Dermatology

Question 1

What is Hereditary Haemorrhagic Telangiectasia otherwise known as?

Answer 1

Osler-Weber-Rendu syndrome

Question 2

What is the inheritance pattern of HHT?

Answer 2

Autosomal dominant

Question 3

What are the diagnostic domains of HHT? (4)

Answer 3

1) Epistaxis
2) Telangiectasia
3) Visceral lesions
4) Family history

Question 4

Pellagra is characterised by a deficiency in..?

Answer 4

Nicotinic acid (Niacin, Vitamin B3)

Question 5

What are the two main types of Pellagra?

Answer 5

1) Primary (inadequate dietary intake)
2) Secondary (Poor ability to utilise available Niacin or Tryptophan)

Question 6

What are the underlying causes of secondary Pellagra? (4)

Answer 6

1) ETOH XS
2) Long-term diarrhoea
3) Carcinoid syndrome
4) Isoniazid

Question 7

What are the 3 main clinical features of Pellagra?

Answer 7

1) Dermatitis
2) Diarrhoea
3) Dementia

Question 8

“Casal collar” is a rash associated with what condition?

Answer 8

Pellagra

Question 9

Define Pyoderma Gangrenosum

Answer 9

A form of neutrophilic dermatosis; dense infiltration of neutrophils into an affected area.

Question 10

What is the typical disease progression for Pyoderma Gangrenosum?

Answer 10

Minor injury -> Pustule/Blister -> Epithelial breakdown -> Painful ulcer -> Necrosis

Question 11

What conditions are associated with Pyoderma Gangrenosum? (6)

Answer 11

1) Idiopathic (approx. 50%)
2) IBD (10-15%)
3) Rheumatological conditions, inc. RA and SLE
4) Haematological, including myeloproliferative disorders, lymphoma, monoclonal gammopathy
5) Granulomatosis w/ polyangiitis
6) PBC

Question 12

What is the management of Pyoderma Gangrenosum?

Answer 12

1) High-dose steroids
2) If not working, Ciclosporin/Infliximab

Note: Surgery should be postponed due to potential to worsen condition

Question 13

What clinical features of rash are found in Eczema Herpeticum? (5)

Answer 13

• Monomorphic
• Punched-out erosions
  
  • Circular
  • Depressed
  • Ulcerated
• 1-3mm in circumference

Question 14

What treatment is indicated in Eczema Herpeticum?

Answer 14

IV Aciclovir

Question 15

In what group of people is Eczema Herpeticum often seen?

Answer 15

Children with atopic eczema

Question 16

What is the underlying cause of Lichen planus?

Answer 16

Unknown, but thought to be immune-mediated

Question 17

What features are seen in the rash of Lichen Planus? (4)

Answer 17

• Pruritis
• Papular
• Polygonal
• “White lines”

Question 18

What are Wickham’s striae?

Answer 18

Linear white lines seen over the surface of the rash seen in Lichen Planus

Question 19

What is Koebner’s phenomenon?

Answer 19

The formation of new lesions at the site of trauma in Lichen planus

Question 20

What percentage of patients with Lichen planus will have oral involvement?

Answer 20

50%

Question 21

What extra-cutaneous manifestations are seen in Lichen planus?

Answer 21

Longitudinal ridging of nails with plate thinning

Question 22

What drugs can induce Lichen planus? (3)

Answer 22

• Gold
• Quinine
• Thiazides

Question 23

What is the management option for skin manifestations of Lichen planus?

Answer 23

Potent topical steroids
Oral steroids or immunosuppression in severe disease

Question 24

What is the management option for oral manifestations of Lichen planus?

Answer 24

Benzyldamine mouthwash/spray

Question 25

In what areas of the body is Lichen planus often seen? (4)

Answer 25

• Palms
• Soles
• Genitals
• Flexor surfaces of arms