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3B Revision > Dermatology > Flashcards

Dermatology Flashcards

1
Q

3 things to describe a rash?

A

Distribution
Configuration
Morphology

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2
Q

Give 3 examples of distribution a rash can be

A

Skin folds
Flexural
Hands and feet

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3
Q

Give 4 examples of rash configuration

A

Linear
Annular (ring)
Discoid (coin)
Cluster

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4
Q

What is macule morphology?

A

<0.5cm flat (non-palpable) areas e.g. freckle

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5
Q

What is patch morphology?

A

> 0.5cm flat area e.g. port wine stain

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6
Q

What is papule morphology?

A

<0.5cm solid raised lesion

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7
Q

What is nodule morphology?

A

> 0.5cm solid raised lesion with deeper component i.e. granuloma

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8
Q

What is plaque morphology?

A

Well circumscribed, PALPABLE scaling lesion e.g. psoriasis

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9
Q

What is vesicle morphology?

A

<0.5cm raised, clear fluid filled lesion - HSV

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10
Q

What is bulla morphology?

A

> 0.5cm raised, clear fluid filled lesion

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11
Q

What is pustule morphology?

A

<0.5cm pus containing lesions - acne

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12
Q

What is abscess morphology?

A

Localised accumulation of pus in dermis or subcutaneous

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13
Q

What is a weal?

A

Transient raised lesion due to dermal oedema - urticaria

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14
Q

What is a boil?

A

Staphylococcus infection around or within hair follicle

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15
Q

What is excoriation?

A

Loss of epidermis after trauma e.g. eczema

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16
Q

What is lichenification?

A

Well defined roughening, thickening of skin with loss of skin markings

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17
Q

What is a scale?

A

Flakes of stratum corneum

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18
Q

What is a crust?

A

Rough surface of dried blood serum or pus

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19
Q

What is a scar?

A

New fibrous tissue occurring post wound healing

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20
Q

3 types of scars

A

Atrophic - thinning
Hypertrophic - hyperproliferation within boundary
Keloidal - hyperproliferation beyond boundary

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21
Q

What is an ulcer?

A

Loss of the epidermis and dermis

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22
Q

What is a fissure?

A

Epidermal crack due to excess dryness

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23
Q

6 functions of normal skin

A 
Protection
Temperature regulation
Sensation
Vitamin D synthesis
Immunosurveillance
Stop fluid loss
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24
Q

3 layers of skin in order from top to bottom

A

Epidermis - top
Dermis
Subcutaneous tissue - bottom

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25
Q

4 cell types in epidermis

A

Keratinocytes produce keratin
Langerhan’s cells activate T lymphocytes
Melanocytes produce melanin
Merkel cells for sensation

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26
Q

4 layers of the epidermis?

A 
Stratum basale (dividing cells)
Stratum spinosum (differentiating)
Stratum granulosum (lose nuclei)
Stratum corneum (keratin)
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27
Q

What is the dermis made from (4)

A

Collagen mainly
Elastin
Glycoaminoglycans
Fibroblasts

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28
Q

4 stages of wound healing?

A

Haemostasis (vasoconstriction, platelet aggregation)
Inflammation (vasodilation, migration of neutrophils)
Proliferation (granulation tissue)
Remodelling (scar)

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29
Q

SHIP DOC systemic corticosteroids side effects

A 
Syndrome
Hypertension
Immunosuppression
Psychosis
Diabetes
Osteoporosis
Cataracts
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30
Q

What is eczema?

A

A chronic, relapsing inflammatory skin condition characterised by itchy erythematous scaly patches

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31
Q

Distribution of eczema?

A 
Flexor surfaces (skin folds) in children/adults
INFANTS - face and extensor surfaces
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32
Q

Cause of eczema?

A

Combination of genetic susceptibility and environment

Defect in skin barrier function and immune dysregulation after allergen exposure

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33
Q

What is the genetic defect in skin barrier function in eczema?

A

Mutation in filaggrin - epidermal barrier protein

Increased exposure and sensitivity

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34
Q

What is the immune dysregulation in eczema?

A

Th2 mediated immune response
Over expression of Il-4, 5, 13
Leads to increased IgE and eosinophilia

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35
Q

6 exacerbating factors of eczema

A 
Infection
Soaps
Dust mites
Sweat
Heat 
Stress
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36
Q

Risk factors for eczema (2)

A

Atopy

Family history

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37
Q

How is eczema diagnosed?

A

Itchy skin +3 of:
Flexural involvement - historical or visible
History of asthma, hayfever of family history if <4
Generally dry skin in last year
Onsert before 2 years old

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38
Q

Symptoms of eczema (5)

A 
Itchy skin (pruritis)
Dry skin (xerosis)
Erythematous scaly patches on flexor surfaces
Acute lesions - weeping
Lichenification/excoriation
Hypopigmentation
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39
Q

Investigations for eczema?

A

Serum IgE levels

Allergy testing - specific IgEs skin prick or RAST (radioallergosorbant test)

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40
Q

2 complications of eczema

A 
Bacterial superinfection (staph aureus)
Eczema herpeticum - EMERGENCY
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41
Q

4 stages of eczema treatment

A

1 - emollients, avoid irritants/soaps, identify triggers
2 - low/mid potency topical corticosteroids (hydrocortisone) or topical calcineurin inhibitors (tacrolimus)
3 - mid/high potency topical corticosteroids and/or topical calcineurin inhibitors (tacrolimus)
4 - systemic corticosteroids (prednisolone), azathioprine or ciclosporin, or UV therapy

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42
Q

What is tacrolimus?

A

Calcineurin inhibitor - steroid sparing immunomodulator

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43
Q

How to treat bacterial infection of eczema

A

Flucloxacillin or erythromycin

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44
Q

How to treat eczema herpeticum

A

Aciclovir

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45
Q

What is contact dermatitis?

A

Hand eczema - history of contact with irritants/allergic reaction
Localised burning, itching, blistering at site of contact

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46
Q

How to treat contact dermatitis

A

Irritant - emollients, topical corticosteroids, avoid irritant
Allergic - topical corticosteroids, avoid allergen

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47
Q

What is seborrhoeic dermatitis?

A

Pruritic, erythematous, scaly patched on SCALP, NASOLABIAL FOLD OR FRONT CHEST
Cradle cap in infants, dandruff adults or pityriasis capitis (fungal)

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48
Q

Treatment of seborrhoeic dermatitis?

A

Infants - emollients, topical corticosteroids
Adults - topical shampoo, topical corticosteroids, topical antifungals (ketoconazole)
Oral ketoconazole if persistent

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49
Q

What is psoriasis?

A

Inflammatory disease due to proliferation of keratinocytes and inflammatory cell infiltrate

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50
Q

What does psoriasis plaque look like?

A

Erythematous, well-circumscribed, scaly plaques at extensor surfaces and scalp

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51
Q

2 associated symptoms/conditions with psoriasis

A

Nail changes - pitting, Beau’s lines, oncholysis

Psoriatic arthritis

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52
Q

Cause of psoriasis?

A

Interaction between genetic (TNF alpha), immunological, environmental (stress), infection

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53
Q

Pathology of psoriasis?

A

Hyperproliferation of keratinocytes. Silver scale is dead cells

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54
Q

6 types of psoriasis

A 
Plaque - most common
Guttate (post strep throat)
Seborrheic - nose, ears
Flexural
Palmar-plantar pustular
Erythrodermic
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55
Q

Management of psoriasis? (8)

A 
Avoid triggers
Emollients
Vitamin D analogues 
Topical corticosteroids
Coal tar preparations
Phototherapy
Oral methotrexate, retinoids, ciclosporin
Biologics - etanecerpt, infliximab
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56
Q

How is plaque psoriasis treated?

A

Topical corticosteroid and/or vitamin D analogue

Phototherapy/methotrexate/retinoid/biologic

57
Q

What is acne vulgaris?

A

Inflammatory disease of pilosebaceous follicles

58
Q

What causes acne?

A

Hormones - androgens cause increased sebum, comedones form and become colonised with propionibacterium acnes, causes inflammation

59
Q

Types of non inflammatory acne (2)

A

Blackheads - open comedones

Whiteheads - closed comedones

60
Q

Types of inflammatory acne (3)

A

Papules
Nodules
Cysts

61
Q

Topical therapies for acne (3)

A

Topical keratolytic - salicyclic acid
Topical retinoids - isotrenoin
Topical antibiotics - erythromycin

62
Q

Oral therapies for acne (3)

A

Oral antibiotics - doxycycline
Anti-androgens - COCP
Oral retinoids - isotrenoin

63
Q

What are the types of skin cancer

A

10% melanoma
20% squamous cell carcinoma METS COMMON (premalignant = actinic keratosis, in situ = Bowen’s)
70% basal cell carcinoma METS RARE

64
Q

What is squamous cell carcinoma?

A

Locally invasive malignant tumour of epidermal keratinocytes, potential to metastasise

65
Q

Risk factors for squamous cell carcinoma? (4)

A 
UV exposure
Chronic inflammation
Immunosuppression
Fair skin
Outdoor occupation
66
Q

Presentation of squamous cell carcinoma? (3)

A

Keratotic (crusty/scaly) ill defined nodule
Possible ulceration or bleeding
Possible lymphadenopathy or hepatomegaly if spread

67
Q

Investigations of squamous cell carcinoma?

A

Biopsy - keratinocyte atypia

CT/MRI for mets

68
Q

Management of squamous cell carcinoma? (3)

A

In situ - cryotherapy or topical chemotherapy
Invasive - wide surgical excision
Metastatic - excision plus radiotherapy

69
Q

What is basal cell carcinoma?

A

Slow growing, locally invasive, malignant tumour of epidermal keratinocytes arising from hair follicle

70
Q

Risk factors for basal cell carcinoma

A 
UV exposure
Fair skin
Age
Male
Immunosuppression
71
Q

Presentation of basal cell carcinoma?

A

Rodent ulcer - small papule/nodule with surface telangectasia, pearly rolled edge and necrotic or ulcerated centre

72
Q

Investigation of basal cell carcinoma?

A

Biopsy for histopathology - small dark staining basal cells invading the dermisM

73
Q

Management of basal cell carcinoma? (3)

A

Surgical excision
Radiotherapy
If low risk - cryotherapy, photodynamic therapy, topical chemotherapy

74
Q

How to describe a pigmented lesion?

A 
Asymmetry
Border
Colour
Diameter
Evolution
75
Q

What is malignant melanoma?

A

Invasive malignant tumour of the epidermal melanocytes

76
Q

Risk factors for malignant melanoma?

A 
UV exposure
Fair skin
Lots of moles/atypical
Family history
Immunosuppression
77
Q

Presentation of melanoma?

A

Asymmetrical, jagged border, non uniform colour
>6mm diameter
Evolving colour shape or size

78
Q

Investigations of melanoma? (3)

A

Dermatoscopy for ABCDE
Skin biopsy - abnormal melanocytic proliferation
Assess mets - lymph node biopsy, CXR, liver USS, CT

79
Q

Management of melanoma (3)

A

In situ - wide local excision
Invasive - wide local excision with sentinel lymph node biopsy
Mets - lymphadenectomy, radiotherapy, chemotherapy

80
Q

What is impetigo?

A

Staphylococcus aureus infection common in children

Golden crusts or vesicles in bullous impetigo

81
Q

What causes impetigo

A

Staph aureus infection in skin susceptible post trauma, in eczema

82
Q

How is impetigo treated?

A

Topical fusidic acid

Oral flucloxacillin

83
Q

Types of herpes simplex?

A

1 - oral
2 - genital

Treat with aciclovir

84
Q

What is cellulitis?

A

Spreading bacterial infection of deep subcutaneous tissue causing overlying skin inflammation (red, oedema, warm, tender)

85
Q

What is erysipelas

A

Acute superficial cellulitis

86
Q

Organism in cellulitis

A

Staph aureus (or strep pyogenes)

87
Q

Risk factors for cellulitis

A 
Immunosuppression
Wounds
Leg ulcers
Poor hygiene
Poor vascularisation
88
Q

Investigations for cellulitis

A

Bloods - raised WCC on FBC, blood culture, swab

89
Q

Management of cellulitis

A

Flucloxacillin 250mg 6hrly

If very ill, IV vancomycin or tazocin to cover MRSA

90
Q

Give some examples of fungal infections

A

Tinea corporis
Tinea pedis - moist fissures between toes
Tinea capitis - scalp ringworm - broken hair, scaling
Tinea unguium - yellow crumbly nails
Candidiasis - white plaques on mucosa

91
Q

Treatment of fungal infections?

A 
Swabs for organism
Treat triggers - moisture, immunoosuppressives
Topical antifungals - ketoconazole
Oral antifungals - fluconazole
AVOID TOPICAL STEROIDS
92
Q

What is a wart and what causes it

A

Elevated round, hyperkeratotic skin papules with rough grey brown surface
HPV 6-11

93
Q

Treatment of warts

A

Cryotherapy
Salicyclic acid
Silver nitrate
Debridement

94
Q

What is molloscum contagiosum?

A

Viral, acquired skin to skin
Pearly smooth papule with central umbilication, face and groin
Treated with cryotherapy

95
Q

What is scabies?

A

Infection with mites, transmissed skin to skin

Itchy red papules, linear burrows between fingers

96
Q

Investigation of scabies?

A

Microscopic confirmation of mites eggs or faeces in skin scrapings

97
Q

Treatment of scabies

A

Treat whole family, hot wash clothes

Topical permethrin

98
Q

What is an ulcer?

A

Abnormal break in the epithelial surface, commonly venous

99
Q

Causes of venous ulcers?

A

Chronic venous insufficiency
Incompetent valves, blood squeezed into superficial veins causing dilatation, raised pressure causes oedema and fibrin deposition, poor oxygenation of skin and ulcration

100
Q

Signs of chronic venous insufficiency? (5)

A 
Ankle swelling
Hyperpigmentation
Heavy legs
Dry scaly skin
Varicosities
101
Q

Risk factors for venous ulcers? (4)

A

Age
Family history
Smoking
DVT

102
Q

Presentation of venous ulcers (5)

A

Medial/lateral malleolus between knee and ankle

Large, shallow, painless/mild pain, irregular border, moist granulating base

103
Q

Investigation of venous ulcers

A

ABPI and doppler to exclude arterial
Swabs for microbiology
Biopsy if atypical

104
Q

Management of venous ulcers (4)

A

Graduated compression and leg elevation
Debridement and cleaning
Occlusive hydrocolloid dressing
ABX if infected

105
Q

Cause of arterial ulcers?

A

Atherosclerosis, tissue hypoxia

106
Q

Risk factors for arterial ulcers

A

CV RFs - smoking, diabetes
Absent pulses
Ischaemia - pain, pulseless, perishingly cold, paraesthesia, paralysis

107
Q

Site of arterial ulcers

A

more distal than venous - dorsum of foot or toes

108
Q

Presentation of arterial ulcers (4)

A 
Painful
Irregular edge initially
Grey granulating base
No bleeding on debridement
Punched out, cold shiny surrounding skin
109
Q

Investigations of arterial ulcers

A

ABPI (cuff above ankle) and doppler (on dorsum of feet)

Divide systolic at ankle by that at arm - <0.9 indicates peripheral arterial disease

110
Q

Management of arterial ulcers

A

Management of peripheral vascular disease - analgesia, refer to surgeons

111
Q

What are neuropathic ulcers?

