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MBChB 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the functions of skin?

A

Protection:

  • Mechanical, heat, cold, light

Metabolic:

  • Conversion of T4
  • Synthesis of Vitamin D
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2
Q

What questions should be explored in history of presenting complaint for a skin condition?

A
  • How long has it beeng going on for
  • How has it progressed?
  • Has it regressed and replased?
  • Associated with exposure to anything
  • How has it affected work etc
  • How have you been trying to treat it?
  • Have you been put on any next drugs?
  • FHx of skin conditions/ Family have skin problems (lice/scabies)
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3
Q

What is the distribution of a scabies infection?

A

Ankles, Knees, Belt, flexor surface wrist, cubital fossa ( flexor surface), Axilla

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4
Q

Typically where do you not see scabies above?

A

Neck and above

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5
Q

What are the features of a macule?

A
  • Flat lesions
  • < 1cm
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6
Q

What are the features of a patch?

A
  • Flat lesions >1cm
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7
Q

What are the features of a papule?

A
  • Raised lesions
  • < 0.5mm
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8
Q

What are the features of a nodule?

A
  • Raised lesions > 0.5 mm
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9
Q

What are the features of plaques?

A
  • Raised edge
  • Flatter surface
  • > 1 cm
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10
Q

What are the features of a pustule?

A
  • Raised lesions filled with pus
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11
Q

What are the features of a vesicle?

A
  • Raised lesions filled with fluid < 0.5mm
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12
Q

What are the features of a bulla?

A
  • Raised lesions filled with fluid > 0.5mm
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13
Q

What are the features of purpura?

A

Raised red rash that will not blanch

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14
Q

What are the features of a wheal?

A

A compressible dermal swelling

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15
Q

What feature suggestes a chronic ulcer?

A

Undermining

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16
Q

What are fungal infections associated with?

A

A fine scaly edge / patch

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17
Q

Describe the nail anatomy

A

Nail matrix

Root of nail

Proximal nail fold

Eponychium (visble part of nail that is under cuticle)

Curticle

Lanula ( halfmoon base of nail)

Peronichium

Nail plate ( Body of nail)

Hyponychium

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18
Q

What is the hair cycle?

A
  • Anagen: Growing phase
  • Catogen: Cease growing phase
  • Telogen: Resting phase
  • Exoge: Hair falls out, pushed by another new hair
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19
Q

What questions should you ask related to hair loss?

A

Pattern of loss:

  • Generalised
  • Scarring
  • Localised

Hair denstity changes

Inflammation?

Pustules? –> Follicular plugging

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20
Q

What is telogen effluvium?

A
  • Gernalised synchronised catogen
  • Sudden abrupt hairless resulting from recent body stress
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21
Q

What may cause telogen effluvium?

A

Triggered by:

  • Severe illness
  • bouts of fever
  • haemorrhage,
  • childbirth
  • severe dieting
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22
Q

How does telogen effluvium differ from aplopecia arreta?

A
  • Alopecia areata is more patchy hairloss
  • Onset is abrupt, but waxes and wanes in alopecia
  • Presence of “exclamation mark hairs” in alopecia arreta
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23
Q

What conditions may cause generalised hair loss?

A

Telogen Effluvium

Alopecia areata

Malnutriton

Androgenic alopecia

Endocrine: thyroid disease

Drugs

Deficiecny: Iron, zinc, vitamin D

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24
Q

Is telogen effluvium perminent?

