Dermatology MSRa Flashcards
skin conditions associated with Reiter’s syndrome?/ reactive arthritis? waxy yellow rash
Keratoderma blennorrhagica
Rash target lesions on back of hands/ feet before spreading to torso after starting allopurinol?
other causes? - Pretend Another New Chant Can Stick
most common cx?
severe form?
erythema multiforme
cx: penicillin, carbemazepine, allopurinol, cocp, nssaids, sle, sarcoid, cancer, bacteria,
commonL herpes simplex
severe: mucosal involvement. erthema multiforme major
lichen sclerosis/ vs planus
planus - purple, pruritic, papular, polygonal rash on flexors. painful on vulva, not itchy wickham’s striae with red borders, can cause discharge and bleeding, koebner phenomenon (trauma sites), scarring alopecia
cx: gold, quinine, thiazide
tx: topical clobetasone butyrate/ topical cs/ benzydamine mouth wash
sclerosis - plaques, itchy. risj: cancer
red rash, nasolabial folds eczema and scalp, af parkinsons and HIV?
sebh derm
risks: ottitis externa and blepharitis
post phenytoin, mouth ulcers to blisters , fever, unwell?
other cx?
toxic epidermal necrolysis
cx: allopurinol, penicillns, nsaids, carbemazepine, penicillins
hypopigmented, scaley patches after a sun tan?
tx?
petyriasis vesicolor (fungal infection malassezia
topical antifungal
pregnancy/ breastfeeding: selenium sluphid
red crusted lesions around mouth, small testes, alopecia, anorexic?
zinc deficiency
first line hyerhidrosis tx?
topical aluminium chloride, iontophoresis - hands and feet, botulinum toxic (axillary
cx of acathiosis nigricans?
pcos, GI cancer, obese, acromegaly, cushings, hypothyroid, praderwilli, cocop, nicotinic acid
recent cold sore, rash?
erythema multiforme
sunbed, legs of women with different shades of brown?
chronic older people with slow growing features?
red/black lump that bleeds/ oozes?
superficial spreading melanoma (most common)
lentigo maligna - slow growing on face, neck arms
nodular - second most commonmiddle ages expsoed
type of melanoma: develops slowly, chronic sun exposre on face, neck arms?
lentigo maligna
sun exposed older person with waxy scaly appearance upper body?
seborrhaic keratosis
shiny area of raised skin with blood vessels running over it, central ulceration?
rodent ulcer
itchy, bruises, red palms, distended abdomen?
liver disease cx itch
ruddy complexion, paiful MTCP swelling, peptic ulcer disease, pruritus?
polyctythaemia
itchy skin, lethargy, oedema, weight gain, HTN?
CKD
scabies tx?
what type of hypersensitivity?
permethrin 5% ( leave for 8- 12 hrs)
2nd malathion (24 hrs)
repeat tx 7 days after
itchiness can stay for 4-6 weeks post eradication.
(type 4 hypersensitivity - itch caused by not mites themselves)
young boy, cyst on lateral aspect of eyebrow?
dermoid cyst
enlarging brown lesions on torso - localised proliferation of basal layer of episdemis
seborrhaeic keratossi
mobile subcutaneous lump fluctuates in size, prone to infections
sebaceous cyst
sudden patchy hair loss, positive pull test, perifollicular inflammation on biopsy?
aF?
alopecia areataa
associated with autoimmune coditions
post hair dye causing dermatitis, pigmentation, scarring alopecia?
what tpe of hypesensitive reaction?
allergic contact dermatits
TX: c/s, PDE4
non healing lesion reddish/ blue on hand/ feet with surface ulceration, blood blister like
pyogenic granuloma
androgenic alopecia men drug? lisenced?
finasteride
normal ABPI?
tx venous ulcers?
tx compression banges. normal abpi is 0/9-1.2
admitted with burns then has severe epigastric pain, haematemesis, melaena and haemodynamic instability?
infection of burns?
formula to assess extent of burns?
how to calculate fluid deficit?
describe depth of burns?
when to admit to secondary care?
