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Year 3 MedEd > Dermatology > Flashcards

Dermatology Flashcards

Derm

1
Q

What is a malignant melanoma?

A

Invastive malignant tumour of the epidermal melanocytes which have a potential to metastasise

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2
Q

What is the epidemiology of malignant melanomas?

A

Least common skin cancer

Average age 63, can affect people in their 30s

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3
Q

What are the risk factors for malignant melanomas?

A 
Excessive UV exposure
Fitzpatrick skin type 1 (always burns, never tans)
Hx multiple/atypical moles
FHx melanoma
Hx melanoma
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4
Q

What are the characteristics of a malignant melanoma?

A-F

A 
Asymmetry
Border irregularity
Colour irregularity
Diameter 7mm+
Evolution of lesion (size)
Funny looking mole (nodular)
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5
Q

What are the symptoms of a malignant melanoma?

A 
Inflammation
Oozing
Change in sensation
On legs (F)
On trunk (M)
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6
Q

What is the scoring criteria for a malignant melanoma?

A

NICE 7 point checklist

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7
Q

What is the scoring for the NICE 7 point checklist?

A 
Asymmetry: 2
[Border irregularity]
Colour irregularity: 2
Diameter 7mm+: 1
Evolution of lesion (size): 2
Inflammation: 1
Oozing: 1
Change in sensation: 1
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8
Q

At what score of the NICE 7 point checklist do you send the Pt for a 2 week wait referral?

A

3+

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9
Q

What are the subtypes of malignant melanomas?

LANS

A

Lentigo maligna
Acral lentiginous
Nodular
Superficial spreading

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10
Q

What are the characteristics of a lentigo maligna melanoma?

A

Present in the elderly
Common on the face
Chronic UV exposure

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11
Q

What are the characteristics of an acral lentiginous melanoma?

A

Common in darker skin types

Found on palm of hand, sole of foot, or under the nails

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12
Q

What are the characteristics of a nodular melanoma?

A

Poor prognosis

Vertical spread

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13
Q

What are the characteristics of a superficial spreading melanoma?

A

Most common subtype

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14
Q

What are some melanocytic lesions?

A 
Seborrheic warts
Congenital naevi
Junctional naevi
Compound naevi
Intradermal naevi
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15
Q

What are the characteristics of seborrheic keratoses?

A

Present in the elderly
Often multiple
Wart-like, greasy
Stuck on appearance

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16
Q

What are the characteristics of congenital naevi?

A

Large
Pigmented
Hairy

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17
Q

What are the characteristics of junctional naevi?

A

Small
Flat
Dark

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18
Q

What are the characteristics of compound naevi?

A

Raised
Warty
Hairy

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19
Q

What are the characteristics of intradermal naevi?

A

Dome shaped nodule

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20
Q

What are the investigations for melanomas?

A 
2WW referral
Examine with dermatoscope
Full thickness excisional biopsy
Take photo and review in 3/12 if atypical
If risk of mets:
-CXR
-Liver US
-CT CAP
-Brain MRI
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21
Q

What is a basal cell carcinoma?

A

Slow growing local invasive tumour of basal cells of the dermis.

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22
Q

What are the risk factors of BCCs?

A 
Skin type 1
Age
Male
Immunosuppression
Hx/FHx skin cancer
Excessive UV exposure
Frequent sunburns in childhood
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23
Q

Are BCCs likely to metastasise?

A

No

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24
Q

Where do BCCs commonly present?

