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Y4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Melanoma in situ - what is the treatment (and margins)

A

Excision with 5mm clearance

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2
Q

Melanoma <1mm past basement membrane - what is the treatment (and margins)

A

Excision with 1cm clearance

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3
Q

Melanoma >1mm past basement membrane - what is the treatment (and margins)

A

Excision with 2cm clearnance

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4
Q

melanocytes proliferate and form clusters of cells at the DE junction - what does this suggest

A

Junctional nevus

childhood

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5
Q

BCC arises from _____cytes in the ____ layer of the epidermis/dermis

A

BCC

  • arises from keratinocytes
  • basal layer of epidermis
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6
Q

Non healing ulcer, telangectasia, rolled out edges, central ulceration - what does this suggest

A

BCC

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7
Q

If you remove the entire BCC lesion, the patient is cured. True or false?

A

True

- there is no risk of recurrence (in that area)

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8
Q

SCC arises from _____cytes in the ____ layer of the epidermis/dermis

A

SCC

  • arises from keratinocytes
  • supra basal layer of epidermis
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9
Q

there is no risk of recurrence with SCC. True or false?

A

False

- there is risk of recurrence.

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10
Q

Name 2 precancerous skin lesions for SCC

A
  • bowen’s disease

- actinic keratosis

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11
Q

Where does bowens disease typically present?

A

Legs

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12
Q

Where does actinic keratosis typically present?

A

Head and neck

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13
Q

Explain morphology of seborrhoeic keratosis

A
  • Stuck on appearance
  • Greasy hyperkeratotic surface (looks like a muffin)
  • Warty surface
  • Well defined border
  • Can be muti-coloured
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14
Q

Describing PIGMENTED skin lesions

ABCD

A

Asymmetry

  • shape and colour
  • think of horizontal and vertical axis

Border

  • well differentiated?
  • regular or irregular?

Colour

Diameter

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15
Q

Management of actinic keratosis?

A 
Cryotherapy (if small) 
Imiquimod cream 
5-FU cream 
Photodynamic therapy 
There is no need to excise
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16
Q

bowens disease: partial/full thickness dysplasia of epidermis?

A

Full thickness

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17
Q

Name 2 aggressive areas for SCC?

A

Lips

Ears

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18
Q

Melanoma growth - initial

A

Horizontal (radial growth)

  • grows flat
  • has good prognosis
  • no danger of metastasising
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19
Q

Melanoma - vertical growth phase

A

Measure the breslow thickness

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20
Q

If breslow thickness over 1mm, what is the management

A

Wide local excision

Sentinal node biopsy (done under GA)

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21
Q

BCC type: raised, well defined

A

Nodular BCC.
This is the typical BCC you would imagine
Tx: eliptical excision

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22
Q

Superficial BCC

A

Flat, well defined

Tx: non-surgical management (cryotherapy, imiquimod, 5-FU)

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23
Q

What is moh’s surgery used for?

A

BCC

Poorly defined lesion on difficult body site

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24
Q

Contact allergic dermatitis is which type of hypersensitivity reaction?

A

Type IV

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25
Q

Soap, detergent, cleaning prodcuts are common causes of

  • contact allergic dermatitis
  • irritant contact dermatitis
A

Irritant contact dermatitis

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26
Q

‘monomorphic punched out lesions’

A

Eczema herpeticum

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27
Q

Treatment of mild atopic eczema

A

Emollients

mild potency topical steroids

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28
Q

Treatment of moderate atopic eczema

A

emollients
moderate-potency topical corticosteroids
topical calcineurin inhibitors
bandages

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29
Q

Treatment of severe atopic dermatitis

A 
emollients
potent topical corticosteroids
topical calcineurin inhibitors
bandages
phototherapy
systemic therapy.
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30
Q

areas of rapidly worsening, painful eczema

clustered blisters consistent with early-stage cold sores

punched-out erosions (circular, depressed, ulcerated lesions) usually 1 mm to 3 mm that are uniform in appearance (these may coalesce to form larger areas of erosion with crusting)

possible fever, lethargy or distress.

What diagnosis does this make you think of?
And what would the treatment be?

A

Eczema herpeticum

Tx: aciclovir (oral or systemic)

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31
Q

Eczema often starts in the flexor/extensor surfaces then becomes more prominent in the flexor/extensor surfaces?

A

Starts in extensors

Then becomes apparent in flexors

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32
Q

What is the main cause of atopic dermatitis

A

Break down of the skin barrier
loss of water molecules in the skin barrier means pathogens can get through and cause irritation and inflammatory reaction

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33
Q

Side effects of topical corticosteroids (4)

A

Thinning of skin
Reduced growth
Increased skin infections
Striae

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34
Q

What is the main mode of action of using topical corticosteroids for eczema?

A

Anti-inflammatory

Vasoconstrictive

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35
Q

Hydrocortisone 1%

  • mild
  • moderate
  • potent
  • very potent
A

Mild

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36
Q

Betnovate 0.1%

  • mild
  • moderate
  • potent
  • very potent
A

Potent

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37
Q

Eumovate

  • mild
  • moderate
  • potent
  • very potent
A

Moderate

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38
Q

Dermovate

  • mild
  • moderate
  • potent
  • very potent
A

Very potent

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39
Q

Name 2 calcineurin inhibitors

A

Tacrolimus

Pimecrolimus

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40
Q

Which calcineurin inhibitor is for adults only?

A

Tacrolimus

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41
Q

Step 1 eczema managmenet

A

Emollients alone

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42
Q

Step 2 eczema management

A

Emollients + mild topical corticosteroid (hydrocortisone)

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43
Q

Step 3 eczema management (moderate)

A

Emollients + moderate topical coticosteroid (eumovate)

+ calcineurin inhibitors

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44
Q

Step 4 eczema management (severe)

A

Emollients + potent/very potent corticosteroid (betnovate/dermovate)
Specialist help

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45
Q

patient who suffers with eczema that has developed a widespread, painful, vesicular rash with systemic symptoms such as fever, lethargy, irritability. The rash is usually widespread and can affect any area of the body. It is erythematous, painful and sometimes itchy, with vesicles containing pus. The vesicles appear as lots of individual spots containing fluid. After they burst, they leave small punched-out ulcers with a red base.

A

Eczema herpeticum

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46
Q

What is the main feature of Seborrhoeic dermatitis in infants?

A

Cradle cap

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47
Q

Treatment of Seborrhoeic dermatitis of the scalp in adults?

A

Ketoconazole shampoo

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48
Q

Name a systemic drug that may be used in severe eczema?

A

Ciclosporin

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49
Q

Child with fever, corzyal symptoms and conjunctivitis. a few days later develops rash which starts on face and then spreads to rest of body. Erythematous and macular rash with flat lesions. What condition is this describing?

A

Measles

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50
Q

red-pink, blotchy, macular rash with rough “sandpaper” skin that starts on the trunk and spreads outwards. Patients can have red, flushed cheeks.

Other features:

Fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Cervical lymphadenopathy
A

Scarlet fever

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51
Q

What is the treatment of scarlet fever

A

Phenoxymethylpenicillin

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52
Q

What is the main complication of roseola infantum?

A

Febrile convulsions

- high temperature

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53
Q

Which drug is used in the management of chronic urticaria?

A

Fexofenadine

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54
Q

Cocksackie A virus causes which skin condition?

A

Hand foot and mouth disease

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55
Q

Molluscum contagiosum requires no treatment. True or false?

A

True

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56
Q

What is topical fusidic acid?

A

Topical antibiotic

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57
Q

Which condition is associated with a herald patch (and what is a herald patch)

A

Pityriasis rosea

- faint pink scaly oval lesion usually occuring on torso

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58
Q

Onychomycosis - what is this

A

Fungal nail infection

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59
Q

In ring worm, the centre/edge of the lesion is darker in colour?

A

Edge

- giving it a well demarcated border

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60
Q

How do you treat non bullous impetigo

A

Topical fusidic acid

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61
Q

HOw do you diagnose impetigo?

A

Swab the vesicles

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62
Q

Streptococcal throat infection -> many small raised papules across the trunk and limbs (looks like raindrops). The papules are mildly erythematous and can be slightly scaly

A

Guttate psoriasis

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63
Q

WHat is the Koebner phenomenon

A

development of psoriatic lesions to areas of skin affected by trauma

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64
Q

What is a treatment option for severe acne?

A 
Oral isotretinoin (roacutane) 
- highly teratogenic
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65
Q

What is the commonest causacian skin cancer?

A

BCC

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66
Q

Solar urticaria is a type X hypersensitivity reactio?

A

Type 1

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67
Q

What is the most common hepatic porphyria?

A

Porphyria cutanea tarda

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68
Q

Management of porphyria cutanea tarda

A

Chloroquine

Venesection

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69
Q

How do porphyrias arise?

A

Deficiency in the enzymes involved in haem synthesis.

Leads to increased porphyrins

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70
Q 
Young-middle aged female 
on OCP 
Following Symptoms come in attacks and in the meantime the patient is healthy 
-	Abdominal pain
-	Nausea
-	Vomiting
-	Urine becoming darker in colour

What is the likely diagnosis?

  • porphyria cutanea tarda
  • acute intermittent porphyria
  • Erythropoeitic protoporphyria
A

Acute intermittent porphyria

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71
Q

Urine in acute intermittent porphyria

A

Dark brown/ red

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72
Q

Which porphyria causes bullous eruptions on exposure to sunlight?

A

Porphyria cutanea tarda

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73
Q

Investigation for porphyria cutanea tarda?

A

Woods lamp

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74
Q

Child crying in direct sunlight, which porphyria?

  • porphyria cutanea tarda
  • acute intermittent porphyria
  • Erythropoeitic protoporphyria
A

erythropoeitic protoporphyria

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75
Q

Port wine stain
Neurological abnormalities
Vision abnormalities (glaucoma)

A

Sturge Weber Syndrome

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76
Q

Cafe au lait spots in which condition

- how many do you need to have for it to be relevant

A

Neurofibromatosis type 1

- need to have at least 6

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77
Q

Ash leaf macule is seen in which condition?

A

Tuberous sclerosis

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78
Q

Allergic contact dermatitis - type X hypersensitivity reaction

A

Type 4

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79
Q

What is the investigation of choice to confirm contact allergic dermatitis?

A

Patch testing

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80
Q

Outline how patch testing works

A

Day 1: Take Hx and apply patches
Day 3: remover patches and note any reactions
Day 5: record final readings

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81
Q

a common yeast infection of the skin which can affect melanocyte function leading to variable pigmentation

A

Pityriasis versicolor

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82
Q

ABPI measurements:

0.8-1.3 normal

< 0.8 vascular disease

> 1.3 calcification

When can you use compression stockings

A

if over 0.8 but probs below 1.3

83
Q

Worsening psoriasis, currently managed on emollients. What is the next step?

a. Refer for phototherapy
b. Coal tar
c. Topical retinoid
d. Topical steroid + calcipotriol (vitamin D analogue)
e. Topical salicylic acid

A

d. Topical steroid + calcipotriol (vitamin D analogue)
- NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily for up to 4 weeks as initial treatment to reduce plaques.

84
Q

management of lyme disease

A

2 weeks of doxycycline

85
Q

a severe drug reaction with necrosis and loss of the epidermis affecting over 30% of body surface area

A

Toxic epidermal necrolysis

86
Q

epidermal thickening, absence of granular layer, presence of parakeratosis and Munro microabscesses.. What condition does this suggest?

A

Psoriasis

87
Q

BCC management

a.
Urgent excision
b.
Imiquimod cream (Aldara)
c.
Diagnostic biopsy
d.
Cryotherapy
e.
Routine excision
A

Routine excision

88
Q

Name 3 potential management options for vitilligo

A

Camoflague creams
Topical steroids
Phototherapy

89
Q

What condition is vitilligo often confused with?

A

Pityrisis vesicolor

- yeast infection

90
Q

What is the kobner phenomenon?

A

the appearance of new skin lesions of a pre-existing dermatosis on areas of cutaneous injury in otherwise healthy skin

91
Q

Herald patch is associated with which condition

A

Pityrisis rosea

92
Q

2-4cm patch on tummy then a few days later there is truncal eruption of small pink oval lesions with peripheral scale.

A

Pityrisis rosea

93
Q

Violaceous (pink/ purple) flat-topped shiny papules
Intensely itchy
What does this suggest?

A

Lichen planus

94
Q

Describe the pathophysiology of acne

A

Occlusion of the pilosebaceous unit

  • ductal hypercornification
  • blackheads or whiteheads
  • cosmetic occlusion
95
Q

Increased/decreased sebum production in acne

A

Increased

96
Q

There is a relationship between number of bacteria and acne severity. true or false?

A

False

97
Q

Ice pick scars are common in which condition?

A

Acne

98
Q

How is mild acne treated

A

Topical treatment only

99
Q

How is moderate acne treated

A

Topical treatment +
Oral antibiotics +
Dianette (female)

100
Q

How is severe acne treated

A

isotretinoin (Roaccutane)

101
Q

Name 4 topical treatments for acne

A

Tretinoin
Adapalene
Nicotinamide
Benzoyl peroxide

102
Q

What are the 3 properties/functions of benozyl peroxide

A

Keratolytic - reduces duct occlusion, reduces comedones
ANti-inflammatory
Anti-microbial

103
Q

What caution should you give to patients using benzoyl peroxide

A

Bleaches skin, clothes, hair

104
Q

Which acne treatment should you not use in pregnancy?

A

Isotretinoin

105
Q

name 4 oral antibiotics that can be used in moderate acne?

A 
TETRACYCLINES 
- Doxycyclin 
- Lymecycline 
- Oxytetracycline 
Erythromycin (if pregnant)
106
Q

Contraceptives can be useful in the treatment of acne for females. Why?

A

Decrease androgen production
Eg:
COCP
Diannette

107
Q

Contraceptives are as useful as oral antibiotics in the treatment of acne. True or false?

A

True

- can be used instead of oral antibiotics in women

108
Q

Name 3 indications for using isotretinoin (roacutane)

A

inadequate response to conventional therapy
significant scarring
nodulo/cystic acne

109
Q

List some side effects of using isotretinoin

A 
Dry skin, lips, eyes (contact lenses) & nose(bleeds)
Skin fragility
Hyperlipidaemia
Abnormal liver function
Teratogenesis- contraception
Mood alteration
110
Q

Rosacea is more common in males / females?

A

Females

111
Q

Prominent facial flushing exacerbated by sudden change in temperature , alcohol & spicy food

A

Rosacea

112
Q

Which antibiotic can be used in the management of rosacea

A

Topical metronidazole

113
Q

Rosaces has increased/decreased/normal sebum excretion rate?

A

NORMAL

- unlike acne which is increased

114
Q 
Presence of papules and pustules makes you think 
- mild 
- moderate
- severe 
acne
A

Moderate

115
Q

a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics. True or false?

A

True

- this reduces the risk of antibiotic resistance

116
Q

There is a role for dietary modification in patients with acne. True or false?

A

False

- there is no role for dietary modification

117
Q

Patients with rosacea with rhinophyma should be referred to dermatology. true or false?

A

True

118
Q

which class of antibiotics are used in acne vulgaris?

A

Tetracyclines

119
Q

Risk factors for skin cancer

A 
Sun exposure 
Immunosuppressants 
occupation 
lived abroad 
any blistering sunburns in the past
120
Q

Slow growing lesions, celtral ulceration, rolled pearly edge, telangectasia

A

BCC (nodular)

121
Q

Superficial BCC treatment

A

Imiquimod
5-FU
Cryotherapy

122
Q

Actinic keratosis features

A

lots of scale

123
Q

SCC grows quickly/slowly and is tender/non tender?

A

Quickly

Tender

124
Q

partial/full thickness epidermal dysplasia in actinic keratosis

A

Partial

125
Q

Bowens disease common location

A

legs

126
Q

In the immunosuppressed patient, what is the most common skin cnacer?

