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AMC CAT MCQ > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Management options for Acrochordon/fibroepithelial polyp

A
  1. No treatment
  2. Removal of lesions
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2
Q

The commonest dermatologic cyst

A

An epidermoid cyst (Sebaceous cyst/epidermal cyst/ epidermoid inclusion cyst/Pilar cyst)

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3
Q

Appearance and feel of Epidermoid cyst

A
  • Firm to soft regular lump (usually round)
  • Fixed to the skin
  • A central pore or punctum may be present.
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4
Q

Location of epidermoid cyst in decreasing frequency

A
  • Scalp»»Face»>Neck»Trunk>Scrotum
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5
Q

Origin of epidermoid cyst

A

Hair follicles

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6
Q

Management options for Epidermoid cyst

A
  • No treatment
  • Surgical removal
  • Antibiotics, I&D, steroids for inflamed cyst
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7
Q

A superficial scalp nodule, lobulated with defined edges, mobile but stony feel to palpation

A

Pilomatrixoma

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8
Q

Diagnosis of Pilomatrixoma

A
  • Tent sign
  • Skin crease sign
  • Ultrasound evidence of Calcification
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9
Q

Treatment of choice for Pilomatrixoma

A

Surgical excision, with margins of at least 1–2 cm

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10
Q

Cyst caused by puncture injury

A

implantation cyst

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11
Q

Features distinguishing implantation cyst from epidermoid cyst

A
  • Absence of a punctum
  • Age of the patient (Adults)
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12
Q

Management of implantation cyst

A

Surgical removal (incisional removal)

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13
Q

Management of choice mucoceles

A

Spontaneous resolution in 2-3 weeks

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14
Q

Ranula (mucocele of the sublingual gland) is managed by

A

removal of sublingual gland

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15
Q

People at risk for developing keloids

A
  • Past hx of keloids
  • Family hx of keloids
  • People of colour
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16
Q

Treatment of choice of scarring (keloids or hypertrophic scar)

A

Intralesional Steroids

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17
Q

Commonest sites of Common warts

A
  • Hands
  • Feet (plantar)
  • Extensor surfaces
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18
Q

Commonest sites of Plane (flat) warts

A
  • Face
  • distal limbs
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19
Q

HPV implicated in common warts

A

1,2,4,27 and 57

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20
Q

HPV implicated in plane warts

A

3, 10

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21
Q

HPV implicated in genital warts

A

6 and 11

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22
Q

Initial Management of common warts and plane warts -(other than the face).

A
  • No tx (most resolve within 2 yrs
  • 1st line - Salicylic acid plus or minus lactic acid
  • 2nd line - Liquid Nitrogen
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23
Q

Treatment options for recalcitrant warts

A
  1. Destruction TX:
    (Aggressive cryotherapy, electrosurgery, Laser TX)
  2. Intralesional chemotherapy
  3. Intralesional immunotherapy
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24
Q

Treatment of facial Plane warts

A
  1. No TX (resolves within 12 months)
  2. Topical retinoid
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25
Q

Important lesion that can be confused with Seborrhoeic Keratoses

A

Lentigo maligna melanoma

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26
Q

Treatment of seborrheic Keratoses

A
  1. no TX
  2. destructive techniques (Cryotherapy, Ablative laser)
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27
Q

Treatment of choice for molluscum contagiosum

A

Spontaneous resolution (in 6-9 months or longer)

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28
Q

Prevention of Molluscum contagiosum spread

A

1- Avoid using the bath
2.- avoid bathing with others
3.- Avoid sharing towels with others

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29
Q

TX options for pyogenic granuloma (granuloma telangiecticum)

A
  • 1st line-Surgical
    (excision, curettage, shave excision)
  • Next line: cryotherapy or ablative tx
  • No TX (spontaneous resolution)
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30
Q

Characteristic feature of dermatofibroma

A

Dimple sign on pinching margins

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31
Q

Treatment options for dermatofibroma

A
  1. Reasurrance
  2. Surgical excision (on request or rapidly enlarging nodule)
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32
Q

Prevalence of actinic (Solar) keratoses In Australia

A

-40-50% in over 40 year olds
- more than 80% in the 7th decade

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33
Q

Risk of progression of Actinic keratoses to SCC

A

LOW= 0.075-0.096% per year

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34
Q

Tx options for actinic keratosis

A
  • Prevent further sun damage
    (Sunscreen, appropriate clothing
  • Lesion specific therapy
    (Cryotherapy with liquid nitrogen (T-o-C), curettage (+or- cautery) & shave excision).
  • Field Therapy
    (5-FU,Diclofenac, PDT, Imiquimod)
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35
Q

A rapidly growing lesion on sun-exposed skin with smooth outer dome and a central keratin plug

A

Keratoacanthoma

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36
Q

Keratoacanthoma can be confused with?

A

SCC

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37
Q

Recommended treatment for Keratoacanthoma

A

Surgical excision with 2-4mm margin

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38
Q

Management of Lipoma

A
  1. Reassurance
  2. Surgical excision (cosmetic reasons or to relieve discomfort from pressure)
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39
Q

Multiple soft (or rubbery), lobulated mass located in the subcutaneous tissue of a woman with similar hx in her mother

A

Lipoma

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40
Q

A Solitary firm, painless, subcutaneous lumps invaginated with direct digital pressure (‘ the buttonhole sign) is?

A

A neurofibroma

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41
Q

Incidences of skin cancers in Australia

A
  1. BCC-80%
  2. SCC- 15-20%
  3. Melanoma < 5%
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42
Q

Skin cancer type associated with most deaths

A

Melanoma

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43
Q

High risk factors for melanoma

A
  1. > 5 dysplastic naevi
  2. > 100 simple melanotic Naevi
  3. Personal hx of previous melanoma
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44
Q

Most common location of melanoma in men & women.

A

Women- Lower limbs
Men- Upper back

45
Q

Red flag pointers of melanoma

A
  1. New or changing lesion
  2. A Prominent pigmented lesion that stands out
  3. A Rapidly growing nodule of any color
  4. Non-healing lump or ulcer
  5. A lesion that concerns to the patient
  6. Dermoscopic changes on ff up or poor dermoscopic-clinical correlate
46
Q

Prognostic factors of melanoma

A
  • Thickness of lesion
  • Length of lesion
  • Site of lesion
  • Sex, Age, Amelanotic melanoma & ulceration
47
Q

Breslow classification of melanoma thickness

A

Clark I: tumor thickness =0mm
Clark 2: < 0.76mm= 5yr survival rate of 95%
Clark 3: 0.76-1.5mm= 70-98%
Clark 4: 1.51–4.0mm= 55–85%
Clark 5: > 4.0mm =30–60%

48
Q

Diagnosis of Melanoma

A

Clinical exam by Maggylamp & dermoscopy

49
Q

Features of melanoma lesion on dermoscopy

A

A = Asymmetry
B = Border= well defined & irregular
C = Colour= classically= blue–black.
D = Diameter= when first seen, most are ≥7mm
E = Evolution &/or Elevation= indicates invasion & is a sign of more advanced dx

50
Q

Management of choice for Melanoma

A

Excision

51
Q

Excision margin for melanoma

A

Is based on the thickness of lesion
- Melanoma in situ (lentigo maligna) — excision margin = 5 mm

  • <1 mm thick—excision margin=1cm
  • 1–4 mm thick– excision margin of 1cm-2cm
  • > 4 mm thick, excision margin ≥2 cm
52
Q

Management of a suspected melanoma (diagnosis unsure)

A
  • Local excision biopsy with 2 mm margin to mid-fat layer for histology
  • If other diagnosis; No further excision
  • If melanoma is diagnosed; re-excised as per the thickness rule
53
Q

What are follow-up rules for melanoma after tx

A
  • 1 mm thick = 6 monthly reviews for 2 years
  • 1–2 mm thick = 4 monthly for 2yrs, 6 monthly for next 2yrs, then yearly for 10yrs
  • > 2 mm thick = review by both specialist and GP, regularly, for 10 years
  • A yearly CXR is advisable.
54
Q

Commonest sites of BCC

A

Mostly on sun-exposed areas:
Face (mainly), neck, upper trunk, limbs (10%)

55
Q

Pattern of spread of BCC

A

A slow-growing tumor that spreads locally (not via lymph nodes or blood)!!!

56
Q

Management of choice for BCC

A

Best: Simple elliptical excision (3–4 mm margin)

57
Q

Other treatment options for BCC

A
  • Mohs micrographic surgery
  • Radiotherapy: frail people
  • Photodynamic therapy
  • Cryotherapy (avoid head & neck)
  • Imiquimod 5% cream
58
Q

Indications for Mohs micrographic surgery for BCC

A

o Mohs micrographic surgery
- Large or recurrent tumors
- Located where tissue conservation is required. (nose, eyelid & around the eyes, center of face)
- Infiltrative (morphoeic / micronodular subtypes)
- Poorly defined, so the extent of the tumor is not obvious clinically

59
Q

Commonest sites of SCC

A

Mainly on sun-exposed areas (head, neck, back of hands, limbs, upper trunk)

60
Q

Pattern of spread of SCC

A
  • A fast-growing tumor capable of Metastases & involves regional lymph nodes
61
Q

Origin of SCC

A
  • De novo
  • Premalignant lesions
62
Q

Premalignant lesions of SCC

A
  • Solar (actinic) keratoses
  • keratoacanthoma
  • Bowen disease
  • Burns/chronic ulcers/leucoplakia
63
Q

Treatment of choice for SCC?

A

Early Surgical excision with a 3 to 4 mm margin
(Wedge excision for SCCs of the ear and lip)

64
Q

Other treatment options for SCC

A
  • Specialized surgery &/or radiotherapy if large/in difficult site/lymphadenopathy
65
Q

Post-excision follow up of SCC

A

Follow-up every 3-6 months for at least 2 years

66
Q

A 20 year old girl with underlying history of inflammatory bowel disease and painful arthropathy of digits presents with non-itchy chronic red-silvery rash on the the extensor surfaces of elbows and knees that improves on sun exposure, there was similar hx in mother?

A

Psoriasis

67
Q

Aggravating factors for Psoriasis

A
  • Trauma (or physical stress, emotional stress, sunburn, winter)
  • Infection (esp. GAS)
    -Puberty/menopause
    -Smoking
  • Drugs (BB, CQuine, Li, NSAIDs, OCPs)
68
Q

commonest type of Psoriasis

A

Plaque (80%)

69
Q

Diagnosis of psoriasis

A
  • Clinical (biopsy may be needed to confirm diagnosis & r/o differentials)
70
Q

Mainstay of treatment for Psoriasis

A

Topical Steroid

71
Q

Initial recommended treatment for mild to moderate psoriasis

A
  • Night: Dithranol 0.1+salicylic acid 0.3% +/-LPC (tar) 10% in paraffin or sorbolene cream
  • Morning: Topical fluorinated corticosteroid (e.g. betamethasone) after shower
72
Q

Treatment of Chronic stable plaque psoriasis

A

stronger fluorinated steroid +tar+ salicylic acid in sorbolene cream overnight or Calcipotriol or Calcipotriol+steroids

73
Q

Tx of resistant localized plaque

A

Intralesional steroid injection (Triamcinolone)

74
Q

Tx of severe psoriasis

A
  • Systemic treatments: Chemotherapy: MTX/cyclosporine/Steroid/Acitretin
  • Biologic: anti TNF agents, monoclonal antibodies
  • Physical: Narrow band UV-B photo-therapy / photo-chemotherapy (Psoralen and UV-A).
75
Q

Adjunctive management of psoriasis

A
  • Exercise, rest, holidays preferably in the sun (No sunburn)!!!
  • Avoid smoking
76
Q

Conditions associated with Psoriasis

A
  • CVS dx, DM, Obesity
  • Depressive illness
  • Arthritis, IBD, lymphoma
77
Q

what makes an Acne mild?

A

Primarily composed of comedones + or - papules.

78
Q

What are the features of moderate Acne?

A
  • non-inflammatory comedones+inflammatory lesions (including papules
    and a few pustules).
79
Q

What are the features of moderate to severe Acne?

A
  • Numerous comedones, pustules and papules +or- a few cysts or nodules.
80
Q

What are the features of Severe Acne?

A

As for moderate to severe Acne + numerous nodules and/or cysts

81
Q

How to treat Mild Acne?

A

Comedonal:
-1st line= Topical Retinoid
-alternative= Salicylic acid
- Inflammatory acne:
1st line=Top. Retinoid+BPO or BPO /Topical Ab.

82
Q

How to manage Moderate Acne?

A

-1st line: BPO/topical AB
or Topical retinoid+BPO
-alternative (females): Hormonal therapy
±BPO/topical AB
or Topical retinoid

83
Q

Management of moderate to severe Acne?

A

1st line: Topical AB + BPO + topical retinoid or
Oral AB + BPO +topical retinoid
Alt: Oral isotretinoin
Alt: (females) : Hormonal therapy ± BPO/topical AB
or Topical retinoid

84
Q

Treatment of Severe Acne?

A

1st line: Oral isotretinoin
Alt (all): Oral AB+topical retinoid+BPO
or BPO/topical AB
Alt (females): Hormonal tx + topical retinoid +or- BPO
or BPO/Topical AB

85
Q

Maintenance therapy for acne

A

Topical retinoid ± BPO or BPO/topical AB

86
Q

What organism is implicated in Acne Vulgaris?

A
  • Propionibacterium acnes
87
Q

What organism is implicated in erythrasma?

A

-Corynebacterium minutissimum

88
Q

Appearance of erthrasma

A

well defined scaly red, pink or brown patches in intertigous areas.

89
Q

Predisposing factor to erythrasma

A

-Obesity
-Hyperhidrosis
- DM
- tropical climates

90
Q

Diagnosis of erythrasma

A
  • Clinical
  • wood lamp (grows bright pink) to confrm diagnosis
91
Q

Treatment of erythrasma

A
  1. Local antibiotics (clarithromycin/erythromycin)
  2. Oral antibiotics (clindamycin/erythromycin)
92
Q

Clostridial myonecrosis (gas gangrene) diagnosis

A
  • Mainly clinical (gas in soft tissues by palpation)
    -culture and radiography supports diagnosis.
93
Q

Management of Gas gangrene

A

Surgical debridement + Benzylpenicillin

94
Q

58 year old woman with multiple hyper-pigmented lesions on the inner lower lip and buccal mucosa. family history of metastatic gastric cancer and metastatic colon cancer in mother and her brother respectively. Most likely diagnosis?

A

Peutz-Jeghers syndrome

95
Q

Key features of Peutz-Jeghers syndrome

A
  • Muco-cutaneous hyper-pigmented macules in association with hamartomatous polyps
    in the GI tract.
  • Prone to developing cancers, GI bleeding,
    & intestinal obstruction
96
Q

Cause of peutz-jeghers

A
  • Can arise denovo or Autosomal dominantly inherited
  • Usually due to deletion of Serine threonine kinase 11 (STK11) gene on chromosome 19.
97
Q

What are close differentials of Peutz-Jeghers Syndrome?

A
  • Oral naevi & melanotic
    (melanocytic) macule
  • Oral melanoacanthoma
  • Smoker’s melanosis
  • Addison disease
98
Q

Investigations in Peutz-Jeghers Syndrome

A

1st line: FBC
2nd line (if low MCV) ;
iron studies, FOBT
- genetic testing may be offered (MLPA)

99
Q

Etiology of Acute paronychia

A

Bacterial (often S. aureus) secondary to injury.

100
Q

Presentation of Acute paronychia

A

Solitary painful distal finger + or - Pus

101
Q

Management of Acute Paronychia

A

Antibiotics + or - I & D (if pus collection).

102
Q

Etiology of Chronic Paronychia

A

Candida Yeast infection

103
Q

Clinical presentation of Chronic Paronychia

A

. Painless nail fold swelling with loss of cuticle.
- Ridging & discoloration may occur

104
Q

Management of Chronic Paronychia

A
  • keep the skin dry
  • Avoid manicures
  • Topical imidazole
105
Q

Treatment of choice for onychomycosis

A

-Oral Terbinafine
alternatives = flucocanzole & itraconazole

106
Q

Typical presentation of Pyoderma gangrenosum

A

Inflammatory papule or pustule that progresses to a painful ulcer with violaceous undermined border.

107
Q

Etiology of pyoderma gangrenosum

A

immune dysregulation plays a role

108
Q
A

AMC CAT MCQ (1 decks)

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