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Year 4 Medicine > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

Define toxic epidermal necrolysis

A

Potentially life-threatening dermatological disorder characterised by widespread erythema, necrosis and bullous detachement of epidermis and mucous membranes

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2
Q

What is the milder form of TEN called?

A

Stevens-Johnson syndrome (<10% involvement)

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3
Q

What are the risk factors for TEN?

A

Children
HIV/AIDS
Drugs

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4
Q

What drugs can cause TEN?

A 
Sulphonamides
Phenobarbital 
Carbamazepine
Lamotrigine
Allopurinol
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5
Q

What is the aetiology of TEN?

A

Adverse drug reaction
Infection
Vaccination
Graft vs host disease

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6
Q

What are the symptoms of TEN?

A

Prodrome of cough, myalgia and anorexia 2-3 days before
Itching
Burning
Fever

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7
Q

What are the examination findings in TEN?

A

Involvement of mucosa and internal epithelial surfaces

Nikolsky’s sign

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8
Q

What is Nikolsky’s sign?

A

Slight rubbing of the skin results in exfoliation - occurs in TEN

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9
Q

What investigations can be done for a patient with suspected TEN?

A

Bloods - FBC, U&Es, CRP
Skin biopsy
Blood cultures

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10
Q

How is TEN managed?

A

ITU, burn, gynae, ophthalmology involvement
Stop all drugs
Analgesia and fluids
IVIG

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11
Q

What are the differential diagnoses for TEN?

A

Bullous pemphigoid

Bullous pemphigus

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12
Q

What are the complications of TEN?

A 
Death 
Dehydration/malnutrition
ARDS
GI ulceration/perforation
Infection 
Sepsis
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13
Q

What is the prognosis of TEN?

A

30-50% mortality

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14
Q

Define erythema multiforme

A

Acute hypersensitivity rash caused by infection or drugs

Usually mild but makor form can affect mucous membranes

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15
Q

What are the risk factors for EM?

A

History of EM or infection
Suspect drugs
Vaccinations - diphtheria, tetanus

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16
Q

What is the aetiology of EM?

A 
HSV
EBV
Drugs - sulphonamide, anticonvulsants
Mycoplasma
Autoimmune 
HIV
Wegener's
Carcinoma, lymphoma
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17
Q

What features are seen on examination of a patient with EM?

A

Erythematous polycyclic/annular/concentric rings (target lesions)
May blister
Symmetrical rash

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18
Q

What investigations can be done for a patient with suspected EM?

A

Bloods - FBC, U&Es
Serology - HSV, VZV
M.pneumoniae titre
CXR

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19
Q

How is EM managed?

A

Treat underlying cause
Recurrent - aciclovir
Resistant - azathioprine

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20
Q

What are the differential diagnoses of EM?

A

TEN

SJS

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21
Q

What are the complications of EM?

A

Sepsis
Cellulitis
Permanent skin/eye damage and scarring
Inflammation of internal organs

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22
Q

What is the prognosis of EM?

A

Usually self-limiting

Can recur

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23
Q

How can EM be prevented?

A

Prophylactic antivirals for HSV

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24
Q

Define acute urticaria

A

Development of itchy weals/swellings in the skin due to leaky dermal vessels
AKA hives

