Dermatology Flashcards

Question

What are the recognised subtypes of psoriasis and their key features?

Answer 1

plaque psoriasis: most common : well-demarcates red scaly patches on extensor surfaces, sacrum, scalp flexural psoriasis: smooth lesions in flexural areas guttate psoriasis: transient rash, often after strep infection, multiple red, teardrop lesions on body Pustular psoriasis: often affects palms and soles

Answer 2

Appearance: Erythematous plaques with silvery-white scale Sites: extensor surfaces ( elbows, knees), scalp, trunk, buttocks, peri-umbilical area Borders: clear delineation between normal and affected skin size : plaques range 1-10 cm Auspitz's sign: removing scale reveals red membrane with pinpoint bleeding points

Answer 3

epidemiology: more common in children/adolescents trigger: streptococcal infection 2-4 weeks before onset features: - tear drop (gutta= drop) papules on trunk/limbs - pink, scaly patches or plaques - acute onset over days chronic plaque: large well defined thick silvery scaly plaques on extensor surfaces. guttate: sudden outbreak of small drop shaped scaly lesions often after strep throat infection usually in children/young adults.

Answer 4

most resolve spontaneously in 2-3 months abx to eradicate strep: no firm evidence topical agents as per psoriasis UVB phototherapy Tonsillectomy may be needed in recurrent episodes

Answer 5

pityriasis rosea: self limiting skin rash resolves on own within 6-12 weeks and starts with single "herald patch" (large oval scaly lesion) and then followed by multiple smaller oval patches on trunk, often in Christmas tree pattern. cause is usually viral Prodome : - Guttate: classically strep sore throat 2-4 weeks earlier - pityriasis rosea : may follow URTI but not typical in exams Appearance : - Guttate - tear drop scaly papules trunk/limbs - Pityriasis rosea : herald patch then multiple oval lesions with fine peripheral scale. Distribution: - guttate: scattered papules - pityriasis rosea: lesions follow langer's lines : giving "fir-tree" pattern. Natural History: Guttate: resolves in 2-3 months: treat with topical/UVB pityriasis : self-limiting resolves approx 6 weeks.

Answer 6

acute self limiting rash so no treatment resolves in 6-12 weeks. affects younger adults not fully understood - thought that human herpes virus HHV-7 might play a role

Answer 7

prodrome: - most patients: none - minority: recent viral infection herald patch: - usually on the trunk subsequent rash: - eythematous , oval, scaly patches - characteristic distribution: lesions run parallel to langer's lines: produces a "fir- tree" appearance. langers lines are: natural skin tension lines.

Answer 8

nail signs: pitting onycholysis : separation of nail plate from nail bed. arthritis (psoriatic arthritis)

Answer 9

psoriatic arthropathy (approx. 10% of patients) metabolic syndrome: cluster of conditions that increase risk of cvd and t2dm: key features 3 or more: central obesity, high bp, high triglycerides, low hdl cholesterol, high fasting glucose/insulin resistance cardiovascular disease venous thromboembolism psychological distress

Answer 10

cardiovascular disease hypertension venous thromboembolism depression ulcerative colitis Crohn's disease non-melanoma skin cancer other cancers: liver lung upper Gi

Answer 11

general: regular emollients to reduce scale/pruritus 1st line (up to 4 weeks) : - potent corticosteroid once daily + vit d analogue once daily - apply separately (1 morning 1 evening) 2nd line (after 8 weeks no improvement) : - vit d analogue twice daily 3rd line (after 8-12 weeks no improvement) : - potent corticosteroid twice daily up to 4 weeks or coal tar preparation once/twice daily - short-acting dithranol can also be used.

Answer 12

phototherapy: - Narrowband UVB : treatment of choice - 3 times a day -PUVA (psoralen+ UVA) also used Adverse effects: skin ageing , increased risk of SCC (not melanoma) Systemic therapy: - methotrexate (1st-line, esp with joint disease) - ciclosporin - systemic retinoids - biologics : infliximab, etanercept, adalimumab - ustekinumab (IL-12/IL-23 blocker, promising in trials)

Answer 13

1st line: potent topical corticosteroid once daily for 4 weeks if no improvement after 4 weeks: - switch to different formulation (Shampoo/mousse) and/or - use agents to remove adherent scale before steroid (e.g. salicylic acid, emollients, oils)

Answer 14

mild/moderate potency corticosteroid once or twice daily max 2 weeks.

Answer 15

Risks: skin atrophy, striae, rebound symptoms Areas at risk: scalp, face, flexures → max 1–2 weeks/month Systemic risk: if potent steroids applied to >10% body surface area NICE limits: Potent steroids: ≤8 weeks at a time Very potent steroids: ≤4 weeks at a time Aim for a 4-week break before restarting

Answer 16

Examples: calcipotriol, calcitriol, tacalcitol Mechanism: ↓ cell division/differentiation → ↓ epidermal proliferation Pros: long-term use possible, no smell/staining, uncommon adverse effects Cons: reduce scale/thickness but not erythema Precautions: avoid in pregnancy; max adult weekly dose = 100 g

Answer 17

Mechanism: inhibits DNA synthesis Use: short-contact treatment, wash off after ~30 mins Adverse effects: burning, staining

Answer 18

Mechanism: not fully understood, likely inhibits DNA synthesis Limitations: unpleasant smell, staining of skin/clothing

Answer 19

Diagnostic uncertainty Severe/extensive disease (>10% BSA affected) Cannot be controlled with topical therapy, or if: Acute guttate psoriasis requires phototherapy Nail disease causes major functional/cosmetic impact Any type has major physical, psychological, or social impact Children/young people: refer to specialist at presentation

Answer 20

Erythroderma (widespread redness and scaling affecting > 90% of BSA. Generalised pustular psoriasis.

