Dermatology

Question 1

Order of pharmacotherapy for acne

Answer 1

1. Benzyl Peroxide 2.5-5%
2. Topical retinoids +/- BP
3. Fixed dose BP/Clinda (Clindoxyl or TactuPump)
4. Clinda/tretinoin (Biacna)
5. OCP if female
6. If papulopustular - systemic antibiotics - tetracycline
7. Isotretinoin - Accutane

Question 2

Features of plaque psoriasis

Answer 2

• Most common
• Presents as young adult
• Symmetrical plaques involving scalp, extensor elbow, knees, back, trunk, buttocks
• Erythematous, raised, silver shine

Question 3

Features of guttate psoriasis

Answer 3

• Abrupt appearance of small lesions, salmon-pink
• Typically occurs as an eruption in young with no prev hx
• Strong association with strep infection

Question 4

Features of pustular psoriasis

Answer 4

• Can be severe with serious complicaitons
• Acute onset of widepsread erythema, scaling and sheets of superficial pustules w erosions on painful and inflamed skin.
• Can be on palms and soles
• Reported causes are pregnancy, infectoom, withdrawal oral glucocorticoids

Question 5

Features of erythrodema

Answer 5

• Erythema covering >90% Cody
• Hypothermia
• Low albumin
• Imbalanced lytes
• Cardiac failure

Question 6

General first line pharmacotherapy for psoriasis

Answer 6

• Lubricants
• Vitamin D analogues (calcipotriene, calcitriol)
• Topical steroids - mod to very strong
• Topical retinoids
• Coal tar
• Salicylic acis
• Anthralin

Question 7

General second line pharmacotherapy for psoriasis

Answer 7

• Phototherapy
• Cyclosporin
• Methotrexate
• Oral retinoid

Question 8

General third line pharmacotherapy for psoriasis

Answer 8

Biologics i.e. infliximab

Question 9

Diagnosis and complications of Kawasaki

Answer 9

Diagnosis:
Fever 5 or more days with 4 of the following
- Bilateral conjunctival injection
- Oral changes - cracked lips, strawberry tongue
- Cervical lymphadenopathy
- Extremity changes - palm/sole erythema, desqaumation
- Polymorphous rash

Complications:
CAA, myocarditis, pericarditiss, pericardial effusion, valvular dysfunction, LV dysfunction, arrythmia

Question 10

Management of Kawasaki

Answer 10

IVIG + high dose ASA (80-100mg/kg/day divided into 4 doses)
After fever decrease dose to 3-5mg/kg/d for 6-8 weeks

Question 11

Measles signs and symptoms

Answer 11

Macular rash begins on face, shoulders, spreads inferiorly
URTI prodome - coryza, cough, malaise, fever
Rash on 4th febrile day
Koplik’s spot 1-2d prior to rash

Question 12

Parovirus signs and symptoms

Answer 12

Slapped cheek appearance
Progressive reticular rash
Prodome fever
Complications of severe aplastic anaemia in patients with chronic hemolytic anaemia

Question 13

Rocky moutain spotted fever signs and symptoms

Answer 13

Abrupt onset fevers, myalgia. . With rash 4 days later. Evolves from pink macule to red papules to petechiae on wrists and ankles angd spreads inwards
Hx tick exposure

Question 14

Roseola (HHV-6) signs and symptoms

Answer 14

Fever for 3-4 days, rash within 2-3
Diffuse mascular rash that spares face

Question 15

Rubella signs of symptoms

Answer 15

Pink macules and papules on forehead spread downwards
Rash fades in reverse order
Prodrome uncommon in kids
Forcheimer spots

Question 16

Scarlet fever signs and symptoms

Answer 16

Acute strep infection
Linear petechiae in antecubical and axillar folks
Initially white strawberry tongue follow by red strawberry tpngue
Punctuated rash that starts on trunk and spreads to extremities
Flushed rash with perioral pallor

Question 17

Features and tx of Mycosis Fungoides

Answer 17

T cell lymphoma:
Patches - superficial
Poikiloderma
Plaques

Tx: Topical steroids and/or PUVA or UVB

Question 18

Features and tx of Sezary syndrome

Answer 18

T cell lymphoma:
Widespread systemic type
Red man syndrome
Fatigue, fever
Often fatal

Tx: Oral retinoids. Interferon. May be radiotherapy.