Phase 3a - Arun&Erin > GP > Flashcards

GP Flashcards

(101 cards)

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1
Q

Organism that causes scabies

A

Sarcoptes scabiei

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2
Q

How is scabies spread

A

prolonged skin contact

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3
Q

What type of reaction is scabies

A

type IV hypersensitivity reaction to mites/eggs

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4
Q

Features of scabies

A

-widespread pruritus
-linear burrows on the side of fingers, interdigital -webs and flexor aspects of the wrist
-in infants, the face and scalp may be affected
-secondary features are seen due to scratching: excoriation, infection

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5
Q

Mx of scabies

A

*permethrin 5% is first-line
*malathion 0.5% is second-line
*give appropriate guidance on use
*pruritus persists for up to 4-6 weeks post eradication

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6
Q

Patient guidance on scabies treatment

A

repeat tx a week later

*avoid close physical contact with others until treatment is complete

*household and close physical contacts treated at the same time, even if asymptomatic

*launder, iron or tumble dry clothing, bedding, towels on the first day of treatment

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7
Q

What is crusted (Norwegian) scabies

A

Seen in patients with suppressed immunity, especially HIV - causes crusting of skin

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8
Q

Treatment for crusted scabies

A

Ivermectin and isolation

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9
Q

What is limes diseases caused by

A

Spirochaete - borrelia burgdorgeri

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10
Q

What is Lyme disease spread by

A

Ticks

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11
Q

Early features of lymes disease

A

erythema migrans
headache
Lethargy
Fever
Arthralgia

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12
Q

What is erythema migrans

A

A bulls eye rash that originates from site of the tick bite
slowly increases in size and is painless

in around 80% of px

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13
Q

Later Fx of lymes disease

A

Cardio
*heart block
*peri/myocarditis

Neuro
*facial nerve palsy
*radicular pain
*meningitis

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14
Q

Investigation for Lyme disease (3)

A

usually clinically with erythema migrans

*ELISA test - first line
If negative then repeat in 4-6 weeks if still suspected

If ELISA positive then immunoblot test

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15
Q

Mx of asymptomatic tick bites

A

-remove tick with fine tipped tweezers and wash area after
-no need for abx treatment

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16
Q

Mx of conformed/ suspected Lyme disease

A

doxycycline in early disease
-amoxicillin if doxycycline CI e.g pregnant

ceftriaxone in disseminated disease

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17
Q

If theres fever, rash and tachycardia after giving abx in Lyme disease what is the Dx

A

Jarisch-Herxheimer reaction

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18
Q

Biggest prognostic factor for malignant melanoma

A

Breslow thickness

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19
Q

Risk factors for malignant melanoma (5)

A

*genetics
*UV exposure
*fair skin/freckling/light hair (low Fitzpatrick)
*previous melanoma
*prescence of atypical moles

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20
Q

4 subtypes of malignant melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous

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21
Q

Most common subtype of malignant melanoma

A

Superficial spreading

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22
Q

What are the features of acral lentiginous melanoma

A

*usually in the nails/palms/soles

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23
Q

What is hutchinsons sign

A

Seen in acral lentigous melanoma - subungual pigmentation

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24
Q

7 point checklist for malignant melanoma major/minor

A

Major (3)
-change in size
-change in shape
-change in colour

Minor (4)
-diameter +7mm
-oozing/ bleeding
-inflammation
-altered sensation

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25
Mc Malignant melanoma metastases
Lung Liver Bone Brain
26
Treatment for MM
*suspicous lesion then **excision biopsy** *biopsy reviewed and then excised with further margin
27
What are the margins of re excision in malignant melanoma
0-1mm = 1cm excisions 1-2mm = 1-2cm excision 2-4mm = 2-3cm excision +4mm = 3cm excision
28
What is bowens disease
Premalignant dermatosis precursor to squamous cell carcinoma
29
Features of bowens disease
-Red scaly patches -10-15mm in size -slow growing -site - scalp/ temples/ head
30
Managment of bowens disease
First line - **topical 5 fluorouracil** for 4 weeks (+topical hydrocortisone to reduce inflammation) *cryotherapy *excision
31
Actinic keratoses what is it
A premalignant skin lesion developing due to chronic sun exposure
32
Features of actinic keratosis
*small, crusty/ scaly lesions *pink/red/brown colour *typcially on scalp/ temples *multiple lesions
33
Mx of actinic keratosis
Prevention - AVOID SUN/ WEAR SUN CREAM Medical *fluorouracil cream (+hydrocortisone) *topical diclofenac *imiquimod *cryotherapy *curetage and cautery
34
Squamous cell carcinoma risk factor (5)
*immunosupression *chronic sun exposure *smoking *Actinic K/ bowens *xeroderma pigmentosum
35
Features of SCC
*sun-exposed sites *rapidly expanding painless, ulcerate nodules *cauliflower-like appearance *bleeding
36
Tx of SCC
** Surgical excision with 4mm margin if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm** *mohs micrographic surgery in high risk/ cosmetic cases
37
Basal cell carcinoma Tx
1st line - surgical removal *curettage *cryotherapy *imiquimod *radiotherapy
38
Features of BCC
*Nodular *pearly/ fleshy *rolled edges *telangasctasia *central crater *sun exposed areas
39
Three forms of tinea
Tinea capitis Tinea corpora’s Tinea pedis
40
Diagnosis of tinea capitis
**Scalp scrapings** Microsporum canis specifically - green fluorescence under woods lamp
41
Tx of tinea capitis
Trichopython: terbinafine Micrsporum: griseofulvin **to reduce transmission ketoconazole shampoo for 1st 2 weeks
42
Treatment of tine corporis
Oral fluconazole
43
Causes of tinea corporis
Trichophyton rubrum and Trichophyton verrucosum
44
What is pityriasis rosea
acute, self-limiting rash which tends to affect young adults due to herpes hominis 7 virus
45
What can cause pityriasis rosea in certain px
Recent viral infection but not common
46
What is the characteristic marking in ptyriasis rosea
Herald patch - appears 1-2 weeks before rash
47
Mx of pityraisis rosea
self-limiting - usually disappears after 6-12 weeks
48
What is the rash like in pityriasis rosea
erythematous, oval, scaly patches which follow a characteristic distribution - fir tree distribution
49
What is pityriasis/ tinea versicolor
superficial cutaneous fungal infection caused by Malassezia furfur
50
Features of pityriasis versicolor (4)
*commonly affects trunk *patches may be hypopigmented, pink or brown (hence versicolor). *scale is common *mild pruritus
51
Predisposing factors to pityriasis versicolor (4)
*occurs in healthy individuals *immunosuppression *malnutrition *Cushing's
52
Mx of pityriasis versicolor
ketoconazole shampoo If doesn’t respond - send scrapings + oral itraconazole
53
Psoriasis types
Plaque psoriasis Guttate psoriasis Flexural psoriasis Pustular psoriasis Erythrodermic psoriasis
54
What is guttate psoriasis
A psoriasis common in children after a strep infection 2-4 weeks prior causing pink tear drop lesion on the skin.
55
Management of guttate psoriasis
*usually resolves spontaneously - 2-3months *topical agents e.g corticosteroids *UVB phototherapy *tonsillectomy if recurrent episodes
56
What is auspitz sign in psoriasis
If the scale is removed, a red membrane with pinpoint bleeding points may be seen
57
Chronic plaque psoriasis management
*use regualr emollient to reduce scale 1st line - **topical potent corticosteroid + vitamin D analogue for 4 weeks** 2nd line -vitamin D analogue twice daily 3rd line - topical corticosteroid twice daily// coal tar
58
Secondary care mx for plaque psoriasis
1st line - phototherapy (UVB) / photochemotherapy (psoralen + UVA) Systemic therapy - oral methotrexate -ciclosporin -systemic retinoids -infliximab
59
Scalp psoriasis mx
-potent topical corticosteroids used once daily for 4 weeks -no improvement after 4 weeks then use a different formulation of the corticosteroid e.g shampoo +topical agents to remove adherent scale salicylic acid, emollients and oils
60
Face / flexural psoriasis mx
mild potency corticosteroid applied once or twice daily for a maximum of **2 weeks**
61
What is the risk of psoralen
SCC increased risk
62
Should vitamin D analogues be used in pregnancy
E.g calcitriol NO it is teratogenic
63
How long of a break from corticosteroids in between treatments should you have in psoriasis
4 weeks apart
64
What is folliculitis
Inflammation of hair follicles which can be caused by irritation or infection or physical injury
65
What is a furuncle
*aka - a boil is a deeper more pronounced infection of the hair follicle
66
Causes of folliculitis (5)
Infectious: Bacterial: Most commonly due to **Staphylococcus aureus**. Hot tub folliculitis may develop due to infection with **Pseudomonas aeruginosa**. Fungal: **Candida** especially in immunocompromised Viral: **Herpes simplex virus** can cause folliculitis known as herpetic folliculitis. Non-infectious: Chemical Folliculitis: Caused by topical steroids, oils, or tar. Physical Folliculitis: Due to shaving, tight clothing, or occlusive dressings.
67
Presentation of folliculitis
*small red bumps *white headed pimples *itching *pus filled blisters
68
Folliculitis barbea presentation
Lesions are seen in the bearded area Due to infection with Staphylococcus aureus
69
What is pseudo follicultis barbae
Pseudofolliculitis barbae is a condition characterized by inflammation and **irritation** not infection of hair follicles, typically occurring in the beard area, often due to ingrown hairs after shaving. ## Footnote commonly seen in individuals with curly hair - black African and can lead to painful bumps and pustules.
70
Tx for mild folliculitis
Mild superficial folliculitis: - Often self-limiting - Warm compresses, antiseptic washes (chlorhexidine or povidone-iodine) - Topical antibiotics - fusidic acid or mupirocin for bacterial cases - Avoid precipitating factors (tight clothing, shaving, occlusion)
71
Tx for more severe folliculitis
- Oral antibiotics for 7-10 days: - flucloxacillin (500mg QDS) for staphylococcal infection - If MRSA suspected or confirmed: doxycycline, clarithromycin, or co-trimoxazole - Consider nasal decolonisation with mupirocin ointment for recurrent staphylococcal folliculitis
72
Psuedomonas folliculitis tx (hot tub follicultiis)
- Usually self-limiting within 7-10 days - Ciprofloxacin may be considered for severe or persistent cases
73
Fungal folliculitis tx
Topical or oral antifungals: ketoconazole shampoo, itraconazole, or fluconazole
74
Gram negative folliculitis tx
May occur in patients on long-term antibiotics for acne - Treat with oral isotretinoin or appropriate antibiotics (ampicillin or trimethoprim)
75
How long do you have to have fatigue syndrome for to be diagnosed
3 months
76
Features of Chronic fatigue syndrome
*Fatigue *sleep problems - insomnia, disturbed sleep wale cycle *muscle and joint pain *headaches *painful lymph nodes - no enlarge *sore throat *physcial/ mental exertion makes worse
77
Ix for chronic fatigue syndrome
FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening and also urinalysis
78
Mx of chronic fatigue syndrome
*energy management - stay within energy limit *physical activity and exercise - under specialist guidance *CBT - supportive
79
Acne types
*comedones - open/closed *inflammatory lesions - papules/ pustules *excessive inflammatory lesions - nodules/cysts
80
Scar types that can be caused by acne
Ice pick Hypertrophic
81
What acne is seen in steroid use
Pustules
82
What is acne fulminans and what the tx
Severe variant of acne vulgaris characterised by painful ulcerative nodules on face, chest and back Tx - oral corticosteroids
83
Acne causing bacteria
**Propionibacterium acnes**
84
Mild to moderate acne first line tx options (3)
(Adapelene and tretinoin are retinoids) Adapalene + benzoyl peroxide OR tretinoin + clindamycin OR benzoyl peroxide + clindamycin
85
If mild to moderate acne tx if topical retonoids/ abx are contraindicated
Benzoyl peroxide monotherapy
86
Moderate to severe acne tx
**One of** for 12 weeks Adapalene + benzoyl peroxide Tretinoin + clindamycin Adapalene + benzoyl peroxide + oral antibiotic Azelaic acid + oral antibiotic
87
Oral antibiotics used for acne
Lymecycline or doxycycline
88
CI for tetracyclines
*pregnancy (erythromycin instead) *breastfeeding *children under 12
89
Rules for antibiotics in acne
*no longer than 6 months use *always combine with retinoids or benzoyl peroxide *never use topical and oral together
90
Why not use minocycline for acne
Causes permanent skin pigmentation
91
Long term acne abx complication
Gram negative folliculitis
92
Tx for gram negative folliculitis
High dose oral Trimethoprim
93
Hormonal options for acne (women)
COCP+ topical tx
94
NICE referral criteria for DEFINITE referral to a dermatologist for acne
*nodulo cystic acne *conglobate acne - extensive inflammatory condition
95
NICE referral for CONSIDERATION for acne (5)
*mild to moderate acne has not responded to two completed courses of treatment *moderate to severe acne has not responded to previous treatment that includes an oral antibiotic *acne with scarring *acne with persistent pigmentary changes *acne is causing or contributing to persistent psychological distress or a mental health disorder
96
What is rhinosinusitis
inflammatory disorder of the paranasal sinuses and linings of the nasal passages lasting 12 weeks or longer.
97
Predisposing factors for rhinosinusitis
*atopy: hay fever, asthma *nasal obstruction e.g. Septal deviation or nasal polyps *recent local infection e.g. Rhinitis or dental extraction *swimming/diving *smoking
98
Fx of chronic rhinosinusitis
*frontal facial pressure worse on bending forward *nasal discharge - clear if allergy / purulent if infection *nasal obstruction - mouth breathing *post nasal drip
99
Mx of rhinosinusitis
*avoid the allergen *nasal corticosteroids *nasal irrigation with saline soln
100
Red flag nasal symptoms (3)
*unilateral *persistent despite compliance with tx *epistaxis
101
Fungal toe nail tx
Terbinafine - OD 3-6 months - if trichophytn rubrum Oral itrconazole if yeast is cause
Phase 3a - Arun&Erin
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