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DERMATOLOGY > PASSMED > Flashcards

PASSMED Flashcards

1
Q

what is erythema multiforme

A

hypersensitivity reaction which is most commonly triggered by infections. It may be divided into minor and major forms.

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2
Q

features of erythema multiforme

A

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

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3
Q

causes of erythema multiforme

A

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

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4
Q

what is alopeica areata

A

autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs

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5
Q

management of alopecia areata

A 
Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients. Other treatment options include:
topical or intralesional corticosteroids
topical minoxidil
phototherapy
dithranol
contact immunotherapy
wigs
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6
Q

small rubbery mass

A

lipoma

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7
Q

what is a lipoma

A

benign tumour of adipocytes

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8
Q

pathophysiology of lipomas

A
  • they are generally found in subcutaneous tissues
  • rarely, they may also occur in deeper adipose tissues
  • malignant transformation to liposarcoma is very rare
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9
Q

features of lipoma

A

lump characteristics:
smooth
mobile
painless

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10
Q

if lipoma more than 5cm what do u do

A

US to rule out liposarcoma

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11
Q

management of lipoma

A
  • may be observed

- if diagnosis uncertain, or compressing on surrounding structures then may be removed

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12
Q

features of liposarcoma

A

Size >5cm
Increasing size
Pain
Deep anatomical location

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13
Q

derm drug that causes gynaecomastia

A

ketoconazole

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14
Q

how to differentiate between spider naevi and telangectasia

A

press on lesion

fill from the centre - spider naevi

fill from the edge - telangiectasia

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15
Q

what is spider naevi

A

describe a central red papule with surrounding capillaries. The lesions blanch upon pressure. Spider naevi are almost always found on the upper part of the body.

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16
Q

associations of spider naevi

A

liver disease
pregnancy
combined oral contraceptive pill

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17
Q

1 day following skin grafts he becomes tachycardic and hypotensive. He vomits twice and this shows evidence of haematemesis

A

Curlings Ulcer

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18
Q

urine analysis he has + blood. His U+E’s show mild hyperkalaemia and a CK of 3000

A

rhabdomyolysis

aggressive IV fluids

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19
Q

increasing pain in lower leg and on examination there is parasthesia and severe pain in the lower leg. Foot pulses are normal

A

compartment syndrome

Eshcarotomy is required, and compartmental decompression

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20
Q

features of lichen planus

A
  • itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
  • rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
  • Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
  • oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
  • nails: thinning of nail plate, longitudinal ridging
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21
Q

causes of lichenoid drug eruptions

A

gold
quinine
thiazides

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22
Q

management for lichen planus

A
  • potent topical steroids are the mainstay of treatment
  • benzydamine mouthwash or spray is recommended for oral lichen planus
  • extensive lichen planus may require oral steroids or immunosuppression
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23
Q

venous ulceration commonly seen

A

above the medial malleolus

24
Q

Ix for venous ulceration

A

ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing

a ‘normal’ ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)

25
Q

management for venous ulceration

A

compression bandaging, usually four layer (only treatment shown to be of real benefit)

oral pentoxifylline, a peripheral vasodilator, improves healing rate

small evidence base supporting use of flavinoids

little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression

26
Q

melasma ass with

A

sun exposure
NSAIDs
oral contraceptives

27
Q

DD for shin lesions

A
  • erythema nodosum
  • pretibial myxoedema
  • pyoderma gangrenosum
  • necrobiosis lipoidica diabeticorum
28
Q

features of pretibial myxoedema

A

symmetrical, erythematous lesions seen in Graves’ disease

shiny, orange peel skin

29
Q

features of Necrobiosis lipoidica diabeticorum

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

30
Q

what is Necrobiosis lipoidica diabeticorum

A

rare granulomatous skin disorder which can affect the shin of insulin-dependent diabetics, although it may occur in non-diabetic subjects as well.

31
Q

features of HHT

A
  • epistaxis : spontaneous, recurrent nosebleeds
    telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
    visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
    family history: a first-degree relative with HHT
32
Q

features of Von Hippel Lindau disease

A

faulty tumour suppressor gene resulting in the development of multiple unusual tumours

1) haemangioblastoma, 2)phaeochromocytoma
3) renal cell carcinoma.

33
Q

peutz jegher syndrome

A

large numbers of polyps in the intestine which become cancerous in a majority of patients.

34
Q

features of Granulomatosis with polyangiitis

A

Sinus dysfunction is the most common initial symptom causing nasal congestion or epistaxis. If a rash is present, it is usually made up of palpable purpura from small vessel inflammation.

35
Q

what is HHT

A

autosomal dominant condition

36
Q

features of strawberry naeuvs

A

erythematous, raised and multilobed tumours.

37
Q

duration of strawberry naevus

A

until around 6-9 months before regressing over the next few years

38
Q

common sites of strawberry naevus

A

face, scalp and back

39
Q

potential complications of strawberry naevus

A
  • mechanical e.g. Obstructing visual fields or airway
  • bleeding
  • ulceration
  • thrombocytopaenia
40
Q

treatment of strawberry naevus if required

A

propranolol is increasingly replacing systemic steroids

41
Q

features of iron deficiency anaemia

A

Pallor

Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

42
Q

features of polycythaemia

A

Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease

43
Q

features of CKD

A

Lethargy & pallor
Oedema & weight gain
Hypertension

44
Q

features of lymphoma

A

Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
§

45
Q

what are salmon patches

A

pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck.

birthmark

46
Q

A 35-year-old woman presents with a 6 week history of a worsening facial rash. She says she has a history of ‘intermittent eczema’‛ on the face for which she self medicates with a topical agent.

A

perioral dermatitis

47
Q

management for perioral dermatits

A

oral ABx like acne

stop steroids

48
Q

what is eryhtema ab igne

A

skin reaction caused by chronic exposure to infrared radiation in the form of heat

49
Q

what is erythema gyratum repens

A

rare paraneoplastic type of annular erythema w a distinctive figurative ‘wood grain’ appearance

strong ass w malignancy

50
Q

predisposing factors of keloid scars

A

ethnicity: more common in pp with dark skin
- more common in young adults
- common site -> sternum, shoulder, neck. face, extensor surface of limbs, trunk

51
Q

Mx of keloid scars

A

early ones may be treated with intra-lesional steroids ie. triamcinolone

52
Q

causes of itch eruption (pruritus)

A 
eczema
scabies
urticaria
lichen planus
iron deficiency anaemia 
parasitic infestation
53
Q

Mx of pruritus

A 
keep the pt cool
keep skin well oiled with emoillients
avoid excessive bathing - drying
antihistamines
sedatives
low dose amitryptilline
short nails
54
Q

CKD features

A

Lethargy & pallor
Oedema & weight gain
Hypertension
pruritus

55
Q

advise about emollients

A

Initially applying emollients 2-3 times per day (including immediately after washing)
When skin worsens emollients can be applied hourly
Wash hands before applying emollient to prevent infection of damaged skin
Either dispense emollient using a pump or spoon from a tub to avoid contamination of the tub.
Apply emollient generously to all areas of the body onto the skin in a downward motion in direction of hair
Do not rub in emollients, but rather leave them to soak in.

DERMATOLOGY (21 decks)

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