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taz year 3 gp > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Describe the four skin types

A

I - Always Burns, Never Tans
II - Always Burns, Sometimes Tans
III - Sometimes Burns, Always Tans
IV - Never Burns, Always Tans

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2
Q

Using the mnemonic SCAM - how would you describe an individual lesion?

A

Size (and shape)
Colour
Associated secondary change
Morphology (and margin)

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3
Q

Using the mnemonic ABCD - how would you describe a pigmented lesion?

A

Asymmetry
(Irregular) Border
Colour (two or more)
Diameter (>6mm)

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4
Q

Define: Lesion, Rash, Naevus, Comedone

A

Lesion - area of altered skin
Rash - an eruption
Naevus - Localised malformation of tissue, commonly pigmented
Comedone - blocked hair follicle/pore containing altered sebum/bacteria and cellular debris. Can be open (blackheads) or closed (whitehads)

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5
Q

What is the Koebner Phenomenon in dermatological distribution?

A

Linear eruption

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6
Q

Define the following Dermatological Configuration terms: Discrete, Confluent, Target, Annular, Discoid

A 
Discrete - Separate Lesions
Confluent - Lesions merging together
Target - Concentric rings like a dartboard
Annular - Circle/Ring (like ringworm)
Discoid - Coin shaped
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7
Q

Describe Erythema

A

Redness due to inflammation and vasodilation, that blanches under pressure

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8
Q

Describe Purpura

A

Red/Purple discolouration due to bleeding into skin/mucous membrane that does not blanch with pressure
Can be Petichae (small pinpoint) or Ecchymoses (large bruise)

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9
Q

What is the difference between Hypopigmentation and Depigmentation?

A

Hypopigmentation - areas of paler skin (eg Pityriasis Versicolor)
Depigmentation - White skin due to lack of melanin (eg Vitiligo)

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10
Q

Define the morphological terms: Macule, Patch and Plaque

A

Macule - flat area of altered colour (freckles)
Patch - larger flat area of altered colour
Plaque - Palpable scaling raised lesion>0.5cm in diameter

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11
Q

Define the morphological terms: Papule and Nodule

A

Papule - Solid raised lesion <0.5cm (eg Xanthomata)

Nodule - Solid raised lesion >0.5cm

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12
Q

Define the morphological terms: Vesicle and Bullae

A

Vesicle - Raised clear fluid filled lesion <0.5cm

Bullae - Raised clear fluid filled lesion>0.5cm

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13
Q

Define the morphological terms: Pustule and Abscess

A

Pustule - Pus containing lesion<0.5cm in diameter

Abscess - Localised accumulation of pus in dermis or subcut tissue

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14
Q

Define the morphological terms: Wheal, Furuncle, Carbuncle

A

Wheal - Transient raised lesion due to dermal oedema
Furuncle - Staph infection in or around a hair follicle
Carbuncle - Staph infection around adjacent follicle

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15
Q

Define: Excoriation, Lichenification and Scaling

A

Excoriation - loss of epidermis following trauma
Lichenification - well defined roughening of skin with accentuation of skin markings
Scaling - Flakes of Stratum Corneum

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16
Q

Describe three different scar complications

A

Atrophic - thinning
Hypertrophic - Hyperproliferation within wound boundaries
Keloidal - Hyperproliferation beyond wound boundary

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17
Q

Define Ulcer and Fissure

A

Ulcer - Loss of dermis and epidermis

Fissure - Epidermal crack due to excess dryness

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18
Q

What is Hypertrichosis?

A

Non androgen dependent pattern of hair growth

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19
Q

Define: Koilonychia, Oncholysis, Pitting

A

Koilonychia - Spoon depression of nail plate
Oncholysis - Separation of distail nail from nail bed (psoriasis, fungal nail function)
Pitting - Depression in nail plate (psoriasis, eczema)

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20
Q

Describe the four different special cells of the skin

A

Keratinocytes (protective barrier)
Langerhans (immunological)
Melanocytes (protects cell nuclei from UV)
Merkel Cells (specialised nerve endings for sensation)

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21
Q

Describe the four main layers of the epidermis

A

Stratum Corneum - Keratin
Stratum Granulosum
Stratum Spinosum - Prickle Cell
Stratum Basale - Actively dividing cells

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22
Q

What is the ‘extra’ layer of the epidermis and where is it found?

A

Stratum Lucidum - Paler compact keratin

In areas of ‘thick skin’ (eg soles of feet)

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23
Q

Describe the composition of the Dermis

A

Made collagen/elastin/GAGs

Contains immune cells, nerves, lymphatics and blood supply

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24
Q

What are the three main types of hair?

A

Lanugo - Fine long hair in foetus
Vellus - Fine short hair on body’s surface
Terminal - Coarse long hair on scalp/eyebrows/eyelashes

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25
Q

What are Sebaceous Glands?

A

Produce sebum via hair follicles
Lubricates and waterproofs skin
Stimulated by androgens

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26
Q

What are Sweat Glands? State the two types.

A

Innervated by sympathetic nervous system
Eccrine - Universally distributed in skin
Apocrine - located in axilla and genitalia etc and function from puberty onswards

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27
Q

Describe the pathophysiology of Urticaria

A

Mast cell releases mediators causing locally increased permeability of capillaries and venules
Involves only epidermis

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28
Q

How would you manage Urticaria?

A

Antihistamines

Corticosteroids if severe

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29
Q

What is Angio-Oedema? How would you manage it?

A

Swelling of epidermis AND dermis

Managed by corticosteroids

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30
Q

Describe Hereditary Angio-Oedema

A

Autosomal dominant deficiency of C1 esterase inhibitor (which normally aims to prevent reactviation of compliment system)
Causes recurrent swelling
Treated by C1 Esterase Inhibitor Concentrate (found in FFP)

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31
Q

What is Anaphylaxis?

A

Bronchospasm, facial and laryngeal oedema

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32
Q

How would you manage Anaphylaxis?

A

Adrenaline, Corticosteroids and Antihistamines

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33
Q

What is Erythema Nodosum? Give 4 causes

A

Hypersensitivty reaction to a variety of stimuli causing inflammation of fat cells under skin
Strep Pyogenes, TB, Malignancy, IBD

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34
Q

How does Erythema Nodosum present?

A

Tender nodules usually on shins , after 2 weeks leave bruise like discolouration as they resolve
50% may experience arthralgia or morning stiffness

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35
Q

How do you manage Erythema Nodosum

A

Generally self limiting
Cool compresses and bed rest
NSAIDs
Treat underlying cause

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36
Q

Over 50% of Erythema Multiforme is caused by HSVI and HSVII, give a non infective cause

A

Drugs - Barbiturates, Penicillins, Sulfonamides, NSAIDs

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37
Q

Describe the presentation of Erythema Multiforme

A

Rash begins on extremities, symmetrically

Initially a dull red macule that develops a central papule/bullae to form a target lesion

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38
Q

How would you manage Erythema Multiforme?

A

Self Limiting

Analgesics and Steroid Creams

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39
Q

What is Steven Johnson’s Syndrome?

A

A severe form of Erythema Multiforme, caused by hypersensitivity reaction normally to drugs such as Allopurinol/Carbemazepine/Penicillins

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40
Q

How might Steven Johnson Syndrome present?

A

May have a prodromal phase
Mucocutaneous Lesions (Erythema Multiforme)
May have other organ involvement (Dysuria, Conjunctivitis, Mouth Ulcers)

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41
Q

Describe four different managements for Steven Johnson Syndrome

A

Remove offending cause
Supportive
Immunomodulation (potentially pulsed steroids to avoid poor wound healing)
Plasmphoresis

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42
Q

What is SCORTEN?

A

Predicts mortality for Steven Johnson Syndrome

Score greater than 3 requires ITU

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43
Q

What is Erythroderma? Give four causes.

A

Exfoliative dermatitis involving atleast 90% skin’s surface

Previous skin disease, Lymphoma, Drugs (Penicillin, Allopurinol), Idiopathic

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44
Q

How might Erythroderma present?

A

Skin appears inflamed, oedematous and scaly

Pt feels systemically unwell with malaise and lymphadenopathy

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45
Q

How would you manage Erythroderma? Give 3 complications.

A

Emollients and wet wraps to maintain skin’s moisture
Topical steroids

Hypothermia, Secondafry Infection, High Output Heart Failure

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46
Q

What is Eczema Herpeticum?

A

Rare and serious skin infection caused by Herpes Simlex Virus
Many possible complications so treated as an emergency

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47
Q

How does Eczema Herpeticum present? How would you manage it?

A

Systemically unwell with extensive crusted papules/blisters/erosions
Antivirals (Acyclovir)

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48
Q

What is Necrotising Fasciitis?

A

Rapidly progressing infection of the deep fascia causing necrosis of subcutaneous tissue

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49
Q

How does Necrotising Fasciitis present?

A

Severe pain, Erythema, Tachycardia, Crepitus (Subcutaneous Emphysema)

50
Q

How would you manage Necrotising Fasciitis?

A

Extensive Surgical Debridement

IV Antibiotics

51
Q

Define Cellulitis

A

Spreading bacterial infection of the skin involving the deep subcutaneous tissue and dermis

52
Q

What is the difference between Cellulitis and Erysipelas?

A

Erysipelas is a more superficial form

Erysipelas has more sharply demarcated borders than Cellulitis

53
Q

Give 5 risk factors for Cellulitis/Erysipelas

A 
IVDU
Elderly
Venous Insuffiency
Lymphoedema
Alcoholism
54
Q

Erysipelas is mainly caused by Strep Pyrogenes, name the causative organisms of Cellulitis.

A

Staph Aureus

Post Op - Strep Pyogenes, Closdtrodium Perfringes (crepitus)

55
Q

How would you manage Cellulitis/Erysipelas?

A

Rest, Elevation and Analgesia
Uncomplicated - Flucloxacillin 500mg QTS
Facial Involvement - Co _ Amoxiclav

56
Q

What is Staphylococcal Scalded Syndrome?

A

Scald appearance seen in infancy and early childhood

Caused by epidermolytic strain of toxigenic STaph Aureus

57
Q

How might Staphylococcal Scalded Syndrome present?

A

Scald appearance followed by large bullae
Painful lesions
Lesions on buttocks/hands/feet/face

58
Q

How would you manage Staphylococcal Scalded Syndrome?

A

Flucloxacillin (or Vancomycin for MRSA)
Analgesia
Petroleum Jelly

59
Q

Describe Tinea Corporis and Tinea Cruris

A

Corporis - Fungal infection of Trunk/Limbs, ittchy circular lesions with raised edges
Cruris - same as corporis but in groin and natal cleft

60
Q

Describe Tinea Manuum and Tinea Pedis

A

Tinea Manuum - Fungal infection of hands
Tinea Pedis - Athlete’s Foot
Scaling and fissuring dryness

61
Q

Describe Tinea Capitus and Tinea Unguium

A

Capitis - Scalp Ringworm (patches of broken hair, scaling and infammation)
Unguium - Fungal infection of the nail causing yellowed discoloration/thickened/crumbly nail

62
Q

What is Tinea Incognito?

A

Due to inappropriate treatment of fungal infection with steroid creams
Ill defined and less scaly

63
Q

What is Ptyriasis/ Tinea Versicolor?

A

Cutaneous infection with the yeast Malassezia

Causes scaly brown patches on upper trunk that fail to tan on sun exposure

64
Q

How would you manage fungal skin infections?

A

Topical treatment - Terbinafine cream

If severe - Oral antifungals such as Itraconazole

65
Q

State the two non melanoma skin cancers

A

Basal Cell Carcinoma

Squamous Cell Carcinoma

66
Q

Give 3 risk factors of skin cancer

A

Age
UV exposure
Type I skin

67
Q

Describe the presentation of nodular BCC (TURP)

A

T- Telangiectasia
U- Ulceration
R- Rolled Edges
P- Pearly

68
Q

What is Squamous Cell Carcinoma?

A

Locally invasive malignant tumour of keratinocytes with the ability to metastasise

69
Q

Name 3 pre malignant conditions that are a risk factor for SCC?

A

Actinic Keratoses (ie sun spots)
Bowens Disease
Leukoplakia

70
Q

How do Squamous Cell Carcinomas present?

A

Keratotic
Ill defined
Potentially ulcerating

71
Q

Describe four managements of Skin Cancer

A

Surgical Excision
Radiotherapy
Cryotherapy/Cautery
Mohs Micrographic Surgery

72
Q

What is Mohs Micrographic Surgery

A

Borders progressively excised until free of tumour microscopically
Good for cosmetically sensitive areas

73
Q

What is a Malignant Melanoma?

A

Invasive malignant tumour of epidermal melanocytes with the ability to metastasise

74
Q

Describe the four types of Malignant Melanoma

A

Superficial Spreading - common on lower limbs
Nodular Melanoma - Common on trunk
Lentigo Maligna Melanoma - common on face in elderly due to long term cumulative exposure
Acral Lentigous Melanoma - Palms, soles and nail beds

75
Q

What is the Breslow Thickness?

A

The risk of recurrence of Malignant Melanoma

The thicker the melanoma the higher the risk

76
Q

Describe the presentation of Atopic Eczema

A

Usually develops in childhood and resolves during adulthood

Itchy erythematous dry scaly patches normally on flexor aspects (but can be on face and extensor aspects in infants

77
Q

Give 3 other dermatological features of atopic eczema

A

Excoriation
Lichenification
Nail pitting

78
Q

Name two conservative managements of Eczema

A 
Avoid triggers (such as wool/synthetic fibres and extremes of temperature)
Frequent emollients
79
Q

Give 3 pharmacological managements for Eczema

A

Topical Therapies - topical steroids (for flares) or topical immunomodulators (tacrolimus)
Oral therapies - antihistamines
Immunosupressants for severe non responsive cases

80
Q

State three secondary viral infectons of Eczema

A

Molluscum Contagiosum
Viral Warts
Eczema Herpeticum

81
Q

What is Acne Vulgaris?

A

Inflammatory disease of pilosebaceous follicles

Due to androgens there is increased sebum production which subsequently causes them to become blocked

82
Q

What is Propionibacterium Acne?

A

Bacterial colonisation and inflammation of sebaceous glands

83
Q

Acne Vulgaris can be non inflammatory or inflammatory . Describe the appearance of both

A

Non Inflammatory - Open and closed comedones

Inflammatory - Papules/postules/nodules/cysts

84
Q

Describe three topical therapies for Acne Vulgaris

A

Benzoyl Peroxide - reduces sebum production and growth of P.Acnes (may cause burning sensation)
Topical Abx - Clindamycin/Tetracycline (normally combined with another therapy)
Topical Retinoids - Tretinoin, anti inflammatory (contraindicated in pregnancy)

85
Q

How long do systemic treatments for Acne take to work?

A

3-4 months

86
Q

Describe three oral treatments for Acne

A

Doxycycline
Anti-Androgens - COCP
Oral Isotretinoin (VERY TOXIC)

87
Q

What is Psoriasis?

A

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

88
Q

Describe the pathophysiology of Psoriasis

A

Injury/infection increases pro-inflammatory markers such as IL6 and TNF
APC activated which then activate TH1 and TH17
Abnormal keratinocyte differentiation (decreasing keratinocyte transit time)

89
Q

State four subtypes of Psoriasis

A

Chronic Plaque (most common)
Guttate (raindrop lesions)
Seborrhoeic (scalp and behind ears)
Pustular (plantar, palmar)

90
Q

How does Psoriasis present? Describe two extra-epidermal manifestations.

A 
Well demarcated erythematous scaly plaques, common on extensor surfaces and scalp
Nail changes (pitting,oncholysis) and Psoriatic Arthropathy
91
Q

What is Auspitz Sign?

A

Scratch and gentle scale removal causes capillary bleeding in Psoriasis

92
Q

Describe two oral and two topical therapies for Psoriasis

A

Topical - Vitamin D Analogues, Topical Steroids

Oral - Methotrexate, Retnoids

93
Q

Name a complication of Psoriasis

A

Erythroderma

94
Q

What determines blister fragility?

A

Depends on the level of split within the skin
More fragile - intraepidermal
Less fragile - subepidermal

95
Q

What is Bullous Pemphigoid?

A

Immunobullous blistering (subepidermal) condition usually affecting the elderly

96
Q

How will Bullous Pemphigoid present?

A

Tense fluid filled blisters on an erythematous base, often itchy
Normally affects trunk or limbs

97
Q

How do you manage Bullous Pemphigoid?

A

Topical steroids for local disease

Oral therapies for widespread (steroids, tetracycline)

98
Q

What is Pemphigus Vulgaris?

A

Immunobullous blistering (intraepidermal) condition usually affecting the middle aged

99
Q

How will Pemphigus Vulgaris present?

A

Flaccid and easily ruptured blisters, often painful and affecting mucosal areas

100
Q

How would you manage Pemphigus Vulgaris?

A

High dose steroids

Immunosupressants

101
Q

Scabies is an itchy rash caused by a parasitic mite, give four risk factors.

A

Overcrowding
Poverty
Homelessness
Poor Hygiene

102
Q

How does Scabies present?

A 
Signs and symptoms don't develop for 3-4 weeks
Widespread itching (worse at night and when warm)
Papular/Vesicular lesions at burrow sites
103
Q

How do you investigate Scabies?

A

Usually just clinical

Ink Burrow Test - Ink rubbed over burrow and wiped with an alcohol wipe, ink should track the burrow sites

104
Q

Describe four management points for Scabies

A

All close contacts should be treated on the same day to avoid reinfestation
Topical Parasiticidal Cream (Permethrin) applied head to toe once a week
Wash clothes/towels/bedding
Antihistamines for itching

105
Q

How does Senile Purpura present?

A

Elderly population with sun damaged skin

Extensor surfaces of hands and forearms

106
Q

Describe the presentation of a Venous Ulcer (including common sites)

A

Large shallow and irregular usually in malleolar area
Exudative and granulating base
Pain on standing

107
Q

How would you manage a Venous Ulcer?

A

Compression bandaging

108
Q

Describe the presentation of an Arterial Ulcer (including common sites)

A

Small and sharply defined with a deep necrotic base
Abent peripheral pulses, shiny skin and loss of hair
Pain at night/elevation of leg

109
Q

How would you manage an Arterial Ulcer?

A

Vascular Reconstruction

110
Q

What is ABPI? What do values indicate?

A

Ankle Brachial Pressure Index, compares peripheral blood flow
Normal is 1-1.4
If less than 0.8 it is suggestive of arterial insufficiency

111
Q

Describe the presentation of a Neuropathic Ulcer (including common sites)

A

Often painless, variable in size and shape
Granulating base
Often in pressure sites (heels, soles, toes)
Can be Neuroischaemic

112
Q

How would you manage a Neuropathic Ulcer?

A

Wound debridement
Regular repositioning
Good nutrition
Appropriate footwear

113
Q

What is a Dermatofibroma?

A

Benign mass, often mistaken for a more serious pathology, following on from insect bites such as mosquitos

114
Q

State the two layers of the dermis

A

Papillary

Reticular

115
Q

Describe the relevance of a skin lesion (suspected malignancy) itching and bleeding respectively

A

Itching - Perineural Invasion

Bleeding - Ulcerative component

116
Q

When would you do a punch lesion of a suspicious lesion?

A

If it was in a cosmetically sensitive area

117
Q

Name 5 subtypes of BCC

A 
Nodular
Superficial (can appear like dermatitis)
Morphoeic
Pigmented
Basosquamous
118
Q

Apart from pre-malignant conditions, give three risk factors specific for SCC

A

Viral Infections
Chronic Wounds
Psoriasis Treatment

119
Q

What is Bowen’s Disease?

A

In- Situ SCC disease (pre-malignant condition)

Erythematous plaques and sharp borders

120
Q

Name four types of SCC

A

Ulcerative
Verrucous
Marjdins (arising from chronic wounds)
Subungal (underneath nail bed)

121
Q

What is Gorlin Syndrome?

A

Autosomal Dominant condition increasing risk of BCCs. Presents as Multiple BCCs

taz year 3 gp (12 decks)

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