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Royal College Exam > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Erythematous rash in newborn that SPARES folds…

A

Contact dermatitis

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2
Q

Erythematous rash in newborn INVOLVING folds…

A

Candida

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3
Q

Treatment of mild acne

A

Topical retinoid +/- anti-inflammatory (benzoyl peroxide)

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4
Q

TWO risk of giant congenital nevus (> 20cm predicted adult size)

A
  1. Leptomeningeal melanocytosis (CNS involvement) 2. 1-2% risk of developing melanoma (with almost 100% mortality)
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5
Q

First line treatment of scabies

A

5% permethrin - leave on overnight, treat close contacts, repeat in 1 week

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6
Q

First line treatment of head lice

A

1% permethrin x 15 mins, repeat one week later

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7
Q

MRSA skin abscess management, < 1 month

A
  • admit - drainage - vancomycin IV
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8
Q

MRSA skin abscess, infant 1-3mos, no surrounding erythema/cellulitis

A

Septra (if concern for cellulitis, add keflex)

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9
Q

MRSA skin abscess > 3 mos

A

I&D, send for culture

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10
Q

Name of the skin lesion associated with SJS & TEN

A

Erythema multiforme

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11
Q

SJS

A

< 10% skin involvement

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12
Q

Toxic epidermal necrolysis

A

> 30% skin involvement

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13
Q

Sturge-Weber syndrome

A
  • nevus flammeus (port-wine stain) in V1 - glaucoma - leptomeningeal angioma
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14
Q

Infants with subcutaneous fat necrosis are at risk of

A

hypercalcemia

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15
Q

If resistant lice (failure of treatment), what can you treat with?

A

Resultz

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16
Q

If a teen with acne failed topical anti-inflammatory/antibiotics + retinoids; what else can you do?

A

Doxycycline Anti-androgens (in female patients) Add topical retinoids/benzoyl peroxide

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17
Q

Treatment for tinea capitus

A

oral terbinafine

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18
Q

Treatment of comedonal acne

A

retinoids

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19
Q

Treatment of inflammatory acne - mild

A

retinoids + anti-inflammatory (benzoyl peroxide + antibiotic)

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20
Q

Name the lesion, when they occur, natural history

A

Halo nevus

May occur during puberty or pregnancy

The central pigmented nevus may disappear and the depigmented area usually repigments

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21
Q

Name the lesion

A

Spitz nevus

(pink/red, smooth, dome-shaped, firm, hairless papule)

usually < 1cm

local recurrence happens after excision 5% of the time

if suspect melanoma, excise entire lesion

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22
Q

Syndromes associated with the development of melanoma (3)

A

Familial mole-melanoma syndrome

Dysplastic nevus syndrome

BK mole syndrome

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23
Q

Definition of atypical nevus

When do they appear?

Management

A

Acquired, 5-15mm, round to oval, irregular margins/colour

Usually develop in puberty

Management: skin exam Q6-12 mos, photos, sun protection, monitoring for melanoma

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24
Q

What meds should you think of if someone has photosensitivity?

A

NSAIDs

Diuretics

Voriconazole

Antibiotics

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25
Q

What is Nikolsky sign?

A

Applying slight pressure with the thumb, the skin will wrinkle and the epidermis will separate from the dermis

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26
Q

How does isotrentoin (Accutane) work for acne?

A

Isotretinoin reduces size and secretion of sebaceous glands, normalizes follicular keratinization, prevents new microcomedone formation, decreases the population of P. acnes, and exerts an anti-inflammatory effect.

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27
Q

How long should someone avoid becoming pregnant after stopping Accutane?

A

at least 6 weeks

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28
Q

How can you prevent the teratogenic effect of Accutane?

A

Counsel patients to use 2 forms of birth control, do monthly pregnancy tests

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29
Q

What is this? Why does it occur?

A

Traction alopecia, common in black school-aged children, due to trauma from tight-braids, headbands (increased risk if chemically-relaxed hair)

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30
Q

Clinical features of Trichotillomania

A

Pulling, twisting, breaking of hair producing irregular areas of hair loss. Remaining hairs are various lengths and are blunt tipped (from breaking). Scalp appears normal.

Closely related to OCD.

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31
Q

What is this probably caused by?

A

Trichotillomania

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32
Q

Which cells in the skin are important for making Vit D?

A

Spinous cells in the epidermis

33
Q

How would you recognize a Langerhans cell under electron microscopy?

A

Birbeck granule

34
Q

What type of hair is on your body? (short, soft, less pigmented)

A

Vellus

35
Q

What type of hair is on your head, eyebrows, beard, etc?

A

Terminal (coarse hair)

36
Q

What happens to your hair during puberty?

A

Androgens stimulate pubic, axillary and beard hair to change from vellus to terminal

37
Q

What is vernix in the newborn?

A

Produced by stimulation of the fetal sebaceous glands by maternal androgens

AND

desquamated stratum corneum cells

38
Q

Eccrine sweat glands on the palms and soles respond to…

A

psychophysiologic stimuli (stress!)

39
Q

Eccrine sweat glands on the hairy body surfaces respond to…

A

Body temperature

(Supplied by a sympathetic nerve, sweating is mediated by acetylcholine)

40
Q

What is an erosion?

A

Focal loss of epidermis

Heals without scarring

41
Q

What is an ulcer?

A

Lesion extending INTO dermis

Heals with scarring

42
Q

What is a Wood lamp, and what can you use it for?

A

It emits UV light at 365 nm

Useful for detecting hypopigmented macules (TUBEROUS SCLEROSIS!), certain superficial fungal infections of the scalp

43
Q

Ways to test for viruses (HSV, VZV)

A

Tzanck smear

Direct fluorescent assay

PCR

44
Q

What is this rash?

A

Malar rash, associated with SLE

45
Q

This rash appears in a 2 weeks old infant. What is it? What is it associated with?

A

Neonatal lupus

Manifest during the first weeks to months of life (annular, erythematous, scaly plaques on head/neck/trunk)

May be worsened by light exposure

Due to maternal transfer to anti-Ro/La, levels of these antibodies wane by 6 mos

10% of babies with NL have both 3rd degree heart block and skin findings

Should do labs to check for cytopenias, cholestases etc

46
Q

Skin findings of Juvenile Dermatomyositis

A

Heliotrope rash - over eyelides (or racoon eyes)

Gottron papules - over knuckles

Shawl sign - telangiectasians over shoulders

Nail fold telangectasias

Palmar hyperkeratosis “mechanics hands”

47
Q
A

Gottron’s papules of Juvenile dermatomyositis

48
Q

What is this?

What condition is it associated with?

A

Pyoderma gangrenosum

Ulcerative colitis, Crohn’s disease

49
Q

What is Sweet syndrome?

A

A tender, erythematous plaque/nodule on skin associated with

fever

anemia

leukocytosis

biopsy: neutrophilic infiltrate

50
Q

Rash of a glucagonoma?

A

Necrolytic Migratory Erythema

51
Q

When do medication-related skin eruptions occur?

Classic findings?

A

7-10 days after exposure

Start on trunk, spread peripherally, usually pruritic

May have eosinophilia

52
Q

Common medications causing drug eruptions?

A

Penicillins, cephalosporins

Sulfa drugs

NSAIDS

AEDs (carbamazepine, phenytoin, phenobarb)

53
Q

When does the rash of GVHD occur?

A

1-3 weeks after transplant, at the time of engraftment

54
Q

What is DRESS (triad)

A

Drug reaction with eosinophilia and systemic symptoms

Triad: Fever, rash, hepatitis

Occurs 1-6 weeks after exposure to the medication

30% of patients have eosinophilia

55
Q

This patient is on septra. He developed neutrophilia, fever and this rash. What is this rash called?

A

Acute generalized exanthematous pustulosis (AGEP)

Often drug-related (penicillins, macrolines, sulfa drugs)

Non-follicular, sterile pustules with underlying erythema

Associated with neutrophila, fever

Tx: stop drug! May need steroids

56
Q

Side effects of topical corticosteroids

A

Atrophy

Striae

Telangectasia

Aneiform eruptions

Purpura

Hypopigmentation

Increased hair growth

57
Q

2nd line treatment for eczema (does not thin skin)

A

Elidel, protopic (tacrolimus, pimecrolimus)

58
Q

Term infant, what is this?

A

Sebaceous hyperplasia, will disappear within the first few weeks of life

59
Q

Newborn infant, what is this?

A

Milia

Superficial epidermal inclusion cysts, contain keratinized material

1-2mm

Pearly white

On face, and in mid-line palate (Epstein pearls)

60
Q

What are Epstein pearls

A

Milia on the midline of the palate

61
Q

Newborn back

A

Mongolian spots (slate-gray nevus)

Found in people with darker skin tone

Look blue-ish because the melanocytes are arrested in their migration to the epidermis (mid-dermal)

Usually fade during first years of life, do not have malignant degeneration

62
Q
A

Erythema toxicum:

firm, yellow-white, 1- to 2-mm papules or pustules with a surrounding erythematous flare

Peak incidence day 2 of life

Smear shows eosinophils

63
Q

Newborn rash

Three types of lesions

A

Transient neonatal pustular melanosis

THREE TYPES OF LESIONS:

  1. Pustules (+PMNs) w/ NO erythema
  2. Ruptured pustules (colarette)
  3. Hyperpigmented macules (may persist up to 3 months!)
64
Q

Rash that starts at 2-10 months of age, more common in black males

Discrete erythematous papules / vesicles / pustules

Very pruritic

On hands, soles

Episodic, lasting 7-14 days

Cyclic x 2 yrs

A

Infantile Acropustulosis

65
Q
A

Aplasia Cutis (developmental absence of skin)

multiple or solitary, non-inflammatory, well-demarcated ulcers

may have collar of hair

associated with syndromes/diseases: Patau (Trisomy 13), epidermolysis bullosa

66
Q

Dyskeratosis Congenita - TRIAD

A

Reticulated hyperpigementation of th eskin

Dystrophic nails

Mucous membrane leukoplakia

(also: bone marrow failure, increased squamous cell carcinoma!)

67
Q

Causes of Erythema Multiforme

A

HSV

Develops 10-14 days after onset of HSV

68
Q

What is this? What is it associated with?

A

Erythema multiforme

(Target lesions)

Associated with HSV

Lesions typically resolve in 2 weeks

Does NOT progress to SJS

69
Q

Treatment of Erythema Multiforme?

A

Supportive - topical emollients, anti-histamines, NSAIDs

Avoid steroids (no evidence, may make sxs worse)

70
Q

Causes of Stevens-Johnson Syndrome

A

Mycoplasma pneumoniae

Drugs - sulfa, NSAIDs, antibiotics, AEDs

Genetic predisposition - Han Chinese (certain HLA types) develop this after receiving carbamazepine

71
Q

SJS vs TEN

A

Rash + involvement of > 2 mucous membranes (eyes, GI, GU, resp) forming bullae, ulcers, hemorrhage

SJS < 10%

TEN > 10% + skin tenderness, no target lesions

MUST consult ophtho - scarring can lead to vision loss

Infection is the leading cause of death

72
Q

What is this?

A

Staph scalded skin syndrome

73
Q

How do you differentiate TEN from staph scalded skin?

A

SSS - Nikolsky sign is widespread, perioral crusting/erythema, sparing of intra-oral mucous membranes (can have crusted lips, conjunctivitis)

TEN - Nikolsky sign over erythematous skin, hx of drug ingestion

(also, BIOPSY!)

74
Q

Do the bullae in staph scalded skin grow any bugs?

A

nope! they are sterile - the separation of the epidermis is due to toxin production

75
Q

Treatment for staph scalded skin

A

IV cloxacillin + clindamycin (to stop production of toxins)

76
Q

Medications causing pseudoporphyria (photosensitivity reaction)

A

NSAIDs

Tetracyclines

Diuretics

Sulfa drugs

77
Q

Baby with suspected PHACE syndrome. What other tests should you do to work-up?

A

ECHO - can have cardiac abnormalities like coarct

Ophtho exam - eye anomalies (glaucoma, cataracts)

MRI brain - posterior-fossa abnormalities, dandy-walker malformation

78
Q

these lesions developed in a female newborn

the vesicles were high in eosinophils, and the systemic WBC shows eosinophilia

what condition should you think of?

A

Incontinentia pigmenti

x-linked dominant

due to mutation in IKK-gamma/NEMO gene

Royal College Exam (32 decks)

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