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| < 5 mm circumscribed elevation w/ serous fluid |
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| > 5mm circumscribed lesion w/ serous fluid |
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| vary in size but contain purulent fluid |
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| Abnormal "stratum corneum" |
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| <1 cm deposit of blood/pigment |
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| > 1 cm deposit of blood/pigment |
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| round lesion w/ central clearing; ring shaped |
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round lesion w/ central clearing
coin shaped |
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| irregular, rough, and ruggated |
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| erythematous rash that has some areas that are flat and some raised |
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| dermatits - inflammation of the skin |
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| thickened skin w/ distinct borders |
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| dilated, superficial blood vessels |
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| S&S that indicate almost beyond a doubt the correct dx of a dz |
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| Sx indicating the onset of a disease |
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| A raised, itchy (pruritic) area of skin that is almost always an overt sign of allergy. |
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| Are most skin lesions malignant or benign? |
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| What are the most common malignant skin lesions? |
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| What procedure is indicated for visual subtle differences in melanin pigment? |
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| What color would poryphria be in urine when examined by a woods lamp? |
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| What color would tinea capitis be when examined under a wood's lamp? |
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| What color would erythrasma be when viewed under a woods lamp? |
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| What study is indicated to examine a lesion to determine if the red color of a non-blanchable macule/papule is caused by capillary dilation (erythema) or extravation of blood vessels (purpura)? |
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| Which study is a non-invasive technique to visualize the deeper layers of the epidermis and dermis and is used to distinguish benign from malignant lesion? |
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| What is KOH indicated for? |
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ALL SCALING LESIONS
FUNGUS OR YEAST |
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| A patient presents and you suspect a form of the herpes virus, what test would you order to help confirm your dx? |
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Tzank Smear
Confirm w/: culture and immunoflourescne |
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| You are in your first rotation in a gynceology clinic and you suspect a vulvar wart, what test can you order to help you confirm your suspicion? |
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Acetowhitening
(Also used in penile warts)
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| You are working in a primary care clinic, and your 5 y/o patient presents with itching and red bumps on his back. Pt admits to playing in the grass earlier and says this isnt the first occurance. What is your dx? What test can you order to confirm? |
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Allergies to grass
Test: Patch Testing |
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| What type of biopsy is indicated if you want to get through all the layers of the skin? |
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| What type of biopsy is indicated if you have a nodule? |
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| Incisional - large wedge removal of SQ |
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| What type of biopsy is indicated if you want all the borders of a lesion? |
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| What type of biospy is indicated if you are only concerned about the superficial layer? |
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| What procedure is 90% effective and is used to remove superficial skin CA, BCC < 5 mm, early stage SCC, and new skin CA? |
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| Curettage and Electrosurgery |
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| What procedure is 99% effective and is used to remove SCC and BCC tumors precisly from the skin? |
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| You are working in a derm clinic, and you have a patient that is fair-skinned and is working construction. What is your suggestion to the patient to do as a means to track changes in his skin? |
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Total body photography
Used in patients who are high risk for melanoma |
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| You are working in primary care, and a mom presents with her 3 y/o son. The c/c is itchiness, but states that everytime the child scratches a rash develops. Mom also states that when the child scratches it leaves distinct lines, almost like "writting on his skin". What is your dx? What is the term for "writting on skin"? Tx? |
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Atopic Dermatitis
Dermographism
Wet, Cool Dressing and
Topical Steroids (sparingly) |
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| What is the term for intraorbital lines associated w/ "Atopic Dermatitis"? |
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| In Atropic Dermatisis, where are the functional creases located? |
