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Dermatology > Skin and systemic disease > Flashcards

Skin and systemic disease Flashcards

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Dermatology Board Prep flashcards
1
Q

Presentation of dermatomyositis - hands

A

Gottron’s papules - flat-topped, red, lichenoid, over MCPs and IPs

Nails - telangiectasia, ragged edges, inflammation, highly suggestive

Rash may be itchy or asymptomatic

Hx of Raynaud’s common

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2
Q

Presentation of dermatomyositis - non-hand

A

Heliotrope (purple) rash in periorbital distribution, often w/ oedema

Photosensitive rash around upper arms, chest, back (‘shawl sign’)

Symmetrical proximal myopathy

Possible scalp involvement - alopecia

Calcinosis of skin

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3
Q

Aetiology of dermatomyositis

A

Drugs - esp statins

Idiopathic

Malignancy - may precede or follow malignancy

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4
Q

Differential for proximal myopathy

A

Thyrotoxicosis

Polymyalgia rheumatica

Cushing’s

Alcohol excess

Also consider SLE or overlap w/ e.g. systemic sclerosis

Polymyositis/dermatomyositis

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5
Q

Investigation of dermatomyositis

A

ESR, CRP

CK

FBC

ANA, anti-Jo, anti-Mi

Skin/Muscle biopsy, EMG, muscle MRI

Malignancy screen?

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6
Q

Management of dermatomyositis

A

Photoprotection, rest

Systemic steroids - 0.5-1mg/kg of prednisolone

Second-line: steroid sparing e.g. HCQ, AZA, MTX

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7
Q

Dermatological manifestation of SLE

A

Malar rash, erythema, photosensitive

Raised or non-raised

Sparing nasolabial folds

Non-scarring (c.f. discoid), no pustules (c.f. rosacea)

Fine scale

Doesn’t necessarily indicate systemic involvement

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8
Q

Dermatological appearance of discoid lupus

A

Discoid rash over face, ears, scalp, chest

Progresses to hyperkeratotic, pigmented, papules appearance –> atrophic, hypopigmented scarring

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9
Q

Dermatological appearance of subacute lupus

A

Annular, polycyclic lesions

Non-scarring

May have non-indurated psoriasiform appearance

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10
Q

Management of SLE

A

Sun protection

Stop smoking

Topical steroids for localised skin disease

HCQ for systemic disease

Oral steroids for acute flare-ups

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11
Q

Presentation of dermatitis herpetiformis

A

Intensely pruritic vesicles

Extensor distribution - buttocks, knees, elbows, forehead/scalp

?coeliac

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12
Q

Investigation of dermatitis herpetiformis

A

Skin biopsy of early blister

Anti-TTG or anti-endomysial Abs

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13
Q

Management of dermatitis herpetiformis

A

PO dapsone 50-200mg - need FBC (haemolysis, agranulocytosis) and LFT (hepatitis) monitoring

GF diet

Gastro referral - increased risk of small bowel lymphoma so surveillance

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14
Q

Presentation of cutaneous vasculitis

A

Palpable, nonblanching purpura

Usually lower legs

May become necrotic/ulcerate

?symptoms of systemic vasculitis

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15
Q

Causes of cutaneous vasculitis

A

Idiopathic - not necessarily systemic

Drugs - esp abx

ANCA-assoc vasculitides

CTD e.g. SLE, RA

Infx - e.g. strep, Hep B/C, TB, leprosy

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16
Q

Management of cutaneous vasculitis

A

May take 6w to resolve

Compression stockings, elevation, dressing

Topical/oral steroid dep on severity

Remove ppt cause

17
Q

Investigation of cutaneous vasculitis

A

Vasculitic screen - FBC, CRP/ESR, ANCA, U&Es, LFTs, complement

Urine dip and BP - exclude renal involvement

?CXR if pulmonary involvement

18
Q

Presentation of meningococcal septicaemia

A

Viral-like prodrome

Meningism, nausea, vomiting, photophobia, neck stiffness

Petechial rash with grey centre > nonblanching purpura w/ necrotic centre

19
Q

Management of meningococcal septicaemia

A

Sepsis-6 + supportive care

LP

IV ceftriaxone

Notify PHE, contact tracing (ciproflox)

20
Q

Presentation of acanthosis nigricans

A

Hyperpigmented

Hyperkeratotic - rough, velvety texture

Symmetrical

Warty/skin tag lesions

Flexural - neck, groin, axillae, antecubittal/popliteal

21
Q

Associations of acanthosis nigricans

A

Endocrine - polycystic ovarian disease, diabetes mellitus, obesity

Neoplastic - gastric adenocarcinoma

Iatrogenic - OCP, steroids

22
Q

Presentation of erythema nodosum

A

Red-blue, raised, indurated nodules

Thighs, shins, upper arms

Painful, non-scarring

Last 2-3w

Systemically unwell - fever, malaise

23
Q

Aetiology of erythema nodosum

A

Infection - TB, HBV, Yersinia, chlamydia, GrpA strep

Iatrogenic - OCP, dapsone, sulphonamides (e.g. trimethoprim)

Neoplastic - haem malignancy, pregnancy

Inflammatory - IBD, sarcoidosis

24
Q

Management of erythema nodosum

A

Treat underlying cause

NSAIDs

Bed rest, leg elevation, compression stockings

25
Q

Presentation of necrobiosis lipoidica

A

Red plaque > yellow-brown w/ telangiectasia > ulceration

Often shins, possible bilateral

Usually assoc w/ diabetes mellitus

smaller + not rapidly enlarging + purple edges c.f. pyoderma gangrenosum

26
Q

Management of necrobiosis lipoidica

A

Avoid trauma

Topical, intralesional and oral steroids

27
Q

Presentation of pretibial myxoedema

A

Waxy - peau d’orange

Nontender and normal temp (c.f. cellulitis)

Erythematous, nonpitting oedema around legs and feet

28
Q

Management of pretibial myxoedema

A

Very potent topical and intralesional steroids

Ix thyroid - usually Grave’s or hashimotos, treat

29
Q

Presentation of erythema multiforme

A

Symmetrical, ‘target lesions’ with central blister

Widespread (c.f. migrans tick bite)

Mucosal – worry about SJS

30
Q

Associations of erythema multiforme

A

Drugs - abx, NSAIDs, allopurinol, anticonvulsants

Collagen disorders

Infx - mycoplasma, herpes

31
Q

Presentation of vitiligo

A

Macular hypopigmentation +/- inflamer, hyperpigmented borders

Usually symmetrical

Sunlight makes them itch

32
Q

Management of vitiligo

A

Assoc w/ autoimmune disorders and premature ovarian failure

Treat w/ cosmesis, sunscreen, ?topical steroids/tacrolimus

33
Q

Types of xanthomata

A

Xanthalesema: Over eyelid

Tuberous: Pressure points e.g. knees, elbows

Tendinous: Commonly Achilles

Eruptive: Usually buttocks, shoulders, extensor surfaces

Yellow or yellow-pink nodules, lipid accumulation

34
Q

Presentation of lichen planus

A

Violaceous papules > coalesce to polygonal plaques

White streaks overlying - Wickham’s striae

Intensely pruritic (but not oral)

Esp volar wrist/ankle

May cause ulceration in genital or mouth mucosa

Hyperpigmentaion after resolution

Trachyonychia - sandpaper-like nails

35
Q

Features of tuberous sclerosis

A

Ash-leaf hypopigmented macules

Suede-like shagreen patches on lower back

Multiple angiofibromata, firm skin overgrowths

Cafe-au-lait macules

Most suffer from epilepsy and developmental delay

36
Q

Features of Sturge-Weber syndrome

A

Port-wine stain in ophthalmic distribution of trigeminal nerve - may thicken/hypertrophy

Conjunctival haemangiooma

Increased risk of glaucoma ipsilaterally

Focal neurology, developmental delay

37
Q

Features of Peutz-Jeghers syndrome

A

Pigmented macules commonly around mouth

Can occur aroun umbilicus, genitalia, anus

Prolapsed rectal polyp

Increased risk of malignancy

38
Q

Management of lichen planus

A

Topical corticosteroid

Screen for HCV if concern

39
Q

Melasma

A

Facial skin pigmentation

Assoc w/ hypothyroid, pregnancy, OCP, sun damage

Dermatology (10 decks)

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