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Neurology and Special Senses > Common Important Derm Problems > Flashcards

Common Important Derm Problems Flashcards

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1
Q

What history is indicative of a venous ulcer?

A

Painful
Worse on standing
History of venous disease - varicose veins, DVT

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2
Q

Where do venous ulcers commonly affect?

A

Malleolar area - more commonly medial

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3
Q

Describe how a venous ulcer would appear?

A

Large shallow irregular ulcer

Exudative and granulating base

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4
Q

What is a venous ulcer associated with?

A 
Warm skin
Normal peripheral pulses
Leg oedema, haemosiderin and melanin deposition (brown pigment)
Lipodermatosclerosis
Atrophie blanche
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5
Q

How would you investigate a venous ulcer?

A

ABPI would be between 0.8-1 (normal)

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6
Q

How are venous ulcers managed?

A

Compression bandaging

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7
Q

Describe the typical history of an arterial ulcer

A

Painful - esp. at night
Worse on leg elevation
History of arterial disease - atherosclerosis

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8
Q

What sites are commonly affected by arterial ulcers?

A

Pressure and trauma areas - pretibial, supramalleolar (usually lateral) and at distal points

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9
Q

What sort of lesion would you expect with an arterial ulcer?

A

Small, sharply defined, deep ulcer

Necrotic base

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10
Q

What features are associated with arterial ulcers?

A

Cold skin
Weak or absent peripheral pulses
Shiny pale skin
Loss of hair

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11
Q

What possible investigations would you request for an arterial ulcer?

A

ABPI - will be <0.8

Doppler studies and angiography

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12
Q

How are arterial ulcers managed?

A

Vascular reconstruction

Compression bandaging contraindicated!!

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13
Q

How do neuropathic ulcers present?

A

Painless
Abnormal sensation
History of diabetes/neurological disease

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14
Q

Where do neuropathic ulcers commonly affect?

A

Pressure sites - soles, heels, toes, metatarsal heads

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15
Q

How do neuropathic ulcers present?

A

Variable size and depth
Granulating base
May be surrounded by or underneath a hyperkeratotic lesion

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16
Q

What features are associated with neuropathic ulcers?

A

Warm skin
Normal peripheral pulses - can be weak, cold or absent if neuroischaemic
Peripheral neuropathy

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17
Q

What investigations would you recommend for neuropathic ulcers?

A

ABPI <0.8 suggest neuroischaemic

X-Ray - exclude osteomyelitis

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18
Q

How are neuropathic ulcers managed?

A

Wound debridement

Regular repositioning - appropriate footwear and good nutrition

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19
Q

What differentials would you consider for itchy eruptions?

A 
Eczema
Scabies
Urticaria
Lichen Planus
Tinea - pedis, capitis, corporis
Candida
Chicken pox
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20
Q

What key things in a history would indicate eczema as the cause of an itchy eruption?

A

Personal or family history of atopy - eczema, hay fever, asthma

Exacerbating factor - allergen, irritant

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21
Q

Where does eczema commonly affect?

A

Varies - usually flexural aspects if atopic eczema

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22
Q

How would an eczematous lesion appear?

A

Dry, erythematous patches

Acute is erythematous, vesicular and exudative

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23
Q

What features may be associated with eczema?

A

Secondary bacterial or viral infection

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24
Q

How would you investigate eczema?

A

Patch testing
Serum IgE
Skin swab

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25
How is eczema managed?
Copious use of emollients Topical corticosteroids - step up intensity Immunomodulators Non-Sedating Antihistamines - loratadine/ceterizine Can use light therapy or oral corticosteroids (prednisolone) Manage secondary infections with appropriate antibiotics
26
What is the step wise progression of topical corticosteroids for eczema?
Hydrocortisone Eumovate - Clobetsone Butyrate 0.05% Betnovate - Betamethasone Valerate 0.1% Dermovate - Clobetasol Propionate 0.05%
27
What history would be indicative of scabies?
History of contact with symptomatic individuals Pruritus worse at night History of sleeping rough/on unclean mattress
28
What are the common sites that scabies affects?
``` Sides of fingers Finger webs Wrists Elbows Ankles Feet Nipples Genitals ```
29
Describe a scabies lesion
Linear burrows - may be tortuous Rubbery nodules Erythematous papules
30
What features may be associated with scabies?
Secondary eczema | Impetigo
31
How would you investigate scabies?
Skin scrape - extraction of mite | View under microscope
32
How would you manage scabies?
Permethrin 5% applied to whole body and washed off after 8-12 hours. Repeat in a week Antihistamines Treat all household members and sexual contacts Wash bedding and clothing at 60 degrees
33
What findings in the history would be indicative of urticaria?
Precipitating factors - food, drugs, contact
34
Describe a lesion that is typical of urticaria
Pink wheals - transient May be round, annular or polycyclic Raised itchy rash
35
What features may be associated with urticaria?
Angioedema | Anaphylaxis
36
What investigations would you do for urticaria?
Bloods and urinalysis to exclude systemic cause
37
How would you manage urticaria?
Antihistamines | Corticosteroids
38
What findings in the history would indicate lichen planus?
Family history - 10% of cases | May be drug induced
39
Where does lichen planus usually affect?
Forearms Wrists Legs Always examine oral mucosa
40
How would you describe a lichen planus rash?
5P's Pruritic Planar Purple Polygonal Papule Symmetrically distributed
41
What features are associated with lichen planus?
Nail changes Hair loss Wickham's Striae - lacy white streaks on oral mucosa and skin lesions
42
How would you investigate lichen planus?
Skin biopsy
43
How would you manage lichen planus?
Corticosteroids - topical, oral if extensive Antihistamines Benzydamine mouth wash if oral
44
Which drugs can cause lichenoid eruptions?
Thiazides Gold Quinine
45
What are the causes of a changing pigmented lesion?
Benign - typically dont need management, can be excised - Melanocytic Naevi - Seborrhoeic Keratoses Malignant - Malignant Melanoma
46
What findings in the history would be typical or melanocytic naevi?
Changing pigmented lesion Not usually present at birth but develop during infancy, childhood or adolescence Asymptomatic
47
How would you describe a melanocytic naevi lesion?
Congenital - May be large, pigmented, protuberant and hairy Junctional - small, flat and dark Intradermal - Dome-shaped Compound - raised and warty, hyperkaratotic, hairy
48
What findings in the history are typical of seborrhoeic keratoses?
Arise in middle age or elderly | Asymptomatic
49
Describe a common seborrhoeic keratoses lesion
Usually on face or trunk Warty, greasy papules or nodules Stuck on appearance - well defined edges Keratotic plugs may be seen
50
What findings in the history are indicative of a malignant melanoma?
Adults/middle age Evolution of lesion May be symptomatic - bleeding or itchy Risk factors
51
Describe a common malignant melanoma lesion
More common on legs in women, trunk in men ``` Asymmetrical shape Border irregularity Colour irregularity Diameter >6mm Evolution of lesio ```
52
How are malignant melanomas managed?
Must be excised
53
What differentials would you consider for a purpuric eruption in children?
``` Meningococcal septicaemia ALL Congenital bleeding disorders ITP HSP Non-accidental injury ```
54
What history would be indicative of meningococcal septicaemia?
Acute Meningitis symptoms - headache, photophobia, N&V, stiff neck etc. Septicaemia Systemically unwell
55
Where does meningococcal septicaemia commonly affect?
Extremities
56
Describe a meninococcal rash
``` Petechiae Ecchymoses Haemorrhagic bullae Non-blanching Tissue necrosis ```
57
How would you investigate meningococcal septicaemia?
Bloods | Lumbar Puncture
58
How would you manage meningococcal septicaemia?
Ceftriaxone
59
What history would be indicative of DIC?
History of trauma, malignancy, sepsis, obstetric complications. transfusions or liver damage Systemically unwell
60
Where does DIC commonly affect?
Spontaneous bleeding from ENT, GI tract, resp tract or wound site
61
Describe a DIC lesion
Petechiae Ecchymosis Haemorrhagic Bullae Tissue necrosis
62
What history is indicative of a vasculitis?
Painful lesions
63
Where do vasculitis lesions commonly affect?
Dependent areas - legs, buttocks, flanks
64
Describe a vasculitis lesion
Palpable purpura
65
What investigations would you request for DIC?
Bloods - clotting screen
66
How would you manage DIC?
treat underlying cause Transfuse for coagulation deficiency Anti-coagulants for thrombosis
67
How would you investigate a vasculitis rash?
Bloods Urinalysis Skin biopsy
68
How would you manage a vasculitis rash?
Treat underlying cause Steroids and immunosuppressants - systemic involvement
69
What history is indicative of senile purpura?
Elderly population Sun damaged skin Systemically well
70
Describe where and how a senile purpura would appear
Extensors surfaces of hands and forearms - easily traumatised Non-palpable purpure Atrophic, thin surrounding skin
71
How would you investigate senile purpura?
None needed - no management required
72
What could be the cause of a red swollen leg?
Cellulitis Erysipelas Venous thrombosis Chronic venous insufficiency
73
What history would indicate cellulitis/erysipelas?
Painful spreading rash History of abrasion or ulcer Systemically unwell - fever and malaise May have lymphangitis
74
What is the difference between erysipelas and cellulitis in appearance?
Erysipelas - well defined edge (confined to upper dermis) Cellulitis - diffuse edge (affect deeper layers)
75
What investigations would you recommend for erysipelas/cellulitis? How is it managed?
Anti-streptococcal O titre Skin swab Antibiotics - flucloxacillin (clarithromycin in pen allergic)
76
What history would indicate venous thrombosis?
Pain with swelling and redness History of prolonged bed rest - long haul flight, clotting tendency Systematically well but can present with PE
77
Describe how a venous thrombosis lesion may appear?
Red swollen leg Complete occlusion can lead to cyanotic discolouration
78
How is venous thrombosis investigated and managed?
D dimer Doppler ultrasound Anticoagulants - DOACS (rixaroxaban/apixaban)
79
What history would chronic venous insufficiency present with?
Heaviness or aching of leg - worse on standing and relieved by walking History of DVT
80
Describe skin features seen with chronic venous insufficiency
Discoloured - blue-purple Oedema - improve in morning Venous congestion and varicose veins Lipodermatosclerosis - erythematous induration - champagne bottle appearance Stasis dermatitis - eczema with inflammatory papule, scaly and crusted erosions Venous ulcer
81
How would you investigate/manage chronic venous insufficiency?
Doppler ultrasound Leg elevation and compression stockings Sclerotherapy or surgery for varicose veins
82
What causes scabies?
Mite burrow into epidermis and tunnel through stratum corner
83
What causes intense pruritus in scabies?
Delayed type IV hypersensitivity reaction to mites/eggs - occur 30 days after initial infection
84
How would you manage seborrhoeic keratosis?
Reassure of benign nature Options for removal - curettage, cryosurgery and shave biopsy
85
What is purpura?
Bleeding into the skin from small blood vessels which produce a non-blanching rash
86
What causes for purpuric eruptions would you consider in adults?
ITP Bone marrow failure - secondary to leukaemia, myelodysplasia or bone metastases Senile purpura Drugs Nutritional deficiency - vitamin B12, C and folate

Neurology and Special Senses (28 decks)

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