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2a mid tier > Derm > Flashcards

Derm Flashcards

1
Q

What is the aetiology of venous skin ulceration?

A
  • Sustained venous hypertension caused by incompetent valves in deep or perforating veins, previous DVT, atherosclerosis, vasculitis e.g. RA, SLE
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2
Q

What is the pathophysiology of venous skin ulceration?

A
  • Increased pressure causes extravasation of fibrinogen through the capillary walls, giving rise to perivascular fibrin deposition which leads to poor oxygenation of surrounding skin
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3
Q

What are the risk factors of venous skin ulceration?

A
  • Varicose veins or DVT
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4
Q

What is the presentation of venous skin ulceration?

A
  • Sloping and gradual edges
  • Ulcer is large, shallow, irregular and exudative
  • Usually minimal pain
  • Oedema of the lower leg
  • Venous eczema
  • Brown pigmentation from haemosiderin
  • Varicose veins
  • Pulses present
  • Warm skin
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5
Q

How is venous skin ulceration diagnosed?

A
  • Ankle brachial pressure index (ABPI) is normal

- Doppler USS to exclude significant arterial disease

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6
Q

How is venous skin ulceration managed?

A
  • High compression 4 layered bandage
  • Leg elevation to reduce venous hypertension
  • Antibiotics for infection
  • Analgesia
  • Support stockings for life
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7
Q

What are the risk factors of arterial skin ulceration?

A
  • Arterial disease e.g. atherosclerosis
  • Smoking
  • Hypercholesterolaemia
  • Diabetes mellitus
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8
Q

What is the presentation of arterial skin ulceration?

A
  • Punches-out ulcers high up the leg or on the feet
  • Intense pain worse when elevated
  • Cold and pale leg
  • Ulcer is small, sharply-defined and has a necrotic base
  • Spine pale skin and loss of hair
  • Absent peripheral pulses
  • Arterial bruits (murmurs)
  • No oedema
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9
Q

How is arterial skin ulceration diagnosed?

A
  • Doppler USS to confirm arterial disease

- ABPI suggests arterial insufficiency

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10
Q

How is arterial skin ulceration managed?

A
  • Keep ulcer clean and covered
  • Analgesia
  • Vascular reconstruction if appropriate
  • Never use compression bandaging
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11
Q

What are the risk factors of neuropathic skin ulceration?

A
  • Diabetes and neurological disease (peripheral neuropathy
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12
Q

What is the presentation of neuropathic skin ulceration?

A
  • Often painless
  • Over pressure areas of feet e.g. metatarsal heads or heels
  • Variable sizes
  • Surrounded by cellulitis
  • Warm skin
  • Normal peripheral pulses
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13
Q

How is neuropathic skin ulceration managed?

A
  • Keep clean
  • Remove pressure/trauma from affected area
  • Correctly fitting shoes and specialist podiatrist help for diabetics
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14
Q

What is the presentation vasculitic skin ulceration?

A
  • Cutaneous features which may erode and ulcerate: haemorrhagic papules, pustules, nodules, plaques
  • Purpuric lesions do not blanch with pressure from a glass slide
  • Pyrexia and arthralgia are common
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15
Q

How is vasculitic skin alteration managed?

A
  • Analgesia
  • Support stockings
  • Dapsone (antibiotic) or prednisolone
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16
Q

What is the aetiology of cellulitis?

A
  • Group A beta-haemolytic strep e.g. S.pyogenes
  • Staph aureus
  • Sometimes MRSA
17
Q

What is the pathophysiology of cellulitis?

A
  • Typically affects the lower leg or arm and spreads proximally
  • Other sites include abdomen, perianal and periorbital areas
  • Can also affect just one side of the face
18
Q

What are the risk factors of cellulitis?

A
  • Lymphoedema
  • Leg ulcer
  • Immunosuppression
  • Traumatic wounds (normally an obvious point of entry of pathogen)
  • Athletes foot
  • Leg oedema
  • Obesity
19
Q

What is the presentation of cellulitis?

A
  • Local inflammation – proximally spreading
  • Hot erythema in the affected area
  • Poorly demarcated margins, swelling, warmth and tenderness
  • Occasionally blister especially if oedema is prominent
  • Systemically unwell with pyrexia
20
Q

How is cellulitis diagnosed?

A
  • Clinical
  • Skin swabs are usually negative unless taken from broken skin
  • Serological testing to confirm a strep infection
21
Q

How is cellulitis managed?

A
  • Antibiotics e.g. oral phenoxymethylpenicillin or oral flucloxacillin (oral erythromycin is penicillin allergic)
  • If infection is widespread then 3-5d IV antibiotic then at least 2w oral therapy
  • If recurrent then give prophylaxis lose-dose antibiotics e.g. oral phenoxymethylpenicillin twice daily
22
Q

What is the aetiology of necrotising fasciitis? (Type 1 and type 2)

A

Type 1
- Caused by a mixture of aerobic and anaerobic bacteria following abdominal surgery or in diabetics

Type 2
- Caused by group A beta-haemolytic strep, most common cause, arises in previously healthy patients

23
Q

What are the risk factors of the necrotising fasciitis?

A
  • Abdominal surgery

- Immunosuppression

24
Q

What is the presentation of necrotising fasciitis?

A
  • Fever, toxicity and pain out of proportion to skin findings
  • Severe pain that is out of proportion to the skin findings at the initial site of infection, rapidly followed by tissue necrosis
  • Infection track rapidly along the tissue plans, causing spreading erythema, pain and sometimes crepitus
  • Multi-organ failure is common and mortality is high
25
Q

How is necrotising fasciitis diagnosed?

A
  • Soft tissue gas seen on XR
  • Raised CRP
  • Very raised WCC
26
Q

How is necrotising fasciitis managed?

A
  • Must be treated aggressively and promptly
  • Antibiotics for confirmed group A strep (IV benzylpenicillin and IV clindamycin)
  • If unknown aetiology e.g. type 2 broad spec IV antibiotics with IV metronidazole
  • Urgent surgical exploration with extensive debridement or amputation if necessary

2a mid tier (10 decks)

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