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GP by Moe > Dermatology > Flashcards

Dermatology Flashcards

learn those skin

1
Q

What is this?

A

Herpes zoster/ Shingles

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2
Q

What is this?

A

Atheles foot, tinea pedis

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3
Q

What could this be?

A

basal cell carcinoma

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4
Q

What is this called? This is a type of ____.

A

Pyogenic granuloma

Nodule: Solid raised lesion >5mm in diameter with a deeper component

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5
Q

What is this called? This is a type of ____.

A

pompholyx from eczema of the palms and feet

Vesicle: Raised clear fluid filled lesion <5mm in diameter e.g.

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6
Q

What kind of lesion is this?

A

macule

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7
Q

what kind of lesion is this?

A

Patch: Larger flat area of altered colour or texture >10mm e.g. Port wine stain (naevus flammeus

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8
Q

what kind of lesion is this?

A

Plaque

Plaque: Palpable raised scaling lesion
>5mm in diameter e.g. psoriasis

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9
Q

what kind of lesion is this?

A

papule

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10
Q

what kind of lesion is this?

A

bulla
Raised clear fluid filled lesion >5mm in diameter e.g. blister

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11
Q

What is a naevus and an example?

A

Naevus: Localised malformation of tissue structures e.g. mole

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12
Q

What is this? what type of lesion?

A

mole. naevus.

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13
Q

What is a comedone and an example?

A

Comedone: A plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris e.g. acne

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14
Q

What is this? What type?

A

acne. comedone.

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15
Q

blackheads are a type of ___ lesion and they are (open/closed)

A

comedone, open

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16
Q

WHiteheads are a type of ___ lesion and they are (open/closed)

A

comedone, closed

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17
Q

This is an example of _____.

A

Pustule: Pus-containing lesion <5mm in diameter e.g. Mod-severe acne

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18
Q

A absecess is a localised accumulation of ____ in ________ tissues. an example is?

A

Localised accumulation of pus in dermis or SC tissues e.g. Periungal abscess in acute paronychia

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19
Q

Describe this

A

Acne:
Open and closed Heads.
Open- Blackheads
Closed- Whiteheads

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20
Q

Describe this

A

Infected eczema of the back of the knees/ atopic dermatitis
Shiny and red (wet/moist)
Crust formation
Erythematous
Papular

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21
Q

Describe and what could this be?

A

Malignant melanoma.
Asymmetrical, irregular border, colour variance

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22
Q

What are the red flags of benign skin lesions?

A

Sudden change in size
Irregularity, itching or bleeding
Sudden appearance of new lesions

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23
Q

Describe.
Management?

A

Sebacesous cyst

Skin coloured nodule with central punctum, regular border, symmetrical, mobile, overlying telangiectasia.

Commonly found on:
Neck
Face
Trunk

Treatment:
No intervention necessary
Excision- Whole cyst wall must be excised

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24
Q

Describe.
Management?

A

Large, dome-shaped, subcutaneous lesion, soft to medium consistency, regular surface and border. No surface changes.

What is it?
Benign, slow-growing subcutaneous tumours made of adipose cells
Usually asymptomatic

Management:
If dx uncertain do US +/- biopsy
No intervention necessary
Can be surgically excised

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25
Q

Describe what you see

A

Seborrhoeic keratosis:

Usually appears as a brown, black or light tan growth on the face, chest shoulders and back.
The growth has a waxy, scaly slightly elevated appearance

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26
Q

Describe. What is it?

A

Seborrhoeic keratosis
Darkly pigmented papule (or plaque)
Irregular, hard surface - Rough dry crumbling
‘stuck on’ appearance
No malignant potential
Can become irritated

Treatment:
None
Surgical excision
Cryotherapy (freezing or near freezing temperatures to destroy the tissue)

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27
Q

Describe what you see. What are these?

A

Skin tags

Multiple, flesh coloured or brown polypoid lesions attached by a stalk. Soft. Mobile.

Commonly found on:
Neck
Groin
Body folds

Management:
No treatment necessary
Can be removed by excision, cryotherapy, diathermy

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28
Q

What is this?

A

Sebaceous cyst

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29
Q

What are the 2 pre-malignant skin conditions?

A

Actinic keratosis
Bowen’s disease (SCC in situ)

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30
Q

Describe. What might it be?

A

Erythematous, scaly rough patches, somewhat papular.
+/- Adherent yellow crusts
Actinic keratosis

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31
Q

Actinic keratosis has a risk of progressing to ______

A

Squamous cell carcinoma

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32
Q

What might this be?

A

Actinic keratosis

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33
Q

What might this be?

A

Actinic keratosis

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34
Q

Pharmacological management options for actinic keratosis?

A

Topical 5-fluorouracil (OD x 4/52)
3% diclofenac gel (BD x 2-3/12)

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35
Q

surgical management options for actinic keatosis

A

Cryotherapy
Curettage and cautery

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36
Q

Describe what you see. What might it be?

A

Irregular scaly patch,
with irregular surface and scattered papules.
Pink/red surface.

Bowen’s disease

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37
Q

What is Bowen’s disease?

A

Intradermal SCC i.e. SCC in-situ

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38
Q

treatment options for bowen’s disease?

A

Cryotherapy
Superficial skin surgery
Photodynamic therapy

medical: Topical Treatment- 5-Fluorouracil/Imiquimod

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39
Q

Describe this. What might it be?

A

The classic presentation of Bowen’s disease is of an asymptomatic, well circumscribed, solitary, erythematous patch or plaque on a sun-exposed site (typically head, neck, or limb), usually 10-15 mm in diameter that has been slowly growing.Longstanding lesions can attain more than 2 cm in size through lateral spread. The surface can be dry, scaly, hyperkeratotic, or fissured with irregular borders. Ulceration, bleeding, pain, or nodule formation should arouse suspicion of progression to squamous cell carcinoma.

Can progress to SCC (3-5%)
Assd w/ sun damage, immunosuppression

A clinical diagnosis of Bowen’s disease can be made in primary care when an indolent, well demarcated, erythematous, scaly patch or plaque is detected on a sun-exposed site in a person with skin type 1 or 2. A

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40
Q

Uses of Imiquimod?

A

Uses: Genital warts, Superficial BCC, Actinic keratosis

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41
Q

Aldara 5% is brand name of ______

A

Imiquimod’s brand name is Aldara 5%

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42
Q

Actinic Keratosis VS Bowen’s Disease? Think SCAM

A
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43
Q

3 malignant skin lesions

A

Malignant melanoma
Basal cell carcinoma (BCC)
Squamous cell carcinoma (SCC)

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44
Q

malignant melanoma accounts for ___% of skin cancers
and ___% of skin cancer deaths

A

1% of skin cancers

Accounts for 80% of skin cancer deaths

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45
Q

Describe features of a malignant melanoma lesion with ABCDE

A

Asymmetry
Border: irregular
Colour: Variegation Two or more colours within the lesion
Diameter: >6mm
Evolving: change in size/colour/bleeding

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46
Q

Ugly duckling sign is a feature of _____

A

Malignant melanoma

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47
Q

Risk factors of malignant melanoma?

A
  • UV exposure
  • History of frequent or severe sunburn in childhood
  • Skin type I (always burns, never tans)
  • Increasing age
  • Male
  • Immunosuppression
  • Previous history of skin cancer
  • Genetic predisposition
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48
Q

Manaegment of malignant melanoma?

A

Surgical excision - definitive treatment (plastic surgery team)
+/- Radiotherapy
Chemotherapy for metastatic disease (oncology team)

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49
Q

melanoma in situ is confined to ______ but is considered _____ melanoma when cells grow past it.

A

basement membrane
invasive melanoma

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50
Q

what is this?

A

melanoma in situ

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51
Q

what is this?

A

melanoma in situ

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52
Q

Picture shows a (superficial/nodular) type of melanoma.

