Derm Flashcards

Question

how might eczema present?

Answer 1

- itchy, erythematous rash - repeated scratching may exacerbate affected areas - in infants the face and trunk are often affected - in younger children, eczema often occurs on the extensor surfaces - in older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck

Answer 2

1. emollients to prevent water loss and allow repair 2. middle potent topical corticosteroids itch - non-sedating antihistamines 3. topical calcineurin inhibitors 4. phototherapy 5. oral steroids

Answer 3

- apply sparingly on affected areas (about an amount from last crease of finger to tip enough for area covering both palms of hand, wash hands before applying, don’t use with emollient as may dilute, no more than twice a day during flare ups long term use can lead to side effects due to systemic absorption hence give lowest potency controlling the eczema, advice on side effects such as transient burning, acne, or even systemic side effects such as adrenal suppression

Answer 4

referral to dermatology is diagnosis uncertain, eczema not controlled with current treatment, recurrent secondary infection, high risk complications or for bandage advice - referral to immunologist if food allergy trigger and not available in primary care - referral to clinical psychologist if psychological wellbeing affected or not improving

Answer 5

eczema herpeticum (rapidly worsening, painful eczema, clustered blisters and punched out erosions)

Answer 6

urticarial weals can be few centimetres in diameter, coloured white or red, with or without red flare

Answer 7

superficial swelling of the skin (epidermis and mucous membranes) resulting in red, raised and itchy rash

Answer 8

- time of onset, severity using urticaria activity score - any known causes or triggers like food allergies - especially if occuring 1h after exposure to food - family history of atopy - consider possiblity of angio-oedema and offer non-sedating antihistamines and remove offensive cause - acute urticaria with fever can be the first sign of covid, in children caused by infection

Answer 9

- suspected anaphylaxis or angio-oedema different - identify trigger or underlying cause, symptoms diary - non-sedating antihistamine, if severe oral corticosteroid - arrnage referral if painful and persistent, not controlled with antihistamines, angio-oedema - clinical psychologist for quality of life affected

Answer 10

pediculosis capitis - infests hairs on scalp and feeds on human blood

Answer 11

- age 4-11 - female - sharing beds, clothing, hairbrushes - greater number of children in family - overcrowded living conditions

Answer 12

- scalp pruritus - feeling of things moving in hair - scratching, causing crusting and scale *small red papules under hairline at nape of neck and behind ears = louse bites

Answer 13

- topical insecticide and wet combing - demiticone - physical barrier to cause suffocation - second application 7-10 days after first - wet combing - most effective - four session over 2 weeks - good for pregnant or lactating women - oral ivermectin

Answer 14

rash - erythematous papules, excoriations which may appear as vesicles if complications like infection. granulomatous nodules on dark skin and may appear grey not red

Answer 15

transmissable disease caused by parasitic mite infests humans ‘sarcoptes scabiei’ 5-15 per host

Answer 16

risk factors include contact with infected, poverty and social deprivation, institutionalisation, winter

Answer 17

- ‘itchy rash’ 4-6w after initial infection, symmetrical lesions, hands, wrists, axillae, thighs, buttocks and genitalia. neck and above spared and may appear aczematous - crusted scabies in immunocompromised, elderly with neck and above

Answer 18

- good prognosis given compliance, treat pt and family, itching treatment, permethrin cream (insecticide) onto cool skin and wash off after 8h then next week, decontaminate bedding clothes etc, sedating antihistamine to help sleep - re-treat if persisting 2-4 weeks or new burrows, dermatology referral for persistent nodular scabies for steroid treatment, specialist advice if child under 2

Answer 19

erythematous maculopapular lesions with satellite pustules in the intertriginous areas lesions are moist, eroded, and accompanied by fine scaling and pruritus

Answer 20

- infancy or old age - warm climate - broad-spectrum abx - DM - iron deficiency - immunosuppression - cancer, malnutrition, HIV - chemo etc

Answer 21

- skin - imidazole creams - mouth - nystatin oral suspension - vagina - imidazole cream +/- pessary

Answer 22

ringworm and tinea fungal infection caused by dermatophytes - a group of fungi that invade and grow in dead keratin

Answer 23

- round and well defined, annular, erythematous lesions with papules and pustules with a more inflamed edge - rash scaly, dry, swollen or itchy

Answer 24

- described differently depending on where it affects - scalp/ trunk, legs. arms / feet - tinea pedis, cruris, capitis, unguigum, corporis

Answer 25

- skin scrapings sent from edge of lesion - scalp brushings - nail clippings - culture

Answer 26

- take measures to prevent spread by washing clothes, bedding etc and not sharing towels etc - confirm diagnosis before tx - topical anti-fungal eg: terbenafine, clotrimazole twice daily for 2w - may be managed with oral fluconazole

Answer 27

- dermatomal distribution of blisters confined to cutaneous distribution of one or two adjacent sensory nerves - starts off as red papules - each blistering or becomes pustular and then crusts over - unilateral, with a sharp cut-off at the anterior and posterior midlines

Answer 28

- localised, blistering and painful rash caused by reactivation of varicella-zoster virus (VZV) - VZV remains dormant in dorsal root ganglia in spine for years before it is reactivated and migrates down sensory nerves to skin to cause herpes zoster

Answer 29

- localised pain without tenderness or any visible skin change - pain might be one spot or it may spread out - unwell with fever, headache, LN enlarged - within one to three days of the onset of pain, a blistering rash appears in the painful area of skin - complete within 2–3 weeks in children and young adults, and within 3–4 weeks in older patients

Answer 30

- rest, pain relief - protective ointment applied to the rash like petroleum jelly - oral abx for secondary infections - Antiviral treatment can reduce pain and the duration of symptoms if started within one to three days after the onset - Aciclovir 800 mg 5 times daily for seven days - steroids unproven

Answer 31

- eye complications - deep blistters - muscle weakness - ramsay hunt - infections - post-herpetic neuralgia

Answer 32

- persistence or recurrence of pain in the same area, more than a month after the onset of herpes zoster - could be an itch mx: early antivirals, local anaesthetic, topical capsaicin, amitryptylline

Answer 33

pink or pearlish white papules with central umbilication, upto 5mm in diameter which appear anywhere except palms and sole of feet

Answer 34

- Molluscum contagiousum caused by poxvirus - transmission via direct close contact - skin to skin - shared towels - auto-inoculation by scratching - sexual - mostly in pre-school children

Answer 35

- common viral skin infection of childhood that causes localised clusters of umbilicated epidermal papules. - affects young children under age of 10 - more in warm climates, overcrowded environments - commonly in warm, moist places, armpit, behind knees, groin, genital - induces dermatitis skin becomes pink dry and itchy

Answer 36

White molluscum bodies can often be expressed from the centre of the papules skin biopsy histopathology

Answer 37

- reassure as self limiting, about 18m, treatment if troublesome with itching or if inflammation develops - referrals if HIV positive or anogenital lesions to GUM clinic - physical: cryotherapy, laser ablation - medical: antiseptic like hydrogen peroxide - topical corticosteroid for secondary dermatitis

Answer 38

- Keep hands clean - Avoid scratching or shaving - Cover all visible lesions with clothing or watertight bandages - Dispose of used bandages - Do not share towels, clothing, or other personal effects - Adults should practice safe sex or abstinence

Answer 39

- secondary infection - conjunctivitis - disseminated secondary eczema - scarring

Answer 40

vesicular rash, small erythematous macules on scalp, face, trunk and proximal limbs and may progress to papules, clear vesicles and pustules with fever and malaise

Answer 41

- primary infection with the varicella-zoster virus, of the *Herpesviridae* family → This virus is sometimes called herpesvirus type 3 - transmission via contact or droplet spread where infectious 1-2 days before rash and until vesicles dry and crusted over 5 days since rash onset

Answer 42

- itchy red papules progressing to vesicles on the stomach, back and face, and then spreading to other parts of the body - Blisters can also arise inside the mouth - high fever, headache, cold-like symptoms, vomiting and diarrhoea - prodromal symptoms for up to 48 hours before breaking out in the rash. These include fever, malaise, headache, loss of appetite and abdominal pain - blisters clear up within one to three weeks but may leave a few scars

Answer 43

- A clue to the diagnosis is in knowing that the patient has been exposed to an infected contact within the 10–21 day incubation period - Patients may also have prodromal signs and symptoms - PCR - culture of blister fluid - serology IgM, IgG

Answer 44

- specialist care if pregnant, immunocompromised etc - self limiting in children, analgesia - keep cool, trim nails - calamine lotion - antivirals for immunocompetent adult or adolescent if 24h within rash onset, if high risk of complications, topical calamine lotion, chlorphenamine

Answer 45

Advise that the most infectious period is 1-2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash)

Answer 46

- may complicate to bacterial infection, lung involvement in adults or varicella pneumonia in immunocompromised - secondary infection - NSAIDs increase risk - dehydration - exacerbation of asthma - viral pneumonia - encephalitis - disseminated haemorrhagic chickenpox - scarring

Answer 47

spontaneous abortion, fetal chorioretinitis, cataracts, limb atrophy, cerebral cortical atrophy and microcephaly, cutaneous scars, and neurological disability

Answer 48

- cluster of small, fluid-filled vesicles on an erythematous base - vesicular eruptions with crusting

Answer 49

- avoid sunlight, reduce stress - acyclovir - oral, IV, ointment - for bothersome sx, prevent transmission

Answer 50

- localised area of red, painful, swollen skin and systemic symptoms - mostly on limbs - goes hand in hand with Erysipelas → superficial form of cellulitis in the upper dermis

Answer 51

- FBC, CRP - blood culture - CXR - USS doppler - MRI

Answer 52

MDR elevate limb mark edges analgesia, hydration IV abx fluclox switch to oral when fever settles

Answer 53

- necrotising fasciitis - more serious soft tissue infection recognised by severe pain, skin pallor, loss of sensation, purpura, ulceration and necrosis - gas gangrene - severe sepsis - infection of other organs, eg pneumonia, osteomyelitis, meningitis - endocarditis

Answer 54

inflamed hair follicles with or without pus - tender red spot, often with a surface pustule - may be superficial or deep, affecting anywhere there are hairs, including chest, back, buttocks, arms and legs

Answer 55

- bacterial boil - hygiene, antiseptic cleanser, abx ointment, oral abx - viral severe - antivirals

Answer 56

well defined lesions usually starting around nose and face with honey-coloured crusts on erythematous base bullous - superficial, small or large thin roofed bullae which tend to spontaneously rupture and ooze yellow fluid leaving scaley rim

Answer 57

- skin conditions - atopic dermatitis - skin trauma - immunosuppression - warm, humid climate - poor hygiene - crowded environments

Answer 58

- 2-5 year olds - non-bullous - face or extremities but any involved - bullous - face, trunk, extremities, buttocks, perineal - systemic malaise, fever, lymphadenopathy

Answer 59

- clinical - skin swab for cultures and sensitivity for MRSA - nasal swabs to identify staph nasal carriage - rarely biopsy

Answer 60

*self-limiting in 2-3w - localised - antiseptic - topical fusidic acid for localised - oral antibiotics eg: flucloxacillin QDS for 7 days if severe - hygiene advice - hand washing, gentle cleansing, watertight dressing

Answer 61

- cellutlitis - scarlet fever - staphylococcal scalded skin syndrome - detachment of the outermost skin layer

Derm Flashcards

(85 cards)