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Medicine and Surgery Mushkies > Passmed Dermatology Mushkies > Flashcards

Passmed Dermatology Mushkies Flashcards

1
Q

What is a common and benign condition characterised by the development of a painful nodule on the ear?

A

Chondrodermatitis nodularis helicis (CNH)

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2
Q

What are some things that cause chondrodermatitis nodularis helicis (CNH)?

A
  1. Persistent pressure on ear
  2. Trauma
  3. Cold
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3
Q

How does one manage chondrodermatitis nodularis helicis?

A
  1. Reducing pressure on ear (foam ear protectors)
  2. Cryotherapy/steroid injection/collagen injection
  3. Surgical Rx, but high recurrence rate
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4
Q

What does CNH stand for?

A

Chondrodermatitis nodularis helicis

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5
Q

What are some differential diagnoses for shin lesions?

A
  1. Erythema nodosum
  2. Pyoderma gangrenosum
  3. Pretibial myxoedema
  4. Necrobiosis lipoidica diabeticorum
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6
Q

How does one describe erythema nodosum?

A

Symmetrical, erythematous, tender nodules which heal without scarring

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7
Q

What are the most common causes of erythema nodosum?

A
  1. NO = idiopathic
  2. Drugs = penicillin/sulphonamides
  3. OCP/Pregnancy
  4. Sarcoidosis/TB
  5. UC/CD/Behcets
  6. Micro = Streptococcus, mycoplasma, EBV
  7. Malignancy/lymphoma
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8
Q

What are 3 drugs that can cause erythema nodosum?

A
  1. Penicillins
  2. Sulphonamides
  3. OCP
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9
Q

How does one describe pretibial myxoedema?

A

Symmetrical, erythematous lesions seen in Graves disease

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10
Q

What are the SBA buzzwords for pretibial myxoedema?

A

Shiny, orange peel skin

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11
Q

How does one describe pyoderma gangrenosum?

A

A small red papule that develops into deep, red, necrotic ulcers with a violaceous border

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12
Q

What are some causes of pyoderma gangrenosum?

A
  1. Idiopathic = 50%
  2. IBD
  3. CTD
  4. Myeloproliferative disorders
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13
Q

How does one describe necrobiosis lipoidica diabeticorum?

A

Shiny, painless areas of yellow/red skin typically on the shin of diabetics

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14
Q

What other dermatological finding is necrobiosis lipoidica diabeticorum often associated with?

A

Telangectasia

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15
Q

Where is venous ulceration most typically seen?

A

Above the medial malleolus

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16
Q

What is the most important investigation for venous ulceration?

A

ABPI

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17
Q

What is the normal range for ABPI?

A

0.9-1.2

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18
Q

What ABPI value typically indicated arterial disease?

A

<0.9

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19
Q

When might you find a pt with arterial disease with ABPI >1.2?

A

False negative results secondary to arterial calcification e.g. in diabetics

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20
Q

What is the management of venous ulcers?

A
  1. Compression bandage, usually four layer
  2. Oral pentoxifylline, a peripheral vasodilator, improves healing rate
  3. Flavinoids (small evidence base)
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21
Q

What is the only treatment shown to be of real benefit for rx of venous ulcers?

A

Compression bandaging

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22
Q

How can one remember the site of ulceration for venous and arterial ulcers?

A
  1. vEnous = mEdial

2. Arterial = lAteral

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23
Q

What are risk factors for SCC of the skin?

A
  1. Sunlight exposure
  2. Actinic keratoses and Bowen’s disease
  3. Immunosuppression
  4. Smoking
  5. Long standing ulcers e.g. Marjolin ulcers
  6. Genetic
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24
Q

What are 2 genetic conditions that predispose to SCC of skin?

A
  1. Xeroderma pigmentosum

2. Oculocutaneous albinism

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25
Q

What should the surgical excision margin be for SCCs that are <20mm in diameter?

A

4mm

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26
Q

What should the surgical excision margin be for SCCs that are >20mm in diameter?

A

6mm

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27
Q

What do you call stress ulcers in burns patients?

A

Curlings ulcers

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28
Q

What is a common result of Curlings ulcers?

A

Haematemesis

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29
Q

What is a Curling’s ulcer?

A

Acute gastric erosion from severe burns as reduced plasma volume leads to ischaemia and cell necrosis of gastric mucosa

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30
Q

What is a Dieulafoy lesion?

A

Large, single, tortuous arteriole in stomach submucosa that erodes and bleeds, but can also present anywhere in GI tract.

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31
Q

How do you manage burns causes by heat?

A
  1. Remove person from source
  2. Irrigate with cool (not iced) water for 10-30 mins
  3. Cover burn using cling film
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32
Q

How do you manage electrical burns?

A

Switch off power supply, remove person from the source

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33
Q

How do you manage chemical burns?

A

Brush off any powder, irrigate with water

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34
Q

What are 3 ways you can assess the extent of a burn?

A
  1. Wallace’s rule of Nines
  2. Lund and Browder chart
  3. Palmar surface area method
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35
Q

What is Wallace’s rule of Nines for burns?

A
  1. Head + Neck = 9%
  2. Arm = 9%
  3. Anterior leg = 9%
  4. Posterior leg = 9%
  5. Anterior chest = 9%
  6. Posterior chest = 9%
  7. Anterior abdomen = 9%
  8. Posterior abdomen = 8%
  9. Yeah kan do
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36
Q

What is the most accurate method for assessing the extent of a burn?

A

Lund and Browder chart

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37
Q

What is the Palmar surface area method for assessing burns?

A
  1. Palmar surface = roughly 1% of TBSA

2. Not accurate for burns >15% TBSA

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38
Q

What is the histology and appearance of a 1st degree burn?

A
  1. Superficial epidermal

2. Red and painful

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39
Q

What is the histology and appearance of a 2nd degree burn?

A
  1. Superficial dermal /deep dermal (partial thickness)

2. Pale pink, painful, blistered/white and reduced sensation

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40
Q

What is the histology and appearance of a 3rd degree burn?

A
  1. Full thickness

2. White/brown/black, no blisters, no pain

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41
Q

When are IV fluids indicated for burns?

A
  1. > 10% TBSA in children

2. >15% TBSA 2nd/3rd degree burns in adults

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42
Q

What is the formula used for fluid given in burns pts?

A

Parkland formula

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43
Q

What is the Parkland formula?

A

Volume of fluid = TBSA x weight in kg x 4

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44
Q

How much of the calculated fluid requirement in a burns pt should be given in the first 8 hours?

A

Half

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45
Q

What do you call the tough leathery tissue remaining after a full-thickness burn?

A

Eschar

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46
Q

What is an escharotomy?

A

Surgical procedure used to treat full-thickness (3rd degree) burns

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47
Q

What is the rationale behind an escharotomy?

