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Year 3 Conditions MEGADECK > Dermatology > Flashcards

Dermatology Flashcards

1
Q

<p>Define basal cell carcinoma.</p>

A

<p>Basal cell carcinoma (BCC) of the skin is a common neoplasm, related to exposure to sunlight.</p>

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2
Q

<p>Explain the aetiology/risk factors of basal cell carcinoma.</p>

A

<p>Ultraviolet (UV) radiation<br></br>Sun exposure<br></br>X Ray exposure<br></br>Arsenic exposure<br></br>Xeroderma pigmentosum<br></br>Basal cell nevus syndrome (Gorlin-Goltz syndrome)<br></br>Transplant patients</p>

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3
Q

<p>Summarise the epidemiology of basal cell carcinoma.</p>

A

<p>BCC is the most common malignancy of the skin in fair-skinned adults in the US, Australia, and Europe and its incidence is increasing.</p>

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4
Q

<p>Recognise the presenting symptoms of basal cell carcinoma.</p>

A

<p>Papules with associated telangiectasias<br></br>Plaques, nodules, and tumours with rolled borders<br></br>Small crusts and non-healing wounds<br></br>Non-healing scabs<br></br>Pearly papules and/or plaques</p>

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5
Q

<p>Recognise the signs of basal cell carcinoma on physical examination.</p>

A

<p>Metastases associated with large or neglected BCC</p>

<p>Local destruction with advanced lesion</p>

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6
Q

<p>Identify appropriate investigations for basal cell carcinoma and interpret the results.</p>

A

<p>Biopsy for dermatohistopathology</p>

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7
Q

<p>Define candidiasis.</p>

A

<p>Oral candidiasis involves a local infection of oral tissues by yeasts of the genus Candida, mostly C albicans.</p>

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8
Q

<p>Explain the aetiology/risk factors of candidiasis.</p>

A

<p>Hyposalivation/xerostomia<br></br>Poor oral hygiene, especially among denture wearers<br></br>Malabsorption and malnutrition<br></br>Advanced malignancy<br></br>Cancer chemotherapy and radiotherapy<br></br>HIV infection<br></br>Endocrine disturbance (e.g., diabetes mellitus, hypoparathyroidism, pregnancy, hypoadrenalism)<br></br>Immunosuppressive agents (e.g., systemic corticosteroid therapy)<br></br>Current or recent past use of broad-spectrum or multiple narrow-spectrum antibiotics</p>

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9
Q

<p>Summarise the epidemiology of candidiasis.</p>

A

<p>It is the most common oral fungal infection and is commonly seen in infants and older adults, and also with states of local and systemic immunological suppression.</p>

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10
Q

<p>Recognise the presenting symptoms of candidiasis. Recognise the signs of candidiasis on physical examination.</p>

A

<p>Creamy white or yellowish plaques, fairly adherent to oral mucosa<br></br>Cracks, ulcers, or crusted fissures radiating from angles of the mouth (angular cheilitis).<br></br>Spotty red areas on the buccal mucosa<br></br>Lesions confined to the outline of a dental prosthesis</p>

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11
Q

<p>Identify appropriate investigations for candidiasis and interpret the results.</p>

A

<p>Superficial smear of lesion for microscopy</p>

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12
Q

<p>Define cellulitis.</p>

A

<p>Cellulitis is an acute spreading infection of the skin with visually indistinct borders that principally involves the dermis and subcutaneous tissue. It is characterised by erythema, oedema, warmth, and tenderness, and commonly occurs in an extremity.</p>

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13
Q

<p>Define erysipelas.</p>

A

<p>Erysipelas is a distinct form of superficial cellulitis with notable lymphatic involvement and is raised, sharply demarcating it from uninvolved skin.</p>

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14
Q

<p>Explain the aetiology/risk factors of cellulitis and erysipelas.</p>

A

<p>Prior episode of cellulitis<br></br>Ulcer/wound<br></br>Dermatosis<br></br>Tinea pedis interdigitalis<br></br>Lymphoedema<br></br>Venous insufficiency/chronic leg oedema</p>

