Dermatology

Question 1

What is eczema typically presented with?

Answer 1

erythema
pruritus (itchiness)
Xerosis (dry skin)
site of skin involvement

Question 2

what are the risk factors that can cause eczema?

Answer 2

flagging gene mutation
age <5yrs
family history of eczema
allergic rhinitis
asthma

Question 3

What investigation would you do for ppl with eczema?

Answer 3

*Clinical findings
Bloods - IgE levels
skin-prick testing
oral food challenge
trial elimination diet
patching testing
Skin biopsy

Question 4

what sort of medication would you give for eczema patient?

Answer 4

emollients
topical steroids
topical antibiotics therapy

Question 5

how would you know how severe is an eczema?

Answer 5

use a EASI score
-check the severity of Eczema

Question 6

what’s the first line treatment for topical steroid uses?

Answer 6

Mild:
Hydrocortisone 1%

Moderate:
Betnovate RD
Eumovate

Potent:
Betnovate
Betacap

Very potent:
Dermovate

Question 7

what is eczema herpeticum

Answer 7

viral skin infect cause by HSV / varicella zoster virus

Question 8

presentation of eczema herpeticum

Answer 8

widespread, painful, vesicular rash
fever
lethargy
irritability
reduce oral intake
lymphadenopathy (swollen lymph nodes)

Question 9

treatment for eczema herpeticum

Answer 9

immediate hospitalisation
aciclovir

Question 10

What is psoriasis?

Answer 10

Chronic autoimmune condition that causes recurrent symptoms of psoriatic skins lesions

Question 11

what would a psoriasis patient presented with?

Answer 11

Symmetrically distributed of dry, flaky, scaly, faintly erythematou skin lesion that appear in raised and rough plaques, scale is typically silvery white, except in skin folds where the plaques often appear shiny with a moist peeling surface.
* commonly over the extensor surfaces of the elbows and knees and on the scalp
–> Auspitz sign - small points of bleeding when plaques are scraped off
–> Koebner phenomenon - development of psoriatic lesions to areas of skin affected by trauma
–> Residual pigmentation of the skin after the lesions resolve

Question 12

what is Guttate psoriasis

Answer 12

small raised papules across the trunk and limbs.
They’re mildly erythematous
triggered by a streptococcal throat infection

Question 13

what would a plaque psoriasis presented with?

Answer 13

thickened erythematous plaques with silver scales
seen on the extensor surfaces and scalp

Question 14

which types of the psoriasis that are rare and requires admission to hospital?

Answer 14

Pustular psoriasis

Erythrodermic psoriasis

Question 15

What tool can be used to assess psoriasis?

Answer 15

PASI score

Question 16

what are the management for psoriasis?

Answer 16

• Topical steroids
• Topical vitamin D analogues (calcipotriol)
• Topical dithranol
• Topical calcineurin inhibitors (tacrolimus) are usually only used in adults
• Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis

Question 17

List 2 product that are commonly prescribe by specialist for psoriasis

Answer 17

Dovobet
Enstilar

Question 18

what is the pathophysiology of acne?

Answer 18

the sebaceous glands increase production of sebum(natural skin oils and waxy substance) which traps the keratin (dead skin cells) and block the pilosebaceous unit (pockets within the skin)
this causes swelling and inflammation

Question 19

which hormones is responsible for the production for sebum?

Answer 19

Androgenic hormones

Question 20

define the following terminology:
- Macules
- Papules
- Comedomes
- Ice pick scars
- hypertrophic scars
- Rolling scars

Answer 20

• Macules are flat marks on the skin
• Papules are small lumps on the skin
• Pustules are small lumps containing yellow pus
• Comedomes are skin coloured papules representing blocked pilosebaceous units
• Ice pick scars are small indentations in the skin that remain after acne lesions heal
• Hypertrophic scars are small lumps in the skin that remain after acne lesions heal
• Rolling scars are irregular wave-like irregularities of the skin that remain after acne lesions heal

Question 21

What are the treatments for acne

Answer 21

• Topical benzoyl peroxide reduces inflammation, helps unblock the skin and is toxic to the P. acnes bacteria
• Topical retinoids (chemicals related to vitamin A) slow the production of sebum
• Topical antibiotics such as clindamycin (prescribed with benzoyl peroxide to reduce bacterial resistance)
• Oral antibiotics such as lymecycline
• Oral contraceptive pill can help female patients stabilise their hormones and slow the production of sebum

Question 22

What medication would be best for severe acne?

