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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 HSV

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
Q

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu) syndrome inheritance?

A

Autosomally dominant

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24
Q

What is the cause of porphyria cutanea tarda?

A

inherited defect in uroporphyrinogen decarboxylase

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25
Q

Triad of niacin deficiency?

A

Dementia + Depression
Diarrhoea
Dermatitis

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26
Q

What can percipitate lithium toxicity?

A

dehydration

renal failure

drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

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27
Q

Mx of oculogyric crisis?

A

intravenous antimuscarinic: benztropine or procyclidine

can also use diphenhydramine

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28
Q

What are patients recieving CHOP for non-Hodgkins lymphoma at increased risk of? how can this risk be reduced?

A

Tumour lysis syndrome and associated gout secondary to hyperuricaemia

Reduce this risk by co-prescribing allopurinol

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29
Q

Which people are more likely to develop isoniazid toxicity?

A

Slow acetylators

30
Q

Which drugs are affected by acetylator status?

A

H DIPS

hydralazine

dapsone
isoniazid
procainamide
sulfasalazine

31
Q

An itchy rash affecting the face and scalp distribution is typical of …

A

Seborrhoeic dermatitis - malassezia furfur

associated w HIV and PD

32
Q

What are some common complications of seborrhoeic dermatitis?

A

Blepharitis and otitis externa

33
Q

What deficiency is pellagra?

A

B3 - Niacin (Nicotinic acid)

34
Q

How to mx face, flexural or genital psoriasis?

A

Mild / moderate corticosteroid topically OD / BD for max 2 weeks

35
Q

Which skin disorder is associated with Graves? What does this look like?

A

Pretibial myxoedema - symmetrical, erythematous skin with shiny, orange peel appearance

36
Q

Pityriasis rosea causative organism?

A

Herpes hominis virus 7

HHV 7

37
Q

A non-healing painless ulcer associated with a chronic scar

is suggestive of?

A

SCC

38
Q

shiny, atrophic, yellow-brown plaques on the shins with telangiectasia and occasional ulceration on shins are suggestive of?

A

Necrobiosis lipoidica diabeticorum

associated with diabetes

39
Q

Possible causes of acanthosis nigricans?

A

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
Q

Causes of hypertrichosis?

A

drugs: minoxidil, ciclosporin, diazoxide

congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis

porphyria cutanea tarda

anorexia nervosa

41
Q

Mx of roseaca?

A

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
Q

Which ca is Acquired ichthyosis associated with?

A

Lymphoma

43
Q

Acquired hypertrichosis lanuginosa is associated with which ca?

A

GI and Lung ca

44
Q

Dermatomyositis is associated with which ca?

A

Ovarian + lung ca

45
Q

Erythema gyratum repens is associated with which ca?

A

Lung

46
Q

Erythroderma is associated with which ca?

A

Lymphoma

47
Q

Migratory thrombophlebitis is associated with which ca?

A

Pancreatic ca

48
Q

Necrolytic migratory erythema is associated with which ca?

A

Glucagonoma

49
Q

Pyoderma gangrenosum (bullous and non-bullous forms) is associated with which ca?

A

Myeloproliferative

50
Q

Sweet’s syndrome is associated with which ca?

A

Haematological malignancy e.g. Myelodysplasia - tender, purple plaques

51
Q

Tylosis is associated with which ca?

A

Oesophageal cancer

52
Q

Pyoderma gangrenosum mx?

A

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
Q

Adverse effects associated with retinoid use?

A

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
Q

Describe where keloid scars are most likely to form?

A

common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk

55
Q

What can exacerbate psoriasis?

A

trauma

alcohol

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

withdrawal of systemic steroids

56
Q

What is systemic mastocytosis and what are the features?

A

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
Q

How is systemic mastocytosis diagnosed?

A

Raised serum tryptase

Urinary histamine

58
Q

MoA of pemphigus vulgaris? what are the features of this disease?

A

Desmoglein 3 antibodies -> mucosal ulceration, skin blistering + acantholysis on biopsy?

59
Q

Linear, well-demarcated skin lesions that appear suddenly, with ‘la belle indifference’ →

A

dermatitis artefacta

60
Q

What is melasma, how does it present?

A

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
Q

Adverse effects of (psoralen + ultraviolet A light) PUVA therapy?

A

adverse effects: skin ageing, squamous cell cancer (not melanoma)

62
Q

Mx of keloid scars?

A

early keloids may be treated with intra-lesional steroids e.g. triamcinolone

63
Q

What are the features of vitiligo?

A

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
Q

What is telogen effluvium?

A

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
Q

itchy white spots suggestive of ? where does it occur

A

Lichen sclerosus - typically vulval but can affect buttocks, thighs and other areas

in men affects glans penis - called balantitis xerotica obliterans

66
Q

What often precedes guttate psoriasis?

A

Strep sore throat 2-4 weeks prior

67
Q

indurated ulcerating lower lip lesion with an outdoor occupation with significant sun exposure (tour guide) and smoking history

most likely?

A

Lower lip malignancy most likley SCC

68
Q

Eczema herpeticum organism?

A

primary infection of the skin caused by herpes simplex virus (HSV) and uncommonly coxsackievirus

69
Q

Livedo reticularis causes?

A

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
Q

Pigmentation of nail bed affecting proximal nail fold suggests ???

A

Acral lentiginous melanoma - sign described is hutchingsons sign

typically affecting 40+ typically seen in darker skin tones

71
Q

What is erythema ab igne caused by and look like? Complication?

A

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
Q

Mx of lichen planus?

A

Potent topical steroids

Benzydamin mouthwash for oral lichen planus

Extensive - oral steroids / immunosuppression

73
Q

Porphyria cutanea tarda is caused by

A

nherited defect in uroporphyrinogen decarboxylase

74
Q

blistering rash on the face and dorsal hands provoked by sunlight and alcohol

+ hypertrichosis is suggestive of?

A

Porphyria cutanea tarda

MRCP - Passmed (17 decks)

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