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| Anticubital and popliteal fossa |
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| Patient presents to the urgent care clinic complaining of an itchy rash on his lower arm. Patient states that he recently went hicking in the woods and the rash appeared a few days after. On PE the rash is erythematous and well demacated. What is your dx? and Tx? |
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contact dermitis
Topical Corticosteroids |
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| A 30 y/o Patient Presents to the clinic with a rash characterized by circular "coin-shaped" erythmatous plaques on her arms. Lesions itch and are recurrent. What is your dx and tx? |
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Dx: Nummular Eczema
Tx: Emollients and Topic Steroids |
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| Patient presents to your clinic with a PmHx of PVD. You check his skin, and notice a inflammatory pigemnted papule with scaly, crusty lesions on his medial malleolus? What is your dx? and tx? |
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Dx: Stasis Ulcer
Tx: Compression stockings |
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| Patients presents to clinic with vesicles that line the lateral edges of his fingers and a few vesicles in the palm. Patient admits to iching. What is your dx and tx? |
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Definition
Dx: Dyshidrotic Dermatitis
Tx: HD topical steroids and cold compress |
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| This is a 65 y/o patient with a history of DM. Patient complains of numerous blister formation ang his arms. Dx and Tx? |
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Bullous Pemphigoid
Tx: anti-inflamatory and immunesuppresant |
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| Patient presents to the clinic complaining of "disfiguring lesions". Upon physical examination you notice on the extensor surface of her arm "silver scaling". What is your dx? what test would you perform? |
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Dx:Psoriasis
Test: Auspitz sign - removal of scales results in minute blood droplets
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| Patient presents to the clinic withn a pmhx of influenza and a c/c of a rash that runs down her arm. Patient said that it previously started as a small lesion. Upon PE you notice a characteristic "christmas tree pattern". What is your dx and tx? |
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Dx: Pityriasis Rosea
Tx: Reassurance |
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| Patient presents with a chief complaint of a itchy spot on her left arm. Upon examination you notcice that the spot appears to a be a "purple plaque". What is your dx? and tx? |
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Dx: Lichen Planus
6 Ps: puritis, plaque, papules, polygonal, planar, and purple
Tx: Reassurance - self limiting |
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| Patient presents to the clinic with a "peristant, well circumscribed patch" on his wrist. When getting his history you ask if he ever scatches his wrist. He replies, "ya, I scatch it all the time, my family calls it a problem and says I must stop, which is why I came here". What is your dx? |
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Lichen Simplex Chronicus
"neurodermatitis"
Caused by repetitive rubbing or scratchng |
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| Patient presents to the clinic complaining of a rash that suddenly developed. When asking have you started any new medications? Patient replies "ya, I was started on a new Abx yesterday for a UTI". What is your dx? Tx? |
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Dx: drug eruption
Tx: prompt ID and withdrawal of drug |
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| Patient presents to the ED, in respiratory compromise. Upon examination, you notice that the patient is flushed to the face, and has raised, palpable wheals all over his trunk. What is your dx? and Tx? |
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Uticaria (Hives)
Tx:
Immediate EPI
Respiratory comprimise: nebulized albuterol
Also administer diphenydramine and hydroxyzine |
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| Patients presents to the ED complaining of a mutlicolor rash on his trunk. Patient states that the rash originally started as a small spot, but has now gotten worse over 24-48 hours. On hx, patient tells you that he recently started a new Abx and says it is "sulfa something". On PE you notice that the rash has a marked appearance of round erythematous lesion with a pale center. What is your dx and tx? |
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Erythema Multiform
"Target Lesion" |
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| Patient presents to the ED complaining fo a painful rash on his trunk. When you examnine the patient the lesion appears as a "vesicle surrounded by macular erythema of only 2 colors". You also notice that the superficial layer the patient's skin is starting to peel off in certain areas. You ask the patient if anything has changed in his medical status, such as a new meds. Patient admits to starting a new HTN med 3 days ago. What is your dx and tx? |
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Steven's Johnson Syndrome
Tx:
Admit
systemic corticosteroids
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| Patient admits to the clinic complaining in acute distress and screaming in pain about a progressive rash after recently starting a new medication. Upon physical exam you notice bullous formation, and "sheets" of epidermis falling off as you touch the patients skin that covers 30% of his BSA. Dx? Tx? What sign is seen? |
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Toxic Epidermal Necrolysis (TEN)
Sign: Nekolsy's Sign
Tx:
Admit - MEDICAL EMERGENCY!
Tx for Fluid loss, systemic corticosteroids |
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| Patient presents with a complaint of "pimples" to the face and chest. Patient states that homecomming is next week and this needs to be fixed ASAP. PE is (+) for Comedones and 3 papulopustular lesions. What is your dx? what stage? and Tx? |
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Acne Vulgaris
Stage: mild
Tx: Combo Tx
Benzoyl Peroxide
Abx: erythromycin and clindamycin
Topical Retinoids |
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| A 18 y/o female presents to your dermatology clinic new bumps on her skin. Patient admits to increased stress while applying to college. On PE you notice the presence of comedones and an increase in papulopustular lesions from her last visit (3 --> 10) additionally the patient has a new sign of inflammatory papules. What is your dx? stage? tx? |
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Definition
Dx: Acne Vulgaris
Stage: Moderate
TOC: Minocycline
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| 20 y/o female patient presents to clinic with a complaint of disfiguring spots on her face. Patient has previously been to your clinic in times of stress for a similar condition. On PE the skin appears to have papulopustular lesions with comedones, inflammatory papules, as well a 6 cm nodules that have resulted in some scarring. Patient has already had a previous tx regime of Abx, benzoil peroxide, and retinoids. What is your dx? stage? and what is your tx? what must you monitor? |
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Acne Vulgaris
Stage: Nodular/Severe
Tx: Oral Isotrentinoin (Accutane)
Must Monitor:
Pregnancy (monthly) - pt must be on OC
LFTS (hepatotoxic)
Lipids (increase in TG, LDL, and Total Cholesterol)
Vision (night vision affected)
Skin (eczema experienced)
Nasal d/c (epistaxis experienced)
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| What are two "specials forms" of Acne Vulgaris? |
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Adult Women -
hirtuism also presnets - check for abnormal androgen levels
Infants
nose and cheeks - related to glandular development - transient |
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| A 50 y/o women presents to clinic with a c/c of "flushing of the face". On physical exam you notice telangiectasis, coarse skin, and inflammatory papulopustular erruption. There are no comedones present. What is your dx? and Tx? What is the term for the complication noted by an thickened and disfigured nose? |
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Rosacea
Tx: Metronidazole (Macrolides)
TOC: vascular lasers
Rhinophyma |
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| A 75 y/o white male presents to your dermatology clinic complaining of a spot of his head his wife mentioned 2 weeks ago. On physical exam the lesion appears to be small verrucous lesion (dry, rough, crusty). What is your dx? Tx? and What is this patient at risk for? |
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Actinic Keratosis
Tx: 5-fu and cryosurgery
Risk: SCC |
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| A 65 y/o male presents to your primary care clinic for a routine check up. Upon noticing some dark spot on his arms you ask if it is ok to do a full body dermatological exam. Upon examination you notice the patient has numerous "barnicle-type" dark brown lesions on his trunk also. What is your dx? is this benign/malignant? Tx? |
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Seborrhaic Dermatitis
Benign
Tx:
Height: Ammonion lactate and alpha-hyoxyl acid
Superificial: ticholoroacetic acid
Topical: Tazarotene |
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| What is the superficial layer of the skin? What layers is it broken into, from top to bottom? |
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Definition
Epidermis
Stratum Corneum
Stratum Granulosum
Stratum Spinosum
Statum Basale |
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| What is the middle layer of the skin? What is primarily composed of? What is located there? |
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Definition
Dermis
Collagen Fibers
Sebaceous Glands, some blood vessels, and hair follices |
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| What is the deepest layer of the skin? what is its primary composition? what components are located there? |
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Definition
Subcutaneous
Adipose tissue
Blood vessels and nerves |
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| What pigment is colored blue in the skin? |
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Definition
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| What pigment is "red" in color in the skin? |
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Definition
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| What pigment is yellow in the skin? |
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Definition
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| What is the primary pigment of the skin and what color is it? |
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Definition
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| A hispanic females presnts to the clinic complaining of a "lightening of her skin". Upon PE you notice a depigmented patch on her right arm. What is your dx? What conditions are associated w/ this condition? |
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Definition
Vilitigo
DM, Thydroid disorder, psoriasis, IBD, pernicious anemia |
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| You are working in an OBGYN clinic, and you 6 mo pregnant patient presents to the clinic complaining of a "darkening spot on her cheek". On PE you notice a pigmented hypermalanous patch on her right cheek. What is your dx? and tx? |
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Definition
Melasma -
"mask of pregnancy"
Tx: Hydroquinine cream, strict sun avoidance
(if she wasnt pregnant - stop estrogen) |
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| Patients presents to a clinic, stating that people are calling him dirty b/c of a darkening on his neck. On PE you notice a dark velvety patch on his posterior neck. What is your dx? tx? what is condiiton associated with? |
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Definition
Acanthosis Nigricans
Tx:
tx underlying condition (benign)
Surgery (malignant)
Associted w/ Insulin resistance and DM
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| UVA is associated w/ what process in the skin? How far does it penetrate? |
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Definition
Aged Apperance
Penetrates Dermis |
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| UVB light is associated w/ what conditions in the skin? What layers of the skin is it absorbed in? |
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Definition
NMSC - SCC and BCC; 1000x more erythrogenic than UVA, melanogensis, tanning, sunburn, and VitD
Statrum Corneum (10% of dermis) |
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| Patient presents to your dermatology clinic after a day out on the beach during spring break. On PE you note a edematous rash with a sunburn appearance. Patient describes the rash as a "burning and tingling". While checking her chart, you notice that you 2 days ago you prescribed a new acne medication. What is your dx? |
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Definition
Phototoxic Reaction
(non IgE mediated) |
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| A mom presents to your clinic with her 5 y/o daughter. Patient has a c/c of an erythematous rash that has progressively gotten worse over her last 3 times in the sun. What is your dx? |
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Definition
Photoallergy
Uticaria is common and it is IgE Mediated |
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| What is a major complication of burns? Tx? |
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Definition
Edema and Max fluid loss of plasma volume in first 8-12 hours.
