Dermatology Flashcards

Question

Lichenoid drug eruption causes?

Answer 1

1. Gold 2. Quinine 3. Thiazides

Answer 2

1. Potent topical steroids 2. Benzydamine mouthwash or spray for oral 3. If extensive may require oral steroids or immunosuppression

Answer 3

Regular emollients 1. 1st line = Potent corticosteroid OD + Vitamin D analogue OD, apply separately one in AM and one in PM, for up to 4 weeks as initial treatment 2. 2nd line = If no improvement after 8 weeks, Vitamin D analogue BD 3. 3rd line = If no improvement after 8-12 weeks, Potent corticosteroid BD up to 4 weeks or coal tar OD/BD 4. Short acting dithranol can also be used

Answer 4

1. Phototherapy 2. Systemic therapy

Answer 5

1. Narrowband UVB 3x week preferred 2. Photochemotherapy (PUVA)

Answer 6

Skin ageing, SCC (not melanoma)

Answer 7

1. Oral MTX 1st line 2. Ciclosporin 3. Systemic retinoids 4. Biological = Infliximab, Etanercept, Adalimumab 5. Ustekinumab (IL12 & IL23) showing promise

Answer 8

1. Potent topical corticosteroid OD 4 weeks 2. If no improvement after 4 weeks --> use different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

Answer 9

Mild/moderate potency corticosteroid OD/BD for maximum 2 weeks

Answer 10

1. S/e = skin atrophy, striae, rebound symptoms 2. Don't treat scalp, face and flexures for more than 1-2 weeks per month 3. Systemic s/e seen when used >10% BSA 4. 4 week break before starting another course of topical corticosteroids 5. Potent corticosteroids for no longer than 8 weeks at a time, very potent corticosteroids for no longer than 4 weeks at a time

Answer 11

1. Calcipotriol (Dovonex), calcitriol, tacalcitol 2. Reduce cell division and differentiation, reducing epidermal proliferation 3. Adverse effects are uncommon 4. Can be used long term, do not smell or stain 5. Avoid in pregnancy 6. Maximum weekly amount for adults is 100g 7. Tend to reduce the scale and thickness of plaques but not the erythema

Answer 12

Inhibits DNA synthesis, wash off after 30 mins, s/e = burning, staining

Answer 13

Probably inhibits DNA synthesis

Answer 14

Above medial malleolus

Answer 15

ABPI (Normal 0.9-1.2). Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)

Answer 16

1. 4 layer compression banding (only treatment shown to be of real benefit) 2. Oral pentoxifylline (peripheral vasodilator), improves healing rate 3. Flavinoids 4. Little evidence for hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression

Answer 17

Autoimmune blistering skin disorder associated with coeliac disease

Answer 18

Deposition of IgA in the dermis

Answer 19

Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

Answer 20

Skin biopsy = direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis

Answer 21

1. Gluten-free diet 2. Dapsone

Answer 22

1. Irritant 2. Allergic

Answer 23

Common non-allergic reaction due to weak acids or alkalis (e.g. detergents). Often seen on the hands. Erythema is typical, crusting and vesicles are rare

Answer 24

Type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid is indicated

Answer 25

Cement. The alkaline nature of cement may cause an irritant contact dermatitis whilst the dichromates in cement also can cause an allergic contact dermatitis.

Answer 26

Small, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns.

Answer 27

Capillary haemangioma

Answer 28

1. Not present at birth but may grow rapidly in 1st month of life 2. Erythematous, raised, multilobed tumours 3. Typically they increase in size until around 6-9 months before regressing over the next few years (around 95% resolve before 10 years of age). 4. Common sites include the face, scalp and back. Rarely they may be present in the upper respiratory tract leading to potential airway obstruction 5. Capillary haemangiomas are present in around 10% of white infants. Female infants, premature infants and those of mothers who have undergone chorionic villous sampling are more likely to be affected

Answer 29

1. Mechanical = obstructing visual fields or airway 2. Bleeding 3. Ulceration 4. Thrombocytopenia

Answer 30

If treatment is required (e.g. Visual field obstruction) then propranolol is increasingly replacing systemic steroids as the treatment of choice. Topical beta-blockers such as timolol are also sometimes used.

Answer 31

Deep capillary haemangioma

Answer 32

Guttate psoriasis

Answer 33

1. More common in children and adolescents 2. May be precipitated by streptococcal infection 2-4 weeks prior to lesions appearing 3. Tear drop papules on the trunk and limbs, pink/scaly patches or plaques of psoriasis 4. Tends to be acute onset over days

Answer 34

1. Usually resolve spontaneously within 2-3 months 2. No evidence for Abx 3. Topical agents as per psoriasis 4. UVB phototherapy 5. Tonsillectomy may be necessary with recurrent episodes

Answer 35

Pityriasis rosea

Answer 36

1. Many patients report recent respiratory tract infections but this is not common in questions 2. Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a 'fir-tree' appearance 3. Self-limiting, resolves after around 6 weeks

Answer 37

Autoimmune condition which results in the loss of melanocytes and consequent depigmentation of the skin

Answer 38

1% of the population and symptoms typically develop by the age of 20-30 years.

Answer 39

1. Well demarcated patches of depigmented skin 2. Peripheries tend to be most affected 3. Koebner phenomenon

Answer 40

1. T1DM 2. Addison's 3. Thyroid 4. Pernicious anaemia 5. Alopecia areata

Answer 41

1. Sunblock 2. Camouflage make-up 3. Topical corticosteroids may reverse the changes if applied early 4. May also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients

Answer 42

Bleeding into the skin from small blood vessels that produces a non-blanching rash. Smaller petechiae (1-2 mm in diameter) may also be seen. It is typically caused by low platelets but may also be seen with bleeding disorders, such as von Willebrand disease.

Answer 43

Bleeding into the skin from small blood vessels that produces a non-blanching rash. Smaller petechiae (1-2 mm in diameter) may also be seen. It is typically caused by low platelets but may also be seen with bleeding disorders, such as von Willebrand disease.

Answer 44

Bleeding into the skin from small blood vessels that produces a non-blanching rash. Smaller petechiae (1-2 mm in diameter) may also be seen. It is typically caused by low platelets but may also be seen with bleeding disorders, such as von Willebrand disease.

Answer 45

Closer personal contact, fomites

Answer 46

Maximum incidence 1-4 y/o

Answer 47

1. Pinkish/pearly white papules with central umbilication, up to 5mm in diameter 2. Do not occur on palms or soles

Answer 48

1. Self limiting, within 18m 2. Avoid sharing towels etc., do not scratch lesions 3. No exclusion from school/gym/swimming necessary

Answer 49

1. Not usually recommended, if lesions troublesome use simple trauma or cryotherapy 2. Squeezing with fingernails or piercing with orange stick following a batch 3. Cryotherapy in older children or adults 4. Eczema can develop around lesion --> 1% hydrocortisone if itching problematic, fusidic acid 2% if skin looks infected

Answer 50

Urgent referral to HIV specialist

Answer 51

Urgent referral to ophthalmologist

Answer 52

Refer to GUM for screening for other STIs

Answer 53

Patch testing

Answer 54

A chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population.

Answer 55

1. Eczematous lesions on sebum-rich areas: scalp, periorbital, auricular and nasolabial folds 2. Otitis externa and blepharitis may develop

Answer 56

1. HIV 2. Parkinsons

Answer 57

1. OTC containing zinc pyrithione (H&S) and tar (Neutrogena T/gel) 1st line 2. Ketoconazole 2nd line 3. Selenium sulphide and topical corticosteroid may also be useful

Answer 58

1. Topical antifungals = ketoconazole 2. Topical steroids = short periods 3. Difficult to treat = recurrences are common

Answer 59

Sarcoptes scabiei

Answer 60

The scabies mite burrows into the skin, laying its eggs in the stratum corneum. The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection.

Answer 61

1. Widespread pruritis 2. Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist 3. In infants, the face and scalp may also be affected 4. Secondary features are seen due to scratching: excoriation, infection

Answer 62

1. Permethrin 1st line 2. Malathion 0.5% 2nd line 3. All household/close physical contacts should be treated at the same time, even if asymptomatic 4. Launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.

