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Finals > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the general term given to skin disease

A

dermatosis

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2
Q

dermatitis definition

A

inflammation of the skin

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3
Q

seborrheic dermatitis/ cradle cap is a common condition that affects infants and is characterised by over production of

A

sebum

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4
Q

psoriasis affecting scalp appears different to seborrheic dermatitis how

A

powdery and silver surface. Scales are thicker and drier

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5
Q

give 2 symptoms of seborrheic dermatitis

A

greasy itchy scales and erythema

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6
Q

seborrheic dermatitis may involve infection by what yeast

A

malassezia fufur

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7
Q

in adults seborrheic dermatitis can affect any area with a large number of sebaceous glands (oily areas), list some different areas that could be affected

A

scalp
face
trunk

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8
Q

true or false, dandruff is a form of seborrheic dermatitis

A

true

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9
Q

what do: Clotrimazole
Econazole nitrate
Ketoconazole
Tioconazole
have in common

A

antifungals containing an imidazole group

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10
Q

list some different treatment options for seborrheic dermatitis

A

washing to remove scales
topical imidazoles and hydrocortisone and ketoconazole shampoo

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11
Q

How should ketoconazole shampoo be used to control seborrheic dermatitis?

A

Rinse area with water. Massage shampoo into scalp into a lather, leave shampoo on for 3-5 minutes, wash off with water

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12
Q

How should ketoconazole shampoo be used to prevent the recurrence of seborrheic dermatitis?

A

once every 1-2 weeks. Leave on scalp for 5 minutes before rinsing.

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13
Q

OTC first line for scalp psoriasis?

A

Salicylic acid shampoos and scalp solutions

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14
Q

what compound reduces keratinocyte proliferation and own inherent anti-inflammatory activities
Helps maintain cutaneous barrier homeostasis in psoriasis

A

vitamin D

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15
Q

what can you add to vitamin D preparation to increase its efficacy

A

Combination corticosteroid and Vitamin D preparations (calciptriol with betamethasone) ointment/ gel: Dovobet or foam: Enstilar

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16
Q

what OTC drugs linked to psoriasis onset/ flare ups?

A

NSAID naproxen and indomethacin

also exacerbated by:
bb
Li
antimalarials
terbinafine
ACEi
benzos
biologics

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17
Q

why should psoriatic patients be referred to the GP if they develop joint pain?

A

psoriatric arthritis

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18
Q

//ACNE VULGARIS

acne is what type of skin disease

A

pilosebaceous

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19
Q

acne is characterised by pustules, nodules, cysts and or open and closed:

A

comedones

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20
Q

give some different causes of acne 4

A

sebum overproduction
increase testosterone sensitivity
hormonal changes F
drug induced

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21
Q

in acne pores are usually blocked by a mixture of sebum and

A

dead skin cells

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22
Q

blocked pores in acne can be contaminated by the usually harmless bacteria known as

A

propionibacterium acnes

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23
Q

name a kerolytic product that can be purchased otc for the treatment of acne

A

salicylic acid

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24
Q

why should benzyl peroxide for the treatment of acne be initiated at a low dose and titrated up slowly

A

minimise irritancy

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25
Q

azaleic acid can be used to treat acne at what % strength

A

20

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26
Q

true or false, topical retinoids can be potentially irritant for use in acne treatment

A

true

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27
Q

topical abx may be used to treat inflammatory acne, what may be the risk of using these formulations

A

resistance

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28
Q

oral abx for the treatment of acne should be water or lipid soluble

A

lipid

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29
Q

would isotretinoin usually given to patients for acne treatment within primary or secondary conditions

A

secondary

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30
Q

// ATOPIC DERMATITIS

true or false, atopic dermatitis is one type of eczema which is considered a chronic condition but major improvements or complete disappearance can occur

A

true

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31
Q

Atopic dermatitis is more common in children with other atopic (i.e. allergic) conditions such as 3

A

food allergies
asthma
hayfever

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32
Q

what epidermal protein has recently been identified as having a potential contributing factor to the development of atopic dermatitis

A

filaggrin

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33
Q

what are some of the common symptoms of atopic dermatitis that patients may present with

A

itchy skin
red and dry cracks

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34
Q

mainstay treatment for atopic dermatitis?

A

topical emolients

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35
Q

emollients should be used freely and frequently to maintain skin hydration but should be applied gently, why should patients favour preparations with the fewest excipients

A

some can act as irritants

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36
Q

name of another severe complication of atopic dermatitis that can also occur in association with other inflammatory skin conditions

A

Erythroderma atopic dermatitis

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37
Q

How can the use of oral corticosteroids affect growth in children?

