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MRCP part 2 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Actinic keratoses features

A
  • Premalignant lesions in sun exposed areas

- Crusty, scaly lesions

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2
Q

Actinic keratosis mx

A
  • Topical 5-fu
  • Topical imiquimod
  • Cryotherapy
  • Curettage / cautery
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3
Q

Skin disorders in pregnancy and basic features

A

Polymorphic eruption of pregnancy

  • pruritic erythematous eruption
  • last trimester

Pemphigoid gestationis

  • pruritic blistering lesions
  • peri-umbilical before spreading
  • 2nd or 3rd trimester, rarely seen in 1st pregnancy

Melasma

  • large flat hyperpigmented macules
  • cheeks, forehead, nose, upper lip
  • resolves after delivery
  • also HRT / COCP use
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4
Q

Polymorphic eruption of pregnancy mx

A
  • emollients
  • mild topical steroids
  • oral steroid
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5
Q

Pemphigoid gestationis

A

PO steroids

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6
Q

Dermatitis herpetiformis features

A
  • inflammatory skin condition assoc w/ coeliac

- pruritic, vesicular, blistering lesions on EXTENSORS

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7
Q

Dermatitis herpetiformis ix

A

Skin biopsy: IgA deposition granular pattern (upper dermis)

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8
Q

Dermatitis herpetiformis mx

A

Dapsone

  • monitor fbc (risk haemolytic anaemia, agranulocytosis)
  • be aware peripheral neuropathy

Gluten free diet (ix coeliac)

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9
Q

Acne rosacea mx

A

All: suncream, camouflage creams

1) topical metro
- topical brimonidine for predominant flushing
- Laser therapy: for predominant telangiectasia

2) systemic abx e.g. oxytetracycline

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10
Q

Shingles mx

A

1) PO aciclovir
2) Simple analgesia
3) Neuropathic drugs e.g. pregabalin
4) Corticosteroids PO (acute only)

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11
Q

Shingles vaccine

A

Live attenuated VZV
All patients 70-79
Contraindicated: immunosuppression

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12
Q

Pityriasis rosea features

A
  • can be preceded by prodromal illness
  • Hypopigmented herald patch trunk
  • then erythematous, oval, scaly patches ‘fir tree’ distribution
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13
Q

Pityriasis rosea mx

A

None

Self limiting 6-12 weeks

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14
Q

Erythema multiforme causes

A
  • viruses: HSV
  • bacteria: Mycoplasma, Streptococcus
  • drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
  • CTD: SLE, sarcoid
  • malignancy
  • idiopathic
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15
Q

Erythema nodosum causes

A
  • Infection: streptococci, TB, brucellosis
  • systemic disease: sarcoidosis, IBD, Behcet’s
  • malignancy / lymphoma
  • drugs: penicilin, sulphonamides, COCP
  • pregnancy
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16
Q

Pyogenic granuloma features

A
  • benign lesions
  • small brown spot -> raised -> spherical
  • may catch and bleed
  • trauma, pregnancy, young women

Mx: cryo, cautery, excision

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17
Q

Pyoderma gangrenosum features

A
  • usually lower limbs
  • small red papule -> deep, red, necrotic ulcers
  • violaceous border
  • +/- fever, myalgia
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18
Q

Causes pyoderma gangrenosum

A
  • idiopathic 50%
  • IBD, PBC
  • RA / SLE
  • haem: lymphoma, leukaemia, MGUS, myeloproliferative disorders
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19
Q

Mx pyoderma gangrenosum

A

1) PO steroids

2) Consider immunosuppresion: ciclosporin / infliximab

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20
Q

Complication of psoriasis

A
  • 10% psoriatic arthropathy
  • metabolic syndrome
  • CV disease
  • VTE
  • psychological distress
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21
Q

Pemphigus vulgaris features

A
  • autoimmune disease vs desmoglein 3 (cadherin)
  • ashkenazi jewish
  • can be associated with coeliac
  • flaccid skin blistering
  • Nikolsky’s sign
  • mucosal involvement
    IX: direct immunofluorescence, acatholysis (biopsy)
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22
Q

Pemphigus vulgaris mx

A

1) PO steroids

2) immunosuppression

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23
Q

Factors that exacerbate psoriasis

A
  • trauma
  • alcohol
  • beta blockers
  • ACEi
  • NSAIDs
  • lithium
  • antimalarials (chloroquine and hydroxychloroquine)
  • infliximab
  • withdrawal of systemic steroids
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24
Q

Squamous cell carcinoma features

A
  • scaly, crusted lesion
  • painful
  • may bleed / ulcerate
  • might be within actinic keratosis
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25
Q

