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BRS YEAR2 > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

How would Lupus Erythmatosus present

A

Proteinuria, High ESR/CRP, dsDNA positive, pancytopenia, has fever and fatigue
Photodistributed erythematous rash
Chilblains: itchy swelling
Livedo reticularis: net like redness
Cutaneous vasculitis: inflamed blood vessels
Alopecia

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2
Q

What are the two types of Lupus

A

Systemic LE:
Cutaneous/Discoid LE

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3
Q

How is SLE dignosed

A

Mucocutaneous: cutaneous lupus- spiderlike rash, oral ulcers
Haematological: haemolytic anaemia, thrombocytopenia, leukopenia
Immunological: ANA, anti-dsDNA, anti-SM

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4
Q

How can SLE and CLE be diffrentiated between

A

CLE causes scarring , SLE doesnt

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5
Q

What type of lupus is present in children and what antibody is present and what test should be done

A

Neonatal lupus
Ro positive
Test ECG as risk of heart block

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6
Q
A
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7
Q

What is the autoimmune connective tissue disease which caused proximal extensor inflammatory myopathy, a photodistributed pink violet rash on the extensors, eyes and scalp

A

Dermatomyositis

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8
Q

What signs are seen in dermatomyositis

A

High ALT, high CK, antinuclear antibody(ANA) and lots of other antibodies,
weakness, weight loss, fatigue

Heliotrope rash: on eyelids
Gottrons papules: papules on interphalangeal and metacarpal joints
Ragged cuticles
Shawl sign: rash on upper back
Photosensitive erythma

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9
Q

How would a patient with vasculitis present

A

IgA vasclitis
abdominal pain, GI bleeding,

Small vessel problems:
purapura - macular and palpable, non blanching

Medium vessel problem:
Digital necrosis
Retiform purapura ulcers
Subcutaneous nodules along blood vessels

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10
Q

What is the name of the systemic granulomatous disorder

A

Sarcoidosis

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11
Q

How does sarcoidosis present

A

Affects many systems: lungs, skin. LUNGS: cough with ?

Reactive oxygen species, joint pain
Red to brown violaceous papules
lupus pernio: blue to violet nodules and papules
disfiguring lesions on nose, lips,
Ulcerative
scar sarcoid
Granulatomous plaques

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12
Q

What symptoms does DRESS cause and what does DRESS stand for

A

Drug reaction with eosinophilia and systemic symptoms: taken an antibiotic, anti epileptic, ibuprofen or medication 2-6 weeks before

multiple myeloma
Rash, fever, tachycardia, renal (interstitial neprhitis), heart (myocarditis) and liver (hepatitis) starting to fail
Lymphadenopathy, high eosinophils

RASH: widespread papules, maculopapular, erythroderma, head/neck oedema

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13
Q

How is DRESS treated

A

take away the cause, corticosteroids

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14
Q

What is graft versus host disease

A

if face involvement, acral involvement and diarrhoea then GvHD rather than DRESS

Reaction to stem cell transplant or new drugs: a multiple organ disease. Donor T lymphocyte activity against antigens.
Skin, liver, GI tract

Erythmatous macules and papules, scleral icteus

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15
Q

what is the condition called when it is a constant itch without a rash

A

Pruritus

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16
Q

What is pruritus suggestive of and what investigations should be done

A

Renal failure, iron deficiency, Hep, HIV, cancer

GBC, rnal tets, LFT, ferritin, XR chest, BLoods for Hep ABC and HIV

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17
Q

What skin sign can occur in pruritis

A

Nodular prurigo: chronic scratichin causing nodules to form

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18
Q

What causes scurvy

A

Vit C (ascorbic acid) deficiency

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19
Q

What are the symptoms of scurvy

A

Spongey gingivae with bleeding and erosion
Petechiae, ecchymoses, follicilar hyperkaratosis, corkscrew hairs with perifollicular haemorrhage

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20
Q

What is the name of the protein deficiency and what are the skin signs

A

Kwashiorkor
Sparse dry hair
soft thin nails
cheilitis- inflam of lips
desquamation (peeling skin) large areas of erosion

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21
Q

How doe zinc deficiency present

A

dermatitis, diarhhoea, depression
perioral, acral and perineal skin with scaly erosive erythmea

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22
Q

What is carcinoid syndrome and how does it present

A

Metastases of malignant carcinoid tumour, 5HT secretion.
Flushing, diarrhoea, wheezing, dizziness, usually started on amlodipine, hypotension

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23
Q

What skin illness begins with flu, sore eyes and oral ulcers and develops into an extensive painful rash

A

Stevens Johnson Syndrom/ Toxic Epidermal Necrolysis

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24
Q

How does Stevens Johnson Syndrome develop into Toxic epidermal Necrolysis

A

flu like, abrupt lesions on trunk first then face and limbs. Get macules, blisters and erythme. blisters then merge to make sheets of skin detatchment (wet wallpaper)

Full thickness epidermal necrosis in less than 2-3 days
called TEN when more than 30% skin detachment

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25
How does Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis occur
cell mediated cytotoxic reaction against epidermal cells Drugs usually cause anti epileptics, NSAIDs, ABs,
26
What score is used to assess severity of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
SCORTEN: over 40yrs, % epidermal detatchment, serum urea glucose and bicarbonate, malignancy
27
What are the complications of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Death, blindness
28
How does erythroderma present
Erythema affecting more than 90% of body can get oedema, loss of fluid and proteins, sepsis risk, tachy
29
What is the cause of erythroderma
Drug reactions Psoriasis Atopic eczema
30
How is erythrodema treated
Treat underlying cause restore fluid and electrolytes and body temp Emollients to help skin barrier Topical steroids and Abs
31
What are the different signs of chronic kidney disease
Excoriations/prurigo Xerosis: dryness Half and half nails Calciphylaxis: cow print looking Anaemia Signs to the primary cause like SLE or immunosuppression like viral warts
32
What are the different signs of chronic liver disease
Excoriations/prurigo Jaundice Muehrckes lines of nails Terrys nails ( white nail then a line of normal coloured nail right before the white) Palmar erythema Spider telangiectasia: red blob with spider capillary lines as legs Clubbing
33
How may Diabetes mellitus manifest cutaneously
Necrobiosis Lipoidica: plaques with red-brown raied edge, a yellow/brown atrophic centre Teerys nails, Xerosis, Xanthelesma and xanthom, Granuloma annulare (ring of pink), skin infection, neuropathic ulceration
34
How does graves disease present cutaneously
Pre tiial myxoedema
35
How may acromegaly manifest cutaneously
Cutis gyrata verticis: scalp lines Acne
36
How may HIV manifest cutaneously
Morbilliform rash Urticaria Erythema multifome: red round marks looks like a target oral/genital ulceration
37
How does GI disorders affect the skin
Orofacial granulomatosis- swelling in mouth/face lips panniculitis psoriasis
38
How does celiac disease manifest
Dermatitis herpetiformis : blistering vesicles on skin
39
What sign is associated with IBD, obesity and smoking
Hidradenitis superitiva: inflamed nodes- sterile absecces, hypertrophic scars : underarms, genitals and inframammory
40
What is the name for skin folds
Intertriginous areas
41
What is the sign associated with IBD, leukaemia, seronegative arthritis
Pyoderma gangrenosum: pustule on erythmatous base which ulcerates and extends with a necrotic border, is painful looks like a chunk of fat and skin has been taken out
42
What test would you do for SLE
FBC, U&E, ANA, anti-dsDNA, complement an urinalysis
43
When would you do a lipid panel
Xanthelesma
44
What presentation is associated with scurvy
Corkscrew hairs and perofillicular purapura
45
What symptoms is associated with crhonic kidney disease
calciphylaxis
46
What is he difference between nail changes in chronic kidney and chronic liver disease
Chronic liver: Terrys nails, Muerches nails Chronic kidney: Half and half, terrys
47
What is melanoma
malignant tumour from melanocytes Pigmented, asymmetrical lesion, colour variation, irregular border
48
What are the risk factors of melanoma
FHx, fair skin, red hair Sun exposure, subeds, immunosuppressed
49
What is the pathogenesis of melanoma
MAP kinase messaging pathways that are important for cell migration during embryogenesis but are also important in melanoma generations. MAP kinase pathway can lead to NRAS and BRAf mutations which can can lead to activation of the pathway leading to melanocyte reproduction leading to melanoma
50
How does the body respond to melanoma formation
CD8 Tcell recognise mealnoma antigens and are able to kill CTLA-4 inhibits T cell abctivation by removing B7 on APC so T Cells CD28 has nothing to bind to
51
What immunotherapy is based on blocking CTLA-4 so that T cells can be activated
Ipilimumab
52
What are the subtypes of melanoma
Superficial spreading Nodular Lentigo maligna : o face Acral lentiginous : on elbows Unclassifyale
53
How does superficial spreading melanoma present
fair skin, trunk of men and womens legs, (sometimes white/depigmentation in centre as immune cells fight) Symmetry, border irregularity, large diameter because of Horizontal/radial growth phase then Vertical/downwards (nodule like if goes downwards)
54
How do nodular melanomas present
in fair skinned individuals, trunk head and neck blu to black or pink to red nodule Only vertical growth which makes it more aggressive
55
How does lentigo maligna melanoma present
over 60 yrs, chronicall sun damaged skin, usually face slow growwing, asymmetric brown/black macule, irregular border
56
How does acral lentiginous melanoma present
palms and soles or around nails deep pigmentation can get ulceration
57
What sign on the nails can be indicative of melanoma
Melanonychia
58
What is the name of the melanoma that doesnt produce pigment
Amelanotic melanoma
59
What is indicative of a poor prognosis in melanomas
Inc breslow thickness ulceration age men lymph node
60
How are melanomas nvestigated
Dermoscopy Biopsy
61
How are melanomas managed
Excision to subcutaneous fat , 2mm peripheral margin unless lentigo maligna. wide excision : 5mm if in situ , 10mm for 1mm breslow depth Sentinel lymphoma node biopsy: pT1b (less than 0.8mm but ulcerated) Imaging in stage 3 or 4 (2-4mm,>4mm) PET-CT, MRI
62
Prognostic factor for metastatic melanoma
LDH
63
If a melanoma is metastatic or unresectable what is the next step
Immunotherapy CTLA-4 inhibition Ipilimumab (in BRAF negative) PD-L1 Nivolumab together is better Mutated oncogene targeted therapy BRAF and MEK inhibitor
64
What types of keratinocyte dysplasia are there
Actinic keratoses : some dysplastic cells in the epidermis Bowens disease: SCC in situ (same place) Squamous cell carcinoma: SCC (mets likely) Basal cell carcinoma: locally invades no mets
65
Pathogenesis of basal cell carcinoma (3 points)
Basal Cell carcinoma: - UV radiation, receptors for PDGF upregulated in mesencyhmal cells of stroma, PDGF upregulated in tumour cells. - Proteolytic activity (metalloproteinases, collagenases) that degrade dermal tissue so can spread - Chromosome 8q loses function (PTCH gene), p53 mutations usually there too
66
Pathogenesis of squamous cell carcinoma and how it may present
-UV radiation is a risk factor - addition of genetic alterations - alterations in p53 and CDKN2A - NOTCH1 and NOTCH2 present: erythmematous/skin coloured, papule or plaque, exophytic (mushroom looking), hyperkeratotic, ulcers
67
What are the risk factors of keratinocyte carcinomas
BCC more common than SCC pale ppl men old - 68 RF: UV (PUVA), fair skin, genetic syndromes, immunosuppresant drugs, non-healing wounds,
68
What is actinic keratosis
Atypical keratinocytes confined to epidermis sundamaged skin macules (flat) or papules (raised) red or pink scale (looks like scaley sundamage that older people have)
69
What is bowens disease
SCC in situ erythmatous scaly pathc/ elevlated plaque looks like actinic keratoses, eczema, psoriasis
70
What is the treatment of actinic keratoses and bowens disease
5-fluorouracil cryotherapy imiquimod cream photodynamic therapy curettage and cautery (scrape and burn) excision
71
What are some high risk factors of SCC
more than 1cm on head and neck more than 2cm on trunk and lim in immunosuppressed or ppl whove had radiotherapy poorly differentiated PERINEURAL( around a nerve) LYMPHATIC OR VASCULAR INVASION
72
A patient presents with a rapidly enlargeing papule, a circumscribed crateriform nodule with a keratotic core what is the diagnosis and how is it managed
Keratoacanthoma will go away by itself
73
How is SCC investigated
clinical diagnosis, biopsy if uncertain, US of lymph nodes if think mets
74
How is SCC treated
Excision radiotherapy if unresectable or perineural invasion Cemiplimab if metastatic skin monitoring and sun protection advice
75
What are the types of BCC and how to identify
Nodular : pearly papule, shiny Superficial : pink flat lesions, plaque, thin papule Morphoeic: light pink to white colour, elevated or depressed area Infiltrative Basisquamous : combination of both Micronodular: nodular but destructive and usually spreads
76
How to diagnose BCC
biopsy
77
How to treat BCC
surgical excision mohs micrographic surgery (if recurrent, aggressive or in critical site) can do topical 5-Fluorouraci or Imiquimod, or photodynamic therapy all the same things as SCC
78
What are cutaenous T cell lymphomas
Neoplasms of T cells that attack skin
79
What are the two types of cutaenous T cell lymphomas
Sezary syndrome : erythroderma, generalised lymphadenopathy, neoplastic T cells Mycosis fungoides: looks like patch then plaque at first, may take 4-6 years to become a tumour.
80
What is kaposi sarcoma
HHV8 : bruised coloured noduled/papules, systemic disease may be related to immunosuppression
81
What is merkel cell carcinoma
Cells that resemble merkel cells highly anaplastic rapidly growing nodule, pink to red to violet, firm and domed shaped

BRS YEAR2 (11 decks)

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