Answer 22

Oral retinoids
–> Isotretinoin

Question 23

what are the side effect of using isotretinoin?

Answer 23

• Dry skin and lips
• Photosensitivity of the skin to sunlight
• Depression, anxiety, aggression and suicidal ideation
• (Rarely) Stevens-Johnson syndrome and toxic epidermal necrolysis)

Question 24

what is exanthem?

Answer 24

widespread rash that is usually accompanied by systemic symptoms such as fever, malaise and headache.
usually caused by an infectious condition such as a virus

Question 25

What causes exanthems

Answer 25

• Measles (measles virus)
• Scarlet Fever (group A streptococcus infection)
• Rubella (rubella virus)
• Dukes’ Disease
• Parvovirus B19
• Roseola Infantum (human herpesvirus 7 (HHV-7))

Question 26

What is Erythema Multiforme

Answer 26

Erythematous rash caused by a hypersensitivity reaction.
common cause from viral infection and medications.
associated with Herpes Simplex Virus (HSV) and mycoplasma pneumonia

Question 27

What is the presentation of Erythema multiforme?

Answer 27

widespread, itchy, erythematous rash.
- Target lesion (red rings within larger red rings, with the darkest red at the centre
- sore mouth (stomatitis)
- mild fever
- muscle and joint aches
- headaches
- general flu-like symptoms

Question 28

What is the management for erythema multiforme?

Answer 28

usually resolves within one to four weeks without any treatment or lasting effects.

Severe cases
- may need to admission to hospital
- prednisone

Recurrent disease
acyclovir/aciclovir(antiviral therapy)

Question 29

Complication of erythema multiforme

Answer 29

hyperpigmentation
Keratitis
Conjunctival scarring
Uveitis
Permanent visual impairment.

Question 30

how to diagnosed erythema multiforme?

Answer 30

***based on history and clinical examination
- Complete blood
LFT
ESR
serological testing
Chest X-ray
Skin biopsy
recurrent EM –> HSV

Question 31

What is shingles / herpes zoster

Answer 31

localised, blistering and painful rash caused by reactivation of varicella-zoster virus (VZV)

Question 32

What is the pathophysiology of herpes zoster?

Answer 32

shingles…
VZV lies dormant with the dorsal root ganglia. When the immune system is weakened, it may extend out in a dermatomal distribution leading to the characteristic vesicular rash.

Question 33

what are the Clinical features of shingles?

Answer 33

unilateral
erythematous
vesicular rash in a dermatomal distribution

Paraesthesia
pain
scarring
Hutchinson’s signs

Question 34

what investigation can be made with patient that have shingles

Answer 34

• clinical diagnosis and appearance of the classical rash
• PCR testing –> VZV
• test for immunosuppression

Question 35

what is the management for shingles?

Answer 35

• Anti-viral therapy (aciclovir, valaciclovir, famciclovir), within 72 hours of rash onset
• analgesia
  paracetamol / NSAIDs
  amitriptyline, gabapentin
• hospital admission
• good hygiene
• vaccination

Question 36

complication of shingles

Answer 36

• Post-herpetic neuralgia
  scarring
  secondary bacterial infection
  ramsay hunt syndrome
  herpes zoster ophthalmicus
  motor neuropathy
  CNS: encephalitis, meningitis

Question 37

folliculitis
> cause by
> symptoms
> risk factor
> treatment

Answer 37

> staphylococcus aureus
papules, pustules, or cysts around the hair follicles
warm moist skin, irritation of the skin (shaving/drying)
anti-septic treatment (dermol)
deep / persistent lesion - systemic antibiotics (tetracyclines)
recurrent infection - mupirocin (bactroban)

