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Dermatology > Lecture 3 Acute & Emergency Dermatology > Flashcards

Lecture 3 Acute & Emergency Dermatology Flashcards

1
Q

Consequence of mechanical barrier to infection

A

Sepsis

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2
Q

Consequence of failure of temperature regulation

A

Hypo-Hyperthermia

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3
Q

Consequence of failure of fluid and electrolyte balance

A

Protein and fluid loss
Renal impairment
Peripheral vasodilation

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4
Q

Causes of erythoderma

A 
Psoriasis
Eczema
Drugs
Cutaneous lymphoma
hereditary disorders
Unknown
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5
Q

Management of Erythroderma

A
  • Remove any offending drugs
  • Careful fluid balance
  • Good nutrition
  • Temperature regulation
  • Emollients – 50:50 Liquid Paraffin : White Soft Paraffin
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6
Q

Mild drug reaction

A

Morbilliform exanthem

Macular rash, similar to measles

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7
Q

Severe drug reaction

A

Erythroderma, Stevens Johnson Syndrome/Toxic epidermal necrolysis, DRESS

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8
Q

Secondary causes of SJS

A 
NSAIDs
Antibiotics
Anticonvulsants
Allopurinol
NSAIDs
onset can be delayed
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9
Q

Clinical features of SJS

A 
•	Fever
•	Malaise
•	Arthralgia
•	Rash
–	Maculopapular, target lesions, blisters
–	Erosions covering <10% of skin surface
•	Mouth ulceration
–	Greyish white membrane
–	Haemorrhagic crusting
•	Ulceration of other mucous membranes
•	Painful
•	Dusky Skin sloughing
•	Lung involvement- CXR
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10
Q

Clinical Features of Toxic Epidermal Necrlysis

A

• Often presents with prodromal febrile illness
• Ulceration of mucous membranes
• Rash
– May start as macular, purpuric or blistering
– Rapidly becomes confluent
– Sloughing off of large areas of epidermis – ‘desquamation’ > 30% BSA
– Nikolsky’s sign may be positive- minor trauma removes epidermis

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11
Q

Management of severe drug reactions

A
  • Identify and discontinue culprit drug

* Supportive therapy

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12
Q

How is the prognosis of severe drug reactions scored

A

SCORTEN criteria

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13
Q

What is SCORTEN criteria

A 
–	Age >40
–	Malignancy
–	Heart rate >120
–	Initial epidermal detachment >10%
–	Serum urea >10- dehydrated
–	Serum glucose >14- hyperglycaemic
–	Serum bicarbonate <20- highly acidic
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14
Q

SCORTEN 0-1

A

> 3.2% mortality

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15
Q

SCORTEN 2

A

> 12%

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16
Q

SCORTEN 3

A

> 35%

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17
Q

SCORTEN 4

A

> 58%

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18
Q

SCORTEN 5 or more

A

> 90%

19
Q

Long term compilation of severe drug reactions

A 
–	Pigmentary skin changes
–	Scarring- genital sites
–	Eye disease and blindness
–	Nail and hair loss
–	Joint contractures- if scarring causes keloids
20
Q

What causes erythema Multiforme

A

• Hypersensitivity reaction usually triggered by infection

– Most commonly HSV, then Mycoplasma pneumonia

21
Q

Clinical features of Erythema Multiforme

A

• Abrupt onset of up to 100s of lesions over 24 hours
– Distal  proximal
– Palms and soles
– Mucosal surfaces (EM major)
– Evolve over 72 hours
• Pink macules, become elevated and may blister in centre
• “Target” lesions

22
Q

How is Erythema Multiforme managed

A
  • Self limiting and resolves over 2 weeks
  • Symptomatic and treat underlying cause
  • More common in children and younger patients
23
Q

Clinical features of DRESS

A
  • Macules on skin
  • Fever, lymphadenopathy, abnormal LFTs
  • Eosinophilia
  • DIC (Disseminated Intravascular Coagulation)
  • Acute renal failure
24
Q

Treatment of DRESS

A
  • Stop causative drug
  • Symptomatic and supportive
  • Systemic steroids
  • +/- Immunosuppression or immunoglobulins
25
Q

Clinical features of Pemphigus

A 
Uncommon
Not acute
Middle aged patients
Blisters very fragile- no intact
Mucous membrane affected
Patients unwell
26
Q

How is Pemphigus treated

A

Systemic steroids
Dress erosions
Supportive therapies

27
Q

Cause of Pemphigus

A

Antibodies targeted against desmosomes

Split epidermis = blister

28
Q

How is Pemphigus diagnosed

A

• Immunofluorescence- key test to diagnose- process it with antibodies IgG = strongly positive
Histology

29
Q

Clinical features of Pemphigoid

A

Common
Elderly patients
Blisters often intact and tense
Patients fairly well systemically

30
Q

How is pemphigoid treated

A

Topical steroids

31
Q

What are the common causes of Erythrodermic psoriasis and Pustular Psoriasis

A

– Infection

– Sudden withdrawal of oral steroids or potent topical steroid

32
Q

Clinical features of Erythrodermic psoriasis and Pustular Psoriasis

A

Fever
Elevated WBC
• Rapid development of generalised erythema, +/- clusters of pustules

33
Q

Treatment of Erythrodermic psoriasis and Pustular Psoriasis

A
  • Exclude underlying infection, bland emollient, avoid steroids
  • Often require initiation of systemic therapy
34
Q

What is Eczema Herpeticum

A

• Disseminated herpes virus infection on a background of poorly controlled eczema

35
Q

What are the clinical features of Eczema Herpeticum

A

• Monomorphic blisters and “punched out” erosions
– Generally painful, not itchy
• Fever and lethargy
Elevated WCC

36
Q

Treatment of Eczema herpeticum

A

Aciclovir

Mild topical steroid to treat eczema

37
Q

What is Staphylococcal Scaled Skin Syndrome

A

Diffuse erythematous rash with skin tenderness

38
Q

What is the cause of Staphylococcal Scaled Skin Syndrome

A

Staph infection

39
Q

Clinical features of Staphylococcal Scaled Skin Syndrome

A

• More prominent in flexures
• Blistering and desquamation follows
– Staphylococcus produces toxin which targets Desmoglein 1 (desmosal protein)
• Fever and irritability

40
Q

Treatment for Staphylococcal Scaled Skin Syndrome

A

IV antibiotics

resolves 5-7 days

41
Q

What is acute urticaria

A

<6 week history

usually Viral or Idiopathic

42
Q

What is the treatment for acute urticaria

A

Oral anti-histamine

4 doses

43
Q

What is chronic urticaria

A

> 6 week history

Autoimmune/idiopathic

44
Q

What is the treatment for Chronic urticaria

A
  1. Non sedating H1 antihistamine
  2. Higher dose up to four times
  3. Consider 2nd line agent anti-leukotriene or angiodema
  4. Immunomodulant- omalizumab, cyclosporine

Dermatology (11 decks)

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