question

What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

answer

B. Papule palpable lesion, <10 mm

question

What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

answer

C. Patch

question

What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

answer

D. Plaque

question

What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

answer

E. Ulcer

question

axilla distribution, *burrows*

answer

Scabies

question

*burrows*

answer

Scabies

question

*burrows*; finger web involvement

answer

Scabies

question

RIGHT mite itself MIDDLE poop LEFT cyst

answer

Scabies

question

answer

Nodular Scabies

question

hundred to thousands of mites

answer

Nodular Scabies

question

pustules papulovesicles

answer

Fire Ant Sting

question

nits

answer

Head lice

question

answer

Pubic Louse

question

answer

Body/Head Louse

question

answer

Tick

question

answer

Flea

question

leg involvement not displaying "breakfast, lunch, and dinner" pattern

answer

Flea Bites

question

necrotic ulceration

answer

Brown Recluse Bite (Note that Black Widow bites do not cause cutaneous lesions.)

question

necrotic ulceration

answer

Brown Recluse Bite (Note that Black Widow bites do not cause cutaneous lesions.)

question

purple, polygonal, pruritic papules and plaques commonly seen on the wrists, genitalia, and buccal mucosa

answer

*Lichen Planus* (*Can progress to squamous cell carcinoma.*)

question

purple, polygonal, pruritic papules and plaques *Wickham's striae* (reticulated scaling) on the *buccal mucosa* also seen on the wrists and genitalia

answer

*Lichen Planus* (*Can progress to squamous cell carcinoma.*)

question

"dew drops" without inflammation

answer

Miliaria Crystalina (Caused by occlusion of eccrine sweat ducts and seen in "hot, humid" weather. Note that miliaria *rubra [monomorphic red papules]* and *profunda [with pustules]* are progressively deeper with more inflammation.)

question

keratotic firm flesh-colored to red follicularly based papules seen on lateral arms, thighs, +/- cheeks

answer

Keratosis Pilaris

question

flat-topped, asymptomatic, shiny papules seen on arms, dorsal hands, genitalia, and trunk

answer

Lichen Nitidus (Histology demonstrates a characteristic *ball and claw* pattern.)

question

What other body parts does this "like?" A. Eye B. Feet C. Finger D. Mouth E. Scalp

answer

D. Mouth *Lichen planus "likes" the buccal mucosa, specifically.*

question

Name the acne.

answer

Open comedonal (non-inflammatory) (Acne is caused by the gram positive anaerobe **Proprionibacterium acnes**.)

question

Name the acne. ("Are you impressed by it?")

answer

Severe Nodulocystic Acne

question

central facial erythema

answer

Acne Rosacea (Findings include facial erythema, telangiectasias, papules, and pustules. *Does not present with comedomes.* Rosacea is exacerbated by sun exposure, ethanol, and "flushing" agents.)

question

usually in males with long history of sun exposure and ethanol consumption

answer

Rhinophyma (This is a complication of rosacea. Ocular symptoms include blepharitis, conjunctivitis, keratitis.)

question

pustules on acne patient

answer

Gram Negative Folliculitis (Treat with ampicillin or augmentin.)

question

*honey crusts* can have vesicles or bullae

answer

Impetigo (Caused by S. aureus or Streptococcus pyogenes.)

question

beefy red eroded plaque, intertriginous areas *satellite pustules and papules*

answer

Satellite Candida (Associated with obesity and DM.)

question

beefy red plaque, intertriginous areas *satellite pustules and papules*

answer

Satellite Candida (Associated with obesity and DM.)

question

*lake of pus* with skin sloughing

answer

Pustular Psoriasis (Most commonly limited to palms and soles. Treat with MTX or Soriatane.)

question

Type of acne? A. Comedonal B. Inflammatory C. Mixed D. Nodulocystic E. Rosacea

answer

A. Comedonal

question

white, well demarcated plaque of induration with rim of hyperpigmentation perhaps some violaceous change

answer

Morphea (Biopsy shows markedly thickened collagen bundles, with entrapment or compression of sweat glands, adnexal structures, and blood vessels. *Labs results are negative for ANA, anti-centromere, and Scl-70.*)

question

*coup de sabre*

answer

Morphea (Biopsy shows markedly thickened collagen bundles, with entrapment or compression of sweat glands, adnexal structures, and blood vessels. *Labs results are negative for ANA, anti-centromere, and Scl-70.*)

question

shiny, swollen fingers difficulty opening mouth (beaked facies)

answer

Progressive Systemic Sclerosis (*Positive for ANA, Scl-70. Treat with physical therapy.* Complications include severe HTN, conduction defects, pericarditis, CHF, renal failure, pulmonary fibrosis; esophageal dysmotility and strictures.)

question

superficial dilated blood vessels

answer

CREST Syndrome: Telangiectasias (Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; *positive for ANA, anti-centromere, negative for Scl-70.*)

question

sausage digits, swollen, shiny

answer

CREST Syndrome: Raynaud's (Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; *positive for ANA, anti-centromere, negative for Scl-70.*)

question

porcelain white; sharply demarcated with purpura; *cigarette paper* skin usually seen in genital area, but may be generalized

answer

Lichen Sclerosus (et atrophicus) (Commonly misdiagnosed as child abuse. Treat with high potency topical steroids with or without minocyclin/doxycycline.)

question

annular papules/plaques with central clearing seen on the dorsal hands and feet

answer

Granuloma Annulare (Commonly diagnosed as *ringworm, which displays annular papules/plaques with scaling.*)

question

red-brown to yellow plaques with prominent telangiectasias commonly seen on the shins

answer

Necrobiosis Lipoidica (Called "diabeticorum," as 2/3 of patients also have abnormal glucose metabolism.)

question

What is the diagnosis? A. Granuloma annulare B. Morphea C. Necrobiosis lipoidica D. Lichen sclerosus E. Systemic sclerosis

answer

B. Morphea ("coup de sabre*)

question

pinpoint to 3mm in size

answer

Petechiae (Most prominent in legs; if patient is bedridden, in back and sacrum.)

