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MRCP 2 > derm > Flashcards

derm Flashcards

1
Q

eczema pathophysiology

A

null mutations in filaggrin gene
> epidermal permeability
Th2 inflammatory response

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2
Q

topical steroids for eczema

A

mild- hydrocort
mod- clobetasone butyrate/eumovate
potent- betamethansone/betnovate
v potent- clobetasol propionate/dermovate

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3
Q

specialist treatment for eczema

A

calcineurin inhib- tacrolimus/pimecrolimus
UVB or PUVA
ciclosporin or azathioprine
alitretinoin (hand dermatitis)

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4
Q

BCC treatment and types

A

surgical excision, routine referral to derm
imiquimod for small low risk BCC
vismodegib for advanced/metastatic

nodular (most common) pearly raised edges, telangiectasia, may ulcerate
morphoeic (sclerosing) mostly on face, waxy
pigmented
superficial (plaques) most common in younger adults
mixed basosquamous, more aggressive

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5
Q

7 point checklist for malignant melanoma

A

major (2 points):
change in size
irregular shape/border
irregular colour

minor (1 point):
diameter > 7mm
inflammation
oozing/crusting
change in sensation

refer if 3 points

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6
Q

bullous pemphigoid antibodies

A

BP antigen II BP180
BP antigen I BP230
IgG

inflam cells release proteases
> degrade hemidesmosomal proteins connecting basal cells to lamina lucida

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7
Q

pemphigoid treatment

A

dx:
skin biopsy for light microscopy
skin biopsy for direct immunofluorescence
indirect immunofluorescence on serum

topical steroids for local disease
systemic for widespread
azathioprine/ciclosporin if steroid resistant
usually self limiting within months-years

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8
Q

pemphigoid risk factors

A

previous chronic inflam skin diseases
furosemide, abx, NSAIDs
PD, epilepsy, dementia

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9
Q

cellulitis organisms

A

staph and strep pyogenes

strep pneum, haem infl, gram neg, anaerobes- injury, burns
pseudomonas aeruginosa- hot tubs, sponges, nail puncture
vibrio vulnificus- salt water
aeromonas hydrophila- fresh water
erysipelothrix- butcher, vet, fish handler
myobacterium marinum- aquarium
pasteurella, capnocytophaga- cat/dog bite
eikenella- human bite
streptobacillus moniliformis- rodent bite

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10
Q

eron classification of cellulitis

A

1: no systemic symptoms or comorbidities
2: systemically unwell or comorbidity
3: severe systemic symptoms (tachy/hypotensive) or unstable comorbidities
4. severe infection e.g. nec fasc

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11
Q

cellulitis admission criteria

A

severe infection or systemic symptoms
infection close to eyes or nose
might be caused by uncommon organism
not responding to oral tx
lymphangitis

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12
Q

cellulitis treatment

A

fluclox
clari or doxy if pen allergic
erythromycin if pregnant
coamox or clari +metro if near eyes
amox if lymphoedema

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13
Q

abstinence and testing after chlamydia

A

abstain for 7 days after treatment with azithromycin
re-test after 3-6 months
test of cure only for pregnant people (3 weeks after treatment)

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14
Q

dermatitis herpetiformis biopsy

A

microabscessses containing neutrophils and eosinophils
granular IgA deposits

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15
Q

treating dermatitis herpetiformis

A

oral dapson
sulfapyridine
rituximab
steroids

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16
Q

causes of erythema multiforme

A

HSV, HIV, hepB, EBV
mumps
mycoplasma
psittacosis
rickettsia
barbiturates, penicillins, sulfonamides
SLE, polyarteritis nodosa, sarcoid

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17
Q

causes of erythema nodosum

A

strep, salmonella, campylobacter, tb
sarcoid, UC, crohns
lymphoma, leukaemia
penicillin, tetracycline, OCP
pregnancy

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18
Q

erythroderma risk factors

A

eczema, psoriasis
lymphoma
sezary syndrome
drug reactions
blistering conditions
pityriasis rubra pilaris
HIV
other malignancies

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19
Q

erythroderma dx and tx

A

raised IgE
tx:
urgent admission
IV fluids
emollients, wet dressings
topical steroids
warm room to prevent hypothermia

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20
Q

erythroderma

A

> 90% skin inflammation and shedding

21
Q

what drugs can cause alopecia?

A

retinoids
anticoagulants
anti mitotics
OCP
carbimazole
thiouracil
lithium

22
Q

causes of scarring alopecia

A

ichthyosis
TB, syphilis
burns, RTx
kerion, tinea capitis
lichen planus
lupus, sarcoid, pemphigoid
morphoea

23
Q

alopecia areata associations

A

nail dystrophy
cataracts
vitiligo
autoimmune thyroid disease
pernicious anaemia
addisons

24
Q

anagen/telogen effluvium

A

anagen effluvium:
hair loss during anagen stage
pointed tip
alopecia areata, CTX, retinoids

telogen effluvium
hair loss when increased number of hairs enter telogen stage and shed
postpartum, trauma, illness, stress, weight loss

25
Q

types of hypersensitivity reaction

A

1:
IgE, mast cells, basophils
atopy, anaphylaxis, contact dermatitis

2: antibody dependent
IgG
drug induced haemolysis, acute transfusion, goodpastures

3: immune complex
serum sickness, SLE, post strep GN

4: delayed cell mediated
helper and cytotoxic T cells
contact dermatitis, BCG

26
Q

lichen planus treatment

A

topical steroids
tacrolimus ointment
oral steroids if widespread
MTX for hair and nails
UVB second line

27
Q

types of melanoma

A

superficial spreading- irregularly pigmented macule/plaque
nodular- often rapidly growing
lentigo- irregularly pigmented macule, older patients and slowly expanding
acral- pals, soles, toenails
amelanotic

28
Q

melanoma treatment

A

CTX for metastatic unresectable
vemurafenib for v-raf murine sarcoma BRAF mutation
ipilimumab
resect with 2mm margin

29
Q

molluscum contagiosum treatment

A

not normally indicated
hydrogen peroxide cream or iodine
pdophyllotoxin
topical salicylic acid
cantharidin

30
Q

strawberry naevi

A

treat if it obstructs vital structures
> propranolol and prednisolone

Kasaback Merritt- low platelets, enlarging haemangioma, haemolysis, consumption coagulopathy

PHACE- posterior fossa defects, arterial anomalies, cardiac defects, eye anomalies

31
Q

sebaceous naevi

A

present at birth on scalp/face
can undergo neoplastic change after puberty

32
Q

neurocutaneous melanosis

A

melanocytic naevi
EEG abnormalities
raised ICP, hydrocephalus, SOL

33
Q

neurofibromatosis

A

1:
NF1 chromo 17, auto dom
neurofibromas, cafe au lait
freckles
dermatofibromas
lisch nodules

2:
NF2, chr 22, auto dom or de novo
b/l acoustic neuromas
meningiomas, glial tumours
fewer cafe au lait spots
reduced life expectancy

schwannomatosis:
tender cutaneous schwannomas without vestibular neuroma
high tumour load

34
Q

pemphigus HLA alleles and antibodies

A

paraneoplastic: HLA DR4, HLA DQ1
vulgaris: HLA DRB1

IgG mediated

vulgaris: desmoglein 1 and 3 antibodies
foliaceus: desmoglein 1 antibodies

35
Q

paraneoplastic pemphigus compared to pemphigus vulgaris

A

nikolsky negative
no scalp pruritus
no dysphagia
background malignancy

36
Q

drug causes of photosensitivity

A

doxy, fluoroquinolones, voriconazole
chlorpromazine, prochlorperazine
furosemide, thiazires
sulfonamides, amiodarone, promethazine, NSAIDs, metformin, vemurafenib

37
Q

pityriasis versicolour cause

A

malassezia

38
Q

vitiligo treatment

A

topical steroid or pimecrolimus

39
Q

cause of plantar warts

A

HPV 1, 2, 4, 27, 57

40
Q

psoriasis pathophysiology

A

expansion of Th1, Th17, Th22
> release cytokines IL 17, !L 22, TNF a

41
Q

what drugs might exacerbate psoriais?

A

beta blockers
lithium
antimalarials
interferon
withdrawal of oral steroids

42
Q

systemic treatment for psoriasis

A

MTX (need to monitor P3NP)
ciclosporin (first line if acute control is needed or palmar pustular)
retinoids

etanercerpt, adalimumab, infliximab (TNFa inhib)
ustekinumab (IL 12 and 23 antibody)

43
Q

conditions associated with pyoderma gangrenosum

A

UC, crohns
RA, ank spond
chronic hepatitis, PBC, sclerosing cholangitis
leukaemia, lymphoma, myeloproliferative
DM, thyroid, sarcoid, granulomatosis w/ polyangiitis

44
Q

rosacea treatment

A

mild/mod: topical metro or azelaic acid
mod/severe: bromonidine (for erythema alone), PO abx
refer to derm for persistent flushing and telangiectasia for beta blockers, clonidine, isotretinoin

45
Q

SCC referral

A

2ww
low risk of malignancy but early treatment prevents extensive treatment

46
Q

lesions related to SCC

A

keratoacanthoma (excision)
bowens (cryo, excision or 5FU)
actinic keratoses (cryo, excision, 5FU, diclofenac or imiquimod cream)

47
Q

causes of SJS and TEN

A

allopurinol
cephalosporin
NSAIDs
phenytoin
carbamazepine
sulfasalazine
sertraline
antivirals

HSV, resp infections, mumps
EBV, coxsackie, influenza

HLA B1502, HLA B1508 increases risk

48
Q

SJS vs TEN

A

SJS: < 10% total body surface area skin detachment, widespread macules or targets

overlap: 10-30% skin detachment with widespread macules or targets

TEN: > 30% body surface area skin detachment with macules or targets
OR > 10% with large epidermal sheets and no purpuric macules

MRCP 2 (12 decks)

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