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Phase 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Give some differentials for a non-blanching rash:

A

Non blanching is caused by petechiae or purpura bleeding and can be checked via the glass test.

  • Meningitis
  • Henoch schonlein Purpura
  • Acute leukaemia
  • Haemolytic uraemic syndrome
  • Compressional trauma to the skin
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2
Q

What is the management of a non-blanching rash?

A

If there is any doubt - treating as meningitis

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3
Q

What is erythema nodosum associated with?

A

Bacterial:

  • Streptococcal infection
  • Mycoplasma pneumonia
  • TB
  • Lymphogranuloma venereum

Viral:

  • EBV
  • Hep B

Chronic illness:

  • Inflammatory bowel disease
  • Sarcoidosis
  • leukaemia
  • lymphoma

Drugs:

  • sulfonamides
  • NSAIDs
  • contraceptive pill
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4
Q

If urticaria continues for more than 24 hours, what should you investigate for?

A

urticarial vasculitis

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5
Q

How is SJS defined? and how is TEN defined?

A

<10% detachment of the skin - SJS

> 30% detachment of skin - TEN

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6
Q

How does SJS/ TENs usually present?

A

Prodromal symptoms

  • fever
  • cough
  • headache
  • 2- 3 days prior to onset of skin disease

Cutaneous lesion - erythematous macules which get larger and join together and eventually blister off.

Development of mucosal lesions

Mucosa involving the G.I, respiratory and G.U are all affected.

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7
Q

How should SJS/ TEN be managed?

A

Burns unit
Ophthalmology
ITU

**assess for secondary infection

IV immunoglobulins
IV Steroids
Anti-histamines

  • nutritional support
  • IV fluids/ electrolytes
  • dressing

**infection control is key. a serious complications is infection on top of the burns

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8
Q

What may be seen on a histological slide of psoriasis?

A

Parakeratosis

Increased lymphocyte infiltration

Loss of granular layer

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9
Q

What are the different types of dermatitis?

A

Eczema

Contact

  • allergy
  • Irritant

Discoid

Seborrhoeic Dermatitis
- pityrosporum ovale

Venous dermatitis

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10
Q

What is acanthosis nigricans associated with?

A

Hyperinsulinemia states:

  • DM
  • PCOS
  • Hypothyroidism

Gastric carcinoma

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11
Q

What is the treatment of pyoderma gangrenosum?

A

steroids

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12
Q

What is it called when there is an adverse reaction, leading to almost all the body becoming erythematous?

A

Acute erythroderma

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13
Q

What is it called when the epidermal cells release their attachment from one another in a pathological manner?

A

Acantholysis

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14
Q

Name an intra-dermis blistering disease:

A

Bullous Pemphigus

- damage to the desmosomes

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15
Q

How is Pemphigus vulgaris investigated and treated?

A

Nikolsky sign
Mucocutaneous lesions

Skin biopsy

  • acantholysis
  • Desmosome antibodies (immunofluorescent)

Treatment:
- IV immunoglobulins to gain control

  • High dose prednisolone
  • refer to dermatology
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16
Q

Which skin pathology cause sub-epidermal bullae?

A

bullous Pemphigoid

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17
Q

Where is the most common places for bullous pemphigoid to affect?

A

Abdomen

Inner forearms

Upper thighs

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18
Q

How is bullous pemphigoid investigated and treated?

A

Investigations:

* Nikolysky sign is NEGATIVE 
* Skin biopsies 

- Antibodies 
- Complement 

• APAG1 &amp; 2 blood test 
- Anti-bodies against the particular antigens on hemidesmosomes

Treatment:

Remove medication causing it.

Oral steroids.

Azathioprine

Localised: - topical steroids.

Infection control

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19
Q

List some pre-malignant skin conditions:

A

Actinic Keratoses (squamous):

  • erythematous silver plaques
  • cryotherapy, 5 fluorouracil

Bowen’s disease (squamous):

  • squamous cell carcinoma in situ
  • 5 fluorouracil

Lentigo Maligna:
- macular pigmentation area

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20
Q

What is the treatment for rosacea?

