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Things I don't know, but need to know, for fourth year > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Toxic Epidermal Necrolysis - Cause

A

NSAID, Penicillin, Sulphonamides, Allopurinol, Carbamezapine, Phenytoin

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2
Q

Toxic Epidermal Necrolysis - Presentation

A

Systemically Unwell
Nikolsky +ve
Affects mucosa

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3
Q

Toxic Epidermal Necrolysis - Treatment

A

IV Immunoglobulins

Immunosuppresion

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4
Q

At what body coverage is Steven Johnson Syndrome diagnosed?

A

<10%

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5
Q

At what body percentage is TEN diagnosed?

A

> 30%

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6
Q

Primary Management of Extensor Psoriasis

A

Topical Potent Steroid + Topical Vit D for 8 weeks 1x daily
After 4 weeks no improvement -> 4 weeks Vit D 2x daily
Potent Steroid 2x daily or Coal Tar

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7
Q

If the psoriasis is on the face or body how is it treated?

A

Mild or moderate topical steroid 1/2x daily for two weeks

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8
Q

If the patient has scalp psoriasis how is it treated?

A

Potent Topical steroid 1x daily

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9
Q

If initial management for scalp psoriasis hasn’t worked what is second line?

A

Different application method i.e shampoo

+ salicylic acid applied before

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10
Q

Lichen Planus - Signs and Symptoms

A 
Purple
Pruritic
Papular
Polygonal 
Flat
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11
Q

Triggers for lichen planus flairs.

A 
B blockers
Thiazides
Penicillamine
ACEi
Anti malaria's
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12
Q

Seborrhoic Dermatitis - Management

A

Topical Antifungal - Ketoconazole
Steroids - used in short term
If scalp - Head and Shoulders

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13
Q

Rosacea - Treatment

A

Mild - Topical Metronidazole
Severe - Oral Oxytetracyline
Flushing - Topical Brimonidine
Telangectasia - Laser therapy

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14
Q

Behcets

A

Oral + Genital Ulcers + Anterior Uveitis

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15
Q

Erythema Ab Igne

A

Over exposure to infrared radiation

risk of squamous cell carcinoma

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16
Q

First line Abx for animal/human bite

A

Co-Amoxiclav

Doxycycline + Metronidazole

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17
Q

Mildy pruritic, hypo pigmented lesion generally

A

Ptyriasis Versicolour

Topical ketoconazole

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18
Q

Causes of erythema multiform

A

HSV #

Mycoplasma, streptococcus, penicillin, sulph, carbamezapine, allopurinol, NSAIDs, COCP, SLE, Sarcoidosisi

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19
Q 
Abdominal Pain 
Vomting
Motor Neuropathy 
Depression
Hypertension 
Tachychardia
Urine turns RED on standing
A

Acute Intermittent Porphyria

Autosomal Dominant defect inn porphobilinogen deaminase -> reduce harm synthesis

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20
Q

Management of Acute Intermittent Porphyria

A

Avoid Triggers + IV Haem Arginate (Haematin)

IV glucose if unavailable

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21
Q

Pemphigus - general description

A

Nikolsky +ve
Intraepidermal IgG - desmoglein proteins
Affects mucous membranes
Systemic glucocorticoids is mainstay of treatment

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22
Q

Subtypes of Pemphigus and brief description

A

Vulgaris - Desmoglein III, ulceration and pain

Foliaceous -Desmogein I , Milder than vulgaris, no mucous membrane

IgA - Vesicles and erythematous plaques - occurs on trunk

Paraneoplastic - severe, erosive stomatitis, treat underlying cause, usually
haematogenous cancer

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23
Q

Management of Pemphigus

A

Systemic corticosteroid -> recurrence = reducing dose + rituximab
Azathioprine or mycophenolate
Plasma exchange in severe acute

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24
Q

Pemphigoid - general description

A

Nikolsky -ve
No mucous membrane involvement
IgG and compliment deposited subepidermally - along basement membrane

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25
Q

Pemphigoid types

A

Bullous Pemphigoid
Pemphigus Gestationis
Mucous Membrane

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26
Q

Bullous Pemphigoid

A

Tense bullae preceded by pruritic plaque
No scarring
Potent topical steroid -> oral if severe - taper dose 2 weeks after last blister
Long term cover - mycophenolate or azathioprine
Non responsive - IV immunoglobulin or rituximab

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27
Q

Mucous membrane pemphigoid

A

Scarring is real risk

Blindness and airway compromise

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28
Q

Pemphigus Gestationis

A

Plaques and bullae develop around the umbilicus
Topical -> oral steroids
Delivery is curative

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29
Q

Dermatitis Herpetiformis

A 
IgA deposition within the dermis 
Papules pustules and vesicles 
Erosions but no scarring 
Elbows knees buttocks 
Stop gluten + Dapson to reduce inflammation and blisters
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30
Q

Linear IgA bullous dermatitis

A

jewel like IgA deposition along basement membrane
Drug induced - stop Vancomycin Antihypertensives NSAIDs
Idiopathic - dapsone is given

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31
Q

Pityriasis Rosea

A

Herald spot
Widespread with scale rings
Resolves over 4-6 weeks rarely needs treatment
Oral antihistamines or topical steroid occasionally
Severe - oral acyclovir or phototherapy

32
Q

Guttate psoriasis

A

Preceding URTI strep throat
Small red individual spots
May need similar treatment to psoriasis

33
Q

Impetigo Management

A
  1. Hydrogen Peroxide 1%
  2. Fusidic acid
  3. Mupirocin if MRSA
  4. Oral flucloxacillin or erythromycin if pen allergic. For widespread or systemically unwell.
34
Q

Impetigo - diagnosis and management

A

Staph Aureus or Strep Pyogenes
Golden crusting
Stay of school until 48 hours of abx or lesions have crusted over
If antibiotics don’t clear swab for sensitivity

35
Q

Scabies managment

A

Permethrin is first line
Malathion lotion second line
All household and close contact individuals treated swell
Clean all bedding and clothes

36
Q

Scabies in an immunosuppressed patient?

A

Crusted “norwegian” scabies

Invermectin is first line

37
Q

How long can the itch last post scabies treatment?

A

4-6 weeks

38
Q

Excision margins in SCC

A

If lesion under 20mm = 4mm margin

If lesion over 20mm = 6mm margin

39
Q

Describe the effect the breslow thickness has on the revision and wide local excision of the melanoma site.

A 
0-1mm = 1cm border
1-2mm = 1-2cm border
2-4mm = 2-3cm border
>4mm = 3cm border
40
Q

At what breslow thickness is a lymph node screen advised?

A

0.8mm

41
Q

Can mimic NF
Rapidly growing painful ulcer
Linked to autoimmune diseases - Crohns, AS etc or minor trauma

A

Pyoderma Gangrenosum

Treat with steroids and immunosuppression NEVER surgical debridement Neutrophil mediated

42
Q

Bright red raised lump - overgrowth of blood vessels
Can mimic an amelanotic Melanoma
Generally post trauma in diabetic etc

A

Pyogenic Granuloma

43
Q

Management of a dermatophyte fungal nail infection.

A

Oral terbenafine
6 weeks to 3 months for fingernail
3 - 6 months for toe nail

44
Q

Management of a candida fungal nail

A

Mild - topical amorolfine

Severe - oral itraconazole 12 weeks

45
Q

Single rapidly growing lesion up to 1-2 cm
Spontaneoulsy regresses sloughing of tissue
Leaves scar

A

Smooth dome -> crater with keratin centre
Keratoacanthoma - often precursor to SCC
Requires excision

46
Q

Black hairy tongue

A

Brown green or pink - slightly itchy
Poor oral hygiene, recent antibiotics, head or neck irradiation, HIV and IVDU
Tongue scraping required to rule out Candida
NO treatment unless positive for candida

47
Q

Localised well demarcated hair loss
Broken exclamation mark hairs at border
Linked to autoimmune conditions

A

Alopecia Areata
50% recover hair within a year
80-90% eventualy
Topical steroids may be helpful

48
Q

Cellulitis Management

A

Clinical Diagnosis
Mild - Flucloxacillin or Clarithromycin in Pen allergic ( Erythromycin in pregnant)
Severe - Co Amoxiclav Cefuroxime Clindamycin Ceftriaxone

49
Q

When do you admit to hospital in cellulitis?

A 
Severe or rapid spread
<1yr
Facial Cellulitis - unless very mild
Frail
Immunocompressed
Significant Lymphedema
50
Q

Purple papule or plaque affecting the skin or mucosa
Often ulcerated
Respiratory mucosal involvement leads to haemoptysis
Hx of immunosuppression related diseases

A

Kaposi Sarcoma - HIV
Human Herpes Virus 8 -
Radiotherapy and resection

51
Q

Commonest Melanoma

A

Superficial Spreading - younger - arms legs chest

52
Q

Other types of less common melanoma

A

Nodular - 2nd commonest - sun exposed middle aged - lumpy and more aggressive
Lentigo maligna - chronic sunexposed - older
Acral lentigous - palms soles - darker skin types

53
Q

Management of Tinea

A

Clinical diagnosis -

Topical Terbanifine -> no improvement skin scraping

54
Q

Nodules + Pustules + Sinus tracks with rope like scars affecting the intertroginous areas.
Recurrent furuncles and boils

A

Hidradenitis Supporative
Smoking obesity PCOS and FH all risk factors
Axilla is commonest site

55
Q

Management of Hidradentis Suppurotiva

A

Good hygiene loose clothes weight loss and stop smoking

Acute - Steroids (oral or intralesional) or flucloxacillin
- Surgical excision and drainage
Chronic - Topical clindamycin or oral lymecyline
- surgical excision

56
Q

Type 1 hypersensitivity

A

IgE mast cell
Anaphylaxis
Atopy
Asthma etc

57
Q

Type II Hypersensitivity

A

IgM or IgG binding to cells

Pernicious anaemia, Rheumatic fever, ITP, Autoimmune Haemolytic anaemia

58
Q

Type III hypersensitivity

A

Antibody mediated deposition of immune complex

SLE, Post glomerulonephritis, farmers lung, extrinsic allergic alveolitis

59
Q

Type IV Hypersensitivity

A

Delayed T cell mediated

Contact allergic dermatitis, Graft versus host, TB, MS, Guilian Barre, Chronic Extrinsic allergic alveolitis

60
Q

Type V hypersensitivity

A

Graves or Myasthenia Gravis

61
Q

Management of hyperhydrosis

A

Topical Aluminium Chloride
Iontophoresis - gentle electrical stimulation
Botulinum toxin - axilla
transthorasc Sympathectomy

62
Q

Cellulitis near nose or eyes. What antibiotic is required?

A

Co-Amoxiclav

Amoxicillin + Clavulanic Acid

63
Q

Solitary firm papule which dimples on pinching.

A

Dermatofibroma

64
Q

Necrotising Ulcerative Gingivitis - Management

A

Refer to dentist

Meanwhile give Metronidazole oral + Chlorehexidine Mouth wash + analgesia

65
Q

Lichen Sclerosis - Management

A

Topical steroid + emollient

Tacrolimus if resistant to steroid

66
Q

Management of a lipoma

A

Generally observed unless…

Uncertain of diagnosis or compressing on other structures - removed

67
Q

When is an USS advised in a suspected lipoma?

A 
Ruling out liposarcoma 
>5cm 
Increasing in size
Pain
Deep anatomical location
68
Q

Koebners phenomena is common in

A

Psoriasis - #

Vitiligo

69
Q

Commonest cause of leg cellulitis

A

Strep Pyogenes

70
Q

Junctional Melanocytic naevi

A

Flat pigmented

71
Q

Compound melanocytes naevi

A

Raised pigmented

72
Q

Intradermal Melanocytic naevi

A

Raised and pale

73
Q

Congenital melanocytic naevi

A

Present at birth

Large and hairy

74
Q

Dysplastic melanocytic naevi

A

Atypical can resemble a melanoma

75
Q

Spitz naevi

A

Develop in children
Grow rapidly
Pink or red in colour

Things I don't know, but need to know, for fourth year (31 decks)

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