Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Core clinical problems > 37. Itch > Flashcards

37. Itch Flashcards

1
Q

History taking PC: itch

A

HoPC: timing, severity, location, crawling sensation? Prickling sensation? Burning? Relieving factors?
Red flags: weight loss, night sweats, fatigue, fever, lumps
Nocturnal itch may suggest
MHx: any skin problems, any liver problems, any kidney problems
DHx:
FHx: haematological cancers?, autoimmune problems, atopy?
SHx: alcohol (liver), living conditions, anyone else got an itch?, stress
ICE: impact on persons life and mental wellbeing/confidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Examination: itch

A

General: skin colour (jaundiced?plethroic?), skin lesions, scratch marks, pattern of rash?, signs of iron deficiency anaemia? weight loss? weight gain?
Lymph nodes: lymphadenopathy?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

surgical sieve PC:itch

A

Vascular
Immune/infectious: scabies, eczema, psoriasis
Trauma:
Autoimmune: urticaria, thyroid, diabetes
Metabolic: liver pathology, renal failure, cholestasis, iron deficiency anaemia
Iatrogenic: drugs?
Neoplastic: lymphoma, polycythaemia vera
Congenital: liver problem?
Degenerative:
Environment: allergic to cosmetic
Functional: prolonged itch,
Psychiatric: parasitosis,
Pregnancy:

Topical:
Infection : scabies
Immune : eczema, psoriasis, urticaria
Allergy: contact dermatitis, allergic to cosmetic

Systemic:
- metabolic: diabetes, iron deficiency anaemia, allergy to drug
- autoimmune : thyroid pathology
- organ: liver failure, cholestasis, renal failure
- neoplastic : lymphoma, polycythaemia Vera

Functional : prolonged itch
Psychiatry : parasitosis
Pregnancy: liver things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Plan invetsigation widespread itch with no rash?

A

Skin:
Inflammatory markers such as ESR and/or CRP

Systemic:
Liver: LFTs, viral hepatitis serology
Metabolic: FBC, U&E, iron studies, TFTs, HbA1c
Neoplastic: FBC, blood film, bone chemistry
CXR
Pregnancy: pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

severe itch with skin marks and scratch marks present for 2 weeks and getting worse, itch worse at night time- impacting sleep,

A

scabies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

typical history and examination scabies

A

PC: severe itch with skin marks and scratch marks present for 2 weeks and getting worse
HoPC: itch worse at night time- impacting sleep,
Red flags: no fever, no weight loss, some fatigue but thinks this is due to reduced sleep due to itch, no night sweats, no lumps
MHx: none
DHx: none
Allergies: nkda
FHx: none
SHx: 1st year at uni, new sexual partner also experiencing severe itch
ICE: sleep is severely affected and is affecting uni work, skin marks affecting confidence, concerned it is infectious as her partner is having the same problem - is embarrassed to talk to anyone about it

o/e: Widespread erythematous papules on fingers, front of torso, genitalia, extensor surfaces of arms, scratch marks, thread-like tracks measuring around 5–10 mm in between fingers,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pathophysiology scabies

A

Scabies is a transmissible skin disease caused by the ectoparasitic mite Sarcoptes scabiei var. Hominis.

Itch is due to a delayed type-IV hypersensitivity reaction to the mite and mite products (faeces and eggs) so symptoms appear 4-6 weeks after infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Plan ?scabies

A

Management:
Permethrin 5% cream
Inform close contacts
Wash bedding and clothes at 60 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

typical history urticaria

A

PC: widespread rash that came up yesterday
HoPC: itchy, burning sensation
Red flags: no throat swelling, no difficulty breathing, has an epi-pen on her,
MHx: asthma, current URTI, has been taking ibuprofen as feels rubbish, has had this type of rash in the past
DHx: blue inhaler, brown inhaler
Allergies: egg
SH: none
ICE:

o/e: widespread areas of raised patchy skin swelling (weals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

triggers urticaria

A

classic allergy: food allergy, bee sting, contact urticaria-rubber latex

infection:acute infection

drugs: antibiotics, NSAIDs, vaccination, radiocontrast,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

plan ?urticaria

A

Management:
non-sedating antihistamines are first-line eg: cetirizine, loratadine, and fexofenadine
prednisolone is used for severe or resistant episodes

In children: cetirizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pathophysiology urticaria

A

type 1 hypersensitivity

Weals are due to release of chemical mediators from tissue mast cells and circulating basophils. These chemical mediators include histamine, platelet-activating factor and cytokines. The mediators activate sensory nerves and cause dilation of blood vessels and leakage of fluid into surrounding tissues. Bradykinin release causes angioedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

typical history polycythaemia vera

A

PC: Pruritus particularly after warm bath
HoPC:
Red flags: fatigue, weight loss, night sweats, fever
MHx: previous DVT, previous stroke,
DHx:
FHx:
SHx:
ICE:
o/e: ruddy complexion, splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

pathophysiology polycythaemia vera

A

uncontrolled proliferation of a single type of stem cell: in PV this is erythroid cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

plan ?polycythaemia vera

A

Investigation:
diagnosis: JAK2 + raised haematocrit or if not JAK2 more complicated

bloods:
FBC - inc haematocrit (high)
Ferritin - low in primary, normal in secondary
JAK2 mutation
U&E, LFTs

