Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
55 Cards in this Set
- Front
- Back
Papule |
Description: elevated, firm, circumscribed area; < 1 cm in diameter Example: Freckles, flat moles (nevi), petechiae, measles, scarlet fever, lentigo |
|
Macule |
Description: elevated, firm, circumscribed area; < 1 cm in diameter Description: flat, circumscribed area that is a change in the color of the skin; < 1 cm in diameter Example: Wart (verruca), elevated moles, lichen planus, seborrheic keratosis |
|
Nodule |
Description: Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1 to 2 cm in diameter Example: Erythema nodosum, lipoma, basal cell carcinoma |
|
Vesicle |
Description: Elevated, circumscribed, superficial, not into dermis; filled with serous fluid; <1 cm in diameter Example: Chickenpox, shingles, contact dermatitis |
|
Bullae |
Description: Vesicle > 1 cm in diameter Example: Blister; pemphigus vulgaris |
|
Confluent |
Description: Lesions run together Example: Childhood exanthems |
|
Nevus (mole) |
Description: Mole which can be flat, slightly raised, dome-shaped, smooth, rough, or hairy Example: Mole |
|
Verruca (wart) |
Description: Small, rough growth Example: Verruca plantaris, HPV |
|
Plaque |
Description: Elevated, firm, and rough lesion with flat top surface > 1 cm in diameter Example: Psoriasis, seborrheic, and actinic keratosis |
|
Pustule |
Description: Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid Example: Impetigo, acne, folliculitis |
|
Rubeola (Measles) |
Causative: Measles; viral exanthem; systemic illness Symptoms: Three C's - cough, coryza (runny nose) and conjunctivitis; Koplik's spot (white lesion, red halo, buccal mucosa) Differentials: Abdominal pain, OM, and bronchopneumonia associated; IgM IgG measured Description: Rash (confluent/salmon color) starts on neck and ears; then face, arms, chest; 2nd day rash covers lower torso and legs; 3rd day rash is on feet and face; 4th day rash begins to fade |
|
Scarlatina* (scarlet fever) |
Causative: Strep pyogenes (culture group A strep) Symptoms: fine, mildly erythematous papule; pastia lines; fever, sore throat, Differentials: begins axillae, groin and neck (but avoids face), circumoral pallor Description: strawberry tongue, sand paper rash found on trunk, skin on hands and feet will peel @ end |
|
Rubella |
Causative: Rubella viral exanthem Symptoms: maculopapular and confluent rash; petichae soft palate Differentials: generalized tender lymphadenopathy of post auricular, posterior occipital nodes Description: rash begins on face and spreads all over within 24 hrs; rash lasts 3 days |
|
Scalded Skin Syndrome (Ritter's) |
Causative: Staph Aureus Symptoms: fluid filled blisters, painful erythroderma-face, diaper area. Description: separation of superficial layer of the epidermis |
|
Fifth's Disease* (Erythema infectiosum; slapped-cheek) |
Causative: Parvovirus B19 (viral) Symptoms: bright red maculopaular rash face; diffuse maculopapular rash on trunk/extremities 2-3 days later Differentials: Rash on cheeks, intense, red, circumoral pallor Description: associated children hemolytic anemia --> aplastic crisis; IgM, IgG measured |
|
Roseola infantum |
Causative: human herpes virus 6; most common exanthema of children <3 Symptoms: high fever 3-4 days, nothing else wrong, fever resolves then break out in maculopapular rash Differentials: posterior cervical lymphadenopathy & edema eyelid may be seen Description: pink, morbilliform, cutaneous eruption after fever; starts on trunk and spreads quickly |
|
Mongolian spots (infant/newborn) |
Appearance: darker skinned infants, blue/gray spots (look like bruise) found on back, buttocks, upper legs. Implications: no risks, may appear abused but not; congenital dermal melanocytosis; asians Anticipatory Guidance: attentive to documentation by provider/parent if there is a question regarding bruises |
|
Café au lait patches (infant/newborn) |
Appearance: flat, light brown macules. May get darker when older, "birthmarks" Implications: neurofibromatosis (family hx 1st degree, >6 spots that are >5mm, freckling in axilla and groin) 95% have these patches Anticipatory Guidance: +family neurofibromatosis = autosomal dominantly inherited dz |
|
Mottling (infant/newborn) |
Appearance: normal variation; may be brought on by cold distress Implications: normal finding in baby |
|
Telangiectastic nevi (stork bites) (infant/newborn) |
