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Finals > Derm > Flashcards

Derm Flashcards

1
Q

Functions of the skin

A 
Protect against environment
Temp regulation
Vit D synthesis
Immunosureveillance
Stop fluid loss
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2
Q

Which skin cells present antigens and activate t-lymphocytes?

A

Langerhans

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3
Q

Merkel cells?

A

Nerve endings for sensation

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4
Q

Melanocytes?

A

Produce melanin - pigment and protects nuclei from UV radiation induced DNA damage

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5
Q

Epidermis is made from?

A

Keratinocytes

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6
Q

Types of sweat gland and function?

A

Eccrine (skin)

Apocrine (axilla, anus. genitalia –> from puberty, body odour)

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7
Q

Stages of wound healing

A

Haemostasis
Inflam
Proliferation
Remodeling

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8
Q

What happens in haemostasis and inflammation?

A

Vasoconstriction and pt aggregation (clot formation)

Vasodilation, migration NP and MP –> phagocytosis of debris

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9
Q

What happens in proliferation and remodelling?

A

Granulation tissue formation and angiogenesis

Collagen fibre reorganisation, scar maturation

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10
Q

Why use emollients?

A

Rehydrate skin, re-establish surface lipid layer.

Use at dry, scaling conditions as soap substitute

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11
Q

SE of emollients?

A

Irritant - rash

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12
Q

Indications for topical corticosteroids?

A

Anti-inflammatory, anti-proliferative

Allergic/immune conditions, blistering, inflam skin, connective tissue disease, vasculitis

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13
Q

4 strengths of topical corticosteroid cream (weakest to strongest)

A

Hydrocortisone

Clobetasone butyrate (eumovate)

Betamethasone valerate (betnovate)

Clobetasol propionate (dermovate)

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14
Q

SEs of topical corticosteroids?

A

Skin atrophy, telangiectasia, striae, exacerbation skin conditions, acne

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15
Q

SEs of oral corticosteroids

A 
Syndrome (Cushings)
HTN
Immunosuppression
Psychosis
Diabetes
Osteoporosis
Cataracts
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16
Q

Egs of topical abx

A

Fusidic acid
Mupirocin
Neomycin

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17
Q

SEs of abx

A

Local (irritation, allergy)

Systemic: GI upset, rash, anaphylaxis, candidiasis, abx assos infections

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18
Q

Eg of an oral retinoid

A

Isotretinoin, acitretin

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19
Q

Indications for oral retinoids?

A

Acne
Psoriasis
Disorders of keratinisation

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20
Q

SEs of oral retinoids?

A

Mucocutaneous reaction [dry skin, lips, eyes]

Disordered LFTs

Hypercholesterolaemia

Myalgia, arthralgia, depression

Teratogenicity

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21
Q

SE of ciclosporin?

A

HTN and renal dysfunction

MUST monitor BP, U+Es

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22
Q

SEs of azathioprine?

A

Hepatotoxicity

Myelotoxicity

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23
Q

Atopic eczema?

A

Chronic, relapsing inflammatory skin condition characterised by itchy, erytheatous scaly pathces

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24
Q

Where is eczema in infants?

In adults?

A

Infants = face + extensor

Adults = flexor surfaces

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25
Q

Dx of eczema?

A

Itchy skin + 3 of:

  • history of flexural involvement
  • visible flexural dermatitis
  • personal hx of asthma, hayfever (or FH if <4y)
  • Dry skin
  • onset < 2
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26
Q

Ix in atopic eczema

A

Serum IgE

Allergy testing

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27
Q

Complications of eczema

A

Psychological stress

Bacterial superinfection

Eczema herpeticum - EMERGENCY

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28
Q

Mx of occupational dermatitis?

A

Avoid irritant (eg gloves)

Topical corticosteroids

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29
Q

Seborrhoeic dermatitis found where?

A

Scalp
Nasolabial fold
Anterior chest

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30
Q

What is seborrhoeic dermatitis called in babies?

A

Cradle cap (usually resolves by 12m)

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31
Q

Mx of seborrhoeic dermatitis?
Scalp?
Non-scalp?

A

Scalp [topical shampoo: salicylic acid, coal tar, ketoconazole. Topical corticosteroids]

Non-scalp [topical corticosteroids +/- topical ketoconazole]

If >3months –> oral ketoconazole

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32
Q

Psoriasis?

A

Inflammatory disease due to hyperproliferation of keratinocytes and inflammatory cell infiltrate

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33
Q

Biopsy of psoriasis?

A

Focal parakeratosis

Epidermal acanthosis

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34
Q

Associations with psoriasis?

A

50% - nail changes [pitting, onycholysis]

10% psoriatic arthiris

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35
Q

Most common form of psoriasis?

A

Plaque - well circumscribed, erythematous scaly plaques

Bleed on picking (Auspitz’s sign)

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36
Q

Guttate psoriasis appearance?

Who seen in?

A

Raindrop like on trunk, arms and legs

Post strep tonsillitis in the young

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37
Q

Mx of psoriasis?

