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Derm, Opth + ENT > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How to examine a skin lesion

A

Inspect - site, number of lesions, distribution and configuration
Describe - size, shape, colour, secondary changes, morphology, margin
If pigmented: Asymmetry, irregular Border, two or more Colours, >7mm Diameter
Palpate - consistency, mobility, tenderness, temperature
Systemic check - nails, scalp, hair + mucous membranes

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2
Q

What is a lesion?

A

Area of altered skin

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3
Q

Definition of a rash

A

An eruption

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4
Q

Definition of a naevus

A

Localised malformation of tissue structures

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5
Q

Definition of a comedone

A

Plug in sebaceous follicle containing sebum, bacteria and cellular debris
Open = blackheads
Closed = whiteheads

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6
Q

Definition of generalised

A

All over body

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7
Q

Definition of widespread

A

Extensive

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8
Q

Definition of localised

A

One area of skin only

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9
Q

Pressure areas

A

Sacrum, buttocks, ankles, heels

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10
Q

Photosensitive

A

Affects sun-exposed areas such as face, neck and back of hands

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11
Q

What is distribution?

A

Pattern of spread of lesions:
Generalised, widespread, localised?
Flexor/ extensor/ pressure areas/ dermatomes/ photosensitive area?

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12
Q

What is configuration?

A

Pattern or shape of grouped lesions:

Discrete, confluent, linear, target, annular, discoid

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13
Q

Definition of discrete

A

Individual lesions separated from each other

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14
Q

Definition of confluent

A

Merging together

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15
Q

Definition of linear

A

In a line

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16
Q

Definition of target

A

Concentric rings (bullseye)

