Dermatology/ENT Flashcards
Pellagra
Dermatitis
Diarrhoea
Dementia
Pregnant lady with acne - tx options
Topical benzyl peroxide
Oral erythromycin
Single nodule
- one dimples when pressed
- one doesn’t dimple when pressed
Diagnosis?
Dimple - dermatofibroma
Not dimple - amelanocytic melanoma
Erythema multiforme Vs Erythema Marginatum
Multiforme Causes
viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy
Marginatum: rheumatic fever (Group A strep)
Difference in appearance between necrobiosis lipoidica diabeticum (NLD) and pre-tibial myxoedema
NLD - both shins but often asymmetrical and with irregular shaped patches, more prone to ulcerate, prominent blood vessels
PD: more diffuse swelling and lumpiness caused by deposition of glycosaminoglycans in dermal layer, more prone to THICKENING (rather than ulcerating), discolouration and with promiment HAIR FOLLICLES which give the ‘orange peel’ texture
Management of alopecia areata
watchful waiting (self-limiting)
intralesional steroid injections
topical steroid creams
minoxidil 5% solution
Treatment options for scabies
permethrin cream - 1st line
malathion cream - 2nd line
severity stages of eczema
Clear: no evidence of eczema
Mild: areas of dry skin with infrequent itching, +/- small erythematous patches of skin
Moderate: areas of dry skin with frequent itching, erythematous area of skin and excoriations
Severe: widespread area of dry skin, continuous itching, bleeding, oozing, skin thickening, altered skin pigmentation
Treatment of eczema
Topical emollient
Moderately potent topical steroid (betamethasone valerate 0.025% or clobetasone butyrate 0.05%)
Oral abx if infected
treatment of lichen planus
topical clobetasone butyrate
what can be prescribed to aid healing of ulcers?
pentoxifylline
how to treat psoriasis
dithranol or anthraline (anthracene derivative)
candidiasis VS leukoplakia VS lichen planus
Lesions that cannot be wiped away: leukoplakia and lichen planus
Lesion that can be wiped away: candidiasis
treatment of lichen planus
topical steroids
immunomodulators
Criteria for 2WW dermatology
Any lesion scoring 3points or more / features of melanoma.
Scoring:
Major (2 points each): change in size, irregular shape or border, irregular colour
Minor (1 point each): >7mm greatest diameter, inflammation, oozing or crusting, change in sensation including itch
cause of :
- blue nails
- opaque nails
- green nails
Blue: chloroquine
Opaque: diabetes mellitus, cardiac failure, psoriasis
Green: pseudomonas spp infection
what disease is psoriatic patients most at risk of?
cardiovascular disease
non-alcoholic fatty liver disease
hyperlipidaemia
type 2 diabetes
hypertension
common side effect of lymecycline
photosensitivity
(PS: lymecycline is used to treat acne)
which medical condition would deteriorate in pregnancy?
SLE
herpes simplex
acne rosaecea
Cowden’s syndrome
multiple haemartoma syndrome
autosomal dominant
variable expression
young adults
increasing number of hair follicles tumours, a cobblestone appearance of the oral epithelium, oral papillomas, multiple skin tags
associated with high risk of breast, thyroid, GI carcinomas
where can you find scabies?
- burrow on hands and feet
- skin of axillae, thighs, umbilicus
difference between scrofuloderma and lupus vulgaris?
scrofuloderma - breakdown of skin overelying the tuberculous focus usually at a lymph node bus also occur in skin over infected bones or joints
Lupus vulgaris: painful cutaneous tuberculous skin lesions with nodular appearance. usually over face around nose, eye lids, lids, cheeks and ears. sharply marginated, red-brown papules of gelatinous consistency (apple-jelly nodules) that slowly evolve by peripheral extension and central atrophy into large plaques.
treatment of post-herpetic neuralgia
amitryptiline
gabapentin
topical capsaicin 0.075%
topical lidocaine
young child. swelling at lateral aspect of eyebrow/
?diagnosis
dermoid cyst
-cystic teratoma contains mature skin with hair follicles, sweat glands and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, thyroid tissue
what is seberrhoiec keratoses?
localised proliferation of basal layer of epidermis
AKA basal cell papillomas
tx is rarely necessary - if required, superficial cryotherapy
androgenetic alopecia VS alopecia areata VS alopecia effluvium
androgenetic: male pattern baldness
areata: non-scarring and ?autoimmune
effluvium: chemotherapy/immunosuppression / radiotherapy causes rapid hair loss.
telogen effluvium VS anagen effluvium
telogen: at the ‘dormant phase’ so that hair thins out due to physiological (eg infection) or psychological (tension) cause.
anagen: at the hair growing phase
furunculosis - what is it?
infection of hair follicle & in distal part of auditory meatus
- caused by staphylococcus
- resolve by itself in 4-10days
- pain at site of lesion usualyl exacerbated by pressure of the tragus and movement of pinna. may be slight deafness.
Acne vulgaris - what is it?
androgen driven increase in sebum production
Things that make it worse:
- POP
- hormonal changes around the period
- thick or greasy makeup
- picking/squeezing
- sweating/humid
- tight slothes
- phenytoin, steroids (anabolic/creams)
dermovate - is it a strong or weak topicalsteroids?
- more potent
- this contains 0.05% clobetasol propionate!
treatment of keloid scar
most effective: intralesional steroids
keratoacanthoma - what is it?
benign epithelial tumour. They are more common with advancing age and rare in young people.
Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
tx: surgical removal
what is the name of the classification for cellulitis?
Eron
1: no systemic signs or uncontrolled comorbidities
2: systemically unwell or well with comorbidity (peripheral artery disease, venous insifficiency, obese_
3: significant systemic upset or life threatening infection due to vascular compromise
4: sepsis or severe life threatening infection such as necrotizing fasciitis
treatment of cellulitis
depends on which class it is!
urgent hospital admission for class 3-4 OR vulnerable patients OR facial cellulitis OR susppected orbital or periorbital cellulitis
class 2: short term hospitalisation and discharge with OPAT
class 1: GP managed with PO fluclox or co-amox
give ONE diagnosis for the following scenarios where complain of pain, watering, blepharospasm and photophobia of these patients:
- welder
- climbers/skiers
- sunbed users
keratitis
(due to exposure to ultraviolet light & if they don’t use protective goggles)
common organisms causing these infections:
- pinna cellulitis
- pinna perichondritis
celulitis: staph aureus
perichondritis: pseudomonas
why does ear wax cause tinnitus, vertigo, dizzyness, hearing loss, ear discomfort of cough?
stimulating the branch of vagus nerve that supplies the outer ear
nasal polyps can be associated with what other diseases?
cystic fibrosis
asthma
hayfever
what is samter’s triad?
CF
nasal polyps
aspirin hypersensitivity
molluscum contagiosum - what is it?
clusters of small shiny papules with umbilicated centre - can be inflammed and crusty.
common in flexural skin area.
caused by poxvirus
no tx needed usually. OR molludab (5% potassium hydroxide) for <2yo OR cryotherapy OR curettage for histology
presenting complaint of scabies
severe itch, greyish-white linear burrows and papules around the finger webs, wrists, upper and lower limbs, and belt area
tx: permethrin, melathion
presenting complaint of lichen planus
itchy, purple, flat-topped papules with interspersed lacy white lines on wrists, genitalia or mucous membranes
Tx: systemic antihistamines, weak coal tar preparations, 1-2% menthol in calamine lotion and topical steroids
treatment of onychomycosis (fungal nail)
amorolfine 5% nail lacquer (for mild/superficial)
oral terbinafine 1st line (6weeks to 3 months for fingernails and 3-6months for toenails)
oral itraconazole 2nd line
AKA tinea unguium
affects toenails more than fingernails (4:1)
fungi responsible: trichophyton rubrum OR yeasts : candida
difference in presentation between acne rosaecea and seborrhoiec dermatitis
AR spare the nasolabial folds
SD affects the folds
seborrhoiec dermatitis
due to yeast malassezia ovale aka pityrosporum ovale
tx: antifungal shampoo
tx of acne rosacea
topical brimonidine gel (alpha agonist)
topical ivermectin (reduce inflammation)
topical metronidazole
systemic antibiotics eg oxytetracycline
sunscreen
camouflage creams
laser therapy for patients with prominent telangiectasia
organism causing erysipelas
strep pyogenes
tx of erythema ab igne
topical tretinoin or laser
another name for otitis media with effusion
glue ear - NO inflammation/infection
differentiate these acne!
- acne vulgaris
- acne rosacea
- acne conglobata
- acne fulminans
- acne keloidalis nuchae
- acneiform eruptions
acne vulgaris: obstruction of the pilosebaceous follicles with keratin plugs which results in comedones, inflammation and pustules.
acne rosacea: flushing is often first symptom, telangiectasia, later develops into persistent erythema with papules and pustules, rhinophyma, ocular involvement: blepharitis, sunlight may exacerbate symptom
acne conglobata: a rare and severe form of acne found mostly in men that presents with extensive inflammatory papules, suppurative nodules (that may coalesce to form sinuses) and cysts on the trunk. also associated with hydradenitis suppurativa.
acne fulminans: rare skin disorder presenting as an acute, painful, ulcerating, and hemorrhagic clinical form of acne.
acne keloidalis nuchae: firm, dome-shaped, inflammatory papules and pustules over the nape of the neck.
acneiform eruptions: like acne vulgaris but caused by drugs
1yo with soft transilluminable mass in the posterior triangle
?diagnosis
cystic hygroma
16yo with longstanding, solitary, painless mass on the lateral side of the neck
brachial cyst
- it may become swollen intermittent with tenderness during URTI
- discharge may be reported if lesion is associated with a sinus tract
2 weeks widespread rash started in abdomen. O/E multiple discrete pink-red flat and slightly raised circular and oval lesions (multiple small ones and one large lesion)
?diagnosis
pityriasis rosea
tx: supportive (will resolve 2-3months)
emollient or topical steroids can be used if itchy
very itchy, coin shaped papules - may be vesicular or crusted. occur in the limbs first.
?diagnosis
discoid eczema
chronically dry skin with widespread coin-shaped lesions. begin as itchy patches of vesicles and papules - later ooze serum and crust over. lesions are most prominent on extensor surface of extremities and buttocks.
?diagnosis
discoid eczema
AKA nummular dermatitis
tx of acute tonsillitis
phenoxybenzylpenicillin for 10/7
what is the first line of investigation for tinnitus?
audiogram
OR otoacoustic emission testing
presbyacusis - what type of hearing loss is this?
sensorineural hearing loss
treatment of allergic rhinitis
- mild to moderate intermittent OR mild persistent
- moderate to severe persistent
- intranasal or oral antihistamines
- Intranasal beclomethasone
