Passmedicine Questions Flashcards
1
Q
What is the nomenclature of dermatology?
A
2
Q
What is actinic keratosis?
A
A pre-malignant skin condition that develops due to chronic sun exposure
3
Q
What is the management of actinic keratosis?
A
Sun avoidance + Sun cream
Treatment:
Fluorouracil cream for 2-3 weeks (+topical hydrocortisone for inflammation)
OR
Topical diclofenac (for milder AK, less side effects)
4
Q
Where are you most likely to find lichen planus?
A
Palms
soles
genitalia
flexor surfaces of arms
Mucous membrane
5
Q
What are the most common causes of acanthuses nigricans?
A
Type 2 diabetes Mellitus
Gastrointestinal adenocarcinoma
Obesity
Polycystic ovarian syndrome
6
Q
What is the most common trigger of gutter psoriasis?
A
Usually occurs 2-4 weeks after a streptococcal infection (tonsilitis)
7
Q
How would you describe the look and distribution of gutter psoriasis?
A
Tear drop papule on the trunk and limbs
8
Q
What are the differences between actinic keratosis and Bowens disease?
A
Both forms of sun damage where abnormal cells have developed in the top layer of skin (epidermis). Both usually range from 0.5-2cm.
Actinic Keratosis: Called solar keratoses, they vary in colour.
Bowens disease: Called squamous cell carcinoma in situ, more red and scaly.
9
Q
What are the risks associated with actinic keratosis and Bowens disease?
A
Development of squamous cell carcinoma.
10
Q
What is the treatment for Bowens disease?
A
- Topical 5-fluorouracil (2x daily for 4 weeks) - topical steroids also given to reduce inflammation.
- cryotherapy
- excision
11
Q
How is molluscum contagiosum described and where is it found?
A
pink or pearl-coloured raised papule with central umbilication, usually 1-2mm.
It can be found in clusters anywhere APART from the palms and soles.
Clusters of lesions often appear at areas of injury (Koebners phenomenon).
12
Q
How is molluscum contagiosum managed?
A
Usually self limiting - will resolves on its own within 18 months.
Lesions are contagious Don’t share towels, clothing and baths. CAN STILL GO TO SCHOOL.
If lesions are troublesome - can attempt trauma or cryotherapy.
13
Q
What causes seborrhoea dermatitis?
A
Caused by an inflammatory reaction to the skin fungus malassezia furfural.
14
Q
How is seborrhoea dermatitis described and where is it found?
A
Eczematous lesions in sebum rich areas (scalp, periorbital, auricular or nasolabial folds).
15
Q
how is seborrhoea dermatitis of the scalp managed?
A
Using zinc pyrithione (head and shoulders or tar neutropenia gel).
Second like - ketoconazole
Other - selenium sulphide and topical corticosteroids
16
Q
How is seborrhoeic dermatitis of the body managed?
A
Topical antifungals - ketoconazole
Topical steroids - Only used for short periods
17
Q
What are the 4 subtypes of melanoma?
A
Superficial spreading (most common)
Nodular (second most common - MOST AGGRESSIVE)
Lentigo Maligna
Acral lentiginous
18
Q
What does a nodular melanoma look like?
A
A red or black lump which bleeds or oozes
19
Q
What is vitiligo?
A
An autoimmune condition which results in the loss of melanocytes and causes depigmentation of the skin.
20
Q
What is vitiligo associated with?
A
Type 1 diabetes
Addisons disease
Alopecia
Autoimmune thyroid disorders
Pernicious anaemia
21
Q
What are common features of Vitiligo
A
Well-demarcated patches of depigmented skin
The peripheries tend to be most affected
Trauma may precipitate new lesions (Koebner phenomenon)
Often affects the hands and feet symmetrically
22
Q
What is the management of vitiligo?
A
Sunblock for affected areas of skin
Camouflage make-up
Topical steroids - may reverse the changes if applied early enough
23
Q
Where are the most common sites of keloid scars?
A
- Sternum
- Shoulder
- Neck
- Face
- Extensor surface of limbs
- Trunk
24
Q
Which part of the body is often spared in polymorphic eruption of pregnancy?