Answer 21

Psoriasis cannot be controlled with topical therapy and Has significant physical/psychological/social impact and One or more of: Extensive psoriasis (>10% BSA or PASI >10) Localised psoriasis with significant functional impairment/distress (e.g. severe nail disease, high-impact sites) Phototherapy ineffective, not possible, or relapse within 3 months (>50% return of baseline severity)

Answer 22

Agents: methotrexate, ciclosporin Methotrexate: generally first-line Ciclosporin preferred if: Need rapid/short-term control (e.g. flare) Palmoplantar pustulosis - a chronic skin condition with recurrent sterile pustules on the palms and soles, often on a red, scaly base. Patient considering conception (male or female) and systemic therapy cannot be avoided

Answer 23

Agents & routes: Adalimumab – subcutaneous injection Etanercept – subcutaneous injection Infliximab – intravenous infusion Ustekinumab – subcutaneous injection Prerequisite: Failed trial of methotrexate, ciclosporin, and PUVA (non-biologics and phototherapy)

Answer 24

doesn't reflect severity affects both fingers and toes strong association with psoriatic arthropathy: 90-90% pts of psoriatic arthropathy have nail changes. pitting onycholysis (separation of nail from nail bed) subungual hyperkeratosis loss of the nail

Answer 25

pressure ulcers develop in patients unable to move parts of their body due to illness, paralysis, or advancing age. typical sites: over bony prominences (eg sacrum, heel) predisposing factors: - malnourishment - incontinence (urinary and faecal) - lack of mobility - pain (reduced mobility)

Answer 26

Scoring System: Waterlow Score Factors included: - BMI - Nutritional Status - Skin type - Mobility - Continence

Answer 27

Grade 1 : non-blanchable erythema of intact skin. other possible indicators (esp in darker skin): discolouration, warmth, oedema, induration, hardness Grade 2 : partial thickness skin loss involving epidermis or dermis (or both). Clinically appears as abrasion or blister. Grade 3: Full thickness skin loss with damage/necrosis of subcutaneous tissue. May extend down to (but not through) underlying fascia. Grade 4: Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures, with or without full thickness skin loss

Answer 28

maintain a moist wound environment to encourage healing : hydrocolloid dressings and hydrogels may help avoid use of soap - to prevent drying the wound. wound scabs: not routinely done (ulcers usually colonised with bacteria) - systemic abx only if clinical evidence of infection (Surrounding cellulitis) - consider referral to a tissue viability nurse. - surgical debridement may be beneficial in selected wounds

Answer 29

inflammation of subcut fat lesion: tender, erythematous, nodular lesions typical sites: usually on the shins, but may also occur on forearms and thighs course: usually resolves within 6 weeks healing: lesions heal without scarring.

Answer 30

Infection: Streptococci Tuberculosis Brucellosis Systemic disease: Sarcoidosis - inflammatory disease where the body forms non-caseating granulomas (tiny clumps of immune cells) in organs, most often the lungs and lymph nodes. Inflammatory bowel disease Behçet’s disease - rare inflammatory condition causing recurrent mouth ulcers, genital ulcers, eye inflammation, and skin lesions, due to blood vessel inflammation. Malignancy/lymphoma Drugs: Penicillins Sulphonamides Combined oral contraceptive pill Other: Pregnancy

Answer 31

hypersensitivity reaction, most commonly triggered by infections major and minor major is with mucosal involvement relation to sjs: they thought it was just a very severe form of EM but proved otherwise

Answer 32

target lesions initially appear on back of hands/feet, then spread to torso upper limbs more commonly affected than lower limbs pruritus: occasionally present, usually mild.

Answer 33

viruses: - herpes simplex virus (MC) - ORF - skin disease of sheep/goats, parapox virus idiopathic bacteria: mycoplasma, streptococcus drugs: - penicillin -sulphonamides -carbamazepine -allopurinol - nsaids -oral contraceptive pill - nevirapine connective tissue disorder like SLE other: sarcoidosis, malignancy

Answer 34

tumour-like lesions that arise from connective tissue of a scar extent: extend beyond dimensions of the original wound.

Answer 35

more common in people with dark skin more common in young adults , rare in elderly common sites (Decreasing frequency): - sternum - shoulder - neck - face - extensor surface of limbs - trunk

Answer 36

keloid scars are less likely if incisions are made along relaxed skin tension lines. langer lines (based on cadaver studies) aren't as reliable: incisions along skin tension lines give better cosmetic results.

Answer 37

early keloids: intra-lesional steroids (triamcinolone) excision: sometimes required, but risk of stimulating further keloid scarring : consider carefully

Answer 38

definition: head lice (pediculosis capitis (nits)) - common condition in kids caused by : parasitic insect: pediculus capitis - lives on and amongst scalp hair. lifestyle: live only on humans. feed on human blood. eggs: - grey/brown pinhead-sized - glued close to the scalp , hatch in 7-10 days nits: - empty egg shells white and shiny - found further along hair shaft as hair grows.

Answer 39

transmission: - spread by direct head to head contact - cannot jump fly or swim - more common in children due to close play symptoms: - initially asx when newly infected - itching and scratching on scalp occur 2-3 weeks after infection. incubation period: none

Answer 40

fine-toothed combing of wet/dry hair

Answer 41

tx indicated only if living lice found tx options: - malathion - wet combing - dimeticone -isopropyl myristate -cyclomethicone contacts: - household contacts do not need treatment unless also affected school: - children with head lice shouldnt be excluded from school.

Answer 42

inflammation of hair follicles can result from infection, chemical irritation or physical injury can be mild, superficial form to severe deep infections that can cause scarring or permanent hair loss. furuncle is a boil: deeper more pronounced infection of hair follicle

Answer 43

bacterial: - mc: staphylococcus aureus - pseudomonas aeruginosa: hot tub folliculitis fungal : candida species, dermatophytes (Esp in immunocompromised) viral : herpes simplex virus : herpetic folliculitis non-infectious : - chemical folliculitis: from topical steroids, oils, tar - physical folliculitis: shaving, tight clothing, occlusive dressings

Answer 44

small red bumps or white-headed pimples around hair follicles itching or tenderness pus-filled blisters that may rupture and crust over

Answer 45

folliculitis barbae: lesions in bearded area caused by staphylococcus aureus infection pseudofolliculitis barbae: bearded area, caused by irritation, predominantly affects men of black African or African Caribbean ancestry.

