids 
  • systemic antimircobials if secondary infection 

109

What % of the population is affected by Psoriasis?

2% (3-5 million people)

110

Chronic, inflammatory, scaling condition of the skin that also may involve the mucous membranes 

Psoriasis 

111

What is the pathology of psoriasis?

greatly enhanced epidermal cell turnover (28x normal)

112

Raised, pink to red papules and plaques with distinct margins and loosely adherent silvery scales 

Psoriasis 

113

What sign can be seen with Psoriasis?

Auspitz sign 

114

Where is psoriasis most often found on the body?

Scalp and extensor surfaces of the elbows and knees 

115

What inflammatory dx can occur with psoriasis?

  • Psoriatic arthritis in 5-10% of patients
  • Involves distal joints of hands and feet, typically asymmetric
  • can be seen without skin lesions 

116

How do you dx psoriasis?

History and appearance 

117

What are variants of psoriasis?

Psoriasis vulgaris, psoriatic erythroderma, guttae psoriasis, and pustular psoriasis 

118

What is psoriasis vulgaris?

Most common variant of psoriasis. Involves chronic recurring scaling papules and plaques 

119

What is psoriatic erythroderma?

  • lesions involve entire skin surface
  • exfoliative amd serious

120

What is Guttate psoriasis?

  • characterized by acute eruption of typical and atypical lesions in a disseminated pattern
  • spares palms and soles 
  • often appears after streptoccal pharyngitis 

121

What is pustular psoriasis (von Zumbusch syndrome)?

  • abrupt life threatening condition
  • characterized by widespread pustules that coalesce to form lakes of pus
  • fever, malaise, leukocytosis 

122

What is tx for mild psoriasis?

Topical corticosteroids and topical Vit. D prep (calcipotriene)

123

What tx does molderate psoriasis respond to?

Tazarotene gel (topical retinoid) 

124

What tx is used for more serious cases of psoriasis?

UVB phototherapy, PUVA, and methotrexate but carry risks of skin cancer, cataracts,