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MSRA 2022 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Where is the most common site of keloid scar formation?

A

Sternum (other common sites = shoulders, neck + face, extensor surfaces of limbs)

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2
Q

What is the typical presentation of acne rosacea?

A

Commonly transient erythema initially, progressing into erythematous rash of papules and pustules and telangiectasia involving nose and cheeks, may progress into rhinophyma in late stage.

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3
Q

What are the different layers in the structure of the skin?

A

Epidermis (avascular, 4 x layers : corneum, granulosum , spinosum and basale. 3x main cells: keratinocytes (secrete extracellular proteins and lipids and store the melanin), melanocytes (neural crest derived cells that produce melanin and migrate to the skin at the end of the 1st trimester) and langerhan cells (the immune cells of the skin).
Dermis (vascular. Extracellular matrix of collagen and elastin secreted by fibroblast cells. Mast cells are the immune cells of the dermis)

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4
Q

What is the common presentation of livedo reticularis?

A

A purple lace like, non-blanching rash often on the legs caused by swollen venules. Commonly seen in the elderly and exacerbated by the cold, association with SLE.

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5
Q

Treatment of acne rosacea?

A

1st advise on avoiding triggers (food diary, avoid UV etc)
1st line topical treatment for erythema = topical brimonidine 0.5% gel OD for temporary relief of redness onset within 30 mins and lasting around 3-6 hours).
For papules / pustules = topical ivermectin (a topical insecticide) OD for 8-12 week course. Topical metronidazole or azelaic acid can be used for papulopustular rosacea if ivermectin contraindicated eg pregnancy. If severe / limited improvement, can add course of oral doxycycline

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6
Q

What is the classical presentation of pretibial myxoedema?

A

Symmetrical erythematous rash over shins with ‘orange peel’ texture seen in Grave’s disease (antibodies to TSH receptor which active release of thyroid hormones = hyperthyroidism).

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7
Q

What is the typical presentation of erythema nodosum and what are some of the most common causes?

A

RAPID onset TENDER red nodules all over the shins.
A hypersensitivity reaction as a result of either:
* Drugs - penicillin antibiotics, sulfasalazine or COCP
* Acute bacterial or viral infection
* Inflammatory bowel disease

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8
Q

What are the 2 main categories of alopecia?

A

Scarring (destruction of the hair follicle) and non-scarring (preservation of the hair follicle)

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9
Q

What are common causes of scarring alopecia?

A
  • discoid lupus
  • lichen planus
  • trauma / burns
  • radiotherapy
  • tinea capitis (ringworm of the scalp - caused by trichophyton and microsporum dermatophyte species)
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10
Q

What are common causes of non-scarring alopecia?

A
  • Drugs - carbimazole, heparin, COCP, colchicine
  • Iron deficiency
  • Zinc deficiency
  • Alopecia areata (an autoimmune condition)
  • Telogen effluvium = hair loss after a stressful period
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11
Q

What is the Fitzpatrick system?

A

Grades the way your skin responds to the sun.
Fitzpatrick grade I = very fair, always burns never turns, typically freckly / ginger etc
Fitzpatrick grade V = very brown or black

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12
Q

Which skin conditions are associated with diabetes mellitus?

A
  • Necrobiosis lipoidica (painless shiny area of yellowy/brown skin typically on the shin)
  • ^ risk of infection (candida, staph)
  • Vitiligo (patches of depigmented skin due to loss of melanin)
  • Lipoatrophy (localised loss of fat tissue leading to dimpling in the skin -> associated with autoimmune conditions but also with the repeated subcut injections of insulin)
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13
Q

How should capillary haemangiomas be managed?

A

They may be present at birth or develop within the first 6 months of life.
~ 80% of haemangiomas stop growing by 5 months then they plateau then they shrink. The majority resolve by 10 years of age.
Haemangioms near the eye need close monitoring.
If they begin to affect vision / don’t resolve - PROPRANOLOL is 1st line treatment. If this fails, can try laser therapy or systemic steroids.

