Other cases - symptoms + signs Flashcards

Question

Describe the lesion in malignant melanoma

Answer 1

• Worrisome signs of melanoma – ABCDE o Asymmetrically shaped o Borders - irregular o Colouration varies (pigmented) o Diameter > size of pencil eraser (>6mm) o Rapidly evolves + can cause skin elevation o Can be itchy or painful or bleed or crust over • Can be flat or elevated Can metastasise to the brain Cancer of melanocytes in the epidermis ABCDE Inflammation or border erythema Bleeding, oozing, itching, elevation, altered sensation Having multiple (>50) melanocytic naevi

Answer 2

``` • Melanocytic lesion – not ABCDE o Symmetrical o Flat o Regular borders o Does not bleed, itch, ulcerate, crust over ```

Answer 3

• Flexures * Erythema * Pruritus * Scaling * Dry skin * Vesicles, papules * Hypopigmentation * Chronic – lichenification * Worsens in the presence of allergens, changes in the weather, emotional stress

Answer 4

Allergic and irritant * Localised burning, stinging, itching, blistering, redness, swelling * Allergic contact – if soles affected suggests allergic contact rather than irritant because soles don’t touch anything in daily life that can cause irritation

Answer 5

* Relapsing-remitting * Recurrent painful vesiculobullous eruption on palms + soles * Intense Pruritus * Old lesions – erythema, scale, fissures • Exacerbating factor - irrigation - frequent hand washing, hyperhidrosis, stress, water, detergents, solvents

Answer 6

* Yellow greasy scales on erythematous plaques * Patches – red, inflamed, pruritic * Particularly in nasolabial folds, eyebrows, scalp, presternal area * Scalp itching + scaling (dandruff) • Worsens with stress, cold weather

Answer 7

* Coin shaped symmetrical lesions that burn or sting (1-10cm) * Legs + trunk, upper + lower extremities * Face and scalp not involved * Start as erythematous or violaceous papules or vesicles - coalesce to form confluent plaques - these then form macules with brown hyperpigmentation (over time they become more dry and scaly) * Pruritus worse at night * Worse in cold + dry weather, better in warm + humid conditions

Answer 8

Medical Emergency as it can disseminated Superimposed HSV1 • Systemic symptoms – fever, lethargy, distress, lymphadenopathy * Areas of rapidly worsening, painful eczema * Blisters filled with fluid, oozing, weeping then become crusted over in areas of atopic eczema * Most common on the face or neck • Punched-out erosions (circular, depressed, ulcerated lesions) that are uniform in appearance (may coalesce to form larger areas of erosion with crusting) * More common in young children who already have eczema * Or in other people who have other causes of skin breaks e.g. burns or other skin conditions

Answer 9

• Affects extensors + scalp (elbows, knees, extensor limbs, scalp) ``` • Lesions o Red/Salmon coloured o Dry, flaky skin o Itchy, painful o Inflamed o Silvery-white o Circumscribed papule and plaques ``` • Nail signs o Onycholysis o Pitting o Subungual hyperkeratosis * Auspitz phenomenon – pinpoint bleeding with removing scales * Koebner phenomenon – skin lesions may develop at the site of trauma/scars * Nail pitting may appear in any subset of psoriasis Psoriatic arthritis is a symmetrcal polyarthritis, nail pitting o Amir Sam’s example of psoriatic arthropathy in DPD 6 was – sacroiliitis + asymmetrical distal IP oligoarthritis Psoriatic arthritis can present in a lot of ways o Monoarthritis o Distal asymmetrical oligoarthritis (DIP) o Dactylitis (IP arthritis + flexor tenosynovitis) o Symmetrical polyarthritis o Arthritis mutilans o Ankylosing spondylitis

Answer 10

Widespread, erythematous, fine, scaly papules (water drop appearance) on trunk, arms, legs Lesions often appear after an URTI 2 weeks post-streptococci sore throat

Answer 11

Plaques/pustules on palms + plantars [smoking, middle aged women, autoimmune thyroid disease]

Answer 12

Generalised erythema with fine scaling Systemic body redness + inflammation Pain, irritation, severe itching, fall off in sheets Often temperature dysregulation, electrolyte imbalances Requires hospitalisation

Answer 13

Patients very unwell, malaise, febrile, low BP but high HR (tachycardic) Assosciated with hypoparathyroidism

Answer 14

Symmetrical, well-demarcated erythematous plaques with silver scales over extensor surface (knee, elbows, scalp, sacrum)

Answer 15

