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Year 4k: Dermatology > Common Important Problems > Flashcards

Common Important Problems Flashcards

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Dermatology Board Prep flashcards
1
Q

What are types of Chronic Leg Ulcers?

A
  • Venous Ulcers
  • Arterial Ulcers
  • Neuropathic Ulcers
  • Vasculitic Ulcers (purpuric, punched out lesions)
  • Infected Ulcers (purulent discharge, may have systemic signs)
  • Malignancy (e.g. squamous cell carcinoma in long-standing non-healing ulcers).
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2
Q

What are the different histories in Venous, Arterial and Neuropathic ulcers?

A

Venous Ulcers: Often painful and worse on standing. There is a history of venous disease e.g. varicose veins, deep vein thrombosis

Arterial Ulcers: Painful especially at night, worse when legs are elevated. History of arterial disease e.g. atherosclerosis

Neuropathic Ulcers: Often painless and abnormal sensation. There is a history of diabetes or neurological disease

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3
Q

What are the common sites in Venous, Arterial and Neuropathic ulcers?

A
  • Venous Ulcers: Malleolar area (more common over medial than lateral malleolus)
  • Arterial Ulcers: Pressure and trauma sites e.g. pretibial, supramalleolar (usually lateral), and at distal points e.g. toes
  • Neuropathic Ulcers: Pressure sites e.g. soles, heel, toes, metatarsal heads
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4
Q

What are the appearances of lesions in Venous, Arterial and Neuropathic ulcers?

A
  • Venous Ulcers: Large, shallow irregular ulcer. They have a exudation and a granulating base
  • Arterial Ulcer: Small, sharply defined deep ulcer with a necrotic base
  • Neuropathic Ulcer: Variable size and depth. Has a granulating base. May be surrounded by or underneath a hyperkeratotic lesion (e.g. callus)
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5
Q

What are associated features of Venous Ulcers?

A
  • Warm skin
  • Normal peripheral pulses
  • Leg oedema, haemosiderin and melanin deposition (brown pigment)
  • Lipodermatosclerosis
  • Atrophie blanche (white scarring with dilated capillaries)
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6
Q

What are associated features of Arterial Ulcers?

A
  • Cold skin
  • Weak or absent peripheral pulses
  • Shiny pale skin
  • Loss of hair
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7
Q

What are associated features of Neuropathic Ulcers?

A
  • Warm skin
  • Peripheral neuropathy
  • Normal peripheral pulses but *cold, weak or absent pulses if it is a neuroischaemic ulcer*
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8
Q

What are possible investigations for Venous Ulcers, Arterial Ulcers, and Neuropathic Ulcers?

A
  • Venous Ulcers: Normal ankle/brachial pressure index (i.e. ABPI 0.8-1)
  • Arterial Ulcers: ABPI <0.8 shows presence of arterial insufficiency. Doppler studies and angiography
  • Neuropathic Ulcers: ABPI <0.8 implies a neuroischaemic ulcer. X-ray to exclude osteomyelitis
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9
Q

What are management options for Venous Ulcers, Arterial Ulcers, and Neuropathic Ulcers?

A
  • Venous Ulcers: Compression bandaging (after excluding arterial insufficiency)
  • Arterial Ulcers: Vascular reconstruction. Compression bandaging is contraindicated
  • Neuropathic Ulcers: Wound debridement. Regular repositioning, appropriate footwear and good nutrition
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10
Q

What is the history of Eczema, Scabies, Urticaria, and Lichen Planus?

A
  • Eczema: Personal or family history of atopy. Exacerbating factors (e.g. allergens, irritants)
  • Scabies: May have history of contact with symptomatic individuals. Pruritus worse at night
  • Urticaria: Precipitating factors (e.g. food, contact, drugs)
  • Lichen Planus: Family history in 10% of cases. May be drug-induced
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11
Q

What are common sites of Eczema, Scabies, Urticaria, and Lichen Planus?

A
  • Eczema: Variable (e.g. flexor aspects in children and adults with atopic eczema). Lichen nitidus pattern in darker skin
  • Scabies: Sides of fingers, finger webs, wrists, elbows, ankles, feet, nipples and genitals
  • Urticaria: No specific tendency
  • Lichen Planus: Forearms, wrists, and legs. Always examine the oral mucosa
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12
Q

What is the presentation of lesions in Eczema, Scabies, Urticaria, and Lichen Planus?

A

Eczema: Dry, erythematous patches. Acute eczema is erythematous, vesicular and exudative

Scabies: Linear burrows (may be tortuous) or rubbery nodules

Urticaria: Pink wheals (transient). May be round, annular, or polycyclic

Lichen Planus: Violaceous (lilac) flat-topped papules or hyperpigmented papules (in darker skin). Symmetrical distribution

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13
Q

What are the associated features aside from the lesions in Eczema, Scabies, Urticaria, and Lichen Planus?

A
  • Eczema: Secondary bacterial or viral infections
  • Scabies: Secondary eczema and impetigo
  • Urticaria: May be associated with angioedema or anaphylaxis
  • Lichen Planus: Nail changes and hair loss. There are lacy white streaks on the oral mucosa and skin lesions(Wickham’s striae)
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14
Q

What are possible investigations for Eczema, Scabies, Urticaria, and Lichen Planus?

A
  • Eczema: Patch testing, Serum IgE levels, Skin swab
  • Scabies: Skin scrape, extraction of mite and view under microscope
  • Urticaria: Bloods and urinalysis to exclude a systemic cause
  • Lichen Planus: Skin biopsy
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15
Q

What is the management for Eczema, Scabies, Urticaria, and Lichen Planus?

A

Eczema: Emollients, Corticosteroids, Immunomodulators, Antihistamines

Scabies: Scabicide (e.g. permethrin or malathion), Antihistamines

Urticaria: Antihistamines, Corticosteroids

Lichen Planus: Corticosteroids, Antihistamines

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16
Q

What is the history of Melanocytic Naevi, Seborrhoiec Wart and malignant melanoma?

A

Melanocytic Naevi: Not usually present at birth but develop during infancy, childhood or adolescence. It is asymptomatic

Seborrhoiec Wart: Tend to arise in the middle-aged or elderly. Often multiple and asymptomatic

Malignant melanoma: Tend to occur in adults or the middle-aged. History of evolution of lesion and may be symptomatic (e.g. itchy, bleeding). There is a presence of risk factors usually

17
Q

What are common sites for Melanocytic naevi, Seborrhoeic wart, Malignant melanoma?

A
  • Melanocytic naevi: Variable
  • Seborrhoeic wart: Face and trunk
  • Malignant melanoma: More common on the legs in women and trunk in men. Darker skin tones present on acral sites
18
Q

What is the presentation of Melanocytic Naevi?

A
  • Congenital naevi may be large, pigmented, protuberant and hairy
  • Junctional naevi are small, flat and dark
  • Intradermal naevi are usually dome-shape papules or nodules
  • Compound naevi are usually raised, warty, hyperkeratotic, and/or hairy
19
Q

What is the presentation of a Seborrhoeic Wart?

A
  • Warty greasy papules or nodules
  • ‘Stuck on’ appearance, with well-defined edges
20
Q

What is the presentation of Malignant Melanoma?

A
  • Asymmetrical shape
  • Border irregularity
  • Colour irregularity
  • Diameter > 6mm
  • Evolution of lesion
21
Q

What is the management of melanocytic naevi, seborrhoeic wart and malignant melanoma?

A
  • Melanocytic Naevi: Only if symptomatic. Shave or complete excision
  • Seborrhoeic Wart: Only if symptomatic. Curette and cautery or Cryotherapy
  • Malignant Melanoma: Local Excision. Treatment based on Breslow Thickness
22
Q

What are common causes of Purpuric Eruptions?

A
  • Meningococcal septicaemia
  • Disseminated intravascular coagulation
  • Vasculitis
  • Actinic purpura
23
Q

What is the history of Purpuric Eruptions?

A
  • Meningococcal Septicaemia: Acute onset. Symptoms of meningitis and septicaemia
  • Disseminated Intravascular Coagulation: History of trauma, malignancy, sepsis, obstetric complications, transfusions, or liver failure
  • Vasculitis: Painful lesions
  • Actinic Purpura: Arise in the elderly population with sun-damaged skin
24
Q

What are common sites for Meningococcal septicaemia, Disseminated intravascular coagulation, Vasculitis, Actinic purpura?

A
  • Meningococcal septicaemia: Extremeties
  • Disseminated intravascular coagulation: Spontaneous bleeding from ear, nose and throat, gastrointestinal tract, respiratory tract or wound site
  • Vasculitis: Dependent areas (e.g. legs, buttocks, flanks)
  • Actinic purpura: Extensor surfaces of hands and forearms. Such skin is easily traumatised
25
Q

What is the presentation of Meningococcal septicaemia, Vasculitis, Disseminated intravascular coagulation and Actinic purpura?

A
  • Meningococcal septicaemia: Petechiae, ecchymoses, haemorrhagic bullae and/or tissue necrosis
  • Disseminated intravascular coagulation: Petechiae, ecchymoses, haemorragic bullae and/or tissue necrosis
  • Vasculitis: Palpable purpura (often painful)
  • Actinic purpura: Non-palpable purpura that surrounds skin which is atrophic and thin
26
Q

What are the investigations for Meningococcal septicaemia, Vasculitis, Disseminated intravascular coagulation and Actinic purpura?

A
  • Meningococcal septicaemia: Bloods, Lumbar puncture
  • DIC: Bloods (a clotting screen is important)
  • Vasculitis: Bloods and urinalysis, Skin biopsy
  • Actinic Purpura: No investigation is needed
27
Q

What is the management for Meningococcal septicaemia, Vasculitis, Disseminated intravascular coagulation and Actinic purpura?

A

Meningococcal septicaemia: Antibiotics

DIC: Treat the underlying cause, Transfuse for coagulation deficiencies, Anticoagulants for thrombosis

Vasculitis: Treat the underlying cause. Steroids and immunosuppressants if there is systemic involvement

Actinic Purpura: No treatment is needed

28
Q

What common reasons for a red swollen leg?

A
  • Cellulitis/Erysipelas
  • Venous thrombosis
  • Chronic Insufficiency
29
Q

What are the different histories in Cellulitis/Erysipelas, Venous thrombosis and Chronic Insufficiency?

A
  • Cellulitis/Erysipelas: Painful spreading rash. Has a history of abrasion or ulcer
  • Venous thrombosis: Pain with swelling and redness. Has a history of prolonged bed rest, long haul flights or clotting tendency
  • Chronic Insufficiency: Heaviness or aching of leg, which is worse on standing and relieved by walking. Has a history of venous thrombosis
30
Q

What are the examination signs of Cellulitis/Erysipelas, Venous thrombosis and Chronic Insufficiency?

A
  • Cellulitis/Erysipelas: Erysipelas has a well-defined edge and Cellulitis has a diffuse edge
  • Venous thrombosis: Complete venous occlusion may lead to cyanotic discolouration
  • Chronic Insufficiency: Discoloured (blue-purple), and Oedematous (improved in the morning). Venous congestion and varicose veins
31
Q

What are associated features of Cellulitis/Erysipelas?

A
  • Systemically unwell with fever and malaise
  • May have lymphangitis
32
Q

What are associated features of Venous thrombosis?

A
  • Usually systemically well
  • May present with pulmonary embolism
33
Q

What are associated features of Chronic Venous Insufficiency?

A
  • Lipodermatosclerosis: erythematous induration, creating ‘champagne bottle’ appearance)
  • Stasis dermatitis: eczema with inflammatory papules, scaly and crusted erosions)
  • Haemosiderin deposition
  • Venous ulcer
34
Q

What are the possible investigations for Cellulitis/Erysipelas, Venous thrombosis and Chronic Insufficiency?

A
  • Cellulitis/Erysipelas: Anti-streptococcal O titre (ASOT), Skin Swab
  • Venous thrombosis: D-dimer, Doppler ultrasound and/or venography
  • Chronic Insufficiency: Doppler ultrasound and/or venography
35
Q

What is the management of Cellulitis/Erysipelas, Venous thrombosis and Chronic Insufficiency?

A
  • Cellulitis/Erysipelas: Antibiotics
  • Venous thrombosis: Anticoagulants
  • Chronic Insufficiency: Leg elevation and compression stockings. Sclerotherapy or surgery for varicose veins

Year 4k: Dermatology (9 decks)

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