DERMATOLOGY

Question 1

skin

Answer 1

largest organ in body
contains adnexal structures - hair, nails, glands, sensory structures
important role in protection, homeostasis and transmission of sensations

Question 2

3 stages of hair cycle

Answer 2

anagen

catagen

telogen

Question 3

anagen phase of hair cycle

Answer 3

active growing phase
80-90% of hair

Question 4

catagen phase of hair cycle

Answer 4

2-3wk phase growth stops/follicle shrinks
1-3% of hairs

Question 5

telogen phase of hair cycle

Answer 5

resting phase for 1-4months
up to 10% of hairs in a normal scalp

Question 6

functions of skin

Answer 6

thermoregulation
skin immune system
barrier
Vit D synthesis
interpersonal communication

Question 7

why skin disease is important

Answer 7

disfigurement
discomfort
disability
depression
death

Question 8

external causes of skin disease

Answer 8

temp
UV
chemical
infection
trauma

Question 9

internal causes of skin disease

Answer 9

systemic disease
genetics
drugs
infection

Question 10

morphology

Answer 10

appearance of skin lesions

Question 11

how big is “small”

Answer 11

usually means less than 5mm

Question 12

small and large flat circumscribed areas

Answer 12

macule - small
patch - large

Question 13

small and large raised areas

Answer 13

papule - small
plaque - large

Question 14

small and large fluid filled

Answer 14

vesicle - small
bulla - large

Question 15

small and large pus filled

Answer 15

pustule - small
abscess - large

Question 16

loss of epidermis (& dermis)

Answer 16

erosion - loss of epidermis
ulcer - loss of epidermis & dermis

Question 17

macule & patch

Answer 17

non-palpable change in skin colour with distinct borders

Question 18

papule and plaque

Answer 18

papule - solid lesion < 1cm diameter
plaque - solid lesion > 1cm in diameter

Question 19

nodule

Answer 19

palpable lesion > 1cm diameter which is taller than it is wide

Question 20

vesicle & bulla

Answer 20

vesicle - fluid-containing, superficial, thin-walled cavity < 1cm
bulla - fluid-containing, superficial, thin-walled cavity > 1cm

Question 21

erosion and ulcer

Answer 21

erosion - skin defect where there has been loss of the epidermis only
ulcer - skin defect where there has been loss of the epidermis and dermis

Question 22

pustule and abscess

Answer 22

pustule - pus containing, superficial, thin-walled cavity
abscess - thick-walled cavity containing pus

Question 23

most common skin conditions (give 5 examples)

Answer 23

psoriasis
acne
eczema
urticaria
leg ulcers

Question 24

cutaneous signs

Answer 24

erythema nodosum
sarcoidosis
vasculitis
malignancy
autoimmune conditions

Question 25

acanthosis nigricans

Answer 25

associated with insulin resistance, obesity, malignancy flexural distribution hyperkeratosis and hyperpigmentation, papules 'velvety' appearance

Question 26

investigations in derm (if bacterial inf suspected)

Answer 26

charcoal swab ask for MC&S - microscopy - culture - sensitivities

Question 27

investigations (if viral inf suspected)

Answer 27

viral swab for PCR can swab vesicle/bulla if vesicular eruption if systemic illness, can take throat swab

Question 28

investigations (if fungal inf suspected)

Answer 28

skin scraping nail clipping hair sample fungal cultures

Question 29

skin biopsy

Answer 29

punch biopsy

Question 30

homeothermic

Answer 30

tightly regulate temperature (37 +/- 0.5)

Question 31

temperature varies with...

Answer 31

external temp activity circadian rhythm menstrual cycle

Question 32

location of peripheral thermoreceptors

Answer 32

skin, especially in face and scrotum

Question 33

location of central thermoreceptors

Answer 33

spinal cord, abdominal organs, hypothalamus

Question 34

response to cold stress - how is heat production within body increased?

Answer 34

general metabolism - oxidative phosphorylation and other chemical reactions are not 100% efficient voluntary muscular activity - "futile" muscular activity shivering thermogenesis - involuntary muscular activity non-shivering thermogenesis - only significant in infants due to brown adipose tissue

Question 35

response to cold stress - how is heat loss from body reduced?

