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CBL > Dermatology CBL > Flashcards

Dermatology CBL Flashcards

1
Q

What epithelium is the epidermis?

A

Stratified squamous keratinising epithelium

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2
Q

5 epidermal layers

A 
Basale
Spinosum
Granulosum
Lucidum
Corneum
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3
Q

Langerhan Cells

A

Dendritic cells, residing in epidermis. Ingest, rpocess and present antigens to T lympocytes

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4
Q

Melanocytes

A

Originate in neural crest and migrate to skin during early development. Live in dermis or epidermis and make pigment (melanin). Also important for skin and hair pigmentation.

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5
Q

Diff dx of chronic, red scaly skin?

A 
Psoraisis 
Exzema
Seborrhoeic dermaitits
Tinea (fungal) 
Pityriasis rosea
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6
Q

Clinical features of psoriasis

A

Well demarcated plaques on extensor surfaces
Silvery scale, hyperkeratosis
Salmon-pink inflammatory base
Flexural involvement around ears
Painful hacks and fissures within plaques on feet

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7
Q

Risk factors for psoriasis

A

Genetic - HLA subtypes.
Environmental - drugs e.g. lithium
Infection
Stress

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8
Q

Pathogenesis of psoriasis

A

Hyperproliferatioon of epidermal keratinocytes leading to reduction in transit time from basal layer to stratum corneum.

Activation of t-lymphocytes.

Thickening of epidermis, epidermal neutrophils and dilated dermal capillaries

Production of cytokines e.g. TNFa and Interleukins

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9
Q

Rheumatological signs linked with psoriasis

A

Pain and tenderness on active and passive movement of fingers and toes
Synovitis/red/swelling
Limited range of movements
Stiff sore back

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10
Q

Psoriatic arthropathy

A

Seronegative arthritis typically affecting the sacro-illiac and distal interphalangeal joints

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11
Q

Psoriasis is more common in px with which disease?

A

Chrons disease

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12
Q

Tests for psoriatic arthritis

A

FBC, Inflamm markers (CRP), RF (Negative), Alkaline phosphatase

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13
Q

Treatment for psoriasis

A

Topical - tar, corticosteroids, retinoids, Vit D3 analogs, dovobet

Systemic - retinoids, immunosuppression (methotrexate)
Final option - biological (infliximab, adalumimab)

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14
Q

Itchy skin, improves on holiday?

A

Atopic eczema most likely, possible element of allergic contact dermatitis

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15
Q

Factors involved in development of atopic eczema?

A

Defective barrier function i.e. genetic fillagrin skin protein dysfunction, irritant soaps, overworking, poor handcare

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16
Q

Investigations for atopic eczema

A 
Skin swab (2ndary bacterial infection) 
Consider fungal skin scrape to exclude tinea

Contact dermatitis patch testing

IgE count

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17
Q

Tx of atopic eczema

A

Emollient moisturisers (creams and oinments)
Potent topical steroid
Finger tip unit applications

If doesnt improve -
UV phototherapy
Oral alitretinoin
Systempic immunosuppresives (methotrexate)

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18
Q

Alopecia areata clinical symptoms/features

A 
Well circumscribed areas of hair loss
Non scarring
Follicular architecture intact
Hair pull test positive
Vellous white hair growth
Occassional nail changes
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19
Q

Aetiologies involved in development of alopecia areata

A

Exact mechanism unknown - possible autoimmune?

20
Q

Therapies for alopecia areata

A 
Topical steroid
Injected steroid
Irritant contact dermatitis treatments e.g. DCP
UVB phototherapy
Minoxidil for widespread hair loss
21
Q

Different patterns of non-scarring alopecia areata?

A 
Single patch, localised
Multiple patches
Widespread
Alopecia totalis
Alopecia universalis
Parietal pattern
22
Q

What conditions may cause hair loss including those that scar?

A

Androgenic male pattern hair loss
Scalp cellulitis
Syphilis
Untreated ringworm

23
Q

Brown marks on skin differential dx

A 
Melanocytuic naevi (moles)
Seborrhoeic keratoses (warts)
Freckles
Melanoma
Hyperpigmentation
Pigmented basal cell carcinoma
24
Q

Melanoma important dx features

A

Irregularity in shape or colour
Change in size
Bleeding or ulceration, inflammation, irritation
Lesions >5mm

25
Q

Findings on biopsy of melanoma

A

> 5mm
Active melanocytic lesion with junctional and invasive intradermal component
Cells are large, contain mitotic features
Pale cells are neoplastic melanocytes spreading in the epidermis –> dermis
Stain for melan A
Breslow thickness

26
Q

Risk factors for melanoma

A

UV irradiation (natural and artificial)
Countries with populations of white skinned individuals exposed to strong sunshine
Genetic
Numerous atypical naevi

27
Q

Genetic mutation in melanoma

A

Tumour suppressor gene CDKN 2A

28
Q

Preventative measures for melanoma’s

A

Avoid UV exposure - sunblock
Avoid sunburn
Stop using sunbeds
Follow up px with atypical naevi or strong fhx of melanoma

29
Q

Most important prognostic feature for melanoma?

A

Tumour thickness - breslow thickness

30
Q

Staging for melanomas

A

Stage 1 - Tumours <1mm thick
Tumours 1-2mm thick without ulceration

Stage 2 - Tumours 1-2mm thick with ulceration

Stage 3 - regional lymph node involvement

Stage 4 - Distant metastases

31
Q

Tx of melanoma

A

Excision with narrow margins then wide local excision

Sentinel node studies offered to px with thicker melanomas

32
Q

Distinguishing arterial with venous ulcer?

A

Venous tends to be less painful, more superficial and diffuse

33
Q

Social/lifestyle factors involved in the development of venous ulcer?

A

Multiple pregnanices
Varicose veins
Standing in a shop

34
Q

Important initial inv in venous leg ulcer

A

Ankle brachial pressure index should be roughly equal

0.8 ratio may suggest occulsion

35
Q

Initial tx for venous leg ulcer

A

Compression - 3 layer bandaging
Compression stockings
Moisturiser emollient
Topical steroid

36
Q

If the ulcer didn’t heal - what other investigations should be done?

A 
MRI angiography
SKin biopsy incase of ISD
Bacterial swabs
Exclude drug ulceration
Patch testing for bandages, dressings and steroids
37
Q

Causes of leg ulceration

A 
Arterial
Diabetic
Neuropathic
Pressure sores
Trauma
Infection
38
Q

Teenage px presents with spots on face. What is the differencial dx?

A

Acne vulgaris
Rosacea
Folliculitis
Pustular drug reaction

39
Q

Features needed for a diagnosis of acne vulgaris

A

Papules
Pustules
Comedones

May also be evidence of scarring, hyperpigmentation, nodules

Chest, back and upper arms may also be involved

40
Q

Aetiology of acne vulgaris

A

Seborrhoea, sebum retention and inflammation

May be related to excess sensitivity of sebaceous end organs to androgens

Ovarian or adrenal hyperandrogenism

Sebum retention is hyperkeratinisation of the sebaceous duct

41
Q

Therapies for acne vulgaris

A 
Topical antiseptics - benzyl peroxide
Topical Antibiotics - clindamycin 
Oral antibiotics - limecycline, doxycyline
Duac - clindamycin/benzyl peroxide
OC - Dianette
Oral retinoids - isotretinoin
42
Q

Implications of using oral isotretinoin in a teenage girl

A 
Common side effects - 
Swelling of lips
Fragile and weaker skin
Nosebleeds
Photosensitivity 
Elevated liver enzymes
Alopecia
Vision problems
Serious side effects - 
Major birth defects
Depression 
Erectile dysfunction
Hepatotoxicity
43
Q

Irregular menstruation, excess hair and severe acne?

A

Consider PCOS and congenital adrenal hyperplasia

Do hormone profiling - testosterone, progesterone, prolactin

44
Q

Social and psychological implications of acne

A

Depression
Social withdrawal
Self esteem and body image issues

45
Q

Dysmorphophobic acne

A

Some px consider their minor acne to be severe.

46
Q

A genetic compound deficiency within the skin has been implicated in eczema, what is it?

A

Filaggrin deficiency

CBL (9 decks)

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