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MSRA Revision > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Vitiligo

  1. Appearance?
  2. Pathophysiology?
  3. Treatment?
A

Vitiligo

  1. Depigmentation of skin
  2. Autoimmune attack on melanocytes
  3. Sunblock, make-up to camouflage it, topical steroids, phototherapy, Tacrolimus last line
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2
Q

Lichen Sclerosus

  1. Pathophysiology?
  2. Epidemiology?
  3. Appearance?
  4. Associated risks?
  5. Treatment?
A

Lichen Sclerosus

  1. Inflammatory condition
  2. Elderly women
  3. Itchy white spots on vulva and inner thighs
  4. Increased risk of vulval cancer
  5. Emollients, topical steroids
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3
Q

Pityriasis Versicolor

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Pityriasis Versicolor

  1. Pathophysiology - superficial fungal infection
  2. Appearance and clinical features - Mildly itchy lesions on the trunk (hypoigmented / pink / brown patches +/- scaling)
  3. Treatment - Antifungal shampoo
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4
Q

Acne Rosacea

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Acne Rosacea
1. Pathophysiology - unclear, chronic condition
2. Appearance and clinical features - Facial flushing, erythema + papules, end stage rhinophyma
3. Treatment -
Mild = topical metronidazole
Severe = PO Abx
Flushing = topical Brimiodine gel
Suncream, laser therapy, camouflage make-up
No role of steroids!

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5
Q

Seborrheic Dermatitis

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Seborrheic Dermatitis

  1. Pathophysiology - inflammatory reaction to skin fungal flora in skin folds
  2. Appearance and clinical features - Skin-folds and scalpe, eczematous inflamed lesions. Seen more in HIV and Parkinson’s
  3. Treatment - Head-and-shoulder shampoo, topical Ketoconazole, steroids 2nd line
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6
Q

SJS/TENS

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

SJS/TENS

  1. Pathophysiology - drug eruption (90%), commonly antibiotics, anti-convulsants, allopurinol
  2. Appearance and clinical features - flu-like prodrome, painful+++ red erythematous rash -> blistering. +ve Nikolsky sign (skin shearing with lateral force), mucosal involvement
  3. Treatment - Stop precipitant, supportive / ICU care, IVIg
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7
Q

Acne Vulgaris

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Acne Vulgaris
1. Pathophysiology - Inflammatory skin reaction
2. Appearance and clinical features - adolenscence, varying comedomes and eruptions / pustules on face / back / neck / chest
3. Treatment -
1, Topical benzoyl peroxide or retinoid
2, Combination of above
3, Topical antibiotics
4, Oral antibiotics 3m with ongoing topical BP / retinoid
5, COCP if female
6, PO Isotretinion

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8
Q

Granuloma Annulare

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Granuloma Annulare

  1. Pathophysiology - chronic inflammatory hypersensitivity reaction
  2. Appearance and clinical features - Young females. Hands / feet, annular, smooth papules / plaques (centrally depressed, coloured / red bumps, often over joints)
  3. Treatment - self-resolves, topical steroids if not
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9
Q

Erythema Multiforme

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Erythema Multiforme

  1. Pathophysiology - hypersensitivity reaction triggered by HSV
  2. Appearance and clinical features - Flu-like prodrome, eruption of few-hundreds ot target lesions, start on hands feet and extend to trunk. Polymorphous and may involve mucosa
  3. Treatment - usually self-resolves, if not Pred / Aciclovir
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10
Q

Pityriasis Rosea

  1. Pathophysiology?
  2. Appearance and clinical features?
  3. Treatment?
A

Pityriasis Rosea

  1. Pathophysiology - Viral rash
  2. Appearance and clinical features - started with “Herald” patch on trunk (single plaque, pink/red, with central pallor), then days later multiple scaly patches over chest and body
  3. Treatment - self-limiting
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11
Q

Psoriasis

  1. Pathophysiology?
  2. Sub-types and appearances?
  3. Triggers?
  4. Treatment - plaque psoriasis?
  5. Max duration of steroids?
A

