dermatology Flashcards

1
Q

polycythaemia features

A

Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease

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2
Q

pemphigus vulgaris feartures

A

antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule
more common in the Ashkenazi Jewish population.
mucosal ulceration is common and often the presenting symptom. Oral involvement is seen in 50-70% of patients
skin blistering - flaccid, easily ruptured vesicles and bullae. Lesions are typically painful but not itchy. These may develop months after the initial mucosal symptoms. Nikolsky’s describes the spread of bullae following application of horizontal, tangential pressure to the skin
acantholysis on biopsy

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3
Q

acanthosis nigricans causes

A

Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin

Causes
gastrointestinal cancer
diabetes mellitus
obesity
polycystic ovarian syndrome
acromegaly
Cushing's disease
hypothyroidism
familial
Prader-Willi syndrome
drugs: oral contraceptive pill, nicotinic acid
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4
Q

hidradenitis suppurativa

A

multible abscesses in sweat gland areas

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5
Q

lichen planus Ps

A

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

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6
Q

hirsutism associated with

A

cushings

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7
Q

psoriasis exacerbating factors

A

The following factors may exacerbate psoriasis:
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

Streptococcal infection may trigger guttate psoriasis.

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8
Q

commonest keloid site

A

sternum

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9
Q

Pigmentation of nail bed affecting proximal nail fold

A

Acral lentiginous melanoma (Hutchinson’s sign)

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10
Q

lichen sclerosus mx

A

Lichen sclerosis is a dermatological condition that affects the vulva. The first line treatment is a strong topical steroid thus the answer is topical clobetasol propionate.

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11
Q

TEN drug causes

A
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
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12
Q

seborrhoeic dermatitis fx

A

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population

Features
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

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13
Q

erythroderma

A

Erythroderma is a term used when more than 95% of the skin is involved in a rash of any kind.

Causes of erythroderma
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic
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14
Q

Necrobiosis lipoidica diabeticorum fx

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

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15
Q

impetigo tx

A

topical fusidic acid is first-line
topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin (Bactroban) should, therefore, be used in this situation

Extensive disease
oral flucloxacillin
oral erythromycin if penicillin-allergic
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

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16
Q

granuloma annulare

A

papular lesions that are often slightly hyperpigmented and depressed centrally
typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs

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17
Q

PUVA therapy risk factor for

A

SCC

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18
Q

most accurate way of assessing burns

A

lund brower chart

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19
Q

lentigo maligna

A

Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

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20
Q

pyoderma gangrenosum causes

A
idiopathic in 50%
inflammatory bowel disease: ulcerative colitis, Crohn's
rheumatoid arthritis, SLE
myeloproliferative disorders
lymphoma, myeloid leukaemias
monoclonal gammopathy (IgA)
primary biliary cirrhosis
21
Q

pityriasis rosea

A

HHV 7

herald patch first

22
Q

fungal nail

A

trichophyton rubrum

23
Q

mx pyoderma gangernosum

A

the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases

24
Q

koebner phenomenon

A
psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum
25
acne mx
topical retinoids combination topical- retinoids, benzyl peroxide, abx oral abx (cocp in females) oral isotretinoin
26
pregnancy skin
Pemphigoid gestationis pruritic blistering lesions often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy oral corticosteroids are usually required Polymorphic eruption of pregnancy pruritic condition associated with last trimester lesions often first appear in abdominal striae management depends on severity: emollients, mild potency topical steroids and oral steroids may be used
27
acne organism
Propionibacterium acnes
28
ketoconazole s/e
hepatotoxicity, gynaecomastia
29
pyogenic granuloma
These present as friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common. They may be treated with curettage and cautery, formal excision may be used if there is diagnostic doubt.
30
actinic keratosis mx
prevention of further risk: e.g. sun avoidance, sun cream fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects topical imiquimod: trials have shown good efficacy cryotherapy curettage and cautery
31
psoriasis mx
first-line: NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment second-line: if no improvement after 8 weeks then offer a vitamin D analogue twice daily third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily 2ndary care- phototherapy, MTX, ustekinimab
32
ketatoacanthoma fx
Features - said to look like a volcano or crater initially a smooth dome-shaped papule rapidly grows to become a crater centrally-filled with keratin
33
MM types
Superficial nodular (most aggressive) lentigo acral
34
Chondrodermatitis nodularis helicis
Chondrodermatitis nodularis helicis (CNH) is a common and benign condition characterised by the development of a painful nodule on the ear. It is thought to be caused by factors such as persistent pressure on the ear (e.g. secondary to sleep, headsets), trauma or cold. CNH is more common in men and with increasing age.
35
hyperhidrosis mx
aluminium chloride
36
isotretinoin s/e
contraception (e.g. Combined oral contraceptive pill and condoms) dry skin, eyes and lips/mouth: the most common side-effect of isotretinoin low mood* raised triglycerides hair thinning nose bleeds (caused by dryness of the nasal mucosa) intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason photosensitivity
37
acne rosacea mx
topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques) topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia more severe disease is treated with systemic antibiotics e.g. Oxytetracycline recommend daily application of a high-factor sunscreen camouflage creams may help conceal redness laser therapy may be appropriate for patients with prominent telangiectasia patients with a rhinophyma should be referred to dermatology
38
pyogenic granuloma
Overgrowth of blood vessels. Red nodules. Usually follow trauma. May mimic amelanotic melanoma.
39
erythrasma
Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum Examination with Wood's light reveals a coral-red fluorescence. Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection
40
chondrodermatitis nodularis helicis vs actinic keratosis
chondrodermatitis is painful
41
lipoma 5cm ix
uss
42
types of burns
Superficial epidermal First degree Red and painful Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered Partial thickness (deep dermal) Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation Full thickness Third degree White/brown/black in colour, no blisters, no pain
43
mx bcc eyelid
mohs micrographic surgery
44
curlings ulcers
complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa
45
embryological remnants and may be lined by hair and squamous epithelium
dermoid cyst
46
bowens disease
intra epithelial scc
47
pyogenic granuloma
most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy initially small red/brown spot rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape the lesions may bleed profusely or ulcerate
48
mx hirsute
advise weight loss if overweight cosmetic techniques such as waxing/bleaching - not available on the NHS consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding