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MSRA > Dermatology/ Allergies > Flashcards

Dermatology/ Allergies Flashcards

1
Q

Lichen planus
Feature
Location
Shape

Rx

A
  1. itchy, papular rash
  2. palms, soles, genitalia and flexor surfaces of arms
  3. Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
  4. polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)

Rx

  1. Topical steroids
  2. Oral lesions - benzydamine mouthwash
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2
Q 
Lichen planus
Drug causes (3)
A
  1. gold
  2. quinine
  3. thiazides
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3
Q 
Acne rosacea 
Features (3)
Location
What can cause an exacerbation of symptoms?
Mx
A
  1. Flushing, telangiectasia, rhinophyma
  2. Typically affects nose, cheeks and forehead
  3. Sunlight may exacerbate symptoms
Mx
Mild
1. Topical metro
2. Topical brimonidine gel for pts with flushing but limited telangiectasia
Severe
3. Oxytetracycline
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4
Q 
Pemphigus vulgaris is an automimmune condition against?
Which population?
Describe the lesions
Biopsy findings
Rx (2)
A
  1. desmoglein 3
  2. Ashkenazi Jewish population
  3. Flaccid, easily ruptured vesicles and bullae, painful, not itchy
  4. acantholysis

Rx steroids, immunosuppressants

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5
Q

itchy, tense blisters typically around flexures
the blisters usually heal without scarring
there is usually no mucosal involvement

Rx

A

Bullous pemphigoid

Rx PO steroids

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6
Q

Difference between bullous pemphigoid and pemphigus vulgaris?

A

Nil mucosal involvement on bullous pemphigoid
Tense blisters in pemphigoid
Flaccid easily ruptured blisters in pemphigus
Itchy in pemphigoid, not itchy in pemphigus

Pemphigus Vulgaris - not itchy, mucosal, flaccid
Bullous pemphigoid - itchy, tense, nil mucosal involvement

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7
Q

Rash is typically maculopapular with target lesions being characteristic
May develop into vesicles or bullae
mucosal involvement
severe systemic symptoms: fever, arthralgia
starts with flu-like symptoms, followed by a painful rash that spreads and blisters

A

Stevens- Johnson syndrome

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8
Q

Stevens- Johnson syndrome

Causes

A 
penicillin
sulphonamides
anti-epileptics lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
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9
Q

Name the condition
Seen in which disease?
shiny, painless areas of yellow/red skin typically on the shin
often associated with telangiectasia

A

Necrobiosis lipoidica diabeticorum

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10
Q

Name the condition
Seen in which disease?
initially small red papule
later deep, red, necrotic ulcers with a violaceous border

A

Pyoderma gangrenosum

IBD

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11
Q

Name the condition
Seen in which disease?
symmetrical, erythematous lesions
shiny, orange peel skin

A

Pretibial myxoedema

Grave’s

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12
Q

Name the condition

symmetrical, erythematous, tender, nodules which heal without scarring

A

Erythema nodosum

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13
Q

Itchy, red skin lesions, lymphadenopathy, hepatosplenomegaly
Name the condition
What is it?

A

Mycosis fungoides
rare form of T-cell lymphoma that affects the skin
lesions tend to be of different colours in contrast to eczema/psoriasis where there is greater homogenicity

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14
Q

Psoriasis: exacerbating factors

What can exacerbate guttate psoriasis?

A

trauma
alcohol
drugs: BB, lithium, antimalarials, NSAIDs, ACEi, infliximab
withdrawal of steroids

Streptococcal infection may trigger guttate psoriasis.

BL. STAINS

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15
Q

Isotretinoin is used to treat which condition?

A

Severe acne

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16
Q

Young adult with an abdominal herald patch, followed by erythematous, oval, scaly patches in a ‘fir-tree’ distribution.
Associated with which virus?
Minority have a preceding viral illness
Mx

A

Pityriasis rosea
Self limiting 6-12 weeks
Herpes hominis virus 7 (HHV-7)

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17
Q

Differentiating guttate psoriasis and pityriasis rosea
Prodrome
Appearance
Treatment

A

Guttate: strep throat infection 2-4 weeks prior
Pityriasis: for exam situation, will unlikley to have a virus prior

Guttate:
‘Tear drop’, scaly papules on the trunk and limbs
Pityriasis: Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions. Fir tree appearance.

