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Benign Lesions

Derm

QuestionAnswer
Seb keratosis found anywhere except palms & soles
Seb keratosis variants dermatosis papulosa nigra (AA pts): on the face; stucco keratosis (older Caucasians): on lower legs, ankles, and dorsal hands / feet
Sign of Leser-Trelat: Sudden eruption of many seborrheic keratoses may be a cutaneous sign of internal malignancy
Achrocordon most common in: women & obese pts
Dermatofibroma sites usually legs, but also trunk & arms
Dimple sign & button sign: for: dermatofibroma
Contents: cheesy consistency and a nasty odor: epidermal cyst
organized clusters of melanocyte-derived nevus cells nevi (moles)
These have a life cycle of their own: nevi
Nevus: 3 types junctional, compound, intradermal
Junctional nevus: clustered at the dermal-epidermal junction (DEJ); Flat or slightly raised, tan or brown, round or oval lesions
compound nevus: Nevus cells found at both the DEJ & in the dermis; Slightly to markedly raised, tan, brown, or black papules.
intradermal nevus: Raised, soft, flesh-colored, tan, or brown papules. Pigment may be arranged in flecks; may see coarse hairs
halo nevus rim of depigmentation; autoimmune; usually repigments; may be assoc w/vitiligo & malignant melanoma
spitz nevus kids (rarely adults); benign, pink, tan, or brown dome-shaped smooth papules; face, scalp, neck, and legs; rapid growth; excision bc melanoma may arise from spitz nevus
developmental anomaly appearing as a brown patch, a patch of hair, or both: becker’s nevus
Congenital Melanocytic Nevus: Increased risk of malignant melanoma in: lesions larger than 20 cm.
Ephilides = freckles
Fordyce spots: Ectopically located sebaceous glands
Do not blanch well using diascopy: cherry angioma
Spider angioma: diascopy: Common, benign, dilatation of superficial bleed vessels; Arteriole perpendicular to skin; radiating vessels easily blanch with diascopy, but central vessel may not, and may pulsate
Common papulosquamous lesions (raised/have scale) Psoriasis; Seborrheic dermatitis; Pityriasis rosea; Lichen planus; Tinea corporis; Syphilis; Drug reaction
Seb dermatitis: adults infreq shampooing; bedridden / chronic ill; PD; persistent cases, check for fungal infxn
Causes of lichen planus Drugs (gold, chloroquine, methyl-dopa, penicillamine); film processing; Bac infxn (secondary syphilis); Post-BMT GVHD
Wickham’s stria lacy-reticulated pattern of white lines on surface; focal areas of epidermal thickening; in lichen planus
Lichen planus sites Most commonly on flexor surface of wrists and forearms; legs above the ankles; lumbar; eyelids; shins, scalp
ACD acute vs chronic Acute: macules, papules, vesicles, bullae; Chronic: lichenified, scaling, fissured lesions
Darier sx rubbing lesion causes urticarial flare
Auspitz sx pinpoint bleeding after scale is removed
Nikolsky sx pushing blister => further separation from dermis
Shagreen skin: oval nevoid plaque; skin pigmented on trunk/back; assoc w/tuberous sclerosis
atopic dermatitis: itch-scratch cycle => pruritic circumscribed plaques = lichen simplex chronicus
5 P's of Lichen planus: purple, polygonal, pruritic, papule, planar
erythematous, annular patch w/central clearing; fine scale: dermatophytosis
varicella zoster is reactivation of VZV that was dormant in: ganglionic satellite cells
Hutchinson sign VZV; involve trigeminal nerve => eye & nose
Ramsay Hunt VZV; affect external ear, facial palsy, & geniculate
Beefy red, sharp bordered rash (patches/plaques) in groin (infants), under breast folds with satellite lesions Candida
Warm, erythematous, tender skin with possible induration or fluctuance Cellulitis
Red, less distinct borders; coral red fluorescence under Wood’s lamp: Erythrasma (Corynebacterium minutissimum)
Distinct, sharp raised demarcated border with fever, chills. Group A Strep Erysipelas
Grouped vesicles on erythematous base Herpes virus
Infant or pediatric w/ grouped vesicles on thumb or “tapioca” vesicles on thumb Herpetic whitlow
Pain preceding vesicular rash in dermatomal pattern Herpes Zoster (if involved eye = herpes keratitis)
if a group of lesions has a dermatomal distribution what disease is it likely to be herpes zoster (shingles)
Honey colored crusts on erythematous base around nose & mouth Impetigo; tx: mupirocin
Small white papules on diffusely red base on buccal mucosa = Koplik spots: Rubeola (Measles); spots occur before rash
Cough, coryza, conjunctivitis Rubeola (Measles)
Pastia’s lines, positive ASO titer Scarlet fever (Grp A Strep)
Strawberry tongue Scarlet fever (Grp A Strep)
Dewdrops on rose petal, pustules & vesicles in crops (different stages of healing), centripetal pattern = Varicella (Chicken Pox)
Christmas tree pattern, erythematous papules w/ oval plaques w/ scaly itchy border. Large oval plaque w/ central clearing & scaly border (herald patch) precedes rash by 1-2 weeks = Pityriasis rosea (resolves in 6-12 weeks). May tx w/erythromycin stearate 250mg QID x2 weeks to prevent eruption
Hypopigmented lesions, white, scaly. Gets worse w/ tanning or sun exposure Pityriasis Alba
Erythematic ring with scaly border & central clearing Tinea (fungal infection); KOH prep = hyphae
spaghetti & meatballs Tinea (fungal infection
Thick, yellow, brittle nails Onychomycosis. Tx = PO Terbinafine
Infant w/ erythematous, scaly crusty lesions at vertex of scalp Cradle cap – seborrheic dermatitis (Tx in infants w/ baby shampoo, warm olive oil compress, mild Hydrocortisone cream; Adults – selenium sulfide shampoo)
Children < 10yo w/ vesicles on pharynx, mouth, hands, feet w/ NO ulceration Hand-Foot-Mouth disease. Coxksackie Virus
Healthy looking < 5yo with lace-like rash on both cheeks – red papules Erythema infectiosum; “Slapped cheek”, “5th Dz” (parvo B19)
Pediatric with high fever then after fever macular rash over trunk and neck. (rash after defervesence) Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
Truncal Rash in pediatric after fever Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
Fever, pharyngitis, “sandpaper” rash over face, neck, trunk, extremities Scarlet Fever
High fever (up to 105F) x 5 days then rash. May have conjunctivitis, cracking, lip fissures Kawasaki Disease; look for cardiac complications (myocarditis, pericarditis, arteritis, aneurysms)
Erythema marginatum Rheumatic Fever
Dark skinned person with “whitening or lightening” of skin. Hx pernicious anemia or other autoimmune disease Vitiligo. Skin biopsy to diagnose
Postauricular & occipital LAD; maculopapular rash on face then spreads = Rubella (german measles); dx w/paired sera; resolves in 4 days; sx tx
Leser-Trelat sx: Sudden eruption of many seborrheic keratoses may be a cutaneous sign of internal malignancy
Dermatofibroma sites usually legs, but also trunk & arms
Dimple sign & button sign: for: dermatofibroma
junctional nevus: clustered at the dermal-epidermal junction (DEJ); Flat or slightly raised, tan or brown, round or oval lesions
compound nevus: Nevus cells found at both the DEJ & in the dermis; Slightly to markedly raised, tan, brown, or black papules.
intradermal nevus: Raised, soft, flesh-colored, tan, or brown papules. Pigment may be arranged in flecks; may see coarse hairs
halo nevus rim of depigmentation; autoimmune; usually repigments; may be assoc w/vitiligo & malignant melanoma
spitz nevus kids (rarely adults); benign, pink, tan, or brown dome-shaped smooth papules; face, scalp, neck, and legs; rapid growth; excision bc melanoma may arise from spitz nevus
developmental anomaly appearing as a brown patch, a patch of hair, or both: Becker’s nevus
Ephilides = freckles
Fordyce spots: Ectopically located sebaceous glands
These do not blanch well using diascopy: cherry angioma
Herpes keratitis tx NO steroids. Get immediate ophthalmology referral
oral candida (thrush) tx fluconazole, itraconazole, or Ampho B
Candidal fungemia tx life threatening (40% mortality); IV ampho B; add flucytosine if disseminated dz
hidradenitis suppurativa mgmt If abscess: I&D then inject triamcinolone. Abx
hidradenitis suppurativa risk factors obesity, apocrine gland obstruction, FH of acne or hidradenitis suppurativa
molluscum contagiosum etiology Poxvirus (MCV-1 & MCV-2) via skin-skin contact. Mostly kids, adults (via sex) & pts with HIV
Cellulitis in kids H flu: tend to occur on face & neck. S aureus: tend to occur on extremities. GABHS also common organism
Cellulitis organisms in adults S aureus and GABHS
Cellulitis tx If penicillinase producer: Augmentin, dicloxacillin, azithro. If not: Pen VK, Keflex (esp for H flu)
Necrotizing fasciitis tx Oxacillin, nafcillin, or cefazolin IV
Tx of sxs (eg, paronychia) in cutaneous candida Castellani paint
Cutaneous candidiasis tx topical nystatin or imidazole cream QID x14d; if failure: Ketoconazole
Most common benign tumors of infancy Hemangiomas
Hemangioma mgmt Corticosteroids 1stline (Vincristine if resistant). Propranolol. Surgical: cryoablation
Sudden enlargement of existing hemangioma with low platelets & coagulopathy = Kasabach-Merritt syndrome (high mortality). Positive Glut-1 marker helps with dx
Port wine stains (PWS) may be associated with: Sturge-Weber syndrome (PWS in ophthalmic branch of trigeminal nerve) or Klippel-Trenauney-Weber syndrome (Parkes Weber syndrome if AVF)
Created by: Abarnard