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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
Q

What rashes are associated with lymphoma?

A

Erythroderma

Acquired ichthyosis

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26
Q

What rashes are associated with diabetes?

A

Necrobiosis lipoidica
Candidiasis
Lipotrophy granuloma annulare

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27
Q

What are 5 causes of erythema nodosum?

A 
Strep infection
Sarcoid
Pregnancy
IBD
Penicillins/sulphonamides/COCP
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28
Q

What are 5 causes of pyoderma gangrenosum?

A 
Idiopathic
IBD
CTD
Myeloproliferative disorders
SLE
PBC
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29
Q

What are 6 causes of hirsuitism?

A 
PCOS
Cushing's
CAH
Obesity (insulin resistance)
Androgen therapy
Phenytoin/steroids
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30
Q

What is the scoring system used for hirsuitism?

A

Ferriman-Gallwey

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31
Q

What are the treatments for hirsuitism?

A

Weight loss
Co-cyprindiol/ethinylestradiol and drospirenone
Topical eflornithine

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32
Q

What are 6 causes of hyperptrichosis?

A 
Porphyria cutanea tarda
Minoxidil
Ciclosporin
Congenital hypertrichosis lanuginosa
Anorexia
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33
Q

What rash is seen in glucagonoma?

A

Necrolytic migratory erythema

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34
Q

What is the cause of pityriasis/tinea versicolor?

A

Superficial infection with malassezia furfur

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35
Q

What is the treatment of pityriasis versicolor?

A

Topical ketoconazole

36
Q

What is the cause of pityriasis rosea?

A

Reactivation of HHV 6 and 7

37
Q

What is characteristic of pityriasis rosea?

A

Herald patch

38
Q

What rash occurs with overgrowth of the diphtheroid corynebacterium minutissimum?

39
Q

What occurs when erythasma is examined with Wood’s light?

A

Coral red fluorescence

40
Q

What is the treatment of erythasma?

A

Topical miconazole –> PO erythromycin

41
Q

What is the pathophysiology of acne vulgaris?

A

Follicular epidermal hyperproliferation –> keratin plug

Obstruction of pilosebaceous follicle

Colonisation by anaerobic bacterium propiobacterium acnes + inflammation

42
Q

What is the initial and 2nd line treatment of acne?

A

Single topical therapy e.g. retinoids, benzoyl peroxide

Then, combination therapy (2 of retinoids, benzoyl peroxide, antibiotic)

43
Q

What is the 3rd line treatment of acne?

A

PO antibiotic e.g. tetracyclines (not preg) or COCP

Co-prescribe topical retinoid/benzoyl peroxide to reduce risk of abx resistance

44
Q

What is the 4th line treatment of acne?

A

PO isotretinoin

45
Q

What are 6 side effects of isoretinoin?

A 
Depression
Dry skin, eyes, mouth
Teratogenic
Raised triglycerides
Hair thinning
IIH
46
Q

What is erythroderma?

A

95% skin involved in a rash of any kind

47
Q

What molecule is implicated in the development of rosacea?

A

Cathelicidins - innate response to chronic exposure to UV radiation

48
Q

What is the treatment of rosacea?

A

Topical metronidazole –> oxytetracycline

49
Q

What is the primary care treatment of psoriasis?

A
  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
Q

What type of phototherapy is used for psoriasis in secondary care?

A

Narrowband UV B light 3x week

OR

Psoralen + UV A light (photochemotherapy, PUVA)

51
Q

What are the risks of phototherapy?

A

Skin ageing

SCC

52
Q

What are 4 other systemic treatments of psoriasis in secondary care?

A

PO methotrexate
Ciclosporin
Systemic retinoids
Anti-TNFs

53
Q

Name 6 factors that exacerbate psoriasis?

A 
Beta blockers
Lithium
Antimalarials
NSAIDs
ACEIs
Trauma
Alcohol
54
Q

What is the treatment of guttate psoriasis?

A

Ultraviolet B phototherapy

55
Q

What is the treatment of flexural psoriasis?

A

Topical steroids

56
Q

What is Nikolsky’s sign?

A

Epidermis separates with mild lateral pressure

57
Q

What is the treatment of toxic epidermal necrolysis?

A

Stop causative drug
Supportive care
IVIG
Ciclosporin/CYC

58
Q

What drugs cause toxic epidermal necrolysis?

