Dermatology

Question 1

Itchy tender blisters around flexures with no mucosal involvement

Answer 1

Bullous pemphigoid

With mucosal is pemphigus vulgaris

Question 2

Skin biopsy of itchy tense blisters with no mucosal involvement

Answer 2

IgG and C3 at dermoepidermal junction (bullous pemphigoid is autoimmune) give corticosteroids

Question 3

What is positive Nikolsky’s sign?

Answer 3

the appearance of epidermis separating with mild lateral pressure in toxic epidermal necrolysis

Question 4

features of toxic epidermal necrolysis

Answer 4

Nikolsky’s sign positive (separating epidermis with mild lateral pressure)
Extensive scalded-like rash
Systemically unwell

Question 5

Intensely itchy vesicular rash on back of elbows

Answer 5

Dermatitis herpetiformis. IgA deposits, anti gliadin antibody, associated with coeliac

Question 6

Skin patch Vs skin prick

Answer 6

Patch is useful for contact dermatitis
Prick is for food allergies and pollen
RAST is IgE amount that reacts to known allergens.. food allergies and pollen too

Question 7

Which antibiotics are most associated with development of Stephen Johnson’s syndrome

Answer 7

Cotrimoxazole , penicillins

Question 8

Teardrop lessons following a sore throat

Answer 8

Guttate psoriasis

Question 9

Treatment for guttate psoriasis

Answer 9

Self resolve in 2-3 months but can use UVB therapy and tonsillectomy if recurrent

Question 10

Features of leprosy

Answer 10

Hypopigmented skin with reduced sensation

Question 11

diagnosis for erythematous lesions on shins with orange peel texture

Answer 11

pretibial myxoedema (see n in graves)

Question 12

Pan systolic murmur, V waves in JVP, (tricuspid incompetence) in young patient diagnosis

Answer 12

Ebsteins abnormality -congenital heart defect with low insertion of tricuspid valve

Question 13

INR target for aortic and mitral mechanical valves

Answer 13

3 and 3.5

Question 14

How long does erythema nodosum usually last

Answer 14

6 weeks, no scarring

Question 15

Old burn or scar… Patient presents with painless ulcerated lesion.. what is it?

Answer 15

SCC in 80% of cases. And is more dangerous -likely to metastasise

Question 16

Treatment for alopecia areata

Answer 16

50% resolve within a year, 80-90% eventually.

Can give topical corticosteroids

Question 17

A 55-year-old man presents with multiple erythematous target lesions two days after starting a new medication. What drug?

Answer 17

Erythema multiforme… Caused by viruses (HSV), mycoplasma/strep,
Penicillin, sulphonamides, carbamazepine, nsaids, contraceptive pill

Sarcoid

Question 18

small blisters on the palms and soles
pruritic, sometimes burning sensation

Diagnosis

Answer 18

Pompholyx… Type of eczema often triggered by hot climates.
Cold compress, emollients, topical steroids… But quite resistant to treatment

Question 19

Treatment for keloid scar

Answer 19

triamcinolone (topical steroids) if early

Question 20

What hypersensitivity is allergic contact dermatitis

Answer 20

Type IV (delayed…) T cell mediated

Question 21

What condition is associated with plucked chicken skin —

Small, yellow papules of 1-5 mm in diameter in a reticular pattern and coalescing at places into plaques

Answer 21

Pseudoxanthoma elasticum

Also get angoid streaks

Question 22

Treatment for Norwegian scabies

Answer 22

Ivermectin, isolate

Question 23

Management of venous ulcer

Answer 23

Compression bandages

Question 24

Most common skin lesion in TB

Answer 24

Lupus vulgaris… Usually on face, erythematous flat plaque which gradually becomes elevated and may ulcerate later

Question 25

Patient develops oval erythematous plaque then generalised pruritic rash. Diagnosis and what virus is linked to it?

Answer 25

Pityriasis rosacea | Herpes hominis virus 7 (HHV-7) is thought to play a role in the aetiology

Question 26

Patient with herpes... What sign indicates ocular involvement is likely?

Answer 26

Vesicles on the tip of the nose, or vesicles on the side of the nose...Hutchinson's sign which is strongly predictive for ocular involvement...

Question 27

pinpoint petechial 'blueberry muffin' skin lesions

Answer 27

congenital cytomegalovirus

Question 28

erythematous oval lesions on his back and upper arms which have a slight scale just inside the edge. They vary in size from 1 to 5 cm in diameter. What is the most likely diagnosis?

Answer 28

Pityriasis rosea Guttate is usually smaller and scale isn't just round the edge

Question 29

Diagnosis... Initially smooth dome papule then becomes crater or volcano

Answer 29

Keratoacanthoma Benign epithelial tumour... But refer for excision as might be SSC

Question 30

Small erythematous patch with Wood grain appearance. Smoking history

Answer 30

Erythema gyratum repens... Paraneoplastic eruption commonly seen w lung cancer

Question 31

What is infection that causes pityriasis versicolour? typically hypopigmentation

Answer 31

Malassezia, so treat with anti fungal ketoconazole shampoo or oral itraconazole

Question 32

Flaccid oral blisters, acantholysis on biopsy

Answer 32

Pemphigus vulgaris Bullous pemphigoid is more common is the elderly, and blisters are tense, with no Acantholysis

Question 33

Management for impetigo

Answer 33

hydrogen peroxide 1% cream is first line of systemically well and few chances of complications Followed by fusidic cream Can give Oral fluclox if extensive disease

Question 34

Diagnosis of monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter this is accompanied by pruritic painful blisters...

Answer 34

Eczema herpeticum life threatening -treat with IV aciclovir

Question 35

Fungal cause of tinea capitus -scalp ring worm

Answer 35

Trichophyton tonsurans

Question 36

Asymp flat slightly scarlet pink or brown symmetrical rash around groin or axillae

Answer 36

Erythrasma Overgrowth of diphtheroid Corynebacterium minutissimum Coral red florescence on Wood's light Topical miconazole

Question 37

Pregnant lady develops large, flat, symmetrical, brown-pigmented patch across her cheeks, forehead, nose and upper lip.

Answer 37

Melasma. Benign and relatively common.

Question 38

perioral dermatitis: red, crusted lesions Alopecia What deficiency?

Answer 38

Zinc May also have geophagia - ingesting clay/soil

Question 39

Red spots with blue/white centre in mouth

Answer 39

Koplik spots in measles

Question 40

Symmetrical, brown, velvety plaques on neck/axilla/groin.....what is acanthosis nigracans associated with?

Answer 40

It's caused by insulin resistance... All things that are associated with weight gain...hypothy, DM, PCOS, COCP, obesity, prader willi, acromegaly, ......and gastric cancer

Question 41

photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands

Answer 41

Porphyria cutanea tarda inherited defect in uroporphyrinogen decarboxylase or caused by hepatocyte damage e.g. alcohol, hepatitis C, oestrogen.

Question 42

Erythroderma

Answer 42

90% or more of the skin is affected

Question 43

pigmented lesions on lips, oral mucosa, face, palms and soles, diarrhoea

Answer 43

Peutz-Jeghers syndrome

Question 44

Necrobiosis lipoidica management

Answer 44

Skin condition in diabetes Topical corticosteroids

Question 45

Rash assx with Mycoplasma pneumoniae

Answer 45

Erythema multiforme or nodosum