1
Q
Which of the following cell types are seen in the epidermis?
A. Merkel cells
B. Langerhans cells
C. Melanocytes
D. Keratinocytes
E. All above
A
E
1
Q
Which one of the following structures is considered a skin appendage?
A. Epidermis
B. Dermis
C. Pilosebaceous unit
D. Subcutaneous fat
E. Cutaneous nerves
A
C
2
Q
Examples of skin appendages
A
- hair follicle (eg) pilosebaceous unit
- apocrine sweat gland
- Eccrine sweat gland
- nails
- sebaceous gland
3
Q
The layers of the skin, starting from the surface inwards are what?
A
- epidermis
- dermis
- Within which the cutaneous nerves reside
- subcutaneous fat (also known as the hypodermis)
4
Q
Hirsutism is defined as the growth of excess hair occurring in androgenic
dependent areas
(eg, the abnormal growth of chest or facial hair in women). The causes include:
A
- Polycystic ovarian disease
- adrenal/ovarian tumours;
- Cushing’s syndrome;
- acromegaly
- Congenital adrenal hyperplasia;
- androgen/corticosteroid therapy.
5
Q
Hypertrichosis, which is described as
The growth of excess hair in non-androgenic areas can be congenital or acquired.
Causes include:
A
- hypothyroidism
- malnutrition
- anorexia nervosa (eg, lanugo hair)
- drugs
(e.g. cyclosporin, minoxidil, penicillamine, psoralens)
6
Q
Dermatitis herpetiformis is most associated with what?
A
Coeliac disease
7
Q
Contact dermatitis is described as what type of reaction?
A
Type IV hypersensitivity - delayed cell mediated
8
Q
Whats a major side effect of penicillins to be aware about
A
Toxic epidermal necrolysis
= erythematous rash that has come on, that has a red, ‘scalded’ appearance
9
Q
What is most associated with psoralen + ultraviolet A light (PUVA) therapy?
A
SSC
10
Q
A 55-year-old man with end-stage renal failure is due to have a renal transplant. He has read that having a renal transplant will increase his risk of cancer and would like to know more about this.
The risk to which cancer is he most at risk of following renal transplantation?
A
SSC
11
Q
A non-healing painless ulcer associated with what?
A
SSC
12
Q
‘A 53-year-old man presents with a nodule on his chin. He is concerned because it has grown extremely rapidly over the preceding week. On examination, he has a swollen, red, dome-shaped lesion with a central defect that contains a keratinous type of material’
What is this describing?
A
Keratoacanthoma
13
Q
How can the pattern of telangiectasia help differentiate basal cell carcinoma (BCC) from other skin lesions?
A
In BCC, telangiectasia (small visible blood vessels) are usually seen on the rolled, pearly edge of the lesion. If the blood vessels are scattered randomly around the lesion, it’s less likely to be BCC
14
Q
Trauma is a common precipitant of what?
A
pyogenic granuloma = contact bleeding, and ulceration are common
15
Q
A non-healing, painless ulcer associated with a chronic scar is indicative of what?
A
SSC
16
Q
A 25-year-old lady presents to the GP with itchy eyes. She describes a gritty feeling in both her eyes and has noticed that they stick together in the morning. The grittiness is also worse first thing when she wakes up. She complains of no other symptoms.
Given her presentation, what is the most likely diagnosis?
A
Blepharitis
17
Q
‘A 21-year-old lady presents with a nodule on the posterior aspect of her right calf. It has been present at the site for the past 6 months and occurred at the site of a previous insect bite. Although the nodule appears small, on palpation it seems to be nearly twice the size it appears on examination. The overlying skin is faintly pigmented’
What is this describing?
A
Dermatofibroma
18
Q
‘A 28-year-old female presents with a small nodule on the back of her neck. It is excised for cosmetic reasons, and the histology report states that the lesion consists of a sebum-filled lesion surrounded by the outer root sheath of a hair follicle’
What is this describing?
A
Pilar cyst
= Pilar cysts may contain foul smelling cheesy material and are surrounded by the outer part of a hair follicle
19
Q
‘A 30-year-old man cuts the corner of his lip whilst shaving. Over the next few days, a large purplish lesion appears at the site, which bleeds on contact’
What is this describing?
A
Pyogenic granuloma
20
Q
What diseases are associated with onycholysis - lifting of the nail bed?
A
- Psoriasis
- Eczema = atopic dermatitis
- Rheumatoid arthritis
- Systemic lupus erythematosus (SLE)
- Hyperthyroidism (Graves’ disease)
- Hypothyroidism (myxedema)
- Iron deficiency anaemia
- Leukaemia
- Chronic sinusitis
- Psoriatic arthritis
- Tinea unguium
- Ringworm)
21
Q
What diseases show pitting of the nails?
A
- Psoriasis
- Eczema = atopic dermatitis
- Alopecia areata
- Psoriatic arthritis
22
Q
What diseases show HLA-DQ2/DQ8?
A
- Coeliac disease
- Type 1 diabetes (also DR3/DR4)
23
Q
Name key examples of tumour suppressor genes associated with inherited cancer syndromes or sporadic cancers
A
- BRCA1
- p53
- BRCA2
- APC
- Rb
- NF1
- WT1
- multiple tumour suppressor 1 (MTS-1, p16
24
What term describes the itchiness commonly associated with urticaria?
Pruritic
25
What are the characteristic features of urticaria?
1. Pale
2. pink raised skin lesions
3. Often described as hives, wheals, or nettle rash
4. They are pruritic (itchy)
26
What is the first-line treatment for acute urticaria?
Non-sedating antihistamines such as loratadine or cetirizine
27
For how long should non-sedating antihistamines be continued after an episode of acute urticaria?
up to 6 weeks
28
What medication may be added at night if urticaria is affecting sleep?
A sedating antihistamine like chlorphenamine, in addition to the daytime non-sedating antihistamine
29
: What is used for severe or resistant cases of urticaria?
Prednisolone
30
What drugs commonly cause urticaria?
1. Aspirin
2. penicillins
3. NSAIDs
4. opiates
31
What is used after the treatment of scabies to relieve residual itch?
Crotamiton
32
Depigmented 'ash-leaf' spots mean what and is related to what?
Tuberous sclerosis, whiteness patch on the skin
33
Which cytokine plays a key role in the pathogenesis of atopic eczema and is a target for biologics like dupilumab?
A. IL-1
B. IL-4
C. IL-8
D. IL-12
E. IL-17
IL-4
34
Dyshidrotic eczema (pompholyx) is best described as what?
Pruritic vesicles on the palms and soles
35
In adult-onset atopic eczema, what is a common associated condition?
Asthma
36
A 28-year-old woman presents with intensely itchy vesicles on her palms that worsen with stress. No obvious allergens are identified. She has no history of asthma or hay fever. What is the most likely diagnosis, and how does its clinical presentation help differentiate it from other types of eczema?
Dyshidrotic eczema
= Itchy vesicles on palms, stress-triggered, no atopy or allergen needed
37
Describe the role of IL-4 in atopic eczema. Include its effect on the immune system and skin barrier, and explain why IL-4 is a therapeutic target in severe cases
IL-4 drives Th2 immune responses, leading to inflammation and barrier dysfunction
= which is why IL-4 inhibitors like dupilumab are effective in treating severe cases
38
A patient presents with circular, coin-shaped plaques on their lower legs during cold weather. What type of eczema is this?
Nummular eczema
39
What cell secretes the majority of tumour necrosis factor in humans?
Macrophages
40
Eczema herpeticum is a primary infection of the skin caused by what?
herpes simplex virus (HSV) and uncommonly coxsackievirus 16
41
A 29-year-old woman comes to the GP surgery with a several-month history of a facial rash. She wears sunscreen but avoids wearing make-up as she thinks this makes the rash worse. She has tried some over-the-counter hydrocortisone, which didn't improve the rash.
On examination, the skin appears dry, and there is an acneiform eruption of clusters of erythematous papules and vesicles located around the nose and mouth. The rest of her cheeks and forehead appear clear.
What is the first-line treatment for this condition?
Perioral dermatitis should be treated with topical or oral antibiotics
42
A 34-year-old female presents to her GP with a red rash on her hands. She first noticed the rash a month ago when she moved into her partner's apartment. However, it has become incredibly itchy in the last few days and keeps her awake at night.
She has tried using her regular moisturiser cream, which has not helped. On examination, a bilateral erythematous rash on both hands extends into the interdigital spaces, with numerous excoriation marks. The rash is not present elsewhere, and there are no other significant findings.
Given the likely diagnosis, what is the mechanism behind this patient's presentation?
She has scabies
= The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivity
43
A 35-year-old woman presents to her GP with an intensely itchy, red rash affecting her hands and arms. She says it started a few days ago, and the itching is severe enough to affect her sleep. She has no family history of hay fever, eczema or asthma, and she is otherwise well. Upon questioning, she reveals that a co-worker had a similar issue last week.
On examination, there is a widespread erythematous rash on both hands, particularly in the interdigital web spaces and the flexor aspect of the wrists, with excoriation marks. There is no crusting, and the rash is not present anywhere else.
Given the likely diagnosis, what is the first-line treatment?
Permethrin is the treatment of choice for scabies
44
What does Breslow thickness refer to?
The depth from the granular layer of the epidermis to the deepest melanoma cell
45
Which subtype is the worst?
nodular
46
What is the most effective treatment for malignant melanomas?
Radical surgery
47
If pregnant whilst having acne, what are the treatments you can take?
E
Acezaid acid or benzoyl peroxide
48
A 22-year-old woman presents to her GP surgery with a 6-month history of persistent widespread papules and pustules affecting her face and upper back. She is otherwise well, takes no regular medication, and is not pregnant. She has previously completed a 12-week course of topical adapalene with benzoyl peroxide, which resulted in only minimal improvement. She now wishes to discuss further management options. Examination reveals numerous inflammatory lesions but no scarring or nodules. She is concerned about the cosmetic impact of her acne but does not wish to take long-term antibiotics if other options are available.
Which is the most appropriate next step in her management?
Start a combined oral contraceptive pill alongside topical therapy
49
Clindamycin is what?
A tropical antibiotic
50
A 26-year-old man presents to his GP with an itchy red rash on his hands, which he reports is spreading. He attended the GP only a week ago and received a course of antibiotics to treat tonsillitis. On examination, the rash is made up of circular oedematous papules that are pale on the centre and pink around the edge
Given the history and examination findings, what is the most likely diagnosis?
Erythema multiforme
51
A young female is brought to A&E by paramedics with ongoing seizures. She requires two doses of intravenous lorazepam to terminate the latest seizure
On examination, she is postictal and drowsy. She has numerous reddish bumps across her nose and cheeks. There are multiple hypomelanotic macules across her torso and fleshy growths around her nails
Which underlying condition does this patient likely have?
Tuberous sclerosis
52
Man has actinic keratosis. What could he potentially get in the future?
SSC
53
An 82-year-old man presents to his GP due to an enlarging bump on his nose. On examination, there is a 1x1 cm nodule on the tip of his nose which has a central crusted depression. He is referred to dermatology due to a suspected keratoacanthoma.
What is the most appropriate management of this condition?
Surgical
54
A 65-year-old man presents with a rapidly growing, scaly, erythematous nodule on his right ear that has been present for several months. On examination, the nodule is firm and measures approximately 1 cm in diameter
What is the most likely diagnosis?
SSC
55
What is the first line management for seborrhoeic keratoses?
Cryotherapy
56
The image demonstrates the erosions and crusts seen in Pemphigus Vulgaris, resulting from ruptured fragile bullae (large blisters).
Pemphigus Vulgaris is an autoimmune blistering skin condition caused by autoantibodies against antigens in the epidermis
What is the treatment?
1. Oral corticosteroids are used to control the symptoms
2. Immunosuppressants
= Methotrexate or Azathioprine
57
The most common malignancy in the lower lip is a squamous cell carcinoma.
What is the treatment?
Mohs
= used for high-risk patients and in cosmetically important sites (e.g. face)
58
A 78-year-old woman presents to her general practitioner with several small lesions on her forehead. She explains that they have been present for some years and have not significantly changed in appearance or size. She has no significant past medical history and is a retired farmer.
On examination, the lesions range from several millimetres to 1cm in diameter. They have the appearance of scaly, pink plaques. Two of them appear hyperkeratotic.
What is the most appropriate next step in management?
Actinic keratoses are premalignant and may be found incidentally on those with high cumulative sun exposure in primary care
= Topical fluorouracil
59
Tonsilar SCC is associated with HPV infection.
What is its other name?
Human papillomavirus
60
A 23-year-old male attends the GP surgery with troublesome sneezing and eye irritation that is worse in the spring and summer months. On further questioning, he has an itchy rash on the flexor surface of his elbow. Allergic rhinitis is an example of which type of hypersensitivity reaction?
Type 1
61
A new medical student presents to your general practice to check his tuberculosis vaccination status. As part of this process, he undergoes a Mantoux test.
The inflammatory reaction to the Mantoux test is an example of a delayed hypersensitivity reaction. Which immune mediator is this type of reaction usually associated with?
T cells
62
In the Gell and Coombs classification of hypersensitivity reactions scabies is an example of what?
4
63
A 41-year-old man develops itchy, polygonal, violaceous papules on the flexor aspect of his forearms. Some of these papules have coalesced to form plaques. What is the most likely diagnosis?
Lichen planus
64
An area of rapidly worsening painful eczema is an early sign of what?
Eczema herpeticum
65
What drug is responsible for Alopecia?
Asprin
66
A 45-year-old woman presents you with a 3-day history of an ovoid patch of tender erythema on the posterolateral aspect of her left calf, which has been increasing in size. She recalls injuring her left leg a week ago while gardening. On examination, the patient is afebrile and on inspection of the left calf, the patch of erythema measures roughly 3 × 3 cm with poorly demarcated edges.
On palpation, the zone of erythema is warm and very tender. Full blood count reveals a white cell count 20.1 with a neutrophil count of 15.0. What organism is the most likely cause of this condition?
Staphylococcus aureus
67
A 68-year-old man is diagnosed with right forearm cellulitis. You are asked to start the patient on treatment, and he has no known drug allergies. Which one of the following antibiotics would be the most appropriate choice in this scenario?
A. IV clindamycin
B. Oral clindamycin
C. IV flucloxacillin
D. Oral flucloxacillin
E. Oral erythromycin
C
68
A 75-year-old man presents to your clinic with a dark lump on his forehead, which has been increasing in size over the last 6 weeks. He first noticed the lump, which initially appeared as a small pinkish-red patch of skin, over a month ago. On examination, you observe a 1 × 2 cm hyperpigmented nodule with everted edges and a centrally deep, ulcerated red base.
What has this just described?
SSC
69
A patient on the ward has a nodule-like rash, and you are asked by your registrar to define the meaning of a nodule.
What best describes a nodule?
A solid lump greater than 0.5 cm in diameter which may be
subcutaneous or intradermal
70
A 71-year-old farmer presents to his GP with a skin lesion on the dorsum of his left hand. The lesion is a red papulo-nodule with scale and ulceration. A biopsy is undertaken, and a diagnosis of cutaneous squamous cell carcinoma is made.
What would most likely be found on histological examination of the biopsy?
keratin pearls on biopsy
71
A 24-year-old woman presents to her GP complaining of having difficulty at work. Over the last month, she has been experiencing episodes of painful fingers on both hands, which turn white and then red. She works as a gardener and requires a high level of dexterity for her role. The episodes resolve after she finishes her shift.
What is the pathophysiological process responsible for the patient's presentation?
Exaggerated vasoconstriction
72
An 8-year-old boy presented with a painless swelling on the superotemporal aspect of his orbit. It was smooth on examination, produced no visual disturbances.
Following excision it was found to be lined by squamous epithelium and hair follicles. Which lesion most closely matches these findings?
Dermoid cyst
73
A 61-year-old female presents to the rheumatology clinic with a new diagnosis of rheumatoid arthritis. She is started on a short course of steroids and a disease modifying anti-rheumatic drug.
What type of joint is primarily affected in rheumatoid arthritis?
Synovial
74
A 24-year-old woman attends with an intensely itchy rash over her buttocks and knees. She also complains of bloating, and diarrhoea. On examination, you note vesicular skin lesions over the elbows, knees, and buttocks.
What would you expect to see on a skin biopsy?
Dermatitis herpetiformis - caused by IgA deposition in the dermis
75
Mr Briggs comes to the surgery having noticed a new lesion on his arm. Examination reveals worrying features of malignancy.
Which features would be most in keeping with a malignant melanoma in situ?
ABCDE of assessing a pigmented lesion:
1. Asymmetry
2. Border
3. Colour
4. Diameter
5. Evolution
76
A 32-year-old lady presents with a 1.5cm pigmented lesion on her back. The surgeon is concerned that this may be a melanoma. What is the most appropriate course of action?
Excisional biopsy of the lesion
= Suspicious naevi should NOT be partially sampled as histological interpretation is severely compromised. Complete excision is mandatory where lesions fulfil diagnostic criteria. However, wide excision for margins may be deferred until definitive histology is available
77
Sjogrens syndrome is associated with what?
autoimmune thyroiditis = Hashimoto's thyroiditis
78
A 28-year-old man presents to his general practitioner with an itchy rash on his buttocks. He has a past medical history of coeliac disease.
On examination, there is a vesicular rash on both buttocks.
What will a biopsy of the lesion demonstrate?
IgA deposition in the dermis
79
"Ankylosing spondylitis typically presents in a young man with lower back pain and stiffness that is worse in the mornings"
What is the most likely radiological finding?
Sacroiliitis
Year 2- Derm
flashcards
Decks in class (17)
# Cards
-
Derm random80
-
Vitamin Deficiencies / Nutrition54
-
Cutaneous Drug Eruptions41
-
Derm - Infections111
-
Common Rashes89
-
Eczema (dermatitis)69
-
Psoriasis49
-
Blistering Skin Disorders56
-
Dysplastic/Pre-malignant Skin Lesions29
-
Basal Cell Carcinoma27
-
Squamous Cell Carcinoma14
-
Malignant Melanoma32
-
Benign Skin Lesions42
-
Pressure sores24
-
Skin signs of systemic disease72
-
Tinea - dermatophytoses13
-
Keloid Scars9
