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Dermatology Flashcards

1
Q

What are some key questions to ask in a dermatological history

A

Initial appearance and evolution of the lesion

Symptoms - itch/pain/bleed

Aggravating and relieving factors

Previous and current treatments

Recent contacts, stressful events, illness and travel

History of sunburn and tanning machines

Skin type

History of atopy

FH of skin disease

Occupation - skin contacts at work and improvement of symptoms when away from work

Treatments tried/other medication

QOL impact

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2
Q

Describe an examination of a skin lesion

A

Inspect - general observation, note if richly pigmented skin, site and number of lesions, if multiple the pattern of distribution and configuration

Individual lesion  - SCAM
Size, shape 
Colour 
Associated secondary change
Morphology, margin (border)

ABCDE - the presence of these features increase the likelihood of melanoma

Palpate - surface, consistency, mobility, tenderness, temperature

Systematic check - nails, scalp, hair and mucous membranes

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3
Q

Define comedone

A

Plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris

Open - blackhead
Closed - whitehead

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4
Q

Define Koebner phenomenon

A

A linear eruption arising at a site of trauma

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5
Q

What are the flexural areas

A

Body folds

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6
Q

What are the extensor areas

A

Knees, elbows and shins

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7
Q

Define dermatome

A

An area of skin supplied by a single spinal nerve

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8
Q

Define confluent

A

Merging together

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9
Q

Define target

A

Concentric rings

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10
Q

Describe annular

A

Circle or ring

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11
Q

Define discoid

A

A coin shaped or round lesion

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12
Q

Define purpura

A

Red or purple colour - does not blanche on pressure - petechiae (small pinpoint macules) or ecchymoses (larger bruise like patches)

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13
Q

Describe hypo-pigmentation

A

Areas of paler skin

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14
Q

Describe de-pigmentation

A

White skin due to absence of melanin

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15
Q

Describe hyper-pigmentation

A

Darker skin which may be due to various causes

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16
Q

Define macule

A

A flat area of altered colour

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17
Q

Define patch

A

Larger flat area of altered colour or texture

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18
Q

Define papule

A

Solid raised lesion <0.5cm in diameter

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19
Q

Define nodule

A

Solid raised lesion >0.5 cm in diameter with deeper component

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20
Q

Define plaque

A

Palpable scaling raised lesion >0.5cm in diameter

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21
Q

Define vesicle

A

Raised, clear fluid filled lesion <0.5cm in diameter

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22
Q

Define bulla

A

Raised, clear, fluid filled lesion >0.5cm in diameter

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23
Q

Define pustule

A

Pus containing lesion <0.5cm in diameter

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24
Q

Define abscess

A

Localised accumulation of pus in the dermis or subcutaneous tissue

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25
Q

Define wheal

A

Transient raised lesion due to dermal oedema

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26
Q

Define boil/furuncle

A

Staphylococcal infection around or within a hair follicle

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27
Q

Define carbuncle

A

Staphylococcal infection of adjacent hair follicles

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28
Q

Define excoriation

A

Loss of the epidermis following trauma

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29
Q

Define Lichenification

A

Well defined roughening of the skin with attenuation of skin markings

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30
Q

Define scales

A

Flakes of corneum

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31
Q

Define crust

A

Rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis

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32
Q

Define scar

A

New fibrous tissue which occurs post-wound healing and may be atrophic (thinning), hypertrophic (hyperproliferation within wound boundary) or keloidal (hyperproliferation beyond the wound boundry)

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33
Q

Define ulcer

A

Loss of the epidermis and dermis

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34
Q

Define fissure

A

Epidermal crack often due to dryness

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35
Q

Define striae

A

Linear areas which progress from purple to pink to white and with the histopathological appearance of a scar

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36
Q

Define alopecia

A

Loss of hair

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37
Q

Define hirsutism

A

Androgen dependent hair growth in a female

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38
Q

Define hypertrichosis

A

Non-androgen dependent pattern of excessive hair growth

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39
Q

Define clubbing

A

Loss of the angle between the posterior nail fold and nail plate

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40
Q

Define koilonychia

A

Spoon shaped depression of the nail plate

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41
Q

Define onycholysis

A

Separation of the distal end of the nail plate from the nail bed - trauma, psoriasis, fungal nail infection and hyperthyroidism

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42
Q

Define pitting

A

Punctate depressions of the nail plate

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43
Q

List the functions of the skin

A

Protective barrier against environmental insults and infection

Temperature regulation

Sensation

Vit D synthesis

Immunosurveillence

Appearance or cosmesis

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44
Q

Describe the structure of skin

A

Epidermis
Dermis
Subcutaneous tissue
Skin appendages - hair, nails, sebaceous glands and sweat glands

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45
Q

Describe the layers of the epidermis

A

4 layers representing a different stage of maturation of the keratinocytes

  • Basal cell layer/stratum basale - actively dividing cells (deepest layer)
  • Stratum spinosum - differentiating cells
  • Stratum granulosum - cells lose their nuclei and contain granules of keratohyaline - secrete lipid into intercellular spaces
  • Stratum corneum/horny later - layer of keratin, most superficial layer
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46
Q

What is the dermis composed of

A

Collagen
Elastin
Glycosaminoglycans - synthesised by fibroblasts - provide skin with elasticity and strength

Nerves, immune cells, skin appendages as well as lymphatic and blood vessels

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47
Q

What are the 3 main types of hair

A

Lanugo - fine long hair in fetus
Vellus hair - fine short hair on body surfaces
Terminal hair - eyebrows, eyelashes, scalp and pubic area

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48
Q

List the 3 growth phases of hair

A

Anagen
Catagen
Telogen

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49
Q

What are sebaceous glands and give their function

A

Produce sebum via hair follicles to lubricate and waterproof the skin

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50
Q

What sweat glands are inflamed/infected in hidradenitis suppurativa

A

Appocrine

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51
Q

Which sweat glands are overactive in hyperhidrosis

A

Eccrine

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52
Q

Describe the 4 phases of wound healing

A

Haemostasis

  • Vasoconstriction and platelet aggregation
  • Clot formation

Inflammation

  • Vasodilation
  • Migration of neutrophils and macrophages
  • Phagocytosis of cellular debris and invading bacteria

Proliferation

  • Granulation tissue formation and angiogenesis
  • re-epithelisation

Remodelling

  • collagen fibre re-organisation
  • scar maturation
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53
Q

Describe urticaria and its treatment

A

Local increase in permeability of capillaries and small venules caused by local mediator release of histamine from mast cells presenting with itchy wheals from swelling of the superficial dermis

Treat with antihistamines

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54
Q

Describe angioedema and its treatment

A

Deeper swelling of the dermis and subcutaneous tissues

Swelling of the tongue and lips

Corticosteroids for severe acute urticaria and angioedema

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55
Q

Describe anaphylaxis and its treatment

A

Bronchospasm, facial and laryngeal oedema, hypotension

Lie patient flat, Establish airway, high flow Oxygen
Adrenaline IM 500 mcg 1:1000 - repeat after 5 mins - anterolateral aspect of middle third of the thigh
Chlorphenamine 10mg IM/IV
IV fluids 500ml over 15 mins
Hydrocortisone 200mg IV

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56
Q

What blood test can be done to determine if a reaction was due to anaphylaxis

A

Serum tryptase

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57
Q

What is erythema nodosum

A

A hypersensitivity response to a variety of stimuli

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58
Q

What causes erythema nodosum

A 
Group A beta haemolytic streptococcus 
Primary TB
Pregnancy
Malignancy
Sarcoidosis
IBD
Chlamydia
Leprosy
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59
Q

Describe the presentation of erythema nodosum

A

Discrete tender nodules which may become confluent
Lesions continue to appear for 1-2 weeks and leave bruise like discolouration as they resolve
Lesions do not ulcerate and resolve without atrophy or scarring
The shins are the most common sight

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60
Q

Describe erythema multiforme

A

Often unkown cause
Acute self limiting condition with herpes simplex virus being a precipitating factor
Other infections and drugs (penicillin, NSAIDs, allopurinol, COCP) are also causes
Mucosal involvement is absent or limited to one mucosal surface

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61
Q

Describe stevens-johnson syndrome

A

Mucocutaenous necrosis with at least two mucosal sites involved

Skin involvement may be limited or extensive

Drugs (penicillin, phenytoin) or infection are main associations

Epithelial necrosis with few inflammatory cells is seen on histopathology

May have prodromal illness

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62
Q

Describe the management of erythema multiforme, stevens-johnson syndrome and toxic epidermal necrolysis

A

Full supportive care to maintain haemodynamic equilibrium

Early recognition and call for help

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63
Q

What are deaths from SJS and TEN due to

A

Sepsis
Electrolyte imbalance
Multisystem organ failure

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64
Q

Which bacteria commonly causes acute meningococcaemia

A

Gram negative diplococcus Neisseria meningitides

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65
Q

Describe the presentation of acute meningococcaemia

A

Features of meningitis - headache, fever, neck stiffness

Features of septicaemia - hypotension, fever, myalgia

Typical rash - non blanching purpuric rash on the trunk and extremities which may be preceded by a blanching maculopapular rash and can rapidly progress to ecchymoses, haemorrhagic bullae and tissue necrosis

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66
Q

Which prophylactic antibiotics doe you give to close contacts (within 14 days of exposure) of acute meningococcaemia

A

Rifampicin

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67
Q

Describe erythroderma

A

Exfoliative dermatitis >90% skin surface
Skin appears inflamed, oedematous and scaly
Systemically unwell with lymphadenopathy and malaise
Richly pigmented skin may look darker with hint of erythema, palpating the skin reveals increased temperature

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68
Q

List some causes of erythroderma

A

Previous skin disease - eczema and psoriasis

Lymphoma

Drugs - sulphonamides, gold, sulphonlyureas, penicillin, allopurinol, captopril

Idiopathic

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69
Q

Describe the management of erythroderma

A

Treat the underlying cause
Emollients and wet wraps to maintain skin moisture
Topical steroids to relieve inflammation

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70
Q

List some complications of erythroderma

A 
Secondary infection
Fluid loss
Electrolyte imbalance
Hypothermia
High output cardiac failure
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71
Q

Describe eczema herpeticum

A

Widespread eruption
Complication of atopic eczema
Extensive crusted papules, blisters and erosions
Systemically unwell with fever and malaise

72
Q

What causes eczema herpeticum

A

Herpes simplex virus

73
Q

Describe the management of eczema herpeticum

A

Antivirals (Aciclovir)

Antibiotics for bacterial secondary infection

74
Q

List some complications of eczema herpeticum

A

Herpes hepatitis
Encephalitis
DIC
Death

75
Q

Describe necrotising fasciitis

A

A rapidly spreading infection of the deep fascia with secondary tissue necrosis

Severe pain, erythematous, blistering and necrotic skin, systemically unwell with fever and tachycardia, presence of crepitus, X-ray may show soft tissue gas

76
Q

What causes necrotising fasciitis

A

Group A haemolytic streptococcus

Mixture of anaerobic or aerobic bacteria

77
Q

List some risk factors for necrotising fasciitis

A

Abdominal surgery

Co-morbidities - DM (SGLT2 inhibitors) or malignancy

78
Q

Describe the management of necrotising fasciitis

A

Urgent referral for extensive surgical debridement

IV antibiotics

79
Q

Describe erysipelas and cellulitis

A

Spreading bacterial infection of the skin

Cellulitis - deep SC tissue

Erysipelas - acute superficial form of cellulitis and involves the dermis and upper subcutaneous tissue

80
Q

What are the causes and risk factors for erysipelas and cellulitis

A

Streptococcus pyogenes and staphylococcus aureus

Immunosuppression, wounds, leg ulcers, toe web intertrigo and minor skin injury

81
Q

Describe the presentation of erysipelas and cellulitis

A

Erysipelas - well defined, raised, red border

Local signs of inflammation - swelling (tumour), erythema (rubor), warmth (calor), pain (dolor) - may be associated with lymphangitis

Systemically unwell with fever, malaise and rigors

82
Q

How is cellulitis and erysipelas treated

A

Antibiotics - flucloxacillin or benzylpenicillin

Supportive care - rest, leg elevation, sterile dressing and analgesia

83
Q

What are some complications of cellulitis and erysipelas

A

Local necrosis
Abscess
Septicaemia

84
Q

Describe staphylococcal scalded skin syndrome

A

Seen in infancy and early childhood

Production of epidermolytic toxin from phage group 2, benxylpenicillin resistant staphylococci

Develops within hrs to days and may be worse over axillae, groin , face and neck

Scalded like skin appearance followed by large flaccid bullae
Perioral crusting 
Intraepidermal blistering
Lesions are painful
Eruption may be more localised 
Recovery within 5-7days
85
Q

