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Ax Derma Flashcards

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Dermatology Board Prep flashcards
1
Q

Common causes of cellulitis

A

Nonpurulent recurrent cellulitis- streptococcus pyrogens and other steptococcus species.

Prudent cellulitis( associated penetrating trauma, ulcer, abscess) - staph aureus

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2
Q

Indications of IV AB in cellulitis

A
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3
Q

What’s Molluscum contagiosum

A

Viral infection of childhood
Molluscipox virus
Pearly white , firm, smooth, spherical papules with a central dimple (umbilicus) ( 1-3 mm)
Commonly - flexures and areas of friction ,anogenital areas, eyelid margins (may lead to chronic conjunctivitis)

Benign course of nature
Spontaneous resolution within 6 months to 3 years.
(Active treatment is not recommended)

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4
Q

How contagious is molluscum c.

A

No need to isolate. But better to avoid sharing towels and bathing together as they may increase risk of spread.

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5
Q

Characteristic features of seborrheic keratosis ?

A

Brown plaque on sun exposed region.
Appears to stuck on.
Finely warty surface.
KERATOTIC PLUGGING of the surface of the lesion( YELLOW colored)

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6
Q

What’s seborrheic keratosis (SK)

A

Commonest benign tumor in older adults.
Typically FLAT, oval or round , WELL DEFINED lesion on Mostly SUN EXPOSED areas.
Colour will range from black to tan.
It has velvety to warty surface appears to stuck on. MAY MISTAKE WITH WARTS.

Difficult to dif from melanoma and lentigo maligna.

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7
Q

What’s actinic keratosis

A

FLAT small SCALY lesions on SUN EXPOSED areas of adults.( specially back of the hand)
PRECANCEROUS —->SCC

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8
Q

What’s Bowen’s disease

A

Similar to AK
On sun damaged areas of skin.
PRECANCEROUS.
FLAT and scaly as AK , but LARGER DIAMETER and WELL DEMARCATED BORDERS AND THICKER.

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9
Q

What’s malignant melanoma

A

Flat lesion of VARIOUS COLOURS and IRREGULAR BORDER AND SHAPE.

But nodular melanomas may present with pigmented DOME SHAPED lesion ( much like a SK )

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10
Q

What’s Dermatosis papulosa nigra

A
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11
Q

What’s the drug interaction of amiodarone and warfarin

A

Causes decreased metabolization of warfarin—-> increased bleeding tendency.

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12
Q

What’s the management of shingles

A

Immediately - pain relief ( Amitriptylin or gabapentine)
Antiviral agents- acyclovir, valaciclovir, Famiciclovir( not given in pregnancy)

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13
Q

What’s Ramsey hunt syndrome

A

Acute peripheral facial neuropathy causes by reactivation of latent varicella zoster virus infection.

Erythematous vesicular rash of skin of ear canal , auricle and oropharyngeal mucus membranes.
May have vertigo, tinnitus, hyperacusis, paroxysmal otalgia.
Classic triad - ipsilateral facial nerve palsy, ear pain , vesicles at auditory canal.

Rx- antiviral started within 72hours of onset.
Antivirals can be given.

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14
Q

When can IM adrenaline given in dermatological conditions

A
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15
Q

What’s promithazine

A

An antihistamine that can be used in urticaria without features or anaphylaxis.—> IV route of severe or if eyelids involved. —> if no response oral corticosteroids given.

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16
Q

What are photoeruptions

A

Photosensitivity associated with medications. Eruption typically exaggerated by sunburn, often with blisters.

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17
Q

What’s re phototoxic eruptions

A

Most common drug induced phtooeruptions.
By absorption of UV light by causative drug resulting in cell damage.
Common wavelength- UVA light.
Typically exaggerated by sunburn.
Common causes-
1. NSAIDs
2. Quinolones
3. Tetracyclines (doxycycline)
4. Sulfonamides
5. Phenothiazines.

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18
Q

What’s photoallergic eruptions

A

Reaction to exposure to UVA.
Widespread ECZEMA in photoexposed areas ( face, upper chest, back of the hand )

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19
Q

Common treatment of acne

A

Doxycycline ( a tetracycline)

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20
Q

What’s Acne rosacea

A

*Mainly involves face.
*Erythema affecting central face or butterfly area.
*Sometimes associated edema seen.
*Telangectasia ( spider veins) present often.
*Sterile inflammatory papules, pustules, nodules may mimick acne.
*No comedones.
* commonly complains of how born sting over the affected area

Etiology unknown: trigger factors-
Hot or cold temperature, wind, hot drinks, ALCOHOL, caffeine, exercise.

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21
Q

What’s pityriasis rosea

A

Common in children and young adults.
Cause is viral.

Eruption begins with Harold’s patch ( mimics tinea)
After 2 WEEKS - multiple, scaly, salmon colored macules (1-2 cm size, oval) —-> Christmas tree appearance
Symmetrical.
Involve- chest, back, abdomen. (Face hands and limbs not affected )
Crismas tree appearance, ITCHY RASH, mild prodromal symptoms (malaise, fatigue, headache, anorexia, fever)

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22
Q

Management of pityriasis rosea

A

Resolves spontaneously in 6-8 weeks.
Hypo or hyperpigmentation may follow the rash.

Symptomatic management-
1. Menthol for itching
2. corticosteroids in severe itching.
3. Exposure to sunlight maybe helpful with healing process.

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23
Q

What’s Tinea versicolor

A

Common fungal infection by Malasszia furfur.
Well demarcated macular rash that are hyper or hypopigmented and slightly itchy.

Commonly seen in upper trunk.
Have no central clearing.

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24
Q

What’s tinea unguium

A

Infection of fingernails or toenails caused by dermatophytes.
Commonly affected part is nail plate.

( generally fungal finger infection is called onychomycoses)

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25
Q

What are types of tinea unguium

A
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26
Q

Treatment for mild papulopustular acne

A

Tropical either retinoid or benzoyl peroxide.
If treatment fails - topical clindamyxin or erythromycin

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27
Q

For mild truncal acne

A

Salicylic acid 3-5% in 70% ethanol.

28
Q

For moderate papulopustular acne +/- truncal involvement

A

increased strength of topical retinoids or benzoyl peroxide and oral antibiotics ( first line - doxycycline or if contraindicated(pregnancy) erythromycin )

29
Q

For moderate to severe acne +/- nodules +/- cysts.

A

Topical Adapalene or tretinoin plus antibiotics used. —-> if not responding dose increase of AB—-> if still no response ,systemic treatment - Isotretinoin

30
Q

What’s alopecia areata

A

One of more discrete area of hair loss.
Autoimmune inflammation of hair bulb leading to cessation of hair growth , but not destruction of hair follicle.

Variable course of disease- patches may resolve spontaneously, may remain unchanged or expand into alopecia totalis (entire scalp) or alopecia universalis (entire body)

31
Q

How to manage alopecia areata

A
  1. First line- intralesional or topical potent corticosteroids.
  2. Intralesional corticosteroid injection ( Triamcinolone or Betamethasone) appropriate for small areas.
  3. For extensive and not responding - potent contact allergen( topical immunotherapy) to precipitate an allergic dermatitis
32
Q

How to manage alopecia areata in children <10

A

Minoxidil and topical steroids

33
Q

Scraping of scalp and preparation with KOH for microscopy for what

A

Tinea capitis

34
Q

What’s lentigo maligna melanoma

A

Irregular borders and different Colour shades ( suggestive of melanoma)
HEAD AND NECK of OLDER INDIVIDUALS
who have a history of LONG TERM SUN EXPOSURE ( therefore greatest RF for LMM is chronic sun exposure )

35
Q

Lipoma features

A

Freely mobile
In any layer
LOBULATED
Not premalignant

36
Q

What’s adipose Dolorsa ( Dercum disease)

A

Diffuser painful subcutaneous fat deposition without focal discrete lumps. Often seen in abdomen and thighs.

37
Q

What are epidermoid cysts

A

Keratinized material confined to dermis.
Attached to overlying skin and not mobile.
Central punctum seen.

May become infected and form an abscess—-> therefore EXCISION is recommended.

NO PROGRESSION TO MALIGNANCY..

38
Q

What’s multiple symmetrical subcutaneous lipomas

A

As the name implies
Soft, rubbery ,lobulated
Can become painful at times.

39
Q

Treatment of scabies

A

Permethrin 5%
Benzyl Benzoate (irritable to skin and poor compliance)

40
Q

What are RF of melanoma

A
  1. History of melanoma( >10times risk)
  2. Multiple melanotic naevi ( benign) (count more than 100 has 7 fold risk)
  3. Multiple dysplastic naevi
  4. History of nonmelanoma skin cancer
  5. Family history of melanoma in first-degree relative.
  6. Fair complexion
  7. UV exposure - acute and blistering carries more risk (highest of exposure intermittently on adolescence and childhood )
41
Q

What are nail apparatus melanoma ( subungual melanoma)

A

Rare but fatal neoplasms.
Commonest - 70s
Presents as longitudinal pigmented streak - Hutchinson sign—-> mail plate maybe destroyed( by this time LN Mets have already spread)

70% - thumb and big toe

Finger amputation from DIP,PIP or MCP joints are an options.

42
Q

What’s the prognostic factor of melanoma

A

Increased tumor depth and presence of ulcer are associated with a worse prognosis and reduced 5 year survival.

43
Q

What are features of cutaneous SCC

A

over sun exposed areas.
Surface changes-
1. Scaling
2. Shallow Ulcerations
3. Crusting
4. Cutaneous horn.
Less commonly presents as pink cutaneous nodule without overlying surface changes.

44
Q

How to differentiate if pigmentation is noted?

A

If pigmentation is seen two most likely diagnosis are simple /melanocytes nevi or melanoma
If melanoma ABCD features maybe seen.

A- Asymmetry
B- border irregularity
C- Colour that tends to be very dark or blue or variable
D- diameter >6mm

If ABCD seen more likely melanoma
Simple naevi-

45
Q

Commonest skin malignancy arising from burn scar

A

SCC
Marjoin ulcer is a less common SCC found on chronic ulcers and burn scars.( commonly over legs and feet)

46
Q

Types of benign melanocytic naevi

A
  1. Intradermal navus - all Nevis within dermis ( NOT MALIGNANT)
  2. Junctional nevus- at junction of nasal epidermal layers and dermis
  3. Combined nevus- both intradermal and junctional

Benign melanocytic naevi coins more than 100 is associated with 7 fold risk of

47
Q

List of precancerous lesions of SCC

A
  1. Acitinic keratosis ( raised plaques on sun exposed areas)
  2. Leukoplakia( whitish lesion in oral cavity)
  3. Bowen disease
  4. Chronic radiation dermatitis.
48
Q

UV exposure is greatest RF for which MELANOMAS?

A

Lentigo malignant melanoma(LMM)
Which frequently appear on head and neck of individuals who have a history of long term sun exposure.

49
Q

Which PRECANCEROUS OF SCC lesions are seen in LIGHT SKINNED INDIVIDUALS who have had SIGNIFICANT SUN EXPOSURE

A

Actinic ( solar) keratosis and Bowen’s disease.

50
Q

What are aggravating factors of tinea versicolor

A

Heat and damp
Not sun exposure.

51
Q

What’s Dermatofibroma/ sclerosing hemangioma

A

Pigmented nodule in the dermis due to proliferation of fibroblast, usually following MINOR TRAUMA.

Common in WOMEN on the LOWER LEG.

Button like nodule , firm , freely mobile and well circumscribed. Size 0.5-1cm. DIMPLING SIGN+
Often asymptomatic but could be Itchy and tender.

52
Q

What’s keratoacanthoma (KA)

A

Keratinizing skin tumor.
DOMED nodule with a NECROTIC PLUG in the center is characteristic ( volcano appearance)
RAPIDLY grow ( 6-8 weeks) compared to BCC,SCC and melanoma.
Exclusively seen in SUN EXPOSED AREAS. ( but not due to sun exposure)

Spontaneous healing ( in 3-6 months) or metastasis could occur.

Mx - elliptical surgical excision ( because difficulty to DIFFERENTIATE FROM SCC)

  • surgical resection is more IMP in patients with ORGAN TRANSPLANTATION because they could grow malignantly due to immunosuppression.
53
Q

What is difficult to differentiate form keratoacanthoma

A

SCC
Sometimes cytology even not enough to diagnosis, the whole specimen would be needed.

54
Q

What’s the most imp prognostic factor of BCC

A

Generally prognosis is 100% for BCC.
Even though BCC is malignant it barely metastasize. ( if so sites- lung, LN, bone)

Curative in >95%/ but recurrence rates are higher.
Prognostic factors for recurrence - absence of tumor cells in excision margins ( most imp) , clinical location, architectural patterns.

55
Q
A

Seborrheic keratosis

56
Q
A

Malignant melanoma
( pigmentation of different colors and rapid progression)

57
Q
A

Keratoacanthoma

58
Q
A

Nodular BCC.
Could be in non sunexposed areas as well.
Commonest subtype of BCC.
Features - pearly appearance, shiny surface and telangectasis are characteristic.

59
Q
A

Bowen’s disease. ( SCC in situ of the skin)
Sun exposed areas.
Well demarcated, erythematous, scaling plaques.

Ix- confirmed by punch or shaved biopsy.

Rx-( same effect with 10% recurrence rate)
1. Topical fluorouracil or imiquimod
2. Cryotherapy
3. Curettage.
4. Cautery
5. Excision
6. Laser or radiation

60
Q
A

Pyogenic granuloma(PG)
(Fleshy red , dome shaped, papule or nodule, easily bleeds, common on interphalangeal joints)

Common benign acquired vascular neoplasm of skin.
Unknown etiology.
( neither pyogenic nor granuloma)

61
Q
A

Mucus (synovial) cyst of the finger.
Subcutaneous cystic lesions found on the dorsal aspect of distal phalanx, distal to the distal interphalangeal joint and overlying the germinal nail bed.
Maybe PAINFUL.
They may cause distortion of the nail growth.
Located midline or laterally.

62
Q
A

Benign mucus cyst / mucocele.
Smooth, soft, rounded, fluid filled lump.
Commonest- inner surface of lower lip
If bothersome can do incision and evacuation.

63
Q
A
64
Q

What are statin related adverse effects.?

A

Increased activity of statins may course muscular pain, myopathy and rarely rhabdomyelisis.

65
Q

What are features of psoriasis?

A

Erythematous patches in a symmetrical fasion.
SILVERY SCALING seen.

66
Q

What’s leukoplakia

A

Whitish lesion in oral cavity
Associated with SCC

Dermatology (1 decks)

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