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FINALS > BREAST/DERM/INFECTIOUS DISEASES > Flashcards

BREAST/DERM/INFECTIOUS DISEASES Flashcards

1
Q

What are the 3 components of the triple assessment?

A
  1. Clinical assessment
  2. Imaging - USS or mammogram
  3. Biopsy
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2
Q

What are some risk factors for developing breast cancer?

A
  1. PROLONGED OESTROGEN EXPOSURE
    = early menarche, late menopause, 1st birth over 30y, nulliparity, no breast feeding, COCP, HRT
  2. ENDOGENOUS FACTORS
    = post-menopausal, greater breast density
  3. LIFESTYLE
    = obesity, smoking, lack of physical activity, alcohol, radiation
  4. FHx
    = 2x risk if 1st degree relative. BRCA1 + 2
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3
Q

Where are the sites that breast can metastasise to?

A
  1. Lungs
  2. Liver
  3. Bone
  4. Brain
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4
Q

Where do breast lumps tend to occur?

A

Upper outer quadrant

  • swelling, skin irritation/dimpling, breast/nipple pain
  • skin fixation or skin tethering
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5
Q

What is the 2ww criteria for suspected breast cancer?

A
  1. Aged over 30y + have an unexplained breast lump with or without pain
  2. Aged over 50 with any of the following in one nipple only:
    - discharge
    - retraction
    - other changes of concern
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6
Q

When is a mastectomy indicated for breast cancer?

A
  • multifocal disease
  • local recurrence
  • invasion more than 4cm
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7
Q

What are some causes of microcalcification?

A
  • fibroadenoma
  • cysts, trauma or surgery
  • DCIS must be ruled out
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8
Q

How is DCIS managed?

A

Low grade = WLE
Moderate grade = WLE + radiotherapy
High grade = mastectomy + reconstruction

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9
Q

How is DCIS followed-up?

A

annual mammogram for 5-yrs

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10
Q

When do you consider excision of a fibroadenoma?

A
  • lesion is over 4cm
  • it is growing
  • on request from the patient
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11
Q

What are the clinical features of cyclical mastalgia?

A
  • heaviness
  • affects both breasts
  • radiates to axilla + arms
  • worse at end of cycle
  • no point tenderness
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12
Q

How do you manage cyclical mastalgia?

A
  1. Look for focal lesions e.g. cysts
  2. Wear supportive bra
  3. Flaxseed oil/evening primrose oil
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13
Q

When do you suspect infectious mastitis?

A
  • nipple fissure that looks infected
  • no improvement after 24hrs of effective milk removal
  • breast milk culture is +ve
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14
Q

How do you manage mastitis?

A
  1. Continue to breast feed
  2. US-guided drainage of abscess
  3. Flucloxacillin
  4. Breastfeeding counselling
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15
Q

What are the nail signs which are seen in psoriasis?

A
  • Onycholysis = lifting of nail plate from nail bed
  • Subungal keratosis = chalky material under nail
  • pitting
  • beau’s lines
  • splinter haemorrhages
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16
Q

How do you manage chronic plaque psoriasis?

A
  1. Regular emollients to reduce scale loss + reduce pruritus
  2. Potent steroid + Vit D analogue applied OD
    - continue for 4 weeks
  3. Vit D analogues 2x daily if no improvement w/in 8 wks
  4. Potent steroid 2x daily for 4wks if no improvement after 8-12 wks
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17
Q

What do NICE suggest in terms of topical steroid treatment duration?

A

Do not use potent steroids for longer than 8-weeks at a time
Or v.potent for more than 4-weeks
- Aim for a 4 wk break before starting topical steroids again

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18
Q

How do vitamin D analogues work?

A

Work by reducing cell division + differentiation
- adverse effects uncommon
- may be used long term
- do not smell or stain
- reduce the scale + thickness of plaques but NO erythema
AVOID IN PREGNANCY

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19
Q

When should you refer psoriasis pts same-day to a dermatologist?

A

Generalised pustular psoriasis or erythroderma

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20
Q

What is general pustular psoriasis?

A

Pustules within the plaques

  • triggered by withdrawal or inappropriate use of steroids
  • requires emergency hospital admission
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21
Q

What type of skin cancer are you at risk of from UVB phototherapy?

A

Squamous cell carcinoma

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22
Q

What are some systemic treatments that can be used in psoriasis?

A 
1st = Methotrexate 
others = ciclosporin, acitretin, fumaderm

Can then step up to biologicals - adalimumab

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23
Q

What are closed + open comedones?

A

Closed = whiteheads

Open = blackheads

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24
Q

What grading system is used to define the severity of acne?

A

Leeds revised grading system

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25
Q

When + what oral antibiotics should you use in treatment of acne?

A

Acne resistant to topical treatment

  • use tetracycline for 3-months
  • switch to lymecycline if ineffective

Continue with topical treatments

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26
Q

What features would trigger a dermatology referral for starting isotretinoin?

A
  • severe acne
  • acne unresponsive to prolonged Abx
  • scarring
  • acne associated with psychological problems
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27
Q

What is rhinophyma?

A

Skin of nose is coarse + grossly thickened

- happens in chronic rosacea

28
Q

What are the clinical features of rosacea?

A
  • facial flushing
  • persistent erythema
  • telangiectasia
  • inflammatory papules
  • pustules
  • oedema
29
Q

What conditions are associated with rosacea?

A
  • conjunctivitis
  • blepharitis
  • eyelid oedema
30
Q

How do you manage rosacea?

A

Identify trigger factors + avoid them
Avoid skin irritants, use sunscreen
1. Topical metronidazole
2. Oral Abx = doxycycline, erythromycin

31
Q

What is pityriasis alba?

A

Variant of atopic eczema

Pale patches develop on the face of children

32
Q

What differences are seen clinically between allergic + irritant contact dermatitis?

A 
ALLERGIC = intensely itchy, erythema, oedema, vesicles, chronic lesions are lichenified 
IRRITANT = itchy or sore, erythema, fissuring
33
Q

What are the symptoms you should tell pts about to recognise infected eczema?

A
  • weeping
  • pustules
  • crusts
  • atopic eczema failing to respond to treatment
  • rapidly worsening
  • fever + malaise
34
Q

How do you manage infected eczema?

A

1-2 week course of flucloxacillin or erythromycin or clarithromycin

35
Q

With topical steroids, how much body surface area will 1 FTU cover?

A

2 adult palms

36
Q

What is the steroid hierarchy? Going from mild to potent

A
  1. Hydrocortisone
  2. Eumovate
  3. Betnovate
  4. Dermovate (beclometasone)
37
Q

What are the criteria for referring a mole on 2ww?

A

Refer any:

  • new mole, growing quickly
  • long standing mole changing shape or colour
  • any mole which has 3 or more colours OR lost its symmetry
  • new nodule growing is pigmented + vascular
  • new pigmented lines in nails
  • something growing under nail
38
Q

What patients are at particular risk of SCC?

A

Immunosuppressed + transplant pts

39
Q

What are some differentials for a pt presenting with fever, abdominal pain + jaundice?

A
  1. Acute cholecystitis
  2. Ascending cholangitis
  3. Acute viral hepatitis
  4. Liver abscess
  5. Malaria
40
Q

What is the management of hepatitis A?

A
  1. Supportive therapy = basic analgesia, typically resolves within 3-months
  2. Avoid alcohol
  3. Rarely, interferon alpha for fulminant hepatitis
41
Q

What is HBsAg?

A

Surface antigen - first to appear
Active infection = active for 1-6 months
Chronic = over 6 months +ve

42
Q

What is anti-HBs?

A

Implies immunity

- may mean resolved infection or immunity

43
Q

What is anti-HBc?

A

Implies past/current infection
IgM = acute, remains for 4-8 months
IgG = chronic infection, carrier

44
Q

What is HBeAg?

A

Marker of infectivity

  • appears early in acute infection
  • more than 3 months implies chronic
45
Q

What does Anti-HBc +ve, HBsAg -ve indicate?

