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MRCP - Part 1 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is bullous pemphigoid

A

Autoimmune sub-epidermal condition characterised by large, tense blisters found on the limbs, trunks and flexors
Bullae/erosions may be also found on oral/genital mucosa

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2
Q

What autoantibodies are present in bullous pemphigoid

A

BP antigen II and I

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3
Q

Treatment of bullous pemphigoid

A

Steriods
Supportive measures

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4
Q

Risk factors for developing bullous pemphigoid

A

Previous chronic inflammatory skin conditions (e.g. lichen planus or psoriasis)
Drugs
- furosemide
- antibiotics
- NSAIDs
Neurological disease
- PD
- dementia
- Epilepsy

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5
Q

Causes of bullous eruptions

A

Congenital
Strep infection
Staph scalded skin syndrome
TEN
Diabetic bullae
CKD
Haemodialysis
Barbituate overdose
Immunological

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6
Q

What is erythema multiforme?

A

Presents as eruptions of multiple lesions, which are maculopapular, target shaped rashes but can appear in various forms (hence the name multiforme)

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7
Q

Where can erythema multiforme occur?

A

Anywhere on the body
Palms
Soles
Oral mucosa

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8
Q

What may there be a history of with erythema multiforme?

A

Viral illness

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9
Q

Where does the rash usually start and spread with eyrthema multiforme?

A

Starts distally
Spreads proximally

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10
Q

What is Koebeners phenomenon?

A

Lesions appearing on areas of previous skin trauma

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11
Q

Differentials of erythema multiforme

A

Insect bites
SJS
TEN
Drug eruption
Dermatitis
Bullous pemphigoid
Pemphigus
Dermatitis herpetiformis

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12
Q

What is neurofibromatosis?

A

A genetic condition characterised by lesions of the skin, CNS and skeleton

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13
Q

Types of neurofibromatosis

A

Type I
Type II
Schwannomatosis

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14
Q

Genetics of neurofibromatosis type I

A

Autosomal dominant inherited disorder
Caused by mutation in the neurofibromin gene (NF1) on chromosome 17

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15
Q

Presentation of NF1

A

Often presents in first year of life and increase in number with age
Leads to multiple tumours that grow along the NS anywhere in the body
Skin lesions
- multiple neurofibromas (skin coloured lesions) and cafe au lai macules
- freckling, particularly in skin folds
Neuro dermatofibromas arise from nerve trunks and can cause paraesthesia when pressed
Lisch nodules (seen on eye with slit lamp)
Short stature
Macrocephaly
Around 30% develop
- Mild learning disability
- Acoustic neuromas
- epilepsy

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16
Q

Rare assosiation of NF1

A

Phaechoromocytoma

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17
Q

Main difference NF2 vs NF1

A

CNS tumours being more characteristic than skin lesions

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18
Q

Presentation of NF2

A

Bilateral acoustic neuromas are characteristic
Meningiomas
Glial cell tumours
Usually present with deafness in their 20s; tinnitus, veritgo

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19
Q

Genetics of NF2

A

Mutation found on chromosome 22
Can be autosomal dominance or de novo (up to 50%)

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20
Q

Treatment of acoustic neuroma

A

Surgical excision

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21
Q

Mean survival from diagnosis of NF2

A

15 years

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22
Q

What is schwannomatosis?

A

Occurence of multiple tender cutaneous schwannomas without the vestibular neuroma assosiated with NF2
Often a very large tumour load requiring assessment with MRI

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23
Q

Is life expectancy affected in schwannomatosis?

A

No

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24
Q

Which NF is more common?

A

Type 1

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25
Q

Presendation of schwannomatosis

A

Pain
Related or unrealated to masses
Paraesthesia and weakness

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26
Q

Genetics of schwannomatosis

A

Medatiations of tumour suppression genes such as SMARCB1 and LZtr1

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27
Q

Complications of NF

A

Tumours of optic nerves (gliomas) (15% of childre with NF1)
Scoliosis
Osteoporosis
Epilepsy
Increased risk of brain tumours, leukaemias and other malignancies of neural crest origins
Malignant change if there are peripheral sheath tumours in NF1 (assosiated with poor survival)

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28
Q

First line treatment for scabies

A

Permethrin cream

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29
Q

What is erythema nodosum

A

Acute panniculitis (inflammation in the fat) that produces tender nodules or plaques on the shins and occassionally elsewhere

