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Phase 4 Medicine > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Name 3 types of skin malignancies

A

Basal cell carcinoma

Squamous cell carcinoma

Malignant melanoma

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2
Q

Name and describe 3 layers of the skin

A

Epidermis (thin outer portion of the skin)

Dermis (thicker inner portion of the skin - comprised of connective tissue, nerves, vessels and sweat glands)

Hypodermis (inner most layer - consists of adipose tissue and sweat glands)

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3
Q

What is the most common form of skin cancer?

A

Basal cell carcinoma

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4
Q

Define basal cell carcinoma

A

Describes a non-melanoma form of skin cancer.

BCCs develop slowly in the upper layers of the skin and rarely metastasize.

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5
Q

Give 4 risk factors for basal cell carcinoma

A

Low geographic latitude (i.e Australia)

Low pigment status (fair skin prone to sunburn)

History of skin cancer

Artificial exposure to UV radiation (especially from a young age)

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6
Q

Which skin layer is affected in by basal cell carcinoma?

A

Basal cell layer of the epidermis

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7
Q

What genes are usually mutated in basal cell carcinoma?

A

PTCH and TP53

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8
Q

Name 3 types of Basal Cell Carcinoma. Which is the most common?

A

Nodular (most common)

Superficial

Morpheaform

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9
Q

Give 5 characteristic features of Nodular Basal Cell Carcinomas

A

Pearly, Shiny Lesions with;

Rolled Borders

Depressed Centre

Small Arborising telangiectasias

Lesions are sensitive and may bleed with minor trauma

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10
Q

Describe the appearance of a Superficial Basal Cell Carcinoma (2)

A

Presents as a plaque/patch of well defined, scaly, pink skin.

Mostly occur on the trunk and extremities and in younger patients.

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11
Q

What investigations are required for the definitive diagnosis of a basal cell carcinoma?

A

Punch Biopsy and Histopathological Examination (minimum)

(other biopsies inc - Excisional, Incisional and Shave)

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12
Q

How are low risk BCCs treated? (2)

A

Complete surgical removal or Electrodesiccation and Curettage

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13
Q

Give 3 possible complications of BCC

A

Recurrence

Increased risk of other forms of skin cancer

Disfiguration

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14
Q

What is the leading cause of Squamous Cell Carcinoma?

A

UV exposure (Specifically UVB rays)

Chronic UVB exposure damages the DNA of squamous Keratinocytes, leading to tumour formation.

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15
Q

What gene is commonly mutated in Squamous Cell Carcinoma?

A

P53 Tumour Suppressor Gene

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16
Q

Give 4 risk factors for Squamous Cell Carcinoma

A

UV radiation (specifically UVB)

Immunosuppression

Increasing age

Fitzpatrick Skin types I and II (fairer skin)

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17
Q

Give 4 typical physical features of Squamous Cell Carcinoma

A

Firm to palpate (may be nodular/plaque-like)

May ulcerate and bleed

May be tender or painful

May have crusty keratotic top with a nodular base

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18
Q

Where do squamous cell carcinoma’s tend to appear?

A

In sun-exposed areas (e.g lips, back of hands, upper part of face or scalp)

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19
Q

Cancerous mutations in which cells causes the formation of squamous cell carcinoma?

A

In squamous keratinocytes in the epidermis (outermost layer of the skin)

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20
Q

Give 3 differentials in the context of suspected Squamous Cell Carcinoma

A

Actinic keratosis

Basal Cell Carcinoma

Seborrhoeic Keratosis

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21
Q

Describe Actinic Keratosis

A

Describes the formation of precancerous scaly lesions on the skin.

Have a 10% risk of developing into SCC, therefore must be monitored and treated accordingly.

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22
Q

How should SSC’s be investigated? What indications are used for each type of biopsy?

A

Biopsy and histological examination

Excisional or Shave biopsy - Removes whole lesion. Is used if lesion is small, accessible and not in a cosmetically sensitive area.

