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All conditions - Year 3 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is Basal cell carcinoma (BCC)

A

Slow growing locally invasive tumour of the basal cells of the epidermis - Rarely metastasizes

This is the most common form of skin malignancy also known as rodent ulcer

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2
Q

What are the risk factors for BCC

A
  • Excessive UV radiation exposure
  • Frequent/severe sunburn in childhood

Other

  • Skin type 1 - Fitzpatrick skin types
  • Older age
  • Males
  • Immunosuppression
  • FHx or PMH of skin cancer
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3
Q

Where on the body are BCCs usually found

A

Face
Scalp
Ears
Trunk

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4
Q

What are the different types of BCC

A

Nodulo-ulcerative (Most common)

  • Small glistening translucent skin over a coloured papule
  • Slowly enlarges
  • Central ulcer with raised pearly edges
  • Fine telangiectasia over the tumour surface
  • Cystic change in larger lesions

Morphoeic

  • Expanding
  • Yellow/white waxy plaque with an ill-defined edge
  • More aggressive than nodulo-ulcerative

Superficial

  • Most often on trunk
  • Multiple pink/brown sclay plaques with a fine edge expanding slowly

Pigmented
- Specks of brown or black pigment may be present in any BCC

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5
Q

How is BCC diagnosed

A

It is diagnosed histologically through biopsy (Shave biopsy or punch biopsy)

Shave for cosmetically challenging

Routine referral

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6
Q

What is Squamous cell carcinoma (SCC)

A

Locally invasive malignant tumour of the epidermal keratinocytes or appendages, with potential to metastasise

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7
Q

What are the risk factors for SCC

A
  • Excessive UV radiation exposure
  • Premalignant skin conditions - Actinic keratoses - Crumbly yellow-white crusting
  • Chronic inflammation - Leg ulcer, wound scar (Marjolin’s ulcer)
  • Immunosuppression
  • FHx or PMH of skin cancer
  • 2nd most common - Middle aged and elderly
  • Men
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8
Q

Where on the body are SCCs usually found

A
  • Head & Neck - 84%

- Extensors upper limbs - 13%

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9
Q

How is SCC diagnosed

A

Biopsy

Staging - CT, MRI, PET

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10
Q

What is Melanoma

A

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

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11
Q

What are the risk factors for Melanoma

A
  • Excessive UV radiation exposure
  • Skin type 1 - Always burns, never tans
  • History of multiple moles or atypical moles
  • FHx or PMH of skin cancer
  • Least common skin cancer
  • Average age is 63 years can be younger
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12
Q

How does Melanoma present

A 
Asymmetrical shape (2pts)
Border irregularity
Colour irregularity (2pts)
Diameter 7mm or more (1pt)
Evolution of lesion (Size) (2pts)

Symptoms:

  • Inflammation (1pt)
  • Oozing (1pt)
  • Change in sensation (1pt)

(NICE 7 point checklist pt - Greater than 3 points 2 week wait referral)

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13
Q

Where do Melanomas usually present

A

Legs in women

Trunk in men

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14
Q

What are the different types of Melanoma

A 
Superficial spreading (70%)
- Arises in a pre-existing naevus, expands in a radial fashion before a vertical growth phase

Nodular (15%)

  • Arises de novo
  • Aggressive
  • No radial growth

Lentigo maligna (10%)

  • Elderly sun damaged
  • Large flat lesion
  • Progresses slowly
  • Usually on the face

Acral lentiginous (5%)

  • Arises on palms, soles and subungual areas
  • Most common type in non-white populations
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15
Q

How is Melanoma investigated

A
  • Examination with dermatoscope in secondary care
  • Biopsy - Full thickness excisional biopsy - Definitive
  • Atypical take pictures and compare months later

Sentinel lymph node biopsy
Staging - CT, MRI, CXR

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16
Q

What is Molluscum contagiosum

A

A common skin infection caused by a pox virus that affects children and adults

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17
Q

What are risk factors for Molluscum contagiosum

A

Viral skin infection - MCV a type of pox virus

  • Transmitted via contact: Swimming pool, sexual contact
  • HIV infection
  • Atopic eczema
  • Children 1-4
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18
Q

What are the signs and symptoms of Molluscum contagiosum

A

Incubation period of 2-8 weeks
Usually asymptomatic
Potential tenderness pruritus and eczema around lesion

Firm, smooth, pearly, umbilicated papule
2-5mm in diameter
Children: Trunk and extremities
Adults: Lower abdomen, genital area and inner thighs

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19
Q

How is Molluscum contagiosum diagnosed?

