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Finals!!! > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the types of tumours of the epidermis?

A
  • Actinic keratosis
  • Bowen’s disease
  • SCC
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2
Q

Key features of Actinic Keratosis

A
  • Sun exposed areas- hands, nose etc
  • Yellow scaly plaque with irreg. edges
  • Tx- topical chemo, cyro, curettage, photodynamic therapy
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3
Q

Key features of Bowen’s Disease

A
  • Full thickeness dysplasia
  • Causes- sun, carcinogens, radio. ++immunosuppressed
  • Ix- biopsy
  • Tx- Cryo, curettage, excision, topical chemo, photodynamic therapy
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4
Q

Key features of SCC

A
  • Cause- sun, radio, carcinogens, mercury, progression from prev ulcer
  • Scaly/cruty raised area of skin with red inflamed base
  • Common in sun exposed areas
  • Ix- biopsy
  • Excition +/- radio
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5
Q

Types of basal cell skin tumours and Key features of BCC

A
  • Seborrheoic keratosis= wart. brown. middle aged.
  • Basal cell carincoma:
    • Cause= cumulative sun exposure
    • Pearly, rolled edges, telangectasia. Can form ulcer.
    • Invade local structure. don’t met.
    • Tx- excision, radio, curettage, cryo
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6
Q

Types of melanocytic lesions and key features of melanoma

A
  • Ephelis- freckle
  • Melanocytic naevus= benign pigmented macule
  • Lentigo= liver spot. Flat pigmented area.
  • Malignant melanoma:
    • Cause= BURN (UV B). trunk/ legs. pale people.
    • Presentation- asymmetrical, variable pigmentation, irregular edge, bleeding, itching, at least 6mm diameter
    • Met early and unpredictably
    • Ix= biopsy –> Breslow thickness
    • Tx= excision, chemo, radio
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7
Q

2 week wait referral criteria for melanoma

A
  • Dermatoscopy suggesting melanoma
  • OR 3 points from:
    • Major (2 points each): Change in size, irregular colour, irregular size
    • Minor (1 point each): >6mm, inflammation, oozing, change in sensation
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8
Q

What is cellulitis, what are common organisms and RF?

A
  • = Acute infection of lower dermis and SC tissue
  • Organisms: Strep. pyogenes (2/3), Staph. Aureus
  • RF:
    • Immunocompromise- steroids, DM, HIV, chemo
    • Entry point- wound, skin fissures, ulcer
    • CKD
    • Chronic liver disease
    • Alcoholism
    • PMH cellulitis
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9
Q

Presentation of cellulitis

A
  • Presentation:
    • Local- redness, hot, swelling, erythema, blisterds, erosions, abscess, purpura, purulent
    • Unilateral
    • Streaking away from lesion
    • Systemic- tachycardia, tachypnoea, malaise, fevers/chills, rigors, sepsis
    • Entry site? Wound, cannula, ulcer, bite
    • Lymphadenopathy
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10
Q

Complications of cellulitis

A
  • Necrotising fasciitis
  • Gas gangrene
  • Sepsis
  • Infections to other organs eg endocarditis, osteomyelitis
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11
Q

Ix and Tx of cellulitis

A
  • Ix:
    • Bedside- swabs (inc MRSA), obs
    • Bloods- WCC, CRP, cultures
    • Imaging- USS ?DVT, X-ray ?osteomyelitis
  • Tx:
    • Cons- rest, elevate, mobilise, fluids, draw margins.
    • Medical:
      • Analgesia
      • Antipyretics
      • ABx- 1. Fluclox (erythromicin). 2.Clindamicin. Co-amox if facial/ systemic.
      • MRSA- doxycycline
    • Surgical- debridement
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12
Q

Key features of necrotising fasciitis

A
  • = Rapidly progressive infection of deep fascia –> necrosis of SC tissue.
  • Presentation:
    • ++pain out of proportion
    • Rapidly spreading erythema, blistering, oedema
    • Systemic Sx- sepsis, fever, sweating, N+V, anorexia, diarrhoea
  • Ix- obs, swabs, bloods, x-ray
  • Tx:
    • ABCDE. Senior help ASAP!
    • ABx- micro. IV BenPen, gentamicin, clindamicin, metronidazole
    • Surgical debridement ASAP!
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13
Q

Presentation of eczema

A
  • Dry red and scaly patches
  • Itchy
  • Poorly demarcated rash. Acute= oozing papules + vesicles. Subacute= red + scaly.
  • Chronic –> lichenification. Skin thickening + exaggeration of skin markings.
  • Atopy= Eczema, hayfever, asthma. PMH/ FHx?
  • Triggers- fabrics, inhaled allergens, stress, heat, hormones, skin infections, dietary etc
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14
Q

