General Medical cards Dan Flashcards

Question

What is Blue rubber bleb syndrome?

Answer 1

Sporadic or AD Usually presents in adulthood Multiple venous malformations of skin, gut, spinal cord and viscera - skin lesions are painful No glomus cells

Answer 2

Eg. Cetux, pmab, erlotinib, gefitinib 'EGFR makes(MEK) a fast car' (rhymes) - if you have a fast car you get 'MPH PRIDE' Mucositis Photosensitivity Hair changes eg hypertrichosis, hirsuitism, trichomegally of eyelashes + Alopecia (androgenetic or rarely scarring) Papulopustular eruption Regulatory changes in hair Itching Dryness Easy breaking nails (brittle) + paronychia + onycholysis + pyogenic granulomas NB; MEK inhibitors have same side effects eg. Seletanib, trametinib

Answer 3

``` Due to insulin resistance in women Subtype of PCOS. Triad of; Hyperandrogenism HA Insulin resistance IR Acanthosis nigricans AN ```

Answer 4

Rare type of local immune complex (type 3) hypersensitivity vasculits due to injection of an antigen, usually esp diphtheria or tetanus toxoid in a sensitized individual. Local pain, swelling, redness and sometimes purpura or necrosis in 4-10 hrs then settles.

Answer 5

``` AD lentiginosis syndrome Mutation in PRKAR1A gene Cutaneous lentigines + atrial myxomas + endocrine tumours and overactivity 2 subsets: NAME and LAMB Think Name the Lamb PATT Naevi Atrial Myxoma Myxomas of skin Ephelides Lentigines Atrial myxoma Mucocutaneous myxomas Blue naevi Pituitary adenoma Adrenal Cushings Thyroid tumours Testicular tumours ```

Answer 6

Idiot Kids Traumatized By Fist Knuckle Pads Idiopathic in kids Trauma Bart-Pumphrey syndrome Fibromatoses Keratin 9 Epidermolytic palmoplantar keratoderma - Vorner's Papillon-Lefevre syndrome

Answer 7

``` variant of myeloma Polyneuropathy - sensory and motor Organomegally - Liver, spleen LNs Endocrinopathy - mainly DM M protein - monoclonal gammopathy Skin changes - hyperpigmentation, hypertrichosis, scleroderma, Terry's nails treat with chemo and autologous SCT ```

Answer 8

Spontaneous onset of painful haematomas/bruises on fingers in middle aged females Unknown cause but lesions often triggered by minor trauma Usually resolves

Answer 9

``` Lipoma syndromes; Dercum's Family Makes Bull Shit Other syndromes; 1,1,P10, He-man's Garden Dercum’s disease (adiposis dolorosa) – painful lipomas Familial multiple lipomatosis Benign symmetrical lipomatosis NF1 MEN 1 PTEN syndromes; Bannayan-Riley-Ruvalcaba Proteus Cowden's lumbosacral haemangioma Gardner's syndrome ```

Answer 10

``` Blue ANGEL or BLEND AN EGG Blue rubber bleb Angiolipoma Neuroma Glomus tumour Eccrine spiradenoma Leiomyoma ``` ``` Blue rubber bleb Leiomyoma Eccrine spiradenoma Neuroma - Morton's, traumatic Dermatofibroma (sometimes) Angiolipoma Neurilemmoma Endometrioma Glomus tumour Granular cell tumour also Tufted angioma in 30% of cases ```

Answer 11

``` 4 D's Dermatitis Diarrhoea Dementia Death ```

Answer 12

``` U LAD Ulceration Livedo reticularis Atrophie blanche, Acrocyanosis Degos-like lesions ```

Answer 13

If you find one, always look for the others; 1. Hidradenitis suppuritiva 2. acne conglobata 3. dissecting cellulitis of scalp 4. Pilonidal sinus

Answer 14

STAMPER - 7 diagnostic, 6 possible; Symptoms persist >2 wks after stopping drug Temp >38 degrees ALT >100; hepatitis or other visceral inflammation Maculopapular rash >3wks after starting drug Palpable LNs Eosinophilia or high WCC or raised atypical lymphocytes >5% Re activation of HHV6

Answer 15

``` Mostly antibiotics Also antifungals, diltiazem, paracetamol + quinolones, HCQ Do My Pits Pus Today? Diltiazem Macrolides Penicillins, beta lactams Plaquenil Terbinafine and azole antifungals ```

Answer 16

``` Common derm; Eczema + variants (seb derm, stasis, contact) 40% Psoriasis 25% PRP CTCL (MF or Sezary) 15% Pemph foliaceous or other immunbullous Idiopathic 10% Rare derm causes; HOSTING Lovely ladies Double Ds Hailey-hailey Ofuji's papuloerythroderma Sarcoidosis Toxic Shock Syndrome Icthyoses Norwegian scabies GvHD Lupus Lichen planus Dermatophyte Dermatomyositis Non derm causes; Drugs - 10% - esp CASA - Carbamazepine/phenytoin - Allopurinol - Sulphasalazine - Ampicillin/penicillinsSystemic lymphoma/leukaemia Hypereosinophilic syndrome HIV seroconversion ```

Answer 17

THE INET + Metabolic Thermoregulation + Thrombosis Haemodynamic – ARF, CHF/high output cardiac failure, odema Ectropion + other eye complications Infection – skin, pneumonia etc Nutrition, Nails & Nodes (low albumin marker of poor protein status) Enteropathy (iron, B12, folate, protein and fat malabsorption and deficiency) Telogen effluvium Metabolic - electrolyte imbalance

Answer 18

``` Autoimmune PolyEndocrinopathy Candidiasis Ectodermal Dystrophy syndrome Type 1 autoimmune polyendocrine syndrome Addisons Hypoparathyroidism Immune deficiency Skin features - CHAV nail; Candidiasis - chronic mucocutaneous Hyperpigmentation of Addisons Alopecia areata Vitiligo - in most cases Nail dystrophy ```

Answer 19

Need at least 1 clinical and 1 lab feature Clinical; - One or more episodes of arterial, venous or small vessel thrombosis - Pregnancy complications One or more unexplained foetal loss at 10 wks or later (normal foetus) One or more prem delivery of normal neonate before 34 wks 3 or more unexplained consecutive miscarriages before 10 wks Laboratory (remember LAB); - Positive Lupus anticoagulant Ab test on ≥2 occasions ≥12 wks apart - IgM or IgG Anticardiolipin Abs at mod-high levels on ≥2 occasions ≥12 wks apart - Positive Beta2-glycoprotein 1 Abs test on ≥2 occasions ≥12 wks apart NB thrombocytopenia is no longer in the diagnostic criteria

Answer 20

``` ARM and Leg - rash seen on extremeties Apiaceae (Umbelliferae) - Parsnip - Celery - carrots - Parsley - Cow parsley/hogweed - Giant hogweed Rutaceae - Bergamot lime (Citrus bergamia) also causes berloque dermatitis - Citron (Citrus medica) - Pomelo (Citrus maxima) - Ruta spp ('Rue') Moraceae - Fig Leguminosa - Beans ``` NB; Phytophoto is a type of phototoxic rcn mainly due to plant furocoumarins, not a photoallergy compositae [asteraceae] cause ACD but not photoACD or phototoxicity - Ragweed and parthenium cause airborne bush dermatitis However it is theorised that a reaction occurs between plant material in this species and human DNA which renders the patient photosensitive accounting for hight rates of compositae allergy in pts with CAD

Answer 21

Kebner (isomorphic resposne) = skin condition occuring at site of a scar (healed) Pseudo Koebner phenomenon = infection such as warts or molluscum at sites of trauma Reverse Koebner phenomenon = trauma to a site of dermatosis causes resolution Isotopic response = dermatosis occurring at the site of a previously healed, unrelated dermatosis Pathergy is more appropriate terms in Behcets, Sweets and PG if the wounds are new

Answer 22

'Sinus Histiocytosis with massive Lymphadenopathy' rare type of non-Langerhan's cell, Non-dendritic cell histiocytosis affects age 10-30, M>F, all races >600 reported cases - Massive, painless cervical lymphadenopathy - Fever - Mild anemia and neutrophilia, high ESR - 40% have extranodal involvement with skin being most common site (bone, CNS, genitourinary, GIT, heart, thyroid) Skin involved in 10%; can be only extranodal site involved + rare skin-limited form Multiple red-brown or xanthomatous macules, papules, nodules or plaques of eyelids and malar regions Often indolent, self-limiting Many lesions are asymptomatic and heal spontaneously Rare fatal cases Poor prognosis if; disseminated LN Dx or involvement of liver, kidneys or lungs

Answer 23

7 types; Mibelli Giant DSP/DSAP (if only on sun-exposed areas) Linear Porokeratosis palmaris, plantaris et disseminata (PPPD) Punctate porokeratosis (may be variant of PPPD) Porokeratotic Eccrine Ostial and Dermal Duct Naevus (PEODDN)

Answer 24

Blaschko Linear Acquired Inflammatory Skin Eruption includes lichen striatus in children and adult blaschkitis

Answer 25

AKA Oid-Oid disease or Exudative discoid and lichenoid chronic dermatosis widespread disocid eczema - lesions go through exudative and lichenified (not lichenoid) stages mainly adult jewish men, cause unknown penis and scrotum invovlement pathognomonic Very itchy can be eosinophilia can be gynaecomastia treatment resistant - try pred or AZA Chronic - months-years

Answer 26

1. Recurrent pulling of ones own hair causing hair loss 2. Increasing sense of tension when resisting and immediately before hair pulling 3. Pleasure, relief or gratification after pulling out hair4. Not part of another mental disorder 5. Causes problems or distress with social life or work or other areas of functioning Can support diagnosis by creating a ‘hair growth window’ – weekly shave a small area of involved scalp and see normal confluent growth at end of week

Answer 27

``` Psoriasis Eczema Scrotal/fissured tongue Downs Diabetes Reiter's syndrome hormonal disturbance Anaemia Lithium EGFR inhibitors ```

Answer 28

``` Melkersson-Rosenthal syndrome Down syndrome Less often; Cowdens syndrome Acromegally (with macroglossia) Pachyonychia congenita ```

Answer 29

Malabsorption - Crohn's, coeliac, any other cause Vitamin deficiency – B12, folate, iron, riboflavin (B2) Geographic tongue (benign migratory glossitis) Median rhomboid glossitis Allergic contact stomatitis e.g. foods, cosmetics etc Strawberry tongue – characteristic of Kawasaki Dx and Scarlet fever Sometimes seen in toxic shock syndrome or familial dysautonomia Trauma Necrolytic migratory erythema (glucagonoma) - painful beefy glossitis + angular cheilitis in 1/3 Pemphigus vulgaris (rarely)

Answer 30

``` Congenital; Downs syndrome Neurofibromatosis Lingual thyroid Storage diseases Rare syndromes Acquired; Diabetes Hypothyroidism Acromegally Amyloidosis TB/ other mycobacterial infectionT umour ```

Answer 31

``` Gum involvement in several disease not a specific diagnosis LP Lichenoid (contact) mucositis Pemphigus vulgaris MM pemphigoid, Linear IgA, EBA LE GVHD EM FDE chronic ulcerative stomatitis ```

Answer 32

``` Behchets IBD cyclic neutropenia vit def coeliac or other malabsorption EBV HIV PFAPA syndrome DDs EM/SJS fixed drug eruption allergic/irritant contact stomatitis recurrent HSV ```

Answer 33

``` Periodic Fever Aphthous stomatitis Pharyngitis Adenitis occurs in young children ```

Answer 34

``` ill fitting dentures or braces oral candida thumb sucking in kids prominent skin fold in older people Nutritional def - iron, zinc, riboflavin diabetes HIV or immunodeficiency states needs exclusion Secondary syphilis causes split papules ```

Answer 35

Oral laryngeal Anogenital (Buschke Lowenstein) Plantar surface of foot

Answer 36

2 meanings; Was originally coined to describe idiopathic granulomatous cheilitis either alone or as part of Melkersson-Rosenthal syndrome - in this use it specifically excludes other causes of granulomatous change of the lips such as Crohn's disease It is also used more loosely as a cover-all term for all kinds of granulomatous change of the lips and oral areas

Answer 37

BRILLIANCE B - Bullous – PV, Paraneo pemph, BP, MMP, LinIgA, EB, DH R - Recurrent apthous stomatitis, Reiters I - Infections and immune deficiency – Hand-foot-mouth, Herpangina (coxsackie A16), HSV, HIV, leishmaniasis L - Lupus, LP L - Low nutrition I - Iatrogenic/drugs/trauma – GVHD, dental work, heat, cold, chemicals, XRT, artefact, A - Amyloidosis, Angina bullosa haemorrhagica N - Neutrophilic - Behcets, sweets, vasculits (wegeners, PAN, GCA) and Neoplasia –myelodysplasia, leukaemia, cyclic neutropenia, SCC, melamonoma, sarcoma, lymphoma C - Crohns, UC(rare), coeliac E - EM, SJS/TEN Also PFAPA syndrome, systemic dimorphic fungal infection, eosinophilic ulcer, necrotizing sialometaplasia

Answer 38

Good oral hygiene and chlorhex mouthwash Control w potent TCS gel TDS or inhaler reduces pain and healing time Topical tacrolimus TCS ILCS May need oral pred. Topical analgesia/local anaesthetic may help pain Complex disease may need colchicine/dapsone/thalidomide

Answer 39

``` Types of LICHEN PLANUS Little/atrophic Increased (hypertrophic), Inverse Classic Hair – LPP, GL, FFA Exanthematous Nails Pemphigoide/bullous/pigmentosus Linear Annular Nitidus Ulcerative, erosive, vulvovaginal-gingival Sun (actinicus), Substances – drug, photodrug, FDE ```

Answer 40

``` International criteria for Behcet’s disease ICBD –need 4 or more points; GOO2 CVSP Genital ulcers = 2 Oral ulcers = 2 Occular manifestations = 2 CNS manifestations = 1 Vascular manifestations = 1 Skin manifestations = 1 Positive pathergy test if performed = 1 ```

Answer 41

``` BOTS Bird mites Onchocerciasis Thrips Scabies ```

Answer 42

``` PPAIR Psoriatic arthritis with spondylitis Or Pustular psoriasis Ankylosing spondylitis (strongest) IBD Reiter's disease ```

Answer 43

``` General measures Topicals; Tacrolimus/pimecrolimus (1st line) Potent TCS minocycline swish and spit ILCS for resistant apthosis Systemic Rx of Behcets – Rx ladder 1st line – topicals + a systemic below; Colchicine 0.6mg TDS Oral zinc sulphate 100mg TDS Sucralfate 1g QDS before meals 2nd line Dapsone 100-200mg OD (as effective but more AEs/monitoring) Thalidomide 100-300mg daily MTX Prednisolone taper for severe flare ups 3rd line for recalcitrant orogenital ulceration IFNα TNFα blocker - Infliximab 5mg/kg, Etanercept Isotretinoin AZA, CsA, cyclophosphamide, MMF Many others listed in reports ```

Answer 44

``` Apocrine miliaria blocked apocrine sweat ducts affects young women esp axillae, pubic region, inframammary, nipples itchy small red-pink papules reduced sweating persistant Rx with topical retinoids, steroids or antibiotics ```

Answer 45

Dermal infiltration causing sclerosis (scleredermoid in appearance) DDx: post radiation morphoea VS recurrence of breast cancer

Answer 46

Inflammatory metastatic carcinoma Resembles erysipelas but without the pyrexia or toxaemia Tumour cells lie within dilated lymphatic vessels in skinoften in breast region

Answer 47

``` Superficial obliterative phlebitis affecting the thoraco-epigrastric, lateral thoracic, or superior epigastric vein Ages 30-60F >> M Red linear 2-3mm thick cord running from lateral margin of breast, crossing costal margin, and extending to abdominal wall Subsides in few weeks and no known complications Risk factors: Large pendulous breasts Strenuous physical activity Direct trauma Breast surgery Sentinel node biopsy Infection near affected vessel Breast cancer (occasional cause) ```

Answer 48

White - titanium or zinc oxide Red - cinnabar(mercury sulphide) or cadmium red, sienna(Ferric hydrate) sandalwood, brazilwood Red/brown - iron (ferric) oxide Yellow - cadmium sulfide Green - chromium salts, Phthalocyanine dyes Blue - Cobalt Purple - manganese, aluminium Black - carbon(India ink), iron oxide, logwood

Answer 49

Keratosis pilaris atrophicans faciei (bearded face) Erythromelanosis follicularis faciei et colli (face and neck) Ulerythema ophryogenes (eyebrows) Keratosis follicularis spinulosa decalvans (scalp) Atrophoderma vermiculata (cheeks)

Answer 50

Werners Blooms Rothmund-Thompson Dyskeratosis Congenita Kindler syndrome XP Trichothiodystrophy (photosensitive type-PIBIDS) Hartnup disease Mendes da Costa syndrome (erythrokeratoderma variabilis) Hereditary acrokeratotic poikiloderma of Weary (one family described only) Hereditary sclerosing poikiloderma of Weary Degos –Touraine syndrome Neutral lipid storage disease

Answer 51

Incontinentia pigmenti with poikiloderma and GI symptoms

Answer 52

``` Poikiloderma of Civatte Dermatomyositis Cutaneous lupus LP Systemic sclerosis MF Poikiloderma with neutropenia (syndrome) Pre-lymphomatous poikiloderma (chronic superficial scaly dermatosis that has developed atrophy and reticulate pigmentation) Chronic cold or heat exposure XRT Acrodermatitis chronica atrophicans (lyme) ```

Answer 53

AR ABCC6 gene on Chr 16 (A Big Cucoo Clock 6 'o clock) Calcium accumulates in elastic fibres of skin + tissues skin changes often present in childhood CHICS (skin looks like chicken skin) Comets, Angioid streaks + peau d'orange of eyes Haemorrhage (upper GI bleed) Ischaemic heart disease Claudication (PVD) >age 30 Squeaky valves; MR/AR/ aortic dissection NB also; May get reticulate pigmentation on abdo acneiform lesions Usually arises before 30. Occasionally old age. Persists indefinitely Changes similar to skin occur on all mucosal surfaces Exaggerated horizontal or oblique mental crease pathognomonic finding Eye changes due to calcification of Bruch’s membrane of retina Risk of; Bleeding - GI, intracranial Miscarriage

Answer 54

blepharochalaxis + progressive enlargement of the upper lip due to hypertrophy and inflammation of the labial salivary glands May be excessive salivation

Answer 55

``` AD mutation in fibrillin-1 gene (FBN1) 30% new mutations MARFANS Mitral valve prolapsed, Myopia Aortic Regurge, Aneurysm, Dissection Retinal detachment Fibrillin gene, Chr Fifteen + PH(marPHan)- Pectus excavatum, High arched palate Arachnodactyly Negative Nitroprusside test (differentiates from homocystinuria), neural deafness (6%) Subluxated lens (Upward/up + lateral dislocation of Lens) Skin features - HESP Hyperexensible skin Elastosis perforans serpiginosa Striae atrophicae Papraceous scars ```

Answer 56

``` A DERM POP Acrogeria Down’s syndrome EDS Rothmund-Thomson Marfans PXE Osteogenesis imperfecta Penicillamine: produces abnormal elastin. (Disrupts desmosin cross links within elastin) ```

Answer 57

``` skeletal abnormalities cutis laxa, craniostenosis ambiguous genitalia retardation facial abnormalities ```

Answer 58

``` Leonine facies - many causes Extensive congential cerebriform melanocytic naevus on scalp Pachydermoperiostosis Acanthosis nigricans Dissecting cellulitis of scalp ```

Answer 59

Mouth and Genital Ulcers with Inflamed Cartilage | Combination Behcet’s + relapsing polychondritis

Answer 60

Age (peak between puberty and 30) Race (B>W), Afro Caribeans Sites = ear lobes/ shin / neck/ shoulders/ upper trunk/ LL and sites that stretch Mechanism of injury; burns, scalds Infected wound Foreign material = sutures/ endogenous hair Scarring acne on back FHx Recent Roacutane + laser Polyfibromatosis syndrome = Dupuytren’s Other associations; acromegaly, post thyroidectomy, Dubowitz, Rubinstein-Taybi, EDS, pachydermoperiostosis Linear keloids in athletes taking anabolic steroids Keloid scarring can be triggered by pregnancy Spontaneous keloids - presternal region of chest, probably micotrauma. Can be seen in in syndromes; rubinstein-taybi, noonan and Dubowitz, Goeminne

Answer 61

Dx: 1 major from 2 systems Probable: 2 major from same cat or 1 major + 1 minor from another category Major: 1) Skin: yellow papules/plaques neck or body,Or bx with histo changes from affected skin 2) Eye: angioid streaks Or peau d'orange 3) Genetics: mutation of both alleles of ABCC6, Or 1st degree relative Minor: 1) eye: 1 streak shorter than 1 disk Diameter, comets in retina, 1 or more wing signs 2) Genetics: 1 allele mutation

Answer 62

``` granulomatous infiltrates; Sarcoidosis Lupus vulgaris Acne agminata Lupoid leishmaniasis ```

Answer 63

``` RA + 3 Ls Large spleen (Splenomegaly) Leg ulcers Leukopenia Clinical: Rheumatoid arthritis with leg ulcers, splenomegaly with leukopenia and granulocytopenia ```

Answer 64

``` Let's See HOPE for these poor kids Letterer Siwe Hepatosplenomegally Osteolytic bone lesions Pulmonary lesions Enlarged LN ```

Answer 65

``` None definite Possibly; Localized GA associated w/ autoimmune thyroiditis esp in women type 1 diabetes (not type 2) uveitis Plummers syndrome (toxic nodular goitre) malignancy ```

Answer 66

2 thirds of necrobiosis pts have diabetes esp type 1 and insulin-dependent Many more have abnormal GTT 0.3% of diabetic pts get NLD 2.8% of pts with MODY

Answer 67

approx 50%

Answer 68

Eruptive pseudoangiomatosis

Answer 69

modified Dessau definition - 3 features must be present; Typical lesions present – deep-seated painful nodules/ blind boils Lesions must be in one or more of the typical sites for HS Clear history of chronicity or recurrence

Answer 70

SKEPTICAL Sarcoidosis - subcutaneous Kids - Sclerema neonatorum, Fat necrosis of the newborn (needle-shaped clefts within lipocytes); sclerema is a screamer - bad prognosis; fat nec has good prog Erythema induratum (Bazin or Whitfield)(w/ vasculitis) Pancreatitis (necrosis is early feature) Traumatic - blunt trauma, injectable substances (oil, DA etc), cold panniculitis, sclerosing lipogranuloma Idiopathic Nodular panniculitis Infectious Calcifying panniculitides - pancreatic, crystal (gout, oxalosis), alpha1 antitrypsin deficiency, calciphylaxis AI - Dermatomyositis, Lupus profundus, RA, Hashimotos, Crohns (w/ vasculitis) Lipodermatosclerosis Lipodystrophies (Cold panniculitis, Nodular cystic fat necrosis) Lepra reactions; Lucio’s phenomenon or Erythema nodosum leprosum (NOT type 1 rcn) (w/ vasculitis)

Answer 71

Totally Bitch SLAPPED do at 8am on day 3-5 of menstrual cycle (not on OCP for last 2 months); Total and free testosterone BetaHCG SHBG LH and FSH Androstenedione Prolactin (NB baseline test should ideally be after 11am) 17α-hydroxyProgesterone (8am on day 1-3) oEstradiol DHEAS + Worth doing the TFTs and 8am cortisol routinely 8AM cortisol – high in Cushings or late CAH - 8am 17α-hydroxyprogesterone high in late CAH (usually due to mutation in 21-hydroxylase) - Dexamethasone suppression test confirms Cushings (alternative is 24hr urinary cortisol repeated x 2)

Answer 72

``` PCOS – Rotterdam diagnostic criteria (need 2 of 3 of HOP - Peacocks hop!); Hyperandrogenism - evidenced by; - Raised testosterone or; - Hirsuitism or male pattern hair loss (AGA) Oligo/anovulation Polycystic ovaries on USS (12 or more 2-9mm follicles in each ovary and/or ovarian vol >10mls) ``` ``` Also may have; Raised LH (LH:FSH ratio may be raised (>3:1) but not always – FSH is normal or low) ``` And need to exclude DDs; NCAH, androgen secreting ovarian/adrenal tumour, Cushings, Hypothyroidism (oligomenorrhoea), hyperprolactinaemia, Pregnancy and premature ovarian failure are also causes of amenorrhoea

Answer 73

This is like natural gene therapy where areas of thr skin revert to wildtype causing islands of sparing; Icthyosis en confetti Some types of EB esp Dystrophic EB types

Answer 74

SARA RUCA Sexually Acquired Reactive Arthritis Rash - mucocutaneous features Urethritis (non-gonococcal) Conjunctivits (or; epislceritis, iridocyclitis, Keratitis) Arthritis mucocutaneous features; oral ulcers scaly red patches/plaques resembling psoriasis keratoderma blennorrhagicum balanitis circinata (scaly/eroded rash on glans) papules and pustules on fingers and toes paronychia Mostly due to Chlamydia trachomatis can be salmonella or campylobacter, HIV, HSV or CMV

Answer 75

PABA and its derivatives; - IPPD - PABA containing sunscreens - ester local anessthetics (benzocaine on ABS) - Parabens (preservative in lignocaine) - Sulphonamides - Sulphonylureas - Thiazides

Answer 76

``` My Ford Car Solely Plays CDs Angiokeratoma of Mibelli Angiokeratoma of Fordyce (scrotal angiokeratoma) Angiokeratoma Circumscriptum Solitary Papular angiokeratoma angiokeratoma Corporis Diffusum ```

Answer 77

DRB1*0407 is very supportive of diagnosis | DRB1*0401 is supportive

Answer 78

Spontaneous atrophic scarring of the cheeks - Atrophia maculosa varioliformis cutis (AMVC) KP atrophicans variants; - Vermiculate Atrophoderma (AD, sporadic, Rombo; cheeks, preauricular) - KP atrophicans faciei (AD; eyebrows, forehead) - Keratosis follicularis spinulosa decalvans (infancy, cheeks, alopecia) Follicular atrophoderma (Bazex, others) Lipid proteinosis Erythropoeitic protoporphyria Hyper IgE syndrome (Job syndrome) Hydroa vacciniforme DA Varicella scars, acne scars, actinic prurigo scars, DLE scars etc

Answer 79

Allergic response to microscopic larvae of non-human schistosomes (flukes) (humans not primary host) Starts 12-24 hrs after exposure Usually fresh water, can be salt water Esp summer in temperate climates (UK, USA, southern Aus) Mainly affects exposed areas not covered by swimsuit Starts with prickling sensation after leaving water; lasts for 1-2 hrs Subsides in under 12h if not sensitized If sensitized turns into itchy papules and plaques over 24hrs and lasts 1-2 weeks Histo – spongiosis w/ collections of neuts and eos in epi. Can see cercariae (tadpole shaped larva) in outer epi if taken within 48 hrs Vigorous towelling after swimming may prevent cercariae penetrating skin Rx - shower, topical menthol or calamine for itch NB - the same clinical syndrome can be the presenattion of acute human schistosomal infection in endemic countries (Schistosomiasis AKA Bilharziasis) - look out for acute systemic disease 2-8wks later

Answer 80

= nematocyst dermatitis, ‘sea lice’ Irritant contact rcn to the nematocysts (sting organ) of the larval stage of cnidaria (jelly fish and sea anemones and coral) Itchy, erythematous papules and weals occur predominantly under swimwear, and lesions are usually concentrated in tight-fitting areas The organisms become trapped under bathing costume and discharge of nematocysts is triggered subsides in mins to hrs Rx - shower, topical menthol or calamine for itch

Answer 81

Rare syndrome of widespread livedo racemosa and multiple cerebral ischaemic episodes Leads to progressive neurological impairment May be vasculitis, vasculpoathy or coagulaopathy – unclear Histo is characteristic - A subendothelial pad of smooth muscle cells (‘intimal proliferation’) with subtotal or total occlusion of the lumen in at least one arteriole or small artery With correct clinical and histo signs must exclude antiphospholid syndrome to make the diagnosis

Answer 82

Uncommon condition can present with livedo reticularis Multiple recurrent painful ulcers on the lower legs – heal slowly leaving atrophie blanche scars Fibrin in vessel walls and perivascular stroma and hyaline thrombi in lumen

Answer 83

``` Endemic/venereal syphilis esp congenital Leprosy Rhinoscleroma Mucocutaneous leishmoniasis (Tapir nose) Paracoccidiodomycosis Tuberculosis Glanders Zygomycosis due to Mucorales species (mucormycoses) Other infection e.g. pseudamonas Wegner’s granulomatosis Relapsing polychondritis NK/T-cell lymphoma, nasal type cocaine use ```

Answer 84

``` MASKUT BS Take 2-3 wks to culture in lab Mycobacterium...... Marinum Avium Scrofulaceum Kansasii Ulcerans Tuberculosis Bovis Szulgai ```

Answer 85

``` Rap(id) A Smeg For CHristmas Take 3-5 days to grow Mycobacterium...... Abscessus Smegmatis Fortuitum Cholenaei ```

Answer 86

Investigations; • Biopsy Histo - Calcification of tunica media of small subcut vessels + necrosis of overlying tissue - Can be calcification of septae in subcutis and of adipocytes - May see thrombosed vessels - Can be dermal inflammation only if before ulceration phase - Can be bullae Sometimes repeated biopsy is required to find the calcified small vessels • Xray may show calcification of small vessels in skin • Check ELFTs, serum calcium, phosphate, PTH and protein C and S ``` Treatments; Low calcium and phosphate dialysate Non-calcium phosphate binders Parathyroidectomy Drugs to alter calcium metabolism • sodium thiosulphate (increases solubility of calcium depsois + antioxidant action – more useful in pts w/out hyperparathyroidism) • bisphosphonates e.g. pamidornate • cinacalcet (calcimimetic which lowers PTH and calcium-phosphorus product – esp useful if pt has hyperparathyroidism) Daily dressings and strict antispesis – infection is major cause of mortality Debride if ulcerated Antibiotics if secondary infection Hyperbaric oxygen Tissue plasminogen activatior ```

Answer 87

Non-inflammatory “SHORE PICC ME” Systemic alteration in coagulation – APLS, protein C/S defcy, warfarin necrosis, B12/folate/vit C defcy (scurvy), vit K defic, anti-thrombin III def, Factor V Leiden mut, DIC Hyperviscosity - Hypergammaglobulinaemic purpura of Waldesntrom, paraproteinaemia Organisms – vessel invasive fungi, ecthyma gangrenosum, disseminated strongyloides RBC occlusion – sickle cell disease, severe haemolytic anaemia, severe malaria, polycythaemia Emboli – cholesterol, oxalate crystal, endocarditis, myxoma, decompression sickness Platelet d/o – heparin necrosis, decr/incr plt, myeloproliferative d/o, TTP, ITP paroxysmal noctural haemoglobinuria, VWd, aspirin/drug effect, Dengue Intravascular lymphoma (B cell) Conditions – livedoid vasculopathy, Degos, Sneddon’s, Calciphylaxis Cold-related – cryoglobulins, cryofibrinogens, cold agglutinins Mechanical – CT d/o, incr intravasc pressure, decr support (Amyloidosis, Ehlers Danlos, solar, senile, steroids) External – trauma/artefact, Gardner Diamond Inflammatory; Vasculitis - Small vessel – palpable purpura e.g. CSVV, HSP - Medium vessel – inflammatory retiform purpura e.g. mixed cryoglobulinaemia, rheumatic, PAN, MPA, WG, CSS Occlusion – livedoid vasculopathy, perniosis, septic/infective vasculitis, Thromboangitis Obliterans (Buergers disease), levamisole cut cocaine

Answer 88

General measures Educate esp on signs of secondary infection Lightweight clothes - cotton Sunscreen – UV flares skin and increases skin Ca risk and reactivates HSV Prevent aggravation due to heat, sweating and sun exposure Daily skin antimicrobial cleansers to reduce colonization and malodor Keratolytic emollients to reduce scaling and irritation - urea, sal acid Psychoscial support, support groups, psych for depression, carers if very mentally handicapped Genetic counseling Avoid lithium Topical topical retinoids (adapalene, tazarotene, tretinoin) – starting with alternating days increasing to daily as tolerated as can be irritating. Esp good for localized/linear disease Addition of TCS can alleviate irritation Also addition of antibiotic with TCS can be used as superinfection common (BetC) Tacrolimus Efudix – has caused temporary remission in reported cases Systemic oral retinoids mainstay of Rx in widespread disease (isotretinoin 0.5-1mg/kg/day or acitretin 10-25mg/day initially) – use continuously or intermittently Cyclosporine Prednisone for vesiculobullous variant Physical – esp for resistant flexural disease Laser ablation (CO2, erbium:YAG), PDL has also been used BoTox to reduce sweating if hyperhidrosis PDT Electron beam XRT Dermabrasion deep to pap dermis Electrosurgery Surgical debridement Surgical excision and flap with tissue expanders or split-thickness skin grafting Nail removal and partial distal matrix excision for nail disease

Answer 89

General measures Education on disease, gen measures and recognizing infection Lightweight clothing to avoid friction and sweating, weight loss Antimicrobial cleansers +/- antibiotics to treat secondary bacterial, fungal, viral infections Analgesia Patch test if concerns as high risk for ACD esp to medicaments Genetic counseling Support groups Topical TCS combined with topical antimicrobials and cleansers – NB need to be aware of SFX of TCS in flexures eg) alternating days. Lowest effective strength TCS antimicrobials; clindatech or clioquinol Intralesional steroids can be used Tacrolimus/pimecro good option to spare steroid use calcitriol efudix - has been tried ``` Systemics No clear evidence for retinoids dapsone/CsA only anecdotal reports but can try if topical failed pred – short course may help biologics – few reports but increasing Low dose naltrexone Antivirals if secondary HSV ``` Procedural Dermabrasion Laser – erbium YAG better or CO2 PDT – painful and limited success reported Electron beam XRT Botox to reduce sweating, breast reduction to reduce submammary maceration Surgery – Excision and 2nd intention or SSG – last resort

Answer 90

General measures Avoid soap, simple emollients, colloidal oatmeal baths Wet compresses with zinc oxide or calamine Remain cool to reduce sweating Prantal powder - diphemanil methylsulfate (20mg/g) (antiperspirant; opposes action of parasympathetic nerves that control sweating) Topical Moderate to potent TCS in a cream or lotion 1% menthol in Aq cream Calcipotriol bd Systemic acitretin / isotretinoin pred high dose vitamin A – 50,000 units TDS for 2 weeks Physical PUVA / UVA1 (PUVA can also trigger Grovers)

Answer 91

Non-fluorescent arthroconidia within hair shaft Anthropophilic species Nearly always Trychphyton esp Tonsurans and Violaceum also Soudanense (esp in Africa) remember ‘TVSets are IN houses’ Clinically can be; scale only/ black dots /alopecia

Answer 92

Hyphae and arthroconidia grow outside hair shaft – cause destruction of cuticle Mostly Microsporon esp Canis Mostly zoophilic (T. ferrugineum and M. audouinii are exceptions) May fluoresce under Wood's lamp Clinically can be scaly and patchy alopecia up to kerion

Answer 93

Cash Allows Very Many TV Sets M. Canis (cats, dogs) - griseo for this only M. Audouinii (anthropothilic) M. Verrucosum (from cattle, very slow growing, kerion) T. Mentangrophytes (quite common, guinea pigs, kerion) T. Tonsurans T. Violaceum (T. Soudanense rare in Aus unless refugee etc) (T. Schoenleinii rare, favus - rare in Aus unless refugee) *CAVM are ectothrix, TVS are endothrix as 'TV Sets are IN houses'

Answer 94

``` FACDs T ferrugineum (yellow) M audouinii (green-yellow) M canis (green) M distortum (yellow) T schoenleinii (blue-white/pale-dull green) T triple M T ```

Answer 95

0.5% of kids w/ skin JXG have eye JXG 40% of kids w/ eye JXG have skin JXG at diagnosis – ALWAYS MULTIPLE NB: eye JXG can cause hyphema (bleeding) and glaucoma leading to blindness therefore if child has 2 or more JXGs must look at eyes and refer to ophthalmology

Answer 96

``` Mossy foot (Podoconiosis - nonfiliarial elephantiasis) Foot inuries in neuropathies TB Madura foot (mycetoma) Human hook worm Dog/cat hook worm (larva migrans) Strongyloides (larva currens) Bushfeet ```

Answer 97

SADS seb K accessory nipple dermatofibroma solar lentigo (according to ACD module) Other features of melanocytic lesions found in non-melanocytic lesions are; Globules - SebK, pigmented BCC, dermatofibroma, talon noir Streaks - SebK, pigmented BCC Homogenous blue - Kaposi sarcoma, pigmented BCC, XRT tattoo

Answer 98

- Grevillea esp Robyn Gordon type (allergen is pentadecylresorcinol) Grevillea (in Proteaceae family) can cross react with members of the Anacardiaceae family esp mango tree, cashew tree and brazillian pepper tree (all 3 contain resorcinol) and less often rhus (in Aus) and other toxicodendrons (both also anacardiaceae) eg Poison Ivy, poison oak and poison sumac (in USA; main allergens are catechols) - Mango tree sap also common allergen NB; all the above plant allergens cross react as they contain urushiols - mixtures of catechols and resorcinols - Tea tree is common ACD but usually contact is via use as a medicament rather than with the plant; the same is true for feverfew (a compositae) and balsam of Peru (Myroxylon pereirae) - Compositae (allergen sesqueterpine lactone) allergy is common but usually causes an airborne contact or presents as allergy to cross reactants e.g. Balsam of Peru, colophony - Alliaceae - includes onion, chives and garlic - garlic allergy most common esp in chefs or home cooks (main allergen is diallyl sulfide)

Answer 99

For all of these infections excision may be considered for smaller isolated lesions in amenable sites. Also always involve ID M. marinum; clarithro 500mg bd 12 wks+/-rifampicin Or Mino 100mg od Or Bactrim M. Ulcerans; Rifampicin 300bd + clarithromycin 8wks-12wks if severe Or excision +ABs and/Or heat Rx reported AND high dose pred if paradoxical rcn Nocardiosis; Bactrim mainly, 6wks to months or combination IVs if resistant Sporotrichosis; Terbinafine 250mg/d Or Itraconazole 200mg/d Or SSKI all taken until lesions resolved-many months (3-6 or more) chromoblastomycosis; - Small lesions; can excise + oral antifungals - Itraconazole 200mg/day for at least 6 months – cure in 80%+ - Terbinafine 250mg/day for at least 6 months - Others; 5-Flucytosine + oral thiabendazole or IV amphotericin B or an oral triazole - Heat - Cryotherapy + Antibiotics if secondary bacterial infection phaeohyphomycosis; excise if possible Or Itraconazole 200mg bd for 12 months

Answer 100

5 H's Haemorrhage - perifollicular + purpura + Gums + GI + intrarticular, intramuscular, cerebral Haematologic abnormality - anaemia, low folate Hypochondriasis - anxiety, depression Hyperkeratosis of follicles - KP + phrynoderma + corkscrew hairs Hypertrophy of gums + loose teeth + bleeding gums At risk; alcoholics, the elderly or disabled with reduced access to fresh foods, food faddists or those on dietry restrictions Increased requirements occur with drugs such as aspirin, indomethacin, tetracycline, OCP and corticosteroids Smokers (lowers vit C) Dialysis – Vit C is lost in dialysis (haem and peritoneal)

Answer 101

HLA-DQ2 or HLA-DQ8 | +ve in almost 100% of pts and v unlikely to ever get coeliac if negative

Answer 102

Gluten: Barley, Rye, Oats, Wheat (‘BROW’) Hidden-gluten products: beer, meat products containing breadcrumbs, some icecreams, malt vinegar, vegemite, Gluten-free: meat, dairy, fruit, vegetables, corn, rice, polenta Gluten-free flours: corn, rice, coconut, lentil, polenta, potato Measure serum TTG level - goes down to normal if stay off gluten

Answer 103

High Zn - meat, fish, shellfish, eggs and legumes High Zinc in human breast milk is also highly bioavailable (Zn in formula less bioavailable) Investigations; measure serum elemental zinc, LFTs and albumin. + FBC may show anaemia Rubber blood tube stoppers can cause false high zinc result Can measure urinary zinc – excretion will be low Measure mums breast milk elemental zinc if currently breast fed baby Biopsy is non specific but may r/o DDs Swab for secondary infection - highly likely Rx Usually Zinc sulphate or gluconate PO 1-3mg/kg/day or zinc chloride for parenteral Rx. Treat mum if breastmilk deficient otherwise Rx case. Lifelong treatment required for AE + high zinc diet. Improve quickly. Caution high zinc can impair copper absorption and cause anaemia. Zinc toxicity can occur so don't OD Genetic testing and counselling/screen parents Serum Zinc, Cu, Fe, ALP levels every 3-6 months to ensure within normal range Treat any secondary impetiginisation with oral antibiotics, condys crystal soaks, topical emollient

Answer 104

``` DH Psoriasis IgA pemphigus Alopecia Mouth ulcers Thrombocytopenic purpura ``` ``` Systemic associations with possible skin manifestations; SLE RA Sjogrens Sarcoidosis Diabetes AI thyroid disease Addisons Anaemia Autoimmune hepatitis, PBC, PSC MS and neuropathies ```

Answer 105

Difficult as Nickel in may things Allow tap to run before using water Avoid nickel-plated cookware and cutlery and avoid cooking acidic foods in stainless steel cookware Avoid all canned foods Avoid high nickel content foods such as; cocoa, chocolate, soya beans, oatmeal, nuts, almonds and fresh and dried legumes Take other nickel-containing foods in moderation - including most fruits and veges Milk products and cereals are fine Meats are generally lower in Nickel than fruit and veg

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