A

SCC

127
Q

Treatment of basal cell papilloma

A

Mainly nothing

Can do cryotherapy

128
Q

Firm centre, small red spot

A

dermatofibroma

129
Q

Acute dermatitis - what process is happening?

A

spongiosis

- fluid between the epidermal cells

130
Q

full thickness epidermal thickening in histology of patient with eczema - what is this likely to be clinically

A

Lichenefication

131
Q

Seborrhoeic dermatitis location of distribution

A

Paranasal folds

Hair line

132
Q

Seborrhoeic dermatitis - treatment

A

emollients

anti fungal creams

133
Q

In a child with eczema, the nappy area is usually involved/spared?

A

Spared

134
Q

What does biopsy for Hishprung disease show

A

Absence of ganglion cells in the submucosa

135
Q

Which type of murmur is pulmonary stenosis?

A

Ejection systolic

136
Q

What is eisenmeiger syndrome?

A

When the pulmonary pressure is higher than the systemic pressure (occurs in ASD/VSD sometimes) and the L->R shunt seen in ASD/VSD reverses to R->L which is more worrying

137
Q

What is folliculitis

A

Bacterial infection of hair follicles

138
Q

Management of localised folliculitis

A

topical antibiotics

139
Q

Management of impetigo

A

Don’t go to school or nursery
Topical fusidic acid
Avoid sharing towels and bed sheets

140
Q

Management of necrotising fasciitis

A

IV antibiotics

Surgical debridements

141
Q

WHich virus causes viral warts

A

HPV (types 6 and 11)

142
Q

Treatment options for viral warts?

A

Cryotherapy
Salicylic acid
imiquimod

143
Q

viral warts around the nail. Which treatment should you not use?

A

Cryotherapy

- topical treatments are better

144
Q

Treatment of shingles

A

Self limiting

Caught within 72 hours give aciclovir

145
Q

You can catch ____ with someone who has shingles

A

chickenpox

146
Q

How do you investigate fungal infections?

A

Skin scraping

147
Q

When might terbinifine be used

A

Fungal infections

148
Q

Name 2 causes of non-scarring hair loss

A

Alopecia

Tinea capitis

149
Q

What is ptyriasis versicolor

A

Yeast infection which interferes with normal melanin production
- can be hyper or hypo pigmented

150
Q

Treatment of candidiasis

A

Cotrimaxazole

151
Q

Describe staphylococal scalded skin syndrome

A

Superficial split in epidermis, split between dermosomes in the granular layer of the epidermis

152
Q

staphylococal scalded skin syndrome more common in adults/children?

A

Children

153
Q

staphylococal scalded skin syndrome - management

A

Hospitalisation and IV antibiotics

154
Q

ERYSIPELAS - more deep/superficial than cellulitis

A

More superficial

155
Q

How long should you take oral antibiotics for acne?

A

at least 4 months

156
Q

Which pill should you give in acne?

  • COCP
  • POP
A

COCP

157
Q

WHich antibiotic may be used in rosacea?

A

Metronidazole (topical)

158
Q

Split is “at the junction between epidermis and dermis” this is true of

  • bullous pemphigoid
  • pemphigus vulgaris
A

Bullous pemphigoid

159
Q

What is the first line management of sebhorroeic dermatitis?

A

Ketokonazole

160
Q

Angiofibromas
Peri-ungal fibroma
Ash leaf macules

A

Tuberous sclerosis

161
Q

Lisch nodules
Cafe au lait macules
makes you think

A

Neurofibromatosis

162
Q

How to differentiate erisipylis and cellulitis

A

Erysipleas - sharp demarcation at the border, more firey looking

163
Q

Satellite lesions makes you think which condition

A

Candidiasis

164
Q

If you have necrobiosis, which condition is this associated with?

A

Diabetes

165
Q

Acanthosis nigricans is associated with

A

Diabetes

166
Q

What does scarring alopecia mean?

A

No hair follicles left

167
Q

Heloptrope rash
Grottons papules
which condition

A

Dermatomyositis

168
Q

WHat is the main cause of erythema multiforme?

