Dermatology Teaching Flashcards

1
Q

What is teledermatology?

A

also known as skin analytics

professional clinical photography of skin lesions that can be sent digitally to a dermatologist for triage

helpful when seeing patients in clinic to review these images for comparison

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2
Q

Which benign lesion presents similarly to melanoma?

A

atypical naevus (funny looking mole)

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3
Q

Which premalignant lesions present similarly to SCC?

How would you explain these to patients who ask - “ so is this cancer? “

A

Actinic keratosis
Bowen’s disease

Sun damage to top layer of skin = actinic keratosis
Sun damage that goes slightly deeper = Bowens disease
Sun damage that affects the full thickness of the skin = squamous cell carcinoma - ulceration suggests carcinoma as it affects the full thickness

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4
Q

Which is more concerning - darker pigment at the centre of a mole, or darker pigment at the periphery?

A

Darker pigment at the periphery - suggests it is spreading

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5
Q

What are Longitudinal melanonychia?

A

dark stripes on the nails - patients with darker skin should check in their nail beds for these as they can be a precursor to melanoma

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5
Q

What is Hutchinson’s sign?

A

Suggestive of melanoma

periungual extension of brown-black pigmentation from longitudinal melanonychia onto the proximal and lateral nailfolds

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5
Q

Kaposi sarcoma often presents with visible lesions on the mucosa. How else may it present ?

A

with unilateral limb swelling

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5
Q

Which are the high risk areas of skin post-transplant for patients with darker skin?

A

patients with darker skin are more at risk in their sun protected sites post transplant- palms of hands and soles of feet and genital area - they should keep an eye on these areas for any changes

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5
Q

Which types of skin lesions are transplant patients with fair skin more susceptible to?

Which type of lesions are transplant patients with darker skin more susceptible to?

A

patients with lighter skin are more at risk of SCC
patients with darker skin are more at risk of Kaposi sarcoma

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6
Q

Which are the high risk areas of skin post-transplant for patients with lighter skin?

A

sun exposed areas - backs of hands, forearms, face, ears

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7
Q

What blood tests may you want to do for a patient with hair loss?

A

check thyroid, ferritin (aim for 70 and above) and vitamin D

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8
Q

What are these lesions?

A

solar lentigos - sun spots

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9
Q

What is this lesion?

A

an intradermal naevus

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10
Q

Do you expect new moles to develop in the older population?

A

no - any new moles over the age of 40 is concerning

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11
Q

Which immunosuppressant drug is a particular driver of skin cancer?

A

Azathioprine

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12
Q

How can you roughly estimate the percentage of body surface affected by a rash / a burn?

A

palm rule : the size of their palm = 1% of their body surface area

rule of 9s: arm = 9%, chest = 9%, stomach = 9%

13
Q

What type of hypersensitivity reaction is SJS?

A

Type 4 hypersensitivity reaction – unlike anaphylaxis, symptoms gradually come on as offending drug builds up in the body

14
Q

What should you ask all patients with suspected SJS?

A

Always ask about palms, soles and mucous membranes – involvement of these is the distinguishing feature

Always ask about OTC meds as well as prescribed
Ask about recent infection

15
Q

What systemic sxs may be seen in SJS?

A

Pyrexia
Sore throat
Flu like sxs
Sore red eyes, conjunctivitis
Arthralgia

16
Q

What is the difference between SJS and TENS?

A

SJS = 10% body involvement
TENS is the same as SJS but with over 30% body involvement

17
Q

How might you investigate SJS?

A

Skin biopsy
Culture – swab culture or blood culture
Blood tests for inflammatory markers
CXR for lung involvement

18
Q

What can be used to predict mortality in SJS?

A

SCORTEN score can be used to predict mortality in SJS and TENS cases:
Age >40
Presence of malignancy
HR >120
Initial epidermal detachment >10%

19
Q

How can you manage SJS?

A

Stop offending meds
IV Fluids
Wound care, Eye care
Analgesics, topical steroids, abx
IV Immunoglobulins (within 72 hours)

20
Q

What is pyoderma gangrenosum? How would you describe the lesions?

A

Autoimmune neutrophilic dermatosis
Usually on the legs because it is a common site of trauma
Well demarcated, erythematous, ulcerative nodule on a background of normal skin

21
Q

How could you investigate pyoderma gangrenosum?

A

Pathergy test positive – skin prick test causes a papule, pustule or ulcer
Wound swab
Skin biopsy
ANCA blood test

22
Q

How can you manage pyoderma gangrenosum?

A

Potent topical steroid – e.g. dermovate
Can also do intralesional steroid injections
Can give doxycycline because it is a very good anti-neutrophil drug
Can give oral prednisolone if severe

23
Q

Skin changes around a stoma =

A

think Pyoderma gangrenosum!