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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 (painful coloured shins)
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
Mx of keloid scaring
Intra-lesional steroids triamcinolone
26
Nickel dermatitis dx
Skin patch test
27
Erythema nodosum sx
Symmetrical, erythematous, tender, nodules are found on shins
28
Mx of vitiligo
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,
29
Mx of BCC
Urgent - high risk areas (eyelid, nasal ala) should be referred for surgical excision Otherwise routine referral
30
Common complications of seborrhoeic dermatitis.
Otitis externa and blepharitis
31
Mx of acne
Topical retanoid/BPO and oral abx 2 courses- then refer
32
Mx of acne in pregnancy
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
Mx of venous ulcers
compression bandaging, usually four layer (only treatment shown to be of real benefit) oral pentoxifylline, a peripheral vasodilator, improves healing rate
34
Pyogenic granuloma
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
Parkland formula
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
Burn thickness
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
Capillary haemangiomas
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
Molluscum contagiosum with eyelid or ocular involvement
Urgent ophthalmology review
39
Necrobiosis lipoidica , Granuloma annulare and Lipoatrophy
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
Chronic plaque psoriasis
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
Dermatitis herpetiformis
cutaneous manifestation of coeliac disease characterised by an intensely itchy, papulovesicular rash, with blisters filled with watery fluid.
42
Keratoacanthoma sx and mx
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
Spider naevi vs telangiectasia differentiation
Spider naevi fill from the centre, telangiectasia from the edge
44
Tina corporis sx and mx
well-defined annular, erythematous lesions with pustules and papules may be treated with oral fluconazole
45
Tinea capitis sx and mx
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
Erythema multiforme
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
Erythema marginatum
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
Cardiac medication causing worsening psoriasis
B blockers
49
Factors exacerbating psoriasis
trauma alcohol drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab withdrawal of systemic steroids
50
Seborrhoeic keratoses sx
benign skin lesions that commonly occur in older individuals They present as well-defined, waxy, 'stuck-on' papules or plaques
51
Rash is purple, raised, and has fine white lines on the surface. Inside the mouth, the patient has white striae on the oral mucosa
Lichen planus Wickham Striae
52
Sx and Mx of Lichen planus
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
SE of topical steroids
Skin depigmentation (particularly in patients with darker skin), skin atrophy (thinning), and excessive hair growth.
54
Skin disorders associated with pregnancy
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
Shingles mx
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
Urticaria sx and mx
pale, pink raised skin. Variously described as 'hives' non-sedating antihistamines (e.g. loratadine or cetirizine) are first-line
57
SCC features
hyperkeratotic, crusting, ulcerated appearance. immunosuppression
58
BCC
Rolled edges with pearlesence and telangectasia
59
Dermatofibroma
solitary firm papule or nodule, typically on a limb typically around 5-10mm in size overlying skin dimples on pinching the lesion
60
Large birthmark that is purplish in colour, probably not resolve by itself and could be associated with other vascular problems.
Port wine stain
61
Mx of scabies
permethrin 5% is first-line malathion 0.5% is second-line
62
Mx of flexural/face/genital psoriasis
mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks Not vit D as no scaling
63
Steven Johnson Syndrome sx
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
SJS causes
penicillin sulphonamides lamotrigine, carbamazepine, phenytoin allopurinol NSAIDs oral contraceptive pill
65
Nail changes in psoriasis
pitting onycholysis (separation of the nail from the nail bed) subungual hyperkeratosis loss of the nail
66
Livedo reticularis
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
When to refer to derm for acne
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
Toxic epidermal necrolysis
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
Causes of TEN
phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs
70
Mx of TEN
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
Cause of spider navei
liver disease pregnancy combined oral contraceptive pill
72
Skin type Fitzpatrick 1
Never tans, always burns (often red hair, freckles, and blue eyes)
73
Dermaphyte nail infection tx
Oral terbinafine
74
Leukoplakia
white, hard spots on the mucous membranes of the mouth. It is more common in smokers. Can't be rubbed off like candida Can transform into SCC
75
Red crusted lesions around the mouth- cause ?
Zinc Def acrodermatitis: red, crusted lesions acral distribution peri-orificial perianal
76
Scalp psoriasis mx
NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse)
77
Mx of capillary haemangioma
If treatment is required (e.g. Visual field obstruction) Proponalol
78
Seborrhoeic dermatitis sx
chronic or relapsing form of eczema/dermatitis that primarily affects sebum-gland rich areas including the scalp, face, and trunk. The presentation of an itchy, red rash on the neck, behind the ears and around the nasolabial folds
79
Mx of lichen sclerosis
Management topical steroids and emollients Follow-up: increased risk of vulval cancer
80
Pathophysiology of dermatitis herpetiformis
Formation of IgA AB
81
Mx of guttate psoriasis
Reassurance + topical treatment if symptomatic
82
Causes of pruritic
Liver disease IDA Polycythaemia CKD Lymphoma
83
Pompholyx eczema
vesicles and/or blisters on the palms which can cause intense itching and burning commonly related to sweating, with flares during hot weather and humid conditions.
84
Impetigo mx
hydrogen peroxide 1% cream for 'people who are not systemically unwell or at a high risk of complications' topical antibiotic creams: topical fusidic acid Extensive disease oral flucloxacillin
85
Pyoderma gangrenosum
Starts as small pustule, red bump or blood-blister then the skin then breaks down resulting in an ulcer which is often painful the edge of the ulcer is often described as purple, violaceous and undermined. may be accompanied by systemic symptoms fever myalgia Idiopathic IBD Rheum Haem
86
Management of Pyoderma gangrenosum
potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
87
Ulcer developing after burns
Curling Ulcer
88
Small, benign, keratin-filled cysts that typically appear around the face
Milia
89
Erythema multiforme major
severe form, erythema multiforme major is associated with mucosal involvement.
90
Mx of sebaceous cyst
Surgical excision
91
Mx of Children with new-onset purpura
Referred immediately for investigations to exclude ALL and meningococcal disease
92
Complication following PUVA therapy
SCC
93

MSRA (11 decks)

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