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PANCE Practice > PANCE Prep- Derm > Flashcards

PANCE Prep- Derm Flashcards

1
Q

What do the following describe?

  1. Macule
  2. Papule
  3. Plaque
  4. Vesicle
  5. Bulla
  6. Wheal
  7. Pustule
  8. Petechaie
  9. Nodule
  10. Patch
A
  1. Macule: flat nonpalpable <10mm
  2. Papule: solid, raised <5mm
  3. Plaque: raised, flat-topped lesion >10mm
  4. Vesicle: circumscribed, elevated fluid-filled <5mm
  5. Bulla: circumscribed, elevated fluid-filled >5mm
  6. Wheal: transient, elevated lesion (local edema)
  7. Pustule: pus-filled vesicle or bulla
  8. Petechaie: small punctate hemorhages that DONT blanch
  9. Nodule: solid, raised >5mm
  10. Patch: flat, nonpalpable >10mm
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2
Q

Clinical Manifestation:

  1. Smooth discrete circular patches of complete hair loss that develops over a period of weeks
  2. Exclamation point hairs- short hairs broken off a few mm from the scalp at the margins of the patches with tapering near the proximal hair shaft
  3. Nail pitting or fissuring
A

Alopecia areata *commonly associated w/ other autoimmune disorders (thyroid, Addison’s disease, etc) *non-scarring immune mediated hair loss targeting the anagen hair follicles

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3
Q

Management of alopecia areata

A

if Local: inralesional corticosteroids

if extensive: topical corticosteroids

*may be observed if mild

**Relapse is common

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4
Q

Clinical Manifestations:

Varying degrees of hair thinning and nonscarring hair loss MC affecting the temporal scalp, midfront scalp or vertex area of scalp

A

Androgenetic alopecia

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5
Q

Management of androgenetic alopecia

A
  1. Minoxidil
  2. Oral Finasteride (5-alpha- reductase inhibitor) –> androgen inhibitor which inhibits the conversion of testosterone to DHT
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6
Q

SE of finesteride

A

5-alpha-reductase inhibitor (androgen inhibitors)

  1. Decreased libido or sexual function
  2. ED
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7
Q

Diagnose

A

Androgenetic Alopecia

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8
Q

Diagnose

A

Alopecia Areata

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9
Q

What is the atopic triad? and its pathophysiology

A
  1. Eczema
  2. Allergic rhinitis
  3. Asthma

**Starts in childhood

Type 1 Hypersensitivity, IgE mediated: Altered immune reaction in genetically susceptible people when exposed to certain tiggers–> T cell mediated immune activation and increase IgE production

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10
Q

Clinical Manifestations:

  1. Prurtic, erythematous, ill defined blisters/papules/plaques –> later dries, crusts over and scales
  2. +/- dermatographism (localized development of hives when the skin is stroked)
A

Atopic dermatits aka eczema

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11
Q

Where is Eczema most commonly found

A

flexor creases (antecubital and popliteal folds)

-Starts on face in infancy and then spreads to extremities w/ age

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12
Q

Treatment/plan for atopic dermatitis (eczema)

A
  1. topical corticosteroids for 14 days (steroid before moisturizer)
  2. antihistamines for itching (diphenhydrame, hydroxyzine)
  3. Daily skin hydration w/ emollients: Eucerin or Aquaphor
  4. Short baths a few times a week
  5. Educate: Avoid irritants (soaps, detergents, freq. baths, perspiratoin, heat), Chronic condition
  6. If infected: oral cephalexin or topical mupirocin x 7 days
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13
Q

Diagnose

A

Atopic Dermatitis (Eczema)

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14
Q

Clinical Manifestations:

Sharply defined discoid/coin-shaped* lesion especially on the dorsum of the hands, feet, and extensor surfaces (knees, elbows)

A

Nummular eczema

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15
Q

Diagnose:

A

Nummular Eczema

*sharply defined discoid/coin-shaped lesions on dorsum of hands, feet, and extensor surfaces (knees, elbows)

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16
Q

Treatment/Plan for contact dermatitis

A
  1. Avoid irritants
  2. Topical Corticosteroid
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17
Q

Describe and diagnose

A

Contact dermatitis (diaper rash) with possible candidiasis satellite lesions

erythematous macular rash along the skin folds where the diaper rubs, with possible annular satellite lesions

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18
Q

Treatment/Plan for diaper rash

A
  1. Frequent diaper changes
  2. hydrocortisone 1% cream or a diaper rash ointment such as Desitin or A & D.
  3. Candida diaper rash (satillite lesions)- Nystatin cream for 7 days
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19
Q

Clinical Manifestations:

  1. Pruritic “tapioca-like” tense VESCILES* on the soles, palms and fingers (lateral digits)
  2. Triggers: sweating, emotional stress, warm and humid weather, metals (nickel)
A

Dyshidrosis (dyshidrotic eczema) (Pompholyx)

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20
Q

Describe/Diagnose and treat

A

Dyshidrosis (dyshidrotic eczema)- tense VESICLES

  1. Topical steroids (med-high) ointment preferred
  2. cold compresses
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21
Q

Clinical Manifestations:

Scaly, well-demarcated, rough hyperkeratotic plaques w/ exaggerated skin lines*

A

Lichen Simplex Chronicus (neurodermatitis)

  1. skin thickening in pts w/ eczema
  2. secondary to repetitive rubbing/scratching- itch/scratch cycle
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22
Q

Describe/Diagnose and Treat

A

Lichen Simplex Chronicus (neurodermatitis)- scaly, well-demarcated rough hyperkeratotic plaques w/ exaggerated skin lines

  1. topical steroids (high strength)
  2. Educate: Avoid scratching the lesions (can use antihistamines)
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23
Q

What are the 5 P’s of Lichen Planus

A
  1. Purple
  2. Polygonal
  3. Planar
  4. Pruritic

. Papules w/ fine scales and irregular borders

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24
Q

Describe the clinical manifestations of lichen planus

A
  1. 5 P’s: purple, polygonal, planar, pruritic papules w/ fine scales and irregular borders
  2. MC on flexor surfaces of extremities, SKIN, MOUTH, SCALP, GENITALS, NAILS, and mucous membranes
  3. +/- Koebner’s phenomenon: new lesions at sites of trauma
  4. Wickham Striae***- fibe white lines on the skin lesions or on the oral mucosa, nail dystrophy
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25
Q

Describe/Diagnose and Treat

A

Lichen Planus- purple, polygonal, planar, prurtic papules w/ fine scales and irregualr borders and wickham striae (fine white lines on the skin lesions or on the oral mucosa)

  1. Topical corticosteroid
  2. antihistamines for itch
  3. 2nd line: PO steroids
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26
Q

There is an increased incidence of ___ skin rash with hepatitis C

A

lichen planus

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27
Q

Clinical Manifestation:

  1. Herald patch* (solitary salmon-colored macule) on the trunk 2-6cm in diameter–> general exanthem 1-2 weeks later: smaller, very pruritic 1 cm round/oval salmon colored papules w/ white circulare (collarette) scaling along cleavage lines* in a christmas tree pattern*

*Confied to trunk and proximal extremities (face usually spared)

A

Pityriasis rosea

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28
Q

Treatment of Pityriasis rosea

A
  1. NONE NEEDED: Resolves in 6-12 weeks
  2. antihistamines, topical corticosteroids for pruritis
  3. can mimic syphilis so order RPR if pt is sexually active
  4. Educate: generally thought not to be contagious but unknown cause- possibly viral
29
Q

Describe and Diagnose

A

Pityriasis rosea

  1. Herald patch* (solitary salmon-colored macule) on the trunk 2-6cm in diameter–> general exanthem 1-2 weeks later: smaller, very pruritic 1 cm round/oval salmon colored PAPULES w/ white circulare (collarette) scaling along cleavage lines* in a christmas tree pattern*

*Confied to trunk and proximal extremities (face usually spared)

30
Q

Pathophysiology of Psoriasis: keratin hyperplasia (proliferating cells in the ___ + ___ due to ___ and ____–> greater epidermal thickenss and increased epidermis turnover)

A

Stratum basale + stratum spinosum due to T cell activation and cytokine release

31
Q

Clinical Manifestations:

  1. raised, dark-red palques/papules w/ thick silver/whilte scales* MC on extensor surface of elbows, knees, scalp, nape of neck
  2. Nail pitting- yellow/brown discoloration under the nail (oil spot**)
  3. Auspitz sign- punctate bleeding w/ removal of plaque/scale
  4. Koebners phenomenon: new lesions at site of skin trauma
A

Plaque Psoriasis

32
Q

Describe and diagnose

A

Plaque Psoriasis:

  1. raised, dark-red palques/papules w/ thick silver/whilte scales* MC on extensor surface of elbows, knees, scalp, nape of neck
  2. Nail pitting- yellow/brown discoloration under the nail (oil spot**)
  3. Auspitz sign- punctate bleeding w/ removal of plaque/scale
  4. Koebners phenomenon: new lesions at site of skin trauma
33
Q

Treatment and Plan for Plaque Psoriasis

A
  1. Mild-mod: topical steroids (high strength)+/- Vit. D analogs (Calcipotriene)
  2. Mod-severe: phototherapy (UVB), methotrexate (systemic tx)
34
Q

Describe and diagnose

A

Guttate psoriasis- small, erythematous PAPULES with fine scales, discrete lesions and confluent papules

35
Q

Clinical Manifestations:

  1. hyper/hypopigmented, well-demarcated round/oval MACULES w/ fine scaling. Often coalesce into patches on the trunk, face, extremities
  2. The involved skin fails to tan w/ sun exposure
A

Pityriasis (tinea) versicolor

36
Q

How do you diagnose and treat tinea versicolor?

A

Dx:

  1. KOH prep frob skin scraping: hyphae and spores- “spaghetti and meatball appearance”
  2. Wood’s lamp: yellow-green fluorescene

**Overgrowth of the yeast Malassezia furfur- part of normal skin flora**

TX: Topical antifungals: selenium sulfide**, sodium sulfacetamine,

“azoles” (itraconazole or fluconazole) if widespread or fail topical tx

37
Q

Describe and diagnose

A

Tinea Versicolor- hypopigmented, well demarcated round/oval macules with fine scaling

38
Q

Clinical Manifestations:

  1. erythematous plaques with fine white scales (MC on scalp) (dandruff), eyelids, beard mustache, nasolabial folds, trunk (chest) and intertriginous regions of the groin
A

Seborrheic dermatitis

(Aka “cradle cap in infants”)

39
Q

Describe/Diagnose and treat

A

Seborrheic dermatitis

  1. Topical selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream) or steroids
  2. oral antifungals
40
Q

Acral lentiginous melanoma may occur where?

A

on the palm, sole, nail bed, or mucus membrane

41
Q

__ is characterized by cough, coryza, and conjunctivitis, along with a fever as a prodrome. Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash

A

Rubeola (measles)

42
Q

Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash and are pathognomonic for ___.

A

rubeola

43
Q

___ produces erythematous red tender nodules, especially on the shins.

A

Erythema nodosum

44
Q

Medications are most frequently implicated in toxic epidermal necrolysis. These usually include:

A
  1. analgesics (NSAIDs),
  2. antibiotics (Ampicillin) and
  3. anticonvulsants (Carbamazepine)
45
Q

__ is the acquired loss of pigmentation due to the absence of epidermal melanocytes presenting on the back of hands, face, or body folds.

A

Vitiligo

46
Q

____ is the treatment of choice for isolated superficial actinic keratosis.

A

Cryotherapy

47
Q

Multinucleated cells found on Tzanck smear indicate ___

A

herpes

48
Q
A
49
Q

Ring-shaped lesions with scaly borders and central clearing are most likely caused by ____ which can be diagnosed by ____

A
  • fungal infection
  • Microscopic examination of scrapings reveals hyphae on KOH prep
50
Q

__ is the most common cause of skin cancer

A

Basal cell cancer

*usually occurring on sun-exposed areas.

51
Q

__ is one of the major Jones criteria for the diagnosis of acute rheumatic fever

A

Erythema marginatum

52
Q

People living in warm, tropical climate, people wearing occlusive clothing or shoes, obese patients, and those with hyperhidrosis are at increased risk for ____ which can be diagnosed by ____

A
  • erythrasma
  • demonstration of a coral red fluorescence.
53
Q

Acetowhitening is used to facilitate the diagnosis of ___

A

condyloma acuminata lesions.

54
Q

Potassium hydroxide tests are used to rule out the presence of ___

A

dermatophyte (fungal and yeast) infections.

55
Q

Wood’s light fluoroscopy is used in the assessment of:

A

dermatophyte infection and a bacterial infection known as erythrasma.

56
Q

__ is used to kill the scabies mite

A

Permethrin

57
Q

Telangiectatic vessels are often visible skin findings with __

A

basal cell carcinoma.

58
Q

___ is an acute eruption of fine scaling fawn-colored papules and plaques that are distributed along the cleavage lines of the trunk. A single plaque, called a herald patch, precedes the secondary eruption by 1-2 weeks.

A

Pityriasis rosea

-rash along cleavage lines of trunk is often referred to as a Christmas tree pattern.

59
Q

__ is a common benign plaque in the elderly that characteristically has a velvety or warty surface associated with a stuck on appearance and greasy feel.

A

Seborrheic keratosis

60
Q

___ most commonly are seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders.

A

Lentigines

61
Q

__ usually present as small patches of flesh-colored, pink or yellow-brown lesions often with an erythematous component. The lesions are better felt than seen, having a rough, sandpaper feel and are often tender to palpation.

A

Actinic keratosis

62
Q

Wood’s light examination reveals a “milk-white” fluorescence over the lesion.

A

Vitiligo

63
Q

Those who received a killed MMR virus immunization between __ and __ should receive a live attenuated booster vaccination

A

1963 and 1967

64
Q

Tx of Molluscum contagiosum

A
  1. mechanical (curettage, laser, or cryotherapy with liquid nitrogen or nitrous oxide cryogun),
  2. chemical (trichloroacetic acid, tretinoin), or
  3. immunologic (imiquimod)
65
Q

If the area of affected skin of Impetigo is limited, __ is an effective therapy

A

mupirocin

* topical mupirocin therapy and has been shown to be more effective than the other topical antibiotics (i.e., neomycin, bacitracin, polymyxin B, and gentamicin).

66
Q

Malignant acanthosis nigricans is associated with __

A

with an intestinal cancer such as gastric carcinoma

67
Q

Describe The Rules of Nines for Burns

A
  1. head and neck, 9%;
  2. arm (each), 9%;
  3. trunk (anterior), 18%
  4. trunk (posterior), 18%
  5. leg (each), 18%;
  6. genitalia, 1%
68
Q

__ is described as the “mask of pregnancy.”

A

Melasma, also referred to as chloasma,

PANCE Practice (26 decks)

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