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144 Cards in this Set

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what is psoriasis?
1. pink plaques c/ slivery-white scaling
2. occurring on extensor surfaces such as elbow and knees
3. fingernail pitting
4. can be a/c arthritis
5. Auspitz sign= removal of overlying scale causes pinpoint bleeding b/c of thin epidermis above dermal papillae
5. Kobner's phenomenon--psoriatic lesions appear at sites of cutaneous physical trauma (skin scratching, rubbing or wound)
what is found with Auspitz sign and Kobner's phenomenon?
1. psoriasis
what is Auspitz sign?
1. removal of overlying scale causes pinpoint bleeding b/c of thin epidermis above dermal papillae
2. seen in psoriasis
what is Kobner's phenomenon?
1. psoriatic lesions appearing at sites of cutaneous physical trauma (skin scratching, rubbing or wound)
what is dx for psoriasis?
1. clincial
2. bx is gold standard
what is tx for psoriasis?
1. topical steroids are fist line
2. PUVA (Psoralens + UV A light) is second line
3. methotrexate and cyclosporin are third line
how are psoriasis lesions described?
1. dry, NOT pruritic
2. well-circumscribed
3. silvery, scaling papules an plaques
what is eczema?
1. eczematous dermatitis
2. family of superficial, intensely pruritic, erythematous skin lesions
3. atopic dermatitis, contact dermatitis, seborrheic dermatitis
what are si/sx of aptopic dermatitis?
1. an "itch that rashes"
2. rash secondary to scratching
2. chronic pruritus commonly found on the face in infancy
3. later in childhood can present on the flexor surfaces such as antecubital and popliteal fossa
what is atopy (atopic syndrome)?
inherited predisposition to:
1. asthma
2. allergies
3. dermatitis
what is tx for aptopic dermatitis?
1. avoid irritants or triggers
2. keep skin moist c/ lotions
3. use steroids and antihistamines for sx relief of itching and inflamm
whare are si/sx of contact dermatitis?
1. linear pruritic rash at site of contact
2. caused by delayed-type hypersensitivity rxn after exposure to poison ivy, poison oak, nickel or chemicals
3. dx is clinical
4. hx of exposure crucial
5. tx is as per atopic dermatitis
what is seborrheic dermatitis?
1. erythema, scaling, white flaking (dandruff) in areas of sebaceous glands (face, scalp, groin, axilla, and ext ear)
2. called "cradle cap" in infants
what is "cradle cap" in infants?
1. seborrheic dermatitis
2. erythema, scaling, white flaking (dandruff) in areas of sebaceous glands
what is dx of seborrheic dermatitis?
1. clincial and
2. KOH prep to r/o fungal infxn
what is tx for seborrheic dermatitis?
1. (erythema scaling white flaking in areas of sebaceous glands)
2. selenium shampoo on face and trunk
3. steroids for severe dz
what is urticaria caused by?
1. utricaria=hives
2. common disorder caused by mast cell degranulation and histamine release
what are si/sx of urticaria?
(hives!!)
1. transient papular wheals
2. intensely pruritic
3. surrounded by erythema
4. dermographism (write a word on the skin and it remains imprinted as erythematous wheals
where do you see transient papular wheals and dermographism?
urticaria (hives!)
what causes urticaria?
(hives!)
1. lesious are usually immunoglobulin (Ig)E-mediated (type I hypersensitivity)
2. exercise,
3. certain chemicals in sensitive pts
4. inhibitors of prostaglandin synthesis (e.g. aspirin)
also can cause IgE-independent rxns
5. can cause respiratory emergency requiring intubation
what is dx of urticaria?
1. skin testing or
2. aspirin or
3. exercise challenge
what is tx of urticaria?
1. avoidance of triggers, antihistamines, steroids, epinephrine
what is vitiligo?
1. hypopigmentation
2. loss of melanocytes in discrete areas of skin
3. appearing as sharply demarcated depigmented patches
4. e.g. Michael Jackson, Amanda Kelling
what do you call a loss of melanocytes in discrete areas of skin?
1. vitiligo/hypopigmentation
where do you see vitiligo?
1. loss of melanocytes
2. occurs in all races, but most apparent in darkly pigmented pts
3. chronic condition that may be autoimmune in nature
4. a/c thryoid dz in 30% of pts, esp women
what is vitiligo a/c in 30% of pts?
1. thyroid dz
2. esp. women
what is the pathophys of albinism?
1. melanocytes are present,
2. but fail to produce pigment d/t tyrosinase deficiency
what is seen with tyroxinase deficiency?
1. albinism
what are si/sx of tyrosinase deficiency?
1. albinism
2. white skin and eyelashes
3. nystagmus, iris translucency
4. decreased visual acuity, decreased retinal pigment
5. strabismus
the oculocutaneous form of what predisposeds to skin cancer?
1. albinism (tyrosinase deficiency)
what is pityriasis alba?
1. nonpathologic areas of hypopigmentation on face or upper ext
2. can be secondary to infxn or infalmm, often regresses over time
3. differentiated from tinea versicolor by KOH prep
how do you differentiate pityriasis alba from tinea versicolor?
KOH prep
what do you call nonpathologic areas of hypopigmentation on face or upper ext?
pityriasis alba
what is an ephelis caused by?
1. ephelis= a freckle
2. caused by normal melanocyte number, but increased melanin within basal keratinocytes
3. darkens with sun exposure
what do you call it when normal melanocytes increase the melanin within basal keratinocytes that darkens with sun exposure?
ephelis--freckles!!
what is lentigo?
1. pigmented macules
2. caused by melanocyte hyperplasia
3. unlike, freckels, do not darken with sun exposure
what do you call pigmented macules caused by melanocyte hyperplasia that do not darken with sun exposure?
lentigo
what should you think of in an adult male with thrush?
1. candidiasis
2. HIV/AIDS
how do you tx thrush?
1. candidiasis
2. tocal or topical nystatin or
3. imidazoles (miconazole, clotrimazole)
4. oral therapy (nystatin or ketoconazole) used for extensive or resistant disease
what should you think of in a pt with new exposure to a classic offending agent (poison ivy, nickel earrings, deodorant)?
1. contact dermatitis
2. type IV hypersensitivity rxn
what derm condition is found in the presence of gluten-sensitivity?
1. dermatitis herpetiformis!
2. look for diarrhea and wt loss
3. skin has IgA depositis even in unaffected areas
which three drug groups commonly cause rashes?
1. penicillins
2. cephalosporins
3. sulfa drugs
what two drug groups commonly cause photosensitivity?
1. tetracyclines
2. phenothiazines
what should you think of in a pt with excessive perspiration?
1. hyperthyroidism
2. pheochromocytoma
what fungal skin infxn is found on body/trunk?
1. tinea corporis
2. Trichophyton spp
what fungal skin infxn is found as athlete's foot?
1. Tinea pedis
2. Trichophyton spp.
what fungal skin infxn is found as onychomycosis?
1. Tinea unguium
2. Trichophyton spp.
what fungal skin infxn is found on the scalp?
1. Tinea capitis
2. Trichophyton spp
3. highly contagious in children
4. may hav inflamed, boggy granuloma of the scalp known as a kerion--usually resolves on its own
if the hair fluoresces under Wood's lamp, what organism is the cause?
Micorsporum spp.
if the hair does NOT fluoresce under Wood's lamp, what organism is the cause?
Trichophyton spp.
how do you tx tinea capitis and onychomycosis?
1. oral agents: terbinafine, fluconazole, griseofulvin
what do you call a flesh colored lesion with a central crater that is found on the face and had a very rapid onset (growth to full size in 1-2 mon) and involutes spontaneously?
1. keratoacanthoma
2. looks like squamous cell CA
3. requires no tx
how do you tx pediculosis?
1. lice!!
