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118 Cards in this Set

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  • Back
How many layers are there i nthe epidermis?
4
straum corneum (or 5 in palms and soles)
stratum lucidum (only in palms and soles)
stratum granulosum stratum spinosum
stratum germinativum
What are the tissue layers of the skin
the epidermis, dermis and subctaneous layers.
What is a macule?
A macule is a primary skin lesion that circumscribed alteration in the color of the skin, not visbly raised or depressed, or presentinga ny change in the consistency of the skin; examples are freckles or tatto marks.
What is a patch?
A patch is a primary skin lesion taht is a larger macule It is greater than 1 cm in diameter
What is a papule?
A papule is a primary lesion. It is a small elevatiion above the skin level varying in size from 1 mm to 1 cm in diameter. An example would be s small elevated nevus or wart.
What is a plaque?
A plaque is a primary lesion that elevated above the skin level and is greater than 1 cm in diameter. An example could be a > 1 cm corn or wart.
What is a nodule?
A nodule is a primary lesion that is solid and larger than 1 cm in diameter consisting of inflammatory cellular infiltrates or neoplasm.
What is a wheal?
A wheal is a primary lesion which is a plateau-like elevation prouced by edma i the upporium and leaking of blood plasma throug the vessels walls. Mosquito bites start as wheals.
What is a vesicle?
A vesicle is a primary lesion that is circumscribed elevation of the skin measuring less than 5 mm in diameter and is fluid filled. An example would be a lsesion of herpes simplex or acute tinea pedis.
What is a bulla?
A bulla is a primary lesion that is larger than 5mm and produced by factors such as chemicals, heat and frictoin (friction blister), as well as primary skin conditions such as bullous pemphigoid. Some require that blisters be <or= 1 cm before using the term bullae
What is a pustule?
A pustule is a primary skin lesion that is a circumscribed liquid accumulation of free pus as seen in acne or impetigo.
What is a skin tumor?
A tumor is a primary lesion of new growth, varying size and composed of skin and subcutaneous tissue. It can be either benign or malignant.
what are secondary lesions?
Secondary lesions evolve over time from pirmary lesions usually because of scrtching or infection
What is a scale?
A scale is a secondary skin lesion. It is exfliation of accumulated debris of dead strtum corneum and results in imperfect cornification; examples are scale of psoriasis, tinea, and dandruff
What is a crust?
A crust is a secondar skin lesion. It is a coagulation productof blood, serum, pus ora combinaition of two or more of these. eXamples are scabs of impetigo.
What is a crust?
A crust is a secondary skin lesion. It is a coagulation product of blood, serum, pus or a combination of two or more of these. Examples are scabs of impetigo.
What is an excoriation?
An excoration is secondary lesion that represents a superficial loss of epidermis as a result of scrtaching or rubbing
What is a fissure?
A fissure is a secondary change in the skin that presetns as a linear superficial crack in the epidermis. Often seen withn hyperkeratotic heel rims.
What is an erosion?
An erosion is a secondaryh lesion. It is a shallow scooped out superficial loss of all or part of the epidermis. Often seen in interdigital tinea pedis
What is a pustule
A pustule is a primary skin lesion that is a circumscribed liquid accumulation of free pus as seen in acne or ipmetogio
What is a skin tumor
A tumor is aprimary lesion of new growthk, varying size and composed of skin and subcutaneous tissue. It can be either benign or malgnant
What are secondary lesions?
Secondary lesions evolve over time form primary lesions usuallly because of scratching or infection
What is a scale
A scale is a secondary skin lesion. It is exfolaition fo accuumualte debris of ded stratum corneum and results form iperfect cornification; examples are scle so psoriases, tiena and dandruff
What is scrust?
A crust is a secondary skin lesion. It s as coagulation product of plood, seru, pus or a combination fo two ro more osf these. exampels are scbs of impetigo.
What is an excoriation?
An excoration is a secondary lesion that represents a superfical lsos fo epidermis as a result of scratching or rubbing
What is a fissure?
A fissure si a secondary change in the skin that presents as a linerar superfical crack in the epidermsi. Ofent seen within hyperkeratortic heel rims.
What is an erosion?
An erosion is a secondary lesion. It is a shallow scooped out superfical loss of all or part of the epeidermis. Oftne seen in interdigital tinea pedis.
What is an ulcer?
An ulcer is a secondary skin lesion. It is damged sking of varying depth. A result of a destructive process of thepidermsi. that may extend deep tot he dermis, sucutis or eve bone.
How are stage one (national pressur ulcer classification) pressure ulcr be staged and treated?
Stage one pressure ulcers apppear as non=blanchable erythema of intact skin, the heralding lesion fo skin ulcerations. Often seen over a bony promennencer form prolonged pressor ro shoe irritation. Discoloration fo the skin, warmth, edma, induration, hyperkeratosis or hardnes smay also be indicators. Paring of hyper keratois and//or pressure relief are appropriate managemtn measues.
how are stage two (NPU classification) pressure ulcer be sated and treated?
Stage tow pressure ulcers have partial thickness skin loss involving epdermis, dermis or both, the ulcer is superfical nad presents clinically as an abrasion, blister, or shallwo crated. Pressure relief, topical antibiotic and simple dressing are indicated
How are stage four pressure ulce be stage dand treated?
Stage three pressure ulcers represent full thickness skin loss involving damage ot or necrosis of hte subctaneoud tissue that may extend own to but not through the underlying fascia. THe ulcer presents cilincially as a dep crater withn or withnout undreming of adjacent tissue. Vascualr workup, system ic antibiosis, pressure releif and wound care shoud be sonsidered.
How ar stage four pressure ulcers staged and treated?
Stage four pressure ulcers represnt full thickness skin loss with extensive destruciton, tissue necrosis, or damge to muslce bone tendon joint capsule. undermining and sinus tracts also may be assocated with stage four pressure uslcers. Hospitalization for vascular workup, operative surgical depridement, systemic antibiosis and wound care should be considered
How is a keloid defined
keloid is a scar tissue that extends beyond hte area of original trauma
what is lichenification?
lichenification is thenicneng of hte sking with exaggerationg of hte normal skinlines. Hyperpigmentation scaling and pruritius oftne accompany. Favors anterior anklse and suggest repetive rubbing or scratching
t are telangiectasias?
Telangectasia are visible dilated superfical blood vessels seen in connection with ceartain heritable disease, e.g. familial elangiectaseia; associated iwth liver diseases and pregnancy and a sa sequel to x-ray treatment. often seen about the ankles i the elderly..
How is a KOH examination performed
Scrape epidermal flakes ot glass slide, apply 20% KOH, warm or use dimehty sulfoxid sovent (DMSO) wait tien minutes examine under low power and reduced light
What is the diagnostic finding on a KOH examination in chronic tinea pedis?
segmented branchign hyphae
What are Koen's tumors
multiple firm periungual fibromas associatede with tuberosu slcerosis
Describe the clinical finding in eprmolysi bullsa simplex
EB presents a s spontaneous blister so fe finger stoes knees or elbows form minor tarum beginnign at borith or early childhood. the blisters hneal wihout scarrign. The diseas is due to defect inkeratins 5 and 14 and is an austosoma dominant train.
What is papulosquamous skin disorder
any of anumber erythematous or purple palule and plques topped wiht scales
t are telangiectasias?
Telangectasia are visible dilated superfical blood vessels seen in connection with ceartain heritable disease, e.g. familial elangiectaseia; associated iwth liver diseases and pregnancy and a sa sequel to x-ray treatment. often seen about the ankles i the elderly..
Which papulosquamous diseas can be seen on the foot or ankle?
psoriass, lichen planus, lichen nitidus, pityriasis rubra pilaris
How is a KOH examination performed
Scrape epidermal flakes ot glass slide, apply 20% KOH, warm or use dimehty sulfoxid sovent (DMSO) wait tien minutes examine under low power and reduced light
Describe th echaracteristic rash of pityriassi rosea
pind to erythmeatoud maculo-paplular rahs of hte chest nad or back following a viral infiection. Spares the soles. starting with a sinngle 204 cm hsarpy defined thin oval plaques with a charateristic collarette of scale then with a few dys to weeks, crops of similar but smaller lesions follow and resolve spontaneously.
What is the diagnostic finding on a KOH examination in chronic tinea pedis?
segmented branchign hyphae
what is pmpholys
pomphlyx is anepsidc veculobllous ecsema of the plam and sole sespeciallyedges of eh fingers. multipel deep seated pruritiic nits and evolving vesicles
What are Koen's tumors
multiple firm periungual fibromas associatede with tuberosu slcerosis
What is and ind reactinnon and how is tit managed
immune mediated symjpathetic response to acute tinear. Sterile eruption sdistant from the acute site i.e. fingers palms chest or back. treat the primary tinea and ht eidreaction will resolve with it.
Describe the clinical finding in eprmolysi bullsa simplex
EB presents a s spontaneous blister so fe finger stoes knees or elbows form minor tarum beginnign at borith or early childhood. the blisters hneal wihout scarrign. The diseas is due to defect inkeratins 5 and 14 and is an austosoma dominant train.
What is papulosquamous skin disorder
any of anumber erythematous or purple palule and plques topped wiht scales
Which papulosquamous diseas can be seen on the foot or ankle?
psoriass, lichen planus, lichen nitidus, pityriasis rubra pilaris
Describe th echaracteristic rash of pityriassi rosea
pind to erythmeatoud maculo-paplular rahs of hte chest nad or back following a viral infiection. Spares the soles. starting with a sinngle 204 cm hsarpy defined thin oval plaques with a charateristic collarette of scale then with a few dys to weeks, crops of similar but smaller lesions follow and resolve spontaneously.
what is pmpholys
pomphlyx is anepsidc veculobllous ecsema of the plam and sole sespeciallyedges of eh fingers. multipel deep seated pruritiic nits and evolving vesicles
What is and id reactinnon and how is tit managed
immune mediated symjpathetic response to acute tinear. Sterile eruption sdistant from the acute site i.e. fingers palms chest or back. treat the primary tinea and ht eidreaction will resolve with it.
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Explain the pathogneesis of allergic contact dermatitiis
allergic contact dermatitis is a delayed cell mediated hypersesitivity . first a hapten contaccts skin adn formas a protein complex. Langerhans skin cell presents the coplet antigien to the t-helper cell casueign mediator release. senstization takes 5-21 days. Upon re-exposure three is proleiferation of activated t Cells, mediatoer relase and migration fo cytotoxic t cells resulting in cutaneous eczematous ijmflammation oa the site of contact. this take 4-72 hours after re-exposure. small exposure cna trigger erutions in sensitiae perosn
name two types of contact dermatitis
priamry irritant and allergic contact dermatitis
how is patch testing done
patch testing is necessary to distinguish between irritant contact deramtitis and allergic dermatitis. a small amount of allergen in a petrolatum base is applied in indvidual aluminum wells affixed to a strip of paper tape applied ot he patients upper back for 48 hrs and read for erythema edema and vsecualtion and thena gaint at 72 and 96 hours for delayed reaction indicatve of allergic reaction
how is contact dermatitis mangae
identify and remove allergen. prtection measures. cool compresses and topical steroids
how are ht e bullous disease classified/defiend?
Bullous diseases are classified by the depth fo involvement, either within gthe epidermis or below hte epidermis
what are several intra-epidermal bullous diseases?
allergic contact dermatitis, epdermal bullosa simplex, bullous diabeticorum, herpes simplex and zostaer are all exxamples of inter-epidermal bullous diseases
What are several sub-epdiermal bullous diseases
bullous pemphigoid, dystrophic epidermal bullosa and prohyria cutanea tarda are a few examblses
what special tests may ben cessary to diagnose blistering disases of the skin?
cutlures fo rbacteria, smears for viruses, biopsy with direct immunofluescencea are all helpful
what are some durgs that can cause vesiculobullosu erutiopns?
