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Yr3 - GP > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Define pruritus

A

Itching

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2
Q

Define lesion

A

Area of altered skin

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3
Q

Define naevus

A

Localised malformation of tissue structure (mole)

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4
Q

Define comedone

A

Plug in sebaecous follicle containing altered sebum, bacteria and cellular debris
Can present as either open (blackhead) or closed (whitehead)

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5
Q

Define flexural

A

In body fold

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6
Q

Define Koebner phenomenon

A

Linear eruption arising at site of trauma

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7
Q

Define discrete

A

Individual lesions separated from each other

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8
Q

Define confluent

A

Lesions merging together

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9
Q

Define annular

A

Circle or ring

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10
Q

Define discoid/nummular

A

Coin shaped/round lesion

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11
Q

Define erythema

A

Redness which blanches on pressure

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12
Q

Define purpura

A

Red or purple colour which does not blanch on pressure

  • petechiae = small pinpoint macules
  • ecchymoses = larger bruise like patches
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13
Q

Define hypopigmentation

A

Areas of paler skin

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14
Q

Define depigmentation

A

White skin due to absence of melanin

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15
Q

Define hyperpigmentation

A

Darker skin

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16
Q

Define macule

A

Flat area of altered colour

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17
Q

Define patch

A

Larger flat area of altered colour or texture

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18
Q

Define papule

A

Solid raised lesion < 0.5cm in diameter

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19
Q

Define nodule

A

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

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20
Q

Define plaque

A

Palpable scaling raised lesion > 0.5cm in diameter

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21
Q

Define vesicle

A

Raised clear fluid-filled lesion < 0.5cm in diameter

Small blister

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22
Q

Define bulla

A

Raised clear fluid-filled lesion > 0.5cm in diameter

Large blister

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23
Q

Define pustule

A

Pus-containing lesion < 0.5cm in diameter

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24
Q

Define abscess

A

Localised accumulation of pus in the dermis or subcutaneous tissues

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25
Q

Define wheal

A

Transient raised lesion due to dermal oedema

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26
Q

Define boil

A

Staphylococcal infection around or within hair follicle

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27
Q

Define carbuncle

A

Staphylococcal infection of adjacent hair follicles

Multiple boils

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28
Q

Define excoriation

A

Loss of epidermis following trauma

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29
Q

Define lichenification

A

Well-defined roughening of skin with accentuation of skin markings

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30
Q

Define scales

A

Flakes of stratum corneum

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31
Q

Define crust

A

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

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32
Q

Define scar

A

New fibrous tissue which occurs post-wound healing a- - atrophic = thinning

  • hypertrophic = hyperproliferation within wound boundary
  • keloidal = hyperproliferation beyond wound boundary
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33
Q

Define ulcer

A

Loss of epidermis and dermis

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34
Q

Define fissue

A

Epidermal crack often due to excess dryness

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35
Q

Define striae

A

Linear areas which progress from purple to pink to white

- histopathological appearance of a scar

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36
Q

What are striae a/w?

A

Excessive steroid usage
Glucocorticoid production
Growth spurts
Pregnancy

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37
Q

Define alopecia

A

Loss of hair

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38
Q

Define hirsutism

A

Androgen-dependent hair growth in a female

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39
Q

Define hypertrichosis

A

Non-androgen dependent pattern of excessive hair growth

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40
Q

Define clubbing

A

Loss of angle between posterior nail fold and nail plate

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41
Q

What is clubbing associated with?

A

Suppurative lung disease
Cyanotic heart disease
Inflammatory bowel disease
Idiopathic

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42
Q

Define koilonychia

A

Spoon-shaped depression of nail plate

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43
Q

What is koilonychia a/w?

A

Iron-deficiency anaemia
Congenital
Idiopathic

44
Q

Define onycholysis

A

Seperation of distal end of nail plate from nail bed

45
Q

What is onycholysis a/w?

A

Trauma
Psoriasis
Fungal nail infection
Hyperthyroidism

46
Q

Define pitting

A

Punctate depression of nail plate

47
Q

What is nail pitting a/w?

A

Psoriasis
Eczema
Alopecia areata

48
Q

Define cellulitis

A

Spreading bacterial infection of skin

- involves deep subcutaneous tissue

49
Q

Define erysipelas

A

Acute superficial form of cellulitis

- involves dermis and upper subcutaneous tissue

50
Q

Causes of cellulitis

A

Streptococcus pyogenes

Staphylococcus aureus

51
Q

Risk factors for cellulitis

A 
Immunosuppression
Wounds
Leg ulcers
Toeweb intertrigo
Minor skin injury
52
Q

Presentation of cellulitis

A 
Most common in lower limbs
Local signs of inflammation
- tumor
- rubor
- calor
- dolor
Systemically unwell with fever, malaise or rigors
53
Q

