Derm Cram

Question 1

Immune cells found in erythema toxicum?

Answer 1

Eosinophilia

Question 2

Pathogenesis of acne?

Answer 2

Abnormal keratinisation
Increased sebaceous gland production
P Acnes
Inflammation

Question 3

Mechanism & indication for isotretinoin (Accutane)?

Answer 3

Severe nodulocystic acne
Reduces size and secretion of sea glands, normalises keratinisation
Course of 4-5 months
HIGHLY TERATOGENIC
Causes liver dysfunction (contraindication)

Question 4

Treatment of allergic contact dermatitis?

Answer 4

Avoidance of trigger
Topical corticosteroids
Topical calcineurin inhibitors
Systemic corticosteroids indicated if >20% BSA or if affect the face, hands, feet or genitalia

Question 5

Treatment of irritant contact dermatitis?

Answer 5

Increase emollient use
Topical corticosteroids
Gloves
Systemic corticosteroids are not indicated

Question 6

Pathogen related to seborrheic dermatitis?

Answer 6

Pityrosporum ovale yeast

Question 7

Treatment of seborrheic dermatitis?

Answer 7

If scalp - medicated shampoo, wet compresses +/- topical antifungals
If not scalp - topical corticosteroids +/- antifungals
Consider pimecrolimus in severe disease

Question 8

Yellow-gold on wood’s lamp exam

KOH preparation shows groups of thick walled spores, short angular hyper resembling spaghetti and meatballs

Answer 8

Tinea/Pityriasis Versicolour

Question 9

Preferred topical anti fungal agent?

When systemic therapy indicated?

Answer 9

Terbinafine
If chronic/resistant infection or scalp/nail involvement use systemic therapy
Baseline ALT/AST required prior to systemic therapy

Question 10

Indications for treatment of haemangiomas?

Answer 10

If large/rapidly growing
Periorbital
Airway (beard distribution) / liver / GIT lesion
If ulcerating

Question 11

> 5 haemangiomas?

Answer 11

Needs liver USS to investigate for liver haemangioma

Question 12

Thrombocytopenia/coagulopathy with large haemangioma?

Answer 12

Kasabach-Merritt phenomenon

platelet trapping in vascular tumour

Question 13

Segmental haemangioma on face/head?

Answer 13

PHACE
Posterior fossa brain malformation
Haemangioma
Arterial anomaly
Cardiac/coarctation
Eye and endocrine

Question 14

Segmental haemangioma on lumbosacral region?

Answer 14

Assoc myelopathy
Spinal and genitourinary anomalies
Needs MRI as investigation

Question 15

Beard hameangioma

Answer 15

Airway haemangioma

Risk of airway sx at 6-12 weeks when haemangioma proliferation is rapid

Question 16

SEs of propranolol?

Answer 16

Low BP and HR (peaks 2hrs post)
Wheeze & bronchospasm
Hyperkalaemia
Diarrhoea
Masks low BGL symptoms except sweating - parents need to be aware
Infants <2mths admitted for observation with first doses

Question 17

When not to use propranolol in haemangiomas?

Answer 17

Sinus brady/1st degree heart block
Bronchial asthma
Hypersensitivity to BBs
Prem infant aged <5 weeks

PHACE with cervical stenosis/coractation
Drop in BP -> ischaemia

Question 18

Itchy worse at night with tracks between fingers

Answer 18

Scabies

Question 19

Treatment for scabies?

Answer 19

Ivermectin/permethrin

Question 20

Flat, non-blanching red rash not crossing midline
Growing with child
Management?

Answer 20

Port Wine Stain/Naevus Flammeus

Pulsed dye laser - lightens without causing scarring

Question 21

Associations with port wine stain?

Answer 21

Glaucoma
Spinal dyraohism
Stoft tissue/bony overgrowth

Question 22

Port wine stain V1/V2 trigeminal distribution
Leptomeningeal angiomatosis
Glaucoma

Answer 22

Sturge Weber Syndrome

Question 23

Port wine stain on limb
Venous/lymphatic malformation
Soft tissue/bone hypertrophy

Answer 23

Kippel-Trenaunay Syndrome

Question 24

Port wine stain limb
AV shunts with CCF
AVM

Answer 24

Parkes-Weber Syndrome

Question 25

Newborn with raised brown lesion with irregular margin | Biopsy shows nevus cells in lower reticular dermis

Answer 25

Congenital melanocytic naevi

Question 26

Risk of malignant transformation in congenital melanocytes naevus?

Answer 26

5% | Risk proportional to size

Question 27

Melanocytic nevus on biopsy shows atypical intraepidermal melanocytes +/- angiogenesis?

Answer 27

Atypical Melanocytic Naevi

Question 28

Risk factors for paediatric melanoma?

Answer 28

Atypical mole/melanoma syndrome Xeroderma pigmentosum Acquired melanocytic naevi/atypical naevi

Question 29

Hairless, red, dome shaped naevus

Answer 29

Spitz Naevus

Question 30

Patchy skin pigmentation following lines of Blashko?

Answer 30

McCune Albright

Question 31

Conditions presenting with lentigines? | Lentigines = small round dark brown macule like freckles/moles

Answer 31

LAMB syndrome LEOPARD syndrome Puetz Jeghers

Question 32

Conditions presenting with cafe au last macule?

Answer 32

``` NF Tuberous sclerosis Turner's Fanconi Anaemia Russell-SIlver McCune Albright (Blashko) Bloom Cowden ```

Question 33

Absent/reduced pigment in hair, skin, eyes?

Answer 33

Oculocutaneous albinism

Question 34

Rash begins on face | Koplik spots

Answer 34

Measles

Question 35

Rosy cheeks developing into lacy rash which spares the palms and soles

Answer 35

Parvovirus

Question 36

Small raised erythematous lesions beginning on trunk and spreading to limbs

Answer 36

Roseola Infantatum | HHV6,7

Question 37

Nonpruritic rash beginning on face and spreading downwards

Answer 37

Rubella

Question 38

Umbilicated epidermal papules

Answer 38

Molluscum | In immune competent 50% have cleared within 12 months

Question 39

HPV assoc w genital warts and respiratory papillomatosis?

Answer 39

HPV 6 and 11 11 more severe and more common Treat with laser, cidofivir or interferon

Question 40

HPV assoc w cervical Ca?

Answer 40

16, 18 | Detected in 70% of Cervical Ca

Question 41

RF for staph scalded skin?

Answer 41

Neonates - renal excretion of staph toxin reduced

Question 42

Unwell infant week 1 of life with fever Blistering skin which heals without scars Nikolsky sign positive Mucus membranes not involved

Answer 42

Staph scalded skin

Question 43

Differentiation between staph scalded skin and TENS/SJS?

Answer 43

Staph scalded skin = intraepidermal cleavage and NO mucosal involvement TEN = sub epidermal cleavage and necrosis and vast mucosal involvement

Question 44

Scaling on extensor surfaces, flexural surfaces spared Keratosis pillars Hyperkeratosis of palms and soles

Answer 44

Icthyosis Vulgaris Most common disorder or keratinisation AD - fillagrin mutation Treat with moisturiser and salicylic acid

Question 45

Harlequin Ichthyosis treatment?

Answer 45

Oral retinoids Now 80% survive beyond infancy ABA12 mutation

Question 46

Alopecia Unilateral yellow, waxy, scaling Hemidysaplsia Limb defects

Answer 46

CHILD syndrome | Congenital Hemidysplasia with Ichthyosiform erythroderma and Limb Defects

Question 47

Baby presents with unilateral facial swelling over a period of weeks-months Painless mass that can be transilluminated Sudden increase in size, accompanied by fever

Answer 47

Lymphatic malformation 50% head/neck 50% at birth and rest develop prior to age 2 Rapid enlargement can be due to bleed or infection

Question 48

Skin thickening and tethering to underlying tissue | Renal failure

Answer 48

Nephrogenic systemic fibrosis

Question 49

Most common superinfectioms in VZV?

Answer 49

Strep pyogenes | Staph Aureus

Question 50

Erythematous macules in infancy with increasing wheals/dermatographism which touched

Answer 50

Urticaria pigmentosa