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Internal medicine > Derm > Flashcards

Derm Flashcards

1
Q

Causative organism of scarlet fever

A

GABHS Strep pyogenes

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2
Q

SJS vs TENS

A

SJS less than 10%
TENS more than 30%

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3
Q

Treatment for toxic shock syndrome

A

Iv clindamycin and cloxacillin(hard to isolate causative pathogen)

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4
Q

Nikolsky sign and causes

A

Skin shears off with light pressure

SJS or Staph scalded skin syndrome

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5
Q

Cellulitis Mx

A

PO or IV Abx depending on severity

Beta lactams eg cefazolin or vanconycin if not responding

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6
Q

D.A.M. of derm hx taking

A

Distribution of rash

Associated symptoms eg Fever, itch and pain

Morphology: and whether there is change b/w primary and secondary

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7
Q

Causative drugs of SJS/TENS

A

Penicillins
Anticonvulsants
Allopurinol
Others eg corticosteroids, antiretrovirals

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8
Q

Causes of impetigo

A

Staph aureus or B hemolytic strep

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9
Q

Mx of impetigo

A

Few lesions:topical Abx creams
Extensive lesions: IV Abx eg cloxacillin, cefazolin for 10 days

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10
Q

Cx of impetigo

A

Post strep glomerulonephritis

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11
Q

HSV 1 vs HSV 2

A

HSV 1 gingivastomatitis with lymphadenopathy

HSV 2 Genital lesions

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12
Q

Causes of HFMD

A

Coxsackie and rhinovirus/enterovirus

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13
Q

Cx of chickenpox/varicella zoster

A
  1. Secondary bacterial infection
  2. Shingles/Herpes zoster
  3. Encephalitis and cerebellar ataxia
  4. Pneumonia
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14
Q

What is eczema herpeticum

A

Secondary infection of herpes simplex in atopic patient

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15
Q

Pathognomonic statement for psioriasis

A

Salmon pink plaques with silvery scales

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16
Q

Pityriasis alba

A

Hypopigmented patches on the face, indistinct borders in an atopic patient

Not an infective causes, treat with sunblock/emollient

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17
Q

Pityriasis versicolor

A

Dry, scaly and itchy plaques and papules

Caused by Malassezia furfur

Treat with topical ketoconazole or if extensive use ketoconazole shampoo

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18
Q

Mx of psioriasis

A

Topical steroids

Phototherapy for severe cases

Refer dermatology

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19
Q

Mx of atopic eczema

A
  1. Lifestyle changes eg avoiding triggers
  2. Topical steroid and moisturiser
  3. Oral corticosteroid and antibiotics if severe flares

Systemic treatment for severe cases
1. Phototherapy
2. Traditional immunosuppresants eg methotrexate, cyclosporin
3. Biologics eg dupixumab
4. Jak inhibitors

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20
Q

First line investigations specific for Neisseria Gonorrhea

A
  1. Smear for gram stain
  2. Send for nucleic acid testing for Gonorrhea as well as syphilis
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21
Q

Cytology of N Gonorrhea

A

Gram negative diplococcus
-Also N meningitidis

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22
Q

Abx for empirical cover of unconfirmed gonorrhea/chlamydia

A

doxycycline

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23
Q

Gold standard treatment of N gonorrhea

A

IM ceftriaxone injection+ PO doxycycline 1/52

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24
Q

Cx of gonorrhea

A
  1. Epididymo orchitis
  2. Pelvic inflammatory disease
  3. Fitz Hugh Curtis
  4. Ophthalmia Neonatorium
  5. Disseminated gonococcal infection
  6. GONOCCOCAL ARTHRITIS
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25
Q

Causes of non gonococcal Urethritis(NGU)

A
  1. Chlamydia Trachomatis
  2. Mycoplasma Genitalium
  3. Trichomonas Vaginalis
  4. HSV
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26
Q

Ddx for vaginal discharge

A

STI: NG, Chlamydia, M genitalium, T vaginalis

Non Vaginalis: Bacterial Vaginosis, Candida

Other ddx: Atrophic vaginitis, contact dermatitis

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27
Q

Cx of Chlamydia

A

M: Epididymo orchitis, Prostatitis
F: PID

General: Reactive Arthritis( SARA), Conjunctivitis, Fitz Hugh Curtis

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28
Q

Mx of Chlamydia

A

Non pregnant: Doxycycline 100mg BDx 1/52
Pregnant: Amoxicillin 500mg TDS x 1/52

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29
Q

How to ddx Mycoplasma Genitaloium

A
  1. PCR
  2. Swabs
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30
Q

Mx of Mycoplasma Genitalium

A

Doxycycline 1/52 followed by Azithromycin 4days

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31
Q

Cause of strawberry cervix

A

Trichomonas Vaginalis

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32
Q

Dx of Trichomoniasis

A

Smear

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33
Q

Mx of Trichomoniasis

A

Metronidazole 400mg BD 1/52

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34
Q

Candida appearance of cytology

A

Spaghetti and meatball

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35
Q

RFs for genital candidiasis

A
  1. DM
  2. Pregnancy
  3. OCPS
  4. Broad spectrum abx
  5. Immunosuppressive drugs
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36
Q

Spot diagnosis of candida

A

Curd/ Cheese like discharge coating mucosa

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37
Q

Mx of candidiasis

A

Nystatin/ Miconazole/ Clotrimazole/Fluconazole

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38
Q

Causes of painful genital ulcers

A
  1. HSV: Herpetiform appearance
  2. Chancre: Syphilis
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39
Q

Mx of genital HSV

A

Acyclovir or Valcyclovir

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40
Q

Cx of INTRAVENOUS ACYCLOVIR

A

Acute Tubular/ intersitital Nephritis

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41
Q

Causative agent of Chancroid

A

Haemophilus Ducreyi

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42
Q

Mx of Chancroid

A

IM ceftriaxone

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43
Q

Why dark ground microscopy does not work for ddx Syphilis in oral and anal regions

A

Presence of other spirochetes from flora

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44
Q

Invx of suspected Syphilis

A

1.Rapid Plasma Regain(RPR)
2. Treponema Pallidum Particle Agglutination(TPPRA)

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45
Q

Classical lesion of primary syphilis

A

Chancre NOT chancroid
-A type of ischemic ulcer
-Often but not always painless, non tender and rubbery

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46
Q

Signs of primary syphilis

A
  1. Chancre
  2. Regional lymphadenopathy
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47
Q

Sx of secondary syphilis

A
  1. Constitutional Sx
  2. Generalized or regional LNopathy
  3. Rash
  4. Systemic organ involvement eg hepatitis
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48
Q

What does lightning like pain suggest

A

Tabes Dorsalis due to tertiary syphilis

49
Q

mnemonic for late neurosyphilis

PARESIS

A

Personality
Reflexes
Eye
Sensory
Intellect
Speech

50
Q

Follow up tests for Syphilis

A

RPR for recurrence?

51
Q

Mx of fibroepithelial polyps(skin tags)

A
  1. Snip excision
  2. Electrocautery
  3. Liquid nitrogen
52
Q

Mx of keloids

A

Intralesional steroid injection

53
Q

Mx of maligant skin tumours

A

Wide local excision or Mohs Micrographic surgery

54
Q

Cutaneous signs of Cushings

A
  1. Lipodystropy
  2. Acne and hirsutism
  3. Purple striae on abdomen
55
Q

Cutaneous signs of IBD

A

Pyoderma gangrenosum and Erythema Nodosum

56
Q

Causes of erythema nodosum

A

1) Idiopathic
2) Autoimmune: IBD, sarcoidosis
3) Drugs eg OCPs
4) infectious: Streptococcus, Yersinia
5) Pregnancy
6) Malignancy

57
Q

Causes of Palmar erythema

A

1) Chronic Liver Disease
2) Pregnancy

58
Q

Pathophysiology of Calciphylaxis

A

Necrotic and painful eschar due to calcium deposits intra and extravascularly causing ischemia

59
Q
A

1) Sodium thiosulfate: Via dialysis or intralesional
2) Non calcium phosphate bindera
3) stop calcium supplements

60
Q

Severe Cutaneous Adverse Reactions(SCAR) from drugs

A

DRESS
SJS/TENS
Acute Generalised Exanthematous Pustulosis(AGEP)

61
Q

Drugs that commonly cause ADRs

A
  1. Penicillins
  2. Anticonvulsants
  3. Anti tuberculosis
62
Q

Mx of exanthemous drug rxn

A
  1. Stop drug
  2. Topical steroids and antihistamines
  3. Monitor for progression
63
Q

Types of drug related urticaria

A

Immunologically related eg to penicillins

Non immunological eg to nsaids

64
Q

Mx of Anaphylaxis-Urticaria

A
  1. IM adrenaline
  2. IV dexamethasone
  3. IV diphenhydramine?
65
Q

Drugs that commonly cause fixed drug eruptions

A

NSAIDs
Paracetamol
Abx eg cotrimoxazole, tetracycline, penicillins

66
Q

Classic presentation of SJS TENS

A

Dusky patches, targetoid lesions and blisters

Skin pain

67
Q

Causes of target lesions

A
  1. Erythema Nodosum
  2. SJS TENS causes targetoid(2 colors)
68
Q

Drugs that commonly cause SJS TENS

A
  1. Penicillins
  2. Allopurinol
  3. Anticonvulsants
  4. Antiretrovirals
  5. Sulfonamides eg bactrim
  6. Nsaids
69
Q

Microbe that may cause SJS TENS

A

Mycoplasma Pneumoniae

70
Q

Cx of SJS TENS

A
  1. Electrolyte imbalance via fluid loss
  2. Sepsis
  3. ARDS/pneumonitis
71
Q

Mx of Anaphylactic angioedema

A
  1. IM adrenaline deep into anterolateral thigh
  2. IV hydrocortisone
  3. IV diphenhydramine
  4. Antihistamines and PO pred for 2 days after
72
Q

Mx of Acute Generalized Pustular Psioriasis

A
  1. Manage hypotension
    2.Immunosuppresants: Cyclosporin or MTX
  2. Retinoids
  3. Anti TNF Biologics
73
Q

Causes of Generalised Exfoliative Dermatitis(Erythroderma)

A
  1. Poorly controlled eczema or Psioriasis
  2. Drug induced
  3. Cutaneous T Cell Lymphoma(Mycosis Fungoides)
  4. Scabies
  5. Pemphigus Foliaceous
  6. Chronic actinic dermatitis
  7. Idiopathic
  8. Underlying solid organ malignancy
74
Q

Mx of eczema herpecticum

A
  1. PO or IV Acyclovir depending on severity
  2. Cover with Antistaphylococcal Abx in case of superinfection
  3. Refer eye tro Herpetic Keratitis
75
Q

Local side effects of topical steroids

A
  1. Atrophy
  2. Telegiectasia
  3. Steroid acne
  4. Easy bruising
  5. Hypopigmentation
  6. Hypertrichosis
  7. Allergic contact dermatitis
  8. Others
76
Q

Major SE of isotretinoin

A

Teratogenicity
- Stop for 3 months before trying to conceive
- Double contraception while on drug

77
Q

Margin for elliptical excision of suspicious moles

A

4mm of normal looking skin

78
Q

Advantages of Mohs micrographic surgery

A
  1. Better resection margins: lower tumor recurrence
  2. More tissue preservation
79
Q

Indications for Mohs micrographic surgery

A
  1. Areas of key tissue preservation eg fingers, genitals
  2. High risk tumor subtype
  3. Prev recurrence
  4. Large size >2cm
  5. Immunocompromised py
  6. Underlying genetic syndromes
80
Q

Ideal biopsy method for melanoma

A

Excisional biopsy: Punch biopsy may not capture deepest area and unintentionally downstage the malignancy

81
Q

Mx of Viral warts

A
  1. Fortnightly cryotherapy x9 sessions
  2. Imiquimod
  3. Local MMR vaccine as immunotherapy
82
Q

How to ddx scarring and non scarring alopecia

A

Whether the follicle is intact

83
Q

SEs of isotretinoin

A
  1. Teratogencity
  2. Transaminitis
  3. Photosensitivity
  4. Dry mouth
84
Q

Cause of tinea versicolor and characteristic feature

A

Malassezia furfur

Furry scaling

85
Q

Hallmark of small vessel Vasculitis

A

Palpable purpura

86
Q

Symptoms of erythema nodosum

A

1.Inflamed tender pre tibial nodules
2. Fever
3. Malaise
4. Arthralgia
5. Sx of etiologies eg IBD

87
Q

Most common allergen of allergic contact dermatitis

A

Nickel

88
Q

Prerequisites for accurate patch

A

No oral antihistamines or topical steroids for 2 weeks

89
Q

Mx of Bacterial Vaginosis(Gardnerella vaginalis)

A

PO or PV metronidazole

Clindamycin 2nd line

90
Q

Indications for phototherapy

A
  1. Vitiligo
  2. Psoriasis
  3. Mycosis Fungoides
  4. Atopic dermatitis
91
Q

What is PUVA

A

Psoralen+ UV phototherapy

92
Q

Indications of photodynamic therapy

A
  1. Actinic Ketatosis
  2. BCC
  3. Bowens disease
93
Q

Treatments for androgenic alopecia

A
  1. Topical minoxidil
  2. Finasteride
  3. Intralesional steroids
  4. Follicle transplant
94
Q

Indications for cryotherapy

A
  1. Viral warts HPV
  2. Molluscum contagiosum
  3. Pyogenic granuloma
  4. Prurigo nodularis
  5. Seborrheic Keratosis
  6. Solar lentigo
  7. Actinic Keratosis
  8. Pickers nodules
95
Q

What is Hutchinsons sign

A

Extension of hyperpigmentation from subungual to the lateral and posterior nail folds, suggests Acral lentiginous melanoma over melanonychia

96
Q

Causes of pyoderma gangrenosum

A
  1. IBD
  2. Hematological malignancy
  3. IgA?
  4. Granulomatosis with polyangiitis
97
Q

Causes of painful skin lesions

A
  1. Drug related
  2. Zoster
  3. Autoimmune blistering
98
Q

Sx suggestive of SCARs

A

Blisters + mucosal involvement + pain

99
Q

Organs involved in DRESS

A
  1. Hepatitis(most common)
  2. Renal
  3. Myocarditis
  4. Pancreas
  5. Thyroid
  6. Pneumonitis
  7. Herpes virus reactivation
100
Q

Hallmarks of atopic dermatitis

A

Papules and macules on erythematous background with excoriations

101
Q

4 areas of dangerous herpes zoster

A
  1. Oticus
  2. Ophthalmicus
  3. C4 diaphragm
  4. Sacral
102
Q

Mucocutaneous features of SLE via SLICC criteria

A
  1. Malar rash
  2. Discoid rash
  3. Mucositis
  4. Alopecia
103
Q

Causes of drug induced hyoerpigmentation

A

Minocycline
Clofazimine
Amiodarone

104
Q

How to manage asymptomatic partner of patient with Syphilis

A

Serial monitoring rather than prophylactic mx

105
Q

Treatment of M leprae

A

Dapsone+Rifampicin+Clofazimine

106
Q

Causes of erythema nodosum mnemonic

A

SORE SHINS C

Streptococci
OCPs
Rickettsia
Eponymous(Behcet)

Sulfonamides
Hansens disease
IBD and idiopathic
Non Hodgkin Lymphoma
Sarcoidosis

Cutaneous TB

107
Q

Best drug for generalised pustular psioriasis(GPP)

A

Acitretin

108
Q

Best drug for plaque psoriasis

A

Cyclosporin

109
Q

Drugs that cause hypertrichosis

A
  1. Cyclosporin
  2. Minoxidil PO
110
Q

Features of PCOS

A
  1. ACNE
  2. Hirsutism(male pattern hair growth)
  3. Irregular period
  4. Deepening of voice, increased muscle mass etc
111
Q

Side effects of isotretinoin

A
  1. Transaminitis
  2. Teratogenic
  3. Myalgia, arthralgia
  4. Headache, fatigue
    5.
112
Q

Ddx for acne vulgaris

A

Rosacea
Adenoma sebaceum

113
Q

Mx of Acne vulgaris

A

Topicals:
1) Clindamycin + benzyl benzoate
2) Topical retinoids

Oral
1) Doxycycline
2) Isotretinoin
3) Erythromycin

114
Q

Ddx of Viral warts

A
  1. Calluses
  2. Arsenical keratosis
    3.?
115
Q

“Washout period” for isotretinoin before pregnancy

A

Minimum 1 months, ideally 2 months

116
Q

Antibiotics that can and cannot be taken with isotretinoin for acne treatment

A
  1. CANNOT use with doxycycline: benign intracranial hypertension
  2. CAN use with erythromycin
117
Q

SEs of isotretinoin

A
  1. Transaminitis
  2. Hyperlipidemia
  3. Mood changes
  4. Teratogenic
118
Q

Treatment of actinic keratosis

A

Cryotherapy

Must treat as pre malignant

Internal medicine (15 decks)

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