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Dermatology
Dermatology NYCOM MS2
101
Medical
Not Applicable
11/15/2003

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Cards

Term
Define a Macule
Definition
...a flat well circumscribed to illdefined discoloration
...can be any color or hypopigmented (paler than normal skin)
...you will not feel a macule when you run your finger across it
Term
Define a Patch
Definition
...a confluence of macules
...you will not feel this when you run your hand across it
Term
Define a Nodule
Definition
...an elevated and circumscribed solid lession that is greater than 0.5cm...this lession is well defined and will be felt because it is raised
Term
Define a Vesicle and the three subtypes
Definition
...it is a fluid containing lession of which there are 3 types...1) a bullae is greater than 0.5cm...2) pustules are a collection of leukocytes...3) cysts are a sac containing fluid
Term
Define CRUSTS and 3 examples
Definition
...crusts are dried exudates...serous dried exudates are honey colored... purulent dried exudates are yellow to brown... bloody exudates are rusty brown colored
Term
Define Scales
Definition
...it is excess dead epidermal cells produced by abnormal keratinization and shedding
Term
What is bandlike distribution?
Definition
lessions along a dermatome... shingles or herpes present like this...you won't see crossing of the body's midline unless the patient is HIV positive
Term
What is Photodistribution and what are its sites?
Definition
...lessions occur in sun exposed areas like the face, neck, arms, etc... lupus presents in this distribution pattern
Term
Where are intertriginous areas of the bidy?
Definition
...the axilla, breast fold, and groin...diseases that present this way are yeast, fungus, and psoriasis
Term
Describe the Woods light dx tool
Definition
a uv light that causes color changes in certain diseas states...fungal infections like microsporum audouini will appear green...bacterial infections like corynebacterium minutissimum will appear orange...pigmentary disorders like viteligo will appear ivory-white
Term
describe diascopy as a diagnostic tool
Definition
...it is a slide you put over a lession that distinguishes between vascular disorders(vessels disapear) and melanoma(don't disapear)...purpuric lesions will not disapear...and lupus vulgaris will look like apple jelly
Term
what is auspitz sign?
Definition
in psoriasis you will have bleeding points under scales when you pry them up
Term
what is the darier sign?
Definition
in urticaria pigmentosa rubbing the skin will make it edematous and erythramatous
Term
what is dermatographism?
Definition
in a person prone to urticaria (hives) if you scratch the back you will raised area
Term
what is the nikolsky sign?
Definition
describes pemphigus= a mobile blister under pressure to contrast pemphigoid is a tense blister that is non-mobile
Term
waht is a tzanck smear?
Definition
it is a viral culture usually used to dx HSV
Term
what is a weak topical steroid?
Definition
hydrocortizone
Term
what is a weak topical steroid?
Definition
hydrocortizone
Term
what is a medium strength topical steriod?
Definition
triamcinolone
Term
what is a strong topical steriod?
Definition
fluocinonide
Term
name 9 adverse reactions to topical corticosteriods
Definition
1) rosacia 2)skin atrophy =stria 3)tinea incognito 4)allergic contact dermititis 5)systemic absorbtion=cataracts 6)miliaria 7)folliculitis 8)nonhealing leg ulcers 9)hypopigmentation
Term
what is seborrheic dermatitis?
Definition
an inflamation of the skin that is chronic and known as craddle cap in infants and pityriasis sicca (dandruff) in adults
Term
what are the predisposing factors to seborrheic detmatitis?
Definition
heredity, parkinsons ds, facial paralysis, euroleptic drugs, hiv...it is also caused by thr yeast pityrosporum ovale
Term
what is the DDX for seborrheic dermatitis?
Definition
psoriasis, dermatophytosis (fungus), pitoryasis rosea, candidiasis, SCLE (lupus) or nutritional deficiency
Term
what is koebners phenomenon and in what ds does it occur?
Definition
it is a trigger in psoriasis vulgaris of rubbing and scratching that stimulates psoriasis proliferation
Term
what is the pathogenesis of psoriasis?
Definition
the kell kinetics are altered so that there is a shortening of the cell cycle from 311 days to 36 hours whick results in 28 times the production of epidermal cells
Term
what does psoriasis vulgaris look like on PE?
Definition
salmon-pink papules and plaques that are sharply marginated with silver white scale
Term
what is the primary DDx for psoriasis vulgaris?
Definition
seborreic dermatitis
Term
what are the 5 "P's" of lichen planus?
Definition
purple, polygonal, pruritic, planar, papules
Term
what does lichen planus look like on PE?
Definition
flat topped, violacious, shiny papules with white lines called wickhams striae
Term
what is a pterygium?
Definition
a term specific to lichen planus where you don't see the nail folds
Term
what is a herald patch?
Definition
it is an oval, slightly raised plaque with fine scales at the perifery of the body. it is found in 80% of patients with pityriasis rosea
Term
what dermatophyte occurs in a moccasin type distribution?
Definition
tinea pedis
Term
on hand, 2 feet syndrome refers to what dermatophyte?
Definition
tinea manuum
Term
what are the common causes of tinea capitis?
Definition
in u.s. trichophyton tonsurans (black dot)
...worlswide it is microsporum canis (grey patch)
Term
what is a kerion?
Definition
tinea capitis that is not treated correctly and becomes inflamed
Term
what is tinea incognito?
Definition
a dermatopphytosis that occurs after the topical application of steroids to a dermatophyte site... will not look like fungus after steroid use even though it is
Term
what causes tinea versicolor?
Definition
pityrosporum orbiculare
Term
how do you Dx tinea versicolor?
Definition
microscopicaly you see spaghetti (hyphae) and meatballs (spores)
Term
describe candidiasis upon PE?
Definition
firery red with satellite pustules
Term
what are acne myths? corrected
Definition
1. there is no DIET correlation 2. COSMETICS are not a cause 3.CHOCOLATE does not cause acne 4. DIRT not due to being dirty 5. SUN it does not relive acne 6. TEENAGERS ONLY not true, occurs in adults too
Term
what causes acne?
Definition
androgen excess, stress, medication like lithium and mechanical irritation
Term
how do you treat moderate to severe acne?
Definition
you add an oral antibiotic to the topical regime, this is the next step and goes beyond topicals. add- tetracycline, minocycline, doxycycline, erythromycin
Term
how do you treat recalcitrant acne?
Definition
this is long term acne and is treated with 13-cis-retinoic acid (accutane)
Term
what do you have to be aware of with accutane?
Definition
user must not get pregnant, beware of depression or suicide int he family history, and triglycerides increase always. you have to monitor to make sure no one gets into a very high range
Term
what are other effective acne treatments?
Definition
intalesional injections with triamcinalone. this is a steroid and usually causes acne but here by injecting it it gets rid of inflamation and prevents scarring.
Term
what is perioral dermatitis?
Definition
it is an acne rosea like dermatitis that occurs around the mouth and eyes almost exclusivly in women 20-40 yoa
Term
what does periorbital dermatitis look like upon PE?
Definition
small erythramatous papules that coalesce to form eczematous patches with satellite papules and pustules
***this eruption looks like eczema but is actually acne, the name is a misnomer***
Term
what is the DDx for perioral/orbital dermatitis?
Definition
allergic contact dermatitis, atopic dermatitis, seborreheic dermatitis, sarcoidosis ***all of these are treated with topical steriods but we are actually dealing with an acne!*** steroids will exacerbate it
Term
how do you treat perioral/orbital dermatitis?
Definition
do not use topical steriods and start toical antibiotic, most patients require an oral antibiotic also
Term
what is telogen effluvium?
Definition
loss of hair in the telogen phase- since 10% of hair is in this phae only 10% is lost-
Term
what are the causes of telogen effluvium?
Definition
post partum, crash dieting, surgery, birth control pills, HIGH FEVER, drugs like anticoagulants and accutane
Term
how do you treat telogen effluvium?
Definition
reassurance, hair will grow back in time
Term
what is pseudofolliculitis barbae?
Definition
hair grows out of the follicle then curls upa nd repenetrates the skin
Term
how do you treat pseudofolliculitis barbae?
Definition
discontinue close shaving and use retinoids
Term
what is a habit tic deformity?
Definition
it is a nail deformity that occurs from the patient constantly pushing back on his cuticle, mostly on thumbs and it wwill leave horiz. impressions. this will go away when a patient breaks this habit
Term
what is an onycomycosis?
Definition
subungal debris of fungus
Term
what are beau's lines?
Definition
stress (the same that causes telogen effluvium) on the body puts the nail into a temporary growth arrest. you see horiz. ridges in nail that represent no growth over time. differentiate from habit tic b/c this happens on all nails not just thumbs
Term
what is the most common type of drug reaction?
Definition
exanthematous drug eruption
Term
what are the non-allergic causes of urticaria, angioedema, and anaphalaxis?
Definition
nsaids, and radiographic contrast media
Term
what drug can induce pigmented skin findings?
Definition
zidovudine- brown macules on lips or oral mucosa and longitudinal brown bands in nails
Term
a deficiency in waht can lead to warfarin necrosis?
Definition
protein c
Term
what is the atopic dermatitis triad?
Definition
will occur with a personal or family history of hay fever, asthma, or allergic rhinitis
Term
what is the dennie-morgan sign?
Definition
in atopic dermatitis there will be an infraorbital wrinkle below the eyelid
Term
what causes seborrheic dermatitis?
Definition
lipophilic yeast, pityrosporon ovale
Term
what is the common distribution of seborrheic dermatitis on the face?
Definition
in a butterfly area of face, behind ears, forehead, nasolabial fold, glabella
Term
what is a blue nevus?
Definition
it represents a localized proliferation of melanin producing dermal melanocytes called the tindle effect
Term
when does a blue nevus occur?
Definition
childhood or late adolesence
Term
what is the treatment and course of a blue nevus?
Definition
it is an aquired lesion that is usually biopsied to rule out melanoma, they are usually benign
Term
what is a halo nevus?
Definition
a mole encircled by a halo of leukoderma or depigmentation (white)
Term
where do halo nevi usually occur?
Definition
the trunk
Term
what diseases is a halo nevus usually associated with?
Definition
vitiligo or metastatic melanoma
Term
what is the age of onset for a spitz nevus?
Definition
1/3 of patients are under 10, 1/3 are 10-20, and 1/3 are over 20 but rarley over 40
Term
where do spitz nevi occur?
Definition
usually the head and neck and 90% are aquired
Term
what is the course and treatment of a spitz nevus?
Definition
full excision with a border of 5mm to prevent reoccurance and biopsy to rule out melanoma b/c the can lookalike histologically
Term
what is the histology of nevus spilus?
Definition
a combination between a lentigo and a nevus
Term
what does a nevus spilus look like on physical exam?
Definition
light brown macule with many dark brown spots scattered throughout the lighter background
Term
describe a compound nevus?
Definition
they are a combination of junctional (flat and uniform color nevi) and a dermal (flesh colored and elevated nevus)...this skin lesion is usually darkly pigmented and dome shaped
Term
what is nevus flammeus?
Definition
called also stork bite, it occurs in infants on the neck, face and looks likea port wine stain. it is treated with a pulsed dye laser
Term
what is sturge weber syndrome?
Definition
a port wine stain varient that includes vascular malformations of the eye and leptomeninges of the brain
Term
what is klippel trenaunay?
Definition
may be associated with port wine stain that overlies the deeper vasculature and malformations of the soft tissue and bone
Term
what is actinic keratinosis?
Definition
a common sun induced premalignat lesion
Term
what do actinic keratinosis look like?
Definition
thay are discrete, rough and adherent scaly papules that occur in areas of dermatoheliosis (sun damaged skin)head, neck, hands, earlobes...
Term
why are we worried about actinic keratinsis?
Definition
they have premalignant potential and may develop into SCC, it should be treated with 5-FU (flourouracil) it attacks the premalignant cells and turns them red thereby helping to determine cancer status
Term
what are the 5 types of basal cell carcinoma and which has the worst prognosis?
Definition
superficial, nodular, pigmented, ulcerative (rodent ulcer) and morpheaform (worst prognosis)
Term
what are the 5 cardinal features of melanoma? a-e
Definition
assymetry, borders (irregular), colors (mottled-haphazard), diameter >6mm, enlargment or elevation
Term
what is a pyogenic granuloma?
Definition
a bright red and smooth dome shaped nodule that bleeds frequently...it occurs on fingers, lips, mouth, trunk, toes...it must be surgically removed
Term
what is a dermatofibroma?
Definition
it is abutton like nodule which is a fibrous rxn to a trauma or bite
Term
what is the dimple sign?
Definition
associated with dermatofibroma...it is a lateral compression with the thumb and index finger that produces a dimple frequncy is legs>arms>trunk
Term
what is the sign of leser trelat?
Definition
in seborrheic keratosis an acute exacerbation can be related to adnocarcinoma or gi carcinoma
Term
what is kasabach-merritt syndrome?
Definition
a bv disorder of a deep cavernous type with platlet entrapment and trombocytopenia
Term
what are keloids?
Definition
scars with over expressed fibrous repair, mc in blacks on the earlobes and upper parts of body
Term
to what organ ds is spider angioma related?
Definition
liver ds
Term
what are the melanoma risk factors? mm risk
Definition
moles atypical >5, moles common >50, redhair, inability to tan, sunburn, kindred (family hx of melanoma)
Term
where are common nevi found?
Definition
on sun exposed areas
Term
where are dysplastic nevi found?
Definition
on sun protected areas
Term
what is huchinsons sign?
Definition
in malignant melanoma a mole around a nail that bleeds into normal skin
Term
what are the side effects of accutane?
Definition
teratogenic (cat x), inreases triglyserides, and suicidal depression
Term
what is hydradenitis suppuritiva?
Definition
an abcess of the apocrine sweat glands in the anogenital or axillary region
Term
What are the viral manifestations of hiv 6 of them?
Definition
acute exanthem of hiv (early aids rash), HSV, cytomegalovirus, oral hairy leukoplakia, molluskum contagiosum, HPV
Term
describe oral hairy leukoplakia?
Definition
it is highly correlated with the progression of aids... it is white corrugated plaques on the lateral margins of the tounge...it may become verrocous and lead to dysphagia...candidiasis may be superimposed
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