Dermatology

Question 1

What is the pathophysiology behind acanthosis nigricans?

Answer 1

Insulin resistance leads to increased insulin secretion, which stimulates proliferation of fibroblasts and keratinocytes via IGFR-1

Question 2

List 3 causes of acanthosis nigricans?

Answer 2

T2DM, GI malignancy, PCOS

Question 3

Describe the lesion associated with acanthosis nigricans?

Answer 3

Symmetrical dark, brown or black, velvety patches of skin develop in the axillae, groin, neck.

Question 4

What is acne vulgaris?

Answer 4

A chronic skin condition, usually affecting the face, which is characterised by obstruction and inflammation of the pilosebaceous units.

Question 5

What are comedones?

Answer 5

non-inflamed blackheads/whiteheads

Question 6

What are papules?

Answer 6

inflamed dome-shaped bumps

Question 7

What is characterised as mild, moderate and severe acne?

Answer 7

Mild-mostly non-inflammatory (comedones)

Moderate-more widespread, papules and pustules

Severe- Widespread inflammation, with large papuyles, pustules and deeper nodules/cysts. May have scarring

Question 8

What is the 1st line mx of mild-moderate acne?

Answer 8

Prescribe a 12 week course of a combined topical treatment. Options:
-Topical adapalene with benzoyl peroxide
-Topical tretinoin with clindamycin
-Topical benzoyl peroxide with clindamycin

Question 9

What is the 1st line mx of moderate/severe acne?

Answer 9

Topical adapalene with benzoyl peroxide AND oral tetracycline (lymecycline/doxycycline

Question 10

When should a referral to dermatology be made regarding acne?

Answer 10

Mild-Moderate acne has not responded to 2 x complete course of treatment
Moderate-Severe acne has not responded to treatment which included PO ABx
Scarring, pigmentary changes, or psychological distress
Secondary care treatments include: PO Isotretinoin (contraindicated in pregnancy)

Question 11

What is actinic keratosis?

Answer 11

Premalignant skin lesions which occur secondary to chronic sun exposure.

The presence of AK suggested that the patient is at an increased risk of SCC

Question 12

What are the mx options for actinic keratosis?

Answer 12

Topical - fluorouracil, diclofenac, imiquimod
Cryotherapy, curettage, cautery

Question 13

What is the mainstay management of eczema?

Answer 13

Generous use of emollients/ointments

Question 14

What is the mx of acute flares of eczema and list the stepladder of tx?

Answer 14

Topical corticosteroids
1st- Hydrocortisone 0.5-2.5%
2nd- Betnovate or EUmovate
3rd- Cutivate or betnovate (0.1)

Question 15

What are the clinical features of a BCC?

Answer 15

Nodular BCC is the most common subtype
-Pearly, pink/flesh coloured papule with telangiectasia
-May ulcerate in the centre or bleed
-Often have rolled edges due to the presence of central depression/ulceration

Question 16

What is the referral process for BCC?

Answer 16

enerally, if a BCC is suspected, a routine referral should be made

Question 17

What are the mx options for a BCC?

Answer 17

surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy

Question 18

What are the features of alopecia areata?

Answer 18

autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs

Question 19

What is Bowens disease?

Answer 19

a type of precancerous dermatosis that is a precursor to squamous cell carcinoma.

Question 20

What are the features of bowens disease?

Answer 20

red scaly patches (10-15mm)
slow growing
often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs

Question 21

what is the 1st line mx of bowens disease?

Answer 21

topical 5-fluorouracil

Question 22

What is subherroic keratosis and list its features?

Answer 22

A benign, warty spot which occurs as part of ageing

Flat or raised lesions which can be several cm
May have a “stuck-on” appearance
Can appear in groups - e.g. under the breasts, in the groin, or across the back

Question 23

What are the most common causative organisms of cellulitis?

Answer 23

Strep. pyogenes, Staph. Aureus

Question 24

What are the exam findings of cellulitis?

Answer 24

pain, erythema, swelling and warmth around affected site

Question 25

What classification is used to determine oral vs IV abx in cellulitis?

Answer 25

ERON claasification

Question 26

WHat is cellulitis?

Answer 26

Infection of the dermis and subcutaneous tissue

Question 27

What type of reaction is allergic dermatitis?

Answer 27

A T-cell mediated type 4 hypersensitivity reaction

Question 29

What is the name of the rash associated with coeliacs and describe it?

Answer 29

Dermatitis herpetiformis intensely itchy, papular rash with vesicles affecting the extensor surfaces - especially the elbows, buttocks, shoulders and knees