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CP2 - Dermatology > Dermatology LOs > Flashcards

Dermatology LOs Flashcards

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Dermatology Board Prep flashcards
1
Q

The Skin and Systemic Disease: Recognise and describe the cutanous manifestations of diabetes, thyroid disease and SLE

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2
Q

The Skin and Systemic Disease: Recognise and describe the cutaneous manifestations of internal cancers

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3
Q

The Skin and Systemic Disease: Be able to diagnose erythema nodosum and suggest a list of possible triggers

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4
Q

The Skin and Systemic Disease: Recognise and describe cutaneous vasculitis, suggest a list of possible triggers and specify the appropriate investigations

A

Cutaneous vasculitis: Painful, palpable, purpura.

Purpuric papules arise in affected areas, 3-6mm in diameter.

Possible triggers:

  • Malignancy
  • Systemic disease
  • Medications
  • Infection
  • Autoimmune

Appropriate investigations:

  • Physical examination ?masses ?peripheral stigmata
  • Urine dip: ?+blood or +proteins
  • BP
  • ESR and biochemical testing (U&Es etc)
  • CXR
  • Skin biopsy
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5
Q

The Skin and Systemic Disease: Recognise and describe skin eruptions which may be caused by drugs

(THINK of specific manifestations of drug reactions)

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6
Q

Know the appropriate supportive care for patients with skin failure

A
  • Fluids: Encourage oral if possible
  • Temperature regulation e.g. blankets
  • Create an artificial barrier using emollients
  • Analgesia

May be a sequelae of erythroderma (>90% of the skin erythematous)

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7
Q

Benign and Malignant Melanocytic lesions: Know the different types of benign melanocytic naevi

A
  • Congenitial

Acquired naevi:

  • Junctional: Macular, uniform colour. Usually circular.
  • Compound: Slight elevation, lighter colour, warty, hyperkeratotic and/or hairy
  • Intradermal: Usually dome-shaped papules or nodules. Usually hairy. Light brown to flesh coloured, paler than compound.
  • Blue
  • Halo
  • Dysplastic/atypical
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8
Q

List risk factors for the development of malignant melanoma

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9
Q

Benign and Malignant Melanocytic Lesions: Recognise and describe the features of a typical melanoma

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10
Q

Benign and Malignant Melanocytic Lesions: Be familiar with the different subtypes of melanoma

A

Superficial spreading melanoma

Nodular melanoma

Lentigo maligna melanoma

Acral lentiginous melanoma

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11
Q

Benign and Malignant Melanocytic Lesions: Know the differential diagnosis of benign and malignant pigmented lesions

A
  • Pigmented seborrhoeic keratosis
  • Pigmented basal cell carcinoma: Suggestive features include translucency, firmness and telangiectasia
  • Talon noir
  • Dermatofibroma
  • Pyogenic granuloma
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12
Q

Benign and Malignant Melanocytic Lesions: Be able to discuss prognosis and management of pigmented lesions with patients

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13
Q

Benign and Malignant Melanocytic Lesions: Be able to give appropriate sun protection advice

A

Avoid excessive sun exposure by taking the following precautions: Stay in the shade between 11am - 3pm; do not burn; wear a tshirt, sunglasses and wide brimmed sunhat; take extra care with children and use sun protection factor 30+.

Application of suncream

  • Apply 2 tablespoons to the whole body
  • Apply 15-30 minutes before going into the sun
  • Reapply every 2 hours and immediately after swimming
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14
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Recognise and describe the clinical features of the pre-malignant lesions

A

Actinic keratosis

Intraepithelial carcinoma

Keratoacanthoma

Treatment options

Topical preparations

  • Imiquimod (aldara)
  • 5-fluorouracil (efudix)
  • Diclofenac

Cryotherapy

PDT

Excision

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15
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Recognise and describe the clinical features of malignant lesions, basal cell carcinoma and squamous cell carcinoma

A

Basal cell carcinoma:!Each subtype has its own clinical features!

Nodular: *MOST COMMON* Plaques/nodules with rolled pearly edges and associated telangiectasia. May have a central ulceration (common)

Superficial: Plaque-like, often indistinguishable from Bowen’s disease

Cystic

Morpheoic

Keratotic

Pigmented: Can resemble a melanoma

Squamous cell carcinoma: Keratotic (scaly/crusty), ill defined nodule which may ulcerate

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16
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Recognise and describe the clinical features of the following benign lesions

A

1: Pyogenic granuloma
2: Seborrheic keratosis
3: Dermatofibroma
4: Viral wart
5: Epidermoid cyst
6: Neurofibroma
7: Pilar cyst (found on the scalp. Orignates from the outer hair root sheath)
8: Strawberry naevus
9: Cherry angioma

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17
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Demonstrate a knowledge of the risk factors for skin cancer

A
  • Sun exposure/damage
  • Skin types 1 and 2
  • Immunosuppression: Post-transplant, HIV/AIDs
  • FHx
  • Previous skin cancer
  • Congential conditions
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18
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Discuss the difference treatment modalities available for the management of pre-malignant and malignant skin cancers

A

Pre-malignant skin cancers

  • Topical treatments: Imiquimod, 5-fluoruracil, diclofenac
  • Cryotherapy
  • PDT
  • Excision
  • Chemical peels

Malignant skin cancers

  • Excision
    • Mohs micrographic surgery is used for tumours in cosmetically sensitive areas
  • Radiotherapy
  • Chemotherapy
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19
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Be able to plan appropriate treatment for patients with the above conditions (i.e. pre-malignant and malignant skin cancers)

A
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20
Q

Non-melanoma Skin Cancers and Benign Skin Tumours: Be familiar with the various skin biopsy techniques

A
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21
Q

Leg Ulceration: Be able to diagnose a leg ulcer by correctly interpreting clinical signs

A
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22
Q

Leg Ulceration: Be able to differentiate between venous and arterial leg ulcers

A
23
Q

Leg Ulceration: Discuss the pathophysiology of venous leg ulcers

A

Venous valve incompetence and/or loss of venous muscle pump function → pooling in the venous system → venous hypertension → accumulation of toxic products, release of inflammatory products and ischaemia .

24
Q

Leg Ulceration: Discuss the management of venous leg ulcers

A

*Elevate and Compress*

  • 4-layer compression bandaging, after checking for arterial insufficiency (ABPI > 0.8 (ankle systolic pressure/brachial systolic pressure))
  • Lifelong graduated compression hosiery
25
Q

Leg Ulceration: List the 3 most common complications of chronic venous ulceration

A
  1. Wound infection and sequelae: Periostitis, osteomyelitis, osteoporosis
  2. Contact irritant dermatitis to exudates and bacterial colonisation
  3. Contact allergic dermatitis to topical medicaments
26
Q

Leg Ulceration: Carry out and interpret a Doppler assessment of ABPI

A

Ankle systolic pressure/brachial systolic pressure

Normal result: 1.2 - 1.0

*REMEMBER* Perform systolic readings on both side and then use the highest reading to calculate ABPI

27
Q

Eczema: Recognise the features of an eczematous rash

(eczema a.k.a. atopic dermatitis)

A
  • Erythema
  • Scaling
  • Xerosis (dryness)
  • Blisters and weeping
  • Fissures and lichenification in chronic disease
28
Q

Eczema: Name the main types/causes of endogenous and exogenous eczema

A
29
Q

Eczema: Know how to distinguish irritant contact from allergic contact dermatitis

A

Allergic contact: Occurs due to direct contact with the causative agent causing a skin reaction. A delayed type IV hypersensitivity reaction to an exogenous allergen. Diagnosis is confirmed through patch testing e.g. latex sensitivity

Irritant contact: Occurs due to the irritant compromising the barrier function of the skin

30
Q

Eczema: Describe the theory behind patch testing, its method and indication

A

Method:

Substances are placed under metal discs on the back. The patient is examined for reactions at 48 and 72 hours.

Indications:

  • Suspected allergic contact dermatitis
31
Q

Eczema: Recognise and describe the distribution and morphology of atopic, discoid, varicose, pompholytoc and seborhoeic eczema

A
32
Q

Eczema: List the common exacerbating factors for atopic eczema

A
  • Weather: Too hot/cold
  • Stress
  • Food allergy
  • Irritants
33
Q

Eczema: Develop a management plan for a patient with atopic eczema

A
34
Q

Eczema: List the main side effects of topical steroids and the measures needed to safeguard against these

A

Main side effects:

  • Thinning of the skin (causing telangiectasia and erythema)
  • Worsening of acne
  • Rebound psoriasis
  • Pigmentary changes
  • Local increase in hair growth

Safe use:

  • Ointments > creams
  • OD/BD application with ‘steroid free’ days
  • Only apply to active areas
  • ‘Fingertip’ units should be used e.g. 1 fingertip unit per hand
35
Q

Bacterial and Viral infections: Understand what commensal bacteria are

A

An organism which lives on or in another without causing disease under normal circumstances

36
Q

Bacterial and Viral infections: Name and recognise the different types of skin conditions that can be caused by Staphylococcus aureus

A
37
Q

Bacterial and Viral infections: Name and recognise the different types of skin conditions that can be caused by Streptococcus Pyogenes

A
38
Q

Bacterial and Viral infections: Be familiar with the clinical presentation of skin conditions caused by HPV, pox virus and VZV. Discuss management.

A
39
Q

Psoriasis: Be familiar with the different clinical presentations of psoriasis

A

Subtypes:

  • Plaque
  • Guttate
  • Plantr
  • Palmoplantar
  • Localised (flexural, genitals scalp)
40
Q

Psoriasis: List the systemic complications of severe psoriasis

A
  • Nail involvement: Onycholysis, subungal hyperkeratosis, pitting. Seen in ~50% of patients
  • Joint involvement (psoriatic arthritis)
  • Erythrodermic psoriasis *dermatological emergency*
  • Psychological distress
41
Q

Psoriasis: List at least 5 possible aggrevating factors

A
  1. Stress
  2. Smoking and alcohol
  3. Medications: ß-blockers, lithium, antimalarias
  4. UV exposure
  5. Acute illness e.g. streptococcal throat infection
  6. Skin trauma/friction
  7. Hormonal changes
42
Q

Psoriasis: Know the various topical treatment options and be able to discuss the pros and cons of each

A
43
Q

Psoriasis: Know how to write a prescription for topical treatments

A
44
Q

Psoriasis: Understand the difficulties experienced by patients

A

The PASI (psoriasis area and severity index) may be used to assess the effect of the condition.

The DLQI (dermatology life quality index) may also be used to assess the effect of the condition on hte pt.

45
Q

Psoriasis: Know the various second line treatment options and be able to discuss the risks and benefits of each

*treatments used when topical therapies have failed*

A
46
Q

Acne: Understand the 3 processes involved in the pathophysiology of acne

A
  1. Follicular hyperkeritinisation
  2. Increased sebum production
  3. Proliferation of bacterium within the sebaceous unit (p. acnes) and subsequent inflammation
47
Q

Acne: List the 3 types of acne and explain why differentiating between them is important

A
  1. Acne vulgaris
  2. Acne fulminans: Associated with systemic symptoms (fluctuating fever, arthralgia, malaise, hepatosplenomegaly)
  3. Acne conglobata
48
Q

Acne: Know the indication and potential side effects of the topical treatments used in acne

A
49
Q

Acne: Be able to describe 2 treatment options for scarring

A

Superficial scarring → microdermabrasion, dermabrasion

Ice-pick scarring1 → removal by punch biopsy

Keloid scars2 → intralesional steroids

Ice-pick scars: Associated with loss of collagen

Keloid scars: Associated with an increase in collagen

50
Q

Fungi and Infestations: Recognise and describe the cardinal physical signs of dermatophyte infection of the skin and nails

A
  • Annular rash
  • Erythematous border with central clearing
  • Well demarcated
  • Associated scaling
  • ‘Erythematous scaly annular lesion, with an area of central clearing’

Symptoms:

  • Pruritic
51
Q

Fungi and Infestations: Know how to treat infections of the skin and nails, and reocgnise when systemic therapy is required

A

Treatment of fungal infections (onychomycosis) of the nails:

  • Diagnostic nail clippings should be taken to confirm fungal infection
  • Systemic antifungal treatment - PO terbinafine

Treatment of fungal infections of the skin:

  • Diagnostic skin scrapings or follicle sample should be taken to confirm fungal infection
  • Trunk/legs/arm (corporis), face, groin/inner thigh, feet fungal infections require topical treatment
  • Hands and scalp fungal infections require systemic antifungal treatment

Indications for systemic therapy:

  • Nail, scalp, hand, beard and Majocchi’s granuloma
52
Q

Fungi and Infestations: Know the 2 common skin conditions that have been attributed to Malassezia furfur and be able to suggest appropriate treatments for these conditions

A
53
Q

Fungi and Infestations: Identify scabies infection using information from history and examination

A

History:

  • Nocturnal pruritis
  • Infestation of friends and family

Examination:

  • Linear morphology, with evidence of burrows
  • Excoriation
  • Seen at commonly affected sites such as the finger webs, flexures, axillae, breasts, ankles and insteps
54
Q

Fungi and Infestations: Know the treatments for scabies and head lice and describe how to use them properly

A

Treatment of Scabies:

  • Topical malathion or permethrin
  • Apply to the skin for 12 hours, overnight is best
  • Treatment should be repeated 1/52
  • Close contacts should also receive treatment
  • Bedding and clothing should also be washed on a high heat

Treatment of head lice:

  • Wet combing with a fine comb and plenty o conditioner
  • Should be repeated at days 5, 9 and 13.
  • There are also lotions and sprays which may be applied

CP2 - Dermatology (1 decks)

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