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Derm Flashcards

1
Q

What is a small, crusty/scaly lesion that is pink, brown, red, or neutral, which develops as a consequence of chronic sun exposure?

A

Actinic/solar keratoses

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2
Q

What is the treatment of actinic keratoses?

A

2-3 weeks fluorouracil cream

Topical imiquimod

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3
Q

What benign epithelial tumour looks like a volcano then grows to become a crater filled with keratin?

A

Keratoacanthoma

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4
Q

What are the characteristics of basal cell carcinoma?

A 
Morphoeic
Firm/rough/waxy
Pearly/flesh coloured
Papular
Telangiectasia
Lateral ulceration
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5
Q

What is the treatment of BCC?

A

Routine referral
Topical imiquimod/fluorouracil
Moh’s surgery

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6
Q

What are 6 risk factors for SCC?

A 
Sunlight
Actinic keratoses/Bowen's disease
Immunosuppression
Smoking
PUVA therapy for psoriasis
Oculocutaneous albinism
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7
Q

What are the characteristics of SCCs that arise in a chronic scar?

A

Aggressive

Increased risk of metastases

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8
Q

What is the management of SCC?

A

<20mm diameter: excision with 4mm margins

>20mm diameter: excision with 6mm margins

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9
Q

What is the most important prognostic factor in malignant melanoma?

A

Breslow thickness (invasion depth)

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10
Q

50% malignant melanoma patients have which mutation?

A

BRAF mutation

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11
Q

What is vemurafenib?

A

BRAF inhibitor which improves survival in malignant melanoma

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12
Q

What are the 2 types of contact dermatitis?

A

Irritant

Allergic

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13
Q

What is skin prick test useful for?

A

Pollen and food allergies

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14
Q

What does RAST do?

A

Determines that amount of IgE that reacts specifically with suspected or known allergens

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15
Q

What type of dermatitis is skin patch testing used for?

A

Contact

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16
Q

What are the characteristics of eczema herpeticum?

A

Monomorphic
Punched out erosions
Pruritic blisters/vesicles

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17
Q

What is the treatment of eczema herpeticum?

A

IV aciclovir

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18
Q

What fungi is seborrhoeic dermatitis an inflammatory reaction to?

A

Malassezia furfur

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19
Q

What is seborrhoeic dermatitis associated with?

A

HIV

Parkinsons

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20
Q

What is the treatment of keyloid scars?

A

Intra-lesional steroids e.g. triamcinolone

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21
Q

What is the cause of livedo reticularis?

A

Obstruction of capillaries resulting in swollen venules

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22
Q

What are the causes of livedo reticularis?

A 
SLE
PAN
Cryoglobulinaemia
APS
Homocystinuria
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23
Q

What is the pathophysiology of dermatitis herpetiformis?

A

Deposit of IgA in the dermis

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24
Q

What rash is associated with lung cancer?