Answer 35

vasomotor control - sympathetic arteriolar constriction reduces delivery of blood to the skin behavioural responses - adding clothing, moving to warmer environment, reducing surface area

Question 36

hypothermia - response to cold stress

Answer 36

a fall in deep body temp to below 35

Question 37

who is at risk of hypothermia

Answer 37

neonates elderly homeless people cold store workers outdoor pursuits

Question 38

treatment of cold stress

Answer 38

dry/insulate to prevent further heat loss slow re-warming with bag/blankets internal re-warming with hot drinks and/or warm air rapid re-warming by immersion in water, extracoporeal circulation

Question 39

frost bite: vascular component

Answer 39

vasoconstriction increase in viscosity promotes thrombosis causes anoxia

Question 40

frost bite: cellular component

Answer 40

ice crystals form in extracellular space increases extracellular osmolality causes movement of water from intracellular space cell dehydration and death

Question 41

how is heat production minimised? response to heat stress

Answer 41

decreased physical activity and food intake

Question 42

as a response to heat stress, how is heat loss from the body increased?

Answer 42

vasomotor control - arteriolar dilation increases delivery of blood to the skin sweating - sympathetic cholinergic fibres increase evaporative heat loss behavioural responses - removing clothing, moving to shaded area, increasing surface area

Question 43

heat exhaustion is a consequence of heat stress (heat illness) - explain

Answer 43

body temp raised in range 37.5-40 results in vasodilation and drop in central blood volume caused by a disturbance of the body's fluid/salt balance due to excessive sweating symptoms include headache confusion nausea profuse sweating clammy skin tachycardia hypotension weak pulse fainting and collapse

Question 44

heat stroke (heat injury) - consequence of heat stress explain

Answer 44

body temp raised above 40 body's temp control mechanisms fail symptoms include hot dry skin (sweating stops) and circulatory collapse

Question 45

who is most at risk of heat stress

Answer 45

neonates elderly people doing physical work in hot, humid environments workers wearing non-breathable protective clothing

Question 46

treatment of heat stress

Answer 46

move to cool environment remove clothing fan sponge with tepid water give fluids (oral, IV)

Question 47

fever

Answer 47

part of body's mechanism for fighting infection caused by endogenous pyrogens (IL-1, IL-6) concept of 'set point' controlled by hypothalamus - endogenous pyrogens shift set point - caused by local production of prostaglandins by cyclo-oxygenase in the hypothalamus - explains why aspirin and paracetamol reduce fever

Question 48

what agencies to meds have to be approved/licensed by

Answer 48

MHRA - Medicines and Healthcare Products Regulatory Agency EMA - European Medicines Agency SMC - Scottish Medicines Consortium

Question 49

unlicensed

Answer 49

not approved for use in UK

Question 50

'off-label'

Answer 50

a licensed medication that is being used for an unlicensed indication

Question 51

'specials'

Answer 51

unlicensed dermatological preparations long history of use, no strong evidence base but clinically effective

Question 52

causes of prescription errors

Answer 52

lack of knowledge - about patient, meds or allergies mistake writing/generating prescription poor communication no local/national guidelines pharmacy/medicine info service

Question 53

factors associated with poor adherence

Answer 53

psychiatric co-morbidities slower acting agents multiple applications per day lack of patient education cosmetic acceptability of treatments unintentional non-adherence the NHS spends £100 million annually on unused medicine

Question 54

pharmacology

Answer 54

branch of medicine concerned with uses, effects and modes of action of drugs

Question 55

define pharmacokinetics

Answer 55

effect of body on drug

Question 56

define pharmacodynamics

Answer 56

effect of drug on body

Question 57

pharmacokinetics

Answer 57

need to think about route of administration - topically where possible, if oral, optimal absorption important distribution - where drug goes metabolism - esp in liver disease excretion - esp in renal disease

Question 58

pharmacodynamics

Answer 58

individual variation in response think about - age of patient - pregnancy risk - drug interactions - pharmacogenetics

Question 59

topical therapy

Answer 59

medication applied to skin vehicle + active drug

Question 60

vehicle

Answer 60

pharmacologically inert, physically and chemically stable substance that carries the active drug