2. tx with permethrin cream
3. preferred over lindane b/c of lindane's neurotoxicity
what are the 4 Ps of lichen planus?
1. pruritic
2. purple
3. polygonal
papules
4. and oral muscosal lesions
what is the worst type of malignant melanoma?
1. nodular melanoma
2. b/c it tends to grown downward first
what is px of malignant melanoma related to?
1. the depth of vertical invasion
what kind of melanoma presents are black dots on the plams and soles or under the fingernail?
1. acrolentiginous type
what is characterized by lesions are that are skin-colored, smooth, waxy pappules c/ a central depression [umbilicated] that are roughtly 0.5 cm?
1. molluscum contagiosum
2. poxvirus infxn
3. common in children
4. may be transmitted sexually
where do you see a "herald patch"?
1. pityriasis rosea
2. erythematous ring-shaped or oval and scaly patch classically seen on the trunk
what is Bowen's disease?
1. squamous cell cancer in situ
what is the depigmentation a/c:
1. pernicious anemia
2. hypothryoidism
3. Addison's dz
4. DM
1. vitiligo!
2. pts ofen have antibodies to melanin, parietal cells or thyroid
what is a nevocellular nevus?
1. common mole
2. benign tumor derived from melanocytes
what is a blue nevus?
1. black-blue nodule present at birth
2. often mistaken for melanoma
what is a spitz nevus?
1. red-pink nodule
2. often seen in children
3. confused with hemangioma or melanoma
what is a dysplastic nevus?
1. atypical, irregularly pigmented lesion
2. with increased risk of transformation into malignant melanoma
3. dysplastic nevus syndrome is AD inherited dz
what is melasma?
1. chloasma
2. masklike hyperpigmentation on face
3. seen in pregnancy
4. accentuated by sunlight
5. typically fades postpartum
what is tx for chloasma?
1. melasma=masklike phyperpigmentation on face seen in pregnancy
2. minimize facial exposure to sun or use hydroquinone cream (for any hyperpigmentation)
what is tx for any hyperpigmentation?
use hydroquinone cream
what is a hemangioma?
1. group of "birthmarks"
2. capillary hemangiomas present at birth
3. port-wine stains, strawberry hemangiomas, cherry hemangiomas
what are port-wine stains a/c?
1. Sturge-Weber sx
2. purple-red on face or neck
3. must screen for glaucoma and CNS dz (CT scan)
what must you screen for in someone with a port-wine stain?
1. glaucoma and CNS dz (CT scan)
2. think of Struge-Weber sx
what are strawberry hemangiomas?
1. bright red raised lesions
2. benign
3. most disappear on their own
what are cherry hemangiomas?
1. benign small red papule
2. tx with lase therapy
what is xanthoma?
1. yellowish papules
2. often accumulations of foamy histiocytes
3. may be a/c familial hyperlipidemia
4. if seen on eyelids, call "xanthelasma"
how do you tx xanthomas?
1. decrease hyperlipidemia
2. surgically excise papules as needed
3. can be idiopathic or a/c familial hyperlipidemia
what do you call accumulations of foamy histiocytes that present as yellowish papules?
1. xanthomas
2. xanthelasmas if seen on eyelids
what is pityriasis rosea charcterized by?
1. erythematous maculopapular rash c/ scales apparent in center
2. often preceded by a "herald patch" on trunk
3. can appear on back in a Christmas tree distribution
4. tx c/ sunlight, or spontaneously remitsin 6-12 wks
what do you think of with a maculopapular rash with scales, a herald patch on the trunk and a Christmas tree distribution on the back?
1. pityriasis rosea
2. may spontaneously remit in 6-12 wks
What is erythema nodosum?
1. inflamm of subcutaneous fat (panniculitis) and adjacent vessels
2. tender red nodules occurring on the lower legs and sometimes forearms
3. usually resolves in 6-8 wk
what is characterized by tender red nodules occurring on the lower legs that ususally resolves in 6-8 wks?