A

Superficial spreading (50-75%)

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53
Q

(Superficial spreading/ nodular) melanoma is common on the lower limbs in young and middle aged adults

A

superficial spreading melanoma Common on the lower limbs in young and middle aged adults.
Related to intermittent high intensity UV exposure

54
Q

Picture shows a (superficial/nodular) type of melanoma.

A

Nodular melanoma:
Common on the trunk in young and middle aged adults.
Related to intermittent high intensity UV exposure

55
Q

(Superficial spreading/ nodular) melanoma is common on the trunks in young and middle aged adults

A

nodular

56
Q

what is this?

A

lentigo maligna (5-15%) melanoma:
Common on the face in elderly population.
Related to long term cumulative UV exposure.

57
Q

What is this?

A

Acral lentiginous melanoma:
Common on palms, soles and nail beds in elderly population.
No clear relation with UV exposure

58
Q

What is this?

A

Squamous cell carcinoma:
Nodule, irregular, with central ulceration. Crusty, scaly.

59
Q

Describe

A

Squamous cell carcinoma:
Hyperkeratotic skin coloured to erythematous papule/nodule/plaque.
Scaling, ulceration, crusting

60
Q

Treatment for SCC?

A

Depends on site, size, location and number of SCCs
Surgical excision
Radiotherapy

61
Q

____ is the 2nd most common skin cancer

A

SCC

62
Q

SCC on a chronic wound/ scar is called ____

A

Marjolin’s ulcer

63
Q

4 types of BCC?

A

Nodular, Superficial, Pigmented, Morphoeic

64
Q

treatment for BCC?

A

Surgical excision
Radiotherapy
Topical therapies- 5-fluorouracil/Imiquimod 5% cream
Cryotherapy

5-fluorouracil: Anti metabolite chemotherapy
Imiquimod 5% cream: Immune response modifier

65
Q

What is this?

A

atopic dermatitis/ eczema

Presents as itchy erythematous dry scaly patches, with associated papules and/or vesicles

66
Q

Dermatitis is asociated with family/personal history of ____

A

Associations:
Personal/Family history of Asthma
Allergic rhinitis
Atopy

67
Q

What is this?

A

atopic dermatitis/ Eczema

Presents as itchy erythematous dry scaly patches, with associated papules and/or vesicles

68
Q

Management of atopic eczema?

A

Management
Emollients!!! (moisturiser)
Topical steroids for flare ups
Topical immunomodulators can be used as steroid sparing agents e.g. Tacrolimus
Phototherapy and immunosuppressants for severe non responsive cases

69
Q

areas affected in eczema

A

Areas affected
Infants: Face and extensor aspects of limbs
Children and adults: Flexor aspects

70
Q

What is this?

A

irritant dermatitis

71
Q

What is this?

A

allergic dermatitis

72
Q

Describe the lesion. What is this?

A

proximal to the medial malleolus
Hyper-pigmented, thickened, scaling skin
champange bottle appearence

This is a Venous eczema

73
Q

Treatment for this condition?

A

Treatment for venous eczema:
Leg elevation
Support stockings (after excluding PAD)
Weight reduction
Emollients
Topical steroids (hydrocortisone to eumovate to betnovate)

74
Q

Describe the picture. What might it be? Give other DDx.

A

Seborrhoeic dermatitis
White yellowish scale on erythematous patches/plaques
Chronic, superficial inflammation affecting hairy regions
Associated with contact dermatitis to Malassezia yeast

DDx:
Atopic eczema
Psoriasis

75
Q

WHat is this? Treatment?

A

Seborrhoeic dermatitis on eyebrows and face

Seborrheic dermatitis is a superficial fungal disease of the skin, occurring in areas rich in sebaceous glands.

Treatment:
Ketoconazole shampoo +/- cream
Topical keratolytics and steroids

76
Q

What is this?

A

Psoriasis. Sharply demarcated pruritic, erythematous plaques with overlying silvery scale

77
Q

Psoriasis is an independent risk factor for ___

A

CVD

78
Q

Precipitating factors of psoriasis?

A

Trauma
Infection
Drugs
Stress
Alcohol

79
Q
A

plaque psoriasis

80
Q
A

Guttate psoriasis
Multiple drop like lesions that is usually preceded by a streptococcal sore throat/ tonsillitis

81
Q

WHat is this? Management?

