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ID, Breast, Oncology, Derm > Derm > Flashcards

Derm Flashcards

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Dermatology Board Prep flashcards
1
Q

Examination of skin lesion

A
  1. Shape
  2. Pattern- grouped, scattered or generalised?
  3. Border
  4. Surface
  5. Elevation
  6. Colour
  7. Temperature
  8. Evolution
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2
Q

ABCDEF criteria to identify suspicious pigmented lesions

A

Asymmetry
Border irregularity or blurring
Colour variation with shades of black, brown, blue or pink
Diameter >6mm (cannot be covered by end of a pencil)
Elevation (all changing moles- size, elevation and/or colour are suspect)
Funny looking mole- stands out or different from others

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3
Q

Types of melanoma

A

Superficial spreading melanoma
Nodular melanoma- most aggressive type
Acrylic lentiginous melanoma
Lentigo maligna melanoma

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4
Q

Premalignant skin conditions

A

Acitinic keratoses

Bowen’s Disease

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5
Q

Treatment of mild psoriasis

A

Emollient

Steroids

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6
Q

Signs of palpation

A 
Surface
Consistency
Mobility
Tenderness
Temperature
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7
Q

Open comedone

A

Blackhead

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8
Q

Closed comedone

A

Whitehead

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9
Q

Purpura

A

Red or purple colour (due to bleeding into the skin or mucous membrane) which doesn’t blanch on pressure

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10
Q

Lichenification

A

Well-defined roughening of skin with accentuation of skin markings

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11
Q

Ulcer

A

Loss of epidermis and dermis

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12
Q

Nail signs to look for on exam

A

Clubbing
Kolinychia
Onycholysis- psoriasis, fungal nail infection
Pitting- psoriasis, eczema and alopecia areata

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13
Q

Function of skin

A
  1. Protective barrier against environmental insults
  2. Temperature regulation
  3. Sensation
  4. Vitamin D synthesis
  5. Immunosurveillance
  6. Appearance/cosmesis
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14
Q

Layers of the epidermis

A

Stratum corneum- most superficial
Stratum granulosm
Stratum spinosum
Stratum basale- deepest layer

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15
Q

Urticaria, angioedema and anaphylaxis: presentation

A

Urticaria- itchy wheals. swelling of superficial dermis
Angioedema- swelling of tongue and lips. deeper swelling involving dermis
Anaphylaxis- bronchospasm, facial and laryngeal oedema, hypotension. can initially present with urticaria and angioedema

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16
Q

Management of urticaria

A

Antihistamines or corticosteroids if severe

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17
Q

Management of angioedema

A

Corticosteroids

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18
Q

Management of anaphylaxis

A

Adrenaline
Corticosteroids
Antihistamines

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19
Q

Erythema nodusm: definition and causes

A

Hypersenstivity to variety of stimuli

Causes: Group A- Beta haemolytic strep, primary TB, pregnancy, malignancy, IBD, chlaymida, sarcoidosis, leprosy

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20
Q

Erythema nodusm: presentation

A

Discrete tender nodules- may become confluent
1-2w and then leave bruise like discolouration as they resolve
Don’t ulcerate
Shins are most common site

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21
Q

Steven-Johnson syndrome and Toxic epidermal necrosis

A

SJS- mucocutaneous necrosis with at least two mucosal sites involved
TEN- drug induced severe disease characterised by extensive skin and mucosal necrosis accompanied by systemic toxicity

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22
Q

SJS and TEN: management and complications

A

Management: early recognition and call for help. Supportive care to maintain haemodynamic stability

Morality rate 5-12% SJS and >30% TEN- sepsis, electrolyte imbalance or multisystem organ failure

23
Q

Acute meningococcal septicaemia

A

Features of meningitis
Non blanching purpuric rash on trunk and extremities which may be preceded by blanching maculopapular rash

Mx: Abx, prophylactic Abx for close relatives

24
Q

Erythroderma- definition and causes

A

Exfoliative dermatitis involving at least 90% of skins surface

Cause- previous skin disease e.g. eczema or psoriasis, lymphoma, drugs or idiopathic

25
Q

Erythroderma- presentation and management

A

Presentation:
Skin is inflamed, oedematous and scaly
Systemically unwell with lymphadenopathy and malaise

Management:
Treat underlying cause if known
Emollients and wet wraps- skin moisture
Topical steroids- inflammation

Mortality of 20-40%

26
Q

Eczema herpeticum

A

Widespread eruption- serious complication of atopic eczema due to herpes simplex virus
Presentation- extensive crusted papules, blisters and erosions. Systemically unwell with fever and malaise
Mx- antivirals (aciclovir) and antibiotics for bacterial secondary infection.

