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Dermatology Flashcards

1
Q

Give some causes of pyoderma gangrenosum?

A 
Inflammatory bowel disease
Acute leukaemia 
Polycythemia rubra vera
Autoimmune hepatitis 
Wegeners granulomatosis 
Myeloma
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2
Q

For how long should children with impetigo stay off school for?

A

Stay off until had 48h of effective treatment

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3
Q

What is necrobiosis lipoidica?

A

Shiny area on shin with yellowish skin and telangiectasia seen in diabetes mellitus

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4
Q

What does pyoderma gangrenosum look like?

A

Recurring nodulo pustular ulcers with tender red/blue overhanging necrotic edge, healing with cribriform scars

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5
Q

What is the difference between bullous pemphigoid and pemphigus vulgaris?

A

Bullous pemphigoid: tense bullae filled with clear fluid on normal or erythematous skin. Blistering occurs subepidermally
Pemphigus vulgaris: thin walled and fragile blisters, few intact blisters occurring at dermal epidermal junction

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6
Q

What is Kawasaki disease?

A

Mucocutaneous lymph node syndrome

Fleeting erythematous rash associated with fever, cracked lips, red tongue, swollen hands and swollen neck glands

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7
Q

What is necrobiosis lipoidica diabeticorum?

A

Painless rash with central lipid like core surrounded by brownish purplish periphery
Found in type 1 and 2 diabetes

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8
Q

How do you treat necrobiosis lipoidica diabeticorum?

A

PUVA and improved therapeutic control

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9
Q

What is Kawasaki disease? How does it present?

A

Acute vasculitis of medium sized vessels classically involves the coronary arteries
Prolonged fever for more than 5 days with mucocutaneous changes and lymphadenopathy
Desquamation of fingers and toes begins in periungual region, may involves palms and soles and is observed 1-2 weeks after fever

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10
Q

How does measles present?

A

Generalised macular rash starting on head and spreads to trunk and extremities over few days
Rash lasts at least 3 days and fades in order of appearance
Can leave behind a brownish discolouration and can become confluent over the buttocks

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11
Q

A 26 year old man presents with weight loss, generalised pruritus particularly over his bottom. On examination there are some vesicles and urticarial papules over his bottom. What is it?

A

Dermatitis herpetiformis - systemic manifestation of coeliac

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12
Q

A 30 year old female who is 28 weeks pregnant presents with hyperpigmentation around cheeks, eyes and forehead giving a mask like appearance. What is it?

A

Melasma - mask of pregnancy

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13
Q

With what infections is erythema nodosum associated?

A

TB, sarcoid and mycoplasma

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14
Q

A 64 year old male presents with multiple discrete lesions of approximately 0.5-1cm in diameter over his scalp, neck and back of hands. They are scaly and rough surfaced. What are they?

A

Actinic keratosis

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15
Q

A 40 year old man presents with pruritic flat topped papules around his wrist. He has a history of bipolar disorder and takes lithium. On examination there are widespread white lace like streaky lesions on the papules and on the buccal mucosa. What is it?

A

Lichen planus

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16
Q

What drugs can cause lichen planus?

A 
Lithium
Gold 
Quinine
Beta blockers
Spironolactone
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17
Q

What is the correct name given to white lace like patterns found in lichen planus?

A

Wickhams striae

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18
Q

A 3 year old girl presents with macular confluent rash which appeared initially behind the ears and has spread. Over past 5 days she has had low grade fever, catarrh and conjunctivitis. Her mother is vague about her imms hx. What does she have?

A

Measles

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19
Q

What type of organism causes measles?

A

RNA paramyxovirus

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20
Q

How is measles spread?

A

Respiratory droplets

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21
Q

What is the incubation period for measles?

A

10-21 days

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22
Q

What symptoms occur in the prodromal phase of measles?

A 
Fever
Conjunctivitis 
Runny nose
Coughing 
Last 5 days
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23
Q

What are koplik spots?

A

Bright red lesions with central white dot which appear on buccal mucosa in measles

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24
Q

How is a diagnosis of measles made?

A

Clinical features
Viral culture from lesions
Greater than 4x rise in antibody titres

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25
What is subacute sclerosing panencephalitis?
Progressive brain disorder related to measles | Abnormal immune response leading to brain inflammation several years after measles infection
26
What are some complications of measles?
Otitis media Pneumonia Meningitis Subacute sclerosing panencephalitis
27
A 2 year old boy is mildly unwell. His mother noticed vesicles in his mouth, palms and soles of his feet. What does he have and what is the causative organism?
Hand foot and mouth | Coxsackie A16 virus
28
What are characteristic features of hand foot and mouth disease?
Fever Sore throat Ulcerating vesicles in palms, oropharynx and soles
29
What is the incubation period for hand foot and mouth?
5-7 days
30
How do hand foot and mouth lesions heal?
Without crusting
31
How is chicken pox spread?
Respiratory droplets and contact with somebody who has shingles
32
What is the causative organism in chickenpox?
Varicella zoster virus
33
What are some complications of chickenpox?
Pneumonia Encephalitis Bacterial infection of skin
34
What is the incubation period for chickenpox?
14-21 days
35
What symptoms might be experienced in the prodromal phase of chickenpox?
Malaise
36
What are the 3 stages of a chickenpox rash?
Spots: red raised spots on face or chest before spreading to rest of body Blisters: over next few hours or following day, very itchy fluid filled blisters develop on top of the spots Scabs and crusts: after a further few days, blisters dry out and scab over to form crust which gradually fall off by themselves over next week or 2
37
When is chickenpox contagious until?
Until all blisters have scabbed over | Usually 5 or 6 days after rash appears
38
In which patients with chickenpox might you use antiviral therapy?
Systemic disease in immunocompromised
39
What is the first and second line treatment for scabies?
Permethrin | Malathion
40
What is alopecia areata?
Autoimmune condition causing discrete areas of hair loss
41
What is treatment for alopecia areata?
Cortisone injections into affected area | Topical cortisone creams
42
What are cavernous haemangiomas?
Well circumscribed and lobulated lesions which appear in first 2 weeks of life on face neck or trunk Blood vessel malformation - benign tumour
43
What are symptoms of varicella pneumonia?
``` Tachypnoea Cough Dyspnoea Fever Cyanosis Pleuritic chest pain Haemoptysis ```
44
What are naevus flammeus?
Capillary malformation Usually present at birth Mainly in region supplied by cranial nerve 5 Port wine stain
45
If you have a well child with a cough and cold with small petechiae in the distribution of the SVC (right arm, head, neck and trunk above diaphragm). What do they have?
Cough petechiae | Vigorous coughing/vomiting raise SVC pressure sufficiently to cause capillary bleeding
46
What is onychogryphosis?
Over proliferation of the germinal matrix leading to excessive growth of the nail plate
47
How do you treat onychogryphosis?
Zadeks procedure - avulsion of nail and ablation of nail bed
48
Where do you find pyogenic granulomas?
Hands and face of children and young adults | Lips and gums of pregnant women
49
What is a pyogenic granuloma?
Benign capillary haemangiomas
50
How do you treat a pyogenic granuloma?
Curettage and diathermy of the base
51
What two features of an excised melanoma can give prognostic information about the chance of cure?
Breslow thickness | Clark level
52
What are predisposing factors for squamous cell carcinoma (SCC)?
Sun exposure Radiation exposure Pre malignant conditions: bowens, senile keratosis, lupus vulgaris, Paget's disease Inherited: xeroderma pigmentosum, albinism Chronic irritation: marjolins ulcer, leukoplakia, varicose veins, osteomyelitis sinus Infection: HPV 5 and 8
53
What is the histopathologic pattern in papular urticaria?
Mild subepidermal oedema Extravasation of erythrocytes Interstitial eosinophils Exocytosis of lymphocytes
54
What bug causes scarlet fever?
Streptococcal group A infection
55
What bug causes cellulitis?
Streptococcus pyogenes | Sometimes staph aureus
56
What are multiple or genital molluscum associated with?
HIV infection
57
How is molluscum contagiosum transmitted?
Direct skin to skin contact
58
What causes hidradenitis suppurativa?
Occlusion of the ducts of apocrine glands by antigen antibody complexes leading to secondary infection and abscess formation
59
Which bug causes cutaneous anthrax?
Bacillus anthracis
60
What are risk factors for cutaneous anthrax?
Contact with infected hoofed animals - sheep goats
61
What is the treatment for cutaneous anthrax?
Ciprofloxacin Doxycycline Penicillin
62
What is the Eron classification for cellulitis?
Class 1: no signs of systemic toxicity and no uncontrolled comorbidities Class 2: systemically unwell or has a comorbidity which may complicate or delay resolution Class 3: significant systemic upset - confusion, tachycardia/pnoea, hypotension, unstable comorbidities or limb threatening infection due to vascular compromise Class 4: sepsis or severe life threatening infection - necrotising fasciitis
63
What does NICE guidance say on using the Eron classification for managing cellulitis?
``` Admit for IV antibiotics: Eron class III or IV Severe or rapidly deteriorating Under 1 year of age or frail Immunocompromised Significant lymphoedema Facial cellulitis or periorbital ```
64
How is severe cellulitis managed?
IV benzylpenicillin and flucloxacillin
65
How are fungal nail infections treated?
Dermatophyte infection: oral terbinafine 6 weeks to 3 months Candida: topical antifungals - amorolfine if mild. Oral itraconazole if severe for 12 weeks
66
What are differential diagnosis for shin lesions?
Erythema nodosum Pretibial myxoedema Pyoderma gangrenosum Necrobiosis lipodica diabeticorum
67
What is the management for impetigo?
Limited localised disease: topical fusidic acid. Topical mupirocin if MRSA Extensive disease: oral flucloxacillin or erythromycin if allergy
68
What are skin manifestations of SLE?
Photosensitive butterfly rash Discoid lupus Alopecia Livedo reticularis
69
What are causes of acanthosis nigricans?
``` GI cancer DM Obesity PCOS Acromegaly Cushings disease Hypothyroidism Familial Prader willi Oral contraceptive pill Nicotinic acid ```
70
What is the management for acne rosacea?
``` Topical metronidazole if mild Oxytetracycline if severe Recommend daily high factor sunscreen Camouflage creams Laser therapy if prominent telangiectasia ```
71
What is the management for chronic plaque psoriasis?
Regular emollients First line: for potent corticosteroid once daily plus vitamin D analogue once daily applied separately for 4 weeks Second line: if no improvement after 8 weeks then vit D analogue twice daily Third line: if no improvement after 8-12 weeks then potent steroid twice daily or coal tar once or twice daily
72
How do vitamin D analogues work for psoriasis?
Reduce cell division and differentiation to reduce scale and thickness of plaques Avoid in pregnancy
73
What is hutchinsons sign?
Melanonychia Pigmentation of proximal nail fold Sign of subungal melanoma
74
What is pityriasis versicolor?
Overgrowth of Malassezia yeast Common in young males Multiple patches of skin discolouration mainly on the trunk Can be flaky and itchy Often present after spending time in sunny humid environments
75
How is pityriasis versicolor treated?
Topical antifungals - ketoconazole shampoo | Oral itraconazole if no response
76
What are predisposing factors for black hairy tongue?
``` Poor oral hygiene Antibiotics Head and neck radiation HIV IV drug use ```
77
What causes black hairy tongue?
Defective desquamation of the filiform papillae
78
What are causes of erythema multiforme?
``` Herpes simplex Orf Idiopathic Mycoplasma Streptococcus Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, COCP, nevirapine SLE Sarcoidosis Malignancy ```
79
Which scoring system is used to assess severity of psoriasis?
PASI and DLQI
80
What is necrobiosis lipoidica diabeticorum?
Shiny painless areas of yellow/red skin on shin of diabetics often associated with telangiectasia
81
What is keratoderma blennorrhagica?
Skin lesions on palms or soles seen as a feature of reactive arthritis
82
What factors may exacerbate psoriasis?
