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Y3 GP > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What should be asked in a history for a dermatological condition ?

A

Site of onset And any evolution
Duration - acute / chronic
Distribution
Flexor / extensor
Sun exposed area
Affecting mucous membranes
Ask about symptoms - itchy or sore
Aggravating or relieving factors
PMH
Any atopy in the family
Drug history
Travel history
Any current stress

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2
Q

What is the medical term for a small lump ( less than 5mm ) ?

A

Papule

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3
Q

What is the medical term for a larger lump ( 5 - 10 mm ) ?

A

Nodule

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4
Q

What is the medical term for redness ?

A

Erythema

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5
Q

What is the medical term for a small water blister ?

A

Vesicle

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6
Q

What is the medical term for a large water blister ?

A

Bulla

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7
Q

What is the medical term for a pus filled vesicle ?

A

Pustule

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8
Q

What is the medical term for a hairiness ?

A

Hirsutism

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9
Q

What is the medical term for scratch marks ?

A

Excoriations

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10
Q

What is the medical term for stretch marks ?

A

Striae

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11
Q

What is the medical term for itching ?

A

Pruritus

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12
Q

What is a macule ?

A

A non palpable area of discolouration

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13
Q

what is a patch ?

A

Macule larger than 2cm

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14
Q

What is a plaque ?

A

Palpable, flat topped area 1-2cm

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15
Q

What is an ulcer ?

A

Loss of epidermis and dermis

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16
Q

What is lichenification ?

A

Thickening of the skin with exaggerated skin markings

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17
Q

What is cellulitis ?

A

A deep infection of the connective tissue, usually skin and subcutaneous tissues, in which there is obvious oedema.

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18
Q

What are the most commonly causative agents of cellulitis ?

A

Streptococcus pyogenes
Staphylococcus aureus

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19
Q

How does cellulitis present ?

A

Hot
Tender
Redness
Fever
Rigors

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20
Q

What investigations are done when suspecting cellulitis ?

A

FBC
Blood cultures
Swabs of the area

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21
Q

What is the treatment of cellulitis ?

A

Systemic antibiotics for example oral penicillin V plus flucloxacillin

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22
Q

What is erysipelas ?

A

A rapidly spreading streptococcal infection of the skin and subcutaneous tissue characterised by cellulitis and lymphangitis.

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23
Q

What is the most likely cause of erysipelas ?

A

Streptococcus pyogenes

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24
Q

What are some clinical features of erysipelas ?

A

Fever
Tachycardia
Chills
Malaise
Red, hot, tender ( usually red shiny plaque on face )

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25
Q

What investigations are performed when suspecting erysipelas ?

A

Swab to culture
There is also often Leucocytosis and a raised ESR

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26
Q

What are some differentials for erysipelas ?

A

Cellulitis
Erysipeloid
Necrotising fasciitis

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27
Q

What is the management of erysipelas ?

A

Offer antibiotics - flucloxacillin is first line or clarithromycin or doxycycline

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28
Q

What are some complications of erysipelas ?

A

Arthritis in near by joints
Sepsis ( rare )
Endocarditis ( rare )

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29
Q

What is impetigo ?

A

A highly contagious, superficial skin infection caused by staphylococcus aureus or streptococcus pyogenes.

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30
Q

What are some clinical features of impetigo ?

A

Multiple lesions affecting the face or extremities.
Honey coloured or golden crusts
Itching is common but should be resisted

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31
Q

What is the management of impetigo ?

A

Swab the lesions and culture

Topical treatment - topical fusidic acid or mupirocin

If systemically ill treat with oral antibiotics such as flucloxacillin

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32
Q

What are some complications of impetigo ?

A

Pneumonia
Glomerulonephritis
Osteomyelitis

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33
Q

What is candidiasis ?

A

An infection caused by the yeast Candida albicans

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34
Q

What is tinea ?

A

It is a very common superficial fungal skin infection caused by dermatophytes.
Usually causes athletes foot, nail infections, tinea corporis.

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35
Q

How can a dermatophyte infection be transmitted ?

A

Direct contact with the infected person or animal
Contact with the soil - rare
Indirect contact - through objects contaminated with the fungus

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36
Q

What is tinea ( a dermatophyte infection ) associated with ?

A

Hot, humid environments
Sweating or maceration of the skin
Use of hair greases or oils
Occlusive footwear
DM

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37
Q

What are some clinical features of tinea pedis ?

A

Affects toe webs, sole or lateral aspect of the foot
Itchy
Erythematous, soggy scaling

38
Q

What are some clinical features of tinea corporis ?

