Derm Flashcards
(118 cards)
1
Q
Causative organism of scarlet fever
A
GABHS Strep pyogenes
2
Q
SJS vs TENS
A
SJS less than 10%
TENS more than 30%
3
Q
Treatment for toxic shock syndrome
A
Iv clindamycin and cloxacillin(hard to isolate causative pathogen)
4
Q
Nikolsky sign and causes
A
Skin shears off with light pressure
SJS or Staph scalded skin syndrome
5
Q
Cellulitis Mx
A
PO or IV Abx depending on severity
Beta lactams eg cefazolin or vanconycin if not responding
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
7
Q
Causative drugs of SJS/TENS
A
Penicillins
Anticonvulsants
Allopurinol
Others eg corticosteroids, antiretrovirals
8
Q
Causes of impetigo
A
Staph aureus or B hemolytic strep
9
Q
Mx of impetigo
A
Few lesions:topical Abx creams
Extensive lesions: IV Abx eg cloxacillin, cefazolin for 10 days
10
Q
Cx of impetigo
A
Post strep glomerulonephritis
11
Q
HSV 1 vs HSV 2
A
HSV 1 gingivastomatitis with lymphadenopathy
HSV 2 Genital lesions
12
Q
Causes of HFMD
A
Coxsackie and rhinovirus/enterovirus
13
Q
Cx of chickenpox/varicella zoster
A
- Secondary bacterial infection
- Shingles/Herpes zoster
- Encephalitis and cerebellar ataxia
- Pneumonia
14
Q
What is eczema herpeticum
A
Secondary infection of herpes simplex in atopic patient
15
Q
Pathognomonic statement for psioriasis
A
Salmon pink plaques with silvery scales
16
Q
Pityriasis alba
A
Hypopigmented patches on the face, indistinct borders in an atopic patient
Not an infective causes, treat with sunblock/emollient
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
18
Q
Mx of psioriasis
A
Topical steroids
Phototherapy for severe cases
Refer dermatology
19
Q
Mx of atopic eczema
A
- Lifestyle changes eg avoiding triggers
- Topical steroid and moisturiser
- 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
20
Q
First line investigations specific for Neisseria Gonorrhea
A
- Smear for gram stain
- Send for nucleic acid testing for Gonorrhea as well as syphilis
21
Q
Cytology of N Gonorrhea
A
Gram negative diplococcus
-Also N meningitidis
22
Q
Abx for empirical cover of unconfirmed gonorrhea/chlamydia
A
doxycycline
23
Q
Gold standard treatment of N gonorrhea
A
IM ceftriaxone injection+ PO doxycycline 1/52
24
Q
Cx of gonorrhea
A
- Epididymo orchitis
- Pelvic inflammatory disease
- Fitz Hugh Curtis
- Ophthalmia Neonatorium
- Disseminated gonococcal infection
- GONOCCOCAL ARTHRITIS
25
Causes of non gonococcal Urethritis(NGU)
1. Chlamydia Trachomatis
2. Mycoplasma Genitalium
3. Trichomonas Vaginalis
4. HSV
26
Ddx for vaginal discharge
STI: NG, Chlamydia, M genitalium, T vaginalis
Non Vaginalis: Bacterial Vaginosis, Candida
Other ddx: Atrophic vaginitis, contact dermatitis
27
Cx of Chlamydia
M: Epididymo orchitis, Prostatitis
F: PID
General: Reactive Arthritis( SARA), Conjunctivitis, Fitz Hugh Curtis
28
Mx of Chlamydia
Non pregnant: Doxycycline 100mg BDx 1/52
Pregnant: Amoxicillin 500mg TDS x 1/52
29
How to ddx Mycoplasma Genitaloium
1. PCR
2. Swabs
30
Mx of Mycoplasma Genitalium
Doxycycline 1/52 followed by Azithromycin 4days
31
Cause of strawberry cervix
Trichomonas Vaginalis
32
Dx of Trichomoniasis
Smear
33
Mx of Trichomoniasis
Metronidazole 400mg BD 1/52
34
Candida appearance of cytology
Spaghetti and meatball
35
RFs for genital candidiasis
1. DM
2. Pregnancy
3. OCPS
4. Broad spectrum abx
5. Immunosuppressive drugs
36
Spot diagnosis of candida
Curd/ Cheese like discharge coating mucosa
37
Mx of candidiasis
Nystatin/ Miconazole/ Clotrimazole/Fluconazole
38
Causes of painful genital ulcers
1. HSV: Herpetiform appearance
2. Chancre: Syphilis
39
Mx of genital HSV
Acyclovir or Valcyclovir
40
Cx of INTRAVENOUS ACYCLOVIR
Acute Tubular/ intersitital Nephritis
41
Causative agent of Chancroid
Haemophilus Ducreyi
42
Mx of Chancroid
IM ceftriaxone
43
Why dark ground microscopy does not work for ddx Syphilis in oral and anal regions
Presence of other spirochetes from flora
44
Invx of suspected Syphilis
1.Rapid Plasma Regain(RPR)
2. Treponema Pallidum Particle Agglutination(TPPRA)
45
Classical lesion of primary syphilis
Chancre NOT chancroid
-A type of ischemic ulcer
-Often but not always painless, non tender and rubbery
46
Signs of primary syphilis
1. Chancre
2. Regional lymphadenopathy
47
Sx of secondary syphilis
1. Constitutional Sx
2. Generalized or regional LNopathy
3. Rash
4. Systemic organ involvement eg hepatitis
48
What does lightning like pain suggest
Tabes Dorsalis due to tertiary syphilis
49
mnemonic for late neurosyphilis
PARESIS
Personality
Reflexes
Eye
Sensory
Intellect
Speech
50
Follow up tests for Syphilis
RPR for recurrence?
