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Dermatology Flashcards

1
Q

Medical student suddenly develops a spotty teardrop-shaped rash over his chest and arms 6wks after strep throat. Improves with phototherapy.
Every time he gets a strep throat thereafter however, he again gets the rash. His GP thus gives early antibiotics whenever he gets tonsillitis.

A

Guttate psoriasis

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2
Q

Round, coin-shaped circles of very itchy, red skin. No central clearing. Weepy and crusts, gets infected easily.

A

Discoid eczema

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3
Q

8yo boy with hayfever and asthma gets itchy crook of elbow and behind the knee. As a baby he had the same thing on his face.

A

Atopic eczema

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4
Q

Man has to stop wearing Levi jeans because he gets an itchy area where the metal button touches his abdomen. Patch testing confirms nickel is the culprit.

A

Allergic dermatitis (type 4 hypersensitivity reaction)

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5
Q

Hairdresser gets very itchy, red fingers after a day of shampooing models’ hair in preparation for a shoot.

A

Irritant (contact) dermatitis

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6
Q

Bored office worker sits at desk all day mindlessly itching the side of his knee. Notices that the area is now red with little lines all over it.

A

Lichen simplex

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7
Q

Elderly man with scaly irregular dry skin around his ankles. Looks like crazy paving.

A

Asteototic eczema

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8
Q

Overweight lady with champagne bottle legs, skin over shins feels hard to touch, has irregular painless ulcer over medial maleolus. Whole area is “very itchy”.

A

Varicose eczema

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9
Q

24yo man with itchy fluid-filled vesicles on his hands and soles of his feet

A

Pompholyx eczema

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10
Q

17yo concerned by little bumps on forehead

A

Comedonal acne

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11
Q

40yo man complains of easy flushing, pustules, papules, redness, broken capillaries on face. No comodones. Notices that his nose is “getting bigger” too.

A

Rosacea

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12
Q

Teen with combination of pus-filled and just raised bumps over his cheeks, forehead and chin. Red and inflamed.

A

Papulo-pustular acne

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13
Q

Teen with large, erythematous, raised, tender lesions over the face. Very disfiguring.

A

Nodulo-cystic acne

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14
Q

“Ace of Clubs” sign

A

Rosacea (forehead, cheeks)

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15
Q

Deep red patches in axilla and groin. No scale. You thought it was tinea, but anti-fungal didn’t work

A

Flexural psoriasis

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16
Q

Man taking doxycycline for a sore throat gets red, itchy rash on arm after being in the sun. Rash stops exactly where his sleeve starts

A

Photoallergic dermatitis

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17
Q

Where does psoriasis affect?

A

Scalp, elbows, bellybutton, lower back and buttocks, knees, NAILS. Spares the face.

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18
Q

52yo university lecturer with itchy red rash on cheeks, sides of nose (butterfly-shaped), eyebrows, chest and scalp.

A

Seborrhoeic dermatitis

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19
Q

Treatment for mild comedonal acne?

A

Topical retinoid

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20
Q

21yo man complains of burning, painful, pus-filled spots on his hands and feet. Some brown macules around them too. You swab them, but to they grow nothing (they’re sterile)

A

Pustular psoriasis

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21
Q

Three cardinal signs of psoriatic nails

A

Thickening
Pitting
Onycholysis

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22
Q

Koebner phenomenon?

A

In psoriasis: scratching normal skin causes a psoriatic plaque to appear.

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23
Q

What’s the difference between a plaque and a macule (or patch)?

A

A plaque is RAISED. You could feel on with your eyes shut. Macules and patched are flat.

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24
Q

Does sunlight make psoriasis better or worse?

A

Better. This is why psoriasis spares the face (too much sun, psoriasis doesn’t like it)

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25
Q

Usually, is psoriasis itchy?

A

No.

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26
Q

What are 2 bugs that can infect an area of eczema?

A 
Staph aureus ("impetigenisation". Oral fluclox)
Herpes simplex ("eczema herpeticum". Serious, admit to hospital)
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27
Q

What’s best for eczema: creams or ointments of topical steroids?

A

Ointments (messier, but more effective since they moisturise too). Creams do not moisturise.

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28
Q

Pathophysiology of atopic eczema?

A

Mutation in filaggrin gene leads to dry skin caused by decrease of fatty acids in the epidermis

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29
Q

What % of children get eczema?

A

20% of children get eczema

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30
Q

What % of eczema cases are allergic?

A

Only 10%! These cases tend to be more severe (kids with perioral eczema from foods; adults with facial/hand eczema from dustmites)

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31
Q

What layer of skin does eczema affect?

A

Epidermis

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32
Q

2 SEs of topical steroid used near the eye

A

Glaucoma, cataracts

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33
Q

Does a steroid for psoriasis need to be potent or not? Why?

A

POTENT! Scale is thick, so needs a strong steroid to get through it.

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34
Q

What 2 common myths are thought to cause acne?

A

Diet and insufficient facial washing

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35
Q

25yo unusually bulky man complains of acne. Possible cause?

A

Anabolic steroids

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36
Q

29yo lady can’t fall pregnant. Quite overweight, hairy face, acne. Possible cause of acne?

A

PCOS

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37
Q

2 things to do for ALL patients with acne (a question and something to check)

A

Ask psychological impact. Check for scarring (needs more aggressive treatment)

38
Q

“I have rosacea. What should I avoid?”

A

Things that exacerbate flushing, like sunlight, alcohol, spicy food, heat

39
Q

Lady has been using topical steroid on her face for a while. Now complains of papules around her mouth. Diagnosis? Cause? Treatment?

A

Perioral rosacea. Stop the topical steroid (expect rebound worsening). Give Abx as for acne for 1-2 months. Should clear completely and not recur.

40
Q

Type of laser for persistent erythema and flushing in rosacea patient?

A

Vascular laser

41
Q

Type of laser for man with established rhinophima?

A

Ablative laser

42
Q

Boy in Year 3 gets golden crusted pustules around his lips. His mum refuses to keep him away from school: soon all the kids at his table have the same crusts - in armpits and hands too

A

Impetigo (school sores)

43
Q

Started as a small inflammation around an armpit hair, now large pustule that is tender and firm to touch, with lots of redness around it

A

Furuncle

44
Q

Woman who owns cats complains of scaly “crop circles” on her arms and legs. Itchy, central clearing.

A

Tinea corpis (Trichophyton rubrum, or Microsporum canis from cats and dogs)

45
Q

Rugby play with very itchy genitalia. Red scaly patch spreading from the scrotum down the inner thigh.

A

Tinea curis (jock itch)

46
Q

Man had to grow a beard after he got “pimples” around each hair stubble. Improved with chlorhexidine wash…until he got the same thing on his buttocks.

A

Folliculitis

47
Q

Lazy teenage boy can’t be bothered wearing new socks each day. He notes that the skin between his toes is moist and peeling away.

A

Tinea pedis (Athlete’s foot). Give Lamisil - terbinafine antifungal cream

48
Q

After getting a kidney transplant (now on ciclosporin) Sam embarrassed by the bumps on her fingers (they disrupt the nail growth too) and soles of her feet.

A

Warts (Human Papilloma Virus). Cryotherapy or salicylic acid paints (“Wart Off”)

49
Q

56yo woman complains of pain “on her left rib”. Two days later a vesicular red rash appears. She sees you two days later Treatment?

A

Give oral aciclovir (within 72 of vesicles appearing)

50
Q

How long is shingles contagious for?

A

Until the vesicles have crusted over, and now new vesicles are forming.

51
Q

“My shingles pain is so bad, what can I put on it?”

A

Capsaicin cream

52
Q

This is the most dangerous dermatome for shingles to affect

A

Ophthalmic division of trigeminal nerve (V1). Can affect cornea, leading to blindness. IV aciclovir, and aciclovir eye drops!

53
Q

24yo woman is embarrassed by the cluster of small vesicles on her lower lip. They keep appearing whenever she gets stressed. Treatment?

A

Coldsores. Topical aciclovir (Zovirax)

54
Q

Man with tinea pedis develops a red, oedematous rash in his left foot. It seems to be spreading upwards. It is very warm to touch. Little red spidery lines spreading up from it (name?)

A

Cellulitis. Lines are lymphangitis; infection spreading in the lymphatics

55
Q

What drug for cellulitis? What if they’re allergic to penicilin?

A

Flucloxicillin. Or clindamycin if allergic to penicillins.

56
Q

Man develops flaky, well-demarcated discoloured patches on his trunk - they’re like dark spots against his white skin. The flakes look like bran. Cause?

A

Pityriasis versicolour. Caused by yeasts of Malassezia genus.

57
Q

Woman with a diffuse, erythematous, scaly discoid rash. Started as one patch, but then spread all over her body. Lesions follow the skin creases - her back looks like a Christmas tree. Cause?

A

Pityriasis rosea. Caused by herpes virus. No treatment, goes in 6-12wks

58
Q

Redheaded kid is covered in brown spots on her face. They darken in summer, and lighten in winter. They fade away as she ages.

A

Ephelides (freckles)

59
Q

What causes the colour of freckles?

A

Increased melanin production in response to sun exposure

60
Q

After falling pregnant, Deb develops a blotchy brown symmetrical pigmentation over her face. Improves with hydroquinone + tretinoid + corticosteroid prescription cream.