Management:
- aspirin: reduces the risk of thrombotic events

  • venesection (first-line treatment to keep the haemoglobin in the normal range)
  • chemotherapy (hydroxyurea - slight increased risk of secondary leukaemia, phosphorus-32 therapy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

complications polycythaemia vera

A

can lead to secondarily myelofibrosis or acute myeloid leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

typical history atopic dermatitis

A

PC: rash, general dry skin, itchiness in flexures. In infants=face and trunk, in slightly older = extensor surfaces, >4 in flexures
HoPC:
Red flags:
Environment: triggers: irritants eg soaps, detergents, food allergy (particularly in children), house dust mites, pollens, pets, stress, hormonal changes
MHx:
DHx:
Allergies:
FHx: family history of atopy. Genetic mutations affecting production of filaggrin
SHx:
ICE:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

plan ?atopic dermatitis

A

Emollient 500g/week for an adult, 250g/week for a child

Steroid ladder (mild if face) HEAD Hydrocortisone, Eumovate, Betnovate, Dermovate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

name 2 thin emollients and 2 thick emollients

A

thin:
Diprobase cream
cetraben cream
E45
Aveeno

thick:
diprobase ointment
cetraben ointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

typical history contact dermatitis

A

PC: dermatitis following direct skin contact with irritant - most commonly on the hands
HoPC:
Red flags:
Environment: work involves irritants, new job
MHx: none, no atopy
DHx:
Allergies:
FHx:
SHx:
ICE:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

plan ?contact dermatitis

A

Avoid irritant
Emollient
Steroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

inflamed greasy areas with fine scaling, locations: beard area, nasolabial folds, eyelashes/eyebrows, behind ear, scalp

A

seborrhoeic dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

typical history seborrhoeic dermatitis

A

PC: inflamed greasy areas with fine scaling, locations: beard area, nasolabial folds, eyelashes/eyebrows, behind ear, scalp
HoPC:
Red flags:
Environment: change of season, stress,
MHx: may have HIV or recent illness,
DHx: certain medications eg buspirone, chlorpromazine, cimetidine, griseofulvin, haloperidol, lithium, interferon alfa and methyldopa
Allergies:
FHx:
SHx:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pathophysiology seborrhoeic dermatitis

