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Year 2- Dermatology > Acute and Emergency Dermatology > Flashcards

Acute and Emergency Dermatology Flashcards

1
Q

The skin is a mechanical barrier to infection. What happens regarding this if the skin fails?

A

Sepsis

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2
Q

The skin has a role in temperature regulation. What happens regarding this if the skin fails?

A

Hypo and hyper thermia

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3
Q

The skin has a role in fluid and electrolyte balance. What happens regarding this if the skin fails?

A

Protein and fluid loss
Renal impairment
Peripheral vasodilation

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4
Q

Erythrederma?

A

Any inflammatory skin disease affecting >90% of the total skin surface

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5
Q

List some of the causes of erythroderma.

A

Psoriasis
Eczema
Drugs
Cutaneous lymphoma
Hereditary disorders

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6
Q

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis are two conditions which are similar too each other and are secondary to drugs.

Which is more severe?

A

Toxic Epidermal Necrolysis

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7
Q

Which drugs can cause SJS or TENs?

A

Antibiotics
Anticonvulsants
Allopurinol
NSAIDs

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8
Q

When is it SJS or TEN?

A

SJS when <10% detachment of the epidermis

TEN when 30% or more detachment of the epidermis

SJS-TEN overlap when 10-30%

->regions where the epidermis has died and come off, hence detachment

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9
Q

What are the clinical features of SJS?

A

Fever, malaise, arthralgia
Rash covering <10% of skin
Mouth ulceration
Ulceration of other mucous membrnaes

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10
Q

Presentation of TEN?

A

Prodromal febrile illness
Ulceration of mucous membranes
Rash > 30%, skin starts to come off in sections

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11
Q

Management of SJS or TEN?

A

Identify and stop culprit drug
Supportive therapy as patient usually unwell

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12
Q

Which score is used to see what the patient’s prognosis is for SJS or TEN?

A

SCORTEN

->the higher the score, the higher the risk of mortality

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13
Q

What triggers erythema multiforme?

A

Infection, most commonly Herpes Simplex

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14
Q

What happens in erythema multiforme?

A

Abrupt onset of 100s of lesions over 24hrs, palms an soles being common sites

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15
Q

Which investigation is useful in erythema multiforme?

A

Swab for infection

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16
Q

What is the treatment of erythema multiforme?

A

Self limiting and usually resolves within 2wks
Treat symptoms and underlying cause if required

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17
Q

DRESS?

A

Drug reaction with Eosinophilia and Systemic Symptoms

->just to say, doesn’t look too dramatic, just red rash all over but patient will have systemic symptoms and be unwell

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18
Q

What is the treatment of DRESS?

A

Stop drug causing it
Symptomatic and supportive treatment

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19
Q

What is the difference between DRESS drug reaction and SJS/TEN drug reaction?

A

In DRESS, reaction occurs 2-8wks after drug exposure

In SJS/TEN, drug reaction occurs in first few weeks

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20
Q

Which type of drug is usually the cause of DRESS?

A

Anticonvulsant

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21
Q

Pemphigus and pemphigoid are two types of blister.

Which is more common?

A

Pemphigoid

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22
Q

Pemphigus and pemphigoid are two types of blister.

Which has blisters which are more fragile and may not be intact?

A

Pemphigus

->pemphigoid blisters are usually tense and require popping in order to burst them

23
Q

Which age group tend to be affected more by pemphigus blisters, the more fragile blisters?

A

Middle aged

24
Q

Which age group tend to be affected more by pemphigoid blisters, the more tough blisters?

A

Elderly patients

25
Q

Where does pemphigus blisters usually affect?

A

Mucous membranes
Can affect nose, eyes and genital areas

26
Q

Which type of blister is more deep- pemphigoid or pemphigus?

A

Pemphigoid

->think d for deep in pemphigoiD and s for superficial is pemphiguS

27
Q

Describe pemphigus blisters.

A

Flaccid blisters which rupture very easily

28
Q

Summarise pemphigus blisters.

A

Uncommon
Middle age
Fragile blisters
Often affect mucous membranes
If extensive, patient systemically unwell

29
Q

Summarise pemphigoid blisters.

A

Common
Elderly
Tense and intact blisters
Patients usually well systemically even if widespread

30
Q

What is the treatment for pemphigus blisters?

A

Systemic steroids
Dressings for erosions
Supportive therapy

31
Q

What is the treatment for pemphigoid blisters?

A

Topical steroids

32
Q

Psoriasis can occur as Erythrodermic psoriasis or pustular psoriasis, usually in those who have previously had psoriasis or have a strong family history.

What are some of the causes?

A

Infection
Sudden withdrawal of oral steroids or potent topical steroid

33
Q

What is seen in patients with erythrodermic psoriasis or pustular psoriasis?

A

Fever
Elevated WCC
Pustules- however, sterile pus so if popped, no infection

34
Q

What causes Eczema Herpeticum, a skin emergency, mostly seen in children?

A

Disseminated Herpes virus infection on a background of poorly controlled eczema

35
Q

What does the skin look like in eczema herpeticum?

A

Monomorphic blisters with a punch out appearance (basically small, red and round)
They are generally painful instead of itchy

36
Q

What is the treatment of Eczema Herpeticum?

A

Aciclovir
Mild topical steroid if required to treat eczema
Treat secondary infection

37
Q

If an adult presented with eczema herpeticum, what should you be clinically suspicious of?

A

Immunocompromise

38
Q

When does staphylococcal scalded skin syndrome usually occur?

A

In childhood, can occur in immunocompromised adults too

39
Q

What causes staphylococcal scalded skin syndrome?

A

Initial staph infection

40
Q

Where in the body is staphylococcal scalded skin syndrome most prominent~?

A

Flexures

41
Q

What is the treatment of staphylococcal scalded skin syndrome?

A

Admission for IV antibiotics and supportive care

42
Q

Staphylococcal scalded skin syndrome is usually seen in children. If an adult presented similarly, what would you suspect it to be and how could you differentiate?

A

TEN or drug reaction
Biopsy to differentiate

43
Q

What are some other terms for urticaria?

A

Hives, weals

->like an allergy reaction or nettle rash

44
Q

What does urticaria look like?

A

Central swelling of variable size surrounded by erythema
Dermal oedema is present

45
Q

What are the symptoms of these hives/urticaria?

A

Itching, sometimes burring

->caused by release of histamine release into dermis

46
Q

How long does urticaria last?

A

Has a fleeting nature and duration can vary between 1-24hrs

47
Q

How long does urticaria last to be termed acute?

A

<6wks

48
Q

Causes of acute urticaria?

A

Half unknown
Infection, usually viral
Drugs or allergy - IgE mediated
Food- IgE mediated

49
Q

What is the treatment for acute urticaria?

A

Oral antihistamine
Sometimes short course of oral steroids

50
Q

Which drugs should be avoided in those with urticaria?

A

Opiates
NSAIDs

->both exacerbate urticaria

51
Q

What is the most common cause of chronic urticaria ~(>6 wks)

A

Autoimmune

52
Q

What is used in the management of chronic urticaria?

A

Tranexamic acid
Montelukast
Immunosuppression

53
Q

OKAYYYY END OF THIS BLOCK

A

Watch the QnA at the end of this block and try and answer all the questions for revision xx

54
Q

OKAYYYY END OF THIS BLOCK

A

Watch the QnA at the end of this block and try and answer all the questions for revision xx

Year 2- Dermatology (10 decks)

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