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Dermatology Flashcards

0
Q

Name 4 functions of skin. (4)

A 
Physical barrier against friction
Protection against infection, chemical and UV
Prevention of water loss
UV induced synthesis of vit D
Temperature regulation
Sensation
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1
Q

What is the 3 main layers of the skin? (3)

A

Epidermis
Dermis
Subcutaneous fat

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2
Q

What is cellultis? (1)
What is the most common bacterial causes? (2)
Name 3 risk factors. (3)

A

Spreading infection involving the dermis and deep subcutaneous layer it preferentially involves the lower extremities.
Staphylococcus aureus or streptococcus pyogenes.
Lymphoedema, site for entry (eg ulcer, trauma, tinea pedis), venous insufficiency, leg oedema and obesity.

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3
Q

What is erysipelas? (1)

A

Superficial skin infection of the epidermis and dermis, often on the face.
Group A beta haemolytic streptococcus ( strep pyogenes)

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4
Q

A 54 year old man attends A&E with a swollen red painful leg. Give 2 differentials. (2)

A

DVT
Cellulitis
Erysipelas

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5
Q

What part of the skin is affected by nectrotising fasciitis? (2)
What symptoms may be seen? (2)
What is the management? (2)

A

Deep seated infection of the subcutaneous tissue causing destruction of fat and fascia but spares the skin.
Severe pain at site of infection, systemic toxicity.
Surgical debridement and aggressive broad spectrum antibiotics (benzylpenicillin and clindamycin, ?metronidazole if diabetic)

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6
Q

What is tinea corporis? (1)

What are the symptoms? (3)

A

Ringworm

Slightly itchy, asymmetrical, scaly patches with central clearing a d an advancing scaly raised edge.

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7
Q

What is the causative agent in thrush? (1)

Where is it usually found? (1)

A

Candida albicans

Normal flora especially found in the GI tract

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8
Q

What are the features of acne vulgaris? (4)

A

Papules and pustule, open and closed comedones.

Also hypertrophic or keloidal scarring and hyperpigmentation in darker complexions. (More likely in dark complexions)

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9
Q

What is the pathophysiology of acne vulgaris? (3)

A

Increased sebum production by sebaceous glands, blockage of pilosebaceous units, follicular epidermal hyperproliferation and infection.

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10
Q

What agents are first line therapy for mild acne? (3)

A

Keratolytic agents- benzoyl peroxide
Topical retinoids- isotretinoin
Topical retinoid like agents- adapalene
Topical Antibiotics- clindamycin, erythromycin

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11
Q

Lucy has acne and has already tried topical erythromycin and acne soaps.
What is the second line treatment? (2)
What is the third line treatment? (2)

A

Dianette CO
Low dose oral antibiotics eg oxytetracycline

Oral retinoids eg isotretinoin or acitretin.

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13
Q

What are retinoids? (2)

Why do women need pregnancy tests during treatment? (2)

A

Eg isotretinoin. Synthetic vitamin A analogues that affect cell growth and differentiation.
Highly teratogenic and contraindicated in pregnancy.
Women of child bearing age should have pregnancy test and contraceptive advice before starting and monthly pregnancy tests over the 4 month course.

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14
Q

Explain the difference between a skin lesion and a rash. (2)

A

Lesion is any single area of altered skin, single or multiple. Rash is a widespread eruption of 20+ lesions.

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15
Q

What is the difference between annular, target and discoid lesions? (3)

A

Target lesions look like concentric circles.
Annular lesions are lesions that occur in a circle.
Discoid are single round circular lesions.

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16
Q

What is a lesion that looks like a straight line called? (1)

A

Linear

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17
Q

A patient attends your surgery with a rash.
On examination is appears to be a red area that blanches on pressure. What is the medical term? (1)
The rash is spread across the whole body. What is the term for this? (1)

A

Erythema, skin looks red due to increased blood supply.

Erythroderma if over 90% of total body surface area.

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18
Q

Name 2 causes of hyper pigmentation. (2)

A

Melanin and Haemosiderin.

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19
Q

What is the difference between purpura and petechiae? (2)

What causes them? (1)

A

Petechiae are less than 0.3cm in diameter and Purpura and 0.3-1cm in diameter.
Caused by bleeding vessels under the skin, they do not blanch with pressure.

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20
Q

Man attends clinic with a small flat area of hyper pigmentation on his arm and a larger area of flat hyper pigmentation on his back. You are unable to feel either area with your eyes closed.
What are the dermatological terms used to describe these? (2)

A 
Small= macule
Large= patch
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21
Q

A patient has a small raised lesions on his chest of less than 0.5cm in diameter.
What is the term for these lesions if they were solid? (1)
What is the term for these lesions if they were filled with clear fluid? (1)
What is the term for these lesions if they were filled with pus? (1)

A

Papule
Vesicle (small blister)
Pustule

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22
Q

A patient has a raised lesion on the dorsum of his hand of more than 0.5cm in diameter.
What is the term for these lesion if it were solid? (1)
What is the term for these lesion if it were filled with clear fluid? (1)
If a bulla has burst and left behind a red area of raw looking skin, what is the term? (1)

A

Nodule
Bulla
Erosions

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23
Q

What is the term for “flaky” skin? (1)

What is a scaly palpable raised lesion called? (1)

A

Scaly

Plaque

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24
Q

What is a furuncle? (1)

What is a carbuncle? (1)

A

Staph infection in or around a hair follicle.

Staph infection of adjacent hair follicles.

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25
Q

What is a crust? (1)

A

Rough surface consisting of dried serum, blood, bacteria, cellular debris. (exudate)

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26
Q

What is a scar? (1)

What are the 3 types of scar tissue? (3)

A

New fibrous tissue that occurs post-wound healing.
Atrophic - thinning
Hypertrophic - hyper proliferation within wound boundary
Keloid - hyper proliferation beyond wound boundary

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27
Q

Define an ulcer? (1)

A

Loss of epidermis and dermis.

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28
Q

What are the 4 steps to managing a dermatological emergency? (4)

A

Supportive - ABCDE
Remove causative agent e.g. drug
Manage complications
Specific treatment

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29
Q

Name 4 types of psoriasis. (4)

Which is the most common? (1)

A 
Chronic plaque**
Flexural (non-scaly plaques)
Guttate (raindrop like on trunk)
Seborrhoeic (naso-labial and retro-auricular)
Pustular (palmar-plantar)
Erythrodermic (whole body)
30
Q

What is Koebner phenomenon? (1)

A

Skin lesions occurring on lines of trauma.

31
Q

What is the precipitating event in Guttate psoriasis? 91)

A

Streptococcal throat infections.

32
Q

A patient has chronic plaque psoriasis.

What parts of the body would you examine? (5)

A 
Nails - pitting, onycholysis, yellow-brown discolouration.
Hands - dactylics, inflammation of DIP
Ears, scalp
Back, gluteal cleft, external genitalia
Soles feet and palms of hands
33
Q

Define psoriasis. (2)

A

Common, chronic hyper proliferative disorder characterised by presence of well demarcated red scaly plaques over extensor surfaces and in the scalp.

34
Q

Describe the management steps in psoriasis. (4)

What commonly used oral medication for severe eczema is not used in psoriasis and why? (2)

A

Emollients
Topical: Vit D analogues (calcipotriol), corticosteroids (clobetasone), coat tar preparations, dithranol, retinoids, keratolytics
Phototherapy (extensive disease): UVB or PUVA
Systemic (extensive and severe or with systemic involvement): methotrexate, retinoids, ciclosporin, mycophenolate. Biologic agents: infliximab, etanercept

Oral steroids eg prednisolone can cause rebound symptoms on withdrawal.

35
Q

What is the pathophysiology behind urticaria? (2)

A

Degranulation of mast cells, predominantly in the dermis. Skin becomes red and swollen due to vasodilation and increased vascular permeability.

36
Q

What is dapsone? (1)

A

It is an antibiotic of the sulphonamide daily, with anti inflammatory properties used to treat various skin conditions.

37
Q

How is urticaria managed? (2)

A

Avoidance of triggers e.g. salicyclates or food allergies.
Oral non-sedating H1 anti-histamines.
H2 blockers and dapsone if necessary.

38
Q

What is the most common type of eczema? (1)
What other 2 conditions is it associated with? (2)
What is the most likely secondary bacterial and viral infection? (2)

A

Atopic
Allergic rhinitis and asthma
Staph aureus - crusted weeping
Herpes simplex - blisters and punched out lesions (eczema herpeticum)

39
Q

Descrive the management options for eczema. (3)

A 
Emollients
Topical steroids
Calcineurin inhibitors
Antibiotics if infected
Severe non-responsive: prednisolone, azathioprine, ciclosporin.
40
Q

A young girl attends clinic with itchy, well demarcated erythema of the hands. She has no PMH, but has recently started training as a hairdresser.
What is the most likely diagnosis? (1)
What investigation could you perform? (1)
What is the best management? (1)

A

Contact dermatitis
Patch testing on the back (patches left on for 48 hours, no showering and recheck in a further 48 hours to look for Type IV hypersensitivity)
Avoidance of irritant e.g. get a new job if necessary, steroid creams may be helpful short term.

41
Q

What is panniculitis? (1)

A

Inflammation of the subcutaneous fat, causing skin to feel hard and nodules may develop.

42
Q

What is erythema nodosum? (2)

Give 3 causes of erythema nodosum. (3)

A

Acute and sometimes recurrent panniculitis producing painful dusky blue-red nodules (up to 5cm) on shins or lower limbs. (occasional spread to arms and thighs). The nodules appear over 2 weeks and gradually fade to leave bruising and staining of the skin.

Idiopathic, sarcoidosis, streptococcal infection, IBD, Drugs eg sulphonamides and COC, bacterial gastroenteritis, TB, chlamydia, leprosy.

43
Q

What is the treatment of erythema nodosum? (2)

A

NSAIDs, light compression bandaging and bed rest.

Resistant cases: dapsone, oral prednisolone, colchicine.

44
Q

What is erythema multiform and what is the typical lesion? (2)
What are the differences between minor and major? (2)

A

EM is a hypersensitivity reaction characterised by target lesions.
EM minor: majority are idiopathic or viral cause (some drug reactions, will resolve in 2-3 weeks, give aciclovir if recurrent
EM Major: Majority are drug reactions (some viral cause), need to address the cause for resolution, mucosal involvement and systemic upset.

45
Q

Name 3 drug causes of erythema multiforme. (3)

What blood test would help to distinguish between a viral cause and a drug induced cause? (2)

A

Anticonvulsants, sulphonamides and penicillin based antibiotics, NSAIDs
FBC - raised eosinophils in drug cause, raised lymphocytes in viral cause.
Skin swabs and biopsy can also be helpful in determining causative agent.

46
Q

Name 3 areas of mucous membranes that can be affected in erythema multiforme major. (3)

A 
Eyes - uveitis, conjunctivitis, corneal ulcers
GI
Oropharynx
Respiratory
Genitals
47
Q

You are treating a patient who was given a course of sulphonamides and now have erythematous target lesions and extensive mucosal involvement.
What diagnosis are you most suspecting? (1)
Give 2 management steps in this patient. (2)
Name 2 complications they are at risk of. (2)

A

Erythema multiforme major

Hospitalise
Drug history - remove causative agent
Anti histamine (itch)
Antiseptic and analgesic mouth wash
Regular emollient
Temperature controlled environment

Dehydration
Sepsis

48
Q

What is Nikolsky’s sign? (1)

Name 2 conditions where this sign may be positive. (2)

A

When apparently normal epidermis is separated and removed by a sliding motion.
Pemphigus vulgaris, toxic epidermal necrolysis.

49
Q

What is SJS and TEN? (2)
What is the difference between Steven-Johnsons Syndrome and Toxic Epidermal Necrolysis? (2)
What score can be used to establish risk of mortality? (1)

A

Part of a spectrum of severe drug reactions characterised by mucocutaneous involvement (at least 2 mucous sites involved)
SJS: affects < 10% BSA , histology shows epithelial necrosis
TEN: affects > 30% BSA, histology show full thickness epidermal necrosis with sub epidermal detachment.

SCORTEN

50
Q

Name 4 different blistering/bullous diseases. (4)

A

Bullous pemphigoid, pemphigus vulgaris, dermatitis herpetiformis.
Chickenpox, herpes simplex, herpes zoster, impetigo, pompholyx eczema, insect bite reactions.

51
Q

A patient who was started on phenytoin for his epilepsy 3 days ago has returned feeling unwell with a fever of 38.3’C and a widespread pustular eruption.
You are concerned about a drug reaction.
What Severe Cutaneous Adverse Reaction is most likely? (1)
How would you manage this patient? (3)

A

AGEP (acute generalised exanthematous pustulosis)

ABC - supportive (resolution within 15 days)
Stop phenytoin
Emollients
Topical steroids

52
Q

Describe pyoderma gangrenosum. (2)

Name 2 conditions associated with this skin manifestation. (2)

A

Erythematous nodules or pustules which frequently ulcerate. Ulcers are often large and have bluish undermined edge and purulent surface.

IBD, RA, primary biliary cirrhosis and haematological malignancies. (lymphoma, leukaemia, myeloma)

53
Q

Describe acanthosis nigricans. (2)
Name 2 conditions associated with this. (2)
What is the management? (1)

A

Thickened, hyper pigmented skin predominantly of the flexures that appears warty or velvety.
Obesity, DM (insulin resistance), underlying GI malignancy, hyper-androgenism in females (Cushings, PCOS, acromegaly), Addison’s, Hypothyroidism
No treatment, treating root cause may help.

54
Q

What is the inheritance pattern of neurofibromatosis? (1)

Which chromosomes are affected? (2)

A

Autosomal dominant
Type 1 : chromosome 17, gene NF1 (neurofibromin protein)
Type 2: chromosome 22 (protein Schwannomin)

55
Q

Which type of neurofibromatosis is the most common? (1)

Describe features of Type 1 and Type 2. (3)

A

Type 1

1: multiple fleshy skin tags, neurofibromas, cafe-au-lait, axillary freckling, scoliosis, and increased incidence of neural tumours e.g. meningioma, 8th nerve tumours, gliomas.
2: (more neuro than cutaneous); bilateral acoustic neuromas, cutaneous neurofibromas.

56
Q

What is tuberous sclerosis? (2)

Describe 3 features of tuberous sclerosis. (3)

A

Autosomal dominant due to a mutation in TSC1 or TSC 2 gene.
Mental retardation, epilepsy and cutaneous abnormalities;(periungal fibromas (nail bed nodules), shagreen patches, ash-leaf hypo-pigmentation, cafe-au-lait patches, adenoma sebaceum (reddish papules around the nose))

57
Q

Dermatitis herpetiformis is associated with which disease? (1)

A

Coeliac

58
Q

Dermatitis herpetiformis, bullous pemphigoid and pemphigus vulgaris are all autoimmune diseases.
Which antibodies are responsible for each. (3)
What are the management for each? (3)

A

DH: ?Anti-gliadin IgA deposition in the skin.
Dapsone for itch, gluten free diet.
BP: Anti-hemidesmosomal. IgG depositions in the dermo-epidermal junction.
High-dose oral prednisolone and immunosuppressants
PV: Anti-Desmoglein 3. IgG depositions in the intra-epidermal layer.
High dose oral prednisolone and imunosuppressants

59
Q

What are the 3 main types of skin cancers. (3)

Which may metastasise? (2)

A

Basal cell, squamous cell and malignant melanoma.

Squamous and melanoma

60
Q

Describe a BCC. (2)

What is the treatment? (1)

A

On sun exposed areas, most present as shiny, pearly nodule which may ulcerate.
Surgical excision.

61
Q

Describe a SCC. (2)
Name the 2 pre-malignant conditions for SCC. (2)
What is the treatment for SCC? (1)

A

Ill-defined nodules that grow rapidly.
Solar keratoses and Bowen’s disease
Excision or occasionally radiotherapy.

62
Q

Name the 4 types of malignant melanoma. (4)

A

Nodular - rapid growth which bleeds/ulcerates
Superficial spreading - large, flat, irregular, grows lateral before vertical
Lentigo maligna - slow growing macular area of pigmentation on face of elderly
Acral lentiginous - pigmented on palms, soles or sub-ungal.

63
Q

What is the treatment for a malignant melanoma? (2)

A

Wide local excision depending on thickness (1cm margin for thin melanoma (<1mm) and 3cm margin for thick)
Metastatic disease responds poorly to all modalities.

64
Q

What factors are used to stage malignant melanoma? (3)

A

Tumour thickness, mets and lymph node status.

65
Q

What is the ABCDE criteria for malignant melanoma? (5)

A 
Asymmetry
Border irregular
Colour - more than 2
Diameter
Elevation
66
Q

What is the Glasgow 7 point checklist? (1)

A

UK clinical criteria for diagnosing malignant melanoma.
Major criteria: Change in size, shape or colour
Minor: Diameter>6mm, inflammation, oozing or bleeding, mild itch or altered sensation.

67
Q

A 41-year-old man develops itchy, polygonal, violaceous papules on the flexor aspect of his forearms. Some of these papules have coalesced to form plaques.
What is the most likely diagnosis? (1)

A

Lichen planus
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

68
Q

What causes alopecia areata? (1)

A

Autoimmune. Treat with steroids.

Hair will regrow in 1 year in 50% and in up to 90% eventually.

69
Q

What is the difference between 1st, 2nd and 3rd degree burns? (3)

A

1st - superficial epidermal burn, red and painful
2nd -
Partial thickness - superficial dermis - pink, painful and blisters
Partial thickness - deep dermis - white, patches of non blanching erythrma. Reduced sensation
3rd - Full thickness - black, brown or white with no pain or blisters.

70
Q

What is the treatment for scabies? (2)

A

Permethrin or Malathion

71
Q

What is necrobiosis lipoidica diabeticorum? (2)

A

Yellow or red shiny painless areas on shins of diabetics.

Associated with telengectasia.

72
Q

What is the treatment for impetigo? (2)

A

Topical fucidic acid

Oral flucloxicillin.

Medicine (14 decks)

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