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Dermatology 1 > Various Derm Dz (Brooks) > Flashcards

Various Derm Dz (Brooks) Flashcards

(59 cards)

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1
Q

two types of sweat glands

A
  • apocrine: larger; only in axillae, inframammary, groin and genital; release secretion into hair follicles
  • eccrine: all over body; palms, soles, forehead;release sweat directly onto the skin
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2
Q

hidradenitis suppurative

A
  • Chronic, suppurative, inflammatory condition of the aprocine gland.
  • Common in intertriginous skin regions: axillae, groin, perianal, perineal, inframammary skin
  • Characterized by recurrent “boils” and draining sinus tracts with subsequent scarring.
  • Pain, fluctuance, discharge and sinus tract formation are characteristic.
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3
Q

epidemiology of hidradenitis suppurativa

A
  • F>M
  • MC in AA
  • 2nd and 3rd decades of life
  • males: anogenital
  • females: axillary
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4
Q

general pathophys behind HS

A
  • follicular plugging within apocrine gland bearing skin –> mechanical stress in intertriginous regions –> immune response
  • secondary bacterial involvement
  • rupture and reepithelialization cause sinus tracts to form
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5
Q

risk factors for HS

A
  • obesity and smoking***
  • hyperandrogenism
  • OCPs
  • Acne
  • PCOS
  • lithium
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6
Q

S/S of HS

A
  • initially painful, inflammatory nodules and abscesses
  • 0.5 - 3cm in size
  • may drain
  • eventually form scars
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7
Q

if there is infection in chronic HS, what are the common pathogens?

A
  • staph aureus

- staph epidermidis

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8
Q

Hurley clinical staging system for HS

A

I: abscess formation w/o sinus tracts or scarring
II: widely separated, recurrent abscesses w/ tract formation and scarring
III: diffuse, multiple interconnected tracts and abscesses

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9
Q

HS increases the risk for what other disease?

A
  • squamous cell carcinoma

- if concerned, bx

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10
Q

HS prognosis

A
  • individual lesions heal 10-30 days

- can recur for years

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11
Q

complications of HS

A
  • SCC
  • lymphedema
  • psychosocial issues
  • anemia
  • amyloidosis
  • lumbosacral epidural abscess
  • disseminated infection
  • fistulas
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12
Q

what is the MC soft tissue tumor?

A

lipoma

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13
Q

what is a lipoma

A
  • slow growing benign fatty tumor that form soft lobulated masses enclosed by a thin capsule
  • often found in shoulders, back, neck, and head
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14
Q

what type of tumors are lipomas?

A

mesenchymal (they can develop in almost all organs)

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15
Q

lipomas in the GI tract

A
  • submucosal fatty tumors
  • MC location: esophagus, stomach, SI
  • can cause luminal obstruction and bleeding
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16
Q

typical pt. presenting w/ a lipoma

A
  • 40-60 yo group
  • rare in children
  • no clear gender predilection
  • F: chondroid, myolipoma, adiposis dolorosa
  • M: spindle cell, speomorphic, intramuscular, lipoblastoma, multiple symmetric lipomatosis
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17
Q

RF for lipoma

A
  • obesity
  • ETOH
  • liver dz
  • glucose intolerance
  • soft tissue trauma
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18
Q

S/S of lipoma

A
  • often asx
  • slow growing (if fast, suspect other dx)
  • sx will vary depending on location
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19
Q

PE of lipoma

A
  • subQ, nontender, rubbery feel
  • “slippage sign”
  • overlying skin is nl
  • commonly <5cm
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20
Q

what should you consider if a lipoma is over 5 cm?

