Week 3 Flashcards
(100 cards)
1
Q
What is the definition of a leg ulcer?
A
Any break in the skin of the lower leg above the ankle - present for more than 4 weeks
2
Q
What type are 60 - 80% of leg ulcers?
A
Venous
3
Q
When making a leg ulcer diagnosis - what 6 causes must you consider?
A
- Venous
- Arterial
- Diabetic
- Vasculitic
- Malignant
- Hydrostatic - dependant limb
4
Q
When assessing the ulcer what two things must you record?
A
Position of ulcer
Measure surface area
5
Q
What do lipodermatosclerosis, hyperpigmentation and malleolus relate to?
A
Venous ulcer
6
Q
What is the normal ABPI levels?
A
0.8 - 1.3
7
Q
What does an ABPI of
A
Vascular disease
8
Q
What does an ABPI of >1.5 suggest?
A
Calcification
9
Q
What investigation differentiates between venous and arterial ulcers?
A
ABPI
10
Q
When might you do a wound swab of a leg ulcer?
A
When it is increasinly painful, exudative, smelly and enlarging
11
Q
What 4 bloods would you investigate for a leg ulcer?
A
FBC
LFTs
U&Es
CRP
12
Q
What are the 6 steps in venous ulcer treatment?
A
CANDE4: control pain, ABPI, non-adherent dressing, de-sloughing agent (hydrogel/honey), elevation and 4 layer compression bandaging
13
Q
What involves graduated compression with 40mmHg at ankle and 25mmHg below knee?
A
4 layer bandaging system
14
Q
What ulcers tend to have a shallow edge like a beach?
A
Venous ulcers
15
Q
What ulcers may have very sharp, cliff-like edges and can be described as being “punched out”?
A
Arterial ulcers
16
Q
Where do venous ulcers normally develop?
A
Around the malleoli
17
Q
Where do diabetic or arterial ulcers tend to develop?
A
On feet, especially around pressure sites such as the heel
18
Q
Give two physical descriptions of a dermatofibroma
A
- Firm to touch
2. Increased pigment around rim
19
Q
What are acquired during childhood and early adulthood, gradually lose pigment over the years and are usually regular but not always?
A
Common melanocytic naevi
20
Q
Give 5 types of skin disease due to adverse reactions to amoxycillin?
A
- Morbilliform (measles like) eruption
- Urticaria
- Angiodema
- Fixed drug eruption
- Generalised pustulosis
21
Q
What can cryotherapy, solaraze, 5 FU, PDT, imiquimod and resurfacing be used to treat?
A
Common precancers
22
Q
What are the five layers of the scalp?
A
Skin Connective tissue Aponeurosis Loose connective tissue Periosteum and parietal bone
23
Q
What are the three divisions of the trigeminal nerve?
A
1: Opthalmic
2: Maxillary
3: Mandibular
24
Q
What gives the sensory nerve supply to the face and motor to the muscles of mastication?
A
Trigeminal nerve
25
How do you clinically test the sensory component of the trigeminal nerve?
Ask patient to close their eyes. Gently brush the skin in each dermatome with a fine tip of cotton wool. Ask the patient to tell you when they feel their skin being touched.
26
What does one forament in the maxilla, close to the zygomatic bone transmit?
CN V2
27
How do you clinically test the function of the maxillary division (V2)?
Ask the patient to close their eyes. Gently brush the skin over the maxilla with a fine tip of cotton wool. Ask the patient to tell you when they feel their skin being touched.
28
What nerve division is found on the lateral aspect left side of the mandible?
Mandibular V3
29
A fracture 'where' may damage the sensory nerve supply to the chin and lower lip making them "numb"?
lateral Mandible
30
How do you clinically test the mandibular division of the trigeminal nerve?
Ask the patient to close their eyes. Gently brush the skin over the chin with a fine tip of cotton wool. Ask the patient to tell you when they feel their skin being touched.
