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derm Flashcards

1
Q

Mild acne vulgaris

A

Open and closed comedones with or without sparse inflammatory lesions

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2
Q

Moderate acne vulgaris

A

Widespread non-inflammatory lesions and numerous paperless and pustules

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3
Q

Severe acne vulgaris

A

Extensive inflammatory lesions, which may include nodules, pitting and scarring

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4
Q

Single topical therapy for acne

A

Topical retinoids and benzoyl peroxide

*for mild do not use antibiotics

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5
Q

For moderate acne management

A

Topical antibiotic, benzoyle peroxide, topical retinoid

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6
Q

Oral antibiotics for acne vulgaris

A

Tetracyclines though AVOID in pregnant women

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7
Q

How to differentiate between a pyogenic granuloma may mimic amelanotic melanoma

A

a pyogenic granuloma may mimic the amelanotic melanoma but is caused by trauma

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8
Q

Risk factors for developing a pyogenic granuloma

A

Trauma
Pregnancy
More common in women and young adults

Found most commonly on head/neck/trunk and hands

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9
Q

Management of pyogenic granuloma

A

Lesions associated with pregnancy = resolve spontaneously
Other = curettage, cauterisation, cryotherapy, excision

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10
Q

What are the 2 types of contact dermatitis

A

irritant contact dermatitis - non-allergic due to weak acids or alkalis often seen on hands
Allergic contact dermatitis - type IV hypersensitivity - rare - seen on scalp after hair dyes = potent steroids are indicated

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11
Q

Unusual cause of contact dermatitis - irritant

A

Cement

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12
Q

Buzzwordy = acute onset, tear-drop/small spot scale papules, trunk and limbs, young person, following a throat infection (streptococcal)

A

guttate psoriasis

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13
Q

Treatment of guttate psoriasis

A

most cases resolve spontaneously within 2-3 months
UVB phototherapy
Topical agents same as psoriasis

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14
Q

What is dactylitis

A

Diffuse swelling of the digits

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15
Q

What is only onycholysis

A

Painless detachment of the nail from the nail bed

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16
Q

What are the nail changes associated with psoriasis

A

Nail pitting
Onycholysis

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17
Q

BUZZWORD** pearly rolled edges with telangiectasia surrounds central crater

A

basal cell carcinoma

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18
Q

Topicals for basal cell carcinoma

A

Imiquimod, fluorouracil

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19
Q

What class of drugs exacerbate psoriasis

A

Beta blockers
NSAIDs
ACEi
TNF-a
Anti-malarials

Also lithium

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20
Q

Which acne medication is contraindicated in pregnancy

A

Oral isotretinoin

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21
Q

What are main medication to treat acne vulgaris

A

Topical retinoids
Benzoyl peroxide

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22
Q

What is the antibody associated with dermatitis herpetiforms

A

Anti-tissue transglutaminase antibody

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23
Q

What is dermatitis herpetiformis

A

Itchy vesicular rash that presents on elbows knees and buttocks and is associated with Coeliac

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24
Q

What malignancy is a renal transplant patient most at risk of in the future

A

Skin cancer - squamous cell carcinoma of the skin

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25
Q

Features of scabies

A

Widespread pruritus
Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist

Scratching = excoriation, infection

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26
Q

Management for scabies - first line

A

Permethrin 5%

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27
Q

What is erythema nodosum

A

Inflammation of subcutaneous fat

Typically causes tender erythematous, nodular lesions

Usually occurs over shins - may occur forearms thighs

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28
Q
  • ‘hives’ ‘wheals’ ‘nettle rash’
A

= urticaria
first line = antihistamines

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29
Q

First line for seborrhoeic dermatitis

A

Topical ketoconazole (anti-fungals)

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30
Q

What causes seborrhoeic dermatitis

A

Malassezia furfur

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31
Q

First line for pityriasis versicolor

A

Ketoconazole shampoo (anti-fungal)

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32
Q

Which medications can cause a flare up of psoriasis

A

Beta-blockers
Lithium
Anti-malarials (Chloroquine etc)
NSAIDs
ACEi
Infliximab

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33
Q

*exclamation mark hairs

A

= alopecia areata

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34
Q

What skin condition is associated with IBDs

A

Pyoderma gangrenosum

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35
Q

Skin problems make up x percent of GP consultations

A

15-23%

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36
Q

What is the enzyme deficiency in acute intermittent porphyria

A

PBG deaminase

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37
Q

Description of the hypersensitivity reactions …

A

Type I = immediate hypersensitivity
Type II = direct cell killing
Type III = immune complex mediated
Type IV = delayed type hypersensitivity

