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
2
Q
Causes of pruritus ani
A
Fissure Incontinence Poor hygiene Tight underwear Threadworm Fistula Dermatoses Lichen sclerosis Anxiety Contact dermatitis Unknown cause
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
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
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
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
7
Q
Management of Bowen’s disease
A
Fluorouracil Imiquimod (inflammation) Cryotherapy Photodynamic therapy Curettage, excision
8
Q
Causes of Bowen’s disease
A
UV exposure Radiation Immune suppression Arsenic HPV (in genital area)
9
Q
Most common skin cancer?
A
Basal Cell Carcinoma
10
Q
Describe the 2 types of BCC
A
Nodular: pearly nodule, rolled telangiectasia edge, face
Superficial: red scaly plaque, trunk/shoulders
11
Q
Management of BCC
A
Excision Cryotherapy Curettage Radiotherapy Photodynamic therapy Imiquimod/fluorouracil (superficial low risk)
12
Q
Management of primary squamous cell carcinoma?
A
Local complete excision
13
Q
Most common cancers causing cutaneous mets?
A
Breast Stomach and colon Lung GU (uterus, ovary, kidney, bladder) Non-Hodgkins, Leukaemia
14
Q
Describe Paget’s disease of the nipple
A
Itchy red scaly crusted nipple, from direct extension of intraductal adenocarcinoma
15
Q
How do you differentiate Paget’s disease of the nipple from eczema?
A
Eczema is bilateral, non-deforming, comes and goes
16
Q
Risk factors for melanoma?
A
UV exposure Sun burn Fair complexion >50 melanocytic/dysplastic naevi FHx Prev melanoma ^Age
17
Q
Ring-like (annular) lesions indicate what type of infection?
A
Fungal infection
18
Q
Target-like pattern of lesions =?
A
Erythema multiforme
19
Q
> 5 cafe au last spots, consider what condition?
A
Neurofibromatosis
20
Q
What is melasma?
A
Brown/greyish patches of pigmentation develop, usually on face
21
Q
What can cause melasma?
A
Pregnancy
COCP
22
Q
What systemic disease that can cause hyperpigmentation?
A
Addison’s
Haemachromatosis
23
Q
Investigations in itch?
A
FBC Haematinics LFT U+E ESR Glucose TSH
24
Q
Skin signs in DM
A
Flexural candidiasis Necrobiosis lipoidica Acanthosis nigricans Granuloma annulare Folliculitis
25
Rare granulomatous skin disorder that can affect the shin of insulin-dependent diabetics?
Necrobiosis lipoidica
26
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?
Acanthosis nigricans
27
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)
Granuloma annulare
28
Skin signs in coeliac disease?
Dermatitis Herpetiformis
29
Dermatitis Herpetiformis
a) Pathophysiology?
b) Immediate management?
c) Diagnosis?
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)
30
Which disease is dermatitis herpetiformis associated with?
Coeliac disease
31
Features of dermatitis herpetiformis?
ITCHY
| Vesicular skin lesions on extensor surfaces (elbows, knees, buttocks)
32
Skin signs in IBD?
Erythema nodosum
| Pyoderma gangrenosum
33
Rapidly enlarging, very painful ulcer on lower limbs w/ fever, myalgia. Seen in patients with IBD?
Management?
Pyoderma gangrenosum
Oral steroids
34
Skin signs in Lupus?
Facial butterfly rash
Photosensitivity
Diffuse alopecia
Lupus erythematosus (chilblain, discoid, psoriasis-like plaques, vasculitis, oral ulcers, palmar erythema, periungal erythema, raynauds)
35
Erythema multiforme is a hypersensitivity reaction usually triggered by what organism?
Herpes simplex
36
Management of erythema multiforme?
Topical steroid for discomfort
Aciclovir for HSV
Resolves spontaneously
37
Causes of acanthosis nigricans?
Obesity
DM
Lymphoma
Gastric Ca
38
RFs for psoriasis and triggers?
FHx
Triggers: stress, infections, skin trauma, drugs (lithium, NSAIDs, BB), alcohol, obesity, smoking, climate
39
Systemic upset found with generalised severe psoriasis?
^WCC
Fever
Dehydration
40
Nail changes in psoriasis?
