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Finals Revision > Derm > Flashcards

Derm Flashcards

1
Q

Chronic plaque psoriasis 1st, 2nd, 3rd line?

How do emollients help?

A

1st - potent steroid and vit D analogue applied once daily each one in morning and one in evening (up to 4 weeks for initial treatment)

2nd - if no improvement after 8 weeks - VitD analogue twice daily

3rd - if no improvement after 8-12 weeks - potent steroid applied twice daily or coal tar preparation applied once/twice daily. Dithranol another option.

Emollients help reduce scale loss and pruritis

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2
Q

Secondary care management of chronic plaque psoriasis?

A

Phototherapy - UVB or PUVA

Systemic - methotrexate 1st line, cyclosporin, retinoids, biologics

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3
Q

Treatment of scalp psoriasis?

A

Potent steroids for 4 weeks

If no improvement, consider using something to break up adherent scale (salicylic acid/oils) and a different formulation of potent steroid (shampoo/mousse)

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4
Q

Treatment of facial, flexural or genital psoriasis?

A

Mild-mod steroid 1-2 times daily for max of 2 weeks

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5
Q

Potential side effects of topical steroids? When might systemic symptoms start to occur?
How long should courses be?
How long between courses?

A

Skin atrophy, striae, rebound symptoms

1-2 weeks on face/flexures/genitalia
8 weeks max for mild-mod steroids
4 weeks max for potent

4 weeks between courses

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6
Q

Vit D analogues (Calcipitriol):

  • How do they work?
  • Can they be used long term?
  • Can they be used in pregnancy?
  • SE?
A

Reduce cell division and differentiation - reduce scale but not erythema

Yes they can be used long term (unlike steroids)

No not in pregnancy

No SE

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7
Q

How does dithranol work?

SE?

A

Inhibits DNA synthesis

Burning and staining - wash off after 30 mins

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8
Q

How does coal tar work?

A

Not fully understood - probably inhibits DNA synthesis

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9
Q

How long must a kid with impetigo be excluded from school?

A

Until 48 hours after commencing treatment

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10
Q

Person with Crohn’s has end ileostomy and develops deep, painful ulcer at stoma site - cause?

A

Pyoderma gangrenosum - most common on lower limbs but can occur anywhere - assoc w Crohn’s

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11
Q

Red papule with surrounding capillaries which blanch on pressure?
Causes?

A

Spider naevi

Liver disease, COCP, pregnancy (increased oestrogen)

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12
Q

Enlarged, red, itchy scar at injury site?
Most common location to occur?
Skin type?
Rx?

A

Keloid scar
Sternum
Darker skins
Intra-lesional steroids or excision

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13
Q

Is rosacea photosensitive?
Treatment initially?
If severe telangiectasia?
When to refer to derm?

A

Can exacerbate symptoms

  1. topical metronidazole (limited papules and pustules, no plaques)
  2. Oral oxytetracycline if more severe
    Brimonidine gel helps with flushing and telangiectasia

Laser therapy

If rhinophyma

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14
Q

pathophysiology of acne vulgaris?

A

Follicular hyperproliferation causing keratin plug of pilosebaceous unit - obstruction and colonisation by proprionobacterium acnes

Inflammation

Sebaceous gland can be controlled by androgen

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15
Q

Open and closed comedones?
Mild, mod and severe acne?
What is acne fulminans?

A

Open - blackhead
Closed - whitehead

Mild - open/closed comedones with/without sparse inflammatory lesions

Mod - Widespread non-inflammatory lesions with numerous papules and pustules

Sev - Extensive inflammatory lesions including nodules, pitting and scarring

Fulminans - severe acne assoc w systemic upset e.g. fever. Hospital admission often required

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16
Q

Acne treatment ladder?

A
  1. topical retinoid/benzoyl peroxide
  2. Combination topical therapy - retinoid/benzoyl peroxide/abx
  3. Oral antibiotic - tetracycline (or erythromycin in pregnancy, breastfeeding, young) WITH topical retinoid or benzoyl peroxide - at least 3 months
  4. WOMEN only - COCP or co-cyrindiol (dianette) - increased risk of VTE compared to COCP, 3 months max
  5. Oral isotretinoin
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17
Q

5 treatment options for AK?

