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Year 4 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Delirium (acute confusional state)

A

clinical syndrome with acute onset, fluctuating change in mental status with inattention, disorganised thinking & altered levels of consciousness usually seen in >65y/o hospitalised pts

Characterised by high morbidity & mortality

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2
Q

Epidemiology of delirium

A

most common complication of hospitalisation in the elderly & high incidence in those with pre-existing cognitive impairment

↑ incidence with age

usually seen in those >65 y/o

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3
Q

Risk factors for delirium

A 
age >65 yrs
male sex
pre-existing cognitive deficit e.g. dementia
severe comorbidity
previous delirium
current severe illness/hip fracture 
↑ pain
drug use/dependence / substance misuse
visual/hearing impairment 
poor mobility
social isolation
terminal illness
ICU admission
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4
Q

Aetiology of delirium

A 
Acute infections especially UTIs
prescribed drugs e.g. benzos, analgesia (morphine), steroids, antiparkinson meds
surgery/trauma 
urinary retention 
constipation
sleep deprivation
pain
dehydration 
toxic substances (drugs/alcohol)
neoplasia/malignancy
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5
Q

Subtypes of delirium

A

Hypoactive:
↓ psychomotor activity, apathy & quiet confusion
mostly seen in elderly pts

Hyperactive:
↑ psychomotor activity, agitation, delusions & disorientation
usually seen with substance abuse/withdrawal

Mixed delirium:
fluctuating psychomotor activity between hyper/hypoactive states
most common in general population

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6
Q

Presentation of delirium

A

usually acute presentation
fluctuating course throughout day
may be worse in evening (sundowning)

disorganised thinking, hallucinations (usually visual), cognitive deficits, impaired memory, emotional lability,, agitation, combativeness, disorientation, poor concentration, psychotic ideas (short duration & simple content)

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7
Q

Investigating delirium

A 
Full physical examination 
Bloods (FBC/U&Es/LFTs/TFTs/Mg2+/Ca2+/creatinine/glucose)
ECG
Urine dip + MC&S
CXR
blood cultures
ABG
imagine/investigations for suspected cause
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8
Q

Management of delirium

A

treatment of underlying condition

Supportive care:
clear communication, reminders of day/time/location, familiar objects from home, involve family & carers

Environmental:
side room, control noise/lighting/temp

adequate nutrition
attention to continence / help with constipation
stop offending medication (e.g. benzos, morphine, warfarin, furosemide, lithium, TCAs, steroids)

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9
Q

Alzheimers dementia (AD)

A

a chronic neurodegenerative disease wait insidious onset & progressive but slow decline, may occur commonly with other types of dementia e.g. vascular

most common type of dementia

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10
Q

Characteristics of Alzheimer dementia (AD)

A

widespread cortical atrophy
extracellular senile/amyloid plaques made from beta amyloid
intracellular neurofibrillary tangles made from hyperposphorylated Tau
↓cholinergic function (acetylcholine deficiency)

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11
Q

Risk factors for Alzheimer dementia (AD)

A 
caucasian heritage
↑ age
hyperlipidaemia
diabetes
HTN
smoking
alcohol misuse
Down's syndrome
Genetics
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12
Q

Presentation of Alzheimer dementia (AD)

A

insidious onset & slow progression

short term memory impairment (episodic memory affected first)
disorientation (in time & place, subtle at first e.g. misplacing items/getting lost)

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13
Q

Presentation of Alzheimer dementia (AD)

A

insidious onset & slow progression

short term memory impairment (episodic memory affected first)
disorientation (in time & place, subtle at first e.g. misplacing items/getting lost)
nominal dysphasia
apathy
impaired ADLs
personality change / mood change
poor abstract thinking & judgement
psychiatric symptoms
agitation & irritability
impaired executive function (later on in disease)

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14
Q

Investigations for Alzheimer dementia (AD)

A

Bedside cognitive assessment (MMSE, MoCA, AMTS)

CT/MRI head (cortical atrophy)

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15
Q

Management of Alzheimer dementia (AD)

A

Person centred MDT care (memory assessment, memory enhancement strategies, therapies e.g. aroma/music therapy)

Pharmacological:
1st line: AChE inhibitors e.g. donepezil, galantamine, rivastigmine (for moderate AD)
2nd line: NMDA receptor antagonist e.g. memantine (if AChE contraindicated/as add on to AChE)

SSRIs as depression

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16
Q

Genetics of Alzheimer dementia (AD)

A

Amyloid precursor protein (APP)
Presenilin 1
Presenilin 2
ApoE4 (late onset)

NB ApoE3 = neutral & ApoE2 = portective

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17
Q

Vascular dementia (VD)

A

also know as multi infarct dementia, is a chronic progressive cognitive impairment caused by cerebrovascular disease leading to ischaemia / haemorrhage

2nd most common type of dementia

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18
Q

Sybtype of vascular dementia (VD)

A

its a spectrum of disease called vascular cognitive impairment of which vascular dementia is the worst

stroke related VD - multi/single infarct
subcortical VD - small vessel disease
mixed dementia - presence of both VD & AD

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19
Q

Inherited form of Vascular dementia

A

inherited as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

RARE

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20
Q

Risk factors for vascular dementia (VD)

A 
↑ age
history of stroke/TIA
AF
HTN
Diabetes 
smoking
obesity 
CHD
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21
Q

Investigation/Assessment of vascular dementia (VD)

A

cognitive impairment screening

MRI/CT (may show infarcts / white matter changes)

NINDS-AIREN for diagnosis of probably VD (presence of cognitive decline interfering with ADLs, presence of CVD, relationship between the 2 suspected)

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22
Q

Management of vascular dementia (VD)

A

Individualised person centred care (cognitive stimulation programmes, therapies, multi sensory stimulation)

consider AChE inhibitors or memantine if comorbid Alzheimers

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23
Q

Frontotemporal dementia

A

progressive neurodegenerative disease of the frontal and/or temporal lobe generally due to mutations of proteins leading to lobar atrophy

3rd most common type of dementia

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24
Q

Onset of Frontotemporal dementia

A

usually age <65yrs

i.e. earlier than other dementias

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25
Q

Presentation of Frontotemporal dementia

A 
insidious onset
relatively preserved memory & visuospatial skills
personality change
social conduct problems
disinhibition 
inappropriate social behaviour
loss of empathy/sympathy
lack of insight
may have difficulties with speech (hesitant, loss of vocabulary, ↓fluency)
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26
Q

Investigations/Assessment of Frontotemporal dementia

A

formal cognitive testing & dementia screen

MRI (atrophy of frontal and/or temporal lobe)

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27
Q

Management of Frontotemporal dementia

A

patient centred care (SALT, therapies, supportive therapy)

SSRIs = 1st line to modify behavioural symptoms
atypical antipsychotics = 2nd line

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28
Q

Hallmarks of the subtypes of frontotemporal lobar degeneration

A

Chronic progressive aphasia:
Non fluent speech with meaning

Semantic dementia:
fluent but empty speech

Pick’s disease (frontotemporal dementia)
personality change, disinhibition & inappropriate social conduct

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29
Q

Lewy body dementia (LBD)

A

clinical syndrome of progressive conginitve decline characterised by pathological alpha-synuclein cytoplasmic inclusion (Lewy bodies) in the substantial migration, paralimbic & neo cortical areas

~20% of all dementia

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30
Q

Lewy body dementia vs Parkinsons dementia

A

LBD:
onset of cognitive & motor symptoms within 1 year of each other

Parkinsons dementia:
if cognitive symptoms occur >1 year after onset of motor symptoms

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31
Q

Presentation of Lewy body dementia (LBD)

A

progressive cognitive impairment in contrast to Alzheimer’s, early impairments in attention and executive function

cognition may be fluctuating, in contrast to other forms of dementia

parkinsonism

visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

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32
Q

Presentation of Lewy body dementia (LBD)

A

progressive cognitive impairment (memory loss, decline in problem solving ability, spatial awareness difficulties, impairment of executive function & attention)
conginiton may be fluctuation (fluctuating levels of attention & awareness)
Mild parkinsonism (tremor, rigidity poverty of facial expression, bradykinesia)
visual hallucinations
frequent falls
REM sleep disturbances

NB unlike AD there is early impairment of executive function & attention rather than just memory

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33
Q

Management of Lewy body dementia (LBD)

A

patient centred care (care plans, therapies, cognitive stimulation programmes)

Pharmacological:
AChE inhibitors & memantine can be used as in AD

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34
Q

Medication to avoid in Lewy body dementia (LBD)

A

Its very sensitive to antipsychotics

may cause them to develop irreversible parkinsonism & worsen the dementia

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35
Q

Osteoporosis

A

progressive systemic skeletal disease characterised by ↓ bone mass & micro-architectural deterioration of bone tissue leading to ↑ fragility of the bone & ↑ susceptibility to fractures

more common in women
↑incidence with age

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36
Q

Bone density assessment

A

Bone density is expressed as standard deviation in relation to a reference population

A Z-score compares bone density of an individual to normal at that age, with a score of -2 indicating bone density below the normal for that age

A T-score compares bone density of an individual to that of a young healthy population

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37
Q

Characterising bone density assessment

A

Normal:
T-score ≥ -1

Osteopenia:
T-score < -1 but > -2.5

Osteoporosis:
T-score ≤ -2.5

Severe osteoporosis:
T-score ≤ -2.5 + a fracture

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38
Q

Risk factors for osteoporosis

A 
female sex
↑ age
low BMI
smoking
alcohol misues
prolonged immobilisation
corticosteroid use
menopause 
medications (PPIs, L-thyroxine, anticonvulsants, heparin, steroids)
family history of osteoporosis / fragility fractures
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39
Q

Management of osteoporosis

A

For everyone: Vit D & Calcium supplementation

1st line: Bisphosphonates e.g. Alendronate (1st line) or risendronate (2nd line)

2nd line: denusomab (has increasing role as 2nd line), Raloxifene, strontium ranelate

NB if alendronate not tolerated try risendronate before moving onto 2nd line medication e.g. denusomab

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40
Q

Management of osteoporosis

A

For everyone: Vit D & Calcium supplementation

1st line: Bisphosphonates e.g. Alendronate (1st line) or risendronate (2nd line)

2nd line: denusomab (has increasing role as 2nd line), Raloxifene, strontium ranelate

NB if alendronate not tolerated try risendronate before moving onto 2nd line medication e.g. denusomab

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41
Q

Investigation / Assessment of osteoporosis

A

DEXA scan /plain X-rays

FRAX or Q-fracture scores to assess 10yr rick of pt developing frailty fracture

Ca2+ / Phosphate / PTH / Alkaline phosphatase (all normal)

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42
Q

How to take Bisposphonates

A

How to take:

take 30 min before meal in morning & evening with plenty of water & standing up/keep upright for 30 min after

43
Q

Adverse effects of Bisposphonates

A

Adverse effects:
oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)

osteonecrosis of the jaw (presents as jaw pain)

↑ risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

44
Q

Pressure sores / ulcers

A

A focal area of unrelieved pressure resulting in ischaemia, cell death & necrosis of the epidermis & soft tissue, which typically develop over bony prominences

45
Q

Pressure sores / ulcers

A

A focal area of unrelieved pressure resulting in ischaemia, cell death & necrosis of the epidermis & soft tissue, which typically develop over bony prominences

generally develop in its unable to move parts of their bodies due to illness / paralysis / age

46
Q

Risk factors for developing Pressure sores / ulcers

A 
malnourishment
incontinence 
lack of mobility
↑ age
surgery
previous pressure ulcers
sensory impairment
diabetes 
dementia
critical care pts
47
Q

Score used for risk assessment of Pressure sores / ulcers

A

Waterlow score

includes a number of factors including body mass index, nutritional status, skin type, mobility and continence.

48
Q

Grade 1 Pressure sores / ulcers

A

non blanching erythema of intact skin / discolouration of skin

warmth/oedema/induration/hardness may be used as indicators especially in those with darker skin where it may appear blue/purple

49
Q

Grade 2 Pressure sores / ulcers

A

partial thickness skin loss involving epidermis / dermis or both, the ulcer is superficial & presents clinically as an abrasion or blister

surrounding skin may be red / purple

50
Q

Grade 3 Pressure sores / ulcers

A

full thickness skin loss involving damage to / encores of subcutaneous tissue that ma extend down to but not through the underlying fascia

51
Q

Grade 4 Pressure sores / ulcers

A

extensive destruction / tissue necrosis / damage to muscle/bone/supporting structures with or without full thickness skin loss

extremely difficult to heal & predisposes to potentially fatal infection

52
Q

Unstageable Pressure sores / ulcers

A

full thickness tissue loss in which the base is covered by slough and/or eschar in the wound resulting in inability to determine true depth

53
Q

Typical locations of Pressure sores / ulcers

A

Sacrum
Heels

others include elbows, lateral malleolus, greater trochanter

54
Q

Secondary infections of decubitus ulcers

A

very common

especially with staph aureus & pseudomonas

55
Q

Investigations of Pressure sores / ulcers

A

generally clinical diagnosis

may want to consider wound swab

56
Q

Management of Pressure sores / ulcers

A

often difficult to heal

pressure relief e.g. alternating pressure mattresses, reposition (every 2h), mobilising pt

adequate nutrition, treat underlying condition, adequate pain relief

infection control (clean, senile dressing) + Abs (if indicated)

dressings & debridement

57
Q

Time between admission and assessment of pressure ulcer risk

A

<6h

pressure sores can develop within hours in an immobilised individual

58
Q

Pathological / fragility fractures

A

fractures that result from mechanical forces that would not ordinarily result in a fracture, known as low energy trauma e.g. forces equivalent to a fall from standing height or less

59
Q

Aetiology of Pathological / fragility fractures

A

Metastatic tumours:
breast, lung, thyroid, renal, prostate

Bone disease:
osteogenesis imperfecta (brittle bone disease), osteoporosis, metabolic bone disease, Paget's disease

Local benign conditions:
chronic osteomyelitis, solitary bone cysts

Primary malignant tumours:
chondrosarcoma, osteosarcoma, Ewing’s sarcoma

60
Q

Presentation of Pathological / fragility fractures

A

common sites include vertebrae (compression), hip fracture distal radius (Colles)

other sited include ribs, pelvis, arm, shoulder

NB vertebral compression fractures may often go unrecognised & cause worsening back pain

61
Q

Assessment of Pathological / fragility fractures

A

FRAX score / Q-fracture score (used to assess risk of fragility fracture in the next 10yrs)

± a DEXA scan

62
Q

Prognosis of Pathological / fragility fractures

A

often result in ↓QoL, pain, disability & loss of independence

63
Q

Falls in the elderly

A

falls are a major threat to older peoples QoL often causing ↓ in self care ability & participation in physical & social activities

fear of falling can often lead to further decline in activity

64
Q

Risk factors for falling

A 
lower limb muscle weakness
vision problems
incontinence 
age >65
fear of falling
polypharmacy (>4 meds)
depression
postural hypotension 
psychoactive drugs
cognitive impairment
arthritis
balance/gait disturbances 
low weight 
history of falls
alcohol misuse
confusion 
inappropriate footwear
environmental factors
malnutrition
65
Q

Risk of injury from falls

A 
weak bones (e.g. osteoporosis, osteomalacia, pagets)
poor self protection (lack of subcutaneous fat, neurological problems)
66
Q

Investigations for falls

A

Full history (including risk assessment & medication review) & examination
BP, LSBP, bloods glucose, urine dip, ECG
FBC/U&Es/LFTs/bone profile/Vit B12/TFTs
CXR/X-ray of injured limb, CT head, echo

67
Q

Prevention of falls

A

Environmental: home assessment & modification
Power & balance: exercise
Alcohol: ↓intake
Neurological issues: treat underlying disease & PT/OT/SALT input
visual disturbance: e.g. cataracts (can be managed)
Medication: should be reviewed, with STOPP-START guide

68
Q

Falls assessment tests

A

Turn 180° test

timed up and go test

69
Q

Medications that commonly cause falls

A

Meds causing postural hypotension:
nitrates, diuretics, anticholinergics, beta blockers, L-Dopa, antidepressants, ACE-Is

Other meds causing falls:
benzos, antipsychotics, opiates, codeine, digoxin, anticonvulsants, sedatives

70
Q

STOPP-START guide

A

A screening tool in older people to recognise medicine safety concerns: STOPP identifies medications where the risk outweighs the therapeutic benefits in certain conditions and START suggests medications that may provide additional benefits ie proton pump inhibitors for gastroprotection in patients on medications increasing bleeding risk

71
Q

Incontinence

A

lack of voluntary control over urination or defecation

associated with loss of dignity & social isolation

related issues include moisture, pressure sores, skin breakdown & infection

72
Q

Urinary incontinence

A

common problem affecting 4-5% of the population, but grossly underreported (affectes 30-40% of people aged >65yrs)
especially common in elderly females

73
Q

Risk factors for urinary incontinence

A 
pregnancy 
childbirth
↑ age
high BMI
Family history
hysterectomy 
UTIs
cognitive impairment 
neurological disorders
74
Q

Stress incontinence

A

involuntary leakage of urine on effort/exertion e.g. coughing or laughing

due to weak/incompetent sphincters e.g. due to obesity/pelvic trauma/post prostate surgery
or secondary to weak pelvic floor muscles e.g. due to childbirth or genitourinary prolapse

positive bladder stress test i.e. urine leakage on ↑ intraabdominal pressure

75
Q

Functional incontinence

A

does not involve lower urinary tract but rather due to environmental / psychological / cognitive / physical impairement

e.g. pts unable to make it to toilet in time due to poor mobility

76
Q

Urge incontinence

A

aka overactive bladder

strong sudden sense of urgency followed by involuntary leakage of urine i.e. a compelling desire to urinate that cannot be deterred

due to detrusor instability / hyperreflexia leading to involuntary detrusor contraction

often idiopathic or may be secondary to PD/MD/dementia etc

77
Q

Overflow incontinence

A

frequent & involuntary intermittent/constant dribbling of urine in absence of the urge to urinate

due to impaired/weak detrusor e.g. in MS with neurogenic bladder leading to incomplete voiding
or a bladder outflow obstruction e.g. BPH

78
Q

Mixed incontinence

A

mixture of urge & stress incontinence

79
Q

Investigating urinary incontinence

A 
history & examination
urine dipstick & culture
post void bladder scan
urodynamics study
FBC/U&Es/LFTs
80
Q

General management of incontinence

A

temporary containment products e.g. pads / collecting devices to achieve social continence

lifestyle changes e.g. change fluid intake, regular toileting

81
Q

Management of stress incontinence

A

1st line: pelvic floor exercises

2nd line: duloxetine / surgery (e.g. mid urethral tape)

82
Q

Management fo urge incontinence

A

1st line: bladder retraining

2nd line: bladder stabilising drugs e.g. antimuscarinics including oxybutynin/tolterodine

if worried about anticholinergic effects in frail elderly pts consider mirabegron

NB avoid oxybutynin in frail older women

83
Q

Management of mixed incontinence

A

1st line: bladder retraining & pelvic floor exercises

84
Q

Management of overflow incontinence

A

relieve obstruction e.g. finasteride/tamsulosin for BPH

intermittent self catheterisation

85
Q

Faecal incontinence

A

inability to control / involuntary discharge of stool / gas

86
Q

Risk factors for faecal incontinence

A 
↑ age
diarrhoea 
urinary incontinence
constipation 
multiple child births
87
Q

Aetiology of faecal incontinence

A
  • childbirth (especially if associated with obstetric trauma)
  • surgery (e.g. haemorrhoidectomy / anal tissue repair)
  • degeneration of internal anal sphincter (↓resting pressure)
  • neurological disease (post stroke, cerebral tumours, MS, dementia)
  • constipation (faecal impaction can lead to overflow incontinence)
  • medication (e.g. laxative abuse/overuse)
88
Q

Investigations for faecal incontinence

A

change in bowel habit warrants investigation
FBC/ferritin/U&Es/bone profiel/TFTs
stool sample
faecal occult blood

89
Q

Management of faecal incontinence

A

diet & nutrition, optimise hydration
bower training & regular timing of going to bathroom
medication (consider alternative to meds that may contribute to incontinence e.g. loperamide)
skin protection

NB if pts with faecal loading/impaction = rectal bowel clearance with enemas or potent oral laxatives

90
Q

Multimorbidity

A

defined as the presence of ≥ 2 long term health conditions including defined physical / mental health conditions, learning disabilities, symptom complexes such as chronic pain, sensory impairments & alcohol / substance misuse

91
Q

Risk factors for multimorbidity

A 
↑ age
female sex
low socio-economic status 
smoking
alcohol misuse
lack of physical activity
poor nutrition
obesity
92
Q

Assessment of frailty

A

Rockwood frailty score
PRISMA-7 questionnaire
establish extent of disease burden
assess pain management

93
Q

Colon cancer

A

3rd most common cancer in the UK, 2nd leading cause of cancer death

Screened for via faecal occult test every 2yrs for all those aged 60-74 in England & offered a colonoscopy if abnormal

presents with weight loss, night sweats, fever, fatigue, abdo discomfort, change in bowel habits, blood in stool

staged with Duke’s classification on colonoscopy / CT + measure CEA (carcinoembryonig antigen)

managed with surgery ±radio/chemo

94
Q

Breast cancer

A

most common cancer in females, with invasive ductal carcinoma being the most common

screening is a 3 yearly mammogram for all those aged 50-70 yrs

presents with palpable mass, retraction, skin dimpling, nipple inversion, bloody discharge, lymphadenopathy

95
Q

Breast cancer

A

most common cancer in females, with invasive ductal carcinoma being the most common

screening is a 3 yearly mammogram for all those aged 50-70 yrs

presents with palpable mass, retraction, skin dimpling, nipple inversion, bloody discharge, lymphadenopathy

investigated with mammography, USS, fine needle aspiration / core needle biopsy

managed with mastectomy / wide local excision ± sentinel node biopsy ± radio/chemo

96
Q

Prostate cancer

A

very common cancer in men (95% are adenocarcinoma)

presents with lower urinary tract symptoms e.g. hesitancy, polyuria, nocturia, retention, haematuria but often asymptomatic initially

investigated with PSA, PR exam, transrectal USS, Biopsy (scored using Gleason score) ± MRI/CT

managed with prostatectomy, radiotherapy or goserelin (GnRH agonist)

97
Q

Pancreatic cancer

A

commonly adenocarcinoma that tend to be diagnosed late

presents very non specific i.e. weight loss fatigue, epigastric pain, painless jaundice (pancreatic cancer until proven otherwise), pruritic, atypical back pain

investigated with USS & high resolution CT

only ~20% suitable for surgery at diagnosis, Whipples resection (pancreatoduodenectomy)

98
Q

Stomach cancer

A

usually seen in those aged 70-80, associated with smoking & H. pylori infections

presents with dyspepsia, N&V, anorexia, weight loss, dysphagia

investigated with endoscopy & biopsy + CT for staging

Managed with subtotal/total gastrectomy + chemo

99
Q

Lung cancer

A

leading cause of cancer death world wide, 90% are attributable to smoking

presents with haemoptysis, persistent cough, dyspnoea, weight loss, chest pain, hoarseness, wheezing

investigated with CXR, CT & bronchoscopy

managed with surgical resection ± chemo, or radiotherapy if inoperable

100
Q

Oesophageal cancer

A

most commonly adenocarcinoma, often relayed to GORD/Barretts oesophagus or smoking

presents with dysphagia, weight loss, vomiting, hoarseness, odynophagia

investigated with upper GI endoscopy, contrast swallow & CT

managed with oesophagectomy ± adjuvant chemo

101
Q

Chronic lymphocytic leukaemia (CLL)

A

monoclonal proliferation of well differentiated lymphocytes, usually B-cells (99% of cases)

usually asymptomatic, but may present with weight loss, anorexia, infections, lymphadenopathy

investigated with FBC, blood film and immunophenotyping

managed with close observation if asymptomatic otherwise chemo & rituximab/ibrutinib

102
Q

Myeloma

A

characterised by plasma cell proliferation usually seen round the age 70

presents with hypercalcaemia (constipation, nausea, confusion), renal impairment, anaemia, bleeding/bruising, bone pain, fragility fractures & infections

investigated with blood film, serum/urine electrophoresis (↑ monoclonal IgG/IgM), Ca2+ (↑), FBC (anaemia) & MRI (lytic bone lesions)

managed with Thalidomide + an Alkylating agent + Dexamethasone as old people unlikely to be suitable for stem cell transplant

103
Q

Basal cell carcinoma (BBC)

A

most common type of skin cancer & cancer in the western world

presents on sun exposed areas e.g. head/neck as rodent ulcers which grow very slowly, often initally a pearly white coloured papule with telangiectasia

managed with surgical excision with histopathology ± radiotherapy

104
Q

Squamous cell carcinoma (SCC)

A

common skin cancer, 2nd most common after BCC

presents initially as plaque like nodular papillomatous rash which then ulcerates usually with red inverted edges, the floor of the ulcer bleeds easily
found on face/neck especially lower lip/ear/hands

managed with surgical excision + margins with histopathology after

Year 4 (12 decks)

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