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Year 4 > Medicine - Dermatology > Flashcards

Medicine - Dermatology Flashcards

1
Q

Describe a macule

A

<0.5cm flat area of discolouration

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2
Q

Describe a patch

A

> 0.5cm flat area of discolouration

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3
Q

Describe a papule

A

<0.5cm palpable lesion

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4
Q

Describe a nodule

A

> 0.5cm palpable lesion

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5
Q

Describe a vesicle

A

<0.5cm fluid filled lesion

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6
Q

Describe a bullae

A

> 0.5cm fluid filled lesion

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7
Q

Describe a pustule

A

<0.5cm small pus filled vesicular lesions

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8
Q

Describe an abscess

A

> 0.5cm pus filled vesicular lesions

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9
Q

Describe a plaque

A

raised, flat topped area often with surface discharge

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10
Q

Describe toxic epidermal necrolysis (TEN)

A

A derm emergency
Drug induced blistering and skin detachment disorder
Ass. with fever and >10% body SA involved

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11
Q

What can cause toxic epidermal necrolysis (TEN)

A

Drugs! - epilepsy drugs, allopurinol, NSAIDs

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12
Q

How does TEN present?

A
  • bullae

- Niklosky’s sign +ve (the epidermis sloughs easily when pressure is applied)

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13
Q

How is TEN managed?

A
  • stop offending drug

- supportive

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14
Q

What is Stevens Johnson Syndrome?

A

same as TEN but <10% body SA involved

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15
Q

What is erythema multiforme and its S/Sx

A

A derm emergency
hypersensitivity reaction associated with drugs/certain infections:
- HSV
- mycoplasma pneumoniae

Has classical target appearance
Mucosal-cutaneous involvement: therefore mucosal erosions and difficulty urinating

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16
Q

How is erythema multiforme classified and treated?

A

EM minor = <10% body SA affected and no mucosal involvement
EM major = mucosal involvement

usually resolves by itself in 2-3 weeks, supportive treatment and antibiotics/antivirals depending on the cause

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17
Q

What is acute urticaria and its causes

A

A derm emergency
Itchy wheals, oedema and erythema
acute (<6 weeks)
mainly due to FOOD/DRUG allergic reactions, but also viral/bacterial infections or vaccinations

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18
Q

How is acute urticaria managed and what complication can arise?

A

Antihistamines
Steroids
Immunosuppression

Complication = anaphylactic shock!

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19
Q

What is erythroderma and its causes

A

A derm emergency
intense widespread reddening of the skin
Normally associated with other skin conditions - dermatitis, psoriasis

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20
Q

What are S/Sx of erythroderma

A

warm, itchy scaly skin
Nail thickening
serous oozing
generalised lymphadenopathy

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21
Q

How is erythroderma treated and what complications can arise

A

Emollients
Topical steroids
Antibiotics
Antihistamines

Complications:
dehydration/electrolyte imbalances
hypothermia
hypoalbuminaemia = oedema
secondary skin infections
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22
Q

Describe cellulitis and its RFx

A

Acute spreading dermal infection

RFx: PVD, DM, skin breaks, oedema, DVT, eczema

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23
Q

What are cellulitis S/Sx

A 
erythema
oedema
warmth
tenderness
discomfort
disruption of the cutaneous barrier
24
Q

How is cellulitis investigated?

A 
Hx and Ex
Bloods
Blood cultures
Skin biopsy
MRI (?nec fasc), X-ray (?osteomyelitis)
25
Q

What classification system is used for cellulitis

A

Enron classification

26
Q

How is cellulitis treated?

A 
Moderate = IV flucloxacillin
Severe = IV Flucloxacillin, Clindamycin, Gentamycin
27
Q

Describe necrotising fasciitis and its RFx

A

life threatening soft tissue infection
rapidly progressive and pain out of proportion
- IVDU, immunosuppression, hospitalisation, skin lesions, VSV infection

28
Q

What are the two types of nec fasc?

A

Type 1 - polymicrobial (in existing wounds)

Type 2 - group A strep only (in previously healthy tissue, usually strep pyogenes)

29
Q

What antibiotics are used to treat nec fasc?

A 
IV: fat must be clinically gross
flucloxacillin
metronidazole
benzylpen
clindamycin
gent
30
Q

Describe impetigo and its cause

A

golden crusty skin lesions, contagious, common in children
- caused by staph aureus
usually mild and self-limiting

31
Q

What is tinea and how is it diagnosed/treated?

A

Superficial fungal infection of skin (ring worm, athletes foot) or nails

Diagnose with skin scrapings and treat with antifungal creams (-azoles)

32
Q

What is pityriasis rosea?

A

Common rash in young adults, cause unclear
may be prodromal cold symptoms
usually herald patch and then christmas tree rash
usually self resolving but may need anti-itch and steroid creams

33
Q

Describe vitiligo hypopigmentation

A

an acquired pigmentation disorder, usually symmetrical

immune destruction of melanocytes = less melanin

34
Q

Describe eczema (dermatitis) and its various subtypes

A

Itchy, dry, sore red skin

  • atopic: linked to allergy
  • seborrheic: over skin with sebacious glands
  • discoid: circular patches
  • varicose: gravitational
  • contact: delayed T4 hypersensitivity reaction
  • pompholyx: restricted to hands/feet
35
Q

What is the pathophys behind dermatitis and its presentation?

