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Dermatology Flashcards

1
Q

Causes of erythema multi forms

A

Infection: 90%
- mycoplasma
-HSV

Drugs 10%
- NSAIDs
- abx: sulphonamides
- anti-epileptics

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2
Q

Description of erythema multiforme

A

Target lesions
Raised plaques
Confluent
Erythema

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3
Q

Describe herpes zoster opthalmicus

A

Vesicular
Small lesions
Dermatomal over V1
Erythematous
Unilateral

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4
Q

5 complications of herpes zoster opthalmicus

A

Eye: keratitis, uveitis, acute glucoma
Optic neuritis
Progressive outer retinal necrosis
Disseminated herpes zoster
Meninigoencephalitis
Ramsey hunt syndrome
Blindness
Heretic ulcers
Post herpetic neuralgia
Social/ employment complications
Analgesia dependent

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5
Q

Who requires admission for herpes zoster opthalmicus

A

Severe ocular involvement - globe
Pain requiring IV opiates
Systemically unwell
Immunocompromised

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6
Q

Blistering skin eruptions ddx

A

Erythema Miltiforme
Ten/SJS
Toxic shock syndrome
Staph scalded skin syndrome
Bullous Pemphigoid
Pemphigus vulgaris
Sunburn
Kawasaki
Insect bite
Impetigo
Drug reaction

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7
Q

Vesicular lesions

A

Primary varicella
HSV oral, genital, whitlow eczema
Hand foot and mouth cocksackie
Allergic and contact dermatitis

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8
Q

Maculopapular rashes

A

Viral exanthum
Erythema infectiousum
Roseola
Measles
Rubella
Infantile
Kawasaki
Scarlet fever
drug reaction dress

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9
Q

Petechial rash

A

cutaneous: trauma/ steroid use
Systemic: uraemic von wile brand disease
Infectious: meningococcal, influenza; haemophilia, streptococcus
Thrombocytopenia: itp, ttp, hITS, DIC, liver failure
Vasuclitis: hsp, Kawasaki chrug stras
Coughing, vomiting

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10
Q

Definition
Macular
Patch
Papule
Nodule
Petechiae
Pupura

A

Macular: flat discloration <10mm,
Patch: flat discolouration A>10mm
Papule raised <10mm
Nodule raised <10mm
Petechiae <3mm
Pupura >3mm

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11
Q

Diagnosis of Kawasaki

A

Crash and burn
Fever >5/7
4/5 criteria
1. Conjunctivitis, bilateral bulbar
2. Rash- polymorphous rash
3. Adenopathy, >1.5cm in cervical region
4. Strawberry tongue, mouth, mucosal involvement
5. Hand and feet hyperaemia, desquamatisation

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12
Q

Incomplete Kawasaki

A

Fever 5/7
And 2/3. Criteria

Or <6m and fever for 7 days unexplained

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13
Q

Ix Kawasaki

A

Fbc, crp, esr
Lfts, albumin alt
UA
Echo: coronary A aneurysm
Asot / anti dnase scarlet fever

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14
Q

Tx Kawasaki

A

Aspirin 5mg/kg
IVIG 2g/kg 10 days - prevent coronary artery aneurysm

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15
Q

Echo Kawasaki when

A

Diagnosis
2 weeks and 6 weeks

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16
Q

What is most common vasculitis in children

A

Henoch Schlein Pupura
IgA vaculitis
2-8 year olds

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17
Q

Henoch Schlein Pupura
IgA vaculitis
Age
Symptoms

A

Age 2-8 year olds
Symptoms
- palpable Pupura: lower limbs
- renal involvement: 25% Haematuria, proteinuria
- abdominal pain heme positive stool

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18
Q

Investigation and follow up hsp

A

Urinalysis and BP
Renal function
Weekly 1 month
Fortnightly 1 m
6 and 12m

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19
Q

Complications HSP

A

Interception and perforation
Renal failure

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20
Q

Erythema nodosum
Causes

A

Idiopathic
Infections: HSV, HIV, hepatitis, EBV,
Bacterial: streptococcal, TB, Yesenia
Drugs: sulfonamides, OCP, sulphonyureas
Inflammatory: sarcoidosis, IBD, bacterial, sle
Malignancy: lymphoma, leukaemia
Pregnancy