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14
Q

What is the first line treatment for psoriasis of the trunk + limbs

A

1) Potent topical corticosteroid + either oral vitamin D or topical vitamin D applied separately to the steroid (ie one in the morn and one in the eve) for upto 4 weeks, max 8 wks
2) if steroid + vit D fails after 8 wks -> vit D BD
3) If BD vit D fails -> BD topical steroid OR topical coal tar OR OD calcipotriol (vit D) + betamethasone cream for upto 4 wks

4) if all else fails
- > VERY potent topical steroid under specialist supervision
- > phototherapy = NARROW BAND UV B
- > photochemotherapy = PUVA = Psoralen + UVA
- > systemic therapies -> Methotrexate 1st line oral agent in psoriasis. other options = retinoids, ciclosporin, infliximab

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15
Q

What is the 1st line treatment for scalp psorasis?

A

1) Topical corticosteroid OD for upto 4 wks
2) if no improvement, consider pre-steroid exfoliant / salicylic acid or a different preparation of the steroid eg a shampoo
3) If no improvement then = calcipitriol + betamethasone OR vitamin D
4) -> very potent steroid for upto 2 wks OR coal tar -> if these fail then refer to specialist.

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16
Q

What is the 1st line treatment for facial / flexure or genital psoriasis?

A

Mild/moderate steroid for max 2 wks

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17
Q

Can vitamin D analogues for psoriasis be used in pregnancy?

A

NO - vit D analogues should be avoided in pregnancy

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18
Q

Typical presentation of lichen planus?

A

Itchy raised flat-topped lesions on the flexor surfaces / palms (have fine white lines on the surface = Wickham’s striae)
May have associated oral lichen planus = lacy white pattern in the mouth

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19
Q

What is the typical presentation of dermatitis herpetiformis and what condition is it associated with?

A

++ ITCHY blistering rash on reddened skin on the elbows, ankles and shoulders
Men > women
(looks similar to shingles hence the name herpetiformis)
Associated with COELIAC DISEASE -> Tx = Dapsone + gluten-free diet

20
Q

What are risk factors predisposing to SLE?

A
  • Sunlight exposure
  • Genetic predisposition -> HLA-B8 and DR3
  • Viral infection including Epstein-Barr
  • Emotional stress
  • Toxins including smoking
  • Females > males
21
Q

What proportion of SLE patients get skin manifestations and what types of skin manifestations are there in SLE?

A 
80% get cutaneous SLE. 
Malar rash -> butterfly rash sparing the nasolabial folds 
Bullous SLE -> blistering rash 
Non-scarring alopecia 
Photosensitivity
22
Q

What is the typical presentation of dermatomyositis and what conditions is it associated with?

A

Inflammation of striated muscle. Diagnosis = muscle biopsy. Anti-Jo1 + Anti-Mi2 antibodies.
Associated with malignancy, especially lung + breast cA

Presents w/

  • muscle weakness
  • heliotrope rash (red/purple rash over the eyelids)
  • Gottron’s papules (red papules over the knuckles)
  • macular rash over the shoulders (shawl sign)
23
Q

What is the typical presentation of erysipelas?

A

erysipelas = superficial form of cellulitis
typically with STREP PYOGENES
Presents w/ localised, tender, well-defined edge.
Old age + immunodeficiency including diabetes is a risk factor

24
Q

Erythema ab igne?

A

Patchwork / reticulated rash due to exposure to hot water bottle / sitting near fire etc

25
Q

What is the typical presentation of Bowen’s disease?

A

Bowen’s disease = slow-growing isolated red scaly plaque
-> linked to arsenic exposure
= SCC in situ (hasn’t invaded the BM) -> progression to SCC is rare
Tx = cryotherapy or topical 5-fluorouracil

26
Q

What drugs can be used to treat male-pattern baldness?

A

Regaine

Finasteride

27
Q

Recommended management of rosacea?