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15
Q

<p>Summarise the epidemiology of cellulitis and erysipelas.</p>

A

<p>Cellulitis is a common condition; a general practice with approximately 2000 people will have about 30 consultations for 'cellulitis and abscess' each year.</p>

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16
Q

<p>Recognise the presenting symptoms of cellulitis and erysipelas. Recognise the signs of cellulitis and erysipelas on physical examination.</p>

A

<p>Skin discomfort<br></br>Macular erythema with indistinct borders on the skin<br></br>Disruption of cutaneous barrier<br></br>Raised erythema with clearly demarcated margins (erysipelas)</p>

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17
Q

<p>Identify appropriate investigations for cellulitis and erysipelas and interpret the results.</p>

A

<p>FBC<br></br>Purulent focus culture and molecular diagnostic procedures</p>

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18
Q

<p>Generate a management plan for cellulitis and erysipelas.</p>

A

<p><strong>1st line: </strong>Parenteral antibiotic with MRSA cover</p>

<p><u>Plus:</u><br></br>Antibiotic with Pseudomonas cover if immunocompromised</p>

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19
Q

<p>Identify the possible complications of cellulitis and erysipelas and its management.</p>

A

<p>Sepsis<br></br>Chronic oedema in affected extremity</p>

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20
Q

<p>Summarise the prognosis for patients with cellulitis and erysipelas.</p>

A

<p>The prognosis of cellulitis is excellent. Most episodes of cellulitis resolve with therapy, and major sequelae are absent. However, it is believed that an episode of cellulitis may leave residual damage to draining lymphatics and perhaps increase the likelihood of recurrence in the future.</p>

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21
Q

<p>Define eczema.</p>

A

<p>Eczema is an inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course.</p>

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22
Q

<p>Explain the aetiology/risk factors of eczema.</p>

A

<p>Age <5<br></br>Asthma<br></br>Family history of eczema<br></br>Allergic rhinitis<br></br>Active and passive exposure to smoke</p>

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23
Q

<p>Summarise the epidemiology of eczema.</p>

A

<p>It can affect all age groups, but it is most commonly diagnosed before 5 years of age and affects 10% to 20% of children. Eczema usually presents in childhood, with 45% of patients diagnosed by 6 months of age, and 70% to 85% by 5 years of age.</p>

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24
Q

<p>Recognise the presenting symptoms of eczema. Recognise the signs of eczema on physical examination.</p>

A

<p>Pruritus<br></br>Xerosis (dry skin)<br></br>Erythema<br></br>Scaling<br></br>Vesicles<br></br>Papules<br></br>Keratosis pilaris<br></br>Excoriations<br></br>Lichenification<br></br>Hypopigmentation</p>

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25
Q

<p>Identify appropriate investigations for eczema and interpret the results.</p>

A

<p>No investigations are needed.</p>

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26
Q

<p>Define epidermoid and pilar cysts.</p>

A

<p>Epidermoid cysts, also called sebaceous, keratin, or epithelial cysts, are small, hard lumps that develop under the skin. These cysts are common. They grow slowly. They do not cause other symptoms and are nearly never cancerous. About 1% of these may progress to SCC or BCC.</p>

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27
Q

<p>Explain the aetiology/risk factors of epidermoid and pilar cysts.</p>

A

<p>HPV infection<br></br>Acne<br></br>Excessive exposure to the sun<br></br>Other skin conditions</p>

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28
Q

<p>Summarise the epidemiology of epidermoid and pilar cysts.</p>

A

<p>Epidermoid cysts are the most common cutaneous cysts and typically occur in the third and fourth decades of life.</p>

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29
Q

<p>Recognise the presenting symptoms of epidermoid and pilar cysts. Recognise the signs of epidermoid and pilar cysts on physical examination.</p>

A

<p>Epidermoid cysts are often found on the face, head, neck, back, or genitals. They can range in size from 1/4 inch to 2 inches across. They look like a small bump, are tan to yellow in color, and are filled with thick, smelly matter. They do not cause any pain and can usually be ignored.</p>

