Dermatology

Question 1

What does a basal cell carcinoma look like?

Answer 1

Slow growing lesion, pearly indurated edges, pink, not usually ulcerated

Question 2

If you suspect a BCC, what is the management?

Answer 2

Routine referral to dermatology for excision

Question 3

What does a squamous cell carcinoma look like?

Answer 3

Large centrally ulcerated area, sometimes with a rolled edge

Question 4

If you suspect an SCC, what is the management?

Answer 4

2ww referral for excision, as more likely to metastasise than a BCC

Question 5

What are the 3 major criteria in the weighted 7 point checklist for skin lesion assessment?

Answer 5

Change in size
Irregular shape or border
Irregular colour

Question 6

What are the four minor criteria in the weighted 7 point checklist for skin lesions?

Answer 6

Diameter 7mm or more
Inflammation
Oozing or crusting of lesion
Change in sensation

Question 7

Rough, raised, scaly lesion in sun exposed area. What is the likely diagnosis and what are the potential options for management?

Answer 7

Actinic keratosis

Treatment options = fluorouracil, cryotherapy, topical diclofenac

Question 8

Pt presents with a 2/7hx of vesicular rash around bottom of ribs on R side of body. Reports feeling unwell for a couple of days before the rash appeared.
Based on the likely diagnosis, what is the management?

Answer 8

Likely to be shingles

Treat with acyclovir 800mg 5x daily for 7/7 within 72hrs of rash onset

Question 9

A parent brings their 2yr old daughter in with a rash on her cheek on one side of the face. The rash has a honey-coloured crust.
What is the likely diagnosis?

Answer 9

Impetigo

Question 10

Pt presents with a rash on their legs, formed of red spots with surface pustules. The spots are tender on pressure. What is the likely diagnosis?

Answer 10

Folliculitis

Question 11

What is the management for genital herpes?

Answer 11

If initial presentation: HIV blood test, refer to sexual health for full screen.
Give aciclovir for 5-10 days, starting up to 5 days after onset of herpes.
Prophylactic aciclovir if having >6 flares a year

Question 12

A parent brings their child in - they have a 2/7 hx of small red spots across their whole body. The parent says they had strep throat last week.
Given the likely diagnosis, what is the management?

Answer 12

Likely scarlet fever.

Give penicillin V for up to 10 days, and advise parent to give Calpol for fevers, and other supportive management advice

Question 13

A 14 y/o presents with a rash formed of small scaly oval red patches on her back and chest. She says she’s noticed one patch on her back that is larger than the others.
What is the likely diagnosis, and what is the management?

Answer 13

Pityriasis rosea

No treatment - usually resolves itself in 6-10 weeks

Question 14

A sporty 11 y/o presents with annular lesions with a hypo pigmented centre in his natal cleft.
What is the likely diagnosis and what is the management?

Answer 14

Ringworm

Treat with Daktacort, and give hygiene advice for the household - eg. no towel sharing

Question 15

What is intertrigo, and what is the first line treatment?

Answer 15

Sweat rash usually found in flexures - inflamed, red rash, can crack/peel
Treated with Daktacort

Question 16

What is scabies, and what is the first line treatment?

Answer 16

Mite infection - itchy burrows in webbed spaces, arms and legs.
First line tx is topical permethrin (leave on for 12 hrs, wash off, and then repeat treatment in 7/7)

Question 17

What is the systemic treatment for fungal nails, and which blood test do you need to do beforehand and after 6/52?

Answer 17

Terbinafine

LFTs

Question 18

What is the treatment for tinea versicolour, and how does it present?

Answer 18

Ketoconazole shampoo used as body wash

Areas of hypopigmentation, usually on chest

Question 19

A mother presents with her 5 y/o child, who has a cluster of pearlescent nodules on her abdomen.
What is your management plan given the likely diagnosis?

Answer 19

Molluscum contagiosum

Advise mother that they will resolve themselves in a few months, and to leave them alone.