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Year 4 > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

In an inflammatory history, what key points are different in derm?

A

Nature, site and progression
Recent contacts, stressful events, travel
History of atopy
Occupation and improvement away from work
DH

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2
Q

In a neoplastic history, what key points are different in derm?

A

Initial appearance and rate of change/evolution
Itch? Pain?
History of sunburn (occupation), tanning machines
Skin type
History of skin cancer/lesions & FH
Immunosupression

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3
Q

What are the stages of examining the skin?

A

Inspect
Describe
Palpate
Systematic check

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4
Q

How do you describe a lesion?

A 
SCAMM
Size
Colour
Associated secondary change (eg texture)
Morphology
Margin
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5
Q

Pigmented lesion acronym?

A 
ABCDE
Asymmetry
irregular Border
two or more Colours
Diameter>6mm
Evolution
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6
Q

What do you note on palpation?

A 
Surface
Consistency
Mobility
Tenderness
Temperature
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7
Q

What does the systematic check include?

A

Nails
Scalp
Hair
Mucous membranes

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8
Q

What is the derm way of saying mole?

A

Pigmented melanocytic naevus

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9
Q

What is a comedome?

A

A plug in a sebaceous follicle, containing altered sebum, bacteria and cellular debris
Open (blackhead), closed (whitehead)

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10
Q

What sites are described as flexural?

A

Body folds (groin, neck, behind ears, popliteal fossae, antecubital fossae)

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11
Q

What sites are described as extensor?

A

Sacrum, buttocks, ankles, heels

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12
Q

What is a Köebner?

A

A linear eruption arising at site or trauma

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13
Q

Opposite of discrete?

A

Confluent

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14
Q

What is purpura?

A

Red/purple due to bleeding into skin, does not blanche on pressure
Petechiae if small, ecchymoses are larger bruise like patches

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15
Q

What is eccyhymoses?

A

Big bruise-like pupura

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16
Q

What are flat lesions described as?

A

Small: macule
Larger: patch

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17
Q

What are raised lesions called?

A

Small: papule
Large and domed: nodule
Large and table top: plaque

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18
Q

What is a vesicle? eg?

A

Small raised fluid filled lesions

eg in varicella zoster

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19
Q

What is larger than a vesicle?

A

A bulla

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20
Q

What is a pus containing lesion called?

A

Small: pustule
Large: Abscess

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21
Q

What can staph infection in the skin form?

A

Small: boil/furuncle around hair follicle
Large: Carbuncle

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22
Q

What is it called if someone scratches off the epidermis (eg in eczema)

A

Excoriated lesion

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23
Q

What are scales?