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30
Q

<p>Identify appropriate investigations for epidermoid and pilar cysts and interpret the results.</p>

A

<p>No investigations are necessary. They can be diagnosed by examination only. Sometimes an ultrasound may be used.</p>

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31
Q

<p>Define erythema multiforme.</p>

A

<p>Erythema multiforme (EM) is typically an acute, self-limiting but often relapsing, mucocutaneous inflammatory condition. It is a hypersensitivity reaction associated with certain infections, vaccinations, and, less commonly, medications.</p>

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32
Q

<p>Explain the aetiology/risk factors of erythema multiforme.</p>

A

<p>Prior occurrence<br></br>Herpes simplex virus (HSV) infection<br></br>Mycoplasma pneumonia</p>

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33
Q

<p>Summarise the epidemiology of erythema multiforme.</p>

A

<p>The incidence of EM is not known, although it is considered to be relatively common. Peak incidence occurs in the second and third decades, and it rarely occurs in patients under 3 or over 50 years of age.</p>

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34
Q

<p>Recognise the presenting symptoms of erythema multiforme. Recognise the signs of erythema multiforme on physical examination.</p>

A

<p>Target lesions of the extremities<br></br>Recurrent disease<br></br>Mucosal erosions<br></br>Rapid onset of lesions<br></br>Self-limiting course<br></br>Clustered vesicles on an erythematous base<br></br>Rhonchi, rales, and/or wheezes</p>

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35
Q

<p>Identify appropriate investigations for erythema multiforme and interpret the results.</p>

A

<p>FBC<br></br>Serum electrolytes<br></br>Herpes simplex virus (HSV) serology<br></br>Rapid PCR<br></br>Cold-haemagglutination serology<br></br>M pneumoniae titres<br></br>CXR</p>

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36
Q

<p>Define erythema nodosum.</p>

A

<p>Erythema nodosum (EN) is a common cutaneous hypersensitivity reaction consisting of erythematous, tender nodules most commonly located over the shins, but also reported over the thighs, upper extremities, calves, buttocks, and face.</p>

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37
Q

<p>Explain the aetiology/risk factors of erythema nodosum.</p>

A

<p>Streptococcal infection<br></br>Sarcoidosis<br></br>Tuberculosis<br></br>Coccidioidomycosis<br></br>Histoplasmosis<br></br>Blastomycosis<br></br>Behcet's disease<br></br>Oral contraceptives<br></br>Leprosy</p>

38
Q

<p>Summarise the epidemiology of erythema nodosum.</p>

A

<p>Erythema nodosum occurs more frequently in Europe than in North America, although the exact incidence is not known. It can occur at any age but peaks between 20 and 30 years.</p>

39
Q

<p>Recognise the presenting symptoms of erythema nodosum. Recognise the signs of erythema nodosum on physical examination.</p>

A

<p>Nodules on shins<br></br>Uveitis, red eyes, retinal nodules, or candle-wax drippings<br></br>Nodules on other skin areas<br></br>Joint pains<br></br>Fever</p>

40
Q

<p>Identify appropriate investigations for erythema nodosum and interpret the results.</p>

A

<p>FBC<br></br>Antistreptolysin-O titre<br></br>CXR<br></br>Purified protein derivative skin testing</p>

41
Q

<p>Define herpes simplex virus.</p>

A

<p>The major clinical manifestations of infection with herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2) are oral, genital, and ocular ulcers.</p>

42
Q

<p>Explain the aetiology/risk factors of herpes simplex virus.</p>

A

<p>HIV<br></br>Immunosuppressive drugs<br></br>High risk sexual behaviour</p>

43
Q

<p>Summarise the epidemiology of herpes simplex virus.</p>

A

<p>Worldwide, it is estimated that 67% of persons aged 0-49 years are infected with herpes simplex virus type 1 (HSV-1). The infection is most commonly acquired during childhood, and seropositivity increases with age.</p>

44
Q

<p>Recognise the presenting symptoms of herpes simplex virus. Recognise the signs of herpes simplex virus on physical examination.</p>

