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CCE > Derm > Flashcards

Derm Flashcards

1
Q

Jock itch?

A

Tinea Cruris (most common cause is T.rubrum)

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2
Q

DDx for inflammatory skin condition (7)

A
  • Atopic dermatitis (ECZEMA)
  • Discoid eczema
  • Contact dermatitis
  • Chronic plaque psoriasis
  • Guttate psoriasis
  • Lichen Planus
  • Pityriasis Rosea
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3
Q
A

Flexural Psoriasis (axillary)
- Often colonised with candida
- note no central sparing/changes as in fungal

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4
Q

Psoriasis features of management
5 + 5

A
  1. Advice - avoid triggers, etoh, smoking, obesity
  2. Emollients
  3. Topical steroids
  4. Topical Vit D analogue (calcipotriol)
  5. Coal Tar solution

Refer to Derm for:
1. UVB
2. MTX
3. Acicretin
4. ciclosporin
5. biologics

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5
Q

Treatments of tinea infections

A

Tinea capitis + onychomycosis
- Oral terbinafine 250mg OD for 12wks
Tinea corporis/cruris/pedis
- Topical Terbinafine 1% 1-2wks

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6
Q

Treatment for Melasma - 3 pharma + 2 non pharma

A
  1. Topical hydroquinone 2%
  2. Topical tretinoin nocte
    3 Topical Kligmans formula ( hydroquinone + tretinoin + dexamethasone), twice daily, for 3-4weeks (ideally in winter)
  3. Strict sun protection with zinc oxide
  4. Cease COCP (hormonal trigger)
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7
Q

DDx of pruritic erythematous plaque (5)

A
  1. Flexural psoriasis
  2. Candidal intertrigo (+ pustules, +- foul smelling)
  3. Irritant contact dermatitis (vesication or bullae, painful)
  4. Seborrhoeic dermatitis (yellow scales)
  5. Erythrasma (brown macules, minimally itchy)
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8
Q

Features of melasma

A
  • Brown to dark brown facial hyperpigmentation
  • predominantly in reproductive aged women of colour
  • NOT PRURITIC
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9
Q

DDx of melasma (facial hyperpigmentation)

A
  • Post- inflammatory hyperpigmentation
  • Drug-induced hyperpigmentation
  • Actinic lichen planus
  • Exogenous ochronosis (2ndry to hydroquinone use)
  • discoid lupus erythematosus
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10
Q

Pityriasis rosea treatment

A

1 - Reassure no specific treatment required, slef limiting in 6-8wks
2. severe itch can be treated with betamethasone valerate 0.02% topically, OD-BD

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11
Q

intermittent rash on face. No itch, burning or pain. Worsens in winter and with stress

A

Seborrheic dermatitis
- Unclear cause, malassezia often thought to contribute
- Different treatments depends on area
- Scalp - shampoo daily -> anti-yeast shampoo twice weekly -> add topical steroid
- Face/flexural/scrotal - hydrocort 1% + clotrim 1% OD-BD until clear/2wks

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12
Q

Management of pinworm

A

Family hygiene
- Hands washed after toilet and before food
- Short fingernails
- Wear pajamas and shower each morning
Pharma for pt and household contacts - pyrantel single dose +Rpt in 2-3wks

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13
Q

23yo M, lesion on calf, unclear how long, frequent sun exposure. Uniform, dimples on pinching

A

Dermatofibroma
- benign
- often on lower legs
- solitary firm papule
- overlying skin dimples on pinching
- pink-light brown in white skin, dark brown-black in dark skin
- some appear paler in centre

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14
Q

68F, lesion on right arm, noticed a few months ago, but has rapidly expanded. Not painful or itchy
What is it?

A

Keratocanthoma
- variant of SCC
- cant be reliably distinguished, so surgical treatment
- often starts as pimple like lesion with more solid core
- then grows quickly

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15
Q

15yo, rapid onset rash. Otherwise well, IUTD, no sick contacts. Rash over torso and proximal limbs

A

Guttate Psoriasis
- most frequently Dx adolescents +young adults
- not fully understood relationship to post streptococcal infection
- unpredictable course, may remit over several wks-moths, may progress to chronic plaque psoriasis

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16
Q

4yo, 2/7 of fever, sorethroat and vomiting. Followed by rash appeared at neck, then spread, most prominent in skin folds, absenst from her face/palm/soles

A

Scarlet fever (streptococcus pyogenes)

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17
Q

Common triggers/factors that exacerbate psoriasis? (6)

A
  1. Obesity
  2. Smoking
  3. ETOH
  4. NSAID (ACE-I, b-blockers, Lithium)
  5. Stress
  6. Infections (Strep + viral)
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18
Q

