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MRCP 1 > Derm > Flashcards

Derm Flashcards

(103 cards)

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1
Q

Rosacea signs

A

typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms

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2
Q

Rosacea treatment

A

Sun cream
If erythema - topical brimonidine
Mild-mod pustules - topical ivermectin
Severe pustules - ivermectin and doxycycline
Laser therapy for prominent telangectiasia

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3
Q

Most common BCC description

A

sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’

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4
Q

BCC management

A

surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy

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5
Q

Pityriasis vesicolor organism

A

Malassezia furfur

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6
Q

Pityriasis versicolor features

A

patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

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7
Q

Pityriasis versicolol predisposing factors

A

occurs in healthy individuals
immunosuppression
malnutrition
Cushing’s

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8
Q

Pityriasis versicolor management

A

Ketoconazole shampoo

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9
Q

Stevens Johnson’s description

A

Stevens-Johnson syndrome is a severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction.

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10
Q

Stevens-Johnson’s causes

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

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11
Q

Stevens-Johnson’s features

A

the rash is typically maculopapular with target lesions being characteristic
may develop into vesicles or bullae
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
mucosal involvement
systemic symptoms: fever, arthralgia

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12
Q

What is Nikolsky sign

A

the top layers of the skin slip away from the lower layers when rubbed

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13
Q

Where do you get Nikolsky sign

A

Staph infection
Stevens-Johnson’s

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14
Q

What is systemic mastocytosis

A

Systemic mastocytosis results from a neoplastic proliferation of mast cells

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15
Q

Features of systemic mastocytosis

A

urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
flushing
abdominal pain
monocytosis on the blood film

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16
Q

Diagnostics for systemic mastocytosis

A

raised serum tryptase levels
urinary histamine

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17
Q

Risk factors for skin SCC

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

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18
Q

Features of skin scc

A

typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding

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19
Q

Good prognostic factors for skin scc

A

Well differentiated tumours
<20mm diameter
<2mm deep
No associated diseases

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20
Q

Which melanoma is most aggressive

A

Nodular

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21
Q

Which malignant melanoma is most common

A

Superficial spreading

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22
Q

Superficial spreading melanoma affects

A

Arms, legs, back and chest, young people

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23
Q

Nodular melanoma affects

A

Sun exposed skin, middle-aged people

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24
Q

Lentigo maligna malignant melanoma affects

A

Chronically sun-exposed skin, older people

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25
Appearance of Nodular malignant melanoma
Red or black lump or lump which bleeds or oozes
26
Flexural psoriasis signs
well defined, shiny, erythematous patches in the flexural areas
27
Flexural psoriasis treatment
Topical steroid
28
Face psoriasis management
Topical steroid - maximum 2 week
29
Features of scabies
widespread pruritus linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist in infants, the face and scalp may also be affected secondary features are seen due to scratching: excoriation, infection
30
Inheritance pattern of hereditary haemorrhagic telangiectasia
Autosomal dominant with age related entrance
31
Diagnostic criteria of hereditary haemorrhagic telangiectasia
Epistaxis Telangiectases Visceral lesions (AVM’s, GI telangiectasia) Family history
32
Lichen Planus features
Itchy, popular wash on palms, soles, arms & genitals Polygonal in shape with white lines over them Koebner phenomenon Oral involvement in 50% Thinning nails and longitudinal ridging
33
Lichen Planus management
Potent topical steroids Benzydamine mouthwash for oral
34
Causes of lichenoid drug eruptions
Gold Quinine Thiazides
35
5 P’s of lichen Planus
Planus, purple, pruritic, papular, polygonal
36
Venous ulcers investigation
ABPI in non-healing
37
Venous ulceration management
Compression bandage Oral pentoxifylline
38
Seborrhoeic dermatitis associated conditions
HIV Parkinson’s
39
Seborrhoeic dermatitis features
Eczematous lesions on - scalp, periorbit, auricular, nasolabial folds Otitis external and blepharitis
40
Seborrhoeic dermatitis scalp management
Ketoconazole shampoo H&S & T gel otc Selenium sulphide Topical corticosteroid
41
Seborrhoeic dermatitis face and body management
Topical Ketoconazole Topical steroids
42
Dermatitis herpetiformis association
Coeliac
43
Dermatitis herpetiformis causes
IgA deposition in the dermis
44
Dermatitis herpetiformis features
Itchy vesicular lesions on the extensors
45
Dermatitis herpetiformis diagnosis
Skin biopsy, direct immunofluorescence shows IgA in granular pattern in dermis
46
Management of dermatitis herpetiformis
Gluten free diet Dapsone
47
Pyoderma gangrenosum causes
Idiopathic IBD - crohns, UC Rheum - RA, SLE Haem - myeloproliferative, lymphoma, myeloid leukaemia Granulomatosis with polyangitis Primary biliary chirrosis
48
Features of pyoderma gangrenosum
Lower limb Sudden, small pustule or red bump Then skin breaks down to ulcer, edge is purple and undermined, deep and necrotic May have fever or myalgia
49
Management of pyoderma gangrenosum
Oral steroids Ciclosporin and infliximab
50
Causes of acanthosis Nigricans
T2DM, gastro cancer, obesity, PCOS, acromegaly, Cushings, hypothyroidism, familial, prader-willi, COCP, nicotinic acid
51
Features of a keratoacanthoma
Looks like a volcano or crater. Initially a smooth dome-shaped papule. Then rapidly grows to a crater filled with keratin
52
Drugs that exacerbate psoriasis
Trauma, alcohol, drugs Inc beta blockers, lithium, anti malarials, nsaids, ace inhibitors, infliximab, withdrawal of systemic steroids
53
Erythema multiforme features
Target lesions, hands and feet first then torso, upper limb more than lower, pruritus occasional but mild
54
Erythema multiforme causes
HSV. Idiopathic, bacteria (mycoplasma and streps) drugs, penicillin, sulphonamides, carbamazepine, allopurinol, nsaids, cocp, SLE, sarcoidosis, malignancy
55
Blisters/Bullae exam features
Mucosal involvement - pemphigus No mucosal involvement - bullous pemphigoid
56
Rosacea features
Nose,cheeks & forehead Flushing Telangiectasia Later persistent erythema with papules and pustules Rhinophyma Blepharitis
57
Features of acrodermatitis
Red crusted lesions Acral distribution Peri orifice Perianal
58
Cause of acrodermatitis
Zinc deficiency
59
Where are keloid scars most likely to form?
Sternum
60
Features of pompholyx
Small blisters on palms and soles Pruritus Dry and cracked skin when blisters burst
61
Management of pompholyx
Cool compress Emollient Topical steroids
62
3 D’s of Pellagra
Dermatitis, diarrhoea and dementia (and depression)
63
Describe livedo reticularis
Purplish, non-blanching reticulated rash
64
Causes of livedo reticularis
Idiopathic Polyarteritis nodosa SLE Cryoglobulinaemia Antiphospholipid syndrome Ehlers-Danlos Homocystinuria
65
What condition gives pretibial myxoedema
Graves
66
Features of pretibial myxoedema
Shiny orange peel skin Symmetrical
67
What is melasma?
Benign skin condition in pregnancy. Discolouration of skin. Large, flat, symmetrical.
68
Treatment for atopic eruption of pregnancy
Nil
69
Features of atopic eruption of pregnancy
Eczematous, itchy red rash
70
Features of polymorphic eruption of pregnancy
Last trimester Abdominal striae Pruritic
71
Treatment of polymorphic eruption of pregnancy
Emollient Mild potency topical steroid Oral steroid
72
Features of pemphigoid gestationis
Pruritic blistering lesions 2/3 trimesters Peri umbilical region to trunk and back and buttocks
73
Treatment of pemphigoid gestationis
Oral steroids
74
Causes of hypertrichosis
Minoxidil, ciclosporin & diazoxide Congenital Porphyria cutanea tarda Anorexia nervosa
75
Malignancy associated with acanthosis nigricans
Gastric
76
Malignancy associated with acquired ichthyosis
Lymphoma
77
Malignancy associated with acquired hypertrichosis lanuginosa
GI and Lung
78
Malignancy associated with dermatomyositis
Ovarian and lung
79
Malignancy associated with erythema gyratum repens
Lung
80
Malignancy associated with erythroderma
Lymphoma
81
Malignancy associated with migratory thrombophlebitis
Pancreatic
82
Malignancy associated with necrolytic migratory erythema
Glucagonoma
83
Malignancy associated with pyoderma gangrenosum
Myeloproliferative disorders
84
Malignancy associated with seeets syndrome
Haemotological
85
Malignancy associated with tylosis
Oesophageal
86
What is necrobiosis lipoidica
Shiny painless areas of yellow/red/brown skin. On shin. Telangiectasia. Associated with diabetes.
87
Conditions associated with diabetes
Necrobiosis lipoidica Candidasis & staphs Neuro ulcers Vitiligo Lipoatrophy Granuloma annulare
88
Adverse effects with isotretinoin
Teratogenicity Low mood Dry eyes and skin and lip Raised triglycerides Hair thinning Nose bleeds
89
What is yellow nail syndrome
Slowing of nail growth, leads to thick and discoloured nails
90
Yellow nail syndrome associations
Congenital lymphoedema Pleural effusions Bronchiectasis Chronic sinus infections
91
Fungal nail causative organisms
Dermatophytes - mainly trichophyton Yeasts - candida
92
Risk factors for fungal nail infections
Increasing age Diabetes Psoriasis Repeated nail trauma
93
Management of fungal nail
Nil if patient ok Limited involvement then amorolfine nail lacquer Oral terbinafine 6-12 weeks for dermatophyte Oral itraconazole if candida
94
What’s the Koebner phenomenon
Skin lesions that appear at the site of injury
95
Where do you see Koebners phenomenon
Psoriasis Vitiligo Warts Lichen planus Lichen sclerosus Molluscum
96
What is erythrasma
Superficial skin infection Groin Corynebacterium Well defined, pink or brown patches with fine scaling Woods lamp for porphyrins
97
What are the mild topical steroids
Hydrocortisone 0.5-2.5
98
What are the moderate topical steroids
Betamethasone valerate (betnovate) 0.025% Clobetasone butyrate 0.05% (eumovate)
99
What are the potent topical steroids
Fluticasone propionate 0.05% (cutivate) Betamethasone valerate (0.1%) (betnovate)
100
What is the very potent topical steroid
Dermovate Clobetasol propionate 0.05%
101
Psoriasis management
First line - topical steroid and topical vit D 2nd - vit D BD 3rd - steroid BD or coal tar
102
Psoriasis secondary care management
Phototherapy - UVB or PUVA (SCC side effect) Oral methotrexate Ciclosporin Systemic retinoids Infliximab, etanercept
103
Scalp psoriasis management
Potent topical steroid for four weeks

MRCP 1 (14 decks)

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