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IK6 - Exams > Dermatology > Flashcards

Dermatology Flashcards

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
Q

what is this?

A

eczema

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26
Q

what is the pathophysiology of erythema multiforme?

A

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

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27
Q

What are some precipitating factors for erythema multiforme?

A

DRUGS - penicillin, phenytoin

INFECTION - HERPES (main factor), EBC, chlamydia, adenovirus

INFLAMMATORY - RA, SLE, sarcoidosis, ulcerative colitis

MALIGNANCY - haematological

radiotherapy

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28
Q

what is the epidemiology of erythema multiforme?

A

2M: 1 F

children + young adults but can affect all ages

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29
Q

What are the clinical features of erythema multiforme?

A
  • classic target (bull’s eye) lesions
  • vesicles/bullae
  • urticarial plaques
  • often symmetrical extending over limbs including palms, soles + extensors
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30
Q

what is this?

A

erythema multiforme

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31
Q

what is this?

A

erythema multiforme

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32
Q

What is erythema nodosum?

A

It is an inflammation of the subcutaneous fat tissue which presents with red/violet subcutaneous nodules

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33
Q

What is erythema nodosum associated with?

A

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
Q

What is the epidemiology of erythema nodosum?

A

3F:1M

young adults most commonly affected

35
Q

what are the clinical features of erythema nodosum?

A

tender red/violet nodules bilaterally on both shins

sometimes thighs + forearms

systemic: fever, anorexia, weight loss, arthralgia (tender painful joints on movement)

36
Q

what investigations may help confirm a diagnosis of erythema nodosum?

A

Bloods -> anti-streptolysin O titres, FBC, CRP, ESR, U&E, serum ACE (sarcoidosis)

throat swab + culture

mantoux test

CXR

37
Q

what is this?

A

erythema nodosum

38
Q

what is this?

A

erythema nodosum

39
Q

what is a lipoma?

A

it is a slow-growing benign adipose tumous usually found in the subcutaneous tissue.

40
Q

What is the epidemiology associated with lipomas?

A

most common in 40-60s

relatively common condition

41
Q

what are the clinical features of a lipoma?

A
  • 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
Q

what is a melanoma?

A

It is a malignancy arising from neoplastic transformation of melanocytes. it is the leading cause of death from skin disease

43
Q

What are the four histopathological types of melanoma?

A
  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
Q

what is the most common type of melanoma?

what is the most aggressive type?

A

common = superficial spreading

aggressive = nodular

45
Q

how do you assess a lesion suspected of being a melanoma?

A

Asymmetry

Border - irregular

Colour - variation within lesion

Diameter - > 6/7mm

Evolution - elevation and progression/change

46
Q

what investigations might you perform if you suspect melanoma?

A

excisional biopsy for histology

lymphoscintography + sentinel lymph node biopsy - locate nodes and check for mets

staging scans

bloods - LFTs as common met site

47
Q

where does melanoma commonly metastasise to?

A

liver

48
Q

what is this?

A

melanoma

49
Q

What is molluscum contagiosum?

A

a skin infection caused by a pox virus usually transmitted by direct skin contact

50
Q

what are risk factors for molluscum contagiosum?

A

actopic eczema

children

immunocompromised

51
Q

what is the epidemiology of molluscum contagiosum?

A

common, usually affects those < 15 years but can affect all ages

most do not seek medical attention

52
Q

what are the clinical features of molluscum contagiosum?

A

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
Q

what is this?

A

molluscum contagiosum

54
Q

what is psoriasis?

A

chronic inflammatory skin condition characterised by lesions. May be complicated by arthritis (psoriatic arthritis)

55
Q

Are there risk factors for different types of psoriasis?

A

guttate psoriasis - strep sore throat

palmoplanter psoriasis - smoking, middle aged F, autoimmune thyroid disease

generalised pustular psoriasis - hypoparathyroidism

56
Q

what is the peak age of onset for psoriasis?

A

20

57
Q

what are the presenting features of psoriasis?

A
  • 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
Q

How many psoriasis patients have psoriatic arthritis?

what are the fatures of psoriatic arthritis?

A

5-8% have it

CLINICAL FEATURES

  • asymmetrical oligomonoarthritis
  • symmetrical polyarthritis
  • distal interphalangeal joint predominance
  • arthritis mutilans (flexion deformity of DIP joint)
  • psoriatic spondylitis
59
Q

what is this?

A

psoriasis

60
Q

what is this?

A

GUTTATE PSORIASIS

small dop-like lesions over the trunk and limbs

61
Q

what is this?

A

PALMOPLANTER PSORIASIS

erythematous plaques with pustules on palms and soles

62
Q

what is this?

A

FLEXURAL PSORIASIS

psoriasis affecting flexor surfaces such as axilla, groin, perianal, genital skin

the plaques are less scaly

63
Q

what is a sebaceous cyst?

A

an epithelium lined, keratinous, debris-filled cyst arising from a blocked hair follicle (aka epidermal cyst)

64
Q

what are the clinical features of a sebaceous cyst?

A

non tender slow growing skin swelling. usually multiple

common in hair growing regions of the body (think face, scalp, trunk and scrotum)

65
Q

what are the clinical features of a sebaceous cyst?

A

smooth tethered lump

overlying skin punctum

may discharge a granular creamy material that smells foul

66
Q

What are the management options for a sebaceous cyst?

A

conservative - leave alone if causing no pt distress

surgical - removal of cyst with LA
medical - Abx if infeciton present

67
Q

what are the possible complications of a sebaceous cyst?

A

infection

abscess formation

recurrence

ulceration

68
Q

what is squamous cell carcinoma?

A

a malignancy of epidermal kertinocytes of the skin

69
Q

what is this?

A

sebaceous cyst

70
Q

what are the risk factors for sqaumous cell carcinoma?

A

UV radiation

radiation

carcinogens

chronic skin disease
HPV
long-term immunosuppression

71
Q

what is the epidemiology of squamous cell carcinoma?

A

20% of all skin cancers

mainly affects MIDDLE-AGES + ELDERLY

light skinned at higher risk

2-3M:1F

72
Q

What are the presenting features of a squamous cell carcinoma?

A
  • keratotic (scaly, crusty) ill defined nodule which may ulcerate
  • recurrent bleeding
  • non-healing
  • often on sun-exposed skin areas
73
Q

what is this?

A

squamous cell carcinoma

74
Q

what is this?

A

squamous cell carcinoma

75
Q

what is urticaria?

A

itchy red blotchy rash from swelling of the superficial layers of the skin.

76
Q

what is the pathophysiology of urticaria?

A

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
Q

what is acute urticaria and what are potential triggers?

A

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
Q

what is chronic urticaria and what are potential triggers?

A

chronic urticaria refers to patiens whose symptoms last longer than 6 weeks

triggers: chronic spontaneous urticaria, autoimmune

79
Q

what are the clinical features of urticaria?

A

central itchy white papule or plaque surrounded by erythematous skin.

lesions vary in size + shape

may have angiooedema

80
Q

what is this?

A

urticaria

81
Q

what is this?

A

urticaria

82
Q

management of chronic plaque psoriasis

A
  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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