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Medicine > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What do anti-CCP abs present indicate?

A

Psoriatic Arthritis

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2
Q

What is Urticaria, how does it present, and how do we manage it?

A

Urticaria is swelling of the superficial dermis that raises the epidermis. It is caused by a local increase in permeability of capillaries and small venules largely mediated by histamine.
Px: itchy wheals
Rx: anti-histamines, or corticosteroids for severe acute urticaria

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3
Q

Angioedema: Presentation, management, and complications

A

Px: Swelling of the tongue and lips (due to deeper swelling involving the dermis and subcut tissue)

Rx: Corticosteroids

Complications: asphyxia, cardiac arrest and death

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4
Q

Anaphylaxis: Presentation, Management and Complications

A

Px: bronchospasm, facial and laryngeal oedema, hypotension; can present initially as urticaria or angioedema
Rx: Adrenaline, corticosteroids, and anti-histamines
Complications: Asphyxia, cardiac arrest and death

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5
Q

What are the causes of Erythema Nodosum?

A 
Group A beta-haemolytic streptococcus
Primary TB
Pregnancy
Malignancy
Sarcoidosis
Inflammatory Bowel Dx (IBD)
Chlamydia
Leprosy
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6
Q

Erythema Nodosum Px?

A

Located on shins
Discrete tender nodules that last 1-2 weeks before resolving and leaving discolouration but no scarring or atrophy.
Lesions do not ulcerate.

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7
Q

What is Stevens-Johnson Syndrome?

A

Mucocutaneous necrosis with at least 2 mucosal sites involved.
Drugs are most common association.
Epithelial necrosis with few inflammatory cells is seen on histology.
May have features overlapping with toxic epidermal necrolysis Eg prodromal illness

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8
Q

How do you distinguish between Stevens-Johnson syndrome and erythema multiforme?

A

The extensive necrosis in Stevens-Johnson

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9
Q

What is Toxic Epidermal Necrolysis?

A

An acute severe dx characterised by extensive skin and mucosal necrosis accompanied by systemic toxicity.
Usually drug-induced
Full thickness epidermal necrosis with subepidermal detachment on histology.

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10
Q

What is the cause of acute meningococcaemia?

A

Gram -ve diplococcus Neisseria meningitides

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11
Q

What is acute miningococcaemia?

A

Meningococcemia is a rare infectious disease characterized by upper respiratory tract infection, fever, skin rash and lesions, eye and ear problems, and possibly a sudden state of extreme physical depression (shock) which may be life-threatening without appropriate medical care.

Transmitted via resp secretions.

Px: Typical meningitis features (headache, fever, neck stiffness) + myalgia + septicaemia + rash.

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12
Q

Describe the rash present in acute meningococcaemia.

A

Non-blanching purpuric rash on the trunk and extremities.

May have had a blanching maculopapular rash 1st.

Can rapidly progress into ecchymoses, haemorragic bullae and tissue necrosis.

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13
Q

How do you manage acute meningococcaemia?

A

Abx (Eg benzylpenicillin)

Prophylactic Abx (Eg Rifampicin)for close contacts within 14 days

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14
Q

List the common complications of acute meningococcaemia.

A

Septicaemic shock
DIC (Disseminated intravascular coagulation)
Multi-organ failure
Death

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15
Q

Where are the extensor areas of the skin?

A

Knees, elbows, shins.

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16
Q

Where are the most common pressure areas of the skin?

A

Sacrum, buttocks, ankles, heels.

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17
Q

How does erythema multiforme present?

A

Target lesions!
No mucosal involvement.
Assoc. with HSV infection.
Self-limiting.

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18
Q

How does ringworm (Tinea corporis) present?

A

Annular lesions on buttocks, trunk, arms and legs.

May be itchy.

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19
Q

What is erythema?

A

Redness (due to inflammation and vasodilatation) which blanches on pressure

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20
Q

What is purpura?

A

Red or purple colour (due to bleeding into the skin or mucous membrane) which does not blanch on pressure – petechiae (small pinpoint macules) and ecchymoses (larger bruise-like patches)

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21
Q

Vesicle vs Bulla vs Pustule

A

Vesicle is a raised, clear fluid-filled lesion <0.5cm in diameter.
Bulla is the same but >0.5cm.
Pustule is vesicle containing pus.

Bulla is big blister, vesicle is small blister

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22
Q

Hirsutism vs Hypertrichosis

A

Hirsutism is androgen-dependent hair growth in females.

Hypertrichosis is non-androgen dependent excessive hair growth (Can be in males and females).

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23
Q

What are the conditions clubbing is associated with?

A

Suppurative lung disease, cyanotic heart disease, inflammatory bowel disease and idiopathic

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24
Q

What is koilonychia and what does it indicate may be present?

A

Iron-deficiency anaemia, congenital or idiopathic causes.

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25
Q

Onycholysis: definition and associations.

A

Onycholysis is separation of the distal end of the nail plate from the nail bed.

Assoc. with trauma, psoriasis, fungal nail infections and hyperthyroidism.

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26
Q

Nail pitting: definition and associations.

A

Pitting is punctuate depressions of the nail plate.

Associations: psoriasis, eczema, + alopecia areata.

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27
Q

What is Eczema Herpeticum (Kaposi’s varicelliform eruption)?

A

Widespread eruption - a serious complication of atopic eczema ( + other skin conditions)

Caused by Herpes Simplex Virus

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28
Q

Px of Eczema Herpeticum?

A

Extensive crusted papules, blisters and erosions.

Systemically unwell with fever and malaise.

Hutchinson’s sign: pustules on the end of the nose. Indicated trigeminal involvement - precedes opthalmic herpes zoster infection (VERY BAD!)

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29
Q

Rx of Eczema Herpeticum?

A

Antivirals (Eg Aciclovir)

Abx for secondary bacterial infection

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30
Q

Complications of Eczema Herpeticum

A

Herpes hepatitis
Encephalitis
DIC

31
Q

What is Necrotising Fasciitis?

A

Necrotising Fasciitis is a rapidly spreading infection of the deep fascia with secondary tissue necosis.

32
Q

Causes of necrotising Fasciitis?

A

Group A Haemolytic streptococcus.

Or a mixture of aerobic and anaerobic bacteria.
Risk factor = abdo surgery + co-morbidities

33
Q

Necrotising Fasciitis Px

A

Severe pain
Erythematous, blistering + necrotic skin.
Systemically unwell with fever and tachycardia
Crepitus (subcutaneous emphysema)

X-ray may show soft tissue gas

34
Q

Management of necrotising fasciitis?

A

Urgent extensive surgical debridement
IV abx
Mortality up to 76%

35
Q

What is cellulitis?

A

Spreading bacterial infection of the skin involving the deep subcut tissue

36
Q

What is erysipelas?

A

An acute superficial form of cellulitis that involves the dermis and upper subcut tissue.

37
Q

Causes of cellulitis?

A

Streptococcus pyogenes + Staphylococcus Aureus

38
Q

Px of cellulitis

A
  • Most common in lower limbs
  • Local inflammation - swelling, redness, warm, pain
  • systemically unwell w/ fever, malaise or rigors
39
Q

How do you distinguish erysipelas from cellulitis?

A

Erysipelas has a well-defined, red raised border.

40
Q

Cellulitis management

A

Abx (Eg Flucloxacillin or benzylpenicillin).

Rest, leg elevation, sterile dressings and analgesia

41
Q

Staphylococcal scalded skin syndrome Px

A
  • Infant/ young child
  • worse over face, neck, axillae or groin
  • A scald-like appearance then large flaccid bulla
  • Perioral crusting
  • Intra-epidermal blistering
  • Painful lesions
  • Recovery within 5-7 days
42
Q

Staphylococcal scalded skin syndrome management

A

Abx (Eg a systemic penicillinase-resistant penecillin, Fusidic acid, erythromycin, or a cephalosporin)

Analgesia

43
Q

Tinea corporis (Tinea fungal infection of the trunk and limbs) Px?

A

Itchy, circular or annular lesions with a clearly defined, raised, + scaly edge

44
Q

Tinea cruris (Tinea fungal infection of the groin and natal cleft) Px?

A

Very itchy, similar to tinea corporis (circular or annular lesions with well defined raised and scaly edge)

45
Q

Tinea pedis (Athlete’s foot) Px?

A

Moist scaling and fissuring in toewebs, spreading to the sole and dorsal aspect of foot

46
Q

Tinea manuum (Fungal hand infection) Px?

A

Scaling + dryness in palmar creases

47
Q

Tinea capitis (Scalp ringworm) Px?

A

Patches of broken hair, scaling and inflammation

48
Q

Tinea unguium (Fungal nail infection) Px?

A

Yellow discolouration, thickened and crumbly nail

49
Q

Tinea incognito (inappropriate of tinea fungal infection with topical or systemic corticosteroids) Px?

A

Ill-defined + less scaly lesions

50
Q

Candidiasis skin infection Px?

A

White plaques on mucosal areas, erythema with satellite lesions in flexures.

51
Q

Pityriasis/Tinea versicolor (Malassezia furfur infection) Px?

A

Scaly, pale brown patches on upper trunk that fail to tan on sun exposure

Usually asymptomatic

52
Q

How do you confirm a diagnosis of a fungal skin infection?

A
  • Skin scrapings
  • Hair or nail clippings (for dermatophytes/tinea)
  • Skin swabs (for yeasts)
53
Q

Fungal infection management?

A
  • Topical antifungals (Eg terbinafine cream)
  • Oral antifungals (Eg Itraconozole) for severe, widespread, or nail infections
  • Avoid topical steroids - can lead to tinea incognito
54
Q

What is Chronic Plaque Psoriasis?

A

Chronic, relapse-remitting autoimmune dermatosis causing abnormal proliferation of keratinocytes

55
Q

What age does Chronic Plaque Psoriasis commonly develop?

A

Bimodal onset - 30s and 60s

+ve family history

56
Q

Chronic plaque psoriasis Px?

A

Well-demarcated, erythematous plaques distributed symmetrically on extensor surfaces.

Can also occur at sites of recent skin trauma (Koebner’s phenomenon) + in scalp.

Silvery surface scaling which can give pinpoint bleeding when gently scratched (Auspitz sign).

57
Q

What are the main precipitating factors for chronic plaque psoriasis?

A

Drugs (lithium,beta-blockers), alcohol, smoking, stress

58
Q

What is the management for chronic plaque psoriasis?

A

Emollients for moisturising.

1st line -topicalcorticosteroid + vitamin D analogue once daily
2nd line - topicalitamin D analogue twice daily
3rd line - topical coal tar preparation once/twice daily

For extensive or refractory dx, consider phototherapy and oral immunosuppressants + biologics

59
Q

What is Guttate psoriasis?

A

Guttate psoriasis is diffuse small scaly ‘tear drop’ plaques on trunk and proximal limbs.
Commonly follows URTI by Streptococcus and most cases resole in 2-3 months.
Treat same as chronic plaque psoriasis

60
Q

What is Pityriasis Rosea?

A

Pityriasis rosea is an inflammatory disorder of unknown cause that affects teens and young adults.

61
Q

Pityriasis Rosea Px?

A

Herald patch (single oval red plaque with scaling on inside edge) followed by diffuse small annular patches with dry scaly surface in “Christmas tree” distribution on chest and back.
Non-itchy
Self-limits in 6-12 weeks

62
Q

What typeof hypersensitivity reaction is anaphylaxis?

A

Type 1

63
Q

Atopic Dermatitis Px?

A

Poorly-defined, itchy and scaly erythematous patches on flexural surfaces, neck and face
Litchenification of persistent scratching

64
Q

What type of dermatitis is IgE mediated?

A

Atopic dermatitis

65
Q

Atopic dermatitis treatment?

A

Emollients, topical corticosteroids, oral anti-histamines

66
Q

What is a common complication of atopic dermatits?

A

Eczema herpeticum (HSV)

67
Q

What is discoid dermatitis?

A

Multiple well-defined annular erythematous plaques with normal skin in-between

Intensly itchy.
Can occur at any age.

68
Q

What is seborrhoeic dermatits?

A

Dermatitis affecting sebaceous gland-rich areas (nasolabial folds, eyebrows, post-auricular) due to proliferation of commensal fungus

69
Q

Seborrhoeic dermatitis Px?

A

Poorly-defined pink, scaly plaques or patches
Presents as a cradle cap in infants.
Non-itchy
Associated with Parkinsons

70
Q

Seborrhoeic dermatitis Rx?

A

Topical anti-fungals and corticosteroid

71
Q

What is Irritant Contact dermatitis?

A

Caused by occupational exposure

Lesions usually confined to site of contact (classically hands)

72
Q

What is allergic contact dermatitis?

A

Type 4 (T cell) hypersensitivity reaction
Commonly nickel
Dx by skin patch test
Blistering and vesicles less common than irritant dermatitis

73
Q

What is stasis dermatitis?

A

Venous insufficiency in lower limbs.
See inverted champagne bottle appearance and Lipodermatosclerosis
Also hemosiderin deposition and venous ulceration is seen

Medicine (16 decks)

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