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Derm Flashcards

1
Q
  1. What are papules ?
A
  • Small, red, inflamed bumps
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2
Q
  1. What are pustules
A
  • Papules (small, red inflamed bumps) with pus in them
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3
Q
  1. How would you describe an acne rash ?
A
  • Papules and pustules
  • Comedones
  • Excessive inflammation may result in icepick and hypertrophic scars
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4
Q
  1. How is mild to moderate acne managed ?
A
  • Fixed combination of topical adapalene with topical benzoyl peroxide
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5
Q
  1. How is moderate to severe acne managed ?
A
  • Fixed combination of adapalene with benzoyl peroxide with oral lymecycline or doxycycline
  • COCP can be used instead of oral Abx in women
  • Oral isotretinoin can be used only under specialist supervision
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6
Q
  1. What is acne fulminans ?
A
  • Very severe acne associated with systemic upset
  • Hospital admission is required and condition usually responds to steroids
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7
Q
  1. How do arterial ulcers typically present ?
A
  • Occur on toe or heel
  • Typically ‘deep punched out’ appearance
  • Painful
  • Cold with no palpable pulse
  • Low ABPI measurement
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8
Q
  1. How are arterial ulcers managed ?
A
  • Urgent referral
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9
Q
  1. What differentiates arterial ulcers ?
A
  • Arterial = toe or foot
  • Smaller and deeper
  • Well defined borders
  • Punched out appearance
  • Pale and cold due to blood supply
  • Painful and less likely to bleed
  • Pain worse at night on elevation
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10
Q
  1. What differentiates venous ulcers ?
A
  • Gaiter area (top of foot and bottom of calf muscle)
  • Chronic venous changes such as hyperpigmentation and venous eczema
  • Larger, more superficial and irregular
  • More likely to bleed
  • Less painful
  • Relieved on elevation
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11
Q
  1. How are venous ulcers managed ?
A
  • Vascular surgery where mixed or arterial ulcers are suspected
  • Tissue viability / specialist leg ulcer clinics in complex or non-healing ulcers
  • Dermatology where an alternative diagnosis is suspected, such as skin cancer
  • Pain clinics if the pain is difficult to manage
  • Diabetic ulcer services (for patients with diabetic ulcers)
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12
Q
  1. What is involved in good wound care ?
A
  • Cleaning the wound
  • Debridement (removing dead tissue)
  • Dressing the wound
  • Compression therapy is used to treat venous ulcers (after arterial disease is excluded with an ABPI).
  • Pentoxifylline (taken orally) can improve healing in venous ulcers (but is not licensed).
  • Antibiotics are used to treat infection.
  • Analgesia is used to manage pain (avoid NSAIDs as they can worsen the condition).
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13
Q
  1. How would you describe eczema ?
A
  • Pruritus
  • Erythema
  • Skin lesions
  • Acute lesions: Characterised by erythematous papules or vesicles that may coalesce into larger plaques with serous exudate
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14
Q
  1. How are eczema flares managed ?
A
  • Thicker emollients
  • Topical steroids
  • Wet wraps
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15
Q
  1. How does eczema herpeticum present ?
A
  • Commonly seen in children with atopic eczema and often presenting as a rapidly progressing painful rash
  • Monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter are typically seen
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16
Q
  1. How is eczema herpeticum managed ?
A
  • This is a potentially life-threatening and children should be admitted for IV aciclovir
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17
Q
  1. Describe basal cell carcinomas
A
  • ‘rodent’ ulcers
  • Slow growth and local invasion
  • Many types – most common is nodular BCC
  • Sun-exposed sites – especially the head and neck account for the majority of lesions
  • Initially a pearly, flesh-colored papule with telangiectasia
  • May later ulcerate leaving a central ‘crater’
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18
Q
  1. Where do basal cell carcinomas typically develop ?
A
  • Sun exposed sights – especially the head and neck account for the majority of lesions
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19
Q
  1. How are basal cell carcinomas managed ?
A
  • Routine referral
  • Surgical removal
  • Curettage
  • Cryotherapy
  • Topical cream: imiquimod, fluorouracil
  • Radiotherapy
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20
Q
  1. How do superficial epidermal burns present ?
A
  • Red and painful
  • No blisters
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21
Q
  1. How do partial thickness (superficial dermal) burns present ?
A
  • Pale pink
  • Painful
  • Blisters
  • Slow cap refill
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22
Q

How do partial thickness (deep dermal) burns present ?

A
  • Typically white but may have patches of non-blanching erythema
  • Reduced sensation, painful to deep pressure
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23
Q
  1. How do full thickness burns present ?
A
  • White (waxy)/brown (leathery)/ black in colour
  • No blisters
  • No pain
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24
Q
  1. When to refer a burn to secondary care ?
A
  • All deep dermal and full-thickness burns.
  • Superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
  • Superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
  • Any inhalation injury
  • Any electrical or chemical burn injury
  • Suspicion of non-accidental injury
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25
25. What is the MCC of cellulitis ?
- Streptococcus pyogenes - Less common staph aureus
26
26. Cellulitis presentation
- Erythema  Well defined margins but some cases may present with diffuse erythema - Blisters and bullae may be seen with more severe disease - Swelling - Systemic upset – Fever, Malaise and Nausea
27
27. What are the 2 types of contact dermatitis ?
- Irritant contact dermatitis – due to weak acids or alkalis. Often seen on hands – erythema, crusting and vesicles are rare - Allergic contact dermatitis – type IV hypersensitivity reaction – hair dyes – acute weeping eczema which responds to topical potent steroid treatment
28
28. RFs for malignant melanoma
- History of skin cancer, melanoma, or atypical naevi - Family history of melanoma - Pale skin (Fitzpatrick skin type I and II) - Red or light-coloured hair - High freckle density - Light coloured eyes - History of sunburn - Sun exposure or tanning bed exposure - Large amounts of moles - Increasing age - Immunosuppression - Outdoor occupation - Genetic syndromes with skin cancer predisposition (for example, xeroderma pigmentosum)
29
29. Types of malignant melanoma
- Superficial spreading - Nodular - Lentigo Maligna - Acral lentiginous
30
How does Superficial spreading malignant melanoma present ?
- 70% of cases - Arms, legs, back and chest - Common in young - Appearance: a growing mole(s)
31
31. How does Nodular malignant melanoma present ?
- 2nd most common - Typically affects: sun exposed skin, middle-age people - Appearance: red or black lump which bleeds or oozes
32
32. How does Lentigo Maligna malignant melanoma present ?
- Less common - Typically affects: chronically sun-exposed skin and older people - Appearance: a growing mole
33
33. How does Acral lentiginous malignant melanoma present ?
- Rare - Nails, palms or soles - Common in people with darker skin pigmentation - Subungual pigmentation (Hutchinson’s sign or on palms or feet)
34
34. What is the ABCDE criteria of assessing skin lesions ?
- A – asymmetrical shape - B – border irregularity, including poorly defined margins - C – colour change and variation - D – diameter of the mole (most melanomas are >6mm) - E – evolving (such as changing in size, shape and colour)
35
35. Management of malignant melanoma ?
- Suspicious lesions should undergo excision biopsy - Once diagnosis is confirmed the pathology report should be reviewed to determine whether further re-excision of margins is required
36
36. Key DDs for malignant melanoma ?
- Benign naevus - Lentigines - Seborrhoeic keratoses - Dermatofibroma - Pigmented BCC
37
37. How do malignant melanoma typically present ?
- Asymmetrical - Irregular borders - 2 or more colors – pink/grey/white in a brown lesion increased chance of malignancy - Malignancy is more likely to be in lesions over 6mm in diameter - Evolution – quick growth and rapid appearance change are concerning
38
38. How does seborrheic keratoses present ?
- Benign epidermal skin lesions seen in older people - Large variation in colour from flesh to light-brown to black - Stuck on appearance - Keratotic plugs may be seen on the surface
39
39. Management of seborrheic keratoses ?
- Reassurance about benign nature of the lesion is an options
40
40. What are RFs for pressure ulcers ?
- Malnourishment - Incontinence: urinary and faecal - Lack of mobility - Pain
41
41. How are pressure ulcers classified ?
- Waterlow score
42
42. How does psoriasis present ?
- Raised red, scaly patches on the skin
43
43. What are subtypes of psoriasis ?
- Plaque psoriasis - Flexural psoriasis - Guttate psoriasis - Pustular psoriasis
44
44. How does plaque psoriasis present ?
- The most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
45
45. How does guttate psoriasis present ?
- Transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
46
46. How does pustular psoriasis present ?
- Commonly occurs on the palms and soles
47
47. How does flexural psoriasis present ?
- In contrast to plaque psoriasis the skin is smooth
48
48. What can exacerbate psoriasis ?
- Trauma - Alcohol - Drugs e.g. BB, lithium NSAIDs, ACE-I etc - Withdrawal of systemic steroids - Streptococcal infection may trigger guttate psoriasis.
49
49. GP management of plaque psoriasis
- Regular emollients may help to reduce scale loss and reduce pruritus - 1st line: NICE recommend: a potent corticosteroid applied once daily plus vitamin D analogue applied once daily for up to 4 weeks - 2nd line: if no improvement after 8 weeks then offer: a vitamin D analogue twice daily - 3rd-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily - Short-acting dithranol can also be used - Secondary care
50
50. Secondary care management of plaque psoriasis
- Phototherapy - Adverse effects: skin ageing, squamous cell cancer (not melanoma) - Systemic therapy: - Oral methotrexate is used first-line. It is particularly useful if there is associated joint disease - Ciclosporin - Systemic retinoids - Biological agents: infliximab
51
51. What are features of Squamous cell carcinoma ?
- The most common variant of skin cancer - Typically on sun-exposed sites such as the head, neck or dorsum of the hands and arms - Rapidly expanding, painless ulcerate nodules - May have a cauliflower-like appearance - May be areas of bleeding
52
52. Risk factors for squamous cell carcinoma ?
- 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. xerpderma pigmentosum
53
53. Management of squamous cell carcinoma
- Surgical excision within 4mm margins if lesion < 20 mm in diameter - If tumour > 20mm then margins should be 6 mm
54
54. Good prognosis for a squamous cell carcinoma ?
- Well differentiated tumours - < 20mm in diameter - < 2mm deep - No associated disease
55
55. Poor prognostic indicators for a squamous cell carcinoma ?
- Poorly differentiated tumour - >20 mm in diameter - >4mm deep - Immunosuppression for whatever reason
56
56. What is urticaria ?
- Local or generalised superficial swelling of the skin - The MCC is allergy although non-allergic causes are seen
57
57. How does urticaria present ?
- Pale, pink raised skin - Described as ‘hives’ ‘wheals’ ‘nettle rash’ - Pruritic
58
58. How is urticaria managed ?
- Non-sedating antihistamines e.g. loratadine or cetirizine 1st line - These should be continued for up to 6 weeks - Sedating anti-histamine e.g. chlorphenamine may be used in addition and for troublesome sleep symptoms - Prednisolone is used for severe or resistant episodes
59
59. What is a dermatofibroma ?
- DD of malignant myeloma - Common benign fibrous skin lesions - Caused by abnormal growth of dermal dendritic histocyte cells, often following a precipitating injury
60
60. What are common features of a dermatofibroma ?
- Solitary firm papule or nodule, typically on a limb - Typically around 5-10mm in size - Overlying skin dimples on pinching the lesion
61
61. What is Erythema Nodsoum ?
- Inflammation of the subcutaneous fat - Typically causing tender, erythematous, nodular lesions - Usually occurs over shins but may occur elsewhere e.g. forearms or thighs - Usually resolves within 6 weeks lesions healing without scarring
62
62. What can cause erythema Nodsoum ?
- Infection - Streptococci - Tuberculosis - Brucellosis - Systemic disease - Sarcoidosis - Inflammatory bowel disease - Behcet's - Malignancy/lymphoma - Drugs - Penicillins - Sulphonamides - combined oral contraceptive pill - Pregnancy

Phase 4 (17 decks)

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