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Finals > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Describe toxic epidermal necrolysis

A

*Most commonly seen secondary to a drug reaction
*Covers >10% of the body surface area
*Systemically unwell: pyrexia and tachycardia

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2
Q

What is Nikolsky’s sign?

A

Epidermis separates with mild lateral pressure - Toxic epidermal necrolysis

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3
Q

Which drugs are known to induce TEN?

A

*Phenytoin
*Sulphonamides
*Allopurinol
*Penicillin
*Carbamezapines
*NSAIDs

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4
Q

What predicts mortality in toxic epidermal necrolysis

A

SCORTEN

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5
Q

What is the management of toxic epidermal necrolysis?

A

*Stop the precipitating factor
*Admit to ICU: special sheets and mattress, non-adherent dressing
*Volume loss and electrolyte derangement are potential complications - needs monitoring
*IV immunoglobulin 1st line, consider immunosuppressive agents e.g. cyclosporin

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6
Q

What are the complications of toxic epidermal necrolysis?

A

*Secondary infection: cellulitis and sepsis
*Permanent skin damage
*Visual complications

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7
Q

What is Erythema multiforme?

A

Hypersensitivity reaction most commonly triggered by infection, target lesions with mild pruritus

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8
Q

What are the features of erythema multiforme?

A

*Target lesions
*Initially seen on the back of hands/feet, spreads to torso
*Upper limbs more commonly affected than lower limbs
*Mild pruritis
*May be associated with a mild fever/stomatitis, muscle aches and joint aches, headaches or flu like symptoms

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9
Q

What are the causes of erythema multiforme?

A

*Viruses: herpes simplex
*Idiopathic
*Bacteria: mycoplasma, streptococcus
*Drugs: penicillin, sulphonamides, carbamezapine, allopurinol, NSAIDs, Oral contraceptive pill
*Connective tissue disease e.g. SLE
*Sarcoidosis
*Malignancy

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10
Q

What is the management of erythema multiforme?

A

*Look for underlying cause - if there is nothing from cultures consider CXR looking for mycoplasma pneumonia
*Normally resolves in 1-4 weeks but may be recurrent
*Severe cases: IV fluids, analgesia, steroids, antibiotics or antivirals if infection

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11
Q

What is acute urticaria?

A

*Hives caused by a histamine release by mast cells
*Raised itchy rash on the skin

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12
Q

What type of reaction is immune mediated urticaria?

A

Type 1 IgE

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13
Q

What are the causes of urticaria?

A

*Food/medication/animal allergy
*Contact with chemicals, latex or nettles
*Medication
*Viral infection
*Insect bites

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14
Q

What is the management of urticaria?

A

*High dose antihistamines: fexofenadine
*Oral steroids: prednisolone may be considered
*If severe: anti-leukotrienes e.g. montelukast or Omalizumab

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15
Q

What is erythroderma?

A

When over 95% of the body is covered by any type of rash

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16
Q

What are the causes of erythroderma?

A

*Eczema
*Psoriasis
*Drugs e.g. gold
*Lymphoma, leukaemia
*Idiopathic

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17
Q

What is the presentation of cellulitis?

A

*Erythema
* Warm or hot to the touch
*Tense/thick skin
*Oedematous
*Bullae
*If there is a golden crust this indicates staphylococcus aureus infection

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18
Q

What are the causes of cellulitis?

A

*Staphylococcus aureus
*Group A streptococcus e.g. strep pyogenes
*Group C streptococcus e.g. strep dysgalactiae
*MRSA

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19
Q

What is the ERON classification?

A

*Classifies the severity of cellulitis
*Class 1: no systemic symptoms or co morbidities
*Class 2: Systemic symptoms or co-morbidities
*Class 3: significant symptoms or co-morbidities
*Class 4: sepsis

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20
Q

What is the management of cellulitis?

A

*If ERON class 3 or 4, admit for IV antibiotics
*Flucloxacillin is usually first line

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21
Q

What is impetigo?

A

Superficial bacterial infection, usually caused by staphylococcus aureus, less commonly by streptococcus pyogenes, it is contagious

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22
Q

What is the difference between bullous and non bullous impetigo?

A

*Non bullous tends to occur around the nose and mouth, yellow crust
*Bullous forms 1-2cm fluid filled vesicles

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23
Q

How do you treat bullous impetigo?

A

Take swabs then give antibiotics, usually flucloxacillin

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24
Q

How do you treat non bullous impetigo?

A
  • Topical fusidic acid, oral fluclox if widespread
    *Give advice to not touch, not share cutlery or towels, avoid other people for 48hours following antibiotics or healed
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25
Q

What are the complications of impetigo?

A

*Cellulitis
*Scarring
*Sepsis
*Post strep glomerulonephritis
*Scarlet fever

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26
Q

Mild steroid

A

Hydrocortisone

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27
Q

Moderate steroid

A

Eumovate

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28
Q

Potent steroid

A

Betnovate

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29
Q

Very potent steroid

A

Dermovate

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30
Q

What are the symptoms of eczema herpeticum?

A

*Fever
*Lethargy
*Reduced oral intake
*Lymphadenopathy
*Erythematous rash, painful, sometimes itchy with vesicles and pus

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31
Q

What is the treatment of eczema herpeticum?

A

Aciclovir

32
Q

What are the 4 types of leg ulcer?

A

*Venous
*Arterial
*Pressure
*Diabetic foot

33
Q

Describe arterial ulcers

A

*Distal - affecting the dorsum of foot or toes
*Punched out, well defined
*Deep
*Painful
*Pain is worse on elevation and improved by lowering, worse at night as pt horizontal
*Pale colour due to poor blood supply
*Less likely to bleed
*Associated with PAD, absent pulses intermittent claudication, pallor

34
Q

Describe venous ulcers

A

*Gaiter area - between top of foot and bottom of calf
*Associated with chronic changes e.g. venous eczema, hyperpigmentation
*More superficial and less painful
*Larger
*Increased likelihood of bleeding
*Irregular border
*Pain relieved by elevation, worse on lowering

35
Q

What is the treatment of venous ulcers?

A

*Compression therapy
*Analgesia
*Refer to nursing for cleaning, debridement and dressing
*Refer to dermatology, pain clinic if required

36
Q

What investigations should be carried out for leg ulcers?

A

*ABPI to assess for arterial disease
*FBC and CRP looking for infection, anaemia or malnutrition
*Skin biopsy if suspected cancer
*Charcoal swab if infection is suspected

37
Q

What is psoriasis?

A

Chronic, relapsing and remitting skin disease

38
Q

What are the peak age onsets of psoriasis?

A

*20-30
* 50-60

39
Q

What are the types of psoriasis?

A

*Plaque: plaques with silver scales
*Pustular: pustules form under erythematous skin- can be systemically unwell
*Guttate: small raised papules, often triggered by a streptococcal throat infection, resolves in 3-4 months
*Erythrodermic: extensive erythematous inflamed areas - skin comes away in large patches
*Inverse/flexural
*Palmar/plantar

40
Q

What is the management of psoriasis?

A
  • Topical creams and ointments
    *Phototherapy light treatments
    *Systemic therapies/immunosuppression: methotrexate, acitretin, dimethyl fumerate
41
Q

What are the associations of psoriasis?

A

*Nail psoriasis: pitting, thickening, onycholysis, ridging, discolouration
*Psoriatic arthritis
*Psychosocial: self esteem/mood

42
Q

What are the features of rosacea?

A

*Flushing
*Telangiectasia
*Persistent erythema
*Rhinophyma
*Blepharitis if ocular involvement

43
Q

What is the management of roseca?

A

*Topical metronidazole for mild symptoms
*Topical brimonidine gel if predominantl flushing and limited telangiectasia

44
Q

What is pemphigus vulgaris?

A

*Autoimmune condition against desmoglein 3
*Mucosal ulceration, Emily ruptured skin blisters
*painful but not itchy

45
Q

What is the treatment of pemphigus vulgaris?

A

Steroids

46
Q

What is bullous pemphigoid?

A

*Autoimmune against hemidesmosomal proteins
*Itchy, tense blisters, typically around the flexures, heal without scar
*Usually mouth is spared- no mucosal involvement

47
Q

What is the management of bullous pemphigoid?