A

Avoidance of triggers
- sunlight etc

1st:
- topical metronidazole
- Topical Brimonidine - vasoconstriction
- topical benzyl peroxide

2nd:
- laser treatment

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21
Q

What are some complications of shingles?

A

Herpes Zoster Ophthalmicus

  • *if it involves the tip of the nose this is Hutchison’s sign and suggestive of ophthalmology involvement
  • refer urgently to ophthalmology

Ramsay Hunt Syndrome

Post herpetic neuralgia
- most common in the elderly

Dissemination
- immunocompromised

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22
Q

What tests can be done to diagnose VZV/ Shingles?

A

Tzanck smear

PCR

**usually it is a clinical diagnosis though

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23
Q

An individual with fever, lymadnopahty, sore throat and fatigue is prescribed antibiotics. they then break out in a large erythematous rash, what is the likely pathogen?

A

EBV

- do not prescribe penicillin. it induces a hypersensitivity rash

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24
Q

What are the broad types of psoriasis?

A

Plaque Psoriasis

Guttate
- following a strep infection

Erythrodermic psoriasis
- medical emergancy

Koebner
- develops over a scar

Inverse
- develops over the flexures

Palmer/pustular

Psoriatic arthritis

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25
Q

What are the different types of basal cell carcinomas?

A
  • Nodular
  • most common
  • squamous
  • pigmented
  • sclerortic
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26
Q

How is the prognosis of Melanoma measured?

A

Breslow’s depth

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27
Q

What are the different types of melanomas?

A

Superficial Malignant melanoma

Nodular

Subungnal

Amelanotic melanoma

Lentigo maligna melanoma
- develops form Lentigo Maligna (benign)

Acaral Melanoma

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28
Q

What is an immunological therapy used for melanoma?

A

Vemurafenib
- BRAF V600 mutation

Ipilimumab
- Anti CTLA -4

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29
Q

What are the surgical incisions for melanoma?

A

<1mm = 1cm

> 1mm = 2cm

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30
Q

What are some side effects of topical steroids?

A

thinning of skin

lightening of the skin on darker skin

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31
Q

What are the treatments for plaque psoriasis?

A

1st line:

  • emollients and anti-pruritus medication
  • topical steroids + vitamin D analogue

2nd line:
- double the vitamin D analogue

3rd line:
- increased topical steroid dose + coal tar

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32
Q

What is the most common cause of fungal nail infections?

A

Trichophyton Rubrum

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33
Q

What type of surgery can be used for squamous cell and basal cell carcinoma in cosmetically important sites?

A

Moh’s micrography

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34
Q

Which blistering skin condition typically involves the mucosa?
- what other symptom helps differentiate it?

A

Bullous Pemphigus

easily ruptured blisters - especially with horizontal pressure applied
- Nikolsky’s sign

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35
Q

What conditions are associated with Seborrheic dermatitis?

A

Parkinson’s

HIV

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36
Q

How is bullous pemphigoid investigated?

A

Skin biopsy with immunofluorescence IgG to the basement membrane

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37
Q

What are the main diagnostic features of skin cancer?

A

Change in shape
Change in colour
Change in size

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38
Q

How does actinic keratosis present?

A

Scaly lesions, which are not well demarcated upon sun exposed surfaces
- multiple lesions may be present

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39
Q

What is the treatment for actinic keratosis?

A

Topical fluorouracil
Topical Diclofenac
cauterage
Incision

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40
Q

What is the treatment for rosacea?

A

1st line:
Topical metronidazole
Topical Brimonidine
Topical Benzoyl perioxide

2nd line:
tacrolimus
laser therapy

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41
Q

What are some triggers to psoriasis?

A 
Stress 
Infection - especially strep 
Trauma - Kobner 
Drugs - lithium/ NSAIDs/ Antimalarials
Climate 
Smoking
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42
Q

What are the nail changes seen in psoriasis?

