Dermatology Flashcards
1
Q
yellow nail syndrome associated with (4)
A
pleural effusions
bronchiectasis
chronic sinus infections
congenital lymphoedema
2
Q
Causes of Stevens-Johnson syndrome
A
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
3
Q
Treatment of TEN
A
- stop precipitating factor
- supportive care
- Iv ig has been shown to be effective and is now commonly used first-line
- immunosuppressive agents (ciclosporin and cyclophosphamide),
- plasmapheresis
4
Q
Treatment of SJS
A
hospital admission is required for supportive treatment
5
Q
Pemphigus vulgaris is an autoimmune disease caused by antibodies directed against….
A
desmoglein 3, a cadherin-type epithelial cell adhesion molecule
6
Q
mucosal ( ulceration ) involvement
In Bullous pemphigoid or Pemphigus vulgaris?
A
Pemphigus vulgaris
7
Q
Pemphigus vulgaris is more common in the ……. population.
A
Ashkenazi Jewish
8
Q
3 Features of Pemphigus vulgaris
A
- mucosal ulceration
- skin blistering
- acantholysis on biopsy
9
Q
Treatment of Pemphigus vulgaris
A
steroids are first-line
immunosuppressants
10
Q
Causes of Onycholysis
A
idiopathic
trauma e.g. Excessive manicuring
infection: especially fungal
skin disease: psoriasis, dermatitis
impaired peripheral circulation e.g. Raynaud’s
hyper- and hypothyroidism
11
Q
Bullous pemphigoid is secondary to the development of antibodies against …….
A
hemidesmosomal proteins BP180 and BP230
12
Q
Bullous pemphigoid is more common in
A
elderly patients
13
Q
Skin biopsy in Bullous pemphigoid
A
immunofluorescence shows IgG and C3 at the dermoepidermal junction
14
Q
Treatment of Bullous pemphigoid
A
referral to a dermatologist for biopsy and confirmation of diagnosis
oral corticosteroids are the mainstay of treatment
topical corticosteroids, immunosuppressants and antibiotics are also used
15
Q
Causative organisms of Fungal nail infection (onychomycosis)
A
- dermatophytes
account for around 90% of cases
mainly Trichophyton rubrum
- yeasts
account for around 5-10% of cases
e.g.Candida
- non-dermatophyte moulds
16
Q
4 Risk factors of Fungal nail infection (onychomycosis)
A
increasing age
diabetes mellitus
psoriasis
repeated nail trauma
17
Q
Investigation of fungal nail infection
A
nail clippings +/- scrapings of the affected nail
18
Q
Treatment of fungal nail infection
A
- do not need to be treated if it is asymptomatic
- dermatophyte or Candida infection is confirmed
- limited involvement (‰¤50% nail affected, ‰¤ 2 nails affected, more superficial white onychomycosis): topical treatment with amorolfine 5% nail lacquer; 6 months for fingernails and 9 - 12 months for toenails
- if more extensive involvement due to a dermatophyte infection:oral terbinafineis currently recommended first-line; 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
- if more extensive involvement due to a Candida infection: oral itraconazole is recommended first-line; ‘pulsed’ weekly therapy is recommended
19
Q
11 Causes of Acanthosis nigricans
A
- T2DM
- Cushing’s disease
- acromegaly
- hypothyroidism
- polycystic ovarian syndrome
- obesity
- gastrointestinal cancer
- familial
- Prader-Willi syndrome
- OCP
- nicotinic acid
20
Q
Pathophysiology of Acanthosis nigricans
insulin resistance → hyperinsulinemia → stimulation of ……….. via interaction with insulin-like growth factor receptor-1 (IGFR1)
A
keratinocytes and dermal fibroblast proliferation
21
Q
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
Features of
A
Actinic, or solar, keratoses
22
Q
Managment of Actinic, or solar, keratoses
A
prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
topical imiquimod: trials have shown good efficacy
cryotherapy
curettage and cautery
23
Q
5 Causes of Scarring alopecia
A
trauma, burns
radiotherapy
lichen planus
tinea capitis
discoid lupus
- Tom really likes To do scarring alopecia
24
Q
Causes of Non-scarring alopecia
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
25
Management of Basal cell carcinoma
surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy
26
Dermatitis herpetiformis caused by deposition of .....