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21
Q

What is erythema nodosum symptoms

A

Tender nodules eryhematous, bilateral, subcutaneous nodules
Most: LL, ankles

Symmetrical pre tubial is most common
Tender nodule
Poor margins
1 week hard
2nd fluctuat
Lesions last 2 weeks
Arthralgia 90%

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22
Q

Biopsy of erythema nodusum

A

Michener granuloma

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23
Q

Treatment of erythema nodosum

A

Treat cause
Cease drugs
NSAIDs
Steroids
Follow up derm/ rheum

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24
Q

TeN// SJS different

A

SJS: <10%
SJS/ TEN 10-30%
TEN >30%

Severe cutaneous condition
Extreme necrosis and
Detachment of epidermis

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25
Nikolsy sign
When pressure on skin leads to lateral expansion and detachment of the epidermis
26
Causes of SJS/ TEN
Drugs 1. ABX: penicillins, sulphonamides, 2. Anticonvulsants: carbamazapine, keepra 3. NSAIDs Other 4. Malignancy 5. Infections: mycoplasma, hsv, hiv 6 autoimmune: sle
27
Erythema multi form Minor and major
Minor - no mucous membrane involvement Major - mucous membrane involvement less then 2 SJS/ ten - >2 mucous membrane Staph scalded skin syndrome - nil
28
Complication of SJS/ ten
Fluid and electrolytes Hypothermia Pain secondary bacterial infections Sepsis Ards Mof
29
Erythema mulifrome causes
Infection: hsv, mycoplasma, ebv, adenovirus Drugs: penicillin, NSAIDs, sulfonamides Malignant
30
Erythema multiforme rash
Target lesions: darker central zone, light pink, bright red Erythematous macular Base raised plaque Lesions central sparing Varying size Limbs- proximally
31
Scroten score
Mortality Age >40 = 1 Hear rate >120= 1 Cancer/ malignancy =1 Epidermal detachment >10% =1 on day one Urea >10 =1 Glucose >14 =1 Baird -<20mmol = 1 0-1= 13% 2 = 12% 3= 35% 4 = 60% 5 = 90%
32
What type of sensitive reaction is scabies Pathognomic rash Treatment
Type 4 Linear burrows Rash- small erythema is, Papule, hemorrhagic cysts Tx/ permethion cream 5%
33
What is symptoms of bachets disease
1. Relapsing uveitis 2. Oral ulcers 3. Genital ulcers Vasculitis
34
Biggest risk factor of cellulitis
Lymphedema
35
Risk factors for cellulitis
Immunosupression Diabetes Immunodeficiency Cancer Venous stasis Chronic liver disease Peripheral arterial disease
36
Causes of urticaria
Drugs: penicillin, sulfa, aspirin, NSAIDs, morhine Infection: ebv, hep b cockamamie Environment: dust, heat cold, animals Foods: fish, eggs, fruit Other: latex
37
Abcde melanoma
Asymetry Border irregularity Colour variation Diameter >6mm Evolution
38
What is association psoriasis What is it
Hla b27 Autoimmune skin condition related cd 4 and 8 r cells
39
Auspik sign
When plaques removed in psoriasis leads to pin point bleeding
40
Treatment of psoriasis
Topical emollient Steroids Vitamin A and D ointment t Cold tar Immunomodulators Uv therapy
41
What is associated Gerald patch
Pityriasis rosea Herald path- 5-10 days widespread rash Trunk and limb Christmas tree on back HPV 6,7,8 Tx reassurance
42
Treatment bullous pemphigoid
Doxycycline
43
Different bullous pemphigoid and pemphigus vulgaris
Bollous pemphigoid Age >60 Intensely puritic large tense blisters Rupture form erosions No mucous membranes Nikolsy -ve Pemphigus vulgaris Younger 40-60 Involves mucous membranes Flaccid blisters Nikolsy sign +ve
44
What causes erypsealis
