Dermatology Flashcards
A 52 year old woman presents with a painful irregular keratinous nodule on her forearm. She states that she noticed it 2 months ago and it has already doubled in size. She is currently a smoker with a 20 pack year hx.
PMH: diabetes, renal transplant 9 years ago
What is the most likely diagnosis?
What is the management of this condition? (2)
Squamous cell carcinoma
Urgent referral to dermatology
+ efudix cream (5-fluorouracil)
B..
Name the term used for the following description:
“A blister (greater than 5mm in diameter) consisting of clear fluid accumulated within or below the epidermis”
Bulla
Herpes virus (simplex/zoster) is treated with which antiviral?
Acyclovir
Stevens-johnson syndrome forms a spectrum with toxic epidermal necrosis.
What is the difference (by definition) of the 2 conditions?
SJS: < 10% body surface affected
TEN: > 30% body surface affected
Which type of melanoma is the most aggressive and thus carries the worst prognosis?
Describe what this may look like:
Nodular melanoma
Red nodule that often bleeds easily
A 6-year-old girl is brought into the general practice by her father. He is concerned about a new, itchy rash that has developed around his daughter’s mouth. Apart from this rash, she is well in herself.
What is the diagnosis?
How would you manage this condition currently? If it spreads further, how would you manage it then?
What advice would you give the father regarding personal hygiene around their house and attending school?
Impetigo
Topical hydrogen peroxide 1% cream / fusidic acid, extensiuve disease = oral flucloxacilin
School: stay off school under either all the lesions have crusted over OR it has been 48h since starting antibiotics (topical fusidic acid)
Hygiene: don’t share towels!
U..
Name the term used for the following description:
“A circumscribed area of skin loss extending through the epidermis into the dermis”
Ulcer
C..
Name the term used for the following description:
“A nodule consisting of an epithelial-lined cavity filled with fluid or semi-solid material”
Cyst
P..
Name the term used for the following description:
“A palpable, plateau-like elevation of the skin, usually more than 2cm in diameter”
Plaque
Describe the
1. inflammatory (3)
2. non-inflammatory (2)
lesions that may be seen in acne vulgaris:
Which parts of the body are the above features usually found on? (4)
-
inflammatory:
~ papules
~ pustules
~ nodules -
non-inflammatory:
~ comdomes
~ pseudocysts
Face, neck, chest, back
List 3 common features seen in a patient presenting with atopic eczema:
What is the every-day management atopic eczema? (2)
What is the management of acute atopic eczema flares:
1. mild severity
- moderate severity
- severe severity
- Dry skin
- Itchy skin
- Erythema
Emollients & avoid triggers that cause flares
Mild flare: hydrocortisone
Moderate flare: eumovate
Severe flare: betnovate
All once daily for 7-14 days
What is the name of the sign seen below?
What condition is this a common feature of?
Lichenification
Atopic eczema (longstanding disease)
V..
Name the term used for the following description:
“A small blister (less than 5mm in diameter) consisting of clear fluid accumulated within or below the epidermis”
Vesicle
A mother brings in her 6 year old child with a rash in his armpits that you diagnose as molluscum contagiosum.
She is asking whether she needs to keep him off school until the rash had cleared. What advice should you give her?
He can still go to school as normal
Name the 2 commonest bacteria that cause cellulitis:
Strep pyogenes (60%)
Staph aureus (30%)
What is the management of:
1. uncomplicated cellulitis (eg, without systemic illness)
- complicated cellulitis (eg, with systemic illness)
- cellulitis in a patient with a penicillin allergy
Name 3 complications associated with unresolved cellulitis:
Uncomplicated: oral flucloxacillin
Complicated: IV co-amoxiclav
Penicillin allergy: clarithromycin
Complications:
~ sepsis
~ necrotising fasciitis
~ gas gangrene
A 23 year old man presents to the GP with intense itching, especially at night.
It is noted there is a polymorphic symmetrical rash on his wrists, elbows and in the webs of his fingers.
He notes that he has recently been travelling and staying in hostels for the past two months.
What is the most likely diagnosis?
Scabies
A 3m girl is brought to the GP as her parents are worried about a skin lump that has appeared on her neck. It is non-tender and isn’t bothering her, but it is growing in size.
