Derm and misc

Question 1

What is acne?

Answer 1

Localised skin inflammation as a result of overactivity of the oil glands at the base of specialised hair follicles

Question 2

Why does acne occur?

Answer 2

Acne occurs when hair follicles become blocked and nearby sebaceous (oil) glands begin to produce too much sebum. This mixes with dead skin cells and forms a plug in the follicle

Question 3

What are the symptoms of acne?

Answer 3

Whiteheads (closed plugged pores)
Blackheads (open plugged pores)
Small, red, tender bumps (papule)
Pimples (pustules)
Large, solid, painful lumps beneath the surface of the skin (nodules)

Question 4

How is acne diagnosed?

Answer 4

Skin exams

Question 5

How is acne managed?

Answer 5

Over the counter acne products, medications that can - control the acne, avoid scarring
Combined oral contraceptive pill
Steroid injection

Question 6

What is eczema?

Answer 6

An inflammatory condition of the skin characterised by redness, itching and vesicular lesions

Question 7

What are the 2 types of causes of eczema?

Answer 7

Atopic: itchy rash of the folds of the elbow/knee
Exogenous: itchy rash following contact with an irritant

Question 8

How does eczema present?

Answer 8

Atopic: itchy red rash, scaling and oozing
Exogenous: red, crusting and scaling, fissures, hyperpigmentation

Question 9

How is eczema diagnosed?

Answer 9

Skin exam, patch tests to exclude other skin diseases

Question 10

How is eczema managed?

Answer 10

Atopic: avoid irritants, regular emollients to hydrate, corticosteroids
Exogenous: avoid irritants, steroid cream

Question 11

What is psoriasis?

Answer 11

A chronic relapsing skin disorder associated with abnormal hyper proliferation of the epidermis

Question 12

What are known factors that trigger psoriasis?

Answer 12

Stress, infections, climate, alcohol, smoking, trauma

Question 13

What are the different types of psoriasis?

Answer 13

Chronic plaque psoriasis, flexural psoriasis, guttate, erythrodermic and pustular

Question 14

How does psoriasis present?

Answer 14

Well-demarcated erythematous plaques with adherent silvery scale
Elbows, knees, scalp

Question 15

How is psoriasis diagnosed?

Answer 15

Skin exam, biopsy to rule out other disorders

Question 16

How is psoriasis managed?

Answer 16

Topical corticosteroids

Question 17

What is skin ulceration?

Answer 17

Ulcers are abnormal breaks in an epithelial surface

Question 18

What causes skin ulcers?

Answer 18

Neuropathy, lymphedema, vasculitis, malignancy, infection, trauma

Question 19

How are skin ulcers diagnosed?

Answer 19

Skin exam, skin and ulcer biopsy to assess for malignant change.

Question 20

How are skin ulcers managed?

Answer 20

Treat cause and focus on prevention - optimise nutrition

Charing-Cross 4 layer compression bandaging

Question 21

What is the major risk factor for skin cancers?

Answer 21

UV radiation exposure

Question 22

How do malignant melanomas present?

Answer 22

Pigmented skin lesions demonstrating ABCD:

Asymmetry, irregular Borders, uneven Colour, Diameter >6mm

Question 23

How are malignant melanomas managed?

Answer 23

Urgent excision - curative

Chemotherapy for metastatic disease

Question 24

How do squamous cell carcinomas present?

Answer 24

Skin plaques or nodules, often with a keratinous surface crust.
Ulceration may be present

Question 25

How are squamous cell carcinomas managed?

Answer 25

Excision + radiotherapy to treat recurrence

Question 26

How do basal cell carcinomas present?

Answer 26

Most appear as pearly papule or nodules on sun-exposed skin | Ulceration may occur

Question 27

How are basal cell carcinomas managed?

Answer 27

Excision, cryotherapy

Question 28

What is HIV?

Answer 28

A retrovirus which infects and replicates in human lymphocytes and macrophages

Question 29

What is AIDS?

Answer 29

Acquired immunodeficiency syndrome - progressive immune system dysfunction, opportunistic infection and malignancy

Question 30

Who is at most risk of HIV?

Answer 30

Men who have sex with men, migrant workers, IV drug abusers, commercial sex workers, truck drivers

Question 31

What does HIV bind to in the human body?

Answer 31

CD4 receptors on helper T cells, monocytes and macrophages

Question 32

Describe the virology of HIV

Answer 32

Attachment, cell entry, interaction with host cells, replication, assembly, release

Question 33

How is HIV transmitted?

Answer 33

Unprotected sex, contaminated needles, breast milk and transmission from mother to baby at birth

Question 34

How does HIV present?

Answer 34

Flu-like symptoms, erythematous/ maculopapular rash. | Fever, lymphadenopathy, sore throat, myalgia, rash and mouth ulcers

Question 35

How is HIV diagnosed?

Answer 35

Two markers: CD4 cell count and HIV viral load. ELISA for HIV antibody and antigen Viral load: used to monitor response to ART

Question 36

How can HIV be prevented?

Answer 36

Condom use, post-exposure prophylaxis, pre-exposure prophylaxis (ART for high risk people)

Question 37

How does antiretroviral therapy work?

Answer 37

CCR5 antagonists inhibit the entry of the virus into the cell by blocking the CCR5 co-receptor

Question 38

What are the risk factors for breast carcinoma?

Answer 38

Early menarche/ late menopause Increased weight/ high alcohol consumption Oral contraceptive use Positive family history

Question 39

How are breast lumps assessed?

Answer 39

Clinical examination Histology/ cytology Mammography/ ultrasound

Question 40

How is breast cancer staged?

Answer 40

Stage 1: confined to breast, mobile Stage 2: growth confined to breast, lymph nodes in ipsilateral axilla Stage 3: tumour fixed to muscle Stage 4: complete fixation of tumour to chest wall, distant metastases

Question 41

How are breast carcinomas managed?

Answer 41

``` Local disease (1-2): surgery, radiotherapy, chemotherapy Distant disease (3-4): radiotherapy to bony lesions, tamoxifen ```

Question 42

Name 3 differential diagnoses for breast lumps

Answer 42

Fibroadenoma Intraductal papilloma Breast cyst