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MRCP 2 > Derm > Flashcards

Derm Flashcards

1
Q

Crusted scabies in patient with HIV

A

Norwegian scabies… extremely infectious

Isolate. Oral Ivermectin

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2
Q

Dermatitis herpetiformis

A

Intensely itchy rash on buttocks and top of thigh, assx w coeliac

If gluten free diet doesn’t resolve, can use dapsone with relief of itch within a few days

Oral and potent steroids are used second line

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3
Q

Chickenpox exposure management in pregnancy

A

Give immunoglobulin if all of

  1. Significant exposure
  2. Increased risk of severe reaction - immunosuppressed, neonates or pregnant
  3. No antibodies
  4. Rash not already developed

In <20 week preg if they’re not immune, give VZIG asap if within 10 days after exposure

if > 20 weeks and not immune then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

> 20 weeks and gets it, then oral aciclovir. Under 20 than consider with caution

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4
Q

salmon-pink, maculopapular rash

A

Adult onset Stills disease

feat: Arthralgia, pyrexia, Elevated ferritin

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5
Q

Target lesions

A

Erythema multiforme

Most commonly caused by herpes simplex virus
Followed by Mycoplasma pneumoniae

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6
Q

Patient with end stage renal failure, raised calcium and PTH,painful necrotic skin lesions. What are they?

A

Calciphylaxis

.,.deposition of calcium within arterioles causing microvascular occlusion and necrosis of the supplied tissue

Warfarin is contraindicated

confirmed on skin biopsy. PTH is sensitive but not specific for calciphylaxis

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7
Q

Tense fluid filled blisters. Management?

A

Bullous pemphigoid: PO steroids

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8
Q

Young patient with hypothyroidism presents with round bald patches on scalp
Diagnosis and management

A

Alopecia areata
Autoimmune, triggered by viral
Monitor… Half get spontaneous regrowth in months

Can sometimes give topical steroids, dithranol, triamcinolone acetonide injections

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9
Q

Non healing sterile (culture negative) ulcer

Diagnosis

A

Pyoderma granulosum
Painful,assx with RA
Pred 60mg OD usually resolves it

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10
Q

Most common trigger of erythema Multiforme

A

Hsv in ~50%

target lesions, initially seen on the back of the hands / feet before spreading to the torso

next most common mycoplasma

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11
Q

Management for bullous pemphigoid

A

Derm ref for biopsy
- immunofluorescence shows IgG and C3 at the dermoepidermal junction
Oral corticosteroids, usually heal without scarring

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12
Q

11mm eryhrmatous papule with minimally everted edges, slight scale, no telangiectasia

A

SCC

Can be side effect of treatment for melanoma w vemurafenib paradoxically

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13
Q

Difference between birthmark that is from birth Vs adolescence

A

Aka epidermal naevi

Adolescence is more like to have linear pattern

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14
Q

Management of actinic keratosis

small, crusty or scaly, lesions … pink, red, brown or the same colour as the skin on exposed areas

A

fluorouracil cream: typically a 2 to 3 week course.

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15
Q

Patient presents w white patch on the side of the tongue with a corrugated appearance. Cannot be scraped off

A

Oral hairy leukoplakia

Ebv in HIV; AIDS defining

Benign
best Tx is antiretrovirals, resolve as CD4 goes up

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16
Q

velvety hyperpigmented skin in axilla is called ? and associated with?

A

acanthosis nigricans

gastric Ca, obesity, insulin resistance, hypothyroidism

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17
Q

Crohn’s stoma presents with soreness

well-demarcated, full-thickness skin ulceration around stoma. A little slough and Punched-out appearance w violaceous border

Mx

A

pyoderma gangrenosum
- a recognised complication of Crohn’s. and commonly involves peristomal skin ?Koebner phenomenon.

PO prednisolone

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18
Q

skin conditions w reactive arthritis

A 
Urethritis
Circinate balanitis (painless vesicles on the coronal margin of the prepuce)
Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
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19
Q

painful oral ulceration, flaccid blisters and erosions

diagnosis and what investigation?

A

pemphigus vulgaris

Ix: direct immunofluorescence of skin
Tx steroids

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20
Q

pemphigus vulgaris investigation to diagnosis

A

Direct immunofluorescence of skin

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21
Q

two month hx of 1cm, firm keratotic nodule on the back of his right hand, BG of renal transplant

A

sun-exposed, rapid growing, immunosuppressed,

SCC
excise and histology

22
Q

what causes pityriasis versicolor

A

the yeast Malassezia furfur

23
Q

what dressing do you use for ulcers?

A

Hydrocolloid dressings

or Antibacterial and silver-impregnated if local infection
Alginate dressings exudative wounds

24
Q

Dressings used w exudative wounds

A

Alginate dressings

or Antibacterial and silver-impregnated if local infection

25
Q

lace-like purplish mottled skin appearance. Causes?

A

livedo reticularis - SLE, Polyarteritis nodosa, antiphos syndrome, chol embolism, Amantadine (PD drug) SE

26
Q

malar rash and arthralgia

ANA positive , dsDNA negative

A

Drug-induced lupus

May have anti-histone antibodies ( 80-90%)

27
Q

Macpap rash on palms and soles
Diarrhoea

Post liver transplant

A

Graft Vs host

28
Q

pregnant
penetrating injury then small red/brown spot
then raised, red/brown lesion, spherical in shape

A

Pyogenic granuloma

preg is a risk factor
often resolve spontaneously post-partum

29
Q

necrobiosis lipoidica diabeticorum management

A

topical steroids

painless rash on shins typically in diabetics

30
Q

pt w T-cell cutaenous lymphoma develops pruritis, erythroderma typically affecting the palms, soles and face,

A

Sezary syndrome

31
Q

Coumarin skin necrosis mechanism

A

when first started, biosynthesis of protein C is reduced
…leading to temporary PROcoagulant state

Can be avoided by bridging w heparin

32
Q

patient on long term 20mg Pred develops chickenpox. MAnagement

A

> 14d 20mg pred is immunosuppressed or >7d 40mg

so treat w IV aciclovir

NSAIDs may increase risk of secondary bacterial infection

33
Q

Rash in Microscopic polyangiitis

A

palpable purpura

34
Q

superimposed worsening erythema and signif pain following chickenpox infection… what cause?

A

Invasive group A Streptococcus, a β-haemolytic Streptococcus, has been implicated as the cause for necrotizing fasciitis in patients with chickenpox.

35
Q

person w Crohn’s develops non-melanoma skin cancer.. why?

A

Azathioprine increased risk of non-melanoma skin cancer

36
Q

Patient with end stage renal failure, raised calcium and PTH, painful necrotic skin lesions. What test to confirm diagnosis?

A

Calciphylaxis, confirmed on skin biopsy. PTH is sensitive but not specific for calciphylaxis

37
Q

Calciphylaxis prognosis

A

mortality rate associated with calciphylaxis is as high as 60–80% (!)

Better if distal lesions, worse if proximal

38
Q

pt notices a ‘slate-grey’ appearance after starting a med

A

Amiodarone

39
Q

What is positive Nikolsky’s sign?

A

the appearance of epidermis separating with mild lateral pressure in toxic epidermal necrolysis and Pemphigus vulgaris

40
Q

Treatment for guttate psoriasis

A

Self resolve in 2-3 months but can use UVB therapy

Can do tonsillectomy if recurrent

(Tonsillitis is a common streptococcal inf, which can trigger guttate psoriasis)

41
Q

diagnosis for symmetrical erythematous lesions on shins with shiney orange peel texture

A

pretibial myxoedema (seen in Graves)

42
Q

Old burn or scar… Patient presents with painless ulcerated lesion.. what is it?

A

SCC in 80% of cases. And is more dangerous -likely to metastasise

43
Q

Small blisters on the palms and soles
Pruritic, sometimes burning sensation

Diagnosis

A

Pompholyx…AKA Dyshidrosis

Type of eczema often triggered by hot climates.
Cold compress, emollients, topical steroids… But quite resistant to treatment

44
Q

Treatment for keloid scar

A

Triamcinolone (topical steroids) if early

45
Q

Patient develops oval erythematous plaque then generalised pruritic rash. Diagnosis and what virus is linked to it?

A

Pityriasis rosea
Herpes hominis virus 7 (HHV-7) is thought to play a role in the aetiology

self-limiting - usually disappears after 6-12 weeks

46
Q

Patient with herpes… What sign indicates ocular involvement is likely?

A

Vesicles on the tip of the nose, or vesicles on the side of the nose…Hutchinson’s sign

  • strongly predictive for ocular involvement…
47
Q

pinpoint petechial ‘blueberry muffin’ skin lesions

A

congenital cytomegalovirus

48
Q

Small, red-brown macules that may coalesce into larger patches with sharp borders; may be asymptomatic or pruritic; fluoresces coral-red on Wood lamp examination

A

Erythrasma

Overgrowth of diphtheroid Corynebacterium minutissimum, often due to humid environments

Coral red florescence on Wood’s light

Topical miconazole

(Acnathosis nigracans is: Hyperpigmentation with velvety, thickened skin, predominantly on posterior neck and body folds)

49
Q

photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands

A

Porphyria cutanea tarda

inherited defect in uroporphyrinogen decarboxylase
OR caused by hepatocyte damage e.g. alcohol, hepatitis C, oestrogen

urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood’s lamp

Mx: chloroquine

50
Q

Skin biopsy of tender nodules on legs

A

Erythema nodosum - neutrophil panniculitis

51
Q

patient had chickenpox recently then presents w painful rash, hypotensive, fever, AKI
Diagnosis / management

A

Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotising fasciitis

NSAIDs may increase the risk of developing this

Tx: Surgery

MRCP 2 (13 decks)

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