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Derm ex1
Derm
71
Medical
Professional
11/28/2011

Additional Medical Flashcards

 


 

Cards

Term
function of keratinocytes?
Definition

produce keratin which provides protection

 

 

keratinocytes (aka squamous cells) are constantly produced by basale layer and take 26-42 days to reach surface

 

connected by desmosomes

Term
melanocytes
Definition
everyone has the same number, but different people produce different amounts of melanin; different number of melanosomes
Term
birbeck granules
Definition
found in langerhans cells, they may be linked to langerhans cell's ability to deliver surface Ags to T-cells
Term
where are merkel cells found?
Definition

the basal layer of palms and soles, mucus membranes, nail beds

 

have special nerven endings that can detect touch

Term

Stratum lucidum


Definition

Contain organelles called Odland bodies

   (barrier to water loss)

Seen in thick epidermis-palms, soles

Term
what happens to cells as they reach the surface of the epidermis?
Definition
they flatten out and lose nucleus.  maintaining the nucleus is pathological
Term
primary cells of the dermis?
Definition
fibroblasts which produce collagen, elastin and ground substances
Term


 -scavengers of the dermis


Definition

 Histiocytes-engulfs hemosiderin, melanin, debris

Term
vasculature of the dermis
Definition
rich in supply of capillaries, arterioles, and venules in the dermal papillae.  this parallels a vast network of dermal lymphatics
Term
where are sensory nerves most abundant?
Definition
on the hairless surfaces of mucocutaneous areas
Term
three types of hair
Definition

3 types

Lanugo – fetus

Vellus – Fine

Covers most of body

at puberty, develops into terminal hair on certain areas i.e. beard, pubic, axilla

Terminal – larger, coarser, more pigmented

Term

Cyclic pattern of growth and regression


Definition

Anagen – cells of hair bulb divide-growing

Catagen –cells stop dividing

Telogen –club hair remains until a new anagen follicle develops and dislodges the club hair-resting phase (if it has the white bulb on the end, that's good because it's being displaced naturally)

Term
what is a macule
Definition
nFlat well circumscribed to illdefined discoloration
nbrown, blue, red, hypopigmented

a confluence of them becomes a patch
Term
what is a papule?
Definition
nElevated solid lesion
nup to .5 cm
nflat-topped, umbilicated, dome, verrucous (warty)

a confluence of these would be called a plaque
Term
what is a nodule?
Definition
nElevated circumcribed solid lesion greater than .5 cm
Term
what is a vesicle?
Definition
nFluid containing lesions
nbullae greater than .5 cm
npustules-collection of leukocytes
ncyst-sac containing fluid


Term
what is a wheal?
Definition
nErythematous, edematous areas resulting from infiltration of the dermis with fluid
nlasts minutes to hours
Term
what is a crust composed out of?
Definition

dried exudate

 

it is serous honey colored, purulent brown, of blood-rusty brown

Term
what are scales composed of?
Definition
excess dead epidermal cells prodiced by abnormal keratinization and shedding
Term

define Intertriginous

Definition
an area of skin which may rub against another area of skin.  can harbor large amounts of aerobic bacteria
Term
wood's light and its purpose?
Definition

ultraviolet light at 365 nm where certain bacteria will illuminate (i.e. pseudomonas, minutissmum, cornebacteriium)

 

can also detect fungus, porphyrias, and pigmentary disorders

Term
what does diascopy do?
Definition

determines if their is blood underneath such as in:

 

nVASCULAR LESION VS. MM
nPURPURIC LESIONS
nLUPUS VULGARIS
Term

manipulations of clinical lesions

nAUSPITZ-PSORIASIS
nDARIER-URTICARIA PIGMENTOSA
nDERMATOGRAPHISM
nNIKOLSKY
Definition
nAUSPITZ-PSORIASIS - punctuate bleeding when scabs are ripped off
nDARIER-URTICARIA PIGMENTOSA - rubbing causes more inflammation
nDERMATOGRAPHISM - writing on skin
nNIKOLSKY - slight rubbing of the skin causes exfoliation
Term
why shouldn't you give steroids to a fungus?
Definition
because it will seem to get better and then come back with a vengence
Term
where should you never use lotrimin?
Definition
the groin area
Term
seborrheic dermatitis facts
Definition

dandruff in adults, cradle cap in kids (more common in men)