A

slows growth rate

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38
Q

why are ointments preferred to creams and lotions

A

higher water content

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39
Q

why might creams and lotions be more acceptable for patients

A

they do not leave a greasy film on the skin

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40
Q

why might patients be required to change their emollients over time

A

loss of efficacy or irritancy

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41
Q

atopic dermatitis is typically treated with a short course of topical

A

corticosteroids

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42
Q

prolonged use of corticosteroids is not recommended due to side effects including

A

change in skin colour
withdrawal
secondary infections
acne
cataracts

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43
Q

nice recommends that corticosteroids for eczema are used od below 12 and if above 12 they are used

A

bd

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44
Q

what 2 topical calcineurin inhibitors may be prescribed to patients as second line treatment but only by expert clinicians

A

tacrolimus and picrolimus

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45
Q

how can calcineurin inhibitors help to treat atopic dermatitis/ eczema

A

blocking calcineurin prevents inflammatory reaction at basis of atopic dermatitis

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46
Q

true or false, unlike topical corticosteroids, calcineurin inhibitors do not cause skin atrophy

A

true

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47
Q

list some different treatment options for atopic dermatitis

A

uv light
abx
corticosteroids
azathioprine
cyclosporine
mtx
biologicals

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48
Q

// PSORIASIS

psoriasis is an inflammatory condition characterised by the presence of red flaky crusty patched covered with scales, what colour are these scales

A

silver

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49
Q

what causes patches to form in psoriasis

A

hyperproliferation of epidermal cells

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50
Q

in psoriasis the turnover of epidermal cells is significantly accelerated meaning it takes x instead of weeks

A

days

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51
Q

what is the most common type of psoriasis

A

plaque

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52
Q

guttate psoriasis is more common in young adults and children and often follows a bacterial infection such as as strep throat. how is its presentation different to plaque psoriasis

A

smaller and thinner lesions and can appear on trunk, limbs and scalp

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53
Q

give one differential for the presentation of scalp psoriasis

A

seborrheic dermatitis

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54
Q

what different things does the classification of psoriasis depend on

A

age of onset
surface area affected
localisation of lesions
size and thickness of lesions

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55
Q

psoriasis is considered to be a x lymphocyte auto immune disease

A

t

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56
Q

true or false, in psoriasis t cells do not appear to accumulate on the skin

A

false

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57
Q

how can t cells trigger an immune response resulting in psoriasis

A

apc present antigen
t cell activated
trigger immune response
cytokines release
fast growth and maturation of epidermal cells
epidermis thickens

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58
Q

what does increased blood supply to the site cause in psoriasis

A

reddening of lesions

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59
Q

give one tool that is available to assess the severity of psoriasis

A

PASI

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60
Q

which of the following is not an additional physiological consequence of psoriasis

erythrodermic dermatitis
pustular psoriasis
arthritis
nail disease
cardiovascular disease
kidney disease

A

kidney disease

61
Q

list some different topical treatment options for psoriasis

A

emollients
corticosteroids
vitamin d analogues
coal tar
dithranol

62
Q

what light therapies are available to treat psoriasis

A

uvb and puva

63
Q

what different systemic therapies are available for the treatment of psoriasis

A

mtx
cyclosporine
apremilast

64
Q

what is the drug class of apremilast

A

anti tnf alpha

65
Q

what 2 classes of biological drugs can be used for the treatment of psoriasis

A

anti tnf alpha
anti interleukins

66
Q

// ECZEMA

Eczema is often used in place of dermatitis; both refer to inflammation of the skin, anme some diff types

A
  • Atopic
  • Pytiriasis Alba
  • Lichen nitidus
  • Discoid
  • Seborrheic
  • Photo-aggravated
  • Chronic actinic
  • Varicose/venous
  • Irritant
  • Contact
67
Q

Corticosteroids share a common structure with which endogenic molecule

A

Cholesterol

68
Q

Corticosteroids can possess glucocorticoid and mineralocorticoid activity. Which activity is the most desirable in atopic eczema?

A

GC, dampen immune response and prevent flare up
MC: Na, K, not relevant here
Skin thinner for kids. Potent meds for adults, even more for kids
Eczema manifests at young age

69
Q

main risks associated with prolonged use of topical corticosteroids?
What factors can increase the risk of developing these SEs?

A

rebound flares
atrophy
rosocea

  • extremities of age
  • body site e.g. intertriginous areas,
  • high-potency topical steroid, occlusion and moisture.
70
Q

common name for erythema

A

redness

71
Q

common name for pruritus

A

itchy skin

72
Q

common name for xerosis

A

dry skin

73
Q

main differences between allergic contact dermatitis and irritant contact dermatitis?

A

ICD caused by the non–immune-modulated irritation of skin by a substance, -> skin changes.

ACD: delayed hypersensitivity reaction in which a foreign substance comes into contact with skin; skin changes occur after reexposure

74
Q

// NAPKIN DERMATITIS

(nappy rash) what 3 possible therapeutic management used to treat

A
  • Barrier cream (zinc pastes)
  • Non-pharmacological interventions
  • Antibacterial or antifungal cream if infection confirmed
75
Q

chicken pox, Molluscum Contagiosum,impetigo, cold sores
all examples of what

A

Infectious dermatoses/ viral rashes

76
Q

chicken pox characterised by fever and blistered rash and caused by what virus?

A

varicella zoster virus

77
Q

Chicken pox is usually self-limiting in healthy children but complications can include

A

pneumonia and secondary bacterial infection of skin lesions from scratching

78
Q

After first chicken pox infection, virus can be re-activated to cause

A

shingles (herpes zoster)

79
Q

Shingles targets one dermatome (region of the skin innervated by a single spinal nerve) often located where

A

thorax or abdomen

80
Q

how do shingles lesions appear?

A

grouped vesicles on top of reddened skin (erythema).

81
Q

within how long will chicken pox/ shingles vesicles dry up, crust, and clear

A

2 weeks

82
Q

t/f shingles may cause scarring

A

true.
some patients may experience lingering pain after lesions have healed (postherpetic neuralgia).

83
Q

Antipyretics and antihistamines can be used for chickenpox tx but why should you avoid ibu and aspirin

A

due to increased risk of secondary infections (ibuprofen) and Reyes syndrome (aspirin)

84
Q

what lotion can be used for topical application for chickenpox

A

calamine

85
Q

for severe chickenpox and at-risk patients, treat w what 2?

A

o Immunoglobulins
o Antivirals (should be started early within 24h of rash starting)

86
Q

//MOLLUSCUM

Molluscum Contagiosum is a viral skin infection and symtoms include

A

small, painless papules

87
Q

t/f Molluscum Contagiosum in children
is usually self-limiting and does not require treatment. However, treatment may be required in adults and immunocompromised patients.

A

true

88
Q

how is molluscum contagiosum treated/ counselled

A

tell px avoid scratching
Tx: destruction of the lesions and various topical treatments. This conditions is sometimes associated with atopic dermatitis.

89
Q

name of common bacterial infection cause by Staph aureus or Strep pyogenes

A

impetigo

90
Q

// IMPETIGO

impetigo px are contagious until Xh after treatment is started or lesions have healed.

A

48

91
Q

what may symptoms include for non-bullous impetigo

A

non-bullous: small pustules, break down, leaving honey-coloured crusted lesions and exudation; with time, and will be replaced with reddish lesions that should disappear without scarring.

92
Q

what may symptoms include for bullous impetigo

A

bullae. blisters will rupture, leaving crusted skin lesions, exudation and eventually peeling.

93
Q

what should px be told to avoid, for impetigo

A

scratching to limit transmission and complications.

94
Q

Impetigo often clears-up on its own, but treatment can help to fasten healing. name 3 options

A
  • Antiseptic washes
  • Antibacterial cream (e.g. mupirocin 2%; for localised lesions/mild cases)
  • Oral antiobiotics (severe cases)
95
Q

// COLD SORES

= visible manifestation of a viral infection by which virus

A

herpes simplex virus (HSV) type 1 or type 2.

96
Q

When the virus becomes active again, cold sores will manifest as

A

vesicles (small blisters).

97
Q

cold sores is self limitng (7-10 days) but remains contagious when?

A

until the lesions have healed.

98
Q

which px may be at risk of complications of cold sores

A

Immunocompromised patients, neonates and patients suffering from other skin conditions

99
Q

what can trigger cold sores

A

stress, injury, systemic infection (fever), immunosuppression (disease or drug-induced), tiredness, menstruation and sunlight.
…

100
Q

what tx can be used to speed up cold sore healing

A

antiviral creams

101
Q

name 3 therap options for cold sore tx (many available w/out prec)

A
  • Antiviral creams
  • Oral antivirals (severe cases and at-risk populations)
  • Non-antiviral topical preparations
102
Q

name 2 antiviral creams for cold sores

A

acyclovir, penciclovir

103
Q

why would you give non-antiviral topical preparations for cold sore management

A

to alleviate symptoms

104
Q

What advice should you give to patients wishing to use antiviral creams for the treatment of cold sores?

A

Do not apply other skin products unless told to do so
Do not cover area with plastic or waterproof bandages unless told to do so
apply affected area five times a day at approx 4h intervals for 4 days. Wash your hands, apply cream and wash hands again. Use enough to completely cover sore and surrounding area.

105
Q

// URTICARIA

what is urticaria/ hives characterised by

A

presence of wheals and itchy skin.

106
Q

urticaria/ hives is non-infectious and fairly common due to release of what in skin

A

histamine and other messengers

107
Q

what can cause sudden release of histamine

A

allergic reaction (food or insect bites…nettle), exposure to cold or heat, infections such as the common cold or can be drug-induced.

108
Q

urticaria can be idiopathic or X

A

auto-immune

109
Q

Urticaria can be one of the symptoms of anaphylaxis. what else can

A

itchy skin
swollen eyes
lightheaded
mouth swelline
unconscious

110
Q

Some patients may develop an angioedema which is characterised by an abrupt, transient swelling of the deeper layer of the skin, including the hypodermis what does it often affect

A

eyes and lips, hands and feet. If the swelling affects the tongue or throat, the patient may experience trouble swallowing or breathing (beware!).

111
Q

drug tx for urticaria?

A
  • Oral antihistamines (H1)
  • Adrenaline injection (rare cases; angioedema affecting breathing)
  • Omalizumab (chronic spontaneous urticarial)
112
Q

// SDL: dermatology

case 1 acne
how long should treatment with benzoyl peroxide or any acne treatment be tried for before switching

A

most people need 6 week course but treatment should be stopped if no response within a 2 month period

113
Q

what factors should be checked before considering a switch in someones acne treatment

A

using correctly

114
Q

why should benzoyl peroxide be used sparingly

A

irritation

115
Q

true or false, benzyl peroxide can make skin more sensitive to sunlight

A

true

116
Q

what are the advantages of using a combination of benzoyl peroxide and a topical antibacterial

A

topical abx can become resistant so combining with antiseptic reduces number of bacteria on the skin

117
Q

topical abx works by killing bacteria on the skin that are responsible for causing clogged hair follicles, name 2 appropriate abx

A

clindamycin or erythromycin

118
Q

name some different oral abx that may be used for moderate acne

A

lymecycline
doxycycline
oxytetracycline
tetracycline
trimethoprim

119
Q

lymecycline dose

A

480mg od

120
Q

doxycycline dose

A

100mg od

121
Q

oxytetracycline and tetracycline doses

A

500mg bd

122
Q

why is minacycline rarely used now

A

causes lupus like reaction and blue discolouration of face

123
Q

true or false, trimethoprim works well for acne but is not licensed to treat it

A

true

124
Q

what drug can be used for acne in younger children but runs the risk of resistance therefore requires close monitoring of response

A

erythromycin

125
Q

list the indications for isotretinoin treatment

A

nodulocystic acne
acne at risk of permanent scarring
acne that hasnt responded to oral abx

126
Q

what sexual side effects may be caused by isotretinoin treatment

A

erectile dysfunction and loss of libido

127
Q

why should patients and their families be aware of mood changes on isotretinoin treatment

A

can cause depression and suicidal ideation

128
Q

what skin lip eyes side effects might patients on isotretinoin experience

A

dryness

129
Q

true or false, isotretinoin is not associated with sensitivity to sunlight and associated headaches

A

false

130
Q

what are females required to undertake prior to isotretinoin treatment

A

pregnancy prevention programme
if sexually active 2 forms of contraception
monthly pregnancy tests

131
Q

case 2

name of serious disorder which is an ADR and affects skin mucus membranes genital and eyes etc

A

SJS

132
Q

sjs begins with x like symptoms

A

flu

133
Q

sjs can be caused by infection but the most common cause is

A

ADR

134
Q

how does sjs manifest

A

purple rash spread
blisters
affected skin dies and peels off

135
Q

what ward/ unit would sjs patients be admitted to

A

intensive care or burns

136
Q

sjs can cause x detachment from underlying areas

A

epidermis

137
Q

how can sjs be officially diagnosed from TENS

A

sjs if epidermal detachment affects <10% total body area

138
Q

TENS is diagnosed if epidermal detachment affects >x% total body area

A

30

139
Q

scarring can occur if sjs is not treated properly true or false

A

true

140
Q

what life threatening complication can occur as a result of tens

A

sepsis

141
Q

list 3 common antibacterial causes of sjs

A

amoxicillin
cephalosporins
co trimoxazole

142
Q

list 2 antiepileptics that can cause sjs

A

lamotrigine
carbamazepine

143
Q

2 nsaids that can cause sjs

A

peroxicam
meloxicam

144
Q

name some different drug classes that can cause sjs

A

antibacterials
antiretrovirals
sulfonamide derivatives
anticonvulsants
antiepileptics

145
Q

what can increase your risk of developing sjs

A

recombinant viral infection
weakened immune system
family history

146
Q

where should sjs be reported

A

mhra yellow card

147
Q

for sjs what is the usual dose of immunoglobulin

A

2mg/kg

148
Q

immunoglobulin only comes in vials of 2.5/5/10 and

A

20

Finals (29 decks)

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