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AKT > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Erythema Nodosum causes

A

symmetrical, erythematous, tender, nodules which heal without scarring

Causes:
streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

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2
Q

Pretibial myxodema

A

symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

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3
Q

Pyoderma Gangrenosum

A

initially small red papule - later deep, red, necrotic ulcers with a violaceous border

idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

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4
Q

Necrobiosis lipoidica diabeticorum

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

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5
Q

Chronic plaque psoriasis Mx

A

regular emolients
1st - potent corticosteroid plus Vit D analogue once daily
2nd - Vit D analogue twice daily
3rd - Potent corticosteroid twice daily
OR - coal tar preparation

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6
Q

Seborrheic Dermatitis Fx

A

An itchy rash affecting the face and scalp distribution

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7
Q

Seborrheic Dermatitis associations (2)

A

HIV
Parkinsons

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8
Q

Perioral dermatitis Mx

A

PO/ Top Antibiotics

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9
Q

Perioral dermatitis Fx

A

more common in women
acne-like rash, with persistent redness, papules and occasional pustules affecting the area around the mouth and nose

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10
Q

Dermatophyte nail infections Mx

A

PO Terbinafine 12 weeks

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11
Q

Fungal nail infections Mx

A

Take nail sample to confirm before treatment

Limited disease - Top Amorolfine 5%
Extensive disease eg Dermatophyte - PO Terbinafine
More extensive eg Candida - PO Itraconazole

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12
Q

Acne Rosacea Fx

A

chronic skin condition which causes persistent facial flushing, erythema, telangiectasia, pustules, papules and rhinophyma

Associated with blepharitis, keratitis, conjunctivitis

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13
Q

Scalp psoriasis Mx

A

1st - topical potent corticosteroid

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14
Q

Lichen planus association

A

Wickham’s striae

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15
Q

Chondrodermatitis nodularis helicis Fx

A

Benign painful nodule on cartilage of ear

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16
Q

Causes of scarring alopecia (5)

A

trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*

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17
Q

Causes of non scarring alopecia (7)

A

male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
hair loss following stressful period e.g. surgery
trichotillomania

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18
Q

Pyoderma gangrenosum Fx Mx

A

Painful skin ulceration - common on legs

Cx - idiopathic, autoimmune disease (RA, SLE, IBD)

Mx - steroid, immune suppression

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19
Q

Seborrhoeic dermatitis Fx

A

An itchy, scaly, greasy rash distributed across the face, scalp, upper back, chest and skin flexures

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20
Q

Sebhorroeic Dermatitis Mx

A

Ketoconazole shampoo (scalp)/ topical (body)

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21
Q

Dermatitis herpetiformis Fx

A

Chronic, itchy - grouped erythematous papules, vesicles and bulla
associated with coeliac disease

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22
Q

Contact dermatitis Ix

A

Patch test

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23
Q

Guttate Psoriasis Mx

A

1 - resolve within 3 months
2 - if >10% coverage or has psychological impact -for Urgent Dermatology for UVB phototherapy

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24
Q

Guttate Psoriasis Fx

A

Can be precipitated by strep infection (eg pharyngitis)
Tear drop papules
acute onset

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25
Q

Discoid Eczema Fx

A

Coin shape, extremely itchy, on peripheries

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26
Q

Topical steroid ladder
Mild
Mod
Potent
very potent

A

Mild
- Hydrocortisone

Mod
- Betamethasone 0.025% (Betnovate RD)
- Clobetasone 0.05% (Eumovate)

Pot
- Fluticasone 0.05%
- Betamethasone 0.1% (Betnovate)

V Potent
- Clobetasol 0.05% (Dermovate)

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27
Q

Hidradenitis suppurativa Mx

A

topical/ oral abx (eg clindamycin/ doxycycline)

