MSK 2 > Matthys > Flashcards

Matthys Flashcards

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1
Q

flat spot on skin measuring <1 cm?

> 1 cm?

A

Macule

Patch

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2
Q

nonpustular, nonvesicular lesion on skin <1 cm?

> 1 cm

A

papule

nodule

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3
Q

small blisters < 1 cm?

> 1 cm?

A

vesicle

bulla

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4
Q

a collection of leukocytes in the epidermis?

A

pustule

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5
Q

broad, elevated flat lesions > 1 cm

A

plaque

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6
Q

Description of lesions in atopic dermatitis

A
  • erythematous popular
  • areas of scaling
  • pruritic
  • appears as patchy, dry, scaly eruptions
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7
Q

location of lesions in atopic dermatitis

A
  • facial rash on cheeks, sparing perioral and perinasal areas
  • generalized erythematous popular rash on trun and extremities with sparing of diaper area
  • no eruptions noted on interdigital web areas of toes or fingers
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8
Q

associated clinical findings with atopic dermatitis

A
  • xerosis and icthyosis vulgaris
  • pigmentary changes
  • eye and periorbital changes
  • hand and foot dermatitis
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9
Q

complications with Atopic Dermatitis

A
  • infection
  • exfoliative erythroderma
  • mental and emotional anguish with growth disturbance
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10
Q

pathogenesis of Atopic Dermatitis

A
  • T cell
  • food allergy
  • Aeroallergens
  • irritant contactants
  • Histology non specific with spongiosis, eos, and features consistent with LSC
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11
Q

Treatment of Atopic Dermatitis

A
  • Moisturize
  • Avoid irritants
  • Avoid known food allergies
  • Topical and oral antipruritic agents
  • anti inflammatory agents
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12
Q

-Acute, rapidly spreading nonsuppurative infection of the skin and underlying soft tissue NOT including the muscle

A

Cellulitis

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13
Q

Clinical finding in Cellulitis

A
  • Tender, warm poorly demarcated boggy plaque
  • commonly on extremity
  • Trauma
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14
Q

pathogenesis of cellulitis

A
  • Trauma to an extremity either known or unknown

- concurrent ulcer

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15
Q

risk factors for cellullitis

A
  • stasis dermatitis

- Lymphedema

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16
Q

Treatment of Cellulitis

A
  • it is usually Staph or Strep pyogenes
  • first gen cephalosporin, macrolide or clindamycin
  • elevation
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17
Q

symmetric erythematous nodules and plaques located on the anterior lower extremities

A

erythema nodosum

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18
Q

age for erythema nodosum

A

peak 20-30

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19
Q

clinical findings in Erythema Nodosum

A
  • Tender nodules and plaques on the bilateral knees, ankles, and shins
  • sometimes thighs and upper extremity
  • 1-15 cm in size
  • rarely ulcerate
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20
Q

etiology of erythema nodosum

A

-hypersensitivity response (infection, medicine, herbs vitamins) . .can be brought on by birth control

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21
Q

Treatment of erythema nodosum

A
  • anti inflammatory

- rest

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22
Q

Psoriasis: Koebner?
Ausptitz?
Woronoff’s ring?

A
  • Recreate psoriasis based on trauma
  • Peel off scale and get pinpoint bleeding
  • Get rid of psoriasis and it leaves a sort of stain behind
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23
Q

Histology of Psoriasis

A
  • Acanthotic epidermis with club shaped rete ridges and an ABSENT GRANULAR LAYER
  • tortuous vessels seen in the papillary dermis
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24
Q

