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Dermatology > acute and emergency derm > Flashcards

acute and emergency derm Flashcards

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Dermatology Board Prep flashcards
1
Q

consequence of skin not acting as a mechanical barrier?

A

sepsis

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2
Q

consequence of skin not regulating temperature?

A

hypo/hyper - thermia

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3
Q

consequence of skin not blanking fluid and electrolytes?

A

protein and fluid loss

renal impairment

peripheral vasodilation

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4
Q

erythroderma definition?

A

any inflammatory skin disease affecting >90% of total skin surface

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5
Q

name 4 causes of erythroderma ?

A

psoriasis
eczema
drugs
cutaneous lymphoma

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6
Q

name 5 principles of management of erythroderma?

A

remove offending drugs

careful fluid balance

good nutrition

T regulation

Emollients - 50:50 liquid paraffin

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7
Q

describe mild form of drug reaction?

A

Morbilliform exanthem

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8
Q

describe severe form of drug reaction?

A

erythroderma/

Stevens Johnson Sydrome (SJS)/

Toxiz epidermal necrolysis (TEN)/

DRESS

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9
Q

explain link between SJS and TEN?

A

thought to form part of the same spectrum

both rare

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10
Q

which drugs are often a cause of 2y SJS/TEN?

A

antibiotics
anticonvulsants
allopurinol
NSAIDs

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11
Q

name 5 clinical features of SJS?

A 
fever
malaise
arthralgia (joint pain)
rash 
mouth ulceration (or any other mucous membrane)
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12
Q

clinical features of TEN?

A

prodromal febrile illness

ulceration of mucous membranes

rash

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13
Q

which sign is often positive in TEN?

A

Nikolsky’s sign -

cleaving skin where Skin reddens, fluid collects underneath and skin rubs off, leaving raw red base

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14
Q

2 key things for managing TEN/SJS?

A

identify and stop culprit drug ASAP

supportive therapy

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15
Q

name 4 other possible treatments for TEN/SJS?

A

ciclosporin
IV immunoglobulins
high dose steroids
Anti-TNF therapy

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16
Q

scoring system for prognosis for TEN/SJS?

A

SCORTEN

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17
Q

name 7 possible areas on SCORTEN system?

A

age >40

malignancy

HR >120

initial epidermal detachment >10%

serum urea >10

serum GLC >14

serum bicarbonate <20

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18
Q

SCORTEN score = 0-1

A

mortality risk - 3.2%

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19
Q

SCORTEN score = 2

A

mortality risk - 12.1%

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20
Q

SCORTEN score = 3

A

mortality risk - 35.3%

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21
Q

SCORTEN score = 4

A

mortality risk - 58.3%

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22
Q

SCORTEN score = 5+

A

mortality risk - 90%

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23
Q

what is Erythema Multiforme?

A

hypersensitivity reaction, usually trigger by HSV or mycplasma pneumonia

24
Q

onset of Erythema Multiforme?

A

abrupt - 100s of lesions form within only 24hrs

25
Q

pattern of spread with Erythema Multiforme?

A

distal to proximal -

palms and soles are affected first

26
Q

characteristic presentation of Erythema Multiforme?

A

evolves over 72hrs, TARGET lesions

27
Q

treatment of Erythema Multiforme?

A

it is self-limiting and resolves over 2 weeks -

treat underlying cause

28
Q

DRESS?

A

Drug Reaction with Eosinophilia and Systemic Symptoms

29
Q

presentation of DRESS?

A

fever
widespread rash
eosinophilia and deranged liver function
lymphadenopathy

often other organ involvement

30
Q

treatment of DRESS?

A

stop causative drug

symptomatic and supportive

systemic steroids

+/- Immunosuppression or immunoglobulins

31
Q

clinical features of pemphigus?

A

flaccid blisters - easily rupture
Nikolsky’s sign +ve

common sites -
face
axillae
groins

ill defined erosions in mouth

32
Q

pathology of pemphigus - what is used?

A

immunofluorescence

histopathology

33
Q

clinical features of pemphiGOID?

A

blisters are tense and intact

intact epidermis forms roof of blister

34
Q

where are the antibodies directed at on pemphigus v.s. pemphigoid?

A

pemphigus - at desmosomes

pemphigoid - dermo-epidermal junction

35
Q

5 differences pemphigus v.s. pemphigoid?

A

pemphigus:

uncommon 
middle aged patients 
patients are unwell if extensive lesions 
fragile blisters
treat with systemic steroids

pemphigoid:

common
elderly patients 
extensive lesions, patients still well 
intact and tense blisters 
topical steroids as treatment
36
Q

common diagnosis for patients with rapid development of generalised erythema, and a history of psoriasis?

A

Erythrodermic psoriais and Pustular Psoriasis

37
Q

common causes of Erythrodermic psoriais and Pustular Psoriasis?

A

infection

sudden withdrawal of steroids (topical/oral)

38
Q

2 signs of Erythrodermic psoriais and Pustular Psoriasis?

A

fever

raised WBC count

39
Q

Eczema Herpeticum - common group?

A

children and babies

40
Q

treatment for Eczema Herpeticum?

A

dose of Aciclovir

topical steroid to treat eczema if needed

41
Q

cause of Eczema Herpeticum?

A

herpes virus, with background of eczema

42
Q

possible complication of Eczema Herpeticum?

A

peri-ocular disease - requires ophthalmology

43
Q

what needs to be considered in adults with Eczema Herpeticum?

A

underlying immunocompromise

44
Q

Staphylococcal Scalded Skin Syndrome - groups affected?

A

commonly - children

also immunocompromised adults

45
Q

cause of Staphylococcal Scalded Skin Syndrome?

A

initial staph. infection

46
Q

presentation of Staphylococcal Scalded Skin Syndrome?

A

Diffuse erythematous rash with skin tenderness

More prominent in flexures

Blistering and desquamation follows

Fever

irritability

47
Q

treatment of Staphylococcal Scalded Skin Syndrome?

A

IV antibiotics initially
supportive care

resolves over 5-7 days with treatment

48
Q

3 words associated with a type of Urticaria?

A

weal
wheal
hive

49
Q

what is Urticaria?

A

Central swelling of variable size, surrounded by erythema Dermal oedema

50
Q

what is the cause of itching/burning caused by Urticaria?

A

histamine is released into the dermis

51
Q

what is angiodema urticaria?

A

a deeper swelling of skin/ mucous membranes

52
Q

what qualifies as an acute urticaria?

A

<6 week history

53
Q

most common cause of acute urticaria?

A

idiopathic (50%)

54
Q

other causes of acute urticaria?

A

viral infection
drugs (IgE mediated)
food (IgE mediated)

55
Q

treatment for acute urticaria?

A

oral antihistamine - taken continuously, up to x4 dose

short course of oral steroid if cause of urticaria is clear

56
Q

what drugs need to be avoided when treating urticaria?

A

NSAIDs and opiates - these exacerbate urticaria

57
Q

management of chronic urticaria?

A

1 - non-sedating H1 antihistamine

2 - higher dose of H1 antihistamine (up to x4 more)

3 - anti-leukotriene OR tranexamic (if angioedema is present)

4 - omalizumab

Dermatology (8 decks)

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