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Dermatology Flashcards

1
Q

What type of condition is eczema?

A

Chronic atopic

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2
Q

What causes eczema?

A

Defects in the normal continuity of the skin barrier, leading to inflammation

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3
Q

At what stage does eczema usually present?

A

In infancy

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4
Q

How does eczema usually present?

A

Dry, red, itchy sore patches of skin over flexor surfaces

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5
Q

What are the main areas of the body where eczema presents?

A

Flexor surfaces- inside of elbows and knees

Face and neck

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6
Q

What is the pathophysiology of eczema?

A

Defects in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation

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7
Q

What are the two aspects to eczema management?

A

Maintenance and management of flares

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8
Q

What is the key to maintenance of eczema?

A

Create an artificial barrier over the skin to compensate for the defective skin barrier

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9
Q

What is used as maintenance eczema treatment?

A

Emollients

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10
Q

How should emollients be used?

A

As thick and greasy as can be tolerates, used as often as possible. Used particularly after washing and before bed

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11
Q

What should patients with eczema avoid?

A

Activities that break down the skin barrier such as bathing in hot water, scratching or scrubbing their skin
Soaps that remove natural oils

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12
Q

What factors may trigger an eczema flare?

A 
Changes in temperature
Dietary products
Washing powders
Cleaning products
Emotional events
Stress
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13
Q

How can eczema flares be treated?

A

Thicker emollients
Topical steroids
Wet wraps
Treat complications

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14
Q

What may specialist treatment of severe eczema include?

A

Zinc bandages
Tacrolimus
Phototherapy
Systemic immunosuppressnats (corticosteroids, methotrexate)

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15
Q

What are some examples of some thin emollient creams?

A

E45
Dibprobase
Aveeno
Cetraben

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16
Q

What are some examples of thick, greasy emollitents?

A

50:50 ointment
Hydromol
Diprobase
Cetraben

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17
Q

What is the general rule for topical steroid treatment in eczema?

A

Use the weakest steroid for the shortest period required to get the skin under control

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18
Q

What are the side effects of using topical steroids?

A

Can lead to thinning of the skin which can make it more prone to flares, bruising, tearing, stretch marks and telangiectasia.
May be systemic absoprtion

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19
Q

What is the the steroid ladder?

A

Mild: Hydrocortisone
Moderate: Eumovate
Potent: Betnovate
Very potent: Dermovate

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20
Q

What is a common side effect of eczema?

A

Opportunistic bacterial infection of the skin

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21
Q

What is the most common organism that causes bacterial skin infection associated with eczema?

A

Staph. aureus

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22
Q

How is opportunistic skin bacterial infection treated?

A

Oral antibiotics (Flucloxacillin)

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23
Q

What is eczema herpeticum?

A

Viral skin infection in patients with eczema

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24
Q

What organisms cause eczema herpeticum?

A

Herpes simplex virus (HSV)

Varicella zoster virus (VZV)

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25
Q

What is the most common causative organism of eczema herpeticum?

A

HSV-1

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26
Q

In which patients does eczema herpeticum usually occur?

A

Those with a pre-existing skin condition (e.g. eczema or dermatitis) where the virus can easily enter the skin

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27
Q

How does eczema herpeticum present?

A

Widespread, painful, vesicular rash with systemic symptoms

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28
Q

What systemic symptoms may be found with eczema herpeticum?

A 
Fever
Lethargy
Irritability
Reduced oral intake
Lymphadenopathy
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29
Q

What is the rash like in eczema herpeticum?

A

Widespread, erythematous, painful and sometimes itchy

Has vesicles that contain pus which may burst to leave small ulcers

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30
Q

How is a eczema herpeticum diagnosis confirmed?

A

Viral swabs of the vesicles

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31
Q

How is eczema herpeticum treated?

A

Aciclovir (oral or IV in severe cases)

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32
Q

What are the complications of eczema herpeticum?

A

Can be life threatening if not treated adequately

Bacterial superinfection can occur

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33
Q

What is psoriasis?

A

Chronic autoimmune condition that causes recurrent psoriatic skin lesions

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34
Q

What proportion of patients with psoriasis have a first degree relative with the condition?

A

1/3

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35
Q

What is the patches like in psoriasis?

A

Dry, flaky, scaly lesions that appear in raised rough plaques

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36
Q

Where is psoriasis commonly found on the body?

A

Extensor surfaces (elbows, knees and scalp)

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37
Q

What happens to the areas of psoriasis after a while?

A

There is abnormal buildup and thickening of the skin due to the rapid regeneration of new skin cells

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38
Q

What are the different types of psoriasis?

A

Plawue
Guttate
Pustular
Erythrodermic

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39
Q

What is plaque psoriasis?

