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Dermatology 1 Flashcards

1
Q

Acanthosis nigricans are associated with which conditions? (9)

A

T2DM
GI ca
Obesity
PCOS
Acromegaly
Cushing’s
Hypothyroidism
Prader Willi
COCP

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2
Q

Severe acne associated with systemic upset =
Mx (2)

A

Acne fulminans
Hospital admission and PO steroids

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3
Q

Classification of acne

A

Mild - comedones
Moderate - papules and pustules, widespread lesions
Severe nodules, pitting, scarring, extensive inflammatory lesions

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4
Q

Mild- moderate acne mx (4)

A

12 week course of OD in the evening
1. topical adapalene with topical benzoyl peroxide
OR
2. topical tretinoin with topical clinda
OR
3. topical benzoyl peroxide with topical clinda
OR
4. Topical bonzoyl peroxide as monotherapy if above is CI

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5
Q

Moderate to severe acne mx (6)

A

12 weeks course of
1. Top adapalene with benzoyl peroxide
OR
2. Top tretinoin with top clinda

OR
3. option 1 + PO lymecycline 408mg OR PO doxy 100mg OD

OR
4. Topical azelaic acid BD + PO lymecycline 408mg or PO dozy 100mg OD

OR
5. COCP

OR
6. Monotherapy benzylperoxide

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6
Q

Alternative abx of choice in acne treatment

A

If not lymecycline or doxy then consider trimethoprim or erythro

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7
Q

When to refer to a dermatologist for acne? (5)

A
  1. Nil response to two completed courses of treatment (mild-mod)
  2. Mod-severe
    If has not responded to previous treatment with PO abx
  3. Scarring
  4. Persistent pigmentary changes
  5. Psychological distress
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8
Q

How do you follow up a patient with acne?
If completely clear
If has only improved

A

FU 12 weeks after treatment
If completed cleared
- consider stopping abx but cont the topical treatment

If improved
- cont for a further 12 weeks
(Do not continue abx for more than six months)

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9
Q

Who should get maintenance therapy for acne?
How is it treated?
When do you review the maintenance therapy?

A

History of frequent relapse after treatment

Topc adapalene and benzoyl peroxide or topical monotherapy

Review again in 12 weeks

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10
Q

Tetracyclines should be avoided in? (3)
Why is minocycline avoided?

A

Pregnancy
Breastfeeding women
Children <12yo

Irreversible pigmentation

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11
Q

Mx of actinic keratoses (6)

A
  1. Fluorouracil cream (2-3 weeks) (skin will become red and inflamed)
  2. Topical HC to settle the inflammation
  3. Topical diclofenac
  4. Topical imiquimod
  5. Cryo
  6. Curretage
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12
Q

Localised, well demarcated patches of hair loss =
At the edge of hair loss what might you see?

A

Alopecia areata
Exclamation mark hairs

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13
Q

Alopecia areata mx (4)

A

Topical/ intralesional steroids
Topical minoxidil
Phototherapy
Dithranol

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13
Q

Examples of:
Sedating anti-histamine (1)
Non sedating (2)

A

Chlorpheniramine

Loratadine
Cetirizine (can cause drowsiness still however)

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14
Q

Side effects of aqueous cream

A

As a leave on emollient it can cause skin irritation
Can be used as a soap substitute

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15
Q

What can be used to treat athlete’s foot? (3)

A

Topical imidazole, undecenoate or terbinafine

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16
Q

Eczematous, itchy red rash in pregnancy =

A

Atopic eruption of pregnancy

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17
Q

Pearly, fleshy coloured papule with telangiectasia
May later ulcerate leaving a central crater =

Mx (2)

A

Basal cell carcinoma

Routine referral to derm
Surgery

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18
Q

Describe features of BCC (5)

A

Slow growing
Most common is nodular
Sun exposed sites
Pearly, flesh coloured
Central crater

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19
Q

Describe Bowen’s disease
Speed in growth
Location

Mx (3)

A

Red scaly patches
Slow growing
Sun exposed

Mx
1. topical 5-fluorouracil BD for 4/52 + topical steroids due to inflammation
2. Cryo
3. Excision

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20
Q

What drugs can cause bullous disorders? (2)

A

Barbiturates
Furosemide

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21
Q

Autoimmune condition
Itchy tense blisters around the flextures
No mucosal involvement (mouth is spared)
=

A

Bullous pemphigoid

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22
Q

bullous pemphigoid Mx (3)

A

Mx
1. Derm referral
2. Biopsy
3. PO steroids

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23
Q

Classic differentiating feature between pemphigoid and pemphigus

A

Pemphigoid = mucosal spared, tense blisters, itchy
Pemphigus = mucosal ulceration, flaccid, easily ruptured vesicles, not itchy

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23
Q

Mucosal ulceration
Autoimmune
Ashkenazi Jewish population
Flaccid easily ruptured vesicles
Not itchy
= which condition?
What is seen on biopsy?
Mx (2)

A

Pemphigus vulgaris
Acantholysis
Steroids + immunosuppressants

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24
Q

erythematous, papular lesions
firm red, blue, or purple papule
typically 1-3 mm in size
non-blanching
not found on the mucous membranes
more common in advancing age
=
Mx

A

Cherry angioma
Benign, no treatment

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25
Q

Painful nodule on the ear
Caused by persistent pressure on the ear
M>F
Increasing age
=

A

Chondrodermatitis nodularis helicis

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26
Q

How does allergic contact dermatitis usually present?
Usually caused by what?
What type of hypersensitivity is it?
Mx

A

Type IV
Acute weeping eczema affecting the margins of the hairline
Usually following hair dyes
Mx steroids (potent)

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27
Q

Rare psycho dermatological condition characterised by self inflicted skin lesions =

A

Dermatitis artefacta

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28
Q

Dermatitis herpetiformis is associated with which condition?
Location

A

Coeliac disease
Extensor surface, elbows, knees, buttocks

29
Q

itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
Coeliacs
Mx (2)

A

Dermatitis herpetiformis

Mx
1. Gluten free diet
2. Dapsone

30
Q

solitary firm papule or nodule, typically on a limb
typically around 5-10mm in size
overlying skin dimples on pinching the lesion

A

Dermatofibroma

31
Q

typically present as round or oval plaques on the extremities
the lesions are extremely itchy
central clearing may occur giving a similar appearance to tinea corporis
=

A

Discoid eczema

32
Q

Eczema herpeticum is caused by
Seen in which age range?
Seen with which condition?
Presenting with?

A

Herpes simplex virus 1 or 2
Children
Atopic eczema
Rapidly progressing painful rash

33
Q

seen in children with atopic eczema and often presents as a rapidly progressing painful rash.

monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.

Mx

A

Eczema herpeticum
Admission + IV aciclovir

34
Q

Burns
Heat mx
Electric mx
Chemical mx

A
  1. Within 20 mins irrigate with cool water for 10-30 minutes, cover with cling film in layers
  2. remove from source
  3. brush any powder off then irrigate with water
35
Q

Classification of burns
Superficial
Partial thickness - superficial
Partial thickness - deep
Full thickness

A

Superficial/ first degree:
- red and painful

Partial thickness - superficial/ second
- pale pink, painful, blistered

Partial thickness - deep/ second
- white, but may have non-blanching erythema, reduced sensation

Full thickness - third degree
- white/ brown/ black, no pain

36
Q

What percentage of burns requires IVF for children + adults

A

10%, 15%

37
Q

Topical steroids by potency

A

Mild: Hydrocortisone

Mod: Betamethasone 0.025% (betnovate RD) + clobetasone 0.05% (eumovate)

Potent: Fluticasone (cutivate) + betamethasone 0.1% (betnovate)

38
Q

Explain the finger tip rule

A

1 finger tip unit = 0.5g, sufficient to treat two flats of adult hands

39
Q

Fingertip units
Hand and fingers front and back
A foot (all over)
Front of chest and abdomen

A

Hand and fingers front and back
1

A foot (all over)
2

Front of chest and abdomen
7

40
Q

Fingertip units
Back and buttocks
Face and neck
An entire arm and hand
An entire leg and foot

A

Back and buttocks
7

Face and neck
2.5

An entire arm and hand
4

An entire leg and foot
8

41
Q

Topical steroids that should be prescribed in grams for an adult for a single daily application for 2 weeks
Face and neck
Both hands
Scalp
Groin and genitalia

A

15-30g

42
Q

Topical steroids that should be prescribed in grams for an adult for a single daily application for 2 weeks
Both arms
Both legs
Trunk

A

Both arms 30-60g
Both legs 100g
Trunk 100g

43
Q

reticulated, erythematous patches with hyperpigmentation and telangiectasia. A typical history would be an elderly women who always sits next to an open fire

A

Erythema ab igne

44
Q

Erythema ab igne is caused by over-exposure to?
If the cause is not treated it can lead to?

A

Infra-red exposure
Squamous cell skin ca

45
Q

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild
=
usually triggered by?

