Dermatology

Question 1

What are the features of pityriasis rosea?

Answer 1

• majority no prodrome, some recent hx of viral infection
• herald patch (usually trunk)
• followed by erythematous, oval, scaly patches following a characteristic distribution with the longitudinal diameters of the oval lesions
• parallel to lines of langer
• may produce a ‘fir-tree’ appearance

Question 2

What are the features of lichen planus?

Answer 2

Planus:
Purple
Pruritic
Papular
Polygonal rash on flexor surface
(Wickhams striae over surface)
(Oral involvement common)
Can occur site of scars etc (koebner’s response)

Question 3

What’s the management of lichen planus?

Answer 3

Potent topical steroids
Benzydamine mouthwash or spray for oral

Question 4

How does eczema herpeticum present?

Answer 4

Children with existing eczema
Rapidly progressing painful rash - monomorphic punched out erosions

Question 5

what are the causes of acanthosis nigricans?

Answer 5

• t2dm
• gastrointestinal cancer
• obesity
• PCOS
• acromegaly
• cushing’s disease
• hypothyroidism
• familial
• prader-willi syndrome
• drugs
  > COCP
  > nicotinic acid

Question 6

what are the causes of erythema nodosum?

Answer 6

• infection
  > strep, tuberculosis, brucellosis
• systemic disease
  > sarcoidosis, IBD, Behcet’s
• drugs
  > penicillins, sulphonamides, COCP
• pregnancy

Question 7

management options for SCC?

Answer 7

• excision with 4mm margins for lesion <20mm
• excision with 6mm margins for lesion >20mm
• mohs micrographic surgery for highrisk pts and in cosmetically important sites

Question 8

what is intra-epidermal squamous cell carcinoma?

Answer 8

Bowen’s disease

Question 9

what is the management for intra-epidermal SCC/bowen’s disease?

Answer 9

topical 5-fluorouracil

Question 10

what is the management for urticaria?

Answer 10

1L: non-sedating antihistamines
2L: prednisolone used for severe or resistant episodes

Question 11

how is contact dermatitis investigated?

Answer 11

patch testing

Question 12

what nail changes are seen in psoriatic arthropathy?

Answer 12

pitting
onycholysis (separation of nail from nail bed)
subungual hyperkeratosis (chunky)
loss of the nail

Question 14

What is the management for dermatophyte nail infections?

Answer 14

Oral terbinafine

Question 15

What is the first line management for acne vulgaris?

Answer 15

Topical combination therapy (eg adapalene and benzoyl peroxide for mild-mod, or topical tretinoin and topical abx)

Question 16

What complication does psoriasis put you at higher risk of?

Answer 16

Cardiovascular disease

Question 17

What are the causes of stevens johnson syndrome?

Answer 17

Penicillin
Sulphonamides
Lamotrigine, carbamazepine, phenytoin
Allopurinol
NSAIDs
Oral contraceptive pill

Question 18

how long should the break be between courses of topical steroids?

Answer 18

4 weeks

Question 19

management for fungal nail infections?

Answer 19

if limited involvement - topical amorolfine 5% nail lacquer
if more extensive (mod-sev) - oral terbinafine for 6weeks-3months

Question 20

what is the management for venous ulceration?

Answer 20

• compression bandaging
• oral pentoxifylline (peripheral vasodilator)

Question 21

features of dermatitis herpetiformis?

Answer 21

itchy vesicular skin lesions on extensor surfaces

Question 22

dx of dermatitis herpetiformis?

Answer 22

skin biopsy

Question 23

antibodies associated with dermatitis herpetiformis?

Answer 23

anti-ttg
-> associated with coeliac

Question 24

where is venous ulceration most commonly seen?

Answer 24

above the medial malleolus

Question 25

what are the causes of acanthosis nigricans?

Answer 25

type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing’s disease
hypothyroidism
familial
Prader-Willi syndrome
drugs
combined oral contraceptive pill
nicotinic acid

Question 26

scabies mgt?

Answer 26

two treatments with permethrin one week apart for patient and all close contacts

Question 27

nail signs seen in psoriatic arthritis?

Answer 27

pitting
onycholysis
subungual hyperkeratosis
loss of nail

Question 28

first line mgt in rosacea with severe papules and/or pustules?

Answer 28

topical ivermectin and oral doxycyline

Question 29

features of pityriasis versicolor?

Answer 29

most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor).
May be more noticeable following a suntan
scale is common
mild pruritus

Question 30

malignancy most common secondary to immunosuppression?

Answer 30

skin cancer -squamous cell carcinoma

Question 32

first line management of psoriasis?

Answer 32

topical corticosteroid
vitamin D analogue

Question 33

management of pityriasis versicolor?

Answer 33

ketoconazole shampoo

Question 34

first line mgt mild/moderatre rosacea?

Answer 34

topical ivermectin

Question 35

features of bullous pemphigoid?

Answer 35

itchy tense blisters around flexures
blisters heal without scarring
stereotypically no mucosal involvement

Question 36

most important prognostic factor in melanoma?

Answer 36

invasion depth of the tumour

Question 37

what is koebner phenomenon?

Answer 37

skin lesions that appear at the site of injury

Question 38

which conditions is koebner phenomenon associated with?

Answer 38

psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

Question 39

mgt of dermatitis herpetiformis?

Answer 39

IV aciclovir (admission)

Question 40

features of takayasu’s arteritis?

Answer 40

systemic vasculitis features eg malaise, headache
unequal BP in upper limbs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurg

Question 41

investigations for takayasu’s arteritis?

Answer 41

vascular imaging of arterial tree - MRA or CTA

Question 42

management for takayasu’s arteritis?

Answer 42

steroids

Question 43

what is erythema nodosum?

Answer 43

inflammation of subcut fat

Question 44

features of erythema nodosum?

Answer 44

tender, erythematous, nodular lesions
usually over shins, may occur elsewhere

Question 45

causes of erythema nodosum?

Answer 45

infection - strep, TB, brucellosis
systemic dx - sarcoidosis, IBD, behcets
malignancy/lymphoma
drugs - penicillins, sulphonamides, COCP
pregnancy

Question 46

features of alopecia areata?

Answer 46

localised, well demarcated patches of hair loss
-> regrows in 50% by one year, and 80-90% eventually

Question 47

mgt options for alopecia areata?

Answer 47

topical or intralesional steroids
topical minoxidil
phototherapy
dithranol
contact immunotherapy
wigs

Question 48

causative organism of pityriasis versicolor?

Answer 48

malassezia furfur

Question 49

features of seborrheic dermatitis?

Answer 49

eczematous lesions on sebum rich areas - scalp, periorbital, auricular and nasolabial folds
otitis externa and blepharitis may dvlp

Question 50

conditions associated with seborrheic dermatitis?

Answer 50

HIV
Parkinsons

Question 51

causes of koebners phenomenon mnemonic?

Answer 51

previous wounds lead 2 various marks
Psoriasis
Warts
Lichen planus/sclerosus
Vitiligo
Molluscum contagiousum

Question 52

mgt for impetigo?

Answer 52

localised:
hydrogen peroxide 1%
topical abx if hydrogen peroxide not suitable:
fusidic acid
mupirocin if fusidic acid resistance

extensive dx: oral fluclox
oral erythromycin if pen allergic

Question 53

name for invasion depth of a melanoma?

Answer 53

breslow depth

Question 54

when is referral necessary in molluscum contagiosum?

Answer 54

HIV positive - ref to HIV specialist
eyelid-margin or ocular lesions and red eye - ref to ophth
adults with anogenital lesions - ref to GUM

Question 55

features of pyoderma gangrenosum?

Answer 55

initially small red papule
-> later deep, red, necrotic ulcers with violaceous border

Question 56

what is a curlings ulcer?

Answer 56

stress ulcers in duodenum of burns patients
more common in children

Question 57

mnemonic for drugs that worsen psoriasis?

Answer 57

psoriasis gives you blanc plaques
Beta blockers
lithium
alcohol
NSAIDs
Quines (hydroxychloroquine etc)