A

Transient loss of hair

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25
What is androgenic alopecia?
* Non-scarring hair loss in male pattern/female pattern balding * Familial
26
How does androgenic alopecia differ in men and women?
Men: Hair loss begins at temples and then crown Women: Diffuse hair loss over crown. Bald areas replaced by vellos hair
27
What is traction alopecia?
Hair pulled out by beatification treatment, including repeated straigthening,
28
What is this?
Tinea capitus: Patch of scaling with broken hairs
29
What investigations should be undertaken for hair loss?
* Hair pull test * Hair pluckings * Skin scraping * Scalp biopsy (+ immunofluorescence for CDLE) * Blood tests
30
What electrolyte is important for hair?
Iron
31
Causes of scarring hair loss?
* Burns/Trauma * Cutaneous discoid lupus erythematosus * Frontal fibrosing alopecia * Lichen planus
32
What is this diagnosis?
Alopecia areata * Yellow/black dots * Broken hairs * Tapering hairs * Exclamation point hair
33
What is the treatment for alopecia areata?
* None * Topical steroids/systemic steroid * PUVA * Dithranol * Diphenocyoprone ( causes dermatitis reaciton on scalp)
34
What is trichotillomania?
Obscession in pulling out hairs
35
What are the investigations for tinea capitus?
Skin scramping Hair plucking Woods lamp
36
Trx for tinea capitus?
Oral antifungal: Giseofluvin
37
What nail features may be assoicated with telogen effluvium?
Beaus lines
38
What are the treatment for cuteanous discoird lupus erythematosis?
Topical Steroid Hydroxychloroquine Photoprotection
39
Treatment for andriogenic alopecia?
* Minoxidil (anti-hypertensive, helps with hair regain) * Anti-androgens * Wig service
40
What do Beau's like form?
Acute arrest of the nail from bodily stress
41
What conditions are associated with hirsutism?
Adrenal hyperplasia (adrenal tumour) PCOS Ovarian malignancy Hyperprolatinaemia Drugs: Danazol, glucocorticoids Associatied with: Seborrhea, acne and androgenetic alopecia
42
What investigations should be carried out for hirsutism?
Testoesterone Dehydroepiandrostone (DHEA) Sex Hormone Binding Globulin (Free androgen index) LH FSH
43
What is the most adundant circulating steroid?
Dehydroepiandrosterone (DHEA)
44
Why should you measure sex hormone binding globulin in hirsutism?
Measure the amount of bound and unbound steroid. Increased unbound steroid/androgen is associated with hirsuitism
45
What is hypertrichosis?
Excessive hair growth in a non-andogengenic distribution
46
What may cause hypertrichosis?
Malnutrition Anoexia Porphyria C.T Drugs
47
What drugs are associated with hypertrichosis?
Minodixil Phenytoin Cyclosporin
48
Is hyerptrichosis localised or generalised?
Both
49
What is this condition ?
Acute paronychia
50
What are the organisms associated with acute paronchyia?
Staph aureus Strep Pyogenes
51
What is the cause of chronic paronychia?
Mostly candida
52
This is an accral malignant melanoma. What sign is it displaying?
Hutchinson Sign: Spreading pigmentation
53
What is a myxoid cyst?
* Smooth domed swelling that contains clear jelly-like material. * Found on proximal nail folds
54
What is genital lichen sclerosis?
* Non-induated shiny macules on genital (penis / vulva) * Intractable itch * Men: * May cause urethral meatus stenosis * Fusion of foreskin to gland * Females: * Increased risk of vulval carcinoma
55
What are the nail features of lichen planus?
* Longitudinal ridging * Pterygium
56
What is lichen planopilaris?
Scarring hair loss resulting from lichen planus on scalp
57
What type of drug reaction is this?
Exanthematous drug erruption | (Most common type of drug erruption)
58
What drugs are associated with drug erruptions?
Penicillins Carbamazepine Allopurinol NSAID
59
When can a exanthematous drug eruption occur?
Anywhere up to 2-3 weeks post administration
60
What drug reaction typically occurs up to 36 hours after comsuming?
Drug induced urticaria
61
What is this?
Erythema Nodosum ## Footnote Large painful dusky plaques on shins
62
What are the causes of erythema nodosum
**_SUBLOTS_** ## Footnote **S**ulphonamides **U**lcerative Collitis **B**echet's **L**eprosy **O**ral contraceptive pill **T**uberculosis **S**arcoidosis
63
What is steven johson syndrome?
Mucosal errosions and epidermal detahcmenrt on \< 10% of skin * Associated with fever
64
What may steven johnson syndrome turn into?
Toxic epidermal necrolysis (TEN) when \>30% of skin affected Patients may become septic
65
What drugs may cause steven-johnson syndrome?
* Allopurinol * Anti-convulsants * NSAIDs
66
What is SJS/TEN?
Overlap of steven johnson syndrome and toxic epidermal necrolysis (between 10-30% of skin affected)
67
What is the diagnosis?
Erythema Multiforme * Discoid target lesions * Requires 3 distinct colours to be termed multiforme/tagret lesions
68
What are the causes of erythema multiforme?
**_MIPPSS_** * **M**ycoplasma * **I**diopathic (50%) * **P**enicillin * **P**henytoin * Herpes **S**implex * **S**ulphonamides
69
What small vessel vasculitis can be associated with drug erruptions?
Leukoclastic vasculitis
70
What drugs may cause leukoclastic vasculitis?
**_PANTS_** ## Footnote Penicillin Allopurinol Aniodarone NSAIDs Thiazide Sulphonamides
71
What complication is associated with leukocytoclastic vasculitis?
Kidney failure | (It's an IgA vascultis)
72
What are the drug causes of Erythroderma?
Barbiturates Beta blockers Gold Quinine Sulphonamides Hydroxychloroquine
73
What diseases can cause erythroderma?
Psoriasis T cell lymphoma
74
