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Year 3 - General Practice > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the main causes of Urticaria?

A

Idiopathic

Food

Iatrogenic

Contact

Insect bites

Viral

Parasitic infections

Autoimmune

Hereditary

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2
Q

Explain the pathophysiology behind Urticaria?

A

Local inflammatory response causes the release of histamine from mast cells.

This causes vasodilation of local capillaries and venues leading to swelling of the superficial dermis. This raises the epidermis causing itchy wheals.

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3
Q

What are the cytokines involved in Urticaria?

A

Histamine

Leukotrienes

Prostaglandins

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4
Q

What is the management for Urticaria?

A

Antihistamines (eg. Chlorphenamine 4mg)

Corticosteroids can be prescribed for severe Urticaria and angioedema

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5
Q

What is Erythema nodosum?

A

This is localised inflammation of subcutaneous fat.

It presents as discrete tender nodules which may become confluent and are commonly found on the shins.

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6
Q

What are the main causes of Erythema nodosum?

A

Pregnancy

IBD

Sarcoidosis

Group A beta-haemolytic Streptococci

Primary TB

Malignancy

Chlamydia and Leprosy

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7
Q

What is the management of Erythema nosodum?

A

Conservative management. It is a condition that is usually self-resolving.

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8
Q

What is Erythema multiforme? What usually causes this condition?

A

This is an acute self-limiting inflammatory condition that is caused by Herpes simplex virus.

Mucosal involvement is absent or limited to one surface.

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9
Q

What is Stevens-Johnson syndrome?

What is its appearance on Histology?

A

It is a mucocutaneous necrosis with at least two mucosal sites involved.

Its appearance on Histopathology is epithelial necrosis with a few inflammatory cells.

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10
Q

What causes Stevens-Johnson syndrome?

A

It is commonly caused by medication. Examples include

  • Allopurinol
  • Carbamazepine
  • Phenytoin
  • Lamotrigine
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11
Q

How are Stevens-Johnson syndrome and Toxic epidermal necrosis similar?

A

They have overlapping features which include prodromal illness.

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12
Q

What is Toxic epidermal necrosis?

A

This is a drug-induced acute severe disease characterised by extensive skin and mucosal necrosis with systemic toxicity. Full thickness epidermal necrosis occurs with sub epidermal detachment.

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13
Q

How do you manage TEN and SJS?

A

Early recognition and escalation to a senior.

Stop offending/causative substance.

Full supportive care to maintain haemodynamic equilibrium.

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14
Q

What is the cause of death in SJS and TEN?

A

Sepsis, electrolyte imbalance or multi-system organ failure.

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15
Q

What is the name of the condition whereby a patient presents with exfoliative dermatitis that covers at least 90% of the skin surface?

A

Erythroderma!

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16
Q

How does a patient with Erythoderma present?

A

Skin inflamed, oedematous and scaly.

General malaise.

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17
Q

Management of erythoderma?

A

Treat the underlying cause

Emollients and wet wraps to maintain skin moisture.

Topical steroids.

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18
Q

What is necrotising fasciitis?

A

A rapidly spreading infection of the deep fascia with secondary tissue necrosis.

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19
Q

How does necrotising fasciitis present?

A

Severe pain

Erythematous splitting necrotic skin

Fever

Tachycardia

Pulmonary crepitus

X-ray may show soft tissue gas.

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20
Q

Management of necrotising fasciitis?

A

Urgent referral for extensive surgical debridement.

IV antibiotics.

Mortality is 76%

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21
Q

What is Erysipelas?

A

Acute superficial form of cellulitis that involves the dermis and the upper subcutaneous tissues

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22
Q

What is cellulitis?

A

Inflammation of the deep subcutaneous tissues

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23
Q

What are the most common causes of Erysipelas and Cellulitis

A

Streptococcus. pyogenes

Staphylococcus aureus

24
Q

What is the management for cellulitis?

A

Antibiotics (Flucloxacillin or Benzylpenicillin)

Supportive care: rest, leg elevation, sterile dressings and analgesia.

25
Q

How does Staphylococcal scalded skin syndrome present?

A

Commonly seen in early childhood

Caused by coagulase positive Staphylococcus aureus

Perioral crusting, scalded skin like appearance that can be accompanied with bullae.

26
Q

How do you treat scalded skin syndrome?

A

Antibiotics (penicillinase resistant penicillin, fusidic acid, erythromycin or an appropriate cephalosporin)

Analgesia

27
Q

What is a Tinea infection of the trunk and limbs called? How does it present?

A

Tinea corporis - annular circular lesions with clearly defined, raised and scaly edge.

28
Q

What is a Tinea pedis?

A

Athletes foot - moist scaling and fissuring in the towers, spreading to the sole and dorsal aspect of the foot.

29
Q

What would you call a Tinea infection of the hand?

