derm Flashcards
(149 cards)
1
Q
Mild acne vulgaris
A
Open and closed comedones with or without sparse inflammatory lesions
2
Q
Moderate acne vulgaris
A
Widespread non-inflammatory lesions and numerous paperless and pustules
3
Q
Severe acne vulgaris
A
Extensive inflammatory lesions, which may include nodules, pitting and scarring
4
Q
Single topical therapy for acne
A
Topical retinoids and benzoyl peroxide
*for mild do not use antibiotics
5
Q
For moderate acne management
A
Topical antibiotic, benzoyle peroxide, topical retinoid
6
Q
Oral antibiotics for acne vulgaris
A
Tetracyclines though AVOID in pregnant women
7
Q
How to differentiate between a pyogenic granuloma may mimic amelanotic melanoma
A
a pyogenic granuloma may mimic the amelanotic melanoma but is caused by trauma
8
Q
Risk factors for developing a pyogenic granuloma
A
Trauma
Pregnancy
More common in women and young adults
Found most commonly on head/neck/trunk and hands
9
Q
Management of pyogenic granuloma
A
Lesions associated with pregnancy = resolve spontaneously
Other = curettage, cauterisation, cryotherapy, excision
10
Q
What are the 2 types of contact dermatitis
A
irritant contact dermatitis - non-allergic due to weak acids or alkalis often seen on hands
Allergic contact dermatitis - type IV hypersensitivity - rare - seen on scalp after hair dyes = potent steroids are indicated
11
Q
Unusual cause of contact dermatitis - irritant
A
Cement
12
Q
Buzzwordy = acute onset, tear-drop/small spot scale papules, trunk and limbs, young person, following a throat infection (streptococcal)
A
guttate psoriasis
13
Q
Treatment of guttate psoriasis
A
most cases resolve spontaneously within 2-3 months
UVB phototherapy
Topical agents same as psoriasis
14
Q
What is dactylitis
A
Diffuse swelling of the digits
15
Q
What is only onycholysis
A
Painless detachment of the nail from the nail bed
16
Q
What are the nail changes associated with psoriasis
A
Nail pitting
Onycholysis
17
Q
BUZZWORD** pearly rolled edges with telangiectasia surrounds central crater
A
basal cell carcinoma
18
Q
Topicals for basal cell carcinoma
A
Imiquimod, fluorouracil
19
Q
What class of drugs exacerbate psoriasis
A
Beta blockers
NSAIDs
ACEi
TNF-a
Anti-malarials
Also lithium
20
Q
Which acne medication is contraindicated in pregnancy
A
Oral isotretinoin
21
Q
What are main medication to treat acne vulgaris
A
Topical retinoids
Benzoyl peroxide
22
Q
What is the antibody associated with dermatitis herpetiforms
A
Anti-tissue transglutaminase antibody
23
Q
What is dermatitis herpetiformis
A
Itchy vesicular rash that presents on elbows knees and buttocks and is associated with Coeliac
24
Q
What malignancy is a renal transplant patient most at risk of in the future
A
Skin cancer - squamous cell carcinoma of the skin
25
Features of scabies
Widespread pruritus
Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
Scratching = excoriation, infection
26
Management for scabies - first line
Permethrin 5%
27
What is erythema nodosum
Inflammation of subcutaneous fat
Typically causes tender erythematous, nodular lesions
Usually occurs over shins - may occur forearms thighs
28
* ‘hives’ ‘wheals’ ‘nettle rash’
= urticaria
first line = antihistamines
29
First line for seborrhoeic dermatitis
Topical ketoconazole (anti-fungals)
30
What causes seborrhoeic dermatitis
Malassezia furfur
31
First line for pityriasis versicolor
Ketoconazole shampoo (anti-fungal)
32
Which medications can cause a flare up of psoriasis
Beta-blockers
Lithium
Anti-malarials (Chloroquine etc)
NSAIDs
ACEi
Infliximab
33
*exclamation mark hairs
= alopecia areata
34
What skin condition is associated with IBDs
Pyoderma gangrenosum
35
Skin problems make up x percent of GP consultations
15-23%
36
What is the enzyme deficiency in acute intermittent porphyria
PBG deaminase
37
Description of the hypersensitivity reactions …
Type I = immediate hypersensitivity
Type II = direct cell killing
Type III = immune complex mediated
Type IV = delayed type hypersensitivity
38
Function of collagen
Vitamin D metabolism
39
Function of subcutaneous fat
energy storage
40
Function of collagen
Tensile strength
41
Function of Basal cells
Epidermal proliferation
42
Function of mast cells
Release of inflammatory mediators
43
At what point of gestation do sweat glands develop
6 months
44
Where do melanocytes migrate from (gestation)
From: Neural crest
To: skin
45
T/F blashko’s lines develop in the distribution of cutaneous nerves
F - they are developmental
46
Which layer of the skin is the most metabolically active ?
Basal layer
47
Features of mucosal membranes
Highly specialised for function ie
They are often affected by skin disease, they are keratinised, have sensory functions (taste) and often contain glands
48
Why do steroids need to be lipophilic ?
To allow for passive diffusion across the plasma membrane where they combine with cell receptors and bind to steroid responsive elements in the DNA
They are anti-proliferatives, anti-inflammatory and vasoconstrictive
49
Describe which arteries to get from lungs to big toe
pulmonary vein > left side of the heart > aorta > abdominal aorta > common iliac artery > external iliac artery > femoral artery > popliteal artery > dorsalis pedis
50
Which 3 things are important in maintaining good peripheral vasculature
Venous valves
Pulse pressure
The muscle pump
51
How many days does it take for a cell to migrate from basal layer to keratin layer
28 days (later ahah lol :/ )
52
How many cells thick is the granular layer
2-3 cells thick
53
What percent of the keratin layer is keratin and filaggrin
80%
54
Which component of MRSA causes necrotising fasciitis
PVL - panton valentine leukocidin
55
Features of Langerhan cells
Formed in bone marrow
Migrate throughout epidermis and dermis
Travel via lymphatics to present antigen in lymph nodes
56
Describe the route to get from big toe to heart
deep plantar vein > great saphenous > femoral vein > external iliac vein > common iliac > abdominal vena cava > inferior vena cava > RA
57
What is this
Crust
58
What is this
Erosion
59
What is this
Scale
60
What is this
Lichenification
61
What is this
maceration
62
Breslow thickness arises from what layer in the skin
Granular layer
63
What does eczema look like on histology
64
What does spongiosis look like on histology
65
What is Buerger’s disease
A vasculitis disease most common in young males who smoke
-foot pain during exertion is a symptoms
Can lead to hypercellular occlusive thrombus
*tortuous corkscrew collaterals may reconstitute patent segments of the distal tibial or pedal vessels
66
*corkscrew shaped collateral vessels distally on angiogram
Buergers disease
67
What is Takayasu arteritis
Can be divided into: acute and chronic
In chronic - upper limb claudication
In later stages the vessels will typically show changes of intimacy proliferation, together with band fibrosis of the intima and media
68
what are the large vessel vasculitis
Temporal arteritis
Takayasu arteritis
69
what are the medium vessel vasculitides
Polyarteritis nodosa
Kawasaki disease
70
what are the small cell vasculitides
ANCA - associated (GPA, eGPA - churgstrauss)
Immune complex - henoch schonlein, anti-GBM
71
What is the most common associated malignancy of Acanthosis nigricans
Gastrointestinal adenocarcinoma
72
Investigation for distal limb ulcers
Ankle-brachial pressure index
Normal range = 0.9-1.2
Anything below or above could be due to arterial disease
73
*target lesions
=erythema multiforme
74
Child with atopic eczema has presented with a rapidly progressing painful rash, painful clustered blisters are noted
What is the most appropriate thing to do?
Admit to hospital for life-saving aciclovir
This child is presenting with eczema herpeticum
75
How does insulin resistance cause acanthosis nigricans
It causes hyperinsulineamia which stimulates keratinocytes and dermal fibroblast proliferation
This proliferation causes the characteristic darkened, thickened skin
76
What skin condition is due to autoimmune melanocyte destruction
Vitiligo
77
What does bullous pemphigoid look like
78
Treatment of bullous pemphigoid
Oral corticosteroids, topical “, immunosuppressants, antibiotics
79
what would immunofluorescence show for bullous pemphigoid
IgG and C3 at the dermoepidermal junction
80
Treatment to target dermatophyte nail infections
Oral terbinafine
Dermatophyte nail infection eg trichophyton rubrum
81
*shiny orange peel skin
Graves’ disease - Pretibial myxoedema
82
High electrical voltage burns are associated with what disease
Rhabdomyolysis
83
*crazy high creatinine
Rhabdomyolysis
84
what is curling’s ulcer
A stress ulcer may occur in the duodenum of burn patients and these are more common in children
85
Positive Ziehl-Nielsen staining for acid-fast bacilli ?
Think TB
86
What is a cause of erythema nodosum
TB
Patients will come in with the respective rash but also with haemoptysis, fever, weight loss, coughing
87
What is erythema nodosum
Inflammation of subcutaneous fat
88
What is nikolskys sign ?
Epidermis separating with mild lateral pressure
89
+nikolysky’s sign
Think : toxic epidermal necrosis
90
what is toxic epidermal necrosis
It is a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction
Skin = scalded over an extensive area
91
Drugs that induce toxic epidermal necrosis
Phenytoin
Penicillins
92
Management of toxic epidermal necrolysis
Iv immunoglobulins
93
Features of rosacea
Appears of nose, cheeks and forehead
Flushing, erythema, telangiectasia —> papules and pustules
Sunlight may exacerbate symptoms
94
What is koebners phenomenon
Causes lesion to appear at site of injury
95
What is exhibited here
Molluscum contagiosum - virus
96
How long does pityriasis rosea rash last ?
6-12 weeks
97
What is alopecia areata
An autoimmune condition causing localised, well demarcated patches of hair loss
At the edge of the hair loss there may be small broken ‘exclamation mark hairs’
98
PMH of crohns and presents with a painful ulcer ?
Pyoderma gangrenosum
99
Itchy rash - purple, raised and has fine white lines on the surface
Lichen planus
100
*blue sclera
Osteogenesis imperfecta - type I collagen
101
What precedes pityriasis rosea
Viral infection
102
Virus associated with pityriasis rosea
Herpes hominis virus 7
103
According to NICE guidelines how long should you wait before starting a second course of topical hydrocortisone
4 weeks
104
What is pellagra
Caused by niacin deficiency = dermatitis, diarrhoea, dementia
Can be caused by isoniazid therapy
105
This rash is non-itchy - what is it
Erythema multiforme
= giant , non- itchy , target lesions
This rash is usually caused by by infections or drug interactions ie amoxicillin
106
“Herald patch” followed by later (a week) by additional lesions
Lethargy + limited lesions to the trunk
= stereo-typical presentation of what ?
Pityriasis rosea
107
Drugs that exacerbate psoriasis
Beta blockers , lithium , anti-malarials (chloroquine and hydroxychloroquine) , NSAIDs , ACEi + infliximab
108
*red or black lump that oozes or bleeds, and is located on sun exposed skin
Nodular melanoma
109
What to do if eczema herpeticum is suspected
It is potentially life threatening in children and so they should be admitted into hospital and given IV aciclovir
110
What is the most common side effect of isotretinoin
Dry skin
111
Iron deficiency anaemia
112
*heliotrope rash
Dermatomyositis
113
Initial investigation of dermatomyositis and polymyositis
Creatinine kinase
114
Dermatomyositis + polymyositis definitive diagnosis
Muscle biopsy
115
*gottrons papules
Dermatomyositis
116
What are the common complications of toxic epidermal necrolysis
Fluid loss
Electrolyte imbalance
117
Treatment for Toxic epidermal necrolysis
Supportive care - volume loss and electrolytes
IV immunoglobulins
118
Drugs known to cause toxic epidermal necrolysis
Phenytoin
Sulphonamides
Allopurinol
Penicillin - main one
NSAIDs
Carbamezapine
119
Can you prescribe oral isotretinoin in the GP practice ?
No - can only be prescribed under specialist care therefore if you suspect patient has severe acne then refer to dermatology
120
What should benzoyl peroxidase and retinoids be co-prescribed with
Antibiotics oral
121
Management of venous ulcers
Compression bandaging
Oral pentoxifylline
122
*deep, dry, punched out ulcer
Arterial ulcer
Would also present with burning pain in the leg
Ulceration over bony prominence
(Lateral malleolus)
123
*ulcer round medial malleolus / gaiter region
Venous ulcer
124
What is the organism that causes Athlete’s foot
Trichophyton
125
First line for athletes foot
Topical imidazole, undecenoate or terbafine
126
*monomorphic punched out erosions - circular, depressed ulcerated lesions
Eczema herpeticum
127
What are the two premalignant lesions to melanoma
Bowens
Actinic keratosis
128
What is erythema ab igne
A lesion caused by infrared radiation and is commonly associated with hot water bottles or open fire
129
What is this ?
Erythema ab igne
(Overexposure to infraredradiation)
130
If heat source isn’t removed in erythema ab igne , what could the patient go on to develop ?
Squamous cell carcinoma
131
1st line for lichen planus
Topical steroids
132
*antistreptolysin - O titre raised
Erythema nodosum
133
Common causes of erythema nodosum
Pregnancy
Streptococcal infection
134
*honeycomb arrangement on immunofluorescence
Pemphigus vulgaris
135
Virus infection of HSV-1 can cause what ?
Eczema herpeticum
136
*painless purple lesion associated with HHV-8
Kaposi’s sarcome
137
Management of scabies
2 treatments of Permethrin
All close contacts will require treatment
138
Management of impetigo
Topical fusidic acid + flucloxacillin
Patients are no longer contagious: after lesions have crusted over OR have been on 48 hours of treatment
139
First line for hyperhidrosis
Topical aluminium chloride
140
What is an associated complication of acne rosea
Blepharitis
141
Management of rosacea
Simple = concealer and high factor sunscreen
With flushing but limited telangiectasia = topical brimonidine gel
With mild - moderate papules = topical ivermectin is first line
With moderate - severe = dual therapy of ivermectin and oral doxycycline
(Prominent telangiectasia = laser therapy)
142
Management of vitiligo
Sunblock
Camouflage make up
Topical corticosteroids
(Topical tacrolimus and phototherapy)
143
1st line for lichen planus
Topical betamethasone
144
*net like pattern of reddish blue skin discolouration that is non-blanching
Livedo reticularis
145
Should psoriasis patients take a break from their topical corticosteroids ?
Yes - aim for a 4 week break in between courses of topical corticosteroids
146
What are the hyperinsulinaemic states (Acanthosis nigricans)
T2DM
GI cancer
Obesity
PCOS
Acromegaly
Cushings disease
Prader willi
147
Acute rash on face and neck , multiple red monomorphic blisters and erosions
Systemic upset - lymphadenopathy and fever
Eczema herpeticum
A serious complication of eczema caused by Herpes simplex virus
148
Most common nail change in psoriasis
Nail pitting
149
= squamous cell carcinoma
