Dermatology Flashcards

1
Q

usually starts with a single ‘herald patch’, followed by a ‘Christmas-tree’ distribution of smaller patches along skin cleavage lines, predominantly on the trunk.

A

Pityriasis rosea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

late pregnancy

benign

erythematous papules, vesicles or plaques. The rash often starts on the abdomen, particularly within stretch marks (striae), and can spread to the thighs and buttocks but rarely involves the face or mucous membranes

A

Polymorphic eruption of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

is a rare autoimmune blistering disorder associated with pregnancy. It usually begins in the second or third trimester or immediately postpartum. Lesions often start around the umbilicus before spreading to other parts of the body but unlike PEP, pemphigoid gestationis frequently involves the palms, soles and mucous membranes.

A

Pemphigoid gestationis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

poxvirus
multiple dome-shaped papules with central umbilication
small, multiple lesions
umbilicated
6-12 months

A

Molluscum contagiosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

purple, polygonal, pruritic papules and plaques, often with a white lacy pattern (Wickham’s striae) visible on their surface. The lesions are typically larger than 1-2mm and lack umbilication. They commonly affect the flexor surfaces of wrists, legs, and oral mucosa.

A

lichen planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

congenital haemangioma occurring in around one in 20 babies. They tend to grown rapidly over the first few months of life then spontaneously regress over the course of a few years.

A

strawberry naevus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when is strawberry naevus a problem?

A

if over the spine (or impairing vision/ hearing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The rolled, pearly edges with telangiectasia on the inferior border of the lesion

A

BCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

hand eczema, precipitated by humidity (e.g. sweating) and high temperatures

A

Pompholyx eczema (dyshidrotic eczema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how to manage sebaceous cyst?

A

Excision of the cyst wall needs to be complete to prevent recurrence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

stress ulcer that can occur after severe burns

A

Curling’s ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

areas of bluish discolouration over the lower back and buttock which often disappear by 1 year of age.

A

mongolian blue spots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

raised brown/black nodules which can be hairy and up to 20cm in diameter. There is a risk of developing melanomas from these and so they should be closely monitored.

A

melanocytic naevi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

white patches in the oral cavity that cannot be rubbed off and are not attributed to any other identifiable cause. It is important to exclude other conditions such as lichen planus and squamous cell carcinoma through biopsy,

A

leukoplakia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

well-demarcated areas of depigmentation due to destruction of melanocytes.

A

vitiligo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

management scabies

A

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

apply the insecticide cream or liquid to cool, dry skin
pay close attention to areas between fingers and toes, under nails, armpit area, creases of the skin such as at the wrist and elbow
allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off
reapply if insecticide is removed during the treatment period, e.g. If wash hands, change nappy, etc
repeat treatment 7 days later

itching can persist for up to 6 weeks after successful treatment due to a delayed hypersensitivity reaction to the mites, even if all the mites have been killed. Retreatment should only be considered if new burrows or rashes appear, or if living mites are found upon examination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of scarring alopecia

A

include trauma/burns, radiotherapy, lichen planus, discoid lupus, tinea capitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

non scaring alopecia causes

A

male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium: hair loss following stressful period e.g. surgery
trichotillomania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

molloscum contagious - do they need to go off school?

A

Time off school is not necessary but, as the condition is infectious, it is advised to avoid sharing baths, towels, or clothing with others to prevent transmission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

flexural psoriasis treatment

A

only mild/moderate steroid NOT fit D

Remember that the treatment of flexural psoriasis differs from extensor psoriasis. The skin of flexure areas of the body is much thinner and more sensitive to steroids compared to the extensor surfaces. Flexural surfaces that tend to be affected are the groin, genital region, axillae, inframammary folds, abdominal folds, sacral and gluteal cleft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

chronic plaque psoriasis management

A

a potent corticosteroid applied once daily plus vitamin D analogue applied once daily
should be applied separately, one in the morning and the other in the evening)
for up to 4 weeks as initial treatment

2nd line= just vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

scalp psoriasis management

A

just potent steroid NOT vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the defining feature of erythema multiforme major

A

associated with mucosal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Blisters/bullae - what two skin disease? (2)

A

NO MUCOSAL INVOLVEMENT = bullous pemphigoid

MUCOSAL INVOLVEMENT =pemphigus vulgaris

(Vulgaris =mucus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Skin disorders and malignancy:
acanthosis nigricans