Psoriasis
1. Pathophysiology - chronic autoimmune disorder
2. Sub-types and appearances
Plaque psoriasis - well demarcated red patches with silver plaques on extensor surfaces
Flexural - red patches in skin folds
Guttate - widespread (trunk), multiple teardrop plaques
Scalp - on scalp
Pustular - pustules on palms, soles
Nail disease - onycholysis and pitting
Psoriatic arthropathy
3. Triggers - traume (koebner), Alcohol, drugs, withdrawal of steroids, strep infection (=guttate)
4. Treatment - plaque psoriasis
1 - Topical steroids / topical Vit D analogues (apply separately)
2 - Vit D analogues BD
3 - Steroids BD
4 - Phototherapy / oral MTX (secondary care only)
5. Max duration of steroids - 8 weeks if potent, 4 weeks if very potent

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12
Q

Shingles

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Shingles
1. Pathophysiology - HZV re-activation in reduced immunity, infection via dorsal nerve roots
2. Appearance / clinical features - dematomal distribution or painful, blistering, papular/pustular lesions
3. Treatment
Zoster vaccine to prevent if >60y
Analgesia
Aciclovir 800mg 5d if caught in 1st 3 days of symptoms

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13
Q

Impetigo

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Impetigo
1. Pathophysiology - S aures / pyogenes infection
2. Appearance / clinical features - children, honey crusting on face / hands
3. Treatment - Anti-septic and hygeine
Systemically unwell = oral Fluclox
Not systemically unwell = 1% hydrogen peroxide cream / topical fusidic acid
Off school for 48hrs after lesions heal or Abx started

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14
Q

Allergic Contact Dermatitis

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Allergic Contact Dermatitis

  1. Pathophysiology - type 4 (delayed) hypersensitivity reaction
  2. Appearance / clinical features - eczema and erythema on areas of contact with allergen, e.g. nickel, hair dye
  3. Treatment - Potent steroids
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15
Q

Irritant Contact Dermatitis

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Irritant Contact Dermatitis

  1. Pathophysiology - non-allergic reaction
  2. Appearance / clinical features - mild erythema, typically hands (soap etc)
  3. Treatment - remove irritant
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16
Q

Atopic Dermatitis (Eczema)

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A 
Atopic Dermatitis (Eczema)
1. Pathophysiology - chronic inflammatory condition
2. Appearance / clinical features - dry and inflamed skin, extensor surfaces
3. Treatment - 
Avoid irritants
Emollients+++
Topical steroids for flares
PO ciclosporin is last resort
17
Q

Eczema Herpaticum

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Eczema Herpsticum
1. Pathophysiology - in people with e zema, severe disseminated HSV infection
2. Appearance / clinical features - clusters of itchy and painful lesions, progressing to systemically unwell with discharging blistering eczematous lesions
3. Treatment - Admit to hospital!
PO Aciclovir +/- Abx if secondary infection

18
Q

Bullous Pemphigoid

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Bullous Pemphigoid

  1. Pathophysiology - Sub-epidermis autoimmune attack
  2. Appearance / clinical features - elderly pts, itchy, tense blisters in flexures that don’t involve mucosa and don’t burst
  3. Treatment - PO/top steroids
19
Q

Pemphigus

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Pemphigus

  1. Pathophysiology - autoimmune attack on dermis
  2. Appearance / clinical features - mucosal ulceration, blisters that break down easily, painful but not itchy
  3. Treatment - Steroids
20
Q

Dermatitis Herpetiformis

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Dermatitis Herpetiformis

  1. Pathophysiology - autoimmune condition in coeliac disease - IgA deposits in dermis
  2. Appearance / clinical features - Extensor surfaces, itchy vesicular lesions
  3. Treatment - gluten-free diet
21
Q

Actinic Keratosis (AK)

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Actinic Keratosis (AK)

  1. Pathophysiology - premalignant lesion
  2. Appearance / clinical features - small crusty / scaly pink/red/brown lesions in sun-exposed skin
  3. Treatment - 5-FU cream
22
Q

BCC

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

BCC

  1. Pathophysiology - benign cancer
  2. Appearance / clinical features - pearly / rolled edges with central ulcer
  3. Treatment - routine referral
23
Q

SCC

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

SCC

  1. Pathophysiology - malignant CA
  2. Appearance / clinical features - enlarging crusted / scaly lumps, may ulcerate
  3. Treatment - 2ww referral
24
Q

