Final Review

diabetic dermopathy

- Occurs in patients with Type 1 and Type 2 Diabetes - Hyperpigmented pretibial scaly patches, shin spots - Atrophic Does not require treatment Improves with better glucose control

vesicle

-Circumscribed, elevated, palpable mass containing serous fluid -<0.5 cm -Herpes simplex/zoster, varicella, poison ivy, second-degree burn (blister)

bulla

-Circumscribed, elevated, palpable mass containing serous fluid ->0.5 cm -Pemphigus, contact dermatitis, large burn blisters, poison ivy, bullous impetigo

crust

-Dried residue of serum, blood, or pus on skin surface -Large, adherent crust is a scab -Residue left after vesicle rupture: impetigo, herpes, eczema

wheal

-Elevated mass with transient borders; often irregular; size and color vary -Caused by movement of serous fluid into the dermis; does not contain free fluid in a cavity (e.g., as a vesicle does) -Urticaria (hives), insect bites

nodule

-Elevated, palpable, solid mass that extends deeper into the dermis than a papule -0.5-2 cm; circumscribed -Lipoma, squamous cell carcinoma, poorly absorbed injection, dermatofibroma

tumor

-Elevated, palpable, solid mass that extends deeper into the dermis than a papule ->1-2 cm; do not always have sharp borders Larger lipoma, carcinoma

cyst

-Encapsulated fluid-filled or semisolid mass in the subcutaneous tissue or dermis -Sebaceous cyst, epidermoid cyst

scales

-Flakes secondary to desquamated, dead epithelium that may adhere to skin surface; color varies (silvery, white); texture varies (thick, fine) -Dandruff, psoriasis, dry skin, pityriasis rosea

keloid

-Hypertrophied scar tissue secondary to excessive collagen formation during healing; elevated, irregular, red -Greater incidence among African Americans

fissure

-Linear crack in the skin that may extend to dermis -Chapped lips or hands, tinea pedis

erosion

-Loss of superficial epidermis that does not extend to dermis; depressed, moist area -Ruptured vesicles, scratch marks

pustule

-Pus-filled vesicle or bulla -Acne, impetigo, furuncles, carbuncles

ulcer

-Skin loss extending past epidermis; necrotic tissue loss; bleeding and scarring possible -Stasis ulcer of venous insufficiency, pressure ulcer

lichenification

-Thickening and roughening of the skin or accentuated skin markings that may be secondary to repeated rubbing, irritation, scratching -Contact dermatitis

atrophy

-Thin, dry, transparent appearance of epidermis; loss of surface markings; secondary to loss of collagen and elastin; underlying vessels may be visible -Aged skin, arterial insufficiency

patch

-a flat, discolored area on the skin -larger than 1 cm, irregular border

plaque

-a solid mass greater than 1 cm in diameter and limited to the surface of the skin -Psoriasis, actinic keratosis

plantar fascitis

-an inflammation of the foot-supporting fascia -presents as an acute onset of heel pain experienced with the first steps in the morning

pediculosis corpis

-body lice -disease of those who live in close quarters -most commonly affected areas are those that are in contact with underclothing

hidradenitis suppurativa (HS)

-chronic skin disease characterized by clusters of abscesses -apocrine sweat glands - underarms, under breasts, inner thighs, groin and buttocks

pes cavus

-clawfoot -refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot

pes planus

-common disorder in which the longitudinal arch of the foot is diminished -signs and symptoms include a burning sensation, fatigue, clumsy gait, edema, and pain

open fracture

-compound/complex fracture -breaks the skin

scabies

-contagious skin disease transmitted by the itch mite, commonly through sexual contact -most commonly found in people living in substandard hygienic conditions and people who are sexually active

cyclosporine

-cyclic peptide immunosuppressive agent used for severe, therapy resistant psoriasis -may cause HTN and nephrotoxicity -therapy should last no longer than 6 months