A

Erythema gyratum repens

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25
What rashes are associated with lymphoma?
Erythroderma | Acquired ichthyosis
26
What rashes are associated with diabetes?
Necrobiosis lipoidica Candidiasis Lipotrophy granuloma annulare
27
What are 5 causes of erythema nodosum?
``` Strep infection Sarcoid Pregnancy IBD Penicillins/sulphonamides/COCP ```
28
What are 5 causes of pyoderma gangrenosum?
``` Idiopathic IBD CTD Myeloproliferative disorders SLE PBC ```
29
What are 6 causes of hirsuitism?
``` PCOS Cushing's CAH Obesity (insulin resistance) Androgen therapy Phenytoin/steroids ```
30
What is the scoring system used for hirsuitism?
Ferriman-Gallwey
31
What are the treatments for hirsuitism?
Weight loss Co-cyprindiol/ethinylestradiol and drospirenone Topical eflornithine
32
What are 6 causes of hyperptrichosis?
``` Porphyria cutanea tarda Minoxidil Ciclosporin Congenital hypertrichosis lanuginosa Anorexia ```
33
What rash is seen in glucagonoma?
Necrolytic migratory erythema
34
What is the cause of pityriasis/tinea versicolor?
Superficial infection with malassezia furfur
35
What is the treatment of pityriasis versicolor?
Topical ketoconazole
36
What is the cause of pityriasis rosea?
Reactivation of HHV 6 and 7
37
What is characteristic of pityriasis rosea?
Herald patch
38
What rash occurs with overgrowth of the diphtheroid corynebacterium minutissimum?
Erythasma
39
What occurs when erythasma is examined with Wood's light?
Coral red fluorescence
40
What is the treatment of erythasma?
Topical miconazole --> PO erythromycin
41
What is the pathophysiology of acne vulgaris?
Follicular epidermal hyperproliferation --> keratin plug Obstruction of pilosebaceous follicle Colonisation by anaerobic bacterium propiobacterium acnes + inflammation
42
What is the initial and 2nd line treatment of acne?
Single topical therapy e.g. retinoids, benzoyl peroxide Then, combination therapy (2 of retinoids, benzoyl peroxide, antibiotic)
43
What is the 3rd line treatment of acne?
PO antibiotic e.g. tetracyclines (not preg) or COCP Co-prescribe topical retinoid/benzoyl peroxide to reduce risk of abx resistance
44
What is the 4th line treatment of acne?
PO isotretinoin
45
What are 6 side effects of isoretinoin?
``` Depression Dry skin, eyes, mouth Teratogenic Raised triglycerides Hair thinning IIH ```
46
What is erythroderma?
95% skin involved in a rash of any kind
47
What molecule is implicated in the development of rosacea?
Cathelicidins - innate response to chronic exposure to UV radiation
48
What is the treatment of rosacea?
Topical metronidazole --> oxytetracycline
49
What is the primary care treatment of psoriasis?
1. Potent steroid OD + vit D analogue OD (applied separately) 2. Vit D analogue BD 3. Potent steroid BD or coal tar OD or BD
50
What type of phototherapy is used for psoriasis in secondary care?
Narrowband UV B light 3x week OR Psoralen + UV A light (photochemotherapy, PUVA)
51
What are the risks of phototherapy?
Skin ageing | SCC
52
What are 4 other systemic treatments of psoriasis in secondary care?
PO methotrexate Ciclosporin Systemic retinoids Anti-TNFs
53
Name 6 factors that exacerbate psoriasis?
``` Beta blockers Lithium Antimalarials NSAIDs ACEIs Trauma Alcohol ```
54
What is the treatment of guttate psoriasis?
Ultraviolet B phototherapy
55
What is the treatment of flexural psoriasis?
Topical steroids
56
What is Nikolsky's sign?
Epidermis separates with mild lateral pressure
57
What is the treatment of toxic epidermal necrolysis?
Stop causative drug Supportive care IVIG Ciclosporin/CYC
58
What drugs cause toxic epidermal necrolysis?
N-CAPS ``` NSAIDs Carbamazepine Allopurinol Phenytoin/penicillin Sulphonamides ```
59
What are the most common causes of erythema multiforme?
HSV Mycoplasma Strep
60
What are the features of erythema multiforme?
Target lesions Back of hands/feet --> torso Upper limb>lower limb Kobner phenomenon
61
What type of ulcer is usually seen above the medial malleolus?
Venous
62
What ABPI result is abnormal?
<0.9 - arterial disease | >1.3 - calcification
63
What is the management of venous ulcer?
``` Compression bandaging PO pentoxiflline (peripheral vasodilator) ```
64
What is the condition of a neoplastic proliferation of mast cells?
Systemic mastocytosis
65
What are the features of systemic mastocytosis?
Urticaria pigmentosa Darier's sign Flushing Abdo pain (from increased histamine -> gastric acid)
66
How is systemic mastocytosis diagnosed?
Monocytosis Raised serum tryptase Raised urinary histamine
67
What are the symptoms of zinc deficiency caused by TPN?
``` Acrodermatitis herpetiformis Perioral dermatitis Alopecia Short stature Hepatosplenomegaly ```
68
What are the features of hereditary haemorrhagic telangiectasia?
``` Epistaxis Telangiectasias Visceral lesions e.g. GI telangiectasia Pulmonary/cerebral/spinal AVMs Family history ```
69
What are the associations of yellow nail syndrome?
Congenital lymphoedema Pleural effusions Bronchiectasis Chronic sinus infections
70
What are the causes of bullous pemphigoid?
``` Chronic skin disease NSAIDs Furosemide Captopril Penicillamine ```
71
What is the autoantigen in bullous pemphigoid?
Type 17 collagen | Hemidesmosomal proteins BP180 and BP230
72
What is the function of type 17 collagen?
Forms the junction between the epidermis and BM of dermis
73
What are the features of bullous pemphigoid?
Tense subepidermal blisters/bullae on urticated base Painful and pruritic Mucus membrane involvement in 25% Patient otherwise well
74
What is seen on histology of bullous pemphigoid?
Deposits of IgG and C3 at dermal/epidermal junction on epidermis half Intact epidermis Fibrin and inflammatory infiltrate, eosinophil predominance
75
What is the treatment of bullous pemphigoid?
PO pred --> AZA/MMF
76
What type of patient gets pemphigoid vulgaris?
``` Older age Female Ashkenazi Jews Pregnancy Stress ```
77
What is the autoantigen in pemphigoid vulgaris?
Desmogleins DSG3 on surface of keratinocytes
78
What are the features of pemphigus vulgaris?
Flaccid epidermal blisters on normal or erythematous skin Painful not pruritic Mucus membrane involvement
79
How is pemphigus vulgaris diagnosed?
Direct and indirect immunofluorescence | ELISAs for DSG1 and DSG3 in serum
80
What is the treatment pemphigus vulgaris?
PO pred --> plasmaphresis with AZA/CYC --> IVIG
81
What are the risk factors for lichen planus?
Hepatitis C Female PBC
82
What are the features of lichen planus?
Purple, pruritic, polyangular, planus, papules Flexor surfaces of upper extremities, mucus membranes Wickham's striae Scarring alopecia Longitudinal nail ridges
83
What is the treatment of lichen planus?
Mod potent topical steroids +/- antifungals PUVA PO pred Oral fluticasone spray
84
What is the most common type of melanoma?
Superficial spreading Growing mole
85
What is nodular melanoma?
2nd most common | Red or black lump that bleeds/oozes
86
What is lentigo maligna?
Less common melanoma Older people Chronically sun exposed skin Growing mole
87
What is the rarest form of melanoma?
``` Acral lentiginous Subungal pigmentation (Hutchinson's sign) or on palms/feet ```

MRCP (17 decks)

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