Rashes, psoriasis and dermatitis

Question 1

what would you see on biopsy of a person with dermatitis

Answer 1

spongiosis

inflammatory cell infiltrate

Question 2

biggest issue with a child with atopic dermatitis?

Answer 2

pruritus at night when sleeping

can cause insomnia and impaired cognitive function

Question 3

what else is atopic dermatitis associated with

Answer 3

asthma
allergic rhinitis
food allergy

Question 4

how would atopic dermatitis be seen in a patient with skin of colour

Answer 4

well defined, papular instead of macular, extensive lichenification

Question 5

what is discoid eczema

Answer 5

well defined border, disc shaped

Question 6

what is photosensitive eczema

Answer 6

dermatitis due to photosensitivity to certain wavelengths of light

Question 7

what is stasis eczema

Answer 7

dermatitis due to increased hydrostatic pressure or oedema, commonly in the legs

Question 8

what is pompholyx eczema

Answer 8

joining of pongiotic vesicles to create a larger vesicle that may weep

Question 9

what is lichen simplex

Answer 9

not a disease, person scratches at an area so much it gives them dermatitis

Question 10

causes of psoriasis (not the immunology of it)

Answer 10

genes
stress
drugs - BB
Infection - strep throat

Question 11

increases risk factors due to psoriasis?

Answer 11

3x MI
diabetes
hyperlipidaemia 
diabetes
obesity 
depression 
chron's disease 
cancer
psoriatic arthritis

Question 12

what is koebner phenomenon

Answer 12

psoriasis in area of skin trauma

Question 13

what is auspitz sign

Answer 13

pinpoint bleeding under scale due to elongated dermal papillae

Question 14

pathogenesis of acne?

Answer 14

poral occlusion of pilosebaceous unit due to increased sebum
bacterial colonisation and dermal inflammation

Question 15

what is wickham’s striae

Answer 15

lace like pattern on surface of papules and buccal mucosae

hallmark of lichen planus

Question 16

what is nikolsky’s sign

Answer 16

shearing off of a blister

+ve is indicative of pemphigus vulgaris

Question 17

why is mortality increased in pemphigus vulgaris

Answer 17

blister bursts easily so secondary bacterial infection

Question 18

types of allergic drug reactions and their rashes involved

Answer 18

type I - urticaria
type II - pemphigus and pemphigoid
type III -purpura
type IV - maculopapular

Question 19

true/false - allergic drug reactions are dose dependent

Answer 19

false - they are not

Question 20

types of non-allergic drug reactions

Answer 20

eczema 
phototoxicity 
atrophy 
psoriasis 
xerosis 
erosion

Question 21

most common drug rash

Answer 21

exanthemous - maculopapular

Question 22

what type of hypersensitivity is an exanthemous drug reaction and what immune cell mediates it

Answer 22

type IV

t cell

Question 23

when would you see an exanthemous rash present

Answer 23

4-21 days after being on a drug

Question 24

when would an exanthemous rash become life threatening

Answer 24

wheeze
blisters
very high fever
purpura
facial erythema/oedema and genital involvement 
widespread confluent oedema

Question 25

what drugs commonly cause exanthemous rashes

Answer 25

``` penicllin suphonamide erythromycin NSAIDs antiepileptics ```

Question 26

an urticarial rash has two methods of pathophysiology, describe them and the drugs that happen

Answer 26

immediate IgE after exposure - beta lactams | direct mast cell mediator release - aspirin, opiates, NSAIDs, vancomycin

Question 27

what can cause purputic rash

Answer 27

warfarin necrosis

Question 28

what can cause an acneiform rash

Answer 28

glucocorticoids | androgens, lithium, isoniazid, phenytoin

Question 29

what can cause drug induced bullous pemphigoid

Answer 29

ACEI, penicillin, furosemide

Question 30

what drugs can cause pigmentation

Answer 30

minocyclone | hydroxyurea

Question 31

who to consider for drug rash

Answer 31

any patient on medication with symmetrical skin rash elderly, females, viral infection, genes B-lactams, multiple drugs

Question 32

what is a fixed drug eruption ans what causes it

Answer 32

well demarcated painful red round plaque, causes pigmentation when drug stiopped doxy, paracetamol, NSAIDs

Question 33

what causes toxic epidermal necrolysis

Answer 33

cephalosporins, sulphonimides, NSAIDs, sertraline, pantoprazole

Question 34

what causes AGEP

Answer 34

antibiotics, CCB, antimalarials

Question 35

consequences of DRESS, TEN, AGEP

Answer 35

``` hypothermia fluid loss protein loss sepsis multi organ failure ```

Question 36

how do drugs cause phototoxic reactions

Answer 36

can act as a chromophore

Question 37

managing drug reactions?

Answer 37

``` discontinue use alternative topical steroids and antihistamines for type I allergy bracelet tell MRHA ```

Question 38

causes of pruritoceptive itch

Answer 38

lichen planus asteatotic eczema psoriasis insect bite

Question 39

causes of neuropathic itch

Answer 39

shingles

Question 40

causes of neurogenic itch

Answer 40

``` haematological paraneoplastic liver/bile duct kidney disease thyroid disease ```

Question 41

psychogenic itch is?

Answer 41

psychological