Dermatology 👨🏼‍⚕️

Question 1

what is psoriatic arthritis

Answer 1

inflammatory arthritis affecting joints and connective tissue and is associated with psoriasis of skin or nails

“pencil in cup” radiological feature

Question 2

mx of psoriatic arthritis

Answer 2

NSAIDs and DMARDs

Question 3

1st and 2nd line systemic treatment for psoriasis

Answer 3

1st - methotrexate
2nd - ciclosporin

Question 4

what nail deformities are associated with psoriasis

Answer 4

nail pitting
leukonychia
onycholysis

Question 5

are systemic retinoids teratogenic? Should they be prescribed in pregnancy or during breastfeeding

Answer 5

yes they are teratogenic so NO should not be prescribed

Question 6

features of acne rosacea

Answer 6

common
chronic
facial flushing covering usually cheeks, nose, chin and forehead
usually presents in ages 30-60 and females

Question 7

how does acne rosacea present

Answer 7

red rash consisting of papule and pistules on an erythematous background

Question 8

what exacerbates rosacea

Answer 8

facial flushing causing factors like eating spicy foods, hot weather, sun exposure, stress etc

Question 9

mx of rosacea

Answer 9

general therapies like sunscreen, camouflage cream
topical treatments like azelaic acid, brimonidine and ivermectin
topical antibiotics like metronidazole

Question 10

urticaria

Answer 10

hives

Question 11

what is psoriasis

Answer 11

chronic autoimmune disease characterised by well-demarcated, erythematous, scaly plaques

Question 12

Cutaneous clinical features of chronic plaque psoriasis

Answer 12

Itchy, well-demarcated circular-to-oval bright red/pink elevated lesions (plaques) with overlying white or silvery scale, distributed symmetrically over extensor body surfaces and the scalp.

Question 13

1st line topical treatment for psoriasis

Answer 13

All patients should use an emollient to reduce scale and itch
1st: potent topical corticosteroid OD (eg Betnovate) + topical vitamin D OD (eg Dovonex) applied at different times

Question 14

characteristic features of basal cell carcinoma

Answer 14

round and nodular
skin coloured with a pearly rolled edge
telangicestoma
located on sun exposed areas - head and neck

Question 15

mx of basal cell carcinoma

Answer 15

Management of a BCC depends on its size, location, type and local guidelines - but the majority are managed surgically

Question 16

what is tinea

Answer 16

athletes foot

Question 17

how is Lyme disease spread

Answer 17

tick bites

Question 18

causes of erythema nodosum

Answer 18

NODOSUM
NO cause
Drugs
OCP
Sarcoidosis
Ulcerative colitis/Crohns
Micro: tuberculosis, streptococcus, toxoplasmosis

Question 19

presentation of erythema nodosum

Answer 19

tender raised red nodules that usually affect the shin

Question 20

presentation of BCC

Answer 20

small, skin-coloured or pink nodule with a central depression
they often have a pearly rolled edge and surface telangiectasia
often located on sun-exposed areas

Question 21

difference between actinic keratosis and seborrheic keratosis

Answer 21

AK is lighter in colour and has a silvery appearance
SK has a more greasy appearance ranging in colour from tan/brown to black

Question 22

presentation of seborrhoeic dermatitis

Answer 22

classically appears as ill-defined, greasy, flaky scales on an erythematous background

affects in particular the nasolabial folds, scalp and posterior auricular skin

can present with dandruff

Question 23

triggers/risk factors for psoriasis

Answer 23

skin trauma
infection
drugs - BALI, Beta-blockers, Antimalarials, lithium, Indomethacin
withdrawal of steroids
stress
alcohol+smoking
cold/dry weather

Question 24

presentation of pyoderma gangrenosum

Answer 24

painful ulcers develop most commonly on the legs
associated with IBD

A 55-year-old woman with a background of ulcerative colitis attends a gastroenterology follow-up appointment. On examination, there is a 2x3cm ulcer on the left shin which is malodorous with a purulent base and an irregular, erythematous border

Question 25

treatment of pyoderma gangrenosum

Answer 25

small ulcers - topical corticosteroids large ulcers or if pt is systemically unwell - oral corticosteroids severe cases may require surgical management

Question 26

what is contact dermatitis

Answer 26

type of eczema following exposure to a causative agent two types: irritant and allergic

Question 27

presentation of contact dermatitis

Answer 27

o/e a dry erythematous rash with blistering and fissuring of the skin is seen

Question 28

management of contact dermatitis

Answer 28

involves emollient creams and topical corticosteroids

Question 29

how does cellulitis present

Answer 29

commonly occurs on the shins usually unilateral erythema swelling systemic upset

Question 30

management of cellulitis

Answer 30

oral or admit for iv abx depending on certain factors

Question 31

for cellulitis who gets admitted for IV abx

Answer 31

severe or rapidly deteriorating cellulitis under 1 y/o or frail immunocompromised significant lymphedema facial or periorbital cellulitis hemodynamically unstable

Question 32

management of scabies

Answer 32

topical 5% permethrin

Question 33

presentation of scabies

Answer 33

intensely itchy pruritic rash commonly seen in the interweb spaces, flexures of the wrist, axillae, abdomen and groin

Question 34

management of shingles

Answer 34

oral antiviral - valaciclovir - if eye involvement or immunocompromised IV antiviral if severe

Question 35

presentation of shingles

Answer 35

tingling feeling in a dermatomal distribution progresses to erythematous papules which develop into fluid-filled vesicles which then crust over

Question 36

What is the condition? Characterised by 6 P’s Purple Pruritic Polygonal Planar Papules or Plaques Usually found on flexor aspects of wrist and ankles

Answer 36

Lichen planus

Question 37

Autoimmune disease where there are well defined patches of hair loss

Answer 37

Alopecia areata

Question 38

Commonest causes of eyrthroderma (widespread erythema with hypothermia and systemic symptoms)

Answer 38

Dermatitis Psoriasis

Question 39

ABCDE assessment of malignant melanoma

Answer 39

Asymmetry Birder irregularity Colour variation Diameter > 6mm Evolves over time

Question 40

Most common type of malignant melanoma

Answer 40

Superficial spreading melanoma

Question 41

If a melanoma lesion was located on the soles, palms or nail bed what type is it likely to be

Answer 41

Acral lentiginous melanoma

Question 42

Describe the features of superficial spreads melanoma

Answer 42

Initially resembles a freckle or mole but grows slowly into an asymmetrical patch Commonly on lower limbs Mostly in young or middle aged adults

Question 43

Management of lichen planus

Answer 43

Potent topical steroids

Question 44

Oral lichen planus features

Answer 44

Characterised by mucosal ulceration and Wickham’s striae that cannot be wiped off unlike oral Candida