A

Well outlined scaly plaques with thickened scales
Scalp psoriasis

Management:
T gel shampoo
Steroid scalp lotion and vitamin D analogue

If still problematic then:
Massage cocois oil into scalp and leave overnight followed by vitamin D/steroid scalp lotion

82
Q

Treatment for localised and mild psoriasis?

A

Emollients to reduce scales

+ Topical therapies such as Vitamin D analogues, Corticosteroids, Coal tar, Dithranol

Dovobet (calciprotriol + betamethasone)
+/- Dovonex (calciprotriol)

83
Q

What does Dithranol do?

A

Anthralin- Inhbits keratinocyte hyperproliferation

84
Q

Treatment for Extensive severe psoriasis or psoriasis with systemic involvement?

A

Oral therapies e.g. methotrexate
Biologics e.g TNF-alpha inhibitors

85
Q

What is this called? In which disease do you find it?

A

Oncycholysis- Separation of the distal end of the nail plate from the nail bed

Psoriasis nail involvement

86
Q

What might this be? what cause it?

A

Acne

Contributing factors:
Increased sebum production
Abnormal follicular keratinization
Bacterial colonization (propionbacteruim acnes)
Inflammation

87
Q

Acne is defined as inflammation disease of the ______

A

An inflammatory disease of the pilosebaceous follicle

88
Q

what parts of the body does acne commonly affect?

A

Face
Chest
Upper back

89
Q

Mild acne is defined as <_____(number) lesions. They are mainly _____(type of lesion), consisting of _____ which are blackheads, ____ which are white heads

A

< 30 LESIONS
Mainly comedones = plug in sebaceous follicle containing sebum, bacteria, cellular debris
Open (blackheads)
Closed (whiteheads)
May have a few inflammatory papules and pustules

90
Q

Moderate acne is defined as ____(number) of lesion,
______(type of lesion) with several inflammatory papules and pustules, a few nodules

A

30-125 LESIONS
Comedones with several inflammatory papules and pustules, a few nodules

91
Q

Severe acne is defined as >___(number) lesions. It involves ____ unlike mild and moderate

A

> 125 LESIONS
Comedones, several inflammatory papules and pustules, multiple nodules,

  • Involves SCARRING
92
Q

1st line Treatment for mild comedonal acne

A

Topical retinoid (e.g. Adapalene)

93
Q

Acne treatment with oral ABX is reviewed every ___ weeks

A

12 weeks

94
Q

For ACNE, _____ might be used ONLY if all other rx failed for severe acne in AFAB (assigned female at birth) patients, due to risk of thrombosis

A

Co-cyprindiol (COCP)

95
Q

For ACNE, Patients are referred to dermatology if treatment fails after ___ months

A

6 months OR 6/12

96
Q

Treatment for mild to moderate acne papules and pustules.

A
97
Q

Treatment for Moderate to severe acne OR when previous rx failed

A
98
Q

For moderate to severe acne treatment, if patient if pregnant or < 12 years old, which ABX is/are recommended?

A

If pregnant, <12 yo: erythromycin or trimethoprim

99
Q

complications of acne

A

Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological and social effects

100
Q

What is this? Describe.

A

Rosacea
Erythema, flushing and papules

101
Q

What is this?

A

Rhinophyma

102
Q

____ is chronic inflammation of facial dermatosis

A

Rosacea

103
Q

Rosacea is common in ____ years old

A

Common in 30-50 yo

104
Q

Triggers of Rosacea

A

Sun exposure/heat
Stress, exercise
Alcohol

105
Q

Treatment for Rosacea

A

Topical antibiotics e.g. metronidazole gel
Oral antibiotics e.g. tetracycline

106
Q

For Rosacea, refer to dermatology if ….

A

Refer to dermatology if complications e.g. Rhinophyma or failure to respond

107
Q

What is this? What is it caused by?

