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Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the 5 layers of the epidermis?

A 
from top:
Stratum corneum,
Stratum lucidum,
Stratum Granulosum,
Stratum spinosum,
Stratum basale
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2
Q

What is the name of the area under the nail plate?

A

Hyponychium

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3
Q

What are the 3 stages of the hair cycle?

A

Anagen, catagen, telogen

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4
Q

What happens in the anagen stage of the hair cycle?

A

Growing, it is the active growing phase

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5
Q

What happens in the catagen stage of the hair cycle?

A

2-3week phase of growth stops and follicle shrinks

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6
Q

What happens in the telogen stage of the hair cycle?

A

Resting phase for 1-4 months

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7
Q

Ehat are the main functions of skin?

A

Thermoregulation, skin immune system, barrier, sensation, vitamin D synthesis, interpersonal communication

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8
Q

What are the main external causes of skin disease?

A

Temperature, UV, chemical (allergen or irritant), infection, trauma

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9
Q

What are the main internal causes of skin disease?

A

Systemic disease, genetics, drugs, infection

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10
Q

What is dermatitis artefacta?

A

Self induced injuries without ownership

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11
Q

An example of an internal autoimmune skin disease?

A

Bullous pemphigoid

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12
Q

What is the name of a small circumscribed area skin lesion

A

Macule

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13
Q

What is the name of a large circumscribed area skin lesion

A

Patch

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14
Q

What is the name of a small raised area skin lesion

A

Papule

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15
Q

What is the name of a large raised area skin lesion

A

Plaque

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16
Q

What is the name of a small fluid filled area skin lesion

A

Vesicles

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17
Q

What is the name of a large fluid filled area skin lesion

A

Bulla

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18
Q

What is the name of a small pus filled area skin lesion

A

Pustule

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19
Q

What is the name of a large pus filled area skin lesion

A

Abscess

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20
Q

What is the name of a skin lesion which has loss of epidermis?

A

Erosion

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21
Q

What is the name of a skin lesion which has loss of epidermis and dermis?

A

Ulcer

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22
Q

When would you see eruptive xanthoma?

A

In a patient with hyperlipidaemia as is deposits of lipids in the skin

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23
Q

When would you see acanthosis nigricans?

A

Someone with insulin resistance, obesity, malignancy in flexural areas

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24
Q

What does acanthosis nigricans look like?

A

Hyperkeratosis and hyperpigmentation, papules and a velvety appearance

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25
Q

What investigation would you use if a bacterial infection is suspected?

A

Charcoal swab, with MC&S- microscopy, culture, sensitivities

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26
Q

What investigation would you use if a virial infection is suspected?

A

Viral swab for PCR

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27
Q

Go through dermatology PowerPoint

A

PowerPoint

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28
Q

What is Psoriasis?

A

Chronic, genetically determined, immune-mediated, inflammatory skin condition, usually characterised by typical well defined, scaly, plaques

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29
Q

What causes Psoriasis?

A

Overactivity of the immune system
There is excesssive production of TH1 cytokines including TNF-alpha, this causes vascular proliferation (erythema) nd increased cell turnover (plaques and scaling)

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30
Q

What can cause Psoriasis?

A

Genetics, environment, infection (strep, candida), drugs (lithium, b-blockers, NSAIDs, steroid withdrawal), trauma, sunlight, stress, alcohol, smoking

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31
Q

What is happening at a histological view in Psoriasis?

A

Hyperkeratosis (thickening of stratum corneum)
Parakeratosis (keratinocytes with nuclei in stratum corneum)
Neutrophils in stratum corneum
Hypogranulosis (no granular layer)
Psoriasiform hyperplasia: Acanthosis (thickening of squamous cell layer) with elongated rete ridges
Dilated dermal capillaries
Perivascular lymphohistiocytic infiltrate
T cell infiltration

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32
Q

What are the 8 subtypes of Psoriasis?

A

Chronic plaque, guttate, scalp, nail, palmo-plantar, flexural/ inverse, pustular, erythrodermic

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33
Q

What is a common cause of guttate Psoriasis?

A

Post-viral

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34
Q

How do you treat guttate Psoriasis?

A

Normally self-limiting, responds well to phototherapy

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35
Q

What features can be seen in nail psoriasis?

A

Pitting, onycholysis

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36
Q

What is special about flexural/ inverse psoriasis?

A

It lacks scales

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37
Q

What is another name for erythrodermic Psoriasis?

