Derma

Question 1

Management of impetigo

• limited, localised non bulbous disease
• extensive non bulbous or bulbous impetigo

Answer 1

• limited =
  hydrogen peroxide cream 1% - 1st line (antiseptic)
  Fusiliers acid 2% or umpire in - 2nd line (antibiotic)

Extensive =
Oral flucloxacillin
Oral erythromycin - if allergic to penicillin

Children excluded from school until lesions are crusted and healed or 48 hrs after start of antibiotic treatment

Question 2

Bulbous impetigo

Organism

Answer 2

Impetigo - fluid filled blisters >1cm
Staph aureus

*non bulbous impetigo more common

Question 3

Treatment of eczema herpeticum

Answer 3

Acyclovir

Painful rash associated with fever + hx of eczema

Question 4

Impetigo vs HSV

Answer 4

HSV = recurrent cold sores, prodromal pain , clear fluid vesicles
ADULTS

Impetigo - children

Question 5

Acne rosacea

Answer 5

Nose cheeks foreheads 
Flushing esp after alcohol or sunlight 
Later develops - persistent erythema w/ papules + pustules 
If eyes involved - blepharitis 
Rhinophyma - nose disfigurement

Question 6

Treatment acne rosacea

Answer 6

Topical metronidazole - mild sx

More severe disease - oxytetracycline, tetracycline (systemic ABx )

Question 7

Treatment tinea capitis

Complication of tinea capitis

Answer 7

Oral terbinafine , itraconazole, fluconazole
Systemic antifungal because of risk of scarring

Children — Griseofulvin

Comp - alopecia

Question 8

What dermatological condition is linked to coeliac disease

Answer 8

Dermatitis herpetiformis

- severely itchy rash over scalp sacrum elbows knees in pt wt/ coeliac disease

Question 9

Indications of IM adrenaline (6)

Answer 9

Wheeze, SOB, hoarseness of voice

Stridor, shock, swelling (facial tongue cheek)

Question 10

Skin disorders of pregnancy

Answer 10

Polymorphic eruption of pregnancy (PEP)
= PUPP - pruritic urticaria papules and plaques of pregnancy

Pemphigoid gestationis

Question 11

Polymorphic eruption of pregnancy (PEP)
= PUPP - pruritic urticaria papules and plaques of pregnancy

Features
Management

Answer 11

Itchy urticaria like rash , usually in 3rd trimester , primi
1st appear as abdominal striae, no blisters and spare umbilicus

Emollients
Mild topical steroids
Oral steroids

Question 12

Pemphigoid gestationis
Features
Treatment

Answer 12

Pruritic blistering lesions
Periumbilical - spread to trunk, back , buttocks , arms
2-3 trimester - rarely seen in 1st

Tx - oral corticosteroids

Question 13

Erythema multiforme
Causes
Common site

Answer 13

Site - back of hands, feet - spreads to trunk
Cause =
Virus - HSV - most common
Idiopathic
Bacteria - mycoplasma pneumonia , streptococcus
Drugs - penicillin , sulphonamide, carbamazepine, NSAIDs allopurinol COCP
Connective tissue disease - SLE
Sarcoidosis
Malignancy

Question 14

Treatment of erythema multiforme

Answer 14

Symptomatic
Oral antihistamines, analgesics
Local skin care and mouthwash - warm saline/xylocaine/diphenhydramine, kaopectate
Consider topical steroids

Question 15

History of camping w/ target lesions

Answer 15

Lyme disease

Erythema migrants

Question 16

Pink rings, non itchy , barely raised

Seen in rheumatic fever

Answer 16

Erythema marginatum - part of jones major criteria

Question 17

Erythema nodosum seen in

Answer 17

Painful tender nodules on shins

IBD - UC,CD
Penicillin
Sarcoidosis
TB

Question 18

Erythema infectiosum / slapped cheek

Treatment

Answer 18

Parvovirus B 19

Rest + analgesia

Question 19

Chronic infrared radiation exposure (heat)

Causes what skin manifestation

Answer 19

Erythema Ab Igne

Question 20

Rashes on flexor surfaces

Answer 20

Lichen planus - not contagious

Scariest - contagious

Question 21

Contagious skin conditions

Answer 21

Scabies
Molluscum contagiosum
Impetigo - very!

Question 22

Management of Mongolian blue spot

Dermal Melanosis

Answer 22

Reassure

Fades with time (few years)

Question 23

Xanthelasma

Management

Answer 23

Occur w/ or w/o hyperlipidemia

Check fasting lipid levels
If hyperlipidemic - formally assess CVD risk

Lesions can be left alone
Refer private clinic if removal

Question 24

Acne vulgaris
Colonising organism
Treatment

Answer 24

Obstruction of pilosebaceous follicle
Proprionibacterium (anaerobic)

T - topical benzoyl peroxide - reduces resistant proprioni in its on antibiotics

Question 25

Acne management

Answer 25

1. Single topical therapy - retinoids , benzoyl peroxide
2. Combo therapy - topical ABx, benzoyl, retinoids
3. Oral ABx - tetracycline ,doxy , “cyclines”
   Oral isotretinoin - under supervision
   Avoid tetra in pregnancy and <12 - use erythromycin in pregnancy
   Retinoids CI pregnancy

Question 26

Alternative sin acne treatment in pregnant women

Answer 26

COCPs ( alt to ABx)+ topical agents

Or

Question 27

Gram negative folliculitis as complication of long term ABx use in acne
How do you treat?

Answer 27

High dose oral trimethoprim

Question 28

Side effects of oral isotretinoin

Answer 28

Isotretinoin = 13 cis retinoids acid

Dry eyes, mouth , nose
Nose bleeds

Question 29

Red circular itchy rash

Answer 29

Ringworm likely = dermatophytosis

Tx - clotrimazole cram

Question 30

Linear tracks on skin (burrows) + severe itching on flexures of skin
Wrist finger webs , elbow, axillary, genitalia
Tx

Answer 30

Scabies
1st line - topical permethrin 5%
2nd line - malathion .5%

Hint = elderly in nursing home
Treat all family members even if asymptomatic

Question 31

Rash after URTI

Answer 31

• pityriasis rosea
  -Guttate psoriasis
  Both resolve spontaneously

Question 32

Guttate psoriasis

Answer 32

Classically preceded by strept throat infection 2-4 weeks prior
Tear drop scaly papules on trunk and limbs
Resolve spontaneously w/in 2-3 months

Or use topical psoarisis agents

Question 33

Pityriasis rosea
Features
Treatment

Answer 33

Recent resp infection
Herald patch 1-2 weeks later - slightly raised oval lesions w/ fine scale confined to outer aspect
Characteristic distribution - parallel to lager lines - fir tree appearance

Resolves in 6 weeks

Question 34

Non sedating antihistamines

Answer 34

Cetrizine loratidine

Question 35

sedating antihistamines

Answer 35

Chlorpheniramine

Question 36

Management of lipoma

Answer 36

Reassure
If doubts about liposarcoma - size >5 cm , increased size, painful or in a deep anatomical location - do US
If US suspicious- MRI +/- surgical removal

Question 37

Ritters/Lyell disease
Organism -
Cause

Answer 37

= staphylococcal scalded skin syndrome (SSSS)
Caused by release of 2 exotoxins
-epidermolytic toxins A &B from toxigenix strains of staph aureus

Ritter/Lyell - when it happens in infants / newborns

SSSS - children < 5

Question 38

Signs and symptoms of SSSS

Answer 38

Fever, irritability
Widespread redness
Fluid filled blisters within 24-48 hrs - rupture easily
Nilosky sign +ve (gentle strokes of skin = exfoliation)

Question 39

Dx of SSSS

Tx

Answer 39

Tzanck smear
Skin biopsy = intraepidermal cleavage at granular layer
Bacterial culture

Tx - hospitalisation
IV flucloxacillin and supportive treatment
Recovery writhing 5-7 of treatment

Question 40

Bullous pemphigoid
Cause
Common in
Features

Answer 40

Autoimmune - 2ry to development of antibodies against BP180 BP 230

Elderly >60
Blisters around dlexures, mouth spared
Heal w/o scarring

Question 41

Bullous pemphigoid
Investigation
Treatment

Answer 41

Skin biopsy - immunofluorescence = igG and C3 at dermoepidermal jn

Tx - oral corticosteroids
Refer to derma for biopsy and confirmation

2ry infection can occur causing delirium

Question 42

Paronychia/ whitlow
Organism
Treatment

Answer 42

Staph aureus
Topical fusidic acid - minor
Oral flucloxacillin / clarithromycin- severe (both considered 1st line)

Question 43

Treatment of impetigo

Answer 43

Hydrogen peroxide - antiseptic = 1st line

2nd line - antibiotics - fucidic acid or mupirocin

Extensive impetigo - oral flucloxacillin

Question 44

Herald patch

Answer 44

The biggest lesion in Pityriasis rosea