Curling’s ulcer (peptic stress ulcer)
staph A
extent: wallace rule of 9s
parkland formula - fluid resus over first 24 hrs= total body surface area x wegith x 4. half fluid in first 3 hrs
give fluid to adults with 15%+, child 10%+
1- sup epidermal (no blisters
2- superficial dermal blisered, slow CRT red
2- deep dermal - white+red, reduced sensation, pain on deep pressure. (cleanse, non adherent dressing, r/v 24 hrs
3rd - full thickenss, white/waxy/leathery/brown, no pain
admit: superficial dermal 3%+ TBSA aduts/ 2%child, electrical, inhalation
small red spots on hands, FH first degree relative, recurrent nose bleeds/ rectal bleed?
aslos AF?
hereditary hemofrraghic telangectasia + AV malformations
red spots on lips and tongue, rectal bleeding
AF: hepaic, GI, av malformations, cerebral, spinal,
Acne mx? mild to mod?
mod?
pregnant?
when to refer to derm? SE of this drug?
a 12-week course
topical adapalene (CI pregnancy) with topical benzoyl peroxide
topical tretinoin with topical clindamycin
topical benzoyl peroxide with topical clindamycin
mod -add one antibiotics
topical adapalene with topical benzoyl peroxide + oral lymecycline/ doxycycline
a topical azelaic acid + oral lymecycline /doxycycline
consider for p/o isotretinoin - if carring, tried 2 abx. SE: dry skin rasied triglycerises, hair thinning, nose bleeds, ICP raised
pregnancy - erythromycin
light brown well defines nodule on shin from trauma/ insect. mild itch? overlying skin dimples
dermatofibroma
post sore throat, tear drop shapes papules on trunk.
when do they resolve by?
How is pityriasis rosea presenting differently?
guttate psoriasis (post streptococcal). normally resolve by 3 months
herald patch followed by fir tree change along line of langer. post viral infection. .self limiting resolve by 6 weeks/ christmas tree
skin conditions in pregnancy?
polumorphic eruption of pregnancy
pemphigoid gestinitis
child eczema on face worse overnight with painful blisters?
punched out erosions over cheeks and dorsal wrist
cx?
eczema herpeticum - needs antivirals iv
cx:
hsv1/2
Bullous pemphigoid vs pemphigus vulgaris?
what is nikolsky’s
bullous - no mucosal involvement. immunoflourences shows igg and C3 at dermo epidermal junction. need referral secondary care
mucosal - pemphigus.
nikolsky - spread of bullae after putting pressure on skin. painful, not itchy, flaccid vesicles. positiv ein TEN
psoriasis cx
BLANQ
nail features?
BB, lithium
ace/arb_alcohol, NSAIDS, Quinines
nails: pitting, onycholysis, subingal hyperkeratosis, loss of nail
deep red birthmark presnet at birth irrgeular colour
small ref patch appears in first month of life increase in size until 9 months, regress spontaneously?
removal?
complications?
portwine stain - does not resolve on its own
resolve on their own by 10 yrs, grow from 1 month to 9 months - strawberry naevus/ haemangioma - tx by BB/CS
bleeds, ulcer, obstructing visual defenct, low platelets
thickened, discoloured nails, onychomycosis tx?
oral terbinafine (trychophrton rubrum)/ candida
NODOSUM cx?
SORE SHINS
IX?
Streptococci/ TB
OCP
Rickettsia
Eponymous (Bechets)
Sulfonamides
Hansen’s disease (leprosy)
IBD
NHL
Sarcoidosis
other: penicillin, pregnany
telangiectasia vs spider naevi?
telangiectasia - fill from the tails
side naevi frill from the centre of the web. commone with pregnancy OCP, liver disease
alopecia areata? tx?
scarring alopecia examples?
areata - exclamation mark hairs, well demarked, regrow in 50%. try topical CS/ minox/phototherapy/ dithranol (autoimmune)
scarring - trauma, lichen planus, discoid lupus, tinea capitic (kerion)
psoriasis mx?
on hands?
scalp?
face/flexural/ genital?
steroid break?
Se of coal tar?
does vit D reduce redness?
potent C/s OD + vit D analogue separately 4 weeks
2) no improvement after 8 weeks, do vit D BD
8-12 weeks, do C/s BD for 4 weeks/ coal tar once or twice a day
scalp: topical cs 4 weeks OD
face/ gential - mild to mod C/S OD or BD for 2 weeks max/ month
secondary care: uvb 3 times a week
coal tar: stains, smells
vit d only reduces scale and plaque - avoid in pregnancy
impetigo tx?
extensive disease?
exclusion from school?
hydrogen peroxide 1%/
then
topical fusidic acid or topical mupiricon (if fusidic is resistant)
oral fluclox/ erythromycin
until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
Cx of hirsutism?
PCOs, adrenal therpay, obese, adrenal tumour/ congnital adrenal hyperplasia, phenytoin, C/S
leukoplakia is?
premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers. dx of exlcusion
acute urticaria - tx?
non sedating antihistamines (loratadine/ cetirizine) 6 weeks troublesome sleep - chlorphenimine (sedating
scaly, pink plaques, hyperkeratotic small lesions on farmer’s forehead. x?
actinic keratosis premalignant
tx: topical fluorouracil 3 weeks followed by hydrocortisone
topical diclofenac - for mild
topical imiquimod
diabetic woman bilateral erythematous lesions on her shins surrounded by telangiectasia. yellow/ blue normally no sx
other skin conditions associated with DM
necrobiosis lipoidica
DML neuropathic ulcer, vitiligo
granuloma annulare - slight hyperpigmented papular lesions, depressed centrally
34-year-old man with a history of polyarthralgia, back pain and diarrhoea is found to have a 3 cm red lesion on his shin which is starting to ulcerate
other cx?
pyoderma gangrenosum . BG (UC). starts on lower limb, pethargy (soften at site of minor injury)
PBC, IBD, SLE, IGA, haem cancers, granulopatosis with polyangitis
red crusted lesions around mouth? deficiency?
other s association?
zince
other: short, short, hepatosplenomegaly,
pruritus cx with ruddy complexion/ gout?
cx with oedema, HTN, lethargy, derranged U+ES?
with hepatosplenomegaly and w/L?
other cx?
Polycythaemia - gout, ruddy, peptic ulcer disease
CKS
lymphoma - b sx
other: irone deficiency anaemia, liver disease (ascites, jaundice, enceph, gynacomastia, spider naeci etc)
diabetes with waxy yellow lesions?
symmetrical shiny orange peel skin, red on shins, feels very hot and restless?
necrobiosis lipoidica diabeticorum
pretibial myxoedema (af graves)
ix for non healing venous ulcer?
ABPI - assess for poor arterial flow which could be affecting healing (normal 0.9-1.2)
tx: compresison bandages,
venous normally on medial malleous
can you combine tetracycline and isotretinoin?
other Se of isotretinoin
no risk of intracranial HTN
dry skin, eyes and lips/mouth - nose bleeds
low mood
raised triglycerides
hair thinning
intracranial hypertension:
photosensitivity
umbillicated small circle lesions in child? eye involvement?
molloscum contagiosum.refer urgently to opthal if eye involement
UVA ligh therapy can cause?
scc
small itchy blisters on palms and soles after sweating?
pompholyx - cold compress, emollients, top cs
conditions associated with vitiligo?
type 1 diabetes mellitus
Addison’s disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
koebner’s phenomenon
keloid scars most likely to form?
sternum, shoulder, neck, face, trunk
tx: intran-lesional steroids - triamcinolone
redness around cheeks and nose worse after drinking alcohol?
tx?
flushed, telangectasia, rhinophyma, blepharitis, worse in sunlight.
tx: mild: brimonidine is a topical alpha-adrenergic agonist
mild to mod pustule topical ivermectin +- doxycycline
tender, erythematous plaques and nodules, often accompanied by fever and neutrophilia with B/G fever, high neutrophils, malignancy haematological?
sweet’s syndrome/ febrile neutrophilic dermatosis
80 YO man with painful nodule on ear
Chondrodermatitis nodularis helicis
TEN cx:
difference between SJS and TEN?
TEN TBSA 30%+ and mucous membranes. positve nkikolsky’s, unwell.
phenytTENoin, peicillin, carbemazeTENPINE, allopurinTENlol, sulphonamides
SJS rash with TBSA <10% and antiepileptics, OCP, allopurinol
purplish, lace-patterned discolouration of the skin?
associated conditions?
livedo reticularis
AF: SLE, APLS, EDS, homocystinuria, polyarteritis nodosa, ideopathy (most common)
BCC features?
tx?
if in high risk areas?
peary collloured, central crater, rolled edges, central crater
normally routin referral
if in high risk areas - surgical excision. urgent (nose/ eyes)
topical imiquimod, fluoruracil
volcano like growth with smooth dome, past growing. likely dx?
will it resolve?
keratocanthoma
likely to resolve in 3 months but need urent derm opinion to exclude scc and excise
itchy, violaceous papules on the flexor aspects of her wrists
lichen planus - likely to have membranous involvement
purple, pruritic, papular, polygonal rash on flexors
rich white women, stress mouth ulcers, jus stopped smoking and is now chewing gum
recurrenty apthous somatitis. pain lasts 48 hrs
tx: conservative, then topical C/S/ betamethasone tablets/ beclamethason spray
consider b12
sus cancer: f 3 weeks+ swelling/ rf