Ix and Tx of eczema

A
  • Ix- usually none. IgE, RAST (specific Ab), patch testing
  • Tx:
    • Cons- avoid triggers and scratching. Soap substitutes eg dermol. Emollients- epaderm, diprobase
    • Medical= topical steroids. 1% hydrocortisone –> eumovate –> betnovate –> dermovate
    • 2nd line therapies- topical tacrolimus, phototherapy, ciclosporin, azathioprine
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15
Q

What are the eczema variants and their features?

A
  • Discoid- circular, oozing and crusting patches
  • Contact dermatitis to irritants eg soaps
  • Varicose eczema- varicose veins. Red/itchy. Borwn scars. Lipodermatosclerosis. –>?ulcer
  • Seborrhoeic dermatitis- red and scaly. Overgrowth of skin yeast. In eyebrows, scalp, cheeks, nasolabial folds. Tx= daktacort (miconazole + hydrocortisone)
  • Dyshydrotic eczema- blisters on soles of feet and hands. Related to stress and allergies
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16
Q

What is psoriasis? + RF/ aggravating factors

A
  • = AI disorer. Inflammation of dermis with epidermal hyperproliferation.
  • RF/ aggravating factors:
    • FHx
    • Stress
    • Smoking/ alcohol
    • Obesity
    • Infections (esp strep), skin injury
    • Hormonal
    • Meds- beta blockers, lithium, antimalarials
17
Q

Presentation of chronic plaque psoriasis

A
  • Itchy, dry patches +/- bleeding
  • Plaques- pink/red, scaly. Esp extensors (elbows, knees), lower back, scalp. Well demarcated and symmetrical.
  • Nail changes- pitting, onycholysis
  • 10-40% –> seronegative arthritis (mono/polyarthritis). Asymmetrical. DIPs.
18
Q

Variants of psoriasis and their presentation

A
  • Pustular- palms and soles
  • Guttate- Sudden. 2-3w post strep throat. Papules on trunk.
  • Flexural- older people. No scale. Groin, nasal cleft, submammary
19
Q

Tx of psoriasis

A
  • Cons- avoid triggers, soap substitutes eg aqueous cream. Emollients eg epaderm/dermol/diprobase.
  • Topical therapy- steroids, Vit D3 analogue (calciprotriol), tar, retinoids (eg tazarotene).
  • UVB phototherapy
  • Systemic:
    • Biological- anti-TNFalpha eg infliximab
    • Non-biological- methotrexate, ciclosporin
20
Q

What is Tinea and its types? + Tx

A
  • Tinea= superficial mycosis caused by dermatophytes (fungi)
  • Presentation= Round, scaly, itchy lesions with central clearing. Slightly raised. Well demarcated. Scaly edge.
  • Types:
    • Tinea corporis= symmetrical. spreading. on body.
    • Tinea faciei= face.
    • Tinea cruris= Groin. More red and plaque-like.
    • Tinea pedis= athlete’s foot. ++ itchy. Fissured and macerated skin.
  • Tx= topical antifingals eg clotrimazole. PO if widespread.
21
Q

What is scabies? Presentation, Ix and Tx

A
  • = Skin infection with saropptoes scabiei
  • Rash- ++ itchy, papular. Site- interdigital, ankles, wrist, axillae, umbilicus
  • Linear skin burrows= pathopneumonic.
  • Ix- skin scraping
  • Tx- wash clothes/ sheets. Scabicide to whole body eg malathion.
  • ++ Contagious
22
Q

What is candida albicans? Presentation + Tx

A
  • = Yeast infection.
  • Thrives in warm moist areas- nappies, body fold, interdigital space.
  • Rash- Erythematous, ragged, peeling edge +/- small pustules
  • Mouth + genital- white plaques/ discharge
  • Tx:
    • Cons- clean and dry skin
    • Topical antifugal- cream eg clotrimazole, drops eg nystatin, pessaries eg clotrimazole.
    • PO Fluconazole if resistant
23
Q

What are the key features of acne vulgaris?

A
  1. Keratinocyte proliferation
  2. ++ Sebum
  3. Bacteria colonisation
  4. Inflammatiion
  5. White and black heads
24
Q

Tx of acne vulgaris

A
  • Cons- screen for mental health
  • Med:
    1. Topical ABx + bezoyl peroxide
    2. PO ABx 4-6m + bezoyl peroxide. Eg doxycycline.
    3. ?OCP
    4. –> Specialist. Isotretanoin. SE= dryness, depression, teratogenic
25
Q

What is acne rosacea and how does it present?

