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IK6 - Exams > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

What is a basal cell carcinoma? And what features does it have?

A

It is a skin malignancy arising from epidermal keratinocytes.

Features:

  • slow growing
  • locally invasive
  • rarely metastasises
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2
Q

What are the risk factors for basal cell carcinoma?

A
  • sun exposure
  • UV radiation
  • frequent and severe sunburn
  • tar
  • arsenic
  • photosensitising pitch
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3
Q

What is the epidemiology of basal cell carcinoma?

A

common in fair skinned people

usually in areas exposed to sun light

elderly (rare before 40 years of age)

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4
Q

What are common areas affected by BCC?

A

face

scalp

ears

trunk

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5
Q

describe a typical basal cell carcinoma

A

lesion with:

  • rolled edge
  • pearly appearance
  • telangiectasia
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6
Q

What are the types of basal cell carcinoma and which one is the most common?

A

nodulo-ulcerative (most common, typical appearance)

morphoeic (expanding, yellow/white plaque, more aggressive than nodulo-ulcerative)

superficial (usually on trunk, pink/brown)

pigmented

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7
Q

what is this?

A

basal cell carcinoma

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8
Q

what is this?

A

morphoeic basal cell carcinoma

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9
Q

What is contact dermatitis?

A

An inflammatory skin reaction arising due to an external stimulus which is acting as an allergen or irritant

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10
Q

What are the types of contact dermatitis?

A
  1. allergic contact dermatitis
    • delayed type IV hypersensitivity reaction
  2. irritant contact dermatitis
    • inflammation usualyl due to damage to the skin by extrinsic factor e.g. chemicals
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11
Q

What are some allergens and irritants that might cause contact dermatitis

A
  1. ALLERGENS
    • cosmetics
    • metals
    • topical medications
    • textiles
  2. IRRITANTS
    • detergents
    • soaps
    • solvents
    • powders
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12
Q

what are of the body is most commonly affected by contact dermatitis?

A

hands

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13
Q

describe the appearance of an area of contact dermatitis?

A
  • redness
  • vesicles + papules in the area
  • crusting and papules of the skin
  • itching
  • pain
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14
Q

what is this?

A

contact dermatitis

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15
Q

what is eczema?

A

it is a pruritic papulovesicular skin reaction to endogenous and exogenous agents. it is a TYPE IV HYPERSENSITIVITY reaction

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16
Q

What is the pathophysiology of eczema?

A

allergen → antigen presenting cell →T helper 2 cells stimulate B cells → IgE production increased → mast cell and basophils are activated. → sensitisation

secondary allergen exposure → mast cell degranulation→ inflammation → vasodilation → dry + scaly skin with reduced barrier function

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17
Q

what is the epidemiology of atopic eczema?

A

Onset usually in the first year of life with childhood incidence around 10-20%

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18
Q

What are the types of eczema?

A

contact

atopic

seborrhoiec

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19
Q

What are features of eczema?

A
  • itching (worse at night)
  • heat
  • tenderness
  • redness
  • weeping
  • crusting
  • affecting flexors and exposed areas of skin
  • Hx of atopy [personal or family]

ACUTE: poorly demarcated erythematous + oedmatous dry scaly patches. may have papules + vesicles. excoriation marks

CHRONIC: thick epidermis, skin lichenification, fissures, change in pigmentation

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20
Q

fill in the table

A
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21
Q

what investigations might you perform to confirm a diagnosis of eczema ?

A

skin patch testing if contact eczema

lab testing with IgE for atopic eczema

otherwise clinical diagnosis

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22
Q

what is erythema multiforme?

A

an acute hypersensitivity reaction affecting the skin and mucous membranes

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23
Q

what is stevens-johnson syndrome?

A

a severe form of erythema multiforme meaning a severe hypersensitivity reaction affecting the skin and mucous membrane.

for diagnosis > 2 mucous membranes must be affected.

features: bullous lesions + necrotic ulcers

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24
Q

How does the areas of body affected by atopic eczema change with age?

A
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25
what is this?
eczema
26
what is the pathophysiology of erythema multiforme?
The basal epidermal cells degenerate and vesicals form between basement membrane cells. lymphocyte invasion to tissue also occurs. Precipitating factors identified in only 50% of cases
27
What are some precipitating factors for erythema multiforme?
DRUGS - penicillin, phenytoin INFECTION - **HERPES** (main factor), EBC, chlamydia, adenovirus INFLAMMATORY - RA, SLE, sarcoidosis, ulcerative colitis MALIGNANCY - haematological radiotherapy
28
what is the epidemiology of erythema multiforme?
2M: 1 F children + young adults but can affect all ages
29
What are the clinical features of erythema multiforme?
* classic target (bull's eye) lesions * vesicles/bullae * urticarial plaques * often symmetrical extending over limbs including palms, soles + extensors
30
what is this?
erythema multiforme
31
what is this?
erythema multiforme
32
What is erythema nodosum?
It is an inflammation of the subcutaneous fat tissue which presents with red/violet subcutaneous nodules
33
What is erythema nodosum associated with?
INFECTION = **group A beta-haemolytic streptococcus**, EBV, histoplasmosis SYSTEMIC DISEASE = ***sarcoidosis***, ***IBD***, behcet's disease MALIGNANCY = leukaemia, hodgkin's lymphoma DRUGS = penicillin, OCP *PREGNANCY*
34
What is the epidemiology of erythema nodosum?
3F:1M young adults most commonly affected
35
what are the clinical features of erythema nodosum?
**tender red/violet nodules** **bilaterally** on both **shins** sometimes thighs + forearms systemic: fever, anorexia, weight loss, arthralgia (tender painful joints on movement)
36
what investigations may help confirm a diagnosis of erythema nodosum?
Bloods -\> anti-streptolysin O titres, FBC, CRP, ESR, U&E, serum ACE (sarcoidosis) throat swab + culture mantoux test CXR
37
what is this?
erythema nodosum
38
what is this?
erythema nodosum
39
what is a lipoma?
it is a slow-growing benign adipose tumous usually found in the subcutaneous tissue.
40
What is the epidemiology associated with lipomas?
most common in 40-60s relatively common condition
41
what are the clinical features of a lipoma?
* soft or firm nodule with smooth surface. dough feel * most \< 5cm * mobile * most are asymptomatic * pain may be caused by compression of nearby nerves
42
what is a melanoma?
It is a malignancy arising from neoplastic transformation of melanocytes. it is the leading cause of death from skin disease
43
What are the four histopathological types of melanoma?
1. SUPERFICIAL SPREADING * most common * arising from existing naevus expanding radial before vertically 2. NODULAR * **aggressive** * arise de novo * vertical growth, no radial expansion really 3. LENTIGO MALIGNA * common in elderly with sun damage * large flat lesions often on face 4. ACRAL LENTIGINOUS * palms, soles, subungal areas * usually in non-white populations
44
what is the most common type of melanoma? what is the most aggressive type?
common = superficial spreading aggressive = nodular
45
how do you assess a lesion suspected of being a melanoma?
****_A_**symmetry** ****_B_**order** - irregular ****_C_**olour** - variation within lesion ****_D_**iameter** - \> 6/7mm ****_E_**volution** - elevation and progression/change
46
what investigations might you perform if you suspect melanoma?
excisional biopsy for histology lymphoscintography + sentinel lymph node biopsy - locate nodes and check for mets staging scans bloods - LFTs as common met site
47
where does melanoma commonly metastasise to?
liver
48
what is this?
melanoma
49
What is molluscum contagiosum?
a skin infection caused by a pox virus usually transmitted by direct skin contact
50
what are risk factors for molluscum contagiosum?
actopic eczema children immunocompromised
51
what is the epidemiology of molluscum contagiosum?
common, usually affects those \< 15 years but can affect all ages most do not seek medical attention
52
what are the clinical features of molluscum contagiosum?
incubation for 2-8 weeks * most are asymptomatic * symptoms: * tenderness * pruritus * eczema around lesions * lesions are **firm, smooth and umbilicated papules 2-5mm** * children = trunk + extremities ; adults = lower abdomen, genital areas, inner thighs
53
what is this?
molluscum contagiosum
54
what is psoriasis?
chronic inflammatory skin condition characterised by lesions. May be complicated by arthritis (psoriatic arthritis)
55
Are there risk factors for different types of psoriasis?
guttate psoriasis - strep sore throat palmoplanter psoriasis - smoking, middle aged F, autoimmune thyroid disease generalised pustular psoriasis - hypoparathyroidism
56
what is the peak age of onset for psoriasis?
20
57
what are the presenting features of psoriasis?
* itching + tender/burning skin * koebner phenomenen - psoriasis lesions developing near sites of trauma/scars * well demarcated erythemaous **scaly plaques** * common on extensor surfaces + scalp * auspitz sign - scratching and gentle removal of scales cause capillary bleeding
58
How many psoriasis patients have psoriatic arthritis? what are the fatures of psoriatic arthritis?
5-8% have it CLINICAL FEATURES * asymmetrical oligomonoarthritis * symmetrical polyarthritis * distal interphalangeal joint predominance * arthritis mutilans (flexion deformity of DIP joint) * psoriatic spondylitis
59
what is this?
psoriasis
60
what is this?
GUTTATE PSORIASIS small dop-like lesions over the trunk and limbs
61
what is this?
PALMOPLANTER PSORIASIS erythematous plaques with pustules on palms and soles
62
what is this?
FLEXURAL PSORIASIS psoriasis affecting flexor surfaces such as axilla, groin, perianal, genital skin the plaques are less scaly
63
what is a sebaceous cyst?
an epithelium lined, keratinous, debris-filled cyst arising from a **blocked hair follicle** (aka epidermal cyst)
64
what are the clinical features of a sebaceous cyst?
non tender slow growing skin swelling. usually multiple common in hair growing regions of the body (think face, scalp, trunk and scrotum)
65
what are the clinical features of a sebaceous cyst?
smooth tethered lump overlying skin **_punctum_** may discharge a granular creamy material that smells foul
66
What are the management options for a sebaceous cyst?
conservative - leave alone if causing no pt distress surgical - removal of cyst with LA medical - Abx if infeciton present
67
what are the possible complications of a sebaceous cyst?
infection abscess formation recurrence ulceration
68
what is squamous cell carcinoma?
a malignancy of epidermal kertinocytes of the skin
69
what is this?
sebaceous cyst
70
what are the risk factors for sqaumous cell carcinoma?
UV radiation radiation carcinogens chronic skin disease HPV long-term immunosuppression
71
what is the epidemiology of squamous cell carcinoma?
20% of all skin cancers mainly affects MIDDLE-AGES + ELDERLY light skinned at higher risk 2-3M:1F
72
What are the presenting features of a squamous cell carcinoma?
* keratotic (scaly, crusty) ill defined nodule which may ulcerate * recurrent bleeding * non-healing * often on sun-exposed skin areas
73
what is this?
squamous cell carcinoma
74
what is this?
squamous cell carcinoma
75
what is urticaria?
itchy red blotchy rash from swelling of the superficial layers of the skin.
76
what is the pathophysiology of urticaria?
it is a hypersensitvity reaction with mast cell activation leading to histamine release. the vasodilation of the vessels causes the erythematous appearance of the skin. if the oedema occurs in deeper tissue such as the lower dermis or subcut then it is ANGIOOEDEMA
77
what is acute urticaria and what are potential triggers?
acute urticaria is urticare where symptom onset is rapid but resolves within 48 hours triggers: allergens, viral infection, skin contact with chemicals, physical stimuli
78
what is chronic urticaria and what are potential triggers?
chronic urticaria refers to patiens whose symptoms last longer than 6 weeks triggers: chronic spontaneous urticaria, autoimmune
79
what are the clinical features of urticaria?
central itchy white papule or plaque surrounded by erythematous skin. lesions vary in size + shape may have angiooedema
80
what is this?
urticaria
81
what is this?
urticaria
82
management of chronic plaque psoriasis
1. topical potent corticosteroid (betamethasone) + topical calcipotriol (Vit D) 2. Vitamin D analogue BD + OD steroid 3. BD steroid + BD vit D _+_ coat tar 4. phototherapy - narrowband UVB 5. systemic - methotrexate, ciclosporin, infliximab

IK6 - Exams (24 decks)

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