31
What nerve gives sense of taste and is the motor to the muscles of facial expression?
Facial nerve CN VII
32
What is the border on the lips called?
Vermillion border
33
What is the spincter of the eye?
Orbicularis oculi
34
What is the sphincter of the mouth?
Orbicularis oris
35
How do you clinically test CN VII (motor)?
Ask the patient to frown and close eyes tightly. Also to smile and puff out cheeks - if sphincter intact then no air leak from mouth.
36
What is the maximum safe dose of lignocaine (lidocaine)?
50ml 1% lignocaine with adrenaline
37
What is excretion of lignocaine reduced in?
Liver, renal, cardiac failure, young and elderly
38
What type is lignocaine?
Amide type
39
What drug prolongs anaesthesia and reduces bleeding?
Adrenaline
40
In what patients should you avoid adrenaline?
Cardiac disease and those on psychotropic drugs
41
What would you use electrosurgery for?
Haemostasis and treatment of minor skin lesions (skin tags)
42
What are the two main types of skin cancer?
Non-melanoma - keratinocytes (can be BCC or SCC)
| Melanoma - melanocytes
43
What are BCC usually present as?
Translucent, painless, slow growing lump or a non-healing ulcer
44
What do SCC usually arise on?
Sun-damaged skin
45
What is the ABCDE rule for diagnosing melanoma early?
```
Asymmetry
Border
Colour
Diameter
Evolution
```
46
What type of skin cancer is a hyperkeratotic (crusted) lump or ulcer that arises on sun-damaged skin?
Squamous cell carcinoma
47
Give two precursor lesions for squamous cell carcinomas?
1. Actinic keratoses
| 2. Bowen's disease
48
What type of sun exposure leads to a SCC?
Chronic - total sun exposure
49
List three genetic susceptibility factors for skin cancer?
1. DNA repair syndromes e.g. Xeroderma Pigmentosum
2. Albinism
3. Naevoid basal cell carcinoma (Gorlin's syndrome)
50
What is an autosomal dominant familial cancer syndrome with palmar pits, jaw cysts and ectopic calcification falx?
Naevoid basal cell carcinoma (Gorlin's syndrome)
51
Name an immunological factor that is a risk factor for skin cancer?
Transplant areas
52
What is carcinogenesis?
The process by which a normal cell becomes a malignant cancer cell
53
What UV light gives indirect DNA damage, is more prevalent and penetrates more deeply into the skin?
UVA
54
What UV light gives direct DNA damage, is 1000 times more damaging than UVA and occurs only when the sun is directly overhead?
UVB
55
What is the UV signature mutation?
Pyrimidine dimer
56
When is there an increased risk of SCC in relation to AK?
When they have merged to give a field change rather than discrete AK
57
What is NBCCS (Gorlin's) due to?
A germline mutation in PTCH gene
58
What mutation is common and early events in skin cancer, and is found in AK, carcinoma in situ and SCC?
TP53
59
List 5 phototoxic drugs?
1. Voriconazole
2. Thiazide diuretics
3. NSAIDs
4. Anti-TNF
5. Azathioprine
60
Where are melanocytes derived from?
The neural crest
61
In early embryogenesis where do melanoblasts migrate from the neural crest to?
1. Skin
2. Uveal tract
3. Leptomeninges
62
Once melanoblasts settle in the skin what do they form?
Melanocytes
63
What gene determines the balance of pigment in skin and hair?
MC1R
64
What does MC1R turn phaeomelanin into?
Eumelanin
65
What does one defective copy of MC1R cause?
Freckles
66
What are patchy increases in melanin pigmentation and occur after UV exposure?
Freckles
67
What are actinic lentigines also know as and related to?
Age or liver spots
| Related to UV exposure
68
During infancy the melanocyte:keratinocyte ratio breaks down at a number of cutaneous sites and causes what?
Simple naevi
69
What type of acquired naevus develops in childhood?
Junctional naevus
70
What type of acquired naevus develops in adolescence?
Compound naevus
71
What type of acquired naevus develops in adulthood?
Intradermal naevus
72
What naevi has architectural atypia and cellular atypia, host reaction fibrosis and inflammation, epidermis unaffected?
Dysplastic naevi
73
What naevi have a peripheral halo of depigmentation as well as showing inflammatory regression and overrunning by lymphocytes?
Halo naevi
74
What naevi are entirely dermal and consist of pigment rich dendritic spindle cells, the variant may have mitoses and mimic melanoma?
Blue naevi
75
What naevi consist of large spindle epithelioid cells, may closely mimic melanoma, benign and are rare?
Spitz naevi
76
Give two clinical features of Spitz naevi?
1. Pink coluration due to prominent vasculature
| 2. Epidermal hyperplasia
77
What are the four main types of malignant melanoma?
1. Superficial spreading - commonest - trunks and limbs
2. Acral/mucosal lentiginous - acral and mucosal
3. Lentigo maligna - sun-damaged face
4. Nodular - varied sites but often trunk
78
How do SSM, A/MLM and LMM maligant melanomas all grow?
As macules when either entirely in-situ or with dermal microinvasion
79
What type of melanomas are the only ones that can metastasise?
VGP melanomas
80
What type of malignant melanoma only has lesions with VGP?
Nodular melanoma
81
With melanoma prognostic indicators - what is a strong adverse indicator?
Ulceration
82
What causes melanocytic naevi present at birth?
Benign proliferations of melanocytes in the epidermis and or dermis
83
What can be seen through a dermoscope when looking at a melanoma?
Atypical pigment network, black dots, irregular streaks, focally a blue-whitish veil and a white regression zone with hairpin vessels
84
What is the most common subtype of melanoma?
Superficial spreading melanoma
85
What subtype of melanoma is usually macule with irregular border and colour which may have been growing in size for years (slow horizontal growth phase) before developing a nodule (rapid vertical growth phase)?
Superficial spreading melanoma
86
What subtype of melanoma is blue-black or red skin coloured nodule which may be ulcerated or bleeding and has usually developed rapidly - vertical growth from outset?
Nodular
87
What type of melanoma is invasive developing within a lentigo maligna?
Lentigo maligna melanoma
88
What subtype of melanoma is usually found in elderly patients and affects palms or soles or nails - Hutchinson sign is pigmented extension into the nail fold?
Acral lentiginous melanoma
89
Describe an amelanotic melanoma?
Absent or minimal visible pigment
90
What lesions look "stuck on", often warty, regular border and are often found on trunk?
Seborrheic keratoses
91
What can be possibly due to insect bites and are deep, brown/grey firm nodules?
Dermatofibroma
92
What are benign, precancerous dysplasias and can get invasive malignancies?
Epidermal tumours
93
Give an example of a benign epidermal tumour?
Seborrhoeic keratosis
94
What might an eruptive appearance on seborrhoeic keratosis indicate?
Internal malignancy - Leser-Trelat sign
95
Give three clinical features of seborrhoeic keratosis?
1. Epidermal acanthosis
2. Hyperkeratosis
3. Horn cysts
96
Give three precursors of squamous cell carcinoma?
1. Bowen's disease - especially on legs
2. Actinic keratosis - especially on head/neck
3. Viral lesions - especially on anogenital skin
97
What condition is described with scaly patch/plaque, irregular border, no dermal invasion, squamous cell carcinoma in-situ and has female excess (mostly on lower leg)?
Bowen's disease
98
What HPV type is associated with dysplasia?
type 16
99
Give three situations where SCC may occassionally arise?
1. Chronic leg ulcers (stasis ulcers)
2. Sites of burns; sinuses (chronic osteomyelitis)
3. Chronic lupus vulgaris
100
Give three rare associations for SCC?
1. Xeroderma pigmentosum
2. Dystrophic variant
3. Epidermolysis bullosa
