Week 225 Malignant Melanoma

Front 1

What are the skin manifestations of Atopic Eczema

Back 1

Distressing, itchy skin - usually within 2 years (4-6m most commons), face and neck often first affected, pruritis leads to sleep disturbance and irritability

Front 2

In older children, what sites are most commonly affected by Atopic Eczema?

Back 2

Flexures - this can lead to secondary infection with Staph. Aureus

Front 3

How do emollients work?

Back 3

Improve barrier function and prevent further water loss from the skin

Front 4

How can atopic eczema be managed?

Back 4

Emollients and other topical agents can be used, topical steroid in those >40 years old

Front 5

Is non-compliance an issue with corticosteroid?

Back 5

Yes, concerns regarding steroid-phobia and effect delay encourage non-compliance

Front 6

Which of dermovate, betnovate, eumovate and hydrocortisone is the most potent steroid?

Back 6

His Enormously Big Dick

- Hydrocortisone (mild)

- Eumovate (moderate)

- Betnovate (potent)

- Dermovate (v. potent)

Front 7

What should you consider when prescribing corticosteroid?

Back 7

Age (young children more susceptible to SEf), site (thin areas more susceptible) and extent (more potential for systemic absorption if widespread disease)

Front 8

What are the side-effects of topical corticosteroid?

Back 8

Skin thinning, rebound flares (tachyphylaxis), perioral dermatitis and hirsuitism

Front 9

A patient with atopic dermatitis presents with umbilicated papules that contain jelly-like material, what is the likely diagnosis and treatment?

Back 9

Molluscum contagiosum - no Rx is advised, can perform cryotherapy and capsule puncture

Front 10

A patient presents with a lesion (ulcerated) on the lip, patient complains that they have had this lesion before, what is the likely diagnosis and treatment?

Back 10

Herpes Simplex Virus

Front 11

How does Varicella normally present?

Back 11

2 week incubation, febrile patient with crops of vesicles that are infectious till they crust that can scar

Front 12

How does Measles normally present?

Back 12

10-12 day incubation, fever (>40)/conjunctivitis / coryza/cough, patient develops Koplik's spots at 2-3 days and rash on head at 5 days

Front 13

How does Rubella normally present?

Back 13

Mild disease, slight fever and sore throat, rash starts on head and spreads down with tender lymph nodes

In neonates, congenital rubella presents with 'blueberry muffin syndrome'

Front 14

How does Fifth disease (Erythema infectiosum) normally present and what is the causative organism?

Back 14

Fifth disease causes bilateral slapped cheek appearance, developing a lacey rash in peripheral distribution follows several days later

Parvovirus B19

Front 15

How does Hand, Foot and Mouth normally present and what is the causative organism?

Back 15

Enterovirus infection (Coxsackie A) that outbreaks commonly in the summer, causes small flat ulcers/blisters on hands, feet and mouth (hence the name).

Front 16

How can headlice/pediculosis capitis be eriadicated

Back 16

Permethrin or malathion, reinfestation is common however

Front 17

How is scabies (sarcoptes scabei) spread?

Back 17

Direct physical contact

Front 18

How can scabies (sarcoptes scabei) be treated?

Back 18

Topical permethrin (5% cream)

Front 19

How can Acne be treated?

Back 19

Topical - Benzoyl peroxide, topical retinoid

Systemic - Oral antibiotics, OCP, Isotretinoin

Front 20

What are the different forms of Acne?

Back 20

Mild comedonal, papules and pustules and finally nodulocystic

Front 21

How does Erythroderma present?

Back 21

Large proportion of the skin is red spreading rapidly, cytokines are in a hyperactive state and this compromises skin function

Front 22

What conditions can precipitate Erythroderma?

Back 22

Atopic eczema, psoriasis, pityriasis rubra pilaris and mycosis fungoides

Front 23

4S - Staphylococcal Scalded Skin Syndromme usually present in what way?

Back 23

Caused by staphylococcal exfoliate toxin, antibiotics are essential and additional skin protecting precautions should be put in place

Front 24

What causes Urticaria?

Back 24

Mast cell degranulation

Front 25

How can Urticaria be managed?

Back 25

High dose anti-histamine (chlorphenamine), steroid (IV hydrocortisone), manage BP drop and look for C1 esterase inhibitor deficiency

Front 26

What form a hypersensitivity reaction is Toxic Epidermal Necrolysis?

Back 26

TEN is a type IV (cell mediated) drug reaction

Front 27

What is Nikolsky's sign?

Back 27

Creases and tearing of the skin causing shredding under limited pulling pressure

Front 28

What is the first line treatment of Toxic Epidermal Necrolysis?

Back 28

Stop the offending drug - now call ITU, reuss support and call plastics

Front 29

What is the most common infective agent when a patient with cellulitis following a venous leg ulcer?

Back 29

Staphylococcus epidermis and aureus

Front 30

How should cellulitis be treated?

Back 30

Flucloxacillin +/- Macrolide/Penicillin

Front 31

Which patient groups are more likely to suffer from Necrotising Fasciitis?

Back 31

Diabetes patients, IV drug users and the immunocomprimised

Front 32

How does an actinic (solar) keratosis present?

Back 32

Discrete, rough or scaly patches of skin on sun exposed areas, very common, more common in immunosuppresion

Front 33

How does Bowen's Disease often present?

Back 33

Usually a single patch of erythematous and scaly skin, lower leg site is common in women, it slowly expands over several years and 3% develop into invasive squamous cell carcinoma

Front 34

How can Bowen's disease and Actinic Keratosis be treated?

Back 34

Cryotherapy, chemotherapy (5-flurouracil) cream, photodynamic therapy, immunotherapy (imiquimod) and surgical removal if required

Front 35

80% of Basal Cell Carcinoma's occur in which region?

Back 35

Face and Neck

Front 36

What are the risk factors associated with basal cell carcinoma development?

Back 36

Cumulative sun exposure, fair skin, age, previous radiotherapy and Arsenic

Front 37

How does a basal cell carcinoma present?

Back 37

Asymptomatic, nodular-cystic lesion, may be pigmented

Front 38

How can a basal cell carcinoma be treated?

Back 38

Surgical excision, radiotherapy and Moh's micrographic surgery

Front 39

How does a squamous cell carcinoma look on gross inspection?

Back 39

Ulcerating lesion, may appear scaly with enlarging nodules

Front 40

How can a squamous cell carcinoma be treated?

Back 40

Treatment is mainly surgical, radiotherapy can be performed if the patient is frail

Front 41

What are the risk factors for metastasis of a squamous cell carcinoma?

Back 41

Immunosupressed patients, large tumour (>2cm), poorly differentiated and occuring in an area of scarring

Front 42

What are the 4 Malignant Melanoma subtypes?

Back 42

Superfical spreading, nodular, acral and lentigo maligna

Front 43

What is Breslow thickness and how does it contrast to Clark's level?

Back 43

Measurement from the granular cell level in the epidermis to the deepest part of the tumour, Clark's level assess based on layer of dermis the lesion permeates through

Front 44

How is a malignant melanoma managed?

Back 44

Surgical excision with wide margins followed by sentinel node biospy is key, adjuvant interferon and metastatic treatment depending on metastatic concern

Front 45

What causes Eczema?

Back 45

Barrier dysfunction of the skin

Front 46

All eczema can be itchy and red, but how can you differentiate between acute and chronic Eczema?

Back 46

Acute - Weepy and vesicular

Chronic - Dry, scaly and lichenified

Front 47

What microbial agent is responsible for Seborrhoeic eczema and how is it treated?

Back 47

Malassezia Furfur

Rx - Antifungals, shampoo if on scalp

Front 48

Which form of eczema presents in a red raised plaque-like lesion similar to that of psoriasis?

Back 48

Discoid eczema

Front 49

What is Pompholyx?

Back 49

Itchy vesicles on the skin, typical on the palms and soles where thicker skin is found

Front 50

What is the most common cause of low leg eczema?

Back 50

Chronic venous insufficiency

Front 51

What is contact eczema more commonly known as?

Back 51

Dermatitis

Front 52

Are ointments better than creams?

Back 52

Yes, ointments are paraffin based and greasy, creams are usually water based which make them better for social use

Front 53

What are the key for findings of Acne Vulgaris?

Back 53

Increased sebum excretion, hyper-keratosis blocking the follicle, colonisation of the duct with proprionobacterium and release of inflammatory mediators

Front 54

The description, chronic, inflammatory, facial dermatosis with erythema and pustules best describes what condition?

Back 54

Acne Rosacea

Front 55

How is Acne Rosacea treated?

Back 55

Metronidazole cream or system tetracycline

Front 56

When Malassezia furfur infects other regions of the body, the condition is known as...

Back 56

Pityriasis Versicolour

Front 57

Vitiligo is defined as the...

Back 57

absence of normal pigmentation of the skin