stasis dermatitis

-eczematous eruption that occurs on the lower legs of patients with venous insufficiency -very common with diabetes -large vessels are damaged, skin lacks nutrients

macule

-flat, colored spot on the skin -< 1 cm, circumscribed border

pediculosis capitis

-head lice -nits are laid near the scalp, hatch in about 10 days and reach maturity in 2 weeks -most commonly found in the back of the head and behind the ears

septic arthritis

-inflammation of the joint caused by infection -most commonly in the knee and hips

compartment syndrome

-involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles -most serious complication of casting and splinting

hallux vagus

-lateral or outward deviation of the great toe -bunion

psoriasis

-noncommunicable chronic inflammatory multisystem skin disorder -characterized by silvery plaques on the skin -autoimmune -results in epidermal hyperplasia of poorly formed and immature cells that cannot adhere to one another -mild: < 5% body surface area -moderate: 5-10% body surface area -severe: > 10% body surface area

biphosphonates

-pharmacologic therapy for osteoporosis -alendronate, risedronate, ibandronate, zoledronic acid

Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)

-potentially fatal acute skin disorders characterized by widespread erythema and macule formation with blistering, resulting in epidermal detachment or sloughing and erosion formation -most cases are triggered by a medication reaction -cell-mediated cytotoxic reaction -erythema involving most of the skin and mucous membranes; flaccid bullae; shedding of large sheets of the epidermis as well as fingernails, toenails, eyebrows, and eyelashes; weeping on surfaces where skin is lost -possible complications include keratoconjunctivitis, sepsis, and multiple organ dysfunction syndrome (MODS) -results from a CBC may show leukopenia and a normochromic normocytic anemia

pediculosis pubis

-pubic lice or "crabs" -extremely common and usually spread by sexual contact -gray-blue macules may form as a result of a reaction between the louse's saliva with bilirubin

oral retinoids

-reduce sebaceous gland size and inhibit sebum production. They also cause the epidermis to shed (epidermal desquamation), thereby unseating and expelling existing comedones -most common side effect is cheilitis -teratogenic

herpes zoster

-shingles, caused by VZV -characterized by a painful vesicular eruption along the area of distribution of the sensory nerves from one or more posterior ganglia -has a preeruptive, acute eruptive, and postherpetic neuralgia phase

closed fracture

-simple fracture -does not break the skin

papule

-small, solid, raised lesion on surface of the skin smaller than 0.5 cm -Elevated nevi, warts, lichen planus

impetigo

-superficial infection of the skin caused by staphylococci, streptococci, or multiple bacteria -exposed areas of the body, face, hands, neck, and extremities are most frequently involved -contagious by direct and indirect contact

topical retinoids

-synthetic vitamin A acids -applied topically to clear the keratin plugs from the pilosebaceous ducts -symptoms may worsen during early weeks of therapy -improvement may take 8-12 weeks

methotrexate

-systemic cytotoxic agent used for moderate to severe psoriasis -inhibits DNA synthesis in epidermal cells -can be toxic to liver, kidneys, and bone marrow -teratogenic

Tinel's sign

-tingling, numbness, and pain with light percussion over the median nerve -indication of carpal tunnel syndrome

retapamulin (Altabax)

-topical antibiotic prescribed for impetigo when it is limited to a small area -must be applied several times a day for 5-7 days

dapsone

-topical antibiotic that reduces inflammatory lesions -usually works better on females than males

azelaic acid

-topical antibiotic with comedolytic, antibacterial, and anti-inflammatory effects -lightening effect on the skin

calciprotriene 5% (Dovonex)

