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Derm Flashcards

1
Q

is lichen planus more likely to present with pruritis or pain?

A

pain

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2
Q

causes of pruritis ani

A 
fissure
incont
poor hygiene
tight pants
threadworm
fistula
dermatoses
lichen sclerosis
anxiety
contact dermatitis
or unknown cause
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3
Q

Mx of pruritis ani

A 
hygiene
avoid scrating
avoid foods that loosen stool
soothing ointment
mild topical corticosteroids if inflamm
oral antihist for night
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4
Q

pre-malignant crumbly yellow-white scaly crusts on sun exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes. What is the diagnosis, and give 2 differentials

A

actinic [solar] keratoses

Bowen’s
psoriasis
BCC
serorrhoeic keratosis

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5
Q

Ix and Mx in actinic keratoses

A

biopsy if in doubt of diagnosis

none, emollient, diclofenac gel,
fluorouracil [inflamm rn>heal]
imiquimod [inflamm]
cryotherapy
photodynamic therapy
surg excision + curettage
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6
Q

a well defined slowly enlarging red scaly plaque with a flat edge [asymptomatic]. Histology shows full thickness dysplasia/carcinoma in situ. Diagnosis?

A

bowen’s disease

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7
Q

Mx of bowen’s disease

A 
fluorouracil [inflamm rn>heal]
imiquimod [inflamm]
cryo
photodynamic
curettage, excision
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8
Q

causes of bowens disease

A 
UV exposure
radiation
imm.supp.
arsenic
HPV [in genital area]
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9
Q

most common skin cancer

A

BCC

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10
Q

describe the 2 types of BCC

A

nodular: pearly nodule, rolled telangiectasia edge, face
superficial: red scaly plaque, trunk/shoulders

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11
Q

Mx BCC

A 
excision
cryo
curettage
radiotherapy
photdynamic
imiquimod/fluorouracil [superficial low risk]
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12
Q

Mx of primary SCC

A

local complete excision

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13
Q

most common cancers causing cutaneous mets

A 
breast
stomach and colon
lung
GU [uterus/ovary/kidney/bladder]
non-hodgkins, leukaemia
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14
Q

describe pagets diseas eof the nipple

A

itchy red scaly crusted nipple, from direct extension of intraductal adenocarcinoma

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15
Q

how do you differentiate pagets diseas eof the nipple from eczema?

A

eczema is bilateral, non-deforming, waxes and wanes

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16
Q

risk factors for melanoma

A 
UV exposure
sunburn
fair complexion
>50 melanocytic/ dysplastic naevi
FH
previous melanoma
^age
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17
Q

ring like (annulatr lesions ) indicate what?

A

fungal infection

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18
Q

target-like pattern of lesions = ?

A

erythema multiforme

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19
Q

> 5 cafe au lait spots, consider what disease?

A

neurofibromatosis

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20
Q

what can cause melasma

A

preg

COCP

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21
Q

systemic diseses that can cause hyperpigmentation

A

addisons

haemochrom

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22
Q

Ix.s in itch

A 
FBC
haematinics
LFT
U+E
ESR
glucose
TSH
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23
Q

skin signs in DM

A 
flexural candidiasis
necrobiosis lipoidica
acanthosis nigricans
granuloma anulare
folliculitis
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24
Q

skin signs in coeliac

A

dermatitis herpetiformis

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25
dermatitis herpetiformis immediate Mx
dapsone
26
skin signs in IBD
erythema nodosum | pyoderma gangrenosum
27
skin signs in lupus
facial butterfly rash photosensitivity diffuse alopecia lupus erythematosus [chilblain, discoid, psoriasis-like plaques, vasculitis, oral ulcers, palmar erythema, periungal erythema, raynauds]
28
erythema multiforme is a hypersensitivity rn usualy triggered by what organism
herpes simplex
29
Mx of erythema multiforme
topical steroid for discomfort aciclovir for HSV resolves spontaneously
30
causes of acanthoiss nigricans
obesity DM lymphoma gastric CA
31
risk factors for psoriasis + triggers
FH triggers: stress, infetions, skin trauma, drugs [lithium, NSAIDs, BB], alcoohol, obesity, smoking, climate
32
systemic upset found with generalised severe psoraisis
^WCC fever dehydration
33
nail chnages in psoroaiss
pitting onycholysis thickening subungual hyperketatosis
34
differentials for psoriasiss
eczema tinea [few lesions] mycosis fungoides [asymmetric] seborhoeic dermatitis
35
Mx of psoriasis
``` topical emollient + steroids [betnovate] topical vit D Prep [Calcipotriol] (DOVOBET = vit D + steroid) COAL tar dithranol retinoid [acitretin] phototherapy (methotrex, ciclosporin) (infliximab etc) ```
36
scalp psoriasis Mx
steroid/vit D/coal tar shampoo
37
tell parents of eczema patient to report any severe weeping rash e.g. around the mouth. Why?
may be eczema herpeticum - primary herpes infection which may be fatal
38
Mx of eczema
``` emollient, soap substitutes topical steroids Abx for infection tacrolimus/methotrex/azathiop/ciclo in severe antihistamines for itch [hydroxyzine] ```
39
what does seborrhoeic dermatitis look like? which areas does it affect? what causes it? how is it treated?
red, scaly scalp [dandruff], eyebrows, nasolabial folds, cheeks, flexures over gorwth of skin yeasts [malassezia] daktacort [steroid + antifungal]
40
Mx of acute flare of contact dermatitis
topical steroid
41
local SEs of topical steroid use
``` skin thinning striae telangiectasia worsening of infection contact dermatitis ```
42
what ix can help you diagnose tinea/ ringworm?
skin scraping/ scalp brushings/ nail clippings for microscopy + culture
43
Tx of ring worm
antifungal e.g. fluconazole
44
Mx of skin, mouth and vaginal candida infection
SKIN: clotrimazole cream MOUTH: miconazole VAG: clotrimazole cream +/- pessary
45
peak age for impetigo + commonly responsible organism how is it treated?
2-5 yrs staph aureus topical fusidic acid, oral fluclox if severe
46
what causes erysipelas? how does it present? how is it treated?
strep pyogenes sharply defined superficial infection on face. Fever, ^WCC Abx
47
signs and Sx of cellulitis
``` pain swelling erythema warmth systemic upset lymphadenopathy ```
48
Mx of cellulitis
Abx - e.g. benzylpenicillin IV + fluclox PO if penicillin allergic, erythromycin
49
what pathogen causes warts?
HPV
50
treatment of warts
``` self-limiting if painful/persistent/unsightly: topical salicylic acid cryotherapy duct tape occlusion ```
51
Mx of genital warts
sigificant treatmnt failure/ relapse podophyllin/ imiquimod cryo
52
complications of herpes zoster/ shingles
post-herpetic neuralgia meningitis encephalitis
53
what are the 5 pillars of acne?
1. basal keratinocyte proliferation in pilosebaceous follicles [androgen + corticotrophin-releasing hormone driven] 2. ^sebum productiion 3. propionibacterium acnes colonization 4. inflamm 5. comedones blocking secretions -> papules, nodules, cysts, scars
54
acne Mx
topical benzoyl peroxide topical retinoid [isotretinoin] topical Abx [clindamycin] azelaic acid PO Abx [doxy/tetracycline] COCP/dianette [antiandrogen]
55
isotretinoin [topical retinoid] SEs
teratogenic skin + mucosal dryness depression
56
common drug culprits for urticaria
``` penicillins cephalosporins [cefurox/ceftriax] opiates NSAIDs ACEi thiazides phenytoin ```
57
Mx of urticaria
antihist +/- hydrocort/adrenaline if anaphylaxis
58
vague URT Sx 2-3 weeks after starting a new medication. Then rash: painful erythematous macules > target lesions, mucosal ulceration (conjunctivae, oral, labia, urethra). Diagnosis + culprits?
stevens-johnson syndrome sulfonamides anti-epileptics penicillins NSAIDs
59
How do you manage toxic epidermal necrolysis + stevens-johnson syndrome
supportive in ICU IVIg analgesia protect skin
60
flu like Sx. widespread painful dusky erthema, the necrosis of large sheets of epidermis, severe mucosal involvement. Following new medication. Diagnosis
toxic epidermal necrolysis
61
drug causes of toxic epidermal necrolysis
``` sulfonamides anti-epileptics penicillins NSAIDs cephalosporins [cefurox/ceftriax] allopurinol ```
62
Mx of lichen planus
topical steroids +/-antifungal
63
pt presents with purple itchy flat-topped papules on inner wrists and legs with white lacy markings. She also has lacy white areas on the inside of her cheeks. Diagnosis?
lichen planus
64
what is the difference in prognosis for scarring and non-scarring alopecia
scarring implies non reversible
65