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30
Q

Assosiations of erythema nodosum

A

Idiopathic
Sarcoidosis
Pregnancy
IBD
Strep infections
TB
Treatment with sulfonamides or OCP

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31
Q

Treatment of erythema nodosum

A

NSAIDs

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32
Q

What is pyroderma gangronosum assosiated with

A

IBD
Vasculitis
Haematological malignancy

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33
Q

Presentation of pyoderma gangrenosum

A

Deep ulcer
Violet border

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34
Q

What is koebeners phenomenon

A

New disease lesions develop at the site of skin injury

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35
Q

What coniditons provide a true koebeners response

A

Psoriasis
Vitiligo
Lichen planus

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36
Q

Rash in lichen planus

A

Pigmented
Itchy

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37
Q

Diseases assosiated with PLEVA

A

Toxoplasmosis
EBV
HIV
CMV
Parovirus
Staph A septicaemia
Group A beta haemolytic strep infection

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38
Q

Presentation of PLEVA

A

Initial area of erythema
Develops rapidly into multiple pus filled papules

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39
Q

What is onchyolysis

A

Seperation of nail bed from nail plate

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40
Q

Causes of onchyolysis

A

Psoriasis
Trauma
Infection
Drugs - tetracycliens, psoratens
Thyrotoxicosis

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41
Q

What is bowens disease

A

A form of SCC
Presents as a red scaley plaque

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42
Q

How does polyphyria cutanea tarda occur

A

Bullous eruptions after exposure to sunlight
Eruptions heal into scarring and milia
Photodistribution of the rash

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43
Q

Investigation of polphyria cutanea tarda

A

Clinically
High levels of urinary uroporphyrin

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44
Q

How can remission of polyphyria cutanea tarda be induced

A

Venesection

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45
Q

Presentation of rash in dermatomyositis

A

Red or volacious periorbital eruption known as the helitrope rash
May be assosiated oedema
Linear volacious changes over dorsal aspect of fingers
Shawl sign - erythema over upper back and posterior neck
Weakness of major proximal muscles

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46
Q

Investigations of scabies

A

Ink test

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47
Q

What is pemphigus vulgaris

A

Mucosal involvement with ulceration
Flaccid blisters (on trunk in particular)

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48
Q

What would be found in a biopsy for pemphigus vilgaris

A

Intercellular IgG deposition

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49
Q

What is the test for marfan syndrome

A

Fibrillin 1 (FBN1) gene testing

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50
Q

What is pseudoxanthoma elasticum

A

Rare genetic disease causing systemic calcium deposition and fragmentation of elastic tissue

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51
Q

Complications of pseudoxanthoma elasticum

A

Central blindness
CVS events
GI bleeding

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52
Q

Skin manifestations of pseudoxanthoma elasticum

A

Multiple small yellow papiles, possibly joining into larger patcges
Later in the disease, skin can become lax, wrinkled and hanging in like fold like appearances e.g. on upper arms
on neck (commonest), inside elbows, back of knees, umbilicus, groin
Oral, genital and rectal mucosa

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53
Q

Diagnosis of pseudoxanthoma elasticum

A

Skin biopsy

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54
Q

Drugs that can cause photosensitivity

A

Doxycycline
NSAIDs
retinoids
Diuretics
CVS drugs (amoidarone, enalapril, quinidine, diltiazem)
Sulfounryea drugs
Phenthoiazines

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55
Q

What can immunosuppresision cause in relation to shingles?

A

Muti-dermatomal
Disseminated disease

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56
Q

In the pathogenesis of psoriasis, which cell type is most implicated in the inflammatory response

A

T lymphocytes

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57
Q

What drugs can worsen psoriasis

A

Beta blockers
Anti-malarials
Lithium
Withdrawl of oral corticosteriods, especially if sudden

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58
Q

What can precipitate guttate psoriasis

A

Strep infection

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59
Q

What is melasma

A

Hormonally stimulated increase in melaogensis that mainly appears on the face

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60
Q

What can worsen melasma

A

Sun exposure
COCP
Pregnancy

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61
Q

Where does melasma occur mainly

A

On the face

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62
Q

Secondary syphillis presentation

A

Polymorphic rash
- particularly on palms and soles of feet

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63
Q

Presentation of primary syphillis

A

Painless ulcer

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64
Q

What causes pellagra

A

Chronic vitamin B3 deficiency

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65
Q

Presentation of pellagra

A

3Ds
- photosensitive dermatitis
- diarrhoea
- dementia

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66
Q

What condition can pellagra be seen in

A

Carcinoid syndrome

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67
Q

Skin manifestations of systemic sclerosis

A

Taunt, shiny skin
Telangiectasis
Salt and pepper discolouration
Ulceration
Sclerodactyly

68
Q

What is necrobiosis lipoidica

A

Unusual complication of DM
May also occur in non diabetic patients
Small vessel damage leads to partial necrosis of detmal colleagen and connective tissue, with a histiocytic cell response

69
Q

Presentation of necrobiosis lipoidica

A

Mostly on the legs
Erythematous plaques
Gradually develop into yellow brown waxy discolouration
Marked atrophy and prominant telangiectasia

70
Q

Poor prognostic indicators of malignant melanoma

A

Depth (breslow thickness)
Ulceration

71
Q

Most common CVS complications seen in pseudoxanthoma elasticum

A

Accelerated atherosclerosis
Mitral valve prolapse

72
Q

Eye characterisation of pseudoxanthoma elasticum

A

Angioid streaks

73
Q

Presentation of pemphigoid of pregnancy

A

Rare immunobullous disease
Tends to begin second trimester but can occur whenever
Some cases, worsens after delivery
Tense blisters

74
Q

Investigation of pemphigoidof pregnancy

A

Biopsies for histology and immunoflorencence

75
Q

Treatment of pemphigoid of pregnanct

A

PO steriods

76
Q

Presentation of polymoprhic eruption of pregnancy

A

Pruritic and urticated papules and plques
Itchy
Blistering unusual
Spares the umbilical area

77
Q

Bioppsy results of dermatitis herpetiformis

A

IgA

78
Q

Presentation of pemphigus

A

Flaccid blisers that erode / erupt easily

79
Q

Blisters pemphigus vs pemphigoid

A

Pemphigus - flacid blisters that erode / erupt more easily
Pemphigoid - blisters tense and do not rupture easily

80
Q

Age pemphigus vs pemphigoid

A

Pemphigus - 40-60 y/o
Pemphigoid - older

81
Q

Investigation of pemphigus

A

Immunofloureosecne
- antibodies to the cells in the epidermis
Anti-desmoglein antibodies (type I and III) in blood samples

82
Q

Management of chronic spontaentous urticaria if two antihistamines arent controlling symptoms

A

Monteleukast
- thought to be useful in reduction of duration and severity of episodes

83
Q

Presentation of pityriasis rosea

A

Herald patch
Followed by widespread similar red patches with a fine collaret of scale
Can be asymptomatic

84
Q

Investigation of pityriasis rosea

A

Clinical

85
Q

Treatment of pityriasis rosea

A

COnservative
Rash usually resolves up to 12 weeks later

86
Q

Antibodies seen in paraneoplastic pemphigus

A

Envoplakin
Periplakin
Bullous pemphigoid antigen I
Desmoplakin
Desmoplakin II
Alpha 2 macroglobulin like 1

87
Q

WHat does an older patient with intact blisters on their limbs indicate

A

Bullous pemphigoid

88
Q

Presentation of HSP

A

Purpura in dependent areas (buttocks and legs) (vasculitic rash)
Abdo pain and vomiting
With or without upper gi haemorrhage
Nephritis (less commonly nephrotic syndrome)

89
Q

What age do oyu commonly see HSP

A

4 -15 y/o but can occur at any age

90
Q

Pathophysiology of HSP

A

Mediated by IgA
Deposited in affected organs

91
Q

Antigen triggers of HSP

A

Drugs
Foods
Immunisation
Various infections

92
Q

Treatment of HSP

A

Supportive

93
Q

Presentation of molluscum contagiosum

A

Crops of firm, smooth umbilicated papules

94
Q

Treatment of molluscum contagiousum

A

Cryotherapy
Can resolve spontaenously up to 18 months

95
Q

Treatment of peristomal pyoderma gangrenosum

A

Topical tacrolimus

96
Q

What HLA subtype is most assosiated with chronic plaque psoriasis

A

HLA-CW6

97
Q

HLA subtype related to T1DM

A

HLA-DR3

98
Q

WHat HLA subtype is related to psoriatic arthritis and pustular psoriasis

A

HLA-B27

99
Q

What can worsen skin manifestations of NF1

A

Pregnancy

100
Q

Presentation of a sebacous cyst

A

fluid filled lesion
skin smooth and intact on top
painless
occassionally become painful and inflammed
discharge caseous material

