Derm and infection

Question 1

-Dry, red, itchy and sore patches on flexor surfaces (inside elbows and knees)

Answer 1

Eczema

Question 2

what is the maintenance management of eczema

Answer 2

-Emollients

Question 3

how are flares of eczema managed

Answer 3

• Thicker emollients
• Topical steroids : mildest - hydrocortisone
  ‘wet wraps;
• Rarely : IV Abx or oral steroids

Question 4

what is the most common organism to cause infection in eczema

Answer 4

staph aureus

Question 5

• Previous eczema
• widespread PAINFUL, vescicular rash
• Punched - out erosions
• systemic : fever, lethargy, irritability and reduced oral intake
• lymphadenopathy

Answer 5

eczema herpeticum -> caused by HSV, will need IV aciclovir and paeds referal

Question 6

• Non specific : fever, cough sore throat, mouth, eyes and itchy skin.
• Later : blistering rash across skin
• Pain, erythema, blistering and shredding of lips and mucous membranes
• Eyes, urinary tract, lungs and internal organs can be affected

Answer 6

Stevens-johnson syndrome (SJS) or toxic epidermal necrolysis (TEN)

Question 7

Explain. thedifference between SJS and TEN

Answer 7

Both a result of epidermal necrosis
SJS : <10% body surface
TEN : >10%

Question 8

give 4 medications and 4 infective causes of SJS and TEN

Answer 8

• Medication : penicillin, allopurinol, NSAIDs, COCP, anti-epileptics (lamotrigine, carbamazepine, phenytoin)
• Infections : HSV, mycoplasma pneumonia, cytomegalovirus, HIV

Question 9

Urticaria : definition , pathophysiology, management

Answer 9

• Superficial swelling of the skin
• Pale, pink raised skin (‘hives’, ‘wheals’)
• Caused by histamine release from mast cells
• Managed with antihistamines (fexofenadine) or pred in severe cases

Question 10

2 causes of impetigo

Answer 10

• Staph aureus
• Strep pyogenes (always non bullous)

Question 11

• ‘golden’ crusted skin lesions usually around the mouth

Answer 11

Impetigo

Question 12

Stepwise treatment of impetigo

Answer 12

1. Topical 1% hydrogen peroxide for 5 days(non bullous & not systemically unwell)
2. Topical 2% fusidic or 2% mupirocin for 5 days if around eyes or above ineffective
3. Oral flucloxacillin or clarithromycin if bullous or unwell

Question 13

Explain school exclusion for impetigo

Answer 13

• Until lesions dry and scab over
• 48 hrs after abx

Question 14

Explain the steroid ladder

Answer 14

• H : Hydrocortisone (1%)
• E : eumovate (clobetasone)
• A : betnovate (betamethasone)
• D : dermovate (clobetasol)

Question 15

• Pain, pus, discharge and crusts on existing eczema

Answer 15

• Infected eczema
• Tx with flucloxacillin or clarithromycin)

Question 16

• Intense itching of hands, wrists and inter-digital webs
• Worse at night
• Disseminated erythematous papules and thin, brown-grey lines 0.2-1cm in length

Answer 16

scabies -> saroptes scabiei

Question 17

How is scabies managed

Answer 17

• Permethrin 5% cream for everyone in household
• Wash everything >50 degress

Question 18

what causes anaphylaxis

Answer 18

severe type 1 hypersensitivity

IgE stimulate masts cells to release histamine

Question 19

how is anaphylaxis managed

Answer 19

• ABCDE
• IM adrenalin (repeat after 5 mins if needed)
  Following stabilisation
• Antihistamines (chlorphenamine, cetirizine)

Question 20

how can anaphylaxis be confirmed

Answer 20

measuring serum mast cell trypase within 6 hrs of event

Question 21

runny, blocked, itchy nose
sneezing
itchy, red, swollen eyes
personal or Fx of atopy

Answer 21

allergic rhinitis - IgE mediated type 1 hypersensitivity reaction

Question 22

how is allergic rhinitis managed

Answer 22

oral antihistamines

Question 23

IM adrenaline dose by age

Answer 23

< 6 mnths : 100-150 mcg
6mnths - 6 yrs : 150 mcg
6-12 yrs : 300mcg
>12 : 500mcg

Question 24

• Port wine stain present from birth
• Grows with infant
• Caused by vascular malformations of capillaries in the dermis
• Tx : laser therapy

Answer 24

Naevus flammeus

Question 25

white pimples on nose and cheeks
common in newborns

Answer 25

Milia