A

<p>Oral ulcer (cold sore)<br></br>Genital ulcer<br></br>Dysuria<br></br>Lymphadenopathy</p>

45
Q

<p>Identify appropriate investigations for herpes simplex virus and interpret the results.</p>

A

<p>Viral culture from lesions<br></br>HSV polymerase chain reaction (PCR)<br></br>Glycoprotein G-based type-specific serology (gG1 and gG2)</p>

46
Q

<p>Define lipoma.</p>

A

<p>Benign tumours composed of adipose tissue.</p>

<p>Can occur in any area of the body, although they are most frequently found on the trunk or proximal limbs. Most commonly found in subcutaneous tissues.</p>

47
Q

<p>Explain the aetiology/risk factors of lipomas.</p>

A

<p>Genetic<br></br>Trauma<br></br>Heavy alcohol consumption</p>

48
Q

<p>Summarise the epidemiology of lipomas.</p>

A

<p>Approximately 1% of the general population has a lipoma. Although they can occur at any age, they are most common between 40 and 60 years of age. Congenital lipomas have been reported in children.</p>

49
Q

<p>Recognise the presenting symptoms of lipomas.</p>

A

<p>Muscle weakness<br></br>Paraesthesia</p>

50
Q

<p>Recognise the signs of a lipoma on physical examination.</p>

A

<p>Soft, mobile, superficial mass<br></br>GI obstruction<br></br>GI bleeding</p>

51
Q

<p>Identify appropriate investigations for a lipoma and interpret the results.</p>

A

<p>Biopsy<br></br>MRI<br></br>CT<br></br>Ultrasound</p>

52
Q

<p>Define melanoma.</p>

A

<p>Melanoma is a malignant tumour arising from melanocytes. It is among the most common forms of cancer in young adults and typically presents as a new or changing deeply pigmented skin lesion.</p>

53
Q

<p>Explain the aetiology/risk factors of melanoma.</p>

A

<p>FHx of melanoma<br></br>Personal hx of melanoma<br></br>Personal hx of skin cancer (including actinic damage)<br></br>Hx of atypical naevi<br></br>Fitzpatrick skin type I or II (light-coloured skin)<br></br>Red or blond hair colour<br></br>High freckle density<br></br>Sun exposure<br></br>Sunbed use<br></br>Immunosuppression<br></br>Xeroderma pigmentosum</p>

54
Q

<p>Summarise the epidemiology of melanoma.</p>

A

<p>The age-adjusted incidence of melanoma per 100,000 population is 21 in the US, 17 in the UK, and 50 in Australia. Australia has the highest prevalence of melanoma in the world. It is more common in men than women.</p>

55
Q

<p>Recognise the presenting symptoms of melanoma. Recognise the signs of melanoma on physical examination.</p>

A

<p>Altered pigmented lesion (ABCDE signs)<br></br>>50 benign melanocytic naevi<br></br>Atypical naevi<br></br>Melanocytic lesion that does not resemble surrounding melanocytic naevi ('ugly duckling')<br></br>Pigmented lesion, asymmetric appearance, ill-defined/irregular borders, colour variation</p>

56
Q

<p>Identify appropriate investigations for melanoma and interpret the results.</p>

A

<p>Dermatoscopy<br></br>Skin biopsy</p>

57
Q

<p>Define molluscum contagiosum.</p>

A

<p>This condition is caused by the molluscum contagiosum virus, a ubiquitous poxvirus that escapes immune destruction for months to years.</p>

58
Q

<p>Explain the aetiology/risk factors of molluscum contagiosum.</p>

A

<p>Close contact with an infected individual<br></br>Sexual contact with an infected individual<br></br>HIV infection<br></br>Tropical climate<br></br>Swimming</p>

59
Q

<p>Summarise the epidemiology of molluscum contagiosum.</p>

A

<p>The condition most commonly affects children, with an overall prevalence in children estimated to be between 5% and 12%. Adults may also be infected via sexual transmission.</p>

60
Q

<p>Recognise the presenting symptoms of molluscum contagiosum. Recognise the signs of molluscum contagiosum on physical examination.</p>

A

<p>Pearly papule with a central dell<br></br>Surrounding erythema<br></br>Facial or groin distribution of lesions<br></br>Pruritus<br></br>Atopic dermatitis</p>

61
Q

<p>Identify appropriate investigations for molluscum contagiosum and interpret the results.</p>

A

<p>Curettage biopsy<br></br>Tzanck stain<br></br>Haematoxylin and eosin staining<br></br>HIV test</p>

<p>All of these are not that common since molluscum contagiosum is mainly diagnosed through history and examination.</p>

62
Q

<p>Define pressure sores.</p>

A

<p>Localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or of pressure in combination with shear.</p>

63
Q

<p>Explain the aetiology/risk factors of pressure sores.</p>

A

<p>Immobility<br></br>Sensory impairment<br></br>Older age<br></br>Surgery<br></br>Intensive care stay<br></br>Malnourishment</p>

64
Q

<p>Summarise the epidemiology of pressure sores.</p>

A

<p>A comparative study of patients with pressure ulcers in the UK, US, and Canada demonstrated prevalence in hospitalised patients of 4.7% to 32.1%.</p>

65
Q

<p>Recognise the presenting symptoms of pressure sores. Recognise the signs of pressure sores on physical examination.</p>

A

<p>Shallow open wound or tissue loss on areas subjected to pressure<br></br>Localised tenderness and warmth around area of wound<br></br>Increased exudate and/or foul odour</p>

66
Q

<p>Identify appropriate investigations for pressure sores and interpret the results.</p>

A

<p>Diagnostic tests are not used to make the diagnosis of pressure ulcers but may help in diagnosing complications of pressure ulcers including wound infection and osteomyelitis.</p>

67
Q

<p>Define psoriasis.</p>

A

<p>Psoriasis is a chronic inflammatory skin disease characterised by erythematous, circumscribed scaly papules, and plaques. It can cause itching, irritation, burning, and stinging.</p>

68
Q

<p>Explain the aetiology/risk factors of psoriasis.</p>

A

<p>Genetic<br></br>Infection<br></br>Local trauma</p>

69
Q

<p>Summarise the epidemiology of psoriasis.</p>

A

<p>In most developed countries, prevalence is between 1.5% and 5.0%; there is some evidence that prevalence is increasing in these regions. The mean age of onset is 28 years, with equal distribution between men and women.</p>

70
Q

<p>Recognise the presenting symptoms of psoriasis. Recognise the signs of psoriasis on physical examination.</p>

A

<p>Skin lesions<br></br>Skin discomfort</p>

71
Q

<p>Identify appropriate investigations for psoriasis and interpret the results.</p>

A

<p>Usually no tests are necessary.</p>

72
Q

<p>Define squamous cell carcinoma.</p>

A

<p>Cutaneous squamous cell carcinoma (SCC) is the proliferation of atypical, transformed keratinocytes in the skin with malignant behaviour. It ranges from in situ tumours (also known as Bowen's disease) to invasive tumours and metastatic disease. Precursor lesions for SCCs are called actinic (or sun-damage) keratosis.</p>

73
Q

<p>Explain the aetiology/risk factors of squamous cell carcinoma.</p>

A

<p>Sun exposure<br></br>Immunosuppression<br></br>Fair skin<br></br>Hereditary skin conditions<br></br>Older age<br></br>Male sex<br></br>Ionising radiation<br></br>Carcinogens<br></br>Actinic keratosis<br></br>Previous skin cancer</p>

74
Q

<p>Summarise the epidemiology of squamous cell carcinoma.</p>

A

<p>Non-melanoma skin cancers, also referred to more specifically as 'keratinocyte cancers', are the most common class of skin cancers. SCC is the second most common non-melanoma skin cancer worldwide (after basal cell carcinoma). SCCs are most frequently observed in photoexposed skin, often in those >40 years of age.</p>

75
Q

<p>Recognise the presenting symptoms of squamous cell carcinoma. Recognise the signs of squamous cell carcinoma on physical examination.</p>

A

<p>Growing tumours<br></br>Bleeding<br></br>Crusting<br></br>Evidence of sun damage to skin<br></br>Tender or itchy non-healing wound originally caused by trauma<br></br>Erythematous papules or plaques<br></br>Thin, flesh-coloured or erythematous plaques<br></br>Dome-shaped nodule<br></br>Exophytic, fungating, verrucous nodules or plaques</p>

76
Q

<p>Identify appropriate investigations for squamous cell carcinoma and interpret the results.</p>

A

<p>Skin biopsy</p>

77
Q

<p>Define urticaria.</p>

A

<p>Urticaria, also known as welts, hives, or wheals, is characterised by the appearance of intensely pruritic erythematous plaques. It appears clinically as pruritic, pale, blanching swellings of the superficial dermis that last for up to 24 hours.</p>

78
Q

<p>Explain the aetiology/risk factors of urticaria.</p>

A

<p>Allergy<br></br>Infection<br></br>Systemic disease<br></br>Minor physical trauma</p>

79
Q

<p>Summarise the epidemiology of urticaria.</p>

A

<p>Urticaria (chronic, acute, or both) affects 15-25% of the population at some time in their lives. The incidence of acute urticaria is higher in people with atopy, and the condition occurs most commonly in children and young adults.</p>

80
Q

<p>Recognise the presenting symptoms of urticaria. Recognise the symptoms of urticaria on physical examination.</p>

A

<p>Raised bumps<br></br>Erythema<br></br>Pruritus</p>

81
Q

<p>Identify appropriate investigations for urticaria and interpret the results.</p>

A

<p>This is usually identifiable by examination.</p>

<p>Investigations may be carried out in order to determine the cause of urticaria.</p>

82
Q

<p>Define varicella zoster.</p>

A

<p>Varicella (chickenpox), one of the childhood exanthemas, is caused by the human alpha herpes virus, varicella zoster. Varicella-zoster virus (VZV) is an exclusively human virus. The incubation period is about 14 days (range 9 to 21 days).</p>

83
Q

<p>Explain the aetiology/risk factors of varicella zoster.</p>

A

<p>Age 1 to 9 years<br></br>Exposure to varicella<br></br>Unimmunised status<br></br>Occupational exposure</p>

84
Q

<p>Summarise the epidemiology of varicella zoster.</p>

A

<p>Varicella-zoster virus (VZV) is found worldwide and is very contagious. Over 90% of unimmunised people become infected, but infection occurs at different ages in different parts of the world.</p>

85
Q

<p>Recognise the presenting symptoms of varicella zoster.</p>

A

<p>Pruritus<br></br>Headache<br></br>Fatigue/malaise<br></br>Sore throat</p>

86
Q

<p>Recognise the signs of varicella zoster on physical examination.</p>

A

<p>Fever<br></br>Vesicular rash<br></br>Vesicles on mucous membranes<br></br>Tachycardia</p>

87
Q

<p>Identify appropriate investigations for varicella zoster and interpret the results.</p>

A

<p>Clinical findings are usually sufficient to make a diagnosis.</p>

88
Q

<p>Generate a management plan for varicella zoster.</p>

A

<p>Supportive care is generally enough but in some cases, oral antivirals may be given. Antihistamine may be given topically or orally to help with the itching.</p>

89
Q

<p>Identify the possible complications of varicella zoster and its management.</p>

A

<p>A secondary bacterial infection may capitalise on the viral infection. The viral infection may also spread elsewhere and cause more serious complications such as encephalitis or meningitis.<br></br>All complications are rare.</p>

90
Q

<p>Summarise the prognosis for patients with varicella zoster.</p>

A

<p>Typically, varicella is a self-limiting disease. After initial infection and clinical syndrome, no follow-up is necessary. In up to one third of infected people, varicella-zoster virus reactivates later in life as shingles or herpes zoster.</p>

Year 3 Conditions MEGADECK (15 decks)

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