Answer 63

Up to 4-6 weeks post eradication

Answer 64

1. Apply to cool, dry skin 2. Pay close attention to areas between fingers and toes, under nails, armpit area, creases of the skin such as at the wrist and elbow 3. Allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off 4. Reapply if insecticide is removed during the treatment period, e.g. If wash hands, change nappy, etc 5. Repeat treatment 7 days later

Answer 65

1. Seen in patients with suppressed immunity, especially HIV 2. Will have hundreds of thousands of organisms 3. Ivermectin is the Rx of choice and isolation is essential

Answer 66

Androgen-dependent hair growth in women

Answer 67

Androgen-independent hair growth

Answer 68

1. PCOS, Cushings, CAH, Androgen therapy 2. Obesity, adrenal tumour, androgen secreting ovarian tumour 3. Drugs = phenytoin, corticosteroids

Answer 69

Ferriman-Gallwey scoring system = 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

Answer 70

1. Weight loss if overweight 2. Waxing/bleaching not available on NHS 3. COCP e.g. co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin) 4. Facial hirsutism = topical eflornithine - contraindicated in pregnancy and breast-feeding

Answer 71

1. Drugs = minoxidil, ciclosporin, diazoxide 2. Congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis 3. Porphyria Cutanea Tarda 4. Anorexia Nervosa

Answer 72

Obstruction of the pilosebaceous follicles with keratin plugs which results in comedones, inflammation and pustules

Answer 73

1. Mild = open and closed comedones with or without sparse inflammatory lesions 2. Moderate = widespread non-inflammatory lesions and numerous papules and pustules 3. Severe = extensive inflammatory lesions, which may include nodules, pitting, and scarring

Answer 74

1. Single topical therapy = topical retinoids, benzoyl peroxide 2. Topical combination therapy 3. Oral Abx 4. COCP 5. Oral isotretinoin

Answer 75

1. Tetracycline = lymecycline, doxycycline, oxytetracycline 2. Avoid tetracyclines in pregnant/breastfeeding/children<12y/o 3. Use erythromycin in pregnancy 4. Single oral abx should be used for maximum of 3m 5. Topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing 6. Gram-negative folliculitis may occur as a complication of long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs

Answer 76

High dose oral trimethoprim

Answer 77

1. Use in combination with topical agents 2. Dianette (co-cyprindiol) is sometimes used as it has anti-androgen properties. However, it has an increased risk of venous thromboembolism compared to other COCPs, therefore it should generally be used second-line, only be given for 3 months and women should be appropriately counselled about the risks

Answer 78

1. Inflammation of subcutaneous fat 2. Tender, erythematous, nodular lesions 3. Occur over shins, may also occur elsewhere e.g. forearms, thighs 4. Usually resolves within 6 weeks 5. Lesions heal without scarrgin

Answer 79

1. Infection = Strep, TB, Brucella 2. Inflammation = Sarcoid, IBD, Behcets 3. Malignancy/lymphoma 4. Drugs = penicillins, sulphonamides, COCP 5. Pregnancy

Answer 80

Symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.

Answer 81

1. T2DM, Obesity, PCOS, Acromegaly, Cushings, Hypothyroidism 2. GI Cancer 3. Familial 4. Prader-Willi syndrome 5. Drugs = COCP, Nicotinic acid

Answer 82

Insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

Answer 83

A hypersensitivity reaction that is most commonly triggered by infections. It may be divided into minor and major forms. Previously it was thought that Stevens-Johnson syndrome (SJS) was a severe form of erythema multiforme. They are now however considered as separate entities.

