Derm/others Flashcards
What is the epidemiology of HIV (3)
- More common in men overall
- Most prevalent in sub-saharan Africa
- Majority of new cases in 15-24 year olds
Which individuals are at most risk of HIV (4)
- Unprotected sex (homosexual often)
- Sex workers
- Truck drivers (they murder prostitutes)
- IV drug users
What are the methods of transmission of HIV (4)
- Sexual contact
- Blood products
- Sharing needles
- Mother to child
Describe the pathophysiology of HIV
- Targets CD4 T-cells
- Causes activation and hence their cell death by apoptosis
- This results in cell mediated immunodeficiency causing increased susceptibility to infection
- AIDS is said to be at CD4 T-cell levels <200 cells per mm3
How do you diagnose HIV (2)
- Clinical history if suspected send for HIV test eg. ELISA
- CD4 T-cell levels used to monitor
How do you treat HIV
- 2NRTI and 1 NNRTI
- NRTI = nucleotide reverse transcriptase inhibitors
eg. = Abacavir and didanosine - NNRTI = non-nucleotide reverse transcriptase inhibitor
eg. Etravirine
What is the epidemiology of breast cancer (3)
- 1 in 9 women affected
- Risk increases with age
- 2nd most common cause of death in the UK
What are the risk factors for breast cancer (7)
- Increasing age
- Family history
- BRCA 1/2 gene mutation
- Not breastfeeding/not having children
- Hormone replacement therapy
- Oral contreception
- Obesity
What are the types of breast cancer (3)
- Infiltrating ductal carcinoma (70%)
- Lobular carcinoma (15%)
- Medullary cancers (5%) - more affects younger people
How might breast cancer present (4)
- Mostly painless, increasing lump
- Nipple discharge
- Skin tethering
- Ulceration
How do you diagnose breast cancer (4)
- Triple diagnosis
- Clinical exam
- Ultrasound <35, Ultrasound and mammography >35
- Histology - Biopsy/aspiration
How do you treat breast cancer (3)
- Surgery - excision/mastectomy
- Radiotherapy/chemotherapy
- Endocrine therapy
1) Oestrogen receptor blockers (postmenopause only)
2) Aromatase inhibitors (reduce oestrogen production) (postmenopause only)
3) GnRH analogues (if premenopausal)
What is anaphylaxis
- A type 1 IgE mediated hypersensitivity reaction
How might anaphylaxis present (6)
- Itching
- Sweating
- Diarrhoea/vomiting
- Wheeze
- Breathless/cyanotic
- Tachycardia/hypotension
How do you treat anaphylaxis (5)
- 100% oxygen + secure airway
- IM adrenaline
- IV hydrocortisone and clorphenamine
- Fluids
- Nebulised salbutamol
What is the function of skin (6)
- Barrier to infection
- Thermoregulation
- Protects against trauma
- Protects against UV
- Synthesises Vitamin D
- Regulates H2O loss
What are common causes of itch with no rash (6)
- Renal failure
- Liver failure/jaundice
- Polycythaemia
- Diabetes
- Lymphoma
- Fe deficiency
What are common causes of itch with rash (2)
- Psoriasis
- Atopic eczema
What is the epidemiology of Acne (3)
- Usually in adolescence then resolves by mid 20s
- 70-87% of teenagers
- Affects face, back and chest
Describe the pathophysiology of Acne
- Narrowing of hair follicles leads to increased sebum production (greasy)
- Some of the sebum gets trapped in the narrow follicle
- This causes anaerobic conditions allowing growth of propionibacterium acnes
- This causes irritation, inflammation and neutrophil attraction
- Neutrophils cause increased inflammation and pus production
How do you treat Acne (4)
- Mild
- Benzoyl peroxide gel
- Topical antibiotics (clindamycin)
- Severe
- Oral tetracyclines (1st line - doxycycline 2nd line - minocycline)
- Hormonal - Co-cyprindiol (androgen blocker)
What is the epidemiology of eczema (4)
- Strong familial/maternal link
- 10% of population at any time
- 40% at some time
- Increased risk of inflammation due to breakdown of skin caused by thinning of stratum corneum
What are the types of eczema (2)
