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Y3 GP > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the A-E approach used in dermatology?

A 
A- asymmetrical?
B- Borders
C- colour
D-diameter
E- evolving
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2
Q

if a melanoma is suspected what investgiation needs to occur?

A

2 week wait referral to be biopsied

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3
Q

when would a melanoma be suspected?

A 
irregular looking naevus 
indistinct borders 
mild asymmetry 
irregularity of colour
inflammation 
oozing/crusting 
change in sensation
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4
Q

what are some risk factors of melanoma?

A
  • FHx of melanoma
  • Personal Hx of melanma
  • immunosupression
  • XS UV light exposure
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5
Q

what is the managment of a melanoma in primary care ?

A
  1. biopsy on 2 wk wait referral
  2. give advice on UV protection
  3. come back if other moles look simialr/irregular
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6
Q

what is the managemnt of a benign pigmented lesion?

A

if high degree of confidnece, reaasure patient

provide them with info regarding changes that suggest malignant transformation

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7
Q

what are the features of contact dermatitis?

A

erythema and vesiculation
- dryness, scaling and bullae
can be itchy in allergic contact dermatitis

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8
Q

how is contact dermititis managed?

A
  • avoid trigger
  • no aqueous creams
  • topical corticosteroid prescribed
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9
Q

what are teh clinical features of acne vulgaris

A
  • comedones (white or black)
  • papules and pustules (superficial raised lesions less than 5mm in diameter)
  • nodules or cysts (larger than 5mm in diameter)
  • scarring
  • pigmentations
  • seborrhoea
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10
Q

what is the management of acne vulagris?

A
  • discuss reasons for acne
  • OTC treatment options
  • topical retinoids and oral tetracyclines
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11
Q

how does psoriasis present?

A
  • widespread monomorphic erythematous plaque
  • covered by silvery white scale
    0 usually found on scalp, behind ears, trunk, buttocks, periumbilical, extensor surfaces
  • clear delineation between normal and affected skin
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12
Q

what is the management of psoriasis?

A
  • stop smoking, xs alcohol
  • weight loss
  • reduce stress
  • emollients
  • corticosteroids topical
  • vitamin D
  • possible salycylic acid
  • follow up within 4 wks
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13
Q

what is the presentation of a patient with a fungal infection?

A

single or multiple red or pink, flat or slightly raised annular patches of varying sizes which enlarge outwards
active red, scaly advancing edge and clear central area, larger lesions and coalescence of lesions
rare but could have pustules
most commonyl affects: inguinal folds, proximal medial thighs, perinanl skin, buttock, above waistline, below breasts

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14
Q

what is the manageent of a skin fungal infection?

A
  • wash sheets, loose fitting clothes, good hygeine
  • topical antifungal cream (clotrimazole, miconazole, or econazole cream)
  • consider topical corticosteroid (hydrocortisone 1%) for 7 days
  • if v severe, consider oral antifungals (oral terbinafine)
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15
Q

what is the presentation of a basal cell carcinoma?

A
  • irregular borders, asymmetrical
  • dome shaped papule
  • prominent telangiectatic surface vessels
  • appears on areas exposed to UV
  • lesions enlarge with time
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16
Q

what is the referral recommendation for basal cell carcinomas?

A
  • only do 2 wk wait referral if particular concern that a delay may have a significant impact
  • basal cell carcinomas are most common type of skin cancer and least deadly
17
Q

what is the management for a basal cell carcinoma and squmous cell carcinoma?

A 
referral to dermatologist
biopsy taken 
1. excision surgery 
2. cyrotherapy 
3. radiotherapy 
4. photodynamic therapy 
5. Mohs micrographic surgery
18
Q

what is the referral recommendation for a squamous cell carcinoma?

A

consider a 2 week wait referral

19
Q

what is teh presenation of a squamous cell carcinoma?

A
  • firm, smooth or hyperkeratotic papule or plaque, oftne with central ulceration
20
Q

what is the presenation of eczema?

A

generalized dryness and itching localised to flexure of limbs
thickened (lichenified) skin resulting from repeated scratching.
poorly demarcated redness to fluid in the skin (vesicles), scaling, or crusting of the skin - in acute ezcema flare

21
Q

what is the management of eczema?

A

mild: emollients + mild topical corticosteroid (1% hydrocortisone)
moderate: refer, emollients + potent topical corticosteroid (betamethasone valerate 0.025%), consider antihistamines for 1 month
severE: refer, emollients + potent topical corticosteroid (betamethasone valerate 0.1%, 0.025% for sensitive areas), antihistamines for 1 month

22
Q

what is the presenation of a patient with urticaria?

A

3 features:

  • A central swelling of variable size (red or white in colour), surrounded by redness (flare).
  • itching or burning.
  • fleeting, with the skin returning to its normal appearance, usually within 1–24 hours.

> 6 wks = chronic urticaria

23
Q

managment of a patient iwht urticaria?

A

manage causes/trigger factors (if mild)
non sedating antihistmaine for 6 wks (if moderate)
topical antipruritic treatment (calamine lotion) to relieve itch
oral corticosteroid -prednisolone 40 mg daily, 7 days (if severe)

24
Q

what is the presenation of a patient with cellulitis?

A

acute onset of red, painful, hot, swollen, and tender skin, that spreads rapidly - usually lower limb
Fever, malaise, nausea, shivering, and rigors
diffuse redness or a well-demarcated edge
Blisters and bullae may be seen

25
Q

what investgiatiosn can be done for cellulitis?

A

A swab for culture - MAIN

  • ultrasonogrpahy
  • skin biopsy
  • WCC, esr, CRP
26
Q

management of cellulitis?

A

for class I cellulitis (no signs of systemic toxicity and no uncontrolled comorbidities) manage in primary care:

  • elevate leg, drink fluids, avoid compression, mark area w a pen
  • paracetamol/ibuprofen
  • oral flucloxacillin 500–1000 mg QID for 5–7 days, if pencillin allergic then clarithromycin 500 mg BID for 5–7 days
27
Q

what are the clinical features of shingles?

A
  • prodromal phases of skin burning, stabbing or throbbing - can be intermittent or constant
  • headache
  • photophobia
  • malaise
  • fever
  • in 2-3 days rash appears in dermatomal distribution
28
Q

describe the shingles rash

A

maculopapuar lesions then develops into clusters of vesicles - painful, itchy, tingly, vesicles burst and crust over
healing occurs over 2-4 weeks

29
Q

what is shingles?

A

viral infection of an individual nerve and the skin surface that is served by the nerve - caused by varicella zoster that causes chicken pox

30
Q

how do you manage a patient with shingles?

A
  • oral antiviral treatment - aciclovir 7 days (prescribe within 72 hrs of rash onset)
  • manage pain
  • ## avoid ppl who havent has chicken pox
31
Q

when do you admit a person with shingles?

A
  • hutchinsons signs
  • visual symptoms
  • severely immunocompromised (meningitis, encephalitis, myelitis)
  • serious complications
32
Q

how can shingles be prevented?

A

shingles vaccination

to immunocomprimised over >70

33
Q

what are the clinical features of scabies?

A
  • pruritus - particularly at night
  • linear burrows - wavy threadlike whitesh gray lines
  • symmetric erythematous papules, often excoriated (fingers, flexor aspects, nipples, penic, umbilica, buttocks, upper medial aspect of thighs)
  • nodules - common on penis and scrotum, buttocks, groins, axilla
34
Q

how do you manage scabies in primary care?

A

non crusted scabies: topical insecticide (premethrin 5% cream) apply to whole body ,once a week for 2 wks, cool dry skin (including face and scalp in immunocomprimiseD)
wash bed sheets, towels etc

crusted scabies: topical insecticide and oral ivermectin

age <2 months: specialist advice needed pead dermatologist

35
Q

what are the clinical features of rosacea?

A
  • phymatous changes - fibrosis and facial skin thickening
  • persistent erythema - centerofacial redness
  • flushing
  • inflammatory papules an dpustules
  • telangiectasia
  • ocular manifestations: eye discomfort, irritation, tearing
36
Q

management of rosacea?

A
  • may relapse after treatment
  • remove triggers (dairy)
  • sunscreen and sunglasses
  • regular non oily emollients if skin dry
  • gentle soap free otc cleansers
  • if persistent erythema: topical brimonidine 0.5% gel once daily
  • if mild to moderate papules or pastules: topical ivermectin once daily 8-12 wks (can be presicbred together with oral doxycycline if sevre paupules/pustules)

Y3 GP (10 decks)

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