Pitting
Onycholysis
Thickening
Subungual hyperkeratosis
41
Scaling under the nail due to excessive proliferation of keratinocytes in the nail bed and hyponychium
Subungual hyperkeratosis
42
Differentials for psoriasis?
Eczema
Tinea (few lesions)
Mycosis fungoides (asymmetric)
Seborrheoic dermatitis
43
Management of psoriasis
```
Topical emollient + steroids (Betnovate)
Topical vit D prep (Calcipotriol)
DOVOBET (vit D + steroid)
COAL tar
Dithranol
Retinoid (Acitretin)
Phototherapy
Methotrexate, Ciclosporin
Infliximab
```
44
Scalp psoriasis management?
Steroid
Vit D
Coal tar shampoo
45
Why is it important to tell parents of eczema patient to report any severe weeping rash, e.g. around the mouth?
May be eczema herpeticum - primary herpes infection, which may be fatal
46
Management of eczema?
Emollient, soap substitutes
Topical steroids
Pimecrolimus (topical calcineurin inhibitor)
Abx for infection
Tacrolimus/methotrexate/azathioprine/ciclosporine in severe
Antihistamines for itch (hydroxyzine)
47
What is a topical steroid-free anti-inflammatory medication used to treat atopic dermatitis?
Pimecrolimus
48
What does seborrheic dermatitis look like?
Red, scaly
49
What areas does seborrheic dermatitis affect?
Scalp (dandruff), eyebrows, nasolabial folds, cheeks, flexures
50
What causes seborrheic dermatitis?
Over-growth of yeast (malassezia)
51
How is seborrheic dermatitis treated?
Daktacort (steroid + anti fungal)
52
Management of acute flare of contact dermatitis?
Topical steroid
53
Side effects of topical steroid use?
```
Skin thinning
Striae
Telangiectasia
Worsening of infection
Contact dermatitis
```
54
What investigation can help you diagnose tinea/ringworm?
Skin scraping/ Scalp brushings/ Nail clippings for microscopy and culture
55
Treatment of ringworm?
Antifungal, e.g. fluconazole
56
Management of skin, mouth and vaginal candida infection?
Skin: clotrimazole cream
Mouth: miconazole
Vag: clotrimazole cream +/- pessary
57
Peak age for impetigo, and commonly responsible organism?
2-5 years
| Staph Aureus
58
Treatment of impetigo?
Topical fusidic acid, oral fluclox if severe
59
Signs and symptoms of cellulitis?
```
Pain
Swelling
Erythema
Warmth
Systemic upset
Lymphadenopathy
```
60
Management of cellulitis?
Abx - e.g. penicillin IV + fluclox PO
| erythromycin if penicillin allergic
61
What pathogen causes warts?
HPV
62
Treatment of warts?
Self-limiting
If painful/persistent/unsightly:
Topical salicylic acid
Cryotherapy
Duct tape occlusion
63
Management of genital warts?
Podophyllin/ imiquimod
| Cryotherapy
64
Complications of herpes zoster/ shingles?
Post-herpetic neuralgia
Meningitis
Encephalitis
65
What are the 5 pillars of acne?
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
Management of acne?
Step-wise:
Single topical therapy (retinoids, benzoyl peroxide)
Topical combo therapy (Abs, ben perox, retinoid)
Oral Abx
(or COCP)
Oral isotretinoin
67
Isotretinoin (topical retinoid) side effects?
Teratogenic
Skin + mucosal dryness
Depression
68
Common drug culprits for urticaria?
```
Penicillins
Cephalosporins
Opiates
NSAIDs
ACEi
Thiazides
Phenytoin
```
69
Management of urticaria?
Antihistamine +/- hydrocortisone/adrenaline if anaphylaxis
70
```
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?
```
Stevens-Johnson syndrome
Sulfonamides
Anti-epileptics
Penicillins
NSAIDs
71
How do you manage toxic epidermal necrolysis + stevens-johnson syndrome?
Supportive in ICU
IVIg
Analgesia
Protect skin
72
Flu-like Sx. Widespread painful dusky erythema, the necrosis of large sheets of epidermis, severe mucosal involvement. Following new medication. Diagnosis?
Toxic epidermal necrolysis
73
Which drugs can cause toxic epidermal necrolysis?
```
Sulfonamides
Anti-epileptics
Penicillins
NSAIDs
Cephalosporins (cefuro/ceftriax)
Allopurinol
```
74
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?
Lichen planus
```
5Ps
Polygonal
Pruritic
Planar
Papular
Purple
```
75
Management of lichen planus?
Topical steroids +/- anti-fungals
76
What is the difference in prognosis for scarring and non-scarring alopecia?
Scarring implies non-reversible
77
Smooth, well-defined round patches of hair loss on scalp. Exclamation mark hairs. Diagnosis?
Alopecia areata
78
What is alopecia areata?
Non-scarring hair loss
79
What is the management of alopecia areata?
80% sport regrowth in 3 months
Topical steroid
Psych support
Minoxidil (in androgen-dependent)
80
Bullous Pemphigoid is the chief autoimmune blistering disorder in the elderly. What causes it?
IgG autoantibodies to the basement membrane proteins (BP180 and BP230)
81
Elderly lady presents with tense blisters 1-3cm in size. A biopsy shows +ve immunofluorescence (IgG and complement along the basement membrane). Diagnosis?
Bullous pemphigoid
82
Management of bullous pemphigoid?
Refer to derm
Oral corticosteroids
(+ topical steroids, immunosuppressants, Abx)
83
Difference between pemphigus and bullous pemphigoid?
Pemphigus affects younger (<40)
Oral mucosa affected (spared in bp)
Flaccid blisters (tense in bp)
PemphiguS is Superficial
Bullous PemphigoiD is Deep
84
Management of pemphigus?
Prednisolone
| Rituximab + IV Ig in resistant
85
Precipitants for urticaria?
Infection/parasites (helminth)
Chemicals - insect bites, latex, drugs, food
Systemic disease
86
Risk factors for venous leg ulcers?
```
Varicose veins
DVT
Venous insufficiency
Poor calf muscle function
AV fistulae
Obesity
Leg fracture
Minimal trauma over medial malleolus
```
87
What is the name of the skin changes seen in venous leg ulcers/ venous HTN?
Lipodermatosclerosis
| or haemosiderin deposition
88
Give 5 causes of ulcers
Neuropathy
Trauma
Vascular: venous/ arterial/ mixed
```
Rarer:
Vasculitis (SLE)
Malignancy
Pyoderma gangrenosum (IBD-related)
Sickle cell
Infection (leishmaniasis)
Drugs (nicorandil for angina)
```
89
Management of venous leg ulcers (including initial investigations)?
```
Doppler to rule out arterial
Graded compression bandaging, dressings
PO Abx if infection
Analgesia
(pentoxifylline)
```
90
Risk factors for pressure ulcers?
```
Extremes of age
Reduced mobility
Reduced sensation
Vascular disease
Chronic/terminal illness
Incontinence
Spinal injury
```
91
Risk factors for pressure ulcers?
```
Extremes of age
Reduced mobility
Reduced sensation
Vascular disease
Chronic/terminal illness
Incontinence
Spinal injury
```
92
Complication of pressure ulcers?
Osteomyelitis
93
Treatment of pressure ulcers?
```
Pressure relieving mattress
Frequent repositioning/turning
Nutrition
Abx for infection
Modern dressings
Debridement
-ve pressure
```
94
Prevention of pressure ulcers?
Regular skin inspection
Minimise moisture
Positioning/turning
Pillows to separate knees + ankles
95
Skin causes of pruritus in the elderly?
Eczema
Scabies
Pemphigoid
Dry skin
96
Medial/systemic causes of pruritus in the elderly?
```
Anaemia
Polycythaemia
Lymphoma
Solid neoplasms
Hepatic/renal failure
Hypo/hyperthyroidism
DM (candida)
```
97
Causes of pruritus vulvae?
```
Systemic, e.g. liver/renal/anaemia
Lichen planus, psoriasis
Candida
Allergy (washing powder)
Infestation (scabies)
Vulval dystrophy (lichen sclerosis, carcinoma)
```
Exacerbating: obesity, incontinence
98
Difference between wet and dry gangrene?
Wet is with infection
99
Features of acute seroconversion in HIV? When does this occur?
```
1-3 weeks after exposure
Acute EBV-type illness
Maculopapular eruption on trunk
Lymphadenopathy
Malaise
Headache
Fever
Oral/genital ulcers/ candidiasis
```
100
Give some pathogens that would not usually cause disease, but HIV+ve patients are at increased risk of infection from?
```
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
Management of HIV associated with Kaposi's Sarcoma?
```
Optimise HAART
Radiotherapy
Chemotherapy
Cryotherapy
Laser therapy
Photodynamic therapy
Excision
Interferon alpha
```
102
Management of candidiasis in HIV?
Topical nystatin
| Systemic imidazoles
103
Management of skin cryptococcosis in HIV?
Fluconazole
104
Scabies management, including practical measures?
```
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
Which skin neoplasia may be seen in HIV patients?
```
Kaposi sarcoma
BCC
SCC
Melanoma
Skin lymphomas
Merkel cell cancer
```
106
What is immune reconstitution inflammatory syndrome in HIV?
Immunity begins to recover, but then responds to previously acquired opportunistic infection with a powerful inflammatory response. Worsening of Sx, often involves skin
107
Patient presents with itching around their chest and wrists + itchy red penile and scrotal papules. Diagnosis?
Scabies
108
Management of headline?
Malathion or dimeticone lotion
| Combing
109
Management for crab lice?
Malathion or permethrin
110
Hanging legs over the side of the bed to relieve pain indicates what type of ulcer, and why?
Arterial
| Use gravity to aid blood flow to ischaemic tissue
111
Management of arterial ulcers?
Optimise vascular RFs, e.g. quit smoking
Regular inspection
Surgery: revascularisation, amputation
112
ABCDEF criteria for suspicious pigmented lesion?
```
Asymmetry
Border irregularity
Colour variation
Diameter >6mm
Evolution
Funny looking (different from rest)
```
113
Briefly describe the 4 types of melanoma.
Which is the most common?
Superficial spreading (most common)
Nodular (aggressive)
Acral lentiginous (palm and soles)
Lentigo maligna
114
Management of melanoma?
Excision
Interferon alpha for mets
Palliative chemo
NOT radio
115
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?
Keratoacanthoma
116
What is keratoacanthoma?
Benign epithelial tumour
Initially smooth dome-shaped papule.
Rapidly grows to become crater centrally-filled with keratin
Eventually sloughs off and scars
117
Management of keratocanthoma?
Commonly spontaneously regress within 3 months
| HOWEVER urgent excisal recommended as difficult to exclude SCC
118
What is hyperhidrosis?
Excessive production of sweat
119
Management of hyperhidrosis?
Topical aluminium chloride (SE skin irritation)
Iontophoresis
Botulinum toxin (for axillary Sx)
Surgery (e.g. endoscopic transthoracic sympathectomy)
120
What is onychomycosis?
Fungal infection of the nails
121
What is the first-line treatment for a patient with a dermatophyte infection of the nail?
Oral terbinafine
122
What type of hypersensitivity reaction is contact dermatitis?
Type IV hypersensitivity
123
How is Nickel dermatitis diagnosed?
Skin patch test
124
What are the four D’s of pellagra (vitamin B3 deficiency)?
Diarrhoea
Dermatitis
Dementia
Death
125
What type of test is carried out to investigate:
a) Food allergy
b) Contact dermatitis
a) Skin prick or RAST
| b) Skin patch testing
126
Causes of erythema multiforme?
Infections, e.g. HSV, mycoplasma
Drugs: SNAPP (sulphonamide, NSAIDs, allopurinol, Pill (COCP), penicillin)
127
What is the name for the stress ulcers in burns patients that may cause haematemesis?
Curlings ulcers
128
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?
Molluscum contagiosum
129
What is the management for molluscum contagiosum?
Reassurance (self-limiting)
Education (contagious)
Encourage not to scratch
130
Eczema herpeticum is a severe primary infection of the skin by HSV1/HSV2. It is most commonly seen in children with atopic eczema.
Management?
Urgent referral to hospital
IV aciclovir
131
What is a pyogenic granuloma?
Overgrowth of blood vessels
Red nodules
Usually follows trauma
May mimic amelanotic melanoma
132
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?
Tetracyclines: lymecycline, oxytetracycline, doxycycline
Erythromycin
Topical retinoid
133
Acne. What is a potential complication of long-term antibiotic use? Treatment?
G-ve folliculitis
Trimethoprim
134
Give 2 RFs for pellagra
Isoniazid
| Alcoholic
135
Give 3 drugs known to exacerbate psoriasis?
```
Lithium
Beta blockers
NSAIDs
ACEi
TNF-alpha inhibitors
Anti-malarials
```
