Skin Signs Of Systemic Disease

Question 1

What is a leg ulcer

Answer 1

Open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks

Question 2

What is the most common cause of leg ulceration

Answer 2

Venous blood stasis

Question 3

What causes arterial ulcers

Answer 3

Insufficient blood supply due to peripheral vascular disease

Question 4

What causes venous ulceration

Answer 4

Increased hydrostatic pressure in the vessels

Question 5

Where do the majority of venous ulcers occur

Answer 5

The gaiter area

Question 6

Describe venous ulcers

Answer 6

Shallow exudative and warm

Question 7

Give some signs of venous insufficiency

Answer 7

Ankle swelling
Varicose veins
Haemosiderin deposition
Venous eczema
Lipodermatosclerosis

Question 8

What is lipodermatosclerosis

Answer 8

Inflammation and fibrosis of the subcutaneous fat layer, usually in the lower legs

Question 9

How does lipodermatosclerosis present

Answer 9

Woody texture, skin appears hardened and reddish-brown

Question 10

Where do arterial ulcers tend to affect

Answer 10

The foot

Question 11

Presentation of arterial ulcers

Answer 11

Punched-out appearance, cold, white and shiny skin

Question 12

Clinical signs or PAD

Answer 12

Absent peripheral pulses, delayed capillary refill, intermittent claudication

Question 13

Investigations for leg ulcers

Answer 13

ABPI for arterial
Bloods
Patch testing for treatments
Biopsy to check for malignancy

Question 14

Management of arterial ulcers

Answer 14

Managed by reducing modifiable risk factors

Question 15

Management of venous ulcers

Answer 15

Compression stockings + elevation
De-sloughing if necessary
Control pain

Question 16

Complications of leg ulceration

Answer 16

Infection
Contact allergy to dressings and topicals
Malignant transformation

Question 17

What is epidermolysis bullosa

Answer 17

A group of inherited disorders with blister formation in response to mechanical trauma

Question 18

What are the 3 main types of epidermolysis bullosa

Answer 18

Simplex, Junctional and dystrophic

Question 19

Investigations for epidermolysis bullosa

Answer 19

Skin biopsy

Question 20

Management of epidermolysis bullosa

Answer 20

Mainly supportive

Question 21

Clinical presentation of epidermolysis bullosa

Answer 21

Skin blisters and erosions

Question 22

What is neurofibromatosis type 1

Answer 22

A genetic condition that causes tumours along the nervous system

Question 23

Inheritance in neurofibromatosis type 1

Answer 23

Autosomal dominant

Question 24

What causes neurofibromatosis type 1

Answer 24

Mutations in the NF1 gene

Question 25

Main clinical sign of neurofibromatosis type 1

Answer 25

Cafe au lait macules

Question 26

Other clinical signs of neurofibromatosis type 1

Answer 26

Plexiform neuroma, axillary or inguinal freckling, 2 or more lisch nodules

Question 27

What mediates a type 1 allergic reaction

Answer 27

IgE

Question 28

Routes of exposure that cause a type 1 allergic reaction

Answer 28

Skin contact, inhalation, ingestion and injection

Question 29

Sensitisation stage of a type 1 allergy

Answer 29

Production of IgE by B cells in response to an initial allergen exposure Residual antibodies mind to circulating mast cells by Fc receptors

Question 30

Allergic stage of a type 1 allergy

Answer 30

On re-exposure, allergen will bind to IgE coated mast cells, causing degranulation of histamine etc.

Question 31

Clinical presentation of type 1 allergy

Answer 31

Urticaria, angioedema, wheezing, anaphylaxis

Question 32

What are other names for urticaria

Answer 32

Hives, wheals, nettle rash

Question 33

What is urticaria

Answer 33

Very itchy lesions which appear with 1 hour of interaction with an allergen

Question 34

What is angioedema

Answer 34

Localised swelling of subcutaneous tissue or mucous membranes

Question 35

Is angioedema pitting or non-pitting

Answer 35

Non-pitting

Question 36

What investigations confirms anaphylaxis

Answer 36

Serum mast cell tryptase level

Question 37

Testing for a type 1 allergy

Answer 37

Specific IgE bloodwork Prick testing Challenge test

Question 38

What is used to manage anaphylaxis

Answer 38

Adrenaline autotinjector

Question 39

What can be used to help asthma in patients with allergies

Answer 39

Mast cell stabiliser

Question 40

Name one mast cell stabiliser

Answer 40

Sodium cromoglycate

Question 41

Long term management of a type 1 allergy

Answer 41

Avoidance Antihistamines as first line Corticosteroids as second line

Question 42

3 step plan for an acute allergic reaction

Answer 42

Chrophenamine at first sign of reaction Prednisolone if no resolution Adrenaline IV if symptoms get worse: become blue or collapse

Question 43

What is the inheritance in tuberous sclerosis

Answer 43

Autosomal dominant

Question 44

How is tuberous sclerosis characterised

Answer 44

By a range of benign tumours in various organ systems

Question 45

Earliest cutaneous signs of tuberous sclerosis

Answer 45

Ash leaf macules

Question 46

What are ash leaf macules

Answer 46

Depigmented macules

Question 47

Other clinical signs of tuberous sclerosis

Answer 47

Shargreen patches and enamel pitting

Question 48

How may an infant present with tuberous sclerosis

Answer 48

Seizures

Question 49

Tumours seen in tuberous sclerosis

Answer 49

Periungual fibromas Facial angiofibromas Hamartomas/angiomyolipomas Bone cysts

Question 50

What are periungual fibromas

Answer 50

Benign tumours around the nail