Dermatology - Lumps and Bumps

Question 1

Psoriasis, eczema, contact dermatitis

Indications

Answer 1

Differential diagnosis may be difficult

Red patches, swelling, itchy and painful

Question 2

Main differences between psoriasis and eczema

Answer 2

Psoriasis - scaly, affects nail and scalp, adults, arthritis

Eczema - face and hands,. no scaling, only children, no arthritis

Question 3

Psoriatic arthritis is associated with

HLA association - what is this

Answer 3

ulcerative colitis
HLA - human leukocyte antigens - self antigens displaced by MHCs
AUTOIMMUNE

Question 4

Psoriasis tx

Aims and methods

Answer 4

Reduce keratinocyte proliferation
Coal tar
Retinoids
Vit D

Immune suppression
Steroids
Methotrexate
TNF blocker

Question 5

Eczema tx

Answer 5

Identify triggers
Emollient cream 
Topical steroids 
Antihistamines for itchiness  
Antibiotics if infected

Question 6

Oral manifestations of skin disease

Answer 6

Lichen planus
Herpes
Blistering conditions

Question 7

Lichen planus

Describe
Location

Histological appearance

Answer 7

Auto immune
Itchy papular rash
Flexor surfaces, mouth and genitalia

Band like T cell infiltrate
Saw-shaped rête ridges

Question 8

Herpes infections

Post herpetic

Answer 8

Herpes simplex
Chicken pox
Herpes Zoster (shingles)
Recurrent herpes labialis

Ocular keratitis
Myalgia due to infection

Question 9

Examination of lumps - criteria

Answer 9

Site
Size 
Shape
Mobility 
Consistency 
Surface
Covering mucosa
Pulsatile

Question 10

Site of lesion criteria

Answer 10

Where
Neck
Face scalp or nose

Question 11

Size, shape

Answer 11

Two dimensions unless round

Question 12

Mobile or fixed

Answer 12

Moved freely

Fixed to skin, bone and muscle

Question 13

Consistency/surface texture

Answer 13

Consistency - hard, firm, soft rubbery, fluctuant

Surface - irregular, smooth craggy

Question 14

Covering skin/mucosa

Answer 14

Normal, ulcerated, colour, erythema, blanches

Question 15

Other featres

Answer 15

Compressible, thrill, pulsatile,

Question 16

Gorlin’s

Answer 16

Multiple odontogenic keratocysts of the jaw

Question 17

Common skin lumps/pigmented lesions

Answer 17

Epidermal cysts
Basal cell carcinoma
Squamous cell carcinoma - rolled edge 
Vascular malformations
Seborrheic warts
Benign pigmented naevi
Melanoma

Question 18

Seborrheic warts

Answer 18

More in elderly 
Basal cell papilloma
May be multiple
Well defined
Raised edge 
Warty pigmented

Question 19

Epidermal cysts

Answer 19

AKA sebaceous cyst
Fixed
Punctum - small distinct point
History of discharge
May become infected

Question 20

BCC

Distribution

Characteristics

Answer 20

Common in elderly
Scalp, face and neck in 80% of patients
Light genetic predisposition in people with Gorlin Goltz

Pearlescent

Well defined
Rarely metastasises
Slow growing 
Pearly edge 
May crust then appear to regress

Question 21

SCC

Answer 21

Non-melanoma skin cancer 
Elderly due to sun exposure
Face head and arms 
Variable growth 
May metastasise

Question 22

Melanoma

Answer 22

Young patients
Sun exposure
Found on trunk and limbs
Usually metastasises

Question 23

Kerastoacanthoma

Answer 23

large necrosed centre due to accelerated growth of tissue peripherally
Skin lesion occurring in sun damaged skin

Question 24

Malignant melanoma

Indications

Answer 24

Deep melanoma is worse

Asymmetric, irregular border, off colour, larger diameter

Question 25

Treatment of BCC

Answer 25

Surgery
Radiotherapy
Imiquimod - immune stimulation

Question 26

Treatment of SCC

Answer 26

Surgery 1-3mm margin around lesion - primary and then to deal with lymph node metastasis
Radiotherapy

Question 27

Psoriasis - phenomenon?

Answer 27

Koebner - raised bumps on superficial wounds

Question 28

Eczema aetiology? HLA?
What causes it then

Type I
Type IV

Answer 28

No HLA association
Caused by IgE
Atopic eczema

Allergic contact dermatitis