Derm Flashcards
(167 cards)
1
Q
Mx of rosacea if mild/mod
A
1) topical ivermectin
alternative = topical metronidazole
+ brimonidine (alpha agonist) for symptomatic relief
NOTE –> if telangectasia is the primary symptom -> brimonidine alone may be sufficient
2
Q
Mx of rosacea if extensive
A
topical ivermectin and oral doxy
3
Q
what can be used for rosacea if telangiectasia is prominent
A
laser (need secondary care referral for this)
4
Q
what causes rhinophyma
A
enlargement of the sebaceous glands
5
Q
what is a dermatofibroma
A
solitary lesion that normally occurs at the site of previous injury
6
Q
cause of acne
A
blockage and inflammation of pilosebaceous unit, propionibacterium acnes involvement
7
Q
stages of acne
A
mild - open and closed comedones, sparse inflam lesions
moderate - widespread non inflam lesions with numerous inflam
severe - extensive inflam, scarring, pitting
8
Q
why can oral abx for acne not be used with topical abx
A
risk of antibiotic resistance
9
Q
when should someone with acne be referred to secondary care
A
1) mild/mod that have completed 2 courses of 12 week tx and no improvement
2) mod that have completed 12 week course of topical and oral abx with no improvement
3) psychological distres
4) acne conglobata (where there are sinus tracts between cysts vvv bad) –> ALWAYS REFER OR acne fulminans which is a rare type of conglobata where there are systemic symptoms 0pop-[
10
Q
precipitating factors of psoriasis
A
infection (strep), stress, alcohol, koebner phenomenon, lithium, beta blockers
11
Q
when does guttate psoriasis normally appear
A
2/4 weeks after a strep infection
12
Q
O/E of psoriasis
A
nail changes, auspitz sign (gentle scraping causes pinpoint capillary bleeding)
13
Q
firstline tx for psoriasis
A
potent steroid + vit D analogue (calcipotriol) applied at diff times of day
-if this doesn’t work after 8 weeks add vit D analogue to twice daily
-if this doesn’t work after 8 weeks, steroid twice a day OR coal tar preparation once or twice daily
14
Q
phototherapy of choice for psoriasis
A
narrowband UVB
15
Q
complications of psoriasis
A
resistance to Tx, psychological burden, erythrodermic psoriasis, arthritis
16
Q
what immunosuppressants can be used for psoriasis
A
methotrexate and ciclosporin
17
Q
how long should non sedating antihistamines be continued for after an episode of acute urticaria
A
6 weeks
18
Q
what is the pattern of growth in a lentigo maligna melanoma
A
they grow slowly, start off has hutchinson freckle where the cancer cells are in situ
18
Q
what is acral lentiginous melanoma
A
on palms and soles
19
Q
what is an amelanocytic melanoma
A
no pigment, may be pink of skin coloured (note - any type of melanoma can be amelanocytic)
20
Q
2WW for melanoma (or any high clinical suspicion)
A
3 points in total
Each major feature scores 2 points:
1) change in size
2) irregular shape
3) irregular colour
Each minor feature scores 1:
1) largest diameter 7mm or more
2) inflammation
3) oozing
4) change in sensation
21
Q
what features on a dermatoscopy suggest melanoma
A
atypical network, aggregated black/brown dots and globules
22
Q
if suspecting a melanoma on clinical examination, what else should be done
A
lymph node exam and check the rest of the body
23
Q
what margin is given for an excisional biopsy of melanoma
A
2mm (then breslow thickness is assessed and may need to re-excise further
-also test sentinel lymph node, if this is positive need to do a lymph node dissection
24
staging of melanoma
1 = <2mm thickness
2 = >2mm thickness or >1mm thickness and ulceration
3 = melanoma spread to involve local lymphnodes
4 = distant metastases
25
advice on how to apply sunscreen
apply 15-30 minutes before sun exposure and then reapply every 2 hours. Apply in large amounts and 30 ml is the amount required to cover the whole body.
26
what is the most common Tx of melanoma
wide local excision
27
how does a BCC present
initially a pearly, flesh coloured papule with telangiectasia and a rolled edge
-can also be nodular where it is raised over 1cm
28
what does dermatoscope show of a BCC
telangiectasia and microulcerations
29
Mx of BCC
1) surgical removal --> need a 3-5mm margin
2) radiotherapy
3) cryotherapy --> this is only effective for smaller, low risk of superficial BCC
4) 5-FU
5) MOHs
30
what is gold standard for Tx of BCC
MOHS!
31
what counts as a high risk BCC
location of face, hands, feet, immunosuppressed
32
what margin is needed for excision of a BCC
4mm
33
where do the mutations occur the cause squamous cell carcinoma
they occur in the squamous keratinocytes which are in the stratum spinous
34
what are the layers of the epidermis
stratum corneum (cells die and lose their cellular components but continue to produce keratin)
(stratum lucidum)
stratum granulosum (cells secrete lipids)
stratum spinosum (keratinocytes become joined by desmosomes)
stratum basale (mitosis of keratinocytes)
35
what layer of the skin are appendages in like hair follicles
dermis
36
what are the two types of sweat glands
1) apocrine - in the axillary and genital regions
2) eccrine - the major sweat gland, involved in thermoregulation, produce most sweat (odourless)
37
what is the pathophysiology of psoriasis
mitosis of keratinocytes in stratum basale is increased
38
when is a skin biopsy necessary
clinical suspicion of VIN or not responding to treatment
39
how is pyoderma gangrenosum described
full thickness ulcer with violaceous border
40
how does pyoderma gangrenosum present and progress
small pustule, red bump which then rapidly turns into an ulcer
41
Dx of pyoderma gangrenosum
-can do wound swabs but these should be negative
-biopsy (show neutrophilS)
42
MX of pyoderma gangrenosum
remove necrotic tissue, oral pred, ciclosporin
43
associations with pyoderma gangrenosum
IBD, idiopathic, RA, SLE, lymphoma
44
Mx of pityriasis versicolor (malassezia furfur)
ketoconazole shampoo and cream --> should start to improve in 2/3 months
45
is there normally a prodrome for pityriasis rosea
no
46
any associated symptoms of pityriasis rosea
may itch (can tx with emollient and antihistamine for the itch)
47
how long does pityriasis rosea normally go in
6-12 weeks
48
what virus causes molluscum contagious
pox virus
49
advice for molluscum contagiousum
good hygiene, don't scratch, wash hands
50
how may HSV1 present in children
gingivostomatitis (fever, excessive dribbling, bad breath, sore gums)
51
what can recurrence of hsv be causes by
stress, minor trauma and hormonal factors
52
complications of herpes infection
keratitis, eczema herpeticum, erythema multiform
53
incubation period for chicken pox
10-21 days
54
what groups of people do you give aciclovir to tx chicken pox
neonate, immunocomp, adolescents presenting in first 24 hours and pregnant
55
what's the only way you can confirm chicken pox
having more than one lesion at any point in time
56
complications of chicken pox
pneumonia, encephalitis, disseminated infection, nec fas
57
complications of shingles
herpes zoster ophthalmic (Va affected), Ramsay hunt syndrome, encephalitis
58
MX of a viral wart (HPV)
soften wart by soaking in warm water, debride the wart, topical salicylic acid (this can take 12 weeks)
59
how to distinguish between a plantar wart and a callus
plantar wart - lateral pressure, callus - direct pressure
60
how does erythema nodosum present
tender, erythematous nodules
61
causes of erythema nodosum
infection --> strep and Tb
sarcoidosis and IBD
malignancies
some drugs like COCP
pregnancy
62
progression of erythema nodosum
normally resolve in 6 weeks and lesions heal without scarring
63
Mx of eczema herpeticum
admission to hospital and IV aciclovir
64
what causes SJS (and TEN >10% of boys surface)
medicines --> anti epileptics, antibiotics, allopurinol and penicillins
Infections --> like herpes
65
presentation of SJS
fever, cough --> purple/red maculopapular rash which starts to blister.
-nikolsky +
-mucosal involvement!!
