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2nd year > derm > Flashcards

derm Flashcards

1
Q

what type of melanin does MRC1 produce

A

eumelanin (darker pigment)

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2
Q

outline eccrine gland

A

Found all over the body

Secrete sweat and are responsible for thermoregulation

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3
Q

outline apocrine gland

A

Found in axillae and perineum

Secrete oily fluid

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4
Q

outline sebaceous gland

A

Found mainly on face and chest

Secrete oily sebum which moisturises skin

Part of pilosebaceous unit

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5
Q

function of arrector pili muscle

A

contracts to cause hair to stand on end (thermoregulation)

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6
Q

what side effect can steroids cause

A

skin atrophy

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7
Q

what is the pneumonic for the four strength classes of steroids

A

Help - hydrocortisone
Every - eumavate
Budding - becnovate
Dermatologist - dermovate

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8
Q

outline UVA

A

Penetrates deeper

Taken with psoralen to enhance effect (PUVA)

Given twice weekly

Increased skin cancer risk

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9
Q

outline UVB

A

More superficial action

Narrow band UVB more effective than wide band

Given three times weekly

No increased cancer risk (more commonly used)

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10
Q

outline a secondary staph aureus infection to atopic dermatitis

A

‘golden crust’

pustules/papules

flucloxacillin

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11
Q

what is the treatment for eczema herpeticum

A

urgent acyclovir

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12
Q

outline seborrhoeic dermatitis

A

Proliferation of Malassezia fungus affecting sebaceous gland rich areas
Scaly erythematous patches often on the face and scalp
Treat with antifungal azole

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13
Q

outline stasis dermatitis

A
  • Immune response against fluid collecting in lower legs
  • Associated with venous insufficiency (elderly, DVT, varicose veins, peripheral oedema)
  • Lipodermatosclerosis: inverted champagne bottle, hyperpigmentation
  • Treat with short term potent steroid, emollient and compression
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14
Q

aetiology of acne vulgaris

A

Increased androgen production of puberty acts on sebaceous gland resulting in excess sebum

Excess sebum blocks the sebaceous gland forming comedones

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15
Q

give definition and management of mild acne

A

mainly comedones, a few papules/pustules

topical retinoid/salicylic acid (keratolytic)

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16
Q

give definition and management of moderate acne

A

comedones and many papules/pustules

add oral tetracycline/erythromycin

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17
Q

give definition and management for severe acne

A

painful, nodulocystic, scarring

isotretinoin (teratogenic, dry skin, mood disturbance)

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18
Q

what should be stopped in females with acne

A

progesterone only pill

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19
Q

describe the rash in rosacea

A

Rash is erythematous, composed of papules/pustules and telangiectasia and can cause rhinophyma

Doesn’t have comedones

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20
Q

causes of rosacea

A

Can be triggered by steroids, sunlight, spicy food, alcohol

May be increased immune response to demodex mite

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21
Q

management of rosacea

A

Preventative: avoid steroids, triggers
Topical treatments such as Azelaic acid, Brimonidine (first-line according to NICE) or Ivermectin
Topical: metronidazole
Oral: doxycycline
Aesthetic: laser therapy

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22
Q

what are the biopsy findings in psoriasis

A

neutrophilic abscesses (Munro microabscesses) and hyperkeratosis, parakeratosis

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23
Q

describe guttate psoriasis

A

self-limiting, small plaques forming over most of body, may be preceded by viral infection

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24
Q

describe Palmoplantar pustulosis psoriasis

A

pustular form affecting soles and palms

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25
Q

describe Erythrodermic psoriasis

A

massive skin erythema and shedding, may be fatal

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26
Q

outline lichen planus

A

=> Inflammatory condition, itchy purple papules on wrists/ankles
=> white laces on oral mucosa (Wickham’s striae)
=> irregular sawtooth epidermis, potent topical steroids

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27
Q

list the two differentials for post-viral rashes and what differentiates them

A

guttate psoriasis or pitryasis rosea.

Differentiate with ‘herald patch’ (pitryasis rosea)

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28
Q

management for Polymorphic Light Reaction (‘Prickly Heat’)

A

prednisolone or desensitising phototherapy

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29
Q

management of impetigo

A

Topical fusidic acid if localised, oral flucloxacillin if extensive

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30
Q

describe different types of hair follicle infection

A

Superficial = folliculitis

Deep = furuncle/boil

Carbuncle = cluster of boils (associated with PVL)

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31
Q

what is the most common cause of skin infection and what treatment is it sensitive to

A

staph. aureus

fluclox.

