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Flashcards in Spot Diagnosis Deck (41):
1

You are the FY1 doing a GP job

A 6 year old boy presents with tiny pustules with honey-coloured crusted plaques under 2 cm in diameter around the mouth

The infecting organism for the above condition is more commonly Staphylococcus aureus (non-bullous type)
The infection can also be cause by streptococcus pyogenes

Which condition am I?

Impetigo

2


You are the FY2 in the endocrinology ward
A 69 year old man complains of pain in his right lower leg.

On examination the anterior surface of the right lef is red, swollen and warm to the touch. The lesion covers most of the lower limb. The man has an ulcer on his leg in the same region that he hasnt been keeping clean and dry

What is most likely to be causing the redness?

Cellulitis

commonly seen in the lower limbs and usually affects one limb

many cases, there is an obvious precipitating skin lesion, such as a traumatic wound or ulcer, or other area of damaged skin.

erythema, pain, swelling and warmth of affected skin

3

You are the Paediatrician

A 1 year old boy presents with a red lesion on the face. No other symptoms such as fever itchiness or coughs and cold. The most common tumours of infancy.

The majority of these lesions will involute spontaneously over time and will require no treatment. Currently, propranolol is the preferred treatment

Which condition am I?

Strawberry Naevi (Haemangioma)

4

You are the Paediatrician

Posterior fossa defects
Haemangioma
Arterial anomalies
Cardiac anomalies
Eye abnormalities
Sternal clefting/Spraumbilical midline raphe

Which condition am I that may present with all or some of these problems?

PHACES Syndrome

5

You are the Paediatrician

You see a 1 year old girl with a red lesion over the v1 trigeminal distrubution of her face. On further examination the lesion is flat and not painful.

You suspect ____ and check patient.info which says
a neurological disorder marked by a distinctive port-wine stain on the forehead, scalp, or around the eye. This stain is a birthmark caused by an overabundance of capillaries near the surface of the skin

Which syndrome may present with a port wine stain?

Sturge–Weber syndrome

6

You are the Paediatrician

A rare genetic condition that causes mainly benign tumours to develop in different parts of the body.

Cutaneous features: ash leaf macules, angiofibromas, shagreen patches, periungual fibromas

Which condition am I?

Tuberous Sclerosis (TSC)

7

You are the Paediatrician

You see a 3 year old girl with generalised redness of a large area of her skin with blistering. It is painful and she has a temperature as well. There is no mucosal involvement.

You swab the area. The results show S. aureus epidermolytic toxin A and/or B. Toxins reach skin from distant focus of infection
eg umbilicus, nappy area, conjunctiva

You give antibiotics and provide supportive measures

Healing occurs without scarring

Which condition am I?

Staphylococcal scalded skin syndrome

SSSS

8

You are the Paediatrician

You see a 4 year old. Mum tells you he has a temperature, and is nauseaous. On examination you find he has abdo pain, ‘strawberry tongue’ and a rash which looks like ‘sunburn with goose pimples’

Diagnosis: clinical/throat swab/blood test (ASO, anti-DNAase B titres)

What is the diagnosis?

Scarlet fever

9

You are the Paediatrician

You see a 2 year old boy with a rash. Dad tells you that the rash started on his face but has been spreading to his chest and arms. The infant has a temperature 39, puffy eyes, runny nose, cough, On examination you notice he has white spots on the inside of his cheeks reminiscent of Kopliks spots.

You suspect a highly contagious viral infection transmitted through the air.

What is the most likely diagnosis?


Measles

10

You are the Paediatrician

9 yr old girl presents with small diffuse red itchy papules. Mum tells you that some of the spots have scabbed over.

On examination you notice that some of the red papules have become fluid filled vesicles.

You decide to do a viral swab.
Diagnosis: clinical +/- Swab from vesicle (viral PCR)
Symptomatic treatment

What is the most likely differential?

Treat high risk groups (pregnant women, immunocompromised patients) with aciclovir. Routine vaccination not used in UK

Causative agent Varicella-zoster virus (HHV-3)
Incubation period 10-20 days
Reoccurence as Shingles

Chicken pox

11

Very common skin condition

Red (erythematous) patches of dry skin +/- papules
May be weepy or crusty
Chronic: lichenification, pigmentary change
Infancy: Face & extensor surfaces
1-2 years onwards: limb flexures
Adults: flexures, trunk, scalp, hands

Atopic Eczema

12

Wheals (hives): pale, raised areas surrounded by erythema; very itchy

Mast cell release of histamine, bradykinin, leukotrienes, prostaglandins
Acute (< 6 weeks) or chronic (>6 weeks).

Acute: viral infection, food & drug allergy (IgE mediated)

Chronic: often idiopathic
Inducible/physical urticaria: cold, heat, vibratory, aquagenic

Treatment: avoid trigger(s), second generation anti-histamines

Urticaria

13

Red nodules on shins
+/- fever, malaise, arthralgia
Hypersensitivity reaction
Inflammation of subcutaneous fat
Common causes: Strep throat, sarcoidosis, inflammatory bowel disease, TB, pregnancy drugs eg OCP, salicylates, sulphonamides
Treat underlying infection
Light compression, anti-inflammatories

Erythema Nodosum

14

Red papules, evolve to target lesions
Hands, feet +/- limbs, may be itchy/painful
Usually triggered by infection: Herpes simplex virus (50%), Mycoplasma, EBV, CMV,VZV and others
Drugs/Vaccinations (<10%)
EM minor- no mucosal involvement
EM major ≥ mucosal site involved
Treat associated infection eg HSV, Mycoplasma
Resolves ≤ 2 weeks, can recur