Trauma Alcohol Drugs: beta blockers, lithium, antimalarials, NSAIDs, ace inhibitors, infliximab Withdrawal of systemic steroids
83
What are causes of Stevens Johnson syndrome?
``` Idiopathic Bacteria: mycoplasma, streptococcus Virus: herpes simplex, orf Drugs: penicillin, sulphonamides, lamotrigine, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill SLE Sarcoidosis Malignancy ```
84
What are causes of livedo reticularis?
Malignancy Vasculitis SLE Cholesterol embolisation
85
What is erythema marginatum?
Pink rings on trunk and inner surfaces of arms and legs which come and go for months Associated with rheumatic fever
86
What is the management of impetigo?
Topical fusidic acid Topical retapamulin second line MRSA: topical mupirocin Extensive disease: oral fluclox/ erythromycin if allergy
87
What is the management of acne vulgaris?
Single topical therapy: retinoids, benzyl peroxide Topical combination therapy: antibiotic, benzyl peroxide, retinoid Oral antibiotics: oxytetracyline, doxycycline Oral isotretinoin
88
What is the most significant complication of PUVA therapy for psoriasis?
Squamous cell skin cancer
89
How do vitamin D analogues work for psoriasis?
Reduce cell division and differentiation
90
What are features of lichen planus?
Itchy, papular rash on palms, soles, genitalia, flexor surface of arms Polygonal shape, lace like - wickhams striae Koebner phenomenon Oral involvement in 50% Thinning of nail plate, longitudinal ridging
91
Which drugs can cause lichenoid eruptions?
Gold Quinine Thiazides
92
What is the management of lichen planus?
Topical steroids | If extensive - oral steroids or immunosuppression
93
What is erythema nodosum?
Panniculitis characterised by tender nodules on extensor surfaces of lower legs
94
With which condition is erythema marginatum associated?
Rheumatic fever (part of duckett jones criteria)
95
Which medications can precipitate psoriasis?
``` Beta blockers NSAIDs Antimalarials Lithium Tapering doses of steroids ```
96
What is the most common cause of acanthosis nigricans?
Insulin resistance - increased circulating levels, spillover into skin, leads to abnormal increase in growth
97
What clinical features are associated with dermatomyositis?
``` Heliotrope rash Proximal myopathy Clubbing Lymphadenopathy RA Raynauds Calcinosis Cachexia Dilated capillary loops of base of nails Gottrons patches ```
98
What is the name of the facial rash associated with dermatomyositis?
Heliotrope rash
99
In what percent of dermatomyositis cases is there an underlying malignancy?
15%
100
What are management options for hyperhydrosis?
Topical aluminium chloride Iontophoresis Botox Surgery: endoscopic transthoracic sympathetomy
101
What is the first line management for lichen sclerosis?
Strong topical steroid: clobetasol proprionate
102
What is necrobiosis lipoidica diabeticorum?
Painless rash with central yellowish lipid like core surrounded by brownish purplish periphery Found in type 1 and 2 diabetes
103
What are complications of chicken pox?
``` Secondary bacterial infection Pneumonia Encephalitis Disseminated haemorrhagic chicken pox Arthritis Nephritis Pancreatitis ```
104
How is seborrhoeic dermatitis managed?
Topical antifungals: ketoconazole | Topical steroids
105
What are management options of actinic keratosis?
``` Prevention of further risk: sun avoidance, sun cream Fluorouracil cream Topical diclofenac Topical imiquimod Cryotherapy Curettage and cautery ```
106
What is the name of the rash seen in secondary syphilis?
Keratoderma blennorrhagica
107
What is the management of dermatitis herpetiformis?
Gluten free diet | Dapsone
108
What is the management for pyoderma gangrenosum?
Oral steroids | Immunosuppressant therapy: ciclosporin and infliximab in difficult cases
109
What is auspitz sign?
scratch and gentle removal of scales causes capillary bleeding in psoriasis
110
What is the management of psoriasis?
General measures: Avoid precipitating factors, Regular emollients to reduce scale Topical therapies: Vitamin D analogues, Topical steroids, Coal tar preparations, Dithranol, Topical retinoids Oral therapies: Methotrexate, Retinoids, Ciclosporin Biological Agents eg infliximab Phototherapy UVB or psoralen + UVA