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32
Q

give the most common causative organisms in cellulitis

A

Staphylococcus aureus or Streptococcus pyogenes

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33
Q

treatment for cellulitis

A

IV flucloxacillin

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34
Q

cause of necrotising fascitis

A

type 1: by mixed anaerobes/aerobes following GI surgery (most common)

type 2: Streptococcus pyogenes

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35
Q

treatment of necrotising fascitis

A

Treat with urgent surgical debridement and IV antibiotics

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36
Q

where is the most commonly affected site in necrotising fascitis and what is this sometimes called

A

perineum (Fournier’s gangrene).

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37
Q

what bacteria is involved in syphilis

A

Treponema pallidum spirocheate

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38
Q

outline the different stages of syphilis

A

Primary = painless chancre

Secondary = widespread erythematous rash, mucosal ‘snail-track’ ulcers

Tertiary – multi-organ damage

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39
Q

treatment of syphilis

A

IM benzylpenicillin

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40
Q

what bacteria is involved with lymes disease

A

Borrelia burgdorferi spirocheate

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41
Q

symtoms and signs of lymes disease

A

Early = erythema migrans (expanding ‘bullseye’ target lesion)
Late = arthritis, neuropathy, encephalopathy

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42
Q

treatment for lymes disease

A

Doxycycline

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43
Q

what age is recommended for shingles vaccine

A

70

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44
Q

what virus causes chickenpox and shingles

A

varicella zoster

herpes zoster

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45
Q

give presentations of HSV and treatment

A

Primary infection in childhood (gingivostamatitis)

Reactivate in adulthood with blistering on lip (herpes libialis/cold sore)

Erythema multiforme: hypersensitivity reaction forming erythematous target lesions

Topical/oral acyclovir

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46
Q

give presentations, complications and management of human papilloma virus (HPV)

A

Causes ‘viral warts’ – rough, hyperkeratotic lesions

Regular topical keratolytic (salicylic acid) or cyrotherapy

risk factor for cervical cancer

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47
Q

outline molluscum contagiosum

A

Poxvirus, fleshy, pearlescent nodules, contagious, common in children, can be sexually transmitted, self limiting/cryotherapy

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48
Q

outline Herpangina

A
  • Coxsackie virus
  • painful oral mucosal blistering
  • swab/stool PCR diagnosis
  • self-limiting
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49
Q

outline hand, foot and mouth disease

A
  • Coxsackie enterovirus
  • discolored lesions on hands,
    feet and mouth
  • presents in children and family outbreaks
50
Q

outline Erythema infectiosum (slapped cheek disease)

A
  • Parovirus B19
  • slapped cheek appearance and
    macular rash
  • can cause chronic anaemia
  • diagnose with IgM blood test
51
Q

Infection from farm animal, firm fleshy nodule, self limiting, common in farmers

A

orf

52
Q

what stimulates sebaceous gland

A

androgen

53
Q

how long does it take for molluscum to resolve

A

18 months

54
Q

describe koebners phenomenon

A

presence of a new skin lesion on previously healthy skin following trauma

55
Q

satellite lesions

A

candida

56
Q

treatment for candida

A

topical azole/nystatin

57
Q

who is candida common in

A

diabetics

58
Q

annular lesions (‘ringworm’)

A

dermatophyte

59
Q

treatment for scabies

A

Topical permethrin overnight (all skin below neck)

60
Q

outline Norwegian scabies

A

form of scabies affecting elderly or immunocompromised, crusting lesions containing thousands of mites

61
Q

treatment for lice

A

Treat with dimeticone wash

62
Q

describe Sebhorrhoeic Keratosis

A

Common benign lesion in elderly
Rough/warty, ‘stuck on’ appearance

63
Q

describe solar letignes

A

Common benign lesion in elderly
Pigmented patch on sun exposed site

64
Q

dysplastic meaning

A

pre-malignant

65
Q

side effect of lamotrigine use

A

steven jonsoooon syndrome

66
Q

what protein controls freckles/red hair

A

MC1R protein

67
Q

what scoring system is used to predict reoccurrence of melanoma’s

A

Breslow Thickness

68
Q

when should a sentinel node biopsy be done

A

Breslows thickness> 1mm

69
Q

staging of melanoma

A

Stage 0 = 0.5cm
Stage I = 1cm
Stage II = 2cm

70
Q

where do acral lentigenous melanomas occur

A

soles palms and nail beds

71
Q

outline seborrhoeic keratosis (basal cell papillomas)