Question 61

factors affecting topical absorption

Answer 61

concentration base/vehicle chemical properties of drug thickness and hydration of stratum corneum temperature skin site occlusion

Question 62

examples of vehicle

Answer 62

solution cream lotion gel foam tape paste spray powder shampoo ointment paint

Question 63

examples of topically used drugs (give 6 examples)

Answer 63

corticosteroid antibiotic antiviral chemo antiinflam salicyclic acid

Question 64

topical steroids - anti-inflam and immunosuppressive properties

Answer 64

regulate pro inflam cytokines suppress fibroblast, endothelial and leukocyte function vasoconstriction inhibit vascular permeability

Question 65

topical steroids

Answer 65

range of potencies used appropriately - very safe prescribe enough - see BNF , can use finger-tip units - 0.5g , should treat area double size of one hand - useful in young children , charts available for age

Question 66

6 examples of side effects of topical steroids

Answer 66

thinning/atrophy bruising telangiectasia acne/rosacea glaucoma cataracts

Question 67

systemic treatments in derm

Answer 67

retinoids traditional immunosuppressants biologics (also immunosuppressive)

Question 68

retinoids

Answer 68

vit A analogues - normalise keratinocyte function - anti inflam and anti cancer effects teratogenic - careful patient selection

Question 69

side effects of retinoids

Answer 69

cheilitis and xerosis increase transaminases and triglycerides rarely psychiatric, eye, bone side effects

Question 70

4 diff molecules used orally in derm

Answer 70

acne - isotretinoin psoriasis - acitretin cutaneous T cell lymphoma - bexarotene hand eczema - alitretinoin

Question 71

immunosuppressants

Answer 71

treatment of inflam skin disorders oral steroids azathioprine ciclosporin methotrexate mycophenolate mofetil risk of malignancy and serious infection need regular blood test monitoring - FBC - renal and liver function (ciclosporin and methotrexate)

Question 72

biologics in derm

Answer 72

next generation in treatment of inflam conditions - genetically engineered proteins derived from human genes - designed to inhibit specific components of the immune system - very effective, but expensive

Question 73

'cept' suffix

Answer 73

indicates it is a receptor fusion

Question 74

'mab' suffix

Answer 74

used to denote monoclonal antibodies

Question 75

risk of infection with biologics

Answer 75

TB reactivation serious infection avoid line vaccines malignancy TNF inhibitors - risk of demyelination

Question 76

how can we make a diagnosis of a skin inf

Answer 76

history examination investigations

Question 77

signs of an infection

Answer 77

erythema hot tender pus exudate fever

Question 78

impetigo

Answer 78

superficial skin condition - most common bacterial skin inf in children can be bullous staph aureus, strep pyogenes

Question 79

treatment for impetigo

Answer 79

always check local formulary if localised: fusidic acid 2% cream 3-4times daily for 5 days mupirocin 2% cream up to 3x daily for 5 days if widespread, severe, bullous: flucloxacillin 500mg oral 4x daily for 7 days erythromycin 500mg oral 4x daily for 7 days

Question 80

likely organism of cellulitis/erysipelas

Answer 80

streptococcus pyogenes staphylococcus aureus

Question 81

1st choice antibiotic for cellulitis/erysipelas

Answer 81

flucloxacillin 1g IV every 6hrs plus benzylpenicillin 1.8g IV every 6hrs

Question 82

differential diagnosis of cellulitis

Answer 82

DVT venous eczema allergic contact dermatitis necrotising fasciitis

Question 83

oedema blisters

Answer 83

acute exacerbation of oedema dorsum of feet often erythematous can feel hot

Question 84

lipodermatosclerosis

Answer 84

if acute can be hot and tender - look for signs of venous disease - bilateral (often misdiagnosed as cellulitis) treatment - treat underlying venous disease - topical steroids

Question 85

fungal infections

Answer 85

tinea - infection by a dermatophyte candidiasis

Question 86

tinea on body

Answer 86

ringworm or tinea corporis

Question 87

tinea on head

Answer 87

tinea capitis

Question 88

tinea on feet

Answer 88

tinea pedis (athlete's foot)

