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Dermatology conditions Flashcards

1
Q

What is Basal cell carcinoma?

A

Common neoplasm, related to exposure of sunlight.

Can be locally aggressive, rarely metastasises

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2
Q

What causes basal cell carcinoma?

A

Repetitive and frequent exposure to UV radiation induces DNA damage in keratocytes.
Exponential increased of BCCS in relation to UV exposure

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3
Q

What are the risk factors of Basal cell carcinoma?

A 
Prolonged sun UV radiation exposure
Seen in Gorlin's syndrome
Most commonly head and neck
Increasing age
Male sex
Skin types I and II
Immunosuppression
Arsenic exposure
Previous BCC
Xeroderma pigmentoasum
Albinism
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4
Q

What is Gorlin-Goltz syndrome?

A 
A condition with multiple BCCs
Pitting of palms and soles
Jaw cysts
Spine and rib anomalies
Calcification of the falx cerebri
Cataracts
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5
Q

What are the symptoms of Basal cell carcinoma?

A

Slow, progressive skin lesion
Papules with associated telangiectasis
Pearly papules and/or plaques
Found on: Face, scalp, ears, trunks

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6
Q

What are the types of Basal Cell Carcinoma?

A 
Nodular (most common)
Superficial
Morphoeic
Pigmented
Basosquamous
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7
Q

What are the signs of nodular BCC?

A
  • Pearly nodule with rolled telangiectatic edge
  • Telangiectasis
  • Slowly enlarges
  • May have central ulcer
  • Micronodular and micirocystic types may infiltrate deeply
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8
Q

What are the signs of superficial BCC?

A
  • Multiple on trunk and shoulders
  • Erythematous well-demarcated plaques, larger than 20mm, central clearing and a thread-like border, rolled edge if stretched (may bleed or weep)
  • Slow growth, usually not aggressive, rarely invasive and very rarely metastasise
  • Confused with Bowen’s disease or inflammatory dermatosis
  • Particularly responsive to medical > surgical
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9
Q

What are the signs of Morphoeic BCC?

A
  • Sclerosing or infiltrative BCC
  • Found in mid-facial sites
  • More aggressive with poorly defiend borders
  • Characterised by thickened yellow plaques
  • Present late and become very large and require extensive plastic surgical reconstruction, may infiltrate nerves
  • Prone to recurrence after treatment
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10
Q

What are the signs of Pigmented BCC?

A
  • Brown, blue or greyish lesion
  • Nodular or superficial histology
  • Seem nore often in dark skinned people
  • May resemble malignant melanoma
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11
Q

What are the signs of basosquamous BCC?

A
  • Mixed BCC / SCC

- Potentially more aggressive than other forms

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12
Q

What are the investigations for BCC?

A

Biopsy rarely needed but can do biopsy if wanted

Diagnosis is mainly on clinical suspicion

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13
Q

What is a burns injury?

A

Burns are very common injuries, predominantly to the skin and superficial tissues, caused by heat from hot liquids, flames or contact with heated objects, electrical current or chemicals

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14
Q

What are the risk factors for burns injuries?

A

Young children
>60
Male sex

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15
Q

What does a first degree burn look like?

A

Red and painless

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16
Q

What does a second degree burn look like?

A

Wet + Painful burns

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17
Q

What does a third degree burn look like?

A

Dry + Insensate burns

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18
Q

What does a 4th degree burn look like?

A

Burns affecting subcutaneous tissue, tendon or bone

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19
Q

What is a sign of severe burn?

A

Clouded corneas

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20
Q

What investigations are done for burns injuries?

A

FBC (Low Hct, hypovolaemia, neutropenia, thrombocytopenia)
Metabolic panel (High level urea, glucose, creatinine, hyponatraemia, hypokalaemia)
Carboxyhaemoglobin (high in inhlaation injruy)
ABG (Metbaolic acidosis in inhalation injury)
Flourescein staining (Damaged epithelial cells in burns)
CT scan head and spine (Based on history or mode of injury)
Wound biopsy culture (if septic)
Wound histology (If septic)

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21
Q

What is Candidiasis?

