Dermatology

Question 1

46 y/o male known chronic plaque psoriasis diagnosis
- usually well controlled with emollients

• has had flare up in last couple weeks
• patches of psoriasis over elbows and knees

what might you give him to control his flare?

Answer 1

• potent topical corticosteroid

AND a

• separate topical vitamin D preparation

Question 2

32 y/o with known psoriasis.
- usually well controlled

• has had flare up in last couple weeks
• patches of psoriasis in axilla

what would you prescribe to control his flare up?

Answer 2

• mild topical corticosteroid alone

- skin of flexure areas in much thinner and more sensitive to steroids compared to extensor surfaces

Question 3

potent steroid applications should be limited to how many weeks?

what might be given as next line treatment?

Answer 3

• 8 weeks, with atleast 4 week break

- topical vitamin D analogue twice daily.

Question 4

children with new purpuric rash should be admitted immediately for investigations as it may be a sign of :

Answer 4

• meningococcal septicaemic

- acute lymphoblastic leukaemia

Question 5

The following description is indicative of what rash:

• herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions
• fir tree appearance

Answer 5

Pityriasis rosea

• acute
• self limiting
• usually disappears after 6-12 weeks

Question 6

how long does pityriasis rosea last?

Answer 6

6 to 12 weeks

Question 7

patient presenting with

• erythematous rash on nose. forehead, cheeks
• associated with telangiectasis and papules
• flushing symptoms

characteristic of:

Answer 7

acne rosacea

Question 8

management of acne rosacea?

Answer 8

topical metronidazole may be used for mild symptoms

Question 9

rhinophyma is a common complication of

Answer 9

acne rosacea

Question 10

onchomycosis is a …

Answer 10

fungal infection of the nails

Question 11

65 y/o male

• T2DM
• subungual hyperkatosis of both bit toenails
• yellow discoloration
• onycholysis
• really bothering patient

clippings confirm onychomycosis cause by dermatophytes

first line medication of dermatophyte nail infections?

Answer 11

oral terbinafine

do not need to be treated if it is asymptomatic and the patient is not bothered by the appearance

Question 12

onychomycosis if a fungal infection of the nails.

may be caused by ? (3)

Answer 12

1. dermatophytes (mainly trichophyton rubrum, 90%)
2. yeasts (candida)
3. non-dermatophyte moulds

Question 13

generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae.

Answer 13

erythrasma

- usually treated with oral erythromycin

Question 14

female patient post birth presents with
- itchy, erythematosus papules on face, neck, chest and extensor surfaces of limbs

most likely to be

Answer 14

atopic eruption of pregnancy

Question 15

female pregnant patient with:

• pruritic blistering lesions
• often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
• usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy

indicative of:

Answer 15

pemphigoid gestationis

• usually requires oral corticosteroids

Question 16

5 3 y/o female

• worsening erythematous rash on nose, forehead and cheeks
• associated with telangiectasia and papules
• aggravated by sun exposure
• NKDA

condition and first line management?

Answer 16

• acne rosacea

- topical metronidazole

Question 17

what condition is characterised by the following:

• acute eruptions of deep seated vesicles in the palms and fingers
• followed by scaling and fissuring of affected areas
• associated with hot, humid environments

Answer 17

pompholyx eczema

Features
- small blisters on the palms and soles

• pruritic
• —–often intensely itchy
• —–sometimes burning sensation

-once blisters burst skin may become dry and crack

Management: cool compresses, emollients, topical steroids

Question 18

pink discoloration commonly on nape of neck. flat vascular lesion from birth.

likely to be a :

Answer 18

salmon patch

They are pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck. They usually fade over a few months, though marks on the neck may persist.

Question 19

62 y/p lesion on RHS of nose.

lesion described to be:

• rolled pearly edges
• with telangiectasia surrounding central crater

likely diangosis?

Answer 19

basal cell carcinoma

- slow growth , local invasion

Question 20

the intense pruritus associated with scabies is due to a:

Answer 20

delayed type IV hypersensitivity reaction to mites/ eggs which occurs 30 days post infection

Question 21

blepharitis is

Answer 21

inflammation of the eyelids

Question 22

72 y/o female

• 4 week hx of sore gritty eyes
• inflamed skin with fine scaling around nasolabial folds and eyelashes
• ear canal is erythematous, obscured by debris
• pmh parkinsons

likely diagnosis?

Answer 22

seborrhoeic dermatitis
- pt has both otitis externa and blepharitis

• more common in parkinson’s disease

Question 23

what does the koebner phenomenon describe?

Answer 23

• skin lesions that appear at site of injury

- molluscum contagiosum is a common viral lesion which exhibits this phenomenon

Question 24

Red or black lump, oozes or bleeds, sun-exposed skin

indicative of:

Answer 24

nodular melanoma

Question 25

how can spider naevia be differentiated from telangiectasia?