Question 89

tinea on groin

Answer 89

tinea cruris

Question 90

tinea on nails

Answer 90

onychomycosis

Question 91

treatment of tinea

Answer 91

topical treatment - terbinafine or clotrimazole cream requires antifungals - if affecting scalp or nails check and treat other family members

Question 92

treatment for candida

Answer 92

nystatin miconazole ketoconazole cream

Question 93

acne vulgaris

Answer 93

disease of pilo-sebaceous unit (PSU) - face, chest, back causes "sticky" keratinocytes + increased sebum viscosity blocked follicles = COMEDONES change in commensal bacteria behaviour (propionobacterium) = INFLAMMATION papules, pustules, nodules, cysts, scars

Question 94

comedones

Answer 94

blocked follicles

Question 95

topical treatment for acne vulgaris

Answer 95

benzoyl peroxide antibiotic: clindamycin, dalacin T lotion, erythromycin retinoids: adapalene combination: duac (BPO and clindamicin) treclin (tretinoin and clindamicin) epiduo gel - adapalene and BPO others - azaleic acid, nicatinamide gel

Question 96

systemic treatment for acne vulgaris

Answer 96

antibiotics: tetracyclines, erythromycin, trimethoprim anti-androgens: combined oral contraceptive pill isotretinoin (roaccutane) UVB dapsone

Question 97

isotretinoin

Answer 97

retinoid medication - vit A derivative most effective treatment - reserved for treatment failure, evidence of scarring, severe acne, acne fuminans prescribed by dermatologists and dispensed by hospital pharmacy weight based treatment - aim to achieve total cumulative dose 120mg/kg can have multiple treatment courses if needed multiple side effects - dry skin, lips, epistaxis, dry brittle hair, myalgia counselling required prior to treatment -risk of low mood teratogenic can raise triglycerides

Question 98

acne fulminans

Answer 98

sudden onset acneform eruption feverish and unwell joint pains start low dose isotretinoin but cover with prednisolone

Question 99

treatment for scarring

Answer 99

treat inflam first if had isotretinoin usually should wait for 1yr before looking into treatment for scarring - depends on type of scarring - intralesional steroid - excision of ice pick scars - laser - dermabraison - chemical peels

Question 100

acne rosacea

Answer 100

chronic inflam - PSU - cutaneous vasculature ace of clubs distribution unusual on non-facial sites

Question 101

subtypes of acne rosacea

Answer 101

erythemato-telangiectatic papulo-pustular phymatous (M>>>F) ocular no comedones

Question 102

topical treatment for acne rosacea

Answer 102

metronidazole - rosex, metrogel azeleic acid - finacea ivermectin - soolantra brimonidine - mirvaso

Question 103

systemic treatment for acne rosacea

Answer 103

oral antibiotics - tetracyclines and erythromycin isotretinoin - low dose light based treatments laser

Question 104

atopic eczema

Answer 104

aka atopic dermatitis inflammatory skin condition commonly affects flexural areas multiple types and a spectrum of severity wide range of external or internal factors can induce condition

Question 105

definition of atopic eczema

Answer 105

an itchy skin condition in the last 12 months plus 3 of following: - onset before age 2 - history of flexural involvement - history of generally dry skin - history of other atopic disease - history in 1st degree relative if under 4yrs

Question 106

pathogenesis of atopic eczema

Answer 106

genetics - many genes implicated - key role for filaggrin gene - atopic FH - atopic eczema, asthma, hay fever (allergic rhinitis), food allergy - epidermal barrier dysfunction - environmental factors - immune system dysregulation

Question 107

pathology of atopic eczema

Answer 107

spongiosis (intercellular oedema) within the epidermis acanthosis - thickening of epidermis inflammation - superficial perivascular lymphohistiocytic infiltrate

Question 108

clinical features of atopic eczema

Answer 108

itch distribution - flexures, neck, eyelids, face, hands and feet tends to spare nappy area acute changes - pruritus, erythema, scale, papules, vesicles exudate, crusting, excoriation chronic changes - lichenification, plaques, fissuring

