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Phase 2a - conditions > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the pathophysiology of acne?

A

Blocking of a pilosebaceous follicle due to abnormal keratinisation of skin and increased sebum production. Leads to skin colonisation and inflammation.

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2
Q

What is the clinical presentation of acne?

A 
Typically on face, chest and back
Comedomes 
Papules 
Pustules 
Can leave scars.
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3
Q

What are the complications of acne?

A

Scarring

Psychological - anxiety, depression, low self esteem.

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4
Q

What is the first line treatment for acne?

A

Advice - avoid over washing, don’t pick, healthy diet.

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5
Q

What is the pharmacological option for mild acne?

A

Topical retinoid and benzoyl peroxidase

Topical antibiotics and benzoyl peroxidase

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6
Q

What is the pharmacological option for moderate acne?

A

Oral antibiotic and topical retinoid and benzoyl peroxidase.

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7
Q

What is the pharmacological option for severe acne?

A

High dose antibiotic and retinoid and benzoyl peroxidase.

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8
Q

What is eczema?

A

A group of inflammatory skin diseases.

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9
Q

What are three types of eczema?

A

Atopic eczema
Seborrhoeic eczema
Contact dermatitis

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10
Q

What is the pathophysiology of atopic eczema?

A

It is a multifactorial condition - barrier dysfunction, IgE hypersensitivity, environmental factors.

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11
Q

Where is atopic eczema on the body?

A

Infant - face then body

Older - flexor surfaces

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12
Q

What is the presentation of atopic eczema?

A 
Itchy 
Erythematous (redness) 
Scaly patches 
Possible nail changes - pitting and ridges 
Relapsing and remitting
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13
Q

What is the possible complication fo atopic eczema?

A

Infections

Psychological

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14
Q

What are possible exacerbating factors for eczema?

A

Stress
Infection
Pets
Strong detergents

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15
Q

How to diagnose eczema?

A

Clinical diagnosis mostly

80% of patients show raised IgE on blood tests

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16
Q

What is the general advice you can give a patient with eczema?

A

Avoid exacerbating factors

Emollients

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17
Q

What are possible medical therapies for eczema?

A

Topical mild steroids

Tacrolimus (calcineurin inhibitor)

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18
Q

What are possible adjuvant therapies for eczema?

A

Oral antihistamines
Oral antibiotics
Bandages

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19
Q

What can you offer in severe cases of eczema?

A

Phototherapy

Oral immunomodulators

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20
Q

Where does seborrhoeic eczema usually effect?

A

Face and scalp

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21
Q

What is the pathophysiology of psoriasis?

A

Hyperproliferation of keratinocytes, with a chronic inflammatory response.

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22
Q

Types of psoriasis?

A

Chronic plaque - most common
Gluttate
Seborrhoeic
Flexural

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23
Q

Where does psoriasis usually effect?

A

Extensor surfaces - lower back, elbow, knees.
Scalp
Behind ears

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24
Q

What is the presentation of psoriasis?

A

Red scaly patches
Can be itchy/painful
Nail changes in 50%

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25
Q

What are the nail changes in psoriasis?

A

Oncholysis (nail plate separation)

Nail pitting

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26
Q

What are the possible complications of psoriasis?

A

Psoriatic arthritis

Psychological

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27
Q

What are the precipitating factors for psoriasis?

A

Trauma
Drugs
Stress
Infection

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28
Q

What advice can be offered for psoriasis?

A

Avoid irritants

Use emollients

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29
Q

What is the first line pharmacological therapy?

A

Topical vitamin D analogues +/- corticosteroids

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30
Q

What is the second line therapy for psoriasis?

A

Phototherapy +/- immunomodulators

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31
Q

What is the third line therapy for psoriasis?

A

Biological agents - anti-TNF/monoclonal antibodies.

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32
Q

Name three types of ulcers?

A

Venous ulcer
Arterial ulcer
Neuropathic ulcer

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33
Q

What causes a venous ulcer?

A

Sustained venous hypertension (ie. due to faulty venous valves) results in damage to the small vessels in the skin and ischaemia/infarction to areas of the skin.

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34
Q

What is the presentation of a venous ulcer?

A 
Large
Shallow 
Irregular 
Normal pulse 
Usually in the gaiter region
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35
Q

What investigation should be carried out with a venous ulcer?

A

Ankle-brachial pressure index = normal 1-1.2

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36
Q

What is the management for a venous ulcer?

A

High compression bandaging
Leg elevation
Analgesia

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37
Q

What are the causes of arterial ulcers?

A

Peripheral vascular disease
Vasculitis
Trauma (+more)

38
Q

What is the presentation of an arterial ulcer?

A 
Small 
Deep
Well defined 'punched out' appearance
Necrotic base
Often on pressure sites - feet
39
Q

What investigations should be carried out with an arterial ulcer?

A

Ankle-brachial pressure index = <0.8
Doppler studies
Angiography

40
Q

How to manage arterial ulcers?

A

Analgesia

Vascular reconstruction

41
Q

What is the cause of a neuropathic ulcer?

A

Local paraesthesia leads to extended microtrauma or injury, damages tissues and causes ulcer.

42
Q

What are the risk factors for neuropathic ulcer?

A

Diabetic

Neurological disease

43
Q

What is the presentation of a neuropathic ulcer?

A

Variable size and depth
Painless
On pressure sites - soles and heels of feet

44
Q

What investigations should be carried out with a neuropathic ulcer?

A

ABPI

X-Ray (to exclude osteomyelitis)

45
Q

What is the management of a neuropathic ulcer?

A

Debridement
Pressure relief
Foot care adjustments and checks

46
Q

Name three types of skin cancer?

A

Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma

47
Q

Which is the most common skin cancer?

A

Basal cell carcinoma

48
Q

What are the risk factors for skin cancers?

A 
UV radiation 
Increasing age 
Long-term immunosuppression
Pale skin 
Family history
49
Q

What is the presentation of a basal cell carcinoma?

A

On sun exposed areas - face and neck
Pearly/shiny papule
Rolled edges

50
Q

What is the progression of a basal cell carcinoma?

A

Very slow growing
Locally evasive
Little metastatic potential

51
Q

How do you treat a basal cell carcinoma?

A

Surgical excision or radiotherapy if not

52
Q

What is the presentation of a squamous cell carcinoma?

A

Sun exposed areas - ears and lower lip
Ulcerated lesion
Scaly
Dried blood often present

53
Q

What is the potential of a squamous cell carcinoma?

A

More aggressive than BCC, has metastatic potential.

54
Q

What is the management of a squamous cell carcinoma?

A

Surgical excision or radiotherapy if not

55
Q

What is the potential of a melanoma?

A

Very high malignant potential

56
Q

What is the presentation of a melanoma?

A 
Pigmented 
Asymmetrical 
Border irregularity 
Changes over time 
Colour irregularity
57
Q

What is the treatment of a melanoma?

A

Surgical excision if possible
Lymph node removal if spread
Chemotherapy

58
Q

What is gangrene?

A

Death of tissue due to a poor vascular supply

59
Q

What is dry gangrene?

A

Necrosis of tissue but with no infection

60
Q

How to treat dry gangrene?

A

Restore blood supply

Amputate

61
Q

What is wet gangrene?

A

Necrosis with a later infection

62
Q

How to treat wert gangrene?

A

IV antibiotics
Analgesia
Surgical debridement
Amputation

63
Q

What is cellulitis?

A

An acute bacterial infection of the dermis and subcutaneous tissue.

64
Q

What are the common causative organisms of celluitis?

A

Staphhylococcus aureus

Streptococcus pyogenes

65
Q

What are the risk factors for cellulitis?

A

Skin breaks
Ulcers
Immunosuppresion

66
Q

What is the presentation of cellulitis?

A 
Acute onset 
Hot 
Red
Swollen 
Painful 
Fever and malaise
Typically lower leg or arm
67
Q

What are the differential diagnoses of cellulitis?

A

Deep vein thrombosis
Septic arthritis
Gout

68
Q

What are the complications of cellulitis?

A

Necrotising fasciitis

Septicaemia

69
Q

What is the treatment of cellulitis?

A

Antibiotics

Supportive - rest, elevation , analgesia

70
Q

What is necrotising fasciitis?

A

Life threatening infection of the deep fascia causing necrosis

71
Q

What are the common causative organisms of necrotising fasciitis?

A

Polymicrobial

Group A streptococci

72
Q

What are the risk factors for necrotising fasciitis?

A

Abdominal surgery

Comorbidities

73
Q

What is the presentation of necrotising fasciitis?

A

Pain out of proportion with the skin findings
Pain at site of infection
Fever and malaise

74
Q

What is the management of necrotising fasciitis?

A

Radical debridement
IV antibiotics
Amputation

75
Q

What is amyloidosis?

A

Disorder of protein folding in which normally soluble proteins are deposited extracellularly.

76
Q

What is the epidemiology of breast cancer?

A

1 in 8 women will be diagnosed with breast cancer in their lifetime.

77
Q

What are the risk factors for breast cancer?

A 
Increasing age 
Lifestyle - weight, alcohol, sedentary 
Increased oestrogen exposure - HRT, early menstruation and late menopause, having no children. 
Family history 
Genetics
78
Q

What genes are associated with breast cancer?

A

BRACA 1 - chromosome 17
BRACA 2 - chromosome 13
TP53

79
Q

What is the screening programme for breast cancer?

A

Checks every three years from 50-70

80
Q

What type of cancer is breast cancer?

A

Adenocarcinoma

81
Q

What is Paget’s disease?

A

A form of breast cancer in which cancerous cells are around the nipple and cause eczematous change of the nipple.

82
Q

What is the presentation of breast cancer?

A 
Painless lump 
Nipple discharge 
Nipple inversion 
Skin changes - peau d'orange due to lymph blockage 
Skin tethering
83
Q

What are the common metastatic sites for breast cancer?

A 
Liver 
Bone 
Lung 
Brain
Lymph
84
Q

What is the typical investigation of a breast lump?

A

Triple assessment -
clinical assessment
imaging - ultrasound, mammogram, MRI
histology - biopsy

85
Q

What is the first line treatment for early breast cancer?

A

Surgical excision - lumpectomy/mastectomy
Adjuvant therapy - reduce risk fo recurrence
Neo-adjuvant therapy - shrink pre surgery

86
Q

What are the possible endocrine therapies for oestrogen sensitive breast cancer?

A

Tacrolimus - blocks oestrogen receptor

Aromatase inhibitor - blocks production of oestrogen

87
Q

What are the possible endocrine therapies for HER2 receptor positive breast cancer?

A

Herceptin

88
Q

What is the treatment of advanced breast cancer?

A

Medical therapies - chemotherapy, radiotherapy, medical therapies.

89
Q

What are the side effects of surgery?

A

Lymphoedema from axilla surgery.

90
Q

What are the side effects of chemotherapy?

A

Infections - due to immunosuppresion
Hair loss
Nausea and vomiting
Fatigue

91
Q

What are the side effects of endocrine therapies?

A

Osteoporosis
Vaginal dryness
Loss of libido

92
Q

What are the differential diagnoses of breast lumps?

A

Fibroadenoma
Breast cyst
Breast abscess
Cancer

Phase 2a - conditions (11 decks)

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