Derm Flashcards
Squamous cell carcinoma summary card
Cancer of keratinocytes in epidermis
= FHx, UV light, lighter skin, acitinic keratosis (pre-cancerous)
= hyperkeratotic, scaly/crust, ulcerated, non-healing, rolled edges
= locally invades into dermis, can metastasise
Basal cell carcinoma summary card
Cancer of keratinocytes epidermis in stratum basale
= FHs, UV light, lighter skin
= nodule w/ pearly edges, rolled edges, central ulcer (rodent ulcer), central fine telangiectasia
= slow growing, local invasion into dermis, barely metastasises
Malignant melanoma presentation
RFs: FHx, UV light, lighter skin
A symmetry B order (irregular) C olour (pigmented) D iameter (>6mm) E volution (size/shape) = may also bleed, itch, ulcerate, crust over
Locally invades into dermis, can metastasise (CXR, LFTs, brain MRI, CT chest, abdo + pelvis)
Subtypes of melanoma
Superficial spreading
= most common
Leutigo maligna
= fla lesions often on face (elderly)
Nodular
= domed shape, rapid growth
Acral lentiginous
= palms, soles + nail beds, non-Caucasians
Ix for ?cancer lesions
Physical examination, basic obs
Dermatoscope
Referral (melanoma + SqCC urgent, BCC routine)
Skin biopsy (Clark level/Breslow thickness to see melanoma invasion)
CT/MTI/PET (for staging)
What are melanocytic lesions?
Benign neoplasms of melanocytes via epidermis
= symmetrical lesion, flat, regular borders, does not bleed/itch/ulcerate/crust over
= often congenital or arise during childhood
= RARELY transform into melanomas
How can eczema present?
Dry skin
Itchy, erythematous
Lichenification (if chronic)
Distributed on flexures
Eczema subtypes
Atopic dermatitis
= type I hypersensitivity (IgE), flezures
Contact dermatitis
= type IV hypersensitivity, often nickel/latex, either irritant/allergic trigger
Discoid dermatitis
= coin-shaped/disc lesions, itchy, middle-aged/elderly
Seborrhoeic dermatitis
= distributed eyebrows, nasolabial, scalp (cradle cap)
= yellow, greasy scaly rash in babies often
Dyshidrotic aka pompholyx
= itchy/painful blisters, distributed on palms and plantars
Eczema herpeticum
= medical emergency, super-imposed HSV-1
Psoriasis presentation
Hyperproliferation of keratinocytes result in: Scaly, purple, silvery plaques Dry, flaky skin Itchy/painful Distributed on extensors and scalp
Nail signs: pitting, onycholysis, subunual hyperkeratosis
RFs: PMHx/FHx of psoriasis, triggers include alcohol, smoking, stress
Psoriasis subtypes
Plaque psoriasis (presentation example) = most common
Pustular aka palmo-planter
= plaques/pustules on palms + plantars
Guttate psoriasis
= white, scaly, raindrop plaques form on trunks and extremities, often 2 weeks post-strep (URTI)
Flexural
= occurs in body folds; per-anal area, groin, axilla
Erythrodermic
= requires hospitalisation, systemic body reness and inflammation
= often temperature, dysregulation, electrolyte imbalances
Cellulitis vs erysipelas
Cellulitis
= affects dermis and subcutaneous tissue, patchy borders, less commonly has systemic effect, more commonly leads to sepsis
Erysipelas
= affects epidermis (superficial), well demarcated borders, typically fever/rigors, less commonly leads to sepsis
Presentation of cellulitis/erysipelas
Acute onset
Inflammation: painful, red, hot, swollen
RFs: wounds/ulcers/bites, IV cannula, immunocompromised
Complications of cellulitis
Sepsis Abcess Necrotising fascitis Oribital cellulitis* Periorbital cellulitis* *visual impairment = medical emergency!!
Ix of cellulitis/erysipelas
Physical examination Basic obs; ?sepsis Bloods; increased WCC + CRP Blood cultures Pus/wound stab MCS CT/MRI if orbital cellulitis to identify posterior spread of infection
Mx of cellulitis/erysipelas
Conservative
= monitor obs, oral fluids, draw around lesion to see if it grows/shrinks
Medical
= oral Abx (flucloxacillin) or IV Abx if severe
Admit if
= sepsis (high HR, RR and low BP)
= confusion (assess AVPU, GCS)
Erythema nodosum summary card
Inflammation of subcutaneous fat; type IV hypersensitvity
= red/purple lesions, bilateral nodules, tender, distributed on anterior shins/knees, no ulcers/scars
= infection (step pyogenes, TB, HIV), systemic diseases (IBD, sarcoidosis, Behcet’s disease), drugs (sulphonamides), pregnancy
Erythema multiforme summary card
Inflammation of skin and mucous membranes; type IV hypersensitivity
= target lesions (central vesicle with ring of pallor), starts on hands then spreads, tender/itchy/painful
= infection (HSV, mycoplasma, HIV), drugs (sulphonamides)
Molluscum contagiousm summary card
Skin infection due to pox virus, common condition affecting children
= smooth papule, umbilicated, often painless + itchy
= RFs: immunocompormised (HIV), atopic eczema
= transmitted via close contact (swimming pools, sexual contact)
Ix for erythema nodosum/multiforme and molluscum cont.
Physical examination, basic obs
Test for underlying cause of erythema nodosum and multiforme
Test for HIV if many lesions of molluscum in adults
Usually clinical diagnosis
A 67 year old man sees his GP because his wife is worried about a lesion on his back. On examination, the lesion is hyperkeratotic, non-pigmented and has started to ulcerate.
What is the most likely diagnosis?
