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Dermatology > Pathology Part 1 > Flashcards

Pathology Part 1 Flashcards

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1
Q

Ecchymosis

A

Large confluent area of purpura (‘bruise’)

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2
Q

Impetigo

A

Superficial bacterial skin infection usually caused by either S.aureus or Group A Strep.

Can be a primary infection or a complication of an existing skin condition such as eczema, scabies or insect bites.

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3
Q

Causes of Impetigo

A

o Staph aureus

o Group A strep

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4
Q

Treatment for Impetigo (Limited, localised disease)

A
  1. Hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
  2. Topical antibiotic creams such as topical fusidic acid
    Topical mupirocin should be used if fusidic acid resistance is suspected
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5
Q

Treatment for Impetigo (Extensive disease)

A

Oral flucloxacillin

Oral erythromycin if penicillin-allergic

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6
Q

School exclusion guidelines in Impetigo

A

Children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

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7
Q

Impetigo features

A

‘golden’, crusted skin lesions found around the mouth
very contagious
Spread by direct contact

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8
Q

Staphylococcal scalded skin syndrome (SSSS)

A

A disorder that develops because of a toxin produced by a staphylococcal infection. In SSSS the toxin spreads to the skin through the blood stream and specifically binds to a target protein very high in the epidermis (outer layer of the skin) producing total body reddening of the skin and blistering and sloughing of the skin resembling a hot water burn or scalding of the skin.

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9
Q

Staphylococcal scalded skin syndrome (SSSS) features

A
  1. Infancy and early childhood
  2. Worse over face, neck, axillae and groin
  3. Scald-like skin appearance followed by large flaccid bulla
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10
Q

Cause of Staphylococcal scalded skin syndrome (SSSS)

A

Bullous impetigo

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11
Q

Treatment for Staphylococcal scalded skin syndrome (SSSS)

A

Flucloxacillin

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12
Q

Difference between Staphylococcal scalded skin syndrome and Toxic epidermal necrolysis (TEN)

A

Differentiated by
• Mucosal involvement only occurs in TEN
• Skin biopsy; more superficial split in SSSS than TEN

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13
Q

Cellulitis

A

An inflammation of the skin and subcutaneous tissues, typically due to infection by Streptococcus pyogenes or Staphylcoccus aureus.

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14
Q

Features of cellulitis

A
  1. commonly occurs on the shins
  2. erythema, pain, swelling
  3. systemic upset such as fever
  4. Often blisters especially is oedema is present
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15
Q

Causes of cellulitis

A
  1. Group A strep
  2. S.aureus
  3. May be an obvious portal of entry for infection
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16
Q

Eron classification

A

To guide how we manage patients with celluliti

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17
Q

Categories for admitting patient wit cellulitis for IV antibiotics

A
  1. Has Eron Class III or Class IV cellulitis.
  2. Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
  3. Is very young (under 1 year of age) or frail.
  4. Is immunocompromized.
  5. Has significant lymphoedema.
  6. Has facial cellulitis (unless very mild)
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18
Q

Management of mild/moderate cellulitis

A

Flucloxacillin as first-line

Clarithromycin, erythromycin (in pregnancy) or doxycyline is recommended in patients allergic to penicillin.

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19
Q

Management of severe cellulitis (based on categories)

A

IV antibiotics

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20
Q

Necrotising fasciitis

A

Is a rare but serious bacterial infection that affects the tissue beneath the skin and surrounding muscles and organs (fascia).

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21
Q

Necrotising fasciitis classifications

A

Type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type

Type 2 is caused by Streptococcus pyogenes

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22
Q

Necrotising fasciitis risk factors

A
  1. Skin factors: recent trauma, burns or skin infections
  2. Diabetes mellitus
  3. Intravenous drug use
  4. Immunosuppression
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23
Q

Features of Necrotising fasciitis

A 
>	Widespread tissue destruction 
>      Acute onset
>	Severe pain
>	Fever 
>	Necrosis
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24
Q

Fournier’s gangrene

A

Sometimes life-threatening form of necrotizing fasciitis that affects the genital, perineal, or perianal regions of the body.

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25
Q

Most commonly affected area in Necrotising fasciitis

A

The most commonly affected site is the perineum (Fournier’s gangrene).

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26
Q

Management of Necrotising fasciitis

A

Urgent surgical referral debridement

Intravenous antibiotics such as benzylpenicillin and clindamycin

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27
Q

Folliculitis

A
  • Inflammation of the hair follicle
  • Caused by staph aureus
  • Caused by Pseudomonas ovale with hot tub use
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28
Q

Folliculitis features

A
  • Presents as itchy or tender papules and pustules
  • Commoner in humid climates
  • Hot tub use
  • Extensive, itchy folliculitis of the upper trunk - possibility underlying HIV infection
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29
Q

Management of Folliculitis

A

Oral erythromycin

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30
Q

Leprosy

A

A granulomatous disease primarily affecting the peripheral nerves and skin. It is caused by Mycobacterium leprae.

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31
Q

Cause of leprosy

A

Mycobacterium leprae.

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32
Q

Classifications for Leprosy

A
  1. Interdeterminate leprosy
  2. Tuberculoid leprosy
  3. Lepromatous leprosy
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33
Q

Interdeterminate leprosy

A

Small hypopigmented or erythematous circular macules with occasional mild anaesthesia and scaling

May resolve spontaneously or progress to one of the other types

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34
Q

Tuberculoid leprosy

A

Few larger hypopigmented or erythematous plaques with an active erythematous, often raised, rim.

Lesions are usually marked, dry and hairless (reflecting the nerve damage)

Nerves may be enlarged and palpable

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35
Q

Lepromatous leprosy

A

Presents with multiple inflammatory papules, plaques and nodule

Loss of the eyebrows and nasal stuffiness are common

Skin thickening and severe disfigurement and may follow

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36
Q

Diagnosis of Leprosy

A
  1. Hypopigmented/reddish patches with sensory loss
  2. Thickening of peripheral nerves
  3. Acid fast bacilli seen on skin-slit smears/biopsy
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37
Q

Management of leprosy

A

Triple therapy: rifampicin, dapsone and clofazimine

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38
Q

Leprosy features

A

> Patches of hypopigmented skin
buttocks, face, and extensor surfaces of limbs
Sensory loss

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39
Q

Slapped cheek syndrome

A
  • Infection Caused by parvovirus B19
  • Bright red rash seen on the face (slapped cheek)
  • Arthritis
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40
Q

Another name for Slapped cheek syndrome

A

Erythema infectiosum

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41
Q

Features of HSV infection

A

May present with a severe gingivostomatitis
Cold sores
Painful genital ulceration
Can autoinoculate into sites of trauma and present as painful blisters/pustules
Herpetic whitlow

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42
Q

HSV strain types

A

HSV-1 & HSV-2

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43
Q

Herpetic whitlow

A

A painful infection of the finger caused by the herpes virus. It’s easily treated but can come back - typically seen in healthcare workers

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44
Q

Management for HSV infection

A

Oral aciclovir for gingivostomatitis and genital herpes

Topical aciclovir for cold sores

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45
Q

Management of pregnant women with HSV primary attack at >28 weeks gestation

A

C-section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation

46
Q

Complications of HSV infection

A
  1. Corneal ulceration
  2. Eczema herpeticum
  3. Erythema multiforme
47
Q

Varicella zoster virus

A

Produces two distinct diseases:

  1. Chickenpox (varicella)
  2. Shingles
48
Q

Chicken pox

A

Occurs in childhood
Virus entering through the mucosa of the upper respiratory tract
Air borne transmission

49
Q

Shingles

A

> Arises from the reactivation of latent viruses

> Most common in the elderly

50
Q

Varicella zoster virus infection

A 
Chickenpox = none
Shingles =  acyclovir
51
Q

Hutchenson’s sign

A

Presence of vesicular lesions on the side or tip of the nose - Acute herpes zoster ophthalmicus and shingles

52
Q

What two conditions are associated with Hutchenson’s sign?

A

Acute herpes zoster ophthalmicus

Shingles

53
Q

Features of Shingles

A

> Unilateral and restricted to a single dermatone
Neuralgic pain
Hutchenson’s sign

54
Q

How does Varicella zoster virus lead to shingles?

A

Following recovery of chickenpox in childhood, the virus remains latent in dorsal root and cranial nerve ganglia

Reactivation of infection then results in shingles

55
Q

Management of pregnant woman with recurrent herpes

A

Should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low.

56
Q

What strains of HPV is associated with genital warts?

A

6 and 11

57
Q

What strains of HPV is associated with cancer?

A

Types 16, 18 and 33

58
Q

What strains of HPV is associated with non-genital warts?

A

Types 1 to 4

59
Q

Molluscum Contagiosum

A

A common skin infection caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family.

60
Q

Transmission of Molluscum Contagiosum

A

Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels.

Highly contagious

61
Q

Features of Molluscum Contagiosum

A
  • Highly contagious
  • Small, firm, umbilicated pearlescent nodules
  • Look fluid filled but are solid
  • Not painful, but itchy
  • Common in children, can transmit sexually
62
Q

Onychomycosis

A

Is a fungal infection of the nails

63
Q

Dermatophytes

A

Are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails.

64
Q

Causes of onychomycosis

A
  1. Dermatophytes - mainly Trichophyton rubrum
  2. Yeasts - such as Candida
  3. Non-dermatophyte moulds
65
Q

Risk factors for onychomycosis

A

Diabetes mellitus

Increasing age.

66
Q

Investigations of onychomycosis

A

Nail clippings

Scrapings of the affected nail

67
Q

Management of onychomycosis

A

Asymptomatic = none
Dermatophytes - oral terbinafine/itraconazole
Candida - Amorolfine/itraconazole

68
Q

Dermatophyte nail infection management

A

Oral terbinafine first-line with oral itraconazole as an alternative

Fingernails - 6 weeks - 3 months therapy
Toenails - 3 - 6 months therapy

69
Q

Candida infection management

A

Mild disease - topical antifungals (e.g. Amorolfine) Severe infections - oral itraconazole for a period of 12 weeks

70
Q

Tinea cruris

A

Dermatophyte infection affecting the groin

71
Q

Tinea pedis

A

Dermatophyte infection affecting the foot

72
Q

Tinea manuum

A

Dermatophyte infection affecting the palms

73
Q

Tinea unguium

A

Dermatophyte infection affecting the nails

74
Q

Tinea capitis

A

Dermatophyte infection affecting the scalp

75
Q

Tinea corporis

A

Dermatophyte infection affecting the whole body

76
Q

Pityriasis versicolor

A

Also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

77
Q

Features of Pityriasis versicolor

A

> White people - red/brown scaly macules
Black people - hypo pigmented macules
May be more noticeable following a suntan
Scale is common
Mild pruritus

78
Q

Management of Pityriasis versicolor

A

Ketoconazole shampoo

If failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole

79
Q

Scabies

A

Caused by the mite Sarcoptes scabiei and is spread by prolonged skin contact. It typically affects children and young adults.

80
Q

Pathophysiology of scabies

A

The scabies mite burrows into the skin, laying its eggs in the stratum corneum. The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection.

81
Q

Scabies features

A

> Widespread pruritus
Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
In infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection

82
Q

Management of Scabies

A
  1. permethrin 5% is first-line

2. malathion 0.5% is second-line

83
Q

Crusted (Norwegian) scabies

A

Seen in patients with suppressed immunity, especially HIV.

84
Q

Treatment of crusted (Norwegian) scabies

A

Ivermectin is the treatment of choice and isolation is essential

85
Q

Guidance on management of scabies patient and close contacts

A

Avoid close physical contact with others until treatment is complete

All household and close physical contacts should be treated at the same time, even if asymptomatic

86
Q

Linear or curved skin burrows

A

Scabies

87
Q

Common sites of infection for scabies

A

Between the webs of the fingers and toes

88
Q

Lice

A
  • Blood sucking parasites
  • Can affect the head, body, or pubis
  • Presents with itch, excoriations
89
Q

Atopic eczema

A

Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, dry and cracked.

90
Q

Atopic eczema features

A
  • Extensor aspects in infants, flexor aspect in adults
  • Chronic itching/rubbing can lead to lichenification
  • Often positive family history of atopy
91
Q

Treatment for Atopic eczema

A 
o	Avoid exacerbating agents
o	Frequent emollients 
o	Topical steroids for flareups
o	Antivirals if secondary herpes infection
o	Phototherapy for severe cases
92
Q

Pathophysiology of eczema

A

The simplified pathophysiology is that eczema is caused by defects in the barrier that the skin provides.

Tiny gaps in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation and the associated symptoms.

93
Q

Steroid potency ladder

A

Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)

94
Q

Discoid eczema

A

A morphological variant of eczema characterised by well-demarcated scaly patches, especially on the limbs

Tends to follow an acute/sub-acute rather thana chronic pattern - Often an infective component

95
Q

Eczema herpeticum

A

A viral skin infection in patients with atopic eczema caused by the herpes simplex virus 1 or 2.

96
Q

Management of Eczema herpeticum

A

Emergency - IV aciclovir

97
Q

Sebhorrhoeic eczema

A
  • Affects body sites rich in sebaceous glands
  • Neonates – yellow thick crusts on scalp
  • No pruritus
98
Q

Varicose eczema

A
  • Tends to occur in older people, especially women
  • Usually lower legs and ankles
  • Past history of venous thrombosis
  • Leg ulcer or varicose veins may be present
99
Q

Varicose eczema management

A
  1. Compression stockings
  2. Emollients
  3. Moderately potent topical steroids
100
Q

Asteatotic eczema

A

Also known as winter eczema, eczema craquele, senile eczema - Often occur in elderly people

Dry plate-like cracking of the skin with a red, eczematous component - “Crazy paving pattern”

101
Q

Causes of allergic contact dermatitis

A 
>	Nickel
>	Chromate
>	Latex
>	Perfume
>    Hair dye
102
Q

Causes of irritant contact eczema

A

> 

Detergents
Soaps
Bleach
103
Q

Treatment for irritant and allergic contact eczema

A
  1. Avoid the causative agent
  2. Wear protective gloves
  3. Change occupation/hobbies
104
Q

Irritant contact dermatitis

A

Common - non-allergic reaction due to weak acids or alkalies (e.g. detergents). Often seen on the hands. Erythema is typical, crusting and vesicles are rare

105
Q

Allergic contact dermatitis:

A

Type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself.

106
Q

Two types of contact eczema/dermatitis

A
  1. Irritant

2. Allergic

107
Q

Lichen simplex

A

A localised area of chronic, lichenified eczema/dermatitis. There may be a single or multiple plaques. It is also called neurodermatitis.

108
Q

Common sites for Lichen simplex

A 
>	Nape of the neck
>	Lateral calves
>	Upper thighs
>	Upper back
>	Scrotum
>	Vulva
109
Q

Cow’s milk protein intolerance/allergy features

A
  1. regurgitation and vomiting
  2. diarrhoea
  3. urticaria, atopic eczema
  4. ‘colic’ symptoms: irritability, crying
  5. wheeze, chronic cough
  6. rarely angioedema and anaphylaxis may occur
110
Q

Management of Cow’s milk protein intolerance/allergy if formula-fed

A

Extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms

111
Q

Management of Cow’s milk protein intolerance/allergy if breast-fed

A

Continue breastfeeding

Eliminate cow’s milk protein from maternal diet.

Dermatology (4 decks)

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