What is this?
Erythroderma (\>90% of body affected)
75
What is this?
Lichenoid erruption
76
What drugs are associated with lichenoid eruptions?
B blockers Catopril (Ace inhibitor) Thiazides Frusemide
77
What drugs promote photosensitivity?
Quinine Thiazide Doxycycline
78
What drugs are associated with drug induced lupus erythematosis?
Beta blockers Thiazides Phenytoin Hydralazine (smooth muscle dilator) Porcainamide (anti-arrhythmatic)
79
What drugs are associated with drug induced pemphius?
Catopril Penicillin Penicillamine Gold
80
What drugs are associated with drug induced pemphigoid?
Frusemide Penicillamine Penicillin Sulphasalazine
81
82
What essential questions should you ask in history of presenting complaint for queried skin cancer?
How long has it been there? Associated symptoms? How has it progressed over time? Have you had skin cancer before? Immunosuppressed
83
What skin cancers are mostly related to prolonged sun damage?
BCC SCC
84
What skin cancer is related to intermittent burst of sun damage?
Melanoma Associated sites are places exposed on "sunny days" (e.g. women legs, mens torso)
85
What is this?
Keratoacanthoma ( mimics SCC)
86
What are the features of a keratoacanthoma?
* Shouldered volcano * Central necrotic region * Rapid growth, then regress
87
What is the Clark Level?
Clark 1: Confined to epidermis Clark 2: Confied to papillary dermis Clark 3: Full fitness to end of papillary dermis Clark 4: Reticular dermis invasion Clark 5: Invasion of deep subcutaenous tissue
88
What are the subtypes of BCC?
Nodular BCC Superficial BCC Infiltrative (Sclerotic)
89
What are the features of basal cell carcinomas?
* Rodent ulcers ( crust, falls off, recrusts) * Rolled edges * Pearly edge * Telectangasia
90
How does infiltrative BCC differ in morphology?
* Poorly defined margins
91
What are the subtypes of SCC?
* Actinic Keratosis * Bowenoid disease
92
Describe the features of Squamous cell carcinoma?
* Scaly lesions * Ulcerating lesions * Indurated edge
93
What genetic mutation do most SCC's carry?
p53 tumours suppressor mutation
94
What autosomal dominant genetic condition is associated wtih multiple self-healing SCC?
Ferguson-Smith: Chromosome 9q mutation
95
Where are SCC most commonly found?
Lower lip and mouth ( oral cancer attributable to smoking)
96
Describe surgical management for skin lesions?
1. Basic excision (low risk lesions) 2. Mohs surgery (\> 6mm) * Recurrent lesions * Higher risk lesions
97
What is partial thickness squamous carcinoma termed?
Acitinic Keratosis
98
How can skin lesions be managed non-surgically?
* Cryotherapy * Topical chemotherapuetics: * Imiquidmod * Efudex (5-flurouracil) * Photodynamic therapy
99
What is full thickness squamous carcinoma termed?
Bowens disease
100
Describe this lesions? What is it?
* State site + size * Plaque with reniform projections * Sharply demarcated border * Mild crusting/ keratosis Bowens disease
101
What are the benefits of Mohs micrographic surgery (MMS)?
* Surgical lesions removal + real time histology * Opportunity to clear margins before closing * Goldstandard for : SCC + High risk BCC
102
When is Mohs surgery indiciated?
* Contiguous tumour ( No multifocal elsions/ satelite lesions) * Poorly defined borders * Recurrent tumours * Critical tumour site * Large tumours \>6mm * Aggressive histology
103
What are the mask areas of the face?
Periauricular Periorbital Temple Nasal Perioral
104
How would you describe Mohs surgery to a patient?
* Examines 100% of tumour margins * Tumour is cut one layer at a time from the underside * If bottom layer is free of dysplastic cells, then margins are clear / If not, required to extend margins
105
What are the features of an aggressive SCC?
* Large \> 2 cm * Recurrent lesions * Poorly differenitated * Perinasal / perivascular invasion ( on microscopy) * Rapid growth * Formed on previously irradiated skin * Immunosuppressed patient * Deep invasion \> 4mm ( Clark 4 )
106
What percentage of SCC metastasise?
5%
107
What type of hypersenitivity reaciton is contact dermatitis?
Type IV
108
What monitoring should be consider for oral anti-fungals?
LFT May cause hepatitis
109
What is a misdiagnosed tinea infeciton termed?
Tinea Incognito Excessively grows due to previous treatment of steroid and immunosuppression of skin
110
Names of mild, moderate, potent and very potent steroids?
Mild: Hydrocortisone Moderate: Eumovate Potent: Betnovate Very potent: Dermovate
111
What is Fucidic acid used as?
An anti-microbial
112
When should canestin HC be considered as treatment?
Seborrhaic dermatitis (Anti-fungal + steroid works as it is a fungal infected area)
113
What is melasma?
Mask of pregnancy | (find further information)
114
What is Pleva?
(Get notes)
115
What must be monitored with dapsone treatment?
FBC - Dapsone may cause haemoloysis leading to anaemia
116
What is palmoplantar pustulosis and what is dyshydrosiform pemphigoid?
(get notes)
117
What are the bacterial causes of blisters?
Bullous impetigo ( Staph aureus) Staph scalded skin syndrome Necrotising fascitis (Strep pyogenes)
118
What are the viral causes of blistering?
Herpes simplex - Eczema herpeticum Varicella zoster - chicken pox Coxsackie - hand, foot and mouth disease Parapox - Orf
119
What condition(s) cause intradermal blisters?
Pemphigus
120
What condition(s) cause supradermal blisters?
* Bullous pemphigois * Dermatitis herpetiformis * Linear IgA disease * Epidermolysis bullosa acquisita
121

MBChB 4 (9 decks)

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