A

Education, avoid triggers
Emollients
Topical corticosteroids
Vit D analogues

Phototherapy

If severe [MTX, ciclosporin, acitretin,]

Biologics [etanercept, infliximab]

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38
Q

Mx of guttate?

A

Phototherapy

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39
Q

Mx of pustular psoriasis?

A

Oral retinoid (acitretin)

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40
Q

Comps of acne?

A

Depression
Scarring
Deformity
Hyperpigmentation

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41
Q

Mx of mild acne?

A

Topical keratolytic
or topical retioid
or topical abx

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42
Q

Mx of mod acne?

A

Topical retinoid

+ oral abx (doxycycline)

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43
Q

Mx of severe acne?

A

Oral retinoid –> isotretinoin

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44
Q

Which cells are BCC from?

A

Hair follicle

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45
Q

RFs for SCC?

A 
UV exposure
Pre-malignant [actinic keratoses, Bowen's]
Chronic inflam
Immunosuppression
White
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46
Q

Pres of SCC?

A

Keratotic, ill defined nodule +/- ulceration +/- bleeding

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47
Q

What is Bowens?

A

Superficial red, scaley patch on skin - easy to treat

AKA “SCC in situ”

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48
Q

Ix for SCC?

A

Biopsy

CT/MRI

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49
Q

Types of SCC?

A

Actinic keratosis
Bowen’s
Invasive - penetrates basal memb to dermis

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50
Q

Mets for SCC

A

LNs, lung, liver, brain, bone

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51
Q

Mx of Bowen’s disease?

A 
Cryotherapy
Topical chemo (fluoracil)
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52
Q

Mx of invasive SCC?

If mets?

A

Wide surgical excision

+ radiotherapy

53
Q

BCC RFs

A 
UV exposure
Sunburn 
Skin type I
Age
Male
Immunosuppresion
54
Q

Pres of BCC?

A

Rodent ulcer

55
Q

Histopathology of BCC?

A

Small, dark staining basal cells, invading dermis

56
Q

Mx of BCC?

A

Surgical

57
Q

How to describe a lesion?

A 
Asymmetry
Border
Colour
Diameter
Evolution
58
Q

Problem with melanoma?

A

Mets early

59
Q

RFs melanoma?

A

UV exposure
Skin type I
FHx
Immunosuppressed

60
Q

Where do you get melanoma?

Who?

A

Common on lower limbs

Young / middle aged

61
Q

Appearance of melanoma?

A

Large + flat + irreg pigment

62
Q

Growth of melanoma?

A

Laterally then invades deep

63
Q

Ix for melanoma?

A

Deramatoscope
Biopsy
Assess for mets [sentinel LN biopsy, liver USS, CXR, CT chest/abdo/pelvis]

64
Q

Mets from melanoma to where?

A

Liver

65
Q

Mx melanoma in situ?

A

Wide local excision / Mohs

66
Q

What is bullous pemphigoid?

A

Chronic blistering disorder usually affecting elderly

67
Q

Cause of bullous pemphigoid?

A

Autoantibodies against hemidesmosal antigens in epidermis and dermis

68
Q

Ix for bullous pemphigoid

A

biopsy - histopathology

69
Q

Mx of bullous pemphigoid

A

Wound dressing, monitor for infections

Topical corticosteroids

If widespread –> Prednisolone PO + antihistamine

Immunosuppresants

70
Q

What is pemphigus vulgaris?

A

Autoimmune blistering skin disorder affecting the middle aged

71
Q

Cause of pemphigus vulgaris?

A

Autoantibodies against antigens in epidermis

shallower than bullous

72
Q

Mx pemphigus vulgaris?

A

Wound dressing, monitor for infection

High dose oral steroids, immunosuppressants

73
Q

Impetigo pres?

Cause?

A

Golden crust / vesicles
S. aureus

seen in kids

74
Q

What makes susceptible to impetigo?

A

Trauma

Skin breaks - eg eczema

75
Q

Mx impetigo

A

Topical fusidic acid
Intranasal mupirocin
Oral flucloxacillin

76
Q

Mx of orbal cellulitis

A

Ceftriaxone (IV) + Vancomycin (IV) +/- orbital decompression

Risk of blindness / abscess

77
Q

Causer of scalded skin syndrome?

A

Production of a circulating epidermolytic toxin from benzypenicillin-resistant Staph.

78
Q

Mx of scalded skin

A

analgesia, abx (flucloxacillin), fluids

79
Q

Ix of fungal infections

A

skin scrapings / swabs / nail clippings

80
Q

Mx of fungal infections

A

Treat precipitating factors

Topical antifungal [ketoconazole]

Oral antifungal [itraconazole, fluconazole]

81
Q

Cause of warts

A

HPV (6-11)

82
Q

Mx of warts

A

Cryotherapy
Silver nitrate
Debridement
Salicylic acid

83
Q

Molluscum contagiosum appearance?

Distribution?

A

Pearly, smooth papule with a central umbilication

Face and groin

84
Q

Mx of molluscum contagiosum?

A

Curettage

Cryotherapy

85
Q

Scabies cause?>

A

infection with mites

86
Q

Mx of scabies?