A

erythema multiforme
infections

46
Q

Name five causes of erythema multiforme

A

Viruses (herpes simplex virus)
Bacteria e.g mycoplasma
SLE
Sarcoidosis
Malignancy

47
Q

Name six medications that can cause erythema multiforme

A

Penicillin
Sulphonamides
Carbamezapine
Allopurinol
NSAIDs
COCP

48
Q

inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring

=

A

Erythema nodosum

49
Q

Causes of erythema nodosum (6)
Name three drugs

A

Infection - e.g strep, TB, brucellosis
Sarcoidosis
IBD
Behcet’s
Malignancy
Pregnancy
Drugs penicillin, sulphonamides, COCP

50
Q

bacterial infection that affects the skin. It usually appears in the folds of the skin. It’s more commonly seen in warm or humid climates
flat, slightly scaly, pink or brown rash usually found in the groin or axilla

Examination with Wood’s light reveals a coral-red fluorescence.
caused by Corynebacterium minutissimum
=

Mx (2)

A

Erythrasma

Mx topical miconazole OR PO erythro

51
Q

Causes of red man syndrome/ erythroderma (5)

A

Eczema
Psoriasis
Gold
Lymphomas/
Leukemias

52
Q

Dermatophyte infection mx (2)
Length of treatment for fingernails versus toenails

A

PO terbinafine OR PO itraconazole
6 weeks - 3 months therapy fingernails
3-6 months for toenails

53
Q

Candida nail infection mx
Mild (1)
Severe (1)
Length of treatment for topical treatment fingernails versus toenails

A

Mild: amorolfine topical
Severe: PO itraconazole

Six months fingernails
9-12 months toenails

54
Q

seen most commonly on the skin of children, teenagers, or young adults.
papular lesions that are often slightly hyperpigmented and depressed centrally
typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs or knuckles
= ?

A

Granuloma annulare

55
Q

tear drop papules on the trunk and limbs
common in children and adolescents
precipitated by strep infection 2-4 weeks prior to lesions appearing
acute onset over days
=

Resolves spontaneously within?

A

guttate psoriasis
2-3 months

56
Q

Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions

May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

No prodrome
= ?
Mx

A

Pityriasis rosea
Self limiting - resolved after 6 weeks

57
Q

Causes of periorificial dermatitis

Mx (1)

A

Usually caused by topical/ inhaled steroids
So can worsen condition if given this to treat

Mx topical/ PO abx

58
Q

Pellagra is caused by deficiency in?
Features (3)
Can be caused by which drug?

A

Niacin
3 D’s, dementia, dermatitis, diarrhoea
Isoniazid

59
Q

itchy, red patches which are
lesions tend to be of different colours
=
Is a rare form of which cancer?

A

Mycosis fungoides - rare for of T cell lymphoma

60
Q

pinkish or pearly white papules with a central umbilication
appear in clusters, palms and soles sparing
In children lesions are commonly seen on the trunk and in flexures, but anogenital lesions
=

A

Molluscum contagiosum

61
Q

Molluscum contagiosum
Mx
School?

A

Self limiting - resolution within 18 months
Contagious, avoid sharing towels, clothing, baths etc
No exclusion necessary

62
Q

Melasma causes (3)

A

Pregnancy
COCP
HRT

63
Q

Hyperpigmented macules in sun-exposed areas, particularly the face.

A

Melasma

64
Q

What is the single most important factor in determining the prognosis of a patient with malignant melanoma?

A

Breslow depth/ depth of a tumour
>4mm 50% 5 year survival rate

65
Q

white patches that may scar
itch is prominent
may result in pain during intercourse or urination
lesions around the genitalia

Mx (2)

Increased risk of?

A

Lichen sclerosus

Mx topical steroids + emollients

Vulval ca

66
Q

What is leukoplakia?
Ix
Mx

A

Pre-malignant condition
White hard spots on mucous membranes
Common in smokers

Ix biopsy to r/o SCC
Regular FU as increased risk of SCC (1%)

67
Q

Skin lesions that appear at the site of injury is called the?

Name five conditions where this may be seen?

A

Koebner phenomenon

Psoriasis
Vitiligo
Warts
Lichen planus + sclerosus
Molluscum contagiosum

68
Q

Said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin

Mx

A

Keratoacanthoma

Mx urgently excised as it is difficult to exclude SCC

69
Q

Strawberry naevus

Develops when?
Increases in size until age?
Regresses over what time period?
95% resolved by age?

Mx if visual field obstruction?

A

Develops rapidly in the first month of ife
Increase in size until 6-9 months
Regress over the next few years, 95% resolve before age 10

Propranolol

70
Q

Port wine stains
Description
Colour
Unilat/bilat
Mx (2)

A

Unilateral, deep red or purple in colour
Birthmarks
Often darken and become raised over time
Do not resolve - so cosmetic camouflage or laser therapy

71
Q

Venous ulceration is usually seen?
Ix
Normal range
Mx (2)

A

Medial malleolus
ABPI
0.9-1.2

Compression bandaging
PO pentoxifylline

72
Q

Angiomas on the lips are called?

A

Venous lakes

AKT (52 decks)

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