Skin System Sammons Ish On The Exam

Front 1

Sammons Questions:

Acne Inflammatory Lesion

Back 1

Papules, pustules, nodules (cysts)

Front 2

Sammons Questions:

Acne non-inflammatory Lesion

Back 2

open & closed comedones

Front 3

Sammons Questions:

Anti-androgen Drug

Back 3

too much androgens may cause acne in womens.

spironolactone-act at the peripheral level (hair follicle, sebaceous gland)
-only used in women
-androgen receptor blocker
-reduces sebum production by 75%
-don't use during pregnancy!

Front 4

Sammons Questions:

Benzoyl Peroxide

Back 4

Antibacterial – effectively reduced P. acnes counts

Front 5

Sammons Questions:

Acne is a disease of the...

Back 5

..pilosebaceous unit

Front 6

Sammons Questions:

Acne Etiology

Back 6

Sebaceous glands
-Sebum
-Enlarge & more active in puberty
Follicular plugging
Cornified cells adhere to the follicular wall and form a plug (open & closed comedone)

Front 7

Sammons Questions:

Topical Retinoids

Back 7

-Reverse the abnormal pattern of keratinization – reduce follicular plugging

-Works at the level of the microcomodone (precursor of all acne)

-All forms of acne

Front 8

Sammons Questions:

Drugs that may reduce effectiveness of oral contraceptives

Back 8

antibiotics
-(Most recent data suggests only rifampin)

Front 9

Sammons Questions:

Adult Acne

Back 9

Acne Rosacea
-NO comedones!
-Erythema, telangiectasias, papules, pustules
-Rhinophyma (big nose)

Front 10

Sammons Questions:

Psoriasis

Back 10

Common, non-curable, familial, treat with anti-inflamms

Front 11

Sammons Questions:

Actinic Keratosis

Back 11

Common

Sun exposed areas

Erythematous rough scaled papules/plaques

Pre-cancerous

Front 12

Sammons Questions:

Basal Cell Carcinoma

Back 12

Most common type of skin cancer

Directly related to sun exposure early in life

Tend to be a pearly ulcerated papule with rolled borders

Front 13

Sammons Questions:

Squamous Cell Carcinoma

Back 13

Second most common type of skin cancer

Has the potential to metastasize

If found early and appropriately removed, cure rate is as high as 95%

Front 14

Sammons Questions:

A big macule is a...

Back 14

PATCH. Greater than 1cm

A circumscribed, flat discoloration that may be brown, blue, red, or hypopigmented

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Sammons Questions:

A big papule is a...

Back 15

PLAQUE. Greater than 1 sontimeter.

An elevated SOLID lesion with no visible fluid

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Sammons Questions:

Nodule

Back 16

circumscribed, elevated, solid leasion. this time they're ball-like.

Front 17

Sammons Questions:

A big vesicle is a...

Back 17

BULLA!

Circumscribed epidermal elevation that contains free fluid (serous or seropurulent fluid)

Front 18

Sammons Questions:

Wheals

Back 18

Evanescent, edematous, plateau-like elevations of various sizes

Tend to be oval or arcuate and surrounded by a “flare” of macular erythema

Develop quickly and tend to be transient, usually lasting only a few hours

Front 19

Sammons Questions:

Pustules

Back 19

Circumscribed collection of necrotic inflammatory cells and free fluid

Tend to have an inflammatory areola

May develop from papules or vesicles

Vary in size

Front 20

Sammons Questions:

3 Types of Skin Cleansers

Back 20

Soaps- pH 9 to 10. Increase skin surface pH, disrupting stratum corneum.
-good for real dirty skin

Combars- more thorough cleaning than syndets. alkaline.
- good for normal skin with dirt

Syndets- beauty cleansers. pH 5.4, skin's natural pH.
- least damaging to cutaneous barrier.

Front 21

Sammons Qs:

Moisturizers put water back into the skin

Back 21

WRONG. LiAR. they dont put water back into the skin externaly, nor do they get incorporated into the intracellular lipids. they just retard the transepidermal water loss and create an optimal environment for the restoration of the stratum corneum.

Front 22

Sammons Qs:

Humectants do this

Back 22

Substances that attract moisture

Humectants can only hydrate the skin from the environment when the ambient humidity exceeds 70%

Improve skin texture by inducing keratinocyte swelling and minimizing voids between desquamating keratinocytes

Front 23

Sammons Qs:

Occlusive moisturizers

Back 23

Prevent evaporation of water by placing an oily substance on the skin surface through which water cannot penetrate

petrolatum is the most effective--> 99% water loss prevention, yo!

