Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the pathophysiology of Acne Vulgaris?

A

Multifactorial

Follicular epidermal hyperproliferation forms a keratin plug which obstructs the pilosebaceous follicle

Colonisation with P acnes

Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the difference between a whitehead and a blackhead regarding the pilosebaceous unit.

A

Whitehead is when the top is closed thus no [O] cf blackhead is when it is open thus [O] occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the management for Acne fulminans?

A

Hospital admission

Oral steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical features of drug-induced acne?

A

Monomorphic lesions

Steroid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How would you classify acne?

A

Mild (<34 lesions + <1 nodule): open + closed comedones ± inflammatory lesions

34+ lesions + >2 nodules
Moderate: wide-spread lesions + numerous plaques/papules

> 3 nodules
Severe: Extensive inflammatory lesions with nodules, pitting and scarring

Actually mild-to-moderate or moderate-to-severe

Acne Conglobata: Inflammatory nodulocystic with interconnecting sinuses and abscesses -> Severe scarring

Acne fulminans: Severe form of acne conglobata with systemic features of fever, arthralgia and lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline the Acne treatment ladder.

A

Supportive: Face wash (with neutral pH cleanser); avoid oil-based products; reduce make up; try not to scratch/pick

1st: Topical therapy (Retinoid/BPO/ ABX)
2nd: Topical combination therapy

3rd: Oral ABX
Tetracyclines for 3 months

If pregnant, use Macrolides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which management is contraindicated in a pregnant woman with acne?

A

Tetracyclines

Isotretinoin

Note: Ceiling of care is essentially Erythromycin for 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A 27 year old chap presents with severe acne. He says he has had it since he was 17. He reports a fever and lymphadenopathy.

O/E you see multiple communicating nodules which are inflamed.

What is your management?

A. Oral tetracycline for 3 months

B. Oral tetracycline for 6 months

C. Hospital admission and Oral steroids

D. Oral steroids

A

C - This is Acne Fulminans, a severe form of Acne Conglobata with systemic features requiring hospital admission and oral steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the contraindications of Oral Isotretinoin?

A 
Pregnancy/no contraception 
Hyperlipidaemia 
Hypervitaminosis A 
Liver dysfunction 
Allergies to constituents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe atopy.

A

Atopy refers to a predisposition to an abnormally exaggerated IgE response to allergen exposure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of Atopy?

A

Atopic eczema

Allergic rhinitis

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What gene is responsible for the heritability of atopy?

A

MZ 80% concordance

Mutation in FLG gene which codes for Filaggrin protein used to form an effective barrier.

Therefore deficiency allows the access of antigens to penetrate, picked up by CD4+ T helper cells which differentiate and cause an exaggerated IgE response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical features of atopy?

A

Early onset

Eczema - flexural, scaly, itchy, erythematous patches

Rhinitis

Asthma

Note: Afro-Carib ethnicity may have a different distribution with extensor prevalence and pigmentation changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How may atopic eczema be classified?

A

Mild: areas of dry skin with infrequent itching

Moderate: areas of dry skin with frequent itching

Severe: widespread areas of dry skin with itching and extensive skin thickening, bleeding, oozing or cracking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is Atopic Eczema managed?

A

Supportive: Stop triggers; bathing in gentle soaps; food diaries/trigger diaries;

+

Medical: Stepwise approach used

1st: Emollients (vehicle-only) via lotion > cream > ointment or gel/spray

2nd: Topical steroids
Hydrocortisone < Clobetasone 0.05% < Betamethasone 0.1% < Clobetasol 0.05%

In moderate-severe
3rd: Calcineurin inhibitors e.g. Tacrolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the Atopic Eczema treatment ladder.

A

Mild:
Emollient
Mild potency topical corticosteroids

Moderate:
Emollient
Moderate potency steroids
Topical calcineurin inhibitors

Severe: 
Emollients
Potent topical corticosteroids
Topical calcineurin inhibitors 
Bandages/Phototherapy/Systemic therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Does Atopic Eczema ever?

A

Atopic eczema has a tendency to improve as children grow older and transition into adolescence and adulthood.

75% gone by age of 16 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which of the following is not a risk factor for Psoriasis?

A. MHC gene

B. Streptococcal infection

C. Trauma to skin

D. IV Drugs

A

D - IV drugs

Other risk factors include
Iatrogenic: ß-blockers, Lithium, ACEi, Chloroquine

HIV
Smoking
Alcohol
Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the pathophysiology of Psoriasis?

A

Antigen stimulates immune response which causes myeloid dendritic cells to be attracted and produce IL-23 which stimulates T cells. This results in hyperproliferation of keratinocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What appears first in Psoriatic arthritis?

A

Psoriatic plaques with arthritis following skin disease 5-10 years later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

You notice raised, scaly, well-demarcated plaques which are symmetrically distributed on the extensor surfaces, trunk and gluteal cleft. Lesions are itchy and fissured.

What type of skin condition is this?

A. Guttate psoriasis

B. Chronic plaque psoriasis

C. Atopic eczema

D. Inverse psoriasis

A

B - Chronic plaque psoriasis

Features: 
Symmetrical distribution, extensor surfaces, gluten, knees, elbows
Colour: opposite to natural skin colour 
Thickened plaques (hypertrophic) 
Itchy or painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

You notice raised (onycholysis), thickened nail plates with plaques underneath (subungual hyperkeratosis). They appear white (leukonychia) and you see oil drop discolouration.

What type of skin condition is this?

A. Guttate psoriasis

B. Chronic plaque psoriasis

C. Nail psoriasis

D. Inverse psoriasis

A

C - Nail psoriasis

Subungual hyperkeratosis 
Onycholysis 
Leukonychia
Nail pitting 
Splinter haemorrhages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

You notice thick plaques which have a pink/white pigmentation, thickening and fissures present. The distribution is within the intertriginous areas.

What type of skin condition is this?

A. Guttate psoriasis

B. Chronic plaque psoriasis

C. Atopic eczema

D. Inverse psoriasis

A

D - Inverse Psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

You notice small, discrete plaques with a truncal distribution 2 weeks ago, this patient had a sore throat.

