Dermatology, Infectious Diseases + Sexual Health Flashcards
What is Stevens-Johnson syndrome (toxic epidermal necrolysis)?
-usually a reaction to medication (usually amoxicillins) that starts with flu-like symptoms (fever, sore throat etc), followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days (looks like a burn)
-Nikolsky’s sign = rubbing the skin makes it shed
-type 4 hypersensitivity reaction
-can affect genitals and mouth mucosal membranes
-if 10% of body is affected then it’s steven-johnson but if >30% then it’s toxic epidermal necrolysis
–>fluids, creams, anti-inflammatories, potentially abx, painkillers
What are verucas and what is the treatment?
warts caused by a virus on the feet, fingers, hands, palms, knuckles and knees
usually no treatment and should slowly fade within months or about 2 years for one flare up
treatment for long term is first topical salicylic acid (15-50%) for 12 weeks and then potentially cryotherapy if you need
What is the difference between psoriasis and pityriasis rosea?
Psoriasis is a chronic, autoimmune condition that it is possible to manage but not cure—> can be seen at the site of injuries healing
Pityriasis rosea is a skin condition without a known cause and lasts about 6-8 weeks. A single pink or red oval patch of scaly skin, called the herald patch”
treatment for both: steroids, vit D, phototherapy
What is impetigo?
a staph aureus skin infection which forms fluid-filled vesicles around the mouth (NOT in the mouth like hand, foot and mouth disease) and nose which burst dry to form a “golden crust”
can be seen on tummy as blisters
—> hydrogen peroxide cream or topical fusidic acid if can’t have the cream
What is Pott’s disease?
also known as ‘Spinal tuberculosis’ and is the commonest extrapulmonary manifestation of TB spreading to spine from the lungs via blood.
usually the lower thoracic and upper lumbar vertebrae
kyphotic deformity of the spine, gradual back pain, fever, night sweats, weight loss, spinal cord compression symptoms
x-ray, MRI, blood cultures, Mantoux Tuberculin skin tests (results are positive in 84-95% of the patients having Pott’s disease)
treatment: anti-tubercular chemotherapy (rifampin, isoniazid, pyrazinamide, and ethambutol), external bracing and rest
What is the blood test for diagnosing syphillis?
non-treponemal test
can also get a treponemal test which is more specific
causes of false positive non-treponemal test:
pregnancy
SLE
TB
leprosy
malaria
HIV
What are the SS+ RNA viruses?
Yellow fever (high LFTs and troponin)
dengue
HepC
HIV
What is the first line treatment for:
chlamydia
gonorrhoea
Trichomonas vaginalis/bacterial vaginosis
Syphilis
Chlamydia = doxycycline but azithromycin in pregnancy
gonorrhoea = IM ceftriaxone
Trichomonas vaginalis (GREEN and STRAWBERRY CERVIX)/bacterial vaginosis (WHITE and FISHY)= oral metronidazole but if women have BV and are asymptomatic then no abx unless termination of pregnancy
Syphilis is treated using IM benzathine penicillin
What can cause guillan-barré syndrome and how do you treat it?
campylocater —> symmetrical weakness in lower limbs
diplopia
diarrhoea
urinary retention
LUMBAR PUNCTURE- isolated HIGH protein in CSF
nerve conduction studies
—> IV immunoglobulins
What is congenital dermal melanocytosis?
also known as Mongolion Blue Spots” - blue/grey spots/birthmarkususally on the base of the back/buttocks from birth but fade by teen years and can be lasered
common among people of Asian
What is an Angel’s kiss”?”
Known as a Stork bite (nevus simplex) or salmon patch
newborn birthmarks that are pink/red that fade completely within a couple of months and are not harmful
nape of neck, neck, eyelids, forehead, under the nose, on top of the head or lower back
What is Coombs test?
Checks blood for antibodies
What are the different type of hypersensitivity reactions?
ACID
type 1: Anaphylactic: IgE
type 2: Cytotoxic: IgG/M
type 3: Immune complex: IgG/A
type 4: Delayed hypersensitivity: T-cell: scabies, Guillian Barre, multiple sclerosis, tuberculosis, dermatitis
What is the difference between melasma and systemic lupus erythematosus (SLE)?
both have the butterfly pattern across face
melasma = hyperpigmentation
SLE = inflammatory (red)
What is the first line therapy for cellulitis?
Oral flucloxacillin
Severe OR NEAR EYES OR NOSE: IV co-amoxiclav
What is the treatment for the different types of infectious diarrhoea:
-campylobacter
-C.diff
-salmonella
-salmonella TYPHI/PARATYPHI (typhoid fever)
-Verocyto-toxic e.coli bacteria
-cholera
-giardia lamblia
-cryptosporidium
campylobacter = erythromycin –> guillian-barre + arthritis
C.diff (usually from over-use of abx usually starting with C or OEMEPRAZOLE) = oral vancomycin - 125mg 4 times a day for 10 days (+ IV metronidazole in life threatening situ)
if vanc doesn’t work try fidaxomicin
salmonella = no abx unless it is very severe (immunocompromised, children under 6months etc) then give Ciprofloxacin or cefotaxime
salmonella T/P = Ceftriaxone or Azithromycin –> cough, constipation, ‘rose spots’ on trunk in paratyphoid and yellow green ‘pea-soup’ diarrhoea in typhi
Verocyto-toxic e.coli bacteria = fluids and NO ABX
cholera = fluids and vaccine
giardia lamblia = metronidazole
cryptosporidium = no treatment unless have AIDS and give HAART treatment
What is the treatment for vitiligo and what conditions is it associated with?
Associated with:
type 1 diabetes, Addison’s, alopecia
management:
-sunblock for affected areas of skin
camouflage make up
-topical corticosteroids may reverse the changes if applied early
-there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients
What is rosacea and the treatment for it?
chronic skin disease
typically affects nose, cheeks and forehead
flushing is often first symptomt
elangiectasia are common
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms
-topical brimonidine gel = redness and flushing
-topical ivermectin = pustules
-topical ivermectin + oral doxycycline = very severe pustules
-daily application of a high factor sunscreen
-laser therapy may be appropriate for patients with prominent telangiectasia
-patients with a rhinophyma should be referred to dermatology
What is an Escharotomy?
emergency surgical procedure involving incising through areas of burnt skin to release the eschar and its constrictive effects, restore distal circulation, and allow adequate ventilation
used in bad 3rd degree burns that present with the 6P’s
What is pityriasis versicolor (tinea versicolor)?
superficial cutaneous fungal infection caused by Malassezia furfur
most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor)
May be more noticeable following a suntan
mild pruritus (itchy) or coming back from a holiday abroad
treatment:
-topical antifungal e.g. ketoconazole shampoo
-if failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole
What abx are usually given for intrabdominal infections?
AMG
amoxicillin, metronidazole, gentamicin
What is the difference between venous ulcers and arterial ulcers?
Venous ulcers = usually medial malleolus
Arterial ulcers = usually lateral malleolus, toes and top of feet
management –> compression bandaging if ABPI > 0.8
a ABPI < 0.5 = limb ischaemia
What is glandular fever?
caused by the Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4 and infectious mononucleosis)
diagnosed by monospot test
-The classic triad of sore throat, pyrexia and lymphadenopathy
-splenomegaly occurs in around 50% of patients and may rarely predispose to splenic rupture
-palatal petechiae
-maculopapular prutitic rash when take amoxicillin and didn’t know had EBV
-supportive management
-avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture
What is the treatment for scabies?
permethrin cream keep on for 8-12 hours and then wash off. Repeat treatment 7 days later
post-scabietic itch with crotamiton cream
All members of their household, their sexual partners within the past month, and any other close personal contacts (even if asymptomatic) should also be treated
bedding, clothing, and towels (and those of all potentially infested contacts) should be decontaminated
What is guttate psoriasis?
more common in children and adolescents.
It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
tear drop papules on the trunk and limbs
most cases resolve spontaneously within 2-3 months
What is the treatment for Pyoderma gangrenosum and what GI condition is it associated with?
oral steroids e.g. prednisolone
associated with IBD + Crohn’s
What is Urticaria?
local or generalised superficial swelling of the skin.
The most common cause of urticaria is allergy although non-allergic causes are seen.
can be caused by aspirin
pale, pink raised skin
‘hives’, ‘wheals’, ‘nettle rash’
pruritic
treatment:
non-sedating antihistamines are first-line e.g. loratadine
prednisolone is used for severe or resistant episodes
What is the treatment for acne vulgaris?
Mild: open and closed comedones
Moderate: non-inflammatory lesions and papules and pustules
Severe: inflammatory lesions, nodules, scarring (needs referral to derm)
Mild/moderate: 12 weeks of:
-topical adapalene with benzoyl peroxide
-topical tretinoin with topical clindamycin
-topical benzoyl peroxide with topical clindamycin
Moderate/severe: 12 weeks of:
-same as above + oral doxycycline (never an abx by itself)
-COCP
-oral isotretinoin: REFER to derm
What is Schistomiasis (Bilharzia)?
parasitic worm infection in infected fresh water
swimmers’ itch
Katayama fever- fever, urticaria, cough, diarrhoea
blood in urine or pain passing urine
can give praziquantel
What is the test for latent TB?
Mantoux test
What are the most common causes of BACTERIAL meningitis?
0-3 months = group B strep
3 months - 6 years = neisseria
6 years - 60 years = neisseria
> > 60 years = strep pneumoniae
What are the incubation periods for staph aureus, bacillus, salmonella, E.coli, shigella, campylobacter, giardiasis and ameobiasis regarding diarrhoea?
staph aureus + bacillus = 1-6hrs
salmonella + E.coli (most common in travellers) = 12-48hrs
shigella + campylobacter = 48-72hrs
giardiasis + ameobiasis = more than 7 days
What are the differences between Hep A, B, C, D and E?
A- faecal/oral spread (gay sex), RUQ pain, jaundice, vaccine for travellers/chronic liver disease/gay/IV drug/sewage and lab workers
B- body fluids from mother to child, fever, haundice, ‘ground glass’ hepatocytes, vaccine for children, healthcare workers, sex workers, hep B family, IV drug users, chronic kidney + liver disease–> managed by pegylated interferon-alpha
C- needles/blood from mother to child or IV drug users, fatigue, jaundice, arthralgia, NO vaccine –> treat with ribavirin
D- like hep B
E- faecal/oral spread, undercooked pork, mostly common in pregnancy and no vaccine yet
What is red man syndrome?
an ADR of giving rapid IV vancomycin
redness, pruritus, burning sensation, usually in upper body
stop giving IV vancomycin and when symptoms resolve then RESTART at a slower rate
What is syphilis?
PAINLESS ulcer (unlike chancroid which is painful- think of Ls)
lymph node enlargement feversrash on trunk, palms and soles
buccal ‘snail track’ ulcers Hutchinson teeth is a sign of congenital syphilis
treated with IM benzathine penicillin
What abx is recommended for animal bites and human bites?
co-amoxiclav
Whats the most common cause of central line infections?
staph epidermidis
What is dengue fever?
viral infection –> progress to haemorrhagic fever
fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
supportive treatment
What is Chancroid?
painful genital ulcers with UNILATERAL painful lymph node enlargement
treat with azithromycin
Who should be offered the influenza vaccine?
over 65 OR with:
-chronic resp (asthma who use inhaled steroids/COPD/cystic fibrosis), kidney (stages 3/4/5), liver, neuro and heart disease
-diabetes
-immunosuppressed
-splenic dysfunction
-pregnant
-healthcare workers
What is Botulism?
from tinned contaminated food or IV drug use
patient usually fully conscious with no sensory disturbance
flaccid paralysis (Tetnus has facial spasms rathen than paralysis)
diplopia
ataxia
bulbar palsy
What is the treatment for MRSA?
Vancomycin
What is the treatment for genital warts?
Topical podophyllum (multiple warts) or cryotherapy (single warts)
What is Trypanosomiasis?
protozoal diseasetwo types:
African (sleeping sickness) and American (Chagas’)
African:
-painless subcut nodule at site
-intermittent fever and lymph nodes
-headaches, mood changes–> treat with IV pentamidine for acute and IV melarsoprol for chronic
American:
-red nodule at site
-periorbital oedema
-myocarditis
-GI features: megaoesophagus and megacolon–> treat with benznidazole for acute
What is a pyogenic granuloma?
common benign skin lesion- seen in hand surgery
seen in trauma, pregnancy and more common in women and young adults
Features:
most common sites are head/neck, upper trunk and hands.
Lesions in the oral mucosa are common in pregnancy
initially small red/brown spot
rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
the lesions may bleed profusely or ulcerate
If someone has a negative HIV test when they are asymptomatic, what should you do and what are the tests?
repeat test at 12 weeks
HIV antibody and p24 antigen
What is Pneumocystis jiroveci/carinii penumonia?
in HIV patients, dyspnoea, dry cough, fever
causes exercise induced desaturation
give trimoxazole and ALL patients with a CD4 less than 200 should be given PCP prophylaxis
What is Jarisch Herxheimer reaction (JHR)?
after giving abx patients get infected by spirochetes: syphilis, Lyme disease and fever
What is the most common cause of travellers’ diarrhoea?
E.coli
What drugs are used to treat TB and what are the side effects?
RIPE for the first 2 months and then just RI for the next 4 months
Rifampicin = turns urine and tears orange
Isoniazid = peripheral neuropathy (numbness and tingling) –> treat with B6 pyridoxine
Pyrazinamide: gout, arthralgia, hepatitis
Ethambutol: optic neuritis
What is the treatment for genital herpes and how do you diagnose it?
HERPES is usually fluid filled unlike warts
oral aciclovir (even in pregnancy until delivery but must also have a C-section if have a flare up)
use the nucleic acid amplification tests (NAAT)
What is Leishmaniasis?
spread by bites of sandflies in the tropics, subtropics and southern europe
crusting of site and may be underlying ulcer
give an antifungal
What are the different types of dermatitis and how are they treated:
Dermatitis herpetiformis
Contact dermatitis
Nickel dermatitis
Periorificial dermatitis?
Dermatitis herpetiformis = associated with coeliac’s, on extensor surfaces (elbows, knees, bum), skin biopsy if IgA –> gluten free diet, dapsone
Contact dermatitis =
1) irritant: on hands
2) allergic: often seen on head after hair dye, weeping eczema –> topical steroid
Nickel dermatitis = caused by jewellery –> skin patch test
Periorificial dermatitis = perioral, perinasal and periocular region, looks like acne or rosacea, woman 20-45years –> topical/oral abx
What is molluscum contagiosum?
skin infection usually seen in children and can be very contagious
pinky or pearly white papules with central umbilication
usually NOT seen on palms of hands and soles of feet
no need to be off school and usually no treatment needed
What is seborrheic keratosis?
benign skin lesion seen in older peoplecan be flesh coloured to light-brown/black
have a ‘stuck on’ appearance
keratotic plugs may be seen on the surfacere
assurance and removal
What is keratosis pilaris (chicken skin)?
skin on back of upper arms
usually becomes rough and bumpy
gets better on own
moisturise skin with emollients
What is actinic keratoses?
skin lesions due to chronic sun exposure
sun exposed areas
pink, red or brown
suncream
fluorouracil cream
crytotherapy
cautery
What is ringworm (tinea)?
tinea capitis (scalp):
-scarring alopecia seen in children
-pustular spongy mass called a kerion may form
-most commonly caused by trichophyton tonsurans or by microsporum canis from cats or dogs–> oral antifungals e.g. terbinafine and also topical ketoconazole shampoo for 2 weeks
tinea corporis (ringworm):
-caused by trichophyton rubrum and verrucosum from cattle
-well defined annular erythematous lesions with pustules and papules–> oral fluconzaole
What is Bowen’s disease?
Precancerous squamous cell carcinoma
More common in elderly
Red scaly patches
Slow growing
Sun exposed areas
—> topical 5-fluorouracil for 4 weeks (causes redness) and steroids
Cryotherapy
Excision
What is a cherry haemangioma?
AKA Campbell de Morgan spots
Benign proliferation of capillaries
No treatment required
What is a dermatofibroma?
ALA histiocytomas
Often after an injury
Firm papule or nodule
What is erythrasma?
A rash found in groin or axillae
Flat
Slightly scaly
Pink/brown
Overgrowth of diphtheroid Corynebacterium minutissimum
Examination with Wood’s light reveals a coral-red fluorescence.
Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection
What is leukoplakia?
Premalignant condition
White hard spots in the mucous membranes in the mouth
Common in smokers
How can you tell the difference between a BCC, SCC and melanoma?
BCC:
reddish/pink with PEARLY white edges
may ulcerate
often telangiectasia
SCC:
white, pink or brown
scaly/crusted
may have ulceration
melanoma:
asymmetrical/irregular shape
may ulcerate
bleeds/itchy
