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Yr 4 dermatology > passmed > Flashcards

passmed Flashcards

1
Q

acanthosis nigricans assoicated with what malignancy

A

gastric adenocarcinoma

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2
Q

what is the koebner phenomenan

A

The Koebner phenomenon describes the worsening or development of skin lesions at the sites of injury.
psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

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3
Q

what skin condition follows langers lines in distribution

A

ptyrias rosacea

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4
Q

difference between dermoid cyst and dermoid tumour

A

Dermoid cysts are embryological remnants and may be lined by hair and squamous epithelium, located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion. excision

Desmoid tumours develop in ligaments and tendons. consist of fibroblast dense lesions (resembling scar tissue). They should be managed in a similar manner to soft tissue sarcomas.

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5
Q

Tinea is a term given to dermatophyte fungal infections. Three main types of infection are described depending on what part of the body is infected
what are they

A

tinea capitis - scalp
tinea corporis - trunk, legs or arms
tinea pedis - feet

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6
Q

Chondrodermatitis nodularis helicis is usually painful, what is it

A

Chondrodermatitis nodularis chronica helicis (CNH) is a benign inflammatory condition that affects the skin and cartilage of the pinna.

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7
Q

renal transplant linekd to what skin cancer

A

SCC
secondary to immunosuppresion

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8
Q

guttate psoriaisi forms after what type of infection

A

strep

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9
Q

how does Calcipotriol work

A

is a vitamin D analogue that reduces epidermal proliferation therefore reducing the scale and thickness of psoriatic plaques, but not the associated erythema.

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10
Q

when should IV fluids be given for burns

A

‘In adults, IV fluids should be given in second or third degree burns that cover 15% body surface area or more. In children, IV fluids are recommended when burns cover 10% body surface area.’

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11
Q

shingles treat with what

and why

A

oral antiviral within 72hours

prevent the incidence of post-herpetic neuralgia

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12
Q

severe uticaria tx

A

Severe urticaria - A short course of an oral corticosteroid may required in addition to a non-sedating antihistamine

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13
Q

acne refeeral to derm

A

scarring

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14
Q

Dermatitis herpetiformis key sx

A

very ithcy - cna be on stomach elbows, below knees

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15
Q

pityriasis versicolor tx

A

ketoconazole shampoo thenr oral fungal
hypopigmented patches

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16
Q

difference between vitiligo and pityriasis versicolor

A

Pityriasis versicolour is a fungal infection that characteristically causes light patches on the trunk which can be mildly pruritic. It affects many groups including the healthy, the immunocompromised and physically active individuals. Vitiligo would typically present with a more symmetrical pattern. The other options present with different looking lesions.

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17
Q

A non-healing painless ulcer associated with a chronic scar potentially post burn is indicative of

A

SCC - marjolin

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18
Q

eczema herpticum

A

refer
commonly after trialled treat for eczema
face

On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.

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19
Q

features of subhorrbeic dermatitis

A

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

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20
Q

‘dimple’ sign is described in the brief. This is when a lesion dimples when it is pinched. This sign is typically associated with

A

dermatofibroma

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21
Q

2nd line for rosacea after topical abx already used

A

Oral doxycycline + topical ivermectin

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22
Q

what is hyperhidrosis

A

Hyperhidrosis describes the excessive production of sweat.

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23
Q

A 15-year-old girl comes to see you as she has noticed that her hands become very sweaty. She says that this can become quite awkward in social situations for example if she has to shake hands with someone. She is also worried about how this may affect her upcoming GCSE exams.

Which one of the following is most suitable for first line management of this condition?
huperhidrosis

A

topical aluminium chloride preparations are first-line. Main side effect is skin irritation

other options

iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
botulinum toxin: currently licensed for axillary symptoms
surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

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24
Q

side effect of aluminium chloride

A

skin irritation

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25
Q

onychomycosis tx

A

nail fungus casused by dermatophytes

Oral terbinafine

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26
Q

A 63-year-old man presents to his general practitioner with a three-week history of an itchy rash over the face and upper chest. His only past medical history is HIV for which he is poorly compliant with his anti-retroviral medications.

On examination, areas of erythema over the eyebrows, nasolabial folds, and upper chest are noted. Excoriations surrounding the rash are present.

What is the most appropriate initial treatment?

