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Dermatology Board Prep flashcards
1
Q

What is the difference and similarity between a macule and a patch?

A

BOTH are flat
Macule - <1.5cm in diameter

Patch - >1.5cm in diameter

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2
Q

What is the difference and similarity between a papule and a nodule and a plaque?

A

both solid, raised palpable lesion
Papule - <0.5cm in diameter

Nodule - >0.5cm in diameter

Plaque - elevated >5mm + scaling

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3
Q

What is the similarity and difference between a vesicle and a bulla?

A

Both raised, clear, fluid filled lesions
Vesicle <0.5cm

Bulla >0.5cm

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4
Q

What is a simialrity and difference between a pustule and an abscess?

A

Pustule – pus-containing lesion <0.5cm in diameter

Abscess – localised accumulation of pus
Both are pus containing lesions

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5
Q

What is a wheal?

A

Oedematous papule or plaque caused by dermal oedema

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6
Q

What is eczema and how does it present?

A

Inflammation of the epidermis

Dry, erythematous skin, can be flaky, itchy (excoriation), over the flexor surfaces (inside elbows and knees)

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7
Q

How do you manage eczema?

A

Emoillients used as often as possible
Avoid triggers
Treat flare ups with topical steroids and wet wraps and calcineurin inhibitors eg tacrolimus
Immunosuppressants eg ciclosporin, antihistamines, azathioprine

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8
Q

Name some emoillients - thick and thin

A

Thin creams:

E45
Diprobase cream
Oilatum cream
Aveeno cream
Cetraben cream
Thick, greasy emollients:
50:50 ointment (50% liquid paraffin)
Hydromol ointment
Diprobase ointment
Cetraben ointment
Epaderm ointment
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9
Q

Describe the steroid ladder. What must you be careful of when using steroids?

A

Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
PO steroid
HEBDO!
1 finger tip unit = can treat size of twice flat adult hand

Skin thinning and making condition worse!

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10
Q

What is discoid eczema?

A

Discoid eczema causes distinctive circular or oval patches of eczema aka nummular eczema

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11
Q

Describe eczema herpeticum

A

Infection of eczema with herpes or varicella

Presents with a widespread vesicular rash. rapidly progresses, often in children, punched out erosions

Rx: aciclovir PO (IV if NBM or critically ill)

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12
Q

What is actinic keratosis?

A

Actinic keratosis is a scaly spot found on sun-damaged skin. It is also known as solar keratosis. It is considered precancerous or an early form of cutaneous squamous cell carcinoma (a keratinocyte cancer).

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12
Q

What is actinic keratosis?

A

aka solar keratoses, dry, scaly patches

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12
Q

What is actinic keratosis?

A

aka solar keratoses, dry, scaly patches

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13
Q

What is Bowen’s disease?

A 
Intraepidermal SCC (early and superficial form) 
Are scaly plaques
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14
Q

What is a BCC?

A

Usually occurs in middle age, on head/neck with PEARLY/ TRANSLUCENT papules and telangiescasia, central ulceration, rolled edge

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15
Q

Name some fungal infections and describe their key features

A

candida, tinea, aspergillus - are superficial and itchy

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16
Q

Describe the different types of ringworm/tinea

A

Tinea capitis - ringworm scalp - often have hair loss

tinea pedis- atheletes foot

tinea corporis - body

Onychomycosis- nail infection

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17
Q

What is a SCC?

A

May develop on background of solar keratosis, immunosuppression, Bowen’s disease (leukoplakia) or de novo

Begin as nodules on a firm indurated base, ulcerating as they enlarge

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19
Q

Describe the different types of ringworm/tinea

A

Tinea capitis - ringworm scalp - often have hair loss - boddy mass, give topical ketoconazole shampoo

tinea pedis- atheletes foot

tinea corporis - ringworm, on body, annular, well defined, erythematous lesions with pustules/ papules, treat with PO flyconazole

Onychomycosis- nail infection

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19
Q

What is the management of tinea?

A

Diagnosis clinical/ MCS off scrapings.

Treat with:
Topical antifungal
E.g. terbinafine cream, ketoconazole/selenium sulphate shampoo

Oral antifungal
E.g. itraconazole, fluconazole

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20
Q

How is molloscum contagiosum managed?

A

reassure, don’t share towels, can use imiquimod if makes them sad

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21
Q

How does ringworm/ tinea corporis present?

A

itchy, eryhematous, scaly, annular lesions

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23
Q

What is molluscum contagiosum?

A

viral infection causing Pearly, smooth papule with a central umbilication (dimple) commonly distributed at face and groin in crops

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24
Q

What is scabies and its presentation?

A

Infection with mites usually from close contact via sarcoptes scabiei

present with Pruritic, erythematous papules linear burrows in interdigital web space

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24
Q

A woman takes a 20 day regime of lamotrigine and once she stops develops an erythematous maculopapular rash with temperature and tenderness, what up?

A

Steven johnson syndrome/ toxic epidermal necrolysis

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25
Q

What is SJS and TEN?

A

are a spectrum of the same pathology (SJS is <10% body surface) where epidermal necrosis occurs after taking a drug/ having infection. Drug is commonly anti-epileptic, abx, allopurinol, NSAIDs

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26
Q

What is the mx for TEN/ SJS?

A

STOP drug, admit, burn care, steroids, Ig, immunosuppression

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27
Q

What is psoriasis? presentation?

A

chronic autoimmune condition which presents with dry, flaky, scaly, pink/ silver plaques. On the extensor surfaces of knees and elbows.
Associated with nail psoriasis + psoriastic arthiritis.

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28
Q

What is SJS and TEN?

A

are a spectrum of the same pathology (SJS is <10% body surface) where epidermal necrosis occurs after taking a drug/ having infection. Drug is commonly anti-epileptic, abx, allopurinol, NSAIDs, OCP

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29
Q

What is erythema Nodosum? Associations?

A

condition where red tender lumps appear across the patient’s shins.

Associated with: Infection: strep throat, primary TB, chlamydia, histoplasmosis, giardiasis

Drugs: amoxicillin, NSAIDs, oral contraceptives

Inflammatory: IBD, sarcoidosis

Malignancy: lymphoma, leukaemia

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30
Q

What causes Scarlet Fever ?

A

group A streptococcus - like tonsillitis eg strep pyogenes

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31
Q

What is psoriasis? presentation?

A

chronic autoimmune condition which presents with dry, flaky, scaly, pink/ silver plaques. On the extensor surfaces of knees and elbows.
Associated with nail psoriasis + psoriastic arthiritis.

Types: Plaque, flexural (smooth), guttate, pustular (palms and soles)

May be worsened by: Trauma, alcohol, BB, ACE-i, NSAIDs, anti-malarials, withdrawal steroids

32
Q

How does scarlet fever present?

A

sanpaper rash, red flushed cheeks, strawberry tongue, lympadenopathy

33
Q

mx of scarlet fever?

A

phenoxymethylpenicillin (penicillin V) for 10 days.

34
Q

How is psorisasis managed?

A

1) Topical steroids - strong stuff like betnovate plus Topical vitamin D analogues (calcipotriol) OD
2) a vitamin D analogue twice daily
3) a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily. Topical dithranol can also be used.
4) Secondary care: Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis

35
Q

How does rubella present?

A

milder erythematous macular rash compared with measles. The rash starts on the face and spreads to the rest of the body. The rash classically lasts 3 days. lymphadenopathy.

36
Q

What is slapped cheek syndrome cause by?

A

Parvovirus 19

37
Q

How does slapped cheek present?

A

mild fever, coryza and non-specific viral symptoms such as muscle aches and lethargy. After 2 – 5 days the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”. A few days later a reticular mildly erythematous rash affecting the trunk and limbs appears that can be raised and itchy. BEWARE in aplastic anaemias

38
Q

What is roseala caused by?

A

Herpes 6 (6th disease)

39
Q

How does roseola present?

A

high fever, corzyal sx, lymphadenoathy, macular red rash, febrile convulsions with high temp.

40
Q

How is erythema multiforme managed?

A

Look for cause, address cause, supportive

41
Q

What is the cause of urticaria aka hives?

A

Histamine is released by mast cells due to allergy/ autoimmune reaction

42
Q

What is erythema multiforme? How does it present?

A

hypersensitivity reaction to drug/ infections eg streptococcus, HSV, pemicillin, carbamazepine, allopurinol, NSAIDs, COCP, SE, sarcoidosis, cancer

Presents with eryhtematous, itchy, TARGET lesions, stomatitis

43
Q

How is urticaria managed?

A

ANTI-HISTAMINES eg fexofenadine , steroids, LTRA, omalizumab

44
Q

How does varicella present?

A

erythematous, widespreas, vesicular lesions, fever, itchy

45
Q

When do you get non-supportive mx for varicella?

A

Varicella Ig given in pregnany if non-immune + on aciclovir around time of delivery.
aciclovir if immunocompromised

46
Q

What causes hand, foot and mouth disease?

A

coxsackie A virus.

47
Q

How does hand, foot and mouth present?

A

URTI sx, ulcers which then blister particularly around the name sake

48
Q

What causes pityrasis rosea?

A

we think human herpes virus (HHV-6 or HHV-7

49
Q

How do you tell the difference between nappy rash and candida?

A

Think candida if:

- larger red macules, rash into skin folds, circular pattern like ringworm, satellite lesions, oral thrush

50
Q

What is staphylococcal scalded skin syndrome? How does it present?

A

Caused by S.aureus, causing breakdown of skin - usually only effects <5 yrs. Presents with erythema, thinning, wrinkling then bullae which burst (like a burn).

Nikolsky sign is where very gentle rubbing of the skin causes it to peel away. This is positive in SSSS.

51
Q

How does pityrasis rosea present?

A

URTI, then start with a HERALD PATCH - faint scaly, oval shaped lesion, usually on torso, christmas tree distribution
rash is red/pink, scaly, oval, itchy

52
Q

How do you describe non-blanching rashes dermatologically?

A

Petechiae are small (< 3mm), non blanching, red spots on the skin caused by burst capillaries. Purpura are larger (3 – 10mm)

54
Q

What are the differentials for a non-blanching rash?

A 
meningococcal septicaemia
HSP - heoch-schonlein purpura
ITP
acute leukaemias
HUS - haemolutic uraemic syndrome
55
Q

What causes impetigo? How does it present?

A

S.aureus / strep. pyogenes

presents with golden crust, exudate, have bullous and non-bullous types

55
Q

What is a seborrhoeic keratosis?

A

Age related, look stuck on, benign

56
Q

What can seborrheic dermatitis present as?

A

cradle cap
dandruff
seborrheic blepharitis
is salmon pink, scaly, plaques

57
Q

How is impetigo managed?

A

Bullous - 1)flucloxacillin 2) erythromycin

non-bullous - hydrogen peroxide 1% cream first line and then fuscidic acid

58
Q

What is rosacea?

A

flushing of face, visible veins, some papules and pustules, feels hot and tender, may get a bulbous nose

59
Q

Describe tuberous sclerosis

A

Present with seizures+

■ Adenoma sebacum (angiofibromas)

■ Periungal fibroma

■ Ash leaf maculeseriungal fibromas

■ Shagreen patches

60
Q

What is dermatitis herpetiformis? What is it associated with?

A

Associated with coeliacs.

Summetrical on buttocks, elbows and knees

61
Q

What is pemphigus vulgaris?

A

Autoimmune (desmoglein antibodies) causing Painful flaccid blisters easily rupture –> painful erosions
nikolsky positive, often oral involvement
Mx: steroids!

62
Q

What is pityriasis versicolor?

A

A yeast infection in young people which leads to discolouration of the chest and back

63
Q

What is vitiligo?

A

Autoimmune destruction of melanocytes leading to depigmentation

64
Q

What is pityriasis versicolor?

A

A yeast infection in young people which leads to discolouration of the chest and back. more noticeable on suntan, mil itching, scaling common

Mx: Topical antifungal - ketoconazole shampoo!!

65
Q

How do you dermatologically describe eczema?

