Dermatology Flashcards
1
Q
lesion of scabies
A
Burrow (primary)
Pleomorphic: papule, scales, vesicles, bullae, crusts, pustules, nodules, excoriation
2
Q
MOT of scabies
A
Man to man or animal to man by close contact
3
Q
Infant lesion destribution of scabies
A
All over including scalp and face
4
Q
In adults scabies itch spares?
A
Face, head and inter scapular region
5
Q
Diagnosis if scabies
A
Scraping ~> kOH or mineral oil ~> microscope ~> eggs/ mites
6
Q
DD of scabies
A
- Imperigo
- Insect bite
- Contact and atopic dermatitis
- Papular urticaria
7
Q
Common lesion of infant scabies
A
Vesicular lesions in face, palms and soles plus the usual sites
8
Q
Self limiting scabies
A
Animal contact (no burrow)
9
Q
Itchy after adequate scabies therapy?
A
- Nodular scabies
- Inadequate? Therapy
- Re infection
- Irritation from treatment
- Acarophobia
10
Q
Scabies clothing and bedding management
A
Boiled or ironed or closed in a bag for 10 days
11
Q
Only topical scabies ttt for pregnant
A
Sulfur and permethrin preparations
12
Q
Scabies topical ttt
A
All given at night
1. Permethrin: 2.5/ 5% day 1&8
2. Sulfur: 5,10% (3-5 days)
3. Gamma benzene hexachloride 1% day 1&8
4. Malathione 0.5% day 1&8
5. Crotamiton 10% (3-5days)
6. Benzyl benzoate emulsion 25-33%
13
Q
Scabies systemic ttt
A
Ivermectin and oral antihistamines
14
Q
Commonest site of affection of head louse
A
Occipital and post auricular
15
Q
Ttt of pediculosis humanis capitis
A
- Treat pyogenic infec if present
Medication day 1 then day 8 to kill nits - Permethrin 2.5/5%
- Malathion 0.5%
- Gamma benzyl hexachloride 1%
- Benzyl benzoate emulsion 25%
- Oral ivermectin
- Remove remaining eggs with fine toothed comb+/- vinegar
16
Q
Yeast
A
Unicellular + budding
17
Q
Dermatophytes
A
Multicellular filamentous and spores forming
18
Q
Trichophyton violaceum causes
A
Scaly ringworm and black dot ringworm
19
Q
Scaly ringwork caused by
A
Trichophyton violeceum
Microsporum canis
20
Q
Favus pathogen
A
Trichophyton schoenleinii
21
Q
Kerion DD
A
Acute pyogenic abscess but
1. No LN
2. General condition is good
3. Drainage is CI
4. It is a painless swelling studded with pustules
22
Q
Kerion is caused by
A
Trichophyton verrucosum
Trichophyton mentagrophytes
Zoophilic
23
Q
DD of scaly scalp
A
Scaly ringworm
Impetigo
Psoriasis
Seborrheic dermatitis
24
Q
Coconut hair
A
Favus
25
Cup shaped yellow crusts
Favus (sulfur cups or scutula)
26
Wood’s light
Microsporun canis and audeni: green
Trichophyton violaceum: does not
Malassezia yeast: golden yellow
Corynebacterium Minutissimum: coral red
27
Age of onset of scalp ringworm
Most Children except favus
28
Investigation of scalp ringworm
1. Microscopy: scrape, KoH10-20% and gentle warming : hyphae and spores
2. Culture: sabourad’s agar 2-4weeks
3. Wood’s light (screening)
29
CI of Griesofulvin
Pregnancy
Hepatic failure
Photosensitivity
30
Side effects of griseofulvin
GI upset
Headsche
Photosensitivity
SLE
31
Griseofulvin dosage for tinea capitis
12.5mg/kg/day for 6-8 weeks (favus 8-10wks)
1 tablet = 125mg
Max daily dose = 6 tablets
32
Tinea denotes
Dermatophytes
33
DD of Tinea cruris
Erythrasma
Candida of groin
Intertrigo
Seborrheic dermatitis
Flexural psoriasis
34
Tinea cruris caused by
Trichophyton rubrum
Epidermiphyton floccosum
35
DD of tinea corporis
Circinate impetigo (not itchy, large vesicles, crusts and negative microscope)
Pytriasis rosea (oval, scales make collar, edge not raised and negative direct microscope
36
Castallini paint
Macerated toe web and chronic paronchyia
Antifungal anti bacterial anti-inflammatory drying agent
37
Chronic interdigital by
Tinea pedis macerated web space ( commonly 4,5th toe-web itchy
Topical imidazole or systemic itraconazole
38
Onychomycosis
Candida nail fold
Dermatophytes nail plate
Mould
39
Onychomycosis facilitated by
DM
Trauma
Moisture
40
Cigarette paper-like scales
Pityriasis versicolor
41
Imidazole
Tinea pedis
Pityriasis versicolor
42
TTT pityriasis versicolor
Topical:
Aqueous solution: Sodium hyposulphite 20-25%
Broad spectrum: imidazole group
Systemic: severe and extensive -> itra/flu/keto (conazoles)
43
Non infectious fungal skin discoloration
Pitryasis versicolor
44
C/P of pityriasis versicolor
- Well defined hypo/hyper pigmented macules and patches covered by cigarette paper like scales, mainly trunk and neck
- golden yellow by woods
- high recurrence after ttt
45
Whitish curd like patches when scrubbed leave erthymatous base
Oral candidiasis
46
What is Candidal balanitis
Genital candida in glans penis - STD
47
Oral candidiasis is associated with
Angular stomatitis perleche
48
Festooned edge
Candidal intertrigo
49
Lesions with Active edge
Tinea
50
Satellite lesion outside the edge
Candida infection - intertrigo
51
DD of rash in napkin area
1. Candidal intertrigo: well defined festooned and satellite lesion involving folds
2. Napkin dermatitis: illdefined erthematous sparing folds
3. Psoriasis: well defined no scales
52
Erosio interdigitalis blastomycetica
Wet workers who do not dry their hands properly
53
Griseofulvin is not effective in
Pityriasis versicolor and candidiasis
54
Terbinafine active against
Dermatophytes
55
Examples of imidazole group drugs
Clotrimazole
Econazole
Ketoconazole
56
Whitfield ointment
For candida/ fungal infection
Salicylic acid 3
Benzoic acid 6
Lanolin 10
Vaseline 100
57
Primamry lesion of eczema
Vesicles
58
Stages of eczema
Acute, subacute, chronic
59
Ill-defined erthymatous patch, papulo-vesicular eruption with exudation of serum
Acute eczema
60
Shbacute eczema
Erthyma and scalling
61
Chrinic stage of eczema
Dryness and lichenification
62
Mention ex of endogenous eczema
1. Atopic dermatitis
2. Pityriasis alba
3. seborrheic dermatits
4. Stasis dermatitis
5. Discoid eczema
63
Allergic Vs irritant contact dermatitis
Irritant: physical/ chemical substance leading to direct noxious effect on skin barrier
Allergic: type 4 hypersensitivity reaction, it’s a sensitization dermatitis
64
Patch test
Diagnose allergic contact dermatits
65
Pathogenesis of atopic dermatitis
Genetic, environmental and immune dysregulation
66
C/P of atopic dermatitis
Constant Itching, dry xerotic skin with loss of its barrier function
Site and morphology depend on age
67
Neurodermatitis
Adulthood phase of atopic dermatitis
68
Lymphadenopathy
-Infantile phase of atopic dermatitis
69
Erthymatous itchy oedematous papules discrete or confluent that mainly affects the face. May become exudative or crusted. 2ndry bact infection and LN are common
Infantile phase of atopic dermatitis
70
Childhood stage atopic dermatits
Erthymatous edematous papule replaced by lichenification; vesiculation in discoid patches
In flexural area
71
Symmetrical and bilateral demarcated coin shaped lesion on extensor aspect of limbs
Discoid eczema
72
Ulceration around malleoli is a complication of?
Stasis or varicose dermatits
73
Slate blue macules of hemosidrin deposits seen in?
Varicose dermatits
74
Stasis dermatitis
Varicose LL scaly oozing erthymatous area surrounded by slate blue macule of hemosiderin deposits
75
Malassezia
Pityriasis versicolor
Seborrheic dermatitis
76
Cradle cap
Infantile seborrheic dermatits
showing greasy yellowish scales on erthymatous area of scalp
In 2 weeks to 10 months of age
77
Precaution when you find a pompholyx lesion
Check feet for tinea pedis
78
Acute or subacute itchy vesicular eruptions that dry up in 2 weeks with desquamation of skin.
Dyshidroric eczema
Starts on sides of digits extending to soles deep seated vesicles
79
Allergic reaction to distant focus of infection happening in heavily perspiring individuals
Pompholyx (dyshidrotic eczema)
80
Ill-defined patch or erthymatous plaque with fine lamellar or branny whitish scalling
Pityriasis alba
81
Pitryasis alba Lesion subsides leaving
Scaling and hypopigmentation
82
Pityriasis alba is sometimes a manifestation of
Atopic dermatitis
83
Fine lamelar or branny whitish scalling
Pityriasis alba
84
TTT of eczema depends on
Clinical stage and almost irrespective to the type
85
What is the best line of treatment of eczema
Find the cause and avoid it
86
Long term use of moisturizers is indicated in
Atopic dermatitis
87
Acute eczema TTT
1. Compresses:
~ potassium permanganate solution1/8k
~ 1/10.000 of lead sub acetate0.5% for oozing cases
2. Topical CS cream
88
Transient skin or mucosal swelling due to plasma leakage
Urticaria
89
Primary lesion of urticaria?
Wheals
90
Define wheals
Primary lesion of urticaria characterized by an itchy pink or pale swelling of the superficial dermis that lasts less than 24hrs
91
Whats the difference b/w wheals and angioedema
Angioedema includes swellings in the deep dermis, and subcutanous tissue or the submucosa
92
Pathogenesis of wheals
Mast cell degranulation -> histamine, IL, TNF -> vasodilation and permeability
93
What type of hypersensitivity is allergic urticaria
Type I
94
Pathogenesis of non allergic urticaria
Direct mast cell degranulation without Ag/Ab interaction
Usually by drugs and physical agents
95
Types of physical urticaria
1. Dermographism (mechanical)
2. Cold/heat urticaria (weather)
3. Solar urticaria (uv rays)
4. Aquagenic urticaria (water)
5. Cholinergic urticaria ( exercise)
96
Most cases of cases are idiopathic or follow URTI
Acute urticaria
97
Lesion due to autoimmune process or physical stimuli; food could aggravate it but not the cause
Chronic urticaria (single causative factor rarely found)
98
C/P of urticarial wheal
Very itchy sudden onset edematous plaques of various sizes subsiding within a few hours
99
Investigation of acute urticaria
Skin prick test of little value
100
Investigation of chronic urticaria
Check for Autoantibodies
101
First line management of urticaria
2nd generation antihistamine
- daily for 2-3 weeks ~> no control ~> incr dose x4 the recommended
- single agent better than combination
102
Biological therapy of urticaria
Monthly subcutaneous Anti-IgE Ab
103
In management of urticaria: systemic steroid
a short course in severe cases only
104
Adrenaline is CI in
HTN and heart ds
105
Adrenaline dose in airway obstruction
1/1000 1cc subcutaneously
106
Type4 hypersensitivity to insect bite
Papular urticaria
107
Prurigo of Hebra
Severe papular urticaria in an atopic person
108
C/P of papular urticaria
Edematous itchy papule then becomes firm pruritic papule lasts for few days
Groups in cluster/ crops at irregular interval and may vesiculate
Associated with scratch mark & possible 2• bacterial infection
109
Target or iris lesion
Erythema multiforme
110
Most common cause of erthyma multiforme
As an immune reaction to infection by HSV
111
Bilateral symmetrical lesions
1. Discoid eczema
2. Erythema multiforme
3. Psoriasis vulgaris
4. Drug eruption (symmetrical& generalized)
5. Pityriasis rosae rash ( symmetrical& generalized)
6. Secondary syphillis
112
Erythema multiforme lasts for
1-2 weeks (appears as successive crops at intervals for few days)
113
If EM is recurrent secondary to HSV
Give acyclovir 400mgx2 day for 6-12 weeks
114
Cutanous reaction to topically applied drug is?
Allergic Contact dermatitis
115
Dusky violaceous sharply margunated erythematous patch
Fixed drug eruption
116
Permanent slate blue discoloration
Healing fixed drug eruption
117
Commonest sites of FDE
Lips, dorsum of hands, penis
118
If bullae develop on a FDE lesion and rupture if will leave?
Superficial erosions
119
FDE TTT
Stop drug
Emollient and topical steroid
120
Acne is
Chronic inflammation of sebaceous hair follicle
121
Pathogenesis of acne
1. Incr sebum production
2. Pilosebaceous duct cornification
3. Colonization by P. Acne
4. Inflammatory mediators
122
Sebum of acne prone skin is deficient in?
Leinoleic acid
123
Leinoleic acid
Important for normal cornification of cells of pilosebaceous follicles
124
Open comedone
Black head
125
Whitehead lesion
Closed comedones
126
Deficient leinoleic acid in sebum leads to
Hyperkeratosis of pilosebaceous duct -> obstruction of pathway
127
Lipase by P. Ance
Cause of inflammation in acne by:
1. Degrade TAG ~> FFA ~> irritant~> hyperkeratosis
2. Chemoattractant
128
Cyproterone acetate
Anti-androgens for acne
CI in males
129
Post acne scar ttt
1. Dermabrasion
2. Laser resurfacing: Fractional co2 laser
3. Chemical peeling
130
Silvery laminated scales
Psoriasis
131
Psoriasis is a ds of adults except
Napkin Psoriasis and guttate psoriasis
132
Patho of psoriasis
Prob immune reaction involving T cell. Incr in epidermal cell proliferation 20x and vascular proliferation
More than 30% +ve family historyb
133
Koebner phenomenon
psoriasis at site of trauma
Napkin psoriasis is a presentation of it
134
Guttate psoriasis
Streptococcal throat infection
135
Psoriasis precipitating factors
1. Trauma
2. Stretococcal sore throat
3. Puberty and menopause
4. Pregnancy ( improve or worsen to generlized pustular)
5. Stress
6. Sun, humidity, hot weather (improve it)
7. Hypocalcemia
8. Antimalarial, BB, lithium : vulgaris
While sys steroids erythrodermic/ pustular
136
Primary lesion of psoriasis
Erythematous Papule
137
Erthymatous papule covered with silver scales coalesing to a well defined plaque
Psoriasis
138
Drop-like lesions on trunk preceded by acute strep infection
Guttate psoriasis
139
All psoriasis has silver scales except
Flexural psoriasis due to moisture sites and continuous friction
140
30-50% of localized psoriasis are
Psoriasis of the nails
141
Commonest form of psoriasis is
Psoriasis vulgaris
142
Psoriasis of nail characterized by
1. Pitting of nail
2. Transverse lines
3. Subungal hyperkeratosis
4. Onycholusos
143
Test for diagnosis of psoriasis
Grattage test ~> auspitz sign (pinpoint bleeding after scraping the membrane)
144
TTT of psoriasis depends on?
Extent, impact on life, side effect
145
Phototherapy and photo-chemotherapy used in
Specific ttt of psoriasis (NB-UVB - PUVA)
146
Systemic ttt of psoriasis
Methotrexate
Cyclosporin
Acitretin
Biologics
147
Mainstay ttt of moderate to severe psoriasis
NB-UVB - safe in pregnancy, lactation and children
148
Intra-lesion steroids in
Resistant nail psoriasis lesion
Hypertrophic lichen planus
Alopecia areata
149
Anthralin (dithranol)
Psoriasis ttt
Antimitotic
Highly Effective but Irritant & Stains skin
150
Goekerman technique
Tar preparation (coal tar) + UVB for psoriasis
151
Tar preparation side effect
Unpleasant odour and stain cloth
152
Methotrexate side effect
BM suppression and hepatotoxicity
CI in pregnancy and liver ds
153
Side effects of acitretin
Teratogenicity and increase serum cholesterol
CI in children and pregnancy
154
Bran-like scales
Pityriasis rosea
155
First clinical sign of pityriasis rosea
Herald patch
156
Commonest site of pityriasis rosae
Anterior chest (trunk)
157
Christmas tree pattern
2ndry rash of pityriasis rosea in the back which follow line of cleavage of skin
158
Prognosis of piyriasis rosea
-Lesion disappear in 6-8 weeks unless severe/atypical form lasts longer
-Recurrence uncommom
159
Treatment hastens pityriasis rosea clearance
Fasle
160
Rosea is usually self-limiting (6-8weeks) asymptomatic with variable degress of itching
True
161
TTT note for pityriasis rosea
Reassurance of patient
162
DD of pityriasis rosea
1. Tinea circinate
2. Guttate psoriasis
3. Secondary syphillitis rash
4. Pityrisiform drug eruption
163
How long after herald patch does the rash of rosea erupt?
