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3B GH > Derm > Flashcards

Derm Flashcards

1
Q

is lichen planus more likely to present with pruritis or pain?

A

pain

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2
Q

causes of pruritis ani

A 
fissure
incont
poor hygiene
tight pants
threadworm
fistula
dermatoses
lichen sclerosis
anxiety
contact dermatitis
or unknown cause
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3
Q

Mx of pruritis ani

A 
hygiene
avoid scrating
avoid foods that loosen stool
soothing ointment
mild topical corticosteroids if inflamm
oral antihist for night
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4
Q

pre-malignant crumbly yellow-white scaly crusts on sun exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes. What is the diagnosis, and give 2 differentials

A

actinic [solar] keratoses

Bowen’s
psoriasis
BCC
serorrhoeic keratosis

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5
Q

Ix and Mx in actinic keratoses

A

biopsy if in doubt of diagnosis

none, emollient, diclofenac gel,
fluorouracil [inflamm rn>heal]
imiquimod [inflamm]
cryotherapy
photodynamic therapy
surg excision + curettage
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6
Q

a well defined slowly enlarging red scaly plaque with a flat edge [asymptomatic]. Histology shows full thickness dysplasia/carcinoma in situ. Diagnosis?

A

bowen’s disease

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7
Q

Mx of bowen’s disease

A 
fluorouracil [inflamm rn>heal]
imiquimod [inflamm]
cryo
photodynamic
curettage, excision
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8
Q

causes of bowens disease

A 
UV exposure
radiation
imm.supp.
arsenic
HPV [in genital area]
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9
Q

most common skin cancer

A

BCC

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10
Q

describe the 2 types of BCC

A

nodular: pearly nodule, rolled telangiectasia edge, face
superficial: red scaly plaque, trunk/shoulders

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11
Q

Mx BCC

A 
excision
cryo
curettage
radiotherapy
photdynamic
imiquimod/fluorouracil [superficial low risk]
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12
Q

Mx of primary SCC

A

local complete excision

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13
Q

most common cancers causing cutaneous mets

A 
breast
stomach and colon
lung
GU [uterus/ovary/kidney/bladder]
non-hodgkins, leukaemia
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14
Q

describe pagets diseas eof the nipple

A

itchy red scaly crusted nipple, from direct extension of intraductal adenocarcinoma

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15
Q

how do you differentiate pagets diseas eof the nipple from eczema?

A

eczema is bilateral, non-deforming, waxes and wanes

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16
Q

risk factors for melanoma

A 
UV exposure
sunburn
fair complexion
>50 melanocytic/ dysplastic naevi
FH
previous melanoma
^age
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17
Q

ring like (annulatr lesions ) indicate what?

A

fungal infection

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18
Q

target-like pattern of lesions = ?

A

erythema multiforme

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19
Q

> 5 cafe au lait spots, consider what disease?

A

neurofibromatosis

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20
Q

what can cause melasma

A

preg

COCP

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21
Q

systemic diseses that can cause hyperpigmentation

A

addisons

haemochrom

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22
Q

Ix.s in itch

A 
FBC
haematinics
LFT
U+E
ESR
glucose
TSH
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23
Q

skin signs in DM

A 
flexural candidiasis
necrobiosis lipoidica
acanthosis nigricans
granuloma anulare
folliculitis
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24
Q

skin signs in coeliac

A

dermatitis herpetiformis

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25
Q

dermatitis herpetiformis immediate Mx

A

dapsone

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26
Q

skin signs in IBD

A

erythema nodosum

pyoderma gangrenosum

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27
Q

skin signs in lupus

A

facial butterfly rash
photosensitivity
diffuse alopecia
lupus erythematosus [chilblain, discoid, psoriasis-like plaques, vasculitis, oral ulcers, palmar erythema, periungal erythema, raynauds]

