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EOY4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What makes up a good skin examination?

A

Inspect

Describe

Palpate

Systematic Check

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2
Q

What makes up general inspection of the skin?

A

General observation

Site and number of lesions

Pattern and distribution if multiple

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3
Q

How should the individual lesion be described?

A

SCAM

Size (widest diameter) Shape

Colour

Associated secondary change

Morphology, margin border

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4
Q

How should the lesion be described if it is pigmented?

A

ABCD

Asymmetry

irregular Border

2+ Colours

Diameter >6mm

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5
Q

What should be felt when palpating a lesion?

A

Surface

Consistency

Mobility

Tenderness

Temperature

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6
Q

What makes up a systematic check?

A

nails, scalp, hair, mucous membranes

general exam

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7
Q

What is pruritus?

A

itching

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8
Q

What is a lesion?

A

An area of altered skin

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9
Q

What is a rash?

A

An eruption

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10
Q

What is a naevus?

A

A localised malformation of tissue structures

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11
Q

What is a comedone?

A

a plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris

open = blackheads
closed = whiteheads
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12
Q

What does generalised mean in dermatology?

A

all over the body

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13
Q

What does widespread mean in dermatology?

A

extensive spread

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14
Q

What does localised mean in dermatology?

A

restricted to only one area of the skin

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15
Q

what is a dermatome?

A

an area of skin supplied by a single spinal nerve

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16
Q

What does photosensitive mean in dermatology?

A

affects sun exposed areas e.g. face, neck, backs of hands

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17
Q

What does discrete mean in dermatology?

A

individual lesions separated from each other

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18
Q

What does confluent mean in dermatology?

A

lesions merge together

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19
Q

What does target mean in dermatology?

A

concentric rings like a dartboard

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20
Q

What does annular mean in dermatology?

A

a circle or a ring

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21
Q

What does discoid mean in dermatology?

A

coin shaped, round lesion

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22
Q

What is erythema?

A

Redness due to inflammation or vasodilation that blanches on pressure

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23
Q

What is purpura?

A

Red/purple colouring due to bleeding into the skin or mucous membranes

does not blanch on pressure

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24
Q

What are petechiae?

A

small pinpoint macules

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25
Q

what are ecchymoses?

A

large, bruise like patches

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26
Q

what is a macule?

A

a flat area of altered colour

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27
Q

what is a patch?

A

a flat area of altered colour or texture

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28
Q

what is a papule?

A

a solid raised lesion above 0.5cm in diameter

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29
Q

what is a nodule?

A

a solid raised lesion >0.5cm in diameter with a deeper component

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30
Q

what is a plaque?

A

a palpable, scaling lesion >0.5cm in diameter

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31
Q

what is a vesicle?

A

small blister

raised, clear fluid filled lesion less than 0.5cm in diameter

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32
Q

what is a bulla?

A

large blister

raised, clear fluid filled lesion more than 0.5cm in diameter

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33
Q

What is a pustule?

A

pus containing lesion <0.5cm in diameter

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34
Q

what is an abscess?

A

localised accumulation of pus in the dermis or subcutaneous tissue

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35
Q

what is a wheal?

A

transient, raised lesion due to dermal oedema

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36
Q

what is a boil?

A

staphylococcal infection around or within a hair follicle

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37
Q

what is a carbuncle?

A

staphylococcal infection in adjacent hair follicles

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38
Q

what is an excoriation?

A

loss of epidermis due to trauma

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39
Q

what is lichenification?

A

well-defined roughening of skin with accentuation of skin markings

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40
Q

what are scales?

A

flakes of stratum corneum

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41
Q

what is a crust?

A

rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis

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42
Q

what is a scar?

A

new fibrous tissue which occurs post wound healing

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43
Q

what is an ulcer?

A

loss of epidermis and dermis

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44
Q

what is a fissure?

A

an epidermal crack often due to excess dryness

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45
Q

what are striae?

A

linear areas which progress from purple to pink to white with the histopathological appearance of a scar

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46
Q

What is alopecia areata?

A

a well defined patch of complete hair loss

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47
Q

What is hirsutism?

A

androgen dependent hair growth in a female

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48
Q

what is hypertrichosis?

A

non-androgen dependent excessive hair growth

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49
Q

what is clubbing?

A

loss of angle between the posterior nail fold and nail plate - CLUBBING

C ardiac e.g. cyanotic heart disease, IE
L ung disease e.g. CF, TB, asthma
U lcerative Colitis
B iliary cirrhosis
B ronchogenic carcinoma (small cell)
I diopathic
N ot COPD
G I malabsorption - coeliac, crohns, cirrhosis
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50
Q

What is koilonychia?

A

spooning of the nails

Iron deficiency anaemia

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51
Q

What is oncholysis?

A

separation of the distal end of the nail plate from the nail bed

trauma, psoriasis, fungal nail infections, hyperthyroidism

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52
Q

what is pitting of the nails?

A

punctate depressions of the nail plate

psoriasis, eczema, alopecia areata

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53
Q

What are the 5 functions of normal skin?

A
  • protection
  • Temperature regulation
  • sensation
  • Vitamin D synthesis
  • Immunosurveillance
54
Q

What are the 4 main cell types found in the epidermis?

A

Keratinocytes - produce keratin for protection

langerhans’ - APCs and T cell activation (immunity)

melanocytes - melanin producing = skin pigment and protection from UV damage

Merkel cells - sensation

55
Q

What are the layers of the epidermis?

A

Horny Giants Pinch Bums

Horny = Stratum Corneum (keratin)
Granular = Stratum Granulosum 
Prickle = Stratum Spinosum (cells differentiate)
Basal = Stratum Basale (actively dividing cells)
56
Q

What stimulates sebaceous glands?

A

conversion of androgens to dihydrotestosterone

think boys and PCOS

57
Q

What are the 4 stages of wound healing?

A

1) haemostats - vasoconstriction + platelet aggregation = clot formation
2) inflammation - vasodilation + immune reaction
3) proliferation - granulation tissue formation + angiogenesis + re-epithelialisation
4) remodelling - scar maturation + collagen re-organisation

58
Q

What is urticaria? what is the pathophysiology?

A

Swelling of the superficial dermis leading to a raise in the epidermis

immunological or non-immunological stimulus causes localised increase in capillary permeability leading to leakage of proteins into the extravascular space

main inflammatory mediator is histamine released from mast cells but prostaglandins, leukotrienes also involved

59
Q

What is angioedema?

A

Deeper swelling with involvement of the dermis and subcutaneous tissues e.g. Tongue and lips

60
Q

what does anaphylaxis involve?

A

initially urticaria and angioedema

bronchospasm, facial and laryngeal oedema, hypotension

61
Q

What are some common causes of urticaria/angioedema/anaphylaxis? (6)

A

food

drugs

insect bites

contact

hereditary

autoimmune

62
Q

what is the management of urticaria, angioedema and anaphylaxis?

A

urticaria = antihistamines

angioedema (+severe urticaria) = corticosteroids

anaphylaxis = adrenaline, corticosteroids + urticaria (see emergency drugs)

63
Q

What is erythema nodosum?

A

A hypersensitivity response to various stimuli

64
Q

how does erythema nodosum normally present?

A

Discrete and tender nodules, usually on the shins. May become confluent.

Lesions don’t ulcerate and continue to appear for 1-2 weeks before leaving bruisey discolouration as they resolve

65
Q

What are the causes of erythema nodosum? (6)

A

NO – idiopathic
D – drugs (penicillin sulphonamides)
O – oral contraceptive/pregnancy
S – sarcoidosis/TB
U – ulcerative colitis/Crohn’s disease/Behçet’s disease
M – microbiology (streptococcus, mycoplasma, EBV and more)

66
Q

What is erythema multiforme? how does it normally present?