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28
Q

Facial, flexural, genital psoriasis Mx

A

Topical Mild to mod steroid only

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29
Q

Actinic keratosis Mx

A

Topical flurouracil cream

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30
Q

Keloid scar Mx

A

refer for intralesional steroid eg Triamcinolone

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31
Q

sebhorriec dermatitis associated features

A

otitis externa
blepharitis

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32
Q

Pityriasis vesicolour Mx

A

Ketoconazole 2% shampoo

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33
Q

Impetigo Mx

A

1st - top hydrogen peroxide 1%
2nd - top Fusidic acid
3rd - top Mupirocin

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34
Q

Tinea capitis Mx

A

Oral terbinafine with topical ketoconazole shampoo for the first 2 weeks

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35
Q

Psoriasis exacerbating factors

A

Trauma
Alcohol
B Blockers
Lithium
Antimalarial - chloroquine
NSAID
ACEi
withdrawal of systemic steroids

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36
Q

necrobiosis lipoidica diabeticorum

A

Diabetes, waxy yellow shin lesions

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37
Q

Perioral dermatitis exacerbated by

A

topical steroids

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38
Q

Dermatitis artefacta Fx

A

Linear, well-demarcated skin lesions that appear suddenly, with ‘la belle indifference’
- self inflicted (usually psychological problem) - eg stress, self harm
a psychocutaneous disorder in which the patients consciously create lesions in skin, hair, nail, or mucosae to satisfy a psychological need, attract attention, or evade responsibility.

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39
Q

Lichen planus Mx

A

Potent topical steroid

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40
Q

Pompholyx Fx

A

AKA dyshidrotic eczema
intensely itchy vesicles on the palms and soles

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41
Q

Erythema Multiforme causes

A

viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy

42
Q

Acanthosis nigrans associated conditions

A

type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing’s disease
hypothyroidism
familial
Prader-Willi syndrome
drugs
combined oral contraceptive pill
nicotinic acid

43
Q

Fungal nail infection Mx

A

Send nail clippings for lab analysis prior to treatment

If asymptomatic - no treatment
limited disease <50% - Topical Amorolfine 5%
extensive disease - Oral Terbinafine (dermatophyte)
very extensive disease - oral Itraconazole (candida)

44
Q

bullous pemphigoid Mx

A

Refer dermatology
oral corticosteroids

45
Q

Bowens disease (intra-epidermal SCC) Mx

A

Top 5-fluorouracil

46
Q

Pemphigus vulgaris Fx

A

Autoimmune blistering
oral lesions initially then skin lesions

47
Q

Guttate psoriasis Fx

A

Acute onset of tear-drop scaly papules on trunk and limbs
triggered by preceding Strep - eg tonsilitis

48
Q

Roseaca Fx

A

nose, cheeks, forehead
flushing, telangiectasia
leads to pustules and papules
Blepharitis

49
Q

Roseaca Mx

A

Mild - Brimonidine PRN
Mod topical ivermectin + oral doxycycline
Mod 2nd line topical metronidazole/ Top azelaic acid

50
Q

Severe systemic psoriasis Mx

A

Methotrexate and ciclosporin

51
Q

Coeliac disease is associated with what skin condition

A

Dermatitis herpetiformis

52
Q

Acne Vulgaris Mx

A

1st - top combination (mild to mod)
- benzoyl peroxide/ clindamycin/ retinoin (Combination of two - rarely use monotherapy)

2nd - Top + PO Abx (mod to sev)
- topical retinoid/ benzoyl + PO lymecycline/ doxycyline (erythromycin if pregnancy)

Consider COCP in addition for severe acne in young women

53
Q

Perioral dermatitis Mx

A

oral lymecycline

54
Q

Psoriasis nail changes (4)

A

pitting
onycholysis
subungal hyperkeratosis
loss of nail

55
Q

Notalgia paraesthetica Fx

A

chronic itch on medial border of scapula

56
Q

Lichen planus Fx

A

pink/ purple plaque - shiny, flat, firm - on flexor surfaces
crossed with fine white lines (Wickham striae)
range from non to extreme itch
associated with mucous membrane involvement

57
Q

Depth of Burns
Superficial epidermal
Superficial dermal
Deep derma
Full Thick

A

Superficial epidermal - Red and painful, dry, no blisters

Partial thickness (superficial dermal) - Pale pink, painful, blistered. Slow capillary refill

Partial thickness (deep dermal) - Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure

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

58
Q

Erythema nodosum Fx

A

symmetrical, tender erythematous nodules heal without scarring
associated: strep, sarcoid, IBD, COCP, penicillin

59
Q

Pretibial myxoedema Fx

A

symmetrical shiny orange peel
associated: Graves

60
Q

Pyoderma gangrenosum Fx

A

initially small red papule -> deep, red, necrotic ulcer
associated: idiopathic, IBD,

61
Q

Necrobiosis lipoidica diabeticorum

A

shiny painless yellow/red skin in diabetics

62
Q

Porphyria cutanea tarda Fx

A

photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands

63
Q

Isoretinoin SE

A

dry skin
teratogenic
low mood
Intracranial hypertension (thus should not be combined with tetracyclines)
photosensitivity
raised lipids

64
Q

Pityriasis versicolor cause

A

Malassezia furfur

65
Q

Oral lichen planus Mx

A

Benzydamine mouth wash

66
Q

Hidrandenitits suppravita Mx

A

Long term top/ po lymecycline

67
Q

Molluscum contagiosum cause

68
Q

Hyperhydrosis (excessive sweating) Mx

A

Top Aluminium Chloride

69
Q

Facial hirsutism Mx

A

1st - Top Eflornithine
2nd - Co-cyprindol

70
Q

Seborrheic dermatitis cause

A

malassizia furfur

71
Q

Blisters/bullae differentials (2)

A

Blisters/bullae
no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris

72
Q

Potency of steroid creams

A
  • Mild
    Hydrocortisone 0.5-2.5%
  • Moderate
    Betamethasone valerate 0.025% (Betnovate RD)
    Clobetasone butyrate 0.05% (Eumovate)
  • Potent
    Fluticasone propionate 0.05% (Cutivate)
    Betamethasone valerate 0.1% (Betnovate)
  • Very Potent
    Clobetasol propionate 0.05% (Dermovate)
73
Q

Erythema Multiforme Fx

A

Target lesions
back of hands/ feet, spread to torso
Upper limbs > lower limbs
Mild pruritis

74
Q

Erythema multiforme causes

A

Virus - herpes simplex (most common)
Idiopathic
Bacteria - Mycoplasma, streptococcus
Drugs - penicillin, sulphonamides, carbemazepine, allopurinol, NSAIDs, COCP
SLE
Sarcoid
Malignancy

75
Q

Erythema Nodosum Fx

A

Tender, erythematous, nodular lesions
usually shins, but elsewhere also (forearms, thighs)
self resolves with 6 weeks
lesions heal WITHOUT scarring

76
Q

Erythema nodosum causes

A

Infection - streptococci, Tb, brucellosis
Systemic - sarcoid, IBD, Behcets
Malignancy/ lymphoma
Drugs - penicillin, sulphonamides, COCP
Pregnancy

77
Q

Chronic plaque Psoriasis Mx

A

Regular emollients
1st - Potent corticosteroid plus vitamin D analogue applied separately, one in morning one in evening
2nd - Vitamin D analogue BD only
3rd - Potent corticosteroid BD only OR coal tar preparation BD
4th - refer to Derm - phototherapy, biologics, immunotherapy

Short acting dithranol can also be used

78
Q

Scalp psoriasis Mx

A

1st - Potent topical corticosteroid 4 weeks
2nd - alternative topical corticosteroid

79
Q

Face, Flexural, genital psoriasis Mx

A

Mild to Mod topical corticosteroid
- Max 2 weeks per month

80
Q

(Acne) Rosacea Mx

A

1st - Top Brimodine/ PO Metronidazole?
2nd - Top Ivermectin (Mild to mod)
3rd - Top Ivermectin + PO Doxycycline (Mod to Sev - have pustules)

81
Q

Isoretinoin SE (7)

A

Teratogenic
dry skin, lips, mouth
low mood
nose bleeds (epistaxis)
intracranial hypertension
photosensitivity
hyperlipidaemia

82
Q

Psoriasis exacerbating factors (9)

A

trauma
alcohol
B blockers
Lithium
antimalarials
NSAIDs
ACEi
infliximab
withdrawal of systemic steroids

83
Q

Steven Johnson syndrome causes (6)

A

penicillin
sulphonamides (eg sulfasalazine)
anti epileptics - lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
COCP

84
Q

Fungal nail infections Mx

A

asymptomatic- no treatment

IF CONFIRMED (take sample before treatment) dermatophyte or candida:
1st - Top Amorolifine
2nd - PO Terbinafine (Dermatophyte)
3rd - PO Itraconazole (Candida)

85
Q

Lichen planus Fx

A

itchy
purple, papular
flexor surfaces, palms
Covered with a “white lace”

86
Q

Differentiating Shin lesions

Erythema Nodosum
Pretibial myxoedema
pyoderma gangrenosum
necrobiosis lipoidica diabeticorum

A

EN - Symmetrical, Tender nodules, heal without scarring

PM - symmetrical, shiny, orange peel

PG - small red papule -> deep red necrotic ulcer

87
Q

Guttate psoriasis Fx

A

Children/ adolescents
tear drop papules on trunk
after sore throat (strep throat)

88
Q

Skin disease related to Coeliac disease

A

Dermatitis herpetiformis - itchy vesicles on buttocks and elbows

89
Q

Skin conditions in pregnancy
Polymorphic eruption
Pemphigoid gestationis

A

Polymorphic eruption
- Last trimester, striae, itchy

Pemphigoid gestationis
- blistering, peri-umbilical, 2nd/ 3rd trimester

90
Q

Tinea capitis Fx

A

scarring alopecia in children
Kerion - boggy, pustular, raised lesion on scalp

91
Q

Juvenile Spring Eruption Fx

A

Itchy rash on tops of ears, worse in sun
classically boys aged 5-14 years in the spring (Sun)

92
Q

Actinic keratosis Fx

A

AKA Solar keratosis
Small crusty/ scaly lesions
sun exposed areas - top of head, ears

93
Q

Actinic Keratosis Mx

A

1st - Fluorouracil cream for 2-3 weeks - can lead to soreness and redness of skin
Can use hydrocortisone after 2-3 weeks to help with inflammation

2nd - Top Diclofenac

94
Q

Porphyria Cutanea Tarda Fx

A

Photosensitivity, blistering and skin fragility - on face, dorsum of hands

95
Q

Tinea pedis (athletes foot) Mx

A

Top Miconazole

96
Q

Causes of spider naevi (3)

A

liver disease
pregnancy
COCP

97
Q

Alopecia Areata Mx

A

Watch and wait - self resolve within 1 year

If psychological stress, >50% hair loss - Dermatology refer and Topical High potency steroid

98
Q

Impetigo School exclusion time

A

2 days after treatment starts or
once all lesions have crusted over

99
Q

Melanoma prognosis scoring system

A

Breslow thickness

100
Q

weighted 7 point check list for skin lesions

A

weighted seven-point checklist includes:

Major features (two points each):

Change in size
Irregular shape
Irregular colour
Minor features (one point each):

Inflammation
Altered sensation
Largest diameter 7 mm or more
Oozing of lesion

> 3 = dermatology refer

101
Q

Recurrent oral ulcers of no known cause (extensively investigated with no cause) Mx

A

All - Simple/ Antiseptic mouthwash
1st - Topical corticosteroids
2nd - Topical anaesthetics, topical analgesics/anti-inflammatory agents, antibiotic rinses and oral vitamin B12
3rd - Systemic steroids and low threshold for referral for specialist input

AKT (21 decks)

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