What type of skin condition is this?

A. Guttate psoriasis

B. Chronic plaque psoriasis

C. Atopic eczema

D. Inverse psoriasis

A

A - guttate psoriasis

‘Raindrop’ Psoriasis which have multiple small circular plaques forming 2 weeks after streptococcal sore throats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

You notice sterile pustules on reddened skin present in a truncal distribution.

What type of skin condition is this?

A. Localised pustular psoriasis

B. Chronic plaque psoriasis

C. Generalised pustular psoriasis

D. Inverse psoriasis

A

C - Pustules present widespread on a background of erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the management ladder for Psoriasis?

A

1st line: Potent corticosteroid OD + Vitamin D analogue OD
- apply separately, once in morning, once at night

2nd line: Vitamin D analogue BD
- 8-12 weeks

3rd line: Potent corticosteroid BD OR Coal tar OD/BD
- 4 weeks

Hospital: Phototherapy
- UVB; PUVA

Hospital: Systemic therapy

  • Methotrexate
  • Ciclosporin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a potential side effect of Psoralen + UVA?

A

Skin ageing

Squamous cell cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the management for scalp psoriasis?

A

Potent corticosteroids OD for 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the management for face psoriasis?

A

Mild/moderate potency for 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When may you begin to notice systemic side effects from topical steroids?

A

> 10% BSA

Using more than 1-2 weeks per month

Not keeping to a 4 week break before starting another course of topical corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the MOA of Calcipotriol?

A

Vitamin D analogue

Reduce cell division and differentiation to reduce epidermal proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the side effect of Dithranol?

A

Stains skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the potential complications of Psoriasis?

A

Psychosocial difficulties

Systemic upset - from GPP or EP or medications

Medication related side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which is the causative pathogen of Lyme disease?

A

Borrelia burgdorferi

B. burgdoferi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the clinical features of Lymes disease?

A

Erythema migraines: Bulls eye rash which develops 1-4 weeks after bite; >5cm diameter

Systemic features:

  • Headache
  • Lethargy
  • Fever
  • Arthralgia

Late features:
CV:
- Heart block
- Peri/myocarditis

Neurological:

  • Facial nerve palsy
  • Radicular pain
  • Meningitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is Lyme disease diagnosed?

A. Clinically based on fever and headache after walking in the woods

B. Clinically based on erythema migraines present

C. ELISA with B burgdoferi Abs

D. PCR test

A

B - Erythema migrans present is enough for ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the management of asymptomatic tick bites?

A

Supportive: Remove tick; ABX if Sx develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the management for suspected/confirmed Lyme disease?

A

Doxycycline 200mg OD 21 days

Doxycycline 100mg BD 21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Following treatment with Doxycycline for a rash which appeared following a suspected tick bite, a 37 year old patient presents with headache and muscle ache.

He is orientated, has no new rashes but has a regularly regular HR of 90bpm and a blood pressure of 100/65mmHg.

What is your diagnosis?

A. Allergy to antibiotic

B. Jarish-Herxheimer reaction

C. Drug exanthem

D. SJS

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is VZV also known as?

A. HHV-1

B. HHV-6

C. HHV-8

D. HHV-3

A

D - HHV-3

HHV-1 = oral lesions

HHV-6 = Pityriasis rosea

HHV-8 = Kaposi’s sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Explain the pathophysiology of Shingles.

A

Following primary infection of VZV resulting in a generalised vesicular rash within 14 days of exposure, the VZV lies dormant in the dorsal root ganglia.

This can reactivate and present in a dermatomal distribution years later as Shingles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

A patient who is on Azathioprine presents, concerned that their brother-in-law who he has just seen, has presented with chickenpox. The patient is unsure if he has ever had chickenpox.

How do you manage this?

A

Check VZV Abs and give VZIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A 24 week pregnant woman who is G3P2 presents worried she may have caught chickenpox. She is asymptomatic however her youngest child has been at school with an individual who has chickenpox.

She is unsure if she has had chickenpox when she was younger.

What is your management?

A

> 20 weeks and unsure…

Check VZV Abs

If not, give Oral Aciclovir at 7-14 days post-exposure

OR

VZIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

A 14 week pregnant woman who is G3P2 presents worried she may have caught chickenpox. She is asymptomatic however her youngest child has been at school with an individual who has chickenpox.

She is unsure if she has had chickenpox when she was younger.

What is your management?

A

<20 weeks and unsure…

Check VZV Abs

Give VZIG STAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How long is someone infective for when they have chickenpox?

A

4 days before rash, 5 days after rash

“4 before, 5 after”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What medication should be avoided when chickenpox is present and why?

A

NSAIDs - increase risk of bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Who should receive the VZV vaccine?

A

Healthcare workers unexposed

Contacts of immunocompromised individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How long should a child be away from school following a chickenpox infection?

A

All lesions crusted over - “4 before, 5 after”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How long should a child be off school following a sore throat and a sandpaper like rash?

A

24 hours from ABX

This is Scarlet Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How long should a child be off school following whooping cough?

A

2 days from ABX or 21 days from symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How long should a child be off school following spots on the oral mucosa, fever and a maculopapular rash?

A

This is measles and it is 4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How long should a child be off following a maculopapular rash, lymphadenopathy and positive Rubella Abs?

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which of the following is not a typical feature of Varicella Zoster Syndrome?

A. Skin scarring

B. Limb hypoplasia

C. Macrocephaly

D. Chorioretinitis

A

C - Microcephaly occurs

Mnemonic: E-NHS

Eyes: Chorioretinitis, Cataracts, Microphthalmia

Neurological: Microcephaly; learning difficulties; bladder and bowel dysfunction

Hypoplasia of limbs

Scarring of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Why should aspirin be avoided in children with Chickenpox?

A

Reye’s syndrome may occur with encephalopathy and liver impairment

Features:

  • Confusion
  • Seizures
  • Cerebral oedema
  • Hypoglycaemia
  • Fatty infiltration of kidneys, liver and pancreas (steatosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which of the following is not a risk factor for the development of Shingles?

A. Age above 85 years old

B. CKD

C. Taking Salbutamol

D. Transplant recipients

A

C - Salbutamol is not a risk factor for Shingles.

Risk factors:
Immunocompromised
Transplant recipients 
Autoimmune conditions
HIV
Co-morbidites: CKD; COPD; Diabetes;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the term for a vesicular eruption along the tip of the nose?

What does this suggest?

A

Hutchinson’s sign

CN V1 dermatome infected §with VZV thus increased risk of Herpes zoster ophthalmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the indications for anti-viral therapy in Shingles?

A

Facial distribution (Ramsay-Hunt or Herpes Zoster Ophthalmicus)

Pregnancy

Immunocompromised

Patients >50 years old

Severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the potential complications of Shingles?

A 
Secondary bacterial infection 
Dissemination 
Ramsay Hunt Syndrome 
Herpes Zoster Ophthalmicus 
Post-herpetic neuralgia
CNS involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How is Post-Herpetic neuralgia managed?

A

Paracetamol/Co-codamol

If uncontrolled:
Neuropathic analgesia: Amitriptyline; Gabapentin; Pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the typical distribution of Erythema nodosum?

A

Anterior legs (shins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the pathophysiology of erythema nodosum?

A

Hypersensitivity reaction resulting in panniculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Give 5 causes of Erythema nodosum.

A 
Idiopathic 
Pregnancy 
Streptococcal infection
TB
Sarcoidosis 
HIV
Hepatitis B
Parasitic infection 
Crohn's Disease
Ulcerative colitis
Malignancy 
COCP 
Penicillins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the management for Erythema Nodosum?

A

Identify cause: Bloods, XR, ASO, Mantoux test

Supportive: NSAIDs; Rest; Compression stockings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which of the following is not a cause of erythema nodosum?

A. Streptococcal infection

B. Behcet’s disease

C. Lymphoma

D. Metformin

A

D - metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the clinical features of Erythema multiforme?

A

Hypersensitivity reaction of the skin, secondary to infection or drugs.

Discoid lesions - central blister and surrounding pallor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Give 5 causes of Erythema multiforme.

A

Idiopathic
M pneumoniae
HSV
Streptococcus

Drugs: Penicillin; Sulphonamides; Carbamazepine; Allopurinol; NSAIDs; COCP
CT disease 
Sarcoidosis 
TB
Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the difference between Erythema multiforme and Erythema multiforme major?

A

Becomes major when involves oral mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How long does it take for Erythema multiforme to resolve?

A

Spontaneously resolves over 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the causative pathogen of Impetigo?

A

S aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

For how long should children be excluded from school following impetigo?

A

48 hours after ABX or lesions healed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the management for Impetigo?

A

Localised
Fusidic acid
Mupirocin

Widespread/Bullous
Oral Flucloxacillin

Severe disease (systemic upset)
Hospital admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the potential complications of Impetigo?

A 
Cellulitis 
Staphylococcal scalded skin syndrome 
Lymphangitis 
Osteomyelitis/septic arthritis 
Scarlet fever (GAS) 
Acute glomerulonephritis (1-2 weeks post-infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the clinical features of Impetigo?

A

Depigmented macules (<1cm) or patches (>1cm)

Koebner phenomenon

Distribution: Dermatomal (segmental) or Non-segmental: Focal; Acrofacial; Mucosal; Generalised; Universal; Follicular; Mixed (segmental and non-segmental forms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the management of Vitiligo?

A

Supportive: Psychosocial interventions; Patient education; Skin camouflage service; Dermatology referral
+
Medical: Topical steroids (segmental/localised); Systemic steroids (widespread); Phototherapy (UVB)

± Refractory to Tx
Surgical: Skin grafts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Give 5 RFs for BCC.

A

Sun-exposure
Increasing age
Genetics: p53; Albinism; Gorlin Syndrome
PMHx
Immunosuppression
Carcinogens: Ionising radiation; Arsenic; Hydrocarbons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the inheritance of Gorlin-Goltz Syndrome?

A

PCTH1 gene inherited in autosomal dominant manner q

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the clinical features of Gorlin-Goltz syndrome?

A 
BCCs 
Hypertelorism
Bifid ribs 
Odontogenic keratocysts
Calcification of faux cerebri
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the clinical features of a BCC?

A

Telangiectasia
Ulceration
Rolled edges
Pearly border

Mnemonic: TURP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

A 56 year old lady presents with a skin lesion on her cheek.

O/E it is fleshy and well-defined, about 5mm, circular. There is an large area of central ulceration seen with telangiectasia noted.

What is your DDx?

A. Nodular BCC

B. Infiltrative BCC

C. Basosquamous BCC

D. Superficial BCC

A

A - Rodent ulcer described

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

A 76 year old lady presents with a plaque on her arm. She noticed it 3 months ago and it has not grown much since.

O/E it is a 3mm lesion, fairly regular, it is dry with some crusting. It has a blue-tinge to it.

What is your DDx?

A. Superficial BCC

B. Infiltrative BCC

C. Basosquamous BCC

D. Actinic keratosis

A

A - features of a Superficial BCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

A 78 year old male presents with a skin lesion on his face. The shape is irregular, with a scar-like tissue around it. You see a roughly spherical lesion which has a central area and some telangiectasia.

What is your DDx?

A. Nodular BCC

B. Infiltrative BCC

C. Basosquamous BCC

D. Superficial BCC

A

B - scar-like lesion with BCC features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

You see a skin lesion that is very dark, purple with an area of central necrosis and a pearly border.

What is your DDx?

A. Nodular BCC

B. Infiltrative BCC

C. Basosquamous BCC

D. Pigmented BCC

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

A patient presents with what he says is a large, cut like skin lesion. He reports no history of injury.

O/e you see a 5cm, irregular lesion with crusting and telangiectasia.

What is your DDx?

A. Nodular BCC

B. Infiltrative BCC

C. Basosquamous BCC

D. Superficial BCC

A

C - features of both BCC and SCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How is a BCC managed?

