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Medical Finals 2020 > Dermatology > Flashcards

Dermatology Flashcards

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USMLE® Step 1 flashcards
1
Q

Which of the following are risk factors for skin infections?

a. Sunlight exposure
b. Diabetes mellitus
c. Steroids
d. Phenytoin
e. HIV Infection

A

All except Phenytoin

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2
Q

A 39 year old female presents with an erythematous rash on her legs. She has just returned from holiday in North Africa. The lesions are purpulish, painful and warm to the ouch. She has a medical history of Crohn’s disease and at present, has a flare-up of her symptoms with diarrhoea.

A

Raised, purple painful red areas on legs suggest erythema nodosum which is associated with Crohn’s disease

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3
Q

True or False? In eczema…

a. the rash is rarely itchy
b. the rash is often on the extensor surfaces
c. stress can be a trigger factor
d. ciclosporin is the usual treatment
e. there can be an association with asthma

A

a. false
b. false
c. true
d. false
e. true

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4
Q

A 12 year old female presents with an erythematous rash on her arms. She has a history of asthma. She also says that she is having difficulty sleeping because of itching. The rash is flexural in distribution and she has nail pitting. What is the most likely diagnosis?

A

History of atopy. Distribution suggests Eczema.

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5
Q

A 28 year old male presents with a rash on his hands. It is weeping fluid and in a parts has yellow crusting areas. His girlfriend has a similar rash. It responds to treatment with antibiotics. What is the most likely diagnosis?

A

Yellow crusts strongly suggests Staph. aureus infection of Impetigo.

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6
Q

A skin lesion consisting of weeping, exudative areas with a honey coloured crust is likely to be what? What is the causative agent?

A

Impetigo

Staph or group A beta-haem strep

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7
Q

What are the main causative agents for cellulitis?

A

Streptococcus
Community acquired MRSA, rare
Gram neg organisms or anaerobes in immunosuppressed or diabetic patients

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8
Q

What is the treatment for cellulitis?

A

Flucloxacillin 500mg QDS 5 days

If widespread give IV for 3-5 days

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9
Q

What is type 1 necrotizing fasciitis caused by and when is it seen?

A

Mixture of aerobic and anaerobic bacteria seen following abdominal surgery

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10
Q

What is type 2 necrotizing fasciitis caused by and when is it seen?

A

Group A streptococci, it arises spontaneously in otherwise healthy people

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11
Q

What is the treatment for necrotizing fasciitis?

A

Type 1 - broad spec abx - metronidazole
Type 2 - benpen and clindamycin, high dose
Debridement/amputation

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12
Q

What is the treatment for atopic eczema?

A

Topical steroid, frequent emollients and bath oil with soap substitutes

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13
Q

Which diseases are associated with seborrhoeic eczema?

A

Parkinsonism

HIV

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14
Q

Describe the pathophysiology of psoriasis

A

Papulo-squamous disorder, in which the skin becomes inflamed and hyperproliferates, it is t-lymphocyte driven

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15
Q

A skin biopsy showing epidermal acanthosis nd parakeratosis with an absent granular layer and elongated and clubbed rete ridges is likely to have what?

A

Psorias

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16
Q

What changes are seen in the dermis in psoriasis?

A

Capillary dilation, mixed lymphatic and lymphocytic pericascular infiltrate

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17
Q

What changes are seen in the epidermis in psoriasis?

A

Acanthosis, parakeratosis, absent granular layer, polymorphonuclea abscesses (upper epidermis), elongated and clubbed rete ridges

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18
Q

What drugs can aggravate psoriasis?

A

Lithium, antimalarials, beta blockers

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19
Q

What nail changes are seen in psoriasis?

A 
Pitting of the nail plate
Distal seperation of the nail plate
Yellow-brown discolouration
Subungal hyperkeratosis
Damaged nail matrix and loss of nail bed (rarely)
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20
Q

What is pityriasis versicolor?

A 
Hypopigmented patches
Fungal infection
Pruritic
Scale common
Treat with topical antifungal
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21
Q

How does a scabies rash present and what is the underlying pathology?

A

Pruritis
Linear burrow on the side of the fingers, interdigital webs and flexor aspect of wrist
Excoriation
Often occurs in family members
Type IV delayed hypersensitivity reaction

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22
Q

How is scabies treated?

A

Permethrin 5%
Malathion 0.5%
Itchiness persists for 4-6 weeks

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23
Q

What is acanthosis nigricans and what is it associated with?

A

Symmetrical brown velvety plaques - neck, axilla and groin

DM, PCOS, acromegaly, Cushing’s, hypothyroidism, obesity, familial

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24
Q

What is eczema herpeticum?

A

Serious - requires IV abx
Cluster of itchy and painful blisters
Infection by herpes simplex virus 1 or 2

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25
Q

What is the most aggressive subtype of melanoma?

A

Nodular

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26
Q

What factors help aid ulceration healing?

A

ABPI - excludes arterial insifficiency - if abnormal (below 0.9) then refer to vascular surgeons
Active management: compression bandaging (if fails then consider malignancy biopsy)

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27
Q

How do you test for irritants and allergens for contact dermatitis?

A

Skin patch test

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28
Q

What is a skin prick test used for?

A

Food allergies

Pollen

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29
Q

What is pemphigoid gestationis?

A

Pruritic blistering lesions, often peri-umbicular

Treat with PO steroids

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30
Q

What rashes are associated with pregnancy?

A

Pemphigoid gastationis

Polymorphic eruption of pregnancy

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31
Q

What bacteria is known to contribute to acne development?

A

Propionibacterium acnes

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32
Q

A skin lesion consisting of weeping, exudative areas with a honey coloured crust is likely to be what? What is the causative agent?

A

Impetigo caused by staphylococci or group A β-haemolytic streptococci

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33
Q

What is type 1 necrotizing fasciitis caused by and when is it seen?

A

Mixture of aerobic and anaerobic bacteria seen following abdominal surgery

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34
Q

What is type 2 necrotizing fasciitis caused by and when is it seen?

A

Group A streptococci, it arises spontaneously in otherwise healthy people

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35
Q

What is the treatment for necrotizing fasciitis?

A

type 1 – broad spectrum combination including metronidazole

type 2 – high doses of benzylpenicillin and clindamycin

Debridement/ amputation

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36
Q

What nail changes are seen in psoriasis?

A
  • pitting of the nail plate
  • distal separation of the nail plate
  • yellow-brown discolouration
  • subungual hyperkeratosis
  • damaged nail matrix and loss of nail bed (rarely)
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37
Q

What is the difference between a discrete and confluent lesions?

A

Discrete - separate edges

Confluent - patches that blur together

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38
Q

Give some causes of petechiae

A 
Trauma
Bruising
Meningococcal
ITP (low platelets)
Henoch-Schonlein Purpura
DIC
Thrombocytopenia
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39
Q

Give 5 systemic causes of an itch

A 
Cholestasis
Polycythaemia Rubra Vera
Lymphoma
Liver Disease
Chronic Renal Insufficiency
Hyperthyroidism
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40
Q

What disease is dermatitis herpetiformis associated with?

A

Coeliac disease - itching burning blisters on shoulders, elbows, scalp, ankles

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41
Q

What is erythema multiforme and when does it occur?

A

Steven Johnson Syndrome - mucosal involvement, target lesions

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42
Q

What are risk factors for cellulitis?

A

Diabetes
Trauma
High BMI
Immunocompromised

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43
Q

What is erysipelas?

A

Superficial cellulitis layers of skin

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44
Q

What are common causes of cellulitis?

A

Staph aureus
Strep pyogenes
Beta-haem streptococcus

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45
Q

What would scarlet fever present with?

A

Mobiliform rash
Tonsillitis
Strawberry tongue with white papilla

46
Q

What is folliculitis?

A

Inflammation of hair follicles, itchy or tender papules/pustules

47
Q

How does measles present?

A

Mobiliform rash (measle-like rash)
Cough, coryza
Koplik’s spots - white spots inside of mouth
Miserable

48
Q

A child with red swollen cheeks is likely to have what infection?

A

Viral

Parvovirus

49
Q

Give 3 symptoms of rubella infection

A

Non-photogenic rash that starts on the face and spreads
Vague, lacy ill-defined non-itchy rash
Lymphadenopathy

50
Q

What is your management for Shingles?

