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Dermatology Flashcards

1
Q

What is the cutaneous manifestation of SLE?

A
  • Photosensitive ‘butterfly’ rash
  • Discoid lupus
  • Alopecia
  • Livedo reticularis: net-like rash
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2
Q

What is the big patch found in pityriasis rosea called?

A

Herald patch

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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

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4
Q

What is the management of Pityriasis rosea?

A

Self limiting - usually disappears after 6-12 weeks

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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.
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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.

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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
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8
Q

What is the first line treatment used for mild symptoms of roscea?

A

Topical metronidazole

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9
Q

What is the treatment for patients with roscea who have predominant flushing but limited telangiectasia?

A

Topical Brimonidine gel

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10
Q

What is the treatment for severe roscea?

A

Oxytetracycline

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11
Q

What is the treatment for roscea with prominent telangiectasia?

A

LAser therapy

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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

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13
Q

Which cardiac medication is known to cause worsening of psoriatic plaques?

A

Bisoprolol

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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
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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
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16
Q

What is the cause of onychomycosis?

A

fungal infection of the nails - Trichophyton rubrum

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17
Q

What is the management of onychomyosis?

A

Oral terbinafine - 1st line

Oral itraconazole - alternative

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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

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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

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20
Q

what are the things that exacerbate roscea?

A

Sunlight, pregnancy , certain drugs and food

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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

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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

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23
Q

What is the characteristic feature of leukoplakia?

A

persistent white plaques which cannot be scraped off

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24
Q

What are the causes of leukoplakia?

A

tobacco smoking

alcohol consumption

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25
Q

What can leukoplakia develop into?

A

Squamous cell carcinoma

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26
Q

What are the 6 Ps of lichen planus?

A 
Pruritic
Polygonal
Planar (flat- topped)
Purple papules
Plaques
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27
Q

What are the differentials for a white tongue lesion that are hard to be scraped away?

A

Candiasis

Lichen planus - lace-like pattern - wickham striae

Leukoplakia - white plaques

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28
Q

What is the tx for scabies?

A

permethrin 5% is first-line

malathion 0.5% is second-line

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29
Q

What is the diagnostic criteria for herediatry haemorrhagic telegiectasia?

A

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
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30
Q

What are the drugs known to induce Toxic epidermal necrolysis (TEN)?

A 
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
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31
Q

What is the tx of TENS?

A
  1. stop precipitating factor
  2. supportive care - often in ICU
  3. IV Ig - commonly used 1 st line
    immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis
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32
Q

What is the treatment of lichen sclerosus?

A

topical steroids and emollients

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33
Q

What is the typical prodrome of guttate psoriasis?

A

Classically preceded by a streptococcal sore throat 2-4 weeks
Onset - acute - over days

34
Q

What is the clinical feature of erythema mutiforme?

A
  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
Q

What are the causes of erythema mutliforme?

A
  • 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
Q

What is the tx of seborrheic dermatitis?

A

topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods
difficult to treat - recurrences are common

37
Q

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

A

Topical betamethasone

38
Q

What is the self-care advice given for mollascum contagiosum?

A
  • 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
Q

What is the prognostic marker of malignant melonama?

A

depth of the tumour

40
Q

is it normal for prutitus to persist after 4-6 weeks of treatment for scabies?

A

YES

does not need re-treatment

41
Q

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?

A

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
Q

Who is at risk of developing a strawberry naevus?

A
  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
Q

What is the treatment of strawberry naevus?

A

If treatment is required (e.g. Visual field obstruction) then propranolol is increasingly replacing systemic steroids as the treatment of choice

44
Q

What is the investigation required for venous ulcerations?

A

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
Q

What is the mx of venous ulcers?

A

compression bandaging, usually four layer (only treatment shown to be of real benefit)

oral pentoxifylline, a peripheral vasodilator, improves healing rate

46
Q

how do you differentiate atopic eruption of pregnancy from polymorphic eruption of pregnancy ?

A

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
Q

What are the causes of erythema nodosum?

A

NODOSUM

NO cause 
Drugs - penicillins, sulphonamides
Oral contraceptives, pregnancy
Sarcoidosis or lofgren syndrome 
Ulcerative colitis, bechchet
MIcrobiology: TB, HSV, EBV, HIV, Campylopbacter, syphilis
48
Q

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?