``` • Acute onset Calor, dolor, rubor, tumor • Warmth - hot • Tenderness - painful • Erythema - red • Oedema - swollen ``` ``` Cellulitis • Dermis, SC tissue • More patchy, indistinct borders • Systemic involvement less common • Sepsis more common • Commonly occurs in an extremity (lower limb is the most common site of involvement) ``` ``` Erysipelas • Epidermis • Well demarcated • Systemic involvement more common (fever, rigors) • Sepsis less common ```

Answer 16

``` • Erythematous tender nodules over the anterior shins/knees o Bilateral o Tender o Red/purple o Does not ulcerate o Does not scar ``` * Fever * Arthralgia * Swollen ankles • Uveitis, red eyes, retinal nodules, candle-wax drippings (waxy deposits on the sides of retinal veins)- sarcoidosis

Answer 17

• Prodrome – Mild symptoms of URTI, fever, aches • Target lesions o Central vesicle/crust o Ring of pallor o Ring of erythema o Starts on extremities, being symmetrical + spreading centrally o Skin is not tender (but there might be some mild burning or itching sensation) • Erosions, blisters, crusts o Can be noted in any of the mucous membranes (however mucosal involvement is mild + tends to be limited to just one mucosal surface) o Are typically painful + tender o Clustered vesicles on an erythematous base o This can lead to difficulty eating + urinating, requiring hospital admission

Answer 18

* Cutaneous lesions (less commonly mucosal) * Pear-like, smooth papules * Central dell/Umbilicated * Local erythema, swelling, pruritus * Painless but itchy * In children they are usually on the trunk or extremities * In adults they are on the lower abdomen, inner thighs, genital region Children do not need exclusion from school

Answer 19

``` Sudden appearance painful lump middle aged smoker fever, skin erythema, warm skin, tethering rapid increase in size most common pathogen - staph aureus ```

Answer 20

Breast pain that varies with menstrual cycle FNA - Straw coloured/green fluid (vs fibroadnomas which are painless)

Answer 21

- Inflammatory condition - Dilation + shortening of subareolar ducts - present with Nipple discharge - cheesy, green-yellow, blood stained Nipple retraction - slit like Palpable subareolar mass - fixed Tender - non cyclical mastalgia smoking is a key RF

Answer 22

generalised swelling of the breast + inflamed overlying skin nipple may be cracked redness, firm very tender + uncomfortable, warm to touch flu like symptoms - fever, aches, chills, generally unwell Non-lactational: tend to present with a history of previous infections with less pronounced systemic upset (non lactational breast abscess tend to reoccur)

Answer 23

Formed when sebaceous glands are blocked therefore can present anywhere except palms and soles (no sebaceous cysts there) Often assosciated with a punctum smooth, fluctuant, non-tender, cannot be moved separately from overlying skin, mobile over deeper tissues

Answer 24

Psoriatic arthritis is a symmetrcal polyarthritis, nail pitting o Amir Sam’s example of psoriatic arthropathy in DPD 6 was – sacroiliitis + asymmetrical distal IP oligoarthritis Psoriatic arthritis can present in a lot of ways o Monoarthritis o Distal asymmetrical oligoarthritis (DIP) o Dactylitis (IP arthritis + flexor tenosynovitis) o Symmetrical polyarthritis o Arthritis mutilans o Ankylosing spondylitis ``` DIP disease Psoriatic spondyloarthropathy Symmetrical polyarthritis Asymmetrical oligoarthritis Arthritis mutilans  telescoping of the digits ``` • Nail signs o Onycholysis o Pitting o Subungual hyperkeratosis

