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Medicine - Finals > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the layers of the skin?

A 
Come Lets Get Sun Burnt
Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale
Dermis
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2
Q

What are the cells that give skin its pigmentation, and which layer are they found in?

A

Melanocytes

Stratum basale

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3
Q

When describing skin lesions, what pattern should be followed?

A

DCM:
Distribution
Configuration
Morphology

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4
Q 
What conditions are associated with the following distribution patterns?
Flexures
Extensors
Face
Dermatomal
Symmetrical
A 
Where on the body it is:
Flexures: eczema
Extensors: psoriasis
Face: seborrheic
Dermatomal: shingles

Pattern
Symmetrical: vitiligo

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5
Q 
Which conditions are the following configurations associated with?
Linear
Targeted
Annular
Discoid
Reticular
A 
Linear: Koebner phenomenon (eg psoriasis)
Targetoid: Erythema multiforme
Annular: tinea, lupus
Discoid: discoid lupus, discoid eczema
Reticular: livedo reticularis
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6
Q

Give 4 words for describing the morphology of a skin lesion

A 
Macule
Papule
Plaque
Nodule
Vesicle
Crust
Scale
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7
Q

What is the most important diagnosis to consider with any type of skin lesion?

A

Cancer

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8
Q

What are the Fitzpatrick skin types?

A

I - never tans, always burns (red hair, freckles)
II - usually tans, always burns
III - always tans, sometimes burns (dark hair, brown eyes)
IV - always tans, rarely burns (olive skin)
V - sunburn and tan after extreme UV (brown skin)
VI - black skin, never tans/burns

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9
Q

Give 4 RFs for BCC

A

UV exposure - elderly (over long timeframe)
Fair skin (fitzpatrick 1/2)
Immune suppression
Genetic susceptibility

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10
Q

Give 4 features of a BCC

A 
Shiny 'pearly' surface
Telangiectasia
Central nodule
Surface ulceration
Rolled edge
Locally invasive - do not metastasise
Slow-growing
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11
Q

Management of BCC?

A

Excision (Moh’s micrographic surgery)

Radiotherapy

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12
Q

Give 4 RFs for malignant melanoma

A 
UV light exposure
Fair skin (fitz 1/2)
Red hair
>100 naevi on body
>5 atypical naevi
FHx
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13
Q

What are the features of malignant melanoma?

A 
ABCDE
Asymmetrical
Border irregularity
Colour irregularity
Diameter >6mm 
Evolving
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14
Q

What is the most common type of melanoma?

Give 3 other types

A

Superficial spreading

Nodular
Lentigo maligna
Melanoma of the nails

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15
Q

What is the most important prognostic indicator for malignant melanoma?

A

BRESLOW THICKNESS

Thickness of melanoma - measured from granular layer down to deepest part of invasion
Used in TNM staging
Thicker = worse prognosis

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16
Q

How is malignant melanoma treated?

A

Excision

Chemo, radio and immunological therapy for palliative patients with widely metastatic disease

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17
Q

Where do malignant melanomas commonly metastasise to?

A

Lungs

Brain

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18
Q

Give 4 RFs for SCC

A

UV light exposure over long timeframe
Immune suppression
Actinic keratoses and Bowen’s disease
Smoking
Long-standing leg ulcers (Marjolin’s ulcer)
Genetic conditions - albinism, xeroderma pigmentosum

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19
Q

What are the features of SCC?

A

High risk sites - lips and ears
Keratotic appearance
Potential to metastasise

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20
Q

How are SCCs treated?

A

Surgical excision (4mm margins if <20mm, 6mm margins if >20mm)

Moh’s micrographic surgery may be used in high-risk patients and in cosmetically important sites

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21
Q

What are the 3 types of ulcers seen on the skin?

A

Arterial
Venous
Neuropathic

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22
Q

Give 4 features of a venous ulcer

A 
Commonly over medial malleolus
Varicose veins
Haemosiderin patches/deposits in skin
Lipodermatosclerosis
Venous eczema (dry and shiny)

Due to venous insufficiency

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23
Q

How are venous ulcers managed?

A

Compression bandages
DO NOT USE IF ABPI <0.9
If this doesn’t work, consider referral to vascular surgeons

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24
Q

What is the most important investigation to perform for skin ulcers?

A

ABPI

Normal is 0.9-1.2. DO NOT USE COMPRESSION BANDAGES IF <0.9 as sign of arterial disease and could lead to critical limb ischaemia

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25
Q

Give 4 features of arterial ulcers

A 
Peripherally located - distal points, pressure sites
Deep, punched out, necrotic
Painful
Shiny skin
Increased CRT
May not be able to feel pulses in feet
Signs of hypoperfusion
RFs for arterial disease present
Abnormal ABPI
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26
Q

How are arterial ulcers managed?

A

Referral to vascular surgeons for revascularisation surgery
Exercise (build up collateral blood supply)
Modify cardio RFs

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27
Q

Give 4 features of neuropathic ulcers

A

Plantar surface of metatarsal head and hallux
Occur on pressure sites
Punched out/necrotic
Sensory impairment to area

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28
Q

How are neuropathic ulcers managed?

A

Education on diabetic foot health to prevent

Cushioned shoes to reduce callous formation

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29
Q

What are some triggers/causes of eczema?

A

Dry skin
Hot/cold
Irritants
Allergy

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30
Q

How does eczema present?

A

Patches of dry, red, itchy skin on flexor surfaces
(face and trunk in babies)
If contact dermatitis: specific pattern depending on where on body the patient is exposed

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31
Q

Management of eczema?

A

EMOLLIENTS
Topical steroids for acute flares
Steroid sparing agents

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32
Q

Give some examples of steroid sparing agents that may be used in treating eczema

A

Topical calcineurin inhibitors (tacrolimus)
Antihistamines
2nd line systemic agents (e.g. methotrexate)

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33
Q

What is eczema herpeticum?

A

LIFE THREATENING EMERGENCY
Skin infection (HSV 1/2)
More common in children with pre-existing eczema
May have s.aureus superinfection, leading to impetigo

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34
Q

Management of eczema herpeticum?

A

Admit to hospital

IV Aciclovir

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35
Q

What is psoriasis?

A

Chronic skin condition - scaly plaques form on extensor surfaces of the body

Can also affect scalp and nails

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36
Q

What is the most common type of psoriasis?

Give 6 other types

A

Chronic plaque psoriasis

Flexure psoriasis (ask about genitals)
Scalp
Guttate
Palmar-plantar
Nail
Generalised pustular (hospitalisation may be needed)
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37
Q

Give 3 nail features of psoriasis

A

Pitting
Onycholysis (nail separating from skin beneath)
Thick/hyperkeratotic nails

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38
Q

What is the term for when psoriasis spreads to an area of skin that has been broken?

A

Koebner phenomenon

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39
Q

How is psoriasis managed?

A

Emollients
Topical steroids + Vit D analogues (e.g. calcitriol)
UV light therapy
Systemic therapies (retinoids, MTX, ciclo)
Biologics (Infliximab, adalimumab)

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40
Q

What are the corticosteroids that may be prescribed in psoriasis? (list in increasing order of strength)

A 
HI YOU BET DERM
Mild: Hydrocortisone
Mod: Eumovate
Potent: Betnovate
V potent: Dermovate
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41
Q

What are 2 extra-dermal complications of psoriasis?

A

Psoriatic arthritis

Increased risk of cardiovascular disease

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42
Q

Patient with sore throat for the last few days. Presents with raindrop shaped plaques with silvery scale on their trunk. Likely diagnosis?

A

Guttate psoriasis

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43
Q

What is the typical trigger for guttate psoriasis?

A

Strep throat (Group A Streptococcus)

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44
Q

How is guttate psoriasis investigated and treated?

A

Ix: throat swab for anti-streptolysin O titre
Rx: most self-resolve in 2-3 months, topical agents (like normal psoriasis)

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45
Q

What is the causative organism of acne vulgaris?

A

Propionibacterium acnes

46
Q

What are the features of acne?

A 
Comedones (dilated sebaceous follicles)
Papules
Pustules
Nodules
Cysts
Scarring - ice pink, hypertrophic
47
Q

Management of acne vulgaris?

A

1) Single topical therapy (retinoids or benzyl peroxide)
2) Topical combination (tetracycline + stage 1 topical)
3) Oral Abs (oxytetracycline/doxycycline)
4) Oral isotretinoin

48
Q

What are some side effects of isotretinoin? (Roaccutane)

A 
Dry skin
Depression
LFT derangement
Increased serum triglycerides
Teratogenic 
Hair thinning
Nose bleeds
Idiopathic intracranial hypertension
Photosensitivity
49
Q

What is Wallace’s rule of 9s for burns?

A 
Head = 9
Arm = 9 each
Torso = 9 front, 9 back
Abdo = 9 front, 9 back
Leg = 9 front, 9 back
50
Q

What are the different gradings for burns?

A

1) Superficial - red, painful
2) Superficial dermal - red, painful, blistered
3) Deep dermal - decreased sensation, white, blistered
4) Full thickness - white, no pain, no blisters. May have muscle/bone involvement

51
Q

What is the Parkland formula for burns?

A 
Fluid requirement in burns victims over 24h.
Fluid requirement (ml) = TBSA% x weight (kg) x 4

TBSA = total body surface area affected

52
Q

How are burns managed?

A 
ABCDE
Stop the burning
Layered clingfilm
Monitor U+Es
Emollients (if superficial)
Escharotomy if circumferential
Appropriate analgesia
Non-adherent dressing
53
Q

What are some indications for burns to be referred to secondary care?

A 
Affects face, neck, hands, feet or genitals
Deep dermal/full thickness
Smoke inhalational injury
Chemical/electrical
Non-accidental injuries
54
Q

What are the features of acne rosacea?

A

Flushing
Telangiectasia
Affects nose, cheeks, forehead
Persistent erythema with papules and pustules
Rhinophyma
Ocular involvement - blepharitis, keratitis, conjunctivitis

55
Q

What is rhinophyma?

A

Large, bulbous nose associated with granulomatous infiltration, commonly due to untreated rosacea

56
Q

Management of acne rosacea?

A 
Metronidazole (topical)
Oxytetracycline (systemic antibiotics)
Daily suncream
Camouflage cream
Laser treatment for telangiectasia
Surgical repair of rhinophyma
57
Q

What is bullous pemphigoid?

A 
Autoimmune, sub-epidermal blistering of skin
Affects elderly patients
Itchy, tense blisters
Typically around flexures
Usually heal without scarring
Mouth spared
58
Q

What would you see on biopsy of bullous pemphigoid?

A

IgG and C3

59
Q

How is bullous pemphigoid managed?

A

Refer to derm - biopsy to confirm diagnosis

Oral corticosteroids

60
Q

What is vitiligo?

A

Autoimmune disease
Loss of melanocytes leading to depigmentation
Affects 1% population
Commonly presents 20-30yrs

61
Q

How is vitiligo managed?

A

Sunscreen for affected areas
Camouflage makeup
Topical corticosteroids (may reverse changes if applied early)

Role for tacrolimus and phototherapy

62
Q

Give 5 diseases associated with vitiligo?

A 
T1DM
Addison's
Pernicious anaemia
Autoimmune thyroid disease
Alopecia areata
63
Q

What is alopecia areata? What would you see?

A

Autoimmune, localised hair loss
Well-demarcated patches
May be small broken ‘exclamation’ hairs

64
Q

How is alopecia areata managed?

A

Hair tends to regrow in 50% by 1 year - need to explain this to patient

Treatments:
Topical steroids
Topical minoxidil
Phototherapy
Contact immunotherapy
Wigs
65
Q

What is erythema nodosum?

A

Inflammation of subcutaneous fat

66
Q

What are the features of erythema nodosum?

A

Tender
Erythematous
Nodular lesions
Usually over shins but may occur elsewhere too

67
Q

Give 5 causes of erythema nodosum

A

1) Infection (TB, strep)
2) Systemic disease (IBD, sarcoidosis, Behcet’s)
3) Malignancy (lymphoma)
4) Pregnancy
5) Drugs (penicillin, COCP, sulphonamides)

68
Q

Management of erythema nodosum?

A

Usually self-resolves within 6 weeks
Lesions heal without scarring
Symptomatic treatment, e.g. analgesia

69
Q

What are the features of pellagra?

A 
4 Ds
Diarrhoea
Dementia/depression
Dermatitis (brown, scaly skin on sun-exposed sites)
Death (if not treated)
70
Q

What causes pellagra?

A

Deficiency of NICOTINIC ACID (Vit B3)
May occur as result of isoniazid therapy
More common in alcoholics

71
Q

Management of pellagra?

A

Vitamin B3 supplementation

72
Q

What is keratoacanthoma? What is it important to rule out?

A

Benign epithelial tumour filled with keratin
Looks like volcano/crater
Rule out SSC

73
Q

Management of keratoacanthoma?

A

Excision (5% progress to SCC)

However, usually regresses in 3 months (scars)

74
Q

Itchy, red patches seen in T-zone and in naso-labial folds. Likely diagnosis? What is this due to?

A 
Seborrheic dermatitis
Malassezia furfur (over-proliferation of normal skin inhabitant)
75
Q

Give 2 RFs for seborrheic dermatitis

A

HIV

Parkinson’s

76
Q

Which parts of the body does seborrheic dermatitis affect?

A 
Sebum-rich areas:
Scalp (may cause dandruff)
Periorbital
Auricular
Nasolabial folds
Cheeks
77
Q

Management of seborrheic dermatitis:

a) On face and body?
b) On scalp?

A

a) Ketoconazole (topical anti fungal), Topical steroids

b) Head and shoulders shampoo (contains zinc pyrithione), Ketoconazole, Topical steroid (selenium)

78
Q

What are seborrheic warts? Management?

A

Benign, epidermal plaques
Vary in colour

May be removed if they are irritating (curettage, cryosurgery, shave biopsy)

79
Q

What are actinic keratoses?

A

Premalignant condition associated with chronic sun exposure

80
Q

What is the spectrum of disease associated with actinic keratosis?

A

Photodamage > Actinic keratosis > SSC in situ (Bowen’s disease) > Invasive SCC

81
Q

Give 4 features of actinic keratosis?

A

Small, crusty, scaly lesions
Vary in colour (pink, red, brown, skin-colour)
Sun-exposed areas (temples of head)
Multiple lesions may be present

82
Q

Management of actinic keratoses?

A

Sun avoidance + sunscreen (avoid further risk)
Fluorouracil cream
Cryotherapy
Curettage + cautery

83
Q

What is the name of the rash you might get due to heat exposure?

A

Erythema ab igne

84
Q

What cancer is a patient with erythema ab igne at risk of developing?

A

SCC

85
Q

Patient with brown/black velvety hyperpigmentation in body folds (neck, axilla, groin, umbilicus). What is this condition called?

A

Acanthosis nigricans

86
Q

What condition is acanthosis nigricans associated with?

A 
Insulin resistance (T2DM)
Paraneoplastic (pancreatic, gastric malignancies - suspect if mucous membranes involved)
87
Q

What would you worry about if you see a patient with acanthosis nigricans that affects the mucous membranes?

A

Malignancy (e.g. pancreatic, gastric)

88
Q

How does pyoderma gangrenosum develop?

A

Starts as small red papule. Develops into deep, red, necrotic ulcer with purple border
May have systemic symptoms (fever, myalgia)

89
Q

Which part of the body does pyoderma gangrenosum typically affect?

A

Lower limbs

90
Q

What are the causes of pyoderma gangrenosum?

A 
50% idiopathic
IBD
Connective tissue disease - RA, SLE
Myeloproliferative disorders
Lymphoma, myeloid leukaemia
Monoclonal gammopathy
Primary bilbos cirrhosis
91
Q

How is pyoderma gangrenosum treated?

A 
Oral steroids (first line)
Immune suppression (ciclosporin, infliximab)
92
Q

What are the features of lichen sclerosis?

A

Inflammatory condition affecting vulva
White plaques due to atrophy of epidermis
ITCHY

93
Q

Management of lichen sclerosis?

A

Topical steroids
Emollients

Careful follow up due to increased risk of vulval cancer

94
Q

What are the features of lichen planus?

A 
4 Ps:
Purple
Polygonal
Papules
Pruritic

Commonly on palms, soles, genitals
White lace pattern on surface - Wickham’s striae
May see Koebner phenomenon
Oral involvement in 50%
Nail signs: thinning of nail plate, longitudinal ridging

95
Q

Give 3 causes of lichenoid drug eruptions

A

Gold
Quinine
Thiazides

96
Q

How is lichen planus managed?

A

Topical steroids
Oral disease - benzylamine mouthwash
Oral steroids/immune suppression for extensive disease

97
Q

What is molluscum contagiosum? What causes it?

A

Viral disease caused by close personal contact/contaminated surfaces (shared towels, flannels)

98
Q

What are the features of molluscum contagiosum?

A 
Pink/pearly white papules
Central umbilication
<5mm diameter
Clusters
Spares palms and soles
99
Q

Management of molluscum contagiosum?

A

Advice: Self-limiting (<18 months), contagious (avoid towel sharing etc)

Treatment: squeeze after bath, cryotherapy, steroids (if itchy), antibiotics if crusty/infected

100
Q

When would someone with molluscum contagiosum require specialist input?

A

HIV positive
Eyelid/ocular margin lesions
Anogenital lesions - refer to GUM

101
Q

What organism causes scabies?
Who does it tend to affect?
Where are the eggs laid?

A

Sarcopetes scabeii
Children and young adults (uni students in shared houses)
Eggs in stratum corneum

102
Q

Features of scabies?

A

ITCH - worse on trunk and between fingers
Linear burrows
Excoriations

Itch persists for about a month after treatment

103
Q

How is scabies treated?

A

Permethrin 5% (topical)

Ensure whole household treated on same day. Clothes, bedding, towels washed at high temp.

104
Q

What is hyperhidrosis and how is it managed?

A

Excess sweating

Topical aluminium chloride
Electric current - iontophoresis
Botox of axilla
Surgery - endoscopic transthoracic sympathectomy

105
Q

What is petechiae on tongue/inside gum and telangiectasia on skin suggestive of?

A

Hereditary haemorrhagic telangiectasia

106
Q

How is hereditary haemorrhagic telangiectasia inherited?

A

Autosomal dominant

107
Q

What are the 4 key diagnostic criteria for HHT?

A

1) Epistaxis
2) Telangiectasia
3) Visceral lesions
4) FHx

108
Q

What are the features of pityriasis roses?

A

Acute self-limiting rash - resolves after 4-12 weeks
Young adults
Associated with HHV-7
‘Herald patch’ - appears on trunk
Followed by erythematous, oval scaly patches on trunk (‘fir tree’)
May have URTI prodrome

109
Q

What is Steven-Johnson Syndrome?

A

Systemic reaction to drug

<10% body surface area affected

110
Q

What is Toxic Epidermal Necrolysis?

A

Systemic reaction to drug

>35% surface area affected

Medicine - Finals (13 decks)

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