A

An infection caused by candida. Common commensal on skin, pharynx or Vagina. Invasion implies when the fungus is in normally sterile tissues.

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22
Q

What causes candidiasis?

A

Caused by 15 different candida species

Candida albicans is the most common cause

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23
Q

What are the main types of candidiasis?

A 
Oral 
Oesophageal (AIDS defining condition)
Candidial vulvovaginitis
Candidal skin infections
Invasive candidal infections
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24
Q

What are the Risk factors for candidiasis?

A 
Broad-spectrum antibiotics
Immunocompromised
Central venous lines
Cushing's disease
Diabetes mellitus
GI tract surgery
Poor oral hygiene
Pregnancy and pill
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25
Q

What are the signs and symptoms of Oral candidiasis?

A

Oral thrush

- Curd-like white patches in mouth, removed easily revealing an underlying red base. More common in neonates.

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26
Q

What are the signs and symptoms of oesophageal candidiasis?

A

Dysphagia
Pain on swallowing food or fluids
AIDS-defining illness

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27
Q

What are the signs and symptoms of candidal skin infections?

A

Soreness and itching
Skin appearance can be variable
Red, moist skin area with ragged, peeling edge and possibly papules and pustules

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28
Q

What are the signs of vaginal thrush?

A

White curd discharge

Vulva and vagina may be red, fissured and sore

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29
Q

What are the signs of invasive candidiasis?

A

Fever and chills

Can spread to cause fungemia, endocardiits, endophthalmost, osteomyelitis and CNS infections

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30
Q

What are the investigations for candidiasis?

A

Therapeutic trials of antifungal (fluconazole)
Skin scraping/oral swabbing/endoscopy
Culture on Sabouraud’s medium
Blood cultures

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31
Q

What is cellulitis and Erysipelas?

A

Commonly seen as manifestations of the same condition and the terms are often used interchangeably.
They are acute, painful and potentially serious infections of the skin and SC tissues.

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32
Q

What is the most common cause of cellulitis and Erysipelas?

A

Streptococcus spp.
Staphylococcus spp.

Caused by a wide range of aerobic and anaerobic bacteria

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33
Q

What is cellulitis?

A

Infection of dermis and subcutaneous tissue and has poorly demarcated borders

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34
Q

What is Erysipelas?

A 
Superficial cellulitis (Dermis and Upper SC tissues)
Sharply demarcated borders
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35
Q

What causes cellulitis?

A

Most infections that affect skin due to streptococci, although other organisms may be responsible if integrity is compromised
Gram negative organisms, anaerobes or fungi may cause cellulitis
Cellulitis around surgical wounds, less than 24hrs postoperatively may result from group A beta-haemolytic streptococci or clostridium perfringens (Producing gas/crepitus)

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36
Q

What is Erysipelas?

A

Most are group A streptococci

Strep. Pneumoniae, Klebsiella pneumoniae, haemophilus influenzae tybe B, yersinia enterocolitica adn moraxella spp.

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37
Q

What are the risk factors for Cellulitis and Erysipelas?

A 
Previous erysipelas or cellulitis
Venous insufficiency
Elderly age
Alcoholism
IV drug use
Lymphoedema
Overweight/obesity
Athlete's foot/skin abrasions
Inflammatory dermatoses
Insect bites
Pregnancy
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38
Q

What are the symptoms of Erysipelas?

A

Painful, shiny light-red swelling of clearly defined area of skin
Cause blisters and swelling of nearby lymph nodes
Fever and malaise

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39
Q

What are the symptoms of cellulitis?