A
  • = Chronic relapsing remitting disorder of BVs adn pilosebaceous units
  • Presentation:
    • More in fair skinned
    • Pre-rosacea- flushing in repsone to stress etc
    • Central rash- symmetrical, erythema, telangectasia, papules, pustules, inflamm nodules
26
Q

Tx of acne rosacea

A
  • Cons- soap substitutes. Sun cream.
  • Med:
    1. Topical metronidazole
    2. PO doxycycline
    3. Isotretanoin
27
Q

What is erythema multiforme? Presentation + Tx

A
  • = Hypersensitivity. Mostly to HSV
  • Rash- Erythematous, round, well defined ‘target lesions’. Extensor surfaces. Lesions at different stages (multiforme)
  • Major= severe mucosal involvement, systemic upset.
  • Tx= usually none. ?Steroids ?aciclovir
28
Q

What is Steven-Johnson Syndrome- causes, presentation

A
  • = Serious disease of skin and mucous membranes. Hypersensitivity reaction to drugs/ infection
  • Drugs- NSAIDs, penicillins, anti-epileptics, sulfonamides
  • Presentation- Starat drug –> vague URTI Sx for 2-3w –> painful erythematous macules –> severe mucosal ulcerations
29
Q

Erythroderma - What is it? Presentation, complications, Tx

A
  • = Intense widespread reddening of skin due to inflammatory skin diseases. ‘Red man syndrome’
  • Causes/ RF: Drug eruption, dermatitis, psoriasis, infection, systemic disease (HIV, GVHD, malignancy).
  • Presentation:
    • Often preceded by eruptions, plaques, dermatitis.
    • Generalised erythema (>90% skin surface). Warm.
    • Oedema
    • Systemic- lymphadenopathy, hepatosplenomegaly
  • Complications- hypothermia, dehydration, electrolyte imbalance, HF, secondary skin inf, hypoalbuminaemia (–> oedema)
  • Tx- Regulate body temp, fluid status and electrolytes. Wet wraps, emollients (thick white paraffin), topical steroids.
30
Q

What are the types of malignant melanoma?

A
  • Superficial spreading
  • Nodular
  • Lentigo maligna melanoma (face. prev. lentigo maligna)
  • Acral lentigenous melanoma (nails)
  • Amelanotic melanoma
31
Q

Types of severe cutaneous drug reaction and presentation

A
  • Widespread macular papular rash.
  • Features of severe:
    • Temp >40
    • Hypotension
    • Lymphadenopathy
    • SOB/ wheeze
    • Erythroderma
    • Swelling of face/ tongue
    • Pain/ burning
    • Erosions/ shearing
    • Blistering/ bullae
  • SJS= <10% surface areas with blisters
  • TEN= >30%. Toxic epidermal necrolysis.
32
Q

Presentation of eczema herpeticum + Ix and Tx

A
  • Sudden deterioration of stable eczema:
    • ++ pain
    • Unwell +/- fever
    • Small punched out ulcers (can merge)
    • Dissemination
  • Ix- viral swabs
  • Tx- PO aciclovir +/- flucloxicillin
33
Q

What is staphylococcal scaled skin syndrome?

A
  • Esp infants, elderly, immunocompromised.
  • Infection of Staph (may not be skin) –> release epidermolytic toxins
  • Mucosal surface never involved, no necrosis
  • Look for local focus eg nasopharynx
  • Ix- blood culture and swabs
  • Tx= fluclox
34
Q

Types of Bullous skin disorders + key features

A
  • Bullous pemphigoid- Elderly w/ neuro disease. Itchy skin with large tense bullae. Risk of infection. Tx= steroids
  • Pemphigoid vulgaris- younger, more severe. Flaccid superficial blisters. Tx- systemic steroids/ immunosuppression
  • Dermatitis herpetiformis- Esp in coeliac. Sysmmetrical ++ itchy blisters. +/- GI Sx. Tx= gluten free
35
Q

Categories of skin lesion morphology

A
  • Flat: Macule <0.5cm, patch >0.5cm
  • Raised: Papule <0.5cm, nodule >0.5cm
  • Plaque= large, plateau, superficial
  • Fluid filled: vesicle= <0.5cm, bulla= >0.5cm, pustule= pus filled
  • Abscess= fluid filled lesion

Finals!!! (19 decks)

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