Question 38

Cellulitis
> cause by
> symptoms
> treatment

Answer 38

> Strep. pyogenes & strep. aureus
Spreads rapidly, common on the leg; red, painful, hot, swollen skin
first line - flucloxacillin 500mg QDS; clarithromycin 500mg BD if penicillin allergy
facial cellulitis - co-amoxiclav

Question 39

Impetigo
> common in what population?
> cause by
> how long it should resolve?
> symptoms
> what complication will this can lead to ?
> treatment

Answer 39

> children
strep. aureus / group a strep
within 2-3 weeks
various forms: bullous, vesicular / pustular
bullous - large, flaccid bullae erythematous
non- bullous - vesicular lesion and pustules with ‘honey colour crust’
Ecthyma; acute post streptococcal glomerulonephritis; staphylococcal scalded skin syndrome
cover affected area
- wash hands regularly
- separate towels
- First-line –> fusidic acid 7-10days
if resistance –>mupirocin

Question 40

Hidradenitis suppurativa
> what is it?
> where it affects
> appearance
> investigation
> treatment

Answer 40

> chronic follicular occlusive disorder that affects the apocrine glands
axillary, groin, perianal, perineal, inframammary skin
papules, pustules, inflammatory nodules, deep fluctuant abscesses, draining sinuses, severe band-like scars
bacterial culture, skin biopsy
antibiotic therapy, corticosteroid, incision and drainage

Question 41

Herpes simplex (HSV)
> difference of HSV 1, HSV 2 and cutaneous herpes
> acquired from ?
> symptoms
> investigations
> treatment

Answer 41

> HSV 1 - oral herpes, fever, blister
HSV 2 - genital herpes
cutaneous herpes - herpes gladiatorum
direct contact, droplets, infected secretion entering the skin / mucous membranes
lymphadenopathy, dysuria(in women), genital ulcer, oral ulcer, tingling sensation
HSV polymerase chain reaction (PCR), viral culture, Glycoprotein G-based type-specific serology (gG1 and gG2)
aciclovir, valaciclovir / famciclovir

Question 42

Warts
> cause by?
> types of warts
> what factor increases the risk of inoculation
> symptoms
> investigations
> treatment

Answer 42

> Human papilloma virus (HPV)
common, plantar, plane, genital
damaged epithelium
lesion growth over weeks to months; round raised papule; tiny black dots on surface of lesion; hyperkeratosis; greyish-white / light brown colour
skin biopsy, immunoperoxidase stain, skin culture
no treatment, supportive management
- salicylic acid; cryotherapy; curettage and cautery

Question 43

Fungal infection - Tinea / (dermatophyte infections)
> most ideal condition for fungal infections?
> cause by
> presentation
> types of Tinea
> investigation
> treatment

Answer 43

> warm, moist / thickly keratinised skin
Trichophyton & Microsporum species; yeast / candida
generic lesion are inflammatory and appear eczematous, flaky, red and itchy
corporis (body), pedis (foot), cruris (groin area), capitis (head)
potassium hydroxide microscopy; dermoscopy; fungal culture; PCR; wood lamp examination
milder cases of tinea - terbinafine / imidazole creams (miconazole)
- oral antifungals - allylamines, triazoles, imidazoles

Question 44

Parasites - scabies
> cause by
> transmission pathway
> most common in?
> symptoms
> investigation
> treatment

Answer 44

> mite called sarcoptes scabiei var. hominis
skin to skin contact / sexually transmitted / clothing and beddings
children
generalised and intense pruritus, worse at night; burrows; papules, vesicles, excoriations; positive ink burrow test
ectoparasite preparation, skin biopsy, epiluminescence light microscopy
5% permethrin cream; antibiotics (flucloxacillin/ erythromycin if penicillin allergy)

Question 45

Eczema
> Clinical features
> investigation
> treatment

Question 46

Psoriasis
> characteristic
> pathophysiology
> factors that triggers it
> common area affected
> complication it can associate with
> treatment

Answer 46

> chronic, sharply demarcated, dull-red, scaly plaques, particularly on the extensor prominences and in the scalp. patches / flaky skin, itching
large T-cells triggers the release of cytokines –> inflammation
stress, alcohol, smoking, trauma, infection, drugs, pregnancy, sunlight
scalp