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17
Q

Definition of annular

A

Rings

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18
Q

Definition of discoid

A

Coin shaped/ round

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19
Q

Types of colour of a lesion

A

Erythema/ purpura

Hypo/ hyper/ depigmented

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20
Q

Definition of erythema

A

Redness which blanches

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21
Q

Definition of purpura

A

Red or purple that does not blanch

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22
Q

Definition of petechiae

A

Purpura - small pinpoint macules

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23
Q

Definition of ecchymoses

A

Purpura - large bruise like patches

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24
Q

Hypo/ hyper/ depigmented

A 
Hypo = paler skin
Hyper = darker skin 
De = white skin due to absence of melanin
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25
Definition of morphology
Structure of lesion
26
Definition of macule
Flat area of altered colour (freckle)
27
Definition of patch
Large flat area of altered colour
28
Definition of papule
Solid raised lesion <0.5cm (xanthomata)
29
Definition of nodule
Solid raised lesion >0.5cm
30
Definition of plaque
Palpable scaling raised lesion >0.5cm (psoriasis)
31
Definition of vesicle
Raised, clear fluid filled lesion <0.5cm (acute hand eczema)
32
Definition of bulla
Raised, clear fluid filled lesion >0.5cm (reaction to insect bites)
33
Definition of pustule
Pus containing lesion <0.5cm (acne)
34
Definition of abscess
Localised accumulation of pus in dermis
35
Definition of weal
Transient raised lesion due to dermal oedema (urticaria)
36
Definition of boil/ furuncle
Staph infection around or within hair follicle
37
Definition of carbuncle
Staph infection of adjacent hair follicles (multiple boils)
38
Definition of secondary lesions
Excoriation, scales, crust, scar, ulcer, fissure, striae
39
Definition of excoriation
Loss of epidermis following trauma
40
Definition of scales
Excoriations in eczema (psoriasis showing silvery scales)
41
Definition of crust
Rough surface made of serum, blood, bacteria and debris Exuded through eroded epidermis eg impetigo
42
Definition of a scar
New fibrous tissue post wound healing Atrophic = thinning Hypertrophic = hyperproliferation within would boundary Keloidal = hyperproliferation beyond wound boundary
43
Definition of an ulcer
Loss of epidermis and dermis
44
Definition of a fissure
Epidermal crack due to excess dryness
45
Definition of striae
Linear areas going from purple > pink > white | Due to steroid use or growth spurts
46
Definition of hirsutism
Androgen dependant hair growth in a female
47
Definition of hypertrichosis
Non androgen dependant hair growth
48
Definition of koilonychia
Spoon shaped depression of nail due to anaemia
49
Definition of onycholysis
Separation of distal end of nail from nail bed | Due to psoriasis or hyperthyroidism
50
Definition of pitting
Punctate depressions of nail due to psoriasis and eczema
51
Psoriasis presentation
Raised area of red skin covered in silvery scales (plaques). Found on extensor surfaces + scalp, usually widespread confluent lesions. Itchy and painful
52
Pathophysiology of psoriasis
New cells move up skin layers to outermost level in 2-6 days - not fully mature cells build up causing red, flaky scales
53
What is guttate psoriasis?
In young children and adults Small pink patches without scaling Develops after strep throat
54
Treatment for psoriasis
``` Phototherapy Medications: 1) Acitretin (retinoid) - not for women of child bearing age 2) Ciclosporin 3) Methotrexate 4) Hydroxycarbamide ```
55
Atopic eczema presentation
Itchy erythematous dry scaly patches on face and extensor aspects in infants, and flexor aspects in children and adults Acute lesions are exudative papules and vesicles on erythematous base Chronic scratching can cause excoriations May have nail pitting
56
Eczema management
Emollients Topical steroids for flare ups Oral abx for secondary bacterial infections Oral steroids for severe resistant cases
57
Eczema complications
Secondary bacterial infections Molluscum contagiosum Viral warts Eczema herpeticum
58
Presentation of acne
Open and closed comedones | Papules, pustules and nodules
59
Complications of acne
Hyperpigmentation Scarring Deformity
60
Basal cell carcinoma presentation
Nodular is most common Small, skin coloured papule or nodule with surface telangiectasia + pearly rolled edge Lesion may have necrotic or ulcerated centre Usually over head or neck
61
Squamous cell carcinoma presentation
Keratotic (scaly, crusty) ill defined nodule, may ulcerate
62
Malignant melanoma presentation
Asymmetrical, irregular border, irregular colour, large diameter, changing in size or shape Common on legs and trunk May itch or bleed
63
What is erythema nodosum + what are the causes?
Inflammation of SC fat Causes tender, red nodular lesions over shins/ forearms Due to strep/ IBD/ sarcoidosis/ penicillins/ COCP
64
Treatment for actinic keratosis
Fluoruracil cream or imiquimod cream
65
Treatment for lupus
NSAIDs Corticosteroids Hydroxychloroquine (especially for the rash)
66
Erysipelas presentation and treatment
Sharply demarcated raised edge rash | Treat with penicillin/ erythromycin
67
Treatment for impetigo
Fusidic acid or mupirocin
68
Treatment for shingles
Oral acyclovir
69
What is atopic dermatitis?
Hypersensitivity to allergens Form of eczema Infants: face + nappy area Children: flexures, neck + Dennie-Morgan folds Adults: flexures + hands
70
Treatment of atopic dermatitis
Emollients, steroids, immunomodulatory therapy