A

Melasma

61
Q

Commonest type of lentigo. Not related to sun exposure. Develop in early childhood usually.

A

Lentigo simplex

62
Q

Lentigo that develops after sun exposure, especially on the back of old people’s hands

A

Solar lentigo (actinic lentigo, liver spot)

63
Q

What causes the colour of lentigines?

A

Benign linear proliferation of melanocytes along the basal layer of the epidermis.

64
Q

This type of naevus is found in the basal epidermis and the upper dermis.

A

Junctional naevus. Flat, colourful macules.

65
Q

This type of naevus is found just in the dermis. Thick, protruding mole that may be skin coloured or brown.

A

Dermal naevus

66
Q

This type of naevus has naevus cells both at the junction of the epidermis and dermis, as well as within the dermis. Raised centre with a flat coloured border.

A

Compound naevus.

67
Q

What causes the colour of a naevus?

A

Nests of melanocytes that have proliferated. These melanocytes lack dendrites, so are called “naevus cells”

68
Q

Under what 3 circumstances is it OK to remove a mole?

A

Possible malignancy, nuicance (catches on clothes), cosmetic reasons

69
Q

What types of congenital naevi (birthmarks) are there?

A

Small, medium, giant, hairy congenital naevi. Cafe au lait macules. Speckled lentiginous naevi. Bluish marks = Naevus of Ota, mongolian spot.

70
Q

What types of acquired naevi are there?

A

Common (flat, uniform colour). Dysplastic (some ABCDE features). Spitz (pink or brown dome in kids). Halo (in puberty when white halo forms around mole, then mole disappears). Blue naevus. Cellular naevus (non-pigmented dermal mole). Meyerson naevus (mole surrounded by eczema)

71
Q

40yo man with Hx of intermittent burns each summer with an enlarging brown spot on his back.

A

Superficial spreading melanoma

72
Q

Black man with line under his toenail.

A

Acral lentiginous melanoma

73
Q

65yo woman with a “black ball” growing on her arm over the last 2 months.

A

Nodular melanoma

74
Q

Flat brown patch growing on 67yo man’s nose over the past 10 years. He worked as a gardener his whole life.

A

Lentigo maligna melanoma

75
Q

Why is a melanoma that’s confined to the epidermis cured if it’s cut out?

A

Epidermis lacks lymphatics or blood, so melanoma cells can’t spread

76
Q

What are some features on dermoscopy that are seen in melanomas?

A

Blue grey veil, multiple colours, multiple brown spots, pseudopods and radial streaming

77
Q

What % of melanomas arise from existing moles?

A

25%

78
Q

What % of melanomas arise out of the blue, from normal skin?

A

75%

79
Q

What are some risk factors for melanoma?

A

Having fair skin, many moles, many (>5) dysplastic moles, FHx melanoma, personal Hx melanoma or other skin cancer, increasing age

80
Q

What are the ABCDEs of melanoma?

A

Asymmetry, Border irregualrity, Colour variation, Diameter >6mm, Evolution over time

81
Q

2 fungal causes of pigmented lesions?

A

Pityriasis versicolour, Tinea nigra

82
Q

2 types of keratosis that can cause pigmented lesions?

A

Pigmented actinic (solar) keratosis, seborrhoeic keratosis (“stuck-on”)

83
Q

Type of pigmented skin lesion caused by dermal histiocyte proliferation; buckles when pinched

A

Dermatofibroma

84
Q

Type of pigmented lesion that may appear after a splinter gets under the skin

A

Foreign body granuloma

85
Q

Type of pigmented lesion that is usually large, hairy, and over the back - caused by epidermal overgrowth?

A

Becker naevus

86
Q

Type of pigmented lesion seen on the soles of the feet of a runner

A

Talon noid (heel petechiae from trauma)

87
Q

3 types of vascular causes of pigmented lesions?

A

Port wine stain, stork bite, cherry haemangioma

88
Q

Type of pigmented lesion that looks like a strawberry or raw minced meat, appears after minor trauma like a pin prick or thorn scratch

A

Pyogenic granuloma

89
Q

Difference between a mole and a lentigo?

A

Bother are proliferation of melanocytes. In moles, proliferation is in nests (junctional, dermal, or compound). In lentigines, proliferation is in lines (along the basal layer of the epidermis.)

90
Q

2 melanocytic pigmented skin lesions caused by an increased amount of melanin

A

Ephelides and melasma

91
Q

3 non-melanocytic pigmented skin lesions caused by an increase in the number of melanocytes

A

Naevi, lentigines, melanoma

GP (2 decks)

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