On examination there is a 2 x 2cm firm, well demarcated lesion with visible telangiectasia. There are no other skin lesions.
What is the likely diagnosis? - what is this?
What would the treatment be here?
What would the treatment be if the lesion was near the eyes/ rapidly enlarging or was ulcerating?
Haemangioma - a vascular birth mark that isnt present at birth but appears from 6 weeks onwards. It will proliferate & grow up until 8m and then self resolve.
Treatment if asymptomatic: nothing - they will self resolve (involute)
Treatment if problematic: Oral propanolol
What conditions are included in the atopic triad?
- Asthma
- Hayfever
- Eczema
W..
Name the term used for the following description:
“A transitory, compressible papule/ plaque of dermal oedema. It’s usually red or white in colour and signifies urticaria”
Wheal
A 42-year-old woman presents to her GP with a rash on her wrist which she has had for about a week. She reports it is very itchy, especially at night. She reports that her 7-year-old son has also got a similar itchy rash but this is between his fingers and on his palms. Her husband and daughter are unaffected.
On examination, you can see a red spotty rash and the skin looks very excoriated. You can just make out some linear burrows.
What is the most likely diagnosis?
What would the management be?
Scabies
Treat WHOLE household with permethrin 5% for 7 days
A 41 year old female presents to ED with a painful skin rash of sudden onset. The last few days she has felt unwell with a fever, sore throat, conjunctivitis and malaise.
On examination, she has a diffuse erythematous rash on her trunk, with macules, target lesions and blisters. When you rub one of the blisters, the top layer of skin slides off.
She also has painful ulcers on her lips and genitals.
She recently was treated for a UTI by her GP.
What is the diagnosis?
What is the name of the sign that is indicated here? (rubbing blister causes top layer of skin to slide off)
What is the likely cause of this condition in this example?
Stevens-johnson syndrome (EMERGENCY!!!)
Nikolsky sign
The cause in this woman is her recent trimethoprim use
~ trimethoprim is a common cause
What condition should you think of if you see silvery white scales affecting the extensor surfaces?
Psoriasis
Eczema herpeticum is caused by which virus?
List some of the presenting features seen in this condition: (include a description of the skin rash) (4)
What is the management of this condition?
Herpes simplex virus type 1 or type 2
- fever
- lymphadenopathy
- blistering rash with punched out lesions
- contains vesicles & pustules
Oral acyclovir
Which body surfaces are affected in atopic eczema? (flexors/extensors)
Which season of the year is atopic eczema usually worse in?
What is a common feature of longstanding atopic eczema? ~ describe what this looks like..
Flexor surfaces
Winter months
Lichenification
A 56 year old man presents with a couple of hard, scaly lesions on his nose and cheeks. You notice that the lesion has a yellow scale.
What is the diagnosis?
What is the management of this condition? (2)
Actinic keratosis
Management: cryotherapy + efudox (5-fluorouracil)
A mother brings her 2-year-old son to the GP with a lesion on his chin. She says it started two days ago and appears to be getting bigger. She says that he has never had any skin problems previously.
On examination there is a single golden crusty lesion on the child’s face.
What is the most likely diagnosis?
If you were unsure of the diagnosis, what investigation would you do?
What is the management of this condition?
If this management hasn’t worked and the rash has spread across his face, what would be the next best management option?
Impetigo
Swab the lesion for MC&S
Topical fusidic acid/hydrogen peroxide 1% cream
→ oral flucloxacilin if rash is extensive (2nd line management after fusidic acid)
If someone presents with hypo or hyperpigmented patches of skin after recent travel to a hot country, what condition should you think of?
Pityriasis versicolor (also known as tinea versicolor)
A 26 year old presents to the GP with flaky, hypopigmented skin on her back since returning from her holiday to Greece.
She denies getting sunburnt on holiday and wants to know why her skin is looking like this.
What is the diagnosis?
What is the management of this condition in:
1. minor disease
- extensive disease
Tinea vesicolor (also known as pityriasis vesicolor)
Minor disease: topical imidazole (eg clotrimazole)
Extensive disease: ketoconazole shampoo
Which GI condition is associated with developing Pyoderma gangrenosum?
IBD
