Week 2 Flashcards by Jenna Cook

What are some possible consequences to steroid use?

Thinning skin
Purpura (purple areas non-blanching)
Stretch marks
Steroid rosacea
Perioral dermatitis
Fixed talangectasia (blood vessels showing through skin)
Glycoma

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Give an example of a steroid in the mild, moderate, potent and very potent class

Mild; hydrocortisone
Moderate; butyrate
Potent; betamethasone
Very potent; clobetasol proprionate

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What is the advantage to using tacrolimus over betamethasone?

Same strength as the steroid but doesnt cause local side effects. Used to suppress lymphocyte action

Used to treat eczema

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What is the role of antiseptics? Examples?

Used for reccurent infections, acute exudative eczema, instead of antibiotics
Potassium permanganate soak, povidone iodine, chlorhexidine, tricosan, hydrogen peroxide

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Women presents with candida infection of the vagina, treatment?

Nystatin ointment , clotrimazole

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Man presents with athletes foot what is the causative organism? Treatment?

Dermatophytes (ring worm)

Antifungal- nystatin or clotrimoxazole

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What is the treatment for warts?

Mechanical removal and one of keratolytics, formaldehydes, glutaraldehyde, silver nitrate

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What are some of the red flags for drug allergies manifesting in the skin?

AngiOedema, high fever, blistering, arthalgia

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Man presents with a symmetrical wide distrubuted rash with an intense itch and mild fever. He was started on antibiotics 2 days ago. What likely cause?

Penicillins, beta lactams

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Man 60yrs presents with bullous pemphigoiD (Dermis) he recently started new medications. Likely causes?

ACE inhibitors
Furosemide

Vancomycin, penicillin

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What are some of the severe consequences of cutaneous drug reactions

Steven johnson syndrome (fever then painful red/purple rashes that spread and blister)

Toxic epidermal necrolysis (sheeting off of the epidermis)

Drug reaction with eosinophilia and systemic symptoms (DRESS) High fever

Acute generalised exanthematous pustulosis (RARE)

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What are some drugs that cause the same reaction when re-exposed and can leave hyperpigmentation

Doxycyline
Paracetamol
NSAIDS
Carbamazepine

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What major drug classes commonly cause cutaneous drug eruptions

Antibiotics; tetracuclines, paracetamol, NSAIDS, anti-epileptics [ carbazepine, pheytoin ]

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Photosensitive drugs are immunological so only affect certain people. T/F

F not immunological can happen to anyone

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Presentation for photosensitivity from drugs? Common causes?

Redness, prickly skin, exaggerated tanning, skin fragility

Doxycycline, thiazide diuretics, calcium antagonists, quinine, PPI, antibiotics

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You do a culture and it appears golden with grape like bunches, it is coagulase positive and gram positive. Organism?

Staphylococcus aureus

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How would you treat non- methicillin resistant staph aureus ?

Flucoxacillin

If allergic then vancomycin

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How do you treat MRSA?

Doxycyline oral
Co-trimoxazole
Clindamycin

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What are some of the toxins involved with staph aureus

PVL
Enterotoxin
Staphylococcal scalded skin syndrome toxin ( SSST)

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You culture an organism that appears white on agar, is coagulase negative and gram positive. Likely organism?

Staphylococcus epidermis

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What organism can cause imeptigo, cellulitis, erysipelas, necrotising fascititis? Treatment

Strep pyogenes

If just group A beta haemolytic strep then penicillin if both group A and staph aureus then flucloaxacillin

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You do a skin biopsy and staph epidermis, corneybacterium (diptheroids) and propionibacterium come back. Treatment?

Nothing

Skin commensals

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What is tinea pedis? Causative organsim? Treatment?

Athletes foot (eczema)
Caused by tichophyton rubrum - ring worm
Clotrimoxazole (canestan)

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Women presents with intensely itchy rash on the writsts and in the finger webs, there are some linear burrows. She recently went to a youth hostel. Diagnosi? Treatment?

Scabies

Malathian lotion

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Child of 2 years presents with an all over rash and fever. Mom says it was just raised ares, that then got bigger and fluid filled and now they’ve popped and became scabby. Diagnosis? Causative organism?

Chicken pox | Varicella virus

Why does shingles cause infection to a dermatome?

As when the varicella virus of chicken pox self limits it becomes dormant in the dorsal root ganglion in the sensory nerve roots. So if reactivated will move along a nerve fibre

Young women presents with white itchy areas in her mouth looking quite angry and some vesicles around the vermillion border. Shes just finished freshers week. Diagnosis?

Herpes simplex virus

What treatment couldbe given to shorten the duration of a herpes simplex virus/ chicken pox?

Aciclovir

What virus commonly causes warts?

Human papilloma virus

Child presents with small, blister like ulcers in the mouth roof and back of the throat. They have a sore throat, fever and headache. Diagnosis? Causative organism?

Herpangina | Enterovirus (coxsackie A/ echovirus)

Young child presents with joint pain in her wrists and a rash that looks like a slap across the cheek. Its occured suddenly over last few days

Erythema infectiosum by parvovirus B19 Investigate with blood test for antibodies

Young gay man presents with ulcers in his mouth like snail tracks and a red discontinous spotted rash prominent on the soles of feet and palms of the hands. Its not itchy. Diagnosis? Treatment?

