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Dermatology Flashcards

1
Q

33F. Itchy rash on both elbows. Worsening for the past week. O/E: multiple polygonal, flat-topped papular lesions, 5mm diameter on the flexural surface of her elbows, bilaterally. No other rash on the rest of her body. What is the most likely diagnosis?

A

Lichen planus

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2
Q

Causes of pruritus ani

A 
Fissure
Incontinence
Poor hygiene
Tight underwear
Threadworm
Fistula
Dermatoses
Lichen sclerosis
Anxiety
Contact dermatitis
Unknown cause
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3
Q

Management of pruritus ani

A 
Hygiene
Avoid scratching
Avoid foods that loosen stool
Soothing ointment
Mild topical corticosteroids if inflammation
Oral antihistamine for night time
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4
Q

Pre-malignant, crumbly, yellow-white scaly crusts on sun-exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes. What is the diagnosis? Give 2 differentials

A

Actinic (solar) keratoses

Bowen’s
Psoriasis
BCC
Seborrheic keratosis

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5
Q

Investigation and Management of actinic keratoses

A

Biopsy if in doubt of Dx

Prevention of risk (sun avoidance)
Fluorouracil cream (+ hydrocortisone)
Topical diclofenac
Topical imiquimod
Cryotherapy
Curettage and cautery
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6
Q

Well-defined, slowly enlarging red scaly plaque with a flat edge (asymptomatic). Histology shows full thickness dysplasia/carcinoma in situ. Diagnosis?

A

Bowen’s disease

i.e. SCC in situ

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7
Q

Management of Bowen’s disease

A 
Fluorouracil
Imiquimod (inflammation)
Cryotherapy
Photodynamic therapy
Curettage, excision
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8
Q

Causes of Bowen’s disease

A 
UV exposure
Radiation
Immune suppression
Arsenic
HPV (in genital area)
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9
Q

Most common skin cancer?

A

Basal Cell Carcinoma

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10
Q

Describe the 2 types of BCC

A

Nodular: pearly nodule, rolled telangiectasia edge, face
Superficial: red scaly plaque, trunk/shoulders

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11
Q

Management of BCC

A 
Excision
Cryotherapy
Curettage
Radiotherapy
Photodynamic therapy
Imiquimod/fluorouracil (superficial low risk)
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12
Q

Management of primary squamous cell carcinoma?

A

Local complete excision

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13
Q

Most common cancers causing cutaneous mets?

A 
Breast
Stomach and colon
Lung
GU (uterus, ovary, kidney, bladder)
Non-Hodgkins, Leukaemia
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14
Q

Describe Paget’s disease of the nipple

A

Itchy red scaly crusted nipple, from direct extension of intraductal adenocarcinoma

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15
Q

How do you differentiate Paget’s disease of the nipple from eczema?

A

Eczema is bilateral, non-deforming, comes and goes

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16
Q

Risk factors for melanoma?

A 
UV exposure
Sun burn
Fair complexion
>50 melanocytic/dysplastic naevi
FHx
Prev melanoma
^Age
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17
Q

Ring-like (annular) lesions indicate what type of infection?

A

Fungal infection

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18
Q

Target-like pattern of lesions =?

A

Erythema multiforme

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19
Q

> 5 cafe au last spots, consider what condition?

A

Neurofibromatosis

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20
Q

What is melasma?

A

Brown/greyish patches of pigmentation develop, usually on face

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21
Q

What can cause melasma?

A

Pregnancy

COCP

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22
Q

What systemic disease that can cause hyperpigmentation?

A

Addison’s

Haemachromatosis

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23
Q

Investigations in itch?

A 
FBC
Haematinics
LFT
U+E
ESR
Glucose
TSH
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24
Q

Skin signs in DM

A 
Flexural candidiasis
Necrobiosis lipoidica
Acanthosis nigricans
Granuloma annulare
Folliculitis
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25
Q

Rare granulomatous skin disorder that can affect the shin of insulin-dependent diabetics?

A

Necrobiosis lipoidica

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26
Q

Skin disorder characterised by hyperpigmentation and hyperkeratosis of the skin, occurring mainly in the folds of the skin in the armpit, groin and back of neck?

A

Acanthosis nigricans

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27
Q

Rare skin disorder with groups of small firm bumps in the skin forming a characteristic ring shaped (annular) patch. Typically 1-2 sites of the body, often bony areas (back of hands, feet, elbows or ankles)

A

Granuloma annulare

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28
Q

Skin signs in coeliac disease?

A

Dermatitis Herpetiformis

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29
Q

Dermatitis Herpetiformis

a) Pathophysiology?
b) Immediate management?
c) Diagnosis?

A

a) IgA deposits in dermis
b) Dapsone (antibiotic - previously used to treat leprosy), usually reduces itch in 3 days; Gluten free diet
c) Skin biopsy (direct immunofluorescence shows deposition of IgA in upper dermis)

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30
Q

Which disease is dermatitis herpetiformis associated with?

A

Coeliac disease

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31
Q

Features of dermatitis herpetiformis?

A

ITCHY

Vesicular skin lesions on extensor surfaces (elbows, knees, buttocks)

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32
Q

Skin signs in IBD?

A

Erythema nodosum

Pyoderma gangrenosum

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33
Q

Rapidly enlarging, very painful ulcer on lower limbs w/ fever, myalgia. Seen in patients with IBD?

Management?

A

Pyoderma gangrenosum

Oral steroids

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34
Q

Skin signs in Lupus?

A

Facial butterfly rash
Photosensitivity
Diffuse alopecia
Lupus erythematosus (chilblain, discoid, psoriasis-like plaques, vasculitis, oral ulcers, palmar erythema, periungal erythema, raynauds)

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35
Q

Erythema multiforme is a hypersensitivity reaction usually triggered by what organism?

A

Herpes simplex

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36
Q

Management of erythema multiforme?

A

Topical steroid for discomfort
Aciclovir for HSV
Resolves spontaneously

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37
Q

Causes of acanthosis nigricans?

A

Obesity
DM
Lymphoma
Gastric Ca

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38
Q

RFs for psoriasis and triggers?

A

FHx

Triggers: stress, infections, skin trauma, drugs (lithium, NSAIDs, BB), alcohol, obesity, smoking, climate

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39
Q

Systemic upset found with generalised severe psoriasis?

A

^WCC
Fever
Dehydration

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40
Q

Nail changes in psoriasis?

A

Pitting
Onycholysis
Thickening
Subungual hyperkeratosis

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41
Q

Scaling under the nail due to excessive proliferation of keratinocytes in the nail bed and hyponychium

A

Subungual hyperkeratosis

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42
Q

Differentials for psoriasis?

A

Eczema
Tinea (few lesions)
Mycosis fungoides (asymmetric)
Seborrheoic dermatitis

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43
Q

Management of psoriasis

A 
Topical emollient + steroids (Betnovate)
Topical vit D prep (Calcipotriol)
DOVOBET (vit D + steroid)
COAL tar
Dithranol
Retinoid (Acitretin)
Phototherapy
Methotrexate, Ciclosporin
Infliximab
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44
Q

Scalp psoriasis management?

A

Steroid
Vit D
Coal tar shampoo

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45
Q

Why is it important to tell parents of eczema patient to report any severe weeping rash, e.g. around the mouth?

A

May be eczema herpeticum - primary herpes infection, which may be fatal

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46
Q

Management of eczema?

A

Emollient, soap substitutes
Topical steroids
Pimecrolimus (topical calcineurin inhibitor)
Abx for infection
Tacrolimus/methotrexate/azathioprine/ciclosporine in severe
Antihistamines for itch (hydroxyzine)

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47
Q

What is a topical steroid-free anti-inflammatory medication used to treat atopic dermatitis?

A

Pimecrolimus

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48
Q

What does seborrheic dermatitis look like?

A

Red, scaly

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49
Q

What areas does seborrheic dermatitis affect?

A

Scalp (dandruff), eyebrows, nasolabial folds, cheeks, flexures

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50
Q

What causes seborrheic dermatitis?

A

Over-growth of yeast (malassezia)

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51
Q

How is seborrheic dermatitis treated?

A

Daktacort (steroid + anti fungal)

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52
Q

Management of acute flare of contact dermatitis?

A

Topical steroid

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53
Q

Side effects of topical steroid use?

A 
Skin thinning
Striae
Telangiectasia
Worsening of infection
Contact dermatitis
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54
Q

What investigation can help you diagnose tinea/ringworm?

A

Skin scraping/ Scalp brushings/ Nail clippings for microscopy and culture

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55
Q

Treatment of ringworm?

A

Antifungal, e.g. fluconazole

56
Q

Management of skin, mouth and vaginal candida infection?

A

Skin: clotrimazole cream
Mouth: miconazole
Vag: clotrimazole cream +/- pessary

57
Q

Peak age for impetigo, and commonly responsible organism?

