MedEd derm Flashcards
(102 cards)
1
Q
when describing lesions what are the 3 types?
A
flat
fluid filled
raised
2
Q
what are the types of flat skin lesions and how do they differ?
A
macule= small patch= large
3
Q
what are the types of fluid filled skin lesions and how do they differ?
A
vesicle= small ie <0.5cm diameter bulla= large ie >0.5cm diameter pustule= pus filled
4
Q
what are the types of raised skin lesions and how do they differ?
A
papule= small ie <0.5cm in diameter nodule= large ie >0.5cm diameter
5
Q
what type of skin lesions are macules and patches? how do they differ?
A
flat skin lesions
macules are small
patches are large
6
Q
what type of skin lesions are pustules, vesicles and bullae? how do they differ?
A
raised
pustule= pus filled
vesicles= <0.5cm
bullae= >0.5 cm
7
Q
what type of skin lesions are papules and nodules? how do they differ?
A
raised
papules are small
nodules are large
8
Q
what is squamous cell carcinoma?
A
cancer of keratinocytes in the epidermis
9
Q
what is the most common and second most common skin cancer?
A
most common= basal cell carcinoma
second most common= squamous cell carcinoma
10
Q
what is the nature of invasion in squamous cell cacinoma?
A
local invasion into the dermis
can metastasise, common sights are lung, bone, brain and liver
11
Q
what is basal cell carcinoma?
A
cancer of keratinocytes in the epidermis in the stratum basale
12
Q
what are rf for squamous cell carcinoma?
A
UV light
fhx
lighter skin
actinic keratosis
13
Q
what are rf for basal cell carcinoma?
A
UV light
fhx
lighter skin
14
Q
what condition might increase risk of someone developing squamous cell carcinoma?
A
actinic keratosis
15
Q
what is the nature of invasion in basal cell cacinoma?
A
slow growing local invasion into the dermis and doesnt metastasise
16
Q
what does basal cell carcinoma look like?
A
nodule
pearly edges
central ulcer called a rodent ulcer
central fine telangiectasia
17
Q
what is found at the center of a basal cell carcinoma nodule?
A
rodent ulcer
18
Q
out of basal and squamous cell carcinoma which metastasises?
A
squamous cell
19
Q
what are the types of basal cell carcinoma and how might they differ?
A
nodular= most common, pearly edges with rodent ulcer and central fine telangiectasia superficial= flat morpheic= yellow waxy plaque, scar like pigmented= dense and specks of colour
20
Q
what acronym is used to remember how you describe a lesion and what does it stand for?
A
ABCDE: asymmetry border colour diameter evolution
21
Q
what is the most deadly skin cancer?
A
malignant melanoma
22
Q
what is malignant melanoma?
A
cancer of the melanocytes in the epidermis
23
Q
what are rf for malignant melanoma?
A
UV light
fhx
lighter skin
24
Q
what is the nature of invasion of malignant melanoma?
A
local invasion into the dermis
can metastasise, common sites include lung, bone, brain and liver
25
what does a malignant melanoma look like (go via ABDE)
```
Asymmetrical
Border is irregular
Colour is pigmented (dark)
Diameter is over 6mm
Evolution- might bleed, itch, crust over, ulcerate
```
26
how quick does referral need to be done for malignant melanoma v squamous v basal cell carcinoma?
malignant melanoma= urgent within 2 weeks
squamous= urgent within 2 weeks
basal= routine within 6 weeks
27
what ix are done for skin cancer? why are they done
```
bedside= dermatoscope
bloods= ALP to check for bone mets, LFTs to check for liver mets
imaging= CT/MRI/PET for staging
biopsy= measure breslow thickness so see melanoma invasion extent, good for prognosis
```
28
what is breslow thickness?
it is a measure of melanoma invasion which can help judge prognosis and is done when a biopsy is taken
29
what is measured when a biopsy is taken is skin cancer and why?
breslow thickness
| it shows the extent of melanoma invasion and can help judge prognosis
30
how is squamous cell carcinoma managed?
if in situ= cryotherapy
| if invasive= surgical excision and radiotherapy
31
how is basal cell carcinoma managed?
non cosmetically challenging= surgical excision
| cosmetically challenging= moh's surgery
32
how is malignant melanoma managed?
early stage= surgical excision and lymph node biopsy
advanced but resectable= surgery and systemic therapy with nivolumab
advanced= systemic therapy (nivolumab) and treat mets
33
what systemic therapy is used in skin cancer for advanced malignant melanoma?
nivolumab
34
what type of skin condition is eczema?
inflammatory (NOT autoimmune)
35
what are rf of eczema?
pmhx/fhx of atopy eg food allergy, hay fever, asthma
| filaggrin gene mutation
36
what does eczema look like?
distributed in flexures
dry, itchy, erythematous skin
lichenification if its chronic
37
what feature might you see in chronic eczema?
lichenification
38
where is eczema distributed?
in the flexures
39
describe atopic dermatitis. what skin condition does it fall under?
eczema
type I/IV hypersensitivity
IgE mediated
in the flexures
40
describe contact dermatitis. what skin condition does it fall under?
type IV hypersensitivity, delayed
often nickel/latex
two types are irritant and allergic
41
what subtype of eczema is associated with nickel/latex?
contact dermatitis
42
describe discoid dermatitis. what skin condition does it fall under?
it is a subtype of eczema
associated with coin shaped plaques
more common in middle aged/elderly
43
what type of eczema is a medical emergency?
eczema herpeticum
44
what is eczema herpeticum superimposed by?
HSV 1
45
what type of condition is psoriasis?
autoimmune
46
what is psoriasis?
an autoimmune condition where there is hyperproliferation of keratinocytes
47
what cells proliferate in psoriasis?
keratinocytes
48
what are rf for psoriasis?
stress
smoking
alcohol
49
what are features of psoriasis?
nail signs: onycholysis, subungal hyperkeratosis, pitting
psoriatic arthritis: symmetrical polyarthritis
dry, scaly, itchy, erythematous plaques which are purple/silvery in colour on the extensor/scalp surfaces
50
what are some conditions where you might see onycholysis?
psoriasis
thyrotoxicosis
trauma
fungal infections
51
what is onycholysis?
painless separation of the nail from the nail bed
52
what do psoriasis lesions look like?
dry, scaly, erythematous, itchy plaques which are purple/silvery in colour
53
where re psoriasis plaques distributed?
on the extensor surfaces and scalp
54
what is the most common type of psoriasis?
plaque psoriasis
55
what test may be done to diagnose contact dermatitis?
skin patch testing
56
what test may be done to diagnose atopic dermatitis?
IgE-RAST
57
what test may be done to diagnose food allergies?
skin prick testing
58
how are guttate, pustular and plaque psoriasis managed?
guttate: 1st line phototherapy, 2nd line ciclosporin, 3rd line methrotrexate
pustular: 1st line acitretin, 2nd line ciclosporin
plaque: topical hydrocortisone
59
how is acute v chronic eczema treated?
```
acute= emollient with topical corticosteroid
chronic= emollient with low potency corticosteroid
```
60
what is urticaria?
skin lesions that develop rapidly often from hypersensitivity reactions
often associated with angioedema
61
what is urticaria often associated with?
agioedema- swelling underneath the skin
62
what is angioedema?
swelling underneath the skin
63
what are triggers for urticaria?
allergen
| viral infections- common in children
64
what does urticaria look like?
erythematous, not painful and non blanching
65
how long does it take urticaria to resolve?
usually within 24 hrs
acute <6 weeks
chronic >6 weeks
66
what ix are done for urticaria? why?
FBC- to establish baseline eosinophil count
CRP
ESR
67
how is urticaria managed?
identify the trigger
antihistamines (up to 6 weeks)
oral corticosteroids
68
what will be in an eczema sba?
lichenification
pmhx or fhx or atopy eg food allergy, hayfever
itchy, dry skin
distribution in flexures
69
what will be in a psoriasis sba?
purple/silver erythematous plaques that are itchy
distribution on extensor surfaces
onycholysis, subungal keratosis
70
what are cellulitis and erysipelas?
bacterial infections of the skin
71
what organisms is likely to be the cause of cellulitis and erysipelas?
strep pyrogenes most commonly
| staph aureus
72
what similarities do cellulitis and erysipelas have in common?
acute onset
| red, painful, hot, swollen lesions
73
what are rf for cellulitis and erysipelas?
```
wounds
bites
ulcers
IV cannula
immunosupression
```
74
how can you differentiate cellulitis and erysipelas?
```
erysipelas= lesion is epidermal, lesion is more well demarcated, more likely to have fever and rigors but sepsis is uncommon
cellulitis= lesion is dermal, it is less demarcated/more patchy, systemic symptoms like fever/rigors are less likely but sepsis is more likely
```
75
out of cellulitis and erysipelas which is more likely to progress to sepsis?
cellulitis
76
what is the difference in location of infection between cellulitis and erysipelas?
```
cellulitis= dermis
erysipelas= epidermis
```
77
what are complications of sepsis and which are surgical or medical emergencies?
abscess
sepsis- medical emergency
periorbital or orbital cellulitis- medical emergency
necrotising fasciitis- surgical emergency
78
how is periorbital or orbital cellulitis managed?
IV abx
79
what ix are done for cellulitis and erysipelas and what will you see?
usually diagnosis is clinical
skin swab MCS/ blood culture- strep pyrogenes positive
bloods- raised WCC, CRP
CT/MRI- if orbital cellulitis
80
how is cellulitis/erysipelas managed?
conservative= mark around the lesion, painkillers, monitor it
medical= oral abx, IV abx if near eyes
admit if they are septic or confused!!
81
when are IV abx used over oral in cellulitis/erysipelas?
if cellulitis is near the eyes
82
what is necrotising fasciitis?
a life threatening infection of subcutaneous soft tissue
83
what are signs and symptoms of necrotising fasciitis?
severe pain or anaesthesia over the sight
systemic signs= fever, tachypnoea, tachycardia, palpitations
warm, erythematous lesion with oedema which may turn violet
84
what does necrotising fasciitis look like?
warm, erythematous lesions with oedema that may turn violet
85
where is infection located in necrotising fasciitis?
subcutaneous soft tissue
86
how is necrotising fasciitis managed?
immediate surgical exploration- surgical debridement
do blood and tissue cultures after but do not delay surgery for results
IV abx and supportive care
87
what is erythema multiforme?
inflammation of the skin and mucous membranes
88
what type of reaction is erythema multiforme?
type IV
89
what organisms cause erythema multiforme?
herpes most commonly
mycoplasma
HIV
can be due to drug reactions- sulphonamides
90
what organism is likely to cause erythema multiforme?
herpes
91
what does erythema multiforme look like?
target lesio with a central vesicle/crust
ring of pallor or erythema around it
often starts in the hands and spreads up
92
what are signs and symptoms of erythema multiforme?
prodrome of fever, aches
| tender/itchy/painful target lesions with a central vesicle/crust, they have a ring of pallor or erythema
93
how is erythema multiforme managed?
```
if minor (only involves skin)- topical emollient and oral corticosteroids
if major (involves skin and mucosa)- topical emollient and oral/IV corticosteroids
```
94
what is molluscum contagiosum?
a skin infection due to the molluscum contagiosum virus
95
what does molluscum contagiosum look like?
smooth papule that is umbilicated
may be itchy
painless
96
how is molluscum contagiosum transmissed?
close contact eg sexual, swimming pools
97
how is molluscum contagiosum managed?
observation
topical potassium hydroxide
cryotherapy 2nd line
98
what are pressure sores?
localised damage to skin/soft tissue over bony prominences due to prolonged pressure
99
what are rf for pressure sores?
immobility
sensory impairment
older age
100
describe lesions in pressure sores
```
in tact skin or
open wound (superifcial or deep)
```
101
what ix are done for pressure sores?
consider doing a wound swab
| ESR, CRP
102
how are pressure sores managed?
1st line= reposition, reduce pressure
| clean and dress them, analgesia, diet