-topical derivative of vitamin D used for psoriasis -decreases mitotic turnover of plaques -most common side effect is local irritation -monitor for hypercalcemia -not recommended for older adults or pregnant/lactating women

tazarotene

-topical retinoid used for psoriasis -causes sloughing of the scales covering plaques -causes photosensitivity and is teratogenic -side effects include burning, erythema, or irritation at the site of application, and worsening of psoriasis

chronic osteomyelitis

-xray shows large irregular cavities, raised periosteum, sequestra or dense bone formation are seen -WBC and ESR will be normal

acute osteomyelitis

-xray shows soft tissue edema -after 2-3 weeks, periosteal elevation and bone necrosis are shown -elevated WBC and ESR (sed rate) -antibiotics are started

pain, poikilothermia, pallor, pulselessness, parasthesia, paralysis

6 P's of neurovascular compromise

comminuted fracture

A fracture in which bone has splintered into several fragments

tinea

a common superficial fungal infection on the skin or scalp; also called ringworm

avulsion fracture

a fracture in which a fragment of bone has been pulled away by a tendon and its attachment

crepitus

a grating sound or sensation made by rubbing bony fragments together

disarticulation

amputation through a joint

clubbing

associated with pulmonary disease and can be a sign of chronic hypoxia

cherry angioma

bright red "moles"

metastatic bone disease

cancer originates somewhere else and metastisizes to the bone

seborrheic keratosis

crusty brown "stuck on" patches

plicamycin

cytotoxic antibiotic that may be used for severe paget's disease resistant to other therapies

melasma

dark discoloration of the skin

sequestrum

dead bone in abscess cavity

avascular necrosis (AVN)

death of tissue secondary to a decrease or lack of perfusion; also called osteonecrosis

pitted nails

definitive of psoriasis

Paget's disease

disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae

xerosis

dry skin

impacted fracture

fracture in which a bone fragment is driven into another bone fragment

depressed fracture

fracture in which fragments are driven inward

greenstick fracture

fracture in which one side of the bone is broken and the other side is bent

compression fracture

fracture in which the bone is compressed

oblique fracture

fracture occurring at an angle across the bone

epiphyseal fracture

fracture through the epiphysis

lentiginies

freckles

spoon nails

indicate severe iron-deficiency anemia

cheilitis

inflammation of the lips (when dry, cracking, inflamed skin occurs at the corners of the mouth, it is called angular cheilitis; when caused by sun exposure, it is called solar cheilitis)

paronychia

inflammation of the skin around the nail

folliculitis

inflammatory condition of the cells within the wall and ostia of the hair follicles that may be caused by a bacterial, viral, fungal, or parasitic infection

solar lentigo

liver spots

carbuncle

localized skin infection involving several hair follicles

furuncle

localized skin infection of a single hair follicle; also known as a boil

corticosteroids, heparin, anticonvulsants, thyroid hormone

medications that affect calcium absorption and metabolism and may increase risk for osteoporosis

osteomalacia

metabolic bone disease characterized by inadequate mineralization of the bone resulting a in soft and weak skeleton

clindamycin, erythromycin

most commonly prescribed topical antibiotics to treat acne

involucrum

new bone growth around a sequestrum

hematogenous osteomyelitis

osteomyelitis due to bloodborne spread of infection

secondary osteoporosis

osteoporosis caused by medication or disease that affects bone metabolism

primary osteoporosis

osteoporosis in post menopausal women and older men

subluxation

partial separation of joint surfaces

delayed union

prolongation of expected healing time for a fracture

razor burn

pseudofolliculitis barbae

telangiectasias

red marks on skin caused by stretching of the superficial blood vessels

Beau's lines

reflect retarded growth of the nail matrix because of severe illness or, more commonly, local trauma

Dupuytren's contracture

results in a slowly progressive contracture of the palmar fascia that causes flexion of the fourth, fifth, and, sometimes, middle finger, rendering these fingers more or less useless

spider angiomas

small dilated blood vessels on the skin

Morton's Neuroma

swelling of the third (lateral) branch of the median plantar nerve

biologic agents

treatment for psoriasis that acts by inhibiting activation and migration, eliminating the T cells completely, slowing postsecretory cytokines or inducing immune deviation

osteochondroma

tumor of bone and cartilage

xanthelasma

yellowish waxy deposits on upper and lower eyelids