A

2-5 years

Staph Aureus

58
Q

Treatment of impetigo?

A

Topical fusidic acid, oral fluclox if severe

59
Q

Signs and symptoms of cellulitis?

A 
Pain
Swelling
Erythema
Warmth
Systemic upset
Lymphadenopathy
60
Q

Management of cellulitis?

A

Abx - e.g. penicillin IV + fluclox PO

erythromycin if penicillin allergic

61
Q

What pathogen causes warts?

A

HPV

62
Q

Treatment of warts?

A

Self-limiting

If painful/persistent/unsightly:
Topical salicylic acid
Cryotherapy
Duct tape occlusion

63
Q

Management of genital warts?

A

Podophyllin/ imiquimod

Cryotherapy

64
Q

Complications of herpes zoster/ shingles?

A

Post-herpetic neuralgia
Meningitis
Encephalitis

65
Q

What are the 5 pillars of acne?

A
  1. Basal keratinocyte proliferation in pilosebaceous follicles (androgen + corticotrophin-releasing hormone driven)
  2. ^Sebum production
  3. Propionibacterium acnes colonisation
  4. Inflammation
  5. Comedones blocking secretions -> papule, nodules, cysts, scars
66
Q

Management of acne?

A

Step-wise:
Single topical therapy (retinoids, benzoyl peroxide)

Topical combo therapy (Abs, ben perox, retinoid)

Oral Abx

(or COCP)

Oral isotretinoin

67
Q

Isotretinoin (topical retinoid) side effects?

A

Teratogenic
Skin + mucosal dryness
Depression

68
Q

Common drug culprits for urticaria?

A 
Penicillins
Cephalosporins
Opiates
NSAIDs
ACEi
Thiazides
Phenytoin
69
Q

Management of urticaria?

A

Antihistamine +/- hydrocortisone/adrenaline if anaphylaxis

70
Q 
Vague URT Sx 2-3 weeks after starting a new medication. 
Then rash (painful erythematous macule > target lesions, mucosal ulceration [conjunctivae, oral, labia, urethra]. Diagnosis, and culprits?
A

Stevens-Johnson syndrome

Sulfonamides
Anti-epileptics
Penicillins
NSAIDs

71
Q

How do you manage toxic epidermal necrolysis + stevens-johnson syndrome?

A

Supportive in ICU
IVIg
Analgesia
Protect skin

72
Q

Flu-like Sx. Widespread painful dusky erythema, the necrosis of large sheets of epidermis, severe mucosal involvement. Following new medication. Diagnosis?

A

Toxic epidermal necrolysis

73
Q

Which drugs can cause toxic epidermal necrolysis?

A 
Sulfonamides
Anti-epileptics
Penicillins
NSAIDs
Cephalosporins (cefuro/ceftriax)
Allopurinol
74
Q

Patient presents with purple itchy flat papule on inner wrists and legs with white lacy markings. She also has lacy white areas on the inside of her cheeks. Diagnosis?

A

Lichen planus

5Ps
Polygonal
Pruritic
Planar
Papular
Purple
75
Q

Management of lichen planus?

A

Topical steroids +/- anti-fungals

76
Q

What is the difference in prognosis for scarring and non-scarring alopecia?

A

Scarring implies non-reversible

77
Q

Smooth, well-defined round patches of hair loss on scalp. Exclamation mark hairs. Diagnosis?

A

Alopecia areata

78
Q

What is alopecia areata?

A

Non-scarring hair loss

79
Q

What is the management of alopecia areata?

A

80% sport regrowth in 3 months

Topical steroid
Psych support
Minoxidil (in androgen-dependent)

80
Q

Bullous Pemphigoid is the chief autoimmune blistering disorder in the elderly. What causes it?

A

IgG autoantibodies to the basement membrane proteins (BP180 and BP230)

81
Q

Elderly lady presents with tense blisters 1-3cm in size. A biopsy shows +ve immunofluorescence (IgG and complement along the basement membrane). Diagnosis?

A

Bullous pemphigoid

82
Q

Management of bullous pemphigoid?

A

Refer to derm
Oral corticosteroids
(+ topical steroids, immunosuppressants, Abx)

83
Q

Difference between pemphigus and bullous pemphigoid?

A

Pemphigus affects younger (<40)
Oral mucosa affected (spared in bp)
Flaccid blisters (tense in bp)

PemphiguS is Superficial
Bullous PemphigoiD is Deep

84
Q

Management of pemphigus?

A

Prednisolone

Rituximab + IV Ig in resistant

85
Q

Precipitants for urticaria?