Question 109

exogenous (external) types of eczema

Answer 109

contact dermatitis - irritant and allergic lichen simplex photoallergic or photoaggravated eczema

Question 110

endogenous (internal) types of eczema

Answer 110

atopic discoid venous seborrhoeic dermatitis pompholyx juvenile plantar dermatitis asteatotic

Question 111

allergic contact dermatitis

Answer 111

type 4 hypersensitivity delayed hypersensitivity - 48-72hrs to develop reaction antigen presenting cells take hapten/allergen to LN and present to naive T cells clonal expansion of these T cells, released into blood stream when these T cells next encounter hapten - mast cell degranulation, vasodilatation and neutrophils

Question 112

irritant contact dermatitis

Answer 112

skin injured by... 1. friction - microtrauma, cumulative 2. environmental factors - cold, over-exposure to water, chemicals such as acids, alkalis, detergents and solvents

Question 113

patch testing

Answer 113

potential allergens applied (no needles involved) baseline/standard series - applied to all patients applied monday - removed wednesday - re-assess friday

Question 114

seborrheic dermatitis - infants

Answer 114

distinctive pattern predilection for scalp, proximal flexures <6months age usually often clears within weeks of treatment

Question 115

seborrheic eczema - adults

Answer 115

chronic dermatitis malassezia yeast increased in the scaly epidermis of dandruff and seborrheic dermatitis red, sharply marginated lesions covered with greasy looking scales distinctive distribution - areas rich in supply of sebaceous glands (scalp, face, upper trunk)

Question 116

discoid eczema

Answer 116

circular plaques of eczema cause often unknown may develop at sites of trauma/irritation

Question 117

asteatotic eczema

Answer 117

very dry skin cracked scaly appearance most commonly shins affected climate - heat excessive washing/soaps

Question 118

venous eczema

Answer 118

stasis eczema or varicose eczema increased venous pressure oedema ankle and lower leg involved resolution of oedema can help - compression stockings

Question 119

treatment of eczema

Answer 119

patient education avoid causative/exacerbating factors emollients (moisturisers) - ointments - greasy but effective - creams - lighter - lotions - more watery soap substitutes intermittent topical steroids - different potency - hydrocortisone, betamethasone sometimes need antihistamines or antimicrobials calcineurin inhibitors - topical pimecrolimus and tacrolimus

Question 120

treatment of severe eczema

Answer 120

UV light immunosuppression - azathioprine - ciclosporin - mhycophenolate mofetil - methotrexate biologic - dupilumab (IL-4/IL-13 inhibitor)

Question 121

what is psoriasis

Answer 121

chronic, immune mediated disease sharply demarcated erythematous plaques with micaceous scale 3% of UK pop 20-30yrs and 50-60yrs 75% before 40yrs systemic disease - 5-30% develop psoriatic arthritis - psychosocial implications - metabolic syndrome

Question 122

pathogenesis of psoriasis

Answer 122

polygenic predisposition + environmental triggers 35-90% have FH infection drugs trauma sunlight

Question 123

histology of psoriasis

Answer 123

hyperkeratosis neutrophils in stratum corneum psoriasiform hyperplasia : acanthosis with elongated rete ridges dilated dermal capillaries T cell infiltration

Question 124

subtypes of psoriasis

Answer 124

chronic plaque psoriasis guttate psoriasis palmo-plantar psoriasis, or pustulosis scalp psoriasis nail psoriasis flexural/inverse psoriasis pustular psoriasis erythodermic psoriasis

Question 125

diagnosis of psoriasis

Answer 125

clinical skin biopsy if atypical

Question 126

differential diagnosis of psoriasis

Answer 126

seborrheic dermatitis lichen planus mycosis fungoides Bowens disease, drug eruption, infection, secondarry syphillis, contact dermatitis

Question 127

management of psoriasis

Answer 127

primary care - emollients - soap substitutes - vit D3 analogues - coal tar creams - topical steroid - with care - salicylic acid secondary care - optimise topical therapy - crude coal tar - dithranol - UVB phototherapy - oral retinoids - acitretin, teratogenic