A

“Red man” syndrome

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38
Q

What percentage of the body is involved in erythrodermic psoriasis?

A

> 90% of the body surface area

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39
Q

What are common differential diagnosises for psoriasis?

A

Seborrhoeic dermatitis, lichen planus, mycosis fungoides

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40
Q

Go over PowerPoint flashcards for Psoriasis

A

PowerPoint

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41
Q

Go over acne spreadsheet

A

Spreadsheet

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42
Q

Go over rosacea spreadsheet

A

Spreadsheet

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43
Q

Go over PowerPoint flash cards acne

A

Flash card PowerPoint

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44
Q

Go over Rosacea flash card PowerPoint

A

Flash card PowerPoint

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45
Q

Definition of atopic eczema?

A 
An itchy skin condition in the last 12 months plus 3 of the following:
Onset before 2,
History of flexural involvement,
History of general dry skin,
History of other atopic disease
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46
Q

Which gene plays a key role in eczema?

A

Filaggrin gene

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47
Q

4 pathogensis of eczema?

A

Genetics, epidermal barrier dysfunction, environmental factros, immune system dust evils toon

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48
Q

What 3 things would a skin biopsy show of eczema?

A

Spongiosis (intercellular oedema), acanthodians (thickening of epidermis), inflammation

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49
Q

What the of reaction is allergic contact dermatitis?q

A

Type 4 hypersensitivity

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50
Q

What cells are involved in an allergic contact dermatitis reactions?

A

T cells

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51
Q

On second exposure to a hapten in allergic contact dermatitis what happens in the body?

A

The T cells cause mast cell degranulation, vasodilation and neutrophils

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52
Q

Name the different types of eczema?

A

Allergic contact dermatitis, irritant contact dermatitis, seborrhoeic dermatitis, discoid eczema, pompholyx/ vesicular eczema, asteatotic eczema, venous eczema, eczema herpeticum

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53
Q

Go over eczema spreadsheet

A

Spreadsheet

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54
Q

Go over eczema powerpoint flash cards

A

Powerpoint flashcards

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55
Q

What are some predisposing factors for impetigo?

A

Warm temp, high humidity, poor hygiene, skin trauma

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56
Q

What bacteria causes impetigo?

A

Staphylococcus aureus,

Sometime streptococcus pyogenes

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57
Q

What is the development of impetigo?

A

Begins as a macule, then becomes a vesicule, pustule, erosion with a yellow crust

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58
Q

What is folliculitis?

A

Infection of the hair follicle

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59
Q

What bacteria is a common cause of folliculitis?

A

Staph aureus

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60
Q

What is the treatment of impetigo?

A

Local wound care, topical antibiotics

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61
Q

What are predisposing factors of folliculitis?

A

Occlusion, maceration and hyper hydration, shaving or waxing, topical corticosteroids and diabetes

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62
Q

Where are common sites of folliculitis?

A

Face, chest, back, axillae or buttocks

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63
Q

Treatment of folliculitis?

A

Antibacterial washes, antibacterial ointments

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64
Q

What is erysipelas?

A

An superficial infection of the dermis with lymphatic involvement, most commonly caused by group A streptococci

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65
Q

Symptom of erysipelas?

A

Erythema with well defined margins, the affected skin feels hot, tense and indurated
Most commonly affects the face and lower extremities

66
Q

treatment for erysipelas?

A

10-14 day course of penicillin

67
Q

What is cellulitis?

A

Infection of the deep dermis and subcutaneous tissue caused most commonly by strep pyogenes and staph aureus

68
Q

What are the predisposing factors for cellulitis?

A

Lymphedema, alcoholism, DM, IV drug abuse and peripheral vascular disease

69
Q

Symptoms of cellulitis?

A

Rubor, calor, dolor, tumor (erythema, warmth, pain, swelling)
The lesion will have ill-defined, non-palpable borders.
In children the head and neck and affected and extremities in adults

70
Q

How is cellulitis treated?

A

Antibiotics

71
Q

What is syphilis?

A

STI caused by bacteria treponema pallidum, has episodes of active disease and is then followed by latent periods

72
Q

How does primary syphilis appear?

A

Painless ulcer where the infection entered (gentians, anus, mouth), this is known as a chancre

73
Q

What is a chancre?

A

A single small firm red painless papule that quickly ulcerates, appears in primary syphilis

74
Q

What is the sign of secondary symphilis?

A

Widespread rash that appears 3weeks-months after primary syphilis, the rash doesn’t;t itch and commonly Preston’s of the trunk and palms and soles

75
Q

What is tertiary syphilis?

A

Solitary granulomatous lesions (gummas) may be found on the skin, mouth and throat or in bones

Can affect brain, spinal cord, heart, liver, eyes

76
Q

Investigations for syphilis?

A

Serological tests turn positive about 5-6 weeks after infection
Use Non-specific non-treponemal tests (VDRL) or Specfic anti-treponemal antibody tests (TTPA)

77
Q

How is sypholis treated?

A

Penicillin by injection

78
Q

What is the herpes simples virus

A

Orolabial and genital infection

79
Q

How does herpes simples virus present?

A

Sore areas with erythematous base with vesicles followed by pustules and ulcerations

80
Q

What virus causes chickenpox?

A

Varicella-zoster virus

81
Q

How does chicken pox develop?

A

Red macules- vesicules- pustules-crusts

82
Q

What is shingles?

A

Localised, blistering and painful rash caused by reactivation of varicella-zoster virus, it is characterised by dermatomal distribution

83
Q

What are complications of shingles?

A

Infection, post-herpetic neuralgia

84
Q

What is treatment of shingles?

A

Area clean to prevent infection, pain relief and rest

85
Q

What virus causes viral warts?

A

Human papillomavirus

86
Q

How do viral warts present?

A

Hyperkeratotic papules, thick hyperkeratotic plaques

87
Q

Treatment of viral warts?

A

Salicylic acid, cryotherapy

88
Q

When should you refer someone with viral warts?

A

When diagnosic uncertainty exists, eg if patients are immunocompromised or warts are large or extensive

89
Q

What os molluscum contagiosum?

A

Common viral skin infection caused by a pox virus, mainly affects children under 10, it is more common in warm climates and in obvercrowding

90
Q

What do molluscum contagiosum lesions look like?

A

Lesions are firm, umbilicated perly papules with waxy surface, most common in skin folds and genital region

91
Q

What is the treatment for molluscum contagiosum?

A

Curettage, liquid nitrogen, chemovesicants

92
Q

What is dermatophytoses?

A 
Usually affects postpuberal hosts, normally has refer edges, different types:
Tinea corporis ringworm,
Tinea crusis, ringworm of groin,
Tinea capitis, ringworm of scalp,
Tinea pedis, ringworm of foot,
Tinea unguium, rigneworm of nail
93
Q

What are predisposing factors of mucocutaneous candida infections?

A

DM, occlusion, hyperidrosis, broad spectrum antibiotics, immunosuppresion

94
Q

What causes mucocutaenous canfdida infections?

A

Candida albicans

95
Q

What does mucoocutaneous candida infection look like?

A

Erythematous patches that are often accompanied by satellites pustules, if affects intertriginous zones and diaper areas

96
Q

Treatment for mucocutaenous candida infections?

A

Remove predisposing factors, topical antifungals, oral antifungals

97
Q

What is pityriasis versicolor?

A

Multiple oval to round patches with mild scale, caused by the malassezia, increased chance in high temperatures and humidity, oily skin and in excessive sweating

98
Q

Treatment for pityriasis versicolor?

A

Topical antimycotic (shampoos, creams)

99
Q

What causes scabies?

A

Sarcoptes scabiei

100
Q

How can you diagnose scabies?

A

Very itchy,

Use skin scraping, visualise burrows

101
Q

What do scabies burrows appear as?

A

0.5-1.5cm grey irregular tracts in the web spaces between the fingers, on the palms and wrists

Appears on the trunk and limbs

102
Q

Treatment for scabies?

A

Antiscabietic topical treatment in the patient and close contacts, repeat after 1 week

103
Q

Treatment for head lice?

A

2 applications of insecticide and/or physical methods

104
Q

Describe a Seborrhoeic ketatoses?

A

Benign lesion, warty growths that look stuck on, patients often have multiple +/- cherry agiomas

105
Q

Treatment of seborrhoeic keratoses?

A

Only treated if troublesome, with cryotherapy and curettage

106
Q

What is Leser-Trelat?

A

Abrupt onset of widespread seborrhoeic keratosis, could indicate an underlying solid malignancy eg GI adenocarcinoma

107
Q

What are cysts?

A

Encapsulated lesion containing fluid or semi-fluid material, they are usually firm and fluctuant

108
Q

Wha are the different types of cysts?

