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Derm, Opth + ENT > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How to examine a skin lesion

A

Inspect - site, number of lesions, distribution and configuration
Describe - size, shape, colour, secondary changes, morphology, margin
If pigmented: Asymmetry, irregular Border, two or more Colours, >7mm Diameter
Palpate - consistency, mobility, tenderness, temperature
Systemic check - nails, scalp, hair + mucous membranes

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2
Q

What is a lesion?

A

Area of altered skin

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3
Q

Definition of a rash

A

An eruption

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4
Q

Definition of a naevus

A

Localised malformation of tissue structures

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5
Q

Definition of a comedone

A

Plug in sebaceous follicle containing sebum, bacteria and cellular debris
Open = blackheads
Closed = whiteheads

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6
Q

Definition of generalised

A

All over body

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7
Q

Definition of widespread

A

Extensive

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8
Q

Definition of localised

A

One area of skin only

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9
Q

Pressure areas

A

Sacrum, buttocks, ankles, heels

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10
Q

Photosensitive

A

Affects sun-exposed areas such as face, neck and back of hands

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11
Q

What is distribution?

A

Pattern of spread of lesions:
Generalised, widespread, localised?
Flexor/ extensor/ pressure areas/ dermatomes/ photosensitive area?

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12
Q

What is configuration?

A

Pattern or shape of grouped lesions:

Discrete, confluent, linear, target, annular, discoid

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13
Q

Definition of discrete

A

Individual lesions separated from each other

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14
Q

Definition of confluent

A

Merging together

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15
Q

Definition of linear

A

In a line

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16
Q

Definition of target

A

Concentric rings (bullseye)

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17
Q

Definition of annular

A

Rings

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18
Q

Definition of discoid

A

Coin shaped/ round

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19
Q

Types of colour of a lesion

A

Erythema/ purpura

Hypo/ hyper/ depigmented

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20
Q

Definition of erythema

A

Redness which blanches

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21
Q

Definition of purpura

A

Red or purple that does not blanch

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22
Q

Definition of petechiae

A

Purpura - small pinpoint macules

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23
Q

Definition of ecchymoses

A

Purpura - large bruise like patches

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24
Q

Hypo/ hyper/ depigmented

A 
Hypo = paler skin
Hyper = darker skin 
De = white skin due to absence of melanin
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25
Q

Definition of morphology

A

Structure of lesion

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26
Q

Definition of macule

A

Flat area of altered colour (freckle)

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27
Q

Definition of patch

A

Large flat area of altered colour

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28
Q

Definition of papule

A

Solid raised lesion <0.5cm (xanthomata)

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29
Q

Definition of nodule

A

Solid raised lesion >0.5cm

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30
Q

Definition of plaque

A

Palpable scaling raised lesion >0.5cm (psoriasis)

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31
Q

Definition of vesicle

A

Raised, clear fluid filled lesion <0.5cm (acute hand eczema)

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32
Q

Definition of bulla

A

Raised, clear fluid filled lesion >0.5cm (reaction to insect bites)

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33
Q

Definition of pustule

A

Pus containing lesion <0.5cm (acne)

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34
Q

Definition of abscess

A

Localised accumulation of pus in dermis

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35
Q

Definition of weal

A

Transient raised lesion due to dermal oedema (urticaria)

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36
Q

Definition of boil/ furuncle

A

Staph infection around or within hair follicle

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37
Q

Definition of carbuncle

A

Staph infection of adjacent hair follicles (multiple boils)

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38
Q

Definition of secondary lesions

A

Excoriation, scales, crust, scar, ulcer, fissure, striae

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39
Q

Definition of excoriation

A

Loss of epidermis following trauma

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40
Q

Definition of scales

A

Excoriations in eczema (psoriasis showing silvery scales)

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41
Q

Definition of crust

A

Rough surface made of serum, blood, bacteria and debris
Exuded through eroded epidermis
eg impetigo

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42
Q

Definition of a scar

A

New fibrous tissue post wound healing
Atrophic = thinning
Hypertrophic = hyperproliferation within would boundary
Keloidal = hyperproliferation beyond wound boundary

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43
Q

Definition of an ulcer

A

Loss of epidermis and dermis

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44
Q

Definition of a fissure

A

Epidermal crack due to excess dryness

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45
Q

Definition of striae

A

Linear areas going from purple > pink > white

Due to steroid use or growth spurts

46
Q

Definition of hirsutism

A

Androgen dependant hair growth in a female

47
Q

Definition of hypertrichosis

A

Non androgen dependant hair growth

48
Q

Definition of koilonychia

A

Spoon shaped depression of nail due to anaemia

49
Q

Definition of onycholysis

A

Separation of distal end of nail from nail bed

Due to psoriasis or hyperthyroidism

50
Q

Definition of pitting

A

Punctate depressions of nail due to psoriasis and eczema

51
Q

Psoriasis presentation

A

Raised area of red skin covered in silvery scales (plaques). Found on extensor surfaces + scalp, usually widespread confluent lesions. Itchy and painful

52
Q

Pathophysiology of psoriasis

A

New cells move up skin layers to outermost level in 2-6 days - not fully mature cells build up causing red, flaky scales

53
Q

What is guttate psoriasis?

A

In young children and adults
Small pink patches without scaling
Develops after strep throat

54
Q

Treatment for psoriasis

A 
Phototherapy 
Medications:
1) Acitretin (retinoid) - not for women of child bearing age 
2) Ciclosporin 
3) Methotrexate 
4) Hydroxycarbamide
55
Q

Atopic eczema presentation

A

Itchy erythematous dry scaly patches on face and extensor aspects in infants, and flexor aspects in children and adults
Acute lesions are exudative papules and vesicles on erythematous base
Chronic scratching can cause excoriations
May have nail pitting

56
Q

Eczema management

A

Emollients
Topical steroids for flare ups
Oral abx for secondary bacterial infections
Oral steroids for severe resistant cases

57
Q

Eczema complications

A

Secondary bacterial infections
Molluscum contagiosum
Viral warts
Eczema herpeticum

58
Q

Presentation of acne

A

Open and closed comedones

Papules, pustules and nodules

59
Q

Complications of acne

A

Hyperpigmentation
Scarring
Deformity

60
Q

Basal cell carcinoma presentation

A

Nodular is most common
Small, skin coloured papule or nodule with surface telangiectasia + pearly rolled edge
Lesion may have necrotic or ulcerated centre
Usually over head or neck

61
Q

Squamous cell carcinoma presentation

A

Keratotic (scaly, crusty) ill defined nodule, may ulcerate

62
Q

Malignant melanoma presentation

A

Asymmetrical, irregular border, irregular colour, large diameter, changing in size or shape
Common on legs and trunk
May itch or bleed

63
Q

What is erythema nodosum + what are the causes?

A

Inflammation of SC fat
Causes tender, red nodular lesions over shins/ forearms
Due to strep/ IBD/ sarcoidosis/ penicillins/ COCP

64
Q

Treatment for actinic keratosis

A

Fluoruracil cream or imiquimod cream

65
Q

Treatment for lupus

A

NSAIDs
Corticosteroids
Hydroxychloroquine (especially for the rash)

66
Q

Erysipelas presentation and treatment

A

Sharply demarcated raised edge rash

Treat with penicillin/ erythromycin

67
Q

Treatment for impetigo

A

Fusidic acid or mupirocin

68
Q

Treatment for shingles

A

Oral acyclovir

69
Q

What is atopic dermatitis?

A

Hypersensitivity to allergens

Form of eczema Infants: face + nappy area

Children: flexures, neck + Dennie-Morgan folds

Adults: flexures + hands

70
Q

Treatment of atopic dermatitis

A

Emollients, steroids, immunomodulatory therapy

71
Q

What is seborrhoeic dermatitis?

A

Rash appears in sebaceous glands ie scalp, sides of nose, behind ears

Cradle cap in infants (starts at 2-6 months)

Thick, yellow, waxy scales

72
Q

Treatment for seborrhoeic dermatitis

A

Adult = medicated shampoo

Infants = emollients

73
Q

What is stasis dermatitis?

A

AKA Varicose eczema

Common in later life

Vein walls weakened, blood pools in legs forming red-brown speckles on skin which are hot and itchy

74
Q

RF for stasis dermatitis?

A

Poor circulation, DVTs, cellulitis, varicose veins, phlebitis, obesity

75
Q

Treatment for stasis dermatitis?

A

Lose weight, treat varicose veins, compression stockings, emollients, topical steroids

76
Q

What is asteatoic dermatitis?

A

Eczema cracquelee

Over 60s

Appears on shins with ‘crazy paving’ appearance

Treat with emollients + steroids

77
Q

What is contact dermatitis?

A

Result of contact with irritants or allergens

Common on hands + face

78
Q

Histological findings of psoriasis

A

Thick epidermis (acanthosis) with saw tooth appearance

Papillary dermis close to surface

Vascular proliferation (Auspitz’s sign)

79
Q

How do you assess psoriasis?

A

Psoriasis Area and Severity index (PASI)

Dermatology Life Quality Index (DLQI)

80
Q

Advise for pts with acne

A

Avoid over-cleaning
Use non-comedogenic makeup
Avoid picking or squeezing
Acne treatments take 8 weeks to work

81
Q

Management of mild acne with open + closed comedones

A

Single topical treatment eg retinoid (adapalene) or benzoyl peroxide
Azelaic acid 2nd line

82
Q

Management of moderate acne with inflammatory lesions

A

Add oral abx (lyme/doxycycline)

83
Q

When should isotretinoin be considered for acne?

A

Non-response to 2 courses of abx or scarring

84
Q

Pathology + S+S of warts

A

Small rough growths caused by HPV

Usually on hands + feet

85
Q

What is a verruca?

A

Plantar wart (on sole of foot)

86
Q

Types of warts

A 
Common = firm + raised with rough surface, resembles cauliflower 
Plane = round, flat topped + yellow, commonly on hands 
Filiform = long + slender, commonly face + neck 
Plantar = soles of feet 
Mosaic = palmar or plantar warts coalesce into larger plaques
87
Q

Management of warts

A

Watch + wait if asymptomatic
Salicylic acid, cryotherapy or combo
In secondary care: physical ablation, topical podophyllotoxin, virucidal tx

88
Q

Types of pigmented lesion

A 
Melanoma 
Moles (naevi)
Seborrhoic keratoses 
Freckles
Dermatofibromas 
Lentigines 
Pigmented BCC
89
Q

Types of melanoma

A

Superficial spreading, nodular, lentigo maligna, acral lentiginous

90
Q

RF for melanoma

A 
Fam hx 
Pale skin + light eyes, burns easily 
Red or blonde hair 
Hx of sunburn 
Hx of indoor tanning
Lots of moles 
Increasing age 
Organ transplant recipients
91
Q

What is the weighted 7 point checklist?

A 
Assess melanoma 
Major features (2 points) = change in size, irregular shape, border or colour 
Minor features (1 point each) = >7mm diameter, inflammation, oozing or crusting, change in sensation

Score >3 = suspicious

92
Q

Pathology of leg ulcer

A

Break in skin below knee that has not healed in 2 weeks

93
Q

Causes of leg ulcers

A

Venous, diabetic, arterial disease, RA, vasculitis, sickle cell, malignancy, drugs (nicorandil, steroids, NSAIDs)

94
Q

Pathology of venous leg ulcers

A

Sustained venous HTN, due to chronic venous insufficiency due to valve incompetence or impaired calf muscle pump

95
Q

RF for venous leg ulcers

A 
Obesity
Immobility 
Increasing age 
Varicose veins 
Hx od DVT
96
Q

Complications of venous leg ulcers

A

Chronic pain
Infection
Contact dermatitis

97
Q

Management of leg ulcers

A

Compression therapy

Pentoxifylline to increase blood flow

98
Q

RF for BCC

A 
Fam hx 
UV exposure (head + neck common) 
Increasing age 
Male sex 
Skin types 1 + 2
99
Q

Types of BCC

A

Superficial - multiple on upper trunk/ shoulders, erythematous well-demarcated scaly plaques
Nodular = solitary, shiny red nodule with large telangiectatic vessels, commonly on face
Morphoeic = more aggressive, thickened yellowish plaques
Pigmented = brown, blue, grey, seen in dark skinned pts
Basosquamous = mixed SCC + BCC

100
Q

RF for SCC

A 
UV light 
Fair skin 
HPV 
Ionising radiation exposure 
Immunodeficiency
101
Q

Pathology of actinic keratosis

A 
UV induced DNA damage 
Epidermal lesion characterised by:
Collections of atypical keratinocytes 
Epidermis abnormal in architecture 
Mitotic figures present
102
Q

Description of actinic keratosis

A

Small rough spots

Can become red + scaly

103
Q

Management of actinic keratosis

A 
5-FU cream
Salicylic acid 
Diclofenac gel 
Imiquimod cream 
Cryotherapy 
Photodynamic therapy
104
Q

What is a keloid scar?

A

Overgrowth of dense fibrous tissue

Extends beyond borders of wound

105
Q

Management of keloid scars

A 
Intralesional steroid injections (triamcinolone) 
Pressure dressings 
RT 
Cryotherapy 
Laser
106
Q

Pathology of Kaposi’s sarcoma

A

Connective tissue cancer caused by herpes 8, usually in immunosuppressed pts
Spindle cells
Highly vascular
Surrounding inflammatio

107
Q

Types of Kaposi’s sarcoma

A

Classic
Endemic/ African - affect young adult men in Africa
Transplant related
Epidemic - occurs in HIV pts
Non-epidemic - occurs in homosexual men who do not have hiv

108
Q

S+S of Kaposi’s sarcoma

A

Skin lesions that are nodular, papular or blotchy

Around mouth, nose + throat

109
Q

Management of Kaposi’s sarcoma

A

RT
Cryotherapy
Surgery

110
Q

What is staphylococcal scalded skin syndrome?

A

Caused by exotocin
Prodrome of fever, irritability, skin tenderness
Sudden onset of diffuse erythema, warm + tender to touch
Flaccid bullae that desquamate in large sheets
Usually in children

111
Q

What is toxic shock syndrome?

A

Caused by superantigen from S aureus

Presents as shock + multiorgan failure with diffuse erythematous macular rash

Derm, Opth + ENT (6 decks)

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