51
Mx of fibroepithelial polyps(skin tags)
1. Snip excision
2. Electrocautery
3. Liquid nitrogen
52
Mx of keloids
Intralesional steroid injection
53
Mx of maligant skin tumours
Wide local excision or Mohs Micrographic surgery
54
Cutaneous signs of Cushings
1. Lipodystropy
2. Acne and hirsutism
3. Purple striae on abdomen
55
Cutaneous signs of IBD
Pyoderma gangrenosum and Erythema Nodosum
56
Causes of erythema nodosum
1) Idiopathic
2) Autoimmune: IBD, sarcoidosis
3) Drugs eg OCPs
4) infectious: Streptococcus, Yersinia
5) Pregnancy
6) Malignancy
57
Causes of Palmar erythema
1) Chronic Liver Disease
2) Pregnancy
58
Pathophysiology of Calciphylaxis
Necrotic and painful eschar due to calcium deposits intra and extravascularly causing ischemia
59
1) Sodium thiosulfate: Via dialysis or intralesional
2) Non calcium phosphate bindera
3) stop calcium supplements
60
Severe Cutaneous Adverse Reactions(SCAR) from drugs
DRESS
SJS/TENS
Acute Generalised Exanthematous Pustulosis(AGEP)
61
Drugs that commonly cause ADRs
1. Penicillins
2. Anticonvulsants
3. Anti tuberculosis
62
Mx of exanthemous drug rxn
1. Stop drug
2. Topical steroids and antihistamines
3. Monitor for progression
63
Types of drug related urticaria
Immunologically related eg to penicillins
Non immunological eg to nsaids
64
Mx of Anaphylaxis-Urticaria
1. IM adrenaline
2. IV dexamethasone
3. IV diphenhydramine?
65
Drugs that commonly cause fixed drug eruptions
NSAIDs
Paracetamol
Abx eg cotrimoxazole, tetracycline, penicillins
66
Classic presentation of SJS TENS
Dusky patches, targetoid lesions and blisters
Skin pain
67
Causes of target lesions
1. Erythema Nodosum
2. SJS TENS causes targetoid(2 colors)
68
Drugs that commonly cause SJS TENS
1. Penicillins
2. Allopurinol
3. Anticonvulsants
4. Antiretrovirals
5. Sulfonamides eg bactrim
6. Nsaids
69
Microbe that may cause SJS TENS
Mycoplasma Pneumoniae
70
Cx of SJS TENS
1. Electrolyte imbalance via fluid loss
2. Sepsis
3. ARDS/pneumonitis
71
Mx of Anaphylactic angioedema
1. IM adrenaline deep into anterolateral thigh
2. IV hydrocortisone
3. IV diphenhydramine
4. Antihistamines and PO pred for 2 days after
72
Mx of Acute Generalized Pustular Psioriasis
1. Manage hypotension
2.Immunosuppresants: Cyclosporin or MTX
3. Retinoids
4. Anti TNF Biologics
73
Causes of Generalised Exfoliative Dermatitis(Erythroderma)
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
Mx of eczema herpecticum
1. PO or IV Acyclovir depending on severity
2. Cover with Antistaphylococcal Abx in case of superinfection
3. Refer eye tro Herpetic Keratitis
75
Local side effects of topical steroids
1. Atrophy
2. Telegiectasia
3. Steroid acne
4. Easy bruising
5. Hypopigmentation
6. Hypertrichosis
7. Allergic contact dermatitis
8. Others
76
Major SE of isotretinoin
Teratogenicity
- Stop for 3 months before trying to conceive
- Double contraception while on drug
77
Margin for elliptical excision of suspicious moles
4mm of normal looking skin
78
Advantages of Mohs micrographic surgery
1. Better resection margins: lower tumor recurrence
2. More tissue preservation
79
Indications for Mohs micrographic surgery
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
Ideal biopsy method for melanoma
Excisional biopsy: Punch biopsy may not capture deepest area and unintentionally downstage the malignancy
81
Mx of Viral warts
1. Fortnightly cryotherapy x9 sessions
2. Imiquimod
3. Local MMR vaccine as immunotherapy
82
How to ddx scarring and non scarring alopecia
Whether the follicle is intact
83
SEs of isotretinoin
1. Teratogencity
2. Transaminitis
3. Photosensitivity
4. Dry mouth
84
Cause of tinea versicolor and characteristic feature
Malassezia furfur
Furry scaling
85
Hallmark of small vessel Vasculitis
Palpable purpura
86
Symptoms of erythema nodosum
1.Inflamed tender pre tibial nodules
2. Fever
3. Malaise
4. Arthralgia
5. Sx of etiologies eg IBD
87
Most common allergen of allergic contact dermatitis
Nickel
88
Prerequisites for accurate patch
No oral antihistamines or topical steroids for 2 weeks
89
Mx of Bacterial Vaginosis(Gardnerella vaginalis)
PO or PV metronidazole
Clindamycin 2nd line
90
Indications for phototherapy
1. Vitiligo
2. Psoriasis
3. Mycosis Fungoides
4. Atopic dermatitis
91
What is PUVA
Psoralen+ UV phototherapy
92
Indications of photodynamic therapy
1. Actinic Ketatosis
2. BCC
3. Bowens disease
93
Treatments for androgenic alopecia
1. Topical minoxidil
2. Finasteride
3. Intralesional steroids
4. Follicle transplant
94
Indications for cryotherapy
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
What is Hutchinsons sign
Extension of hyperpigmentation from subungual to the lateral and posterior nail folds, suggests Acral lentiginous melanoma over melanonychia
96
Causes of pyoderma gangrenosum
1. IBD
2. Hematological malignancy
3. IgA?
4. Granulomatosis with polyangiitis
97
Causes of painful skin lesions
1. Drug related
2. Zoster
3. Autoimmune blistering
98
Sx suggestive of SCARs
Blisters + mucosal involvement + pain
99
Organs involved in DRESS
1. Hepatitis(most common)
2. Renal
3. Myocarditis
4. Pancreas
5. Thyroid
6. Pneumonitis
7. Herpes virus reactivation
100
Hallmarks of atopic dermatitis
Papules and macules on erythematous background with excoriations
101
4 areas of dangerous herpes zoster
1. Oticus
2. Ophthalmicus
3. C4 diaphragm
4. Sacral
102
Mucocutaneous features of SLE via SLICC criteria
1. Malar rash
2. Discoid rash
3. Mucositis
4. Alopecia
103
Causes of drug induced hyoerpigmentation
Minocycline
Clofazimine
Amiodarone
104
How to manage asymptomatic partner of patient with Syphilis
Serial monitoring rather than prophylactic mx
105
Treatment of M leprae
Dapsone+Rifampicin+Clofazimine
106
Causes of erythema nodosum mnemonic
SORE SHINS C
Streptococci
OCPs
Rickettsia
Eponymous(Behcet)
Sulfonamides
Hansens disease
IBD and idiopathic
Non Hodgkin Lymphoma
Sarcoidosis
Cutaneous TB
107
Best drug for generalised pustular psioriasis(GPP)
Acitretin
108
Best drug for plaque psoriasis
Cyclosporin
109
Drugs that cause hypertrichosis
1. Cyclosporin
2. Minoxidil PO
110
Features of PCOS
1. ACNE
2. Hirsutism(male pattern hair growth)
3. Irregular period
4. Deepening of voice, increased muscle mass etc
111
Side effects of isotretinoin
1. Transaminitis
2. Teratogenic
3. Myalgia, arthralgia
4. Headache, fatigue
5.
112
Ddx for acne vulgaris
Rosacea
Adenoma sebaceum
113
Mx of Acne vulgaris
Topicals:
1) Clindamycin + benzyl benzoate
2) Topical retinoids
Oral
1) Doxycycline
2) Isotretinoin
3) Erythromycin
114
Ddx of Viral warts
1. Calluses
2. Arsenical keratosis
3.?
115
“Washout period” for isotretinoin before pregnancy
Minimum 1 months, ideally 2 months
116
Antibiotics that can and cannot be taken with isotretinoin for acne treatment
1. CANNOT use with doxycycline: benign intracranial hypertension
2. CAN use with erythromycin
117
SEs of isotretinoin
1. Transaminitis
2. Hyperlipidemia
3. Mood changes
4. Teratogenic
118
Treatment of actinic keratosis
Cryotherapy
Must treat as pre malignant
