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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
What are the nail changes in psoriasis?
Oncholysis (nail plate separation) | Nail pitting
26
What are the possible complications of psoriasis?
Psoriatic arthritis | Psychological
27
What are the precipitating factors for psoriasis?
Trauma Drugs Stress Infection
28
What advice can be offered for psoriasis?
Avoid irritants | Use emollients
29
What is the first line pharmacological therapy?
Topical vitamin D analogues +/- corticosteroids
30
What is the second line therapy for psoriasis?
Phototherapy +/- immunomodulators
31
What is the third line therapy for psoriasis?
Biological agents - anti-TNF/monoclonal antibodies.
32
Name three types of ulcers?
Venous ulcer Arterial ulcer Neuropathic ulcer
33
What causes a venous ulcer?
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.
34
What is the presentation of a venous ulcer?
``` Large Shallow Irregular Normal pulse Usually in the gaiter region ```
35
What investigation should be carried out with a venous ulcer?
Ankle-brachial pressure index = normal 1-1.2
36
What is the management for a venous ulcer?
High compression bandaging Leg elevation Analgesia
37
What are the causes of arterial ulcers?
Peripheral vascular disease Vasculitis Trauma (+more)
38
What is the presentation of an arterial ulcer?
``` Small Deep Well defined 'punched out' appearance Necrotic base Often on pressure sites - feet ```
39
What investigations should be carried out with an arterial ulcer?
Ankle-brachial pressure index = <0.8 Doppler studies Angiography
40
How to manage arterial ulcers?
Analgesia | Vascular reconstruction
41
What is the cause of a neuropathic ulcer?
Local paraesthesia leads to extended microtrauma or injury, damages tissues and causes ulcer.
42
What are the risk factors for neuropathic ulcer?
Diabetic | Neurological disease
43
What is the presentation of a neuropathic ulcer?
Variable size and depth Painless On pressure sites - soles and heels of feet
44
What investigations should be carried out with a neuropathic ulcer?
ABPI | X-Ray (to exclude osteomyelitis)
45
What is the management of a neuropathic ulcer?
Debridement Pressure relief Foot care adjustments and checks
46
Name three types of skin cancer?
Basal cell carcinoma Squamous cell carcinoma Malignant melanoma
47
Which is the most common skin cancer?
Basal cell carcinoma
48
What are the risk factors for skin cancers?
``` UV radiation Increasing age Long-term immunosuppression Pale skin Family history ```
49
What is the presentation of a basal cell carcinoma?
On sun exposed areas - face and neck Pearly/shiny papule Rolled edges
50
What is the progression of a basal cell carcinoma?
Very slow growing Locally evasive Little metastatic potential
51
How do you treat a basal cell carcinoma?
Surgical excision or radiotherapy if not
52
What is the presentation of a squamous cell carcinoma?
Sun exposed areas - ears and lower lip Ulcerated lesion Scaly Dried blood often present
53
What is the potential of a squamous cell carcinoma?
More aggressive than BCC, has metastatic potential.
54
What is the management of a squamous cell carcinoma?
Surgical excision or radiotherapy if not
55
What is the potential of a melanoma?
Very high malignant potential
56
What is the presentation of a melanoma?
``` Pigmented Asymmetrical Border irregularity Changes over time Colour irregularity ```
57
What is the treatment of a melanoma?
Surgical excision if possible Lymph node removal if spread Chemotherapy
58
What is gangrene?
Death of tissue due to a poor vascular supply
59
What is dry gangrene?
Necrosis of tissue but with no infection
60
How to treat dry gangrene?
Restore blood supply | Amputate
61
What is wet gangrene?
Necrosis with a later infection
62
How to treat wert gangrene?
IV antibiotics Analgesia Surgical debridement Amputation
63
What is cellulitis?
An acute bacterial infection of the dermis and subcutaneous tissue.
64
What are the common causative organisms of celluitis?
Staphhylococcus aureus | Streptococcus pyogenes
65
What are the risk factors for cellulitis?
Skin breaks Ulcers Immunosuppresion
66
What is the presentation of cellulitis?
``` Acute onset Hot Red Swollen Painful Fever and malaise Typically lower leg or arm ```
67
What are the differential diagnoses of cellulitis?
Deep vein thrombosis Septic arthritis Gout
68
What are the complications of cellulitis?
Necrotising fasciitis | Septicaemia
69
What is the treatment of cellulitis?
Antibiotics | Supportive - rest, elevation , analgesia
70
What is necrotising fasciitis?
Life threatening infection of the deep fascia causing necrosis
71
What are the common causative organisms of necrotising fasciitis?
Polymicrobial | Group A streptococci
72
What are the risk factors for necrotising fasciitis?
Abdominal surgery | Comorbidities
73
What is the presentation of necrotising fasciitis?
Pain out of proportion with the skin findings Pain at site of infection Fever and malaise
74
What is the management of necrotising fasciitis?
Radical debridement IV antibiotics Amputation
75
What is amyloidosis?
Disorder of protein folding in which normally soluble proteins are deposited extracellularly.
76
What is the epidemiology of breast cancer?
1 in 8 women will be diagnosed with breast cancer in their lifetime.
77
What are the risk factors for breast cancer?
``` Increasing age Lifestyle - weight, alcohol, sedentary Increased oestrogen exposure - HRT, early menstruation and late menopause, having no children. Family history Genetics ```
78
What genes are associated with breast cancer?
BRACA 1 - chromosome 17 BRACA 2 - chromosome 13 TP53
79
What is the screening programme for breast cancer?
Checks every three years from 50-70
80
What type of cancer is breast cancer?
Adenocarcinoma
81
What is Paget's disease?
A form of breast cancer in which cancerous cells are around the nipple and cause eczematous change of the nipple.
82
What is the presentation of breast cancer?
``` Painless lump Nipple discharge Nipple inversion Skin changes - peau d'orange due to lymph blockage Skin tethering ```
83
What are the common metastatic sites for breast cancer?
``` Liver Bone Lung Brain Lymph ```
84
What is the typical investigation of a breast lump?
Triple assessment - clinical assessment imaging - ultrasound, mammogram, MRI histology - biopsy
85
What is the first line treatment for early breast cancer?
Surgical excision - lumpectomy/mastectomy Adjuvant therapy - reduce risk fo recurrence Neo-adjuvant therapy - shrink pre surgery
86
What are the possible endocrine therapies for oestrogen sensitive breast cancer?
Tacrolimus - blocks oestrogen receptor | Aromatase inhibitor - blocks production of oestrogen
87
What are the possible endocrine therapies for HER2 receptor positive breast cancer?
Herceptin
88
What is the treatment of advanced breast cancer?
Medical therapies - chemotherapy, radiotherapy, medical therapies.
89
What are the side effects of surgery?
Lymphoedema from axilla surgery.
90
What are the side effects of chemotherapy?
Infections - due to immunosuppresion Hair loss Nausea and vomiting Fatigue
91
What are the side effects of endocrine therapies?
Osteoporosis Vaginal dryness Loss of libido
92
What are the differential diagnoses of breast lumps?
Fibroadenoma Breast cyst Breast abscess Cancer

Phase 2a - conditions (11 decks)

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