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Medicine year 3- EOCP > Frailty- 4 > Flashcards

Frailty- 4 Flashcards

1
Q

Chancre

A
  • Primary syphilis
  • Treponema pallidum
  • Small firm red papule which ulcerates to forma painless ulcer
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2
Q

Secondary syphilis

A
  • Widespread rash and flu like symptoms
  • Rough, red, or reddish brown macules on palms and soles
  • Wart like sores in mouth or genital area
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3
Q

Tertiary syphilis

A
  • Can affect multiple organ systems e.g. neurosyphilis
  • Syphillis known as ‘The Great mimic’, as can imitate many other diseases
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4
Q

Viral exanthem

A
  • Exanthem: widespread rash accompanied by systemic symptoms
  • Common in childhood i.e. chicken pox, measles, rubella, parvovirus B19
  • Drug reaction is an important differential
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5
Q

Herpes simplex virus (HSV)

A
  • Type 1 – usually orofacial
  • Type 2 – usually anogenital
  • After primary infection, recurrent infections can occur
  • Recurrent Type 1 HSV occurs most frequently on face esp lips – herpes simplex labialis
  • Dx – viral swabs for PCR
  • Rx – mild cases do not required Rx, severe cases may require acyclovir
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6
Q

Eczema herpeticum

A
  • Dissemination Herpes simplex virus (HSV) infection
  • Fever, clusters of painful, itchy blisters and punched out erosions
  • Usually a complication of atopic eczema
  • Complicated by secondary bacterial infection
  • Antiviral treatment, IV antivirals required if patient unwell or immunocompromised
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7
Q

Herpes zoster (shingles)

A
  • Localised, painful blistering rash
  • Reactivation of Varicella zoster virus (VZV).
  • Dermatomal distribution
  • More common in adults esp older people and immunosuppressed
  • After primary infection, VZV stays dormant in dorsal root ganglia nerve cells in spine for years before reactivation. It then migrates down sensory nerves to skin causing zoster.
    *Pain usually first symptom, within 1-3 days blistering rash appears in painful area of skin
  • Cx – post herpetic neuralgia
  • Treatment – Oral antiviral – reduce pain and duration of symptoms if started within 1-3 days
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8
Q

Viral wart

A
  • Caused by Human papilloma virus (HPV)
  • Common in children and in immunocompromised
  • Keratotic surface
  • Tiny dots can be seen – intracorneal haemorrhage (absent in callocities)
  • Common on backs of fingers and toes
  • Treatment-salicylic acid
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9
Q

Fungal infections

A
  • Superficial (common), Deep (rare, tropical)
  • Superficial: Dermatophytes (Tinea), Candida, yeasts
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10
Q

Tinea corporis

A
  • Dermatophyte skin infection
  • Prefix tinea + body site
  • Tinea pedis (foot), Tinea capitis (scalp),
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11
Q

Onychomycosis

A
  • Fungal infection of nails
  • Can be caused by dermatophytes, yeasts, moulds
  • Commonly due to Tricophyton rubrum
  • Ix-nail clippings for microscopy and culture
  • Rx- topical antifungals if limited, usually needs oral
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12
Q

Candidial intertrigo

A
  • Intertrigo describes the rash in body folds
  • Candida often affects intertriginous area typically inflammatory
  • Pink to bright red moist patches +/- satellite papules and pustules
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13
Q

Scabies

A
  • Sarcoptes scabiei
  • Parasitic mite that burrows under skin
  • Causes an intensely itchy rash
  • Worse at night disturbing sleep
  • Burrows – grey irregular tracks
  • Look in webspaces of fingers, palms and flexor surfaces wrists
  • Also found on elbows, nipples, buttocks, penis, soles
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14
Q

Scabies- treatment

A
  • 5% permethrin cream applied all over skin and left on for 8-10 hours
  • Oral ivermectin 200mcg/kg stat
  • Treatment repeated a week later to kill newly hatched mites
  • Identify and treat contacts
  • Itching may persist up to 6 weeks, if it persists after 6 weeks consider if it has been applied correctly or if it’s the right diagnosis
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15
Q

Emollients- creams (dermatology treatment)

A
  • Pros; easy to rub in, doesn’t rub off on clothes, will rub into weepy skin
  • Cons: not the best moisturisers, contains preservatives (can cause contact allergy)
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16
Q

Emollients- lotions (dermatology treatment)

A
  • Mainly water based
  • Cons: poor moisturisers
  • Pros: easy to apply to hairy areas (scalp)
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17
Q

Emollients- Ointments (dermatology treatment)

