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MS4 - Dermatology > Dermatology > Flashcards

Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

Cream def

A

water+oil

non greasy

easily absorbed into skin

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2
Q

Ointment def

A

greasy

No added water

Mild anti-inflamm effect

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3
Q

Lotion use

A

cooling effect eg calamine lotion

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4
Q

Emollient use

A

Could be lotion, ointment or cream

Treats dry eczematous and scaling skin

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5
Q

Describe macule

A
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6
Q

Describe patch

A
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7
Q

Describe vesicle

A
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8
Q

Describe Blister

A
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9
Q

Describe Bulla

A
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10
Q

Describe Postule

A
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11
Q

Describe papule

A
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12
Q

Describe Nodule

A
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13
Q

Describe Plaque

A
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14
Q

Describe Wheal

A
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15
Q

Describe Erosion

A
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16
Q

Describe Ulcer

A
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17
Q

Describe fissure

A
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18
Q

Describe telangiectasia

A
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19
Q

Describe purpura

A
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20
Q

Describe Ecchymosis

A
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21
Q

Describe Spider naevus

A
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22
Q

Describe Petechia

A
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23
Q

Descrbe crust

A
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24
Q

Describe scale

A
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25
Q

Describe excoriation

A
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26
Q

Describe lichenfication

A
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27
Q

Purpura cause

A

small vessel vasculitis

(palpabale)

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28
Q

Vitiligo sx

A

smooth white depigmented patches or macules

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29
Q

Vitiligo causes

A

autoimmune eg thyroid

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30
Q

Vitiligo management

A

Sun protection

Cosmetic camouflage

Strong steroids if recent onset

UVB/PUVA

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31
Q

Lentigo vs freckles

A

Lentigo:

  • larger brown macules/patches,

persist in winter (unlike freckles)

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32
Q

Congenital melanocytic naevi

size

A

>1cm

present at birth/early neonatal

if >5 cm, risk of malignant change

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33
Q

Acquired melanocytic naevi development

A

Junctional naevus: flat

Comound naevus: raised- dome shaped

Intradermal naevus: pale brown papules

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34
Q

Halo naevi

A
  • white halo around benign melanocyte naevi
  • form in adolescence
  • if in adults (40-50) may mean melanoma elsewhere
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35
Q

Seborrhoeic warts (keratoses)

A

Benign greasy-brown warts

On chest, back and face

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36
Q

Granuloma annulare

A

Chronic non infectious ring shaped lesion

Usually on the back of the hand

Associated DMI

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37
Q

Erythema multforme

A

Target-like lesion, often on extensor surface

3 different zones (outer ring, pale inner ring, central zone)

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38
Q

Causes of erythema multiforme

A

Mycoplasma pneumonia

herpes simplex

medication

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39
Q

2 types of erythema multiforme

A

Minor form: just the lesions

Major form: lesions + systemic upset (fever)

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40
Q

Treatment of erythema multiforme

A

No Rx

Topical steroids may aid sx, but dont speed recovery

Treat the cause (eg HSV with accivlovir)

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41
Q

Acne development stages

A
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42
Q

Mild acne sx

A

Mainly facial comedones (white/black heads)

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43
Q

Mild acne treatment

A

1st line: topical Rx: retinoids: eg isotretinoin or benzoyl peroxide

2nd line: azelaic acid

for up to 8 weeks

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44
Q

CI of retinoids

A

pregnancy as teratogenic (contraception for duration of rx + 1mo after)

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45
Q

Moderate acne sx

A

dominate papules + postules

affect face +/- torso

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46
Q

Management of moderate acne

A

1st line: Combined (abx + retinoid or abx + benzoyl peroxide) treatment

(Note: the abx could be either topical or PO)

Abx eg. tetracycline or doxycycline or lymecycline etc

In women: Consider COCP + 1st line

for >4-6 months

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47
Q

Severe acne sx

A

cysts

scars

papules + postules

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48
Q

Mx of severe acne

A

Isotretinoin (reduces sebum production and pituitary hormones)

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49
Q

SE of isotretinoin

A

teratogenic

depression -> suicidal

skin (esp lip) dryness

muscle aches

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50
Q

Different types of basal cell carcinoma

A

Nodular

Superficial

Morpheic

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51
Q

Superficial BCC

A

Multiple

develops over months to years

upper trunk and shoulders

bleed/ulcerate easiy

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52
Q

Nodular BCC

A

Pearly nodule with rolled telangiectatic edge +/- central ulcer

On face

could be Cystic

Often bleeds spontaneously, then heals

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53
Q

Morpheic BCC

A

AKA sclerosing bcc

skin coloured

found mid facial sites

may infiltrate nerve

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54
Q

Rx of nodular BCC

A

surgical excision

radiotherapy

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55
Q

Morpheic BCC mx

A

micrographic surgery (multiple biopsies and checking under microscope as tend to recur)

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56
Q

Superficial BCC mx

A

surgical excision

Cuerettage

cryotherapy

topical 5-FU (chemotherapy)

topical imiquimod (immune modulator)

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57
Q

Causes of BCC

A

uv exposure

immunosuppression

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58
Q

Describe Squamous cell carcinoma

A

Persistant ulcerated or crusted form irregular lesion

tenderness

hyperkeratosis

flesh colour

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59
Q

Risk factors for SCC

A

smoking

thermal burn

leg ulcers

immunosupperession

infection (HPV)

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60
Q

Risk of metastasis with BCC vs SCC

A

BCC rarely mets

SCC is locally invasive and may metastesize

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61
Q

Treatment of squamous cell cancer

A

local complete excision

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62
Q

Sunburn/exposure and risk of cancer

A

Sunburn increases risk of BCC and malenoma

Chronic sun exposure increases risk of SCC

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63
Q

Causes of atopic eczema

A

Multifactorial

genetic: FH of atopy (70%)

Infection: staphs colonize leision

Diet or allergens (dust mite) rarely cause it

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64
Q

Dx of eczema in a child

A

Itchy skin (or parent report scratching) + 3 or more of:

1- onset <2yo

2- past flexural involvement

3- Hx general dry skin

4- personal hx of other atopy

  1. Visible flexural dermatitis (or cheeks /forehead and outer side of limbs if <4yrs)
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65
Q

Chronic atopic eczema

A

mostly grow out of it by 13 yo

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66
Q

Mx of atopic eczema

A

Emollients and soap substitute: 3-4 /day dry skin more susceptible
Topical corticosteroids: OD for 30 mins after emollient

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67
Q

Which topical steroids to use for atopic eczema

A

dermovate (clobetasol) hands/feet (or elecon if hasnt worked)

eumivate (clobetasone): face

elecon (mometasone): body

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68
Q

Discoid eczema

A

Late onset elderly

Could get discoid in atopic eczema

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69
Q

Adult seborrhoeic dermatitis

A

Older patients

Red, scaly rash

Affect scalp, eyebrows, nasolabial folds and cheeks

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70
Q

Cause of adult seborrhoeic dermatitis

A

eg overgrowth of skin yeasts (malassezia)

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71
Q

Risk with Actinic keratosis

A

Aka solar keratosis

pre malignant (SSC)

yellow-white scaly crust on sun exposed skin

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72
Q

Mx of actinic keratosis

A
  1. diclofenac gel
  2. fluorouracil cream (5FU)
  3. Imiquimod
  4. cryotherapy
  5. curettage
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73
Q

Describe Bowens disease natural history

A

premalignant (SSC)

well defined

slow enlarging

red scaly plaque w/ flat edges

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74
Q

Causes of Bowens disease

A

uv exposure

radiation

immunosuppression

arsenic

hpv infection

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75
Q

Management of Bowens disease

A
  1. fluorouracil cream (5FU)
  2. Imiquimod
  3. cryotherapy
  4. curettage
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76
Q

RFs for malenoma

A

Hx of SCC or BCC or malenoma

Sun exposure/sunburn in childhood

Fair skin

FHx

Large number of moles or abnomal moles (atypical or dysplastic naevi)

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77
Q

How diagnose malenoma

A

ABCD

Asymmetry - in colour or shape

Border - irregular or sharp cut off

Colour- 3 or more colours

Diameter - >7 mm

Evolution - change in size/shape/etc

Funny looking- out of ordinary

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78
Q

Types of melanoma

A

superficial spreading melanoma 70%

nodular melanoma 15%

acral lentiginous melanoma 10%

lentigo maligna melanoma 5%

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79
Q

Superficial spreading melanoma description

A

slowly enlarging pigmented lesion

colour variation

irregular border

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80
Q

Where superficial spreading melanoma mostly occur

A

trunks of men

legs of women

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81
Q

Superficial spreading melanoma natural progression

A

starts growing in radial plane (thin)

but may also grow vertical

very slow growth

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82
Q

Nodular malenoma natural hx

A

no radial growth

grows rapidly

invades deeply and mets early

most aggressive

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83
Q

Acral lentiginous melanoma most common in

A

common in black and asians

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84
Q

Acral lentiginous melanoma distribution

A

palms

soles

sunburn areas

hutchinsons nail sign

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85
Q

Prognosis of melanoma

A

Berlows thickness (histological measurement of tumour depth)

If >75 mm, then 5 % survival 5 yrs

If <4mm, then 45% survival 5 yrs

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86
Q

genetics of psoriasis

A

Multiple genes ass with

if both parents have it, 50% risk of getting it

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87
Q

Triggers for psoriasis

A

Environmental: Stress, infection, climate, skin trauma (kobner phenomenon)

Modifiable: alcohol, smoking, meds, obesity

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88
Q

Which meds trigger psoriasis

A

NSAIDS

B blockers

antimalarials

lithium

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89
Q

Types of psoriasis

A

Chronic plaque

Flexural

Guttate

Postular

Generalised (erythrodermic or postular)

90
Q

Chronic plaque psoriasis

A

symmetrical well defined red plaques with sliver scale

on extensor surfaces

91
Q

Flexural psoriasis

A

In moist areas: axilla, elbow, groin, submammary, umbilicus

92
Q

Guttate psoriasis

A

large number of small plaques <1cm over trunk and limbs

often in young, post strep infection

93
Q

Postular(palmoplantar) psoriasis

A

yellow-brown postules within plaques affecting palms/soles

94
Q

Generalised erythrodermic psoriasis

A

May cause systemic sx (high temp, WCC, dehydration)

Medical emergency

95
Q

Generalised postular psoriasis

A

May cause systemic sx (high temp, WCC, dehydration)

Medical emergency

96
Q

Nail changes in psoriasis

A

pitting

onycholysis

thickening and subungal keratosis

97
Q

What is this

A

onycholysis( separation from nail-bed)

98
Q

What is this

A

subungal keratosis

99
Q

Topical treatment of plaque psoriasis

A

Corticosteroid (eg betnovate) OD

AND

vit D (affects cell division, eg dovonex) ON

If widespread: Coal tar lotion (Exorex)

Dithranol cream (slows cell division) if resistant to Rx

-

100
Q

How long can steroids be used for plaques

A

8 weeks followed by 4 week break

Vit D could continue

101
Q

Scalp psoriasis mx

A

potent topical steroids

OR

vit D prep

or

Coal tar shampoo

102
Q

Flexural psoriasis mx

A

2 weeks topical steroids and 4 week break

+/- antifungal/antibiotic

103
Q

When to consider biologics for psoriasis

A

If PASI >10 or DLQI >10 for over 6 months and one of:

  • resistant/ SE from treatment
  • CI to other systemic agents
  • severe life threatening disease
104
Q

Biologics mechanism of action

A

inhibit T cell activation and function or neutralise cytokines

105
Q

Phototherapy use in psoriasis

A

UVB- for guttate - wide spread

PUVA- psoralen + UVA : large plaque psoriasis )

106
Q

Problem with PUVA

A

increased risk of SCC of skin

107
Q

Overview of psoriasis mx

A

Topical steroid/vit D

Coal tar lotion

Dithranol

UVB/PUVA

Non-biologics (methotrexate, ciclosporin, acitreitin)

Biologics (infliximab, adalimumab, enteracpet)

108
Q

What is utricaria

A

Wheals (hives) +/- angio-oedema

109
Q

what is this

A

Wheal

lasts mins to 24hrs

causes pruritis (itch)

affects deep dermal, raising the epidermis

110
Q

What is this

A

angio-oedema

lasts up to 72 hrs

Deep dermal/subcutaneous tissue

111
Q

Types of urticaria

A

acute <6 wks, mostly paeds

chronic >6wks mostly adults

112
Q

Causes of urticaria

A

Idopathic

infection

meds- IgE

autoimmune

113
Q

physical urticaria

A

induced by an external trigger

eg dermographism (rubbing/itching)

or sun exposure

Rx with anti histamine

114
Q

Urticaria Rx?

A

H1 antihistamines:

Sedating: Hydroxyzine, Chlorpheniramine

Non-sedating: Loratidine, Cetirizine, Fexofenadine

H2 antihistamines:

Ranitidine

115
Q

Mx of urticaria if refractory to primary mx

A

if acure : pred for 5 days

if chronic: ciclosporin or omalizumab

116
Q

Endogenous causes of dermatitis

A

Seborrhoeic

Discoid

Pompholyx

Gravitational

117
Q

Venous causes of dermatitis

A

Asteatotic

Lichen simplex

118
Q

Napkin dermatitis causes

A

Faecal enzymes

Alkalinity

Heat

Humidity

119
Q

Pompholyx

A

pruritic vesicular rash on hands and feet

120
Q

Graviational eczema

A

Ass with venous HTN

Haemosiderin staining common

121
Q

Asteatotic eczema

A

Crazy paving appearance of cracks in skin surface

Shins most common site

122
Q

Asteatotic eczema causes

A

Central heating

low humidity

overwashing

diruetics

hypothyroid

123
Q

Lichen simplex cause

A

due to repeated rubbing /scratching

124
Q

common sites for lichen simplex

A

Men lower leg

women neck

both anogenital

125
Q

Lichen planus features

A

on flexor aspects of wrist forearms ankles and legs + white lacy markings

Itchy

126
Q

Rx for lichen planus

A

topical steroids

127
Q

Pyogenic granuloma

A

vascular lesion arises from minor trauma

mainly on fingers

grows rapidly and bleeds

128
Q

Alopecia types

A

Scarring (irreversible)

  • Inflammatory : lichen planus, discoid lupus
  • Trauma
  • Tumour : BCC, SCC

Non-scarring (may be reversible):

  • areata
  • totalis
  • universalis
129
Q

How to treat androgenic alopecia

A

Minoxidil

130
Q

Nutritional causes of alopecia

A

Fe and Zn deficiency

131
Q

Alopecia areata

A

well definded round patches of hair loss on scalp

exclamation mark hair

Spontaneous regrowth in 3 months in 80%

132
Q

alopecia totalis

A

complete loss of scalp hair

133
Q

alopecia universalis

A

total body hair loss

134
Q

Bullous pemphigoid

A

autoimmune IgG against basement membrane

blistering disorder

relapse remitting over 5-10 yrs

135
Q

Bollous pemphigoid Rx?

A

Clobetasol (steroid) topical

Prednisolone PO

136
Q

Pemphigus description

A

affects young <40 yrs

IgG against desmosomal component

flaccid superficial blister, rupture easily to leave widespread erosions

137
Q

Pemphigus Rx

A

prednisolone PO

Rituximab + iv immunoglobulin if resistant

138
Q

Venous leg ulcer risk factors

A

varicose vein

dvt

venous insufficiency

fracture

139
Q

Commonest place for venous leg ulcers

A

medial malleolus

140
Q

Venous leg ulcer management

A

Graded compression bandages (40mmHg -ankle, 15-20 mmHg- calf)

Occlusive dressing

Pentoxyphylline 400mg TDS PO up to 6/12

141
Q

pressure ulcer common places

A

sacrum

heel

greater trochanter

142
Q

Stages of pressure ulcer

A

Stage I non blanching erythema over intact skin

Stage II partial thickness skin loss

Stage III full thickness skin loss extending to fat

Stage VI Destruction of bone, muscle, tendons

143
Q

Rx of pressure ulcers

A

Debride dead or necrotic

Pressure-relieving mattress/cusion

Turning chart

Dress

144
Q

Dermatophyte infections

A

tinea (ringworm) fungal infections,

grow and invade dead keratin

145
Q

Different species of dermatophytes

A

Human only (anthropophilic) eg Trichophyton rubrum

+animals (zoophilic) eg Microsporum canis

+ soil (geohilic) eg Micosporum gypseum

146
Q

Tinea rash description

A

round scaly

itchy

more inflammed edge than centre

147
Q

Tinea pedis

A

dermatophyte infection of foot

148
Q

tinea cruris

A

dermatophyte infection of groins

149
Q

tinea capitis

A

dermatophyte infection of scalp

150
Q

tinea unguium

A

dermatophyte infection of nails

151
Q

tinea corporis

A

dermatophyte infection of body

152
Q

Diagnosis of dermatophyte infections

A

skin scrappings

scalp brushings

nail clippings

hair plucking

153
Q

Topical antifungals

A

Imidazoles e.g Clotrimazole (Canesten cream)

Terbinafine e.g (Lamisil cream)

Amorolfine e.g (Loceryl Nail lacquer)

154
Q

Systemic antifungals

A

Itraconazole

Terbinafine

Griseofulvin

155
Q

Yeast skin infections

A

candida albicans

pityriasis vesicolor

156
Q

Candida albicans affects which areas

A

mouth

vagina/ glans of penis

skin fold

toe web and nail

157
Q

Description of candida albicans leisions

A

pink and moist

+/- satellite leisions

158
Q

Skin candida albicans rx

A

imidazole cream

159
Q

Mouth candida albican rx

A

nystatin oral suspension

or miconazole oral gel

160
Q

vaginal canida albicans rx

A

imidazole cream +/- pessary

161
Q

Pityriasis vesicolor species

A

Malassezia (eg M urfur)

162
Q

Pityriasis vesicolor lesion description

A

multiple hypopigmented scaly macules on the upper trunk and back

(they produce azelaic acid which prevents tanning of skin)

163
Q

Rx of pityriasis vesicolor

A

Imidazole cream

Ketaconazole shampoo if more generalised

164
Q

Erythrasma description

A

superficial skin infection that causes brown, scaly skin patches

165
Q

Erythrasma organism

A

corynobacteria

166
Q

Pitted keratolysis decription

A

a superficial bacterial skin infection that affects the soles of the feet

167
Q

Pitted keratolysis organism

A

corynobactor

168
Q

Erythrasma/pitted keratolysis rx

A

topical clindamycin or oral erythromycin

169
Q

Impetigo description

A

contagious superficial infection

start around nose and face honey coloured crust at base

170
Q

Impetigo pathogens

A

staph aureus +/- staph phyogenes

171
Q

Impetigo Rx

A

fusidic acid for local infection

flucloxacillin QDS 7 days

172
Q

Erysipelas

A

sharply defined superficial infection

173
Q

Erysipelas pathogen

A

S pyogenes

174
Q

Erysipelas affects where

A

face unilaterally + fever

175
Q

Difference between cellulits and erysipelas

A

cellulites less well defined and is deeper

176
Q

Pathogens causing cellulites

A

B haemolytics strep + staphs

177
Q

Rx of cellulites and erysipelas

A

elevate affected part

benzylpenicillin 600mg/6hr IV + flucloxacillin 500mg/6hr PO

178
Q

chancre

A

Painless inoculation ulcer

From direct sexual contact

Primary Syphillis

179
Q

Syphillis progression

A

Primary: chancre from direct sexual contact

Secondary: rash or multitude of other sx

latent

Tertiary: gummatous,cardio,neuro

180
Q

Rx of syphillis

A

Penicillin G - 1 dose

181
Q

Lyme disease

A

tick borne

182
Q

Lyme disease rx

A

doxycycline/penicillin

183
Q

Lupus vulgaris

A

red brown scarring plaque

Primary inoculation in person with some immunity

caused by TB

184
Q

Mycobacterium marinum

A

contact with topical fish tank or swimming pool

aka fish tank granuloma

185
Q

Leprosy features

A

tubercloid ( anaesthetic patch)

lepromatous (thickened areas)

186
Q

what is this

A

herpes simplex

187
Q

what is this

A

chicken pox

188
Q

Shingles pathology

A

VZV becomes dorment in root ganglia after chicken pox infection subsided

affects one or more dermatomes

189
Q

what is it

A

shingles

190
Q

HSV rx

A

Nothing for oral

Genital: aciclovir for 200mg 5/daily 1wk + avoid sex until lesions clear (you dont have to worry about this one TOM)

191
Q

What is this

A

filiform (common viral wart)

192
Q

What is this

A

planar wart

flat skin coloured or brown

resist treatment

193
Q

what is this

A

verrucous (viral wart)

aka plantar wart

194
Q

what is this

A

genital wart

195
Q

Which malignancies is HPV associated with

A

CIN, VIN, PIN

(penile,cervical,vulvar intraepithelial neoplasia)

196
Q

Rx for genital warts

A

Cryotherapy every 3wks, up to 4 times

Topical salicytic acid gel (keratolytic) 12 wks

Padophyllin or imiquimod cream

197
Q

What is this

A

molluscom contagiosum

198
Q

Molluscum contagiosum pathogen

A

pox virus

199
Q

molluscum contagiosum rx

A

nil

may takes months to go aways

Squeeze in bath

200
Q

Scabies spread

A

direct person to person eg by holding hands, sharing a bed

201
Q

What causes scabies

A

female mite digs a hole and lay eggs

itch and subsequent rash due to hypersensitivity reaction

202
Q

Scabies rx

A

topical permethrine 5% :

  • left on for 24 hours , applied to neck down , reapplied to hands after washing
  • repeated after 1 week
  • Contacts must be treated to prevent reinfestation
203
Q

Headlice spread

A

head to head contact

204
Q

Headlice rx

A

Topical permethrin or malathion

repeat after 1 week

205
Q

Furuncle def

A

aka boil

deep folliculitis- infection of hair follicle

206
Q

Carbuncle

A

cluster of furuncles together

207
Q

Skin sensitivity to ultraviolet (UV) light (Fitzpatrick classification)

A
208
Q

Rosacea description

A

relapsing remitting disorder of blood vessels and pilosubaceous units

symmetrical facial rash

209
Q

Rosacea vs acne

A

both may papules/postules

rosacea doesnt have comedones

210
Q

Rosacea mx

A

Topical or oral abx

211
Q

Erythema ab igne

A

Painful

RF: heat exposure

may lead to SSC

212
Q

trichotillomania

A

Pulling out your own hair

213
Q

Pityriasis rosea

A

Solitary “Herald” patch

Days later more lesions on trunk

214
Q

Mx of pityriasis rosea

A

Self limiting

May use topical steroids for itch

215
Q

Mx Hyperhidrosis

A

Aluminium chloride

2nd line: Botux or topical glycopyrrolate

216
Q

Skin conditon ass with coeliac

A

dermatitis herpetiformis

217
Q

Pyoderma gangrenosum ass condtions

A

IBD

Rheumatoid

Autoimmune (SLE)

218
Q

Lupus pernio

A

Sarcoid

219
Q

Erythema chronicum migrans

A

lyme disease

220
Q

Keloid vs hypertrophic scar

A

keloid: within the boundary of scar
hypertrophic: beyond the boundary of scar

MS4 - Dermatology (3 decks)

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