 

flares with sunlight

 

has been linked to immunosupression

 

pityrosporum ovale may be a cause

 

white dry scalp with macules and papules of varying size resulting in scaling

 

occurs in regions where sebaceous glands are most active

Term

seborrheic dermatitis tx

Definition

recurs and goes into remission

 

can alleviate with age if originally present as an infant

 

ntopical therapy- selenium sulfide, zinc pyrithione shampoos; ketoconazole shampoo; tar shampoo; low potency glucocorticoids;
ncradle cap: remove crusts w/warm compresses followed by baby shampoo +/- HC 2.5% cream or ketoconazole cream 
Term
two types of psoriasis
Definition

non-pustular and pustular

 

non is chronic plaque (psoriasis vulgaris) and can be initiated by rubbing Koebner's phenomenon (cover up a lesion and it get worse once you remove the bandage) and scratching, certain drugs, stress, HIV

-the epidermal growth period is severely quickened

-severe itch

-DDx: seb derm, tinea capitis

 

the pustular can be life threatening because skin will come off and expose pt to infection

-nGeneralized type-von zumbusch

nSpecial types

  impetigo herpetiformis-pregnant

  acrodermatitis continua of hallopeau-nail/finger

  annular type-mostly in children

  the pustules are always sterile

Term
dx findings of psoriasis  vulgaris
Definition
nQuite common (25% of patients with psoriasis) and commonly occurs with arthritis
nMay disappear spontaneously
nPitting (random pits in nails)
nSubungual hyperkeratosis (thickening)
nOnycholysis (separation of nail from nailbed)

**********
 
 
nOil spots (pathognomonic)-yellowish brown spots under nail plate

 

Term
necessary tests to distinguish between psoriasis vulgaris  and eruptive guttate psoriasis
Definition
ASO titer and throat culture if a strep infection is suspected
Term
psoriasis tx
Definition
nhigh potency topical steroids +/- occlusion,
ncalcipotriene cream
ntar therapy, anthralin,
nphototherapy with emollients (PUVA, UVB),
nmethotrexate, retinoids, cyclosporine or combination therapy,
nnew biologic therapy   
Term
ichthyosis
Definition

hyperkeratosis, eczema related

 

thickened corneum while basale layer proliferates normally

Term

what types of ichthyosis takes place in males that is ichthyosisin males that is

 

dirty brown scales on neck, trunk, extremities

 

Definition
x-linked icthyosis
Term
parapsoriasis en plaques
Definition

small and large variety, both are gradual

 

the large type may be premycotic and least to CTCL

Term
CTCL
Definition
nSuperficial erythematous scaly plaques
nLesions become thicker and bizarre
nMay get nodules and tumors
nExtensive infiltration may cause

  leonine facies (LION FACE)

nConfluence may lead to erythroderma
nLymphadenopathy (lymph nodes)
 
 
nLeukemic form consisting of:

  erythrodermared man syndrome

  lymphadenopathy (lymph nodes)

  elevated WBC (>20,000)

  atypical lymphocytes (sezary cells)

  in skin and blood

  pruritis (itch), hair loss

Term
PityriasisLichenoides
Definition

two types, acute (PLEVA); papules, vescicles and crusts

 

and chronic (PLC), some scales

Term
exfoliative erythroderma
Definition
generalized redness and scaling
Term
disease defined by many P's
Definition

lichen planus

 

nflat-topped, violaceous, shiny papules w/white lines (Wickhamsstriae); 
Term
lichen planus varients
Definition

on the feet of black men

 

follicular leading to "graham little syndome" incolving mucus membranes and leading to alopecia

 

oropharyngeal involvement usually affecting white papules on buccal mucosa and lips

 

treat with steroids

Term
PityriasisRosea
Definition
starts with a "herald patch" then becomes a christmas tree like configuration over the next 3 weeks; usually confined to trunk and extremities
Term
most common bacterial cause of jock itch?
Definition
t. rubrum
Term
what is the majority of tinea capititus caused by in the US?
Definition
nTrichophytontonsurans (blackdot);
nMC worldwide-Microsporumcanis (gray patch)
Term
how does tinea incognito occur?
Definition
nafter the topical application of steroids to a dermatophyte site
nOccurs when a dermatophyte is mistaken for psoriasis or eczema
nPE: red or violaceous follicular papules
nTx: antifungals
Term
bacteria causing tinea barbae
Definition
T. verrucosum
Term
LP disorder causing skin to grow over nail?
Definition
lichen planus pterygium
Term
tinea versicolor
Definition
nPityrosporumorbiculare

 

worse with sebum production

 

spaghetti and meatball appearance on a skin scrape because of hyphae and spores

Term
Onychomycosis
Definition

nClassification by anatomic site:

  distal & lateral subungual (mc type of   onychomycosis;T. rubrum),

nDx: KOH prep, fungal culture, Woods lamp

  superficial white (T. mentagrophytes), proximal subungual (assoc w/HIV), candida onychomycosis

 