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28
Q

erythema multiforme is a hypersensitivity rn usualy triggered by what organism

A

herpes simplex

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29
Q

Mx of erythema multiforme

A

topical steroid for discomfort
aciclovir for HSV
resolves spontaneously

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30
Q

causes of acanthoiss nigricans

A

obesity
DM
lymphoma
gastric CA

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31
Q

risk factors for psoriasis + triggers

A

FH

triggers:
stress, infetions, skin trauma, drugs [lithium, NSAIDs, BB], alcoohol, obesity, smoking, climate

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32
Q

systemic upset found with generalised severe psoraisis

A

^WCC
fever
dehydration

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33
Q

nail chnages in psoroaiss

A

pitting
onycholysis
thickening
subungual hyperketatosis

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34
Q

differentials for psoriasiss

A

eczema
tinea [few lesions]
mycosis fungoides [asymmetric]
seborhoeic dermatitis

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35
Q

Mx of psoriasis

A 
topical emollient + steroids [betnovate]
topical vit D Prep [Calcipotriol]
(DOVOBET = vit D + steroid)
COAL tar
dithranol
retinoid [acitretin]
phototherapy
(methotrex, ciclosporin)
(infliximab etc)
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36
Q

scalp psoriasis Mx

A

steroid/vit D/coal tar shampoo

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37
Q

tell parents of eczema patient to report any severe weeping rash e.g. around the mouth. Why?

A

may be eczema herpeticum - primary herpes infection which may be fatal

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38
Q

Mx of eczema

A 
emollient, soap substitutes
topical steroids 
Abx for infection
tacrolimus/methotrex/azathiop/ciclo in severe
antihistamines for itch [hydroxyzine]
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39
Q

what does seborrhoeic dermatitis look like?

which areas does it affect?

what causes it?

how is it treated?

A

red, scaly

scalp [dandruff], eyebrows, nasolabial folds, cheeks, flexures

over gorwth of skin yeasts [malassezia]

daktacort [steroid + antifungal]

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40
Q

Mx of acute flare of contact dermatitis

A

topical steroid

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41
Q

local SEs of topical steroid use

A 
skin thinning
striae
telangiectasia
worsening of infection
contact dermatitis
42
Q

what ix can help you diagnose tinea/ ringworm?

A

skin scraping/ scalp brushings/ nail clippings for microscopy + culture

43
Q

Tx of ring worm

A

antifungal e.g. fluconazole

44
Q

Mx of skin, mouth and vaginal candida infection

A

SKIN: clotrimazole cream
MOUTH: miconazole
VAG: clotrimazole cream +/- pessary

45
Q

peak age for impetigo + commonly responsible organism

how is it treated?

A

2-5 yrs
staph aureus

topical fusidic acid, oral fluclox if severe

46
Q

what causes erysipelas?

how does it present?

how is it treated?

A

strep pyogenes

sharply defined superficial infection on face. Fever, ^WCC

Abx

47
Q

signs and Sx of cellulitis

A 
pain
swelling
erythema
warmth
systemic upset
lymphadenopathy
48
Q

Mx of cellulitis

A

Abx - e.g. benzylpenicillin IV + fluclox PO

if penicillin allergic, erythromycin

49
Q

what pathogen causes warts?

A

HPV

50
Q

treatment of warts

A 
self-limiting
if painful/persistent/unsightly:
topical salicylic acid
cryotherapy
duct tape occlusion
51
Q

Mx of genital warts

A

sigificant treatmnt failure/ relapse
podophyllin/ imiquimod
cryo

52
Q

complications of herpes zoster/ shingles

A

post-herpetic neuralgia
meningitis
encephalitis

53
Q

what are the 5 pillars of acne?

A
  1. basal keratinocyte proliferation in pilosebaceous follicles [androgen + corticotrophin-releasing hormone driven]
  2. ^sebum productiion
  3. propionibacterium acnes colonization
  4. inflamm
  5. comedones blocking secretions -> papules, nodules, cysts, scars
54
Q

acne Mx

A

topical benzoyl peroxide
topical retinoid [isotretinoin]
topical Abx [clindamycin]
azelaic acid

PO Abx [doxy/tetracycline]
COCP/dianette [antiandrogen]

55
Q

isotretinoin [topical retinoid] SEs

A

teratogenic
skin + mucosal dryness
depression

56
Q

common drug culprits for urticaria

A 
penicillins
cephalosporins [cefurox/ceftriax]
opiates
NSAIDs
ACEi
thiazides
phenytoin
57
Q

Mx of urticaria

A

antihist +/- hydrocort/adrenaline if anaphylaxis

58
Q

vague URT Sx 2-3 weeks after starting a new medication. Then rash: painful erythematous macules > target lesions, mucosal ulceration (conjunctivae, oral, labia, urethra). Diagnosis + culprits?

A

stevens-johnson syndrome

sulfonamides
anti-epileptics
penicillins
NSAIDs

59
Q

How do you manage toxic epidermal necrolysis + stevens-johnson syndrome

A

supportive in ICU
IVIg
analgesia
protect skin

60
Q

flu like Sx.
widespread painful dusky erthema, the necrosis of large sheets of epidermis, severe mucosal involvement.
Following new medication.
Diagnosis

A

toxic epidermal necrolysis

61
Q

drug causes of toxic epidermal necrolysis

A 
sulfonamides
anti-epileptics
penicillins
NSAIDs
cephalosporins [cefurox/ceftriax]
allopurinol
62
Q

Mx of lichen planus

A

topical steroids +/-antifungal

63
Q

pt presents with purple itchy flat-topped papules on inner wrists and legs with white lacy markings. She also has lacy white areas on the inside of her cheeks. Diagnosis?

A

lichen planus

64
Q

what is the difference in prognosis for scarring and non-scarring alopecia

A

scarring implies non reversible

65
Q

smooth, well-defined round patches of hair loss on scalp. Exclamation mark hairs. diagnoiss?

A

alopecia areata

66
Q

mx of alopecia areata

A

80% spont regrowth in 3 months

topical steroid
psych support
Minoxidil [in androgen-dpeendent]

67
Q

bullous pemphigoid is the chief autoimmune blistering disorder in the elderly. what cayses it?

A

IgG autoantibodies to basement membrane

68
Q

elderly lady presents with tense blisters 1-3cm in size. A biopsy shows +ve immunofluorescence, [IgG and complement along the basement membrane]. Dx?

A

bullous pemphigoid

69
Q

bullous pemphigoid mx

A

topical steroids + pred PO [+PPI+bisphos]

70
Q

difference between pemphigus + bullous pemphigoid

A

pemphigus younger [<40], oral mucosa affected, flaccid blisters [tense in BP]

71
Q

Mx of pemphigus

A

pred

ritux + IV Ig in resistant

72
Q

precipitants for urticaria

A

infection/parasites[helminth]
chemicals - insect bites, latex, drugs, food
systemic disease

73
Q

risk factors for venous leg ulcers

A 
varicose veins
DVT
venous insufficiency
poor calf muscle fn.
AV fistulae
obesity
leg fracture
minimal trauma over medial malleolus
74
Q

what is the name of the skin changes seen in venous leg ulcers/ venous HTN?

A

lipodermatosclerosis

[or haemosiderin deposition]

75
Q

give 5 causes of ulcers

A

neuropathy
trauma
vascular: venous/arterial/mixed

rarer:
vasculitis [e.g. SLE]
malignancy
pyoderma gangrenosum [IBD]
sickle cell
infection [leishmaniasis]
drugs [nicorandil for angina]
76
Q

Mx of venous leg ulcers [including initial Ix]