Describe the management of staphylococcal scalded skin syndrome

A

Antibiotics - erythromycin or cephalosporin

Analgesia

86
Q

What are the 3 main groups of superficial fungal infections of the skin

A

Dermatophytes (tinea/ringworm)
Yeast (candidiasis, malassezia)
Moulds (aspergillus)

87
Q

Describe tinea corporis

A

Tinea infection of the trunk and limbs

Itchy, circular or annular lesions with clearly defined, raised, scaly edge

88
Q

Describe tinea cruris

A

Tinea infection of the groin and natal cleft

Very itchy

89
Q

Describe tinea pedis

A

Athletes foot

Moist scaling and fissuring in the toe webs, spreading to the sole and dorsal aspect of the foot

90
Q

Describe tinea manuum

A

Infection of the hand

Scaling and dryness in the palmar creases

91
Q

Describe tinea capitis

A

Infection of the scalp - patches of broken hair, scaling and inflammation

92
Q

Describe tinea unguium

A

Infection of the nail
Yellow discoloration
Thickened
Crumbly nail

93
Q

Describe tinea incognito

A

Inappropriate treatment of tinea infection with topical or systemic corticosteroids - ill defined and less scaly lesion

94
Q

Describe candidiasis skin infection

A

White plaques on mucosal areas, erythema with satellite lesion in flexures

95
Q

Describe pityriasis/tinea versicolor

A

Infection with malassezia furfur
Scaly pale brown patches on upper trunk that fail to tan on sun exposure
Usually asymptomatic

96
Q

Describe the management of superficial fungal skin infections

A

Establish correct diagnosis by skin scrapings, hair or nail clippings (dermatophytes) and skin swabs (yeast)

Treat underling immunosuppression, remove moist environments

Topic antifungal agents (terbinafine cream)

Oral antifungal agents (itraconazole) for severe, widespread or nail infections

97
Q

Why should topical steroids be avoided in superficial fungal infections

A

Lead to tinea incognito

98
Q

Describe basal cell carcinoma

A

Slow growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older individuals - only rarely metastasises
Most common

Nodular (most common) - small, skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge, the lesion may have a necrotic or ulcerated centre

99
Q

List some risk factors for basal cell carcinoma

A 
UV expisure
History of frequent or severe sunburn in childhood
Skin type 1 - always burns, never tans 
Increasing age
Male
Immunosuppression
Previous skin cancer
FH
100
Q

Describe the management of basal cell carcinomas

A

Surgical excision - examination of tumour and margins

Mohs micrographic surgery - excision of lesion and tissue borders are progressively excised until specimens are microscopically free of tumour - high risk recurrent tumours

Radiotherapy - when surgery is not appropriate

Cyrotherapy, currettage and cautery, topical photodynamic therapy, topical treatment (imiquimod cream)

101
Q

List the complications of BCC

A

Local tissue invasion and destruction

102
Q

Describe the prognosis of BCC

A

Depends on size, site, type, growth pattern/histology, failure of previous treatment/recurrence and immunosuppression

103
Q

Describe squamous cell carcinoma

A

Locally invasive malignant tumour of the epidermal keratinocytes or its appendages which has the potential to metastasise

Keratotic (scaly, crusty), ill defined nodule which may ulcerate

104
Q

List some risk factors of SCC

A 
Excessive UV exposure
Pre-malignant skin conditions 
Chronic inflammation 
Immunosuppression
Genetic predisposition
105
Q

Describe the management of SCC

A

Surgical excision - treatment of choice
Mohs micrographic surgery - ill defined large, recurrent tumours
Radiotherapy - large, non-resectable tumours

106
Q

Describe malignant melanoma

A

Invasive malignant tumour of the epidermal melanocytes which have the potential to metastasise

107
Q

List some risk factors of malignant melanoma

A 
Excessive UV exposure 
Skin type 1 
History of >100 moles/atypical nevus syndrome moles
FH in 1st degree relative 
Previous melanoma
108
Q

Describe the ABCDE symptoms rule for malignant melanoma

A 
Asymmetrical shape
Border irregularity 
Colour irregularity 
Diameter >6mm
Evolution of the lesion - change in size and shape
Symptoms - itching or bleeidng
109
Q

Describe superficial spreading melanoma

A

Most common type - 70%
More common on the lower limbs in young/middle aged adults
Related to intermittent high UV exposure

110
Q

Describe nodular melanoma

A

Common on the trunk in young and middle aged adults, related to intermittent high intentity UV exposure

111
Q

Describe lentigo maligna melanoma

A

Common on the face, in elderly population, related to long term cumulative UV exposure

112
Q

Describe acral lentiginous melanoma

A

Common on palms, soles and nail beds in elderly population

No clear relation to UV exposure

113
Q

Describe the management of malignant melanoma

A

Surgery
Radiotherapy
Chemotherapy

114
Q

How is malignant melanoma staged

A

Breslow’s thickness
Lymph node involvement
Metastasis
Stage 1-4

115
Q

What is thought to be the primary gene defect in eczema

A

Loss of protein filaggrin function - defect in skin barrier function

116
Q

List some eczema exacerbating factors

A 
Infection
Allergens - food, chemicals, dust, pet fur 
Sweating
Heat
Occupation 
Severe stress
117
Q

Describe the acute presentation of eczema

A

Itchy papules and vesicles often weepy

118
Q

Describe the chronic presentation of eczema

A

Dry scaly itchy patches can be erythematous in paler skin or grey/brown in richly pigmented skin
Chronic scratching leads to Lichenification
Hypo/hyperpigmentation
Nails may show pitting and ridging

119
Q

Where is eczema located

A

Flexor aspects in children and adults (extensors in infants)

120
Q

How may eczema present in richly pigmented skin

A

Brown, grey, purple bumps

121
Q

Describe the management of eczema

A

Avoid exacerbating factors
Frequent emollients and banadages and bath oil/soap substitutes

Topical therapies - topical steroids for acitve areas and topical immunomodulators (tacrolimus and pimecrolimus) for maintenance therapy as steroid sparing agents

Oral therapy - antihistamines for symptomatic relief, antibiotics (flucloxacillin) for secondary bacterial infection and antivirals (Aciclovir) for secondary herpes infection

Phototherapy and immunosuppressants for severe non-responsive cases and biologic therapy

122
Q

List some complications of eczema

A

Secondary bacterial infection - crusted weepy lesion
Secondary viral infection - molluscum contagiosum (pearly papules with central umbilication), viral warts and eczema herpeticum

123
Q

Describe acne vulgaris

A

Inflammatory disease of the pilosebaceous follicle
Hormonal, increased sebum production, abnormal follicular keratinization, bacterial colonization and inflammation

Non-inflammatory lesions (mild acne) - open and closed comedones

Inflammatory lesions (moderate and severe acne) - papules, pustules, nodules and cysts

In richly pigmented skin - inflammatory lesions not so apparent instead with hyperpigmented lesions or nodules detected by palpation

124
Q

Describe the management of acne

A

Treatment for 6 weeks to see effect

Topical therapy - benzoyl peroxidase and topical antibiotics and topical retinoids

Oral therapy - oral antibiotics and anti-androgens in females

Oral retinoids for severe acne

125
Q

Describe psoriasis

A

Chronic inflammatory skin disorder due to hyperproliferation of keratinocytes and inflammatory cell infilration

126
Q

List some types of psoriasis

A

Chronic plaque psoriasis - most common

Guttate (raindrop lesions)
Flexural (body folds)
Pustular (palmar-plantar)
Erythrodermic (total body redness)

127
Q

List some precipitating factors of psoriasis

A

Trauma - koebner phenomenon

Infection

Drugs (beta blockers, lithium) and alcohol

Stress

128
Q

Describe the presentation of psoriasis

A

Well demarcated erythematous scaly plaques

Richly pigmented skin - psoriasis can be brown, grey or purple patches/plaques

Lesions can be burning, itchy and painful

Common on extensor surfaces and over scalp

Auspitz sign - scratch and gentle removal of the scales causes capillary bleeding

50% have associated nail changes

5-8% have associated psoriatic arthropathy - symmetrical polyarthritis, asymmetrical oligomonoarthritis, lone distal interphalangeal disease, psoriatic spondylosis, arthritis mutilans (flexion deformity of the dip joints)

129
Q

Describe the management of psoriasis

A

Avoid precipitating factors
Use emollients to reduce scales

Topical therapies - vitamin D analogues (calcipotriol, calcitriol), topical corticosteroids, coal tar preparations, dithranol, topical retinoids, keratinolytics and scalp preparations

Phototherapy for extensive disease - UVB and photochemotherapy psoralen UVA

Oral therapy - methotrexate, retinoids, ciclosporin, mycophenolate mofetil, fumaric acid esters, biological agents

130
Q

List some complications of psoriasis

A

Erythroderma, psychological and social effects

131
Q

What is a complication of PUVA therapy

A

SCC

132
Q

In psoriasis, how long should you wait before starting a second course of the same treatment (steroids)

A

4 weeks

133
Q

What does the fragility of blisters depend on

A

The level of the split in the skin

134
Q

What blisters rupture easily

A

Intraepidermal - Split within the epidermis

135
Q

Which blisters do not rupture easily

A

Sub-epidermal - Split between the epidermis and dermis

136
Q

Describe pompholyx

A

Vesicular eczema of the hands and feet

137
Q

Describe bullous pemphigoid

A

Blistering skin disorder which affects the elderly

Autoantibodies against antigens between the epidermis and dermis causing a sub-epithelial split in the skin

Tense, fluid filled blisters on an erythematous base, lesions are itchy and may be preceded by a non specific itchy rash

Usually affects the trunk and limbs

138
Q

Describe the management of bullous pemphigoid

A

Wound dressings where required, monitor for signs of infection

Topical therapies for localised disease - topical steroids

Oral therapies for widespread disease - oral steroids, combination or oral tetracycline and nicotinamide, immunosuppressive agents (azathioprine, mycophenolate, mofetil, methotrexate)

139
Q

Describe pemphigus vulgaris

A

Blistering skin disorder which usually affects middle aged

Autoantibodies against antigens in the epidermis (desmosomes) causing intra-epidermal split in the skin

Flaccid, easily ruptured blisters forming erosions and crusts

Lesions are often painful

Usually affects the mucosal areas - precede skin involvement

140
Q

Describe the management of pemphigus vulgaris

A

Wound dressing where required, monitor for signs of infection, good oral care

Oral therapies - high dose steroids, immunosuppressive agents (mycophenolate mofetil, methotrexate, azathioprine, cyclophosphamide)

141
Q

Describe vitiligo

A

Autoimmune, acquired disorder where the innate immune system causes loss/destruction of melanocytes leading to depigmentation

Presents at any age

Koebner phenomenon - favours site of injury

Face, hands, feet, body folds and genitalia

142
Q

Describe the management of vitiligo

A

Minimise skin injury

Topical treatment - topical steroids and calcineurin inhibitors (topical tacrolimus and pimecrolimus)

Phototherapy (UVB)

Oral immunosuppression - methotrexate, ciclosporin and mycophenolate mofetil

143
Q

Describe melasma

A

Acquired chronic skin disorder of increased pigmentation

Genetic predisposition plus sun exposure, hormone changes with pregnancy and contraceptive pills

Overprouction of melanin by melanocytes

Brown macules.larger patches with irregular border
Symmetrical distribution

Forehead, cutaneous upper lips and cheeks, rarely occur on neck, shoulders and upper arms

144
Q

Describe the management of melasma

A

Lifelong sun protection

Discontinuation of hormone products

Cosmetic camouflage

Topical treatments - inhibit formation of new melanin - hydroquinone, azelaic acid, vitamin C

Laser treatment used with caution as heat from lasers can cause post inflammatory hyperpigmentation

145
Q

Describe a venous ulcer

A

Medial malleolus
Painful when standing up
History of venous disease
Large, shallow, irregular ulcer with exudative and granulating base
Warm skin, normal peripheral pulses, leg oedema, hemosiderin, melanin deposition, lipodermatosclerosis and atrophie blanche

146
Q

How are venous ulcers managed

A

Compression bandaging after excluding arterial insufficiency

147
Q

Describe an arterial ulcer

A 
Painful especially at night or when legs are elevated 
History of arterial disease
Occur on pressure and trauma sites 
Cold skin
Weak/absent pulses
Shiny pale skin 
Loss of hair
148
Q

How is arterial ulcer managed

A

ABPI <0.8

Doppler studies and angiography - referral to vascular

149
Q

Describe a neuropathic ulcer

A 
Often painless, abnormal sensation 
History of diabetes or neurological disease 
Occur on pressure sites
Variable in size and depth
Granulating base
May be surrounded by or underneath a callus 
Warm skin
Normal peripheral pulses 
Peripheral neuropathy
150
Q

Describe the management of neuropathic ulcers

A

X-ray to exclude osteomyelitis
Wound debridement
Regular repositioning, appropriate footwear and good nutrition

151
Q

Describe scabies

A

May have history of contact with symptomatic indiviuals
Pruititis worse at night
Sides of fingers, finger webs, wrists, ankles, feet , nipples and genitals
Linear burrows or rubbery nodules
Secondary eczema and impetigo

152
Q

How is scabies diagnosed

A

Skin scrape
Extraction of mite
View under microscope

153
Q

How is scabies treated

A

Permethrin or malathion

Antihistamines

154
Q

Describe lichen planus

A 
FH (10%)
May be drug induced 
Forearms, wrists and legs 
Always examine the oral mucosa 
Violaceous flat topped papules or hyperpigmented papules 
Symmetrical distribution 
Nail changes and hair loss 
Lacy white streaks on the oral mucosa and skin lesions (Wickham's striae)
155
Q

How is lichen planus investigated

A

Skin biopsy

156
Q

Describe the management of lichen planus

A

Corticosteroids

Antihistamines

157
Q

Describe melanocytic naevi

A

Asymptomatic
Congenital may be large, pigmented, protuberant and hairy
Junctional naevi are small, flat and dark
Intradermal naevi are usually dome shaped papules or nodules
Compound naevi are usually raised, warty, hyperkeratotic and/or hairy

158
Q

Describe seborrheic wart

A

Occur on the face and trunk
Multiple and asymptomatic
Middle aged/elderly
Warty greasy papules/nodules with a stuck on appearance and well defined edges

159
Q

Describe the management of seborrheic warts

A

Only if symptomatic
Curette and cautery
Cryotherapy

160
Q

Describe DIC

A

History of trauma, malignancy, sepsis, obstetric complications, transfusions or liver failure

Spontaneous bleeding from ENT, GI, resp or wound site

Petechiae, ecchymoses, haemorrhagic bullae and tissue necrosis, systemically unwell

161
Q

Describe DIC treatment

A

Treat underlying cause
Transfuse for coagulation deficiency
Anticoagulants for thrombosis

162
Q

Describe vasculitis

A

Painful lesions
Dependent areas
Palpable purpura - often painful
Systemically unwell

163
Q

Describe actinic purpura

A 
Extensor surfaces of hands and forearms
Such skin is easily traumatised
Non-palpable purpura 
Surrounding skin is atrophic and thin 
Systemically unwell 
No investigations or treatment needed
164
Q

Give some examples of emoliients

A

Aqueous cream
Emulsifying ointment
Liquid paraffin and white paraffin 50:50
500g per tub

165
Q

Name a mildly potent topical steroid

A

Hydrocortisone

166
Q

Name a moderately potent topical steroid

A

Clobetasone butyrate (Euvomate)

167
Q

Name a potent topical steroid

A

Betamethasone valerate (Betnovate)

168
Q

Name a very potent topical steroid

A

Clobetasol propionate (dermovate)

169
Q

List some local side effects of topical steroids

A 
Skin atrophy 
Telangiectasia
Striae 
May mask, exacerbate or cause skin infections 
Acne 
Perioral dermatitis
Allergic contact dermatitis
170
Q

List some systemic side effects of oral steroids

A 
Cushings syndrome 
Immunosuppression
HTN
DM
Osteoporosis
Cataract 
Steroid induced psychosis
171
Q

List some side effects of oral Aciclovir

A

GI upset
Raised liver enzymes
Reversible neurological reactions
Haematological disorder

172
Q

Describe the side effects of oral antihistamines

A

Sedative

Anticholinergic - Dry mouth, blurred vision, urinary retention and constipation

173
Q

List the side effects of isotretinoin

A

Mucocutaneous reaction - dry skin, dry lips and dry eyes, disordered liver function, hypercholesterolaemia, hypertriglyceridemia, myalgia, arthralgia and depression
Teratogenic

174
Q

Describe the SMART ways to avoid sun exposure

A

Spend time in the shade between 11am-3pm
Make sure you never burn
Aim to cover up with a T-shirt, wide brimmed hat and sunglasses
Remember to take extra care with children
Then remember SPF 30+

175
Q

Describe the Fitzpatrick skin phototypes

A 
1 - always burns, never tans
2 - always burns, sometimes tans
3 - sometimes burns, always tans
4 - never burns, always tans
5 - tans very easily, rarely burns
6 - tans very easily, never burns
176
Q

Rash after amoxicillin may indicate…

A

Glandular fever
CLL
ALL
Side effect

Finals (18 decks)

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