A

seborrhoeic dermatitis

topical keto

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27
Q

A 43-year-old female presents to her general practice with multiple red lesions on her hands. She reports that these have developed over the past 24 hours, are slightly itchy but not painful. There is no involvement of the mucous membranes. Clinical examination reveals:
what durg

A

co-amoxiclav

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28
Q

erythema multiform commonyl seen where

A

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

29
Q

target lesions, seen on hands and feet later spread to torso what causes

A

viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy

30
Q

difference between bullous pempigoid and pemphigus vulgaris

A

Blisters/bullae
no mucosal involvement (in exams at least*): bullous pemphigoid
mucosal involvement: pemphigus vulgaris

31
Q

complciations of erythroderma

A

Inpatient treatment for erythroderma must be monitored for complications like dehydration, infection and high-output heart failure

32
Q

what is erthroderma and what are the causes

A

Erythroderma is a term used when more than 95% of the skin is involved in a rash of any kind.

Causes of erythroderma
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic

33
Q

what is a keratocanthoma

A

Keratoacanthoma is a dome-shaped lump or tumor that grows on your skin.
older males with a history of chronic sun exposure.

34
Q

pneumonic for things that cause nodosum

A

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)

35
Q

in acne can you antibiotics as a monotherapy

A

Acne vulgaris: topical or oral antibiotics should not be used as monotherapy

36
Q

An itchy rash affecting the face and scalp distribution is commonly caused by

A

Seborrhoeic dermatitis is a common, chronic, or relapsing form of dermatitis that mainly affects the sebaceous gland-rich regions of the scalp, face, and trunk.

37
Q

violaceous papules on the flexor aspects of her wrists

A

lichen planus

38
Q

what 3 drugs cause lichenoid drug eruptions

A

gold
quinine
thiazides

39
Q

difference betwen lichen planus and lichen sclerosus

A

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women

40
Q

tx lichen planus

mainstay
mouth
extensive

A

potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression

41
Q

parkinsons associated with what skin conditon

A

sebhorrheic dermaitits

42
Q

what skin reaction presetns like lupus

A

rosacea

43
Q

what is urticara

A

Urticaria describes a local or generalised superficial swelling of the skin. The most common cause of urticaria is allergy although non-allergic causes are seen.

pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
pruritic

44
Q

1st line treatment for uticara

and then what do we also given for severe or resistant episodes

A

non-sedating antihistamines are first-line

prednisolone is used for severe or resistant episodes

45
Q

7 features of rosacea ( basically adult acne)

A

typically affects nose cheeks and forehead
flushing
telangiectasia
persistent erythema with papules and pustules
rhinophyma - skin disorder that causes the nose to enlarge and become red, bumpy, and bulbous.
blepharitis
sunlight exacerbates it

46
Q

in rosacea if you have persistant flushing what can you do

A

topical brimonidine - alpha adrenergic agonist - reduces redness within 30 minutes reaction peak action at around 3-6hours

47
Q

mild to moderate papules or pustules in acne rosacea

A

topical ivermectin

48
Q

moderate to severe papules/pustules acne rosacaea

A

combo of topical ivermectin and oral doxy

49
Q

when do consider referral for acne rosacea and what happens

A

primary care hasnt resolved it
laser therapy - if prominenet telangiectasia
pts with rhunophyma

50
Q

The parents of an 8-year-old girl have noticed a small growth on the sole of her foot for the last 3 months that has become painful. On examination, there is a small, firm, hyperkeratotic growth with tiny overlying black dots.tx

A

This child has a plantar wart, also known as a verruca. The tiny black dots are caused by thrombosed capillaries. They often self-resolve, but if treatment is desired, topical salicylic acid (15–50%) applied daily for up to 12 weeks can be tried.

51
Q

A 76-year-old man has a longstanding patch of rough, itchy skin on his scalp which has not changed in size. On examination, there is a 1cm area of erythema and some scaling which is rough in texture, with evidence of surrounding sun damage. There is no ulceration or bleeding.

condtion adn tx

A

This man likely has an actinic keratosis, a common hyperkeratotic lesion that arises on areas of skin that have had long-term cumulative sun exposure. There are no features to suggest that it has transformed into a squamous cell carcinoma.

There are a variety of topical treatments, of which diclofenac is the only available option from the list above. Alternatives include 5-fluorouracil and imiquimod.

52
Q

acanthosis nigricans associated with what

A

Oral contraceptive pill
32%
Obesity
5%
Polycystic ovarian syndrome
5%
Insulin-resistant diabetes mellitus

53
Q

sebaceous cyst description

A

Sebaceous cysts are most frequently located in the scalp and have an associated central punctum.

54
Q

Superficial dermal burns covering >3% TBSA in adults must be

A

must be referred to secondary care

55
Q

burns what six points need to be referred to secondary care

A

all deep dermal and full-thickness burns.
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury

56
Q

intial mx of burns

A

initial first aid as above
review referral criteria to ensure can be managed in primary care
superficial epidermal: symptomatic relief - analgesia, emollients etc
superficial dermal: cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours

57
Q

A 27-year-old man presents to the emergency department with a 2-day history of fever, tiredness, and a tingling sensation in the lateral aspect of his right thigh. He has found the tingling was initially bearable but has become painful in the past 24 hours. On examination, the area described is erythematous with a macular rash appearing

A

shingles

58
Q

A 18-year-old female has presented with pustule and nodules in her neck and axillae with a narrow tract visible in the skin. She has noted that they can become swollen, painful and have a small amount of yellow discharge at times.

She has a body mass index (BMI) of 25kg/m2 and has a 1-year smoking history.

Given the presentation, what is the most likely diagnosis?

A

Hidradenitis suppurativa is a chronic, painful, inflammatory skin disorder is characterized by nodules, pustules, sinus tracts, and scars in intertriginous areas

59
Q

intertriginous areas

A

Intertriginous skin, also known as skin folds, are sites in which opposing skin surfaces come into contact while at rest, resulting in chronic skin occlusion. The primary intertriginous skin areas include the groin folds, axillae, and gluteal cleft.

60
Q

Initial manifestation involves recurrent, painful, and inflamed nodules. casuing rope like scarrin g

A

Hidradenitis suppurativa

61
Q
A

Encourage good hygiene and loose-fitting clothing
Smoking cessation
Weight loss in obese
Acute flares can be treated with steroids (intra-lesional or oral) or flucloxacillin. Surgical incision and drainage may be needed in some cases.
Long-term disease can be treated with topical (clindamycin) or oral (lymecycline or clindamycin and rifampicin) antibiotics.
Lumps that persist despite prolonged medical treatment are excised surgically.

62
Q

Hidradenitis suppurativa differentials

A

Acne vulgaris - It primarily occurs on the face, upper chest, and back, whereas HS primarily involves intertriginous areas.
Follicular pyodermas (folliculitis, furuncles, carbuncles) - Unlike HS, follicular pyodermas are transient and respond rapidly to antibiotics
Granuloma inguinale (donovanosis) - It is a sexually transmitted infection caused by Klebsiella granulomatis. Suspect donovanosis if there is an enlarging ulcer that bleeds in the inguinal area.

63
Q

skin patch testng used when

A

Useful for contact dermatitis. Around 30-40 allergens are placed on the back. Irritants may also be tested for. The patches are removed 48 hours later with the results being read by a dermatologist after a further 48 hours

64
Q

RAST test when

A

Determines the amount of IgE that reacts specifically with suspected or known allergens, for example IgE to egg protein. Results are given in grades from 0 (negative) to 6 (strongly positive)

Useful for food allergies, inhaled allergens (e.g. Pollen) and wasp/bee venom

Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines

65
Q

skin prick testing used when

A

Most commonly used test as easy to perform and inexpensive. Drops of diluted allergen are placed on the skin after which the skin is pierced using a needle. A large number of allergens can be tested in one session. Normally includes a histamine (positive) and sterile water (negative) control. A wheal will typically develop if a patient has an allergy. Can be interpreted after 15 minutes

Useful for food allergies and also pollen

66
Q

what is pompholyx

A

Pompholyx is a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema.

67
Q

what precipitates pompholyx

A

Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures.

68
Q

sx and mx of pomphyolyx

A

Features
small blisters on the palms and soles
pruritic
often intensely itchy
sometimes burning sensation
once blisters burst skin may become dry and crack

Management
cool compresses
emollients
topical steroids

Yr 4 dermatology (10 decks)

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