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Flashcards in Dermatology Deck (85)
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1
Q

What is CREST syndrome?

A

Systemic scleroderma
Calcinosis (calcium lumps under skin on fingers), Raynaud’s disease, (O)Esophageal dysmotility, Sclerodactyly, Telangiectasia

2
Q

What is seborrheic keratosis?

A

Start as small rough areas, over time develop thick wart like surface, waxy, scaly elevated appearance
Usually brown, can be difficulty to distinguish from melanoma

3
Q

What is actinic keratosis?

A

Dry scaly patches of skin caused by sun damage
Pink, red or brown, skin thickening, can look like horns
Can develop into SCC if not treated
Seen in fair skinned people

4
Q

What are gottrons patches?

A

Scaly erythematous eruptions or red patches overlying the knuckles, elbows and knees
Characteristic of dermatomyositis

5
Q

Describe features of psoriasis and its epidemiology

A

Pink scaly plaques, particularly on extensor surfaces which may be itchy and sore
Equally affects males and females
Two peaks of ages of onset: early onset 16-22, late onset 55-60

6
Q

What are first line treatments for psoriasis?

A

Topical agents: emollients, steroids, calcipotriol, retinoids, purified coal tar
Phototherapy
Systemic therapy: methotrexate

7
Q

An anxious 19 year old woman presents with a pigmented lesion on her left inner thigh. There is no significant past medical or family history. Inspection reveals a brown purple lesion of approximately 1cm diameter with a raised smooth surface. What is the likely diagnosis?

A

Dermatofibroma - benign skin lesion found especially on the legs

8
Q

What is a Marjolins ulcer?

A

Squamous cell carcinoma developing in areas of chronic inflammation such as burn sites or varicose ulcers

9
Q

A 68 year old woman is referred with an ulcerated lesion on the side of her nose. It was first noticed 4 months prior to presentation and had been slowly growing. Prior to that there was crusting of the skin which had been present for some years. Inspection reveals 12mm ulcer with raised everted edge. No lymph nodes are palpable. What is the likely diagnosis? What was the crusty lesion described before it developed?

A

Squamous cell carcinoma

Pre lesion - actinic keratosis

10
Q

What are predisposing factors for squamous cell carcinoma?

A

Sun exposure
Radiation exposure
Pre malignant conditions: bowens, senile keratosis, lupus vulgaris, Paget’s disease
Inherited: xeroderma pigmentosum, albinism
Chronic irritation: Marjolins ulcer, leukoplakia, varicose veins, osteomyelitis sinus
Infection: HPV 5 and 8

11
Q

What is xeroderma pigmentosum?

A

Hereditary defect of enzyme system that repairs DNA after UV damage resulting in extreme sensitivity to sunlight and a tendency to develop skin cancer

12
Q

What is lupus vulgaris?

A

Chronic direct infection of the skin with TB causing dark red patches with a nodular appearance, often around the face and neck

13
Q

What is leukoplakia?

A

White patch in the mouth - area of keratosis

14
Q

What is lichen planus?

A

Disease of skin and/or mucus membranes that resembles lichen

Autoimmune process

15
Q

Who is most likely to get psoriasis and at what age?

A

Males and females equally likely

Peaks of onset: 16-22 and 55-60

16
Q

What is pemphigoid?

A

Autoimmune blistering condition characterised by development of bullous like lesions which typically develop on the lower limb

17
Q

What is erythema nodosum?

A

Raised erythematous lesions on shins
Associated with drugs - sulphonamides, oral contraceptives and penicillins
Associated with infections - mycoplasma pneumonia, RA and sarcoidosis

18
Q

What is pre tibial myxoedema?

A

Waxy discoloured induration of skin - orange peel

Occurs in graves, Hashimoto’s and stasis dermatitis

19
Q

How does a basal cell carcinoma typically present?

A

Small pink coloured nodule or papule with visible surface telangiectasia and pearly rolled edges

20
Q

What is erysipelas?

A

Acute episode of cellulitis

21
Q

What are 3 causes for erythema nodosum?

A

Inflammatory bowel disease
Sarcoidosis
Pregnancy

22
Q

How does erythema multiforme present?

A

Acute inflammatory condition often precipitated by herpes simplex
Tender nodules surrounded by page rings - target

23
Q

Give 5 features of a lesion which make you suspect skin cancer

A
Change in size 
Change in shape
Change in colour
Bleeding
Sensory change
24
Q

Name 2 features of an examination that would make you suspect a basal cell carcinoma

A

Pearly nodule with rolled telangiectatic edge

Ulcer

25
Q

Where would you look for secondary spread in a basal cell carcinoma?

A

Regional lymph nodes

26
Q

Name 3 treatments for basal cell carcinoma

A

Excision
Cryotherapy and curettage
Radiotherapy

27
Q

Name 1 feature of the examination of a basal cell carcinoma which would narrow the treatment options available

A

Size

28
Q

What is pyoderma gangrenosum associated with?