1. erythema nodosum
2. tx directed at underlying cause
what are common causes of erythema nodosum?
1. infxns=Mycoplasma, Chlamydia, Coccidioides immitis, Mycobacterium leprae
2. drugs= sulfonamides and BCPs
3. infalmm bowel dz, sarcoidosis, rheumatic fever
4. pregnancy
what is dermatomyositis?
1. autoimmune disorder sometimes seen c/ polymyositis
2. presents c/ heliotropic (reddish purple) patches on eyelids and erythematous scaly rash on hands
what presents with heliotropic patches on eyelids and erythematous scaly rash on hands?
1. dermatomyositis
2. autoimmune disorder sometimes seen c/ polymyositis
3. tx with high-dose steroids
what presents as black or brown benign plaques, appearing to be stuck onto the skin surface?
1. seborrheic keratosis
2. commonly seen in elderly, runs in families
3. can be mistaken for melanoma
what is seborrheic keratosis?
1. black or brown benign plaques,
2. appear to be stuck onto skin surface
3. commonly seen in elderly, runs in families
4. can be mistaken for melanoma
5. tx with liquid nitrogen freezing, usually too many to tx
what presents as black velvety plazues on flexor surfaces and intertriginous areas?
1. acanthosis nigricans
2. seen in obesity and endocrine disorders
3. can mark underlying malignancy
what is acanthosis nigricans?
1. black velvety plaques on flexor surfaces and intertriginous areas
2. seen in obesity and endocrine disorders (DM)
3. can mark underlying malignancy (GI/GU, lymphoma)
what is the classic triad of bronze diabetes?
1. increased skin pigmentation
2. cirrhosis
3. DM
seen in primary hemochromatosis
what is primary hemochromatosis?
1. familial defect causing intestinal hyperabsorption of iron
2. the likely dx in any pt with osteoarthritis involving the metacarpophalangeal joints
what is the liekly dx in any pt with osteoarthritis involving the metacarpophalangeal joints?
1. hemochromatosis!!
2. dx= transferrin saturation (iron/total iron binding capacity)> 50%
what is seen in primary hemochromatosis?
1. bronze diabetes
2. familial defect causing intestinal hyperabsorption of iron
3. classic triad= increased skin pigmentation, cirrhosis, DM
4. cardiomyopathy, pituitary failure, arthropathies
5. pts with osteoarthritis involving the metacarpophalangeal joints
6. transferrin saturation >50%
what is dx and tx for primary hemochromatosis?
1. dx=transferrin saturation (iron/total iron binding capacity) >50%
2. phlebotomy, improves survival if started early
what are verrucae?
1. warts
what are verruca vulgaris?
1. hand warts
what are verruca plana?
1. flat warts
2. smaller than vulgaris (hand warts)
3. seen on hands and face
what HPV types cause skin and plantar warts?
1. HPV types 1-4
what HPV types cause anorectal and genital warts (condyloma acuminatum)?
1. HPV 6 & 11
what do HPV 6 and 11 cause?
1. anorectal and
2. genital warts (condyloma acuminatum)
what HPV types cause cervical cancer?
16, 18, 31, 33, 35
what are condylomata lata (flat warts) caused by?
1. Treponema pallidum (syphillis)
what flat warts are caused by Treponema pallidum (syphillis)?
1. condylomata lata
what is the m/c skin CA?
1. basal cell carcinoma
2. classic "rodent ulcer" on face
3. pearly translucent borders
4. fine telangiectasias
5. not usually on the lips
6. almost never metastasizes
what is characterized by:
1. rodent ulcer on face
2. pearly translucent borders
3. fine telangiectasias
basal cell CA
tx= excision
px= excellent
what are si/sx of basal cell CA?
1. m/c skin ca
2. rodent ulcer on face
3. pearly translucent borders
4. fine telangiectasias
5. not usually found on lips
what appears as erythematous nodules on sun-exposed area that eventually ulcerate and crust and is frequently preceded by actinic keratosis?
squamous cell CA
what are si/sx of squamous cell CA?
