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Phase 4 - GR > Dermatology > Flashcards

Dermatology Flashcards

1
Q

name 3 functions of the skin

A 
Protection against environment
Temperature regulation
Neurological - Sensation
Storage and synthesis - Vitamin D synthesis
Immunosurveillance
Stop fluid loss
Aesthetics and communication
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2
Q

What cells in the skin present antigens and activate t-lymphocytes ?

A

langerhans

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3
Q

What are merkel cells

A

nerve endings for sensation

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4
Q

Function of melanocytes

A

produce melanin - pigment and protects nuclei from UV radiation induced DNA damage

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5
Q

the epidermis is made from?

A

keratinocytes (various levels of maturation)

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6
Q

2 types of sweat gland and function

A

eccrine (skin)

apocrine (axilla, anus, genitalia - only function from puberty, bacteria - body odour).

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7
Q

4 stages of wound healing

A

Haemostasis
Inflammation
Proliferation
Remodelling

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8
Q

What happens in the stages haemostasis and inflammation

A

Vasoconstriction and Pt aggregation (clot formation)

Vasodilation, migration NP and MP -> phagocytosis of debris

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9
Q

What happens in proliferation and remodeling

A

Granulation tissue formation (fibroblasts) and angiogenesis. Re-epithelialization

Collagen fibre-reorganisation, scar maturation

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10
Q

What might you use emollients for?

A

Rehydrate skin, re-establish surface lipid layer.

Use at dry, scaling conditions as soap substitute

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11
Q

SE of emollients

A

irritant - rash

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12
Q

Name 3 indications for topical corticosteroids

A

Anti-inflammatory, anti-proliferative

allergic/immune conditions, blistering, inflammatory skin conditions, connective tissue disease, vasculitis

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13
Q

4 strengths of topical corticosteroid cream - getting stronger

A

Hydrocortisone

Clobetasone butyrate (Eumovate)

Betamethasone valerate (Betnovate)

Clobetasol propionate (Dermovate)

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14
Q

Name 2 local SEs of topical corticosteroids

A

Skin atrophy, telangiectasia, striae, exacerbation skin conditions, acne, perioral dermatitis

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15
Q

Name 3 SEs od oral corticosteroids

A

SHIP DOC

Syndrome (Cushing’s)
HTN
Immunosuppression
Psychosis
Diabetes
Osteoporosis
Cataracts
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16
Q

Eg of topical Abx

A

Fusidic acid
mupirocin
neomycin

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17
Q

SEs of Abx. Name 3

A

Local (irritation, allergy)

Systemic: GI upset, rash, anaphylaxis, candidiasis, ABX associated infections

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18
Q

Eg of an oral retinoid

A

Isotretinoin, acitretin

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19
Q

Indication for oral retinoids . name 2

A

Acne, psoriasis, disorders of keratinisation

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20
Q

SEs of oral retinoids. Name 2

A

Mucocutaneous reactions: dry skin, lips, eyes

Disordered liver function (LFT)

Hypercholesterolaemia (Blood test)

Myalgia, arthralgia, depression

Teratogenicity (effective contraception one month before, during and after isotretinoin, 2 years after acitretin)

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21
Q

What is the main SEs of ciclosporin? what should you do?

A

HTN and renal dysfunction

monitor BP and Ur + Cr

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22
Q

Ciclosporin is what kind of drug?

A

immunosuppressant

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23
Q

What type of drug is azathioprine? SEs?

A

Immunosuppressant

Hepatotoxicity and myelotoxicity

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24
Q

what is atopic eczema?

A

A chronic, relapsing inflammatory skin condition characterised by itchy, erythematous scaly patches.

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25
Q

Where is eczema usually in infants? older?

A

infants - face and extensor
Older
Flexor surfaces (skin folds)

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26
Q

What is needed for Dx of eczema

A

Itchy skin + 3 of

History of flexural involvement

Visible flexural dermatitis

Personal history asthma, hayfever (or family if <4)

Generally dry skin in last year

Onset at <2

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27
Q

What might you Ix in atopic eczema

A

Serum IgE levels,

allergy testing (specific IgE) = skin prick test or RAST (radioallergosorbant test)

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28
Q

Name 2 complications of eczema

A

Psychological stress

Bacterial superinfection (s.aureus)

Eczema herpeticum (vesicular, HSV) - emergency

SE of treatment

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29
Q

contact dermatitis usually comes with a Hx of contact with irritants / occupational Hx
(REMEMBER THE OSCE STATION YOU FUCKED)

How would you mx Irritant?
Allergic?

A

Irritant: emollients/topical corticosteroids + irritant avoidance (gloves)

Allergic: topical corticosteroids + allergen avoidance (±topical calcineurin… as AD)

The same basically

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30
Q

Seborrhoeic dermatitis is usually found where?

A

scalp, nasolabial fold, anterior chest

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31
Q

what is Seborrhoeic dermatitis called in children ? mx?

A

cradle cap (resolves by 12 months)

emollients and topical corticosteroidsif needed

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32
Q

Stress tends to flare Seborrhoeic dermatitis in adults. Mx of scalp?
non scalp?
What if it lasts >3/12?

A

(scalp only) -

  • topical shampoo (salicylic acid - keratolytic, coal tar, antifungal - ketoconazole)
  • topical corticosteroids

Adults (non-scalp)
topical corticosteroids ± topical antifungals (ketoconazole)

Lasting over 3 months - oral antifungal (ketoconazole)

Basically just topical corticosteroids - I’ve left the other stuff in so its recognisable in the MCQ)

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33
Q

What is psoriasis? Characteristic?

A

Inflammatory disease due to hyperproliferation of keratinocytes and inflammatory cell infiltrate

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34
Q

Seen on biopsy of psoriasis?Name 2 things

A

focal parakeratosis (retained nuclei,
absent granular layer),
epidermal acanthosis (thickening),
dilated capillaries

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35
Q

2 key associations with psoriasis

A

50% - nail changes
(pitting, Beau’s lines (horiz) and onycholysis - lift off bed)

10% have psoriatic arthritis
symmetrical polyarthritis, asymmetrical oligomonoarthritis

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36
Q

Most common form of psoriasis?

A

Plaque
Well-circumscribed, erythematous, scaly plaques with silver scaling
Bleed on scale removal/picking
(Auspitzs sign)

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37
Q

Where is/ appearance of guttate psoriasis ? Who gets it?

A

Raindrop like on trunk, arms and legs

post streptococcal tonsillitis @young

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38
Q

Mx of psoriasis

A 
General Educate, avoid triggers (drug stress alcohol)
emolllients 
Topical 
Topical corticosteoids
Vid D analouges

Phototherapy (extensive disease)

Oral - Severe
Methotrexate
ciclosporin
acitretin

Biologic
etanercept, infliximab

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39
Q

guttate 1st line

A

phototherapy

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40
Q

Pustular psoriasis 1st line

A

oral retinoid (acitretin)

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41
Q

Complications of acne . Name 3

A

depression

Post-inflammatory hyperpigmentation, scarring, deformity, psychological

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42
Q

Mx of mild acne

A 
Topical keratolytic Eg Benzoyl peroxide 
OR
Topical retinoids 
Eg isoretinoin 
\+ Topical Abx if needed  (clindamycin/erythromycin)
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43
Q

Mx of mod/severe acne

A

Topical retinoid + oral antibiotics - (tetracycline, doxycycline)

Anti-androgens (females) - COCP

Oral retinoids (severe only) - isotretinoin (see SE)

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44
Q

Which skin Ca has the highest reccurence and METS?

A

SCC (from keratinocytes)

BCC and SCC are keratinocytes, melanoma is melanocytes.

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45
Q

What cell are BCCs from?

