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Peri-op > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the proper name for a strawberry birthmark? Describe its features.

A

Cavernous/infantile haemangioma or strawberry naevus

  • raised or flat
  • usually involutes (decreases in size normally)
  • intervention req. if lesion involves the eyes (causes ambylopia - use propanolol), if it ulcerates/bleeds frequently (shunts large volumes of blood, can cause cardiac failure or consume clotting factors - Kasabach-Merritt syndrome)
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2
Q

What is the proper name for a port wine stain? Describe its features.

A

Capillary haemangioma

  • laser treatment req. to remove
  • 2% have Sturg-Weber syndrome: calcified meningeal capillaries on ipsilateral side which causes epilepsy, hemiplegia, and bupthalmos (eyeball enlargement) (esp. if lesion is in distribution of CNV1)
  • if near or one the eye there is a risk of glaucoma (ophthalmic assessment req.)
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3
Q

What are Campbell de Morgan spots?

A

Cherry angioma

Common, benign angiokeratomas which appear as pinpoint red papules

  • esp. on trunk
  • increased no. & freq. with age
  • no treatment req.
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4
Q

What are spider naevi? Describe its features.

A

Swollen, dilated central arteriole with red “spider legs” (veins) which can be occluded with pressure (veins refill from centre).

Located in distribution of the SVC (face, neck, upper trunk & arms).

Caused by increased oestrogen

  • pregnancy
  • liver disease: reduced oestrogen metabolism causing gynaecomastia, testicular atrophy, etc.
  • HRT
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5
Q

What are the features of a papilloma?

A

Benign tumour derived from epithelium

Can be smooth and pedunculated (e.g. skin tag), sessile (e.g. HPV wart) or pigmented (e.g. melanoma)

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6
Q

What are the key features which help diagnose a skin lump?

A

Is the lump IN the skin (moves with the skin)?

Is the lump BENEATH the skin (skin moves over it)?

Is the lump FLUCTUANT (i.e. fluid-filled)?
- put fingers either side and use other finger to push down on lump

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7
Q

What is a neurofibroma?

A

Benign nerve sheath tumour in PNS.

Can occur on their own or as part of neurofibromatosis

  • acoustic neuromas (CNVIII)
  • café au lait patches

Can be dermal (originate in the nerves of the skin) or plexiform (originate in the nerves of the skin or from internal nerve bundles).

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8
Q

What is a café au lait patch?

A

Permanent light brown flat macule caused by a collection of melanocytes in the epidermis which may be associated with neurofibromatosis (5

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9
Q

What is a dermatofibroma/histiocytoma?

A

Firm elevated pigmented nodule in skin containing histiocytes (histamine, therefore very itchy).

Often caused by insect bites.

Excise to release.

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10
Q

Describe the features of a lipoma.

A

Most common type of benign soft tissue tumour, composed of adipose tissue (therefore non-fluctuant).

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11
Q

Describe the features of a ganglion cyst.

A

Benign lump beneath skin caused by leakage of synovial fluid from a joint into a cavity (most common in the hands and feet).

  • myxoedamatous (“jelly-like”) degeneration of joint sheath
  • can burst by hitting with a book/pushing down with fingers
  • can use wide bore needle to suck out fluid
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12
Q

Describe the features of an epidermal (sebaceous) cyst.

A

Cystic swelling of skin with central punctum containing keratin (therefore found everywhere apart from palms and soles)

Frequently infected by Staph. aureus

Known as pilar cysts when on scalp within hair

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13
Q

Describe the features of a dermoid cyst.

A

Arise from cystic changes in epithelial remnants sequestered beneath the skin at lines of embryological fusion (midline).

Contains keratin, hair, sebaceous glands.

Commonly found in the midline, retroauricular, and on lateral canthus.

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14
Q

Contrast ovarian dermoid cysts with testicular teratomas.

A

Ovarian dermoid cyst = mature cystic ovarian teratoma

Testicular teratomas (seminomas) are more malignant (increased rate of cell turnover compared to ovaries).

