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MRCP Revision > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Stevens-Johnson syndrome hypersensitivity type and most significant RF

A

Type 4
HIV x100

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2
Q

Causes of stevens johnson syndrome

A

Abx (penicillin, sulphonamides - sx within 1 wk), AEDs (lamotrigine, carbamazepine, phenytoin - within 2 months), allopurinol, NSAIDs, oral contraceptives

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3
Q

Features of steven johnson syndrome

A

Prodromal fever, myalgia, sore throat, then after a few days maculopapular, target lesions (may develop into vesicles/bullae, Nikolski’s +ve), mucosal involvement, arthralgia.

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4
Q

HLA assx with SJS

A

HLA B*1502 - carbamazepine-induced SJS+TEN in Han Chinese

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5
Q

Erythema multiforme features

A

target lesions, initially on back of hands/feet, then spread to torso, upper > lower limbs, mild pruritis common

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6
Q

Features of erythema multiforme major

A

mucosal involvement, more severe

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7
Q

Causes of Erythema multiforme

A

viruses (HSV), Orf (parapox), idiopathic, mycoplasma, streptococcus, penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptives, nevirapine, SLE, sarcoidosis, malignancy

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8
Q

Features of TEN

A

life-threatening. Scalded appearance over extensive area.
systemically unwell, +ve Nikosky’s sign (epidermis separates with mild lateral pressure)

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9
Q

Causes of TEN

A

Abx (penicillins, sulphonamides), AEDs (carbamazepine, phenytoin), allopurinol, NSAIDs. Rx: stop precipitating factor, supportive care (ICU), IVIG, immunosuppressants, plasmapheresis

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10
Q

Scoring system for hirsutism

A

Ferriman-Gallwey scoring system (Severe >15).

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11
Q

What is hirsutism driven/dependent on/by

A

androgens

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12
Q

Causes of hirsutism

A

PCOS (most common), Cushing’s, CAH, Androgen therapy, Obesity (insulin resistance culprit), adrenal tumour, androgen secreting ovarian tumour, phenytoin, steroids.

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13
Q

Rx for hirutism

A

weight loss, COCP (co-cyprindiol - Dianette - has VTE risks; ethinylestradiol and drospirenone - Yasmin), topical eflornithine for facial hirsutism (contraix in pregnancy, breast-feeding)

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14
Q

Hypertrichosis - is it dependent on androgens?

A

no - androgen independent

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15
Q

Causes of hypertrichosis

A

minoxidil, ciclosporin, diazoxide, congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis, PCT, anorexia nervosa

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16
Q

What is onycholysis

A

separation of nail plate from nail bed.

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17
Q

Causes of onycholysis

A

DIRT PIT
dermatitis, idiopathic, Raynaud’s, Trauma (excessive manicuring), Psoriasis, Infections (fungal), Thyroid disease (hyper/hypo)

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18
Q

Causes of impetigo

A

S aureus, S pyogenes,

Primary or 2 to eczema, scabies, insect bites.

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19
Q

Features of impetigo

A

Common in children, esp in warm weather. Often on face, flexures, limbs. Incubation period 4-10 days. Golden, crusted skin lesions, very contagious (spread via direct + indirect contact).

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20
Q

Rx for impetigo

A

hydrogen peroxide 1% if not systematically unwell or high risk, or topical fusidic acid (topical mupirocin if fusidic resistance suspected or MRSA). Flucloxacillin (erythromycin if pen allergic) if extensive. School exclusion 48hrs after abx start or until lesions crusted + healed

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21
Q

Skin manifestations in TB

A

lupus vulgaris (50% of cases, occurs on face, nose, mouth, initially erythematous flat plaque, becomes elevated, may ulcerate later), erythema nodosum, scarring alopecia, scrofuloderma (breakdown of skin overlying TB focus), verrucosa cutis, gumma

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22
Q

Erythema nodosum causes

A

Strep, TB, brucellosis, sarcoidosis, IBD, behcet’s, malignancy/lymphoma, penicillins, sulphonamides, COCP, pregnancy.

