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GP Year 4 > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

what is the best prognostic indicator of melanoma mortality

A

Breslow Thickness

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2
Q

What are the 5 year survival of individual breslow thickness with regards to melanoma?

A

4 mm = 50%

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3
Q

what are the clarke level invasion with regards to melanoma?

A 
level 0 = carcinoma in situ 
level 1 = thin melanoma < 2mm thick 
level 2 = thick melanoma > 2mm thick 
level 3 = melanoma involves the LN 
level 4 = metastases are involved
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4
Q

what are the prognostic factors of melanoma

A 
Breslow thickness 
Clarke level 
mitotic rate per mm2 
ulceration 
lymphovascular invasion
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5
Q

what is the excisional margin of melanoma with regards to their thickness?

A

melanoma carcinoma in situ = < 1 mm thick = < 1 cm margin
melanoma 1 - 4 mm thick = 1 - 2 cm margin
melanoma > 4mm thick = 2 cm margin

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6
Q

what are the bio-markers associated with melanoma?

A

BRAF,

MEK

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7
Q

what are the classification of melanoma, their associations and their epidemiology?

A 
superficial spreading melanoma (70%): more common subtype of melanoma, related to intermittent sun exposure, thin, curable tumors of less than 1mm thickness 
nodular melnoma (15%): rapid growth, 15% of all invasive melanomas, more common in older people and men 
lentigo maligna (in situ melanoma) (5%): most common in sun exposed areas, begin as a tan brown macule, enlarges and develops darker, assymetric foci, color variegation 
acral lentiginous (10%）：darker skinned people, palms/soles/under nails, usually risen from trauma
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8
Q

outline the management for mild plaque psoriasis (preventive, acute, maintenance)

A

preventive measures: avoid skin damage and stress, take rest and holidays, reassurance
address psychological effects of having psoriasis
pharmacological treatment: topical steroids, tars, calcipotriol, dithranol

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9
Q

what is the difference in clinical features between rosacea and acne?

A

rosacea lacks the presence of comedones c.f acne vulgaris

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10
Q

what is the management of rosaceas

A

avoid aggrevating factors such as alcohol, sun, warm environments, hot tea and coffee, spicy food, topical steroids

use mild soap free cleanser and a non irritant sun block

mild roscaea: (topical agents) metronidazole, clindamycin cream, erythromycin gel

severe rosacea: doxycycline, erythromycin (oral)

other treatments:
rhinophyma = co2 laser therapy w/ dermatologist
telengiectasia and erythema can be removed w/ laser

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11
Q

what are the 3 treatment approach to treating acne

A

comedolysis
decrease bacterial activity
decrease sebaceous gland activity

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12
Q

treatment for mild acne

A

if just comedones = topical retinioids

if pastulopapular = use topical antibiotics such as clindamycin, erythromycin OR topical antiseptics (benzoyl peroxide)

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13
Q

treatment for moderate acne

A

oral a/b: doxycycline or erthyromycin (first line), minocycline (has more side effects)

in females, hormonal treatment can be considered. They are OCP that contain anti-androgenic progestagens, spironolactone, cyproterone acetate

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14
Q

treatment for severe acne/nodulocystic acne

A

specialist referal for prescription of oral isotertinoin

scarring can be cured by laser treatment

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15
Q

what are some drugs that can cause acne

A 
steroids 
lithium 
anti epileptics 
Oral contraceptives 
iodides/bromides
quinine
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16
Q

what’s the management of peri-oral dermatitis

A

mild cases: topical erythromycin OR metronidazole gel, pimecrolimus, azelaic acid
if more severe: doxycycline oral 50mg BD, or ethryromycin oral for 6 - 8 weeks

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17
Q

what is the treatment for resistant localized psoriasis plaque

A

intralesional corticosteroid 1:1 normal saline injection w/ local anesthetic

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18
Q

what is the treatment of widespread plaque psoriasis

A

pharmacological mx: dithranol, tar, topical corticosteroids, phototherapy. others are: methotrexate, acitretin, cyclosporin, biological agents

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19
Q

what is the treatment for scalp psoriasis

A

tar shampoo, topical corticosteroid lotions

if severe, can use tar/dithranol pomades, tar shampoo, systemic therapy

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20
Q

what is the treatment for genital psoriasis

A

topical corticosteroids, tars

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21
Q

what is the gene associated with psoriasis

A

HLA-B27 gene

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22
Q

what are common agents that cause allergic contact dermatitis

A 
Nickel
Chrome 
epoxy resin 
fragrances and perfurmes 
latex 
plants 
neomycin 
preservatives
rubber accelerators
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23
Q

what are common agents that cause irritant contact dermatitis

A 
common and oftenly used agents: 
acids
alkalis 
detergents
soaps
oils 
solvents
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24
Q

describe the distribution and morphology of irritant contact dermatitis

A

distirbution: usually areas in contact w/ irritating substances - most oftnely hands, eyelids
morphology: erythema, chapped skin, dryness and mild fissuring. +/- pruritus

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25
what condition usually has a preceding herald patch in up to 80% of the patient population
Pityriasis rosea
26
describte the distribution and morphology of pityriasis rosea
christmas tree like on the trunk and back (+ upper arms, upper legs, lower neck) old swimming suit distribution morphology: oval, salmon pink spots, copper colored eruptions, that has scaly margins
27
treatment of pityriasis rosea
non pharm: bathe with soothing bath oil, use neutral pH soap pharm: itch - calamine lotion, topical steroid 1% cream, methold 1% in aqeous cream. if itch is severe, use potent topical or oral steroid. UV therpay
28
describe distribution and morphology of a secondary syphillis rash
usually occurs 6 - 8 week after the presence morphology: faint, pink maculopapular rash. it can be dull red, round on flexor surfaces. distribution: flexor surfaces, palms, soles, can be around the whole body
29
what is the diagnostic test for syphillis? what is its treatment?
``` T pallidum hemagluttanin assay, FTA-ABS (fluorescent antibody- antibody test) IM benpen (first line) and oral azithromycin (second line) ```
30
describe the distribution and morphology of infective mononucleosis rash.
``` commonly associated with cervical lymphadenopathy and a sore throat (important to rule out HIV infection) primary rash; pinkish, maculopapular secondary rash (drug rash w/ ampicillin, amoxicillin): sometimes has a purplish brown tinge ```
31
what is the time period in which SJS/TEN usually presents
usually average of 14 days - but re-exposure may cause the onset of symptoms as little as 48 hours
32
describe the morphology/distribution of SJS
morphology: ill defined coalescing erythematous macules w/ purpuric centres or may present w/ diffuse erythema distribution: mucocutaneous eruptions that are usually oral, facial, urogenital
33
describe the clinical course of SJS
prodrome: acute onset febrile illness and malaise, possibly myalgia and arthralgia acute: cutaneous lesions that start at face, thorax then begins spreading. slowly progresses to formation of vesicles and bullaes, and sloughing of skin
34
describe mophology of erythema multiforme
target lesions with dusky central disc/bullae, and an infiltrated pale ring. erythematous edematous halo
35
describe the management of toxic epidermal necrolysis
stop causative drug and all non life sustaining drugs admit burn units, ICU give supportive treatment: wound care, fluids and nutrition, ocular care, prevention of infection give systemic steroids and high dose IVIG future drug avoidance
36
describe urticaria distribution and morphology
pruritic, circumscribed, raised/papular, erythematous eruption with central pallor. may coalesce with other lesions and disappear within 24 hours
37
what is the prognosis of pityriasis rosea
mild, self limiting illness with spontaneous remission in about 2 - 10 weeks
38
what is the most common cause of erythema nodosum
sarcoidosis
39
what are the other causes of erythema nodosum
``` sarcoidosis crohn's disease infections: TB, staph, viral infections chlamydia malignancy drugs: tetracycline, sulphonamides, oral contraceptives ```
40
what is the treatment of erythema nodosum
investigate causes and treat cause mild: rest and give NSAIDs severe: systemic steroids
41
describe the mophology and distribution of erythema nodosum
morphology: bright red, nodular, painful distribution: most oftenly shins, but can also be found on the thighs and arms
42
what are the 4 types of rosacea
ocular erythematous telangiectasia papulopustular fimeatous
43
what is ramsay hunt syndrome?
shingles in the facial nerve CN 7
44
describe the morphology and distribution of shingles
morphology: vesicular eruptions, erythematous distribution: dermatomal distribution
45
describe the morphology and distribution of scabies
morphology: intensely pruritic, erythematous, papular. often scattered, red, small, monomorphous distribution: found on hand webbings, wrists
46
what is the management of scabies
symptomatic relief: anti histamines acute treatment: permethrin cream 5%, benzyl benzoate 25% emulsion. applied topically full body. for children, use sulphur 5% cream OD for 2 - 3 days, then use crotamiton 10% cream Prevention: wash bedsheet, clothings, hang in sun
47
what is the management of tinea
prevention: keep toes dry, carefully dry feet after bathing, use anti fungal between toes, remove flaky skins form beneath toes, wear light socks made of natural absorbent fibres, change socks and shoes daily, wear open sandals with porous soles and uppers when infected pharmacological: clotrimazole, ketoconazole, terbinafine, cream/gel. If severe, add oral terbinafine, griseofulvin.
48
what is angular chelitis associated wtih?
chronic wetness of the lips | B12/folate deficiency
49
how do you differentiate between geographical tongue and candidiasis
geographical tongue that cannot be scraped off
50
what are the side effects of oral isotretinoin?
``` GI upset skin, mucosal, eye dryness headaches epistaxis myalgia, arthralgia, sport intolerance lethargy cannot be given with doxycycline (oral) as it can cause benign intracranial hypertension ```
51
what are the indications for oral isotertinoin?
severe acne nodulocystic acne scarring acne patient in severe psychological distress
52
what are the indications for referral to specialist?
PCOS caused acne not sure about diagnosis patient requires oral isotretinoin trouble tolerating medications
53
what is the treatment for infantile acne?
infant sebaceous glands stimulated from testosterone from babies acne which respond to intrauterine hormones topical retinoids and/or anitbiotics (similar to mild acne treatment)
54
what agent can be used when acne has crusting?
keratolytic = salicylic acid 2%
55
what are some lifestyle modifications for acne prevention/
``` avoid greasy sunscreen/moisturizer avoid hot bathes/steam rooms avoid hot humid working situations stop squeezing or picking avoid over exposure to sun ```
56
what is the clinical features of rosacea?
no comedones commonly facial erythema w/ telengectisia and flushing presence of pustules and papules easy flushing, experiencing burning, stinging, itching irritated by cream and sun exposure
57
what are some complication of rosacea
rhinophyma and facial oedema
58
what is the treatment of corticosteroid induced rosacea?
stop corticosteroid treatment immediately and use oral tetracyclines for 6 weeks
59
what is the treatment of childhood rosacea?
use erythromycin as doxycycline is contraindicated in children less than 8 years old
60
what is the duration in which it takes for treatment to act for rosacea?
takes 6 - 12 weeks for response. maintenance treatment is often required for the long term
61
when would you refer atopic dermatitis to the dermatologist?
chronic, recurrent infections severe eczema that cannot be controlled w/ topical therapy not sure with the diagnosis
62
what is the feature of asteatotic eczema? what is the management of asteatotic eczema?
dry skin, scaling, crazy 'paving' on the lower limbs dryness management: avoid soap, use a soap substitute and use daily application of emollionts at least 2ice a day if there is inflammation, use a mild - moderate topical corticosteroid w/ wet dressing and antibiotics
63
what is the feature of stasis dermatitis? what is the most important part of treatment?
hyperpigmentation swelling of the legs dryness, scale and brown pigmentation (hemosiderin staining) associated varicose veins, ulcerations elevation and graded compression is most important + dry management (w/ wet dressings, daily emollioants twicea day, using a soap substitute)
64
what is the feature of nummular/discoid eczema? and what is its management?
ITCHY, round/oval shaped with well defined edges (not much scaling) common to have superinfection w/ s. auerues treatment: use potent topical corticosteroids + wet dressing (even in children) if non responsive to topical treatment, oral antibiotics may be required topical steroids/steroid injections for lichenified lesions
65
what is the feature of pompholyx or dyshidrotic eczema?
found on soles and palms. characterstically bullous and vesicular. has severe attacks that can prevent patient from attending work. can be trigged by physical or emotional stress. treatment: potent topical steroid + wet dressing rest is important patient needs to protect their hands from irritating soap substances for the next 3 months if severe attacks = refer to derm, may require 2 - 3 weeks course of oral prednisolone
66
what is the features of child seborrheic dermatitis?
site: scalp, face, neck, groin, axillae, nappy areas morphology: erytheatous w/ crusting (if superinfection), non itchy!! well defined lesions w/ greasy scale covering management: topical steroids (mild) + anti fungal/antibiotics if necessary keratolytics can be used to get rid of scales
67
what is the feature of adult seborrheoic dermatitis?
erythema and fine greasy scale in cheeks, nose and nasolabial folds sites: scalp, central face, eyebrows/lids, chests, flexures, axillae, genital regions triggers; physical stress, emotional stress management: topical steroids (mild) + topical anti fungals if necessary if scalp involvement, use anti-fungal shampoos containing selenium sulphide, ketonazole, miconazole
68
what is the treatment for atopic dermatitis?
patient education about its chornicity, prgnosis, lifestyle modifications by avoiding triggers and using emollionts on a daily basis possible allergen testing and allergen avoidance pharmacological treatment: mild topical steroid first OR TIMS (pimecrolimus, tacrolimus) preventions; use wet dressing over topical emollients and anti-inflammatory agents address psychological issues
69
what are the triggers for atopic dermatitis
``` wool clothes, blankets, lambskins synthetic fabrics soap, shampoo, bubble bath hot baths and very hot weather sand at the beach and sand in the sandpits ```
70
name some examples of mild, moderate, potent topical corticosteroids
mild: hydrocortisone 1%, hydrocortisone acetate 1% and 0.05% cream, desonide 0.05%, clobetasone butyrate 0.05% cream moderate: betamethasone valerate 0.02%, triamcinolone acetonide 0.02% potent: betamethasone valerate 0.1%, betamethasone diproprionate 0.05% cream, ointment, lotion, methylprednisolone aceponate 0.1% cream, ointment, lotion
71
what is the treatment for palmoplantar psoriasis (both pustular and hyperkeratotic forms)
pustular forms: tars, topical corticosteroids, tetracyclines, acitretin, calcipotriol, phototherapy. if severe methotrexate, cyclosporin hyperkeratotic: keratolytics (salicylic acid), tars, calcipotriol, acitretin
72
give some examples of treatment options for psoriasis?
emollients - used when irritating /scaling is a prominent feature keratolytics (salicylic acid 2% - 10%）－　can be used to soften an dlift scale corticosteroids - used to reduce itch in pulse treatment tars (2% - 10% cream/ointment) - used as an anti-inflammatory or anti pruritic calcipotriol - proliferation, differentiation of keratinocytes, useful for widespread psoriasis dithranol - antiproliferative effect, especially useful for thick plaque psoriasis

GP Year 4 (14 decks)

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