Dermatology

Question 1

Describe the presentation of Atopic Eczema

Answer 1

Usually develops in childhood and resolves during adulthood Itchy erythematous dry scaly patches normally on flexor aspects (but can be on face and extensor aspects in infants

Question 2

Give 3 other dermatological features of atopic eczema

Answer 2

Excoriation Lichenification Nail pitting

Question 3

Name two conservative managements of Eczema

Answer 3

Avoid triggers (such as wool/synthetic fibres and extremes of temperature) Frequent emollients

Question 4

Give 3 pharmacological managements for Eczema

Answer 4

Topical Therapies - topical steroids (for flares) or topical immunomodulators (tacrolimus) Oral therapies - antihistamines Immunosupressants for severe non responsive cases

Question 5

State three secondary viral infectons of Eczema

Answer 5

Molluscum Contagiosum Viral Warts Eczema Herpeticum

Question 6

What is Bullous Pemphigoid?

Answer 6

Immunobullous blistering (subepidermal) condition usually affecting the elderly

Question 7

How will Bullous Pemphigoid present?

Answer 7

Tense fluid filled blisters on an erythematous base, often itchy Normally affects trunk or limbs

Question 8

How do you manage Bullous Pemphigoid?

Answer 8

Topical steroids for local disease Oral therapies for widespread (steroids, tetracycline)

Question 9

What is Pemphigus Vulgaris?

Answer 9

Immunobullous blistering (intraepidermal) condition usually affecting the middle aged

Question 10

How will Pemphigus Vulgaris present?

Answer 10

Flaccid and easily ruptured blisters, often painful and affecting mucosal areas

Question 11

How would you manage Pemphigus Vulgaris?

Answer 11

High dose steroids Immunosupressants

Question 12

How does Senile Purpura present?

Answer 12

Elderly population with sun damaged skin Extensor surfaces of hands and forearms

Question 13

Describe the presentation of a Venous Ulcer (including common sites)

Answer 13

Large shallow and irregular usually in malleolar area Exudative and granulating base Pain on standing

Question 14

How would you manage a Venous Ulcer?

Answer 14

Compression bandaging

Question 15

Describe the presentation of an Arterial Ulcer (including common sites)

Answer 15

Small and sharply defined with a deep necrotic base Abent peripheral pulses, shiny skin and loss of hair Pain at night/elevation of leg

Question 16

How would you manage an Arterial Ulcer?

Answer 16

Vascular Reconstruction

Question 17

What is ABPI? What do values indicate?

Answer 17

Ankle Brachial Pressure Index, compares peripheral blood flow Normal is 1-1.4 If less than 0.8 it is suggestive of arterial insufficiency

Question 18

Describe the presentation of a Neuropathic Ulcer (including common sites)

Answer 18

Often painless, variable in size and shape Granulating base Often in pressure sites (heels, soles, toes) Can be Neuroischaemic

Question 19

How would you manage a Neuropathic Ulcer?

Answer 19

Wound debridement Regular repositioning Good nutrition Appropriate footwear

Question 20

What is a Dermatofibroma?

Answer 20

Benign mass, often mistaken for a more serious pathology, following on from insect bites such as mosquitos

Question 21

State the two layers of the dermis

Answer 21

Papillary Reticular

Question 22

Describe the relevance of a skin lesion (suspected malignancy) itching and bleeding respectively

Answer 22

Itching - Perineural Invasion Bleeding - Ulcerative component

Question 23

When would you do a punch lesion of a suspicious lesion?

Answer 23

If it was in a cosmetically sensitive area

Question 24

Name 5 subtypes of BCC

Answer 24

Nodular Superficial (can appear like dermatitis) Morphoeic Pigmented Basosquamous

Question 25

Apart from pre-malignant conditions, give three risk factors specific for SCC

Answer 25

Viral Infections Chronic Wounds Psoriasis Treatment

Question 26

What is Bowen’s Disease?

Answer 26

In- Situ SCC disease (pre-malignant condition) Erythematous plaques and sharp borders

Question 27

Name four types of SCC

Answer 27

Ulcerative Verrucous Marjdins (arising from chronic wounds) Subungal (underneath nail bed)

Question 28

What is Gorlin Syndrome?

Answer 28

Autosomal Dominant condition increasing risk of BCCs. Presents as Multiple BCCs

Question 29

What is Rosacea?

Answer 29

Chronic relapsing disease of facial skin characterised by flushing episodes, persistent erythema, telangiectasia, papules and pustules

Question 30

What is a common presentation of Rosacea in men?

Answer 30

Rhinophyma - enlarged nose

Question 31

What is the first line management for Rosacea?

Answer 31

Topical Metronidazole

Question 32

How does Lichen Planus present?

Answer 32

Affects flexor surfaces of wrists/forearms/legs Intensely itchy 2-5mm red/violet shiny topped pamphlet (Wickham Striae) Mucous Membranes - White raises trabecular lesions

Question 33

How is Lichen Planus managed?

Answer 33

Topical Steroids if required