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15
Q

Describe the features of an implantation dermoid cyst.

A

Penetrating injury (e.g. rose thorn) causes implantation of epidermal fragments into the dermis —> epidermis continues to grow and forms a cyst lined with stratified squamous epithelium and filled with keratin.

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16
Q

Describe the features of a pilonidal sinus.

A

Cyst/abscess (Staph. aureus) near or on the natal cleft (intergluteal cleft) which contains hair and skin debris.

Hairs pushed beneath skin causes foreign body reaction.

Excise down to the sacrum and heal by secondary intention.

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17
Q

Describe the features of seborrhoeic keratosis.

A

Benign tumour of keratinocytes which increase in frequency with age.

Mostly found on back.

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18
Q

Describe the features of a pyogenic granuloma.

A

Benign tumour of blood vessels following trauma e.g. rose thorn.

  • friable
  • often found on fingers/lips
  • excise to prevent transformation into melanoma
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19
Q

What is a keratocanthoma?

A

Keratin horn

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20
Q

What is a hypertrophic scar? Contrast to a keloid scar.

A

Hypertrophic scar = raised scar caused by excessive collagen deposition

Keloid scar = excessive collagen production occurring following injury

  • common in West Africans/Carribbeans
  • common on the sternum
  • pointless to excise
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21
Q

What is erythema ab igne?

A

Skin condition caused by longterm exposure to heat.

Causes:

  • laptops
  • hot water bottles (esp. for chronic pain e.g. pancreatitis)

Pain worse at night due to reduced sensory input

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22
Q

What are the different types of skin lesion shapes? Give examples of each.

A

Sloping e.g. healing venous ulcer

Punched-out e.g. diabetic ulcer (trophic, arterial, or neuropathic)

Undermined e.g. pressure sore on buttock (can fit hand under surrounding skin)

Rolled e.g. basal cell carcinoma

Everted e.g. squamous cell carcinoma (sun exposure, immunosuppression, coal - chimney sweep and scrotal SCCs)

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23
Q

What is hidradenitis suppurativa?

A

Cluster of abscesses in areas containing many apocrine sweat glands (e.g. armpits, under breasts, inner thighs, groin, buttocks) caused by repeated infection of hair follicles.

Excision required.

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24
Q

What is a carbuncle?

A

Combination of furuncles (boils) formed by Staph. aureus infection.

Classically on the face.

Excise and let heal by secondary intention.