A

Reddened skin less clearly defined, often is dark-red/purple
Produces pus
History of cut, scratch or injury

Periorbital cellulitis - painful swollen red skin around the eye

Orbital cellulitis - Painful or limited eye movements, visual impairment

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40
Q

What are the signs of Cellulitis and Erysipelas?

A

Lesions (Erythema, oedema, warm, tender distinct margins, pyrexia (suggest systemic spread))
Periorbital (swollen eyelids and conjunctival infection)
Orbital cellulitis (Proptosis, Impaired visual acuity and eye movements, test for RAPD, visual acuity and colour vision)

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41
Q

What are the investigations for Cellulitis and Erysipelas?

A 
Blood culture (pathogen growth)
FBC (Leucocytosis)
Discharge sample and send for MC&S
Aspiration
CT scan 
MRI (if NF suspected)
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42
Q

What is the management for cellulitis and Erysipelas?

A

General (Rest, elevation of limbs and analgesia)
Prescribe analgesia (paracetamol/ibuproden)
Flucloxacillin 500mg 4x/day, sometimes penicillin V for cellulitis

Erythromycin 50mg 4x daily if penicillin allergic, Clarithromycin if intolerant
Clindamycin (second line)
Co-amoxiclav if facial involvement
NSAIDs and CORTICOSTEROIDS

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43
Q

What are the complications of Cellulitis and Erysipelas?

A

Sepsis

Chronic oedema in affected extremity

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44
Q

What is Eczema?

A

Inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course. Affects all age groups, commonly misdiagnosed before 5 and affects 10-20% of children

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45
Q

What causes Eczema?

A

Cells of stratum corneum form a barrier between cells that are lipids and proteins
Defects in barrier leads to eczema
Many patients have a gene mutation in filagrin gene

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46
Q

What are the risk factors/causes for exogenous eczema?

A

Irritants
Contact
Atopic
Eczema herpeticum

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47
Q

What are risk factors/causes for endogenous eczema?

A 
Atopic
Seborrheic
Pompholyx
Varicose
Lichen simplex
Discoid
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48
Q

What are the risk factors for eczema?

A 
Age <5 years
Family history of eczema
Allergic rhinitis
Asthma
Antihelminthic treatment in utero
Active and passive exposure to smoke
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49
Q

What are the symptoms of Eczema?

A 
Itching
Heat
Tenderness
Redness
Weeping
Crusting
Ask about occupational exposure to irritants
Ask about personal/gmaily history of atopy
Loss of pigment
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50
Q

What are the signs of eczema?

A 
Acute:
- Poorly demarcated erythematous oedematous dry scaling patches
- Papules
- Vesicles with exudation and crusting
- Excoriation marks
Chronic:
- Thickened epidermis
- Skin Lichenification
- Fissures
- Change in pigmentation
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51
Q

Where does atopic eczema act?

A

Mainly faces and flexure surfaces

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52
Q

Where does seborrhoeic eczema act?

A

Yellow, greasy scales on erythematous plaques.

Found on eyebrows, scalp and presternal area

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53
Q

Where does pompholyx eczema act?

A

Vesiculobullous eruptions on palms and soles

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54
Q

Where does Discoid eczema act?

A

Coin shaped

On legs and trunk

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55
Q

Where does asteatotic eczema act?

A

Dry, crazy pairing patern

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56
Q

What investigations are done for eczema?

A

Clinical diagnosis
Allergy testing
IgE levels (elevated)
Skin biopsy

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57
Q

What is Erythema multiforme?

A

Acute hypersensitivity reaction of the skin and mucous membranes.
Stevens-Johnson syndrome is a severe, rare form with bullous lesions and necrotic ulcers

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58
Q

What causes erythema multiforme?

A

Skin-directed immune reaction which occurs following exposure to a trigger in predisposed individuals

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59
Q

What changes occur in erythema multiforme?

A

Degeneration of basal epidermal cells
Development of vesicles between cells in the basement membrane
Lymphocytic infiltrate around the blood vessels and at the dermo-epidermal junction

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60
Q

What can cause erythema multiforme?

A

Drugs (sulphonamides, NSAIDs, anti-convulsants, allopurinol)
Infections (HSV, EBV, adenovirus, chlamydia)
Inflammatory conditions (RA, SLE, Sarcoidosis, UC)
Malignancy (Lymphomas, leukaemia, myeloma)
Radiotherapy
50% are Idiopathic

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61
Q

What are the symptoms of Erythema multiformer?

A

Non-specific prodromal symptoms of URTI
Sudden itching/burning/painful skin lesions
Few to hundreds of red papules (spots) which begin over back of feet and hands and spread upwards to the trunk
Over time papules evolve to plaques and then to typically targe shaped lesions
Skin lesions fade leaving pigmentation
Steven-Johnsons’ syndrome (fever and mucosal involvement too)

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62
Q

What are the signs of Erythema multiforme?

A

Classic target lesions with a rim of erythema surrounding paler area
Vesicles / Bullae
Urticarial plaques
Lesions are symmetrical and distributed over arms and legs

63
Q

What are the characteristic signs of Steven-Johnsons’ syndrome?

A

Affecting >2 mucous membranes (e.g. conjunctiva, cornea, lips, mouth, genitalia)
Systemic symptoms (e.g. sore throat, cough, fever, headache, myalgia, arthralgia, diarrhoea/vomiting)
Shock (hypotension and tachycardia)

64
Q

What are the investigations for Erythema multiforme?

A

Usually unneeded
Bloods (Leucocytosis, Eosinophils, ESR/CRP)
Imaging (exclude sarcoidosis and atypical pneumonia)
Skin biopsy (if doubted)

65
Q

What is Erythema nodosum?

A

Panniculitis (Inflammation of SC fat tissue) presenting as red or violet SC nodules on B/L shins

66
Q

What causes Erytma nodosum?

A

Delayed hypersensitivity reaction to antigens associated with various infectious agents, drugs, diseases, pregnancy and BCG vaccinations

67
Q

What infections cause Erythema nodosum?

A 
Bacterial e.g. streptococcus
Viral e.g. EBV
Fungal e.g. Histoplasmosis
Mycobacterium e.g. TB, leprosy
Yersinia
68
Q

What diseases cause Erythema nodosum?

A 
Sarcoidosis
IBD
Behcet's disease
Leukaemia
Hodgkin's disease
69
Q

What drugs cause erythema nodosum?

A

Sulphonamides
Penicillin
Oral contraceptive pills
Dapsone

70
Q

What are the symptoms of Erythema nodosum?

A 
Tender red or violet raised nodules B/L on both shins
Occasionally on thighs or forearms
Fatigue
Fever
Anorexia
Weight loss
Arthralgia
Symptoms of underlying cause
71
Q

What are the signs of Erythema nodosum?

A

Crops of red/violet dome-shaped nodules usually present on both shins
Occasionally appear on thighs and forearms
Nodules are tender to palpation
Low-grade pyrexia
Joints may be tender and painful on movement
Signs of underlying cause

72
Q

What are the investigations for Erythema nodosum?

A 
Anti-streptolysin-O titres
FBC
CRP/ESR
U&amp;Es
Serum ACE (Raised in sarcoidosis)
Throat swabs and cultures
Mantoux/head skin test for TB
CXR: B/L hilar lymphadenopathy indicates sarcoidosis and unilateral indicates TB
73
Q

What is Herpes?

A

A disease resulting from HSV1/HSV2 infection
It can manifest in many ways
(Genital, Gingivostomatitis, Herpetic whitlow, Herpes gladiatorum, eczema herpeticum, herpes meningitis, HSV keratitis, Recurrent HSV)

74
Q

What is gingivostomatitis?

A

Ulcers filled with yellow sough around mouth

75
Q

What is herpetic whitlow?

A

Infection of the virus in abrasions near fingernail/nailbed

76
Q

What is Herpes gladitorium?

A

Vesicles wherever HSV is ground into the skin by force

77
Q

What is HSV Keratitis?

A

Corneal dendritic ulcers

78
Q

What causes Herpes?

A

Transmitted via close contact with an individual who is shedding the virus.
After primary infection, virus becomes dormant
Reactivation occurs in response to physical and emotional stresses or immunosuppression
Virus causes cytolysis of infected epithelial cells leading to vesicle formation

79
Q

What are the symptoms of HSV1 infection?

A 
Possible symptoms of primary:
- Pharyngitis
- Gingivostomatitis
- Herpetic whitlow
Possible symptoms of reactivation:
- Prodrome of perioral tingling and burning
- Vesicles appear 
- Heal within 8-10 days
80
Q

What are the symptoms of HSV2 infection?

A
  • Painful blisters and rash in the genital, perigenital and anal area
  • Dysuria
  • Fever
  • Malaise
81
Q

Which virus causes herpetic encephalitis?

A

HSV1

82
Q

What are the symptoms of HSV keratoconjunctivitis?

A

Watering eyes

Photophobia

83
Q

What are the signs of HSV1 infections?

A 
Presents as herpetic labialis (cold sores)
Tender cervical lymphadenopathy
Erythematous, oedematous pharynx
Oral ulcers filled with yellow slough
Herpetic whitlow
Signs of encephalitis
84
Q

What are the signs of HSV2 infections?

A

HSV2 is nearly always sexually transmitted and causes genital herpes - genital or anal blisters
- Maculopapular rash
- Vesicles
- Ulcers
- All found on external genitalia, anal margin and upper thighs
- inguinal lymphadenopathy, pyrexia
HSV keratoconjunctivitis - Dendritic ulcer on the iris

85
Q

What are the investigations for Herpes?

A

Clinical diagnosis

Vesicle fluid can be sampled and sent for electron microscopy, PCR

86
Q

What is a lipoma?

A

Slow-growing, benign adipose tumours that are most often found on SC tissues.

87
Q

What causes a lipoma?

A 
Benign tumours of adipocytes
Occur wherever fat can expand i.e. not scalp or palm
Conditions associated with lipomas:
- Familial multiple lipomatosis
- Gardner's syndrome
- Decrum's disease
- Madelung's disease
Liposarcoma - rare malignant tumour of adipose tissue
88
Q

What is Decrum’s disease?

A

A disease causing multiple scattered lipomas which may be painful, typically in post-menopausal women

89
Q

What are the signs and symptoms of Lipomas?

A 
Most are asymptomatic
Compression of nerves can cause pain
Soft or firm nodule
Smooth normal surface
Skin coloured
Most are <5cm diameter
Mobile
Soft/doughy feel
Hint of fluctuance
90
Q

What are the investigations for lipoma?

A

Usually clinical

US/MRI/CT if any doubt

91
Q

What is a melanoma?

A

Malignancy arising from neoplastic transformation of melanocytes, the pigment forming skin cells. The leading cause of death from skin disease.

92
Q

What are the types of melanoma?

A

Lentigo maligna melanoma
Superficial melanoma
Nodular melanoma
Acral lentiginous melanoma

93
Q

What are Lentigo maligna melanoma?

A

Patch of lentigo maligna develops a papule or nodule signalling invasive tumours

94
Q

What is superficial melanoma?

A

Large, flat, irregularly pigmented lesion which grows laterally before vertical invasion develops

95
Q

What is nodular melanoma?

A

Most aggressive type

Rapidly growing pigmented nodule which bleeds or ulcerates. Rarely amelanotic and mimic pyogenic granuloma

96
Q

what is acral lentiginous melanoma?

A

Pigmented lesions on palm, sole or under the nail, usually presents late, most common in non-white people

97
Q

How do melanomas mestastasise and where to?