101
Q

Are macules raised or flat

A

flat

102
Q

Presentatio n of tuberculoid leprosy

A

Hypopigmented areas of skin
Accompanied by reduced sensation

103
Q

Investigation of leprosy

A

Mycobacterium leprea on skin biopsy or slit-skin smear

104
Q

Treatment of acne

A
  1. Topical antibiotics
  2. Oral antibiotics (3 month trial - then trial another antibiotic)
  3. Topical retinoid
  4. Oral retinoid
105
Q

Causative orgganism of lymes disease

A

Borrelia Burgdorferi

106
Q

Presentation of dermatitis herpatiformis

A

Vesicles / blisters (quickly excoriated so may not be seen)
scaly itchy plaques

107
Q

Who is zinc deficiency commonly seen in

A

alcoholics

108
Q

Presentation of zinc deficiency

A

Anorexia / lethargy
Diarrhoea
Growth retardation
Delayed sexual maturation
Hypogonadism / hypospermia
Intellecutal disability, impaired nerve conduction and nerve damage
Hepatomegaly
Immune disorders
Susceptibility to infections
Alopecia / dermatitis / paronychia

109
Q

What is erysipelas

A

A superficial form of cellulitis

110
Q

Features of erysipelas

A

Distinctive, warm, red tender skin lesion
Induration and is sharply defined
Raised, rapidly advancing border
Vesicles or bullae may develop
Face is commonly affected

111
Q

Causative organism for erysipelas

A

Group A beta haemolytic strep (strep pyogenes)

112
Q

another name for vitamin B3

A

Naicin

113
Q

Treatment of pyoderma gangrenosum

A
  1. Very potent topical steriods
  2. Prednisolone
  3. Ciclosporin or other immunosuppressive agents
  4. Dapsone
  5. Tetracycline Abz
114
Q

Treatment of venous ulceration

A

Compression bandaging

115
Q

Where is acral lentigious melanoma seen

A

Sole of the foot
Occassionally on the palm of the hand

116
Q

Presentation of acral lentigious melanoma

A

Normally seen on sole of the foot
Can be seen in the palm of the hand
Irregulatly pigmented macule, but thicker palpable areas may appear if it progresses
Size can range from a few mm to a few cm

117
Q

When does lentigo maligna melanoma tend to present

A

Chronically sun exposed skin
Typically the face

118
Q

Features of nodular melanoma

A

Aggressive
Grows deeper
Presents as a papular or nodular lesion
Deeply pigmented but can be amelanotic

119
Q

Where does subungal melanoma occur

A

Nail apparatus

120
Q

What is the most common subtype of melanoma

A

Superficial spreading melanoma

121
Q

Inheritance of dariers disease

A

AD

122
Q

Presentation of dariers disease

A

Apparent in early adulthood
Warty papules and plaques in seborrhoeic areas (e.g. central chest and back, scalp, flexures), palmar pits and nail dystrophy
Secondary infection of the lesions can lead to crusting and malodour

123
Q

Treatment of dariers disease

A

Retinoid acitretin can be used to treat symptomatic cases

124
Q

What is wickhams strae and what condition is it characteristic of

A

Fine, white lacy pattern over the papules
Characteristic of lichen planus

125
Q

What is erypsillas assosiated with

A

systemic upset (fevers, chills)

126
Q

Where does SCC occur

A

Chronically sun exposed areas such as face and lips
May arise from
- actinic keratosis
- Bowens disease
- chronic wounds
- areas of inflammation (known as marjolins ulcer)

127
Q

What is PUVA

A

A type of ultraviolet light therapy (phototherapy)

128
Q

Presentation of kapsois sarcoma

A

Red, purple or brown cutaneous nodules or plaques, lesions may occur in mouth or internal organs
Typically affects legs, head and neck
Lesions are usually asymptomatic

129
Q

WHat antibody is present in virtually all patients with SLE at some stage

A

anti-nuclear antibody

130
Q

Presentation of sweets syndrome

A

Skin lesions are
- plum coloured
- may be papules, plaques or nodules
Mucosal involvement and blistering may occur
Often fever and neutrophilia

