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PLAB Dra. Sommerhalder > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Anti-dsDNA and Anti-smith

A

Systemic Lupus Erythematosus (SLE)

The initial test for SLE is ANA

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2
Q

Anti-histone

A

Drug induced lupus (hydralazine)

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3
Q

Anti-scl70

A

Systemic Sclerosis

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4
Q

Anti-centromere

A

Limited sclerosis/CREST syndrome

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5
Q

Anti-Jo1

A

Polymyositis

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6
Q

Anti-Ro, Anti-La

A

Sjogren’s disease

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7
Q

Anti-mitochondrial

A

Primary biliary cirrhosis

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8
Q

Anti-smooth muscle

A

Autoimmune hepatitis

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9
Q

pANCA

A

Churg Strauss (Eosinophilic Granulomatosis with Polyangiitis)

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10
Q

cANCA

A

Wegener’s Granulomatosis (Granulomatosis with Polyangiitis)

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11
Q

Anti-tissue transglutaminase and IgA, Anti-gliadin, Anti-endomysial

A

Celiac disease

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12
Q

ANA

A

Rheumatoid Arthritis (RA), initial test for SLE, other auto-immune diseases.

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13
Q

What is cellulitis?

Typically due to…?

A

Inflammation of the skin and subcutaneous tissues.

G +ve like Streptococcus pyogenes and Staphylococcus aureus

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14
Q

Features of cellulitis

A

Commonly on the shins

Erythema, pain, swelling

May be associated with systemic upset such as fever

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15
Q

Management of cellulitis

A

1st line Fucloxacillin

Allergic to penicillin> Clindamycin or Clarithromycin (clindamycin if failed to respond to flucloxacillin like MRSA)

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16
Q

Severe cellulitis and MRSA skin infection management

A

Severe cellulitis> IV benzypenicillin + flucloxacillin

MRSA skin infeciton> Vancomycin

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17
Q

4Ps + F and LP for lichen planus

A 
Pruritic
Purple
Papular
Polygonal rash on the 
Flexor surfaces

White LACY PATTERN on the buccal mucosa

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18
Q

Management of lichen planus

A

topical steroids

Benzydamine mouthwash or spray is recommended for oral lichen planus

Extensive lichen planus may require oral steroids or immunosuppression

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19
Q

ABCDE of malignant melanoma (when to suspect?)

A

Asymmetry- the 2 halves of the mole look different in shape

Border- Irregular edges

Color- Different shades of black, brown and pink

Diameter- >6mm

Evolves- Enlarge, grows upwards, downwards, outwards as a flat lesion

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20
Q

Management of a benign mole?

A

A benign mole that does not bleed or interfere with life can be referred to a PRIVATE dermatology clinic.

NHS does not provide Cosmetic Services

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21
Q

Depth of invasion is important as a …… factor for malignant melanoma

A

Prognosis

bad prognosis factor

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22
Q

What is the most important prognostic factor indicator in a malignant melanoma that was excised?

A

Breslow thickness

The depth in mm

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23
Q

Most common melanomas in the UK?

A

70% are superficial spreading melanomas.

More common in people with pale skin and freckles, less common in darker skinned people.

They initially grow outwards rather than downwards, so don’t pose a problem. If they grow downwards into deeper skin layers then they can spread to other parts of the body.

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24
Q

Melanomas that usually appear as a changing lump on the skin which might be black to red in colour.

A

Nodular melanomas, they develop faster and can quickly grow downwards into deeper layers of the skin if not removed.

They often grow on previously normal skin and most commonly occur on the head and neck, chest or back. Bleeding or oozing is a common symptom

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25
Q

What is SLE (systemic lupus erythematosus)

A

Multisystem autoimmune disorder.

Presents early in adulthood and is more common in women and Afro-Caribbean origin.

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26
Q

General Features of SLE (systemic lupus erythematosus)

A

atigue, fever, lymphadenopathy

Mouth ulcers (large, multiple and painful)

Remitting and relapsing illness

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27
Q

Skin features of SLE (systemic lupus erythematosus)

A

Malar (butterfly) rash (spares nasolabial folds)

Discoid rash- scaly, erythematous, well demarcated rash in sun-exposed areas. They may progress to become pigmented and hyperkeratotic before becoming atrophic

Photosensitivity

Raynaud’s phenomenon (1/5th of the pxs but often mild)

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28
Q

Musculoskeletal, cardiovascular and respiratory features of SLE (systemic lupus erythematosus)

A

Arthralgia and non-erosive arthritis

Pericarditis (the most common cardiac manifestation)
and myocarditis

Pleurisy and fibrosis alveolitis

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29
Q

Renal and neuropsychiatric features of SLE (systemic lupus erythematosus)

A

Proteinuria and glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)

Anxiety and depression
Psychosis
Seizures

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30
Q

SLE immunology

A

99% is ANA positive (screening= sensitive but not specific)

20% are rheumatoid factor positive

anti-dsDNA is highly specific (>99%) but less sensitive (70%)

anti-Smith is the most specific (>99%) but very low sensitivity (30%)

31
Q

The initial screening for SLE is …?

And the confirmatory test for SLE is…?

A

Anti-nuclear antibody (ANA) is the most sensitive

Anti-dsDNA is the most specific (confirmatory)

32
Q

Immunology in drug-induced lupus and drug examples

A

Anti-histone antibodies

Hydralazine
Procainamide
Isoniazid (TB drug!)

33
Q

Drug induced lupus is just like SLE

True or false?

A

FALSE
Not all typical features are seen

Renal and nervous system involvement is rare

Resolves on its own after stopping the causative drug

34
Q

Features of drug induced lupus

A

Arthralgia
Myalgia
Skin (malar rash) and pulmonary involvement (pleurisy) are common

35
Q

Immunology of drug induced lupus

A

ANA positive in 100%

dsDNA negative

Anti-histone antibodies are found in 80-90% (usually the answer in exams)

36
Q

Urticaria

A

Wheals (central itchy white papules or plaques surrounded by erythema)

Variable in size and shape

± swelling of soft tissues (eyelids, tongue, lips) > angioedema

Here today, gone tomorrow> come and go within a few minutes or hours

37
Q

Acute and chronic urticaria

A

Acute <6 weeks

Chronic >6 weeks

38
Q

Why aspirin and opiates cause urticaria?

A

Aspirin and opiates may elicit the release of histamine from mast cells > urticaria

39
Q

Management of urticaria

A

Tx the cause and aggravating factors
(Stop aspirin, opiates, overheating, stress, alcohol, caffeine)

Non-sedating H1 anti-histamines (cetirizine or loratadine)

In pregnant, give sedating anti-histamine like chlorphenamine

40
Q

Psoriasis main features

A

Itchy, scaly, well demarcated, circular, reddish, elevated lesions (plaques)

Overlying white or silvery scales

It can be on elbows, knees, scalp etc.

NOT contagious

On the extensor surfaces and scalp

Strong genetic basis

Vigorous scrapping> pinpoint bleeding> Auspitz’ sign

New lesions appear at sites of injury of the skin> Kobner’s reaction

Family Hx is often given as a hint

± nail changes (pitting, onycholysis)

41
Q

Psoriasis Rx

A

Topical steroids

Vitamin D analogues

Tar preparations

42
Q

Eczema main features

A

Chronic, relapsing Inflammatory skin condition

Itchy red rash

Affects skin creases (flexures like wrist, elbow folds, behind knees)

Triggered by environmental irritants and allergens. Also URTIs (upper respiratory tract infection) can cause a flare up eczema

Family history of atopic diseases like asthma and hay fever

43
Q

Eczema treatment

A

1st line> emollients

Topical steroids

44
Q

Seborrheic dermatitis main features

A

Scaling rash

Affects sebaceous glands

Found on face, scalp and chest

Inflammatory reaction to yeast

Presents as inflamed greasy areas with fine scaling

Can present as dandruff when on scalp.

45
Q

Seborrheic dermatitis management

A

Regular antifungal

Intermittent topical steroids

46
Q

Px with hx of immunosuppression and smoking, with thick white marks ± inflamed mouth/tongue that can be rubbed out.

A

Oral thrush (candidiasis)

Plaques might enlarge and become painful, causing discomfort while eating and swallowing.

It might also present with inflamed painful sore mouth angles.

47
Q

Management of oral thrush

A

Stop smoking
Good inhaler techniques, spacer device, rinse mouth with water after use.

Oral fluconazole 50mg OD for 7 days or fluconazole oral suspension

48
Q

Px with hx of smoking, with white oral lesion with raised edges, bright white patches, sharply well-defined edges and cannot be rubbed out.

A

Leukoplakia

Rx stop smoking and biopsy! (they are premalignant)

49
Q

Oral lichen planus…

A

Lace (ornamented) like appearance lesions.

Remember the 4Ps+F
Purple, pruritic, polygonal, papular rash on flexor surfaces

50
Q

Eczema in infants and children affect which part of the body?
(infants, young children and older children)

A

Infants> face and trunk then extremities

Younger children> on extensor surfaces

Older children> typical distribution with flexor surfaces affected and the creases of the face and neck.

Eczema occurs in around 15-20% of children and is becoming more common

It typically presents before the age of 6 months but clears around 50% of children by 5 years of age and in 75% of children by 10 years of age.

51
Q

Management of Eczema in infants and children

A

1st line> emollients (at least BID= twice daily) + washing, bathing (moisturising)

2nd line> topical steroids (for eczema itself)

52
Q

Hydrocortisone acetate is a mild, moderate, potent or very potent strength steroid?

A

Mild

Comes topical 0.5%, 1% or 2.5%

To be used in mild eczema or a new case that is not responding to emollients.

53
Q

Example of a moderate strength steroid for eczema

A 
Betamethasone valerate (0.025%)
or
Clobetasone butyrate (0.05%)

for a moderate eczema with wide area of dryness, crackling and redness

54
Q

Example of a potent strength steroid for eczema

A

Betamethasone valerate (0.1%)
or
Mometasone 0.1%
(For severe eczema that causes bleeding, intense itching that prevents sleeping, and not responding to emollients and hydrocortisone)

Hydrocortisone butyrate

55
Q

Very potent strength steroid for eczema

A

Clobetasol propionate

56
Q

What should be done if emollients and steroids are to be given together?

A

Apply emollient 1st, then wait 30 minutes, then apply the topical steroid.

Also, avoid irritants and stress
Tx bacterial infection if present (flucloxacillin is 1st line)
If eczema awakens the patient at night then consider a sedative antihistamine (chlorphenamine)

57
Q

Clotrimazole is a…..

used for….

A

Antifungal agent

Used for athlete’s foot, fungal groin infections, fungal nappy rash

58
Q

What should be administered in a patient referring an insect bite with itching skin and no signs and symptoms of anaphylaxis?

What if he develops a severe reaction?

A

Oral anti-histamine

If a severe reaction develops (affects breathing) then give IM adrenaline

59
Q

One of the 3 main types of skin cancer

Lesions known as Rodent Ulcers

Characterized by slow-growth and local invasion

Metastases are extremely rare.

A

Basal cell carcinoma

BCC is the most common type of cancer in the western world.

60
Q

Features of Basal Cell Carcinoma

A

Many types of BCC are present.

The most common type is nodular BCC
(Sun-exposed sites, especially the head and neck
Initially pearly, flesh-coloured papule with telangiectasia
May later ulcerate leaving a central “crater”)

61
Q

Patient with white umbilicated ulcer with central depression….

A

Basal Cell Carcinoma

Rodent ulcers

62
Q

Management of BCC

A 
Surgical removal
Curettage
Cryotherapy
Topical cream: imiquimod and fluorouracil
Radiotherapy
63
Q

White or pink papules with an umbilicated (depressed) central punctum. If squeezed they produce cheesy white material.

A

Molluscum contagiosum (pox virus)

Can be found anywhere on the skin

They resolve spontaneously in 6-24 months

Usually in children and immunocompromised patients. (consider AIDS if extensive pink umbilicated papules)

64
Q

Golden crusted skin lesions commonly found around the mouth (honey coloured crust) in children.

A

Impetigo

Superficial bacterial skin infection usually caused by Staph aureus or Strepto pyogenes.

Can be primary or a complication of an existing skin condition like eczema, scabies or insect bites.

Incubation period of 4 to 10 days.

Lesions tend to occur on the face, flexures and limbs not covered by clothing.

Very contagious!

65
Q

Rx of impetigo

A

Limited, localised, non-bullous disease
1st line hydrogen peroxide cream 1%

Fusidic acid 2% or mupirocin (2nd line)

If extensive non-bullous or bullous impetigo
Oral flucloxacillin
or Oral erythromycin if penicillin allergic.

66
Q

What should be done with a child with impetigo?

A

They should be excluded from school until the lesions are crusted and healed.

Or 48 hrs after commencing the antibiotic treatment.

67
Q

What if the rash is painful and associated with fever, especially in a child with Hx of eczema?

A

Consider eczema herpeticum and give aciclovir.

68
Q

When to suspect Cold Sore of Herpes Simplex Virus and not Impetigo

A

Hx of recurrent episodes
Pain (tingling, itching, burning) before the onset of vesicles (prodromal pain)

Vesicles initially filled with clear fluids
More common in adults.

69
Q

Patient that complains of flushing after alcohol or sunlight exposure. Telangiectasia can be seen in his nose, cheeks and forehead.

A

Acne Rosacea- a chronic skin disease of unknown aetiology

Telagiectasia is common
Later develops into persistent erythema with papules and pustules

Rhinophyma is a nose disfigurement

Ocular involvement: blepharitis

70
Q

Rx of Acne Rosacea

A

Topical metronidazole may be used for mild symptoms (limited number of papules and pustules, NOT PLAQUES)

More severe disease is treated with systematic antibiotics like Oxytetracycline or tetracycline

71
Q

What is Tinea Capitis?

A

A fungal infection involving hair follicles and causing hair loss (alopecia) very rapidly

72
Q

Rx of Tinea Capitis

A

Because of the risk of scarring, Rx is with a systemic oral antifungal such as oral terbinafine, itraconazole, or fluconazole.

In children griseofulvin is used.

73
Q

Dermatitis Herpetiformis is linked to which disease?

Px with bloating, loose stools, abdominal pain, iron deficiency anemia and folate deficiency with severly itchy rash distributed over scalp, sacrum, elbows and knees.

A

Celiac disease.

Tissue transglutaminase IgA and endomysial Abs are (+)ve

74
Q

Indications of IM adrenaline in anaphylaxis

A 
Hoarseness of voice
Wheezes
Shortness of Breath (SOB)
Stridor
Shock
Facial, tongue or cheek swelling

PLAB Dra. Sommerhalder (7 decks)

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