A

Ulcer formed due to paraesthesia and peripheral neuropathy - painless skin breakdown

112
Q

Site of neuropathic ulcers

A

under callouses, pressure points

plantar aspect of 1st and 5th metatarsopharangeal joint

113
Q

Presentation of neuropathic ulcers (4)

A 
Punched out, deep
Surrounded by chronic inflammatory tissue
Bleeding on debridement
Painless
May be necrotic
114
Q

Treatment of neuropathic ulcers

A

Seek cause - often diabetes

Diabetic foot management - socks, shoes, hygiene, check sensation

115
Q

What is urticara?

A

Itchy wheals - transient central swellling with peripheral oedema

116
Q

Pathophysiology of urticaria

A

Local increase in permeability of capillaries and venules mediated by histamine derived from skin mast cells, IgE response

117
Q

Treatment of urticaria

A

antihistamines - chlorphenamine, loratidine

118
Q

3 Signs of anaphylaxis

A

Bronchospasm - stridor
Facial and laryngeal oedema
Hypotension

119
Q

Causes of urticaria/anaphylaxis (4)

A 
Food allergy - nuts, shellfish
Drugs - penicillin
Contact - latex
Bites - bees
Autoimmune
120
Q

What is erythema nodosum?

A

Erythematous lumps on shins due to inflammation of subcutaneous fat

121
Q

Causes of erythema nodosum (4)

A

IBD
TB
Strep throat
Sarcoidosis

122
Q

Treatment of erythema nodosum

A

Treat cause

Prednisolone

123
Q

What is erythema multiforme

A

Hypersensitivity reaction triggered by infection
Acute, self limiting inflammation, HSV, SLE
Lesions spreading from back hands/top feet to body

124
Q

What is steven-johnson syndrome?

A

Mucocutaneous necrosis with at least 2 mucosal sites

Preceding use of medication use or infection - anticonvulsants, ABX, NSAIDs

125
Q

What is toxic epidermal necrolysis?

A

Mucocutaneous necrosis with at least 2 mucosal sites involved with SYSTEMIC TOXICITY
25% mortality

126
Q

Signs of SJS/TEN?

A

Maculopapular rash
Bullae
Sloughing under pressure

127
Q

Management of SJS/TEN

A 
Escalate
Withdraw causative agent
Dressings, topical emollients
IV fluids
Analgesia
128
Q

What is necrotising fasciitis?

A

Rapidly spreading infection of deep fascia with secondary tissue necrosis

129
Q

Cause of nec fas

A

Group a haemolytic strep - pyogenes

RFs - abdo surgery, diabetes, comorbidities

130
Q

Presentation of nec fas

A

Severe pain
Erythematous, blistering necrotic skin
Systemically unwell - fever, tachycardi
Crepitus - asubcutaneous emphysema

131
Q

management of nec fas

A

Surgical debridement
Haemodynamic support
Empirical broad spec ABX - i.e. vancomycin, tazocin

132
Q

What is seborrheic keratosis and how treated?

A

Common multiple benign lesions affecting over 50s
Well circumsribed plaques or papules, warty, brown
Painless

Steroids or cryotherapy

133
Q

What is lichen planus?

A

Self limiting inflammatory disease affecting skin and genitals, nails, hair
Common in middle ages women
Intense pruritus, scarring

134
Q

How does lichen planus present

A

Itchy, shiny, flat topped papules
Extremities, mucosal
Overlying white lacy network

135
Q

Management of lichen planus

A

Topical corticosterois and antihistamine

Oral corticosteroid if on mouth

136
Q

5 causes of systemic itch

A

Renal failure - urea mediated
Cholestatic pruritus - bile salt mediated
Haematological - polycythaemia vera = increased basophils and mast cells
Endocrine - hyper/hypothyroid, diabetes
Malignant - hodgkins lymphoma

137
Q

What is alopecia areata?

A

Autoimmune disease - inflammatory t cells target hair follicles preventing growth
Associated with HLA

138
Q

Treatment for alopecia

A

Limited. Topical corticosteroid, cosmetic camouflage
Topical immunotherapy
Often spontaneous regrowth

3B Revision (3 decks)

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