Answer 84

1. Target lesions initially seen on back of hands/feet before spreading to the torso 2. Upper limbs are more commonly affected than the lower limbs 3. Pruritis occasionally seen and is usually mild

Answer 85

1. Viral = HSV (most common), Orf 2. Bacteria = Mycoplasma, Streptococcus 3. CTD = SLE 4. Sarcoidosis 5. Malignancy 6. Idiopathic 7. Drugs = Penicillins, sulphonamides, carbamazepine, allopurinol, NSAIDs, COCP, Nevirapine

Answer 86

Mucosal involvement

Answer 87

1. Scarring = destruction of hair follicle 2. Non-scarring = preservation of hair follicle

Answer 88

1. Trauma, burns 2. Radiotherapy 3. Lichen planus 4. Discoid lupus 5. Tinea capitis

Answer 89

1. Male-pattern baldness 2. Iron and zinc deficiency 3. AI = alopecia areata 4. Telogen effluvium = hair loss following stressful period 5. Trichotillomania 6. Drugs = cytoxic drugs, carbimazole, heparin, COCP, colchicine

Answer 90

If a kerion develops

Answer 91

An inflammatory condition that usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming

Answer 92

1. White patches that may scar 2. Itch is prominent 3. May result in pain during intercourse or urination

Answer 93

Clinical, but biopsy may be performed if atypical features present

Answer 94

Topical steroids and emollients

Answer 95

Increased risk of vulval cancer

Answer 96

1. Never tans, always burns (often red hair, freckles, and blue eyes) 2. Usually tans, always burns 3. Always tans, sometimes burns (usually dark hair and brown eyes) 4. Always tans, rarely burns (olive skin) 5. Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian) 6. Black skin (e.g. Afro-Caribbean), never tans, never burns

Answer 97

1. Trauma 2. Alcohol 3. Withdrawal of systemic steroids 4. Drugs

Answer 98

1. BB 2. Lithium 3. Antimalarials = chloroquine and HCQ 4. NSAID 5. ACEi 6. Infliximab

Answer 99

Increased risk of drug-induced lupus and hyperpigmentation

Answer 100

1. Papular lesions that are often slightly hyperpigmented and depressed centrally 2. Typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs

Answer 101

1. Premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers. 2. Diagnosis of exclusion. Candidiasis and lichen planus should be considered, especially if the lesions can be 'rubbed off' 3. Biopsies are usually performed to exclude alternative diagnoses such as squamous cell carcinoma and regular follow-up is required to exclude malignant transformation to squamous cell carcinoma, which occurs in around 1% of patients.

Answer 102

Fungal infection of the nails

Answer 103

1. Dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases 2. Yeasts e.g. Candida 3. Non-dermatophyte moulds

Answer 104

DM and age

Answer 105

1. Unsightly nails 2. Thickened, rough, opaque nails

Answer 106

1. Psoriasis 2. Repeated trauma 3. Lichen planus 4. Yellow nail syndrome

Answer 107

1. Nail clippings 2. Nail scrapings 3. False-negative for cultures are around 30%, so repeat samples may need to be sent if the clinical suspicion is high

Answer 108

1. No Rx needed if asymptomatic and pt not bothered by appearance 2. Dx should be confirmed by microbiology before starting treatment 3. Rx depends on organism

Answer 109

1. Oral terbinafine is currently recommended first-line with oral itraconazole as an alternative 2. 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months 3. Treatment is successful in around 50-80% of people

Answer 110

1. Mild disease should be treated with topical antifungals (e.g. Amorolfine) whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks 2. if topical topical treatment is given treatment should be continued for 6 months for fingernails and 9-12 months for toenails

Answer 111

Otitis externa and blepharitis

Answer 112

Dermatophyte fungal infection

Answer 113

1. Tinea capitis = scalp 2. Tinea corporis = trunk, legs or arms 3. Tinea pedis = feet

Answer 114

1. A cause of scarring alopecia mainly seen in children 2. If untreated, a raised, pustular, spongy/boggy mass called a kerion may form 3. Most common cause is Trichophyton tonsurans in the UK and the USA 4. May also be caused by Microsporum canis acquired from cats or dogs 5. Diagnosis: lesions due to Microsporum canis green fluorescence under Wood's lamp*. However the most useful investigation is scalp scrapings

Answer 115

1. Oral terbinafine for Trichophyton tonsurans 2. Oral griseofulvin for Microsporum 3. Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission

Answer 116

1. Causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle) 2. Well-defined annular, erythematous lesions with pustules and papules 3. Rx = oral fluconazole

Answer 117

Athlete's foot

Answer 118

1. Atopic eruption of pregnancy 2. Polymoprhic eruption of pregnancy 3. Pemphigoid gestationis

Answer 119

1. Commonest in pregnancy 2. Eczematous, itchy rash 3. No specific Rx needed

Answer 120

1. Last trimester 2. Lesions appear first in abdominal striae 3. Rx depends on severity = emollients, mild potency topical steroids, oral steroids

Answer 121

1. Pruritic blistering lesions 2. Often in peri-umbilical region, later spread to trunk, back, buttocks and arms 3. Usually presents in 2nd or 3rd trimester and is rarely seen in the first pregnancy 4. Oral corticosteroids are usually required

Answer 122

Tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

Answer 123

1. Ethnicity = dark skin 2. Young adults, rarely in elderly 3. Common sites = sternum, shoulder, neck, face, extensor surface of limbs, trunk

Answer 124

Along relaxed skin tension lines

Answer 125

1. Early keloids may be treated with intra-lesional steroids e.g. triamcinolone 2. Excision is sometimes required but careful consideration needs to given to the potential to create further keloid scarring

Answer 126

Zinc deficiency (also Vitamin B2 riboflavin deficiency)

Answer 127

1. Acrodermatitis = red, crusted lesions = acral distribution, peri-orificial, peri-anal 2. Alopecia 3. Short stature 4. Hypogonadism 5. Hepatosplenomegaly 6. Geophagia (ingesting clay/soil) 7. Cognitive impairment

Answer 128

A recessively inherited partial defect in intestinal zinc absorption

Answer 129

1. Pitting 2. Onycholysis (separation of the nail from the nail bed) 3. Subungual hyperkeratosis 4. Loss of the nail

Answer 130

Breslow thickness

Answer 131

1. <0.75 mm = 95-100% 2. 0.76 - 1.5 mm = 80-96% 3. 1.51 - 4mm = 60-75% 4. >4mm = 50%

Answer 132

Keratoacanthoma

Answer 133

A benign epithelial tumour. They are more common with advancing age and rare in young people.

Answer 134

1. Said to look like a volcano or crater 2. Initially a smooth dome-shaped crater 3. Rapidly grows to become a crater centrally-filled with keratin

Answer 135

Spontaneous regression of keratoacanthoma within 3 months is common, often resulting in a scar. Such lesions should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma. Removal also may prevent scarring.

Answer 136

Describe a central red papule with surrounding capillaries. The lesions blanch upon pressure. Spider naevi are almost always found on the upper part of the body.

Answer 137

Spider naevi fill from the centre, telangiectasia from the edge

Answer 138

10-15%, and they are more common in childhood

Answer 139

1. Liver disease 2. Pregnancy 3. COCP

Answer 140

Planus: 1. Purple 2. Polygonal 3. Pruritic 4. Papular

Answer 141

1. 1st line = topical aluminium chloride preparations, main s/e = skin irritation 2. Iontophoresis = particularly useful for patients with palmar, plantar and axillary hyperhidrosis 3. Botulinum toxin = axillary symptoms 4. Surgery = Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

Answer 142

1. Sun-exposed sites 2. Pearly, flesh coloured papule with telangiectasia 3. May ulcerate, leaving a central crater

Answer 143

If suspected, routine referral should be made

Answer 144

1. Surgical removal 2. Curettage 3. Cryotherapy 4. Topical cream = Imiquimod, Fluorouracil 5. Radiotherapy

Answer 145

Classified as a neutrophilic dermatosis. Neutrophilic dermatoses are skin conditions characterised by dense infiltration of neutrophils in the affected tissue and this is often seen on biopsy

Answer 146

1. Idipathic in 50% 2. IBD 3. Rheum = RhA, SLE 4. Haem = myeloproliferative disorders, lymphoma, myeloid leukaemias, monoclonal gammopathy (IgA) 5. GPA 6. PBC

Answer 147

1. Location = typically lower limb, often at the site of a minor injury 2. Usually starts suddenly, small pustule, red bump or blood-blister 3. Skin breaks down, resulting in an ulcer. Edge of ulcer often purple, violaceous and undermined. Ulcer itself may be deep and necrotic 4. May be accompanied by fever and myalgia

Answer 148

1. Often made by the characteristic appearance, associations with other diseases, the presence of pathergy, histology results and when other diseases have been ruled out 2. Histology is not specific and can vary depending on the time and site of the specimen but may be helpful in ruling out other causes of an ulcer

Answer 149

1. Oral steroids 1st line (potential for rapid progression is high) 2. Ciclosporin and infliximab in difficult cases 3. Surgery should be postponed until the disease process is controlled on immunosuppression to risk worsening of the disease (pathergy)

Answer 150

1. Erythema nodosum 2. Pretibial myxoedema 3. Pyoderma gangrenosum 4. Necrobiosis lipoidica diabeticorum

Answer 151

1. Symmetrical, erythematous lesions seen in Graves' disease 2. Shiny, orange peel skin

Answer 152

1. Shiny, painless areas of yellow/red skin typically on the shin of diabetics 2. Often associated with telangiectasia

Answer 153

1. Mild 2. Moderate 3. Potent 4. Very potent

Answer 154

Hydrocortisone 0.5-2.5%

Answer 155

1. Betamethasone valerate 0.025% (Betnovate RD) 2. Clobetasone butyrate 0.05% (Eumovate)

Answer 156

1. Fluticasone propionate 0.05% (Cutivate) 2. Betamethasone valerate 0.1% (Betnovate)

Answer 157

Clobetasol propionate 0.05% (Dermovate)

Answer 158

1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand

Answer 159

Pretibial myxoedema

Answer 160

An autosomal dominant condition characterised by multiple telangiectasia over the skin and mucous membranes. Twenty percent of cases occur spontaneously without prior family history.

Answer 161

2 = possible Dx, 3 = definite diagnosis 1. Epistaxis 2. Telangiectasias 3. Visceral lesions 4. FHx

Answer 162

1. GI 2. Lung AVM 3. Hepatic AVM 4. Cerebral AVM 5. Spinal AVM

Answer 163

Histiocytoma

Answer 164

Common benign fibrous skin lesions. They are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury. Common areas include the arms and legs.

Answer 165

1. Solitary firm papule or nodule, typically on a limb 2. Typically 5-10mm in size 3. Overlying skin dimples on pinching lesions

Answer 166

Dermatofibroma

Answer 167

Impetigo is a superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes. It can be a primary infection or a complication of an existing skin condition such as eczema, scabies or insect bites. Impetigo is common in children, particularly during warm weather. The infection can develop anywhere on the body but lesions tend to occur on the face, flexures and limbs not covered by clothing.

Answer 168

Spread is by direct contact with discharges from the scabs of an infected person. The bacteria invade the skin through minor abrasions and then spread to other sites by scratching. Infection is spread mainly by the hands, but indirect spread via toys, clothing, equipment and the environment may occur. The incubation period is between 4 to 10 days.

Answer 169

1. 'Golden' crusted skin lesions typically found around the mouth 2. Very contagious

Answer 170

1. Hydrogen peroxide 1% cream for 'people who are not systemically unwell or at a high risk of complications' 2. Topical Abx cream = Fusidic Acid, Mupirocin if fusidic acid resistance suspected

Answer 171

1. Oral flucloxacillin 2. Oral erythromycin if pen-allergic

Answer 172

Children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

Answer 173

Polycythaemia

Answer 174

1. Pruritis after warm bath 2. ruddy complexion 3 Gout 4. Peptic ulcer disease

Answer 175

Superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

Answer 176

1. Most commonly affects trunk, patches may be hypopigmented/pink/brown. Msay be more noticeable following a suntan 2. Scale is common 3. Mild pruritis

Answer 177

1. Occurs in healthy individuals 2. immunosuppression 3. Malnutrition 4. Cushing's

Answer 178

1. Ketoconazole shampoo 2. If failure to respond consider other diagnosis e.g. send scrapings + oral itraconazole

Answer 179

Skin patch tst

Answer 180

Alopecia areata

Answer 181

A presumed autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken 'exclamation mark' hairs

Answer 182

Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients.

