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Onc/ Breast / Derm - C.U > Dermatology > Flashcards

Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

Important aspects of a social Hx in dermatology

A

Occupation
Hobbies
Sun beds
Skin type

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2
Q

Macule =

A

change in skin colour without elevation

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3
Q

Papule =

A

circumscribed raised lesion (0.5-1mm)

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4
Q

Plaque =

A

a circumscribed, palpable lesion more than 1 cm in diameter; most plaques are elevated.

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5
Q

Nodule =

A

circumscribed raised lesion >1cm

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6
Q

vesicle =

A

raised lesion that contains fluid

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7
Q

bullae =

A

vesicle >0.5cm

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8
Q

lichen simplex =

A

hard thickening of skin with accentuated skin markings

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9
Q

nummular lesion =

A

coin like lesion

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10
Q

pustle =

A

lesions containing purulent material

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11
Q

ulceration =

A

loss of the whole thickness of the epidermis and upper dermis
heels with scaring

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12
Q

erosion =

A

superficial loss of epidermis, generally heels without scarring.

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13
Q

annular lesions =

A

lesions in a ring

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14
Q

reticulate =

A

net like

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15
Q

hidden areas in a full skin exam -

A

nails, web spaces, scalp, mouth and flexures.

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16
Q

Extra parts to a skin exam to offer -

A

Lymph nodes
Pulses
Joint examination

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17
Q

3 layers of skin

A

Epidermis
Dermis
Subcut layer

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18
Q

mild topical steroid -

A

1% hydrocortisone

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19
Q

moderate topical steroid -

A

2.5% hydrocortisone

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20
Q

Strong topical steroid -

A

betnovate

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21
Q

treat puritis in eczema with -

A

antihistamine

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22
Q

2nd line topical therapy for eczema -

A

topical tacrolimus
bandages
stockinette garments

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23
Q

3rd line for eczema -

A

phototherapy

systemic agents

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24
Q

common causes of secondary infection in eczema -

A

strep pyogenes and staph aureus

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25
Q

example of a combined antibiotic and steroid cream for secondary infection of eczema

A

fucidin H

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26
Q

secondary viral infection due to chicken pox in children with eczema -

A

molluscum contagiosum

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27
Q

dermatological emergency caused by HSV

A

eczema herpeticum

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28
Q

presentation of eczema herpeticum

A 
areas of painful worsening eczema 
clustered blisters - like early cold sores
punched out erosions 
fever 
lethargy
distress
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29
Q

chronic plaque psoriasis

A

commonest clinical presentation of psoriasis
raised erythematous patches
covered with a silverly white build up of dead skin cells
often itchy / painful

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30
Q

Plaques are often found where in chronic plaque psoriasis?

A 
Behind the ears 
Genitalia 
Scalp 
Nails 
Umbilicus 
Knees 
Elbows 
Natal Cleft
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31
Q

Guttate psoriasis =

A

small pink plaques on the trunk
raindrop lesions
often seen after a strep sore throat
1/3 go on to develop CPP

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32
Q

Flexural psoriasi =

A

psoriasi in genitalia / axillae - sites of friction

erythermatous and slightly shiny - don’t have the charactersitic scale

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33
Q

erythodermic psoriasis =

A 
total body redness 
lack of clearly defined plaques 
skin is red, hot and painful 
can feel systemically unwell and become hypotensive
should be admitted to hospital
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34
Q

generalised pustular psoriasis =

A

flare of psoriasis -> pustles with plaques

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35
Q

on which surfaces are psoriatic plaques usually found?

A

extensor

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36
Q

asupitz sign =

A

scratching of the plaques causes capillary bleeding

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37
Q

how many patients with psoriasis suffer from associated arthropathy ?

A

5%

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38
Q

Initial treatment for mild localised psoriasis

A

Emolliant regularly to improve scale

once a day topical potent steroid (not for longer than 8 weeks)

once a day vit D analogue

(applied one in morning and one at night)

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39
Q

What is used to treat extensive psoriasis?

A

phototherapy

oral therapies - methotrexate, retinoids, biologics (useful if joint disease)

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40
Q

Hormone conditions causing acne -

A 
POCS 
Virilizing tumours 
Congenital adrenal hyperplasia 
Cushings 
Acromegaly
41
Q

Medications causing acne -

A 
Topical / systemic steroids 
OCP 
Phenytoin 
Barbituates 
Isoniazid 
Ciclosporin 
Lithium
42
Q

Topical therapies for acne

A

Benzoyl peroxide
Azelaic acid
Topical AB
Topical retinoids

43
Q

What should you not combine in terms of acne therapy?

A

Oral and topical AB

44
Q

3 types of oral treatments for moderate - severe acne -

A

AB
Hormonal therapy - co-cyrindiol (anti androgen)
Oral retinoid (isoretinoin) - must be given be a dematologist

45
Q

Size effects of isoretinoin

A

Severe skin dryness
Mucous membrane dryness
Nose bleeds
Joint pains

46
Q

Other general principles of acne prevention

A

Avoid humid conditions
Stop smoking
Eat plenty of fruit and veg
Minimise application of oils and cosmetics
Abrasive skin treatments can aggrevate
Do not wash >2 p/d
Women should consider COC in those that require contraception.

47
Q

Actinic keratoses =

A

Pre malignant skin condition
Found on exposed skin on those that have worked outdoors / exposed to high intensity UV
Rough areas of skin and can be raised keratotic lesions with irregular edges. Usually <1cm in diameter.

