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Year 3 > Dermatology > Flashcards

Dermatology Flashcards

Derm

1
Q

What is a malignant melanoma?

A

Invasive malignant tumour of the epidermal melanocytes which have a potential to metastasise

most deadly skin cancer

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2
Q

What is the epidemiology of malignant melanomas?

A

Least common skin cancer

Average age 63, can affect people in their 30s

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3
Q

What are the risk factors for malignant melanomas?

A

Excessive UV exposure
Fitzpatrick skin type 1 (always burns, never tans)
Hx multiple/atypical moles
FHx/Hx melanoma

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4
Q

What are the characteristics of a malignant melanoma?

A-F

A 
Asymmetry
Border irregularity
Colour irregularity (pigmented)
Diameter >6mm
Evolution of lesion (size/shape changes)
Funny looking mole (nodular)

May bleed, itchy, ulcerate, crust over

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5
Q

What are the symptoms of a malignant melanoma?

A 
Inflammation
Oozing
Change in sensation
On legs (F)
On trunk (M)
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6
Q

What is the scoring criteria for a malignant melanoma?

A

NICE 7 point checklist

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7
Q

What is the scoring for the NICE 7 point checklist?

A 
Asymmetry: 2
[Border irregularity]
Colour irregularity: 2
Diameter 7mm+: 1
Evolution of lesion (size): 2
Inflammation: 1
Oozing: 1
Change in sensation: 1
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8
Q

At what score of the NICE 7 point checklist do you send the Pt for a 2 week wait referral?

A

3+

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9
Q

What are the subtypes of malignant melanomas?

LANS

A

Lentigo maligna
Acral lentiginous
Nodular
Superficial spreading

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10
Q

What are the characteristics of a lentigo maligna melanoma?

A

Present in the elderly
Common on the face
Chronic UV exposure

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11
Q

What are the characteristics of an acral lentiginous melanoma?

A

Common in darker skin types

Found on palm of hand, sole of foot, or under the nails

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12
Q

What are the characteristics of a nodular melanoma?

A

Poor prognosis
Rapid growth
Vertical spread

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13
Q

What are the characteristics of a superficial spreading melanoma?

A

Most common subtype

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14
Q

What are some melanocytic lesions?

A 
Seborrheic warts
Congenital naevi
Junctional naevi
Compound naevi
Intradermal naevi
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15
Q

What are the characteristics of seborrheic keratoses?

A

Present in the elderly
Often multiple
Wart-like, greasy
Stuck on appearance

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16
Q

What are the characteristics of congenital naevi?

A

Large
Pigmented
Hairy

(ie birthmarks)

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17
Q

What are the characteristics of junctional naevi?

A

Small
Flat
Dark

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18
Q

What are the characteristics of compound naevi?

A

Raised
Warty
Hairy

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19
Q

What are the characteristics of intradermal naevi?

A

Dome shaped nodule

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20
Q

What are the investigations for melanomas?

A 
2WW referral
Examine with dermatoscope
Full thickness excisional biopsy
Take photo and review in 3/12 if atypical
If risk of mets:
-CXR
-Liver US
-CT CAP
-Brain MRI
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21
Q

What is a basal cell carcinoma?

A

Slow growing local invasive tumour of basal keratinocytes in epidermis (in stratum basale)

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22
Q

What are the risk factors of BCCs?

A 
Skin type 1
Age
Male
Immunosuppression
Hx/FHx skin cancer
Excessive UV exposure
Frequent sunburns in childhood
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23
Q

Are BCCs likely to metastasise?

A

No- but may be locally invasive eg into dermis

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24
Q

Where do BCCs commonly present?

A

Around the head and neck

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25
Q

What are the characteristics of a BCC?

A 
Nodule, small
Pearly, rolled edges
\+/-Central ulcer (rodent ulcer)
Central fine surface telangiectasia
Skin coloured
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26
Q

What are the investigations for a BCC?

A

Routine derm referral (not 2WW)
Examine with a dermatoscope
Excise the lesion

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27
Q

What is a squamous cell carcinoma?

A

Locally invasive malignant tumour of the epidermal keratinocytes/its appendages, with the potential to metastasise

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28
Q

What are the risk factors of SCCs?

A

Excessive UV exposure
Pre-malignant skin conditions (actinic keratoses)
Chronic inflammation (eg leg ulcer, would scar)
Immunosuppression
FHx
Lighter skin

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29
Q

What are the characteristics of a SCC?

A 
Hyperkeratotic (scaly, crusty)
Ill-defined nodule
May ulcerate
Non-healing lesion
Everted/rolled edges
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30
Q

What are the investigations for a SCC?

A

Refer to dermatology (2WW)
Examine with a dermatoscope
Biopsy/complete excision

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31
Q

What is molluscum contagiosum?

A

A viral skin infection

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32
Q

What is the epidemiology of molluscum contagiosum?

A

Pre-school children age 1-4

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33
Q

What are the risk factors for molluscum contagiosum?

A

Close contact/swimming pools/sexual contact
HIV infection
Atopic eczema

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34
Q

What is the presentation of molluscum contagiosum?

A 
Dome shaped
Flesh coloured
Pearly white papules
Central umbillication
May be >100 if immunocompromised
Systemically well
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35
Q

What are the investigations for molluscum contagiosum?

A

No investigations

Clinical diagnosis

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36
Q

What is cellulitis?

A

Acute bacterial infection of the dermis and subcutaneous tissue

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37
Q

What is erysipelas?

A

Distinct form of superficial cellulitis which is sharply demarcated

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38
Q

What are the common causative organisms of cellulitis/erysipelas?

A

Streptococcus pyogenes
Staphylococcus aureus
Haemophilus influenzae (periorbital)

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39
Q

What is necrotising fasciitis?

A

Infection of the deep fascia with secondary tissue necrosis

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40
Q

Which pathogen causes necrotising fasciitis?

A

Group A beta-haemolytic streptococcus

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41
Q

What are the risk factors for necrotising fasciitis?

A

Surgical wounds
Skin breakage
Medical co-morbidities
50% occur in healthy people

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42
Q

What are the signs and symptoms of necrotising fasciitis?

A

Severe pain
Erythematous blistering, necrotic skin
Fever/tachycardia
Crepitus (subcutaneous emphysema)

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43
Q

What are the investigations you would do for necrotising fasciitis?

A 
FBC- WCC
U+E- high urea
CRP, CK
Blood and tissue cultures
XR/CT- soft tissue gas
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44
Q

What is eczema?

A

Chronic itchy inflammatory skin condition

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45
Q

What is the epidemiology of eczema?

A

10-30% of children

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46
Q

What is the presentation of eczema?

A

Itchy dry skin affecting flexures
Can affect face/extensor surfaces in small infants
Lichenification (chronic itching)

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47
Q

What are the characteristics of atopic dermatitis?

A

Lichenification
Flexures
Type 1 hypersinsitivity (IgE mediated)

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48
Q

What are the characteristics of seborrheic dermatitis?

A

Yellow greasy scales
Can cause nappy rash
Adults- dandruff, plaques on nasolabial fold, eyebrows
Associated with malassezia yeasts

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49
Q

What are the characteristics of contact dermatitis?

A

Nickel/chromate/perfume/latex/plant hypersensitivity

Type 4 reaction (T cell mediated)

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50
Q

What are the characteristics of dyshidrotic/pompholyx dermatitis?

A

Vescicles/blisters
Hands and feet
Related to sweating

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51
Q

What are the characteristics of discoid/nummular eczema?

A

Scattered round patches
Itchy
Hx of atopic eczema/skin injury

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52
Q

What are the characteristics of eczema herpeticum?

A

Herpes simplex infection in an eczema sufferer

Medical emergency

53
Q

What are the investigations for atopic eczema?

A

Clinical diagnosis

54
Q

What are the investigations for contact dermatitis?

A

Skin patch test

55
Q

What is psoriasis?

A

Chronic inflammatory skin disease due to hyperproliferation of keratinocytes

56
Q

What is the epidemiology of psoriasis?

A

2%

peak age 20yrs

57
Q

What are the risk factors of psoriasis?

A

Genetic/environmental factors

Triggers: smoking, alcohol, stress

58
Q

What is the presentation of psoriasis?

A

Red/silver scaly plaques on extensor surfaces
Itchy/painful
Nail pitting/onycholysis
Symmetrical polyarthritis
Koebner phenomenon (lesions on traumatised skin)
Auspitz sign (removal of scale causes bleeding)

59
Q

What are the nail changes in psoriasis?

POSh

A

Pitting
Onycholysis
Subungal hyperkeratosis

60
Q

What does chronic plaque psoriasis look like?

A

Silver scales

61
Q

What can long term psoriatic arthritis present with?

A

Telescoping

62
Q

What does pustular psoriasis look like?

A

Generalised lesions around body

Palmar plantar presentation

63
Q

What does guttate psoriasis look like?

A

After a strep throat infection
Salmon-pink
Drop-like lesions

64
Q

What does erythroderma look like?

A

Generalised red inflamed skin

1/3 due to worsening psoriasis

65
Q

What is erythema multiforme?

A

Acute self-limiting inflammation of skin and mucous membranes

most commonly due to HSV

‘target/bullseye’ lesions

66
Q

What is the epidemiology of erythema multiforme?

A

Any age group, common in children/young adults

M:F 2:1

67
Q

What are the infections cause erythema multiforme?

A

Viral: HSV, HIV
Bacterial: mycoplasma, chlamydia
Fungal: histoplasmosis

68
Q

What is the presentation of erythema multiforme?

A

Prodromal symptoms (viral cause)

Target lesions

  • Itching/burning/painful
  • Central vesicle/crust
  • Ring of pallor
  • Ring of erythema
  • may fade + cause depigmentation
69
Q

What are the investigations for erythema multiforme?

A

Usually clinical diagnosis

FBC raised WCC
ESR, CRP
HSV serology
Throat swab
CXR (sarcoid, atypical pneumonia)
70
Q

What is Stevens-Johnson syndrome?

A

Painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days

71
Q

What is the presentation of Stevens-Johnson syndrome?

A

Systemically unwell
Sore throat, fever, cough, headache, diarrhoea, vomiting
Shock (hypotension, tachycardia)

72
Q

What are the investigations for Stevens-Johnson syndrome?

A 
Usually clinical diagnosis
FBC raised WCC
ESR, CRP
HSV serology
Throat swab
CXR (sarcoid, atypical pneumonia)
73
Q

A 64 year old man presents with a lesion on his upper ear that has been present for months but has now begun to ulcerate. On examination: non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on the pinna.
What is the most likely diagnosis?

A. Basal call carcinoma
B. Malignant melanoma – superficial spreading type
C. Malignant melanoma – nodular type
D. Non-healing scab
E. Squamous cell carcinoma
A

E. Squamous cell carcinoma

Hints:
Age
Classic site
Non-pigmented
Hyperkeratotic, crusty
Everted edges
74
Q

A 64 year old man presents with a lesion on his upper ear that has been present for months but has now begun to ulcerate. On examination: non-pigmented, hyperkeratotic, crusty lesion with raised everted edges on the pinna.
How should the GP proceed?

A. Provide sun exposure advice
B. Monitor for changes with serial follow up
C. Treat in primary care
D. Dermatology referral - routine
E. Dermatology referral – 2 week wait
A

E. Dermatology referral – 2 week wait

Hints:
Diagnosis = SCC
Potentially malignant spread
Must refer urgently, as for melanoma

75
Q

A 32-year old professional surfer had a seizure three days ago. He has no history of epilepsy and reports headaches for the past 5 months. The headaches are worse when he goes to bed. On examination, a dark irregular skin lesion is found on the back of his neck. An MRI scan shows multiple lesions across both cerebral hemispheres.
What is the most likely diagnosis?

A. Acoustic neuroma
B. Glioblastoma multiforme
C. Meningioma 
D. Metastases 
E. Neurofibromatosis type I
A

D. Metastases

Hints:
Signs of raised ICP (brain mets)
Lesion suspicious of melanoma
Significant sun exposure

76
Q

A 76-year-old woman has recently attended her GP because of a ‘spot that won’t go away’. The lesion is on her nose and has pearly, rolled edges with telangiectasias.
What is the most likely diagnosis?

A. Squamous cell carcinoma
B. Molluscum contagiosum
C. Basal cell carcinoma
D. Acne rosacea
E. Acne vulgaris
A

C. Basal cell carcinoma

Hints:
Classic site
Features of BCC

77
Q

A 4-year old girl presents to the GP with multiple lesions on her face. The lesions are raised and shiny, non-tender, non-erythematous, and 3 mm in diameter. They have an umbilicated centre. The patient is known to be HIV positive.
What is the most likely diagnosis?

A. Chicken pox
B. Molluscum contagiosum
C. Atopic eczema  
D. Eczema herpeticum
E. Herpes simplex virus
A

B. Molluscum contagiosum

Hints:
Classic appearance
HIV

78
Q

A 52-year-old woman presents to the GP with redness and swelling of her right cheek. On examination the area of erythema is well-demarcated and warm to touch. Her temperature is 37.9 and she feels unwell.
What is the most appropriate management plan for this patient?

A. Cold compress, reassure, home
B. Admit to intensive care unit
C. Take skin swabs, blood cultures, and give paracetamol
D. Draw around the lesion, give pain relief, oral fluids and antibiotics
E. Emergency dentist referral

A

D. Draw around the lesion, give pain relief, oral fluids and antibiotics

Hints:
Well-demarcated & systemic upset – probably erysipelas

79
Q

A 12-year-old girl presents with dry, itchy skin that involves the flexures in front of her elbows and behind her knees. She has symptoms of hay fever and was diagnosed with egg and milk allergy at 6 months old.Her mother has asthma.
What is the most likely diagnosis?

A. Seborrheic dermatitis
B. Atopic dermatitis
C. Psoriasis (chronic plaque)
D. Psoriasis (guttate)
E. Urticaria
A

B. Atopic dermatitis

Hints:
Age
Flexures
Allergies
FHx atopy
80
Q

A 23-year-old man was recently given penicillin for a throat infection (now resolved). He now complains of sore red ‘targetoid’ lesions on his extremities. Later he develops ulcers around his lips and conjunctiva.
What is the diagnosis?

A. Erythema multiforme
B. Chicken pox
C. Herpes simplex virus
D. Stevens-Johnson’s syndrome
E. Toxic epidermal necrolysis
A

A. Erythema multiforme

Hints:
Target lesions
TWO mucosal sites affected!

81
Q

how do you describe skin lesions?

A

FLAT - small = macule, large = patch
FLUID FILLED- small = vesicles, puss = pustules, large = bullae
RAISED- small = papules, large = nodule

(where small = <0.5cm)

82
Q

A 67 year old man sees his GP because his wife is worried about a lesion on his back. On examination, the lesion is hyperkeratotic, non-pigmented and has started to ulcerate.

What is the most likely diagnosis?

A Melanocytic naevus
B Squamous cell carcinoma
C  Melanoma
D Basal cell carcinoma
E Eczema
A

Squamous cell carcinoma

83
Q

Common sites for metastasis of SCC and malignant melanoma

A 
Can invade locally into dermis
Lung
Bone
Brain
Liver
84
Q

What are the different types of BCC?

A

Nodular- most common
Superficial- flat macule/patch
Morpheic- yellow/waxy plaque, scar like
Pigmented- dark, flecks, looks like a melanoma

85
Q

Investigations for malignant melanoma

A

Dermatoscope- aids clinical examination

Bloods- for metastases

  • Calcium (bone mets or PTHrp)
  • ALP (bone mets)
  • LFTs (liver mets)

Imaging- for staging
- CT/MRI/PET

Skin biopsy
- (Breslow thickness – how deep the melanoma has spread into dermis, guides surgical excision and prognosis)

86
Q

What is the appearance of melanocytic naevi? (moles)

A

Symmetrical
Flat
Regular borders
(i.e. not ABCDE)

Does not bleed, itchy, ulcerate, crust over

87
Q

Define melanocytic naevi, give some common characteristics

A

BENIGN neoplasms of melanocytes in epidermis

  • Often congenital
  • Arise during childhood
  • Rarely can transform into melanoma
88
Q

A 73 year old man sees his GP because he has been experiencing headaches, especially when coughing and lying down. He is otherwise fit and healthy, which he attributes to having a physically intensive occupation – he was a gardener for all his working life. On examination, you see a pigmented lesion on his abdomen that he says is getting bigger.

What is the most likely diagnosis?

A Melanocytic naevus
B Squamous cell carcinoma
C  Melanoma
D Basal cell carcinoma
E Eczema
A

Melanoma
Headache, worse when coughing and lying = brain mets
Gardener = UV exposure

89
Q

A 14 year old boy develops an itchy rash. On observation, the rash looks like purple plaques and it is distributed on the extensor surfaces. His nails also look abnormal; some show signs of pitting whilst the nail on his right index finger appears to be coming off the nail bed. His grandfather has the same condition, which he manages using steroids.

What is the most likely diagnosis?

A Eczema
B Lichen planus
C Psoriasis
D Herpes zoster
E Cellulitis
90
Q

Define eczema

A

inflammatory skin condition (NOT-AUTOIMMUNE)

- response to triggers

91
Q

RF for eczema

A 
PMHx/FHx of atopy
        Food allergies
        Hay fever
        Asthma
Filaggrin gene mutation
92
Q

signs/symptoms of eczema

A 
Dry skin
Itchy
Erythematous
Distribution: flexures
Lichenification- if chronic, skin thickens to protect from scratching
93
Q

Eczema triggers

A 
Soaps, shampoos
Food allergies
Pollen
House dust mites
Pets
94
Q

What type of reaction is atopic dermatitis?

A

Type I (IgE mediated) or IV(T cell) hypersensitivity)

95
Q

Different subtypes of eczema

A
  • atopic dermatitis (most common eczema subtype)
  • contact dermatitis (often nickel/latex)
  • discoid dermatitis
  • Seborrhoeic dermatitis (yellow, greasy/scaly)
  • Dyshidrotic (AKA pompholyx)- blisters on hands and feet
  • Eczema Herpeticum- medical emergency
96
Q

Features of discoid dermatitis

A

middle age/elderly

disc like plaques (50p piece)

97
Q

Features of seborrhoeic dermatitis

A

Yellow, greasy scaly rash

Distribution: eyebrows, nasolabial, scalp (cradle cap)

98
Q

Features of dyshidrotic dermatitis (pompholyx)

A

Itchy/painful blisters

Distribution:
palms + plantars
i.e. hands + feet

99
Q

Eczema herpeticum is eczema superimposed with which virus?

100
Q

Define psoriasis

A

auto-immune condition characterised by hyperproliferation of keratinocytes

101
Q

Features of psoriasis lesions

A 
Lesion:
Purple, silvery 
plaques
Dry, flaky skin
Itchy/painful

Distribution: Extensors/scalp

102
Q

extra-dermatological features of psoriasis

A

Nail signs:

  • Onycholysis
  • Pitting
  • Subungual hyperkeratosis

Psoriatic arthritis
- Symmetrical polyarthritis

103
Q

State some causes of onycholysis

A

Psoriasis
Fungal infection
Trauma
Thyrotoxicosis

104
Q

Subtypes of psoriasis

A
  • Plaque psoriasis (large, flat lesions)
  • Guttate psoriasis (raindrop on back)
  • Palmar-plantar- painful
  • Flexural psoriasis
  • Erythrodermic reactions- medical emergency (ITU)
105
Q

whic type of psoriasis might occur 2 weeks post strep infection?

A

Guttate psoriasis

Raindrop plaques

106
Q

most common type of psoriasis

A

plaque psoriasis

107
Q

which type of psoriasis is a medical emergency?

A

Erythrodermic

Systemic body redness and inflammation
Often temperature dysregulation, electrolyte imbalances

Requires hospitalisation

108
Q

What investigations are done for dermatitis?

A

Usually clinical diagnosis

Done by specialists:
Skin patch testing-  (contact dermatitis)
Bloods- IgE - RAST (atopic dermatitis)
Biopsy
Skin prick testing- allergies
109
Q

What type of hypersensitivity reaction is contact dermatitis?

A

Type 4
delayed-type hypersensitivity (DTH), involves T cell-antigen interactions that cause activation and cytokine secretion
24–48 h after exposure to soluble antigens.

110
Q

A 33 year old man presents to A&E with PR bleeding and abdominal cramps, particularly in the right iliac fossa. He decided to see the doctor because he has developed a tender rash on both of his shins, which consists of purple nodules.

What is the most likely cause of his dermatological condition?

A TB
B Ulcerative colitis
C Psoriasis
D Strep pyogenes infection
E Crohn’s disease
A

Crohn’s disease

PR bleeding + abdo pain + RIF pain = Crohn’s disease (type of IBD)

Tender purple nodules = Erythema nodosum

111
Q

A 65 year old woman presents to A&E with a 3-day history of a red, painful rash on her left shin. Her vital signs are all normal, and she is afebrile. Blood tests are unremarkeable

What is the most appropriate management?

A Topical anti-fungals
B IV antibiotics
C Commence sepsis 6 protocol 
D Oral antibiotics
E Low-molecular weight heparin
A

Oral antibiotics

112
Q

Compare the similarities between cellulitis and erysipelas

A

Both acute onset, red, hot, swollen, painful inflammation.

113
Q

Compare sites of cellulitis and erysipelas

A

CELLULITIS: dermis and deeper into subcutaneous tissue (fat)
ERYSIPELAS: more superficial, just the epidermis

114
Q

Compare appearance of cellulitis and erysipelas

A

CELLULITIS: more patchy
ERYSIPELAS: well demarcated

115
Q

Compare systemic features of cellulitis and erysipelas

A

CELLULITIS: fevers and rigors uncommon, SEPSIS more common

ERYSIPELAS: FEVERS + RIGORS common, sepsis uncommon

116
Q

RF for cellulitis/erysipelas

A

Anything that causes a break in the skin and allows bacteria to enter:

  • Wounds, ulcers, bites
  • IV cannula

Immunosuppression

117
Q

Complications of Cellulitis

A

Abscess- persistent, uncontrolled infection
Sepsis (MEDICAL EMERGENCY)- haemodynamic compromise
Necrotising fasciitis (SURGICAL EMERGENCY- need to debride tissue or it will spread)

118
Q

Complications of sinusitus

A

Periorbital cellulitis
Orbital cellulitis

MEDICAL EMERGENCY- affects vision and requires IV Abx (may require surgical decompression)

119
Q

Investigations for Cellulitis and Erysipelas

A

Usually clinical diagnosis
- Skin swab MCS

Bloods

  • FBC- high WCC
  • CRP - high
  • Blood cultures- identifies pathogen and antibiotic susceptibility

Imaging
- CT/MRI (if orbital cellulitis)

120
Q

Management of Cellulitis and Erysipelas

A

CONSERVATIVE
Draw around lesion (to see if it grows or shrinks)
Oral fluids, painkillers
Monitor observations

MEDICAL
Oral ABx (flucloxacillin)
IV ABx (if severe, or near eyes) (e.g. co-amoxiclav)

Admit if septic (confused, tachycardia/pnoea, hypotensive)

121
Q

Define erythema nodosum

A

Inflammation of subcutaneous fat (panniculitis) – type IV hypersensitivity

122
Q

Causes of erythema nodosum

A

Infections

  • Strep pyogenes
  • TB
  • HIV

Systemic diseases

  • IBD
  • Sarcoidosis
  • Behçet’s disease

Drugs- sulphonamides (ABx)

Pregnancy

123
Q

How does erythema nodosum present?

A

Bilateral nodules
Tender
Red/purple

Distribution:

  • Anterior shins
  • Knees

Does not ulcerate
Does not scar

124
Q

Non-infectious causes of erythema multiforme

A

Rheumatoid arthritis, SLE, sarcoid
Leukaemia, lymphoma, myeloma
Pregnancy
Sulphonamides, penicillin

125
Q

Which skin infection is caused by pox virus?

A

Molluscum Contagiosum.

Clinical diagnosis

126
Q

What are the features of Molluscum Contagiosum?

A

Smooth papule
Umbilicated

Usually painless
Often itchy

127
Q

RF for Molluscum Contagiosum

A

immunocompromised- HIV

not a worrying diagnosis but if widespread suggests underlying immunocompromise

128
Q

How is Molluscum Contagiosum transmitted?

A

Close contact (e.g. swimming pools, sexual contact)

Year 3 (38 decks)

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