Msk Part 1

Front 1

shadow ~~

Back 1

palpability

Front 2

evaluating skin lesions:

(8)

Back 2

1. raised, flat, or depressed?

2. fluid?

3. Size

4. Shape

5. Color

6. Texture

7. Configuration

8. Distribution

Front 3

small (<1 cm), flat =

Back 3

macules

Front 4

2 extra features of macules:

Back 4

1. process confined to epidermis

2. can scale or crust

Front 5

scales =

Back 5

keratinocytes holding on for dear life

Front 6

crust =

Back 6

dried liquid from lesion

Front 7

large (>1 cm), flat =

Back 7

patch

Front 8

large, raised, plateau-like =

Back 8

plaques

~~ epidermis or superficial dermis

Front 9

“Skin-colored” refers to:

Back 9

the same color as the pt's skin tone

Front 10

small, raised =

Back 10

papule

- also ~~ epidermis or superficial dermis

Front 11

a larger, deep papule is called a:

Back 11

nodule

~~ mid-dermis
=> *epidermis is nl* - overlies abnl process in mid-dermis

Front 12

small, raised, fluid-filled =

Back 12

vesicle

Front 13

large, raised, fluid-filled =

Back 13

bulla

Front 14

vesicle filled with pus =

Back 14

pustule

Front 15

superficial loss of the epidermis is called:

Back 15

erosion

- can weep => crust

Front 16

loss of epidermis AND dermis =

Back 16

ulcer

Front 17

erosions and ulcers are _____________ lesions

Back 17

secondary

- evolve from primary lesions or caused by scratching, inf, etc.

Front 18

Ulcers often heal with scarring; erosions:

Back 18

usually don't

Front 19

The efficacy of any topical medication is related to the:

(4)

Back 19

strength,

location,

vehicle,

and concentration

Front 20

Topical medications can be very ____________

Back 20

expensive

- NOT covered by insurance

Front 21

When writing a prescription for a topical medication, include:

(6)

Back 21

1. generic name,

2. vehicle,

3. concentration,

4. directions,

5. amount

6. # of refills

Front 22

corticosteroids are organized into classes based on:

Back 22

strength (potency)

Front 23

pot. local SE's of corticosteroid use:

(4)

Back 23

1. skin atrophy,

2. acne,

3. striae,

4. telangiectasias
(spider-web looking vessels due to dilation of caps)

Front 24

the higher the potency, the more likely:

Back 24

SE's are to occur

- use the least potent steroid for the shortest time while still being effective

Front 25

for one application of topical med to cover an entire adult body, it takes:

Back 25

30 grams

Front 26

when do you use benzoyl peroxide?

Back 26

with topical antibiotics,

to prevent the development of antibiotic R in acne tx

Front 27

m.c.c. of tx failure in acne pts =

Back 27

non-adherence

- it takes 2-3 mths for effect to show

Front 28

*topical* antifungals are preferred for:

Back 28

most *superficial* fungal inf's of limited extent

Front 29

antiH's are best for:

(2)

Back 29

1. pruritus

2. chronic urticaria

- 2nd-gen are less sedating than 1st-gen

Front 30

mech of many of the topical meds used in psoriasis:

Back 30

inhibit keratinocyte prolif.

Front 31

intertriginous =

Back 31

where two skin areas touch or rub together

- axilla, breasts, GU, nares

Front 32

when to use ointments:

(3)

Back 32

1. non-hairy

2. dry (so avoid in intertriginous)

3. hyperkeratotic

Front 33

hyperkeratosis appears as:

Back 33

thickening of skin or mucous membranes

Front 34

use cream in:

Back 34

intertriginous areas

Front 35

use lotion in:

Back 35

hairy areas

Front 36

use oils in:

Back 36

scalp

Front 37

mech. of topical steroids:

Back 37

produce anti-inflammatory response in the skin

Front 38

topical steroids used for lesions with:

(3)

Back 38

1. hyperproliferation

2. inflam

3. immunologic involvement

Front 39

strength (potency) of the corticosteroids is inherent to:

Back 39

the mlcl, NOT the concentration

- remember, based on class

Front 40

Super High potency = Class I =

Back 40

Clobetasol

Front 41

High potency = Class II =

Back 41

Fluocinonide

Front 42

medium potency = Class III-V =

Back 42

Triamcinolone acetonide

(ointment > cream > lotion)

- when several are listed, they are given in order of most strong

Front 43

low potency = Class VI, VII =

(3)

Back 43

1. Fluocinolone acetonide

2. Desonide

3. Hydrocortisone

Front 44

Super High/Class I are used for:

(4)

Back 44

1. scalp

2. palms

3. soles

4. thick plaques on extensor surfaces

Front 45

medium to high-potency (Class II-V) are used for:

(2)

Back 45

nonfacial and nonintertriginous areas

Front 46

low potency (Class VI, VII) are used for:

(4)

Back 46

1. face

2. eyelid

3. genital

4. intertriginous areas

Front 47

Super High potency tends to be used for:

Back 47

<3 weeks

- high-to-medium ~~ 6-8 weeks

Front 48

stop corticosteroid tx when:

Back 48

skin condition resolves

- to avoid rebound/flares: taper with gradual reduction of both potency and dosing frequency every 2 weeks

Front 49

1 pt. palm =

Back 49

1% BSA

Front 50

fingertip unit (FTU) =

Back 50

500 mg = 1/2 gram

- ***treats 2% BSA*** / covers 2 palms

Front 51

in other words, 2% of BSA / 2 palms is treated with:

Back 51

1 FTU / 500 mg's

Front 52

how many grams of topical steroid should you prescribe for 1 month?

Back 52

30 grams **for every 2 palms of area affected**

- 2 palms 2 times per day = 1 gram per day

Front 53

1 FTU covers:

Back 53

2% BSA

- always keep BID in mind

Front 54

to cover Face with topical steroids, you need:

Back 54

30-45 grams

Front 55

to cover extensor surfaces of both arms with topical steroids, you need:

Back 55

120-150 grams

Front 56

if lesion is widespread on trunk, legs, arms, it takes _____________ of topical med to cover it

Back 56

1-2 pounds

(454 grams = 1 lb.)

Front 57

the best way to assure you are giving the right amount is to:

Back 57

re-assess on follow-up

Front 58

Remember that children, esp. infants, have a high BSA-to-Volume ratio, which puts them at risk for:

Back 58

systemic absorption of topically-applied meds

Front 59

Potent steroids should be avoided in high risk areas such as:

(3)

Back 59

1. the face,

2. folds,

3. occluded areas (e.g. diaper)

Front 60

common SE of benzoyl peroxide =

Back 60

bleaching of hair

Front 61

never use _______________________ as monotherapy

Back 61

topical antib's

Front 62

Topical retinoids = Vit. A derivatives; used for:

(4)

Back 62

1. acne

2. photodamaged skin

3. fine wrinkles

4. hyperpigmentation

Front 63

oral tx of mod-to-severe inflam. acne:

Back 63

Tetracyclines

- contra in prg and <8 yo

SE's = GI upset

Front 64

Calcitriol =

Back 64

Vit. D analog that inhibits keratinocyte prolif.

- used to treat psoriasis

Front 65

never use ____________ and _____________________ together

Back 65

topical retinoids and benzoyl peroxide

- alternate them (days)

Front 66

isotretinoin is used for:

Back 66

severe acne failing other therapies

- absolutely contra in preg.

Front 67

hair and nail inf's do NOT respond to:

Back 67

topical antifungals

Front 68

skin has an immunologic function:

Back 68

contains resident T-cells that respond to pathogens

Front 69

melanin =

Back 69

dark pigment in the epidermis that protects cells against UV radx

- dysfunction of melanin production causes the pt to be more susceptible to skin cancer

Front 70

no matter what your skin color, the ratio of melanocytes to keratinocytes =

Back 70

1:10, always

Front 71

desquamation =

Back 71

shedding of skin

Front 72

radx on skin can cause:

Back 72

loss of repair ability

=> poor wound healing

Front 73

epidermis:

(2)

Back 73

1. consists primarily of keratinocytes

2. 4 layers

Front 74

4 layers of epidermis and fun fact for each:

Back 74

1. stratum basale
(stem cells)

2. spinosum
(visible desmosomes)

3. granulosum
(tiny purple strip; filaggrin)

4. corneum
(a-nucleated)

Front 75

3 features of stratum basale:

Back 75

1. source of epidermal stem cells

2. cell division occurs here

3. keratinocytes start here are take 2 weeks to reach corneum

Front 76

Basal Cell Carcinoma:

(4)

Back 76

1. m.c. form of skin cancer

2. histo: cells resemble keratinocytes

3. erythematous papules or plaques

4. ~~sun-exposed layers

Front 77

spinosum's spiny appearance is due to:

Back 77

desmosomal junctions holding keratinocytes together

Front 78

function of granulosum layer:

Back 78

water barrier that keeps water in skin

(via filaggrin prot.)

Front 79

2 features of corneum:

Back 79

1. desquamating keratinocytes

2. **thick, A-nucleated cells** = barrier to trauma, inf.

Front 80

think of the corneum as bricks and mortar:

Back 80

1. bricks = flattened keratinocytes filled with keratin and filaggrin

2. mortar = lipid mixture, which surrounds the keratinocytes and provides the water barrier

Front 81

Filaggrin =

Back 81

prot. of granulosum

- filaggrin retains water within keratinocytes

Front 82

mut's in filaggrin cause:

Back 82

atopic dermatitis

Front 83

Bullous pemphigoid =

Back 83

AI blistering dz w/ autoAB's to antigens on hemidesmosomes that anchor basal layer to dermis

=> loss of adhesion

=> epidermis = roof, dermis = base of bullae

Front 84

3 main cells of epidermis:

Back 84

1. Keratinocytes

2. Melanocytes
(~ basal layer)

3. Langerhans cells
(DC's of skin)
~ contact dermatitis

Front 85

moles = nevi = benign collections of:

Back 85

melanocytes

Front 86

dermis consists primarily of:
(3)

and contains:
(4)

Back 86

fibroblasts, collagen, and elastic fibers;

contains:

1. VAN

2. sweat glands

3. mast cells
(fried egg)

4. hair follicles with associated sebaceous glands

Front 87

2 layers of dermis:

Back 87

1. papillary

2. reticular
(much bigger)

Front 88

fibroblasts are responsible for:

Back 88

the synthesis and degradation of CT prot's

- they are instrumental in wound healing and scarring

Front 89

mast cells ~~

Back 89

immediate-type hypersensitivity rxns in the skin

- major effector cell in urticaria

Front 90

subcutis =

Back 90

fat layer which separates the dermis from deeper underlying structures such as fascia and muscles

- hair follicles begin here

Front 91

panniculitis =

Back 91

inflammation of the subcutis

- e.g. erythema nodosum - deep erythematous nodules

Front 92

Pilosebaceous unit consists of:

(4)

Back 92

1. a hair follicle

2. sebaceous (oil) glands

3. apocrine sweat glands
(axilla, anoGU area)

4. an arrector pili muscle

Front 93

acne is caused by:

(4)

Back 93

1. excess androgens

2. plugging of the hair follicle as a result of abnl keratinization of the upper portion (gives rise to comedones)

3. sebaceous gland activity
(increased in presence of androgens) P. acnes in the hair follicle

4. P. acnes in the hair follicle
(lives on the oil and breaks it down to free fatty acids which cause inflam.)

Front 94

In contrast to apocrine glands, eccrine sweat glands:

Back 94

do NOT involve the hair follicle

- they open directly onto the skin surface and are present throughout the body.