A

Itchy erythematous rash
Usually on the groin or axillae
One or more scaly papules

39
Q

What are the differences between the 2 types of herpes infections ?

A

Type 1 or HSV I - spread by infected saliva, oral facial lesions

Type 2 or HSV II - spread by genital contact, vesicles on the genitalia

40
Q

How does herpes simplex infections present ?

A

Blisters or sores around the mouth, nose, genitals and buttocks but may occur Lamotrigine anywhere on the skin.

41
Q

What are some investigations to perform when suspecting herpes simplex infection ?

A

Diagnosis is usually clinical
Swab and send for culture

42
Q

What is the management of a herpes simplex infection ?

A

The infection can be self limiting
Oral anti-viral medications include Acyclovir
Used to reduce pain, viral shedding and healing time

43
Q

What is molluscum contagiosum ?

A

A viral skin disease characterised by firm, round, translucent, multiple, dome shaped papules. Is it usually benign.

44
Q

How does molluscum contagiosum spread ?

A

Direct skin - skin contact

45
Q

What are some clinical features of molluscum contagiosum ?

A

Pink or white shiny wax-like papules
Dome shaped - central pit
Mildly itchy
Usually on trunk, inner thighs and genitalia

46
Q

What are some differentials for molluscum contagiosum ?

A

Warts
Sebaceous cysts

47
Q

What is the management of molluscum contagiosum ?

A

No specific treatment is required - usually self limiting
Can use cryotherapy or expression of the contents of the pearly core

48
Q

What is shingles ?

A

An acute, unilateral, self limiting inflammatory disease of cerebral ganglia and the ganglia of posterior nerve roots and peripheral nerves in a segmented distribution caused by the varicella zoster virus.

49
Q

What are the clinical features of the shingles ?

A

Occurs 1 - 5 days before the onset of the rash
Malaise
Headache
Photophobia
Itchy
Burning
Affects singular dermatomes

50
Q

What are some differentials for shingles ?

A

HSV
Impetigo
Candidiasis
Contact dermatitis
Insect bites

51
Q

What are some complications of shingles ?

A

Neuralgia
Temporary paralysis
Neurological complications - encephalitis, hemiparesis, Guillian-Barre syndrome

52
Q

What treatment can be given for shingles ?55

A

Oral antivirals
Analgesics

53
Q

What is chicken pox ?

A

A highly infective disease predominately of children under the age of 10 caused by the varicella zoster virus

54
Q

How is chicken pox transmitted ?

A

Direct person to person contact
Airborne droplet infection
Contact with infected articles of clothing

55
Q

What are some clinical features of chicken pox ?

A

Incubation 14 - 21 days
Macular lesions which develop it not papular or vesicular lesions
Mostly affects the face, trunk and sparsely on the limbs
Erythema
Itchy

56
Q

What are some differentials for chicken pox ?

A

Herpes simplex
Impetigo
Contact dermatitis
Scabies

57
Q

What treatment options are there for chicken pox ?

A

Paracetamol
Calamine lotion
Oral acyclovir can be given for adults

58
Q

What are some complications of chicken pox ?

A

Pneumonia
Cerebellar ataxia
Encephalitis
Bacterial infection of the lesion

59
Q

What is basal cell carcinoma ?

A

A locally invasive carcinoma of the basal layer of the epidermis. It almost never metastasises.

60
Q

What are some features of basal cell carcinoma ?

A

Slow growing
locally invasive
Malignant

61
Q

What are some clinical features of basal cell carcinoma ?

A

Usually affects elderly and middle aged people
Common sites are in scar tissue or sun damaged skin
Small pearly white nodule with visible blood vessels

62
Q

What are some causes of basal cell carcinoma ?

A

Sun exposure
Related to Gorlin’s disease

63
Q

What is the treatment for basal cell carcinoma ?

A

Surgery - excision
Radiotherapy
Chemotherapy

64
Q

What is a squamous cell carcinoma ?

A

A malignant tumour of the epidermis in which the cells, if differentiated, show keratin formation.

65
Q

What are some causes of squamous cell carcinoma ?

A

Exposure to UV light
Chronic exposure to industrial carcinogens
Premalignant conditions - bowens disease
Immunosuppression

66
Q

What are some differentials for squamous cell carcinoma ?

A

Basal cell carcinoma
Keratocanthoma
Malignant melanoma

67
Q

What are some clinical features of squamous cell carcinoma ?

A

Develop on sun exposed skin
Rapidly expanding
Painless
Ulcerated nodules
Cauliflower appearance
Metastatic spread may occur via local lymph nodes

68
Q

What is the management of squamous cell carcinoma ?

A

If it is localised and well differentiated ( producing keratin pearls ) can excise it

Poorly differentiated lesions may require the addition of radiotherapy

69
Q

What is melanoma ?

A

Malignant tumour of the pigment producing cells of the skin - melanocytes.
It is not restricted to the skin and can affect the eyes, mucosa, GI tract and Genitourinary tract.

70
Q

What are some risk factors of melanoma ?

A

UV radio audio exposure
Family history
History of 3 more severe sun burns
Presence of freckles
Immunosuppression
Blonde or red hair

71
Q

What are some clinical features of melanoma ?

A

May arise from moles
Ulcerated
Inflamed
Irregular edges
Changes in colour
Changes in shape
Changes in size
Itching

72
Q

What are some differentials for melanoma ?

A

Benign naevi
Pigmented basal cell carcinoma
Kaposi’s sarcoma

73
Q

What investigations are performed when melanoma is suspected ?

A

Excision biopsy
CXR
LFT’S
FBC
CT scan
Sentinel lymph node biopsy

74
Q

What is the management of melanoma ?

A

Excision biopsy and histological examination
Surgery to excise the cancer
May need additional radiotherapy or immunotherapy if more advanced.

75
Q

What is the ABCDE guide to checking moles ?

A

Asymmetry
Border - irregular
Colour - uneven and different shades of colour
Diameter - at least 6mm
Evolution - has changed in appearance

76
Q

What is eczema ?

A

A common and chronic relapsing inflammatory skin disorder characterised by intense pruritis and excoriation.

77
Q

What are some characteristic features of eczema ?

A

Itch
Hot skin
Oedema
Oozing and weeping
Crusting
Excoriation
Secondary infection

78
Q

What is the management of eczema ?

A

Emollients - combat dry skin
Topical corticosteroids
Topical calcineurin inhibitors - Tacrolimus
Antibiotcs if infected
Antihistamines

79
Q

What is psoriasis ?

A

A common chronic skin disease characterised by cutaneous inflammation and epidermal hyper proliferation usually over the extensor aspect of the knees and elbows.

80
Q

What causes psoriasis ?

A

Genetics
Infection
Stress
Trauma
Drugs
Smoking and alcohol

81
Q

How is a diagnosis of psoriasis made ?

A

Based on clinical features
Rarely a biopsy is needed
Scalp lesions and nail lesions

82
Q

How does psoriasis present ?

A

Raised, erythematous and scaly lesions
Red and silvery scales
Bleeding
Itching
Oozing

83
Q

What are the treatment options for psoriasis ?

A

Corticosteroids
Vitamin D analogues
Phototherapies

84
Q

What is the referral criteria for psoriasis ?

A

Diagnosis is uncertain
Psoriasis is severe
Nail disease
Children

85
Q

What is acne vulgaris ?

A

A common chronic inflammatory disease of the pilosebaceous unit. It is characterised by the obstruction of the pilosebaceous follicle with keratin plugs resulting in comedones, inflammation and pustules.

86
Q

What are some clinical features of acne vulgaris ?

A

Comedones - blackheads, whiteheads, sandpaper
Papules ( inflamed )
Pustules ( contains pus )
Lesions usually present on the forehead, nose and chin. It can also affect the upper chest and back.
Scarring can occur

87
Q

What are some treatment options for acne vulgaris ?

A

Topical retinoid
Topical antibiotic
+ benzoyl peroxide

Topical corticosteroids shouldn’t be used

88
Q

When should a referral be made to a dermatologist be made for acne vulgaris ?

A

Hasn’t responded to 2 completed courses of treatment
Acne with scarring
Persistent pigmentary changes
Psychological harm

89
Q

What is urticaria ?

A

Vascular reaction of the skin marked by transient appearance of slightly elevated patches and red or pale swellings with severe itching.

90
Q

What are the clinical features of urticaria ?

A

Rapid change
erythematous
Itchy
Swellings
Blotches

91
Q

What investigations should be performed when suspecting urticaria ?

A

Diagnosis is mainly clinical
FBC - Hb, WBC, eosinophils, platelets
ESR
LFT’s
Urinalysis

92
Q

What is the management of urticaria ?

A

Avoid triggers
Antihistamines
Antileukotrienes
Corticosteroids
Adrenaline - acute

Y3 GP (12 decks)

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