question

ecchymoses; skin atrophy and bleeding usually seen on dorsolateral arms and dorsal hands

answer

Actinic ("Solar") Purpura (Chronic sun induces blood vessel fragility; loss of "shock absorbers" of the dermis. Skin atrophy and solar elastosis is usually severe.)

question

eyelid purpura

answer

Systemic Amyloidosis (Also shows pinch purpura and macroglossia.)

question

petechiae, purpuric stellate (irregular) ecchymosis; central necrosis most characteristic

answer

DIC (Uncontrolled clotting causes diffuse thrombus formation, which leads to consumption of platelets and thrombocytopenia. Other findings include prolonged prothrombin time, hypofibrinogenemia, and fibrinogen degradation products.)

question

palpable purpura of the legs

answer

Leukocytoclastic Cutaneous Vasculitis (Check for fever and arthritis in order to rule out sepsis. Causes include SLE and RA. Order ANA, viral hepatitis panel [especially for Hepatitis C] and rheumatoid factor to determine cause.)

question

necrotic, hemorrhagic pustule on extremity may also present with swollen knee

answer

Gonococcemia caused by N. gonorrhoeae (Culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.)

question

fairly well demarcated, hypopigmented atrophic plaques with fine scale usually seen on chest, back, and shoulders

answer

Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

question

fairly well demarcated, hyperpigmented atrophic plaques with fine scale usually seen on chest, back, and shoulders

answer

Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

question

fairly well demarcated, erythematous atrophic plaques with fine scale usually seen on chest, back, and shoulders

answer

Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

question

*chopped spaghetti and meatballs* KOH stain

answer

Tinea (Pityriasis) Versicolor (Hyphae and spores can be seen.)

question

periorificial, sharply marginated white (depigmented) non-scaly patches

answer

Vitiligo (Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

question

periorificial, sharply marginated white (depigmented) non-scaly patches

answer

Vitiligo (Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

question

process from hair follicle outward

answer

Repigmentation in Vitiligo (Vitiligo is associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

question

hypopigmented poorly demarcated atrophic plaques with fine white scale. usually affects the cheeks; also commonly involves upper outer arms

1 year.)" alt="Pityriasis Alba (Usually first noticed in spring or summer. Repigmentation takes >1 year.)">

answer

Pityriasis Alba (Usually first noticed in spring or summer. Repigmentation takes >1 year.)

question

rim of hyperpigmentation at edge scarring in center

answer

Postinflammatory Hypopigmentation (Can be caused by contact dermatitis, autoimmune effects, local trauma; Xrays and frostbite; phenols and sulfhydryl compounds, discoid lupus erythematosus, atopic dermatitis, psoriasis.)

question

subtle, somewhat well-demarcated scaly white patches/macules

answer

Postinflammatory Hypopigmentation (Can be caused by contact dermatitis, autoimmune effects, local trauma; Xrays and frostbite; phenols and sulfhydryl compounds, discoid lupus erythematosus, atopic dermatitis, psoriasis.)

question

"ash-leaf" macule/patch

answer

Tuberous Sclerosis (Cutaneous findings include *ash leaf macules/patches*: 80-90%, *adenoma sebacum*/facial angiofibromas): 80-90%; periungual fibromas/*Koenen's tumors*: 50% *shagreen patches*: 21-80%; flesh to yellowish-orange plaques (*orange peel/pigskin*) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.) )

question

4+ ash-leaf patches

answer

Tuberous Sclerosis (Cutaneous findings include *ash leaf macules/patches*: 80-90%, *adenoma sebacum*/facial angiofibromas): 80-90%; periungual fibromas/*Koenen's tumors*: 50% *shagreen patches*: 21-80%; flesh to yellowish-orange plaques (*orange peel/pigskin*) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)

question

Shagreen patch "ash-leaf" patch

answer

Tuberous Sclerosis (Cutaneous findings include *ash leaf macules/patches*: 80-90%, *adenoma sebacum*/facial angiofibromas): 80-90%; periungual fibromas/*Koenen's tumors*: 50% *shagreen patches*: 21-80%; flesh to yellowish-orange plaques (*orange peel/pigskin*) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)

question

adenoma sebaceum angiofibromas dental enamel pits

answer

Tuberous Sclerosis (Cutaneous findings include *ash leaf macules/patches*: 80-90%, *adenoma sebacum*/facial angiofibromas): 80-90%; periungual fibromas/*Koenen's tumors*: 50% *shagreen patches*: 21-80%; flesh to yellowish-orange plaques (*orange peel/pigskin*) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)

question

Koenen's tumors

answer

Tuberous Sclerosis (Cutaneous findings include *ash leaf macules/patches*: 80-90%, *adenoma sebacum*/facial angiofibromas): 80-90%; periungual fibromas/*Koenen's tumors*: 50% *shagreen patches*: 21-80%; flesh to yellowish-orange plaques (*orange peel/pigskin*) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)

question

What is the best diagnosis? A. ITP B. Leukocytoclastic vasculitis C. Neisseria infection D. Solar purpura E. TTP

answer

C. Neisseria infection Gonococcemia is the diagnosis; culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.

question

macules, "sprinkled confetti" seen on shins of females

answer

Idiopathic Guttate Hypomelanosis (No good therapy.)

question

hypopigmented, hypestetic macule/patch/plaque

answer

Leprosy (Tissue biopsy for Fite stain. Caused by Mycobacterium leprae and spread by armadillos.)

question

hypopigmented areas, bathing trunk distribution

answer

Hypopigmented Mycosis Fungoides (Cutaneous T-Cell Lymphoma.)

question

Which of the following may be found in this patient? A. Cafe au lait macules B. Coup de sabre C. Neurofibromas D. Shagreen patch

answer

D. Shagreen patch Cutaneous findings in Tuberous Sclerosis include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area.

question

significant thinning of the parietal region no inflammation or scarring

answer

Telogen Effluvium (Pull test: many telogen hairs (small bulb at end of hair), club-shaped hairs. Order CBC, ANA, RPR, thyroid to rule out anemia, hypothyroidism, nutritional, toxic drugs, lupus, syphilis.)

question

thinning of the vertex scalp

answer

Telogen Effluvium (Pull test: many telogen hairs (small bulb at end of hair), club-shaped hairs. Order CBC, ANA, RPR, thyroid to rule out anemia, hypothyroidism, nutritional, toxic drugs, lupus, syphilis.)

question

no scarring or inflammation

answer

Androgenic Alopecia (Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)

question

no scarring or inflammation

answer

Androgenic Alopecia (Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)

question

vertex loss

answer

Androgenic Alopecia (Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)

question

irregularly-shaped with variable hair length no scaling or erythema

answer

Trichotillomania (Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in *strange geometric patterns*, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)

question

diffuse thinning "difficult to tell here"

answer

Trichotillomania (Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in *strange geometric patterns*, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)

question

bizarre geometric shape

answer

Trichotillomania (Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in *strange geometric patterns*, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)

question

oval/round patch, exclamation point hairs

answer

Alopecia Areata (Caused by autoimmune hair loss; physical exam shows *round or oval patches, exclamation point hairs*, no inflammation or scarring and skin biopsy shows *"Swarm of Bees"*- lymphocytes surrounding base of hair follicles.)

question

sharply demarcated, oval and smooth patch

answer

Alopecia Areata, Ophiasis type (most common) (Caused by autoimmune hair loss; physical exam shows *round or oval patches, exclamation point hairs*, no inflammation or scarring and skin biopsy shows *"Swarm of Bees"*- lymphocytes surrounding base of hair follicles.)

question

totalis

answer

Alopecia Areata (Caused by autoimmune hair loss; physical exam shows *round or oval patches, exclamation point hairs*, no inflammation or scarring and skin biopsy shows *"Swarm of Bees"*- lymphocytes surrounding base of hair follicles.)

question

answer

Nonspecific nail pitting, here associated with Alopecia Areata

question

erythema scaling some scarring, possibly

answer

Lupus Erythematosus (Causes chronic/discoid patchy scarring or non-scarring alopecia; broken hairs at frontal hairline, carpet tack scale, dyspigmentation, inflammation. Biopsy shows interface dermatitis- lymphocytic infiltrate and DE junction, liquifactive degeneration of basal cells, follicular plugging.)

question

lots of erythema scaling

answer

Lupus Erythematosus (Causes chronic/discoid patchy scarring or non-scarring alopecia; broken hairs at frontal hairline, carpet tack scale, dyspigmentation, inflammation. Biopsy shows interface dermatitis- lymphocytic infiltrate and DE junction, liquifactive degeneration of basal cells, follicular plugging.)

question

young children

answer

Tinea Capitis (Demonstrates scarring alopecia [*if you see scarring on the scalp of a child, think tinea*]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; *topicals do not work.*)

question

exclamation point young child

answer

Tinea Capitis (Demonstrates scarring alopecia [*if you see scarring on the scalp of a child, think tinea*]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; *topicals do not work.*)

question

Diagnosis in this 8 year old? A. Exzema B. Discoid Lupus erythematous C. Psoriasis D. Seborrheic Dermatitis E. Tinea capitis

answer

E. Tinea capitis (Demonstrates scarring alopecia [*if you see scarring on the scalp of a child, think tinea*]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; *topicals do not work.*)

question

"crumbly nails" debris, yellow change DIFFERENTIAL psoriasis, trauma, lichen planus

answer

Onychomycosis (Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)

question

hallux involvement

answer

Onychomycosis (Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)

question

onycholysis oil drop

answer

Psoriasis (Caused by increased rate of proliferation of keratinocytes; physical exam shows *nail pitting*, dystrophy, onycholysis, *"oil drop sign"* [yellow color under nail], fingernails affected more than toenails.)

question

pitting

answer

Psoriasis (Caused by increased rate of proliferation of keratinocytes; physical exam shows *nail pitting*, dystrophy, onycholysis, *"oil drop sign"* [yellow color under nail], fingernails affected more than toenails.)

question

nail and skin involvement pustules, "lakes of pus"

answer

Pustular Psoriasis (Most commonly limited to palms and soles. Treat with MTX or Soriatane.)

question

answer

Psoriasis (Caused by increased rate of proliferation of keratinocytes; physical exam shows *nail pitting*, dystrophy, onycholysis, *"oil drop sign"* [yellow color under nail], fingernails affected more than toenails.)

question

red, swollen

answer

Acute Paronychia (ACUTE S. aureus infection leading to inflammation and infection of proximal and lateral nail folds; red, swollen, painful; CHRONIC Candida infection leading to inflammation and infection of proximal and lateral nail folds; loss of cuticle, creases in nail plate, scaling)

question

swollen

answer

Acute Paronychia (ACUTE S. aureus infection leading to inflammation and infection of proximal and lateral nail folds; red, swollen, painful; CHRONIC Candida infection leading to inflammation and infection of proximal and lateral nail folds; loss of cuticle, creases in nail plate, scaling)

question

180 degrees)" alt="Clubbing (Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)">

answer

Clubbing (Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)

question

spoon-shaped

answer

Koilonychia (Caused by iron deficiency anemia, Plummer-Vinson syndrome, Hemachromatosis, CAD, syphilis, polycythemia, acanthosis nigricans, familial forms; physical exam shows spoon nails, thin and concave)

question

transverse furrows affecting all nails

answer

Beau's Lines (Temporary arrest of growth of nail plate leading to ransverse furrows that grow out; Triggered by traumatic/stressful events: childbirth, febrile illness, drug reaction. Note that the nails *grow out at a rate of 1mm/month.*)

question

What is the diagnosis? A. Beau's lines B. Clubbing C. Fungus D. Koilonychia E. Paronychia F. Psoriasis

answer

A. Beau's Lines (Temporary arrest of growth of nail plate leading to ransverse furrows that grow out; Triggered by traumatic/stressful events: childbirth, febrile illness, drug reaction. Note that the nails *grow out at a rate of 1mm/month.*)

question

medial aspect of lower leg full thickness epidermal loss with petechiae (pinpoint - 3 mm)

answer

Stasis (Venous Insufficiency) Ulcers (Common in CHF and incompetent leg vein vales; physical exam shows significant, bilateral swelling of medial lower legs, brownish dyspigmentation and petechiae, commonly *Most common etiology of leg ulcers,* check DP/PT pulses to rule out associated arterial disease.)

question

sharply demarcated, "punched out" ulcer

answer

Arterial Ulcers (History commonly shows intermittent claudication, rest pain; physical exam demonstrates punched out ulcers on the lateral aspects of the legs (classically); DP/PT pulses absent, cool extremities, local hair loss.)

question

cribriform scarring

answer

Pyoderma Grangrenosum (Physical exam shows distinctive ulceration: acute onset of a painful ulcer with an undermined border [Dr. Stetson likes to say "you could stick a probe into it"], which heals with *cribriform scarring*; associated with ulcerative colitis, rheumatoid arthritis, and acute myeloblastic leukemia; *biopsy reveals neutrophils throughout the dermis, but cultures are negative.*)

question

answer

Chancre in Primary Syphilis (Note that the *chancre caused by Treponema pallidum is painless*, whereas the *chancroid caused by Haemophilus ducreyi is painful*.)

question

dark field microscopy

answer

Spirochetes (You can test for the syphilitic Treponema pallidum by dark field microscopy.)

question

*"nickles and dimes" on palm*

answer

Secondary Syphilis HIGHLY STRESSED)

question

"moth-eaten" alopecia

answer

Secondary Syphilis

question

"punched out, painful" ulcers

answer

Chancroid (This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)

question

painful, ragged ulcer "undetermined" NOTE difficult to culture

answer

Chancroid (This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)

question

"school of fish" gram negative coccobacilli

answer

Haemophilis ducreyi (Causative agent of chancroid.)

question

grouped ulcerations on erythematous base

answer

HSV

question

grouped vesicles on erythematous base

answer

HSV

question

Tzanck smear showing multinucleated keratinocytes, ballooning degeneration steel-gray nuclei chromatin margination

answer

HSV

question

*angulated linear heme-crusted ulcer*

answer

Factitial Ulcer (Causes include a variety of insults: deep excoriations, injections of foreign material, heat/cold. Note that the patient will often deny causing the ulceration and the history will be unreliable. These ulcers appear as bizarre, geometric shaped angulated ulcers. Must be suspected clinically; especially if location is unusual for ulcerations, and there are no other explanation for the ulcer.)

question

What is the best diagnosis? A. Arterial ulcer B. Factitial ulcer C. Pyoderma gangrenosum D. Stasis ulcer E. Syphilis

answer

C. Pyoderma gangrenosum Note underlying edge, where "one could stick a probe."

question

cheek, arms

answer

Eczema, Atopic Dermatitis (Most common form is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *infantile form favors face*, scalp and extensors; 80% develop allergic rhinitis)

question

plaque, erythematous papules seborrheic appearance

answer

Eczema, Atopic Dermatitis (Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *childhood form favors flexors; often lichenified*; 40% have persistent disease as adults)

question

possible lichenification in the cubital fossa

answer

Eczema (Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *childhood form favors flexors; often lichenified*; 40% have persistent disease as adults)

question

hyperlinear palms

answer

Eczema (Associated with keratosis pilaris, xerosis, icthyosis vulgaris, Dennie-morgan lines, *hyperlinear palms*, pityriasis alba; can become erythrodermic. Often impetiginized [S. aureus, honey crusted] or considered *eczema herpeticum [painful super-infection by HSV]*).

question

thickening NOTE the papulovesicles on the lateral finger

answer

Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

question

answer

Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

question

answer

Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

question

"plate-like or fish-like" changes dry river bed

answer

Asteatotic Eczema (Appearance is termed "eczema craquele" and "dried river bed;" favors shins, flanks, post axillary line. Associated with aging, xerosis, low humidity, frequent bathing)

question

*coin-shaped*, scaly

answer

Nummular Dermatitis (Appears as pruritic coin-shaped eczematous lesions with a chronic, recurrent course. Associated with contact sensitization and stasis, but not atopy. More common in older patients.)

question

answer

Nummular Dermatitis (Appears as pruritic coin-shaped eczematous lesions with a chronic, recurrent course. Associated with contact sensitization and stasis, but not atopy. More common in older patients.)

question

eye involvement linear pattern

answer

Phyto Contact Dermatitis (Poison Ivy here) (Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of *Neosporin/Polysporin/Triple antibiotics or topical benadryl*])

question

eczematous changes with vesicles

answer

Acute Contact Dermatitis (Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of *Neosporin/Polysporin/Triple antibiotics or topical benadryl*])

question

answer

Contact Dermatitis, caused by leather (Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of *Neosporin/Polysporin/Triple antibiotics or topical benadryl*])

question

scalp involvement

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

answer

Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

intertrigious area

answer

Seborrheic Dermatitis, here as cradle cap in infant (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

eyebrow scaling

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

answer

Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

scalp and forehead involvement

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

answer

Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

brown, angular, ring shaped could be fungal

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

answer

Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

impressive scaling and redness over the face guttate (drop-like)

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

answer

Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

answer

Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

question

varicosities, venous ulceration pigmentary changes

answer

Stasis Dermatitis (Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)

question

petechiae, ulceration, hyperpigmentation

answer

Stasis Dermatitis (Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)

question

pigmentary changes only, longstanding

answer

Stasis Dermatitis (Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)

question

answer

Lichen Simplex Chronicus (Secondary finding due to chronic rubbing and scratching; continued by *Itch-scratch-itch cycle*)

question

spikiness; not all at same level vertical streaking of collagen *irregular epithelial hyperplasia* NOTE compare to psoriasis histology

answer

Lichen Simplex Chronicus (Secondary finding due to chronic rubbing and scratching; continued by *Itch-scratch-itch cycle*)

question

irregular presentation linear heme crusts post inflammatory changes

answer

Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

question

old scarring from past flares angulated upper back only

answer

Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

question

linear scratches DIFFERENTIAL contact dermatitis

answer

Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

question

bizarre ulceration pattern

answer

Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

question

sharply demarcated, erythematous papules, plaques, some annular (central clearing) not very much scaling truncal predominance

answer

Pityraisis Rosea (Appears as *classically well circumscribed papules and plaques* in a "Christmas" or "fir" tree appearance on back, upside down on chest; primarily involves trunk. The primary plaque is referred to as a herald patch.)

question

sharply demarcated annular and erythematous papules and plaques truncal distribution

answer

Pityriasis Rosea (Appears as *classically well circumscribed papules and plaques* in a "Christmas" or "fir" tree appearance on back, upside down on chest; primarily involves trunk. The primary plaque is referred to as a herald patch.)

question

papulosquamous eruption at scalp thick scaling

answer

Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

papulosquamous eruption sharply demarcated scaly

answer

Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

very erythematous swollen joints with potential arthritic changes

answer

Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

*nail pitting* plaque on right

answer

Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

onycholysis *oil drop*

answer

Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

club shaped equal level NOTE compare to histology of lichen simplex chronicus

answer

Psoriasis (Dermatologic appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

*Monroe's microabscess* NOTE compare to histology of lichen simplex chronicus

answer

Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

question

plaques, slightly scaly buttocks and lower trunk most affected

answer

Mycosis Fungoides, a cutaneous T cell lymphoma (Erythrodermic patch progresses to intensely pruritic, well-developed plaques in a *bathing trunk distribution* [clinically diagnostic]. These then progress to low grade, insidious tumors. Less developed lesions are typically not pruritic. Median duration from onset to definitive diagnosis is 4-6 years. Dermatopathic lymphadenopathy usually present.)

question

orange/salmon color some scaling

answer

Mycosis Fungoides, a cutaneous T cell lymphoma (Erythrodermic patch progresses to intensely pruritic, well-developed plaques in a *bathing trunk distribution* [clinically diagnostic]. These then progress to low grade, insidious tumors. Less developed lesions are typically not pruritic. Median duration from onset to definitive diagnosis is 4-6 years. Dermatopathic lymphadenopathy usually present.)

question

answer

Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

question

annulare with scaling

answer

Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

question

answer

Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

question

answer

Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

question

answer

Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

question

segmented; hyphae in fungus

answer

Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

question

What is the most likely diagnosis? A. Allergic contact dermatitis B. Candidiasis C. Eczema D. Psoriasis E. Tinea

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/c-eczemanote-that-this-is-on-the-cheek-in-a-child-approximately.jpg" title="C. Eczema Note that this is on the cheek in a child approximately <2 months. Psoriasis does not "like" the face. (Most common form of eczema is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *infantile form favors face*, scalp and extensors; 80% develop allergic rhinitis)" alt="C. Eczema Note that this is on the cheek in a child approximately

answer

C. Eczema Note that this is on the cheek in a child approximately <2 months. Psoriasis does not "like" the face. (Most common form of eczema is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *infantile form favors face*, scalp and extensors; 80% develop allergic rhinitis)

question

round, "punched out" ulcers yellow/white necrotic base with surrounding erythema

answer

Aphthous Stomatitis (Affects 20-60% of the population and manifests as recurrent, idiopathic oral ulcers commonly called "canker sores" with a whitish, yellow necrotic surface/base and surrounding erythema; variants include herpetiform and major aphthae [1-3 cm; may be an initial manifestation of Behcet's, but this is rare in Lubbock].)

question

uncommon oral ulcer

answer

Histoplasmosis

question

uncommon oral ulcer

answer

Pemphigus Vulgaris (90% will develop oral ulcers, and 50% present with oral ulcers, may involve buccal mucosa or tongue.)

question

uncommon ulcerative scarring of mucosa

answer

Mucosal/Cicatricial Pemphigoid

question

blister on erythematous base

answer

Herpes Labialis

question

blisters, erythema around it on hand

answer

Hand, Foot, Mouth Disease (Diagnosis especially likely if dermatologic findings are in a child.)

question

answer

Squamous Cell Carcinoma of the Lip

question

answer

Squamous Cell Carcinoma of the Tongue

question

plaque

answer

Leukoplakia (Appearance is a "white-plaque" that does not scrape off, commonly seen in the middle aged and elderly with history of gradual onset, smoking, snuff, dentures. Biopsy shows hyperkeratosis, acanthosis, dysplasia and atypia, lymphocytic infiltrate, carcinoma in-situ.)

question

plaque

answer

Leukoplakia (Appearance is a "white-plaque" that does not scrape off, commonly seen in the middle aged and elderly with history of gradual onset, smoking, snuff, dentures. Biopsy shows hyperkeratosis, acanthosis, dysplasia and atypia, lymphocytic infiltrate, carcinoma in-situ.)

question

histologically appears like psoriasis

answer

Geographic tongue (Occurs after eating hot foods or drinking hot beverages; benign finding that will heal.)

question

What is the best diagnosis? A. Candidiasis B. Cicatricial pemphigoid C. Herpes virus infection D. Pemphigus vulgaris E. Syphilis

answer

C. Herpes virus infection

question

Is this lesion malignant? A. True B. False

answer

A. True Note the pearly color and presence of telangiectasias. This is a basal cell carcinoma.

question

flesh-colores firm papules/nodules interrupts normal skin lines usually on hands, fingers

answer

Verruca Vulgaris, the Common Wart (Caused by multiple types of human papilloma virus infecting epidermal cells. Appears as flesh-colored firm papule or nodule with hyperkeratotic (corrugated) surface with black dots, interrupting normal skin lines. Commonly found on hands, fingers. Treat with *non-specific destruction*.)

question

flesh-colores firm papules/nodules interrupts normal skin lines usually on hands, fingers

answer

Verruca Vulgaris, the Common Wart (Caused by multiple types of human papilloma virus infecting epidermal cells. Appears as flesh-colored firm papule or nodule with hyperkeratotic (corrugated) surface with black dots, interrupting normal skin lines. Commonly found on hands, fingers. Treat with *non-specific destruction*.)

question

Slightly raised, flat surfaced papule

answer

Flat Warts

question

often covered by callus can be painful

answer

Plantar Warts

question

soft, moist papule cauliflower-like

answer

Condyloma Acuminatum, the Venereal Wart (Appears as a soft, moist papule or plaque, can be sessile or pedunculated and is often cauliflower-like.)

question

yellow-brown, well circumscribed, scaly papules not interrupting skin lines usually on feet and toes

answer

Corn (Clavus or Heloma) (Localized thickening of epidermis caused by pressure or friction, appears as white-gray or yellow-brown, well circumscribed, scaly papules or nodules that *do not interrupt skin lines*; most commonly involving toes. )

question

tan to dark brown; round and waxy *"stuck on"*, like you could peel it off

answer

Seborrheic Keratosis (Arises as benign neoplasm of epidermal cells; appearance varies in size and color: flesh, tan, brown, occasionally black; oval to round, waxy, well-demarcated, *"stuck on"* appearance; may have *verrucous* or crumbly surface, occasionally with keratin-filled pits. Spares palms and soles.)

question

tan to dark brown; round and waxy-appearing *"stuck on"*, like you could peel it off

answer

Seborrheic Keratosis (Arises as benign neoplasm of epidermal cells; appearance varies in size and color: flesh, tan, brown, occasionally black; oval to round, waxy, well-demarcated, *"stuck on"* appearance; may have *verrucous* or crumbly surface, occasionally with keratin-filled pits. Spares palms and soles.)

question

soft, *pedunculated* papule

answer

Skin Tag (An extremely common benign fleshy tumor; appears as a tan- to flesh-colored, soft *pedunculated* papule with smooth, folded surface. Commonly found on the eyelids, neck, and skin folds (inframammary, axilla, inguinal). No therapy is necessary.)

question

flesh-colored papules with smooth, folded surface in the axilla

answer

Skin Tag (An extremely common benign fleshy tumor; appears as a tan- to flesh-colored, soft *pedunculated* papule with smooth, folded surface. Commonly found on the eyelids, neck, and skin folds (inframammary, axilla, inguinal). No therapy is necessary.)

question

hard, smooth, dome-shaped flesh-colored central *umbilication with "cheesy" core*

answer

Molluscum Contagiosum (Caused by *poxvirus infection* of epidermal cells, common in childhood; also venereal transmission as an adult; *suspect HIV if 100s of persistent lesions*; will commonly see pontaneous *remission* over several months. Appears as 2-5mm hard, smooth, dome-shaped flesh colored or translucent papules demonstrating *central umbilication with 'cheesy' core content*.)

question

hard, smooth, dome-shaped flesh-colored central *umbilication with "cheesy" core*

answer

Molluscum Contagiosum (Caused by *poxvirus infection* of epidermal cells, common in childhood; also venereal transmission as an adult; *suspect HIV if 100s of persistent lesions*; will commonly see pontaneous *remission* over several months. Appears as 2-5mm hard, smooth, dome-shaped flesh colored or translucent papules demonstrating *central umbilication with 'cheesy' core content*.)...

question

rough, yellowish adherent scale

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/actinic-keratoses-sun-spotsprecancerous-epidermal-neoplasm-caused-by-exposure-to-uv-light-appears-as-1-10-mm-wide-reddish-ill-defined-indistinct-borders-with-rough-yellowish-adherent-scale-o.jpg" title="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)" alt="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~

answer

Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)

question

rough, yellowish adherent scale

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/actinic-keratoses-sun-spotsprecancerous-epidermal-neoplasm-caused-by-exposure-to-uv-light-appears-as-1-10-mm-wide-reddish-ill-defined-indistinct-borders-with-rough-yellowish-adherent-scale-o.jpg" title="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)..." alt="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~

answer

Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)...

question

scaling, indurated nodule

answer

Squamous Cell Carcinoma (Malignancy of *keratinocytes caused by UV light with potential to metastasize* [2% overall], appearing as a scaling, indurated plaque or nodule that sometimes bleeds or ulcerates. Persistent ulceration or bleeding warrants a biopsy. *Treat by surgical excision*)

question

scaling plaque

answer

Squamous Cell Carcinoma (Malignancy of *keratinocytes caused by UV light with potential to metastasize* [2% overall], appearing as a scaling, indurated plaque or nodule that sometimes bleeds or ulcerates. Persistent ulceration or bleeding warrants a biopsy. *Treat by surgical excision*)

question

red, scaly, crusted and well-defined plaque

answer

Bowen's Disease (Squamous Cell Carcinoma in Situ)

question

rapidly growing, crater-like nodule

answer

Keratoacanthoma (May involute, but difficult to differentiate from SCC, so treat regardless.)

question

pearly, semitranslucent nodules central depression

answer

Basal Cell Carcinoma (Malignancy of the *epidermal basal cell* that rarely metastasizes, but can be *locally destructive*; caused most commonly by *UV radiation*, nodular subtype most common. Appears as a *pearly*, semitranslucent papule or nodule, often with central depression and *telangiectasias*. Borders are rolled and waxy or cratered. *Treat with surgery.*(

question

ulceration and crusting pearly appearance with telangiectasias

answer

Basal Cell Carcinoma with Rodent Ulcer (Malignancy of the *epidermal basal cell* that rarely metastasizes, but can be *locally destructive*; caused most commonly by *UV radiation*. Appears as a *pearly*, semitranslucent papule or nodule, often with central depression and *telangiectasias*. Borders are rolled and waxy or cratered. *Treat with surgery.*)

question

pearly with rolled margin shiny blue-black color, speckled

answer

Pigmented Basal Cell Carcinoma

question

pearly with telangiectasias blue-black color, speckled

answer

Pigmented Basal Cell Carcinoma

question

red, slightly scaling, well-demarcated plaque DIFFERENTIAL eczema

answer

Superficial Basal Cell Carcinoma

question

red, slightly scaling, well-demarcated plaque DIFFERENTIAL eczema

answer

Superficial Basal Cell Carcinoma

question

atrophic white plaque that looks like scar

answer

Sclerosing (Scarring) Basal Cell Carcinoma (Least common and most aggressive.)

question

atrophic white plaque that looks like scar

answer

Sclerosing (Scarring) Basal Cell Carcinoma (Least common and most aggressive.)

question

flesh-colored solitary nodule with central pore

answer

Epidermal Inclusion Cyst / Epidermoid Cyst (Derived from the upper portion of the hair follicle lining and commonly located in the mid and lower dermis. *Discharges cheesy, foul-smelling macerated keratin*. Appears as a flesh-colored, firm, but often malleable, solitary nodule with central punctum or pore. *Multiple epidermal inclusion cysts are a feature of Gardner's syndrome.*)

question

flesh-colored solitary nodule with central pore

answer

Epidermal Inclusion Cyst / Epidermoid Cyst (Derived from the upper portion of the hair follicle lining and commonly located in the mid and lower dermis. *Discharges cheesy, foul-smelling macerated keratin*. Appears as a flesh-colored, firm, but often malleable, solitary nodule with central punctum or pore. *Multiple epidermal inclusion cysts are a feature of Gardner's syndrome.*)

question

bright red lesion

answer

Hemangioma, Superficial (Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)

question

bluish lesion

answer

Hemangioma, Subcutaneous (Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)

question

bright red, dome-shaped lesion

answer

Hemangioma, Mixed (Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)

question

Pinching shows central dimpling Light tan to dark brown

answer

Dermatofibroma (Dermal fibrotic papule or small nodule of unknown origin, possibly trauma; appears as a slightly elevated area ~5mm, often with overlying hyperpigmentation and epidermal thickening. When palpated, these are firm and indurated; demonstrate *"dimple sign."*)

question

dark brown, overlying hyperpigmentation and thickening

answer

Dermatofibroma (Dermal fibrotic papule or small nodule of unknown origin, possibly trauma; appears as a slightly elevated area ~5mm, often with overlying hyperpigmentation and epidermal thickening. When palpated, these are firm and indurated; demonstrate *"dimple sign."*)

question

dark brown elevated, firm, protuberant nodules/plaque usually appearing on earlobes, shoulders, upper chest, and back

answer

Keloids (Exuberant scar tissue due to *excessive proliferation of collagen*, most common in young black people. Appear as *overgrown scars*; pink to dark brown, elevated, firm, protuberant nodules/plaque; *more extensive than the original wound*; irregular claw-like borders. New and active lesions *often itch*. Treat these cautiously due to their high recurrence rate.)

question

pink elevated, firm, protuberant nodules/plaque usually appearing on earlobes, shoulders, upper chest, and back

answer

Keloids (Exuberant scar tissue due to *excessive proliferation of collagen*, most common in young black people. Appear as *overgrown scars*; pink to dark brown, elevated, firm, protuberant nodules/plaque; *more extensive than the original wound*; irregular claw-like borders. New and active lesions *often itch*. Treat these cautiously due to their high recurrence rate.)

question

rubbery, flesh-colored nodule usually seen on trunk, neck, and upper extremities

answer

Lipoma (Benign subcutaneous *fat* tumor, most common in midlife. Appears as freely mobile, rubbery, flesh-colored nodules, only slightly elevated above the skin's surface, but easily palpable deep in skin. Biopsy if rapidly growing; therapy is usually not required, but if desired can be excised.)

question

rubbery, flesh-colored nodule usually seen on trunk, neck, and upper extremities

answer

Lipoma (Benign subcutaneous *fat* tumor, most common in midlife. Appears as freely mobile, rubbery, flesh-colored nodules, only slightly elevated above the skin's surface, but easily palpable deep in skin. Biopsy if rapidly growing; therapy is usually not required, but if desired can be excised.)

question

soft, flesh-colored, protruding papule or nodule DIFFERENTIAL skin tags

answer

Neurofibroma (Focal proliferation of neural tissue in the dermis; multiple lesions are seen in Neurofibromatosis Type 1 [von Recklinghausen's disease]; appear as soft, flesh colored *protruding papule* or nodule which demonstrate characteristic *"buttonhole sign"* [when compressed, the papule feels like it can be pushed through a defect in the skin]; less often, these can be deep, firm nodule [plexiform neurofibroma] and be tender; "feels like bag of worms.")

question

large, deep, firm nodule "feels like a bag of worms"

answer

Plexiform Neurofibroma (Focal proliferation of neural tissue in the dermis; multiple lesions are seen in Neurofibromatosis Type 1 [von Recklinghausen's disease]; most commonly appear as soft, flesh colored *protruding papule* or nodule which demonstrate characteristic *"buttonhole sign"* [when compressed, the papule feels like it can be pushed through a defect in the skin]; less often, these can be deep, firm nodule [plexiform neurofibroma] and be tender; "feels like bag of worms.")

question

yellowish plaques on eyelids

answer

Xanthelasma (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

question

reddish-yellow papules and plaques

answer

Eruptive Xanthomas (*due to very high triglycerides* (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

question

potato-like nodules commonly seen on elbows, buttocks

answer

Tuberous Xanthoma (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

question

deep, flesh-colored, hard nodules located within peripheral tendons most commonly involving Achilles tendon and extensor fingers

answer

Tendon Xanthomas (*due to very high cholesterol) (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

question

purple macules, papules, plaques, and nodules

answer

Kaposi's Sarcoma (Malignant *vascular tumor caused by HHV8*; appears as *purple* macules, papules, plaques and nodules. In classic Kaposi's Sarcoma (elderly men of Mediterranean descent), it appears as lower leg lesions. If AIDS-associated, the lesions may appear anywhere.)

question

purple macules, papules, plaques, and nodules

answer

Kaposi's Sarcoma (Malignant *vascular tumor caused by HHV8*; appears as *purple* macules, papules, plaques and nodules. In classic Kaposi's Sarcoma (elderly men of Mediterranean descent), it appears as lower leg lesions. If AIDS-associated, the lesions may appear anywhere.)

question

hyperpigmented macules

answer

Freckle/Ephelis (Sun-induced hyperpigmented macules that only occur in sun-exposed areas; very common. *Amount of melanin is increased*, but number of melanocytes stays the same.)

question

hyperpigmented macules

answer

Lentigo (Hyperpigmented macule caused by *increased number of melanocytes* Two main types: (1) Lentigo simplex: childhood, idiopathic, few in number, (2) Actinic lentigo: adults, *sun induced*, often numerous, more common.)

question

hyperpigmented macules

answer

Lentigo (Hyperpigmented macule caused by *increased number of melanocytes* Two main types: (1) Lentigo simplex: childhood, idiopathic, few in number, (2) Actinic lentigo: adults, *sun induced*, often numerous, more common.)

question

light to dark brown macule

answer

Junctional Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

brown, rough-surfaced papule

answer

Compound or Intradermal Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

flesh-colored smooth-surfaced papule

answer

Compound or Intradermal Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

variegated in color; irregular, indistinct border erythematous background

answer

Dysplastic Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

variegated in color; irregular, indistinct border

answer

Dysplastic Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

elevated, dark brown papule or plaque with discrete borders

answer

Congenital Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

elevated, dark brown papule or plaque with discrete borders NOTE large congenital nevi (> 20cm) have increased chance of developing into melanoma

answer

Cognenital Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

question

irregular in color, surface, border may occur anywhere on body but show predilection for upper back in males and lower legs in females

answer

Superficial Spreading Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that *superficial spreading melanoma is the most common type.*)

question

irregular in color, surface, border may occur anywhere on body but show predilection for upper back in males and lower legs in females

answer

Superficial Spreading Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that *superficial spreading melanoma is the most common type.*)

question

rapidly growing, blue-black, eroded nodule occur anywhere on the body

answer

Nodular Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)

question

rapidly growing, blue-black, smooth nodule occur anywhere on the body

answer

Nodular Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)

question

multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years) occurs on sun-exposed skin

answer

Lentigo Maligna Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)

question

multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years) occurs on sun-exposed skin

answer

Lentigo Maligna Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)

question

irregular, enlarging, black growth occurs on palms, soles, toes or fingers DIFFERENTIAL lentigo maligna melanoma

answer

Acral Lentiginous Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. *Note that acral lentiginous melanoma is most frequent in blacks and Asians.*)

question

irregular, enlarging, black growth occurs on palms, soles, toes or fingers DIFFERENTIAL lentigo maligna melanoma

answer

Acral Lentiginous Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. *Note that acral lentiginous melanoma is most frequent in blacks and Asians.*)

question

Main treatment is surgical excision, with increasing margins for increasing thickness.

answer

Survival Statistics Based on Melanoma Depth

question

shiny, blue-black color, speckled rolled borders; waxy and cratered

answer

Pigmented Basal Cell Carcinoma

question

irregular in color, surface, border

answer

Superficial Spreading Melanoma

question

variegated in color; irregular, indistinct border

answer

Combined Melanocytic Nevus

question

This vesicular eruption is caused by: A. HSV B. VZV C. Poison Ivy D. Streptococcus

answer

C. Poison Ivy Linear and geometric patterns usually have their source outside the body.

question

grouped vesicles on erythematous base

answer

HSV (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

question

grouped vesicles on erythematous base fingers

answer

Herpetic Whitlow (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

question

generalized skin infection with predisposing skin disease

answer

Eczema Herpeticum (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

question

Tzanck smear multinucleated giant cells

answer

HSV

question

grouped vesicles in plaque

answer

Chronic HSV

question

generalized, pruritic vesicular eruption various lesions (macules, papules, vesicles) "dewdrop on a rose petal"

vesicles --> pustules --> crust. Typically all types of lesions seen at the same time 'Dewdrop on a rose petal' is classic.)" alt="Varicella (Caused by primary VZV infection. Crops of macules develop into papules --> vesicles --> pustules --> crust. Typically all types of lesions seen at the same time 'Dewdrop on a rose petal' is classic.)">

answer

Varicella (Caused by primary VZV infection. Crops of macules develop into papules --> vesicles --> pustules --> crust. Typically all types of lesions seen at the same time 'Dewdrop on a rose petal' is classic.)

question

unilateral eruption of groups of vesicles along dermatome

answer

Zoster (Caused by reactivation of VZV in sensory nerve; can involve adjacent [*but not bilateral*] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)

question

unilateral eruption of groups of vesicles along dermatome

answer

Zoster (Caused by reactivation of VZV in sensory nerve; can involve adjacent [*but not bilateral*] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

...

question

answer

Superficial desquamation beginning.

question

answer

Superficial desquamation after toxic erythema.

question

answer

...

question

erythematous plaques, violaceous hue; sun exposure DIFFERENTIAL drug reaction

answer

...

question

sparing of the nasolabial folds; "butterfly rash"

answer

...

question

redness, warmth, swelling, pain intact epidermis blisters occur only rarely

answer

Cellulitis (displaying the four cardinal signs)

question

answer

Fungal Cellulitis (cannot determine cause by observation)

question

answer

...

question

sharply demarcated red plaque with orange peel appearance (follicles accentuated)

answer

...

question

associated hair follicle

answer

Furuncle

question

no associated hair follicle fluctuates when pressed

answer

Abscess

question

red, ill-defined nodules with bruise-like appearance on shins will be painful when touched

answer

Erythema Nodosa (Causes: Strep, OCPs, Pregnancy, or idiopathic)

question

sharply demarcated red plaques, later dusky same lesion can reappear prefers the distal extremities, face, lips, and genitalia

answer

Fixed Drug Eruption (Causes: *NSAIDs, sulfonamides,* tetracyclines, carbamazepine)

question

persistent flushing of the face due to high levels of 5HT

answer

Carcinoid Syndrome

question

cutaneous metastases mimicking cellulitis painful, hot

answer

Carcinoma Erysipeloides

question

slightly raised, some blanching at border edematous plaques

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/urticariaindividual-lesions-last.jpg" title="Urticaria (*Individual lesions last <24 hours*)" alt="Urticaria (*Individual lesions last

answer

Urticaria (*Individual lesions last <24 hours*)

question

localized, acute dermal edema

answer

Uritcaria

question

localized, acute dermal edema geographic patterns

answer

Urticaria, cold induced

question

localized, acute dermal edema

answer

Urticardia, cold induced

question

localized, acute dermal edema

answer

Urticaria, pressure induced

question

answer

...

question

target lesions with rim of pallor and outermost zone of red

answer

(*Most often caused by HSV*)

question

target lesions with rim of pallor and outermost zone of red

answer

(*Most often caused by HSV*)

question

slowly expanding, >5 cm red expanding plaque

answer

Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

question

slowly expanding, >5 cm red expanding plaque

answer

Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

question

answer

Ixodes tick

question

slowly expanding, >5 cm red expanding plaque

answer

Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

question

reaction to internal malignancy

answer

Erythema gyratum repens

question

reaction to distal infection? scaling trailing behind red border

answer

Erythema annular centrifugum

question

answer

...

question

answer

...

question

answer

...

question

answer

...

Dermatology Pathology Slides from Lecture – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards