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MSRA > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Rosacea sx

A

typically affects nose, cheeks and forehead

flushing is often first symptom
telangiectasia are common

later develops into persistent erythema with papules and pustules

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2
Q

Rosacea mx

A

mild-to-moderate papules and/or pustules
topical ivermectin is first-line

alternatives include: topical metronidazole or topical azelaic acid

moderate-to-severe papules and/or pustules
combination of topical ivermectin + oral doxycycline

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3
Q

Seborrhoeic dermatitis tx

A

first-line treatment is topical ketoconazole

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4
Q

Alopecia areata sx and mx

A

patchy, well demarcated hair loss on the scalp

Topical steroids and referral to derm

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5
Q

Hyperhydrosis mx

A

Topical aluminium chloride

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6
Q

Hyperpigmentation and thickening of the skin in her groin and axilla- which malignancy associated

A

Gastric adenocarcinoma

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7
Q

bullous pemphigoid vs pemphigus vulgaris

A

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

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8
Q

Cancer likely to develop after renal transplant

A

Squamous carcinoma

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9
Q

Mx of psoriasis

A

first-line: NICE recommend:
a potent corticosteroid applied once daily plus vitamin D analogue applied once daily (calcipotriol)
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

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10
Q

Actinic keratoses

A

common premalignant skin lesion that develops as a consequence of chronic sun exposure

Features
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

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11
Q

Mx of actinic keratoses

A

Management options include
prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream: typically a 2 to 3 week course.

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12
Q

Erythema nodosum causes

A

infection
streptococci
tuberculosis

systemic disease
sarcoidosis
inflammatory bowel disease
Behcet’s

malignancy/lymphoma

drugs
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy

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13
Q

Pityriasis rosea

A

Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.

oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

Self-limiting, resolves after around 6 weeks

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14
Q

Guttate psoriasis

A

Classically preceded by a streptococcal sore throat 2-4 weeks

‘Tear drop’, scaly papules on the trunk and limbs

Most cases resolve spontaneously within 2-3 months
Topical agents as per psoriasis
UVB phototherapy

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15
Q

Telogen effluvium

A

loss and thinning of hair in response to severe stress
uniformly thin, but without any areas of total hair loss

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16
Q

Eczema herpeticum

A

monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter are typically seen.

herpes simplex virus 1 or 2.

potentially life-threatening children should be admitted for IV aciclovir.

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17
Q

Acquired ichthyosis sx and associated cancer

A

dry, scaly skin.

Lymphoma

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18
Q

Acquired hypertrichosis lanuginosa sx and associated cancer

A

abnormal growth of lanugo-type hair on the face, neck, trunk, and limbs

GI and lung cancer

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19
Q

Dermatomyositis sx and associated cancer

A

muscle weakness and skin rash

Ovarian and lung cancer

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20
Q

Erythroderma sx and associated cancer

A

widespread redness and scaling of the skin
lymphoma

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21
Q

Tylosis sx and associated cancer

A

skin on the palms and soles of the feet to thicken and fissure

Oesophageal cancer

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22
Q

Chondrodermatitis nodularis helicis

A

painful nodule on the ear.

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23
Q

SE of retinoids

A

teratogenicity

dry skin, eyes and lips/mouth

low mood

raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension
photosensitivity

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24
Q

Pityriasis versicolor sx and mx

A

superficial cutaneous fungal infection caused by Malassezia furfur

patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common

ketoconazole shampoo as this is more cost effective for large areas
if failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole

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25
Q

Mx of keloid scaring

A

Intra-lesional steroids

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26
Q

Nickel dermatitis dx

A

Skin patch test

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27
Q

Erythema nodosum sx

A

Symmetrical, erythematous, tender, nodules are found on shins

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28
Q

Mx of vitiligo

A

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,

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29
Q

Mx of BCC

A

Urgent - high risk areas (eyelid, nasal ala) should be referred for surgical excision

Otherwise routine referral

30
Q

Common complications of seborrhoeic dermatitis.

A

Otitis externa and blepharitis

31
Q

Mx of acne

A
32
Q

Mx of acne in pregnancy

A

mild to moderate acne:
a 12-week course of topical combination therapy should be tried first-line:
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical benzoyl peroxide with topical clindamycin

moderate to severe acne:
a 12-week course of one of the following options:
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
a topical azelaic acid + either oral lymecycline or oral doxycycline

oral isotretinoin: only under specialist supervision

33
Q

Mx of venous ulcers

A

compression bandaging, usually four layer (only treatment shown to be of real benefit)
oral pentoxifylline, a peripheral vasodilator, improves healing rate

34
Q

Pyogenic granuloma

A

initially small red/brown spot
rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
the lesions may bleed profusely or ulcerate

Where trauma occurred
Pregnancy

35
Q

Parkland formula

A

weight x BSA x 4ml
Half of the fluid is administered in the first 8 hours.

Wallace’s Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%

36
Q

Burn thickness

A

Superficial epidermal First degree Red and painful, dry, no blisters

Partial thickness (superficial dermal) Second degree
Pale pink, painful, blistered. Slow capillary refill

Partial thickness (deep dermal)
Second degree
Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure

Full thickness
Third degree
White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

37
Q

Capillary haemangiomas

A

small red patch which develops in the first month of life, increasing in size until around 9 months and becoming more vascular. They are not present at birth and regress spontaneously

38
Q

Molluscum contagiosum with eyelid or ocular involvement

A

Urgent ophthalmology review

39
Q

Necrobiosis lipoidica , Granuloma annulare and Lipoatrophy

A

All associated With DM

NL- yellow-brown atrophic plaques with telangiectasia, typically on the anterior shin, and can ulcerate.

Granuloma annulare- flesh-coloured to erythematous annular plaques

Lipoatrophy - localised loss of subcutaneous fat at insulin injection sites

40
Q

Chronic plaque psoriasis

A

erythematous plaques covered with a silvery-white scale
typically on the extensor surfaces such as the elbows and knees. Also common on the scalp, trunk, buttocks and periumbilical area

41
Q

Dermatitis herpetiformis

A

cutaneous manifestation of coeliac disease characterised by an intensely itchy, papulovesicular rash, with blisters filled with watery fluid.

42
Q

Keratoacanthoma sx and mx

A

raised lesion with a central keratin filled crater

Urgent referral to derm

Spontaneous regression of keratoacanthoma within 3 months is common, often resulting in a scar. Such lesions should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma. Removal also may prevent scarring.

43
Q

Spider naevi vs telangiectasia differentiation

A

Spider naevi fill from the centre, telangiectasia from the edge

44
Q

Tina corporis sx and mx

A

well-defined annular, erythematous lesions with pustules and papules
may be treated with oral fluconazole

45
Q

Tinea capitis sx and mx

A

a cause of scarring alopecia mainly seen in children
if untreated a raised, pustular, spongy/boggy mass called a kerion may form

Trichophyton tonsurans

oral antifungals: terbinafine

Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission

46
Q

Erythema multiforme

A

Erythema multiforme presents as multiple target lesions with an outermost erythematous ring and paler centre.

acute, self-limiting skin eruption most commonly secondary to an infective trigger (e.g. herpes simplex virus or Mycoplasma pneumoniae).

drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis

47
Q

Erythema marginatum

A

manifestation of acute rheumatic fever.

annular erythematous macules or papules that spread outwards with central clearance. The lesions are not itchy or painful and may be asymptomatic.

48
Q

Cardiac medication causing worsening psoriasis

A

B blockers

49
Q

Factors exacerbating psoriasis

A

trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

50
Q

Seborrhoeic keratoses sx

A

benign skin lesions that commonly occur in older individuals

They present as well-defined, waxy, ‘stuck-on’ papules or plaques

51
Q

Rash is purple, raised, and has fine white lines on the surface. Inside the mouth, the patient has white striae on the oral mucosa

A

Lichen planus

Wickham Striae

52
Q

Sx and Mx of Lichen planus

A

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)

Potent topical steroids

53
Q

SE of topical steroids

A

Skin depigmentation (particularly in patients with darker skin), skin atrophy (thinning), and excessive hair growth.

54
Q

Skin disorders associated with pregnancy

A

Atopic eruption of pregnancy
is the commonest skin disorder found in pregnancy
it typically presents as an eczematous, itchy red rash.
no specific treatment is needed

Polymorphic eruption of pregnancy
pruritic condition associated with last trimester
lesions often first appear in striae on the abdomen and spares the periumbilical region

management depends on severity: emollients, mild potency topical steroids and oral steroids may be used

Pemphigoid gestationis
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
oral corticosteroids are usually required

55
Q

Shingles mx

A

antivirals within 72 hours for the majority of patients,

unless the patient is < 50 years and has a ‘mild’ truncal rash

infectious until the vesicles have crusted over, usually 5-7 days following onset

56
Q

Urticaria sx and mx

A

pale, pink raised skin. Variously described as ‘hives’

non-sedating antihistamines (e.g. loratadine or cetirizine) are first-line

57
Q

SCC features

A

hyperkeratotic, crusting, ulcerated appearance.

immunosuppression

58
Q

BCC

A

Rolled edges with pearlesence and telangectasia

59
Q

Dermatofibroma

A

solitary firm papule or nodule, typically on a limb
typically around 5-10mm in size
overlying skin dimples on pinching the lesion

60
Q

Large birthmark that is purplish in colour, probably not resolve by itself and could be associated with other vascular problems.

A

Port wine stain

61
Q

Mx of scabies

A

permethrin 5% is first-line
malathion 0.5% is second-line

62
Q

Mx of flexural/face/genital psoriasis

A

mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks

Not vit D as no scaling

63
Q

Steven Johnson Syndrome sx

A

severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction.

the rash is typically maculopapular with target lesions being characteristic
mucosal involvement
systemic symptoms: fever, arthralgia
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently

64
Q

SJS causes

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

65
Q

Nail changes in psoriasis

A

pitting
onycholysis (separation of the nail from the nail bed)
subungual hyperkeratosis
loss of the nail

66
Q

Livedo reticularis

A

purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules.

Causes
systemic lupus erythematosus
antiphospholipid syndrome
Ehlers-Danlos Syndrome

67
Q

When to refer to derm for acne

A

Patients should also be referred if they have moderate-severe acne that has not responded to a 3-month trial of treatment with an oral antibiotic

mild to moderate acne has not responded to two completed courses of treatment
moderate to severe acne has not responded to previous treatment that includes an oral antibiotic
acne with scarring
acne with persistent pigmentary changes
acne is causing or contributing to persistent psychological distress or a mental health disorder

68
Q

Toxic epidermal necrolysis

A

systemically unwell e.g. pyrexia, tachycardic
positive Nikolsky’s sign: the epidermis separates with mild lateral pressure

presentation of widespread rash with fluid-filled blisters

69
Q

Causes of TEN

A

phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

70
Q

Mx of TEN

A

stop precipitating factor
supportive care
often in an intensive care unit
volume loss and electrolyte derangement are potential complications
intravenous immunoglobulin has been shown to be effective and is now commonly used first-line

71
Q

Cause of spider navei

A

liver disease
pregnancy
combined oral contraceptive pill

MSRA (8 decks)

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