Front 24

Sammons Qs:

rank moisturizer effectiveness...

Back 24

lotions→creams→ ointments

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Sammons Qs:

SPF

Back 25

is a measure of UVB protection.

ratio of the duration of UV radiation exposure necessary to produce minimum erythema dose in sunscreen protected skin compared to the time for unprotected skin.

Front 26

Sammons Qs:

sunscreens are good for..

Back 26

UVB but bad for UVA coverage

Front 27

Sammons Qs:

UVA vs UVB vs UVC

Back 27

UVA- less substantially blocked by the atmosphere, not blocked by glass. 100x greater radiation than UVB

UVB- substantially blocked by ozone, blocked by glass. more erythemogenic than UVA.

UVC- blocked by water and ozone

Front 28

Sammons Qs:

Corticosteriod Potency. 1 vs 7

Back 28

Group 1 is the most potent.
Group 7 is the least potent; OTC.

Front 29

Sammons Qs:

Topical Anti-fungals:
Cidal vs Static

Back 29

Cidal” – those that kill the fungal elements

“Static” – those that supress the fungal elements

Front 30

Sammons Qs:

Most common vascular lesion

Back 30

Cherry angiomas

Common on the trunk

Appear with increasing age
Can be treated with electrical cautery or Pulse dye laser

Front 31

Sammons Qs:

cafe au lait spots can be associated with...

Back 31

neurofibromatosis – 6 or more café au lait spots are one criteria

but normally no tx needed. just cosmetic concern, yo.

Front 32

Sammons Qs:

Seborrheic Keratosis

Back 32

One of the most common benign skin neoplasms

Waxy brown “stuck on” plaques

No malignant transformation

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Sammons Qs:

Skin Tags

Back 33

because of friction. can bleed if cut off.

Front 34

Sammons Qs:

Dermatofibroma

Back 34

very firm, common, found usually on the legs. fibrous reaction to trauma, insect bite, or an infection. DIMPLE SIGN (compress with attempts to elevate them)

Front 35

Sammons Qs:

Prurigo Nodularis

Back 35

patients do this to themselves. itching nodules. increased with stress.

Front 36

Sammons Qs:

keratosis pilaris

Back 36

bumps and red dots on the back of your arms. mad common. anterior thighs and buttocks. sometimes on the lateral cheeks of kids. congental, genetic, not dangerous at all. increased growth of the stratum corneum that forms around the hair follicles.

Front 37

Sammons Qs:

vitiligo

Back 37

true DEpigmentation, autoimmune disease where the body is attacking the melanocytes

Front 38

Sammons Qs:

roseola

Back 38

mad high fever without any other other symptoms. then he gets a rash.

Front 39

Sammons Qs:

Melanocytic Nevi:
Congenital

Back 39

Congenital: birthmarks, present at birth and vary in size. malignany pot'l depends on histo pattern and to an extent, clinical size. Large--> malignant transformation occurs.

Front 40

Sammons Qs:

Blue Nevus

Back 40

large amount of pigment located in the dermis.
-Tyndall Effect gives blue color

Front 41

Sammons Q:

Classic Malignany Melanoma

Back 41

sometimes have clearing in the center because the immune system has attacked the melanoma. Regression is a bad prognostic factor because it means that the melanoma has been there too long.

Front 42

Sammons Q:

Types of Malignant Melanoma

Back 42

Superficial spreading type- 70% of melanomas; multicoloured
Nodular Type- 2nd more common. looks like blood blisters.
Lentigo maligna type- sun damaged skin.

Front 43

Sammons Q:

Hutchinsons's Sign

Back 43

Appearance of a pigmented band with extension into the proximal or lateral nail fold

Suggests acral lentiginous melanoma (ALM)

Nail matrix biopsy is mandatory

Front 44

Sammons Q:

ABCDEs of Malignant Melanoma

Back 44

ABCDE’s
Asymmetry
Border- should be smooth
Color- more colors, more worser
Diameter- not as imp. but should be <6mm
Evolving

Front 45

Sammons Q:

Do a shave biopsy for suspecting melanoma, right?

Back 45

Heck no. not recommended as you may not get the full tumor depth. want to go all the way down to the fat.