A

gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Skin disorders and malignancy:
acquired ichthyosis

A

lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Skin disorders and malignancy:
acquired hypertrichosis lanuginosa

A

gastrointestinal and lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Skin disorders and malignancy:
dermatomyositits

A

ovarian and lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Skin disorders and malignancy:
erythroderma

A

lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Skin disorders and malignancy:
migratory thrombophlebitis

A

pancreatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Skin disorders and malignancy:
pyoderma gangrenosum

A

myeloproliferative disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Skin disorders and malignancy:
sweet syndrome

A

haematologyical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Skin disorders and malignancy:
tylosis

A

oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Guttate psoriasis

A

2-4 weeks pre streptococcal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Guttate psoriasi vs pitiriasiis rosea

A

Guttate:
tear drops

PR:
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.

May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

non sedating antihistamine

A

cetirizine AND Loratadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Fitzpatrickk

A

I: Never tans, always burns (often red hair, freckles, and blue eyes)
II: Usually tans, always burns
III: Always tans, sometimes burns (usually dark hair and brown eyes)
IV: Always tans, rarely burns (olive skin)
V: Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)
VI: Black skin (e.g. Afro-Caribbean), never tans, never burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Diabetes, waxy yellow shin lesions

A

necrobiosis lipoidica diabeticorum

The characteristic clinical presentation includes shiny plaques on the anterior aspect of the lower legs that are yellowish-brown with telangiectasias and atrophic skin. The plaques may be asymptomatic or painful and usually start as small papules that slowly enlarge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

qsymmetrical, erythematous, tender, nodules which heal without scarring
most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

A

erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Shin skin problems:
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

A

Pretibial myxoedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Shin problems:
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

A

Pyoderma gangrenosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Shin problems:
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

A

Necrobiosis lipoidica diabeticorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Impetigo management

A

management
1st= hydrogen peroxide 1% cream
2nd= topic fuscidic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

benign, painful nodule on the ear

A

Chondrodermatitis nodularis helicis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Pityriasis rosea - what is the cause ? (1)

A

self limiting

herpes hominis virus 7 (HHV-7)

herald patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

hyperhidrosis

A

topical aluminium chloride preparations are first-line. Main side effect is skin irritation
iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
botulinum toxin: currently licensed for axillary symptoms
surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Causes of puritis:
History of alcohol excess
Stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynaecomastia etc
Evidence of decompensation: ascites, jaundice, encephalopathy

A

liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Causes of puritis:
Pallor
Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

A

iron deficiency anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Causes of puritis:
Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease

A

Polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Causes of puritis:
Lethargy & pallor
Oedema & weight gain
Hypertension

A

Chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Causes of puritis:
Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
Fatigue

A

Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

first line plaque psoriasis

A

POTENT steroids + vit D (BETAMETHASON not hydrocortisone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ankylosing spondylitis is associated HLA B27, a risk factor for which skin disease?

A

psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Lichen Planus vs lichen schlerosus

A

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

A 45-year-old woman presents with itchy, violaceous papules on the flexor aspects of her wrists. She is normally fit and well and has not had a similar rash previously. What is it?

A

lichen plants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Management lichen plants

A

potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

reatment of choice in capillary haemangiomas requiring intervention

AKA strawberry naevus

A

propanalol

Topical beta-blockers such as timolol are also sometimes used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Eczema herpeticum is a primary infection of the skin caused by …

A

herpes simplex virus (HSV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

eczema herpeticum treatment

A

IV acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

dermatofibroma: where usually found? (1)
can be started by (2)

A

lower limbs

trauma or insect bites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Renal transplant patients are at risk of what cancer

A

squamous cell due to immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Polymorphic eruption of pregnancy vs phemigoid gestationis

A

phemhigoid gestations= BLISTERING

62
Q

Acne vulgaris in pregnancy treatment

A

erythromycin
(if topical acne treatments not effective)

63
Q

most common type of melanoma with typical features of changing mole (85% of cases)

A

Superficial spreading melanoma

64
Q

keratocanthoma management

A

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.

65
Q

Topical adapalene is a type of

A

retinoid

66
Q

shinglets treatment

A

oral antivirals
(can be any of aciclovir, famciclovir, or valaciclovir are recommended)

67
Q

Seborrhoeic dermatitis associated with which diseases

A

HIV and parkinsons

68
Q

Seborrhoeic dermatitis main features

A
  • eczematous lesions on scalp, periorbital, auricular and nasolabial folds
  • otitis externa
  • blepharitis
69
Q

Dermatophyte nail infections (onychomycosis)

A

oral terbinafine

70
Q

A 65-year-old lady presents to the GP as she has noticed some small spots on her shoulder. She describes small lesions with a number of tiny blood vessels radiating from the middle. On examination you can press down on them, causing them to go white and then refill from the centre.
what is this?

A

spider nevi

71
Q

Spider naevi vs talengiectasia

A

PRESS ON THEM
Spider naevi fill from the centre, telangiectasia from the edge

72
Q

purplish, lace-patterned discolouration of the skin

A

Livedo reticularis

73
Q

how is alopecia areata caused?

A

autoimmune (related to all the other autoimmune disorders)

74
Q

spider naevi causes

A

liver disease
pregnancy
combined oral contraceptive pill

75
Q

what is purpura?

A

bleeding into the skin from small blood vessels that produces a non-blanching rash

76
Q

purpura in kids

A

meningococcal septicaemia or acute lymphoblastic leukaemia.

77
Q

Telogen effluvium

A

loss and thinning of hair in response to severe stress

78
Q

Trichotillomania

A

a disorder where people pull their own hair out, would give asymmetrical, uneven hair loss, and might be preceded by other psychiatric complaints.

79
Q

acne rosacea

A
  • chronic inflammatory skin condition primarily affecting the central face
  • characterised by transient or persistent erythema, telangiectasia, papules and pustules but not comedones
  • typically affects nose, cheeks and forehead
    flushing is often first symptom
    telangiectasia are common
    later develops into persistent erythema with papules and pustules
    rhinophyma
    ocular involvement: blepharitis
    sunlight may exacerbate symptoms
80
Q

Curling’s ulcer

A

a gastric ulcer caused by necrosis of the gastric mucosa, usually due to hypovolaemia. They carry a high rate of bleeding and mortality.
(caused by stress and burns)

81
Q

Which one of the following complications is most associated with psoralen + ultraviolet A light (PUVA) therapy?

A

squamous cell cancer

82
Q

actinic keratoses vs seborrhoeic keratosis

A

ACTINIC: premalignant skin lesions caused by chronic exposure to ultraviolet (UV) radiation, typically seen in fair-skinned individuals and those with a history of outdoor work such as builders. The appearance of these lesions as erythematous, rough patches is consistent with actinic keratoses. In some cases, they can progress to squamous cell carcinoma if left untreated.

SEBORRHOEIC: Seborrhoeic keratoses are benign epidermal growths that appear as waxy, brownish-black ‘stuck-on’ plaques. They commonly occur on the trunk and face but have a different appearance than the erythematous, rough lesions described in this case.

83
Q

keloid scar treatment

A
  1. intra-lesional steroids e.g. triamcinolone
  2. excision is sometimes required but careful consideration needs to given to the potential to create further keloid scarring
84
Q

symmetrical vesicular rash as shown below and also some early lesions on the back of his arms.

A

Coeliac (Dermatitis herpetiformis)

85
Q

pityriasis vesicolor management

A

topical antifungal. NICE advises 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

86
Q

psoriasis nail features (4)

A

oncholysis (separation of the nail from the nail bed)
pitting
sublingual hyperkeratosis
loss of nail

87
Q

Seborrhoeic dermatitis first line (dandruff)

A

topical ketoconazole (for head and arms/ trunk too)

88
Q

isotretinoin most common SE

A

dry skin

89
Q

what type of reaction can scabies cause

A

delayed type IV hypersensitivity reaction

90
Q

when to consider retreating for scabies

A

e itching can persist for up to 6 weeks after successful treatment due to a delayed hypersensitivity reaction to the mites, even if all the mites have been killed. Retreatment should only be considered if new burrows or rashes appear, or if living mites are found upon examination.

