Dermatology Flashcards
1
Q
What is the cutaneous manifestation of SLE?
A
- Photosensitive ‘butterfly’ rash
- Discoid lupus
- Alopecia
- Livedo reticularis: net-like rash
2
Q
What is the big patch found in pityriasis rosea called?
A
Herald patch
3
Q
What is the diagnosis when there is a erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer|?
A
Pityriasis rosea
4
Q
What is the management of Pityriasis rosea?
A
Self limiting - usually disappears after 6-12 weeks
5
Q
A 30-year-old man cuts the corner of his lip whilst shaving. Over the next few days a large purplish lesion appears at the site which bleeds on contact.
What is the diagnosis?
A
Pyogenic granuloma
- Overgrowth of blood vessels.
- Red nodules.
- Usually follow trauma.
- May mimic amelanotic melanoma.
6
Q
A 72-year-old man presents with a large nodule on his face. It is friable. There is no regional lymphadenopathy. He is lost to follow up and re-attends several months later. On this occasion the lesion has been noted to resolve with scarring.
A
Keratoacanthoma
Keratoacanthomas may reach a considerable size prior to sloughing off and scarring.
7
Q
What are the features of acne roscea?
A
- Typically affects nose, cheeks and forehead
- Flushing is often first symptom
- Telangiectasia are common
- Persistent erythema with papules and pustules
- Ocular involvement - blepharitis
- sunlight may exacerbate syumptoms
8
Q
What is the first line treatment used for mild symptoms of roscea?
A
Topical metronidazole
9
Q
What is the treatment for patients with roscea who have predominant flushing but limited telangiectasia?
A
Topical Brimonidine gel
10
Q
What is the treatment for severe roscea?
A
Oxytetracycline
11
Q
What is the treatment for roscea with prominent telangiectasia?
A
LAser therapy
12
Q
How do you differentiate basal cell carcioma from malignant melonoma from squamous cell carcinoma?
A
Malignant melanoma - occur from heavy sun expposure and multipigmented
basal cell carcinoma - localised to the face, scalp, nose or ear. Described as pearly-shaped rodent ulcers with telangiectasia and do not metastasize
Sqamous cell carcinoma - tend to have ulceration - increased risk in immunosuppreseed
13
Q
Which cardiac medication is known to cause worsening of psoriatic plaques?
A
Bisoprolol
14
Q
What causes acanthosis nigricans?
A
- Type 2 DM
- Gastrointestinal cancer
- Obesity
- PCOS
- Acromegaly
- Cushing’s disease
- Hypothyroidism
- Familial
- Prader-willi-syndrome
- drugs - COCP, nicotinic acid
15
Q
What are the causes of erythema nodosum?
A
NODOSUM
NO cause (idiopathic in 50%) Drugs: sulfonamides, dapsone OCP Sarcoidosis Ulcerative colitis/Crohn's Micro: Tuberculosis, Streptococcus, Toxoplasmosis
16
Q
What is the cause of onychomycosis?
A
fungal infection of the nails - Trichophyton rubrum
17
Q
What is the management of onychomyosis?
A
Oral terbinafine - 1st line
Oral itraconazole - alternative
18
Q
What are the features of bowen’s disease?
A
red, scaly patches
- slow growing
occur in the sun exposed areas such as the head, neck and lower limbs
19
Q
What is the management of bowen’s disease?
A
Topical 5-fluorouracil - twice daily for 4 weeks
often results in significant inflammation/ erythema. - Topical steroids are given to control this
20
Q
what are the things that exacerbate roscea?
A
Sunlight, pregnancy , certain drugs and food
21
Q
A teenager with history of viral infection and prominent macule in the back, which is followed by oval, erythematois scaly patches, what is the diagnosis and treatment?
A
Pityriasis rosea
It is self-limiting and resolves around 6 weeks
22
Q
52 yr old Afro-caribbean woman
PC: patch of pigmented skin on her toe, enlarging over 5 mths
O/E- pigmentation of nail bed of great toe, affecting the adjacent cuticle and proxmial nail fold.
What type of melanoma?
A
Acral lentiginous melanoma
Hutchinson’s sign - pigmentation of the nail bed
23
Q
What is the characteristic feature of leukoplakia?
A
persistent white plaques which cannot be scraped off
24
Q
What are the causes of leukoplakia?
A
tobacco smoking
alcohol consumption
25
What can leukoplakia develop into?
Squamous cell carcinoma
26
What are the 6 Ps of lichen planus?
```
Pruritic
Polygonal
Planar (flat- topped)
Purple papules
Plaques
```
27
What are the differentials for a white tongue lesion that are hard to be scraped away?
Candiasis
Lichen planus - lace-like pattern - wickham striae
Leukoplakia - white plaques
28
What is the tx for scabies?
permethrin 5% is first-line
| malathion 0.5% is second-line
29
What is the diagnostic criteria for herediatry haemorrhagic telegiectasia?
4 main diagnostic criteria. If 2 - possible diagnosis
If they meet 3 or more - definite diagnosis of HHT:
1. epistaxis : spontaneous, recurrent nosebleeds
2. telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
3. visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
4. family history: a first-degree relative with HHT
30
What are the drugs known to induce Toxic epidermal necrolysis (TEN)?
