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Dermatology Flashcards

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1
Q

Give some differentials for a non-blanching rash:

A

Non blanching is caused by petechiae or purpura bleeding and can be checked via the glass test.

  • Meningitis
  • Henoch schonlein Purpura
  • Acute leukaemia
  • Haemolytic uraemic syndrome
  • Compressional trauma to the skin
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2
Q

What is the management of a non-blanching rash?

A

If there is any doubt - treating as meningitis

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3
Q

What is erythema nodosum associated with?

A

Bacterial:

  • Streptococcal infection
  • Mycoplasma pneumonia
  • TB
  • Lymphogranuloma venereum

Viral:

  • EBV
  • Hep B

Chronic illness:

  • Inflammatory bowel disease
  • Sarcoidosis
  • leukaemia
  • lymphoma

Drugs:

  • sulfonamides
  • NSAIDs
  • contraceptive pill
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4
Q

If urticaria continues for more than 24 hours, what should you investigate for?

A

urticarial vasculitis

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5
Q

How is SJS defined? and how is TEN defined?

A

<10% detachment of the skin - SJS

> 30% detachment of skin - TEN

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6
Q

How does SJS/ TENs usually present?

A

Prodromal symptoms

  • fever
  • cough
  • headache
  • 2- 3 days prior to onset of skin disease

Cutaneous lesion - erythematous macules which get larger and join together and eventually blister off.

Development of mucosal lesions

Mucosa involving the G.I, respiratory and G.U are all affected.

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7
Q

How should SJS/ TEN be managed?

A

Burns unit
Ophthalmology
ITU

**assess for secondary infection

IV immunoglobulins
IV Steroids
Anti-histamines

  • nutritional support
  • IV fluids/ electrolytes
  • dressing

**infection control is key. a serious complications is infection on top of the burns

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8
Q

What may be seen on a histological slide of psoriasis?

A

Parakeratosis

Increased lymphocyte infiltration

Loss of granular layer

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9
Q

What are the different types of dermatitis?

A

Eczema

Contact

  • allergy
  • Irritant

Discoid

Seborrhoeic Dermatitis
- pityrosporum ovale

Venous dermatitis

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10
Q

What is acanthosis nigricans associated with?

A

Hyperinsulinemia states:

  • DM
  • PCOS
  • Hypothyroidism

Gastric carcinoma

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11
Q

What is the treatment of pyoderma gangrenosum?

A

steroids

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12
Q

What is it called when there is an adverse reaction, leading to almost all the body becoming erythematous?

A

Acute erythroderma

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13
Q

What is it called when the epidermal cells release their attachment from one another in a pathological manner?

A

Acantholysis

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14
Q

Name an intra-dermis blistering disease:

A

Bullous Pemphigus

- damage to the desmosomes

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15
Q

How is Pemphigus vulgaris investigated and treated?

A

Nikolsky sign
Mucocutaneous lesions

Skin biopsy

  • acantholysis
  • Desmosome antibodies (immunofluorescent)

Treatment:
- IV immunoglobulins to gain control

  • High dose prednisolone
  • refer to dermatology
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16
Q

Which skin pathology cause sub-epidermal bullae?

A

bullous Pemphigoid

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17
Q

Where is the most common places for bullous pemphigoid to affect?

A

Abdomen

Inner forearms

Upper thighs

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18
Q

How is bullous pemphigoid investigated and treated?

A

Investigations:

* Nikolysky sign is NEGATIVE 
* Skin biopsies 

- Antibodies 
- Complement 

• APAG1 &amp; 2 blood test 
- Anti-bodies against the particular antigens on hemidesmosomes

Treatment:

Remove medication causing it.

Oral steroids.

Azathioprine

Localised: - topical steroids.

Infection control

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19
Q

List some pre-malignant skin conditions:

A

Actinic Keratoses (squamous):

  • erythematous silver plaques
  • cryotherapy, 5 fluorouracil

Bowen’s disease (squamous):

  • squamous cell carcinoma in situ
  • 5 fluorouracil

Lentigo Maligna:
- macular pigmentation area

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20
Q

What is the treatment for rosacea?

A

Avoidance of triggers
- sunlight etc

1st:
- topical metronidazole
- Topical Brimonidine - vasoconstriction
- topical benzyl peroxide

2nd:
- laser treatment

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21
Q

What are some complications of shingles?

A

Herpes Zoster Ophthalmicus

  • *if it involves the tip of the nose this is Hutchison’s sign and suggestive of ophthalmology involvement
  • refer urgently to ophthalmology

Ramsay Hunt Syndrome

Post herpetic neuralgia
- most common in the elderly

Dissemination
- immunocompromised

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22
Q

What tests can be done to diagnose VZV/ Shingles?

A

Tzanck smear

PCR

**usually it is a clinical diagnosis though

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23
Q

An individual with fever, lymadnopahty, sore throat and fatigue is prescribed antibiotics. they then break out in a large erythematous rash, what is the likely pathogen?

A

EBV

- do not prescribe penicillin. it induces a hypersensitivity rash

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24
Q

What are the broad types of psoriasis?

A

Plaque Psoriasis

Guttate
- following a strep infection

Erythrodermic psoriasis
- medical emergancy

Koebner
- develops over a scar

Inverse
- develops over the flexures

Palmer/pustular

Psoriatic arthritis

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25
What are the different types of basal cell carcinomas?
* Nodular - most common * squamous * pigmented * sclerortic
26
How is the prognosis of Melanoma measured?
Breslow's depth
27
What are the different types of melanomas?
Superficial Malignant melanoma Nodular Subungnal Amelanotic melanoma Lentigo maligna melanoma - develops form Lentigo Maligna (benign) Acaral Melanoma
28
What is an immunological therapy used for melanoma?
Vemurafenib - BRAF V600 mutation Ipilimumab - Anti CTLA -4
29
What are the surgical incisions for melanoma?
<1mm = 1cm >1mm = 2cm
30
What are some side effects of topical steroids?
thinning of skin lightening of the skin on darker skin
31
What are the treatments for plaque psoriasis?
1st line: - emollients and anti-pruritus medication - topical steroids + vitamin D analogue 2nd line: - double the vitamin D analogue 3rd line: - increased topical steroid dose + coal tar
32
What is the most common cause of fungal nail infections?
Trichophyton Rubrum
33
What type of surgery can be used for squamous cell and basal cell carcinoma in cosmetically important sites?
Moh's micrography
34
Which blistering skin condition typically involves the mucosa? - what other symptom helps differentiate it?
Bullous Pemphigus easily ruptured blisters - especially with horizontal pressure applied - Nikolsky's sign
35
What conditions are associated with Seborrheic dermatitis?
Parkinson's HIV
36
How is bullous pemphigoid investigated?
Skin biopsy with immunofluorescence IgG to the basement membrane
37
What are the main diagnostic features of skin cancer?
Change in shape Change in colour Change in size
38
How does actinic keratosis present?
Scaly lesions, which are not well demarcated upon sun exposed surfaces - multiple lesions may be present
39
What is the treatment for actinic keratosis?
Topical fluorouracil Topical Diclofenac cauterage Incision
40
What is the treatment for rosacea?
1st line: Topical metronidazole Topical Brimonidine Topical Benzoyl perioxide 2nd line: tacrolimus laser therapy
41
What are some triggers to psoriasis?
``` Stress Infection - especially strep Trauma - Kobner Drugs - lithium/ NSAIDs/ Antimalarials Climate Smoking ```
42
What are the nail changes seen in psoriasis?
Nail pitting Onycholysis Subungual hyperkeratosis
43
What are the most common drugs to cause TEN?
``` Sulfonamides Anti-epileptics Penicillins Allopurinol NSAIDs ```
44
What is the treatment for alopecia areata?
Topical steroids Topical Minoxidil Phototherapy Contact immunotherapy
45
What is the management for TEN?
Stop the medication causing the reaction Admitted to ITU for burns IV Immunoglobulin Antihistamines Steroids Fluids Analgesia
46
What investigations should be done into Alopecia?
Examination: - Hair pull test - Dermoscopy - check eyebrows - check occipital region - check for scaring Bloods - TFT - B12 Fungal samples Syphilis serology Autoimmune screen Skin Biopsy
47
What skin manifestation is typically seen with pancreatic cancer?
Thrombophlebitis migrans
48
List come skin conditions seen with Diabetes:
Necrobiosis lipoidica - waxy shiny yellow skin Acanthosis nigricans Granuloma annulare
49
What is Erythema Multiforme most commonly caused by?
Herpes simplex - 70% Mycoplasma CMV
50
What skin condition is seen with lung cancer?
Erythema Gyraton Repens
51
What skin condition is typically seen with glucagonomas?
Necrolytic migratory erythema
52
What investigations should be done into ulcers?
Bloods: - FBC - anaemia - Glucose levels Orifices: - urine dipstick for glucose X-ray: - Duplex ultrasound - Angiography if arterial E S - Skin swabs - ABPI
53
What complications can occur with venous ulcers?
Bacterial colonisation Lipodermatosclerosis Lymphoedema Squamous cell carcinoma - Marjolin ulcer
54
How are venous ulcers managed?
Life style factors Elevation of leg Compressional bandages (if ABPI >0.8) Non- absorbent hydrocolloid gel dressings Topical hydrocortisone for surrounding tissueWhat is
55
What are the two grading systems used for Malignant melanoma?
Breslow's depth Clark's Staging
56
Where is malignant melanoma most like to spread to and what are some poor prognostic factors?
Liver Eyes Prognostic: - Male - High Miosotis - Lymphatic spread - distant metastasis - Ulceration
57
What can cause squamous cell ulcers?
Sun exposure Long term ulceration Long term exposure to impressiveness medication - kidney transplant (cylosporin)
58
What is the treatment for Basal Carcinoma?
Moh's - complete circumferential removal - Cryotherapy/ Radiotherapy
59
What are the triggers for psoriasis?
Stress Streptococcal infection - Guttate Injury - Koebner Sunburn Drugs - beta blockers - lithium - NSAIDs - TNF- alpha
60
What is an medical emergency psoriasis?
Erythrodermic psoriasis | - generalised psoriasis
61
What nail changes are seen in psoriasis?
Nail pitting Onycholysis Subungual Hyperkeratosis Yellow brown discolouration Damaged nail plate with loss of nail
62
What are the main infections that can occur in Eczema?
Eczema herpticum - Herpes simplex virus infection Staph infection - MRSA - Staph Aureus
63
How is contact dermatitis tested for?
Patch test
64
How does seborrheic dermatitis present and how is it treated?
Dandruff around the: - eyes - eyebrows - nasolabial folds - Cheeks Cradle cap in the babies Erythroderma - in the elderly Miconazole + Hydrocortisone
65
What are the causes of erythema multiforme?
``` Mycoplasma HSV Drugs: SNAPP - Sulfonamides - NSAIDs - Allopurinol - Penicillin - Phenytoin ```
66
In SJS, what worrying infection is someone more at risk of?
HIV
67
Name some causes of pruritus:
Cholestasis Haematological: - Anaemia - Polycythemia rubra vera - Leukemia - Hodgkin lymphoma Endocrine: - Hypothyroidism - DM - Pregnancy Skin: - Urticaria - Eczema - Dermatitis Herpetiformis
68
On biopsy of bullous pemphigoid what would you expect to see?
Subepidermal blistering with eosinophil rich inflammatory infiltrate
69
What are the clinical signs of psoriasis?
``` Extensors Plaque Well demarcated Auspitz sign Koebner effect ```
70
What two systemic drugs are used in psoriasis?
Methotrexate Cyclosporine
71
What are the clinical findings of eczema?
``` Flexure surface Lichenification Scratch marks Small vesicle formation Itchy ```
72
What skin disease is associated with poor zinc absorption?
Acrodermatitis enteropathica Classic triad of: - peri-oral, peri- acral dermatitis - diarrhoea - Alopecia Caused by: - primary zinc transporter defect - secondary to deficiency - seen when weaning, cystic fibrosis
73
What are some risk factors for acne?
Age 12- 24 years Family history Greasy skin
74
What is a serious type of acne that require steroid treatment and what are some causes?
Acne fulminans - Anabolic steroids - Isotretinoin A
75
What are some complications of acne?
Scarring Dyspigmentation Psychological effects
76
What are the treatment options for acne vulgaris, in order of 1st line:
1st line: - topical benzoyl peroxide - Oral contraceptive 2nd line: - Oral antibiotics - tetracycline, erythromycin - topical antibiotics 3rd line: - isotretinoin A
77
What tests need to be done when on isotretinoin A?
Monthly LFTs and lipids
78
Name two creams used is psoriasis which contain both a potent steroid and vitamin D:
Dovobet Enstilar
79
Name some common skin blistering conditions:
Chickenpox herpes impetigo Pompholyx eczema
80
How is Dermatitis herpetiformis treated? and what is the risk of this medication?
Gluten free diet Dapsone - haemolytic anaemia - especially true in G6PD deficiency
81
What are the subtypes of epidermolysis bullosa and what is their inheritance pattern?
Epidermolysis bullosa simplex - autosomal dominant Epidermolysis bullosa dystrophica Junctional Epidermolysis bullosa - autosomal recessive
82
Name some drugs that cause TEN:
Penicillin Co-trimoxazole Carbamazepine NSAIDs
83
What are some of the causes of erythroderma?
Atopic eczema Psoriasis Drugs: - penicillin - allopurinol - Sulphonamides Cutaneous T cell lymphoma
84
What is a major complication of erythroderma, what is it typically seen with and how should it be managed?
Leaky capillary syndrome Psoriasis ITU admission
85
What is the general treatment of erythroderma?
Monitoring: - fluid - Electrolytes - albumin - Temperature Fluids Electrolytes Warmth Bed rest steroids
86
What are the general complications of erythroderma?
High output heart failure Hypothermia Fluid loss Increased metabolic rate
87
What is the underlying pathological process to erythema multiforme? and name some common causes:
Type IV hypersensitivity reaction - T cell mediated - herpes simplex - EBV - Anti-epileptic drugs - Mycoplasma infection - SLE - HIV infection
88
How is erythema multiforme treated?
Most will self resolve in 2-4 weeks. Persistent: - aciclovir or - azathioprine
89
How is pyoderma gangrenosum treated?
High dose oral steroids
90
What are the symptoms of Drug induced hypersensitivity syndrome:
Typically caused by Anticonvulsant therapy - eosinophilic reaction occurs 2-4 weeks later ``` Maculopapular rash fever lymphadenopathy arthralgia pharyngitis periorbital oedema ```
91
What will a blood film show on Drug induced hypersensitivity syndrome:
Eosinophilia Lymphocytosis Atypical lymphocytosis
92
What are the features of rosacea:
Flushing of the skin around: - cheeks - Nose - Forehead Telectangasia Pustule formation Rhinophyma - due to sebaceous gland enlargement
93
What is the Nikolsky sign?
When a blister is rubbed laterally and causes it to shed/ burst. Differentiates between an: - intra-epidermal blister - Sub-epidermal blister
94
What are the histological findings of eczema?
Spongiosis - fluid in the upper levels between the keratinocytes - Thickening of the epidermis - lichenification - Hyperkeratosis in the upper levels
95
What are some triggers for eczema?
Infection/ systemic and local Detergents Stress/ anxiety Teething in children Cat fur
96
What are some clinical features of Eczema:
Itchy erythematous scaly patches Flexural distribution Lichenification Scratch marks Small vesicle formation - which may weep Hyperpigmentation/ hypopigmentation Follicular hyperkeratosis - usually seen on the back of the arms - association
97
What are the viral infections that can effect someone with eczema?
HSV - Eczema herpaticum Molluscum contagiosum Both require acyclovir
98
What are some of the severe complications of eczema?
Secondary infection Kaposi's varicelliform eruption Keratoconjunctivitis Retarded growth in children
99
Where are the potent and very potent steroids typically used?
On palm surfaces due to thickening of skin
100
What are the three age groups who get seborrhoeic eczema?
Babies - cradle cap Teenagers - dandruff Elderly - can cause erythroderma
101
What are the two peak onsets of psoriasis?
Teenagers 50-60s
102
What gene is associated with psoriasis?
PSORS1
103
What are the different types of psoriasis??
Chronic plaque psoriasis Guttate Erythroderma - systemic reactions Pustular - usually has systemic systems Palmopustular Inverse
104
What is one of the risk factors of using vitamin D preparation on extensive psoriasis?
Hypercalcemia
105
What advice should be given to patients on methotrexate?
Use contraception - need to be off for 3-6 months before pregnancy LFTs need regularly checked Avoid alcohol Avoid NSAIDs
106
How does ustekinumab work?
IL12/23 inhibitor
107
Which drugs are typically implicated in Bullous Pemphigoid?
NSAiDs Furosemide Penicillin
108
What ulcer develops over venous ulcers following long term irritation?
Marjolin's ulcer
109
How can acne rosacea be differentiated from seborrhoeic dermatitis?
Sparing of the nasolabial folds
110
What gene is Psoriasis associated with?
HLA B13/17
111
If someone develops eczema herpcitum how shoud they be managed?
Admitted to hospital Aciclovir
112
In liver failure how can you differentiate a spider naevi from another skin condition?
It will blanche and refill from the middle
113
What is your treatment of eczema herpaticum?
Due to HSV which spreads throughout damaged eczema skin Stop topical steroids Fluxocacillin Acyclovir

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