A

5-FU (2-3 week course, skin becomes inflamed, sometimes hydrocortisone with)

Topical diclofenac

Topical imiquimod

Cryotherapy

Curettage and cautery

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18
Q

Prognosis of alopecia areata?

6 treatment options for alopecia areata?

A

50% hair will grow back in 1 year, 90% will eventually

  • topical/intralesional steroid
  • topical minoxidil
  • phototherapy
  • dithranol
  • contat immunotherapy
  • wigs
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19
Q

Antihistamines which receptor?
Sedating antihistamine?
Non-sedating?
What other side effects might they have?

A

H1

Sedating - chlorphenamine

Non-sedating - cetirizine/loratadine

Antimuscarinic (urinary retention, dry mouth)

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20
Q

Fungus causing athlete’s foot?

A

Tricophyton

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21
Q

3 types of BCC?
typical description?
Type of referral?
Management options?

A

Nodular, superficial, infiltrative

Pearly skin coloured papule with telangiectasia which ulcerates in centre, with picket fence border

Routine referral

Leave alone
Surgical removal - conventional or Mohs
Topical: imiquimod/5-FU

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22
Q

Chance of SCC with AK?

Bowen’s disease?

A

1/1000

5-10%

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23
Q

Antibodies in bullous pemphigoid?
Do blisters heal?
Ix?
Rx?

A

anti-hemidesmosome

Yes, usually without scarring

IF - IgG and C3 at DEJ

Rx - Oral corticosteroids mainstay
Topical corticosteroids, immunosuppressants and abx also used

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24
Q

What are cherry haemangioma’s?
4 features?
Management?

A

Campbell de Morgan spots

Benign skin lesion causing abnormal proliferation of capillaries - more common with advancing age

Erythematous, papular lesion
1-3mm in size
Non-blanching
NOT on mucous membranes

None

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25
Q

Management of contact dermatitis (both types)?

A

Allergen/irritant avoidance
Emollients
Topical steroids when flares

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26
Q

HSV type causing eczema herpeticum?

Rx?

A

Either 1 or 2

Admit for IV aciclovir

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27
Q

Atopic eczema distributon in infants vs children and adults?

Yellow, weeping crust over eczema?

A

infants - face and extensor surfaces (napkin area and flexural surfaces spared)

Older - flexural surfaces esp wrist, cubital fossa, popliteal fossa and ankles

GAS infection

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28
Q

Treatment for atopic eczema?

A

Emollients - lots and lots

Itch - antihistamines (good to give regularly to build up good levels in blood)

Flare: steroids

Topical calcineurin inhibitors can be used (Tacrolimus) as steroid sparing agents if needed long-term

When no response to potent steroids:
Light therapy (PUVA or UVB)
Immunosuppression

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29
Q

Most common cause of erisypelas?

When is Rx given IV?

A

Strep Pyogenes

Facial - cavernous sinus drainage - need to avoid

Also give IV if Staphylococcal Scalded Skin Syndrome

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30
Q

Erythema ab igne?

Risk?

A

Skin disorder caused by infrared radiation (heat) exposure - classically old woman next to open fire
Looks a bit like livedo reticularis

Can develop SCC

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31
Q

Erythema multiforme usual progression?
Causes?
What is erythema multiforme major?
Rx?

A

Target lesions starting on back of hands (or feet) and spreading to torso
Pruritis can occur but is mild

Causes:
Usually drugs - penicillin, sulphonamides, carbamazepine, COCP NSAIDs, allopurinol
Viruses - HSV, orf
SLE
Malignancy

Major - more severe form, mucosal involvement

Rx: supportive - treat underlying cause

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32
Q

Apart from shins, where else can erythema nodosum happen?
Causes?
How long to heal?

A

Forearms, thighs

No cause (60%)
Infection - strep, TB
Sarcodosis
IBD
Behcet's
Malignancy
Pregnancy
Drugs - penicillins, COCP

Heals in 6 weeks without scarring

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33
Q

What is erythrasma?
Cause?
Ix?
Rx?

A

Asymptomatic, flat, pink/brown, slightly scaly rash in groin/axillae

Overgrowth of diptheroid corynebactrium

Wood’s light - coral-red fluorescence

Topical antibiotic/miconazole
Oral erythromycin if widespread

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34
Q

What is erythroderma/exfoliative dermatitis?

Causes?

A

Widespread inflammatory lesion affecting >95% body followed by widespread exfoliation, with generalised lymphadenopathy

Lots of causes:

  • drugs - too many
  • atopy
  • Psoriasis
  • Leukaemias
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35
Q

What is red man syndrome?

A

Whole body erythema as a result of vancomycin hypersensitivity

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36
Q

What is granuloma annulare?
Where does it occur?
Cause?

A

Papular lesion that is hyperpigmented and depressed (or clear) cetrally

Dorsal hands/feet, extensors of arms/legs

Unknown

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37
Q

Guttate psoriasis?

Management?

A

Widespread small ‘tear drop’ scaly papules on trunk and limbs 2-4 weeks following sore throat (strep infection)

Most resolve spontaneously in 2-3 months
Topical agents as per psoriasis
UVB phototherapy

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38
Q

Inheritance of HHT?

A

AD

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39
Q

Hiradenitis suppuritiva?

A

inflammatory nodules, pustules, sinus tracts and scars in intertrigous areas (e.g. axillae, groin, perineum) - suspect in post-pubertal pts with recurrent furuncles or boils

Chronic inflammatory occlusion of pilosebaceous units that obstruct apocrine glands and prevent keratinocytes from shedding. Nodules can result in plaques, sinus tracts and rope-like scarring

Rx:
Stop smoking, weight loss, good hygiene
Acute - intra-lesional steroids/flucloxacillin
Long-term - topical clindamycin or oral tetracycline
If still persistent - surgical excision

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40
Q

DDx of hiradenitis suppuritiva? (3)

A

Acne vulgaris - this primarily occurs on face, back and upper chest, not intertrigous areas

Follicular pyodermas (folliculitis/furuncles/carbuncles) - these are transient and respond rapidly to abx

Granuloma inguinale (donovanosis) - STI caused by klebsiella granulomatis - enlarging ulcer that bleeds in inguinal area

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41
Q

Difference between hirsutism and hypertrichosis?

A

Hirsutism - androgen-dependent hair growth in women

Hypertrichosis - androgen-independent hair growth

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42
Q

Causes of hirsutism?

A

Most commonly PCOS

Also:

  • Cushing’s
  • CAH
  • Androgen therapy
  • obesity (insulin resistance)
  • androgen-secreting ovarian tumour
  • Drugs - phenytoin, corticosteroids

Management:

  • weight loss
  • COCP/co-cyprindiol (co-cyprindiol 3 months max VTE)
  • topical eflornithine for facial (not in pregnancy)
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43
Q

Causes of hypertrichosis?

A

Drugs: minoxidil, ciclosporin, diazoxide

congenital hypertrichosis lanuginosa/terminalis

porphyria cutanea tarda

anorexia nervosa

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44
Q 
2 causes of impetigo?
1st line treatment for simple impetigo?
If no/not good enough response to hydrogen peroxide?
If MRSA?
If widespread?
A

Staph Aureus, Strep Pyogenes

topical hydrogen peroxide

topical fucidic acid

MRSA - topical mupirocin

Widespread - oral fluclox (or erythromycin)

Excluded from school until lesions healed/crusted over OR 48 hours after commencing abx

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45
Q

2 complications of impetigo?

What causes it?

A

Bullous - splitting in granular layer causing blisters that burst to look like burns (localised SSSS)

SSSS - widespread erythema and desquamation causing epidermis loss. Similar to SJS/TENS but unlike them doesn’t involve mucosa. IV abx, extensive emollients and fluids

exotoxin A/B release

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46
Q

Keratoacanthoma?

Management?

A

Benign epithelial tumour more common in elderly

initially smooth dome-shaped papule that rapidly grows to become a crated centrally filled with keratin

Spontaneous regression within 3 months but scars. However, should be excised immediately to rule out SCC - this also prevents scarring

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47
Q

5 types of melanoma?

A

Superficial spreading - long radial growth phase, most common

Nodular - straight into vertical growth phase, bad prognosis

Acral lentigous - on palms/soles/subungal

Amelanotic - no pigment

Lentigo maligna - melanoma in-situ - very slowly progressive but may at some stage develop into malignant

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48
Q

What is koebner phenomenon seen in?