111
What are causes of acne vulgaris?
Hormonal (androgen) Increased sebum production Abnormal follicular keratinization Bacterial colonisation (Propionibacterium acnes)
112
What are the different presentations of acne vulgaris?
Non-inflammatory - open and closed comedones | Inflammatory - papules, pustules, nodules and cysts
113
What is the management of acne vulgaris?
Topical therapies eg benzoyl peroxide, antibiotics, retinoids Oral therapies eg antibiotics, anti-androgens, retinoids Need to continue for at least 6 weeks to see effect
114
What are complications of acne vulgaris?
Post-inflammatory hyperpigmentation Scarring Psychological and social effects
115
What is treatment of seborrhoeic dermatitis?
Cleanse with non-soap cleanser or anti-dandruff shampoo Keratolytic cleansers or creams containing salicylic acid and/or sulphur Topical antifungal cream especially ketoconazole or ciclopirox Intermittent use of mild topical steroid or tar preparations
116
What drugs cause SJS?
``` Sulfonamides: cotrimoxizole Beta-lactam: penicillins, cephalosporins Anti-convulsants: lamotrigine, carbamazepine, phenytoin, phenobarbitone Allopurinol Paracetamol NSAIDs (oxicam type mainly) Nevirapine (non-nucleoside reverse-transcriptase inhibitor) ```
117
What are non drug causes of SJS?
Viral: herpes simplex, Epstein-Barr, enteroviruses, HIV, Coxsackievirus, influenza, hepatitis, Bacterial: Group A beta-haemolytic streptococcus, mycobacteria, Mycoplasma pneumoniae Fungal: coccidioidomycosis, dermatophytosis and histoplasmosis Protozoal: malaria and trichomoniasis Immunisation: measles, hepatitis B
118
What is the management of actinic keratosis?
Cryotherapy Curettage Topical treatment: Diclofenac gel twice daily for 3 months, it is fairly well tolerated but less effective than rest. 5-Fluorouracil, cytotoxic agent. Cream applied once or twice daily for 2 to 8 weeks (efudix). Sometimes combined with salicylic acid (actikerall). Ingenol mebutate gel (protein kinase gel) is effective after only 2–3 applications
119
What is management of bowens disease?
Observation in v elderly Curettage Cryotherapy 5-flouracil cream topical
120
What are treatment options for lichen simplex?
``` Potent topical steroids 4-6 weeks with occlusion for a few hours after application Intralesional injection steroids Coal tar Moisturiser Antihistamine ```
121
What is the management of molluscum contagiosum?
``` Leave alone Cryotherapy Molludab (Potsssium Hydroxide) Curettage Salicylic acid ```
122
What are underlying systemic causes of pyoderma gangrenosum?
Inflammatory Bowel Disease– more frequent in UC Rheumatoid arthritis Chronic Active hepatitis Haematological malignancies
123
An 11 year old girl presents with increasing numbers of erythematous papules on her cheeks. There is no response to topical benzoyl peroxide gel or oral tetracycline. What are these skin lesions called? With which condition are they associated?
Facial angiofibromas or adenoma sebaceum | Associated with tuberous sclerosis
124
What are cutaneous associations of tuberous sclerosis?
Facial angiofibromas Ungual fibroma Ash leaf macules Shagreen patch
125
What are treatment options for discoid eczema?
Emollients Topical steroid Antibiotics – topical or oral Phototherapy
126
What factors can precipitate discoid eczema?
``` Localised injury such as scratch, insect bite or thermal burn Impetigo or wound infection Contact dermatitis Dry skin Varicose veins (varicose eczema) ```
127
Who gets discoid eczema?
Discoid eczema can affect children and adults Slightly more prevalent in adult males than females Males over the age of 50 years, association with chronic alcoholism Discoid eczema can occur in atopic eczema
128
How should eczema herpeticum be managed?
Oral aciclovir
129
What causes erythema ab igne?
Chronic exposure to infrared radiation
130
How long does pityriasis rosea usually persist for?
8-12 weeks
131
Does pityriasis rosea need any management?
No
132
What are causes of erythema nodosum?
Idiopathic in 1/3 Infective: Streptococcal infections (often URTI), Tuberculosis, atypical mycobacterial infection Sarcoidosis Pregnancy Oral contraceptive pill Medications: penicillin, sulphonamides, hepatitis B vaccine, isotretinoin, SSRI Rheumatological and autoimmune conditions Inflammatory bowel disease - ulcerative colitis or Crohn's disease Malignancy, mainly haematological
