Dermatology

Question 1

Sedating antihistamines?

Answer 1

Chlorphenamine

Question 2

Non-sedating antihistamines?

Answer 2

Loratidine
Cetirizine

Question 3

What is the management of Lichen Planus?

Answer 3

1) potent topical steroids are the mainstay of treatment
2) benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression

Question 4

Describe Guttate psoriasis

Answer 4

tear drop papules on the trunk and limbs

acute onset

may be precipitated by a streptococcal infection 2-4 weeks prior

Question 5

What is the management of acne rosacea?

Answer 5

Predominant erythema/flushing:
- topical Brimonidine

Mild-to-moderate papules and/or pustules:
1st line- topical Ivermectin
2nd line- topical metronidazole or topical azelaic acid

moderate-to-severe papules and/or pustules:
- combination of topical ivermectin + oral doxycycline

Question 6

What are the causes of spider naevi?

Answer 6

1) liver disease
2) pregnancy
3) combined oral contraceptive pill

Question 7

What are the exacerbating factors for psoriasis?

Answer 7

1) trauma
2) alcohol
3) drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
4) withdrawal of systemic steroids

Question 8

What malignancy is she most likely to develop if she does proceed to transplantation

Answer 8

Renal transplant patients - skin cancer (particularly squamous cell) is the most common malignancy secondary to immunosuppression

Question 9

What skin conditions are associated with diabetes mellitus?

Answer 9

1) Necrobiosis lipoidica
2) Vitiligo
3) Neuropathic ulcers
4) Granuloma annulare
5) Lipoatrophy
6) infection: Candida, staph

Question 10

What is the treatment of a capillary hermangioma?

Answer 10

Propranolol

Question 11

What is the management of eczema herpeticum?

Answer 11

IV aciclovir

Question 12

What is the causative organism of eczema herpeticum?

Answer 12

Herpes Simplex Virus (HSV)

Uncommonly Coxsackie

Question 13

What are some causes of erythema multiforme?

Answer 13

• viruses: herpes simplex virus (the most common cause), Orf*
• idiopathic
• bacteria: Mycoplasma, Streptococcus
• drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
• connective tissue disease e.g. Systemic lupus erythematosus
• sarcoidosis
• malignancy

Question 14

What is the management of actinic keratoses?

Answer 14

1st: Fluorouracil- 2-3 week course
2nd- topical diclofenac, topical imiquimod, cryotherapy, curettage and cautery

Question 15

What is the management of hyperhidrosis?

Answer 15

1st line: topical aluminium chloride
Other:
1) iontophoresis
2) botulinum toxin
3) surgery: e.g. Endoscopic transthoracic sympathectomy

Question 16

What is a safe treatment of acne in pregnancy?

Answer 16

Oral erythromycin

Question 17

What are the 4 main diagnostic criteria for Hereditary haemorrhagic telangiectasia?

Answer 17

1) epistaxis : spontaneous, recurrent nosebleeds

2) telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)

3) visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM

4) family history: a first-degree relative with HHT

Question 18

What is the management of keloid scar?

Answer 18

intra-lesional steroids e.g. triamcinolone

Question 19

What is the management of impetigo?

Answer 19

Limited localised disease:
1st Hydrogen peroxide 1% cream
2nd: topical antibiotic creams e.g. fusidic acid or mupirocin

Extensive disease:
Oral flucloxacillin
Oral erythromycin if penicillin allergic

NOTE: exclude from school until lesions crusted over or healed

Question 20

What are the causative organisms of Impetigo?

Answer 20

Staphylcoccus aureus or Streptococcus pyogenes

Question 21

What are common complications of seborrhoeic dermatitis?

Answer 21

1) Blepharitis
2) Otitis externa

Question 22

How can you differentiate between spider naevi and telangiectasia?

Answer 22

By pressing down and watching them fill.

Spider naevi fill from the centre, telangiectasia from the edge.

Question 23

What drugs often cause TEN?

Answer 23

phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

Question 24

What is the management of vitiligo?

Answer 24

1) sunblock for affected areas of skin

2) camouflage make-up

3) topical corticosteroids may reverse the changes if applied early

4) there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients