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Medical Finals 2020 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Which of the following are risk factors for skin infections?

a. Sunlight exposure
b. Diabetes mellitus
c. Steroids
d. Phenytoin
e. HIV Infection

A

All except Phenytoin

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2
Q

A 39 year old female presents with an erythematous rash on her legs. She has just returned from holiday in North Africa. The lesions are purpulish, painful and warm to the ouch. She has a medical history of Crohn’s disease and at present, has a flare-up of her symptoms with diarrhoea.

A

Raised, purple painful red areas on legs suggest erythema nodosum which is associated with Crohn’s disease

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3
Q

True or False? In eczema…

a. the rash is rarely itchy
b. the rash is often on the extensor surfaces
c. stress can be a trigger factor
d. ciclosporin is the usual treatment
e. there can be an association with asthma

A

a. false
b. false
c. true
d. false
e. true

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4
Q

A 12 year old female presents with an erythematous rash on her arms. She has a history of asthma. She also says that she is having difficulty sleeping because of itching. The rash is flexural in distribution and she has nail pitting. What is the most likely diagnosis?

A

History of atopy. Distribution suggests Eczema.

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5
Q

A 28 year old male presents with a rash on his hands. It is weeping fluid and in a parts has yellow crusting areas. His girlfriend has a similar rash. It responds to treatment with antibiotics. What is the most likely diagnosis?

A

Yellow crusts strongly suggests Staph. aureus infection of Impetigo.

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6
Q

A skin lesion consisting of weeping, exudative areas with a honey coloured crust is likely to be what? What is the causative agent?

A

Impetigo

Staph or group A beta-haem strep

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7
Q

What are the main causative agents for cellulitis?

A

Streptococcus
Community acquired MRSA, rare
Gram neg organisms or anaerobes in immunosuppressed or diabetic patients

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8
Q

What is the treatment for cellulitis?

A

Flucloxacillin 500mg QDS 5 days

If widespread give IV for 3-5 days

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9
Q

What is type 1 necrotizing fasciitis caused by and when is it seen?

A

Mixture of aerobic and anaerobic bacteria seen following abdominal surgery

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10
Q

What is type 2 necrotizing fasciitis caused by and when is it seen?

A

Group A streptococci, it arises spontaneously in otherwise healthy people

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11
Q

What is the treatment for necrotizing fasciitis?

A

Type 1 - broad spec abx - metronidazole
Type 2 - benpen and clindamycin, high dose
Debridement/amputation

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12
Q

What is the treatment for atopic eczema?

A

Topical steroid, frequent emollients and bath oil with soap substitutes

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13
Q

Which diseases are associated with seborrhoeic eczema?

A

Parkinsonism

HIV

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14
Q

Describe the pathophysiology of psoriasis

A

Papulo-squamous disorder, in which the skin becomes inflamed and hyperproliferates, it is t-lymphocyte driven

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15
Q

A skin biopsy showing epidermal acanthosis nd parakeratosis with an absent granular layer and elongated and clubbed rete ridges is likely to have what?

A

Psorias

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16
Q

What changes are seen in the dermis in psoriasis?

A

Capillary dilation, mixed lymphatic and lymphocytic pericascular infiltrate

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17
Q

What changes are seen in the epidermis in psoriasis?

A

Acanthosis, parakeratosis, absent granular layer, polymorphonuclea abscesses (upper epidermis), elongated and clubbed rete ridges

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18
Q

What drugs can aggravate psoriasis?

A

Lithium, antimalarials, beta blockers

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19
Q

What nail changes are seen in psoriasis?

A 
Pitting of the nail plate
Distal seperation of the nail plate
Yellow-brown discolouration
Subungal hyperkeratosis
Damaged nail matrix and loss of nail bed (rarely)
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20
Q

What is pityriasis versicolor?

A 
Hypopigmented patches
Fungal infection
Pruritic
Scale common
Treat with topical antifungal
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21
Q

How does a scabies rash present and what is the underlying pathology?

A

Pruritis
Linear burrow on the side of the fingers, interdigital webs and flexor aspect of wrist
Excoriation
Often occurs in family members
Type IV delayed hypersensitivity reaction

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22
Q

How is scabies treated?

A

Permethrin 5%
Malathion 0.5%
Itchiness persists for 4-6 weeks

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23
Q

What is acanthosis nigricans and what is it associated with?

A

Symmetrical brown velvety plaques - neck, axilla and groin

DM, PCOS, acromegaly, Cushing’s, hypothyroidism, obesity, familial

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24
Q

What is eczema herpeticum?

A

Serious - requires IV abx
Cluster of itchy and painful blisters
Infection by herpes simplex virus 1 or 2

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25
What is the most aggressive subtype of melanoma?
Nodular
26
What factors help aid ulceration healing?
ABPI - excludes arterial insifficiency - if abnormal (below 0.9) then refer to vascular surgeons Active management: compression bandaging (if fails then consider malignancy biopsy)
27
How do you test for irritants and allergens for contact dermatitis?
Skin patch test
28
What is a skin prick test used for?
Food allergies | Pollen
29
What is pemphigoid gestationis?
Pruritic blistering lesions, often peri-umbicular | Treat with PO steroids
30
What rashes are associated with pregnancy?
Pemphigoid gastationis | Polymorphic eruption of pregnancy
31
What bacteria is known to contribute to acne development?
Propionibacterium acnes
32
A skin lesion consisting of weeping, exudative areas with a honey coloured crust is likely to be what? What is the causative agent?
Impetigo caused by staphylococci or group A β-haemolytic streptococci
33
What is type 1 necrotizing fasciitis caused by and when is it seen?
Mixture of aerobic and anaerobic bacteria seen following abdominal surgery
34
What is type 2 necrotizing fasciitis caused by and when is it seen?
Group A streptococci, it arises spontaneously in otherwise healthy people
35
What is the treatment for necrotizing fasciitis?
type 1 – broad spectrum combination including metronidazole type 2 – high doses of benzylpenicillin and clindamycin Debridement/ amputation
36
What nail changes are seen in psoriasis?
- pitting of the nail plate - distal separation of the nail plate - yellow-brown discolouration - subungual hyperkeratosis - damaged nail matrix and loss of nail bed (rarely)
37
What is the difference between a discrete and confluent lesions?
Discrete - separate edges | Confluent - patches that blur together
38
Give some causes of petechiae
``` Trauma Bruising Meningococcal ITP (low platelets) Henoch-Schonlein Purpura DIC Thrombocytopenia ```
39
Give 5 systemic causes of an itch
``` Cholestasis Polycythaemia Rubra Vera Lymphoma Liver Disease Chronic Renal Insufficiency Hyperthyroidism ```
40
What disease is dermatitis herpetiformis associated with?
Coeliac disease - itching burning blisters on shoulders, elbows, scalp, ankles
41
What is erythema multiforme and when does it occur?
Steven Johnson Syndrome - mucosal involvement, target lesions
42
What are risk factors for cellulitis?
Diabetes Trauma High BMI Immunocompromised
43
What is erysipelas?
Superficial cellulitis layers of skin
44
What are common causes of cellulitis?
Staph aureus Strep pyogenes Beta-haem streptococcus
45
What would scarlet fever present with?
Mobiliform rash Tonsillitis Strawberry tongue with white papilla
46
What is folliculitis?
Inflammation of hair follicles, itchy or tender papules/pustules
47
How does measles present?
Mobiliform rash (measle-like rash) Cough, coryza Koplik's spots - white spots inside of mouth Miserable
48
A child with red swollen cheeks is likely to have what infection?
Viral | Parvovirus
49
Give 3 symptoms of rubella infection
Non-photogenic rash that starts on the face and spreads Vague, lacy ill-defined non-itchy rash Lymphadenopathy
50
What is your management for Shingles?
Acyclovir PO 800mg 5 times daily for 5 days
51
What is Coxsackie?
Hand, Foot and Mouth Disease Tender lumps on hands, foot and mouth Non-itchy
52
What gland swells in mumps?
Parotid gland
53
How are verucas treated and what virus causes them?
Human Papillomavirus Cryotherapy (10-40% success) Duofilm Salicylic Acid
54
What management is given for a large pink-red lobulated mark on a newborn baby?
Cavernous Haemangioma (strawberry mark) Usually self-limiting, no treatment Propranolol
55
What is the other term for a port wine stain and how is it treated?
Capillary Haemangioma Permanent, usually harmless, laser therapy
56
What may indicate neurofibromatosis in a newborn?
>5 cafe au lait spots
57
What do you give to treat candida?
Nystatin | Chlorohexane
58
What is timodine?
Antifungal | Used in nappy rash
59
What is Tinea?
Fungus | Causes ringworm
60
What features and history might you see from someone with a scabies infection?
Family affected Burrow lesion between fingers Explain and treat with permethrin 5% cream
61
What is erythema ab igne and what does is look like?
Hot water bottle rash | Swelling of capillaries, caused by heat exposure and swelling
62
What is hyperhidrosis and your first line management?
``` Excess production of sweat Topical aluminium chloride (SE skin irritation) Iontophoresis Botulinum toxin Surgery ```
63
What is your management in children with new onset purpura?
Immediate referral to paediatrics to ensure no meningoccal disease or ALL Purpura are larger than petichiae
64
What drugs exacerbate psoriasis?
``` Lithium BB NSAIDs ACE-i TNF-a-i Anti-malarias ```
65
What is your first line management of athlete's foot and what is given if this fails?
``` Topical antifungal (imidazole) PO antifungal (terbinafine) ```
66
What is the pathophysiology or urticaria?
Mast cell degranulation, histamine activation, vasodilations, increased capillary permeability, caused by allergens, trauma (heat, sun cold)
67
What is the difference between acute and chronic urticaria?
Acute: <6 weeks Chronic: >6 weeks
68
What kind of dermatological involvement do you see in urticaria?
``` Wheals Erythema Central white Local purpura Itching and burning rash Might be fever and arthralgia ```
69
How do you manage urticaria?
Antihistamines: PO chlorphenamine | Prednisolone
70
What is angioedema?
An urticarial subcutaneous tissue swelling of the lips, eyelids, genitalia, tongue and/or larynx.
71
What can be measured in angioedema?
Serum C4 complement level
72
How do you treat acute angioedema?
Facial oxygen, IM adrenaline, IM hydrocortisone, salbutamol nebs (occurs often in anaphylaxis)
73
What is required for an eczema diagnosis in children?
``` Itchy skin condition in the past six months Skin crease involvement History of asthma or hayfever Generally dry skin Flexural dermatitis ```
74
Give 4 different types of eczema?
Atopic - hypersensitivity reaction Discoid - asymmetrical distribution, blistering or crusting plaques Seborrhoeic - scalp, irritant or allergic
75
What is pompholyx?
Intensely itchy small vesicles on the palms and side of fingers
76
What is your baseline management for eczema?
Trigger avoidance Detergent avoidance Emollients (frequent use)
77
What is your mild management for eczema?
Sedative antihistamines Antibiotics (if required) Topical corticosteroids Topical calcineurin inhibitors
78
What is your management of moderate eczema?
Systemic antihistamines - chlorphenamine, hydroxyzine IV treatment Calcineurin inhibitor - tacrolimus immune modulators - azathioprine
79
Name one mild, moderate, potent and very potent steroid
Mild - hydrocortisone 1% Moderate - Betamethasone/Clobetasone 0.05% Potent - mometasone furoate Very potent - dermovate
80
What dose are topical steroids given in?
Finger tip units
81
What are some side effects of topical steroids?
Skin thinning Cushings Cataracts Acne
82
What is often the cause of seborrhoeic dermatitis?
Malassezia yeast - commensal found on the skin
83
What is the difference between dermatitis and eczema?
One is usually triggered by contact, the other by allergens but the terms can be used interchangably. Contact dermatitis - irritant reaction causing dry, red, eczematous lesions
84
Name at least 3 of the 6 types of psoriasis
``` Plaque Scalp Inverse Guttate Palmoplantar Pustular ```
85
Where is psoriasis usually located on the body?
Extensor pattern
86
What are 4 symptoms of psoriasis?
Itch Hyperproliferation of the epidermis - nucleus still present under microscope Improves with heat, worse with stress Nail changes - pitting, onycholysis
87
What is Koebner phenomenon?
The appearance of skn lesions in areas of cutaneous injury - inflammatory lines
88
What is your management options for psoriasis?
Atopic vitamin D - calcipotriol (suppresses skin proliferation, promotes keratinocyte differentiation) Topical corticosteroids Topical retinoids
89
What is the bacteria that propagates in acne?
Propionbacterium acne
90
What are the 5 pillars of acne formation?
1. keratinocyte proliferation 2. increased sebum production 3. p. acne colonisation 4. inflammation 5. comedones
91
What is your choice of antibiotic to give in acne?
PO doxycycline
92
What are some management options in acne?
Antibiotics Benzoyl peroxide Azelaic acid Topical retinoids
93
What is used to treat rosacea?
Metronidazole Azelaic acid Isotretinoin
94
Give 2 complications of rosacea
Rhinophyma - enlarged nose with sebaceous hyperplasia | Blepharitis - inflamed eyelids, dry eyes
95
What is the classical rash in rosacea?
Butterfly rash - facial
96
Give some differentials for a pigmented skin lesion
Seborrheic keratosis Seborrheic wart Melanoma Naevi
97
What change in a naevi should be reported?
Any change - shape, colour, pigmentation, itching, pain
98
What is considered natural variation in naevi?
Halo naevi - common in teenagers | Irregular pigmentation, black in colour, haloed by pale skin
99
What are clinical features of a melanoma?
``` Asymmetry Border irregularity Colour variability Diametre >5mm Elevation and enlargement ```
100
What is a lentigo maligna?
Looks like a giant irregular freckle, found in elderly, can be present for years before getting darker
101
What are major risk factors for melanomas?
Skin exposure
102
What excision margin is required for melanomas?
1cm excision margin for every mm depth, up to 3 cm
103
What are common metastases sites for melanomas?
Liver Brain Lung Bone
104
What is Breslow thickness?
Deepest point to surface <1mm good prognosis, 95% cure Staging for melanoma
105
What is the common presentation of a basal cell carcinoma?
Pearly Raised rolled edge Ulceration or dip in the middle 'rodent ulcer' Telangiectasia
106
What is your management for a BCC?
Mohs Surgery Radiotherapy Cryo + curettage
107
What are some variations found in squamous cell carcinomas?
Actinic keratosis - scaly spot in sundamaged skin, often a SCC precursor Bowen's diseease - red scaly patches, pre-cancerous Keratoacanthoma - slow growing or benign skin cancer, can resolve spontaneously
108
What is the causative organism in mumps and what structure does it affect?
Paramyxoma virus, parotid gland
109
What investigative samples do you take in mumps? What are some potential consequences of the disease?
Throat swab – viral PCR, sputum sample – salivary IgG | Orchitis, infertility, meningitis, pancreatitis
110
What is the most common cause of type 2 necrotising fasciitis?
Strep pyogenes – gram positive cocci in chains

Medical Finals 2020 (25 decks)

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