Guttate: self limiting 2-3 months
Pityriasis: self limiting 6 weeks

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18
Q

Zinc deficiency

Features

A
  1. perioral dermatitis: red, crusted lesions
  2. acrodermatitis
  3. alopecia
  4. short stature
  5. hypogonadism
  6. hepatosplenomegaly
  7. geophagia (ingesting clay/soil)
  8. cognitive impairment
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19
Q

What is vitiligo?
Features (2)
Location (1)

A

autoimmune condition which results in the loss of melanocytes and consequent depigmentation of the skin

  1. well-demarcated patches of depigmented skin
  2. peripheries
  3. trauma may precipitate new lesions (Koebner phenomenon)
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20
Q

Vitiligo associated conditions

A
  1. type 1 diabetes mellitus
  2. Addison’s disease
  3. autoimmune thyroid disorders
  4. pernicious anaemia
  5. alopecia areata
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21
Q

Vitiligo

Mx

A
  1. Topical steroids can reverse it if used early
  2. Sunblock
  3. Phototherapy/ topical tacrolimus
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22
Q

Venous ulceration is typically seen where?

Mx

A

Above medial malleolus
Mx
1. Compression bandaging
2. Oral pentoxifylline (improves healing rate)

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23
Q

Venous ulceration

Ix

A

ABPI

Normal range 0.9 - 1.2, low or high could indicate arterial disease

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24
Q

Difference between arterial and venous ulcers

A

Arterial lateral malleolus, end of toes, tops of feet
Venous medial malleolus

Arterial punched out, necrotic, black, deep, or pale/ light pink, well demarcated
Venous edges irregular, deep pink to red, shallow

Arterial, dry, little drainage
Venous skin will be tight, drainage present, brown pigmentation

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25
Q

symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin

A

Acanthosis nigricans

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26
Q

Acanthosis nigricans

Causes

A 
type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing's disease
hypothyroidism
Prader-Willi syndrome
drugs: oral contraceptive pill, nicotinic acid
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27
Q

It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
tear drop papules on the trunk and limbs
Age group
Mx (4)

A

Guttate psoriasis
children and adolescents

Self limiting 2-3 months
topical agents as per psoriasis
UVB phototherapy
tonsillectomy may be necessary with recurrent episodes

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28
Q 
'golden', crusted skin lesions typically found around the mouth
very contagious
=
Caused by which two bacterium?
Location
A

Impetigo

  1. Staph Aureus
  2. Strep pyogenes

tend to occur on the face, flexures and limbs

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29
Q 
Impetigo Mx (3) 
If extensive (1) 
Pen allergy (1)
School - can they go?
A

Not systemically unwell
1. hydrogen peroxide 1% cream
2. topical fusidic acid
3. topical mupirocin should be used if fusidic acid resistance is suspected
If extensive
1. Oral fluclox, if pen allergic, erythro

children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

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30
Q 
Pellagra 
Features (3) 
Deficiency in what? 
Common in which group of people? 
Describe the dermatitis, what is the name?
A 
Pellagra
3D's dementia, dermatitis, diarrhoea 
Niacin deficiency 
More common in alcoholics
Dermatitis (brown scaly rash on sun-exposed sites - termed Casal's necklace if around neck)
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31
Q

seen in children with atopic eczema and often presents as a rapidly progressing painful rash.

O/E: monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter
=?
Rx

A

Eczema herpeticum
HSV 1 or HSV2
Rx IV aciclovir = life threatening

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32
Q

An elderly woman develops a reticulated, hyperpigmented rash after using a hot water bottle excessively
over exposure to infrared radiation
Which condition
If not treated at risk of which condition?

A

Erythema ab igne

Risk of SCC

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33
Q 
atrophy of the epidermis with white plaques forming
itch 
Which condition 
Mx
Risk of which condition?
A

Lichen sclerosis
Mx topical steroids + emollients
Risk of vulval cancer

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34
Q

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

A

Seborrhoeic dermatitis

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35
Q

Seborrhoeic dermatitis

Associated with which conditions?

A

HIV

Parkinson’s disease

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36
Q

Seborrhoeic dermatitis
Scalp mx
Everywhere else mx

A

Scalp

  1. over the counter preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’)
  2. Ketoconazole

Everywhere else
topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods
difficult to treat - recurrences are common

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37
Q

large variation in colour from flesh to light-brown to black
have a ‘stuck-on’ appearance
keratotic plugs may be seen on the surface

Name the condition
Management

A

Seborrhoeic keratoses

Mx

  1. Reassurance - benign
  2. options for removal include curettage, cryosurgery and shave biopsy
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38
Q

Cysts that have a punctum?

Name two types and location

A

Sebaceous cysts

  1. Epidermoid (face, neck, trunk - can be be anywhere)
  2. Pilar (mainly scalp)
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39
Q

Scabies mx

Advice (3)

A
  1. permethrin 5% is first-line (8-12hrs)
  2. malathion 0.5% is second-line (24hrs)
    Repeat treatment 7 days later

avoid close physical contact with others until treatment is complete
all household and close physical contacts should be treated at the same time, even if asymptomatic
launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.

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40
Q

potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction. In this condition, the skin develops a scalded appearance over an extensive area

systemically unwell e.g. pyrexia, tachycardic
positive Nikolsky’s sign: the epidermis separates with mild lateral pressure

A

Toxic epidermal necrolysis

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41
Q

TEN (Toxic epidermal necrolysis)

Causes

A 
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

PSPCAN

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42
Q

TEN

Mx

A
  1. IVIG

2. immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis

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43
Q

usually not present at birth but may develop rapidly in the first month of life. They appear as erythematous, raised and multilobed tumours.
Female infants, premature infants and those of mothers who have undergone chorionic villous sampling are more likely to be affected

Mx

A

Strawberry naevus/ capillary haemangioma

  1. Topical BB e.g timolol
44
Q

What is a Cavernous haemangioma?

A

a deep capillary haemangioma

45
Q

Acne vulgaris

Classification

A

Mild
open and closed comedones with or without sparse inflammatory lesions

Moderate
widespread non-inflammatory lesions and numerous papules and pustules

Severe
extensive inflammatory lesions, which may include nodules, pitting, and scarring

46
Q

Acne vulgaris

Mx

A

Step up regime
1. single topical therapy (topical retinoids, benzoyl peroxide)

  1. topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
  2. PO tetracycline e.g lymecycline, oxytetracycline, doxycycline (max three months)
    (if pregnant use erythro)
  3. COCP (in combination with topical rx)
  4. oral isotretinoin
47
Q

Why is minocycline no longer used in treatment of acne vulgaris?

A

Risk of irreversible pigmentation

48
Q

Most common long term complication of long term abx use in acne vulgaris?
Mx

A

Gram-negative folliculitis

Mx trimethoprim

49
Q

Erythema nodosum

Causes

A 
streptococci
tuberculosis
sarcoidosis
inflammatory bowel disease
Behcet's
malignancy/lymphoma
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy
50
Q

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs > lower limbs
pruritus
Triggered by an infection
Nil mucosal involvement, if it does it is called?
Most commonly caused by?

A

Erythema multiforme
Erythema multiforme major

herpes simplex virus

51
Q

premalignant skin lesion
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present

Mx (6)

A

Actinic keratoses

Mx

  1. Avoid sun exposure
  2. fluorouracil cream: typically a 2 to 3 week course
  3. Topical hydrocortisone
  4. Topical diclofenac
  5. Topical imiquimod
  6. Cryo/ curretage/ cautery
52
Q 
caused by Malassezia furfur 
most commonly affects trunk
patches may be hypopigmented, pink or brown  more noticeable following a suntan
scale 
pruritus
A

Pityriasis versicolor

Mx
1. Topical ketoconazole
if not responsive, send scrapings +/- + oral itraconazole

53
Q 
Name the condition 
Pruritus particularly after warm bath
'Ruddy complexion'
Gout
Peptic ulcer disease
A

polycythaemia

54
Q 
Name the condition 
Pruritus
Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
Fatigue
A

lymphoma

55
Q

vascular birthmarks that tend to be unilateral. They are deep red or purple in colour
often darken and become raised over time
Rx

A

Port wine stains

Rx

  1. Cosmetic camouflage
  2. Lasertherapy
56
Q

may be precipitated by humidity (e.g. sweating) and high temperatures.

small blisters on the palms and soles
pruritic
often intensely itchy
sometimes burning sensation
once blisters burst skin may become dry and crack

Mx (3)

A

Pompholyx

Mx
cool compresses
emollients
topical steroids

57
Q

eczematous, itchy red rash in pregnancy

most common skin condition in pregnancy

A

Atopic eruption of pregnancy

58
Q

pruritic condition associated with last trimester
lesions often first appear in abdominal striae

Rx (3)

A

Polymorphic eruption of pregnancy

Rx

  1. Emollients
  2. Topical steroids
  3. PO steroids
59
Q

pruritic blistering lesions in pregnancy
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms

Rx

A

Pemphigoid gestationis

PO steroids

60
Q

Skin disorders associated with malignancy

Gastric cancer

A

Acanthosis nigricans

61
Q

Skin disorders associated with malignancy

Ovarian and lung cancer

A

Dermatomyositis

62
Q

Skin disorders associated with malignancy

Pancreatic cancer

A

Migratory thrombophlebitis

63
Q

Skin disorders associated with malignancy

Myeloproliferative disorders

A

Pyoderma gangrenosum

64
Q

papular lesions that are often slightly hyperpigmented and depressed centrally
In a ring form

A

Granuloma annulare

65
Q

Fungal nail infections

Mx

A

Do not need to be treated unless patient’s prefer
Diagnosis to be confirmed on microbiology before starting treatment

  1. PO terbinafine/ itraconazole
    Fingernails 6 weeks - 3 months
    Toenails 3 - 6 months

If candida

  1. Topical Amorolfine
  2. PO itraconazole if more severe 12 weeks

If topical treatment
Fingernails 6 month
Toenails 9-12 months

66
Q

Early keloid scars can be treated with?

A

triamcinolone

67
Q

What is erythroderma?

Causes:

A 
when more than 95% of the skin is involved in a rash
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic
68
Q

a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
Can become malignant and form which cancer?

A

Leukoplakia

SCC

69
Q

What is telogen effluvium?

A

hair loss following stressful period e.g. surgery

70
Q

What is alopecia areata and it’s treatment?

A

Autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs
Topical steroids

71
Q

pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’
slow-growth and local invasion =

Mx

A

BCC
Routine referral
surgical removal

72
Q

painful nodule on the ear
caused by persistent pressure on the ear

Mx

A

Chondrodermatitis nodularis helicis

reducing pressure on ear
cryotherapy, steroid injection, collagen injection
surgical treatment if high recurrence rate

73
Q

Type of contact dermatitis

A
  1. Irritant - usually on hands following use of detergents
    - Erythema is typical, crusting and vesicles are rare
  2. Allergic - treat with topical steroids, usually following hair dyes
    - acute weeping eczema
74
Q

Coeliacs patient
autoimmune blistering skin disorder
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

Mx

A

Dermatitis herpetiformis

Mx
gluten-free diet
dapsone

75
Q

Hereditary haemorrhagic telangiectasia (HHT)
Diagnostic criteria
Also known as?
AD/AR

A

2 out of 4

  1. FH first degree relative
  2. Epistaxis
  3. Telangiectasia multiple locations
  4. Visceral lesions e.g AV malformations, GI telangiectasia

Osler-Weber-Rendu syndrome
AD

76
Q

SCC RFs

A
  1. excessive exposure to sunlight / psoralen UVA therapy
  2. actinic keratoses and Bowen’s disease
  3. immunosuppression
  4. smoking
  5. long-standing leg ulcers (Marjolin’s ulcer)
  6. genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
77
Q

SCC Mx

A

<20mm in diameter
excision with 4mm margin

> 20mm in diameter
excision with 6mm margin

78
Q

What is the single most important factor in determining prognosis of patients with malignant melanoma?

A

invasion depth of a tumour (Breslow depth)

79
Q

well demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp

A

plaque psoriasis

80
Q

name the type of psoriasis

commonly occurs on the palms and soles

A

pustular psoriasis

81
Q

Complications of psoriasis

A

psoriatic arthropathy
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism

82
Q

Nail changes in psoriasis

A

pitting
onycholysis
subungual hyperkeratosis
loss of nail

83
Q

Children with a new purpuric rash ddx (2)

A
  1. meningococcal septicaemia

2. ALL

84
Q

Causes of pyoderma gangrenosum (7)

Rx

A
  1. Idiopathic
  2. IBD
  3. RA
  4. SLE
  5. Lymphoma/ leukemia
  6. Myeloproliferative disorders
  7. PBC

Rx steroids

85
Q

most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
initially small red/brown spot
rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
the lesions may bleed profusely or ulcerate

Rx

A

Pyogenic granuloma

If in pregnancy - will resolve on its own post partum
Otherwise cautery/ curretage/ cryo

86
Q

What is Hyperhidrosis?

Mx

A

Excessive sweating

  1. topical aluminium chloride S/E skin irritation
  2. iontophoresis useful in palmar, plantar and axillary hyperhidrosis
  3. botulinum toxin: currently licensed for axillary symptoms
  4. surgery: e.g. Endoscopic transthoracic sympathectomy
87
Q

said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
Benign

Mx

A

Keratoacanthoma

Mx
Can resolve on their own within 3 months
However similar looking to SCC therefore excision

88
Q

What is the assessment for hirsutism?

A

Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

89
Q

Hirsutism mx

A
  1. Weight loss
  2. Waxing/bleaching
  3. Dianette/ Yasmin (not for long term use given risk of VTE)
  4. topical eflornithine for facial hirsutism
90
Q

Causes of hypertrichosis

A

drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa

91
Q

characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter. In clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet)
In children - trunk and flextures

sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen

A

Molluscum contagiosum

92
Q

Molluscum contagiosum
Mx

When to refer?

A
  1. Self limiting 18 months
  2. Contagious, do not share towels etc, nil exclusion from school necessary
  3. Squeezing post bath
  4. Cryo
  5. HIV +ve –> refer to HIV specialist
  6. Eyelid involvement –> refer to ophthalmologist
  7. Ano-genital lesions –> refer to genito-urinary medicine for screening for other STIs
93
Q

Prodromal period - burning pain over a dermatome followed by a rash =

Mx

Complications (3)

A

HZV = shingles

Contagious until they are crusted over, avoid pregnant people, cover it up.

Mx

  1. Paracetamol + NSAIDs for pain
  2. PO aciclovir if presenting within 72h hours

Complications

  1. post herpetic neuralgia
  2. herpes zoster ophthalmicus
  3. herpes zoster oticus (Ramsay Hunt syndrome) - ear lesions and facial paralysis
94
Q

Affects children. More common in atopic patients with a history of eczema
Soles become shiny and hard. Cracks may develop causing pain
Worse during the summer

A

Juvenile plantar dermatosis

95
Q

Affects people who sweat excessively
Patients may complain of damp and excessively smelly feet
Usually caused by Corynebacterium
Heel and forefoot may become white with clusters of punched-out pits

A

Pitted keratolysis

96
Q

May be acquired or congenital

Describes a thickening of the skin of the palms and soles

A

Keratoderma

97
Q

Secondary to the human papilloma virus
Firm, hyperkeratotic lesions
Pinpoint petechiae centrally within the lesions
May coalesce with surrounding warts to form mosaic warts

A

Verrucas

98
Q

Psoriasis
Mx
Plaque psoriasis
(4)

A

Plaque psoriasis

  1. Emollients + topical corticosteroids + vit D analogue OD for four weeks
  2. If no improvement after 8- 12 weeks, vit D analogue BD
  3. If no improvement after 8-12 weeks, topical corticosteroids BD for 4 weeks or coal tar prep OD/BD
  4. dithranol
99
Q

Exampled of vit D analogue
How long can they be used for?
How do they work?

A

calcipotriol (Dovonex), calcitriol and tacalcitol
can be used long term
reduce the scale and thickness, but not the erythema
Not to be used in pregnancy
100g max weekly

100
Q

Time between potent steroids
How long can very potent steroids be used for?
How long can potent and topical steroids be used for?
Topical steroids on scalp, face, flexures - how long can they be used for?

A

4 weeks between potent steroids
4 weeks
8 weeks
1-2 weeks/ month

101
Q

Secondary care management of psorasis

A
  1. Phototherapy three times per week
  2. MTX - good for joint disease
  3. Biologics
102
Q 
loss and thinning of hair in response to severe stress
Options
Trichotillomania
Androgenetic alopecia
telogen effluvium
alopecia totalis
A

Telogen effluvium

103
Q 
complete loss of all hair of the head and face.
Options
Trichotillomania
Androgenetic alopecia
telogen effluvium
alopecia totalis
A

alopecia totalis

104
Q

a disorder where people pull their own hair out, would give asymmetrical, uneven hair loss, and might be preceded by other psychiatric complaints.

Options
Trichotillomania
Androgenetic alopecia
telogen effluvium
alopecia totalis
A

Trichotillomania

105
Q

female-pattern baldness, would be suggested by a family history of the same, and is more likely in an older patient.

Options
Trichotillomania
Androgenetic alopecia
telogen effluvium
alopecia totalis
A

Androgenetic alopecia

MSRA (22 decks)

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