Front 46

Sammons Q:

Breslow Depth

Back 46

Most important histologic determinant of prognosis

Measured from the GRANULAR LAYER TO THE DEEPEST PORTION of malignant cells

When greater than 1mm – higher risk for metastasis
-Recommend sentinel lymph node biopsy

Front 47

Sammons Q:

Sentinel lymph node

Back 47

-1st lymph node in the LN basin to which the primary drains
-Lymph node most at risk for metastasis

Breslow thickness ≥ 1.0 mm
Breslow thickness ≤ 1.0 mm with high risk features seen in primary: Ulceration, Regression, Angio-lymphatic invasion, In-transit recurrence-suggests LN involvement
Mitotic rate = 1.0 and patient =60 y/o

Front 48

Sammons Q:

Describe Psoriasis characteristics

Back 48

Common, Treatable but not curable, Familial

Not Contagious, Not Cancerous, Affects 2-3% of the population

Stress, medications, infections, and environmental factors may precipitate psoriasis

T Cell pathophysiology

Front 49

Sammons Q:

Psoriasis Emotional and Physical Impacts

Back 49

3rd worst emotional impact (behind depression and chronic lung disease)

2nd worse physical function, behind CHF

Front 50

Sammons Q:

Guttate Psoriasis

Back 50

looks like drops on the body

Front 51

Sammons Q:

Biologics

Back 51

A group of antibody and fusion protein therapies with different mechanisms of action that target the immune system to combat disease.

tx for psoriasis. dont forget to tx with antiinflammatory treatments, like phototherapy

Front 52

Sammons Q:

Erythema multiforme associated with

Back 52

Associated with preceding HERPES SIMPLEX VIRUS or mycoplasma infection.
-targetoid lesions with purple center, no prodrome,

Front 53

Sammons Q:

Most common cause for SJS/TEN

Back 53

Drugs are the most common cause
-Occurs most often in those treated for seizure disorders

Front 54

Sammons Q:

Distinguish Stevens-Johnson from Toxic Epidermal Necrosis

Back 54

< 10% BSA = SJS
10% - 30% = SJS-TEN
> 30% = TEN

Front 55

Sammons Q:

Stevens-Johnson Syndrome

Back 55

Start with fever and flu-like symptoms

1 – 14 days later there is abrupt onset of symmetric red macules

The oral mucosa is ALWAYS involved
Two or more mucosal sites are ALWAYS involved
Lips tend to form hemorrhagic crusts
Eyes develop severe conjunctival erosions and exudate
There is often vaginal, rectal or airway involvemental

Front 56

Sammons Q:

Toxic Epidermal Necrolysis

Back 56

Begins initially as SJS like changes but progresses to involve full-thickness loss of the epidermis involving LARGE PERCENT OF BODY SURFACE AREA

High mortality rate

Death usually from sepsis

Seen with higher frequency in pts with HIV

Front 57

Sammons Q:

NIKOLSKY’S SIGN

Back 57

Epidermal detachment reproduced by mechanical pressure on an area of erythematous skin.
-POSITIVE IN TEN

Front 58

Sammons Q:

TEN vs. Staph scalded skin syndrome

Back 58

TEN has full thickness skin involvement
-Split at DERMAL-EPIDERMAL JUNCTION
-Much more serious

SSSS has loss of superficial layer
-Split at GRANULAR LAYER of epidermis

Front 59

Sammons Q:

Erythema Nodosum

Back 59

Nodular erythematous eruption that is usually limited to the extensor aspects of the extremities.

In USA most commonly caused by ORAL BIRTH CONTROL PILLS
Lesions begin as red, nodule-like swellings over the shins

Both legs are affected

Front 60

Sammons Q:

The most common cause of erythema nodosum in the west and southwest USA.

Back 60

Coccidiodomycosis

Front 61

Sammons Q:

When I say PALPABLE PURPURA, you say....

Back 61

Vasculitis!!!

Front 62

Sammons Q:

Vasculitis

Back 62

Probably initiated by immune complex deposition

Hypersensitivity vasculitis is the most common form of small-vessel necrotizing vasculitis. mostly in the lower limb. mild fever.