A

Clinical diagnosis

Potential HIV test
Biopsy rarely necessary

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20
Q

What are Pressure sores

A

Damage to the skin usually over a bony prominence as a result of pressure

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21
Q

What are causes of Pressure sores

A

Constant pressure limits blood flow to skin

  • Immobility
  • Alzheimer’s disease
  • Diabetes
  • Very common in hospitals
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22
Q

What are the signs and symptoms of Pressure sores

A

Over bony prominences - Most commonly Sacrum and heels

  • Very tender
  • They may be infected leading to fevers, redness and foul smell

Graded from 1-4
1 - Non-blanching redness of intact skin
2 - Partial thickness skin loss involving epidermis, dermis or both - Abrasion or blister
3 - Full thickness skin loss involving damage to or necrosis of subcutaneous tissue - Through to fascia
4 - Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures

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23
Q

How is the risk of pressure sores in patients predicted

A

Using the Waterloo score

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24
Q

What is a Lipoma

A

Slow-growing, benign adipose tumour that are most often found in the subcutaneous tissues

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25
Q

What are causes of Lipomas

A

Benign tumours of adipocytes

Associated conditions:

  • Familial multiple lipomatosis
  • Gardner’s syndrome
  • Dercum’s disease
  • Madelung’s disease

Liposarcoma - Rare malignant tumour of adipose tissue

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26
Q

What are signs and symptoms of Lipomas

A

Most asymptomatic

Compression of nerves can cause pain
Soft or firm nodule
Smooth surface
Skin coloured
Most <5cm diameter
Mobile
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27
Q

How are Lipomas diagnosed

A

US/MRI/CT used if any doubt
Core needle biopsy
Excisional - Bigger than 3cm

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28
Q

What is Eczema

A

An inflammatory skin condition characterised by dry, pruritic skin with chronic relapsing course

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29
Q

What are causes of Eczema

A

Exogenous:

  • Irritants
  • Contact

Endogenous:

  • Atopic
  • Seborrhoeic
  • Pompholyx
  • Varicose
  • Lichen simplex
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30
Q

What are the symptoms of Eczema

A 
Itching
Heat
Tenderness
Dry
Crusting
Occupational exposure to irritant 
FHx or Hx of atopy
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31
Q

What are signs or Eczema

A
  • Poorly demarcated erythematous oedematous dry scaling patches
  • Papules
  • Vesicles with exudation and crusting
  • Excoriation marks
  • Thickened epidermis
  • Skin lichenification
  • Fissures
  • Change in pigmentation
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32
Q

What are the different types of Eczema

A

Atopic - Mainly affects face and flexures in children - Lichenification

Seborrhoeic - Yellow greasy scales on erythematous plaques. Commonly found on eyebrows, scalp, presternal area

Contact - Nickel or other allergens cause type 4 hypersensitivity

Dyshidrotic/Pompholyx - Vesiculobullous eruption on palms and soles

Discoid/Nummular - Coin shaped, on legs and trunk

Eczema herpeticum - HSV infection in eczema sufferer - Medical emergency

Varicose - Associated with marked varicose veins

Asteatotic - Dry, crazy paring pattern

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33
Q

How is Eczema diagnosed

A

Clinically usually

Skin prick - Contact eczema - a disc containing allergens is diluted and applied on the skin for 48hrs. It is positive if it causes a red raised lesion

IgE levels - Atopic

34
Q

How is Herpes simplex virus contracted

A

It is transmitted via close contact (Kissing, sexual intercourse) with an individual that is shedding the virus

35
Q

What are symptoms of Herpes simplex virus

A

Primary HSV-1:

  • Pharyngitis
  • Gingivostomatitis
  • Herpetic whitlow

Reactivation HSV-1:

  • Prodrome of perineal tingling and burning
  • Vescile appear they will ulcerate and crust over
  • Complete healing in 8-10 days

HSV-2:

  • Painful blisters and rash in the genital, perigenital and anal area
  • Dysuria
  • Fever
  • Malaise

HSV encephalitis:
- Usually caused by HSV-1 so causes HSV-1 type symptoms

HSV keratoconjunctivitis:

