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4th Year > Dermatology notes > Flashcards

Dermatology notes Flashcards

1
Q

% staph aureus carriers

% in people with atopic dermatitis

A

20%

80%

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2
Q

what type of light does what for vitamin D synthesis in skin

A

UV-B light forms vitamin D3 from cholesterol

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3
Q

What is the required amount of time to create your daily amount of vitamin D?

A

About 20 minutes of sunlight over 20% of their body surface (longer does not make more)

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4
Q

What is pitted keratolysis

Mx

A

Overgrowth of corynebacteria in warm wet most environment which causes very superficial punched out lesions. Is sometimes symptomatic.

Tx = topical clindamycin/oral erythromycin

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5
Q

Erythrasma

Mx

A

Overgrowth of corynebacteria in warm wet most environment which causes red/brown discolouration. Is sometimes symptomatic. Becomes coral coloured due to birefringence under special Wood’s lamp.

Tx = topical clindamycin/oral erythromycin

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6
Q

furuncle vs carbuncle

Mx

A

If it has a single ‘head’ it is a furuncle (boil), if it has many heads it is a carbuncle. Usually staph aureus.

Mx = fluclox

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7
Q

erysipelas vs cellulitis

Mx

A

Usually systemically unwell with preceding flu-like illness. Leg is a common place for cellulitis. Can be staph or strep. Erisipelas is usually more superficial and on the face, whereas cellulitis is deeper and on the leg.

Mx = amoxicillin or coamox if very severe

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8
Q

time course of primary and secondary syphilis

A

Primary chancre

Secondary syphilis: 6-10 weeks later papulosquamous eruption often involving palms and soles

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9
Q

lyme disease organism

A

spirochete bug Borrelia burgdorferi

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10
Q

clinical course of lyme disease

A

• A tick buries its head in the person and it carries the spirochete bug Borrelia burgdorferi. It causes:
o Early features
♣ Erythema chronicum migrans = small papule at site of tick bite that develops into a large annular lesion with central bull’s eye.
♣ Systemic flu-like symptoms
o Late features
♣ CVS: heart block, myocarditis
♣ Neurological: cranial nerve palsies, meningitis
♣ Polyarthritis

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11
Q

two types of leprosy

Which has more bacilli around

A
  1. Tuberculoid leprosy – affects nerves (anaesthetic areas) and skin (hypopigmented areas) and has few mycobacteria bacilli around

Lepromatous leprosy – thickened facies, macules, papules, nodules, plaques and has lots of mycobacteria bacilli around

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12
Q

What does mycobacterium marinarum present like?

A

Recent contact with tropical fish tank causing inoculation of bacteria into hand. Causes red scaly plaque on hand which travels up the arm lymphatics causing clusters of lesions as it does so.

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13
Q

molluschi contagiosi in adults?

A

Yes, but worry about immunosuppression

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14
Q

pediculosis

A

lice (head, pubic etc)

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15
Q

incidence peaks of psoriasis

A

20s and 50s

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16
Q

genetic influence of psoriasis

A

PSORS1 and PSORS9

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17
Q

drugs from lecture that trigger psoriasis

A

beta blockers
lithium
interferon
withdrawal of steroids

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18
Q

Auspitz sign

A

when you pick at it, it bleeds.

Happens in psoriasis2

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19
Q

clinical picture of pustular psoriasis

A

Can be generalised or palmar-plantar. Has pustules and is tender. Can be systemically unwell.

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20
Q

Management steps in psoriasis:

GP and dermatologist

A

GP:

  • emollient + vitD analogue + steroid (morning then night)
  • vit D BD
  • steroid BD or other stuff like coal tar or dithroanol

Dermatologist:

  • light therapy
  • immunosuppression
  • biologics
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21
Q

what is psoralen

A

a photosensitiser you put on the skin before UV-A light therapy = PUVA therapy

Good for well demarcated psoriasis (e.g. palmar plantar)

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22
Q

when are you eligible for biologics for psoriasis?

A

Severe:
PASI >10 (psoriasis scale)
DLQI >10 (QoL dermatology scale)

and

failed methotrexate/ciclosporin

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23
Q

2 ways to get urticaria (ppathophysioligcally)

A
  1. IgE and histamine release

2. Direct degranulation of mast cells - can be physical stimuli or ASPIRIN

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24
Q

wheal vs angioedema

A

wheal = superficial and resolves in minutes to hours

angioedema = in dermis and submit tissue and resolves in 72 hours

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25
Q

Mx of anaphylaxis (know doses)

A

500ug adrenaline
200mg hydrocortisone
10mg chlorpheniramine
Oxygen

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26
Q

acute vs chronic urticaria

A

Acute is <6 weeks and is common in children. Chronic is >6 weeks with daily or episodic wheals and is common in middle aged women, usually lasting 2-5 years.

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27
Q

most common causes of acute urticaria

A
  1. Idiopathic (50%)
  2. URT infections (40%)
  3. Drugs – e.g. aspirin (10%)
  4. Food – e.g. shellfish, nuts, fruit (<1%)
28
Q

most common causes of chronic urticaria

A

idiopathic
physical things like pressure, cold, heat, water, vibration, dermographism
autoimmune

29
Q

urticaria management

A
  1. avoid triggers
  2. H1 antagonist (antihistamines)
    ♣ Sedating type at night (chlorpheniramine)
    ♣ Non-sedating type during day (cetirizine)
  3. H2 antagonists
    ♣ Ranitidine (since pathophysiology involves H1 and H2 activation)

chronic –> omalizumab
severe acute –> 4/5days pred

30
Q

main thing to exclude in history of urticaria

A

anaphylaxis - so ask about chest tightness/trouble breathing

31
Q

In atopic dermatitis (eczema), what can you give instead of steroids if you’re worried about thin skin

A

A protopic (calcineurin inhibitor e.g. tacrolimus)

32
Q

eczema - what helps lichenified skin

A

salicylic acid

33
Q

seborhoeic dermatitis in adults Mx

A

ketoconazole +/- hydrocortisone

as malasezia furfur playa a role

34
Q

pompholyx

A

itchy vesicular rash on hands on feet, common in hot months. also called dyshidrosis.

35
Q

discoid eczema presentations

A

round red patches on back of hands in 60-70 year old

36
Q

Asteatotic eczema

A

Common in elderly where you get a crazy paving appearance of the cracks in the skin surface. Most commonly on shins. More common in the winter. Needs lots of emollients.

37
Q

acute eczema

A

Rapid onset ill-defined redness, swelling with scaling, papules and vesicles. Vesicles burst causing exudate and crusting.

38
Q

lichen simplex

A

Isolated patch of lichenification due to repeated scratching or rubbing. Manage by getting patient to stop scratching. 4

39
Q

morphemic bcc

A

Atypical BCC that is skin coloured and doesn’t heal. Take home message is that it doesn’t look right and isn’t healing so you need a biopsy
Micrographic surgery

40
Q

Glasgow 7 point checklist

A

A checklist to determine risk of lesion being a melanoma:

size change
shape change
colour change

> 6mm diameter
inflammation
oozing
change in sensation

41
Q

margins for melanoma

A

2mm margin first

then

Margin in 2nd stage depends on Breslow thickness:
    0-1mm  1cm
    1-2mm  1-2cm
    2-4mm  2-3cm
    >4mm  3cm
\+/- sentinel lymph node biopsy
42
Q

margin in SCC

A

<2cm, 4mm margin
>2cm, 6mm margin
Cosmetically important, Mohs

43
Q

how do efudix and aldara work

A

Efudix = 5-FU, fluorinated uracil gets taken up into cells can causes cell cycle arrest

Aldara = imiquimod and kick starts immune system to attack abnormal cells

44
Q

What is pomade acne

A

Pomade is a non-medical word for a scented ointment or dressing for the hair. Pomade acne is when some of this ointment gets onto the forehead and contributes to acne because it is comedogenic.

45
Q

How does steroid-induced acne look different

A

o You don’t get comedones. It is not the same pathogenesis as acne vulgaris as described above
o It is highly inflammatory with many papules and pustules
o It is monomorphic (all lesions look similar)

46
Q

What is acne fulminans?

A

The worst end of the spectrum of acne. Widespread nodular and cystic appearance and can be quite explosive in onset and appear over a couple months. Patients can be quite systemically unwell (arthralgia, fever), thought to be from a hypersensitivity reaction to P. acnes. This is one of the rare times you would use a short course of steroids to treat acne.

47
Q

What is acne conglobata?

A

A form of acne where you get deep and very tender cysts. It describes a subset of very severe acne.

48
Q

what 2 metabolic syndromes cause acne

A

PCOS

CAH

49
Q

When should you review a patient with acne after starting or changing treatment

A

2m

50
Q

Acne vulgaris treatment escalation

A

Avoid comedogenic makeup/sunscreen. Advise not related to food or hygiene
1st line = benzoyl peroxide + topical clindamycin/topical retinoids. Wait a month.
2nd line = add the third. Oral COCP may be tried in women
3rd line = add oral lymecycline/doxycycline
4th line = oral isotretinoin with dermatologist
Refer anyone at any point for oral retinoids with scarring acne +/- severe acne

51
Q

Yes of isotretinoin (roacutane)

A

side effects of isotretinoin include: dry skin/eyes/mouth, nose bleeds, photosensitivity, teratogenicity (need 2 forms of contraception), low mood, raised triglycerides (needs monthly blood tests), hair thinning

52
Q

instead of topical clindamycin and oral lymecycline, what Abx do you use in pregnancy?

A

erythromycin.

and don’t use topical retinoid

53
Q

polyarteritis nodosa:

  • size of vessel
  • painful?
  • cutaneous sign
  • pathogenesis
  • associated condition
  • autoantibody
A
  • medium vessel
  • very painful
  • lived reticularis
  • IgM and C3 in vessel walls
  • Hep B
  • pANCA
54
Q

does sun make SLE better or worse

A

WORSE - key symptom

55
Q

rash in:

  • acute lupus
  • subacute lupus
  • chronic lupus
A

acute = butterfly rash with nasolabial sparing

subacute = nonindurated annular lesions that don’t scar

chronic = discoid lupus with scarring annular lesions

56
Q

important condition to exclude if someone presents with dermatomyositis

A

cancer. malignancy in 30%!

57
Q

wounds in which age group heal the best and worst:
adults
embryos
children

A

embryos heal without scarring (best)

children heal with excessive scarring (worst)

adults have slower healing but better scar

58
Q

skin changes in venous insufficiency (4)

A
  1. haemosiderin staining
  2. atophie blanche
  3. lipodermatosclerosis (inverted champagne bottle)
  4. ulceration
59
Q

venous ulcer location

A

medial malleolus

60
Q

associations:

  • erythema nodosum
  • pyoderma gangrenosum
A

erythema nodosum = IBD + sarcoid

Pyoderma gangrenosum = IBD + RA

61
Q

types of nec fash, causes and treatment

A

type 1 = polymicrobial = vancomycin and tazocin

type 2 = strep pyogenes = benzyl pen + clindamycin

All IV

62
Q

Name 3 emollients in terms of oiliness

A

Least oily = diprobase
Middle = epaderm
Most oily = 50/50 liquid parafin:white soft paraffin

63
Q

In what body areas are steroids more effective

A

In occluded areas like armpit and natal cleft

64
Q

lichen simplex

A

Thick skin due to chronic itching. can be from many things, including eczema

65
Q

which UV therapy has more chance of causing cancer

A

PUVA&raquo_space; UVB

66
Q

Yes of methotrexate

A

liver fibrosis, lung fibrosis, hair loss, bone marrow suppression, N&V, teratogenic. Must use folate alongside.

67
Q

Unilateral hand dermatitis cause

A

Probably fungal (single hand eczema is very rare)

4th Year (10 decks)

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