A

-liposarcoma

but regular lipomas can be > 10 cm

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21
Q

indications for imaging a lipoma

A
  • larger lesions w/ irregular shape

- suggestive of myofacial involvement

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22
Q

imaging modalities for lipoma

A
  • start w/ US but MRI is most sensitive

- MRI helpful in differentiating lipoma from sarcoma

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23
Q

gold standard for histological dx of lipoma

A
  • open surgical bx

- although core-needle bx is preferred

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24
Q

tx of lipoma

Study These Flashcards
A
  • observation is an option
  • tx is usually surgical excision
  • if it’s superficial, can try steroid injection or liposuction
  • kybella injections have been successful
25
indications for removal of lipoma
- diagnostic uncertainty - cosmetic concerns - nerve impingement - pain - increase in size - irregular characteristics - > 5 cm - core needle bx w/ atypical features - features consistent w/ sarcoma
26
complications of a lipoma
- hematoma and seroma MC - infections rare but possible - high risk of recurrence
27
what kind of lipomas have the highest rate of recurrence?
- intramuscular - lipomas w/ infiltrating tendencies - bilobar lipomas
28
what is the MC cutaneous cyst?
-epidermoid cysts (EC)
29
epidermoid cysts are aka
- sebaceous cysts | - epidermoid inclusion cysts
30
what are ECs?
- benign cysts that can form anywhere on the body - MC on face, scalp, neck and trunk - very rarely can become malignant
31
patho of EC
- derived from epidermis or epithelium of hair follicle - epithelium encloses w/i the dermis and becomes filled w/ keratin and lipid - walls are thin and rupture is common
32
epidemiology of ECs
- no racial predilection - M>F - 3rd-4th decade of life
33
what are pilar cysts?
- appear identical to epidermal inclusion cysts but 90% are on the scalp - usually have fam hx
34
S/S of ECs
- usually asx - discharge of malodorous "cheeselike" material - can get inflammed/infected
35
PE of EC
- dermal or SQ nodule - firm and usually solitary - 0.5-5 cm - may have central pore or punctum
36
diagnostics of an EC
- labs typically unnecessary - if recurrent infection, C&S indicated - if in unusual location (breast, bone, intracranial), imaging indicated or FNA
37
general measures in tx of EC
- asx ECs need no tx | - oral abx if infected
38
surgical care of EC
- simple excision or incision w/ removal of cyst and cyst wall (or will recur) - if inflamed, I&D
39
complications of EC
- rare; infection, scarring | - malignancy is rare
40
pilonidal dz
-spectrum of clinical presentations ranging from asx hair containing cysts and sinuses to large sx abscesses of the sacrococcygeal region w/ tendency to recur
41
synonym for pilonidal dz
jeep dz
42
epidemiology of pilonidal dz
- M>F - late teens - early 20s - decreases after 25 - rare > 45 - Caucasians > AA > Asians
43
patho of pilonidal dz
- hair in natal cleft draws into deeper tissues via movement of buttocks - follicle is occluded from stretching and pore blocking from debris - inflammation w/ secondary infection occurs - polymicrobial d/t proximity to anorectal region
44
genetic component in pilonidal dz
- congenital dimple in natal cleft - spina bifida occulta - follicular occluding tetrad
45
what is the follicular occluding tetrad (there are actually 4)?
- ance conglobata - dissecting cellulitis - hidradenitis supperativa - pilonidal dz
46
RFs for pilonidal dz
- sedentary/prolonged sitting - excessive body hair - obesity / increase sacrococcygeal fold thickness - congenital natal dimple - trauma to coccyx
47
asx presentation of pilonidal dz
-painless cyst or sinus at top of gluteal cleft
48
acute presentation of pilonidal dz
-acute abscess: severe pain, swelling, discharge from top of gluteal cleft that may or may not have drained spontaneously
49
chronic presentation of pilonidal dz
-chronic abscess w/ persistent drainage from a sinus tract at the top of the gluteal cleft
50
which presentation of pilonidal dz is MC?
acute abscess
51
PE in pilonidal dz
- pt is usually afebrible and nontoxic - inflamed cystic mass at top of gluteal cleft w/ limited surrounding erythema - +/- drainage or sinus tract - less common presentation: significant cellulitis of surrounding tissue
52
diagnostic tests for pilonidal dz
- it's a clinical diagnosis - consider CBC and wound culture if severe infection - consider MRI to differentiate perirectal abscess and pilonidal
53
tx of pilonidal dz
- I&D is primary tx for recurrent dz | - meds: abx not indicated unless significant cellulitis
54
if pilonidal dz needs abx (cellulitis suspected), what is used empirically?
-cefazolin + metronidazole or -amoxicillin-clavulanate
55
criteria for admission for pilonidal dz
- severe celluitis | - large area excision
56
F/u recommendations for pilonidal dz
- frequent dressing changes after I&D - f/u wound checks - monitor for fever, more extensive celluitits
57
pt education in pilonidal dz
- wash area briskly w/ washcloth daily - remove hair from crypts weekly - avoid prolonged sitting - neg. pressure wound therapy - laser epilation of hair in gluteal fold
58
prognosis of pilonidal dz
-simple I&D has 55% failure rate -median time to healing is 5 weeks more extensive surgical excisions involve hospital stays and longer healing time
59
complications of pilonidal dz
malignant degeneration is a rare complication if untreated

Dermatology 1 (19 decks)

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