Answer 46

General measures: Maintain good hygiene Avoid shaving/irritants and tight clothing Use warm compresses to relieve discomfort Bacterial folliculitis: Mild → topical antibiotics (e.g. fusidic acid, clindamycin) Severe/recurrent → oral antibiotics (e.g. flucloxacillin) Hot tub folliculitis (Pseudomonas): Usually self-limiting; avoid contaminated pools/hot tubs Fungal folliculitis: Topical or systemic antifungals (depending on severity) Viral folliculitis (HSV): Oral antivirals (e.g. aciclovir) Non-infectious folliculitis: Remove/avoid triggers (e.g. stop topical steroids, avoid oils/tar, loosen clothing, modify shaving practices)

Answer 47

irritant: - cause : non allergic reaction to weak acids/alkalis (eg detergents) - epidemiology: common, often seen on the hands - features: erythema typical: crusting and vesicles rare allergic: - mechanism: type iv hypersensitivity reaction - epi: uncommon, often seen on head following hair dyes - features: acute wheeping eczema, mainly at hairline margins ( not the hairy scalp itself) - tx: topical potent corticosteroid

Answer 48

Irritant contact dermatitis: From the alkaline nature of cement Allergic contact dermatitis: From dichromates present in cement

Answer 49

1 of 3 main types of skin cancer. other name: rodent ulcer characteristics: - slow growing -locally invasive - metastases are extremely rare epi: most common type of cancer in western world

Answer 50

Site: Sun-exposed areas, especially head and neck Appearance: Initially: Pearly, flesh-coloured papule with telangiectasia Later: May ulcerate, leaving a central crater

Answer 51

routine referral

Answer 52

Surgical removal (mainstay) Curettage Cryotherapy Topical creams: imiquimod, fluorouracil Radiotherapy

Answer 53

systemic: (whole body problem) liver disease, iron def anaemia, polycythaemia, ckd, lymphoma, hyperthyroidism, hypothyroidism, diabetes pregnancy non: (local skin problem) - senile pruritus, urticaria, eczema, scabies, psoriasis, pityriasis rosea

Answer 54

hx of alcohol excess stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynaecomastia signs of decompensation: ascites, jaundice, encephalopathy

Answer 55

pallor koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

Answer 56

itching esp with a warm bath ruddy complexion (reddish healthy and flushed) may have gout or peptic ulcer disease

Answer 57

Lethargy, pallor Oedema, weight gain Hypertension

Answer 58

Night sweats Lymphadenopathy Splenomegaly, hepatomegaly Fatigue

Answer 59

Onycholysis describes the separation of the nail plate from the nail bed Causes idiopathic trauma e.g. Excessive manicuring infection: especially fungal skin disease: psoriasis, dermatitis impaired peripheral circulation e.g. Raynaud's ( fingers toes change colour response to cold or stress due to spasm of small blood vessels reducing blood flow) systemic disease: hyper- and hypothyroidism

Answer 60

nail pitting: psoriasis and alopecia areata blue nails: Wilsons disease leukonychia: hypoalbuminemia, less common is fungal disease or lymphoma half and half: distal portion brown and proximal portion pale. chronic renal failure nail patella syndrome: rare genetic with abnormal nails might be missing ridged or small. knee problems - absent or underdeveloped patellae. yellow nail syndrome: associated with congenital lymphoedema, pleural effusions, bronchiectasis and chronic sinus infections

Answer 61

Definition: Fungal nail infection that may involve any part of the nail or the entire nail unit Epidemiology: Toenails are much more likely to be infected than fingernails Causative organisms: Dermatophytes (type of fungi that infect keratinised tissue so skin hair nails) (~90% of cases, mainly Trichophyton rubrum) Yeasts (~5–10% of cases, e.g. Candida) Non-dermatophyte moulds

Answer 62

Increasing age Diabetes mellitus Psoriasis Repeated nail trauma

Answer 63

Most patients present due to “unsightly” nails Thickened, rough, opaque nails are the most common finding

Answer 64

Psoriasis Repeated trauma Lichen planus Yellow nail syndrome

Answer 65

Investigations: Nail clippings ± scrapings Microscopy and culture Indication: Should be done in all patients if antifungal treatment is being considered Limitation: False-negative rate of cultures is ~30% → repeat samples may be needed if clinical suspicion remains high

Answer 66

No treatment needed if asymptomatic and patient not bothered by appearance If dermatophyte or Candida infection confirmed: Limited involvement (≤50% nail, ≤2 nails affected, superficial white onychomycosis): Topical amorolfine 5% nail lacquer Duration: 6 months (fingernails), 9–12 months (toenails) Extensive involvement due to dermatophyte infection: Oral terbinafine (first-line) Duration: 6 weeks–3 months (fingernails), 3–6 months (toenails) Extensive involvement due to Candida infection: Oral itraconazole (first-line, pulsed weekly therapy)

Answer 67

common benign tumour of adipocytes usually in subcut tissues. rarely in deeper adipose tissue. malignant transformation : very rare to liposarcoma 1 in 1000 mc in middle aged adults

Answer 68

lump characteristics: smooth mobile painless clinical diagnosis

Answer 69

observation if asx removal if diagnosis is uncertain or compressing surrounding structures

Answer 70

features suggestive of liposarcoma: size> 5cm increasing size pain deep anatomical location if all 4 features present : upto 85% risk of sarcoma in 1 series

Answer 71

Main cause: venous hypertension secondary to chronic venous insufficiency Other causes: calf pump dysfunction or neuromuscular disorders.

Answer 72

In chronic venous hypertension, pressure in the veins → capillaries also get over-pressurised. Plasma (including fibrinogen) leaks out of those tiny capillaries. Fibrinogen becomes fibrin, and wraps around the capillaries like a thin cuff. That “fibrin cuff” makes it harder for oxygen and nutrients to diffuse into the skin → poor healing and ulceration. leucocyte sequestration too : venous htn so blood flow in capillaries slows then wbc(leucocytes) stick to capillary walls (endothelium) and become trapped (sequestered) and release inflammatory mediators and enzymes. both lead to microcirculatory damage, poor oxygenation and poor tissue healing so tissue breakdown.

Answer 73

oedema brown pigmentation (haemosiderin deposition which is iron containing pigment coming from rbc breakdown) lipodermatosclerosis (fibrosis and hardening of skin) venous eczema

Answer 74

usually above the ankle (gaiter area and just above the medial malleolus) painless shallow ulcer with irregular edges surrounding skin often shows venous changes (pigmentation, eczema, swelling, oedema, fibrosis)

Answer 75

deep venous insufficiency: usually due to previous dvt superficial venous insufficiency: often due to varicose veins.

Answer 76

Doppler ultrasound: detects presence of reflux Duplex ultrasound: assesses anatomy and venous flow.

Answer 77

used to assess for arterial disease in non-healing ulcers (as poor arterial flow impairs healing) normal ABPI: 0.9-1.2 <0.9 : suggests arterial disease >1.3 : may also indicate arterial disease due to arterial calcification (false-negative result eg in diabetics)

Answer 78

Main treatment: 4 layer compression bandaging but only after excluding arterial disease. (check ABPI before applying compression) Surgical Options: consider surgery for venous insufficiency If ulcer fails to heal after 12 weeks or is >10cmsquared , skin grafting may be required. adjuncts: oral pentoxifylline: peripheral vasodilator that improves healing rate. flavonoids: some evidence of benefit though limited hydrocolloid dressings, topical growth factors, ultrasound therapy, intermittent pneumatic compression - all have little evidence for efficacy.

Answer 79

squamous cell carcinoma developing at sites of chronic inflammation (eg old burns, chronic osteomyelitis) usually appears 10-20 years later, most commonly on the lower limb.

Answer 80

sites: toes and heels appearance: deep punched out ulcers with well defined angles pain: painful (Especially at night or when legs elevated) associated findings: cold limbs, no palpable pulses, possible gangrene, and low ABPI measurements.

Answer 81

commonly on plantar surface of the metatarsal heads and plantar surface of the hallux (big toe) - l shape kinda caused by pressure and loss of protective sensation due to peripheral neuropathy (commonly diabetic)

Answer 82

plantar neuropathic ulcer

Answer 83

use cushioned shoes and pressure relieving footwear to reduce callous formation and redistribute pressure

Answer 84

neutrophilic dermatosis causing rapidly enlarging ulcers. (inflammatory skin disease) associated with inflammatory bowel disease (especially ulcerative colitis and rheumatoid arthritis) can occur at stoma sites.

Answer 85

start as erythematous nodules or pustules that ulcerate, often with painful, undermined (edge with the red bit being inside) , violaceous edges.

Answer 86

arterial (ischaemic) ulcers are chronic wounds caused by insufficient arterial blood supply, most commonly bc of peripheral arterial disease(PAD) result from tissue ischaemia and necrosis secondary to reduced arterial blood flow. typically painful slow to heal and can impair QoL

Answer 87

caused by reduced arterial perfusion which causes tissue ischaemia which causes necrosis and ulceration. primary cause: atherosclerosis, narrowing and hardening of arteries other factors: thrombosis, embolism, trauma ischaemia deprives tissue of oxygen and nutrients impairs healing and leads to ulcer formation.

Answer 88

SAME AS CV DISEASE smoking diabetes htn hyperlipidemia obesity sedentary lifestyle

Answer 89

found on lower extremities, especially over bony prominences: lateral malleolus toes anterior tibial area appearance: small round with well-defined, "punched-out" edges. base: pale, dry or necrotic often surrounded by shiny, thin, hairless, pale skin

Answer 90

pain: severe, often worse at night or when leg is elevated (relieved by hanging leg down) surrounding skin: shiny, thin, hairless, with atrophy and pallor pulses: diminished or absent peripheral pulses (dorsalis, pedis, posterior tibial) temperature: cool limb due to poor perfusion may be associated with areas of gangrene.

Answer 91

physical exam: inspect ulcer characteristics and assess peripheral pulses. ABPI: non-invasive test comparing ankle and arm blood pressures. ABPI < 0.9 indicates PAD. doppler ultrasound: assesses arterial blood flow and detects stenosis or occlusion. imaging: MRA or CTA to visualise arterial anatomy and localise blockages blood tests: lipid profile, blood glucose, and other tests to identify modifiable cv risk factors.

Answer 92

improve blood supply, promote ulcer healing, and prevent recurrence.

Answer 93

risk factor modification: - smoking cessation - diet change ( reduce saturated fats, improve cv health) - regular exercise (As tolerated) - control comorbidities : DM, HTN, HYPERLIPIDEMIA Optimisation of blood flow: - revascularisation procedures: angioplasty,stenting,bypass surgery to restore arterial flow. -pharmacotherapy so antiplatelets like aspirin or clopidogrel or statins for lipid control and atherosclerosis management. Wound care: - debridement: remove necrotic tissue (surgical, enzymatic or with specialised dressings) - dressings: maintain moist wound environment and protect against infection (hydrocolloid, alginate or foam dressing) - infection control: topical/systemic abx if infection evidence. monitor for comps: - watch for osteomyelitis, gangrene and critical limb ischaemia

Answer 94

compression further reduces arterial perfusion so worsens ischaemia. always exclude arterial disease (ABPI) before applying compression - only indicated in venous ulcers.

Answer 95

premalignant skin lesion caused by chronic sun exposure (UV damage) result from cumulative uv radiation = keratinocyte dysplasia. happens in fair skinned older adults - esp those with outdoor occupations. POTENTIAL TO PROGRESS TO SCC.

Answer 96

small crusty scaly lesions on sun-exposed skin. colour: pink red brown or same as surrounding skin surface: rough sandpaper like texture. location: commonly on temples face scalp(bald men), ears forearms and dorsum of hands often multiple lesions may be present simultaneously

Answer 97

prevent further damage: avoid sun, protective clothes, regular sunscreen (spf 30+) topical therapy: - fluorouracil (5-FU) cream : 2-3 week course. can cause redness and inflammation during tx. give topical hydrocortisone after to reduce inflammation - topical diclofenac: for milk AK. moderate efficacy but fewer side effects. - topical imiquimod: - good efficacy shown in trials. stimulates local immune response to abnormal cells. procedural options: - cryotherapy (liquid nitrogen) for isolated lesions. - curettage and cautery for thicker or resistant lesions. (scrape of cancerous tissue and then apply heat to destroy)

Answer 98

because AK premalignant - can progress to SCC if left untreated

Answer 99

superficial bacterial skin infection. usually caused by staphylococcus aureus or streptococcus pyogenes (Group A b-haemolytic streptococcus) can be primary (on normal skin) or secondary to other skin conditions like eczema scabies or insect bites

Answer 100

common in children esp in warm weather when bacterial growth and skin contact increase

Answer 101

can appear anywhere but commonly on: face flexures exposed limbs - areas not covered by kapreh

Answer 102

direct contact with discharges from lesions/scbas bacteria enter via minor abrasions and spread through scratching. mainly transmitted via hands, but also toys clothing equipment and the environment. incubation: 4-10 days

Answer 103

golden crusted skin lesions typically around mouth andnose. lesions may start as vesicles that rupture and form honey coloured crusts. highly contagious. usually painless, but may cause mild itching or irritation. systemic symptoms are rare.