Topical agents for psoriasis based on location (4)

A
  1. Scalp = steroid lotion (advantan)
  2. Trunk/limbs/palms = LPC+salicylic acid
  3. Nails - Daivobet ointment nocte
  4. Flexural + face - Advantan fatty ointment + avoid calcipotriol OR salicylic acid
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19
Q

Sweaty stinky feet, look like this. What is it and 2x treatment options

A

Pitted Keratolysis
1st line - Topical clindamycin BD for 10 days
2nd line - multiple. Can trial high concentration antiperspirants (15% aluminium chloride)

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20
Q

Differential causes for this painful nodular rash (7)

A

Erythema Nodosum
1. Idiopathic
2. Sarcoidosis
3. Infections - Strep, TB, chlamydia, more
4. Crohns
5. Medications - COCP, tetracyclines, sulphonamides
6. Malignancy
7. Pregnancy

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21
Q
A

Spa folliculitis - caused by pseudomonas
Usually self limiting
Rx with Ciprofloxacin

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22
Q

Recent UTI, had recurrence of rash had couple of months ago.
?Diagnosis ?common triggers (1/3/3)

A

Fixed drug reaction
Triggers
- NSAIDs
- ABx: Sulfonamides, tetracyclines, penicillin
- AEDs: Phenobarbital, lamotrigine, phenytoin

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23
Q

KFP: Non pharma management advice for pt with melanoma (5)

A
  1. Advise regular skin + LN check by doctor every 3-12months
  2. Advise regular self skin-check every 3months
  3. Advise regarding sun protection (sunscreen)
  4. Advise regarding suspicious skin lesions
  5. Advise return for review if notices any worrying lesions
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24
Q

40F presents with pain localising to toes bilaterally. Feel numb + burning, especially during colder months. Cool but normal pulses. Dx + Mx (3)

A
  1. Topical Elocon ointment
  2. Vasodilation - topical GTN OR nifedipine CR
  3. Wear thick warm socks
25
Q

DDx for ulcerated genital lesions in young person (5)

A
  1. Genital Herpes
  2. Apthous ulcers
  3. Allergic OR contact dermatitis
  4. Self harm/exocriation related/trauma related
  5. Molluscum contagiosum (~~)
26
Q

Pharmacological Rx of acute Genital herpes (2)

A

Oral valciclovir 500mg BD for 5-10days
Topical lignocaine gel PRN

27
Q

12yo with this on back of arms, wants treatment?

A

Keratosis Pillaris
Rx with 10% Urea cream, OD

28
Q

KFP: DDx for this skin lesion - useful for any non pigmented growth (4)

A
  1. SCC (or keratocanthoma)
  2. Amelanotic melanoma
  3. BCC
  4. Atypical fibroxanthoma (head+neck)
29
Q

Non pharma management of acne (4)

A
  1. Mild non soap cleanser once daily
  2. Use non comedogenic cosmetics+sunscreens
  3. Refrain from picking or squeezing pimples
  4. Avoid hot+humid environments
30
Q

39F with rash on her wrist over last 2months, often very itchy?

A

Lichen Planus
Rx with potent topical steroid

31
Q

57M had this intensely itch rash on his body. Seems to be worse when he sweats

A

Grovers Disease (transient anantholytic dermatosis)
- unclear cause, commonly mistaken for heat rash
- last for months to years
- Rx with potent steroid (antroquoril)

32
Q

Spot diagnosis and association

A

Acanthosis nigricans
- insulin resistance assoc with obesity

33
Q

Rx of mild recurrences of oral HSV (2)

A
  1. Topical aciclovir 5x/day for 5/7
  2. oral famciclovir stat dose
34
Q

Rx of initial episode oral HSV (non severe) (2) + Severe (1)

A
  1. Topical difflam Q2-3H
  2. Topical lignocaine viscous
    Severe - oral famciclovir BD for 7/7
35
Q

Supressive therapy for recurrent oral HSV (1)

A
  1. Valciclovir OD for 6/12 then review
36
Q

Common triggers of this (4)

A

Target lesion = Erythema multiforme
Triggers:
1. Infections (HSV)
2. Medications (NSAIDs, AEDs, Abx)
3. Inflammatory Bowel disease
4. Leukaemia/lymphoma/solid organ cancer

37
Q

General dermatological exam findings that confer higher risk? (5)

A
  1. > 5+ atypical naevi
  2. > 50 naevi in total
  3. Naevi >5cm
  4. Fitzpatrick skin type I or II
  5. Evidence of actinic skin damage
38
Q

Pharm Mx of peri-orificial dermatitis (4)

