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Special Senses > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Which layer of the skin are melanocytes in ?

A

Epidermis

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2
Q

Functions of the skin ?

A
  • barrier against infection, chemicals and radiation
  • fluid balance
  • temperature control
  • hormonal e.g. Vit D
  • immunological
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3
Q

Consequences of skin failure ?

A
  • insufficient temperature
  • malabsorption
  • fluid loss
  • infection
  • death
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4
Q

Causes of skin failure

A
  • erythroderma
  • drug reactions- toxic epidermal necrolysis
  • erythema multiforme (stevens-Johnson syndrome)
  • pustular psoriasis
  • lupus
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5
Q

Define macule

A

Small flat lesion without elevation or depression e.g. Freckle

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6
Q

A small (

A

Papule e.g. Xanthoma

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7
Q

Define patch (derm)

A

Larger, flat area of altered colour or texture e.g. Vascular malformation- naevus flammeus (port wine stain)

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8
Q

A solid raised skin lesion, >0.5cm in diameter , with a deeper component is known as what ?

A

Nodule

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9
Q

Define plaque

A

Palpable scaling raised lesion >0.5cm e.g. Psoriasis

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10
Q

Define vesicle ?

A

Raised, clear fluid filled lesion

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11
Q

Define bulla

A

Raised, clear fluid filled lesion >0.5cm e.g. Reaction to insect bite

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12
Q

Pus containing lesion

A

Pustule e.g. Acne

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13
Q

What is an abscess?

A

Localised accumulation of pus in dermis or subcut tissue

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14
Q

What is a wheal ?. (Derm)

A

Transient raised lesion due to dermal oedema e.g. Urticaria/hives

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15
Q

What is a boil/furuncle?

A

Staphlococcal infection around or within hair follicle

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16
Q

What is meant by discrete vs confluent lesions of the skin?

A
  • discrete = separate, confluent = merging
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17
Q

What is the name for multiple boils/furuncles?

A

Carbuncle

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18
Q

Define excoriation?

A

Loss of epidermis following trauma e.g. Scratching in eczema

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19
Q

What is hypertrichosis ?

A

Non-androgen dependent pattern of excessive hair growth e.g. In pigmented naevi

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20
Q

Classic appearance of psoriasis ?

A
  • Well defined, Salmon pink, erythematous, flaky, crusty patches of skin covered with silver scales
  • can be anywhere, but usually on the extensor surfaces and symmetrical
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21
Q

What age does psoriasis usually develop ?

A

16-22

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22
Q

Triggers for psoriasis ?

A
  • injury to skin
  • alcohol
  • smoking
  • stress
  • drugs e.g. Lithium, antimalarials, ibuprofen, ACEi
  • throat infections (guttate psoriasis after strep throat)
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23
Q

Pharmacological treatment of psoriasis ?

A
  • acitretin = retinoid (vit A)
  • ciclosporin = immunosuppressant (severe psoriasis)
  • methotrexate - slows down the rapid division of cells and reduces inflammation (alters immune system)
  • hydroxycarbamide = slows rapid division of skin cells
  • rotational therapy of all these
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24
Q

Non pharmacological therapy for psoriasis ?

A
  • phototherapy - UVB or PUVA
  • emollients
  • vitamin D analogues
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25
Q

Presentation of eczema ?

A
  • characterised by papules and vesicles on an erythematous base
  • usually on extensor surfaces & face in adults
  • flexor surfaces in children
  • itchy, erythematous, dry scaly patches
  • acute lesions can be vesicular and weepy
  • scratching -> excoriation and lichenification
  • nails = pitting and ridging
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26
Q

Exacerbating factors for eczema ?

A
  • infections
  • allergens (chemicals, food, dust)
  • sweating
  • heat
  • stress
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27
Q

Management of eczema

A
  • avoid exacerbating factors
  • frequent emollient +/- bandages and bath oil/soap substitute topical therapies
  • topical steroids for flare ups
  • topical immunomodulators (e.g. Tacrolimus) as steroid sparing agents
  • antihistamine for symptom relief
  • phototherapy and immunosuppressants for severe cases
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28
Q

Complications of eczema?

A
  • secondary bacterial infections (crusted weepy lesions)
    secondary viral infection:
  • molluscum contagiosum (pearly papules with central umbilication)
  • viral warts
  • eczema herpeticum
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29
Q

What is acne vulgaris?

A

Inflammatory disease of the pilosebaceous follicle

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30
Q

Aetiology and contributing factors to acne vulgaris ?

A 
Hormonal(androgen)
Contributing: 
- increased sebum production
- abnormal follicular keratinisation
- bacterial colonisation (proprionibacterium acne)
-  inflammation
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31
Q

Presentation of acne vulgaris ?

A
  • non inflammatory lesions (mild acne) = open and closed comedones
  • inflammatory lesions (mod-severe) = papules, pustules, nodules, cysts
  • commonly affects face, chest and upper back
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32
Q

Management of acne vulgaris ?

A
  • avoid food that triggers break outs
  • topical: benzoyl peroxide, antibiotics, retinoids
  • oral: antibiotics, anti-androgen, oral retinoids
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33
Q

Complications of acne vulgaris

A
  • post inflammatory hyperpigmentation
  • scarring
  • deformity
  • psychological/social effects
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34
Q

What is a basal cell carcinoma ?

A
  • Slow growing, locally invasive malignant tumour of the epidermal keratinocytes
  • rarely metastasises
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35
Q

Presentation of basal cell carcinoma ?

A
  • can be: nodular, plaque-like (superficial), cystic, morphoeic (sclerosing), keratotic or pigmented
  • small skin coloured papule/nodule with surface telangiectasia & pearly rolled edge
  • lesion may have necrotic or ulcerated centre
  • most commonly on head and neck
36
Q

Management of basal cell carcinoma ?

A
  • Surgical excision
  • radiotherapy when excision not appropriate
  • topical imiquimod cream
37
Q

Which type of eczema usually presents in infancy and resolves in teenage years ?

A

Atopic

38
Q

What is the appearance of pomphylox eczema ?

A

Blisters on hands and feet

39
Q

What is stasis eczema ?.

A

Dermatitis as a result of blood pooling e.g. In the leg from insufficient venous return

40
Q

Differences between allergic and irritant dermatitis ?

A
  • allergic: appears a few days after exposure and is more localised
  • irritant: appears immediately and is more likely to be widespread
41
Q

Which is more likely to metastasise, basal cell or squamous cell carcinoma ?

A

Squamous cell

42
Q

Risk factors of squamous cell carcinoma

A
  • UV exposure
  • pre malignant conditions e.g. Actinic keratoses
  • chronic inflammation e.g. Leg ulcers, wound scars
  • immunosupression and genetic predisposition
43
Q

Presentation of squamous cell carcinoma ?

A

Keratotic (scaly and crusty), I’ll defined, nodule which may ulcerate

44
Q

Risk factors for malignant melanoma

A
  • UV
  • skin type I
  • history of multiple moles/ atypical moles
  • fam hist
  • previous Melanoma
45
Q

Presentation of malignant melanoma?

A

ABCDE symptom rules:

Asymmetrical shape
Border irregularity
Colour irregularity
Diameter >7mm
Evolution of lesion (change in size/shape)

*bleeding and itching

46
Q

How do lentigo malignant melanoma present in ?

A

Common on the face of elderly people

47
Q

How do superficial spreading and nodular melanomas present ?

A

In young and middle aged people
Superficial = lower limb
Nodular = trunk

48
Q

What is urticaria ?

A
  • aka hives
  • pale, red, raised, itchy bumps
  • may cause burning or stinging
  • usually due to allergic reaction
49
Q

Symptoms of rosacea ?

A
  • flushing
  • persistent facial redness
  • telangectasia
  • papules and pustules
  • dry peeling skin
  • dry gritty eyes
  • thickened skin
50
Q

Treatments for rosacea

A
  • metronidazole or azelaic acid creams
  • oral abx: tetracycline, doxycycline, erythromycin
  • briminidine tartrate - gel to treat flushing
  • clonidine (relaxes blood vessels), b-blocker
  • laser
51
Q

What are seborrhoeic warts ?

A

Benign, hyperkeratotic skin lesions associated with ageing

52
Q

Visual appearance of seborrhoeic warts

.

A
  • flat topped, warty-looking lesion
  • appears ‘stuck on’ to the skin
  • usually pigmented, pale-black
  • well circumscribed border
53
Q

When would you be suspicious that a lipoma is infarct a malignant liposarcoma ?

A
  • > 5cm
  • located in extremities, retroperitoneally, groin, scrotum, abdo wall
  • deep (beneath or fixed to fascia)
  • malignant behaviour e.g. Rapid growth, invasion of bone or nerve
54
Q

Presentation of lipoma

A

usually non-painful, round, mobile, soft doughy mass with normal skin overlying

55
Q

Presentation of Epidermoid cysts

A
  • painless, round, firm skin lump
  • may discharge foul cheese-like discharge
  • can become infected, red and inflamed
  • flesh, yellow or white coloured
56
Q

Sites most commonly affected by Epidermoid cysts ?

A
  • face
  • trunk
  • neck
  • extremities
  • scalp
57
Q

What are dermofibromas

A

Benign skin tumours

58
Q

Presentation of dermofibromas

A
  • usually single nodules that develop on extremity, most commonly lower leg
  • mobile, firm-hard (feel like small lentil under skin)
  • overlying skin may be dimpled or smooth
  • can be skin coloured or pink
  • after initial growth remain static
59
Q

What are Campbell de morgan spots?

A
  • aka cherry haemangiomas
  • benign skin lesions of Middle age+ due to proliferating dilated capillaries
  • non-blanching
60
Q

Presentation of Campbell de morgan spots

A
  • usually occur over trunk and extremities
  • any skin site other than mucous membranes
  • bright cherry red, non blanching lesions
  • widespread in the elderly
61
Q

What are fibroepithelial polyps?

A
  • skin tags
  • pedunculated, skin coloured/brown papules
  • commonly forming at skin folds e.g. Neck, axillary, groin
62
Q

Which layer of the skin are all the blood vessels in ?

A

Dermis

63
Q

What is intertrigo ?

A

Inflammation of the body folds

  • usually due to the chafing of warm moist skin - usually in the overweight
  • appears red and sore looking, may ooze or itch
64
Q

What are tinea infections ?

A

Fungal infections caused by dermatophytes (grip of fungi that invade and ow in dead keratin)

65
Q

Common organisms causing tinea infections?

A
  • Trichophytons rubrum, tonsurans etc
  • microsporum canis
  • epidermophyton
66
Q

Presentation of tinea infections

A
  • itching, Radha no nail discolouration
  • hair loss in tinea capitus
  • common in those who play contact sport
67
Q

Complications of tinea infections ?

A
  • cellulitis

- impetigo

68
Q

What is pityriasis vesicolour ?

A

Skin condition where flaky discoloured patches appear, mainly on chest and back

69
Q

What causes pityriasis vesicolour?

A
  • Proliferation of lipophilic yeast, malassezia furfur (aka pityrosporum orbiculare in its yeast-like form)
  • is part of normal flora of skin
70
Q

Presentation of pityriasis vesicolour

A
  • insidious onset
  • macular lesions and patches of altered pigment
  • superficial scale, best seen my scrapping lesion with finger nail
  • not contagious
71
Q

What is the name of the organism causing scabies?

A

Sarcoptes scabiei (mite)

72
Q

Presentation of scabies

A
  • Widespread itching, worse at night and when warm
  • track marks
  • papules, vesicles, pustules, nodules
73
Q

Treatment for scabies

A

permethrin 5% dermal cream

74
Q

Which conditions are dermatological emergencies ?

A
  • drug eruptions
  • erythroderma
  • erythema multiforme/SJS/TEN
  • urticaria & angioedema
75
Q

Features of drug eruption

A
  • facial/mucous membrane involvement
  • widespread erythema
  • skin pain
  • blistering
  • fever
  • lymphadenopathy/arthralgia
  • shock
76
Q

What is morbilliform ?

A
  • Rash resembling measles

- due to drug eruption

77
Q

What is acute generalised exanthematous pustulosis?

A
  • rapid onset drug eruption (2d) lasting for 1-2 weeks
  • starts in flexures and face
  • erythema with widespread pustules
  • neutrophil leucocytosis
78
Q

What is drug hypersensitivity syndrome ?

A
  • drug reaction with eosinophilia and systemic symptoms
  • severe reaction 2-8 weeks after drug initiation
  • wide spread Mac-pac rash with pustules
  • can have multi organ involvement
79
Q

General treatment for most drug eruptions ?

A
  • antihistamine
  • emollient
  • topical steroid
80
Q

Presentation of erythroderma

A
  • inflammation of entire skin surface
  • pruritis
  • hair loss
  • hyperkeratosis
  • exfoliating dermatitis
  • lymphadenopathy
81
Q

Causes of erythroderma?

A
  • Drug reactions
  • dermatitis
  • psoriasis
  • immunobullous disorders
  • cutaneous T cell lymphoma
  • HIV
  • systemic malignancy
82
Q

What type of hypersensitivity reaction is erythema multiforme ?

A

4 - presents with eruption of 3 zoned target lesions (mild)

83
Q

Clinical features of erythema multiforme ?

A
  • prodromal flu-like symptoms
  • acral rash consisting of target lesions
  • spreads symmetrically and proximally
  • may koerbnerise (skin lesions appearing at site of injury)
84
Q

Presentation of TEN/Stevens-Johnson syndrome?

A
  • widespread blisters mostly on face or trunk
  • erythematous or pruritic macule a
  • mucous membrane involvement
  • epidermal detachment
85
Q

What type of hypersensitivity reaction is urticaria and angioedema ?

A

Type I

86
Q

Presentation of lichen planus

A

Itchy eruption of plaques:

  • shiny
  • purple
  • polygonal
  • flat topped
  • wickhams striae
  • wrists and ankles

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