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Year 3 diagnosis and management > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Most common skin malignancy?

A

Basal cell carcinoma

aka rodent ulcer

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2
Q

Main risk factor for BCC?

A

UV

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3
Q

Where is BCC most commonly found?

A
  • Scalp
  • Face
  • Ears
  • Trunk
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4
Q

Describe a BCC

A
  • Ulcerated central crater
  • Raised pearly edges
  • Fine telangiectasia over surface
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5
Q

How can burn injuries be subdivided?

A

Superficial epidermal (1st degree)

Partial thickness (2nd degree)
• Superficial
• Deep

Full thickness (3rd degree)

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6
Q

What does a superficial partial thickness burn look like, is it painful, and how long does it take to heal?

A
  • Red and oedematous
  • Painful
  • Heals in about 7 days with peeling of dead skin
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7
Q

What does a deep partial thickness burn look like, is it painful, and how long does it take to heal?

A
  • Blistering and mottling
  • Painful
  • Heals over 3 weeks, usually no scarring
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8
Q

What does a full thickness burn look like, is it painful, and how does it heal?

A
  • Destruction of epidermis and dermis
  • Charred leathery eschars
  • Firm and painless (loss of sensation)
  • Scarring or contractures - requires skin grafting
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9
Q

Investigations for burn injuries?

A
  1. Bloods - including carboxyhaemoglobin (high in inhalation injury), high urea, creatinine, glucose; low Na+ and K+
  • Wound biopsy
  • CK, urine myoglobin, ECG
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10
Q

What percentage of healthy adults and HIV positive people are carriers of candidiasis?

A

Healthy - 60%

HIV - 80%

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11
Q

What does oral thrush (pseudomembranous oral candidiasis) look like?

A
  • Curd-like white patches in the mouth
  • Removed easily revealing underlying red base
  • Most common in neonates
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12
Q

In whom is oesophageal candidiasis very common and what does it cause?

A
  • Most common cause of oesophagitis in HIV patients
  • AIDS-defining illness
  • Dyphagia
  • Odynophagia (painful swallowing)
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13
Q

Presentation of candidal skin infections?

A
  • Soreness and itching
  • Red, moist skin area
  • Ragged, peeling edge
  • Possible papules and pustules
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14
Q

Investigations for:
• oral candidiasis
• oesophageal candidiasis
• invasive candidiasis

A
  • Oral - superficial smear of lesion for microscopy / therapeutic antifungal trial
  • Oesophageal - endoscopy
  • Invasive - blood cultures
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15
Q

What is cellulitis and erysipelas?

A

Cellulitis - spreading infection of subcutaneous tissue (acute, non-purulent, overlying skin inflammation)

Erysipelas - superficial cellulitis (upper dermis and superficial cutaneous lymphatics)

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16
Q

Cause of cellulitis?

A

Streptococcus pyogenes

Staphylococcus aureus

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17
Q

Features of cellulitis (including periorbital and orbital)?

A
  • Commonly on shins
  • Erythema, pain, swelling
  • Fever

Periorbital - swollen eyelids, conjuctival infection

Orbital - proptosis (protrusion), impaired visual acuity and eye movements

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18
Q

Investigations for cellulitis and erysipelas?

A
  1. FBC - raised WCC
  2. Culture - if pustular

(CT sinus with contrast if peri-/orbital)

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19
Q

Management of cellulitis

A
  1. Flucloxacillin
  2. Severe - co-amoxiclav or cefuroxime

Peri-/orbital - hospital admission with IV antibiotics

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20
Q

What is eczema?

A

Pruritic papulovesicular skin reaction to endogenous (e.g. seborrheic) and exogenous (e.g. contact) agents

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21
Q

Where is eczema usually found?

A
  • Infants - face and trunk
  • Younger children - extensor surfaces
  • Older children - flexor surfaces, creases of face and neck
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22
Q

Signs of acute and chronic eczema?

A

Acute
• Poorly demarcated erythematous oedematous dry scaling patches
• Vesicles with exudation and crusting
• Excoriations marks

Chronic
• Skin lichenification
• Thickened epidermis
• Fissures
• Change in pigmentation
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23
Q

Outline atopic, seborrhoeic, dyshidrotic and herpecticum eczema

A
  • Atopic - mainly face and flexures
  • Seborrhoeic - yellow greasy scales on erythematous plaques
  • Dyshidrotic (pompholyx) - vesiculobullous eruption on palms and soles
  • Herpeticum - monomorphic punched-out erosions caused by HSV 1/2 or coxsackie, life-threatening for children
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24
Q

What are epidermoid and pilar cysts?

A

Sebaceous cysts
• Epidermoid - from epidermal cells
• Pilar - cells from hair follicles

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25
Q

What is erythema multiforme and what is the ‘severe form’ of it called (actually different entity)?

A
  • Acute hypersensitivity reaction of skin and mucous membranes
  • Stevens-Johnson syndrome - bullous lesions and necrotic ulcers
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26
Q

Features of erythema multiforme?

A
  • Target lesions
  • Vesicles
  • Initially back of hands/feet - spreads to torso
  • Upper limbs more common than lower limbs
  • Pruritus
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27
Q

Causes of erythema multiforme?

A

Most common - HSV

others: drugs, bacteria, connective tissue disease

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28
Q

Investigations for erythema multiforme?

A

Clinical but:
• Raised WCC
• HSV serology, varicella PCR, M pneumoniae serology
• CXR - exclude sarcoidosis / atypical pneumonia
• Immunofluorescence biopsy

29
Q

What is erythema nodosum?

A

Panniculitis (inflammation of subcutaneous fat) presenting as red or violet subcutaneous nodules

30
Q

Causes of erythema nodosum?

A
  • STREPTOCOCCI
  • TB
  • SARCOIDOSIS
  • IBD
  • Behcet’s
  • Drugs e.g. sulphonamides
  • Pregnancy
31
Q

Presentation of erythema nodosum?

A
  • Tender nodules on both shins
  • Occasionally on thighs or forearms
  • Lesions heal without scarring
  • Pyrexia
32
Q

Investigations for erythema nodosum?

A
  • FBC - raised WCC
  • Anti-streptolysin-O titre - elevated in strep. infection
  • Serum ACE - raised in sarcoidosis
  • Mantoux test - for TB
  • CXR - bilateral hilar adenopathy - sarcoidosis
33
Q

What does HSV do to cells?

A

Cytolysis of infected epithelial cells => vesicle formation

34
Q

Apart from classic symptoms, what other symptoms are there for HSV1?

A
  • Pharyngitis
  • Gingivostomatitis (might make eating painful)
  • Herpetic whitlow
35
Q

Symptoms of HSV2?

A
  • Painful blisters and rash in genital, perigenital and anal area
  • Dysuria
  • Fever
36
Q

Symptoms and signs of HSV keratoconjunctivitis?

A
  • Watering eyes
  • Photophobia

• Dendritic ulcer - better visualised with fluorescein

37
Q

Investigations for HSV?

A
  • Clinical

* Viral culture / PCR

38
Q

What is a lipoma?

A

Slow-growing, benign adipose tumour found in subcutaneous tissues

39
Q

Features of a lipoma?

A
  • Smooth
  • Mobile
  • Painless
  • Soft-doughy feel
40
Q

Investigations for lipoma?

A

Clinical

41
Q

What are the 4 types of melanoma (in order of incidence) and which is the most aggressive?

A

1) Superficial spreading
2) Nodular - most aggressive
3) Lentigo Maligna
4) Acral Lentiginous

42
Q

Where on the body and in whom are the 4 types of melanoma found?

A

Superficial spreading
• arms, legs, back, chest
• young people

Nodular
• Sun exposed skin, middle-aged people

Lentigo maligna
• chronically sun-exposed skin (usually face), older people

Acral Lentiginous
• nails, palms, soles
• African-Americans or Asians

43
Q

Appearance of the 4 types of melanoma?

A

Superficial spreading
• Growing pre-existing mole (naevus) - radial then vertical

Nodular
• Arises de novo
• red or black lump which bleeds or oozes - just vertical growth

Lentigo maligna
• Large flat lesions
• From pre-existing mole (naevus)

Acral Lentiginous
• Subungual (under nail) pigmentation - Hutchinson’s sign

44
Q

How is incidence of melanomas changing?

A

Increasing

45
Q

Criteria for examining moles/melanoma?

A 
ABCDE
• Asymmetry
• Border irregularity
• Colour variation
• Diameter > 6mm
• Elevation/evolution
46
Q

Investigations for melanoma?

A
  1. Dermatoscopy
  2. Skin biopsy - full-thickness excision
  3. Sentinel lymph node biopsy - metastasis
  4. CT chest, abdomen, pelvis - staging
  • Lymphoscintigraphy - traces lymph drainage
  • LFTs - metastasis
47
Q

What is molluscum contagiosum?

A

Common skin infection caused by pox virus (MCV) - spread by direct skin contact or indirectly via fomites e.g. towels

48
Q

Who does molluscum contagiosum mainly affect?

A
  • Children

* Immunocompromised

49
Q

Features of molluscum contagiosum?

A
  • Small pinkish/pearly white papules
  • Central umbilication
  • Lesions appear in clusters - commonly on trunk and flexures
  • Sexual contact areas in adults

(spontaneous resolution within 18 months)

50
Q

Investigations for molluscum contagiosum?

A

Clinical

H+E staining is definitive, HIV test if refractory

51
Q

Where do pressure sores most commonly occur?

A

Sacrum and heel

52
Q

What score is used to predict risk of pressure sores in patients?

A

Waterlow score

53
Q

What conditions is psoriasis likely to lead onto?

A

Arthritis and cardiovascular disease

54
Q 
Characteristics of the following:
• Plaque psoriasis
• Flexural psoriasis
• Guttate psoriasis
• Pustular psoriasis
A

Plaque (most common)
• Well demarcated red, scaly patches
• Extensor surfaces, sacrum and scalp

Flexural
• As above but smooth

Guttate psoriasis
• Transient rash trigerred by strep
• Multiple red, teardrop lesions

Pustular/palmo-plantar
• On palms and soles

55
Q

What is Auspitz and Koebner phenomenon in psoriasis?

A

Auspitz - pinpoint bleeding with removing scales

Koebner - skin lesions at sites of trauma

56
Q

What can trigger psoriasis, especially guttate psoriasis?

A
  • Trauma, alcohol, smoking, drugs, withdrawal of steroids, thyroid disease
  • Guttate - strep sore throat
57
Q

Nail signs of psoriasis?

A
  • Pitting
  • Onycholysis
  • Subungual hyperkeratosis
58
Q

Investigations for guttate and flexural psoriasis?

A

Guttate - anti-streptolysin-O titre, throat swab

Flexural - skin swabs to exclude candidiasis

59
Q

Squamous cell carcinoma is a malignancy of which cells?

A

Epidermal keratinocytes

60
Q

Risk factors for SCC?

A

Main: UV - leads to actinic keratosis

  • Immunosuppression - following renal transplant
  • Smoking
  • Xeroderma pigmentosum
61
Q

Presentation of SCC?

A
  • Ulcerated
  • Hyperkeratotic
  • Crusted
  • Recurrent bleeding - non-healing
  • Lips of smokers too
62
Q

Investigations for SCC?

A
  1. Biopsy
  2. FNA / lymph node biopsy
  3. CT/MRI/PET for staging
63
Q

Describe an urticaric rash

A
  • Central itchy white papule or plaque

* Surrounded by erythematous flare

64
Q

Timescales between acute and chronic urticaria?

A

Acute - symptoms develop quickly and resolve within 48 hours

Chronic - persists for > 6 weeks

65
Q

Define varicella zoster

A

Varicella - primery infection (chickenpox)

Zoster - reactivation in dorsal root ganglia (shingles)

66
Q

Presentation of varicella zoster

A

Chickenpox
• Prodromal fever
• Itchy rash on head/trunk then spreads
• Macular => papular => vesicular

Shingles
• Following stress
• Painful vesicular maculopapapular rash
• Dermatomal distribution

67
Q

Investigations for varicella zoster?

A

Clinical

• Immunosuppressed - do viral PCR, culture, immunofluorescence

68
Q

Management for varicella zoster?

A
  • Children (chickenpox) - treat symptoms
  • Adults - oral acyclovir
  • Pregnant / immunocompromised - IV acyclovir

Year 3 diagnosis and management (9 decks)

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