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Virtual Ward > Rash > Flashcards

Rash Flashcards

1
Q

Under which headings would you describe an individual lesion?

A 
SCAM
Size, shape
Colour
Associated secondary change
Morphology, margin
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2
Q

If a lesion is pigmented, the presence of which features increase the likelihood of melanoma?

A

Asymmetry (lack of minor image in any of the four quadrants)
Irregular Border
Two or more Colours within the lesion
Diameter > 6mm

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3
Q

Differentiate between macule, patch, plaque, papule, nodule, vesicle, pustule and bulla.

A

Macule- flat lesion less than 1 cm, without elevation or depression
Patch- flat lesion greater than 1 cm, without elevation or depression
Plaque- flat, elevated lesion, usually greater than 1 cm
Papule- elevated, solid lesion less than 1 cm
Nodule- elevated, solid lesion greater than 1 cm
Vesicle- elevated, fluid-filled lesion, usually less than 1 cm
Pustule- elevated, pus-filled lesion, usually less than 1 cm
Bulla- elevated, fluid-filled lesion, usually greater than 1 cm

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4
Q

What are the four main rashes?

A 
maculopapular
erythematous
petechial/purpuric
vesiculo/bullous
(look up pics)
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5
Q

Describe a rash consistent with psoriasis.

A

red demarcated plaques, with secondary crusting, erosions and scale on extensor surfaces

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6
Q

Describe a systematic approach to discussing rashes.

A 
Colour
Size
Morphology
Pattern
Distribution
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7
Q

What kind of descriptions would you use for the pattern of a rash?

A 
discrete or confluent?
demarcated or indistinct?
linear?
target?
annular (ring-shaped)?
discoid?
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8
Q

What kind of descriptions would you use for the distribution of a rash?

A 
generalised/localised
central/peripheral
flexural/extensor surfaces
dermatomal area
site-specific
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9
Q

What rash may become secondary to vancomycin therapy?

A

‘red man syndrome’ - widespread, urticarial erythematous rash

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10
Q

What is Adult-onset Still’s disease?

A

rare systemic autoinflammatory disease characterized by the classic triad of fevers, joint pain, and a distinctive salmon-coloured bumpy rash which only appears when pyrexial

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11
Q

What is the word you would use to describe someone who is red all over?

A

erythroderma

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12
Q

Name some conditions which present with erythroderma.

A 
psoriasis erythroderma
eczema
pityriasis rubra pilaris
cutaneous adverse drug reaction
cutaneous lymphoma
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13
Q

How does cutaneous lupus typically present?

A

annular patchy rash or discoid plaque type

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14
Q

Name three drugs which may worsen psoriasis.

A

antimalarials, B blockers, lithium

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15
Q

What is the prevalence of psoriatic arthritis among patients with psoriasis?

A

5-30%

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16
Q

Which areas are important to examine in a patient with suspected psoriasis?

A

flexures, nails, scalp, joints, genital regions, post-auricular regions

17
Q

Which nail changes are associated with psoriasis?

A

pitting, onycholysis, subungual hyperkeratosis, leukonychia, oil drop

18
Q

What are the six different types of psoriasis?

A

plaque, guttate, flexural, palmoplantar, pustular, erythrodermic

19
Q

What often triggers guttate psoriasis?

A

streptococcal throat infections

20
Q

How does guttate psoriasis present?

A

usually seen in children and adolescents

numerous small red patches develop on trunk, often clears in a few months but plaque psoriasis may develop later

21
Q

Describe the presentation of flexural psoriasis.

A

submammary axillary and anogenital folds - sharply demarcated, glistening salmon pink in colour, can have superimposed candida

22
Q

Which type of psoriasis can present with significant scaling and painful fissures of palms and soles?

A

palmoplantar

23
Q

How does pustular psoriasis present?

A

localised palmoplantar pustulosis (recalcitrant, multiple sterile pustules on palms and soles) or generalised pustular psoriasis which is an emergency

24
Q

What is the most common arthropathy in psoriatic arthritis?

A

asymmetric mono or oligoarthritis

25
Q

What are the first line managements in a patient with psoriasis?

A 
emollients
topical steroids
vitamin D analogues
coal tar
weight loss (relation to metabolic syndrome)
alcohol cessation
26
Q

Where would you examine for evidence of mucosal involvement?

A

conjunctiva
genitals and urinary tract
lips and mouth

27
Q

What are some of the skin features of TEN/SJS?

A

diffuse erythema
macules
targetoid lesions
skin detachment, erosions and flaccid blisters

28
Q

What is Nikolsky sign?

A

when blisters and erosions appear when the skin is rubbed gently - TEN/SJS

29
Q

What drugs can cause SJS/TEN?

A

allopurinol, NSAIDs, anti-epileptics e.g. carbamazepine, antibiotics

30
Q

SJS and TEN are considered part of a spectrum of disease, based on the degree of skin involvement. Discuss.

A

SJS: <10% BSA affected, plus widespread erythematous/purpuric macular rash or flat atypical targets
SJS/TEN overlap: 10-30%, widespread purpuric macules or flat atypical targets
TEN: epidermal detachment > 30%

31
Q

Discuss the scoring system in place for assessing the severity of SJS/TEN to predict mortality.

A 
age > 40 years
malignancy
HR > 120
initial % epidermal detachment >10%
serum urea > 10 mmol/L
serum glucose > 14 mmol/L
serum bicarb < 20 mmol/L
32
Q

What should be considered a part of the management of SJS/TEN?

A 
identify and stop culprit drug
fluid balance
temperature control
barrier nursing
glycaemic control
skin care
mouth and eye care
analgesia
identification and treatment of infection
VTE prophylaxis
33
Q

What is the bacteria which is involved in the pathogenesis of acne?

A

Propionibacterium acnes - if a follicle becomes blocked by excess sebum or skin cells, the bacteria can multiply
causing inflammation within the follicle

34
Q

Name some drugs which can induce or worsen acne.

A

topical and oral corticosteroids, lithium, ciclosporin, progesterone only contraceptives

35
Q

What kind of topical and systemic treatments are available for acne?

A

topical: Benzoyl peroxide, Adapalene (topical retinoid), Clindamycin
systemic: COCP, doxycycline, isotretinoin (oral retinoid)

36
Q

Why should patients who are taking isotretinoin avoid alcohol?

A

due to the risk of transaminitis

37
Q

What are the five patterns of psoriatic arthropathy?

A 
Distal interphalangeal arthritis
Symmetrical polyarthritis
Asymmetrical oligoarthritis
Spondyloarthropathy
Arthritis mutilans
38
Q

What are the classic features of basal cell carcinoma?

A

rolled edge, pearly appearance and telangiectasia

39
Q

What are the different classes of steroid and give an example of each?

A

mild - Hydrocortisone
moderate - eumovate
potent - betnovate
very potent - dermovate

Virtual Ward (11 decks)

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