131
Q

Diagnosis of sweets syndrome

A

Skin biopsy

132
Q

What condition makes up the majority of cases of patients with paraneoplastic pemphigus

A

NHL

133
Q

What pattern does pityriasis rosecea occur in

A

Christimas tree distribution

134
Q

What is rosacea often assosiated with

A

Rhinophyma (enlarged sebaceous cysts around nose)
Ocular rosacea
- conjunctivitis
- blepharitis
- keratitis

135
Q

Treatment of rosacea

A

Topical azelaic acid
Topical ivermectin
Brimonidine
Doxycycline
Tetracycline

136
Q

What is more severe, TEN or SJS

A

TEN

137
Q

Presentation of TEN/SJS

A

Flu like prodrome
Followed by a red/purple rash which then blisters/forms bullae
Affects the skin, mucous membranes, eyes and genitalia

138
Q

Treatment of TEN/SJS

A

Identify and remove/treat underlying cause
Analgesia
Fluids
Corticosteriods
Abx

139
Q

80% of TEN/SJS is caused by what

A

Drugs

140
Q

What drugs can precipitate SJS/TENS

A

Allopurinol
Cephalosporin
NSAIDs
Phenytoin
Carbamazepine
Sulfa group Abx
Sulfasalazine
Sertraline
Antivirals

141
Q

Risk factors for developing TENS/SJS

A

Previous Hx
Family Hx
Genetic predisposition - HLA b1502 or HLA b1508 genes

142
Q

Pathology of SJS/TENS

A

Type IV hypersensitivity reaction

143
Q

SCORTEN system for severity of TENS/SJS includes

A

Age > 40
Prescence of malignancy
HR > 120
Epidermal detachment > 10% body surface
Urea > 10
Glucose > 14
Bicarb < 20

144
Q

Treatment of lichen sclerosus

A

Reducing course of topical Clobetasol 0.05%

145
Q

What is the most useful cytokine to target in the treatment of psoriasis with potent monoclonal antibodies

A

IL17

146
Q

What should we check for if there is angio eoedema in the abscence of urticaria

A

C1-esterase inhibitor deficiency
ACE inhibitor induced angiooedema

147
Q

How can rosacea be distinguished from acne

A

Abscence of comedones
Distrbution of the rash (almost always confined to the face)
Lack of scarring
Effect of sunlight (brings an improvement in acne)
Age (rosacea more common > 40)

148
Q

What is erythroderma

A

Any inflammatory skin condition covering in excess of 90% of the body surface

149
Q

Causes of erythyroderma

A

Eczema
Psoriasis
Drug eruption
Cutaneous lymphoma
Pityriasis ruba pilaris

150
Q

WHat causes pityriasis versiolour

A

Fungus malassezia globosa

151
Q

When is malassezia globosa commmon

A

Area of skin covered by occlusive clothing or is more subject to sweating
More likely to occur in hotter weather

152
Q

Whta toxin does staph A produce in recurrent skin infections

A

PVL

153
Q

Signs of melanoma in an existing mole

A

Asymmetry of pigmentation
Irregularity in shape and border
Multiple colours
Enlargement
Darkening
Bleeding without trauma

154
Q

What is discoid lupus erythematous also known as

A

Chronic cutaneous lupus erythematous

155
Q

what is tyolosis assosiated with

A

carcinoma of the oesophagus

156
Q

Where does lichen planus commonly affect

A

Wrist and ankles

157
Q

Treatment of cutaneous leishmaniasis

A

Sodium Stibogluconate

158
Q

Features of Behects syndrome

A

Recurrent orogenital ulceration
Uveitiis
Arhtiritis

159
Q

Pathology of behects disease

A

Autoimmune
Assosiations - HLA B12, B51 and B5

160
Q

3 features of acute intermittent porphyria

A

Abdominal pain (may mimic acute abdomen)
HTN
Psychiatric disturbance

161
Q

How does AIP

A

Defect in porphobiligen deaminase

162
Q

Treatment of acute attacks of AIP

A

IV haem arginate

163
Q

What is often seen (and in the diagnostic crtieria) for NF1 that you would see on slit lamp examination

A

At least two Lisch nodules (iris hamartomas)

164
Q

Treatment of acne rosacea

A

Topical azelaic acid

165
Q

How long does it take for kertatinocytes to transform to anucleate corneocytes

A

3 days

166
Q
A

MRCP - Part 1 (19 decks)

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