66
Mx of SJS
hospital admission, analgesia and ophthalmologist input, fluid replacement, stop precipitating factors, IVIG
67
pathophysiology of SJS
disproportionate immune response
68
complications of SJS
secondary infection, permanent skin damage and visual complications, kidney failure
69
what is necrotising fasciitis
life threatening infection involving any layer of the deep soft tissue compartments
70
clinical findings of necrotising fasciitis
bad pain!!!, poorly defined margins with pain extending beyond the margins of erythema, offensive discharge, bullae, haemodynamic instability
71
who does SSSS (staphylococcal scalded skin syndrome) affect and why
young children due to immature immune system, reduced toxin clearance in renal system
72
Mx of SSSS (caused by exotoxin released from staph aureus)
IV flucloxacillin
73
what does erythroderma normally occur secondary to
a pre-existing inflammatory skin disease
74
Mx of erythroderma
-emollient, stop any offending mets, keep hydrating, nurse in a warm room to protect skin function
75
general complications of systemic skin disorders
dehydration, electrolyte imbalance, secondary bacterial infection, hypothermia and high output heart failure
76
% change that actinic keratosis progress into squamous cell carcinoma
10% (suspect this if it becomes hyperkeratotic or nodular)
77
RF of squamous cell carcinoma (apart from sun exposure)
Bowens disease, actinic keratoses, immunosuppression, smoking, xeroderma pigmentosum
78
lesions for excision of a squamous cell carcinoma
4mm!! (but If lesion if > 2mm then need a 6mm margin)
79
what's the best excision to do for a skin cancer
elliptical excision
80
high risk features of seaumous cell carcinoma
size >2mm deep, site (face, ear, genitals), recurrence
81
poor prognostic features of a squamous cell carcinoma
poorly differentiated, >20mm in diameter, >4mm deep and immunosuppressed
82
83
how to distinguish keratoacanthoma from SCC
keratin core in keratoacanthoma (they also can progress very rapidly)
84
how does Bowens disease present
it is SCC in situ, presents with an erythematous scaling patch / elevated plaque arising on sun-exposed skin in an elderly patient
85
what is a pyogenic granuloma
site of minor trauma, bleeding on contact is common
86
apart from penicillins and COCP, what other drugs can cause erythema nodosum
sulfasalazine
87
features of hidradenitis suppurativa
RF - family history, smoking, obesity, PCOS
Features --> painful, inflamed, nodules which may have an odourous discharge
88
Dx of hidradenitits suppurativa
clinical
89
Mx of hidradenitis suppurativa
weight loss, stop smoking, steroids for acute flares, abx (lymecycline), some lumps may need surgery
90
what is a non healing lesion likely to be
SCC
91
apart from sunburn, what else can cause SCC
renal transplant and thermal injury!
92
what causes seborrhoea dermatitis
inflam skin condition of the sebaceous gland - malassezi furfur
93
where does seborrhoea dermatitis commonly affect
eyelids, nasolabial folds, upper chest, scalp
94
what's the difference between the terms hirsutism and hypertrichosis
hirsutism = androgen dependent hair growth
hypertrichosis = androgen independent hair growth
95
what are the 4 Ds of pellagra (vit B3 (AKA niacin) deficiency)
diarrhoea, dermatitis, dementia, death
96
what is hereditary haemorrhagic telangiectasia
epistaxis, telangectasisa, visceral vascular lesions --> +++ family history
97
how does polymorphic eruption of pregnancy present
pruritic condition which presents in the last trimester, spares the periumbilical area and normally starts in the striae.
-tx with emollient and steroid
98
what type of hypersensitivity R if erythema multiforme
type IV
99
RF for erythema multiform
HSV1/2, mycoplasma infection
100
if needing to confirm Dx of erythema multiforme, what can be done?
skinn biopsy
101
Mx of erythema multiform
tx the active infection, antihistamines for itch
102
what is erythema multiforme major
more severe form with mucosal involvement
103
how can keloid scars be treated
intralesional steroids
104
what kind of drug is adapalene
topical retinoid and hence is contraindicated in pregnancy
105
what is erythema ab igne
mottled rash you get when hot/cold --> caused by chronic exposure to infrared radiation
106
what is pemphigoid gestationis
blistering lesions, develop in periumbilical region, usually in 2nd or third trimester
-tx with ORAL steroids
107
50% of people will regrow hair with alopecia areata in one year, what are other TX options
topical or intralesional corticosteroids
108
what is bullous pemphigoid
autoimmune condition which affects older population, large tense blisters NO MUCOSAL INVOLVEMENT
antibodies against the basement membrane (hemidesmosomes)
109
Dx of bullous pemphigoid
skin biopsy (immunofluroscence shows IgG)
110
Mx or bullous pemphigoid
oral steroids for two years
111
firstline tx for impetigo
1%hydrogen peroxide
112
when does someone with impetigo need to stay off school until
48 hours after abx or until healed
113
how is diagnosis of bullous impetigo confirmed
take swabs of vesicles to confirm
114
what is ecthyma
where ulcers form under the sores (impetigo)
115
most common bacteria causing impetigo
staph aureus (strep pyogenes does too but to a lesser extent)
116
what bacteria can cause folliculitis (inflamed hair follicle)
staph aureus
117
what viral can cause folliculitis
HSV
118
Rf for bacterial folliculitis
frequent shaving or waxing, use of topical steroids, obesity, friction from tight clothing
119
what is a carbuncle
when the focus of skin infection involves several hair follicles and has multiple draining sinus
120
Mx of carbuncle / folliculitis
warm compress, antiseptic cleanser like hydrogen peroxide, topical ABx
121
when is prophylaxis for cellulitis considered
when there are 2+ episodes in 12 months
122
how long do you need to spend off school/work with scabies
24 hours after Tx
123
when would ivermectin be used instead of permethrin 5%
when oral compliance is an issue
124
how long can the itch, due to a delayed type IV hypersensitivity reaction last in scabies
4-6 weeks
125
signs of photoaging (Caused by UVA)
wrinkling, pigmentation, loss of elasticity, telangiectasia
126
although diagnosis of actinic keratosis is clinical, what would a biopsy show
atypical keratinocytes confined to the lower 1/3 of the epidermis
127
if a patient is very young and has actinic keratosis, what should you suspect?
xeroderma pigmentosa
128
if actinic keratosis is very mild, what can be used to treat it
diclofenac
129
tx for AK
1) 5-fu --> apply every night for 4 weeks +/- hydrocortisone
2) imiquimoid
3) cryotherapy if they are thicker
4) sun protection
130
what the chance Bowens disease will transform into an invasive SCC
3%
131
what does a biopsy show for Bowens disease
full thickness epidermal dysplasia
132
MX of bowens
same as for AK 1) 5-fu 2) imiquimod
133
complications of eczema
staph aureus infection, psychosocial issues and higher cardiovascular events
134
what is daktocort
mild steroid and mild antibiotic cream
135
what can be used as an alternative to steroids for eczema tx
topical calcineurin inhibitors (tacrolimus)
136
what questionnaire can be used for eczema
EASI - eczema assessment severity index
137
Dx of eczema
diagnosis is clinical but high IgE or eosinophils would support diagnosis
138
advise for someone with venous eczema
walk, don't stand for long periods of time, elevate feet when sitting, compression stocking
1) emollient 2) topical steroid
139
description of a ringworm rash
solitary annular plaque with a raised scaly edge and a central clearing
140
Dx of ringworm
clinical diagnosis but can do skin scrapings
141
Mx of ringworm
1) topical terbinafine 1% 2) oral terbinafine or oral itraconazole
142
does someone with ringworm need to stay off school or work
no
143
what is tinea incognito
tinea infection which is worsened by inappropriate tx like steroids
144
good Dx for tinea
discoid eczema (very itchy patches, normally multiple patches around the body)
145
description of a sebaceous cyst
fluctuant, smooth lump with central epithelial defect
146
give important considerations of pruritus
-liver disease
-CKD
-polycythaemia
-lymphoma
-IDA
147
What do you see in the mouth of lichen planus
wickhams striae
148
features of lichen planus
very itchy, polygonal rash, koebner phenomenon
149
how do you treat oral lichen planus (wickhams striae)
benzydamine mouthwash
150
what is the Mx of a dermoid cyst
complete excision as they can reoccur
151
where can dermoid cysts occur
in the midline / mouth / supraorbital (contain teeth/ hair follicles)
152
tinea capitis vs seborrhoeic dermatitis
tinea = hair loss
153
firstline for hyperhidrosis
aluminum chloride
154
what is pemphigus vulgaris
flaccid blisters, mucosal involvement, autoimmune condition in Jewish population
antibodies against desmosomes
155
when do you US a lipoma
when it is >5cm
156
what can be prescribed to stop hair growth in hirsutism
eflornithine
157
what is marjolin ulcer
rare SCC that occurs in a thermal lesion/scar/ulcer - rapidly progressing
158
Lamotrigine is firstline for all seizures in females apart from what
myoclonic which levetiracetam is firstline for
159
where is the CTZ (vomit centre)
medullar
160
definition of urticaria
itchy, raised qheels
-becomes chronic if > 6 weeks
161
what can trigger urticaria
idiopathic or inducible (water, cold, dermatographism)
162
RF of urticaria
female, age 20-40, atopy, chronic stress
163
what Ix can be done for chronic INDUCIBLE urticaria
provocation testing
164
Mx of urticaria
1) avoid triggers
2) non sedating antihistamine
3) oral pred
4) refer to specialist --> biologics
165
how do we test for contact dermatitis
skin PATCH test (T cell mediated T4)
166
how do we test for hypersensitivity R (IgE)
skin prick test
