Dermatological Emergencies

Question 1

Necrotising fasciitis progression

Answer 1

Painful erythema
Few days later - skin breakdown
Later - Anaesthesia + blue/grey necrosis
Hypotension + Fever

Question 2

Types of necrotising faciitis

Answer 2

Type I

Type II

Question 3

Type I necrotising faciitis

Answer 3

Polymicrobial

Mix of aerobic and anaerobic pathogens

Question 4

Type II necrotising faciitis

Answer 4

Monomicrobial:

Staph Aureus - most common
GAS

Question 5

Mx of necrotising faciitis

Answer 5

Urgents surgical referral
Debridement
Broad spectrum IV abx
Haemodynamic support
Amputation

Question 6

Abx for necrotising faciitis

Answer 6

Carbapenam or beta lactamase inhibitor bacteria
+ Clindamycin
+ MRSA cover (Vancomycin)

Question 7

When to think about necrotising faciitis

Answer 7

Disproportional painful erythema
Erythema with purple/grey tinge
Systemically unwell

Question 8

Other name of meningococcaemia

Answer 8

Meningococcal septicaemia

Question 9

RFs for Meningococcal septicaemia

Answer 9

Immunocompromised

Asplenic

Question 10

Sx of Meningococcal septicaemia

Answer 10

Fever
Non blanching rash
Headache
N/V
Neck stiffness
Photophobia
Seizure

Question 11

Rx of Meningococcal septicaemia

Answer 11

Ceftriaxone IV 7 days

Question 12

Close contact prophylaxis for Meningococcal septicaemia

Answer 12

Rifampicin

Question 13

Complications of Meningococcal septicaemia

Answer 13

Seizures
DIC
Raised ICP

Question 14

Scale of Stevens-Johnson syndrome

Answer 14

Erythema multiforme
Stevens-Johnson syndrome - mucus membrane involvement
Toxic Epidermal Necrolysis

Question 15

Sx of Stevens-Johnson syndrome

Answer 15

Flu like Sx
Few days later - target rash non itchy
Burning/peeling of skin
Ulcers - genital tract, mouth/throat, corneal

Question 16

Complications of Stevens-Johnson syndrome

Answer 16

Death
Blindness
Skin scarring
Secondary cellulitis

Question 17

Mx of Stevens-Johnson syndrome

Answer 17

Stop causative medication / abx for infection
Moisturiser
Fluids
Corticosteroids - skin inflammation

Question 18

Medication causes of Stevens-Johnson syndrome

Answer 18

Allopurinol
Carbemazepine
Lamotrigine
Cotrimoxazole

Question 19

Viral causes of Stevens-Johnson syndrome

Answer 19

Mumps
HSV
EBV
Coxsackie virus

Question 20

RFs for Stevens-Johnson syndrome

Answer 20

Immunosuppression
Previous Stevens-Johnson syndrome
FHx of Stevens-Johnson syndrome

Question 21

Prognosis of Stevens-Johnson syndrome

Answer 21

Skin grows back depending on severity

Weeks to months

Question 22

Erysipelas

Answer 22

Distinct superficial cellulitis of face

Question 23

Eczema Herpeticum Sx

Answer 23

Punched out blisters
Painful
Clusters
Systemically unwell
Lymphadenopathy

Question 24

Causes of Eczema Herpeticum

Answer 24

HSV

HSV 1 most common

Question 25

Complications

Answer 25

Scarring Herpetic keratitis -> blindness Secondary bacterial infection

Question 26

Mx of Eczema Herpeticum

Answer 26

IV acyclovir Supportive care - fluids, analgesia, antipyretics Avoid corticosteroids until recovered

Question 27

Duration of Eczema Herpeticum

Answer 27

Infection 16 days | Lesions heal over 2 - 6 weeks

Question 28

Transmission of Eczema Herpeticum

Answer 28

Skin to skin

Question 29

Anaphylaxis pathophysiology

Answer 29

Severe type I IgE mediated hypersensitivity reaction | Mast cells + Basophils

Question 30

Anaphylaxis Mx

Answer 30

Adrenaline IM 0.5 ml 1 in 1000 Hydrocortisone 200 mg Chlorphenamine 10 mg

Question 31

Angioedema

Answer 31

Can occur w/o anaphylaxis (swelling alone) | Commonly caused by ACEi