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MRCP 1 > Derm > Flashcards

Derm Flashcards

1
Q

Rosacea signs

A

typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms

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2
Q

Rosacea treatment

A

Sun cream
If erythema - topical brimonidine
Mild-mod pustules - topical ivermectin
Severe pustules - ivermectin and doxycycline
Laser therapy for prominent telangectiasia

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3
Q

Most common BCC description

A

sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’

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4
Q

BCC management

A

surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy

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5
Q

Pityriasis vesicolor organism

A

Malassezia furfur

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6
Q

Pityriasis versicolor features

A

patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

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7
Q

Pityriasis versicolol predisposing factors

A

occurs in healthy individuals
immunosuppression
malnutrition
Cushing’s

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8
Q

Pityriasis versicolor management

A

Ketoconazole shampoo

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9
Q

Stevens Johnson’s description

A

Stevens-Johnson syndrome is a severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction.

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10
Q

Stevens-Johnson’s causes

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

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11
Q

Stevens-Johnson’s features

A

the rash is typically maculopapular with target lesions being characteristic
may develop into vesicles or bullae
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
mucosal involvement
systemic symptoms: fever, arthralgia

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12
Q

What is Nikolsky sign

A

the top layers of the skin slip away from the lower layers when rubbed

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13
Q

Where do you get Nikolsky sign

A

Staph infection
Stevens-Johnson’s

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14
Q

What is systemic mastocytosis

A

Systemic mastocytosis results from a neoplastic proliferation of mast cells

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15
Q

Features of systemic mastocytosis

A

urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
flushing
abdominal pain
monocytosis on the blood film

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16
Q

Diagnostics for systemic mastocytosis

A

raised serum tryptase levels
urinary histamine

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17
Q

Risk factors for skin SCC

A

excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen’s disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin’s ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

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18
Q

Features of skin scc

A

typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding

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19
Q

Good prognostic factors for skin scc

A

Well differentiated tumours
<20mm diameter
<2mm deep
No associated diseases

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20
Q

Which melanoma is most aggressive

A

Nodular

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21
Q

Which malignant melanoma is most common

A

Superficial spreading

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22
Q

Superficial spreading melanoma affects

A

Arms, legs, back and chest, young people

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23
Q

Nodular melanoma affects

A

Sun exposed skin, middle-aged people

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24
Q

Lentigo maligna malignant melanoma affects

A

Chronically sun-exposed skin, older people

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25
Q

Appearance of Nodular malignant melanoma

A

Red or black lump or lump which bleeds or oozes

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26
Q

Flexural psoriasis signs

A

well defined, shiny, erythematous patches in the flexural areas

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27
Q

Flexural psoriasis treatment

A

Topical steroid

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28
Q

Face psoriasis management

A

Topical steroid - maximum 2 week

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29
Q

Features of scabies

A

widespread pruritus
linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
in infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection

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30
Q

Inheritance pattern of hereditary haemorrhagic telangiectasia

A

Autosomal dominant with age related entrance

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31
Q

Diagnostic criteria of hereditary haemorrhagic telangiectasia

A

Epistaxis
Telangiectases
Visceral lesions (AVM’s, GI telangiectasia)
Family history

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32
Q

Lichen Planus features

A

Itchy, popular wash on palms, soles, arms & genitals
Polygonal in shape with white lines over them
Koebner phenomenon
Oral involvement in 50%
Thinning nails and longitudinal ridging

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33
Q

Lichen Planus management

A

Potent topical steroids
Benzydamine mouthwash for oral

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34
Q

Causes of lichenoid drug eruptions

A

Gold
Quinine
Thiazides

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35
Q

5 P’s of lichen Planus

A

Planus, purple, pruritic, papular, polygonal

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36
Q

Venous ulcers investigation

A

ABPI in non-healing

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37
Q

Venous ulceration management

A

Compression bandage
Oral pentoxifylline

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38
Q

Seborrhoeic dermatitis associated conditions

A

HIV
Parkinson’s

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39
Q

Seborrhoeic dermatitis features

A

Eczematous lesions on - scalp, periorbit, auricular, nasolabial folds
Otitis external and blepharitis