  • Watering eyes
  • Photophobia
36
Q

What are signs of Herpes simplex virus

A

Primary HSV-1:

  • Tender cervical lymphadenopathy
  • Erythematous, oedematous pharynx
  • Oral ulcers filled with yellow slough (gingivostomatitis)
  • Herpetic whitlow

HSV-2:

  • Maculopapular rash
  • Vesicles
  • Ulcers
  • All of these are found on the external genitalia, anal margin and upper thighs
  • Others: inguinal lymphadenopathy, pyrexia

HSV encephalitis:
- Signs of encephalitis

HSV keratoconjunctivitis:
- Dendritic ulcer on the iris (Better visualised by fluorescein)

37
Q

How is Herpes simplex virus diagnosed

A

Usually clinical

Viral culture

38
Q

What are the different types of Burns injury

A 
Contact with hot object
Electricity
UV light
Irradiation
Chemicals
39
Q

What are the different thicknesses of burns

A

Partial thickness burn

  • Superficial: Red and oedematous skin + painful - Heals within around 7 days with peeling of dead skin
  • Deep: Blistering and mottling + painful - Heal within over 3 weeks, usually without scarring

Full thickness burn: Destruction of the epidermis and dermis. Charred leathery eschars. Firm and painless with loss of sensation. Healing will occur by scarring or contractors and requires skin grafting

40
Q

What other signs should be considered in burn victims

A

Signs of inhalational injury or airway compromise:

  • Stridor
  • Dyspnoea
  • Hoarse voice
  • Soot in nose
  • Singed nose hairs
  • Carbonaceous sputum
41
Q

What are the investigative findings in Burn injuries

A

FBC - Low Ht, Hypovolaemia, Neutropenia, Thrombocytopenia

U&Es - Urea, Creatinine, Glucose, Hyponatraemia, Hypokalaemia

42
Q

What are the main types of Candidiasis

A 
Oral
Oesophageal
Candidal vulvovaginitis
Candidal skin infections
Invasic candidate infections
43
Q

What are risk factors for Candidiasis

A
  • Broad spectrum antibiotics
  • Immunocompromise (HIV, Corticosteroids)
  • Central venous lines
  • Cushing’s disease
  • DM
  • GI tract surgery
44
Q

What are signs and symptoms of Candidiasis

A

Oral thrush - Curd-like white patches in the mouth, which can be removed easily revealing an underlying red base

Oesophageal - Dysphagia, Odynophagia, It is an AIDS-defining illness

Candidal skin infections - Soreness and itching, skin appearance can be variable, red, moist skin area with ragged, peeling edge and possibly papule and pustules

45
Q

How is Candidiasis diagnosed

A

Oral Candidiasis - Therapeutic trials of antifungal (-azole) can help diagnosis

Oesophageal - Endoscopy

Invasive - Blood cultures required if candidaemia is possible

46
Q

What is a Sebaceous cysts

A

This is an epithelium-lined, keratinous, debris-filled cyst arising from a blocked hair follicle

47
Q

What are signs and symptoms of Sebaceous cysts

A
  • Non-tender slow growing skin swelling
  • Often multiple
  • Hair-bearing regions of the body
  • May become infected and inflammed
  • May discharge granular creamy material that smell bad
48
Q

What is Erythema multiforme

A

An acute hypersensitivity reaction of the skin and mucous membranes.

Stevens-Johnson syndrome is a severe form with bullous lesions and necrotic ulcers

49
Q

What are causes of Erythema multiforme

A

50% idiopathic

Precipitating factors:

  • Drugs: Sulphonamides, Penicillin, Phenytoin
  • Infection: HSV, EBV, Adenovirus, Chlamydia, Histoplasmosis
  • Inflammation: RA, SLE, Sarcoidosis, UC
  • Malignancy: Lymphoma, Leukaemia, Myeloma
  • Radiotherapy
50
Q

Who is mainly affected by Erythema multiforme

A

Any age group
Mainly children and young adults
Twice as common in males

51
Q

What are symptoms of Erythema multiforme

A
  • Prodromal symptoms of URTI
  • Sudden appearance of itching/burning/painful skin lesions
  • Skin lesions may fade leaving pigmentation
52
Q