A

Tinea mannum - scaling in the palmar creases.

30
Q

What would you call a Tinea infection of the scalp and how would it present?

A

Patches of broken hair, scaling and inflammation. This is often due to a ringworm infection.

31
Q

What is Pityriasis versicoloured?

A

This is a scaly pale brown patch on the upper trunk that fails to tan on sun exposure. It is usually asymptomatic.

32
Q

How would you manage any Superficial fungal infections?

A
  • Diagnose with skin scrapings, hair or nail samples, skin swabs for yeast.
  • Topical anti fungal agent - Terbinafine cream
  • Oral anti fungal agent (itraconazole) for severe or widespread or nail infections.

Correct predisposing factors where you can

33
Q

What happens if you treat a superficial fungal infection with corticosteroids?

A

This can cause tine incognito.

34
Q

What are some risk factors for Basal Cell Carcinoma?

A

UV exposure

History of frequent or severe sunburn in childhood

Skin type I

Age

Male sex

Immunosuppression

Genetics

35
Q

What are the different types of Basal Cell Carcinoma?

A

Nodular (most common)

Superficial (plaque like)

Cystic

Morphoeic (sclerosing)

Keratotic

Pigmented

36
Q

How does a nodular basal cell carcinoma appear?

A

Skin coloured papule with surface Telangiectasia, pearly rolled edge, lesion may be necrotic/ulcerated.

37
Q

What is a Squamous cell carcinoma?

A

A locally invasive malignant tumour of the epidermal keratinocytes or its appendages which have the potential to metastasise.

38
Q

Describe the ABCDE symptoms rule for looking for an abnormal skin lesion?

A

A - Asymmetry

B - Border Irregularity

C - Colour irregularity

D - Diameter >6mm

E - Evolution of the lesion (change in size/shape)

39
Q

What is a Melanoma?

A

An invasive malignant tumour of the epidermal melanocytes which has the potential to metastasise

40
Q

Where are Melanomas most commonly found?

A

On the trunk in men and on the legs in women.

41
Q

What is eczema?

A

Papules and vesicles on an erythematous base.

42
Q

How do you manage eczema?

A

General measures - avoid exacerbating agents, frequent emollients and soap substitutes

Topical steroids for flare ups. 
Topical immunomodulators (eg. Tacrolimus) can be used as a steroid sparing agent

Phototherapy used in refractory cases

43
Q

What are two known complications of eczema?

A

Secondary bacterial infection

Secondary viral infection

44
Q

What is the management for Acne vulgaris?

A

Topical therapies - benzoyl peroxide and topical antibiotics (antimicrobial properties)

Topical retinoids (comedolytic and anti-inflammatory properties)

Oral therapies - oral antibiotics and anti-androgens (in females)

Oral retinoids - eg, Roaccutaine for severe acne. This can only be prescribed in specialist care.

45
Q

What is Psoriasis?

A

A chronic inflammatory skin disease due to hyper proliferation of keratinocytes and inflammatory cell infiltration

46
Q

Name some risk factors for Psoriasis?

A

Trauma

Infection

Drugs

Stress

Alcohol

47
Q

Where is Psoriasis common?

A

Over the extensor surfaces and on the scalp.

48
Q

How does Psoriasis appear?

A

Hyperkeratinisation. Well defined plaques. The lesions can be itchy, burning or painful.

49
Q

What is Auspitz sign?

A

This is where gentle removal of scales from the surface of lesions will lead to bleeding.

50
Q

What is the management for Psoriasis?

A

Topical therapies - Topical corticosteroids, vitamin D analogues, topical retinoids

Oral therapy can be used for extensive/severe disease - Methotrexate, retinoids, cyclosporin, mycophenolate mofetil

Phototherapy can be used in extensive disease refractory to all other treatment.

51
Q

What is a complication of Psoriasis?

A

Erythroderma

Infection

52
Q

Name three blistering disorders of the skin

A

Bullous impetigo

Bullous pemphigoid

bulls vulgaris

53
Q

What is Bullous pemphigoid?

A

This is a blistering disorder that usually affects the elderly.

The lesions are often itchy and it is due to an autoimmune reaction in the sub-epidermal split in the skin.

54
Q

What is Pemphigus Vulgaris?

A

Blistering skin disorder that affects middle aged patients

It is intra-epidermal split in the skin

Lesions are painful

55
Q

What is the management for Bullous Pemphigoid?

A

Wound dressings as appropriate

Topical corticosteroids

Oral steroids for widespread diseases and consider DMARD’s for more extensive disease

56
Q

What is the management for Pemphigus vulgaris?

A

General measures include wound dressings and monitoring oral care if mucosa are involved

Oral therapies - oral high dose steroids, and consider DMARD’s.

Year 3 - General Practice (10 decks)

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