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FCM > DERMATOLOGY > Flashcards

DERMATOLOGY Flashcards

1
Q

chronic dry and very itchy skin?

A

Eczema

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2
Q

management of mild eczema?

A

generous emollients

mild topical steroids considered on inflamed areas (1% hydrocortisone)

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3
Q

management of moderate eczema?

A

generous emollients
moderately potent topical steroids (0.025 betamethasone valerate or 0.05% clobetasone butyrate)
use mild topical steroid in delicate areas
sever itch/urticaria = oral 1 month non-sedating antihistamine trial

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4
Q

management of severe eczema?

A

generous emollients
inflamed skin = potent topical steroids (0.1 betamethasone valerate)
moderate potency topical steroid for delicate areas
severe itch/urticaria = one month trial of antihistamine
sleep disturbance = sedating antihistamine
severe, extensive eczema = oral prednisolone

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5
Q

lesions are erythematous, vesicles, crusting, scaling
sharp margins confined to site of exposure
rapid onset/within ours of exposure
may occur in everyone

A

Irritant contact dermatitis

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6
Q

lesions erythematous, papules, vesicles, erosions, crusts and scaling
initially sharp margins which eventually spread out over time
onset after 12-72hrs of exposure
occurs only in sensitized

A

Allergic Contact dermatitis

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7
Q

management of contact dermatitis

A

best Tx = avoid contact and decontaminate using soap and water
aveeno baths. calamine lotions. cool compress and oral antihistamines
mild to high potency topical steroids

severe reactions = oral prednisolone - can taper over 7-21 days

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8
Q

clustered erythematous papules, papulovesicular
and papulopustules
more common around the mouth but can form around eyes and nose

typically in females 20-45yrs and associated with steroid use

A

peri-oral eczema

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9
Q

management of peri-oral eczema?

A 
mild = topical metronidazole/erythromycin 
severe = Oral ABx e.g. lymecycline/doxycycline

avoid irritants, alcohol and spicy foods and steroids

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10
Q

symmetric coin shaped lesions
vesicles and papules merge to form a plaque
itchy/pruritic

A

nummular/discoid eczema

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11
Q

management of nummular/discoid eczema?

A

adv to moisturize
moderate to potent steroid
sedating antihistamine if sleep disturbance

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12
Q

hyperpigamented plaques on anterior/medial aspects of lower legs
erythema, ulcers and some oedema
ulceration usually above medial malleolus

may have hx of varicose veins, HF, thrombophlebitis, trauma/surgery to limb or above 50yrs

A

venous stasis eczema

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13
Q

how is venous stasis eczema investigated

A

ABPI - <0.9 = arterial disease

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14
Q

management of venous stasis eczema?

A

compression
elevation and walking
topical steroids or ABx if indicated
tx the ulcers accordingly

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15
Q 
fever 
swollen lymph nodes 
extremely painful blistering rash
monomorphic punched-out erosions, 
circular depressed ulcertaed lesions ~ 1-3cm
A

eczema herpitcum

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16
Q

investigations for eczema herpiticum?

A

clincial diagnosis - viral swabs can be taken

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17
Q

management of eczema herpiticum?

A

oral/IV acyclovir 400-800mg 5x day

severe/systemically affected = hospital admission and IV antiviral preferred.

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18
Q

eczematous lesions in sebum rich areas
(usually scalp, under eye, near ears and around nose)
associated otitis externa or blepharitis

A

seborrheic dermatitis

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19
Q

management of seborrheic dermatitis

A

scalp = OTC zin pyrithin = head n shoulders
or OTC tar = Tgel shampoo
+ ketoconazole

face and body
topical ketoconazole
short term topical steroids

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20
Q

isolated red/brown macule/papule with rough yellow-brown scale over it
usually on temples
may be more than one

A

actinic keratosis

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21
Q

management of actinic keratosis

A

sun avoidance/sun cream
cryotherapy/surgical removal
diclofenac gel = solarase
5-fluorouracil cream = 2-3 week course

others include
tretinon (retin A)
acid peels

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22
Q

round lesion on scalp
surrounding alopecia
can form spongy/boggy mass (leronion)

A

tinea capitis

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23
Q

management of tinea capitis?

A

topical ketoconazole and
oral griseofulvin for adults or
oral terbinafine for children

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24
Q

well-defined annular erythematous lesion withpapules and pustules and clearer central area

A

tinea corporis

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25
Q

management of tinea corporis?

A

oral fluconazole

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26
Q

usually asymtpomatic but may itch
found mainly on trunk, neck and arms
patches are a copper/brown in colour and scaly
may become non-scaly and white once resolved

early 20s
durations months/years

A

tinea versicolor

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27
Q

investigations to confirm tinea versicolour diagnosis?

A

woodlamp
microscopy
fungal culture
skin biopsy

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28
Q

management of tinea versicolour

A

selenium sulphide 2.5% lotion/shampoo used daily for 7-10/7

topical miconazole for 14/7

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29
Q

pruritic superficial rash - large scaly, well-demarcated red/brown plaques
mainly around the groin and adjacent skin
gentials spared

hx of wearing tight underwear, living in tropical climate
obese
athletic
male

A

tinea cruris

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30
Q

management of tinea cruris?

A

topical azole = ketoconazole, clotrimazole or miconazole

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31
Q

young adults
herald patch
erythematous, oval scaly patches with a longitudinal distribution often described as ‘fir tree appearance’
may have has a prodromal viral infection

A

pityriasis rosea

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32
Q

management of pityriasis rosea?

A

self-limiting = usually resolves in 6 weeks

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33
Q

what are the 5 main drug eruptions?

A 
morbilliform 
urticarial 
fixed 
hyperpigmentation 
chemo-induced acral erythema
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34
Q

often 7-10 days after exposure
maculopapular rash which become confluent
itchy
usually spares the face

A

morbilliform

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35
Q

management of morbilliform eruption?

A

antihistamines and cooling lotion

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36
Q

hives mins-hrs after intiating medication

A

urticarial eruption

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37
Q

management of urticarial eruption?

A

antihistamines and cooling lotion +/- epinephrine

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38
Q

round. rythematous plaques mins-hrs after medication initiation
any part of body affected but common in glans penis

A

fixed eruption

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39
Q

tingling in the palms. soles and then swelling/erythema after several days

A

chemo-induced acral erythema

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40
Q

well demarcated, read/silver rash that is ring-shaped

appearing on stratus coneum, hair/follicles and on nails.

A

dermatophyte infections

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41
Q

diagnosis of demratophyte infections?

A

KOH microscopy

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42
Q

management of dematophyte infections?

A

clotrimazole, miconazole & terbinafine

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43
Q

Pruritic, purple polyglonal papules
can merge into plaques
usually on the wrist, ankles, shins, mucous membranes and penis
‘ white lines on surface/wickham’s striae’
oral/buccal mucosa - white lacey pattern

often an eruptiosn due to gold, quinine or thiazides

A

lichens planus

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44
Q

management for lichens planus

A

potent topical steroids (oral/IM injection considered)
sedating antihistamine
monitor mucous membranes - benzydamine mouthwash
UV therapy

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45
Q

sharply marginated erythematous papule with silvery white scale
scales loose and easily removed from scatching
papules grow sharply maginated plaques which merge with each other

can happen on scalp, palms/soles, nails, extensor surfaces and lower back and anterior tibial surface

can lead to joint pain/arthritis
usually in teens/childhood or older pts in 50s
family history present

A

psoriasis

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46
Q

management of psoariasis?

A
  1. potent corticosteroid + vitamin D (tacalcitol or calcipotriol) - OD
  2. increase vit D analgoue to BD dose
  3. if no imporvement in 8-12 weeks = increase steroid to BD dose or start coal tar O/BD
  4. short acting diathanol/anthralin
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47
Q

commonly on shins
pain, redness, warmth and swelling
macular
usually associated with systemic upset = fever

can be linked with venous stasis

A

cellulitis

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48
Q

management of mild cellulitis?

A

first line - flucloxacillin - doxycycline in allergy and macrolide as alternative in pregnancy

if traumatic consider tetanus prophylaxis and outpatient wound check in 24-48hrs

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49
Q

management of severe cellulitis?

A

clindamycin, vancomycin
co-amoxiclav or ceftriaxone
moxifloxacin

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50
Q

inflammation of small vessels
itching/burning rash
1-3mm lesions which may coalesce
often on legs

recent initiation of medication?
autoimmune disorder hx

A

vasculitis

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51
Q

management of vasculitis?

A

treat underlying cause if identified

compression stockings and elevation
sedating antihistamine
if systemic involvement = high dose steroid
no systemic involvement = colchicine or dapsone

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52
Q 
bright red/fiery red lesion on skin 
superficial layers affects
painful, raised and well-demarcated plaques 
malaise 
often on face and lower extremities
A

erysipleas

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53
Q

management of erisipleas?

A

supportive care and analgesia
flucloxacillin
if on face co-amoxiclav and admit to hospital

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54
Q

‘golden’ crusted skin lesions typically around the mouth

commonly in children and warmer weather

A

impetigo

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55
Q

management of limited/localized impetigo?

A

hydrogen peroxide 1% cream if not systemically unwell

topical ABx = fusidic acid or topical mupirocin

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56
Q

management of extensive impetigo?

A

oral flucloxacillin
or alt = macrolide

school exclusion till lesions have crusted ove/ 48hrs after Abx initiation

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57
Q

excessive pruritis either in hair or around pubic regions

A

lice

58
Q

management of lice?

A

permethrin cream - apply at night and wash off in the morning

59
Q

widespread pruritis
linear burrows on the sides on fingers, iterdigital webs or on flexor ascpects of wrists
typically in children/young adults

A

scabies

60
Q

management of scabies

A

first line = premethrin 5% cream - apply from neck down at night and wash off 8-12hr later
second line = melathion 0.5%
treat any bacterial superinfections

treat entire household

61
Q

early features include
erythema migrans/’bulls eye rash’
usually painless
headaches, lethargy, fever and arthralgia

later features
CVS - heart block or peri/myocarditis
neuro = facila palsy, meningitis
MSK = joint effusions

A

lyme disease

62
Q

lyme disease investiagtions?

A

ELISA antibodies and western blot

63
Q

management of lyme disease

A
  1. doxyxyline 100mg BC 21/7
  2. Amoxicillin 1g TDS 14-21/7
  3. azithromycin 500mg 17/7

refer for any neuro involvement

64
Q

management of animal bites

A

control bleeding and irrigate thoroughly with germicisal
consider tetanus and rabies prophylaxis
Give prophylactic Abx = co-amoxiclav - Doxycycline +metronidazole if allergic

refer if systemic illness

65
Q

human bites management?

A

co-amoxiclav as abx prophylaxis

doxycycline and metronidazole if allergic

66
Q

management of skin lacerations

A

assessment of the injury
heamolysis - elevation, pressure and tourniquet
analgesia = systemic or local
skin prep = irrigate debride ragged edges
closure = primary, delayed, secondary
dressings = either non-adherent, lubricated or dry
infection prevention if high risk
follow up in 48-96hrs

67
Q

red and painful burn?

A

first degree

68
Q

pale pink, painful and blistered

A

epidermal second degree

69
Q

white patches of non-blanching erythema, reduced sensation

A

dermal second degree

70
Q

white/brown or balck in colour, no blisters, no pain

A

3rd degree

71
Q

burn extending to subcut fat, muscle, nerves, major blood vessels or bone

A

4th degree

72
Q

epidermal second degree initial management

A 
initial first aid/ clear skin 
tetanus immunisations
topical Abx = silver sufadiazine with bulky occlusive dressing 
hydration (oral preferred)
analgesia 
elevate limbs to control oedema
73
Q

dermal second degree initial management

A

cleanse wound
leave blisters intact - sterile + protective
non-adherent dressing and avoid topical creams
review in 24hrs

74
Q

third degree burn management

A

usually surgical repair or grafting

75
Q

fourth degree burn management

A

often requires amputation or extensive reconstructive surgery

76
Q

refer to burns unit when?

A 
dermal 2nd degree 
3rd/4th degree
inhalation injury 
electrical/chemical burn 
paediatric 
chronic illness or mental illness in pt
77
Q

management of needlestick injuries?

A

first aid
discuss with healthcare profressional - consider prophylaxix eg: pep
investigations = virology, LFTs and hCG
documentation

prevention is key emphasis on prophylaxis

78
Q

well-raised, circumscribed irregularly shaped areas of erythema and oedema
affects both dermal and epidermal layers
very pruritic/itchy

A

urticaria

79
Q

management of urticaria?

A
  1. H1/H2 blockers = benydryl, hydroxyzine or ranitidine
  2. steroids = prednisolone
  3. consider epinephrine if any airway compromise is present

continue Tx for 5 day

80
Q

well-demarcated patches of depigmented skin
peipheries affected more
trauma may precipitate new lesions/areas of depigementation

linked to T2DM, Addisons, thyroid disorders, penicious anaemia and alopecia

A

vitiligo

81
Q

management of vitiligo?

A

topical corticosteroids
topical tacrolimus

photo/UV light therapy
sunscreen
camouflage makeup

82
Q

initially manifests as recurrent, painful and inflamed lumps
commonly in the axilla
nodules may rupture to release mucopurulent, malodourous discharge
merging of nodules may for plaques, sinus tracts or ‘rope-like’ scarring
double comedomes = form fistulae

commonly affects adults under 40 and women more
FHx, smoker, obesity, diabetic, PCOS

A

hidradenitis supperativa

83
Q

management of hidradenitis supperativa?

A

acute flares = steroids or flucloxacillin, surgical I&D may be needed
long term = topical clindamycine or oral clindamycin, doxycycline or rifampicin

reinforce good hygiene, loose clothing, smoking cessation and weight loss if obese

84
Q

patches of bilateral macular areas of hyperpigementation with irregular borders
typically on face

use of contraceptive, recently pregnant or lots of sun exposure

A

melasma (chioasma)

85
Q

management of melasma?

A

opaque sunblock/avoid sun exposure
topical hydroquinolone
tretinoin

86
Q

smooth, rounded, mobile and non tender lump
average 3-5cm
commonly on neck, upper chest or arms

A

lipoma

87
Q

management of lipoma

A

watchful waiting

surgical excision if large or symptomatic

88
Q

discrete nodules, usually mobile often with punctum
common on head, neck and trunk
if inflamed = eythematous and can rupture to release foul-smelling discharge

A

epithelial inclusion/sebaceous cyst

89
Q

management of epithelial inclusion/sebaceous cyst

A

abx if inflamed

surgical excision = entire cyst wall/capsule to prevent recurrence

90
Q

persistently red, broken skin often extending to underlying surfaces
usually over bony prominence

history of lack of mobility

A

decubitus ulcers/pressure sores

91
Q

management of decubitus ulcers/pressure sores

A

reposition and pressure support products
wound management dressings - hydrocolloid dressings
pan relief
Abx if appears infected

92
Q

dark, thick, velvety skin in body folds/creases
often in axilla, neck or groin
skin looks dirty

Hx of T2DM, GI tumours, endocrine disorder or obesity

A

acanthosis nigricans

93
Q

management of acanthosis nigricans

A

treat underlying cause
GI tumour = surgical exclusion

ammonium lactate - 12% PRN to soften skin
aqua glycolic acid BD

94
Q

more common in elderly patients
itchy, tense blsiters around flexures
erythematous, papular or urticarial bullae in inflammatory plaques
no mucosal involvement - doesn’t spread to mouth

A

bullous pemphigoid

95
Q

diagnosis/Ix for bullous pemphigoid

A

Immunofluorescence - IgG and C3 at dermo epidermal junction

96
Q

management of bullous pemphigoid

A

topical or systemic steroids = oral mainly
+/- immunosuppressants

sometime Abx used

97
Q 
target lesion/iris lesions 
vesicles/bullae form in the centre
initially seen on the back of hands or feet before spreading to the torso
upper limbs more common 
mild pruritis

recent infection,

A

erythema multiforme

98
Q

management of eythema multiforme

A

treat underlying cause

antihistamine, paracetamol, cool compress and steroids

99
Q 
seen in older people 
males>females 
FHx 
stuck to the skin appearance 
brownish papule, grasy/spongy appearance 
commonly on sun exposed areas - back 
keratotic plugs on the surface
A

seborrheic kertoses/ senile keratosis

100
Q

management of seborrheic keratoses

A

have low threshold for melanoma = bisopsy if suspicious

cryotherpay
curettage
routine exams to watch for melanoma

101
Q

found on sun-exposed sites mainly the head and neck
initially pearly, flesh-coloured papule
telangiectasia
may later ulcerate forming a crater and crusting
colour red-pink with a pearly translucent border

A

basal cell carcinoma

102
Q

investigation and diagnosis for BCC

A

biopsy

103
Q

management for BCC?

A

surgical removal, curettage , cyoptherapy
moh’s surgery and radiation therapy

patient ed = avoid sun exposure and self exam

104
Q

slowly evolving isolated keratotic papule or plaque

if highly differentiated = kertainised surface, firm on palpation
if poorly differentiated = no keratinisation, fleshy, granulomatous and soft on palpation

more common in fair skinned blondes and red-heads
may be immunosupressed, smoker, longstanding ulcers, sunlight exposure

A

squamous cell carcinoma

105
Q

investigation for SCC?

