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Year 6 > Derm > Flashcards

Derm Flashcards

1
Q

treatment for mild acne

A

1st line: topical retinoid and/or benzyol peroxide +/- topical Abx (never prescribed alone)

2nd: azelaic acid 20%

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2
Q

treatment for moderate acne

A

oral abx + benzoyl peroxide/retinoid

abx: 1st line- tetra cycles; 2nd line- macrolides
abx alternative: COCP

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3
Q

treatment for chronic plaque psoriasis

A

topical potent steroid + vitamin D analogue e.g. calcipotriol

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4
Q

example of potent corticosteroid

A

betamethasone

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5
Q

what is the most common site for hidradenitis supparativa [2]

A

armpit

also groin

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6
Q

risk factors for hidradenitis suppurativa [5]

A

obesity
DM
PCOS
smoking
female

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7
Q

conservative mx of hidradenitis suppurativa [3]

A

Encourage good hygiene and loose-fitting clothing
Smoking cessation
Weight loss in obese

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8
Q

mx of acute flares of hidradenitis suppurativa

A

steroids
flucloxacillin
incision and drainage of boils

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9
Q

mx of rosacea with just erythema/flushing and limited telangiectasia

A

topical brimonidine gel

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10
Q

mx of mild to mod rosacea

A

topical ivermectin

alternative: topical metronidazole if ivermectin is inappropriate

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11
Q

mx of moderate to severe rosacea

A

topical ivermectin + oral doxycycline

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12
Q

common presentation in rosacea [4]

what are symptoms worsened by? [4]

A

telangiectasia
flushing
face affected
rhinophyma

worsened by sun exposure, spicy food, stress, alcohol

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13
Q

what can untreated erythema ab igne possibly lead to?

A

squamous cell carcinoma

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14
Q

what is suggestive of severe rosacea [2]

A

pustules that have scarred
rhinophyma

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15
Q

how do you distinguish the malar rash seen in SLE with rosacea

A

malar rash in SLE does not involve the nasolabial fold and never involves the chin

rosacea often involves the nasolabial folds and can involve the chin

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16
Q

skin features of hidradenitis suppurativa [4]

A

pustules
nodules
sinus tracts
scars (rope like scarring)

these are painful

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17
Q

simple measures/adjuncts of rosacea [2]

A

sun screen
camouflague cream

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18
Q

how is rosacea treated in pregnant or breastfeeding women

A

metronidazole instead of ivermectin

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19
Q

how are prominent telangiectasia in rosacea treated

A

laser therapy

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20
Q

what ocular manifestation is seen in rosacea [3]

A

blepharitis (sticky, inflamed eye lids)
keratitis
conjunctivitis

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21
Q

describe the lesions in tinea corporis

A

well-circumscribed annular erythematous plaques with an advancing scaly border and central clearing

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22
Q

treatment for tinea corporis, faciei, crursi or pedis

for mild, moderate and severe

A

mild: topical terbinafine, clotrimazole, miconazole
moderate: hydrocortisone cream
severe: oral

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23
Q

long term treatment for psoriasis

A

vitamin D analogue e.g. calcipotriol

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24
Q

what is Koebners phenomenon and which condition is it seen in?

A

Formation of new skin lesions at sites of injury

seen in psoriasis

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25
Q

how does shingles present?

A

A prodromal period of burning pain for 2-3 days which may interfere with sleep
followed by the development of a blistering (or vesicular) rash confined to a specific dermatome
in someone over 50

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26
Q

what is a strong infective risk factor for shingles

A

HIV

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27
Q

Shingles management [3]

A

avoid the pregnant and immunosuppressed

analgesia (paracetamol, NSAID, amitriptyline)

antivirals e.g. ORAL aciclovir, famciclovir or valacyclovir within 72 hours

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28
Q

how long are shingles patients infections

A

until lesions crust over which is around 5-7 days from onset of rash

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29
Q

what analgesia are used in shingles (3 lines)

A

first: paracetamol and NSAIDs
second: amitriptyline
third: corticosteroids in immuncompotent people

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30
Q

which melanoma is the most aggressive

A

nodular

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31
Q

which melanoma is most common and 2nd most common

A

most common: superficial spreading

second: nodular

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32
Q

treatment of suspected melanoma

A

excisional biopsy with margins

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33
Q

3 complications of shingles

A

post-herpetic neuralgia
herpes zoster opthalmicus
herpes zoster oticus (Ramsay Hunt syndrome)

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34
Q

most important prognostic factor of melanoma

A

depth (Breslows thickness)

> 4mm has 50% 5 year survival

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35
Q

which mutation is seen in 50% of malignant melanomas

how can they be potentially treated

A

BRAF

BRAF inhibitors e.g. vemurafenib

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36
Q

which antivirals are preferred in the treatment of shingles?

why are they preferred and therefore first line?

A

famciclovir or valacyclovir

studies have shown that treatment with famciclovir and valacyclovir reduced the likelihood of postherpetic pain when compared to treatment with aciclovir.

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37
Q

which drugs can precipitate psoriasis [6]

A

beta blockers
lithium
antimalarials (chloroquine and hydroxychloroquine)
NSAIDs like aspirin
ACE inhibitors
infliximab

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38
Q

what infective organisms precipitates guttate psoriasis

A

streptococcal infection

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39
Q

features of moderate acne

A

widespread non-inflammatory lesions and numerous papules and pustules

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40
Q

features of severe acne

A

extensive inflammatory lesions, which may include nodules, pitting, and scarring

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41
Q

treatment of eczema herpeticum

A

admit for IV aciclovir

refer to opthalmologist if around the eye

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42
Q

how can transmission of tinea capitis be reduced

A

Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission

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43
Q

how is Microsporum canis causing tinea capitis diagnosed

A

green fluorescence under Wood’s lamp

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44
Q

most common cause of tinea capitis

A

Trichophyton tonsurans

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45
Q

treatment of tinea capitis [2]

A

terbinafine for Trichophyton tonsurans infections
griseofulvin for Microsporum infections.

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46
Q

a physiological cause of erythema nodosum

A

pregnancy

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47
Q

when should the next course of steroid treatment for psoriasis start

A

after a 4 week gap from the previous course to prevent skin atrophy

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48
Q

describe a lentigo maligna melanoma

who does it affect most

A

slow growing melanoma in chronically sun exposed areas typically in older peope

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49
Q

which melanoma is a red or black lump or lump which bleeds or oozes

A

nodular melanoma

rapidly growing

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50
Q

what may help with refractory pain in shingles if simple analgesia and neuropathic analgesia do not help,

A

oral prednisolone

only for acute shingles, has to be alongside antiviral treatment

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51
Q

which fungus causes seborrhoeic dermatitis

A

Malassezia furfur

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52
Q

where are the lesions in seborrhoeic dermatitis often found [4]

A

scalp, periorbital, auricular and nasolabial folds,

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53
Q

two complications of seborrhoeic dermatitis

A

blepharitis
otitis externa

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54
Q

two associated conditions with seborrhoeic dermatitis

A

HIV
Parkinson’s disease

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55
Q

first line treatment of scalp seborrhoeic dermatitis

A

1st line : 2% ketoconazole shampoo

2nd line: zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’)
- may be used if ketoconazole is not appropriate or acceptable to the person

alternative: selenium sulphide and topical corticosteroid may also be useful

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56
Q

first line treatment of face and body seborrhoeic dermatitis

A

topical antifungals: e.g. ketoconazole

topic steroid for short periods may also be used

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57
Q

infective causes of erythema nodosum [3]

A

streptococci
tuberculosis
brucellosis

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58
Q

systemic diseases that cause erythema nodosum [3]

A

sarcoidosis
inflammatory bowel disease
Behcet’s

59
Q

drugs that cause erythema nodosum [3]

A

penicillins
sulphonamides
combined oral contraceptive pill

60
Q

which condition increases the risk of Cardiovascular disease

A

psoriasis

61
Q

which cancer are renal transplant patients at risk of?

A

squamous cell carcinoma due to T-cell ablating immunosuppression

62
Q

risk factors for SCC [6]

A
  • excessive exposure to sunlight / psoralen UVA therapy
  • actinic keratoses and Bowen’s disease
  • immunosuppression e.g. following renal transplant, HIV
  • smoking
  • long-standing leg ulcers (Marjolin’s ulcer)
  • genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
63
Q

4 good prognostic factors of SCC

A

well differentiated
<20 mm diamter
< 2mm depth
no associated disease

64
Q

4 bad prognostic factors of SCC

A

poorly differentiated
>20mm diameter
>4mm depth
associated disease

65
Q

4 features of SCC

A
  • sun-exposed sites such as the head and neck or dorsum of the hands and arms
  • rapidly expanding painless, ulcerate nodules
  • cauliflower-like appearance
  • areas of bleeding
66
Q

4 causes of acanthosis nigracans

A

type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome

67
Q

where are actinic keratoses usually found

A

typically on sun-exposed areas e.g. temples of head

as multiple lesions

68
Q

first line management of actinic keratoses [2]

A

sun protection and topic fluorouracil cream for 2-3 weeks

other: topical diclofenac, topical imiquimod, cryotherapy, curettage and cautery

69
Q

which premalignant lesion is a result of chronic sun exposure [2]

A

actinic keratoses and keratoacanthoma

70
Q

difference between SJS and TEN

A

SJS : <10% skin involvement
TEN: >30% skin involvement

71
Q

what is Nikolsky’s sign?

A

epidermis separates with mild lateral pressure

72
Q

management of TENS, SJS [4]

A
  • stop precipitant
  • admit to ITU
  • IVIG, plasmapharesis
  • immunosuppression
73
Q

what is the definition of erythroderma

name some causes and complications

A

any rash involving >95% of the body

eczema, psoriasis, drugs, lymphoma
complications like dehydration, infection and high-output heart failure

74
Q

causative agent of impetigo

A

staph aureus

other: strep pyogenes

75
Q

treatment of localised non bullous impetigo [1st and 2nd line]

A

hydrogen peroxide 1% cream

2nd: topical fusidic acid 2%

76
Q

treatment of widespread, non-bulbous impetigo [2]

A

oral flucloxacillin or topical fusidic acid

77
Q

treatment of bullous impetigo and systemically unwell

A

oral flucloxacillin

78
Q

what is the school exclusion criteria for impetigo

A

until lesions have crusted over or 48 hours after abx have been started

79
Q

what must be given to women on roaccutane

A

2 forms of contraception as it is very teratogenic

80
Q

causative agent of pityriasis versicolor

A

malassezia furfur

81
Q

treatment of pityriasis versicolor

A

topical metronidazole

82
Q

vitiligo vs pityriasis versicolor

A

p.v- affects the trunk and more discrete patches

vitiligo- affects the peripheries and more confluent

83
Q

which diseases are associated with vitiligo [3]

A

T1DM, Addisons, alopecia

84
Q

treatment of vitilgo[4]

A
  • sunblock
  • camouflage make up
  • topical corticosteroids
  • phototherapy
85
Q

causative agent of pityriasis rosea

A

HHV-7

hx: recent viral infection, herald patch present
mx: self limiting

86
Q

most common type of psoriasis

A

plaque

87
Q

what part of the body does pustular psoriasis affect mainly

A

palms and soles of feet

88
Q

flexural vs plaque psoriasis

A

flexural psoriasis has smooth skin

89
Q

treatment options in secondary care for psoriasis [2]

A

phototherapy or photo chemotherapy
systemic medication e.g. MTX

90
Q

examples of emollient used in eczema

A

Dermol, e45

91
Q

what is mild eczema and how is it treated

A

infrequent itching

mx: emollients and mild topical steroids

92
Q

what is moderate eczema and how is it treated

A

frequent itching and redness

mx: emollients and moderate topical steroid

93
Q

what is severe eczema and how is it treated

A

incessant itching, widespread rash, redness

mx: emollients, potent topical steroid, consider phototherapy, systemic therapy

94
Q

how is infected eczema treated

A

first take skin swab and culture

oral flucloxacillin (allergy–>erythromycin)

95
Q

steroid ladder: Help Every Busy Dermatologist

A

Hydrocortisone
Eumovate (clobetasone butyrate)
Betnovate (betamethasone)
[Elocon- mometasone furoate]
Dermovate (clobetasol propionate)

96
Q

For which severities of ezcema can topical calcineurin inhibitors be used?

name examples

A

for moderate to severe

pimecrolimus and tacrolimus respectively

97
Q

what are the reason for urgent referral for eczema (<2 weeks)

A

severe atopic eczema not responding to optimal treatment within 1 week.

treatment of bacterial eczema has failed

98
Q

what does eczema herpticum look similar to?

A

impetigo

therefore important to cover for both, give abx and aciclovir

99
Q

treatment of scabies

A

permethrin

treat all household contacts with two doses

100
Q

treatment of head lice

A

malathion

101
Q

causative agent of fungal nail infection

A

trichophytum rubrum

102
Q

investigation of fungal nail infection

A

nail clippings and MC&S

103
Q

treatment of dermatophyte nail infection [1st and 2nd line]

A

1st line: terbinafine
2nd line: itraconazole

need to check LFTs before starting

104
Q

treatment of candida nail infection [mild and severe]

A

mild –> topical antifungals e.g. amorolfine

severe –> oral itraconazole

105
Q

what are Wickham’s striae seen in lichen planus

A

white lines in the mouth

106
Q

describe lichen planus [4P]

A

purple, pruritic, papular, polygonal on flexor surfaces

107
Q

describe lichen sclerosis

A

itchy white spots usually on the vulva of elderly women

108
Q

treatment of lichen planus [body and oral]

A

Body–> topical clobetsone butyrate

Oral –> benzydamine mouthwash

109
Q

treatment of lichen sclerosus

A

1st line: clobetasol propionate (dermovate)

2nd: tacrolimus + biopsy

110
Q

treatment of severe cellulitis [4]

A

co-amoxiclav
cefurozime
clindamycin
ceftriaxone

111
Q

class IV Eron classification of cellulitis

A

sepsis, necrotising fasciitis

112
Q

causative agent of erysipelas

A

strep pyogenes

113
Q

erysipelas vs cellulitis

A

well-demarcated superficial skin infection

poorly demarcated deep skin infection

114
Q

causative agent of erythrasma

A

corynebacterium minutissimum

115
Q

investigation of erythrasma

A

wood’s slit lamp –> coral red fluorescence

116
Q

treatment of erythrasma

A

topical miconazole

117
Q

treatment of pyoderma gangrenosum

A

oral steroids

118
Q

AB in bullous pemiphigoid

A

against basement membrane (dermoepidermal junction)

119
Q

AB in pemphigus vulgaris

A

against desmosomes

120
Q

treatment of bullous pemphigoid

A

corticosteroids

121
Q

difference between bullous pemphigoid and pemphigus vulgaris

A

B.P: tense blisters, no oral involvement

P.V: flaccid blisteres, oral involvement

122
Q

two infective causes of erythema multiforme

A

HSV
mycoplasma

123
Q

rash causes by rheumatic fever

A

erythema marginatum

124
Q

rash caused by glucagonoma

A

migratory necrolytic erythema

125
Q

rash in Lyme disease

A

erythema chronicum migrans (bulls-eye)

126
Q

1st line treatment of urticaria

A

non-sedating antihistamines e.g. loratidine or cetirizine

127
Q

treatment of severe or resistant urticaria

A

short course of oral prednisolone

128
Q

what type of drug is adapalene

A

retinoid

129
Q

erythema marginatum vs erythema multiform

A

marginatum: annular lesions

multiforme: target lesion

130
Q

describe urticaria

A

pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
pruritic

131
Q

when should COCP be considered in the treatment of acne

A

in a woman with moderate to severe acne that had tried all other treatments particularly antibiotics

132
Q

what do Marjolin ulcers originate from

A

squamous cell carcinomas

133
Q

treatment of venous ulceration

what medication can improve healing rate

A

compression bandaging

oral pentoxifylline, a peripheral vasodilator, improves healing rate

134
Q

small, broken ‘exclamation mark’ hairs are seen in which condition

A

alopecia areata (autoimmune condition)

135
Q

ringworm is a parasite: true or false?

A

false

its a fungus

136
Q

first-line mx for hyperhidrosis

A

topical aluminium chloride preparations are first-line. Main side effect is skin irritation

iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
botulinum toxin: currently licensed for axillary symptoms
surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

137
Q

treatment of keloid scars

A

early keloids may be treated with intra-lesional steroids e.g. triamcinolone

138
Q

how is dermatitis herpetiformis diagnosed

A

skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis

139
Q

anti fungal that causes moobs

A

ketoconazole

140
Q

If initial topical treatment for athlete’s foot fails, oral _________ treatment is indicated

A

If initial topical treatment for athlete’s foot fails, oral antifungal treatment is indicated

e.g. terbinafine

141
Q

common sites for keloid scars

A

common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk

142
Q

actinic keratosis vs Chondrodermatitis nodularis helicis

A

painless vs painful

143
Q

which one grows faster: SCC or BCC

A

SCC

Year 6 (19 decks)

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