smooth, well-defined round patches of hair loss on scalp. Exclamation mark hairs. diagnoiss?
alopecia areata
66
mx of alopecia areata
80% spont regrowth in 3 months topical steroid psych support Minoxidil [in androgen-dpeendent]
67
bullous pemphigoid is the chief autoimmune blistering disorder in the elderly. what cayses it?
IgG autoantibodies to basement membrane
68
elderly lady presents with tense blisters 1-3cm in size. A biopsy shows +ve immunofluorescence, [IgG and complement along the basement membrane]. Dx?
bullous pemphigoid
69
bullous pemphigoid mx
topical steroids + pred PO [+PPI+bisphos]
70
difference between pemphigus + bullous pemphigoid
pemphigus younger [<40], oral mucosa affected, flaccid blisters [tense in BP]
71
Mx of pemphigus
pred | ritux + IV Ig in resistant
72
precipitants for urticaria
infection/parasites[helminth] chemicals - insect bites, latex, drugs, food systemic disease
73
risk factors for venous leg ulcers
``` varicose veins DVT venous insufficiency poor calf muscle fn. AV fistulae obesity leg fracture minimal trauma over medial malleolus ```
74
what is the name of the skin changes seen in venous leg ulcers/ venous HTN?
lipodermatosclerosis [or haemosiderin deposition]
75
give 5 causes of ulcers
neuropathy trauma vascular: venous/arterial/mixed ``` rarer: vasculitis [e.g. SLE] malignancy pyoderma gangrenosum [IBD] sickle cell infection [leishmaniasis] drugs [nicorandil for angina] ```
76
Mx of venous leg ulcers [including initial Ix]
``` DOPPLER to rule out arterial graded compression bandaging, dressings PO abx if infection analgesia [pentoxifylline] ```
77
prevention of venous leg ulcers
skin care, compression stockings, calf exercises, leg elevation, good nutrition
78
risk factors for pressure ulcers
``` extremes of age reduced mob reduced sensation vasc disease chronic/terminal illness incont spinal injury ```
79
complicaiton of pressure ulcer
osteomyelitis
80
Tx of pressure ulcer
``` pressure relieving mattress frequent repositioning/turning nutrition ABx for infection modern dressings debridement -ve pressure ```
81
prevention of pressure ulcers
regular skin inspection minimise moisture positioning/turning pillows to separate knees + ankles
82
skin causes of pruritus in the elderly
eczema scabies pemphigoid dry skin
83
medial/systemic causes of pruritus in the elderly
``` anaemia polycythaemia lymphoma solid neoplasms hepatic/renal failure hypo/hyperthyroidism DM [candida] ```
84
causes of pruritus vulvae
``` systemic e.g. liver/renal/anaemia etc lichen planus, psoriasis candida allergy [washing powder] infestation [scabies] vulval dystrophy [lichen sclerosis, carcinoma] ``` exacerbating: obesity incont
85
difference between wet and dry gangrene
wet is with infection
86
features of acute seroconversion in HIV + when does this occur?
``` 1-3 weeks after exposure acute EBV-type illness maculopapular eruption on trunk lymphadenopathy malaise headache fever oral/genital ulcers/candidiasis ```
87
examples of pathogens that dont usually cause disease, but HIV +ve patients are at incerased risk on infection from
``` herpes: oral/genital ulcers, varicella [+post-herpetic neuralgia], KS EBV [oral hairy leukoplakia] warts molluscum contagiosum candida tinea syphilis cryptoccus demodicosis scabies ```
88
Mx of HIV associated KS
``` optimize HAART radiotherapy chemo cryo laser photodynamic therapy excision interferon alpha ```
89
Mx of candidiasis in HIV
topical nystatin | systemic imidazoles
90
Mx of skin cryptococcosis in HIV
fluconazole
91
scabies Mx , including practical measures
treat all close contacts permethrin lotion oral ivermectin in severe crotamiton [anti-pruritic] long bath, soap skin all over, scrub under fingernails. wash all bedding, towels, clothing in hot wash
92
HIV skin neoplasias
``` kaposi sarcoma BCC SCC melanoma skin lymphomas merkel cell cancer ```
93
what is immune reconstitution inflamm syndrome in HIV?
with antiretrovirals, immunity begins to recover, but then responds to previously acquired opportunistic infection with a powerful inflamm response. Worsening of Sx, often involves skin.
94
pt presents with itching | + itchy red penile and scrotal papules. Diagnosis?
scabies [ itchy red penile and scrotal papules are virtually diagnostic]
95
Mx of headlice
malathion or dimeticone lotion | combing
96
Mx for crab lice
malathion or permethrin
97
hanging legs over the side of the bed to relieve pain indicates what type of ulcer + why?
use gravity to aid blood flow to ischaemic tissue
98
Mx of arterial ulcers
optimise vascular risk factors e.g. QUIT SMOKING! regular inspection surg: revacularisation, amputation
99
ABCDEF CRITERIA for suspicious pigmented lesion
``` asymmetry border irregularity colour variation diameter >6mm evolution funny looking [diff from rest] ```
100
briefly describe the 4 types of melanoma. which is the mos common
superficial spreading [most common] nodular [agressive] acral lentiginous [palm and soles] lentigo maligna
101
melanoma Mx
excision interferon alpha for mets palliative chemo NOT radio

3B GH (16 decks)

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