A

Surgical: Wide-local excision (low-risk lesions); Moh’s Micrographic Surgery (high-risk lesions)
Destructive (cryotherapy; curettage)

Non-surgical: Radiotherapy; Imiquimod cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which of the following is not a feature of a high-risk BCC?

A. Size >2cm

B. Subtype

C. Poorly defined margins

D. Diabetes

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Which of the following is not a feature of a high-risk BCC?

A. Perivascular invasion seen

B. Previous Tx failure

C. Poorly defined margins

D. Size of 1cm

A

D - size must be above 2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the clinical features of a Melanoma?

A

Mnemonic: ABCDE

Asymmetry 
Border (irregular) 
Colour (2+ pigments)
Diameter (>6mm)
Evolving lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What investigation is required in a suspected melanoma?

A

Excisional biopsy with 2mm margin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the causes of Melanoma?

A

UV Exposure
Severe sun burn in childhood (blistering)
Immunosuppression
Multiple naevi (>100)
Fitzpatrick skin type I and II
FH (cdk ∆s)
Genetic mutations (CDK4; xeroderma pigmentosum; melanocortin 1 receptor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the pathophysiology of melanoma?

A

uncontrolled proliferation of melanocytes in the basal epidermis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the subtypes of Melanoma?

A 
Superficial spreading (70%)
Nodular (vertical growth)
Lentigo maligna (chronic sun-exposure)
Acral lentiginous (under nails, hands and feet) 
Desmoplastic melanoma

Any of these could be amelanotic melanomas (pigment lacking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the most common subtype of melanoma?

A

Superficial spreading (70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What classification systems can be used in melanomas?

A

Breslow thickness (mm)

Ulceration

Mitotic index (mitoses per mm2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What investigations may be done in a melanoma?

A

Excision biopsy with 2mm margin

FBC
U+Es
LFTs
LDH

FNA - if believed to have spread to lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the stages of melanoma?

A

AJCC Cutaneous melanoma staging

Stage 0 = in situ

Stage I = melanoma <0.8mm thick

Stage II = 1-2mm thick ± ulceration

Stage III = lymph node involvement

Stage IV = metastatic spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How is a Melanoma managed?

A

Surgery: Wide-local excision (remove fat down to muscular fascia - determined by Breslow thickness)
±
SNLB (staging tool)

±
Adjuvant therapy: Chemo/Radio/Immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are the clinical features of Rosacea?

A 
Affects nose, cheeks and forehead
Flushing
Telangiectasia 
Develops into persistent erythema with papules and pustules 
Rhinophyma 
Ocular involvement e.g. Blepharitis 
Sunlight and spicy food can worsen
98
Q

Manegement of Rosacea?

A 
Mild symptoms (limited number of pustules and papules) 
Topical Metronidazole

Resistant/Systemic
Orał tetracycline e.g. Doxycycline

Prominent telangiectaisa
Laser therapy

99
Q

What are the layers of the Epidermis?

A

Mnemonic: BSG LC

Stratum basale - mitosis of keratinocytes

Stratum spinosum - keratinocytes join desmosomes

Stratum granulosum - cells secrete lipids and hydrophobic molecules

Stratum lucidum - cells anucleate + keratin production

Stratum corneum - cells lose organelles + produce keratin

100
Q

What epidermal structures determine the fingerprint?

A

Fingerprint determined by stratum basale and stratum spinosum pushing epidermal ridges (rete ridges) into underlying dermis between dermal papillae of papillary layer which is augmented by dermal ridges

101
Q

What are the layers of the dermis?

A
  • Papillary layer: loose; cellular arrangement; highly innervated
  • Reticular layer: deeper; less cellular; thicker ECM (collagen fibres + elastin fibres) organised into regular, structured lines called Langer’s Lines. May have smooth muscle in the reticular area e.g. Dartos Fascia in Penis and Scrotum
102
Q

In which layer of the skin to Langer’s lines lay?

A

Langer’s lines are thick collagen and elastin arrangements in the reticular layer of the dermis

103
Q

Explain the difference between apocrine and eccrine glands.

A

Eccrine
Independent units in dermis with long ducts opening into skin

Throughout the body

Involved in thermoregulation and excretion

Apocrine
Coiled, tubular gland opening into hair follicle
Hair covered areas

Release pheromones in proteinaceous sweat, encourages bacterial growth

104
Q

How can you assess the extent of burns?

A

Use Wallace’s Rule of Nines

Head + Neck = 9%

Each arm = 9%

Anterior leg = 9%

Posterior leg = 9%

Anterior abdomen = 9%

Posterior abdomen = 9%

105
Q

What is the immediate first aid of a heat burn?

A

Remove source

Irrigate burn with cool water for 10-30mins

106
Q

What is the immediate first aid of a electrical burn?

A

Switch off power supply

Remove person from source

107
Q

What is the immediate first aid of a chemical burn?

A

Brush off chemical

Irrigate with water

Do not try to neutralise the chemical

108
Q

Describe a first degree burn?

A

Think of burns in layers…

1st degree is the superficial epidermis

Appears red and painful

109
Q

Describe a second degree burn which is of the deep dermis.

A

Second degree burn

White with patches of non-blanching erythema.

Reduced sensation

110
Q

Describe a second degree burn affecting the superficial dermis?

A

Pale pink, painful and blistered

111
Q

Describe a full thickness burn.

A

White/brown/black in colour; no blisters; no pain

112
Q

Which burns should be referred to hospital?

A

> 3% (adults) and >2% (children) superficial burns

Deep dermal and full thickness burns

Burns involving the face, hands, feet, perineum, genitalia, flexure, circumferential burns of limbs, torso or neck

113
Q

How do you manage a severe burn?

A

Supportive: Assess extent of burns; Intubation (if smoke inhalation/neck involvement); IV fluids if BSA >10% (children) or >15% adults); administer half of the fluids needed in first 8 hours; Analgesia; Urinary catheter

± Circumferential burns
Surgery: Escharotomy (division of burnt tissue to improve ventilation/relieve compartment syndrome)

114
Q

How are IV fluids calculated in a burns patient?

