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Year 3 GP > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Describe the six skin types

A
  • Fitzpatrick
  • I - Always Burns, Never Tans
  • II - Always Burns, Sometimes Tans
  • III - Sometimes Burns, Always Tans
  • IV - Never Burns, Always Tans
  • V- Dark Brown, rarely burns, fast and easy tanning
  • VI- Black, Almost never burns
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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

A
  • Lesion - area of altered skin
  • Rash - an eruption
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5
Q

Define naevus

A

Localised malformation of tissue, commonly pigmented

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6
Q

Define comodone

A

blocked hair follicle/pore containing altered sebum/bacteria and cellular debris. Can be open (blackheads) or closed (whiteheads)

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7
Q

What is the Koebner Phenomenon in dermatological distribution?

A

Linear eruption

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8
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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9
Q

Describe Erythema

A

Redness due to inflammation and vasodilation, that blanches under pressure

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10
Q

Describe Purpura & the 2 types

A

Red/Purple discolouration due to bleeding into skin/mucous membrane that does not blanch with pressure. Can be

  • Petichae (small pinpoint)
  • Ecchymoses (large bruise)
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11
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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12
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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13
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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14
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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15
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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16
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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17
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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18
Q

Describe three different scar complications

A
  • Atrophic - thinning
  • Hypertrophic - Hyperproliferation within wound boundaries
  • Keloidal - Hyperproliferation beyond wound boundary
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19
Q

Define Ulcer and Fissure

A
  • Ulcer - Loss of dermis and epidermis
  • Fissure - Epidermal crack due to excess dryness
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20
Q

What is Hypertrichosis?

A

Non androgen dependent pattern of hair growth

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21
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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22
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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23
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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24
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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25
Q

Describe the composition of the Dermis

A

Made collagen/elastin/GAGs Contains immune cells, nerves, lymphatics and blood supply

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26
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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27
Q

What are Sebaceous Glands?

A

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

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28
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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29
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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30
Q

How would you manage Urticaria?

A

Antihistamines Corticosteroids if severe

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31
Q

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

A

Swelling of epidermis AND dermis Managed by corticosteroids

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32
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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33
Q

What is Anaphylaxis?

A

Bronchospasm, facial and laryngeal oedema

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34
Q

How would you manage Anaphylaxis?

A

Adrenaline, Corticosteroids and Antihistamines

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35
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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36
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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37
Q

How do you manage Erythema Nodosum

A

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

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38
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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39
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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40
Q

How would you manage Erythema Multiforme?

A

Self Limiting Analgesics and Steroid Creams

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41
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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42
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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43
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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44
Q

What is SCORTEN?

A

Predicts mortality for Steven Johnson Syndrome Score greater than 3 requires ITU

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45
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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46
Q

How might Erythroderma present?

A

Skin appears inflamed, oedematous and scaly Pt feels systemically unwell with malaise and lymphadenopathy

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47
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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48
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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49
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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50
Q

What is Necrotising Fasciitis?

A

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

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51
Q

How does Necrotising Fasciitis present?

A

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

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52
Q

How would you manage Necrotising Fasciitis?

A

Extensive Surgical Debridement IV Antibiotics

53
Q

Define Cellulitis

A

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

54
Q

What is the difference between Cellulitis and Erysipelas?

A

Erysipelas is a more superficial form Erysipelas has more sharply demarcated borders than Cellulitis

55
Q

Give 5 risk factors for Cellulitis/Erysipelas

A

IVDU Elderly Venous Insuffiency Lymphoedema Alcoholism

56
Q

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

A

Staph Aureus Post Op - Strep Pyogenes, Closdtrodium Perfringes (crepitus)

57
Q

How would you manage Cellulitis/Erysipelas?

A

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

58
Q

What is Staphylococcal Scalded Syndrome?

A

Scald appearance seen in infancy and early childhood Caused by epidermolytic strain of toxigenic STaph Aureus

59
Q

How might Staphylococcal Scalded Syndrome present?

A

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

60
Q

How would you manage Staphylococcal Scalded Syndrome?

A

Flucloxacillin (or Vancomycin for MRSA) Analgesia Petroleum Jelly

61
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

62
Q

Describe Tinea Manuum and Tinea Pedis

A

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

63
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

64
Q

What is Tinea Incognito?

A

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

65
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

66
Q

How would you manage fungal skin infections?

A

Topical treatment - Terbinafine cream If severe - Oral antifungals such as Itraconazole

67
Q

State the two non melanoma skin cancers

A

Basal Cell Carcinoma Squamous Cell Carcinoma

68
Q

Give 3 risk factors of skin cancer

A

Age UV exposure Type I skin

69
Q

Describe the presentation of nodular BCC (TURP)

A

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

70
Q

What is Squamous Cell Carcinoma?

A

Locally invasive malignant tumour of keratinocytes with the ability to metastasise

71
Q

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

A

Actinic Keratoses (ie sun spots) Bowens Disease Leukoplakia

72
Q

How do Squamous Cell Carcinomas present?

A

Keratotic Ill defined Potentially ulcerating

73
Q

Describe four managements of Skin Cancer

A

Surgical Excision Radiotherapy Cryotherapy/Cautery Mohs Micrographic Surgery

74
Q

What is Mohs Micrographic Surgery

A

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

75
Q

What is a Malignant Melanoma?

A

Invasive malignant tumour of epidermal melanocytes with the ability to metastasise

76
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

77
Q

What is the Breslow Thickness?

A

The risk of recurrence of Malignant Melanoma The thicker the melanoma the higher the risk

78
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

79
Q

Give 3 other dermatological features of atopic eczema

A

Excoriation Lichenification Nail pitting

80
Q

Name two conservative managements of Eczema

A

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

81
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

82
Q

State three secondary viral infectons of Eczema

A

Molluscum Contagiosum Viral Warts Eczema Herpeticum

83
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

84
Q

What is Propionibacterium Acne?

A

Bacterial colonisation and inflammation of sebaceous glands

85
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

86
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)

87
Q

How long do systemic treatments for Acne take to work?

A

3-4 months

88
Q

Describe three oral treatments for Acne

A

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

89
Q

What is Psoriasis?

A

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

90
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)

91
Q

State four subtypes of Psoriasis

A

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

92
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

93
Q

What is Auspitz Sign?

A

Scratch and gentle scale removal causes capillary bleeding in Psoriasis

94
Q

Describe two oral and two topical therapies for Psoriasis

A

Topical - Vitamin D Analogues, Topical Steroids Oral - Methotrexate, Retnoids

95
Q

Name a complication of Psoriasis

A

Erythroderma

96
Q

What determines blister fragility?

A

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

97
Q

What is Bullous Pemphigoid?

A

Immunobullous blistering (subepidermal) condition usually affecting the elderly

98
Q

How will Bullous Pemphigoid present?

A

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

99
Q

How do you manage Bullous Pemphigoid?

A

Topical steroids for local disease Oral therapies for widespread (steroids, tetracycline)

100
Q

What is Pemphigus Vulgaris?

A

Immunobullous blistering (intraepidermal) condition usually affecting the middle aged

101
Q

How will Pemphigus Vulgaris present?

A

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

102
Q

How would you manage Pemphigus Vulgaris?

A

High dose steroids Immunosupressants

103
Q

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

A

Overcrowding Poverty Homelessness Poor Hygiene

104
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

105
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

106
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

107
Q

How does Senile Purpura present?

A

Elderly population with sun damaged skin Extensor surfaces of hands and forearms

108
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

109
Q

How would you manage a Venous Ulcer?

A

Compression bandaging

110
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

111
Q

How would you manage an Arterial Ulcer?

A

Vascular Reconstruction

112
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

113
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

114
Q

How would you manage a Neuropathic Ulcer?

A

Wound debridement Regular repositioning Good nutrition Appropriate footwear

115
Q

What is a Dermatofibroma?

A

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

116
Q

State the two layers of the dermis

A

Papillary Reticular

117
Q

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

A

Itching - Perineural Invasion Bleeding - Ulcerative component

118
Q

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

A

If it was in a cosmetically sensitive area

119
Q

Name 5 subtypes of BCC

A

Nodular Superficial (can appear like dermatitis) Morphoeic Pigmented Basosquamous

120
Q

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

A

Viral Infections Chronic Wounds Psoriasis Treatment

121
Q

What is Bowen’s Disease?

A

In- Situ SCC disease (pre-malignant condition) Erythematous plaques and sharp borders

122
Q

Name four types of SCC

A

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

123
Q

What is Gorlin Syndrome?

A

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

124
Q

What is Rosacea?

A

Chronic relapsing disease of facial skin characterised by flushing episodes, persistent erythema, telangiectasia, papules and pustules

125
Q

What is a common presentation of Rosacea in men?

A

Rhinophyma - enlarged nose

126
Q

What is the first line management for Rosacea?

A

Topical Metronidazole

127
Q

How does Lichen Planus present?

A

Affects flexor surfaces of wrists/forearms/legs Intensely itchy 2-5mm red/violet shiny topped pamphlet (Wickham Striae) Mucous Membranes - White raises trabecular lesions

128
Q

How is Lichen Planus managed?

A

Topical Steroids if required

Year 3 GP (6 decks)

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