1. common in elderly
2. appears as erythematous nodules on sun-exposed areas that eventually ulcerate and crust
3. frequently preceded by actinic keratosis (rough epidermal lesions on sun-exposed areas such as lower lip, ears and nose)
4. tx= excision, radiation
5. px= metastasize more than basal cell but not as much as melanoma
what is squamous cell CA frequently preceded by?
1. actinic keratosis
2. rough epidermal lesions on sun-exposed areas such as lower lip, ears and nose
what is seen in lightly pigmented individuals c/ increased sun exposure?
1. malignant melanoma
2. diagnose with ABCDEs
3. #1 skin ca killer
4. risk of mets increased with depth of invasion on bx
what is the #1 skin CA killer?
1. malignant melanoma
2. risk of mets is increased c/ depth of invasion on bx
what are the ABCDEs of malignant melanoma?
A=asymmetry=malignant, symmetry=benign
B=border=irregular, benign=smooth
C=color=multicolored, benign=1 color
D=diameter >6mm, benign =<6mm
E=elevation=raised above skin, benign=flat
E=enlargement=growing, benign=not growing
what is the frequency of metastasis c/ basal CA, squamous CA and malignant melanoma?
highest rate of metastasis to lowest:
1. malignant melanoma
2. squamous cell
3. basal cell
what is the connective tissue CA caused by HHV-8 and appears as red purple plaques or nodules on skin and mucosa and fequently affects lungs and GI viscer?
Kaposi's sarcoma
what is Kaposi's sarcoma characterized by?
1. connective tissue CA
2. caused by HHV-8
3. appears as red purple plaques or nodules on skin and mucosa
4. frequently affects lungs and GI viscera
5. almost exclusively seen in AIDS pts
what is px of Kaposi's sarcoma?
px= benign unless damages internal organs (GI viscera and lungs)
dx= HIV drugs, chemo
what is a connective tissue CA that appears as red purple plaques or nodules on skin and mucosa and frequently affects lungs and GI viscera?
kaposi's sarcoma (connective tissue CA caused by HHV 8)
what is mycosis fungoides?
1. a cutaneous T-cell lymphoma
2. presents with erythroderma (total body erythematous and pruritic rash)
3. rash can precede malignancy by years
4. leukemic phase of dz called "Sezary syndrome"
what presents with erythroderma (total body erythematous and pruritic rash) and the rash can precede this malignancy by years?
1. cutaneous T-cell lymphoma
2. life expectancy 7-10 yr s/ tx
what is tx for cutaneous T-cell lymphoma?
1. PUVA= Psoralens + UV A light
2. topical chemo
3. radiation
what is the leukemic phase of cutaneous T-cell lymphoma called?
Sezary syndrome (circulating atypical cells=Sezary cells)
what are the essentials of diagnosis for cutaneous t-cell lymphoma?
1. aka Mycosis Fungoides
2. localized or generalized erythematous scaling plaques
3. pruitius
4. lymphadenopathy
5. distincitve histology (Sezary cells)
6. begins on the skin and may involve only the skin for yrs or decades
what is pemphigus vulgaris?
1. rare autoimmune disorder
2. affects 20-40 yr olds
3. presents c/ flaccid epidermal bullae that easily slough off leaving large denuded arease of skin (Nikolsky's sign)
4. skin bx--immunofluorescence surrounding epidermal cells showing "tombstone" fluorescent pattern
what is Nikolsky's sign?
1. seen in pemphigus vulgaris
2. flaccid epidermal bullae that easily slough off leaving large denuded areas of skin
3. increased risk of secondary infxn
what does the skin bx of pemphigus vulgaris show?
1. immunofluorescence surrounding epidermal cells
2. showing "tombstone" fluorescent pattern
3. shows a "fish net or lace like" immunofluorsecence pattern
what is tx and px for pemphigus vulgaris?