1-2 weeks after
164
Well defined reddish brown patch, no active edge, fine scales @ intertriginous area
Erythrasma by Corynebacterium minutissimum
Coral red by wood’s light
165
Koebner phenomenon or isomorphic response
Skin lesions appearing in lines of trauma
Lichen, psoriasis , plane wart, molluscum, linear pattern vitiligo
166
Lichen planus associated with
HCV and autoimmune ds
167
Lichen planus is ppt by
Sun and trauma
168
Lichen planus not common at extremes of age
True
169
Wickham’s striae
Lichen planus
170
4 P of Lichen Planus
Pruritic (marked symptom)
Polygonal
Purple
Papule
171
Flat topped purple papule
Lichen planus
172
Sites commonly affected in lichen planus
Front of wrist and forearm, leg and genitalia
173
Moth eaten alopicia
Secondary syphillis
174
Exclamation mark hairs
Thin proximal and thick distal : alopecia areata
175
Follocular miniaturization
Terminal hair to villus under effect of androgen
176
Melanocytes
Dendritic cells in basal layer
177
Normal skin color
Melanin
Blood
Carotenoids
178
Depigmentation examples
Vitiligo localized
Albinism diffuse
179
How to differentiate b/w dermal and epidermal melasma
Wood’s light
180
Mainstay treatment of vitiligo
NB-UVB phototherapy
181
When can perform surgical auto-grafting in vitiligo
If ds is stationary for one yeat
182
Topical TTT Vitilgo
Potent topical steroid
Topical Calcineurin inhibitors
183
Tranexamic acid
Ttt of melasma
184
Association of melasma
Pregnancy
Ovarian cancer
Oral contraceptive
Idopathic sometimes
185
H. Ducreyi
Chancroid
186
Primary lesion of chancroid
Papule
187
C/P of chancroid
1. Soft papules surrounded by erythema ~> pustules ~> erode ~> ulcer (tender and painful)
2. Vesicles never seen
3. Ulcer: ragged & undermined edge with soft granulation at base that bleeds on manipulation
4. Accompanied by unilateral painful & tender matted LN ~> suppurate + sinuses
188
Corkscrew rotation
T.pallidum
189
Incubation period of syphillis
9-90 days
190
Chancroid incubation period
4-10 days
191
Syphillitic Chancre heal in
2-6 weeks
192
Snail track ulcers
Moth eaten alopecia
Condyloma lata
2ndry syphillis
193
Non itchy rash affecting whole body including palm and soles
Syphillitic rash
194
+ve serology but no s/s of suphillis
Latent stage of syphillis
195
Relapse of syphillis occurs during
Early latent phase (first 2 years)
196
Fate of untreated latent syphillis
1. Spontaneous cure/ burnt out 30%
2. Presistant latent syphillis 30%
3. Benign tertiary syphillis 15%
4. Chronic inflammation of vital organs 25%
197
FTA-ABS IgM
Rule out false positive reagin test and detect late syphillis
It is the first specific test to become +ve and most sensitive
Only one to diagnose neonatal syphilis
Use nichol’s strain
198
Most specific treponemal test
Treponema pallidum immobilization test (TPI)
199
Best indication of succesful syphyillis therapy is?
