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med school finals > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Layers of the skin from superficial to deep?

A

Epidermis
→ keratin layer
→ granular layer
→ prickle cell layer
→ basal cell layer
Dermoepidermal junction
Dermis
→ papillary dermis
→ reticular dermis

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2
Q

Outline the pathophysiology of acne?

A
  • Androgens increase sebum production
  • Sebum and keratin block the pilosebaceous unit leading to swelling and inflammation
  • Colonisation of propionibacterium acnes leads to further inflammation
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3
Q

Features of acne vulgaris?

A

Mild = comedones
Moderate = comedones, pustules, papules
Severe = extensive inflammatory lesions, scarring

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4
Q

Management of acne vulgaris?

A

Depend on severity of symptoms:
→ benzoyl peroxide
→ topical retinoid
→ topical antibiotics
→ oral antibiotics or contraceptive (females)
→ oral retinoid

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5
Q

List some side effects of isotretinoin?

A

Teratogenic
Dry lips/mouth
Hair thinning
Low mood
Photosensitivity

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6
Q

Advice for prescribing Dianette for acne vulgaris?

A

Higher risk of VTE compared to other COCPs
Use for a maximum of 3 months

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7
Q

Advice for prescribing oral antibiotics for acne vulgaris?

A

Co-prescribe benzoyl peroxide or oral retinoid
Tetracycline is preferred
Use for a maximum of 3 months

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8
Q

Features and management of acne rosacea?

A

Facial flushing
Pustules, papules
Telangiectasia
Rhinophyma
Triggers e.g. UV, alcohol
Management = brimonidine (flushing), topical ivermectin, topical metronidazole, oral doxycycline

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9
Q

Topical steroid ladder?

A

Help Every Budding Dermatologist:
Mild = hydrocortisone
Moderate = eumovate (clobestasone butyrate)
Potent = betnovate (betamethasone)
Very potent = dermovate (clobetasol propionate)

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10
Q

Feature of atopic dermatitis (eczema)?

A

Dry, flaky, itchy skin on flexor surfaces
→ extensors/cheeks in babies

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11
Q

Management of atopic dermatitis (eczema)?

A

Emollient +/- topical steroid

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12
Q

Feature, cause and management of eczema herpeticum?

A

Monomorphic “punched out” lesions
Cause = HSV-1 or HSV-2 infection
Management = admission + IV aciclovir

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13
Q

Features, cause and management of impetigo?

A

Golden, crusted lesions around mouth
Cause = staphylococcus or streptococcus
Management = topical hydrogen peroxide or topical fusidic acid (limited), oral flucloxacillin (extensive)

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14
Q

School exclusion for children with impetigo?

A

48 hours after starting antibiotics

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15
Q

Types of contact dermatitis and cause?

A

Irritant = non-allergic reaction to chemical damage
Allergic = type IV hypersensitivity reaction to allergen

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16
Q

Investigation and management of contact dermatitis?

A

Investigation = patch testing
Management = emollient +/- topical steroid

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17
Q

Feature, cause and management of seborrhoeic dermatitis?

A

Dry, flaky, itchy skin on sebum-rich areas
Cause = malassezia furfur (yeast)
Management = topical ketoconazole

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18
Q

Feature and management of dermatitis herpetiformis?

A

Itchy, vesicular rash on extensor surfaces
Management = gluten-free diet, dapsone

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19
Q

Features of plaque psorasis?

A

Red, scaly plaques on extensors, scalp, trunk, buttocks
Nail changes e.g. pitting, onycholysis

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20
Q

Triggers of plaque psoriasis?

A

Skin trauma (Koebner phenomenon)
Beta-blockers, NSAIDs, lithium, anti-malarials

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21
Q

Management of plaque psoriasis?

A

1st line = emollient + topical steroid (OD) + topical vit D analogue (OD)
2nd line = emollient + topical vit D analogue (BD)
3rd line = emollient + topical steroid (BD)
N.B. dithranol (vit A analogue) and coal tar can also be used

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22
Q

Secondary care management of plaque psoriasis?

A

Phototherapy = narrowband UVB
Systemic therapy = methotrexate

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23
Q

Management of scalp psoriasis?

A

Topical steroid + softener e.g. salicylic acid

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24
Q

Features and management of guttate psoriasis?

A

“Tear drop” papules on trunk and limbs
2-4 weeks post-strep infection
Management = self-resolving

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25
Q

Features and management of lichen planus?

A

Itchy, purple, polygonal, papular rash
Wickham’s striae
Management = topical steroid

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26
Q

Drugs which can cause lichenoid eruption?

A

Beta-blockers
Gold
Thiazides
Anti-malarials

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27
Q

Features and management of lichen sclerosus?

A

Mostly elderly women
Genital itch
Atrophy
Scarring
Management = emollients +/- topical steroids

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28
Q

What is erythroderma and most common cause?

A

Erythema covering > 90% of body surface
Exacerbation of existing skin disease e.g. dermatitis

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29
Q

What is erythrasma and most common cause?

A

Pink/brown patches in damp areas e.g. groin
Overgrowth of corynebacterium

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30
Q

What is erythema multiforme and most common cause?

A

Type IV hypersensitivity reaction causing target lesions
HSV infection

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31
Q

What is erythema nodosum and most common cause?

A

Inflammation of subcut fat causing tender nodules
Group B strep infection

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32
Q

What is erythema ab igne and most common cause?

A

Reticulated pattern of erythema and hyperpigmentation
Infrared radiation e.g. hot water bottles

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33
Q

Cause of pityriasis rosea vs pityriasis versicolor?

A

Rosea = HHV-7
Versicolor = malassezia furfur

34
Q

Features and management of pityriasis rosea?

A

Initially single herald patch on trunk
Widespread rash of scaly patches follows
Management = self-limiting

35
Q

Features and management of pityriasis versicolor?

A

Pink, brown or hypopigmented scaly patches
More noticeable with suntan
Management = ketoconazole shampoo

36
Q

Features, cause and management of shingles?

A

Prodromal burning pain over dermatome
Vesicular, blistering rash
Cause = reactivated VZV
Management = aciclovir + paracetamol/NSAIDs

37
Q

Complications of shingles?

A

Post-herpetic neuralgia
Ocular issues (CN V1 involvement)
Facial paralysis (CV VII “Ramsay Hunt”)

38
Q

Outline the shingles vaccination programme?

A

Offered to anyone aged 71-79

39
Q

Management of tinea capitis vs tinea corporis vs tinea pedis?

A

Capitis = topical ketoconazole + oral antifungal
Corporis = oral antifungal
Pedis = topical antifungal (1st line), oral antifungal (2nd line)

40
Q

Management of fungal nail infection?

A

Limited = topical amorolfine 5%
Extensive= oral terbinafine

41
Q

Management of scabies?

A

All household members should be treated:
1st line = permethrin 5%
2nd line = malathion 0.5%

42
Q

Management of head lice?

A

Only treat other household members if symptomatic:
1st line = malathion

43
Q

Features and management of molluscum contagiosum?

A

Pearly papules with central umbilication
Management = self-limiting

44
Q

Features, cause and management of chickenpox?

A

Prodromal fever
Itchy rash (macular → papular → vesicular)
Cause = VZV
Management = supportive, immunocompromised or peripartum exposure = IV VZV Ig → IV aciclovir if chickenpox develops

45
Q

School exclusion for children with chickenpox?

A

Until all lesions are crusted over

46
Q

Features, cause and management of roseola infantum?

A

Prodromal high fever
Febrile convulsions
Maculopapular rash
Nagayama spots (uvula/soft palate)
Cause = HHV-6
Management = self-limiting

47
Q

Features, cause and management of hand, foot and mouth?

A

Generally unwell e.g. fever
Oral ulcers
Vesicles on palms and soles
Cause = coxsackie A16
Management = supportive

48
Q

School exclusion for hand, foot and mouth?

A

No need to stay off if well

49
Q

Red or purple birthmark that gets darker over time?

A

Port wine stain

50
Q

Blotchy pink birthmark that improves over time (except ones on neck)?

A

Salmon patch

51
Q

Red, multi-lobed growth presenting in the first month of life and improving over time?

A

Strawberry naevus

52
Q

Common newborn rash containing small papules surrounded by an erythematous halo?

A

Erythema toxicum

53
Q

Common newborn keratin-filled cysts on face?

A

Milia

54
Q

Brown “stuck on” lesions seen in older people?

A

Seborrhoeic keratosis (basal cell papilloma)

55
Q

Solitary firm papule originating at site of injury e.g. insect bite?

A

Dermatofibroma

56
Q

Features of Lyme disease?

A

Erythema migrans
Generally unwell e.g. fever
Heart block
Pericarditis
Nerve palsies

57
Q

Investigations and management of Lyme disease?

A

Investigations = clinical diagnosis if erythema migrans present, ELISA antibodies to borrelia burgdorferi (1st line)
Management = doxycycline (early disease), ceftriaxone (disseminated disease)

58
Q

Features and management of urticaria?

A

Itchy, pink raised skin
“Hives,” “wheals” etc.
Management = non-sedating antihistamine

59
Q

Examples of sedating vs non-sedating antihistamines?

A

Sedating = chlorpheniramine (Piriton), promethazine, cyclizine
Non-sedating = loratadine, fexofenadine, cetirizine

60
Q

Cause of bullous pemphigoid vs pemphigus vulgaris?

A

Bullous pemphigoid = antibodies against hemidesmosomal proteins
Pemphigus vulgaris = antibodies against desmoglein 3

61
Q

Features and management of bullous pemphigoid?

A

Itchy, tense sub-epidermal blisters
Heal without scarring
Nikolsky’s sign -ve
No mucosal involvement
Management = oral steroids

62
Q

Skin biopsy feature of bullous pemphigoid?

A

IgG and C3 at the DEJ

63
Q

Features and management of pemphigus vulgaris?

A

Painful, flaccid epidermal blisters
Heals with scarring
Nikolsky’s sign +ve
Mucosal involvement
Management = oral steroids

64
Q

Skin biopsy feature of pemphigus vulgaris?

A

Acantholysis

65
Q

Features, cause and management of AIP?

A

GI upset
Motor neuropathy
Depression
Red urine
Cause = porphobilinogen deaminase deficiency
Management = IV haem arginate

66
Q

Features, cause and management of PCT?

A

Photosensitive rash
Hypertrichosis
Hyperpigmentation
Cause = uroporphyrinogen decarboxylase deficiency
Management = chloroquine, venesection

67
Q

Most common causes of SJS/TEN?

A

Antibiotics
Antiepileptics
Allopurinol
NSAIDs

68
Q

Difference between SJS vs TEN?

A

SJS = < 10% body surface
TEN = > 30% body surface
N.B. 10-30% is SJS/TEN overlap syndrome

69
Q

Features and management of SJS/TEN?

A

Widespread erythematous rash
Vesicles and bullae
Nikolsky’s +ve
Sytemically unwell
Management = admission + supportive manegement + IV Igs (TEN)

70
Q

Classification and features of burns?

A

Superficial epidermal (1st degree) = red, painful, dry
Partial thickness (2nd degree)
→ superficial dermal = pink, painful, blistered
→ deep dermal = white +/- patches of erythema, loss of sensation, painful to deep pressure
Full thickness (3rd degree) = white, brown or black, no pain

71
Q

SCC precursors?

A

Actinic keratosis
Bowen’s disease

72
Q

Features and managemnt of actinic keratosis?

A

Small scaly patches on sun-exposed skin
Management = 5-FU, topical diclofenac, imiquimoid, cryotherapy, curettage and cautery

73
Q

Features and management of Bowen’s disease?

A

Pink scaly patch on sun-exposed skin
Management = 5-FU, cryotherapy, excision

74
Q

Features and management of SCC?

A

Rapidly growing lesion
Scale, ulceration, bleeding
PMH chronic sun exposure
Management = excision with 4mm margin if < 20mm, excision with 6mm margin if > 20mm, Mohs surgery if on cosmetically important site e.g. face

75
Q

Epithelial tumour which spontaneously regresses. Can be mistaken for SCC?

A

Keratoacanthoma

76
Q

Features and management of BCC?

A

Slowly growing lesion
Central ulceration
Pearly rolled edges, telangiectasia
PMH intermittent sun exposure
Management = excision with 4mm margin if < 20mm, excision with 6mm margin if > 20mm, Mohs surgery if on cosmetically important site e.g. face

77
Q

ABCDE of worrying skin lesions?

A

Asymmetry
Border irregularity
Colour variation
Diameter > 7mm
Evolving

78
Q

Types of malignant melanoma?

A

Superficial spreading (most common)
Nodular
Lentigo maligna
Acral lentiginous

79
Q

Investigation and management of melanoma?

A

Investigation = excision biopsy
Management = surgery dependent on Breslow thickness

80
Q

Margins of melanoma excision?

A

Breslow thickness:
→ 0-1mm = 1cm margin
→ 1-2mm = 1-2cm margin
→ 3-4mm = 2-3cm margin
→ > 4mm = 3cm margin

med school finals (18 decks)

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