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Dermatology > The Skin and Systemic Diseases > Flashcards

The Skin and Systemic Diseases Flashcards

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Dermatology Board Prep flashcards
1
Q

-some signs that are relatively easy to spot (4)

A
  • tumour invades skin or metastases to skin
  • achne in adrenal tumours
  • flushing in carcinoid syndrome
  • jaundice in bile duct carcinoma
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2
Q

-acanthosis nigricans

>o/e? (3)

>can be a sign of malignancy partularly where (1). differentials for cause (3)

A

-D-major flexures

-M- pigmentation, velvety thickening

  • this can be a sign of malignant tumour. usually in the abdomen
  • obesity, metabolic syndrome inc T2DM, iatrogenic>nicitinic acid for hyperlipidemia
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3
Q
  • acquired ichythyosis
  • ichythyosis o/e? (3)
  • it is usual for ichthyosis to occur in adult life. if it does must rule out (1)
  • differentials inc other causes of dry skin- lepropsy, malabsporption, poor diet, hypothyroid
A

-ichythyosis comes from greek word fish. there are many types of disorders that share this appearance.

-o/e

>dry rough skin

>marked scaling

>no inflammation

-lymphoma - esp hogdkins.

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4
Q

dermatomyositis, in adulthood

  • what is dermatomyositis(2)
  • about how many pts have underlying malignancy?
  • pay special attention to where(1)
  • dd(1)
A

-inflammation of the skin and underlying muscle tissue

>may involving degeneration of collagen, discoloration, and swelling

-30% have underlying malignancy

-pay special attention to ovaries where cancer may be lurking undetected

-dd is autoimmune

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5
Q

pyoderma gangrenosum

  • o/e ? (4)
  • pathology (2)
  • differentials as causes
A

-inflamed pustule or nodule breaks down centrall to form an explanding ulcer with a polycyclic or serpiginous outline. a characteristic bluish edge

-not bacterial, pathology not fully understoof butpresumed to be immunological

-IBD, polyarthritic conditions egRA, haematological malignancies - particuarly myeloid origin

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6
Q

-what skin conditions are more common in DM pts (10)

A
  • necrobiosis lipoidica
  • granuloma annulare
  • diabetic dermopathy
  • candidal infections
  • staphyloccocal infections
  • vitiligo
  • eruptive xanthomas
  • stiff thick skin. on fingers or hands. ‘prayer’ sign - pts cannot oppose hands without a gap.
  • atherosclerosis w. gangrene or ischaemia of feet
  • neuropathic foot ulcers
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7
Q
  • necrobiosis lipoidica. o/e? (2) always think through dmc for o/e. m includes a-e
  • granuloma annulare o/e? (4)
A
  • D- front of shins, M - one or more discoloured areas
  • D- usually lie over knuckles. M - macules. on hands skin coloured. elsewhere dull red/purple. C- annular hence name
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8
Q
  • diabetic dermopathy. occurs in about how many t1dm pts? o/e (2)
  • vitiligo. o/e(1)
  • eruptive xanthoma o/e (1)
A

-50%. D-on limbs most obviously shins. M- multiple, small, sunken, brown scars

-pale, patches to develop on the skin due lack of melanin eg michael jackson, winnie

-sudden eruption of small, red-yellow papules

-

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9
Q

skin conditions that can occur as a result of hyperthyroidism (2). hypothyroidism (1)

A
  • pruritis, urtucaria (=a rash of weals)
  • dry skin
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10
Q
  • SLE and the skin.
  • onset?
  • skin o/e (5)
A
  • typically acute onset
  • malar rash
  • on cheeks(malar) and nose. butterfly shape
  • facial swelling
  • blisters rarely, and signify very active systemic disease

-widespread discoid or annular plaques . can lead to scarring.

-periungual telangiectases sad skin around the nails

-erythema over digits

-ulcers in mouth

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11
Q
  • pathology of erythema nodosum (1)
  • triggers (6)
A

-inflammation of subcutaneous fat (=a panniculitis), immunological reaction.

-caused by

>bacteria > strep, tb, brucellosis, leprosy, yersini, rickettsia, chlamydia

>viruses

>fungi

>iatrogenic > sulphonamides, oral contraceptives

>systemic disease > sarcoidosis, IBD

>pregnancy

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12
Q
  • erythema nodosum Hx and o/e (5)
  • course (1)
A
  • tender red nodule. alone or groups. on legs, forearms. rarely some other areas where there is fat. pts may also have painful joints and fever.
  • lesions usually resolve in 6-8 wks. in interim lesions may enlarge or new ones occur.
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13
Q
  • Mx(1)
  • dd for singlular tender red nodule (3)
  • dd for multiple (1)
A
  • remove cause
  • trauma, infection (early cellulitis or abscess), phlebitis
  • nodular panniculitis > may be caused by pancreatitis, cold, trauma, injection, withdrawal from steroids
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14
Q
  • what is vasculitis and cutaneous vasculitis
  • pathophysiology(4)
  • causes(3)
A
  • vasculitis is inflammation within the vessel wall. erythemas are associated with some inflammation around blood vessels but vasculitis is used for inflammation in the wall. cutaneous vasculitis is inflammation of vessels walls in the skin.
  • 1)circulating immune complexes lodge in vessel walls, 2)this activates compliment, 3)this attracts polymorphs, 4)these release enzymes that damage vessel wall
  • the antigens in these immune complexes an be drugs, auto-antigens and infectious agents such as bacteria
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15
Q

presentation (1)

A

-painful palpable purpura 3 P’S OF VASCULITIS

>some have black centre caused by necrosis of tissue overlying affective blood vessel

>arise in dependant areas eg limbs of active pts, buttocks of bedridden pts

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16
Q

some types

  • henoch-schonlein is a small vessel vasculitis. features (5)
  • urticarial vasculitis is a small vessel vasculitis. features (8)
A
  • painful, palpable purpura, arthritis, abdo pain, children, often preceded by utri
  • urticaria-like rash, last 24hr+, may be purpura on weals, malaise, arthralgia, low complement levels, elevated esr, angioedema sometimes
17
Q
  • course varies with cause, extent, blood vv size, involvment of other organs
  • dd (2)
A

-other causes or purpura > clotting system abnormalities, septicaemia eg menigococcal

18
Q
  • hould be towards cause and detecting internal involvement.*
  • ask in Hx (5)
  • do physical examination
  • investigations.
A

Hx

  • recent infection? bacteria can cause
  • -*myalgia? abdo pain? claudication?confusion?mononeuritis? suggest internal involvement

investigations

  • FBC, ESR inflammation, infection
  • LFTS, U+Es check function organs
  • bloods for circulating immune complexes and low complement
  • implicates immune complexes as cause*
  • -*bloods for paraproteins, hepatitis virus, rheumatic factor, antinuclear antibody causes
  • -*urinalysis important. haematuria and proteinuria. vasculitis can affect kidney subtely!

-CXR infection

-skin biopsy confirm diagnosis of small cell vasculitis - schonlein is IgA deposits

19
Q

-the following can be caused by drugs

  • urticaria. what happens. what drugs may cause (4)
  • erythema multiforme. what drugs may cause (4)
A
  • urticaria = pink, itchy, burning rash of wheals. a common reaction pattern.
  • may be caused by apsirin (a salicylates), antibiotics, insect repellants, nitrogen mustards
  • erythema multiforme = target-like lesions, sometimes bullae appear mainly on extensor aspects of limbs.
  • may be caused by sulphonamides, barbiturates, lamotrigine, phenybutazone
20
Q

-the following skin reactions can be caused by drugs

-toxic epidermal necrolysis. what happens (1). some causes (11)

-steven-johnson syndrome what is this a form of. what happens

A
  • skin appears scalded. causes include sulphonamides, cephalosporins, quinolones, barbiturates, phenylbutazone (an nsaid), oxyphenbutazone (an nsaid), phenytoin, oxicams, carbamazepone, lamotrigine, penicillin
  • steven-johnsons syndrome is a form of toxic epidermal necrosis. life-threatening skin. cell death causes the epidermis to separate from the dermis
21
Q

-main functions of skin(3)

A
  • temperature control
  • barrier
  • cutaneous blood flow
22
Q

-consequences of skin failure

  • loss of temperature control (2)
  • loss of barrier function(3)
  • increased cutaneous blood flow (1)
  • another consequence (1)
A

-loss of temp control

>cannot sweat when too hot

>cannot vasoconstrict when too hot

hence temp sways dangerously up and down

-loss barrier function

>raw skin surfaces lose fluid and electrolytes

>heavy protein loss

>bacterial pathogens multiple on damaged skin

-increased cutaneous blood flow

>vasodilation and increased blood through skin. increased blood volume and cardiac output. may lead to high output cardiac failure in those with poor cardiac reserve

-hair loss and nail loss these regrow

23
Q

-loss of temp control. Mx (1)

-loss barrier function

>raw skin surfaces lose fluid and electrolytes. Mx (1)

>heavy protein loss. Mx (1)

>bacterial pathogens multiple on damaged skin. Mx (2)

-increased cutaneous blood flow

> may lead to high output cardiac failure in those with poor cardiac reserve. Mx (1)

A
  • nurse in temp controlled environment
  • monitor and replace fluids and electrolytes
  • high protein diet
  • antibiotic Rx. bathing.
  • monotior and support vital signs

Dermatology (10 decks)

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