Dermatology

Question 1

Recent virla illness
Started as herald patch on trunk then went to red and scaly in the fir tree appearance

Answer 1

Pityriasis Rosea

(HHV-7)
Self limiting 6-12 weeks

Question 2

Flushing, redness and pustules/papules with some telangiectasis

Dx and Mx

Answer 2

Rosacea

erythema/flushing - top brimonidine gel
Mild-mod papules/pustules - top ivermectin
mod-severe papules/pustules - top ivermectin + po doxy

Question 3

2-4 weeks after a strep sore throat, tear drop rash - dx

Answer 3

Guttate psoriasis

Question 4

Tender, red, nodular lesions mostly on shins.

Answer 4

Erythema nodosum

Inflamm subcut fat
Usually resolves <6wks
Causes - TB, sarcoidosis, IBD, drugs, pregnancy…
Ix for this rash = Serum ACE, sputum culture, CXR

Question 5

1.small red papule
2. Deep red necrotic ulcers

Dx and Mx

PMH IBD

Answer 5

Pyoderma gangrenosum

May be seen in IBD, CT disorders, myeloproliferative disorders
Steroids (Po prednis)

Question 6

Mx seborrheic dermatitis

Answer 6

1. Head and hsoulders (zinc pyrithione) and Tar
   2.Ketoconazole

Question 7

Pinkish or pearly white papules with central umbilication in clusters.

Dx and Mx

Answer 7

molluscum contagiosum

Self-lim, <18m, contagious so dont share towels etc. No exclusion
(Cryotherapy, squeezing but not recommended usually…)

Question 8

Tx impetigo localised vs non localised disease

Answer 8

Localised, limited - hydrogen peroxide 1% cream and if unsuccessful then topical fusidic acid or mupirocin
Extensive disease - fluclox (or erythromycin)
Off school till >48hrs after Abx or lesions crusted

Question 9

Itchy, papular rash, polygonal with white lines on pattern.

Dx and mx

Answer 9

Causes - gold, quinine, thiazides
Potent topical steroids (clobetasone butyrate)
If oral - benzydamine mouthwash or spray
Extensive - oral steroids/immunsup

Question 10

Small crusty or scaly lesions.

Dx and Mx

Answer 10

Actinic Keratosis

Fluorouracil cream 2-3 week course. (+steroid for inflam form this).
Top diclofenac for mild/ topical imiquimoid/cryotherapy..

Question 11

Red scaly patches, slow growing

Dx and mx

Answer 11

Bowens disease

Precursor to SCC

Topical 5-fluorouracil (+ topical steroids to control inflammation form this), cryotherapy, excision.

Question 12

Sun exposed areas, rapidly expanding painless ulcerate nodules, may have cauliflower appearance.

Answer 12

SCC

Question 13

Pearly, flesh coloured with telangiectasia. May later ulcerate -> central crater.

Answer 13

bcc

Question 14

Widespread Pruitis, linear Burrows side fingers, interdigital webs + flexor aspects wrists.

dx/Mx

Answer 14

scabies

1.permethrin (8-12hrs)
2.Malathion (24hrs)
Dry on skin, wash off and repeat at 7 days
Itching persists up to 4-6 weeks.
Treat whole house

Question 15

Prodromal burning pain
Red, macular rash - dermatomal, becomes vesicular

DX/MX

Answer 15

Infectious till crusted vesicle
Paracetamol/NSAIDs and if not responding then amitriptyline considered
PO corticosteroids if immunocompetent <2wks and not responding.
Antivirals <72hours for all

Question 16

Itchy rash Often first appear in abdominal striae
Spares the periumbilical region
Prgenant

Dx/Mx

Answer 16

Pruritic condition ass with last trimester
Mx depends on severity

Question 17

Mx fungal nail infection and the most common organism

Answer 17

Most commonly trichophyton rubrum
Limited involvement - topical amorolfine nail lacquer 6+m

Extensive involvement from dermaophyte infection - PO Terbinafine

Extensive due to Candida - PO Itraconazole

Question 18

Acne Vulgaris Mx

Answer 18

Single topical therapy - retinoids/benzoyl peroxide
Topical combo therapy - retinoids/benzoyl peroxide/ Abx 3m (tetracyclines unles spreg/BF/<12)
COCP - Dianette (3m only as increased risk VTE)
PO Isotretinoin with dermatology

Question 19

Mx Hidradenitis suppurativa

Answer 19

chronic inflammatory skin disorder - inflammatory nodules, pustules, sinus tracts, boils… Axilla is most common site. Acute flares can be treated with steroids or fluclox. Long term with topical clindamycine or oral lymecycline/clindamycin/rifampicin Abx.

Question 20

Mx Psoriasis on body

Answer 20

Potent corticosteroid OD + Vitamin D analogue OD (applied separate) up to 4 weeks

If no improvement after 8 weeks then Vitamin D analogue BD
If no improvement 8-12 weeks then either: Potent corticosteroid BD p to 4 weeks or coal tar prep OD/BD
SHort acting dithranol also
Secondar care - phototherapy, systemic therapy

Question 21

Mx scalp psoriasis

Answer 21

topical corticosteroids OD 4 weeks

Question 22

Cream for facial hirsutism

Answer 22

Eflornithine cream

Question 23

Burns IV fluid formula

Answer 23

TBSA% X weight kg x 4
This is half fluid administered in first 8 hours

Question 24

Venous vs arterial ulcer

Answer 24

venous - Malleolar area, large and shallow, warm skin, normal pulses, ABPI normal (0.8-1). Compression bandage

Arterial -
punched out, cold skin, weak/absent pulses, loss hair, ABPI <0.8.

Question 25

Mx pityriasis versicoloured

Answer 25

ketoconazole

Question 26

Photo sensitive rash with blistering and fragility of face and dorsal aspect hand. Hypertrichosis, hyperpigmentation. Urine test.

Dx and mx

Answer 26

Prophyria cutanea tarda
Chloroquine, venesection

Question 27

What is erythrasma

Answer 27

asymptomatic, flat, slightly scaly, pink brown rash ing rain/axillae. Exam with woods light -> coral red fluorescence.
Topical miconazole or erythromycin in severe