A

Acyclovir PO 800mg 5 times daily for 5 days

51
Q

What is Coxsackie?

A

Hand, Foot and Mouth Disease
Tender lumps on hands, foot and mouth
Non-itchy

52
Q

What gland swells in mumps?

A

Parotid gland

53
Q

How are verucas treated and what virus causes them?

A

Human Papillomavirus

Cryotherapy (10-40% success)
Duofilm
Salicylic Acid

54
Q

What management is given for a large pink-red lobulated mark on a newborn baby?

A

Cavernous Haemangioma (strawberry mark)
Usually self-limiting, no treatment
Propranolol

55
Q

What is the other term for a port wine stain and how is it treated?

A

Capillary Haemangioma

Permanent, usually harmless, laser therapy

56
Q

What may indicate neurofibromatosis in a newborn?

A

> 5 cafe au lait spots

57
Q

What do you give to treat candida?

A

Nystatin

Chlorohexane

58
Q

What is timodine?

A

Antifungal

Used in nappy rash

59
Q

What is Tinea?

A

Fungus

Causes ringworm

60
Q

What features and history might you see from someone with a scabies infection?

A

Family affected
Burrow lesion between fingers

Explain and treat with permethrin 5% cream

61
Q

What is erythema ab igne and what does is look like?

A

Hot water bottle rash

Swelling of capillaries, caused by heat exposure and swelling

62
Q

What is hyperhidrosis and your first line management?

A 
Excess production of sweat
Topical aluminium chloride (SE skin irritation)
Iontophoresis
Botulinum toxin
Surgery
63
Q

What is your management in children with new onset purpura?

A

Immediate referral to paediatrics to ensure no meningoccal disease or ALL

Purpura are larger than petichiae

64
Q

What drugs exacerbate psoriasis?

A 
Lithium
BB
NSAIDs
ACE-i
TNF-a-i
Anti-malarias
65
Q

What is your first line management of athlete’s foot and what is given if this fails?

A 
Topical antifungal (imidazole)
PO antifungal (terbinafine)
66
Q

What is the pathophysiology or urticaria?

A

Mast cell degranulation, histamine activation, vasodilations, increased capillary permeability, caused by allergens, trauma (heat, sun cold)

67
Q

What is the difference between acute and chronic urticaria?

A

Acute: <6 weeks
Chronic: >6 weeks

68
Q

What kind of dermatological involvement do you see in urticaria?

A 
Wheals
Erythema
Central white
Local purpura
Itching and burning rash
Might be fever and arthralgia
69
Q

How do you manage urticaria?

A

Antihistamines: PO chlorphenamine

Prednisolone

70
Q

What is angioedema?

A

An urticarial subcutaneous tissue swelling of the lips, eyelids, genitalia, tongue and/or larynx.

71
Q

What can be measured in angioedema?

A

Serum C4 complement level

72
Q

How do you treat acute angioedema?

A

Facial oxygen, IM adrenaline, IM hydrocortisone, salbutamol nebs (occurs often in anaphylaxis)

73
Q

What is required for an eczema diagnosis in children?

A 
Itchy skin condition in the past six months
Skin crease involvement
History of asthma or hayfever
Generally dry skin
Flexural dermatitis
74
Q

Give 4 different types of eczema?

A

Atopic - hypersensitivity reaction
Discoid - asymmetrical distribution, blistering or crusting plaques
Seborrhoeic - scalp, irritant or allergic

75
Q

What is pompholyx?

A

Intensely itchy small vesicles on the palms and side of fingers

76
Q

What is your baseline management for eczema?

A

Trigger avoidance
Detergent avoidance
Emollients (frequent use)

77
Q

What is your mild management for eczema?

A

Sedative antihistamines
Antibiotics (if required)
Topical corticosteroids
Topical calcineurin inhibitors

78
Q

What is your management of moderate eczema?

A

Systemic antihistamines - chlorphenamine, hydroxyzine
IV treatment
Calcineurin inhibitor - tacrolimus
immune modulators - azathioprine

79
Q

Name one mild, moderate, potent and very potent steroid

A

Mild - hydrocortisone 1%
Moderate - Betamethasone/Clobetasone 0.05%
Potent - mometasone furoate
Very potent - dermovate

80
Q

What dose are topical steroids given in?

A

Finger tip units

81
Q

What are some side effects of topical steroids?

A

Skin thinning
Cushings
Cataracts
Acne

82
Q

What is often the cause of seborrhoeic dermatitis?

A

Malassezia yeast - commensal found on the skin

83
Q

What is the difference between dermatitis and eczema?

A

One is usually triggered by contact, the other by allergens but the terms can be used interchangably.
Contact dermatitis - irritant reaction causing dry, red, eczematous lesions

84
Q

Name at least 3 of the 6 types of psoriasis

A 
Plaque
Scalp
Inverse
Guttate
Palmoplantar
Pustular
85
Q

Where is psoriasis usually located on the body?

A

Extensor pattern

86
Q

What are 4 symptoms of psoriasis?

A

Itch
Hyperproliferation of the epidermis - nucleus still present under microscope
Improves with heat, worse with stress
Nail changes - pitting, onycholysis

87
Q

What is Koebner phenomenon?

A

The appearance of skn lesions in areas of cutaneous injury - inflammatory lines

88
Q

What is your management options for psoriasis?

A

Atopic vitamin D - calcipotriol (suppresses skin proliferation, promotes keratinocyte differentiation)
Topical corticosteroids
Topical retinoids

89
Q

What is the bacteria that propagates in acne?

A

Propionbacterium acne

90
Q

What are the 5 pillars of acne formation?

A
  1. keratinocyte proliferation
  2. increased sebum production
  3. p. acne colonisation
  4. inflammation
  5. comedones
91
Q

What is your choice of antibiotic to give in acne?

A

PO doxycycline

92
Q

What are some management options in acne?

A

Antibiotics
Benzoyl peroxide
Azelaic acid
Topical retinoids

93
Q

What is used to treat rosacea?

A

Metronidazole
Azelaic acid
Isotretinoin

94
Q

Give 2 complications of rosacea

A

Rhinophyma - enlarged nose with sebaceous hyperplasia

Blepharitis - inflamed eyelids, dry eyes

95
Q

What is the classical rash in rosacea?

A

Butterfly rash - facial

96
Q

Give some differentials for a pigmented skin lesion

A

Seborrheic keratosis
Seborrheic wart
Melanoma
Naevi

97
Q

What change in a naevi should be reported?

A

Any change - shape, colour, pigmentation, itching, pain

98
Q

What is considered natural variation in naevi?

A

Halo naevi - common in teenagers

Irregular pigmentation, black in colour, haloed by pale skin

99
Q

What are clinical features of a melanoma?

A 
Asymmetry
Border irregularity
Colour variability
Diametre >5mm
Elevation and enlargement
100
Q

What is a lentigo maligna?

A

Looks like a giant irregular freckle, found in elderly, can be present for years before getting darker

101
Q

What are major risk factors for melanomas?

A

Skin exposure

102
Q

What excision margin is required for melanomas?

A

1cm excision margin for every mm depth, up to 3 cm

103
Q

What are common metastases sites for melanomas?

A

Liver
Brain
Lung
Bone

104
Q

What is Breslow thickness?

A

Deepest point to surface
<1mm good prognosis, 95% cure
Staging for melanoma

105
Q

What is the common presentation of a basal cell carcinoma?

A

Pearly
Raised rolled edge
Ulceration or dip in the middle ‘rodent ulcer’
Telangiectasia

106
Q

What is your management for a BCC?

A

Mohs Surgery
Radiotherapy
Cryo + curettage

107
Q

What are some variations found in squamous cell carcinomas?

A

Actinic keratosis - scaly spot in sundamaged skin, often a SCC precursor
Bowen’s diseease - red scaly patches, pre-cancerous
Keratoacanthoma - slow growing or benign skin cancer, can resolve spontaneously

108
Q

What is the causative organism in mumps and what structure does it affect?

A

Paramyxoma virus, parotid gland

109
Q

What investigative samples do you take in mumps? What are some potential consequences of the disease?

A

Throat swab – viral PCR, sputum sample – salivary IgG

Orchitis, infertility, meningitis, pancreatitis

110
Q

What is the most common cause of type 2 necrotising fasciitis?

A

Strep pyogenes – gram positive cocci in chains

Medical Finals 2020 (25 decks)

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