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Phase 3a > GP - Derm > Flashcards

GP - Derm Flashcards

1
Q

What are the clinical features of eczema?

A
  • Itchy, erythematous rash exacerbated by repeated scratching
  • Infants = face/trunk
  • Young children = extensor surfaces
  • Older children = flexor surfaces/creases of face and neck
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2
Q

Describe the pathophysiology of eczema

A
  • Defects in the normal continuity of the skin barrier
  • Provides entrance for irritants/microbes/allergens
  • Inflammation in skin
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3
Q

What is the management for eczema?

A

Create artificial barrier using emollients
- Thin = creams (E45/diprobase/cetraben/epaderm)
- Thick/greasy = ointments (hydromol/diprobase/cetraben/epaderm)

  • Avoid hot baths/scratching/certain soaps
  • Topical steroids (flares)
  • Wet wraps (flares)
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4
Q

What steroids are used for eczema?

A

Mild = hydrocortisone

Moderate = betamethasone/clobetasone

Potent = fluticasone propionate/betamethasone valerate

Very potent = clobetasol propionate

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5
Q

What are risk factors for psoriasis?

A
  • Genetics = HLA-B13/HLA-B17/HLA-Cw6
  • Environment (skin/trauma/stress)
  • Improves in sunlight
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6
Q

What are the clinical features of psoriasis?

A

-Red/scaly patches on skin
- Pitting/onycholysis
- Arthritis

  • Plaque psoriasis = most common = well-demarcated red scaly patches affecting extensor surfaces/sacrum/scalp
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7
Q

What are the subtypes of psoriasis?

A
  • Plaque psoriasis (most common - typical presentation)
  • Flexural psoriasis (skin is smooth)
  • Guttate psoriasis (transient rash triggered by strep infection –> teardrop lesions)
  • Pustular psoriasis (palms/soles)
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8
Q

What are exacerbating factors for psoriasis?

A
  • Trauma
  • Alcohol
  • Drugs (beta blockers/lithium/antimalarials/NSAIDs/ACEis/infliximab)
  • Withdrawal of systemic steroids
  • Strep infection (may trigger guttate psoriasis)
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9
Q

What is the management for psoriasis?

A
  • Regular emollients
  • Potent corticosteroid + vitamin D analogue
  • Coal tar preparation
  • Short acting dithranol
  • Phototherapy
  • Systemic therapy e.g. methotrexate
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10
Q

What are complications of psoriasis?

A
  • Psoriatic arthropathy
  • Increased risk of metabolic syndrome
  • Increased risk of CVD/VTE
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11
Q

What is Koebner phenomenon?

A

Psoriasis develops in areas of trauma or friction

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12
Q

What is intertrigo?

A

Rash in flexures e.g. behind ears/folds of neck/under arms/finger webs due to skin-to-skin friction intensified by heat and moisture

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13
Q

What are risk factors for intertrigo?

A
  • Obesity
  • Hyperhidrosis
  • Age
  • Diabetes
  • Smoking
  • Alcohol
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14
Q

What are the clinical features of intertrigo?

A
  • Inflamed/reddened/uncomfortable skin
  • Moist/macerated skin leading to fissuring and peeling
  • Foul odour (if secondary bacterial infection e.g. pseudomonas)
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15
Q

What are some infections that can cause intertrigo?

A
  • Thrush (candida albicans)
  • Tinea cruris/athlete’s foot
  • Impetigo (staph aureus/strep pyogenes)
  • Boils (staph aureus)
  • Folliculitis (staph aureus)
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16
Q

What are the investigations for intertrigo?

A
  • Swab for culture/microscopy (bacterial/fungal)
  • Skin biopsy for histopathology
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17
Q

What is the management for intertrigo?

A
  • Treat underlying cause
  • Zinc oxide paste
  • Physical exertion followed by bathing/completely drying skin flexures
  • Antiperspirant cream/powder
  • Topical abx/antifungals
  • Low potency steroid creams
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18
Q

What is tinea and give some examples?

