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Neurology and Special Senses > Common Important Derm Problems > Flashcards

Common Important Derm Problems Flashcards

1
Q

What history is indicative of a venous ulcer?

A

Painful
Worse on standing
History of venous disease - varicose veins, DVT

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2
Q

Where do venous ulcers commonly affect?

A

Malleolar area - more commonly medial

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3
Q

Describe how a venous ulcer would appear?

A

Large shallow irregular ulcer

Exudative and granulating base

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4
Q

What is a venous ulcer associated with?

A 
Warm skin
Normal peripheral pulses
Leg oedema, haemosiderin and melanin deposition (brown pigment)
Lipodermatosclerosis
Atrophie blanche
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5
Q

How would you investigate a venous ulcer?

A

ABPI would be between 0.8-1 (normal)

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6
Q

How are venous ulcers managed?

A

Compression bandaging

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7
Q

Describe the typical history of an arterial ulcer

A

Painful - esp. at night
Worse on leg elevation
History of arterial disease - atherosclerosis

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8
Q

What sites are commonly affected by arterial ulcers?

A

Pressure and trauma areas - pretibial, supramalleolar (usually lateral) and at distal points

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9
Q

What sort of lesion would you expect with an arterial ulcer?

A

Small, sharply defined, deep ulcer

Necrotic base

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10
Q

What features are associated with arterial ulcers?

A

Cold skin
Weak or absent peripheral pulses
Shiny pale skin
Loss of hair

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11
Q

What possible investigations would you request for an arterial ulcer?

A

ABPI - will be <0.8

Doppler studies and angiography

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12
Q

How are arterial ulcers managed?

A

Vascular reconstruction

Compression bandaging contraindicated!!

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13
Q

How do neuropathic ulcers present?

A

Painless
Abnormal sensation
History of diabetes/neurological disease

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14
Q

Where do neuropathic ulcers commonly affect?

A

Pressure sites - soles, heels, toes, metatarsal heads

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15
Q

How do neuropathic ulcers present?

A

Variable size and depth
Granulating base
May be surrounded by or underneath a hyperkeratotic lesion

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16
Q

What features are associated with neuropathic ulcers?

A

Warm skin
Normal peripheral pulses - can be weak, cold or absent if neuroischaemic
Peripheral neuropathy

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17
Q

What investigations would you recommend for neuropathic ulcers?

A

ABPI <0.8 suggest neuroischaemic

X-Ray - exclude osteomyelitis

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18
Q

How are neuropathic ulcers managed?

A

Wound debridement

Regular repositioning - appropriate footwear and good nutrition

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19
Q

What differentials would you consider for itchy eruptions?

A 
Eczema
Scabies
Urticaria
Lichen Planus
Tinea - pedis, capitis, corporis
Candida
Chicken pox
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20
Q

What key things in a history would indicate eczema as the cause of an itchy eruption?

A

Personal or family history of atopy - eczema, hay fever, asthma

Exacerbating factor - allergen, irritant

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21
Q

Where does eczema commonly affect?

A

Varies - usually flexural aspects if atopic eczema

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22
Q

How would an eczematous lesion appear?

A

Dry, erythematous patches

Acute is erythematous, vesicular and exudative

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23
Q

What features may be associated with eczema?

A

Secondary bacterial or viral infection

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24
Q

How would you investigate eczema?

A

Patch testing
Serum IgE
Skin swab

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25
Q

How is eczema managed?

A

Copious use of emollients
Topical corticosteroids - step up intensity
Immunomodulators
Non-Sedating Antihistamines - loratadine/ceterizine

Can use light therapy or oral corticosteroids (prednisolone)
Manage secondary infections with appropriate antibiotics

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26
Q

What is the step wise progression of topical corticosteroids for eczema?

A

Hydrocortisone
Eumovate - Clobetsone Butyrate 0.05%
Betnovate - Betamethasone Valerate 0.1%
Dermovate - Clobetasol Propionate 0.05%

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27
Q

What history would be indicative of scabies?

A

History of contact with symptomatic individuals

Pruritus worse at night

History of sleeping rough/on unclean mattress

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28
Q

What are the common sites that scabies affects?

A 
Sides of fingers
Finger webs
Wrists
Elbows
Ankles
Feet
Nipples
Genitals
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29
Q

Describe a scabies lesion

A

Linear burrows - may be tortuous
Rubbery nodules
Erythematous papules

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30
Q

What features may be associated with scabies?

A

Secondary eczema

Impetigo

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31
Q

How would you investigate scabies?

A

Skin scrape - extraction of mite

View under microscope

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32
Q

How would you manage scabies?

A

Permethrin 5% applied to whole body and washed off after 8-12 hours. Repeat in a week

Antihistamines

Treat all household members and sexual contacts

Wash bedding and clothing at 60 degrees

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33
Q

What findings in the history would be indicative of urticaria?

A

Precipitating factors - food, drugs, contact

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34
Q

Describe a lesion that is typical of urticaria

A

Pink wheals - transient
May be round, annular or polycyclic
Raised itchy rash

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35
Q

What features may be associated with urticaria?

A

Angioedema

Anaphylaxis

36
Q

What investigations would you do for urticaria?

A

Bloods and urinalysis to exclude systemic cause

37
Q

How would you manage urticaria?

A

Antihistamines

Corticosteroids

38
Q

What findings in the history would indicate lichen planus?

A

Family history - 10% of cases

May be drug induced

39
Q

Where does lichen planus usually affect?

A

Forearms
Wrists
Legs

Always examine oral mucosa

40
Q

How would you describe a lichen planus rash?

A

5P’s

Pruritic
Planar
Purple
Polygonal Papule

Symmetrically distributed

41
Q

What features are associated with lichen planus?

A

Nail changes
Hair loss
Wickham’s Striae - lacy white streaks on oral mucosa and skin lesions

42
Q

How would you investigate lichen planus?

A

Skin biopsy

43
Q

How would you manage lichen planus?

A

Corticosteroids - topical, oral if extensive
Antihistamines
Benzydamine mouth wash if oral

44
Q

Which drugs can cause lichenoid eruptions?

A

Thiazides
Gold
Quinine

45
Q

What are the causes of a changing pigmented lesion?

A

Benign - typically dont need management, can be excised

  • Melanocytic Naevi
  • Seborrhoeic Keratoses

Malignant
- Malignant Melanoma

46
Q

What findings in the history would be typical or melanocytic naevi?

A

Changing pigmented lesion
Not usually present at birth but develop during infancy, childhood or adolescence
Asymptomatic

47
Q

How would you describe a melanocytic naevi lesion?

A

Congenital - May be large, pigmented, protuberant and hairy

Junctional - small, flat and dark

Intradermal - Dome-shaped

Compound - raised and warty, hyperkaratotic, hairy

48
Q

What findings in the history are typical of seborrhoeic keratoses?

A

Arise in middle age or elderly

Asymptomatic

49
Q

Describe a common seborrhoeic keratoses lesion

A

Usually on face or trunk

Warty, greasy papules or nodules
Stuck on appearance - well defined edges
Keratotic plugs may be seen

50
Q

What findings in the history are indicative of a malignant melanoma?

A

Adults/middle age
Evolution of lesion
May be symptomatic - bleeding or itchy
Risk factors

51
Q

Describe a common malignant melanoma lesion

A

More common on legs in women, trunk in men

Asymmetrical shape
Border irregularity
Colour irregularity
Diameter >6mm
Evolution of lesio
52
Q

How are malignant melanomas managed?

A

Must be excised

53
Q

What differentials would you consider for a purpuric eruption in children?

A 
Meningococcal septicaemia
ALL
Congenital bleeding disorders
ITP
HSP
Non-accidental injury
54
Q

What history would be indicative of meningococcal septicaemia?

A

Acute
Meningitis symptoms - headache, photophobia, N&V, stiff neck etc.
Septicaemia

Systemically unwell

55
Q

Where does meningococcal septicaemia commonly affect?

A

Extremities

56
Q

Describe a meninococcal rash

A 
Petechiae
Ecchymoses
Haemorrhagic bullae
Non-blanching
Tissue necrosis
57
Q

How would you investigate meningococcal septicaemia?

A

Bloods

Lumbar Puncture

58
Q

How would you manage meningococcal septicaemia?

A

Ceftriaxone

59
Q

What history would be indicative of DIC?

A

History of trauma, malignancy, sepsis, obstetric complications. transfusions or liver damage

Systemically unwell

60
Q

Where does DIC commonly affect?

A

Spontaneous bleeding from ENT, GI tract, resp tract or wound site

61
Q

Describe a DIC lesion

A

Petechiae
Ecchymosis
Haemorrhagic Bullae
Tissue necrosis

62
Q

What history is indicative of a vasculitis?

A

Painful lesions

63
Q

Where do vasculitis lesions commonly affect?

A

Dependent areas - legs, buttocks, flanks

64
Q

Describe a vasculitis lesion

A

Palpable purpura

65
Q

What investigations would you request for DIC?

A

Bloods - clotting screen

66
Q

How would you manage DIC?

A

treat underlying cause
Transfuse for coagulation deficiency
Anti-coagulants for thrombosis

67
Q

How would you investigate a vasculitis rash?

A

Bloods
Urinalysis
Skin biopsy

68
Q

How would you manage a vasculitis rash?

A

Treat underlying cause

Steroids and immunosuppressants - systemic involvement

69
Q

What history is indicative of senile purpura?

A

Elderly population

Sun damaged skin

Systemically well

70
Q

Describe where and how a senile purpura would appear

A

Extensors surfaces of hands and forearms - easily traumatised

Non-palpable purpure
Atrophic, thin surrounding skin

71
Q

How would you investigate senile purpura?

A

None needed - no management required

72
Q

What could be the cause of a red swollen leg?

A

Cellulitis
Erysipelas
Venous thrombosis
Chronic venous insufficiency

73
Q

What history would indicate cellulitis/erysipelas?

A

Painful spreading rash
History of abrasion or ulcer
Systemically unwell - fever and malaise
May have lymphangitis

74
Q

What is the difference between erysipelas and cellulitis in appearance?

A

Erysipelas - well defined edge (confined to upper dermis)

Cellulitis - diffuse edge (affect deeper layers)

75
Q

What investigations would you recommend for erysipelas/cellulitis? How is it managed?

A

Anti-streptococcal O titre
Skin swab

Antibiotics - flucloxacillin (clarithromycin in pen allergic)

76
Q

What history would indicate venous thrombosis?

A

Pain with swelling and redness

History of prolonged bed rest - long haul flight, clotting tendency

Systematically well but can present with PE

77
Q

Describe how a venous thrombosis lesion may appear?

A

Red swollen leg

Complete occlusion can lead to cyanotic discolouration

78
Q

How is venous thrombosis investigated and managed?

A

D dimer
Doppler ultrasound

Anticoagulants - DOACS (rixaroxaban/apixaban)

79
Q

What history would chronic venous insufficiency present with?

A

Heaviness or aching of leg - worse on standing and relieved by walking

History of DVT

80
Q

Describe skin features seen with chronic venous insufficiency

A

Discoloured - blue-purple
Oedema - improve in morning
Venous congestion and varicose veins

Lipodermatosclerosis - erythematous induration - champagne bottle appearance
Stasis dermatitis - eczema with inflammatory papule, scaly and crusted erosions
Venous ulcer

81
Q

How would you investigate/manage chronic venous insufficiency?

A

Doppler ultrasound

Leg elevation and compression stockings
Sclerotherapy or surgery for varicose veins

82
Q

What causes scabies?

A

Mite burrow into epidermis and tunnel through stratum corner

83
Q

What causes intense pruritus in scabies?

A

Delayed type IV hypersensitivity reaction to mites/eggs - occur 30 days after initial infection

84
Q

How would you manage seborrhoeic keratosis?

A

Reassure of benign nature

Options for removal - curettage, cryosurgery and shave biopsy

85
Q

What is purpura?

A

Bleeding into the skin from small blood vessels which produce a non-blanching rash

86
Q

What causes for purpuric eruptions would you consider in adults?

A

ITP
Bone marrow failure - secondary to leukaemia, myelodysplasia or bone metastases
Senile purpura
Drugs
Nutritional deficiency - vitamin B12, C and folate

Neurology and Special Senses (28 decks)

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