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JL Dermatology > Week 3 > Flashcards

Week 3 Flashcards

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

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2
Q

What type are 60 - 80% of leg ulcers?

A

Venous

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3
Q

When making a leg ulcer diagnosis - what 6 causes must you consider?

A
  1. Venous
  2. Arterial
  3. Diabetic
  4. Vasculitic
  5. Malignant
  6. Hydrostatic - dependant limb
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4
Q

When assessing the ulcer what two things must you record?

A

Position of ulcer

Measure surface area

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5
Q

What do lipodermatosclerosis, hyperpigmentation and malleolus relate to?

A

Venous ulcer

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6
Q

What is the normal ABPI levels?

A

0.8 - 1.3

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7
Q

What does an ABPI of

A

Vascular disease

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8
Q

What does an ABPI of >1.5 suggest?

A

Calcification

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9
Q

What investigation differentiates between venous and arterial ulcers?

A

ABPI

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10
Q

When might you do a wound swab of a leg ulcer?

A

When it is increasinly painful, exudative, smelly and enlarging

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11
Q

What 4 bloods would you investigate for a leg ulcer?

A

FBC
LFTs
U&Es
CRP

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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

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13
Q

What involves graduated compression with 40mmHg at ankle and 25mmHg below knee?

A

4 layer bandaging system

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14
Q

What ulcers tend to have a shallow edge like a beach?

A

Venous ulcers

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15
Q

What ulcers may have very sharp, cliff-like edges and can be described as being “punched out”?

A

Arterial ulcers

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16
Q

Where do venous ulcers normally develop?

A

Around the malleoli

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17
Q

Where do diabetic or arterial ulcers tend to develop?

A

On feet, especially around pressure sites such as the heel

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18
Q

Give two physical descriptions of a dermatofibroma

A
  1. Firm to touch

2. Increased pigment around rim

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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

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20
Q

Give 5 types of skin disease due to adverse reactions to amoxycillin?

A
  1. Morbilliform (measles like) eruption
  2. Urticaria
  3. Angiodema
  4. Fixed drug eruption
  5. Generalised pustulosis
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21
Q

What can cryotherapy, solaraze, 5 FU, PDT, imiquimod and resurfacing be used to treat?

A

Common precancers

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22
Q

What are the five layers of the scalp?

A 
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Periosteum and parietal bone
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23
Q

What are the three divisions of the trigeminal nerve?

A

1: Opthalmic
2: Maxillary
3: Mandibular

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24
Q

What gives the sensory nerve supply to the face and motor to the muscles of mastication?

A

Trigeminal nerve

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25
Q

How do you clinically test the sensory component of the trigeminal nerve?

A

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.

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26
Q

What does one forament in the maxilla, close to the zygomatic bone transmit?

A

CN V2

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27
Q

How do you clinically test the function of the maxillary division (V2)?

A

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.

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28
Q

What nerve division is found on the lateral aspect left side of the mandible?

A

Mandibular V3

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29
Q

A fracture ‘where’ may damage the sensory nerve supply to the chin and lower lip making them “numb”?

A

lateral Mandible

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30
Q

How do you clinically test the mandibular division of the trigeminal nerve?

A

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.

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31
Q

What nerve gives sense of taste and is the motor to the muscles of facial expression?

A

Facial nerve CN VII

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32
Q

What is the border on the lips called?

A

Vermillion border

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33
Q

What is the spincter of the eye?

A

Orbicularis oculi

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34
Q

What is the sphincter of the mouth?

A

Orbicularis oris

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35
Q

How do you clinically test CN VII (motor)?

A

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.

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36
Q

What is the maximum safe dose of lignocaine (lidocaine)?

A

50ml 1% lignocaine with adrenaline

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37
Q

What is excretion of lignocaine reduced in?

A

Liver, renal, cardiac failure, young and elderly

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38
Q

What type is lignocaine?

A

Amide type

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39
Q

What drug prolongs anaesthesia and reduces bleeding?

A

Adrenaline

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40
Q

In what patients should you avoid adrenaline?

A

Cardiac disease and those on psychotropic drugs

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41
Q

What would you use electrosurgery for?

A

Haemostasis and treatment of minor skin lesions (skin tags)

42
Q

What are the two main types of skin cancer?

A

Non-melanoma - keratinocytes (can be BCC or SCC)

Melanoma - melanocytes

43
Q

What are BCC usually present as?

A

Translucent, painless, slow growing lump or a non-healing ulcer

44
Q

What do SCC usually arise on?

A

Sun-damaged skin

45
Q

What is the ABCDE rule for diagnosing melanoma early?

A 
Asymmetry
Border
Colour
Diameter
Evolution
46
Q

What type of skin cancer is a hyperkeratotic (crusted) lump or ulcer that arises on sun-damaged skin?

A

Squamous cell carcinoma

47
Q

Give two precursor lesions for squamous cell carcinomas?

A
  1. Actinic keratoses

2. Bowen’s disease

48
Q

What type of sun exposure leads to a SCC?

A

Chronic - total sun exposure

49
Q

List three genetic susceptibility factors for skin cancer?

A
  1. DNA repair syndromes e.g. Xeroderma Pigmentosum
  2. Albinism
  3. Naevoid basal cell carcinoma (Gorlin’s syndrome)
50
Q

What is an autosomal dominant familial cancer syndrome with palmar pits, jaw cysts and ectopic calcification falx?

A

Naevoid basal cell carcinoma (Gorlin’s syndrome)

51
Q

Name an immunological factor that is a risk factor for skin cancer?

A

Transplant areas

52
Q

What is carcinogenesis?

A

The process by which a normal cell becomes a malignant cancer cell

53
Q

What UV light gives indirect DNA damage, is more prevalent and penetrates more deeply into the skin?

A

UVA

54
Q

What UV light gives direct DNA damage, is 1000 times more damaging than UVA and occurs only when the sun is directly overhead?

A

UVB

55
Q

What is the UV signature mutation?

A

Pyrimidine dimer

56
Q

When is there an increased risk of SCC in relation to AK?

A

When they have merged to give a field change rather than discrete AK

57
Q

What is NBCCS (Gorlin’s) due to?

A

A germline mutation in PTCH gene

58
Q

What mutation is common and early events in skin cancer, and is found in AK, carcinoma in situ and SCC?

A

TP53

59
Q

List 5 phototoxic drugs?

A
  1. Voriconazole
  2. Thiazide diuretics
  3. NSAIDs
  4. Anti-TNF
  5. Azathioprine
60
Q

Where are melanocytes derived from?

A

The neural crest

61
Q

In early embryogenesis where do melanoblasts migrate from the neural crest to?

A
  1. Skin
  2. Uveal tract
  3. Leptomeninges
62
Q

Once melanoblasts settle in the skin what do they form?

A

Melanocytes

63
Q

What gene determines the balance of pigment in skin and hair?

A

MC1R

64
Q

What does MC1R turn phaeomelanin into?

A

Eumelanin

65
Q

What does one defective copy of MC1R cause?

A

Freckles

66
Q

What are patchy increases in melanin pigmentation and occur after UV exposure?

A

Freckles

67
Q

What are actinic lentigines also know as and related to?

A

Age or liver spots

Related to UV exposure

68
Q

During infancy the melanocyte:keratinocyte ratio breaks down at a number of cutaneous sites and causes what?

A

Simple naevi

69
Q

What type of acquired naevus develops in childhood?

A

Junctional naevus

70
Q

What type of acquired naevus develops in adolescence?

A

Compound naevus

71
Q

What type of acquired naevus develops in adulthood?

A

Intradermal naevus

72
Q

What naevi has architectural atypia and cellular atypia, host reaction fibrosis and inflammation, epidermis unaffected?

A

Dysplastic naevi

73
Q

What naevi have a peripheral halo of depigmentation as well as showing inflammatory regression and overrunning by lymphocytes?

A

Halo naevi

74
Q

What naevi are entirely dermal and consist of pigment rich dendritic spindle cells, the variant may have mitoses and mimic melanoma?

A

Blue naevi

75
Q

What naevi consist of large spindle epithelioid cells, may closely mimic melanoma, benign and are rare?

A

Spitz naevi

76
Q

Give two clinical features of Spitz naevi?

A
  1. Pink coluration due to prominent vasculature

2. Epidermal hyperplasia

77
Q

What are the four main types of malignant melanoma?

A
  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
Q

How do SSM, A/MLM and LMM maligant melanomas all grow?

A

As macules when either entirely in-situ or with dermal microinvasion

79
Q

What type of melanomas are the only ones that can metastasise?

A

VGP melanomas

80
Q

What type of malignant melanoma only has lesions with VGP?

A

Nodular melanoma

81
Q

With melanoma prognostic indicators - what is a strong adverse indicator?

A

Ulceration

82
Q

What causes melanocytic naevi present at birth?

A

Benign proliferations of melanocytes in the epidermis and or dermis

83
Q

What can be seen through a dermoscope when looking at a melanoma?

A

Atypical pigment network, black dots, irregular streaks, focally a blue-whitish veil and a white regression zone with hairpin vessels

84
Q

What is the most common subtype of melanoma?

A

Superficial spreading melanoma

85
Q

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)?

A

Superficial spreading melanoma

86
Q

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?

A

Nodular

87
Q

What type of melanoma is invasive developing within a lentigo maligna?

A

Lentigo maligna melanoma

88
Q

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?

A

Acral lentiginous melanoma

89
Q

Describe an amelanotic melanoma?

A

Absent or minimal visible pigment

90
Q

What lesions look “stuck on”, often warty, regular border and are often found on trunk?

A

Seborrheic keratoses

91
Q

What can be possibly due to insect bites and are deep, brown/grey firm nodules?

A

Dermatofibroma

92
Q

What are benign, precancerous dysplasias and can get invasive malignancies?

A

Epidermal tumours

93
Q

Give an example of a benign epidermal tumour?

A

Seborrhoeic keratosis

94
Q

What might an eruptive appearance on seborrhoeic keratosis indicate?

A

Internal malignancy - Leser-Trelat sign

95
Q

Give three clinical features of seborrhoeic keratosis?

A
  1. Epidermal acanthosis
  2. Hyperkeratosis
  3. Horn cysts
96
Q

Give three precursors of squamous cell carcinoma?

A
  1. Bowen’s disease - especially on legs
  2. Actinic keratosis - especially on head/neck
  3. Viral lesions - especially on anogenital skin
97
Q

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)?

A

Bowen’s disease

98
Q

What HPV type is associated with dysplasia?

A

type 16

99
Q

Give three situations where SCC may occassionally arise?

A
  1. Chronic leg ulcers (stasis ulcers)
  2. Sites of burns; sinuses (chronic osteomyelitis)
  3. Chronic lupus vulgaris
100
Q

Give three rare associations for SCC?

A
  1. Xeroderma pigmentosum
  2. Dystrophic variant
  3. Epidermolysis bullosa

JL Dermatology (6 decks)

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