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Dermatology Flashcards

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USMLE® Step 1 flashcards
1
Q

History

  1. Social
A
  1. Occupation, hobbies, sun beds, skin type
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2
Q

Rash/lesions - definitions

  1. Macule
  2. Patch
  3. Papule
  4. Plaque
  5. Nodule
  6. Vesicle
  7. Bulla
  8. Pustule
  9. Lichen simplex
  10. Nummular lesion
  11. Annular lesion
  12. Reticulate
A
  1. Change in skin colour without elevation
  2. Large area of colour change, smooth surface
  3. Circumscribed raised lesion (0.5-1cm)
  4. Circumscribed, palpable lesion (>1cm), most elevated
  5. Circumscribed raised lesion (>1cm)
  6. Raised lesion that contains fluid
  7. Larger vesicle (>0.5cm)
  8. Containing purulent material
  9. Hard skin thickening, with accentuated skin markings
  10. ‘Coin-like’
  11. In a ring
  12. ‘Net-like’
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3
Q

Loss of skin layers

  1. Skin layers (3)
  2. Erosion - definition
  3. Ulceration
A
  1. Epidermis, dermis, subcutaneous layer
  2. Superficial epidermis loss, heals without scarring
  3. Loss of whole epidermis + upper dermis, causes scars
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4
Q

Skin exam

  1. Hidden areas
  2. Other things to offer
A
  1. Nails, web spaces, scalp, mouth, flexures

2. Lymph nodes, pulses, joint examination

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5
Q

Topical steroids

  1. Mild
  2. Moderate
  3. Potent
  4. How long to wait before applying after flare up
  5. Apply how often
A
  1. 1% hydrocortisone
  2. Eumovate, 2.5% hydrocortisone
  3. Betnovate
  4. 48 hours
  5. Once a day
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6
Q

Eczema - management

  1. Pruritis
  2. Management - 1st line
  3. 2nd line
  4. 3rd line
A
  1. Antihistamine
  2. Topical emollients + steroid (30 minutes in between)
  3. Topical tacrolimus, bandages, stockinette garments
  4. Phototherapy, systemic medication
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7
Q

Eczema - secondary infection

  1. Common bacterial organisms (2)
  2. Management - combined antibiotic + steroid cream
  3. Secondary viral infection from chicken pox in children
  4. Dermatological emergency from HSV-1
  5. Presentation
  6. Management
A
  1. Staph. aureus, strep. pyogenes
  2. Fucidin H
  3. Molluscum contagiosum
  4. Eczema herpeticum
  5. Painful worsening eczema, clustered blisters (like early cold sores), punched out erosions, fever, lethargy, reduced oral intake
  6. Aciclovir
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8
Q

Psoriasis - general

  1. Commonest type
  2. What percentage have associated arthralgia
  3. Flexural
  4. Erythrodermic
  5. Management
  6. Generalised pustular
A
  1. Chronic plaque
  2. 5%
  3. In genitalia/axilla (friction); erythematous, shiny, no scale
  4. Total body redness/heat/pain, no clear plaques, can feel systemically unwell + become hypotensive
  5. Admit to hospital
  6. Psoriasis flare, leading to pustules with plaques
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9
Q

Chronic plaque psoriasis

  1. Presentation
  2. Plaques found where
  3. Asuptiz sign
  4. Which medication can exacerbate plaque psoriasis
A
  1. Raised erythematous patches, scale (silver-white build up of dead skin cells), often itchy / painful
  2. Behind ears, genitals, scalp, nails, umbilicus, extensor surfaces of knees/elbows, natal cleft
  3. Capillary bleeding from plaque scratching
  4. Beta blockers, lithium, NSAIDs, ACE-i, antimalarials
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10
Q

Guttate psoriasis

  1. Presentation
  2. Often follows what
  3. Common subsequent development of what
  4. Management
A
  1. ‘Raindrop lesions’ - small, pink plaques on trunk
  2. Strep sore throat
  3. 1/3 develop chronic plaque psoriasis
  4. Resolves spontaneously so reassurance, topical psoriasis management if lesions symptomatic
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11
Q

Psoriasis - management

  1. 1st line (mild, localised)
  2. If extensive disease (2)
A
  1. Regular emollient to improve scale
    Topical potent steroid OD (not for longer than 8 weeks)
    Vit D analogue OD (reduce scale, not inflammation)
    Apply one in morning + one at night
  2. Phototherapy
    PO therapies - methotrexate, retinoids, biologics (useful if joint disease)
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12
Q