Falling non treponemal titre
200
Ttt of syphillis
1. Long acting benzathine penicillin:
- early: 2.4million single IM
- late : 2.4 million per week for 3 weeks
2.Erythromycin/ tetracycline 2gm daily (500mg x4 daily) for 15 days (early) 30 days (late)
201
Stratified squamous epithelium is resistant to infection by
N. Gonorrhea
202
N. Gonorrhea
Infects columnar and transitional epithilium using pili and fimbrae
Gram-ve, kidney shaped, intracellular diplocci in PMN cells
203
Birth canal gonorrhea
Ophthalmia neonatorum
204
Male is protected from trichomonas vaginalis by?
Prostatic secretions and absence of glycogen
205
T vaginalis incubation period
3 days to 3 weeks
206
Strawberry cervix and offensive discharge
T. Vaginalis
207
Dark field microscopy for
T. Pallidum and T. Vaginalis
208
Starts anterior urthera the. Posterior if untreated after 2 weeks
Gonococcal urthritis
209
Papanicolaou stain
T. Vaginalis stained smear
(Less reliable)
210
Ttt T. Vaginalis
metronidazole/tomodazole 2 gm Single dose
Or metro 500mg bid 7 days in resistant
Ttt partner too
211
Most common presenting symptom of female gonorrhea
Vaginal discharge from endocervicitis thats thin, purulent, mildly odorus
212
Painful erection and heamospermiaa
N. Gonorrhea in male complicated by seminal vesiculitis
213
Female complications of N gonnorrhea
1. Skenitis
2. PID
3. Batholonotis
4. Perihepatitis with salpingitis
214
If gonococcal cervisitis
Mostly minimum or non-discharge
Cervix 90%, urethra 80% site of affection
215
Predisposing factors to N. gonnorhea in children
1. Immature s. squamous in valvuvaginal epithilium ~> low glycogen and alkaline pH
2. Sexual abuse
3. G. Ophthalmia during birth from mother
1,2 ~> gonococcal vulvovaginitis
216
Disseminated gonorrhea infection more in?
Females.
Fever, joint affection and skin rash + positive blood culture of gonorrhea
217
Morning drop in
Gonorrhea smear test for acute cases / complicated chronic
218
Smears from over night urine for
Test contact for gonorrhea
219
When is culture preferred for gonorrhea
Female
Rectal
Oral
Disseminated infection
220
Selective media for n. Gonorrhea
Thayer martin medium
Chocolate agar: growth media
Aerobic
221
Most sensitice gonoccocal test is?
Radioimmune assay against fimbrae
222
Gonococcal follow up
3rd day no discharge ~> successful ttt
223
Coexisting chlamydial infection give?
Azithromycin oral 1gm single dose
Also prevent post gonococcal urethritis
224
First line ttt for gonococci
Ceftriaxone 250mg IM single dose
225
Alternative ttt for gonococci
Spectinomycin 2g IM single dose
226
Elementary body
Infectious form of Chlamydia trachomatis
Adapted to cellular environment
227
Inclusion body
Intracellular replicating form
228
Incubation period of chlamydia trachomatis
2 to 3 weeks
229
Chlamydia trachomatis discharge is different from gonococcal discharge by
Being mucoid or Muco-purulent discharge, and it is milder than arthritis.
230
Vertical infection of chlamydia causes
Conjunctivitis pneumonia, otitis media
231
Reiter’s syndrome caused by
Chlamydia trachomatis, ureaplasma, mycoplasma infection in male
232
Why is chlamydia trachomatis, mycoplasma and ureplasma dangerous in pregnancy?
It is a cause of abortion, still birth, premature labour
233
Investigation of chlamydia is done by
Serodiagnosis or DNA by PCR as it does not grow on artificial media
234
Mycoplasma plasma differs from chlamydia by
It can grow on artificial media
235
Fried egg colonies
Mycoplasma media on culture
236
Nongonoccoal urthritis ttt
Azithro 1gm single dose
Tetra 500mg x 1 x 4 x 14
Doxcii 100mg x1 x 2 x 14
Erythro 500mg x 1 x 4 x 14 (pregnancy)
237
Salmon red annular lesion
Psoriasis
238
Non vesicular full body rash including palm and soles
2ndry syphilis
