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Third year > Week 10 - Dermatology > Flashcards

Week 10 - Dermatology Flashcards

1
Q

What are some pre-malignant variants of Squamous cell carcinoma?

A

Bowen’s disease
Actinic keratosis

Topical Imiquimod / 5- Fluorouracil
Cryotherapy, photodynamic therapy, Sun protection

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2
Q

Describe characteristics of BCC

A

Face
sun damaged/ UV exposed skin
shiny ‘pearly’, telangiectasia
Mutation to basal cell DNA

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3
Q

List the types of BCC

A

Nodular; >0.5 cm raised lesion, shiny, central ulceration, telangiectasia
Superficial; flatter, broken lightening bolt vessels
Pigmented; shiny, pigmented
morphoeic/ sclerotic; less obvious

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4
Q

Describe characteristics of SCC

A

Crusty
ears, lips, burns
pre-malignant variants
keratinocytes

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5
Q

Name some cutaneous tumour syndromes

A 
Gorlins syndrome (multiple BCC, jaw cysts, risk of breast cancer)
Gardeners syndrome (soft tissue tumours, polyps, bowel cancer)
Cowdens syndrome (multiple hamartomas, thyroid/breast cancer)
Brook spieler syndrome (multiple BCC)
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6
Q

What is cellulitis?

A

A skin and soft tissue bacterial infection. Caused by Streptococcus Pyogens or staphylococcus aureus.

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7
Q

What are some symptoms of cellulitis?

A 
Peau d' organe (dimpling)
Warmth
Blistering
Erosion and ulceration
Abscess formation
Purpura
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8
Q

What antibiotic would you give for cellulitis from S.pyogens?

A

Ampicillin orFlucloxacillin

and give analgesia and fluids

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9
Q

What antibiotic would you give for cellulitis caused by s.aureus or MRSA?

A

Flucloxacillin or vancomycin

and give analgesia and fluids

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10
Q

What is necrotising fasciitis?

A

Rapidly spreading infection of the subcutaneous fascia

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11
Q

How would you differentiate necrotising fasciitis from cellulitis?

A 
Pain becoming painless
Rapid progression
systemically unwell
dusky skin and necrosis
may have skin crepitus
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12
Q

What are the 5 antibiotics used in necrotising fasciitis?

A

Penicillin, flucloxacillin, clindamycin, gentamicin, metronidazole

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13
Q

What is Erysipelas?

A

Superficial form of cellulitis

upper dermis and superficial lymphatics

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14
Q

How could you tell cellulitis from erysipelas (Group A strep)?

A

Erysipelas involves the ears

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15
Q

What does Impetigo look like?

A

Honey coloured crust
Staphylococcal infection of the epidermis
often peri-oral

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16
Q

What is PVL producing S.aureus?

A

PVL is a toxin that destroys WBC

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17
Q

What can the Human Parvovirus B19 cause (via resp droplets)?

A 
Erythema infectiosum (slapped cheeks) - self limiting 7-10d
Fever, headache, runny nose, pruitic rash
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18
Q

What can the Coxsakie virus A16 cause?

A

Hand, foot and mouth disease
Highly contagious in the first few weeks
Fever, rash, sore throat, headache, oropharyngeal ulcers

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19
Q

What viral illness causes Koplik (bright red with white centres on buccal mucosa) spots 3 days after Sx and then presents with a maculopapular red rash 3-5 days after?

A

Measles
starts on the face and hairline as flat spots
Fever, cough, coryzal, conjunctivitis

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20
Q

What virus may be latent in sensory nerve ganglia?

A

Herpes Simplex virus

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21
Q

What virus remind dormant in dorsal root ganglia?

A

Varicella zoster virus

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22
Q

What viral conditions presents with a dermatomal rash?

A

Shingles

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23
Q

What are the classification of burns?

A

Superficial (1st)- Epidermis only (red/dry, painful, blanches with pressure, lasts 7 days)
Partial thickness (2nd)- Epidermis and dermis (blisters, pain>painless, <21 days) - Abx/surgery/grafting
Full thickness (3rd) Subcutaneous tissue (painless, non-blanching)
4th degree - Bone, muscles, fascia

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24
Q

What is the first line of treatment in bites?

A

Agressive debridement and abscess drainage

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25
Q

What is the commonest pathogen isolated from bites?

A

Pasteurella

26
Q

What type of rash may lithium or beta blockers induce?

A

Drug induced psoriasiform rash

27
Q

What type of rash might a slow growing tumour of the alpha pancreatic cells produce?

A

Necrolytic migratory erythema

28
Q

What skin change is described as,

‘reddened concentric bands whorled woodgrain pattern?’

A

Erythema gyratum repens

strong association with Lung cancer

29
Q

What cutaneous feature is B12 deficiency associated with?

A

Angular cheilitis - red, swollen patches at corners of the mouth

30
Q

What cutaneous feature is zinc deficiency associated with?

A

Acrodermatitis Enteropathica
(pustules, bullae, scaling)
Intestinal zinc transporter mutation - inherited
Alcoholic, malabsorption, IBD, bowel surgery - acquired

31
Q

Why might breast milk contain low levels of zinc leading to Acrodermatitis Enteropathica?

A

Alcoholism
Malabsorption states
Inflammatory bowel disease
Bowel surgery

32
Q

What are some cutaneous features of scurvy - Vit C def?