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38
Q

Function of collagen

A

Vitamin D metabolism

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39
Q

Function of subcutaneous fat

A

energy storage

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40
Q

Function of collagen

A

Tensile strength

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41
Q

Function of Basal cells

A

Epidermal proliferation

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42
Q

Function of mast cells

A

Release of inflammatory mediators

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43
Q

At what point of gestation do sweat glands develop

A

6 months

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44
Q

Where do melanocytes migrate from (gestation)

A

From: Neural crest
To: skin

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45
Q

T/F blashko’s lines develop in the distribution of cutaneous nerves

A

F - they are developmental

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46
Q

Which layer of the skin is the most metabolically active ?

A

Basal layer

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47
Q

Features of mucosal membranes

A

Highly specialised for function ie

They are often affected by skin disease, they are keratinised, have sensory functions (taste) and often contain glands

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48
Q

Why do steroids need to be lipophilic ?

A

To allow for passive diffusion across the plasma membrane where they combine with cell receptors and bind to steroid responsive elements in the DNA

They are anti-proliferatives, anti-inflammatory and vasoconstrictive

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49
Q

Describe which arteries to get from lungs to big toe

A

pulmonary vein > left side of the heart > aorta > abdominal aorta > common iliac artery > external iliac artery > femoral artery > popliteal artery > dorsalis pedis

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50
Q

Which 3 things are important in maintaining good peripheral vasculature

A

Venous valves

Pulse pressure

The muscle pump

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51
Q

How many days does it take for a cell to migrate from basal layer to keratin layer

A

28 days (later ahah lol :/ )

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52
Q

How many cells thick is the granular layer

A

2-3 cells thick

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53
Q

What percent of the keratin layer is keratin and filaggrin

A

80%

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54
Q

Which component of MRSA causes necrotising fasciitis

A

PVL - panton valentine leukocidin

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55
Q

Features of Langerhan cells

A

Formed in bone marrow
Migrate throughout epidermis and dermis
Travel via lymphatics to present antigen in lymph nodes

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56
Q

Describe the route to get from big toe to heart

A

deep plantar vein > great saphenous > femoral vein > external iliac vein > common iliac > abdominal vena cava > inferior vena cava > RA

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57
Q

What is this

A

Crust

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58
Q

What is this

A

Erosion

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59
Q

What is this

A

Scale

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60
Q

What is this

A

Lichenification

61
Q

What is this

A

maceration

62
Q

Breslow thickness arises from what layer in the skin

A

Granular layer

63
Q

What does eczema look like on histology

A
64
Q

What does spongiosis look like on histology

A
65
Q

What is Buerger’s disease

A

A vasculitis disease most common in young males who smoke

-foot pain during exertion is a symptoms

Can lead to hypercellular occlusive thrombus

*tortuous corkscrew collaterals may reconstitute patent segments of the distal tibial or pedal vessels

66
Q

*corkscrew shaped collateral vessels distally on angiogram

A

Buergers disease

67
Q

What is Takayasu arteritis

A

Can be divided into: acute and chronic

In chronic - upper limb claudication

In later stages the vessels will typically show changes of intimacy proliferation, together with band fibrosis of the intima and media

68
Q

what are the large vessel vasculitis

A

Temporal arteritis
Takayasu arteritis

69
Q

what are the medium vessel vasculitides

A

Polyarteritis nodosa
Kawasaki disease

70
Q

what are the small cell vasculitides

A

ANCA - associated (GPA, eGPA - churgstrauss)
Immune complex - henoch schonlein, anti-GBM

71
Q

What is the most common associated malignancy of Acanthosis nigricans

A

Gastrointestinal adenocarcinoma

72
Q

Investigation for distal limb ulcers

A

Ankle-brachial pressure index

Normal range = 0.9-1.2

Anything below or above could be due to arterial disease

73
Q

*target lesions

A

=erythema multiforme

74
Q

Child with atopic eczema has presented with a rapidly progressing painful rash, painful clustered blisters are noted

What is the most appropriate thing to do?