 

nTx: prevention-keep area dry & clean; topical antifungals (Lotrimin)

  systemic antifungals (Lamisil)

  selenium sulfide shampoo

Term
important immunologic finding necessary to dx subacute  cutaneous lupus?
Definition
must be ANTI-RO (SS-A) positive
Term
what are some overlapping dx features between dermatomyositis and SLE?
Definition
malar rash and photosensitivity
Term
a disease that periungual telangiectasia and poikloderma (variation in skin color) have been implicated in?
Definition
dermatomyositis
Term
according to hoffman, in dermatomyositis, what malignancy has been reported with the highest frequency in women who have been diagnosed?
Definition
ovarian cancer
Term
define purpura
Definition
leakage of RBCs
Term

what might this tetrad indicate?

-palpable purpura

-nephritis

-colicky abd. pain

-arthritis

Definition
henoch-schonlien
Term
sed rate in urticarial vasculitis
Definition
elevated
Term
cutaneous polyarteritis
Definition
benign variant of PAN where the vasculitis is limited to the skin
Term
churgg-straus triad
Definition

-adult onset asthma

-peripheral eosinophilia

-pulmonary lung involvment

Term
wegeners granulomatosis triad
Definition

-vasculitis of respiratory tract

-glomerulonephritis

-medium vessel vasculitis

Term
sed rate in temporal arthritis
Definition
elevated
Term
pseudoxanthoma elasticum
Definition

hereditary disorder in which elastin fibers are calcified

-yellow papules in a reticular pattern

-peau d'orange (chicken neck)

-ocular involvement-ANGIOD STREAKS which are grey discolorations around the optical disc

Term
gardener's syndrome
Definition

>100 polyps so may have malignant potential 

 

CUTANEOUS FINDINGS
 Multiple epidermal cysts
 Subcutaneous fibromas
 Desmoid tumors
 Osteomas-mc facial bones
 Dental abnormalities

peutz-jager syndrome would have pigmented polyps

cowden's syndrome would have warty polyps on the face
Term

MALABSORPTION
Acrodermatitisenteropathic
a

Dermatitis herpetiformis


what might someone be lacking?

 

 

Definition

ZINC in acro

 

gluten sensitivity in herpetiformis

Term
skin manifestations of LIVER disease
Definition
SPIDER TELANGIECTASIA
PALMER ERYTHEMA
 
 
DILATED ABD WALL VEINS
NAILS
-TERRYS (WHITE NAILS)
-MEUHRCKES (WHITE BANDS)
-CLUBBED NAILS
-KOILONYCHIA (SPOON NAILS)

PRURITIS-itching
JAUNDICE-yellow discoloration of skin
HYPERPIGMENTATION-brown pigment
XANTHOMAS-yellow papules in skin indicating fat deposits 
Term
skin manifestations of PANCREATIC disease
Definition
LABS->AMYLASE
CUTANEOUS-PURPURA
 HEMORRHAGIC PANCREATITIS
 TURNERS-bluish discoloration of flank
 CULLEN SIGN-around umbilicus

SISTER MARY JOSEPH NODULE for pancreatic Ca
Term
vitamin A disorder
Definition

cause drying and scaling, allopecia, liver fibrosis, the vitamin circulates as retinol

 

ACCUTANE

 

a deficiency could cause night blindness and hyperkeratosis

Term

vitamin B1 disorder

---------------

B2 deficiency

---------------

B12 deficiency

Definition

beriberi-burning red tongue

 

B=beriberi

--------------------

ORO-OCULO-GENITAL SYNDROME
SEBORRHEIC DERMATITIS LIKE ERUPTION
LIP INFLAMMATION
OCULAR CHANGES
SCROTAL DERMATITIS
----------------------
hyperpigmentation
Term
NIACIN-PELLAGRA
Definition
3 DS
DERMATITIS-ERYTHEMATOUS ERUPTION IN SUN EXPOSED DISTRIBUATION

                         -HYPERPIGMENTATION

                         -CASALS NECKLACE***

DIARRHEA
DEMENTIA
Term
vitamin C deficiency
Definition

-follicular hyperkeratosis

-corkscrew hairs

-HEMORRHAGE!!

Term
how is carcinoid syndrome manifested on the skin?
Definition

paroxysmal flushing face and chest due to the bodie's release of a vasoreactive substance

-seratonin

Term
skin manifestations of RENAL disease
Definition
ANEMIA-PALE COMPLEXION
GENERALIZED HYPERPIGMENTATION
XEROSIS
PRURITIS
UREMIC FROST
HYPERPARATHYROIDISM
      METASTATIC CALCIFICATION IN SKIN
      FIRM HARD NODULES
NAILS-HALF + HALF
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