Incisional/punch biopsy - Used on large lesions as only samples a small (usually 4mm) part of the lesion.

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23
Q

If metastasis of an SCC is suspected, what other investigations is it important to perform? (2)

A

Ultrasound of Lymph Nodes

CT and MRI for staging or if metastasis is suspected.

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24
Q

Give 4 indicators of a poor prognosis for squamous cell carcinoma

A

Poorly differentiated tumours (histologically)

> 20mm in diameter

> 4mm deep

Patient is immunosuppressed

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25
Q

How are squamous cell carcinomas managed?

A

2 week wait for potential SCCs to a skin cancer screening clinic

Surgical excision with 4mm margins if lesion is <20mm in diameter

Surgical excision with 6mm margins if lesion is >20mm in diameter.

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26
Q

Describe Bowen’s Disease

A

Describes a type of precancerous dermatosis that is a precursor to squamous cell carcinoma.

Commonly seen in elderly patients

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27
Q

What are the 1st line managements for Bowen’s disease?

A

Topical 5-fluorouracil

Cryotherapy

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28
Q

What may be used as primary and secondary prevention of squamous cell carcinoma? (4)

A

UV-A and UV-B coverage suncreams

Avoidance of sun

Discouraging the use of sunbeds

Physical sun protection

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29
Q

Describe Malignant Melanoma

A

Describes a malignant cancer that arises from the melanocyte layer of the skin, normally situated in the basal layer of the epidermis

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30
Q

State 3 ways in which the growth of a melanoma can be described

A

In situ - Tumour is confined to epidermis

Invasive - Tumour has spread into the dermis

Metastatic - Tumour has spread to other tissues

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31
Q

What may form when melanocytes grow in a non-cancerous way?

A

Moles and freckles

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32
Q

Name 2 subtypes of melanoma. Which is the most common? Which is the most aggressive?

A

Superficial spreading melanoma (most common)

Nodular melanoma (most aggressive)

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33
Q

Describe the clinical features of a melanoma using the ABCDE criteria.

A

A - Asymmetrical Shape
B - Border irregularity (inc poorly defined margins)
C - Colour change and variation
D - Diameter of the mole (>6mm)
E - Evolving (changing in size, shape or colour)

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34
Q

List 3 main diagnostic features (major criteria) fo melanoma

A

Relating to previous Mole;

Change in Size

Change in Shape

Change in Colour

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35
Q

List 4 secondary features of melanoma (minor criteria)

A

Diameter >=7mm

Inflammation

Oozing or bleeding

Altered sensation

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36
Q

Give 3 differentials for a pigmented lesion

A

Benign naevus (mole)

Seborrhoeic keratoses

Pigmented basal cell carcinoma

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37
Q

What is used to investigate malignant melanoma?

A

Visualisation using a Dermatoscope

Skin biopsy - Confirms diagnosis

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38
Q

What scoring system is the most important factor for determining prognosis of patients with malignant melanoma?

A

Breslow Depth (invasion depth of a tumour)

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39
Q

What is the definitive management of malignant melanoma?

A

Surgical excision of tumour and margins.

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40
Q

Describe Urticaria. What is it also known as?

A

Describes a pale, pink, pruritic raised rash.

AKA hives, wheals or nettle rash

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41
Q

Name 4 drug classes known to cause urticaria

A

Aspirin

Penicillin’s

NSAIDs

Opiates

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42
Q

How is Urticaria Managed? (3)

A

Non sedating antihistamines - Loratadine/Cetirizine for 6 weeks

Sedating Antihistamine - Chlorphenamine (at night time for sleep symptoms)

Prednisolone - Used for severe or resistant episodes

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43
Q

Give 3 causes of acute urticaria

A

Allergies to foods, medications or animals

Contact with chemicals, latex or stinging nettles

Viral infections

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44
Q

Give 3 forms of chronic urticaria

A

Chronic Idiopathic Urticaria (recurrent episodes with no clear cause/trigger)

Chronic Inducible Urticaria (episodes induced by a trigger)

Autoimmune urticaria (Associated with autoimmune diseases, such as SLE)

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45
Q

Give 4 possible triggers of Chronic Inducible Urticaria

A

Sunlight

Temperature Change

Exercise

Strong emotions

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46
Q

Describe impetigo

A

Describes a superficial bacterial skin infection caused by Staphylococcus Aureus or Streptococcus Pyogenes.