Complications- herpes hepatitis, encephalitis, DIC and rarely death

27
Q

Necrotising fascitis

A

Rapidly spreading infection of deep fascia with secondary tissue necrosis. Cause- group A haemolytic streptococcus
RF- abdo surgery and medical co-morbidities e.g. diabetes, malignancy

Presentation- Severe pain; erythematous, blistering and necrotic skin; systemically unwell with fever and tachycardia; presence of crepitus

Mx- urgent referral for debridement, IV Abx

Mortality up to 76%

28
Q

Cellulitis: definition and causes

A

Deep subcutaneous tissue infection due to streptococcus pyogenes or S.aureus.
RF- immunosuppression, wounds, leg ulcers, minor skin injury

29
Q

Cellulitis: presentation

A

Mostly lower limbs
Local signs of inflammation- swelling, erythema, warmth, pain, may be associated with lyphangitis
Systemically unwell- fever, malaise or rigors

30
Q

Cellulitis: management

A

Abx- flucloxacillin/benzylpenicillin
Supportive care- rest, leg elevation, sterile dressings and analgesia

Complications- local necrosis, abscess and septicaemia

31
Q

Staphylococcal scalded skin syndrome

A

Production of circulating epidermolytic toxin from benzyl-penicillin resistant staphylococci
Scald-like skin appearance, intraepidermal blistering, pain
Abx and analgesia

32
Q

BCC (basal cell carcinoma): RF

A 
UV exposure
Hx of frequent/severe sunburn in childhood
Skin type 1
Increasing age
Male
Immunosuppression
Previous Hx of skin cancer
Genetics
33
Q

BBC : presentation

A

Small, skin coloured papule or nodule with surface telangiectasia and a pearly rolled egde
may have necrotic or ulcerate centre
Previously named rodent ulcer
Most common over head and neck

34
Q

BCC: management

A 
Surgical excision
Radiotherapy if surgery not appropriate
Crythotherapy
Curettage and cautery
Topical photodynamic therapy
35
Q

SCC (squamous cell carcinoma): RF

A

Excessive UV exposure
Pre-malignant skin conditions e.g. actinic keratoses
Chronic inflammation- leg ulcers, wound scars
Immunosuppression
Genetic predisposition

36
Q

SCC: presentation

A

Keratotic (e.g. scaly, crusty), ill-defined nodule which may ulcerate

37
Q

SCC: management

A

Surgical excision- treatment of choice

Radiotherapy

38
Q

Malignant melanoma

A

Invasive malignant tumour of epidermal melanocytes which has potential to metastasise.
More common on legs in women and trunk in men

39
Q

Melanoma: RF

A

Excessive UV exposure
Skin type 1
Hx of multiple moles or atypical moles
FHx/ previous Hx of melanoma

40
Q

Melanoma: Management

A

Surgical excision
Radiotherapy
Chemo for metastatic disease

41
Q

Melanoma: Prognosis

A

Recurrence depends on Breslow thickness

5yr survival depends on TNM classification

42
Q

Breslow thickness

A

Thickness of tumour
<0.76mm- low risk
0.76-1.5mm- medium risk
>1.5- high risk

43
Q

Eczema: Definition and causes

A

Papules and vesicles on erythematous base

Defect in barrier function

44
Q

Eczema: presentation

A

Itchy, erythematous, dry, scaly patches
More common on face and extensore aspect of limbs in infants and flexor aspects in children and adults
Acute- erythematous lesions that are vesicular and weepy
Chronic scratching/rubbing- excoriations and lichenification
Nail pitting and ridging of nails

45
Q

Eczema: management

A

Avoid exacerbating factors
Emollients
Topical steroids
Oral antihistamines or Abx for secondary infection
Phototherapy or immunosuppression for severe non-responsive cases

46
Q

Eczema: complications

A

Secondary bacterial infections- crusted weepy lesions
Secondary viral infection- molluscum contagiosum (pearly papules with central umbilication), viral warts, eczema herpeticum

47
Q

Acne vulgaris: description and causes

A

Inflammatory disease of pilosebaceous follicles
Causes:
Hormonal- androgen
contributing causes- increased sebum production, abnormal follicular keratinization, bacterial colonisation and inflammation

48
Q

Acne vulgaris: presentation

A 
Non-inflammatory lesions (mild)- open and closed comedones
Inflammatory lesions (moderate and severe)- papules, pustules, nodules and cysts
Commonly affects face, chest and upper back
49
Q

Acne vulgaris: management

A 
Topical therapies (mild)- benzyl peroxide and topical Abx and topical retinoids
Oral therapies (moderate to severe)- oral Abx, anti-androgens (females)
Oral retinoids (severe acne)
50
Q

Psoriasis
Description
Causes

A

A chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration

Caused by complex interaction between genetic, immunological and environmental factors. Precipitating factors include- trauma, infection, drugs, stress, alcohol

51
Q

Psoriasis: Types

A

Chronic plaque psoriasis- most common type
Guttate- raindrop lesions
Seborrhoeid- naso-labial and retro-auricular
Flexural
Pustular
Erythrodermic

52
Q

Psoriasis: Presentation

A

Well-demarcated erythematous scaly plaques
Lesions can be itchy, burning or painful
Common on extensor surfaces of body and over scalp
Auspitz sign- scratch and gentle removal of scales cause capillary bleeding
Associated nail changes (50%)- pitting, onycholysis
Psoriatic arthropathy (5-8%)

53
Q

Psoriasis: Management

A

Avoid precipitating factors
Emollients- reduce scales
Mild localised- topical therapies e.g. Vit D analogues, topical corticosteroids, coal tar preparations, topical retinoids
Extensive disease- phototherapy. UVB and photochemotherapy- UVA and psoralen
Extensive + severe disease/ psoriasis with systemic involvement- methotrexate, retinoids, ciclosporin, mycophenolate, biological agents

ID, Breast, Oncology, Derm (4 decks)

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