A

Thickened erythematous plaques with silver scales found on extensor surfaces.

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40
Q

What is the most common type of psoriasis?

A

Plaque psoriasis

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41
Q

What is guttate psoriasis?

A

Small raised papules across trunk and limbs which may eventually turn into plaques

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42
Q

In which patients is guttate psoriasis most common?

A

Children

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43
Q

What may trigger guttate psoriasis?

A

Strep throat
Stress
Medication

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44
Q

What is pustular psoriasis?

A

Rare severe form of psoriasis where pustules form under areas of erythematous skin.

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45
Q

What is erythrofermic psoriasis?

A

Rare severe form with extensive erythematous inflamed areas covering most of the surface of the skin. The skin comes away in large patches

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46
Q

What are the specific signs suggestive of psoriasis?

A

Auspitz sign
Koebner phenomenon
Residual pigmentation

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47
Q

What is auspitz sign?

A

Small points of bleeding when plaques are scraped off

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48
Q

What is Koebner phenomenon?

A

Development of psoriatic lesions to areas of skin where trauma has occured

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49
Q

What are the different treatment options for psoriasis?

A

Topical steroids/ vitamin D analogues/ dithranol/ calcineurin inhibitors
Phototherapy

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50
Q

What conditions is psoriasis associated with?

A

Nail psoriasis
Psoriatic arthritis
Psychosocial implications

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51
Q

What is nail psoriasis?

A

Nail changes that occur with in patients with psoriases including pitting, thickening, discolouration, ridging and onycholysis

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52
Q

In what percentage of patients with psoriasis does psoriatic arthritis occur?

A

10-20%

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53
Q

What is the full name for acne?

A

Acne vulgaris

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54
Q

What is acne caused by?

A

Chronic inflammation in pockets within the skin (pilosebaceous unit)

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55
Q

What are pilosebaceous units?

A

Tiny units in the skin that contain hair follicles and sebaceous glands

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56
Q

What do sebaceous glands produce?

A

Natural skin oils and sebum

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57
Q

What is sebum?

A

A waxy substance produced by the sebaceous glands that coats, moisturises and protects the skin

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58
Q

What 3 things is acne the result of?

A

Increased production of sebum
Trapping of keratin
Blockage of the pilosebaceous unit

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59
Q

What increases the production of sebum?

A

Androgenic hormones

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60
Q

What are comedones?

A

Pores/ hair follicles that have become blocked

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61
Q

What bacteria plays a role in acne?

A

Propionibacterium acnes

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62
Q

What is Propionibacterium acnes?

A

A bacteria that colonises the skin

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63
Q

What are macules?

A

Flat marks on the skin

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64
Q

What are papules?

A

Small lumps on the skin

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65
Q

What are pustules?

A

Small lumps containing yellow pus

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66
Q

What are comedomes?

A

Skin coloured papules representing blocked pilosebaceous units

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67
Q

What are blackheads?

A

Open comedones with black pigmentation in the cntre

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68
Q

What are ice pick scars?

A

Small indentions in the skin that remain after acne lesions heal

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69
Q

What are hypertrophic scars?

A

Small lumps in the skin that remain after acne lesions heal

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70
Q

What are rolling scars?

A

Irregular wave-like irregularities of the skin that remain after acne lesions heal

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71
Q

What are the treatment aims with acne?

A

Reduce the symptoms
Reduce the risk of scarring
Minimise psychosocial impact

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72
Q

What is the stepwise treatment of acne?

A
  1. Topical benozyl peroxide
  2. Topical retinoids
  3. Topical antibiotics
  4. Oral antibiotics
  5. OCP
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73
Q

What is the last line option for acne and why are the last line?

A

Oral retinoids- highly teratogenic

74
Q

Which COCP is the most effective for acne?

A

Dianette due to anti-androgen effects

75
Q

What kind of medication is oral isotretinoin?

A

Retinoid

76
Q

How do retinoids work?

A

Reduce production of sebum, reduce inflammation and bacterial growth

77
Q

Why must careful consideration be taken when prescribing isotretinoin?

A

It is strongly teratogenic

78
Q

What are the common side effects of isotretinoin?

A

Dry skin and lips
Photosensitivity
Depression/ anxiety

79
Q

What is erythema nodosum?

A

Inflammation of the subcutaneous fat in the shins causing red lumps to appear

80
Q

What is panniculitis?

A

Inflammation of fat

81
Q

What is erythema nodosum caused by?

A

Hypersensitivity reaction

82
Q

What are the potential causes of erythema nodosum?

A 
Strep throat
Gastroenteritis
Mycoplasma pnaumoniae
TB
Pregnancy
COCP
NSAIDs
Chronic disease
83
Q

What chronic diseases may cause erythema nodosum?

A

IBD
Sarcoidosis
Lymphoma
Leukaemia

84
Q

How does erythema nodosum present?

A

Red, inflamed, subcutaenous nodules across both shins which may be painful.

85
Q

What investigations should be done when erythema nodosum is suspected?

A 
Inflammatory markers 
Throat swab for strep
CXR
Stool microscopy & culture
Faecal calprotectin
86
Q

What is the management of erythema nodosum?

A

Investigate and treat underlying cause
Manage conservatively with rest & analgesia
Steroids in some causes

87
Q

How long does erythema nodosum usually take to fully resolve?

A

Within 6 weeks

88
Q

What is an exanthem?

A

Eruptive widespread rash

89
Q

How many viral exanthemas are there?

A

6

90
Q

What are the 6 red rashes?

A 
Measles
Scarlet fever
Rubella
Duke's disease
Parvovirus B19
Roseola infantum
91
Q

What is first disease?

A

Measles

92
Q

What is second disease?

A

Scarlet fever

93
Q

What is third disease?

A

Rubella

94
Q

What is fourth disease?

A

Duke’s disease

95
Q

What is fifth disease?

A

Parvovirus B19

96
Q

What is sixth disease?

A

Roseola infantum

97
Q

What causes measles?

A

Measles virus

98
Q

Is measles contageous?

A

Highly

99
Q

How is measles spread ?

A

Respiratory droplets

100
Q

How soon after exposure to measles symptoms develop?

A

10-12 days later

101
Q

What are the initial measles symptoms?

A

Fever
Coryzal symptoms
Conjunctivitis

102
Q

What symptom confirms a diagnosis of measles?

A

Koplik spots

103
Q

What are koplik spots?

A

Greyish white spots on the buccal mucosa

104
Q

What is the buccal mucosa?

A

Lining of the cheeks and back of lips

105
Q

How soon after the onset of symptoms fo koplik spots develop?

A

2 days later

106
Q

Where does the measles rash usually start?

A

On the face/ behind the ears

107
Q

How soon after the fever does the measles rash usually begin to develop?

A

3-5 days later

108
Q

What type of rash is the measles rash?

A

Erythematous, macular rash with flat lesions

109
Q

How long does measles usually last?

A

Self resolves after 7-10 days

110
Q

How long should children with measles be isolated?

A

Until 4 days after their symptoms resolve

111
Q

Who should be informed about all cases of measles?

A

Public health

112
Q

What proportion of patients with measles develop a complication?

A

30%

113
Q

What are the common complications of measles?

A 
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
114
Q

What is the most common causative organism of scarlet fever?

A

Group A strep

115
Q

What usually causes scarlet fever to develop?

A

Tonsillitis

116
Q

What causes scarlet fever (pathophysiology)?

A

Exotoxin produced by strep pyogenes

117
Q

What kind of rash develops with scarlet fever?

A

Red-pink, blotchy, macular rash with rough sandpaper skin

118
Q

Where does the rash start in scarlet fever?

A

On trunk and spreads outwards

119
Q

What other features may be present in scarlet fever?

A 
Red, flushed cheeks
Fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Lymphadenopathy
120
Q

How is scarlet fever treated?

A

Antibiotics for underlying streptococcal infection

121
Q

What antibioitic is used for scarlet fever and for how long?

A

Penicillin V for 10 days

122
Q

Who should be informed about all cases of scarlet fever?

A

Public health

123
Q

What other conditions associated with group A strep infection may patients with scarlet fever also have?

A

Post-strep glomerulonephritis

Acute rheumatic fever

124
Q

What is rubella caused by?

A

Rubella virus

125
Q

How is rubella spread?

A

By respiratory droplets

126
Q

How soon after exposure do symptoms of rubella start?

A

After 2 weeks

127
Q

How does rubella present?

A

Mild erythematous macular rash

128
Q

Where does the rubella rash start?

A

On the face

129
Q

How long does the rubella rash usually last?

A

3 days

130
Q

What symptoms may also occur with rubella?

A

Mild fever
Joint pain
Sore throat
Lymphadenopathy

131
Q

How is rubella managed?

A

Supportive

Self limiting

132
Q

Who needs to notified about all cases of rubella?

A

Public health

133
Q

How long should children with rubella stay off school?

A

At least 5 days

134
Q

What are the rare complications of rubella?

A

Thrombocytopenia
Encephalitis
Congenital rubella syndrome in pregnancy

135
Q

What is congenital rubella syndrome?

A

Triad of deafness, blindness and congenital heart disease

136
Q

What is Parvovirus B19 also known as?

A

Slapped cheek syndrome or erythema infectiosum

137
Q

How does parvovirus B19 start?

A

Mild fever, coryza and non-specific viral symptoms

138
Q

How long after symptoms begin do you get a rash with slapped cheek syndrome?

A

2-5 days

139
Q

What is the rash like in Parvovirus B19?

A

Diffuse red rash on both cheeks

140
Q

What kind of rash appears a few days after the slapped cheek rash?

A

Reticular erythematous rash affecting trunk and limbs. May be raised and itchy

141
Q

Which patients are at risk of complications with parvovirus B19?

A

Immunocompromised
Pregnant women
Patients with haematological conditions

142
Q

What are the complications of slapped cheek syndrome?

A

Aplastic anaemia
Encephalitis/ meningitis
Pregnancy complications

143
Q

What is roseola infantum also known as?

A

Human herpesvirus 6

144
Q

What is the typical pattern of illness with roseola?

A

Presents 1-2 weeks after infection with sudden, high fever that lasts 3-5 days. May also be coryzal symptoms. Rash appears for 1-2 days after fever.

145
Q

What is the rash like in roseola infantum?

A

Mild erythematous macular rash across arms, legs, trunk and face

146
Q

What is the main complication of roseola infantum?

A

Febrile convulsions

147
Q

What is erythema multiforme?

A

Erythematous rash caused by hypersensitivity reaction

148
Q

What are the most common causes of erythema multiforme?

A

Viral infections

Medications

149
Q

How does erythema multiforme present?

A

Widespread, itchy, erythematous rash with characteristic target lesions
May be associated with other symptoms (e.g. stomatitis)

150
Q

What are target lesions?

A

Red rings with larger red ring around (like bulls-eye target)

151
Q

How is erythema multiforme diagnosis made?

A

Clinically based on rash

152
Q

How is erythema multiforme managed?

A

Identify underlying cause

Usually resolves spontaneously

153
Q

What is urticaria also known as?

A

Hives

154
Q

What do hives look like?

A

Small, itchy lumps on skin

155
Q

What other symptoms may be associated with urticaria?

A

Angioedema and flushing of skin

156
Q

What are the typical causes of acute urticaria?

A 
Allergies
Contact with chemicals, latex or stinging lessons
Medications
Viral infections
Insect bites
Rubbing of skin
157
Q

What is the pathophysiology of urticaria?

A

Release of histamine by mast cells

158
Q

What causes acute urticaria?

A

Allergic reaction

159
Q

What causes chronic urticaria?

A

Autoimmune reaction

160
Q

What are the 3 subtypes of chronic urticaria?

A

Chronic idiopathic
Chronic inducible
Autoimmune

161
Q

What is chronic idiopathic urticaria?

A

Recurrent episodes of chronic urticaria without clear underlying cause

162
Q

What is chronic inducible urticaria?

A

Episodes of chronic urticaria that can be induced by certain triggers

163
Q

What may trigger chronic inducible urticaria?

A 
Sunlight
Temperature change
Exercise
Strong emotions
Hot or cold weather
Pressure
164
Q

What is autoimmune urticaria?

A

Chronic urticaria associated with an underlying autoimmune condition

165
Q

How is urticaria managed

A

Antihistamines

166
Q

What is the antihistamine of choice for urticaria?

A

Fexofenadine

167
Q

What is chickenpox caused by?

A

VZV (Varicella zoster virus)

168
Q

What is the characteristic chickenpox rash?

A

Widespread, erythematous, raised, vesicular lesions

169
Q

What does a vesicular rash mean?

A

Fluid filled

170
Q

Where does the chickenpox rash usually start and spread to?

A

Starts on trunk or face and spreads outwards to whole body.

171
Q

What other symptoms may occur with chickenpox?

A

Fever
Itch
General fatigue/ malaise

172
Q

How is chickenpox spread?

A

Direct contact with lesions or through infected droplets

173
Q

How soon after exposure to chicken pox do patients become infected?

A

10 days to 3 weeks

174
Q

What are the complications of chicken pox?

A 
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis
Shingles
175
Q

What can be given to unvaccinated pregnant women after exposure to chickenpox?

A

VZV immunoglobulins

176
Q

What can chickenpox infection before 28 weeks gestation cause?

A

Congenital varicella syndrome: developmental problems in the fetus

177
Q

What can chickenpox in the mother around time of delivery lead to?

A

LIfe threatening neonatal infection

178
Q

How is chickenpox managed in otherwise healthy children?

A

Self-limiting

179
Q

What medication can be used in immunocompromised patients with chickenpox?

A

Aciclovir

180
Q

What causes hand foot and mouth disease?

A

Coxsackle A virus

181
Q

How does hand foot and mouth disease usually start?

A

With URTI

182
Q

What develops after 1-2 days in hand foot and mouth disease?

A

Small mouth ulcers

Blistering red spots across body

Paeds (18 decks)

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