PD II: EXAM #2 (ALL)

Pityriasis Rosea Hallmarks

Chest or Back. Large Pink, red, or brown Herald Patch is First Patch. 1 or 2 weeks after first patch, more pink patches appear along skin folds of trunk. Spontaneously resolves in 2 to 10 weeks.

Location of Atopic Dermatitis

Flexor Surfaces

Nummular Eczema

Coin Shapped. On extensor thigh or abdomen. No central clearing.

Tinea Pedis

Athlete's Foot. Most common in adolescents. Scaling, fissuring predominantly. Vesiculopustular lesions and macerations are found. Diagnose with KOH prep to see hyphae. Treat with topical antifungal cream or powder. Wear cotton socks. Wear Sandals.

Tinea Versicolor

Patched spotty hypopigmentation of chest and back. Caused by fur fur. Treat with selenium blue shampoo. Leave on for 1 hour before showering it off thoroughly.

Erythema Infectiosum

Slapped Cheek Rash. Caused by Parvovirus B19.

Roseola

Caused by Herpes type 6

Lichen Planus

Flat top violaceous papules of varying size and shape (typical anterior shin) Wickham Striae. Koebner Phenomenon. Lesions on wrists, shin, lower back, genitalia, and scalp.

Lyme Disease

Erythema Migrans is early pathognomonic eruption. Looks like a bulls-eye rash at bite site. Caused by borrelia burgdorferi. In North east or North Central United States

Guttate Psoriasis

Small drop like plaques with scales developed after a child having strep pharyngitis

Psoriasis

Typical erythematous plaques topped with silver scales. On extensor surfaces. Auspitz sign is hallmark. Nail Pitting

Koilonychia

Spooning of nails. Seen in iron deficiency anemia

Terry's Nails

White nail bed. Sign of Aging, or Chronic Disease such as heart failure, cirrhosis.

Beau's Lines

Transverse depression of nail plates, usually bilaterally. Seen in systemic illness that disrupts growth.

Mee's Lines

Curving transverse white bands. Seen in arsenic poisoning. Seen in Heart Failure, Hodgkins Lymphoma and CO Poisoning.

Lindsay's Nails

Half white Half Red Nail Bed. Indicative of Chronic Renal Failure

Lovibond's Angle of Clubbing

180 is clubbing. 160 is normal.

Meissner's Corpuscle Function

Fine Touch Receptors - aka wind blowing

Pacinian Corpuscle Function

Deep Pressure Touch Receptors and Vibration - aka someone holding your arms

What stratum of the epidermis is found exclusively on the lips, palms and soles?

Lucidum

What stratum of the epidermis does the keratin start?

Granulosum

In what structure is the pigment of hair determined?

Cortex

What are the three parts of the hair?

Medulla, Cortex, and Cuticle

Vellus Hair

Short, Fine, Inconspicuous

Terminal Hair

Coarse, Thick, Pigmented

Eponychium

Thin layer of epithelium covering during development. AKA Cuticle

Hyponychium

Epithelial layer that the nail rests on - aka Nail Bed

Nail Matrix

Keratinized cells of the proximal nail fold

Where is carotene located in the body and what color?

Golden yellow pigment in subcutaneous fat

Oxyhemoglobin versus Deoxyhemoglobin. Color and Location

Oxy is bright red in arteries and capillaries. Deoxy is bluish in cutaneous blood vessels.

What skin reaction does an ARB cause?

Marbling rash of the flank of the body

What is a common sensation felt from candida?

Burning

Primary Lesions

Basic lesions that form first. (Macules, Papules, Nodules, Tumor, Plaque, Wheal, Vesicle, Bulla, Pustule)

Secondary Lesions

Evolutionary process of disease or lesions that manifest from scratching or infection (scales, crust, fissure, ulcer, scar, atrophy)

Tenting

Sign of Dehydration. Skin with decreased turgor remains elevated after being pulled up and released. Indicates loss of collagen in the elderly

Turgor

Normal ability of skin to quickly resume its shape

SPECIAL SCAB Mnemonic for describing skin lesions

Size, Pattern, Elevation, Color, Location, Shape, Consistency, and Borders

Discrete

Random Spots

Grouped

Rash is clustered together

Macules

Flat non-palpable < 1 cm (Freckles and Peutz-Jegher Syndrome)

Peutz Jegher's Syndrome

Flat macules on the lips and other mucosa

Patch

Flat, non-palpable >1cm (vitiligo, café au lait spots)

Papule

Elevated solid mass < 1cm

Nevi

Well circumscribed hyperpigmented papule or macule (birthmark, beauty mark, mole)

Tumor

Solid elevated mass >2cm

Vesicle vs Bulla

Vesicle <1cm. Bulla >1cm.

Abscess

Localized accumulation of purulent material in the dermis

Treatment for Abscess

I and D

What are verrucae caused by?

Warts caused by Human Papilloma Virus

Corn versus Callus

Corn is conical structure of keratin pointing toward dermis, therefore painful. Callus is thickening of epidermal keratin.

Scaling

Exfoliated epidermis

Lichenification

Roughening and thickening of epidermis

Petechiae versus Purpura

Petechiae is 1 to 3 mm

Keloid versus Hypertrophic

Keloid moves beyond the scar line, hypertrophic scarring does not

Erosion vs Ulcer

Erosion heals without a scar. Ulcer heals with a scar.

Hematoma vs Ecchymosis

Both are >10mm, hematoma is palpable, ecchymosis is not

Annular

Ring or Target

Example of Annular Lesions

Urticaria, Erythema Multiforme

Stage 1 through 4 Pressure Ulcer

1 is intact. 2 is partial. 3 is full skin. 4 is into muscle or bone, common for sinus tracts.

Patch Test

Validate Diagnoses of Allergic Contact Sensitization

Darier's Sign

Scraping skin causes red, wheals

Nikolsky Sign

Blisters Spread Upon Pressure to Skin

KOH Prep Procedure

Scrape skin, heat slide, add 10% KOH

Tzanck Smear Procedure

Scrape vesicle base, add Giemsa or Wright Stain

Excisional Biopsy

Lesion Completely Removed. Used in melanoma

Incisional Biopsy

Cross-section wedge of tissue through center of lesion. Used when lesion is too big to excise and diagnosis is unsure.

Shave Biopsy

Horizontal Shave of skin lesion with only superficial portion of dermis. Only to remove benign lesions.

Moh's Procedure

Highly specialized method of excision. Debulk obvious tumor then excision performed in stages guided by histological mapping to remove as little tissue as necessary.

Two stages of sun tanning

Immediate pigment darkening primarily from UVA, is photochemical change in melanin not increase in melanin. Synthesis of new melanin occurs within 72 hours.

Kerion is seen in what condition

Tinea Capitis

Queen Anne's Sign

Lateral eyebrow alopecia. Seen in Hypothyroidism

Koilonychia

Spooning of nail. Associated in iron deficiency anemia

Nail Pitting

Associated with psoriasis

Terry's Nail

Nail is mostly white. Sign of Heart Failure, Aging, or chronic disease like Cirrhosis

Brown Yellow Nail Caused by

Phenindione an anticoagulant

Brown Black Nail

Onychomycosis or Paronychia. Fungal infection

Leukonychia

White nail

Splinter Hemorrhages may be seen in

Endocarditis, Vasculitis, Leukemia, Lupus, and Trauma

Beau's Lines

Transverse depression of nail plate. Associated with systemic illness that disrupts growth

Mee's Lines

Curving transverse white bands. Indicates arsenic poisoning, heart failure, hodgkin's disease or carbon monoxide poisoning

Onycholysis

Separation of nail plate from nail bed. Seen in trauma, psoriasis, diabetes, drug interactions, and excessive manicuring

Lindsay's Nails

Half White and Half Red. Indicates Chronic Renal Failure

Lovibond Angle

Normal = 160. Clubbing = 180.

Felon versus Paronychia

Felon is finger tip. Paronychia is nail matrix.

Nail biting causes risk for

Eponychium Infection

White nail plates indicates

Severe liver disease

Guttate Psoriasis

Small drop-like plaques with scales developed after a child having strep pharyngitis

Atopic Dermatitis Location

Flexor Surfaces

Pityriasis Rosea

Christmas Tree, Herald Patch

What is the most common type of allergic contact dermatitis in the US?

Rhus Dermatitis

Poison Ivy description

3 Leaves together, shiny

Where is Meissner's Corpuscles Located

Dermis between epidermal ridges. Unmyelinated

Papillary Dermal Layer

More superficial, directly beneath the epidermis

Reticular Dermal Layer

Contains crisscrossing collagen fibers forming cleavage lines

Arcuate

Partial Ring

Iris

Target

Reticular

Marble Like

Peutz Jeghers Syndrome has a higher chance of developing what

Intestinal Cancer

What is the most common type of basal cell carcinoma?

Nodular Basal Cell Carcinoma

Appearance of Basal Cell Carcinoma

Pearly borders