A

Milia - keratin filled cysts - appears around the face

will resolve spontaneously over a few weeks

49
Q

Drugs causing TENs/SJS ?

A

Never press skin as it can peel

NSAIDs
PhenytoinSulphonamides
Allopurinol
IV IG
carbamezepine 
pencillins
50
Q

What are the exacerbating factors of psoriasis?

A
  1. trauma
  2. Alcohol
  3. Drugs - beta blockers , lithium, antimalarials , NSAIDs and ACEi, infliximab
  4. Withdrawal of systemic steroids
51
Q

What is a marjolin ulcer?

A

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
Q

What are the features suggestive of liposarcoma over lipoma?

A

Size >5cm
Increasing size
Pain
Deep anatomical location

53
Q

Which conditions does koebner phenomenon affect?

A
  1. Psoriasis
  2. Vitiligo
  3. Lichen planus
  4. warts
  5. lichen sclerosus
  6. molluscum contagiosum
54
Q

What are the conditions associated with vitiligo?

A
  1. T1DM
  2. Addison’s disease
  3. Autoimmune thyroid disorder
  4. pernicious anaemia
  5. alopecia areta
55
Q

what does the mx of vitiligo entail?

A
  • 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
Q

What is the 1st line tx for impetigo?

A

if patient is not systemically unwell - hydorgen peroxide 1% cream

2nd line - topical fusidic acid

57
Q

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?

A

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
Q

How do you differentiate nodular melonama from superficial spreading melanoma

A

superficial spreading - growing mole

Nodular - red or black lump which bleeds or oozes

59
Q

How do you differentiate malignant melonama from seborrhoeic keratosis?

A

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
Q

what are the triggers of guttate psoriasis?

A

streptococcal infections

61
Q

what are the triggers of guttate psoriasis?

A

streptococcal infections

62
Q

how do you differentiate between spider naevi and teleangiectasia?

A

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
Q

what are the drugs causing gynecomastia?

A

Some Hormones Create DD Knockers

Spironolactone
Hormones (oestrogen etc.)
Cimentidine
Digoxin/Dopa
Ketoconazole
64
Q

What is the mx of chronic plaque psoriasis?

A
  1. potent corticosteroid applied once daily plus vitamin D analogue - upto 8 week on steroids
  2. vitamin D analogue twice daily after that
65
Q

what are the features of pompholyx eczema?

A

small blisters on the palms and soles
pruritic - often intensely itchy and sometimes burning sensation

tx - cool compress, emollients and topical steroids

66
Q

what are the side-effects of retinoids?

A
  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
  8. photosensitivity
67
Q

what is the nasal complication seen with acne roscea?

A

rhinophyma

68
Q

What are the drugs that trigger psoriasis?

A

B-blockers, Anti-malarials, Lithium, Indomethacin/NSAIDs (BALI)

69
Q

what are the conditions causing pyoderma gangrenosum?

A
  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
Q

what are the other autoimmune disorders?

A
  1. vitiligo
  2. hashimoto’s thyroiditis
  3. pernicious anaemia
  4. SLE
  5. alopecia areate
  6. T1DM
  7. addisons disease
71
Q

what is the treatment for erythasma?

A

Topical antibiotic treatment (e.g., clindamycin, erythromycin)

systemic Abx treatemnt - erythromycin

72
Q

what are the causes of erythema multiforme?

A
  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
Q

how do you differentiate acitinic keratosis from seborrheic keratsois?

A

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
Q

what are the different types of burns and what do they present like?

A

Superficial –> blanching erythema
Superficial dermal –> blisters
Deep dermal –> white; and patches of non-blanching erythema
Full thickness –> painless

75
Q

how long do you need to wait before considering another course of topical steroids in a patient with psoriasis?

A

aim 4 weeks break

76
Q

what is the first line tx for psoriatic plaques?

A

Topcial steorid + topical calcipotriol

77
Q

where is the typical location of venous and arterial ulcers?

A

vEnous - mEdial

Arterial - lAteral

78
Q

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?

A

Pompholyx eczmea

79
Q

what is the treatment for scalp psoriasis?

A
  1. Use of potent topical corticosteroids for 4 weeks

2. 4 weeks after - use different formulation /topical agents

80
Q

what is the tx of face, flexural or genital psoriais?

A

mild or moderate potency corticosteorids applied once or twice daily for a maximum of 2 weeks

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