```
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
```
31
What is the tx of TENS?
1. stop precipitating factor
2. supportive care - often in ICU
3. IV Ig - commonly used 1 st line
immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis
32
What is the treatment of lichen sclerosus?
topical steroids and emollients
33
What is the typical prodrome of guttate psoriasis?
Classically preceded by a streptococcal sore throat 2-4 weeks
Onset - acute - over days
34
What is the clinical feature of erythema mutiforme?
1. Target lesions
2. Initially seen on the back of the hand/feet spreading to the torso
3. Upper limbs are commonly affected than the lower limbs
35
What are the causes of erythema mutliforme?
- viruses: herpes simplex virus (the most common cause), Orf*
- Idiopathic
- Bacteria: Mycoplasma, Streptococcus
- Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
- Connective tissue disease e.g. Systemic lupus erythematosus
- Sarcoidosis
- Malignancy
36
What is the tx of seborrheic dermatitis?
topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods
difficult to treat - recurrences are common
37
52 yr with persistent itchy, rash
several violaceous, polygonal papules and plaques with some overlying white scale, on the palms and flexor surfaces of the arms.
Close examination - mild oncodystrophy
Topical betamethasone
38
What is the self-care advice given for mollascum contagiosum?
- Reassure people that molluscum contagiosum is a self-limiting condition.
- Spontaneous resolution usually occurs within 18 months
- Explain that lesions are contagious, and it is sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings)
- Encourage people not to scratch the lesions. If it is problematic, consider treatment to alleviate the itch
- Exclusion from school, gym, or swimming is not necessary
39
What is the prognostic marker of malignant melonama?
depth of the tumour
40
is it normal for prutitus to persist after 4-6 weeks of treatment for scabies?
YES
| does not need re-treatment
41
A mother brings her 2-week-old baby girl into the surgery for review. She has noted a bright red, well-circumscribed and lobulated lesion developing on her right temple. This wasn't noted at birth but is now 5 mm in diameter. What is the most appropriate management?
It is a strawberry naevus - reassure the mother that most lesions spontaenously regress and suggest review in 3 mths
Tx is only required if the lesion is causing mechanical problem or bleeding
42
Who is at risk of developing a strawberry naevus?
1. Capillary haemangiomas are present in around 10% of white infants.
2. Female infants
3. premature infants
4. those of mothers who have undergone chorionic villous sampling are more likely to be affected
43
What is the treatment of strawberry naevus?
If treatment is required (e.g. Visual field obstruction) then propranolol is increasingly replacing systemic steroids as the treatment of choice
44
What is the investigation required for venous ulcerations?
ABPI is required to assess for poor arterial flow which could impair healing
Normal ABPI is 0.9-1.2
Values below 0.9 and above 1.2 indicate arterial disease
45
What is the mx of venous ulcers?
compression bandaging, usually four layer (only treatment shown to be of real benefit)
oral pentoxifylline, a peripheral vasodilator, improves healing rate
46
how do you differentiate atopic eruption of pregnancy from polymorphic eruption of pregnancy ?
Atopic eruption - presents with prurittic lesions on the extensor surfaces an trunk
Polymorphic eruption - nulliparous women with white skin who have experienced rapid weight gain
- presents at the striae, thought that damage to stretched connective tissue
- umbilical sparing
47
What are the causes of erythema nodosum?
NODOSUM
```
NO cause
Drugs - penicillins, sulphonamides
Oral contraceptives, pregnancy
Sarcoidosis or lofgren syndrome
Ulcerative colitis, bechchet
MIcrobiology: TB, HSV, EBV, HIV, Campylopbacter, syphilis
```
48
A neonate is brought to your surgery because his mother has noticed some skin lesions on his face. On examination there are multiple tiny white papules on the nose. What is the most likely diagnosis?
Milia - keratin filled cysts - appears around the face
| will resolve spontaneously over a few weeks
49
Drugs causing TENs/SJS ?
Never press skin as it can peel
```
NSAIDs
PhenytoinSulphonamides
Allopurinol
IV IG
carbamezepine
pencillins
```
50
What are the exacerbating factors of psoriasis?
1. trauma
2. Alcohol
3. Drugs - beta blockers , lithium, antimalarials , NSAIDs and ACEi, infliximab
4. Withdrawal of systemic steroids
51
What is a marjolin ulcer?
Marjolin's ulcer is a squamous cell carcinoma in an area, such as ulcers (e.g., pressure ulcers, osteomyelitis) and scars (e.g., burn scars)
52
What are the features suggestive of liposarcoma over lipoma?
Size >5cm
Increasing size
Pain
Deep anatomical location
53
Which conditions does koebner phenomenon affect?
1. Psoriasis
2. Vitiligo
3. Lichen planus
4. warts
5. lichen sclerosus
6. molluscum contagiosum
54
What are the conditions associated with vitiligo?
1. T1DM
2. Addison's disease
3. Autoimmune thyroid disorder
4. pernicious anaemia
5. alopecia areta
55
what does the mx of vitiligo entail?