- Endogenous (atopic) - Hypersensitivity reaction
- Exogenous - Contact dermatitis caused by chemicals/irritants/sweat
How might eczema present (4)
- Usually on face/skin creases
- Itchy, erythematous, scaly patches
- Dryness
- Infection
How do you diagnose eczema
- Itchy skin condition in last 6 months plus 3/4 of:
1) History of skin crease involvement
2) History/family history of atopy
3) History of dry skin
4) Childhood onset
How do you treat eczema (5)
- Education (avoid irritants/itching)
- E45 cream
- Topical corticosteroids (hydrocortisone)
- Topical calcineurin inhibitors
- Oral prednisolone/azathioprine
What is the epidemiology of psoriasis (3)
- 2% of UK population
- Peak in early adulthood, uncommon in children
- Hyperproliferation of keratinocytes resulting in inflammatory cell invasion
How might psoriasis present (4)
- Chronic plaque psoriasis (most common)
- Salmon pink, disc shaped, silvery plaques
- Thickening of skin
- Affects scalp, elbows, knees
- Flexural psoriasis
- Red glazed non-scaly plaques only in flexures
- Guttate (raindrop) psoriasis
- Very small circular/oval plaques after strep. infection
- Palmoplantar psoriasis
- Thickening palms and hands
How do you treat psoriasis (4)
- E45 cream (chronic plaque only)
- Topical corticosteroids (hydrocortisone)
- Coal tar/UV B (chronic plaque/guttate)
- TNF alpha blockers (infliximab)
What is the epidemiology of basal cell carcinoma (4)
- Most common malignant skin cancer
- Mostly seen in elderly
- Slow growing and less metastatic but locally destructive
- Malignancy of basal keratinocytes
What are the risk factors for basal cell carcinoma (2)
- Increasing age
- UV light exposure
How might basal cell carcinoma present (3)
- Slow growing shiny nodule on head/neck
- 95% not pigmented
- Bleeds and doesn’t heal
How do you treat basal cell carcinoma (2)
- Surgical excision
- Radiotherapy
What is the epidemiology of malignant melanoma (3)
- Most malignant skin cancer
- Malignant tumour of melanocytes
- Affects younger people more commonly
What are the risk factors for malignant melanoma (4)
- Sun and alcohol combo. is very carcinogenic
- Red hair/pale skin
- Family history
- Atypical mole
How might malignant melanoma present (2)
- Men on chest/back, women on legs
- Very dark/black lesion
How do you diagnose malignant melanoma (5)
- ABCDE Asymmetrical Border irregularity Colour irregularity Diameter >6mm Evolving/change
How do you treat malignant melanoma (3)
- Surgical excision (wide doesn’t help, only curative in early stage)
- Late stage - lymph node removal/radiotherapy/chemo.
- Common metastasis to :
Lungs
CNS
Liver
What is the epidemiology of squamous cell carcinoma (3)
- Malignancy of squamal keratinocytes
- Seen in older people
- 2nd most common skin cancer and medium malignancy
How might squamous cell carcinoma present (3)
- Mostly seen in sun exposed area
- Keratotic and ill defined lesion
- Can often grow rapidly
How do you treat squamous cell carcinoma (2)
- Surgical excision
- Radiotherapy
How might a paracetamol overdose present (4)
- Jaundice
- Encephalopathy
- AKI (Acute tubular necrosis in 25%)
- Hypoglycaemia
How do you treat paracetamol overdose (2)
- Activated charcoal
- IV N-Acetylcysteine
How might aspirin overdose present (3)
- Hyperventilation (leads to resp. alkalosis hence metabolic acidosis in compensation)
- Sweating, vomiting, dehydration
- Epigastric pain
How do you treat aspirin overdose (2)
- Aggressive fluid and electrolyte resuscitation
- IV Sodium bicarbonate (acidosis)
How might Opiate overdose present (4)
- Pinpoint pupils
- Low resp. rate
- Coma
- Hypothermia and hypoglycaemia
How do you treat Opiate overdose
- IV naloxone (repeat every two minutes, aware that it has to a short half life and even when patient is stable the drug has likely longer half life so potential to deteriorate)
