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Medicine Year 1 > Case 8 SAP > Flashcards

Case 8 SAP Flashcards

1
Q

Macule

A

Small flat lesion

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2
Q

Patch

A

Large flat lesion

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3
Q

Papule

A

solid raised lesion <0.5cm

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4
Q

Plaque

A

solid raised lesion >0.5cm

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5
Q

Vesicle

A

raised, clear, fluid-filled lesion <0.5cm

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6
Q

Bulla

A

raised, clear, fluid-filled lesion >0.5cm

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7
Q

Vasculitis

A

autoimmune inflammation of blood vessels. can be small, medium, or large. causes generalised inflammatory symptoms and specific symptoms depending on location of vessels

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8
Q

Small vessel vasculitis examples

A

GPA, microscopic polyangiitis, Churg-Strauss syndrome, Henoch-Schonlein purpura

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9
Q

Medium vessel vasculitis examples

A

Kawasaki disease, Polyarteritis nodosa, Buerger disease

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10
Q

Large vessel vasculitis examples

A

giant cell arteritis, Takayasu arteries

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11
Q

Measles virus family

A

morbillivirus/paramyxovirus

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12
Q

Initial symptoms of measles

A

high fever, cough, coryzal symptoms, conjunctivitis

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13
Q

Type of rash and spots and locations associated with measles

A

Maculopapular rash first to face and behind ears, spreads down the trunk with hands and feet affected last.
Kolpik’s spots (2-3mm red spots with white/blue centres) to buccal mucosa

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14
Q

Rubella virus family

A

togaviridae

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15
Q

Rubella rash

A

maculopapular rash beginning on the face, spreading onto the trunk and limbs. typically pink or light red

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16
Q

Other symptoms of rubella

A

Lymphadenopathy in the head and neck, joint pain and inflammation, low-grade fever, headache, malaise, mild URT symptoms

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17
Q

What can occur if a pregnant person contracts rubella?

A

stillbirth, miscarriage, and congenital rubella syndrome

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18
Q

Erythema infectiosum virus type

A

fifth disease/slapped cheek. caused by parvovirus B19

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19
Q

Erythema infectiosum rash

A

Slapped cheek rash, maculopapular rash to the trunk, back, and limbs that fades to form a reticular (lace-like) pattern

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20
Q

Other symptoms of erythema infectiosum

A

rash preceded by fever, coryzal symptoms, nausea. also arthralgia

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21
Q

Roseola virus type

A

human herpesvirus 6

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22
Q

Roseola rash

A

pink maculopapular rash that starts on the trunk before affecting the face and limbs

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23
Q

Other symptoms of roseola

A

runny nose, sore throat, sudden high fever

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24
Q

Herpes simplex virus types

A

HSV-1 and HSV-2

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25
Q

Herpes simplex virus rash

A

Group of vesicles that rupture leaving superficial ulcers that crust over and heal

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26
Q

Where does herpes simplex virus primarily affect?

A

inside mouth, lips, genitals, eyes, and fingers

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27
Q

Chickenpox virus type

A

varicella zoster virus

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28
Q

Chickenpox rash

A

usually in children. starts as macules which progress to papules, vesicles, and pustules. can have various stages of the rash in different places at the same time. very itchy

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29
Q

Shingles virus type

A

varicella zoster virus

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30
Q

Shingles rash

A

rash appears similar to that of chickenpox. follows dermatomal distribution (area supplied by a single nerve so typically appears as a stripe) and does not cross midline of the body. burning and stabbing pain at the affected site.

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31
Q

What can occur after the shingles rash has gone?

A

post-herpetic neuralgia

32
Q

What causes Henoch-Schonlein Purpura symptoms ?