A

Infection/parasites (helminth)
Chemicals - insect bites, latex, drugs, food
Systemic disease

86
Q

Risk factors for venous leg ulcers?

A 
Varicose veins
DVT
Venous insufficiency
Poor calf muscle function
AV fistulae
Obesity
Leg fracture
Minimal trauma over medial malleolus
87
Q

What is the name of the skin changes seen in venous leg ulcers/ venous HTN?

A

Lipodermatosclerosis

or haemosiderin deposition

88
Q

Give 5 causes of ulcers

A

Neuropathy
Trauma
Vascular: venous/ arterial/ mixed

Rarer:
Vasculitis (SLE)
Malignancy
Pyoderma gangrenosum (IBD-related)
Sickle cell
Infection (leishmaniasis)
Drugs (nicorandil for angina)
89
Q

Management of venous leg ulcers (including initial investigations)?

A 
Doppler to rule out arterial
Graded compression bandaging, dressings
PO Abx if infection
Analgesia
(pentoxifylline)
90
Q

Risk factors for pressure ulcers?

A 
Extremes of age
Reduced mobility
Reduced sensation
Vascular disease
Chronic/terminal illness
Incontinence
Spinal injury
91
Q

Risk factors for pressure ulcers?

A 
Extremes of age
Reduced mobility
Reduced sensation
Vascular disease
Chronic/terminal illness
Incontinence
Spinal injury
92
Q

Complication of pressure ulcers?

A

Osteomyelitis

93
Q

Treatment of pressure ulcers?

A 
Pressure relieving mattress
Frequent repositioning/turning
Nutrition
Abx for infection
Modern dressings
Debridement
-ve pressure
94
Q

Prevention of pressure ulcers?

A

Regular skin inspection
Minimise moisture
Positioning/turning
Pillows to separate knees + ankles

95
Q

Skin causes of pruritus in the elderly?

A

Eczema
Scabies
Pemphigoid
Dry skin

96
Q

Medial/systemic causes of pruritus in the elderly?

A 
Anaemia
Polycythaemia
Lymphoma
Solid neoplasms
Hepatic/renal failure
Hypo/hyperthyroidism
DM (candida)
97
Q

Causes of pruritus vulvae?

A 
Systemic, e.g. liver/renal/anaemia
Lichen planus, psoriasis
Candida
Allergy (washing powder)
Infestation (scabies)
Vulval dystrophy (lichen sclerosis, carcinoma)

Exacerbating: obesity, incontinence

98
Q

Difference between wet and dry gangrene?

A

Wet is with infection

99
Q

Features of acute seroconversion in HIV? When does this occur?

A 
1-3 weeks after exposure
Acute EBV-type illness
Maculopapular eruption on trunk
Lymphadenopathy
Malaise
Headache
Fever
Oral/genital ulcers/ candidiasis
100
Q

Give some pathogens that would not usually cause disease, but HIV+ve patients are at increased risk of infection from?

A 
Herpes: oral/genital ulcers, varicella (+ post-herpetic neuralgia), Kaposi's Sarcoma
EBV (oral hairy leukoplakia)
Warts
Molluscum contagiosum
Candida
Tinea
Syphilis
Cryptococcus
Demodicosis
Scabies
101
Q

Management of HIV associated with Kaposi’s Sarcoma?

A 
Optimise HAART
Radiotherapy 
Chemotherapy
Cryotherapy
Laser therapy
Photodynamic therapy
Excision
Interferon alpha
102
Q

Management of candidiasis in HIV?

A

Topical nystatin

Systemic imidazoles

103
Q

Management of skin cryptococcosis in HIV?

A

Fluconazole

104
Q

Scabies management, including practical measures?

A 
Treat all close contacts
1st line: Permethrin lotion
2nd line: Malathion
Oral ivermectin if severe
Crotamiton (anti-pruritic)

Long bath, soap skin all over, scrub under fingernails, wash all bedding, towels, clothing in hot wash

105
Q

Which skin neoplasia may be seen in HIV patients?

A 
Kaposi sarcoma
BCC
SCC
Melanoma
Skin lymphomas
Merkel cell cancer
106
Q

What is immune reconstitution inflammatory syndrome in HIV?

A

Immunity begins to recover, but then responds to previously acquired opportunistic infection with a powerful inflammatory response. Worsening of Sx, often involves skin

107
Q

Patient presents with itching around their chest and wrists + itchy red penile and scrotal papules. Diagnosis?