A
The peri umbilical area
25
Which part of the body is often spared in polymorphic eruption of pregnancy?
The peri umbilical area
26
What is acne rosacea?
A chronic skin disease of unknown aetiology
27
What are the features of acne rosacea?
Affects nose, cheeks and forehead
Flushing is often the first symptom
Talengectasia is common
Later develops into a persistent erythema with papule and pustules
Rhynophyma
Occular involvement
Sunlight may exacerbate symptoms
28
What is the management of acne rosacea?
Predominant erythema/flushing:
- Topical brimonidine gel
Mild to moderate papules and/or pustules:
- Topical ivermectin (or topical metronidazole or topical azelaic acid)
Moderate to severe papules and/or pustules:
- Combination of topical ivermectin + oral doxycycline
29
When should patients be referred with acne rosacea?
If symptoms haven't improved with optimal primary care management
Patients with rhinopehyma
30
What is a dermatofibroma?
A common benign fibrous skin lesion caused by abnormal growth of dermal dendritic histiocyte cells.
31
What are common features of dermatofibromas?
They are solitary firm papules or nodules
Typical around 5-10mm in size
Overlying skin dimples on pinching the lesion
32
What causes a dermatofibroma?
Usually nothing but often precipitated by an injury like an insect bite or a thorn prick.
33
When are skin PRICK or PATCH tests indicated?
Prick:
- Type I hypersensitivity reaction, IgE mediated (true allergy)
- Systemic reactions
Patch:
- Type IV hypersensitivity reaction, non IgE mediated
- for skin reactions - like nickel
34
What is the management for chronic plaque psoriasis?
First line:
- Potent corticosteroid + Vitamin D analogue (One taken at night and one in the morning) - for up to 4 weeks
Second line:
- if no improvement after 8 weeks
- take the vitamin D twice daily
Third line:
- If no improvement after 8-12 weeks
- Potent corticosteroid, 2x daily for 4 weeks OR
- coal tar preparation applied 1-2x daily
35
What is the treatment for flexure psoriasis?
First line:
- Mild or moderately potent corticosteroid 1-2x daily for up to 2 weeks
*Vitamin D preparations are not beneficial in flexural psoriasis*
36
In psoriasis, how long can corticosteroids be prescribed for?
No longer than 8 weeks, this must be followed by at leas a 4-week break.
37
hat is eczema herpeticum?
A severe primary infection of the skin caused by herpes simplex virus 1 or 2
In patients with atopic eczema
38
How does eczema herpeticum present?
A rapidly progressing painful rash.
An area of rapidly worsening painful eczema is an early sign.
Monomorphic punched out erosions (circular, depressed, ulcerated lesions).
1-3mm diameter.
Often have a temperature
39
What is the treatment for eczema herpeticum in children?
Admitted for IV Aciclovir
40
What is the Koebner phenomenon?
When a skin lesion appears a the site of an injury
41
What conditions are associated with the koebner phenomenon?
Psoriasis
Vitiligo
Warts
Lichen planus
Lichen sclerosus
Molluscum contagiosum
42
What is Wallaces Rule of nines regarding the extent of burns?
head + neck = 9%,
each arm = 9%,
each anterior part of leg = 9%,
each posterior part of leg = 9%,
anterior chest = 9%,
posterior chest = 9%,
anterior abdomen = 9%,
posterior abdomen = 9%
43
When are IV fluids required in burn management?
In children with burns >10% of total body surface area
In adults with burns >15% of total body surface area
44
What is the parkland formula for calculating fluid prescribing in burns?
Volume of fluid = Total body surface area of the burn % X Weight (Kg) X4.
- Half of the fluid is administered in the first 8 hours.
- The second half is administer within the next 16 hours.
45
What is the most important factor regarding prognosis in melanoma?
The depth of a tumour (Breslow depth).
- < 0.75 mm = 95-100%
- 0.76 - 1.50 mm = 80-96%
- 1.51 - 4 mm = 60-75%
- > 4 mm = 50%
46
What are the causes of fungal nail infections?
- Trichophyton rubrum (dermatophytes) - 90%
Candida (yeast) - 5-10%
47
What is the treatment for fungal nail infections?
If dermatophyte or candida:
- Limited involvement (<50% of nail) - Topical amorolfine 5% nail lacquer, 6 months for finger, 9-12 months for toenails
- More extensive involvement:
- Dermatophyte - Oral terbinafine, 6 weeks - 3 months for fingers, 3-6 months for toes
- Candida infection - Oral itraconazole
48
What is a normal ABPI?
0.9-1.2
49
What is the management of venous ulcers?
compression dressings/bandages
50
What ABPI pressure indicates PAD?
<0.9 and >1.3
51
What is alopecia areata?
An autoimmune condition causing localised, well demarcated patches of hair loss
52
What is th likeliness of hair regrowth in alopecia aerate?
Hair growth will occur in 50% of patients by 1 year
Hair regrowth will occur in 80-90% eventually.
53
What tests should be done if alopecia aerate is suspected?
Screening for other autoimmune conditions:
Thyroid (TFT)
Diabetes (HbA1c)
Pernicious anaemia (B12)
FBC
54
What is urticaria?
Localised or generalised superficial swelling of the skin.
55
What does urticaria look like?
Pale, pink, raised skin.
Desribed as - hives, wheals, nettle rash
ITCHY
56
What is the management of urticaria?
Non sedating antihistamines
Prednisolone for severe/resistant episodes.
57
What is bullous pemphigoid?
An autoimmune condition causing sub-epidermal blistering of the skin.
58
What is the difference between bullous pemphigoid and pemphigus vulgarise?
Bullous pemphigoid - NO mucosal involvement
Pemphigus vulgaris - MUCOSAL INVOLVEMENT
59
What does bullous pemphigoid look like?
Itchy, tense blisters around flexures
60
hat is the management of bullous pemphigoid?
Referral to dermatologist + Oral corticosteroids
Topical corticosteroids, immunosuppressants and antibiotics are also used
61
What is Hidradenitis Suppurativa
A chronic, painful inflammatory skin disorder.
Causes inflammatory nodules, pustules, sinus tracts and scars in intertriginous areas (skin folds).
62
What are the rsik factors for hydradenitis suppurative?
Female
Adults < 40
Family history
Obesity
Diabetes
Polycystic ovarian syndrome
Smoking
Mechanical stretching of the skin
63
What is the appearance of hydradenitis suppurative?
Painful, inflamed nodules
Axilla is most common site
Nodules may rupture - discharge purulent, smelly material.
Nodules can result in plaques, sinus tracts and rope like scarring.
64
What is the treatment for hydradenitis suppurative?
Good hygeine and loose fitting clothes
Smoking cessation
Weight loss
Acute flares: Steroids or flucloxacillin or surgical drainage.
Long term - Topical clindamycin or oral antibiotics.
Lumps that persist can be excised surgically.
65
What is the treatment for hydradenitis suppurative?
Good hygeine and loose fitting clothes
Smoking cessation
Weight loss
Acute flares: Steroids or flucloxacillin or surgical drainage.
Long term - Topical clindamycin or oral antibiotics.
Lumps that persist can be excised surgically.
66
What is the step-up management used in acne vulgaris?
Single topical therapy (retinoids, benzoyl peroxide)
Topical combination therapy (antibiotic, benzoyl peroxide, retinoid)
Oral antibiotics (tetracyclines) + Topical retinoid/benzoyl peroxide
Combined oral contraceptive (as an alternative to oral antibiotics in women)
Dianette (co-cyrindol)
Oral isotretinoin (only under specialist supervision)
67
What is the most common retinoid used?
Isotretinoin
68
What antibiotic is used in acne vulgaris?
Tetracycline: Lymecycline, oxytetracycline, doxycycline.
For a MAXIMUM of 3 months.
69
When are tetracyclines avoided?
In pregnancy, breastfeeding women and children under 12.
Erythromycin is used in pregnancy.
70
What is the treatment for scabies?
- Two doses of permethrin cream 5% applied over the whole body.
- Leave one week between applications.
- Treatment should be for both patient and contacts.
Malathion liquid 0.5% is second line.
71
What bacteria causes acne vulgaris?
Propionibacterium acnes.
72
What is erythema Multiforme?
A hypersensitivity reaction most commonly triggered by infections.
Split into minor and major forms.
73
What does erythema multiforme look like?
Target lesions on the back of hands and feet before spreading to the torso.
Upper limbs>lower limbs.
Pruritis is often mild
74
What are the causes of erythema multiforme?
Viruses (HSV)
Idiopathic
Bacteria
Drugs: Penicillin, NSAIDs, allopurinol, oral contraceptive, carbamazepine, sulphonamides
Sarcoidosis
SLE
Malignancy
75
is erythema multiforme major?
The more severe form or erythema multiforme - associated with MUCOSAL involvement.
76
What is Tinea?
The term given to dermatophyte Fingal infections.
77
What are the main types of Tinea infections?
Tinea capitis - Scalp ringworm
Tinea corporis - Trunk, legs or arms (ringworm)
Tinea pedis - athletes foot
78
What is the treatment for tinea corporals?
Oral fluconazole
79
What is lichen sclerosis?
An inflammatory condition that affects the genitalia and is more common in elderly females.
Causes atrophy of the epidermis with white plaques forming.
80
What are the signs and symptoms of lichen sclerosis?
White patches that may scar
Prominent ITCH
Pain whilst urinating or intercourse
Associated with other autoimmune conditions
81
How is lichen sclerosis diagnosed?
Usually on clinical examination
Skin biopsy IF - atypical features are present.
82
What is the management for lichen sclerosis?
Topical steroids (topical clobetasol propionate) and emollients
Follow up - increased risk of vulval cancer.
83
What are the side effects of retinoids? (Isotretinoin)
- Dry skin, eyes, lips and mouth (most common)
- Teratogenicity (women should ideally use 2 types of contraception)
- Low mood
- Raised triglycerides
- Hair thinning
- Nose bleeds
- Intracranial hypertension
- Photosensitivity
84
What are examples of topical steroids?
- Strong steroid - betamethasone
- weak steroid - hydrocortisone
85
What is an example of a vitamin D analogue?
Topical calcipqotriol
86
What is pemphigoid gestationis?
- pruritic blistering lesions
- develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
- usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
- oral corticosteroids are usually required
87
What is pemphigoid gestationis?
- pruritic blistering lesions
- develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
- usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
- oral corticosteroids are usually required
88
What is toxic epidermal necrolysis?
- a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction.
In this condition, the skin develops a scalded appearance over an extensive area.
- Some authors consider TEN to be the severe end of a spectrum of skin disorders which includes erythema multiforme and Stevens-Johnson syndrome,
89
What drugs are known to induce TEN?
- phenytoin
sulphonamides
allopurinol
penicillin
carbamazepine
NSAIDs
90
What is the management of TEN?
Stop precipitating factor
first line:
IV immunoglobulin
supportive care (often in UCI)
Fix volume loss and electrolyte disrutbances
Other treatment:
Immunosuppressives agents (cyclosporin and cyclophosphamide)
91
What are causes of erythema nodosum?
Infection (streptococci, tuberculosis, brucellosis)
Sarcoidosis
Inflammatory bowel disease
Malignancy
Lymphoma
Penicillin
Sulphonamides
COCP
Pregnancy
92
What is pityriasis versicolor?
A superficial cutaneous fingal infection caused by malassezia furfur
93
does pityriasis versicoloured present?
As scales on the trunk or back
Hypopigmented, pink or brown
*More noticeable after a suntan*
Scaly
Mild itch
94
What is the treatment for pityriasis versicolor?
Topical anti fungal - Ketoconazole shampoo
95
What is the management for erythema nodosum?
Baseline investigation (CXR) to identify cause
No active treatment, arrange routine follow up
96
How common is metastasis in squamous cell arcing?
2-5% of patients
97
What are the risk factors for squamous cell carcinoma?
Excessive exposure to sunlight
Actinic keratosis
Bowens disease
IMMUNOSUPPRESSION - Kidney transplant, HIV
Smoking
Long-standing leg ulcers (marlins ulcer)
Xeroderma pigmentosum (extreme sun sensitivity)
Oculocutaneous albinism (skin, hair, and eyes have no melanin)
98
What are typical features of squamous cell carcinomas"
Typically on sun-exposed sites (head, neck, dorm of hands)
Rapidly expanding, painless, ulcerated nodules
Cauliflower like appearance
Red, scaly plaques on top with crusting and ulceration
Areas of bleeding
Hyperkeratotic lesion with crusting and ulceration
Usually more aggressive than BCC
99
What is the treatment for squamous cell carcinoma?
Surgical Excision:
- Lesion <20mm in diameter = 4mm margin.
- Lesion >20mm in diameter = 6mm margin.
Mohs micrographic surgery
100
What are squamous cell carcinomas?
A skin cancer involving the squamous keratinocytes (the cells lining the top of the epidermis)
101
What are pre-cancerous lesions of squamous cell carcinoma called?
Actinic Keratosis
Bowens disease
102
What are the two main types of contact dermatitis?
1. Irritant contact dermatitis
2. Allergic contact dermatitis
103
What are the main features of irritant contact dermatitis?
common, non-allergic reaction
due to weak acids or alkalis
Erythema of the hands is typical
Crusting and vesicles are rare
104
What are the main features of allergic contact dermatitis?
A type IV hypersensitivity reaction
Uncommon - often seen on the head after using the hairdryer
An acute, weeping eczema
Topical potent steroids are indicated
105
is dermatitis herpetiformis?
An autoimmune blistering skin disorder associated with coeliac disease.
Caused by deposition of IgA in the dermis.
Itchy, vesicular skin lesions on extensor surfaces
106
What is the diagnosis and management of dermatitis herpetiformis?
Diagnosis - skin biopsy shows deposition of IgA
Management - Gluten free diet and dapsone
107
is the management of hyperhidrosis?
Excessive sweating
First line: Topical aluminium chloride
Other: Iontophoresis, botulin toxin, surgery.
108
What are exacerbating factors of psoriasis?
Trauma
Alcohol
Beta blockers
Lithium
Antimalarials (chloroquine and hydroxychloroquine)
NsAIDS
ACE inhibitors
Infliximab
Withdrawal of Systemic steroids
Streptococcal infection - gutter psoriasis
109
What is the treatment for shingles?
Aciclovir (within 72hrs of onset) - to reduce the chance of post-herpetic complications
Amitryptiline - for management of post-herpetic neuralgia
Prednisolone - second line analgesic for patients not adequately pain free with OTC analgesia.
110
What are complications of shingles?
post herpetic neuralgia
Herpes zoster ophthalmic
Herpes zoster optics (Ramsay Hunt syndrome)
111
what is seborrhoea keratosis?
Benign epidermal skin lesions that are common in >50 yrs
112
What are common features of seborrhoea keratosis?
Have a stuck on appearance
Keratotic plugs may be seen on the surface
large variation in colour from flesh to light-brown to black
113
What is the treatment for seborrhoeic keratosis?
Reassurance about the benign nature + leave it alone
Removal: Curettage, cryosurgery and shave biopsy
114
What is the treatment for seborrhoeic keratosis?
Reassurance about the benign nature + leave it alone
Removal: Curettage, cryosurgery and shave biopsy
115
What are basal cell carcinomas?
A cancer of the basal cells (the cells lining the bottom of the epidermis) outermost layer of the skin.
The most common type of skin cancer.
116
What are typical features of basal cell carcinomas?
Most common type is Nodular BCC
Slow growing and locally invasive
Metastasis is extremely rare
Sun exposed site
Pearly, flesh-coloured papule with telangiectasia
May ulcerate later leaving a central crater
117
what is the treatment of BCC?
Surgical removal
Curettage
Cryotherapy
Topical cream: Imiquimod, fluorouracil
Radiotherapy