A

abnormal filaggrin expression, impaired skin barrier function, increased exposure to foreign antigens, triggers immune mediated response

S/Sx:

  • vesicles and papules
  • pruritis
  • xerosis
  • flexural involvement!!!!!!
  • erythema
  • scaling
36
Q

How is dermatitis treated?

A 
emollients
topical steroids
oral Abx
antihistamines
immunosuppression
UV light therapy
37
Q

Describe psoriasis and its subtypes

A

Chronic immune mediated inflammatory condition
20% pts get arthritis

Types:

  • plaque
  • guttate -> tear shaped, after strep throat infection!
  • pustular
  • erythrodermic
  • flexural/inverse -> in genitals/skin folds
  • koebner phenomenon -> develops on healthy skin at site of cutaneous injury
  • palmar/plantar pustulosis
38
Q

Describe the pathophysiology of psoriasis

A

Hyperproliferation -> increased turnover of skin cells and release of pro-inflammatory cytokines
Certain drugs can predispose: lithium, B blockers

39
Q

What are the S/Sx of psoriasis?

A 
Itching
Burning
Silvery, scaly plaques with a pinky salmon base
Nail changes (pitting, onycholysis)
Auspitz sign
40
Q

What is the management of psoriasis

A 
Moisturisers
Topical steroids
Vit D analogue/phototherapy
Immunosuppression
Oral retinoid
Coal tar
Dithranol
41
Q

Describe acne vulgaris and its subtypes

A

Skin disease affecting the sebacious glands
types:

  • vulgaris (papulopustular, nodulocystic, comedonal)
  • fulminans (sudden onset and systemic upset)
  • rosacea
  • inversus (in groin/axilla/nasal cleft)
  • agminate (in middle aged/adult patients)
42
Q

Describe the pathophys of acne vulgaris

A

Multifactorial
XS androgens in puberty
Keratinocytes do not shed properly and clog pores
Pores infected with propionibacterium acnes

43
Q

What are the treatments for acne?

A 
Salicylic acid
Topical benzylperoxide
Topical Abx and retinoid
Oral Abx/retinoid/corticosteroidd
Oral isotretinoin!
44
Q

Describe rosacea, its causes and presentation:

A

Chronic skin condition characterised by redness, telangectasia, roughened skin and general inflammation
- cause unclear but triggers: climatic exposures, drugs…

Presents: redness, flushing, telangectasia, watery/irritated eyes, rhinophyma

45
Q

Describe the two autoimmune blistering skin conditions, their causes, the differences between them and how they are treated

A

Bullous pemphigoiD = deep blister
Bullous pemphiguS = superficial blister

Due to autoimmune attack of the epidermal-dermal junction

Mainly affects older pts with neurological conditions! (PD, epilepsy, stroke, MS, ALS)

Presents with tense erosions and blister which are Nikolsky sign -ve

Treated with topical/oral steroids depending severity, anti-inflammatory medications, immunosuppression

46
Q

What cell type is malignant in BCC?

A

Basal cells

Rarely metastasises/kills

47
Q

What cell type is malignant in SCC?

A

Keratinocytes

Increased risk of mets and death

48
Q

What cell type is malignant in melanoma?

A

Melanocytes?

49
Q

What is Breslow thickness?

A

Breslow thickness = determines the excision margin

  • melanoma in situ =5mm margin
  • <1mm = 1cm
  • 1-4mm = 1-2cm
  • > 4mm = >2cm
50
Q

What questions are important to ask about a skin lesions?

A 
A-E
assymetry
border
colour changes
diameter
enlarging/evolving
51
Q

Describe the cause of alopecia and its types

A

Autoimmune attack of hair follicles by inflammatory CD4+ T cells causing hair loss

Scarring type (irreversible hair loss)

  • discoid lupus
  • syphilis
  • scalp cellulitis
  • tinea

Non-scarring (reversible hair loss)

  • alopecia areata
  • alopecia totalis (all head)
  • alopecia universalis (all body)
52
Q

What are the S/Sx of alopecia areata

A 
well circumscribed areas
Hair pull test +ve
small white hair growth
Exclamation hairs
Psychological effects:
- anxiety
- depression
- isolation
53
Q

What is livedo reticularis and in what conditions would you see it?

A

mottled red/blue non-blanching skin lesions, associated with RA/SLE/PAN

54
Q

What is acanthosis nigricans and what is it associated with?

A

Benign, smooth, hyperketotic plaques in intertriginous areas

Seen in DM

55
Q

What is pyoderma gangrenosum and in what conditions is it seen?

A

Enlarging painful ulcers with purple overhanging edge
Seen in:
IBD, RA, myeloma, leukaemia

56
Q

What is erythema nodosum and in what conditions is it seen?

A

Erythematous tender nodules over shins

Associated with IBD/TB/Sarcoidosis

57
Q

In what conditions is erythema multiforme associated with?

A

Mycoplasmae pneumoniae, HSV

Year 4 (28 decks)

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