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40
Q

Seborrhoeic dermatitis scalp management

A

Ketoconazole shampoo
H&S & T gel otc
Selenium sulphide
Topical corticosteroid

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41
Q

Seborrhoeic dermatitis face and body management

A

Topical Ketoconazole
Topical steroids

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42
Q

Dermatitis herpetiformis association

A

Coeliac

43
Q

Dermatitis herpetiformis causes

A

IgA deposition in the dermis

44
Q

Dermatitis herpetiformis features

A

Itchy vesicular lesions on the extensors

45
Q

Dermatitis herpetiformis diagnosis

A

Skin biopsy, direct immunofluorescence shows IgA in granular pattern in dermis

46
Q

Management of dermatitis herpetiformis

A

Gluten free diet
Dapsone

47
Q

Pyoderma gangrenosum causes

A

Idiopathic
IBD - crohns, UC
Rheum - RA, SLE
Haem - myeloproliferative, lymphoma, myeloid leukaemia
Granulomatosis with polyangitis
Primary biliary chirrosis

48
Q

Features of pyoderma gangrenosum

A

Lower limb
Sudden, small pustule or red bump
Then skin breaks down to ulcer, edge is purple and undermined, deep and necrotic
May have fever or myalgia

49
Q

Management of pyoderma gangrenosum

A

Oral steroids
Ciclosporin and infliximab

50
Q

Causes of acanthosis Nigricans

A

T2DM, gastro cancer, obesity, PCOS, acromegaly, Cushings, hypothyroidism, familial, prader-willi, COCP, nicotinic acid

51
Q

Features of a keratoacanthoma

A

Looks like a volcano or crater. Initially a smooth dome-shaped papule. Then rapidly grows to a crater filled with keratin

52
Q

Drugs that exacerbate psoriasis

A

Trauma, alcohol, drugs Inc beta blockers, lithium, anti malarials, nsaids, ace inhibitors, infliximab, withdrawal of systemic steroids

53
Q

Erythema multiforme features

A

Target lesions, hands and feet first then torso, upper limb more than lower, pruritus occasional but mild

54
Q

Erythema multiforme causes

A

HSV. Idiopathic, bacteria (mycoplasma and streps) drugs, penicillin, sulphonamides, carbamazepine, allopurinol, nsaids, cocp, SLE, sarcoidosis, malignancy

55
Q

Blisters/Bullae exam features

A

Mucosal involvement - pemphigus
No mucosal involvement - bullous pemphigoid

56
Q

Rosacea features

A

Nose,cheeks & forehead
Flushing
Telangiectasia
Later persistent erythema with papules and pustules
Rhinophyma
Blepharitis

57
Q

Features of acrodermatitis

A

Red crusted lesions
Acral distribution
Peri orifice
Perianal

58
Q

Cause of acrodermatitis

A

Zinc deficiency

59
Q

Where are keloid scars most likely to form?

A

Sternum

60
Q

Features of pompholyx

A

Small blisters on palms and soles
Pruritus
Dry and cracked skin when blisters burst

61
Q

Management of pompholyx

A

Cool compress
Emollient
Topical steroids

62
Q

3 D’s of Pellagra

A

Dermatitis, diarrhoea and dementia (and depression)

63
Q

Describe livedo reticularis

A

Purplish, non-blanching reticulated rash

64
Q

Causes of livedo reticularis

A

Idiopathic
Polyarteritis nodosa
SLE
Cryoglobulinaemia
Antiphospholipid syndrome
Ehlers-Danlos
Homocystinuria

65
Q

What condition gives pretibial myxoedema

A

Graves

66
Q

Features of pretibial myxoedema

A

Shiny orange peel skin
Symmetrical

67
Q

What is melasma?

A

Benign skin condition in pregnancy. Discolouration of skin. Large, flat, symmetrical.

68
Q

Treatment for atopic eruption of pregnancy

A

Nil

69
Q

Features of atopic eruption of pregnancy

A

Eczematous, itchy red rash

70
Q

Features of polymorphic eruption of pregnancy

A

Last trimester
Abdominal striae
Pruritic

71
Q

Treatment of polymorphic eruption of pregnancy

A

Emollient
Mild potency topical steroid
Oral steroid

72
Q

Features of pemphigoid gestationis

A

Pruritic blistering lesions
2/3 trimesters
Peri umbilical region to trunk and back and buttocks

73
Q

Treatment of pemphigoid gestationis

A

Oral steroids

74
Q

Causes of hypertrichosis

A

Minoxidil, ciclosporin & diazoxide
Congenital
Porphyria cutanea tarda
Anorexia nervosa

75
Q

Malignancy associated with acanthosis nigricans

A

Gastric

76
Q

Malignancy associated with acquired ichthyosis

A

Lymphoma

77
Q

Malignancy associated with acquired hypertrichosis lanuginosa

A

GI and Lung

78
Q

Malignancy associated with dermatomyositis

A

Ovarian and lung

79
Q

Malignancy associated with erythema gyratum repens

A

Lung

80
Q

Malignancy associated with erythroderma

A

Lymphoma

81
Q

Malignancy associated with migratory thrombophlebitis

A

Pancreatic

82
Q

Malignancy associated with necrolytic migratory erythema

A

Glucagonoma

83
Q

Malignancy associated with pyoderma gangrenosum

A

Myeloproliferative disorders

84
Q

Malignancy associated with seeets syndrome

A

Haemotological

85
Q

Malignancy associated with tylosis

A

Oesophageal

86
Q

What is necrobiosis lipoidica

A

Shiny painless areas of yellow/red/brown skin. On shin. Telangiectasia. Associated with diabetes.

87
Q

Conditions associated with diabetes

A

Necrobiosis lipoidica
Candidasis & staphs
Neuro ulcers
Vitiligo
Lipoatrophy
Granuloma annulare

88
Q

Adverse effects with isotretinoin

A

Teratogenicity
Low mood
Dry eyes and skin and lip
Raised triglycerides
Hair thinning
Nose bleeds

89
Q

What is yellow nail syndrome

A

Slowing of nail growth, leads to thick and discoloured nails

90
Q

Yellow nail syndrome associations

A

Congenital lymphoedema
Pleural effusions
Bronchiectasis
Chronic sinus infections

91
Q

Fungal nail causative organisms

A

Dermatophytes - mainly trichophyton
Yeasts - candida

92
Q

Risk factors for fungal nail infections

A

Increasing age
Diabetes
Psoriasis
Repeated nail trauma

93
Q

Management of fungal nail

A

Nil if patient ok
Limited involvement then amorolfine nail lacquer
Oral terbinafine 6-12 weeks for dermatophyte
Oral itraconazole if candida

94
Q

What’s the Koebner phenomenon

A

Skin lesions that appear at the site of injury

95
Q

Where do you see Koebners phenomenon

A

Psoriasis
Vitiligo
Warts
Lichen planus
Lichen sclerosus
Molluscum

96
Q

What is erythrasma

A

Superficial skin infection
Groin
Corynebacterium
Well defined, pink or brown patches with fine scaling
Woods lamp for porphyrins

97
Q

What are the mild topical steroids

A

Hydrocortisone 0.5-2.5

98
Q

What are the moderate topical steroids

A

Betamethasone valerate (betnovate) 0.025%

Clobetasone butyrate 0.05% (eumovate)

99
Q

What are the potent topical steroids

A

Fluticasone propionate 0.05% (cutivate)

Betamethasone valerate (0.1%) (betnovate)

100
Q

What is the very potent topical steroid

A

Dermovate
Clobetasol propionate 0.05%

101
Q

Psoriasis management

A

First line - topical steroid and topical vit D
2nd - vit D BD
3rd - steroid BD or coal tar

102
Q

Psoriasis secondary care management

A

Phototherapy - UVB or PUVA (SCC side effect)
Oral methotrexate
Ciclosporin
Systemic retinoids
Infliximab, etanercept

103
Q

Scalp psoriasis management

A

Potent topical steroid for four weeks

MRCP 1 (14 decks)

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