Management of cellulitis

A

Antibiotics - flucloxacillin or benzylpenicillin

Supportive care - rest, leg elevation, sterile dressings and analgessia

54
Q

Complications of cellulitis

A

Local necrosis
Abscess
Septicaemia

55
Q

Define staphylococcal scaled skin syndrome

A

Serious skin infection caused by staphylococcus aureus

Red blistering skin - looks like burn/scald

56
Q

Causes of SSSS

A

Production of circulating epidermolytic toxin from phage group II, benzylpenicillin resistant (coagulase positive) staphylococci

57
Q

Presentation of SSSS

A

Commonly seen in infancy and early childhood
Develops within few hours to few days
Worse over face, neck, axillae and groins
Scald-like appearance followed by large flaccid bulla
Perioral crusting
Intraepidermal blistering
Painful

58
Q

Management of SSSS

A

Antibiotics - erythromycin

Analgesia

59
Q

Cause of superficial fungal infections

A

Dermatophytes - tinea/ringworm
Yeasts - candidiasis, malassezia
Moulds - aspergillus

60
Q

Define tinea corporis

A

Tinea infection of trunk and limbs

Itchy, circular or annular lesions with clearly define, raised and scaly edge

61
Q

Define tinea cruris

A

Tinea infection of the groin and natal cleft

62
Q

Define tinea pedis

A

Athlete’s foot

Moist scaling and fissuring in toewebs, spreading to sole and dorsal aspect of foot

63
Q

Define tinea capitis

A

Scalp ringworm

Patches of broken hair, scaling and inflammation

64
Q

Define candidiasis

A

Candidial skin infection

White plaques on mucosal areas, erythema with satellite lesions in flexures

65
Q

Treatment of superficial fungal infections

A

Establish correct diagnosis - skin scrapings, hair or nail clippings or skin swabs
Treat know precipitating factors
Topical antifungal agents - terbinafine cream
Oral antifungal for severe - itraconazole
Avoid topical steriods

66
Q

Describe squamous cell carcinoma

A

Locally invasive malignant tumour of epidermal keratinocytes or appendages
Potential to metastasise

67
Q

Risk factors of squamous cell carcinoma

A

Excessive UV exposure
Pre-malignant skin conditions - actinic keratoses
Chronic inflammation - leg ulcers, wound scars
Immunosuppression
Genetic

68
Q

Presentation of squamous cell carcinoma

A

Keratotic (scaly, crusty), ill-defined nodule which may ulcerate

69
Q

Management of squamous cell carcinoma

A

Surgical excision
Mohs micrographic surgery - ill-defined, large, recurrent
Radiotherapy - large, non-resectable tumours

70
Q

Describe malignant melanoma

A

Invasive tumour of epidermal melanocytes

Potential to metastasise

71
Q

Risk factors for malignant melanoma

A

Excessive UV exposure - always burns never tans
History of multiple moles or atypical moles
FH
PH

72
Q

Presentation of malignant melanoma

A 
Asymmetrical shape
Border irregularity
Colour irregularity
Diameter > 6mm
Evolution of lesion 
Symptoms - bleeding, itching
More common on legs in women and trunk in men
73
Q

Types of malignant melanoma

A

Superficial spreading
- common on lower limbs, in young and middle age
- related to intermittent high-intensity UV exposure
Nodular melanoma
- common on trunk, in young and middle aged adults
- related to intermittent high-intensity UV exposure
Lentigo maligna melanoma
- common on face, in elderly population
- related to long-term cumulative UV exposure
Acral lentiginous melanoma
- common on palms, coles and nail beds, elderly population
- no clear relation to UV exposure

74
Q

Management of malignant melanoma

A

Surgical excision - definitive treatment
Radiotherapy
Chemotherapy - metastatic disease

75
Q

Functions of normal skin

A 
Protective barrier against the environment
Temperature regulation
Sensation
Vitamin D synthesis
Immunosurveillance
Appearance/cosmesis
76
Q

Function of main cell types in the epidermis

A

Keratinocytes - produce keratin as a protective barrier
Langerhan’s cells - present antigens and activate T-lymphocytes for immune protection
Melanocytes - produce melanin - gives pigment to skin and protects cell nuclei from UV radiation induced DNA damage
Merkel cells - contain specialised nerve endings for sensation

77
Q

Layes of the epidermis

A

Stratum basale - actively dividing cells - deepest layer
Stratum spinosum - differentiating cells
Stratum granulosum - cells lose nuclei and contain granules of keratohyaline - secrete lipids into intracellular spaces
Stratum corneum - layer of keratin - most superficial

78
Q

Types of sweat glands

A

Eccrine - universally distributed
Apocrine - found in axillae, areolae, genitalia and anus
- function only from puberty onwards

79
Q

Stages of wound healing

A

Haemostatsis
- vasocontriction and platelet aggregation
- clot formation
Inflammation
- vasodilation
- migration of neutrophils and macrophages
- phagocytosis of cellular debris and invading bacteria
Proliferation
- granulation tissue formation and angiogenesis
- re-epilelialisation
Remodelling
- collagen fibre re-organisation
- scar maturation

80
Q

Define atopic eczema

A

Characterised by papules and vesicles on an erythematous base
Atopic eczema - most common
- usually develops by early childhood and resolves during teenage years

81
Q

Causes of atopic eczema

A

Not fully understood
Commonly positive FH of atopy
Primary genetic defect in skin barrier function

82
Q

Exacerbating factors of atopic eczema

A 
Infections
Allergens - chemicals, food, dust, pet fur
Sweating
Heat
Severe stress
83
Q

Presentation of atopic eczema

A

Commonly presents as itchy, erythematous dry scaly patches
More common on face and extensor aspects of limbs in infants and flexor aspects in children and adults
Acute lesions are erythematous, vestibular and weepy
Chronic scratching/rubbing can lead to excoriations and lichenification

84
Q

Management of atopic eczema

A

General measures
- avoid exacerbating agens
- frequent emollients/bandages/bath oil or soap substitute
Topical therapies
- topical steriods for use in flare-ups
- topical immunomodulators as steriod sparing
Oral therapies
- antihistamines for symptomatic relief
- antibiotics for secondary bacterial infections
- antivirals for secondary herpes infections
Phototherapy and immunosuppressants for severe non-responsive cases

85
Q

Complications of atopic eczema

A

Secondary bacterial infection - crusted weepy lesion

Secondary viral infection - pearly papules with central umbilications, viral warts

86
Q

Define acne vulgaris

A

Inflammatory disease of the pilosebaceous follicle

87
Q

Causes of acne vulgaris

A

Hormonal - androgen

88
Q

Contributing factors of acne vulgaris

A

Increased sebum production
Abnormal follicular keratinization
Bacterial colonisation
Inflammation

89
Q

Presentation of acne vulgaris

A

Mild acne - non-inflammatory lesions
- open and closed comedones (black and whiteheads)
Moderate and severe acne - inflammatory lesions
- papules, pustules, nodules and cysts
Commonly affects face, chest and upper back

90
Q

Management of acne vulgaris

A 
General measures
- no specific food identified
- treatment needs to be continues for at least 6 weeks to produce effect
Topical therapies
- benzoyl peroxide
- topical antibiotics
- topical retinoids
Oral therapies
- antibiotics
- anti-androgens (female)
Oral retinoids
91
Q

Complications of acne vulgaris

A

Post-inflammatory hyperpigmentation
Scarring
Deformity
Psychological and social effects

92
Q

Define psoriasis

A

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

93
Q

Types of psoriasis

A 
Chronic plaque - most common
Guttate - raindrop lesions
Seborrhoeic - naso-labial and retro-auricular
Flexural - body folds
Pustular - palmar-plantar
ERythrodermic - total body redness
94
Q

Causes of psoriasis

A

Complex interaction between genetic, immunological and enviromental factors

95
Q

Precipitating causes of psoriasis

A 
Trauma
Infection - tonsillitis
Drugs
Stress
Alcohol
96
Q

Presentation of psoriasis

A

Well-demarcated erythematous scaly plaques
Lesions can be itchy, burning or painful
Common on extensor surfaces of body and over scalp
Auspitz sign - scratch and gentle removal of scales causes capillary bleeding
50% -> nail changes - pitting, onycholysis
5-8% -> psoriatic arthropathy

97
Q

Management of psoriasis

A 
General measures
- avoid known precipitating factors
- emolients to reduce scales
Topical therapies
- vitamin D analogues
- corticosteriods
- coal tar preparations
- dithranol
- retinoids
- keratolytics
- scalp preparations
Phototherapy
Oral
- methotrexate
- retinoids
- ciclosporin
- mycophenolate mofetil
- fumaris acid esters
- biological agents - infliximab
98
Q

Complications of psoriasis

A

Erythroderma

Psychological and social effects

99
Q

Causes of urticaria, angioedema and anaphylaxis

A 
Idiopathic 
Food
 - nuts
- sesame seeds
- shellfish
- dairy
Drugs
- penicillin
- contrast media
- NSAIDs
- morphine
- ACE-i
Insect bites
Contact
- latex
Viral or parasitic infections
Autoimmune
Hereditary
100
Q

Describe urticaria

A

Due to local increase in permeability of capillaries and small venules
Large number of inflammatory mediators play a role but histamine derived from skin mast cells = major
Local mediator release from mast cells can be induced by immunological or non-immunological mechanisms

101
Q

Presentation of urticaria

A

Swelling involving superficial dermis, raising dermis

Itchy wheals

102
Q

Presentation of angioedema

A

Deeper swelling involving dermis and subcut tissues

Swelling of tongue and lips

103
Q

Presentation of anaphylaxis

A

Bronchospasm
Facial and laryngeal oedema
Hypotension
Can initially present as urticaria and angioedema

104
Q

Management of urticaria, angioedema and anaphylaxis

A

Antihistamines - urticaria
Corticosteroids - severe acute urticaria and angioedema
Adrenaline, corticosteriods and antihistamines for anaphylaxis

105
Q

Complications of urticaria, angioedema and anaphylaxis

A 
Urticaria is normally uncomplicated
Angioedema and anaphylaxis can lead to 
- asphyxia
- cardiac arrest
- death

Yr3 - GP (8 decks)

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