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25
Is assessing lumps in neck by asking the patient to swallow helpful?
No - whole thyroid moves directly during swallowing as it is surrounded by pretracheal fascia. However, thyroglossal cysts move when the tongue is poked out due to the foramen caecum.
26
What is the management of a benign papilloma?
Skin tag - no potential for malignant change - excise if problematic
27
What is the management of a seborrhoeic keratosis?
Excisional biopsy if diagnosis in doubt Can attempt to treat with topical medication, cryotherapy, curretage, etc.
28
What is Lesser-Trelat sign?
Sudden appearance of multiple pruritic seborrhoeic keratoses Associated with development of adenocarcinoma of GI tract, lymphoma, acute leukaemia
29
What is impetigo?
Bacterial infection of superficial layers of epidermis by Staph. aureus/Strep. pyogenes - highly contagious - bullous or non-bullous - discrete pustules which dry into yellow scabs after a few days, scabs eventually fall off - most often seen around the mouth, face, and hands - exclude MRSA in outbreaks - consult nephrologist in ?acute glomerulonephritis (post-strep. glomerulonephritis) Oral Abx (cephalosporin, penicillin, or beta-lactam), topical Abx for 7-10days bd/tds, chlorhexidine wash
30
What is furunculosis?
Furuncles (only containing pus) or boils (contains solid core) caused by infection entering hair follicles. - usually Staph. aureus - sometimes related to immunodeficiency, anaemia, diabetes, iron deficiency - painful cutaneous lump which is red and fluctuant, central area may become white, yellow, or black - oral Abx (fluclox.) may be req. - incision and drainage if large area involved
31
What is erysipelas?
"St. Anthony's Fire" Superficial bacterial infection of skin which characteristically extends into the cutaneous lymphatics (cellulitis) - mostly on legs - most due to Strep. pyogenes or non-group A streptococci - skin is red, tender, and oedematous (advanced edge is raised and palpable) + pyrexia - risk factors: lymphoedema, diabetes, alcohol abuse, HIV, nephrotic syndrome, immunodeficiency - elevate and rest affected limb, PO/IV Abx (penicillin)
32
What is hidradenitis suppurativa?
Chronic/recurring infection of apocrine (axillae/groin) sweat glands - multiple (tender) swellings which coalesce and discharge pus - most likely Staph. aureus, coagulase-ve Staph, anaerobic Strep., Bacteroides - improve hygiene, weight loss, radical surgical excision
33
Whatis anthrax?
Cutaneous manifestation has papule which becomes serous or haemorrhahic vesicle, which bursts into black slough. - Bacillus anthracis - Can lie dormant as spores and then germinate in appropriate environment - IV Abx = doxycycline, amoxicillin, ciprofloxacin
34
What is syphilis?
Treponema pallidum (microaerophilic spirochete) - dark field microscopy Infectious lesions, blood-borne, or vertical transmission Penicillin
35
What is leprosy?
Chronic granulomatous disease affecting skin and PNS Mycobacterium leprae (acid fast/Ziehl-Nielsen) Abx = Dapsune, rifampicin, ofloxacin, minocycline
36
Describe the features and management of non-genital viral warts.
Elevated pale papilliferous growths covered with greyish epithelium Leave - 65% of the time they regress sponatenously within 2yrs Give topical agents for extensive spreading, symptomatic warts, or warts lasting 2+yrs (salicylic acid, canthoridin, trichloracetic acid) Cryosurgery/laser therapy
37
What is candidosis?
Yellow-white plaques on epithelial surface Candida albicans Most commonly an infection of superficial skin and mucosa e.g. buccal mucosa, tongue, intertrigo (in flexures/body folds), nappy dermatitis, perianal dermatitis, balanitis (penis), paronychia (nail fold) Expose and dry skin, topical antifungals (miconazole, nitrate, clotrimazole), PO antifungals (nystatin, clotrimazole, fluconazole)
38
What is tinea pedis?
Athlete's foot - soggy white skin + distinctive smell Dematophyte infection of soles and interdigitial spaces (Trichophyton rubrum) Expose and dry, topical antifungals (clotrimazole, econazole, ketoconazole), oral antifungals (fluconazole, itraconazole)
39
Describe the features and management of giant hairy naevi.
Brown/black hairy moles > 20cm in diameter or cover >5% of body - 2%-4% risk of malignant change - surveillance or prophylactic removal by excision, dermabrasion, curettage, or laser ablation Congenital
40
Describe the different types of acquired naevus cell naevi.
Not associated with malignant transformation. - junctional = nests of naevus cells clustered around the epidermal-dermal junction, childhood/adolescence - compound = same as above but extending into dermis - intradermal = clustered within dermis, adults
41
What is a Spitz naevi?
