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ICM - OBS > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How are nail clippings collected?

A
  1. Can be used on finger or toenails š
  2. The nail sample should be taken from the area of
    deformity/ discolouration and cut back as much as
    possible and through entire thickness of nail of a
    good sample.
  3. Sample collected in dermapak for transport.
    - If not
    available, then in paper towel and in sterile
    universal pot.
  4. Normally takes ~4-5 days for culture results
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2
Q

What are nails clippings used to differentiate between?

A

Differentiate between fungal and dystrophic nails/

other pathology

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3
Q

When do you use skin scraping?

A
  • If unknown skin rash

- Rash not responding to treatment.

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4
Q

What can skin scraping be used to diagnose?

A
  • Mainly used for fungal skin infection

- Detects scabies/bacterial infection

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5
Q

What investigations are carried out with skin scrappings?

A

microscopy & culture

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6
Q

How is skin scrapping performed?

A
  1. 70% alcohol wipe used to clean skin to avoid contamination/ aid microscopy if creams on the skin.
  2. Sterile scalpel blade used to take a superficial scraping of the skin of the rash/ affected area of
    concern.
  3. Sample put into dermapak for transport to the lab or wrap in paper towel and put into sterile universal sample pot.
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7
Q

How long does skin scrapping results take?

A

4-5 days

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8
Q

What is wood’s lamp?

A

Handheld device emits long wave ultraviolet light.

Aka blacklight as little light seen to the naked eye

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9
Q

How is wood’s lamp carried out ?

A

Used in a darkened room over area of skin of concern to help in diagnosis. Abnormal skin will become fluorescent.

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10
Q

What is wood’s lamp used to diagnose?

A
  1. Fungal infections of the skin (green/blue)
  2. Bacterial infections of the skin (coral red)
  3. Vitiligo (blue/white)
  4. Head lice
  5. Other pigmented lesions
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11
Q

Use of wood’s lamp in diagnosis

A
  1. Can strengthen or lessen suspicion of a diagnosis
    depending on the colour of the fluorescence of the skin.
  2. Normal skin will not fluoresce
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12
Q

Indications for allergy testing

A
  1. Previous symptoms of Anaphylaxis – URGENT ALLERGY
  2. Food allergy suspected
  3. Drug allergy suspected
  4. Urticaria/ angioedema: acute and chronic
  5. Asthma: unexplained deterioration/ uncontrolled
  6. Allergic rhinitis: severe symptoms/ not controlled on standard treatment.
  7. Eczema/ dermatitis: where allergic cause possible e.g unexplained deterioration/ more
    frequent unexplained flare ups/ not controlled with standard treatment.
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13
Q

Types of allergy testing

A
  1. Skin prick test
  2. Skin patch test
  3. RAST/Immunochap (blood test)
  4. Food Challenge
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14
Q

How is skin prick test carried out?

A
  1. Start by taking history and deciding what allergens to test for
    –> can have
    false positive results so avoid testing
    allergens not indicated
  2. Suspected allergen applied to the skin
    (normally forearm)
  3. lancet used to prick the skin.
  4. Reaction measured in 10-15
    minutes.
  5. Negative (saline) and positive
    (histamine) controls used.
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15
Q

Where is skin prick test carried out and why?

A

Performed in hospital environment due
to very rare but hypothetical risk of
anaphylaxis reaction.

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16
Q

When do you use skin patch test?

A

Used for delayed/ contact reactions of the

skin. e.g. contact dermatitis.

17
Q

Where is skin patch test carried out?

A

Performed in hospital/ clinic setting.

18
Q

How is skin patch test carried out?

A
  1. Common allergens that come into contact
    with the skin + others from history taken are
    applied onto the skin with small disc patches
    and held on with hypoallergenic tape.
  2. 3 appointments in a week. - Initial appointment will apply the allergens.
    - Second appointment in 2 days after patches applied to remove the discs and assess reactions.
    - Third appointment 4 days after patches applied to assess for delayed reactions.
  3. Positive test- red/ raised/ reaction formation
    on area of patch.
19
Q

What is RAST/immunochap?

A

Blood test for to measure IgE antibodies to an allergen.

20
Q

Why is RAST/immunochap carried out?

A

Testing IgE to allergen often used to confirm if reaction is a false positive if unexpected
reaction on skin prick test. Ie someone able to eat said allergen but forms skin reaction.

21
Q

When is RAST/immunochap indicated?

A

Can be used if skin prick test cannot be used

(Give equivalent information to skin prick but more expensive, cannot get results on the
same day and less acceptable especially for children.)

22
Q

How do you describe a rash/mole?

A

ABCDE criteria

A- Asymmetry š
B- Border š
C- Colour š
D- Diameter (largest diameter
more than 7mm) š
E- Evolution
23
Q

Indications for 2WW referral in derm

A

Red flags of skin lesions/ suspected cancer:

  1. Melanoma
  2. Squamous Cell Carcinoma
  3. Cutaneous T-cell lymphoma
  4. Kaposi’s sarcoma

If 100% sure lesion in keeping with Basal Cell Carcinoma- routine referral to dermatology as
slow growing.
–> In reality would refer any lesions with red flags via 2ww pathway

24
Q

What is a dermatoscopy?

A
  1. Easy to use and light weight microscope- high quality
    lens that can magnify up to 10-14 times that of the
    naked eye
  2. Allows visualisation of subsurface patterns/
    pigmentation and structures not seen by the naked
    eye.
  3. Come in small handheld devices/ attachable
    accessories for phones.
25
Q

When is dermatoscopy used?

A

Normally used for lesions with red flags to accurately
diagnose skin cancer however can be used on rashes/
other skin lesions to confirm diagnoses.

26
Q

Importance of dermatoscopy

A

Can be up to 35% more accurate than clinical

diagnosis and stop unnecessary benign lesions being excised surgically.

27
Q

Indications for skin biopsy

A
  1. Removal of skin cancer confirmed
  2. Removal of skin lesion with abnormal features to confirm type of skin cancer under histology
  3. Unknown skin lesions to confirm via histology
  4. Skin tags
  5. Warts
  6. Unknown growths
28
Q

Types of skin biopsy

A
  • Local anesthetic used around the area.
  • Patient awake during procedure

Types (depending on diagnosis expected):

  1. Shave biopsy
  2. Punch biopsy
  3. Excisional biopsy
29
Q

Explain shave biopsy

A

Used for raised lesion
1. scalpel or blade to shave skin lesion off
the surface of the skin.
2. Does not normally need sutures.

30
Q

Explain punch biopsy

A

Used for lesions that require dermal or subcutaneous tissue
1. circular tool used to take core sample

  1. used to burrow into deeper layers of skin (epidermis, dermis and fat layer).
  2. Will need normally 1-2 sutures.
31
Q

Explain excisional biopsy

A
  1. usually used with wider skin excisions. i.e. melanoma with margins.
  2. Portion of skin around the lesion will be taken for margin checks
    and down into fatty layer of skin.
32
Q

What happens after the biopsy?

A

Biopsy put into prefilled formalin pots for fixation for transport to the lab.

Tissue looked at under the microscope to confirm diagnosis/ cancerous cells.

33
Q

What is mole mapping?

A
  • Body photography with dermatoscope attachment on camera.
  • Whole body photography taken for regular repeat photography of same area to monitor any changes to lesions both as photos and dermatoscope images.
34
Q

Who usually have mole mapping?

A

Individuals at high risk of developing:

  • malignant melanoma
  • previously removed melanoma
  • atypical naevi
  1. Cannot just refer someone for mole mapping on the NHS/ normally patients are those who have had 2ww pathway and need monitoring
  2. Otherwise individuals will need to go privately for routine mole mapping
35
Q

Indication for punch biopsy

A

Rashes or blisters involving dermis:

  • Drug reaction
  • erythema multiforme
  • Kaposi sarcoma
  • lupus erythematosus
  • pemphigoid
  • pemphigus
  • vasculitis

Processes involving the subcutis:
- Erythema nodosum

36
Q

Indication for excisional biospy

A

Atypical moles and pigmented lesions:

- malignant melanoma

37
Q

Indications for dermoscopy

A
  1. Aid in the decision-making process as to whether to perform a biopsy
  2. Evaluation of amelanotic lesions; this is feasible because of the ability to evaluate the morphology, distribution, and arrangement of blood vessels and white shiny structures
  3. Evaluation of pigmented and nonpigmented skin lesions; in particular, it helps differentiate melanoma and basal cell carcinoma from benign skin lesions
38
Q

When is skin swab indicated

A

Bacterial or viral cause

ICM - OBS (18 decks)

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