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55 Cards in this Set

  • Front
  • Back

Papule

Description: flat, circumscribed area that is a change in the color of the skin;   < 1 cm in diameter

Example: Freckles, flat moles (nevi), petechiae, measles, scarlet fever, lentigo

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



Example: Wart (verruca), elevated moles, lichen planus, seborrheic keratosis

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

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;

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

Description: Vesicle > 1 cm in diameter




Example: Blister; pemphigus vulgaris

Confluent

Description: Lesions run together


Example: Childhood exanthems

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

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

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

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

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; I...

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, ...

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 al...

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

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 hemoly...

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

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 document...

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 ...

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

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, Fl...

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 inflamm...

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 


Differential...

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 i...

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


Descrip...

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-...

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

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

...

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


Differen...

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

Diffe...

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: pr...

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...

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, i...

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

...

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: contagio...

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

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 break...

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, genital...

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