Dermatology

Question 1

What are features of rosacea?

Answer 1

Photosensitive rash on cheeks/nose
Papules/pustules
Telangiectasia
Rhinophymia

Question 2

What is mild rosacea and how is it managed?

Answer 2

Erythema/flushing only - no pustules or papules

Mangement - topical brimonidine and lifestyle changes

Question 3

What is moderate rosacea and how is it managed?

Answer 3

Mild papules and pustules
Topical metronidazole
Topical azelaic acid

Question 4

What is severe rosacea and how is it managed?

Answer 4

Extensive papule and pustules

Oral abx e.g. oral oxytetracycline

Question 5

How are telangiectasia in rosacea managed?

Answer 5

laser therapy

Question 6

What are medications which exacerbate psoriasis?

Answer 6

BLANQET
Beta blockers
Lithium
Anti-malarials
NSAIDs
Quinolones
E
T

Question 7

How is eczema herpeticum treated?

Answer 7

Needs admission for IV Aciclovir

Question 8

Which infections are associated with erythema multiforme?

Answer 8

HSV

Mycoplasma pneumoniae

Question 9

Which rash presents with a herald patch and then a fir tree rash?

Answer 9

Pityriasis rosea

Question 10

Which rash presents with a tear drop rash?

Answer 10

Guttate psoriasis

Question 11

How is actinic keratosis treated?

Answer 11

5-fluorouracil cream
topical imiquimod

sun avoidance/suncream

Question 12

What margins are needed for excisional biopsy for SCC?

Answer 12

Less than 20mm = 4mm margins

More than 20mm = 6mm margins

Question 13

Major criteria for melanoma?

Answer 13

Change in size
Change in shape
Change in colour

Question 14

Minor criteria for melanoma?

Answer 14

Diameter > 7mm
Inflammation
Oozing/bleeding
Altered sensation

Question 15

What is lichen planus (what signs do you see) and how is it managed?

Answer 15

Skin disorder
Purple, pruritic, papular, polygonal
Koebner phenomenon - new lesions at site of trauma
Wickham’s striae - white line pattern

Management = topical corticosteroids

Question 16

What drugs can cause SJS/TEN?

Answer 16

Never Press Skin As It Can Peel (Nikolsy’s Sign)

NSAIDs
Phenytoin
Sulphonamides
Allopurinol/Anti-epileptics - Lamotrigine/Carbamazepine/Phenyton
IV Ig
COCP
Penicillins

Question 17

SJS vs TEN?

Answer 17

SJS = Maculopapular rash + target lesions with systemic features e.g. fever, arthralgia

TEN = Very high fever, widespread tender erythema and widespread mucosal involvement
Leads to full thickness necrosis

TEN = Nikolsy’s sign (skin peels with pressure)

Question 18

What is Bowen’s disease? How does it present and how is it managed?

Answer 18

Precancerous lesion which can become SCC
Red scaly patches in sun exposed areas
5-fluorouracil cream

Question 19

Which type of melanoma can affect areas not exposed to the sun?

Answer 19

Acral lentiginous melanoma

Question 20

Which rash is associated with coeliac disease and how is it managed?

Answer 20

Dermatitis herpetiformis

Dapsone

Question 21

How to tell the difference between the different types of burns?

Answer 21

Superficial –> blanching erythema
Superficial dermal –> blisters
Deep dermal –> white; and patches of non-blanching erythema
Full thickness –> painless

Question 22

What skin cancer is most common in patients with a renal transplant?

Answer 22

Squamous cell carcinoma

Question 23

What are risk factors for SCC?

Answer 23

• excessive exposure to sunlight / psoralen UVA therapy
• actinic keratoses and Bowen’s disease
• immunosuppression e.g. following renal transplant, HIV
• smoking
• long-standing leg ulcers (Marjolin’s ulcer)
• genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

Question 24

What is a keratocanthoma?

Answer 24

Benign epithelial tumour
Slow growing but can look similar to a SCC
Urgent excision needed due to difficulty excluding SCC

Question 25

What medications can cause erythema nodosum?

Answer 25

Penicillins
Sulphonamides
COCP

Question 26

In which conditions is the Koebner phenomenon seen in?

Answer 26

• psoriasis
• vitiligo
• warts
• lichen planus
• lichen sclerosus
• molluscum contagiosum

Question 27

What are causes of spider naevi?

Answer 27

Liver disease
Pregnancy
COCP

Question 28

Rosacea vs. malar rash in SLE?

Answer 28

SLE – spares nose

Question 29

Spider naevi vs. telangiectasia?

Answer 29

Spider naevi fill from the centre

Telangiectasia fill from the edge

Question 30

What is Athlete’s foot and how does it present? How is it managed?

Answer 30

Tina infection (tinea pedis)
Scaling/flaking/itchy between toes

Topical ketoconazole

Question 31

How is a fungal nail infection treated?

Answer 31

If singular nail can use Amorolfine nail lacquer

Otherwise - oral terbinafine

Question 32

Which melanoma is most common?

Answer 32

Superficial spreading

Question 33

Which melanoma is most aggressive and most likely to bleed/ooze?

Answer 33

Nodular

Question 34

What are risk factors for squamous cell carcinoma?

Answer 34

Actinic keratosis
Bowen’s disease
Immunosuppressed
Smoking

Question 35

When should you admit someone with cellulitis?

Answer 35

If they are:
Under 1 year
Frail
Significant systemic upset - tachycardia/tachypnoea/hypotension
Sepsis
Necrotising fasciitis
Immunocompromised
Facial cellulitis

Question 36

How is severe cellulitis treated?

Answer 36

Co-amox

Question 37

What is pyoderma gangreosum? What is it associated with? How is it. managed?

Answer 37

Rapidly enlarging painful ulcer
IND
RA
SLE
Myeloproliferative disorders

management = oral steroids

Question 38

How is erythema nodosum treated?

Answer 38

Self-limiting

Can give NSAIDs

Question 39

What are non dermatological causes of pruritus?

Answer 39

Liver disease
Iron deficiency anaemia
Chronic kidney disease 
Polycythaemia
Lymphoma

Question 40

What is the stepwise management of psoriasis in primary care?

Answer 40

1) topical potent corticosteroid + vitamin D analogue (both once daily)
2) vitamin D analogue twice a day
3) topical potent corticosteroid twice a day or coal tar preparation twice a day