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Y2- random cant remember > derm overall > Flashcards

derm overall Flashcards

1
Q

eczema herpeticum

A

quite serious infection
caused by herpes simplex virus
monomorphic punched out lesions

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2
Q

treatment of porphyria cutanea tarda

A

low dose anti-malarials can be used
chloroquinolone
work by removing excess porpyrins from the liver

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3
Q

dermatophyte

A

fungi that requires keratin for growth

causes superficial infection of skin hair and nails

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4
Q

treatment for dermatophyte (ringworm) infection

A

small areas
clotrimazole (brand name- canestan)- topical or similar
or topical nail pain- amorolfine

extensive
terbinafine- orally- when nails affected too
itraconazole - oral

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5
Q

candida skin inefections

A

candida intertrigo can cause infections in areas where skin is warm and moist- skin folds- closely opposing skin surfaces
clotrimazole cream
oral fluconazole

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6
Q

pityriasis versicolour

A

yeast infection caused by melassezia common in hot humid areas
notice after a holiday- more noticeable when tanned

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7
Q

treatment for scabies

A

malathion lotion
applied overnight to whole body then washed off

benzyl benzoate- not suitable in children

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8
Q

treatment for acne

A

mild- topical therapy only (benzyle perociase and retinoids)- could add antibiotic (clindamycine. erythromycin)

mod- topical therapy (benzyle peroxidase and retinoid)
plus oral antibiotic
can use contraceptive pill in women

severe- topical therapy (benzyl peroxidase plus retinoid)
plus isotretinon (oral retinoid)
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9
Q

treatment for rasacea

A

Topical therapies
🡪 metronidazole
🡪 ivermectin (to reduce demodex mite)

Oral therapy
🡪 oral tetracycline long term
🡪 isotretinoin (only if severe)

Telangiectasia = vascular laser

Rhinopyma = surgery / laser shaving

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10
Q

A lichenoid eruption

A

is a skin disease characterised by damage and infiltration between epidermis and dermis

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11
Q

Wickham’s striae

A

fine lace-like pattern on surface of papules and buccal mucosa
🡪 results in burning in mouth when drinking
🡪 rough, thinning nails

seen in lichen planus disorders

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12
Q

histology of lichen planus

A

irregular SAWTOOTH acanthosis
🡪 hypergranulosis and orthohyperkeratosis
🡪 band-like upper dermal infiltrate of lymphocyte and basal damage with formation of cytoid bodies

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13
Q

bullous pemphigoid

A

IgG antibodies reacts with antigens of the hemidesmosomes anchoring basal cells to the basement membrane

split is deeper- no sign of antholysis

low mortality
may need tetracycline antibiotics

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14
Q

nikosky sign

A

slight rubbing of the skiin results in exfoliation of the outermost layer
positive in pemphigus
negative in pemphigoid

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15
Q

pemphigus

A

IgG auto- antibodies made against desmoglein 3

high mortality

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16
Q

treatment for pemphigoid/pemphigus

A 
Systemic steroids
Other immunosuppressive agents 
Topical treatment 
🡪 emollients 
🡪 topical steroids 
🡪 topical antiseptics / hygiene measures

In pemphigoid = tetracycline antibodies

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17
Q

treatment for herpes simpllez virus

A

analgesia
acyclovir- oral/IV

selectively incorporated into viral DNA inhibiting replication
🡪 does not eliminate latent virus

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18
Q

molluscum contagiosum

A

self limiting viral infection seen commonly in children
fleshy firm umbliated (dip in middle) nodules
can be sexually transmitted
managed via a local application of liquid nitrogen

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19
Q

what human papilloma virus causes

A

warts

cervical cancer

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20
Q

warts

A

commonest in children
infection by HPV
verucas are squashed flat examples

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21
Q

management of warts

A

Self-limiting
🡪 topical salicylic acid (keratolytic)

Mechanical pairing (removing dead skin with emery board / file) plus:
🡪 local application of liquid nitrogen (cryotherapy)
🡪 formaldehyde
🡪 glutaraldehyde
🡪 silver nitrate
🡪 podophyllin if genital warts

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22
Q

herpangina

A

painful blistering rash of the back of the mouth
commonest in childhood
self limiting
caused by Enteroviruses eg coxsackie virus and echovirus

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23
Q

hands foot and mouth disease

A 
typically in children
can have fam outbreaks
enterovirus causing eg coxsackie virus and echovirus 
promdromal feer
malaise
after few days- mouth ulcer and rash
self limiting- no treatment
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24
Q

erythema infectiosum

A

slapped cheek disease
caused by parovirus B19

children- rash on face which fades to lacy macular rash on body
adults - rash may be absent and acute POLYARTHIRITIS of small joints eg of hands may be more prominent

supportive treatment- aantipyretics sometimes used

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25
Q

testing for erythema infectiosum

A

Antibody testing for parvovirus B19 IgM

over swabs

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26
Q

results of parovirus B19 soemtimes

A

🡪 spontaneous abortion
🡪 aplastic crises (organ failure) in patients with short RBC life span
🡪 chronic anaemia in immunosuppressed patients

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27
Q

orf

A

viral skin disease
firm fleshy nodule on the hands of afamer
caused by parapox virus in sheep

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28
Q

treatment of orf

A

Self-limiting
🡪 clears in 3-6 weeks
🡪 may be useful to cover the lesion with dressing

If you develop a bacterial infection with orf then may need antibiotic

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29
Q

cause of syphillis

A

treponema pallidum

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30
Q

signs of syphilis

A

Primary infection
🡪 chancre (painless ulcer) at site of entry

Secondary infection
🡪 red rash over body, prominent on soles of feet and palms
🡪 mucous membrane “snail track” ulcers

Tertiary infection
🡪 symptoms relating to CNS, cardiovascular, gums etc

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31
Q

treatment of syphilis-

A

penicillin injection

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32
Q

lymes disease

A

bacterial infection caused by borrelia burgdorferi
Early:
🡪 erythema migrans (rash that looks like a bullseye)

Late:
🡪 heart block, nerve palsies, arthritis

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33
Q

diagnosing and treating lymes

A

clinical or serolology

doxycycline/amoxicillin

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34
Q

necrotising fascitis

A

caused by group A strep
little to see but mass tissue destruction under the surface- painful
requires quick tissue debridement
plus antibiotics- 🡪 group A = clindamycin plus penicillin

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35
Q

tuberous sclerosis

A

A rare multisystem genetic disease that causes growth of benign tumours
Infantile seizures
🡪 caused by cortical tubers

Ash-leaf macule = earliest sign
🡪 depigmented macules
🡪 hard to see in pale skin so woods lamp used

causes tumours

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36
Q

epidermolysis bullosa

A

a group of genetic skin fragility disordesr that causes mass blistering and mucous membrane
blisters occur with minor fracture and trauma

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37
Q

types of epidermolysis bullosa

A

simplex- affects the epidermis
junctional- affects dermo epidermal junction
dystrophic- affects the dermis

38
Q

neurofibromatosis type 1

A

multisystem autosomal dominanty genetic condition

Café-au lait macules 
🡪 coffee coloured flat marks 
🡪 >5 suggests genetic learning difficulties 
Neurofibromas (soft neural tumours)
Axillary or inguinal freckling

systemic manifestations
Optic glioma
2 or more Lisch nodules on iris

39
Q

what are lisch nodules

A

dome shaped gelatinous masses developing on surface of iris
🡪 gold-tan to brown in colour
🡪 may grow up to 2mm in diameter and attain variable sizes on same iris

