Dermatology

Question 1

define atopic dermatitis (eczema)

Answer 1

a common skin condition starting in childhood that causes dry skin and flares of erythematous, poorly demarcated itchy patches

Question 2

areas commonly affected by eczema

Answer 2

in infants:

• cheeks of the face
• patches on the body

in older children:
- flexures (bends of elbow and behind knees)

Question 3

NICE diagnostic criteria of eczema

Answer 3

itchy skin +3-5 of: 
visible flexural eczema 
history of flexural eczema 
history of dry skin
history of asthma or allergic rhinitis 
onset < 2yrs

Question 4

risk factors/triggers of eczema

Answer 4

irritants
abrasive fabrics
filaggrin protein deficiency
stress

Question 5

management of eczema (step wise approach)

Answer 5

mild: hydrocortisone
moderate: eumovate
potent: betnovate
very potent: dermovate

Question 6

additional management of eczema

Answer 6

avoiding use of soaps or potential irritants

use of emollients (e.g. ointments or creams)

Question 7

side effects of topical corticosteroid use

Answer 7

skin thinning, striae and telangiectasia

Question 8

eczema complication: eczema herpeticum

Answer 8

an infection due to disseminated HSV that occurs as a result of impaired skin protection

Question 9

clinical features of eczema herpeticum

Answer 9

monomorphic vesicular rash that ulcerates and crusts

fever

Question 10

diagnosis and management of eczema herpeticum

Answer 10

swab + Tzanck test

IV aciclovir

Question 11

eczema complication: erythrodema

Answer 11

widespread erythema (>90% skin surface) due to exacerbation of eczema

Question 12

define contact dermatitis

Answer 12

eczema that occurs following exposure to a causative agent

Question 13

clinical features of contact dermatitis

Answer 13

dry rash commonly located on the hands asymmetrically that is: 
erythematous
blistering 
painful 
pruritic 
fissured

Question 14

types of contact dermatitis

Answer 14

irritant contact dermatitis

allergic contact dermatitis

Question 15

define irritant contact dermatitis

Answer 15

follows repeated exposure to a metal, solvent or detergent
common in those with an underlying skin condition
presents with rash limited to area of contact
rash is painful and burns

Question 16

define allergic contact dermatitis

Answer 16

occurs in those sensitised to allergens
rash is pruritic and extends beyond contact site
type of IV hypersensitivity reaction

Question 17

management of contact dermatitis

Answer 17

emollient creams
topical corticosteroids
identify and avoid irritant or allergen

Question 18

investigations of contact dermatitis

Answer 18

patch testing - range of allergens in separate patches on the skin

Question 19

define infantile seborrhoeic dermatitis (cradle cap)

Answer 19

a skin condition in infants <3mnths that causes diffuse, yellow and greasy scales on the scalp, groin or armpit with NO erythema

Question 20

management of infantile seborrhoeic dermatitis

Answer 20

topical emollient (e.g. olive oil) massaged into scalp

if symptoms persist:
topical antifungal

Question 21

appearance of meningitis

Answer 21

rapidly developing non-blanching purpuric rash with: 
lethargy 
headache 
fever 
rigors 
vomiting

Question 22

immediate management of meningitis

Answer 22

IM benzylpenicillin and hospital admission

Question 23

appearance on slapped cheek syndrome (Parvovirus B19)

Answer 23

symmetrical erythematous rash on both cheeks with associated fever

additional reticular rash on trunk and limbs

Question 24

appearance of hand, foot and mouth disease

Answer 24

blisters on the hands and feet
ulcers on the tongue
fever

Question 25

common cause of hands, foot and mouth disease

Answer 25

Coxsackle virus A16

Question 26

appearance of Scarlett fever

Answer 26

red rash with 'sandpaper' texture 
sore throat 
fever 
headache 
bright red tongue

Question 27

treatment of Scarlett fever

Answer 27

10 day course of phenoxymethylpenicillin

Question 28

appearance of measles

Answer 28

erythematous and blanching maculopapular rash over the body
fever
cough
Koplik’s spots

Question 29

appearance of chickenpox

Answer 29

red maculopapular rash that crust over to form blisters
pruritic rash
loss of appetite
lethargy