Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

- FINALS > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Definition of acne? Causes?

A

Inflammatory disease of the pliosebaceous follicle.

Causes

  • Hormonal (androgens)
  • Increased sebum production
  • Abnormal follicular keratinisation
  • Bacterial colonisation
  • Inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs/symptoms of mild and moderate/severe acne?

A

Mild

  • Non-inflammatory lesions
  • Open and close comedones (blackheads and whiteheads)

Moderate/Severe

  • Inflammatory lesions
  • Papules, pustules, nodules and cysts
  • Affects face +/- torso
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of Acne?

A

Topical Therapies

  • Benozyl peroxide (2.5%)
  • Topical retinoid (isotretinoin) - avoid in prego
  • Topical abx (dalacin T)

Oral Therapies

  • Tetracycline, oxytet, doxy, lymecycline
  • Erythro if pregnant or <12
  • COCP if contraception needed

Oral Retinoids

  • Roaccutane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mode of action of isotretinoin? Side effects?

A

Reduced sebum production and reduced pituitary hormones

  • Teratogenic (contraception during and 1 month after)
  • Skin and mucosal dryness
  • Depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Definition of eczema?

A

Inflammation characterised by papules and vesicles on an erythematous base

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Presentation of eczema?

A

Symptoms

  • Itchy, erythematous and dry scaly patches
  • Infants = face/extensor limbs
  • Adults = flexor limbs
  • Acute lesions = erythematous, vascular and exudative

Signs

  • Chronic scratching –> excoriations and lichenificaion
  • May show nail pitting and ridging of nails
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complication of eczema (secondary infection)?

A

Bacterial

  • Staph aureus/Strep pyogenes
  • Golden crust and postulation
    • Rx = antiseptic washes and topical antibacterial ointments. Oral abx and topical steroids for widespread infections.

Viral

  • Chickenpox, molluscum contagiosum
  • Eczema herpeticum = monomorphic clusters of vesicles that erode and crust. Systemic aciclovir and same day derm referral.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

General advice in eczema?

A
  • Avoid irritants (soap and biological detergents)
  • Clothing to skin should be pure cotton where possible
  • Cut nails short to reduce damage from scratching
  • Mittens at night in the very young
  • Avoid proven precipitants (e.g. cows milk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medical management of eczema?

A

Emolients

  • Apply liberally 2+ times a day and after bath.

Topical Steroids

  • Benefits outweight risks - lowest effective strength.
  • Apply thinly and don’t use on the face.

Others

  • Antihistamines for itching
  • Abx/antivirals for secondary infection
  • 2nd line = topical calcineurin inhibitors (tacrolimus), bandages and stockinette garmets
  • 3rd line = phototherapy and systemic agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Potency of topical steroids?

A

Mild = 1% hydrocortisone

Moderate = 2.5% hydrocortisone

Strong = betnovate/dermovate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Definition of psoriasis? Precipitating factors?

A

Chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration.

  • Trauma (koebner phenomenon)
  • Infection (tonsilitis)
  • Drugs/alcohol
  • Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of psoriasis?

A
  • Chronic plaque (most common)
  • Guttate (raindrop lesions)
  • Seborrhoeic (naso-labial and retro-auricular)
  • Flexural (body folds)
  • Pustular (palmar-plantar)
  • Erythrodermic (total body lesions)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms and signs of psoriasis?

A

Symptoms

  • Well-demarcated erythematous scaly plaques – usually extensor surfaces of body and over scalp
  • Can be itchy, burning or painful

Signs

  • Auspitz sign (scratch and gentle removal of scales causes capillary bleeding)
  • 50% have nail changes (pitting, onycholysis)
  • 5-8% have associated psoriatic arthropathy (seronegative)
  • Oligo/monoarthritis, psoriatic spondylitis, asymmetrical polyarthritis, arthritis mutilans (destructive – DIPJs), rheumatoid-like polyarthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

General advice/management of psoriasis?

A
  • Education
  • Avoid precipitating factors
  • Emollients to reduce scales and relieve irritation
  • For topical treatments choose a base the patient prefers (ointment, cream, lotion, gel or foam)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of psoriasis?

A

Topical Therapies (localised and mild)

  • Vitamin D analogues (dovonex)
  • Topical steroids (betnovate) - no more than 8 weeks
    • Combination = dovobet
  • Coal tar preparations (Exorex) - if widespread

Phototherapy

  • If >10% body surface or uncontrolled by conventional therapy
  • Narrowband UVB phototherapy/PUVA (PUVA increases SCC risk)

Oral Therapies

  • Non-biologics - methotrexate, ciclosporin, acitretin
  • Biologics - TNF-a antagonists, IL antagonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Side effects of non-biologic therapies for psoriasis?