Question 128

seborrheic keratoses

Answer 128

benign warty growths, "stuck on appearance" can have variable appearance patients often have multiple +/- cherry angiomas generally left untreated, but if troublesome - cryotherapy and curettage

Question 129

cryotherapy

Answer 129

liquid nitrogen pros - cheap and easy to perform "on the day" cons - can scar, failure/recurrence, no pathology result

Question 130

sign of leser-trelat

Answer 130

paraneoplastic phenomenon abrupt onset of widespread seborrheic keratosis, particularly in a younger individual SKs remain benign but may indicate underlying solid organ malignancy - GI adenocarcinoma

Question 131

viral warts

Answer 131

due to HPV rough hyperkeratotic surface difficult to treat will clear when immunity developed to virus cryotherapy or wart paints can stimulate immune system slightly can curette in severe cases

Question 132

what is a cyst

Answer 132

encapsulated lesion containing fluid or semi-fluid material usually firm and fluctuant

Question 133

different types of cysts

Answer 133

epidermoid cyst pilar cyst steatocystoma dermoid cyst hidrocystoma ganglion cyst

Question 134

how to treat cysts

Answer 134

excision if inflamed/infected - antibiotics - intralesional steroid - incision & drainage

Question 135

dermatofibroma

Answer 135

benign, fibrous nodule, often on limbs - proliferation of fibroblasts cause is unknown firm nodule, tethered to skin but mobile over fat pale pink/brown , often paler in centre dimple sign positive usually asymptomatic - can be itchy or tender excision if concern or symptomatic

Question 136

lipoma

Answer 136

benign tumour consisting of fat cells common cause unknown smooth and rubbery subcutaneous mass usually asymptomatic if tender - angiolipoma, liposarcoma - rare malignancy

Question 137

angioma

Answer 137

vascular lesion

Question 138

explain angiomas

Answer 138

overgrowth of blood vessels in the skin due to proliferating endothelial cells generally asymptomatic - can be unsightly or bleed occur in all age groups , both sexes pregnancy and liver disease excision or laser

Question 139

explain pyogenic granulomas

Answer 139

rapidly enlarging red/raw growth, often at a site of trauma bleed easily cause unknown occur in up to 5% of pregnancies common on head and hands removed by curettage and cautery

Question 140

Bowen's disease

Answer 140

aka intraepidermal squamous cell carcinoma - full thickness dysplasia, entirely contained within the epidermis, no metastatic potential - potential to become malignant irregular, scaly erythematous plaque

Question 141

how to treat Bowen's

Answer 141

cryotherapy curettage - lesion scraped off and heat applied to seal vessels and destroy residual cancer cells photodynamic therapy imiquimod

Question 142

what is photodynamic therapy

Answer 142

photochemical reaction to selectively destroy cancer cells topical photosensitising agent applied - concentrates in cancerous cells red light applied (light colour dependant on which agent is used) photodynamic reaction occurs between light, photosensitiser and oxygen causing inflammation and destruction of cells

Question 143

pros and cons of photodynamic therapy

Answer 143

pros : done for patient by hosp staff can treat multiple areas including those which would be hard to reach by patient 1 or 2 treatments cons: requires hosp appts can be painful and scar

Question 144

imquimod

Answer 144

aldara immune response modifier - stimulates cytokine release

Question 145

actinic keratoses

Answer 145

rough scaly patches on sun damaged skin low risk of transformation to SCC treatment - cryotherapy - curettage - diclofenac gel - imiquimod

Question 146

melanoma in situ

Answer 146

melanoma cells entirely confined to epidermis no metastatic potential treated with excision

Question 147

lentigo maligna

Answer 147

type of melanoma in situ usually facial

Question 148

sun protection

Answer 148

cover up avoid sun at peak hours - 10am-4pm don't burn and try not to tan avoid sunbeds sunscreen - UVA and UVB radiation - at least SPF 30/4 star - need to apply 2tbsps every 2hrs

Question 149

risk factors for non-melanoma skin cancer

Answer 149

UV radiation photochemotherapy (PUVA) chemical carcinogens ionising radiation human papilloma virus familial cancer syndromes immunosuppression