A

NB: Same as rosacea
1st line - Ivermectin cream OD
2nd line - topical metronidazole OD-BD
Then orals
oral doxy OD for 3-8wks
if doxy CI - oral erythromycin BD

39
Q

Spot Dx of these 2

A

Superficial BCC
- could be slow growing but likely given hx such as - slow growing, not responding to treatment, RFs for skin cancer

40
Q

Treatment options for superficial BCC (3)

A
  1. Excision with 3-5mm margins
  2. Imiquimod cream - 3-5x/week for 6-16wks
  3. Cryotherapy with double freeze-thaw
    Others
    - photodynamic therapy, referral to plastics
41
Q

pharma treatment for oral candidiasis (1)

A

Miconazole 2% gel QID (1st line option for both adults + <2yo)

42
Q

Risk factors for melanoma (5Hx + 3Ex)

A
  1. Unprotected UV exposure
  2. Hx short intense sun exposure/burns
  3. Immunosupression
  4. FHx of melanoma in 1st degree relative
  5. PMHx of melanoma (or non-melanocytic skin cancer)
    Examination:
  6. Fitzpatrick 1/2 - light fair hair, blue/green eye colour
  7. > 50 naevi
  8. > 5+ atypical/dysplastic naevi
43
Q

Skin lesion on older individuals face

A

Lentigo maligna (an in-situ melanoma)
- mostly on severely sun damaged skin
- mainly older patients

44
Q

Spot diagnosis

A

Acral lentiginous melanoma
- most common melanoma in dark skin types
- palms, soles or nail bed

45
Q

Itchy vesicles on elbows, knees, and lumbosacral area - Dx to consider?

A

Dermatitis Herpetiformis
Associated with coeliacs

46
Q

Young kid with this. Dx + Mx (3)

A

Pityriasis alba
- mild form of dermatitis in which post inflammatory hypopigmentation is marked - - - - less clear borders, differentiates from vitiligo
Mx
- use soap substitues
- emollient BD
- HC 1% if itch

47
Q

Itchy painful toes after exposed to cold. No clear pattern - Rx (4)

A
  1. Warm gradually with socks/blankets
  2. Potent steroid BD (advantan)
  3. If recurrent - GTN ointment
  4. Nifedipine CR OD - for recurrent + severe
48
Q

Differentiating seborrhoiec dermatitis on face, from rosacea (4)

A
  1. Rosacea triggered by heat, seb derm more often in winter
  2. Rosacea has sterile acneiform papules/pustules, seb derm doesn’t
  3. Age - Rosacea rare <25
  4. Location - Rosacea just face, seb derm can affect other sites

Rosacea - old, hot and angry
Seb derm - young dry + flaky

49
Q

Tinea infections that warrant oral Rx (5)

A
  1. Onychomycosis
  2. Tinea capitis
  3. Extensive skin involvement
  4. Failed topical treatment
  5. Immunosupressed
50
Q

DDx for vesicular rash (5)

A
  1. HSV
  2. Shingles/varicella zoster
  3. Chickenpox
  4. Dermatitis Herpetiformis
  5. Pompholyx
51
Q

DDx for intertrigo (6)

A
  1. Contact irritant dermatitis
  2. Thrush - candida intertrigo, quick developing, satellites
  3. Tinea - slowly spread, irregular annular plaques
  4. Flexural psoriasis - well defined, smooth shiny red, symmetrical
  5. Seborrhoiec dermatitis - often unnoticed, ill defined salmon pink
  6. Erythrasma - Asx brown patches
52
Q

Topical treatment option for HPV wart (2)

A
  1. Warticon cream BD for 3days/week for 4-6wks (podophullotoxin)
  2. Imiquimod 3x/week at bedtime until resolution
53
Q

Dx + Treatment

A

Cervical ectropion
- no treatment required

54
Q

Histo back on suspected melanoma, when to refer (3)

A
  1. > 1mm thick
  2. > 0.75mm thick + high risk features (ulceration, clark 4/5, invasion)
  3. Unable to excise yourself with appropriate margins
    Essentially ends up as all but in-situ
55
Q

Treatment of Genital HSV - first episode + episodes

A

Initial - oral aciclovir TDS for 10/7
Episodes - oral aciclovir TDS for 2/7

56
Q

Treatment of headlice 1+2pharma

A
  1. Wet combing
    +
    Pharma:
    1st line: benzyl alcohol lotion topically for 10mins, rpt at 7 + 14 days
    2nd line: oral ivermectin single dose, rpt at 7 days
57
Q

Dx

A

Fibroepithelial polyp

58
Q

Combination of painful mouth ulcers, genital ulcers, eye problems and skin lesions

A

Behcet disease

CCE (18 decks)

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