Dermatology Flashcards
What is the usual distribution of atopic eczema?
Symmetrical flexor creases: elbows, knees
Name 3 atopic conditions
eczema
hayfever
asthma
allergic rhinitis
food allergy
Describe the classical findings of eczema on examination
Erythematous, scaly, excoriations, crust
Most likely organism group causing infection in eczema
Staphylococcus (aureus)
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
what serum immunoglobulin is usually elevated in patients who suffer from severe eczema
IgE
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?
What is the classical appearance of plaque psoriasis?
scaly, well demarcated, faintly red
Other than plaque psoriasis, name 2 other forms
Guttate
Erythrodermic
Pustular
Psoriasis elbow rash
Where else should you examine?
Scalp
Nails
Other extensor surfaces
State 4 treatments for plaque psoriasis
Emollients
Topical steroids
Vitamin D analogues (e.g. calcipotriol)
Phototherapy
What is the Koebner phenomenon?
skin lesions which develop at a site of injury
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
What is the medical term for large blister?
Bulla
What tests would you order for query pemphigus vulgaris
Biopsy, screen for autoantibodies
What is Nikolskys sign?
Seperation of skin layers when skin is rubbed
Treatment for pemphigus vulgaris
Immunosuppression
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?
Other than sun exposure, give 2 risk factors for developing malignant melanoma
fair complexion
family history
sunburn
What is the most significant feature of malignant melanoma in predicting prognosis?
Superficial to deep thickness (Breslow thickness)
Other than skin, name 2 other sites at which malignant melanoma can occur
Choroid of eye
CNS
GI tract
What is the mainstay of treatment for malignant melanoma lesions
Wide local excision
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
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: sacicylic acid, benzoyl peroxide, topical antibiotics
Systemic: oral antibiotics, COCP e.g. Dianette, spironolactone
Name 2 common side effects of isotretinoin
dry skin
dry lips
dry eyes
depression
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
