Clinical Cases

Question 1

What questions should be asked to any patient with suspected psoriasis?

Answer 1

if theyve had any problems with their scalp or joint pain or nails

Question 2

What might be seen on examination of the nails of a patient with psoriasis?

Answer 2

pitting; onycholysis; subungal hyperkeratosis; dystrophy

Question 3

What does guttate psoriasis look like?

Answer 3

small, red/salmon pink papules on the skin with scales

Question 4

What often precipitates guttate psoriasis?

Answer 4

strep throat infection

Question 5

What is the auspitz sign?

Answer 5

removal of surface scale reveals tiny bleeding points

Question 6

What is auspitz sign caused by pathologically?

Answer 6

dilated capillaries in elongated dermal papillae

Question 7

What are the 4 main types of psoriasis?

Answer 7

chronic plaque psoriasis (psoriasis vulgaris)
guttate psoriasis
palmoplantar pustular
erythrodermic/ widespread pustular

Question 8

What other diseases are psoriasis patients at risk of?

Answer 8

cardiovascular risk is increased

Question 9

Why are lifestyle questions important in psoriasis?

Answer 9

as CVS risk is increased, risk factors need to be managed

Question 10

What are the topical therapies available for psoriasis?

Answer 10

vitamin D analogues
coal tar
dithranol
steroid ointments
emollients

Question 11

What are the actions of emollients?

Answer 11

anti-inflammatory

anti-hyperkeratotic

Question 12

What other treatments are there for psoriasis?

Answer 12

phototherapy
immunosppression
immune modulation (anti-TNFalpha)

Question 13

What is the pathogenesis of acne?

Answer 13

poral occlusion
bacterial colonisation of duct (p. acnes)
dermal inflammation
increased sebum production

Question 14

What is the morphology of acne?

Answer 14

comedones
pustules and papules
cysts
erythema

Question 15

What are the topical treatments available for acen?

Answer 15

benzoyl peroxide
topical vit A derivatives
topical antibiotics

Question 16

What are the systemic treatments available for acne?

Answer 16

antibiotics

isotretinoin

Question 17

Why are there no comedones found in rosacea

Answer 17

rosacea is not a disease of the pilosebaceous unit

Question 18

Aside from facial effects, what else can be caused by rosacea?

Answer 18

conjuctivitis/gritty eyes

Question 19

What are the topical therapies available for rosacea?

Answer 19

metronidazole

ivermectin

Question 20

What are the systemic therapies available for rosacea?

Answer 20

tetracycline

isotretinoin

Question 21

What are Wickham’s striae?

Answer 21

whitish lines seen in the papules of lichen planus and in the buccal mucosa

Question 22

What drugs can cuase lichenoid drug eruptions?

Answer 22

ACEI; statins

Question 23

How is lichen planus treated?

Answer 23

topical steroid

Question 24

What areas does lichen planus typically effect?

Answer 24

volar wrists/forearms, shins and snkles

Question 25

What is the difference between bullous pemphigoid and pemphigus?

Answer 25

pemphigoiD- split is Deeper through DEJ

pemphiguS-split more Superficial, intra-epidermal

Question 26

What is Nikolsky’s sign?

Answer 26

top layers of the skin slip away from the lower layers when slightly rubbed

Question 27

What does Nikolsky’s sign indicate?

Answer 27

plane of cleavage is within the epidermis

Question 28

What age of patient is bullous pemphigoid seen in?

Answer 28

elderly patients

Question 29

Where is bullous pemphigoid seen on the body?

Answer 29

localised to one area or widespread on the trunk and proximal limbs

Question 30

What is seen early in the disease progression of bullous pemphigoid?

Answer 30

urticated itchy plaques

Question 31

What areas does pemphigus vulgaris affect?

Answer 31

scalp, face, axillae, groins

Question 32

Is pemphigus or pemphigoid nikolsky sign positive?

Answer 32

pemphigoid

Question 33

Does pemphigus or pemphigoid tend to have muscosal involvement?

Answer 33

pemphigus