A

biopsy

106
Q

management for SCC

A

excision, mohs surgery or radiation therpay

107
Q

a ‘growing mole’
evolving, enlarging or has become elevated
mean diamete 8-12mm
more common in caucasians

family hx or fair skin and chronic sun exposure

A

melanoma

108
Q

investigation for melanoma

A

biopsy

109
Q

management for melanoma

A

2wwr
total excision with margins
stage 1-2 = interferon a
chemo/immunotherapy for metastatic disease

110
Q

smaller blisters on the palms & soles - vesicular eruptions and pruritic
can have a burning sensation

rupture of blister leaves behind dry cracked skin
precipitated by humidity and high temps

A

dyshidrosis/pompholyx

111
Q

management of dyshidrosis/pompholyx

A

topical steroids

emollients
cool compress
burrow’s solution - 10% aluminum acetate dilution

112
Q

well-demarcated, round, oval or linear plaques of confluent papules
thickened skin
accented skin markings
dull red-dark brown/black

usually due to repetitive rubbing/scatching/itching

A

lichen simplex chronicus

113
Q

management of lichen simplex chronicus

A

must stop itching/scratching
occlusive dressing nocte
topical steroids
sedating antihistamines

114
Q

fever malaise
headaches
widespread rash

may have a infection or initiated a drug

A

exanthems

115
Q

management of exanthems

A

treat underlying cause/infection

116
Q

acute, unilateral painful blistering rash - can be erythematous and doesn’t cross the midline

initial prodromal feature include a burning pain over the affected dermatome, fever lethargy and headache

commonly in T1-L2

A

shingles

117
Q

management of shingles

A

NSAIDS/paracetamol - or amitriptyline

if within 72hrs = aciclovir

118
Q

small fleshy warts on the genitals or rectum

may itch or bleed

A

genital warts or condyloma acuminata

119
Q

management of genital warts

A

topical podophyllum or cryotherapy

imiquimod topical cream
trichloroacetic acid
electrocautery laser

120
Q

pinkish or pearly white papules with a central umbilication
usually appear in clusters on the trunk or in flexors
anogenital lesions can occur

A

molluscum contagiosum

121
Q

management of molluscum contagiosum

A

treatment not recommended unless troublesome or unsightly

simple trauma, cryotherapy

122
Q

small rough raised or flattened lumps occur ocer the pressure of areas of the feet

A

verrucae/plantar warts

123
Q

management of verrucae

A

salicylic acid - apply daily for 3/12

freezingtx/cryotherapy

124
Q

maculopapular rash with target lesions which may develop into vesicles or bullae
mucosal involvement
fever and arthralgia

recently started a new medication

A

stevens-johnsons syndorme

125
Q

systemically unwell - pyrexia and tachycardia
scalded appearance over an extensive area
+nikolsky’s sign = epidermis seperated with mild lateral pressure

A

toxic epidermal necrolysis

126
Q

management of toxic epidermal necrolysis

A

stop the precipitating factor
supportive care

IVIG first line
immunosuppressive agents and plasmapheresis

127
Q

presence of whiteheads or blackheads
papules or pustules
modules or cysts
usually in teens/young adults

A

acne vulgaris

128
Q

management of acne

A
  1. good skin hygiene and a single topical agent - retinoid, benzoyl peroxide or steroid, then try combine two single agents
  2. oral abx on a daily basis or oral COC
  3. oral isotretinoin (roacutane)
129
Q

typically affecting the nose, mouth and forehead
flushing/heat on face
telengiestasia
persistent erythema - sometimes with pustules and papules

maybe associated with conjunctivitis, stye.chalazions and blepharitis
rhinophyma

usually 30-50s and more common in females

A

rosacea

130
Q

management of rosacea

A
  1. daily topical metronidazole
  2. oral Abx = tetracyclines
    last resort = isotretinoin or private laser tx

reduce exposure to alcohol and hot beverages
pt with rhinophyma - refer

131
Q

itchy, erythematous pustules - often clustered and by hair follicles

A

folliculitis

132
Q

management of folliculitis

A

topical aseptic wash = chlorhexidine
oral Abx = flucloxacillin for s.aureus
ciprofloxacin for pseudomonas

133
Q

eythematous painful swollen lateral or proximal nail fold

might have purulent/abscess

A

paronychia

134
Q

management of paronychia

A

warm socks
flucloxacillin
consider I&D

135
Q

bitemporal recession of hair often spared at the occiput and a thin band around the sides
horse-shoe shape
in males mainly

in females = loss of oestrogen = thinning

A

androgenic alopecia

136
Q

management of androgenic alopecia

A

minoxidil (2% or 5% in males)

finesteride in males only

137
Q

yellow white nail separates from nailbed

A

distal or lateral subungual

138
Q

nail soft dry powdery and adherent to bed and not thick

A

superficial white

139
Q

nail surface intact

debris causes nail to seperate

A

proximal subungual

140
Q

thick nail plate

yellow/brown colour

A

candida nail infection

FCM (16 decks)

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