A

= previous HBV (>6-months ago), not a carrier

46
Q

How do you manage hepatitis B?

A

ACUTE
= supportive care, antivirals, stop smoking + alcohol, fibroscan for cirrhosis + USS for hepatocellular carcinoma
CHRONIC
= peginterferon + antivirals

47
Q

Can hepatitis B be spread by breastfeeding?

A

NO

48
Q

How do you manage acute alcoholic hepatitis?

A
  1. Screen for infections + perform ascitic fluid tap
    - treat SBP with cefotaxime if present
  2. STOP alcohol - use IM lorazepam for withdrawals
  3. Pabrinex
  4. Prednisolone - for 5-days then tapered over 3 wks
49
Q

Who does autoimmune hepatitis tend to affect? How will they present?

A

young + middle-aged women

- fever, malaise, urticarial rash, polyarthritis, pleurisy, pulmonary infiltration, or glomerulonephritis

50
Q

What antibodies are associated with autoimmune hepatitis?

A

ANA, SMA and LKM1 antibodies

51
Q

How do you tell the difference between amoebic + pyogenic abscesses?

A

On USS Amoebic tend to be singular whereas pyogenic abscess tends to be multiple

52
Q

What investigations should be performed in suspected TB?

A
  1. CXR
  2. Cultures - Ziehl-Neelsen staining shows bright red
  3. NAAT
  4. Histology - cavitating graulomata
  5. Mantoux test + IGRAs
53
Q

What treatment is given for TB?

A

Rifampicin + Isoniazid for 6-months

Pyrazinamide + Ethambutol for 2/3 months

54
Q

What is given alongside isoniazid? What complication is this to avoid?

A

Pyridoxine (vit B6)

- prevent peripheral neuropathy

55
Q

What are the side effects of rifampicin?

A

Red/orange discolouration of secretions
- cP450 inducer = reduces effects of drugs metabolised in this system such as COCP
Hepatotoxicity

56
Q

What are the side effects of isoniazid?

A

Peripheral neuropathy

Hepatotoxicity

57
Q

What are the side effects or pyrazinamide?

A

Can cause hyperuricaemia resulting in gout

Hepatotoxicity

58
Q

What are the side effects of ethambutol?

A

Colour blindness

Reduced visual acuity

59
Q

What are the treatment options for pts with suspected influenza who are at risk of complications?

A
  1. Oral oseltamivir 75mg BD for 5-days
    OR
  2. Inhaled Zanamivir 10mg BD for 5-days
    Treatment should be started within 48h of symptom onset to be effective
60
Q

Who are influenza vaccinations given to?

A
  • aged over 65
  • young women aged 2-7
  • pregnant women
  • chronic health conditions e.g. asthma, COPD, heart failure + diabetes
  • healthcare workers + carers
  • long stay care-homes, nursing homes + residential homes
61
Q

How do you diagnose malaria?

A

Malaria blood film - send in EDTA bottle

- 3 samples over 3 consecutive days

62
Q

What are the 2 main malaria treatment options to remember for exams?

A 
Oral = quinine 
IV = artesunate
63
Q

What is the classic triad of infectious mononucleosis?

A
  1. Fever
  2. Pharyngitis
  3. Lymphadenopathy - may be in anterior + posterior triangles of neck - whereas in tonsilitis it is typically in upper anterior cervical chain being enlarged
64
Q

What investigation + management should be performed in suspected infectious mononucleosis?

A

Monospot test - perform FBC + monospot in 2nd week illness to confirm diagnosis

  1. Rest, lots of fluid, avoid alcohol
  2. Simple analgesia
  3. Avoid contact sports for 8 wks to avoid splenic rupture
65
Q

What classification system is used to determine the severity of cellulitis?

A

Eron classification

66
Q

What pts are at risk of necrotising fasciitis?

A

IVDU

67
Q

How do you manage necrotising fasciitis?

A

Surgical debridement + supportive Abx

FINALS (14 decks)

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