Answer 25

Vitamin A = retinol * Night blindness * Xerophthalmia

Answer 26

B1 = thiamine • Beriberi (cardiac + neurologic) o Cardiac (wet beriberi) – tachycardia, SOB, leg oedema o Neurologic (dry beriberi) – numbness of the hands and feet, confusion, trouble moving the legs, pain, depressed tendon reflexes, loss of vibration sense • Wernicke + Korsakov syndromes (alcoholic confusion + paralysis) ``` B2 = riboflavin • Glossitis – Painful red tongue • Sore throat • Chapped/cracked lips • Angular cheilitis • Eye changes – itchy, watery, bloodshot, photophobia • Normocytic anaemia • Dermatitis • Brain dysfunction • Impaired iron absorption ``` B3 = niacin • Pellagra – dermatitis, diarrhoea, dementia, death – 4Ds o The dermatitis occurs on areas of skin exposed to sunlight ``` B6 = Pyridoxine • Peripheral neuropathy (isoniazid depletes it) • Glossitis • Cheilosis • Depression • Confusion • Seizures ``` ``` B9 = folate • Macrocytic megaloblastic anaemia • Neural tube + other birth defects • Heart disease • Stroke • Impaired cognitive function • Depression ``` ``` B12 = cobalamine • Macrocytic megaloblastic anaemia • Peripheral neuropathy • Hyporeflexia • Subacute degeneration of the cord ```

Answer 27

``` Vitamin C = ascorbic acid • Scurvy haemorrhages, bleeding from the skin anaemia weakness fatigue weight loss low resistance to infection general aches + pains connective tissues are affected ``` * Swollen bleeding gums * Loose teeth

Answer 28

* Rickets * Osteomalacia * Osteoporosis * Colorectal cancer

Answer 29

* Vitamin E is essential to the CNS – deficiency - oxidative stress - muscle weakness * Fragility of RBC + degeneration of neurones (particularly peripheral axons + posterior column neurones) * Coordination + walking difficulties * Peripheral neuropathy * Vision deterioration * Impaired immune function

Answer 30

* Bruising * Bleeding gums * Epistaxis * Heave menstrual bleeding

Answer 31

• Chronic discharge • Sacrococcygeal o Discharge o Pain + swelling o Sinus tracts • Infection may supervene and lead to an abscess

Answer 32

• Necrotising fasciitis should be suspected in any patient with a soft tissue infection accompanied by prominent pain +/or anaesthesia over the infected area, or signs + symptoms of systemic toxicity, particularly if the pt also has DM, malignancy, alcohol abuse, chronic liver/renal disease • Mimics cellulitis in its initial stages – local pain, swelling, erythema o Margins of infection are poorly defined, tenderness extends beyond the apparent area of involvement (unlike cellulitis) o No response to abx (unlike cellulitis) o Lymphangitis is rarely seen (unlike cellulitis) o SC tissues have a wooden-hard feel (unlike cellulitis or erysipelas) * Important early clues – pain, tenderness, systemic illness out of proportion to the localised signs * Severe pain that might progress from intense tenderness to anaesthesia as the nerves are destroyed * Crepitus due to SC gas * Oedema extending beyond the margin of erythema * Fever, palpitations, tachycardia, tachypnoea, hypotension, lightheadedness, confusion * Septic shock • N+V

Answer 33

DIP predominance Assymmetrical oligoarthritis (commonly featuring dactylitis) Symmetrical polyarthritis – resembling RA but less severe + not associated with rheumatoid nodules Psoriatic spondylitis – resembling ankylosing spondylitis but less severe Arthritis mutilans – erosion of bone + cartilage in the fingers leads to telescoping

Answer 34

``` Pupil dilation Lacrimation Sweating Diarrhoea Abdominal cramp-like pains N+V Insomnia Tachycardia ```

Answer 35

``` N+V Autonomic hyperactivity Insomnia Delirium Seizures ```

Answer 36

Meiosis ``` Loss of coordination Slurred speech Decreased attention + memory Disinhibition Aggression Hypotension Respiratory depression ```