Keratocanthoma

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Keratocanthoma

  1. Pathophysiology - type of AK
  2. Appearance / clinical features - dome shaped volcano
  3. Treatment - Surgical excision as may progress to SCC
25
Q

Erythema Ab Igne

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Erythema Ab Igne

  1. Pathophysiology - premalignant lesions secondary to infrared radiation (e.g. fires)
  2. Appearance / clinical features - elderly women with reticulated, erythematous patches
  3. Treatment - refer
26
Q

Lichen Planus

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Lichen Planus

  1. Pathophysiology - T-cell mediated autoimmune attack
  2. Appearance / clinical features - Flat-topped firm papules / plaques with Wickham striae (white lines). Hypertrophic and scaling, mostly on wrists, back and ankles. Itchy+++
  3. Treatment - Topical steroids / tacrolimus / retinoids. PO steroids if widespread, can consider MTX
27
Q

Scabies

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
  4. HIV variant?
A

Scabies

  1. Pathophysiology - burrowing mite infection
  2. Appearance / clinical features - burrowing tracts and surrounding erythema, itchy+++
  3. Treatment - 5% Permethrin 1st line, 0.5% malathion second, treat all household contacts
  4. Crusted scabies - Ivermectin
28
Q

Melanoma

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Prognostication?
  4. Treatment?
A

Melanoma

  1. Pathophysiology - skin CA of melanocytes
  2. Appearance / clinical features - Asymmetry, Border irregularity, Colour variability, Different, Evolving
  3. Prognostication - Breslow thickness / Clark level of invasion, then staging
  4. Treatment - WLE + SN biopsy + immunotherapy may be initiated
29
Q

Alopecia

  1. Scarring alopecia - definition?
  2. Scarring alopecia - causes?
  3. Non-scarring alopecia - definition?
  4. Non-scarring alopecia - causes?
A

Alopecia

  1. Hair follicles destroyed
  2. Trauma, burns, RT, Lichen planus
  3. Hair follicles preserved
  4. Male-pattern baldness, Drugs, nutrition, autoimmune alopecia, stress
30
Q

Erythema Nodosum

  1. Appearance?
  2. Causes?
A

Erythema Nodosum

  1. Tender, erythematous nodules on the shins
  2. Infection, systemic inflammation, malignancy, drugs, pregnancy. IBD!
31
Q

Fungal Nail Disease

Treatment?

A

Only treat if pt unhappy with appearance
Must confirm with microbiology before starting treatment
PO Terbinafine 6w-3m (hands), 3m-6m (feet)
Amorolfine for Candida

32
Q

Molluscum Contagiosum

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Molluscum Contagiosum
1. Pathophysiology - skin infection
2. Appearance / clinical features - pinkish, pearly white papules with central umbilicus, trunk and flexures in children
3. Treatment - self-limiting, but avoid towel sharing etc as contagious+++
Consider HIV in adults

33
Q

Pellagra

  1. Pathophysiology?
  2. Causes?
  3. Appearance / clinical features?
  4. Treatment?
A

Pellagra

  1. Pathophysiology - nicotinic acid deficiency
  2. EtOH, Isoniazid therapy
  3. Appearance / clinical features - 3 D’s: Dermatitis (sun-exposed areas), Diarrhoea, Dementia and depression
  4. Treatment?
34
Q

Pyoderma Gangrenosum

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Pyoderma Gangrenosum

  1. Pathophysiology - inflammatory ulcers related to chronic inflammatory disorders (IBD, RA, SLE, lymphoma, PBC)
  2. Appearance / clinical features - initial red papules on legs, progressing to deep erythematous ulcers
  3. Treatment - PO steroids, immunosuppressants in complex cases
35
Q

Pyogenic Granuloma

  1. Pathophysiology?
  2. Appearance / clinical features?
  3. Treatment?
A

Pyogenic Granuloma

  1. Pathophysiology - cause unknown, but occur more in pregnancy and trauma
  2. Appearance / clinical features - upper body and hands, small red/brown spot that progresses to a large eruptive haemangioma
  3. Treatment - often self-resolve, cautery or cryo if not

MSRA Revision (6 decks)

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