Answer 25

- by pressing on them - spider naevia fill from centre - telangiectasia fill from edge

Question 26

symmetrical typical brown, velvety patches which affect the axilla, neck and groin. known as:

Answer 26

acanthosis nigricans

Question 27

pt with Parkinson's presents with - itchy red rash on neck, behind ears, around nasolabial folds - similar flare up last winter likely to be:

Answer 27

seborrhoea dermatitis - causes eczematous lesions on sebum rich areas - otitis externa and blepharitis may develop

Question 28

baby with multiple white tiny papule on nose. likely diagnosis?

Answer 28

- milia - common, normal finding on new borns - usually resolve spontaneously over the course of a few weeks

Question 29

small, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns. indicative of:

Answer 29

milia

Question 30

condition characterised by | - multiple telangiectasia over the skin and mucous membranes

Answer 30

hereditary haemorrhagic telangiectasia autosomal dominant diagnostic criteria: 1. epistaxis 2. telangiectasis 3. visceral lesions: GI t.tasia 4. FH

Question 31

autoimmune condition causing - sub-epidermal blistering of skin - itchy, tense blisters typically around flexures - blisters usually heal without scarring - no mucosal involvement

Answer 31

bullous pemphigoid mainstay of treatment - oral corticosteroids

Question 32

tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

Answer 32

keloid scars

Question 33

17 y/o female - very fine layer of soft un-pigmented hair covering entire body - apart from palmar and plantar surfaces most likely cause:

Answer 33

- pt has lanugo hair - malnutrition - common finding in anorexia nervosa pts

Question 34

stress ulcers in burns patients are referred to as

Answer 34

curlings ulcers

Question 35

A 19-year-old student presents with a 1 cm golden, crusted lesion on the border of her left lower lip. characteristic of:

Answer 35

impetigo

Question 36

what is impetigo?

Answer 36

- superficial bacterial skin infection - caused by either staph aureus, or strep progenies - very contagious

Question 37

treatment of impetigo?

Answer 37

1. hydrogen peroxide 1% cream 2. topical antibiotic creams - topical fusidic acid

Question 38

white hard spots on mucous membranes of mouth. more common in smokers.

Answer 38

leukoplakia - premalignant condition you should also consider candidiasis and lichen planus esp if the lesions can be rubbed off

Question 39

17 y/o with pmh of asthma and eczema. normally fit and well but developed rash on face extending down to torso yday generally unwell with flu like symptoms most likely:

Answer 39

eczema herpeticum | - severe primary infection of the skin by herpes simplex virus 1 or 2

Question 40

itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks) autoimmune blistering skin condition associated with coeliac disease

Answer 40

dermatitis herpetiformis

Question 41

36 y/o - 4 month hx intermittment bloating and loose stools - never passed blood - lost couple kgs in weight anti TTG positive likely diagnosis?

Answer 41

coeliacs disease

Question 42

During NIPE: You notice a flat purple lesion on the babies cheek which has been present since birth. This does not seem to be painful. All other examinations are normal. likely diagnosis

Answer 42

port wine stain - capillary malformation seen at birth - does not require treatment

Question 43

drugs known to exacerbate psoriasis include:

Answer 43

Lithium Beta-blockers NSAIDs ACEi TNF-alpha Inhibitors Anti-malarials

Question 44

which skin condition is characterised by the following - caused by overgrowth of malassezia yeast - common in young people - causes multiple patches of skin discolouration - mildly flaky and itchy - may present after spending time in sunny humid environments

Answer 44

pityriasis versicolor

Question 45

autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule.

Answer 45

pemphigus vulgaris Ketoconazole shampoo is used to treat pityriasis versicolor

Question 46

The raised pearly edges in an ulcerated lesion at a sun exposed site makes what diagnosis likely?

Answer 46

basal cell carcinoma

Question 47

A 78-year-old man presents with symptoms of headaches and deteriorating vision. He notices that there is marked pain on the right hand side of his face when he combs his hair. indicative of:

Answer 47

giant cell arteritis treatment with immunosuppressants should be started promptly.

Question 48

32 y/o male, smoker - foot pain during exertion - foot pulses are absent - pulses present to level of popliteal - formation of corkscrew shaped collateral vessels distally indicative of:

Answer 48

burger's disease

Question 49

Pruritus particularly after warm bath 'Ruddy complexion' Gout Peptic ulcer disease common condition:

Answer 49

polycythaemia

Question 50

Night sweats Lymphadenopathy Splenomegaly, hepatomegaly Fatigue condition:

Answer 50

lymphoma

Question 51

Lethargy & pallor Oedema & weight gain Hypertension condition:

Answer 51

chronic kidney disease