A

usually occurs in childhood. IgA immune complexes are present in the small blood vessel walls which triggers inflammation

33
Q

HSP rash

A

red or purple non-blanching purpuric rash usually to the lower limbs and buttocks

34
Q

Other symptoms of HSP

A

arthralgia, arthritis, abdominal pain, bloody diarrhoea, nausea, vomiting, proteinuria and haematuria

35
Q

Kawasaki disease description

A

occurs in children. infection triggers an autoimmune response. can affect coronary arteries so should present to hospital

36
Q

Kawasaki disease symptoms

A

Fever >39, red palms and soles with desquamation, conjunctivitis, inflammation of lips, tongue, and mouth, lymphadenopathy

37
Q

Polyarteritis nodosa incidence and association

A

peak incidence aged 10 and 40-50. can be associated with hep B infection

38
Q

Cutaneous signs of polyarteritis nodosa

A

tender nodules, skin necrosis, ulceration, livedo reticularis (mottled blue/purple discolouration) due to reduced blood supply to the skin

39
Q

Which areas does polyarteritis nodosa affect?

A

Peripheral nerves, kidneys (hypertension or AKI), GI tract (abdominal pain after eating), and skin

40
Q

Diabetic dermopathy

A

cause unknown but associated with damage to small vessels and nerves that occurs with diabetes. presents with oval, light brown patches that occur over bony areas possibly in response to injury

41
Q

Acanthosis Nigricans

A

associated with insulin resistance but can also occur due to certain medication or malignancy (GI cancers). hyperpigmentation of skin especially in creases (neck, armpits, groin) and skin may thicken

42
Q

Eruptive Xanthomatosis

A

firm, yellow, pea-like enlargements in the skin surrounded by a red halo, may be itchy. sign of uncontrolled type I diabetes and raised triglycerides

43
Q

Necrobiosis lipodica diabeticorum (NLD)

A

starts as a dull red lesion that can then become a shiny scar with a violet border. on shin. rare, mostly seen in women

44
Q

Systemic lupus erythematosus (SLE) description

A

multisystem autoimmune condition with unknown cause. more common in women and is relapsing and remitting in nature.

45
Q

Skin symptoms of SLE

A

sun sensitivity, butterfly rash to the face that spares the nasolabial folds

46
Q

Systemic symptoms of SLE

A

symmetrical arthralgia, joint stiffness, fatigue, Raynaud’s, nephritis, pericarditis, pleuritis

47
Q

Describe the pathophysiology of acne

A

blockage and inflammation of pilosebaceous unit.
androgens increase production of sebum in enlarged sebaceous glands → follicles become impacted and distended by keratinocytes and sebum → causes comedones. proliferation of bacteria in sebum causes inflammation of pilosebaceous unit and inflammatory lesions

48
Q

Which bacteria is responsible for acne?

A

propionibacterium acnes

49
Q

Open comedones

A

blackheads

50
Q

Closed comedones

A

whiteheads

51
Q

Presentation of acne

A

open and closed comedones , inflamed papules and pustules, nodules and pseudocysts in severe, scars, psychological effects.

52
Q

Categorisation of acne

A

based on numbers of lesions. mild <30, moderate 30-125, severe >125

53
Q

Pathophysiology of eczema

A

Occurs with weakened skin barrier and predisposition to allergic inflammation.
Allergen gets through skin barrier → hypersensitivity reaction → skin barrier becomes more permeable and leaky → more allergen can enter and more water can escape → dry skin itches so patient scratches → skin barrier weakened further → cycle repeats itself

54
Q

What genetic mutation can be associated with eczema?

A

decreased production of filaggrin which makes the skin barrier more permeable

55
Q

Actions of filaggrin

A

helps convert keratinocytes to corneocytes, helps formation of lipid matrix so gives structure to stratum corneum

56
Q

Which immune cell do some eczema patients have increased numbers of?