A
  • Greasy, form waterproof barrier
  • Pros: better moisturisers than cream, better for eczema/dry skin
  • Cons: don’t rub in as easily as creams, can be more unwieldy, can make clothes/sheets messy
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18
Q

Topical steroids

A
  • Range of potencies
  • Essential for all but the mildest eczema: effective and safe with appropriate use
  • Toxicity: atrophy, acne, rarely adrenal suppression
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19
Q

Topical steroid; side effects

A
  • Skin thinning (atrophy) usually only seen with strong steroids, prolonged periods, at certain body sites (face, skin creases)
  • Acne
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20
Q

Rules of steroid use

A
  • Do not use a strong steroid if a weaker steroid is effective
  • Stronger steroids in short blasts are safe
  • Use ointment base rather than creams
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21
Q

Treatment for actinic keratosis

A
  • liquid nitrogen cryotherapy
  • 5-flurouricil (Efudix)
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22
Q

Treatment with ultraviolet radiation

A
  • Psoriasis: UVB and PUVA
  • Atopic eczema: UVB
  • Cutaneous T cell lymphoma: PUVA
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23
Q

UV protection

A
  • Appropriate clothing
  • Sunscreens
  • SPF (UVB)
  • Star rating (UVA)
24
Q

Hyperactive and Hypoactive delirium

A

Hyperactive delirium: Agitation, Delusions, Hallucinations, Wandering, Aggression
Hypoactive delirium: Lethargy, Slowness with everyday tasks, Excessive sleeping, Inattention

25
Q

Causes of Delirium

A

CHIMPS PHONES
* Constipation
* Hypoxia
* Infection
* Metabolic disturbance
* Pain
* Sleeplessness
* Prescriptions
* Hypothermia/pyrexia
* Organ dysfunction (hepatic or renal impairment)
* Nutrition
* Environmental changes
* Drugs (over the counter, illicit, alcohol and smoking)

26
Q

Malignant melanoma

A

Melanoma develops from melanocytes which start to grow and divide more quickly. Can metastisise

27
Q

4 main types of skin melanomas

A
  • Superficial spreading melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral lentiginous melanoma
    Can develop from new mole or old mole
28
Q

Symptoms of a melanoma: ABCDE

A
  • Asymmetry- irregular in shape
  • Border- uneven
  • Colour- more than one colour such as brown, black, red, pink, white or blue tint
  • Diameter- usually more than 6mm wide, tend to get bigger
  • Evolving- change in size, shape and colour
29
Q

Risk factors for melanoma

A
  • Age
  • Ultraviolet light exposure- out in the sun
  • Fair skin
  • Having lots of moles or a large birth mark
  • Family history of melanoma
  • Reduced immunity
30
Q

Investigations and treatment melanomas

A

Investigations
* Excision biopsy: to test the mole
* A sentinel lymph node biopsy- to the lymph node nearest the melanoma
* CT scan- to check for metastasise

Treatment- surgery

31
Q

Diagnosis and treatment of basal cell carcinoma

A

Diagnosed through a skin biopsy

Treatment
* Surgery- BCC is removed as well as some clear skin around it, the skin is closed with a few stitches but sometimes a graft is needed
* Mohs micrographic surgery- for more complex BCC’s presenting at difficult sites or recurrent BCC’s. You examine the skin under a microscope to see if all the BCC has been removed
* Radiotherapy: shinning x-rays onto the BCC

32
Q

Superficial BCC treatment

A
  • Curettage and cautery- the skin is numbed with local anaesthetic and the BCC is scrapped away (curettage) and the skin is sealed by heat (cautery)
  • Cryotherapy- with liquid nitrogen
  • Creams: 5-fluorouracil (5-FU) and imiquimod
  • Photodynamic therapy: a cream is applied to BCC, it is taken up by the cells that are then destroyed when exposed to a specific wavelength of light
33
Q

Appearance of squamous cell carcinoma

A

Can appear as scaly red patches, open sores, rough, thickened or wart-like skin, or raised growths with a central depression. At times, SCCs may crust over, itch or bleed. The lesions most commonly arise in sun-exposed areas of the body.

34
Q

Risk factors for squamous cell carcinoma

A
  • Unprotected exposure to ultraviolet (UV) radiation from the sun or tanning beds.
  • Weakened immune system due to illness or certain immunosuppressive medications.
  • History of skin cancer including basal cell carcinoma (BCC).
  • Age over 50: Most SCCs appear in people over age 50.
  • Fair skin: People with fair skin are at an increased risk for SCC.
  • Gender: Men are more likely to develop SCC.
  • Sun-sensitive conditions including xeroderma pigmentosum.
  • Chronic infections and skin inflammation from burns, scars and other conditions.
  • Skin precancers including actinic keratosis.
  • History of human papilloma virus (HPV)
35
Q

Treatment for SCC

A
  • Excisional surgery- removes tumour and safety margin of normal skin
  • Mohs surgery- repeats surgery till all cancerous cells are removed, looks at the biopsy under a microscope to see if any cancerous cells remain
  • Cryosurgery- apply liquid nitrogen to freeze the tumour
  • Curettage and electrodesiccation (electrosurgery)
  • Laser surgery
  • Radiation
  • Photodynamic therapy (PDT)
  • Topical medications
  • Immunotherapy
36
Q

Difference between replacement, resuscitation and redistribution of fluid

A
  • Replacement: deterioration of patient in hospital
  • Resuscitation: used when the patient is haemodynamically unstable, acutely unwell
  • Redistribution: when fluid is in the wrong compartment i.e. heart failure
37
Q

Giving potassium

A

Do not give potassium at rates >10mmol/hr
Do not give pottassium at concentrations >40mmol/he

38
Q

In what types of fluid can you add extra potassium

A
  • In 0.9% sodium chloride
  • In 5% glucose
39
Q

Types of fluid bolus

A

Fluid bolus: 500ml
Cautious bolus: 250- if the patient is frail or has heart failure

40
Q

How much glucose do you need to give

A

You need to give glucose to cover 16-18% of BMR so metabolism does not become completely catabolic

41
Q

How do you calculate the rate fluid is given

A

You calculate how much is meant to be given over 24 hours then you divide by 24 to get the hourly rate

42
Q

Normal fluid regimen for a 70kg man

A

1L Hartman solution over 10 hours
1L 5% glucose over 10 hours with 40mmol of added K+

43
Q

How long do you give fluid over and how big are the bags

A

Over 8, 10 or 12 hours. Give over a longer time if they have heart failure
The bags are 250ml, 500ml and 1L

44
Q

Maximum amount of fluid bolus stat you can give

A

4 (2L)

45
Q

How much glucose do you give over 24 hours

A

50-100 grams

46
Q

What drugs should be stopped if the patient has an AKI

A

Ramipril and Metformin

47
Q

What drugs can cause oral candidiasis

A

Amoxicillin, Fluticasone and Prednisolone

48
Q

Causes of eczema

A
  • Stress
  • Precipitants of barrier defect i.e. winter, frequent washing, soaps
  • Irritant factors i.e. soaps, dusty environment, cosmetics
49
Q

Causes of psoriasis

A
  • Stress
  • Obesity/ smoking/ EtOH
  • Streptococcus i.e. guttate
  • Trauma i.e. koebnerisation
  • Iatrogenic i.e. beta blockers, lithium, anti-malarials, NSAID’s, steroid withdrawal
50
Q

Topical treatment of eczema

A
  • Emollients: lotions vs creams vs ointments
  • Topical steroids
  • Calcineurin inhibitors i.e. tacrolimus
51
Q

Topical treatment of psoriasis

A
  • Emollients: lotions vs creams vs ointments
  • Topical steroids
  • Calcineurin inhibitors i.e. tacrolimus
  • Vitamin D analogues i.e. calcipotriol
  • Tar based preparation
52
Q

Photopherapy: eczema and psoriasis

A

Eczema: UVB (x2 week for 8-12 weeks)
Psoriasis: UVB (x3/week for 8-12 weeks) and PUVA (x2/week for 12 weeks)

UVB courses can only be once a year whilst PUVA are 5-6 a lifetime

53
Q

Medical treatment for eczema

A
  • Methotrexate: immunosuppressant, teratogenic, liver fibrosis
  • Ciclosporin: immunosuppressant, duration of use limited by significant risk of HTN and renal failure
  • Azathioprine: immunosuppressant, requires TPMT enzyme measuring prior to use because if its deficient, azathioprine will accumulate in toxic levels
54
Q

Medical treatment for psoriasis

A
  • Methotrexate: immunosuppressant, teratogenic, liver fibrosis
  • Ciclosporin: immunosuppressant, duration of use limited by significant risk of HTN and renal failure
  • Acitretin: vitamin A analogue, teratogenic, associated drying of the skin and thinning of the hair, requires monitoring of LFT’s and lipid profile
55
Q

Biological treatment for eczema and psoriasis

A

Eczema: Anti IL-4
Psoriasis: Anti TNF, Anti IL12-23, Anti IL-17

Medicine year 3- EOCP (27 decks)

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