Term
|
Definition
| flat, non-palpable, less than 1 cm |
|
|
Term
|
Definition
| flat, non-palpable, greater than 1 cm |
|
|
Term
|
Definition
| solid, elevated lesion, palpable, less than 1 cm |
|
|
Term
|
Definition
| flat-topped, palpable, elevated lesion, greater than 1 cm |
|
|
Term
|
Definition
| palpable solid lesion greater than 1 cm (not flat-topped) |
|
|
Term
|
Definition
| elevated, circumscribed lesion with clear fluid, less than 5 mm |
|
|
Term
|
Definition
| elevated, circumscribed lesion with clear fluid, greater than 5mm |
|
|
Term
|
Definition
| itchy, transiently edematous area |
|
|
Term
| 2. What is vitiligo and what diseases are a/w it? |
|
Definition
Skin depigmentation; pts. have antibodies to melanin
a/w autoimmune diseases (pernicious anemia, hypothyroidism, Addison's, type 1 DM)
-autoantibodies to parietal cells, thyroid, etc.) |
|
|
Term
| 3. Pruritic conditions to consider for Step 2? |
|
Definition
Serious: obstructive biliary disease, uremia, polycythemia rubra vera (esp. after warm shower or both)
Also: contact or atopic dermatitis, scabies, lichen planus |
|
|
Term
| 4. What is contact dermatitis? How to recognize it? What are the classic causes? |
|
Definition
red and tichy skin often w/ vesicles or bullae
-due to type IV hypersensitivity rxn. (but may be due to irritating or toxic substance)
-classic causes: poison ivy, nickel, deodorant
-rash is well-circumscribed and only occurs in area of contact
-requires avoiding causative agent
-patch testing if need to determine antigen |
|
|
Term
| 5. atopic dermatitis; what history points to this dx? |
|
Definition
chronic allergic-type condition beginning of first year of life w/ red, tichy, weeping skin on the head, UEs and occ. diaper area
-clues: FH, h/o of allergies, h/o asthma
-problem: scratching leading to skin breaks leading to infection
-tx: avoid drying soaps, use antihistamines and topical steroids |
|
|
Term
| 6. Seb. Derm.; what body part, how to treat? |
|
Definition
Cause of blepharitis (eyelid inflamm.), cradle cap, dandruff
exam: scaling on scalp and eyelids
tx: dandruff shampoo (selenium, tar), corticosteroids, and/or ketoconazole |
|
|
Term
| 7. Name the dermatological fungal infections. |
|
Definition
Tinea corporis: body/trunk, red ring-shaped plaques with raised borders, central clearing
Tinea pedis: (athlete's foot) macerated, scaling web spaces b/t toes that itch and may be a/w thickened, distorted toenails (onychomycosis); tx: good foot hygiene
Tinea unguium (onychomycosis): thickened, distorted nails w/ debris under nail edges
Tinea capitis (scalp: highly contagious, scaly patches of hair loss and may have inflamed, boggy granuloma of scap (kerion) that resolves on its own
Tinea cruris: (jock itch) found in crural folds of upper, inner thighs, more common in obese males |
|
|
Term
| 8. what organisms cause fungal infections? |
|
Definition
Most due to Trichophyton.
In tinea capitis, if hair fluoresces under Wood's lamp: Microsporum; if does not: Trichophyton |
|
|
Term
| 9. How are fungal infections diagnosed and treated? |
|
Definition
formal dx: scrape and do KOH prep to visualize by microscope (on USMLE, always do this test before treating!)
tx:
-oral antifungals must be used for tinea capitis and onychomycosis
-other fungal infections: topical antifungals (imidazoles such as miconazole, clotrimazole, ketoconazole) or griseofulvin (better for severe/persistent infections) |
|
|
Term
| 10. T or F: Candidiasis is normal in some women and children. |
|
Definition
T. Oral thrush (creamy white patches on tongue or buccal mucosa that CAN be scraped off) is nl in kids. Candida vulvovaginitis is nl in women, esp. during pregnancy or after abx.
However, in different patients or diff. time periods, may be sign of DM or immunodeficiency (ex: thrush in a man = AIDS) |
|
|
Term
| 11. How to treat candidiasis? |
|
Definition
topical nystatin or imidazoles (like miconazole, clotrimazole).
oral tx (nystatin or ketoconazole) for extensive or resistant disease |
|
|
Term
| 12a. What causes scabies? |
|
Definition
|
|
Term
| 12b. how do you recognize scabies? |
|
Definition
severe pruritis
-burrows in skin, esp. in finger web spaces and flexor surfaces of wrists
-facial involvement in infants
-may have bacterial infection from scratching |
|
|
Term
|
Definition
| scrape mite out of burrow and see it under a microscope |
|
|
Term
|
Definition
permethrin cream, apply to whole body
-treat ALL contacts (ie, whole family)
-do NOT use lindane unless can't use permethrin, effective but causes neurotoxicity, esp. in young children |
|
|
Term
| 14a. what causes tinea versicolor? |
|
Definition
|
|
Term
| 14b. how do you recognize tinea versicolor? |
|
Definition
multiple patches of various size and color on torso of young adults
-noticeable in summer b/c affected areas fail to tan and look white |
|
|
Term
| 14c. how do you dx tinea versicolor? |
|
Definition
| KOH prep of lesion scrapings |
|
|
Term
| 14d. how do you treat tinea versicolor? |
|
Definition
| selenium sulfide shampoo or topical imidazoles |
|
|
Term
|
Definition
lice (pediculosis): itchy!
-head: Pediculus capitis (esp. school age kids)
-body: Pediculus corporis (not usually in ppl w/ good hygiene)
-pubic area (crabs): Phthirus pubis (sexually transmitted) |
|
|
Term
|
Definition
|
|
Term
|
Definition
permethrin cream
decontaminate sources of reinfection (ie, wash or sterilize combs, hats, bed sheets, clothing) |
|
|
Term
| 16a. presentation for warts? |
|
Definition
older children, classically on the hands
-infectious (contagious) |
|
|
Term
|
Definition
common warts: HPV (human papillomavirus) 6 and 11
genital warts: HPV 16 and 18- a/w cervical ca |
|
|
Term
|
Definition
| salicylic acid, liquid nitrogen, curettage |
|
|
Term
| 17a. what is molluscum contagiousum? |
|
Definition
|
|
Term
| 17b. presentation of molluscum contagiosum? |
|
Definition
skin-colored, smooth, waxy papules with central depression (umbilicated), ~0.5cm
-common in kids but also transmitted sexually |
|
|
Term
| 17c. what would molluscum contagiosum look like under a microscope? |
|
Definition
| cells w/ inclusion bodies |
|
|
Term
| 17d. how to tx molluscum contagiosum? |
|
Definition
|
|
Term
| 18. T or F. A child w/ genital molluscum is a victim of sexual abuse. |
|
Definition
F. The child may be a victim of sexual abuse, or the child may have autoinnoculated themselves when scratching the genital area
-don't automatically assume sexual abuse, but must r/o |
|
|
Term
| 19a. what kind of lesions can acne cause? |
|
Definition
comedones (whiteheads and blackheads)
papules
pustules
inflamed nodules
superficial pus-filled cysts
and/or possible inflammatory skin changes, like scars |
|
|
Term
| 19b. what is the pathogenesis of acne? |
|
Definition
| Propionibacterium acnes, as well as blockage of pilosebaceous glands |
|
|
Term
| 20. T or F. Acne is not related to food, exercise, or sex. |
|
Definition
T. Acne is NOT related to food, exercise, or sex (including masturbation).
-cosmetics can aggravate acne
-however, if a pt.'s acne is related to food, try discontinuing it. |
|
|
Term
| 21. treatment options for acne? |
|
Definition
1st: benzoyl peroxide
2nd: Abx- topical clindamycin, oral tetracycline or erythromycin (to eradicate P. acnes)
3rd: topical retinoids- tretinoin
4th: oral retinoids- isotretinoin
-note: isotretinoin is teratogenic and women must be tested for pregnancy before and during course of med.
-also watch for dry skin and mucosae, mm and joint pain, and LFT abnormalities |
|
|
Term
| 22a. presentation of rosacea? |
|
Definition
looks like acne, but begins in middle age
-rhinophyma: bulbous red nose
-blepharitis
-pathogenesis not understood, not related to diet |
|
|
Term
| 22b. treatment for rosacea? |
|
Definition
| topical metronidazole or oral tetracycline |
|
|
Term
| 23. what should you think about hirsutism if on the step 2 exam? |
|
Definition
idiopathic
if other signs of virilization (deepening voice, clitoromegaly, frontal balding): think androgen-secreting ovarian tumor
-no virilization: think Cushing's, polycystic ovary syndrome (Stein-Leventhal syndrome), and drugs (minoxidil, corticosteroids, phenytoin) |
|
|
Term
| 24. common causes of baldness? |
|
Definition
-trichotillomania: psychiatric disorder in which pts. pull out their hair; hairloss is patchy and irregular
-alopecia areata: idiopathic, but a/w autoantibodies and antimicrosomal
-lupus
-syphilis
-after cancer chemo. |
|
|
Term
| 25. what causes ordinary male pattern baldness? |
|
Definition
| genetic disorder requiring androgens for expression |
|
|
Term
| 26. describe classic psorisis |
|
Definition
dry, well-circumscribed silvery scaling papules and plaques that are not pruritic
-seen on scalp and extensor surfaces of elbows and knees |
|
|
Term
| 27a. what history and physical findings may be seen w/ psoriasis? |
|
Definition
FH of psoriasis
Caucasians in early adulthood
pitting of the nails
arthritis resembling RA but is rheumatoid factor-negative |
|
|
Term
| 27b. how to dx psoriasis? |
|
Definition
| appearance, but biopsy if doubtful case |
|
|
Term
| 27c. how to treat psoriasis? |
|
Definition
UV light (sunlight)
lubricants
topical steroids
keratolytics (coal tar, salicylic acid, anthralin) |
|
|
Term
| 28a. presentation of pityriasis rosea? |
|
Definition
-adults
-herald patch (erythematous, scaly, ring-shaped or oval patch on the trunk), followed by many similar lesions 1 week later that are itchy
-lesions on back with long axis paralleling the Langerhan's skin cleavage lines (Christmas tree pattern)
-ddx: symphilis |
|
|
Term
| 28b. how to treat pityriasis rosea? |
|
Definition
| remits spontaneously w/in 1 month |
|
|
Term
| 29. characteristics of lichen planu? |
|
Definition
Pruritic, Purple (violaceous), Polygonal, Planar Papules
Often on wrists or lower legs, usually adults
white reticular pattern may be seen on oral mucosa |
|
|
Term
| 30. Classic drugs that cause photosensitivity |
|
Definition
| Tetracyclines, phenothiazines, birth control pills |
|
|
Term
| 31a. target (iris) lesions |
|
Definition
|
|
Term
| 31b. drugs that cause erythema multiforme? |
|
Definition
| sulfa drugs, penicillins, also herpes (but may just be idiopathic) |
|
|
Term
| 31c. what is stevens-johnson syndrome and how do you treat? |
|
Definition
severe form of erythema multiforme, often fatal b/c of widespread skin involvement
-treat supportively |
|
|
Term
| 32a. tender red nodules, esp. on shins (pretibial) |
|
Definition
erythema nodosum
-disease of inflammation of SQ tissue (panniculitis) |
|
|
Term
| 32b. what diseases are a/w erythema nodosum? |
|
Definition
32b. on Step 2, think: sarcoidosis, coccidiomycosis, ulcerative colitis
-also infections (strep, TB) and drugs (sulfa) |
|
|
Term
| 33a. multiple bullae involving oral mucosa and spreading to skin of the rest of the body |
|
Definition
|
|
Term
| 33b. what is pemphigus vulgaris? |
|
Definition
bullous autoimmune disease of middlea-aged and elderly ppl
-potentially life threatening |
|
|
Term
| 33c. how to dx and rx pemphigus vulgaris? |
|
Definition
dx: biopsy stained for antibody will show IgG to desmoglein III (a/w desmosomes) in a lace-like or fishnet immunofluorescence pattern
rx: steroids |
|
|
Term
| 33d. how is bullous pemphigoid different from pemphigus vulgaris? |
|
Definition
-targets BP1, BP2 in a linear immunofluorescence pattern
-milder, only involves skin (usually arms, thighs)
-still treat w/ steroids |
|
|
Term
| 34. what skin disease is a/w celiac sprue (gluten intolerance or sensitivity)? how to dx and rx that skin disease? |
|
Definition
dermatitis herpetiformis
-very pruritic vesicles, papuels, wheal on extensor elbows, knees, possibly face or neck
-look for diarrhea, weight loss a/w celiac sprue
-biopsy: IgA deposits (even in unaffected areas.
-rx: gluten-free diet and dapsone |
|
|
Term
| 35. what are decubitus ulcers? how to prevent and rx? |
|
Definition
ulcers due to prolonged pressure against the skin
-best rx: prophylaxis- periodic turning of paralyzed, bedridden or debilitated patients and use of special air mattresses; cleanliness and dryness, periodic skin checks
-if missed, may lead to ulcerate to the bone, infection, sepsis, then death
-rx: aggressive surgical debridgement, and abx if signs of infection |
|
|
Term
| 36. if excessive perspiration on USMLE, what should you think about? |
|
Definition
| think serious! such as MI, TB or infection, hyperthyroidism, or pheochromocytoma |
|
|
Term
| 37. T or F. Most melanomas start as simple moles. |
|
Definition
True. Moles are common and benign, but malignant transformation is possible.
-Excise or biopsy if too large if mole becomes asymmetric, develops irregular borders, changes color in any part, enlarges, becomes inflamed, or becomes painful or itchy |
|
|
Term
| 38. multiple dysplastic-appearing nevi (more than 100 moles), FH of melanoma. what is it, and how to manage? |
|
Definition
dysplastic nevus syndrome
-careful f/u, excision or biopsy any suspicious lesions
-avoid sun exposure, use sunscreen |
|
|
Term
| 39a. flesh-colored lesion w/ central crater and keratinous material, often on face, growing rapidly |
|
Definition
|
|
Term
| 39b. what is notable about keratoacanthomas? how to treat? |
|
Definition
mimics squamous cell cancer
-unlike SCC, grows RAPIDLY, to full size in 1-2 mo
-treat with observation, not biopsy (for the Step2), as lesion will involute spontaneously in a few months |
|
|
Term
| 40. in whom and where are keloids seen? how to manage? |
|
Definition
keloids = overgrowth of scar tissue after an injury
-frequenly seen in black ppl
-classically seen on upper back, chest, deltoids, also after ear piercing
-do not excise, as may worsen scarring |
|
|
Term
| 41. shiny papule, slow growing w/ umbilicated/ulcerated center and telangiectasias. What is it, what are the risks, who is it seen in, and how to dx, rx? |
|
Definition
BCC
-risks: sunlight exposure
-seen in elderly, light-skinned ppl
-biopsy any suspicious lesions, rx: excision |
|
|
Term
| 42. T or F. Basal cell carcinoma almost never develops metastases. |
|
Definition
|
|
Term
| 42a. hard, sharp, red, scaly lesion in sun-exposed area |
|
Definition
|
|
Term
| 42b. nodular, warty or ulcerated lesion from burn scars or hard,sharp,red,scaly lesion |
|
Definition
|
|
Term
| 43c. what to do with SCC? does it metastasize? |
|
Definition
biopsy if AK transforms
-in situ = Bowen's disease
-mets occur more frequently in SCC than BCC, but still rarely |
|
|
Term
| 44. what determines the prognosis of malignant melanoma? |
|
Definition
| the vertical depth of the invasion into the skin |
|
|
Term
| 45. black dots on palms or soles or under fingernail that change in appearance or cause sx |
|
Definition
acrolentiginous melanoma
-seen usually in black ppl, but still rare |
|
|
Term
| 46. Unilateral, red, oozing or crusting nipple in an adult woman, fails to respond to topical treatment. What is it, and what is the significance? |
|
Definition
Paget's disease of the nipple.
-rare, only 1-2% of breast ca
-indicates underlying breast ca, usually invasive ductal carcinoma or ductal carcinoma in situ, extending to the skin |
|
|
Term
| 47. fissures at corner of mouth. What is it, and what causes it? |
|
Definition
Stomatitis (here, anugular stomatitis)
-inflammation of mucous membranes of mouth
-watch for deficiencies of B-complex vitamins (riboflavin, niacin, pyridoxine) or vitamin C |
|
|