teracycline, sulfonamides, vancomycin, lithium, thiazides, furosemide, and naproxen
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Explain the pathogneesis of allergic contact dermatitiis
allergic contact dermatitis is a delayed cell mediated hypersesitivity . first a hapten contaccts skin adn formas a protein complex. Langerhans skin cell presents the coplet antigien to the t-helper cell casueign mediator release. senstization takes 5-21 days. Upon re-exposure three is proleiferation of activated t Cells, mediatoer relase and migration fo cytotoxic t cells resulting in cutaneous eczematous ijmflammation oa the site of contact. this take 4-72 hours after re-exposure. small exposure cna trigger erutions in sensitiae perosn
name two types of contact dermatitis
priamry irritant and allergic contact dermatitis
how is patch testing done
patch testing is necessary to distinguish between irritant contact deramtitis and allergic dermatitis. a small amount of allergen in a petrolatum base is applied in indvidual aluminum wells affixed to a strip of paper tape applied ot he patients upper back for 48 hrs and read for erythema edema and vsecualtion and thena gaint at 72 and 96 hours for delayed reaction indicatve of allergic reaction
how is contact dermatitis mangae
identify and remove allergen. prtection measures. cool compresses and topical steroids
how are ht e bullous disease classified/defiend?
Bullous diseases are classified by the depth fo involvement, either within gthe epidermis or below hte epidermis
what are several intra-epidermal bullous diseases?
allergic contact dermatitis, epdermal bullosa simplex, bullous diabeticorum, herpes simplex and zostaer are all exxamples of inter-epidermal bullous diseases
What are several sub-epdiermal bullous diseases
bullous pemphigoid, dystrophic epidermal bullosa and prohyria cutanea tarda are a few examblses
what special tests may ben cessary to diagnose blistering disases of the skin?
cutlures fo rbacteria, smears for viruses, biopsy with direct immunofluescencea are all helpful
what are some durgs that can cause vesiculobullosu erutiopns?
teracycline, sulfonamides, vancomycin, lithium, thiazides, furosemide, and naproxen
What are the more common pustular skin eruptiosn
folliculitis, ipetigoe and acne
what do the lesions of pusltualr psoriasis contain?
only leukocytes,n bacteria
Describe the characteristic primary lesion fo lichen planus.
pruritic purple and pink papules and plaques on the flexor wrists, pterygium nail dystrophy may occur
What are the characteristic oral findings in lichen planus?
Wichamm's strieae, a white netlike or reticulated, patterend discoloration o the buccal mucosa
Describe the isomorphic response i nlichen planus?
THe development of new lesion in response ot external trauma or scratching.
What is lichen simplex chronicus?
a pepetuating itch scratch cycle creating chronic often lichenified plaque.
How is lichen simplex chrnocus treated?
stop scratching and frictional trauma. Often responds to occlusive topical steroid therapy.
How does granuloma nanulare ususally present clinically?
typically presents with violaceous or flesh-colorred dermal papules arranged in an annular configuration affecting dorsum of hands nad feet.
What is the ususal clinical course of granuloma annulare
classic granulma annulare sponateous resolves but cna recur
How do adverse drug reactions differ from true drug allergies?
true drug allergies are immune mediated.
What are some typical cutaneous ractions to drugs?
pruritius, erythema, macujlar to papular erutpitons, urticaria, angiodedema, erytheam multiforme and exfoliative dermatiitis
Which drugs commonly cause photo eruptions?
sulfonamides, thiazides, oral hypolgycemias, NSAIDss, and griseofulvin
What is vasculitis
inflammation of blood vessels
What is leukocytoclastic vasculitis
purpuric papules most often onthe extremities assciated with many immune mediated disease, infections, drugs or malgnancy. Alse know as paplable purpura or necrotizzing vasculitis
List several key features of henoch-schonlenin purpura (HSP)
intemeittient purpura of the exttremities and buttocks usually affecting children. abdominal pain, arhtaralgia and hematura may accompany the purura
List three disease that a wood's lamp can be used as an ide in diagnosis?
erythrasma, tinea capitis, tiena versicolor.
tinea pedis does not glow
what is the primary lesion of viitligo?
hypopigmented patches and macules
list the clinical features of tuberous slcerosis?
multiple seabceosu adenoma, mental reatardation and koen's tumors
What cutaneous lesions are seen with hansen's disease
cutaneous numbnees, neutorphic ulscers, eythema nodosum , and erythematous macules and eyebrow loss.
what is erythema nodosum?
inflammatory nodules and infiltrates i in the subctaneous layers of hte lower extemities associated with a streptococcus infection, sarcoidossi or drgs especially oral contraceptives
What causes acne
heredity, androgens, abnormal keratinization and prionibacterium acnes all play a roll in acne.
What is hidradenitis suppurativea
this is a chronic recurrent axiallary or groin deep skin infectiosn fo the apocrine glands. abscesses and sinus tracts ofent develop
what is rosacea
Rosacea presents with telangiectasia, sebaceous gland hyperplasia and acne of he forehead cheeks nose and chin in the elderly. Mite infestation might play a role
What are the key skin features of lupus erythematosus?
Malar erythematous facial rash and psoriaform erutptions in a photo exposed skin pattern.
What are the key skin features of scleroderma?
scleroderma presents with morphea (firm sclerotic indurated plaques). The lesions are often multiple smooth topped with a white center and puple border
Whic viruses cause acral-located lesions of the hands and or feet?
human papilloma virus, herpes simplex, herpes zoster and Coxsackie virus cna be found on the han ds or feet.
What is porokeratosis plantris discreta
PPD is a small plantar focal hyperketaosis with a central horny plug that is probably a pressure induced keratosis. Some beleive it si a plugge deccrine duct or cyst.
What is the appropriate surgical anatomical inferor boudnary when curetting plantar warts?
The dense superficial fascia of hte sole is hte boundary, not hte basement membrane hsitological feture
Whic ornaism ususallly cause chnric tinea pedis
usually tricophyton rubrum cause the dry form of tinear pedis
Whic organism usually causes vesicualr tiena pids?
usually tricophyton mentagrophytes casues the blistering form of teia pedis
How can chornic tiena pedis that has been resistant to topical therapies be treated?
Oral terbinafine 250 mg qd for two weeks or itraconcale 400 mg qd for one week can be tried
Whic clincial type sof onychomycosis are associated with AIDS
Both whie supeficial and proximal subungual onychomycosis have abeen associated with AIDS
Which fungal oragnism causes more than 90% of onychomycosis
trichophyton rubrum.
What are the most effective FDA approved oral treatment regimes for pedal onychomycosis?
itraconazole 200mg qd for three monts and terbinafine 250 mg qd for three months
What cause juvenile plantar dermatosis or "We foot dry foot" syndrome?
hyperhidrosis that dries out too quickly when occlusive footgear is remvoed in dry air.
What is effective prevention for juvenile plantar dermatoss or "wet fooot dry foot" syndrome?
prompt application of emollients liek A&D ointment or vaseline each time shoes are removed
A pigmented lesion's width is suspicious when its diameter reaches wht dimension?
melanoma should be suspected when a pigmented lesions grows larger than 6 mm or the diameter of a pencil eraser.
Which different anatomical surfaces are affected by psoriasis and lichen planus?
generally psorisasis affects extensor surfaces and lichen planus affects flexor surfaces and mucous membranes
What is the chief dignostic histological featrue seen in plantar verucae
basilar intracellular inclusion bodies.
What is the chief dignostic histological featrue seen in porokeratosis plantaris discreta?
hyperkeratosis and coronoid lamellae formation
What histological feature distignusihes pressusure induced hyperkeratossis form inheritied hyeprkeratosis (keratoderma)
the steturm granulosum cell lyaer is maintianed in inheriteid keratodermas while it is lost in the centeral highest pressure areas of peressure kertoses
What are the kdery feature sof treating plantar psoriasis
tars, terinoin, pulsed high poetncy topical corticosteroids under oclusion couldped with calcipotriene (Doveonex) have all shown usefulness in plantar psoriasis
What cause pitted keratolysis
hyperhidrosis iwht overgowth of micrococcus sedentarius cause the superficial erosive horny pits.
How does one manage pedal scabies
topical permethrin (elimite), sulphur or chlordane (lindane) applied ear to toes have all been used to clear pedal scabies