40
Q

treatment for neurofibromatosis type 1

A

targeted therapy on MEK inhibitors

41
Q

types of melanoma

A
  • superficial = commonest (trunk and limbs) (30-50yr olds)
  • nodular (60yr olds)- anywhere- varied Refer if >3 points on Glasgow scale, or with 1 point if suspicious
  • lentigo maligna = sun damaged face / scalp / neck >60 years of age, slow growth
  • acral lentiginous - nail, palms and soles, commonly diagnosed at advanced stage

most to least common

42
Q

when to biopsy and refer for melanoma

A

Refer if >3 points on Glasgow scale, or with 1 point if suspicious

2 points for each of:
🡪 change in size
🡪 change in shape
🡪 change in colour

1 point for each of:
🡪 inflammation, crusting or bleeding
🡪 sensory change
🡪 diameter >7mm

43
Q

what melanoma biopsy measured in

A

measured in Breslow Thickness (deepest tumour from granular level)

44
Q

treating melanoma

A

Urgent excision biopsy can be curative
🡪 chemotherapy gives response in 10-30%

If advanced disease = chemo, immunotherapy and genetic therapies:
🡪 dasatinib + imatinib target c-kit
🡪 vemurafenib + dabrafenib target B-Raf
🡪 trametinib targets MEK
🡪 ipilimumab and tremelimumab targets CTLA-4 on T cells
🡪 pembrolizumab targets PD-1 on T cells

45
Q

prognosis from a melanoma

A

all grow as macules before cells invade dermis forming expansile mass with mitosis (RGP)
Except nodular which are just simple tumour of nodular tissue (VGP)

once becomes VGP
Breslow thickness:

Regional lymph node metastases = common
Blood spread = skin, soft tissue, heart, lungs, GI tract, liver, brain
🡪 lung, brain and liver most common

46
Q

Breslow thickness results

A 
<1mm = 5 year survival 95-100%
>4mm = 50% survival 
Metastases = 6%

measured from granular layer as far down as the melanoma invades

47
Q

why melanoma is most serious

A

greater potential to metastasise

48
Q

basal cell carcinoma

A

75% of skin cancers

Arise from keratinocytes within basal layer of epidermis

49
Q

cause of bcc and scc compared

A

bcc
Associated with intermittent burning episodes of sun exposure

scc
Long term cumulative UV exposure eg working outdoors and ageing population
🡪 90% on head, neck, hands and forearms

50
Q

presentation of bcc and scc compared

A 
bcc
Slow growing lump or non-healing ulcer 
🡪 painless and often ignored 
🡪 pearly or translucent 
🡪 visible, arborizing blood vessels 
🡪 central ulceration – “rodent ulcer”
🡪 can present as scaly plaque

scc
Warty / crusty growth or ulcer which grows fast
🡪 may be painful / bleed

Lip and scalp are high risk sites

51
Q

pre cursor lesions for scc

A

🡪 actinic keratosis
🡪 Bowen’s disease
🡪 viral precursors

52
Q

what scc and bcc commonly misdiagnosed as

A

scc
May be confused with a keratoacanthoma
🡪 fast growing benign, self limiting papule plugged with keratin

Superficial BCC often misdiagnosed as eczema or psoriasis

53
Q

further tests after surgical excision for bcc and scc

A

need to do a further biopsy after scc removal to check for spread to lymph nodes but not for bcc

54
Q

treatment for bcc and scc

A

bcc
Excision and cryotherapy
For superficial BCCs:
🡪 topical fluorouracil or imiquimod

scc
Excision and then possibly radiotherapy to treat recurrence / affected nodes
Risk of metastasis about 5% and when this happens, prognosis poor

55
Q

mutations associated with bcc development

A

Mutation in PTCH1

🡪 target treatment = vismodegib

56
Q

acitinic keratosis

A

progressive appearance of rough and patchy scaly patch of skin
developes from years of sun exposure
common precursor of scc
🡪 middle aged female legs associated with developing SCC or BCC
🡪 give 5-flurouracil cream
suspect scc if lesion develops a thickened [ainful base or ulcerates

57
Q

viral precursors

A

viral genital lesions are often dysplastic

associated human papillomato virus

58
Q

bowens disease

A

scc in situ
rarely progress to scc
chronic uv exposure
scaly patch erythematous plaque

59
Q

leg ulcer

A

A chronic leg ulcer is open lesion between knee and ankle joint that remains unhealed for at least 4 week

60
Q

comparing venous and arterial ulcers

A

Venous ulcers usually form below knee and on inner area of ankle
🡪 inflammation, swelling, aching, itchy and hard, scabbing or flaking, brown or black skin, discharge

Arterial ulcers usually form on outer side of ankle, feet, heels or toes
🡪 red, yellow or back sores, deep wound, tight hairless skin, leg pain at night, no bleeding, cool to touch, leg reddens when dangled and turns pale when elevated

61
Q

ABPI

A 
ABPI = establish if any arterial disease 
🡪 1 = normal 
🡪 0.8-1.3 = compress 
🡪 <0.8 = vascular disease 
🡪 >1.5 – calcification
62
Q

when to swab a leg ulcer

A

Swab only if ulcer increasingly painful / exudate / malodour / enlarging

63
Q

treating leg ulcers

A

Control pain

Non-adherent dressing
🡪 seldom heals wound on their own

Desloughing agent if necessary eg hydrogel / honey

Compression stockings 
🡪 class 1 (weak) to class 3 (strong) 
🡪 most patients manage class 2 
4 layer compression bandaging 
Leg elevation

Wound bed preparation
🡪 autolytic = use of dressing to create moist environment and hydrate necrotic tissue
🡪 sharp debridement with scalpel / scissors
🡪 biological = larvae therapy
🡪 surgical under general anaesthetic

64
Q

causes if ulcers

A

Venous ulcers due to insufficient return of blood back to heart

Arterial ulcers develop as result of damage to arteries due to lack of blood flow to tissue

65
Q

Lipodermatosclerosis

A

woody tethered skin

66
Q

flat lesions

A

macule - smaller than 1cm

patch- bigger than 1cm

67
Q

raised lesions

A

papule- smaller than 0.5cm

nodule- bigger than 0.5cm

68
Q

maculopapular lesions

A

flat and elevated components

69
Q

plaque

A

raised edge and flatter surface- grester than 1cm

70
Q

wheal

A

erythmastous zone

red swollen mark

71
Q

fluid filled lesions

A

vesicle- less than 0.5cm

bulla- greater than 0.5cm

72
Q

cyst

A

nodule containing semi solid material

pus filled lesion lined by epithelium

73
Q

pusutle

A

pus filled

74
Q

SCALE

A

accumulated fragments of keratin layer

75
Q

crust

A

dried exudate- serum- yellow brown

impetigo

76
Q

lichenified

A

thickened skin with increased skin markers

77
Q

scar

A

normal tissue replaced by fibrous tissue

78
Q

fissures

A

linear split in epidermis

79
Q

atrophy

A

loss of epidermis and or dermis

surface remains intact

80
Q

erosion

A

superficial break in the epidermis

81
Q

ulcer

A

deeper break into the dermis

82
Q

parakeratosis

A

persistence of nuclei in the keratin layer

reason for loss of the granular layer is psoriasis

83
Q

papillomatosis

A

irregulat epithelium thickening

84
Q

spongiosis

A

oedema filled space between keratinocytes

85
Q

acantholoysis

A

breaking of desmosomes in epidermis

86
Q

aconthosis

A

darkened patches

87
Q

diseases caused by staph AUREUS

A

cellulitis

impetigo

88
Q

diseases caused by beta strep

A

celluluts
ersipelas
(impetigo)

89
Q

diseases caused by alpha strep

A

necrotising fasciitis- type 2

impetigo

90
Q

diseases caused by pseudomonas

A

folliculitis from hot tub

Y2- random cant remember (6 decks)

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