1
Q
What causes arterial ulcers?
A
- insufficient blood supply to skin due to peripheral arterial disease
2
Q
What causes venous ulcers?
A
- pooling of blood and waste products in skin secondary to venous insufficiency
3
Q
What are the characteristics of arterial ulcers? location and pain
A
- occur distally near end arteries
- toes, heels, lateral malleolus
- severe, resting pain (ischaemia)
- painful at night, worse on elevation due to gravity
4
Q
What is the appearance of arterial ulcers?
- surrounding skin
- definition
- depth
- hair
A
- pale, dry, cool surrounding skin
- sharply defined
- deep, punched out appearance
- loss of hair on surrounding skin
5
Q
What happens to pulses with arterial ulcers?
A
- diminished or absent pulses
- pallor and intermittent claudication from PAD
6
Q
Which antibiotic is prescribed for animal bites?
A
co-amoxiclav
7
Q
What are common causes of burns?
A
- heat sources
- electricity
- chemical agents
8
Q
What are risk factors for burns?
A
- young children
- elderly
- occupation
- alcohol, drugs, smoking
- poverty
- medical conditions: epilepsy, cerebral palsy, peripheral neuropathy
9
Q
How are burns patients managed?
A
- ABCDE approach
10
Q
What is the Wallace rule of nines method?
A
- quick estimate of % of body burnt, each representing 9%
- head + neck
- each arm
- each anterior/posterior leg
- anterior/posterior chest
- anterior/posterior abdomen
11
Q
What is the Lund and Browder chart?
A
- most accurate method for measuring burns
- suitable for use in paeds
12
Q
What is the palmar surface method for burns?
A
- estimate small burns or unburnt surfaces
- patient’s entire hand size = 0.8%. inaccurate if >15% burnt of TBSA
13
Q
What is the immediate first aid for heat burns?
A
- remove from source
- within 20 mins: irrigate with cool water for 10-30 mins
- cover using clingfilm layers
14
Q
What is the immediate first aid for chemical burns?
A
- brush off powder
- irrigate with water
- don’t try to neutralise
15
Q
Describe first-degree burns:
- skin layer
- appearance
- bleeding and CRT
- healing time
A
- superficial: only epidermis
- dry, erythematous, no blisters, painful
- brisk bleeding and CRT
- heals in 5-10d without scarring
16
Q
Describe superficial partial burns:
- degree
- skin layers
- appearance
- CRT
- healing time
A
- 2nd degree
- epidermis and upper dermis
- wet, blistered, erythematous
- pale pink and painful
- slower CRT
- heals in <3 weeks
17
Q
What is the pathophysiology of acne vulgaris?
A
- chronic inflammation ± localised infection
- increased production of sebum
- this traps keratin and blocks the pilosebaceous unit
- leads to swelling and inflammation
- androgenic hormones increase sebum production
18
Q
What is a comedone? What are the 2 types?
A
- dilated sebaceous follicle
- closed top: whitehead
- open top: blackhead
19
Q
What are papules and pustules?
A
- inflammatory lesions that form when the follicle bursts and releases irritants
- papules: small lumps
- pustules: pus filled
20
Q
What are the 3 types of scars that commonly form after acne?
A
- ice pick: small indentations
- hypertrophic: small lumps
- rolling: wave like irregularities on the skin
21
Q
What does drug induced acne look like?
A
- monomorphic
- often pustules in steroid use
22
Q
How is mild, moderate and severe acne differentiated? (level of inflammatory lesions + extras)
A
- mild: sparse inflammatory lesions, open and closed comedones
- moderate: widespread non-inflammatory lesions, papules, pustules
- severe: extensive inflammatory lesions, nodules, pitting, scarring
23
Q
What is the 1st line management of mild to moderate acne?
A
- 12 week course combination therapy
- adapalene with benzyl peroxide
- tretinoin with clindamycin
- benzoyl peroxide with clindamycin
24
Q
What is the 1st line management of moderate to severe acne?
A
- 12 week course
- adapalene and benzoyl peroxide (+ oral lymecycline/doxycycline)
- tretinoin with clindamycin
- azelaic acid + either lymecycline/doxycycline
25
Which oral contraceptive can be used in the treatment of acne?
- dianette: co-cyprindiol
- anti-androgenic effects
- higher VTE risk so max 3 months + risk counselling
26
What is oral isotretinoin for acne treatment? How does it work? Give a CI?
- retinoid
- reduces sebum, inflammation and bacterial growth
- prescribed by dermatologist
- teratogenic so must be on contraception and stop for >1mo before conceiving
27
Which bacteria plays a role in acne?
- Propionibacterium acnes
- anaerobic
- colonises the skin
- topical benozyl perozide is toxic
28
What are side effects of isotretinoin?
- dry skin and lips
- photosensitivity of skin
- depression, anxiety, suicidal ideation
29
What may be a side effect of long term Abx use to treat acne and how is this treated?
- gram negative folliculitis
- treat with high-dose oral trimethoprim
30
What type of medication must always be prescribed with a retinoid or benzoyl peroxide?
- oral Abx
31
What is squamous cell carcinoma?
- non-melanoma skin cancer
- 2nd MC type of skin cancer
32
What layer does squamous cell carcinoma occur in?
- squamous keratinocytes in epidermis
- epidermis outermost layer of skin
33
What are risk factors for SCC?
- UV radiation (UVB)
- immunosuppression
- smoking
- Bowen's disease
- actinic keratoses
34
What are the features of SCC? (incl location and appearance)
- sun-exposed sites: head, neck, dorsum of hands and arms
- features of sun damage near lesion
- rapidly expanding, painless ulcerate nodules
- cauliflower appearance
- bleeding
35
How is SCC investigated?
- excisional or shave biopsy if small lesion
- incisional/punch biopsy if large - samples 4mm of lesion
36
How is invasive SCC managed?
- surgical excision with 4mm margins
- if cosmetically sensitive location: Mohs micrographic surgery
37
What diameter and depth constitutes a good vs bad prognosis for SCC?
- good: <20mm diameter, <2mm deep
- bad: >20mm diameter, >4mm deep
38
What is Bowen's disease? What is the epidemiology?
- precancerous dermatosis
- precursor to SCC, potential to become invasive
- more common in elderly
39
What are the features of Bowen's disease?
- red, scaly patches
- 10-15mm in size
- slow growing
- sun exposed areas
40
How is Bowen's disease managed?
- topical 5-fluorouracil BD for 4 weeks
- can result in inflammation/erythema, give topical steroids
- cryotherapy
- excision
41
What are the features of actinic keratoses?
- small, crusty, scaly lesions
- sun exposed areas
- pink, red or brown
42
How are actinic keratoses managed?
- avoid sun, suncream
- fluorouracil cream 2-3 weeks
- topical diclofenac or imiquimod
- cryotherapy
- curettage and cautery
43
What is the pathophysiology of psoriasis? What genes is it associated with?
- HLA-B13 and B17
- abnormal T cell activity stimulates keratinocyte proliferation
- worsened, triggered or improved by environmental factors
44
What are the 4 subtypes of psoriasis?
- plaque: MC
- flexural
- guttate
- pustular
45
What are the features of chronic plaque psoriasis?
- erythematous plaques with silvery white scale
- on extensor surfaces: elbows and knees
- clear delineation
- bleeding points if scale removed (Auspitz's sign)
46
What is the cause and epidemiology of guttate psoriasis?
- MC cause is streptococcal 2-4 weeks prior
- common in children and adolescents
47
What are the features of guttate psoriasis?
- tear drop papules on trunk and limbs
- plaques of psoriasis
- acute onset over days
48
How is guttate psoriasis managed?
- spontaneously resolves within 2-3 months
- UVB phototherapy
- topical agents
49
What is 1st line treatment for psoriasis?
- regular emollients
- 1st: potent corticosteroid + vit D analogue OD
- apply one in morning and other in evening for up to 4wks
50
What is 2nd line for psoriasis?
- 2nd: no improvement after 8 weeks: offer vit D analogue BD
3rd: after 8-12wks either a potent corticosteroid BD for 4 weeks or coal tar preparation
51
Describe phototherapy for psoriasis
- narrowband UVB light 3x per week
- photochemotherapy: psoralen + UV A light
52
Descrive systemic therapy in secondary care for psoriasis
- oral methotrexate
- ciclosporin
- systemic retinoids
- biologics: infliximab, etanercept
53
How is scalp psoriasis managed?
- potent topical corticosteroids OD for 4 weeks
54
How is flexural or face psoriasis managed?
- mild-moderate corticosteroid OD/BD for 2 weeks
55
What cautions should be taken when using steroids in psoriasis?
- 4 week break between courses
- use potent <8wks and very potent <4wks
56
Give examples of vit D analogues for psoriasis and mechanism
- calcipotriol, calcitriol
- decrease cell division and differentiation
- reduce scale and thickness of plaques
57
What cautions should be taken with vit D analogues in psoriasis (pregnancy and max dose)?