- sunblock for affected areas of skin
- camouflage make-up
- topical corticosteroids may reverse the changes if applied early
- there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients
56
What is the 1st line tx for impetigo?
if patient is not systemically unwell - hydorgen peroxide 1% cream
2nd line - topical fusidic acid
57
39yr old man, presents with new rash on his torso and arms. H/O rash 7 days and in the last 2 days - fever with marked malaise. PMH - asthma and poorly controlled eczema. Has cold sores on out lips
O/E - several monomorphic punched out lesions about 2 mm in diameter, located on both arms and on upper torse. Bilateral axillary lymphadenopathy
what is the likely diagnosis?
Eczema herpeticum - caused by HSV 1
usually associated with people with atopic dermatitis
clinical features - fever, malaise and lymphadenopathy along with extensive painful eruptions
Requires IV acyclovir
58
How do you differentiate nodular melonama from superficial spreading melanoma
superficial spreading - growing mole
Nodular - red or black lump which bleeds or oozes
59
How do you differentiate malignant melonama from seborrhoeic keratosis?
Serborrhoeic keratoisis - typically described as well-circumscribed plaques or papules with a 'stuck on' appearance, and most commonly affect the torso or face. The colour of the lesions can vary, but they are most commonly grey-brown or black.
a malignant melanoma typically varies more in colour, such as brown/blue/black and red. Furthermore, melanomas do not have a 'stuck on' appearance as in this case
60
what are the triggers of guttate psoriasis?
streptococcal infections
61
what are the triggers of guttate psoriasis?
streptococcal infections
62
how do you differentiate between spider naevi and teleangiectasia?
Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge
63
what are the drugs causing gynecomastia?
Some Hormones Create DD Knockers
```
Spironolactone
Hormones (oestrogen etc.)
Cimentidine
Digoxin/Dopa
Ketoconazole
```
64
What is the mx of chronic plaque psoriasis?
1. potent corticosteroid applied once daily plus vitamin D analogue - upto 8 week on steroids
2. vitamin D analogue twice daily after that
65
what are the features of pompholyx eczema?
small blisters on the palms and soles
pruritic - often intensely itchy and sometimes burning sensation
tx - cool compress, emollients and topical steroids
66
what are the side-effects of retinoids?
1. teratogenicity
2. dry skin, eyes and lips/mouth - most common side effect
3. low mood
4. raised triglicerides
5. hair thinning
6. nose bleeds
7. intracranial HTN
6. photosensitivity
67
what is the nasal complication seen with acne roscea?
rhinophyma
68
What are the drugs that trigger psoriasis?
B-blockers, Anti-malarials, Lithium, Indomethacin/NSAIDs (BALI)
69
what are the conditions causing pyoderma gangrenosum?
1. IBD
2. Rheumatological - rhemuatoid arthritis, SLE
3. haematological - myeloproliferative disorder, lymphoma, myeloid leukaemia, monoclonal gammopathy
4. granulamtosis with polyangiitis
5. primary biliary cirrhosis
70
what are the other autoimmune disorders?
1. vitiligo
2. hashimoto's thyroiditis
3. pernicious anaemia
4. SLE
5. alopecia areate
6. T1DM
7. addisons disease
71
what is the treatment for erythasma?
Topical antibiotic treatment (e.g., clindamycin, erythromycin)
systemic Abx treatemnt - erythromycin
72
what are the causes of erythema multiforme?
1. viruses - HSV (the most common cause)
2. idiopathic
3. bacteria - mycoplasma, streptococcus
4. drugs - penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pills
5. connective tissue disease - SLE
6. sarcoidosis
7. malignancy
73
how do you differentiate acitinic keratosis from seborrheic keratsois?
seborrheic keratosis - benign epidermal skin lesions seen in older people. large varition in clooir - have a stuck on apperance
acitinic keratosis - rough, scaly patch on the skin that develops from years of sun exposure - precancerous squamous cell carcinoma
74
what are the different types of burns and what do they present like?
Superficial --> blanching erythema
Superficial dermal --> blisters
Deep dermal --> white; and patches of non-blanching erythema
Full thickness --> painless
75
how long do you need to wait before considering another course of topical steroids in a patient with psoriasis?
aim 4 weeks break
76
what is the first line tx for psoriatic plaques?
Topcial steorid + topical calcipotriol
77
where is the typical location of venous and arterial ulcers?
vEnous - mEdial
| Arterial - lAteral
78
A 32-year-old female presents to her general practitioner with worsening blistering of the fingers and palms of both hands. She has a past history of blistering and fissuring of her hands and recently returned from a holiday in a foreign country with a hot, humid environment. Examination identifies numerous areas of irritable, erythematous vesicles on the palms of both hands.
What is the most likely diagnosis?
Pompholyx eczmea
79
what is the treatment for scalp psoriasis?
1. Use of potent topical corticosteroids for 4 weeks
| 2. 4 weeks after - use different formulation /topical agents
80
what is the tx of face, flexural or genital psoriais?
mild or moderate potency corticosteorids applied once or twice daily for a maximum of 2 weeks