A

Flakes of stratum corneam

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24
Q

What is it called when you lose epidermis/dermis

A

Loss of epidermis: erosion

Loss of dermis: ulcer

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25
What is it called when you lose a patch of hair?
Alopecia
26
What is koilonychia?
Spoon shaped nail | Iron deficiency
27
What happens to the nails in psoriasis?
Onchylosis (nail comes away from nail bed distally) Pitting Craggy
28
6 functions of the skin
``` Protective barrier Thermoregulation Sensation Vit D synthesis Immunosurveillance Appearance/cosmetic ```
29
Name the skin appendages
Nails Hair Sebaceous glands Sweat glands
30
Name the cell types found in the epidermis
Keratinocytes (produce keratin barrier) Langerhans' (antigen presenting) Melanocytes (pigment, protects from UV) Merkel (specialised nerve endings)
31
Layers of the epidermis
``` Stratum basale (stem cells) Stratum spinosum Stratum granulosum (secretion of lipid) Stratum corneum (keratin) ```
32
What is beneath the stratum corneum on the soles of the feet?
Stratum lucidum
33
What does the dermis mainly consist of?
``` Collagen Elastin Glycosaminoglycans Fibroblasts Immune cells nerves Skin appendages Lymphatics Blood vessels ```
34
What are the 3 main types of hair?
``` Lanugo (fine long hair in fetus) Vellus (fine short hair all over body) Terminal hair (coarse long hair on scalp, eyebrows, eyelashes and pubic areas) ```
35
What are the stages of hair growth?
Anagen (long growing phase) Catagen (short regressing phase) Telogen (resting/shedding phase)
36
What are the 2 different types of sweat glands and difference?
Eccrine: everywhere Apocrine: axillae, areolae, genitalia and anus
37
What happens to the skin in anaphylaxis?
Urticaria and angioedema
38
What is urticaria?
Local increase in permeability of capillaries and small venules due to prostaglandins, leukotrienes, and HISTAMINE Swelling of the superficial dermis raising the epidermis into wheals
39
What is angioedema?
Deeper swelling that involves dermis and subcutaenous tissues Esp tongue and lips
40
Treatments of urticaria, angioedema and anaphylaxis?
Urticaria: antihistamines Angioedema: Corticosteroids Anaphylaxis: Adrenaline, corticosteroids and antihistamines
41
Diagnostic criteria of atopic eczema
itchy skin flexural involvement (visible/history of) Personal history of asthma/hayfever (or if under 4, parents/siblings) Dry skin over last year Onset under age 2
42
Different types of emollients
``` Ointment cream lotion bath oils soap substitutes ```
43
Name 4 topical steroids, weakest first
``` Hydrocortisone 1% Clobetasone Butyrate (Eumovate) Bethamethasone valerate (Betnovate) Clobetasol Propionate (Dermovate) ```
44
Which is stronger: Eumovate or Betnovate?
Betnovate
45
How to treat severe infected eczema
Emollients/ointments Potent topical steroids Flucloxicillin for bacterial infection
46
How would you describe classic chronic psoriasis?
Red scaly plaque, well demarcated edges | Due to hyperproliferation of keratinocytes and inflammatory cell infiltration
47
Name the areas most commonly affected by psoriasis
Scalp, exterior knees and elbows, lower back
48
Describe 5 nail changes seen in psoriasis
Nail pitting Onchylosis (excessive proliferation of nailbed) Salmon patch (discolouration in nailbed) Beau's lines (transverse, intermittent inflammation) Leukonychia
49
What non-cutaneous manifestation of psoriasis is there?
Arthropathy | 5-8% of psoriatic patients
50
Treatment of psoriasis
Emollients Topical (coal tar, corticosteroids, vit D analogues, dithranol, keratolytics) Phototherapy (UVB, PUVA) Oral (methotrexate, cyclosporin, oral retinoids, mycophenolate mofetil) Biological agents (infliximab, etanercept)
51
Describe eczema dermatology style
Macular papular rash affecting mainly the flexor surfaces. Scaling crust secondary to infection No well defined borders and always pruritic Affects 20% of under 12s
52
Symptoms of rosacea
Telangiectasia Aggravated by hot and spicy drinks and food and sun exposure Sensitive skin: burning and itching with creams/makeup Papules and pustules on nose/forehead/cheeks and chin Rhinophyma & erythema
53
Treatments of rosacea
Topical metronidazole | If mod-severe papulopustular: tetracyclines (lymecycline)
54
