Derm 3

Question 1

True/false

Venous ulcer’s are more common on the lateral malleolus

Answer 1

False – they are more common on the medial malleolus

Question 2

True/false

Venous ulcers have a necrotic base

Answer 2

False – arterial ulcers do; venous ulcers have a granulating base

Question 3

True/false

Arterial ulcers are worse in bed at night

Answer 3

True – when the leg is raised the blood supply to the foot is less, so patients commonly dangle their foot from the end of the bed increase the blood supply and ease the pain.

Question 4

True/false

Neuropathic ulcers are painful

Answer 4

False– they are painless

Question 5

True/false

Dermatomyositis muscle involvement comes after cutaneous signs

Answer 5

False – Muscle involvement can occur concurrently, precede or may follow skin disease

Question 6

True/false

A SCC arising from an area of Bowens disease is most likely to metastasise

Answer 6

True

Question 7

True/false

Erythroderma is inflammatory skin disorder affecting >90% of skin

Answer 7

True

Question 8

Which disease is most likely associated with intractable vasculitic ulcers
A: Diabetes
B: SLE
C: Rheumatoid arthritis
D: Leprosy

Answer 8

C: Rheumatoid arthritis

Question 9

Which is the most likely malignancy in a long-standing ulcer
A: SCC
B : BCC
C: Malignant melanoma
D: Viral wart

Answer 9

SCC

Question 10

Compression stockings contraindicated below which ABPI:-
A: 1
B: 0.9
C: 0.8
D: 0.7

Answer 10

0.8

Question 11

Which of these is NOT classically associated with pyoderma gangrenosum

A: IBD
B: Myeloma
C: Diabetes
D: Rheumatoid arthritis

Answer 11

diabetes

Question 12

Erythema Nodosum is NOTassociated with:

A: OCP
B: Sarcoid
C: Vasculitis
D: Streptococcal infection

Answer 12

Vasculitis

Question 13

Acanthosis Nigracans is associated with

A: Diabetes
B: Stomach cancer
C: Vasculitis
D: Obesity

Answer 13

Diabetes

Question 14

Dermatomyositis is NOT associated with

A: Malignancy
B: Papules on the volar aspect of the IP joints
C: Photosensitive rash
D: Periorbital purple rash

Answer 14

B – they tend to involve the dorsal aspect of the IP joints

Question 15

1. Which of the following has the worst prognosis?
2. Which is most common in Caucasians?
3. Which most common in Orientals?

A: Lentigo Maligna Melanoma
B: Nodular melanoma
C: Acral lentiginous melanoma
D: Superficial spreading melanoma

Answer 15

1. B
2. D
3. C

Question 16

Which does NOT predict poorer prognosis in melanoma

A: Ulceration
B: Nodule
C: Amelanosis
D: Female sex

Answer 16

D Females have a better prognosis

Question 17

When would you consider sentinel lymph node biopsy

A: >1mm depth
B: >2mm depth
C: >3mm depth
D: Melanoma of any depth

Answer 17

A

Question 18

How would you initially stage a melanoma

A: Excision biopsy
B: Shave biopsy
C: Punch Biopsy
D: Sentinal node biopsy

Answer 18

A – an excision biopsy is preferred, including initially 1-2mm margin of all layers of skin and some subcutaneous fat to determine depth/extent of lesion. If suggestive lesion is in cosmetically sensitive site, incisional/punch biopsy may be apt. These should be taken from the most abnormal area of lesion.

Question 19

What clearance do you require for excision of melanoma in situ

A: 0.5cm
B: 1cm
C: 2cm
D: 3cm

Answer 19

A

Question 20

Which of these are first line for scabies infestation

A: Topical Steroids
B: Antihistamine
C: Permethrin
D: Malathione

Answer 20

C: Permethrin

Question 21

What are the types of penicillin, how are they administered and what are they used for?

Answer 21

IV: Benzylpenicillin sodium (Penicillin G)
- streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas-gangrene, and leptospirosis. Pneumococci, meningococci, and gonococci which have decreased sensitivity to penicillin have been isolated; benzylpenicillin sodium is no longer the drug of first choice for pneumococcal meningitis.

Oral: Phenoxymethylpenicillin (Penicillin V)

• not be used for serious infections because absorption can be unpredictable and plasma concentrations variable
• indicated principally for respiratory-tract infections in children, for streptococcal tonsillitis, and for continuing treatment after one or more injections of benzylpenicillin sodium when clinical response has begun
• It should not be used for meningococcal or gonococcal infections
• Phenoxymethylpenicillin is used for prophylaxis against streptococcal infections following rheumatic fever and against pneumococcal infections following splenectomy or in sickle-cell disease.

Question 22

When is flucloxacillin used?

Answer 22

Most staphylococci are now resistant to benzylpenicillin because they produce penicillinases. Flucloxacillin, however, is not inactivated by these enzymes and is thus effective in infections caused by penicillin-resistant staphylococci, which is the sole indication for its use. Flucloxacillin is acid-stable and can, therefore, be given by mouth as well as by injection. Flucloxacillin is well absorbed from the gut.