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Year 3 > MedEd derm > Flashcards

MedEd derm Flashcards

1
Q

when describing lesions what are the 3 types?

A

flat
fluid filled
raised

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2
Q

what are the types of flat skin lesions and how do they differ?

A 
macule= small
patch= large
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3
Q

what are the types of fluid filled skin lesions and how do they differ?

A 
vesicle= small ie <0.5cm diameter
bulla= large ie >0.5cm diameter
pustule= pus filled
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4
Q

what are the types of raised skin lesions and how do they differ?

A 
papule= small ie <0.5cm in diameter
nodule= large ie >0.5cm diameter
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5
Q

what type of skin lesions are macules and patches? how do they differ?

A

flat skin lesions
macules are small
patches are large

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6
Q

what type of skin lesions are pustules, vesicles and bullae? how do they differ?

A

raised
pustule= pus filled
vesicles= <0.5cm
bullae= >0.5 cm

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7
Q

what type of skin lesions are papules and nodules? how do they differ?

A

raised
papules are small
nodules are large

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8
Q

what is squamous cell carcinoma?

A

cancer of keratinocytes in the epidermis

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9
Q

what is the most common and second most common skin cancer?

A

most common= basal cell carcinoma

second most common= squamous cell carcinoma

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10
Q

what is the nature of invasion in squamous cell cacinoma?

A

local invasion into the dermis

can metastasise, common sights are lung, bone, brain and liver

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11
Q

what is basal cell carcinoma?

A

cancer of keratinocytes in the epidermis in the stratum basale

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12
Q

what are rf for squamous cell carcinoma?

A

UV light
fhx
lighter skin
actinic keratosis

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13
Q

what are rf for basal cell carcinoma?

A

UV light
fhx
lighter skin

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14
Q

what condition might increase risk of someone developing squamous cell carcinoma?

A

actinic keratosis

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15
Q

what is the nature of invasion in basal cell cacinoma?

A

slow growing local invasion into the dermis and doesnt metastasise

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16
Q

what does basal cell carcinoma look like?

A

nodule
pearly edges
central ulcer called a rodent ulcer
central fine telangiectasia

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17
Q

what is found at the center of a basal cell carcinoma nodule?

A

rodent ulcer

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18
Q

out of basal and squamous cell carcinoma which metastasises?

A

squamous cell

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19
Q

what are the types of basal cell carcinoma and how might they differ?

A 
nodular= most common, pearly edges with rodent ulcer and central fine telangiectasia
superficial= flat
morpheic= yellow waxy plaque, scar like 
pigmented= dense and specks of colour
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20
Q

what acronym is used to remember how you describe a lesion and what does it stand for?

A 
ABCDE:
asymmetry 
border
colour
diameter
evolution
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21
Q

what is the most deadly skin cancer?

A

malignant melanoma

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22
Q

what is malignant melanoma?

A

cancer of the melanocytes in the epidermis

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23
Q

what are rf for malignant melanoma?

A

UV light
fhx
lighter skin

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24
Q

what is the nature of invasion of malignant melanoma?

A

local invasion into the dermis

can metastasise, common sites include lung, bone, brain and liver

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25
Q

what does a malignant melanoma look like (go via ABDE)

A 
Asymmetrical
Border is irregular
Colour is pigmented (dark) 
Diameter is over 6mm
Evolution- might bleed, itch, crust over, ulcerate
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26
Q

how quick does referral need to be done for malignant melanoma v squamous v basal cell carcinoma?

A

malignant melanoma= urgent within 2 weeks
squamous= urgent within 2 weeks
basal= routine within 6 weeks

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27
Q

what ix are done for skin cancer? why are they done

A 
bedside= dermatoscope 
bloods= ALP to check for bone mets, LFTs to check for liver mets 
imaging= CT/MRI/PET for staging 
biopsy= measure breslow thickness so see melanoma invasion extent, good for prognosis
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28
Q

what is breslow thickness?

A

it is a measure of melanoma invasion which can help judge prognosis and is done when a biopsy is taken

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29
Q

what is measured when a biopsy is taken is skin cancer and why?

A

breslow thickness

it shows the extent of melanoma invasion and can help judge prognosis

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30
Q

how is squamous cell carcinoma managed?

A

if in situ= cryotherapy

if invasive= surgical excision and radiotherapy

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31
Q

how is basal cell carcinoma managed?

A

non cosmetically challenging= surgical excision

cosmetically challenging= moh’s surgery

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32
Q

how is malignant melanoma managed?

A

early stage= surgical excision and lymph node biopsy
advanced but resectable= surgery and systemic therapy with nivolumab
advanced= systemic therapy (nivolumab) and treat mets

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33
Q

what systemic therapy is used in skin cancer for advanced malignant melanoma?

A

nivolumab

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34
Q

what type of skin condition is eczema?

A

inflammatory (NOT autoimmune)

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35
Q

what are rf of eczema?

A

pmhx/fhx of atopy eg food allergy, hay fever, asthma

filaggrin gene mutation

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36
Q

what does eczema look like?

A

distributed in flexures
dry, itchy, erythematous skin
lichenification if its chronic

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37
Q

what feature might you see in chronic eczema?

A

lichenification

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38
Q

where is eczema distributed?

A

in the flexures

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39
Q

describe atopic dermatitis. what skin condition does it fall under?

A

eczema
type I/IV hypersensitivity
IgE mediated
in the flexures

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40
Q

describe contact dermatitis. what skin condition does it fall under?

A

type IV hypersensitivity, delayed
often nickel/latex
two types are irritant and allergic

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41
Q

what subtype of eczema is associated with nickel/latex?

A

contact dermatitis

42
Q

describe discoid dermatitis. what skin condition does it fall under?

A

it is a subtype of eczema
associated with coin shaped plaques
more common in middle aged/elderly

43
Q

what type of eczema is a medical emergency?

A

eczema herpeticum

44
Q

what is eczema herpeticum superimposed by?

A

HSV 1

45
Q

what type of condition is psoriasis?

A

autoimmune

46
Q

what is psoriasis?

A

an autoimmune condition where there is hyperproliferation of keratinocytes

47
Q

what cells proliferate in psoriasis?

A

keratinocytes

48
Q

what are rf for psoriasis?

A

stress
smoking
alcohol

49
Q

what are features of psoriasis?

A

nail signs: onycholysis, subungal hyperkeratosis, pitting
psoriatic arthritis: symmetrical polyarthritis
dry, scaly, itchy, erythematous plaques which are purple/silvery in colour on the extensor/scalp surfaces

50
Q

what are some conditions where you might see onycholysis?

A

psoriasis
thyrotoxicosis
trauma
fungal infections

51
Q

what is onycholysis?

A

painless separation of the nail from the nail bed

52
Q

what do psoriasis lesions look like?

A

dry, scaly, erythematous, itchy plaques which are purple/silvery in colour

53
Q

where re psoriasis plaques distributed?

A

on the extensor surfaces and scalp

54
Q

what is the most common type of psoriasis?

A

plaque psoriasis

55
Q

what test may be done to diagnose contact dermatitis?

A

skin patch testing

56
Q

what test may be done to diagnose atopic dermatitis?

A

IgE-RAST

57
Q

what test may be done to diagnose food allergies?

A

skin prick testing

58
Q

how are guttate, pustular and plaque psoriasis managed?

A

guttate: 1st line phototherapy, 2nd line ciclosporin, 3rd line methrotrexate
pustular: 1st line acitretin, 2nd line ciclosporin
plaque: topical hydrocortisone

59
Q

how is acute v chronic eczema treated?

A 
acute= emollient with topical corticosteroid
chronic= emollient with low potency corticosteroid
60
Q

what is urticaria?

A

skin lesions that develop rapidly often from hypersensitivity reactions
often associated with angioedema

61
Q

what is urticaria often associated with?

A

agioedema- swelling underneath the skin

62
Q

what is angioedema?

A

swelling underneath the skin

63
Q

what are triggers for urticaria?

A

allergen

viral infections- common in children

64
Q

what does urticaria look like?

A

erythematous, not painful and non blanching

65
Q

how long does it take urticaria to resolve?

A

usually within 24 hrs
acute <6 weeks
chronic >6 weeks

66
Q

what ix are done for urticaria? why?

A

FBC- to establish baseline eosinophil count
CRP
ESR

67
Q

how is urticaria managed?

A

identify the trigger
antihistamines (up to 6 weeks)
oral corticosteroids

68
Q

what will be in an eczema sba?

A

lichenification
pmhx or fhx or atopy eg food allergy, hayfever
itchy, dry skin
distribution in flexures

69
Q

what will be in a psoriasis sba?

A

purple/silver erythematous plaques that are itchy
distribution on extensor surfaces
onycholysis, subungal keratosis

70
Q

what are cellulitis and erysipelas?

A

bacterial infections of the skin

71
Q

what organisms is likely to be the cause of cellulitis and erysipelas?

A

strep pyrogenes most commonly

staph aureus

72
Q

what similarities do cellulitis and erysipelas have in common?

A

acute onset

red, painful, hot, swollen lesions

73
Q

what are rf for cellulitis and erysipelas?

A 
wounds
bites
ulcers
IV cannula
immunosupression
74
Q

how can you differentiate cellulitis and erysipelas?

A 
erysipelas= lesion is epidermal, lesion is more well demarcated, more likely to have fever and rigors but sepsis is uncommon
cellulitis= lesion is dermal, it is less demarcated/more patchy, systemic symptoms like fever/rigors are less likely but sepsis is more likely
75
Q

out of cellulitis and erysipelas which is more likely to progress to sepsis?

A

cellulitis

76
Q

what is the difference in location of infection between cellulitis and erysipelas?

A 
cellulitis= dermis
erysipelas= epidermis
77
Q

what are complications of sepsis and which are surgical or medical emergencies?

A

abscess
sepsis- medical emergency
periorbital or orbital cellulitis- medical emergency
necrotising fasciitis- surgical emergency

78
Q

how is periorbital or orbital cellulitis managed?

A

IV abx

79
Q

what ix are done for cellulitis and erysipelas and what will you see?

A

usually diagnosis is clinical
skin swab MCS/ blood culture- strep pyrogenes positive
bloods- raised WCC, CRP
CT/MRI- if orbital cellulitis

80
Q

how is cellulitis/erysipelas managed?

A

conservative= mark around the lesion, painkillers, monitor it
medical= oral abx, IV abx if near eyes
admit if they are septic or confused!!

81
Q

when are IV abx used over oral in cellulitis/erysipelas?

A

if cellulitis is near the eyes

82
Q

what is necrotising fasciitis?

A

a life threatening infection of subcutaneous soft tissue

83
Q

what are signs and symptoms of necrotising fasciitis?

A

severe pain or anaesthesia over the sight
systemic signs= fever, tachypnoea, tachycardia, palpitations
warm, erythematous lesion with oedema which may turn violet

84
Q

what does necrotising fasciitis look like?

A

warm, erythematous lesions with oedema that may turn violet

85
Q

where is infection located in necrotising fasciitis?

A

subcutaneous soft tissue

86
Q

how is necrotising fasciitis managed?

A

immediate surgical exploration- surgical debridement
do blood and tissue cultures after but do not delay surgery for results
IV abx and supportive care

87
Q

what is erythema multiforme?

A

inflammation of the skin and mucous membranes

88
Q

what type of reaction is erythema multiforme?

A

type IV

89
Q

what organisms cause erythema multiforme?

A

herpes most commonly
mycoplasma
HIV
can be due to drug reactions- sulphonamides

90
Q

what organism is likely to cause erythema multiforme?

A

herpes

91
Q

what does erythema multiforme look like?

A

target lesio with a central vesicle/crust
ring of pallor or erythema around it
often starts in the hands and spreads up

92
Q

what are signs and symptoms of erythema multiforme?

A

prodrome of fever, aches

tender/itchy/painful target lesions with a central vesicle/crust, they have a ring of pallor or erythema

93
Q

how is erythema multiforme managed?

A 
if minor (only involves skin)- topical emollient and oral corticosteroids 
if major (involves skin and mucosa)- topical emollient and oral/IV corticosteroids
94
Q

what is molluscum contagiosum?

A

a skin infection due to the molluscum contagiosum virus

95
Q

what does molluscum contagiosum look like?

A

smooth papule that is umbilicated
may be itchy
painless

96
Q

how is molluscum contagiosum transmissed?

A

close contact eg sexual, swimming pools

97
Q

how is molluscum contagiosum managed?

A

observation
topical potassium hydroxide
cryotherapy 2nd line

98
Q

what are pressure sores?

A

localised damage to skin/soft tissue over bony prominences due to prolonged pressure

99
Q

what are rf for pressure sores?

A

immobility
sensory impairment
older age

100
Q

describe lesions in pressure sores

A 
in tact skin or 
open wound (superifcial or deep)
101
Q

what ix are done for pressure sores?

A

consider doing a wound swab

ESR, CRP

102
Q

how are pressure sores managed?

A

1st line= reposition, reduce pressure

clean and dress them, analgesia, diet

Year 3 (104 decks)

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