A 
Epidermoid cyst, 
Pilar cyst (hair follicle),
Steatocystoma,
Dermoid cyst,
Hidrocystoma,
Ganglion cyst
109
Q

How would you treat a cyst?

A

With excision,

If inflamed: antibiotics, intralesional steroid and incision and drainage

110
Q

What are dermatofibromas?

A

Benign fibrous nodules often found on limbs,
They are a fun nodule, tethered to skin but mobile over fat, dimple sign positive
Pale pink/brown colour

111
Q

What is a lipoma?

A

Benign tumour consisting of fat cells, looks like a smooth and rubbery subcutaneous mass

112
Q

What is the risk of a lipoma if tender?

A

Could be angiolipoma or liposarcoma

113
Q

What is an angioma?

A

Overgrowth of blood vessels in the skin due to proliferating endothelial cells

114
Q

What are the types of angiomas?

A

Cherry angiomas, spider naevi, venous lakes

115
Q

What is a pyogenic granuloma?

A

Rapidly enlarging red/raw growth, often at site of trauma,

Common on head and hands

116
Q

Treatment of pyogenic granuloma?

A

Curettage and cautery

117
Q

Name some pre-malignant lesions

A

Actinic keratoses,
Bowen’s disease,
Melanoma in situ

118
Q

What is actinic keratoses?

A

Rough scaly patches on sun damaged skin, has a low risk of transformation to SCC

119
Q

Treatment of actinic keratoses?

A

Cryotherapy, curettage, diclofenac gel, imiquimod

120
Q

What is Bowen’s disease

A

Squamous cell carcinoma in situ- characterised by full thickness dysplasia, contained within the epidermis, looks like an irregular, scaly, erythematous plaque

121
Q

Treatment of Bowens

A

Cryotherapy, curettage, photodynamic therapy, imiquimod

122
Q

What is photo-dynamic therapy?

A

Photochemical reaction to selectively destroy cancer cells.
Topical photsensitising agent is applied, this concentrates in the cancerous cells and red light is applied, creating the photodynamic reaction to occur

123
Q

What is imiquimod?

A

Aldara cream

Is an immune response modifier, it stimulates cytokines release causing inflammation and destruction of the lesion

124
Q

Risk factors of non-melanoma skin cancer?

A 
UV radiation, 
Photochemotherapy- PUVA,
Chemical carcinogens,
X-ray and thermal radiation,
Human papilloma virus,
Familial cancer syndromes, 
Immunosuppresion
125
Q

Types of basal cell carcinoma?

A

Modular, superficial, pigmented, morphoeic

126
Q

How do nodular basal cell carcinomas look?

A

Pearly rolled edge, telangiectasia, central ulcearation, arborising vessels on dermoscopy

127
Q

Treatment of basal cell carcinoma?

A

Excision- ellipse with rim of unaffected skin,

Sometimes curettage

128
Q

Indications for MOHs surgery for basal cell carcinoma?

A 
Site,
Size,
Subtype,
Poor clinical margin definition, 
Recurrent, 
Perineural or perivascular involvement
129
Q

Indications for vismodegib use in basal cell carcinoma?

A

Locally advanced BCC that isn’t suitable for surgery or radiotherapy,
Metastatic BCC

130
Q

What is vismodegib?

A

Selectively inhibits abnormal signalling in the hedgehog pathway, which is a molecular driver in BCC,
Can shrink BCC

131
Q

Side effects of Vismodegib?

A

Hair loss, weight loss, altered taste, muscle spasms, nausea, fatigue

132
Q

Describe squamous cell carcinoma?

A

Derived from keratinising squamous cells, usually on sun exposed sites, is a fast growing, tender, scaly/crusted of fleshy growth and can ulcerated

133
Q

Treatment of SCC?

A

Excision +/- radiotherapy

134
Q

What would class SCC as high risk and need a follow up after treatment?

A 
Immunosuppressed,
>20mm diameter,
>4mm depth, 
Ear, nose, lip, eyelid where the SCC locations, 
Perineural invasion, 
Poorly differentiated
135
Q

What is keratoacanthoma?

A

A variant of squamous cell carcinoma, it erupts from hair follicles in sun damaged skin

136
Q

Treatment of keratoacanthoma?

A

Surgical excision

137
Q

Risk factors of melanoma skin cancer?