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47
Q

Where does impetigo tend to manifest?

A

Can develop anywhere.

Tends to manifest on face (around lips), flexures and limbs not covered by clothing.

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48
Q

How is impetigo spread?

A

Spread by direct contact with discharges from the scabs of an infected person.

Bacteria invade skin through minor abrasions and then spread to other sites by scratching.

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49
Q

What is the incubation period for impetigo?

A

4 to 10 days

50
Q

How is impetigo managed in people who are not systemically unwell or at high risk of complications?

A

Hydrogen peroxide 1% cream

51
Q

What oral antibiotic is used to treat wise spread or severe impetigo?

A

Oral Flucloxacillin

(Oral erythromycin if penicillin allergy)

52
Q

What topical antibiotic cream can be used to treat impetigo?

A

Topical Fusidic Acid.

53
Q

For how long should children with impetigo be excluded from school?

A

Until lesions are crusted and healed OR 48 hours after commencing antibiotic treatment.

54
Q

Describe cellulitis

A

Describes an infection of the skin and the deeper subcutaneous tissues.

55
Q

What pathogen most commonly causes cellulitis?

A

Streptococcus pyogenes

56
Q

What is it important to look for when examining a patient with cellulitis?

A

A breach in the skin. As this will be the point of entry for the bacteria

(may be due to skin trauma, eczema, fungal nail infections or ulcers)

57
Q

Give 4 clinical features of cellulitis (specifically regarding skin changes)

A

Skin changes include;

Erythema (red discolouration)

Warm or hot to touch

Oedematous

Bullae (fluid-filled blisters)

58
Q

What clinical skin feature may suggest cellulitis due to Staphylococcus aureus infection rather than Streptococcus pyogenes?

A

A golden-yellow crust.

59
Q

What life-threatening complication can occur as a result of cellulitis?

A

Sepsis (suspect if patient is systemically unwell)

60
Q

What criteria is used to assess the severity of cellulitis?

A

Eron Classification

61
Q

How is cellulitis diagnosed?

A

Clinical diagnosis.

Conduct bloods and blood cultures of sepsis is suspected.

62
Q

When treating cellulitis, in whom are IV antibiotics indicated? (6)

A

Eron Class III or IV cellulitis

Severe or rapidly deteriorating cellulitis

Very young (<1) or frail

Immunocompomised

Has significant lymphoedema

Has facial cellulitis or periorbital cellulitis

63
Q

What oral antibiotics are given to manage Eron Class I and II?

A

1st line - Oral Flucloxacillin

2nd - Oral Clarithromycin, Erythromycin (in pregnancy) or Doxycycline (if penicillin allergy)

64
Q

How is Eron Class III-IV cellulitis managed?

A

Admit

Oral/IV co-amoxiclav/clindamycin/cefuroxime or ceftriaxone

65
Q

What is the 1st line antibiotic for cellulitis near the eyes or nose?

A

Co-amoxiclav

66
Q

Describe eczema. Where does it tend to present?

A

Describes a chronic atopic condition caused by defects in the normal continuity of the skin barrier, leading to inflammation in the skin.

Presents during infancy with dry, red, itchy and sore patches of skin over the flexor surfaces (inside elbows and knees) and on face and neck.

67
Q

How does eczema tend to behave?

A

Patients experience periods where the condition is well controlled and periods where the eczema is more problematic, known as flares.

68
Q

How is eczema managed? (4)

A

Avoid irritants

Simple emollients (create an artificial barrier over the skin)

Wet wraps (cover area with thick emollient and wrap to keep mositure locked in overnight)

Topical steroids (weakest steroid for the shortest period)

69
Q

How often should emollients be used in patients with eczema?

A

Use as often as possible, particularly after washing and before bed.

70
Q

What can be used to treat severe cases of eczema?

A

Ciclosporin (DMARD)

71
Q

Describe a the steroid ladder from weakest to most potent. Give examples

A

Mild - Hydrocortisone

Moderate - Eumovate

Potent - Betnovate

Very potent - Dermovate

72
Q

What bacteria most commonly invades skin in eczema? What is used to treat this infection?

A

Staphylococcus aureus.

Flucloxacillin

73
Q

Name 1 severe complication of eczema and describe it’s cause

A

Eczema herpeticum

Caused by Herpes Simplex Virus 1 (or 2)

74
Q

How may Eczema Herpeticum present? (3)

A

Widespread, painful vesicular rash

Systemic symptoms; fever, lethargy, irritability

Lymphadenopathy

75
Q

How is Eczema Herpeticum investigated?

A

Viral swabs - Confirm diagnosis

76
Q

How is Eczema Herpeticum managed?

A

Mild to moderate disease - Oral Aciclovir

Severe disease - IV aciclovir

77
Q

Give 1 complication of eczema herpeticum

A

Bacterial superinfection, leading to more severe illness.

78
Q

What is the name of the mite that causes scabies?

A

Sarcoptes scabiei

79
Q

How is scabies spread?

A

Prolonged skin contact

80
Q

Where in the skin does the scabies mite lay it’s eggs?

A

Striatum corneum

81
Q

What causes the intense pruritus associated with scabies?

A

A delayed type IV hypersensitivity reaction to mites/eggs which occurs 30 days after the initial infection

82
Q

Give 3 clinical features of scabies

A

Widespread pruritus

Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrists

Excoriation or infection secondary to scratching.

83
Q

What is the 1st and 2nd line treatment for scabies?(2)

A

1st line - Permethrin

2nd line - Malathion

84
Q

For how long can scabies induced pruritus persist post eradication?

A

4-6 weeks

85
Q

What additional advice should be given to patients being treated for scabies?

A

Avoid close physical contact with others until treatment is complete

All household and physical contacts should receive treatment, even if asymptomatic

Launder, iron and tumble dry clothing, bedding and towels on 1st day of treatment to kill of mites

86
Q

What variation of scabies is seen in HIV? and how is it treated?

A

Crusted scabies

Treated with Ivermectin

87
Q

What parasitic insect commonly causes headlice?

A

Pediculus capitis

88
Q

How long does it take for headlice eggs to hatch?

A

7-10 days

89
Q

How is headlice spread?

A

Direct head-to-head contact

90
Q

How is headlice diagnosed?

A

Fine-toothed combing of wet or dry hair

91
Q

How is headlice managed?

A

Treatment is only indicated if living lice are found.

Wet combing

Malathion

92
Q

Do household contacts of patients with headlice need treatment?

A

No, unless they are also affected

93
Q

Do children with headlice require school exclusion?

A

No

94
Q

What type of hypersensitivity reaction is allergic contact dermatitis?

A

Type 4 Hypersensitivity Reaction

95
Q

What test can be used to determine an allergic contact dermatitis?

A

Patch testing in response to a specific allergen

96
Q

Name 2 types of contact dermatitis

A

Irritant contact dermatitis (most common - Often seen in hands due to weak acids of alkalis, e.g detergents)

Allergic contact dermatitis (uncommon - often seen in head following hair dyes)

97
Q

Acne vulgaris is caused be chronic inflammation in pockets of skin known as what? Describe these/

A

Pilosebaceous units

Describes tiny dimples in the skin containing hair follicles and sebaceous glands. The sebaceous glands produce natural skin oils and a waxy substance known as Sebum.