RFs for squamous cell carcinoma

A
  • elderly males
  • sun exposure
  • actinic keratosis
  • smoking
  • immunosuppressing disease e.g. CLL, HIV, organ transplant
  • immunosuppresant drugs e.g. azathioprine, infliximab
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26
Q

Mx squamous cell carcinoma

A

1) excision
+ adjuncts for locally advanced / metastatic disease
- radiotherapy
- cemiplimab (PD-1 and PD-2 inhibitor)

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27
Q

Thromboangiitis obliterans / Buerger’s disease

A
  • inflammatory nonatherosclerotic peripheral vascular disease & limb ischaemia
  • young male smokers
  • angio: patchy occlusion distally, corkscrew collaterals
  • mx: stop smoking
28
Q

Necrobiosis lipoidica

A
  • usually on both shins and are rarely found in other sites
  • oval, round or irregular plaques
  • yellow / red and shiny
  • centre starts to become pale with telangiectasia
  • asymptomatic or painless
  • may ulcerate after injury
  • seen in insulin-dependent diabetes
  • mx: systemic steroids, immunosuppression
29
Q

Seborrhoeic keratosis

A
  • benign ageing spot
  • stuck on, brown, waxy appearance
  • Leser-Trélat sign: sudden appearance of several lesions suggests underlying cancer, usually GI
30
Q

Seborrhoeic dermatitis

A 
- malassezia furfur
greasy, scaly, oily patches / plaques
- affects face, nasolabial folds, scalp
- gets better with sun
- RFs: HIV, Parkinson's
- complications: blepharitis, otitis externa

Mx: topical ketoconazole +/- steroids

31
Q

Guttate psoriasis presentation

A
  • 1st presentation of psoriasis
  • OR flare of known psoriasis
  • classically few weeks post strep throat
  • tear trop scaly papules over trunk and limbs
  • rarely affects hands / feet
32
Q

Guttate psoriasis mx

A
  • usually self resolve in 2-3 months
  • topical agents as for psoriasis: emollients, topical steroid / vit D analogue, coal tar preparation
  • UVB phototherapy
  • tonsillectomy if recurrent
33
Q

Vitiligo mx

A
  • sun block
  • camouflage make-up
  • topical corticosteroids may reverse the changes if applied early
  • topical tacrolimus
  • phototherapy
34
Q

Basal cell carcinoma mx

A
  • surgical removal
  • curettage
  • cryotherapy
  • topical cream: imiquimod, fluorouracil
  • radiotherapy
35
Q

Scabies

A

1) 5% permethrin - apply to whole body, leave for 6 hours, repeat in 1 week. All household contacts to do the same
2) 0.5% malathion
Immunosuppressed with crusted scabies: isolate and ivermectin

36
Q

Bullous pemphigoid features

A
  • Itchy, tense blisters
  • usually spares mucosa
  • usually heals without scarring
37
Q

Bullous pemphigoid RFs

A
  • elderly
  • PD1 inhibitors e.g. pembrolizumab
  • furosemide
  • captopril
  • penicillin & other abx
  • sulfasalazine
38
Q

Bullos pemphigoid IX and MX

A

IX: skin biopsy - immunofluorescence shows IgG and C3 at the dermoepidermal junction

Mx:

  • emollients
  • topical steroids (if <10%)
  • systemic steroids
  • abx e.g. doxycycline
  • immunosuppression
39
Q

Erythroderma

A
  • any rash involving >95% skin

Typical causes

  • eczema
  • psoriasis
  • drugs e.g. gold
  • lymphomas, leukaemias
  • idiopathic
40
Q

Bowen’s disease

A

Intra-epithelial SCC - 3% risk of becoming invasive cancer

41
Q

Bowen’s disease mx

A
  • topical 5-fluorouracil or imiquimod
  • cryotherapy
  • excision
42
Q

Scalp psoriasis mx

A

1) 4 weeks topical steroid

2) Different formulation e.g. shampoo +/- agent to remove scale e.g. emollient, agent with salicylic acid

43
Q

Flexural / genitial psoriasis

A

1) 2 weeks max mild-mod potency topical steroid

44
Q

Pityriasis versicolor features

A
  • malassezia furfur
  • scaly hypopigmented patches, itchy
  • usually on trunk
  • RFs: immunosuppression, malnutrition, Cushing’s
45
Q

Pityriasis versicolor ix & mx

A
  • Ix:
  • skin scrapings
  • yellow/green under Wood’s lamp
  • Mx: ketoconazole topical -> oral itraconazole
46
Q

Stevens-Johnson Syndrome features

A
  • 1-4 weeks post drug exposure
  • maculopapular lesions, target lesions
  • my develop vesicles / bullae
  • Nikolsy sign
  • mucosal involvement
  • fever, arthralgia
47
Q

Stevens-Johnson Syndrome causes

A
  • penicillin
  • sulphonamides e.g. sulfamethoxazole in co-trimox
  • lamotrigine, carbamazepine, phenytoin
  • allopurinol
  • NSAIDs
  • combined oral contraceptive pill
48
Q

SJS / TEN overlap

A
  • <10% is SJS
  • 10-30% SJS/TEN overlap
  • > 30% is TEN
49
Q

Keratoacanthoma

A
  • benign epithelial tumour
  • fast growing
  • initially fleshy -> keratinised centre
  • following minor skin trauma OR areas of sun damaged skin
  • Mx: excise to exclude SCC
50
Q

Solar lentigo vs lentigo maligna

A
  • Lentigo maligna is more irregular

- can progress to lentigo maligna melanoma

51
Q

Lichen planus

A
  • purple, polygonal, pruritic, papules / plaques
  • oral lesions can occur
  • white line pattern over the surface ‘wickham’s striae’
  • koebner phenomenon
  • betablockers, thiazide diuretics, anti-malarials can precipitate

mx: topical steroids

52
Q

Causes of acanthosis nigricans

A
  • gastrointestinal cancer
  • diabetes, PCOS, obesity, Cushing’s disease
  • acromegaly, hypothyroidism
  • familial
  • Prader-Willi syndrome
  • drugs: oral contraceptive pill, nicotinic acid
53
Q

Chondrodermatitis nodularis helicis

A

Painful nodule on the ear

54
Q

Psoriasis management

A

ALL regular emollients

1) 4 weeks potent topical corticosteroid OD + OD vit D analogue
2) BD vit D analogue
3) BD potent corticosteroid OR coal-tar preparation

Phototherapy

1) narrow band UVB
2) Psoralen + UVA

Systemic therapy - failed above / can’t tolerate phototherapy / >10% body / severe uncontrolled sx with poor QoL

1) methotrexate
2) ciclosporin if intolerant / doesn’t work / want to conceive

Biologics
infliximab, etanercept and adalimumab
ustekinumab

55
Q

Palmar-plantar erythrodysesthesia

A
  • days to months into chemo treatment
  • tingling or numbness first in the fingers and palms and then toes and soles of the feet
  • followed by an erythematous rash which can desquamate, blister and ulcerate
  • mx: supportive or delay chemo
56
Q

Leukoplakia

A
  • white oral mucosal lesions similar to candida
  • can’t be rubbed off
  • hard
  • assoc HIV

Mx: ART if HIV

57
Q

Drugs causing photosensitive skin rashes

A
  • abx: tetracyclines, fluroquinolones, sulphonamides
  • NSAIDs
  • furosemide, bumetanide
  • sulphonylureas
  • neuroleptics e.g. chlorpromazine
  • antifungals e.g. terbinafine, itraconazole
  • amiodarone, diltiazem
58
Q

Mx photosensitive drug rash

A
  • discontinue
  • topical steroid
  • systemic steroid if severe
59
Q

Tinea features and management

A
  • annular lesion
  • alopecia if on scalp
  • ix: wood’s lamp fluorescence
  • mx
    1) ketoconazole cream
    2) oral itraconazole
    3) terbinafine PO
60
Q

Lichen planus mx

A

1) topical steroid
2) oral pred
Usually resolves in 6-18 months

61
Q

Erythema nodosum HLA linkage

A

B27

62
Q

Mx erythema nodosum

A

1) NSAIDs
2) topical K iodide
3) PO pred

63
Q

Treatment of male pattern hairloss in women

A

1) topical minoxidil

2) PO finasteride (antiandrogen)

64
Q

Acitretin and pregnancy

A

Avoid 4 weeks before starting

Avoid 3 years after completing

65
Q

Pyoderma gangrenosum mx

A

1) topical steroids
2) PO steroids
3) Immunosuppressants: ciclosporin, MMF, anti-TNF

66
Q

Discoid lupus

A
  • photosensitive dermatosis
  • 28% develop full SLE
    Mx
    1) sun block
    2) topical stroids
    3) hydroxychloroquine
    4) immunosuppressants
67
Q

Granuloma annulare

A

Circular lesion
Otherwise asymptomatic
Mx: months to self-resolve, otherwise topical steroids

MRCP part 2 (11 decks)

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