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4th Year > Dermatology notes > Flashcards

Dermatology notes Flashcards

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1
Q

% staph aureus carriers

% in people with atopic dermatitis

A

20%

80%

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2
Q

what type of light does what for vitamin D synthesis in skin

A

UV-B light forms vitamin D3 from cholesterol

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3
Q

What is the required amount of time to create your daily amount of vitamin D?

A

About 20 minutes of sunlight over 20% of their body surface (longer does not make more)

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4
Q

What is pitted keratolysis

Mx

A

Overgrowth of corynebacteria in warm wet most environment which causes very superficial punched out lesions. Is sometimes symptomatic.

Tx = topical clindamycin/oral erythromycin

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5
Q

Erythrasma

Mx

A

Overgrowth of corynebacteria in warm wet most environment which causes red/brown discolouration. Is sometimes symptomatic. Becomes coral coloured due to birefringence under special Wood’s lamp.

Tx = topical clindamycin/oral erythromycin

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6
Q

furuncle vs carbuncle

Mx

A

If it has a single ‘head’ it is a furuncle (boil), if it has many heads it is a carbuncle. Usually staph aureus.

Mx = fluclox

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7
Q

erysipelas vs cellulitis

Mx

A

Usually systemically unwell with preceding flu-like illness. Leg is a common place for cellulitis. Can be staph or strep. Erisipelas is usually more superficial and on the face, whereas cellulitis is deeper and on the leg.

Mx = amoxicillin or coamox if very severe

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8
Q

time course of primary and secondary syphilis

A

Primary chancre

Secondary syphilis: 6-10 weeks later papulosquamous eruption often involving palms and soles

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9
Q

lyme disease organism

A

spirochete bug Borrelia burgdorferi

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10
Q

clinical course of lyme disease

A

• A tick buries its head in the person and it carries the spirochete bug Borrelia burgdorferi. It causes:
o Early features
♣ Erythema chronicum migrans = small papule at site of tick bite that develops into a large annular lesion with central bull’s eye.
♣ Systemic flu-like symptoms
o Late features
♣ CVS: heart block, myocarditis
♣ Neurological: cranial nerve palsies, meningitis
♣ Polyarthritis

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11
Q

two types of leprosy

Which has more bacilli around

A
  1. Tuberculoid leprosy – affects nerves (anaesthetic areas) and skin (hypopigmented areas) and has few mycobacteria bacilli around

Lepromatous leprosy – thickened facies, macules, papules, nodules, plaques and has lots of mycobacteria bacilli around

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12
Q

What does mycobacterium marinarum present like?

A

Recent contact with tropical fish tank causing inoculation of bacteria into hand. Causes red scaly plaque on hand which travels up the arm lymphatics causing clusters of lesions as it does so.

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13
Q

molluschi contagiosi in adults?

A

Yes, but worry about immunosuppression

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14
Q

pediculosis

A

lice (head, pubic etc)

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15
Q

incidence peaks of psoriasis

A

20s and 50s

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16
Q

genetic influence of psoriasis

A

PSORS1 and PSORS9

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17
Q

drugs from lecture that trigger psoriasis

A

beta blockers
lithium
interferon
withdrawal of steroids

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18
Q

Auspitz sign

A

when you pick at it, it bleeds.

Happens in psoriasis2

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19
Q

clinical picture of pustular psoriasis

A

Can be generalised or palmar-plantar. Has pustules and is tender. Can be systemically unwell.

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20
Q

Management steps in psoriasis:

GP and dermatologist

A

GP:

  • emollient + vitD analogue + steroid (morning then night)
  • vit D BD
  • steroid BD or other stuff like coal tar or dithroanol

Dermatologist:

  • light therapy
  • immunosuppression
  • biologics
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21
Q

what is psoralen

A

a photosensitiser you put on the skin before UV-A light therapy = PUVA therapy

Good for well demarcated psoriasis (e.g. palmar plantar)

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22
Q

when are you eligible for biologics for psoriasis?

A

Severe:
PASI >10 (psoriasis scale)
DLQI >10 (QoL dermatology scale)

and

failed methotrexate/ciclosporin

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23
Q

2 ways to get urticaria (ppathophysioligcally)

A
  1. IgE and histamine release

2. Direct degranulation of mast cells - can be physical stimuli or ASPIRIN

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24
Q

wheal vs angioedema

A

wheal = superficial and resolves in minutes to hours

angioedema = in dermis and submit tissue and resolves in 72 hours

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25
Mx of anaphylaxis (know doses)
500ug adrenaline 200mg hydrocortisone 10mg chlorpheniramine Oxygen
26
acute vs chronic urticaria
Acute is <6 weeks and is common in children. Chronic is >6 weeks with daily or episodic wheals and is common in middle aged women, usually lasting 2-5 years.
27
most common causes of acute urticaria
1. Idiopathic (50%) 2. URT infections (40%) 3. Drugs – e.g. aspirin (10%) 4. Food – e.g. shellfish, nuts, fruit (<1%)
28
most common causes of chronic urticaria
idiopathic physical things like pressure, cold, heat, water, vibration, dermographism autoimmune
29
urticaria management
1. avoid triggers 2. H1 antagonist (antihistamines) ♣ Sedating type at night (chlorpheniramine) ♣ Non-sedating type during day (cetirizine) 3. H2 antagonists ♣ Ranitidine (since pathophysiology involves H1 and H2 activation) chronic --> omalizumab severe acute --> 4/5days pred
30
main thing to exclude in history of urticaria
anaphylaxis - so ask about chest tightness/trouble breathing
31
In atopic dermatitis (eczema), what can you give instead of steroids if you're worried about thin skin
A protopic (calcineurin inhibitor e.g. tacrolimus)
32
eczema - what helps lichenified skin
salicylic acid
33
seborhoeic dermatitis in adults Mx
ketoconazole +/- hydrocortisone | as malasezia furfur playa a role
34
pompholyx
itchy vesicular rash on hands on feet, common in hot months. also called dyshidrosis.
35
discoid eczema presentations
round red patches on back of hands in 60-70 year old
36
Asteatotic eczema
Common in elderly where you get a crazy paving appearance of the cracks in the skin surface. Most commonly on shins. More common in the winter. Needs lots of emollients.
37
acute eczema
Rapid onset ill-defined redness, swelling with scaling, papules and vesicles. Vesicles burst causing exudate and crusting.
38
lichen simplex
Isolated patch of lichenification due to repeated scratching or rubbing. Manage by getting patient to stop scratching. 4
39
morphemic bcc
Atypical BCC that is skin coloured and doesn’t heal. Take home message is that it doesn’t look right and isn’t healing so you need a biopsy Micrographic surgery
40
Glasgow 7 point checklist
A checklist to determine risk of lesion being a melanoma: size change shape change colour change >6mm diameter inflammation oozing change in sensation
41
margins for melanoma
2mm margin first then ``` Margin in 2nd stage depends on Breslow thickness: 0-1mm 1cm 1-2mm 1-2cm 2-4mm 2-3cm >4mm 3cm +/- sentinel lymph node biopsy ```
42
margin in SCC
<2cm, 4mm margin >2cm, 6mm margin Cosmetically important, Mohs
43
how do efudix and aldara work
Efudix = 5-FU, fluorinated uracil gets taken up into cells can causes cell cycle arrest Aldara = imiquimod and kick starts immune system to attack abnormal cells
44
What is pomade acne
Pomade is a non-medical word for a scented ointment or dressing for the hair. Pomade acne is when some of this ointment gets onto the forehead and contributes to acne because it is comedogenic.
45
How does steroid-induced acne look different
o You don’t get comedones. It is not the same pathogenesis as acne vulgaris as described above o It is highly inflammatory with many papules and pustules o It is monomorphic (all lesions look similar)
46
What is acne fulminans?
The worst end of the spectrum of acne. Widespread nodular and cystic appearance and can be quite explosive in onset and appear over a couple months. Patients can be quite systemically unwell (arthralgia, fever), thought to be from a hypersensitivity reaction to P. acnes. This is one of the rare times you would use a short course of steroids to treat acne.
47
What is acne conglobata?
A form of acne where you get deep and very tender cysts. It describes a subset of very severe acne.
48
what 2 metabolic syndromes cause acne
PCOS | CAH
49
When should you review a patient with acne after starting or changing treatment
2m
50
Acne vulgaris treatment escalation
Avoid comedogenic makeup/sunscreen. Advise not related to food or hygiene 1st line = benzoyl peroxide + topical clindamycin/topical retinoids. Wait a month. 2nd line = add the third. Oral COCP may be tried in women 3rd line = add oral lymecycline/doxycycline 4th line = oral isotretinoin with dermatologist Refer anyone at any point for oral retinoids with scarring acne +/- severe acne
51
Yes of isotretinoin (roacutane)
side effects of isotretinoin include: dry skin/eyes/mouth, nose bleeds, photosensitivity, teratogenicity (need 2 forms of contraception), low mood, raised triglycerides (needs monthly blood tests), hair thinning
52
instead of topical clindamycin and oral lymecycline, what Abx do you use in pregnancy?
erythromycin. | and don't use topical retinoid
53
polyarteritis nodosa: - size of vessel - painful? - cutaneous sign - pathogenesis - associated condition - autoantibody
- medium vessel - very painful - lived reticularis - IgM and C3 in vessel walls - Hep B - pANCA
54
does sun make SLE better or worse
WORSE - key symptom
55
rash in: - acute lupus - subacute lupus - chronic lupus
acute = butterfly rash with nasolabial sparing subacute = nonindurated annular lesions that don't scar chronic = discoid lupus with scarring annular lesions
56
important condition to exclude if someone presents with dermatomyositis
cancer. malignancy in 30%!
57
wounds in which age group heal the best and worst: adults embryos children
embryos heal without scarring (best) children heal with excessive scarring (worst) adults have slower healing but better scar
58
skin changes in venous insufficiency (4)
1. haemosiderin staining 2. atophie blanche 3. lipodermatosclerosis (inverted champagne bottle) 4. ulceration
59
venous ulcer location
medial malleolus
60
associations: - erythema nodosum - pyoderma gangrenosum
erythema nodosum = IBD + sarcoid Pyoderma gangrenosum = IBD + RA
61
types of nec fash, causes and treatment
type 1 = polymicrobial = vancomycin and tazocin type 2 = strep pyogenes = benzyl pen + clindamycin All IV
62
Name 3 emollients in terms of oiliness
Least oily = diprobase Middle = epaderm Most oily = 50/50 liquid parafin:white soft paraffin
63
In what body areas are steroids more effective
In occluded areas like armpit and natal cleft
64
lichen simplex
Thick skin due to chronic itching. can be from many things, including eczema
65
which UV therapy has more chance of causing cancer
PUVA >> UVB
66
Yes of methotrexate
liver fibrosis, lung fibrosis, hair loss, bone marrow suppression, N&V, teratogenic. Must use folate alongside.
67
Unilateral hand dermatitis cause
Probably fungal (single hand eczema is very rare)

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