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Derm I Flashcards

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Dermatology Board Prep flashcards
1
Q

Define atopic eczema

A

A chronic, relapsing inflammatory skin condition

Characterised with itchy, erythematous scaly patches

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2
Q

Pathophysiology of atopic eczema

A 
Defect in the skin barrier 
Immune function disorder
- Th2 mediated immune response 
Exacerbating factors 
- infection, soaps
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3
Q

Presentation of atopic eczema

A 
RF
- hx of atopy 
- family hx 
Pruritus 
Xerosis ( dry skin) 
Erythematous scaly patches @ FLEXOR surfaces 
Acute lesions: vesicles and weeping 
Lichenification and excoriation 
Hypopigmentation
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4
Q

Diagnostic criteria of eczema

A

Itchy skin + 3 of

  • Flexural invovlement
  • Visible dermatitis
  • Person history of atopy
  • General dry skin for the last year
  • Onset <2
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5
Q

Management of atopic eczema

A
  1. Skin hydrate, emollients, avoid irritants, identify and address the triggers
  2. Low/ Mid potency TCS/ TCI (tacrolimus)
  3. Mid/ High potency TCS and/ or TCI
  4. Systemic therapy or UV therapy
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6
Q

List the types of contact dermatitis

A

Irritant
- direct toxicity without prior sensitisation
Allergic
- delayed hypersensitivity

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7
Q

Management of contact dermatitis

A

Irritant

  • Emollients
  • Topical corticosteriods
  • Irritant avoidance

Allergic

  • Topical corticosteroids
  • Allergen avoidance
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8
Q

Presentation of seborrhoeic dermatitis

A

Pruritic erythematous scaly patched
Scalp, nasolabial fold
Anterior chest

Infants: cradle cap
Adults: flares with stress

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9
Q

Treatment of seborrhoeic dermatitis

A

Infants

  • emollients
  • topical corticosteriods

Adults

  • topical shampoo
  • topical corticosteriods

if non scalp: topical anti fungal (Ketaconazole)
if > 3months: oral anti fungal

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10
Q

Define psoriasis

A

Inflammatory disease due to hyper proliferation of keratinocytes and inflammatory cell infiltrate

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11
Q

Presentation of psoriasis

A

Extensive erythematous, well circumscribed scaly plaques
Silver surfaces
Extensor surfaces

Nail changes

  • Pitting
  • Beau’s lines
  • Onychlysis

Psoriatic arthritis

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12
Q

List the types of psoriasis

A
  1. Plaque
    - well-circumsided, erythematous, scaly plaques with silver scales
    - Auspitz sign: blled on scale removal
  2. Guttate
    - raindrop on trunk, arms and legs post strep tonsillitis
    - young
  3. Seborrhoeic
    - nasolabial
  4. Flexural
    - body folds
    - seen in women
  5. Palmar-plantar pustular
    - yellow brown pustules
  6. Eryhrodermic
    - total body redness
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13
Q

Outline the treatment options for psoriasis

A

General

  • Educate
  • Avoid precipitants
  • Emollients

Topical

  • Vit D analogues (calcipotriol)
  • Topical corticosteriods
  • Coal tar prep
  • Dithranol (for 20 minutes and then wash off)

Phototherapy

  • Extenspive disease
  • UVB + PUVA

Oral therapies

  • Methotrexate
  • Acitretin (retinoid)
  • Ciclosporin

Biological

  • Adalimumab
  • Etanercept
  • Infliximab
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14
Q

List the first line treatment for the following types of psoriasis

  • Plaque
  • Erythrodermic
  • Guttate
  • Pustular
A

Plaque

  • Topical corticosteriod
  • Vit D analogue

Eryhtrodermic
- Ciclosporin

Guttate
- Phototherapy

Pustular
- Oral retinoid

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15
Q

Outline the pathology of acne vulgaris

A

Inflammatory disease of pilosebaceous follicles
Hormonal
- excess androgens
- increase sebum production
- comedone formation by hypercornification of abnormal follicles
- colonised with propionibacterium acnes
- inflammatory reaction

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16
Q

List the conditions associated with acne

A

PCOS
Cushings
Steroid use
Puberty

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17
Q

Presentation of acne vulgarise

A 
Open comedones (blackhead)
Closed comedones (whiteheads)
Papules 
Nodules 
Cysts

Post inflammatory hyperpigmentation
Scarring
Deformity

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18
Q

Management of acne vulgarise

A

Mild

  • Topical keratolytic (benzoyl peroxide or salicyclic acid
  • Topical retinoids (synthetic Vit A - isotretinoin)
  • Topical Abx (clindamycin/erythromycin)

Moderate/Severe

  • Topical retinoid + oral abx (tetracyclin, doxycycline)
  • Anti-androgens (COCP)
  • Oral retinoids, isotretinoin, beware of suicidal thoughts side effects
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19
Q

List the pre-malignant and malignant conditions

A 
Actinic keratosis
Bowen's disease 
Squamous cell carcinoma 
Basal cell carcinoma 
Malignant melanoma
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20
Q

Presentation of squamous cell carcinoma

A 
Keratotic
Ill defined nodule 
Ulceration 
Bleeding 
Lymphadenopathy
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21
Q

Management of squamous cell carcinoma

A 
In-situ: cryotherapy (destructive) 
topical chemotherapy (fluoracil)
Invasive: wide surgical excision 
<2cm: MOH's micrographic surgery 
Metastic: excision + radiotherapy 
3-6 months f/up
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22
Q

Presentation of basal cell carcinoma

A

Rodent ulcer
Slow growing, locally invasive, malignant tumour or epidermal keratinocytes
From hair follicle

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23
Q

Types of basal cell carcinoma

A

Nodular: head/neck, papule nodule, rolled edge
Superficial: central clearing, threadlike border, truck and shoulders
Sclerosing: blue, brown grey melanoma

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24
Q

Management of a basal cell carcinoma

A
  1. Surgical excision
  2. Moh’s micrographic surgery
  3. Radiotherapy
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25
Q

Presentation of malignant melanoma

A

Irregular
Ulcerates
Bleeds

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26
Q

List the investigations for malignant melanoma

A
  1. Dermatoscopy
  2. Skin biopsy
    - if confined to the epidermis (melanoma in situ)
    - if spread to the dermis (invasive melanoma)
  3. Assess metastasis
    (liver most common site)
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27
Q

Staging of a malignant melanoma

A

Breslow’s thickness
- depth of invasion, measured on histology

Clark’s levels
- less accurate

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28
Q

Management of melanoma

A

IN SITU
- wide local excision

Melanoma

  • wide local excision
  • sentinel lymph node biopsy

Metastatic disease
- lymphadenectomy

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29
Q

List the types of blistering disorders

A

Immunobullous disease
- bullous perphigoid

Blistering skin infection

  • herpes simplex
  • impetigo
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30
Q

Pathology of bulls pemphigoidd

A

A chronic blistering skin disorder affecting the elderly

autoantibodies vs hemidesmosal antigens in epidermis and dermis

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31
Q

Presentation of bullous pemphigoid

A 
Tense fluid filled blisters on erythematous base 
Itchy 
Trunk and limbs 
Symmetrical 
Favour flexures 
Non specific itchy rash
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32
Q

Management of bulls pemphiigoid

A

General measure

  • Wound dressing
  • Monitor for signs of infection

Topical therapies (for localised)

  • Corticosteriods
  • Tacrolimus

Oral therapies (widespread lesions)

  • Steriods (prednisolone,
  • Sedating antihistamines (hydroxyzine)
  • Nicotinamide + oral tertracycline
  • Immunosupressives (azathioprine, methotrexate, ciclosporin)
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33
Q

Pathology of pemphigus vulgaris

A

Autoimmune blistering skin disorder
Middle aged
Autoantibodies vs antigens in the epidermis
Intra-epidermal spilt

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34
Q

Presentation of pemphigus vulgaris

A

Flaccid easily rupture blisters forming erosions and crusts

Mucosal areaS

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35
Q

Management of pemphigus vulgaris

A

General

  • wound dressing
  • prevent infection

Oral therapies

  • High dose oral steriods
  • Immunosupressants (methotrexate, azathioprine, cyclophosphamide)
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36
Q

List the pathogens responsible for impetigo

A

Staph aureus

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37
Q

Presentation of impetigo

A

Children
Golden crust or vesicles/bullae in bullous impetigo
Highly contagious

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38
Q

Management of impetigo

A

Good hygiene to avoid spread
Topical fusidic acid
Intranasal mupirocin
Oral flucloxacillin

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39
Q

Types of herpes simplex

A

Type I: oral herpes (oral ulcer with vermillion border or vesicles
Type II: Gential herpes

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40
Q

Treatment with herpes simplex

A

Aciclovir

Oral or topical

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41
Q

List the common causing organism involved in cellulitis

A

S.aureus
Strep pyogenes
Spreading bacterial infection of the deep subcutaneous tissue

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42
Q

Presentation of cellulitis

A

Local signs of inflammation
Systemically unwell
Well defined raised red border

@ eyes

  • periorbital cellulitis
  • orbital cellulitis
  • beaware as it can track back and cause near infection
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43
Q

Management of cellulitus

A

General
- flucloxacillin 250mg/ 6hourly

Orbital

  • ceftriaxone (IV) + vancomycin (IV)
  • orbital decompression

Severely ill

  • parenteral abx
  • MRSA cover (vac/taz)
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44
Q

Pathology of scalded skin syndrome

A

In children

Production of epidermolytic toxin from benzylpenicillin-resistant coagulase negative staph

45
Q

Presentation of scalded skin syndrome

A

Painful intraepidermal blistering
Flaccid bullae
Perioral crusting
Fever

46
Q

Treatment of scalded skin syndrome

A

Analgesia
Antibiotics: flucloxacillin, start IV then oral
Fluids

47
Q

List the three main groups of fungal infections

A

Dermatophytes

  • tinea
  • ringworm

Yeast
- candidiasis

Moulds
- aspergillus

48
Q

Types of tinea

A

Tinea corporis
- titchy annular lesions with clear defined raised scaly edge

Tinea pedis
- scaling and fissuring (toewebs)

Tinea capitis

  • scaly ringworm
  • patches of broken hair
  • scaling and inflammtion
49
Q

Presentation of candidiasis

A

White plaques on mucosal read

Erythema with satellite lesions in flexures

50
Q

Management of fungal infections

A

Establish dx

  • skin scrapings
  • swabs

Rx precipitating factors
- immunosupressives

Topical antifungal

  • ketocanazole
  • selenium sulphate shampoo

Oral antifungal
- fluconazole

Avoid topical steroids
- tinea incognito

51
Q

Treatment of warts

A

Cryotherapy
Silver nitrate
Debridement
Salicylic acid

common in the immunocompromised

52
Q

Presentation of molluscum contagious

A

Acquired through skin to skin contact
Pearly sooth papule with a central umbilication
@ face and groin

53
Q

Treatment of molluscum contagiosum

A

Curettage

Cryotherapy

54
Q

Treatment of scabies

A

Topical permetin (apply from the neck down, wash after 8 hours)
Antihistamines
Wash clothes at >60 degrees

55
Q

Pathology of venous ulcers

A

Chronic venous insufficiency

Other signs

  • Ankle swelling
  • Hyperpigementation
  • Lipodermatosclerosis
  • Telangiectasias
  • Varicose veins
56
Q

Presentation of venous ulcers

A 
Medial/ lateral malleolus 
Knee and ankle 
Large 
Shallow/sloping edge
Painless/mild pain 
Irregular border 
Most granulating base
57
Q

Management of venous ulcers

A

Graduated compression + leg elevation
Debridement and cleaning
Dressing

58
Q

Pathology of arterial ulcers

A

Atherosclerosis and tissue hypoxia

Think of arterial disease risk

59
Q

Presentation of an arterial ulcer

A 
Dorsum of the foot and toes 
Painful
Irregular edge
Grey granulating base 
Punched out appearance
60
Q

Management of arterial ulcers

A

ABPI <0.9 peripheral arterial disease
Do NOT use compression
Refer to vascular surgeon