A 
DOPPLER to rule out arterial
graded compression bandaging, dressings
PO abx if infection
analgesia
[pentoxifylline]
77
Q

prevention of venous leg ulcers

A

skin care, compression stockings, calf exercises, leg elevation, good nutrition

78
Q

risk factors for pressure ulcers

A 
extremes of age
reduced mob
reduced sensation
vasc disease
chronic/terminal illness
incont
spinal injury
79
Q

complicaiton of pressure ulcer

A

osteomyelitis

80
Q

Tx of pressure ulcer

A 
pressure relieving mattress
frequent repositioning/turning
nutrition
ABx for infection
modern dressings
debridement
-ve pressure
81
Q

prevention of pressure ulcers

A

regular skin inspection
minimise moisture
positioning/turning
pillows to separate knees + ankles

82
Q

skin causes of pruritus in the elderly

A

eczema
scabies
pemphigoid
dry skin

83
Q

medial/systemic causes of pruritus in the elderly

A 
anaemia
polycythaemia
lymphoma
solid neoplasms
hepatic/renal failure
hypo/hyperthyroidism
DM [candida]
84
Q

causes of pruritus vulvae

A 
systemic e.g. liver/renal/anaemia etc
lichen planus, psoriasis
candida
allergy [washing powder]
infestation [scabies]
vulval dystrophy [lichen sclerosis, carcinoma]

exacerbating:
obesity
incont

85
Q

difference between wet and dry gangrene

A

wet is with infection

86
Q

features of acute seroconversion in HIV + when does this occur?

A 
1-3 weeks after exposure
acute EBV-type illness
maculopapular eruption on trunk
lymphadenopathy
malaise
headache
fever
oral/genital ulcers/candidiasis
87
Q

examples of pathogens that dont usually cause disease, but HIV +ve patients are at incerased risk on infection from

A 
herpes: oral/genital ulcers, varicella [+post-herpetic neuralgia], KS
EBV [oral hairy leukoplakia]
warts
molluscum contagiosum
candida
tinea
syphilis
cryptoccus
demodicosis
scabies
88
Q

Mx of HIV associated KS

A 
optimize HAART
radiotherapy
chemo
cryo
laser
photodynamic therapy
excision
interferon alpha
89
Q

Mx of candidiasis in HIV

A

topical nystatin

systemic imidazoles

90
Q

Mx of skin cryptococcosis in HIV

A

fluconazole

91
Q

scabies Mx , including practical measures

A

treat all close contacts
permethrin lotion
oral ivermectin in severe
crotamiton [anti-pruritic]

long bath, soap skin all over, scrub under fingernails.
wash all bedding, towels, clothing in hot wash

92
Q

HIV skin neoplasias

A 
kaposi sarcoma
BCC
SCC
melanoma
skin lymphomas
merkel cell cancer
93
Q

what is immune reconstitution inflamm syndrome in HIV?

A

with antiretrovirals, immunity begins to recover, but then responds to previously acquired opportunistic infection with a powerful inflamm response. Worsening of Sx, often involves skin.

94
Q

pt presents with itching

+ itchy red penile and scrotal papules. Diagnosis?

A

scabies [ itchy red penile and scrotal papules are virtually diagnostic]

95
Q

Mx of headlice

A

malathion or dimeticone lotion

combing

96
Q

Mx for crab lice

A

malathion or permethrin

97
Q

hanging legs over the side of the bed to relieve pain indicates what type of ulcer + why?

A

use gravity to aid blood flow to ischaemic tissue

98
Q

Mx of arterial ulcers

A

optimise vascular risk factors e.g. QUIT SMOKING!
regular inspection
surg: revacularisation, amputation

99
Q

ABCDEF CRITERIA for suspicious pigmented lesion

A 
asymmetry
border irregularity
colour variation
diameter >6mm
evolution
funny looking [diff from rest]
100
Q

briefly describe the 4 types of melanoma.

which is the mos common

A

superficial spreading [most common]

nodular [agressive]

acral lentiginous [palm and soles]

lentigo maligna

101
Q

melanoma Mx

A

excision
interferon alpha for mets
palliative chemo
NOT radio

3B GH (16 decks)

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