Beta haemolytic streptococci pyogenes
45
Erypsealis rash
Intense erythematous plaques well demarcated tender and raised Upper dermis only
46
Bite injuries abx 1st line
Augmentin 875/125 bd for 5 days Or Doxy 100mg bd Bactrim 1 bd Ciprofloxacin 450 tds Levofloxacin 750 od Plus one of Metronidazole 500mg po tds Clindamycin 450 tds
47
What organisms in human bites
Staph Viridian strep Ekinella
48
What organism causes moluscum contagiosum
Poxvirus
49
What rash is umbilcated small flesh coloured dome Papule S
Molluscum contagiosum
50
Hand foot and mouth
Cocksackie virus
51
Rosella
Human herpes virus 6
52
Erythema migrans
Lymes disease
53
Erythema marginatum Disease related to
Rheumatic fever Macular with central clearing spares face
54
Erythema infectiosum
Slapped cheek Parovirus b19 Circumoral palor
55
What is ritters diseases
Staph scalded skin syndrome
56
What causes staph scalded skin syndrome
Exotoxin A/B Break down desmosomes causing detachment within epidermal layer
57
Rocky Mountain spotted fever Organisms
Ricketsia ricketsia Macular rash on wrists ankles spares face
58
3 Cs measles
Conjunctivitis Cough Coryza
59
Mesels rash
Mobilitorm coarse blotches Starts face 1-2 days Spreads down Kopilk - white spots in mouth 1-4 days pre rash
60
Measles MMR who gets dose
< 6 m immune >6months non immune >12 m 1 dose receive early Immunocompromised or pregnancy or children -<6m
61
When infectious in measles
3-4 days pre rash Post exposure fever 10 days Rash 14 days post
62
Complications of measles
Acute otitis media Pneumonia - leading cause of death ADEM - acute disseminated encephalomyelitis SSPE - sub acute pan encephalitis
63
What causes eczema herpetiform
HSV Disseminated viral skin reaction complicating atopic eczema Normal skin barrier is compromised
64
Common causes of contact dermatitis
Cosmetic dyes Plants Metals- nickel Chemicals Latex Rubber Photosensitive
65
Diagnostic criteria for eczema
Pruotic skin conditions Plus 3 of - hx of skin creases, elbows, knees and cheeks - ph asthma, hay fever - hx dry skin - hx visible flex oral eczema - onset <2 years Scorad - scoring atopic dermatitis
66
What is erythroderma rash
>90% inflammatory skin conditions erythema Exfoliation Oedema Serous ooze Eyelid swelling Secondary infection Lymphadenopathy
67
Causes of erythroderma
Secondary to chronic skin condition - pre existing dermatitis atopic, contact Pre existing psoriasis Pre existing blisters Generalised drug reaction Malignancy Other physical Infection
68
Complications of erythroderma
Dehydration Electrolyte loss Hypothermia Pain Secondary bacterial infection Protein loss High output cardiac failure
69
Causes of toxic shock syndrome
Tampons Osteomyelitis Wounds Post miscarriage
70
Causes of toxic shock syndrome Organisms
Life threatening inflammatory reaction caused by infection with toxins Staph or strep pyogenes
71
Treatment toxic shock
IVF Supportive ABX - flucloxacillin and clindamycin Vasopressin Strep - Ben pen - clinda
72
Symptoms toxic shock
Hypotension Fever Rash - diffuse eyrthematous Desquamatisation Headache Reduced LOC
73
Staph scalded skin syndrome caused by Age
Exfoliative toxin producing staph aureus - lysis Children <5 years Symptoms: widespread rash, progresses to blisters, rupture to burns Fever and irritability Systemically well Nikolsy +ve Good prognosis No mucous membrane s
74
Most common skin cancer
BCC
75
Precursor SCC
Actinic keratosis

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