Answer 104

1st line: hydrogen peroxide 1% cream - if not systemically unwell or at high risk of comps. - recommended to reduce abx resistence and is just as effective as topical abx for non-bullous impetigo. alternative if topical abx required: topical fusidic acid. topical mupirocin if fusidic acid resistance is suspected. MRSA: resistant to fusidic acid and retapamulin = use topical mupirocin instead. EXTENSIVE: - -1ST LINE - ORAL FLUCLOXACILLIN. - IF PENICILLIN ALLERGY: ERYTHROMYCIN (MACROLIDE ALTERNATIVE)

Answer 105

exclude from school until lesions are crusted and healed or 48 hrs after starting abx treatment (whichever comes first)

Answer 106

prevent spread to other body areas and contacts. key measures: - handwashing - avoid sharing towels - cover lesions

Answer 107

airway breathing circulation (ABC) - assess first! stop burning process and prevent further injury

Answer 108

remove from heat source. within 20 mins of injury irrigate with cool (not iced) water for 10-30 mins. dont use ice. cover the burn with cling film - apply in layers not wrapped around limbs (to allow for swelling)

Answer 109

electric: switch off power supply first then remove person from source. chemical: - brush off any dry/powder chemicals then irrigate thoroughly with water. - don't attempt neutralisation of chemical.

Answer 110

wallaces rule of nines: - head and neck: 9% - each arm : 9% - each anterior leg - each posterior leg - anterior chest - posterior chest - anterior abdomen - posteriori abdomen lund and browder chart: most accurate, adjusts for age and body proportions palmar surface method: patients palm is like 1% total body surface area (TBSA) - useful for small burns under 15%.

Answer 111

1st degree: superficial epidermal: red painful dry no blisters 2nd degree: partial thickness (superficial dermal) - pale pink painful blistered slow capillary refill 2nd degree: partial thickness deep dermal - white or mottled reduced sensation painful to deep pressure non-blanching erythema. 3rd degree - full thickness - white(waxy) , brown(leathery) or black , no blisters painless (nerve destruction)

Answer 112

all deep dermal and full-thickness burns superficial dermal burns over 3 % tbsa adult or 2% tbsa for children. burns involving face, hands, feet, perineum, genitalia, flexures or circumferential burns of limbs torso or neck. inhalation injury suspected electrical/chemical burns. suspicion of non-accidental injury.

Answer 113

immediate first aid (cooling, covering, ABCs) review referral criteria - ensure appropriate setting. superficial epidermal burns: symptomatic relief - analgesia, emolients, etc superficial dermal burns: - cleanse wound leave blisters intact apply non-adherent dressing, avoid topical creams and then review in 24 hrs

Answer 114

local response: progressive tissue loss, release of inflammatory cytokines. systemic effects: - fluid loss and third spacing: hypovolemia, shock - catabolic state: protein breakdown, metabolic stress - immunosuppression, leading to bacterial translocation from gut into normally sterile tissue (cross the intestinal barrier into like liver, portal venous system, mesenteric lymph nodes) : sepsis (common cause of death in major burns)

Answer 115

stop burning process and resuscitate. airway: - assess for smoke inhalation and airway oedema. - early intubation if facial/neck burns, stridor, or oropharyngeal blistering. breathing/circulation: - iv fluids if >10% TBSA in children or >15% in adults. - use parkland formula for resuscitation: volume (ml) = % TBSA* weight(kg) * 4 - give half in first 8 hours half over next 16 hours. - insert urinary catheter for monitoring output. - analgesia as needed. transfer if: - complex burns, hands/perineum/face - over 10% in adults 5% in children.

Answer 116

escharatomy: surgery where burn eschar ( tough leathery dead skin) cut open to relieve pressure and restore circulation or ventilation to underlying tissues. do if: - circumferential full-thickness burns to limbs or torso that: - restrict respiration (if chest/torso) or - cause compartment syndrome (if limb) procedure is careful division of burnt tissue (eschar) to relieve pressure and improve perfusion * compartment syndrome - high pressure in closed muscle compartment cutting blood flow = ischaemia = emergency fasciotomy needed

Answer 117

superficial burns: conservative management most heal within 2 weeks. deep/complex: possible excision and skin grafting required. primary close : not usually performed due to high infection risk. no evidence prophylactic systemic or topical abx. maintain strict asepsis, pain control and nutritional support.

Answer 118

skin condition characterised by symmetrical, brown, velvety, hyperpigmented plaques. common sites: neck, axillae, groin ( can affect elbows, knees, or umbilicus) lesions are typically painless, thickened with velvety texture.

Answer 119

caused by insulin resistance = leads to hyperinsulinemia Excess insulin stimulates keratinocyte and dermal fibroblast proliferation via insulin-like growth factor receptor-1 (IGFR1). Leads to epidermal thickening (acanthosis) and increased pigmentation.

Answer 120

Endocrine/metabolic causes: - obesity - T2DM - Polycystic ovary syndrome (PCOS) - Cushing's syndrome - Acromegaly - Hypothyroidism Genetic/Familial causes: - Familial acanthosis nigricans - Prader-Willi Syndrome Malignant Cause: - Gastrointestinal (especially gastric) adenocarcinoma - particularly if onset is sudden in an older patient. Drug Induced: - Combined Oral Contraceptive pill (COCP) - Nicotinic Acid (niacin)

Answer 121

suggests a paraneoplastic cause, most commonly gastrointestinal adenocarcinoma (Especially gastric cancer) should prompt evaluation for malignancy.

Answer 122

Identify and treat the underlying cause: - Weight loss for obesity - Improved glycaemic control in T2DM. - Manage associated endocrine disorders. Symptomatic treatment: - Topical keratolytics such as topical retinoids may help smooth thickened skin. Screen for malignancy: - Especially in sudden-onset cases or older patients without clear metabolic cause.

Answer 123

Inflammatory skin disorder of unknown aetiology, most likely immune-mediated (T-cell driven autoimmune reaction against basal keratinocyte (bottom layer cells of epidermis - stem cells that divide and move upward becoming the different layers of skin as they mature.) can affect skin, oral mucosa, genitalia, nails and occasionally the scalp.

Answer 124

itchy, papular rash - often intensely pruritic. Common sites: palms, soles, genitalia, and flexor surfaces of the arms (especially wrists) papules are polygonal (flat-topped) and may merge into plaques. Wickham's Striae: fine white lacy lines visible on the surface of the lesions. Koebner phenomenon: new lesions appear at sites of trauma.