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25
What is the difference between urticaria and angio-oedema?
Angio-oedema involves sub-dermal vessels; life-threatening | Urticaria involves dermal vessels
26
What are the types of urticaria?
``` Cold Pressure Stress Heat/cholinergic Solar Aquagenic Contact ```
27
What are the risk factors for urticaria?
Atopy | Young age
28
What is the aetiology of urticaria?
``` Autoimmune Viral/parasitic infection Drug reaction Food allergy SLE Idiopathic ```
29
What drugs can cause urticaria?
NSAIDs Penicillin ACEi Opiates
30
What would be the examination findings of a patient with urticaria?
Cutaneous swellings/weals, develop over a few minutes anywhere on the body and resolve spontaneously in minutes/hours Lesions are intensely itchy and erythematous
31
How is urticaria managed?
``` Treat underlying cause Avoid salicylates and opiates Oral antihistamines (e.g. cetirizine) ```
32
How is angio-oedema managed?
IM adrenaline | IV steroids
33
What are the differential diagnoses for urticaria?
Blisters Dermatitis Insect bite Drug reaction
34
What are the complications of urticaria?
Anaphylaxis | Airway blockage
35
What is the prognosis of urticaria?
Usually spontaneously resolves | May become chronic
36
How can urticaria be prevented?
Prophylactic antihistamines for predisposed individuals
37
Define erythroderma
Clinical state of inflammation/redness of all/most of the skin
38
What are the risk factors for erythroderma?
Male | Older age
39
What is the aetiology of erythroderma?
``` Atopic eczema Psoriasis Drugs Seborrhoeic eczema Idiopathic Rare - leukaemia, HIV, toxic shock syndrome ```
40
What drugs can cause erythroderma?
``` Sulphonamides Gold Sulfonylureas Penicillin Allopurinol Captopril ```
41
What are the symptoms of erythroderma?
Tight, itchy skin Malaise Pyrexia Widespread lymphadenopathy
42
What signs are seen on examination of a patient with erythroderma?
Hair loss Ectropion Nail shedding Pustules
43
How is erythroderma investigated?
Skin biopsy
44
How is erythroderma managed?
``` Keep patient warm Regular observation and fluid balance Swab for infection Stop drugs Bed rest Emollient/mild topical steroid ```
45
What are the complications of erythroderma?
``` Death Cardiac failure Hypothermia Fluid loss Hypoalbuminaemia Capillary leak syndrome ```
46
Define impetigo
Highly contagious superficial bacterial infection with yellow crusting most common in children
47
What are the risk factors for impetigo?
Age 2-5 Crowded conditions (schools) Warm, humid weather Broken skin
48
What bacteria are most commonly implicated in impetigo?
S.aureus | Group A β-haemolytic streptococcus
49
What does impetigo look like on examination?
Weeping, exudative areas with honey-coloured crust
50
How is impetigo investigated?
Nasal swabs (resistant infection)
51
How is impetigo managed?
Topical fusidic acid or oral antibiotics
52
What are the differential diagnoses for impetigo?
Bullous impetigo | Scabies
53
Give a complication of impetigo
Cellulitis
54
What is the prognosis of impetigo?
Self-limiting and mild
55
How can impetigo be prevented?
Good personal hygiene | Avoid direct contact with affected
56
Define tinea
Superficial fungal infection of skin/nails by dermatophytes
57
What is tinea more commonly known as?
Ringworm
58
Give a risk factor for tinea
Immunosuppression
59
What are the 3 main organisms implicated in tinea?
Microsporum Epidermophyton Trichophyton
60
What does tinea look like on examination?
Asymmetrical, scaly patches with central clearing Advancing, scaly, raised edges Vesicles/pustules may be present
61
How can tinea be investigated?
Skin scrapings
62
How is tinea managed?
Topical terbinafine or systemic terbinafine/itraconazole
63
What are the differential diagnoses for tinea?
Nummular eczema Granumola annulare Psoriasis Contact dermatitis
64
What are the complications of tinea?
Bacterial superinfection | General invasion of dermatophyte infection
65
What is the prognosis of tinea?
Curable
66
How can tinea be prevented?
Good skincare | Not sharing things with people who are affected
67
Define soft tissue abscess
Infection in the dermis/fat with development of walled off infection
68
What 2 organisms are most commonly implicated in soft tissue abscesses?
S.aureus | S.pyogenes
69
How are soft tissue abscessed managed?
Surgical drainage | Antibiotics if severe infection
70