A

Following a full-thickness burn, as the underlying tissues are rehydrated, they become constricted due to the eschar’s loss of elasticity, leading to impaired circulation distal to the wound. An escharotomy can be performed as a prophylactic measure as well as to release pressure, facilitate circulation and combat burn-induced compartment syndrome

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48
Q

When is an escharotomy typically used?

A
  1. Circumferential burns affecting a limb

2. Severe torso burns impeding respiration

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49
Q

Is there any evidence to support the use of Abx prophylaxis/topical Abx in burns pts?

A

No

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50
Q

What is a Marjolin’s ulcer

A

An aggressive ulcerating SCC presenting in an area of previously traumatised, chronically inflamed, or scarred skin

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51
Q

What is a midline swelling lined by squamous epithelium and hair follicles likely to be?

A

Dermoid cysts

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52
Q

Why are dermoid cysts typically located in the midline?

A

They are embryological remnants

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53
Q

What kind of tumour is also referred to as aggressive fibromatosis?

A

Desmoid tumour

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54
Q

Where do desmoid tumours typically arise?

A

In ligaments and tendons

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55
Q

What is the most common form of skin cancer?

A

BCC

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56
Q

Where do BCCs typically occur?

A

Sun exposed sites apart from the ear

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57
Q

What are 4 subtypes of BCCs?

A
  1. Nodular
  2. Morphoeic
  3. Superficial
  4. Pigmented
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58
Q

What is the growth of BCCs like?

A

Typically slow growing with low metastatic potential

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59
Q

What is the management of a BCC?

A

Surgical excision, topical chemotherapy and radiotherapy are all successful

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60
Q

What is the treatment of choice for SCCs?

A

Wide local excision

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61
Q

How can one classify the main diagnostic features for malignant melanoma?

A
  1. Major criteria

2. Minor criteria (secondary features)

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62
Q

What are the major criteria for diagnosis of malignant melanoma?

A
  1. Change in size
  2. Change in shape
  3. Change in colour
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63
Q

What are the minor criteria for diagnosis of malignant melanoma?

A
  1. Diameter >6mm
  2. Inflammation
  3. Oozing/bleeding
  4. Altered sensation
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64
Q

How should one manage lesions that are suspicious and may be a malignant melanoma?

A

Excision biopsy, followed by further re-excision of margins once diagnosis is confirmed by pathology report

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65
Q

What are the margins of excision of a malignant melanoma, with regards to Breslow thickness?

A
  1. 0-1mm = 1cm
  2. 1-2mm = 1-2cm
  3. 2-4mm = 2-3cm
  4. > 4mm = 3cm
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66
Q

What is Kaposi’s sarcoma?

A

A tumour of vascular and lymphatic endothelium, associated with immunosuppression from e.g. HIV

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67
Q

What does Kaposi’s sarcoma look like?

A

Purple cutaneous nodules

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68
Q

What is dermatitis herpetiformis?

A

Autoimmune blistering skin disorder, associated with Coeliac disease

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69
Q

What is a dermatofibroma?

A

A benign lesion consisting of histiocytes, blood vessels and fibrotic changes

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70
Q

How do dermatofibromas present?

A

Firm elevated nodules, usually with a history of trauma

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71
Q

What are pyogenic granulomas?

A

Red nodules that are a overgrowth of blood vessels, that usually follow trauma

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72
Q

What other skin lesion do pyogenic granulomas mimic?

A

Amelanotic melanomas

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73
Q

What is acanthosis nigricans?

A

Brown to black, poorly defined, velvety hyperpigmentation of the skin

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74
Q

Where is acanthosis nigricans typically found?

A

In body folds

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75
Q

What is the most common cause of acanthosis nigricans?

A

Insulin resistance

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76
Q

What is the pathophysiology of acanthosis nigricans?

A

Insulin resistance –> raised circulating insulin levels –> insulin spillover into skin –> hyperplasia of skin

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77
Q

What do you call acanthosis nigricans in the context of a malignant disease?

A

Acanthosis nigricans maligna, is a paraneoplastic syndrome

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78
Q

What complication are electrical high voltage burns associated with and thus what is the treatment?

A

Rhabdomyloysis –> ATN –> Aggressive IV fluids

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79
Q

What virus causes molluscum contagiosum?

A

MCV

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80
Q

What family of viruses is molluscum contagiosum found in?

A

Poxviridae

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81
Q

How is molluscum transmitted?

A
  1. Directly = close personal contact

2. Indirectly = fomites e.g. shared towels

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82
Q

In what population do the majority of cases of molluscum occur?

A

In children (often with atopic eczema), max. incidence in preschool children aged 1-4 years

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83
Q

How can one describe molluscum?

A

Pinkish/pearly white papules with a central umbilication, up to 5mm in diameter

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84
Q

Where on the body does molluscum not appear?

A

Palms of hands and soles of feet

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85
Q

In children, where are molluscum lesions commonly seen?

A

Trunk and flexures, but anogenital lesions can also occur

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86
Q

How can one manage molluscum?

A
  1. Self care measures

2. Treatment measures

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87
Q

What are some self care measures for molluscum?

A
  1. Reassure it is self-limiting
  2. Spontaneous resolution within 18m
  3. Avoid sharing towels
  4. Dont scratch
  5. Exclusion from school/swimming/gym is not required
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88
Q

What are some treatments for molluscum?

A
  1. Cryotherapy

2. Squeezing/piercing

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89
Q

When should molluscum be referred?

A
  1. HIV-positive
  2. Eyelid-margin/ocular lesions
  3. Adults with anogenital –> GUM for other STI screening
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90
Q

What is used to treat pityriasis versicolor?

A

Ketoconazole shampoo

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91
Q

What is pityriasis versicolor?

A

A superficial cutaneous fungal infection caused by Malassezia furfur

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92
Q

What does pityriasis versicolor look like?

A

Hypopigmented/pink/brown, may be more obvious following a suntan, scale is common, mild pruritis

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93
Q

Where does pityriasis versicolor typically occur?

A

Trunk

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94
Q

What is the pathophysiology of dermatitis herpetiformis?

A

Deposition of IgA in the dermis

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95
Q

What are the features of dermatitis herpetiformis?

A

Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

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96
Q

How does one diagnose dermatitis herpetiformis?

A

Skin biopsy

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97
Q

What does one see on skin biopsy of dermatitis herpetiformis?

A

Direct immunofluorescense shows deposition of IgA in a granular pattern in the upper dermis

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98
Q

What is the management of dermatitis herpetiformis?

A
  1. Gluten-free diet

2. Dapson

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99
Q

What is pityriasis rosea?

A

An acute, self-limiting rash which tends to affect young adults

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100
Q

What is the aetiology of pityriasis rosea?

A

Not fully understood, herpes hominis virus 7 (HHV-7) may play a role

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101
Q

What are the features of pityriasis rosea?

A
  1. Recent viral infection
  2. Herald patch on trunk
  3. Followed 1-2 weeks later by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to Langer’s lines
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102
Q

What condition has a ‘fir-tree’ distribution?

A

Pityriasis rosea

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103
Q

What is the management of pityriasis rosea?

A

Self-limiting, usually disappears after 6-12 weeks

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104
Q

What is the main differential to consider for pityriasis rosea?

A

Guttate psoriasis

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105
Q

What are the features of guttate psoriasis?

A
  1. Strep sore throat 2-4 weeks earlier

2. Tear-drop scaly papules on trunk and limbs

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106
Q

What is the management of guttate psoriasis?

A
  1. Most resolve spontaneously within 2-3m
  2. Topical agents as per psoriasis
  3. UVB phototherapy
  4. Tonsillectomy may be necessary with recurrent episodes
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107
Q

What is the gold standard for management of morphoeic BCC?

A

Mohs micrographic surgery

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108
Q

What are some topical chemotherapies that can be used for treatment of BCC?

A

Imiquimod, Fluorouracil

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109
Q

What are some factors that may exacerbate psoriasis?

A
  1. Trauma
  2. Alcohol
  3. Steroid withdrawal
  4. Drugs
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110
Q

What drugs can exacerbate psoriasis?

A
  1. BBs
  2. Lithium
  3. Antimalarials
  4. NSAIDs
  5. ACEi
  6. Infliximab
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111
Q

What can be used for the treatment of mild actinic keratoses?

A

Topical diclofenac

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112
Q

What are actinic/solar keratoses?

A

A common premalignant skin lesion that develops as a consequence of chronic sun exposure

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113
Q

What are features of actinic keratoses?

A
  1. Small, crusty/scaly lesions
  2. May be pink/red/brown/skin colour
  3. Typically on sun-exposed areas
  4. Multiple lesions may be present
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114
Q

What are the management options for actinic keratoses?

A
  1. Sun avoidance and sun cream
  2. FU cream (2-3wk course)
  3. Topical diclofenac (if mild)
  4. Topical imiquimod
  5. Curettage and cautery
  6. Cryotherapy
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115
Q

When can a child with impetigo return to school?

A

When they are no longer contagious =

  1. When all lesions have crusted over
  2. 48hr after treatment starts
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116
Q

What is impetigo?

A

A superficial bacterial skin infection usually caused by either S. aureus or S. pyogenes

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117
Q

How is impetigo transmitted?

A
  1. Direct contact with discharges from the scabs of an infected person
  2. Indirect via toys, clothing, equipment and environment
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118
Q

What are the key features of impetigo?

A

Golden, crusted skin lesions typically found around the mouth

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119
Q

How can you classify management of impetigo?

A
  1. Limited, localised disease

2. Extensive disease

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120
Q

What is the management of limited, localised impetigo?

A
  1. Topical fusidic acid first line
  2. Topical retapamulin second line
  3. Topical mupirocin if MRSA
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121
Q

What is the management of extensive impetigo?

A
  1. Oral flucloxacillin

2. Oral erythromycin if penicillin-allergic

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122
Q

What is acne vulgaris?

A
  1. A common skin disorder which usually occurs in adolescence
  2. Typically affects the face, neck and upper trunk
  3. Is characterised by the obstruction of pilosebaceous follicles with keratin plugs which results in comedones, inflammation and pustules
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123
Q

How can you classify acne?

A

Mild, moderate and severe

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124
Q

What is mild acne?

A

Open and closed comedones with or without sparse inflammatory lesions

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125
Q

What is moderate acne?

A

Widespread non-inflammatory lesions and numerous papules and pustules

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126
Q

What is severe acne?

A

Extensive inflammatory lesions, which may include nodules, pitting and scarring

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127
Q

What is the step-up management of acne?

A
  1. Single topical therapy
  2. Topical combination therapy
  3. Oral Abx
  4. COCP
  5. Oral isotretinoin
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128
Q

What are single topical therapies used for acne?

A

Topical retinoids and benzoyl peroxide

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129
Q

What are some topical combination therapies used for acne?

A

Topical retinoid, benzoyl peroxide, topical abx

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130
Q

What is the abx management of acne?

A
  1. Tetracyclines = lymecycline/doxycycline/oxytetracycline

2. Erythromycin in pregnancy

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131
Q

When should tetracyclines be avoided for tx of acne?

A
  1. Pregnant/breastfeeding women

2. Children <12y/o

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132
Q

What is the maximum length of time a single oral antibiotic should be used for acne vulgaris?

A

3m

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133
Q

What should always be co-prescribed with oral abx for acne and why?

A

Topical retinoid/BP, to reduce the risk of abx resistance

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134
Q

Should topical and oral abx be used in combination?

A

No

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135
Q

What may occur as a complication of long term abx treatment of acne?

A

Gram negative folliculitis

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136
Q

What abx is effective for management of gram negative folliculitis after long term abx tx of acne vulgaris?

A

High dose oral trimethoprim

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137
Q

What is a c/i to topical and oral retinoid treatment?

A

Oral isotretinoin, only under specialist supervision

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138
Q

Is there a role for dietary modification in pts with acne?

A

Supposedly not

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139
Q

How can you describe lichen planus?

A
  1. 4Ps = Purple, pruritic, papular, polygonal rash on the flexor surfaces
  2. Wickham’s striae over the surface
  3. Oral involvement in 50%
  4. Koebner phenomenon
  5. Nails = thinning of nail plate, longitudinal ridging
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140
Q

What are Wickham’s striae?

A

Whitish lines visible in the papules of lichen planus and other dermatoses, typically in the oral mucosa

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141
Q

How can you describe lichen sclerosus?

A

Itchy white spots typically seen on the vulva of elderly women

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142
Q

What is lichen planus?

A

A skin disorder of unknown aetiology, most probably being immune-mediated

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143
Q

What are 3 causes of lichenoid drug eruptions?

A
  1. Gold
  2. Quinine
  3. Thiazides
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144
Q

What is the management of lichen planus?

A
  1. Topical steroids are mainstay
  2. Benzydamine mouthwash or spray is recommended for oral lichen planus
  3. Extensive lichen planus may require oral steroids or immunosuppression
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145
Q

Despite being called ‘ringworm’ what is the actual cause of ringworm?

A

Caused by a group of fungi called dermatophytes

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146
Q

What is tinea?

A

A term given to dermatophyte fungal infections

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147
Q

What are the 3 main types of tinea (anatomical)?

A
  1. Tinea capitis
  2. Tinea corporis
  3. Tinea pedis
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148
Q

What is a cause of scarring alopecia, mainly seen in children?

A

Tinea capitis

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149
Q

What may form if tinea capitis is left untreated?

A

A kerion

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150
Q

What is a kerion?

A

A raised, pustular, spongy/boggy mass formed due to untreated tinea capitis

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151
Q

What are the most common causes of tinea capitis?

A
  1. Trichophyton tonsurans most common

2. Microsporum canis

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152
Q

How does one acquire microsporum canis?

A

From cats and dogs

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153
Q

What is the management of tinea capitis?

A
  1. Topical ketoconazole shampoo for first 2 weeks
  2. Tricophyton tonsurans –> terbinafine
  3. Microsporum canis –> griseofulvin
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154
Q

What are the main causes of tinea corporis?

A
  1. Tricophyton rubrum

2. Trichophyton verrucosum

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155
Q

How does one acquire tricophyton verrucosum?

A

From contact with cattle

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156
Q

How does one treat tinea corporis?

A

Oral fluconazole

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157
Q

How can one differentiate between Tricophyton tonsurans and Microsporum canis?

A

Woods lamp –> Trichophyton does not readily fluoresce, Microsporum does

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158
Q

What may topical corticosteroids cause in pts with darker skin?

A

Patchy depigmentation

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159
Q

What is melasma?

A

Hyperpigmented brown/grey macules and patches, usually occurs in pregnancy women

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160
Q

What are some risk factors for melasma?

A
  1. Darker skin
  2. Sun exposure
  3. NSAIDs
  4. OCP/HRT
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161
Q

What is an example of a mild topical steroid?

A

Hydrocortisone 0.5-2.5%

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162
Q

What are 2 examples of a moderate topical steroid?

A
  1. Betamethasone valerate 0.025%, a.k.a Betnovate RD

2. Clobetasone butyrate 0.05%, a.k.a Eumovate

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163
Q

What are 2 examples of potent topical steroids?

A
  1. Fluticasone propionate 0.05%, a.k.a Cutivate

2. Betamethasone valerate 0.1% a.k.a Betnovate

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164
Q

What is an example of a very potent topical steroid?

A

Clobetasol propionate 0.05% (Dermovate)

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165
Q

What is betamethasone valerate aka?

A

Betnovate

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166
Q

What is Clobetasone butyrate aka?

A

Eumovate

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167
Q

What is Clobetasol propionate aka?

A

Dermovate

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168
Q

What is the finger tip rule?

A

1 FTU (finger tip unit) = 0.5g, sufficient to treat a skin area about twice that of the flat of an adult hand

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169
Q

What usually precipitates guttate psoriasis?

A

A streptococcal throat infection

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170
Q

What is the management for chronic plaque psoriasis?

A
  1. Regular emollients ut reduces scale loss and reduce pruritis
  2. 1st line = Potent corticosteroid OD + Vit D analogue OD
  3. 2nd line = No improvement after 8 wks –> Vit D analogue BD
  4. 3rd line = Potent steroid BD/coal tar BD
  5. 4th line = Short-acting dithranol
171
Q

When may systemic side effects be seen when using potent corticosteroids?

A

> 10% TBSA

172
Q

What is the recommended time scale for use of potent and very potent corticosteroids?

A
  1. Potent = 8wks at a time

2. Very potent = 4wks at a time

173
Q

What are some Vit D analogues that can be used for treatment of psoriasis?

A
  1. Calcipotriol (Dovonex)
  2. Calcitriol
  3. Tacalcitol
174
Q

How long should breaks be between steroids when using topical steroids for treatment of psoriasis?

175
Q

What are some secondary care managements for plaque psoriasis?

A
  1. Phototherapy

2. Systemic therapy

176
Q

What are the phototherapy options for treatment of psoriasis?

A
  1. Narrow band UVB 3x/week

2. PUVA = psoralen + UVA light

177
Q

What are some s/e of phototherapy for psoriasis?

A
  1. Skin ageing

2. SCC

178
Q

What are some systemic therapies that can be used for psoriasis?

A
  1. Methotrexate 1st line
  2. Ciclosporin
  3. Systemic retinoids
  4. Biologics
  5. Ustekinumab (IL12 & IL23)
179
Q

What are some biologic agents used for treatment of psoriasis?

A
  1. Infliximab
  2. Etanercept
  3. Adalimumab
180
Q

What is the MOA of coal tar?

A

Probably inhibit DNA synthesis

181
Q

What is the MOA of calcipotriol?

A

Vit D analogue which reduces epidermal proliferation and restores a normal horny layer

182
Q

What is the MOA of dithranol?

A

Inhibits DNA synthesis, wash off after 30 mins

183
Q

What is onychomycosis?

A

Fungal infection of the nails

184
Q

What are 3 causes of onychomycosis?

A
  1. Dermatophytes
  2. Yeasts
  3. Non-dermatophyte moulds
185
Q

What accounts for 90% of cases of onychomycosis?

A

The dermatophyte Trichophyton rubrum

186
Q

What is the main yeast that causes onychomycosis?

187
Q

What are 2 RFs for onychomycosis?

188
Q

What are 4 DDx for onychomycosis?

A
  1. Psoriasis
  2. Lichen planus
  3. Yellow nail syndrome
  4. Repeated trauma
189
Q

What investigations should one do for suspected onychomycosis?

A
  1. Nail clippings

2. Scrapings of the affected nail

190
Q

Does onychomycosis need to be treated if it is asymptomatic and the pt is not bothered by the appearance?

191
Q

What should be done before rx of onychomycosis?

A

Dx should be confirmed by microbiology

192
Q

What is the management of dermatophyte-induced onychomycosis?

A

1st line = oral terbinafine/oral itraconazole as alternative

193
Q

How long does it take to treat fingernail and toenail onychomycosis?

A
  1. Fingernail = 6w-3m

2. Toenail = 3-6m

194
Q

What % of pts with onychomycosis are successfully treated?

195
Q

What is the management of guttate psoriasis?

A
  1. Most cases resolve spontaneously within 2-3m
  2. No firm evidence to support abx for strep infection
  3. Topical agents as per psoriasis
  4. UVB phototherapy
  5. Tonsillectomy may be necessary with recurrent episodes
196
Q

What is pemphigus vulgaris?

A

An Autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule

197
Q

In what pt demographic is pemphigus vulgaris more common?

A

Ashkenazi Jews

198
Q

What are the some features of pemphigus vulgaris?

A
  1. Mucosal ulceration most common
  2. Skin blistering (flacced, easily ruptured vesicles and bullae)
  3. Acantholysis on biopsy
  4. Nikolsky’s sign positive
199
Q

What is the management of pemphigus vulgaris?

A
  1. Steroids

2. Immunosuppressants

200
Q

What is the first line treatment for seborrheic dermatitis?

A

Topical ketoconazole

201
Q

What are 2 conditions associated with seborrheic dermatitis in adults?

A

HIV and Parkinsons

202
Q

What is the management of scalp seborrheic dermatitis in adults?

A
  1. OTC preparations containing zinc pyrithione (Head & Shoulders) and tar (Neutrogena T/Gel) are 1st line
  2. 2nd line = ketoconazole
  3. Selenium sulphide and topical corticosteroids may also be helpful
203
Q

What is the management of face and body seborrheic dermatitis?

A
  1. Topical antifungals e.g. ketoconazole
  2. Topical steroids best used for short periods
  3. Difficult to treat –> recurrences are common
204
Q

What are 3 different allergy tests?

A
  1. Skin prick tests
  2. RAST
  3. Skin path testing
205
Q

What is a skin prick test useful for diagnosing?

A

Food allergies and pollen

206
Q

After how long can a skin prick test be interpreted?

A

15 minutes

207
Q

What does RAST stand for?

A

Radioallergosorbent test

208
Q

How does RAST work?

A

It determines the amount of IgE that reacts specifically with suspected or known allergens, e.g. IgE to egg protein

209
Q

How are RAST results given?

A

In grades from 0 (negative) to 6 (strongly positive)

210
Q

What is RAST useful for diagnosing?

A
  1. Food allergies
  2. Inhaled allergens e.g. Pollen
  3. Wasp/bee pollen
211
Q

What is skin patch testing useful for?

A

Contact dermatitis

212
Q

How is skin patch testing performed?

A

Around 30-40 allergens are placed on the back, patches removed 48 hours later with the results being read by a dermatologist a further 48 hours later

213
Q

How can you differentiate between an amelanotic melanoma and a pyogenic granuloma?

A

A history of trauma

214
Q

What is an alternative name for a pyogenic granuloma and why should you use it instead?

A

Should be called an eruptive haemangioma as it is neither a granuloma nor pyogenic

215
Q

What are 3 RFs for pyogenic granulomas?

A
  1. Trauma
  2. Pregnancy
  3. More common in women and young adults
216
Q

What do pyogenic granulomas look like?

A

A small red/brown spot that rapidly progresses within days to weeks to form raised, red/brown lesions which are often spherical in shape. The lesions may bleed profusely or ulcerate

217
Q

What is bullous pemphigoid?

A

An autoimmune condition causing subepidermal blistering of the skin, secondary to antibodies against hemidesmosomal proteins

218
Q

What are some features of bullous pemphigoid?

A
  1. Itchy, tense blisters typically around flexures
  2. Blisters usually heal without scarring
  3. Mucosa is usually spared
219
Q

What is an SBA way to differentiate between pemphigus vulgaris and bullous pemphigoid?

A

PV has mucosal involvement , no mucosal involvement in BP (not the case in reality, but enough for SBAs)

220
Q

What do you see on skin biopsy of Bullous pemphigoid?

A

Immunofluorescence shows IgG and C3 at the dermoepidermal junction

221
Q

What is the mainstay of treatment for bullous pemphigoid?

A

Oral corticosteroids

222
Q

What kind of malignancies is acanthosis nigricans associated with?

A

GI malignancies e.g. gastric and pancreatic cancer

223
Q

What is lentigo maligna?

A

A precursor to lentigo maligna melanoma, that begins as a susicious flat freckle which can grow over 5-20 years to develop into a melanoma

224
Q

What is the demographic of pts affected by lentigo maligna?

A

Older people on chronically sun exposed skin

225
Q

What are the main 4 subtypes of melanoma?

A
  1. Superficial spreading
  2. Nodular
  3. Lentigo maligna
  4. Acral lentiginous
226
Q

What is the most common melanoma?

227
Q

What is the second most common melanoma?

228
Q

What is the least common melanoma?

229
Q

What is Hutchinson’s sign?

A

Melanonychia with pigmentation of the proximal nail fold, an important sign of subungual melanoma although is not an infallible predictor

230
Q

What are 3 other rogue subtypes of melanoma?

A
  1. Desmoplastic
  2. Amelanotic
  3. Elsewhere in body e.g. ocular
231
Q

What is morphea?

A

A thickened area of skin due to localised scleroderma

232
Q

What is a port-wine stain?

A

A capillary malformation seen at birth which usually requires no treatment

233
Q

What is the management of a port wine stain?

A

Cosmetic camouflage or laser therapy (multiple sessions are required)

234
Q

What is the management for pyoderma gangrenosum?

A
  1. Oral steroids due to potential for rapid progression

2. Ciclosporin/infliximab for hard to treat cases

235
Q

What is vitiligo?

A

An AI condition which results in the loss of melanocytes and subsequent depigmentation of the skin

236
Q

What percentage of the population is affected by vitiligo?

237
Q

What phenomenon is seen with Vitiligo?

238
Q

What are 5 conditions associated with vitiligo?

A
  1. T1DM
  2. Addisons
  3. AI thyroid diseases
  4. Pernicious anaemia
  5. Alopecia areta
239
Q

What is the management for vitiligo?

A
  1. Sunblock for affected areas
  2. Camouflage makeup
  3. Topical corticosteroids may reverse changes if applied early
  4. ?role for topical tacrolimus and phototherapy
240
Q

What is polymorphic eruption of pregnancy and some features of it?

A
  1. Pruritic condition associated with last trimester
  2. Lesions often first appear in abdominal striae
  3. Management depends on severity: emollients, mild potency topical steroids and oral steroids may be used
241
Q

What is pemphigoid gestationis and what are some features of it?

A
  1. Pruritic blistering condition usually seen in the 2nd or 3rd trimester
  2. Lesions often first appear in the peri-umbilical region
  3. Management: oral corticosteroids are usually required
242
Q

What must you screen for when a pt presents with alopecia areata?

A

AI conditions

  1. Thyroid disease
  2. DM
  3. Pernicious anaemia
243
Q

What is alopecia areata?

A

A presumed AI condition causing localised, well demarcated patches of hair loss

244
Q

What are ‘exclamation mark’ hairs indicative of?

A

Alopecia areata

245
Q

What is the prognosis for alopecia areata?

A
  1. 50% regrow by 1 year

2. 80-90% regrow eventually

246
Q

What are some treatment options for alopecia areata?

A
  1. Topical corticosteroids
  2. Phototherapy
  3. Dithranol
  4. Topical minoxidil
  5. Contact immunotherapy
  6. Wigs
247
Q

What is the most common cause of an itchy rash affecting the face and scalp?

A

Seborrheic dermatitis

248
Q

Does seborrrheoic dermatitis involve the nasolabial folds?

249
Q

Does acne rosacea involve the nasolabial folds?

250
Q

How is a nickel dermatitis diagnosed?

A

Skin patch test

251
Q

How does lichen sclerosus present?

A

Itchy, sore white plaque on vulva, typically in elderly woman

252
Q

What is the management of lichen sclerosus?

A

Topical steroid and emollients

253
Q

Why is followup required for lichen sclerosus?

A

Increased risk of vulval cancer

254
Q

When is a skin biopsy required for lichen sclerosis?

A

If woman fails to respond to treatment or there is clinical suspicion of VIN or cancer

255
Q

What is the oral abx of choice for treatment of erythrasma?

A

Erythromycin

256
Q

What is erythrasma?

A

An infection caused by Corynebacterium minutissimum

257
Q

How does erythrasma present?

A

Asymptomatic, flat, slight scaly, pink/brown rash usually found in the groin/axillae

258
Q

What do you see under Wood’s light in erythrasma?

A

Coral-red fluorescence

259
Q

What is the prevalence of psoriasis?

260
Q

What are 2 HLA associations with psoriasis?

A

HLA B13 and B17

261
Q

Is sunlight good or bad for psoriasis?

262
Q

What are 4 subtypes of psoriasis?

A

PFGPPE

  1. Plaque (red scaly patches)
  2. Flexural (smooth skin)
  3. Guttate (teardrop)
  4. Pustular
  5. Palmoplantar
  6. Erythrodermic
263
Q

What are 5 complications of psoriasis?

A
  1. Psoriatic arthropathy (10%)
  2. Metabolic syndrome
  3. Cardiovascular disease
  4. VTE
  5. Psychological distress
264
Q

What causes scabies?

A

Sarcoptes scabiei

265
Q

In what layer does the scabies mite lay its eggs into?

A

Stratum corneum

266
Q

What causes the intense pruritis associated with scabies?

A

A delayed type IV hypersensitivity reaction to the mites/eggs which occurs around 30 days after the initial infection

267
Q

What are the main features of scabies?

A
  1. Widespread pruritis

2. Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist

268
Q

What is the management of scabies?

A
  1. Permethrin 5% first line

2. Malathion 0.5% second line

269
Q

How long does pruritis last in scabies?

A

Up to 4-6 weeks post eradication

270
Q

What is pt guidance to give during scabies treatment?

A
  1. Avoid close physical contact with others
  2. All household contacts and close physical contacts should be treated, even if asymptomatic
  3. Launder all clothing, bedding and towels on first day of treatment to kill off mites
271
Q

When do you see crusted ‘Norwegian’ scabies?

A

Pts with suppressed immunity, especially HIV

272
Q

What is the treatment of choice for crusted Norwegian scabies?

A

Ivemectin and Isolation

273
Q

What produces a symmetrical white lace-like pattern on the buccal mucosa?

A

Lichen planus

274
Q

What is leukoplakia?

A

White, hard spots on the mucous membranes of the mouth, more common in smokers

275
Q

What other conditions must be considered before oral leukoplakia, which is a Diagnosis of Exclusion?

A

Candidiasis and Lichen Planus

276
Q

Why are biopsies usually performed on oral leukoplakias?

A

To exclude alternative diagnoses e.g. SCC

277
Q

What percentage of leukoplakias undergo malignant transformation to SCC?

278
Q

What 2 drugs can cause acanthosis nigricans?

A

OCP and nicotinic acid

279
Q

How long does the rash from pityriasis rosea typically last?

A

6-12 weeks from the presentation

280
Q

What are some features of acne rosacea?

A
  1. Nose, cheeks and forehead

2. Flushing, erythema, telangiectasia –> papules and pustules

281
Q

What is the management of acne rosacea?

A
  1. Topical metronidazole for mild symptoms
  2. More severe disease with systemic Abx e.g. oxytetracycline
  3. Daily high factor sunscreen
282
Q

What is a late complication of severe rosacea?

283
Q

At what TBSA must superficial burns be referred to secondary care in children and adults?

A

> 2% TBSA in children, >3% TBSA in adults

284
Q

What are 4 skin manifestations of SLE?

A
  1. Photosensitive malar rash
  2. Discoid lupus
  3. Alopecia
  4. Livedo reticularis
285
Q

What derm cancer are renal transplant pts at increased risk of?

286
Q

What is the 1st line treatment for impetigo?

A

Topical fusidic acid

287
Q

What are 3 things that must be monitored for in the treatment of erythroderma?

A
  1. Dehydration
  2. Infection
  3. High output HF
288
Q

What is erythroderma?

A

A term used when more than 95% of the skin is involved in a rash of any kind

289
Q

What are some causes of erythroderma?

A
  1. Eczema
  2. Psoriasis
  3. Drugs e.g. gold
  4. Lymphomas, leukaemias
  5. Idiopathic
290
Q

What are the first line treatments for tinea pedis?

A
  1. Topical imidazole
  2. Topical undecanoate
  3. Topical terbinafine
291
Q

What is the most common type of melanoma that has the typical diagnostic features of a changing mole?

A

Superficial spreading melanoma

292
Q

What condition presents with a herald patch?

A

Pityriasis rosea

293
Q

What is the most common precipitant of a pyogenic granuloma?

294
Q

What is the difference in nature of UV exposure that leads to SCCs and BCCs respectively?

A
  1. SCC = chronic long term expsosure

2. BCC = sporadic exposure with burning

295
Q

What is a useful stat for risk of subsequent SCC in actinic keratosis?

A

In pts with 7 actinic keratoses, the risks of subsequent SCC is 10% at 10 years

296
Q

What are 5 types of BCC?

A
  1. Nodular
  2. Superficial
  3. Morpeaform
  4. Cystic
  5. Basosquamous
297
Q

What is a dome-shaped erythematous lesion that develops over a period of days and grows rapidly, that often contain a central pit of keratin?

A

Keratoacanthoma

298
Q

Where does erythema nodosum occur?

A

Typically on shins, also elsewhere e.g. forearms, thighs

299
Q

What causes erythematous nodules over forearms with a high calcium?

A

Erythema nodosum due to sarcoidosis

300
Q

How do you differentiate between spider naevi and telangiectasia?

A

Press on them and watch them fill

  1. Spider naevi fill from centre
  2. Telangiectasia fill from the edge
301
Q

How would one describe a spider naevus?

A

A central red papule with surrounding capillaries that blanch upon pressure

302
Q

What are some causes of spider naevi?

A
  1. Idiopathic
  2. Liver disease
  3. COCP
  4. Pregnancy
303
Q

What is the management of eczema herpeticum?

A

IV Aciclovir

304
Q

What is the first line treatment for hyperhidrosis?

A
  1. Topical aluminium chloride preparations 1st line
  2. Iontophoresis
  3. Botulinum toxin
  4. Surgery
305
Q

What surgical procedure can be undertaken for hyperhidrosis?

A

Endoscopic transthoracic sympathectomy

306
Q

What is erythema ab igne?

A

A skin disorder caused by over exposure to infrared radiation in the form of heatr

307
Q

What are the features of erythema ab igne?

A

Reticulated, erythematous patches with hyperpigmentation and telangiectasia

308
Q

What is a complication of chronic erythema ab igne?

309
Q

What is Bowen’s disease and who is it typically found in?

A

SCC in situ, and is commonly in elderly females

310
Q

What is the risk of developing invasive SCC in Bowen’s disease?

311
Q

What are the management options for Bowen’s disease?

A
  1. Topical 5-Fu or imiquimod
  2. Cryotherapy
  3. Excision
312
Q

What causes a ‘ruddy’ complexion and pruritis after a warm bath?

A

Polycythaemia

313
Q

What is the most common cause of oedema 2 weeks post extensive burns?

A

Hypoalbuminaemia

314
Q

When is an ultrasound necessary for a lipoma?

A

If it is >5cm

315
Q

What is a lipoma?

A

A common, benign tumour of adipocytes

316
Q

What are 3 features of a lipoma?

A

Smooth, mobile, painless

317
Q

What are features suggestive of development of a liposarcoma?

A
  1. Size 5>cm
  2. Increasing size
  3. Pain
  4. Deep anatomical location
318
Q

What has a ‘stuck-on’ appearance?

A

Seborrhoeic keratoses

319
Q

What is the most effective tx for prominent telangiectasia in acne rosacea?

A

Laser therapy

320
Q

How would you describe pyoderma gangrenosum?

A

Initially a small red papule that develops into deep, red necrotic ulcers with a violaceous border

321
Q

What is the first line treatment for pyoderma gangrenosum?

A
  1. Oral steroids

2. Others = ciclosporin, infliximab

322
Q

What causes acne vulgaris?

A

Obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules

323
Q

Is propionibacterium acnes aerobic or anaerobic?

324
Q

What two terms do sebaceous cysts encompass?

A

Epidermoid and pilar cysts

325
Q

What is am epidermoid cyst?

A

A proliferation of epidermal cells within the dermis

326
Q

What is a pilar cyst?

A

Benign cysts that derive from the outer root sheath of the hair follicle

327
Q

What is a characteristic feature of a sebaceous cyst?

A

Central punctum

328
Q

What is the most common cause of toxic epidermal necrolysis?

A

Drug reaction

329
Q

What are some drugs known to cause TEN?

A
  1. P = penicillins, phenytoin
  2. A = allopurinol
  3. NSAIDs
  4. Carbamazepine
  5. Sulphonamides
330
Q

What is the management of TEN?

A
  1. Stop precipitating factor
  2. Supportive care often in ITU
  3. IVIG is now first line
  4. Immununosuppressive agents e.g. ciclosporin and cyclophosphamide
331
Q

What are some management options for a BCC?

A
  1. Surgical removal
  2. Curettage
  3. Cryotherapy
  4. Topical cream: FU, imiquimoid
  5. Radiotherapyu
332
Q

What is the most likely diagnosis in an uncircumsised man who has developed a tight white ring around the tip of his foreskin and phimosis?

A

Lichen sclerosus

333
Q

What is Zoon’s balanitis?

A

A benign condition of uncertain origin affecting uncircumcised men. Presents with orange-red lesions with pinpoint redder spots on the glans and adjacent areas of the foreskin

334
Q

What is circinate balanitis?

A

Chronic balanitis in those with reactive arthritis. It presents with a well-demarcated erythematous plaque with a ragged white border

335
Q

What is erythroplasia of Queyrat?

A

In-situ SCC of the penis

336
Q

What is the most common s/e of isotretinoin?

337
Q

What proportion of pts have a long term remission or cure following a course of oral isotretinoin?

338
Q

What are some s/e of isotretinoin?

A
  1. Teratogenicity
  2. Dry skin and eyes
  3. Low mood
  4. Raised triglycerides
  5. Hair thinning
  6. Nosebleeds
  7. Intracranial HTN
  8. Photosensitivity
339
Q

What is the single most important prognostic factor in malignant melanoma?

A

Depth of melanoma (Breslow thickness)

340
Q

What should pts be acne scarring be referred for?

A

Oral isotretinoin

341
Q

What is the prognosis of a paediatric strawberry naevus?

A

Increase in size until 6-9 months before regressing over next few years, around 95% resolve by 10 y/o

342
Q

What is the formal term for a strawberry naevus?

A

Capillary haemangioma

343
Q

What are some complications of strawberry naevi?

A
  1. Mechanical e.g. obstructing visual fields/airway
  2. Bleeding
  3. Ulceration
  4. Thrombocytopenia
344
Q

What are some medical treatments for strabwerry naevi?

A
  1. Oral propranolol

2. Topical timolol

345
Q

What is a cavernous haemangioma?

A

A deep capillary haemangioma

346
Q

When is treatment usually indicated for a capillary haemangioma?

A

If the lesion is causing a mechanical problem or is bleeding

347
Q

What is a rare but important s/e to be aware of with penicillins?

348
Q

What are 2 skin disorders associated with pregnancy?

A
  1. Polymorphic eruption of pregnancy

2. Pemphigoid gestationis

349
Q

What kind of reaction is erythema multiforme?

A

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

350
Q

What are some features of erythema multiforme?

A
  1. Target lesions
  2. Initially seen on back of hands/feet before spreading to torso
  3. Upper limbs more commonly affected than lower limbs
  4. Pruritis occasionally seen and is usually mild
351
Q

What are some causes of erythema multiforme?

A
  1. Idiopathic
  2. Infection = Viral, bacterial
  3. Drugs
  4. CTD e.g. SLE
  5. Sarcoidosis
  6. Malignancy
352
Q

What is the most common viral cause of erythema multiforme?

353
Q

What are some bacterial causes of erythema multiforme?

A

Mycoplasma, Streptococcus

354
Q

What are some drugs that cause erythema multiforme?

A
  1. Penicillins
  2. Sulphonamides
  3. Carbamazepine
  4. Allopurinol
  5. NSAIDs
  6. OCP
  7. Nevirapine
355
Q

What is erythema multiforme major?

A

A more severe form, is associated with mucosal involvement

356
Q

If you see a painful rash, what is it most likely to be in an adult?

357
Q

What is the treatment for shingles?

A

Oral aciclovir

358
Q

What is shingles?

A

An acute, unilateral, painful blistering rash caused by reactivation of VZV

359
Q

To whom is the shingles vaccine offered?

A

All pts aged 70-79 y/o

360
Q

What are some features of the shingles vaccine?

A

Is live attenuated and is given subcutaneously

361
Q

What is the main contraindication to the shingles vaccine?

A

Immunosuppression as it is a live attenuated vaccine

362
Q

What is the pathophysiology of erythema nodosum?

A

Inflammation of the subcutaneous fat

363
Q

What are 4 AVMs that can occur in HHT?

A
  1. Cerebral
  2. Spinal
  3. Pulmonary
  4. Hepatic
364
Q

What is the eponym for HHT?

A

Osler-Weber-Rendu Syndrome

365
Q

What is the inheritance of HHT?

A

Autosomal dominant, although 20% cases are spontaneous

366
Q

What are the diagnostic criteria for HHT?

A

3 or more out of:

  1. Epistaxis
  2. Telangiectases
  3. Visceral lesions
  4. FHx
367
Q

What 2 condiitons must always be considered in children with new-onset purpura?

A

ALL and meningococcal disease

368
Q

What is purpura?

A

Bleeding into the skin from small blood vessels that produces a non-blanching rash

369
Q

What could be causing petechiae in the upper body after a prolonged cough?

A

Raised SVC pressure

370
Q

What is acne fulminans?

A

A very severe acne associated with systemic upset e.g. fever

371
Q

What is the management of acne fulminans?

A

Oral steroids

372
Q

What is the eponym for ataxia telangiectasia?

A

Louis-Bar syndrome

373
Q

What is the management for dermatitis herpetiformis?

A
  1. Gluten-free diet

2. Dapsone

374
Q

What are some ocular complications of acne rosacea/

A

Blepharitis, keratitis, conjunctivitis

375
Q

What are the 2 main types of contact dermatitis?

A
  1. Irritant contact dermatitis

2. Allergic contact dermatitis

376
Q

What are 2 ways in which cement can cause a contact dermatitis?

A
  1. Alkaline nature can cause irritant contact dermatitis

2. Dichromates in cement can cause allergic contact dermatitis

377
Q

What is the management of allergic contact dermatitis?

A

Topical treatment with a potent steroid

378
Q

What is the most aggressive form of melanoma?

A

Nodular melanoma

379
Q

How does a nodular melanoma present?

A

Red or black lump that oozes/bleeds, on sun-exposed skin

380
Q

What could cause lethargy, pallor and generalised pruritis?

381
Q

How would acral lentiginous melanoma present?

A

Pigmentation of the nail bed affecting the proximal nail fold (Hutchinson’s sign)

382
Q

What is the rarest form of melanoma overall, but is the commonest form in people with darker skin?

A

Acral lentiginous melanoma

383
Q

What are cherry haemangiomas?

A

Benign skin lesions which contain an abnormal proliferation of capillaries

384
Q

What is the eponym for cherry haemangiomas?

A

Campbell de Morgan spots

385
Q

What are some features of cherry haemangiomas?

A
  1. Erythematous, papular lesions
  2. Typically 1-3mm in size
  3. Non-blanching
  4. Not found on mucous membranes
386
Q

What does pityriasis rosea often follow?

A

A viral infection

387
Q

What are 3 triggers for acne rosacea?

A
  1. Sun exposure
  2. Hot drinks
  3. Sun exposure
388
Q

Which of the melanomas invades aggressively and metastasises early?

A

Nodular melanoma

389
Q

What is the most significant complication of PUVA therapy for psoriasis?

390
Q

What is PUVA therapy?

A

Psoralen + UV A light therapy

391
Q

What are the features of Pellagra?

A

Diarrhoea
Dementia
Dermatitis
Death

392
Q

What is Pellagra?

A

Vitamin B3 (Niacin) deficiency

393
Q

What is a cause of Pellagra to be aware of?

A

Isoniazid therapy

394
Q

What do you call Pellagra-induced dermatitis if it is around the neck?

A

Casal’s necklace

395
Q

What is used to calculate the volume of IV fluid required for resuscitation in the first 24 hours after a burn?

A

Parkland formula

396
Q

What is the most common cause of erythema multiforme?

397
Q

Why is oral ketoconazole no longer suggested?

A

Due to hepatotoxicity

398
Q

What is an embarrassing s/e of ketoconazole?

A

Gynaecomastia

399
Q

What is the most common malignancy associated with acanthosis nigricans?

A

GI adenocarcinoma

400
Q

What is the first line treatment for lichen sclerosus?

A

Strong topical steroid e.g. clobetasol propionate

401
Q

How should you treat lichen sclerosus if steroids dont work?

A

Topical tacrolimus

402
Q

What scoring system can be used for hirsutism?

A

Ferriman-Gallwey scoring system

403
Q

What is hirsutism?

A

Excess hair growth in women following a male distribution pattern

404
Q

What is hypertrichosis?

A

Excessive hair growth over and above the normal for age, sex and race of an individual

405
Q

What are some causes of hirsutism?

A
  1. PCOS (most common)
  2. Cushings
  3. CAH
  4. Androgen therapy
  5. Obesity (insulin resistance)
  6. Adrenal tumour
  7. Androgen secreting ovarian tumour
  8. Drugs = phenytoin, steroids
406
Q

What are some managements for hirsutism?

A
  1. Weight loss if overweight
  2. Contraception e.g. co-cypryndiol
  3. facial = topical eflornithine
407
Q

Why should co-cyprindiol not be used long term?

A

Due to increased risk of VTE

408
Q

What are some causes of hypertrichosis?

A
  1. Drugs
  2. Congenital
  3. Anorexia nervosa
  4. Porphyria cutanea tarda
409
Q

What is serborrhoeic dermatitis?

A

An inflammatory reaction to Malassezia furfur

410
Q

What can exacerbate acne rosacea?

A

Sunlight, drugs, post-partum

411
Q

What phenomenon can cause molluscum contagiosum to appear at sites of injury?

A

Koebner phenomenon

412
Q

In what conditions can one see the Koebner phenomenon?

A
  1. Psoriasis
  2. Vitiligo
  3. Warts
  4. Lichen planus
  5. Lichen sclerosus
  6. Molluscum contagiosum
413
Q

What is the first line treatment for hyperhidrosis?

A

Topical aluminium chloride preparations (roll-on applied at night time)

414
Q

How should emollient be applied for eczema?

A
  1. Initially 2-3x daily, increase up to every hour if the skin is very dry
  2. Immediately after showering
  3. Dont rub it in, leave it to soak in
415
Q

What are some management options for eczema?

A
  1. Emollients
  2. Topical steroids
  3. UV radiation
  4. Immunosuppressants
416
Q

What are some immunosuppressants that can be used to treat eczema?

A
  1. Ciclosporin
  2. Antihistamines
  3. Azathioprine
417
Q

What is the mainstay of treatment for lichen planus?

A

Topical steroids

418
Q

What are some features of granuloma annulare?

A
  1. Papular lesions that ore often slightly hyperpigmented and depressed centrally
  2. Typically occur on dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs
419
Q

Where on the body are keloid scars most likely to form?

420
Q

What are keloid scars?

A

Tumour-like lesions that arise from the connective tissue of a scar and extend beyond the original dimensions of the wound

421
Q

What are some prediposing factors for keloid scars?

A
  1. Ethnicity (darker skin)

2. Young adults

422
Q

Where can incisions be made to reduce the chance of keloid scars from forming?

A

If incisions are made along relaxed skin tension lines

423
Q

What is the management of keloid scars?

A
  1. Intra-lesional steroids e.g. triamcinolone

2. Excision is sometimes required

424
Q

What are milia?

A

Small, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns.

Medicine and Surgery Mushkies (52 decks)

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