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Med School Finals > Dermatology > Flashcards

Dermatology Flashcards

(80 cards)

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1
Q

Layers of the skin from superficial to deep?

A

Epidermis
→ keratin layer
→ granular layer
→ prickle cell layer
→ basal cell layer
Dermoepidermal junction
Dermis
→ papillary dermis
→ reticular dermis

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2
Q

Outline the pathophysiology of acne?

A
  • Androgens increase sebum production
  • Sebum and keratin block the pilosebaceous unit leading to swelling and inflammation
  • Colonisation of propionibacterium acnes leads to further inflammation
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3
Q

Features of acne vulgaris?

A

Mild = comedones
Moderate = comedones, pustules, papules
Severe = extensive inflammatory lesions, scarring

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4
Q

Management of acne vulgaris?

A

Depend on severity of symptoms:
→ benzoyl peroxide
→ topical retinoid
→ topical antibiotics
→ oral antibiotics or contraceptive (females)
→ oral retinoid

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5
Q

List some side effects of isotretinoin?

A

Teratogenic
Dry lips/mouth
Hair thinning
Low mood
Photosensitivity

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6
Q

Advice for prescribing Dianette for acne vulgaris?

A

Higher risk of VTE compared to other COCPs
Use for a maximum of 3 months

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7
Q

Advice for prescribing oral antibiotics for acne vulgaris?

A

Co-prescribe benzoyl peroxide or oral retinoid
Tetracycline is preferred
Use for a maximum of 3 months

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8
Q

Features and management of acne rosacea?

A

Facial flushing
Pustules, papules
Telangiectasia
Rhinophyma
Triggers e.g. UV, alcohol
Management = brimonidine (flushing), topical ivermectin, topical metronidazole, oral doxycycline

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9
Q

Topical steroid ladder?

A

Help Every Budding Dermatologist:
Mild = hydrocortisone
Moderate = eumovate (clobestasone butyrate)
Potent = betnovate (betamethasone)
Very potent = dermovate (clobetasol propionate)

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10
Q

Feature of atopic dermatitis (eczema)?

A

Dry, flaky, itchy skin on flexor surfaces
→ extensors/cheeks in babies

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11
Q

Management of atopic dermatitis (eczema)?

A

Emollient +/- topical steroid

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12
Q

Feature, cause and management of eczema herpeticum?

A

Monomorphic “punched out” lesions
Cause = HSV-1 or HSV-2 infection
Management = admission + IV aciclovir

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13
Q

Features, cause and management of impetigo?

A

Golden, crusted lesions around mouth
Cause = staphylococcus or streptococcus
Management = topical hydrogen peroxide or topical fusidic acid (limited), oral flucloxacillin (extensive)

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14
Q

School exclusion for children with impetigo?

A

48 hours after starting antibiotics

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15
Q

Types of contact dermatitis and cause?

A

Irritant = non-allergic reaction to chemical damage
Allergic = type IV hypersensitivity reaction to allergen

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16
Q

Investigation and management of contact dermatitis?

A

Investigation = patch testing
Management = emollient +/- topical steroid

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17
Q

Feature, cause and management of seborrhoeic dermatitis?

A

Dry, flaky, itchy skin on sebum-rich areas
Cause = malassezia furfur (yeast)
Management = topical ketoconazole

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18
Q

Feature and management of dermatitis herpetiformis?

A

Itchy, vesicular rash on extensor surfaces
Management = gluten-free diet, dapsone

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19
Q

Features of plaque psorasis?

A

Red, scaly plaques on extensors, scalp, trunk, buttocks
Nail changes e.g. pitting, onycholysis

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20
Q

Triggers of plaque psoriasis?

A

Skin trauma (Koebner phenomenon)
Beta-blockers, NSAIDs, lithium, anti-malarials

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21
Q

Management of plaque psoriasis?

A

1st line = emollient + topical steroid (OD) + topical vit D analogue (OD)
2nd line = emollient + topical vit D analogue (BD)
3rd line = emollient + topical steroid (BD)
N.B. dithranol (vit A analogue) and coal tar can also be used

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22
Q

Secondary care management of plaque psoriasis?

A

Phototherapy = narrowband UVB
Systemic therapy = methotrexate

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23
Q

Management of scalp psoriasis?

A

Topical steroid + softener e.g. salicylic acid

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24
Q

Features and management of guttate psoriasis?

A

“Tear drop” papules on trunk and limbs
2-4 weeks post-strep infection
Management = self-resolving

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25
Features and management of lichen planus?
Itchy, purple, polygonal, papular rash Wickham's striae Management = topical steroid
26
Drugs which can cause lichenoid eruption?
Beta-blockers Gold Thiazides Anti-malarials
27
Features and management of lichen sclerosus?
Mostly elderly women Genital itch Atrophy Scarring Management = emollients +/- topical steroids
28
What is erythroderma and most common cause?
Erythema covering > 90% of body surface Exacerbation of existing skin disease e.g. dermatitis
29
What is erythrasma and most common cause?
Pink/brown patches in damp areas e.g. groin Overgrowth of corynebacterium
30
What is erythema multiforme and most common cause?
Type IV hypersensitivity reaction causing target lesions HSV infection
31
What is erythema nodosum and most common cause?
Inflammation of subcut fat causing tender nodules Group B strep infection
32
What is erythema ab igne and most common cause?
Reticulated pattern of erythema and hyperpigmentation Infrared radiation e.g. hot water bottles
33
Cause of pityriasis rosea vs pityriasis versicolor?
Rosea = HHV-7 Versicolor = malassezia furfur
34
Features and management of pityriasis rosea?
Initially single herald patch on trunk Widespread rash of scaly patches follows Management = self-limiting
35
Features and management of pityriasis versicolor?
Pink, brown or hypopigmented scaly patches More noticeable with suntan Management = ketoconazole shampoo
36
Features, cause and management of shingles?
Prodromal burning pain over dermatome Vesicular, blistering rash Cause = reactivated VZV Management = aciclovir + paracetamol/NSAIDs
37
Complications of shingles?
Post-herpetic neuralgia Ocular issues (CN V1 involvement) Facial paralysis (CV VII "Ramsay Hunt")
38
Outline the shingles vaccination programme?
Offered to anyone aged 71-79
39
Management of tinea capitis vs tinea corporis vs tinea pedis?
Capitis = topical ketoconazole + oral antifungal Corporis = oral antifungal Pedis = topical antifungal (1st line), oral antifungal (2nd line)
40
Management of fungal nail infection?
Limited = topical amorolfine 5% Extensive= oral terbinafine
41
Management of scabies?
All household members should be treated: 1st line = permethrin 5% 2nd line = malathion 0.5%
42
Management of head lice?
Only treat other household members if symptomatic: 1st line = malathion
43
Features and management of molluscum contagiosum?
Pearly papules with central umbilication Management = self-limiting
44
Features, cause and management of chickenpox?
Prodromal fever Itchy rash (macular → papular → vesicular) Cause = VZV Management = supportive, immunocompromised or peripartum exposure = IV VZV Ig → IV aciclovir if chickenpox develops
45
School exclusion for children with chickenpox?
Until all lesions are crusted over
46
Features, cause and management of roseola infantum?
Prodromal high fever Febrile convulsions Maculopapular rash Nagayama spots (uvula/soft palate) Cause = HHV-6 Management = self-limiting
47
Features, cause and management of hand, foot and mouth?
Generally unwell e.g. fever Oral ulcers Vesicles on palms and soles Cause = coxsackie A16 Management = supportive
48
School exclusion for hand, foot and mouth?
No need to stay off if well
49
Red or purple birthmark that gets darker over time?
Port wine stain
50
Blotchy pink birthmark that improves over time (except ones on neck)?
Salmon patch
51
Red, multi-lobed growth presenting in the first month of life and improving over time?
Strawberry naevus
52
Common newborn rash containing small papules surrounded by an erythematous halo?
Erythema toxicum
53
Common newborn keratin-filled cysts on face?
Milia
54
Brown "stuck on" lesions seen in older people?
Seborrhoeic keratosis (basal cell papilloma)
55
Solitary firm papule originating at site of injury e.g. insect bite?
Dermatofibroma
56
Features of Lyme disease?
Erythema migrans Generally unwell e.g. fever Heart block Pericarditis Nerve palsies
57
Investigations and management of Lyme disease?
Investigations = clinical diagnosis if erythema migrans present, ELISA antibodies to borrelia burgdorferi (1st line) Management = doxycycline (early disease), ceftriaxone (disseminated disease)
58
Features and management of urticaria?
Itchy, pink raised skin "Hives," "wheals" etc. Management = non-sedating antihistamine
59
Examples of sedating vs non-sedating antihistamines?
Sedating = chlorpheniramine (Piriton), promethazine, cyclizine Non-sedating = loratadine, fexofenadine, cetirizine
60
Cause of bullous pemphigoid vs pemphigus vulgaris?
Bullous pemphigoid = antibodies against hemidesmosomal proteins Pemphigus vulgaris = antibodies against desmoglein 3
61
Features and management of bullous pemphigoid?
Itchy, tense sub-epidermal blisters Heal without scarring Nikolsky's sign -ve No mucosal involvement Management = oral steroids
62
Skin biopsy feature of bullous pemphigoid?
IgG and C3 at the DEJ
63
Features and management of pemphigus vulgaris?
Painful, flaccid epidermal blisters Heals with scarring Nikolsky's sign +ve Mucosal involvement Management = oral steroids
64
Skin biopsy feature of pemphigus vulgaris?
Acantholysis
65
Features, cause and management of AIP?
GI upset Motor neuropathy Depression Red urine Cause = porphobilinogen deaminase deficiency Management = IV haem arginate
66
Features, cause and management of PCT?
Photosensitive rash Hypertrichosis Hyperpigmentation Cause = uroporphyrinogen decarboxylase deficiency Management = chloroquine, venesection
67
Most common causes of SJS/TEN?
Antibiotics Antiepileptics Allopurinol NSAIDs
68
Difference between SJS vs TEN?
SJS = < 10% body surface TEN = > 30% body surface N.B. 10-30% is SJS/TEN overlap syndrome
69
Features and management of SJS/TEN?
Widespread erythematous rash Vesicles and bullae Nikolsky's +ve Sytemically unwell Management = admission + supportive manegement + IV Igs (TEN)
70
Classification and features of burns?
Superficial epidermal (1st degree) = red, painful, dry Partial thickness (2nd degree) → superficial dermal = pink, painful, blistered → deep dermal = white +/- patches of erythema, loss of sensation, painful to deep pressure Full thickness (3rd degree) = white, brown or black, no pain
71
SCC precursors?
Actinic keratosis Bowen's disease
72
Features and managemnt of actinic keratosis?
Small scaly patches on sun-exposed skin Management = 5-FU, topical diclofenac, imiquimoid, cryotherapy, curettage and cautery
73
Features and management of Bowen's disease?
Pink scaly patch on sun-exposed skin Management = 5-FU, cryotherapy, excision
74
Features and management of SCC?
Rapidly growing lesion Scale, ulceration, bleeding PMH chronic sun exposure Management = excision with 4mm margin if < 20mm, excision with 6mm margin if > 20mm, Mohs surgery if on cosmetically important site e.g. face
75
Epithelial tumour which spontaneously regresses. Can be mistaken for SCC?
Keratoacanthoma
76
Features and management of BCC?
Slowly growing lesion Central ulceration Pearly rolled edges, telangiectasia PMH intermittent sun exposure Management = excision with 4mm margin if < 20mm, excision with 6mm margin if > 20mm, Mohs surgery if on cosmetically important site e.g. face
77
ABCDE of worrying skin lesions?
Asymmetry Border irregularity Colour variation Diameter > 7mm Evolving
78
Types of malignant melanoma?
Superficial spreading (most common) Nodular Lentigo maligna Acral lentiginous
79
Investigation and management of melanoma?
Investigation = excision biopsy Management = surgery dependent on Breslow thickness
80
Margins of melanoma excision?
Breslow thickness: → 0-1mm = 1cm margin → 1-2mm = 1-2cm margin → 3-4mm = 2-3cm margin → > 4mm = 3cm margin

Med School Finals (18 decks)

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