A

Impetigo

Usual pathogens:
Staph aureus
Strep pyogenes

108
Q

Treatment for this condition

A

Treatmen for impetigo:
Topical antibiotics e.g. fusidic acid
Oral antibiotics e.g flucloxacillin

109
Q

What is this? DDx?

A

Cellulitis

Redness, swelling, warmth, tenderness +/- pyrexia
Border ill-defined

DDx DVT

110
Q

____ is the infection of deep subcutaneous tissues

A

Cellulitis

111
Q

Treatment for cellulitis

A

Treatment:
Abx e.g. Flucloxacillin
If leg – rest and elevation

112
Q

Cellulitis increases risk of developing…

A

Abscess
Sepsis
Recurrence
Lymphoedema

113
Q

What is this? Aetiology?

A

Chicken pox/ varicella,
Herpes Varicella zoster virus

114
Q

____ presents as grouped vesicles on erythematous base.

A

chicken pox/ varicella

Highly contagious airborne disease
Rash (very itchy!) + fever
Macular  papular  vesicular (on erythematous base)
Lesions dry and crust

115
Q

Treatment for this condition?

A

Symptomatic management e.g.paracetamol, calamine lotion

116
Q

Shingles is a (painful/painless) blistering rash caused by reactivation of ____ virus

A

Herpes zoster, or shingles, is a painful blisteringrashcaused by reactivation of the herpes varicella-zoster virus.

117
Q

(shingles/chicken pox) is itchy but (shingles/chicken pox) is painful

A

Chicken pox is itchy
Shingles is painful

118
Q

Herpes zoster is _____(symmetrical/asymmetrical) and ____(unilateral/bilateral), in ______ distribution

A

Asymmetrical, unilateral
Dermatomal distribution

119
Q

Treatment?

A
  1. Oral antivirals e.g. acyclovir/valciclovir
    HSE antimicrobial guidelines specify that it may be commenced within 72 hours of rash onset, if patient >50 years old
  2. Analgesia
120
Q

What is this? Describe.

A

Ringworm/ Tinea corporis

Itchy circular/annular lesions with a clearly defined raised and scaly edge

Contagious

121
Q

What is this? Describe.

A

Tinea cruris
(groin)

clearly defined raised skin, scaling lesions

Pruritic

122
Q

What is this? treatment?

A

Tinea Pedis

Mild
Topical antifungal creams e.g. Miconazole
+/- topical corticosteroid if inflamed

Widespread/Severe
Oral antifungals e.g. Terbinafine

123
Q

What might this be? DDx?

A

Tinea uinguium
Ddx: Psoriasis

124
Q

Management for this?

A

Advised to confirm diagnosis by sending nail clippings to microbiology lab

use topical first
if severe (more than 1-2 digits)/ no response to topical rx, try oral antifungals.

However, Get baseline LFT as hepatotoxicity. WARN PATIENTS.

Oral anti-fungals 6-12 weeks if finger nails, 3-6 months if toes

125
Q

What could this be?

A

Oral Candida

Ddx: leukoplakia

126
Q

What could this be?

A

Urticaria/ Hives, sudden onset very itchy

127
Q

What is this?

A

AngioOedema

128
Q

Management?

A

Can be an emergency and can be life threatening – may accompany ANAPHYLAXIS

Treatment:
ABCDE
Call for help
Medications- Adrenaline, Hydrocortisone, Antihistamine
High flow oxygen
Monitor- Pulse oximetry, ECG, BP

129
Q

Sx of anaphylaxis

A

Bronchospasm
Facial and laryngeal oedema
Hypotension

130
Q

Angioedema and anaphylaxis can lead to:

A

Asphyxia
Cardiac arrest
Death

131
Q

Fever, neck stiffness, photophobia… Non-blanching petechial or purpuric rash…what are we concerned about?

A

Meningitis/ Meningcoccal disease

132
Q

Management of meningcoccal disease?

A

Management:
Call for help and phone an ambulance
ABCDE approach
IV access, IVFs and high flow oxygen (100%)
Benzypenicillin IM/IV (cefotaxime can also be given instead)

GP by Moe (21 decks)

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