Answer 183

1. Topical/intralesional corticosteroids 2. Topical minoxidil 3. Phototherapy 4. Dithranol 5. Contact immunotherapy 6. Wigs

Answer 184

Rare form of T-cell lymphoma that affects the skin

Answer 185

1. Itchy, red patches 2. Lesions tend to be of different colours in contrast to eczema/psoriasis where there is greater homogenicity

Answer 186

Eczema or psoriasis

Answer 187

Pautrier microabscesses

Answer 188

A relatively common benign skin lesion. The name is confusing as they are neither true granulomas nor pyogenic in nature. There are multiple alternative names but perhaps 'eruptive haemangioma' is the most useful.

Answer 189

1. Trauma 2. Pregnancy 3. More common in women and young adults

Answer 190

1. Most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy 2. Initially small red/brown spot, rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape 3. Lesions may bleed profusely or ulcerate

Answer 191

1. Lesions associated with pregnancy often resolve spontaneously post-partum 2. Other lesions usually persist - removal methods include curettage and cauterisation, cryotherapy, excision

Answer 192

Louis-Bar syndrome

Answer 193

A common premalignant skin lesion that develops as a consequence of chronic sun exposure

Answer 194

1. Small, crusty or scaly lesions 2. May be pink, red, brown or the same colour as the skin 3. Typically on sun exposed areas 4. Multiple lesions may be present

Answer 195

1. Prevention of further risk e.g. sun avoidance, sun cream 2. Fluorouracil cream = typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation 3. Topical diclofenac = may be used for mild AKs. Moderate efficacy but much fewer side-effects 4. Topical imiquimod 5. Cryotherapy, curettage and cautery

Answer 196

Pemphigus vulgaris

Answer 197

An autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule. It is more common in the Ashkenazi Jewish population.

Answer 198

1. Mucosal ulceration is common and often the presenting symptom. Oral involvement is seen in 50-70% of patients 2. Skin blistering - flaccid, easily ruptured vesicles and bullae. Lesions are typically painful but not itchy. These may develop months after the initial mucosal symptoms. Nikolsky's describes the spread of bullae following application of horizontal, tangential pressure to the skin 3. Acantholysis on biopsy

Answer 199

1. Steroids 1st line 2. Immunosuppressants

Answer 200

No, topical mupirocin should be used instead

Answer 201

Chlorphenamine

Answer 202

Loratadine, cetirizine

Answer 203

1. Teratogenicity = 2 forms of contraception 2. Dry skin, eyes and lips/mouth = most common 3. Low mood 4. Raised trigylcerides, hair thinning, nose bleeds 5. Intracranial hypertension 6. Photosesitivity

Answer 204

1. Necrobiosis lipoidica 2. Infection = candida, staph 3. Neuropathic ulcers 4. Vilitigo 5. Lipoatrophy 6. Granuloma annulare

Answer 205

1. Multifactorial and not yet fully understood 2. Genetic = associated HLA-B13, -B17, and -Cw6. Strong concordance (70%) in identical twins 3. Immunological = abnormal T cell activity stimulates keratinocyte proliferation 4. Environmental = recognised that psoriasis may be worsened (e.g. Skin trauma, stress), triggered (e.g. Streptococcal infection) or improved (e.g. Sunlight) by environmental factors

Answer 206

1. Plaque = most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp 2. Flexural = skin is smooth 3. Guttate = transient psoriatic rash frequently triggered by a streptococcal infection 4. Pustular = commonly on palms and soles

Answer 207

Nail signs and arthritis

Answer 208

1. Psoriatic arthropathy (around 19%) 2. Psychological distress 3. Increased incidence of CVD, VTE, metabolic syndrome

Answer 209

1. Sunlight/PUVA 2. Actinic keratoses and Bowne's disease 3. Immunosuppression 4. Smoking 5. Long standing ulcer e.g. MArjolin's 6. Genetic = xeroderma pigmentosum, oculocutaneous albinism

Answer 210

1. Sun exposed sites 2. Rapidly expanding painless, ulcerating nodules 3. Cauliflower-like appearance 4. Areas of bleeding

Answer 211

Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm. Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

Answer 212

1. Poorly differentiated 2. >20mm deep 3. >4mm deep 4. Immunsupression

Answer 213

1. Well differentiated 2. <20mm deep 3. <2mm deep 4. No associated diseases

Answer 214

Refer urgently 2ww

Answer 215

A severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction. Previously it was thought that Stevens-Johnson syndrome (SJS) was a severe form of erythema multiforme. They are now however considered as separate entities.

Answer 216

1. Penicillin 2. Sulphonamides 3. Lamotrigine, carbamazepine, phenytoin 4. Allopurinol 5. NSAIDs 6. COCP

Answer 217

1. Maculopapular rash with target lesions being characteristic = vesicles or bullae, Nikolsky sign positive in erythematous areas 2. Mucosal involvement 3. Systemic symptoms = fever, arthralgia

Answer 218

Hospital admission for supportive treatment

Answer 219

1. Verrucas 2. Tinea pedis 3. Corn and calluses 4. Keratoderma 5. Pitted keratolysis 6. Palmoplantar pustulosis 7. Juvenile plantar dermatosis

Answer 220

1. Secondary to HPV 2. Firm, hyperkeratotic lesions 3. Pinpoint petechiae centrally within the lesions 4. May coalesce with surrounding warts to form mosaic warts

Answer 221

A corn is small areas of very thick skin secondary to a reactive hyperkeratosis

Answer 222

A callus is larger, broader and has a less well defined edge than a corn

Answer 223

1. Acquired or congenital 2. Describes a thickening of the skin of the palms and soles 3. Acquired causes include reactive arthritis (keratoderma blennorrhagica)

Answer 224

1. Affects people who sweat excessively 2. Patients may complain of damp and excessively smelly feet 3. Usually caused by Corynebacterium 4. Heel and forefoot may become white with clusters of punched-out pits

Answer 225

1. Crops of sterile pustules affecting the palms and soles 2. The skin is thickened, red. Scaly and may crack 3. More common in smokers

Answer 226

1. Affects children. More common in atopic patients with a history of eczema 2. Soles become shiny and hard. Cracks may develop causing pain 3. Worse during the summer

Answer 227

Gastric cancer

Answer 228

GI and lung

Answer 229

Ovarian and lung

Answer 230

Pancreatic

Answer 231

Glucagonoma

Answer 232

Myeloproliferative disorders

Answer 233

Oesophageal cancer

Answer 234

Vascular birthmarks that tend to be unilateral. They are deep red or purple in colour. Unlike other vascular birthmarks such as salmon patches and strawberry haemangiomas, they do not spontaneously resolve, and in fact often darken and become raised over time. Treatment is with cosmetic camouflage or laser therapy (multiple sessions are required)

Answer 235

Sebaceous cysts is a general term which encompasses both epidermoid and pilar cysts. It is a bit of a misnomer and probably best avoided where possible. Epidermoid cysts are due to a proliferation of epidermal cells within the dermis. Pilar cysts (also known as trichilemmal cysts or wen) derive from the outer root sheath of the hair follicle.

Answer 236

Surgical excision of the whole structure

Answer 237

Pompholyx is a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema. Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures.

Answer 238

1. Small blisters on the palms and soles 2. Pruritic = often intensely itchy, sometimes burning sensation 3. Once blisters burst skin may become dry and crack

Answer 239

1. Cool compresses 2. Emollients 3. Topical steroids

Answer 240

Humidity and high temperatures

Answer 241

Lupus pernio

Answer 242

A purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules

Answer 243

1. Idiopathic (most common) 2. PAN 3. SLE, APS 4. Cryoglobulinaemia 5. Ehlers-Danlos syndrome, homocystinuria

Answer 244

A local or generalised superficial swelling of the skin. The most common cause of urticaria is allergy although non-allergic causes are seen.

Answer 245

1. Pale, pink raised skin --> AKA hives, wheals, nettle rash 2. Pruritic

Answer 246

1. Non-sedating antihistamines 1st line 2. Prednisolone used for severe or resistant episodes

Answer 247

Stress ulcer than can occur after severe burns

Answer 248

Keratinocytes migrate to form a new layer over the burn site

Answer 249

Dermal scarring. Usually need keratinocytes from skin grafts to provide optimal coverage.

Dermatology Flashcards

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