3 common types of psoriasis

A
  • Plaque type
  • Pustular
  • Guttate
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25
describe Plaque type psoriasis
- well demarcated scaly plaque - elbows, knees, belly button - coin shaped - annular pattern - thick
26
describe pustular type psoriasis
- Sterile sheets of pustules on an erythematous base - Localized or generalized - painful with fever
27
Describe Guttate type psoriasis
- children and young adult - post strep infection - some predisposition to psoriasis - trunk with sparing of palms and soles
28
clinical findings for Herpes Zoster
- local radicular pain 2-3 days prior to the eruption - Disseminated Zoster - Herpes Zoster Ophthalmicus - Postherpetic neuralgia
29
pathology of Herpes Zoster
Steel gray nuclei multinucleated giant cells with eosinophilic intranuclear inclusions
30
Treatment of Herpes Zoster
- Antivirals - Contagious; can cause chickenpox - Pain control - vaccine at age 60
31
what are the papulosquamous diseases
- Psoriasis - Seborrheic dermatitis - Erythrasma - Lichenoid eruptions - Pityriasis rosea - Dermatophyte infections
32
environmental factors fr psoriasis vulgaris? | Genetics?
- Smoking, sun, alcohol | - HLA-B13 autosomal dominant
33
drugs that can lead to psoriasis
- lithium - B-blockers - NSAIDs
34
pregnancy and psoriasis
can make it better
35
highlights for Seborrheic dermatitis
- Scalp/face/chest - P. ovale - Humidity, trauma, seasons - HIV
36
pathophysiology of Seborrheic Dermatitis
- Abnormal immune response to P. Ovale with normal amount of the yeast - Free Fatty acid release
37
describe the lesions of Seborrheic Dermatitis
- Branny greasy red scale on face/chest/penis | - mild flaking in hair baring areas
38
highlight of Erythrasma
- Corynebacterium minutissimum: gram + rod, part of normal skin flora - CHRONIC - Diabetes - warm humid places
39
pathophysiology of erythrasma
- Bacterial infection affecting the intertriginous areas (toes/groin/axilla) - red/brown scaly macules with on erosive collarette like scale - WOOD's LAMP
40
Highlights for Lichen Planus
- Hep C - painful/burning - Wrists/nails/oral cavity/genitalia . . SCC of the oral mucosa - Wickham's stria - puruitic, purple, papules, and plaques
41
Highlights for Pityriasis Rosea
- rose or pink colored scaly patches or thin plaques - spring and fall - Herald patch - pruritic eruption - "Christmas tree" pattern - if around pregnant woman they can have miscarriages at a higher rate
42
pathophysiology of pityriasis rosea
- viral exanthema - increase in CD4 and Langerhan's cells in the dermis - unknown
43
Reddish-orange scaling plaques of unknown etiology with palmoplantar keratoderma and follicular keratotic papules
Pityriasis Rubra pilaris
44
highlights for pityriasis Rubra Pilaris
- Autosomal dominant inheritance | - Disease has many features of a vitamin A deficiency
45
Describe Griffith's classification of Pityriasis Rubra Pilaris
- Type 1: classic adult type, most common, red brown plaques with "islands of sparing" - Type 2: adult atypical, icthyosiform - Type 3: classic juvenile, similar to 1 but before age 2 - Type 4: CIRCUMSCRIBED JUVENILE, well demarcated follicular hyperkeratosis along elbows and knees - type 5: ATYPICAL JUVENILE, prominent follicular hyperkeratosis with scleroderma type changes on palms and soles - Type 6: HIV, orange red plaques with follicular hyperkeratosis and islands of sparing, skin, mucous membranes, nails, eyes
46
Highlights of cutaneous T cell lymphoma
- T cell lymphoma affecting the CD4 helper cells - lymph nodes and organs become involved during the disease process - >50 years of age - 27:1 M:F
47
Pathophysiology of cutaneous T cell lymphoma
- HTLV - unknown - CD8 - B cells
48
Clinical features of cutaneous T cell lymphoma
- Scalin plaques which mimic eczema - itchy - multiple different shades of red-brown - round, oval annular or bizarre shape - CHECK FOR LAD
49
Diagnosis and treatment of cutaneous T cell lymphoma
- Biopsy, chest X ray, CBC with buffy coat | - topical steroids, PUVA, topical nitrogen mustard
50
highlights for Discoid Lupus Erythematosus
- scarring atrophic photosensitizing dermatosis | - 20-40
51
pathophysiology of discoid lupus erythematosus
- not well understood - genetic predisposition - Heat shock protein induced by UV light
52
Clinical features of discoid lupus erythematosus
- mild itching of lesions; most asymptomatic - be aware of SLE symptoms; pericarditis, neurologic sx - malignant transformations (SCC) can occur in chronic lesions - Psoriasis, LP, PCT - Erythematous papule or plaque with modest amount of scale - hypo or hyperpigmented - SCARRED - mucosal, palms and soles
53
Diagnosis and treatment of discoid lupus erythematosus
- ANA and biopsy - sunscreen - topical steroid - IL steroids - surgery - antimalarials
54
pathophysiology and different drugs for Drug eruption
- over dosage: purpura with Coumadin - Accumulation: Argyria with silver nitrate - phototoxic: doxycycline - Imbalance of normal flora: candidiasis with antibiotics - Jarisch-Herxheimer: reaction to killing of bacterial or fungal by appropriate agent
55
who is at 10x risk of getting drug eruption
immunocompromised
56
Clinical features of drug eruption
- morbilliform, erythematous macular popular eruption with minimal scale until progressed or cleared - 2 weeks after new meds - Review all meds of prior 2 months
57
Diagnosis and treatment of drug eruption
- Blood work - Biopsy - HISTORY!!! - Clincal exam - antihistamines - Steroids
58
highlights for Impetigo
- highly contagious gram + bacterial infection of superficial layers of skin . . staph - bullous/nonbullous - <6 most common
59
pathophysiology of impetigo
- S. Aureus - 30% nares small % groin, hand, rectum, pharynx - normal flora - exfoliative endotoxins A and B - Neonates and infants most common for bullous
60
Clinical features of impetigo
- rapid blister, asymptomatic - hot weather - Crowded conditions - poor immune function - Atopic dermatitis, herpes infection, trauma - honey colored crust - Flaccid <1 cm bulla, usually ruptured - collarete of scale - no sore throat or LAD - Face most common but can be anywhere
61
Treatment of Impetigo?
- Antibiotics | - Glomerulonephritis
62
highlights for staph scalded skin syndrome
- Toxin mediated exfoliative dermatitis - severe impetigo to widespread skin denudation - exfoliation followed by painful erythema - Infants and young children - Nurseries and daycare
63
pathophysiology of staph scalded skin syndrome
- S. Aureus - Exotoxins (ET-1 and ET-2) - Blister at the GRANULAR LAYER OF THE EPIDERMIS SPLITTING THE DESMOSOMES
64
Clinical features of staph scalded skin syndrome
- Focus of infection - Fever, faint orange red macules - + nikolsky sign (skin is sloughed off by rubbing) - Paper like wrinkling of the epidermis - cultures are sterile - Dramatic . . heals in 5-7 days
65
Treatment of staph scalded skin syndrome
- Antibiotics - Fluids - culture/biopsy . . frozen section
66
highlights for pemphigus vulgaris
- Autoimmune blistering disease of the skin and oral mucosa | - circulating immunoglobulin G antibody against the intraepidermal keratinocytes
67
pathophysiology of Pemphigus vulgaris
- Binding of IGG autoantibodies causes loss of adhesion b/t keratinocytes - Desmoglein 3 - Circulating IGG1 and IGG4 - Disease activity correlated with circulating antibodies
68
clinical features of pemphigus vulgaris
- All races - 50-70% oral mucosa involvement - mucosa more than skin - flaccid bulla on the skin with an erosion in the oral - + Nikolsky's sign - + Asboe-Hansen sign- Lateral pressure on the bulla will spread the bulla to uninvolved skin
69
Causes of pemphigus vulgaris
- Genetic - Age - Disease Association . . MYASTHENIA GRAVIS AND THYMOMA
70
Diagnosis and treatment of pemphigus vulgaris
- Biopsy (DIF and HE) - IDIF - Prednisone, Imuran - Ophthalmologist
71
highlights of Herpes Simplex
- 2 types; HSV 1 and 2 - M>W - HSV 1 encephalitis 60-80% mortality - Primary infection, latency, recurrence
72
pathophysiology of Herpes Simplex
- HSV 1 respiratory droplets - HSV 2 genital contact - cytolytic infection with fluid filled vesicles - 70-90% of population has HSV1 and 22% has HSV2
73
Clinical features of Herpes simplex
- Asymptomatic to painful; prodrome of itching and burning - Herpetic whitlow and herpes gladiatorum - recurrent lesions common - immune status - encephalitis - Vesicular or ulcerative on an erythematous base - oral, genital, body, keratoconjunctival, encephalitis, anal - Seizures, headaches
74
Diagnosis and treatment of Herpes simplex
- Culture or biopsy | - antivirals
75
pathophysiology of Chicken pox
- Primary varicella virus; herpes family type 3 - Respiratory and direct contact with skin - 10-21 day incubation - Infectious 1-2 days prior to the rash and until the lesion crust
76
clinical features of chicken pox
- history of recent outbreak - Itchy rash - "oval teardrop on a erythematous base" - "dew drop on a rose pedal" - Face, trunk - Fever, shallow aphthous ulcers on oral mucosa - Spares the distal extremity
77
Diagnosis and treatment of Chicken pox
- clinical, culture, biopsy - NO ASPIRIN - VZIG - antivirals - antihistamines
78
highlights for Bullous Pemphigoid
- Chronic, AUTOIMMUNE, subepidermal blistering disease that RARELY involves the oral mucosa - Autoantibodies of IgG - uncommon
79
Pathophysiology of bullous pemphigoid
- IgG binds to skin antibodies activating complement and inflammatory mediators - Inflammatory cells release proteases causing bulla formation - Serum levels of BP Ag 2 may correlate with disease activities in some pts
80
Clinical features of bullous pemphigoid
- subacute or acute formation of tense bulla - UV radiation or drug induced - Bullous, vesicular, urticarial, acral in children - Causes include genetic, age, epitope spreading
81
Diagnosis and treatment of bullous pemphigoid
- Biopsy (HE and DIF) - IDIF - Prednisone and other immunosuppressive
82
Highlights for polymorphous light eruption
- idiopathic photodermatoses relating to sun exposure - papules, vesicles, and plaques - 75% American indian - F 2-3X >M
83
Pathophysiology of polymorphous light eruption
- UNKNOWN - type IV delayed hypersensitivity - UV-A induced ICAM-1
84
Clinical features of Polymorphous light eruption
- sunlight is etiologic factor most of time - Spring, lessens thoughout summer - about 30 min after sun exposure - papules, vesicles, urticarial or EM type features - UV-A or UV-B
85
Diagnosis and Treatmet of polymorphous light eruption
- R/O porphyria, lupus - Photopatch testing - Photo testing MED - topical steroid, oral or IM steroids, antimalarials
86
highlights for Dermatitis herpetiformis
- Immune mediated skin disease with a gluten sensitive enteropathy - rare in African american
87
pathophysiology of dermatitis herpetiformis
- Skin and GI - Circulating immune complexes are found - IgA binds antigen in the bowel and skin - Increased expression of HLA-B1, B8, DR8, DRQ - Patient have uniform gluten sensitivity
88
Clinical features of Dermatitis herpetiformis
- Pruritic, burning skin blisters distributed in a symmetric fashion; grouped - Last days to weeks - Urticarial wheal to vesicle to bulla
89
Diagnosis and treatment of Dermatitis herpetiformis
- HE and DIF biopsy - Clinical exam - Be aware of associated diseases - Dapsone and gluten free diet
90
highlights for Erythema multiforme
- Benign self-limited eruption classically seen as targetoid or iris shaped macules or vesiculopapules on the palms or soles - 50% under age 20
91
pathophysiology of erythema multiforme
- not understood/HSV cell mediated immune response - infection major cause - Drug . . sulfa/phenytoin/PCN/allopurinol - Foods, sunlight, contactants
92
Clinical features of erythema multiforme
- Dull red macules or papules with vesicles on palms or soles with little mucosa involvement - iris or target like - Bilateral and often symmetric - Polycyclic or arcuate - Koebner phenomenon - Mucosal involvement in up to 70% - Lips, anus, eyes, oropharynx
93
Diagnosis and treatment of erythema multiforme
- Biopsy - antivirals - steroids
94
Highlight of Toxic Epidermal Necrolysis (TEN)
- Extensive FULL THICKNESS skin detachment - Erythema multiforme spectrum - Early symptoms non specific
95
pathophysiology of TEN
- HLA-B12 - SLE - HIV - Medicines, infection: cell mediated cytotoxic reaction against epidermal cells, CD8 cells macrophages cytokines
96
Clinical features of TEN
- 1-3 week prodrome - Fever, skin tenderness - skin pain, burning - newly added drugs most common - Morbilliform, EM type eruption - skin with crinkled surface - Sheet like epidermal loss - + Nikolsky's sign - Mucosal membrane involvement
97
Diagnose and treatment of TEN
- D/C drug suspected - IV fluids - Burn unit - Steroids as last resort - IVIG - Prevent infection
MSK 2
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