Dermatology

Question 1

what is BCC a malignancy of?

Answer 1

basal epidermal keratinocytes

Question 2

a pearly, flesh coloured papule with rolled edge
Associated telangiectaisa.
Ulcerated
Bleeds from minor trauma

What is the diagnosis?

Answer 2

BCC

Question 3

1. what is SCC a malignancy of?
2. What are its premalignant lesions known as?
3. What is SCC in situ also known as?

Answer 3

1. epidermal keratinocytes
2. solar keratosis
3. bowen’s disease

Question 4

Ill defined, dome shaped lesion
rapid growing
ulcerated and bleeds easily
multiple associated actinic solar keratoses on surrounding skin.

What is the diagnosis?

Answer 4

SCC

Question 5

What is malignant melanoma a malignancy of?

Answer 5

Melanocytes

Question 6

Mole has grown recently
Borders are now irregular
multiple colours

What is the dx?

Answer 6

Malignant Melanoma

Question 7

1. What is the most common form of Malignant Melanoma?
2. What is the most aggressive type of malignant melanoma and why?
3. What is used to measure depth of spread of melanoma (i.e. T on TNM staging?

Answer 7

1. superficial spreading
2. nodular - vertical invasion
3. breslow thickness

Question 8

1. Inflammatory lesions of acne vulgaris (3)

2. non-inflammatory lesions of acne vulgaris (2)

Answer 8

1. papules, pustules, macules

2. comedomes, pseudocysts

Question 9

stepwise management of acne vulgaris (4)

Answer 9

1. single topical therapy - benzyl peroxide or retinoids
2. combination topical therapy - benzyl peroxide/retinoids + clindamycin
3. oral antibiotics (tetracyclines or erythromycin if contraindicated)/COCP + topical treatments
4. oral isotreinoin

Question 10

elderly patient
itchy, tense blisters, around flexures
mouth is spared

1. what is the diagnosis
2. pathophysiology
3. management

Answer 10

1. bullous pemphygoid
2. autoimmune
3. refer to derm; oral corticosteroids

Question 11

1. Most common subtype of psoriaisis

2. exacerbating factors (5)

Answer 11

1. plaque psoriasis
2. trauma
   alcohol
   drugs - beta blockers, lithium, antimalarials, NSAIDS, ACEi
   withdrawal of systemic steroids
   steptococcal infection (gluttate psoriasis)

Question 12

NAME THE SUBTYPE OF PSORIASIS BASED ON THE FOLLOWING CLINICAL FEATURES

1. well defined, red, scaly patches affecting extensor surfaces, sacrum and scalp
2. shiny, smooth, red, well defined patches localised to skin folds and genitals
3. transient psoriatic rash with multiple teardrop lesions
4. red, tender, rash followed by the appearance of small pustules, which become bigger. Commonly occurs on palms and soles

Answer 12

1. plaque psoriasis
2. flexural psoriasis
3. gluttate psoriasis
4. pustular psoriasis

Question 13

Management of Psoriasis

a) general conservative measure
b) stepwise topical mangagement
c) first line systemic therapy and what this can be useful for

Answer 13

a) regular emollients to reduce scales and pruritis

b) 1. topical potent corticosteroid + vitamin D analogue OD for up to 4 weeks
2. vitamin D analogue BD for up to 8 weeks
3. potent corticosteroid BD for up to 4 weeks, or coal tar preparation

c) methotrexate - associated joint disease

Question 14

1. What other condition is dermatitis herpetiformis associated with and why?
2. how is it managed?

Answer 14

1. coeliac disease - IgA deposition in dermis leading to inflammatory response
2. management of coeliac disease
   Dapsone

Question 15

Itchy, vesicular skin lesions on extensor surfaces
abdominal pain and bloating, weight loss, steatorrhoea

What is the dx?

Answer 15

Dermatitis Herpeteformis

Question 16

Child with atopic eczema
Rash has come on suddenly
painful
round, punched out lesions
feels unwell

What is the dx?

Answer 16

Eczema herpeticum

Question 17

Management of Eczema Herpeticum

Answer 17

• swab for viral PCR and bacterial cultures (impetigo is a ddx; can be complicated by secondary bacterial infection)
• consider admission - dermatological emergency
• acyclovir - oral or consider IV
• systemic Abx if complicated by secondary bacterial infection

Question 18

rapid eruption of multiple target lesions of varying sizes
flat, or slightly raised
painless
preceding viral infection

what is the diagnosis?

Answer 18

Erythema multiforme

Question 19

Causes of Erythema Multiforme:

1. infection
2. drugs
3. systemic diseases

Answer 19

1. herpes simplex, streptococcus, mycoplasma
2. penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraception
3. SLE, sarcoidosis

Question 20

tender, erythematous, nodular lesions over the shins
self resolving over 6 weeks, with no scarring

What is the dx?

Answer 20

erythema nodosum

Question 21

Causes of Erythema Nodosum

1. infection
2. systemic disease
3. drugs

Answer 21

1. streptococcus, tuberculosis
2. Sarcoidosis, IBD, malignancy, lymphoma
3. penicillins, sulfonamides, COCP
   pregnancy

Question 22

1. tinea infection of the head
2. tinea infection of the body
3. tinea infection of the groin

Answer 22

1. tinea capitis
2. tinea corporis
3. tinea cruris

Question 23

ring shaped lesion, with scaly edge, and central hypopigmentation
associated itch

what’s the diagnosis?

Answer 23

dermatophyte infection (tinea)

Question 24

management of tinea

Answer 24

topical antifungals - terbinafine is first line

keep skin clean and dry thoroughly

Question 25

1. Pathophysiology of Impetigo 2. ddx 3. management of impetigo 4. public health measures

Answer 25

1. S. aureus/S. pyrogenes infection 2. eczema herpeticum 3. topical hudrogen peroxide or topical fusidic acid; oral fluclox/erythromycin if extensive disease 4. children should be excluded from school until all lesions are crusted and healed or 48 hours after commencing abx

Question 26

summer child with golden crusted lesions around the mouth what is the dx?

Answer 26

Impetigo

Question 27

What is keratoacanthoma?

Answer 27

A benign epithelial tumour

Question 28

smooth, dome shaped papule central crater filled with keratin what is the dx?

Answer 28

Keratoacanthoma

Question 29

hard white spots on oral mucous membranes/tongue lesions can't be rubbed off 1. what is the dx? 2. what are the concerns with this condition? (2)

Answer 29

1. leukoplakia 2. premalignant condition - can transform to become SCC (regular follow up required) associated with HIV infection

Question 30

itchy, papular rash over flexor surfaces, palms and soles polygonal lesions with white line pattern on surface 1. dx? 2. management?

Answer 30

1. Lichen Planus | 2. potent topical steroids

Question 31

white/hypopigmented crinkled or thickened patches of skin that tend to scar. elderly female, lesion over genitals very itchy 1. diagnosis 2. management 3. concern?

Answer 31

1. lichen sclerosus 2. topical steroids and emollients 3. increased risk of vulval cancer

Question 32

pinkish/pearly white papules with central umbilication <5mm in diameter clusters of lesions found on trunk/flexures/anogenital region 1. dx? 2. cause/pathophysiology? 3. management?

Answer 32

1. molloscum contagiosum 2. viral infection (molloscum contagiosum). spread by close contact 3. self limiting mild topical corticosteroid and emollient if itching is problematic

Question 33

Ashkenazi Jewish patient widespread, painful blisters and mucosal ulceration easily ruptured 1. dx? 2. aetiopathophysiology? 3. management?

Answer 33

1. Pemphigus Vulgaris 2. autoimmune condition - antidesmoglein 3 antibodies 3. steroids and immunosuppressants

Question 34

19 year old patient Initial red patch on trunk now has generalised "fir tree" rash had a URTI last week 1. dx? 2. Ddx?

Answer 34

1. Pitytiasis Rosea | 2. gluttate psoriasis

Question 35

Hypopigmented and pink patches affecting the trunk Itchy Mild scale Recently returned from Cyprus 1. Dx? 2. underlying aetiology 3. management

Answer 35

1. tinea/pitytiasis versicolour 2. superficial fungal infection - Malassezia furfur 3. topical ketoconazole

Question 36

eczema type rash on hands and feet blisters which are very itchy skin is dry and cracked worsened during heatwave last week 1. dx? 2. management?

Answer 36

1. pompholyx | 2. cool compresses, emollients, topical steroids

Question 37

really painful ulcer on leg was initially a small papule, but has rapidly become bigger. necrotic tissue within lesion background of Rheumatoid Arthritis 1. Dx? 2. management

Answer 37

1. pyoderma gangrenosum | 2. oral steroids

Question 38

Flushing of the cheeks and nose some papules and telangiectasia in same distribution of rash got worse during holiday abroad dx?

Answer 38

Rosacea

Question 39

Management of roseaca

Answer 39

topical metronidazole topical brimonidine if flushing is predominant systemic abx if more severe disease daily application of high factor suncream

Question 40

child who can't stop itching excoriations present, predominantly on limbs linear burrows can be seen on interdigital webs and flexor aspect of wrist 1. dx? 2. management?

Answer 40

1. scabies | 2. permethrin 5% to patient and all household contacts

Question 41

multiple lesions on both covered and uncovered skin stuck on lesions, highly variable in colour brother had similar problem 1. dx? 2. management?

Answer 41

1. seborrhoeic keratosis | 2. reassurance

Question 42

Differences between seborrhoeic and actinic keratoses? 1. body distribution? 2. cancerous potential? 3. cause

Answer 42

1. seborrhoeic keratoses can be found on covered and uncovered areas of the body, while actinic keratoses are exclusively found on sun exposed areas 2. actinic keratoses are pre-malignant for SCC. Seborrhoeic keratoses have no malignant potential 3. Actinic keratoses are associated with chronic sun exposure, while seborrhoeic keratoses are associated with genetics/family hx