A

Psoriasis
Lichen planus
Lichen sclerosus
Molluscum contagiosum

49
Q

What is koebner phenomenon seen in?

A

Psoriasis
Lichen planus
Lichen sclerosus
Molluscum contagiosum

50
Q

Management of lichen planus?

A

Potent topical steroids mainstay

Benzydamine mouthwash for oral

Oral steroids/immunosuppression for extensive

51
Q

Lichen sclerosus management?

Follow-up?

A

Topical steroids and emollients

Skin biopsy if not responding or suspicion of neoplastic change - risk of VIN or vulval cancer

52
Q

Smooth, mobile, painless subcut mass?
Rx?
Features suggestive of sarcomatous change?

A

Lipoma

Nothing

>5cm
Increasing size
Pain
Deep anatomical location
(Liposarcoma rare)
53
Q

Management of suspected melanoma?

Exception?

A

Excision biopsy - remove entire lesion

Lentigo maligna - can be large - take biopsies from darkest areas - topical imiquimod can give histological clearance

54
Q

As well as breslow thickness, what else should be done in workup of melanoma in some cases?

A

Sentinel node mapping and block dissection of regional lymph nodes

55
Q

Breslow thickness relation to and excision margins?

A

<1mm - 1cm

1-2mm - 2 cm

2-4mm - 2-3cm

> 4mm - 3cm

<1mm = >95% 5-year survival
>4mm = <50%
56
Q

Most molluscum contagiosum can just be left - when is referral needed? (3)

A

HIV with extensive lesions - HIV specialist

Eyelid margin or ocular - ophthalmologist

Adults with Anogenital - GUM to ensure it’s not something else

57
Q

What is mycosis fungoides?

A

Rare cutaneous form of T-cell lymphoma

Itchy red patches
Lesions tend to be different colours, unlike eczema/psoriasis where they are generally the same colour

58
Q

What vitamin deficiency causes pellagra?

What drug can cause it?

A

B3 - niacin
(3D’s - dermatitis, diarrhoea, dementia/depression)

Isoniazid - stops the conversion of tryptophan to niacin
Most common in alcoholics

59
Q

Antibodies in pemphigus vulgaris?
Sign?
Biopsy?
Rx?

A

Anti-desmoglein 3

Nikolsky sign - spread of bullae followng appliction of shear pressure 
Painful lesions (not itchy like pemphigoid)

Acantholysis
IF - chicken wire

Rx - steroids 1st line
Immunosuppression

60
Q

Periorificial dermatitis?
Cause?
Rx?

A

Clustered papules, papulovesicles and paplopustules in perioral/perinasal/periocular regions
Lips are SPARED

Usually caused by topical/inhaled steroids

Stop steroids
Topical/oral abx

61
Q

How long for pityriasis rosea to clear up?

A

6-12 weeks

62
Q

Fungus causing pityriasis versicolor?

Rx?

A

Malassezia furfur
(may be mild scale)

Topical antifungal or ketoconazle shampoo

63
Q

4 skin manifestations of SLE?

A

Photosensitive butterfly rash
Discoid lupus
Alopecia
Livedo reticularis

64
Q

What can precipitate pompholyx?

Rx?

A

Humidity (sweating) and high temperatures

(Eczema - small blisters/vesicles on palms and soles - often intensely itchy - may burst)

Cool compresses
Emollients
Topical steroids

65
Q

Internal causes of itch?

A

Liver disease - stigmata of liver disease, alcohol excess

Iron deficiency anaemia - pallor, koilonychia, atrophic glossitis, angular stomatitis, post-cricoid webs

Polycythaemia - itchy after warm bath, ‘ruddy’ complexion, gout, peptic ulcer disease

CKD - lethargy, pallor, oedema, hypertension

Lymphoma - night sweats, lymphadenopathy, hepatosplenomegaly, fatigue

Hyper/hypo-thyroid

Diabetes

Pregnancy

Senile pruritis

66
Q

Nail changes in psoriasis? (4)

A

Present in 80-90% with arthropathy

  • Pitting
  • Onycholysis
  • Subungal hyperkeratosis
  • Loss of nail
67
Q

4 subtypes of psoriasis?

4 exacerbating factors?

A

Plaque - most common - extensor, scalp, sacrum

Flexural - skin is smooth

Guttate - transient, post-strep

Palmoplantar pustlosis

Trauma (Koebner)
Alcohol
Withdrawal of systemic steroids
Drugs - B-blocker, lithium, antimalarial, NSAIDS, ACEI

68
Q

DDx purpura in kids? (6)

A

ALL and meningococcal septicaemia - must rule out

Congenital bleeding disorders
ITP
HSP
NAI

69
Q

DDx purpura in adults? (5)

A

ITP
Marrow failure (leukaemia, myelodysplasia, bone mets)
Senile purpura
Nutritional def (B12, folate, C)
Drugs (quinine, antiepileptics, antithrombotics)

Raised SVC pressure e.g. from chronic bad cough may cause upper body petechiae but not purpura

70
Q

Pyoderma gangrenosum?

A

Initially small red papule, develops into deep, red, necrotic ulcer with violaceous border

Idiopathic 50%
Assoc w IBD, SLE, RA, blood cancers and PBC

Oral steroids

71
Q

Pyogenic granuloma?
Who in?
Management?

A

Usually after trauma in young/pregnant women

Initially small red/brown spot, within days-weeks is raised spherical lesion, may bleed profusely or ulcerate (haemangioma)

Oral mucosal lesions common in pregnancy

Pregnancy-assoc spontaneously resolve post-partum
Otherwise, curettage and cauterisation

72
Q

SE retinoids? (7)

What drug cannot be prescribed with it?

A 
Teratogenicity - 2 forms of contraception (COCP, condoms)
Dry skin, eyes, mouth
Low mood
Raised triglycerides
Nose bleeds
Photosensitivity
Raised intracranial hypertension

DO NOT use with tetracyclines - raised ICP

73
Q 
Cause of itch with scabies?
Where else is affected in infants?
Management?
Who else needs treated?
How long might itch last?
Who gets Norwrgian (crusted) scabies?
Rx for this?
A

Type IV hypersensitivity reaction

Scalp and face
(as well as webs and flexors)

  1. Permethin
  2. Malathion
    Apply, leave on for 12 hours (24 malathion), wash off, reapply 7 days later

All close contacts, treat at same time - also launder/iron clothes/bedsheets on 1st day of treatment to kill off mites

4-6 weeks

HIV pts
Ivermectin

74
Q

Where are sebaceous cysts found?
What will they typically contain?
Rx?

A

Anywhere

Punctum

Excision - wall must be excised also to avoid recurrence

75
Q 
Fungus in seborrhoeic dermatitis?
Rash?
Assoc w?
Scalp Rx?
Face/body Rx?
A

Malassezia furfur (same as pityriasis versicolor)

Eczematous lesions in sebum-rich areas - scalp (dandruff), periorbital, airicular, nasolabial folds

HIV, Parkinsons

Scalp - Zinc (head & shoulders) or Tar (neutrogena) shampoo
- Ketoconazole shampoo 2nd line

Face/body:

  1. topical ketoconazole
  2. topical steroids (for short periods)

Recurrence common

76
Q

Seborrhoeic keratosis Rx?

A

Reassurance - leave on

Options or removal:

  • Curettage
  • Cryosurgery
  • Shave biopsy
77
Q

Shingles:

  • rash?
  • antiviral?
  • analgesia?
  • infectivity time?
  • how long does post herpetic neuralgia last?
A

burning pain for 2-3 days then erythematous, macular rash which quickly becomes vesicular
Doesn’t cross midline but may be some ‘bleeding’ into other areas

  • Aciclovir within 72 hours onset
  • paracetamol and NSAIDs 1st line, neuropathic 2nd line e.g. amitriptyline
    Oral steroids in first 2 weeks in pts with normal immunity and localised if severe pain not responding to above
  • infections until vesicles have crusted - usually 5-7 days after onset
    Avoid immunocompromised and pregnant

Mostly cured in 6 months

78
Q

When might shingles cause facial palsy?

A

Ramsay Hunt Syndrome

Ear lesions and facial paralysis, can cause vertigo and deafness as well

79
Q

Purple cutaneous nodule in immunosuppressed pt?

A

Kaposi Sarcoma

80
Q

Excision margins for SCC?

A

If <2cm - 4mm margins

If >2cm - 6mm margins

Mohs microsurgery in high-risk pts or cosmetically important sites

81
Q

Causes of SJS/TEN?

A 
Penicillins
Sulphonamides
Lamotrigine, carbamazepine, phenytoin
Allopurinol
NSAIDs
COCP

Nikolsky sign +ve in TEN often

Admit for supportive and fluid replacement
In TEN may be ICU, with immunosuppression/IVIG

82
Q

Strawberry naevus progression?

If Rx required eg blocking visual field?

A

Capillary haemangioma

Not present at birth, usually develops rapidly in first month of life

Increases in size until about 6-9 months, then starts to regress. 95% resolve by 10 years of age

May bleed, ulcerate or obstruct visual fields

If Rx required:

  1. Propanolol
  2. Topical timolol
  3. Oral steroids
83
Q 
Rx for:
Athlete's foot?
Tinea corporis/cruris?
Tinea capitis?
Candidiasis?
A

Topical terbinafine 7 days

Topical terbinafine 14 days

Oral terbinafine 2-4 weeks + clotrimazole shampoo twice weekly for 2 weeks

Clotrimazole cream 14 days

84
Q

Rx fungal nail infection?

A

Send away clippings first for confirmation, then:

Oral terbinafine 6 weeks - fingers
12 weeks - toes

If non-dermatophyte:
Oral itraconazole

85
Q

Normal ABPI range?
What range can be given compression?
Low Rx in venous ulcer?

A

0.9-1.2

Compression can be safely given between 0.8-1.3

<0.8 - refer for specialist vascular assessment

> 1.3 - likely calcification in diabetics

4 layer compression bandaging

86
Q

How to tell if angioedema?

A

Non-pitting swelling
Usually transient caused by mast cell degranulation in IgE-related process
Resolves in 1-2 days

87
Q 
Which HPV viruses cause:
- warts?
- genital warts?
- oral and cervical cancer?
Treatment of warts?
A

Warts: 1-4

Genital warts: 6/11

Cancer: 16/18/33

Rx: Salicylic acid, cryotherapy, podophyllum, imiquimod

Podophyllum/cryotherapy 1st line genital

88
Q

Young kid, fever for a few days, then oral vesicles and ulcers, with grey vesicles on hands and feet?
Causes?
Rx?

A

Hand, foot and mouth disease

Coxsackie virus or enterovirus

None, self-limiting, 10 days

89
Q

What is tinea incognito?

A

When fungal infection is treated with steroids making it spread and look different

90
Q

Rx for crab lice?

Head lice?

A

Crab lice - same as scabies, household contacts don’t need treatment though

Head lice - Dimeticone lotion or malathion

91
Q

What is herpetic whitlow?

A

Paronychia - painful lesions common in healthcare workers and dentists

92
Q

What is xeroderma pigmentosum?

A

Group of AR disorders causing deficiency of DNA repair mechanisms of skin

Most die in teenage years of skin cancer

93
Q

Acute intermittent porphyria presentation?

Enzyme deficiency?

A

Intermittend acute abdo, psychosis and seizures
Usually female around 30 y/o.

PBG deaminase

94
Q

Porphyria cutanae tardis presentation?
Enzyme deficiency?
Woods lamp?

A

Middle aged men, common with liver disease (alcohol, hep, cirrhosis, haemochromatosis)

Blistering lesion on sun exposed sites that heal with scarring and hyperpigmentation

Uroporphyrinogen decarboxylase

Shines pink instead of blue

95
Q

Erythropoeitic porphyria presentation?

Enzyme deficiency?

A

AD disorder seen in children
May be no rash but will be painful burning and itching when exposed to sun - kid may scream in sun

Ferrochealatase

96
Q

What drugs commonly cause photosensitivity? (5)

A 
Tetracyclines
Ciprofloxacins
Diuretics
Amiodarone
NSAIDs
97
Q

Polymorphic light eruption presentation?

Rx?

A

Women around 30, erythema with varying morphology, papules and blisters and severe itch several hours after sun exposure (Type IV hypersensitivity)

Topical steroids
UVB desensitisation

98
Q

Presentation of chronic actinic dermatitis?