Syphilis. Penicillin

Avid hiker presents with a spreading rash originating on his right lower calf. It has a raised palpable edge and looks like a bullseye. He has a headache and is fatigued. Diagnosis? Treatment?

Rash called erythema migrans Ticks- borelia burgdorferi Treat with doxycylin or amoxicillin

Boy presents with wide spread macular red rash, conjuctivitis, dry cough. He hasn’t been immunised. Diagnosis?

Measles

Young pregnant women contracts zika virus from mosquitos while on holiday. What is the potential consequence to the child?

Microcephaly

What is the significance of parakeratosis on histology?

Persistence of nuclei in the keratin layer indicates that the epidermis is turning over too quickly

Definition of acanthosis? How can this occur??

The thickening of the epithelium Persistent scratching

Papillomatosis definition?

A thickening of the epithelial band abnormally in a wave like pattern

Histology of a sample indicates fluid intercellularly in the epidermis. What is the term for this and what is it a hallmark for?

Spongiosis | Eczema

Female presents with well defined patches with scale on the backs of her elbows and fronts of her knees, she has been experiencing pain in her wrists and knees recently. Nails have onycholysis. She ; Diagnosis?

Psoriasis | Extensor surfaces, joint pain, nail deformities

Name some Vit D analogues used to treat psoriasis

Calcipotriol | Calcitriol

Name some systemic treatments against psoriasis

``` Methotrexate (immunosuppress) Immune modulation (TNF-alpha blockers) ```

Histologically a specimen presents with an irregular sawtooth acanthosis and a band of upper dermal infiltrates of lymphocytes. Patient describes very itchy macuoles and has a white reticular network in the mouth. Diagnosis?

Lichenoid eruptions

What is the treatment for lichenoid eruptions?

Topical steroids, UV treatment

IgG autoantibodies detected in the prickle cell layer against desmogelin 3. Diagnosis?

Pemphigus (Superficial layer) results in fragile blistering (nikolsky test) and acantholysis

Elderly man presents with blistering, it is nikolsky negative, and well defined. It was previously an itchy rash. Diagnosis?

Bullous pemphigoid; blister beneath the epidermal surface

Man with known coeliac disease presents with small lesions on the knees, elbows and buttocks. What is this ?

Dermatitis herpetiformus

What are some of the treatments for acne?

``` Benzoyl peroxide Vit A derivatives like retinoids Antibiotics Oral antibiotics for anti-inflam Oral retinoid (isotretinoin) ```

Complications of acne?

Keyloid scarring Hypertrophic scarring Atrophic scarring Ice-pick scarring

What is the distinguishing feature of rosacea compared to acne?

NO COMEDONES

Man presents with a sagittal rash in the umbilical region of the abdomen just above the waist line. It is scaly, red and itchy. What is the likely diagnoses. Tests to do?

Nickel allergy to a belt buckle | Patch testing

What cell type mediates contact allergic dermatitis?

Langerhan cells

What is the difference between contact allergic dermatitis and irritant contact dermatitis?

Contact allergic is immune mediated | Irriatant contant is a non-specific irritation like detergents, soap and water

Women presents for a check up and has lichenified skin on her hands, some elevated plaques with excoriation and significant scaling. She also has asthma. What was her diagnosis?

Eczema

Women with eczema presents with infection in her eczema areas. Probable organism?

Staph aureus

Women with known eczema presents with monomorphic punched out lesions that started on the backs of her knees and has since spread. Diagnosis?

Herpes simplex virus causing eczema herpeticus

Genetic tests show women has mutated fillagrin gene. Clinical significance?

Skin loses barrier function as fillagrin allows the binding of the corneocytes in the keratin layer. More likely to get severe eczema and have hyperlinear palms (more lines in the skin)

Man presents with a circular papulovesicular rash that was scaling and itchy. It was present on the backs of his knees and the inner of his elbows. Diagnosis?

Discoid eczema

What is the step up treatment for eczema?

Avoidance of irritants, emollients, steroids (mild-> potent)/ calcineurin inhibitors (tacrolimus), phototherapy

What nerve fibres mediate an itch?

Spinothalamic nerve fibres

What are the four typed causes of itch?

Pruritoceptive (within skin) Neuropathic itch (damaged nerves like in MS) Neurogenic (CNS stimulated e.g opiates) Psychogenic (believe something but unreal)

Name some mediators that mast cells release?

``` Proteases like tryptase Heparin (can cause osteoporosis) Histamine Cytokines Platelet activating factor Leukotrienes Prostaglandins ```

Man presents with tinea pedis infection on his nails. Treatment?

Oral terbinafine

If applying sterpid to whole body how much would need per day for oncea day?

20-30g

What endocrine condition can occur due to excessive steroid use?

Cushings syndrome

What anti-itch medication is used post treatment of scabies?

Crotamiton

Give an example of a keratolytic

Salicylic acid

Child presents with fleshy nodules with a depression in the centre, they are really itchy and spread across the body. What is the likely diagnosis?

Molluscum congtagiosum No treatment only if eye then do liquid nitrogen, self limiting but may take up to 18 months

Man presents with very itchy maculous with a shiny top, he was recently started on ACE inhibitor for his blood pressure. Likely diagnosis?

Lichen planus

Week 2 Flashcards

(69 cards)