Define cellulitis
Infection involving the dermis, mostly on the lower limb
71
What 2 organisms are most commonly implicated in cellulitis?
S.aureus | β-haemolytic streptococci
72
How do patients with cellulitis present?
Fever, unwell | Hot, tender area
73
How is cellulitis managed?
IV flucloxacillin for 3-5 days followed by oral therapy for 2 weeks
74
What are the differential diagnoses for cellulitis?
Animal bites DVT Dermatitis
75
What organism is responsible for causing streptococcal toxic shock?
Group A β-haemolytic streptococci (primary infection of throat/skin)
76
How does streptococcal toxic shock present?
Localised infection, fever and shock | Diffuse, faint rash over whole body
77
How is streptococcal toxic shock managed?
Surgery - drain abscess Antibiotics - penicillin, clindamycin IVIG (severe)
78
Define necrotising fasciitis
Immediately life-threatening, rapidly progressive soft tissue infection with deep tissue involvemtn
79
How does necrotising fasciitis present?
Rapidly progressive Pain out of proportion to clinical signs Severe systemic upset Visible necrotic tissue
80
What late signs can be seen on imaging of necrotising fasciitis?
Fascial oedema | Gas in soft tissues
81
How is necrotising fasciitis treated?
Surgical debridement | Broad spectrum antibiotics
82
What are the 2 types of necrotising fasciitis?
Type 1 - polymicrobial, existing wound | Type 2 - group A streptococci, healthy tissue
83
What are the 2 types of herpes simplex virus?
Type 1 - cold sores | Type 2 - genital herpes
84
How is HSV diagnosed?
Clinically Blood/vesicle fluid PCR Serology
85
How is HSV managed?
Aciclovir
86
How is varicella zoster virus infection managed?
Supportive | At risk adults (pregnant, immunocompromised, pneumonitis) should be treated with 48 hours of symptoms with aciclovir
87
Define eczema
Group of skin disorders causing dry, irritated skin
88
List the different types of eczema
``` Atopic Seborrhoeic Varicose Pompholyx Contact Photoreaction ```
89
What is the pathophysiology of eczema?
Abnormalities in skin barrier lead to increased permeability
90
What are the risk factors for eczema?
Family history Hygiene hypothesis Exacerbating factors Atopy
91
What is the aetiology of eczema?
Genetic - loss of function mutation of FLG gene (codes for filaggrin protein)
92
What signs are seen on examination of eczema?
Itchy, erythematous, scaly patches Commonly in flexures Acute lesions may weep/exude and have vesicles Scratching causes excoriations and repeated rubbing causes lichenification
93
What are the associated features of eczema?
Keratosis pilaris Hyperlinear palms Ichthyosis vulgaris
94
How is eczema investigated?
Clinical diagnosis IgE RAST Allergy testing/skin prick Swabs and scrabes
95
How is eczema managed?
General - avoid triggers, good skincare Topical - emollients, soap substitutes and steroids Oral - antibiotics, antihistamines Immune - tacrolimus
96
How are steroids classified by potency in dermatology?
Mild > moderate > potent > super potent
97
How are emollients classified by viscosity in dermatology?
Ointments vs creams vs lotions
98
What second-line agents can be used to manage eczema?
UV phototherapy Immunosuppressants - azathioprine, ciclosporin, methotrexate Oral retinoids - alitretinoin
99
What are the differentials for eczema?
Psoriasis Scabies Tinea
100
What are the complications of eczema?
Secondary skin infection - S.aureus, viral warts Conjunctival irritation, cataracts Retarded growth in children
101
What is the prognosis of eczema?
Spontaneous clearance in most children | Late onset more chronic with remitting/relapsing pattern
102
How can eczema be prevented?
Secondary - moisturise, avoid sudden temperature change, reduce stress, avoid harsh fabrics/soaps
103
What are the 4 main types of leg ulcer?
Venous Arterial Neuropathic Pressure
104
What is the pathophysiology of venous leg ulcers?
Sustained venous HTN in superficial veins causes incompetent valves in deep/perforating veins causing fibrin deposition and poor oxygenation of surrounding skin
105
What is the pathophysiology of arterial leg ulcers?
Reduced arterial blood flow causes decreased tissue perfusion and poor healing
106
What is the pathophysiology of neuropathic leg ulcers?
Repeated trauma over a pressure point
107
What is the pathophysiology of pressure leg ulcers?
Skin ischaemia from sustained pressure over a bony prominence
108
What are the risk factors for venous leg ulcers?
``` Older age FH Venous disease Orthostatic occupation Smoking DVT Female Increasing parity ```
109
What are the risk factors for arterial leg ulcers?
Smoking Diabetes HTN
110
What are the risk factors for neuropathic leg ulcers?
Peripheral neuropathy - diabetes Foot deformity Concurrent vascular disease
111
What are the risk factors for pressure leg ulcers?
Prolonged immobility Decreased sensation Vascular disease Poor nutrition - anaemia, hypoalbuminaemia, vitamin C/zinc deficiency
112
What drug can cause leg ulcers?
Hydroxycarbamide
113
What infections can cause leg ulcers?
TB Deep mycoses Syphilis Yaws
114
What features of the history indicate an arterial ulcer?
Pain | CV features - claudication, HTN, angina, smoker
115
What features of the history indicate a pressure ulcer?
Old/immobile/unconscious Pain of continued pressure Hospital acquired
116
What is seen on examination of a venous leg ulcer?
Gaiter area between medial malleolus and mid-calf Oedma Haemosiderin deposition - hyperpigmentation Lipodermatosclerosis Atrophie blanche - shiny white scarring Telangiectasia
117
What is seen on examination of a arterial leg ulcer?
Lateral aspect of leg or on foot Punched out appearance Leg cold and pale, hair loss, absent peripheral pulses Surrounding skin shiny white
118
What is seen on examination of a neuropathic leg ulcer?
Pressure areas (e.g. metatarsal heads) Surrounded by callus Deep Insensate
119
What is seen on examination of a pressure leg ulcer?
Painful and warm Exudative, foul odour Non-blanching discolouration
120
How is a suspected venous ulcer investigated?
Duplex US - check for reflux
121
How is a suspected arterial ulcer investigated?
Vascular assessment Doppler USS ABPI
122
How is a suspected neuropathic ulcer investigated?
Bloods - glucose, HbA1c US ABPI X-ray foot
123
How is a suspected pressure ulcer investigated?
Clinical diagnosis | Wound swab, WCC, biopsy
124
How is a venous ulcer managed?
High compression bandaging and leg elevation | Analgesia
125
How is an arterial ulcer managed?
Keep clean and covered Analgesia Vascular reconstruction
126
How is a neuropathic ulcer managed?
Remove pressure | Good footcare
127
How is a pressure ulcer managed?
Keep pressure off bony areas Adequate nutrition Analgesia
128
What are the differentials for leg ulcers?
Different types of leg ulcers Squamous cell carcinoma Pyoderma gangrenosum Lymphoedema
129
What are the complications of venous leg ulcers?
DVT Haemorrhage Infection
130
What are the complications of arterial leg ulcers?
Infection Tissue necrosis Amputation
131
What is the prognosis of venous leg ulcers?
80% healed in 6 months
132
How can venous leg ulcers be prevented?
Avoiding prolonged sitting/standing Exercise Smoking cessation
133
How can pressure ulcers be prevented?
Tissue viability nurses identify and assess those at risk
134
Define psoriasis
Common skin disorder characterised by well-dermarcated scaly red plaques due to increased skin turnover
135
What is the Koebner phenomenon?
Development of psoriasis at sites of skin trauma
136
What is the pathophysiology of psoriasis?
T cell mediated autoimmune response causing inflammation and hyperproliferation of the skin
137
What are the risk factors for psoriasis?
``` Age (16-22 and 55-60) FH Drugs Stress Smoking Alcohol Causasian ```
138
What drugs can contribute to psoriasis?
Lithium Antimalarials Beta-blockers
139
What is the aetiology of psoriasis?
Genetics - PSORS 1 gene | Environment
140
What features of a history would indicate psoriasis?
``` Fluctuating course Itching, bleeding Pain Family history Known triggers ```
141
What features would be found on examination of psoriasis?
Pink/red well circumscribed plaques with silver scale Extensor surfaces affected, plus back/ears/scalp Associated - nail dystrophy, psoriatic arthritis, metabolic syndrome
142
What nail features are associated with psoriasis?
Pitting Onycholysis Discolouration Subungual hyperkeratosis
143
How is psoriasis investigated?
Clinial diagnosis | Skin biopsy
144
How is psoriasis managed?
``` Education Emollients Topical therapy - steroids, vitamin D analogues, tacrolimus, coal tar, retinoid, dithranol UV therapy - B or A with psoralen Systemic - methotrexate, actirectin Biologics - adalimumab ```
145
What are the differentials for psoriasis?
``` SLE Pityriasis rosacea Seborrhoeic dermatitis Eczema Lichen planus ```
146
What are the complications of psoriasis?
``` CV disease Psoriatic arthritis Depression/anxiety Lymphoma Secondary infection ```
147
What is the prognosis of psoriasis?
Chronic, life-long | Relapses and remits
148
How can psoriasis be prevented?
Secondary control of flare-ups - moisturise, reduce stress, avoid triggers
149
Give 4 types of psosiasis
Chronic plaque Flexural Guttate Erythrodermic/pustular
150
What are the main features of flexural psoriasis?
Later in life No scaling Large flexures - groin, natal cleft, sub-mammary Often misdiagnosed as candida
151
What are the main features of guttate psoriasis?
Raindrop lesions Children and young adults Explosive eruptions over trunk Triggered by strep throat
152
What are the main features of pustular psoriasis?
Severe, life-threatening Malaise, pyrexia, circulatory disturbance Pustules are sterile collections of inflammatory cells
153
Define acne vulgaris
Formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units
154
What is the pathophysiology of acne vulgaris?
Increased androgens -> increased sebum -> P.acnes overgrowth -> pustule Genetic susceptibility -> blockage of duct -> comedones -> papule -> pustule
155
What are the risk factors for acne vulgaris?
``` Adolescence (12-24) Genetic predisposition Greasy skin type Precipitating drugs PCOS Female ```
156
What drugs can precipitate acne vulgaris?
``` Androgens Steroids Antiepileptics Lithium ACTH ```
157
What is the aetiology of acne vulgaris?
Multi-factorial | Proprionibacterium acnes
158
What features are found on examination of acne vulgaris?
Face and upper torso Non-inflammatory open comedones (blackheads) and closed comedones (whiteheads) Inflammatory papules, pustules, nodules, cysts Scars - raised/hypertrophic or depressed/pitted
159
How is acne vulgaris investigated?
Clinical diagnosis | Hormone levels, bacterial culture
160
How is mild acne vulgaris managed?
``` Comedones = topical retinoid or salicylic acid Inflammatory = topical retinoid + topical antimicrobial ```
161
How is moderate acne vulgaris managed?
Oral antibiotic + topical retinoid +/- benzoyl peroxide/OCP
162
How is severe acne vulgaris managed?
Oral isotretinoin OR High-dose oral antibiotic + topical retinoid + benzoyl peroxide OR OCP + topical retinoid + topical antimicrobial + benzoyl peroxide
163
What antibiotics are used in acne vulgaris?
Tetracyclines | Erythromycin
164
What are the additional considerations with isotretinoin treatment?
Teratogenic - monitor
165
What are the differentials for acne vulgaris?
Folliculitis Rosacea Acneiform eruptions
166
What are the complications of acne vulgaris?
Depression/anxiety/suicide Hyperpigmentation Scarring
167
What is acne fulminans?
Severe form | Fever, arthralgia, myalgia, hepatosplenomegaly, osteolytic bone lesion
168
What is the prognosis of acne vulgaris?
Usually improved after adolescence | Severe lesions may leave scarring
169
How can acne vulgaris be prevented?
Secondary - good skin care
170
Define rosacea
Common inflammatory facial rash with papules and pustules on a background of erythema, most commonly occurring in mid-adult life
171
What are the risk factors for rosacea?
Female Prolonged steroid use Light skin type Exposure to triggers - hot showers, temperature extremes, sunlight, alcohol, emotional stress
172
What is the aetiology of rosacea?
Unknown | May be triggered by demodex folliculorum mite
173
What is seen on examination of rosacea?
``` Flushing/fixed erythema Inflammatory papules and pustules Convexities of face affected Telangiectasia, rough skin, rhinophyma Irritated eyes ```
174
How is rosacea investigated?
Clinical diagnosis | Skin biopsy
175
How is rosacea managed?
Supportive Inflammation - metronidazole/azelaic cream with intermittent oral tetracyclines as required Erythema - topical brimonidine, vascular laser therapy
176
What are the differentials for rosacea?
Seborrhoeic/contact dermatitis SLE Dermatomyositis Acne vulgaris
177
What are the complications of rosacea?
Ocular involvement - blepharitis, conjunctivitis | Sebaceous gland/soft tissue overgrowth (especially nose in men)
178
What is the prognosis of rosacea?
Range of severity and response to treatment
179
How can rosacea be prevented?
Secondary - avoid triggers, good skincare

Year 4 Medicine (2 decks)

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