Skin in systemic disease & pregnancy flashcards
16 high-yield MRCP Part 1 cards from the Intellect Medicos Dermatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Which malignancy is classically associated with acanthosis nigricans?
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Gastric adenocarcinoma.
Why? Most acanthosis nigricans is due to insulin resistance (obesity, type 2 diabetes, PMOS — formerly PCOS); new, rapidly spreading disease in a non-obese adult should prompt a search for malignancy.
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Paraneoplastic skin signs: tylosis (thickened palms and soles) suggests ______; necrolytic migratory erythema suggests glucagonoma.
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oesophageal carcinoma
Why? These non-metastatic skin signs can precede diagnosis of the underlying tumour.
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Paraneoplastic skin signs: tylosis (thickened palms and soles) suggests oesophageal carcinoma; necrolytic migratory erythema suggests ______.
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glucagonoma
Why? These non-metastatic skin signs can precede diagnosis of the underlying tumour.
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What is the first-line treatment for pyoderma gangrenosum?
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Systemic (oral) corticosteroids; ciclosporin or anti-TNF (e.g. in IBD) are alternatives.
Why? Pyoderma gangrenosum is a neutrophilic dermatosis associated with IBD and rheumatoid arthritis, causing painful ulcers with violaceous undermined edges.
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Which investigation must be done before applying strong (therapeutic) compression to a venous leg ulcer?
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Ankle–brachial pressure index (ABPI).
Why? Strong compression on a limb with significant arterial disease can cause ischaemia.
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What is the first-line treatment of a venous leg ulcer once significant arterial disease is excluded?
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Compression therapy (multilayer bandaging or stockings), with leg elevation and exercise.
Why? Compression counteracts venous hypertension, which drives capillary leak and ulceration.
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What is the first-line treatment for limited vitiligo?
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A potent topical corticosteroid (topical tacrolimus for the face), with sun protection and camouflage make-up.
Why? Vitiligo is autoimmune melanocyte destruction; autoimmune thyroid disease is the commonest association. Narrowband UVB is used for more extensive disease.
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A painless, shiny yellow-red plaque with telangiectasia on the shin of a patient with diabetes is ______.
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necrobiosis lipoidica
Why? Compare pretibial myxoedema (painless orange-peel shin plaques in Graves' disease) and erythema nodosum (painful, tender nodules).
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A woman in her first pregnancy at 36 weeks has very itchy urticarial papules that began within her abdominal striae. The skin around the umbilicus is spared and there are no blisters. What is the most likely diagnosis?
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Polymorphic eruption of pregnancy.
Why? It typically occurs in first pregnancies in the third trimester and resolves after delivery; treat with emollients and topical corticosteroids (a short course of oral steroids if severe).
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What is the treatment for pemphigoid gestationis with widespread blisters?
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Oral corticosteroids (prednisolone).
Why? Pemphigoid gestationis is an autoimmune blistering disease of pregnancy that starts around the umbilicus and spreads.
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Paraneoplastic skin signs: erythema gyratum repens suggests ______; acquired ichthyosis suggests lymphoma.
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lung (or breast) carcinoma
Why? These are non-metastatic cutaneous markers of internal malignancy; tripe palms suggest lung or gastric carcinoma, and paraneoplastic pemphigus suggests a lymphoproliferative disorder.
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Paraneoplastic skin signs: erythema gyratum repens suggests lung (or breast) carcinoma; acquired ichthyosis suggests ______.
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lymphoma
Why? These are non-metastatic cutaneous markers of internal malignancy; tripe palms suggest lung or gastric carcinoma, and paraneoplastic pemphigus suggests a lymphoproliferative disorder.
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In suspected systemic mastocytosis, the first-line blood test is serum ______, and the gold-standard diagnostic test is bone marrow biopsy.
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tryptase
Why? Clonal mast cells (usually with a KIT D816V mutation) cause urticaria pigmentosa, flushing, diarrhoea and anaphylaxis; rubbing a lesion causes urtication (Darier's sign). First-line symptomatic treatment is antihistamines.
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In suspected systemic mastocytosis, the first-line blood test is serum tryptase, and the gold-standard diagnostic test is ______.
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bone marrow biopsy
Why? Clonal mast cells (usually with a KIT D816V mutation) cause urticaria pigmentosa, flushing, diarrhoea and anaphylaxis; rubbing a lesion causes urtication (Darier's sign). First-line symptomatic treatment is antihistamines.
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Name four skin conditions that show the Koebner phenomenon.
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Any four: psoriasis, lichen planus, vitiligo, viral warts, molluscum contagiosum, lichen sclerosus, discoid lupus.
Why? New lesions appear at sites of skin trauma such as scratches or surgical scars.
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What is the first-line management of granuloma annulare?
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Reassurance — it is benign and usually resolves spontaneously; a topical corticosteroid if treatment is wanted.
Why? It causes annular, non-scaly papules on the backs of the hands and feet and has a (weak) association with diabetes. Biopsy shows palisading granulomas around degenerate (necrobiotic) collagen.