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Dermatology Flashcards

1
Q

What lesion feels larger than it appears on extremities of younger people

A

Dermatofibroma

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2
Q

Skin lesion in elderly with greasy scaly appearance

A

Seborrheic keratosis

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3
Q

What is balanitis xerotica obliterans

A

Lichen sclerosis on the penis

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4
Q

Smooth painless lump in groin which does not have a cough impulse

A

Lipoma

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5
Q

Management of nec fasc

A

IV abx
Surgical debridement

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6
Q

Most common site for nec fasc

A

Perineum

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7
Q

Which medication increases risk of nec fasc

A

SGLT-2i

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8
Q

Presentation of nec fasc

A

Appears like cellulitis but main things to look for
- severe pain that does not match appearance
- purple
- very tender
- necrosis

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9
Q

What are the types of nec fasc

A

Type 1- mix of anaerobes and aerobes- v comorbid on trunk
Type 2- strep pyogenes- young on limbs
Type 3- clostridium seen in IVDU

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10
Q

What causes SJS

A

A severe systemic reaction to a drug in particular;
- penicillin
- sulphonamides
- lamotrigine, carbamezapine, phenytoin
- allopurinol
- NSAIDs
- COCP

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11
Q

How does SJS appear

A

Macuopapular rash with target lesions
May develop into blisters and erosions- nikolsky positive
Oral ulcesr
Joint pain

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12
Q

Management of SJS and TEN

A

ITU transfer
Lots of fluid
IVIG and ciclopsorin, plasmapharesis

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13
Q

Causes of pyoderma gangrenosum

A

Idiopathic most commonly
IBD
Rheum conditions
- RA
- SLE
Haem cancers

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14
Q

How does pyoderma gangrenosum appear

A

Initially may be a small pustule or blister
Then skin breaks down to ulcerate
Purple and nasty looking border
Can be systemic

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15
Q

Ulcerated lesion on lower leg with purple border

A

Pyoderma gangrenosum

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16
Q

What is management of pyoderma gangrenosum

A

First line oral prednisolone
Ciclosporin or infliximab may be used second line

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17
Q

What drugs may trigger psoriasis

A

NSAIDS
Beta blockers
Lithium
Chloroquines
ACEi
Alcohol

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18
Q

Side effects of isoretinoin

A

Dry skin and lips- most common
Increased triglycerides
Thin hair
Intracranial HTN
Depression

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19
Q

Management of pityriasis versicolor

A

Ketoconazole shampoo

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20
Q

What causes pityriasis versicolor

A

Malassezia furfur

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21
Q
A

Vasculitis

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22
Q

How does osler weber rendu present

A

Telengiectasia in the mouth or nose- seen as red spots
Epistaxis
GI telengiectasia- bloody stool
AVM in lungs, spine and liver
Family history

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23
Q

Management of impetigo

A

If mild and contained
- hydrogen peroxide then fusidic acid second line
If systemic or widespread
- oral fluclox

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24
Q

What is onycholysis

A

Separation of the nail from the nail bed

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25
Q

Management of scabies

A

Whole household to be given 2 doses of permethrin with 1 week inbetween

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26
Q

How can rosacea appear

A

Can appear as blushing with reddening
Telengiectasia visible
Pustules and papules is what it can develop into
Can involve eyelids

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27
Q

Who does rosacea occur in

A

Middle aged women
Fair skin

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28
Q

Management of rosacea

A

If just erythema and flushing then topical brimonidine or topical metronidazole
If putules and papules
- mild= topical ivermectin
- severe= topical ivermectin and oral doxy
Always encourage suncream

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29
Q

How can seborrheic keratoses appear

A

From stuck on slightly raised lesions to almost mole like (see photo)