A

Dermatophyte fungal infections
- Tinea capitis - scalp (scalp ringworm)
- Tinea corporis - trunk/legs/arms (ringworm)
- Tinea pedis - feet (athlete’s foot)
- Tinea cruris - groin

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19
Q

What are the features of tinea?

A
  • Scarring alopecia (tinea capitis)
  • Well-defined erythematous lesions with pustules/papules
  • Itchy/peeling skin
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20
Q

What is the management for tinea?

A
  • Anti-fungal creams (clotrimazole)
  • Anti-fungal shampoos (ketoconazole)
  • Anti-fungal oral medications (fluconazole)
  • Topical steroid
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21
Q

What is pityriasis versicolor and what causes it?

A
  • Common yeast infection of the skin
  • Yeast = malassezia
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22
Q

Describe the epidemiology of pityriasis versicolor

A
  • More common in men
  • More common in hot/humid climates (people that perspire heavily)
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23
Q

What are the clinical features of pityriasis versicolor?

A
  • Flaky discoloured patches on the trunk/neck/arms
  • Usually asx but may be itchy
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24
Q

What is the management for pityriasis versicolor?

A
  • Topical antifungals (selenium sulfide shampoo; topical econazole/ketoconazole cream/shampoo; terbinafine gel)
  • Oral antifungals (itraconazole/fluconazole)
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25
Q

What are some inducible features of urticaria?

A
  • Cold urticaria
  • Cholinergic urticaria
  • Contact urticaria
  • Sun urticaria
  • Heat urticaria
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26
Q

What is the management for urticaria?

A
  • Non-sedating antihistamine e.g. cetirizine/loratadine
  • Sedating antihistamine e.g. chlorphenamine
  • Prednisolone (severe/resistant episodes)
  • Avoidance of trigger factors
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27
Q

What is the cause of chickenpox and how is it spread?

A
  • Varicella zoster virus
  • Shingles = reactivation of dormant virus in dorsal root ganglion
  • Respiratory droplets
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28
Q

What are the clinical features of chickenpox?

A
  • Fever initially
  • Itchy rash that starts on head/trunk = macular –> papular –> vesicular
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29
Q

What is the management for chickenpox?

A
  • Calamine lotion
  • School exclusion until all lesions are dry and have crusted over
  • Varicella zoster immunoglobulin (VZIG) if immunocompromised/newborns
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30
Q

What are complications of chickenpox?

A
  • Secondary bacterial infection (cellulitis/group A strep/necrotising fasciitis) –> DO NOT GIVE NSAIDS
  • Pneumonia
  • Encephalitis
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31
Q

Describe the typical features of measles

A
  • Fever
  • Coryzal sx
  • Conjunctivitis
  • Koplik spots (blue/white spots in cheek)
  • Rash starts behind ears and spreads
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32
Q

What is the management for measles?

A
  • Supportive
  • Consider admission in immunosuppressed/pregnant patients
  • Notify public health
  • MMR vaccine (1 year and 3 years)
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33
Q

What are the complications of measles?

A
  • Otitis media
  • Pneumonia
  • Encephalitis
  • Febrile convulsions
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34
Q

What is molluscum contagiosum and who is it most common in?

A
  • Skin infection caused by molluscum contagiosum virus (MCV)
  • Children (often with atopic eczema) around 1-4 years
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35
Q

What are the clinical features of molluscum contagiosum?

A
  • Pink/white papules with central umbilication/dimple
  • Lesions appear in clusters on the body (NOT palms/soles)
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36
Q

What is the management for molluscum contagiosum?

A
  • Self-limiting
  • Spontaneous resolution within 18 months
  • Avoid sharing towels/clothing/baths as lesions are contagious
  • Don’t scratch

Treatment (not usually recommended - only if troublesome):
- Squeezing/piercing lesions following a bath
- Cryotherapy
- Topical corticosteroid/abx if eczema/inflammation around lesions

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37
Q

What are the features of herpes simplex virus?