A

Oral steroids, immunosuppressants

48
Q

What are the types of skin cancer?

A
  • basal cell carcinoma
  • squamous cell carcinoma
  • malignant melanoma
49
Q

What is the most common skin cancer?

A

Basal cell

50
Q

What are the types of basal cell carcinoma?

A
  • nodular
  • superficial
  • pigmented
  • morphoeic/sclerotic
51
Q

Describe a nodular basal cell carcinoma

A
  • nodule >0.5cm raised lesion
  • shiny ‘pearly’
  • telangectasia/blood vessels
  • often centrally ulcerated
52
Q

Management of basal cell carcinoma

A

surgical excision 3-4mm margin

53
Q

What are the premalignant forms of squamous cell carcinoma?

A
  • actinic keratoses
  • bowen’s disease
54
Q

What is the appearance of a squamous cell carcinoma?

A

keratinisation, nodule

55
Q

What is the management of a squamous cell carcinoma?

A

Surgical excision 4mm margin

56
Q

What is the management of a pre-malignant squamous cell carcinoma?

A
  • topical imiquimod/ 5-fluorouracil cream
  • cryotherapy
  • photodynamic therapy
57
Q

What are the main diagnostic features for malignant melanoma?

A
  • cahnge in size
  • change in shape
  • change in colour
58
Q

What is alopecia areata?

A

Hair loss thought to be autoimmune. Hair will regrow in 50% by 1 year and 80-90% eventually

59
Q

What is acanthosis nigracans?

A

symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin

60
Q

What are the causes of acanthosis nigracans?

A
  • type 2 diabetes
  • GI cancer
  • Obesity
  • Cushings
  • PCOS
  • hypothyroidism
  • acromegaly
  • familial
  • oral contraceptive, nicotinic acid
61
Q

What is erythema nodosum?

A

Tender, erythematous, nodular lesions. Usually over the shins

62
Q

What are the causes of erythema nodosum?

A
  • Infection: streptocci, TB
  • Systemic disease: Sarcoidosis, IBD
  • Malignancy, lymphoma
  • Drugs: penicillin, sulphonamides, OCP
  • pregnancy
63
Q

What are the causes of pyoderma gangrenosum?

A
  • idiopathic
  • IBD
  • Rheumatoid arthritis, SLE
  • Haem: lymphoma, myeloid leukaemia, myeloproliferative disorders
  • Granulomatosis with polyangiitis
64
Q

Describe pyoderma gangrenosum

A
  • typically on the lower limb
  • starts as a small pustule, red bump or blood blister
  • skin breaks down resulting in an ulcer which may be deep and necrotic
65
Q

Describe pretibial myxoedema

A
  • symmetrical, erythemaotus lesions
  • shiny orange peel skin
66
Q

Describe necrolibosis lipodica diabeticorum

A
  • shiny, painless areas of yellow/red skin, typically on the shin of diabetics
  • often associated with telangiectasia
67
Q

Dermatitis hepatiformis

A
  • itchy skin lesions on the extensor surfaces
  • associated with coeliac
  • Ig A deposition
68
Q

What skin condition is associated with coeliac disease?

A

Dermatitis hepatiformis

69
Q

Erythema ab igne

A

Over exposure to infrared

70
Q

Erythema multiforme

A

Target lesions initially on the back of hands/feet then torso

71
Q

What infections cause erythema multiforme?

A
  • HSV
  • mycoplasma
  • streptococcus
72
Q

What are the systemic causes of erythema multiforme?

A
  • SLE
  • Sarcoidosis
  • malignancy
73
Q

What drugs cause erythema multiforme?

A
  • penicillin
  • sulphonamides
  • allopurinol
  • carbamazepine
  • NSAIDs
  • OCP
74
Q

Treatment for keloid

A

Intra lesional steroids

75
Q

What is lichen planus

A
  • itchy papular rash
  • palms, soles, genitalia, flexor surfaces of arms
  • white lacy pattern on buccal mucosa
  • koebner phenomenon may be seen
76
Q

What is the management for lichen planus?

A

Topical steroids

77
Q
A

Finals (37 decks)

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