A

Via blood and lymphatics

Metastasis to: Lymph nodes, liver, lung, bone and brain

98
Q

What causes a melanoma?

A

Arises from melanocytes
Inheritance of sun-sensitive skin and specific melanoma-related genes
Mainly CDKN2A, encoding p16 and p14ARF, affecting p53 and retinoblastoma cycle

99
Q

What are the risk factors for melanoma?

A

Family history of melanoma
Personal history of melanoma
Personal history of skin cancer (including actinic damage)
History of atypical naevi (6mm or larger with irregular pigmentation)
Fitzpatrick skin type I or II (Light-coloured skin)
Red or blonde hair
High freckle density
Sun exposure
Sun bed use
Light eye colour
Increased number of benign-appearing melanocyte naevi
Large congenital naevi
Immunosuppression
Xeroderma pigmentosum

100
Q

What are the symptoms of a melanoma?

A 
Change in size, shape or colour of pigmented skin lesion
Redness
Bleeding
Crusting 
Ulceration
101
Q

What are the signs of a melanoma?

A 
ABCDE(F)
A - Asymmetry
B - Border irregularity
C - Colour variation
D - Diameter >6 mm
E - Elevation
F - Fast evolving
102
Q

What are the investigations for melanoma?

A 
Excisional biopsy
Dermoscopy
Lymphoscintigraphy
Sentinal lymph node biopsy
Staging
Bloods
CDKN2A genetic test
103
Q

What is Molluscum contagiosum?

A

Common skin infection caused by a pox virus that affects children and adults/
Transmission is usually by direct skin contact

104
Q

What causes molluscum contagiosum?

A

Viral skin infection caused by molluscum contagiosum virus (MCV)
It is a type of pox virus

105
Q

What are the risk factors for molluscum contagiosum?

A

Mainly in children
Immunocompromised (HIV)
Atopic eczema

106
Q

What are the symptoms of molluscum contagiosum?

A

Incubation period (2-8 weeks)
Usually asymptomatic
May be tenderness, pruritus and eczema around the lesion
Lesions last for around 8 months

107
Q

What investigations are done for molluscum contagiosum?

A

Clinical diagnosis

Dermatoscopy may be useful if any doubt

108
Q

What is a pressure sore?

A

Damage to skin, usually over a bony prominence, as a result of pressure

109
Q

What causes a pressure sore?

A

Constant pressure limits blood flow to the skin leading to tissue damage
Occurs as a result of pressure, friction and shear

110
Q

What are the Risk Factors for Pressure sores?

A

Immobility
Obesity
Alzheimer’s disease
Diabetes

111
Q

What are the signs and symptoms of pressure sores?

A

Most commonly at the sacrum and heel
Pressure sores staged 1-4
Very tender
May become infected leading to fevers, erythema and foul smell

112
Q

What are the investigations for pressure sores?

A

Clinical diagnosis

Waterlow score to predict risk

113
Q

What is Psoriasis?

A

Chronic inflammatory skin disease characterised by erythematous, circumscribed, scaly papules and plaques.
It can cause itching, irritation, burning and stinging

114
Q

What causes psoriasis?

A

Unknown cause
Made up of genes, infections, immunology and drugs
Immune response defined by T cells in dermis, initiating release of cytokines

115
Q

What are the risk factors for Psoriasis?

A 
Genetic
Infection
Local trauma
Stress
Smoking
Light skin
Beer intake
116
Q

What are the types of Psoriasis?

A

Guttate
Palmoplantar
Generalised pustular

117
Q

What is Guttate psoriasis?

A

Affects teens and those in early 20s
Triggered by streptococcal sore throat
Small pink and scaly lesions

118
Q

What is Palmoplantar psoriasis?

A

Psoriasis on hands and feet

Smoking, middle-aged women, AI thyroid disease, pustules on hands and feet

119
Q

What is generalised pustular psoriasis?