A
  • Gingivostomatitis (blisters on lips/canker sores in mouth)
  • Cold sores
  • Painful genital ulceration
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38
Q

What is the management for herpes simplex virus?

A
  • Oral/topical aciclovir
  • Chlorhexidine mouthwash
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39
Q

What is the guidance for pregnant patients with herpes simplex virus?

A
  • Elective c-section at term if primary attack occurs >28 weeks
  • Recurrent herpes = suppressive therapy to reduce risk of transmission
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40
Q

What is shingles?

A

Herpes zoster infection caused by reactivation of varicella zoster virus - virus lies dormant following primary infection (chickenpox) in dorsal root/cranial nerve ganglia

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41
Q

What are the risk factors for shingles?

A
  • Increasing age
  • HIV
  • Immunosuppression
42
Q

What are the clinical features of shingles?

A
  • T1-L2 dermatomes most affected
  • Prodromal period = burning pain/fever/headache/lethargy
  • Erythematous, macular rash –> becomes vesicular
43
Q

What is the management for shingles?

A
  • Analgesia
  • Infectious until vesicles have crusted over
  • Antivirals within 72 hours (aciclovir/famciclovir/valaciclovir)
44
Q

What are the complications of shingles?

A
  • Post-herpetic neuralgia (most common)
  • Herpes zoster ophthalmicus
  • Herpes zoster oticus (Ramsay Hunt syndrome)
45
Q

What are the clinical features of pityriasis rosea?

A
  • May have recent viral infection sx
  • Herald patch (usually on trunk)
  • Erythematous, oval, scaly patches (fir tree appearance)
46
Q

What is the management for pityriasis rosea?

A

Self-limiting = usually disappears after 6-12 weeks

47
Q

What is impetigo and what is it caused by?

A
  • Superficial bacterial skin infection
  • Usually staph aureus or strep pyogenes
  • Common in children (especially in warm weather)
48
Q

What are the clinical features of impetigo?

A
  • Golden, crusted skin lesions typically found around mouth/face/flexures/limbs
  • Very contagious
49
Q

What is the management for impetigo?

A
  • Hydrogen peroxide 1% cream (first line)
  • Exclusion from school until lesions are crusted/healed or 48 hours after commencing abx treatment
  • Topical abx = fusidic acid/mupirocin
  • Extensive disease = oral flucloxacillin/erythromycin
50
Q

What is cellulitis and what is it caused by?

A
  • Bacterial infection affecting dermis and deeper subcutaneous tissues
  • Strep pyogenes (most common) or staph aureus
51
Q

What are the clinical features of cellulitis?

A
  • Unilateral
  • Usually on shins
  • Erythema
  • Blisters/bullae (more severe)
  • Swelling
  • Systemic sx = fever/malaise/nausea
52
Q

What criteria is used for cellulitis?

A

Eron classification:
- Class I = no signs of systemic toxicity
- Class II = systemically unwell or has a comorbidity which may complicate/delay resolution of infection
- Class III = significant systemic upset e.g. acute confusion/tachycardia/tachypnoea/etc. that may interfere with response to treatment
- Class IV = sepsis syndrome/severe life threatening infection e.g. necrotising fasciitis

53
Q

What is the management for mild/moderate cellulitis?

A

Oral abx = flucloxacillin (first line)/clarithromycin/erythromycin (pregnancy)/doxycycline

54
Q

What is the admissions criteria for cellulitis?

A
  • Eron class III or IV
  • Severe/rapidly deteriorating cellulitis
  • <1 year or frail
  • Immunocompromised
  • Has significant lymphoedema
  • Has facial cellulitis/periorbital cellulitis
55
Q

What is the management for severe cellulitis?

A
  • Admit
  • Oral/IV co-amoxiclav/clindamycin/cefuroxime/ceftriaxone
56
Q

What are the clinical features of acne rosacea?

A
  • Typically affects nose/cheeks/foreheads
  • Flushing
  • Telangiectasia –> persistent erythema with papules/pustules
  • Rhinophyma
  • Blepharitis
  • Exacerbated by sunlight
57
Q

What is the management for acne rosacea?

A
  • High factor suncream
  • Topical brimonidine (flushing - alpha-adrenergic agonist)
  • Topical ivermectin/metronidazole/azelaic acid (mild-moderate papules/pustules)
  • Topical ivermectin + oral doxycycline (moderate-severe papules/pustules)
58
Q

Describe the pathophysiology of acne vulgaris

A

Chronic inflammation/blockage of pilosebaceous units, increased sebum production and trapping of keratin

59
Q

What are the clinical features of acne vulgaris?

A
  • Comedones (whitehead/blackhead)
  • Papules/pustules
  • Nodules/cysts
  • Ice-pick scars/hypertrophic scars
60
Q

What is the management for mild to moderate acne vulgaris?

A
  • Topical benzoyl peroxide
  • Topical retinoid (adapalene/tretinoin)
  • Topical abx (clindamycin)
61
Q

What is the management for moderate to severe acne vulgaris?

A
  • Topical benzoyl peroxide
  • Topical retinoid (adapalene/tretinoin)
  • Topical abx (clindamycin)
  • Oral abx (lymecycline/doxycycline)
  • Topical azelaic acid
  • COCP (co-cyprindiol - Dianette)
  • Oral retinoid (isotretinoin = roaccutane) - specialists only
62
Q

What are the side effects of roaccutane (isotretinoin)?

A
  • Highly teratogenic
  • Dry skin/lips
  • Photosensitivity of skin
  • Depression/anxiety/aggression/suicidal ideation
  • Stevens-Johnson syndrome and toxic epidermal necrolysis
63
Q

What are head lice caused by?

A

Parasitic insect - Pediculus capitis

64
Q

What are the clinical features of head lice?

A

Itching/scratching on scalp 2-3 weeks after infection

65
Q

What is the management for head lice?

A
  • Malathion
  • Wet combing
  • Dimeticone
  • Isopropyl myristate
  • Cyclomethicone
66
Q

What is scabies caused by?

A

Sarcoptes scabiei

67
Q

What are the clinical features of scabies?

A
  • Widespread pruritus
  • Linear burrows on side of fingers/interdigital webs/flexor aspects of wrist/face/scalp
  • Excoriation/infection (due to scratching)
68
Q

What is the management for scabies?

A
  • Permethrin 5% (first line)
  • Malathion 0.5%
  • Treat all household/close physical contacts even if asx
  • Avoid close physical contact with others until treatment complete
69
Q

What is crusted scabies?

A
  • a.k.a Norwegian scabies
  • Seen in patients with suppressed immunity (especially HIV)
  • Management = ivermectin + isolation
70
Q

What is exanthem?

A

Widespread rash usually accompanied by systemic sx e.g. fever/malaise/headache usually caused by a virus

71
Q

What are common causes of exanthems?

A

Viral infections:
- Chickenpox (varicella)
- Measles (morbillivirus)
- Rubella (rubella virus)
- Roseola herpes virus 6B
- Erythema infectiosum (parvovirus B19)

72
Q

What is the management for exanthems?

A
  • Supportive management
  • Paracetamol
  • Emollients
73
Q

What chronic conditions may cause pruritus?

A
  • Liver disease
  • Renal disease
  • Anaemia
  • Diabetes
  • Hyper/hypothyroidism
  • Cancer
74
Q

What are the most common types of malignant melanoma?

A
  • Superficial spreading (most common)
  • Nodular (most aggressive)
  • Lentigo maligna
  • Acral lentiginous
75
Q

What are the risk factors for melanomas?

A
  • Immunosuppression
  • Numerous moles
  • Family history
  • Exposure/overexposure to UV light
76
Q

What are the classic appearances of melanomas?

A

ABCDE:
- Asymmetry
- Border irregularities
- Colour variation
- Diameter >7mm
- Enlargement

Nodule = EFG
- Elevated
- Firm to touch
- Growing

77
Q

What are the clinical features of melanomas?

A
  • New/changed skin lesion (colour/shape/size/ulcerations/pruritus/bleeding)
  • Nausea/vomiting/loss of appetitie/fatigue
78
Q

What is the investigation and management for malignant melanomas?

A

Investigation = sentinel node biopsy

Management = excision biopsy

79
Q

What are the complications of melanomas?

A

Metastasis to lymph nodes/skin/subcutaneous tissue/lungs/liver/brain

80
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

81
Q

What are the main causes of basal cell carcinoma?

A
  • UV radiation
  • Gorlin syndrome (mutation of PTCH1 gene)
82
Q

What are the most common types of basal cell carcninoma?

A
  • Nodular (most common)
  • Infiltrative
  • Micronodular
  • Morpheaform
  • Superficial
83
Q

What are the classic appearances of basal cell carcinomas?

A
  • Nodular = white circular cystic pigmented nodule
  • White/yellow lesion
  • May be waxy
  • Erythematous plaque
84
Q

What are the clinical features of basal cell carcinomas?

A
  • Sun-exposed areas e.g. face/neck/scalp
  • Newly discovered lesion
  • Doesn’t heal within 4 weeks
  • Dimpled at midpoint
  • Grows slowly
  • May bleed
  • Painless/may itch
  • Telangiectasia
  • Ulcerated
85
Q

What is the investigation for basal cell carcinomas?

A

Biopsy and histology = basal cells form clusters (islands) with peripheral palisading nuclei

86
Q

What is the management for basal cell carcinomas?

A
  • Topical 5-fluorouracil/imiquimod
  • Srugical excision
  • Curettage
  • Cryotherapy
  • Radiotherapy

RARELY METASTASISES

87
Q

What are the risk factors for squamous cell carcinomas?

A
  • Overexposure to UV light
  • Actinic keratoses/Bowen’s disease
  • Immunosuppression
  • Smoking
  • Long-standing leg ulcers
88
Q

What are the clinical features of squamous cell carcinomas?

A
  • Sun exposed sites e.g. head/neck/arms
  • Rapidly expanding, painless, ulcerate nodules
  • May have cauliflower-like appearance
  • Bleeding
89
Q

What are the investigations for squamous cell carcinomas?

A
  • Biopsy
  • CT
  • MRI
90
Q

What is the management for squamous cell carcinomas?

A
  • Surgical excision
  • Topical immunomodulators (e.g. tacrolimus)
  • Chemotherapy/radiotherapy
91
Q

What are the complications of squamous cell carcinomas?

A

Metastasis

92
Q

What are the risk factors for venous ulcers?

A

Most common type of leg ulcer

  • Previous DVT
  • Reduced mobility e.g. OA/leg injury/obesity/paralysis
  • Varicose veins
  • Leg surgery
93
Q

What are the clinical features of venous ulcers?

A
  • Typically seen above medial malleolus
  • Pain/itching/swelling in affected leg
  • Discoloured/hardened skin around ulcer
  • Offensive discharge
94
Q

What is the investigation for venous ulcers?

A

ABPI in non-healing ulcers:
- Assess for poor arterial flow which could impair healing
- Normal = 0.9-1.2

95
Q

What is the management for venous ulcers?

A
  • Compression bandaging (4 layer)
  • Oral pentoxifylline (peripheral vasodilator)
  • Abx if infected
96
Q

What is a port-wine stain?

A
  • Capillary malformation seen at birth
  • Flat and dark red/purple
  • Usually requires no treatment
97
Q

What is the most common type of contact dermatitis?

A

Irritant contact dermatitis - non-allergic reaction due to weak acids/alkalis e.g. detergents

98
Q

What is the most common cause of cutaneous warts?

A

Viral - HPV

99
Q

What are common causes of folliculitis?

A
  • Infection e.g. staph aureus/candida albicans/herpes zoster
  • Occlusions e.g. paraffin-based ointments
  • Irritation
  • Skin diseases
  • Overuse of topical steroids
100
Q
A

Phase 3a (21 decks)

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