61
Q

Presentation of a neuropathic ulcer

A 
Over pressure points 
Punched out
Deep sinus 
Surrounded by chronic inflammatory tissue 
Brisk bleeding if probed 
Painless
Necrotic base
62
Q

Treatment of neuropathic ulcers

A

Diabetic foot management

63
Q

Presentation of rosacea

A

Flushing dilated telangiectasia, facial erythema, inflammatory papules
Prominent sebaceous glands
Blepharitis

64
Q

Rosacea triggers

A

Climate (sunshine)
Chemical/ingested agents
Stress
Hot baths/ drinks

65
Q

Management of rosacea

A

Topical antibiotic
Anti-inflammatory + oral antibiotic
- Metronidazole
- Doxycycline/ tetracycline

66
Q

Presentation of sborrhoeic keratosis

A

Stuck on lesions
Well circumscribed plaques on papules
Painless
Warty like lesions

67
Q

Treatment of seborrhoea keratosis

A

Itchy: topical steriods
Flat: cryotherapy
Raised” curettage or cautery

68
Q

Define lichen planus

A

self-limiting inflammatory disease
affects the skin (+genitals), nails, hair and mucous membrane
Intense pruritus
Scarring alopecia

69
Q

Presentation of lichen planus

A

Itchy shiny flat topped violacceous papillose and plaques
On extremitis
Wickham’s striae
Oral erosions

70
Q

Management of lichen planus

A

Cutaneous

  • topical corticosteriods (clobetasol)
  • antihistamine (chlorphenamine)

Oral

  • topical corticosteriods
  • oral corticosteriods

Genital

  • topical corticosteriods
  • calcineurin inhibitor
71
Q

Presentation of urticaria

A

Itchy wheels
Central swelling with peripheral eythema
Swelling of the superficial dermis
Due to the local increase in permeability of capillaries and venules
Driven by histamine
From skin mast cells

Can often present with angiooedema + anaphylaxis

72
Q

Treatment for urticaria

A

Antihistamines

73
Q

Possible causes of urticaria

A

Immune (IgE)

  • Penicillins
  • Cephalosporins

Non-Immune (direct mast cell degranulation)

  • Morphine
  • Codeine
  • NSAIDs
  • Contrast
74
Q

Management of the following scenarios

  • Actue urticaria + angiooedema + airway involvement
  • Acute urticaria + angiooedema + no airway involvement
  • Chronic urticaria
A
  1. IM adrenaline + airway protection + IV antihistamines (chlorphenamine/depenhydramine)
  2. 2nd generation antihistamine H1 receptor antagomist (loratadine) + systemic corticosteriod
  3. Loratadine
75
Q

Pathology of erythema nodosum

A

Erythematous lumps form on the shins due to the inflammation of subcutaneous fat

76
Q

List the possible causes of erythema nodosum

A

Inflammatory bowel disease
TB
Throat infection
Sarcoidosis

If severe give steroids (pred)

77
Q

Pathology of erythema multiform

A

Hypersensitivity reaction triggered by infection
Acute self limiting inflammatory condition
HSV main precipitant (+SLE)

78
Q

Presentation of erythema multiforme

A

Hundreds of lesions spreading from hands/back of feet
Iris/target lesions: sharp margin, regular round shape, 3 concentric colour ones

  1. Outer: bright red
  2. Middle: pale pink, oedematous and raised
  3. Inner: dusky/dark red with blister centre and crust
79
Q

Features of Stevens-Johnson syndrome

A

Mucocutaneous necrosis with at least 2 mucosal sites involved
<10% of total body surface area
Preceding hx of medication use or infection (anticonvulsants, Abx, NSAIDs)
Detachment of epidermis from dermis
Maculopapular rash and bullae (keratinocyte apoptosis )
Nikolsky sign (sloughing at press)

80
Q

Features of Toxic Epidermal Necrolysis

A

Mucocuntaneous necrosis
2 mucosal site involved with systemic toxicity
>30% total body areas
Detachment of epidermis from dermis
Maculopapular rash and bullae (keratinocyte apoptosis )
Nikolsky sign (sloughing at press)

81
Q

Management of SJS and TEN

A
  1. Escalate
  2. Withdrawal of causative agent
  3. Dressing and topical antibacterial and emollients
  4. IV Fluids
  5. Analgesia
82
Q

Complications of SJS and TEN

A

Dehydration
Infection (sepsis)
Electrolyte imbalance
Multi organ failure

83
Q

Pathology of erythroderma

A

Exfoliative dermatitis

Involves 90% of the skin surface

84
Q

Presentation of erythroderma

A

Inflammed
Oedematous scaly skin
Systemically unwell
Lymphadenopathy

85
Q

Cause of erythroderma

A

Previous skin disease (eczema, psoriasis)
Lyphoma
Drugs (sulphonamides, gold, penicillin)

86
Q

Management of erythroderma

A 
Rx cause s
Emollients 
Wet wraps 
Topical steriods 
Beware of secondary infection, fluid loss, electrolyte imbalance, hypothermia, high output cardiac failure.
87
Q

Pathology of necrotising fascitis

A

Rapidly spreading infection of deep fascia with secondary tissue necrosis
Grp A haemolytic strep pyogenes

88
Q

Presentation of necrotising fascitis

A

Severe pain
Erythematous blistering, necrotic skin
Systemically unwell
Crepitus

89
Q

Management of necrotising fasciitis

A

Surgical debridement and haemodynamic support

Empirical broad spectrum Abx ( van and tax)

90
Q

Cause of eczema herpeticum

A

Herpes simplex virus

91
Q

Presentation of eczema herpeticum

A

Extensive crusted papules, blister and erosisns

Systemically unwell with fever and malaise

92
Q

Management of eczema herpeticum

A

Antivirals

Antibiotics

93
Q

Outline the skin manifestation of RA

A

Erythema marginatum

94
Q

Outline the skin manifestation of Lyme’s disease

A

Erythema migrans

95
Q

Outline the skin manifestation of Crohn’s

A

Erythema nodosum

Pyoderma gangrenosum

96
Q

Outline the skin manifestation of dermatomyositis

A

Heliotrope rash on eyelids
Shawl sign
Gottrons papules
Mechanic;s hands

97
Q

Outline the skin manifestation of sarcoidosis

A

Erythema nodosum
Erythema multiforme
Lupus pernio
Hypopigemented areas

98
Q

Outline the skin manifestation of coeliac

A

Dermatitis herpetiformis

99
Q

Outline the skin manifestation of Grave’s

A

Pre-tibial myxoedema

100
Q

Outline the skin manifestation of SLE

A

Malar rash

Discoid rash

101
Q

Outline the skin manifestation of systemic sclerosis

A 
Calcinosis 
Raynaud's 
Sclerodactyly
Telangiectasia 
Generalised skin thickening
102
Q

Outline the skin manifestation of Liver disease

A 
Palmar erythema 
Spider naevi
Brusing 
Jaundice 
Excoritations
103
Q

Outline the skin manifestation of ESRD

A

Pruritus
Xerosis
Pigment change
Bullous disease

104
Q

List the pathology of alopecia aerate

A

Autoimmune disease
Inflammatory cells ( T-cell) target the hair follicle
Prevents growth

105
Q

List the types of alopecia

A

Patchy alopecia areta
Alopecia totalis
Alopecia universalis

106
Q

Treatment for alopecia

A

Limited:

  • topical corticosteroid
  • cosmetic camouflage
  • intralesional corticosteriod

Extensive

  • topical immunotherapy
  • cometic camouflage
107
Q

Pathology of androgenic alopecia (male-pattern baldness)

A

Genetically determined patterned progressive hair loss from the scalp
Dominantly inherited with variable penetrance
Family hx is relevant

108
Q

Presentation of androgenic alopecia

A

Onset 20-25 years
Receding frontal hairline
Thining in temporal areas progressing to crown

109
Q

Treatment for male pattern baldness

A

Topical minoxidil
Oral finasteride (not for women)
Cosmetic aids

Dermatology (3 decks)

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