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Gen Med: Dermatology > Lecture 1: Intro > Flashcards

Lecture 1: Intro Flashcards

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1
Q

What are the layers of the skin?

A
  1. Epidermis
  2. Basement membrane
  3. Dermis
  4. Subcutaneous layer
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2
Q

What are the functions of the skin?

A
  1. Protection from UV through melanin
  2. Resist mechanical shock
  3. Thermoregulation
  4. Mediates sensation
  5. Protects from environment
  6. Affects social/sexual communication
  7. immune barrier to pathogenic org.
  8. assists in Vitamin D synthesis
  9. Assists in toxin excretion
  10. Regulates body fluid loss
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3
Q

How much vitamin D synthesis is performed in the skin?

A

10-15%

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4
Q

What are the categories/terms used to describe skin lesions?

A
  1. Size
  2. Color and descriptive terms
  3. Primary skin lesions
  4. Secondary skin lesions
  5. Special skin lesion
  6. Arrangement
  7. Distribution
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5
Q

What are primary skin lesions?

A

nitial lesions, not altered by trauma, manipulation or natural regression over time

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6
Q

What are secondary skin lesions?

A

How the lesions looks over time or after manipulation (ie. scratching, picking, leaking, bursting)

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7
Q

Define depigmented skin

A
  1. Absent of melanocytes, no melanin therefore no color
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8
Q

How is skin typed?

A
  1. Albino
  2. Caucasian
  3. Mediterranean
  4. Hispanic
  6. Darkly pigmented: african american
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9
Q

What disease causes depigmentation of the skin?

A

Vitilago

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10
Q

Define hypopigmentation

A
  1. Normal number of melanocytes, but Decreased production of Melanin
  2. Lighter than skin color
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11
Q

Define Hyperpigmented skin

A
  1. Normal # of Melanocytes but
    Increased production of Melanin
  2. Darker than skin color
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12
Q

What causes hypopigmented skin?

A

Psoriasis?

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13
Q

Define erythematous skin

A

redness of skin

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14
Q

Define atrophic skin, in the epidermal and dermal layers

A
  1. thinning of skin
  2. Epidermal - “cigarette paper”wrinkling
  3. Dermal/Subcutis – Depression in skin
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15
Q

Define lichenified skin lesions

A
  1. Focal area of thick skin
  2. Produced by chronic manipulation
  3. Accentuated skin lines – “washboard”
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16
Q

Define verrucous skin lesions

A

Hyperkeratotic or Wart Like

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17
Q

Define Umbilicated skin lesions

A

Central “belly button” like depression

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18
Q

What terms are used to describe primary skin lesions?

A 
MACULE   -   PATCH
PAPULE   -   PLAQUE
NODULE
PUSTULE   -   CYST
VESICLE   -   BULLAE
WHEAL
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19
Q

Define macule skin lesions

A
  1. Small
  2. Flat circumscribed skin discolorations
  3. Lacking surface elevation or depression
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20
Q

Define patch skin lesions

A
  1. Large
  2. Flat circumscribed skin discolorations
  3. Lacking surface elevation or depression
  4. A very large macule
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21
Q

Define papule skin lesions

A
  1. Elevated solid lesion

2. <5mm

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22
Q

Define plaque skin lesions

A
  1. Elevated solid confluence of papules
  2. > 5mm
  3. Lacking a deep component
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23
Q

Define nodule skin lesions

A
  1. Elevated solid lesion
  2. > 5mm
  3. A larger and deeper paple
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24
Q

Define pustule skin lesions

A
  1. Papule that contains
    Purulent material
  2. <5mm
  3. Not necessarily infected
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25
Define cystic skin lesions
Nodule that contains | fluid or semisolid material
26
Define vesicular skin lesions
1. Papule that contains clear fluid 2. <5mm 3. called hemorrhagic vesicle if filled with blood
27
Define bullae skin lesions
1. Localized fluid collection 2. A large vesicle 3. >5mm 4. called hemorrhagic bullae if filled with blood
28
Define wheal skin lesions
1. Firm edematous plaque That is evanescent (coming and going) and pruritic 2. Hives
29
What terms are used to describe secondary skin lesions
SCALE - CRUST EROSION - ULCER FISSURE - EXCORIATION SCAR
30
Define scale skin lesions
Thickened Stratum Corneum | secondary to keratinocyte hyperproliferation
31
Define crust skin lesions
Collection of cellular debris | Dried serum, blood = Scab
32
Define erosion skin lesions
Superficial focal loss of epidermis | Heals without scarring
33
Define ulcer skin lesions
Full thickness focal loss of epidermis and dermis | Heals with scarring
34
Define fissure skin lesions
Verticle loss of epidermis and dermis Sharply defined walls | “Cracking” skin
35
Define excoriation skin lesions
Linear erosion induced by scratching
36
Define scarring
A collection of new connective tissue Implies dermoepidermal damage May be hypertrophic (too much collagen-raised scar) or atrophic (too little collagen-depressed scar)
37
What terms are used to describe special lesions?
``` TELANGIECTASIAS PETECHIAE - PURPURA COMEDONES TARGET LESIONS STRIAE BURROW ```
38
Define TELANGIECTASIAS | skin lesions
Small dilated superficial blood vessels | Blanchable
39
Define petechiae | skin lesions
Extravasation of RBC’s into Dermis Non-Blanchable <5mm
40
Define purpura | skin lesions
Extravasation of RBC’s into Dermis Non-Blanchable >5mm Can turn into ecchymosis
41
Define comedomes | skin lesions, open vs. closed
Folliculocentric collection of sebum and keratin Closed Comedone = “whitehead” Open Comedone = blackhead, due to oxidation bc exposed to air
42
Define target | skin lesions
Consist of three zones Center bulls eye Second pale zone Third rim of erythema
43
Define striae | skin lesions
Irreversible atrophic violaceous linear damage to skin "stretch marks" Secondary to Topical Steroids overuse Cushings Syndrome or Excessive rapid growth
44
Define burrows | skin lesions
Elevated channel in the superficial epidermis | Produced by parasites (Scabies, Hookworm)
45
What terms are used to describe the characteristic arrangements of skin lesions? When are they used?
``` ANNULAR GYRATE DERMATOMAL LINEAR GROUPED KOEBNERIZATION Remember to use them in the “description template” just after the type of skin lesions ```
46
Define annular | skin lesions
Ring shaped
47
Define gyrate | skin lesions
From Latin – “to turn in a circle”
48
Define dermatomal | skin lesions
Follows neurocutaneous dermatomes
49
Define linear | skin lesions
Skin lesions in a linear configuration
50
Define grouped | skin lesions
Skin lesions in a grouped configuration
51
Define koebnerization | skin lesions
Traumatized skin produces lesions | Koebner Phenomenon occurs with only certain skin diseases (LP, LN, PSOR)
52
What terms are used to describe specific patterns of distribution?
Bilateral - Unilateral Flexural - Extensor Malar
53
What diagnostic techniques in dermatology?
``` Skin Scrapings Woods Lamp Cultures Patch Test Skin Biopsies ```
54
What are the types of skin scrapings?
KOH, Tzanck Smears, and Scabies Smears
55
What are the different solvents used in skin scrapings?
1. KOH Stain = Potassium Hydroxide 2. Tzanck Smear = Giemsa, Wrights, or Sedi stains 3. Scabies Smear = Mineral Oil, KOH, Saline
56
What is the most sensitive in office skin scraping technique?
KOH
57
What is KOH skin scraping used for?
Can aid in identifying | Tinea/Candida infections
58
HOW IS A KOH SKIN SCRAPING DONE CORRECTLY WHEN LOOKING FOR TINEA?
Sample correct area Tops of vesicles Leading edge of Annular Lesions Deep Scrapings of Nails for subungual debris
59
What is the Tzanck smear used for? What are the limitations?
1. Standard microscopic test for rapid Dx of Herpes infection 2. cannot distinguish between the types of herpes (HSV ½ or VZV)
60
What is the desired target of Tzanck smear?
Looking for Atypical Keratinocytes with Lg Nuclei | Multinucleated Giant Cells
61
HOW IS A TZANCK SMEAR DONE?
``` 1. Sample correct area A. Scrape base of “vesicle/bulla” B. Sample only a “Fresh” lesion 2. Follow these steps A. Use #15 blade to correct area and transfer to slide B. Stain with either Giemsa, Wrights, or Sedi stain C. Coverslip D. Look for “Multinucleated Giant Cells” ```
62
What is the etiology of scabies?
Caused by a mite Sarcoptes Scabiei var. hominis
63
How is scabies diagnosed?
Diagnosis is made by identifying the female mite, her eggs, or fecal material under the microscope
64
HOW IS A SCABIES SMEAR DONE?
1. Sample correct area A. Scrape “Burrows”, vesicles, or papules B. Have patient point with index finger to itchy area C. Important to sample - finger webs, flexural wrists, genitalia 2. Follow these steps A. Apply Mineral oil to sample area B. Use #15 blade and vigorously scrape area (ok to scrape til small amount of bleeding) C. Coverslip D. Look for Female Mite, Eggs, or Fecal Material E. Mites also seen using KOH or Saline wet mount Preps
65
What is the Wood's lamp exam?
Fluorescing affected areas with invisible | “Black Light” (long wave UV radiation)
66
What does the Wood's lamp exam aid in identification of? What are the diagnostic colors of certain pathogens?
1. Tinea Capitis infections (non T. Tonsurans) = yellow-green 2. Tinea Versicolor – dull yellow 3. Erythrasma – coral red 4. Pseudomonal – green 5. Vitiligo – accentuates epidermal pigment if present
67
What are the best methods for bacterial culture swab?
1. Best yield when superficial infection 2. Swab vigorously area of most inflammation 3. Results in about 1 wk
68
What are the best methods for viral culture swab?
Keep Refrigerated Best to sample base of fresh vesicle or bullae Results in about 1 wk
69
What are the best methods for fungal culture swab?
1. DTM – Turns Red if Dermatophyte is present (no ID)Results over several wks 2. Sabouraud’s Dextrose Agar – Used to ID type of Dermatophyte Results over a month
70
What is the test of choice to differentiate between contact allergic vs. irritant dermatitis?
Patch test
71
Define allergic contact dermatitis
1. Immunologically mediated | 2. An acquired sensitivity affecting certain individuals
72
Define irritant contact dermatitis
1. Is not immunologically mediated | 2. Due more to chemical damage to skin
73
When are skin biopsies the best diagnostic technique?
For cutaneous neoplasms that cannont be Dx clinically
74
When are skin biopsies a helpful diagnostic technique?
In inflammatory skin disorders of uncertain etiology
75
What are skin biopsy samples used for?
H&E histology examination | Specialized studies such as Immunofluorescence, electron microscopy, cultures, special stains, PCR studies, etc.
76
What are the different types of skin biopsies? What are the most common types?
``` CURETTE BIOPSY SCISSOR BIOPSY SHAVE BIOPSY PUNCH BIOPSY INCISIONAL BIOPSY EXCISIONAL BIOPSY 2. Shave and punch ```
77
What are the in office treatment procedures for derm?
Lasers, Light Therapy, Phototherapy, and PDT Resurfacing Procedures Injectables

Gen Med: Dermatology (10 decks)

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