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30
Q

First line for plaque psoriasis

A

Potent topical steroid OD after applying vitamin D OD
Reassess in 8-12 weeks

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31
Q

Second line for plaque psoriasis

A

Increase frequency of vitamin D to BD
Reassess in 8-12 weeks

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32
Q

Other than COCP what can use to treat hirsutism

A

Topical eflornithine

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33
Q

Management of acne vulgaris

A

Step up
1. topical benzoyl peroxide
2. combination with topical abx or retinoid
3. add oral abx
4. if women consider COCP

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34
Q

What antibiotic is used for acne

A

Tetracycline
Erythomycin if pregnant or breastfeeding

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35
Q

What are features of lipoma

A

Smooth
Mobile
Painless

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36
Q

What suggests liposarcoma over lipoma

A

Over 5cm
Growing
Pain
Deep location

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37
Q

How does shingles present

A

PAIN initially over area
Then develop erythematous rash which may become vesicular

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38
Q

What is a painful rash most often

A

Shingles

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39
Q

Management of shingles

A

Avoid pregnant and immunocompromised people for 5-7 days until lesions crusted
If present within within 72 hours then aciclovir
Only give steroids if refractory to simple analgesia

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40
Q

With shingles how long should avoid pregnant and immunocompromised people

A

5-7 days until has crusted over

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41
Q

Management of patient with bullous pemphigoid

A

Oral steroids and biopsy

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42
Q

Pemphigus vulgaris vs bullous pemphigoid

A

Pemphigoid= tense blisters, no mucosal involvement
Pemphigus= flaccid blisters, mucosal involvement

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43
Q

Most suitable long term option for psoriasis

A

Vitamin D and emollients

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44
Q

What would cause raised linear dark lesion over a scar

A

Keloid

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45
Q

Presentation of keloid

A

Raised dark lesions on a scar
Darker skinned people
Family history

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46
Q

What is management of a keloid

A

Intra-lesional steroids

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47
Q

What use for pain refractory shingles

A

Steroids if in acute phase

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48
Q

What is a non-healing ulcer over a scar

A

Squamous cell carcinoma

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49
Q

Presentation of lichen planus

A

Itchy lesions (can be asymptomatic)
Raised pink/purple papules
Polygonal in shape
White lines visible on rash
Wichkams striae in mouth
Koebner phenomenam- develop over scars

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50
Q

Management of lichen planus

A

Potent topical steroids- betnovate (betamethasone valerate)

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51
Q

How remember steroid strength

A

Helps every budding dermatologist
Hydrocortisone- mild
Eumovate- moderate
Betnovate- potent
Dermovate- very potent

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52
Q

What is eumovate

A

Clobetasone butyrate 0.05%

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53
Q

What is betnovate

A

Betamethasone valerate 0.1%

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54
Q

What is dermovate

A

Clobetasol propionate 0.05%

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55
Q

Presentation of seborrheic dermatitis

A

Yellow scaly rash on face, nasolabial folds, hair, upper back and chest
Blepharitis and otitis externa common

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56
Q

What are complications of seborrheic dermatitis

A

Blepharitis
Otitis externa

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57
Q

What is management of scalp seborrheic dermatitis

A

1st line- t gel or head and shoulders containing zinc
2nd line- ketoconazole shampoo

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58
Q

What is management of face and body seborrheic dermatitis

A

Topical ketoconazole
If severe in an area use topical steroids

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59
Q

How does fungal nail disease present

A

Unsightly nails
Yellow, thickened and opaque nails

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60
Q

Causes of fungal nail infections

A

Most commonly tricophytum rubrum
Can also be candida

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61
Q

How treat fungal nail disease

A

If asymptomatic and not bothered- can do nothing
If contained to small part of nail then- topical amorolfine nail lacquer
If extensive then oral antifungal
- terbinafine for tricophytum
- itraconazole for candida

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62
Q

What is used for minor fungal nail disease

A

Amorolfine nail lacquer

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63
Q

What is used for extensive tricophytum nail disease

A

Oral terbinafine

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64
Q

What is used for extensive candida nail disease

A

Oral itraconazole

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65
Q

What cancer are people most at risk of in renal cancer immunosuppression

A

Skin cancer- SCC most commonly

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66
Q

How diagnose contact dermatitis

A

Skin patch testing

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67
Q

How does actinic keratosis present

A

Crusty and scaly lesions
Can be pink, red or brown
On sun exposed areas

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68
Q

Management of actinic keratosis

A

Sun cream
Topical fluoracil, diclofenac and immiquimoid

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69
Q

What is problem of topical fluoracil

A

Skin can become very inflammed- give topical steroids

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70
Q

What is most aggressive melanoma

A

Nodular

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71
Q

What is an acral lentinginous melanoma

A

Mole on feet and hands
Get pigmentation under nails

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72
Q

What is pomphloyx eczema

A

Where get blisters and fissures when returning from a hot and humid country
Sweating precipitates this

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73
Q

What is it when get eruption blistering and fissures on hands and feet when returning from high temperatures

A

Pompholyx

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74
Q

Presentation of dermatofibroma

A

Solitary nodule on limbs
Feels larger under skin than appears
Overlying skin dimples when pinching
Often following trauma

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75
Q

Presentation of dermatitis herpetiformis

A

Itchy vesicular rash on the extensor surfaces
Knees, elbows and buttocks

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76
Q

What is management of acne with severe scarring

A

Referral to specialist for prescription of tretinoin

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77
Q

What causes an ulcer to develop at site of stoma in IBD

A

Pyoderma gangrenosum

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78
Q

Causes of erythema nodosum

A

TB
Strep
Sarcoid
Brucellosis
Cancer
Pregnancy
Drugs- penicillin, COCP and sulphonamides

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79
Q

What malignancies is acanthosis nigricans associated with

A

Pancreatic
Gastric

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80
Q

Where does acanthosis nigricans tend to affect in cancer as a paraneoplastic syndrome

A

The tongue

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81
Q

What is a dark velvety coating over the tongue coincidnig with abdominal cancer symptoms

A

Acanthosis nigricans maligna
Is a paraneoplastic syndrome associated with GI cancers

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82
Q

Presentation of erythema ab igne

A

In an older woman who has been sat by a fire or has hot water bottles
Mottled erythema which appears mottled and lace like
Non-tender and blanching

83
Q

What can erythema ab igne progress to

A

SCC

84
Q

Management options for head lice

A

Dimeticone
Malathion

85
Q

What is an intra-epithelial squamous cell carcinoma

A

Bowens disease

86
Q

How does bowens disease appear

A

Red scaly patches
1-1.5 cm wide

87
Q

Management of bowens disease

A

Topical fluoracil- may have to give steroids too as causes a lot of inflammation

88
Q

How differentiate a telengiectasia from a spider naevi

A

Spider naevi refill from the centre whereas telengiectasia refill from the edges

89
Q

What presents with dimpled lesions around a scar

A

Molloscum contagiosum
Get koebner phenomena

90
Q

How does guttate psoriasis present

A

Tear drop itchy scaly papules on trunk and limbs
Prodrome of strep infection

91
Q

Management of guttate psoriasis

A

No need if asymptomatic
Same as normal psoriasis if symptomatic
- steroids
- VIt D
- phototherapy if severe

92
Q

What organism is thought to be behind pityriasis rosea pathology

A

HHV7

93
Q

Presentation of pityriasis rosea

A

Potentially recent viral infection
Herald patch on torso
Develops into mutlipe oval shaped marks with central lighter colour
Often inXmas tree distribution along the lines of langer

94
Q

Where are sebaceous cysts commonly seen

A

SCALP
Trunk
Arms
Face
Back

95
Q
A

Severe rosacea

96
Q

What do if a healthworker does not have antibodies for VZV

A

Vaccinate them

97
Q

What is rash on legs with reddish-blue discolouration made worse by cold

A

Livedo reticularis

98
Q

What is cause of livedo reticularis

A

SLE

99
Q

What is management if someone immunosuppressed presents with a new skin lesion

A

Anything suspicious of cancer should be reffered urgently due to risk of SCC posed by immunosuppression

