Dermatology Flashcards
(170 cards)
1
Q
What is bullous pemphigoid
A
Autoimmune sub-epidermal condition characterised by large, tense blisters found on the limbs, trunks and flexors
Bullae/erosions may be also found on oral/genital mucosa
2
Q
What autoantibodies are present in bullous pemphigoid
A
BP antigen II and I
3
Q
Treatment of bullous pemphigoid
A
Steriods
Supportive measures
4
Q
Risk factors for developing bullous pemphigoid
A
Previous chronic inflammatory skin conditions (e.g. lichen planus or psoriasis)
Drugs
- furosemide
- antibiotics
- NSAIDs
Neurological disease
- PD
- dementia
- Epilepsy
5
Q
Causes of bullous eruptions
A
Congenital
Strep infection
Staph scalded skin syndrome
TEN
Diabetic bullae
CKD
Haemodialysis
Barbituate overdose
Immunological
6
Q
What is erythema multiforme?
A
Presents as eruptions of multiple lesions, which are maculopapular, target shaped rashes but can appear in various forms (hence the name multiforme)
7
Q
Where can erythema multiforme occur?
A
Anywhere on the body
Palms
Soles
Oral mucosa
8
Q
What may there be a history of with erythema multiforme?
A
Viral illness
9
Q
Where does the rash usually start and spread with eyrthema multiforme?
A
Starts distally
Spreads proximally
10
Q
What is Koebeners phenomenon?
A
Lesions appearing on areas of previous skin trauma
11
Q
Differentials of erythema multiforme
A
Insect bites
SJS
TEN
Drug eruption
Dermatitis
Bullous pemphigoid
Pemphigus
Dermatitis herpetiformis
12
Q
What is neurofibromatosis?
A
A genetic condition characterised by lesions of the skin, CNS and skeleton
13
Q
Types of neurofibromatosis
A
Type I
Type II
Schwannomatosis
14
Q
Genetics of neurofibromatosis type I
A
Autosomal dominant inherited disorder
Caused by mutation in the neurofibromin gene (NF1) on chromosome 17
15
Q
Presentation of NF1
A
Often presents in first year of life and increase in number with age
Leads to multiple tumours that grow along the NS anywhere in the body
Skin lesions
- multiple neurofibromas (skin coloured lesions) and cafe au lai macules
- freckling, particularly in skin folds
Neuro dermatofibromas arise from nerve trunks and can cause paraesthesia when pressed
Lisch nodules (seen on eye with slit lamp)
Short stature
Macrocephaly
Around 30% develop
- Mild learning disability
- Acoustic neuromas
- epilepsy
16
Q
Rare assosiation of NF1
A
Phaechoromocytoma
17
Q
Main difference NF2 vs NF1
A
CNS tumours being more characteristic than skin lesions
18
Q
Presentation of NF2
A
Bilateral acoustic neuromas are characteristic
Meningiomas
Glial cell tumours
Usually present with deafness in their 20s; tinnitus, veritgo
19
Q
Genetics of NF2
A
Mutation found on chromosome 22
Can be autosomal dominance or de novo (up to 50%)
20
Q
Treatment of acoustic neuroma
A
Surgical excision
21
Q
Mean survival from diagnosis of NF2
A
15 years
22
Q
What is schwannomatosis?
A
Occurence of multiple tender cutaneous schwannomas without the vestibular neuroma assosiated with NF2
Often a very large tumour load requiring assessment with MRI
23
Q
Is life expectancy affected in schwannomatosis?
A
No
24
Q
Which NF is more common?
A
Type 1
25
Presendation of schwannomatosis
Pain
Related or unrealated to masses
Paraesthesia and weakness
26
Genetics of schwannomatosis
Medatiations of tumour suppression genes such as SMARCB1 and LZtr1
27
Complications of NF
Tumours of optic nerves (gliomas) (15% of childre with NF1)
Scoliosis
Osteoporosis
Epilepsy
Increased risk of brain tumours, leukaemias and other malignancies of neural crest origins
Malignant change if there are peripheral sheath tumours in NF1 (assosiated with poor survival)
28
First line treatment for scabies
Permethrin cream
29
What is erythema nodosum
Acute panniculitis (inflammation in the fat) that produces tender nodules or plaques on the shins and occassionally elsewhere
30
Assosiations of erythema nodosum
Idiopathic
Sarcoidosis
Pregnancy
IBD
Strep infections
TB
Treatment with sulfonamides or OCP
31
Treatment of erythema nodosum
NSAIDs
32
What is pyroderma gangronosum assosiated with
IBD
Vasculitis
Haematological malignancy
33
Presentation of pyoderma gangrenosum
Deep ulcer
Violet border
34
What is koebeners phenomenon
New disease lesions develop at the site of skin injury
35
What coniditons provide a true koebeners response
Psoriasis
Vitiligo
Lichen planus
36
Rash in lichen planus
Pigmented
Itchy
37
Diseases assosiated with PLEVA
Toxoplasmosis
EBV
HIV
CMV
Parovirus
Staph A septicaemia
Group A beta haemolytic strep infection
38
Presentation of PLEVA
Initial area of erythema
Develops rapidly into multiple pus filled papules
39
What is onchyolysis
Seperation of nail bed from nail plate
40
Causes of onchyolysis
Psoriasis
Trauma
Infection
Drugs - tetracycliens, psoratens
Thyrotoxicosis
41
What is bowens disease
A form of SCC
Presents as a red scaley plaque
42
How does polyphyria cutanea tarda occur
Bullous eruptions after exposure to sunlight
Eruptions heal into scarring and milia
Photodistribution of the rash
43
Investigation of polphyria cutanea tarda
Clinically
High levels of urinary uroporphyrin
44
How can remission of polyphyria cutanea tarda be induced
Venesection
45
Presentation of rash in dermatomyositis
Red or volacious periorbital eruption known as the helitrope rash
May be assosiated oedema
Linear volacious changes over dorsal aspect of fingers
Shawl sign - erythema over upper back and posterior neck
Weakness of major proximal muscles
46
Investigations of scabies
Ink test
47
What is pemphigus vulgaris
Mucosal involvement with ulceration
Flaccid blisters (on trunk in particular)
48
What would be found in a biopsy for pemphigus vilgaris
Intercellular IgG deposition
49
What is the test for marfan syndrome
Fibrillin 1 (FBN1) gene testing
50
What is pseudoxanthoma elasticum
Rare genetic disease causing systemic calcium deposition and fragmentation of elastic tissue
51
Complications of pseudoxanthoma elasticum
Central blindness
CVS events
GI bleeding
52
Skin manifestations of pseudoxanthoma elasticum
Multiple small yellow papiles, possibly joining into larger patcges
Later in the disease, skin can become lax, wrinkled and hanging in like fold like appearances e.g. on upper arms
on neck (commonest), inside elbows, back of knees, umbilicus, groin
Oral, genital and rectal mucosa
53
Diagnosis of pseudoxanthoma elasticum
Skin biopsy
54
Drugs that can cause photosensitivity
Doxycycline
NSAIDs
retinoids
Diuretics
CVS drugs (amoidarone, enalapril, quinidine, diltiazem)
Sulfounryea drugs
Phenthoiazines
55
What can immunosuppresision cause in relation to shingles?
Muti-dermatomal
Disseminated disease
56
In the pathogenesis of psoriasis, which cell type is most implicated in the inflammatory response
T lymphocytes
57
What drugs can worsen psoriasis
Beta blockers
Anti-malarials
Lithium
Withdrawl of oral corticosteriods, especially if sudden
58
What can precipitate guttate psoriasis
Strep infection
59
What is melasma
Hormonally stimulated increase in melaogensis that mainly appears on the face
60
What can worsen melasma
Sun exposure
COCP
Pregnancy
61
Where does melasma occur mainly
On the face
62
Secondary syphillis presentation
Polymorphic rash
- particularly on palms and soles of feet
63
Presentation of primary syphillis
Painless ulcer
64
What causes pellagra
Chronic vitamin B3 deficiency
65
Presentation of pellagra
3Ds
- photosensitive dermatitis
- diarrhoea
- dementia
66
What condition can pellagra be seen in
Carcinoid syndrome
67
Skin manifestations of systemic sclerosis
Taunt, shiny skin
Telangiectasis
Salt and pepper discolouration
Ulceration
Sclerodactyly
68
What is necrobiosis lipoidica
Unusual complication of DM
May also occur in non diabetic patients
Small vessel damage leads to partial necrosis of detmal colleagen and connective tissue, with a histiocytic cell response
69
Presentation of necrobiosis lipoidica
Mostly on the legs
Erythematous plaques
Gradually develop into yellow brown waxy discolouration
Marked atrophy and prominant telangiectasia
70
Poor prognostic indicators of malignant melanoma
Depth (breslow thickness)
Ulceration
71
Most common CVS complications seen in pseudoxanthoma elasticum
Accelerated atherosclerosis
Mitral valve prolapse
72
Eye characterisation of pseudoxanthoma elasticum
Angioid streaks
73
Presentation of pemphigoid of pregnancy
Rare immunobullous disease
Tends to begin second trimester but can occur whenever
Some cases, worsens after delivery
Tense blisters
74
Investigation of pemphigoidof pregnancy
Biopsies for histology and immunoflorencence
75
Treatment of pemphigoid of pregnanct
PO steriods
76
Presentation of polymoprhic eruption of pregnancy
Pruritic and urticated papules and plques
Itchy
Blistering unusual
Spares the umbilical area
77
Bioppsy results of dermatitis herpetiformis
IgA
78
Presentation of pemphigus
Flaccid blisers that erode / erupt easily
79
Blisters pemphigus vs pemphigoid
Pemphigus - flacid blisters that erode / erupt more easily
Pemphigoid - blisters tense and do not rupture easily
80
Age pemphigus vs pemphigoid
Pemphigus - 40-60 y/o
Pemphigoid - older
81
Investigation of pemphigus
Immunofloureosecne
- antibodies to the cells in the epidermis
Anti-desmoglein antibodies (type I and III) in blood samples
82
Management of chronic spontaentous urticaria if two antihistamines arent controlling symptoms
Monteleukast
- thought to be useful in reduction of duration and severity of episodes
83
Presentation of pityriasis rosea
Herald patch
Followed by widespread similar red patches with a fine collaret of scale
Can be asymptomatic
84
Investigation of pityriasis rosea
Clinical
85
Treatment of pityriasis rosea
COnservative
Rash usually resolves up to 12 weeks later
86
Antibodies seen in paraneoplastic pemphigus
Envoplakin
Periplakin
Bullous pemphigoid antigen I
Desmoplakin
Desmoplakin II
Alpha 2 macroglobulin like 1
87
WHat does an older patient with intact blisters on their limbs indicate
Bullous pemphigoid
88
Presentation of HSP
Purpura in dependent areas (buttocks and legs) (vasculitic rash)
Abdo pain and vomiting
With or without upper gi haemorrhage
Nephritis (less commonly nephrotic syndrome)
89
What age do oyu commonly see HSP
4 -15 y/o but can occur at any age
90
Pathophysiology of HSP
Mediated by IgA
Deposited in affected organs
91
Antigen triggers of HSP
Drugs
Foods
Immunisation
Various infections
92
Treatment of HSP
Supportive
93
Presentation of molluscum contagiosum
Crops of firm, smooth umbilicated papules
94
Treatment of molluscum contagiousum
Cryotherapy
Can resolve spontaenously up to 18 months
95
Treatment of peristomal pyoderma gangrenosum
Topical tacrolimus
96
What HLA subtype is most assosiated with chronic plaque psoriasis
HLA-CW6
97
HLA subtype related to T1DM
HLA-DR3
98
WHat HLA subtype is related to psoriatic arthritis and pustular psoriasis
HLA-B27
99
What can worsen skin manifestations of NF1
Pregnancy
100
Presentation of a sebacous cyst
fluid filled lesion
skin smooth and intact on top
painless
occassionally become painful and inflammed
discharge caseous material
101
Are macules raised or flat
flat
102
Presentatio n of tuberculoid leprosy
Hypopigmented areas of skin
Accompanied by reduced sensation
103
Investigation of leprosy
Mycobacterium leprea on skin biopsy or slit-skin smear
104
Treatment of acne
1. Topical antibiotics
2. Oral antibiotics (3 month trial - then trial another antibiotic)
3. Topical retinoid
4. Oral retinoid
105
Causative orgganism of lymes disease
Borrelia Burgdorferi
106
Presentation of dermatitis herpatiformis
Vesicles / blisters (quickly excoriated so may not be seen)
scaly itchy plaques
107
Who is zinc deficiency commonly seen in
alcoholics
108
Presentation of zinc deficiency
Anorexia / lethargy
Diarrhoea
Growth retardation
Delayed sexual maturation
Hypogonadism / hypospermia
Intellecutal disability, impaired nerve conduction and nerve damage
Hepatomegaly
Immune disorders
Susceptibility to infections
Alopecia / dermatitis / paronychia
109
What is erysipelas
A superficial form of cellulitis
110
Features of erysipelas
Distinctive, warm, red tender skin lesion
Induration and is sharply defined
Raised, rapidly advancing border
Vesicles or bullae may develop
Face is commonly affected
111
Causative organism for erysipelas
Group A beta haemolytic strep (strep pyogenes)
112
another name for vitamin B3
Naicin
113
Treatment of pyoderma gangrenosum
1. Very potent topical steriods
2. Prednisolone
3. Ciclosporin or other immunosuppressive agents
4. Dapsone
5. Tetracycline Abz
114
Treatment of venous ulceration
Compression bandaging
115
Where is acral lentigious melanoma seen
Sole of the foot
Occassionally on the palm of the hand
116
Presentation of acral lentigious melanoma
Normally seen on sole of the foot
Can be seen in the palm of the hand
Irregulatly pigmented macule, but thicker palpable areas may appear if it progresses
Size can range from a few mm to a few cm
117
When does lentigo maligna melanoma tend to present
Chronically sun exposed skin
Typically the face
118
Features of nodular melanoma
Aggressive
Grows deeper
Presents as a papular or nodular lesion
Deeply pigmented but can be amelanotic
119
Where does subungal melanoma occur
Nail apparatus
120
What is the most common subtype of melanoma
Superficial spreading melanoma
121
Inheritance of dariers disease
AD
122
Presentation of dariers disease
Apparent in early adulthood
Warty papules and plaques in seborrhoeic areas (e.g. central chest and back, scalp, flexures), palmar pits and nail dystrophy
Secondary infection of the lesions can lead to crusting and malodour
123
Treatment of dariers disease
Retinoid acitretin can be used to treat symptomatic cases
124
What is wickhams strae and what condition is it characteristic of
Fine, white lacy pattern over the papules
Characteristic of lichen planus
125
What is erypsillas assosiated with
systemic upset (fevers, chills)
126
Where does SCC occur
Chronically sun exposed areas such as face and lips
May arise from
- actinic keratosis
- Bowens disease
- chronic wounds
- areas of inflammation (known as marjolins ulcer)
127
What is PUVA
A type of ultraviolet light therapy (phototherapy)
128
Presentation of kapsois sarcoma
Red, purple or brown cutaneous nodules or plaques, lesions may occur in mouth or internal organs
Typically affects legs, head and neck
Lesions are usually asymptomatic
129
WHat antibody is present in virtually all patients with SLE at some stage
anti-nuclear antibody
130
Presentation of sweets syndrome
Skin lesions are
- plum coloured
- may be papules, plaques or nodules
Mucosal involvement and blistering may occur
Often fever and neutrophilia
131
Diagnosis of sweets syndrome
Skin biopsy
132
What condition makes up the majority of cases of patients with paraneoplastic pemphigus
NHL
133
What pattern does pityriasis rosecea occur in
Christimas tree distribution
134
What is rosacea often assosiated with
Rhinophyma (enlarged sebaceous cysts around nose)
Ocular rosacea
- conjunctivitis
- blepharitis
- keratitis
135
Treatment of rosacea
Topical azelaic acid
Topical ivermectin
Brimonidine
Doxycycline
Tetracycline
136
What is more severe, TEN or SJS
TEN
137
Presentation of TEN/SJS
Flu like prodrome
Followed by a red/purple rash which then blisters/forms bullae
Affects the skin, mucous membranes, eyes and genitalia
138
Treatment of TEN/SJS
Identify and remove/treat underlying cause
Analgesia
Fluids
Corticosteriods
Abx
139
80% of TEN/SJS is caused by what
Drugs
140
What drugs can precipitate SJS/TENS
Allopurinol
Cephalosporin
NSAIDs
Phenytoin
Carbamazepine
Sulfa group Abx
Sulfasalazine
Sertraline
Antivirals
141
Risk factors for developing TENS/SJS
Previous Hx
Family Hx
Genetic predisposition - HLA b1502 or HLA b1508 genes
142
Pathology of SJS/TENS
Type IV hypersensitivity reaction
143
SCORTEN system for severity of TENS/SJS includes
Age > 40
Prescence of malignancy
HR > 120
Epidermal detachment > 10% body surface
Urea > 10
Glucose > 14
Bicarb < 20
144
Treatment of lichen sclerosus
Reducing course of topical Clobetasol 0.05%
145
What is the most useful cytokine to target in the treatment of psoriasis with potent monoclonal antibodies
IL17
146
What should we check for if there is angio eoedema in the abscence of urticaria
C1-esterase inhibitor deficiency
ACE inhibitor induced angiooedema
147
How can rosacea be distinguished from acne
Abscence of comedones
Distrbution of the rash (almost always confined to the face)
Lack of scarring
Effect of sunlight (brings an improvement in acne)
Age (rosacea more common > 40)
148
What is erythroderma
Any inflammatory skin condition covering in excess of 90% of the body surface
149
Causes of erythyroderma
Eczema
Psoriasis
Drug eruption
Cutaneous lymphoma
Pityriasis ruba pilaris
150
WHat causes pityriasis versiolour
Fungus malassezia globosa
151
When is malassezia globosa commmon
Area of skin covered by occlusive clothing or is more subject to sweating
More likely to occur in hotter weather
152
Whta toxin does staph A produce in recurrent skin infections
PVL
153
Signs of melanoma in an existing mole
Asymmetry of pigmentation
Irregularity in shape and border
Multiple colours
Enlargement
Darkening
Bleeding without trauma
154
What is discoid lupus erythematous also known as
Chronic cutaneous lupus erythematous
155
what is tyolosis assosiated with
carcinoma of the oesophagus
156
Where does lichen planus commonly affect
Wrist and ankles
157
Treatment of cutaneous leishmaniasis
Sodium Stibogluconate
158
Features of Behects syndrome
Recurrent orogenital ulceration
Uveitiis
Arhtiritis
159
Pathology of behects disease
Autoimmune
Assosiations - HLA B12, B51 and B5
160
3 features of acute intermittent porphyria
Abdominal pain (may mimic acute abdomen)
HTN
Psychiatric disturbance
161
How does AIP
Defect in porphobiligen deaminase
162
Treatment of acute attacks of AIP
IV haem arginate
163
What is often seen (and in the diagnostic crtieria) for NF1 that you would see on slit lamp examination
At least two Lisch nodules (iris hamartomas)
164
Treatment of acne rosacea
Topical azelaic acid
165
How long does it take for kertatinocytes to transform to anucleate corneocytes
3 days
166
What can occur at the edge of chronic venous ulcers
Squamous cell carcinomas forming at the margin
167
When does guttate psoriasis occur
approx. 2 weeks after a streptococcal throat infection
(more common in patients with a FH of psoriasis)
168
WHat is the main trigger for acne in young women
Follicular epidermal hyperprolileration
169
Treatment for acne rosacea with assosiated frequent facial flushing
Topical brimonidine
170
