Dermatology Flashcards
(132 cards)
1
Q
What makes up a good skin examination?
A
Inspect
Describe
Palpate
Systematic Check
2
Q
What makes up general inspection of the skin?
A
General observation
Site and number of lesions
Pattern and distribution if multiple
3
Q
How should the individual lesion be described?
A
SCAM
Size (widest diameter) Shape
Colour
Associated secondary change
Morphology, margin border
4
Q
How should the lesion be described if it is pigmented?
A
ABCD
Asymmetry
irregular Border
2+ Colours
Diameter >6mm
5
Q
What should be felt when palpating a lesion?
A
Surface
Consistency
Mobility
Tenderness
Temperature
6
Q
What makes up a systematic check?
A
nails, scalp, hair, mucous membranes
general exam
7
Q
What is pruritus?
A
itching
8
Q
What is a lesion?
A
An area of altered skin
9
Q
What is a rash?
A
An eruption
10
Q
What is a naevus?
A
A localised malformation of tissue structures
11
Q
What is a comedone?
A
a plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris
open = blackheads closed = whiteheads
12
Q
What does generalised mean in dermatology?
A
all over the body
13
Q
What does widespread mean in dermatology?
A
extensive spread
14
Q
What does localised mean in dermatology?
A
restricted to only one area of the skin
15
Q
what is a dermatome?
A
an area of skin supplied by a single spinal nerve
16
Q
What does photosensitive mean in dermatology?
A
affects sun exposed areas e.g. face, neck, backs of hands
17
Q
What does discrete mean in dermatology?
A
individual lesions separated from each other
18
Q
What does confluent mean in dermatology?
A
lesions merge together
19
Q
What does target mean in dermatology?
A
concentric rings like a dartboard
20
Q
What does annular mean in dermatology?
A
a circle or a ring
21
Q
What does discoid mean in dermatology?
A
coin shaped, round lesion
22
Q
What is erythema?
A
Redness due to inflammation or vasodilation that blanches on pressure
23
Q
What is purpura?
A
Red/purple colouring due to bleeding into the skin or mucous membranes
does not blanch on pressure
24
Q
What are petechiae?
A
small pinpoint macules
25
what are ecchymoses?
large, bruise like patches
26
what is a macule?
a flat area of altered colour
27
what is a patch?
a flat area of altered colour or texture
28
what is a papule?
a solid raised lesion above 0.5cm in diameter
29
what is a nodule?
a solid raised lesion >0.5cm in diameter with a deeper component
30
what is a plaque?
a palpable, scaling lesion >0.5cm in diameter
31
what is a vesicle?
small blister
raised, clear fluid filled lesion less than 0.5cm in diameter
32
what is a bulla?
large blister
raised, clear fluid filled lesion more than 0.5cm in diameter
33
What is a pustule?
pus containing lesion <0.5cm in diameter
34
what is an abscess?
localised accumulation of pus in the dermis or subcutaneous tissue
35
what is a wheal?
transient, raised lesion due to dermal oedema
36
what is a boil?
staphylococcal infection around or within a hair follicle
37
what is a carbuncle?
staphylococcal infection in adjacent hair follicles
38
what is an excoriation?
loss of epidermis due to trauma
39
what is lichenification?
well-defined roughening of skin with accentuation of skin markings
40
what are scales?
flakes of stratum corneum
41
what is a crust?
rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis
42
what is a scar?
new fibrous tissue which occurs post wound healing
43
what is an ulcer?
loss of epidermis and dermis
44
what is a fissure?
an epidermal crack often due to excess dryness
45
what are striae?
linear areas which progress from purple to pink to white with the histopathological appearance of a scar
46
What is alopecia areata?
a well defined patch of complete hair loss
47
What is hirsutism?
androgen dependent hair growth in a female
48
what is hypertrichosis?
non-androgen dependent excessive hair growth
49
what is clubbing?
loss of angle between the posterior nail fold and nail plate - CLUBBING
```
C ardiac e.g. cyanotic heart disease, IE
L ung disease e.g. CF, TB, asthma
U lcerative Colitis
B iliary cirrhosis
B ronchogenic carcinoma (small cell)
I diopathic
N ot COPD
G I malabsorption - coeliac, crohns, cirrhosis
```
50
What is koilonychia?
spooning of the nails
Iron deficiency anaemia
51
What is oncholysis?
separation of the distal end of the nail plate from the nail bed
trauma, psoriasis, fungal nail infections, hyperthyroidism
52
what is pitting of the nails?
punctate depressions of the nail plate
psoriasis, eczema, alopecia areata
53
What are the 5 functions of normal skin?
- protection
- Temperature regulation
- sensation
- Vitamin D synthesis
- Immunosurveillance
54
What are the 4 main cell types found in the epidermis?
Keratinocytes - produce keratin for protection
langerhans' - APCs and T cell activation (immunity)
melanocytes - melanin producing = skin pigment and protection from UV damage
Merkel cells - sensation
55
What are the layers of the epidermis?
Horny Giants Pinch Bums
```
Horny = Stratum Corneum (keratin)
Granular = Stratum Granulosum
Prickle = Stratum Spinosum (cells differentiate)
Basal = Stratum Basale (actively dividing cells)
```
56
What stimulates sebaceous glands?
conversion of androgens to dihydrotestosterone
| think boys and PCOS
57
What are the 4 stages of wound healing?
1) haemostats - vasoconstriction + platelet aggregation = clot formation
2) inflammation - vasodilation + immune reaction
3) proliferation - granulation tissue formation + angiogenesis + re-epithelialisation
4) remodelling - scar maturation + collagen re-organisation
58
What is urticaria? what is the pathophysiology?
Swelling of the superficial dermis leading to a raise in the epidermis
immunological or non-immunological stimulus causes localised increase in capillary permeability leading to leakage of proteins into the extravascular space
main inflammatory mediator is histamine released from mast cells but prostaglandins, leukotrienes also involved
59
What is angioedema?
Deeper swelling with involvement of the dermis and subcutaneous tissues e.g. Tongue and lips
60
what does anaphylaxis involve?
initially urticaria and angioedema
bronchospasm, facial and laryngeal oedema, hypotension
61
What are some common causes of urticaria/angioedema/anaphylaxis? (6)
food
drugs
insect bites
contact
hereditary
autoimmune
62
what is the management of urticaria, angioedema and anaphylaxis?
urticaria = antihistamines
angioedema (+severe urticaria) = corticosteroids
anaphylaxis = adrenaline, corticosteroids + urticaria (see emergency drugs)
63
What is erythema nodosum?
A hypersensitivity response to various stimuli
64
how does erythema nodosum normally present?
Discrete and tender nodules, usually on the shins. May become confluent.
Lesions don't ulcerate and continue to appear for 1-2 weeks before leaving bruisey discolouration as they resolve
65
What are the causes of erythema nodosum? (6)
NO – idiopathic
D – drugs (penicillin sulphonamides)
O – oral contraceptive/pregnancy
S – sarcoidosis/TB
U – ulcerative colitis/Crohn's disease/Behçet's disease
M – microbiology (streptococcus, mycoplasma, EBV and more)
66
What is erythema multiforme? how does it normally present?
An acute, self-limiting inflammatory condition, usually due to herpes simplex.
usually takes a classic "target like" appearance on palms of hands but can also affect mucosal membrances
67
what is Stevens-Johnson syndrome?
mucocutaneous necrosis at at least 2 mucosal sites.
differentiates from erythema multiforme due to extensive areas of necrosis
68
What is toxic epidermal necrosis?
Similar to Stevens-Johnson - get extensive skin and mucosal necrosis + systemic toxicity
usually a prodrome of flu like symptoms
differs from SJS - sub epidermal detachment i.e. you can move the skin around and it comes off + full thickness epidermal necrosis
69
How are SJS and TEN managed?
Urgent referral/senior help
Supportive care I.e. keep the skin on and ensure adequate hydration
70
what are the complications of SJS and TEN?
5-12% mortality with SJS
>30% mortality with TEN
death usually sepsis, electrolyte imbalance
71
What is acute meningococcaemia? what is the cause?
communicable infection transmitted by respiratory secretions then bacteria get into blood (Meningitis = bacteria into CSF)
usual cause is gram-negative diplococcus - Neisseria meningitides
72
What is the presentation of acute meningococcaemia?
meningism - photophobia, headache, fever, neck stiffness
septicaemia - hypotension, myalgia, fever
rash - non-blanching, purpuric on trunk and extremities. can quickly progress to tissue necrosis
73
what is the management of acute meningococcaemia?
IM benpen ASAP
prophylactic abx (rifampicin) for close contacts within 14 days of exposure
74
what are the complications of acute meningococcaemia?
DIC, shock, death
75
What is erythroderma? What are the causes?
exfoliative dermatitis involving at least 90% of the skin (basically skin comes off and looks flaky but is red underneath)
previous skin disease, lymphoma, drugs e.g. sulphonamides, allopurinol
76
How does erythroderma present?
inflamed, oedematous and scaly skin
systemically unwell + malaise + lymphadenopathy
77
what is the management of erythroderma?
treat underlying cause
emollients + wet wraps + ? topical steroids
Supportive management e.g. fluid replacement and keep warm
78
what are the complications of erythroderma? (4)
secondary infection
electrolyte imbalance/dehydration
hypothermia
high-output cardiac failure
79
What is eczema herpeticum?
complication of atopic eczema
widespread eruption due to a herpes simplex virus on top of pre-existing eczema
80
how does eczema herpeticum normally present?
extensive crusted papule, blisters and erosions
+ systemically unwell
81
what is the management of eczema herpeticum?
antivirals (usually aciclovir)
abx for bacterial secondary infection
82
what are the complications of eczema herpeticum? (3)
herpes hepatitis
encephalitis
DIC
83
what is necrotising fasciitis? What is the cause?
A rapidly spreading infection of the deep fascia with associated tissue necrosis
Normally caused by group A haemolytic streptococcus or anaerobic + aerobic infections
really dangerous as has high mortality
84
What are the risk factors for nec fasc?
intra-abdominal surgery
co-morbidities e.g. diabetes and malignancy
85
how does necrotising fasciitis present? (4)
severe pain
skin is erythematous, blistering and necrotic. might become purple in the middle
systemically unwell
?crepitus under the skin
86
how is necrotising fasciitis managed?
urgent referral for surgical debridement
IV abx
87
How does cellulitis differ from erysipelas?
cellulitis = deep subcutaneous tissue involvement
erysipelas = more superficial and acute (dermis to upper sc tissue)
both spreading bacterial infections of the skin
88
What normally causes cellulitis/erysipelas?
Staph aureus and strep pyogenes
89
what is the presentation of cellulitis/erysipelas?
usually in the lower limbs
cardinal signs of infection - redness, swelling, pain, warmth
+ systemic signs of infection (particularly erysipelas)
erysipelas has a red, well-defined and raised border
90
What is the management of cellulitis?
abx - usually flucloxacillin
conservative - leg raising, rest, analgesia etc
91
what are the complications of erysipelas and cellulitis? (3)
localised necrosis
abscesses
septicaemia
92
What is staphylococcal scalded skin syndrome? What causes it?
Skin infection normally affecting infants and early childhood
production of circulating epidermolytic toxins from the phage group 2, ben-pen resistant staphylococci
93
How does staphylococcal scalded skin syndrome present?
scald like skin >>> large, flaccid bullae
develops within a few hours
perioral crusting + intraepidermal blistering + PAIN
94
How is staphylococcal scalded skin syndrome managed?
Abx e.g. erythromycin or fusidic acid
analgesia
95
What are the 3 types of fungal infection?
Dermatophytes - tine pedis (athletes fooT)
Yeasts - candidiasis
Moulds - aspergillosis
96
What is a basal cell carcinoma?
Slow growing
Locally invasive
malignant (rarely metastasises)
tumour of epidermal keratinocytes
97
How does BCC normally present?
sun exposed areas e.g. head, backs of hand
nodular - small, skin-coloured papule or nodule with surface telangiectasia + pearly rolled edge. might have a necrotic centre.
superficial (plaque)
cystic
Keratotic and pigmented
98
What is the management of SCC and BCC? When should you 2ww one?
surgical excision / radiotherapy
2ww if in a sensitive area
99
What are the risk factors for BCC and SCC?
```
non-modifiable:
skin type 1 (always burns) + atypical moles (MM)
older age
male sex
genetics
previous history
```
modifiable:
the sun = excessive UV exposure/ sun bed use/ severe sun burn as a child
pre-malignant conditions e.g. actinic keratoses (SCC)
immunosuppression
100
What is a squamous cell carcinoma?
Locally invasive
Malignant + has potential to metastasise
Tumour of epidermal keratinocytes
Faster growing than BCC
101
How do SCCs normally present?
Keratotic
Ill-defined nodule
might ulcerate
2WW them! Follow up for 2 years after
102
What is a malignant melanoma?
Invasive
Malignant tumour of epidermal melanocytes
Has potential to metastasise
103
How does malignant melanoma normally present? What are the ABCDE symptoms rules?
```
A symmetrical shape (red flag)
B order irregularity
C olour irregularity (red flag)
D iameter >6mm
E volution of lesion (change in size or shape) (red flag)
```
Symptoms - bleeding, itching
Common on legs for women and trunk for men
104
What are the types of melanoma?
Do you actually have to know this?
105
What is the Breslow thickness?
Measure of MM prognosis based on tumour thickness
- <0.76mm thickness = low risk
- 0.76mm-1.5mm thickness = medium risk
- >1.5mm thick = high risk
106
What is eczema?
Papules + vesicles on an erythematous base
atopic eczema is most common. usually develops in childhood and resolves by teenager
107
How does eczema normally present?
Itchy, erythematous patches that are dry and scaly
acute = erythema + weeping + vesicular
chronic = excoriations and lichenification
Infants = extensor + face
Children and adults = flexor surfaces
108
What is the management of eczema?
General - triggers, emollients +/- bandages, soap substitutes
Topical - steroids for flares
Oral - antihistamines (symptom relief, esp at night), PO prednisolone, abx if secondary infection
Other - phototherapy, immunosuppressants
109
What is the range of topical steroid potency?
hydrocortisone > Betnovate > eumovate > dermovate
110
what are the complications of eczema?
secondary bacterial infections or secondary viral infections (molluscsum contagiosum, eczema herpeticum)
111
What is acne vulgaris?
An inflammatory disease of pilosebaceous follicles
112
what is the pathophyiology of acne?
increased sebum production
abnormal follicular keratinisation
bacterial colonisation. Normally Propionibacterium acne (anaerobic rod)
Androgen dependent
113
How does acne vulgaris normally present?
Non-inflammatory = open (white) and closed (black) comedones
Inflammatory = papules, pustules, nodules and cysts
114
What is the management of acne vulgaris?
mild = benzoyl peroxide and topical abx (doxy/lymecycline or erythromycin) or retinoids
mod-severe = oral abx, spironolactone (in females)
watch for Retinoid use in women of childbearing age as is highly teratogenic
115
What are the complications of acne vulgaris?
hyper-pigmentation
scarring
deformity
psychological aspect
116
What is psoriasis?
Chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration
117
What are the types of psoriasis?
chronic plaque (most common)
guttate (lots of raindrop lesions)
Seborrhoeic (naso-labial and retro-auricular)
Flexural, pustular, erythrodermic
118
How does psoriasis normally present?
Silver scaly plaques on a background of erythema
+/- itchy/burning/pain
extensor surfaces
auspitz sign - gentle scratching leads to capillary bleeding
nail changes (oncholysis, pitting)
+/- psoriatic arthropathy
119
What is the management of psoriasis?
General = emollients
Topical (mild) = vitamin D, corticosteroids, keratolytics
Special - phototherapy, methotrexate, retinoids, ciclosporin
120
What are the complications of psoriasis?
Erythroderma
Psychosocial effects
121
What are the most common causes of blisters?
Infective - herpes zoster and simplex
Trauma - Burns
Other - Impetigo, contact dermatitis
122
What is bullous pemphigoid?
A blistering skin condition that normally affects the elderly
123
What is the cause of bullous pemphigoid?
Autoantibodies against antigens between the epidermis and dermis
= sub-dermal split
124
How does bullous pemphigoid differ from pemphigus vulgaris?
BP = tense, fluid filled blisters + erythematous base. often itchy and on trunk/limbs
PV = flaccid and easily disrupted blisters = erosions and crusts. Often painful and in mucosal areas
125
What is pemphigus vulgaris?
A blistering skin condition that normally affects the middle aged
126
What is the cause of bullous vulgaris?
Autoantibodies against antigens in the epidermis
= intra-epidermal split
127
How is bullous pemphigoid/ pemphigus vulgaris managed?
general wound care + watch for infection
topical or oral steroids
128
What are the skin types?
1 - always burns, never tans
2 - always burns, sometimes tans
3 - sometimes burns, always tans
4 - never burns, always tans (olive)
5 - Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)
6 - never tans or burns e.g. afro-carribean
129
Anti-TTG is an antibody used to screen for which autoimmune condition and which associated skin condition?
What does this skin condition look like
Coeliac Disease
Dermatitis Herpetiformis is associated
Itchy, vesicular skin lesions on the extensor surfaces
130
How does acne rosacea normally present?
Erythema and telangiectasia leading to formation of papules and pustules
Normally affects the nose, cheeks and forehead
131
What is the management of acne rosacea?
topical metronidazole may be used for mild symptoms
topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
laser/ daily high factor sunscreen/ camouflage creams
132
What are the treatment options for hyperhidrosis?
1st = topical aluminium chloride preparations. Main side effect is skin irritation
2nd =
- iontophoresis: palmar, plantar and axillary hyperhidrosis
- botulinum toxin: axillary symptoms
3rd = surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
