Dermatology Flashcards
(85 cards)
1
Q
What is the pathogenesis fo acne?
A
COMEDONES
2
Q
What is the bacteria that causes inflammation in acne vulgaris?
A
Proprionbacterium acnes
3
Q
What hormone increased acne?
A
Androgens
4
Q
What is the treatment of acne vulgaris?
A
- Birth Control Pill
- Retinoids (Acutane)
- Benzoyl Peroxide
- Antibiotics
- Acid
- Photodynamic therapy
5
Q
What are the causes of Childhood Acne (1-7 y/o)?
A
Red flag
- Precocious adrenarche
- Congenital adrenal hyperplasia
- Cushing syndrome
- Precocious puberty
- Gonadal /adrenal tumour
6
Q
What is a common cause of Post-adolescent/adult acne?
A
PCOS
7
Q
40 years old lady, few years history of central facial erythema, what’s your diagnosis?
A
Rosacea
Papules & Pustules, no comedones
8
Q
What is the rarest, most severe form of rosacea?
A
Phymatous
9
Q
5 years old, 3 months history of asymptomatic hair loss. What’s your diagnosis?
A
allopecia areata (non scarring, still have hair follicules)
10
Q
What’s your diagnosis?
A
Tinea capititis
11
Q
- Well-defined areas of broken hair
- Different lengths, all <1.5 cm
- Fronto-temporal or parieto-temporal
What is your diagnosis?
A
TRICHOTILLOMANIA
12
Q
What is the treatment of Androgenetic alopecia?
A
5-alph reductase
13
Q
- 6 years old girl
- Diffuse shedding over past month
- History : Appendectomy 3 months ago
- Diffuse non scarring hair loss
What’s your diagnosis?
A
TELOGEN EFFLUVIUM
14
Q
What are the causes of telogen effluvium?
A
- Stress :any sever systemic disease, surgery, fever, psychological stress
- Endocrine: Hypo/hyperthyroidism…
- Nutrotional: Iron deficiency….
- Drug: Acitretin, Anticoagulant, Allopurinol…
15
Q
What are the causes of scarring alopecia?
A
- Discoid Lupus
- Lichen planopilaris
- Frontal fibrosing alopecia
16
Q
What’s your diagnosis?
A
Longitudinal melanonychia
17
Q
What’s your diagnosis?
A
Distal subungual onychomycosis
18
Q
2yo boy is brought in for the treatment of these asymptomatic lesions, what’s your diagnosis?
A
Molluscum contagiosum
19
Q
What’s your diagnosis?
A
Pityriasis Versicolor
20
Q
18 y/o very itchy rash after returning from a camping trip, what’s your diagnosis?
A
Scabies
21
Q
5o years old male with painful facial lesions, what’s your diagnosis?
A
Herpes zoster
22
Q
A
Macule (vitilgo)
23
Q
What is this?
A
Patch (café au lat macule)
24
Q
What is this?
A
Papule (MOLLUSCUM CONTAGIOSUM)
25
What is this?
Plaque (PSORIASIS)
26
What is this?
Nodule (BASAL CELL CARCINOMA)
27
What is this?
Tumour (BASAL CELL CARCINOMA)
28
What is this?
Vesicle (HERPES ZOSTER)
29
What is this?
Bulla (BULLOUS PEMPHIGOID)
30
What is this?
URTICARIA
31
What is this?
Cyst (EPIDERMOID CYST)
32
What is this?
Pustule (acne)
33
What is this?
Scale (Tinea pedis)
34
What is this?
Crust (IMPETIGO)
35
What is this?
Atrophy (STRIAE)
36
What is this?
Erosion (PEMPHIGUS VULGARIS: MORTEL ET URGENT)
37
What is this?
Ulcer (diabetic ulcer)
54
Redness and scaling of more than 90% of the skin, caused by dermatitis, psoriasis, drug reactions, cutaneous T cell lymphoma or idiopathic.
What's your diagnosis?
Erythroderma, EMERGENCY --\> biopsy, supportive and symptomatic treatment to relief pain and itching
55
* Pain out of proportion
* Skin is shiny and tense
* Does not respond to antibiotics
* Progresses at an alarming rate
* Characteristic gray–blue color within 36 hours of onset due to vessel thrombosis
* Thin, watery, malodorous fluid
* Sick and septic
What's your diagnosis?
Necrotizing fasciitis EMERGENCY
56
Reaction to a drug 2-6 weeks later?
Dress syndrome EMERGENCY --\> steroids for months
57
Pathogenesis of atopic dermatitis?
1. Lack of **filaggrin** **protein** and other proteins, oil and moisture
2. Hyperreaction of **TH2**
58
* **Pruritus**
* Redness
* Texture
* Typical morphology and distribution: depends on the age: starts on the extensors and on the face (baby) and ends on the flexors (adults)
* Chronic or chronically-relapsing
* Personal or family history
* Increased sensitivity to irritants and environmental stimuli
* Increased rates of infections
* Associated with atopic features (allergy, asthma, allergic rhinitis)
What's your diagnosis?
Atopic dermatitis
59
Investigation rules of a skin lump/bump?
**ABCDE** Rule
* **A**symmetry (color or bordr)
* **B**order (irregular)
* **C**olour (more than 2)
* **D**iameter (\> 6mm)
* **E**volution (wks-months)
**EFG** Rule (nodular or amelanotic subtypes)
* **E**levated
* **F**irm
* **G**rowing
60
What is the most important prognosis factor of skin lump/bump?
depth/thickness
61
Types of Non-melanoma skin cancer (NMSC)?
1. Basal cell carcinoma
2. Squamous cell carcinoma
62
What is a Papulosquamous lesion?
Consists of papules = elevated primary skin lesions \< 1.0 cm _AND_ scale = surface change/laminated masses of keratin from stratum corneum
63
What is the treatment of psoriasis?
* General measures: emollients for moisturizing + avoid trauma
* Topicals: steroids, vitamin D, calcineurin inh.
* Systemics: PO meds, biologics
64
What are the types of Lichen planus?
* Drug-induced: onset = few mths to \> 1 yr (ACE-I, diuretics, anti-malarials, NSAIDs, β-blockers)
* Classic type: multiple P’s = purple, pruritic, polygonal, planar (flat) + papules/plaques
* Oral: multiple variants; most common = white lacy reticulated (buccal mucosa, tongue)
* Genital: most common = white lacy reticulated; erosive = risk of SCC
* Nail: often isolated finding including nail thinning, longitudinal ridging + fissuring, oncholysis
* Scalp: scarring alopecia + red perifollicular papules that are scaly when active
65
What is the treatment of Lichen planus?
* General measures: emollients for moisturizing, avoid trauma, stop meds if drug induced
* Depends on: extent, location, variant, pt charact, nail disease, prior Rx + presence of Hep C
* Topics: steroids, calcineurin inhibitors, retinoids ; systemics Þ retinoids, immunosupp. meds
66
What is Pityriasis rosea?
Red patches common among teens + young adults
* Occurs often in spring + fall, some clustering in close contacts ; maybe linked with viral activat.
* Trauma is NOT assoc.; syphilis looks like PR + can be mistaken so WEAR GLOVES during PE!!
67
Pityriasis rosea treatment?
General measures = stop meds if drug-induced + emollients for moisturizing + topical steroids
68
What are the growth phases of the hair?
1. **Anagen**: matrix cells grow, divide and become keratinized to form the growing hair
2. **Catagen**: matrix proliferating cells abruptly cease proliferating so that hair bulb involutes and regresses
3. **Telogen**: hair falls (100 days)
69
What is Tinea Capitis?
* Infection of the scalp by fungi
* Diagnosis: Scraping, KOH, Culture
* Treatment is oral antifungal; and topical therapy to reduce infectivity
70
What is Trichotillomania?
* Habitual, compulsive plucking of hair
* A well-defined area of hair loss with shortened, broken-off hairs of different lengths (frontoptemporal or parietotemporal)
* Treatment: stop + psychiatric evaluation
71
What is Androgenetic alopecia?
De la calvitie
72
What are the causes of Telogen effluvium Alopecia?
* Stress: any sever systemic disease, surgery, fever, psychological stress
* Endocrine: Hypo/hyperthyroidism…
* Nutrotional: Iron deficiency….
* Drug: Acitretin, Anticoagulant, Allopurinol…
73
Treatement of acne?
75
What is Onychomadesis?
Complete separation of the nail plate from the bed, full but temporary arrest of growth of nail **matrix**, caused by trauma, dermatoligic disease (eczema), fever, viral illness, **hand-foot-mouth disease**
76
What causes Nail pitting?
holes in the plate because of **matrix** problem
77
What usually causes Acute Paronychia?
staph aureus
78
What usually causes Chronic paronychia?
Non purulent, glistening erythema with nail dystrophy, candida and irritation caused by saliva
79
What is Melanonychia?
* brown or black pigmented band along the length of nail, nail matrix nevus or lentigo, MAY BE subungual melanoma
80
What is Racial melanonychia?
Nail problem with darker skin phototypes, benign
81
What is Onychomycosis?
Fungal infection of nail unit, look at interdigital space
82
What are the 2 main players of urticaria?
* **Mast cell**: primary effector cell of urticaria
* **Histamine** released from the mast cells is the most probable mediator
83
What are the 2 Immunologic pathogenesis mechanisms of urticaria?
1. IgE mediated (Type I hypersensitivity): no allergic reaction to the first exposure Þ antibody Þ reaction SECOND exposure
2. Complement mediated:
1. Infections: viral infection (+++), potentially in bacterial and parasitic infections
2. Auto-immune/systemic disease: thyroid, collagen vascular
84
What are the Non-immunologic pathogenesis of urticaria?
1. Chemical histamine liberators: opiates, polymyxin, thiamine in cheese, egg white, muscle relaxant, narcotics
2. Physical agents: cold, heat, sunlight
85
What drug is important to avoid when you have an urticaria crisis?
Aspirin, NSAID
86
What are the possible treatment of urticaria?
* Identification and elimination or reduction of its cause
* Symptomatic relief if not able to detect or avoid cause
* Block the effect of already released histamine
* Block the release of histamine (anti-histamine type 1 and 2)
* Block mediator other than histamine (mast cell stabilizer such as **Ketotifen**, **Leukotrine antagonists,** **Omalizumab**)
* Modulate inflammatory, cellular and immunological component of urticaria
87
What is Angioedema?
* Well-demarcated non-pitting edema that occurs deeper in the dermis and subcutaneous tissue, specially in area of loose connective tissue such as the face, eyelids or mucous membrane involving the lips and tongue
* Often caused by the same pathological factors involved in urticarial
* Not itchy but painful, last 72 hours
88
Factors that contribute to acne?
* ↑ Sebum production
* Follicular Hyperkeratinization
* Proprionibacterium acnes
* Inflammatory response
89
Types of acne?
1. Acne vulgaris (Adolescent acne)
2. Adult acne (post- Adolescent)
3. Infantile and neonatal acne
4. Acne excoriée (jeunes filles, rose)
5. Acne conglobate & acne fulminans (systemic manifestations)
90
Types of Acneiform eruptions?
1. Drug-induced acne
2. Occupational acne & acne cosmetica
3. Acne mechanica
92
What distinguishes rosacea from acne?
comedones
93
What are the rosacea subtypes?
1. Erythematotelangiectatic
2. Papulopustular
3. Phymatous
4. Ocular
94
What is Hidradenitis SUPPURATIVA?
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease characterized by persistent or recurrent flares of inflamed painful nodules, sinuses and scars in the axilla, groin, or both.
95
Macule (vitilgo)
96
What is the triad of drug hypersensitivity syndrome?
1. Fever
2. Exanthametous eruption
3. Internal organ involvement
97
What are the possible causes of hair loss?
**TOP HAT**
**T**elogen effluvium, **T**inea capitis
**O**ut of Fe or Zn
**P**hysical: trichotillomania
**H**ormonal: hypothyroidism, androgenic
**A**utoimmune: SLE, Alopecia areata
**T**oxins: chemotherapy, metals, anticoagulants, SSRIs, vitamin A
98
What are the possible causes of pruritis?
**SCRATCHEDD**
**S**cabies
**C**holestasis
**R**enal
**A**utoimmune
**T**umours
**C**razies (psychiatric)
**H**ematology (polycythemia, lymphoma)
**E**ndocrine (thyroid, parathyroid)
**D**rugs
**D**ry skin
99
What is your diagnosis?
Psoriasis post trauma: Koebner Phenomenon
100
What are the types of Papulosquamous disorders?
* Psoriasis
* Lichen planus
* Pityriasis rosea
* Parapsoriasis
* Pityriasis rubra pilaris
101
If you have a patient with angioedema WITHOUT urticaria, what's your diagnosis?
ACE inhibitors reaction
102
What are the different drugs that have been associated with SJS/TEN?
**SATAN**
**S**ulfa antibiotics, sulfasalazine
**A**llopurinol - **#1**
**T**etracyclines
**A**nticonvulsants (carbamazepine, lamotrigine, phenobarbital, phenytoin)
**N**SAIDS
103
What is the difference between Exanthematous Drug Eruption, DRESS and SJS/TEN?
They are all drug reactions BUT
**Exanthematous Drug Eruption:**
* 7-11 days
* Just generalized skin erythema
**SJS**:
* 1-3 weeks
* Skin peels off
**DRESS**:
* 3 weeks
* Organ involvement
* No skin peeling
