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MEDICINE NEW > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Mutation in which gene is associated with basal cell carcinoma (rodent ulcer)?

A

TP53 tumour supressor gene

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2
Q

How should a suspected melanoma be managed?

A

Wide local excision- 1cm around the lesion for every mm of thickness of the mole up to 3cm

Sentinel node biopsy

If metastatic- molecular analysis used to match tumour with therapeutic agent

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3
Q

What grading system links melanoma thickness with prognosis?

A

Breslow’s depth- the deeper the tumour, the higher the stage:

Stage 1 = < 1mm
Stage 2 = 1-2mm
Stage 3 = 2-4mm
Stage 4 = > 4mm

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4
Q

What is the ABCDE of mole examination (signs of melanoma)?

A 
Asymmetric lesions
Border irregular
Colour irregularity
Diameter >6mm
Evolving in size

Refer patient if:
3 apply
or there’s a spontaneous change in an above factor
Or there’s itching, pain or bleeding of it

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5
Q

What is phimosis and how is it treated?

A

When the foreskin is too tight to retract it.
Normal up to 4 years, may lead to increased risk of glans inflammation (balanitis)

Rx: betamethasone cream may help, stretching exercises BD

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6
Q

What is paraphimosis and how should it be managed?

A

When a retracted foreskin becomes irreplaceable and prevents venous return of the glans.
Oedema and ischaemia may ensue.

Rx:

  1. Patient should try to squeeze glans
  2. 50% glucose can reduce oedema, ice and lidocaine
  3. Circumcision or dorsal slit may be required
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7
Q

What is balanitis and how is it managed?

A

Inflammation of foreskin and glans- often strep or staph

Rx:

  1. Antibiotics + hygiene advice
  2. Circumcision
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8
Q

What may cause pyrexia following an operation in the first 48 hours?

A

Atelectasis- complete or partial collapse of lung lobes as a result of not ventilating normally during surgery (requires physio)

Infection- UTI, toxic shock syndrome, chest, wound, meningitis
Immune- blood transfusion, reaction to antibiotics, malignant hyperthermia, hyperacute transplant rejection

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9
Q

How does management differ between actinic (solar) keratoses, bowen’s disease (SCC in situ) and squamous cell carcinomas?

A

Actinic keratoses + Bowen’s disease
Temperature: cryotherapy, photodynamic therapy
Chemical: fluorouracil, diclofenac gel, imiquimod (induces IFN-a)
Surgical: if SCC suspected

Squamous cell carcinoma
Excision

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10
Q

What are the typical features of mild acne and it’s treatment?

A

Comedones (black heads, white heads)
Inflammatory pustules + papules

Rx: topical retinoid
± topical abx (clindamycin), salicylic acid, benzoyl peroxide

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11
Q

Signs of severe acne and it’s Rx:

A

Nodules, cysts, scarring

Oral retinoid, isotretinoin- monitor cholesterol, LFTs, triglycerides, FBC, need contraceptive (teratogenic)
Co-cyprindiol pill- a contraceptive
Oral abx

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12
Q

What is the pre-malignant and maligant form of each type of skin cancer?

A

Actinic keratoses > Bowen’s disease (in situ) > Squamous CC

Maligna lentigo > malignant melanoma

Basal cell carcinoma

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13
Q

How does the management of squamous cell carcinoma differ from actinic keratoses and Bowen’s disease?

A

Squamous cell carcinoma- excision
only 5-fluorouracil if superficial

Bowen’s + actinic keratosis- 5-FU or cryotherapy or photodynamic therapy

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14
Q

Management of malignant melanoma?

A

Wide local excision- 1cm margin for every mm of depth up to 3cm

If Breslow thickness >1mm then shoud excise sentinel lymph node
Can send to lab for targeted molecular therapies

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15
Q

What is the common skin lymphoma?

A

Mycosis fungoides- involves CD4 T helper cells

PC: well defined red scaly patches or plaques

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16
Q

Causes of blisters?

A 
Infection- herpes, insect bites
Drugs- ACEi, furosemide
Dermatitis herpetiformis
Discoid eczema- starts with vesicles, then coin shaped
Autoimmune- pemphigoid + pemphigus
Trauma- burns
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17
Q

Difference in the pathophysiology and Rx of pemphigus + pemphigoid?

A

Pemphigus- IgG against desmosomal components so keratinocytes separate from each other (crazy paving)
Rx: prednisolone PO or IV Rituximab/ Ig

Pemphigoid- IgG against basement membrane
Rx: clobetasol cream (steroid)

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18
Q

Options for breast reconstruction following surgical mastectomy:

A

Tissue expanders/implants
Latissimus dorsi flap
Transverse rectus abdominis myocutaenous flap

19
Q

How is surface area of a burn estimated?

A 
9% each arm
9% front of leg + 9% of back
18% front torso
18% back torso
9% whole head
20
Q

Volume of Hartmanns to be given in a burn?

A

4 x kg x body surface area burned

1/2 given in 1st 8hrs

21
Q

Rx of tinea infections

A

Terbafine or clomitrazole on skin

22
Q

Rx of seborrhoeic dermatitis

A

Ketoconazole shampoo

23
Q

Rx of candida in mouth and vagina:

A

Mouth- nystatin

Clomitrazole cream + pessary in vagina

24
Q

Rx of impetigo

A

Superficial infection from staph aureus characterised by honey-coloured crusts on erythematous base

Topical fusidic acid
PO flucloxacillin if severe

25
Q

Cause of erysipelas, common way it presents?

A

Strep pyogenes
Erythema of the face which is sharply defined and superficial

PO penicillin

26
Q

Difference between cellulitis and erysipelas?

A

Cellulitis is deeper and less sharply demarcated- needs benzylpenicllin + flucloxacillin whereas erysipelas only needs penicillin (strep pyogenes)

Erysipelas affects the upper dermis whereas cellulitis affects SC fat + dermis

27
Q

Management of genital warts (condylomata acuminata):

A

Cryotherapy
± podophyllin or imiquimod cream

Screen for other STIs
May need yearly cervical screening- risk of HPV 16+18

28
Q

Management of generalised pustular psoriasis (derm emergency):

A

Conservative: emollients, wet dressings

Medical: oral retinoid (acitretin)- LFTs,, glucose, lipids
Biologics (etanercept)- TNFa blocker

29
Q

What is the definition of erythroderma and it’s management?

A

Erythema and scaling of >90% of the skin surface, caused by inflammation

Conservative: 
Fluid balance + temperature
Emollients + topical steroids
Antihistamines
Wet dressings
30
Q

Management of eczema:

A

Conservative: emollients + soap substitutes

Medical:
Topical steroids (hydrocortisone or potent betamethasone)
Tacrolimus (calcineurin inhibitors)

31
Q

5 types of eczema:

A 
Atopic
Venous
Discoid
Pompholx- hands + feet blisters
Asteatotic- old age
32
Q

Allergic contact dermatitis is what type of hypersensitivity reaction?

A

Type 4

Ie allergy to nickel, lanolin

33
Q

Rx of acne rosacea?

A

Inflammatory erythematous telangiectasia
Inflammatory nodules, unlike acne there are no comedones

Rx:

  1. metronidazole
  2. Anitbiotics, oral retinoid
34
Q

Rx of plaque psoriasis:

A
  1. Emollients + soap substitutes
    Vitamin D analogue- calcipotriol
    Topical steroid
  2. Tar, Dithranol
    UV A + Psoralen
  3. If arthropathy of severe:
    Oral retinoid- Acetretin
    Immunosupression- ciclosporin, methotrexate
    Biologics- etanercept
35
Q

Stages of pressure sore:

A

1: non-blanching erythema
2: partial thickness skin loss
3: full skin loss extending into fat
4: destruction of bone, muscle or tendons

36
Q

Features of depression:

A

A: anhedonia, low mood, low energy
B: low concentration, self-esteem,
guilt, unworthiness, pessamistic thoughts, self harm,
reduced sleep and appetite

Mild = 2A + 2B
Moderate = 2A + 3B
Severe = 3A + 4B
37
Q

Hypomania features

A 
4 days of elevated mood or irritable 
and 3 of:
High activity or restless
More distractible
Less need for sleep

More talkative
More sociability

More sexual energy
Mild reckless or irresponsible behaviour

38
Q

What is the difference between hypomania and mania:

A

Hypomania- Sx for 4 days
Mania- Sx for 1 week

Mania includes flight of ideas, loss of inhibition, severe interference of personal function

39
Q

Features of serotonin syndrome:

A

Cognitive: headache, agitated, confused, hallucinating, coma

Autonomic: sweating, shivering, hyperthermia, nausea, high BP+HR

Somatic: myoclonus, hyper-reflexia, tremor

40
Q

Signs of lithium toxicity:

A

GI disturbance, muscle weakness, drowsy, blurred vision

41
Q

Differential of a midline neck lump:

A

Subcutaneous cyst
Lipoma
Lymph node

Thyroid nodule
Thryoid gland
Thyroglossal cyst

42
Q

Differential of a lump in the anterior triangle of the neck?

A

Anterior to sternocleidomastoid:

Subcutaneous cyst
Lymph node
Lipoma

Salivary gland swelling
Laryngocele- reducible
Branchial cyst (failed obliteration of branchial cleft)
Carotid aneurysm- pulsatile + bruit
Carotid body tumour
43
Q

Differential for lumps in the posterior triangle of the neck:

A

Subcutaneous cyst
Lymph nodes
Lipoma

Branchial cyst
Subclavian artery aneurysm- pulsatile
Pharyngeal pouch- reducible
Cystic hygroma- fluctuant

44
Q

Differences between venous, ischaemic and neuropathic ulcers?

A

Venous:
Superficial painful ulcer in the gaiter region with sloping edges, which is pink in colour + granulating

Ischaemic:
Deep punched out ulcer on the sole/pressure areas, which appears sloughy and pale and painful

Pressure:
Deep punched out ulcer on the sole/pressure areas, which appears sloughy and pale but is not painful

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