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Flashcards in Dermatology Deck (85):
1

What is CREST syndrome?

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

2

What is seborrheic keratosis?

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

What is actinic keratosis?

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

What are gottrons patches?

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

5

Describe features of psoriasis and its epidemiology

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

What are first line treatments for psoriasis?

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

7

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?

Dermatofibroma - benign skin lesion found especially on the legs

8

What is a Marjolins ulcer?

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

9

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?

Squamous cell carcinoma
Pre lesion - actinic keratosis

10

What are predisposing factors for squamous cell carcinoma?

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

What is xeroderma pigmentosum?

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

What is lupus vulgaris?

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

13

What is leukoplakia?

White patch in the mouth - area of keratosis

14

What is lichen planus?

Disease of skin and/or mucus membranes that resembles lichen
Autoimmune process

15

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

Males and females equally likely
Peaks of onset: 16-22 and 55-60

16

What is pemphigoid?

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

17

What is erythema nodosum?

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

18

What is pre tibial myxoedema?

Waxy discoloured induration of skin - orange peel
Occurs in graves, Hashimoto's and stasis dermatitis

19

How does a basal cell carcinoma typically present?

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

20

What is erysipelas?

Acute episode of cellulitis

21

What are 3 causes for erythema nodosum?

Inflammatory bowel disease
Sarcoidosis
Pregnancy

22

How does erythema multiforme present?

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

23

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

Change in size
Change in shape
Change in colour
Bleeding
Sensory change

24

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

Pearly nodule with rolled telangiectatic edge
Ulcer

25

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

Regional lymph nodes

26

Name 3 treatments for basal cell carcinoma

Excision
Cryotherapy and curettage
Radiotherapy

27

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

Size

28

What is pyoderma gangrenosum associated with?

Rheumatoid arthritis
Inflammatory bowel disease
Paraproteinaemia

29

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?

Bowens disease

30

What is the main risk factor for bowens disease?

UV exposure

31

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?

Keratoacanthoma: hyperplasia of hair follicles

32

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?

Lentigo maligna: melanoma in situ

33

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?

Kaposis sarcoma: manifestation of HIV infection

34

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?

Nodular melanoma

35

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?

Dermatofibroma

36

What is a pyogenic granuloma?

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

37

What is the other name for neurofibromatosis?

Von recklinghausens disease

38

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

Warm
Oedematous
Eczematous
Haemosiderin deposits
Lipodermatosclerosis
Atrophie Blanche

39

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

Pale
Shiny
Hairless
Cold skin
Painful especially when elevated in bed

40

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

1.2 arterial calcification

41

What are the different types of melanoma?

Nodular
Superficial spreading
Lentigo maligna
Acral lentiginous

42

What are risk factors for developing malignant melanoma?

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

How do you manage a superficial spreading malignant melanoma?

Excise with a 2mm clinical margin to confirm diagnosis
Wider excision will be required, margin depending on thickness of the tumour

44

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

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

45

What can be triggers for erythema nodosum?

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

46

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

Compression stockings
Keeping legs elevated
Avoidance of trauma to skin

47

What are causes of urticaria?

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

48

What can cause reactivation of quiescent herpes simplex virus?

Stress
Trauma
Febrile illness
UV radiation

49

What are complications of hsv 1 infection?

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

50

What is the koebner phenomenon?

Tendency for skin disorders to appear at the sites of trauma

51

What are signs of secondary syphilis?

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

What is a gumma?

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

What are the 6 Ps of lichen planus?

Planar (flat-topped)
Purple
Polygonal
Pruritic
Papules
Plaques

54

What must be excluded in men with balanoposthitis?

Diabetes

55

What are differences between pemphigus and pemphigoid?

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

What is impetigo?

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

What is the treatment for impetigo?

Flucloxacillin for staph
Phenoxymethylpenicillin for strep
Avoid school for 1 week

58

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

Toxin A: bullous impetigo, localised
Toxin B: staph scalded skin syndrome, spreads throughout body

59

What causes viral warts?

Human papilloma virus

60

What can you use to treat a viral wart?

Topical keratolytic agent: salicylic acid
Cryotherapy

61

What is molluscum contagiosum?

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

What is orf?

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

What can be a complication of orf?

Erythema multiforme

64

Describe the lesion seen in tinea corporis

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

65

Describe the lesion seen in Candida albicans

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

How does atopic eczema present?

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

What are complications of atopic eczema?

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

What are treatments for atopic eczema?

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

What is seborrhoeic eczema?

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

70

Who is most likely to get seborrhoeic eczema?

Parkinson's
HIV
Neonates: cradle cap

71

What is the treatment for seborrhoeic eczema?

Mild steroid ointment
Topical anti fungal: miconazole

72

What are the different types of psoriasis?

Chronic plaque
Flexural
Guttate
Erythrodermic
Pustular

73

What can be used to treat psoriasis?

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

74

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

Target lesions
Herpes virus

75

What is nikolskys sign?

Epidermal layer sloughs off when pressure is applied

76

What can maternal infection with rubella cause during pregnancy?

Spontaneous abortion
Foetal death
Congenital abnormalities

77

What signs and symptoms might a patient with rubella have?

Fever
Maculopapular rash
Lymphadenopathy
Conjunctivitis
Arthritis

78

What are some potential complications of measles?

Pneumonia
Laryngotracheitis
Otitis media
Encephalitis

79

What are risk factors for pressure sore development?

Prolonged immobility
Poor nutrition
Vascular disease
Sensory loss
Age
Incontinence

80

What needs to be done before commencing oral retinoid therapy?

Pregnancy test
Contraceptive advice
Signed consent
Monthly pregnancy test

81

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

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

82

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

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

83

What are risk factors for venous ulcer development?

PVD
Varicose veins
Venous hypertension: DVT, valvular incompetence

84

What are risk factors for developing arterial ulcers?

Smoking
High cholesterol
Hypertension
IHD
Age
Diabetes
Obesity

85

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

FBC and U and Es every 3 months