A
  • papules and vesicles over erythemaous surface on flexor surface, ranging 1-6mm, some evidence of lichenification and scaling but no evidence of secondary infection or eczema herpeticum (atopic, seborrhoic, asteotic, disocoid, venous, pompholyx)
66
Q

What is vitiligo?

A

Autoimmune destruction of melanocytes leading to depigmentation, associated with T1DM, thyroid, addisons, pernicious anaemia

mx: Sunblock, camouflage, steroids if done early can reverse

67
Q

How do you dermatologically describe psoriasis?

A
  • multiple, well demarcated, raised, erythematous plaques over the extensor surfaces, range 1-6cm, scaling, evidence of pitting, subungal hyperkaratosis, onchylysis and beau lines on nails. Symmertrical polyarthropathy of DIP with active synovitis. (chronic plaque, guttate, seborrehoic, flexoral, pustural)
68
Q

How do you dermatolically describe a BCC?

A

skin coloured nodule/ papule on left cheek with pearly rolled edge and surface talengactasia, 13mm diameter, no ulceration, necrosis, crusting, scaling or erosiom. On palpation it is firm but not hot or tender.

69
Q

What is the treatment of rosacea?

A

topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)

topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia

more severe disease is treated with systemic antibiotics e.g. Oxytetracycline

70
Q

Summarise pyoderma gangreosum

A

Begin as tender nodules –> Very Painful ulcers with overhanging blue edge and a purulent appearance.
Due to IBD, RA, SLE, AML, lymphoma or idiopathic
Treat with PO steroids and immunosuppression

71
Q

How is pityriasis versicolor treated?

A

Ketoconazole shampoo

72
Q

How do you treat actinic keratosis?

A

fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation

74
Q

What is pemphigus vulgaris?

A

Pemphigus vulgaris (PV) is a rare and serious (potentially life-threatening) condition that causes painful blisters to develop on the skin and lining of the mouth, nose, throat and genitals. Caused by autoimmune/ drugs.

75
Q

How do you treat lichen sclerosis? What is it?

A

Inflammatory condition effecting genitals –> white plaques, itchy, pain intercourse/ urination

F/U for vulval cancer
Mx: topical steroids and emollients

76
Q

Summarise acne vulgaris

A

Excess sebum –> blocks pilosebaceous follicles –> infection –> comedones
Severe: nodules, pitting and scarring

Mx:
1)
12 weeks of any of:
A fixed combination of topical adapalene with topical benzoyl peroxide
A fixed combination of topical tretinoin (retinoids) with topical clindamycin
A fixed combination of topical benzoyl peroxide with topical clindamycin

2) try different option from above
3) PO tetracyclines
4) Refer derm for isotretinoin - remember dries out mucus membranes, teratogenic, migraines, depression SE

77
Q

Summarise acanthosis nigricans

A

Symmetrical, velvety, brown plaques in neck/ axilla/ groin

Associations: T2DM, Cushings, PCOS, obesity, acromegaly, COCP, prader willi. GI cancer

78
Q

Summarise Actinic keratoses

A

Pre-malignant SCC

features: crusty, scaly, pink/ red/ brown, sun exposed areas

Mx: RF management, flurouracil cream, topical diclofenac, topical imiquimod, cryotherapy

79
Q

Summarise Bullpus Pemphigoid

A

Autoimmune condition due to antibodies against hemidesmosmal proteins

Sx: itchy, tense, blisters, flexor surfaces, NO mucus involvement

Ix: Biopsy and Ab

Mx: Refer for biopdy, PO corticosteroids, topical steroids/ immunosuppressants/ abx

80
Q

Summarise shingles

A

Reactivation of VZV which lies dormant in the dorsal root ganglia

RF: HIV, age, immuniosuppression

Sx: Commonly T1-L2, prodrome of burning pain in dermatome 2-3 days, then rash, ertyhematoud, macular, then vescular, IN DERMATOME, does not cross midline

Mx: NSAIDs, neuropathic agents, aciclovir within 72 hrs which reduces post herpetic neuralgia

81
Q

Spider Naevi vs Telangectasia

A

Spider fill from centre, telangectasia from edge when pressed

Dermatology (1 decks)

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