Answer 125

oral involvement : - occurs in approx 50% of pts. - white lace(reticular) pattern on buccal mucosa : sometimes erosive or ulcerative. Nail Changes: - thinning of the nail plate - Longitudinal ridging. - In severe cases, nail loss or pterygium formation (adhesion of proximal nail fold to nail bed)

Answer 126

Gold Quinine Thiazide Diuretics (Acei, B-blockers, and antimalarials.)

Answer 127

1st line: - Potent Topical Corticosteroids (eg betamethasone, clobetasol) - mainstay of treatment. Oral Involvement : - Benzydamine mouthwash or spray for pain and inflammation. Extensive or resistant disease: - oral corticosteroids or immunosuppressants (eg azathioprine, ciclosporin) Supportive: - Antihistamines for itching. - Avoid trauma or scratching (Koebner phenomenon).

Answer 128

Chronic but usually self-limiting within 1-2 years. Recurrences can occur. Oral lichen planus may persistent longer and rarely carry a small risk of malignant transformation to oral squamous cell carcinoma.

Answer 129

Chronic inflammatory skin disorder of unknown aetiology, mainly affecting the face (nose, cheeks, forehead) common in middle - aged fair-skinned adults. more severe in men, especially with rhinophyma. Triggered by sunlight, alcohol, spicy foods, stress, and extremes of temperature.

Answer 130

Flushing - often the earliest symptom. Persistent erythema over central face (nose, cheeks, forehead) Telangiectasia (visible small blood vessels) Papules and Pustules develop later (acneiform but no comedones, unlike acne vulgaris) Rhinophyma: thickened, bulbous, nodular nose (advanced stage) Ocular involvement: blepharitis, conjunctivitis, or keratitis. Sunlight and heat may exacerbate symptoms.

Answer 131

likely immune dysregulation with vascular hyperreactivity and chronic inflammation. Demodex folliculorum mites and UV exposure may contribute.

Answer 132

avoid triggers: sunlight spicy food alcohol hot drinks and stress. apply high-factor sunscreen daily (spf30+) camouflage creams may help conceal redness. gentle skincare: avoid alcohol based or irritating products.

Answer 133

topical brimonidine gel (a-adrenergic agonist) : - used as required to temporarily reduce redness. - reduces erythema within 30 mins, peaks at 3-6 hours and redness returns gradually to baseline. - effective for flushing with limited telangiectasia.

Answer 134

1st line: topical ivermectin. alternative: topical metronidazole or topical azelaic acid. continue general skin care and sun protection.

Answer 135

combination therapy: topical ivermectin + oral doxycycline (tetracycline antibiotic with anti-inflammatory effect)

Answer 136

no improvement with optimal primary care mx. prominent telangiectasia- may benefit from laser therapy prescence of rhinophyma (may require surgical or laser treatment.) severe ocular involvement.

Answer 137

rosacea: no comedones (blackheads/whiteheads) , central facial redness, flushing, telangiectasia and ocular involvement. acne vulgaris: comedone always present, affects wider areas ( face, back, chest) not triggered by flushing.

Answer 138

chronic eczematous dermatitis affect sebum-rich areas of skin. thought to be inflammatory reaction to malassezia furfur fungus (formerly pityrosporum ovale) common - affects about 2% of general population.

Answer 139

Eczematous lesions on sebum-rich areas: - scalp - dandruff - periorbital area - auricular folds - around ears - nasolabial folds - sides of nose may be associated with otitis externa or blepharitis. chronic recurrent course.

Answer 140

HIV infection - can be severe or extensive Parkinson's disease ( due to increased sebum production)

Answer 141

1st line: ketoconazole 2% shampoo (antifungal to reduce malassezia) alternatives/adjuncts: - OTC shampoos containing zinc pyrithione ( eg head and shoulders) - tar-based shampoos ( neutrogena T/gel) - Selenium sulphide may be useful. - Topical corticosteroids for short-term control of inflammation.

Answer 142

topical antifungals eg ketoconazole cream. topical corticosteroids: short courses to reduce inflammation. difficult to treat - recurrences are common. maintain skin hygiene and avoid irritants.

Answer 143

common infant skin condition, typically affects: - scalp (cradle cap) - nappy area - face - limb flexures cradle cap: erythematous rash with coarse yellow scales, developing in the first few weeks of life.

Answer 144

reassure parents - its harmless and resolves spontaneously (usually by 8 months of age) conservative care: - massage topical emollient into scalp to loosen scales. - gently brush with a soft brush. - wash off with mild shampoo. if severe or persistent: - topical imidazole ( antifungal) cream may be used.

Answer 145

usually resolves spontaneously by around 8 months of age. recurrence after infancy is rare.

Answer 146

most common: dog and cat bites. infections are usually polymicrobial, but the most frequent isolate is pasteurella multocida ( especially from cat bites)

Answer 147

Wound care: - thoroughly cleanse and irrigate the wound. - do not suture puncture wounds (unless required for cosmetic or functional reasons, eg face) Antibiotic prophylaxis/treatment: 1st line: co-amoxiclav. if penicillin-allergic: doxycycline + metronidazole. assess tetanus vaccination status and update if required.

Answer 148

usually multimicrobial, including both aerobic and anaerobic bacteria: - streptococcus spp. - staphylococcus aureus - eikenella corrodens - Fusobacterium - Prevotella

Answer 149

Cleanse wound thoroughly and avoid primary closure unless necessary for cosmesis. Antibiotic of choice: co-amoxiclav (as for animal bites) if penicillin-allergic: doxycycline + metronidazole assess for viral transmission risk : consider HIV, hepatitis B, and hepatitis C exposure. Consider HIV post-exposure prophylaxis (PEP) if high-risk source.

Answer 150

bed bugs describe a variety of clinical problems including itchy skin rashes, bites, allergic symptoms secondary to infestation with Cimex Lectularius.

Answer 151

Increasingly common presentation in uk gp. bedbugs thrive in matresses or fabrics and can be extremely difficult to eradicate.

Answer 152

topical hydrocortisone is suitable to control itch.

Answer 153

pest management company involvement and fumigation of the house.

Answer 154

hot-washing bed linen and using mattress covers.

Answer 155

caused by the spirochaete borrelia burgdorferi. spread by ticks (Ticks are blood-sucking arachnids (parasites) that attach to the skin of animals or humans to feed.)

Answer 156

erythema migrans (bull's- eye rash) at the site of the tick bite. develop 1-4 weeks after the initial bite ( may present sooner) usually painless, >5cm in diameter , and slowly increases in size. present in around 80% of patients.

Answer 157

headache lethargy fever arthralgia

Answer 158

heart block peri/myocarditis

Answer 159

facial nerve palsy radicular pain - pain radiating along a nerve root due to irritation or compression of a spinal nerve. meningitis

Answer 160

erythema Migrans is diagnostic - start antibiotics without further tests. first line test: ELISA antibodies to Borrelia Burgdorferi.

Answer 161

if tested within 4 weeks of symptom onset - repeat ELISA in 4-6 weeks. if symptoms for 12 weeks or more and still suspected then perform immunoblot test. if positive or equivocal ELISA, perform immunoblot test for confirmation.

Answer 162

Use fine-tipped tweezers, grasp tick close to skin, and pull upwards firmly. wash the area afterwards. routine antibiotic treatment is not recommended for patients with tick bites.

Answer 163

doxycycline for early disease. amoxicillin if doxycycline is contraindicated ( eg pregnancy) ceftriaxone for disseminated disease. people with erythema migrans should be started on antibiotics without further testing.

Answer 164

jarisch-herxheimer reaction : fever, rash, tachycardia after the first antibiotic dose. more commonly seen in syphilis (another spirochaetal infection)

Answer 165

post menopausal women

Answer 166

vaginal dryness dyspareunia - pain during sex occasional spotting

Answer 167

vagina appears pale and dry

Answer 168

vaginal lubricants and moisturisers are 1st line if they dont help use topical oestrogen cream

Answer 169

vaginal itching common- 1in 10 women seek help at some point. pruritus vulvae usually has underlying cause but pruritus ani doesnt.

Answer 170

irritant contact dermatitis - eg latex condoms, lubricants - mc cause atopic dermatitis seborrheic dermatitis lichen planus lichen sclerosus psoriasis - seen in approx. 1/3 of patients with psoriasis.

Answer 171

take showers rather than baths. clean the vulval area with an emolient such as epaderm or diprobase. clean only once daily - repeated cleaning can worsen symptoms.

Answer 172

most conditions respond to topical steroids. combined steroid-antifungal cream may be used if seborrhoeic dermatitis is suspected.

Answer 173

disease of pilosebaceous unit. several different types of acne lesions are usually seen in each patient.

Answer 174

comedones are due to a dilated sebaceous follicle. if the top is closed, whitehead is seen. if the top opens blackhead forms

Answer 175

inflammatory lesions form when the follicle bursts, releasing irritants. types: papules and pustules

Answer 176

nodules cysts

Answer 177

scarring types: icepick scars hypertrophic scars

Answer 178

drug induced acne is often monomorphic (eg pustules are characteristically seen in steroid use)

Answer 179

very severe acne associated with systemic upset eg fever hospital admission often required usually responds to oral steroids

Answer 180

common skin disorder usually occurring in adolescence. typically affects the face, neck and upper trunk. characterised by obstruction of pilosebaceous follicles with keratin plugs, resulting in comedones, inflammation, and pustules.

Answer 181

Mild: open and closed comedones with or without sparse inflammatory lesions. Moderate: Widespread non-inflammatory lesions and numerous papules and pustules. Severe: Extensive inflammatory lesions, which may include nodules, pitting, and scarring.

Answer 182

12 week course of topical combination therapy should be tried 1st line: - fixed combination of topical adapalene with topical benzoyl peroxide. - fixed combo of topical tretinoin with topical clindamycin. - fixed combo of topical benzoyl peroxide with topical clindamycin topical benzoyl peroxide can be used as monotherapy if these options are contraindicated or the person wishes to avoid using topical retinoid or antibiotic.

Answer 183

12 week course of one of following options: - fixed combo of topical adapalene with topical benzoyl peroxide - fixed combination of topical tretinoin with topical clindamycin - fixed combo of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline - topical azelaic acid + either oral lymecycline or oral doxycycline.

Answer 184

avoid tetracyclines in pregnant and breasfeeding women in children under 12 - erythromycin in pregnancy is good to use. minocycline now considered less appropriate due to possibility of irreversible pigmentation. only continue abx treatment ( topical or oral) for over 6 months in exceptional circumstances. topical retinoid ( if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral abx to reduce abx resistance. topical and oral abx shouldnt be used together. gram negative folliculitis may occur as a complication of long-term abx use - high dose oral trimethoprim is effective if this occurs.

Answer 185

combined oral contraceptives (COCP) can be used as an alternative to oral abx in women. as with abx, they should be used in combo with topical agents. dianette ( co-cyprindiol) is sometimes used because of its anti-androgen properties but: - has increased risk of VTE compared to other COCPs. - Should generally be used 2nd line - only for 3 months and women should be counselled about risks

Answer 186

only under specialist supervision. pregnancy is contraindication to topical and oral retinoid tx.

Answer 187

monotherapy with topical abx. monotherapy with oral abx combination of topical abx and oral abx.

Answer 188

acen conglobata: rare severe form ( mainly in men) with extensive inflammatory papules, suppurative nodules ( may coalesce to form sinuses) and cysts on the trunk. nodulo-cystic acne.

Answer 189

mild to moderate acne that hasnt responded to 2 completed courses of tx. moderate to severe acne that hasnt responded to previous tx including an oral abx. acne with scarring. acne with persistent pigmentary changes. acne causing or contributing to persistent psychological distress or a mental health disorder.

Answer 190

80-90% of teenagers, 60% seek medical advice. could persistent beyond adolescence affecting 10-15% of females and 5% of males over 25 yrs old.

Answer 191

follicular epidermal hyperproliferation leads to formation of keratin plug leads to obstruction of the pilosebaceous follicle. activity of sebaceous glands may be controlled by androgens although levels are often normal in patients. colonisation by proprionibacterium acnes ( anerobic bacterium) inflammation

Answer 192

severe primary infection of the skin by herpes simplex virus 1 or 2. more commonly seen in children with atopic eczema and presents as a rapidly progressing painful rash.

Answer 193

monomorphic punched-out erosions ( circular depressed ulcerated lesions) usually 1-3mm in diameter

Answer 194

potentially life threatening - children should be admitted for iv aciclovir.

Answer 195

occurs in around 15-20% of children and is becoming more common. typically presents before 2 yrs of age. clears in around 50% of children by 5 years, and 7% by 10 years of age

Answer 196

itchy erythematous rash. repeated scratching may exacerbate affected areas. in infants, the face and trunk are often affected. in younger children eczema often occurs on the extensor surfaces. in older children, more typical flexor distribution is seen, affecting creases of face and neck

Answer 197

avoid irritants. simple emolients: - large quantities should be prescribed ( eg 250g/week) roughly in a 10:1 ratio with topical steroids. apply emolient first, then wait 30 mins before applying topical steroid. creams soak in faster than ointments. avoid contamination: dont insert fingers into pots - many have pump dispensers. topical steroids wet wrapping: - large amounts of emolient ( and sometimes topical steroids) applied under wet bandages. in severe cases, oral ciclosporin may be used

Answer 198

avoidance of triggers and skin care education: avoid known irritants and allergens. provide guidance on gentle skin care routines .

Answer 199

integral to all tx plans regardless of severity. use liberally and regularly, even when skin is clear, to maintain hydration and barrier function. selection should be based on pt preference to improve adherence. creams are generally preferred by most people- adherence is key. ointments provide the strongest emolient effect and may be more effective, but are greasy and better at night.

Answer 200

Topical corticosteroids: - vital for managing flare-ups, with potency tailored to severity and site. example treatments (NICE): - mild eczema : hydrocortisone 1% - moderate eczema : betamethasone valerate 0.025% or clobetasone butyrate 0.05% - severe eczema : betamethasone valerate 0.1% topical calcineurin inhibitors: - suitable for sensitive skin regions, include tacrolimus and pimecrolimus. topical antimicrobials: - used when there is clinical evidence of secondary infection.

Answer 201

indicated for severe or unresponsive cases. oral corticosteroids: - used cautiously for acute severe exacerbations. immunosuppressants: - ciclosporin, methotrexate, or azathioprine for chronic severe eczema. biologic therapies: - dupilumab for cases unresponse to conventional therapy.

Answer 202

phototherapy

Answer 203

onset at age 3-6 months. severe disease in childhood. associated asthma or hay fever. small family size. high IgE serum levels.

Answer 204

use the weakest steroid that control symptoms. 1 finger tip unit (FTU) = 0.5g , sufficient to treat a skin area about twice the size of the flat of an adult hand. mild : hydrocortisone 0.5-2.5% moderate: betamethasone valerate 0.0o25% (betnovate RD) clobetasone butyrate 0.05% (eumovate) fluticasone propionate (0.05%) cutivate potent: betamethasone valerate 0.1% (betnovate) very potent: clobetasol proprionate 0.05% (dermovate)

Answer 205

hand and fingers (front and back) : 1.0 a foot (all over) : 2.0 front of chest and abdomen: 7.0 back and buttocks: 7.0 face and neck: 2.5 an entire arm and hand : 4.0 an entire leg and foot : 8.0

Answer 206

Face and Neck: 15 to 30g Both hands: 15 to 30g Scalp: 15 to 30g Both arms: 30 to 60g Both legs: 100g Trunk: 100g Groin and Genitalia: 15 to 30g

Answer 207

bacterial infection affecting the dermis and deeper subcutaneous tissues. clinical diagnosis

Answer 208

streptococcus pyogenes - most common staphylococcus aureus - less common

Answer 209

majority of cases with oral abx

Answer 210

commonly occurs on the shins usually unilateral - bilateral cellulitis is rare and suggests alternative diagnosis. erythema - generally well defined margins, could present with diffuse erythema. blisters and bullae may be seen with severe disease. swelling. systemic upset: fever malaise nausea

Answer 211

clinical diagnosis. no further ix required in primary care. bloods and blood cultures may be requested if pt is admitted and septicaemia is suspected

Answer 212

1 - no signs of systemic toxicity and no uncontrolled co-morbidities. 2 - systemically unwell or systemically well but with co-morbidity like peripheral arterial disease, chronic venous insufficiency, morbid obesity - which may complicate or delay resolution. 3. - significant systemic upset (acute confusion tachycardia tachypnoea hypotension) or unstable co-morbidities that may interfere with response to treatment, or limb threatening infection due to vascular compromise. 4 - sepsis syndrome or severe life threatening infection such as necrotizing fasciitis.

Answer 213

eron class 3 or 4 cellulitis. severe or rapidly deteriorating cellulitis ( eg extensive skin involvement) very young ( under 1 yr) or frail patients. immunocompromised patients. significant lymphoedema. facial cellulitis (unless very mild) or periorbital cellulitis.

Answer 214

admission may not be necessary if community facilities and expertise are available to give iv abx and monitor the patient (check local guidelines)

Answer 215

eron classification

Answer 216

oral flucloxacillin: 1st line for mild/moderate cellulitis if penicillin allergic: oral clarithromycin, erythromycin (in pregnancy) or doxycycline.

Answer 217

admission may not be necessary if community facilities are available give iv abx and monitor pt. check local guidlines.

Answer 218

admit. oral/iv co-amoxiclav, oral/iv clindamycin, iv cefuroxime, or iv ceftriaxone.

Answer 219

4 main types: superficial spreading, nodular, lentigo maligna, acral superficial spread 70% of cases. then nodular , then lentigo (less common) then acral (rare)

Answer 220

superficial spreading: arms legs back and chest, young people nodular: sun exposed skin, middle aged people lentigo maligna: chronically sun-exposed skin, older people acral: nails palms or soles, people with darker skin pigmentation

Answer 221

superficial spreading: growing mole with diagnostic features nodular: red or black lump or lump that bleeds and oozes lentigo maligna: growing mole with diagnostic features acral lentiginous: subungal pigmentation ( hutchinsons sign) or on palms and feet.

Answer 222

desmoplastic melanoma amelanotic melanoma ocular melanoma (melanoma arising in other parts of the body)

Answer 223

change in size change in shape change in colour

Answer 224

diameter of 7mm or more. inflammation oozing or bleeding altered sensation.

Answer 225

excision biopsy remove lesion completely as incision biopsy can make histopathological assessment difficult. once confirmed: remove pathology report to determine whether futher re-excision of margins is needed.

Answer 226

lesion thickness: 0-1mm: 1cm 1-2mm: 1-2 cm - depending on site and pathological features 2-4mm: 2-3cm - depending on site and pathological features over 4mm: 3cm

Answer 227

sentinel lymph node mapping isolated limb perfusion block dissection of regional lymph node groups

Answer 228

invasion depth of the tumour called breslow depth or breslow thickness thicker tumours have worse prognosis and lower 5 year survival. 95-100% 80-96% 60-75% 50%

Dermatology Flashcards

(253 cards)