Derm

Question 1

Name the 5 layer of skin

Answer 1

Question 2

Name the microganisms normally found on skin

Answer 2

Question 3

What causes dementia, diarrhoea and dermatitis.
What is it ass w/

Answer 3

Pellagra is a caused by nicotinic acid (niacin) deficiency.
isoniazid therapy (isoniazid inhibits the conversion of tryptophan to niacin) and it is more common in alcoholics.

Question 4

autoantibodies targeting hemidesmosomal BP antigens results in

Answer 4

Bullous pemphigoid

Question 5

Rx lichen planus

Answer 5

Potent topical steroids

Question 6

Rx early keloids

Answer 6

intra-lesional steroids e.g. triamcinolone

Question 7

Side effect of Minocycline

Answer 7

irreversible skin pigmentation and is now considered a second line drug in acne.

Question 8

Chronic plaque psoriasis management

Answer 8

1. 1st ln regular emollients
   - OD -potent corticosteroid + vitamin D analogue - applied separately, one AM & one in PM eg.- calcipotriol (Dovonex), calcitriol and tacalcitol- work by ↓ cell division & differentiation =↓ epidermal proliferation

• 2nd-line: if no improvement after 8 weeks then offer:** BD vitamin D analogue**
• 3rd-line: if no improvement after 8-12 weeks then offer either:
  o potent corticosteroid bd for up to 4 weeks, or
  o a coal tar preparation applied od or bd
• short-acting dithranol can also be used

Question 9

Chronic plaque psoriasis management in secondary care

Answer 9

Phototherapy:
narrowband ultraviolet B light rx of choice. 3 times a week

**photochemotherapy **- psoralen + UV A light (PUVA)- adverse effects: skin ageing, squamous cell cancer (not melanoma)

Question 10

Scalp psoriasis management

Answer 10

potent topical corticosteroids used once daily for 4 weeks

Question 11

Erythema nodosum
Infection (3)
Systemic d (3)
Drugs (3)

Answer 11

Infection
1. streptococci
2. tuberculosis
3. brucellosis

systemic disease
1. sarcoidosis
2. IBD
3. Behcet’s

malignancy/lymphoma
drugs
1. penicillins
2. sulphonamides
3. COCP

pregnancy

Question 12

Atopic dermatitis eczema lab findings

Answer 12

IgG Eosinophilia

Question 13

Rx Seborrhoeic dermatitis

Answer 13

Rx:
ketoconazole 2% shampoo

2nd ln : preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’)

Selenium sulphide and topical corticosteroid maybe helpful

Question 14

6 p’s of Lichen planus

Answer 14

1. Planar(flat topped); 2.Polygonal (multiple sides);
   3.Purple colored;
   4.Pruritic of
   5.Papules /Plaques.

Question 15

Where is Lichen planus found?
what may be found on the surface?
Where else may it be found

Answer 15

palms, soles, genitalia and flexor surfaces of arms
rash
often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)

Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)

oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging

Question 16

drug causes Lichen planus

Answer 16

Drug eruptions - causes:
gold
quinine
thiazides

Question 17

Pityriasis rosea
Feature
is ass w/ virus
RX

Answer 17

Ass. herpes hominis virus 7 (HHV-7) may play a role.

Features
Minority of pt have hx recent viral infection

herald patch (usually on trunk)- salmon pigmented in light skin, dark pigmented in dark skin; often Neck, chest, back: turns into erythematous, oval, scaly patches spread from top down= ‘fir-tree’ appearance

Rx: Self-limiting, resolves after around 6 weeks

Question 18

Psoriasis HLA associations

Answer 18

genetic: ass. HLA-B13, -B17, and -Cw6. Strong concordance (70%) in identical twins

Question 19

Drug causes of Psoriasis

Answer 19

drugs:
beta blockers,
lithium,
antimalarials (chloroquine and hydroxychloroquine), NSAIDs and
ACE inhibitors,
infliximab

• withdrawal of systemic steroids
  Streptococcal infection may trigger guttate psoriasis

Question 20

Chronic plaque psoriasis management

Answer 20

. regular emollients
-1st ln: OD -potent corticosteroid + vitamin D analogue - calcipotriol (Dovonex), calcitriol and tacalcitol
- should be applied separately, one in the morning and the other in the evening

• 2nd-line: if no improvement after 8 weeks then offer: BD vitamin D analogue
• 3rd-line: if no improvement after 8-12 weeks then offer either:
  o a potent corticosteroid bd for up to 4 weeks, or
  o a coal tar preparation applied od or bd
• short-acting dithranol can also be used

Question 21

What is Lichen sclerosus /lichen sclerosus et atrophicus

Answer 21

inflammatory condition
affects the genitalia and is more common in elderly females.
atrophy of the epidermis with white plaques forming

Features
white patches that may scar
* itch is prominent
* may result in pain during intercourse or urination
* rx topical steroids and emollients

Question 22

Name the layers of the skin

Answer 22