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CP2 Derm > Major presentations and management > Flashcards

Major presentations and management Flashcards

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Dermatology Board Prep flashcards
1
Q

Derm Features of malignant melanoma

A
  • A- asymmetry
  • B- ireg ireg
  • C - variation
  • D - >6mm
  • E - Elevated
  • Morphology -plaque
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2
Q

Risk factors for developing malignant melanoma

A
  • Sun exposure
  • Age
  • Outdoor occupation
  • FHx
  • PMHx moles
  • Immunosuppressants
  • Red hair, blue eyes, pale skin
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3
Q

What are the prognostic factors for malignant melanoma

A
  • TNM stage
  • Breslow thickness
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4
Q

Breslow thickness –> stage

A
  • Stage 1 <0.75mm
  • Stage 2 0.76-1.5mm
  • Stage 3 1.51-2.25mm
  • Stage 4 2.26-3 mm
  • Stage 5 >3.1mm
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5
Q

Management of malignant melanoma

A
  • Excise w/ 2mm margin
    • histology
    • assess Breslow thickness
      • WLE (wide local excision)
      • Chemo
      • Body scans for mets
      • radiotherapy
  • Sun advice
  • Full skin check
  • Skin cancer nurse referal
  • MDT discusssion
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6
Q

Standard sun advice

A
  • Avoid direct sunlight March-Oct, 11am-3pm
  • SpF 50+ idealy minimum 30+ reapply every 2 hrs + 30 mins before going out
  • Cover up
  • No sunbeds
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7
Q

What subtype of malignant melanoma is more prevalent in darker areas?

A

acral lentiginous melanoma

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8
Q

What type of biopsy is required for acral lentiginous melanoma

A

incisional

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9
Q

derm features of benign melanocytic compound hair naevus

A
  • A -symm
  • B - reg reg
  • C - uniform
  • D - <6mm
  • E - elevated
  • Morph - nodule w/ or w/out hair
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10
Q

Management of benign melanocytic compound hair naevus

A

NHS can’t remove unless symptomatic

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11
Q

Derm features of SCC

A
  • A - asym
  • B - ireg ireg
  • C - erythem varied
  • D - >2cm
  • E - Elevated
  • Morph nodule/plaque with keratotic (dead skin), ulceration and crusting

Can present as ulcer on lower limbs esp if edges are raised and it doesn’t respond to simple ulcer measures

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12
Q

History features of SCC

A

PC: SC derm features

HPC: short (weeks)

Risk factors

  • Sun exposure
  • Age
  • Outdoor occupation
  • FHx
  • PMHx
  • Immunosuppressants
  • Red hair, blue eyes, pale skin
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13
Q

Management of SCC

A

Topical

  • Efudix

Surgical

  • Cryo
  • Excision 4-6mm margin

Other

  • Full skin check
  • LNs check
  • Radio therapy for large non resectables
  • MDT approach
  • Skin cancer nurse referal
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14
Q

Derm features of actinic keratosis aka solar keratosis

A

A-asym

B-ireg ireg

C-red, pink, brown or skin-coloured

D-few mm-few cm

E-flat or elevated

Morph - scaly (keratotic) patches

**itchy and sore**

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15
Q

Why do we treat AK

A

Samll chance of developing into SCC

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16
Q

Management of AK (actinic keratosis)

A

Topical

  • E-fudix

Surgical

  • Freeze/cryotherapy if single
  • Curettage and Cautery (C&C) if SCC suspected

Other

  • Full skin check
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17
Q

Risk factors for AK

A

(same as SCC)

  • Sun exposure
  • Age
  • Outdoor occupation
  • FHx
  • PMHx
  • Immunosuppressants
  • Red hair, blue eyes, pale skin
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18
Q

BCC derm features

A

A - asym

B - ireg

C - Shiny/pearly erythem non-uniform

D - Dunno

E - Elevated, depression in the center

Morph - Papule or nodule with central dimple and talengectasia

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19
Q

Which is more common BCC or SCC

A

BCC

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20
Q

Management of BCC

A

Topical

  • Efudix

Surgery

  • Cryo
  • Excision 4mm margin
  • Mohs excision (involves sending to histology to check all remoived)