A

Dry skin, Dry hair, corkscrew curly hairs

palpable Purpura, brusing, hyperpigmentation SHINS

33
Q

What overgrowth causes Seborrhoeic dermatitis?

A

Pityrosporum ovale yeast

34
Q

What is necrobiosis lipodicia?

A

In diabetes, Waxy, shiny, yellow discolouration. Occasionally ulcerates and scars

35
Q

What 2 pathways interact to cause skin cancer?

A

Direct action of UV on keratinocytes for neoplastic transformation via DNA damage
Effect of UV on hosts immune system

36
Q

How would you treat cutaneous anthrax? (black eschar, erythema, lymphadenopathy, serous fluid discharge)

A

5 antibiotics: Ciprofloxacin, clindamycin, flucloxacillin, penicillin, metronidazole

37
Q

What are some complications of infant atopic eczema?
Symmetrical, vesicular
Inflammation of the epidermis

A 
Bacterial infections (s.aureus)
Viral infections (Viral warts, molluscum, eczema herpeticum)
Tiredness, growth reduction, psychological impact
38
Q

What is acne fulminans?

A

Very severe, sudden onset. Can have fever and joint paint.

39
Q

What is necrolytic migratory erythema?

A

Glucagonoma syndrome
Erythematous, scaly plaques on aural, intertriginous and periorificial areas.
Tumour of the islet alpha cells of the pancreas
HYPERGLYCAEMIA, diarrhoea, weight loss, glossitis

40
Q

What is Erythema gyratum repens?

A

Reddened concentric bands whorled woodgrain pattern.
Severe pruitis and peripheral eosinophilia.
strong association with LUNG CANCER

41
Q

What is acanthosis nigricans?

A

Smooth, velvet like hyperkeratonic plaque
Type 1 associated with malignancy - GI adenocarcinomas (stomach cancer)
Type 2 familial AD
Type 3 obesity and insulin resistance

42
Q

What is pellagra and what causes it?

A 
Characterised by Dermatitis, diarrhoea and dementia 
B3 def (Niacin) and death
43
Q

What is caused by B6 (pyridoxine) def?

A

Dermatitis

44
Q

What is Erythema Nodosum?

Associated diseases - IBD, sarcoidosis, pregnancy, OCP, NSAIDs, TB, strep infections, lymphoma

A

Inflammatory disorder affecting the subcutaneous fat. tender bilateral red nodules on the anterior shin. fever and joint pain, NO ulceration.

45
Q

What does pyoderma gangrenous look like?

A

Rapidly enlarging painful blister with PURPLE edge
Shiny, ulcerated plaque
Debride. skin graft, flucloxacillin

46
Q

Tx options in acne?

A

Topical Retinoid, topical (or oral) Benzoyl peroxide (1st line)
Oral Isotretinoin

47
Q

Tx options for psoriasis?

A
  1. Topical - Salicylic acid, Vit D, emollients, steroids
  2. UV phototherapy - reduce T cell proliferation and skin turnover, encourages Vit D
  3. Systemic therapy - Immunosuppressants (methotrexate, cyclosporins), acitretin, dimethyl fumarate, apremilast, 4. Biologics (Adalimumab, Usketinumab - IL12/23)
48
Q

What drugs might cause maculopapular rashes?

A

Antibiotics

49
Q

What drugs might cause photosensitive rashes?

A

Diuretics, antibiotics

50
Q

What drugs might cause Severe idiosyncratic reaction- TEN?

A

Anti-epileptics, antibiotics

51
Q

What drugs might cause urticarial reaction?

A

Opiates, antibiotics, NSAIDs, ACEi

52
Q

Topical imiquimod and 5-fluorouracil cream can be used in BCC and SCC, what do they do?

A

Stimulate the body immune system to target the tumour cells

53
Q

What skin condition may have a BRAF or NRAS mutation?

A

Melanoma

54
Q

Apart from excision what therapies can you use on a melanoma?

A

Immunotherapy - Ipilimumab or Nivolumab
MEK inhibitors/ Check point inhibitors - Trametinib
Biologic antibodies e.g. BRAF genetic defects - Debrafanib
Systemic drug in metastatic - Pembrolizumab

55
Q

What may be described as a chocolate cookie appearance?

A

Seborrhoeic wart

56
Q

What might a beta lactam cause?

A

Acute generalised exanthematous pustulosis

57
Q

Define psoriasis.
20% develop arthritis
PASI, DQLI, SCORAD - severity scores- can use for acne too

A

Chronic relapsing and remitting scaly skin disease. T cell AI mediated. Overproduction of keratinocytes
Red scaly patches - Plaque or guttate

58
Q

What is the Koebner phenomenon?

A

Psorasis at the site of trauma/ scars

59
Q

What biologic is available for eczema?

A

Dupilumab - IL4/13

60
Q

What are the features of Cutaneous anthrax?
Bacillus anthracis
Hands, forearms, face, neck
MP CCF - Methotrexate, penicillin, clindamycin, ciprofloxacin, flucloxacillin

A

local black skin pustules / black eschar
Progresses over 2-6 days - papule, vesicles, ulcer, black eschar
Discharges serous fluid
Local erythema, lymphadenopathy
Systemic malaise, headache, chills, sore throat

Third year (15 decks)

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