4.10 Dermatology

Front 1

Primary Syphilis = ?

Back 1

Painless chancre

Front 2

Secondary Syphilis = ?

Back 2

1. Papules
2. Headache
3. Fevers
4. Arthralgias + Myalgias
5. Generalized Lymphadenopathy

6. Painless mucous membrane lesions

Appear 2-10 weeks after primary chancre

Front 3

Tertiary Syphilis = ?

Back 3

1. General paresis
2. Aortitis {with aneurysms}
3. Optic atrophy : Argyll - Robertson pupil

[ non constrictive to light ; constrict to accommodation ]

Highly specific sign of Neurosyphilis

4. Tabes Dorsalis

5. Dementia
[ In poorly treated / untreated syphilis]

Front 4

Name of reaction that can occur after

antibiotic treatment of secondary syphilis ?

Back 4

" Jarisch - Herxheimer reaction"

Front 5

What skin lesion initially is an erythematous macule, that evolves into a necrotic, purpuric vesicopustule - asymmetric, and distally placed {hands} ?

Back 5

Disseminated gonococcus.

Front 6

5 Features of Disseminated Gonococcus ?

Back 6

1. Systemic septic vasculitis
2. Due to Neisseria gonorrhoea
3. Lesions are :

- asymmetric macules

- distal

- evolve into necrotic purpuric vesicopustules

4. Associated with urethritis + arthralgia
5. Mx with cephalosporin

Front 7

SCORTEN severity score for Toxic Epidermal Necrolysis {TEN} ?

Back 7

S ugar > 14 mmol/L

Cancer / Haematological malignancy

Older age > 40

Rate -HR > 120 / min

Total HCO3 < 20

Epidermal detachment > 10% BSA Day 1

Nitrogen / Urea > 10

Front 8

SCORTEN mortality prediction scoring ?

Back 8

0-1 3% 5%
2 12% 10%
3 33% 30%
4 60% 60%
>5 90% 90%

Front 9

Papule Definition ?

Back 9

• Circumscribed
• firm
• raised
• < 0.5 cm diameter
  

Front 10

Nodule Definition ?

Back 10

• Solid
• firm
• elevated
• palpable
• > 0.5 cm
  

Front 11

Purpura Definition ?

Back 11

• Skin / mucous membrane
• discolouration
• due to RBC extravasation
  

Front 12

Pustule Definition ?

Back 12

• Visible accumulation of yellow fluid
• In form of vesicle / papule
• containing fluid.
  

Front 13

Vesicle definition?

Back 13

• Visible accumulation of clear, serous fluid
• in papule < 5mm
  

Front 14

Blister / Bulla Definition ?

Back 14

• Visible accumulation of fluid
• usually large : > 5mm.
  

Front 15

Plaque Definition?

Back 15

• An area / sheet of elevated skin
• with distinct edge
• usually > 1cm
  

Front 16

Sweet Syndrome ?

[5 features]

Back 16

1. "Acute febrile neutrophilic dermatosis"
2. Tender lesions -demarcated plaques to head and upper extremities
3. Unknown cause ? immunological
4. Many Associations:
- malignancy {20%} AML / breast Ca
- IBD
- autoimmune disease
- infections [bacterial and viral]
5. females > males 4:1

Front 17

Causes of Erythroderma ?

Back 17

1. Eczema 40%
2. Psoriasis 22%
3. Drugs 15%
4. Lymphoma 10% [ Sezary Syndrome]
5. Idiopathic 8%

Front 18

MOST common causes of vesicular / bullous

skin rash?

Back 18

1. Viral [ Herpes simplex ; herpes zoster ]
2. Impetigo
3. Drugs [ sulphonamides / penicillin ]
4. Scabies
5. Insect bites / papular urticaria
6. Bullous eczema / pompholyx

Front 19

LESS Common Causes of vesicular / bullous skin rash?

Back 19

1. Erythema Multiforme [ Minor / Major ]

[ target lesion + mm involvement]
- Mycoplasma / HSV ** / Drugs [ sulphonamides/penicillins]

Idiopathic [ 50% ]

2. SJS and TEN
[ anticonvulsants / NSAIDS / sulphonamides
penicillins ]
3. Staphylococcal scalded skin syndrome (SSSS)
4. Pemphigus and pemphigoid

Front 20

Difference between Bullous pemphigoid {BP} and Pemphigus vulgaris {PV} ?

Back 20

Bullous pemphigoid

= autoantibodies to EPIDERMAL BASEMENT MEMBRANE
= tense bullae
Pemphigus vulgaris

= autoantibodies to Epidermal karatinocytes

= flaccid bullae

Front 21

Treatment of bullous pemphigoid /

pemphigus vulgaris ?

Back 21

1. Steroids
2. Immunosuppressants
- Azathioprine
- MTX
- Cyclophosphamide
3. Burns Unit Mx if widespread

Front 22

Causes of PALPABLE purpura ?