IgA in the dermis
27
Diagnosis of Dermatitis herpetiformis
skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
28
Treatment of Dermatitis herpetiformis
gluten-free diet
dapsone
29
Erythema ab igne If not treated then patients may go on to develop .....
squamous cell skin cancer
30
Erythema ab igne is a skin disorder caused by over exposure to .....
infrared radiation
31
Causes of erythroderma
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic
* Every person goes 2 look inside erythroderma
32
Erythrodermic psoriasis may be triggered by
withdrawal of systemic steroids
33
Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in .....
the groin or axillae
34
Erythrasma is caused by an overgrowth of
diphtheroid Corynebacterium minutissimum
35
Wood's light reveals a coral-red fluorescence.
Seen in
Erythrasma
36
Treatment of Erythrasma
Topical miconazole or antibacterial are usually effective.
Oral erythromycin may be used for more extensive infection
37
Erythema nodosum usually resolves within ...
6 weeks
38
5 main Causes of Erythema nodosum
1. infection
streptococci
tuberculosis
brucellosis
2. systemic disease
sarcoidosis
inflammatory bowel disease
Behcet's
3. malignancy/lymphoma
4. drugs
penicillins
sulphonamides
combined OCP
5. pregnancy
39
Erythema multiforme is a hypersensitivity reaction that is most commonly triggered by ......
infections
40
In Erythema multiforme, the upper limbs are ....
more commonly affected than the lower limbs
41
Causes of erythema multiforme
1. Viruses: HSV , Orf
2. Bacteria: Mycoplasma, Streptococcus
3. sarcoidosis
4. malignancy
5. connective tissue disease e.g. Systemic lupus erythematosus
6. drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
42
The more severe form, erythema multiforme major is associated with
mucosal involvement.
43
Eczema herpeticum is a severe primary infection of the skin by
herpes simplex virus 1 or 2
And uncommonly Coxsackievirus
44
Eczema herpeticum, the rash is characterized by
rapidly progressing painful rash
45
monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter are typically seen in .......
Eczema herpeticum
46
Treatment of Eczema herpeticum
Admission
Iv acyclovir
47
dermatitis artefacta is strongly associated with
personality disorder, dissociative disorders and eating disorders
48
Acrodermatitis enteropathica is a ....... inherited partial defect in intestinal zinc absorption.
recessively
49
acrodermatitis
alopecia
short stature
hypogonadism
hepatosplenomegaly
geophagia (ingesting clay/soil)
cognitive impairment
Features of...
Zinc deficiency
50
Vitiligo is an autoimmune condition which results in the loss of .......... and consequent depigmentation of the skin
melanocytes
51
Vitiligo is associated with
type 1 diabetes mellitus
Addison's disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
52
Management vitiligo
sunblock for affected areas of skin
camouflage make-up
topical corticosteroids may reverse the changes if applied early
there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients
53
ankle-brachial pressure index (ABPI)
1. Normal value ...?
2. Below normal value indicates....?
3. Above the normal value indicates ....?
1. 0.9 - 1.2
2. indicate arterial disease
3. indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)
54
Treatment of Venous ulceration
1. compression bandaging, usually four layer (only treatment shown to be of real benefit)
2. oral pentoxifylline, a peripheral vasodilator, improves healing rate
55
immune complex small-vessel vasculitis
1. Henoch-Schonlein purpura
2. Goodpasture's syndrome (anti-glomerular basement membrane disease)
3. cryoglobulinaemic vasculitis
4. hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)
56
Systemic mastocytosis results from a neoplastic proliferation of ....
mast cells
57
Features and Systemic mastocytosis
1. urticaria pigmentosa - produces a wheal on rubbing (Darier's sign)
2. flushing
3. abdominal pain
4. monocytosis on the blood film
58
Diagnosis of Systemic mastocytosis
raised serum tryptase levels
urinary histamine
59
Causes of Tinea capitis
Trichophyton tonsurans (most common cause in the UK and the USA)
Microsporum canis acquired from cats or dogs
60
Management of Tinea capitis
oral antifungals:
1. terbinafine for Trichophyton tonsurans infection
2. griseofulvin for Microsporum infections
3. Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission
61
Causes of Tinea corporis
Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)
62
Treatment of Tinea corporis
oral fluconazole
63
lesions due to Trichophyton species do not readily fluoresce under .....
