Dermatology

Question 1

Definition of psoriasis

Answer 1

Common chronic inflammatory skin disorder affecting individuals with an underlying genetic predisposition.

Question 2

Manifestation of psoriasis

Answer 2

Sharply demarcated, erythematous, scaly, pruritic plaques, most commonly occurring on the scalp, presacral region and extensor surfaces of the knees and elbows; however, any area of the skin may be affected
Other common findings include arthritis, generally affecting the fingers and lower spine and nail involvement (e.g. pitting, discolouration)

Question 3

Diagnosis of psoriasis

Answer 3

Clinical diagnosis based on symptoms, history and presence of specific signs
Auspitz sign: appearance of small pinpoint bleeding when scales of a cutaneous lesion are scraped off (not sensitive or specific for psoriasis)

Question 4

Treatment for mild, moderate and severe psoriasis

Answer 4

Mild: topical corticosteroids
Moderate to severe: Systemic therapy (phototherapy, biologic agents)

Question 5

History taking questions for skin conditions

Answer 5

Where
When (how long)
Medications?
Infectious/other people with similar rash
History of dermatitis - occupational Hx, family Hx, new or recent exposures

Question 6

Common types of face rash

Answer 6

Rosacea
Impetigo
Atopic dermatitis
Psoriasis
Photosensitivity
Acne
Cancer
Viral exanthem

Question 7

Common types of scalp rash

Answer 7

Psoriasis
Seborrheic dermatitis
Pediculosis
Tinea
Chicken pox

Question 8

Common type of nail rash

Answer 8

Psoriasis
Tinea

Question 9

Common type of flexure rash

Answer 9

Atopic dermatitis
Psoriasis
Seborrheic dermatitis
Tinea
Candida
Pediculosis

Question 10

Rashes that will be present months

Answer 10

Tinea
Psoriasis
Atopic dermatitis
Pityriasis versicolor
Warts
Cancers
Skin infiltrations e.g. granulomata, xanthoma

Question 11

Rashes that are like to be present weeks-months

Answer 11

Viral exanthem
Impetigo
Herpes zoster/simplex
Scabies
Drugs
Pediculosis (lice)
Pityriasis rosea
Candidiasis
Tinea

Question 12

Rashes that are likely to be present hours-days

Answer 12

Uticaria
Contact/allergic dermatitis
Insect bites
Atopic dermatitis
Viral exanthem

Question 13

Match the skin terminology:

1. Bulla
2. Papule
3. Nodule
4. Vesicle
5. Plaque
6. Macule
7. Maculo-papule
8. Patch

A. flat, circumscribed area of altered skin colour < 1 cm in diameter
B. fluid filled blister < 1 cm in diameter
C. a raised and discoloured circumscribed lesion
D. flat topped palpable mass > 1 cm in diameter
E. fluid filled blister > 1 cm in diameter
F. circumscribed palpable lump > 1 cm in diameter
G. palpable lump < 1 cm in diameter
H. flat, circumscribed area of altered skin colour > 1 cm

Answer 13

1. E
2. G
3. F
4. B
5. D
6. A
7. C
8. H

Question 14

Where will erythema multiforme usually appear?

Answer 14

Palms, soles, genitals, mouth, extensor surfaces of arms and legs

Question 15

Causes of erythema multiforme

Answer 15

Idiopathic (up to 30%)
Virus (commonly herpes simplex)
Mycoplasma
Medications (sulphur, trimethoprim, penicillin, thiazides, allopurinol, anticonvulsants)
Immunisations

Question 16

How long does erythema multiforme usually last?

Answer 16

10-20 days, usually self limiting

Question 17

Causes of erythema nodosum

Answer 17

Idiopathic (40%)
Sarcoidosis
Infections; strep throat, viral, TB, leprosy, fungal infection
Drugs; sulphonamides, tetracyclines, OCP
Inflammatory bowel disorders
Pregnancy

Question 18

How long does erythema nodosum last?

Answer 18

Usually 3-8 weeks

Question 19

History taking questions for skin lesions

Answer 19

Previous skin cancers
Previous excisions
Family Hx
Occupation
Level of sun exposure and sun protection
Any other spots of concern

Question 20

Where will a seborrheic keratosis usually present?

Answer 20

Face and trunk

Question 21

Description of a basal cell carcinoma

Answer 21

Pearly, fleshy papule or nodule with depressed or umbilicated centre and telangectasia

Question 22

Description of squamous cell carcinoma

Answer 22

Thickened, red, scaly spot that may bleed and ulcerate over time. Grows over a period of months and is often tender or painful
May arise in premalignant lesion (e.g. solar keratoses, chronic ulcers, burns, leukoplakia)

Question 23

System to describe melanoma

Answer 23

A: asymmetry
B: border; usually irregular
C: colour; variable
D: diameter; >6mm
E: elevation; can be small raised lump

for nodular melanoma
F: firmness; firm to touch
G: grows quickly; r/v if progressive growth >1 month