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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
Important lesion that can be confused with Seborrhoeic Keratoses
Lentigo maligna melanoma
26
Treatment of seborrheic Keratoses
1. no TX 2. destructive techniques (Cryotherapy, Ablative laser)
27
Treatment of choice for molluscum contagiosum
Spontaneous resolution (in 6-9 months or longer)
28
Prevention of Molluscum contagiosum spread
1- Avoid using the bath 2.- avoid bathing with others 3.- Avoid sharing towels with others
29
TX options for pyogenic granuloma (granuloma telangiecticum)
- 1st line-Surgical (excision, curettage, shave excision) - Next line: cryotherapy or ablative tx - No TX (spontaneous resolution)
30
Characteristic feature of dermatofibroma
Dimple sign on pinching margins
31
Treatment options for dermatofibroma
1. Reasurrance 2. Surgical excision (on request or rapidly enlarging nodule)
32
Prevalence of actinic (Solar) keratoses In Australia
-40-50% in over 40 year olds - more than 80% in the 7th decade
33
Risk of progression of Actinic keratoses to SCC
LOW= 0.075-0.096% per year
34
Tx options for actinic keratosis
- 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)
35
A rapidly growing lesion on sun-exposed skin with smooth outer dome and a central keratin plug
Keratoacanthoma
36
Keratoacanthoma can be confused with?
SCC
37
Recommended treatment for Keratoacanthoma
Surgical excision with 2-4mm margin
38
Management of Lipoma
1. Reassurance 2. Surgical excision (cosmetic reasons or to relieve discomfort from pressure)
39
Multiple soft (or rubbery), lobulated mass located in the subcutaneous tissue of a woman with similar hx in her mother
Lipoma
40
A Solitary firm, painless, subcutaneous lumps invaginated with direct digital pressure (' the buttonhole sign) is?
A neurofibroma
41
Incidences of skin cancers in Australia
1. BCC-80% 2. SCC- 15-20% 3. Melanoma < 5%
42
Skin cancer type associated with most deaths
Melanoma
43
High risk factors for melanoma
1. > 5 dysplastic naevi 2. > 100 simple melanotic Naevi 3. Personal hx of previous melanoma
44
Most common location of melanoma in men & women.
Women- Lower limbs Men- Upper back
45
Red flag pointers of melanoma
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
Prognostic factors of melanoma
- Thickness of lesion - Length of lesion - Site of lesion - Sex, Age, Amelanotic melanoma & ulceration
47
Breslow classification of melanoma thickness
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
Diagnosis of Melanoma
Clinical exam by Maggylamp & dermoscopy
49
Features of melanoma lesion on dermoscopy
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
Management of choice for Melanoma
Excision
51
Excision margin for melanoma
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
Management of a suspected melanoma (diagnosis unsure)
- 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
What are follow-up rules for melanoma after tx
- 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
Commonest sites of BCC
Mostly on sun-exposed areas: Face (mainly), neck, upper trunk, limbs (10%)
55
Pattern of spread of BCC
A slow-growing tumor that spreads locally (not via lymph nodes or blood)!!!
56
Management of choice for BCC
Best: Simple elliptical excision (3–4 mm margin)
57
Other treatment options for BCC
- Mohs micrographic surgery - Radiotherapy: frail people - Photodynamic therapy - Cryotherapy (avoid head & neck) - Imiquimod 5% cream
58
Indications for Mohs micrographic surgery for BCC
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
Commonest sites of SCC
Mainly on sun-exposed areas (head, neck, back of hands, limbs, upper trunk)
60
Pattern of spread of SCC
- A fast-growing tumor capable of Metastases & involves regional lymph nodes
61
Origin of SCC
- De novo - Premalignant lesions
62
Premalignant lesions of SCC
- Solar (actinic) keratoses - keratoacanthoma - Bowen disease - Burns/chronic ulcers/leucoplakia
63
Treatment of choice for SCC?
Early Surgical excision with a 3 to 4 mm margin (Wedge excision for SCCs of the ear and lip)
64
Other treatment options for SCC
- Specialized surgery &/or radiotherapy if large/in difficult site/lymphadenopathy
65
Post-excision follow up of SCC
Follow-up every 3-6 months for at least 2 years
66
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?
Psoriasis
67
Aggravating factors for Psoriasis
- Trauma (or physical stress, emotional stress, sunburn, winter) - Infection (esp. GAS) -Puberty/menopause -Smoking - Drugs (BB, CQuine, Li, NSAIDs, OCPs)
68
commonest type of Psoriasis
Plaque (80%)
69
Diagnosis of psoriasis
- Clinical (biopsy may be needed to confirm diagnosis & r/o differentials)
70
Mainstay of treatment for Psoriasis
Topical Steroid
71
Initial recommended treatment for mild to moderate psoriasis
- 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
Treatment of Chronic stable plaque psoriasis
stronger fluorinated steroid +tar+ salicylic acid in sorbolene cream overnight or Calcipotriol or Calcipotriol+steroids
73
Tx of resistant localized plaque
Intralesional steroid injection (Triamcinolone)
74
Tx of severe psoriasis
- 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
Adjunctive management of psoriasis
- Exercise, rest, holidays preferably in the sun (No sunburn)!!! - Avoid smoking
76
Conditions associated with Psoriasis
- CVS dx, DM, Obesity - Depressive illness - Arthritis, IBD, lymphoma
77
what makes an Acne mild?
Primarily composed of comedones + or - papules.
78
What are the features of moderate Acne?
- non-inflammatory comedones+inflammatory lesions (including papules and a few pustules).
79
What are the features of moderate to severe Acne?
- Numerous comedones, pustules and papules +or- a few cysts or nodules.
80
What are the features of Severe Acne?
As for moderate to severe Acne + numerous nodules and/or cysts
81
How to treat Mild Acne?
Comedonal: -1st line= Topical Retinoid -alternative= Salicylic acid - Inflammatory acne: 1st line=Top. Retinoid+BPO or BPO /Topical Ab.
82
How to manage Moderate Acne?
-1st line: BPO/topical AB or Topical retinoid+BPO -alternative (females): Hormonal therapy ±BPO/topical AB or Topical retinoid
83
Management of moderate to severe Acne?
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
Treatment of Severe Acne?
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
Maintenance therapy for acne
Topical retinoid ± BPO or BPO/topical AB
86
What organism is implicated in Acne Vulgaris?
- Propionibacterium acnes
87
What organism is implicated in erythrasma?
-Corynebacterium minutissimum
88
Appearance of erthrasma
well defined scaly red, pink or brown patches in intertigous areas.
89
Predisposing factor to erythrasma
-Obesity -Hyperhidrosis - DM - tropical climates
90
Diagnosis of erythrasma
- Clinical - wood lamp (grows bright pink) to confrm diagnosis
91
Treatment of erythrasma
1. Local antibiotics (clarithromycin/erythromycin) 2. Oral antibiotics (clindamycin/erythromycin)
92
Clostridial myonecrosis (gas gangrene) diagnosis
- Mainly clinical (gas in soft tissues by palpation) -culture and radiography supports diagnosis.
93
Management of Gas gangrene
Surgical debridement + Benzylpenicillin
94
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?
Peutz-Jeghers syndrome
95
Key features of Peutz-Jeghers syndrome
- Muco-cutaneous hyper-pigmented macules in association with hamartomatous polyps in the GI tract. - Prone to developing cancers, GI bleeding, & intestinal obstruction
96
Cause of peutz-jeghers
- Can arise denovo or Autosomal dominantly inherited - Usually due to deletion of Serine threonine kinase 11 (STK11) gene on chromosome 19.
97
What are close differentials of Peutz-Jeghers Syndrome?
- Oral naevi & melanotic (melanocytic) macule - Oral melanoacanthoma - Smoker’s melanosis - Addison disease
98
Investigations in Peutz-Jeghers Syndrome
1st line: FBC 2nd line (if low MCV) ; iron studies, FOBT - genetic testing may be offered (MLPA)
99
Etiology of Acute paronychia
Bacterial (often S. aureus) secondary to injury.
100
Presentation of Acute paronychia
Solitary painful distal finger + or - Pus
101
Management of Acute Paronychia
Antibiotics + or - I & D (if pus collection).
102
Etiology of Chronic Paronychia
Candida Yeast infection
103
Clinical presentation of Chronic Paronychia
. Painless nail fold swelling with loss of cuticle. - Ridging & discoloration may occur
104
Management of Chronic Paronychia
- keep the skin dry - Avoid manicures - Topical imidazole
105
Treatment of choice for onychomycosis
-Oral Terbinafine alternatives = flucocanzole & itraconazole
106
Typical presentation of Pyoderma gangrenosum
Inflammatory papule or pustule that progresses to a painful ulcer with violaceous undermined border.
107
Etiology of pyoderma gangrenosum
immune dysregulation plays a role
108

AMC CAT MCQ (1 decks)

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