What are signs of Erythema multiforme

A
  • Classic target (bull’s eye) lesions with rim of erythema surrounding a paler area
  • Vesicles/bullae
  • Urticarial plaques
  • Lesions are often symmetrical and distributed over the arms and legs including the palms, soles and extensor surfaces.
53
Q

What is Stevens-­‐Johnson

syndrome

A

This is a severe form of Erythema multiforme characterised by:

  • Affecting 2 or more mucous membranes (Conjunctiva, Cornea, Lips, Mouth,Genitalia)
  • Systemic symptoms (e.g Sore throat, Fever, Cough, Headache, Diarrhoea, Vomiting)
  • Shock (Hypotension and tachycardia)
54
Q

How is Erythema multiforme diagnosed

A

Usually clinical

Bloods - High WCC, Eosinophilia
ESR/CRP

Imaging - Exclude sarcoidosis and atypical pneumonia

Skin biopsy - Histology and direct immunofluorescence if in doubt about diagnosis

55
Q

What is Erythema nodosum

A

Hypersensitivity reaction causing inflammation of subcutaneous fat tissue presenting as red or violet subcutaneous nodules

56
Q

What are the causes of Erythema nodosum

A

Infection:

  • Bacterial: Streptococcus
  • Viral: EBV
  • Fungal: Histoplasmosis

Systemic

  • Sarcoidosis
  • IBD
  • Behcet’s disease

Malignancy

  • Leukaemia
  • Hodgkin’s disease

Drugs

  • Sulphonamides
  • Penicillin
  • OCP

Pregnancy

25% of cases have no identifiable cause

57
Q

Who is usually affected by Erythema nodosum

A

Young adults

3x in females

58
Q

What are the signs and symptoms of Erythema nodosum

A
  • Crops of red/violet dome shaped nodules usually present on both shins - Tender
  • Occasionally on thighs or forearms
  • Low grade fever
  • Joints may be tender and painful on movement
59
Q

How is Erythema nodosum investigated

A

Investigations are geared at determining the cause

Bloods:
Anti-streptolysin-O titre
FBC/CRP/ESR - Signs of infection/inflammation
U&amp;Es
Serum ACE - Sarcoidosis

Throat swab and cultures
Mantoux/head skin testing - TB
CXR - Bilateral hilar lymphadenopathy or other evidence of TB, Sarcoidosis or fungal infection

60
Q

What is Urticaria

A

Itchy, red, blotchy rash resulting from swelling of the superficial part of skin.

Angioedema occurs when the deep tissues, lower dermis and subcutaneous tissues are involved and become swollen

AKA Hives

61
Q

What are causes of Urticaria

A

Acute Urticaria:

  • Allergies
  • Viral infections
  • Skin contact with chemicals
  • Physical stimuli

Chronic Urticaria:

  • Chronic spontaneous urticaria
  • Autoimmune
62
Q

What are signs and symptoms of Urticaria

A
  • Central itchy which papule or plaque surrounded by erythematous flare
  • Lesions vary in size and shape
  • May be associated with swelling of the soft-tissues of the eyelids, lips and tongue
  • Individual lesions are usually transient

Timescales:

  • Acute: Symptoms develop quickly but normally resolve within 48 hrs
  • Chronic: Rash persists for >6 weeks
63
Q

How is Urticaria diagnosed

A

Usually clinical

Tests may include (FBC, ESR/CRP, path testing, IgE tests)

64
Q

What is Psoriasis

A

Chronic inflammatory skin disease due to hyper proliferation of keratinocytes that may be complicated by arthritis

65
Q

What are risk factors for Psoriasis

A
  • Guttate - Streptococcal sore throat
  • Palmoplantar - Smoking, middle-aged women, autoimmune thyroid disease
  • Generalised pustular - Hypoparathyroidism
66
Q

What are symptoms of Psoriasis

A
  • Itching
  • Pinpoint bleeding with removing scales
  • Skin lesions may develop at sites of trauma
67
Q

What are the signs of Psoriasis

A

Discoid/Nummular - Symmertrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces

Flexural - Less scaly plaques in axilla, groins, perianal and genital skin

Guttate - Small drop-like lesions over trunk and limbs

Palmoplantar - Erythematous plaques with pustules on palms and soles

Generalised pustular - Pustules over limbs and torso - Hospitalisation (Sudden withdrawal of steroids)

Erythroderma - Generalised red, inflamed skin - Hospitalisation

Nails - POSH (Pitting, Onycholysis, Subungual Hyperkeratosis)

