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Phase 2 > Derm/others > Flashcards

Derm/others Flashcards

1
Q

What is the epidemiology of HIV (3)

A
  • More common in men overall
  • Most prevalent in sub-saharan Africa
  • Majority of new cases in 15-24 year olds
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2
Q

Which individuals are at most risk of HIV (4)

A
  • Unprotected sex (homosexual often)
  • Sex workers
  • Truck drivers (they murder prostitutes)
  • IV drug users
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3
Q

What are the methods of transmission of HIV (4)

A
  • Sexual contact
  • Blood products
  • Sharing needles
  • Mother to child
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4
Q

Describe the pathophysiology of HIV

A
  • 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
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5
Q

How do you diagnose HIV (2)

A
  • Clinical history if suspected send for HIV test eg. ELISA

- CD4 T-cell levels used to monitor

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6
Q

How do you treat HIV

A
  • 2NRTI and 1 NNRTI
  • NRTI = nucleotide reverse transcriptase inhibitors
    eg. = Abacavir and didanosine
  • NNRTI = non-nucleotide reverse transcriptase inhibitor
    eg. Etravirine
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7
Q

What is the epidemiology of breast cancer (3)

A
  • 1 in 9 women affected
  • Risk increases with age
  • 2nd most common cause of death in the UK
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8
Q

What are the risk factors for breast cancer (7)

A
  • Increasing age
  • Family history
  • BRCA 1/2 gene mutation
  • Not breastfeeding/not having children
  • Hormone replacement therapy
  • Oral contreception
  • Obesity
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9
Q

What are the types of breast cancer (3)

A
  • Infiltrating ductal carcinoma (70%)
  • Lobular carcinoma (15%)
  • Medullary cancers (5%) - more affects younger people
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10
Q

How might breast cancer present (4)

A
  • Mostly painless, increasing lump
  • Nipple discharge
  • Skin tethering
  • Ulceration
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11
Q

How do you diagnose breast cancer (4)

A
  • Triple diagnosis
  • Clinical exam
  • Ultrasound <35, Ultrasound and mammography >35
  • Histology - Biopsy/aspiration
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12
Q

How do you treat breast cancer (3)

A
  • 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)
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13
Q

What is anaphylaxis

A
  • A type 1 IgE mediated hypersensitivity reaction
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14
Q

How might anaphylaxis present (6)

A
  • Itching
  • Sweating
  • Diarrhoea/vomiting
  • Wheeze
  • Breathless/cyanotic
  • Tachycardia/hypotension
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15
Q

How do you treat anaphylaxis (5)

A
  • 100% oxygen + secure airway
  • IM adrenaline
  • IV hydrocortisone and clorphenamine
  • Fluids
  • Nebulised salbutamol
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16
Q

What is the function of skin (6)

A
  • Barrier to infection
  • Thermoregulation
  • Protects against trauma
  • Protects against UV
  • Synthesises Vitamin D
  • Regulates H2O loss
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17
Q

What are common causes of itch with no rash (6)

A
  • Renal failure
  • Liver failure/jaundice
  • Polycythaemia
  • Diabetes
  • Lymphoma
  • Fe deficiency
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18
Q

What are common causes of itch with rash (2)

A
  • Psoriasis

- Atopic eczema

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19
Q

What is the epidemiology of Acne (3)

A
  • Usually in adolescence then resolves by mid 20s
  • 70-87% of teenagers
  • Affects face, back and chest
20
Q

Describe the pathophysiology of Acne

A
  • 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
21
Q

How do you treat Acne (4)

A
  • Mild
  • Benzoyl peroxide gel
  • Topical antibiotics (clindamycin)
  • Severe
  • Oral tetracyclines (1st line - doxycycline 2nd line - minocycline)
  • Hormonal - Co-cyprindiol (androgen blocker)
22
Q

What is the epidemiology of eczema (4)

A
  • 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
23
Q

What are the types of eczema (2)

A
  • Endogenous (atopic) - Hypersensitivity reaction

- Exogenous - Contact dermatitis caused by chemicals/irritants/sweat

24
Q

How might eczema present (4)

A
  • Usually on face/skin creases
  • Itchy, erythematous, scaly patches
  • Dryness
  • Infection
25
Q

How do you diagnose eczema

A
  • 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
26
Q

How do you treat eczema (5)

A
  • Education (avoid irritants/itching)
  • E45 cream
  • Topical corticosteroids (hydrocortisone)
  • Topical calcineurin inhibitors
  • Oral prednisolone/azathioprine
27
Q

What is the epidemiology of psoriasis (3)

A
  • 2% of UK population
  • Peak in early adulthood, uncommon in children
  • Hyperproliferation of keratinocytes resulting in inflammatory cell invasion
28
Q

How might psoriasis present (4)

A
  • 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
29
Q

How do you treat psoriasis (4)

A
  • E45 cream (chronic plaque only)
  • Topical corticosteroids (hydrocortisone)
  • Coal tar/UV B (chronic plaque/guttate)
  • TNF alpha blockers (infliximab)
30
Q

What is the epidemiology of basal cell carcinoma (4)

A
  • Most common malignant skin cancer
  • Mostly seen in elderly
  • Slow growing and less metastatic but locally destructive
  • Malignancy of basal keratinocytes
31
Q

What are the risk factors for basal cell carcinoma (2)

A
  • Increasing age

- UV light exposure

32
Q

How might basal cell carcinoma present (3)

A
  • Slow growing shiny nodule on head/neck
  • 95% not pigmented
  • Bleeds and doesn’t heal
33
Q

How do you treat basal cell carcinoma (2)

A
  • Surgical excision

- Radiotherapy

34
Q

What is the epidemiology of malignant melanoma (3)

A
  • Most malignant skin cancer
  • Malignant tumour of melanocytes
  • Affects younger people more commonly
35
Q

What are the risk factors for malignant melanoma (4)

A
  • Sun and alcohol combo. is very carcinogenic
  • Red hair/pale skin
  • Family history
  • Atypical mole
36
Q

How might malignant melanoma present (2)

A
  • Men on chest/back, women on legs

- Very dark/black lesion

37
Q

How do you diagnose malignant melanoma (5)

A 
- ABCDE
Asymmetrical
Border irregularity
Colour irregularity
Diameter >6mm
Evolving/change
38
Q

How do you treat malignant melanoma (3)

A
  • Surgical excision (wide doesn’t help, only curative in early stage)
  • Late stage - lymph node removal/radiotherapy/chemo.
  • Common metastasis to :
    Lungs
    CNS
    Liver
39
Q

What is the epidemiology of squamous cell carcinoma (3)

A
  • Malignancy of squamal keratinocytes
  • Seen in older people
  • 2nd most common skin cancer and medium malignancy
40
Q

How might squamous cell carcinoma present (3)

A
  • Mostly seen in sun exposed area
  • Keratotic and ill defined lesion
  • Can often grow rapidly
41
Q

How do you treat squamous cell carcinoma (2)

A
  • Surgical excision

- Radiotherapy

42
Q

How might a paracetamol overdose present (4)

A
  • Jaundice
  • Encephalopathy
  • AKI (Acute tubular necrosis in 25%)
  • Hypoglycaemia
43
Q

How do you treat paracetamol overdose (2)

A
  • Activated charcoal

- IV N-Acetylcysteine

44
Q

How might aspirin overdose present (3)

A
  • Hyperventilation (leads to resp. alkalosis hence metabolic acidosis in compensation)
  • Sweating, vomiting, dehydration
  • Epigastric pain
45
Q

How do you treat aspirin overdose (2)

A
  • Aggressive fluid and electrolyte resuscitation

- IV Sodium bicarbonate (acidosis)

46
Q

How might Opiate overdose present (4)

A
  • Pinpoint pupils
  • Low resp. rate
  • Coma
  • Hypothermia and hypoglycaemia
47
Q

How do you treat Opiate overdose

A
  • 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)

Phase 2 (10 decks)

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