A

Admit to hospital for life-saving aciclovir

This child is presenting with eczema herpeticum

75
Q

How does insulin resistance cause acanthosis nigricans

A

It causes hyperinsulineamia which stimulates keratinocytes and dermal fibroblast proliferation

This proliferation causes the characteristic darkened, thickened skin

76
Q

What skin condition is due to autoimmune melanocyte destruction

A

Vitiligo

77
Q

What does bullous pemphigoid look like

A
78
Q

Treatment of bullous pemphigoid

A

Oral corticosteroids, topical “, immunosuppressants, antibiotics

79
Q

what would immunofluorescence show for bullous pemphigoid

A

IgG and C3 at the dermoepidermal junction

80
Q

Treatment to target dermatophyte nail infections

A

Oral terbinafine

Dermatophyte nail infection eg trichophyton rubrum

81
Q

*shiny orange peel skin

A

Graves’ disease - Pretibial myxoedema

82
Q

High electrical voltage burns are associated with what disease

A

Rhabdomyolysis

83
Q

*crazy high creatinine

A

Rhabdomyolysis

84
Q

what is curling’s ulcer

A

A stress ulcer may occur in the duodenum of burn patients and these are more common in children

85
Q

Positive Ziehl-Nielsen staining for acid-fast bacilli ?

A

Think TB

86
Q

What is a cause of erythema nodosum

A

TB

Patients will come in with the respective rash but also with haemoptysis, fever, weight loss, coughing

87
Q

What is erythema nodosum

A

Inflammation of subcutaneous fat

88
Q

What is nikolskys sign ?

A

Epidermis separating with mild lateral pressure

89
Q

+nikolysky’s sign

A

Think : toxic epidermal necrosis

90
Q

what is toxic epidermal necrosis

A

It is a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction

Skin = scalded over an extensive area

91
Q

Drugs that induce toxic epidermal necrosis

A

Phenytoin
Penicillins

92
Q

Management of toxic epidermal necrolysis

A

Iv immunoglobulins

93
Q

Features of rosacea

A

Appears of nose, cheeks and forehead
Flushing, erythema, telangiectasia —> papules and pustules

Sunlight may exacerbate symptoms

94
Q

What is koebners phenomenon

A

Causes lesion to appear at site of injury

95
Q

What is exhibited here

A

Molluscum contagiosum - virus

96
Q

How long does pityriasis rosea rash last ?

A

6-12 weeks

97
Q

What is alopecia areata

A

An autoimmune condition causing localised, well demarcated patches of hair loss

At the edge of the hair loss there may be small broken ‘exclamation mark hairs’

98
Q

PMH of crohns and presents with a painful ulcer ?

A

Pyoderma gangrenosum

99
Q

Itchy rash - purple, raised and has fine white lines on the surface

A

Lichen planus

100
Q

*blue sclera

A

Osteogenesis imperfecta - type I collagen

101
Q

What precedes pityriasis rosea

A

Viral infection

102
Q

Virus associated with pityriasis rosea

A

Herpes hominis virus 7

103
Q

According to NICE guidelines how long should you wait before starting a second course of topical hydrocortisone

A

4 weeks

104
Q

What is pellagra

A

Caused by niacin deficiency = dermatitis, diarrhoea, dementia

Can be caused by isoniazid therapy

105
Q

This rash is non-itchy - what is it

A

Erythema multiforme

= giant , non- itchy , target lesions

This rash is usually caused by by infections or drug interactions ie amoxicillin

106
Q

“Herald patch” followed by later (a week) by additional lesions

Lethargy + limited lesions to the trunk

= stereo-typical presentation of what ?

