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RACGP Exams Complete Deck > Derm3 > Flashcards

Derm3 Flashcards

(48 cards)

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1
Q
A

Pompholyx - dishydrotic eczema

Young adults (more F)

FHx of atopic eczema

Some report hyperhidrosis

RF’s - contact with irritants, genetics, drug reactions

RECURRENT episodes of blisters on palms and soles, burning and itching,

Treat: Avoid irritants

Wet dressings/soaks

Potent steroid (mometasone furoate 0.1%)

Oral corticosteroid for 3 weeks

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2
Q
A

Asteatotic eczema

Elderly, hypothyroid or drugs (Statins/diuretics)

Alleviate dry skin - soap substitute

Emmolients and moisturisers

Hydrocortisone 1% ointment

(more potent if not responding)

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3
Q
A

Erythema marginatum

annular erythema to Trunk, upper arms and legs

Non itchy, non painful

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4
Q

What are the causes of erythema nodosum

A
  1. Sarcoidosis (CXRay)
  2. Streptococcal infections (ASOT)
  3. TB
  4. Chron’s disease
  5. Pregnancy
  6. Drugs - tetracyclines, OCP
  7. Malignancy
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5
Q

How do we treat erythema nodosum

A
  1. Treat the cause
  2. Rest, elevate,
  3. Ibuprofen 400mg tds prn if acutely painful
  4. If severe prednisolone 0.75mg/kg daily for 2 weeks
  5. Often settles spontaneously over 3-8 weeks
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6
Q

Tests for Erythema Nodosum?

A

FBE, CXR, ASOT, Mantoux, ESR/CRP

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7
Q

Clinical features of erythema nodosum

A
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8
Q

What is erythrasma? How does it present

A

This is a skin fold rash - well defined PINK or BROWN patches with fine scaling and superficial fissuring. Mildly itchy

APPEARS CORAL PINK UNDER A WOODS LAMP

Treat with fusidic acid 2% BD for two weeks

Prevention - antibacterial soap

Demographics - diabetes, obesity, warm climate

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9
Q

What is a felon? How is it treated

A

This is a an abcess of the pulp of the fingertip.

Multi or single compartment abcess of the pulp.

Predisposed by thorn, wood splinter, minor cuts, infection from a paronychia

Treat with incision and decompression of abcess

Administer antibiotics with sensitivity to MRSA

eg clindamycin

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10
Q
A

A digital myxoid cyst or mucous cyst is a pseudocyst- not surrounded by a capsule

presents as shiny pappule on a finger or a toe - close to the nail

Treatment

  • repeated firm pressing
  • squeezing out of contents
  • cryotherapy
  • steroid injection
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11
Q
A

Glomus tumour

nail bed/finger tip or palm

within the glomus body which helps with thermoregulation

EXTREMELY PAINFUL - esp following temperature or pressure

Excisional biopsy

Remove at same time ;)

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12
Q

Causes of flushing?

A

Commonly - women in menopause (consider HRT)

ROSACEA (will have erythema, papules, pustules)

ETOH

Spicy food

Stress

Phaeo

drugs - calcium channel blockers, sildenafil, nicotinic acid

Treat the cause

If want treatment - Propranolol 10mg bd

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13
Q
A

Folliculitis

Mupirocin ointment BD topically for five days

Recurrent boils:

Swab for MCS

3% Hexaclorophene body wash daily

Mupirocin Nasal ointment 2%

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14
Q
A

Wetsuit folliculitis

Same as spa pool

folliculitis where costume has been - a few days after

Treatment

Gentamycin Cream

Polymyxin B spray

Oral ciprofloxacin

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15
Q
A

spa pool folliculitis

folliculitis on trunk after being in spa or where costume has been - a few days after

PSEUDOMONAL

Treatment

Gentamycin Cream

Polymyxin B spray

Oral ciprofloxacin

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16
Q

What is pseudofolliculitis barbae and folliculitis barbae

A

SHaving rash

Folliculitis barbae - painful pustules

Pseudofolliculitis - foreign body inflammatory rash around ingrown hairs in beard

Advice:

if possible let the beard grow out to avoid ingrown hairs

Moisturise with a lotion containing glycolic acid

Shave in the direction of the follicle (not against)

Use single blade disposable razors

Treatment

folliculitis - mupirocin 2% bd

pseudofolliculitis - Benzoyl peroxide 5% gel

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17
Q

What margins should you keep in a Non melanomatous skin cancer biopsy?

A

2-3mm for well defined - less than 10mm lesion

4-5mm for larger than 10mm or poorly defined lesions.

If lesion is too large for excisional biopsy

do 1) partial b) refer to specialist

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18
Q

If doing a partial biopsy for NMSC what would you do?

A

For a Bowns or superficial BCC - do a partial shave biopsy as they are thin lesions

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19
Q

Treatment options for a NMSC which can’t be treated with excision

A
  1. Curretage and diathermy - superficial BCC and bowens on body and limbs
  2. Liquid nitrogen - superfical lesions body and limbs
  3. Imiquimod - for biopy proven superficial BCC where surgery cant be used
  4. Fluorouracil approved for treatment of Bowens
  5. Radiotherapy - For Older people over 70 - excellent cure rate - 6 weeks - 5 days per week.
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20
Q

How would you manage SCC in ears, eyes, nose or lips

Study These Flashcards
A

DANGER AREAS
needs excisional biopsy not creams or cryo

But in ppl over 70 - you can do radiotx for bcc and scc in head and neck

21
Q

Other areas of body - not head and neck -

22
Q

Superfical proven BCC in areas of body (Apart from head an neck)

Study These Flashcards
A

either - curretage and diathermy, imiquimod or surgical excision

23
Q

Bowens disease management ?

Study These Flashcards
A

Fluorouracil, surgery or curettage and diathermy

24
Q

What happens if there’s perineural or perivascular invasion of a NMSC?

Study These Flashcards
A

REfer to specialist

higher risk of metastasis

25
How often should a patient who has had a skin cancer removed be followed up?
**Yearly skin check and draining lymph nodes for new cancers** If a high risk SCC removed - check three monthly
26
What are the types of BCC?
Nodular Superficial Morphoeic
27
Clinical features of a nodular BCC
Pearly raised edge surface telangiectasia central ulcer (rodent ulcer) commonly on the face
28
Clinical features of a superficial BCC
Well defined red patch Asymettrical (unlike psoriasis, eczema) Stretch the skin to see pearly edge
29
Clinical features of a morphoeic BCC
poorly defined scar can have a pearly edge palpate and stretch the skin
30
Morphoeic bcc
31
Which is the most common skin cancer in AUs
BCC - 68% then scc
32
What are the types of SCC
Classic Keratoacanthoma Bowens disease (SCC in situ)
33
CLinical features of a classic SCC
QUick growin keratotic lesion induration TENDERNESS (v important) Failure to clear with treatment
34
Clinical features of a keratoacanthoma?
Dome shaped, symettrical with a central keratin core
35
Bowens disease Slowly expanding red patch on body or limbs classicaly on legs of older people
36
What is Gorlin Syndrome (Basal cell naevus syndrome)
Multiple and early onset bcc's
37
What are the most common sites of melanoma in men? in women?
IN men? Back in women? Leg
38
What kind of sun exposure is worse for melanoma?
Episodic and intense rather than continuous
39
What is this rash? How would you treat?
Nummular or DISCOID eczema its disc shaped with NO central clearing INTENSELY ITCHY can be exudative or dry Its triggered by: infection, bite, burn, localised injury, varicose veins **TREAT with mometasone furoate 0.1% bd (like atopic eczema)** if not then change to betamethasone dipropionate 0.05% in optimised vehicle
40
What is a morbilliform rash due to in kids? adults?
Viral rash in kids - eg measles In adults - drug rask - toxic erythema - happens a few days after commenecement of drug If has fever and other organ involvement - could be **drug hypersensitivity syndrome - may need hospitalisation** **Can also lead to erythroderma or toxic epidermal necrolysis and SJS**
41
How do you treat a drug rash?
1. Idenitify the cause and STOP IT 2. Careful monitoring in the event of complications/anaphylaxis 3. **Apply emmolients and potent topical steroid** 4. Wet Wraps for very red, inflamed skin 5. Antihistamines are often prescribed but generally not very helpful.
42
How does a fixed drug eruption present
A few hours after the drug is taken bright red face/hands/genitalia eg phenolphthalein, penicillins, tetracyclines STOP DRUG monitor wet wraps emmolient steroid cream
43
How does a photosensitive drug rash present
Phototoxic - eg doxy,chlorpromazine - like a sun burn Photoallergic - eczematous, lichenoid reaction
44
Drugs which cause hyperpigmentation
ACTH, oestrogens/progesterones, phenytoin - affect melanin deposition Mincocycline - affect haemosiderin and pigment Amiodarone - 75% of people get pigment changes
45
Whats your algorithm for hair loss?
Is it generalised or patchy? _Generalised_ - after *chemo/cytotoxics/autoimmune disease/loose anagen syndrome* - **Anagen Effluvium** _2-6 months_ after i*ntense stress,* childbirth, fever/illness - **Telogen Eflluvium** If its **_patchy_** - then is it normal skin? If _normal skin_ - entire patches **Allopecia areata** (trial topical steroids/intralesional) normal skin - with some hair in the patches - **Trichotillomania** (pulls out their own hair) If INFLAMED SKIN **tinea capitis, seborrheic dermatitis** ( greasy yellow scales), **psoriasis** (silvery scale) Traction allopecia - fringe sign Lichen planus - systemic symptoms
46
How common is pattern hair loss/androgenic alopecia
50% of ppl by age 50 Male pattern affects vertex temporal scalp Female pattern is less pronounced and affects anterior scalp
47
What is hair pull test
Anagen hairs (long tapering hairs in growing phase) should not come out -(pathologic) Note - lots of anagen - anagen effluvium lots of telogen telogen effluvium
48
How would you differentiate ptyriasis alba from versicolor from rosea
_Rosea_ - herald patch - then coin like lesions a couple of days later - usually young adults 15-30 - can be after an URTI - Self limiting - reassure - if itchy - mild steroid such as **triamcinolone acetonide 0.02%** _Alba_ - in prepubertal kids - (often with atopic eczema) this presents as poorly demarcated hypopigmented lesions to face and upper limbs with a scale - **hydrocortiosone 1% ointment** _Versicolor_ - Malassezia load in adolescents - hypopigmented areas that are across trunk and limbs and asymptomatic or mildly itchy - **ketaconazole 2% once daily - for 5 minutes -then wash off for five days**

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