Acne - general

  1. Causes - hormone conditions (5)
  2. Causes - medication
A
  1. PCOS, virilising tumours, congenital adrenal hyperplasia, Cushing’s, acromegaly
  2. Topical / systemic steroids, OCP, isoniazid, phenytoin, barbiturates, ciclosporin, lithium
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13
Q

Acne - management

  1. 1st line
  2. 2nd line
  3. 3rd line
  4. ABX of choice
  5. When to avoid above type, what to use instead
  6. Complication of long-term ABX
  7. Management
  8. Alternative to PO ABX, risk + management of this
  9. 4th line (dermatologist only)
  10. Side effects
  11. Other principles of management
A
  1. Single topical therapy (benzoyl peroxide, retinoids)
  2. Topical combination (ABX, benzoyl peroxide, retinoid)
  3. Add PO ABX (remove topical ABX) to BP / retinoid
  4. Tetracyclines (e.g. lyme, oxytetra, doxy)
  5. Pregnant (erythromycin instead) / breastfeeding, children under 12 years old
  6. Gram-negative folliculitis
  7. High dose PO trimethoprim
  8. Dianette (co-cyrindiol) - high VTE risk so 3 months max - slows sebum production
  9. PO retinoid - isotretinoin
  10. Dry skin/mucous membranes, nosebleeds, joint pain, photosensitivity, tetarogenic (stop for a month before becoming pregnant), suicidal ideation
  11. Minimise: humidity, oils, cosmetics, abrasive skin treatments, washing face (maximum 2x a day)
    Stop smoking
    Eat plenty of fruit and vegetables
    Women: consider COCP if need contraception
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14
Q

Actinic (solar) keratoses

  1. What it is
  2. Found where
  3. Description
  4. Sign of AK having malignant change
  5. Changes to
  6. Management - single lesion
A
  1. Pre-malignant skin condition
  2. Exposed skin (worked outdoors/high UV exposure)
  3. Small (<1cm), crusty/roughscaly, pink/red/brown, raised, keratotic, irregular edges - PAINLESS
  4. Rapid growth, painful, inflamed
  5. Squamous cell carcinoma
  6. Cryotherapy, topical fluorouracil/imiquimod/diclofenac
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15
Q

Squamous cell carcinoma

  1. Presentation
  2. Common sites
  3. Risk factors
  4. Poor prognosis
  5. Main management
A
  1. Undular nodular lesions, keratotic, ill-defined, may ulcerate, can be painful
  2. Face, scalp, back of hands
  3. UV exposure, actinic keratosis, Bowen’s disease, chronic inflammation, immunosuppression
  4. > 2cm wise, lip/ear lesion, immunosuppression history
  5. Surgical excision (4-6mm margin)
    Radiotherapy - large non-resectable lesions
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16
Q

Basal cell carcinoma (rodent ulcer)

  1. Presentation - initial
  2. Later
  3. Common sites
  4. Risk factors
  5. Referral speed
  6. Management options
A
  1. Nodule/papule: pearly, translucent, telangiectasia
  2. May ulcerate leaving central ‘crater’
  3. Sun-exposed - head and neck
  4. Age, fair skin, UV exposure, radiation, immunosuppression, previous BCCs
  5. Routine (consider 2ww if delay may have significant impact e.g. due to lesion site / size)
  6. Excision, radiotherapy, grafting, curettage, cautery, cryotherapy
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17
Q

Malignant pigmented lesions

  1. Assessment - ABCDE
  2. What regulates melanocytes
  3. Junctional naevus =
  4. Intradermal naevus =
  5. Intermediate naevus =
  6. Compound naevus =
A
  1. Asymmetry
    Border (? irregular)
    Colour - variety may suggest dysplasia / malignancy
    Diameter (>1cm more likely to be malignant)
    Evolving
  2. MSH
  3. Melanocyte proliferation at dermo-epidermal junction
    Brown, flat lesions
  4. Melanocytes in dermis
    Skin-coloured, raised lesions
  5. Central melanocytes in dermis, peripheral in junction
    Raised centre, brown border
  6. Melanocytes at junction + within dermis
    Raised, brown lesion
18
Q

Malignant melanoma

  1. Risk factors
  2. Scoring system (prognosis depends on)
  3. What indicates poorer prognosis (3)
  4. Management
A
  1. UV exposure, light/poorly tanning skin/hair, personal/FH, presence of giant congenital melanocyte naeve, multiple common moles, mole change
  2. Breslow thickness
  3. Ulceration, lymph node involvement, skin metastases
  4. Excision with a 2mm margin
    FNA if lymph nodes palpable
19
Q

Cellulitis

  1. Management - uncomplicated (staph. aureus)
  2. Mild MRSA
  3. Extensive MRSA
  4. High-risk groups (3)
A
  1. Flucloxacillin
  2. Doxcycline
  3. Vancomycin
  4. Venous stasis, lymphoedema, diabetes
20
Q

Necrotising fasciitis

  1. High-risk groups (3)
  2. Presentation
  3. Diagnosis
  4. Management
A
  1. IVDUs, post-surgery, post-trauma
  2. Pain out of proportion to lesion, systemically unwell, rapid progression
  3. USS but also clinical diagnosis
  4. Surgical debridement of all necrotic tissue
    Broad spectrum ABX
21
Q

Gas gangrene

  1. Causative organism
  2. Features
  3. Complication
  4. Management
A
  1. C perfringens
  2. Tender, skin oedema, haemorrhaging blebs/bullae, crepitus on palpation
  3. Toxaemia and shock
  4. Debridement and excision, ABX, maybe amputation
22
Q

Erythroderma

  1. What it is
  2. Causes
  3. Presentation
  4. Management
A
  1. Exfoliative dermatis involving >90% of skin surface
  2. Previous skin disease e.g. eczema and psoriasis, lymphoma, drugs, idiopathic
  3. Skin inflamed, oedematous + scaly
    Systemically unwell, malaise, lymphadenopathy
  4. Treat underlying cause, + emollients, wet wraps, topical steroids
23
Q

Lesion - 2ww referral

  1. Scale to use
  2. Major features (2 points) (3)
  3. Minor features (1 point) (4)
  4. Other situations where 2ww is considered
A
  1. 7-point scale
  2. Change in size, irregular shape, irregular colour
  3. Largest >7mm, inflammation, ooze, sensation change
  4. Dermatoscopy suggests MM, or SCC suspicion
24
Q

Dermatitis herpetiformis

  1. What it is
  2. Linked to
A
  1. Chronic, itchy, blister clusters

2. Coeliac disease - underlying gluten enteropathy

25
Q

Kaposi’s sarcoma

  1. Tumour of what
  2. Presentation
  3. Associations
  4. Linked virus (apart from HIV)
A
  1. Vascular and lymphatic endothelium.
  2. Slow growing purple cutaneous nodules, elderly men
  3. Immunosuppression (this form much more aggressive, affects those with HIV-related disease)
  4. HHV-8 (human herpes virus 8)
26
Q

Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis

  1. Difference between them
  2. Causes - medication (5)
  3. Causes - infections (4)
  4. Associated with what
  5. Symptoms
  6. Management
A
  1. SJS <10% BSA, TEN >10%
  2. AEDs, ABX, allopurinol, NSAIDs, isotretinoin
  3. HSV, mycoplasma, CMV, HIV
  4. HLA genetic types
  5. Systemically unwell, positive Nikolsky sign
  6. Stop precipitant, supportive, IVIG, other immunosuppressants
27
Q

Viral widespread rashes (exanthemas) - part 1

  1. Measles - rash
  2. Other signs/symptoms
  3. Complications (5)
  4. Scarlet fever - associated virus
  5. Rash
  6. Management
  7. Complications - associated with virus
  8. Rubella - rash
  9. Other symptoms
  10. Risk in pregnancy (triad)
  11. Other complications (2)
A
  1. Erythematous, macular rash behind ears/on face 3-5 days post-fever, then spreads
  2. Koplik spots, fever, corzyal symptoms, conjunctivitis
  3. Otitis media, diarrhoea, pneumonia, encephalitis, blindness
  4. Group A strep (tonsils/skin)
  5. Red-pink, blotchy, macular, rough skin. Starts on trunk, spreads outwards (red cheeks)
  6. ABX for underlying infection
  7. Post-strep GN/reactive arthritis, rheumatic fever
  8. Milder erythematous, macular, starts on face (3 days)
  9. Mild fever, joint pain, sore throat, lymphadenopathy (behind ears/back of neck)
  10. Congenital rubella syndrome - deaf, blind, congenital heart disease
  11. Thrombocytopenia, encephalitis
28
Q

Viral widespread rashes (exanthemas) - part 2

  1. Parvovirus B19 - aka (2)
  2. Rash
  3. Other signs/symptoms
  4. Complications
  5. Roseola - cause
  6. Presentation
  7. Rash
  8. Complication
A
  1. Slapped cheek syndrome / Erythema infectiosum
  2. Rapid diffuse bright red rash on both cheeks; then days later a reticular, raised, itchy, erythematous rash on trunk/limbs
  3. Starts with mild fever, coryzal symptoms
  4. Aplastic anaemia (if immunocompromised), encephalitis/meningitis, hepatitis, myocarditis, nephritis
  5. Human Herpesvirus 6 (HHV-6) + 7 (HHV-7)
  6. Fever >40, sudden, last 3 days then disappears
  7. Mild itchy erythematous macular, across arms, legs, trunk and face
  8. Febrile convulsion
29
Q

Erythema multiforme

  1. Type of reaction
  2. Causes
  3. Rash
  4. Other symptoms
  5. Erythema nodosum - description
  6. Causes - hypersensitivity reactions
  7. Causes - chronic diseases (2)
A
  1. Type 4 hypersensitivity reaction
  2. Viruses e.g. HSV, medications, mycoplasma pneumonia
  3. Widespread, itchy, target lesions
  4. Mild pyrexia, stomatitis, muscle/joint/head aches
  5. Red, inflamed, tender SC nodules across both shins
  6. Recent strep. infection, TB, pregnancy, NSAIDs
  7. IBD, sarcoid
30
Q

Pityriasis Rosea

  1. Starts with
  2. Rash
  3. Other symptoms
  4. Resolution
  5. Pityriasis/tinea versicolour - cause
  6. Rash
  7. Management
A
  1. ‘Herald patch’ on torso - faint red/pink (lighter in darker skinned patients), scaly, oval lesion >2cm wide, 2+ days before rest of rash
  2. Same lesions but smaller, ‘christmas tree’ pattern over ribs
  3. Generalised itch, low fever, headache, lethargy
  4. Spontaneous after about 6 weeks
  5. Superficial cutaneous fungal (Malassezia furfur)
  6. Truncal hypopigmented/pink/brown patches, more noticeable after suntan
  7. Ketoconazole shampoo, 2nd line PO itraconazole
31
Q

Chicken Pox

  1. Rash
  2. Other symptoms
  3. Complications
  4. Management
A
  1. Widespread, erythematous, raised, vesicular (fluid filled), blistering lesions, start on trunk/face
  2. Pyrexia, itch, general malaise
  3. Conjunctival lesions, encephalitis (ataxia)
  4. Aciclovir if immumocompromised, <4 weeks old, at risk or complications
32
Q

Hand, foot and mouth

  1. Cause
  2. Starts with
  3. Rash
  4. Resolution
A
  1. Coxsackie A viruses
  2. Incubation 3-5 days, then typical viral illness symptoms
  3. Small mouth ulcers first, then discreet red spots on hands, feet, around mouth - may blister/itch
  4. Spontaneous after 10 days
33
Q

Molluscum contagiosum

  1. Virus type
  2. Rash
  3. Resolution (+ other options)
A
  1. Pox
  2. Small, flesh coloured papules with central dimple in ‘crops’
  3. Spontaneous after 18 months, can maybe use salicylic acid/cryotherapy
34
Q

Non-blanching rashes

  1. Differentials
  2. FBC - suggestive findings
  3. U+E deranged - suggests
  4. Hypertension
  5. Urine dipstick (proteinuria, haematuria)
A
  1. Meningococcal septicaemia
    HSP (legs/buttocks, associated abdo/joint pain)
    ITP (develops over several days, otherwise well)
    Leukaemia (gradual petechiae, anaemia, lymph nodes)
    HUS (oliguria, anaemia, recent diarrhoea)
    Mechanical (petechiae in SVC distribution)
    Other (trauma, viruses)
2. Anaemia - HUS, leukaemia
Thrombocytopaenia - ITP, HUS
3. HUS/HSP with renal involvement
4. HSP, HUS
5. HUS, HSP with renal involvement
35
Q

Impetigo

  1. Cause
  2. Non-bullous - symptoms
  3. Bullous - description
  4. Management
  5. If bullous widespread, called what
  6. Sign of this
  7. Management
A
  1. Staph. aureus, strep. pyogenes
  2. Sores around nose/mouth that leak fluid to form golden crust, no systemic upset
  3. Larger fluid-filled vesicles (commoner in <2 years old)
  4. Local/non-bullous = fusidic acid, PO flucoxacillin if widespread/bullous
  5. Staphylococcus Scalded Skin Syndrome.
  6. Positive Nikolsky sign, + systemic (fever, irritability, lethargy, dehydration)
  7. Admit, IV fluids, IV ABX
36
Q

Scabies

  1. Symptoms
  2. Management - 1st line
  3. 2nd line
  4. If immunocompromised e.g. HIV, what happens
  5. Symptoms/signs
  6. Management
A
  1. Widespread itch, track marks in finger web spaces
  2. Permethrin 5%
  3. Malathion 0.5%
  4. Crusted (Norwegian) scabies
  5. Generalised red patches, turn into scaly plaques, may not be itchy
  6. Ivermectin, isolation
37
Q

Ringworm (tinea)

  1. Name depending on affected location: scalp, feet, groin, body
  2. Incognito =
  3. Presentation
  4. Capitis - consequence if untreated
  5. Commonest cause
  6. Cause acquired from cats/dogs + diagnosis
  7. Most useful investigation
  8. Management
  9. Head lice - infected with what
  10. Management
A
  1. Capitis, pedis, cruris, corporis
  2. Fungal skin infection incorrectly treated with topical steroids, causing diffuse worsening of rash
  3. Circular, itchy, erythematous, scaly, well-demarcated
  4. Kerion (raised, pustular, spongy/boggy mass)
  5. Trichophyton tonsurans
  6. Microsporum canis (green under Wood’s lamp)
  7. Scraping of area
  8. Ketoconazole shampoo for 2 weeks
    Oral antifungals: terbinafine if TT, griseofulvin if MC
  9. Pediculus humanus capitis parasite
  10. Dimeticone 4% lotion
38
Q

Seborrheic dermatitis

  1. Associated organism
  2. Associated conditions
  3. Presentation
  4. Scalp management
  5. Face/body management
A
  1. Malassezia furfur
  2. HIV, Parkinson’s
  3. Eczematous lesions on sebum-rich areas: scalp, periorbital, auricular and nasolabial folds
    Non-rash: otitis externa, blepharitis
  4. 1st line OTC zinc pyrithione/tar, 2nd ketoconazole
  5. Topical ketoconazole, short course topical steroids
39
Q

Pyoderma gangrenosum

  1. Location
  2. Presentation - rash
  3. Other symptoms
  4. Commonest cause
  5. Associated conditions
  6. Management - 1st line
A
  1. Lower limb
  2. Small red papule, becomes deep red necrotic ulcers with violaceous border
  3. Systemic symptoms e.g. fever, myalgia
  4. Idiopathic (>50%)
  5. IBD, RA, SLE, haem malignancy, PBC
  6. Oral steroids
40
Q

Lichen planus

  1. Rash location
  2. Description
  3. Non-rash signs
  4. Drug causes (3)
  5. Management
  6. Lichen sclerosus =
A
  1. Palms, soles, genitalia, arm flexor, buccal mucosa
  2. Itchy, papular, polygonal shape, white lines on surface (Wickham’s striae), with Koebner phenomenon
  3. Nail plate thinning, longitudinal ridging
  4. Gold, quinine, thiazides
  5. Topical steroids (PO if extensive), benzydamine mouthwash or spray
  6. Itchy white genital plaques in elderly females (give topical steroids)
41
Q

Pruritis - systemic causes (other symptoms)

  1. Liver disease
  2. Iron deficiency anaemia
  3. Polycythaemia
  4. Chronic kidney disease
  5. Lymphoma
  6. Other causes
A
  1. Alcohol, chronic stigmata (spider naevi, bruising, palmar erythema, gynaecomastia), decompensation signs (ascites, jaundice, encephalopathy)
  2. Pale, microcytic anaemia, koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis
  3. Worst after warm bath, ‘ruddy’ complexion, gout, peptic ulcer
  4. Lethargy, pallor, oedema, weight gain
  5. B symptoms, lymphadenopathy, fatigue, hepatosplenomegaly
  6. Thyroid disease, DM, pregnancy, ‘senile’ pruritus, urticaria, eczema / scabies / psoriasis / pityriasis rosea

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