A
  1. Methotrexate
    • Once a week. Avoid in young due to risk of hepatic fibrosis long term.
    • Monitor FBC/LFT
  2. Ciclosporin
    • ↑BP and renal dysfunction
  3. Acitretin (oral retinoid)
    • Teratogenic, dry skin, ↑lipids, glucose and LFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are warts? What causes them?

A

Papules or nodules with a hyperkeratotic or filiform surface, most commonly seen at sites of trauma (fingers, elbows, knees and pressure points on soles) in children

Caused by HPV in keratinocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of warts?

A

Usually disappear (months-2 yrs) without treatment and scarring.

Consider active management if painful, unsightly or persistent.

  • Topical salicylic acid (keratolytic) gel – daily for 12 weeks
  • Cryotherapy (not in small children as is painful) – once every 3-4 weeks for up to 4 cycles.
  • Duct tape occlusion (leave inplace for 6 days at a time for up to 8 weeks – probably placebo)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a BCC? Risk factors?

A

Slow growing locally invasive malignant tumour of the epidermal keratinocytes. Rarely metastasises.

  • UV exposure
  • History of severe or frequent sunburn in childhood
  • Skin type I (always burns, never tans)
  • Age
  • Male sex
  • Immunosuppression
  • Previous hx of skin cancer
  • Genetic predisposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Presentation and complications of BCC?

A
  • Pearly nodule
  • Rolled telangiectatic edge on the face or a sun exposed site
  • +/- central ulcer (necrotic or ulcerated centre – rodent ulcer)
  • Most common on head and neck

Local tissue invasion and destruction if left untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management of BCC?

A
  1. Surgical Excision
    • 1st line - allows histological examination
    • Mohs micrographic surgery - for high risk recurrent tumours
  2. Other
    • Cryotherapy, radiotherapy, photodynamic therapy
  3. Topical
    • Imiquimod or fluorouracil - for superficial lesions at low-risk sites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Definition of SCC? Risk factors?

A

Locally invasive malignant tumour of the epidermal keratinocytes or its appendages, which has the potential to metastasise

  • Excessive UV exposure
  • Pre-malignant skin conditions (actinic keratosis)
  • Immunosuppression
  • Chronic inflammation (leg ulcers, wound scars)
  • Genetic predisposition
  • HPV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does SCC present? Complications?

A

Persistently ulcerated or crusted (keratotic) lesion often on sun-exposed sites

  • Local invasion and metastasis
  • High risk if
    • Near lip, ear or non-sun exposed site (sole, perineum),
    • Immunosuppressed, large etc.
24
Q

Management of SCC?

A
  • Surgical excision – treatment of choice.
  • Mohs micrographic surgery – may be necessary for ill-defined, large, recurrent tumours.
  • Radiotherapy – for large, non-resectable tumours.
25
Q

Definition of melanoma?

A

Invasive malignant tumour of the epidermal melanocytes which has the potential to metastasise

26
Q

Risk factors for melanoma?

A
  • Excessive UV exposure
  • Skin type I
  • History of multiple/atypical moles
  • Personal/family history of melanoma
  • Large numbers of moles
  • 3 or more episodes of sunburn
27
Q

How do most melanomas arise?

A

. Most arise de novo, not in pre-existing melanocytic naevi.

28
Q

Types of melanoma?

A
  1. Superficial spreading
  2. Nodular
  3. Lentigo Malinga
  4. Acral Lentinginous
29
Q
A

Superficial Spreading

Common on the lower limbs, in young and middle aged adults; related to intermittent high intensity UV exposure

30
Q
A

Nodular

Common on the trunk, in young and middle aged adults; related to intermittent high-intensive UV exposure

Ulceration –> bad sign

31
Q
A

Lentigo Malinga

Common on face in elderly population; related to long term cumulative UV exposure

(Melanoma in situ - not yet invasive. When it gets a lump in the middle it becomes lentigo maligna melanoma)

32
Q
A

Acral Lentinginous

Common on the palms, soles and nail beds, in elderly population; no clear relation with UV exposure.

(Acral = hands and feet, lentiginous = flat patch)

Subungual = under the nail

33
Q

Signs of melanoma?

A

ABCDE Symptoms Criteria

  • Asymmetrical shape
  • Border irregularity or blurring
  • Colour irregularity (black, brown, blue, pink)
  • Diameter >6mm
  • Evolution of lesion (e.g. change in size and/or shape)
  • Symptoms (e.g. bleeding, itching).

Others = ulcerated, inflamed

34
Q

Chance of recurrence of melanoma?

A

Based on Breslow thickness

  • <0.76mm – low risk (95% 5 year survival)
  • 0.76mm-1.5mm – medium risk
  • >1.5mm – high risk.
35
Q

What is a venous ulcer and how is it caused?

A
  • Venous HTN from incompetent valves –> superficial varicosities and skin changes (dermatosclerosis)
  • Minimal trauma causes ulcers (usually over medial malleolus)
36
Q

Appearance of arterial ulcers?

A

Punched out

37
Q

Risk factors for venous ulcers?

A

Varicose veins, venous insufficiency, poor calf muscle function, arterio-venous fistulae, obesity, leg fracture

38
Q

Management of venous ulcers?

A

Graded Compression Bandaging

  • Promotes venous return, reduced venous pressure –> healing
  • Do doppler first to exclude PAD

Infected ulcers

  • Systemic abx - avoid topical as they increase resistance and contact dermatitis

General

  • Analgesia
  • If no healing in 3 months, investigate further (biopsy for malignancy)
39
Q

Prevention of recurrence of venous ulcers once healed?

A

compression stockings, skin care, leg elevation, calf exercises, good nutrition

40
Q

What is actinic keratosis?

A
  • Pre-malignant crumbly yellow-white scaly crusts on sun-exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes.
  • Prevalence = 52% at 70 yrs old.
41
Q

What is a keloid scar?

A

Exaggerated scarring (from excess collagen production, especially type III) to beyond the confines of the initial wound and can appear progressively and after a delay

42
Q

What is a ganglion cyst and where do they occur?

A
  • Fluid filled lump associated with a joint or tendon sheath
  • Usually back of wrist or front of wrist
  • No further symptoms usually - can cause pain, numbness, carpal tunnel syndrome.
43
Q

What is this?

A

Congenital Naevus

  • Painless large dark coloured mole - scalp or trunk of body.
  • Increased risk of skin cancer as adults.
44
Q

>6 cafe au lait spots?

A

?neurofibromatosis

45
Q

What is port wine stain associated with?

A

Sturge weber syndrome: seizures, learning disorders, glaucoma

46
Q

What is this?

A

Kaposi’s Sarcoma

  • Abnormally vascularised spindle cell tumour derived from capillary endothelial cells.
  • Cause = HHV-8 (herpes hominis virus)
  • Incidence decreasing due to HAART
  • Purple papules or plaques on the skin and mucosa of any organ. Metastasises to nodes.
47
Q

Skin signs in diabetes?

A
  • Flexural candidiasis
  • Necrobiosis lipoidica
    • Waxy, shiny yellow areas on shins
  • Acanthosis nigricans
  • Granuloma annulare
    • Ring of small pink, purple or skin-coloured bumps. It usually appears on the back of the hands, feet, elbows or ankles
  • Folliculitis
48
Q

Skin sign of coeliac disease?

A

Dermatitis Herpetiformis

  • Itchy ‘burning’ blisters on elbows, scalp, shoulders, ankles
49
Q

Skin signs in IBD?

A

Erythema Nodosum

  • Tender ill-defined nodules on shins
  • Also sarcoid, drugs, TB, strep

Pyoderma Gangrenosum

  • Rapidly growing, very painful, tender red/blue overhanging necrotic edge.
  • Leg, abdomen, face
50
Q

What does erythema multiforme look like? Causes?

A
  • Erythematous well defined lesions on extensor surfaces of peripheries, palms, soles
  • Evolve into target lesions
  • Major form has systemic upset and severe muscoal involvement

Causes = herpes simplex, mycoplasma, CMV, drugs

Resolves spontaneously in 4 weeks

51
Q

What is erythema migrans? Treatment?

A

Lyme disease - red ring lasting weeks to months

Abx treatment = doxy, amox or cefuroxime

52
Q

Examples of cutaneous vasculitis?

A
  • Palpable purpura (e.g. on legs)
  • Nodules
  • Painful ulcers
  • Livedo reticularis

Caused by: idiopathic, PAN, HSP, GPA

53
Q

What is Livedo Reticularis?

A

Non-blanching vague pink-blue mottling, most often on legs.

Caused by connective tissue disease, vasculitis, cholesterol emobil and hyperviscosity states

SLE!!

54
Q
A
55
Q

Keratoanathoma?

A
  • Rapidly growing tumour (weeks) - keratinizing squmous cells, resolving spontaneously (3 months) if untreated
  • Central part of face, hand, forearm
  • Incidence related to sun exposure
  • Need to treat as if SCC

- FINALS (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions