derm Flashcards
1
Q
what is les trelat sign
A
sudden multiple sebborheic keratosis
indicative of cancer
2
Q
sebborheoic keratosis rx
A
cyrotherapy and curettage
3
Q
dermatofibroma rx
A
only excise if sx
4
Q
dermatofibroma description
A
firm elevated nodules like buttons. peripheral ring of pigmentation
often in those with hx insect bites or trauma
5
Q
describe epidermal cysts
A
cysts with central punctum
contains caseous keratin
dermal inflammation
6
Q
where do you get pyogenic granulomas and what do they look like
A
red often on finger
7
Q
what are keratocanthomas
A
epidermal tumours with central necrosis and ulcers
8
Q
what are acitinic keratosis
A
red and silver papules or patches scaly, with conical base and red base
9
Q
rx acitinic keratosis
A
cryo, 5FU (5% diclofenac or imiquimod) or none if nor bothering
10
Q
bowens disease is in which part of the skin
A
epidermis
11
Q
what can keratocanthomas develop to
A
scc
12
Q
what diameter of melanocytic naevi is suspicious for ca
A
7mm
13
Q
where are superficial spreading melanomas commonly found. what is there cause
A
- LL
- intermittent high intensity UV exposure
14
Q
cause of nodular melanoma
A
- intermittent high intensity UV exposure. most common trunk
15
Q
cause of lentigo maligna melanoma
A
- cumulative UV exposure in elderly
16
Q
kaposis sarcoma rx
A
radiotherapy and resection
17
Q
drugs that cause IgE reactions
A
ET is a nuisance because he pees a lot and has cell phone, a pen and a strong muscle;
- NSAID
- Sulphonamides
- Penicillin
- Muscle relaxants
- Diuretics
18
Q
what kind of rash do you get with toxic erythema and how long does it take to manifest after drugs taken
A
- maculopapular
- within 2 weeks
19
Q
drugs that cause urticaria
A
- nsaids
- ace-i
- pen and ceph
- codeine and morphine
20
Q
which drugs give you widespread eythroderma
A
cages give you erythroderma;
- carbamezapine
- Allopurinol
- Gold
- Sulphonamides
21
Q
what is a fixed drug eruption
A
- skin reaction of blistery style rash at same site on skin everytime a specific drug is taken
- leaves purply hyperpigmentation and re erupts at same site on re exposure to drug
- arrive over few hrs from exposure
22
Q
drugs that commonly cause fixed drug eruptions
A
- PTSA
- Paracetemol
- Tetracycline
- Sulphonamides
- Aspirin
23
Q
commonest cause of erythem multiforme
A
HSV
24
Q
prodrome to erythema multiforme sx
A
fever, coryza
25
ix for drug reactions particualrly SJS and TENS
- biopsy - epidermal detachment
- FBC, U and E, ABG, LFT; can cause resp compromise if mucosal involvement in U/L airways
- blood cultures to rule out TSS and SSS; staph/ strep cultures
26
How to treaet TEN
- derm/ burns unit
- IV supportive care for haemodynamic stability
- STM dexamethasona pusle therapy, IVIG
27
define SJS
- Mucucutaneous necrosis with at least 2 mucosal sites involved
28
presentation of SJS
- Resp sx 2-3 / 52 after starting drug. approx 2 days before a rash that effects <10% body
- painful erythematous macules --> target lesions
29
cause of SJS
- Drugs
30
common cause of TENs
- drugs
31
sx of TEN
- extensive skin and mucosal necrosis and systemic toxicity
32
what is nikolskys sign
sloughing off epidermal layer when pressure applied to erythema or blisters
33
SJS drugs causes
PABENS-TG cause SJS -
- Penicillins
- Anti - epileptics
- Antimalarials
- BB
- NSAIDs
- Suphonamides
- thiazides
- GOLD
34
Drugs that cause TEN
```
CAANMPS -BTG
- Cephalosporins
- Anti-epileptics
Anti-malarials
- Allopurinol
- NSAIDs
- Penicillins
- Sulphonamides
- BB
-thiazides
- Gold
```
35
difference between SJS and erythema multiforme
erythema multiforme is the precursor and in SJS there is extensive necrosis
36
difference between SJS and TEN
TEN has sytemic toxicity and is full thickness necrosis.
37
cause of death in TENS and SJS
- Sepsis
- Electrolyte abnormalty
- organ failure
38
3 phases of follicle cycle for growth
- anagen ; long growing phase
- catage - short regressing
- telogen - resting/shedding phase
39
3 types of hair
- lenugo; coarse long in fetus
- vellus; fine and short, whole body
- termina; eyebrows, scalp, lashes, pubic
40
impetigo causes
- GAS
| - Staph
41
impetigo rx
- GAS = pen v
- Staph = fluclox
- usually fusidic acid 2% is enough, then mupirocin. if extensive then above abx given
42
what are the stay at home rules for kids with impetigo
- stay home till lesions crust
43
difference between staphylococcal scalded syndrome and bullous impetigo
- SSS is systemic.
- BI = local
both caused by staph; toxin A = local. Toxin B = systemic
44
what age group is SSS seen in most
- infancy and early childhood
45
SX of SSS
Few hrs to days - worse over the face, neck. axillae and groin
46
how long does it take to recover from SSS
- 5-7/7
47
rx SSS
- Fusidic acid, erythromycin
48
RF for erysipelas and cellulitis
- immunsupression
- ulcers
- wounds
- toeweb iretrigo
- minor tinea pedis
- lymphoedema
49
what causes erysipelas in DM
Staph
50
what causes erysipelas normally
- GAS
51
what causes folliculitis
strep
52
what is a furuncle and what is the rx
- boil
- infected hair follicle
- oral fluclox and I and D
53
What is nec fascitis
- rapidly progressive necrosis of subcutis and fascia = rapidly spreading
- check for gas ins subcut fascia in XR
54
rX NEC FASC
- Fluids
- high dose abx - meropenem and clindamycin
- surgical debridement
55
what is special about ptyrisis versicolor in terms of sx
- scaly pale brown patches on upper trunk that fail to tan on sun exposure
56
what makes pityriasis versicolour worse
- steroids
57
treatment of pitryriasis versicolour
- ketoconazole shampoo or topical antifungalm pigmentation
58
what causes pityriasis versiclour
- fungus; mallasezia furfur
59
- Scabies rx
- permethrin - apply at night from neck down and wash in morning
60
what is the commonest bed bug
- cimex lectularius
61
what to do bed bug bites look like
- pruritic, erythematous, oedematous papules - central punctum
62
rx bed bug bites
nothing as self limiting after 7/7
| or mild steroid cream/ .antihistamine if itchy
63
where do you find sebborhoeic dermaittis
- scalp
- eyebrows
- nasolabial folds
- cheeks
- flexures
64
cause of seborrheoic dermaittis
- skin yeasts overgrowths e.g. malassaezia.
| - more severe in HIV patients
65
rx sebborhoeic dermatitis
- mild topical steroids/ antifungals = daktocort/ ketoconazole shampoo
66
which t cells induces ige response in eczema
th2
67
eczema diagnostic criteria
- <2yrs of age
- flexural involvement in the past
- personal hx or fhx if <4yrs of age
- visible flexor dermatitis
to dx need ithcy skin +3/>3
68
side effects of aciclovir
- GI upset
- LFT abnormalitiyes
- neurological abnormalities
- haem
69
h1R antagonist names
- cetirizine
- loratadine
- chlorphenamine
70
name the two retinoid that can be given for acne, psoriasis and disorders of keratinisation
- isotretinoin
| - acitretin
71
SE retinoids
- LFTs disorders
- depression
- dryy skin. lips. eyes
- high cholesterol and TG
- myalgia
- arthralgia
- teratogen
72
what should you do about contraception if on retinoids
be on contraception 1 month before, during and 1 month after if iso.
be on it for 2 yrs after if acite
73
why are retinoids used in skin disorders
- encourages prompt surface skin cells turnover and binds to receptors to modify follicular keratinisation; tretinoin
74
what does molluscum contagiosum look like
- pearly white papules with central umbillication
| - rx - aciclovir
75
define erythroderma
- widespread erythema and dermatitis affecting >90% body surface
- scaly and oedema
- sytemically unwell with LNA and malaise
76
erythroderma rx
- derm refer
- emollients
- wet wraps
- topical steroids
77
how to treat eczema herpeticum
IV aciclovir
78
atopic ecczema rx ladder
1. emollients and lifestyle
2. topical
- steroids
- tacrolimus (steroid sparing but causes burns, pruritus and acne)
- antihistamines to prevent itching
3. phototherapy
4. systemic agents; steroids, ciclo, azithro, metho
5. biological agents; dupilumab
79
SE ciclosporin
- hepatotoxic
- nephrotoxic
- fluid retention
- gingivitis
- IGT
80
SE azathipprime
- myelosupression
- N and V
- pancreatitis
- non melanoma sc
81
psoriasis - triggering drugs
- Stop the heart; BB and ACE-i
- stop the pain - NSAids
- stops me going insane - Lithium
- stop the inflame - steroids, interforons, TNF
- stop the bac with a tic tac - tetracyclines
- stop the bites from the mites = antimalarials
82
treatment ladder psoriasis
1. emollients + steroids + vit D analogue. max 4/52 streoids
2. vit D analogues BD
3. Potent steroids 4 weeks OR coal tar
5. short acting dithranol +/- refer
6. in secondary care - phototherpay
7. methotrextate, ciclosporin, retinoids esp if joints involved
83
why does vit d analogue help in psoriasis
- inhibit hyperproliferation of epidermis and differentiation of kertatinocutes
