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MRCP 2 > derm > Flashcards

derm Flashcards

(48 cards)

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1
Q

eczema pathophysiology

A

null mutations in filaggrin gene
> epidermal permeability
Th2 inflammatory response

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2
Q

topical steroids for eczema

A

mild- hydrocort
mod- clobetasone butyrate/eumovate
potent- betamethansone/betnovate
v potent- clobetasol propionate/dermovate

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3
Q

specialist treatment for eczema

A

calcineurin inhib- tacrolimus/pimecrolimus
UVB or PUVA
ciclosporin or azathioprine
alitretinoin (hand dermatitis)

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4
Q

BCC treatment and types

A

surgical excision, routine referral to derm
imiquimod for small low risk BCC
vismodegib for advanced/metastatic

nodular (most common) pearly raised edges, telangiectasia, may ulcerate
morphoeic (sclerosing) mostly on face, waxy
pigmented
superficial (plaques) most common in younger adults
mixed basosquamous, more aggressive

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5
Q

7 point checklist for malignant melanoma

A

major (2 points):
change in size
irregular shape/border
irregular colour

minor (1 point):
diameter > 7mm
inflammation
oozing/crusting
change in sensation

refer if 3 points

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6
Q

bullous pemphigoid antibodies

A

BP antigen II BP180
BP antigen I BP230
IgG

inflam cells release proteases
> degrade hemidesmosomal proteins connecting basal cells to lamina lucida

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7
Q

pemphigoid treatment

A

dx:
skin biopsy for light microscopy
skin biopsy for direct immunofluorescence
indirect immunofluorescence on serum

topical steroids for local disease
systemic for widespread
azathioprine/ciclosporin if steroid resistant
usually self limiting within months-years

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8
Q

pemphigoid risk factors

A

previous chronic inflam skin diseases
furosemide, abx, NSAIDs
PD, epilepsy, dementia

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9
Q

cellulitis organisms

A

staph and strep pyogenes

strep pneum, haem infl, gram neg, anaerobes- injury, burns
pseudomonas aeruginosa- hot tubs, sponges, nail puncture
vibrio vulnificus- salt water
aeromonas hydrophila- fresh water
erysipelothrix- butcher, vet, fish handler
myobacterium marinum- aquarium
pasteurella, capnocytophaga- cat/dog bite
eikenella- human bite
streptobacillus moniliformis- rodent bite

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10
Q

eron classification of cellulitis

A

1: no systemic symptoms or comorbidities
2: systemically unwell or comorbidity
3: severe systemic symptoms (tachy/hypotensive) or unstable comorbidities
4. severe infection e.g. nec fasc

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11
Q

cellulitis admission criteria

A

severe infection or systemic symptoms
infection close to eyes or nose
might be caused by uncommon organism
not responding to oral tx
lymphangitis

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12
Q

cellulitis treatment

A

fluclox
clari or doxy if pen allergic
erythromycin if pregnant
coamox or clari +metro if near eyes
amox if lymphoedema

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13
Q

abstinence and testing after chlamydia

A

abstain for 7 days after treatment with azithromycin
re-test after 3-6 months
test of cure only for pregnant people (3 weeks after treatment)

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14
Q

dermatitis herpetiformis biopsy

A

microabscessses containing neutrophils and eosinophils
granular IgA deposits

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15
Q

treating dermatitis herpetiformis

A

oral dapson
sulfapyridine
rituximab
steroids

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16
Q

causes of erythema multiforme

A

HSV, HIV, hepB, EBV
mumps
mycoplasma
psittacosis
rickettsia
barbiturates, penicillins, sulfonamides
SLE, polyarteritis nodosa, sarcoid

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17
Q

causes of erythema nodosum

A

strep, salmonella, campylobacter, tb
sarcoid, UC, crohns
lymphoma, leukaemia
penicillin, tetracycline, OCP
pregnancy

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18
Q

erythroderma risk factors

A

eczema, psoriasis
lymphoma
sezary syndrome
drug reactions
blistering conditions
pityriasis rubra pilaris
HIV
other malignancies

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19
Q

erythroderma dx and tx

A

raised IgE
tx:
urgent admission
IV fluids
emollients, wet dressings
topical steroids
warm room to prevent hypothermia

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20
Q

erythroderma

Study These Flashcards
A

> 90% skin inflammation and shedding

21
Q

what drugs can cause alopecia?

Study These Flashcards
A

retinoids
anticoagulants
anti mitotics
OCP
carbimazole
thiouracil
lithium

22
Q

causes of scarring alopecia

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A

ichthyosis
TB, syphilis
burns, RTx
kerion, tinea capitis
lichen planus
lupus, sarcoid, pemphigoid
morphoea

23
Q

alopecia areata associations

Study These Flashcards
A

nail dystrophy
cataracts
vitiligo
autoimmune thyroid disease
pernicious anaemia
addisons

24
Q

anagen/telogen effluvium

Study These Flashcards
A

anagen effluvium:
hair loss during anagen stage
pointed tip
alopecia areata, CTX, retinoids

telogen effluvium
hair loss when increased number of hairs enter telogen stage and shed
postpartum, trauma, illness, stress, weight loss

25
types of hypersensitivity reaction
1: IgE, mast cells, basophils atopy, anaphylaxis, contact dermatitis 2: antibody dependent IgG drug induced haemolysis, acute transfusion, goodpastures 3: immune complex serum sickness, SLE, post strep GN 4: delayed cell mediated helper and cytotoxic T cells contact dermatitis, BCG
26
lichen planus treatment
topical steroids tacrolimus ointment oral steroids if widespread MTX for hair and nails UVB second line
27
types of melanoma
superficial spreading- irregularly pigmented macule/plaque nodular- often rapidly growing lentigo- irregularly pigmented macule, older patients and slowly expanding acral- pals, soles, toenails amelanotic
28
melanoma treatment
CTX for metastatic unresectable vemurafenib for v-raf murine sarcoma BRAF mutation ipilimumab resect with 2mm margin
29
molluscum contagiosum treatment
not normally indicated hydrogen peroxide cream or iodine pdophyllotoxin topical salicylic acid cantharidin
30
strawberry naevi
treat if it obstructs vital structures > propranolol and prednisolone Kasaback Merritt- low platelets, enlarging haemangioma, haemolysis, consumption coagulopathy PHACE- posterior fossa defects, arterial anomalies, cardiac defects, eye anomalies
31
sebaceous naevi
present at birth on scalp/face can undergo neoplastic change after puberty
32
neurocutaneous melanosis
melanocytic naevi EEG abnormalities raised ICP, hydrocephalus, SOL
33
neurofibromatosis
1: NF1 chromo 17, auto dom neurofibromas, cafe au lait freckles dermatofibromas lisch nodules 2: NF2, chr 22, auto dom or de novo b/l acoustic neuromas meningiomas, glial tumours fewer cafe au lait spots reduced life expectancy schwannomatosis: tender cutaneous schwannomas without vestibular neuroma high tumour load
34
pemphigus HLA alleles and antibodies
paraneoplastic: HLA DR4, HLA DQ1 vulgaris: HLA DRB1 IgG mediated vulgaris: desmoglein 1 and 3 antibodies foliaceus: desmoglein 1 antibodies
35
paraneoplastic pemphigus compared to pemphigus vulgaris
nikolsky negative no scalp pruritus no dysphagia background malignancy
36
drug causes of photosensitivity
doxy, fluoroquinolones, voriconazole chlorpromazine, prochlorperazine furosemide, thiazires sulfonamides, amiodarone, promethazine, NSAIDs, metformin, vemurafenib
37
pityriasis versicolour cause
malassezia
38
vitiligo treatment
topical steroid or pimecrolimus
39
cause of plantar warts
HPV 1, 2, 4, 27, 57
40
psoriasis pathophysiology
expansion of Th1, Th17, Th22 > release cytokines IL 17, !L 22, TNF a
41
what drugs might exacerbate psoriais?
beta blockers lithium antimalarials interferon withdrawal of oral steroids
42
systemic treatment for psoriasis
MTX (need to monitor P3NP) ciclosporin (first line if acute control is needed or palmar pustular) retinoids etanercerpt, adalimumab, infliximab (TNFa inhib) ustekinumab (IL 12 and 23 antibody)
43
conditions associated with pyoderma gangrenosum
UC, crohns RA, ank spond chronic hepatitis, PBC, sclerosing cholangitis leukaemia, lymphoma, myeloproliferative DM, thyroid, sarcoid, granulomatosis w/ polyangiitis
44
rosacea treatment
mild/mod: topical metro or azelaic acid mod/severe: bromonidine (for erythema alone), PO abx refer to derm for persistent flushing and telangiectasia for beta blockers, clonidine, isotretinoin
45
SCC referral
2ww low risk of malignancy but early treatment prevents extensive treatment
46
lesions related to SCC
keratoacanthoma (excision) bowens (cryo, excision or 5FU) actinic keratoses (cryo, excision, 5FU, diclofenac or imiquimod cream)
47
causes of SJS and TEN
allopurinol cephalosporin NSAIDs phenytoin carbamazepine sulfasalazine sertraline antivirals HSV, resp infections, mumps EBV, coxsackie, influenza HLA B1502, HLA B1508 increases risk
48
SJS vs TEN
SJS: < 10% total body surface area skin detachment, widespread macules or targets overlap: 10-30% skin detachment with widespread macules or targets TEN: > 30% body surface area skin detachment with macules or targets OR > 10% with large epidermal sheets and no purpuric macules

MRCP 2 (12 decks)

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