Question 150

basal cell carcinoma

Answer 150

slow growing locally invasive rarely metastasise nodular - pearly rolled edge - telangiectasia - central ulceration - arborising vessels on endoscopy

Question 151

treatment of BCCs

Answer 151

excision is gold standard - ellipse with rim of unaffected skin - curative if fully excised - will leave scar curettage in some circumstances imiquimod if superficial

Question 152

indications for Mohs surgery

Answer 152

site size subtype poor clinical margin definition recurrent perineural or perivascular involvement

Question 153

squamous cell carcinoma

Answer 153

derived from keratinising squamous cells usually on sun exposed sites can metastasise, up to 16% depending on study faster growing, tender, scaly/crusted or fleshy growths can ulcerate

Question 154

treatment of SCC

Answer 154

excision +/- radiotherapy follow up if high risked immunosuppressed >20mm diameter >4mm depth ear, nose, lip, eyelid perineural invasion poorly differentiated

Question 155

keratoacanthoma

Answer 155

varient of squamous cell carcinoma erupts from hair follicles in sun damaged skin grows rapidly, may shrink after few months and resolve surgical excision

Question 156

risk factors for melanoma skin cancer

Answer 156

UV radiation genetic susceptibility - fair skin, red hair, blue eyes, and tendency to burn easily familial melanoma and melanoma susceptibility genes

Question 157

ABCDE rule

Answer 157

Asymmetry Border Colour Diameter Evolution

Question 158

7 point checklist

Answer 158

major features: change in size, shape, colour minor features: diameter >5mm, inflammation, oozing/bleeding, mild itch or altered sensation

Question 159

cutaneous lymphoma

Answer 159

secondary cutaneous disease from systemic/nodal involvement primary cutaneous disease - abnormal neoplastic proliferation of lymphocytes in the skin - cutaneous T cell lymphoma (65%) - cutaneous B cell lymphoma (20%)

Question 160

cutaneous T cell lymphoma

Answer 160

counts for 65% mycosis fungoides sezary syndrome CD30+ lymphoproliferative disorders subcutaneous panniculitis like T cell lymphoma cutaneous CD4+ lymphoma extranodal NK/T cell lymphoma

Question 161

cutaneous B cell lymphoma

Answer 161

counts for 20% cutaneous follicle centre lymphoma cutaneous marginal zone lymphoma cutaneous diffuse large B cell lymphoma

Question 162

mycosis fungoides (MF)

Answer 162

most common CTCL & accounts for around 50% of all primary cutaneous lymphomas incidence 6 per 1 mil pop cause unknown more common in older patients and more common in men than women indolent course

Question 163

stages of MF

Answer 163

patch plaque tumour metastatic

Question 164

sezary syndrome

Answer 164

CTCL affecting skin of entire body lymph node involvement sezary cells in peripheral blood poor prognosis - median survival 2-4yrs

Question 165

treatment of cutaneous lymphoma

Answer 165

dependent on stage topical steroids PUVA or UVB localised radiotherapy interferon bexarotene low dose methotrexate chemotherapy total skin electron beam therapy extracorporeal photophoresis bone marrow transplantation

Question 166

total skin electron beam therapy

Answer 166

type of radiotherapy consisting of very small electrically charged particles delivers radiation primarily to superficial layers

Question 167

extracorporeal photophoresis

Answer 167

step 1 - patients blood drawn and leukocytes collected step 2 - collected white cells mixed with psoralen which makes T cells sensitive to UVA radiation step 3 - exposed to UVA radiation, damaging diseased cells step 4 - treated cells reinfused back to patient

Question 168

cutaneous metastases

Answer 168

can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy - most commonly breast, colon and lung

Question 169

management of cutaneous metastases

Answer 169

treat the underlying malignancy local excision localised radiotherapy symptomatic

Question 170

consequences of skin failure

Answer 170

sepsis hypo and hyper thermia protein and fluid loss renal impairment peripheral vasodilation

Question 171

erythroderma

Answer 171

descriptive term rather than diagnosis "any inflam skin disease affecting >90% of total skin surface"

Question 172

causes of erythroderma

Answer 172

psoriasis eczema drugs cutaneous lymphoma hereditary disorders unknown