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MSK Exam 1
Skin Anatomy
Characteristics
Epidermis
Keratinocytes
Melanocytes
Dendritic Cells
Merkel Cells
Dermis
Sweat Glands
Hair Follicles
Sebaceous Glands
Hypodermis
3 mins
Atopic Dermatitis / Eczema
Presentation
Pruritic Vesicles
Inflammatory Skin Rash
Cheeks in Children
Skin Flexural Areas
Associated with Asthma and Allergic Rhinitis
Treatment
Tacrolimus
Moisturizers
Corticosteroids
Phototherapy
Avoid Triggers
Antihistamines
2 mins
Vitiligo
Pathophysiology
Autoimmune Destruction of Melanocytes
Presentation
Hypopigmentation
Acral Areas and Around Orifices
Diagnosis
Clinical Presentation + Woods Lamp
Risk Factors
Other Autoimmune Diseases
Treatment
Glucocorticoids
Tacrolimus
Phototherapy
2 mins
Psoriasis
Presentation
Epidermal Hyperproliferation Keratinocytes
Defined Red Salmon Plaques
Silvery Scales
Extensor Surfaces
Bleeding when Removed
Auspitz Sign
Pruritus
Nail Changes
Histological Finding
Munro Microabscesses
Nucleated Cells in Stratum Corneum
Treatment
Retinoids
Topical Corticosteroids
Tar
Immunosuppressants
2 mins
Actinic Keratosis
Sun Exposure
Papules or Plaques
Small, Rough
Erythematous
Precursor to Squamous Cell Carcinoma
53 secs
Lichen Planus
Pathophysiology
Mucocutaneous Disorder
30-60 year olds
Signs & Symptoms
Pruritic
Plaques or Papules
Purple & Polygonal
Often Mucosal or Genital Involvement
Wickham Striae
Diagnosis
Biopsy
Sawtooth Infiltrate of Lymphocytes
Treatment
Topical Corticosteroids
Considerations
Hepatitis C Association
2 mins
Erythema Nodosum
Pathophysiology
Panniculitis
Painful Inflammation
Subcutaneous Fat
Anterior Shins
Risk Factors
Coccidioidomycosis
Pregnancy or OCP Use
Crohn's Disease
Tuberculosis (TB)
Histoplasmosis
Sarcoidosis
Ulcerative Colitis
2 mins
Pityriasis Rosea
Preceded by Upper Respiratory Tract Infection
Single "Herald Patch"
"Christmas Tree" Distribution
Plaques with Collarette Scale
Self-resolving in 6-8 Weeks
2 mins
Stevens-Johnson Syndrome
Etiologies
Drugs
Symptoms
< 10% of Body Surface Area (BSA) Involved
10-30% BSA Overlaps with Toxic Epidermal Necrolysis (TEN)
Fever
Affects Skin and Mucous Membranes
Bullae Formation
Necrosis
Sloughing of Skin
High Mortality Rate
Treatment
Supportive Care
IVIG (Intravenous Immunoglobulin)
3 mins
Acanthosis Nigricans
Associations
Endocrine Disorders
Diabetes Mellitus
Obesity
Malignancy
Presentation
Velvety Plaques
Dark, Thickened Flexural Areas
Diagnosis
Hyperkeratosis with Melanocytes
Treatment
Treat Underlying Disorder
2 mins
Pemphigus Vulgaris
Pathophysiology
Autoantibodies against desmosomes
Symptoms
Flaccid Bullae on Skin
Oral Mucosa Involvement
Intraepidermal Acantholysis
Fluid Loss
Infection
Nikolsky Positive
Diagnosis
Biopsy showing Autoantibodies
Treatment
IVIG and Plasmapheresis
Oral Steroids
Immunosuppressants
2 mins
Anti-desmoglein Antibodies
Pemphigus Vulgaris
Flaccid Blisters
Skin and Oral Mucosa
Positive Nikolsky's Sign
59 secs
Bullous Pemphigoid
Linear Deposits of IgG
Affects Hemidesmosomes
Epidermal Basement Membrane
Tense Blisters on Skin
Nikolsky Negative
Contain Eosinophils
Rarely Affect Oral Mucosa
2 mins
Scabies
Pathophysiology
Sarcoptes Scabiei Mite
Signs & Symptoms
Pruritus
Papules with Burrows
Webs of Fingers and Toes
Axilla and Nipples
Diagnosis
Skin Scraping
Dermoscopy
Mites and Eggs on Magnification
Treatment
Permethrin Cream
Oral Ivermectin
Lindane Cream
Considerations
Wash All Linens In Hot Water
3 mins
Rule of 9's for Burns
Total Body Surface Area (TBSA)
Head
Anterior Torso (18%)
Chest
Abdomen
Posterior Torso (18%)
Upper Back
Lower Back
Extremities
Posterior Leg (each)
Anterior Leg (each)
Each Arm
Genitalia 1%
2 mins
Burns Considerations
Maintain Body Temperature
Increased Risk of Infection
Venous Thromboembolism (VTE) Prophylaxis
Curling's Ulcer
Excision and Grafting
Adequate Nutrition
Contractures
2 mins
Stages of Hypothermia
Mild
32 to 35°C (90 to 95°F)
Shivering
Moderate
28 to 32°C (82 to 90°F)
Obvious Motor Impairment
Slowed Thinking
Severe
< 28°C (< 82°F)
Shivering Stops
Paradoxical Undressing
Arrhythmias
3 mins
Squamous Cell Carcinoma of the Skin
Epidemiology
2nd Most Common Skin Cancer
UV Light Exposure
Long-term Immunosuppression
Arsenic Exposure
Signs/Symptoms
Ulcerative Red Lesion
Precursor Actinic Keratosis
Commonly Lower Lip
Diagnosis
Biopsy shows Keratin Pearls
Treatment
Mohs Micrographic Surgery
2 mins
Hypothermia Interventions
Remove From Environment
Remove Wet Clothing
Passive Rewarming
Warm Clothing
Active Rewarming
Heated Blankets
Warm IV Solutions
Heated Oxygen
Warm Gastric Lavage
Considerations
Warm Trunk BEFORE Extremities
2 mins
Basal Cell Carcinoma of the Skin
Pathophysiology
Most Common Skin Cancer
2/3 of Cases Due to UV Light Exposure
Pink, Pearl-like Lesions
Rolled Borders
Telangiectasias
Commonly Upper Lip
Diagnosis
Shave Biopsy
Pallisading Nuclei
Treatment
Mohs Micrographic Surgery
2 mins
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