84
vit d analogue SE
- Itchy
- erythema
- burning
- paraesthesia
- dermatitis
85
phototherapy MOA in psoriasis
- apoptosis
- reduced cytokines
- promote suppression
86
SE retinoids
- teratogen
- dry skin
- mucosa
- increase dlipids
- lower glucose
- increase LFT
87
what happens to foetus exposed to retinoids
foetal retinoids syndrome
- growth delay before and after birth IUGR
- Craniofacial abnormalities
- hydrocephalus
- TOF
88
what are the 4 types of psoriasis and which are an emergency
- guttate - kids, post strep
- plaque - silvery
- erythrodermic - emergency
- pustular - not infectious but emergency +/- systemic upset
89
what cells cause autoimmune issues of psoriasis
TH17
90
guttate psoriasis most commonly appears on which part of the body
trunk and limbs
91
what are the koebner and auspitz phenomenon
- koebner = areas of trauma get plaques
| - auspitz - attacked areas bleed if scratched
92
what type of nose do you have in systemic sclerosis
beak shaped
93
what are the two types of porphyria
- acute
| - cutanea tarda
94
symptoms of acute porphyria
- hepatic porphyrias
- CNS - muscles weakm seizure, mental disturbance
- abdo pain; vomit
- cardiac arrythmia
- acute neuropathy
95
symptoms of cutanea tarda
- dermatitis; photosensitive
- blisters
- skin necrosis and gums
- itchy and swelling and increased hair growth on forehead
96
IBD common skin manifestation
- erythrema nodosum
| - pyoderma gangrenosum
97
chromosome affected in Neurofibromatosis T1
17
98
CHR affected in neurofibramotosis T2
- 22
99
sx NF1
- lisch hamartomas; eye nodules
- phaeochromocytomas
- cafe au lait spots
- peripheral neurofibromas
- freckles in axilla and groin
- scolioiss
100
sx NF2
- Schwannomas esp IC and bilateral vestibular
| - acoustic neruomas
101
cause of neurofibromatosis
- uncoontrolled proliferation of neural crest cells
102
sx tuberous sclerosis
- ash leaf spots
- retinal hamartomas
- seizures
- Intellectual disability
- developmental delay
- shagreen patches/ peau de orange
103
commonest cause of erythema multiforme
HSV
104
types of pyoderma gangrenosum
- classical in immunosupressed. legs and trunk. can be explosive onset and rapid spread with pain and illness. or indolent and slow spread from one area to another
- peristomal; around stoma
- vegetative - single well healing in healthy patients. good response to topicals . head an neck common
- bullous; in haem disease.
- pustular - IBD
- genital
105
define papule
palpable noduel <0.5cm
106
define nodule
papule >0.5cm
107
what causes bullous pemphigoid
- autoantobodies between dermis and epidermis - IGG
108
Rx for bullous pemphigoid
- steroids topical
| - then oral
109
sx bullous pemphogoid
- blistering skin. tense; fluid filled on an erythematous base
- itchy
- trunk and limbs, not often mucosal
110
sx pemphigus
- burning and pain
- mouth often involved
- flaccid and easy rupture unlike pemphigoid
- face, torso, flexors
111
what does nikolskyys sign indicate
- pemphigus; applying pressure with finger to bulla causes displacement
112
how to diagnose pemphigus
skin biopsy - loss of interccellular connections between cells and epidermis
- IgG on immunoflurosecence - autoabs
113
how to diagnose pemphogoid
skin microscopy = itnact subepidermal blisters
114
rx pemphigus
- emergenct
- immunosupress - prednisolone and azathioprine. give pred till reduced blisters
- oral lesions - steroid mouthwash
115
dermatitis herpetiformis rx
- dapsone. but check g6pd
116
polymorphous light eruption typically effects whom
- young women in sprign after light exposure
117
rx polymorphous light eruption
- steroids
| - severe - UVB phototherapy
118
triggers of porphyria cuntanea tarda
- high oestrogen
- high iron
- low ascorbic acid
- hep c
- alcohol
- HIV
119
signs of cutanea tarda
- vesicles/bullae in sun exposed sites, hyperpigmentation
120
ix results in cuanea tarda
- high LFT
- High ferritis
- high plasma
- - high faecal and urinary prophyrins
121
rx cutaenea tarda
- sun avoid
- avoid precipitants
- regular venesection till ferritin normal;
- chloroquine
- ascobic acid
122
rx venous ulcer
- compression bandaging if no arterial insufficiency
123
why should you XR a neuropathic ulcer
- to check for osteomyelitis
124
rx SCC on skin
<20mm diameter = surgical excision with 4mm margins
>20mm = 6mm margins
high risk = mohs