A
  • Benign proliferation of epidermal keratinocytes
  • Very common in ageing skin
  • Eruptive appearance of many lesions may indicate internal malignancy - Leser-Trelat sign
72
Q

greasy stuck on appearance

A

seborrhoeic keratosis

73
Q

management of seborrhoeic keratosis

A
  • Reassurance, most need no treatment
  • If patient would like removal - cryotherapy, curettage
74
Q

treatment for bowens disease/actinic keratosis

A

Removal (cryotherapy/curretage)
+/- Topical 5-fluorouracil/imiquimod

75
Q

BCC

A

Nodular: painless, slow growing, pearly, aborising vessels, central ulceration

76
Q

SCC

A

Painful, fast growing, hyperkeratotic, bleeding, inflamed, poorly defined

77
Q

what gene is associated with malignant melanoma

A

BRAF

78
Q

management for different sizes of melanoma

A

In situ => Excision 0.5mm margins

1mm > Excision 1cm margins

1mm < Excision 1cm margins
+ sentinel node biopsy

Metastatic (BRAF +ve) => Trametenib

79
Q

outline erythema nodosum and its associated condition

A

tender, erythematous nodules on legs, associated with sarcoidosis

80
Q

outline Necrobiosis lipodica and its associated condition

A

yellow/brown/red patches on legs, associated with diabetes

81
Q

outline Acanthosis nigricans and its associated condition

A

Acanthosis nigricans: skin thickening/pigmentation in flexural areas, associated with diabetes

82
Q

outline Dermatitis herpetiformis and its associated disease

A

immunobullous disease characterised by itchy vesicular rash, associated with coeliac disease

83
Q

heliotrope rash

A

dermatomyositis

84
Q

outline arterial ulcer

A

Caused by poor arterial blood supply

Hypertension, smoking, obesity, peripheral vascular disease

Punched out, painful

Hygiene, analgesia, vascular surgery
Avoid compression

85
Q

outline venous ulcer

A

Caused by poor oxygenation secondary to venous hypertension

Peripheral oedema, stasis dermatisis, lipodermatosclerosis

Commoner, painless, medial malleolus

Compression, diuretic, support
stockings for life

86
Q

ABPI < 0.5

A

Severe arterial disease, no compression

87
Q

ABPI 0.5-0.8

A

Aterial disease, avoid compression

88
Q

ABPI 0.8-1.3

A

No arterial disease, compression safe

89
Q

ABPI>1.3

A

Calcified vessels

90
Q

Immunofluorescence shows honey-comb arrangement

A

PEMPHIGUS VULGARIS

91
Q

Immunofluorescence shows linear arrangement

A

BULLOUS PEMPHIGOID

92
Q

Investigations for dermatitis herpetiformis

A

Bloods- Anti-TTG

Biopsy
- Immunoflorescence - will show granular deposits of IgA in dermal papillae
- Histology - sub-epidermal blisters with papillary micro-abscesses

93
Q

treatment for dermatitis herpetiformis

A

Gluten free diet +/- dapsone

94
Q

management of mild eczema

A

Topical steriod

95
Q

management of moderate eczema

A
  • Moderate topical steriod e.g. betamethasone valerate 0.025% or clobetasone butyrate 0.05%
  • If face affected start with mild steroid in that area
96
Q

presentation of keratocanthoma

A
  • Develop as a red papule with a central crater-like, crusty keratinous plug
  • Occur on sun-exposed skin in later life and often reach 2–3 cm in diameter
97
Q

give topical treatment for large patches of actinic keratosis

A

Topical 5-Fluorouracil

98
Q

what dermatological condition is associated with crohn’s disease/UC

A

pyoderma gangrenosum

99
Q

tear drop lesions

A

guttate psoriasis

100
Q

punched out erosions

A

eczema herpeticum

101
Q

exclamation mark hairs

A

alopecia areata

102
Q

chickenpox

A

Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

103
Q

measles

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

104
Q

mumps

A

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

105
Q

rubella

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

106
Q

Erythema infectiosum

A

Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

107
Q

scarlet fever

A

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

108
Q

Hand, foot and mouth disease

A

Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

109
Q

koebner phenomenon conditions

A
  • psoriasis
  • vitiligo
  • warts
  • lichen planus
  • lichen sclerosus
  • molluscum contagiosum
110
Q

sandpaper rash

A

scarlet fever

111
Q

treatment for genital warts

A

Podophyllotoxin
Imiquimod
Cryotherapy
Trichloroacetic acid

112
Q

lymphoma

A

Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
Fatigue

113
Q

CKD

A

Lethargy & pallor
Oedema & weight gain
Hypertension

114
Q

polycythaemia

A

Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease

115
Q

iron deficiency anaemia

A

Pallor
Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

116
Q

liver disease

A

History of alcohol excess
Stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynaecomastia etc
Evidence of decompensation: ascites, jaundice, encephalopathy

117
Q

dermatofibroma

A

This is a solitary firm papule/nodule that dimples when pinched. Dermatofibromas occur following injury

118
Q

features of dermatitis herpetiformis

A

itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

119
Q

what can differentiate pemphigus vulgaris/bullous pemphigoid

A

mucosal involvement: pemphigus vulgaris

120
Q

when may Patients may return to school or work after impetigo

A

when all lesions have crusted over
or
48h after treatment starts

2nd year (9 decks)

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