Rx?

A

Type IV hypersensitivity reaction to sun
Men >50, eczematous rash on sun exposed sites, often assoc w allergic contact dermatitis

Normal eczema treatment and sun protection

99
Q

Solar urticaria presentation?

Rx?

A

Type 1 hypersensitivity causing immediate erythema, urticaria and itch in response to sun exposure, which subsides in a few hours

Sun avoidance and antihistamines

100
Q

What are actinic lentiges?

A

Also called sun/liver spots

Flat brown macule as protective mechanism from melanocyte proliferation in older people in sun-exposed sites

101
Q

Congenital melanocytic naevi?

A

Typically appear at, or soon after birth, usually >1cm, risk of malignant transformation

102
Q

Junctional melanocytic naevi?

A

Circular macules - may have heterogenous colour - most naevi on palms/soles/mucous membranes are this type

103
Q

Compound naevi?

A

Domed, pigmented nodules up to 1cm diameter, arise from junctional naevi, usually have uniform colour and are smooth

104
Q

Spitz naevi?

A

Typically form in first few months of childhood - may be pink/red but may be pigmented - rapid growth that resembles melanoma

Usually excised as a precaution

105
Q 
Acanthosis?
Acantholysis?
Hyperkeratosis?
Papillomatosis?
Spongiosis?
Parakeratosis?
Lichenification?
A

thickening of epidermis

separation of individual epidermal cells

Thickened keratin layer

Rough skin due to hyperplasia of dermal papillary projections

oedema in epidermis

nuclei in keratinocytes

Exaggerated skin markings

106
Q 
Macule?
Patch?
Papule?
Nodule?
Plaque?
A

Flat hyperpigmented <1cm

Flat hyperpigmented >1cm

Raised, well defined, <0.5cm

Raised, well defined, >0.5cm

Raised, flat topped, grows horizontally, >1cm

107
Q 
Vesicle?
Bulla?
Pustule?
Cyst?
Blister?
A

Fluid filled <0.5cm

Fluid filled >0.5cm

Pus-filled lesion

Semi-solid material filled lesion

Collection of fluid within/below epidermis

108
Q

Erosion?
Ulcer?
Fissure?

A

Superficial break in epidermis

Deep skin break that extends to dermis

Horizontal split in epidermis

109
Q

Purpura?
Petechiea?
Ecchymoses?

A

Purpura is the general name given to discolouration of skin/mucous membranes from bleeding from small vessels

Petechiae - purpura <2mm across

Ecchymoses - larger bruises

(in between these just called purpura)

Palpable purpura - purpura that can be felt - often due to vasculitis

110
Q

Cream?

A

Semisolid emulsification of oil in water - contains preservatives - non-greasy

111
Q

Ointment?

A

Semi-solid grease, no preservatives, greasy but limit transdermal water loss

112
Q

Lotion?

A

Liquid formulations suspended in water or alcohol (alcohol can cause stinging) - generally used to treat dry, hairy areas e.g. scalp

113
Q

Gel?

A

Semisolid thickened aqueous solution, used for hairy areas or face

114
Q

Paste?

A

Semisolid made of finely powdered materials e.g. zinc oxide - cool and hydrate skin but difficult to apply

115
Q

When to refer to secondary care for burns?

A

Superficial burns covering >3% TBSA (2% in kids)
All deep dermal/3rd degree burns
Superficial dermal burns of face, hands, feet, perineum, neck
Electrical or chemical burn
Inhalation injury
Suspected NAI

116
Q

Initial management of burns?

A 
Put in ice cool water for 10-30 mins then cover in clingfilm - layered not wrapped
analgesia
clean wound
emollient - leave blisters in tact
non-adherent dressing

If chemical - brush off any powder and rinse off with water - do not attempt to neutralise

117
Q

Widespread sunburn-like rash over body, including lips, with fever and sepsis?
What can cause this in women?

A

Staph toxic shock syndrome

Tampon use

118
Q

Nail changes in psoriasis?

What systemic thing are psoriasis patients more at risk of?

A

Pitting, onycholysis, subungal hyperkeratosis

Cardiovascular disease

Finals Revision (29 decks)

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