A

Scabies

108
Q

Management of headline?

A

Malathion or dimeticone lotion

Combing

109
Q

Management for crab lice?

A

Malathion or permethrin

110
Q

Hanging legs over the side of the bed to relieve pain indicates what type of ulcer, and why?

A

Arterial

Use gravity to aid blood flow to ischaemic tissue

111
Q

Management of arterial ulcers?

A

Optimise vascular RFs, e.g. quit smoking
Regular inspection
Surgery: revascularisation, amputation

112
Q

ABCDEF criteria for suspicious pigmented lesion?

A 
Asymmetry
Border irregularity
Colour variation
Diameter >6mm
Evolution
Funny looking (different from rest)
113
Q

Briefly describe the 4 types of melanoma.

Which is the most common?

A

Superficial spreading (most common)
Nodular (aggressive)
Acral lentiginous (palm and soles)
Lentigo maligna

114
Q

Management of melanoma?

A

Excision
Interferon alpha for mets
Palliative chemo
NOT radio

115
Q

54M. 2 month Hx rapidly growing lesion on R forearm. Lesion initially red papule but in last 2wks has become a crater filled centrally with yellow/brown material. O/E: skin type II, lesion 4 mm in diameter and is morphologically as described above. What is the most likely diagnosis?

A

Keratoacanthoma

116
Q

What is keratoacanthoma?

A

Benign epithelial tumour
Initially smooth dome-shaped papule.
Rapidly grows to become crater centrally-filled with keratin
Eventually sloughs off and scars

117
Q

Management of keratocanthoma?

A

Commonly spontaneously regress within 3 months

HOWEVER urgent excisal recommended as difficult to exclude SCC

118
Q

What is hyperhidrosis?

A

Excessive production of sweat

119
Q

Management of hyperhidrosis?

A

Topical aluminium chloride (SE skin irritation)
Iontophoresis
Botulinum toxin (for axillary Sx)
Surgery (e.g. endoscopic transthoracic sympathectomy)

120
Q

What is onychomycosis?

A

Fungal infection of the nails

121
Q

What is the first-line treatment for a patient with a dermatophyte infection of the nail?

A

Oral terbinafine

122
Q

What type of hypersensitivity reaction is contact dermatitis?

A

Type IV hypersensitivity

123
Q

How is Nickel dermatitis diagnosed?

A

Skin patch test

124
Q

What are the four D’s of pellagra (vitamin B3 deficiency)?

A

Diarrhoea
Dermatitis
Dementia
Death

125
Q

What type of test is carried out to investigate:

a) Food allergy
b) Contact dermatitis

A

a) Skin prick or RAST

b) Skin patch testing

126
Q

Causes of erythema multiforme?

A

Infections, e.g. HSV, mycoplasma

Drugs: SNAPP (sulphonamide, NSAIDs, allopurinol, Pill (COCP), penicillin)

127
Q

What is the name for the stress ulcers in burns patients that may cause haematemesis?

A

Curlings ulcers

128
Q

A 24-year-old student presents due to some lesions on his lower abdomen. These have been present for the past six weeks. Initially, there was one lesion but since that time more lesions have appeared. On examination around 10 lesions are seen; they are raised, around 1-2mm in diameter and have an umbilicated appearance. What is the most likely diagnosis?

A

Molluscum contagiosum

129
Q

What is the management for molluscum contagiosum?

A

Reassurance (self-limiting)
Education (contagious)
Encourage not to scratch

130
Q

Eczema herpeticum is a severe primary infection of the skin by HSV1/HSV2. It is most commonly seen in children with atopic eczema.

Management?

A

Urgent referral to hospital

IV aciclovir

131
Q

What is a pyogenic granuloma?

A

Overgrowth of blood vessels
Red nodules
Usually follows trauma
May mimic amelanotic melanoma

132
Q

Acne. Which oral antibiotics may be used in management?

What is the alternative in pregnant women?

What should be co-prescribed to reduce risk of ABx resistance developing?

A

Tetracyclines: lymecycline, oxytetracycline, doxycycline

Erythromycin

Topical retinoid

133
Q

Acne. What is a potential complication of long-term antibiotic use? Treatment?

A

G-ve folliculitis

Trimethoprim

134
Q

Give 2 RFs for pellagra

A

Isoniazid

Alcoholic

135
Q

Give 3 drugs known to exacerbate psoriasis?

A 
Lithium
Beta blockers
NSAIDs 
ACEi
TNF-alpha inhibitors
Anti-malarials

5 (8 decks)

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