Passmed Flashcards

Question

How do you treat toxic epidermal necrolysis?

Answer 1

Stop the precipitating factor Supportive care - often in ICU - volume loss and electrolyte derangements are possible complications - intravenous immunoglobulins have been shown to be effective and are commonly used first line ``` Other treatments= Immunosuppresive agents (ciclosporin and cyclophosphamide) Plasmapheresis ```

Answer 2

Rare inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow It isn’t infectious

Answer 3

``` Idiopathic in 50% IBD RA, SLE Myeloproliferative disorders Lymphoma, myeloid leukaemias Monoclonal gammopathy (IgA) Primary billiary cirrhosis ```

Answer 4

The potential for rapid progression is high in most patients and therefore most patients advocate oral steroids as first line treatment Other immunosuppresive therapy- ciclosporin and infliximab have a role in difficult cases

Answer 5

Typically affects the nose, cheeks and forehead Flushing is often the first symptom Telangiectasia is common Later develops into persistent erythema with papules and pustules Rhinophyma Ocular involvement- blepharitis Sunlight may exacerbate symptoms

Answer 6

Topical metronidazole may be used for mild symptoms- limited no. Of papules and pustules, but no plaques Topical brumonidine for predominant flushing More severe disease is treated with systemic abx Recommend daily suncream Camouflage cream Laser therapy (not on nhs) for prominent telangiectasia

Answer 7

An acute self limiting rash which tends to affect young adukts The aetiology is not fully understood thought that the herpes hominis virus 7 plays a role

Answer 8

In the majority there is no prodome, however in a minority there may be a hx of a recent viral infection ``` Herald patch (usually on the trunk) Followed by erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions May produce a fir tree appearance ```

Answer 9

In guttate psoriasis there is a classical prodome of a streptococcal sore throat for 2-4 weeks Whereas in pityriasis rosea only some patients report resp tract infections Tear drop appearance in guttate psoriasis, herald patch in pityriasis rosea Most cases of guttate psoriasis will resolve within 2-3 months, UVB, photopherapy Pityriasis rosea is self limiting and resolves after around 6 weeks

Answer 10

This is pruritic blistering lesions found in pregnant women Often develop in the peri-umbilical region and later spread to the trunk, back, buttocks and arms Usually presents in 2nd/3rd trimester and is rarely seen in the first pregnancy Oral corticosteroids are required

Answer 11

Oral tetracycline

Answer 12

Blepharitis, keratitis, conjunctivitis

Answer 13

Also know as osler weber rendu sydrome It is an autosomal dominant condition characterised by multiple telangiectasia over the skin and mucous membranes. 20% of cases occur spontaneously without prior FH There are 4 main diagnostic criteria, if the patient has 2 then they are said to have a possible diagnosis of HHT - Epistaxis - telangiectasia - visceral lesions - FH

Answer 14

Immunosuppressed patients- renal transplant patients

Answer 15

Tumour like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

Answer 16

Ethnicity- more common in people with darker skin Occurs more in young adults, rare in the ekdely Common sites- sternum, shoulder, neck, face, extensor surface of limbs, trunk

Answer 17

Early keloid scars may be treated with intra lesional steroids eg: triamcinolone Excision is sometimes required

Answer 18

Erythrasma is a superficial skin infection that causes brown, scaly skin patches. It is caused by Corynebacterium minutissimum bacteria, a normal part of skin flora (the microorganisms that are normally present on the skin). Treated with erythromycin

Answer 19

``` Liver disease Iron deficiency anaemia Polycythaemia (ruddy coplexion, gout, peptic ulcer disease) Chronic kidney disease Lymphoma ``` Other causes.. - hyper and hypothyroidism - diabetes - pregnancy - senile pruritis - urticaria - skin disorders; eczema, scabies, psoriasis, pityriasis rosea

Answer 20

``` Fitzpatrick Type 1= never tans, always burns Type 2= usually tans, always burns Type 3= always tans, sometimes burns 4= always tans, rarely burns 5= sunburn and tanning after extreme UV exposure 6= black skin never tans and never burns ```

Answer 21

Symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin Causes. - type 2 diabetes mellitus - GI cancer - obesity - PCOS - acromegaly - cushing’s - hypothyroidism - familial - prader willi syndrome - drugs; COCP, nicotinic acid

Answer 22

Photosensitive butterfly rash Discoid lupus Alopecia Livedo reticularis (net like rash)

Answer 23

A chronic, painful, inflammatory skin condition which is characterised by nodules, pustules, sinus tracts and scars in intertriginous areas

Answer 24

Women are more likely to develop it Most commonly affects adult under 40 ``` Risk factors- FH Smoking Obesity, diabetes, PCOS Mechanical stretching of skin ```

Answer 25

Propionibacterium acnes is the bacteria that contributes to the development of acne

Answer 26

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population.

Answer 27

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds otitis externa and blepharitis may develop

Answer 28

HIV | Parkinsons

Answer 29

Scalp disease management over the counter preparations containing zinc pyrithione ('Head & Shoulders') and tar ('Neutrogena T/Gel') are first-line the preferred second-line agent is ketoconazole selenium sulphide and topical corticosteroid may also be useful Face and body management topical antifungals: e.g. ketoconazole topical steroids: best used for short periods difficult to treat - recurrences are common

Answer 30

Pyoderma gangrenosum is associated with inflammatory bowel disease (this patient had a stoma for Crohn's). It is commonly found on lower limbs and described as being painful, the size of an insect bite and growing. It looks like a Margherita pizza (with a red base and yellow topping) Treatment involves steroids. It would be rare for a poorly fitting appliance to cause a deep painful ulcer.

Answer 31

Trauma Alcohol Drugs- beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDS and ACE-I, infliximab Withdrawal of systemic steroids Streptococcal infection may triggee guttate psoriasis

Answer 32

Pityriasis versicolor, also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

Answer 33

Pityriasis versicolor, also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

Answer 34

most commonly affects trunk patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan scale is common mild pruritus

Answer 35

Occurs in healthy individuals Immunosuppression Malnutrition Cushings

Answer 36

topical antifungal. NICE Clinical Knowledge Summaries advise ketoconazole shampoo as this is more cost effective for large areas if failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole

Answer 37

nose, cheeks and forehead | flushing, erythema, telangiectasia → papules and pustules

Answer 38

Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm. Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

Answer 39

excessive exposure to sunlight / psoralen UVA therapy actinic keratoses and Bowen's disease immunosuppression e.g. following renal transplant, HIV smoking long-standing leg ulcers (Marjolin's ulcer) genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

Answer 40

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge .

Answer 41

Around 10-15% of people will have one or more spider naevi and they are more common in childhood. Other associations liver disease pregnancy combined oral contraceptive pill

Answer 42

A common skin infection caused by molloscum contagiosum virus

Answer 43

Typically, molluscum contagiosum presents with characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter. Lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet). In children, lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur. In adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen. Rarely, lesions can occur on the oral mucosa and on the eyelids.

Answer 44

Self care advice... Reassure people that molluscum contagiosum is a self-limiting condition. Spontaneous resolution usually occurs within 18 months Explain that lesions are contagious, and it is sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings) Encourage people not to scratch the lesions. If it is problematic, consider treatment to alleviate the itch Exclusion from school, gym, or swimming is not necessary Treatment is not usually recommended - squeezing with fingernails or piercing lesions may be tried Treatment should be limited to a few lesions at a time

Answer 45

Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis. Diagnosis skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis Management gluten-free diet dapsone

Answer 46

itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms rash often polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae) Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma) oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa nails: thinning of nail plate, longitudinal ridging

Answer 47

potent topical steroids are the mainstay of treatment benzydamine mouthwash or spray is recommended for oral lichen planus extensive lichen planus may require oral steroids or immunosuppression

Answer 48

Lichen planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over surface. Oral involvement common sclerosus: itchy white spots typically seen on the vulva of elderly women

Answer 49

``` Polycystic ovarian syndrome is the most common causes of hirsutism. Other causes include: Cushing's syndrome congenital adrenal hyperplasia androgen therapy obesity: thought to be due to insulin resistance adrenal tumour androgen secreting ovarian tumour drugs: phenytoin, corticosteroids ```

Answer 50

advise weight loss if overweight cosmetic techniques such as waxing/bleaching - not available on the NHS consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding

Answer 51

drugs: minoxidil, ciclosporin, diazoxide congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis porphyria cutanea tarda anorexia nervosa

Answer 52

Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure

Answer 53

small, crusty or scaly, lesions may be pink, red, brown or the same colour as the skin typically on sun-exposed areas e.g. temples of head multiple lesions may be present

Answer 54

prevention of further risk: e.g. sun avoidance, sun cream fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects topical imiquimod: trials have shown good efficacy cryotherapy curettage and cautery

Answer 55

A common benign tumour of adipocytes

Answer 56

Features- lump will be smooth, mobile, painless Diagnosis is clinical If diagnosis is uncertain or compressing on surrounding structures then it may be removed

Answer 57

Pain Increasing size >5cm Deep anatomical location

Answer 58

It is more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash On examination, monomorphic punched out erosions (1-3mm in diameter are typically seen) It is potentially life threatening and therefore children should be admitted for IV aciclovir

Answer 59

Eczema herpeticum describes a severe primary infection of the skin by herpes simplex virus 1 or 2.

Passmed Flashcards

(83 cards)