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  <head>
    <title>034-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Skin function, wounds, infection, tumours">
      <outline text="Orientation and skin structure">
        <outline text="Barrier, immune, sensory, thermoregulatory organ"/>
        <outline text="Describe morphology and distribution before naming"/>
        <outline text="Colour signs differ across pigmentation"/>
        <outline text="Keratinocytes form the stratum corneum">
          <outline text="Corneocytes in lipid layers resist water"/>
          <outline text="Barrier disruption admits irritants and pathogens"/>
        </outline>
        <outline text="Melanin absorbs ultraviolet, limits DNA damage">
          <outline text="Colour reflects melanosomes, not melanocyte number"/>
        </outline>
        <outline text="Langerhans cells survey, Merkel cells aid touch"/>
        <outline text="Papillary dermis interfaces, reticular gives strength"/>
        <outline text="Subcutis cushions, insulates, stores energy"/>
      </outline>
      <outline text="Thermoregulation, sensation, secretion">
        <outline text="Vasodilation sheds heat, vasoconstriction conserves"/>
        <outline text="Eccrine sweat cools by evaporation">
          <outline text="Mainly sympathetic cholinergic control"/>
        </outline>
        <outline text="Impaired sweating or sensation raises injury risk"/>
        <outline text="Itch uses pathways distinct from pain">
          <outline text="Skin, kidney, liver, blood, drug, nerve causes"/>
          <outline text="Scratching damages barrier, sustains the cycle"/>
        </outline>
        <outline text="Sebum, apocrine secretion, vitamin D synthesis"/>
      </outline>
      <outline text="Describing a rash">
        <outline text="Site, number, arrangement, symmetry, distribution"/>
        <outline text="Primary lesions: macules to wheals and cysts"/>
        <outline text="Secondary changes: scale, crust, erosion, scar"/>
        <outline text="Diascopy tests blanching"/>
        <outline text="Dermoscopy shows subsurface pigment and vessels"/>
        <outline text="Precise description narrows mechanism"/>
      </outline>
      <outline text="Inflammatory dermatoses">
        <outline text="Atopic dermatitis: barrier, inflammation, itch">
          <outline text="Emollients, irritant avoidance, topical therapy"/>
          <outline text="Unsupported food avoidance harms nutrition"/>
        </outline>
        <outline text="Contact dermatitis: irritant or allergic">
          <outline text="Patch testing differs from immediate testing"/>
        </outline>
        <outline text="Psoriasis: demarcated scaly extensor plaques">
          <outline text="Systemic, cardiometabolic, psychological burden"/>
        </outline>
        <outline text="Urticaria: transient mast-cell wheals">
          <outline text="Angioedema involves deeper tissue"/>
          <outline text="Airway or anaphylaxis features need adrenaline"/>
        </outline>
      </outline>
      <outline text="Skin infection">
        <outline text="Impetigo, folliculitis, abscess"/>
        <outline text="Cellulitis: usually unilateral spreading infection">
          <outline text="Bilateral red legs often non-infectious"/>
        </outline>
        <outline text="Necrotising infection: pain out of proportion">
          <outline text="Immediate surgery; imaging must not delay"/>
        </outline>
        <outline text="Herpes simplex: grouped painful vesicles"/>
        <outline text="Zoster follows a sensory distribution">
          <outline text="Early antivirals in high-risk sites and hosts"/>
        </outline>
        <outline text="Dermatophytes and Candida: sample first"/>
        <outline text="Scabies: manage contacts and environment"/>
      </outline>
      <outline text="Wounds, ulcers, and pressure injury">
        <outline text="Haemostasis, inflammation, proliferation, remodelling">
          <outline text="Scar never matches uninjured strength"/>
        </outline>
        <outline text="Infection, ischaemia, oedema, pressure delay healing"/>
        <outline text="Dressing follows tissue and moisture, not brand"/>
        <outline text="Venous ulcers: compression after arterial check"/>
        <outline text="Arterial ulcers: painful, distal, poorly perfused"/>
        <outline text="Neuropathic ulcers at insensate pressure points"/>
        <outline text="Pressure and shear compromise microcirculation">
          <outline text="Deep tissue injury before surface breakdown"/>
          <outline text="Reposition, redistribute, off-load heels"/>
          <outline text="Healing lesions are not reverse-staged"/>
        </outline>
      </outline>
      <outline text="Burns">
        <outline text="Depth, area, site, inhalation, mechanism"/>
        <outline text="Superficial burns painful and blanching"/>
        <outline text="Deep burns pale, leathery, or insensate"/>
        <outline text="Circumferential burns impair circulation, ventilation"/>
        <outline text="Cool with running water, avoid ice and hypothermia"/>
        <outline text="Major burns: fluids, warmth, specialist transfer"/>
      </outline>
      <outline text="Drug eruptions and blistering">
        <outline text="Morbilliform eruption: timing, systemic findings"/>
        <outline text="Eosinophilic systemic drug reaction: organ injury"/>
        <outline text="Stevens-Johnson syndrome, toxic epidermal necrolysis">
          <outline text="Stop suspected drugs, urgent specialist care"/>
        </outline>
        <outline text="Autoimmune blistering: antibodies to adhesion">
          <outline text="Biopsy plus perilesional immunofluorescence"/>
          <outline text="Fluid loss, infection, temperature instability"/>
        </outline>
      </outline>
      <outline text="Skin tumours">
        <outline text="Basal-cell carcinoma: local invasion, rare spread"/>
        <outline text="Squamous-cell carcinoma: higher metastatic risk"/>
        <outline text="Melanoma: dangerous metastatic potential">
          <outline text="Evolution or outlier lesion matters most"/>
          <outline text="Nodular melanoma symmetric but enlarging"/>
          <outline text="Excision biopsy, not destructive treatment"/>
        </outline>
        <outline text="Prevention: shade, clothing, sunscreen"/>
        <outline text="Appearance cannot exclude malignancy"/>
      </outline>
    </outline>
  </body>
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