dermatology

Question 1

polycythaemia features

Answer 1

Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease

Question 2

pemphigus vulgaris feartures

Answer 2

antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule
more common in the Ashkenazi Jewish population.
mucosal ulceration is common and often the presenting symptom. Oral involvement is seen in 50-70% of patients
skin blistering - flaccid, easily ruptured vesicles and bullae. Lesions are typically painful but not itchy. These may develop months after the initial mucosal symptoms. Nikolsky’s describes the spread of bullae following application of horizontal, tangential pressure to the skin
acantholysis on biopsy

Question 3

acanthosis nigricans causes

Answer 3

Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin

Causes
gastrointestinal cancer
diabetes mellitus
obesity
polycystic ovarian syndrome
acromegaly
Cushing's disease
hypothyroidism
familial
Prader-Willi syndrome
drugs: oral contraceptive pill, nicotinic acid

Question 4

hidradenitis suppurativa

Answer 4

multible abscesses in sweat gland areas

Question 5

lichen planus Ps

Answer 5

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

Question 6

hirsutism associated with

Answer 6

cushings

Question 7

psoriasis exacerbating factors

Answer 7

The following factors may exacerbate psoriasis:
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

Streptococcal infection may trigger guttate psoriasis.

Question 8

commonest keloid site

Answer 8

sternum

Question 9

Pigmentation of nail bed affecting proximal nail fold

Answer 9

Acral lentiginous melanoma (Hutchinson’s sign)

Question 10

lichen sclerosus mx

Answer 10

Lichen sclerosis is a dermatological condition that affects the vulva. The first line treatment is a strong topical steroid thus the answer is topical clobetasol propionate.

Question 11

TEN drug causes

Answer 11

phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

Question 12

seborrhoeic dermatitis fx

Answer 12

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population

Features
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

Question 13

erythroderma

Answer 13

Erythroderma is a term used when more than 95% of the skin is involved in a rash of any kind.

Causes of erythroderma
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic

Question 14

Necrobiosis lipoidica diabeticorum fx

Answer 14

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

Question 15

impetigo tx

Answer 15

topical fusidic acid is first-line
topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin (Bactroban) should, therefore, be used in this situation

Extensive disease
oral flucloxacillin
oral erythromycin if penicillin-allergic
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

Question 16

granuloma annulare

Answer 16

papular lesions that are often slightly hyperpigmented and depressed centrally
typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs

Question 17

PUVA therapy risk factor for

Answer 17

SCC

Question 18

most accurate way of assessing burns

Answer 18

lund brower chart

Question 19

lentigo maligna

Answer 19

Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

Question 20

pyoderma gangrenosum causes

Answer 20

idiopathic in 50%
inflammatory bowel disease: ulcerative colitis, Crohn's
rheumatoid arthritis, SLE
myeloproliferative disorders
lymphoma, myeloid leukaemias
monoclonal gammopathy (IgA)
primary biliary cirrhosis

Question 21

pityriasis rosea

Answer 21

HHV 7

herald patch first

Question 22

fungal nail

Answer 22

trichophyton rubrum

Question 23

mx pyoderma gangernosum

Answer 23

the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases

Question 24

koebner phenomenon

Answer 24

psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

Question 25

acne mx

Answer 25

topical retinoids combination topical- retinoids, benzyl peroxide, abx oral abx (cocp in females) oral isotretinoin

Question 26

pregnancy skin

Answer 26

Pemphigoid gestationis pruritic blistering lesions often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy oral corticosteroids are usually required Polymorphic eruption of pregnancy pruritic condition associated with last trimester lesions often first appear in abdominal striae management depends on severity: emollients, mild potency topical steroids and oral steroids may be used

Question 27

acne organism

Answer 27

Propionibacterium acnes

Question 28

ketoconazole s/e

Answer 28

hepatotoxicity, gynaecomastia

Question 29

pyogenic granuloma

Answer 29

These present as friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common. They may be treated with curettage and cautery, formal excision may be used if there is diagnostic doubt.

Question 30

actinic keratosis mx

Answer 30

prevention of further risk: e.g. sun avoidance, sun cream fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects topical imiquimod: trials have shown good efficacy cryotherapy curettage and cautery

Question 31

psoriasis mx

Answer 31

first-line: NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment second-line: if no improvement after 8 weeks then offer a vitamin D analogue twice daily third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily 2ndary care- phototherapy, MTX, ustekinimab

Question 32

ketatoacanthoma fx

Answer 32

Features - said to look like a volcano or crater initially a smooth dome-shaped papule rapidly grows to become a crater centrally-filled with keratin

Question 33

MM types

Answer 33

Superficial nodular (most aggressive) lentigo acral

Question 34

Chondrodermatitis nodularis helicis

Answer 34

Chondrodermatitis nodularis helicis (CNH) is a common and benign condition characterised by the development of a painful nodule on the ear. It is thought to be caused by factors such as persistent pressure on the ear (e.g. secondary to sleep, headsets), trauma or cold. CNH is more common in men and with increasing age.

Question 35

hyperhidrosis mx

Answer 35

aluminium chloride

Question 36

isotretinoin s/e

Answer 36

contraception (e.g. Combined oral contraceptive pill and condoms) dry skin, eyes and lips/mouth: the most common side-effect of isotretinoin low mood* raised triglycerides hair thinning nose bleeds (caused by dryness of the nasal mucosa) intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason photosensitivity

Question 37

acne rosacea mx

Answer 37

topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques) topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia more severe disease is treated with systemic antibiotics e.g. Oxytetracycline recommend daily application of a high-factor sunscreen camouflage creams may help conceal redness laser therapy may be appropriate for patients with prominent telangiectasia patients with a rhinophyma should be referred to dermatology

Question 38

pyogenic granuloma

Answer 38

Overgrowth of blood vessels. Red nodules. Usually follow trauma. May mimic amelanotic melanoma.

Question 39

erythrasma

Answer 39

Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum Examination with Wood's light reveals a coral-red fluorescence. Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection

Question 40

chondrodermatitis nodularis helicis vs actinic keratosis

Answer 40

chondrodermatitis is painful

Question 41

lipoma 5cm ix

Answer 41

uss

Question 42

types of burns

Answer 42

Superficial epidermal First degree Red and painful Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered Partial thickness (deep dermal) Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation Full thickness Third degree White/brown/black in colour, no blisters, no pain

Question 43

mx bcc eyelid

Answer 43

mohs micrographic surgery

Question 44

curlings ulcers

Answer 44

complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa

Question 45

embryological remnants and may be lined by hair and squamous epithelium

Answer 45

dermoid cyst

Question 46

bowens disease

Answer 46

intra epithelial scc

Question 47

pyogenic granuloma

Answer 47

most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy initially small red/brown spot rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape the lesions may bleed profusely or ulcerate

Question 48

mx hirsute

Answer 48

advise weight loss if overweight cosmetic techniques such as waxing/bleaching - not available on the NHS consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding