Dermatology Flashcards by Chrissy Bolton

Mutation in which gene is associated with basal cell carcinoma (rodent ulcer)?

TP53 tumour supressor gene

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How should a suspected melanoma be managed?

Wide local excision- 1cm around the lesion for every mm of thickness of the mole up to 3cm

Sentinel node biopsy

If metastatic- molecular analysis used to match tumour with therapeutic agent

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What grading system links melanoma thickness with prognosis?

Breslow’s depth- the deeper the tumour, the higher the stage:

Stage 1 = < 1mm
Stage 2 = 1-2mm
Stage 3 = 2-4mm
Stage 4 = > 4mm

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What is the ABCDE of mole examination (signs of melanoma)?

Asymmetric lesions
Border irregular
Colour irregularity
Diameter >6mm
Evolving in size

Refer patient if:
3 apply
or there’s a spontaneous change in an above factor
Or there’s itching, pain or bleeding of it

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What is phimosis and how is it treated?

When the foreskin is too tight to retract it.
Normal up to 4 years, may lead to increased risk of glans inflammation (balanitis)

Rx: betamethasone cream may help, stretching exercises BD

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What is paraphimosis and how should it be managed?

When a retracted foreskin becomes irreplaceable and prevents venous return of the glans.
Oedema and ischaemia may ensue.

Rx:

Patient should try to squeeze glans
50% glucose can reduce oedema, ice and lidocaine
Circumcision or dorsal slit may be required

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What is balanitis and how is it managed?

Inflammation of foreskin and glans- often strep or staph

Rx:

Antibiotics + hygiene advice
Circumcision

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What may cause pyrexia following an operation in the first 48 hours?

Atelectasis- complete or partial collapse of lung lobes as a result of not ventilating normally during surgery (requires physio)

Infection- UTI, toxic shock syndrome, chest, wound, meningitis
Immune- blood transfusion, reaction to antibiotics, malignant hyperthermia, hyperacute transplant rejection

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How does management differ between actinic (solar) keratoses, bowen’s disease (SCC in situ) and squamous cell carcinomas?

Actinic keratoses + Bowen’s disease
Temperature: cryotherapy, photodynamic therapy
Chemical: fluorouracil, diclofenac gel, imiquimod (induces IFN-a)
Surgical: if SCC suspected

Squamous cell carcinoma
Excision

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What are the typical features of mild acne and it’s treatment?

Comedones (black heads, white heads)
Inflammatory pustules + papules

Rx: topical retinoid
± topical abx (clindamycin), salicylic acid, benzoyl peroxide

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Signs of severe acne and it’s Rx:

Nodules, cysts, scarring

Oral retinoid, isotretinoin- monitor cholesterol, LFTs, triglycerides, FBC, need contraceptive (teratogenic)
Co-cyprindiol pill- a contraceptive
Oral abx

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What is the pre-malignant and maligant form of each type of skin cancer?

Actinic keratoses > Bowen’s disease (in situ) > Squamous CC

Maligna lentigo > malignant melanoma

Basal cell carcinoma

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How does the management of squamous cell carcinoma differ from actinic keratoses and Bowen’s disease?

Squamous cell carcinoma- excision
only 5-fluorouracil if superficial

Bowen’s + actinic keratosis- 5-FU or cryotherapy or photodynamic therapy

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Management of malignant melanoma?

Wide local excision- 1cm margin for every mm of depth up to 3cm

If Breslow thickness >1mm then shoud excise sentinel lymph node
Can send to lab for targeted molecular therapies

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What is the common skin lymphoma?

Mycosis fungoides- involves CD4 T helper cells

PC: well defined red scaly patches or plaques

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Causes of blisters?

Infection- herpes, insect bites
Drugs- ACEi, furosemide
Dermatitis herpetiformis
Discoid eczema- starts with vesicles, then coin shaped
Autoimmune- pemphigoid + pemphigus
Trauma- burns

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Difference in the pathophysiology and Rx of pemphigus + pemphigoid?

Pemphigus- IgG against desmosomal components so keratinocytes separate from each other (crazy paving)
Rx: prednisolone PO or IV Rituximab/ Ig

Pemphigoid- IgG against basement membrane
Rx: clobetasol cream (steroid)

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Options for breast reconstruction following surgical mastectomy:

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Tissue expanders/implants
Latissimus dorsi flap
Transverse rectus abdominis myocutaenous flap

How is surface area of a burn estimated?

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9% each arm
9% front of leg + 9% of back
18% front torso
18% back torso
9% whole head

Volume of Hartmanns to be given in a burn?

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4 x kg x body surface area burned

1/2 given in 1st 8hrs

Rx of tinea infections

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Terbafine or clomitrazole on skin

Rx of seborrhoeic dermatitis

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Ketoconazole shampoo

Rx of candida in mouth and vagina:

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Mouth- nystatin

Clomitrazole cream + pessary in vagina

Rx of impetigo

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Superficial infection from staph aureus characterised by honey-coloured crusts on erythematous base

Topical fusidic acid
PO flucloxacillin if severe

Cause of erysipelas, common way it presents?

Strep pyogenes Erythema of the face which is sharply defined and superficial PO penicillin

Difference between cellulitis and erysipelas?

Cellulitis is deeper and less sharply demarcated- needs benzylpenicllin + flucloxacillin whereas erysipelas only needs penicillin (strep pyogenes) Erysipelas affects the upper dermis whereas cellulitis affects SC fat + dermis

Management of genital warts (condylomata acuminata):

Cryotherapy ± podophyllin or imiquimod cream Screen for other STIs May need yearly cervical screening- risk of HPV 16+18

Management of generalised pustular psoriasis (derm emergency):

Conservative: emollients, wet dressings Medical: oral retinoid (acitretin)- LFTs,, glucose, lipids Biologics (etanercept)- TNFa blocker

What is the definition of erythroderma and it's management?

Erythema and scaling of >90% of the skin surface, caused by inflammation ``` Conservative: Fluid balance + temperature Emollients + topical steroids Antihistamines Wet dressings ```

Management of eczema:

Conservative: emollients + soap substitutes Medical: Topical steroids (hydrocortisone or potent betamethasone) Tacrolimus (calcineurin inhibitors)

5 types of eczema:

``` Atopic Venous Discoid Pompholx- hands + feet blisters Asteatotic- old age ```

Allergic contact dermatitis is what type of hypersensitivity reaction?

Type 4 | Ie allergy to nickel, lanolin

Rx of acne rosacea?

Inflammatory erythematous telangiectasia Inflammatory nodules, unlike acne there are no comedones Rx: 1. metronidazole 2. Anitbiotics, oral retinoid

Rx of plaque psoriasis:

1. Emollients + soap substitutes Vitamin D analogue- calcipotriol Topical steroid 2. Tar, Dithranol UV A + Psoralen 3. If arthropathy of severe: Oral retinoid- Acetretin Immunosupression- ciclosporin, methotrexate Biologics- etanercept

Stages of pressure sore:

1: non-blanching erythema 2: partial thickness skin loss 3: full skin loss extending into fat 4: destruction of bone, muscle or tendons

Features of depression:

A: anhedonia, low mood, low energy B: low concentration, self-esteem, guilt, unworthiness, pessamistic thoughts, self harm, reduced sleep and appetite ``` Mild = 2A + 2B Moderate = 2A + 3B Severe = 3A + 4B ```

Hypomania features

``` 4 days of elevated mood or irritable and 3 of: High activity or restless More distractible Less need for sleep ``` More talkative More sociability More sexual energy Mild reckless or irresponsible behaviour

What is the difference between hypomania and mania:

Hypomania- Sx for 4 days Mania- Sx for 1 week Mania includes flight of ideas, loss of inhibition, severe interference of personal function

Features of serotonin syndrome:

Cognitive: headache, agitated, confused, hallucinating, coma Autonomic: sweating, shivering, hyperthermia, nausea, high BP+HR Somatic: myoclonus, hyper-reflexia, tremor

Signs of lithium toxicity:

GI disturbance, muscle weakness, drowsy, blurred vision

Differential of a midline neck lump:

Subcutaneous cyst Lipoma Lymph node Thyroid nodule Thryoid gland Thyroglossal cyst

Differential of a lump in the anterior triangle of the neck?

Anterior to sternocleidomastoid: Subcutaneous cyst Lymph node Lipoma ``` Salivary gland swelling Laryngocele- reducible Branchial cyst (failed obliteration of branchial cleft) Carotid aneurysm- pulsatile + bruit Carotid body tumour ```

Differential for lumps in the posterior triangle of the neck:

Subcutaneous cyst Lymph nodes Lipoma Branchial cyst Subclavian artery aneurysm- pulsatile Pharyngeal pouch- reducible Cystic hygroma- fluctuant

Differences between venous, ischaemic and neuropathic ulcers?

Venous: Superficial painful ulcer in the gaiter region with sloping edges, which is pink in colour + granulating Ischaemic: Deep punched out ulcer on the sole/pressure areas, which appears sloughy and pale and painful Pressure: Deep punched out ulcer on the sole/pressure areas, which appears sloughy and pale but is not painful

Dermatology Flashcards

(44 cards)