91
Q

Bullous pemphigoid management

A

autoimmune blistering disease that primarily affects the elderly. It is characterised by tense blisters on normal or erythematous skin, often with a urticarial pre-stage and it can be life-threatening if left untreated. The diagnosis of bullous pemphigoid requires histopathological examination and direct immunofluorescence testing, which are not available in primary care. Therefore, patients suspected of having bullous pemphigoid should be referred to secondary care (dermatology) promptly for further evaluation and management.§

92
Q

irritant vs allergic contact dermatitis

A

ALLERGIC = after sensitisation to a specific allergen over time (type IV hypersensitivity reaction). more intense pruritus and may show vesiculation.

IRRITANT= more acute

93
Q

most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
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

A

pyogenic granuloma

94
Q

pyogenic granuloma management

A

lesions associated with pregnancy often resolve spontaneously post-partum
other lesions usually persist. Removal methods include curettage and cauterisation, cryotherapy, excision

95
Q

Molluscum contagiosum - what virus?

A

POXvirus (self-limiting)

Referral may be necessary in some circumstances:
For people who are HIV-positive with extensive lesions urgent referral to a HIV specialist
For people with eyelid-margin or ocular lesions and associated red eye urgent referral to an ophthalmologist
Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections

96
Q

Rosacea first line management if papule and/or pustules

A

Topical ivermectin

97
Q

what formula used for burns

A

Parkland

98
Q

a rash consisting of numerous small patches of psoriasis that develop acutely over several days 1-2 weeks after a streptococcal infection

A

guttate psoriasis

99
Q

management alopecia areata

A

steroids + REFER

100
Q

when does Pompholyx eczema get worse

A

high temperature and humidity (e.g. summer)

101
Q

Abx used in acne rosacea?

A

topical metronidazole

NOT steroids as they can make it worse

102
Q

benign, painful nodule on the ear, more common in men than women

A

Chondrodermatitis nodularis helicis

103
Q

yellow shin
associated with telangiectasis

A

Necrobiosis lipoidica diabeticorum

104
Q

severe systemic reaction affecting the skin and mucosa, almost always caused by a drug reaction. The characteristic rash is typically maculopapular with target lesions.

A

Stevens-Johnson syndrome

105
Q

a hypersensitivity reaction that is most commonly triggered by infections. It may be divided into minor and major forms.

Features
target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

A

erythema multiforme

MUCOSAL INVOLVEMENT= erythema multiform major

106
Q

chronic plaque psoriasis first line management

A

POTENT steroid
topical betamethason + topilla caldipotriol

107
Q

Bullous pemphigoid VS pemphigus vulgaris

A

VULGARIS = MUCOSAL involvement

Blisters/bullae
no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris

108
Q

white patches have been present for the past few months and are asymptomatic. He is a smoker who is known to have type 2 diabetes mellitus.

A

oral leukoplakia

asymptomatic and prolonged nature

–> BIOPSY to confirm diagnosis (and exclude squamous cell carcinoma/ lichen planus)

DIAGNOSIS OF EXCLUSION

CANNOT BE RUBBED OFF (if it can consider candidiasis or lichen planus)

109
Q

oral leukoplakia management

A

monitor as 10-20%–> squamous cell carcinoma

STOP SMOKING

110
Q

DIABETES + SHIN RASH

well-demarcated erythematous plaques on the shins which are often surrounded by telangiectasia and may have a yellowish hue due to lipid deposition

A

Necrobiosis lipoidica

111
Q

Wickham striae on the oral mucosa

A

lichen planus

112
Q

Seborrhoeic dermatitis - first-line treatment

A

topical ketoconazole

113
Q

SEVERE rosacea management

A

topical ivermectin + oral doxycycline is first-line for patients with severe papules and/or pustules

114
Q

lichen planus vs psoriasis

A

distribution: psoriasis EXTENSOR, planus FLEXURAL (we.g. wrists, legs, trunk, oral mucosa)

lesions; psoriasis SILVERY, planus WHITE LINES (WICKHAM STRAE)

nail changes: in both, but planus is thining

115
Q

Cetirizine - sedating or not?

A

NON SEDATING (or loratadine)

116
Q

Chlorphenamine - sedating or not?

A

SEDATING

117
Q

if the scale is removed, a red membrane with pinpoint bleeding points may be seen

A

psoriasis (Auspitz sign)

118
Q

Face, flexural and genital psoriasis management

A

mild/ moderate potency corticosteroids 1-2 x per day, max 2 weeks

NOT vit D

(scalp also just steroids for 4 weeks no vit D )

119
Q

UV light therapy - increased risk of what cancer

A

squamous cell carcinoma

120
Q

severe acne treatment

A

oral antibiotic and topical benzoyl peroxide TOGETHER

and –> REFER

(if mild/moderate then topical of both okay)

121
Q

commonly caused by anti-epileptics such as carbamazepine and is characterised by a rash affecting <10% of body surface area and mucosal involvement.

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

A

Stevens-Johnson syndrome

122
Q

Difference between SJS and Toxic epidermal necrolysis and erythema multiforme major

A

SJS= <10% body

TEN= Toxic epidermal necrolysis also involves mucous membranes but the rash is more extensive affecting at least 30% of body surface area. It is also triggered by drugs.

erythema multiform major= acral distribution and lesions are often raised

123
Q

SJS causes

A

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

124
Q

normal ABPI

A

0.9-1.2

125
Q

what is clobetasone butyrate

A

STEROID (e..g used in lichen planus)

126
Q

gold standard for TB diagnosis

A

Sputum culture

127
Q

longstanding Hx bleeding e.g. nose bleeds or rectal bleeding, red spots, FHx

A

hereditary haemorrhage telangiectasia

128
Q

scarring alopecia

A

trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*

129
Q

non-scaring alopecia

A

male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
hair loss following stressful period e.g. surgery
trichotillomania

130
Q

eye complications in rosacea

A

blepharitis and conjunctivitis

131
Q

target lesions

A

erythema multiforme

132
Q

what is a sebaceous cyst? how to treat

A

basically a spot with a puncture
(non cancer lump with skin/hair contained)

SURGERY to completely remove and prevent reoccurrence

133
Q

Children with new-onset purpura

A

immediate referral to paeds
–> ALL and meningococcal disease

Whilst petechiae can be seen in a viral illness or with increased superior vena cava pressure (e.g. following a cough) purpura are never a normal finding in children. She needs to be immediately admitted to exclude a serious underlying condition.

PURPURA= BAD
PETECHIAE= possibly OK

134
Q

when to do urgent referral for BCC (2WW)

A

if in eyes/ nasal Ala

135
Q

systemic itch

A

CKD
liver disease
iron def
polycythaemia
lymphoma

136
Q

Migratory thrombophlebitis - cancer?

A

pancreatic

137
Q

Dermatomyositis - cancer?

A

ovarian and lung

138
Q

Sweet’s syndrome

A

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

139
Q

carbamazepine and skin

A

causes erythema multiform

140
Q

guttate psoriasis treatment

A

reassurance and topical treament if symptomatic

141
Q

2 main Abx used in acne (2)
what to do if fails to work? (1)

A

doxycycline and lymecycline

if not worked –> ORAL RETINOIDS (vitamin A) (REFER)

a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing. Topical and oral antibiotics should not be used in combination

142
Q

Acne: when to refer
when to consider referring

A
  • patients with acne conglobate acne: a rare and severe form of acne found mostly in men that presents with extensive inflammatory papules, suppurative nodules (that may coalesce to form sinuses) and cysts on the trunk.
  • patients with nodulo-cystic acne

referral should be considered in the following scenarios:
- 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

143
Q

Pityriasis rosea often follows

A

a VIRAL infection

(Streptococcal throat infection tends to trigger guttate psoriasis)

144
Q

treatment actinic keratoses

A

topical fluorouracil

145
Q

keratocanthoma management

A

2WW

(they normally spontaneously regress)

Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin

146
Q

lichen sclerosus management

A

no skin biopsy needed - diagnosis on clinical exam

increased risk of vulval cancer

may scan
itch prominent

147
Q

Superficial spreading melanoma

A

Most common type of melanoma that has the typical diagnostic features of a changing mole

148
Q

Eczema herpeticum - 2 possible causes (2)

A

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

149
Q

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

A

Eczema herpeticum

150
Q

vitiligo and trauma

A

precipitates skin lesions (KOEBNER PHENOMENON)

151
Q

drugs than worsen psoriasis

A

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

AND ALCOHOL AND TRAUMA

152
Q

skin conditions and steroid treatments

A

remember -ONE likely a steroid

e.g. triamcinolone

153
Q

how common is oral involvement in lichen planus

A

COMMON