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Neuro and SS > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is a macule?

A

Flat, non-palpable change in skin colour, <0.5cm diameter

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2
Q

What is a patch?

A

Flat, non-palpable change in skin colour, >0.5cm diameter

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3
Q

What is a vesicle?

A

Fluid within upper layers of skin, <0.5cm diameter

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4
Q

What is a blister?

A

Fluid within upper layers of skin, >0.5cm diameter

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5
Q

What is a bulla?

A

Large fluid-filled lesion below epidermis, >10cm diameter

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6
Q

What is a pustule?

A

Visible collection of pus in subcutis

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7
Q

What is a nodule?

A

Mass or lump >0.5cm diameter

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8
Q

What is a callus?

A

Hyperplastic epidermis, often found on the soles,

palms + other areas of excessive use

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9
Q

What is a plaque?

A

Raised area >2cm diameter

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10
Q

What is a wheal?

A

Dermal oedema

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11
Q

What is a fissure?

A

Linear crack

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12
Q

What is an ulcer?

A

Full thickness skin loss

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13
Q

What is an excoriation?

A

Scratch mark

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14
Q

What is lichenification?

A

Thickening of epidermis with exaggerated skin marking usually due to repeated scratching

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15
Q

What are telangiectasia?

A

Easily visible superficial blood vessels

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16
Q

What is purpura?

A

Rash caused by blood in skin

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17
Q

What is petechia?

A

Micro-haemorrhage, 1-2mm diameter

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18
Q

What are some examples of hypopigmented or depigmented lesions?

A

Vitiligo
Pityriasis versicolor
Pityriasis alba

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19
Q

What are some examples of hyperpigmented lesions?

A 
Lentigos
Café-au-lait spots
Melasma (chloasma)
Melanocytic naevi
Seborrhoeic keratoses
Systemic diseases: Addison’s, haemochromatosis
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20
Q

What are some examples of ring shaped lesions?

A

BCC
Tinea (ringworm)
Granuloma annulare
Erythema multiforme

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21
Q

What are some examples of round/discoid lesions?

A 
Bowen’s disease
Discoid eczema
Psoriasis
Pityriasis rosea
Erythema migrans
Impetigo
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22
Q

What are some examples of linear lesions?

A

Kobner phenomenon: lesions related to skin injury
Dermatitis artefacta: lesions induced by pt
Herpes zoster
Scabies burrows

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23
Q

What dermatological conditions cause itchy lesions?

A

Scabies, urticaria, atopic eczema, dermatitis herpetiformis, lichen planus

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24
Q

What systemic diseases are associated with itchy lesions?

A

Iron def., lymphoma, hypo/hyperthyroidism, liver disease, CKD, polycythaemia, drugs (statins, ACEi, opiates)

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25
Q

How should vitiligo be managed?

A

Sun protection, cosmetic camo, topical steroids may induce repigmentation, phototherapy

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26
Q

What is pityriasis versicolor?

A

Superficial slightly scaly yeast infection

Appears hypopigmented on darker skin

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27
Q

What is pityriasis alba?

A

Post-eczema hypopigmentation, often on child’s face

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28
Q

What are lentigos?

A

Brown macules/patches that persist in winter, unlike freckles

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29
Q

Describe the appearance of seborrhoeic keratoses:

A

Benign greasy-brown warty lesions usually on back,
chest and face
Stuck on appearance

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30
Q

What are actinic (solar) keratoses?

A

Pre-malignant crumbly yellow-white scaly crusts on sun-exposed skin

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31
Q

What are some management options for actinic keratoses?

A

Observation
Topical 5-FU, imiquimod or diclofenac
Cryotherapy, photodynamic therapy
Surgical excision and curettage

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32
Q

What is Bowen’s disease?

A

Well-defined slowly enlarging red scaly plaque with flat edge
3-5% progress to SCC

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33
Q

What are some management options for Bowen’s disease?

A

Cryo, topical 5-FU or imiquimod,

photodynamic, curettage, excision

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34
Q

What is keratoacanthoma?

A

Smooth dome-shaped papule, rapidly grows to become a crater centrally

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35
Q

What is the management for keratoacanthoma?

A

Urgent excision

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36
Q

Describe the appearance of squamous cell carcinoma:

A

Persistently ulcerated or crusted firm irregular lesion often on sun-exposed sites

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37
Q

What factors increase the risk of metastasis in squamous cell carcinoma?

