CH7 Integumentary System

A set of practice Q&A flashcards covering key topics from the dermatology and wound-care lecture notes, including skin cancers, infectious diseases, dermatologic conditions, and wound management.

What is Acral lentiginous melanoma and where is it most commonly located?

Acral lentiginous melanoma is a melanoma subtype most common in darker-pigmented individuals; lesions are located on the nail beds (subungual), palms, and soles, and rarely mucous membranes; subungual melanomas can appear as longitudinal brown-to-black bands on the nail bed.

What is the characteristic presentation of subungual acral lentiginous melanoma?

Longitudinal brown-to-black bands on the nail bed.

What is Actinic Keratosis and who is at highest risk?

Actinic keratosis is a precancerous lesion with dry, round, red lesions and rough texture due to sun exposure; common in older fair-skinned adults; risk of progression to squamous cell carcinoma.

How is anaphylaxis treated in the outpatient setting?

Immediate intramuscular epinephrine (0.3–0.5 mg) with doses every 5–15 minutes as needed; call 911; there are no absolute contraindications to epinephrine in anaphylaxis.

What are the three clinical presentations of Basal Cell Carcinoma and their features?

Nodular: pink/flesh-colored papule with pearly/translucent quality and telangiectasia on the face; Superficial: trunk lesions that are slightly scaly patches or plaques; Morpheaform: smooth, flesh-colored or very light pink papules or plaques with ill-defined borders and induration.

What is the most common risk factor for Basal Cell Carcinoma?

Exposure to ultraviolet radiation from sunlight.

Where are Brown Recluse spiders found and what serious complication can occur in young children?

Found mostly in the midwestern and southeastern United States; systemic symptoms can include fever, chills, nausea, and vomiting; deaths are rare but have occurred in children under 7 years due to hemolysis.

What are the melanoma risk factors?

Family history of melanoma (~10%), extensive/intense sun exposure, blistering sunburn in childhood, tanning beds, high nevus count/atypical nevi, and light skin/eyes.

Can melanoma be located in unusual sites such as the retina?

Yes; lesions can be located anywhere on the body, including the retina.

What is Meningococcemia and how is it managed?

Acute systemic meningococcal disease caused by Neisseria meningitidis; can present with meningitis and meningococcemia; petechial or purpuric rashes, hypotension/shock, DIC possible; rifampin prophylaxis for close contacts; vaccination for at-risk groups; aerosol precautions.

What are the key features and initial treatment for Rocky Mountain Spotted Fever (RMSF)?

Abrupt onset of high fever, chills, severe headache, nausea/vomiting, photophobia, myalgia; rash (petechiae) starting on wrists/forearms and ankles then trunk; most cases spring to early summer; first-line treatment is doxycycline for all ages.

What is Shingles involving the trigeminal nerve (Herpes Zoster Ophthalmicus) and why is timely referral important?

Reactivation of varicella-zoster virus with involvement of the ophthalmic branch of CN V; sudden eruption of vesicles on one side of scalp/forehead and sides/tip of the nose; involvement of the tip of the nose suggests ocular involvement; refer to ophthalmology or ED urgently.

How are Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) differentiated by extent of body involvement?

SJS involves

What is a subungual hematoma and when should it be drained?

Direct trauma to the nail bed with blood trapped under the nail; risk of permanent ischemic damage if >25% of the nail area is involved and not drained; can be treated by trephination with a heated instrument or needle to create a drainage hole; large hematomas may require radiographs, antibiotics, and hand surgery consult.

What are the three skin layers and their main components?

Epidermis (no blood vessels; melanocytes in the bottom layer; vitamin D synthesis); Dermis (blood vessels, sebaceous glands, hair follicles); Subcutaneous layer (fat, sweat glands, hair follicles).

What does Acral mean in dermatology?

Distal portions of the limbs (hands or feet), as in acral melanoma.

What are wheals in urticaria and when is urticaria considered chronic?

Hives—erythematous, raised lesions with discrete borders that appear and disappear; chronic urticaria lasts longer than 6 weeks; multiple etiologies; can be associated with angioedema or anaphylaxis.

Describe Seborrheic Keratoses and their typical appearance?

Soft, wartlike, fleshy growths on the trunk with a “pasted-on” look; color ranges from light tan to black; generally painless and common with aging.

What is Xanthelasma and its clinical implications?

Raised, soft, yellow plaques under the brow or eyelids; suggestive of hyperlipidemia in about 50% of cases; xanthomas on fingers are pathognomonic for familial hypercholesterolemia; obtain a fasting lipid profile.

What is Melasma and who is most commonly affected?

Bilateral brown-to-tan macules/patches on sun-exposed skin (e.g., cheeks, malar area, forehead, chin); common in women of reproductive age; risk factors include genetics, sun exposure, skin phototype, and hormonal factors (pregnancy, oral contraceptives); stains can be permanent but may lighten over time.

What is Vitiligo and its risk factors?

Loss of epidermal melanocytes with white patches; chronic and progressive; risk factors include autoimmune diseases (e.g., Graves’ disease, Hashimoto’s thyroiditis, RA, psoriasis, pernicious anemia).

What is a Cherry Angioma and its management?

Benign small bright cherry-red papules (1–4 mm) due to a nest of malformed arterioles; blanch with pressure; common in middle-aged to older adults; no treatment needed.

What is a Lipoma and when might it be removed?

Soft, fatty, subcutaneous tumors; usually on neck, trunk, and arms; typically 1–10 cm or larger; smooth with discrete edge; excision is an option if symptomatic or for cosmetic reasons.

What are Nevi (moles) and the main types described?

Junctional nevi: flat macules or minimally raised brown/black lesions; Compound nevi: pigmented papules; commonly on trunk and legs.

What is Xerosis and why is it clinically important?

Extremely dry skin; can be part of various dermatoses and complicate management.

What is Acanthosis Nigricans and what conditions is it associated with?

Diffuse velvety thickening of skin, usually behind the neck and in the axilla; associated with diabetes, metabolic syndrome, obesity, and GI tract cancers.

What are Acrochordon (skin tags) and who is more likely to have them?

Painless, pedunculated outgrowths of skin; common on the neck and axillary area; incidence increases with age and is higher in diabetics and obese individuals.

What are the main potency classes for topical corticosteroids and general usage guidelines?

Potency classes I (superhigh) to VII (least potent); use super-high potency for severe dermatoses on non-facial/non-intertriginous areas for up to 2 weeks; medium-high for mild-to-moderate non-facial/non-intertriginous areas; low-medium for larger areas; low-potency for eyelids and genitals; monitor for HPA axis suppression with prolonged use.

Which topical steroids serve as Class I and Class VII examples?

Class I: Halobetasol propionate (Ultravate); Class VII: Hydrocortisone 1% (OTC).

How is mild acne (topicals only) typically treated?

First-line therapy includes topical retinoids, benzoyl peroxide, and topical antibiotics (e.g., tretinoin 0.25% cream started every other night, then nightly; may add benzoyl peroxide and/or clindamycin).

What is isotretinoin REMS (iPLEDGE) and why is it required?

Isotretinoin is teratogenic and requires iPLEDGE REMS: two reliable contraception methods, 1-month supply limit, monthly pregnancy tests, and stopping therapy if adverse effects occur (e.g., depression, visual changes, pancreatitis).

How is moderate acne managed and when might isotretinoin be considered?

Moderate acne: topical therapies plus oral antibiotics; combination therapy often used; Severe nodular acne: isotretinoin is recommended as initial therapy and may be combined with systemic glucocorticoids.

What is Actinic Keratoses’ risk of progression to squamous cell carcinoma and typical management?

Actinic keratoses are precancerous and can progress to squamous cell carcinoma; about 60% of cutaneous SCC arise from pre-existing AKs; management includes biopsy, cryotherapy, or topical agents like 5-FU or imiquimod.

What are the four phases of wound healing?

Hemostasis, Inflammation, Proliferation, Remodeling.

What are the criteria for burn center referral?

Partial-thickness burns >10% TBSA, burns involving face/hands/feet/genitals/major joints, full-thickness burns, electrical/chemical burns, inhalation injury, burns in patients with comorbidities or needing rehab.

What are the main wound healing closure options?

Primary closure (sutures/adhesives) for clean wounds; Secondary intention (healing from wound base with granulation tissue); Tertiary (delayed primary closure) for heavily contaminated or poorly vascularized wounds.

What are the general rules for suturing and wound closure?

Do not suture heavily contaminated or infected wounds; avoid suturing puncture wounds or human/animal bites; old wounds (>12–24 hours) have higher infection risk; choose appropriate suture material and knot technique; avoid closing contaminated wounds.

What is a punch biopsy and when is it indicated?

A skin punch biopsy is used to obtain a sample for histopathology; consider history of bleeding disorders or anticoagulants; label specimen with site and patient information.

What is cryotherapy and its common adverse effects?

Cryotherapy causes ice crystals to form and destroy cells; results in blistering and crusting as the treated area heals; adverse effects include hypopigmentation (more common in darker skin), possible scarring or alopecia; avoid eye area, lip border, nail matrix.

What is the recommended treatment for scabies (classic vs crusted)?

Classic: permethrin 5% cream; crusted (Norwegian): combination therapy with permethrin and ivermectin; treat all household members; wash clothes/bedding; itchy for weeks despite treatment.

What are common dermatophyte infections and their typical treatment approach?

Tinea infections (dermatophytes) include tinea capitis, barbae, corporis, cruris, pedis, unguium; most treatable with topical antifungals (azoles, allylamines, ciclopirox); extensive/refractory disease or tinea capitis requires systemic antifungals (terbinafine, fluconazole, griseofulvin). Nystatin is not effective.

What is Lyme disease’ classic rash and the recommended initial treatment for early disease?

Erythema migrans is an expanding red rash with central clearing (bull’s-eye) that appears 7–14 days after a tick bite; treat with doxycycline 100 mg twice daily for 10 days (or alternatives amoxicillin or cefuroxime axetil for 14 days). Two-step serology (EIA followed by IFA/Western blot) is used for confirmation but not for initial treatment.

What are vaccines related to Varicella and Shingles and their general guidance?

Varicella vaccine: two-dose series for children, adolescents, and adults; Shingrix (recombinant zoster vaccine): two-dose series from age 50+ regardless of prior shingles history; contraindications include allergy to vaccine components or acute illness; pregnant individuals should defer.

What are the key steps in tick removal and why is timing important in RMSF?

Remove tick by steady upward traction, not with heat or substances; early empiric treatment with doxycycline is crucial for RMSF regardless of initial serology; begin treatment promptly if RMSF is suspected.

What are the major cutaneous signs of erythema migrans and their clinical context?

Red target-like expanding lesion (bull’s-eye) associated with early Lyme disease after Ixodes tick exposure; may be accompanied by flu-like symptoms; treat promptly with doxycycline if suspicion is high.

What is the role of EIA/IFA in Lyme disease testing and interpretation?

Two-step testing: initial EIA; if positive or equivocal, confirm with IFA/Western blot; serology alone cannot definitively diagnose Lyme disease, especially early infection where antibodies may be negative.

What is the general management plan for a wound with suspected tetanus risk?

Assess tetanus immunization status; administer Tdap if last dose >5 years ago; provide wound care and tetanus prophylaxis as indicated.

What is the classic presentation and management of impetigo?

Acute contagious superficial bacterial skin infection (beta-hemolytic Streptococcus or Staphylococcus aureus); honey-colored crusts; treat with topical mupirocin for limited lesions or cephalexin for more extensive disease; ensure hygiene and avoid sharing towels.

What is the management approach for purulent vs non-purulent cellulitis and MRSA risk?

Purulent cellulitis: often MRSA; oral options include TMP-SMX, amoxicillin+ doxycycline, or linezolid; Non-purulent cellulitis: typically streptococci; treat with beta-lactams (e.g., dicloxacillin, cephalexin). Elevate limb and monitor response.

What are typical findings and management of dermatitis/eczema (atopic dermatitis)?

Chronic pruritic inflammatory skin condition; infants have broader distribution; adults have flexural involvement; manage with moisturizers, avoid irritants, topical steroids by potency, and consider calcineurin inhibitors for sensitive areas; antihistamines for pruritus.

What factors can impair wound healing and delay recovery?

Older age, poor nutrition, immune suppression, impaired mobility, stress, diabetes, certain medications (steroids), pressure, smoking, and secondary infection.

What distinguishes tinea versicolor from other hypopigmented lesions and how is it treated?

