Skin Emergencies

Question 1

Skin failure changes name depending on severity. At what point does one type become the other and what is each called.

Answer 1

Stevens-Johnson syndrome <10% of body affected

Toxic epidermal necrolysis >30%

Question 2

What is the main cause of skin failure?

Answer 2

Drug induced
Mainly
- antibiotics
- anticonvulsant

Question 3

What is the aetiology behind skin failure?

Answer 3

Autoimmune hypersensitivity reaction

Death of keratinocytes
Skin becomes detached at DEJ

Question 4

Skin failure is associated with a v high mortality rate. Why?

Answer 4

V high risk of infection
Loss of thermoregulation
Increased fluid loss

Question 5

What will biopsy show of skin failure?

What other clinical sign what be positive?

Answer 5

Full detachment at DEJ

Nikolsky sign

Question 6

Where is the patient moved to to be managed for skin failure?

Answer 6

Burns unit

Question 7

How can you tell the difference in presentation of a patient with food intolerance (non-IgE mediated) and food allergen (IgE mediated)

Answer 7

Food intolerance won’t present with resp symptoms/ anaphylaxis/angioedema

Question 8

The following 3 are distinguishing features of a reaction to a food allergen.
Explain what each of them means and how to manage each:
- urticaria
- angioedema
- anaphylaxis

Answer 8

Urticaria

• itchy wheals on skin
• antihistamines

Angioedema

• swelling of tongue and lips
• corticosteroids

Anaphylaxis

• bronchospasm with larngeal/facial oedema + hypotension
• adrenaline (EpiPen)
• corticosteroids
• antihistamines

Question 9

What is the classic triad of meningitis symptoms?

Answer 9

• headache
• neck stiffness
• fever

Question 10

What bacterial cause of meningitis leads to the infamous rash?
Describe how the bacteria appears under microscope?

Describe what that rash looks like

Answer 10

Neisseria meningitidis
Gram -ve diplococci

Non-blanching purpuric rash (when you press a glass to the rash it won’t disappear)

Question 11

What is meningitis?

Answer 11

Inflammation of the leptomeninges (2 most inner layers of the meninges - pia mater and arachnoid)

Occurs when infection makes it into the CSF in sub-arachnoid space

Question 12

Meningitis is a notifiable disease. T/F?

Answer 12

T

Question 13

What are the signs and symptoms of necrosing fasciitis?

Answer 13

• Severe pain
• Swollen and blistering skin
• Subcutaneous crepitus

Question 14

How is necrotising fasciitis managed?

Answer 14

IV antibiotics

Urgent surgical referal for debridement

Question 15

What is the prognosis of necrotising fasciitis?

Answer 15

Up to 76% mortality