A

Herpes simplex virus

169
Q

What is livedo reticularis

A

Mottled skin exacerbated by the cold

170
Q

Which type of cell is primarily responsible for the development of urticaria, angioedema and anaphylaxis, and in which layer of the skin is it found?

A 
Mast cell (releases histamine) 
- layer = dermis
171
Q

Histamine release results in vasoconstriction/vasodilation?

A

Vasodilation

172
Q

prodrome of respiratory symptoms, followed up to 14 days later by erosions of at least 2 mucosal surfaces with a variable degree of cutaneous involvement. Varying degree of cutaneous involvement with target-like lesions / dusky red macules / blistering / desquamation
what does this suggest?

A

Steven johnston syndrome

173
Q

Name 4 classes of drugs which can cause stevens johnston syndrome

A

NSAIDs
Anticonvulsants - lamotrigine
Antibiotics
Sulphonamides

174
Q 
Parakeratosis 
Absence of granular layer 
expanded prickle cell layer 
munro micro-abscesses 
pathology of which condition
A

Psoriasis

175
Q

Management of necrotising fasciitis

A

IV antibiotics

Surgical debridement

176
Q

Nikolsky sign +ve in

  • pemphigus
  • pemphigoid
A

Pemphigus

177
Q

immunofluoresence shows linear/chicken wire IgG in pemphigoid

A

Linear = pemphigoid

178
Q

treatment of localised pemphigoid

A

Topical steroids

179
Q

Treatment of generalised pemphigoid

A

Oral steroids
tetracyclines
azathioprine

180
Q

Lysis of intercellular adhesion sites in

  • pemphigus
  • pemphigoid
A

Pemphigus

181
Q

Dermatitis herpitiformis is associated with which condition?

A

Coeliac disease

182
Q

linear IgG at basement membrane

  • pemphigus
  • pemphigoid
A

Pemphigoid

183
Q

ABPI over 1.5 suggests

A

Claudication

184
Q

Males vs females psoriasis

A

Equal

185
Q

Hyperproliferation of epidermal cells makes you think

A

Psoriasis

186
Q

Psoriasis is often symetrical / asymetrical?

A

Symetrical

187
Q

What is koebner phenomenon

A

Wound / trauma causes psoriasis

188
Q

What is autzpitz sign and which condition is it associated with?

A

Small pinpoint bleeding spots, associated with psoriasis

189
Q

In flexural psoriasis, scale is a predominant feature?

A

False, scale is not a predominant feature in FLEXURAL psoriasis

190
Q

Name 6 potential topical treatments for psoriasis

A 
Emollients 
Coal tar 
Vitamin D analogue (calcipotriol) 
Topical steroids 
Dithranol 
Salicylic acid
191
Q

Which topical treatment for psoriasis causes staining

A

Dithranol

192
Q

What is the function of salicylic acid

A

Keratinolytic agent (removes hyperkeratosis)

193
Q

Typically use low dose / high dose steroids in the management of psoriasis?

A

Low dose

- if you use high dose then there can be rebound flare up

194
Q

Apart from topical treatment, what else can be used in management of psoriasis?

A

Phototherapy

195
Q

Management options for arterial leg ulcers

A 
Pain relief 
Lifestyle factors 
Aspirin 
Crepe bandaging
Refer for vascular surgery if appropriate
196
Q

Psoriasis treatment ladder

A

Topical treatments
- once you get to high dose steroid (dermovate) then move on to

  • phototherapy
  • systemic therapy (methotrexate, retinoids)
197
Q

Which type of phototherapy penetrates deep?

  • UVB
  • PUVA
A

PUVA

198
Q

Outline the growth phases for melanoma

A

radial growth phase (confined to epidermis)

then later get vertical growth phase (metastasis can occur here)

199
Q

Which type of melanoma is vertical growth phase from the outset

A

Nodular melanoma

200
Q

Which type of melanoma is most common on facial skin, especially chronically sun exposed sides

A

Lentigo maligna

201
Q

Which type of melanoma is most common in dark skin types

A

acral

202
Q

Urticaria is swelling of which layer of skin

A

Dermis

203
Q

Which 3 histamine receptors are relevant in urticaria

A

H1, H2, H4

Y4 (23 decks)

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