A

Around the head and neck

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25
What are the characteristics of a nodular BCC?
``` Small Skin coloured Surface telangectasia Pearly rolled edge +/- ulcerated centre ```
26
What are the investigations for a BCC?
Routine derm referral (not 2WW) Examine with a dermatoscope Excise the lesion
27
What is a squamous cell carcinoma?
Locally invasive malignant tumour of the epidermal keratinocytes/its appendages, with the potential to metastasise
28
What are the risk factors of SCCs?
Excessive UV exposure Pre-malignant skin conditions (actinic keratoses) Chronic inflammation (eg leg ulcer, would scar) Immunosuppression FHx
29
What are the characteristics of a SCC?
``` Keratotic (scaly, crusty) Ill-defined nodule May ulcerate Non-healing lesion Everted edges ```
30
WhWhat are the investigations for a SCC?
Refer to dermatology (2WW) Examine with a dermatoscope Biopsy/complete excision
31
What is molluscum contagiosum?
A viral skin infection
32
What is the epidemiology of molluscum contagiosum?
Pre-school children age 1-4
33
What are the risk factors for molluscum contagiosum?
Close contact/swimming pools/sexual contact HIV infection Atopic eczema
34
What is the presentation of molluscum contagiosum?
``` Dome shaped Flesh coloured Pearly white papules Central umbillication May be >100 if immunocompromised Systemically well ```
35
What are the investigations for molluscum contagiosum?
No investigations | Clinical diagnosis
36
What is cellulitis?
Acute bacterial infection of the dermis and subcutaneous tissue
37
What is erysipelas?
Distinct form of superficial cellulitis which is sharply demarcated
38
What are the common causative organisms of cellulitis/erysipelas?
Streptococcus pyogenes Staphylococcus aureus Haemophilus influenzae (periorbital)
39
What are the risk factors for cellulitis/erysipelas?
Immunosuppression Woulds/ulcers IV cannulation Cut/scratch/insect bite
40
What are the signs and symptoms of cellulitis/erysipelas?
Acute onset Red hot painful swollen skin Well defined borders (ersipela) Fever/malaise/rigor Periorbital- painful swollen skin around eye Orbital- visual impairment/limited movement (clinical emergency)
41
What are the investigations for cellulitis/erysipelas?
Mainly clinical diagnosis Can look at WCC Skin swabs not routinely recommended
42
What is the management for cellulitis/erysipelas?
``` Draw around leg Oral fluids Paracetamol/ibuprofen Oral ABx according to local policy Admit if septic (confused, tachycardia/pnoea, hypotensive) ```
43
What are the complications of cellulitis/erysipelas?
``` Local necrosis Abscess Septicaemia Necrotising fasciitis Orbital cellulitis ```
44
What is necrotising fasciitis?
Infection of the deep fascia with secondary tissue necrosis
45
Which pathogen causes necrotising fasciitis?
Group A beta-haemolytic streptococcus
46
What are the risk factors for necrotising fasciitis?
Surgical wounds Skin breakage Medical co-morbidities 50% occur in healthy people
47
What are the signs and symptoms of necrotising fasciitis?
Severe pain Erythematous blistering, necrotic skin Fever/tachycardia Crepitus (subcutaneous emphysema)
48
What are the investigations you would do for necrotising fasciitis?
``` FBC- WCC U+E- high urea CRP, CK Blood and tissue cultures XR/CT- soft tissue gas ```
49
What is eczema?
Chronic itchy inflammatory skin condition
50
What is the epidemiology of eczema?
10-30% of children
51
What are the risk factors for eczema?
Atopy- hay fever, food allergies, asthma Urban environment, small family Type 1 reaction (IgE mediated)- atopic dermatitis Type 4 reaction (T cell mediated)- contact dermatitis
52
What is the presentation of eczema?
Itchy dry skin affecting flexures Can affect face/extensor surfaces in small infants Lichenification (chronic itching)
53
What are the characteristics of atopic dermatitis?
Lichenification Flexures Type 1 hypersinsitivity (IgE mediated)
54
What are the characteristics of seborrheic dermatitis?
Yellow greasy scales Can cause nappy rash Adults- dandruff, plaques on nasolabial fold, eyebrows Associated with malassezia yeasts
55
What are the characteristics of contact dermatitis?
Nickel/chromate/perfume/latex/plant hypersensitivity | Type 4 reaction (T cell mediated)
56
What are the characteristics of dyshidrotic/pompholyx dermatitis?
Vescicles/blisters Hands and feet Related to sweating
57
What are the characteristics of discoid/nummular eczema?
Scattered round patches Itchy Hx of atopic eczema/skin injury
58
What are the characteristics of eczema herpeticum?
Herpes simplex infection in an eczema sufferer | Medical emergency
59
What are the investigations for atopic eczema?
Clinical diagnosis
60
What are the investigations for contact dermatitis?
Skin patch test
61
What is psoriasis?
Chronic inflammatory skin disease due to hyperproliferation of keratinocytes
62
What is the epidemiology of psoriasis?
2%, peak age 20yrs
63
What are the risk factors of psoriasis?
Genetic/environmental factors | Triggers: smoking, alcohol, stress
64
What is the presentation of psoriasis?
Red/silver scaly plaques on extensor surfaces Itchy/painful Nail pitting/onycholysis Symmetrical polyarthritis Koebner phenomenon (lesions on traumatised skin) Auspitz sign (removal of scale causes bleeding)
65
What are the nail changes in psoriasis? | POSh
Pitting Onycholysis Subungal hyperkeratosis
66
What does chronic plaque psoriasis look like?
Silver scales
67
What does palmar plantar psoriasis look like?
Red dry thick skin | Fissures
68
What can long term psoriatic arthritis present with?
Telescoping