A

Rheumatoid arthritis
Inflammatory bowel disease
Paraproteinaemia

29
Q

A 64 year old woman is referred by her GP with an itchy red brown lesion on her cheek. It has been present for many months and has been growing slowly. On examination there is a 1 X 0.5cm lesion with a crusty surface. There are no other lesions and there is no lymphadenopathy. What is the diagnosis?

A

Bowens disease

30
Q

What is the main risk factor for bowens disease?

A

UV exposure

31
Q

A 45 year old woman is referred for a lesion on her cheek. On examination it is raised above the level of the surrounding skin, has an irregular surface with smooth sides, central umbilication and a crusty core. What is it?

A

Keratoacanthoma: hyperplasia of hair follicles

32
Q

A 70 year old woman is referred with a 3 X 2cm pigmented brown black lesion on her right temple. On examination the lesion has an irregular edge but a smooth flat surface. No lymphadenopathy is palpable. What is it?

A

Lentigo maligna: melanoma in situ

33
Q

A 34 year old male IV drug user is seen in the clinic with several new red brown nodules on his limbs. He has also recently been treated for an opportunistic pneumonia and his prescription includes AZT. What does he have?

A

Kaposis sarcoma: manifestation of HIV infection

34
Q

64 year old man referred with an itchy pigmented lesion on his cheek which has recently changed size and shape. On examination the lesion has an irregular edge and raised surface with variable pigmentation. There is a surface clot following a recent contact bleed. What is the likely diagnosis?

A

Nodular melanoma

35
Q

Anxious 19 year old woman presents with pigmented lesion on left inner thigh. No past medical or family Hx. Inspection reveals a brown purple lesion of 1cm diameter with a raised smooth surface. What is the likely diagnosis?

A

Dermatofibroma

36
Q

What is a pyogenic granuloma?

A

Hands and face of children and young adults
Lesions on lips and gums of pregnant women
Benign capillary haemangiomas

37
Q

What is the other name for neurofibromatosis?

A

Von recklinghausens disease

38
Q

What features of a leg ulcer would make you think it is venous?

A
Warm 
Oedematous 
Eczematous 
Haemosiderin deposits 
Lipodermatosclerosis 
Atrophie Blanche
39
Q

What features of a leg ulcer would make you think it is arterial?

A
Pale
Shiny
Hairless
Cold skin
Painful especially when elevated in bed
40
Q

What ankle brachial plexus index values would you be worried about?

A

1.2 arterial calcification

41
Q

What are the different types of melanoma?

A

Nodular
Superficial spreading
Lentigo maligna
Acral lentiginous

42
Q

What are risk factors for developing malignant melanoma?

A

More than 5 episodes of sunburn under age of 10
>100 naevi
Atypical naevus syndrome
Personal and/or family history of melanoma
Large congenital melanocytic naevus
Skin type 1: tending to burn easily and not tan in the sun

43
Q

How do you manage a superficial spreading malignant melanoma?

A

Excise with a 2mm clinical margin to confirm diagnosis

Wider excision will be required, margin depending on thickness of the tumour

44
Q

What is an important risk factor for recurrence of a malignant melanoma?

A

Breslow thickness: depth of tumour, measured on histology in millimetres from granular cell layer to deepest point of tumour

45
Q

What can be triggers for erythema nodosum?

A
Streptococcal throat infection 
TB
Leprosy 
Chlamydia 
Sarcoidosis 
IBD
Pregnancy 
Malignancy 
Drugs: contraceptive pill, sulphonamides
46
Q

What factors can be used to prevent the recurrence of venous leg ulcers?

A

Compression stockings
Keeping legs elevated
Avoidance of trauma to skin

47
Q

What are causes of urticaria?

A
Idiopathic 
Allergy to food 
Insect bites
Drug induced
Infections
Physical: pressure, sunlight, cold
48
Q

What can cause reactivation of quiescent herpes simplex virus?

A

Stress
Trauma
Febrile illness
UV radiation

49
Q

What are complications of hsv 1 infection?

A

Eye infection: Dendritic ulceration, Keratitis
Acute encephalitis
Skin infections: herpetic whitlow, erythema multiforme

50
Q

What is the koebner phenomenon?

A

Tendency for skin disorders to appear at the sites of trauma

51
Q

What are signs of secondary syphilis?

A

Generalised lymphadenopathy
Skin rashes including palms and soles
Condylomata lata: warty plaque like lesions in perianal area
Superficial confluent ulceration of mucosal surfaces: snail track ulcers

52
Q

What is a gumma?

A

Soft, non-cancerous growth resulting from the tertiary stage of syphilis
A form of granuloma
Firm, necrotic center surrounded by inflamed tissue, which forms an amorphous proteinaceous mass

53
Q

What are the 6 Ps of lichen planus?

A
Planar (flat-topped)
Purple
Polygonal
Pruritic
Papules
Plaques
54
Q

What must be excluded in men with balanoposthitis?

A

Diabetes

55
Q

What are differences between pemphigus and pemphigoid?

A

Both characterised by bullae
Pemphigus vulgaris: autoantibodies against epidermal cell junctions, flaccid bullae that burst easily
Bullous pemphigoid: autoantibodies against basement membrane of epidermis, subepidermal bullae, less fragile, tense

56
Q

What is impetigo?

A

Highly infectious skin disease common in children
Weeping exudative area with honey coloured crust
Spread by direct contact
Staph or group A beta haemolytic strep

57
Q

What is the treatment for impetigo?

A

Flucloxacillin for staph
Phenoxymethylpenicillin for strep
Avoid school for 1 week

58
Q

What is the difference between bullous impetigo and staph scalded skin syndrome?

A

Toxin A: bullous impetigo, localised

Toxin B: staph scalded skin syndrome, spreads throughout body

59
Q

What causes viral warts?

A

Human papilloma virus

60
Q

What can you use to treat a viral wart?

A

Topical keratolytic agent: salicylic acid

Cryotherapy

61
Q

What is molluscum contagiosum?

A

Pox virus
Multiple small translucent Papules which look fluid filled but are actually solid
Central punctum
Can occur at any site including genitals
Continue to occur in crops over 6-12 months

62
Q

What is orf?

A

Disease of sheep due to a pox infection
Vesicular and pustular rash
People who have come into contact with fluid may develop lesions on hands
1-2cm reddish Papules with surrounding erythema which usually become pustular

63
Q

What can be a complication of orf?

A

Erythema multiforme

64
Q

Describe the lesion seen in tinea corporis

A

Ringworm of body

Asymmetrical scaly patches which show central clearing and an advancing scaly raised edge

65
Q

Describe the lesion seen in Candida albicans

A

Red ragged peeling edge that may contain a few small pustules
Small circular areas of erythema or small Papules and pustules may be seen in front of the advancing edge - satellite lesions
Mouth/genitals: superficial white or creamy pseudomembranous plaques

66
Q

How does atopic eczema present?

A

Itchy erythematous scaly patches especially in flexures and around neck
In infants, usually starts on face and spreads to the body
Acute lesions may weep or exude and can show small vesicles
Scratching produces excoriations
Repeated rubbing produces lichenification - skin thickening

67
Q

What are complications of atopic eczema?

A

Staph aureus infection: crusted weeping impetigo like lesions
Cutaneous viral infections: viral warts and molluscum
HSV: eczema herpeticum
Conjunctival irritation
Keratoconjunctivitis
Cataract
Retarded growth

68
Q

What are treatments for atopic eczema?

A

Avoiding known irritants
Wearing cotton clothes
Not getting too hot
Triple combination: topical steroid, frequent emollients and bath oil and soap substitute (aqueous cream)

69
Q

What is seborrhoeic eczema?

A

Overgrowth of pityrosporum and strong immune reaction to this yeast produces inflammation and scaling

70
Q

Who is most likely to get seborrhoeic eczema?

A

Parkinson’s
HIV
Neonates: cradle cap

71
Q

What is the treatment for seborrhoeic eczema?

A

Mild steroid ointment

Topical anti fungal: miconazole

72
Q

What are the different types of psoriasis?

A
Chronic plaque 
Flexural 
Guttate 
Erythrodermic 
Pustular
73
Q

What can be used to treat psoriasis?

A
Emollients 
Topical steroids
Vitamin D3 analogues: calcipotriol, calcitriol 
Tazarotene (retinoid) 
Purified coal tar
74
Q

What do erythema multiforme lesions look like? And what typically causes it?

A

Target lesions

Herpes virus

75
Q

What is nikolskys sign?

A

Epidermal layer sloughs off when pressure is applied

76
Q

What can maternal infection with rubella cause during pregnancy?

A

Spontaneous abortion
Foetal death
Congenital abnormalities

77
Q

What signs and symptoms might a patient with rubella have?

A
Fever
Maculopapular rash
Lymphadenopathy 
Conjunctivitis
Arthritis
78
Q

What are some potential complications of measles?

A

Pneumonia
Laryngotracheitis
Otitis media
Encephalitis

79
Q

What are risk factors for pressure sore development?

A
Prolonged immobility
Poor nutrition 
Vascular disease 
Sensory loss
Age
Incontinence
80
Q

What needs to be done before commencing oral retinoid therapy?

A

Pregnancy test
Contraceptive advice
Signed consent
Monthly pregnancy test

81
Q

What characteristics of a lesion would make you think it is seborrhoeic keratosis?

A
Older age group
Face scalp and trunk 
Warty surface 
Stuck on appearance 
Matte surface
Multiple lesions 
Shiny keratin cysts 
Comedo like openings
82
Q

What characteristics of a lesion would make you think it is a benign mole?

A
Longstanding 
Hasn't changed
Regular borders
Well defined 
Only one colour 
Symmetrical 
Small
83
Q

What are risk factors for venous ulcer development?

A

PVD
Varicose veins
Venous hypertension: DVT, valvular incompetence

84
Q

What are risk factors for developing arterial ulcers?

A
Smoking 
High cholesterol 
Hypertension
IHD 
Age 
Diabetes 
Obesity
85
Q

What monitoring should be done for a patient on long term azathioprine?

A

FBC and U and Es every 3 months