A

1) Lifestyle advice -> avoid triggers -> high factor SPF, non-oily emollients
2)
1st line topical or oral agents (dictated by pt preference and rosacea type)
* If erythema -> Topical brimonidine PRN (reduces erythema for a few hours, may make telangiectasia worse)
* if papules,
Mild/mod = topical ivermectin (course for upto 12 wks for papules/pustules) (alternative = topical metronidazole or azelaic acid eg if pregnant)
Severe = topical ivermectin + oral doxycycline/oxytetracycline for upto 12 wks (alternative = oral erythromycin if pregnant/BF)

28
Q

Presentation + Dx of tinea capitis?

A

Scalp ringworm
Dx = wood lamp -> see bright green fluoresence of hair infected by fungi
Occurs mainly in children, immunosuppression + afrocarribean ancestry = risk factors

29
Q

Presentation + Mx of seborrheic dermatitis?

A

Red scaly rash on the face (including nasolabial folds) eyebrows = overgrowth of skin yeasts
Tx = Daptakort = hydrocortisone + miconazole

30
Q

Presentation + mx of allergic contact dermatitis?

A

Itchy red scaly rash where had contact with allergen (nickel or chromate)
Tx = avoidance + topical steroid

31
Q

What is the main method of transmission of plantar warts (verucas)

A

INDIRECT physical contact (virally infected scales on the floor of swimming pools etc)

32
Q

Which skin lesions does sunscreen prevent recurrence of

A

Prevents recurrence of SCC but NOT BCC!!

33
Q

Which herpes simplex causes oral versus genital herpes?

A

oral herpes simplex = HSV1

genital herpes = HSV2

34
Q

which dermatophytes cause tinea corporis?

A

trichophyton, microsporum and epidermophyton

35
Q

typical presentation of erythema toxicum / neonatal urticaria

A

widespread papular rash in the first 2 weeks of life

self-resolves

36
Q

1st line treatment for severe urticaria?

A

Prednisolone 40mg OD + Cetirizine 10mg od (non drowsy)

37
Q

typical presentation of pyoderma gangrenosum?

A

painful skin ulcer normally on the shin
associated w/ ulcerative colitis, crohn’s, rheumatoid and hepatitis
Tx -> debridement and topical steroids

38
Q

pityriasis rosacea typical presetation?

A

initial herald patch (normally on the trunk, bright red + scaly)
follwed by a christmas tree rash spreading out from the trunk several weeks later

39
Q

typical rash of bacterial exanthem (eg in scarlet fever)?

A

BLANCHING MACULOPAUPULAR red rash starts on chest -> limbs

Scarlet fever = (group A strep -> strep pyogenes)

40
Q

typical rash of viral exanthem ?

A

BLANCHING MACULOPAPULAR RASH starts on FACE then -> body

41
Q

typical presentation of erythema multiforme ?

A

= widespread target lesion rash
mostly associated with recent HERPES SIMPLEX infection
(less commonly can be triggered by medications or vaccinations)

If significant mucus membrane involvement = erythema multiforme major

42
Q

typical presentation of steven-johnson syndrome / toxic epidermal necrosis (TEN) ?

A

A RARE but dangerous condition in response to a medication (normally within a few days or weeks of starting an antibiotic or anticonvulsant but can get with virtually any medication)

-> prodrome of feeling unwell with fever + URTI symptoms then a RAPIDLY spreading rash rash with SIGNIFICANT MUCOSAL INVOLVEMENT

43
Q

Tx of scabies?

A

Permethrin

44
Q

typical presentation of pemphigus vulgaris versus bullous pemphigoid?

A

Pemphigus vulgaris -> middle age -> antibodies to desmoglein 1 and 3 - superficial blisters that break easily with buccal / oral involvement, NON-ITCHY

Bullous pemphigoid -> older -> deeper more robust blisters, ITCHY

Both can be seen on immunofluoresence but the IgG is more superficial in pemphigus vulgaris whereas deeper / on the BM in bullous pemphigoid

45
Q

typical appearance of a sebaceous cyst?

A

Firm mass with a PUNCTUM (because it arises from an blocked hair follicle)

MSRA 2022 (23 decks)

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