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referring wisely Flashcards

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Dermatology Board Prep flashcards
1
Q

what are ddx for red legs

A

cellulitis
stasis/venous eczema
DVT

allergic contact dermatitis
vasculitis
erythema nodosum

pretibial myxoedema 
bacterial cellulitis (bilateral)
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2
Q

what is the management for venous eczema

A
  • emollients, soap substitutes
  • topical corticosteroids
  • leg elevation
  • swab and treat secondary infection
  • compression stockings once improved
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3
Q

how are leg ulcers classified

A
  1. venous
  2. arterial
  3. neuropathic
  4. other
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4
Q

what are the features of arterial leg ulcers

A

painful

feet, heels or toes

pale

cool to touch

poor peripheral pulses

history of PVD

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5
Q

what are the features of venous ulcers

A 
painless unless infected
gaiter region
shallow edge
venous insufficiency 
venous eczema
haemosiderin
lipodermatosclerosis
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6
Q

what are the features of neuropathic ulcers

A

painless
pressure points - region
numbness
PMH of diabetes, neuropathy

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7
Q

how are venous leg ulcers managed

A
  1. abpi and venous doppler uss
  2. emollient and steroids
  3. compression stockings or bandages
  4. swab and treat secondary infection
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8
Q

red legs summary

A
  • Bilateral cellulitis is very rare
  • Venous eczema is very common!
  • Compression is key to managing long-standing venous ulcers
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9
Q

how is eczema and psoriasis managed?

A
  1. trigger avoidance - fragrances, soaps
  2. emollients - prescribe normal skin regime even in an acute flare-up
  3. topical corticosteroids for acute flare-ups
  4. antihistamines can be given in allergic dermatitis for pruritis but have a sedating effect
  5. vitamin d derative given in psoriasis = calcipotriol (dovonex)
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10
Q

rank topical corticosteroids in potency used in eczema and psoriasis

A

can be given as cream or ointment

mild = hydrocortisone 1%
moderate = eumovate
potent = Betnovate
very potent = dermovate

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11
Q

aside from steroids which other drug can be prescribed in psoriasis

A

vitamin d derivative - calcipotriol (donovex)

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12
Q

key points about steroids in eczema and psoriasis

A
  1. eczema = short, strong corticosteroids for a flare-up
  2. face/neck/flexures/ children = use only mild and moderate
  3. soles and palms - require potent corticosteroids
  4. psoriasis - avoid potent steroids - can lead to pustular psoriasis
  5. eczema and psoriasis can flare up after a short course of oral/iv steroids/ potent topical = give a reducing regime
  6. avoid oral or iv steroids in psoriasis
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13
Q

what are the features/ prodrome of exanthems

A

exanthem =wide spread rash or eruption on the skin, usually viral but can be caused by drugs or autoimmune disease

fever
malaise
headache
loss of appetite 
irritability 
muscular aches and pains
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14
Q

what are the features in the history of a patient with drug/viral exanthems

A
  1. clear history of viral or drug trigger
  2. blanching rash
  3. no blistering or mucosal involvement
  4. systemically well
  5. no evidence of internal organ involvement - hx/ex/routine bloods
  6. no evidence of underlying bacterial infection from hx/ex/ routine bloods
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15
Q

how are drug/ viral exanthems managed

A
  1. stop offending medication if drug-induced - avoid it in future and inform patient and GP of allergy
  2. emollients
  3. if itchy: topical corticosteroids with or without antihistamines
  4. paracetamol
  5. advice to the patient if they deteriorate
  6. consider HIV/ syphilis serology
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16
Q

what is shingles

A

reactivation of VZV that remained dormant in the trigeminal nerve root ganglion following exposure or clinical manifestation of chickenpox.

leading to painful unilateral dermatomal eruption
seen in elderly/immunosuppressed

17
Q

shingles can lead to, describe it

A
  • facial nerve involvement - Ramsay Hunt Syndrome

* pain + facial paralysis + vesicles

18
Q

what are the complications of shingles

A
  1. secondary bacterial infection
  2. ocular involvement - an ophthalmic division of trigeminal nerve, nasal tip involvement, visual complaints or conjunctival injection
  3. dermatomal spread
  4. pneumonia
  5. encephalitis
  6. post-herpetic neuralgia
  7. pregnancy - stay away from pregnant people who haven’t had chicken pox
19
Q

what are the investigations and management of shingles

A
  1. viral swab with or without a bacterial swab
  2. oral aciclovir
  3. analgesia
  4. contagious VZV until crusted
  5. advice re: complications
20
Q

shingles summary

A

beware of ocular involvement

swab

analgesia and antivirals

21
Q

what are the differentials of generalised pruritus

A
  1. environment = central heating, air-conditioning
  2. irritants = soaps, fragrances
  3. inpatients = dehydrated, stressed, malnutrition, elderly (dry skin), drugs
  4. co-morbidities = uraemia, bilirubinaemia, malignancy, haem disorders including anaemia, heart failure, infection (hip, hep b/c), endocrine disorders, neurological disorders, psychological disorders, pregnancy
22
Q

describe the management of generalised prurutis

A
  1. treat the underlying cause
  2. avoid irritants
  3. soap substitutes - dermol 500/emollient
  4. regular emollients
  5. oral antihistamines - sedating vs non-sedating
  6. topical corticosteroids
  7. consider drug alternatives = opioids, ACE inhibitors, statins (risk vs benefits)

dermatology (6 decks)

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