MedEd Flashcards

1
Q

A 1-year-old boy is brought to the GP clinic with a dry, scaly, erythematous rash on his cheeks and chin. He appears systemically well, and is not crying, however he repeatedly tries to move his hand to the rash. On close inspection of the rash, you also notice some small excoriation marks. The rash is limited to the face, with no spread to the limbs or trunk. On questioning, the father suffers from asthma. Select the likely diagnosis:

Parvovirus B19 infection
Atopic dermatitis
Plaque psoriasis
Contact dermatitis
Impetigo
A

Atopic dermatitis

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2
Q

A 22-year-old woman presents to her GP complaining of a moderately itchy rash present on both arms. She is systemically well. The rash is plaque-like in appearance, with well-defined edges and a silvery surface, present on the extensor surfaces of both elbows. She reports also noting a scaly, itchy rash on her scalp. Which of the following is not associated with this disease:

Arthritic pain
Onycholysis
Nail pitting
Family history of asthma
Rashes on the palms and soles
A

Family history of asthma

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3
Q

A 78 year old diabetic woman with a history of poorly-healing leg ulcers presents to her GP with a painful skin rash, following a 5-day course of topical antibiotic treatment for a skin infection. The rash appears blistered, with several vesicles present over the site of the previous skin infection, some of which have burst on examination, releasing clear fluid. The patient moans that the drug didn’t clear her infection. What is the likely diagnosis?

Erythema multiforme
Pemphigus
Secondary infection with S. aureus
Allergic contact dermatitis
Irritant contact dermatitis
A

Allergic contact dermatitis

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4
Q

what protein is decreased in atopic dermatitis

A

fillagrin

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5
Q

what is fillagrin

A

a protein responsible for keeping moisture in the stratum corneum and for maintaining the skins slightly acidic pH

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6
Q

what sort of hypersensitivity reaction is associated with atopic dermatitis

A

type I (immediate hypersensitivity with igE)

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7
Q

what sort of condition is psoriasis

A

immune-mediated inflammatory condition

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8
Q

who does psoriasis commonly affect

A

young adults

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9
Q

which inflammatory cytokines are associated with psoriasis

A

Il-1B, TNF-a, IL-17a

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10
Q

what are features of plaque psoriasis

A

symmetrical scaly plaques which are salmon pink with silver scales

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11
Q

where is plaque psoriasis commonly found

A

extensor surfaces

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12
Q

what are features of guttate psoriasis

A

“gutta” means teardrop
small red scaly ‘teardrops’ across the body
commonly following a URTI with strep

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13
Q

what is erythroderma

A

dry red skin across the body

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14
Q

what are triggers for erythrodermic psoriasis

A

drugs (anti-malarias, lithium, BBs), infections, low calcium, cessation of steroids

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15
Q

what is the treatment for erythrodermic psoriasis

A

hospitalisation

IV fluids, temp regulation, emollients

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16
Q

what sort of hypersensitivity reaction is allergic contact dermatitis

A

type IV (delayed)

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17
Q

what is characteristic of parvovirus B19

A

‘slapped cheek’ rash and also causes red cell aplasia

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18
Q

what is red cell aplasia

A

erythrocytes stop maturing - causes normocytic anaemia

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19
Q

what is pemphigus

A

a bullous disease where large bullae result from separation of epidermis from the dermis

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20
Q

what sort of condition is pemphigus

A

autoimmune

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21
Q

A 65 year old man presents with what he describes as a strange lump on the side of his nose. He says he first noticed it 4 months ago, but didn’t go to his GP as he spends 6 months of the year in the Cayman islands where his tax-free earnings live. You notice he has many freckles on his face and chest. The lump is a skin-coloured, round, well-circumscribed nodule with rolled edges and a pearly appearance, and blood vessels crossing its surface. Select the likely diagnosis:

Basal cell carcinoma
Fluid-filled cyst
Keratoacanthoma
Malignant melanoma
Squamous cell carcinoma
A

Basal cell carcinoma

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22
Q

A 55-year old Australian man attends your dermatology clinic worried about a mole on his back. He says his wife spotted it when on the beach, and that it appears bigger than when she first noticed it 6 weeks ago. Upon examining his back, you notice more than 10 moles. The mole of concern is different to the others, as it has irregular, poorly-circumscribed edges and variable pigmentation, and is considerably larger than its siblings. Its appearance under the dermatoscope worries you. Select the most appropriate next step:

Immunohistochemical staining
Ultrasound scan
Partial biopsy
Total excision
5-fluorouracil cream
A

Total excision

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23
Q

A 68 year old man with a history of previous BCC comes to your GP rapid access clinic, concerned about a sudden growth on his right ear. He says it started less than two weeks ago as a small pimple, which he tried to pop but couldn’t, and is now the size of an olive (2cm). The nodule is spherical, skin coloured and ulcerated, with a scaly core. Select the likely diagnosis:

Rapidly growing BCC
Keratoacanthoma
Bowen’s disease
HPV-induced wart
Squamous cell carcinoma
A

Keratoacanthoma

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24
Q

A 75 year old woman with a history of topically-treated solar keratoses (scaly sun spots) comes to your GP surgery looking intensely worried. Over the past 8 weeks she has noticed a “horn” growing from the skin at the front of her scalp. The horn is yellow-brown in colour, crusty in appearance, approximately 10mm in height and 5mm in width. The skin at the base is red and indurated. Her persistent concern is that she is turning into a goat. You assure her this is not the case. You also consider a referral to Psych. Select the likely diagnosis:

Keratoacanthoma
Bowen’s Disease
Malignant melanoma
Squamous cell carcinoma
Osteocarcinoma
She is actually becoming a goat
A

Squamous cell carcinoma

25
where are squamous cells in the skin found
outer layer of the epidermis
26
what are features of BCC
shiny pearly nodule with rolled edges and central ulceration | there may be a blood vessel in the middle
27
how quickly does a BCC grow
slowly
28
pathogenesis of BCC
mutation in PTCH1 tumour suppressor gene which inhibits sonic hedgehog signalling cascade
29
what is the most common malignant melanoma
superficial MM
30
what are features of malignant melanoma
``` Asymmetry Borders (irregular) Colour variation Diameter >6mm Evolution ```
31
how is MM diagnosed
dermatoscope: finds suspicious lesion excision of lesion plus 2-3mm of margins pathological diagnosis
32
how is MM staged
breslow thickness which measures melanoma depth from granular layer to deepest point of tumour
33
what are features of SCC
enlarging scaly of encrusted lumps formed of keratin
34
what is cutaneous horn SCC
an outgrowth of keratin in SCC like a horn
35
pathogenesis of SCC
p53 mutation
36
what form of SCC rapidly progresses and rapidly regresses
keratoacanthoma
37
what differentiates keratoacanthoma and true, lethal SCC
keratoacanthoma progresses very rapidly
38
is keratacanthoma benign or malignant
benign (however all other SCCs are malignant)
39
A 28-year-old woman attends her GP with a 1 month history of diarrhoea, which is associated with right lower quadrant pain and mucus in the stool. She reports no blood in stool, but is feeling increasingly tired, which she feels is due to her waking up 3-4 times per night to go to the toilet. She also reports having incredibly painful, red lumps on the front of her leg, which are tender to touch, inflamed and non-ulcerated, with the skin intact. What is this likely to be? ``` Pyoderma gangrenosum Purpura Dermatitis herpetiformis Erythema nodosum Venous ulcer ```
Erythema nodosum
40
what are erythema nodosum
a form of panniculitis (inflammation affecting subcutaneous fat)
41
where does EN commonly occur
shins
42
who is EN common in
women
43
what is pyoderma gangrenosum
autinflammatory condition due to neutrophil dysfunction
44
what condition is both EN and pyoderma gangrenosum associated with
IBD
45
what is characteristic of the ulcer in pyoderma gangrenosum
edge of ulcer is purple and undermined
46
what is dermatitis herpetiformis associated with
coeliacs disease
47
A 49-year old woman presents to her GP with a rash on the back of her hands and feet, which has been there for about 2 days and is concerning her. The lesion are papular (raised), circular, well-defined, erythematous target lesions, and their spread is confined to the dorsum of her hands and feet. She says she has been feeling well, and her only over-the-counter medicine used in the past 2 weeks is some acyclovir for a cold-sore on her lip. When asked, she said she noticed the rash soon after the cold-sore. Select the likely diagnosis: ``` Stevens-Johnson Syndrome Erythema multiforme Urticaria Cellulitis Post-viral fever rash ```
Erythema multiforme
48
what are target lesions common in
erythema multiforme
49
what causes erythema multiforme
infection (HSV, mycoplasmia pneumonia) (most common) | drugs (antibiotics, NSAIDs)
50
where do target lesions form
on the extremities and move towards the trunk
51
what are target lesions
3 layers outer red edge pale pink rink (raised due to oedema) central blistering
52
what is stevens-johnson syndrome
blistering erosive lesions which causes the epidermis to separate from the dermis
53
what causes stevens-johnsons syndrome
drug reactions (majority) such as antibiotics, anticonvulsants
54
A 12 year old boy is admitted to hospital with multiple small (2-3cm) skin lesions across his lower legs, buttocks, elbows and knees. The rash is non-tender, symmetrical, maculopapular and dark purple in colour. His right knee is in pain, and appears swollen and hot. The mother complains about the hygiene of hospital food, as her son has also had “terrible tummy pains” and diarrhoea since getting here. His urine dipstick shows microscopic haematuria. Prior to this his health has been good, apart from a throat infection he had 2 weeks ago, from which he has recovered. Select the likely diagnosis: ``` Immune Thrombocytopaenic Purpura Disseminated Intravascular Coagulation Henoch-Schönlein Purpura Acute leukaemia Haemolytic-uraemic syndrome ```
Henoch-Schönlein Purpura
55
what is Henoch-Schönlein Purpura
a small vessel vasculitis
56
what Ig is associated with Henoch-Schönlein Purpura
IgA
57
what sort of hypersensitivity reaction is associated with Henoch-Schönlein Purpura
type III
58
what commonly precedes Henoch-Schönlein Purpura
a strep throat infection
59
what is the triad of Henoch-Schönlein Purpura
purpura arthitis abdo pain