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Medicine Phase 2a Dermatology > Peer Teaching > Flashcards

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1
Q

3 layers of skin

A

Epidermis
Dermis
Subcutaneous tissue (fat)

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2
Q

Layers of epidermis

A

Stratum corneum (layer of keratin)
Stratum granulosum
Stratum spinosum
Stratum basale (dividing cells)

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3
Q

Corpuscles found in dermis and what they detect

A 
Meissner's corpuscle (light touch)
Pacinian corpuscle (coarse touch/vibration)
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4
Q

Cells types in the epidermis

A

Keratinocytes
Langerhans cells
Melanocytes
Merkel cells

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5
Q

Function of keratinocytes

A

Produce keratin as a protective barrier

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6
Q

Function of langerhans cells

A

Present antigens and activate T cells

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7
Q

Function of melanoytes

A

Produce melanin which protects from UV radiation

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8
Q

Function of Merkel cells

A

Contain specialised nerve endings or sensation

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9
Q

Functions of skin

A 
Sensation
Temperature regulation
Vitamin D synthesis
Immunosurveillence
Protective barrier 
Fluid/electrolyte balance (sweating)
Structural (body shape)
Waterproofing
UV barrier
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10
Q

Inflammatory skin conditions

A

Eczema
Acne
Psoriasis

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11
Q

Cancers of skin

A

Squamous cell carcinoma
Basal cell carcinoma
Malignant melanoma

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12
Q

Infections of the skin

A

Cellulitis/necrotising fasciitis

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13
Q

Other skin conditions (not inflammatory, cancerous or infectious)

A

Ulcers - venous/arterial/neuropathic

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14
Q

Describe eczema

A

Papules and vesicles on an erythematous base

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15
Q

Clinical presentation of eczema

A

Papules and vesicles on an erythematous base; Itchy; Reaction pattern to stimuli
Commonly found on the face and flexure surfaces of the limbs

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16
Q

Types of eczema

A

Endogenous (atopic)

Exogenous (contact dermatitis)

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17
Q

Cause of exogenous eczema

A

Exogenous agent

e.g. Chemicals, Sweat, Abrasives

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18
Q

Describe history suggestive of eczema

A 
Skin crease involvement 
History of asthma or hay fever
Dry skin
Onset in childhood
Family history of atopy
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19
Q

Pathophysiology of exogenous eczema

A

Impaired skin barrier

  • > Exogenous allergen penetration
  • > Inflammation
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20
Q

What is filaggrin

A

A skin barrier protein which, if damaged increases the risk of eczema
Genetic predisposition if faulty gene

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21
Q

Management of eczema

A 
Avoid triggers
Keep nails short in children
Topical therapies (emollients, steroids for flare ups)
Oral therapies (anti-histamines, antibiotics like flucloxacillin, oral steroids if severe, phototherapy, immunosuppressants like ciclosporin)
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22
Q

Medical treatment of eczema

A 
Topical therapies: emollients, steroids for flare ups
Oral therapies: 
anti-histamines, 
antibiotics like flucloxacillin, 
oral steroids if severe, 
phototherapy, 
immunosuppressants like ciclosporin
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23
Q

What is acne vulgaris

A

Inflammatory disease of the pilosebaceous follicles

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24
Q

Pathophysiology of acne vulgaris

A

Increased sebum production (hormonal in adolescents)
Abnormal follicular keratinization
Pilosebaceous duct obstruction
Bacterial colonisation with Propionibacterium acne
Inflammation

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25
Clinical presentation of acne vulgaris
Blackheads and whiteheads (open and closed comedomes), inflammatory lesions, papules, nodules, cysts. Commonly found on face, chest and upper back.
26
Epidemiology of acne vulgaris
Puberty | Polycystic Ovary Syndrome (in adult women in which acne suddenly arises)
27
Management for acne: Mild Moderate Severe
Mild – topical therapies e.g. benzylperoxide and topical antibiotics and topical retinoids Moderate – oral therapies e.g. oral antibiotics and anti-androgens in females (COCP or cyproterone acetate) Severe – oral retinoids
28
What is psoriasis
Chronic, inflammatory skin disease due to hyper-proliferation of Keratinocytes + inflammatory cell infiltration
29
Clinical presentation of psoriasis
Well demarcated erythematous plaques topped with silvery scales on extensor surfaces Associated nail changes - pitting, onycholysis Unusual in children NOT itchy Genetic predisposition
30
Precipitating factors of psoriasis
trauma, drugs (lithium, beta blockers), stress, smoking and alcohol
31
Management of psoriasis: | Mild Moderate Severe
Mild – topical vit D analogues e.g. calcipotriol, topical corticosteroids, coal tar preparations, topical retinoids Moderate – phototherapy Severe – oral methotrexate, retinoids, ciclosporin, infliximab
32
Describe basal cell carcinoma
Slow growing Locally invasive Tumour of the epidermal keratinocytes Rarely metastasises but locally destructive Common on head and neck, Pearly appearance
33
Risk factors of basal cell carcinoma
UV exposure Skin type 1 (burns rather than tans) Aging
34
Treatment of basal cell carcinoma and complications
Surgically excise Radiotherapy if surgery is not appropriate Complications – local tissue destruction
35
Describe squamous cell carcinoma
Locally invasive malignant tumour of keratinocytes
36
Risk factors of squamous cell carcinoma
UV exposure | Chronic inflammation e.g. wound scars, immunosuppression
37
Presentation of squamous cell carcinoma
Scaly and crusty Ill-defined edges May ulcerate
38
Management of squamous cell carcinoma
Surgical excision/radiotherapy if non-resectable
39
What is malignant melanoma
Invasive tumour of melanocytes
40
Risk factors of malignant melanoma
UV exposure, skin type 1, atypical moles, multiple moles, family history
41
*Symptoms and Presentation of malignant melanoma
``` ABCDE symptoms A – asymmetrical shape B – boarder irregularity C – colour irregularity D- diameter >5cm E – evolution/change of lesion SYMPTOMS e.g. bleeding, itching ```
42
Treatment of malignant melanoma
Surgical, radiotherapy | Chemo is metastatic
43
Site of arterial skin ulcers
Toes, foot and ankle
44
Site of venous skin ulcers
Medial gaiter region
45
Edges of arterial vs venous skin ulcers
Arterial - Punched out and Well defined | Venous - Sloping and gradual
46
Wound bed appearance of arterial vs venous skin ulcers
Arterial - Covered with slough and necrotic tissue | Venous - covered with slough
47
Size of arterial vs venous skin ulcers
Arterial - Small | Venous - Large
48
Exudate level of arterial vs venous skin ulcers
Arterial - low | Venous - high
49
Pain level of arterial vs venous skin ulcers
Arterial - has pain | Venous - minimal pain
50
Pulses of arterial vs venous skin ulcers
Arterial - decreased | Venous - is present
51
Capillary refill of arterial vs venous skin ulcers
Arterial - > 3seconds | Venous - <3seconds
52
Oedema in arterial vs venous skin ulcers
Arterial - none | Venous - present
53
Hair in arterial vs venous skin ulcers
Arterial - none | Venous - none or may be some
54
Skin colour of arterial vs venous skin ulcers
Arterial - rubor, elevation pallor | Venous - brown varicose veins
55
Ulcer of arterial vs venous skin ulcers
Arterial - Tip toes, heel, lat ankle | Venous - Medial ankle
56
Risk factors of arterial skin ulcer
Arterial disease (atherosclerosis) Smoking Cholestrol Diabetes Mellitus
57
Describe each of these for arterial skin ulcer: Clinical presentation and symptoms Ulcer appearance ABPI
Pain, worse when legs elevated Ulcer: small, sharply defined, necrotic base Cold skin, absent peripheral pulses, shiny pale skin, loss of hair ABPI < 0.8 suggests arterial insufficiency
58
Investigations and management of arterial skin ulcer
Ix - Doppler studies | Mx - Vascular reconstruction (no compression bandaging)
59
Risk factors for venous skin ulcer
Varicose veins | DVT
60
Describe each of these for venous skin ulcer: Clinical presentation and symptoms Ulcer appearance ABPI
``` Pain (minimal) Large, shallow, irregular, exudative Warm skin Normal peripheral pulses, leg oedema, haemosiderin, lipodermatoosclerosis ABPI normal (>0.8 – 1) ```
61
Management of venous skin ulcer
Compression bandaging
62
Describe neuropathic skin ulcer
Often painless Found at pressure sites (e.g. heel or toes) Variable size, maybe surrounded by callus Warm skin and normal peripheral pulses Associated peripheral neuropathy
63
Management of neuropathic skin ulcer
Appropriate foot wear Control DM Podiatary
64
What is cellulitis
Bacterial infection of the deep subcutaneous tissue
65
Causes of cellulitis
S. pyogenes | S. aureus
66
Risk factors of cellulitis
immunosuppression, wounds, leg ulcers, trauma, athletes foot
67
Presentation of cellulitis
Local inflammation | Systemically unwell
68
Management of cellulitis
Antibiotics (flucloxacilin or benpen)
69
what is necrotising fasciitis
Bacterial infection of deep fascia and tissue necrosis
70
Causes of necrotising fasciitis
Group A haemolytic streptococcus
71
Risk factors of necrotising fasciitis
Abdominal surgery | Immunosuppression
72
Presentation of necrotising fasciitis
severe pain out of proportion, necrotic skin, systemically unwell, soft tissue gas seen on Xray
73
Management of necrotising fasciitis
surgical debridement, IV antibiotics

Medicine Phase 2a Dermatology (8 decks)

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