Tx:
restore IV volume and maintain tissue profusion
Silver sufadlazine (silvadine)
Sterile, nonadherant gauze |
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| Patient presents to the clinic complaining of a "burn" upon spilling starbucks coffee on her wrist. On PE the burn is "erythematous, painful, and edematous". What degree burn is this? |
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Definition
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| Patient presents to the ED complaining of a burn caused by "boiling hot water". On PE the burn is a "partial thickness" burn with some entrance into the dermis. What degree burn is this? Is this burn going to scar? |
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Definition
Second Degree Burn
No - it will heal completley in 2 weeks |
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| Patients presnts to the ED after dropping hot wax on her hand. On PE exam you notice a "full thickness" burn that extends through the epidermis and dermis but doesnt extend into the subQ and fascia. What degree of burn is this? Scarring? |
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Definition
Third Degree
Yes - Scarring is present |
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| Patient presents to the ED after a combusting car accident. PE shows the patient is in a in a critical condition, with a full thickenss burn going into the SubQ, fascia, bone, and muscle. What degree of burn is this? |
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Definition
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In the "Rule of Nines"
What percents is the arms (each)?
Leg (each)
Trunk (Ant/Post)
Head and Neck?
Genitalia and Perineum?
Hands? |
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Definition
Arms - 9%
Leg - 18% each
Trunk - Ant and Post 18% each
Head and Neck - 9%
Genitalia and Pernineum - 1%
Hand - 1%
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| A female patient presents to your dermatological clinic complaining of sores on her genital areas. On PE you see open comedones, sinus tracts, and abscess formation. What is your dx? what are the common locations? common gland? tx? |
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Definition
Hiradenitis Suppurativa
Common location: genitals and axilla
Common gland: Apocrine
Tx: Combo
1. intralesional steroids
2. surgery
3. oral abx
4. isotrentinoin
5. PSYCHOLOGICAL SUPPORT |
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| What is the most common area of pressure sores? Second? |
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Definition
1st: Buttox (sacral and ischial) - "bed sores"
2nd: LE (malleolar, patelar, pretibial, and heal) - Diabetics |
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| What are the symptoms of pressure ulcers? |
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Definition
Pain usually absent
Foul odor or d/c |
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| Patient has been in the hospital for 12 hours. When the nurse goes to check on the patient, she notices a "non-blanchable, erythematous lesion" on the patients buttox. What is your dx? stage? |
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Definition
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| Patient with a PmHx of DM presents to the ED with a "partial thickness wound" on their medial malleoulus. On exam the wound extends into the epidermis and dermis and is surrounded by pink tissue. Dx? Stage? |
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Definition
Pressure Ulcer
Second Stage |
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| Patient presents to the ED with a a PmHx of a living in a nursing home x 3 mo. Upon examining the patients sacral region you notice the patient has a full thickness lesion that extends intot he SubQ but not into the fascia. What is your dx? stage? |
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Definition
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| A patient w/ a PmHx of DM presents to the clinic with a pre-tibial wound. On PE the wound is full thickness and extends through the epidermis, dermis, fascia, muscle and tendon. What is your dx? stage? |
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Definition
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| Pt presents to the ED after being on bed rest for 3 weeks. You notice that on the patients ischial region there is a wound that is full thickness, but you are unable to determine the depth due to an eschar formation. Dx? Stage? What must you perform? |
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Definition
Pressure Ulcer
Unstagable
Debriment of the Eschar around the ulcer |
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