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Dermatology OAU > INVESTIGATIONS & TREATMENTS IN DERMATOLOGY > Flashcards

INVESTIGATIONS & TREATMENTS IN DERMATOLOGY Flashcards

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1
Q

List 7 conditions which WOOD’S LIGHT is used for

A 
Pseudomonas infections 
Porphyrins
Ptyriasis versicolor
Erythrasma
Tuberous sclerosis
Tetracycline stains in teeth
Vitiligo (low grade)
Fungal infections
Mepacrine stains in nails
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2
Q

List 2 conditions in which DIASCOPY is used for

A

Erythematous lesions

Granulomatous lesions – apple jelly nodule

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3
Q

PARTS OF A DERMATOSCOPE?

A

Magnifier (x10 magnification) and Non-polarized light source

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4
Q

What’s a DERMATOSCOPE used for?

A

To diagnose pigmented lesions in vivo

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5
Q

How is DERMATOSCOPY done?

A

Cover up lesion with mineral oil, water or alcohol
Illuminate
Observe at x10 magnification

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6
Q

What is a DERMATOSCOPE particularly used to diagnose?

A

Malignant melanomas and pigmented skin lesions

Others - scabies mites in their burrows

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7
Q

List 7 methods of specimen gathering

A 
Blood films
Hair brushings
Aspiration
Nail clippings
Swabbing 
SKIN(Stratum corneum)scrapings
Skin biopsy
Stool sampling
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8
Q

What is swabbing used for?

A

For ulcerations and abscesses as in impetigo

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9
Q

What is aspiration used for?

A

For intact vesicles, pustules, and Bullae.

After gentle sterilization of surface with alcohol

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10
Q

What is skin scraping/nail clipping majorly used for?

A

Dermatophyte infections

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11
Q

What skin disorders can SKIN biopsy be used for

A

Mycoses fungoides

Cutaneous T-cell lymphoma

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12
Q

When are HAIR BRUSHINGS used for?

A

To obtain material for fungal culture in SUSPECTED SCALP LESIONS

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13
Q

When do we obtain STOOL SAMPLES?

A

To check for oval and parasites in cases of FILARIASIS e.g onchocerciasis and loa loa

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14
Q

Why do we obtain BLOOD FILMS?

A

To check for Blood micofilaria

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15
Q

What time do we take blood films for Loa loa and elephantiasis

A

Los loa - 12:00 noon

Elephantiasis - 10:00 - 2:00am

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16
Q

What determines the time to take a BLOOD FILM?

A

Depends on the species involved and feeding pattern of the athropods

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17
Q

What color will FUNGAL INFECTIONS show on wood’s light?

A

greenish yellow

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18
Q

What color will ERYTHRASMA show on wood’s light?

A

Coral pink

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19
Q

What color will PSEUDOMAONAS PYOCYANAE show on wood’s light?

A

Yellow green

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20
Q

What color will PORPHYRINS show on wood’s light?

A

Bright red

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21
Q

Outline 10 LABORATORY TESTS used in Dermatology

A 
Skin snip
Histology
Electron microscopy
Microscopic examination
Culture 
Skin/surgical biopsy
Prick test
Patch test
Immunoflourescence
DIASCOPY
DNA probes
Wood's light examination
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22
Q

Mention 3 dermatological conditions diagnosable by LIGHT MICROSCOPY?

A

Scabies
Pediculosis
Fungal infections( Tinea and candidiasis)

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23
Q

Mention 3 dermatological conditions diagnosable by ELECTRON MICROSCOPY

A

Herpes simplex e.g Eczema herpeticum in babies and Viral warts
Blistering diseases e.g Epidermolysis bullosa
Genodermatosis

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24
Q

DERMATOSCOPY is otherwise known as what?

A

Dermoscopy or Epiluminoscopy or Epiluminescent microscopy

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25
Q 
What type of preparation is done for the following skin lesions? 
SCALE
PUSTULE/BULLAE
VESSICLE
INDURATED ULCER
A

SCALE - KOH Prep
PUSTULE/BULLAE - KOH prep/Gram stain
VESSICLE - Tzanck Prep
INDURATED ULCER - dark field examination(Suspected syphyllis)

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26
Q

What is the commonest preparation done?

A

KOH prep

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27
Q

What is the 2nd commonest preparation done?

A

TZANCK prep

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28
Q

Outline the 1st step you would take in preparing a KOH mount for a Dermatophytic infection?

A

I’ll vigorously scrape the scales from the edge of the scaling lesion using a no 15 scalpel blade carefully avoiding very thick pieces of scale as they would be difficult to examine

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29
Q

Outline the 2nd step you would take in preparing a KOH mount for a Dermatophytic infection

A

I’ll place 1-2 drops of KOH(20%) on the scale before covering with cover slip

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30
Q

Outline the 3rd step you would take in preparing a KOH mount for a Dermatophytic infection

A

If immediate examination is required, I’ll gently heat the slide over an alcohol lamp until the bottom of the slide feels quite warm to the touch
(AVOID BOILING)

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31
Q

Outline the 4th step you would take in preparing a KOH mount for a Dermatophytic infection

A

I’ll firmly press a paper towel on top of the cover slip or slide

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32
Q

Outline the 5th step you would take in preparing a KOH mount for a Dermatophytic infection

A

I’ll then examine the preparation under light microscope using low illumination

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33
Q

Outline the 6th step you would take in preparing a KOH mount for a Dermatophytic infection

A

I’ll then scan the entire cover slip under low power looking for the hyphae which sometimes appear refractile in the cellular areas

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34
Q

What do you do if suspicious elements are seen under low power?

A

I’ll use the high dry objective lens to examine

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35
Q

Outline the final step you would take in preparing a KOH mount for a Dermatophytic infection

A

I’ll send samples for culture

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36
Q

What’s the essence of the 4th step in KOH mount preparation

A

It spreads the cells into a thin layer on the slide as a monolayer of cells are desired in microscopic examination

Blotting gets rid of excess KOH on and around the cover slip

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37
Q

What % of KOH is used for skin scrapings?

A

10%

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38
Q

What % of KOH is used for T. Corporis?

A

10%

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39
Q

What % of KOH is used for nail clippings?

A

20-30%

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40
Q

What % of KOH is used in Onychomycosis?

A

20-30%

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41
Q

What is the rationale for using KOH in Dermatophytic infections prep?

A

KOH dissolves the keratin thus allowing hyphae to be identified

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42
Q

If KOH contains ______, Ptyriasis vesicolor will show it’s characteristic _______ appearance

A

Indian ink

Spaghetti and meatballs

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43
Q

DIRECT immunoflourescence detects what?

A

Antibodies(IgG) in a patient’s skin

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44
Q

Outline 5 dermatological conditions in which DIF would confirm the diagnosis?

A 
Pemphigus vulgaris
Bullous pemphigoid
Dermatitis herpetiformis
SLE
DLE
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45
Q

INDIRECT immunoflourescence detects what?

A

Antibodies(IgG) in a patient’s serum

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46
Q

Outline 4 dermatological conditions which can be diagnosed using TZANCK preparation?

A

Herpes simplex
Herpes zoster
Varicella zoster
Pemphigus vulgaris

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47
Q

What component of the blister is sample obtained in a TZANCK preparation?

A

The BASE of the blister is gently scraped

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48
Q

What stain is used in a TZANCK preparation

A

Giemsa or Wright stain

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49
Q

What will herpes zoster, herpes simplex and Varicella zoster show on TZANCK prep?

A

Multinucleated giant cells

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50
Q

What viral infections will not be seen on TZANCK prep?

A

Vaccinia(cow pox)

Small pox

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51
Q

What will pemphigus show on TZANCK prep?

A

Acantholytic cells

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52
Q

What are the most frequently sought organisms in CULTURE?

A

Fungi and bacteria

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53
Q

What specimen is required in superficial(dermatophytic) fungal infections?

A

Skin scrapings

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54
Q

What specimen is required for deep fungal infections?

A

Skin tissue

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55
Q

What specimen is required for T. Corporis?

A

Skin scrapings

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56
Q

What specimen is required in Histoplasmosis?

A

Skin tissue

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56
Q

What specimen is required in Histoplasmosis?

A

Skin tissue

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57
Q

How is skin specimen obtained in deep fungal infections?

A

Via a deep punch biopsy from the active border of the lesion

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58
Q

Viruses cannot be cultured in vesicular lesions (T/F)

A

False.

Viral cultures can be obtained in vesicular lesions

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59
Q

What important thing must be done simultaneously during CULTURE prep?

A

Tissue must be sent simultaneously to pathology laboratory for histological examination

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60
Q

Scrapings for culture are inoculated into what agar medium?

A

Sabourauds dextrose agar (glucose +peptone)

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61
Q

Bacteria growth in agar medium is prevented by?

A

Adding antibiotics (penicillin)

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62
Q

Saprophytic mould growth in agar medium is prevented by adding?

A

Cycloheximide

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63
Q

Culture may be continued for how long?

A

3 weeks

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64
Q

Outline 2 dermatological conditions that can be diagnosed with the aid of SKIN SNIPS/SMEARS

A

Onchocerciasis

Leprosy

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65
Q

Mention 3 drawbacks in the use of SKIN SNIPS?

A

It’s painful
Requires appropriate sterilization
May fail to diagnose light infections

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66
Q

Skin smears in leprosy are stained using what method?

A

Modified acid fast method

67
Q

The site for skin slits do not necessarily have to be cleaned with alcohol before taking samples (T/F)

A

False

68
Q

Outline 2 drawbacks of skin/surgical biopsy?

A

Taken under local anaesthetic (lignocaine +/- adrenaline)

Unhelpful in conditions without a specific histology e.g most drug eruptions

69
Q

Outline the 2 main types of SKIN BIOPSY?

A

EXCISIONAL

INCISIONAL

70
Q

When is EXCISIONAL biopsy preferable?

A

For most small lesions up to 0.5cm in diameter

71
Q

When is INCISIONAL biopsy chosen?

A

When partial removal of a larger lesion is adequate for diagnosis
Complete removal might leave an unnecessary and unsightly scar

72
Q

Outline 2 dermatological conditions in which PATCH TEST can be utilized?

A

Allergic contact dermatitis

Hand eczema

73
Q

Which skin site is preferred when carrying out PATCH TEST?

A

The Back (cos it’s really thick)

74
Q

When is the 1st and 2nd reading taken respectively when carrying out patch test?

A

48hrs and 96hrs respectively

75
Q

What type of hypersensitivity rxn does the PATCH TEST detect?

A

Type IV Hyps rxn

76
Q

What universal precaution must be ensured when carrying out a patch test?

A

Patch test material should be at a concentration adequate to elicit allergy but not high enough to be an irritant

77
Q

What skin layer is utilized in intradermal injection

A

Superficial layer of the dermis

78
Q

What size of injection needle is used for intradermal injection

A

Size 26 or 27 guage

79
Q

What skin site is preferred for intradermal injection?

A

Ulnar surface of the forearm (it’s a more sensitive site)

80
Q

What wheal diameter can be relied upon in intradermal injection

A

Wheal diameter above 4mm to 15mm

81
Q

The PRICK TEST is a modified form of intradermal injection (T/F)

A

TRUE

82
Q

What hypersensitivity rxn type does the PRICK TEST detect?

A

Type 1 hyps rxn(immediate)

83
Q

How long after introduction of commercially prepared antigen should wheal be observed in prick test?

A

10mins

84
Q

What needle size is used in the prick test

A

25 guage

85
Q

What comprises the positive and negative control in the PRICK TEST?

A

Positive control - Histamine

Negative control - Antigen diluent

86
Q

______ inhibits the magnitude of the rxn in the PRICK TEST?

A

Systemic antihistamines

87
Q

What universal precaution must be ensured when carrying out a PRICK TEST?

A

RESUSCITATION must be available since systemic rxns may develop in ptx with clear hx of type 1 hyps rxn

88
Q

Immediate weal tests are carried out to detect what?

A

IgE antibodies

89
Q

Immediate weal tests are use primarily in assessing atopic dermatitis (T/F)

A

False.

Immediate weal tests are used principally in assessing hay fever and asthma but have limited space in mgt of asthma

90
Q

Systemic rxns never occur when standard solns are used in immediate weal tests (T/F)

A

False.

Systemic rxns may occur with the correct use of standard solns

91
Q

Tuberculin/mantoux test is a PRICK TEST? (T/F)

A

False.

It’s an INTRADERMAL TEST

92
Q

Mantoux test is done to know if a person is immune to TB or not (T/F)

A

False.

It’s HEAF TEST

93
Q

HEAF TEST can be done before or after vaccination for TB (T/F)

A

False.

HEAF TEST is done prior to vaccination

94
Q

Where is the preferred skin site for a Mantoux test

A

The fore arm

95
Q

The online visual exchange of clinical and histological data is known as what?

A

TELEDERMATOLOGY

96
Q

Outline 2 dermatological conditions in which ORAL PROVOCATIVE TESTS can be employed?

A

Atopic dermatitis

Chronic urticaria and angioedema

97
Q

Outline 4 components used in diagnosis of HIV by serology?

A

Detection of HIV-antibodies in serum of ptx
Detection of HIV-antigens (p24)
Detection of HIV nucleic acids
Viral culture

98
Q

Mention 2 serological tests for detecting hiv-antibodies in ptx serum

A 
Double ELISA(Enzyme linked immuno-absorbent assay) 
Western blot
99
Q

How is HIV-nucleic acid detected via serology

A 
Using PCR(Polymerase chain rxn) 
DNA-PCR and RNA-PCR
100
Q

What serological tests is used to screen for syphyllis?

A

VDRL (venereal disease research laboratory)

RPR (rapid plasma reagin)

101
Q

What does the VDRL TEST measure?

A

It measures the antibody produced in response to Treponema pallidum

102
Q

What specimen is the VDRL test carried out on? And what does the antibodies detected react to?

A 
BLOOD and CSF
diphosphatidyl glycerol (an extract from Oxford heart)
103
Q

What does the VDRL test detect? And how is it visualised?

A

Detects ANTI-CARDIOLOIPIN Ab (IgG, IgA, IgM)

Visualised via flocculation (foaming of a test tube fluid)

104
Q

The VDRL test detects syphyllis in all stages (T/F)

A

False.

VDRL test is positive in secondary and latent syphyllis

105
Q

A positive VDRL test may be confirmed with what?

A

FTA-ABS (Fluorescent Treponema Antibody- ABSorption)

A more specific test

106
Q

Outline 10 causes of VDRL false positive results?

A 
SLE
LYME DX
LEPROSY
INFECTIOUS MONONUCLEOSIS 
MALARIA
HIV
HEPATITIS
PREGNANCY
RHEUMATIC FEVER
RHEUMATOID ARTHRITIS
107
Q

Outline one dermatological condition in which DNA PROBES is useful?

A

WARTS (HPV)

108
Q 
Outline one condition in which the following miscellaneous investigations are utilized? 
CHEST X-RAY
EOSINOPHILIA
ANA test
SEROLOGY
URINE DIP-STICK(glucose)
URINE CYTOLOGY(red cells)
A 
CHEST X-RAY - HISTOPLASMOSIS and TB
EOSINOPHILIA - PARASITIC INFESTATIONS and FILARIASIS
ANA test - SLE
SEROLOGY - STREPTOCOCCAL CELLULTIS
URINE DIP-STICK(glucose) - DM
URINE CYTOLOGY(red cells) - VASCULITIS
109
Q

Itemize 5 classes of treatment of dermatological conditions

A 
Systemic treatments
Physical therapy 
Other special procedures
Topical application
Surgery
110
Q

Outline the 3 components of topical skin treatment

A

Powders
Grease and oil
Liquid

111
Q

Combination of the 3 components of topical skin prep gives rise to what other 3 preps?

A

GREASY PASTES(powders + grease n oil)
LOTIONS, DRYING PASTES AND VARNISHES(powders + liquid)
COOLING PASTE AND CREAMS(powders +grease n oil + liquid)

112
Q

Topical prep are a mixture of what 3 important constituents?

A

Bases
Preservatives
Active ingredients

113
Q

Mention 2 types of Bases?

A

GREASY

NON GREASY

114
Q

When are greasy bases best used?

A

When an impervious covering is needed

When the surface activity of an active ingredient is required

115
Q

Itemize 6 categories of VEHICLES/BASES

A 
PASTES
POWDER
PAINT
CREAM
OINTMEMTS
LOTIONS
116
Q

What kind of vehicle are lotions?

A

Liquid vehicle - alcohol/aqeous based

117
Q

What are lotions used for?

A

Used for inflamed, moist or infected skin

118
Q

How do lotions mediate their function?

A

They reduce inflammation by EVAPORATION which in turn lowers the temp of the skin thereby promotes cooling and rapidly increases the concentration of the active drug

119
Q

What products can lotions be found?

A

ANTIPRURITICS such as calamine lotion (zinc carbonate + ferric oxide)

120
Q

What kind of vehicle is paints/tinctures?

A

ORGANIC SOLVENTS

121
Q

How do paint/tinctures mediate their function?

A

They evaporate rapidly and deposit a film of the active ingredient on the skin

122
Q

What products can paints/tinctures be found?

A

ANTISEPTICS/FUNGICIDES(usually contain aniline dyes)

E.g Gentian violet, castellani’s paint

123
Q

What kind of vehicle are CREAMS?

A

Semi-solid viscous emulsions

124
Q

What are the two types of creams?

A

WATER IN OIL(oily/cold cream)

OIL IN WATER(varnishing cream)

125
Q

Mention 3 examples of water in oil creams and under what conditions are they used?

A

Betnovate cream
Calamine cream
E45 cream

Useful for dry, irritating and icthyotic skin
(cools and leaves oil residue)

126
Q

Mention 3 advantages of using creams

A

Miscibility with surface exudates
Ease of removal
Patient acceptability

127
Q

What kind of vehicle are OINTMENTS?

A

Semi-solid grease or oily based

128
Q

What important constituent do ointments usually contain?

A

Yellow or white soft paraffin

129
Q

Ointments contain little water and preservative is usually required (T/F)

A

False

Ointments contain NO water and preservative NOT usually required

130
Q

How do OINTMENTS mediate their function?

A

They are occlusive and impede water loss from the skin
They have hydrating effects on the stratum corneum
Promote percutaneous absorption of medicinal agents

131
Q

When are OINTMENTS used?

A

To soften and grease thickened dry skin

132
Q

Itemize 3 examples of ointments?

A

Betnovate ointment
Sulphur ointment
Salicylic acid ointment

133
Q

What kind of vehicle is PASTES?

A

Ointment base with a high proportion of powder

134
Q

What important constituent do pastes contain?

A

Zinc oxide/starch and paraffin

135
Q

What are the advantages of pastes over ointments?

A

It being thicker and drier than ointments;

  1. absorbs secretions and exudations more readily
  2. It’s less macerating than ointments
136
Q

What is the disadvantage of pastes compared to ointments?

A

They are LESS easy to remove than ointments

137
Q

What is the contraindication to the use of pastes?

A

They should not be used on hair parts of the body

138
Q

Which body sites are POWDERS best used and why?

A

INTERTRIGINOUS AREAS e.g axillae, intergluteal and interdigital clefts

These areas are moist due to perspiration and are prone to maceration and friction; powders being hygroscopic absorb the sweat reduce the frictional effect of the opposing surfaces

139
Q

What kind of vehicle is GELS?

A

They are semi-plastic aqeous solutions

140
Q

Itemize 3 advantages of using GELS?

A

They are cosmetically elegant
They are easy to apply and wash off
They are transparent, non-greasy, water miscible and varnish on rubbing

141
Q

What is the advantage of gels over pastes?

A

They can be used on HAIRY body parts esp the scalp

142
Q

What is the disadvantage of using gels?

A

They are easily removed by sweat

143
Q

What are COLLOIDONS?

A

They are liquid preparations consising of pyroxylin(cellulose nitrate) in organic solvent

144
Q

When are COLLOIDONS used?

A

They are used as protective to seal minor cuts and abrasion

145
Q

Mention the disadvantage of COLLOIDONS?

A

They are often inflammable irritants to eye and mucous membrane and suitable for small area

146
Q

Why are creams and lotions prone to spoilage?

A

Bcoz they contain water

147
Q

Mention two examples of preservatives?

A

Parabens

Chlorocresol

148
Q

What is the drawback of preservatives?

A

They may occasionally cause contact dermatitis

149
Q

What topical prep requires no preservatives? And why is this so?

A

OINTMENTS

being anhydrous does not support the growth of bacteria and moulds

150
Q

What are MOISTURIZERS?

A

Topically applied products that relieve the signs and symptoms of dry skin

151
Q

Itemize the 3 classes of moisturizers?

A

Keratolytics
Occlusives
Humectants

152
Q

What is the rationale for using MOISTURIZERS?

A

To increase the water holding capacity of the sub-cutis by external application of hygroscopic agents

153
Q

Mention 5 examples of OCCLUSIVES? and state their mech of action?

A 
Liquid paraffin 
Lanolin
Coconut oil
Emulsifying wax
White soft paraffin

They provide a layer of oil on the skin surface and prevent evaporation of water

154
Q

Mention 4 examples of HUMECTANTS? and state their mech of action?

A

Urea
Glycerin
Lactic acid
Glycolic acid

They penetrate the stratum corneum and increase it’s capacity to retain water; hence useful in very dry skin

155
Q

Mention 4 examples of KERATOLYTICS? and state their mech of action?

A

High conc of UREA
allantoin
Lactic acid
Glycolic acid

They break down keratin in cases of icthyosis and chronic eczema

156
Q

Itemize 3 problems of topical therapy

A

Systemic absorption may occur if large areas of skin are treated topically
Contact allergy to topical prep is common
Folliculitis can occur bcoz of blockage of hair follicles

157
Q

Itemize 5 indications for systemic treatment

A 
Immunocompromise conditions
Extensive lesions
Recurrent cases
Resistant cases
Infections of nail and hair
158
Q

Itemize 3 forms of physical therapy

A

Phototherapy
Radiotherapy
LASER

159
Q

Itemize 5 conditions that can be treated with phototherapy?

A 
Lichen planus
Psoriasis(pUVA)
Vitiligo
Alopecia areata
Acne
160
Q

Itemize 5 surgical methods of treatment in dermatology?

A 
Electrosurgery/surgical diathermy
Electrocautery
Cryosurgery
Electrodessication
Electrofulguration
Dermabrasion
Intralesional injection
161
Q

List 5 indications for cryosurgery

A 
Verruca vulgaris
Seborrhoeic warts
Molluscum contagiosum
Angiomas
Telangiectasia
162
Q

Outline 3 indications for dermabrasion

A

Tattoos
Epidermal nevus
Adnexal tumours e.g syringoma

163
Q

Mention 5 indications for Intralesional injection?

A 
Psoriasis
DLE
Hypertrophic lichen planus
Lichen simplex chronicus
Keloids
164
Q

What’s the difference between electrodessication and electrofulguration?

A

electrodessication - electrode tip comes in contact with skin
electrofulguration - electrode tip does not contact the skin

Dermatology OAU (10 decks)

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