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Dermatology Board Prep flashcards
1
Q

layers of the skin

A 
stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum basale
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2
Q

stratum corneum description

A

hard protein envelope with keratin and lipids

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3
Q

stratum lucidum description

A

dead cells with dispersed keratohyalin

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4
Q

stratum granulosum description

A

keratohyalin with a hard protein envelope

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5
Q

stratum spinosum description

A

keratin fibers and lamellar bodies

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6
Q

stratum basale description

A

site of cellular mitosis

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7
Q

functions of skin

A

functions of skin; thermoregulation, immunity via innate and adaptive and a barrier against external damage and retains water, electrolytes and macromolecules. It enables sensation, vitamin D synthesis and interpersonal communication

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8
Q

causes of external skin disease

A

temperature, UV, chemical, infection or trauma. Internally It may arise form systemic disease, genetics, drugs and infection.

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9
Q

eruptive xanthoma cause

A

hyperlipidemia

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10
Q

ancanthosis nigricans causes

A

obesity, malignancy and diabetes

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11
Q

pretibial myxoedema causes

A

thyroid skin disease

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12
Q

macule term

A

small circumscribed area

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13
Q

patch term

A

large circumscribed area

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14
Q

papule term

A

small raised area

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15
Q

plaque term

A

large raised area

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16
Q

vesicle term

A

small fluid filled

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17
Q

bulla term

A

large fluid filled

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18
Q

pustule term

A

small pus filled

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19
Q

abscess term

A

large pus filled

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20
Q

erosion term

A

loss of epidermis

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21
Q

ulcer term

A

loss of epidermis and dermis

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22
Q

bacterial investigations in dermatology

A

if bacterial infection that charcoal swab, microscopy, culture and testing sensitivities.

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23
Q

viral investigations

A

if viral infection then swab for PCR

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24
Q

fungal skin investigations

A

if fungal then skin scrapping, nail clipping, hair sample for fungal cultures

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25
Q

if the mechanical barrier of skin fails

A

sepsis

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26
Q

if fluid or electrolyte balance fails

A

protein, fluid loss, renal impairment and peripheral vasodilation

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27
Q

what drugs can be topically applied in dermatology

A

corticosteroids, antibiotics, antiviral, dithranol, vitamin analogues, chemotherapy, parasiticidals, coal tar, anti-inflammatory, salicylic acid.

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28
Q

topical steroids pharamacology

A

regulate pro inflammatory cytokines, supress fibroblasts, endothelial, leukocytes function. They also stimulate vasoconstriction and inhibit vascular permeability, very safe is used appropriately.

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29
Q

dose of topical steroids

A

0.5g finger tip

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30
Q

side effects of topical steroids

A

thinning, atrophy, striae, bruising, hirsutism, telangiectasia, acne, glaucoma, systemic absorption, cataracts

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31
Q

retinoids pharmacology

A

vitamin A analogues that are anti-inflammatory and anti-cancer for normalising keratinocyte function.

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32
Q

retinoids uses

A

Used in Acne, psoriasis, T cell lymphoma, and hand eczema.

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33
Q

immunosuppressant examples

A

steroids, ciclosporin, methotrexate, azathioprine

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34
Q

biologics pharmacology

A

treating inflammatory conditions. They are genetically engineered proteins derived from human genes for specific components of the immune system.

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35
Q

SJS features

A

– fever, malaise, arthralgia, rash, mouth ulceration (white membrane, haemorrhagic crusting)

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36
Q

toxic epidermal necrolysis features

A

prodromal febrile illness, ulceration of mucous membranes, rash, positive nikolsky’s sign.

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37
Q

management for SJS and toxic epidermal necrolysis

A

stop drug culprit and supportive therapy

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38
Q

pemphigus features

A

flaccid easily ruptured blisters, commonly around face, groin and axillae. Nikolsky’s sign positive, affects mucous membranes, erosion. Patients may be unwell is extensive.

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39
Q

pemphigus treatment

A

; systemic steroids, dress erosions and supportive therapy

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40
Q

pemphigoid features

A

intact blisters usually tense. May be extensive but patient fairly well.

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41
Q

pemphigoid features

A

intact blisters usually tense, may be extensive but patient fairly well

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42
Q

pemphigoid treatment

A

topical steroids, only systemic if diffuse.

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43
Q

erythrodermic psoriasis and pustular psoriasis features

A

withdrawal of topical steroids, rapid development of generalised erythema, clusters of pustules, fever.

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44
Q

erythrodermic psoriasis and pustule psoriasis treatment

A

avoid steroids, initiate systemic therapy

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45
Q

eczema herpeticum features

A

punched out erosions and monomorphic blisters, fever, lethargy

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46
Q

eczema herpeticum treatment

A

aciclovir, treat secondary infection. Mild topical steroid to treat eczema.

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47
Q

staphylococcal scalded skin syndrome features

A

common in children, diffuse erythematous rash with tenderness, prominent in flexures, develops into blistering and desquamation, fever and irritability.

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48
Q

treatment of staphylococcal scalded skin syndrome

A

requires IV antibiotics, and supportive care initially.

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49
Q

urticaria features

A

variable size with erythema with itching and burning sensation. Duration several hours. Acute if less than 6 weeks. Described as a weal, wheal or hive.

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50
Q

acute urticaria treatment

A

oral antihistamine, short course of oral steroids avoid opiates and NSAIDS

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51
Q

chronic urticaria treatment

A

standard dose antihistamine, then increase dose. Second line agent anti-leukotriene, tranexamic acid for angioedema. Finally use of omalizumab or cyclosporine.

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52
Q

DRESS first line therapy

A

systemic steroids

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53
Q

pemphigus first line

A

systemic steroids

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54
Q

pemphigoid 1st line

A

topical steroids

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55
Q

eczema herpeticum 1st line

A

aciclovir

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56
Q

staphylococcal scalded skin syndrome first line

A

IV antibiotics

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57
Q

urticaria first line

A

anti-histamines

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58
Q

presentation of psoriasis

A

sharply demarcated erythematous plaques with micaceous scales with family history. There will be numerous small, widely disseminated papule and plaques with erythroderma and pustules. The nails there will be onycholysis, pitting and oil spots.

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59
Q

signs of psoriasis

A

Signs include koebner phenomenon and woronoff’s ring. Possible symptoms also include arthritis

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60
Q

pathogenesis of psoriasis

A

there is multiple genes involved in its development. It then requires something to trigger it in the form of an infection, drug, injury or even sunlight.
There is activation of immune cells in the skin in response to damage. This is then presented to more immune cells which then attacks the stressed skin cells resulting in further skin cell production. White blood cell involvement results in pus formation.

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61
Q

1st line treatment for psoriasis

A

emollients and soap substitutes with use of vitamin D3 analogues, coal tar creams, careful use of topical steroids and salicylic acid

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62
Q

systemic treatment for psoriasis

A

Systemic include retinoid, immunosuppression via methotrexate (treats PsArthritis), ciclosporin and biologic therapies.

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63
Q

erythrodermic psoriasis requires what treatment?

A

requires admission, regulation of fluid balance, bloods and IV access and thick greasy ointment emollients.

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64
Q

carcinoid syndrome signs

A

episodic flushing, no sweating, facial telangiectasia

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65
Q

paraneoplastic pemphigus signs

A

erosive stomatitis and rash

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66
Q

erythema gyratum repens signs

A

concentric erythematous lesions, variable sites that can be affected

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67
Q

acquired hypertrichosis lanuginose signs

A

acute onset lanugo hairs at face and body

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68
Q

leser trelat signs

A

eruptive seborrheic keratoses

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69
Q

bazex syndrome signs

A

– hyperkeratosis of extremities, resembles psoriasis

70
Q

ectopic ACTH syndrome signs

A

generalised hyperpigmentation

71
Q

paget’s and extra mammary paget’s skin sign’s

A

eczematous plaque at nipple, and primary intraepithelial adenocarcinoma.

72
Q

skin conditions associated with an underlying cancer?

A 
carcinoid syndrome
paraneoplastic pemphigus 
erythema gryatum repens
acquired hypertrichosis
leser trelat
Bazex Syndrome 
ectopic ACTH syndrome
extra-mammary Paget's disease
73
Q

acanthosis nigricans signs

A

older patient, rapid onset, involves lips, weight loss.

74
Q

dermatomyositis signs

A

inflammatory myopathy + rash, periorbital heliotrope rash, gottrons papules over bony prominences, shawl sign, photosensitive poikiloderma, scalp erythema

75
Q

strongly associated with cancer skin condition

A

acanthosis nigricans

dermatomyositis

76
Q

associated with malignancy skin conditions

A

bullous pemphigoid
pyoderma gangrenosum
sweet’s syndrome

77
Q

genetic cancer syndromes with skin manifestations

A

MEN

xeroderma pigmentosa

78
Q

autoimmune GI skin signs

A

malignant atrophic papulosis (GI haemorrhage), erythema nodosum, pyoderma gangrenosum (IBD)

79
Q

genetic GI signs

A

hereditary haemorrhagic telangiectasia, ehlers danlos, pseudo xanthoma elasticum, blue rubber bleb naevus

80
Q

diabetic skin signs

A

ancanthosis nigricans, acral erythema, carotenemia, diabetic bullae, diabetic dermopathy, disseminated granuloma annulare, eruptive xanthomas, necrobiosis lipoidica, rubeosis, scleredema

81
Q

skin conditions associated with autoimmunity

A

cutaneous lupus
cutaneous vasculitis
alopecia
vitiligo

82
Q

impetigo features

A

common in children, arises from poor hygiene and skin trauma. Initially a macule that develops into a vesicle, then pustule with erosion developing with a yellow crust (honeycomb

83
Q

impetigo management

A

treatment is local wound care and topical antibiotics if necessary, e.g. around eye but normally self-limiting.

84
Q

folliculitis features

A

infection of hair follicle from occlusion, maceration, hydration, waxing, topical corticosteroids and diabetes. Initially a pustule that develops into a cyst or abscess.

85
Q

folliculitis managment

A

antibacterial wash and ointments but may require a charcoal swab for identification of bacteria.

86
Q

erysipelas features

A

very young, aged and debilitated with lymphoedema or chronic cutaneous ulcers. Erythema with defined margins. Skin feels hot tense and indurated affecting face or lower extremities. Patient may experience fever, chills, malaise and nausea. Progresses rapidly.

87
Q

erysipelas management

A

laboratory test highlights elevated leukocyte test, requires 10-14 days penicillin.

88
Q

cellulitis features

A

lymphedema, alcoholism, diabetes, IV drug use and peripheral vascular disease. Erythema, warmth, pain and swelling. Ill defined, non-palpable borders. Children affects head and neck, adults affects extremities

89
Q

cellulitis management

A

little to test for, requires antibiotics

90
Q

syphilis features

A

widespread rash and flu like symptoms separated by periods in time. STI that produces initially a painless ulcer (chancre). Secondary in rash with rough, red/brown papules and patches trunk, palms and soles, no itch. Tertiary is a gumma, granulomatous lesion.

91
Q

syphilis management

A

serology test 5-6 weeks after infection, non-specific treponemal tests VDRL, specific anti-treponemal antibody tests TTPA. Treatment is injection of penicillin.

92
Q

herpes features

A

; orolabial (1) or genital (2). Sore areas with erythematous base with vesicles followed by pustules and ulcerations.

93
Q

herpes management

A

topic antiviral therapy

94
Q

chicken pox features

A

contagious virus that causes acute fever, blistering rash in children. Presence of macules that form vesicles, then pustules then crusts. “dew drops on a rose petal”. Starts of scalp and face before spreading to trunk and extremities.

95
Q

chicken pox management

A

symptomatics and calamine lotion

96
Q

shingles features

A

; localised, blistering and painful rash following a reactivation of varicella zoster virus. Dermatomal distribution. Complications include infection and post-herpetic neuralgia (pain persistence)

97
Q

shingle’s managment

A

infection prevention, pain relief and rest.

98
Q

viral warts features

A

hyperkeratotic papules, thick plaques, may form mosaic clusters.

99
Q

viral warts management

A

salicylic acid or cryotherapy.

100
Q

molluscum contagiosum features

A

affects infants <10, overcrowding, warm climates. Firm umbilicated perly papules with waxy surface in skinfolds. molluscum contagiosum management

101
Q

molluscum contagiosum treatment

A

curettage, liquid nitrogen, chemovesicants may be self-limiting.

102
Q

dermatophytosis features

A

post pubertal affects groin, scalp, foot and nail. Wave lake with centre clear. Results in dead scaly skin with loss of hair.

103
Q

dermatophytosis management

A

skin scrape for identifications

104
Q

candida features

A

Predisposing factors are diabetes, occlusion, hyperhidrosis, broad spectrum antibiotics, or immunosuppression. Erythematous patches with satellite pustules in creases and folds particularly moist areas like diapers.

105
Q

candida management

A

remove predisposing factors, oral antifungal or topical antifungal.

106
Q

pityriasis versicolour features

A

sebum rich areas of skin, high temperatures, humid, oily skin, excessive sweating, round oval patches with mild scale. Different colours of brown, white or red.

107
Q

pityriasis management

A

topical antimycotic treatment shampoo and creams

108
Q

scabies features

A

close contact, overcrowding, passionate itching, presence of burrows, water increases itching, spares the scalp with papules, disturbs sleep, irregular tracks between fingers, palms, wrists and fingers.

109
Q

scabies management

A

skin scraping, visualisation and antiscabietic topical treatment.

110
Q

head lice features

A

itch and irritation on scalp, behind nape of neck and skin behind ears, red brown spots on skin. Younger children

111
Q

head lice management

A

easily visible. 2 applications of insecticide or physical methods inform school or day care.

112
Q

clinical features of classical dermatitis

A

flexures, necks, eyelids, face, hands and feet. Acute changes of pruritus, erythema, scale, papules, vesicles, exudate, crusting and excoriation. Chronically there is lichenification (hard leather skin), plaques and fissures.

113
Q

exogenous eczema features

A

contact dermatitis, lichen simplex (scratching), photoallergic.

114
Q

seborrheic eczema features

A

chronic dermatitis due to malassezia yeast causing red, sharp marginated lesion with greasy scales.

115
Q

pompholyx eczema features

A

palms and soles, very itchy, resolution can cause desquamation.

116
Q

asteatotic eczema features

A

very dry skin, cracked scales affecting the elderly due to the loss of oil.

117
Q

venous eczema features

A

increased venous pressure generating oedema

118
Q

eczema herpeticum features

A

disseminated viral infection generating itchy clusters of blisters and erosions

119
Q

filaggrin gene involvement in atopic dermatitis

A

the filaggrin gene. Without this gene there is the loss of the protective lipid layers and anti-microbial peptides resulting in a dysfunctional microbial flora causing dry skin. This aids in a barrier dysfunction which results in the escape of water generates inflammation

120
Q

atopic dermatitis immune response to losing filaggrin gene

A

the response of T2 cells and subsequent interleukins result in more inflammation and barrier dysfunction generating an antagonistic cycle.

121
Q

histology findings for atopic dermatitis

A

there is spongiosis (swelling within the epidermis), acanthosis (thickening of the epidermis) inflammation in the form of superficial perivascular lymphatic infiltrate.

122
Q

features for diagnosis of atopic dermatitis

A

itchy skin, plus 3 of the following onsent before the age of 2, history of flexural involvement, history of generally dry skin, atopic disease.

123
Q

contact dermatitis investigation

A

patch testing applies Monday, remove Wednesday and re-assess Friday

124
Q

seborrheic eczema topical treatment

A

ketoconazole topical anti-yeast

125
Q

venous eczema treatment

A

compression stocking

126
Q

eczema herperticum treatment

A

admission, antivirals, treat secondary bacterial infection

127
Q

general treatment for atopic dermatitis

A

emollients (greasy, light, watery), soap substitutes, intermittent topical steroids. Sometimes may need rotation of topical steroids with calcineurin inhibitors. Anti-histamines and anti-microbials.

128
Q

treatment for severe eczema

A

– ultraviolet light or immunosuppression via methotrexate, ciclosporin, azathioprine

129
Q

acneiform pathophysiology

A

keratocytes normally undergo their cell cycle and are shed around the hair follicle via the infundibulum. The sebaceous lobule also secretes oily liquid to lubricate the hair follicle. The issue arises when the keratocytes are genetically altered resulting in increased adhesions and shedding resulting in a blockage of the infundibulum. This prevents the secretion of sebum (oil). The normal flora present Propionibacterium acnes then proliferate, resulting in an inflammatory reaction. If this penetrates to the dermis It can cause scarring.

130
Q

white head cause

A

white heads if the infundibulum is sealed completely

131
Q

black head cause

A

if there is open entry it forms blackheads as the lipid contents oxidise or become infected and form a pustule

132
Q

epidemiology of acneiform eruptions

A

90% of teenagers have acne, there are genetic syndrome that increase risk and by 40 1% of men and 5% of women are still symptomatic

133
Q

presentations for acneiform eruptions

A

; open and closed comedones, inflammatory lesions, presence of papules, pustules, nodules and cysts in more moderate disease. If severe disease there are the presence of pseudocysts, pigmentation changes and scarring.

134
Q

acne fulminans features

A

rare severe cystic acne that is systemic and abrupt.

135
Q

drug induced acne features

A

pustules without comedones following use of lithium, phenytoin or steroids

136
Q

acne excoriee features

A

picked acne that form crusted scabs that may scar

137
Q

acne vulgaris features

A

younger, open and closed comedones, inflammatory lesions, papules, pseudocysts, pustules, nodules and cysts, permanent scarring and post inflammatory pigmentation, seborrhoea.

138
Q

Rosacea features

A

common in fair skinned individuals, third and fourth decades, vascular changes, episodic flushing, no sweating, erythema with burning sensation by minor irritants, centrally, papules and pustules in advanced cases with tissue thickening, fibrosis, oedema and glandular hyperplasia. Deep red colour, exaggerated pores and lumpy surface. Another symptom may be eye dryness, tired eyes, tearing, pain, chalazia and corneal damage.

139
Q

Acne first line

A

first line is often the use of the anti-inflammatory and anti-septic Benzyl peroxide or topical retinoids (deactivate keratinocyte proliferation)

140
Q

other treatments for acne

A

There is also azelaic acid. First line orally is the antibiotics tetracyclin or lymecycline. Older women with menstruation problems may use a contraceptive pill. Final line may be the use of isotretinoin tablets (anti-keratinocyte proliferation and reduces sebum but lots of side effects and teratogenic as well as a long treatment (1yr

141
Q

rosacea avoid the use of

A

vasodilators and irritants

142
Q

rosacea 1st line treatment

A

1st line is metronidazole cream or gel as a topic therapy

143
Q

rosacea other treatments

A

Alternatives are azelaic acid, ivermectin cream(kills mites), tetracyclines are the most oral medications or surgery for rinophymas

144
Q

pyogenic granuloma features

A

rapid raw growth at site of trauma. Common on hand or head.

145
Q

pyogenic granuloma management

A

curettage or cautery.

146
Q

angioma management

A

excision or laser

147
Q

angioma epidemiology

A

overgrowth of blood vessels, all ages and sexes but due commonly due to pregnancy or liver disease

148
Q

lipoma features

A

smooth, rubbery subcutaneous mass, tender, asymptomatic

149
Q

dermatofibroma features

A

fibrous nodule on limbs, firm and tethered to skin but mobile over fat. Pale pink/brown with positive dimple sign. Usually asymptomatic.

150
Q

dermatofibroma management

A

excision if symptomatic

151
Q

cysts features

A

encapsulated lesion containing fluid or semi fluid, firm and fluctuant

152
Q

cysts management

A

excision, if inflamed then antibiotics, intralesional steroids, drainage

153
Q

viral warts features

A

rough hyperkeratotic surface

154
Q

viral warts management

A

cryotherapy, curette

155
Q

seborrheic keratoses features

A

warty growths, variable, multiple +/- cherry angiomas

156
Q

soberrheic management

A

cryotherapy or curettage

157
Q

actinic keratoses features

A

; low risk precursor to SCC, rough scaly patches on sun damaged skin.

158
Q

bowen’s disease features

A

SSC in situ; full thickness dysplasia, contained in epidermis, irregular scaly erythematous plaque.

159
Q

basal carcinoma features

A

pearly rolled edge, telangiectasia, central ulceration, arborizing vessels on dermoscopy. Slow growing, locally invasive

160
Q

squamous cell carcinoma features

A

sun exposure, metastatic, fast growing, tender, scaly and can ulcerate

161
Q

SSC variant keratoacanthoma features

A

hair follicle from damage skin may rapidly grow and shrink.

162
Q

melanoma features

A

changing size, shape colour, with inflammation, >5mm diameter, oozing and itching black spot resembling a mole it may be superficial, lentigo, nodular, subungal (under nail), acral lentiginous, or ocular.

163
Q

mycosis fungoides features

A

(cutaneous lymphoma); older male patients, flat red oval patches that itch or may resolve, thick itchy plaques, irregular lumpy ulcerating tumour and metastatic.

164
Q

sezary syndrome features

A

(cutaneous lymphoma) red man syndrome, skin thick, scaly and red, very itchy with lymph node involvement.

165
Q

basal cell carcinoma treatment

A

excision, curettage in some circumstances. If not suitable for surgery or RT (i.e. metastatic) then Vismodegib.

166
Q

SSC treatment

A

excision +/- radiotherapy

167
Q

SSC variant keratoacanthoma treatment

A

excision

168
Q

melanoma treatment

A

surgical excision, lymph node biopsy, may require chemo/immunotherapy. i.e. ipilimumab(CTLA4), pembrolizumab (PD1), vemurafenib, dabrafenib (B-RAF).

169
Q

mycosis fungoides and sezary syndrome treatment

A

topical steroids, local radiotherapy, interferon, low dose methotrexate, chemotherapy, bexarotene and total skin electron beam therapy, extracorporeal photophoresis, bone marrow transplant.

170
Q

what regional cancer regularly metastasize to the skin

A

breast lung and colon

171
Q

skin cancers that metastasize

A

mycosis fungoides, melanoma, squamous cells carcinoma, basal cell rarely.

172
Q

lymphoma pathophysiology

A

lymphoma commonly is T cell mediated. It is the result of abnormal neoplastic proliferation of lymphocytes in skin.

dermatology (3 decks)

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