A

Pityriasis rosea

107
Q

Drugs that exacerbate psoriasis

A

Beta blockers , lithium , anti-malarials (chloroquine and hydroxychloroquine) , NSAIDs , ACEi + infliximab

108
Q

*red or black lump that oozes or bleeds, and is located on sun exposed skin

A

Nodular melanoma

109
Q

What to do if eczema herpeticum is suspected

A

It is potentially life threatening in children and so they should be admitted into hospital and given IV aciclovir

110
Q

What is the most common side effect of isotretinoin

A

Dry skin

111
Q
A

Iron deficiency anaemia

112
Q

*heliotrope rash

A

Dermatomyositis

113
Q

Initial investigation of dermatomyositis and polymyositis

A

Creatinine kinase

114
Q

Dermatomyositis + polymyositis definitive diagnosis

A

Muscle biopsy

115
Q

*gottrons papules

A

Dermatomyositis

116
Q

What are the common complications of toxic epidermal necrolysis

A

Fluid loss
Electrolyte imbalance

117
Q

Treatment for Toxic epidermal necrolysis

A

Supportive care - volume loss and electrolytes

IV immunoglobulins

118
Q

Drugs known to cause toxic epidermal necrolysis

A

Phenytoin
Sulphonamides
Allopurinol
Penicillin - main one
NSAIDs
Carbamezapine

119
Q

Can you prescribe oral isotretinoin in the GP practice ?

A

No - can only be prescribed under specialist care therefore if you suspect patient has severe acne then refer to dermatology

120
Q

What should benzoyl peroxidase and retinoids be co-prescribed with

A

Antibiotics oral

121
Q

Management of venous ulcers

A

Compression bandaging

Oral pentoxifylline

122
Q

*deep, dry, punched out ulcer

A

Arterial ulcer

Would also present with burning pain in the leg
Ulceration over bony prominence

(Lateral malleolus)

123
Q

*ulcer round medial malleolus / gaiter region

A

Venous ulcer

124
Q

What is the organism that causes Athlete’s foot

A

Trichophyton

125
Q

First line for athletes foot

A

Topical imidazole, undecenoate or terbafine

126
Q

*monomorphic punched out erosions - circular, depressed ulcerated lesions

A

Eczema herpeticum

127
Q

What are the two premalignant lesions to melanoma

A

Bowens

Actinic keratosis

128
Q

What is erythema ab igne

A

A lesion caused by infrared radiation and is commonly associated with hot water bottles or open fire

129
Q

What is this ?

A

Erythema ab igne

(Overexposure to infraredradiation)

130
Q

If heat source isn’t removed in erythema ab igne , what could the patient go on to develop ?

A

Squamous cell carcinoma

131
Q

1st line for lichen planus

A

Topical steroids

132
Q

*antistreptolysin - O titre raised

A

Erythema nodosum

133
Q

Common causes of erythema nodosum

A

Pregnancy
Streptococcal infection

134
Q

*honeycomb arrangement on immunofluorescence

A

Pemphigus vulgaris

135
Q

Virus infection of HSV-1 can cause what ?

A

Eczema herpeticum

136
Q

*painless purple lesion associated with HHV-8

A

Kaposi’s sarcome

137
Q

Management of scabies

A

2 treatments of Permethrin

All close contacts will require treatment

138
Q

Management of impetigo

A

Topical fusidic acid + flucloxacillin

Patients are no longer contagious: after lesions have crusted over OR have been on 48 hours of treatment

139
Q

First line for hyperhidrosis

A

Topical aluminium chloride

140
Q

What is an associated complication of acne rosea

A

Blepharitis

141
Q

Management of rosacea

A

Simple = concealer and high factor sunscreen

With flushing but limited telangiectasia = topical brimonidine gel

With mild - moderate papules = topical ivermectin is first line

With moderate - severe = dual therapy of ivermectin and oral doxycycline

(Prominent telangiectasia = laser therapy)

142
Q

Management of vitiligo

A

Sunblock
Camouflage make up
Topical corticosteroids

(Topical tacrolimus and phototherapy)

143
Q

1st line for lichen planus

A

Topical betamethasone

144
Q

*net like pattern of reddish blue skin discolouration that is non-blanching

A

Livedo reticularis

145
Q

Should psoriasis patients take a break from their topical corticosteroids ?

A

Yes - aim for a 4 week break in between courses of topical corticosteroids

146
Q

What are the hyperinsulinaemic states (Acanthosis nigricans)

A

T2DM
GI cancer
Obesity
PCOS
Acromegaly
Cushings disease
Prader willi

147
Q

Acute rash on face and neck , multiple red monomorphic blisters and erosions

Systemic upset - lymphadenopathy and fever

A

Eczema herpeticum

A serious complication of eczema caused by Herpes simplex virus

148
Q

Most common nail change in psoriasis

A

Nail pitting

149
Q
A

= squamous cell carcinoma

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