Juvenile melanoma - benign melanocytic tumours - predominantly present in childhood - commonly on face and legs - excise with narrow margin
42
What is atypical naevus syndrome?
>100 dysplastic naevi 5%-10% risk of malignant change Excise representative lesions to confirm and monitor the rest
43
What is a halo naevi?
Destruction of naevus by immune system. Surrounded by depigmented area of skin - tend to regress and leave a small scar - can cause involution
44
Contrast ephelis and lentigo.
Ephelis (freckle) = macular pigmented lesions arising as a result of increased melanin production (normal no. of melanocytes) Lentigo = increased no. of melanocytes
45
What is a blue naevus?
Arrested migration of melanocytes bound for dermal-epidermal junction. Nodular blue-black lesions on extremities, buttocks, and face Malignant transformation rare
46
What is Mongolian blue spot?
Common in Asians and Afro-Carribbeans Blue-grey pigmentation over sacrum which increases after birth and regresses in childhood
47
What are the naevi of Ota and Ito?
Ota = blue-grey discoloration in CNV1 and CNV2 distribution Ito = same as above but in shoulder region
48
What are keloid scars? Contrast to hypertrophic scars.
Overgrowth of dense fibrous scar tissue that extends beyond borders of original wound into normal tissue - tend to recur after excision - enlarge 6-12months after intial surgery Hypertrophic scars = confined to original wound, may resolve spontaneously
49
Describe the features of a dermoid cyst.
Cystic teratoma that contains developmentally mature skin - congenital (entrapment of epidermis during fusion of facial planes) or acquired (penetrating injury) - angular (lat. to orbit) or central when congenital - surgical excision
50
What is a pyogenic granuloma?
Idiopathic benign vascular lesion of skin/mucosa Children/adolescence Solitary, glistening, red papule/nodule prone to bleeding/ulceration Most comon on head, neck, extremities, and upper trunk Associated with trauma Grow rapidly over a period of a few weeks Excise to alleviate bleeding and confirm diagnosis
51
What is a dermatofibroma/histiocytoma?
Cutaneous nodule occurring most often in the lower legs of women after minor trauma e.g. insect bite
52
What is a neurofibroma?
Benign tumours containing mix of neural and fibrous elements - multiple - rubbery, subcutaneous, fusiform, pale lumps
53
What is a keratocanthoma?
Arise in pilosebaceous glands Resemble SCCs - have central necrotic core, grow outwards, fall off Rapidly grow, then spontaneously resolve over 4-6mnths, leaving a deep scar Observe or excise with wide margin
54
What is a solar/actinic keratosis?
UV-induced premalignant keratosis of skin - thickened yellow-brown plaques of variable diameter - on sun-exposed areas - punch, incision, or excision biopsy to confirm Limit sun exposure. Topical agents: 5-flurouracil, 5% imiquimod cream
55
What is Hutchinson's lentigo/lentigo maligna?
Premalignant lesion in head and neck induced by UV light. Large pigmented patch which may be nodular and variegated Incision/excision biospy
56
What is Bowen's disease?
SCC in situ with potential to progress and become an invasive SCC Patches of flat, pink, papular patches (misdiagnosed as eczema) Topical 5-FU or photodynamic therapy or excise
57
Describe the features of basal cell carcinoma.
Malignant tumour of basal layer of epidermis. 95% 40yrs-80yrs Associated with: chronic sun exposure, chemical exposure, immunosupression, sebaceous naevus, Gorlin's syndrome Punch/incision/excision therapy Topical 5-FU, cryotherapy, photodynamic therapy, radiotherapy, excision
58
Describe the features of squamous cell carcinoma.
Malignant tumour of cells in stratum spinosum. Associated with: chronic sun exposure, immunosuppression, HPV, ionising radiation Can arise from chronic wounds - Marjolin's ulcer Punch/incision/excision biopsy Surgical excision/radiotherapy
59
Describe the features of malignant melanoma.
Malignant tumour of melanocytes Peak incidence at 40yrs Excision biopsy Breslow thickness = thickness of melanoma Clark level = depth of tumour invasion Initial 3-6mnth follow-up
60
What is mycosis fungoides?
Cutaneous T-cell lymphoma resembling mushrooms - necrotic red patches - tissue biopsy - cytotoxic chemo
61
What is a Campbell de Morgan spot?
Bright red, clearly defined macule caused by collection of dilated capillaries Usually on neck, chest, abdomen, back, and arms Do not blanch on pressure
62
What is hyperhidrosis?
Sweating in excess of that req. for normal thermoregulation. Idiopathic or secondary to metabolic disorders, febrile illnesses, or medications Ix: thyroid function, blood glucose, urinary catecholamines Mx: topical Drysol, systemic anti-ACh medications, botox, iontophoresis, sympathectomy

Peri-op (15 decks)

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