A

helper T

57
Q

Presentation of eczema

A

80% before the age of 5, 60-70% resolve by early teens.
Skin: red, weeping, crusted, may blister, skin becomes thicker (lichenified) and scaly over time, fissures can occur, erythema can be violaceous in darker skin

58
Q

Presentation of eczema

A

80% before the age of 5, 60-70% resolve by early teens.
Skin: red, weeping, crusted, may blister, skin becomes thicker (lichenified) and scaly over time, fissures can occur, erythema can be violaceous in darker skin
Nail ridging in severe
Location: infants = face and arms, older age = narrowed to flexors, hands, and ankles

59
Q

Pathophysiology of psoriasis

A

Stimulus occurs → T cells and dendritic cells infiltrate the skin → release of pro-inflammatory cytokines like TNF-α and IL-7 → activation and proliferation of keratinocytes → erythema → keratinocytes move up through the epidermis in 3-5 days rather than the usual 21 → thickening of epidermis and thick scaly patches on the skin surface

60
Q

Chronic plaque psoriasis

A

symmetrically distributed, red skin, scaly plaques with well-defined edges, typically silvery white on the surface. Itching can lead to lichenification. Persistent and can resist treatment. Plaques tend to be >3cm. Found mostly on elbows, knees, lower back, and scalp. Coverage can be mild or very extensive. Plaques can become unstable after skin injury, infection, stress, drugs, or drug withdrawal

61
Q

Guttate psoriasis

A

usually post strep throat. Widespread small plaques and raised papules, usually across torso and back

62
Q

Flexural psoriasis

A

found in body folds and genitals, smooth and well-defined, colonised by candida yeast.

63
Q

Sebopsoriasis

A

overlap of seborrheic dermatitis and psoriasis. Found on scalp, face, ears, and chest. Colonised by Malassezia yeast

64
Q

Palmoplantar psoriasis

A

palms and soles, keratoderma, and painful fissuring

65
Q

Nail psoriasis

A

pitting, onycholysis, yellowing, ridging. Associated with inflammatory arthritis

66
Q

Erythrodermic psoriasis

A

rare, acute or chronic, and may result in systemic illness with temperature dysregulation, electrolyte imbalance, and cardiac failure

67
Q

Exacerbating factors of psoriasis

A

strep infections, injuries (Koebnerised psoriasis), dry skin, obesity, smoking, excessive alcohol, stress, medications, and stopping steroids

68
Q

Biological impact of living with skin disease

A

scarring, hyperpigmentation, treatment side effects, itch, peeling skin, and sleep deprivation.

69
Q

Psychological impact of living with skin disease

A

frustration, anger, depression, anxiety, suicide, low self-esteem, poor body image, and restriction of clothing choices

70
Q

Social impact of skin disease

A

isolation, poor school performance, restricted activities e.g. swimming, limited pet choice, career choice and performance, frequent hospital visits, and relationships and sex

71
Q

Define antibiotic stewardship

A

an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness

72
Q

Principles of antibiotic stewardship

A

Prescriber should follow local and national guidelines on prescribing the shortest effective course of the most appropriate dose and route of administration. Prescribers should keep aware of prescribing levels, patient safety incidents, and should be educated and trained effectively. Do not initiate antibiotic treatment in the absence of bacterial infection

73
Q

Describe the basis on which antibiotic choice is made in clinical practice

A

Antibiotics should be given on the shortest course, with the lowest possible dose, and the best route of administration.
Should check with microbiology in hospital settings, primary care with recurrent infections, and non-severe infections with diagnostic uncertainty to give the best possible choice.
Check patient allergies, other illnesses, and contraindications with other medications and food/drink.

74
Q

Broth dilution test

A

inoculate different dilutions of antibiotic with the bacteria. The lowest dilution with no growth is the MIC

75
Q

Disk diffusion test

A

measure clear radius around a disk of antibiotic. Bigger clearance = bacteria more susceptible to that antibiotic. Grouped into resistant, intermediate, and susceptible.

76
Q

Antimicrobial gradient test

A

MIC determined by intersection of growth with strip as measured using scale on strip.

Medicine Year 1 (23 decks)

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