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MBChB > Skin > Flashcards

Skin Flashcards

1
Q

What gene mutation may predispose a person to a BCC?

A

PTCH

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2
Q

Describe a nodular BCC

A

Module >0.5cm
Shiny surface
Telangectasia
Often ulcerated centrally

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3
Q

Describe a superficial BCC

A

Not raised
Rolled margin
Telangectasia
More indolent - doesn’t ulcerate

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4
Q

Describe a pigmented BCC

A

Rolled shiny margin
Telangectasia
Ulcerated
Pigmented

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5
Q

Describe a morphemic/sclerotic BCC

A

Harder to diagnose as filtrating underneath the skin at a slow rate
Harder to manage

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6
Q

Describe the management of a BCC

A 
Surgical exicision: 3-4mm margin
Curettage and cautery
Cryotherapy
Photodynamic therapy 
Topical imiquimod/5-flurouracil cream
Mohs micrographic surgery
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7
Q

What are the pre-malignant variants of SCC?

A

Actinic keratoses

Bowen’s disease

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8
Q

What are high risk sites of metastasis in SCC’?

A

Ears

Lips

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9
Q

What are the clinical features of SCC?

A

Keratin appearance - crusty, scaly
No rolled shiny margin
No ulceration (unless aggressive)

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10
Q

Describe the management of SCC

A

Surgical excision - 4mm margin
Curettage and cautery

If pre-malignant:
Topical imiquimod/5-flurouracil cream
Cryotherapy
Photodynamic therapy

Sun protection

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11
Q

What determines 5y survival of melanomas?

A

Breslow thickness

0-1mm = 97%
1.01 - 2mm = 91%
2.01-4mm = 79%
>4.00mm = 71%

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12
Q

Describe acral melanoma

A

Hands and feet - more likely to present in people with darker skin types

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13
Q

Describe subungal melanoma

A

Underneath nails

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14
Q

Describe amelonatic melanoma

A

No pigment, can be missed, rare

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15
Q

Describe lentigo maligna

A

Pre-malignant melanoma on the face

Can develop into lentigo maligna melanoma

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16
Q

Describe the clinical features of a melanoma

A

No symmetry
Different shades
Pattern of pigmentation is different

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17
Q

What margin is required if Breslow depth is <1mm?

A

1cm

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18
Q

What margin is required if Breslow depth is >1mm?

A

2cm

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19
Q

Describe Gorlin’s syndrome

A

Multiple BCCs
Jaw cysts
Risk of breast Ca

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20
Q

Describe Brook Spiegler syndrome

A

Multiple BCCs

Trichoepitheliomas

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21
Q

Describe Gardner syndrome

A

Soft tissue tumours
Polyps
Bowel Ca

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22
Q

Describe Cowden’s syndrome

A

Multiple hamartomas

Thyroid and breast Ca

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23
Q

Describe pathogenesis of acne

A

Keratin build up in hair follicle
Increased sebum production and thickness - sebaceous glands
Propionibacterium acnes proliferation

24
Q

What are the clinical features of acne

A

Papules
Pustules
Comedones

25
Q

What type of acne is a dermatological emergency?

A

Acne fulminans

26
Q

Describe acne inversus

A

Papules
Pustules
Cysts
Affects groin/buttocks

27
Q

How is acne graded?

A

Leeds Acne Grading System

28
Q

What is first line therapy for reducing the plugging of the hair follicle in acne management?

A

Topical benzoly peroxide

29
Q

What Abx can be used to reduced the amount of bacteria in acne treatment?

A

Topical Abx = erythromycin/clindamycin

Oral Abs = tetracyclines, erythromycin

30
Q

What can be used to reduce sebum production in acne management?

A

Anti-androgens OCP

31
Q

What can be used in the management of severe acne vulgaris?

A 
Oral Isotretinion
Oral retinoid (concentrated form of Vit A)
32
Q

How does oral risotretinoin help with the management of severe acne vulgaris?

A

Reduces sebum production
Reduces plugging of hair follicle
Reduces bacteria load

33
Q

How long is the standard course of oral isotretinoin?

A

16 weeks (1mg/kg)

34
Q

What is the major side effect associated with oral isotretinoin?

A

Teratogenicity (every girl must be on OCP and have monthly pregnancy tests)

35
Q

Side effects associated with oral isotretinoin

A 
Trivial:
Dry lips
Nose bleeds
Dry skin
Myalgia
Serious:
Deranged LFTs
Raised lipids
Mood disturbances
Teratogenicity
36
Q

What are three triggers of vasculitis?

A

Infection
Drugs
Connective tissue disease

37
Q

Describe fixed drug rash

A

Rash that occurs in the same area every time the same drug is used

38
Q

Describe drug induced psoriasiform rash

A

Psoriasis-like
Well demarcated erythema with scale
Sudden onset, no FHx

39
Q

What drugs are associated with a fixed drug rash?

A

Paracetamol

40
Q

What drugs are associated with a drug induced psoriasiform rash?

A

Lithium

Beta-blockers

41
Q

Give 2 examples of drug induced blistering disorders

A

Steven Johnson Syndrome

Toxic Epidermal Necrolysis

42
Q

Give 2 examples of immunobullous diseases

A

Bullous pemphigoid

Bullous pemphigus

43
Q

Describe the management of Toxic Epidermal Necrolysis

A 
Dermatology, ITU, burns involvement
Analgesia
Fluid balance
Special mattress, sheets
Infection control, prophylaxis
Non-adherent dressings
Requires urological, gynaecologist and ophthalmological input
44
Q

Describe erythema multiform

A

Self-limiting allergic reaction
Target lesions
Associated with HSV, EBV, occasionally drug

45
Q

Describe bullous pemphigoid

A

Splits at basal layer

Distinct intact blister

46
Q

Describe pemphigus vulgaris

A

Split is scattered through the epidermis

Don’t have an intact blister

47
Q

Describe the management of an immunobullous disorder

A 
Oral steroids (reduce autoimmune reaction) 
Steroid sparing agents - aziathioprine
Burst any blisters
Dressings and infection control 
Check for oral/mucosal involvement
Screen for underlying malignancy
48
Q

What is dermatitis herpetiformis associated with?

A

Coeliac disease

49
Q

How can dermatitis herpetiformis be treated?

A

Topical steroids
Gluten free diet
Oral dapsone

50
Q

Describe urticaria

A

Itchy wheals
Last <24 hours
Non-scarring
Can be acute/chronic (<6 weeks/>6weeks)

51
Q

What are potential causes of urticaria?

A

Immune related - type I IgE response

Non-immune mediated -
Direct mass cell degranulation
Opiates, Abx, contrast media, NSAIDs

52
Q

What treatment can be used in urticaria?

A

Antihistamines
Steroids
Immunosuppression
Omiluzimab

53
Q

What are potential causes of acute urticaria?

A 
Unknown
Viral infections
Medication - NSAIDs, aspirin, ACEi
Food and food additives
Parasitic infections
Physical stimulants - cold, pressure, solar, cholinergic, aquagenic
54
Q

Define erythroderma

A

Erythema affecting 80-90% of body

55
Q

What are potential causes of erythroderma?

A

Psorasis
Eczema
Drug reaction
Cutaneous lymphoma

56
Q

How can erythroderma be managed?

A

Treat underlying skin disorder
Supportive
Fluid/temperature balance

MBChB (14 decks)

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