A

Hypoparathyroidism

120
Q

What are the symptoms of psoriasis?

A

Commonly: Scalp, Elbows, Knees, Buttocks, Genital area, foot soles itching and occasionally tender skin
Pinpoint bleeding with removing scales (Auspitz phenomenin)
Skin lesions may develop at sites of trauma/scars (Koebner phenomenin)

121
Q

What are the signs of psoriasis?

A

Discoid/nummular psoriasis (symmetrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces)
Flexural psoriasis (Less scaly plaques in axilla, groins, perianal and genital skin)
Guttate psoriasis (small drop-like lesions over trunk and limbs)
Palmoplantar psoriasis - pustules distributed over limbs and torso
- Nail signs (Pitting, onycholysis, subungual hyperkeratosis)
- Joint signs (asymmetrical oligoarthritis, symmetrical polyarthritis, Distal interphalangeal joint, arthritis mutilans, psoriatic spondylitis)

122
Q

What investigations are done for psoriasis?

A

Most do not need investigations
- Guttate psoriasis - anti-streptolysin-O titre, throat swab
- Flexural psoriasis - Skin swabs to exclude candidiasis
Nail clipping analysis for onychomycosis
Joint involvement analysed by checking for rheumatoid factor
Skin biopsy

123
Q

What are sebacious cysts?

A

Either epidermoid or pilar cysts - epithelium lined, keratinous, debris-filled cysts
Both contain keratin, not sebum and do not originate from sebaceous glands

124
Q

What is the difference between epidermoid and pilar cysts?

A

Epidermoid - Epidermis

Pilar - Hair follicles

125
Q

What causes sebaceous cysts?

A

Occlusion of the pilosebaceous gland
Can be caused by traumatic insertion of epidermal elements into the dermis
Embryonic remnants

126
Q

What are the risk factors for sebaceous cysts?

A

Gardner’s syndrome = Autosomal dominant characterised by multiple polyps in the colon and in extra-colonic sites

127
Q

What are the symptoms of sebaceous cysts?

A

Non-tender slow-growing skin swelling
There are often multiple
Common on hair-bearing regions of the body
May become red, hot and tender if superimposed infection or inflammation
Infection is quite common - dischare cheesy foul-smelling pus

128
Q

What are the signs of sebaceous cysts?

A

Firm, round, mobile SC nodules
Characteristic overlying central punctum
Foul pus (granular and creamy) exits through punctum

129
Q

What are the investigations for sebaceous cysts?

A

None needed

Skin biopsy or FNA may be used to rule out other differentials

130
Q

What is a squamous cell carcinoma?

A

Proliferation of atypical, transformed keratinocytes in the skin with malignant behaviour.
Ranges from in situ tumours (Bowen’s disease) to invasive and metastatic disease

131
Q

What causes Squamous cell carcinoma?

A

Excess sun light exposure

132
Q

What are the risk factors for squamous cell carcinoma?

A 
UV radiation exposure
Immunosuppression
Fair skin
Hereditary skin conditions
Older age
Male sex
Ionising radiation
Carcinogens
Actinic keratosis
Previous skin cancer
HPV
Tobacco smoking
Thiazide diuretic and cardiac drugs
Keratoconthomas 
Tattoos
133
Q

What are the symptoms for Squamous cell carcinoma?

A 
Skin lesion
Ulcerated
Recurrent bleeding
Non-healing
Bone pain
Plaques
134
Q

What are the signs of squamous cell carcinoma?

A

Variable appearance - may be ulcerated, hyperkeratotic (with keratin horn), crusted or scaly, non-healing
Sun-exposed areas
Palpate for local lymphadenopathy
Hepatomegaly

135
Q

What are the investigations of squamous cell carcinoma?