- pregnancy: avoid
- max weekly dose: 100g
58
Describe the epidemiology of psoriasis
- caucasian patients
- bimodal: 15-25 and 50-60y
59
What are exacerbating factors to psoriasis?
- trauma
- sunburn
- stress
- smoking and alcohol
- sunlight is relieving
60
How do chronic plaque and flexural psoriasis differ?
- chronic plaque: overlying scale
- flexural: smooth, shiny and moist
61
What nail changes are associated with psoriasis?
- pitting
- onycholysis
- subungual hyperkeratosis
- nail loss
62
What is vitiligo?
- autoimmune
- loss of melanocytes > depigmentation
63
What are the features of vitiligo?
- well demarcated depigmented skin
- affects peripheries
- Koebner phenomenon: trauma precipitates new lesions
64
How is vitiligo managed?
- suncream
- topical corticosteroids if early
- phototherapy
65
What is urticaria?
- generalised superficial skin swelling
- MC cause is allergic
66
What are the features of urticaria?
- pale pink, raised skin
- pruritic
67
What is the management of urticaria?
- non-sedating antihistamines e.g. loratidine or cetirizine
- sedating antihistamine (chloramphenamine at night)
- prednisolone if severe or resistant
68
What is scabies?
- mite: Sarcoptes scabiei
- prolonged skin contact
- eggs in stratum corneum
- type IV hypersensitivity reaction occurring ~30 days after inital infection
69
What are features of scabies?
- widespread pruritus
- linear burrows on sides of fingers, interdigital webs, flexors of wrist
- excoriation and infection due to scratching
70
How is scabies managed?
- 1st line: permethrin 5%
- 2nd: malathion 0.5%
- pruritus persists 4-6 weeks after eradication
71
Give directions of use of permethrin for scabies
- apply in all creases of skin
- dry and leave for 8-12 hrs before washing off
- repeat 7 days later
72
In which patients is crusted scabies seen? How is it treated?
- suppressed immunity, esp HIV
- Ivermectin and isolation
73
What are seborrhoeic keratoses? What are the features?
- benign epidermal skin lesions
- large colour variation
- stuck on appearance
- keratotic plugs
74
What are the 4 subtypes of malignant melanoma?
- superficial spreading (MC)
- nodular
- lentigo maligna
- acral lentiginous
75
What are the main diagnostic features for malignant melanoma?
- change in size, shape and colour
76
What are the secondary features for malignant melanoma?
- diameter ≥7mm
- inflammation
- oozing/bleeding
- altered sensation
77
What is the difference in epidemiology between nodular and lentigo maligna malignant melanoma?
- both sun exposed
- nodular: middle aged
- lentigo: older people
78
What are risk factors for malignant melanoma?
- Hx of skin cancer
- FHx
- pale skin
- Hx of sunburn
- large no of moles
79
What are the ABCDE criteria of melanomas?
- Asymmetrical shape
- border irregularity and poorly defined margins
- colour change and variation
- diameter (>6mm)
- evolving (changes)
80
What is seen when investigating melanoma with a dermatoscope and what is the excision margin?
- atypical network
- aggregated black/brown dots
- excise with margin 2-3mm
81
What are the excision margins for stages 0-2 melanoma recommended by NICE?
- 0: >0.5cm
- 1: >1cm
- 2: >2cm
82
Describe the staging of melanoma
- 0: in situ
- 1: <2mm thickness
- 2: >2mm or >1mm and ulcerated
- 3: local lymph node spread
- 4: distant spread
83
What is tinea? Give the 3 types
- dermatophyte fungal infection
- capitis: scalp
- corporis: trunk, legs, arms
- pedis: feet
84
What are the 2 causes of tinea capitis?
- Trichophyton tonsurans
- cats/dogs: Microsporum canis
85
What is the management of tinea capitis based on cause?
- Trichophyton: terbinafine
- Microsporum: griseofulvin
- topical ketoconazole for first 2wks to reduce transmission
86
What is the presentation and treatment of tinea corporis (ringworm)
- well-defined annular, erythematous lesions with pustules and papules
- scaly edge, hypopigmented centre
- oral fluconazole
87
What is folliculitis?
- inflammation of hair follicles
88
What are features of folliculitis?
- small red bumps/whitehead pimples around follicles
- itching/tenderness
- pus filled blisters
89
What are non-infectious causes of folliculitis?
- chemical: steroids, oils
- physical: tight clothing, shaving
90
What are infectious causes of folliculitis? bacterial, fungal and viral
- bacterial: Staph aureus
- hot tub: pseudomonas
- fungal: candida
- viral: herpes simplex
91
What are features of lichen planus?
- itchy, papular rash
92
What causes pressure sores?
- inability to move
- causes: illness
- lack of mobility
- pain
- incontinence
93
What scoring system is used to grade pressure ulcers? Give 5 factors
- Waterlow score
- BMI
- nutritional status
- skin type
- mobility
- continence
94
Grade 1 pressure ulcer: ____ erythema of intact skin. ____ of the skin, warmth, ____, induration or hardness may also be used as indicators, particularly on individuals with darker skin
**Non-blanchable** erythema of intact skin. **Discolouration** of the skin, warmth, **oedema**, induration or hardness may also be used as indicators, particularly on individuals with darker skin
95
Grade 2 pressure ulcer: ____ thickness skin loss involving epidermis or dermis, or both. The
ulcer is ____ and presents clinically as an abrasion or ____
**Partial** thickness skin loss involving epidermis or dermis, or both. The
ulcer is **superficial** and presents clinically as an abrasion or **blister**
96
Grade 3 pressure ulcer: ____ skin loss involving damage to or ____ of subcutaneous tissue that may extend down to, but not through, underlying ____.
Grade 3 pressure ulcer: **Full thickness** skin loss involving damage to or **necrosis** of subcutaneous tissue that may extend down to, but not through, underlying **fascia**.
97
Grade 4 pressure ulcer:
Extensive destruction, tissue ____, or damage to muscle, bone or supporting structures with or without full thickness skin loss
Extensive destruction, tissue **necrosis**, or damage to muscle, bone or supporting structures with or without full thickness skin loss
98
How is a pressure ulcer managed?
- moist environment encourages healing
- hydrocolloid dressing and hydrogels
- avoid soap
- surgical debridement
99
What are the two types of contact dermatitis?
- irritant
- allergic
100
What causes irritant contact dermatitis? What is the nature of it?
- non-allergic
- weak acids or alkalis
- crusting
101
Describe allergic contact dermatitis and its management
type IV hypersensitivity reaction
- acute weeping eczema
- affects hairline margins
- topical treatment with potent steroid
102
What is cellulitis?
- bacterial infection affecting dermis and deeper subcutaneous tissues
103
What are the most common bacterial causes of cellulitis?
- Step pyogenes
- Staph aureus
104
What are the features of cellulitis?
- commonly occurs on shins
- usually unilateral
- erythema with well-defined margins
- swelling
- systemic upset: fever, malaise, nausea
105
What are the criteria for diagnosis of cellulitis and how may it be investigated?
- clinical diagnosis
- bloods and cultures if sepsis suspected
106
Patients with cellulitis should be admitted for IV Abx if:
- They have Eron Class ___ or Class ____ cellulitis.
- severe or rapidly ____ cellulitis (e.g. extensive areas of skin).
- very young (under ____ year of age) or frail.
- Is _____.
- significant lymphoedema.
- ____ cellulitis (unless very mild) or periorbital cellulitis.
Patients with cellulitis should be admitted for IV Abx if:
- They have Eron Class **III** or Class **IV** cellulitis.
- severe or rapidly **deteriorating** cellulitis (e.g. extensive areas of skin).
- very young (under **1** year of age) or frail.
- Is **immunocompromised**.
- significant lymphoedema.
- **facial** cellulitis (unless very mild) or periorbital cellulitis
107
Which abx are used in Eron Class I cellulitis?
- oral flucloxacillin if mild-moderate
- penicillin allergic: oral clarithromycin or erythromycin (pregnancy)
108
What abx are used in Eron class III/IV cellulitis?
- oral/IV co-amoxiclav
- oral/IV clindamycin
- IV cefuroxime
- IV ceftriaxone
109
MLA
flashcards
Decks in class (28)
# Cards
-
Renal148
-
Respiratory161
-
CV264
-
Derm109
-
Endocrinology271
-
Oncology72
-
Rheumatology226
-
3a Neuro228
-
3a Obstetrics247
-
GI303
-
Ophthalmology250
-
ENT102
-
Gynaecology286
-
Paeds resp117
-
Paeds GI130
-
Sexual Health105
-
Paeds endo26
-
Paeds cardio59
-
Haematology158
-
Ortho90
-
Anaesthesia + surgery4
-
Paeds neuro52
-
Paeds derm41
-
Paeds infectious68
-
Psychiatry269
-
Paeds MSK69
-
Paeds renal5
-
Paeds Genetics38