133
How does rosacea present?
Flushing Papules Pustules Dry and flaky facial skin
134
Give 3 systemic conditions which can cause pruritis
``` Malignancy: Lymphoma (especially Hodgkin’s), Leukaemia, Lung, Gastric tumours Chronic renal failure (dialysis) Liver Disease (intrahepatic cholestasis) Iron-deficiency anaemia Thyroid disorders: Graves Disease Infections: HIV, Hep C ```
135
What advice would you give a patient about keeping an eye on moles for melanoma?
Asymmetry in shape and / or colour Border. Look around edge of mole. Melanoma irregular, uneven or notched border Colour. Several different colours or shades of colour, or a single colour that is different to other moles Dimensions (changing dimensions / size). Melanoma can spread outwards as a flat lesion, or it can grow upwards as a hard lump UV protection advice
136
What can cause urticaria?
Acute viral infection: upper respiratory infection, viral hepatitis, infectious mononucleosis, mycoplasma Acute bacterial infection: dental abscess, sinusitis Food allergy (IgE mediated): usually milk, egg, peanut, shellfish Drug allergy (IgE mediated): often an antibiotic Drug pseudoallergy: aspirin, nonselective nonsteroidal anti-inflammatory drugs, opiates, radiocontrast media, these cause urticaria without immune activation Vaccination Bee or wasp stings
137
What is seborrhoeic dermatitis?
Inflammatory reaction related to proliferation of normal skin inhabitant fungus - malassezia furfur
138
With which conditions is seborrhoeic dermatitis associated?
HIV | Parkinson's disease
139
What is the management of seborrhoeic dermatitis?
Scalp disease: OTC containing zinc pyrithione (head and shoulders), tar (neutrogena, T gel) first line. Ketoconazole second line. Selenium sulphide, topical corticosteroid Face and body: topical antifungal ketoconazole, topical steroids
140
What causes pityriasis versicolor?
Malassezia furfur
141
What are features of pityriasis versicolor?
Commonly on trunk Hypopigmented, pink, brown patches maybe more noticeable following suntan Scale Mild pruritis
142
What are predisposing factors for pityriasis versicolor?
Immunosuppression Malnutrition Cushing's
143
What is vitiligo?
Autoimmune condition resulting in loss of melanocytes and consequent depigmentation of skin
144
Which conditions are associated with vitiligo?
``` Type 1 diabetes Mellitus Addison's disease Autoimmune thyroid disorders Pernicious anaemia Alopecia areata ```
145
What is management of vitiligo?
``` Sun block for affected areas Camouflage makeup Topical corticosteroids Topical tacrolimus Phototherapy ```
146
What is lupus pernio a manifestation of?
Sarcoidosis
147
What is recommended first line for chronic plaque psoriasis?
Regular emollients | Potent corticosteroid once daily plus vitamin D analogue applied separately once daily for up to 4 weeks
148
What are grades of pressure sore?
1: non blanching erththema over intact skin 2: partial thickness skin loss 3: full thickness, extending to subcutaneous fat 4: extensive destruction, muscle bone or supporting tissue involved
149
What are disk factors for pressure sore development?
``` Elderly CV disease Obesity Poor nutrition Immobility Smoking Neuro impairment Faecal/urinary incontinence ```
150
What are appropriate management steps for pressure sores?
``` Nutrition Antibiotics if infection Regular dressings Debridement Pain relief Patient positioning Tissue viability referral Pressure relieving mattress/chair ```
151
What are differentials for a white lesion in a woman’s anogenital region?
``` Lichen sclerosus Localised scleroderma Vitiligo SCC Bowen’s disease Lichen planus VIN ```
152
What are symptoms of lichen sclerosus?
Itching Visible white atrophic area Dysparunia Constipation
153
What is management of lichen sclerosus?
Topical steroids Topical emollients Lubricants
154
What are complications of lichen sclerosus?
``` SCC Constipation Dysparunia Vulvodynia Uropathy Scarring ```

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