1. tx= high dose oral steroids, abx for infxn
2. px= often fatal if not treated
what is a rare autoimmune disorder that affects 20-40 yr olds and presents with flaccid epidermal bullae that slough off leaving lg denuded areas of skin?
pemphigus vulgaris!!
(ddx= bullous pemphigoid)
which melanoma has the best px?
1. superficial spreading melanoma
2. tends to stay superficial and has the best px
what is a common autoimmune dz that affects mostly the elders and presents with hard, tense bullae that do not rupture easily and usually heal s/ scarring?
1. bullous pemphigoid
what is bullous pemphigoid?
1. common autoimmune dz
2. affects mostly the elderly
3. resembles pemphigus vulgaris, but is much less severe clinically
4. presents with hard, tense bullae that do not rupture easily and usually heal s/ scarring
5. dx= skin bx--immunoflorescence as a linear band along the basement MB c/ increased eosinophils in dermis
what is seen on skin bx with bullous pemphigoid?
1. immunofluorescence as a linear band along the basement MB
2. c/ increased eosinophils in dermis
what are si/sx of bullous pemphigoid?
1. hard tense bullae
2. do not rupture easily and ussually heal s/ scarring if uninfected
3. tx c/ oral steroids
4. px is much better than pemphigus vulgaris
what causes erythema multiforme?
1. hypersensitivity rxn to drugs, infxns or
2. systemic disorders such as malignancy or collagen vascular dz
what are si/sx of erythema multiforme?
1. diffuse, erythematous tartgetlike lesions in many shapes ("multiforme")
2. often accompanying a herpes eruption
3. look for classic target (iris) lesions
what is the sever form of erthema multiforme called?
1. Stevens-Johnson sx
2. severe febrile form (sometimes fatal)
3. hemorrhagic crusting also affects lips and oral mucosa
what is Stevens-Johnson sx?
1. the severe febrile form of erythema multiforme
2. sometimes fatal
3. hemorrhagic crusting also affects lips and oral mucosa
what is the dx and tx of erythema multiforme?
1. dx= clinical
2. hx of herpes infxn or drug exposure
3. tx= stop offending drug, prevent eruption of herpes c/ acyclovir
how do you prevent an eruption of herpes in erythema multiforme/Stevens-Johnson?
with acyclovir!
what is porphyria cutanea tarda?
1. AD defect in heme synthesis
2. 50% decrease in uroporphyrinogen decarboxylase activity in RBC and liver
3. presents c/ blisters on sun-exposed arease of face and hands
4. NO abd pain
5. wood's lamp of urine= fluroesces c/ orange pink color b/c of increased levels of uroporphyrins
what are si/sx of porhpyria cutanea tarda?
1. blisters on sun-exposed areas of face and hands
2. increased hair on temples and cheeks
3. NO abd pain (differentiates from other porphyrias)
4. wood's lamp of urine fluoresces orange pink from increased uroporphyrins
what is seen on Wood's lamp of urine in porphyria cutanea tarda?
urine fluoresces with distincitve orange-pink color b/c of increased levels of uroporphyrins
what derm condition is caused by an AD defect in hemem synthesis and the urine fluoresces orange-pink under Wood's lamp?
1. porphyria cutanea tarda
what presents with painless blistering and fragility of the skin of the dorsal surfaces of the hands; liver dz, facial hypertrichosis and hyperpigmentation are common?
1. porphyria cutanea tarda
2. also have elevated urine porphyrins!
what is tx of porphyria cutanea tarda?
1. sunscreen/clothing barriers
2. phlebotomy
3. chloroquine
4. No alcohol
what is px of pophyria cutanea tarda?
1. remitting/relapsing
2. exacerbations resulting from
viral hepatitis
hepatoma
alcohol abuse
estrogen
sunlight
what exacerbates porphyria cutanea tarda?
1. liver dz
2. hepatoma
3. viral hepatitis
4. alcohol abuse
5. estrogen
6. sunlight