A

UV radiation,
Genetic susceptibility- fair skin, red hair, blue eye and tendency to burn easily,
Familial melanoma and melanoma susceptibility genes

138
Q

What is the ABCDE rule for melanoma skin cancers?

A 
Asymmetry,
Border,
Colour, 
Diameter, 
Evolution
139
Q

7 point checklist for melanoma skin cancer?

A

Change in size,
Change in shape,
Change in colour
(Major features)

Diameter more than 5mm,
Inflammation, 
Oozing or bleeding, 
Mild itch or altered sensation 
(Mini features)
140
Q

What is the biological progression of melanoma?

A 
Benign nevus, 
Dysplastic nevus, 
Radial-growth phase, 
Vertical growth phase, 
Metastatic melanoma
141
Q

Name the different types of melanoma

A

Superficial spreading malignant melanoma,
Lentigo maligna melanoma,
Nodular melanoma,
Acral lentiginous melanoma/ subungal melanoma,
Ocular melanoma

142
Q

What is superficial spreading malignant melanoma?

A

Most commonest melanoma, about 10mm

143
Q

What is lentigo maligna melanoma?

A

Melanoma evolved from lentigo maligna, commonly found on chronically sun damaged skin ,
Greater than 20mm

144
Q

What is nodular melanoma?

A

Most aggressive melanoma, tends to grow in thickness more than diameter, but can be 1cm

145
Q

What is acral lentigninous melanoma/ subungal melanoma?

A

Melanoma that appears on palms of hands/ soles of feet/ under nails

146
Q

What is ocular melanoma?

A

Melanoma of the eye

147
Q

Treatment of melanoma?

A

Urgent surgical excision (depends on subtype and Breslow thickness),
Wide local excision,
Sentinel lymph node biopsy,
Chemotherapy/ immunotherapy

148
Q

Treatment of metastasis melanoma?

A

Ipilimumab,
Pembrolizumab,
Vemurafenib and dabrafenib

149
Q

How does ipilimimab work against metastatic melanoma?

A

It inhibits CTLA-4 molecules

150
Q

How does pembrolizumab work against metastatic melanoma?

A

Blocks activity of PD-1

151
Q

How does vemurafenib and dabrafenib work against metastatic melanoma?

A

Blocks B-RAF protein

152
Q

Types of cutaneous lymphoma

A

Secondary cutaneous disease from systemic/nodal involvement,
Primary cutaneous disease (abnormal neoplastic proliferation of lymphocytes in the skin):
Cutaneous T cell lymphoma,
Cutaneous B cell lymphoma

153
Q

Types of cutaneous T cell lymphoma?

A

Mycosis fungoides,

Sezary syndrome

154
Q

Types of cutaneous B cell lymphoma?

A

Cutaneous folllicle centre lymphoma,
Cutaneous marginal zone lymphoma,
Cutaneous diffuse large B cell lymphoma

155
Q

Stages of mycosis fungoides?

A

Patch (flat, red dry, oval lesions),
Plaque,
Tumour (large irregular lumps, can ulcerate),
Metastatic (infiltration of neoplastic cells in lymph nodes, blood and solid organs)

156
Q

What is Sezary Syndrome?

A

“Red man syndrome”
A Cutanteous T cell lymphoma which causes skin thickened, scaly, red and itchy skin.
There is lymph node involvement and sezary cells in peripheral blood

157
Q

What are sezary cells?

A

Atypical T cells, found in Sezary syndrome

158
Q

Treatment of cutaneous lymphoma?

A 
Topical steroids, 
PUVA or UVB,
Localised radiotherapy,
Interferon, 
Bexarotene,
Low dose methotrexate,
Chemotherapy,
Total skin electron beam therapy,
Extracorporeal photophoresis,
Bone marrow transplant
159
Q

What is total skin electron beam therapy?

A

A type of radiotherapy consisting of very small electrically charged particles

160
Q

What is extracorporeal photophoresis?

A

Step 1: patients blood is drawn and leucocytes collected
Step 2: collected white cells mixed with psoralen which makes the T-cells sensitive to UVA radiation
Step 3: exposed to UVA radiation, damaging diseased cells
Step 4: treated cells re-infused back to patient

161
Q

Common causes of cutaneous metastasises?

A

Breast, colon, lung

162
Q

Management of cutaneous metastases?

A

Treat underlying malignancy, local excision, localised radiotherapy, symptomatic

Dermatology (3 decks)

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