A

Parkland formula

BSA x weight x 4 = mL

Give half of fluids in first 8 hours

115
Q

When should a patient be transferred to a burns centre?

A

BSA > 5% (children)

BSA >10% (adults)

116
Q

What is the difference between a petechiae and an ecchymosis?

A

Size, based on 2mm width

117
Q

What is the difference between a macule and a patch?

A

Both flat but size.. macule is smaller cf patch (1.5cm)

118
Q

What is the difference between a papule and a plaque?

A

Both solid, raised lesions - but papule (<0.5cm) cf papule (>1cm)

119
Q

What is the difference between a vesicle and a bulla?

A

Size, bulla > 0.5cm - both raised, clear-fluid filled lesion

120
Q

What is the difference between a pustule and an abscess?

A

Pustule = pus-filled lesion <0.5cm

Abscess = localised pus accumulation

121
Q

Outline the pathological sieve.

A

Stone (metabolic changes)

Infection (pathogen-mediated)

Tumor (cancer)

Tubercle (chronic inflammation)

Trauma (injury)

122
Q

How would you examine a rash?

A

Adequate introductions

General inspection

Distribution
Size 
Colour
Associated changes
Morphology

Inspect hands
Inspect eyes
Inspect mouth

Inspect elbows

Inspect head

Thank patient

Wash hands

Summarise findings

Suggest investigations

Suggest differentials

123
Q

What is the difference between lotion, cream and ointment?

A

Lotion - large water based

Cream - more lipid

Ointment - high lipid content ± urea

124
Q

Outline the topical steroid ladder.

A

Hydrocortisone 1% (mild)
Clobetasone 0.05%
Betamethasone 0.1%
Clobetasol 0.05% (very potent)

125
Q

What are the side effects of topical steroids?

A

Systemiceffects

Skin atrophy

Spread of infection

Secondary infection

Acne rosacea

126
Q

What are the compounds in Trimovate cream?

A

TRI = THREE

Clobetasone
Oxytetracycline
Nystatin

127
Q

What are the components of Flucidin H cream?

A

Fusidic acid 2%

Hydrocortisone 1%

128
Q

You see a patient with psoriasis. When scratching and removing scales, light bleeding is observed. What is this termed?

A

Auspitz sign

129
Q

What are the types of Psoriasis?

A 
Psoriasis 
Guttate distribution of psoriasis 
Flexural
Psoriatic 
Pustular 
Nail psoriasis
130
Q

Outline the pathophysiology of urticaria.

A

Stimuli (autoimmune/infection/ACEi/NSAIDs/penicillin/food) results in Th2 cells secreting IgE via mast cells which increases the permeability of capillaries resulting in wheal formation and erythema.

131
Q

What are the clinical features of Urticaria?

A

Wheals
Pruritus
Oedema of deeper tissues
Swelling of soft tissues

132
Q

Which virus is associated with Erythema Multiforme?

A

HSV-2
CMV
EBV

133
Q

In bullous pemphigoid, where are antibodies directed against?

A

PemphigoiD = Deep

Abs directed against hemidesmosomal proteins between epidermis and dermis resulting in inflammatory cell infiltrate and bullous lesions

134
Q

How is bullous pemphigoid managed?

A

Supportive: Dress; monitor signs of infection
+
Topical steroids

±
Oral ABX if infected

135
Q

Where are autoantibodies directed in pemphigus vulgaris?

A

PemphiguS = Superficial

Autoantibodies directed against desmogleins in epidermis thus intra-epidermal split in the skin

136
Q

You examine a patient with pemphigus and notice the top layer is fragile, breaking under lateral pressure. What is the name of this sign?

A

Nikolsky’s sign

137
Q

How is Pemphigus vulgaris managed?

A

Supportive: Dressings; monitor for infectious signs; good oral care
+
High dose steroids: Prednisolone

138
Q

How is SJS categorised and differentiated from TEN?

A

Skin sloughing and blistering due to mucocutaneous complications

SJS <10% BSA

TEN >30% BSA

139
Q

Give 5 causes of SJS.

A 
Recent infections
Recent vaccinations
AIDS
SLE
Genetic predisposition
Anticonvulsants
Sulfonamides
Penicillins
Cephalosporins 
COCP
Allopurinol
140
Q

What tool can be used in SJS to assess severity and mortality?

A

SCORETEN

Mnemonic: CAABBS as in SJS you call a CAB to the hospital

Cancer 
Age >40 
Area (Wallace's rule of 9) 
BUN >20mg/dL
Bicarbonate <20mEq/L 
BPM >20bpm
Sugar >250mg/dL
141
Q

What are the clinical features of erythroderma?

A

Constitutional symptoms
Lymphadenopathy
Erythema
Hot skin

Keratoderma 
Haemodynamic instability (HR up, BP down)
142
Q

How is erythroderma managed?

A

Supportive: Tx cause; wet wraps; heavy emollient
±
Medical: ABX if needed

143
Q

A 24 year old man presents 7 days after starting Penicillin for a throat infection. He is hot and reports a rash across his trunk.

O/E you see a widespread red rash with small bumps within. The rash is itchy.

What is your differential?

A. Widespread Exanthematous Drug Reaction

B. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

C. Acute Generalised Exanthematous Pustulosis

D. Acute Generalised Pustular Psoriasis

A

A - Widespread Exanthematous Drug Reaction

144
Q

A patient presents with a high temperature and tiredness. They report facial swelling also. They say they are generally well and only take Lamotrigine which they commended 4 weeks ago.

What is your differential?

A. Widespread Exanthematous Drug Reaction

B. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

C. Acute Generalised Exanthematous Pustulosis

D. Acute Generalised Pustular Psoriasis

A

B - DRESS Syndrome

Hypersensitivity reaction which occurs 2-6 weeks following medication

Constitutional symptoms
Maculopapular rash
Facial oedema

Lymphadenopathy

145
Q

Following beginning erythromycin for a throat infection due to a penicillin allergy, a young man presents with a rash.

O/E the rash consists of sterile pustules on oedematous erythema which is present in the flexural regions.

What is your differential?