Arthritis

  • Asymmetrical oligoarthritis
  • Symmetrical polyarthritis
  • DIP joint predominance
  • Arthritis mutilans
  • Psoriatic spondylitis
68
Q

What are Cellulitis & Erysipelas

A

Cellulitis: Acute bacterial infection of the dermis and subcutaneous tissue
Erysipelas: Distinct form of superficial cellulitis which is sharply demarcated

69
Q

What are causes of cellulitis

A

Streptococcus pyogenes
Staphylococcus aureus
Peri-orbital caused by Haemophilus influenzae

Risk factors:

  • Skin break
  • Poor hygiene
  • Immunosuppression
  • Wounds
  • IV cannulation
70
Q

What are signs and symptoms fo Cellulitis & Erysipelas

A

Hx of RFs
Peri-orbital - Painful swollen red skin around the eye
Orbital - Painful or limited eye movements, visual impairment

Lesion: Erythema, Oedema, Warm tender indistinct margins, Fever

Periorbital - Swollen eye lid, conjunctival infection

Orbital - Proptosis, impaired visual acuity and eye movement, Test RAPD, visual acuity and colour vision

71
Q

How are Cellulitis & Erysipelas diagnosed

A

Bloods - WCC, Blood culture
Discharge - Sample and send for MC&S
Aspiration if pus suspected
CT/MRI - If orbital cellulitis is suspected (helps assess posterior spread of infection)

72
Q

How are Cellulitis & Erysipelas treated

A

Mild cases:

  • Draw around lesion
  • Elevated leg
  • Encourage oral fluids
  • Paracetamol/ibuprofen
  • Oral antibiotics: Local policy (Often flucloxacillin)

Admit if septic: Confusion, Tachycardia, Tachypnoea, Hypotension

Surgical: Orbital decompression may be needed in orbital cellulitis (Emergency)

Abscess: Aspirate, incision and drainage, excised completely

73
Q

What are the complications of Cellulitis

A
  • Sloughing of overlying skin
  • Orbital cellulitis - May cause permanent loss of vision, spread to the brain, abscess, formation, meningitis, cavernous sinus thrombosis
74
Q

What is Varicella zoster

A

Primary infection is called varicella (Chickenpox). reactivation of the dormant virus (found in dorsal root ganglia) causes zoster (Shingles).

75
Q

How is Varicella zoster transmitted

A

Aerosol inhalation or direct contact with vesicular secretions

ds-DNA
90% of adults VZV IgG positive (Immunity)

76
Q

What are the signs and symptoms of chickenpox

A
  • Prodromal malaise
  • Mild fever
  • Sudden appearance of intensely itchy spreading
  • Vesicles weep and crust over
  • New vesicles appear
  • Contagious from 48hrs before the rash until after the vesicles have all crusted over (7-10days)
  • Maculopapular rash
  • Areas of weeping and crusting
  • Skin excoriation (from scratching)
77
Q

What are the signs and symptoms of shingles

A
  • May occur after a period of stress
  • Tingling/hyperaesthesia in dermatomal distribution
  • Painful skin lesions
  • Recovery: 10-14 days
  • Vesicular maculopapular rash
  • Skin excoriation
78
Q

How is Varicella zoster diagnosed

A

Clinical diagnosis

  • Vesicle fluid be sent for microscopy viral PCR
  • Chicken pox in adult with previous history of varicella infection may require HIV testing
79
Q

How is Varicella zoster treated

A

Chickenpox: Children - Treat symptoms (Antihistamine - Diphenhydramine), Adults - Consider acyclovir

Shingles: Aciclovir, Valaciclovir, Famciclovir

Prevention: Vaccine

80
Q

What are complications Varicella zoster

A

Chickenpox:

  • Secondary infection
  • Scarring
  • Pneumonia
  • Encephalitis
  • Congenital varicella syndrome

Shingles:

  • Postherpetic neuralgia
  • Zoster opthalmicus (Rash in the ophthalmic division of the trigeminal nerve)
  • Ramsay-Hunt syndrome - Geniculate ganglion causing zoster of the ear and facial nerve palsy. Vesicles may be seen behind the pinna of the ear or in the ear canal
  • Sacral zoster
  • Motor zoster

All conditions - Year 3 (16 decks)

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