Dermatology

Front 1

Multiple lesion of broken bullae, with few intact bullous. Lesion in the mouth. High risk of death from infection.

Back 1

Pemphigus vulgaris. Very thin wall, hence why the bullae does not remain in take for long.

Front 2

Which layer does pemphigus vulgaris affect?

Back 2

Epidermis

Front 3

How would investigate and manage someone wih pemphigus vulagaris?

Back 3

a) Biopsy
b) Steroids

Front 4

Multiple erythematous, denuded lesion in the follicles

Back 4

Pemphigus foliaceus

Front 5

Multiple intact bullous

Back 5

Bullous pemphigoid

Front 6

What layer does bullous pemphigoid effect?

Back 6

The dermal-epidermal junction

Front 7

Very pale and white skin, unable to go in the sun as the sun burns the skin (hypersensitivity reaction to sunlight). Associated with blistering and bullous. Needs phlebotomy to manage it.

Back 7

Porphyria cutanea tarda

Front 8

What is the aetilogy of porphyria cutanea tarda?

Back 8

Chronic Hepatitis C
Iron overload
Liver disease
Alcoholism

Front 9

What occurs in acute intermittent porphyria cutanea tarta

Back 9

Abdominal pain
Psychosis

Front 10

What is the management of urticaria?

Back 10

Non-sedating anti-histamines

Front 11

Defuse erythematous maculopapula rash. Drug reaction (sulfasalazine)

Back 11

Morbilliform hypersensitivity (like measles)

Front 12

What can erythema multiforme (small red rings) be secondary too?

Back 12

Drugs: Penicillin, sulfanizines, aloperidol, rifampicine, lamotragine

Infections: Herpes simplex virus (HSV), mycoplasma

Front 13

Erythema multiforme what involves the mucus membranes. Can affect the respiratory epithelium, conjuntiva.

Back 13

Steven-Johnson Syndrome

Front 14

Large (>5cm) erythema multiforme type rash (large red rings).

Back 14

Limes disease

Front 15

Erthema multiforme rash. Skin coming off with just slight finger pressure. Positive nikolsky's sign.

Back 15

Toxic Epidermal Necrolysis

Front 16

Honey-coloured, crusted plaque

Back 16

Impetigo (S. aureus, Group A Beta-haemolytic strep)

Front 17

Herald patch (large, solitary round lesion, raished border with fine, adherent scales)
Christmas tree pattern of distribution

Back 17

Pityriasis Rosea

Front 18

What is the genetics of neurofibromatosis? NF-1 & NF-2?

Back 18

- Autosomal dominant inheritance
- Most are new mutations
- NF-1 chromosome 17 (most common)
- NF-2 Chromosome 22

Front 19

What condition needs at least 2 of the following:
1) > 6 cafe-au-lait spots
2) Axillary/omguinal freckling
3) > 2 iris Lisch nodules
4) > 2 neurofibromas, or 1 plexiform neurofibroma
5) Osseous lesions - scoliosis, sphenoid dysplasia
6) Optic glioma

Back 19

Neurofibromaosis -1

Front 20

What are the precipitating factors associated with psoriasis?

Back 20

- Koebner phenomenon (trauma to the skin precipittes psoriasis in that area)
- Infection (Strep throat may precipitate guttate psoriasis)
- Drugs (beta-blockers, lithium, antimalarials)
- Sunlight (minority, majority benifit from sunlight)
- Psychological stress
- Cigarettes & alcohol

Front 21

Koebner phenomenon

Back 21

Psoriasis occurs in area where trauma to the epidermis and dermis has occured. e.g. scratch or surgical scar

Front 22

Guttate psoriasis

Back 22

Psoriasis preciptated by a strep throat infection

Front 23

What is this lesion? What is the cause and its association?

Back 23

- koebner phenomenon
- psoriasis as a result of trauma to the epidermis and dermis

Front 24

Describe the lesion? Differential diagnosis? Management

Back 24

-Well-defined, raised erythematus plaque on the elbow. Some waxy white scales.
- Plaque psoriasis

Hint 24

Differentials
- Psoriasiform drug eruption (due to beta-blockers)
- Hypertrophic lichen planus

Management of stable plaque
- Vit D analogue with tropical steroids
- Dithranol (short contact), coal tar, taxarotene
- Narrow-band UV B

Front 25

Describe the lesion? What is this lesion? What is the cause? Differential diagnosis? Management?

Back 25

- Mutiple 'drop-like' erthmatous lesions with little waxy white scales. The borders are well defined.
- Guttate psoriasis
- Occurs following a strep throat infection

Hint 25

Differential diagnosis
- Pityriasis rosea
Management
- Topical steroids (mild/moderate), coal tar
- Narrow-band UV B

Front 26

a) Describe
d) What is it?
c) Differentials
d) Management

Back 26

a) Smooth and glazed erthematous plaques in the axilla. Borders are well defined.
b) Flexural psoriasis
c) Candidiasis of the flexures
d) Topicl steroids (mild/moderate), tacalcitol

Front 27

Where can psoriasis pts obtain self help from?

Back 27

The self-help group The Psoriasis Association

Front 28

How is psoriasis managed?

Back 28

Tropical therapy (1st-line)
- Vitamin D analogues (Calcipotriol (Dovonex))
- Topical steroids
- Coal tar preparations
- Dithranol (Anthralin) (impartical for home use)
- Retinoids
- Keratolytics & scalp preparations

Hint 28

Systemic therapy
- Methotrexate (folate antagonist)
- Retinoids (good for pustular psoriaris)
- Ciclosporin (nephrotoxic)
- PVUA : popular but long term risk of skin cancer

Front 29

a) Describe
b) What is it?
c) Management
d) Extra notes

Back 29

a) Sheets of small, sterile yellowish pustules on a erythematous background
b) Generalised pustular psoriasis
c) Acitretin, methotrexate, ciclosporin, biologicals

Hint 29

d) Rare but serious, even life-threatening form of psoriasis. Onset is usually acute and pts present unwell, with fever and malise and require hospital admission

Front 30

1) Describe
2) Diagnosis
3) Extra feature
4) Differentials
4) Prognosis

Back 30

1) Itchy flat-topped polygonal papules, a few millimetres in diameter. Show a surface network or delicate white lines. Papules are initially red then become violaceous
2) Lichen planus
3) Mucous membrane involvement, Koebner phenomenon
4) Lichenoid drug eruption, Guttate psoriasis, atypical pityriasis rosea

Hint 30

4) Commonly occur in ppl 30-60yrs (rare in extreme of ages). It tends to start in the limbs and becomes generalised within 4 wks (localised forms may progress more slowly). Half of pts are clear by 9 months

Front 31

1) Describe
2) Diagnosis
3) Differentials
4) Pathophysiology

Back 31

1)
2) Urticaria
3)
4) Mast cell degranulation, IgE autoantibodies

Front 32

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 32

2) Toxic erythema
4) Delayed type 4 hypersensitivity reaction

Front 33

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 33

2) Erythema Multiforme

Front 34

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 34

2) Stevens-Johnson-Syndrome

Front 35

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 35

2) Toxic Epidermal Necrolysis

Front 36

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 36

2) Bullous Pemphioid
4) Elderly, dermo-epidermal junction affected, intact bullae

Front 37

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 37

2) Pemphigus vulgaris
4) Desmoglein target, cell-cell adhesions fails, flaccid bullae, skin + mucosae

Front 38

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 38

2) Dermatitis herpetiformis
4) IgA deposits, associated with gluten sensitive enteropathy

Front 39

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 39

2) Discoid Lupus erythematosus

Front 40

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 40

2) Discoid Lupus erythematosus

Front 41

Image + proximal muscle weakness
1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 41

2) Dermatomyositis

Front 42

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 42

2) Pyoderna gangrenosum

Front 43

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 43

2) Diabetic foot ulcer - pheripheral neuropathy

Front 44

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 44

2) Venous ulceration

Front 45

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 45

2) Xanthelasma
4) Lipid deposit in the skin, 50% have abnormal lipid levels

Front 46

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 46

2) Pretibial myxoedema
4) Deposition of hyaluronic acid in the skin, most commonly associated with Grave's disease

Front 47

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 47

2) Addison's disease
4) Adrenal insufficiency most commonly autoimmune destruction of the adrenal gland

Front 48

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 48

2) Alopecia areata
4) Associated with other autoimmune conditions

Front 49

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 49

2) Sarcoid

Front 50

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 50

1) Stuck on warty appearence (can be variety of clours)
2) Seborrhoeic Keratosis
4) Most common benign epithelial neoplasm, >30y.o

Front 51

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 51

1) Dome shaped, dermal nodulem, ill-defined borders, pink/skin coloured, dimples when 'pinched' found in extremities
2) Dermatofibroma

Front 52

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 52

2) Capillary haemangioma
4) Pale patch in first months, rapid enlargement, spontanwous involution, 50% 'disappear' by 5yrs & 100% by 10 yrs

Front 53

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 53

2) Compound Naevus

Front 54

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 54

2) Blue Naevus

Front 55

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 55

2) Mongolian blue spot
4) Congenital blue-grey macular lesion, lumbo-sacral area, disappear in childhood,

Front 56

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 56

2) Congenital Melanocytic Naevus
4) Congenital dark-brown/black lesions. Initially macular becomes paillated & hairy, giant lesions carry small by real risk of melanoma

Front 57

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 57

2) Actinic Keratosis
4) Single or multiple. Dry, rough, adherent scaly lesions, on areas of chronic sun exposure. Histology: keratinocute atypia. Pre-malignant

Front 58

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 58

1) Solitary, well defined erythematous patch, irregular borders
2) Bowen's Disease
4) SCC in situ, Risk of invasive disease
5) Cryotherapy (Liquid N2), Topical 5-Fluouracil, topical imiquimod, curettage & cautery

Front 59

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 59

2) Lentigo maligna
4) Head & neck, variation in hue irregular macular 'stain'. Atypical melanocytes 'in situ'. Precursor of lentigo maligna melanoma

Front 60

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 60

2) Lentigo maligna melanoma

Front 61

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 61

2) Radiodermatitis

Front 62

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 62

2) Basal Cell Carcinoma
5) Depenent on site, size & type. Excision, curettage & cautery, radiotherapy

Front 63

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 63

2) Basal Cell Carcinoma
5) Depenent on site, size & type. Excision, curettage & cautery, radiotherapy

(image 2 is pigmented BCC)

Front 64

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 64

2) Squamous cell carcinoma
4) Image 1) Highly differentiated - hard & keratinised. Indurated papule, plaque, nodule, keratotic scale or hyperkeratosis. Image 2) Poorly differentiated - no signs of keratinisation, soft, fleshy, granulation tissue, erosive papules with ulceration, haemorrhae & crusting
5) Overal remission rate 90%. Urgent excision, radiotherapy

Front 65

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 65

2) Keratoacanthoma
4) Benign. Clinical DDx of SCC. Needs histological confirmation to r/o SCC. Rapidly growing nodule, dome-shaped with keratinous crater

Front 66

What are the major and minor features of malignant melanoma?

Back 66

Major:
- Change in size
- Change in shape
- Change in colour

Minor
- >6mm diameter
- Inflammation
- Oozing/bleeding
- Itch/altered sensation

Front 67

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management
6) Prognosis

Back 67

2) Melanoma
5) Urgent excision, +/- re-excision with appropriate margin, lymph node sampling, disease staging
6) Dependent on tumour thickness (Breslow)

Front 68

Risk factors for melanoma

Back 68

- UV radiation (intense intermittent)
- Skin type I or II
- Pre-existing melanocytic lesions: Multiple banal naevi, dysplastic/atypical naevi, congenital naevi, previous melanoma
- Family hx

Front 69

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 69

2) Amelanotic melanoma

Front 70

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 70

2) Cutaneous lymphoma
4) Monoclonal T-cell proliferation. Mildly symptomatic psoriasiform plaques. 1st manifest in skin but involves lymphoreticular system. Lymph node, blood, visceral organ involvement

Front 71

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 71

2) Kaposi's Sarcoma
4) Multi-system vasular neoplasia, violaceous lesions. HHV-8 Immunosuppression
5) Improve immunity, radiotherapy, chemotherapy

Front 72

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 72

1) Clusters of firm pink-violet papules in 'muzzle' area - adenoma sebaceum
2) Tuberous sclerosis
4) TSC1 (hamartin) & TSC2 (tuberin), autosomal dominant, hamartomas at skin, brain, kidney, eye & heart. C

Front 73

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 73

2) Neurofibromatosis
4) NF1: cafe-au-lait macules, neurofibromas, freckling, optic gliomas, Lisch nodules, osseus lesions. NF1 (neurofibri) Ras signalling (AD)

Front 74

Explain Gorlin's syndrome

Back 74

Basel cell naevus syndrome
- BCCs
- Skeletal anomalies
- Odontogenic cysts
- Mutations in PTCH tumour suppressor gene

Front 75

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 75

2) Oculo-cutaneous Albinism
4) Partial or total absence of melanin pigment. No melanin protection from UV damager

Front 76

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 76

2) Xeroderma pigmentosa
4) Defective DNA repair, photosensitivity, photodamage from infancy. Melanoma by 8-y.o

Front 77

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 77

1) Golden custing, if blisters (bullous impetigo)
2) Impetigo
4) Mainly Staph aureus, infection of stratum corneum, disease by tissue invasion & toxins, children, hightly contagios
5) Flucloxacillin

Front 78

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 78

1) Skin erythematous, sheets of desquamation, fever, irritability
2) Staphylococcus scalded skin syndrome (SSSS)
4) children, usually heals within 7-14 days, exotoxin mediated
5) IV (oral) Flucloxacillin

Front 79

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 79

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Hint 79

1) Well demarcated, erythematous
2) Erysipelas
4) Bacterial infection of dermis (well demarcated), Group A Strep
5) Amoxycillin 1g TDS or Penicillin V 1g daily for 2 wks

Front 80

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 80

1) diffuse erythema
2) Cellulitis
4) Bacterial infection spreading to fat. strep or staph
5) Amoxycillin 1g TDS or Penicillin V 1g daily for 2 wks

Front 81

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 81

1) Inflammation in hair follicles
2) Folliculitis
4) Staph aureus. Sterile pustules can result from occlusion
5) Aseptic wash (hibiscrub dermol 500) topical antibiotic, oral flucloxacillin

Front 82

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 82

1)
2) Carbuncle
4) Hair follicle & subcutaneous tissue involved in infection

Front 83

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Investigations
6) Management

Back 83

2) Herpes Simplex Virus (HSV)
4) Spread by direct contact 'shedding'. Latenet in sensory root ganglion reactivation/recurrence. Triggers: cold, trauma, sun, reduced immunity
5) Ix swab/scraping for EM, IMF, culture
6) Aciclovir (incorporates into viral DNA blocks DNA-polymerase)

Front 84

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 84

2) Eczema herpeticum (HSV)
4) Underlying eczema - abnormal skin barrier function secondary inections more common including HSV

Front 85

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 85

2) Varicella Zoster Virus (VZV) - Shingles
4) Reactivation of latent VZV, pain prior to appearance of vesicles. Dermatomal pattern
5) Aciclovir

Front 86

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 86

2) Molluscum contagiosum - Pox virus
4) Pox virus. Highly contagious by direct contact, incidence 7% children. Spontaneous resolution after months-yrs
5) Cryotheraoy or hydrogen peroxide cream to try to speed resolution

Front 87

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Investigations
6) Management

Back 87

2) Tinea corporis - 'ringworm'
5) mycology - scraping, brushing (show hyphae)
6) Topical/systemic terbinafine, ketoconazole

Front 88

1) Describe
2) Diagnosis
3) Differential
4) Pathophysiology
5) Management

Back 88

1) Whitehead (closed comedome), blackhead (open comedome)
2) Acne
4) Increased sebum excretion, narrowinf of pilosebaceous duct, microbial activity in blocked dyct, secondary inflammation
5) Topical - benzoyl peroxide, antibiotics, isotretinon (Vit-A).
Systemic - hormonal (Dianette, Yasmin), antibiotics (tetracyclines, erythromycin), isotretinoin (Vit A Roaccutane)