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* year 3 special senses > dermatology (in depth) > Flashcards

dermatology (in depth) Flashcards

1
Q

dermatitis

  • main three types? (+ causes)
  • presentation?
  • treatment?
A
  • atopic dermatitis (eczema)
  • allergic contact dermatitis
    (both autoimmune)
  • irritant contact dermatitis
    (caused by over exposure to water, cold, certain chemicals)

red, itchy, scaly patches (norm on inside of joints) with accompanying scarring

  • topical steroids if autoimmune
  • remove irritants/moisturise

nb autoimmune often occurs in ‘flare ups’

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2
Q

psoriasis

  • what is it?
  • presentation?
  • treatment?
A

autoimmune condition which results in over production of skin cells
-> scaly patches on extensor surfaces

  • normally small patches but can be larger and can also effect joints (psoriatic arthritis)

topical steroids and vit D treatment
- if bad, us UV treatment

nb sun is good as damages skin cells!

nb affects around 2% of people, men = women

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3
Q

acne vulgaris

  • what is it?
  • presentation?
  • treatment?
A

inflammatory disease of hair follicle
- androgen makes worse

varying lesions on face, chest + top of back

mild:
- open + closed comedones (black + white heads)

moderate:
- above PLUS inflammatory lesions (papules, pustules, nodules + cysts)

severe:
- above but worse/more lesions

treatment depends on severity:

  • topical therapies (benzoyl peroxide, Abx, retinoids)
  • oral therapies (anti-androgens, Abx, retinoids)

nb vulgaris means common

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4
Q

Rosacea:

  • what is it?
  • presentation?
  • treatment?
A

poorly understood condition

  • flushing
  • persistent facial redness
  • visible blood vessels
  • papules + pustules
  • thickened skin

often worse on nose, cheeks, forehead + chin

nb sunlight makes it worse

  • topical metronidazole
  • topical azelaic acid
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5
Q

urticaria:

  • pathogenesis?
  • causes? 4
  • treatments? 2
A

a trigger causes high levels of histamine to be released in the skin -> leakage from blood vessels -> red, swollen pathes which are itchy

nb looks like a severe nettle rash

  • allergic reaction (eg to food or insect bite/sting)
  • cold or heat exposure
  • infection (eg common cold)
  • some drugs (eg NSAIDs, Abx)

nb complication of severe urticaria is angioedema +/or anaphylaxis

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6
Q

lichen planus:

  • what is it?
  • what does it look like?
  • treatment? 2
  • prognosis?
A

a chronic inflammatory skin condition affecting skin +/or mucosal surfaces
- several different types

  • cutaneous lesions look a bit like psoriasis but less white scale and are often itchy
  • mucosal lesions (most often in mouth) often begin as painless white streaks but can become painful and more ulcer-like
  • lesions on nails cause thinning and ridging of nails + nails may stop growing

nb are other variants but 3 above are most common

  • topical (or oral) steroids
  • if severe, can use drugs such as methotrexate

nb treatment is not needed for mild cases which are often self-limiting

nb can lead to cancer dt chronic inflammation

  • tends to clear within a couple of years in most people but mucosal lichen planus persists longer (eg around a decade)
  • spontaneous recovery is unpredictable + may suffer recurrence
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7
Q

impetigo:

  • appearance?
  • causative organisms? 2
  • how enter skin?
  • other risk factors? 2
A

itchy red sores that eventually crust over before healing with a red patch
- often itchy

  • staph aureus
  • strep pyogenes

through:

  • cut
  • insect bite
  • eczema
  • diabetes
  • immunocompromised (HIV, on chemo)

nb very contagious

nb normally found around nose + mouth but can affect other sites too

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8
Q

impetigo:

  • non-pharm management? 2
  • pharm management? 1
A
  • don’t itch/scratch
  • avoid close ocntact w others (esp kids)
  • topical Abx (oral if v bad, fever etc)
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9
Q

cellulitis and erysipelas:

  • what’s the difference?
  • norm causative organisms? 2
  • who’s at risk? 11
A

erypsiela = infection of upper dermis + sub cut lymphatics

cellulitis = infection of lower dermis + subcut tissue

nb often occur together

  • strep pyogenes (group A strep) - 2/3rds
  • staph aureus - 1/3rd

nb strep pyogenes causes almost all erysipelas

  • previous episode of erysipelas/cellulitis
  • underlying skin condition (athletes foot, tinea pedis, cracked heels)
  • venous disease +/or lymphoedema
  • injury/trauma (incl radiation)
  • immunodeficiency
  • immunosuppressive meds
  • diabetes
  • CKD
  • chronic liver disease/alcoholism
  • obesity
  • pregnancy

nb young and elderly most at risk pops

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10
Q

cellulitis + erysipelas:

  • clinical presentation?
  • where on body norm affected?
  • treatment?
A

very sharp raised border (in erysipelas)

bright red, firm and swollen

(dimpled skin - peus d’orange)

painful and warm

can be blistering and necrotic

can have fever

norm on legs but can be anywhere

  • wound care/dressings
  • elevation of leg

Abx - norm penicillin based

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11
Q

cellulitis:

- differential diagnoses? 10

A
  • eczema/dermatitis
  • psoriasis
  • thrombophlebitis
  • fungal infection (eg tinea corporis)
  • drug reaction
  • insect bites/stings
  • radiation damage (eg radiotherapy)
  • inflammatory breast cancer
  • lipodermatosclerosis
  • DVT
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12
Q

folliculitis:

  • cause?
  • 2 commonest causative organisms?
  • where found on body?
A

inflammation of hair follicles

can be due to infection, occlusion + various skin diseases

norm staph aureus in bacterial folliculitis

(nb pseudomonas aeruginosa infects people in hot tubs if inadequately chlorinated)

norm:

  • chest, back, buttocks, arms, legs or face
  • ie anywhere there’s hair

tender red spots, often with a surface pustule

nb acne is also a form of folliculitis

trestment depends on cause

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13
Q

intertrigo:

  • what is it?
  • where does it affect?
  • risk factors? 3
A

an inflammatory rash in the flexures or body folds

nb can get superficial infection on top of

  • overweight
  • genetic tendency to skin disease
  • hyperhydrosis (incl dt hot/humid climate)
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14
Q

difference between chicken pox and shingles:

  • transmission
  • signs/symptoms
  • distribution of rash
  • character of rash
A

chicken pox:

  • respiratory secretions + vesicular fluid
  • – malaise, fever, rash
  • truck initially, progressing to face + extremities
  • non-grouped, itchy vesicles

shingles:

  • reactivation of VZV in nerve root
  • – dermatological rash, neuralgia, weakness of affected nerve, malaise, fever
  • a nerve root distribution, often on trunk or branch of trigeminal
  • grouped, markedly erythematous, painful vesicles
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15
Q

Herpes simplex:

  • two types? where do they infect?
  • mechanism of reactivation?
  • common triggers? 4
  • treatment?
A

Herpes simplex type 1 - mouth

Herpes simplex type 2 - genitals

  • virus stays active in nerve root and is then reactivated to form a blistering spot, often in the same place
  • other infections (e.g. cold or flu)
  • sunlight on the area
  • generally getting run down
  • a skin injury at the sight of recurrence
  • antiviral tablets (take as soon as notice it’s coming +/- antiviral cream
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16
Q

HIV

  • pathogenesis?
  • high risk groups? 4
  • initial symptoms?
A

Virus binds to CD4 receptors on helper T cells and then replicate inside the cell before bursting out to bind to other helper T cells

  • sex workers
  • MSM
  • black African heterosexuals
  • IVDU

1-2 week flu-like illness

  • fever
  • sore throat
  • body rash
  • fatigue
  • joint pain

nb then can be a latent period varying from a month to over 10 years with no symptoms

17
Q

HIV:

  • definition of AIDS?
  • list some of the conditions?
A

1) infected with HIV virus
AND
2a) a CD4+ T-cell count below 200 cells/uL
OR
2b) has one of the aids-defining conditions

  • candidiasis of oesophagus/trachea/lungs (nb not mouth)
  • cervical cancer (invasive)
  • cytomegalovirus
  • encephalopathy (HIV-related)
  • chronic herpes simplex (ulcer for >month)
  • Kaposi’s sarcoma
  • certain types of lymphoma
  • TB (any)
  • toxoplasmosis of brain
  • wasting syndrome (due to TB)

nb there are about 30 conditions in all!

18
Q

HIV

  • two types of prophylaxis?
  • two monitoring blood tests?
  • treatment
A
  • PEP (post-exposure prophylaxis)
  • PrEP (pre-exposure prophylaxis)
  • HIV viral load (conc of virus in blood)
  • CD4 count (affect of virus on immune system

HAART

19
Q

viral warts:

  • virus cause?
  • what are they?
  • group most commonly affected?
  • possible complication?
  • treatments?
A

human papilloma virus (HPV)

hyperkeratotic papules

children

HPV 16 + 18 infection around genitals can lead to cervical or penile carcinoma

  • paints/gels of salicylic acid
  • occlusion with duct tape
  • cryotherapy
  • regular paring with a scalpel
20
Q

molluscum contageosum:

  • what is it?
  • who gets it?
  • what it looks like?
  • management?
A

Viral infection that affects skin

  • mainly children
  • immunosuppressed (HIV, chemo)

The spots are usually firm and dome-shaped, with a small dimple in the middle. They’re usually less than 5mm (0.5cm) across, but can sometimes be bigger.

They’re typically pink or red, although they may have a tiny white or yellow head in the centre. If this head ruptures (splits), a thick yellowy-white substance will be released, which is highly infectious.

Normally self limiting

Treat if immunosuppresed or particularly unsightly in adults

21
Q 
Tinea:
- causative organism?
Name if infects:
- beard
- head
- body
- groin
- foot
- nail

Treatment?

A
  • dermatophyte fungus
  • beard - tinea barbae
  • head - tinea capitis
  • body - tinea corporis (ringworm)
  • groin - tinea cruris (jock itch)
  • foot - tinea pedis (athletes foot)
  • nail - tinea unguium

Topical antifungals (systemic for barbae, capitis + unguium as doesn’t penetrate hair or nails)

Keep area dry!!

22
Q

genital candida:

  • who’s at risk? 3
  • symptoms in women?
  • symptoms in men?
  • treatment? 3
A
  • pregnant + breastfeeding women
  • diabetes
  • poor immune system
  • white discharge (like cottage cheese, nb not usually smelly)
  • vaginal itching/irritation
  • soreness & stinging during sex or when peeing
  • irritation, burning + redness around head of penis
  • white discharge (like cottage cheese)
  • unpleasant smell
  • difficulty pulling back foreskin
  • oral antifungals
  • antifungal creams
  • pessary (pills in vag)
23
Q

oral candida:

  • risk factors? 5
  • symptoms/signs? 4
  • treatment? 2
  • prevention? 1
A
  • chemo/radiotherapy
  • on corticosteroids (incl inhalers) or wide-spec Abx
  • wear dentures
  • have diabetes
  • have HIV (can spread to oesophagus)
  • white/yellow patches on tongue, lips, gums, roof of mouth + inner cheeks
  • redness + soreness in mouth + throat
  • cracking at corners of mouth
  • pain when swallowing
  • antifungal gels
  • oral antifungals
  • chlohexadine mouthwash if at risk/poor immune system
24
Q

Pityriasis versicolor:

  • what is it?
  • what does it look/feel like?
  • risk factors? 2
  • treatment?
A

yeast infection of the skin

  • scaly patches of hypo or hyper pigmented skin on trunk, neck +/or arms

can be itchy or not

  • young adults
  • hot, humid climates (summer, sweating)
  • topical antifungals
25
Q

scabies:

  • what is it?
  • who most at risk?
  • how does it present? 3
  • pharm management? 1
  • non-pharm management? 2
A

parasite burrowing under the skin + laying eggs

  • people who live in close proximity to others (uni halls, care homes etc)
  • intense itching (esp at night)
  • bumpy lines under skin -> red dots, norm starts on the hand + works way up
  • rash spreads over whole body (norm bar head/neck)

it is VERY contagious so likely to have spread to others in household etc

  • topical cream (Permethrin 5% cream)
  • everyone in house needs to be treated
  • wash all bedding + clothing at hight temps
26
Q

insect bite reactions:

  • three types of reaction?
  • how to treat?
  • when to get help?
A
  • normal reaction
  • local allergic reaction
  • anaphylactic reaction
  • avoid scratching
  • cold compress
  • anti-histamines (cream +/or oral)
  • if get anaphylaxis
  • if symptoms are getting worse or don’t improve after a few days
  • if large area (>10cm) around bite becomes red +swollen
  • flu-like symptoms
27
Q

head lice

  • what are nits?
  • symptoms?
  • treatment?
A
  • head lice eggs
  • itching
    (sometimes feeling like there’s something moving in your hair)
  • OTC head lice shampoos
  • comb through with a special comb
28
Q

what are melanocytic naevi?

A

pigmented moles

have potential to develop in to melanoma but vast majority don’t

29
Q

malignant melanoma:

  • risk factors? 6
  • commonest type?
  • acronym for working out if a mole is likely to be malignant? 5
  • treatment?
  • staging system?
A
  • increasing age
  • many melanocytic naevi (moles)
  • white skin (that burns easily)
  • PMH of any type of skin cancer
  • FH of melanoma
  • excessive sun exposure
  • superficial spreading melanoma (70%)

nb can get nodular or ones around nails or melanotic too

ABCDE

A - Asymmetry
B - Border irregularity/blurred
C - Colour if not uniform
D - Diameter >6mm
E - Evolving size, shape or colour (or elevation)

also

  • itchy
  • bleeding or becoming crusty

normally on back in.men + legs in women

  • surgical removal
  • breslow thickness
30
Q

basal cell carcinoma

  • risk factors? 6
  • colloquially called?
  • look + other symptoms?
  • treatment? 4
A
  • age
  • male
  • PMH of any type of skin cancer
  • sun damage, esp repeated sunburn
  • fair skin
  • immunosuppression
  • rodent ulcer
  • small, shiny pink or pearly white lump, sometimes variation in pigment
  • rolled edge
  • lump slowly grows + may become crusty, bleed
  • non-healing

nb normally found on sun-exposed skin

  • surgery
  • cryotherapy
  • anti-cancer creams
31
Q

squamous cell carcinoma

  • risk factors? 7
  • look and other symptoms?
A
  • age
  • male
  • PMH of any type of skin cancer
  • sun damage, esp repeated sunburn
  • fair skin
  • immunosuppression
  • actinic keratosis
  • enlarging scaly or crusted lumps
  • usually arise within pre-existing actinic keratosis
  • may ulcerate
  • often painful or tender
  • appear on sun-exposed sites
32
Q

squamous cell carcinoma

  • factors which indicate a poorer prognosis? 3
  • primary site of metastasis?
  • treatment?
A
  • diameter > 2cm
  • location on ear, lip, central face, hands, feet, genitalia (near orifices)
  • immunocompromised or elderly patients
  • regional lymph nodes (80%)
  • surgery/excision is mainstay
  • can do intensive cryotherapy if very small
  • can do adjuvant radiotherapy if spread or large
33
Q

seborrhoeic keratosis:

  • colloquial name?
  • what is it?
  • who gets it?
  • prognosis?
  • management?
A

seborrhoeic warts

harmless warty spot that appears during adult life as a common sign of skin aging (some people have hundreds)
- stuck on warty plaque

all people of all races as they get older, start to develop in 30s, rare under age of 20 (90% of over 60s have some)

  • some genetic component
  • not related to sun exposure
  • no malignant potential (but may be mistaken for malignancy)
  • if itchy, catches on clothing or unsightly can be removed by shave excision and other methods
  • if worried, take picture and monitor over time

nb often grow during pregnancy due to increase in hormones

don’t confuse with ACTINIC keratosis which is premalignant!!! - totally different but similar name!

34
Q

lipoma:

  • what are the features of it?
  • risk factors? 3
  • diagnosis?
  • treatment?
A
  • grows under skin in subcutaneous tissue
  • dome or egg-shaped lump 2-10cm in diameter
  • feels soft + smooth + is easily moved under the skin with the fingers
  • some have rubbery or doughy consistency
  • grow slowly over many years
  • most common on shoulders, trunk, neck + arms
  • if painful may be a liposarcoma but, more commonly just have more blood vessels (angiolipoma)
  • FH
  • can occur following trauma to area
  • tend to develop during middle age
  • clinical diagnosis, if any doubt, can do biopsy

often need no treatment, most stop growing
- if interfere with movement can remove surgically or by liposuction

35
Q

epidermoid cyst:

  • previously known as?
  • what are they?
  • common sites?
  • complications? 2
  • management?
A
  • sebaceous cysts

slow-growing overgrowth of epidermoid cells with dense fluid inside
- no malignant potential

anywhere where there is little hair:

  • face
  • neck
  • trunk

most arise in adult life

  • infection
  • rupture (irritates surrounding skin)

leave alone

  • can excise but often recur
  • drain and treat w Abx if infected
36
Q

dermatofibromas:

  • what are they?
  • what do they look like?
  • where normally found?
  • gender more commonly affected?
  • most common complication?
  • treatment? (incl when given)
A

common benign fibrous nodule

small (0.5-1.5cm diameter), firm nodules, tethered to the skin+ mobile over sub cut tissue

  • skin dimples on pinching the lesion
  • may appear paler in the centre

normally found on lower legs (sometimes arms)

  • women
  • often traumatised by things like shaving, may be itchy or painful

nb if immunosuppressed, lots can emerge in short space of time - nb no malignant potential

can be removed surgically if bothering
- can be biopsied if irregular or other signs suspicious of dermatofibrosarcoma

37
Q

campbell de morgan spots

  • aka?
  • what are they?
  • what do they look like?
  • where on body normally found?
  • what increases risk?
  • treatment?
A 
cherry angioma (aka senile angioma)
- benign overgrowth of endothelial/blood vessel cells

firm red, purple or blue papule (when thrombosed, can appear black)

  • trunk + head
  • increase in number after age 40

none, unless remove for cosmetic reasons
- if large may remove to exclude nodular melanoma

38
Q

fibroepithelial polyps:

  • colloquially known as?
  • what can they be mistaken for? 2
  • commonest areas found on body?
  • risk factors? 3
  • treatment?
A

skin tags

often mistaken for:

  • seborrhaeic keratosis
  • molluscum contagiosum
  • skin folds (neck, armpit, groin)
  • obesity
  • diabetes mellitus
  • increased age

harmless
- can be removed for cosmetic reasons using crytherapy, surgery or by ligation (tieing a suture around base)

* year 3 special senses (4 decks)

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