A

affects areas rich in sebaceous glands (​​microscopic glands found in your hair follicles that secrete sebum) so is most common on face, scalp and chest. Inflammatory reaction to yeast called malassezie spp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
plan ?seborrhoeic dermatitis
Investigation: 1. Consider HIV testing Management Adults + Non-greasy emollient soaps + Olive oil leave on and rub scales off 1. Ketoconazole 2% shampoo or cream depending on area Children + Non-greasy emollient soaps + Olive oil leave on and rub scales off 1. A topical imidazole cream (clotrimazole 1% or miconazole 2%)
26
larger plaques, elbows, knees and lower back, and scalp. silvery scale. Kobhner phenomenon- new plaques at sites of skin trauma
Chronic plaque psoriasis
27
widespread small papules/plaques, trunk and limbs
Guttate psoriasis
28
redness in body folds/genitals
?flexural psoriasis
29
what are the psoriasis nail signs
pitting, onycholysis, arthritis
30
Typical history psoriasis
Chronic plaque psoriasis: larger plaques, elbows, knees and lower back, and scalp. silvery scale. Kobhner phenomenon- new plaques at sites of skin trauma Guttate psoriasis: widespread small papules/plaques, trunk and limbs Flexural psoriasis: affects body fold and genitals HoPC: Red flags: Environment: stress, skin trauma, MHx: recent strep throat in guttate psoriasis DHx: lithium FHx: SHx: ICE: o/e: nail signs: pitting, onycholysis, arthritis
31
genetic associations psoriasis
HLA-B13, -B17, and -Cw6.
32
General management psoriasis
+ Improved by sunlight + Regular emollients 1. Potent corticosteroid once daily and vitamin d analogue once daily (separate times) for up to 4 weeks 2. Vitamin d analogue twice daily for 8 weeks 3. Potent corticosteroid twice daily for 4 weeks or coal tar prep applied once or twice daily Secondary care management: Phototherapy UVB 3x per week Methotrexate
33
Management scalp psoriasis
1. Potent corticosteroid once daily for 4 weeks 2. Different formulation
34
Management face/flexural/genital psoriasis
1. Mild/moderate potency corticosteroid once or twice daily for maximum 2 weeks
35
Time limits on topical steroid use?
- Potent steroids no longer than 8 weeks at a time - Very potent corticosteroids for no longer than 4 weeks at a time NICE recommend that we aim for a 4-week break before starting another course of topical corticosteroids
36
when may topical steroids cause systemic effects?
systemic side-effects may be seen when potent corticosteroids are used on large areas e.g. > 10% of the body surface area
37
limits on corticosteroids face/flexures/genitals
no more than 2 weeks in a month
38
side effects of topical corticosteroids
skin atrophy striae rebound symptoms - burning, redness, and itchy skin. Steroid cream withdrawal symptoms may be worse than the skin condition you were taking the steroids to treat.
39
Examples of vitamin D analogues
calcipotriol (Dovonex), calcitriol and tacalcitol
40
how do topical vitamin D analogues work
they work by ↓ cell division and differentiation → ↓ epidermal proliferation they tend to reduce the scale and thickness of plaques but not the erythema
41
Restrictions on topical vit D analogues
they should be avoided in pregnancy the maximum weekly amount for adults is 100g
42
rapidly developing widespread erythema, followed by the eruption of white, sterile non-follicular pustules which coalesce to form large lakes of pus.
pustular psoraisis emergency same day derm appt
43
diffuse, widespread severe psoriasis that affects more than 90% of the body surface area
erythrodermic psoriasis emergency same day derm appt
44
what is lichen planus
autoimmune skin codnition itchy, papular rash most common on the palms, soles, genitalia, oral mucosa and flexor surfaces of arms rash often polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae)
45
pattern of lichen planus
palms, soles, genitalia and flexor surfaces of arms, oral involvement
46
what can cause lichenoid drug eruption
gold quinine thiazides
47
management of lichen planus
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
48
causes pruritus ani
Idiopathic Secondary to Skin conditions Infection eg threadworms Rectal and anal pathology Systemic causes of itch
49
approach to pruritus ani
assessment hx as any other itch examine area and skin for skin conditions invgn swab lower GI invgn if suspected skin biosy if suspected if symptoms dont settle, blood tests for itch eg FBC, ferritin etc.
50
PC threadworms
usually children perianal itching, particularly at night girls may have vulval symptoms
51
management threadworms
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists. for all members of the household hygiene measures
52
causes of pruritis vulvae
irritant contact dermatitis (e.g. latex condoms, lubricants): most common cause atopic dermatitis seborrhoeic dermatitis lichen planus lichen sclerosus psoriasis: seen in around a third of patients with psoriasis
53
most common cause pruritis vulvae
irritant contact dermatitis (e.g. latex condoms, lubricants)
54
general advice pruritus vulvae
In relation to washing: avoid baths, shower instead only 1ce a day clean w emollient such as epaderm
55
what is lichen sclerosus
Lichen sclerosus is a chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin. It commonly affects the labia, perineum and perianal skin in women. It can affect other areas, such as the axilla and thighs. It can also affect men, typically on the foreskin and glans of the penis.
56
symptoms lichen sclerosus
Itching Soreness and pain possibly worse at night Skin tightness Painful sex (superficial dyspareunia) Erosions Fissures The Koebner phenomenon
57
o/e lichen sclerosus
“Porcelain-white” in colour Shiny Tight Thin Slightly raised There may be papules or plaques
58
managenment lichen sclerosus
Potent topical steroids usually clobetasol propionate 0.05% (dermovate)
59
complication lichen sclerosus
5% risk of developing squamous cell carcinoma of the vulva.
60
what are varicose veins
Varicose veins are dilated, tortuous, superficial veins that occur secondary to incompetent venous valves, allowing blood to flow back, away from the heart.
61
reflux in what veins are most common varicose veins
reflux in the great saphenous vein and small saphenous vein
62
risk factors varicose veins
increasing age female gender pregnancy - the uterus causes compression of the pelvic veins obesity
63
presentation varicose veins
PC: cosmetic issue PC symptomatic: aching, throbbing, itching PC: a complication of varicose veins
64
complications of varicose veins
varicose eczema (also known as venous stasis) haemosiderin deposition → hyperpigmentation lipodermatosclerosis → hard/tight skin atrophie blanche → hypopigmentation bleeding superficial thrombophlebitis venous ulceration deep vein thrombosis
65
invetsigation varicose veins
venous duplex ultrasound: this will demonstrate retrograde venous flow
66
management of varicose veins
mainly conservative: leg elevation weight loss regular exercise graduated compression stockings if meet criteria for secondary care: endothermal ablation foam sclerotherapy surgery
67
reasons for rf to secondary care - varicose veins
symptomatic: significant/troublesome lower limb symptoms e.g. pain, discomfort or swelling complication: skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema) superficial thrombophlebitis an active or healed venous leg ulcer previous bleeding from varicose veins

Core clinical problems (94 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions