Week 3.5

Question 1

What are chronic leg ulcers

Answer 1

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

Question 2

What causes arterial leg ulcers

Answer 2

Peripheral arterial disease causing insufficient blood supply to lower limbs

Question 3

Peripheral arterial disease often caused by

Answer 3

Atherosclerosis - narrows the peripheral arteries so less blood flow

Question 4

Presentation of arterial ulcers

Answer 4

Deep
Punched out appearance (like someone made a hole)
Surrounding skin is cold and white
Intermittent claudication
Pain at night
Absent peripheral pulses

Question 5

What may patients describe that they do at night to relief the pain caused by arterial ulcers

Answer 5

hang their legs off the end of the bed

Question 6

What is claudication

Answer 6

Muscle pain triggered by activity and relieved by rest

Question 7

Investigations for arterial leg ulcers

Answer 7

ABPI
Doppler ultrasound

Question 8

What is the ABPI for arterial leg ulcers

Answer 8

< 0.9

Question 9

Management for arterial leg ulcers

Answer 9

Statin
Antiplatelet
Treat hypertension
(the aim is to reduce the modifiable risk factors)

Question 10

Which type of leg ulcer is the most common

Answer 10

Venous leg ulcer

Question 11

What causes venous leg ulcer

Answer 11

Chronic venous insufficiency

Question 12

Describe the pathophysiology of chronic venous insufficiency

Answer 12

1. Elevation in venous pressure in legs causing veins to dilate and valves to become insufficient
2. This causes varicose veins to develop
3. The increased hydrostatic pressure in the vessels causes red blood cell leakage into tissues
4. this causes venous dermatitis, swelling
5. Skin does not heal well from the dermatitis due to poor blood supply hence it breaks down and forms an ulcer

Question 13

Venous ulcers usually occur in

Answer 13

Above the medial malleolus = gaiter area

Question 14

Presentation of venous ulcers

Answer 14

Superficial, shallow
larger than arterial ulcers
Warm
Exudative - oozing
Haemosiderin deposition (brown pigment)
Varicose veins

Question 15

Investigations for venous ulcers

Answer 15

Clinical
ABPI and doppler ultrasound to exclude arterial cause

Question 16

Management for venous ulcers

Answer 16

4 layer compression bandaging
Compression stockings
Pain relief
Leg elevation

Question 17

What is the 4 layer compression bandaging

Answer 17

Graduated pressure - highest at the ankle lowest at the knee

Question 18

Most common type of skin cancer

Answer 18

Basal cell carcinoma

Question 19

Basal cell carcinoma arise from

Answer 19

Basal keratinocytes

Question 20

Where does basal cell carcinoma usually occur on

Answer 20

Sun exposed sites such as head and neck

Question 21

Risk factors for BCC

Answer 21

Sun exposure
History of frequent / severe sun burn
Genetics
Skin type I and II
Immunosuppression
Increasing age
Ionizing radiation
Outdoor occupations / hobby

Question 22

What genetic conditions are associated with BCC and SCC

Answer 22

Xeroderma pigmentosum
Albinism

Question 23

4 Types of BCC

Answer 23

Nodular
Superficial
Infiltrative
Pigmented

Question 24

Features of BCC

Answer 24

Usually does not metastasize
Slow growing tumours

Question 25

Presentation of Nodular BCC - TURP

Answer 25

Telangiectasia Ulceration at the center Rolled edge Pearly white

Question 26

What is the ulceration at the center of nodular BCC called

Answer 26

Rodent ulcer

Question 27

Presentation of superficial BCC

Answer 27

Erythematous plaque Dry / crusted May have bluish-tinge

Question 28

Presentation of infiltrative BCC

Answer 28

Thickened plaque Whitish Not well demarcated

Question 29

Where does infiltrative BCC usually occur

Answer 29

Upper trunk Face

Question 30

Pigmented BCC often looks like

Answer 30

Melanoma

Question 31

Pigmened BCC often present in

Answer 31

Dark skin

Question 32

Investigations for BCC

Answer 32

Visual inspection Narrow excision for histology

Question 33

Management for BCC

Answer 33

Wide excision Curettege / cautery Superficial BCC and low risk of BCC can be managed with non-surgical treatments

Question 34

Non-surgical treatments for BCC

Answer 34

Cryotherapy Radiotherapy Topical imiquimod

Question 35

Precursors of squamous cell carcinoma

Answer 35

Bowen's disease Actinic keratosis

Question 36

Where does squamous cell carcinoma arise from

Answer 36

Supra-basal keratinocytes

Question 37

Risk factors for squamous cell carcinoma

Answer 37

Skin type I or II Sun exposure Genetics Premalignant conditions Immunosuppression Ionising radiation Smoking Increasing age

Question 38

SCC is most common among which group of people

Answer 38

Immunosuppressed population

Question 39

Where can SCC arise from

Answer 39

Sun exposed sites Chronic leg ulcers Sites of burns Chronic lupus vulgaris

Question 40

What is lupus vulgaris

Answer 40

Cutaneous tuberculosis skin lesions

Question 41

Prognosis of SCC

Answer 41

generally well if detected early Poor prognosis if metastasised

Question 42

Presentation of SCC

Answer 42

Irregular red nodule Ulceration Warty lump May be painful May bleed

Question 43

Difference between SCC and BCC

Answer 43

SCC grows faster than BCC SCC can metastasise whereas BCC doesn't usually spread SCC arise from supra-basal keratinocytes whereas BCC arise from basal keratinocytes