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Year 3 diagnosis and management > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

Most common skin malignancy?

A

Basal cell carcinoma

aka rodent ulcer

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2
Q

Main risk factor for BCC?

A

UV

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3
Q

Where is BCC most commonly found?

A
  • Scalp
  • Face
  • Ears
  • Trunk
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4
Q

Describe a BCC

A
  • Ulcerated central crater
  • Raised pearly edges
  • Fine telangiectasia over surface
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5
Q

How can burn injuries be subdivided?

A

Superficial epidermal (1st degree)

Partial thickness (2nd degree)
• Superficial
• Deep

Full thickness (3rd degree)

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6
Q

What does a superficial partial thickness burn look like, is it painful, and how long does it take to heal?

A
  • Red and oedematous
  • Painful
  • Heals in about 7 days with peeling of dead skin
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7
Q

What does a deep partial thickness burn look like, is it painful, and how long does it take to heal?

A
  • Blistering and mottling
  • Painful
  • Heals over 3 weeks, usually no scarring
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8
Q

What does a full thickness burn look like, is it painful, and how does it heal?

A
  • Destruction of epidermis and dermis
  • Charred leathery eschars
  • Firm and painless (loss of sensation)
  • Scarring or contractures - requires skin grafting
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9
Q

Investigations for burn injuries?

A
  1. Bloods - including carboxyhaemoglobin (high in inhalation injury), high urea, creatinine, glucose; low Na+ and K+
  • Wound biopsy
  • CK, urine myoglobin, ECG
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10
Q

What percentage of healthy adults and HIV positive people are carriers of candidiasis?

A

Healthy - 60%

HIV - 80%

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11
Q

What does oral thrush (pseudomembranous oral candidiasis) look like?

A
  • Curd-like white patches in the mouth
  • Removed easily revealing underlying red base
  • Most common in neonates
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12
Q

In whom is oesophageal candidiasis very common and what does it cause?

A
  • Most common cause of oesophagitis in HIV patients
  • AIDS-defining illness
  • Dyphagia
  • Odynophagia (painful swallowing)
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13
Q

Presentation of candidal skin infections?

A
  • Soreness and itching
  • Red, moist skin area
  • Ragged, peeling edge
  • Possible papules and pustules
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14
Q

Investigations for:
• oral candidiasis
• oesophageal candidiasis
• invasive candidiasis

A
  • Oral - superficial smear of lesion for microscopy / therapeutic antifungal trial
  • Oesophageal - endoscopy
  • Invasive - blood cultures
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15
Q

What is cellulitis and erysipelas?

A

Cellulitis - spreading infection of subcutaneous tissue (acute, non-purulent, overlying skin inflammation)

Erysipelas - superficial cellulitis (upper dermis and superficial cutaneous lymphatics)

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16
Q

Cause of cellulitis?

A

Streptococcus pyogenes

Staphylococcus aureus

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17
Q

Features of cellulitis (including periorbital and orbital)?

A
  • Commonly on shins
  • Erythema, pain, swelling
  • Fever

Periorbital - swollen eyelids, conjuctival infection

Orbital - proptosis (protrusion), impaired visual acuity and eye movements

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18
Q

Investigations for cellulitis and erysipelas?

A
  1. FBC - raised WCC
  2. Culture - if pustular

(CT sinus with contrast if peri-/orbital)

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19
Q

Management of cellulitis

A
  1. Flucloxacillin
  2. Severe - co-amoxiclav or cefuroxime

Peri-/orbital - hospital admission with IV antibiotics

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20
Q

What is eczema?

A

Pruritic papulovesicular skin reaction to endogenous (e.g. seborrheic) and exogenous (e.g. contact) agents

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21
Q

Where is eczema usually found?

A
  • Infants - face and trunk
  • Younger children - extensor surfaces
  • Older children - flexor surfaces, creases of face and neck
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22
Q

Signs of acute and chronic eczema?

A

Acute
• Poorly demarcated erythematous oedematous dry scaling patches
• Vesicles with exudation and crusting
• Excoriations marks

Chronic
• Skin lichenification
• Thickened epidermis
• Fissures
• Change in pigmentation
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23
Q

Outline atopic, seborrhoeic, dyshidrotic and herpecticum eczema

A
  • Atopic - mainly face and flexures
  • Seborrhoeic - yellow greasy scales on erythematous plaques
  • Dyshidrotic (pompholyx) - vesiculobullous eruption on palms and soles
  • Herpeticum - monomorphic punched-out erosions caused by HSV 1/2 or coxsackie, life-threatening for children
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24
Q

What are epidermoid and pilar cysts?

A

Sebaceous cysts
• Epidermoid - from epidermal cells
• Pilar - cells from hair follicles

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25
What is erythema multiforme and what is the 'severe form' of it called (actually different entity)?
* Acute hypersensitivity reaction of skin and mucous membranes * Stevens-Johnson syndrome - bullous lesions and necrotic ulcers
26
Features of erythema multiforme?
* Target lesions * Vesicles * Initially back of hands/feet - spreads to torso * Upper limbs more common than lower limbs * Pruritus
27
Causes of erythema multiforme?
Most common - HSV others: drugs, bacteria, connective tissue disease
28
Investigations for erythema multiforme?
Clinical but: • Raised WCC • HSV serology, varicella PCR, M pneumoniae serology • CXR - exclude sarcoidosis / atypical pneumonia • Immunofluorescence biopsy
29
What is erythema nodosum?
Panniculitis (inflammation of subcutaneous fat) presenting as red or violet subcutaneous nodules
30
Causes of erythema nodosum?
* STREPTOCOCCI * TB * SARCOIDOSIS * IBD * Behcet's * Drugs e.g. sulphonamides * Pregnancy
31
Presentation of erythema nodosum?
* Tender nodules on both shins * Occasionally on thighs or forearms * Lesions heal without scarring * Pyrexia
32
Investigations for erythema nodosum?
* FBC - raised WCC * Anti-streptolysin-O titre - elevated in strep. infection * Serum ACE - raised in sarcoidosis * Mantoux test - for TB * CXR - bilateral hilar adenopathy - sarcoidosis
33
What does HSV do to cells?
Cytolysis of infected epithelial cells => vesicle formation
34
Apart from classic symptoms, what other symptoms are there for HSV1?
* Pharyngitis * Gingivostomatitis (might make eating painful) * Herpetic whitlow
35
Symptoms of HSV2?
* Painful blisters and rash in genital, perigenital and anal area * Dysuria * Fever
36
Symptoms and signs of HSV keratoconjunctivitis?
* Watering eyes * Photophobia • Dendritic ulcer - better visualised with fluorescein
37
Investigations for HSV?
* Clinical | * Viral culture / PCR
38
What is a lipoma?
Slow-growing, benign adipose tumour found in subcutaneous tissues
39
Features of a lipoma?
* Smooth * Mobile * Painless * Soft-doughy feel
40
Investigations for lipoma?
Clinical
41
What are the 4 types of melanoma (in order of incidence) and which is the most aggressive?
1) Superficial spreading 2) Nodular - most aggressive 3) Lentigo Maligna 4) Acral Lentiginous
42
Where on the body and in whom are the 4 types of melanoma found?
Superficial spreading • arms, legs, back, chest • young people Nodular • Sun exposed skin, middle-aged people Lentigo maligna • chronically sun-exposed skin (usually face), older people Acral Lentiginous • nails, palms, soles • African-Americans or Asians
43
Appearance of the 4 types of melanoma?
Superficial spreading • Growing pre-existing mole (naevus) - radial then vertical Nodular • Arises de novo • red or black lump which bleeds or oozes - just vertical growth Lentigo maligna • Large flat lesions • From pre-existing mole (naevus) Acral Lentiginous • Subungual (under nail) pigmentation - Hutchinson's sign
44
How is incidence of melanomas changing?
Increasing
45
Criteria for examining moles/melanoma?
``` ABCDE • Asymmetry • Border irregularity • Colour variation • Diameter > 6mm • Elevation/evolution ```
46
Investigations for melanoma?
1. Dermatoscopy 2. Skin biopsy - full-thickness excision 3. Sentinel lymph node biopsy - metastasis 4. CT chest, abdomen, pelvis - staging * Lymphoscintigraphy - traces lymph drainage * LFTs - metastasis
47
What is molluscum contagiosum?
Common skin infection caused by pox virus (MCV) - spread by direct skin contact or indirectly via fomites e.g. towels
48
Who does molluscum contagiosum mainly affect?
* Children | * Immunocompromised
49
Features of molluscum contagiosum?
* Small pinkish/pearly white papules * Central umbilication * Lesions appear in clusters - commonly on trunk and flexures * Sexual contact areas in adults (spontaneous resolution within 18 months)
50
Investigations for molluscum contagiosum?
Clinical | H+E staining is definitive, HIV test if refractory
51
Where do pressure sores most commonly occur?
Sacrum and heel
52
What score is used to predict risk of pressure sores in patients?
Waterlow score
53
What conditions is psoriasis likely to lead onto?
Arthritis and cardiovascular disease
54
``` Characteristics of the following: • Plaque psoriasis • Flexural psoriasis • Guttate psoriasis • Pustular psoriasis ```
Plaque (most common) • Well demarcated red, scaly patches • Extensor surfaces, sacrum and scalp Flexural • As above but smooth Guttate psoriasis • Transient rash trigerred by strep • Multiple red, teardrop lesions Pustular/palmo-plantar • On palms and soles
55
What is Auspitz and Koebner phenomenon in psoriasis?
Auspitz - pinpoint bleeding with removing scales Koebner - skin lesions at sites of trauma
56
What can trigger psoriasis, especially guttate psoriasis?
* Trauma, alcohol, smoking, drugs, withdrawal of steroids, thyroid disease * Guttate - strep sore throat
57
Nail signs of psoriasis?
* Pitting * Onycholysis * Subungual hyperkeratosis
58
Investigations for guttate and flexural psoriasis?
Guttate - anti-streptolysin-O titre, throat swab Flexural - skin swabs to exclude candidiasis
59
Squamous cell carcinoma is a malignancy of which cells?
Epidermal keratinocytes
60
Risk factors for SCC?
Main: UV - leads to actinic keratosis * Immunosuppression - following renal transplant * Smoking * Xeroderma pigmentosum
61
Presentation of SCC?
* Ulcerated * Hyperkeratotic * Crusted * Recurrent bleeding - non-healing * Lips of smokers too
62
Investigations for SCC?
1. Biopsy 2. FNA / lymph node biopsy 3. CT/MRI/PET for staging
63
Describe an urticaric rash
* Central itchy white papule or plaque | * Surrounded by erythematous flare
64
Timescales between acute and chronic urticaria?
Acute - symptoms develop quickly and resolve within 48 hours Chronic - persists for > 6 weeks
65
Define varicella zoster
Varicella - primery infection (chickenpox) | Zoster - reactivation in dorsal root ganglia (shingles)
66
Presentation of varicella zoster
Chickenpox • Prodromal fever • Itchy rash on head/trunk then spreads • Macular => papular => vesicular Shingles • Following stress • Painful vesicular maculopapapular rash • Dermatomal distribution
67
Investigations for varicella zoster?
Clinical • Immunosuppressed - do viral PCR, culture, immunofluorescence
68
Management for varicella zoster?
* Children (chickenpox) - treat symptoms * Adults - oral acyclovir * Pregnant / immunocompromised - IV acyclovir

Year 3 diagnosis and management (9 decks)

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