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23
Q

Erythema nodosum features

A

Symmetrical, erythematous, tender nodules, heal without scarring

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24
Q

Types of contact dermatitis and their features

A

Irritant: common, non-allergic, weak acids/alkalis. Often on hands, erythematous. Rarely crusting/vesicular

Allergic: Acute weeping eczema predominantly affecting hairline margins than hairy scalp itself.Rx: topical potent steroids.

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25
Q

What type of contact dermatitis can cement cause

A

Cement can cause both irritant (alkaline nature of cement) + contact (dichromates in cement)

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26
Q

Pretibial myxoedema features

A

symmetrical, erythematous lesion seen in Grave’s, shiny, orange peel skin

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27
Q

Antibodies in pemphigus vulgaris

A

anti-desmoglein 3

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28
Q

Features of pemphigus vulgaris

A

Ashkenazi Jewish. Flaccid blisters, easily ruptured vesicles, bullae. Painful but not itchy. oral (50-70%), mucosal ulceration, nikolsky’s +ve (spread of bullae following horizontal, tangential pressure), acantholysis on biopsy,

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29
Q

Rx for pemphigus vulgaris

A

steroids
immunosuppression

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30
Q

Bullous pemphigoid antibodies

A

anti hemidesmosomal proteins BP180, BP230

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31
Q

Features of bullous pemphigoid

A

More common in elderly. Itchy, tense blisters around flexures, usually heal without scarring.

Stereotypically no mucosal involvement (actually 10-50% have some mucosal involvement).

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32
Q

How to investigate/diagnose bullous pemphigoid

A

skin biopsy - immunofluorescence showing IgG and C3 at dermoepidermal junction

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33
Q

Rx for bullous pemphigoid

A

derm referral for biopsy, oral steroids, topical steroids, immunosuppressants, abx can be used too

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34
Q

Pyoderma gangrenosum features

A

Neutrophilic dermatosis (dense neutrophil infiltration in affected tissue on biopsy).

Sx: Initially small red papule, later deep, red, necrotic ulcers with violaceous border, typically on lower limb, may be accompanied with fever, myalgia.

May be seen around stoma site

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35
Q

Rx for pyoderma gangrenosum

A

steroids (oral)

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36
Q

Causes of pyoderma gangrenosum

A

Idiopathic in 50%, IBD (10-15%), Rheumatological (RhA, SLE), Haematological (Myeloproliferative, lymphoma, myeloid leukaemia, IgA monoclonal gammopathy), GPA, PBC

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37
Q

Skin disorders in diabetes

A

LOVINNG LipOatrophy, Vitiligo, Infections (strep, staph, candida), Necrobiosis lipoidica diabeticorum, neuropathic ulcers, granuloma annulare

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38
Q

Features of necrobiosis lipoidica diabeticorum

A

shiny, painless areas of yellow/red skin typically on shins of diabetics, often associated with telangiectasia

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39
Q

Features of granuloma annulare

A

papular, slightly hyperpigmented, depressed centrally, on dorsal surfaces of hands, feet, extensor surfaces of arms, legs.

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40
Q

Associations for vitiligo

A

T1DM, Addison’s, Autoimmune thyroid, pernicious anaemia, alopecia areata.

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41
Q
A
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42
Q

Features of vitiligo

A

loss of melanocytes, depigmentation
Trauma may precipitate new lesions (Koebner’s), well-demarcated, peripheries more common

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43
Q

Rx for vitiligo

A

sunblock for affected areas, camouflage make-up, topical steroids if early

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44
Q

Features of retinitis pigmentosa

A

black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium, night, tunnel blindness,

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45
Q

Associations of retinitis pigmentosa

A

Refsum’s, Usher, abetalipoproteinaemia, Lawrence-Moon-Biedl, Kearns-Sayre, Alport’s

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46
Q

Erythema ab igne features

A

reticulated, erythematous patches with hyperpigmentation, telangiectasia

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47
Q

Compliations of erythema ab igne

A

Squamous cell ca

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48
Q

dermatitis herpetiformis features

A

Itchy vesicular lesions on extensor surfaces.

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49
Q

How to diagnose dermatitis herpetiformis

A

90% have small bowel biopsy consistent with gluten-sensitive enteropathy

direct immunofluorescence - deposition of IgA in a granular pattern in the upper dermis

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50
Q

Rx for dermatitis herpetiformis

A

gluten-free diet
dapsone

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51
Q

pityriasis versicolor cause

A

malessezia furfur infection

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52
Q

features of pityriasis versicolor

A

Trunk affected, hypopigmentd, pink or brown (versicolor), more noticeable following suntan, scaly, pruritic.

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53
Q

RF for pityriasis versicolor

A

immunosuppression, malnutrition, Cushing’s.

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54
Q

Rx for pityriasis versicolor

A
  1. topical ketoconazole 2. Oral itraconazole + consider alternative dx (skin scrapings)
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55
Q

Pityriasis rosea cause

A

HHV6 or 7 reactivation
Recentviral infection

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56
Q

Features of pityriasis rosea

A

Herald patch on trunk followed by erythematous, oval, scaly patches with longitudinal diameters of oval lesions running parallel to line of Langer - fir-tree appearance. Scaling confined to just inside edges.

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57
Q

Rx for pityriasis orsea

A

self-limiting within 6-12 wks

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58
Q

Hereditary haemorrhagic telangiectasia/Osler’Weber-Rendu syndrome inheritance pattern

A

Aut dom with age related penetrance
20% spontaneous

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59
Q

Dx for osler-weber-rendu/HHT

A

2/4 of criteria: epistaxis (spontaneous, recurrent nosebleeds), telangiectases (multiple at characteristic sites - lips, oral cavity, fingers, nose), visceral lesions (GI telangiectasia +/- bleeding, pulmonary, hepatic, cerebral, spinal AVMs), FHx (1st degree relative with HHT)

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60
Q

Acne vulgaris features and severity classification

A

obstruction of pilosebaceous follicles with keratin plugs resulting in comedones, inflammation, pustules.

Mild: open/closed comedones +/- sparse inflammatory lesions.

Moderate: widespread non-inflammatory lesions + numerous papules/pustules.

Severe: extensive inflammatory lesions, may include nodules, pitting, scarring

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61
Q

Treatment for mild-moderate acne vulgaris

A

12 wks topical combination (adapalene + benzoyl peroxide, tretinoin + clindamycin, benzoyl peroxide + clindamycin) or topical benzoyl peroxide as monotherapy if contraindications present

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62
Q

Rx for mod-severe acne vulgaris

A

12 wks topical combination rx +/- oral lymecycline/doxy, or topical azelaic acid + oral lymecycline/doxycycline

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63
Q

Doyxycyline contraindications

A

Pregnancy/breastfeeding, <12yrs

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64
Q

Alternative for doxycycline in acne vulgaris if pregnant

A

erythromycin

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65
Q

Minocycline SE

A

irreversible pigmentation

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66
Q

Max abx course in acne vulgaris

A

6 months

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67
Q

What is co-prescribed with abx to avoid abx resistance in acne vulgaris?

A

topical retinoid or benzoyl peroxide

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68
Q

Compl of treatment with abx in acne vulgaris and how to manage this?

A

Gram negative folliculitis - rx high dose oral trimethoprim

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69
Q

When to refer to dermatology in acne vulgaris?

A

acne conglobate (rare, severe form in men with extensive inflammatory papules, suppurative modules that may coalesce to form sinuses, and truncal cysts)

Consider if: refractory to 2 courses of Rx or with oral abx, acne with scaring, with persistent pigmentary changes, contributing to significant psych distress/MH disorder

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70
Q

Retinoids SE

A

teratogenicity, dry skin, eyes, lips/mouth (most common), low mood, raised triglycerides, hair thinning, nose bleeds, intracranial HTN (don’t combine with tetracyclines), photosensitivity

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71
Q

Acne roosacea sx

A

chronic skin condition. Nose, cheeks, forehead, flushing (1st sx often), telangiectasia. Later becomes persistent erythema with papules. Rhinophyma, blepharitis, sunlight exacerbates.

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72
Q

Rx for acne rosacea

A

simple measures (daily high-factor sunscreen, camouflage creams), topical brimonidine (alpha agonist) for predominant erythema/flushing sx (reduces redness in 30 mins, peaks at 3-6hrs)

Mild-mod papules/pustules: topical ivermectin, topical metronidazole or azelaic acid for alternative

Moderate-severe papules/pustules: topical ivermectin + oral doxy

Refer if sx not improved post primary care or rhinophyma → laser therapy for prominent telangiectasia

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73
Q

Acanthosis nigricans features

A

symmetrical, brown, velvety plaques on neck, axilla, groin.

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74
Q

What causes acanthosis nigricans

A

Due to insulin resistance → hyperinsulinaemia → keratinocyte stimulation + dermal fibroblast proliferation via IGFR1 interaction

Causes (all things to do with weight gain): T2DM, GI Ca, Obesity, PCOS, acromegaly, Cushing’s, hypothyroid, familial, Prader-Willi, drugs (COCP, nicotinic acid)

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75
Q

Acquired icthyosis assx

A

lymphoma

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76
Q

acquired hypertrichosis lanuginosa assx

A

GI + lung ca

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77
Q

Dermatomyositis assx

A

ovarian, lung ca

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78
Q

erythema gyratum repens assx

A

lung Ca (precedes by 9 months).

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79
Q

Features of erythema gyratum repens

A

Concentric, erythematous, flat to slightly raised bands with fine white scale in waves located at leading edge of erythema, in wood-grain pattern.

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80
Q

Erythroderma features

A

> 95% skin involvement with rash.

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81
Q

Causes of erythroderma

A

Cutaneous T-cell lymphoma (Sezary syndrome), leukaemias eczema, psoriasis, drugs (e.g. gold), idiopathic

82
Q

What is erythrodermic psoriasis?

A

progression of chronic disease to exfoliative phase with plaques covering most of body + mild systemic upset. May need admission

83
Q

Migratory thrombophlebitis assx:

A

pancreatic ca

84
Q

necrolytic migratory erythema features

A

red, blistering lesion that migrate, heal centrally, leave behind areas of hyperpigmentation

85
Q

necrolytic migratory erythema assx

A

glucagonoma

86
Q

Sweet’s syndrome sx

A

tender, purple plaques - acute febrile neutrophilic dermatosis

87
Q

Sweet’s syndrome assx:

A

AML, MDS, haem malignancy

88
Q

Tylosis assx

A

oesophageal ca

89
Q

Lichen planus sx

A

itchy, papular rash, on palms, soles, genitalia, flexors, polygonal, Wickham’s striae (white lines on surface), Koebner phenomenon possible, oral involvement in 50%, mucosal involvement 70%, thinning of nail plate with longitudinal ridging.

90
Q

Drug Causes of lichenoid eruptions

A

gold, quinine, thiazides

91
Q

Lichen planus rx

A

potent topical steroids, benzydamine mouthwash/spray for oral lichen planus, oral steroids/immunosuppression for extensive lichen planus

92
Q

Lichen sclerosus sx

A

inflammatory condition affecting genitalia, common in elderly females, leads to atrophy of epidermis with white plaques. Sx: white patches, may scar, itchy, dyspareunia/dysuria

93
Q

Dx of lichen sclerosus

A

clinical (biopsy if atypical)

94
Q

Rx for lichen sclerosus

A

topical steroids, emollients, f/u due to vulval ca risk

94
Q

livedo reticularis sx

A

purplish, non-blanching, reticulated rash (obstruction of capillaries → swollen venules).

95
Q

Scabies organism

A

sarcoptes scabiei

95
Q

Causes of livedo reticularis

A

HIP CASE homocystinuria, idiopathic (most common), PAN, Cryoglobulinaemia, Antiphospholipid syndr, SLE, EDS

96
Q

Which layer do scabies lay eggs

A

stratum corneum

97
Q

Sx of scabies

A

T4 hypersensitivity 30 days post infection. Sx: Widespread pruritis, linear burrows on sides of fingers, interdigital webs, flexor aspects of wrists. Face and scalp in infants. Excoriations, infections.

98
Q

Rx for scabies

A
  1. Permethrin 5%, 2. malathione 0.5% (apply everywhere, 8-12hrs for permethrin, 24 hrs for malathion, rpt 7 days later). Pruritis persists 4-6 wks post eradication
    Crusted scabies: Rx with ivermectin
99
Q
A
100
Q

Sx for molluscum contagiosum

A

Pinkish/pearly white papules with central umbilication, upto 5mm diameter, clusters.

101
Q

Rx for molluscum contagiosum

A

self limiting within 18 months, don’t scratch, explain contagious, no exclusion necessary. Cryotherapy, squeezing, piercing can be tried. Treat eczema if it develops.
Refer if HIV+ve with extensive lesions, eyelid-margin/ocular lesions with red eye, anogenital lesions

102
Q

Immune related adverse rash rx

A

topical steroids
severe -systemic steroids

103
Q

Form of mild topical steroid

A

Hydrocortisone 0.5-2.5%

104
Q

Moderate topical steroid forms

A

Betamethasone valerate 0.025% (Betnovate RD),

Clobetasone butyrate 0.05% (Eumovate)

105
Q

Potent topical steroid forms

A

Fluticasone propionate 0.05% (Cutivate), Betamethasone valerate 0.1% (Betnovate)

106
Q

Very potent topical steroid form

A

Clobetasol propionate 0.05% (Dermovate)

107
Q

Finger tip units

A

1 finger tip unit = 0.5g
hand/fingers 1FTU, a foot 2FTU, front of chest + abdo 7FTU, back + buttocks 7FTU, face + neck 2.5FTU, entire arm + hand 4FTU, entire leg + foot 8FTU

108
Q

Psoriasis sx

A

red, scaly patches, nail pitting, onycholysis, arthritis. Worsened by skin trauma/stress, triggered by strep infections, improved by sunlight. Auspitz sign: bleeding when scales scraped off

109
Q

Genetics for psoriasis

A

HLA-B13, B17, Cw6. 70% concordance in identical twins

110
Q

Triggers for psoriasis

A

NABILA NSAIDS, anti-malarials (chloroquine, hydroxychloroquine), beta blockers, infliximab, lithium, ACE inhibitors + trauma, withdrawal of steroids

111
Q

Pathophysiology of psoriasis

A

Abnormal T cell activity → keratinocyte proliferation. Th17, IL17 influence.

112
Q

Types of psoriasis

A

plaque
flexural
guttate
pustular

113
Q

Plaque psoriasis sx:

A

well demarcated red, scaly patches on extensor surfaces, sacrum, scalp

114
Q

Scalp psoriasis rx

A

topical steroids OD 4wks. If no improvement after 4wks, ue different steroid and/or topical agent

115
Q

Flexural psoriasis rx

A

mild/moderate topical steroids OD/BD max 2 weeks

116
Q

Guttate psoriasis sx

A

transient, children and adolescents, triggered by strep infections (2-4wks before), multiple red/pink, teardrop patches/plaques on trunk + limbs. Onset over days.

117
Q

Guttate psoriasis rx

A

Most resolve within 2-3 months, topical agents like in psoriasis, UVB phototherapy also possible. Consider tonsillectomy if recurrent

118
Q

Pustular psoriasis sx

A

on palms and soles (e.g. palmoplantar pustulosis - fluid-filled pustules/blisters on hands and feet)

118
Q

Chronic psoriasis rx

A

regular emollients. 1. Potent topical steroid OM + vit D analogue OE for 4 wks. 2. After 8 wks, vit D analogue BD. 3. After 8-12 wks, steroids BD for 4 wks or coal tar preparation OD/BD

Phototherapy: narrowband ultraviolet B light 3x/wk, photochemotherapy PUVA (psoralen + ultraviolet A light). SE: skin ageing, squamous cell ca

Systemic: methotrexate, ciclosporin, systemic retinoids, infliximab, etanercept, adalimumab, ustekinumab (IL12, IL23, early trials)

118
Q

Complications of psoriasis

A

psoriatic arthropathy (10%), metabolic syndrome, CVS disease, VTE, psychological distress

119
Q

How do vit d analogues act in chronic psoriasis

A

by reducing cell division, differentiation. Can be used long-term, does not reduce erythema but reduces scale, thickness of plaques.

120
Q

Contraindication for vit d analogues

A

pregnancy

121
Q

Cause of seborrhoeic dermatitis

A

malassezia furfur

122
Q

Sx for seborrhoeic dermatitis

A

eczematous lesions on scalp, periorbitally, auricular, nasolabial folds. Otitis externa, blepharitis.

123
Q

Assx for seborrhoeic dermatitis

A

HIV
PD

124
Q

Rx for seborrhoeic dermatitis

A

scalp - ketoconazole, zinc pyrithione, neutrogena, selenium sulphide, topical steroids.

face/body - topical ketoconazole, steroids for short periods

125
Q

Keratoacanthoma sx

A

rapidly growing, benign epithelial tumour, initially appear as red dome-shaped papule, develops into a volcano-like crater filled with keratinatous material. Reach max size in wks-months then regress within 3 months.

126
Q

Rx for keratoacanthoma

A

excise and exclude SCC, prevent scarring

127
Q

Actinic keratoses sx

A

premalignant lesions on sun-exposed areas (face, scalp, arms). Red/pink/brown/neutral colour, small, crusty/scaly lesions.

128
Q

Actinic keratoses rx

A

avoid risk, fluorouracil cream (2-3 wk course, skin will become red, inflamed so can give topical hydrocortisone with it), topical diclofenac (for mild), topical imiquimod, cryotherapy, curettage/cautery

129
Q

Forms of malignant melanomas

A

Superficial spreading
Nodular
Lentigo maligna
acral lentiginous

130
Q

Dx for malignant melanoma

A

Major criteria: change in size, shape, colour

Minor criteria: diameter>7mm, inflammation, oozing/bleeding, altered sensation.

131
Q

Commonest malignant melanoma

A

superficial spreading

132
Q

Superficial spreading melanoma sx

A

70% (commonest). Arms, legs, back, chest, young people

133
Q

Nodular melanoma sx

A

2nd commonest. On sun-exposed skin, middle-aged people, red/black lump which may bleed/ooze. Most aggressive (tends to grow rapidly, downwards into deeper layers of skin, increasing thickness faster than in diameter)

134
Q

Lentigo maligna sx

A

chronically sun-exposed skin, older people

135
Q

acral lentiginous melanoma sx

A

rare. Nails, palms, soles, in darker skin. Subungual pigmentation (hutchinson’s sign)

136
Q

Rx for melanoma (guided by what)

A

excision biopsy by Breslow thickness: 0-1mm: 1cm, 1-2mm: 1-2cm, 2-4mm: 2-3cm, >4mm: 3cm. Any melanoma thicker than 1mm requires sentinel node biopsy

137
Q

Squamous cell carcinoma RFs

A

sunlight, psoralen UVA therapy, actinic keratoses, Bowen’s disease, immunosuppression (post-renal tp, HIV), smoking, long-standing ulcers (Marjolin), xeroderma pigmentosum, oculocutaneous albinism.

138
Q

Sx for Squamous cell ca

A

rapidly expanding painless, ulcerated nodules on sun-exposed sites such as head, neck, dorsum of hands and arms, cauliflower-like appearance, bleeding areas.

139
Q

Rx for squamous cell ca

A

surgical excision with 4mm margins if diameter<20mm. 6mm if >20mm. Mohs micrographic surgery for high risk/cosmetically important sites.

140
Q

Good prognosis factors for Squamous cell ca

A

well differentiated, <20mm diameter, <2mm depth, no assx diseases

141
Q

poor prognosis factors for squamous cell ca

A

poorly differentiated, >20mm diameter, >4mm depth, immunosuppression

142
Q

Basal cell ca sx

A

Rodent ulcers, slow growing, local invasion, rare mets. Nodular most common. Sun-exposed sites, pearly flesh-coloured papule + telangiectasia, may ulcerate leaving central crater.

143
Q

Rx for BCC

A

routine referral, surgical removal/curettage/cryotherapy/topical cream (imiquimod, fluorouracil)/radiotherapy

144
Q

Systemic mastocytosis sx

A

neoplastic mast cell proliferation. Sx: urticaria pigmentosa, Darier’s sign (wheal on rubbing), flushing, abdo pain, monocytosis on blood film

145
Q

Dx for systemic astocytosis

A

high serum tryptase, urinary histamine

146
Q

Systemic mastocytosis forms

A

Indolent
Smouldering
Aggressive

147
Q

Features of smouldering systemic mastocytosis

A

2 or more B findings: bone marrow>30% mast cells +/- tryptase >200ng/ml +/- KITD816V mutation with variant allele frequency (VAF) of >10%, signs of dysplasia/myeloproliferation without frank haem malign + normal FBC, hepatomegaly without liver dysfunction +/- splenomegaly without hypersplenism

148
Q

Features of aggressive systemic mastocytosis

A

1 or more C findings (cytoreduction-requiring/organ dysfunction): one or more cytopenias (Hb<100, pltl<100, neutrophils<1.0, hepatomegaly + liver dysfunction, osteolytic lesions/#, splenomegaly with hypersplenism, malabsorption with weight loss due to GI infiltration

149
Q

Zinc deficiency sx

A

acrodermatitis (red, crusted lesions acrally, peri-orificial, perianal), alopecia, short stature, hypogonadism, hepatosplenomegaly, geophagia (ingesting clay/soil), cognitive impairment.

150
Q

Acrodermatitis enteropathica

A

aut recessive partial defect in intestinal zinc absorption

151
Q

Alopecia forms

A

scarring, non-scarring

152
Q

Scarring alopecia forms

A

(destruction of hair follicle): trauma, burns, radiotherapy, lichen planus, discoid lupus, tinea capitis.

153
Q

Non-scarring alopecia forms

A

(preservation of hair follicle): male-pattern baldness, drugs (cytotoxics, carbimazole, heparin, contraceptives, colchicine), iron, zinc deficiency, alopecia areata, telogen effluvium (post-stressful period), trichotillomania

154
Q

Alopecia areata sx

A

autoimmune, localised, well demarcated patches of hair loss, with small, broken ‘exclamation mark’ hairs.

155
Q

Rx for alopecia areata

A

Will regrow in 50% in 1yr, 80-90% eventually. Otherwise, topical/intralesional steroids, topical minoxidil, phototherapy, dithranol, contact immunotherapy, wigs

156
Q

Pompholyx sx:

A

eczema type (dishidrotic), affecting hands (cheiropompholyx), feet (pedopompholyx).

Sx: small blisters on palms, soles, intensely itchy, burning, dry, cracking skin.

157
Q

Triggers of pompholyx

A

humidity, high temperatures

158
Q

Rx for pompholyx

A

cool compress, emollients, topical steroids

159
Q

Keloid scar rfs

A

dark skin, young adults, sternum, shoulder, neck, face, extensor surfaces, trunk. (less likely if incisions made along relaxed skin tension lines)

160
Q

Sx for keloid scars

A

from connective tissue of scar, extends beyond dimensions of original wound

161
Q

Keloid scars rx

A

intra-lesional steroids (eg triamcinolone)

162
Q

Eczema herpeticum causes

A

HSV1/2
coxsackievirus A16
Vaccinia

163
Q

eczema herpeticum sx

A

Commonly seen in children with atopic eczema. Sx: rapidly progressing painful rash, monomorphic, punched-out erosions (circular, depressed, ulcerated lesions), 1-3mm diameter.

164
Q

Rx for eczema herpeticum

A

Admission + IV aciclovir

165
Q

Dermatitis artefacta RF

A

self-induced,
adolescent females
personality disorder, dissociative disorders, eating disorders (33% increased in bulimia, anorexia).

166
Q

Dermatitis artefacta sx

A

linear/geometric lesions, well-demarcated, appear suddenly, face, dorsum of hands, la belle indifference.

167
Q

Antihistamine forms

A

sedating (also have antimuscarinic properties): chlorpheniramine.

Non-sedating: loratidine, cetirizine

168
Q

Pellagra dermatitis sx

A

brown scaly rash on sun-exposed sites - Casal’s necklace if on neck

169
Q

Venous ulcers location

A

typically above medial malleolus

170
Q

Venous ulcers ix:

A

ABPI in non-healing ulcers (assess for poor arterial flow which impairs healing) (normal 0.9-1.2, arterial disease<0.9. ?calcification (eg in diabetics) >1.3).

171
Q

Rx for venous ulcers

A

compression bandaging (4 layers), oral pentoxifylline (peripheral vasodilator), flavinoids

172
Q

Atopic eruption of pregnancy

A

commonest prengancy skin disorder, eczematous, itchy rash, resolves

173
Q

Polymorphic eruption of pregnancy

A

pruritic, last trimester, lesions first in abdominal striae, spares umbilicus

Rx: depends on severity - emollients, mild potency topical steroids, oral steroids

174
Q

Pemphigoid gestationis

A

pruritic blistering lesions, develop peri-umbilically and spreads to trunk, back, buttocks, arms, 2nd/3rd trimester.

Rx: oral steroids

175
Q

Melasma

A

common in early pregnancy, resolves, symmetrical brown-pigmented patch across cheeks, forehead, nose, upper lip

176
Q

Fungal nail infections causes

A

dermatophytes (tricophyton rubrum) 90%, yeasts (5-10%), non-dermatophyte moulds.

177
Q

RF for fungal nail infections

A

age, DM, psoriasis, repeated nail trauma.

178
Q

Fungal nail infections sx

A

unsightly nails, thickened, rough, opaque nails.

179
Q

Ix for fungal nail infections

A

nail clippings +/- scrapings.

180
Q

Rx for fungal nail infections

A

(if dermatophyte or candida confirmed)
Limited involvement (<50% nail affected, <2 nails affected, more superficial white onychomycosis): topical amorolfine 5% lacquer (6 months fingernails, 3-6 months toenails)

Oral itraconazole for more extensive candida

181
Q

What is Yellow nail syndrome and its assx

A

slowing of nail growth leading to thickened, discoloured nails.

Assx: congenital lympoedema, pleural effusions, bronchiectasis, chronic sinus infections

182
Q

What is Koebner’s phenomenon and assx

A

skin lesions at site of injury.

Assx: psoriasis, vitiligo, warts, lichen planus, lichen sclerosus, molluscum contagiosum

183
Q

Tinea forms

A

capitis
corporis
pedis

184
Q

Tinea capitis sx

A

scalp ringworm. Scarring alopecia in children. Kerion may form if untreated - raised, pustular, spongy/boggy mass

185
Q

Tinea capitis organisms

A

Tricophyton tonsurans commonest. Microsporum canis from cats/dogs

186
Q

Dx for tinea capitis

A

scalp scrapings
Wood’s lamp - microsporum canis shows green fluorescence

187
Q

Rx for tinea capitis

A

oral terbinafine for tricophyton tonsurans, griseofulvin for microsporum. Topical ketoconazole shampoo for 2wks to reduce transmission

188
Q

Tinea corporis organisms

A

Tricophyton rubrum, verrucosum.

189
Q

Sx for tinea corporis

A

well-defined annular, erythematous lesion with pustules, papules.

190
Q

Rx for tinea corporis

A

oral fluconazole

191
Q

Tinea pedis sx

A

athlete’s foot. Itchy, peeling skin between toes.

192
Q

Wood’s light staining for PCT

A

pink

193
Q

Wood’s light staining for tinea capitis microsporum canis

A

green

194
Q

wood’s light staining for malassezia furfur

A

green

195
Q

wood’s light staining for erythrasma

A

red (coral)

196
Q

Hyperhidrosis rx

A

topical aluminium chloride (SE: skin irritation), iontophoresis (useful for palmar, plantar, axillary hyperhidrosis), botulinum toxin (for axillary sx), surgery (eg endoscopic transthoracic sympathectomy - compensatory sweating risk)

MRCP Revision (10 decks)

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