Derm

Question 1

patient has dermatomyositis, what else should be investigated for?

Answer 1

Malignancy - can be a paraneoplastic phenomenon

Question 2

which MHC antigen is psoriasis related to?

Answer 2

HLA-B27

Question 3

treatment for fungal nail infection?

Answer 3

oral terbinafine

Question 4

treatment of psoriasis?

Answer 4

1st line avoid irritants + soap substitutes + emollients (diprobase)

2nd line - topical vit D (calcipitriol) + steroids

3rd line - phototherapy/ oral methotrexate, ciclosporin etc

4th line - biologics - anti TNFs

Question 5

what initially presents as a small patch (herald) with a later widespread rash containing multiple patches? Usually occurs after URTI?

Answer 5

Pityriasis Rosea

Treatment = self limiting (disappears after couple of weeks)

Question 6

causes of erythroderma?

Answer 6

Eczema, Psoriasis, drug-induced

Admit, give IV fluids, watch for fluid loss, electrolytes and hypothermia

Question 7

purple and itchy plaques and lace-like pattern in mouth (stings while eating)

Answer 7

Lichen Planus (ithcy purple - planus)

Question 8

pemphigus vulgarus vs pemphigoid

Answer 8

vulgarus - blisters tend to be burst (IgG within epidermis)

pemphigoid - blisters intact due to deepness (IgG on basement membrane)

Question 9

bacteria involved in acne?

Answer 9

propionibacterium acnes

Question 10

treatment of acne?

Answer 10

stepwise:

• topical benzoyl peroxide
• tetracycline
• vit A analogue
• COCP
• oral isotretinoin

If scarring present then give Oral Isotretinoin

Question 11

slow growing lesion, hx of sun burn, rolled edges (pearlescent?), telangectasia

Answer 11

Basal cell carcinoma - don’t metastasise

• excision with 4 mm margins
• MOH’s micrographic surgery in ‘delicate’ areas

Question 12

> 1mm breslow thickness, what do we do?

Answer 12

sentinel node biopsy! (more likely nodal involvement of melanoma)

Question 13

what is a melanoma? how to treat?

Answer 13

cancerous growth of melanocytes (reduce sun exposure)

2 week referral to derm.

wide local excision + lymphadenectomy
+/- adjuvant radiotherapy

Question 14

causes and how to deal with steven johnsons syndrome?

Answer 14

drug eruption (often a week after)
-erythematous macules > target lesions

Can progress to TEN if >30% body surface

Supportive therapy with skin and eye care

Question 15

history of eczema then presents with widespread rash think…

Answer 15

eczema herpeticum (treat with IV aciclovir)

Question 16

what rash (light red scaly marks) usually appears few weeks after strep throat infection?

Answer 16

Guttate Psoriasis