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MRCP - Passmed > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Most common cause of Erythema multiforme?

A

HSV

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2
Q

Causes of Erythema multiforme

A

viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy

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3
Q

Dermatitis in acral, peri-orificial and perianal distribution

hypogonadotropic hypogonadism

Diagnosis?

A

Zinc deficiency

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4
Q

A non-healing painless ulcer associated with a chronic scar is indicative of ……

A

SCC

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5
Q

Multiple papules and large pustules on and around his nose, and the nose itself is enlarged and erythematous with multiple telangiectasia

Diagnosis? mx?

A

Rosacea

Mild-moderate: Topical ivermectin (or topical metronidazole / topical azelaic acid)

Mod-severe: Topical ivermectin + oral doxycyline

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6
Q

What are some common complications of seborrhoeic dermatitis?

A

Otitis externa and blepharitis

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7
Q

1st line mx of hyperhidrosis?

A

Topical aluminium chloride

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8
Q

What is dermatitis herpetiformis caused by? who is more likley for this?

A

deposition of IgA in the dermis

90% of cases show some gluten insensitivity

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8
Q

Who is most likely to get keloid scars?

A

More common in young, black, male adults

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9
Q

What is the pathophysiology of acanthosis nigricans?

A

insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

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10
Q

Most common malignancies associated with acanthosis nigricans?

A

GI ca - most commonly gastric adenocarcinoma

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11
Q
A
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11
Q

Mx of flexural, face or genital psoriasis?

A

Topical steroids

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12
Q

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 (Wickham’s striae)

Diagnosis?

Mx?

A

Dx - Lichen sclerosus

Mx - topical steroids
(if in mouth benzydamine mouthwash / spray)

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13
Q

Which ca is most common malignancy secondary to immunosupression?

A

Skin cancer - particularly SCC

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14
Q

Blisters / bullae:

No mucosal involvement - dx?
Mucosal involvement - dx?

A

no mucosal involvement (in exams at least*): bullous pemphigoid

mucosal involvement: pemphigus vulgaris

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15
Q

Mx of pityriasis versicolor?

A

Topical ketoconazole

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16
Q

Mx of facial hirsuitism? when not to?

A

Topical eflornithin

CI in pregnancy / breast feeding

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17
Q

small blisters on the palms and soles

pruritic
often intensely itchy
sometimes burning sensation

once blisters burst skin may become dry and crack

Worse in humidity and high temps

Dx?

A

Dx - pompholyx eczema

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18
Q

Extensive umbilicated lesions in HIV

dx?

A

Molluscum contagiosum

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19
Q

Prognosis in malignant melanoma?

A

Invasion depth of tumour (Breslow depth is single most important factor)

> 4mm 50% 5 yr survival
<0.75 95-100% 5 yr survival

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20
Q

A history of a non-healing ulcer at the site of a burn injury

diagnosis?

A

SCC

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21
Q

What are the features of systemic mastocytosis?

A

Systemic mastocytosis results from a neoplastic proliferation of mast cells

Features
urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
flushing
abdominal pain
monocytosis on the blood film

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22
Q

How is systemic mastocytosis diagnosed?

A

Diagnosis
raised serum tryptase levels
urinary histamine

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23
Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu) syndrome inheritance?
Autosomally dominant
24
What is the cause of porphyria cutanea tarda?
inherited defect in uroporphyrinogen decarboxylase
25
Triad of niacin deficiency?
Dementia + Depression Diarrhoea Dermatitis
26
What can percipitate lithium toxicity?
dehydration renal failure drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
27
Mx of oculogyric crisis?
intravenous antimuscarinic: benztropine or procyclidine can also use diphenhydramine
28
What are patients recieving CHOP for non-Hodgkins lymphoma at increased risk of? how can this risk be reduced?
Tumour lysis syndrome and associated gout secondary to hyperuricaemia Reduce this risk by co-prescribing allopurinol
29
Which people are more likely to develop isoniazid toxicity?
Slow acetylators
30
Which drugs are affected by acetylator status?
H DIPS hydralazine dapsone isoniazid procainamide sulfasalazine
31
An itchy rash affecting the face and scalp distribution is typical of ...
Seborrhoeic dermatitis - malassezia furfur associated w HIV and PD
32
What are some common complications of seborrhoeic dermatitis?
Blepharitis and otitis externa
33
What deficiency is pellagra?
B3 - Niacin (Nicotinic acid)
34
How to mx face, flexural or genital psoriasis?
Mild / moderate corticosteroid topically OD / BD for max 2 weeks
35
Which skin disorder is associated with Graves? What does this look like?
Pretibial myxoedema - symmetrical, erythematous skin with shiny, orange peel appearance
36
Pityriasis rosea causative organism?
Herpes hominis virus 7 HHV 7
37
A non-healing painless ulcer associated with a chronic scar is suggestive of?
SCC
38
shiny, atrophic, yellow-brown plaques on the shins with telangiectasia and occasional ulceration on shins are suggestive of?
Necrobiosis lipoidica diabeticorum associated with diabetes
39
Possible causes of acanthosis nigricans?
acanthosis nigricans is associated with all the things that are associated with weight gain: hypothyroid, DM, acromegaly, prader willi, PCOS, COCP, obesity. And then just gotta remember gastric ca on top
40
Causes of hypertrichosis?
drugs: minoxidil, ciclosporin, diazoxide congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis porphyria cutanea tarda anorexia nervosa
41
Mx of roseaca?
Simple - sunscreen + camouflage creams predominant flushing > topical brimonidine gel (topical a-adrenergic agonist) mild-moderate papules / pustules > topical ivermectin (or metro / azelaic acid) moderate-severe papules / pustules > combination of topical ivermectin + oral doxy
42
Which ca is Acquired ichthyosis associated with?
Lymphoma
43
Acquired hypertrichosis lanuginosa is associated with which ca?
GI and Lung ca
44
Dermatomyositis is associated with which ca?
Ovarian + lung ca
45
Erythema gyratum repens is associated with which ca?
Lung
46
Erythroderma is associated with which ca?
Lymphoma
47
Migratory thrombophlebitis is associated with which ca?
Pancreatic ca
48
Necrolytic migratory erythema is associated with which ca?
Glucagonoma
49
Pyoderma gangrenosum (bullous and non-bullous forms) is associated with which ca?
Myeloproliferative
50
Sweet's syndrome is associated with which ca?
Haematological malignancy e.g. Myelodysplasia - tender, purple plaques
51
Tylosis is associated with which ca?
Oesophageal cancer
52
Pyoderma gangrenosum mx?
Oral steroids - due to risk of progression rapidly Immunosuppressants ciclosporin + infliximab may be involved in difficult cases Stop any surgery plans until disease is controlled to risk worsening (pathergy)
53
Adverse effects associated with retinoid use?
Teratogenicity Dry skin, eyes, lips / mouth - most common (also nose bleeds due to drying of nasal mucosa) low mood raised triglycerides hair thinning Intracranial HTN - dont combine w tetracyclines Photosensitivity
54
Describe where keloid scars are most likely to form?
common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk
55
What can exacerbate psoriasis?
trauma alcohol drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab withdrawal of systemic steroids
56
What is systemic mastocytosis and what are the features?
Systemic mastocytosis results from a neoplastic proliferation of mast cells urticaria pigmentosa - produces a wheal on rubbing (Darier's sign) flushing abdominal pain monocytosis on the blood film
57
How is systemic mastocytosis diagnosed?
Raised serum tryptase Urinary histamine
58
MoA of pemphigus vulgaris? what are the features of this disease?
Desmoglein 3 antibodies -> mucosal ulceration, skin blistering + acantholysis on biopsy?
59
Linear, well-demarcated skin lesions that appear suddenly, with 'la belle indifference' →
dermatitis artefacta
60
What is melasma, how does it present?
Melasma, also known as chloasma or 'mask of pregnancy' presents as symmetrical hyperpigmented patches typically affecting the face, particularly the cheeks, forehead, upper lip, and nose Caused by increased oestrogen + progesterone -> stimulation of melanocytes esp during 2nd-3rd trimester
61
Adverse effects of (psoralen + ultraviolet A light) PUVA therapy?
adverse effects: skin ageing, squamous cell cancer (not melanoma)
62
Mx of keloid scars?
early keloids may be treated with intra-lesional steroids e.g. triamcinolone
63
What are the features of vitiligo?
well-demarcated patches of depigmented skin the peripheries tend to be most affected trauma may precipitate new lesions (Koebner phenomenon) Associated w AI conditions: T1DM, Addisons, AI thyroid disorders, pernicious anaemia, alopaecia areta
64
What is telogen effluvium?
temporary hair shedding often related to stress, illness or medication use. results from a larger number of hairs than normal entering into 'telogen' phase - a resting stage in the natural life cycle of a hair follicle - leading to increased daily shedding and diffuse thinning across the whole scalp
65
itchy white spots suggestive of ? where does it occur
Lichen sclerosus - typically vulval but can affect buttocks, thighs and other areas in men affects glans penis - called balantitis xerotica obliterans
66
What often precedes guttate psoriasis?
Strep sore throat 2-4 weeks prior
67
indurated ulcerating lower lip lesion with an outdoor occupation with significant sun exposure (tour guide) and smoking history most likely?
Lower lip malignancy most likley SCC
68
Eczema herpeticum organism?
primary infection of the skin caused by herpes simplex virus (HSV) and uncommonly coxsackievirus
69
Livedo reticularis causes?
A mnemonic I used for the causes of LR is PACE-ISH - Polyarteritis nodosa - Antiphospholipid syndrome - Cryoglobilinaemia - Ehler-Danlos - Idiopathic (Most common) - SLE - Homocystinuria
70
Pigmentation of nail bed affecting proximal nail fold suggests ???
Acral lentiginous melanoma - sign described is hutchingsons sign typically affecting 40+ typically seen in darker skin tones
71
What is erythema ab igne caused by and look like? Complication?
Erythema ab igne is caused by overexposure to infrared radiation - reticulated, erythematous patches with hyperpigmentation and telangiectasia If cause not stopped can lead to SCC
72
Mx of lichen planus?
Potent topical steroids Benzydamin mouthwash for oral lichen planus Extensive - oral steroids / immunosuppression
73
Porphyria cutanea tarda is caused by
nherited defect in uroporphyrinogen decarboxylase
74
blistering rash on the face and dorsal hands provoked by sunlight and alcohol + hypertrichosis is suggestive of?
Porphyria cutanea tarda
75
Most common cause of isotretinoin?
Dry skin
76
TPN can lead to what deficiency? derm finding?
Zinc deficiency can lead to acrodermatitis herpetiformis -> peri-orificial dermatitis and alopecia.
77
Acute onset of tear-drop scaly papules on trunk and limbs +- preceeding strep infection dx?
Guttate psoriasis
78
Most common cause of ca in upper lip?
BCC
79
dermatitis herpetiformis - diagnosis?
Skin biopsy
80
keratin pearls seen in whcih skin ca?
SCC
81
Acne with scarring - what to provide?
Oral isotretinoin
82
slow-growing, flesh-coloured or pink lesions with a pearly appearance. The rolled edges, central depression and presence of telangiectasia (dilated blood vessels) are classic features Suggestive of what>
BCC - most common skin cancer in UK occurring on sun exposed regions
83
first-line treatment for pyoderma gangrenosum?
Oral steroids

MRCP - Passmed (17 decks)

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