A

Skin biopsy - staging
CT body scan / MRI scan / PET scan - lymphadenopathy and/or visceral nodules suggests mets
FBC with differential (Normal except with bone marrow mets)
LFT and CXR (Normal without mets)

136
Q

What is Urticaria?

A

Itchy, red, blotchy rash resulting from swelling of the superficial part of the skin
Angioedema occurs when the deep tissues, lower dermis and SC tissues are involved and become swollen
Angio-oedema occurs in association with urticaria in about 40% of cases (AKA hives)

137
Q

What causes urticaria?

A

Caused by activation of mast cells in the skin, resulting in the release of histamines
The cytokine release leads to capillary leakage, causing swelling of the skin and vasodilatation > erythematous appearance

138
Q

What are the triggers for acute urticaria?

A

Allergies
Viral infections
Skin contact with chemicals
Physical stimuli

139
Q

What are the triggers for chronic urticaria?

A

Chronic spontaneous urticaria - medication, stress, infections
Autoimmune

140
Q

What are the signs and symptoms of Urticaria?

A

Central, itchy white papule or plaque surrounded by erythematous flare
Blanching, oedematous, non-painful, pruritic
Lesions vary in size and shape
May be associated with swelling of soft tissues of eyelids, lips and tongue
Individual lesions are transient
Stridor
Time scales
- Acute - quickly but recover over 48 hours
- Chronic - rash for > 6 weeks

141
Q

What are the investigations for Urticaria?

A

Usually clinical

Tests may be required for chronic urticaria (e.g. FBC, ESR/CRP, patch testing, IgE tests) depending on history

142
Q

What is Varicella Zoster?

A

Primary infection is varicella (Chicken pox)

Reactivates causing zoster (shingles)

143
Q

What causes Varicella zoster?

A

Primary infection with human alpha herpes virus, varicella zoster, in a non-immnue host
Virus Takes a lifelong latency in cranial nerves and dorsal root ganglia

144
Q

What are the risk factors for varicella zoster?

A

Age 1-9 years
Exposure to varicella
Unimmunised status
Occupational exposure

145
Q

What are the symptoms of Varicella?

A

Prodromal malaise
Mild pyrexia
Sudden appearances of intensely itchy spreading rash affecting face and trunk
Vesicles weep and crust over
Contagious from 48hrs before rash until after they have all crusted over

146
Q

What are the symptoms of zoster?

A

May occur after period of stress
Tingling/hyperaesthesia in a dermatome
Painful skin lesions
Recovery 10-14 days

147
Q

What are the signs of varicella?

A

Maculopapular rash
Area of weeping and crusting
Skin excoriation (from scrathing)
Mild pyrexia

148
Q

What are the signs of zoster?

A

Vesicular maculopapular rash
Dermatomal distribution
Skin excoriation

149
Q

What is the management of varicella zoster?

A

Minimalise scratching
Avoid pregnant people and anyone immunocompromised
Analgesia and antipyretics for symptoms
Antivirals

150
Q

What is the antiviral treatment for varicella zoster?

A

Some need IV aciclovir or oral aciclovir

151
Q

Which people would need IV aciclovir?

A
  • High- risk patients who are immunocompromised
  • Sytemic disease
  • Patients on high-dose steroids
  • New lesions after 8 days
152
Q

Which people need Oral aciclovir?

A

Chronic medical condition
Over 12 years old
Secondary case in a household
Pregnant patient

153
Q

What are the complications for varicella?

A 
Secondary infection
Scarring
Pneominits and ataxia
Purpura fulminans
DIX
Pneumonia
Encephalitis
Congenital varicella syndrome
154
Q

What are the complications for zoster?

A

Postherpetic neuralgia
Zoster ophthalmicus (rash in ophthalmic division of the trigeminal nerve)
Ramsay-Hunt syndrome (zoster of the ear and facial nerve - vesicles behind pinna of ear or in the ear canal)
Sacral zoster
Motor zoster

Conditions (18 decks)

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