Hypopigmented macules on trunk/shoulders after tanning; diagnosed by KOH showing hyphae and spores; treated with selenium sulfide or azole antifungals (ketoconazole, terbinafine) topically; lesions may persist for months.

What is necrotizing fasciitis and what is the recommended action?

Rapidly progressive infection with severe pain, erythema, edema, and bullae; often requires urgent ED evaluation and aggressive surgical debridement plus antibiotics.

What is paronychia and its common causative organisms?

Acute infection of the nail folds; commonly caused by S. aureus, S. pyogenes, or Pseudomonas; treat with warm soaks and topical antibiotics; incision and drainage if abscess is present.

What is paronychia’s typical management when an abscess is present?

Incision and drainage; treat with appropriate antibiotics; ensure tetanus status; avoid suturing infected abscess.

What is the difference between a furuncle and a carbuncle?

Furuncle is a boil from a single hair follicle; a carbuncle is a cluster of boils with multiple heads; both may require antibiotics and drainage.

What is a common first-line treatment for impetigo in children?

Topical mupirocin or retapamulin for limited lesions; cephalexin for more extensive disease; ensure hygiene and prevent spread.

What is the standard approach to treating onychomycosis (tinea unguium)?

Diagnosis by fungal culture; milder cases start with topical antifungals (efinaconazole, ciclopirox); more extensive disease or toenails require systemic therapy (terbinafine or itraconazole) for weeks; check liver function if systemic therapy used.

What is the typical presentation and treatment for tinea capitis?

Tinea capitis requires systemic antifungal therapy (griseofulvin, terbinafine, or itraconazole); topical antifungals are insufficient alone.

What is rosacea and its four subtypes?

Chronic inflammatory facial dermatitis with four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular; triggers include spicy foods, alcohol, and sun; management includes sun protection and topical therapies (metronidazole, azelaic acid, ivermectin) with systemic antibiotics for more severe disease.

What is herpes zoster ophthalmicus and why is it urgent to refer?

Herpes zoster involving the ophthalmic division (CN V1) can threaten vision; patients may have ocular pain and vesicular eruption around the eye; urgent ophthalmology referral is needed.

What is the two-step approach to rubella? (Note: This card is not in the provided notes; omitted to maintain accuracy.)

Not applicable.

What vaccine schedule is recommended for varicella vaccination in children and adults?

Two doses: first at 12–15 months, second at 4–6 years; catch-up schedule for adolescents/adults with two doses 4–8 weeks apart; contraindicated in certain immunocompromised states and pregnancy.

What is the management of shingles (herpes zoster) in uncomplicated cases?

Antiviral therapy (acyclovir or valacyclovir) started ideally within 48–72 hours of rash onset; pain control; consider treatment for postherpetic neuralgia with TCAs or gabapentin; lidocaine patches for persistent pain.

What is the general advice for preventing tinea pedis recurrences?

Keep feet dry, dry between the toes, use antifungal powders; treat both feet and any affected nails as needed; avoid sharing footwear and socks.

What are the common laboratory tests used in evaluating suspected RMSF and Lyme disease?

RMSF: diagnosis is clinical; confirm with serology (IFA) later; Lyme: two-step testing with EIA followed by IFA/Western blot; early infection may be seronegative.

What is the main treatment for impetigo and its bullous variant?

For limited lesions: topical antibiotics (mupirocin or retapamulin); for more extensive disease: oral antibiotics (cephalexin or dicloxacillin); bullous impetigo may have larger blisters and widespread crusting.

What is the typical management of cellulitis in MRSA risk situations?

If purulent and MRSA risk factors, consider TMP-SMX, doxycycline with trimeth if necessary, or linezolid; for nonpurulent, use beta-lactams targeting streptococci; monitor closely and escalate if worsens.

What is the clinical significance of Koebner phenomenon in psoriasis?

New psoriatic plaques form at sites of skin trauma; important diagnostic clue in psoriasis.

What is the clinical hallmark of pityriasis rosea?

Herald patch followed by a Christmas-tree distribution rash on the trunk; usually self-limited in 6–8 weeks; treat with mild steroids for itching if needed.

What is the management approach for keratin disorders like ichthyosis? (Note: not covered in the provided notes; omitted to maintain accuracy.)

Not applicable.