Front 63

Sammons Q:

Henoch-Schonlein Purpura

Back 63

Acute vasculitis of small to medium sized vessels

Seen in young patients, ass'd with abdominal pain

Usually follows upper respiratory tract infection

Front 64

Sammons Q:

Hypersensitivity (leukocytoclastic) vasculitis

Back 64

small vasculitis ass’d with drug reactions

Front 65

Sammons Q:

Red-orange plaques
Follicular papules
Islands of sparing

Back 65

Pityriasis Rubra Pilaris

-Little or no itching

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Sammons Q:

Herald Patch, Salmon Pink lesions in whites and hyperpigmented in blacks, cooarette scale

Back 66

Pityriasis Rosea

-CHRISTMAS TREEEEE

Front 67

Sammons Q:

FIVE P's of Lichen Planus

Back 67

Pruritic
Planar
Polyangular
Purple
Papules

Front 68

Sammons Q:

Association with Lichen Planus

Back 68

Association with viral hepatitis C

Front 69

Sammons Q:

Most contagious stage of syphilis

Back 69

secondary. "The Great Imitator"

Results from hematogenous spread of T. pallidum

Copper colored, Macular Papular Rash (characteristic of secondary)

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Sammons Q:

primary syphilis

Back 70

"Chancre"

Painless erosion

If untreated 50% will progress to 2º syphilis other 50% will enter latency

primary, secondary, latent syph can be transmitted from direct sexual or oral contact

Front 71

Sammons Q:

Latent Syphilis

Back 71

GUMMA! (characteristic skin lesion)

Asymptomatic state

Only manifestation is reactive serologic testing

Diagnosis of exclusion

1/3 of patients progress to 3º syphilis

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Sammons Q:

Gumma

Back 72

Painless pink nodules with ulceration

heal with scarring

may cause massive destruction of tissue

rarely contagious

rarely heal

Front 73

Sammons Q:

Always screen this with syphilis

Back 73

Pityriasis Rosea (looks the same as secondary syph)

Front 74

Sammons Q:

Classification Criteria for Systemic Lupus

Back 74

MDSOAPBRAIN: need 4/11 for SLE
M – Malar Rash
D – Discoid Lesions
S – Serositis
O – Oral Ulcers
A – ANA
P – Photosensitivity
B – Blood (Hematologic abnormalities)
R – Renal abnormalities
A – Arthritis
I – Immunologic (other autoantibodies)
N – Neurologic (Seizures, Psychosis)

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Sammons Q:

ANA

Back 75

Systemic Lupus- positive
Discoid Lupus- negative
Subacute Lupus- positive
Drug induced Lupus- positive
Neonatal-

Front 76

Sammons Q:

Discoid Lupus Characteristic

Back 76

The scale penetrates down into the follicular orifices creating a “carpet tack” appearance

Later there is atrophy, hypopigmentation and scarring

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Sammons Q:

Subacute Lupus Erythematosus

Back 77

Papulosquamous Pattern
Annular Polycyclic Pattern

Usually in sun-exposed surfaces

Tends to be chronic and recurrent


Spares the knuckles, inner aspects of the arms, axillae and lateral parts of the trunk

Front 78

Sammons Q:

Drug Induced Lupus Erythematosus

Back 78

Systemic symptoms predominate

Anti-histone antibodies

Often no cutaneous findings

Procainamide is the most common cause in US

Front 79

Sammons Q:

Neonatal Lupus

Back 79

Associated CONGENITAL HEART BLOCK, cardiomyopathy, cholestatic hepatitis, and thrombocytopenia

Front 80

Sammons Q:

Dermatomyositis

Back 80

Positive anti-Jo-1 antibody

ANA positive-60-80%

Poikiloderma- most imp. diagnostic feature

Front 81

Sammons Q:

Raynaud’s phenomenon

Back 81

Systemic Sclerosis

Front 82

Sammons Q:

CREST syndrome-variant of systemic scleroderma

Back 82

Calcinosis cutis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

ANTICENTROMERE ANTIBODIES are highly specific for CREST syndrome and positive in 50-90% of patients

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Sammons Q:

Mixed Connective Tissue Disease

Back 83

Most patients have ant-U1 RNP antibodies

Front 84

Sammons Q:

Dermatitis Herpetiformis

Back 84

Associated with subclinical GLUTEN-SENSITIVE ENTEROPATHY

IgA deposits in the upper dermis

-Begins with a few itchy papules and evolves to intensely burning urticarial papules, vesicles, and rarely, bullae
-Distributed on elbows, knees, scalp, nuchal area, shoulders, and buttocks
-Ass'd with thyroid disorders
-SUBEPIDERMAL separation

Front 85

Sammons Q:

Pemphigus

Back 85

INTRAEPIDERMAL, blistering disease involving the skin and mucous membranes

IgG autoantibodies directed against the cell surface of keratinocytes destroy the adhesion between epidermal cells

Front 86

Sammons Q:

Pemphigus Vulgaris

Back 86

Lesions APPEAR FIRST IN THE MOUTH in 60% of cases or at a site of trauma or burn.

Nikolsky sign-POSITIVE
-Elicited by slight pressure, twisting, or rubbing of the skin.

Asboe-Hansen Sign- POSITIVE
-Elicited by direct pressure on an intact bullae.

Diagnosis is established by histology, DIF, Indirect immunofluorescence (IIF), and/or ELISA testing for anti-desmoglein 1 and anti-desmoglein 3 autoantibodies.

Front 87

Sammons Q:

Pemphigus Foliaceus

Back 87

Characterized by flaccid bullae and localized/generalized exfoliation

Adherent scale crusts may resemble corn flakes

Nikolsky sign POSITIVE

Autoantibodies to Desmoglein 1

Front 88

Sammons Q:

Bullous Pemphigoid

Back 88

Rare, autoimmune SUBEPIDERMAL blistering disease with circulating IgG and basement membrane zone bound IgG antibodies and C3

Antibodies bind to antigens (BP230 and BP180) component of hemidesmosomes in basal keratinocytes)

Absence of acantholysis
Superficial dermal infiltrate of eosinophils

Front 89

Sammons Q:

the most common type of skin cancer in Caucasians

Back 89

BASAL CELL CARCINOMA

Front 90

Sammons Q:

Actinic Keratosis

Back 90

AK’s are the earliest lesion in the development of squamous cell carcinoma

Front 91

Sammons Q:

Can mimic Vurruca Vulgaris

Back 91

Squamous Cell Carcinoma

Front 92

Sammons Q:

Keratoaconthoma

Back 92

Rapidly enlarging nodules with a crater-like center

Front 93

Sammons Q:

What does the classic Basal Cell carcinoma look like?

Back 93

Nodular BCC (most common):
Pearly/shiny papule or plaque, can ulcerate centrally

Front 94

Sammons Q:

For what do you do a ED & C?

Back 94

Scrape and Burn:

Most appropriate for superficial lesions – superficial BCC’s

Front 95

Sammons Q:

For what do you do a Excision Surgery?

Back 95

•Appropriate for all types except morpheaform BCC’s

Front 96

Sammons Q:

morpheaform BCC

Back 96

they're like an octopus, so they have parts that spread out, so when you try to excise, you won't get it all out so some will remain.

Front 97

Sammons Q:

For what do you do a Mohs Micrographic Surgery?

Back 97

•Appropriate for all types that are in either high risk locations or cosmetically important locations.
- do Mohs for morpheaform BCC’s

Front 98

Sammons Q:

Lidocaine with epinephrine

Back 98

Epinephrine produces vasoconstriction
-Reduces bleeding
-Slows absorption of lidocaine
-Anesthesia longer lasting

(avoid finger, toes, nose, hose)

Front 99

Sammons Q:

Side effects of lidocaine

Back 99

Lidocaine toxicity
7 mg/kg max dose of lidocaine with epi
5 mg/kg max dose of lidocaine without epi

Front 100

Sammons Q:

Punch biopsy

Back 100

Can get full thickness skin biopsy including small amount of subcutaneous fat

Good for diagnosis of most tumors or inflammatory skin conditions
-Should avoid in malignant melanoma

Front 101

Sammons Q:

Shave biopsy

Back 101

Good for elevated lesions

Use only if full thickness of tissue is not important

Front 102

Sammons Q:

Excisional Biopsy

Back 102

Biopsy of entire lesion down to and including some subcutaneous fat

Most useful for biopsy of MALIGNANT MELANOMA

Front 103

Sammons Q:

Cryosurgery

Back 103

Liquid nitrogen

Used to treat superficial nonmalignant lesions

Front 104

Sammons Q:

Electrodesiccation & Curettage ED&C

Back 104

TOUCHES THE SKIN

Front 105

Sammons Q:

Electrofulguration

Back 105

→ doesn’t touch

Front 106

Sammons Q:

Moh’s micrographic surgery

Back 106

Tissue sparing technique used to treat some skin cancers

Performed in one day under local anesthesia

Fresh tissue

Tissue is removed in stages and mapped out to ensure complete removal of tumor