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Year 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

In an inflammatory history, what key points are different in derm?

A

Nature, site and progression
Recent contacts, stressful events, travel
History of atopy
Occupation and improvement away from work
DH

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2
Q

In a neoplastic history, what key points are different in derm?

A

Initial appearance and rate of change/evolution
Itch? Pain?
History of sunburn (occupation), tanning machines
Skin type
History of skin cancer/lesions & FH
Immunosupression

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3
Q

What are the stages of examining the skin?

A

Inspect
Describe
Palpate
Systematic check

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4
Q

How do you describe a lesion?

A 
SCAMM
Size
Colour
Associated secondary change (eg texture)
Morphology
Margin
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5
Q

Pigmented lesion acronym?

A 
ABCDE
Asymmetry
irregular Border
two or more Colours
Diameter>6mm
Evolution
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6
Q

What do you note on palpation?

A 
Surface
Consistency
Mobility
Tenderness
Temperature
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7
Q

What does the systematic check include?

A

Nails
Scalp
Hair
Mucous membranes

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8
Q

What is the derm way of saying mole?

A

Pigmented melanocytic naevus

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9
Q

What is a comedome?

A

A plug in a sebaceous follicle, containing altered sebum, bacteria and cellular debris
Open (blackhead), closed (whitehead)

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10
Q

What sites are described as flexural?

A

Body folds (groin, neck, behind ears, popliteal fossae, antecubital fossae)

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11
Q

What sites are described as extensor?

A

Sacrum, buttocks, ankles, heels

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12
Q

What is a Köebner?

A

A linear eruption arising at site or trauma

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13
Q

Opposite of discrete?

A

Confluent

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14
Q

What is purpura?

A

Red/purple due to bleeding into skin, does not blanche on pressure
Petechiae if small, ecchymoses are larger bruise like patches

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15
Q

What is eccyhymoses?

A

Big bruise-like pupura

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16
Q

What are flat lesions described as?

A

Small: macule
Larger: patch

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17
Q

What are raised lesions called?

A

Small: papule
Large and domed: nodule
Large and table top: plaque

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18
Q

What is a vesicle? eg?

A

Small raised fluid filled lesions

eg in varicella zoster

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19
Q

What is larger than a vesicle?

A

A bulla

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20
Q

What is a pus containing lesion called?

A

Small: pustule
Large: Abscess

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21
Q

What can staph infection in the skin form?

A

Small: boil/furuncle around hair follicle
Large: Carbuncle

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22
Q

What is it called if someone scratches off the epidermis (eg in eczema)

A

Excoriated lesion

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23
Q

What are scales?

A

Flakes of stratum corneam

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24
Q

What is it called when you lose epidermis/dermis

A

Loss of epidermis: erosion

Loss of dermis: ulcer

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25
Q

What is it called when you lose a patch of hair?

A

Alopecia

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26
Q

What is koilonychia?

A

Spoon shaped nail

Iron deficiency

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27
Q

What happens to the nails in psoriasis?

A

Onchylosis (nail comes away from nail bed distally)
Pitting
Craggy

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28
Q

6 functions of the skin

A 
Protective barrier
Thermoregulation
Sensation
Vit D synthesis
Immunosurveillance
Appearance/cosmetic
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29
Q

Name the skin appendages

A

Nails
Hair
Sebaceous glands
Sweat glands

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30
Q

Name the cell types found in the epidermis

A

Keratinocytes (produce keratin barrier)
Langerhans’ (antigen presenting)
Melanocytes (pigment, protects from UV)
Merkel (specialised nerve endings)

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31
Q

Layers of the epidermis

A 
Stratum basale (stem cells)
Stratum spinosum
Stratum granulosum (secretion of lipid)
Stratum corneum (keratin)
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32
Q

What is beneath the stratum corneum on the soles of the feet?

A

Stratum lucidum

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33
Q

What does the dermis mainly consist of?

A 
Collagen
Elastin
Glycosaminoglycans
Fibroblasts
Immune cells
nerves
Skin appendages
Lymphatics
Blood vessels
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34
Q

What are the 3 main types of hair?

A 
Lanugo (fine long hair in fetus)
Vellus (fine short hair all over body)
Terminal hair (coarse long hair on scalp, eyebrows, eyelashes and pubic areas)
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35
Q

What are the stages of hair growth?

A

Anagen (long growing phase)
Catagen (short regressing phase)
Telogen (resting/shedding phase)

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36
Q

What are the 2 different types of sweat glands and difference?

A

Eccrine: everywhere
Apocrine: axillae, areolae, genitalia and anus

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37
Q

What happens to the skin in anaphylaxis?

A

Urticaria and angioedema

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38
Q

What is urticaria?

A

Local increase in permeability of capillaries and small venules due to prostaglandins, leukotrienes, and HISTAMINE
Swelling of the superficial dermis raising the epidermis into wheals

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39
Q

What is angioedema?

A

Deeper swelling that involves dermis and subcutaenous tissues
Esp tongue and lips

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40
Q

Treatments of urticaria, angioedema and anaphylaxis?

A

Urticaria: antihistamines
Angioedema: Corticosteroids
Anaphylaxis: Adrenaline, corticosteroids and antihistamines

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41
Q

Diagnostic criteria of atopic eczema

A

itchy skin
flexural involvement (visible/history of)
Personal history of asthma/hayfever (or if under 4, parents/siblings)
Dry skin over last year
Onset under age 2

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42
Q

Different types of emollients

A 
Ointment
cream
lotion
bath oils
soap substitutes
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43
Q

Name 4 topical steroids, weakest first

A 
Hydrocortisone 1%
Clobetasone Butyrate (Eumovate)
Bethamethasone valerate (Betnovate)
Clobetasol Propionate (Dermovate)
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44
Q

Which is stronger: Eumovate or Betnovate?

A

Betnovate

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45
Q

How to treat severe infected eczema

A

Emollients/ointments
Potent topical steroids
Flucloxicillin for bacterial infection

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46
Q

How would you describe classic chronic psoriasis?

A

Red scaly plaque, well demarcated edges

Due to hyperproliferation of keratinocytes and inflammatory cell infiltration

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47
Q

Name the areas most commonly affected by psoriasis

A

Scalp, exterior knees and elbows, lower back

48
Q

Describe 5 nail changes seen in psoriasis

A

Nail pitting
Onchylosis (excessive proliferation of nailbed)
Salmon patch (discolouration in nailbed)
Beau’s lines (transverse, intermittent inflammation)
Leukonychia

49
Q

What non-cutaneous manifestation of psoriasis is there?

A

Arthropathy

5-8% of psoriatic patients

50
Q

Treatment of psoriasis

A

Emollients
Topical (coal tar, corticosteroids, vit D analogues, dithranol, keratolytics)
Phototherapy (UVB, PUVA)
Oral (methotrexate, cyclosporin, oral retinoids, mycophenolate mofetil)
Biological agents (infliximab, etanercept)

51
Q

Describe eczema dermatology style

A

Macular papular rash affecting mainly the flexor surfaces.
Scaling crust secondary to infection
No well defined borders and always pruritic
Affects 20% of under 12s

52
Q

Symptoms of rosacea

A

Telangiectasia
Aggravated by hot and spicy drinks and food and sun exposure
Sensitive skin: burning and itching with creams/makeup
Papules and pustules on nose/forehead/cheeks and chin
Rhinophyma & erythema

53
Q

Treatments of rosacea

A

Topical metronidazole

If mod-severe papulopustular: tetracyclines (lymecycline)

54
Q

How do you manage dermatitis of the scalp?

A

Ketoconazole 2% shampoo (or selenium sulphide) BD for at least a month
4 weeks of potent topical corticosteroid?

55
Q

How do you manage dermatitis of the face?

A

2% ketoconazole cream
Hydrocortisone 0.5%
Eyelid hygiene

56
Q

Signs of a nodular BCC?

A 
Small shiny skin coloured/pinkish lump
Central necrosis/ulcer/crust
Rolled pearly edge
Telangiectasia
Bleed spontaneously and heal over
57
Q

What are the main treatments of BCCs?

A

Surgical excision
Mohs micrographic surgery (expensive)
If frail/no surgery: radiotherapy
If superficial: cryotherapy/5FU

58
Q

What is SCC in situ also called?

A

Bowen’s disease

59
Q

Treatment of Bowen’s?

A

5-flurouracil cream
Cryotherapy
Curettage and cautery
Photodynamic therapy if difuse

60
Q

Features of Bowen’s

A

Can often look like a small patch of psoriasis
Red inflammatory base, plaque
Characteristic tiny regular clods of blood vessels
Disordered structure
Well defined border
Keratin scale

61
Q

Features of actinic keratosis?

A

Flat patch

Strawberry pattern of erythema

62
Q

Risk factors for melanoma

A

Sun exposure
Susceptible genes
Type 1 fair skin
Atypical naevi elsewhere

63
Q

What is atypical mole syndrome?

A

> 50 moles

>3 are atypical

64
Q

Difference between pemphigus vulgaris and bullous pemphigoid

A

PV: flaccid, common mouth involvement, intraepidermal split, Desmoglein antigen
BP: tense, no mouth involvement, subepidermal split, basement membrane antigen

65
Q

Which blistering disease is most fatal?

A

Bullous pemphigoid

Up to 41%

66
Q

Which blistering disease commonly affects those above 70yrs?

A

Bullous pemphigoid

67
Q

Treatment of blistering diseases?

A

Oral corticosteroids in pemphigus vulgaris and BP if severe

Topical corticosteroids in BP if not severe

68
Q

What is dermatitis herpetiformis associated with

A

IgA

Coeliac disease

69
Q

List 4 causes of erythroderma

A

Psoriasis
Dermatitis
Drug eruptions
Cutaneous T cell lymphoma

70
Q

What is eczema herpeticum?

A

HSV-1 infection on eczematous skin

71
Q

Treatment of eczema herpeticum

A

Acyclovir
Emollients
Antibiotics for secondary skin infection

72
Q

What is staphylococcal scalded skin syndrome?

A 
Epidermolytic toxin released from staph phage II
Usually infants
Intraepidermal blistering
Low mortality
Treat with antibiotics (erythromicin)
73
Q

What is toxic epidermal necrolysis?

A

Drug induced full thickness epidermal necrosis with sub epidermal detachment
Any age
Mortality roughly % body affected
Treat by withdrawing drug

74
Q

What usually causes necrotising fasciitis?

A

Group A haemolytic strep

More common in malignancy&diabetes

75
Q

Treatment of necrotising fasciitis?

A

Surgical debridement

IV antibiotics

76
Q

Presentation of necrotising fasciitis

A 
Inflammation of body part
Pain far beyond what would be expected
Rapidly advancing
Vascular occlusion, ischaemia, necrosis
Fever, eiosinophilia, ALT>1000
77
Q

1st line treatment of impetigo

A

Fusidic acid

78
Q

Usual pathogens for impetigo and cellulitis?

A

Staph aureus, strep pyogenes

79
Q

What usually causes warts?

How long do warts last with no treatment?

A

Human papilloma virus

2 yrs

80
Q

Treatment options for warts

A

Cryotherapy

Topical salicylic acid

81
Q

Describe molluscum contageousum like a dermatologist

A

Firm smooth umbilicated papules, 2-5mm in diameter
Skin colour/white/translucent
Usually in clusters

82
Q

Treatment of mild acne

A

1st: topical retinoid, benzoyl peroxide
2nd: Azelaic acid
3rd: Combined oral contraceptive

83
Q

Treatment of moderate/severe acne

A

Lymecycline + topical retinoid

Dianette COCP

84
Q

When would you treat acne with isotertinoin?

A

If severe, hasn’t responded to antibiotics, depression and scarring

85
Q

Whats the main risk of isotretinoin?

A

Teratogenicity

86
Q

What is erythema nodosum?

A

Discrete tender nodules due to a hypersensitivity reaction to group A haemolytic strep/TB/pregnancy/malignancy/sarcoidosis/IBD/chlamydia/leprosy

87
Q

What causes erythrma multiforme?

A

Herpes simplex?

88
Q

What does the skin look like in acute meningococcaemia?

A

Non blanching purpuric rash on the trunk and extremities

-> haemorrhagic bullae and tissue necrosis

89
Q

What are the complications of meningococcal septicaemia?

A

Septic shock
Disseminated intravascular coagulation
Multiorgan failure
Death

90
Q

What is erysipelas?

A

Acute superficial form of cellulitis (dermis and upper subcutaneous tissue)
Has well defined red raised border

91
Q

3 main forms of superficial fungal infections

A

Dermatophytes (ring worm/tinea)
Yeasts (candidiasis)
Moulds (aspergillus)

92
Q

What does tinea look like?

A 
Unilateral, itchy
Circular/annular/polygonal lesions with clearly defined raised and scaly edges
In nail: yellow thickened crumbling nail
Areas fail to tan
Purple w/Wickham striae
93
Q

What does candidiasis look like?

A

White plaques on mucosal areas

Erythema with satellite lesions in flexure

94
Q

Management of fungal infections?

A 
Skin scrapings/nail clippings for diagnosis
Treat underlying immunosupression?
Decrease moist environment
Topical antifungals (terbinifine cream)
Oral if severe (itraconazole)
95
Q

Describe SCC lesion

A

Locally invasive, potential to metastasise

Karatotic (scaly/crusty) ill defined nodule which may ulcerate

96
Q

Main prognostic factor in melanoma?

A

Depth (Breslow thickness on biopsy)
>0.76cm med risk
>1.5cm high risk

97
Q

Cause of eczema

A

Primary genetic defect in skin barrier function

Loss of function of protein filaggrin

98
Q

Types of psoriasis

% population?

A 
Chronic plaque
Seborrhoeic (naso-labial, retroauricular)
Pustular
Erthrodermic
Guttate
2% population
99
Q

3 main types of ulcer

3 not so common causes

A

Arterial
Venous
Neuropathic

Infection(leischmaniasis), vasculitic, carcinoma

100
Q

Venous ulcer features

Treatment?

A

Painful, worse on standing
Hx of varicose veins/DVT
Medial malleolar area
Large shallow irregular ulcer with an exudative granulating base
Warm skin, normal peripheral pulses
haemosiderin and melanin deposit, white scarring
TREAT: compression bandaging

101
Q

Arterial ulcer features

A

Painful at night, worse on elevation
Hx of atherosclerosis
Found on pressure and trauma sights (pretibial, toes)
Small sharply defined deep (punch out lesions)
Necrotic base
Cold skin, weak peripheral pulses, shiny pale skin and hair loss

102
Q

Arterial ulcer investigations and treatment

A 
ABPI<0.8
Arterial insufficiency
Doppler and angiography
Vascular reconstruction
NOT compression bandaging!
103
Q

Features of a neuropathic ulcer

A 
Painless, abnormal sensation
Hx diabetes/neurological disease
Pressure points (soles/heels/toes)
Granulating base, callus
Warm skin, normal pulses, peripheral neuropathy
104
Q

Investigations and treatment in neuropathic ulcers

A 
X ray to exclude osteomyelitis
Wound debridement
Regular repositioning
Appropriate footwear
Good nutrition
105
Q

Where do you often find scabies?

A 
Sides of fingers
Finger webs
Wrists, elbows, ankles, feet
Nipples and genitals
Look like linear burrows/rubbery nodules
-> worse at night, V ITCHY, spares head
106
Q

Treatment of scabies

A

Scabicide (permethrin/malathion)

Antihistamines

107
Q

Function of fillagrin?

A

Binds keratin and hyaline into kerato-hyaline granules

This function is lost in eczema/dermatitis

108
Q

Why is erythroderma dangerous?

A

Fluid and electrolyte balance is lost
High output cardiac failure
Septicaemia can occur

109
Q

What is added in PUVA?

A

Topical psoralen to increase effectiveness of UVA

110
Q

What is PASI?

A 
Psoriasis area and severity index
Areas affected &amp; % of body
Erythema
Induration (thickness)
Desquamation (scaling)
111
Q

Name 9 subtypes of eczema

A

Atopic (most common)
Eczema herpeticum (when infected with HSV1)
Pompholyx eczema (palms and soles, sweating)
Discoid
Venous (haemosiderin deposits in legs, oedema, lipidomatosclerosis)
Allergic and irritant dermatitis
Seborrhoeic dermatitis (1st yr of life, immune reaction to yeast)
Chronic actinic dermatitis
Astatic (elderly, dry legs)

112
Q

Name 2 non sedating antihistamines

A

Cetirizine

Fexofenadine

113
Q

Causes of vasculitis

A 
Viral hepititis
Autoimmune (SLE, Sjögrens, RA, ulcerative colitis)
Strep, staph
Drugs (thiazides, iodines, penicillin)
Lymphoproloferative
114
Q

Signs of HSV1&2

A 
HSV1: generally oral
HSV2: generally genital
Pain/burning preceded lesion
Grouped vesicles->pustules->erosions->ulcers
Scalloped edges
Single ganglia affected
115
Q

What is Ramsay Hunt Syndrome?

A

Varicella Zoster reactivation (shingles)

Causes facial nerve palsy

116
Q

What is a pyogenic granuloma?

A

Overgrowth of blood vessels (esp after minor trauma)

Comes up over 3 months and bleeds profusely

117
Q

Treatment of typical cellulitis versus cat/dog bite

A

Amoxicillin/fluclox

Dog/cat bite: Co-amoxiclav

Year 4 (9 decks)

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