71
What is seborrhoeic dermatitis?
Rash appears in sebaceous glands ie scalp, sides of nose, behind ears Cradle cap in infants (starts at 2-6 months) Thick, yellow, waxy scales
72
Treatment for seborrhoeic dermatitis
Adult = medicated shampoo Infants = emollients
73
What is stasis dermatitis?
AKA Varicose eczema Common in later life Vein walls weakened, blood pools in legs forming red-brown speckles on skin which are hot and itchy
74
RF for stasis dermatitis?
Poor circulation, DVTs, cellulitis, varicose veins, phlebitis, obesity
75
Treatment for stasis dermatitis?
Lose weight, treat varicose veins, compression stockings, emollients, topical steroids
76
What is asteatoic dermatitis?
Eczema cracquelee Over 60s Appears on shins with 'crazy paving' appearance Treat with emollients + steroids
77
What is contact dermatitis?
Result of contact with irritants or allergens Common on hands + face
78
Histological findings of psoriasis
Thick epidermis (acanthosis) with saw tooth appearance Papillary dermis close to surface Vascular proliferation (Auspitz's sign)
79
How do you assess psoriasis?
Psoriasis Area and Severity index (PASI) Dermatology Life Quality Index (DLQI)
80
Advise for pts with acne
Avoid over-cleaning Use non-comedogenic makeup Avoid picking or squeezing Acne treatments take 8 weeks to work
81
Management of mild acne with open + closed comedones
Single topical treatment eg retinoid (adapalene) or benzoyl peroxide Azelaic acid 2nd line
82
Management of moderate acne with inflammatory lesions
Add oral abx (lyme/doxycycline)
83
When should isotretinoin be considered for acne?
Non-response to 2 courses of abx or scarring
84
Pathology + S+S of warts
Small rough growths caused by HPV | Usually on hands + feet
85
What is a verruca?
Plantar wart (on sole of foot)
86
Types of warts
``` Common = firm + raised with rough surface, resembles cauliflower Plane = round, flat topped + yellow, commonly on hands Filiform = long + slender, commonly face + neck Plantar = soles of feet Mosaic = palmar or plantar warts coalesce into larger plaques ```
87
Management of warts
Watch + wait if asymptomatic Salicylic acid, cryotherapy or combo In secondary care: physical ablation, topical podophyllotoxin, virucidal tx
88
Types of pigmented lesion
``` Melanoma Moles (naevi) Seborrhoic keratoses Freckles Dermatofibromas Lentigines Pigmented BCC ```
89
Types of melanoma
Superficial spreading, nodular, lentigo maligna, acral lentiginous
90
RF for melanoma
``` Fam hx Pale skin + light eyes, burns easily Red or blonde hair Hx of sunburn Hx of indoor tanning Lots of moles Increasing age Organ transplant recipients ```
91
What is the weighted 7 point checklist?
``` Assess melanoma Major features (2 points) = change in size, irregular shape, border or colour Minor features (1 point each) = >7mm diameter, inflammation, oozing or crusting, change in sensation ``` Score >3 = suspicious
92
Pathology of leg ulcer
Break in skin below knee that has not healed in 2 weeks
93
Causes of leg ulcers
Venous, diabetic, arterial disease, RA, vasculitis, sickle cell, malignancy, drugs (nicorandil, steroids, NSAIDs)
94
Pathology of venous leg ulcers
Sustained venous HTN, due to chronic venous insufficiency due to valve incompetence or impaired calf muscle pump
95
RF for venous leg ulcers
``` Obesity Immobility Increasing age Varicose veins Hx od DVT ```
96
Complications of venous leg ulcers
Chronic pain Infection Contact dermatitis
97
Management of leg ulcers
Compression therapy | Pentoxifylline to increase blood flow
98
RF for BCC
``` Fam hx UV exposure (head + neck common) Increasing age Male sex Skin types 1 + 2 ```
99
Types of BCC
Superficial - multiple on upper trunk/ shoulders, erythematous well-demarcated scaly plaques Nodular = solitary, shiny red nodule with large telangiectatic vessels, commonly on face Morphoeic = more aggressive, thickened yellowish plaques Pigmented = brown, blue, grey, seen in dark skinned pts Basosquamous = mixed SCC + BCC
100
RF for SCC
``` UV light Fair skin HPV Ionising radiation exposure Immunodeficiency ```
101
Pathology of actinic keratosis
``` UV induced DNA damage Epidermal lesion characterised by: Collections of atypical keratinocytes Epidermis abnormal in architecture Mitotic figures present ```
102
Description of actinic keratosis
Small rough spots | Can become red + scaly
103
Management of actinic keratosis
``` 5-FU cream Salicylic acid Diclofenac gel Imiquimod cream Cryotherapy Photodynamic therapy ```
104
What is a keloid scar?
Overgrowth of dense fibrous tissue | Extends beyond borders of wound
105
Management of keloid scars
``` Intralesional steroid injections (triamcinolone) Pressure dressings RT Cryotherapy Laser ```
106
Pathology of Kaposi's sarcoma
Connective tissue cancer caused by herpes 8, usually in immunosuppressed pts Spindle cells Highly vascular Surrounding inflammatio
107
Types of Kaposi's sarcoma
Classic Endemic/ African - affect young adult men in Africa Transplant related Epidemic - occurs in HIV pts Non-epidemic - occurs in homosexual men who do not have hiv
108
S+S of Kaposi's sarcoma
Skin lesions that are nodular, papular or blotchy | Around mouth, nose + throat
109
Management of Kaposi's sarcoma
RT Cryotherapy Surgery
110
What is staphylococcal scalded skin syndrome?
Caused by exotocin Prodrome of fever, irritability, skin tenderness Sudden onset of diffuse erythema, warm + tender to touch Flaccid bullae that desquamate in large sheets Usually in children
111
What is toxic shock syndrome?
Caused by superantigen from S aureus | Presents as shock + multiorgan failure with diffuse erythematous macular rash

Derm, Opth + ENT (6 decks)

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