69
What does pustular psoriasis look like?
Generalised lesions around body | Palmar plantar presentation
70
What does guttate psoriasis look like?
After a strep throat infection Salmon-pink Drop-like lesions
71
What does erythroderma look like?
Generalised red inflamed skin | 1/3 due to worsening psoriasis
72
What is erythema multiforme?
Acute self-limiting inflammation of skin and mucous membranes
73
What is the epidemiology of erythema multiforme?
Any age group, common in children/young adults | M:F 2:1
74
What are the risk factors of erythema multiforme?
``` Viral (HSV), bacterial (mycoplasma, chlamydia), fungal (histoplasmosis) Rheumatoid arthritis, SLE, sarcoid Leukaemia, lymphoma, myeloma Pregnancy Sulphonamides, penicillin ```
75
What is the presentation of erythema multiforme?
Prodromal symptoms Target lesions Itching/burning/painful May fade -> pigmentation
76
What are the investigations for erythema multiforme?
``` Usually clinical diagnosis FBC raised WCC ESR, CRP HSV serology Throat swab CXR (sarcoid, atypical pneumonia) ```
77
What is Stevens-Johnson syndrome?
Lesion in two mucosal sites (conjunctiva, mouth, lips, oesophagus...)
78
What is the presentation of Stevens-Johnson syndrome?
Systemically unwell Sore throat, fever, cough, headache, diarrhoea, vomiting Shock (hypotension, tachycardia)
79
What are the investigations for Stevens-Johnson syndrome?
``` Usually clinical diagnosis FBC raised WCC ESR, CRP HSV serology Throat swab CXR (sarcoid, atypical pneumonia) ```
80
A 64 year old man presents with a lesion on his upper ear that has been present for months but has now begun to ulcerate. On examination: non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on the pinna. What is the most likely diagnosis? ``` A. Basal call carcinoma B. Malignant melanoma – superficial spreading type C. Malignant melanoma – nodular type D. Non-healing scab E. Squamous cell carcinoma ```
E. Squamous cell carcinoma ``` Hints: Age Classic site Non-pigmented Hyperkeratotic, crusty Everted edges ```
81
A 64 year old man presents with a lesion on his upper ear that has been present for months but has now begun to ulcerate. On examination: non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on the pinna. How should the GP proceed? ``` A. Provide sun exposure advice B. Monitor for changes with serial follow up C. Treat in primary care D. Dermatology referral - routine E. Dermatology referral – 2 week wait ```
E. Dermatology referral – 2 week wait Hints: Diagnosis = SCC Potentially malignant spread Must refer urgently, as for melanoma
82
A 32-year old professional surfer had a seizure three days ago. He has no history of epilepsy and reports headaches for the past 5 months. The headaches are worse when he goes to bed. On examination, a dark irregular skin lesion is found on the back of his neck. An MRI scan shows multiple lesions across both cerebral hemispheres. What is the most likely diagnosis? ``` A. Acoustic neuroma B. Glioblastoma multiforme C. Meningioma D. Metastases E. Neurofibromatosis type I ```
D. Metastases Hints: Signs of raised ICP (brain mets) Lesion suspicious of melanoma Significant sun exposure
83
A 76-year-old woman has recently attended her GP because of a ‘spot that won’t go away’. The lesion is on her nose and has pearly, rolled edges with telangiectasias. What is the most likely diagnosis? ``` A. Squamous cell carcinoma B. Molluscum contagiosum C. Basal cell carcinoma D. Acne rosacea E. Acne vulgaris ```
C. Basal cell carcinoma Hints: Classic site Features of BCC
84
A 4-year old girl presents to the GP with multiple lesions on her face. The lesions are raised and shiny, non-tender, non-erythematous, and 3 mm in diameter. They have an umbilicated centre. The patient is known to be HIV positive. What is the most likely diagnosis? ``` A. Chicken pox B. Molluscum contagiosum C. Atopic eczema D. Eczema herpeticum E. Herpes simplex virus ```
B. Molluscum contagiosum Hints: Classic appearance HIV
85
A 52-year-old woman presents to the GP with redness and swelling of her right cheek. On examination the area of erythema is well-demarcated and warm to touch. Her temperature is 37.9 and she feels unwell. What is the most appropriate management plan for this patient? A. Cold compress, reassure, home B. Admit to intensive care unit C. Take skin swabs, blood cultures, and give paracetamol D. Draw around the lesion, give pain relief, oral fluids and antibiotics E. Emergency dentist referral
D. Draw around the lesion, give pain relief, oral fluids and antibiotics Hints: Well-demarcated & systemic upset – probably erysipelas
86
A 12-year-old girl presents with dry, itchy skin that involves the flexures in front of her elbows and behind her knees. She has symptoms of hay fever and was diagnosed with egg and milk allergy at 6 months old. Her mother has asthma. What is the most likely diagnosis? ``` A. Seborrheic dermatitis B. Atopic dermatitis C. Psoriasis (chronic plaque) D. Psoriasis (guttate) E. Urticaria ```
B. Atopic dermatitis ``` Hints: Age Flexures Allergies FHx atopy ```
87
A 23-year-old man was recently given penicillin for a throat infection (now resolved). He now complains of sore red ‘targetoid’ lesions on his extremities. Later he develops ulcers around his lips and conjunctiva. What is the diagnosis? ``` A. Erythema multiforme B. Chicken pox C. Herpes simplex virus D. Stevens-Johnson’s syndrome E. Toxic epidermal necrolysis ```
A. Erythema multiforme Hints: Target lesions TWO mucosal sites affected!

Year 3 MedEd (29 decks)

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