48
Q

A skin that an actinic keratoses lesion may have malignant changes -

A

rapid growth / painful / inflamed

49
Q

Management for actinic keratoses single lesions -

A

cryotherapy

50
Q

Topical treatments for actinic keratoses -

A

5-Fluorouracil
Imiquimod
Topical NSAIDs

51
Q

Risk factors for SCC

A 
excessive UV exposure 
actinic keratoses 
chronic inflammation 
immunosuppression 
genetic predisposition
52
Q

Presentation of SCC

A 
Indular nodular lesions 
Often keratotic 
Ill defined 
May ulcerate 
Can be painful
53
Q

Common sites for SCC

A

Face
Scalp
Back of hands

54
Q

What clinical features suggested a poorer progression for SCC

A

tumour >2cm in size
Lesion on lip / ear
Hx of immunosuppression

55
Q

Main management of SCC

A 
Surgical excision (4-6mm margin) 
Radiotherapy - large non resectable lesions
56
Q

Risk factors for BCC

A 
Increasing age 
Fair skin 
High intensity UV exposure 
Radiation 
Immunosuppression 
Previous hx
57
Q

Presentation of BCC

A

Small papules
Pearly and translucent quality
Clear to deeply pigmented

58
Q

Treatment options for BCC

A 
excision 
Radiotherapy 
Grafting 
Cuvettage 
Cautery 
Cryotherapy
59
Q

ABCDE of malignant pigmented lesions

A

Asymmetry
Border (? irregular)
Colour - variation may be a sign of dysplasia / malignant change
Diameter (>1cm more likely to be malignant)
Evolving

60
Q

What regulates melanocytes?

A

MSH

61
Q

Junctional naevus =

A

melanocyte poliferation at the dermo-epidermal junction

brown and flat lesions

62
Q

Intradermal naevus =

A

melanocytes in the dermis

skin coloured and raised

63
Q

intermediate naevus =

A

central part melanocytes in the dermis
peripheral in the junction
so a raised centre with a brown border

64
Q

compound naeuvus =

A

melanocytes at the junction and within the dermis

so raised brown lesion

65
Q

risk factors for malignant melanoma

A 
solar radiation 
light skin tones 
poorly tanning skin 
red / fair hair 
personal / FHx 
presence of giant congenital melanocyte naeve 
Multiple common moles 
Changes in moles
66
Q

Prognosis in malignant melanoma depends on?

A

Breslow thickness

67
Q

What indicates a poorer prognosis is multiple melanoma

A

Ulceration
Lymph node involvement
Skin mets

68
Q

Treatment for MM

A

Exision with a 2mm marking

FNA if lymph node palpable

69
Q

Treatment for uncomplicated cellulitis

A

Flucloxacillin

70
Q

Treatment for MRSA cellulitis

A

Doxycycline - mild

Vancomycin - extensive

71
Q

Which patients are at higher risk of cellulitis

A

Venous stasis
Lymphoedea
Diabetes

72
Q

Who are at high risk of necrotising fascitis

A

IV drug user

73
Q

Presentation of nec fas

A

pain out of proportion to the lesion
systemically unwell
rapid progression
post surgery / trauma

74
Q

How to diagnosis NF

A

USS but also clinical diagnosis

75
Q

Treatment of NF

A

Surgical debridement of all necrotic tissue

Wide spectrum of AB

76
Q

Usual cause of gas gangrene

A

C perfirnges

77
Q

Features of gas gangrene

A

Tender
Oedematous skin
Haemorrhaig blebs and bullae
Crepitus and palpation

78
Q

What can gas gangrene progress to?

A

Toxaemia and shock

79
Q

Treatment of gas gangrene

A

Debridement and excision
Amputation may be needed
Antibiotics

80
Q

Erythroderma -

A

exfoliative dermatis involving at least 90% of the skin surface

81
Q

Causes of erythroderma

A

Previous skin disease e.g. eczema and psoriasis
Lymphoma
Drugs
Idiopathic

82
Q

Presentation of erythroderma

A

Skin inflammed, oedematous and scaly
Systemically unwell
Lympadenopathy
Malaise

83
Q

Treatment of erythroderma

A

Treat the underlying cause
Emolliants
Wet wraps
Topical steroids to reduce inflammation

84
Q

Major features of a lesion that needs to be referred for two week wait (these get 2 points)

A

change in size
irregular shape
irregular colour

85
Q

Minor features of a lesion that needs to be referred for two week wait (these get 1 point)

A

Largest diameter >7mm
Inflammation
Oozing
Change in sensation

86
Q

Other cases than the 7 point scale where 2 ww is considered

A
  • dermatoscopy suggestes malginant melanoma

- SCC suspicion

87
Q

BCC referral

A

routine referral

88
Q

When is 2ww considered in BCC

A

When delay may have a significant impact e.g. due to lesion site / size

89
Q

Applying emolliant and corticosteroids

A

wait 30mins between

90
Q

how long after flare up of eczema should you apply corticosteroids?

A

48hrs

91
Q

how often to apply corticosteroids?

A

once a day

92
Q

patch

A

a large area of colour change, with smooth surface

93
Q

action of vit d analogues in psoriasis?

A

they reduce scale but not erythema

94
Q

Dermatitis Herpetiformis is?

A

Chronic itchy clusters of blisters.

Linked to underlying gluten enteropathy (coeliac disease).

95
Q

Scoring system used in melanoma

A

Breslow depth

96
Q

Kaposi’s sarcoma associated with which virus?

A

HHV-8

human herpes virus 8

97
Q

Kaposi sarcoma?

A

Tumour of vascular and lymphatic endothelium.

Purple cutaneous nodules.

Associated with immuno supression.

Classical form affects elderly males and is slow growing.

Immunosupression form is much more aggressive and tends to affect those with HIV related disease.

98
Q

Dermatitis Herpetiformis is?

A

Chronic itchy clusters of blisters.

Linked to underlying gluten enteropathy (coeliac disease).

Onc/ Breast / Derm - C.U (3 decks)

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