A

N-CAPS

NSAIDs
Carbamazepine
Allopurinol
Phenytoin/penicillin
Sulphonamides
59
Q

What are the most common causes of erythema multiforme?

A

HSV
Mycoplasma
Strep

60
Q

What are the features of erythema multiforme?

A

Target lesions
Back of hands/feet –> torso
Upper limb>lower limb
Kobner phenomenon

61
Q

What type of ulcer is usually seen above the medial malleolus?

62
Q

What ABPI result is abnormal?

A

<0.9 - arterial disease

>1.3 - calcification

63
Q

What is the management of venous ulcer?

A 
Compression bandaging
PO pentoxiflline (peripheral vasodilator)
64
Q

What is the condition of a neoplastic proliferation of mast cells?

A

Systemic mastocytosis

65
Q

What are the features of systemic mastocytosis?

A

Urticaria pigmentosa
Darier’s sign
Flushing
Abdo pain (from increased histamine -> gastric acid)

66
Q

How is systemic mastocytosis diagnosed?

A

Monocytosis
Raised serum tryptase
Raised urinary histamine

67
Q

What are the symptoms of zinc deficiency caused by TPN?

A 
Acrodermatitis herpetiformis
Perioral dermatitis
Alopecia
Short stature
Hepatosplenomegaly
68
Q

What are the features of hereditary haemorrhagic telangiectasia?

A 
Epistaxis
Telangiectasias
Visceral lesions e.g. GI telangiectasia
Pulmonary/cerebral/spinal AVMs
Family history
69
Q

What are the associations of yellow nail syndrome?

A

Congenital lymphoedema
Pleural effusions
Bronchiectasis
Chronic sinus infections

70
Q

What are the causes of bullous pemphigoid?

A 
Chronic skin disease
NSAIDs
Furosemide
Captopril
Penicillamine
71
Q

What is the autoantigen in bullous pemphigoid?

A

Type 17 collagen

Hemidesmosomal proteins BP180 and BP230

72
Q

What is the function of type 17 collagen?

A

Forms the junction between the epidermis and BM of dermis

73
Q

What are the features of bullous pemphigoid?

A

Tense subepidermal blisters/bullae on urticated base
Painful and pruritic
Mucus membrane involvement in 25%
Patient otherwise well

74
Q

What is seen on histology of bullous pemphigoid?

A

Deposits of IgG and C3 at dermal/epidermal junction on epidermis half
Intact epidermis
Fibrin and inflammatory infiltrate, eosinophil predominance

75
Q

What is the treatment of bullous pemphigoid?

A

PO pred –> AZA/MMF

76
Q

What type of patient gets pemphigoid vulgaris?

A 
Older age
Female
Ashkenazi Jews
Pregnancy
Stress
77
Q

What is the autoantigen in pemphigoid vulgaris?

A

Desmogleins DSG3 on surface of keratinocytes

78
Q

What are the features of pemphigus vulgaris?

A

Flaccid epidermal blisters on normal or erythematous skin
Painful not pruritic
Mucus membrane involvement

79
Q

How is pemphigus vulgaris diagnosed?

A

Direct and indirect immunofluorescence

ELISAs for DSG1 and DSG3 in serum

80
Q

What is the treatment pemphigus vulgaris?

A

PO pred –> plasmaphresis with AZA/CYC –> IVIG

81
Q

What are the risk factors for lichen planus?

A

Hepatitis C
Female
PBC

82
Q

What are the features of lichen planus?

A

Purple, pruritic, polyangular, planus, papules
Flexor surfaces of upper extremities, mucus membranes
Wickham’s striae
Scarring alopecia
Longitudinal nail ridges

83
Q

What is the treatment of lichen planus?

A

Mod potent topical steroids +/- antifungals
PUVA
PO pred
Oral fluticasone spray

84
Q

What is the most common type of melanoma?

A

Superficial spreading

Growing mole

85
Q

What is nodular melanoma?

A

2nd most common

Red or black lump that bleeds/oozes

86
Q

What is lentigo maligna?

A

Less common melanoma
Older people
Chronically sun exposed skin
Growing mole

87
Q

What is the rarest form of melanoma?

A 
Acral lentiginous
Subungal pigmentation (Hutchinson's sign) or on palms/feet

MRCP (17 decks)

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