Back 22

1. Polyarteritis nodosa (PAN)
2. Henoch Schonlein Purpura (HSP)
3. Infective
- meningococcaemia
- gonococcaemia
- staphylococcus
- ricketssial {RMSP]
- enteroviruses
4. Embolic
5. Allergic [leukocytoclastic]

Front 23

Classes for Causes of NON-PALPABLE purpura?

Back 23

( Broad categories )

1. Non-thrombocytopenic
2. Thrombocytopenic
a. With splenomegaly
b. Without splenomegaly

Front 24

Causes of Non-thrombocytopenic

non-palpable purpura ?

Back 24

1. Cutaneous ( Trauma / Sun / steroids / ageing)
2. Systemic Disorders
a. Uraemia
b. Von-Willebrand's Disease
c. Scurvy
d. Amyloid

Front 25

Classification for Causes of

Thrombocytopenic Non-palpable purpura?

Back 25

1. With splenomegaly
a. normal marrow
b. abnormal marrow
2. Without splenomegaly
a. Normal marrow
b. abnormal marrow.

Front 26

Non-palpable purpura: thrombocytopenia WITH SPLENOMEGALY-causes ?

Back 26

1. Normal marrow
a. Liver disease + portal HTN
b. Myeloproliferative disorders
c. Lymphoproliferative disorders
d. Hypersplenism
2. Abnormal marrow
a. Leukaemia
b. Lymphoma
c. Myeloid metaplasia

Front 27

Non-palpable purpura : thrombocytopenia WITHOUT SPLENOMEGALY-causes ?

Back 27

1. Normal marrow
a. Immune
- idiopathic [ITP] / drugs / infections [ HIV]
b. Non-immune
- vasculitis / sepsis / DIC / HUS / TTP
2. Abnormal marrow
- Cytotoxics / aplasia / fibrosis / infiltration / alcohol / THIAZIDES

Front 28

Associations of Pyoderma gangrenosum?

Back 28

1. IBD inflammatory bowel disease
2. RA rheumatoid arthritis
3. Blood dyscrasias
4. Behcet's Syndrome
5. Malignancy [ myeloma / leukaemia ]

Front 29

Categories for classifying pruritis?

Back 29

1. With skin disease
2. Without skin disease

Front 30

Pruritis + skin disease causes? [10]

Back 30

1. Drugs
2. Urticaria
3. Eczema
4. Contact dermatitis
5. Scabies
6. Insect bites
7. parasites [ roundworm]
8. Lichen planus
9. pityriasis rosea
10 . dermatitis herpetiformis

Front 31

Pruritis WITHOUT skin disease causes ? [6]

Back 31

1. Hepatobiliary

[ jaundice , primary biliary cirrhosis]
2. Chronic renal failure {CRF}
3. Haematological [ lymphoma / PRV ]
4. Endocrine [ myxoedema ; thyrotoxicosis]
5. Carcinoma [ lung ; stomach ]
6. Drugs

Front 32

What are the 3 main categories causes of

Erythema Multiforme ( EM ) ?

Back 32

1. Infection : Herpes Simplex Virus (HSV) / Mycoplasma
2. Drugs: Sulphurs / penicillins

3. Idiopathic : 50%

Front 33

What is the overlap of Body Surface Area (BSA)

classification for Stevens-Johnson Syndrome and TEN?

Back 33

SJS = 10% BSA and 5 % mortality
TEN > 30% BSA and 20-30% mortality

Overlap occurs between 10-30% BSA

Front 34

Which is incorrect regarding Toxic Epidermal Necrolysis (TEN) ?
A. It is more common in Females ( 1.5 : 1 )
B. Is it due to drugs in 90% cases
C. It is more common in the young
D. It is more common in the immunocompromised (HIV ; Lymphoma )

Back 34

C. Increasing age

Front 35

Which is correct regarding SJS ?
A. It is due to drugs in 25% cases.
B. It is more common in Females.
C. It is strongly associated with Mycoplasma pneumoniae.
D. It is more common with increasing age..

Back 35

C.

A = drugs in 50% cases
B = Males
D. It is more common in younger age groups.

Front 36

Which is incorrect regarding SJS ?
A. Target lesions are commonly found.
B. Skin pain and dusky purpuric skin changes heralds the onset of

epidermal destruction.
C. Blistering and epidermal shedding ( desquamation) are Clinical

features.
D. Flu-like symptoms can precede or coincide with the skin blistering.

Back 36

A. Occassional - makes differentiation from EM difficult.

Front 37

Which is incorrect regarding the Management of SJS and TEN ?
A. Immediate cessation of all possible causative drugs is essential -

and has been shown to reduce mortality.
B. Patients with SJS are best treated in a Burns Unit.
C. Ophthalmology Consultation is essential.
D. Ocular complications can be devastating .

Back 37

B. TEN = Burns Unit

Front 38

Which is incorrect regarding SJS and TEN ?
A. High dose IV immunoglobulin and systemic corticosteroids are proven treatments.
B. There is no current accepted therapy for SJS and TEN.
C. Corneal rupture and blindness can occur.
D. Supportive Care is the mainstay of management.

Back 38

A. Controversial