A Melanocytic naevus B Squamous cell carcinoma C Melanoma D Basal cell carcinoma E Eczema
B Squamous cell carcinoma
A 73 year old man sees his GP because he has been experiencing episodic headaches, with no discernible trigger. He is otherwise fit and healthy, which he attributes to having a physically intensive occupation – he was a gardener for all his working life. On examination, you see a pigmented lesion on his abdomen that he says is getting bigger.
What is the most likely diagnosis?
A Melanocytic naevus B Squamous cell carcinoma C Melanoma D Basal cell carcinoma E Eczema
C Melanoma
A 14 year old boy develops an itchy rash. On observation, the skin appears dry and inflamed. There are signs of lichenification. The patient also suffers from hay fever and has allergies to penicillin and eggs.
What is the most likely diagnosis?
A Eczema B Lichen planus C Psoriasis D Herpes zoster E Cellulitis
A Eczema
A 14 year old boy develops an itchy rash. On observation, the rash looks like purple plaques and it is distributed on the extensor surfaces. His nails also look abnormal; some show signs of pitting whilst the nail on his right index finger appears to be coming off the nail bed. His grandfather has the same condition, which he manages using steroids.
What is the most likely diagnosis?
A Eczema B Lichen planus C Psoriasis D Herpes zoster E Cellulitis
C Psoriasis
A 33 year old man presents to A&E with PR bleeding and abdominal cramps, particularly in the right iliac fossa. He decided to see the doctor because he has developed a tender rash on both of his shins, which consists of purple nodules.
What is the most likely cause of his dermatological condition?
A TB B Ulcerative colitis C Psoriasis D Strep pyogenes infection E Crohn’s disease
E Crohn’s disease
A 65 year old woman presents to A&E with a 3-day history of a red, painful rash on her left shin. Her vital signs are all normal, and she is afebrile. Blood tests are below:
Hb normal, platelets normal, WCC high, CRP high, D-dimer normal
What is the most likely diagnosis?
A Chickenpox B Deep vein thrombosis C Cellulitis D Erythema multiforme E Erysipelas
C Cellulitis
A 65 year old woman presents to A&E with a 3-day history of a red, painful rash on her left shin. Her vital signs are all normal, and she is afebrile. Blood tests are below:
Hb normal, platelets normal, WCC high, CRP high, D-dimer normal
What is the most appropriate management?
A Topical anti-fungals B IV antibiotics C Commence sepsis 6 protocol D Oral antibiotics E Low-molecular weight heparin
D Oral antibiotics
A 64 year old man presents with a lesion on his upper ear that has been
present for months but has now begun to ulcerate. On examination:
non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on
the pinna.
What is the most likely diagnosis?
A Basal call carcinoma B Malignant melanoma – superficial spreading type C Malignant melanoma – nodular type D Non-healing scab E Squamous cell carcinoma
E Squamous cell carcinoma
A 64 year old man presents with a lesion on his upper ear that has been
present for months but has now begun to ulcerate. On examination:
non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on
the pinna.
How should the GP proceed?
A Provide sun exposure advice B Monitor for changes with serial follow up C Treat in primary care D Dermatology referral - routine E Dermatology referral – 2 week wait
E Dermatology referral – 2 week wait
A 32-year old professional surfer had a seizure three days ago. He has no
history of epilepsy and reports headaches for the past 5 months. The
headaches are worse when he goes to bed. On examination, a dark
irregular skin lesion is found on the back of his neck. An MRI scan shows
multiple lesions across both cerebral hemispheres.
What is the most likely diagnosis?
A Acoustic neuroma B Glioblastoma multiforme C Meningioma D Metastases E Neurofibromatosis type i
D Metastases
A 76-year-old woman has recently attended her GP because of a ‘spot
that won’t go away’. The lesion is on her nose and has pearly, rolled
edges with telangiectasias.
What is the most likely diagnosis?
A Squamous cell carcinoma B Molluscum contagiosum C Basal cell carcinoma D Acne rosacea E Acne vulgaris
C Basal cell carcinoma
A 4-year old girl presents to the GP with multiple lesions on her face. The lesions are raised and shiny, non-tender, non-erythematous, and 3 mm in diameter. They have an umbilicated centre. The patient is known to be HIV positive.
What is the most likely diagnosis? A Chicken pox B Molluscum contagiosum C Atopic eczema D Eczema herpeticum E Herpes simplex virus
B Molluscum contagiosum
A 52-year-old woman presents to the GP with redness and swelling of her right cheek. On examination the area of erythema is well-demarcated and warm to touch. Her temperature is 37.9oC and she feels unwell.
What is the most appropriate management plan for this patient?
A Cold compress, reassure, home
B Admit to intensive care unit
C Take skin swabs, blood cultures, and give paracetamol
D Draw around the lesion, give pain relief, oral fluids and antibiotics
E Emergency dentist referral
D Draw around the lesion, give pain relief, oral fluids and antibiotics
A 12-year-old girl presents with dry, itchy skin that involves the flexures in front of her elbows and behind her knees. She has symptoms of hay fever and was diagnosed with egg and milk allergy at 6 months old.Her mother has asthma.
What is the most likely diagnosis? A Seborrheic dermatitis B Atopic dermatitis C Psoriasis (chronic plaque) D Psoriasis (guttate) E Urticaria
B Atopic dermatitis
A 23-year-old man was recently given penicillin for a throat infection (now resolved). He now complains of sore red ‘targetoid’ lesions on his extremities. Later he develops ulcers around his lips and conjunctiva.
What is the diagnosis? A Erythema multiforme B Chicken pox C Herpes simplex virus D Stevens-Johnson’s syndrome E Toxic epidermal necrolysis
D Stevens-Johnson’s syndrome
- affects two mucosal sites
- systemically unwell, shock