Target Lesions

15

condition that causes the skin to become itchy, red, dry and cracked. AKA atopic dermatitis

Which condition am I?

atopic eczema

16

is characterized by red, flaky, greasy areas of skin, which are commonly found on the scalp (dandruff), nasolabial folds, eyebrows, behind the ears, and on the upper chest

Which condition am I?

seborrhoeic eczema

17

AKA discoid dermatitis,
is a long-term skin condition that causes skin to become itchy, reddened, swollen and cracked in circular or oval patches.
Without treatment, I can last for weeks, months or even years

Which condition am I?

discoid eczema

18

also known as venous, gravitational or stasis ____, is a long-term skin condition that affects the lower legs. It's common in people with varicose veins.

Which condition am I?

varicose eczema

19

is a type of inflammation of the skin which usually occurs within a few hours or days of exposure. It results from either exposure to allergens or irritants

Which condition am I?

contact dermatitis

20

is a small pocket of body fluid (lymph, serum, plasma, blood, or pus) within the upper layers of the skin, typically caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection

Which condition am I?

blisters

21

the most common type of skin cancer. It often appears as a painless raised area of skin, that may be shiny with small blood vessels running over it or it may present as a raised area with ulceration. Metastases are extremely rare.

Which condition am I?

BCC

22

type of skin cancer often associated with excessive sun exposure. Metastases are rare

Which condition am I?

SCC

23

Type of skin cancer that presents with a dark pigmented lesion that is assessed using SCAM criteria and is excised according to Breslow thickness

Which condition am I?

Malignant Melanoma

24

An abnormal area of skin usually located on the lower limbs typically as a result of either chronic venous insufficiency. If associated with arteries normally occurs on the toes and heel and may be associated with absent pedal pulses

Which condition am I?

Leg ulcer

25

An area of the scalp with an abnormal loss of hair which is accompanied with scarring and requires a biopsy to confirm diagnosis

Which condition am I?

scarring alopecia

26

Well demarcated patches of hair loss with an abnormal loss of hair but no scarring. Typically managed with a watch and wait approach in the first instance

Which condition am I?

non scarring alopecia

27

Often used to describe androgen-dependent hair growth in women, Polycystic ovarian syndrome is the most common cause in women.

Which condition am I?

hirsutism

28

You are the GP

A recent post op patient presents with feeling unwell and severe pain in her arm.

Her General OBS reveal he is pyrexic and tachycardic. Derm Examination reveals her arm is generally tender but there is no redness of obvious swelling.

Over the next few days patients arm becomes increasingly swollen and the skin around her arm becomes grey. There is no longer any pain in her arm. There is crepitus.

Which condition should you be very concerned about?

Necrotising Fasciitis

29

You are the surgeon

A patient has come in with a rapidly progressing lesion. The first line recommendation for this infection is aggressive debridement

Following debridement the recommended antibiotic regime for this rapidly progressing infection starts with benzylpenicillin, clindamycin and gentamicin

What is the name for this infection?

Necrotising Fasciitis

30

Comedones (follicles impacted and distended by incompletely desquamated keratinocytes and sebum) may be open (blackheads) or closed (whiteheads). Inflammation leads to papules, pustules and nodules.

Which condition is this presentation referring to?

Acne

31


PC area of redness on the face normally cheeks nose and forehead which may erupt into papules and pustules

Roseacea

32

PC: Multiple rashes on the back which are red and scaly

Examination Findings: tear drop papules on the trunk and limbs

Mgx: No treatment typically needed as self resolves in 2-3 months

Guttate Psoriasis

33

PC: red scaly patch patient is concerned about

PMH: long term sun exposure

Examination findings: Red Scaly patch

Investigation findings: Isolated to squamous cells

In Situ Squamous Cell Carcinoma

Bowens

34

Chronic itchy clusters of blisters.

Linked to Coeliac disease

Which condition am I?

Dermatitis Herpetiformis

35

Dermatitis Herpetiformis

How do I present on examination of the skin?

Plus which condition am I associated with

Chronic itchy clusters of blisters

Linked to Coeliac disease

36

Acanthosis nigricans

How do I present on examination of the skin?

Which parts of the body am I most likely to appear?

What is the most common cause?

Brown to black, poorly defined, velvety hyperpigmentation of the skin.

Usually found in
• body folds
• posterior and lateral folds of the neck,
• the axilla,
• groin,
• umbilicus,
• forehead,

The most common cause of acanthosis nigricans is insulin resistance,

37

On inspection of the skin during derm examination I present with

Brown to black, poorly defined, velvety hyperpigmentation of the skin.

Usually found in
• body folds
• posterior and lateral folds of the neck,
• the axilla,
• groin,
• umbilicus,
• forehead,

The most common cause of is insulin resistance,

Which condition am I?


Acanthosis nigricans

38

You are the 4th year medical student in a derm clinic

On inspection of the skin you discover that John a 16 year old has open and closed comedones on his face without sparse inflammatory lesions

Which condition is he most likely to be suffering from?

Mild Acne

39

You are the 4th year medical student in a derm clinic

On inspection of the skin you discover that Gemma has widespread non-inflammatory lesions and numerous papules and pustules on her face

Moderate Acne

40

nodules, pitting, and scarring on the face secondary to

Severe Acne

41

Patients on long term immunosuppressants are at risk of this skin cancer

SCC