A

Nail pitting

Onycholysis

Subungual hyperkeratosis

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43
Q

What are the most common drugs to cause TEN?

A 
Sulfonamides 
Anti-epileptics 
Penicillins 
Allopurinol 
NSAIDs
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44
Q

What is the treatment for alopecia areata?

A

Topical steroids

Topical Minoxidil

Phototherapy

Contact immunotherapy

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45
Q

What is the management for TEN?

A

Stop the medication causing the reaction

Admitted to ITU for burns

IV Immunoglobulin
Antihistamines
Steroids

Fluids

Analgesia

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46
Q

What investigations should be done into Alopecia?

A

Examination:

  • Hair pull test
  • Dermoscopy
  • check eyebrows
  • check occipital region
  • check for scaring

Bloods

  • TFT
  • B12

Fungal samples

Syphilis serology

Autoimmune screen

Skin Biopsy

47
Q

What skin manifestation is typically seen with pancreatic cancer?

A

Thrombophlebitis migrans

48
Q

List come skin conditions seen with Diabetes:

A

Necrobiosis lipoidica
- waxy shiny yellow skin

Acanthosis nigricans

Granuloma annulare

49
Q

What is Erythema Multiforme most commonly caused by?

A

Herpes simplex - 70%

Mycoplasma

CMV

50
Q

What skin condition is seen with lung cancer?

A

Erythema Gyraton Repens

51
Q

What skin condition is typically seen with glucagonomas?

A

Necrolytic migratory erythema

52
Q

What investigations should be done into ulcers?

A

Bloods:

  • FBC - anaemia
  • Glucose levels

Orifices:
- urine dipstick for glucose

X-ray:

  • Duplex ultrasound
  • Angiography if arterial

E

S

  • Skin swabs
  • ABPI
53
Q

What complications can occur with venous ulcers?

A

Bacterial colonisation

Lipodermatosclerosis

Lymphoedema

Squamous cell carcinoma
- Marjolin ulcer

54
Q

How are venous ulcers managed?

A

Life style factors

Elevation of leg

Compressional bandages
(if ABPI >0.8)

Non- absorbent hydrocolloid gel dressings

Topical hydrocortisone for surrounding tissueWhat is

55
Q

What are the two grading systems used for Malignant melanoma?

A

Breslow’s depth

Clark’s Staging

56
Q

Where is malignant melanoma most like to spread to and what are some poor prognostic factors?

A

Liver

Eyes

Prognostic:

  • Male
  • High Miosotis
  • Lymphatic spread - distant metastasis
  • Ulceration
57
Q

What can cause squamous cell ulcers?

A

Sun exposure

Long term ulceration

Long term exposure to impressiveness medication
- kidney transplant (cylosporin)

58
Q

What is the treatment for Basal Carcinoma?

A

Moh’s
- complete circumferential removal

  • Cryotherapy/ Radiotherapy
59
Q

What are the triggers for psoriasis?

A

Stress

Streptococcal infection - Guttate

Injury - Koebner

Sunburn

Drugs

  • beta blockers
  • lithium
  • NSAIDs
  • TNF- alpha
60
Q

What is an medical emergency psoriasis?

A

Erythrodermic psoriasis

- generalised psoriasis

61
Q

What nail changes are seen in psoriasis?

A

Nail pitting

Onycholysis

Subungual Hyperkeratosis

Yellow brown discolouration

Damaged nail plate with loss of nail

62
Q

What are the main infections that can occur in Eczema?

A

Eczema herpticum - Herpes simplex virus infection

Staph infection

  • MRSA
  • Staph Aureus
63
Q

How is contact dermatitis tested for?

A

Patch test

64
Q

How does seborrheic dermatitis present and how is it treated?

A

Dandruff around the:

  • eyes
  • eyebrows
  • nasolabial folds
  • Cheeks

Cradle cap in the babies

Erythroderma
- in the elderly

Miconazole + Hydrocortisone

65
Q

What are the causes of erythema multiforme?

A 
Mycoplasma 
HSV 
Drugs: SNAPP 
- Sulfonamides 
- NSAIDs 
- Allopurinol 
- Penicillin 
- Phenytoin
66
Q

In SJS, what worrying infection is someone more at risk of?

A

HIV

67
Q

Name some causes of pruritus:

A

Cholestasis

Haematological:

  • Anaemia
  • Polycythemia rubra vera
  • Leukemia
  • Hodgkin lymphoma

Endocrine:

  • Hypothyroidism
  • DM
  • Pregnancy

Skin:

  • Urticaria
  • Eczema
  • Dermatitis Herpetiformis
68
Q

On biopsy of bullous pemphigoid what would you expect to see?

A

Subepidermal blistering with eosinophil rich inflammatory infiltrate

69
Q

What are the clinical signs of psoriasis?

A 
Extensors 
Plaque 
Well demarcated 
Auspitz sign 
Koebner effect
70
Q

What two systemic drugs are used in psoriasis?

A

Methotrexate

Cyclosporine

71
Q

What are the clinical findings of eczema?

A 
Flexure surface 
Lichenification 
Scratch marks 
Small vesicle formation 
Itchy
72
Q

What skin disease is associated with poor zinc absorption?

A

Acrodermatitis enteropathica

Classic triad of:

  • peri-oral, peri- acral dermatitis
  • diarrhoea
  • Alopecia

Caused by:

  • primary zinc transporter defect
  • secondary to deficiency - seen when weaning, cystic fibrosis
73
Q

What are some risk factors for acne?

A

Age
12- 24 years

Family history

Greasy skin

74
Q

What is a serious type of acne that require steroid treatment and what are some causes?

A

Acne fulminans

  • Anabolic steroids
  • Isotretinoin A
75
Q

What are some complications of acne?

A

Scarring

Dyspigmentation

Psychological effects

76
Q

What are the treatment options for acne vulgaris, in order of 1st line:

A

1st line:

  • topical benzoyl peroxide
  • Oral contraceptive

2nd line:

  • Oral antibiotics - tetracycline, erythromycin
  • topical antibiotics

3rd line:
- isotretinoin A

77
Q

What tests need to be done when on isotretinoin A?

A

Monthly LFTs and lipids

78
Q

Name two creams used is psoriasis which contain both a potent steroid and vitamin D:

A

Dovobet

Enstilar

79
Q

Name some common skin blistering conditions:

A

Chickenpox
herpes
impetigo
Pompholyx eczema

80
Q

How is Dermatitis herpetiformis treated? and what is the risk of this medication?

A

Gluten free diet

Dapsone

  • haemolytic anaemia
  • especially true in G6PD deficiency
81
Q

What are the subtypes of epidermolysis bullosa and what is their inheritance pattern?

A

Epidermolysis bullosa simplex
- autosomal dominant

Epidermolysis bullosa dystrophica

Junctional Epidermolysis bullosa
- autosomal recessive

82
Q

Name some drugs that cause TEN:

A

Penicillin
Co-trimoxazole
Carbamazepine
NSAIDs

83
Q

What are some of the causes of erythroderma?

A

Atopic eczema

Psoriasis

Drugs:

  • penicillin
  • allopurinol
  • Sulphonamides

Cutaneous T cell lymphoma

84
Q

What is a major complication of erythroderma, what is it typically seen with and how should it be managed?

A

Leaky capillary syndrome

Psoriasis

ITU admission

85
Q

What is the general treatment of erythroderma?

A

Monitoring:

  • fluid
  • Electrolytes
  • albumin
  • Temperature

Fluids
Electrolytes
Warmth

Bed rest
steroids

86
Q

What are the general complications of erythroderma?

A

High output heart failure

Hypothermia

Fluid loss

Increased metabolic rate

87
Q

What is the underlying pathological process to erythema multiforme? and name some common causes:

A

Type IV hypersensitivity reaction
- T cell mediated

  • herpes simplex
  • EBV
  • Anti-epileptic drugs
  • Mycoplasma infection
  • SLE
  • HIV infection
88
Q

How is erythema multiforme treated?

A

Most will self resolve in 2-4 weeks.

Persistent:
- aciclovir
or
- azathioprine

89
Q

How is pyoderma gangrenosum treated?

A

High dose oral steroids

90
Q

What are the symptoms of Drug induced hypersensitivity syndrome:

A

Typically caused by Anticonvulsant therapy
- eosinophilic reaction
occurs 2-4 weeks later

Maculopapular rash 
fever 
lymphadenopathy
arthralgia 
pharyngitis 
periorbital oedema
91
Q

What will a blood film show on Drug induced hypersensitivity syndrome:

A

Eosinophilia
Lymphocytosis
Atypical lymphocytosis

92
Q

What are the features of rosacea:

A

Flushing of the skin around:

  • cheeks
  • Nose
  • Forehead

Telectangasia

Pustule formation

Rhinophyma
- due to sebaceous gland enlargement

93
Q

What is the Nikolsky sign?

A

When a blister is rubbed laterally and causes it to shed/ burst.

Differentiates between an:

  • intra-epidermal blister
  • Sub-epidermal blister
94
Q

What are the histological findings of eczema?

A

Spongiosis
- fluid in the upper levels between the keratinocytes

  • Thickening of the epidermis - lichenification
  • Hyperkeratosis in the upper levels
95
Q

What are some triggers for eczema?

A

Infection/ systemic and local

Detergents

Stress/ anxiety

Teething in children

Cat fur

96
Q

What are some clinical features of Eczema:

A

Itchy erythematous scaly patches

Flexural distribution

Lichenification

Scratch marks

Small vesicle formation
- which may weep

Hyperpigmentation/ hypopigmentation

Follicular hyperkeratosis

  • usually seen on the back of the arms
  • association
97
Q

What are the viral infections that can effect someone with eczema?

A

HSV - Eczema herpaticum
Molluscum contagiosum

Both require acyclovir

98
Q

What are some of the severe complications of eczema?

A

Secondary infection

Kaposi’s varicelliform eruption

Keratoconjunctivitis

Retarded growth in children

99
Q

Where are the potent and very potent steroids typically used?

A

On palm surfaces due to thickening of skin

100
Q

What are the three age groups who get seborrhoeic eczema?

A

Babies
- cradle cap

Teenagers
- dandruff

Elderly
- can cause erythroderma

101
Q

What are the two peak onsets of psoriasis?

A

Teenagers

50-60s

102
Q

What gene is associated with psoriasis?

A

PSORS1

103
Q

What are the different types of psoriasis??

A

Chronic plaque psoriasis

Guttate

Erythroderma
- systemic reactions

Pustular
- usually has systemic systems

Palmopustular

Inverse

104
Q

What is one of the risk factors of using vitamin D preparation on extensive psoriasis?

A

Hypercalcemia

105
Q

What advice should be given to patients on methotrexate?

A

Use contraception
- need to be off for 3-6 months before pregnancy

LFTs need regularly checked

Avoid alcohol

Avoid NSAIDs

106
Q

How does ustekinumab work?

A

IL12/23 inhibitor

107
Q

Which drugs are typically implicated in Bullous Pemphigoid?

A

NSAiDs
Furosemide
Penicillin

108
Q

What ulcer develops over venous ulcers following long term irritation?

A

Marjolin’s ulcer

109
Q

How can acne rosacea be differentiated from seborrhoeic dermatitis?

A

Sparing of the nasolabial folds

110
Q

What gene is Psoriasis associated with?

A

HLA B13/17

111
Q

If someone develops eczema herpcitum how shoud they be managed?

A

Admitted to hospital

Aciclovir

112
Q

In liver failure how can you differentiate a spider naevi from another skin condition?

A

It will blanche and refill from the middle

113
Q

What is your treatment of eczema herpaticum?

A

Due to HSV which spreads throughout damaged eczema skin

Stop topical steroids
Fluxocacillin
Acyclovir

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