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Medical School Finals > Speciality: Dermatology > Flashcards

Speciality: Dermatology Flashcards

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USMLE® Step 1 flashcards
1
Q

Patient - Itchy, red, scaly patches on the flexural surfaces. ACF, popliteal fossae.

A

Eczema

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2
Q

Eczema Aetiology

A
  • Genetic FHx
  • Atopy
  • Hygiene hypothesis
  • Climate - heat and cold causes flares.
  • Food antigens.
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3
Q

Eczema Pathology

A
  • Primary immune dysfunction - IgE sensitisation and allergic inflammation.
  • Primary defect of the epithelial layer.
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4
Q

Eczema Presentation

A
  • Itchy, red, scaly patches on the flexural surfaces.
  • In infants, can start on the face.
  • Acute lesion can weep.
  • Can become super infected w/ staph aureus.
  • Excoriations.
  • Eczema herpeticum - super infection with HSV.
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5
Q

Eczema Ix

A

1) Clinical
2) Bloods; eosinophilia and high IgE
3) Skin swabs if super-infection (Black for bacteria and Green for virus)

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6
Q

Eczema Rx

A

1) Education of trigger avoidance
2) Emollients
3) Steroids - topical hydrocortisone.
4) Topical immunomodulators - tacrolimus
5) ABx for superinfection - often flucloxacillin
6) Sedating antihistamines for itch
7) Bandaging
8) Systemic immunosuppression - Ciclosporin

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7
Q

Patient - Red, scaly patches w/ silver scales. Extensor surfaces, lower back, scalp, ears.

A

Psoriasis

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8
Q

Psoriasis Aetiology

A
  • Polygenic
  • Environmental triggers - cold, stress, alcohol, drugs, infection
  • TNF
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9
Q

Psoriasis Pathology

A
  • Skin biopsy shows; epidermal acanthosis and parakeratosis.
  • Increased skin turnover
  • Polymorphonuclear cells present in upper epidermis.
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10
Q

Psoriasis Presentation

A
  • Chronic plaque psoriasis
  • Flexural psoriasis
  • Guttate psoriasis - rain drop like pattern, explosive eruption of small circular/oval plaques on the trunk.
  • Nail changes - pitting, separation from the nail bed, yellowing
  • Arthropathy
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11
Q

Psoriasis Ix

A

1) Clinical

2) Bloods; CRP & RF (PSa is seronegative)

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12
Q

Psoriasis Rx

A

1) Education around triggers
2) Emollients + skin cleaning and bandaging
3) UV exposure
4) Topical steroids
5) Vitamin D analogues (calcipotriol)
6) Severe = immunomodulators such as MTX ow + folic acid. AZA.
7) Biologics - Etanercept, adalimumab, infliximab.

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13
Q

Patient - Teenager w/ blackheads and lots of spots

A

Acne

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14
Q

Acne Aetiology

A
  • Multifactorial
  • Follicular epidermal hyper-proliferation.
  • Blockage of pilosebaceous units
  • Increased sebum production
  • Infections w/ Propionibacterium acnes.
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15
Q

Acne Presentation

A
  • Infantile acne
  • Steroid induced acne
  • Oil acne (work)
  • acne fulminans - young males, severe necrotic and crusted lesions w/ malaise, pyrexia and arthralgia –> Rx urgently w/ oral pred followed by isotretinoin.
  • Presents on the face, back, sternum.
  • Open comedones (black) or closed comedones (whiteheads)
  • Papules/pustules
  • Greasy skin
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16
Q

Acne Ix

A

1) Clinical Dx

2) Skin swab for super-infection.

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17
Q

Acne Rx

A

1) Regular face washing to reduce oils
2) topical agents (kerolytics - benzoyl peroxide) or topical retinoids (tretinoin or isotretinoin) + topical erythromycin or clindamycin.
3) Low dose oral oxytetracycline 500mg Bd
4) Oral isotretinoin (in those w/ scarrin)

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18
Q

Patient - facial malar type flushing w/ papules and pustules around the nose, forehead and cheeks. Telangiectasia

A
  • Rosacea
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19
Q

Rosacea Aetiology

A
  • UK
  • Potential underlying vasomotor instability
  • Skin mite demodex
  • Associated w/ blepharitis, conjunctivitis and keratitis.
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20
Q

Rosacea Presentation

A
  • Often middle aged females
  • Facial flushing w/ inflammatory pustules and papules.
  • Telangiectasia
  • Enlarging of the nose
  • Flushing exacerbated by alcohol, sun and heat
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21
Q

Rosacea Ix

A

1) Clinical

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22
Q

Rosacea Rx

A

1) Long term use of topical 0.075% metronidazole or topical azelaic acid
2) 3 month course of oral tetracycline 500mg BD
3) Laser for telangiectasia.

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23
Q

SCC Aetiology

A
  • Pre-malignant form = Solar keratoses. Silver-scalp papules or patches w/ conical surface and red base.
  • Bowen’s disease = Intraepidermal Carcinoma in situ. Looks like psoriasis.
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24
Q

SCC Presentation

A
  • Asymptomatic
  • Lesions are keratotic, ill-defined nodules which can ulcerate.
  • Can grow fast and metastasize.
25
Q

SCC Ix

A

1) Clinical

2) Confirmed w/ biopsy and pathology

26
Q

SCC Rx

A

1) Solar keratoses = Cryo or topical 5-FU cream

2) SCC = WLE, radio.

27
Q

BCC Aetiology

A
  • Sun exposure
  • Genetics - Gorlin’s syndrome
  • Immunosuppression.
28
Q

BCC Presentation

A
  • Common on sun exposed sites (not ear)
  • Slow growing papule or nodule
  • Roled pearly edge
  • Telangiectasia.
29
Q

BCC Ix

A
  • Clinical
30
Q

BCC Rx

A

1) Surgical excision w/ controlled borders. Mohs procedure for sensitive areas.
2) Cryotherapy
3) Radio

31
Q

MM Aetiology

A
  • Excessive sunlight
  • RF’s = pale skin, lots of moles, immunosuppression, Lentigo maligna.
  • Oncogenes; CDK4, PTEN.
32
Q

MM Presentation

A

1) Lentigo maligna melanoma - patch of lentigo maligna develops a papule or nodule.
2) Superficial spreading MM - Large flat irregularly pigmented lesion growing laterally.
3) Nodular MM - Most aggressive, rapidly growing pigmented nodule which bleed and ulcerates.

33
Q

MM Ix

A 
1) Clinical 
A- asymmetry 
B- Border irregularity 
C - Colour variation 
D - Diameter >6mm 
E - Elevated 
2) Dermatoscope 
3) Excise then histology
34
Q

MM Rx

A

1) Surgery - WLE
2) Sentinel node biopsy
3) Mets = chemo/radio

35
Q

Impetigo Aetiology

A
  • Staphylococcus or GAS

- Abnormal skin flora imbalance

36
Q

Impetigo Presentation

A
  • Weeping exudative areas w/ a honey crusted surface.

- Often around the face/mouth.

37
Q

Impetigo Ix

A

1) Clinical

2) Skin swab + MC&S

38
Q

Impetigo Rx

A

1) Prevention w. good hygiene
2) Topical fusidic acid.
3) Oral Fluclox for Saureus 500mg 4xdaily or phenoxymethylpenicillin 500mg 4xdaily for GAS.

39
Q

HSV Aetiology

A
  • Most facial cold sores = HSV 1
  • Immunosuppression.
  • Colds and illness.
  • Can superinfect eczema.
40
Q

HSV Presentation

A
  • Clusters of painful blisters on the face.
  • Painful gingivalstomatitis
  • Cold sore
41
Q

HSV Ix

A

1) Clinical

2) Skin swab + PCR

42
Q

HSV Rx

A

1) Oral valaciclovir (500mg BD 5 days) for primary and painful HSV
2) Topical acyclovir for cold sores.

43
Q

Athletes foots.

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Fungal
    - Trichophyton
  2. Scaling, flaking, itching between toes.
  3. Clinical
    - Swab
    - Toenail clippings
  4. Topical miconazole.
44
Q

Dermatitis herpetiformis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Autoimmune associated with Coeliac disease.
    - Deposition of IgA in the dermis.
  2. Itchy, vesicular rash on the extensor surfaces; elbows, knees, arse
  3. Skin biopsy + direct immunofluorescence shows IgA in the dermis.
  4. Gluten free diet.
    - Dapsone
45
Q

Pyoderma gangrenosum

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Idiopathic
    - IBD
    - RA/SLE
    - Lymphoma
    - PBC
  2. Lower limbs
    - Initially a small red papule which develops into a red, necrotic ulcer with a violaceous border.
    - Systemic Sx.
  3. Bloods - infection and inflammation
    - Autoantibodies (p-ANCA)
    - Swabs and MC&S
    - Biopsy.
  4. Oral steroids as first line.
    - Difficult cases = cyclosporin or infliximab
46
Q

Lichen Sclerosus

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Inflammatory condition which effects the pussy or the penis.
    - More common in women.
    - Atrophy of the epidermis.
  2. Itch
    - White plaques
  3. Clinical
    - Biopsy if atypical or suspicious of VIN.
  4. Increased risk of Ca
    - Vulval Ca in women
    - Rx with topical steroids and emollients.
47
Q

Acanthosis nigerians associated conditions

A
  • GI cancer
  • DM
  • Fatness
  • PCOS
  • Acromegaly
  • Cushing’s
  • Hypothyroidism
48
Q

Venous ulcers

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Venous blood flow return insufficiency
  2. Ulcer above the medial malleolus.
  3. ABPI - normal = 0.9-1.2 and indicate lack of arterial disease.
    - Values below 0.9 or above 1.3 indicate arterial disease.
  4. Compression bandaging, 4 layers.
    - Little evidence for much else.
    - Keep clean and prevent infection.
49
Q

Scabies

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Mite = Sarcoptes scabiei
    - Spread via skin contact.
    - Mite burrows into the skin and lays eggs in the stratum corneum.
  2. Itching
    - Linear burrows on the side of the fingers.
    - Worse at night
    - Secondary features of scratching and infection.
  3. Clinical
  4. Permethrin 5% first line
    - Malathion 05% is second line.
50
Q

Hereditary haemorrhagic telangiectasia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. AD inherited.
  2. Multiple telangiectasia over the skin and mucous membranes.
    - diagnostic criteria =
    a) Epistaxis - spontaneous and recurrent
    b) Telangiectasia - lips, fingers, nose and oral cavity
    c) FHx
  3. Capillary microscopy.
    - CT/MRI for lesion identification
    - Often clinical
  4. Acute haemorrhage w/ empirical Rx such as blood Tx etc.
    - Surgical or laser ablation of telangiectasia.
    - Septoplasty of the nose
51
Q

Lichen Planus

A

Purple, pruritic, papular, polygonal rash on the flexor surfaces.

52
Q

Granuloma annulare

A
  • Papular lesion
  • Hyperpigmented
  • Central depression
  • occur on the arm and legs.
  • Associated w/ DM
53
Q

Side effects of Isotretinoin

A
  • Teratogenicity
  • Dry skin, lips and eyes
  • Low mood
  • Raised triglycerides
  • Nose bleeds
54
Q

Hirsutism

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. PCOS
    - Cushing’s
    - CAH
    - Androgen therapy
    - Obesity
    - Adrenal tumour
    - Drugs
  2. Increased hair growth
    - Male pattern hair growth
    - Ferrimen-gallwey scoring system; 9 areas.
  3. Clinical
    - Testing for causes listed above.
  4. Cosmetic techniques; waxing etc.
    - Use of COCP
55
Q

Pityriasis Versicolour

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Fungal skin infection
    - Malassezia furfur
    - RF’s = immunosuppression, malnutrition and cushing’s
  2. Commonly affects the trunk
    - Hypopigmented patches; pink or lighter brown.
    - Scale
    - Itch
  3. Clinical
    - Skin scraping for MC&S
  4. Topical antifungal - ketoconazole shampoo
56
Q

Erythema Nodosum

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Inflammation of Subcut fat
    - Sarcoidosis
    - IBD
    - Infection (TB)
    - Drugs; penicillin’s, COCP.
  2. Tender, red, nodular lesion
    - Often on the shin
    - Heals w/o scarring.
  3. Throat swab for strep.
    - CSR for sarcoidosis
    - Serum ACE
    - Look for cause.
  4. Self-limiting
    - Symptom relief only
    - NSAID’s can help.
    - Bed rest w/ foot elevation.
57
Q

Tinea (ring worm)

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Fungal - dermatophytes
  2. Well defined, annular with central clearing.
    - Red lesions w/ pustules and papules
  3. clinical
  4. Oral fluconazole
58
Q

Erythroderma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. When 95% of the body is covered in a rash
    - Eczema
    - Psoriasis
    - Lymphoma
    - idiopathic
    - Drug reaction.
  2. Widespread erythema of the skin.
    - Scaling
    - excoriation
    - itching.
  3. Clinical
  4. Monitor as inpatient
    - Complications include; dehydration, infection and HF
    - bed rest
    - Emollients and wet dressings.
    - Nutritional support.
    - Steroids or ciclosporin and infliximab

Medical School Finals (24 decks)

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