A

An acute, self-limiting inflammatory condition, usually due to herpes simplex.

usually takes a classic “target like” appearance on palms of hands but can also affect mucosal membrances

67
Q

what is Stevens-Johnson syndrome?

A

mucocutaneous necrosis at at least 2 mucosal sites.

differentiates from erythema multiforme due to extensive areas of necrosis

68
Q

What is toxic epidermal necrosis?

A

Similar to Stevens-Johnson - get extensive skin and mucosal necrosis + systemic toxicity

usually a prodrome of flu like symptoms

differs from SJS - sub epidermal detachment i.e. you can move the skin around and it comes off + full thickness epidermal necrosis

69
Q

How are SJS and TEN managed?

A

Urgent referral/senior help

Supportive care I.e. keep the skin on and ensure adequate hydration

70
Q

what are the complications of SJS and TEN?

A

5-12% mortality with SJS

> 30% mortality with TEN

death usually sepsis, electrolyte imbalance

71
Q

What is acute meningococcaemia? what is the cause?

A

communicable infection transmitted by respiratory secretions then bacteria get into blood (Meningitis = bacteria into CSF)

usual cause is gram-negative diplococcus - Neisseria meningitides

72
Q

What is the presentation of acute meningococcaemia?

A

meningism - photophobia, headache, fever, neck stiffness

septicaemia - hypotension, myalgia, fever

rash - non-blanching, purpuric on trunk and extremities. can quickly progress to tissue necrosis

73
Q

what is the management of acute meningococcaemia?

A

IM benpen ASAP

prophylactic abx (rifampicin) for close contacts within 14 days of exposure

74
Q

what are the complications of acute meningococcaemia?

A

DIC, shock, death

75
Q

What is erythroderma? What are the causes?

A

exfoliative dermatitis involving at least 90% of the skin (basically skin comes off and looks flaky but is red underneath)

previous skin disease, lymphoma, drugs e.g. sulphonamides, allopurinol

76
Q

How does erythroderma present?

A

inflamed, oedematous and scaly skin

systemically unwell + malaise + lymphadenopathy

77
Q

what is the management of erythroderma?

A

treat underlying cause

emollients + wet wraps + ? topical steroids

Supportive management e.g. fluid replacement and keep warm

78
Q

what are the complications of erythroderma? (4)

A

secondary infection

electrolyte imbalance/dehydration

hypothermia

high-output cardiac failure

79
Q

What is eczema herpeticum?

A

complication of atopic eczema

widespread eruption due to a herpes simplex virus on top of pre-existing eczema

80
Q

how does eczema herpeticum normally present?

A

extensive crusted papule, blisters and erosions

+ systemically unwell

81
Q

what is the management of eczema herpeticum?

A

antivirals (usually aciclovir)

abx for bacterial secondary infection

82
Q

what are the complications of eczema herpeticum? (3)

A

herpes hepatitis

encephalitis

DIC

83
Q

what is necrotising fasciitis? What is the cause?

A

A rapidly spreading infection of the deep fascia with associated tissue necrosis

Normally caused by group A haemolytic streptococcus or anaerobic + aerobic infections

really dangerous as has high mortality

84
Q

What are the risk factors for nec fasc?

A

intra-abdominal surgery

co-morbidities e.g. diabetes and malignancy

85
Q

how does necrotising fasciitis present? (4)

A

severe pain

skin is erythematous, blistering and necrotic. might become purple in the middle

systemically unwell

?crepitus under the skin

86
Q

how is necrotising fasciitis managed?

A

urgent referral for surgical debridement

IV abx

87
Q

How does cellulitis differ from erysipelas?

A

cellulitis = deep subcutaneous tissue involvement

erysipelas = more superficial and acute (dermis to upper sc tissue)

both spreading bacterial infections of the skin

88
Q

What normally causes cellulitis/erysipelas?

A

Staph aureus and strep pyogenes

89
Q

what is the presentation of cellulitis/erysipelas?

A

usually in the lower limbs

cardinal signs of infection - redness, swelling, pain, warmth

+ systemic signs of infection (particularly erysipelas)

erysipelas has a red, well-defined and raised border

90
Q

What is the management of cellulitis?

A

abx - usually flucloxacillin

conservative - leg raising, rest, analgesia etc

91
Q

what are the complications of erysipelas and cellulitis? (3)

A

localised necrosis

abscesses

septicaemia

92
Q

What is staphylococcal scalded skin syndrome? What causes it?

A

Skin infection normally affecting infants and early childhood

production of circulating epidermolytic toxins from the phage group 2, ben-pen resistant staphylococci

93
Q

How does staphylococcal scalded skin syndrome present?

A

scald like skin&raquo_space;> large, flaccid bullae

develops within a few hours

perioral crusting + intraepidermal blistering + PAIN

94
Q

How is staphylococcal scalded skin syndrome managed?

A

Abx e.g. erythromycin or fusidic acid

analgesia

95
Q

What are the 3 types of fungal infection?

A

Dermatophytes - tine pedis (athletes fooT)

Yeasts - candidiasis

Moulds - aspergillosis

96
Q

What is a basal cell carcinoma?

A

Slow growing

Locally invasive

malignant (rarely metastasises)

tumour of epidermal keratinocytes

97
Q

How does BCC normally present?

A

sun exposed areas e.g. head, backs of hand

nodular - small, skin-coloured papule or nodule with surface telangiectasia + pearly rolled edge. might have a necrotic centre.

superficial (plaque)

cystic

Keratotic and pigmented

98
Q

What is the management of SCC and BCC? When should you 2ww one?

A

surgical excision / radiotherapy

2ww if in a sensitive area

99
Q

What are the risk factors for BCC and SCC?

A 
non-modifiable:
skin type 1 (always burns) + atypical moles (MM)
older age
male sex
genetics
previous history

modifiable:
the sun = excessive UV exposure/ sun bed use/ severe sun burn as a child
pre-malignant conditions e.g. actinic keratoses (SCC)
immunosuppression

100
Q

What is a squamous cell carcinoma?

A

Locally invasive

Malignant + has potential to metastasise

Tumour of epidermal keratinocytes

Faster growing than BCC

101
Q

How do SCCs normally present?

A

Keratotic

Ill-defined nodule

might ulcerate

2WW them! Follow up for 2 years after

102
Q

What is a malignant melanoma?

A

Invasive

Malignant tumour of epidermal melanocytes

Has potential to metastasise

103
Q

How does malignant melanoma normally present? What are the ABCDE symptoms rules?

A 
A symmetrical shape (red flag)
B order irregularity
C olour irregularity (red flag)
D iameter >6mm 
E volution of lesion (change in size or shape) (red flag)

Symptoms - bleeding, itching

Common on legs for women and trunk for men

104
Q

What are the types of melanoma?

A

Do you actually have to know this?

105
Q

What is the Breslow thickness?

A

Measure of MM prognosis based on tumour thickness

  • <0.76mm thickness = low risk
  • 0.76mm-1.5mm thickness = medium risk
  • > 1.5mm thick = high risk
106
Q

What is eczema?

A

Papules + vesicles on an erythematous base

atopic eczema is most common. usually develops in childhood and resolves by teenager

107
Q

How does eczema normally present?

A

Itchy, erythematous patches that are dry and scaly
acute = erythema + weeping + vesicular
chronic = excoriations and lichenification

Infants = extensor + face
Children and adults = flexor surfaces

108
Q

What is the management of eczema?

A

General - triggers, emollients +/- bandages, soap substitutes

Topical - steroids for flares

Oral - antihistamines (symptom relief, esp at night), PO prednisolone, abx if secondary infection

Other - phototherapy, immunosuppressants

109
Q

What is the range of topical steroid potency?

A

hydrocortisone > Betnovate > eumovate > dermovate

110
Q

what are the complications of eczema?

A

secondary bacterial infections or secondary viral infections (molluscsum contagiosum, eczema herpeticum)

111
Q

What is acne vulgaris?

A

An inflammatory disease of pilosebaceous follicles

112
Q

what is the pathophyiology of acne?

A

increased sebum production

abnormal follicular keratinisation

bacterial colonisation. Normally Propionibacterium acne (anaerobic rod)

Androgen dependent

113
Q

How does acne vulgaris normally present?

A

Non-inflammatory = open (white) and closed (black) comedones

Inflammatory = papules, pustules, nodules and cysts

114
Q

What is the management of acne vulgaris?

A

mild = benzoyl peroxide and topical abx (doxy/lymecycline or erythromycin) or retinoids

mod-severe = oral abx, spironolactone (in females)

watch for Retinoid use in women of childbearing age as is highly teratogenic

115
Q

What are the complications of acne vulgaris?

A

hyper-pigmentation

scarring

deformity

psychological aspect

116
Q

What is psoriasis?

A

Chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration

117
Q

What are the types of psoriasis?

A

chronic plaque (most common)

guttate (lots of raindrop lesions)

Seborrhoeic (naso-labial and retro-auricular)

Flexural, pustular, erythrodermic

118
Q

How does psoriasis normally present?

A

Silver scaly plaques on a background of erythema

+/- itchy/burning/pain

extensor surfaces

auspitz sign - gentle scratching leads to capillary bleeding

nail changes (oncholysis, pitting)

+/- psoriatic arthropathy

119
Q

What is the management of psoriasis?

A

General = emollients

Topical (mild) = vitamin D, corticosteroids, keratolytics

Special - phototherapy, methotrexate, retinoids, ciclosporin

120
Q

What are the complications of psoriasis?

A

Erythroderma

Psychosocial effects

121
Q

What are the most common causes of blisters?

A

Infective - herpes zoster and simplex

Trauma - Burns

Other - Impetigo, contact dermatitis

122
Q

What is bullous pemphigoid?

A

A blistering skin condition that normally affects the elderly

123
Q

What is the cause of bullous pemphigoid?

A

Autoantibodies against antigens between the epidermis and dermis

= sub-dermal split

124
Q

How does bullous pemphigoid differ from pemphigus vulgaris?

A

BP = tense, fluid filled blisters + erythematous base. often itchy and on trunk/limbs

PV = flaccid and easily disrupted blisters = erosions and crusts. Often painful and in mucosal areas

125
Q

What is pemphigus vulgaris?

A

A blistering skin condition that normally affects the middle aged

126
Q

What is the cause of bullous vulgaris?

A

Autoantibodies against antigens in the epidermis

= intra-epidermal split

127
Q

How is bullous pemphigoid/ pemphigus vulgaris managed?

A

general wound care + watch for infection

topical or oral steroids

128
Q

What are the skin types?

A

1 - always burns, never tans

2 - always burns, sometimes tans

3 - sometimes burns, always tans

4 - never burns, always tans (olive)

5 - Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)

6 - never tans or burns e.g. afro-carribean

129
Q

Anti-TTG is an antibody used to screen for which autoimmune condition and which associated skin condition?

What does this skin condition look like

A

Coeliac Disease

Dermatitis Herpetiformis is associated

Itchy, vesicular skin lesions on the extensor surfaces

130
Q

How does acne rosacea normally present?

A

Erythema and telangiectasia leading to formation of papules and pustules

Normally affects the nose, cheeks and forehead

131
Q

What is the management of acne rosacea?

A

topical metronidazole may be used for mild symptoms

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

laser/ daily high factor sunscreen/ camouflage creams

132
Q

What are the treatment options for hyperhidrosis?

A

1st = topical aluminium chloride preparations. Main side effect is skin irritation

2nd =

  • iontophoresis: palmar, plantar and axillary hyperhidrosis
  • botulinum toxin: axillary symptoms

3rd = surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

EOY4 (22 decks)

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