Wood's lamp
64
Risk factors of Squamous cell carcinoma of skin
1. excessive exposure to sunlight / psoralen UVA therapy
2. actinic keratoses and Bowen's disease
3. immunosuppression e.g. following renal transplant, HIV
4. smoking
5. long-standing leg ulcers (Marjolin's ulcer)
6. genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
65
Treatment of Squamous cell carcinoma of skin
Surgical excision with 4mm margins if lesion <20mm in diameter.
If tumour >20mm then margins should be 6mm
66
Poor prognosis of Squamous cell carcinoma
1. Poorly differentiated tumours
2. >20mm in diameter
3. >4mm deep
4. Immunosupression for whatever reason
67
Necrobiosis lipoidica often associated with
surrounding telangiectasia
68
5 Skin disorders associated with diabetes
1. Granuloma annulare
2. Necrobiosis lipoidica
3. Neuropathic ulcers
4. Lipoatrophy
5. Vitiligo
69
6 Skin disorders associated with tuberculosis
1. lupus vulgaris (accounts for 50% of cases)
2. erythema nodosum
3. scarring alopecia
4. gumma
5. verrucosa cutis
6. scrofuloderma
70
What is the commonest skin disorder found in pregnancy
Atopic eruption of pregnancy
71
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
Pemphigoid gestationis
72
Treatment of Pemphigoid gestationis
oral corticosteroids
73
pruritic condition associated with last trimester
lesions often first appear in abdominal striae
Polymorphic eruption of pregnancy
74
Tylosis associated with which malignancy
Oesophageal cancer
75
Sweet's syndrome associated with which malignancies?
Haematological malignancy e.g. Myelodysplasia - tender, purple plaques
76
Pyoderma gangrenosum associated with which malignancies?
Myeloproliferative disorders
77
Necrolytic migratory erythema associated with
Glucagonoma
78
Migratory thrombophlebitis associated with
Pancreatic cancer
79
Erythema gyratum repens associated with which malignancies
Lung cancer
80
Acquired hypertrichosis lanuginosa associated with which malignancies?
Gastrointestinal and lung cancer
81
Acquired ichthyosis associated with which malignancies?
Lymphoma
82
Sezary syndrome is
type of T-cell cutaenous lymphoma
83
Features of Sezary syndrome
pruritus
erythroderma typically affecting the palms, soles and face
atypical T cells
lymphadenopathy
hepatosplenomegaly
84
Causes of Livedo reticularis
1. Idiopathic
2. SLE
3. polyarteritis nodosa
4. cryoglobulinaemia
5. antiphospholipid syndrome
6. Ehlers-Danlos Syndrome
7. homocystinuria
85
Nickel is a common cause allergic contact dermatitis and is an example of a type ...... hypersensitivity reaction.
IV
86
Predisposing factors of Keloid scars
1. people with dark skin
2. Male young adults, rare in the elderly
3. sternum ( common site)
87
Koebner phenomenon seen in
lichen planus
lichen sclerosus
psoriasis
vitiligo
warts
molluscum contagiosum
* 2 like people very well & more
88
Mycosis fungoides is a rare form of ....
cell lymphoma that affects the skin.
89
Lentigo maligna is a type of ......1......,
typically progresses slowly but may at some stage become invasive causing .......2......
1. melanoma
2. lentigo maligna melanoma.
90
Management of Hyperhidrosis
1. topical aluminium chloride preparations are first-line. Main side effect is skin irritation
2. botulinum toxin for axillary symptoms
3. surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
91
Guttate psoriasis may be precipitated by a
streptococcal infection 2-4 weeks prior to the lesions appearing.
92
Management of Guttate psoriasis
1. most cases resolve spontaneously within 2-3 months
2. topical agents as per psoriasis
3. UVB phototherapy
4. tonsillectomy may be necessary with recurrent episodes
93
hereditary haemorrhagic telangiectasia (HHT) is an autosomal ...... condition
dominant
94
There are 4 main diagnostic criteria of hereditary haemorrhagic telangiectasia
1. epistaxis : spontaneous, recurrent nosebleeds
2. telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
3. visceral lesions: for example GI telangiectasia , pulmonary arteriovenous malformations , hepatic AVM, cerebral AVM, spinal AVM
4. family history: a first-degree relative with HHT
If the pt has 2 then they are said to have a possible diagnosis of HHT.
If they meet 3 or more of the criteria they are said to have a definite diagnosis of HHT
95
What is the most common causes of hirsutism
Polycystic ovarian syndrome
96
11 Causes of Hirsutism
1. Polycystic ovarian syndrome
2. congenital adrenal hyperplasia
3. androgen secreting ovarian tumour
4. adrenal tumour
5. androgen therapy
6. Cushing's syndrome
7. obesity
8. corticosteroids
9. phenytoin
97
Management of hirsutism
1. weight loss if overweight
2. cosmetic techniques such as waxing/bleaching
3. consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin).
* Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
4. facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding
98
Causes of hypertrichosis
drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa
99
Impetigo usually caused by
either Staphylcoccus aureus or Streptococcus pyogenes
100
Impetigo is common in ....1....., particularly during ......2..... weather.
1. children
2.warm
101
Management of Impetigo
1. hydrogen peroxide 1% cream (for 'people who are not systemically unwell or at a high risk of complications)
2. topical antibiotic creams
3. Extensive disease
oral flucloxacillin
oral erythromycin if penicillin-allergic
102
School exclusion In Impetigo
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
103
Lichenoid drug eruptions - causes
gold
quinine
thiazides
104
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape, with a 'white-lines' pattern on the surface
oral involvement typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging
Features of.....?
Lichen planus
105
Managment of Lichen planus
1. potent topical steroids are the mainstay of treatment
2. benzydamine mouthwash or spray is recommended for oral lichen planus
3. extensive lichen planus may require oral steroids or immunosuppression
106
Lichen sclerosus usually affects ....1... and is more common in .2. .....
1. the genitalia
2. elderly females
107
Management of Lichen sclerosus
topical steroids and emollients
108
Lichen sclerosus increases risk of ..... cancer
vulval
109
What is the most aggressive subtypes of melanoma?
Nodular melanoma
110
In Molluscum contagiosum, Referral may be necessary in some circumstances:
1. For people who are HIV-positive with extensive lesions urgent referral to a HIV specialist
2. For people with eyelid-margin or ocular lesions and associated red eye urgent referral to an ophthalmologist
3. Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections
111
Which virus is thought to play a role in the aetiology of pityriasis rosea
Herpes hominis virus 7 (HHV-7)
112
Pityriasis versicolor is caused by
Malassezia furfur
113
Management of Pityriasis versicolor
ketoconazole shampoo
if failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole
114
Pompholyx eczema may be precipitated by
humidity (e.g. sweating) and high temperatures.
115
Features of Pompholyx
pruritic small blisters on the palms and soles
116
Management of Pompholyx
cool compresses
emollients
topical steroids
117
Psoriasis is associated with HLA-........
HLA-B13, -B17
118
5 Complications of psoriasis
psoriatic arthropathy (around 10%)
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress
119
factors may exacerbate psoriasis
1. Trauma
2. Alcohol
3. withdrawal of systemic steroids
4. drugs: beta blockers, lithium, NSAIDs and ACEi, infliximab, antimalarials (chloroquine and hydroxychloroquine).
*Streptococcal infection may trigger guttate psoriasis.
120
Chronic plaque psoriasis management
first-line : potent corticosteroid applied once daily plus vitamin D analogue applied once daily for up to 4 weeks as initial treatment
second-line: if no improvement after 8 weeks then offer:
a vitamin D analogue twice daily
third-line: if no improvement after 8-12 weeks then offer either:
a potent corticosteroid applied twice daily for up to 4 weeks, or
a coal tar preparation applied once or twice daily
short-acting dithranol can also be used
121
adverse effects of Phototherapy
skin ageing
squamous cell cancer (not melanoma)
122
Dithranol inhibits.....
adverse effects :
1. DNA synthesis
2. adverse effects include burning, staining
123
Coal tar inhibits ........
DNA synthesis
124
Seborrhoeic dermatitis is associated with
Parkinson's disease
HIV
125
common complications of seborrhoeic dermatitis
Otitis externa and blepharitis
126
Treatment of Seborrhoeic dermatitis
Scalp disease management
1. the first-line treatment is ketoconazole 2% shampoo
2. selenium sulphide and topical corticosteroid may also be useful
Face and body management
1. topical antifungals: e.g. ketoconazole
2. topical steroids: best used for short periods
127
Seborrhoeic dermatitis is caused by
Malassezia furfur
128
7 Adverse effects of Retinoids
1. teratogenicity
2. dry skin, eyes and lips/mouth
3. Low mood
4. raised triglycerides
5. hair thinning
6. photosensitivity
7. intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
129
Mild topical steroids by potency
1. Hydrocortisone 0.5-2.5%
130
Moderate topical steroids by potency
1. Betamethasone 0.025%
2. Clobetasone 0.05%
131
Potent topical steroids by potency
1. Fluticasone 0.05%
2. Betamethasone 0.1%
132
Very potent topical steroids by potency
Clobetasol 0.05%
133
Features of Rosacea
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms
134
Management of Rosacea
Predominant erythema/flushing
Topical brimonidine gel ( alpha adrenergic agonist )
135
Treatment of mild-to-moderate papules and/or pustules due to Rosacea
topical ivermectin is first-line
alternatives include: topical metronidazole
136
Treatment of moderate-to-severe papules and/or pustules due to Rosacea
combination of topical ivermectin + oral doxycycline
137
In Rosacea, Referral should be considered if
1. patients with a rhinophyma
2. symptoms have not improved with optimal management in primary care
138
Managment of Pyogenic granuloma
lesions associated with pregnancy often resolve spontaneously post-partum
other lesions usually persist : Removal methods include
curettage and cauterisation, cryotherapy, excision
139
Causes of Pyogenic granuloma
trauma
pregnancy
more common in women and young adults
140
Causes of Pyoderma gangrenosum
1. Idiopathic
2. IBD
3. Rheumatological: RA & SLE
4. Haematological: lymphoma, myeloid leukaemias, monoclonal gammopathy (IgA), myeloproliferative disorders
5. granulomatosis with polyangiitis
6. primary biliary cirrhosis
141
Management of Pyoderma gangrenosum
1. oral steroids as first-line treatment
2. immunosuppressive therapy, for example, ciclosporin and infliximab, have a role in difficult cases
142
Scabies is caused by ........ and is spread by ........
the mite Sarcoptes scabiei
and is spread by prolonged skin contact
143
Management of Scabies
1. permethrin 5% is first-line for 8-12 hours
2. malathion 0.5% is second-line for 24 hours before washing
* repeat treatment 7 days later
pruritus persists for up to 4-6 weeks post eradication
* all household and close physical contacts should be treated at the same time, even if asymptomatic
144
Treatment of Crusted scabies
Ivermectin is the treatment of choice and isolation is essential
145
Crusted scabies is seen in patients
suppressed immunity, especially HIV.
146
Reticulated, erythematous patches with hyperpigmentation and telangiectasia
Hx of exposure to infrared radiation
?
Erythema Ab Igne
147
Describe the rash of eczema herperticum ?
Monomorphic punched out erosions ( circular, depressed, ulcerated lesions )