A

hair follicle

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46
Q

Rfs for SCC

A

UV exposure, pre-malignant conditions (actinic keratoses, Bowen’s disease), chronic inflammation (leg ulcer), immunosuppression, whites, outdoor occupation, previous SCC

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47
Q

How would a SCC present?

A

Keratotic (scaly, crusty), ill-defined nodule ± ulceration± bleeding

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48
Q

What is bowens ?

A

Superficial red, scaley patch on skin

-Easy to treat

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49
Q

Whats the problem with SCC

A

SPREAD Quick growing, local metastases (quicker than BCC)m or spread to local LN

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50
Q

Ix for SCC

A

Biopsy

CT/MRI

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51
Q

What 3 levels of SCC can you see on biopsy?

A

Keratinocyte atypia - actinic keratosis

SCC-in-situ (Bowen’s) - full thickness atypia with intact basement membrane

Invasive tumour - penetrates bm to dermis

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52
Q

Common mets for SCC

A

LNs, lung, liver, brain, bone

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53
Q

Mx of SCC in situ

A 
Cryotherapy (destructive), 
topical chemotherapy (fluoracil - Efudix)
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54
Q

Mx of <2cm invasive SCC

A

Wide surgical excision

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55
Q

Mx of mets

A

excision (if on skin) + radiotherapy

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56
Q

BCC RFs

A

UV exposure, sunburn at childhood, skin type I (burns), increasing age, male, immunosuppression, previous history, genetic predisposition, whites, albinism

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57
Q

How does BCC appear?

A

rodent ulcer

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58
Q

Seen on biopsy of BCC

A

small, dark staining (basophilic) basal cells growing in nests (aggregates), invading the dermis

pearly flesh coloured papule

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59
Q

Mx of BCC is usually

A

surgical (radiotherapy if needed)

60
Q

What is Mohs micrographic surgery?

A

excision of lesion and tumour progressively until specimens are free of tumour

  • good for high risk / reccurent

BCC/SCC

61
Q

Non surgical option for low risk BCC

A

Cryotherapy

Photodynamic therapy

Topical fluorouracil

62
Q

How do you describe a pigmented lesion ?

A 
ABCDE 
Asymmetry
Border
Colour
Diameter
EVOLUTION!
63
Q

Whats issue with melanoma

A

mets early

64
Q

Rfs melanoma

A

Excess UV exposure, skin type I (always burns), history of multiple/atypical moles, Fam Hx, immunosuppression, previous melanoma

65
Q

The most common type of melanoma is superficial spreading mealnoma
Where common? who ?
Appearance

A

Common on lower limbs

young and middle aged,

large + flat + irregularly pigmented,
grow laterally then invade deep

66
Q

3 Ix for melanomas

A

Dermascopy -ABCDE

Biopsy

Assess mets

67
Q

How big an area do you biopsy for melanoma? 2 descriptions?

A

Ideal biopsy is full thickness local excision with margins of 2mm

If confined to epidermis = melanoma in situ

If spread to dermis = invasive melanoma

68
Q

Where is the common site of mets from melanoma?

A

liver and bone

69
Q

3 methods of assing mets in melanoma

A

Sentinel lymph node biopsy

CXR and liver USS (liver and bony mets)

CT chest/abdo/pelvis

70
Q

Mx melanoma in situ

A

Wide local excision / Mohs surgery

71
Q

Mx melanoma

A

Surgical excision (wide local excision) ± sentinel lymph node biopsy

72
Q

Complicationof surgery to lymph nodes

A

lymoedema

73
Q

How is recurrence of melanoma assessed/

A

Breslow Thickness:

0.75mm = low risk0.75-1.5mm = medium risk>1.5mm = high risk

74
Q

What is bullous pemphigoid

A

chinic blistering disorder usually affecting elderly

75
Q

what causes bullous pemphigoid

A

autoantibodies against hemidesmosal antigens in epidermis and dermis

76
Q

Ix for bullous phphigoid

A

biopsy for histopathology

77
Q

Mx of bullous pemphigoid

A

General
Wound dressing, monitor for infection

Topical
Corticosteroids

Oral (for widespread)
Steroids (pred) + antihistamines (hydroxyzine

Nicotinamide + oral tetracycline

immunosupressives

78
Q

pemphigus vulgaris is what?

Cause?

A

Autoimmune blistering skin disorder affecting the middle aged

Autoantibodies against antigens in epidermis
(shallower than bullous)

79
Q

Mx pemphigus vulgaris

A

General wound dressing, monitor for infection

Oral
High dose oral steroids, immunosupressants

80
Q

What is this Golden crust or vesicles/bullae in bullous?

Who gets it and cause?

A

impetigo
children
s aureus

(very contagious)

81
Q

What makes you more susceptible to impetigo?

A

trauma

skin breaks - eg eczema

82
Q

mx impetigo

A

Topical fusidic acid
Intranasal mupirocin
Oral flucloxacillin

83
Q

2 types of herpes and where it affect? mx?

A

Type 1 = oral herpes - oral ulcer with vermillion border or vesicles

Type 2 = genital herpes

Treat with aciclovir - oral ± topical

84
Q

Mx of orbital cellulitis

A

Ceftriaxone (IV) + vancomycin (IV) ± orbital decompression

As risk of blindness / abscess

85
Q

What causes scalded skin? seen in who?

A

commonly seen in children caused by production of a circulating epidermolytic toxin from benzylpenicllin-resistant (coagulase positive) staphylococci

All over body - DEHYDRATION IS MASSIVE PROBLEM

86
Q

Mx of scladed skin

A

analgesia, antibiotics (IV then oral) + fluids

Flucloxacillin

87
Q

Ix and Mx of fungal infections

A

Establish Dx
- with skin scrapings, swabs or hair/nail clippings (dermatophytes)

Treat precipitating factors
-Immunosuppressives, moisture

Topical antifungal
- E.g. terbinafine cream, ketoconazole/selenium sulphate shampoo

Oral antifungal
- E.g. itraconazole, fluconazole

88
Q

Why should you avoid topical corticosterids in fungal infections

A

causes tinea incognito

89
Q

Cause of warts

A

HPV (6-11) - fleshy condylomata accumulata

90
Q

Mx of warts

A

Cryotherapy, silver nitrate, debridement and salicylic acid

91
Q

What does this describe : Pearly, smooth papule with a central umbilication commonly distributed at face and groin

Mx?

A

molluscum contagiosum

curettage, cryotherapy

92
Q

What causes scabies

A

Infection with mites

93
Q

Mx of scabies

A

Treat the whole family + wash clothes >60 degrees

Topical permethrin (5%) + antihistamines: apply from neck down and wash after 8 hours

94
Q

what 3 things do you check in all ulcers

A

Site
Edge
Base

95
Q

What causes venous ulcers

A

chronic venous insufficiency, immunosuppressed, HF, anyone with poor healing.

96
Q

What are the signs of chronic venous insufficiency?Name 3

A

Ulcers

Ankle swelling, hyperpigmentation, lipodermatosclerosis (bound down), heavy legs, dry/scaly skin, telangiectasias, varicose veins, itching

97
Q

Rfs for venous insufficiency

A

Age, family history, smoking, DVT, orthostatic occupation

98
Q

Where are venous ulcers usually

A

Medial/lateral malleolus.

Between knee and ankle

99
Q

Appearance of venous ulcers

A 
Large
Shallow/sloping edge
Painless/mild pain (relieve by elevation)
Irregular border
Moist granulating base
100
Q

Ix for venous ulcers ?

A

ABPI using Doppler for pulses - to exclude arterial

Measure surface area, examine edge, base and note location. Examine other leg

Swabs for microbiology - if signs cellulitis

101
Q

when to biopsy venous ulcers

A

if atypical appearance or fail to heal in 12 weeks

102
Q

Mx of venous ulcers ? When would you give Abx?

A

Graduated compression + leg elevation (exclude art and neuro!)
- Maximise pressure at ankle/gaiter and decrease as higher. Helps control venous insufficiency

Debridement and cleaning - debride slough

Dressing
- Occlusive hydrocolloidal - allows epthelial migration and influx of leukocytes and moisture

ABX if cellulitis suspected

103
Q

Cause of arterial ulcers?

A

atherosclerosis and tissue hypoxia

104
Q

When would you suspect arterial ulcer?

A

CV RFs (smoking, DM etc), absent pulses, features of ischaemia

More distal site

painful

grey granulating base

105
Q

Features of ischemia

A

pale, pulseless, perishingly cold, parasthesia, paralysis

106
Q

How to identify peripheral arterial disease?

A

ABPI:

BP cuff on lower calf above ankle. Doppler probe on dorsalis pedis. Divide systolic at ankle by arm (highest) -> <0.9 implies peripheral arterial disease

107
Q

What is key difference in mx of venous vs arterial

A

NO compressing in arterial

108
Q

Where do you get neuropathic ulcers?

A

bottom of foot - pressure points - hallux

109
Q

Mx of neuropathic ulcers

A

Seek cause of neuropathy (often diabetes)

Diabetic foot management (socks/shoes/pressure/clean/check sensation)

110
Q

How does urticaria present\/

A

itchy wheals - central swelling with peripheral eythema

111
Q

What causes urticaria? Mx?

A

increase in permeability of capillaries and venules mediated by histamine derived from skin mast cells

antihistamines

112
Q

What is angioedema

A

Swelling of tongues, eyelids and lips

113
Q

Complications of angioedema

A

Asphyxia, cardiac arrest and death

Not good

Can get an urticarial rash with it which gives you itchy wheels

  • IgE mediated with mast cells and histamine
  • anti-histamines are treatment and oral corticosteroids
114
Q

3 hallmarks of anaphylaxis

A

Bronchospasm (stridor - beware)

Facial and laryngeal oedema

Hypotension

115
Q

Mx of Acute urticaria ± angioedema with airway involvement

A 
IM adrenaline (1 in 1000) + 
airway protection + 
IV antihistamines (chlorphenamine/dipenhydramine = 2nd generation) + 
IV corticosteroids (hydrocortisone) + 
trigger identification + 
avoidance
116
Q

mx of chronic urticaria

A

Loratadine

117
Q

What is erythema nodosum?

A

Erythematous lumps form on shins due to inflammation of subcutaneous fat

118
Q

Causes of erythema nodosum?

A

Inflammatory bowel disease (UC/Crohn’s)

TB (primary infection)

Throat infection (strep)

Sarcoidosis (assoc with enlarging LNs in lung)

119
Q

What is erythema multiforme ? Usual cause / prognosis

A

Hypersensitivity reaction triggered by infection.

Acute , self limiting - usually HSV

120
Q

Describe the appearance of erythema multiforme

A

few - 100s of lesions

Target lesions
1 -Outer - bright red
2- Middle - pale pink, oedematous and raised
3- Inner - dusky/dark red with blister/crust

121
Q

What causes stevens johnson syndrome?

A

Preceding history of medication use or infection: anticonvulsants, ABX, NSAIDs
(think antiretroviral man in Uganda who fucked it)

122
Q

toxic epidermal necrolysis is basically more severe form of steven johnson.
What characterises them?

A

Detachment of epidermis from dermis manifesting as maculopapular rash and bullae (keratinocyte apoptosis) -> Nikolsky sign (sloughing at pressure

123
Q

Dx of SJS / TEN?

A

skin biopsy and histopathology

124
Q

Mx of SJS / TEN

A 
Call for help
Withdrawal of causative agent
Dressing and topical antibacterial and emollients
IV fluids
Analgesia
125
Q

Complicatios of SJS? TEN

A

Dehydration, infection and sepsis, multi-organ failure

126
Q

What is necrotising fascitis? cause?

A

Rapidly spreading infection of deep fascia with secondary tissue necrosis

Group A haemolytic strep (pyogenes)
Staph aureus
[couple others too eg Pseudomonas aeruginosa)

127
Q

Rfs for nec fasc

A

Abdominal surgery, diabetes, malignancy

128
Q

Presentation of nec fasc

A

SEVERE PAIN

Erythematous, blistering, necrotic skin

Systemically unwell - fever and tachycardia

Crepitus - subcutaneous emphysema

129
Q

Mx nec fasc

A

Surgical debridement and haemodynamic support

Empirical broad spectrum ABX e.g. vancomycin and tazocin

130
Q

How does rosacea present?

A

Flushing, dilated telangiectasia (facial), facial erythema, inflammatory papules

Chronic skin condition affecting nose, cheeks and forehead and it is SYMMETRICAL

131
Q

Triggers of rosacea ? name 2

A

Climate (sunshine), chemical/ingested agents (alcohol), stress, hot baths/drinks

132
Q

Mx rosacea

A

Topical antibiotic/anti-inflammatory ± oral antibiotic

  • Metronidazole/azelaic acid (top)
  • Doxycycline/tetracycline (oral)
133
Q

What is being described?

Common, multiple, benign lesions affecting over 50s (80-100%)
STUCK-ON lesions, well-circumscribed plaques or papules, may be warty appearance, grey-brown-black, painless

A

Seborrhoeic keratosis/basal papilloma

134
Q

Where is Seborrhoeic keratosis/basal papilloma usually found? associations?

A

torso / head

UV sun damage, white

135
Q

Mx of Seborrhoeic keratosis/basal papilloma

A

Itchy - steroids (topical)

Flat - cryotherapy

Raised - curettage or cautery

136
Q

What is lichen planus?

Who normally gets it?

A

A self-limiting inflammatory disease affecting skin (+genitals), nails, hair and mucous membranes

middle aged women

137
Q

Mx of lichen planus

A 
Cutaneous
Topical corticosteroid (clobetasol) + antihistamine (e.g. chlorphenamine)

Oral
Topical corticosteroid ± oral corticosteroid

Genital
Topical corticosteroid/calcineurin inhibitor

138
Q

2ndary causes of systemic itch. Name 2 non malignant and 2 malignant

A

Renal - CKD caused by urea

Cholestatic - bile salts

haematological - basophils / mast cells

endocrine
hyper/hypo thyroid , DM

Malignant
Hodkin - bradykinin
carcinoid syndrome - serotonin

139
Q

What 2 orgas usually hit by vasculitis

A

kidneys skin

140
Q

What is alopecia

A

autoimmune affecting hair follicles

141
Q

3 types of alopecia?

A

Patchy alopecia areata

Alopecia totalis (scalp)

Alopecia universalis - all body hair

142
Q

mx of alopecia?

A

Limited= topical corticosteroid + cosmetic camouflage and support or intralesional corticosteroid

Extensive = topical immunotherapy + cosmetic camouflage + support

143
Q

Pemphigus vs pemphigoid

A

pemphigus goes bust
[between epidermis and dermis so close to surface]
-Blisters pop v early so don’t tend to see them

pemphigoid is deeper so blisters tend to last

144
Q

Layers of the skin

A

epidermis
dermis - mainly connective tissue produced by fibroblasts (inc hair follicles, sweat glands and nerve endings)
fat cells

145
Q

Se of topical steroids - give 3

A 
thinning of skin
bruising and tearing of skin
telangiestasia
trigger other skin conditions
allergy
146
Q

pyoderma gangrenous

A

IBD

small red papule becoming necrotic ulcer

147
Q

Treatment of erythroderma

A

WET WRAPS

20-40% fatality

Phase 4 - GR (22 decks)

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