Other

  • Full skin check
  • LNs check
  • MDT approach
  • Skin cancer nurse referal
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21
Q

Derm features of viral warts

A

A - fairly sym

B - reg

C - grey fairly uniform

D - 2mm-2cm

E - Elevated

Morph - Papules with cribiform appearance (numerous small hole)

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22
Q

Derm features in pyogenic granuloma

A

A - sym

B - reg

C - erythem some yellowness (tissue sloughing off)

D - <1cm

E - Elevated

Morph - Papule

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23
Q

Derm features cherry angioma aka strawberry naevus aka Strawberry hemangiomas and their prognosis

A

A asym

B reg

C cherry red

D up to 1.5 cm

E yes

Morph papule/nodule

Birth mark that can grow will reach peak at 1 year of age and then will slowly dimish may leave yellowish mark

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24
Q

What is important to rule out when presenting with cherry angioma or Pyogenic granuloma

A

SCC

if risk factors are present esp age SCC until peroved otherwise

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25
Q

Derm features of chronic plaque psoriasis aka discoid

A

D wide spread

C none

M discoid erythem well defined patches with scaling

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26
Q

Name the objective tool that can be used to decribed the area and severity of skin involvement in psoriasis

A

Psoriasis area severity index (PASI)

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27
Q

NAme the most common sites affected in chronic plaque psoriasis

A

Extensor surfaces, scalp, nails, flexor surfaces

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28
Q

What are the nail signs of psoriasis

A

Pitting, onycholysis, subungal keratosis

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29
Q

Name the non cutaneous manifestations of psoriasis

A
  • psoriatic arthritis
  • Psyhcological impact

Possible causes chicken egg sitch

  • CV issues
  • Metabolic syndrome
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30
Q

Name the tool used to assess the impact of dermatology conditions on the patients life

A

Dermatology life quality index (DLQI)

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31
Q

Describe the step wise approach to psoriasis treatment

A

**No Oral Steriods**

Lifestyle

  • Dec smoking
  • Dec wgt
  • Dec stress
  • Sunlight does improve psoriasis caution skin cancer

Step 1

  • Topical
    • Steriods mild/moderate
    • Emollients
    • Coal tar preparation
    • Vit D analogue - calcipitol
    • Dovobet/Dovenex (vit D and steriods)

Step 2

  • Phototherapy

Step 3

  • Immunosuppression (meds)
    • Methotrexate
    • Cyclosporin
    • Acitretin

Step 4

  • Biologics (strong immunosuppresants)
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32
Q

Define Erythrodema

A

Intense wide spread red rash affecting ≥90% of the body

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33
Q

Derm features of erythrodermic psoriasis

A

D - Widespread

C - none

M - Erythem plaques

+/- shedding scin, scaling, pustules, blisters

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34
Q

List 4 complications of erythroderma

A
  • Sepsis
  • Hypothermia
  • Dehydration
  • Inc cardiac output
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35
Q

Why don’t we perscribe oral steriods in psoriasis

A

When they come off the steriods they may get rebound erythrodermic psoriasis

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36
Q

Causes of erythroderma

A
  • Eczema
  • Psoriasis
  • Lymphoma cutaneous t-cell
  • Sezary syndrome
  • Adverse drug reaction
  • Idiopathic
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37
Q

Management of erythroderma

A
  • IV fluids
  • Stop any drugs that could be causative
  • Punch biopsy
  • Emollient (50/50)
  • Topical steriods
  • Consider immunosuppresants and non-drousy anti-histamines
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38
Q

Derm features flexural inverse psoriasis

A

D - Flex surfaces (folds)

C - None

M - Erythem plaque

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39
Q

What is the top DD for flexural inverse psoriasis and therefore what is a good drug to perscribe

A

DD: Fungal and bacterial infections

Trimovate b/c contains anti bacterial anti fungal and moderate steriod

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40
Q

Derm features of guttate psoriasis

A

D widespread

C Non

Morph erythem papules/nodules

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41
Q

DDs for guttate psoriais and investigations that need to be done to confirm psoriasis and why

A

Meningococcal septicaema

  • check for systemic illness
  • Illness onset (psoriais will be weeks menigitis will be days)

Investigations

  • Throat swab
  • ASO titre

Guttate is usually cased by a throat strep infection

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42
Q

Treatment of guttate psoriasis

A
  • Emollient
  • Topical steriod
  • Phototherapy
  • Consider system treatment e.g. anti biotics
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43
Q

Prognosis of guttate psoriasis

A

Usually resolves w/in weeks very likely w/in 6 months

Not infectious

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44
Q

Derm features Acne vulgaris

A

D Face chest and back

C non

M asymp erythem papules, pustules, open and shut comedone pitting

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45
Q

Main bacteria that causes acne vulgaris

A

Propionibacterium acnes (P. acnes)

46
Q

Topical treatments of acne vulgaris

A
  • Retiniods
  • Antibiotics (erythromycin)
  • Bensyl peroxide
47
Q

Systemic treatments of acne vulgaris

A
  • Oral antibiotics - doxycycline, erythromycin, trimethoprim
  • Combined pill

Failing that

  • Isotretinoin aka acutane
48
Q

Side effects of Isotretinoin aka acutane

A
  • Depression suicide
  • Teratogenic (not in pregnancy)
  • Dry lips, skin and eyes (mucous membrane)
  • Can worsen acne initially
  • Arthalgia
  • Deranged LFTs ergo no alcohol and risk of pancreatitis
49
Q

Secondary causes of acne vulgaris

A
  • PCOS
  • Cushings
  • Anabolic steriods
  • Lithium
  • Phenytoin
  • isoniazid (anti biotic)
  • POP
  • Steriods
  • Congenital adrenal hyperplasia
50
Q

Derm features of Rosacea

A

D Face

C None

M asymp erythem large patch w/ open and shut comedomes, pustules, papules, rhinophyma (large red bulbous nose), flushing

51
Q

what are the complications of rosacae

A

Ocular rosacea - blepharitis, keratitis

52
Q

Derm features of eczema

A

D Widespread but can affect flex surfaces

C none

Morph pruritic erythem plaques +/- excoriations, thickenings, Xerosis, fissures

53
Q

Social effects of eczema

A

Puritis can lead to poor sleep and concentration having a nock on effect in school/work

54
Q

What can exacerbate atopic eczema

A
  • Infection
  • Irritants e.g. soap
  • Stress
  • Allergens e.g. pollen, pets
  • Environment e.g. winter low humidity
55
Q

Emollient and steriod regime in eczema

A

Emollient

  • Min 2x daily everywhere ideally 4x

Steriod

  • 1% hydrocortisone (mild) on face
  • Anywhere up to Eumovate (moderate to potent steriod) for body
  • Maintanence 2x weekly
  • 1x daily on affected areas for 2 wks

Do not apply emollient and steriod on same area within 30 mins one won’t be absorbed

56
Q

Side effects of topical steriods and how to avoid

A
  • Skin atrophy
  • Stretch marks
  • Easy bruising
  • Telangiectasia
  • Inc suscptability of infection
  • Hair growth

Rare

  • Glaucoma
  • Cataract

Avoid all of these by using sparingly or steriod sparing agents e.g. tacrolimus/protopic ointment

57
Q

Derm features of eczema herpeticum

A

D Usually Perioral or on the face

C none

M Monomorphic (sometimes vesicular) punched out erythem lesions

58
Q

Investigations and management of eczema herpeticum

A

Investigations

  • VIral swabs

Management

  • Aciclovir oral
  • Stop topical steriods
  • Treat any 2ary bacterial infection
  • Opthalm review if eye involved
59
Q

Derm features of impetigo

A

D Usually on face (perioral)

C none

M orange/yellow/gold crusted plaques

60
Q

causes of impetigo and treatment

A

Staph

Strep

Flucloxacillin (oral)

61
Q

Derm features of allergic contact dermaitis

A

D area touching allergen

C clustered

M Erythem plaques

62
Q

Cutaneous manifestation of rheumatoid disease

A

Granulomatous nodules on the elbows

63
Q

Investigations in allergic contact dermatitis

A

Patch test

64
Q

Derm features of non allergic irritant dermatitis

A

D Area affects (usually hands form hand washing)

C none

M generalised erythm w/ scales

65
Q

Derm features of scabies

A

D Wrists, axilla, groin, finger webs, flexural folds

C slightly linear to begin with

M starts with small line of silver dots (papules) –> erythem papules, nodules and patches. Also puritic ergo excoriation

66
Q

Treatment of scabies

A
  • permethrin cream 5% (insectiside)
    • Use on whole body
    • Treat all contact simulanteously
    • Repeat after 7 days
  • Wash all bedding
67
Q

Derm features tinea pedis (athletes foot)

A

D Gaps in toes esp

C none

M White patches with skin degredation

68
Q

Risk factors for tinea pedis

A
  • Long hours in thick boots and socks
  • Sport esp swimming public pools and showers
  • Diabetic
69
Q

Investigations for tinea pedis

A

Skin scrapings

Nail clippings

70
Q

Treatment of tinea pedis

A

Eliminate risk factors

Terbinafine or griseofulvin (anti fungal pill)

71
Q

Derm features tinea capitis

A

D scalp

C none

M erythem plaques w/ scaling and GRADUAL alopecia

72
Q

Important questions to ask in Hx of tinea capitis tp exclusde other causes and spread

A
  • Pets
  • Known allergies
  • Contacts +/- Sx
  • Siblings +/- Sx
  • Other symptoms
73
Q

Major difference between scalp psorisis and tinea capitis

A

no hair loss in psoriasis

74
Q

Investigations to confirm tinea capitis

A

Skin scraping

Hair sample

75
Q

Treatment of tinae capitis

A

griseofulvin - oral anti fungal

AND

Terbinafine - topical anti fungal

76
Q

Derm features of shingles

A

D anywhere of body usually doesn’t cross midline

C dermatomic

M Uniform erythema, haemoragic blisters, pustules crusting

77
Q

What causes shingles

A

Varicella zoster virus

78
Q

Treatment of shingles

A

Oral or IV aciclover depending on severity

Analgesia

Consider opthalm review if eye involved

79
Q

Complication of shingles

A

2ary bacterial infection

Reactiviation

Facial palsy

Post herpetic neuralgia

80
Q

Risk factors for venous ulcer

A
  • Obesity
  • DVT
  • Mobility issues
  • Varicose veins
  • Age
  • Previous leg trauma
81
Q

classical features of a venous ulcer

A
  • Odeoma
  • Stasis dermatitis rash around ulcer from haemosiderin deposition (red brown)
  • Located on legs, ankle or gaiter area ( above ankle where long sock would cover)
  • Minimal pain
  • Shallow
  • Lots of exudate
82
Q

Risk factors for arterial ulcer

A
  • DM
  • HTN
  • Atherosclerosis
  • Age
  • Trauma to leg
  • Decreased mobility
  • Foot deformity causing high pressure on certain areas
  • Weak pulses
83
Q

classic features of an arterial ulcer

A
  • Raised edges (punched out)
  • Deep (down to tendons)
  • Not bleeding
  • shiny, tight, dry, and hairless skin surrounding
  • Leg goes red on de-elevation and white on elevation
  • Leg pain at night resolved by dangling leg off bed
84
Q

Risk factors for neuropathic ulcer

A
  • DM
  • Peripheral neuropathy
  • B12 insufficiency
  • Foot deformity
85
Q

Features of neuropathic ulcer

A
  • On toes or under metatarsal heads (pressure areas)
  • No pain (usually no feeling either)
  • Also have quite punched out appearance
86
Q

What is the test used to help differentiate ulcer type and describe it

A

Ankle Brachial Pressure Index (ABPI)

Difference in BP between ankle and leg.

Calculated: systolic BP in leg/systolic BP in arm

Normal = 0.9-1

87
Q

Changes in ABPI in different ulcers

A

Arterial uler ABPI <0.9 usually 0.5

Else it should be fairly normal

88
Q

Management of venous ulcers

A
  • Compression and leg elevation
  • If venous eczema present –> emollient + moderate steriod
  • Potassium permangonate soaks
  • Refer to vascular surgeon for varicose vv
89
Q

Toxic epidermal necrolysis derm featres

A

D Wide spread

C Non

M erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Sheering

90
Q

Complications of TEN

A
  • Hypothermia
  • Inc cardiac output
  • Sepsis
  • Fluid loss
91
Q

Management of TEN

A
  • Pour on emollients, don’t rub
  • Analgesia
  • Fluid
  • Stop medications (may have caused it)
  • IV immunogloblins
  • Propholactic anti biotics
  • Nutritional support
  • Opthalm review
92
Q

Derm features of vasculitis

A

D Anywhere usually legs

C symmetrical

M Pupuric papules with central necrosis

93
Q

Causes of vasculitis

A
  • Meningococal sepsis
  • HIV
  • TB
  • HSP
  • SLE (lupus)
  • Malignancy
  • Hep C
  • Idiopathic
94
Q

Derm features of lupus

A

D Face

C Butterly

M Erythema

95
Q

Associations of pyoderma gangrenosum

A

Crohns/IBD (bowel disease)

96
Q

List a derm feature of DM1

A

DM1 -> necrobiosis lipoidica

97
Q

List a derm feature of DM (usually type 2)

A

Acanthosis nigricans

98
Q

Name a derm feature of Graves and Hyperthyroidism

A

Pretibial myxoedema

99
Q

urticaria aka hives derm features and causes

A

D-can affect anywhere

C-none

M-Erythem plaque itchy bumps. They may also burn or sting.

Usually caused by insect sting or allergies to food

100
Q

Derm features seborrhoeic warts aka keratosis

A

A asym

B reg reg well defined

C brown yellow uniformish

D small

E elevated

Morph Scaly papules, look warty

Benign but exclude malignant melanoma

101
Q

Types of eczema and how they differ

A

Atopic

  • History of past flexural involvement
  • Onset under the age of 2
  • Current visible flexural dermatitis
  • Personal or family history of atopic disease
  • A generally dry skin

Contact eczema/dermatitis

  • Localised reaction to allergen

Nummular/discoid

  • Circular discoid
  • In children is usually atopic
  • In adults that don’t meet criteria set off by stress, infections and excessive drying of skin
102
Q

Features of lichen planus

A
  • itchy violaceous rash around the ankles, fronts of the wrists, lower sacrum
  • white patches in the mouth.
103
Q

what is Dermographism and how is it diagnosed

A

enhanced ability to realise histamine from the skin on minimal trauma

Itchyness w/out obvious cause but small trauma will produce disproportional marks

104
Q

Drug that causes eruptive acne

A

anabolic steriod/testosterone

105
Q

What is perioral dermatitis and how is it treated

A

mix between acne and dermatitis

Steriod will reduce redness but will cause rebound worsening

Treat with oral tetracyclines e.g. doxycycline

106
Q

What causes Mollusca, derm features and treatment

A

Pox virus

D anywwhere

C clustered

M shiny itchy papules may be red and inflammed due to excoriation

Will naturally resolve

107
Q

vitiligo features and possible cause

A

D sym

C non

M well defined macules of hypopigmentation

can be caused by exposure to hydroquinone products (skin lightening products)

108
Q

Treatment of rosacea

A

Metronidazole cream

109
Q

Bowen’s disease (intra-epithelial carcinoma) derm features and treatment

A

A asym

B ireg

C erythem

D small

E elevated

Morph red, scaly plaque

Risk of becoming SCC

Topical

  • Efudix

Surgical

  • Cryo
  • Excision 4-6mm margin

Other

  • Full skin check
  • LNs check
  • Radio therapy for large non resectables
  • MDT approach
  • Skin cancer nurse referal
110
Q

Derm feature of sarciodosis

A

Erythema Nodosum

111
Q

Derm feature of herpes

A

Erythema multiforme

112
Q

derm features of IBD

A

Pyoderma gangrenosum

Erythema Nodosum

CP2 Derm (4 decks)

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