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DERM > emergency dermatology > Flashcards

emergency dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

what are the causes of urticria, angioedema, anaphylaxis?

A

1) idiopathic
2) food eg nuts
3) drugs eg penicillin
4) insect bites
5) contact eg latex
6) viral or parasitic info
7) autoimmune
8) hereditary in some cases of angioedema

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2
Q

describe the pathophysiology of urticaria

A

local increase in permeability of capillaries and small venules

histamine from skin mast cells major mediator. loca mediator release from mast cells can be induced by imm+ non-immunological mechanisms

other inflammatory mediators involved eg prostaglandins, leukotrienes, chemotactic factors

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3
Q

how does urticaria present

A

swelling involving superficial dermis, raising the epidermis

itchy wheals

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4
Q

how does angioedema present

A

deeper swelling involving dermis + subcutaneous tissues

swelling of tongue + lips

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5
Q

how does anaphylaxis present

A

bronchospasm, facial + laryngeal oedema, hypotension

can present initally with urticaria + angioedema

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6
Q

what is the management of urticaria

A

antihistamines

corticosteroids if severe acute

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7
Q

what is the management of angioedema

A

adrenaline
corticosteroids
antihistamines

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8
Q

what are the complications of angioedema and anaphylaxis

A

can lead to asphyxia
cardiac arrest
death

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9
Q

what is erythema nodosum

A

a hypersensitivity resopnse to a variety of stimuli

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10
Q

what are the causes of erythema nodosum

A 
group a beta-haemolytic streptococcus
primary tuberculosis
pregnancy
malignancy
sarcoidosis
IBD
chlamydia
leprosy
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11
Q

how does erythema nodosum present?

A
  1. discrete tender nodules that can become confluent
  2. leisons continue to appear for 1-2 weeks, leave bruise-like discolouration as they resolve
  3. common site- shins
  4. lesions do not ulcerate, they resolve without atrophy or scarring
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12
Q

what is erythema multiforme

A

acute self-limiting inflammatory condition

muscoal involvement absent or limited to one mucosal surface

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13
Q

what is stevens-johnson syndrome

A

mucocutaneous necrosis with at least 2 mucosal sites involved. skin involvement limited or extensive.

features may overlap with toxic epidermal necrolysis including a prodromal illness

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14
Q

what are the causes of erythema multiforme

A

often unknown
main preciptating factor is HSV
other infections and drugs

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15
Q

what are the causes of stevens-johnson syndrome

A

drugs or combinations of infections/drugs

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16
Q

what can be seen on histopathology with stevens-johnson syndrome

A

epithelial necrosis with few inflammatory cells

the esxtensive necrosis distinguishes from erythema multiforme

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17
Q

what is toxic epidermal necrosis TEN

A

an acute severe disease characterised by extneisve skin + mucosal necrosis accompanied by systemic toxicity

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18
Q

what is the cause of toxic epidemal necrosis

A

usually drug-induced

19
Q

what is seen on histopathology with TEN

A

full thickness epidermal necrosis with subepidermal detachment

20
Q

what is the management of erythema multiforme, SJS, TEN?

A

early recognition
call for help
full supportive care to maintain haemodynamic equilibrium

21
Q

what are the complications of SJS and TEN?

A

mortality rate 5-12% SJS
>30% with TEN
death often due to sepsis, electrlyte imbalance or multi-system organ failure

22
Q

what is acute meningococcaemia?

A

a serious communicable infection transmitted via respiratory secretions

bacteria gets into circulating blood

23
Q

what is the cause of acute meningococcaemia?

A

gram negative diplococcus neisseria meningitides

24
Q

how does acute meningococcaemia present?

A

1) features of meningitis- headache, fever, neck stiff
2) features of septicaemia- hypotension, fever, myalgia
3) rash- non-blanching purpuric rash on trunk+ extremities

25
Q

describe the changing features of a rash in acute meningococcaemia

A

1) can start with a blanching maculopapular rash
2) then non-blanching purpuric rash
3) rapidly progresses to ecchymoses, haemorrhagic bullae + tissue necrosis

26
Q

what is the management of acute meningococcaemia?

A

1) antibiotics eg benzylpenicillin

2) prophylactic abc eg rifampicin for close contacts within 14days exposure

27
Q

what are the complications of acute meningococcaemia?

A

septicaemic shock
DIC
multi-organ failure
death

28
Q

what is erythroderma

A

exfoliative dermatitis involving at least 90% of skin surface (red skin)

29
Q

what are the causes of erythroderma?

A

1) previous skin disease eg eczema, psoriasis
2) lymphoma
3) drugs eg sulphonamides, gold, sulphonylureas, pencillin, allpurinol, captopril
4) idiopathic

30
Q

how does erythroderma present?

A

1) skin appears inflamed, oedematous, scaly

2) systemically unwell with lymphadenopathy + malaise

31
Q

how do you manage erythroderma?

A

1) treat underlying cause if known
2) emollients + wet wraps to maintain skin moisture
3) topical steroids to relieve inflammation

32
Q

what are the complications of erythroderma?

A

1) secondary infection
2) fluid loss + electrolyte imbalance
3) hypothermia
4) high-output HF
5) capillary-leak syndrome

33
Q

what is the prognosis of erythroderma?

A

depends on underlyign cause

overall mortality rate 20-40%

34
Q

what is ezcema herpeticum/kaposi’s varicelliform eruption?

A

widespread eruption- serious complication of atopic eczema and other skin conditions

35
Q

what is the cause of eczema herpeticum

A

herpes simplex virus

36
Q

how does eczema herpeticum present?

A

1) extensive crusted papule, blisters, erosions

2) systemically unwell with fever + malaise

37
Q

how do you manage eczema herpeticum?

A

1) antivirals eg acyclovir

2) abx for bacterial secondary infection

38
Q

what are the complications of eczema herpeticum?

A

herpes hepatitis
encephalitis
DIC
rarely death

39
Q

what is necrotising fasciitis?

A

a rapidly spreading infection of the deep fascia with secondary tissue necrosis

40
Q

what are the causes of necrotising fasciitis?

A

1) group A haemolytic streptococcus

2) mixture of anaerobic + aerobic bacteria

41
Q

what are the risk factors of necrotising fasciitis?

A

abdominal surgery
co-morbidities eg diabetes, malignancy
50% cases occur in healthy

42
Q

how does necrotising fasciitis present?

A

1) severe pain
2) erythematous, blistering, necrotic skin
3) systemically unwell with fever + tachycardia
4) crepitus- subcutaneous emphysema
5) X-ray can show soft-tissue gas

43
Q

how do you manage necrotising fasciitis?

A

urgent referral for extensive surgical debridement

IV abx

44
Q

what is the prognosis of necrotising fasciitis?

A

mortality up to 76%

DERM (5 decks)

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