A. Widespread Exanthematous Drug Reaction

B. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

C. Acute Generalised Exanthematous Pustulosis

D. Eczema Herpeticum

A

C - Acute Generalised Exanthematous Pustulosis

146
Q

A 7 year old presents to the A+E department with a fever and clusters of itchy blisters. The itchy blisters wheep when itched and you can see some yellow crusting. They have a past medical history of Asthma and Dermatitis.

What is your differential?

A. Widespread Exanthematous Drug Reaction

B. Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

C. Acute Generalised Exanthematous Pustulosis

D. Eczema Herpeticum

A

D

147
Q

What is your infective pathogen causes Eczema herpeticum?

A

HSM

148
Q

What is the management for Eczema herpeticum?

A

Oral Acyclovir

Oral Flucloxacillin

149
Q

What is Bowen;s disease a precursor to?

A

Squamous cell carcinoma

150
Q

What is the chance of developing Squamous cell carcinoma when having Bowen’s disease?

A

5-10%

151
Q

What are the clinical features of Bowen’s diseasE?

A

Red, scaly patches 10-15mm in size

Sun exposed areas

152
Q

Give 5 RFs for Squamous Cell Carcinoma.

A
  • Sun exposure
  • Older age
  • Immunosuppression
  • Fair skin
  • Human Papillomavirus
  • Hereditary skin conditions
  • Ionising radiation
  • Environmental toxins: Arsenic or Tar
  • Actinic keratosis
  • Male Sex
153
Q

What are the clinical features of a squamous cell carcinoma?

A 
Keratotic, scaly
Bleeding/crusting
Non-healing wound 
Erythematous plaques/papules 
Dome-shaped nodules
154
Q

What is the management for a SCC?

A

<2cm
Wide-local excision

> 2cm or sensitive area
Mohs Micrographic Surgery

± Metastases
Chemo/Radiotherapy

155
Q

What is the difference between a keratoacanthoma and actinic keratosis?

A

Actinic keratoses: scaly/crusty papule/plaque with skin colour changes

Keratoacanthoma: arises from hair follicle which rapidly grows, well demarcated, firm, hyperkeratotic plug

156
Q

What is Lofgren Syndrome?

A
  • Bilateral hilar lymphadenopathy
  • Migratory polyarthritis (symmetrical arthritis 1º affecting ankles)
  • Erythema nodosum (extensor surface of lower legs)
157
Q

What is Heerfordt Syndrome?

A
  • Parotitis
  • Uveitis
  • Facial palsy
158
Q

State 5 types of Sarcoidosis.

A 
Neuro 
Ocular 
Cardiac 
Cutaneous
Pulmonary 
Systemic
159
Q

A patient presents with a skin lesion which is growing. O/E you see a purple, ulcerated area.

What is your DDx?

A

Pyoderma gangrenosum

160
Q

A patient presents with a widespread rash on the torso. He has been under the care of Oncology recently for his long-standing Lung cancer.

O/E you see concentric rings with a wood-grain appearance. The rash is itchy.

What is your DDx?

A

Erythema Gyratum Repens

161
Q

What are the clinical features of Acute Febrile Neutrophilic Dermatosis?

A 
Fevere 
Sore eyes
Mouth ulcers
Arthralgia 
Headache

Tender and painful papules/vesicles on the neck, limbs and mucosa

Biopsy confirms neutrophils

162
Q

What are the clinical features of Dermatomyositis?

A

Constitutional symptoms

Heliotrope rash
Periorbital violaceous erythema
Macular violaceous erythema

Gottron papules (purple dusty red flat topped papules on bony surfaces)

Proximal muscle weakness

163
Q

What is the difference between Cellulitis and Erysipelas?

A

Cellulitis is an infection of the deep tissues, dermis and subcutaneous tissue whilst erysipelas is a distinct form of superficial cellulitis - it is well demarcated

164
Q

What is the management of Cellulitis?

A

Mild (no systemic signs/systemically unwell)
Oral Flucloxacillin

Severe (significant systemic upset/unstable comorbidity/sepsis)
IV Flucloxacillin

165
Q

What are the risk factors of cellulitis?

A 
Animal bite
Diabetes mellitus 
Immunocompromised 
Venous insufficiency 
Oedema 
Lymphodema 
Eczema
166
Q

Which pathogen causes Necrotising fasciitis?

A 
GAS 
S aureus 
E coli 
Klebsiella 
Proteus
167
Q

What types of Necrotising Fasciitis exist?

A

Type 1 = polymicrobial

Type 2 = mono microbial

Type 3 = V vulnificus

Type 4 = Fungal pathogens

168
Q

What are the clinical features of necrotising fasciitis?

A

Systemic features: Fever/ Nausea/ Vomiting

Grey discolouration of skin 
Necrosis 
Palpitations
Tachycardia
Hypotension
169
Q

What is the management of Necrotising fasciitis?

A

Supportive: Fluids; Admission; Obs
+
Medical: Vancomycin + Pip/Taz + Clindamycin
+
Surgery: Debridement and resection ± Skin graft

170
Q

What pathogen causes Gas gangrene?

A

C perfringens

171
Q

What is the antibiotic given in Neutropenic sepsis?

A. Ceftriaxone

B. Piperacillin/Tazobactam

C. Flucloxacillin

D. Vancomycin

A

B - Tazobactam inhibits beta lactase so that piperacillin remains present to eradicate bacterial infection

172
Q

What is the antibiotic given in MSSA sepsis?

A. Ceftriaxone

B. Piperacillin/Tazobactam

C. Flucloxacillin

D. Vancomycin

A

C

173
Q

What is the antibiotic given in MRSA sepsis?

A. Ceftriaxone

B. Piperacillin/Tazobactam

C. Flucloxacillin

D. Vancomycin

A

D

174
Q

What is the antibiotic given in early onset sepsis?

A. Benzyl Penicillin + Gentamicin

B. Piperacillin/Tazobactam

C. Flucloxacillin

D. Vancomycin

A

A

175
Q

What is the antibiotic given in GBS sepsis?

A. Ceftriaxone

B. Piperacillin/Tazobactam

C. BenPen + Gen

D. Vancomycin

A

C

176
Q

What is the antibiotic given in L monocytogenes sepsis?

A. Amoxicillin + Gentamicin

B. Piperacillin/Tazobactam

C. BenPen + Gentamicin

D. Vancomycin

A

A

177
Q

What is the management of Scarlet Fever?

A

Penicillin

178
Q

What is tinea cruris?

A

Dermatophyte infection of groin

179
Q

What is tinea pedis?

A

Dermatophyte infection of foot

180
Q

What is tinea corporis?

A

Dermatophyte infection of the body

181
Q

What is the management for a Dermatophyte infection?

A

Topical fluconazole

Oral ketoconazole

182
Q

What is the management of Genital warts?

A

Podophyllotoxin

OR

Cryotherapy

183
Q

How is Scabies managed?

A

Permethrin

184
Q

What pathogen causes Scabies?

A

Sarcoptes scabiei

185
Q

What is the management for an animal bite?

A

Supportive: Saline/Iodine
+
ABX: Co-amoxiclav

±
Rabies vaccine + Rabies Ig
+
Tetanus vaccine + Tetanus IG

186
Q

When would a patient not require Tetanus prophylaxis in an animal bite?

A

Patient had course of tetanus vaccine within last 10 years

187
Q

When would a patient need a tetanus vaccination following an animal bite?

A

Not vaccinated

Tetanus prone wound (puncture; foreign body; systemic sepsis occurring)

High risk wound (heavy contamination; extensive devitalised tissue; requires surgical intervention)

187
Q

When would a patient need a tetanus vaccination following an animal bite?

A

Not vaccinated

Tetanus prone wound (puncture; foreign body; systemic sepsis occurring)

High risk wound (heavy contamination; extensive devitalised tissue; requires surgical intervention)

188
Q

What are Campbell de Morgan spots?

A

Benign skin lesions due to abnormal proliferation of capillaries

Non-blanching
1-3mm in size

189
Q

What pathogen causes Pityriasis Versicolor?

A

Malassezia furfur

190
Q

What are the clinical features of Pityriasis versicolor?

A

most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

Follows sun exposure

191
Q

A 21-year-old female has been suffering from well demarcated red, scaly lesions on her elbow and knees for the past few years. She is treated for her condition with corticosteroids and vitamin D.

Which drugs would most likely exacerbate her underlying condition?

A 
Lithium
Beta-blockers
NSAIDs
ACEi
TNF-alpha inhibitors
Anti-malarials
192
Q

What are the clinical features of Erythrasma?

A

Flat, scaly pink/brown rash in groin/axillae

193
Q

What’s the management of Erythrasma?

A

Topical miconazole or Erythromycin

194
Q

A 40-year-old woman visits the GP with a two-month history of unintentional weight loss. She reports feeling more fatigued than usual but otherwise has no localising signs or symptoms. On examination, hyperpigmentation and thickening of the skin in her groin and axilla are noted; the patient believes this has also been present for approximately 2 months.

Which malignancy is most associated with this presentation?

A

Gastric adenocarcinoma

195
Q

What are the clinical features of Pellagra?

A

Mnemonic: 4 Ds

Diarrhoea
Dermatitis
Dementia
Death

196
Q

What are the clinical features of Lemierre’s syndrome?

A

Thrombophlebitis of IJV

Secondary to F necrophorum infection with peritonsillar abscess

Bilateral are throat
Neck pain
Stiffness
Fevers and rigors
Septic pulmonary emboli
197
Q

What is the difference in TIBA between anaemia of chronic disease and iron deficiency anaemia?

A

TIBA is high in IDA

TIBA is low in AOCD

198
Q

Where do keloid scars typically form?

A

Sternum
Extensor surfaces
Trunk

199
Q

A 30-year-old man is trapped in a house fire and sustains 30% partial and full thickness burns to his torso and limbs. Three days following admission he has a brisk haematemesis. Which of the following is the most likely explanation for this event?

A

Curling’s ulcers

200
Q

A 30-year-old woman with known polycystic ovary syndrome presents with excessive hair growth of the chest, back and face. She reports her symptoms first developed around the time of puberty, with the hair continuing to remain prominent, growing back despite removal via waxing and shaving.

The underlying skin is normal and the patient is otherwise well with no other medical conditions.

What topical agent is the treatment of choice for the facial features of this patient’s condition?

A

Topical eflornithine

201
Q

Which drugs may cause Gynaecomastia?

A

Mnemonic: DISCO

Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens

Oestrogens

202
Q

How do you estimate the risk of bleeding in a patient with AF?

A

ORBIT Score

Age >74 
Bleeding risk
Coagulation 
Dick? (Sex)
eGFR <60
203
Q

What are the clinical features of Aortic Stenosis, GI bleeding and angiodysplasia referred to?

A

Heyde’s Syndrome

204
Q

Stroking skin in atopic eczema to elicit a white line is termed?

A

White dermographism

205
Q

What is meant by Besnier’s Prurigo?

A

Chronic inflammatory changes regarding pigmentation and scarring which lead to pruritic nodules overlying eczematous areas

206
Q

Which infections are patients with eczema particularly prone to?

A

Bacterial sepsis

Molluscum contagiosum

Herpes simplex (Eczema Herpeticum)

207
Q

What are the clinical features of Wiskott-Aldrich Syndrome?

A

Atopic eczema + thrombocytopenia

Atopic eczema features

Epistaxis
ICH
Haematochezia

Recurrent bacterial infections
Autoimmune phenomena susceptibility

208
Q

What is Job’s Syndrome?

A

Hyper-IgE syndrome with marked reactions to microbes / pathogens

Eczema
Recurrent infections - recurrent cold abscesses of skin; PNA; cysts; restrictive lung disease
Bony changes: hypertelorism; hyperostosis; scoliosis; osteoporosis

209
Q

What are the clinical features of Kaposi’s varicelliform eruption?

A

HSV infection

Umbilicated vesicles on b/g of erythema
Viraemia

210
Q

What is the MOA of Tacrolimus?

A

IL-2 inhibitor on T cells - dampens T cell mediated inflammatory response

211
Q

What supportive changes may be made for eczema management?