How do you manage dermatitis of the scalp?
Ketoconazole 2% shampoo (or selenium sulphide) BD for at least a month 4 weeks of potent topical corticosteroid?
55
How do you manage dermatitis of the face?
2% ketoconazole cream Hydrocortisone 0.5% Eyelid hygiene
56
Signs of a nodular BCC?
``` Small shiny skin coloured/pinkish lump Central necrosis/ulcer/crust Rolled pearly edge Telangiectasia Bleed spontaneously and heal over ```
57
What are the main treatments of BCCs?
Surgical excision Mohs micrographic surgery (expensive) If frail/no surgery: radiotherapy If superficial: cryotherapy/5FU
58
What is SCC in situ also called?
Bowen's disease
59
Treatment of Bowen's?
5-flurouracil cream Cryotherapy Curettage and cautery Photodynamic therapy if difuse
60
Features of Bowen's
Can often look like a small patch of psoriasis Red inflammatory base, plaque Characteristic tiny regular clods of blood vessels Disordered structure Well defined border Keratin scale
61
Features of actinic keratosis?
Flat patch | Strawberry pattern of erythema
62
Risk factors for melanoma
Sun exposure Susceptible genes Type 1 fair skin Atypical naevi elsewhere
63
What is atypical mole syndrome?
>50 moles | >3 are atypical
64
Difference between pemphigus vulgaris and bullous pemphigoid
PV: flaccid, common mouth involvement, intraepidermal split, Desmoglein antigen BP: tense, no mouth involvement, subepidermal split, basement membrane antigen
65
Which blistering disease is most fatal?
Bullous pemphigoid | Up to 41%
66
Which blistering disease commonly affects those above 70yrs?
Bullous pemphigoid
67
Treatment of blistering diseases?
Oral corticosteroids in pemphigus vulgaris and BP if severe | Topical corticosteroids in BP if not severe
68
What is dermatitis herpetiformis associated with
IgA | Coeliac disease
69
List 4 causes of erythroderma
Psoriasis Dermatitis Drug eruptions Cutaneous T cell lymphoma
70
What is eczema herpeticum?
HSV-1 infection on eczematous skin
71
Treatment of eczema herpeticum
Acyclovir Emollients Antibiotics for secondary skin infection
72
What is staphylococcal scalded skin syndrome?
``` Epidermolytic toxin released from staph phage II Usually infants Intraepidermal blistering Low mortality Treat with antibiotics (erythromicin) ```
73
What is toxic epidermal necrolysis?
Drug induced full thickness epidermal necrosis with sub epidermal detachment Any age Mortality roughly % body affected Treat by withdrawing drug
74
What usually causes necrotising fasciitis?
Group A haemolytic strep | More common in malignancy&diabetes
75
Treatment of necrotising fasciitis?
Surgical debridement | IV antibiotics
76
Presentation of necrotising fasciitis
``` Inflammation of body part Pain far beyond what would be expected Rapidly advancing Vascular occlusion, ischaemia, necrosis Fever, eiosinophilia, ALT>1000 ```
77
1st line treatment of impetigo
Fusidic acid
78
Usual pathogens for impetigo and cellulitis?
Staph aureus, strep pyogenes
79
What usually causes warts? | How long do warts last with no treatment?
Human papilloma virus | 2 yrs
80
Treatment options for warts
Cryotherapy | Topical salicylic acid
81
Describe molluscum contageousum like a dermatologist
Firm smooth umbilicated papules, 2-5mm in diameter Skin colour/white/translucent Usually in clusters
82
Treatment of mild acne
1st: topical retinoid, benzoyl peroxide 2nd: Azelaic acid 3rd: Combined oral contraceptive
83
Treatment of moderate/severe acne
Lymecycline + topical retinoid | Dianette COCP
84
When would you treat acne with isotertinoin?
If severe, hasn't responded to antibiotics, depression and scarring
85
Whats the main risk of isotretinoin?
Teratogenicity
86
What is erythema nodosum?
Discrete tender nodules due to a hypersensitivity reaction to group A haemolytic strep/TB/pregnancy/malignancy/sarcoidosis/IBD/chlamydia/leprosy
87
What causes erythrma multiforme?
Herpes simplex?
88
What does the skin look like in acute meningococcaemia?
Non blanching purpuric rash on the trunk and extremities | -> haemorrhagic bullae and tissue necrosis
89
What are the complications of meningococcal septicaemia?
Septic shock Disseminated intravascular coagulation Multiorgan failure Death
90
What is erysipelas?
Acute superficial form of cellulitis (dermis and upper subcutaneous tissue) Has well defined red raised border
91
3 main forms of superficial fungal infections
Dermatophytes (ring worm/tinea) Yeasts (candidiasis) Moulds (aspergillus)
92
What does tinea look like?
``` Unilateral, itchy Circular/annular/polygonal lesions with clearly defined raised and scaly edges In nail: yellow thickened crumbling nail Areas fail to tan Purple w/Wickham striae ```
93
What does candidiasis look like?
White plaques on mucosal areas | Erythema with satellite lesions in flexure
94
Management of fungal infections?
``` Skin scrapings/nail clippings for diagnosis Treat underlying immunosupression? Decrease moist environment Topical antifungals (terbinifine cream) Oral if severe (itraconazole) ```
95
Describe SCC lesion
Locally invasive, potential to metastasise | Karatotic (scaly/crusty) ill defined nodule which may ulcerate
96
Main prognostic factor in melanoma?
Depth (Breslow thickness on biopsy) >0.76cm med risk >1.5cm high risk
97
Cause of eczema
Primary genetic defect in skin barrier function | Loss of function of protein filaggrin
98
Types of psoriasis | % population?
``` Chronic plaque Seborrhoeic (naso-labial, retroauricular) Pustular Erthrodermic Guttate 2% population ```
99
3 main types of ulcer | 3 not so common causes
Arterial Venous Neuropathic Infection(leischmaniasis), vasculitic, carcinoma
100
Venous ulcer features | Treatment?
Painful, worse on standing Hx of varicose veins/DVT Medial malleolar area Large shallow irregular ulcer with an exudative granulating base Warm skin, normal peripheral pulses haemosiderin and melanin deposit, white scarring TREAT: compression bandaging
101
Arterial ulcer features
Painful at night, worse on elevation Hx of atherosclerosis Found on pressure and trauma sights (pretibial, toes) Small sharply defined deep (punch out lesions) Necrotic base Cold skin, weak peripheral pulses, shiny pale skin and hair loss
102
Arterial ulcer investigations and treatment
``` ABPI<0.8 Arterial insufficiency Doppler and angiography Vascular reconstruction NOT compression bandaging! ```
103
Features of a neuropathic ulcer
``` Painless, abnormal sensation Hx diabetes/neurological disease Pressure points (soles/heels/toes) Granulating base, callus Warm skin, normal pulses, peripheral neuropathy ```
104
Investigations and treatment in neuropathic ulcers
``` X ray to exclude osteomyelitis Wound debridement Regular repositioning Appropriate footwear Good nutrition ```
105
Where do you often find scabies?
``` Sides of fingers Finger webs Wrists, elbows, ankles, feet Nipples and genitals Look like linear burrows/rubbery nodules -> worse at night, V ITCHY, spares head ```
106
Treatment of scabies
Scabicide (permethrin/malathion) | Antihistamines
107
Function of fillagrin?
Binds keratin and hyaline into kerato-hyaline granules | This function is lost in eczema/dermatitis
108
Why is erythroderma dangerous?
Fluid and electrolyte balance is lost High output cardiac failure Septicaemia can occur
109
What is added in PUVA?
Topical psoralen to increase effectiveness of UVA
110
What is PASI?
``` Psoriasis area and severity index Areas affected & % of body Erythema Induration (thickness) Desquamation (scaling) ```
111
Name 9 subtypes of eczema
Atopic (most common) Eczema herpeticum (when infected with HSV1) Pompholyx eczema (palms and soles, sweating) Discoid Venous (haemosiderin deposits in legs, oedema, lipidomatosclerosis) Allergic and irritant dermatitis Seborrhoeic dermatitis (1st yr of life, immune reaction to yeast) Chronic actinic dermatitis Astatic (elderly, dry legs)
112
Name 2 non sedating antihistamines
Cetirizine | Fexofenadine
113
Causes of vasculitis
``` Viral hepititis Autoimmune (SLE, Sjögrens, RA, ulcerative colitis) Strep, staph Drugs (thiazides, iodines, penicillin) Lymphoproloferative ```
114
Signs of HSV1&2
``` HSV1: generally oral HSV2: generally genital Pain/burning preceded lesion Grouped vesicles->pustules->erosions->ulcers Scalloped edges Single ganglia affected ```
115
What is Ramsay Hunt Syndrome?
Varicella Zoster reactivation (shingles) | Causes facial nerve palsy
116
What is a pyogenic granuloma?
Overgrowth of blood vessels (esp after minor trauma) | Comes up over 3 months and bleeds profusely
117
Treatment of typical cellulitis versus cat/dog bite
Amoxicillin/fluclox | Dog/cat bite: Co-amoxiclav

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