Dermatology Flashcards by Belle Storey

What is the usual distribution of atopic eczema?

Symmetrical flexor creases: elbows, knees

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Name 3 atopic conditions

eczema
hayfever
asthma
allergic rhinitis
food allergy

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Describe the classical findings of eczema on examination

Erythematous, scaly, excoriations, crust

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Most likely organism group causing infection in eczema

Staphylococcus (aureus)

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Other than topical steroids and emollients, name 2 other therapies that can be used to treat eczema

Sedating histamines
Paste bandaging
Phototherapy
Oral steroids
Azathioprine
Ciclosporin

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what serum immunoglobulin is usually elevated in patients who suffer from severe eczema

IgE

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rash on elbow

State 4 questions you would ask in the history

How long have you had it?
Is it anywhere else?
Has it spread?
Does anything make it worse or better?
Family history?
Is it painful?
Is it itchy?
History of atopy?

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What is the classical appearance of plaque psoriasis?

silverly scales, well demarcated, faintly red, raised
extensor surfaces
symmetrically distributed

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Other than plaque psoriasis, name 2 other forms

Guttate (raindrop appearance)
Erythrodermic
Pustular

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Psoriasis elbow rash

Where else should you examine?

Scalp
Nails
Other extensor surfaces

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State 4 treatments for plaque psoriasis

Emollients
Topical steroids
Vitamin D analogues (e.g. calcipotriol)
Phototherapy

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What is the Koebner phenomenon?

skin lesions which develop at a site of injury

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Ashkenazi Jewish pt, blisters erupting all over pts body (particularly in his mouth), easily burst and appear loose - likely diagnosis? 2 possible causes?

Pemphigus vulgaris

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What is the medical term for large blister?

Bulla

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What tests would you order for query pemphigus vulgaris

Biopsy, screen for autoantibodies

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What is Nikolskys sign?

Seperation of skin layers when skin is rubbed

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Treatment for pemphigus vulgaris

Immunosuppression

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State 4 questions you would like to ask about an ‘enlarging mole’

Has it changed in colour, or variation of colour within the mole?
Does it itch?
Does it bleed?
Is it symmetrical?
Does it have an odd sensation around that area?
Is it getting wider or thicker?
Does it have a regular border?

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Other than sun exposure, give 2 risk factors for developing malignant melanoma

fair complexion
family history
sunburn

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What is the most significant feature of malignant melanoma in predicting prognosis?

Superficial to deep thickness (Breslow thickness)

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Other than skin, name 2 other sites at which malignant melanoma can occur

Choroid of eye
CNS
GI tract

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What is the mainstay of treatment for malignant melanoma lesions

Wide local excision

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Give 3 possible differential diagnoses of a BCC

SCC
Sebaceous hyperplasia
Actinic keratosis

What is the characteristic appearance of a BCC? Give 3 features

small pearly white nodule, telangiectasia, rolled edge, central ulcer, can be pigmented

Major risk factor for BCC

sun exposure

What is the best surgical technique used to give the best cure rate for BCC?

Mohs micrographic surgery

What advice will you give to prevent recurrence of BCC?

Reduce unnecessary sun exposure Wear sun cream Wear hats

Except for the face, where else does acne occur commonly? (2)

Back Chest Neck

What is the pathophysiology of acne

Increased production of sebum, pilosebaceous follicles become blocked and infected

what is the bacteria species commonly involved in the pathogenesis of acne

P. acnes (Propionibacterium acnes)

Before giving treatment, how will you educate and advice a pt about acne?

Dispel any myths that it is to do with diet or being unhealthy Advise that it will likely stop by age 20 Advise to wash face with soap and water twice daily

Except for isotretinoin, name one topical treatment and one systemic treatment option

Topical: benzoyl peroxide, topical antibiotics Systemic: COCP e.g. Dianette, oral lymecycline

Name 2 common side effects of isotretinoin

dry skin dry lips dry eyes depression - screen for person or FHx of MH teratogenicity migraine

What will you strongly advise her about when prescribing isotretinoin?

do not get pregnant / use effective contraception

Give 3 differential diagnoses of an SCC

BCC, malignant melanoma, wart

What is the common name for carcinoma in situ of SCC called?

Bowen's disease

Risk factors for SCC

Sun exposure Kidney transplant Immunosupression Age

What 2 anatomical sites on the head and neck give a worse prognosis of SCC

Ear Lip

Where else would you examine other than the lesion site for SCC?

Other skin lesions Lymphatic system

Treatment for SCC

Excision

What is the characteristic appearance of shingles? (2)

dermatomal distribution vesicles, crusting, erythematous, swollen plaques

Left side of back to umbilicus - dermatome?

T10

What virus causes shingles?

Human herpes virus 3

Name 2 groups of patients more susceptible to contracting shingles

elderly immunocompromised

Name 2 categories of drugs you would prescribe for a shingles pt

Antivirals (Aciclovir) Analgesia (Amitriptyline)

What is the commonest chronic complication of shingles

Post-herpatic neuralgia

What is ramsay-hunt syndrome?

lower motor neurone lesion causing unilateral facial weakness, occuring after viral infection of herpes zoster

What are the 4 grades of pressure sores? Describe the basic characteristics of each grade

1 - non-blanching erythema over intact skin 2 - partial thickness skin loss 3 - full thickness skin loss, extending into SC fat 4 - extensive destruction with involvement of muscle, bone or supporting tissue

Name 4 risk factors for developing a pressure sore

Elderly CVD Obesity Poor nutrition Immobility Neurologically impaired Incontinence

4 points of management of grade 3 pressure sore

Patient positioning Nutrition Antibiotics if infected Regular dressings Tissue viability referral Pressure relieving mattress

Itchy white atrophic area on anogenital region. Give 3 differential diagnoses other than lichen sclerosus

Scleroderma Vitiligo SCC Bowen's disease

Name 2 other symptoms or signs of lichen sclerosus

itching, dyspareunia, constipation

Name 1 investigation for lichen sclerosus

biopsy

How would you treat lichen sclerosus (2)

topical steroids topical emollients

Name 2 complications of lichen sclerosus

SCC, dyspareunia

Wallace rule of nines for burns

9% head and neck 9% each arm 36% torso (18% anterior 18% posterior) 18% each leg 1% groin

Name 1 reason for referral to a dermatologist in psoriasis

Suspected generalised pustular psoriasis (emergency) Suspected erythrodermic psoriasis (emergency) Uncertainty about diagnosis Moderate or severe disease Resistance to topical drug treatments in primary care