A

Think about vehicle (ointment > cream)

Antihistamines

Diet (oligoallergen theory of Atherton “avoid eggs and milk”)

Bedding (reduce allergen exposure)

Bandaging

Psychological input

212
Q

What is the distribution exhibited in Seborrheic dermatitis?

What is it associated with?

A

Sebaceous gland areas

Scalp; face; flexures

Pityrosporum ovale (Malassezia ovale)

213
Q

Why is discoid eczema referred to as nummular?

A

Nummular is latin for coin e.g. No mullar

214
Q

What is lichen simplex?

A

Eczematous response to scratching of an isolated area of the skin

Histologically caused by acanthosis and hyperkeratosis

215
Q

Describe lichen striatus.

A

Linear distribution of eczema occurring in children and young adults

216
Q

What form of eczema has a predilection for the base of the feet and has linear cracks and fissures?

A

Plantar dermatosis

217
Q

Discuss asteatotic eczema.

A

Eczema craquele

Dry, superficial fissured skin in the elderly; usually present on the shins

Related to the cold, excessive washing and high humidity

218
Q

What are the types of contact dermatitis?

A

Can be thought of as allergy (Type 4 mediated) or irritant

  • Irritant
  • Allergic
  • Eczema craquele (asteatotic)
  • Berloque dermatites (bergamot in colognes and UV light)
  • Plant irritant dermatitis (allergen and UV light)
219
Q

What are the main differences between pomphlyox and pustular psoriasis?

A

Pomphylox is tiny, fluid-filled vesicles in a b/g of eczema/atopy which may coalesce to form tense bullae

  • Any age
  • Sensation of heat/prick

Pustular psoriasis is small, yellow-filled sterile pustules on b/g erythema

  • Adults
  • Scaly
220
Q

A patient presents with a sterile pustule on the tip of the finger. Nail dystrophy is observed.

They have a b/g of dermatitis.

What is your differential?

A

Acrodermatitis continua of Hallopeau

221
Q

When does guttate psoriasis tend to occur?

A

3-4 weeks post-infection presenting with drop like eruption of papules which are deep-red

Based on trunk, limbs and sparing of face, palms and soles

222
Q

What are the clinical features of Reiter’s Syndrome?

A

Post-infectious…3-4 weeks later; HLA-B27

Urethritis
Uveitis
Arthralgia

Mucocutaneous features e.g. Psoriasiform rash: well-demarcated, serpiginous, white and ragged border
Soles
Distributed on penis (25% patients) e.g. Balanitis circinata sicca
Oral lesions

223
Q

What is the term for the patch which precedes the widespread eruption in Pityriasis rosea?

A

Herald patch

224
Q

What are the clinical features of lichen planus?

A 
Purple
Polygonal 
Pruritic 
Planar
Plaques 
Papules
225
Q

What is Wickham’s striae?

A

White lacey lines on the syurface of a lichen planus lesion

226
Q

How may you distinguish between an epidermoid cyst and a dermoid cyst?

A

Epidermoid cyst is derived from squamous epithelial cells in the epithelium cf dermoid cysts are derived from embryological epithelium at sites of fusion.

Epidermoid:

  • develop
  • smooth, mobile, central punctum
  • appear more superficial
  • present on face

Dermoid:

  • present at birth
  • mobile, fleshy
  • appear deeper
  • face
227
Q

What is the distribution and clinical features of acanthoma fissuratum?

A

Behind the ear

Acanthosis, hyperkeratosis

Small plaque, linear groove

228
Q

What are the clinical features of skin tags?

A

Pedunculated, skin coloured

occur with age, pregnancy, IGT/DM; malignant acanthosis nigricans

229
Q

What are the clinical features of an eccrine poroma?

A

Asymptomatic lump on volar surface

Solitary, pink/red plaque/nodule with thickened rim of epidermis (‘moat’)

230
Q

What are the clinical features of a syringoma?

A

Benign tumour of sweat duct

Asymptomatic blemishes on the skin

Distributed symmetrically, around the eyes

Flesh coloured

231
Q

What are the clinical features of a dermatofibroma?

A

Benign tumour occurring on legs

Tender

Raised papule on skin with smooth surface, moveable lateral but adherent to underlying skin. Dimples on lateral pressure

232
Q

What are the clinical features of a neurofibroma?

A

Benign tumours of nerve sheath origin

Flesh coloured, firm or soft; variable size

Buttonhole sign: invaginated with finger tip

233
Q

What are the clinical features of a lipoma?

A

Benign tumour of adipose tissue

Soft, fluctuant, can be lobulated
Variable size
Discrete lesion
Painless

Note: Angiolipomata may be painful as these are vascularised

234
Q

What are the clinical features of a pyogenic granuloma?

A

Benign tumour of vascular origin

Post-injury
Sudden onset
Can bleed
Friable papule/nodule which is red or purple in colour

235
Q

What are the clinical features of solar lentigo?

A

Increased melanocyte number without proliferation along basement membrane

‘Age’ spots
Macules which are pigmented in sun exposed areas

Hyperkeratosis and hypermelanosis

236
Q

What are the clinical features of solar elastosis?

A

‘Wrinkles’ due to sun damage and ageing

Skin can appear yellow/orange

237
Q

What are the clinical features of a cutaneous horn?

A

Outgrowth of skin

Keratinised

Normally a sequalae of another condition

238
Q

What are the clinical features of a solar keratosis?

A

Chronically sun exposed areas
Begins s small and grows to well-defined, red papule/plawue with rough yellow/brown scale

Pre-malignant, becoming squamous cell carcinoma

239
Q

What are the clinical features of Bowens disease?

A

Solar exposure and HPV infection-16 and HPV-18 infection

Solitary rough patch
Well-defined 
Slightly raised
Red plaque 
Adherent scale
240
Q

What are the clinical features of keratoacanthoma?

A

Rapidly growing tumour simulating squamous cell carcinoma however indented with keratin crater

Resolves SPONTANEOUSLY
Begins as a spot
Grows quickly
Sun exposed area distribution

Medicine (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions