Dermatology Flashcards
When are IV fluids recommended for burns in adults?
In adults, IV fluids should be given in second or third degree burns that cover 15% body surface area or more
Describe the clinical features of guttate psoriasis
Tear drop papules on the trunk and limbs
What is the purpose of antivirals for shingles?
May reduce the incidence of post herpetic neuralgia, particularly in older people
Name 4 conditions associated with pyoderma gangrenosum
- IBD
- RA
- Myeloproliferative disorders
- AML
What is the most likely cause of balanitis in an uncircumcised man, who has developed a tight white ring around the tip of the foreskin and phimosis?
Lichen sclerosis
Describe the clinical presentation of seborrhoeic dermatitis
An itchy rash affecting the face and scalp distribution
Usually erythematous, yellow and scaly
What is the first line treatment for a patient with rosacea who has mild papules and/or pustules?
Topical ivermectin
Name one systemic complication patients with psoriatic arthritis are at increased risk of
Cardiovascular disease
A 28-year-old man undergoes an ileocaecal resection and end ileostomy for Crohn’s disease. One year later he presents with a deep painful ulcer at his stoma site. What is the most likely diagnosis?
Pyoderma gangrenosum
A 6-year-old girl is brought to the GP with a 4-week history of flaky and itchy skin on the scalp with associated hair loss. What is the most likely diagnosis?
Tinea capitis
What drug can be given to treat refractory pain in shingles if simple analgesia and neuropathic analgesia do not help?
Corticosteroids e.g. prednisolone
How long should the break be between courses of topical corticosteroids in patients with psoriasis?
4 weeks
Can erythema nodosum be caused by pregnancy?
Yes
Describe the clinical features of atopic eruption of pregnancy
Typically presents as an eczematous, itchy red rash
Describe the clinical presentation of polymorphic eruption of pregnancy
Pruritic condition associated with last trimester
Lesions often first appear in abdominal striae
Describe the clinical presentation of pemphigoid gestationis
- Pruritic blistering lesions
- Often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
- Usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
What is the most likely diagnosis?
Seborrhoeic keratoses
Describe the appearance of a superficial epidermal burn
Red and painful, dry, no blisters
Describe the appearance of a partial thickness (superficial dermal) burn
- Pale pink, painful, blistered
- Slow capillary refill
Describe the appearance of a partial thickness (deep dermal) burn
- Typically white but may have patches of non-blanching erythema
- Reduced sensation, painful to deep pressure
Describe the appearance of a full thickness burn
White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain
What is the first line treatment for acute urticaria?
Non-sedating antihistamines e.g. loratadine, cetirizine
What treatments for acne are contraindicated in pregnancy?
Topical and oral retinoid treatment
What is the first line treatment for athlete’s foot?
Topical miconazole
What is the long-term treatment for psoriasis?
Calcipotriol
What is the most likely diagnosis (history of viral URTI)?
Pityriasis rosea
What is the first line treatment for mild-moderate acne vulgaris?
Topical combination therapy:
* Topical adapalene + topical benzoyl peroxide
- Topical tretinoin + topical clindamycin
- Topical benzoyl peroxide + topical clindamycin
What is the first line treatment for hyperhidrosis?
Topical aluminium chloride preparations
How do you differentiate between a keloid and hypertrophic scar?
If the growth extends past the margins of what would be expected = keloid
Name one chronic condition associated with seborrhoeic dermatitis
HIV
Name the drugs commonly associated with TEN
- Phenytoin
- Sulphonamides
- Allopurinol
- Penicillins
- Carbamazepine
- NSAIDs
Describe the clinical features of nodular melanoma
- Red or black lump or lump which bleeds or oozes
- Typically affects sun exposed skin, middle-aged people
What is the first line treatment for patients with rosacea with predominant flushing but limited telangiectasia?
Brimonidine gel
A 36-year-old lady presents with localised, well demarcated patches of hair loss and small, broken ‘exclamation mark’ hairs. Which blood test is it important to do in this case?
TFTs - in patients with alopecia areata, it is important to screen for other autoimmune conditions, such as thyroid disease, diabetes and pernicious anaemia
A 52-year-old man asks you to look at the side of his tongue. The white patches have been present for the past few months and are asymptomatic. He is a smoker who is known to have type 2 diabetes mellitus.
What is the most likely diagnosis?
Oral leukoplakia
Dermatitis in acral, peri-orificial and perianal distribution should make you consider what vitamin deficiency?
Zinc
What are the treatment options for moderate-severe acne?
- Topical adapalene with topical benzoyl peroxide
- Topical tretinoin with topical clindamycin
- Topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
- Topical azelaic acid + either oral lymecycline or oral doxycycline
Name the drugs which are known to exacerbate plaque psoriasis
- Lithium
- Beta-blockers
- NSAIDs
- ACEi
- TNF-alpha inhibitors
- Anti-malarials
What is pompholyx eczema?
Pompholyx eczema is a subtype of eczema characterised by an intensely pruritic rash on the palms and soles
What is the likely diagnosis?
Pyoderma gangrenosum
Name one side effect of ketoconazole
Gynecomastia
What is the treatment of choice for facial hirsutism?
Topical eflornithine
What is the most likely dianosis?
Basal cell carcinoma
What is the most likely causative organism of erysipelas?
Streptococcus pyogenes
What is the most likely diagnosis?
Pyoderma gangrenosum
What is the first line management for pyoderma gangrenosum?
Oral steroids e.g. prednisolone
How can you differentiate between spider naevi (e.g. seen in liver failure) and telangiectasia (e.g. seen in HHT)?
Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge
What is the most likely diagnosis:
A 53-year-old man presents with a nodule on his chin. He is concerned because it has grown extremely rapidly over the course of the preceding week. On examination he has a swollen, red, dome shaped lesion with a central defect that contains a keratinous type material.
Keratoacanthoma
What is the most likely diagnosis:
A 68-year-old farmer presents with a skin lesion on his forehead. It has been present for the past 6 months and has grown slightly in size during that time. On examination he has an ulcerated lesion with pearly white raised edges that measures 2cm in diameter.
Basal cell carcinoma
What is the most likely diagnosis:
A 34-year-old gardener presents with a lesion affecting the dorsum of his right hand. It has been present for the past 10 days and occurred after he had been pruning rose bushes. On examination he has a raised ulcerated lesion which bleeds easily on contact.
Pyogenic granuloma
What is the first line treatment for dermatophyte nail infections?
Oral terbinafine
Name 3 complications of erythroderma
- Dehydration
- Infection
- High-output cardiac failure
A 14-year-old rugby player presents complaining of a lesion he has noticed for 2 weeks on his back. On examination of his back, there is a round red ring lesion of approximately 1.5cm in diameter with a central area of clearing. The edge of the rash is elevated and scaly on palpation. Which of the following organisms is the likely cause of this lesion?
Fungus (ringworm)
What is the most likely causative organism of a fungal nail infection?
Trichophyton rubrum
During a 6-week baby check, you notice a flat, 30x20mm, pink-coloured, vascular skin lesion over the nape of the baby’s neck, which blanches on pressure. On further questioning, this area has been present since birth and has not changed significantly. They are developing normally.
What is the most likely underlying diagnosis?
Salmon patch
What is the first line treatment for perioral dermatitis?
Topical or oral antibiotics e.g. doxcycline
When is oral antifungal treatment (e.g. terbinafine) indicated for a patient with athlete’s foot?
If initial topical treatment for athlete’s foot fails
You are working in general practice and see a 24-year-old male with a likely diagnosis of pityriasis rosea. What most commonly precedes this condition?
Viral infection
What do the antibodies in pemphigus target?
The desmosomes that connect the cells
Where on the body are keloid scars most common?
Sternum
A non-healing painless ulcer associated with a chronic scar is indicative of what skin malignancy?
Squamous cell carcinoma
What are Curling’s ulcers?
Acute gastric ulcers that develop in response to severe physiological stress, such as burns
Haematemesis is a common presentation
A 32-year-old man is involved in a house fire and sustains extensive partial thickness burns to his torso and thigh. Two weeks post operatively he develops oedema of both lower legs.
What is the most likely cause of this?
Hypoalbuminaemia
How long are patients with shingles infectious for?
People with shingles should be advised that they are infectious until the vesicles have crusted over, usually 5-7 days following onset
A 35-year-old female presents with tender, erythematous nodules over her forearms. Blood tests reveal a raised calcium. What is the most likely diagnosis?
Erythema nodosum - likely underlying diagnosis of sarcoidosis
Name a useful treatment for keloid scars
Intra-lesional steroids
Name two complications of toxic epidermal necrolysis
Volume loss and electrolyte derangement are potential complications
Name a drug which may be associated with spider naevi
COCP
A 78 year-old woman presents with a poorly healing area of skin on her ankle. She has a history of deep vein thrombosis 20 years ago following a hip replacement. She currently takes Adcal D3, and no other medications. On examination there is a shallow ulcer anterior to the medial malleolus. She is otherwise very well.
What investigation would be most useful in determining further management?
ABPI
The most appropriate management of venous ulcers is with compression dressings, however it is important to make sure the patient’s arterial supply is good enough to allow some compression
Describe the clinical features of alopecia areata
Alopecia areata is a presumed autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs.
What is the treatment of choice for Bowen’s disease?
Topical 5-fluorouracil
Are steroids given alongside aciclovir in the management of shinges?
No
Describe the clinical features of dermatitis herpetiformis
Dermatitis herpetiformis is an intensely pruritic, chronic autoimmune skin condition characterised by the presence of papules and vesicles, typically affecting the extensor surfaces such as elbows, knees, and buttocks
Also associated features of coeliac disease
What is Wallace’s rule of 9?
Wallace’s Rule of Nine: each of the following is 9% of the body when calculating surface area % if a burn:
head + neck, each arm, each anterior part of leg, each posterior part of leg, anterior chest, posterior chest, anterior abdomen, posterior abdomen
What is the first line treatment for lichen planus?
Potent topical steroids
A 33-year-old patient comes to see you as she has noticed an itchy rash on both elbows. It has been worsening for the past week. On examination, you see a multiple polygonal, flat-topped papular lesions that each measure 5mm diameter on the flexural surface of her elbows, bilaterally. She has no other rash on the rest of her body.
What is the most likely diagnosis?
Lichen planus
What is the treatment for verrucas?
Topical salicylic acid
Name 3 treatment options for actinic keratosis
Diclofenac, 5-fluorouracil and imiquimod
What is the first line treatment for headlice?
Malathion
What is pityriasis versicolor?
Pityriasis versicolor is a superficial cutaneous fungal infection caused by Malassezia furfur which usually presents on the trunk or back and is scaly is appearance
What is the most common malignacy in renal transplant patients?
Skin cancer (particularly squamous cell) is the most common malignancy secondary to immunosuppression
What is the first line treatment for non-bullous impetigo?
Hydrogen peroxide cream
Which rash of pregnancy spares the periumbilicus?
Polymorphic eruption in pregnancy
What is the first line treatment for a patient with rosacea who has severe papules and/or pustules?
A ombination of topical ivermectin + oral doxycycline
Describe the clinical features of molluscum contagoisum
Presents as multiple small, raised, flesh-coloured or pearly white papules with a central dimple (umbilication). It usually affects children and spreads through direct skin-to-skin contact or via fomites