100
Q

What drug can cause pellagra

A

Isoniazid

101
Q

What is management of keratoacanthoma

A

Urgent referral to rule out SCC

102
Q

What is first line for hyperhidrosis

A

Topical aluminium chloride

103
Q

How differentiate acne vulgaris from acne rosacea

A

There is a typical erythematous and flushing appearance to the face in rosacea
Comedones in acne vulgaris

104
Q

Management of alopecia areata

A

Screen for hypothyroidism and vitamin deficiencies
Treatment options include
- minoxidil
- topical corticosteroids
Will grow back eventually

105
Q

What are cherry haemangiomas

A

AKA campbell de Morgan spots are benign skin lesions which contain an abnormal proliferation of capillaries. Very normal part of aging

106
Q

How do campbell de morgan spots appear

A

erythematous, papular lesions
typically 1-3 mm in size
non-blanching
not found on the mucous membranes

107
Q

What is hidradenitis suppurativa

A

Chronic inflammatory condition where get inflammatory pustules and nodules which become inflammed and lead to sinus tracts, abscess and scarring

108
Q

Where does hidradenitis suppurativa occur

A

Intertriginous areas
- axilla- most common
- inguinal area
- inner thigh
- perianal skin
- neck

109
Q

Presentation of hidradenitis suppurativa

A

Development of pustules and nodules in intertriginous areas
These may become infected and release pus
Sinuses develop
Scarring occurs- rope like

110
Q
A

hidradenitis suppurativa

111
Q

Who does hidradenitis suppurativa occur in

A

Women
Under 40
Fat
Smoker

112
Q

Management of chronic hidradenitis suppurativa

A

Loose fitting clothes
Lose weight
Topical clindamycin or oral lymecycline/clindamycin

113
Q

Management of acute hidradenitis suppurativa

A

Topical steroids
May need oral fluclox and in some cases incision and drainage

114
Q

Concerning causes of itch

A

Polycythaemia
Liver disease
Lymphoma
IDA
CKD

115
Q

Presentation of perioral dermatitis

A

clustered erythematous papules, papulovesicles and papulopustules
most commonly in the perioral region but also the perinasal and periocular region
area around lip spared

116
Q

What can worsen perioral dermatitis

A

Steroids

117
Q

Management of perioral dermatits

A

Topical or oral abx

118
Q

Causes of erythema multiforme

A

HSV- most common
Mycoplasma
Drugs- SNAPP
SLE
Sarcoid

119
Q

Presentation of erythema multiforme

A

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

120
Q
A

Erythema multiforme

121
Q

Presentation of zinc deficiency

A

Hypogonadism
Short
Hair loss
Acrodermatitis around anus and mouth

122
Q

What is acrodermatitis

A

Red crusted lesions- seen in zinc deficiency

123
Q

What is biopsy take for a melanoma

A

Excisional biopsy

124
Q

What is onchomycosis

A

Fungal infection

125
Q

How is leukoplakia diagnosed

A

Diagnosis of exclusion
- key features include hard spots on toungue and mouth which are hard to get off

126
Q

What can leukoplakia develop into

A

Squamous cell carcinoma

127
Q

What do if patient presents with leukoplakia

A

Biopsy to exclude SCC

128
Q

Features of candidiasis in mouth

A

White patches
Can be rubbed off
Can be painful/symptomatic

129
Q

What happens if give steroids for too long on skin

A

Skin depigmentation
Skin atrophy

130
Q

What is a pyogenic granuloma

A

Areas of ulceration with bleeding at site of minor trauma

131
Q

Presentation of pyogenic granuloma

A

Ulcerated lesion
Bleeding on contact
Previous trauma

132
Q

How does athletes feet (tinea pedis) present

A

Scaling and flaking between the toes
Very itchy

133
Q
A

Tinea pedis/athletes foot

134
Q

Management of athletes foot

A

Topical miconazole

135
Q

How best to manage telengiectasia in rosacea

A

Laser therapy

136
Q

Presentation of nodular melanoma

A

Red or black lump or lump which bleeds or oozes

137
Q

What is when a worker or cleanrer prsents with erythematous rash on hands

A

Irritiant contact dermatitis

138
Q

Management first line for flexural vs extensor psoriasis

A

Extensor- topical corticosteroid plus topical vit D
Flexural- mild hydrocortisone alone

139
Q

Causes of hirsutism

A

PCOS
Cushings
CAH
Androgen therapy
Phentyoin

140
Q

What cancer can UVA therapy lead to

A

SCC

141
Q

What long term disease are psoriasis patients at greater risk of

A

Cardiovascular disease

142
Q

What is erythema multiforme major

A

A severe form of erythema multiforme with mucosal involvement and patients are far more ill

143
Q

Presentation of erythema multiforme major

A

Ulceration of the mouth
Sloughing of tissue off
Erythema multiforme lesions

144
Q

What lesion dimples when pinched

A

Dermatofibroma

145
Q

Presentation of pityriasis versicolor

A

Lesions do not need to be hypopigmented, they can be pink or brown
Scales seen
Itchy

146
Q

How does lichen sclerosis present in men

A

Tight white ring around the penis on foreskin
Phimosis

147
Q

What is the koebner phenomena seen in

A

psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

148
Q

How long can wait in between courses of topical hydrocortisone

A

4 weeks

149
Q

What causes erysipelas

A

Strep pyogenes

150
Q

Management of erysipelas

A

Flucloxacillin

151
Q

What is diagnosis if itchy rash over nasolabial fold, back and axilla but cultures show staph aureus

A

Seborrheic dermatitis
Skin always grows staph aureus

152
Q

What abx is used for acne if pregnant or breastfeeding

A

Erythromycin

153
Q

Management of erythema nodosum

A

No active treatment
Self resolves in 6 weeks

154
Q

What are 2 conditions with particularly high rates of seborrheic dermatitis

A

HIV
Parkinsons

155
Q

What can cause erythroderma

A

Eczema
Psoriasis
Blood cancers

156
Q

Management of erythroderma

A

Admit to hospital
Monitor for complications
- infection
- HF
- dehydration

157
Q

What give if athletes foot fails to respond to a topical imidazole

A

Prescribe a course of oral terbinafine

158
Q

What causes spider naevi

A

Liver disease
Pregnancy
COCP

159
Q

What often comes first in shingles

A

Pain

160
Q

Can you use topical retinoins in pregnancy

A

NO

161
Q

Complications of burns

A

ARDS
Secondary infection
Hypoalbuminaemia
Compartment syndrome
DIC
Curlings ulcer

162
Q

What need to do if extensive burns to neck and face area

A

Consider early intubation

163
Q

First aid for burns

A

Cool water irrigation
Cling film in layers over it

164
Q

What can be used to determine body coverage from burns

A

Estimate using the Wallaces rule of 9s
Most accurate is the lund and browder chart

165
Q

How does the rule of 9s work

A

Head and neck=9%
Each arm=9%
Anterior leg=9%
Posterior leg=9%
Anterior chest=9%
Posterior chest=9%
Anterior andomen=9%
Posterior abdomen=9%
Palmar surface= 1%

166
Q

What is most accurate way of measuring body coverage by burns

A

Lund and browder

167
Q

How assess burns

A

New terminology
Superficial epidermal = first
Partial thickness (superficial dermal) = 2nd
Partial thickness (deep dermal) = 2nd
Full thickness = 3rd

168
Q

How do superficial epidermal burns appear

A

Red and painful, dry, no blisters

169
Q

How do partial thickness (superficial dermal) burns appear

A

Pale pink, painful, blistered. Slow capillary refill

170
Q

How do partial thickness (deep dermal) burns appear

A

Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure

171
Q

How do full thickness burns appear

A

White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

172
Q

What burns need referral to secondary care

A

Deep dermal and full thickness
Inhalation injury
Electrical or chemical burns
Superficial dermal affecting face, feet, hands, genitalia or any fold
Superfical dermal over 3% in adults
Superficical dermal over 2% in kids

173
Q

Superfical burns to which part of body warrant secondary care

A

Face
Hands
Feet
Genitalia
Folds

174
Q

Management of superfical epidermal burns

A

Analgesia
Emollients

175
Q

Management of superfical dermal burns

A

Cleanse wound
Leave blisters
Non adherant dressing
Avoid topical creams
Review in 24 hours

176
Q

Management of deep dermal and full thickness burns

A

A- if around neck think early intubation
B
C- IV fluids if over 15% TBSA, put in catheter
Consider excision and skin grafts for severe burns

177
Q

When consider escharotomies

A

Circumfrential burns to torso and limbs
Relieving compartment syndrome and oedema in limbs

178
Q

If someone is ventilated due to burns and ventilation pressures are increasing what need to do

A

Escharotomy

179
Q

Differentiating superficial epidermal from partial thickness (superficial dermal)

A

Partial thickness is pale pink and blisters

180
Q

What is a curlings ulcer

A

Gastric ulcer caused by intravascular depletion leading to ischaemia

181
Q

If burn is painless what is classifcation

A

Full thickness

182
Q

Management of bedbugs

A

Hydrocortisone
Fumigation and pest control main eradication method

183
Q

Bedbugs presentation

A

Hostel stay- poor hygiene exposure
Intensely pruritic ‘lumps’ which have appeared on her arms and legs
Papules and wheals

184
Q

Vitiligo management options

A

Sunblock
Steroids
Ciclosporin

185
Q
A

Seborrheic keratoses

186
Q

What can do for bothersome seborrheic keratoses

A

Freezing them

187
Q

Lichen sclerosis management

A

Topical potent steroids- clobestalol propionate

188
Q

Risk of lichen sclerosis

A

Progression to SCC

189
Q
A

Lipoma

190
Q

Third line for plaque psoriasis

A

Increase steroids to BD
OR
Add coal tar preparation

191
Q

If third line options for plaque psoriasis fail what do

A

Refer to secondary care

192
Q

Secondary care options for plaque psoriasis

A

UVB therapy
Methotrexate
Ciclosporin
Retinoids
Biologics- ustekinumab

193
Q

Scalp psoriasis first and 2nd line

A

1st line- Topical potent steroid
2nd line- change formulation to shampoo etc

194
Q

Genital and face psoriasis management

A

Topical potent steroids

195
Q

When refer acne to dermatology

A

Scarring
Evidence of pigmentation problems
No response to 2 topical treatments
No response to oral abx
Contribution to mental health

196
Q

When have to do an USS on lipoma

A

Over 5cm
Pain
Deep
Growing

197
Q

First line for shingles

A

Aciclovir
Only steroids if pain continues despite simple analgesia and aciclovir

198
Q

What is adapalene

A

Topical retinoid

199
Q

What are 2 types of betnovate

A

Betnovate RD- moderate potency 0.025% betamethasone valerate
Betnovate- potent 0.1% betamethasone valerate

200
Q

BCC features

A

Rolled edges
Telengiectasia
Slow growing
Central ulceration/crater

201
Q

BCC management

A

Routine referral for removal

202
Q

Hair loss in patches differentials

A

Alopecia areata
Tinea capitis
Differentiate by looking at scalp skin- in tinea will be scaly or inflammed

203
Q

Where does erythema ab igne sites

A

Back
Legs
Wherever have applied hot water bottle so will be site of pain

204
Q

Symptomatic urticaria management

A

Oral cetirizine
If refractory then can give short course of prednisolone

Finals (29 decks)

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