Appearance: "birthmark", caused nevi simplex, red spots around back of neck, upper eyelids, nose and upper lip Implications: no risk, usually temporary |
|
Eczema (Atopy) |
Causative: chronic relapsing inflammatory taking several dorms. Erythematous macules, papules and vesicles that may weep/crust. Symptoms: symmetrical; Popliteal/antecubital areas; mild-mod pruritus Differentials: Children often have asthma, Flares before breathing gets bad; hx: asthma, seasonal allergies and eczema Description: dark skinned appear "ashy"; serum IgE, culture for bacteria |
|
Dermatitis (allergic/contact) |
Causative: allergens/poison ivy Symptoms: localized; asymmetrical; may be generalized with airborne allergens/poison ivy; linear pattern with plant dermatitis Differentials: patch testing Description: vesicles/erosions with edema and inflammation with crusts and lichenifications; pruritus |
|
Hand, Foot, and Mouth Disease* |
Causative: Coxsackievirus A16 or other enteroviruses; painful white vesicles with red halo Symptoms: painful ulcers in mouth, palm of hands, soles of feet and buttocks. Small, red papules progress to ulcerative erythematous base Differentials: low grade fever, sore throat, malaise; cervical/submandibular lymphadenopathy Description: spread through droplets, virus may be found in stool, may cause decreased appetite (dehydration) - keep hydrated! |
|
Varicella Zoster* (chickenpox) |
Causative: varicella zoster virus; Symptoms: crops of pruritic lesions begin on trunk turn to vesicles then scabs in 6-10 hrs; crops then appear on mucosal membrane (mouth, larynx and vagina); different stages of healing Differentials: need immune competent patient to give vaccine; ELISA titer confirms Description: 2 wk incubation; infectious for 2 days before rash and until all lesions have crusted |
|
Herpes Simplex* (oral) |
Causative: herpes simplex 1 virus Symptoms: multiple vesicular lesions on erythematous base in a single site around mouth/face; regional lymphadenopathy Differentials: other STIs, HIV; triggered by sun, stress, fatigue, fever, trauma Description: Viral culture Tzanck smear (multinucleated giant cells nonspecific); screen for STIs, HIV |
|
Herpes Zoster* (shingles) |
Causative: varicella zoster virus reactivated as shingles >50 yo or immunosuppressed. Ophthalmologist if eyes involved Symptoms: unilateral dermatomal (pattern) rash erupts 3-4 days progresses maculopapular rash grouped vesicles then pustules 3-4 days Differentials: need immune competent patient to give vaccine; vaccine recommended all adults >60 Description: chickenpox hx increase chance |
|
Scabies |
Causative: Sarcoptes scabiei (mite) allergic reaction to burrowing Symptoms: nocturnal pruritus; usually axillae, webs of fingers and toes, intragluteal are |
|
Pityriasis rosea* |
Causative: oval erythematous lesions; ovals line up along cleavage lines on trunk ("Christmas tree") Symptoms: rarely on face; more common in spring and fall Differentials: if present on palms and/or soles feet and hx warrants check syphilis Description: rash preceded by "herald patch", a single, scaly, erythematous patch on trunk followed by regional outbreak. "christmas tree" "t-shirt and shorts" |
|
Acne Vulgaris |
Causative: hormone related (androgen); age 15-18 resolves by 25; Symptoms: comedones - whiteheads, blackheads, papule, pustule lesions on face, neck, upper body. Neonate: 2-4 wks normal if persistence >12 months may be endocrine related Differentials: not an issue go hygiene; onset of puberty (adolescents), topical/anabolic steroids, systemic corticosteroids, lithium, phenytoin Description: chronic disorder pilosebaceous follicles |
|
Psoriasis* |
Causative: Immune mediated, T-lymphocytes and dendritic cells play central role. Symptoms: erythematous plaque (skin buildup), patches, and papule; sometimes look more red (eczema) than silvery patches found on elbows, knees; chronic Differentials: Auspitz sign (pinpoint bleeding scraped);familial inheritance pattern Description: Adults, pitting nails, autoimmune made worse with beta blockers, NSAIDs, lithium |
|
Seborrheic keratosis |
Causative: epidermal tumors; proliferation of benign, immature keratinocytes Symptoms: well demarcated, round or oval lesions; dull, verrucous surface; usually located on scalp, behind ears, thigh creases and eyebrows; usually asymptomatic Differentials: commonly occur >50 yo; irritation friction trauma Description: "stuck on" appearance |
|
Actinic keratosis |
Causative: UV radiation, hx of sunburn, fair skinned, increase in age, affects men Symptoms: solitary/multiple lesions on highly exposed ares; erythematous scaly macule, papule or plaque. Differentials: visual or touch biopsy Description: precursor basal, squamous, melanoma |
|
Basal cell carcinoma |
Causative: sun exposure during childhood, fair skin, light colored eyes, tanning beds, photosensitivity drugs (tetracycline/diuretics), chronic immunosuppression and arsenic exposure Symptoms: nodular (rolled edges); small fleshed colored papule on head, neck or hands. Superficial; appear on trunk, slightly scaly, non firm macule, patches/think plaques light red/pink Differentials: visual exam; biopsy used for pathology Description: do not spread quickly; untreated begin bleed, crust over and repeat; 95% cure rate |
|
Squamous cell carcinoma |
Causative: sun exposure (usually head and neck); areas of radiodermatitis; predisposition Symptoms: skin eruption irregular flaky; indurated papule, plaque or nodule; may be eroded, crusted or ulcerated Differentials: can be associated HPV, immunosuppression, topical nitrogen mustard, oral PUVA, chronic ulcers Description: visual exam; biopsy used for pathology |
|
Melanoma |
Symptoms: A: Asymmetry, B: irregular borders and C: variation in color - blue/black w white/red D: diameter >6mm; E: evolution or changes in size Differentials: anywhere on body; usually asymptomatic unless bleeding, ulceration, discharge Description: visual exam; biopsy used for pathology |
|
Impetigo* |
Causative: usually staphylococci or streptococci; associated with scratching from insect bites, dermatitis, scabies. Symptoms: vesicular infection; superficial pustular, bullous or nonbullous eruption with honey crusted Differentials: contagion occurs via direct contact; bacterial culture Description: face; any area of body with wound, especially excoriated lesions |
|
Folliculitis |
Little whiteheads (superficial pustular infection) around hair follicles (scalp, beard, axillae, legs); caused by staph aureus; immunocomprised Can spread and cause non healing crusty sores |
|
Furuncle |
Very tender, deep-seated inflammatory nodule usually from folliculitis Boils, abscess under skin, s aureus; treatment must cover MRSA; may I&D for bacterial culture |
|
Cellulitis |
Causative: often MRSA Symptoms: reddened area lower legs, warm, tender touch |
|
Intertrigo (Candidiasis)* |
Causative: Candida albicans; rash (yeast) groin, axilla, gluteal area Symptoms: erythematous (beefy red) maculopapular eruption; mild-intense pruritus |
|
Diaper rash (Candidiasis)* |
Causative: Candida albicans; rash (yeast) diaper area, body folds, mucosal surface, nails and nail folds Symptoms: erythematous (beefy red) maculopapular eruption; mild-intense pruritus Differentials: KOH; culture |
|
Tinea Capitis (Candidiasis)* |
Causative: daycare age, pediatric, contact with infected items (combs, brushes, hat), poor hygiene, infected pets Symptoms: Round, scaly patches on scalp; patches of alopecia with visible black dots; pruritus; may develop alopecia. Hair breaks easily Differentials: Triad - hair loss, scaling and lymphadenopathy; Description: assess household, avoid sharing, discard items |
|
Tinea Versicolor (Candidiasis)* |
Causative: Hot and humid climates, wearing wet clothing, prolonged use of topical steroids, immunocompromised states. Symptoms: Variably colored white to pink to brown scaling upper trunk, axilla, neck, upper arms, abdomen, thighs, genitals. Macules of varying sizes, usually round/oval. May coalesce to form large areas of discoloration Differentials: not contagious; caused by fungus that normally lives on people's skin |
|
Tinea Cruris (Jock Itch) |
Wearing wet clothing, excessive sweating, obesity, obesity, prolonged use of topical steroids, diabetes, immunocompromised states. More common in men. Pruritus; well marginated half-mood plaques; may have eczema-like appearance from scratching; slight elevated; may appear as vesicles. Begins on proximal medial thing, spreads centrifugally, with partial central clearing; does not affect scrotum or penis; may spread to perineum, perianal area, or onto the buttocks. Avoid tight fitting clothes during treatmentCommon sources of infection is person’s own tinea pedis. |
|
Tinea Corporis |
Close contact with animals, warm climates, obesity, prolonged use of topical steroids, immunocompromised states Pruritus; Well circumscribed, circular or oval scaly area. Outer edge usually red and slightly raised with center that is flat and skin colored. Has ring-like border. Some are dry and macular, others moist and vesicular. Skin areas excluding scalp, face, hands, feet, and groin Do not share clothing, sports equipment, or towelsWash thoroughly with soap and shampoo after any sport involving skin-to-skin contact |
|
Tinea Pedis (Athlete's Foot) |
Occlusive footwear, damp footwear, prolonged use of topical steroids, immunocompromised states Pruritic; Red, cracked, tender, and scaly. On the feet, between the toes. May affect palms, nails, or groin. Wear shoes when at gym, pool, or public areas (showers)Use antifungal foot powder, on both feet and in shoesWear open shoes when possible |
|
Hypothyroid |
Anatomy: deficient thyroid hormone production; iodine deficiency; in US autoimmune processes major cause Diagnostics: serum TSH elevated, T3/4 low Differentiation: dry skin, fine hair, galactorrhea, thickening of nails Symptoms: weight gain, cold intolerance, hair loss, hoarseness (low voice), fatigue, constipation, menstrual irregularities (anemia), depression PE: bradycardia, dry skin, generalized edema and delayed TDR |
|
Hashimoto’s Thyroiditis (autoimmune) |
Anatomy: chronic autoimmune thyroiditis; most common cause of hypothyroidism in iodine-sufficient areas; genetic and environmental factors Labs: elevated serum Tg (thyroglobulin) and TPO (thyroid peroxidase); elevated TSH Differentiation: middle age women most common; occurs with other autoimmune disorders: RA, DM1 or lupus Symptoms: same as hypothyroid; progresses very slowly over years |
|
Myxedema (extreme hypothyroid) |
Non pitting edema associated with hypothyroidism Acute causes of this condition include MI, exposure to cold/hypothermia, and with administration of sedative medications (mainly opioids) |
|
Hyperthyroid |
Anatomy: Diagnostics: TSH low (maybe undetectable), T3 high, T4 high Differentiation: moist skin, hyper pigmentation over bones, thin hair, goiter Symptoms: weight loss, nervousness, heat intolerance, nail separation (onycholysis) PE: exophthalmos, tachycardia, afib, tremor, warm moist skin and lid lag; brisk DTR Radioiodine uptake scan differentiates Grave's, toxic nodule and thyroiditis |
|
Grave's Disease (autoimmune) |
Anatomy: thyroid is stimulated by autoantibodies directed against TSH receptor Labs: TSH low, T3 high, Free T4 normal Diagnostics: radioiodine uptake scan Symptoms: same as hyperthyroidism with exophthalmos , goiter Complications: |
|
Diabetes Type 1 (autoimmune; lack of insulin) |
Labs: HgbA1c (<5.7% normal, 5.7-6.4% prediabetes, >6.5% diabetes), FLP, HLA typing, C-peptide normal or low Symptoms: appear sick (sudden), Polyuria, Polydipsia, Polyophagia, Weight loss, fruity breath odor Differentiation: beta cells destruction=insulin deficiency; autoimmune; Complications: DKA, ketotic |
|
Diabetes Type 2 (insulin resistance) |
Labs: CRP (insulin resistance), C peptide elevated (beta cells pancreas), UA, FLP (>126 DM, 100-125 prediabetes) Symptoms: gradual onset, Polyuria, Polydipsia, Blurred vision, Weakness, Fatigue, Chronic skin infections Differentiation: insulin resistance; liver increase glucose; beta cells decreased |
|
Screening Guidelines for Diabetes |
SCREENING: check every visit BP <140 <90; foot, dilated eye exam (DM1 3-5 yr after onset, DM2 @ onset), smoking cessation and dental exam annually LAB: HgbA1c q4-6 months (goal <7%); serum creatinine (onset/annually), FLP annually and urine albumin/creatinine ratio annually VACCINATIONS: Hep B (3 doses to 19-59 yo or older adults high risk), influenza annually, pneumococcus once (>65 require second dose if vaccine was received >=5 years prior and age was <65) EDUCATION: self management review annually (Should occur at onset and anytime there is a change in therapies or medication regimen) |
|
Metabolic Syndrome |
Must have 3 out of 5 to be diagnosed Waist circumference: Men >102 cm (40in), women > 88cm (34-35in) Fasting glucose: > 100mg/dL, or being treated for elevated glucose HDL cholesterol: Men <40 mg/dL, women < 50mg/dL, or being treated Triglycerides: > 150 mg/dL, or being treated BP: > 130/ > 85, or being treated Lifestyle changes: maintain weight, BP, BS, exercise, dietary changes |