98
Q

Describe the pathophysiology of Acne

A

Chronic inflammation of pilosebaceous units > increased production of sebum > trapping of keratin (dead skin cells) > Blockage of pilosebaceous units > Swelling and inflammation.

99
Q

Why is acne exacerbated by puberty and improves with anti-androgenic hormonal contraception?

A

Androgenic hormones increase the production of sebum.

100
Q

What is the name of swollen and inflamed pilosebaceous units?

A

Comedones

101
Q

Colonisation of which anaerobic bacterium plays an important role in acne?

A

Propionibacterium acnes.

Treatments of acne aim to reduce these bacteia

102
Q

Name 4 different types of acne lesions which can be seen in a patient with acne

A

Comedones (Whiteheads and Blackheads)

Papules and Pustules - Moderate inflammation

Nodules and Cysts - Excessive inflammation

Ice-pick and hypertrophic scars - Scarring

103
Q

Define mild acne

A

Mild = Open and Closed comedones with or without sparse inflammatory lesions

104
Q

Define moderate acne

A

Moderate - Widespread non-inflammatory lesions and numerous papules and pustules

105
Q

Define severe acne

A

Extensive inflammatory lesions, which may include nodules, pitting and scaring

106
Q

How is mild to moderate acne treated?

A

12 week course of topical combination therapy;

Topical adapalene + Topical benzoyl peroxide

Topical tretinoin + Topical clindamycin

Topical benzoyl peroxide + Topical clindamycin

107
Q

Can topical benzoyl peroxide be used as a monotherapy if other medications are contraindicated?

A

Yes

108
Q

What class of drugs are Adapalene and Tretinoin?

A

Topical retinoids

109
Q

How is moderate to severe asthma managed?

A

12 week course of topical combination therapy;

Topical adapalene + Topical benzoyl peroxide

Topical tretinoin + Topical clindamycin

Topical adapalene + topical benzoyl peroxide + either oral lymecycline or oral doxycycline

110
Q

What should be offered to treat acne in pregnancy instead of tetracyclines?

A

Erythromycin

111
Q

What should always be co-prescribed with a oral antibiotics to reduce the risk of antibiotic resistance developing? (in acne)

A

Topical retinoid or benzoyl peroxide

112
Q

What is the final line treatment for acne?

A

Oral isotretinoin

113
Q

To reduce risk of antibiotic, name 3 treatment strategies that should NOT be used.

A

Monotherapy with topical antibiotic

Monotherapy with oral antibiotic

A combination of topical antibiotic and an oral antibiotic.

114
Q

How does topical benzoyl peroxide treat acne?

A

Reduces inflammation

Helps unblock the skin

Is toxic to P.acnes bacteria

115
Q

How to topical retinoids treat acne?

A

Slow the production of sebum

116
Q

Give 4 side effects of Isotretinoin

A

Strongly teratogenic (avoid in pregnancy)

Photosensitivity of skin to sunlight

Dry skin and lips

Steven-Johnson syndrome (rarely)

117
Q

Give 4 features of Rosacea

A

Flushing (first symptom)

Telangiectesia

Persistent erythema with papules and pustules

Sunlight may exacerbate symptoms

118
Q

What may exacerbate symptoms of Rosecea?

A

Sunlight

119
Q

What is typically the 1st presenting symptom of Rosecea?

A

Flushing

120
Q

What is used to manage erythema/flushing in rosecea

A

Topical brimonidine (alpha adrenergic agonist)

121
Q

What is used to treat mild to moderate rosecea with papulaes and/or pustules?

A

Topical Ivermectin

122
Q

What is used to treat moderate to severe rosecea?

A

Combination topical ivermectin + oral doxycycline

Phase 4 Medicine (15 decks)

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