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MRCP Part 2 and PACES > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Cutaneous manifestation of sarcoid?

A

Sarcoid granulomas

  • 1a hydroxylase activated by M0
  • conversion of inactive to active vitamin D
  • increased calcium absorption / decreased calcium secretion. PTH suppressed

Lupus Pernio

small black raised papules that may coalesce

Indication of active sarcoid and associated with more severe disease

  • responds poorly to topical agents
  • increase dose of systemic steroid

ERYTHEMA NODOSUM
Painful erythematous or pigmented lesions which are poorly defined
-LOFGRENS SYNDROME = SARCOID with Erythema Nodosum / Hilar involvement / Arthropathy

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2
Q

Pemphigus - describe

A

Flaccid blisters
(raised = pemphigoid)
Ig deposition throughout epidermis
(basement membrane = pemphigus)

Treat with high dose steroids
look for mucosal ulceration

long term low dose steroids to maintain remission - 2 years

mortality on treatment 5-15%

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3
Q

Pemphigoid - describe

A

Cutaenous tense blisters
Ig deposition in basement membrane only and not in epidermis itself

treated with high dose steroids to stimulate remission
Tapering and long term low dose steroids for up to 2 years

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4
Q

Lichen planus

A

Eczematous outbreak with white lines streaking throughout and ITCHY
See white striae especially in mouth

causes pruritis - steroids if so

self limiting.

Flexor surfaces (esp wrists)
(Eczema is on extensor surfaces then moves to flexors)

white lines = WICKHAM’S STRIAE

Koebner phenomen
- follows excoriation lines and scars
(as psoriasis)

Associated:
B blockers
TZD or indapamide
methyl dopa
anti-malarials
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5
Q

What are Wickham’s Striae

A

White lines seen via hand lens pathogenic for lichen planus

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6
Q

What is Koebner’s phenomenon

A

Rash follows scars or excoriations

  • lichen planus
  • psoriasis
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7
Q

Scabies

A

SARCOPTES SCABIEI
Human scabies mite
burrows into epidermis
NOCTURNAL PRURITIS

Pruritis onset 4-6 weeks after infection - hypersensitivity to mite or waste products deposited in skin.
RESULTS IN SECONDARY ECZEMA

See burrows between finger webs and toes
Itchy
penile papules
Widespread itchy macular rash

Residential homes
Hostels

TREATMENT: PERMETHRIN
BOIL WASH / THROW OUT ALL LINEN

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8
Q

Dermatofibroma

A

White pearly papule
dimples when pinched

benign

occurs post trauma

Excision

  • diagnostic to R/O BCC
  • cosmetic
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9
Q

Describe a typical syphillitic chancre and its management

A
  • shallow ulceration
  • typically painless but not always

typically 6 weeks post infection

management:
Benzylpenicillin single dose IM

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10
Q

Describe a benign epidermal naevus

A

Typically over shoulder region
pigmented due to melanocyte melanin deposition
may have a white demarcation as well
may have hair

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11
Q

Describe a mangolian blue spot

A

blue naevus typically on lumbar spine but may also be seen on sclera

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12
Q

Describe naevus flaevum

A

Port wine stain

When on the face should be investigated for leptomeningeal AVM

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13
Q

Describe the associations of acanthosis nigricans

A
  1. Colonic carcinoma
  2. Addisons
  3. Cushings
  4. Hypothyroidism

Deeper pigmentation in creases

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14
Q

Describe the lesions in erythema nodosum

A

Poorly demarcated tender nodular epidermal lesions

Due to neutrophillic inflammation of adipocytes

Sarcoid
mycoplasma pneumonia

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15
Q

Erythema multiforme

A

Target lesions

multiple differentials

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16
Q

Roth spots

A

retinal microhaemorrhages with white centre

multiple pathologies
Ig deposition in vasculitis
HIV
bacterial endocarditis microembolism
mycoplasma pneumonia
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17
Q

Janeway Lesions

A

Bacterial Endocarditis

Palmer SC lesions
Poor demarcated
erythematous
painless

Represent dermal microabscesses secondary to septic embolisation in bacterial endocarditis

18
Q

Osler nodes

A

Bacterial Endocarditis

Vasculitic manifestation therefore purpuric in appearance
Painful / tender nodules
Ig deposition throughout

19
Q

Describe a shingles rash

A

Vesicular outbreak that then crusts and heals
specific to a dermatome in distribution corresponding to the infected anterior horn

Treat with oral aciclovir n the acute instance

If already crusting treat post herpetic neuralgia with gabapentin 300mg daily and increase to 900mg daily (therapeutic dose)
target dose 3.6g/day

20
Q

What is impetigo

A

Superficial infection of the skin by staph aureu / A haemolytic strep

highly contagious

causes maculo-papular vesicular rush with crusting and discharge

topical abx - FUSIDIC ACID

IF WIDESPREAD - FLUCLOX OR ERYTHROMYCIN

21
Q

What is Pyoderma Gangrenosum

A

Auto immune necrotising skin condition cuasing blisterin and ulceration over wound sites and sites of trauma

NON HEALING STERILE PAINFUL ULCER
i.e. no response to fluclox

AssociatIons

Inflammatory bowel disease:
Ulcerative colitis
Crohn’s disease

Arthritides:
Rheumatoid arthritis
Seronegative arthritis

Hematological disease:
Myelocytic leukemia
Hairy cell leukemia
Myelofibrosis
Myeloid metaplasia
Monoclonal gammopathy

Autoinflammatory disease:
Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)

Treatment:
Prednisolone 60mg od

22
Q

How is Atopic Eczema treated?

A

Treatment:
Aqueous creams
topical steroids
Calcineurin inhibitor - Tacrolimus in severe or resistant atopic eczema

23
Q

What is oral hairy leukoplakia?

A

White painless plaques over the lateral aspects of the tongue.

Cause:
REACTIVATION OF EBV
SIGN OF ?HIV in context of EBV reactivation

mx:
HIV testing

24
Q

Describe what erythema gyratum ripens looks like and what its associations are

A

Erythematous rash which appears as concentric rings like wood grains
Associated with Squamous cell carcinoma of the bronchus

25
Q

What are the prognostic markers in malignant melanoma?

A

Form of skin cancer arising from pigmented melanocytes

risk factors:

  1. Family history
  2. sun exposure

prognosis:
depth at excision MOST IMPORTANT-BRESLOW THICKNESS

8 year survival
<0.76MM    93%
<1.69MM    85%
<3.6MM     60%
>3.6MM     33%
signs:
asymmetric
poor defined
elevated
increasing sie
change in colour
26
Q

What is lupus vulgaris?

A

Tuberculoid focal and limited infection
Typically deforming due to granulomatous process

Treat as pulmonary TB
RIPE
rifampicin
isoniazide
pyridoxine (side effects of ethambutol and isoniazid to prevent neuropathy via supplement Vit B6)
ethambutol
27
Q

What is Pityriasis Versicolor?

A

Caused by a fungal skin infection:
MALASSEZIA FURFUR

HYPO OR HYPERPIGMENTED macules <1cm
ring of scar tissue surrounds
fine scaling ring
widespread

treatment:
ketoconazole shampoo
itraconazole 200mg OD

Similar to Vitiligo
VITILIGO = DEPIGMENTATIONS >1CM + NO SCALING + HANDS FACE GENITALIA DOMINATE

28
Q

Cutaneous manifestation of gastric adenocarcinoma

A

Acanthosis nigrans
- dark pigmentation in skin folds / face
LOOK FOR VIRCHOWS NODE

29
Q

Cutaneous manifestation of coeliac disasee

A

Dermatitis Herpetiformis

chronic blistering skin condition, characterised by blisters filled with a watery fluid.

30
Q

Cutaneous manifestation of Crohns disease

A

Erythema nodosum - painful Ig complex deposition + infl

Pyoderma gangrenosum - superficial flaccid ulcers with granulomatous borders

31
Q

Management of keloid scars?

A

Intradermal corticosteroid - helps with resolution and itching.

32
Q

What are the symptoms of ZINC deficiency

A

dermatitis
alopecia
diarrhoea

SEE BEAUS LINES nails

ACRODERMATITS ENTEROPATHICA

33
Q

What are the symptoms of Pellagra?

A

Vit b3 deficiency

Dermatitis
Diarrhoea
dementia

34
Q

What are features of superficial spreading melanoma?

Name 3 differentials

A 
malignant melanoma = cancer of melanocytes
irregular 
increased pigmentation
nodular
66% arise from normal skin
33% arise from existing naevus
Superifical = good prognosis as no deep penetration
depth = prognosis

diffs
lentigo maligna
- benign and superficial but not as well contrasted with skin
BCC
-classically heavy pigmented with pearly rolled border whcih is regular - alignant melanoma classically is irregular

35
Q

How is solar keratosis treated?

What can it progress to?

A

Topical 5 FU
Cryotherapy

Can progress to SCC

36
Q

How is mild / mod acne treated?

Whats the major risk in using it?

A

Isotretinoin topical

TERATOGENIC

37
Q

How is solar keratosis managed?

A

5 fluoro uracil first line
Diclofenac gelt
cryotherapy

38
Q

What is granuloma annulare

A

coalesced dermal papules that form a ring
typically backs of hands / extensor surfaces

degenerative collagen surrounded by granulomas

entirely benign of unclear aetiology
prednisolone = effective remission

39
Q

What does mycobacterium marinum cause?

A

localised mycobacertial infections typically over hands due to mycobacterium marinum

fish tanks / aquariums

40
Q

How does pityriasis versicolor present?

A

fungal infection causing hypopigmented rings
- yeast infection

Superficial cotrimazole

41
Q

Stevens johnson syndrome causes..?

A

toxic epidermal necrolysis (TEN)

drug reactions are associated:

SLE
HLA-DRw4

Han Chinese
HLA-B1502

Japanese and Europe
HLA-1301

42
Q

How is alopecia areata managed?

A

Topical steroids
Intralesional SC steroids - hydrocortisone / triamcinolone
-steroid sparing effects
wigs
counselling - stress
tattooing
topical minoxidil for androgen sensitive alopecia

MRCP Part 2 and PACES (17 decks)

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