A

Treat all contacts + wash clothes

Topical permethrin + antihistamine

87
Q

Things to check in ulcers?

A

Site
Edge
Base

88
Q

Cause of venous ulcers?

A

Chronic venous insufficicency

89
Q

Signs of chronic venous insufficiency?

A

Ulcers

Ankle swelling, hyperpigmentation, lipodermatosclerosis, heavy legs, dry/scaly skin, telangiectasia, varicose veins, itch

90
Q

Where are venous ulcers usually?

A

Medial/lateral malleolus

Between knee + ankle

91
Q

Appearance of venous ulcers>

A 
Large
Shallow/sloping edge
painless
Irreg border
Moist granulating base
92
Q

Ix for venous ulcers?

A

ABPI

Swabs for microbiology

93
Q

When to biopsy venous ulcers?

A

If atypical

or fail to heal in 12 weeks

94
Q

Mx of venous ulcers?

A

Graduated compression + elevation

Debridement + cleaning

Dressing

Abx if cellulitis

95
Q

Cause of arterial ulcers?

A

atherosclerosis and tissue hypoxia

96
Q

When would you suspect arterial ulcer?

A

CV RFs, absent pulses, ischaemic features

More distal

Painful

Grey granulating base

97
Q

Features of ischaemia?

A

Pale, pulseless, perishingly cold, parasthesia, paralysis

98
Q

Dx of peripheral arterial disease?

A

ABPI

Systolic at ankle / systolic at arm
–> <0.9 implies disease

99
Q

Mx of arterial?

A

DO NOT COMPRESS

100
Q

Location of neuropathic ulcers?

A

Bottom of foot - pressure points

101
Q

Mx of neuropathic ulcer?

A

Find cause

Diabetic foot managment (shoes, cleaning etc)

102
Q

Pres of urticaria?

A

Itchy wheals - central swelling with peripheral erythema

103
Q

Cause of urticaria?

A

Skin mast cells –> histamine –> permeable capillaries and venules

104
Q

Mx of urticaria?

A

Antihistamines

105
Q

What is angioedema?

A

Swelling of tongue,, eyelids and lips

106
Q

Comps of angioedema?

A

Asphyxia, cardiac arrest, death

107
Q

Anaphylaxis hallmarks?

A

Bronchospasm
Facial/laryngeal oedema
Hypotension

108
Q

Mx of acute urticaria +/- angioedema with airway involved?

A

IM adrenaline (1/1000)
+ airway protection
+ IV chlorphenamine
+ IV hydrocortisone

109
Q

Mx of chronic urticaria?

A

loratadine

110
Q

Erythema nodosum?

A

Erythematous lumps on shins due to inflam of SC fat

111
Q

Causes of erythema nodosum?

A

IBD
TB
Strep throat
Sarcoidosis

112
Q

Erythema multiforme?

A

Hypersensitivity reaction triggered by infection –> target lesions

113
Q

Cause of erythema multiforme?

mx?

A

Usually HSV

acute + self limiting

114
Q

Cause of Stevens-Johnsons syndrome?

A

Medication / infection

115
Q

TEN vs SJS?

A

Extent of skin coverage..
TEN > 30%
SJS < 10%

116
Q

What characterises TEN + SJS?

A

Detachment of epidermis from dermis

Maculopapular rash + bullae

Keratinocye apoptosis

Sloughs at pressure

117
Q

Dx of SJS / TEN?

A

Skin biopsy + histopathology

118
Q

Mx of SJS / TEN

A 
Help! 
Withdraw causative agent
Dressing + topical abx / emollients
IV fluids
Analgesia
119
Q

Necrotising fasciitis?

Cause?

A

Rapidly spreading infection of deep fascia with 2dary tissue necrosis

Group A haemolytic strep (pyogenes) / S aureus / Pseudomonas aeruginosa

120
Q

RFs for nec fasc

A

abdo surg, DM, malignancy

121
Q

Pres of nec fasc

A

SEVERE PAIN
Erythematous, blistering, necrotic skin
Systemically unwell
CREPITUS subcutaneously

122
Q

Mx of nec fasc

A

Surgical debridement
ABCDE
Empirical broad spec –> Vanc + Taz

123
Q

Rosacea pres

A

Flushing, dilated telangiectasia, erythema

124
Q

Mx of rosacea

A

Topical abx/anti-inflam
+/- oral abx

Metronidazole otpical

Doxycycline PO

125
Q

Seborrhoeic keratosis pres?

A

Multiple lesions ‘Stuck-on’, well dermacated grey-brown-black plaques on torso/head
In over 50yos

126
Q

Mx of seborrhoeic keratosis

A

Itch –> topical steroids

Flat –> cryotherapy

Raised –> curettage/cautery

127
Q

Alopecia?

A

AI affecting hair follicles

128
Q

Mx of alopecia?

A

Corticteroids

+/- immunotherapy

129
Q

Pemphigus vs pemphigoid?

A

Pemphigus goes busy –> blisters pop early

Pemphigoid is deeper so blisters more prononounced

Finals (20 decks)

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