A

If on lip, ear or non-sun exposed site
>2cm
Poor differentiation
Immunosuppression

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38
Q

What is the management for squamous cell carcinoma?

A

Local complete excision with 4-6mm margin

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39
Q

Describe the appearance of nodular basal cell carcinoma:

A

Pearly nodule with rolled telangiectatic edge on face or sun-exposed site

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40
Q

Describe the appearance of superficial basal cell carcinoma:

A

Red, scaly plaques with raised smooth edge, often on trunk or shoulders

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41
Q

How should basal cell carcinoma be managed?

A

Excision

Can use cryo, curettage, RT, photodynamic, topical if superficial at low risk site

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42
Q

What cancers may metastasise to the skin?

A

Breast, stomach + colon, lung, genitourinary

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43
Q

What is leukoplakia? Who is it more common in?

A

Premalignant condition, white hard spots on mucous membrane of mouth
More common in smokers

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44
Q

What is mycosis fungoides?

A

Cutaneous T-cell lymphoma

Well-defined itchy red scaly plaques progressing to red-brown infiltrated plaques and ulcerating tumours

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45
Q

What is Fitzpatrick skin type I?

A

Pale white skin, blonde/red hair

Always burns, does not tan

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46
Q

What is Fitzpatrick skin type II?

A

Fair skin, blue eyes

Burns easily, tans poorly

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47
Q

What is Fitzpatrick skin type III?

A

Darker white skin

Tans after initial burn

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48
Q

What is Fitzpatrick skin type IV?

A

Light brown skin

Burns minimally, tans easily

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49
Q

What is Fitzpatrick skin type V?

A

Brown skin

Rarely burns, tans darkly easily

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50
Q

What is Fitzpatrick skin type VI?

A

Dark brown or black skin

Never burns, always tans darkly

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51
Q

What are some risk factors for malignant melanoma?

A

UV exposure, sunburn, fair complexion, >50 melanocytic or dysplastic naevi, FH, previous melanoma, age

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52
Q

What are some signs of malignant melanoma (ABCDEF)?

A 
Asymmetry in outline of lesion
Border irregularity
Colour variation
Diameter >6mm
Evolution (size, elevation, colour)
Funny looking mole, different from others/mole signature
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53
Q

What are the types of malignant melanoma?

A

Superficial spreading (70%)
Nodular (15%)
Acral lentiginous (10%)
Lentigo maligna melanoma (5%)

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54
Q

How should malignant melanoma be managed?

A

Excision biopsy with 2mm margin allowing for histological diagnosis and Breslow thickness
If MM confirmed, wider excision (up to 3cm) to
ensure complete removal and may do SNLB

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55
Q

How should metastatic melanoma be managed?

A

Palliation: chemo, biological, novel targeting therapy and ipilimumab

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56
Q

What is psoriasis?

A

Chronic inflammatory skin condition characterised by scaly erythematous plaques, typically relapsing remitting course

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57
Q

What are some triggers for psoriasis?

A

Stress, infections, skin trauma (Kobner), drugs (lithium, NSAIDs, beta blockers), withdrawal of systemic steroids

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58
Q

What are the types of psoriasis?

A 
Chronic plaque
Flexural
Guttate
Pustular
Generalised
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59
Q

Describe chronic plaque psoriasis:

A

Symmetrical well-defined red plaques with silvery scale on extensor aspects, scalp and sacrum

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60
Q

Describe guttate psoriasis:

A

Large numbers of small plaques <1cm (teardrop) over trunk and limbs, seen in young (esp. after acute strep infection), lasting 3-4m

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61
Q

What nail changes are associated with psoriaisis?

A

Pitting, onycholysis (separation from nail bed),

thickening, subungal hyperkeratosis

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62
Q

How should psoriatic arthropathy treated?

A

NSAIDs, DMARDs, anti-TNF

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63
Q

What are the management options for psoriasis?

A

Emollients
Topical corticosteroid and topical vit D
Phototherapy or systemic therapy if not controlled or if >10% body area affected

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64
Q

What are the side effects of phototherapy?

A

Increased risk of SCC, sunburn, dry skin, folliculitis, cold sores, polymorphic light eruption

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65
Q

What non-biologic oral drugs may be used in the management of psoriasis?

A

Methotrexate
Ciclosporin
Acitretin
Dimethyl fumarate and apremilast

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66
Q

What biologics may be used in the management of psoriasis and what is the MoA?

A

Inhibit T cell activation and function or neutralise cytokines
Infliximab, adalimumab, etanercept (anti-TNF), ustekinumab (interleukin inhibitor)

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67
Q

What are the diagnostic criteria for atopic eczema?

A

Child must have itchy skin with 3+ of:

  1. Onset before 2y
  2. Past flexural involvement
  3. History of generally dry skin
  4. Personal history of other atopy
  5. Visible flexural dermatitis or on cheeks/forehead if <4y
68
Q

What are the management options for atopic eczema?

A

Emollients: use liberally (3-4x/day)
Topical steroids for exacerbations
Treat secondary bacterial infection with oral Abx
Topical tacrolimus if not controlled
Azathioprine, ciclosporin or methotrexate if uncontrolled severe disease

69
Q

Describe adult seborrheic dermatitis:

A

Overgrowth of skin yeasts causes red, scaly rash affecting scalp (dandruff), eyebrows, nasolabial folds, cheeks and flexures

70
Q

How should adult seborrheic dermatitis be managed?

A

Scalp: OTC preps containing zinc pyrithione (Head + Shoulders)
Body: mild topical steroid/antifungal prep e.g. Daktacort or ketoconazole

71
Q

What can cause irritant dermatitis?

A

Detergents, soaps, oils, solvents, alkalis

72
Q

How should irritant dermatitis be managed?

A

Avoiding irritants, hand care with soap substitutes, emollients, careful drying and gloves

73
Q

What can cause allergic contact dermatitis?

A

Nickel (jewellery, watches), chromates (leather), lanolin, rubber, plants

74
Q

How can allergic contact dermatitis be managed?

A

Patch testing and avoidance of allergen, use topical

steroid based on severity

75
Q

What is an example of a mild topical steroid?

A

Hydrocortisone

76
Q

What is an example of a moderate topical steroid?

A

Eumovate (Clobetasone)

77
Q

What is an example of a potent steroid?

A

Betnovate (Betamethasone)

78
Q

What is an example of a very potent steroid?

A

Dermovate (Clobetasol)

79
Q

What are some side effects of topical steroids?

A

Skin thinning, irreversible striae, telangiectasia, worsening of untreated infection, contact dermatitis

80
Q

Approximately what area is covered by one fingertip unit of topical steroid?

A

Palmar surface of 2 adult hands

81
Q

What is the pathophysiology of acne vulgaris?

A

Basal keratinocyte proliferation in pilosebaceous follicles, ↑sebum production, Propionibacterium acnes colonisation, inflammation, comedones blocking secretions hence papules, nodules, cysts and scars

82
Q

Describe mild acne:

A

Mainly facial comedones

83
Q

What is the management for mild acne?

A

Topical BPO, topical retinoid e.g. isotretinoin or topical Abx alone

84
Q

Describe moderate acne:

A

Inflammatory lesions (papules and pustules)

85
Q

What is the management for moderate acne?

A

Topical BPO combined with Abx or topical retinoid (Epiduo)

Then lymecycline or erythromycin (pregnant or <12y), use for 3m with topical BPO

86
Q

Describe severe acne:

A

Nodules, cysts, scars and inflammatory papules or pustules

87
Q

What is the management for severe acne?

A

Oral isotretinoin

88
Q

What is rosacea?

A

Chronic relapsing/remitting disorder of BVs and

pilosebaceous units in central facial areas

89
Q

What can trigger rosacea?

A

Stress/blushing, alcohol and spices

90
Q

What are some signs of rosacea?

A

Central facial rash with erythema, telangiectasia,

papules, pustules, inflammatory nodules

91
Q

How should rosacea be managed (include mild + severe)?

A

Soap substitutes, avoid sun over-exposure, use sun-block
Mild: topical metronidazole or topical 15% azelaic acid gel
Moderate or severe: oral tetracycline for 4m

92
Q

Describe morbilliform drug eruption:

A

Generalised erythematous macules + papules often on trunk within 1-3w of drug exposure

93
Q

Describe urticaria drug reaction:

A

Itchy erythematous wheals appear rapidly after drug exposure ± angioedema/anaphylaxis

94
Q

Describe erythroderma (exfoliative dermatitis):

A

Widespread erythema and dermatitis affecting >90% body surface

95
Q

Describe Stevens-Johnson syndrome:

A

Painful erythematous macules evolving to form target lesions, severe mucosal ulceration of 2+ surfaces e.g.
conjunctiva, oral cavity, labia, urethra

96
Q

Describe toxic epidermal necrolysis:

A

Widespread painful dusky erythema then necrosis of

epidermis with mucosa severely affected

97
Q

What are some examples of drugs that can cause drug eruptions?

A

Sulphonamides, anti-epileptics, penicillins, NSAIDs, cephalosporins, allopurinol

98
Q

What skin signs can diabetes cause?

A

Flexural candidiasis, acanthosis nigricans, granuloma annulare, folliculitis

99
Q

What skin signs can lupus cause?

A

Facial butterfly rash, photosensitivity, diffuse alopecia, discoid lupus, livedo reticularis

100
Q

What skin signs can IBD cause?

A

Erythema nodosum, pyoderma gangrenosum

101
Q

How does erythema multiforme present?

A

Well defined target lesions on extensor surfaces of

peripheries

102
Q

What can cause erythema multiforme?

A

Herpes simplex (70%), mycoplasma, CMV, drugs.

103
Q

Describe erythema migrans:

A

Papule becomes spreading red ring lasting weeks to months (pathognomonic of Lyme disease)

104
Q

Describe livedo reticularis:

A

Non-blanching vague pink-blue mottling caused by capillary dilatation and stasis in skin venules, most often in legs

105
Q

Describe ringworm infection:

A

Round, scaly, itchy lesion with inflammed edge compared to centre

106
Q

How should ringworm infection be investigated?

A

Sending skin scrapings from active edge, scalp brushings or nail clippings for microscopy and culture

107
Q

How should ringworm infection be managed (include management for nail infection)?

A

Topical antifungal creams (terbinafine or imidazole) for 2w

If nail: oral terbinafine

108
Q

What is the management for candida?

A

Imidazole creams

109
Q

What is the management for pityriaisis versicolor?

A

Imidazole creams, ketoconazole shampoo

110
Q

What is onychomycosis?

A

Thickened, rough, opaque nails

Mainly due to Trichophyton rubrum

111
Q

When and how should onychomycosis be treated?

A

Only treat if symptomatic and use oral terbinafine for months

112
Q

What is impetigo?

A

Contagious superficial infection caused by S. aureus Lesions usually start around nose and face with honey coloured crusts on erythematous base

113
Q

How should impetigo be treated?

A

Hydrogen peroxide, topical fusidic acid or flucloxacillin if severe

114
Q

What is erysipelas?

A

Sharply defined superficial infection caused by S. pyogenes

115
Q

What are some signs of cellulitis?

A

Pain, swelling, erythema, systemic upset, lymphadenopathy

116
Q

How should cellulitis be managed?

A

Benpen IV + fluclox PO

117
Q

What is the cause of warts?

A

HPV in keratinocytes

118
Q

How should common warts be managed?

A

If painful or persisting can use topical salicylic acid, cryotherapy, duct tape occlusion

119
Q

How should genital warts be managed?

A

Observe, podophyllin/imiquimod cream, cryotherapy

120
Q

Describe the appearance of molluscum contagiosum:

A

Pink papules with umbilicated central punctum

121
Q

What is the cause of molluscum contagiosum?

A

Pox virus

122
Q

Describe herpes simplex infection:

A

Grouped painful vesicles on erythematous base

123
Q

When should shingles be treated with oral acyclovir?

A

If >50y, ophthalmic, severe, immunosuppressed

124
Q

What are some complications of herpes zoster infection?

A

Post-herpetic neuralgia, meningitis, encephalitis

125
Q

Describe the appearance of lichen planus:

A

Lesions are purple, pruritic, poly-angular, planar, papules

Can have white lines on surface (Wickham’s striae). Often on flexor aspects of wrists, forearms, ankle and legs

126
Q

How should lichen planus be managed?

A

Topical steroids

127
Q

Describe the appearance of pyogenic granuloma:

A

Fleshy moist red lesion which grows rapidly and bleeds easily

128
Q

How should pyogenic granuloma be managed?

A

Curettage

129
Q

Describe the appearance of pityriasis rosea:

A

Self-limiting rash preceded by herald patch (oval red scaly patch)

130
Q

Describe alopecia areata:

A

Smooth well-defined round patches of hair loss on

scalp, exclamation mark hairs

131
Q

What can cause scarring alopecia?

A

Lichen planus, discoid lupus, trauma, BCC, SCC

132
Q

What is the cause of bullous pemphigoid and how does it present?

A

IgG autoantibodies to BM

Tense blisters on inflammed or normal skin

133
Q

How should bullous pemphigoid be managed?

A

Very potent steroids (clobetasol), oral pred

134
Q

What is the cause of pemphigus vulgaris and how does it present?

A

IgG autoantibodies against desmosomal components which leads to acantholysis (keratinocytes separate from each other)
Mucosal ulceration, skin blistering

135
Q

How should pemphigus vulgaris be managed?

A

Treat with pred

Rituximab + IV Ig (if resistant)

136
Q

What is eczema herpeticum?

A

Severe primary infection often by HSV1/2

More common in children with atopic eczema

137
Q

How does eczema herpeticum present?

A

Rapidly progressing painful rash, monomorphic punched out erosions

138
Q

How should eczema herpeticum be managed?

A

Admit for IV acyclovir

139
Q

What can cause chondrodermatitis nodularis helicis?

A

Persistent pressure (sleep), trauma or cold

140
Q

How should chondrodermatitis nodularis helicis be managed?

A

Use ear protectors during sleep, cryo, steroid infection, collagen injection

141
Q

What is dermatitis herpetiformis?

A

Autoimmune blistering skin disorder associated with

coealic, deposition of IgA in dermis

142
Q

How does dermatitis herpetiformis present?

A

Itchy, vesicular skin lesions on extensor surfaces and buttocks

143
Q

How should dermatitis herpetiformis be managed?

A

Gluten free diet and dapsone

144
Q

What is erythema ab igne?

A

Reticulated, erythematous patches with hyperpigmentation and telangiectasia due to exposure to infrared radiation

145
Q

What is erythema nodosum?

A

Inflamm of subcut fat causes tender, erythematous, nodular lesions
Usually occurs over shins

146
Q

What are some causes of erythema nodosum?

A

Infection (strep, TB), sarcoid, IBD, malignancy, pregnancy

147
Q

Describe the appearance of pyoderma gangrenosum:

A

Small red papule -> deep, red, necrotic ulcer with violaceous border

148
Q

What are some causes of pyoderma gangrenosum?

A

Idiopathic (50%), IBD, RA, SLE, malignancy

149
Q

What is the cause of staphylococcal scalded skin syndrome?

A

Release of exotoxins by S. aureus

150
Q

How should staphylococcal scalded skin syndrome be managed?

A

IV Abx

151
Q

What are some common causes of skin ulcers?

A

Neuropathy
Vascular – venous (75%), arterial (10%), mixed (15%)
Trauma

152
Q

What are some risk factors for venous ulcers?

A

Varicose veins, DVT, venous insufficiency, poor calf muscle function, AV fistula, obesity, leg fracture

153
Q

How should venous ulcers be treated and what investigations must be performed before treatment?

A

Compression bandaging and occlusive dressings

Dopplers and ABPI to exclude arterial disease

154
Q

What are some risk factors for pressure ulcers?

A

Extremes of age, reduced mobility and sensation, vascular disease, chronic/terminal illness

155
Q

What are the 4 stages of pressure ulcers?

A

Stage I: non-blanching erythema over intact skin
Stage II: partial thickness skin loss
Stage III: full thickness skin loss, extending into fat
Stage IV: destruction of muscle, bone or tendon

156
Q

How should pressure ulcers be managed?

A

Pressure-relieving mattress and cushions, freq repositioning, modern dressing, debride dead tissue, negative pressure treatment

157
Q

How can pressure ulcers be prevented?

A

Initial and ongoing assessment, regular inspection of skin, minimise excess moisture, regular turning

158
Q

What is the cause of Kaposi’s sarcoma?

A

HHV-8

159
Q

How does Kaposi’s sarcoma present?

A

Purple patches or plaques on skin and mucosa of any organ

160
Q

What is the treatment for Kaposi’s sarcoma?

A

HAART, systemic interferon alfa or chemo, excision

161
Q

What are some signs of scabies infestation?

A

Very itchy papules, vesicles, pustules and nodules affecting finger webs, wrist flexures, axilla, abdo, buttocks and groins

162
Q

How should scabies be managed?

A

Treat all members of household and close contacts with permethrin 5% cream

163
Q

How should headlice be managed?

A

Malathion, dimeticone

Fine-toothed comb to remove lice and nits

164
Q

What is a papule?

A

Raised area <0.5cm diameter

165
Q

What are some side effects of oral isotretinoin?

A

Teratogen, skin and mucosal dryness, depression

Neuro and SS (5 decks)

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